When sweat lodge does more than talk therapy

Native American communities face a higher rate of myriad mental health conditions and related issues, including substance abuse, trauma, and suicide, and counseling and other conventional services may not work as well as Indigenous cultural practices and spiritual traditions or some combination of the two, health professionals have learned.

Innovative programs in several Native communities in the U.S. and Canada offer a return to traditional cultural practices and ritual participation instead of mainstream therapeutic activities.

It is an approach that blends spirituality and religious experience and fosters community and belonging, said Joseph P. Gone '92, professor of anthropology in the Faculty of Arts and Sciences and of global health and social medicine in the Faculty of Medicine. Even if they don't resemble typical psychosocial interventions, Indigenous healing traditions are rooted in cultural identity, community renewal, and self-determination, he said at "Re-imagining Mental Health Services for American Indian Communities: Centering Indigenous Perspectives," an event organized by the Harvard T.H. Chan School of Public Health on Monday afternoon.

"We need to take seriously the Indigenous claim I hear everywhere I go in Indian country, that 'our culture is our treatment,'" said Gone, who also serves as faculty director of the Harvard University Native American Program. "People often say, 'We don't need the latest evidence-based practice or the latest greatest intervention that have come out of academia. We just need to go back to our traditions; we had our own healing ways. If we can just recapture and recover them, that will solve our problems.' It is a claim that points to therapeutic alternatives and based on, in many instances, reclaimed and revitalized traditional practices."

During the talk, Gone spoke of his work with tribal communities in the U.S. and Canada over more than 25 years to research and integrate Indigenous healing practices into clinical mental health services.

One of his earliest projects was in the Fort Belknap Indian Reservation in Montana in the late 1990s, when he first heard critiques of the conventional services offered to Native Americans to overcome substance abuse and other problems. While there was a real need for help in Native American communities due to historical trauma, generational poverty, and inequities in health care and treatment, said Gone, they were the "wrong services." He described this phenomenon as a "postcolonial predicament."

"On the one hand, we have pretty urgent community needs," said Gone, who is an enrolled member of the Aaniiih-Gros Ventre tribal nation of Montana on the reservation. "On the other hand, the clinical services that are offered, even though they're underfunded and still exist in most communities, are unfortunately sometimes incongruent with what we need."

In some cases, modern therapy doesn't seem to work because of Native Americans' lack of familiarity with psychotherapy and historical distrust of government institutions and services. But when programs offer cultural participation and ceremonial practices such as pipe ceremonies, sweat lodges, and others, people tend to favor them. In 2012, Gone took part in a project in Crystal Creek Lodge on the Blackfeet Nation in Browning, Montana, that featured activities for participants to engage in traditional skills such as tepee set up, berry picking, and cultural practices and ritual ceremonies. It was an effort to take cultural treatment seriously with an emphasis on Indigenous tradition, said Gone.

Gone's research has raised awareness about the need for mental health services that address traditional culture and Indigenous practices that could benefit both Native American communities and the broader field. In 2021, Gone was elected to the National Academy of Medicine for "being a leading figure among Native American mental health researchers whose work on cultural psychology, historical trauma, Indigenous healing, and contextual factors affecting mental health assessment and treatment has been highly influential and widely recognized."

Referring to the project in Crystal Creek Lodge on the Blackfeet Nation, Gone said he was surprised by the results and the participants' positive reception.

"There was no counseling. There was no talk about your feelings, no learning skills relative to self-management, nothing like that," Gone said. "Being part of any kind of sacred, traditional ceremonial practices is understood to be incompatible with substance use and abuse. You don't have to tell anyone, 'Don't drink.' It is just not acceptable. You can't do it and participate in that way of life."