Alaska Natives comprise three distinct ethnic groups: Eskimos, Aleuts, and Indians, each with their own distinct histories, cultures, customs, and traditions. American Indians/Alaska Natives constitute approximately 1% of the U.S. population. However, in Alaska, Native people comprise approximately 17% of the 625,000 people that make up the state’s total population. Thus, Alaska has the 10th largest Native population and the largest Native population per capita in the United States. Alaska Native peoples live primarily in northern and western Alaska, accounting for more than 50% of the total population in those regions. Only 7% of Alaska Natives live in urban set-tings. The rest live in rural and bush areas, often in isolated tribal villages 40 to 60 miles apart.
Alaska Natives have a rich, proud, and varied history. Although protectors of Alaska’s vast natural resources and contributors to the rich cultural heritage of the state, they also experience acculturation stresses brought on by initial and ongoing contact, first with French and Russian Europeans and then with European Americans. As a result, Alaska Natives confront social and psychological challenges that are similar to those confronted by Native Americans from other parts of the United States, including quickly changing social expectations, underemployment, high rates of incarceration, high rates of alcohol and drug abuse, and extremely high rates of suicide.
Alaska Native Cultural Groups
Eskimos (also known as Inuit) are the largest of the three Alaska Native ethnic groups. They comprise 52% of all Alaska Natives. Eskimo subdivisions include the Inupiat (Greenland to northern Alaska), the Yu’pik (western and southwestern Alaska), and the Siberian Yu’pik (St. Lawrence Islanders). Historically, Eskimos lived in extended and multifamily units in tents during the summer and in large underground sod houses during the winter. Although outside temperatures range from -80o F in winter to +40o F in summer, these sod houses were kept at a comfortable 70o F to 85o F by fires, sod roofs, and igloo overhouses.
Alaska Eskimos are related to, and share many of the same cultural beliefs and lifeways as, Eskimos living in Siberia, Greenland, and Canada. Historically, Eskimos practiced an animistic religion that prescribed times of social gathering, rituals, and feasts, as well as religious beliefs and practices concerning the care and respect for all living things (including people, animals, and the environment). Their religion, along with the cultural habits of summer hunting and storage, helped regulate the daily rhythm of arctic life, especially during the 3 months of total darkness and the 3 months of total light that occur in the arctic every year.
Before European contact, Eskimos practiced subsistence living by catching fish and hunting seals, walruses, whales, caribou, musk oxen, and polar bears. They used animal skins to make tents and clothes, which protected them from the extreme arctic weather. They constructed hand tools and weapons from antlers, horns, teeth, and animal bones. In summer, they hunted in boats covered with animal skin, and in winter, they traveled on sleds pulled by dog teams. When traveling in search of game, they built igloos as shelters from blocks of snow and ice.
Alaska Indians comprise 36% of the Alaska Native population. There are four major tribes of Alaska
Indians: the Athabascans, the Tlingits, the Tsimshians, and the Haida. In pre-contact times, people from these four tribes inhabited the whole of Alaska, the western portions of Canada, and the northwestern portions of America. They lived in both coastal and interior regions of the Alaskan territories. They lived in highly structured societies centered on clan membership, with people in each of these clans related by genealogy, history, and possessory rights.
Alaska Indians lived in villages or in camps that followed wild game migrations. Village housing was built with local materials, such as birch bark. Migrant housing tended to be animal skin teepees or lean-to shelters. Dietary practices as a whole depended on hunting and gathering with some farming, but these practices varied somewhat among geographical regions and tribal groups. Alaska Indian religion centered primarily on respect and reverence for nature, belief in an afterlife, and, for some tribes, belief in reincarnation. After Alaska Indians’ first contact with Europeans, many became Russian Orthodox or Protestant Christians. However, in recent years, some younger Alaska Indians have reconverted to their traditional tribal religions.
Aleuts comprise 12% of the Alaska Native population. They live on the Aleutian Islands, a chain of more than 300 small volcanic islands extending westward from the Alaskan Peninsula toward the Kamchatka Peninsula in Russia.
Alaska Eskimos and Aleuts were historically one people who migrated across the Bering Land Bridge between 8,000 and 15,000 B.C. Those who migrated south became Aleuts, and those who migrated north became Eskimos. The first reported settlement of Aleuts was in Nikolski Bay, which is suspected by some archaeologists to be the oldest continuously occupied community in the world.
Aleuts are seagoing people living on meats and processed pelts from the sea lions, otters, whales, and other animals that inhabit the north Pacific. In the relatively warmer climate of the Aleutians (with temperatures ranging from 11o F to 65o F year round), these hunting and fishing activities are carried on in all seasons. Before their initial contact with European and American cultures, there was an estimated 16,000 to 20,000 Aleuts living in the Aleutian Islands. There are approximately 12,000 Aleuts today. The dominant religion in many Aleutian communities is the Russian Orthodox faith.
Social and Psychological Challenges
Before contact with European people (in the early 1700s), Alaska Natives lived free and independent lives. However, upon discovery of the rich resources of the northern Pacific and Alaskan interior by Europeans and non-Native Americans, Alaska Natives as a whole experienced both personal and economic exploitation. Early enslavements of Alaska Native peoples and population decimations from deadly European diseases (e.g., smallpox and tuberculosis) changed Alaska Natives’ life ways and caused severe damage to social structures supporting psychologically healthy lives.
The traditional way of life has ended for most Alaska Natives. Most now live in wooden houses made from imported wooden planks rather than igloos, sod houses, or teepees. They wear modern clothing instead of animal skin garments. They speak English, Russian, or Danish in addition to their native languages. They now must compete in the modern economic world. The kayak and the umiak have given way to motor boats, and the snowmobile has replaced the dog team. Fishing villages are connected with a ferry system, and previously inaccessible mountain and river villages are connected by ski trails, boats, bush pilots, or snowmobiles. Telecommunication devices (e.g., televisions, telephones, and computers), needs for petroleum, and other lifestyle changes have necessitated a cash economy to supplement ancient subsistence practices. Yet, access to full participation in the modern U.S. economy has been slow among Alaska’s Native people.
In 1968, the Senate Interior Committee issued a report that stated that more Alaska Natives were unemployed or seasonally employed than had permanent jobs. More than half of the Alaska Native workforce was jobless most of the year. Year-round jobs were typically few and were limited to such types of employment as school maintenance worker, postal worker, airline station agent, village store manager, or teacher’s aide. Some income was gained through the sale of furs, fish, or arts and crafts. Some Natives found seasonal employment away from their villages, as firefighters, cannery workers, or construction laborers. Most provided for the bulk of their food supply by fishing, hunting, and trapping, and most relied upon a combination of means to obtain the cash needed for fuel, food staples, tools, and supplies. The wage gap was continuing to grow precipitously as immigration into Alaska by other ethnic and cultural groups continued to increase.
In 2004, a report issued by the Center for Educational Research stated that even with the increasing wage gap, Alaska Natives had gained thousands of new jobs and improved their incomes in every decade since 1960. Native women, in particular, had continued to move into the workforce. However, in the 1990s the gains were smaller, and thousands of Natives who wanted jobs could not find them. The modest income gains were not in wages but mostly in transfer payments, including the state Permanent Fund dividend.
Today Native incomes on average remain just over half those of other Alaskans, and Natives are still about a third less likely to have jobs. Native households are 3 times more likely to be poor; poverty is especially high among households headed by women. These economic problems are worse for Natives in remote rural villages. Subsistence hunting and fishing continue to be the only source of provision for many Native families, even as external pressures to maintain a contemporary economic lifestyle are increasing.
The social stress that many Alaska Natives face is even more evident as one examines the breakdown of Alaskan Native families and communities. Alaskan Native adults, who represent about one third of the state’s inmate population, commit crimes that are considered to be among the most violent in nature: assault, sexual assault, sexual abuse of a minor, and murder. Alaska Natives are overrepresented in cases of child abuse by twice what would be expected given the population statistics. Among Alaska Native adolescent males, nearly one in every eight between the ages of 14 and 17 has been, or is currently, in juvenile detention.
Alaska Natives continue to be in a period of cultural, economic, and social transition. Their acculturation has not always been voluntary, and they have not had control over the extent or pace of change. As a result, many experience tremendous stress, which permeates all aspects of their lives. Whereas some Alaska Natives have successfully adjusted to a new way of life, the consequences of this constant and massive stress have put many others at risk for leading lives that are characterized by poverty, violence, and cycles of personal and social destruction. The psychological consequences of living in such circumstances can lead otherwise psychologically healthy people to overuse maladaptive coping strategies. Among Alaska Natives, the coping strategies most often used have been alcohol abuse, drug abuse, and suicide.
Alcohol and Drug Abuse/Dependence
The primary mental health challenge among Alaska Natives is alcohol and drug abuse/dependence. Alcohol was introduced to Alaska Natives only 300 years ago. Since then, alcohol and drug abuse has been a constant source of sorrow and destruction for Alaska Natives. Although exact rates of alcohol and drug abuse/dependence are not available, among Alaska Natives the alcohol-related mortality rate is 3V2 times greater than the rate among non-Natives. The rate of fetal alcohol syndrome for Alaska Natives is 3 times that of the rest of the population of Alaska. The impact of alcohol and drug use has been particularly dramatic among Alaska Native youth. In 1998, of all court referrals of Native youth in the state, 55% were for the offense of possession and/or consumption of alcohol. Among Alaska Natives, alcohol contributes to high rates of motor vehicle crashes, cirrhosis, suicide, homi-cide, domestic abuse, and fetal alcohol syndrome.
The pattern of abuse among most Alaska Natives is drinking to pass out rather than engaging in social drinking. Moreover, alcohol abuse is chronic, and many Alaska Natives become dependent on alcohol at the same time they become users. Drug abuse, which is a newer phenomenon among Alaska Natives, has nevertheless become a serious threat to their communities. For example, in some isolated Alaskan Native villages, there is a 48% lifetime risk of inhalant abuse.
Theories about the magnitude of alcohol abuse among Alaska Natives include genetic predisposition, enculturation pressures, social prohibition, and integration theories. Genetic predisposition theories cite the lack of acetyl dehydrogenase (which breaks down the toxic substances created by alcohol metabolism in the liver) as a causal factor. This genetic variation, which is shared with some Asian races (e.g., Chinese and Japanese), causes distinctive facial reddening, accelerated heartbeat, and increased blood pressure upon the consumption of alcohol. However, this theory cannot fully account for Alaska Native alcoholism, in that Chinese and Japanese Americans have the lowest rates of alcoholism of all American ethnic groups, whereas Alaska Natives and American Indians have the highest.
Enculturation theories examine the poor fit between Native indigenous values and those of the broader American culture. These theories examine the diathesis-stress dimensions of alcohol abuse, citing desperate social and economic conditions as precursors to alcoholism. Through the self-destructive behaviors that result from internalized oppression, Alaska Natives express massive grief over the loss of their cultures and the traditional ways of life. Boredom, stoicism, intense pride, and the lack of cultural models for seeking help reinforce this proclivity to alcoholism among Alaska Natives.
Prohibition theories suggest that Alaska Natives learned binge-drinking behavior from the trappers, miners, and traders with whom they had initial contact. Alaska Natives, according to these theories, invest alcohol with tremendous power and readily accept that they cannot control its effects. In contrast, Chinese and Japanese Americans (who have the lowest rates of alcoholism in the United States) believe that alcoholism is a weakness and that people can and should control their drinking.
Finally, integration theorists combine genetic, enculturation, and social prohibition theories. They assert that alcohol abuse is fundamentally a symptom of a much more complex set of problems within the Native community, that these problems have yet to be identified, and that alcoholism, although a symptom, is also a unique contributor, in that it breeds an abundance of negative personal and community outcomes. Integration theorists remind us that regardless of the physiological, social, or psychological origins of alcoholism, the disease of alcoholism (and drug abuse as well) must be successfully treated if there is to be a livable future for Alaska’s Native people.
Suicide, Depression, and Other Mental Health Issues
The Alaska Native suicide rate, which did not significantly differ from nationwide averages throughout the 1950s, began to take a dramatic turn upward in the 1960s. In the quarter-century between 1964 and 1989, the rate of Alaska Native suicides increased 500%. Today, although Alaska Natives make up just under 20% of the Alaskan population, they represent 41% of all suicides. Although rates have decreased slightly in the past 15 years, the problem continues to be widespread. In all populations, suicide rates are generally higher for adolescents. Among Alaska Natives, the number of adolescent suicide victims is even more pronounced.
Alcohol abuse is a factor in a large majority of Alaska Native suicides. Seventy-nine percent of all Alaska Native suicide victims have detectable levels of blood alcohol. Although there is very little research on the correlates of suicide among Alaska Natives, some theorists believe that suicide in this population is associated with rapid and unpredictable social change, childhood and interpersonal losses, a limited ability to grieve, poor affective relatedness, and very high rates of depressive disorders.
Although there is less empirical research on the prevalence and treatment of other mental health issues among Alaska Natives per se, there are studies of American Indian children and adults that include samples of Alaska Natives. These studies report increasing rates of depression, low self-esteem, and anxiety, citing that Native people do not fit well into the American way of life. Learning disabilities are the second most frequent major diagnosis among American Indians and Alaska Natives. Furthermore, American Indians and Alaska Natives are slightly overrepresented among HIV/AIDS patients, suggesting greater sexual risk behaviors than are found in the U.S. population at large.
The U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) reports that Native Americans/Alaska Natives are more likely to experience mental disorders than are other racial and ethnic groups in the United States. Of great concern is the high prevalence of depression, anxiety, substance abuse, violence, and suicide. Other common mental health problems include psychosomatic symptoms and emotional problems resulting from disturbed interpersonal and family relationships. According to SAMHSA, failure to address the “historic trauma” and culture of American Indians/Alaska Natives in health care only adds to the oppression they experience. Nevertheless, disentangling socioeconomic factors, cultural influences, civil rights issues, and the effects of race/ethnicity is difficult when seeking to understand any health condition, and even more so when seeking to understand mental health disorders.
Service Provision and Treatment Issues
Alaska Natives represent almost 30% of the public mental health clients in Alaska at an overrepresentation of almost 2 to 1 based on the general population. Nevertheless, public health officials believe that Alaska Natives are woefully underrepresented in relation to the magnitude of the mental health challenges they face.
The burden of mental illness looms over Alaska Native people, extracting vitality and interrupting their futures. Worse, the stigma attached to mental illness often deters people from seeking help, thus prolonging illnesses that could be treated or even prevented.
Stigma is not the only challenge to providing mental health services to Alaska Native people. Other challenges include cultural, philosophical, and communication style differences between mental health providers and their Alaska Native clients. Moreover, some Alaska Natives believe that mental health providers use their counseling/psychology positions to extend social dominance and control over Native people’s lives.
More Effective Treatments
Experts in multicultural psychology agree that effective treatments for ethnic minority clients should be based on those clients’ worldview and cultural precepts. Among Alaska Natives, these cultural precepts include respect for traditional knowledge, connections with the land and all living things, use of inductive analysis (inference of a generalized conclusion from particular instances), emphasis on discovering how, and verification of individual facts derived primarily from oral forms of communication. In contrast, European American mental health providers tend to value scientifically derived knowledge, mastery and control of one’s physical and social environments, deductive analysis (the conclusion about particulars follows necessarily from general premises), emphasis on discovering why, and verification of general principles derived primarily from written forms of communication. The primary challenge for European American mental health providers then is to find ways to understand and enter into the world of Alaska Natives to provide the most effective psychological treatments possible.
Within the context of providing culturally sensitive and effective treatments for Alaska Natives, several innovative programs are being introduced. Among the most promising are intertribal, business, and public service consortia, as well as tribally centered programs, that identify and treat alcohol and drug dependency as primary dysfunctions and co-occurring disorders as secondary dysfunctions. These programs typically are designed to (a) treat alcohol and substance abuse in ways that control the availability of alcohol, (b) provide educational and treatment efforts, and (c) reduce the social and environmental factors that increase the risk of harm to both the individual and the community. The treatment programs include using culturally familiar symbols, pictures, signs, and stories, addressing the impact of intergenerational trauma and chemical abuse on both families and com-munities, using Native languages and art forms, and employing traditional interpersonal techniques, such as talking circles and ceremonial protocols. In these programs, tribal elders often are employed both as consultants and as service providers.
A sample program, which has used this psychological treatment/community action model, has shown great success. In this program, which is operating in the Aleutian Pribilof Islands, responsibility for the mental health care of island inhabitants has been undertaken through a consortium of municipal and tribal governments and corporate management. Alcoholism and drug use decreased when island employers began to enforce sobriety policies and conduct random drug testing. Employees with substance addictions were sent off the islands for treatment, and they participated in a mentorship program when they returned. As a result, violence, felonies, suicides, and murders decreased, and psychological adjustment continued to increase as a new pride in island inhabitants’ cultural heritage and self-sufficiency emerged. Social and community support was established for people who suffered with mental health issues. Moreover, there were abundant opportunities for all workers to obtain sustained year-round employment. The affluence in the communities hosting this treatment program currently matches that of many other American cities.
Finally, there has been success in helping American Indians/Alaska Natives establish more productive and fulfilling lives by providing Native-based career counseling. In programs established by the Division of Indian and Native American Programs of the Workforce Investment Act, Alaska Natives are helped to achieve economic self-sufficiency through job training, job counseling, career counseling, academic counseling, and financial aid and educational assistance. These programs provide ongoing case management in a manner that is culturally appropriate and holistic in nature. Through individual development plans, counselors and clients work together to set goals, identify needs, and find referrals to other programs and outside community agencies. Nearly 90% of the individuals served in 2000 under this program were highly satisfied with the services they received.
Future Directions for Mental Health Treatments
Although there have been some successes in providing more effective mental health treatments to Alaska Natives, through the combination of culturally relevant treatments offered within a broader social support structure, there is still a tremendous need to look at short-, medium-, and long-term solutions to alcohol and drug abuse, depression, suicide, and other mental health issues among Alaska Native peoples. There is little empirical research that investigates the correlates of treatment effectiveness, although there is some evidence that consortium and community efforts are effective. Nevertheless, Alaska Native mental health, including the mental health of future generations, will depend on both preventive and remedial efforts that (a) provide empirically validated psychological treatments; (b) address the underlying economic, sociocultural, and other factors that cause Alaska Natives to seek refuge in alcohol and other chemicals; (c) create real economic opportunities; and (d) empower Alaska Natives to participate in crafting their own solutions to potentially devastating mental health challenges.
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