Maria Yellow Horse Brave Heart: Historical Trauma in Native American Populations
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Maria Yellow Horse Brave Heart: Historical Trauma in Native American Populations

August 21, 2019

Dr. Greathouse: Maria, it is such a joy for me to be able to spend time with you while you’re here. Looking forward to your lecture and I feel so honored to be able to be spending this time
asking you some questions. Why don’t you just sort of share a little bit about
your journey to Smith. How did you get here? What made you come? Dr. Brave Heart: I initially never thought of being in academia. I started out as a clinician. I got my master’s at Columbia when it was very
psychoanalytic, psychodynamic and that was the culture there that people were often in their own therapy as part of learning how to do this work, which is also typical in the psychoanalytic training institutes, that you go through a training analysis. So I knew very early on that I wanted to work in behavioral health and all of my focus was behavioral health, mental health, therapy. Both of my field placements, I had the opportunity to work
with both adults and children, which was ideal. – What I love is how you found your way here by listening to people who are important in your life. – I was doing a presentation and this was at what’s now called Sitting Bull Tribal College. It’s on the Standing Rock Reservation in North and South Dakota and one of our elders came up after the presentation and said to me, “That was really good. You need
to get your phD,” she said. She’s a nurse, her name is Bertha Gipp. I’ll always remember that. That just planted the seed in my head. I had never thought
about going on for a phD and that was the first sign. So I started thinking about it, and then I saw an ad for Smith in an NESW newspaper and it also caught my eye and then it talked about Smith having an anti-racist policy. I think I had also some
intuitive sort of things going on too, or just synergistic pieces because I didn’t realize
until I got to Smith and they started talking about the history of the school in classes that Smith was a trauma school. So it was founded initially
to work with war neuroses, to train providers to
work with war neuroses. I just thought, “This is pretty uncanny,” because my area is historical trauma and unresolved grief for native peoples. So it was just, it’s a perfect fit. Within the first two
weeks, Dr. Roger Miller, who was at that time the director of the doctoral program and was asking us to meet with him and to talk with him about what our interests were in thinking about our dissertations,
what we were gonna do. So I talked to him about
my historical trauma work and developing an intervention, wanting to develop an
intervention more fully. That’s when he said,
“Well, you could do that for your dissertation. You could do kind of a
pre-test post-test design of the effectiveness,”
and I was like, “Yes! Thank you! That’s perfect,
absolutely perfect.” So I knew that there was this synergy and Smith was the place,
it was exactly where I was supposed to be. That was very much supported. – Absolutely. Absolutely. When you were talking about the work you had done before you came to Smith, right after your master’s,
I think that the way you started building
your appreciation, even, for not only the
psychoanalytic work you did but for the social work you did is also really important,
it’s an important thread that you carry with you. Like some of your stories
about your first assessment and home visits, I think, are so valuable. – Yeah, I know. What I was sharing with
you before was my first, so I was about 21 years
old, my first home visit and my first year of field placement was at a community, it was an outpatient community mental health
center that had been part of a settlement house
originally, that was its origins, and it was in Spanish Harlem. It was just an amazing experience. The community was so warm and embracing. But my first home visit was in a half-abandoned fifth
floor walkup building and I was very green and I was visiting a woman
who was schizophrenic and stable on her meds and her daughter had been take away but reunited with her, so I was also working with her daughter. This was my very first home visit and– – And you were how old? 21? – I was about 21 and I was, my two biggest fears
were junkies and rats. (both laughing) I was like, I didn’t
want to run into either so I thought if I stomp up the steps that I’ll scare them off. But my plan was foiled because every second or third
step was all rotted out. Big holes in the step. So I made it up to the
top because she lived on the fifth floor and she opened the door and she was pretty flat
from her medication, but she was stable. Then she asked me if I
wanted something to eat and as she was asking me, which I wouldn’t have accepted anyway in terms of the professionalism, but– – Right, that’s the one
thing that we remember. – Yeah. – Boundaries, boundaries. – Right. So as she opens her refrigerator door, roaches are crawling all
over the food inside, it’s just roach-infested. And I said, “Oh, no thank you.” (Tanya laughing)
I think I took a glass of water, though to be, you know, appropriate. So we talked and when our session was over she said, “I’ll watch for you while you go, till you get out the door.” because from her landing
right outside her door, she could look down and see the door. I was just so touched by that, and that was the metaphor
for the community that the people in the community knew who all the Columbia students were, even though many of us
could have blended in with the community, everybody knew. It was just amazing. That whole experience and dispelling those stereotypes that existed at the time that poor
people and people of color don’t have insight. They can’t use insight-oriented therapy, and that was so not my experience. I had kids, I had an ex-gang
member come twice a week and sit and talk, a 14-year-old, and was getting better. So I was just excited. But I got involved within
psychoanalytic training because at that center
where I was working, a lot of people were involved
with psychoanalytic training. So what they did was… I was talking to them and
I was encouraged by it because I felt like, you’re getting deeper to the root of the problem. You’re not putting on Band-Aids. Sometimes I felt like because you have so many people to see that
you only have a chance to sort of do crisis
management and kind of put Band-Aids on and keep
them from falling apart and keep them functioning,
but you’re not getting at what’s underneath all of this. So I started the psychoanalytic
training institute and that’s a powerful experience. – That is great. Yeah. I think also what you
were really highlighting is dispelling the myth that you can’t work with individuals who have significant social, emotional needs because they’re on such a low scale with
Maslow’s hierarchy of needs that you just have to keep
addressing those basic needs. And you’re like, “No, that’s not true.” Individuals, once those needs are met, or even if they’re not met in the way we think they should be, you can still do some very valuable work with them. – It’s funny that you brought that up because a lot of times I’m joking around with my colleagues in the Takini Network, which we’ll talk more about that, but we say that sometimes we feel like we’re operating at multiple
levels of that hierarchy so we’re very altruistic on the top, but we’re dealing with basic needs because there’s no grant money and we’re trying to survive. I think one can travel up and down that sort of pyramid. – Yeah. Nice. So do you want to say anything about your first assessment that you did? – I’m not sure about the first one, but just at the clinic where I was it was very, the structure was pretty… It was pretty rigid. That we had 45 minutes and we had to do a psychosocial history
and come up with diagnoses and do a mini mental
status exam in 45 minutes. (Maria laughs) – Wow. A lot. – Yes, which is a lot. I must have done thousands of intakes so I got good at it, I
got good at honing the, it was almost like intuitive
knowledge or intuitive skills of being able to recognize
there were certain clues. Of course, at that time
it was the Diagnostic Statistical Manual II, which
was only about that thick, so it wasn’t as complicated as now. It was more classical, it sort of went more along classical lines like Fenichel’s writings
about the different kinds of personality disorders and
personality characteristics and things like that. I managed to do that, but we, we had to. That was just the way
it was, we had to do it. So again, that sort of
practice wisdom that evolves in using your intuition. I remember one gentleman, and I hadn’t mentioned this to you before, that came in and… So it got to 40 minutes and
everything sort of checked out, but I just had this feeling like something’s going on. There’s something… I wasn’t sure what diagnosis to put and so I said, but I just had this
uncomfortable feeling so I said, “Can you tell me again
why you’re coming in now?” because you think about
there’s precipitating factors or you look for people
whose symptoms are recent and then how long they’ve
had their symptoms and all of that. We weren’t getting that
information before that. When I asked him that he said, “Because God told me to come
in and I’m Jesus Christ.” I was like, “There it is!” (Tanya laughing) I knew. I knew. So all his delusions started coming out in the last five minutes and I was so glad that I followed my
intuitive, my gut sense, that something else was going on. Because he was able to hold
it together for 40 minutes and not be psychotic
and not show that he had a thought disorder. I often would tell
students that story to say, “Develop your intuitive
skills and your sense. Start observing. Pay attention to what feelings come up because they’re clues,
they will tell you things.” I remember another case where I was, it was in a therapy group, and the individual was talking and starting to talk about a conflict with his fiancée and, all of a sudden, I started craving pizza. Just out of the blue, I
started craving pizza. What you learn is you have this sort of hovering attention with
the psychoanalytic work that you pay attention
to where your mind goes and what associations you have while you’re paying
attention to the person. It’s a very rich and complex thing to do. I observed, I said, “Why
am I craving pizza?” As he kept talking, then
he starts describing an argument with his fiancée
over microwaving pizza, but this was after I
was having the craving. So I was picking up this
unconscious content. – Yeah. That’s, like, crazy. That’s cool. That’s so cool. – Yeah. – This was your really
rich clinical foundation that you had. Then you started thinking about teaching. How did that grow out of that? – Actually, it was when,
in the doctoral program, one of the things that
we read was a book on “How to Complete and Survive
a Doctoral Dissertation.” – Absolutely. I remember that one. – I don’t remember the author or if I have the title exactly correct. One of the things that
they said in the book was some of the best jobs when you’re ABD, all but dissertation, are in academia because of the culture
of academia to write and also the fact that sometimes you can teach courses in the area that matches with your dissertation research, or to try to do that. That was one of the things that I thought, “Well, hey. That’d be interesting.” Then I got a Council on
Social Work Education minority doctoral fellowship and they brought us one year they brought us in to the CSWE meetings and they provided mentoring sessions and orientation sessions to academia. I still was like, “I don’t know if want to actually become a faculty member,” but I thought maybe teaching on the side or something. I had been doing full-time
clinical practice and working with tribes. Then as it went on people started recruiting me. I said I wasn’t done yet but I had… I was close to finishing
the dissertation work. So they started recruiting
me and so I went. I was invited to come to
a campus and one of them said, “We just want
you to present and then if you want to interview,
we’ll interview you,” but they did want to interview me. It just sort of opened up another window and then all of these
things that were going on and talking about, and I thought, “Wow, this might be a good way
to get my work done,” with historical trauma work. – Absolutely. What sort of piqued your
interest in starting to do historical trauma work? – Back in the 70s, I just remembered I was, that was when I was at Columbia. I was just finishing school there and checking into the psychoanalytic
training institutes there to you know, to get started. I was looking at, it was
just one day that I sat and was looking at some
historical photographs in my apartment and I
just started sobbing. I got this sense of overwhelming grief and it felt like it was huge, like it wasn’t my personal grief, that it was something
that was generational. So I paid attention to
that, that I felt like I was carrying something,
carrying this grief and this trauma of our ancestors. After that, I started to just pay attention to that and then at the psychoanalytic
training institute I met a child of Holocaust survivors. That’s also when Helen
Epstein’s book came out, that was around 1976,
“Children of the Holocaust,” which was really a qualitative study of the experiences of
children of the Holocaust. I started hearing more about that and that just really resonated for me and I thought about the
American Indian holocaust in a sense, and started developing more, more and more kind of, allies. I just remember my training
analyst happened to be Jewish and one time I was talking about something and he got it because he said… Because it was something
personal and native-specific and he said, “That’s
genocide,” and I was like, “Yes! Thank you for–” He acknowledged it. He got it. – And affirmed it. – Yeah. And I felt like he
understood. He understood. So that was really encouraging, too. – Very powerful. – Yeah. So I felt like I could keep on this, that I was onto something that could help, help our people. So I started integrating it and working in clinical practice and kind of taking that lens and, and then also in
presentations I was doing and groups I was running and just developing it and
building that in workshops. – Something that runs
through your narrative a lot is your ability to really
reflect on your internal process and your dreams are really
important to you as well. You’ve shared some of
those that helped inform. – Yeah, I had a dream
as a child that later, as an adult, was interpreted
by one of our healers. It was a dream about an elephant that, in my dream, the elephant
had escaped from the circus and I think I was probably
about six years old. It was dark and raining
and all of a sudden this elephant is, like, running. And I’m wide-eyed, just
standing there like, “What do I do?” And what I do in the dream is I just put my arms out, like to
welcome that elephant. Then the elephant jumps into my arms but turns into, like, a little kitten. When I was telling that
dream to the healer he said that was about, kind of, embracing the real ancient ways and the ancient traditions. Because I had another dream later about an elephant who was drowning and a whole group of us,
and this dream was 1992, and then all of us that had been involved with the first historical trauma and unresolved grief intervention, which is my dissertation work, we were all, and all of us are involved in traditional ceremonies. So we were all standing
around that elephant and we were going to that elephant to pray for that elephant and that that was, again, so those were really
connected was what I was told. – Yeah, wow. That’s
really powerful, I think. Really, really powerful. So that’s what, also,
you were referring to as the Takini Network, I believe. Is that right? The training that you did
with those facilitators. – Yeah, so in 1992, which is when I did the
actual dissertation workshop, we had two things. One was the training of the trainers to prepare for delivering
it to a larger group and then followed up within a few weeks by the full intervention, with 45, that was the 45 people involved. What I did was I recruited
all my friends and relatives to join me, because we
trained co-facilitators so each group had a male
and a female co-facilitator. But also, in that sort
of psychoanalytic vein, which I really think is important, is that if you’re going to
do clinical work with people you need to do your own work. So the concept of self-analysis,
training analysis, is really important because otherwise your stuff can get in the
way and that’s not fair to the people you’re working with. The model was that,
that we would go through our own training, healing experience before we would deliver that. So we would go through what we were asking the people to do. So that’s when we formed
the Takini Network. The idea was to have, to almost form an extended
family kinship network to devote to working on this and working on that healing. Those were the original
trainers that were trained, that I recruited. A couple were clinical providers, native, mostly all native folks, and
some were traditional healers, and some were Big Foot Memorial riders, and, you know, just people who were already doing a lot of
their own healing work and just very committed. So those became our core group. – Nice. Now, sort of, um… Do you think you that want to say any more just about your definition
for historical trauma? Before we fast-forward
to what you’re doing now. – Yes, I define it as cumulative emotional and psychological wounding
across generations, including one’s own lifespan, because everything up to
a minute ago is history. Some people misunderstand
it and think that I’m only talking about the
distant past and I’m not. I’m talking about everything
up to the present, including the present reality, which just happened a minute ago. But the idea was to ground it in the past, in the context, because that destigmatizes for people it gives people
a frame of, “No wonder. Look what’s happened to all our people, all our ancestors across time,” that we’re just carrying this on and it’s affecting us and there have been horrendous things that have happened. We lost the right to bury our dead the way that we did traditionally and those were… All cultures have wisdom in
what their practices are, have been, that fits with their culture and so when you can’t
practice it in that way, that’s one way of stunting the grief or trapping the grief. We have certain beliefs that if you don’t have certain ceremonies, the spirit of the person can’t be released and will be trapped on this earth, or that other things could happen. So not being able to do that, being survivors of massacres, you know, like the Wounded Knee Massacre, and the mass graves where those ceremonies couldn’t be performed at that time. Those are things that affect people and that the grief and the trauma just gets carried on and on. So there are ways to heal with that, from that, both traditionally,
in traditional culture, but also incorporating what we know now about healing and alcoholism and trauma and PTSD and complex
grief, complicated grief, or prolonged grief, and
all of this knowledge that we’ve gained over many years. That’s the idea. And in my experience with the evaluation and research we’ve been doing with this is that people at least perceive it as being helpful, the
historical trauma concept. They start to feel this
release of pressure and like, “Oh no, no
wonder I feel this way.” One individual I know that is more of an elder stated that, and had been in outpatient
behavioral health treatment for many years, said that no one ever asked her about her boarding school trauma and she was never able to talk about it until she started doing
the historical trauma work and that she really felt like this weight had been lifted off of her. – Absolutely. Sort of like cathartic. – Yes. – Absolutely. Great. So fast-forward as to
what you’re doing now. – Currently, I have a National Institute of Mental Health grant and so I’ve been progressing
and moving forward and that’s been a dream of mine, too, which I have a little story
about that I’ll tell you. I’ll come back to it in a minute. That is looking at, taking
the historical trauma and unresolved grief intervention, which has been recognized
as a tribal best practice by SAMSA, the Substance
Abuse and Mental Health Services Administration in conjunction with First Nations Behavioral
Health Association. Taking the intervention and combining it with group interpersonal psychotherapy, which I think focuses on the, sort of, the relational
issues around depression and depression triggers, so conflict with another person, or your role, or grief and loss, those kinds of issues that get interwoven, then, into the model. Not saying that people who have depression may not have a biochemical aspect to it and may need medication, and there’s been studies where sometimes medication and the
treatment work really well. This study is combining
both of those models because that IPT is something that NIMH has funded in the past. And I have some colleagues from Columbia who are consultants on
that who are IPT experts. So that’s what’s going on. We’re taking the historical
trauma intervention, combining it with the group
interpersonal psychotherapy, and then randomly assigning
people to the two groups. One gets just the IPT
only and the one gets the enhanced historical trauma group. The goal is later to do
more with a larger study where you can have more sites and so maybe do something with perhaps just
the historical trauma only one with the combined, with the IPT, and other kinds of arrangements like that. We’re finding, we don’t have… We’ve collected the
data on the first wave, but we’re still doing some
follow-up data collection. We don’t have all of that analyzed, so we don’t know what
the data forms will show, but we do know that
what is being expressed by the people who have
stayed in the groups is really positive, that they they feel that this has really helped them and… – Very good. – So that’s– – Good. So that’s what
you’re busy doing now. Nice. Well, Maria, it was such a
joy to catch up with you. I feel so honored to have
been able to sit with you the last couple of days. – Thank you. – So thank you.

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  1. Your work is incredible! I am doing an essay on diversity and stress, and you did all the leg work for what I had thought was correct, thanks! My hope when I am done with school is to work for IHS, and your work is very helpful for that path.

  2. Maria, how powerful. Thank you for enlightening me to this powerful and sensitive topic of Historical Trauma.

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