Mental Health in Indigenous Populations

Mental health in Latin American indigenous populations is an urgent yet neglected problem. Morbidity rates for infectious and non-communicable conditions are considerably higher in Latin American indigenous communities than in the general population (Montenegro and Stephens, 2006). Among these non-communicable conditions, mental health presents an overlooked example. However, addressing indigenous mental health is a complex matter. The conceptions and healing of mental illness in indigenous populations may diverge from many Western approaches, complicating treatment. Moreover, economic, geographic, cultural, and linguistic barriers prevent indigenous communities from accessing the care they need. These barriers indicate a lack of support for indigenous communities, such as Colombian indigenous populations struggling with a suicide rate more than 100 times higher than the national average or the complex problem of alcoholism in rural populations in Mexico. These cases illustrate the struggles of marginalized indigenous Latin Americans.

Mental illness in indigenous populations may be particularly difficult to treat in Western psychiatric or medical institutions due to unique conceptions of health and mental health. An example is indigenous communities in Guatemala which have conceptions of health, such as religion-based understandings, which differ from those of the health professionals (Hautecoeur et al., 2007). At a workshop of indigenous mental health in Santiago, Chile in 2014, indigenous community members from around Latin America discussed conceptions of mental health in their communities. Mental health was not seen as distinct from health in general, diverging from Western notions of mental health (PAHO, 2016). This can be conceived as a unique understanding of mental health, or a view which accounts for overlaps between mental and physical health, social determinants of health and historical trauma and marginalization (PAHO, 2016). Mental wellbeing was also illustrated as a congruence with the natural world, a lifestyle associated with surviving in that environment, and connecting with other members of their community (PAHO, 2016). Traditional practices, such as engaging in indigenous art, were seen as promoting mental wellbeing in the Mapuche of Chile (PAHO, 2016). This is consistent with finding in indigenous communities globally; involvement in indigenous culture is seen as a protective factor against anxiety, suicide and depression (Valeggia and Snodgrass, 2015). Conversely disruption of traditional societal structure, often through processes of colonialism and environmental destruction, increases distress. Indigenous men who have had to adapt their traditional social roles in accordance with new expectations have been found to have increased rates of suicide and substance abuse (Valeggia and Snodgrass, 2015). Thus, by preserving indigenous culture and land, mental illness can be addressed and, to some extent, mitigated.

Indigenous healers and traditional medicine are central when discussing indigenous health, particularly since indigenous populations may feel alienated in biomedical institutions due to cultural differences and past experiences of racism (Incayawar & Maldonado-Bouchard, 2009). Integrating traditional medicine into the medical system could address these barriers; however, few states and institutions have successfully implemented this (Incayawar & Maldonado-Bouchard, 2009). One of the few nations which has implemented traditional medicine into state healthcare is Bolivia under the leadership of Evo Morales. Through a process of ‘decolonization,’ Morales intended to unravel the systems of hierarchy implemented by the European elite and give equal power to the indigenous population (Johnson, 2010). Traditional medicine, or folk healing, has many diverse manifestations among different Latin American cultural groups. However, its efficacy in healing patients suffering from mental illness is attributed to shared values of action-oriented treatment, incorporation of family or community members, lack of bureaucratic procedures, a holistic conception of health, and locating the problem as outside of the self, thus reducing stigma (De La Cancela & Martinez, 1983). Due to cultural identity, conceptions of mental health, and use of holistic methods of healing, traditional medicine provides an important outlet for indigenous communities instead of, or in conjunction with, biomedical providers.

Accessing health care is a great obstacle for indigenous populations since health workers may not understand the role of culture in indigenous health and these populations may be hesitant to seek out treatment due to distrust of the government, negative prior experiences, and internalized racism. In conjunction with these cultural barriers, indigenous populations struggle to surmount economic, geographic, and linguistic barriers. In Rabinal, Guatemala indigenous communities experience geographic barriers to health care due to a lack of transportation. Many do not speak Spanish and worry about the financial costs of visiting a health facility (Hautecoeur et al., 2007). Additionally, they occasionally reported abuse in healthcare facilities, such as mistreatment for not speaking Spanish (Hautecoeur et al., 2007). These abuses are particularly troublesome when considering that mental illness is already highly stigmatized.

Collective pain and trauma are common in indigenous populations subjected to historical and contemporary violence, colonialism, and destruction. In Colombian indigenous populations, suicide rates are higher than in non-indigenous populations, which is often attributed to this trauma. In Colombia, the average suicide rate is 4.4 per 100,000 inhabitants. Among indigenous populations, the suicide rate is 500 per 100,000 inhabitants (Valle & Jiménez, 2012). A “cycle of disadvantage” created by low levels of education, housing and employment, financial insecurity, racism, and feelings of shame, is attributed to depression, substance abuse, and other mental disorders (Valle & Jiménez, 2012). Suicide in Colombian indigenous populations is not only a recent phenomenon; during the colonial period, collective suicide was used as a form of resistance against invasion (Urrego-Mendoza et al., 2017). Indigenous Colombians attributed more recent cases of suicide to a disturbance of spiritual beings and the presence of foreign and threatening actors, such as corporations or settlers, which destroy the land (Urrego-Mendoza et al., 2017). In a national survey of mental health in Colombia, those who self-reported as indigenous had higher rates of displacement due to violence and rates mental illness, including anxiety, depression, and substance abuse (Gómez-Restrepo et al., 2016). Mental illness was associated with not speaking the language of their indigenous community and living in an urban area, indicating that loss of culture is associated with poor mental health (Gómez-Restrepo et al., 2016). Violence and discrimination against indigenous populations and their land has deep psychological impacts which increases prevalence of mental illness and, by extensions, suicide.

Substance abuse among indigenous communities can be both a result of pain originating in longstanding oppression and the marketing of alcohol in these communities. In Mexico this is particularly present in rural, indigenous zones where alcohol is made at home or sold by beer companies which dominate the rural market (Rey & Sainz, 2007). Indigenous populations may be resistant to interventions due to a strong sense of group identity and history of outside intervention and destruction (Rey & Sainz, 2007). In a study of two indigenous communities in the state of Hidalgo in Mexico, researchers found that women were reluctant to talk about alcohol abuse in their family or community due to patriarchal power dynamics, primarily the fear among men that talking to researchers would alter women’s behavior around alcohol use. Additionally, community gossip and the normalization of homemade alcohol for daily consumption hinder discussion of alcoholism (Rey & Sainz, 2007). These factors indicate challenges to addressing substance abuse in Mexican indigenous communities, allowing alcoholism to persist in the community.

Suicide in Colombia and alcoholism in Mexico present two examples of the mental health crisis in Latin American populations. Both of these cases highlight the effect of structures of oppression on indigenous mental health, including the impact of environmental destruction in Colombia and the marketing of alcohol and patriarchal marginalization in Mexico. However, they also serve to illustrate the complexity of addressing indigenous mental health. In Colombia, indigenous communities attributed mental illness to spiritual presences. They also suffered from urbanization and loss of culture, two factors which are difficult to address. In Mexico, indigenous community members, particularly women, were hesitant to speak about substance abuse and largely ignored the problem, which the authors attributed to patriarchy and fear of gossip. Despite the challenges to addressing mental health, steps can be made to preserve indigenous culture and land, minimize economic and geographic barriers, and increase the presence of indigenous healing practices in the health system.

Related Article:

• Indigenous Medicine and Health in the Amazon
• Ataques de Nervios

Additional Resources:

Pan American Health Organization. Mental Health. https://www.paho.org/hq/index.php?option=com_topics&view=article&id=210&Itemid=40870&lang=en. Last Accessed: 9 May. 2019

Ocampo, C. (2010). Is there such a thing as indigenous mental health? Implications for research, education, practice and policy-making in psychology. Special section-Indigenous peoples: Promoting psychological healing and well-being. https://www.apa.org/pi/oema/resources/communique/2010/08/indigenous-mental-health. Last Access: 9 May. 2019

World Health Organization. (2007). Health of Indigenous People. https://www.who.int/mediacentre/factsheets/fs326/en/. Last Accessed: 9 May. 2019

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Gómez-Restrepo, C., Rincón, C. J., & Urrego-Mendoza, Z. (2016). Mental health, emotional suffering, mental problems and disorders in Indigenous Colombians. Data from the National Mental Health Survey 2015. Revista colombiana de psiquiatria, 45, 119-126.

Hautecoeur, M., Zunzunegui, M. V., & Vissandjee, B. (2007). Las barreras de acceso a los servicios de salud en la población indígena de Rabinal en Guatemala. Salud pública de México, 49, 86-93.

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