Healing in Public Health: Oppression, Trauma, and Resilience

An Interview with Kelly Gonzales and Jillene Joseph

February 12, 2020

Dr. Gonzales and Ms. Joseph were in residency recently at the University of Michigan School of Public Health to lead workshops, lectures, and other conversations around intergenerational trauma and various acts of decolonization—self-determination, positivity, using traditional methods, and so on—that they engage in and teach to be agents of healing, hopeful change, and health for all. 

The dehumanization and oppression of Native American people and the erasure of the Native American experience from public health education has led to health inequities and suffering. What does achieving health equity through the healing process look like for Native American populations and why is that important to all of us?

Gonzales: In the United States, the health of Native people is rooted in colonization and continues to be impacted across the generations and today through ongoing settler colonialism, racism, oppression, and the unhealed historical and contemporary traumas caused by these determinants. These determinants disconnect Native peoples from the resources and conditions needed to thrive, which creates unnecessary burden and suffering. Disempowering these determinants requires new actions of healing our systems and healing ourselves by connecting with Indigenous values and addressing systemic inequities.

The accreditation bodies for schools of public health lack competencies that focus on colonization, trauma, and oppression in relation to health. This causes gaps in the curriculum, which means public health students are not learning about colonization—especially settler colonialism—nor about Indigenous values. This lack of knowledge makes health equity for Native Americans inconceivable. Failure to recognize and address these gaps in competencies and curricula prepares a future public health workforce that is ill equipped to consider and meet the needs of Native peoples—populations that experience profound and persistent health inequities. A public health work force trained with these limitations may reproduce conditions of oppression, racism, and colonialism instead of healing these root causes and moving us toward health equity and thriving communities. Because there are so few Indigenous scholars in public health and medicine—and within higher education in general—there are too few of us to address these gaps in ways that are strategic and sustainable.

When institutions address their own equity issues, these changes can flow downstream to benefit the entire system and the peoples served by them. Exploring and addressing system-level inequity is challenging work because it is not prioritized by those closest to the power and those that benefit from the inequitable system. These are the people that never have to consider what it means to carry the burdens of those inequities on their backs, never have to feel the weight of that burden and all that it brings with it. For example, the University of Michigan has the power to inspire conditions that lift up Native American peoples and future generations and be an example to other universities. The university accepted this responsibility—to be a good ally—when it accepted the gifted lands on which the university sits from the original peoples of these lands, including the Anishinaabeg—the Three Fires Confederacy of Ojibwe, Odawa, and Potawatomi peoples. This act of generosity was based on a relational view: creating connections between the university and the respective tribes with an understanding that collectively they could move into a future where all benefit. But this agreement was not upheld by the University of Michigan, and it took 150 years before the first Native student entered this university’s doors.

Understanding this history provides opportunity to ask important questions—the answers to which can remedy the violation so Native people and the university itself benefit. As a result of a university not fulfilling its role in the agreement, how have descendants of the first peoples of these lands been harmed? What factors within the institution itself make indifference to this issue acceptable? How and why has this issue been hidden? How can the university create conditions that prioritize the health and wellness of Native peoples and do so in a way that respects and values the many contributions they offer the broader community?

In light of such historical contexts, we can see that public health education too often is guided by a limited point of view—a western colonial point of view. Without knowledge from other contexts, students learn and reproduce programs, policies, and understanding informed by that limited viewpoint and the biases that come with it. Without deep reflection on their own biases, generations of students may enter the workforce and collectively cause more harm than good. Addressing this possibility is how we can begin to decolonize public health and make possible the idea of Indigenous health equity. We must do this whether or not institutions are ready and willing. Together, we have the power to create the world we want for our children and future generations. As Indigenous peoples, we teach our children to disempower colonialism by healing the damages it causes within us and among us. We do this by creating affirming conditions and environments for our youth so they connect to the best parts of themselves—which includes Native culture and the love of their ancestors. By standing in their own power and their own self-worth, they heal from the traumas of colonization and protect themselves from the damages of ongoing colonialism.

History is alive in us—not only the trauma but also the wisdom. We can move together toward a cycle of trauma that harms us all or a cycle of healing that benefits us all.

Joseph: A lasting impact of colonization is oppression, and when people are oppressed for so long, they internalize the oppression. When you are made to feel less-than because of how you look, when you see someone else who looks like you, you might often treat that person poorly because you feel they are less-than as well. Research shows that oppressed people oppress each other worse than their oppressors oppress them. That is an entrenched and very challenging impact of colonialism that still plays out in our community. Chronic negativity—a lasting impact of trauma—is an epidemic in Native communities.

Oppression and negativity go against our cultural value systems, so we are in a state of constant cultural conflict because some of our behaviors do not match our traditional value systems, which are about respecting the land and honoring Mother Earth—our first mother—which then translates to a deep cultural respect for women, who have the miraculous gift of giving life. Colonization changed that and introduced misogynistic systems of oppression.

Many Native people—men and women—are abusive toward women. My organization, the Native Wellness Institute, exists in part to provide solutions, helping people become aware of this form of oppression and providing opportunities for healing. We work to help people first decolonize and then learn ways to re-Indigenize their communities and live in the ways our ancestors lived.

One central approach to this healing is remembering and re-learning our languages. We have not forgotten our languages—they are asleep in us at the moment. We have to reawaken them and re-learn the cultural values embedded in the languages themselves. Another world opens up to us when we do this, because our people were positive thinkers, and positive thinkers are positive doers. The proof of this positivity is in the languages themselves. Native languages don’t have the B, C, or F words. We don’t have those words and we didn't speak to one another in those ways until we were spoken to with those degrading words by the colonizers.

How do you talk about public health in Native communities, and what can academic public health learn from the experiences of Native wellness?

Joseph: When the Lewis and Clark expedition came to the end of the Organ Trail, an expedition member named Archibald Pelton became mentally ill. The Native community in that part of Oregon did not have a word for mental illness in their tribal language. They adopted Pelton’s name into their language to be able to talk about mental illness. Pelton is now the word for mental illness in that language.

Our people lived a life of balance. Balance is not the same as perfection or freedom from suffering. Tragedy and trauma happened all the time, as they do everywhere. However, when tragedies occurred, we had the tools and the practices to help us stay in a life of balance.

Native concepts often overlap with academic science. For example, the field called epigenetics—how environmental experiences shape the development and expression of our physical selves—is essentially what our elders call blood memory.

We know this from the way our traumatic memories play out over time but also how good things impact us. The knowledge of our languages, our rituals and ceremonies—these are in our blood memory and affect our health. The more we let go of certain cultural baggage and tap into our blood memory, the more we can heal. Kelly and I are the results of that process. We are not perfect, whatever that means. However, we are living the lives of our ancestors and engaging those tools and memories as ways of navigating our complex and still very colonialized social lives. This keeps us moving forward even as we draw on healing powers from our past. Moving forward is a Native teaching, and we do our best to be better people every day.

Gonzales: And when curriculum systematically erases the humanity, experiences, and strengths of a group, such as Natives, students might come to believe that their respective group has no knowledge, no science, no language, and therefore cannot contribute to advancing a good and just world. These perspectives reinforce the idea that Native communities cannot know what is best for them—how to be healthy—and it perpetuates the belief that solutions are found only outside the community. The erasure of Native knowledge occurs when Native experiences, voices, and perspectives are not included in the curriculum, and this creates dependency on external systems. Decolonizing education, and public health in particular, happens when curricula center on the perspectives and values of Native peoples. And this will create affirming learning spaces not only for Native students but for everyone.

What keeps you moving forward when the suffering you see and experience seems overwhelming? How do you stay hopeful?

Gonzales: First, it is okay to admit to being overwhelmed. It is also important not to stay in an overwhelmed state or to let it be the driving force in one’s actions and beliefs, because that is a powerful downward cycle.

When I’m really struggling, I might be feeling impatient because I want big change and I want it faster than what I’m seeing. In those times, I remember that I am not alone and that many of us are doing the work of decolonizing. I also remember that the impact of today’s efforts may not be realized until well into the future. In this way, I remember that our work builds on the work of so many before us. I also try to keep my focus on the smaller changes that are happening around me and within me, and to feel good about them.

In these ways, we can re-center ourselves in the strengths and values of our people, the power that is within us, and the love of many. We can share this knowledge and these ways with our children, just as they were shown to us. And now Jillene’s daughter is inspiring those same possibilities among the next generation, an amazing example of the power we have for promoting healing and thriving in our communities.

Joseph: Yes, my daughter grew up spending lots of time in the Native Wellness Institute. Many of her peers and other Native leaders now in their twenties regularly help us in our work with Native youth. Last year the leaders of our organization decided to find new ways of addressing intergenerational trauma to make a greater impact in bringing healing to our people.

We gathered 17 of our young people and asked them what we can do differently and what healing means for them and others in their generation and how we can bring more of it. We thought they would have a conversation for a few hours. Seven hours later they were finished. And from that conversation was born a movement they named the Indigenous 20 Something Project (I20SP). They have built a nationwide movement to end the lasting impacts of historical and intergenerational trauma on Native communities. They are presenting around the country to groups of educators, other Native youth and their peers, and anyone else who will engage them because they are tired of seeing the impact of historical and intergenerational trauma in their communities and they want to be proactive. They are from an array of backgrounds—doctoral students, filmmakers, hunters, traditional practitioners, language revitalists. They are ready for this and have been, because their whole lives they have been trained and mentored and molded to do this. They are an answer to many of our prayers right before our eyes.

This is an important example of us de-colonizing ourselves. When we can decolonize and then re-Indigenize ourselves, then we can think more like our ancestors, which makes us behave more like our ancestors. Another example is the sobriety movement. Alcohol was strategically given to our people as a chemical warfare agent, meant to subdue Native men and disenfranchise Native women. When we were confined to our reservations, food and clothing had to be given to us. This created one level of dependency on the US government. And in those boxes of rations were also bottles of whiskey for the men, which led to another level of dependency. Alcohol caused problems and then became a coping tool for our people. Because we didn’t have alcohol in our history for thousands of years like Europeans, this first introduction was absolutely devastating.

In the 1970s, a sobriety movement began. Today, we have more sober people in our population, proportionally, than any other population. Because negative stereotypes are so powerful and pernicious, we are still known for the “drunken Indian.” Meanwhile, we have significantly changed our norms. In the 1980s, you would expect to see alcohol around tribal gatherings. You won’t see that today. But the ordeal has helped us understand the effects of colonialism on our entire community.

Gonzales: Public health at its best is guided by the community and led by the perspectives and experiences of the community. This helps to address gaps in the curriculum of public health education. For Native people, health requires balance in all the areas of mental, physical, spiritual, and emotional health. Our current public health curriculum focuses generally on the physical domain of health—the biomedical frameworks guided by values of Western viewpoints—that we often see in medicine, a framework public health is trying to grow out of as it moves toward social determinants.

Without a focus on these other areas of health, the system itself is out of balance, and this shapes what students learn and how they envision future public health systems. Incorporating broader human experiences and contexts can elevate our strengths—traditional values and traditional interventions. And then that is our medicine.

We can create these environments in all of our communities. Students who experience discrimination can find comfort sharing and speaking up, when they experience learning in spaces that are decolonized, when their beliefs and perspectives are considered vital and normative.

What are the challenges in working toward healing and reconciliation in today’s contexts?

Gonzales: Colonization harms everyone. The logic of superiority harms everyone. White fragility, settler-colonial fragility, and ignorance are powerful defense mechanisms that protect systems—and systems are made up of people. When we become aware of these issues and how they show up in our everyday lives, we can use that awareness to heal by practicing new behaviors. The first step is to believe this is possible. The next is to work toward it with deep commitment and to surround ourselves with others doing this work. The work is not perfect, and the path forward isn’t perfect. But collectively we have the power to advance forward a world that supports our best selves.

Joseph: All of this is very much public health. So often the oppressors are the ones most to be pitied, the ones who are the most damaged and who are embodying that negativity in themselves and their communities. The idea that you can steal land and pollute environments with no thought to the health of current and future generations is pitiful.

I see ideas of cultural superiority on a continuum, a spectrum. And at the extreme end, I see it as a mental illness. If we could look at it that way, we would have a much different approach to it. And we could begin to help the oppressors themselves heal and stop oppressing others.

We talk about historical and intergenerational trauma in Native and black communities. What about historical and intergenerational trauma in the white community? What brought their ancestors to this country and were they oppressed? The insights that will come from those kinds of questions will help people of European descent heal and will help all communities heal and work toward reconciliation.

Gonzales: Culture is medicine, and reconnecting to the best parts of ourselves is the healing action that can disempower colonialism and move us closer to the type of world that we want for our grandchildren and their grandchildren.

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Anishinaabeg gaa bi dinokiiwaad temigad manda Michigan Kichi Kinoomaagegamig. Mdaaswi nshwaaswaak shi mdaaswi shi niizhawaaswi gii-sababoonagak, Ojibweg, Odawaag, minwaa Bodwe’aadamiig wiiba gii-miigwenaa’aa maamoonjiniibina Kichi Kinoomaagegamigoong wi pii-gaa aanjibiigaadeg Kichi-Naakonigewinning, debendang manda aki, mampii Niisaajiwan, gewiinwaa niijaansiwaan ji kinoomaagaazinid. Daapanaming ninda kidwinan, megwaa minwaa gaa bi aankoosejig zhinda akiing minwaa gii-miigwewaad Kichi-Kinoomaagegamigoong aanji-daapinanigaade minwaa mshkowenjigaade.

The University of Michigan is located on the traditional territory of the Anishinaabe people. In 1817, the Ojibwe, Odawa, and Bodewadami Nations made the largest single land donation to the University of Michigan, offered ceremonially as a gift in the text of the Treaty at the Foot of the Rapids so that their children could be educated. Through these words of acknowledgment, their contemporary and ancestral ties to the land and their contributions to the University are renewed and reaffirmed.

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Thank you to the department of Health Behavior and Health Education at the University of Michigan School of Public Health and the Rackham Faculty Allies for Diversity program for financial support that helped bring Dr. Gonzales to our communities.

About the Authors

Kelly Gonzales is a citizen of the Cherokee Nation of Oklahoma, Associate Professor in the Oregon Health Science University-Portland State University joint School of Public Health, and the first Native American to receive tenure in the OHSU-PSU School of Public Health. Her research focuses on discrimination, stereotype threat, and colonialism. She considers the role of Indigenous values as protective factors to promote health care engagement and reproductive and diabetes-related health outcomes. As an educator, she teaches public health through Indigenous and decolonizing perspectives to address gaps in curriculum and training to prepare the future public health workforce.

Jillene Joseph is an enrolled member of the Gros Ventre (or Aaniiih) people from Fort Belknap, Montana, and is executive director of the Native Wellness Institute. She holds a bachelor of science degree in Community Health Education and has served American Indian populations for more than 30 years. Whether she is providing youth leadership training, assisting women heal from childhood trauma, or helping to bring wellness to the workplace, Joseph shares her passion for being positive, productive, and proactive.

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