Addictions are prominent among indigenous people in North America in relation to historical and contemporary trauma.

We describe the approach emerging in our services for the five indigenous tribes of Maine (the Wabanaki Confederacy) for culturally sensitive treatment of opiate use disorder.

In our auto-ethnographic approach, we introduce or re-introduce participants to cultural beliefs, values, and methods for treating addictions, inclusive of narrative methods (storytelling) which receive greater acceptance by indigenous and marginalized peoples. Indigenous philosophy states that we see the world using the stories that we have absorbed or constructed to explain our perceptions. Using substances is a story that is connected to poverty and adverse childhood events. We create new stories to develop a sense of agency, the sense that one’s actions can make a difference in one’s life.

We present the lessons learned and the results of our using this approach with a tribal population in Maine. Some key concepts include (1) reframing the person’s self-story about being addicted within a threat-power-meaning network, (2) working with stories about the spirit of the addiction and the consequences of ingesting spirit-laden substances without knowing their songs and protocols, (3) constructing future-self-narratives that explore right relationships and meaningful conduct, (4) constructing stories about the intergenerational transmission of addictions and exploring the question of “whom will be the recipient of your addiction?”

We come to understand that the client sets their goals and defines what recovery means for them, which is the heart of a harm reduction approach.

No significant relationships.

How traditional cultural healing works is difficult for biomedical science to understand. Outcomes do occur that defy the conventional logic of materialistic, reductionistic cause-and-effect.

We aimed to understand how participants understood what happens in traditional cultural healing.

We identified 26 cases of results in which improvement occurred beyond what biomedicine would expect from a placebo response. We interviewed the healers and their clients to understand their experience and how they saw what had happened.

Seven cases involved resolution of cancer; 2 cases, musculoskeletal disorders; 9 cases of rheumatological disorders; 8, other disorders. Each person spoke about the importance of spiritual transformation and described such an experience. They spoke about an attitude of the cultural healer that involved what could best be translated as radical empathy coupled with non-judgmental listening without interpretation. Many of healers had been initiated into their healing roles via a life-threatening illness that resolved when an extra-ordinary being(s) (a spirit or god, or God) entered their life world and became an integral part of their being. This was also a common description given by the participants for what had happened. The healers often described themselves as a hollow bone, a conduit through which spiritual forces flow.

Traditional cultural healing remains important to psychiatry because it defies explanation in our usual paradigm. Spiritual transformation and radical empathy may be necessary, though not sufficient components. For the person who undergoes a profound spiritual transformation, extensive changes in self and world view may occur.

No significant relationships.