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Are there any theories about what health problems would a man of the past suffer in the current age?

Are there any theories about what health problems would a man of the past suffer in the current age?

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Thinking about the problems which the natives of the Americas suffered when they met the Europeans, I wondered how a man of the past could survive in the modern age. Problems could be caused by pollution, different viruses/bacteria, different food (I wouldn't consider social/mental problems, only physical ones).

Of course we can't know it for sure, due to obvious lack of specimens, what I'm asking if there has been any well-thought theory about that, educated guesses, anything based of facts we know and what we can safely assume.

The "past" is left vague on purpose: as long as it's at least 100-200 years old it would be fine - though I can safely guess people from before the Industrial age would suffer much more than those who came after.

Although I think this question seems to be out of scope of this group, I'd try to answer to make it more fit.

If you are interested in genealogy, and ever had created your family tree, you should have noticed that your ancestor had more children than we do (at least in Western culture). Having 10 children was nothing unusual. If you look deeper, you will notice many of them died being infants, so not so many survived to their adulthood.

Of course the reason is poor condition of past medicine. The development allowed us to live longer, healthier (not only medicine counts, but eg. washing your hands before eating), and thus happier (also because it's easier to get a car or brand-new smartphone).

However, the theory of evolution (in simple) says that the weaker organisms shall die, while stronger will survive and multiply. The theory says it's not good to say "weaker/stronger" or "worse/better". The organism that fits better its environment, is better, but we can't say a crocodile is worse than an elephant only because an elephant is a mammal. They are equal, because they live. If a crocodile is not fast enough to hunt an antelope, it will starve to death. If an antelope is not fast enough to escape, it will be eaten. If they die, they won't multiply and bad genotype will be lost.

The same applies to humans, of course. We could harness the nature using weapons (against bigger animals), tools (against flora) and medicine (against smaller organisms like bacteria or parasites).

The development of religion and ethics made us think that human life is always worth to protect.

This is of course against the evolution theory which says that only good organism "is" protected and the worse should be (I'm sorry) eliminated. The development of medicine made us weaker than people from the past, because bad genotypes were stored because we've invented penicillin, we managed to fight some diseases.

We are less immune if compared not to all people from the past, but to all from the past who managed to reach their adulthood and have children. Probably, statistically, if we take all people who lived then (also those who died young) and compare with all living now, we are healthier. But shouldn't we compare only those who survived?

The development of antibiotics allowed to kill many bacteria, but those which survived, are stronger. They need to be killed with stronger antibiotics, but this also weakens us.

You may also notice, when talking with older people, that they managed to live in stronger climate (eg. colder winters), and they are doing pretty well now, while we have civilization diseases like allergies. We are not able to climb a mountain that 80 yo. person travels twice a day.


Read this article, this one, this one, or this one (I understand some of them are popular science and should not be considered as a scientific source). Maybe you'll google more articles on the same topic.

So answering your question: there are many theories leading to a conclusion, that men from past would manage to live in our times better than we do.

I cannot provide adequate evidence to prove, but I think that any problems that might result from transportation from the germ infested past to the relatively sterile modern environment would be overwhelmed by improvements in medical techniques.

  • While there are different modern pathogens, and almost every modern pathogen has evolved to defeat our ancestor's immune systems, access to antibiotics and modern medical care that isn't based on humors or planetary alignments would significantly improve outcomes. Heck, just eliminating the use of mercury as a tonic would create vastly better outcomes. OP constrains the time traveller to be more than 100 years ago; during that time the overwhelming majority of humans shifted from rural to urban life. Statistically speaking this will be worse for our time traveller, since cities require more sophisticated immune systems.

  • Different food would include unimaginable access to a variety and diversity of foods and nutrition. The advent of refrigeration, canning and unimaginable improvements in food transport technology have drive the cost/calorie of diverse nutritious food to rock bottom levels. Food diversity correlates with better outcomes.

  • Pollution wouldn't be a problem; air and water are cleaner and better than they were in Victorian London. Smoke and smog in Victorian London were so bad as to obscure the sun and render it impossible to wear white clothing (all clothing was black within 30 minutes of exposure to external air).

  • Dentistry - So very much better now.

  • OP specified that the time traveller was a man. If we assume that the traveller was female, the situation has some more positive indicators. Today maternal mortality is 15/100,000. 100 years ago that was 600/100,000; go back another hundred years and the rate is 1200/100,000.

I'm posting without sources and I shall endure the deserved downvotes

Prostate Enlargement (Benign Prostatic Hyperplasia)

Benign prostatic hyperplasia—also called BPH—is a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction.

The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. Benign prostatic hyperplasia often occurs with the second growth phase.

As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder completely—cause many of the problems associated with benign prostatic hyperplasia.

What are some common signs of ASD?

Even as infants, children with ASD may seem different, especially when compared to other children their own age. They may become overly focused on certain objects, rarely make eye contact, and fail to engage in typical babbling with their parents. In other cases, children may develop normally until the second or even third year of life, but then start to withdraw and become indifferent to social engagement.

The severity of ASD can vary greatly and is based on the degree to which social communication, insistence of sameness of activities and surroundings, and repetitive patterns of behavior affect the daily functioning of the individual.

Social impairment and communication difficulties
Many people with ASD find social interactions difficult. The mutual give-and-take nature of typical communication and interaction is often particularly challenging. Children with ASD may fail to respond to their names, avoid eye contact with other people, and only interact with others to achieve specific goals. Often children with ASD do not understand how to play or engage with other children and may prefer to be alone. People with ASD may find it difficult to understand other people&rsquos feelings or talk about their own feelings.

People with ASD may have very different verbal abilities ranging from no speech at all to speech that is fluent, but awkward and inappropriate. Some children with ASD may have delayed speech and language skills, may repeat phrases, and give unrelated answers to questions. In addition, people with ASD can have a hard time using and understanding non-verbal cues such as gestures, body language, or tone of voice. For example, young children with ASD might not understand what it means to wave goodbye. People with ASD may also speak in flat, robot-like or a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Repetitive and characteristic behaviors
Many children with ASD engage in repetitive movements or unusual behaviors such as flapping their arms, rocking from side to side, or twirling. They may become preoccupied with parts of objects like the wheels on a toy truck. Children may also become obsessively interested in a particular topic such as airplanes or memorizing train schedules. Many people with ASD seem to thrive so much on routine that changes to the daily patterns of life &mdash like an unexpected stop on the way home from school &mdash can be very challenging. Some children may even get angry or have emotional outbursts, especially when placed in a new or overly stimulating environment.

Perspective about today’s older adults

Many assume that older adults are all alike. However, as this age group includes five decades of individuals, the differences among older adults are great — actually greater than those seen in other age groups.

  • Whereas today, most older adults are White, a dramatic transformation will occur within the next two decades, resulting in a population that is more culturally diverse.
  • Between 2010 and 2030, the White population 65+ is projected to increase by 59 percent, compared with 160 percent for older minorities. Older Latinos will account for the largest increase: In 2030, they will constitute 22 percent of the older population, compared to 8 percent of today’s older adults. The population of older immigrants in the U.S. has increased by 70 percent in the last 20 years, from 2.7 million to 4.6 million.
  • For most older adults, age-associated changes in cognition (thinking) are mild and do not significantly interfere with daily functioning.
  • Older adults are capable of learning new skills even late in life, though learning may take longer than for younger adults.
  • Short-term memory shows noticeable changes with age, but long-term memory declines less with age.
  • Some changes in cognition are normal with age, such as slower reaction times and reduced problem-solving abilities. The speed with which information is encoded, stored, and retrieved also slows as we age. However, many older adults outperform their younger counterparts on intelligence tests that draw on accumulated knowledge and experience.
  • Wisdom and creativity often continue to the very end of life.
  • Personality traits remain relatively stable over time. For example, people who were outgoing during young adulthood are likely to be outgoing in later life.
  • Most older adults report good mental health and have fewer mental health problems than other age groups. However, one in four older adults experiences a mental health problem such as depression, anxiety, schizophrenia or dementia.
  • The suicide rate for men over 85 is higher than that of any other age group.
  • The number of older adults with substance abuse problems is expected to double to five million by 2020.
  • Dementia (including Alzheimer’s disease, the most common type of dementia) is not a normal part of aging. Approximately 5 percent of individuals between 71 and 79 and 37 percent of the population above age 90, are affected.
  • As they age, people are generally more satisfied with their lives and more optimistic about growing older.

A number of physical changes and health issues are more common as we age. However, just as all older adults are not the same, their health status also varies. Many are active and healthy, whereas others are frail, with multiple health conditions.

  • Approximately 92 percent of older adults have at least one chronic condition, and 77 percent have two or more.
  • Four chronic conditions — heart disease, cancer, stroke, and diabetes — cause almost two thirds of all deaths among individuals 65 and older each year.
  • People 55 and older account for over a quarter of all Americans diagnosed with HIV, and this number is increasing.
  • Hearing impairment among older adults is often mild or moderate, yet it is widespread almost 25 percent of adults aged 65–74 and 50 percent aged 75 and older have hearing impairment that is often isolating.
  • Visual changes among aging adults result in such problems as slower reading speed and difficulty reading small print and in dim light, as well as difficulty driving at night.
  • The proportion of older adults needing assistance with everyday activities increases with age. Fewer than one fifth of older adults between ages 65 and 74 need assistance with activities of daily living, such as bathing or eating. This increases to 40 percent of men and 53 percent of women over 85 who need such assistance.
  • Older ethnic and racial minorities have a higher prevalence of obesity, diabetes and hypertension, as well as an earlier onset of chronic illness, than White older adults. Some of the factors contributing to this disparity are poverty, segregated communities with fewer health-promoting resources, poor education, unemployment, discrimination and less access to quality health care.
  • In spite of these mental and physical health issues, two thirds of older adults who are not living in long-term care settings report their health to be good, very good or excellent compared to others their age.


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These factors mentioned are mostly unconnected with statistics. For example, how many men actually die from accidents, hazardous jobs, wars, etc., in contrast to women? The only factor connected to statistics is the factor of heart disease, but even that doesn’t tell me how much I can improve my odds by adopting healthier practices. Such statistics would be quite helpful in telling me how to set priorities in terms of taking preventive measures. For instance, if 95% of the difference in longevity is due to higher incidence of heart disease, then I know I should focus most of my energies on that, and not worry so much about not going to the doctor.

While that info maybe available, and at the same time I wish things were that straight forward myself. As one who worked as a scientist I have rarely found anything regarding human behavior to be simple.

To make statements that are backed by science you must study the change of one variable at a time, however, human behaviors and the motivation behind them, especially ones that effect longevity, are far too complex to study one variable at a time.

While science tries to come as close as possible to ruling out other variables and there are brilliant strategies applied to do just that, human behavior is just too complex to actually limit most studies to one variable and that create problems with saying things with certainty.

The fact is the more complex the topic of study, the more complex saying anything definitive gets and thus the more caveats a true answer requires. This is why you should be sceptical when you hear definitive statements made that are more than general guidelines when it concerns human behavior. Often there is really no way to present data to the general public in a straight forward helpful way with out keeping it simple. This is not because scientists believe the public is less intelligent but the answers are often complex even to the expert.

Unless you address the issues were more than one variable is involved, the caveats, you would over simplifying the truth. Even my attempt to explain the limits of making more than broad general statements or general conclusions in the face of studying a subject that defies the constraint of a single variable is starting to feel too complex.

You often hear a scientist say after a big discovery that “for every question we answered we found many more questions to ask.” These questions have to do with the caveats, which are when multiple variables are at play. When this is the case cause and effect are truly unknown. One variable like men not seeking medical help is compounded by a second variable like the genetic of boys having an XY chromosome and girls having a XX chromosome. Just think how the complexity would grow more and more unwieldy as the number of variables at play increase and you suddenly see why scientists struggle to make more than general conclusions in a short news article. Saying or implying more from a study without explaining the caveats or cases where more things are at play and explaining the limitations of a study is considered both unethical as well as unscientific.

All this to say while I and most other scientists hope studies come out with info presented in ways that are directly applicable to people’s lives and presented in ways that are easier to make decisions like you requested, there are often real scientific and ethical reasons why they do not.


The aim of this study was to ascertain the beliefs and perception about mental health issues prevailing among different populations and cultures, published in different qualitative studies. Synthesizing all those findings of selected articles, the results are presented in the four main categories: 1) symptoms of mental health issues, 2) description of mental health issues, 3) perceived causes, and 4) preferred treatment and help-seeking behavior. These categories are formed considering the repetition of similar themes discussed across different studies. Symptoms of mental health issues are perceived in terms of mood and behavior and discussed largely by the participants. Viewing mental health issues in terms of symptomatology is in harmony with the dual factor model as participants of various studies discussed distinct behavioral and mood symptoms for mental illness. 60 Mood shifts and disturbing emotional conflicts were discussed as important symptoms of mental health issues. Studies revealed implying behavioral and mood-related symptoms such as irrelevant talk, inappropriate behavior, self-talk, crying and sadness, low mood, anger, and lack of attention and concentration symptoms. 15 , 40 , 49 This can be related with symptoms of mood disorders and common mental disorders of depression, anxiety, and some of the negative symptoms of psychotic disorders. 61 Therefore, the emerged theme is in harmony with the dual factor model aspects as various studies have brought forth distinct behavioral and mood symptoms as a result of mental illnesses.

Normalization, stress, and trauma are described by participants in different studies and considered as another theme in this review. Psychosocial stress is seen as among the most severe health problems in the 21st century. 62 Previous studies assessed the positive relationship between stress and mental illnesses. 63 – 65 An increase in the number of mental illnesses owing to psychosocial stressors has been reported. 66 , 67 Researchers have put forth psychosocial models to elaborate how psychological mechanisms and stress influence mental health. 68 – 70 It has also been highlighted that personal resources of an individual either avert or exacerbate mental illness through two mechanisms, either through direct activation of coping mechanisms of an individual or through interactively shielding against stress. 71 , 72 This is a common belief found among different people from different walks of life and is also implied by the psychosocial model of disease that views stress and trauma-related stress as significant factors in the development of mental health problems. 73 Therefore, the present findings are supported by existing literature on psychosocial models of stress and distress, which propose that psychological mechanism plays a vital role in mental health of an individual.

This study also described the treatment options and causes that participants in different studies discussed in terms of mental health problems. Generally, it is worth mentioning here that the pattern found in the causes and treatment is consistent with the approach participants adopted. It means that some participants believed in scientific causes and treatments, while it varies from person to person and among different groups and cultures. It must also be mentioned here that the treatment approach and causes of mental illness adopted by participants were in harmony with the group they belonged to or the culture they lived in. Some participants discussed psychological and psychiatric treatment as their preferred choice for mental health problems so we can ascertain that they are following a scientific approach to mental health problems. However, there are studies 53 , 56 , 61 , 65 , 73 discussing supernatural causes as well as consulting faith healers, religious scholars, and/or spiritual healers for treatment of mental health issues, as participants believed in the supernatural and spiritual etiology for mental disorders and problems. The beliefs related with supernatural causes of mental illnesses and opting related modes of treatment were prevalent across respective cultures. Such perceptions of participants are consistent with Vygotsky’s sociocultural theory, 20 which proposes that culture not only shapes the behavior of individuals but also modifies their behavior to adapt in a certain culture. These findings are well related with the spiritual model of illness causation, 74 which refers to the spiritual etiology of mental health problems and the same treatment discussed under the spiritual treatment theme of our study.

Another important theme among the findings of the published studies is the role of social support and significant others, that is, family members and friends. Participants from different studies discussed the importance of social support for overcoming the mental health problems. 2 , 5 , 40 , 41 , 52 This is in harmony with relationship perspective of social support that proposes how social support influences health and how relationship processes influence an individual, it is interrelated effects of social support on health as well as relationship processes co-occur. 75

The current synthesis study is helpful for clinicians devising management plans for patients with mental health problems as it focuses on the beliefs that are most commonly present in different cultures, thus giving insight to psychotherapists to better plan their interventional plans for patients. Also the recommendations based on the findings could be forwarded to policymakers to devise some policies for awareness-raising campaigns among the general population, as well as in health and educational settings.

Overall, different qualitative studies focused and discussed varying causes, description, and treatment options reflecting different help-seeking behaviors. Based on the findings of this study, we can conclude that mental health beliefs and perceptions vary from culture to culture, but there do exist some similar beliefs and perceptions about the descriptions and causes of mental health problems. Some studies focused on mental health perceptions and variation within the concept of mental health and mental well-being as two distinct concepts and also discussed stigma associated with seeking help for mental health. 40 As in this study, the population was medical students and other students, so we can ascertain that they were a conscious population and cognizant of mental health-related scientific information. Similarly, where the population is general adults such as the one in Vietnam, the findings described symptoms corresponding to those mentioned in the Diagnostic and Statistical Manual for Mental Disorders, and most of the participants not only discussed the priority of medical treatment but also emphasized traditional concepts by few participants. So overall, there were mixed views ranging from medical treatment through to the family’s role and traditional values and also some ignorance regarding adequate information. 2 Again we can see these mixed views as varying perceptions among the lay population about mental health beliefs, and these views are related with behavioral descriptions discussed in psychological theories.

There are differences observed if we look at studies focusing on African-Americans, Bhutanese, Burmese, Ethiopians, Somalians, and Pakistanis. The cultural differences highlighted in a few studies concluded that participants seek mental health help as a last resort and found a stigma associated with treatment and some myth-related beliefs of mental health perception and treatment. Studies such as this provide the grounds to work on awareness-raising regarding mental health perceptions where myths are believed rather than scientific explanations. Likewise, in some other studies, 41 , 42 , 44 , 47 , 51 despite the discussions of psychosocial and medical causes, spiritual phenomenon and supernatural causes are believed to be the major causes of mental health problems, and similar remedies were recommended.

Considering differing concepts ranging from disease and medical model to social issues and spiritual beliefs, there are mixed kinds of beliefs in almost every study. This study has some implications for mental health practitioners as it gives a broader picture of mental health perceived causes. The practitioners can devise management plans considering these varying beliefs, and to enhance awareness, some massive campaigns could be initiated especially for marginalized and ignored populations as well as for general public to develop insight regarding scientific, medical, and psychosocial causes and treatment.

Chapter 9

African Americans have more multigenerational families than white American families, and grandparents play a role in childrearing.

African American males suffer a higher level of unemployment and therefore have more time for family matters and childrearing.

African Americans have larger families and more grandchildren.

vary based on social and psychological factors

vary with lifestyle changes

appear stable across adulthood

Age-related macular degeneration

The space between the brain and skull triples between 20 and 70 years of age.

Blood flow is increased in the brain.

The brain becomes smaller and lighter.

Legal actions and lawsuits for firing the elderly

The elderly going back to school for additional skills

Retirement of baby boomers, shrinking the workforce

The speed at which the elderly process information is slower and perhaps contributes to slow reaction times in retrieving memories.

People in late adulthood have a different ability for inhibiting irrelevant information and thoughts that interfere with learning and recalling memorized information.

The elderly suffer neuron loss that inhibits their ability to hold and retrieve information.

Examining the Theory of Historical Trauma Among Native Americans

The theory of historical trauma was developed to explain the current problems facing many Native Americans. This theory purports that some Native Americans are experiencing historical loss symptoms (e.g., depression, substance dependence, diabetes, dysfunctional parenting, unemployment) as a result of the cross-generational transmission of trauma from historical losses (e.g., loss of population, land, and culture). However, there has been skepticism by mental health professionals about the validity of this concept. The purpose of this article is to systematically examine the theoretical underpinnings of historical trauma among Native Americans. The author seeks to add clarity to this theory to assist professional counselors in understanding how traumas that occurred decades ago continue to impact Native American clients today.

Keywords: historical trauma, Native Americans, American Indian, historical losses, cross-generational trauma, historical loss symptoms

Compared with all other racial groups, non-Hispanic Native American adults are at greater risk of experiencing feelings of psychological distress and more likely to have poorer overall physical and mental health and unmet medical and psychological needs (Barnes, Adams, & Powell-Griner, 2010). Suicide rates for Native American adults and youth are higher than the national average, with suicide being the second leading cause of death for Native Americans from 10–34 years of age (Centers for Disease Control and Prevention [CDC], 2007). Given that there are approximately 566 federally recognized tribes located in 35 states, and 60% of Native Americans in the United States reside in urban areas (Indian Health Services, 2009), there is much diversity within the Native American population. Therefore, it is difficult to make overall generalizations regarding this population (Gone, 2009), and it is important to not stereotype all Native American people. Still, Native American individuals are reported as having the lowest income, least education, and highest poverty level of any group—minority or majority—in the United States (Denny, Holtzman, Goins, & Croft, 2005) and the lowest life expectancy of any other population in the United States (CDC, 2010).

To explain why some Native American individuals are subjected to substantial difficulties, Brave Heart and Debruyn (1998) utilized the literature on Jewish Holocaust survivors and their decedents and pioneered the concept of historical trauma. The current problems facing the Native American people may be the result of “a legacy of chronic trauma and unresolved grief across generations” enacted on them by the European dominant culture (Brave Heart & DeBruyn, 1998, p. 60). The primary feature of historical trauma is that the trauma is transferred to subsequent generations through biological, psychological, environmental, and social means, resulting in a cross-generational cycle of trauma (Sotero, 2006). The theory of historical trauma has been considered clinically applicable to Native American individuals by counselors, psychologists, and psychiatrists (Brave Heart, Chase, Elkins, & Altschul, 2011 Goodkind, LaNoue, Lee, Freeland, & Freund, 2012 Myhra, 2011). However, there has been uncertainty about the validity of this theory due to the ambiguity of some of the concepts with little empirical evidence (Evans-Campbell, 2008 Gone, 2009). Specifically, there has been a lack of research about how the past atrocities suffered by the Native American people are connected with the current problems in the Native American community. The intent of this article is to examine the theoretical framework of historical trauma and apply recent research regarding the impact of trauma on an individual’s physiological functioning and cross-generational transmission of trauma. Through this analysis, the author seeks to assist professional counselors in their clinical practice and future research.

Core Concepts of Historical Trauma

Sotero (2006) provided a conceptual framework of historical trauma that includes three successive phases. The first phase entails the dominant culture perpetrating mass traumas on a population, resulting in cultural, familial, societal and economic devastation for the population. The second phase occurs when the original generation of the population responds to the trauma showing biological, societal and psychological symptoms. The final phase is when the initial responses to trauma are conveyed to successive generations through environmental and psychological factors, and prejudice and discrimination. Based on the theory, Native Americans were subjected to traumas that are defined in specific historical losses of population, land, family and culture. These traumas resulted in historical loss symptoms related to social-environmental and psychological functioning that continue today (Whitbeck, Adams, Hoyt, & Chen, 2004).

Historical Losses

For the last 500 years, individuals from the dominant European cultures have engaged in behaviors that have resulted in the purposeful and systematic destruction of the Native American people (Plous, 2003). Native Americans have been subjected to traumas that have resulted in specific historical losses. These losses include loss of people, loss of land, and loss of family and culture (Brave Heart & Debruyn, 1998 Garrett & Pichette, 2000 Whitbeck et al., 2004).

The population of Native Americans in North America decreased by 95% from the time Columbus came to America in 1492 and the establishment of the United States in 1776 (Plous, 2003). This decline can be explained by two main factors: the intentional killing of Native Americans and the exposure of Native Americans to European diseases (Trusty, Looby, & Sandhu, 2002). The majority of the Native American population died due to its lack of resistance to “diseases such as smallpox, diphtheria, measles, and cholera” that Europeans brought to North America (Trusty et al., 2002, p. 7). While some of the exposure to these illnesses was unintentional on the part of the Europeans, it has been documented that many times the Native American people were purposely subjected to these diseases. In 1763, for instance, Lord Jeffrey Amherst ordered his subordinates to introduce smallpox to the Native American people through blankets offered to them (Plous, 2003).

This loss of population further impacted the Native American community due to the lack of public acknowledgment of these deaths by the dominant culture and the denial of Native Americans to properly mourn their losses. Mourning practices were disrupted when an 1883 federal law prohibited Native Americans from practicing traditional ceremonies (Brave Heart, Chase, Elkins, & Altschul, 2011). This law remained in effect until 1978, when the American Indian Religious Freedom Act was enacted. This disenfranchised grief has resulted in the Native American people not being able to display traditional grief practices (Brave Heart et al., 2011 Sotero, 2006). As a result, subsequent generations have been left with feelings of shame, powerlessness and subordination (Brave Heart & DeBruyn, 1998).

The taking of Native American lands was a primary agenda for the majority of the United States government officials in the 19th century (Duran, 2006 Sue & Sue, 2012). President Andrew Jackson approved the Indian Removal Act of 1830, initiating the use of treaties in exchange for Native American land east of the Mississippi River and forcing the relocation of as many as 100,000 Native Americans (Plous, 2003). The motivation for the confiscation of the lands was often driven by economics (e.g., Fort Laramie Treaty of 1868 Trusty et al., 2002). By 1876, the U.S. government had obtained the majority of Native American land and the Native American people were forced to either live on reservations or relocate to urban areas (Brave Heart & Debruyn, 1998 Trusty et al., 2002). Reservations, for the most part, were not the best lands for agriculture and hunting. Further, being relocated to urban areas removed Native American people from all the lives they were familiar with. Leaving their domestic lands led to a decline in socioeconomic status as Native American men were not able to provide for their families, and the families became dependent on goods provided by the U.S. government (Brave Heart & Debruyn, 1998). These relocations resulted in the death of thousands of Native Americans and the disruption of families.

The agenda throughout the majority of history by U.S. government agencies, churches, and other organizations was to encroach on the Native American population and lands, leading to a disruption to the Native American culture for the preponderance of the Native population (Brave Heart & DeBruyn, 1998 Garrett & Pichette, 2000). Principally, the intent was to force the Native American people to fully assimilate to the dominant European-American culture and completely abandon their own culture. In 1871 the U.S. congress declared Native Americans wards of the U.S. government, and the U.S. government’s goal became to civilize Native Americans and assimilate them to the dominant White culture (Trusty et al., 2002). Government and church-run boarding schools would take Native American children from their families at the age of 4 or 5 and not allow any contact with their Native American relations for a minimum of 8 years (Brave Heart & Debruyn, 1998 Garrett & Pichette, 2000). In the boarding schools, Native American children had their hair cut and were dressed like European American children additionally, all sacred items were taken from them and they were forbidden to use their Native language or practice traditional rituals and religions (Brave Heart & Debruyn, 1998 Garrett & Pichette, 2000). Many children were abused physically and sexually and developed a variety of problematic coping strategies (e.g., learned helplessness, manipulative tendencies, compulsive gambling, alcohol and drug use, suicide, denial, and scapegoating other Native American children) (Brave Heart & Debruyn, 1998 Garrett & Pichette, 2000). Such circumstances led many Native Americans to not engage in traditional ways and religious practices, which led to a loss of ethnic identity (Garrett & Pichette, 2000). The removal of children from their families is considered one of the most devastating traumas that occurred to the Native American people because it resulted in the disruption of the family structure, forced assimilation of children, and a disruption in the Native American community. This situation is considered the crucial precursor to many of the existing problems for some Native Americans (Brave Heart & Debruyn, 1998 Duran & Duran, 1995).

Historical Loss Symptoms

The second core concept of the theory of historical trauma relates to the current social-environmental, psychological and physiological distress in Native American communities, in that these difficulties are a direct result of the historical losses this population has suffered. Specifically, these traumatic historical losses result in historical loss symptoms.

Societal-environmental concerns.Domestic violence and physical and sexual assault are three-and-a-half times higher than the national average in Native American communities however, this number may be low, as many assaults are not reported (Sue & Sue, 2012). Cole (2006) proposed that the breakdown in Native American families due to the forced removal of Native American children can be seen as the reason for the high number of child abuse and domestic violence incidents reported in these families. Additionally, Native American children are one of the most overrepresented groups in the care of child protective services (Hill, 2008). Further, fewer Native Americans have a high school education than the total U.S. population an even smaller percentage has obtained a bachelor’s degree: 11% compared with 24% of the total population. Almost 26% of Native Americans live in poverty compared to 12% for the entire U.S. population (U.S. Census Bureau, 2006). Native Americans residing on reservations have double the unemployment rate compared to the rest of the U.S. population (U.S. Census Bureau, 2006).

Psychological concerns.Native Americans have the highest weekly alcohol consumption of any ethnic group (Chartier & Caetano, 2010). Native American adults reported that in the last 30 days, 44% used alcohol, 31% engaged in binge drinking, and 11% used an illicit drug (National Survey on Drug Use and Health, 2010). Many Native American adolescents have co-occurring disorders related to substance abuse and mental health disorders (Abbott, 2006). Abuse of alcohol by Native individuals may be related to low self-esteem, loss of cultural identity, lack of positive role models, history of abuse and neglect, self-medication due to feelings of hopelessness, and loss of family and tribal connections (Sue & Sue, 2012).

Statistics indicate that a proportionally high level of Native Americans have mood disorders and posttraumatic stress disorder (PTSD CDC, 2007 Dickerson & Johnson, 2012). Suicide rates among Native Americans are 3.2 times higher than the national average (CDC, 2007). For males ages 15–19, Native American suicide rates were 32.7 per 100,000, compared to non-Hispanic White (14.2), Black (7.4), Hispanic (9.9), and Asian or Pacific Islander (8.5) [CDC, 2007]. Studies have shown family disruptions and loss of ethnic identity places Native American adolescents at higher risk for alcoholism, depression and suicide (May, Van Winkle, Williams, McFeeley, DeBruyn, & Serma, 2002). It has been found that an increase in the number of suicides corresponds to a lack of linkage between the adolescents and their cultural past and their ability to relate their past to their current situation and the future (Chandler, Lalonde, Sokol, & Hallet, 2003).

Physiological concerns. The life expectancy at birth for the Native American population is 2.4 years less than that of all U.S. populations combined (CDC, 2010). Further, Native American individuals are overrepresented in the areas of heart disease, tuberculosis, sexually transmitted diseases, and injuries with, diabetes being more prevalent with this population than any other racial or ethnic group in the United States (Barnes et al., 2010). Only 28% of Native Americans under the age of 65 have health insurance (CDC, 2010).

The majority (60%) of Native Americans receive behavioral and medical health services from Indian Health Services (IHS, 2013a). IHS was established and funded by the U.S. government in 1955 to uphold treaty obligations to provide healthcare services to members of federally recognized Native American tribes (Jones, 2006). Three branches of service exist within IHS: (a) an independent, federally operated direct care system, (b) tribal operated health care services, and (c) urban Indian health care services (Sequist, Cullen, & Acton, 2011). However, according to the IHS (2009), the Native American people “have long experienced lower health status when compared with other Americans.” This is substantiated by the IHS (2013a) report that $2,741 is spent per IHS recipient in comparison to $7,239 for the general population of that, less than 10% of these funds were utilized for mental health and substance abuse treatment in 2010 even though the rates of mental health and substance abuse issues are prominent. This disparity in medical and behavioral health services is due to “inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences” (IHS, 2013b). Further, Barnes and colleagues (2010) reported that the inequality may not only be related to the above factors, but epigenetic and behavioral influences. There may be environmental factors that alter the way genes are expressed (Francis, 2009) and behavioral patterns that further negatively influence the situation. In order to gain a better understanding of relationship epigenetic component, it is important to recognize how trauma impacts a person’s physical as well as mental functioning.

The Impact of Trauma on Physiological Functioning

“Traumatic experiences cause traumatic stress, which disrupts homeostasis” in the body (Solomon & Heide, 2005, p. 52). People who have experienced traumatic events have higher rates than the general population for cardiovascular disease, diabetes, cancer and gastrointestinal disorders (Kendall-Tackett, 2009). Specifically, trauma affects the functioning of the sympathetic nervous system and the endocrine system (Solomon & Heide, 2005). When the body is experiencing stress, it needs oxygen and glucose in order to fight or flee from the perceived danger. The brain then sends a message to the adrenal glands telling, them to release epinephrine (Kendall-Tackett, 2009). Epinephrine increases the amount of sugar in the blood stream, increases the heart rate and raises blood pressure. The brain also sends a signal to the pituitary gland to stimulate the adrenal cortex to produce cortisol that keeps the blood sugar high in order to give the body energy to be able to escape the stressor (Solomon & Heide, 2005). This physiological response to stress is created for a short-term remedy. Additionally, it has been found that in people who have experienced a prior trauma, their bodies react quicker to new stressors and thus cortisol and epinephrine are released at a faster rate (Kendall-Tackett, 2009).

Amygdala and Hypothalamic-Pituitary-Adrenal Axis

Experiencing trauma can impact a person’s neurological functioning. After a traumatic event, many people have an overactive amygdala (Brohawn, Offringa, Pfaff, Hughes, & Shin, 2010). This hyperactivation of the amygdala “may be responsible for symptoms of hyperarousal in PTSD, including exaggerated startle responses, irritability, anger outbursts, and general hypervigilance,” and may be the reason for a person re-experiencing the event due to a trauma reminder (Weiss, 2007, p. 116). After the original trauma takes place, any perceived external threat that reminds the body of the original trauma (e.g., sound, face, smell, gesture) will cause the body, through the amygdala, to automatically respond to the perceived threat by producing epinephrine and cortisol (Weiss, 2007). This biological response happens without the person consciously being aware of it. It has been found that “emotionally arousing stimuli are generally better remembered than emotionally neutral stimuli, and the amygdala is responsible for this emotional memory enhancement” (Koenigs & Grafman, 2009, p. 546). The amygdala is responsible for giving emotional meaning to the external stimuli however, the hippocampus provides contextual meaning to the stimuli (Brohawn et al., 2010).

Ganzel, Casey, Glover, Voss, and Temple (2007) examined whether trauma exposure has long-term effects on the brain and behavior in healthy individuals. These researchers compared a group of people who lived within 1.5 miles of the World Trade Center on 9/11 (Ground Zero) and a group of people who lived 200 miles away from Ground Zero. More than three years after the events of 9/11, both groups were shown pictures of fearful and calm faces the amygdala activation of the group members was measured utilizing functional Magnetic Resonance Imaging (fMRI Ganzel et al., 2007). The results indicated that the group that resided closer to Ground Zero had heightened amygdala reactivity when shown images of people in fear.

In another study, researchers utilized fMRI to examine amygdala and hippocampus activation in 18 trauma-exposed non-PTSD control subjects and 18 individuals with PTSD (Brohawn et al., 2010). The results of this study indicated that there was hyperactive amygdala activation when negative emotional stimuli were introduced to the PTSD group. Additionally, when a person is exposed to traumatic events during development, the hypothalamic-pituitary-adrenal (HPA) axis can be altered, which may increase susceptibility to disease, including PTSD and other mood and anxiety disorders (Gillespie, Phifer, Bradley, & Ressler, 2009). The HPA axis is the part of the neuroendocrine system that controls reactions to stress as well as regulates digestion, the immune system, mood and emotions, and sexuality. This overactivation of the amygdala and HPA axis due to re-experiencing the initial trauma sends the message to the adrenal glands to release epinephrine and cortisol (Kendall-Tackett, 2009 Solomon & Heide, 2005). Current research has shown that the continual release of cortisol due to exposure to recurrent stressors, particularly during development, can cause the HPA axis to shutdown, which results in low cortisol levels (Neigh, Gillespie, & Nemeroff, 2009). Therefore, chronic exposure to stressors can relate to either a hypo- or hyper-stress response in the HPA axis.

This impact on the HPA axis functioning may explain why researchers have found a relationship between PTSD and physical illnesses. Weisberg et al. (2003) performed a study of 502 adults 17% had no history of trauma, 46% had a history of trauma but no PTSD, and 37% were diagnosed with PTSD. The researchers found that individuals with PTSD reported a significantly larger number of current and lifetime medical conditions than did other participants, including anemia, arthritis, asthma, back pain, diabetes, eczema, kidney disease, lung disease, and ulcers (Schnurr & Green, 2004 Weisberg et al., 2003). Specifically, a multiple regression indicated that PTSD was a stronger predictor of medical difficulties than physical injury, lifestyle factors, or comorbid depression (Weisberg et al., 2003). A study of veterans found that those participants with PTSD were more likely to have the medical conditions of osteoarthritis, diabetes, heart disease, comorbid depression, and obesity (David, Woodward, Esquenazi, & Mellman, 2004). Additionally, Goodwin and Davidson (2005) conducted a survey study of over 5,500 subjects and found that there was an association between a diagnosis of diabetes and having PTSD.

Integrating Historical Trauma Theory

As evidenced above, the traumas inflicted on the Native American people (historical losses) are well documented and the literature provides significant information regarding the current psychological, environmental-societal, and physiological problems facing the Native American people (historical loss symptoms). The literature also supports the conceptualization of a relationship between experiencing trauma and the brain remembering the trauma when confronted by an emotional meaning stimulus (Brohawn et al., 2010 Weiss, 2007). Further, a relationship between PTSD and physiological functioning has been found (David et al., 2004 Weisberg et al., 2003). Therefore, it can be surmised that, given the substantial historical traumas Native Americans have experienced, they would be at greater risk of developing physical and emotional concerns related to re-experiencing these traumas. However, the question remains whether some Native American people are being confronted by emotionally significant stimuli in the present day that causes them to reflect about the historical traumas that occurred many generations ago.

In answer to this question, Whitbeck and colleagues (2004) developed the Historical Loss Scale and the Historical Loss Associated Symptoms Scale. Whitbeck et al. (2004) surveyed Native American adult parents of children for their perceptions of historical events. These participants were generations removed from many of the historical traumas that had been inflicted on the Native American people. However, 36% had daily thoughts about the loss of traditional language in their community and 34% experienced daily thoughts about the loss of culture (Whitbeck et al., 2004). Additionally, 24% reported feeling angry regarding historical losses, and 49% provided they had disturbing thoughts related to these losses. Almost half (46%) of the participants had daily thoughts about alcohol dependency and its impact on their community. Further, 22% of the respondents indicated they felt discomfort with White people, and 35% were distrustful of the intentions of the dominant White culture due to the historical losses the Native American people had suffered (Whitbeck et al, 2004).

Ehlers, Gizer, Gilder, Ellingson, & Yehuda (2013) utilized the Historical Loss Scale and Historical Loss Associated Symptoms Scale to survey 306 Native American adults. The majority of the participants thought about historical losses at least occasionally and these thoughts caused them distress. In particular, how frequent a person thought about historical losses was linked with not being married, high degrees of Native heritage and cultural identification. When comparing the Whitbeck et al. (2004) and Ehlers et al. (2013) studies, about the same percentage of participants thought about the losses several times a day however, respondents reported less daily and weekly thoughts of historical losses in the Ehlers et al. (2013) results. The differences between the two studies could be a result of “the extent of historical losses suffered by each individual Native community, the impact of current trauma, levels of acculturation, population norms about historical losses, and population admixture” (Ehlers et al., 2013, p. 6). Therefore, it is important to recognize there are differences in how historical losses are impacting Native American communities.

The above findings may clarify one reason why some populations in the Native American community are suffering from such severe emotional, physical and social-environmental consequences related to past traumas. Specifically, their bodies’ ability to deal with stress has been overwhelmed by the reoccurring thoughts related to historical losses they have suffered. However, it is important not to make generalizations and to remember not all of the Native American people have been experiencing severe historical loss symptoms (Evans-Campbell, 2008). These within-group differences in the Native American population would explain the variances in rates of disease, child abuse and neglect, violence, suicide, unemployment, familial disruption, and poverty between tribal affiliations.

Another important consideration is an individual’s perception of being discriminated against. Perceived discrimination has been associated with negative health consequences (Bogart, Wagner, Galvan, Landrine, Klein, & Sticklor, 2011). In particular, Capezza, Zlotnick, Kohn, Vicente, and Saldivia (2012) administered structured diagnostic assessments for major depressive disorder (MDD) and PTSD and the Alcohol Use Disorders Identification Test (AUDIT) to 2,839 participants in Concepción and Talcahuano, Chile. These researchers found that controlling for demographic variables and previous trauma, participants who reported discrimination in the preceding six months were significantly more likely to participate in risky alcohol use, illegal drug use, and be diagnosed with MDD and PTSD than respondents not reporting discrimination.

Another study examined the relationships between neglect and abuse, PTSD symptoms, ethnicity-specific factors (e.g., ethnic orientation, ethnic identity, perceived discrimination), and alcohol and drug problems within adolescent girls (Gray & Montgomery, 2012). These researchers found that abuse and neglect were correlated to alcohol and drug problems, but only in relation with PTSD symptoms. It also was found that greater perceived discrimination was related with an increased influence of abuse and neglect on PTSD symptoms (Gray & Montgomery, 2012). Given the generations of persecution, discrimination, and oppression suffered by the Native American people (Brave Heart et al., 2011), it is reasonable that perceived discrimination could be an aggravating factor.

Cross-Generational Trauma Transmission

As a result of the loss of people, land, and culture, a systematic transmission of trauma to subsequent generations occurred that has resulted in historical loss symptoms for many Native American individuals (Brave Heart et al., 2011 Whitbeck et al., 2004). Specifically, the traumatic events suffered during previous generations creates a pathway that results in the current generation being at an increased risk of experiencing mental and physical distress that leaves them unable to gain strength from their indigenous culture or utilize their natural familial and tribal support system (Big Foot & Braden, 2007). Therefore, the next step in investigating the theory of historical trauma is to understand how the generational transmission of trauma transpires. Significant research has been completed on the cross-generational transmission of trauma regarding Holocaust victims and their descendants (Doucet & Rovers, 2010 Jacobs, 2011 Neigh et al., 2009 Yehuda, Schmeidler, Wainberg, Binder-Brynes, & Duvdevani, 1998).

Based upon this research, three means by which trauma is transmitted to subsequent generations have been identified: (a) children identifying with their parents’ suffering, (b) children being influenced by the style of communication caregivers use to describe the trauma, and (c) children being influenced by particular parenting styles (Doucet & Rovers, 2010). Parental identification is a form of vicarious learning in which the child identifies with trauma and takes on the historical loss symptoms. Lichenstein and Annas (2000) found there is a relationship between a parent having a fear and children developing the same fear due to vicarious learning. This seems to be substantiated by Myhra’s (2011) findings that all 13 participants in a qualitative study examining the relationship between substance use and historical trauma in Native American adults believed that historical trauma was key to their elders’ dysfunctional behavior—in particular, substance abuse. One participant characterized it as “monkey see, monkey do,” in that she was following her family’s pattern of abusing substances and being involved in abusive interpersonal relationships (Myhra, 2011, p. 26). However, it is important to mention that participants also expressed a great respect and admiration for their elders due to their strength and resiliency.

Lichenstein and Annas (2000) also examined if the way parents relayed information to children regarding a stimulus impacted the development of a fear or phobia in the children. The researchers found that there was a relationship between children developing a fear or phobia when parents engaged in negative talk with children regarding the stimulus. In the Native American culture, information and history is often passed down from generation to generation in a narrative summary. Given that the atrocities that were inflicted on the Native American people were substantive, it seems understandable that transmission of historical loss symptoms could occur via this pathway to the children. In fact, Myhra (2011) found that Native American participants connected “the impact of elders’ stories of historical trauma and loss, and their own traumatic experiences, to intrusive thoughts about these ordeals and to fear that trauma will continue for future generations” (p. 25).

Parenting style also can be impacted as a result of trauma. Walker (1999), in completing an extensive literature review of this subject, found that parenting can be impacted as a result of the parental exposure to trauma. First, parents may have difficulty with trust and intimacy as a result of their experiences of being victimized. Therefore, it may be a challenge for them to develop a healthy attachment with their children. Second, many adults who have been subjected to abuse and neglect may in turn unintentionally enter into a cycle of violence with their own children (Walker, 1999). Due to the forced removal of Native children from their homes and tribal communities, the familial structure was interrupted and many suffered extreme abuse and neglect (Cole, 2006). Therefore, subsequent generations of Native Americans may have not been able to develop healthy parenting styles and inadvertently continued a cycle of violence and abuse. A relationship between a parent’s diagnosis of PTSD and abuse and neglect of children also has been found. Children of Holocaust survivors diagnosed with PTSD report more neglect and emotional abuse than demographically similar children of parents who were not diagnosed with PTSD (Neigh et al., 2009 Yehuda, Bierer, Schmeidler, Aferiat, Breslau, & Dolan, 2000). The reasons why Native American children stand overrepresented in the U.S. foster care system (Hill, 2008) may be related to the abuse suffered by many Native Americans while in boarding schools and the high number of Native Americans displaying PTSD symptoms.

As mentioned previously, experiencing traumatic events during development can alter the HPA axis, which may increase susceptibility to disease (e.g., PTSD, mood and anxiety disorders) (Gillespie et al., 2009). Specifically, it has been found that children of Holocaust survivors have significantly lower cortisol levels when compared with control groups (Yehuda et al., 2000). Further, children of parents who developed PTSD after surviving the Holocaust had reduced cortisol levels when compared to children of Holocaust survivors that did not have PTSD. The results of this study provide that trauma exposure can change how the HPA axis functions and increase risk of PTSD symptoms at least one generation removed from the initial trauma experience (Neigh et al., 2009 Yehuda et al., 2000).

Other studies have found that adult children of Holocaust survivors have a greater lifespan occurrence of PTSD, as well as other mood and anxiety disorders, than demographically comparable individuals who reported a similar exposure to trauma (Neigh et al., 2009 Yehuda et al., 1998). Further, children of trauma-exposed Holocaust survivors who did not develop PTSD were at an increased risk of manifesting other mental health disorders (e.g., depression, anxiety, PTSD) when compared to individuals whose parents were not exposed to trauma (Yehuda, Halligan, & Bierer, 2001). Additionally, researchers have looked at the impact of maternal trauma on the unborn child. Nine-month-old infants born to mothers who were diagnosed with PTSD as a result of trauma-exposure related to the September 11, 2001 attacks had lower cortisol levels than infants born to unexposed mothers (Neigh et al., 2009 Yehuda et al., 2005). The results were more significant with infants whose mothers were in their third trimester when the attacks occurred.

Based upon the above cited research, it can be surmised that parents’ exposure to trauma does form a passageway to subsequent generations that results in an increased risk of negative mental health symptoms. In fact, the latest version of the American Psychiatric Association (APA, 2013) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a stressor criterion for adults, adolescents, and children older than six years related to learning that a close relative or close friend was exposed to trauma. Additionally, the DSM-5 added a PTSD diagnosis for a child six years or younger. One of the triggering events is a child learning that a traumatic event has occurred to a parent or caregiving figure (APA, 2013).

Implications for Professional Counselors

The results of this analysis of historical trauma assist in removing some of the ambiguity regarding this theory. Specifically, a link between neurological functioning and trauma and cross-generational trauma transmission were conceptualized and applied to the theory of historical trauma. This comprehensive examination provides professional counselors with an increased understanding of how traumas that occurred within the Native American population generations ago continue to impact clients today. This information is critical to enhance clinicians’ clinical skills when working with Native American clients. Having an understanding of historical trauma will assist professional counselors in being more responsive to the unique needs of members of this population and incorporating historical trauma in their clinical work.

Dionne, Davis, Sheeber, and Madrigal (2009) provide that integrating mainstream mental health intervention in Native American individuals should involve two phases: (a) motivational phase (i.e., historical context around current difficulties in Native American communities is discussed) and (b) intervention phase (i.e., utilizing mainstream evidence-based interventions). Not only do clinicians and interventions need to be culturally competent, but conventional counseling theories need to be adjusted to be culturally appropriate (Wendt & Gone, 2012). Thus, traditional counseling theories should be integrated with elements of historical trauma and the Native American holistic view of the person.

First, professional counselors should reframe historical loss symptoms in terms of collective responses that are employed to assist clients in alleviating symptoms (Brave Heart & DeBruyn, 1998). Thus, the psychological, social-environmental, and physiological concerns that plague many Native people are signs and symptoms of a communal reaction to generations of persecution, discrimination, and oppression. Specifically, historical trauma differs from the diagnosis of PTSD in that many of the traumas that occurred were systemic in nature (e.g., massacres, Trail of Tears, mass removal of children), which led to collective subjugated grief. Brave Heart and DeBruyn (1998) in their pioneering writings on historical trauma proposed that the initial disenfranchised grief of the Native American people resulted in historical unresolved grief. Therefore, a second intervention is the need for clinicians to validate the existence of not only the initial historical losses that occurred but the continued discrimination and oppression that has impacted the Native American people (Brave Heart et al., 2011). Therapeutic change may be difficult for Native American clients to engage in without validation of not only the past atrocities that occurred to Native American communities, but acknowledgment of the current discriminatory environment that many Native people still endure. Given that the dominant European culture has been the perpetrator of many of the historical losses, this validation is especially important when the professional counselor is a member of the White dominant culture. Third, clients should be educated regarding historical trauma to enhance awareness about its impact and the associated grief and loss that can occur (Brave Heart & DeBruyn, 1998). The Native American people are well aware of the history of the traumas of their people however, they might not have insight about how the events of the past may impact them today.

Finally, professional counselors need to understand that historical trauma permeates all domains of existence (e.g., personal identity, interpersonal relationships, collective memory, cultural and spiritual worldviews Weisband, 2009). Clinicians need to have knowledge that historical losses impact all facets of a client. This can be explained to the client by use of the Medicine Wheel Model of Wellness, Balance, and Healing (The Medicine Wheel). According to this model, a person is interconnected through the spiritual, physical, emotional and mental. The Medicine Wheel has been found to be an effective tool in working with Native American individuals (Gray & Rose, 2012).

Implications and Directions for Future Research

This article provides needed insight regarding historical trauma however, future research regarding this concept is needed, as Native Americans are underrepresented in mental health research (Echo-Hawk, 2011). Gone and Alcántara (2007) completed an extensive review of the literature on evidence-based mental health interventions with Native Americans and found 3 randomized or controlled outcome studies, 6 nonrandomized or uncontrolled outcome studies, 16 studies related to intervention descriptions, 7 clinical case studies, and 24 intervention approaches. The majority of these articles did not address assessment of therapeutic outcomes, but were more theoretically based or provided recommendations for working with Native American clients. The 9 outcome studies described pre- and post-intervention results for a treatment group with no control group for comparison, leaving questions about the validity of the treatment intervention. Specifically, there is no proven empirically based treatment modality to utilize when addressing the distinctive mental health needs of Native American clients. Given the severe mental health problems that plague many of the Native American people, determining effective psychological treatments is vital (Gone & Alcántara, 2007). This can be accomplished through future empirical research.

However, the Native people have a history of being devalued and marginalized in the interest of research (Walters & Simoni, 2009). Therefore, research should be conducted in a culturally sensitive and ethical manner. This is best accomplished by utilizing a collaborative approach (Waiters & Simoni, 2009). Therefore, researchers should work in partnership with tribal elders, healers, officials, health administrators and mental health providers. Specifically, future research should utilize a collective approach and take into account the diversity in tribal affiliations of clients (Hartmann & Gone, 2012).

The first area in need of research attention relates to the fact that the majority of the scholarship on historical trauma has been theoretical in nature. Therefore, there is a need to have empirical evidence to substantiate this concept. First, beneficial research would demonstrate a relationship between individuals reflecting on their historical losses (e.g., loss of people, land, family and culture) and suffering from historical loss symptoms (e.g., psychological distress, social-environmental problems, physiological concerns). Given that Whitbeck and colleagues (2004) have created scales to measure historical trauma, other self-report measures (e.g., depression, anxiety, self-efficacy inventories) could be utilized to determine a relationship between positive and negative affect and a person’s degree of historical trauma. Second, this author suggests that the previous research regarding the impact of trauma on physiological functioning can be a catalyst for future research on historical trauma. Specifically, future studies can focus on determining if there is a correlation between neural activity and clients’ self-reported level of historical trauma. In these studies, fMRI technology and Whitbeck et al. (2004) scales can be utilized to determine the relationship between clients’ self-reported level of historical trauma and amygdala and hippocampus activity.

The second area of research should examine the effectiveness of incorporating indigenous healing methods with mainstream counseling approaches. Utilizing a collaborative approach, researchers would utilize the expertise and guidance of culture keepers (e.g., tribal elders, traditional healers) (Hartmann & Gone, 2012) to incorporate indigenous healing methods with mainstream counseling theories. Given that no evidence-based treatment modality has been established for clinicians to utilize when treating Native American clients, additional research in this area is crucial. This article provides clarity on the theory of historical trauma, but there is a need for empirical research in order to improve the understanding of how atrocities perpetuated on the Native American people generations ago continue to manifest today by psychological, social-environmental and physiological means.

Large numbers of the Native American population continue to suffer from severe psychological, economic, social, environmental and physical distress. The theory of historical trauma provides professional counselors a framework to understanding the current issues that are invading the Native American people and their culture. Specifically, practitioners working with this population should have an understanding of how the historical losses suffered generations ago have resulted in historical loss symptoms being transferred to subsequent and current generations of Native Americans. The concept of historical trauma is “collective and multilayered rather than being solely centered on an individual” and this differs from a “typical Eurocentric perspective of illness and treatment, which tends to reduce suffering to discrete illnesses with individual causes and solutions” (Goodkind, Hess, Gorman, & Parker, 2012, p. 1021). Therefore, professional counselors should adapt evidence-based practices by applying tribal-specific healing strategies, community support, and approaches that incorporate validation of grief and loss associated with historical traumas (Brave Heart et al., 2011). Failure of professional counselors to deepen their understanding of this population would continue the disparity of Native clients receiving competent behavioral health services and facilitate the continuation of the cycle of historical trauma to future generations.

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It was once believed that people with psychological disorders, or those exhibiting strange behavior, were possessed by demons. These people were forced to take part in exorcisms, were imprisoned, or executed. Later, asylums were built to house the mentally ill, but the patients received little to no treatment, and many of the methods used were cruel. Philippe Pinel and Dorothea Dix argued for more humane treatment of people with psychological disorders. In the mid-1960s, the deinstitutionalization movement gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms.

Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals, with the emphasis on short-term stays. However, most people suffering from mental illness are not hospitalized. A person suffering symptoms could speak with a primary care physician, who most likely would refer him to someone who specializes in therapy. The person can receive outpatient mental health services from a variety of sources, including psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel. These therapy sessions would be covered through insurance, government funds, or private (self) pay.

Self Check Questions

Critical Thinking Questions

1. People with psychological disorders have been treated poorly throughout history. Describe some efforts to improve treatment, include explanations for the success or lack thereof.

2. Usually someone is hospitalized only if they are an imminent threat to themselves or others. Describe a situation that might meet these criteria.

3. Do you think there is a stigma associated with mentally ill persons today? Why or why not?

4. What are some places in your community that offer mental health services? Would you feel comfortable seeking assistance at one of these facilities? Why or why not?


1. Beginning in the Middle Ages and up until the mid-20th century, the mentally ill were misunderstood and treated cruelly. In the 1700s, Philippe Pinel advocated for patients to be unchained, and he was able to affect this in a Paris hospital. In the 1800s, Dorothea Dix urged the government to provide better funded and regulated care, which led to the creation of asylums, but treatment generally remained quite poor. Federally mandated deinstitutionalization in the 1960s began the elimination of asylums, but it was often inadequate in providing the infrastructure for replacement treatment.

2. Frank is severely depressed. He lost his job one year ago and has not been able to find another one. A few months after losing his job, his home was foreclosed and his wife left him. Lately, he has been thinking that he would be better off dead. He’s begun giving his possessions away and has purchased a handgun. He plans to kill himself on what would have been his 20th wedding anniversary, which is coming up in a few weeks.