Portable construction lights harshly illuminated the scene as men worked in the shadowy dawn that lasts almost until noon out here on the tundra. The men worked steadily and quietly in a manner that suggested front-yard coffin construction was a routine task. I soon learned that it was.
We arrived about 30 minutes earlier via a shaky nine-seat bush plane, the only way in and out of most villages here on the Yukon Kuskokwim Delta east of Bethel, Alaska. There are over 50 Yup’ik villages on this great frozen sponge of a place, where the great flat expanse of land leading to the Bering Sea is actually just permafrost and thus, constantly shifting.
Ray Daw, Navajo, director of Behavioral Health for the tribally owned Yukon Kuskokwim Health Corporation (YKHC) and Rose Domnick, Yup’ik Director of the corporation’s Behavioral Health Prevention Department and leader of Calricaraq invited me along to observe this unique rapid response trauma intervention in action. Calricaraq means (Healthy Living) in Yup’ik and is unlike any other mental health professional intervention team. In addition to those trained in traditional western behavioral health, it includes a group of Yup’ik elders with extensive knowledge of their language and culture. Daw, the first Native director for Behavioral Health describes the expertise of the Calricaraq team as heart skills that can’t be learned from books. “Western interventions are built primarily from books and depend on certification and a system that manages individual behavior by relying on an expert,“ he said. “That system is shunned by our elders and seen as a way to mask issues that individuals may have, issues that need to be addressed and cared for.”
The entire Calricaraq team is Yup’ik and although much of what took place during this intervention was conducted in the Yup’ik language, I was able to follow the flow of events and human drama as it played out. English-speaking team members translated for me when they could.
A man seated on a four-wheeler was waiting for us as our plane bounced down onto the barren airstrip. Clearly overwhelmed by grief, he wordlessly threw his arms around the first member of our group to emerge from the plane, Sophie Jenkins, Yup’ik of the Calricaraq team. The man was the father of the young man who had recently been stabbed to death by another relative, the young man’s niece. Both the attacker and her victim were 19 years old. Since both families entwined by this domestic tragedy requested anonymity to protect their privacy and their grief, I will refer to the family of the deceased as “B.”
The murder was a senseless crime. A now-forgotten argument, fueled by alcohol and maybe drugs escalated into blind rage, and the young woman stabbed her uncle to death. They had grown up together, the niece often staying at the B family home.
It was around 8 degrees that day and although I was raised in Wisconsin, a state with harsh winters, I sensed something different about this cold. It was serious cold. The crystalline clear light all around us was stark and the dry air made everything seem brittle and sharp. The rustic little village seemed imbued with a dangerous kind of beauty; I sensed immediately that this was a climate that demanded respect.
We made our way over the warren of narrow wooden boardwalks that serve as sidewalks out in the village and finally stomped the snow from our boots before entering the B home.
Like all homes here, it is a modest wooden structure on stilts to protect the permafrost. Today it was filled to bursting with extended family and friends who had come to pay their respects at the boy’s wake.
We entered the main room, where an elder, the victim’s grandma, pulled hopelessly mismatched socks onto the feet of a wriggling little girl. I learned later that this was the victim’s daughter. The grandma, who looked to be in her late 70s or early 80s, wore an expression of stunned exhaustion; she moved as though in a daze. Many of the adults in the room wore similar expressions. Children would periodically wander into the room, and seem confused by the somber tone of the gathering. A sleepy teenager stumbled in from some deep corner of the home and made a beeline for a huge box of donuts on the kitchen table.
Calricaraq team member Mardy Hanson, Yup’ik sat between the grandma and another elder woman of about the same age. There was clearly some undefined tension between the two elders, and I watched them closely. The second elder woman especially drew my attention. Her eyes were clear. Although she said nothing, she exuded a calm courage that was both inspiring yet humbling. I would learn more about this remarkable woman later.
We sat in a circle and the team began their work. They spoke of their similar experiences, often crying, and shared painfully personal details of their struggles to survive trauma. The team’s elders spoke of the guiding principals of the Yup’ik systems of living that include the potent medicine of qaruyan (healing) and moreover of kaholian (unconditional love and understanding).
“Our ancestors gave us tools to understand our minds and name our feelings,” one told the group. “Our subsistence way of life, the very act of surviving and providing food for our families is also an important means for healing. We say that true healing can be found on the tundra.”
Eventually family and others began to speak. They said their words slowly, the syllables burbling pleasantly from the deep recesses of their throats in the Yup’ik tongue. The victim’s grandmother embraced the wriggling little girl on her lap and said, “We have lost two of our young people to this tragedy. Alcohol has created an imbalance in our lives.”
The room went silent. It was getting light now; the sun streamed in making the crowded rooms feel close and hot.
After a long pause, the boy’s father spoke, a mix of English and Yup’ik. His face seemed illuminated by some inner light, as though he’d seen a vision. He spoke of his son. “Lately he was so interested in doing subsistence hunting and fishing. He kept pushing me to get our tools ready. I think he must have known,” he said trailing off.
Clearly the father saw the son’s prescient message as a gift meant to help the family heal from his death.
Later, I learned that the father had made a public commitment (in Yup’ik) to remain sober and follow the subsistence living ways, eschewing the food-stamp-dependent life he and his family had led in recent years.
He described this as a gift to his grandchildren, a legacy from his son.
He stopped talking and went out onto the back porch, returning proudly holding a torn cardboard box of raw frozen whitefish. He caught this fish, a Yup’ik delicacy, in his newly set nets, the nets he had planned to set with his son.
He held them out to us like a sacrament, inviting us to feast his son’s great hope for the future.
A huge crowd of people had filled the home by now, many bearing huge pots of rich, dark moose meat stew, big platters of oily dried fish and viscous jars of seal oil; we feasted at the kitchen table in shifts, dipping the raw frozen fish in salted seal oil. It was a Yup’ik orgy of omega 3 fatty acids; everyone smacked their lips appreciatively.
As our turn at the table waned I looked out the big front window and saw that a Russian Orthodox priest had arrived on his four-wheeler. He set up his little altar for Mass in the crowded main room, a sign for the intervention team to slip away.
I followed the team outside into the now-brilliant daylight as we made our way across the village to the home of the perpetrator. The atmosphere here was decidedly different. Her father sat alone on an old couch in his well-worn but clean and tidy house. Although other family members were clearly there, they were conspicuously absent from the darkened room where the father sat chain-smoking cigarettes.
The Calricaraq team again began their work, sharing their stories with him. The father listened silently with his head down for a long time. An elder woman entered the front door of the house, holding the hand of a young girl I learned later was the perpetrator’s daughter.
I suddenly realized it was the silent elder who I had seen earlier sitting next to Hanson and the victim’s grandmother at the wake feast. With a shock, I realized this was the perpetrator’s grandmother!
She took off her coat and sat down. She was unflinching in her determination to take on the challenge of speaking openly about all that had happened, her granddaughter’s part in stabbing her uncle and her son’s unwillingness to talk about the associated pain and helplessness. A tiny woman in her 80s, she was clearly the matriarch of the family. As Jenkins later translated, she said to her son, “I have prepared you, I have taught you our ways that can help you go through tough times; I have taught you kaholian. There is health and wellness in our ways.”
Her son began to cry, a dark, jagged wail, like the sound a wounded animal might make. His thin shoulders heaved with the effort. A teenager who had just entered the room abruptly turned on his heels and left when he saw his uncle crying. Although Grandma followed and reassured him that everything was all right, he soon left the house with a group of boys.
Grandma returned to the meeting with her son and the Calricaraq team. Despite her age, Grandma sat nimbly on the arm of the couch. I could see that she was completely physically present as she spoke gently to her son. “It’s safe to express your feelings and your pain here. We will not belittle you or talk behind your back,” she told him.
He stopped crying. As he lifted his head a bit to look her in the eye, he appeared to be exhausted, completely drained of energy.
After a time, the grandma smiled patiently and invited us into the kitchen to eat.
Her kitchen was like her – although warm and welcoming, its tidy decorations and neatly arranged family photographs commanded respect. A feast of dried king salmon, Pilot bread and hot tea were spread out on the oilcloth-covered table.
Later she proudly showed us her collection of old style Yup’ik tools, a fish trap, an ulu (woman’s knife) and her beautiful ivory story knife covered with notches for each story from her girlhood. In the center was a faded photograph of her father as he worked his nets. He was a vigorous, mature man with a full head of white hair and a weathered smile on his face.
Everything I’d seen and all the folks I met during my visit to the Kuskokwim Delta underscored the Yup’ik spirit of adaptability and resilience in this challenging land.
I recalled a personal anecdote that Mark Anarak, Inupiaq, a tribal behavioral health consultant working with YKHC, had shared earlier with me. It seemed to sum up the tenacious life force of the Yup’ik people. “My wife is Yup’ik. When she was pregnant with our first child she had this (to me) odd habit of walking directly out of our front door immediately after waking in the morning. My mother in law explained that this is how they pass along their values and ability to survive even when the child is in utero.”
All of this pride and capability seemed at odds with the negative data I’d learned about the population in this region. What awful things had happened here to bring such a strong people to their knees?
and a report by CNN Alaska leads the nation in number of reported rapes with almost 80 incidences of rape per 100,000 people. Nationally the rate is 27 per 100,000. Ron Perkins, director of the Alaska Injury Prevention Center, told the Juneau Empire in 2012 that rural Alaska has some of the highest suicide rates in the entire world.
And data supports Juneau Empire reporter Paul Berg’s observation that “a major health and social crisis is spreading throughout regions of Alaska.”
While in Alaska, I met with Elsie Boudreau, Yup’ik, in Anchorage. Boudreau was the lead plaintiff in a 2004 class action lawsuit against the Catholic Church for decades of sex abuse of hundreds of Alaskan Native children in villages in the Yukon Kuskokwim delta and elsewhere in the state. In the PBS Frontline program “The Silence,” reported by Mark Trahant, Shoshone Bannock, Alaska is described as the hardest-hit region in the country in terms of the sex abuse scandal in the Catholic Church that began coming to light in the 1990s.
In 2007 The Oregon Province of the Society of Jesus agreed to settle with Alaska victims for $50 million but after declaring bankruptcy finally agreed to pay $10 million.
Boudreau now works as a counselor for children who have been sexually abused. Through her journey, she has learned about the impact of historical trauma on her people. “I think, no wonder our people have been ranked number one in suicide and all the other social ills given all that’s happened to us!”
The Great Death
Throughout the 20th Century, the Alaskan Native population was brutalized by waves of diseases like measles, influenza, diphtheria and pneumonia. The 1918 flu epidemic wiped out entire villages. Later came polio, tuberculosis and other diseases that were nearly as devastating. According to information from the Alaska History and Cultural Studies of the state’s education department, the 1932 death rate for Alaskan Natives from tuberculosis was 1,302 per 100,000; the rate among non-Natives in the U.S. during the same period was 56 per 100,000.
According to the Alaskan Native Commission Final Report:
A reasonable assumption can also be made that the entire world for the Alaskan Natives, including the most important aspect — the spiritual — was thrown into disarray.
The population decline also undermined leadership, disrupted personal relations, and demoralized the people.7
The extent and depth of the damage such massive death and illness would have on Natives’ cultures and societies is only today being explored and identified. But it stands to reason that the damage was profound. To the plagues and famines were lost spiritual and social leaders, elders and parents, uncles, aunts, children and siblings. Artisans were swept away, as were those who knew best the oral traditions of the people, the historians.
For a people whose existence was tied intimately to the spiritual realm, the failure of their medicine men to bring cures struck to the core of their cultural beliefs. The spiritual void that now existed for the survivors stumbling away from mass death was filled by American missionaries who made greater inroads into the Alaska Native community as the nineteenth century neared its end. For a people whose social and cultural infrastructure was collapsing at their feet, it is little wonder that Native life ways would become subservient to the alien social, political, and economic systems and beliefs being brought to their shores.
Thousands of Alaskan Native children who survived the initial onslaught of disease in the first part of the 20th century were orphaned. “Out of necessity, missionary groups and the federal government began establishing orphanages for these children. In many ways, the Great Death jump-started boarding schools in Alaska,” said Jim La Belle, Inupiaq, retired professor of Native American Studies at the University of Alaska-Anchorage.
La Belle noted that beginning in the 1930s and 40s these orphanages were transformed into large government and religious run boarding schools. These schools, according to La Belle signaled the then popular assimilation process of Alaskan Natives into the dominant U. S. culture. “Authorities told most parents that they had no choice but to give their children over to boarding schools so that they could get a proper education. Parents who resisted were sometimes threatened with jail,” he said.
At the schools, children were taught that their traditional ways, spirituality and language were inferior and even evil, according to boarding school survivors like Boudreau.
Disconnected from family and culture, the children made easy victims.
Investigators in the class action lawsuit against the Oregon diocese allege that the Yukon Kuskokwim delta schools and other remote Alaskan villages became a worldwide Jesuit dumping ground for priests with histories of abuse. “The priests had so much power, we were taught they could do no wrong,” Boudreau said.
The only way for children to make sense of such abuse is to blame themselves according to Boudreau. “We are beginning to heal but there are a lot of people who are still hurting,” she said.
Boudreau noted that at least 30 victims who participated in the lawsuit have since committed suicide.
Western Interventions Don’t Work
Alaska Native communities grew to become ground zero for social “dis-ease” and nothing seemed to help. “Chaos from unresolved trauma is recycled in families here,” says Domnick.
Indeed, scientists say that repeated trauma can hijack the brain, causing people to operate in a constant survival mode of hyper vigilance, impulsivity and dysphoria (a state of unease or generalized dissatisfaction with life).
“In the Kass’aq (white person) way we were taught to stuff our feelings and isolate ourselves from our Yup’ik traditions,” Domnick says.
Anarak, noted that many mental health approaches have been used over the years in the region to address the cycle of trauma. “Money has been spent, various western-style interventions have been attempted. Mental health professionals have logged hours and hours in these efforts but to no avail. All the programs, clinics and interventions simply didn’t work, people just kept getting sicker.”
The best efforts of such western-based mental health intervention models didn’t work for a simple, basic reason, according to Anarak. “People in the villages didn’t embrace them.”
Calricaraq, however, is different, he says. “Although we don’t yet have any precise data, Calricaraq is by far the most requested behavioral health service that YKHC has ever offered,” Anarak reports.
The significant difference between Calricaraq and past intervention methods is that behavioral health staffs don’t deliver the service until community members request that they come to the villages. “The healing process is rooted in Yup’ik culture,” Domnick explains. “We are our own resource experts; we have it within us to transform ourselves and our communities into healthy, thriving places. We can do this by reinforcing what we already know as Yup’ik people.”
In her editorial conclusion of a 2014 report about the role of Yup’ik culture in social change and prevention to the American Journal of Community Psychology, Stacy Rasmus, Lummi, professor at the University of Alaska Fairbank’s Center for Alaska Native Health Research (CANHR) wrote, “The social framework within which our ancestors once lived came out of an adaptive process, consisting of trial and error and testing.
This is how the Yup’ik society was created. Contact and contemporary processes have led the modern Yup’ik peoples away from something that has been developed, tried, and proven over many centuries; and much of the suffering in our communities today is related to this movement away from our traditional core values, subsistence strategies and families.”
Domnick helped found Calricaraq after years of working in behavioral health in her community in Bethel. Inspired by an elder’s wisdom that helped her heal from her own trauma of being molested as a child, she realized that there are powerful tools in Yup’ik culture that speak to mental health.
Traditionally, Yupik people openly discussed their feelings, often turning to elders to help sort out difficult situations and problems. A structured system provided guidance for behavior and working out conflict with others. In the unforgiving climate of the tundra, survival depended on cooperation, effective conflict resolution and maintaining good mental and physical health. Health and healing were found in the everyday actions of subsistence living. Extreme measures, such as banishment, were used, essentially a death sentence on the tundra, as a last resort when all other efforts had failed according to Domenic.
Instead, people turned to the essential guiding principal for traditional Yup’ik behavior, “kaholian.”
Calricaraq defies description using traditional behavioral health language. For instance, Calricaraq would be unlikely to win the behavioral health intervention stamp of approval as an evidence-based practice (EBP). EBPs are interventions for which there is consistent scientific evidence showing that they improve client outcomes according to the journal Psychiatric Services.
Typically, U. S. government agencies fund only EBPs. Substance Abuse and Mental Health Services Administration (SAMSHA), however, has begun to fund projects and protocols that they describe as promising, programs like Calricaraq.
There is little published information assessing such interventions. Joe Gone, PhD, Gros Ventre, professor of psychology at the University of Michigan and several fellow researchers published a study last year in the U.S. National Library of Medicine’s National Center for Biotechnology Information examining what is known about culturally based mental health programs. The researchers note that the complex and holistic approaches often used in cultural interventions complicates efforts to isolate and study specific components. The typical western research method of generalizing such interventions among varied tribes fails to capture important details about their effectiveness.
“Ironically, despite the holistic and balanced nature of wellness to Indigenous people, few studies collected a holistic set of wellness outcomes. While most studies evaluated physical outcomes, such as sobriety, few studies explored spiritual outcomes such as feeling connected or having a sense of belonging,” according to an article by the National Center for Biotechnology Information titled Cultural Interventions to treat addictions in Indigenous populations: findings from a scoping study.
Gone and fellow researchers are working on creating ways to measure the success of traditional culturally based indigenous mental health interventions using a method they call “Two-Eyed Seeing.” This method, they maintain, honors the strengths of both indigenous and Western knowledge.
The Qungasvik (Toolbox) Project, which like Calricaraq is based on traditional Yup’ik ways of living, however, is close to publishing a set of EBTs. With Qungasvik and help from the Calricaraq program, the village of Hooper Bay reduced their youth suicide rate to zero for the past two years. The community had the highest suicide percentage rate between 2004 and 2008 in the state according to the Alaska Bureau of Vital Statistics.
Qungasvik is a community-based youth suicide prevention program operated in partnership with University of Alaska Fairbank’s CANHR. CANHR professor Rasmus, Lummi, is working on creating a set of EBP’s for the project.
Domnick and her team, however, leave such concerns to the administrators. They are busy with their non-stop schedule, bringing healing to their communities. “We are using love and compassion to try and stop this cycle of trauma before it grows into something worse in our families,” she says.
The healing process, however, will take time. Domnick noted, “Who we came to be today has a lot to do with what happened to us over the last 150 plus years.”
So far participant evaluations of Calricaraq programs are very good, according to Anaruk. “We have heard comments from people who were contemplating suicide or stuck in alcohol or drug abuse that had control over their lives. They have said that after hearing the Calricaraq teachings they have begun to change and reexamine their lives using the wisdom of the Yup’ik elders,” he said.
The grandmother of the perpetrator back in the village where I joined the Calricaraq trauma intervention team is a prime example of the traditional Yup’ik way of leading a healthy life according to Domenic. “She demonstrated the real Yup’’ik way. She went to the victim’s home and simply listened in a respectful way. Later at her home she used kaholian to encourage her son to openly voice his feelings. She told us that Calricaraq is absolutely the right way for Yup’ik people to help one another,” Dominic says.
Jenkins said of the victim’s father, “We saw the father’s spirit wake up. He’s ready to use this awakening to remind him of what his son started. He set his nets for the first time. It’s not simple to maintain the nets in this season, the ice gets thicker and thicker and the nets get heavier and heavier. You have to remain vigilant to ensure they don’t freeze; and so it is with our ways of Calricaraq and kaholian.”
This work is supported by the Rosalynn Carter Fellowships for Mental Health Journalism and the USC Annenberg/National Health Journalism Fellowship.