When an Indian Health Service (IHS) provider affixes a label such as attention deficit hyperactivity disorder (ADHD) or bipolar disorder or posttraumatic stress disorder, echoes should be heard of doctors a century ago testifying about “defects of reasoning” and arranging to imprison Native people in lunatic asylums. Today’s “mental health screenings” and “symptom” checklists substitute for yesterday’s Indian Lunacy Determinations in the cloaking and ignoring of chronic inequity and oppression. The shackles of long ago still bind the bodies of Native people through an indoctrination that defines “treatment” as numbness and sedation with mind-altering medications, sometimes with appalling side-effects.
Psychiatric labels currently being affixed to Native people by IHS are so poorly conceived that in 2012 Dr. Tom Insel, director of Big Pharma’s main federal subsidizer, the National Institute of Mental Health (NIMH), vetoed their use in research due to the “absence of biomarkers, the lack of valid diagnostic categories, and our limited understanding…” Strangely, the NIMH continues to use these same psychiatric labels on its website to persuade visitors to believe scientific falsehoods about alleged brain or genetic defects.
Those psychiatric labels are an excellent means to begin exploring the mental health system’s shameful past in Indian country. Branding someone with the label of “not fitting in” was the means by which the mid-19th century mental health system first served forced assimilation.
The Insatiable Lust of Women
Christian intolerance of nonconformity, difference and disability led to public executions during the Inquisitions of the 15th and 16th centuries, and more humanely, the creation of lunatic asylums to segregate those labeled “different,” for whatever reason. In contrast, indigenous North American approaches to unusual behavior or attributes emphasized tolerance and inclusion, even reverence. A widely held presumption regarding the sacredness of life made such European concepts of “disease,” “disability” or “crazy” foreign and unfathomable. A human spirit might become situated in a body or mind more limited than others, but even that misfortune could offer spiritual insight or teaching. The medicines for unwellness were also spiritual, aimed at restoration of balance and connection.
Christianity divided the animalistic urges of the body from the higher aspirations of the spirit. The body was a vile source of sin and corruption, and while the Church conceded that saints might have behaved oddly, other people behaving outside the norm were generally considered possessed by the Devil. Women were much more vulnerable to satanic possession, and the diabolical unleashing of their sexual power was a major moral threat to European men. The most popular procedural textbook for identifying and executing such witches, the Malleus Maleficarum, or “Witches Hammer,” (composed in 1487) said: “All witchcraft comes from carnal lust, which is in women insatiable.” The authors of the Witches Hammer were “greatly concerned with the repression of pagan ceremonies” and provided the guide for burning at the stake as many as 9 million women.
Executing somebody judged to be demonically possessed eventually began to cause the more progressive Christian thinkers to hesitate—they didn’t want to kill someone who might instead be suffering from an affliction. Christian humanitarians began sponsoring medical inquiry into possible defects or diseases in troubling people who might otherwise be considered worthy of redemption. Those considered undeserving of redemption took early European anatomists off the hook by providing opportunities to dissect people without being accused of unholy desecration. They could legally obtain the bodies of executed criminals or bodies left unattended for two days or more.
A less bloody version of grave-robbery or body-snatching is contemporary psychiatry’s research through friendly partners like NIMH to apply scanning technology such as positron emission tomography (PET) and magnetic resonance imaging (MRI). These procedures form the basis of a false brain science currently championed by the IHS. There was a time when Native skulls were just removed, such as when popular U.S. skull anatomist Samuel Morton distinguished crania Americana in 1839 and solidified the race category of “North American Indian,” inventing “craniometry” to measure indigenous mental capacity against a standard of white “Caucasian” skulls. Dr. Morton bemoaned “the inaptitude of the Indian for civilization.” About half of his collection of 1,200 skulls were collected from Indian war battlegrounds, pilfered from American Indian graves and “unknown sources.”
When Western doctors first entered Indian country, they brought with them a Christian-informed, European Enlightenment belief in madness as illness in the body—that is, the belief that loss of one’s reasoning ability came about through defects in the body, specifically, the brain. Very soon, the now-abandoned psychiatric label, lunatic, was being applied to resistant, overwhelmed or merely displaced Native people who were the victims of colonization and oppression.
Lunatic was not a new word for characterizing people bewitched by non-Christian pagan practices. It initially referred to “certain men… molested by devils… [and] deeply affected by certain phases of the Moon,” according to the Malleus Maleficarum. Before being forcibly assimilated themselves, pre-Christian European tribal communities worshipped variations of Diana, goddess of the moon (Luna), childbirth, growth, healing and witchcraft. Our contemporary belief that the full moon increases madnessis an intergenerational remnant of a feminine-centered European indigenous belief, and another demonstration of the past in the present.
American medicine aggressively labeled adverse reactions to oppression as mental disease. Dr. Benjamin Rush, signer of the Declaration of Independence and father of American psychiatry, noted in 1813 that “Africans become insane… soon after they enter upon the toils of perpetual slavery.” Dr. Samuel Cartwright, Rush’s apprentice, soon coined dysaesthesia aethiopica as the diagnostic label for a slave’s “irascible attitude.” Drapetomia, the disease of fleeing from slavery, Cartwright declared, “requires that they should be punished until they fall into that submissive state which was intended for them to occupy” according to the Bible.
In early encounters, Western doctors presumed American Indians lived in a pure and romanticized state that immunized them from madness. In fact, some even recognized that forces in Western civilization could threaten Native stability. In 1844, Dr. Isaac Ray, founding member of the American Association of Medical Superintendents (eventually the American Psychiatric Association) wrote: “If the savage is more exempt than the sage from mental infirmities… the fact is to be attributed to his greater exemption from all the deteriorating influences of civilization.” In the same era, the Medical Examiner reported that Dr. Charles Lillybridge, having examined “more than twenty thousand Indians” during the Cherokee Trail of Tears, “never saw or heard of a case of insanity among them,” while a certain Dr. Butler, “devoted Missionary and Physician among the Cherokees…” for 25 years “never saw a case of insanity.”
Only three decades later, a progressive element within the Western Cherokee Nation felt compelled to launch the first mental health service in Indian country—the Home for the Insane, Deaf, Dumb, and Blind, more commonly referred to as the Cherokee Asylum.
Certain Races Needed to be Erased
Cherokee matrilineal clans once represented an extended family responsible for every mother’s child, regardless of status or disability. If any Native concept akin to land “ownership” existed, it was expressed through the traditional sharing of land within one’s clan. The Cherokee Trail of Tears and forced removal west greatly accelerated the demise of matrilineal traditions and created a new population of rejected, displaced and indigent Native people.
For many years, progressive Cherokees favored white intermarriage and adopting European cultured mores of Southern slaveholding planters. Traditionalists were considerably less inclined to intermarriage, maintained Cherokee ways and held mixed views about slaves. While both sides adopted versions of Christianity, progressives were clearly favored by U.S. government officials, and obtained considerably greater access to land, resources and power. This federal strategy for destroying “traditionalists,” i.e. the preservers of Native culture, was used throughout Indian country.
The Civil War further divided Cherokees progressives and traditionalists, devastating the community such that in 1862, Indian Agent W.G. Coffin described several thousand people “entirely barefooted, and more than their number have not rags to hide their nakedness.” After the war, the Cherokee Nation was punished for siding with the Confederacy by being forced to cede 10 million acres of land to the U.S. It is in the context of a society almost entirely stripped of its strength that the Cherokee Asylum was opened in 1877, six miles south of Tahlequah, Oklahoma. Several hundred thousand dollars derived from land sales were used to create a place for the orphans, Indian lunatics, displaced people, as well as the deaf, dumb, blind and indigent people who had once been the responsibility of matrilineal Cherokee clans.
Do not assume that an inmate at the Asylum was truly disturbed or crazy. To be destitute was the only universal criteria for admission. Whether he or she was drunk, angry or strange, or merely very poor, there was little distinction made when confining this newly-minted Crazy Indian. It required only two Cherokee citizens reporting that someone needed admission to lock a person up. The Asylum’s sole physician could add an opinion, if he felt inclined, but it was up to the Asylum’s board of trustees (Cherokee progressives) to decree both confinement and release.
Although it didn’t succeed, Cherokee Asylum was to be self-supporting, emphasizing full work-days for the able-bodied raising livestock and crops. “Free and unrestrained intercourse between the sexes” was forbidden. The civilizing influence of the Gospel was all-important, and by-laws stated: “It shall be the duty of the steward to secure the services of some member of the Gospel to hold religious services, or preach in the Asylum every Sabbath, or as often as practicable.” However, less pious visitors frequently came and went, and complaints emerged about “relatives and friends of the inmates [who] look upon the Asylum as a public house…” that is, a tavern or bar. In this way, the Western Cherokee Nation became the first to adopt European approaches to housing the destitute, different and non-conforming.
Inmates of Cherokee Asylum were mostly the casualties of cultural destruction, disconnected from their families and disinherited from the shared property of their matrilineal clans. Western Cherokees successfully fought to defend what remained of their weakened matrilineal system when they resisted the 1887 Dawes Act’s attempts to reapportion land to individual allotments by asserting the fee-simple land title structure they’d purposely used to signify commonly-held property. Their struggle was finally lost when the Curtis Act passed in 1898.
Tribal courts of the Five Civilized Tribes were subsequently abolished, leaving the U.S. Court with direct jurisdiction over all Cherokee citizens. The same U.S. Court in Indian Territory that oversaw the provisioning of individual Cherokee land allotments now supervised the leasing of oil and gas development as well as the determination of which Indians were suffering from lunacy. This period, from 1880 to the Indian Reorganization Act of 1934, saw the Indian Agent and the U.S. Court judge rise up as the absolute arbiters on such issues.
Following precedents in British law, U.S. courts began investing Western physicians with the legal privilege of deciding whether defects of reasoning were sufficient for a person to not know right from wrong in criminal proceedings and to be labeled insane. Two highly influential philosophies formed critical features of the Western medical profession’s understanding at this time. The first, postulated by German psychiatrist Emil Kraepelin, declared all mental diseases would ultimately result from braincauses. This same psychiatric ideology, referred to as biological reductionism, traces back through Samuel Morton to the Christian concept of the sinful body, and forward in currently underpinning the “biomedical” philosophy of the Indian Health Service. The second philosophy was eugenics, created by British psychologist (and cousin of Charles Darwin), Sir Francis Galton, who contended that in order to improve the human stock, “more suitable races or strains of blood” of white people needed “a better chance of prevailing speedily over the less suitable.” This meant certain races needed to be erased. In 1865, Sir Francis wrote that American Indians “contain the minimum affectionate and social qualities compatible with the continuance of their race,” meaning they should be exterminated.
Two years prior to Sir Francis’ remarks, scores of Oraibi, Apache and Hopi parents were imprisoned on Alcatraz Island for resisting missionaries and federal agents trying to kidnap their children and take them to boarding school. Now these and other acts of resistance and defiance could be labeled crazy. After all, rejecting the benevolent intent of civilizing officials could only be attributable to a defect of reasoning. Indian Lunacy Determinations became the legal procedure for institutionalizing resistors alongside people displaced, rejected, or reacting to community trauma and oppression, all presumed to be the most inferior among inferior people.
In the last days of Indian Territory in 1905, prior to Oklahoma’s statehood, the court process for a Lunacy Determination was no more standardized than that used for admission to the Cherokee Asylum. Several townspeople (usually white), the Indian agent or an appointed guardian (if applicable) could make a formal request that a U.S. federal judge determine the sanity of a particular Native person. Any physician could undertake an “evaluation,” and a handwritten note with a finding stating insanity or lunacy was all that was required. The testimony and final court determination was often placed in brown envelopes, an example of which I found among many, slightly decayed, in an old box at the National Archives and Records Administration:
Given the ease with which a Native person could be judged insane, it is no surprise that demand for places to confine people began to exceed the number of beds available for these unfortunate souls. Asylums outside Indian country started taking in this overflow, but the associated medical superintendents opposed housing Indians with whites, due to their perceived inferiority, the agitation of racist white inmates and the potential for interracial sex, which violated accepted eugenics principles.
In 1901, the Bureau of Indian Affairs began construction of the Hiawatha Asylum for Insane Indians in Canton, South Dakota. By January, 1904, shortly after Hiawatha’s completion, the Cherokee Advocate reported that there were just 18 inmates in the Cherokee Asylum and the building was “sadly in need of repair, especially the windows, as they are nearly pane-less.” With the imminent statehood of the Territory and the loss of tribal jurisdiction, some Cherokee inmates were eventually placed under Oklahoma state management. Others were transferred to the new BIA government asylum in South Dakota. (I’ll discuss the Hiawatha Asylum in a future piece in this series.)
In 1918, the U.S. Census Bureau endorsed the Statistical Manual for the Use of Institutions for the Insane, published by the National Committee for Mental Hygiene, as a “national system of statistics of mental diseases” to help track the threat of undesirable racial strains and their mental problems. This 1918 document—and not the 1952 first publication of the American Psychiatric Association often cited—constitutes the earliest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Together with the closely-related ICD-10, the DSM is the labeling system currently used by IHS within which the mental health labels I mentioned at the top of this article are found. Table 7 of the 1918 manual clarifies the racial agenda of the mental health system back then:
This early DSM version served eugenics, a powerful social movement aimed at eliminating inferior races through sterilization and reduced birth rates. From 1921 to 1924, a eugenics display supplied by the American Museum of Natural History stood in the Capitol Rotunda, and eugenics philosophies were instituted in social and health services across Indian country.
The 1918 manual set “whiteness” as the most significant standard through which normality and sanity of non-whites should be measured, and this has remained so. The 21 diagnoses and sub-diagnoses of the 1918 manual evolved into the 600 labels of the DSM-5 system recently released by the American Psychiatric Association (APA), greatly expanding opportunities for physicians to talk Native people into believing they suffer from a fictitious disease. Since 1980, the APA task force composing the DSM has described its philosophy as “neo-Kraepelinian”—linking the DSM with Emil Kraepelin’s old contention that “mental dis-ease” would ultimately be traced to brain defects and genetic deformities. The past is in the present, if we would only notice it.
It is very good that Western medical science succeeded in understanding real brain diseases underlying dementias as well as the damage resulting from methamphetamine, alcohol, and other toxin exposure. Yet beyond these exceptions, 200 years of Western medicine has found no scientifically valid brain or genetic defects behind the vast majority of the DSM’s most current psychiatric labels.
What remains virtually unexplored by Western medicine is the sickness of the chronic perpetration of violence and oppression upon generations of Native people. This is due to the fact that the violence emanates in part from the U.S. mental health movement in Indian country, which has for many years woven a spell to make that sickness invisible. A trance has ensued through which the Malleus Maleficarum states that “those who are skilled in sorcery and glamour deceive the human senses with certain apparitions, so that corporeal matter seems to become different to the sight and the touch.”