Trauma, coloniality and survivance among Indigenous peoples in the <scp>US</scp>
Authors: Joseph P. Gone
Journal: World Psychiatry (2025)

Psychological trauma has featured in the lives of Indigenous Americans (i.e., American Indians and Alaska Natives or, simply, Natives) in pronounced fashion since the arrival of Europeans to these lands. My own Indigenous people, the Aaniiih-Gros Ventres of the Northern Plains, for example, experienced cataclysmic adversity during the late 1860s. First, measles and smallpox – originally brought to North America by Europeans – swept through our homelands, decimating our people. Additionally, a massacre by Indigenous rivals, competitors for violent control of the Euro-American fur trade, combined to reduce our population by half within this same five-year period. Although we had become intimately acquainted with such setbacks during the preceding century, the late 1800s were especially devastating. By 1895, only 596 of us had survived on our Montana reservation. Our travails were not over. Diseases of poverty and malnutrition – tuberculosis, trachoma, scrofula – induced further suffering. Corrupt Indian agents ruled our lives in dictatorial fashion. Much of our territory, supposedly guaranteed by treaty with the US, was coercively ceded by government officials. A reservation industrial school was established to "civilize" us. One elderly woman blinded her grandson with her sewing awl rather than allowing him to be carried away to this loveless and abusive institution. The namesake of the Gone family endured ten years as a child in this boarding school. When he emerged, his mother and other relatives were dead, and nobody had told him. The brutality that he encountered there marred him, and later as a husband and father he wounded his own family. Since those desolate days, our homelands have remained hemmed in by racism and mired in poverty, with the accompanying ills of addiction, accident, violence and suicide being tragically common among our loved ones1. These realities are not unique to my people, but impact lives in hundreds of other Native American communities, for which the long legacy of colonial subjugation has sedimented for individuals and families as a cascade of trauma. In their review of post-traumatic stress disorder (PTSD) and its symptoms among Native Americans, Bassett et al2 identified 37 studies published between 1993 and 2012. Although prevalence rates for the entire national Indigenous American population have not been reported, high-quality epidemiological findings exist for some samples and communities. High rates of PTSD in Native respondents were evident from population studies. Among Vietnam-era military veterans, lifetime PTSD in Indigenous veterans was the highest of any ethnoracial group. Native Americans were more likely than other Americans to report traumatic events, including physical attacks and threats to the well-being of loved ones. Indigenous men and women both reported high levels of vulnerability to trauma, but of different types: exposure to accidents for men and to violence for women. Native women were twice as likely as Native men to present lifetime PTSD as a result. Adverse childhood experiences such as physical and sexual abuse contributed independently above other risk factors to PTSD, though experiences of abuse, addiction, illness and violence in adulthood contributed to mood and anxiety disorders more generally. It has been argued that disproportionately high rates of PTSD among Indigenous Americans are primarily due to disproportionately high rates of exposure to trauma. Minimal research on potential benefits of PTSD treatment for our populations has been conducted. PTSD pertains to maladaptive responses to personal trauma. The construct has limitations, however, in accounting for the cascade of trauma described as the colonial legacy for Native Americans. Beginning in the 1990s, Indigenous health scholars heralded new ways of conceiving of Indigenous suffering from histories of colonization as complex trauma and intergenerational PTSD3. Described as a "soul wound" or "historical trauma", this concept recognizes the condition of coloniality, arising from both past and ongoing subjugation, as causal for health inequities – and especially mental health inequities – within Native communities. During the past three decades, Indigenous historical trauma (IHT) has circulated widely in Native settings as an explanation for suffering, impairment and distress. IHT is described as differing from PTSD in several important ways (referred to as the "four Cs" of IHT4): it is colonial in origin, collective in impact, cumulative across waves of adversity, and cross-generational in its reach from ancestors to descendants. In essence, this concept historicizes and socializes trauma beyond the medicalized and individualized dysfunction of PTSD (which privileges the psychological and biological foundations associated with psychiatric illness), emphasizing community dis-order. Thus, whereas only a minority of Indigenous people might warrant a formal diagnosis of PTSD, nearly all Native people are understood to be impacted by IHT. Indeed, IHT offers an explanatory model for Indigenous social suffering, ensuring that prevalent mental health problems – addiction, PTSD, conduct disorder, and suicide5 – are related to their constituting social conditions, rooted in coloniality. Of course, it is nearly impossible to establish cause-effect relationships using the methodological tools of the health sciences to link specific instances of ancestral trauma among prior generations to the suffering of current descendants within Native communities. Many Indigenous proponents of IHT harbor high hopes for the burgeoning science of epigenetics to one day afford such links spanning multiple generations of Native people. Yet, Walters et al6 have called attention to conceptual confusion surrounding IHT with respect to future scientific investigation. Specifically, they noted that, over time, IHT has been characterized in the scholarly literature in four distinct ways: as etiology, mechanism, stressor, or syndrome. Similarly, Hartmann et al7 observed three modes of scholarly engagement with IHT across the scientific literature: as clinical condition, life stressor, or critical discourse. Gone et al8 described formidable limitations in the current measures of IHT that have been developed and deployed within the health sciences, concluding that, as a result, "this literature has yet to cohere into a body of knowledge with clear implications for health policy or professional practice". Interestingly, few investigators have shown interest in establishing distinctive profiles of ancestral trauma for particular Native respondents (e.g., number of great-grandparents to survive a historical military massacre) or in designing studies that aspire to disentangle evidence for intergenerational causal impacts. All of this suggests that the real contributions of the concept of IHT are more critical and discursive rather than empirical and scientific1. Indeed, several non-scientific, discursive functions may be served by IHT1: explain Indigenous health inequities, re-socialize Native community health problems, destigmatize these conditions with reference to shared suffering, legitimate Native healing traditions, harness trauma discourse for claims-making, tap into more plentifully resourced health care services, and represent an Indigenous scholarly contribution to health research. Beyond these, IHT also anchors an "alter-Native psy-ence"5, an Indigenous mental health framework that contests and recasts conventional psychiatric knowledge across several domains: with respect to distress, IHT is preferred over mental disorders; with respect to well-being, Indigenous forms of relational selfhood are preferred over neoliberal individualism; with respect to intervention, Native healing traditions are preferred over empirically supported mental health treatments; and with respect to evaluation, Indigenous "ways of knowing" are preferred over scientific outcome studies. Perhaps most importantly, Native promotion of the concept of historical trauma expresses survivance in the health domain9. A portmanteau of "survival" and "resistance" introduced by Anishinaabe intellectual G. Vizenor, survivance attests to the improbable persistence of Indigenous peoples beyond the long colonial encounter. It rejects "victimry" and insists that Native self-determination is the way forward from trauma, PTSD, and colonial subjugation. It refuses narratives that reductively restrict attention away from Indigenous agency, kinship, love, struggle, tradition, humor and homeland. It insists that we shall remain.