Figure 35-3 All of the elements from Figure 35-2 are depicted in this ceremony of the extended family in the healing process. The drawing shows a quiet gathering of people in a darkened room.

(Courtesy Sinte Gleska University.)

Therefore, as ceremonial practices were suppressed and as government policies undermined the integrity of traditional Indian practices, the cultural fabric of Indian peoples was also torn. Official U.S. government assimilation policies forced many traditional Indian medicine practitioners underground for risk of being cited for committing actions prohibited by government regulation or being accused of “devil worship” and held up to public ridicule. Archie Fire Lame Deer and Richard Erdoes note, “Between 1890 and 1940, the Sundance, as well as all other native ceremonies, were forbidden under the Indian Offenses Act.” They recall the following:

One could be jailed for just having an Inipi [a sweatlodge ceremony] or praying in the Lakota way, as the government and the missionaries tried to stamp out our old beliefs in order to make us into slightly darker, “civilized” Christians. Many historians believe that during those fifty years no Sundances were performed, but they are wrong. The Sundance was held every year . . . but it had to be done in secret, in lonely places where no white man could spy on us. (Lame Deer et al, 1992, p. 230)

Clyde Holler notes that the official ban on the Sundance began on April 10, 1883, with the enforcement of the Rules for Indian Courts; these rules were in effect until 1934, and the ban on piercing was in effect until 1952 or later, depending on interpretation (Holler, 1995; see also Commissioner of Indian Affairs, 1883).

Luther Standing Bear reflected on the profound shift that was occurring as he recalled his experience traveling to the Carlisle Indian School as a boy. He wrote as follows:

It was only about three years after the Custer battle, and the general opinion was that the Plains people merely infested the earth as nuisances, and our being there simply evidenced misjudgment on the part of Wakan Tanka. Whenever our train stopped at the railway stations, it was met by great numbers of white people who came to gaze upon the little Indian “savages.” The shy little ones sat quietly at the car windows looking at the people who swarmed on the platform. Some of the children wrapped themselves in their blankets, covering all but their eyes. At one place we were taken off the train and marched a distance down the street to a restaurant. We walked down the street between two rows of uniformed men whom we called soldiers, though I suppose they were policemen. This must have been done to protect us, for it was surely known that we boys and girls could do no harm. Back of the rows of uniformed men stood the white people craning their necks, talking, laughing, and making a great noise. They yelled and tried to mimic us by giving what they thought were war-whoops. We did not like this. (Standing Bear, 1933)

To this day many older Indian people are reluctant to talk about their traditional ways, and many middle-aged Indian people who were educated in the boarding school system were literally removed from their tribes and forced to assimilate. Resocialized in often abusive environments, many never learned the older traditions and their native languages. Often, students from western tribes were sent east to the Carlisle Indian School in Carlisle, Pennsylvania, and students from eastern tribes were sent west (e.g., the Nanticokes of Delaware were sent to the Haskell Indian School in Kansas) (Clark, 1997).

Other Indians whose behavior seemed odd or troublesome were sent to the infamous Hiawatha Insane Asylum for Indians, also known as the Canton Insane Asylum, which was the only segregated asylum built exclusively for American Indians in the United States, located in Canton, South Dakota (Hoover, 1997; Iron Shield, 1992; Putney, 1984). This institution was opened in 1902 as the second federal institution for the insane (predated by St. Elizabeth’s Hospital in Washington, DC, now long closed) to provide psychiatric care exclusively to Indian people by an act of Congress, despite opposition from the Department of the Interior and the Superintendent of St. Elizabeth’s Hospital when the bill was first passed by Congress in 1898 (Iron Shield, 1988, 1992). Under the abusive administration of Dr. Harry Hummer, the institution would become the subject of a 150-page report filed by Dr. Samuel Silk in 1929 detailing the abhorrent conditions endured by the patient-residents there.

As a result of Dr. Silk’s report, Dr. Hummer was dismissed, and in December 1933, after further study, the Hiawatha Asylum for Indians was closed and its remaining 71 Indian patients were transferred to St. Elizabeth’s Hospital. Over the 31 years of operation, the asylum housed 370 Indians. There are 121 Indians buried on the grounds of the former asylum; the causes of these deaths are unknown. The asylum was founded “as a place to alleviate the suffering of mentally ill tribesmen from the Indian reservations; it ended as an institution that itself caused genuine human misery” (Putney, 1984). The asylum was turned into a community hospital in the 1950s and is now the Canton-Inwood Memorial Hospital. The Indian burial ground is now located next to the Hiawatha Golf Course, which sits adjacent to the grounds of the asylum in Canton (Iron Shield, 1991, 1994, 1997). Harold Iron Shield is currently leading a movement to identify relatives of those buried at the Canton (Hiawatha) asylum and is seeking to repatriate their remains to their respective tribes, when possible, and to preserve the cemetery as a National Historic Site.

Medical treatment and health care for American Indians was historically grossly inadequate and often seen as antagonistic to traditional Indian medicine ways. There was no supervision of agency doctors, and “not until 1891 were physicians placed in a classified service and required to pass examinations in addition to having a medical degree” (DeMallie et al, 1991). Charles Alexander Eastman, a Lakota Sioux Indian who served as an agency physician at Pine Ridge from 1890 to 1892, observed the practice of government-sponsored medical care. He wrote as follows:

The doctors who were in the service in those days had an easy time of it. They scarcely ever went outside of the agency enclosure, and issued their pills and compounds after the most casual inquiry. As late as 1890, when the Government sent me out as a physician to ten thousand Ogallalla Sioux and Northern Cheyennes at Pine Ridge Agency, I found my predecessor still practicing his profession through a small hole in the wall between his office and the general assembly room of the Indians. One of the first things I did was to close that hole; and I allowed no man to diagnose his own trouble or choose his pills. (DeMallie et al, 1991)

Physicians in the Indian Service had to use their own funds and gifts of money from friends to buy medicines and supplies. Drugs supplied to the Indians were “often obsolete in kind, and either stale or of the poorest quality” (DeMallie et al, 1991). In 1893, Dr. Z.T. Daniel recommended that the procedures for Indian Service doctors be reappraised, modernized, and compiled in serviceable form. He also recommended that an agency physician be sent annually as a representative of the American Medical Association, and he urged that Indian Service doctors be supplied with medical textbooks and medical journals.

In light of the inadequate health care provided to Indian people, it is important to keep in mind the decimation Indian people faced through exposure to Old World diseases. Henry Dobyns (1983) estimated that Native people faced serious contagious diseases that caused significant mortality at approximately 4-year intervals from 1520 to 1900. The pandemics affecting Indian people are often treated by white historians and others as types of “natural disasters,” never intended by Europeans (Jaimes, 1992). However, Indian people are cognizant of their history and remember their oral history in which forms of germ warfare were related to have been conducted in military operations against them. One example often cited was the distribution of smallpox-infected blankets by the U.S. Army to Mandan (Indians) at Fort Clark on June 19, 1837, which was thought to be the causative factor in the smallpox pandemic of 1836 to 1840 (Chardon, 1932; Jaimes, 1992).

The shame caused by decades and centuries of efforts to “civilize the heathen Indian” has taken its toll on our American consciousness. One cannot begin to appreciate traditional Indian medicine ways without a profound awareness at a gut level of how much effort went into the eradication of what is now being perceived as “alternative medicine.” This is the uneasy starting point of understanding traditional Indian medicine. Within this historical context, one can better perceive the basis for many Indian peoples’ objections to the growing “popularity” of their traditional spirituality and healing practices among non-Indians—by the wasicun. This Lakota word described the early white hunter’s propensity to take the fatty, choice portion of the buffalo, and leave the rest to rot. Buechel (1983) translates it as “one who takes things.” This term is still used today to express Indian people’s perception of the narrow, materialistic, and destructive worldview of mainstream white culture. Interest among whites in seeking out “Indian medicine men and shamans” and the resultant exploitation of Indian ceremonies (e.g., buying Indian spirituality in weekend or half-day workshops and seminars, paying fees for sweatlodge ceremonies) have prompted some Lakota leaders to issue a “declaration of war” against such exploitation (Mestheth et al, 1993). There are strong feelings about the contemporary curiosity of whites about Indian medicine ways.

WILLIAM PENN’S ACCOUNT OF TENOUGHAN’S SWEATBATH

One of the earliest accounts of a European observing an American Indian healing ceremony is in William Penn’s Own Account of the Lenni Lenape or Delaware Indians (Meyers, 1970). The account portrays many factors relevant to understanding Indian medicine ways and the quality of interaction of Indian people with Europeans. The portion cited here is Penn’s observation of a Lenape man named Tenoughan involved in a healing sweatbath (Figure 35-4).

I called upon an Indian of Note, whose Name was Tenoughan, the Captain General of the Clan of Indians of those Parts. I found him ill of a Fever, his Head and Limbs much affected with Pain, and at the same time his Wife preparing a Bagnio for him: The Bagnio resembled a large Oven, into which he crept, by a Door on the one side, while she put several red hot Stones in a small Door on the other side thereof, and fastened the Doors as closely from the Air as she could. Now while he was Sweating in this Bagnio, his Wife (for they disdain no Service) was, with an Ax, cutting her Husband a passage into the River, (being the Winter of 83 the great Frost, and the Ice very thick) in order to the Immersing himself, after he should come out of his Bath. In less than half an Hour, he was in so great a Sweat, that when he came out he was as wet, as if he had come out of a River, and the Reak or Steam of his Body so thick, that it was hard to discern any bodies Face that stood near him. In this condition, stark naked (his Breech-Clout only excepted) he ran into the River, which was about twenty Paces, and duck’d himself twice or thrice therein, and so return’d (passing only through his Bagnio to mitigate the immediate stroak of the Cold) to his own House, perhaps 20 Paces further, and wrapping himself in his woolen Mantle, lay down as his length near a long (but gentle) Fire in the midst of his Wigwam, or House, turning himself several times, till he was dry, and then he rose, and fell to getting us Dinner, seeming to be as easie, and well in Health, as at any other time (Surveyor General Thomas Holme’s letter, dated 5th Month [May] 7, 1688, concerning the running of a survey line). (Meyers, 1970)

Figure 35-4 Benjamin West’s painting of William Penn’s treaty with the Indians.

(Courtesy Pennsylvania Academy of the Fine Arts, Philadelphia, gift of Mrs. Joseph Harrison, Jr.)

Penn made this observation when he was on a surveying expedition of the “farthest northern region of his Provence,” which was actually near Monocacy, Berks County, Pennsylvania, today about a 45-minute commute from Philadelphia. The river would be the Schuylkill River, now polluted by a century of industrial contaminants and washoff from coal mines and agriculture farther north. This old account provides a powerful illustration of the cultural chasm that separated Penn from Tenoughan’s world of medicine and health care. This story conveys the tremendous gap in appreciating what was happening during the observation. Penn was intent on buying land from the Lenape people, so it was on an economic venture that he stumbled on a healing bath taken by Tenoughan, a Lenape leader of some stature.

The story provides a model for understanding the complexity and the obstacles that confront non-Indian people, embedded in Eurocentrism, who do not comprehend Indian medicine ways. Penn was struck by the exotic and the unusual nature of the event he witnessed, as well as the apparent efficacy of the sweatbath on Tenoughan, but the observation lacks any description of a real personal encounter between Penn and Tenoughan, although we read that Tenough served dinner for his guests after the sweatbath. As old and as minimally detailed as is this account, it provides a number of important insights into American Indian medicine and health care.

First, the sweatbath was located near Tenoughan’s home. It was familiar—literally in his backyard. Second, the practice included the assistance of a family member, Tenoughan’s wife, who actually prepared the sweatbath for him, carried the red hot stones into the bagnio, and assisted in closing the door securely. Much of Indian medicine is family oriented; it is not something that is done by strangers. Medicine is a family matter; family is intimately involved and plays a significant role in the healing process. Later, Tenoughan’s wife assisted in the arduous task of cutting a path through the ice for the “patient” to plunge into the river. Indian medicine often brings the patient into close interaction with the natural world and the elements. After the sweatbath, Tenoughan rests by the fire in his wigwam, and he then serves dinner to his guests. For many Indian people, stone, fire, air, water, food, spirits, and social and familial relationships are seen as medicine.

CULTURE

Sutton and Broken Nose cite a powerful clinical vignette about how cultural differences can create real tension between the expectations of clinical practitioners from the dominant culture and Indian sensibilities and practices. Although they cite the experience of a social worker sent to run an alternative school program on a Montana Indian reservation, the setting could be any health care or service-oriented setting. The vignette is quoted in the following:

One day I came into work and no one was there. There were no teachers, students, or counselors. At first I thought it was Saturday or some holiday I had forgot about. I checked my calendar and the one the tribe printed to see if it was some special kind of Indian holiday, but it was not. Finally, I went riding around in my car. I saw one of the counselors and asked where everyone was. He said Albert Running Horse had died. I found out later that Albert was one of the oldest men in the tribe and was somehow related to almost everyone at school. When I tried to find out when everyone would be back at work, I couldn’t get a definite answer because they weren’t sure when some of Albert’s relatives would come in from out of state. I was upset because I felt we had been making progress with some particularly difficult cases. I was concerned about the continuity of therapy and the careful schedule we had all worked out. When I expressed my frustration to one of my counselors she just shrugged her shoulders and said we all have to grieve. All I could think of is how am I going to explain this to my superiors. (McGoldrick et al, 1996)

This example illustrates the fundamental difference in worldview between Indian and non-Indian Americans and presents a common clinical dilemma that is likely to occur when mainstream approaches to health care come up against the “natural” approach to healing and human relationships typical among Indian people. Which is the better medicine: following the prescribed treatment plan or attending to the sense of community loss and grief on the death of an esteemed elder? Health care practitioners need to look for ways to affirm and support the values, beliefs, and needs of Indian people. Conversely, these values, beliefs, and needs may well be the same for non-Indian people as well, but be denied in the face of economic expediency. Appreciating the impact of diverse cultures on medical and health care practice is essential and is perhaps the most important thing the health care practitioner needs to address in developing cultural competence with Indian people or with any group not often credited or valued by the larger, dominant culture.

First, the concept of “professional helper/healer” is foreign to traditional Indian peoples and has no precedent in prereservation Lakota society. The idea of paid professionals conflicts with the tradition that helping other people is a social responsibility for everyone, not just for a few. Professional or paid health care practitioners are often viewed with suspicion by traditionalists as governmental agents of forced assimilation. Along with government-sanctioned missionary activity, the legacy of Indian boarding schools, and psychiatric hospitalization, health care professionals were associated with oppressive social structures that were intended to “civilize the Indian.” Thus, a Lakota-centric view of health care starts with the awareness of the power of the institutionalized systems (e.g., social, health care, educational systems) to influence and assert social control, which although aimed at “improved health care” or social well-being, may also reflect and enact the larger, more pervasive oppression of racist attitudes, policies, and procedures for “civilizing the Indian.”

Although no permanent or paid professional “health care providers” were among the Lakota bands or tribes in prereservation days, various individuals, groups, and societies within Lakota bands provided health care to the people. In effect, every tribal member was expected to follow the “natural law of creation,” or the wo’ope, the unwritten natural law that guides Lakota life, which emphasizes unselfishness and generosity. The wo’ope embodies the philosophy of mitakuye oyas’in, which, according to White Hat “is what keeps us together.” It is the knowledge “that we come from one source, and we are all related.” However, to make this work, “we must identify the good and evil in us, and practice what is good” (White Hat, 1997). Lakota philosophy does not separate good and evil, sickness and health, or right and wrong as distinct realities, they coexist in each person, in every creation; even in the most sacred thing there is good and evil. The important thing is to understand that there is the negative and the positive within everyone and everything, and to be responsible in one’s life to live in a good, moral, healthy way, in balance with all creation.

The natural law is the way nature acts. Understanding Lakota philosophy begins with understanding the natural law or the seven laws of the Creator (Iron Shell, 1997; Looking Horse, 1997; Lunderman, 1997). The natural law or the wo’ope required each person to exercise shared values, which, if acted on in one’s life, gave the person as well as the extended family (tios’paye) and the tribe wicozani, which was understood as total or perfect health, balance and harmony, good social health, and well-being (Iron Shell, 1997); it implies physical and spiritual health (White Hat, 1997).

Another orienting value of helpers and healers among the Lakotas is nagi’ksapa or self-wisdom, the awareness of your aura or spirit (Iron Shell, 1997). Albert White Hat, Sr. (1997) translates and explains the nagi’ksapa as “one’s spirit, the wise spirit in a person.” White Hat notes that “the Lakotas are very much aware of the spirit within [us]—we talk to our spirit—we ask our spirit to be strong and to help us in our decisions” and life. Iha’kicikta is the ability to look out for one another. If you move camp, you should be concerned that everyone is going to move together. You want to make sure there is enough water and food for everyone (Iron Shell, 1997). Wo’onsila is the ability to have pity on each other (Iron Shell, 1997). White Hat explains the word as “recognizing a specific need of someone or something, and you address that (specific) need.” According to White Hat, Lakota philosophy does not encourage people to “stay stuck” or dependent. Iyus’kiniya is the ability to go do things with a happy attitude (Iron Shell, 1997). Wi’ikt ceya is the measure of wealth by how little one has; it is the capacity to give to others; it is one’s capacity for self-sacrifice (Iron Shell, 1997). Teki’ci’hilapi is the ability to cherish, esteem, and treasure each other (Iron Shell, 1997). Putting into practice these social values ensured good social functioning.

The primary orientation of traditional Indian medicine was universalistic. Health and welfare resources were made available to everyone through the family and community. Prereservation Lakota society emphasized tribalism over individualism, social harmony over self-interest, and a commitment or loyalty to the people or the larger extended family relations over individual success. Health care functions were accomplished by one’s extended family (tios’paye); it was the extended family that provided for the social support and material assistance of all its members. Wealth was distributed through the practice of the giveaway ceremony (wopila), which is still practiced by traditional Lakotas. This practice ensured that no one person’s or one family’s wealth or resources dominated.

Mental health and physical health were viewed as inseparable from spiritual and moral health. The good balance of the one’s life in harmony with the wo’ope, or natural law of creation, brought about wicozani, or good health, which was both individual and communal. Rather than viewing the individual as a mind-body split, which has influenced much of Western psychiatric thinking, traditional Lakota philosophy viewed the individual person as an unexplainable creation with four constituent dimensions of self. The nagi is one’s individual soul; Buechel (1983) translates the word as “the soul, spirit; the shadow of anything, as of a man (wicanagi) or of a house (tinagi).” The nagi la is the divine spirit immanent in each human being. The niya, or “the vital breath,” gives life to the body and is responsible for the circulation of the blood and the breathing process. The fourth element of the person is the sicun, or intellect (Goodman, 1992, p. 41). Albert White Hat, Sr., however, describes the sicun as “your (spirit’s) presence [that] is felt on something or somebody.” Beuchel (1983) translates the word as “that in a man or thing which is spirit or spiritlike and guards him from birth against evil spirits.” Often a person appeals to his or her nagi la for assistance. This is a power within each person that can help him or her overcome obstacles. When one goes on the hanbleceya, or pipe fast, one leaves the physical world as a nagi.

According to Gene Thin Elk, “We are not humans on a soul journey. We are nagi, ‘souls,’ who are making a journey through the material world” (Goodman, 1992). The nagi la has been described as the “little spirit,” which is the “divine spirit immanent in each being” (Goodman, 1992). Existence in the material world is tenuous for the newborn, according to Lakota philosophy: Edna Little Elk commented, “The most important things for infants and little children are to eat good, sleep good and play good,” and doing so persuades the nagi of the child to become more and more attached to its own body (Goodman, 1992). Traditional Lakota philosophy views abuse, rejection, or neglect as affecting the child’s nagi, which may detach from the child’s body and not come back. In this case, ceremonies are conducted by a medicine man to find the child’s nagi and bring it back (Goodman, 1992). Such a condition has been called soul loss. Thus, good mental or emotional health is intimately related to good spiritual, moral, and physical health; these cannot be separated out. (See the Evolve site for a discussion of Native American herbs and medicinal plants.)

CONTRIBUTIONS OF INDIAN PEOPLE TO MEDICINE AND HEALTH CARE

Despite the fact that Native American people have ancient oral traditions of healing and helping tribal members in need during reservation times, prereservation times, and the traumatic transition periods in between (Douville, 1997a; Lunderman, 1997; Red Dog, 1997), much of the health care literature reviewed focused on practice issues concerning Native American people and viewed them primarily as a special client or health care risk group in need of a specialized approach to treatment (DuBray, 1985, 1992; Garrett et al, 1994; Good Tracks, 1973; Williams et al, 1996). This literature generally treats “Native Americans” as a generic, homogeneous group and does not examine specific tribal traditions or practices of help and healing.

DuBray calls for a more holistic approach to treatment intervention based on Native American (Lakota) practices. DuBray (1992) discusses the use of the vision quest, the importance of food as a symbol of love and respect, the role of cultural healing ceremonies, and the importance of the collective unconscious in Indian experience of reality. The contributions of Native American practices, philosophies, and traditions of help and healing have also been discussed in anthropological studies (Wallace, 1958), rehabilitation medicine (Braswell et al, 1994; Hodge, 1989), nursing (Reynolds, 1993; Turton, 1995), and psychiatric literature (Garro, 1990; Hammerschlag, 1988, 1992; Lewis, 1982, 1990). There is a growing use of traditional medicine ways in alcohol treatment programs for American Indians, both on and off the reservation (Hall, 1985, 1986; Red Dog, 1997; Thin Elk, 1995a, 1995b, 1995c), as well as in health programs for Indian children and youth (e.g., Healthy Nations Program of the Cheyenne River Sioux tribe) (Red Dog, 1997).

The timing is ripe for health care and medical educators to look carefully at how native practices, traditions, and values can shape theory, practice, and policy at a foundational level. This is particularly important as tribal governments develop strategies and responses to welfare reform with the implementation of the Temporary Assistance to Needy Families (TANF) program, which is being met with great concern by many Native American tribal leaders and health care providers (Goldsmith, 1996).

ORIENTING CONCEPTS TO INDIAN MEDICINE

In a report to the National Institutes of Health, Alternative Medicine: Expanding Medical Horizons (1992), the Lakotas (Sioux tribe) were cited for the use of healing ceremonies by specialists who are essentially shamanic in their approach to treatment.(The use of the term shamanic for Native American healers is not ethnographically precise because the term was coined for the peoples of Trans-Siberia, notwithstanding the Bering Strait land bridge of the Ice Age.) Although the report cites key ceremonies and practices used by healers and helpers, the report shows a number of important inaccuracies in addition to the use of the term shaman, which now has been perpetrated throughout the CAM community. To understand Indian medicine ways, one cannot rely solely on written accounts. Although written ethnographical studies may provide a wealth of descriptive data, it is best to talk to authoritative sources personally.

Although the sweatlodge, Sundance, and vision quest are all used by Lakotas for health, help, and healing, not all were always conducted by “medicine women” or “medicine men.” The report tends to project an exclusivity of these ceremonies, when in fact there is considerable variation and scope for these practices, most of which were family oriented (Douville, 1997b).

The sweatlodge or “purification ceremony,” for example, is very common and may be conducted by anyone who has “been on the hill” or completed the hanbleceya, often called the vision quest (Figure 35-5). Although the English name emphasizes the physiological reaction of the sweat, this ceremony of the common man (Lakota ikce wicasa), it is really an encounter with one’s spiritual self and one’s spirit relatives. This is a purification that “gives life” (inipi’kogapi, “that which gives life”) to the participants and represents a form of rebirth. It is a family-oriented ceremony and is an integral part of all other Lakota ceremonies. Participants enter a small lodge made of willow saplings (for support) and covered with heavy, darkening canvas. Between 7 and 16 or more red hot stones are brought into this little lodge, which can be 10 to 15 feet in diameter. The stones represent the “first creation” and have deep spiritual meaning in this ceremony. Water is poured over the stones by someone who is permitted to conduct this ceremony, and the steam from this generates intense heat. There is deep spiritual significance to this.

Figure 35-5 Sweatlodge.

(Courtesy Sinte Gleska University.)

Family members usually participate in this ceremony on a regular basis. Often, sweatlodges are located behind people’s homes. There is a prohibition that excludes menstruating women from ceremonies out of respect for the ceremony the woman’s body is undergoing (i.e., menstruation, which is seen by Lakota people as a purification with its own proper spiritual power). This is often viewed by white culture as discriminatory, but the tradition is not intended to be discriminatory. It is an affirmation of the natural feminine power, which white culture tends to minimize, often viewing menstruation as a handicap or a problem (e.g., premenstrual syndrome).

There are also different types of “medicine” people among the Lakotas. It is difficult to generalize about the diverse functions using the English term “medicine man” or medicine woman.” The Lakotas practiced common medicines that included the use of herbal remedies known to families, whose primary medical care was prevention and geared to building up the immune system (Douville, 1997b). The various common medicines included teas, ointments, and smudging (smoke from burning certain herbs, such as prairie sage or “flat cedar”). This first line of medical care was performed by knowledgeable family members or friends. When required, more spiritual consultations were sought from a shaman medicine man or an interpreter for the wakantanka (the great mystery in all creation), which represents sacred medicine.

A “ceremony” could be requested by the patient and was usually held at night with family members, close friends, and singers (see Figure 35-3). Usually the patient presented a sacred pipe to the medicine man, who would smoke it if he accepted the request. The ceremony (which was usually described as a lowanpi or a spirit ceremony) took place in a darkened room in the home. All furniture was removed, and the windows were covered. Certain ceremonial objects were used (e.g., various-colored flags, tobacco offerings, earth). During the ceremony, the spirits instructed the medicine man or interpreter on what remedies would be provided by Unci Maka (Grandmother Earth) to heal the patient. This process was done with the support of the tios’paye, or the extended family, for the wicozani (good health) of the patient.

Along with these practices, family members actively participated in a ceremonial life that revolved around the wo’ope, or natural law of creation, which included the behaviors and attitudes for right living. The wo’ope is embodied in the philosophy of mitakuye oyas’in, which recognizes that all things, persons, and creations (both animate and inanimate, seen and unseen) are related (White Hat, 1997). These laws were not written down; they were learned through observing the creation. These behaviors for right living were reinforced by the ceremonial life of the extended family system, or tios’paye.

Health care was primarily an extended family matter. Medical care was common and free to everyone who needed it, because the herbs or materials for ceremonies used natural elements that could be harvested from nature’s bounty. Although medical care was “free,” it was not provided without cost, because in Lakota philosophy, when someone gives you something, you are expected to return it at fourfold the value. When treated by healers, the people who received help gave something back. The concept of receiving “something for nothing” is not part of Indian philosophy (White Hat, 1997). The Lakota philosophy encourages self-reliance and mutual relations. Something changed when white man’s medicine became institutionalized in the United States, emphasizing intervention over prevention, the individual over the tribe or extended family, materialism over spirituality, and the physical body-self over the spirit-body-self.