Alcohol use among American Indian adolescents: the role of culture in pathological drinking.

Over the last 20 years, the field of substance use among American Indian adolescents has come to be dominated by survey approaches that are unable to answer important questions about how the use of alcohol and drugs is conceptualized and meaningfully integrated in the lives of Indian teens. Without a model of adolescent alcohol use that incorporates culture, the field misapprehends the social and cultural grounding of both normal and pathological drinking, and cannot accurately differentiate between normal and pathological drinking. Traditionally, the field has relied upon either a biological model or a distress model, thus locating pathology in the biochemistry of ethanol ingestion or in psychopathological distress. However, findings from an ethnographic investigation of alcohol use among American Indian adolescents suggest that the criteria for distinguishing pathological drinking lie, instead, in the developmental and gender-specific expectations that derive from cultural values. Specifically, at a Northern Plains site, teen drinking is judged by whether drinking has begun to interfere with developmental tasks relating to the cultural values of courage, modesty, humor, generosity and family honor. We conclude with suggestions for clinicians and researchers that offer the potential to facilitate the incorporation of culture into research and practice in the field of American Indian adolescent alcohol use.

"Feeling worthless": an ethnographic investigation of depression and problem drinking at the Flathead reservation.

The study of depression, drinking and suicidality has long preoccupied students of American Indian life, in part because of the assumed connection between these specific forms of psychiatric distress and generalized demoralization. Given the significant variation in suicidal behavior and prevalence rates intertribally, this assumption deserves closer attention. Recently, researchers working with Western populations have sought to clarify the relationships among depression, alcohol abuse and suicidality through an explicit investigation of their comorbidity. Using data collected at the Flathead Reservation, this paper explores the degree to which the investigation of the comorbidity of these three disorders can validly reveal the relevant contours of psychopathological distress in a cross-cultural setting. The data show that while the comorbidity of problem drinking and depression can sometimes indicate severe psychopathological distress, measured in this case by suicidality, comorbidity cannot account for another group at high risk for suicide. The discrepancy is explicable with reference to the cultural construction of depression, drinking and suicidality in relation to the creation, maintenance and disruption of social bonds, rather than in relation to an internal state of demoralization.

Psychiatric investigations among American Indians and Alaska natives: a critical review.

This review of psychiatric investigations among Native Americans opens with a discussion of the dominant theoretical perspectives in psychiatric anthropology in order to provide an analytic framework with which to assess the substantive findings of researchers in the field. Studies of culture-specific disorders, service utilization and patient population studies, psychiatric epidemiological studies, and studies designed to test the validity of certain diagnostic instruments are scrutinized for evidence of the nature of the role of indigenous cultures in the manifestations of psychiatric disorders among these populations. The review reveals that a universalist theoretical perspective, which tends to obscure the role of local interpretations in the phenomenology of psychiatric illness, dominates this field of inquiry. Nonetheless, evidence has accumulated which indicates the importance of native understandings for a more reliable and valid explanation of the nature of mental disorder among these peoples. The inadequacies of our current knowledge are examined and suggestions for directions in future work are presented in the concluding section. Recommendations include the direct investigation of the local meanings of the signs, symptoms, and syndromes of Western psychiatry; the concentrated search for potentially unique and powerful local signs of distress; and the study of the culturally-constituted social processes of illness.