Essentials of Complementary and Alternative Medicine (June 1999)

CHAPTER 13. N
ATIVE
 A
MERICAN
 M
EDICINE
Ken “Bear Hawk” Cohen
Background
 
Definitions: Who is Native American?
 
Transcribing the Ineffable
 
Review of Literature
Etiology of Health and Disease
 
Health and Wholeness
 
Untreatable Conditions
 
Disease Labels: What's in a Name?
 
Internal and External Causes of Disease
Diagnosis and Divination: The Realm of Spirit
 
Diagnosis
 
Divination
Sacred Technology: How Medicine People Practice Healing
 
Prayer and Chanting
 
Music
 
Smudging
 
Herbalism
 
Laying on of Hands
 
Counseling
 
Ceremony
 
Other Healing Sources
 
Duration of Therapy
Organization
 
Lifelong Training
 
Payment for Services
Prospects for the Future
Chapter References
Now! Long Person [a river or stream], I have just come to pray to You.
Wahya hi:nadu! [Wolf thunder]
Now! You will “remake” my soul.
It will become longer.
I will rise again.
Wahya hi:nadu!
I will be greeting You with my soul!
—C
HEROKEE
 H
EALING
 C
HANT
 (
1
)
BACKGROUND
Definitions: Who is Native American?
Native American medicine is based on widely held beliefs about healthy living, the repercussions of disease-causing activity or behavior, and the spiritual principles 
that restore balance. These beliefs cross tribal boundaries. However, the particular methods of diagnosis and treatment are as diverse as the languages, landscapes, 
and customs of the approximately 500 Nations that constitute the indigenous people of Turtle Island, one of the original names of North America.
Therefore it is important to state, from the outset, that there are problems inherent in the term  Native American, because it implies a uniform culture and healing 
system. The indigenous people of North America identify themselves by Nation (commonly called tribe
1
), band or community, clan, and family. The term Native 
American
2
 became a political necessity—a way for similarly oppressed people to identify their unity in a fight for common rights in the face of the encroachment of 
white military, religious, and educational imperialism. In precontact times (i.e., prior to the arrival of the Europeans), a Native American might identify himself as  Yonah 
Usdi (Little Bear), an  Ani Wahya (Wolf Clan)  Ani Yunwiya (Cherokee) from the town of Kituhwa (near present-day Bryson City, North Carolina). Today, he might add 
the name of his reservation.
The healing traditions of the Native Americans have been practiced on this continent since the Clovis Culture at least 12,000 years ago (
2
), and possibly for more 
than 40,000 years (
3
). Esteemed scholar Vine Deloria, Jr. points out serious loopholes in the commonly accepted theory that Native Americans migrated from an 
original homeland in Siberia over ancient glacial passes in the Bering Straits (
4
). Native American traditions were probably influenced by migrating peoples, as they 
were by waves of ocean-faring Asians (
5
) and, perhaps, Vikings, Celts, or other Europeans (
6
). However, cultural influences and parallels do not confirm cultural 
diffusion any more than the presence of animals in the cave paintings at Lascaux and at Newspaper Rock, Utah, prove that the artists at the American petroglyph site 
were French Neanderthals. According to one school of Native American oral history, Native Americans crossed the Bering Straits  from North America, and being 
unappreciative of the lack of civilization in that New World, crossed back again to return home. To Native Americans, the fact that no pre- Homo sapien hominid 
skeletons have been discovered in North America merely confirms their own stories of creation and emergence; to declare otherwise would be as much an 
assumption of cosmological and theological truth as scientific.
Antiquity is not the only reason for the wealth of Native American healing traditions. Other explanations for healing diversity include:
The migration of tribes and cultural and intellectual exchange among tribes along established trade routes (
7
)
The lack of either precontact literature or churches to rigidify the forms of healing
The acceptance of personal innovation by visionaries and healers (
8
)
Adaptive postcontact strategies of healing (e.g., Native American Church [
9
], Indian Shaker Church [
10
], and various synergies of allopathic and traditional 
Native American healing [
11
, 
12
]). Native American healing is open ended and still evolving. Complementary medicine is a well-accepted principle among Native 
Americans. White man's diseases—“the diseases of civilization”—often require white man's medicine. Native Americans are pragmatic and down-to-earth in 
more ways than one.
Transcribing the Ineffable
Many aspects of Native American healing have never been put to paper and never will. At some healing ceremonies, individuals are appointed to protect the grounds 
from cameras, recorders, notebooks, and uninvited guests. Seneca elder Twylah Nitsch remembers that during her childhood, when anthropologists were spotted 
nearby, her grandfather, a respected medicine man, would tell the family, “Hide the sacred things, the Bigheads are coming!” (personal communication, 1984). Many 
aspects of Native American healing are still closely guarded oral tradition. Specific techniques of healing, sacred songs, and healing rituals are received directly from 
elder healers, from spirits encountered during vision quest, and as a result of initiation into secret societies. To share healing knowledge indiscriminately is to weaken 
the spiritual power of the medicine (
13
). There is also a real danger that a medicine person, succumbing to the curiosity of anthropologists, social scientists, or others 
whom the community defines as “outsiders,” will be ostracized by his or her own community. He or she may be perceived as contributing to the exploitation of Native 

culture.
Yet after five centuries of Red-White interaction, a tremendous amount has been and will continue to be written in books. Native Americans recognize that 
transcribing healing beliefs and practices may preserve tradition for their own future generations. Today, many Native American healers are willing to engage in 
dialogue with physicians, other health care professionals, or interested students outside of their culture if these individuals approach them respectfully and 
unpretentiously, motivated by a common concern to relieve human suffering and recognizing that no culture has a monopoly on healing. Increasing numbers of Native 
American physicians and nurses are stimulating important cross-cultural insights and prospects for collaboration (
14
, 
15
).
Many Native American healers believe that sharing healing ways may be a matter of survival. Indigenous healing traditions and ecology-based values may help 
people prevent the widely prophesied “Purification” of warfare and “earth changes”—i.e., natural catastrophes as divine retribution for environmental destruction (
16
).
Review of Literature
Because of the interface between Native healing, spirituality, and culture, the volume of published works about Native American healing is immense. Vogel's 
American Indian Medicine (
17
) and Beck and Walters'  The Sacred (
18
) are important surveys of various Native healing traditions. The “dark side of the 
force”—malevolent sources of misfortune—are covered in Walker's  Witchcraft and Sorcery of the American Native Peoples (
19
). Eliade (
20
), Kalweit (
21
), and 
Krippner and Welch (
22
) offer cross-cultural perspectives on the relationship between Native American culture and shamanism. The latter work is especially valuable 
for its discussion of contemporary practitioners and strategies for integrating spiritual healing into psychotherapy, nursing, and medicine. The role of dream and vision 
seeking—a major source of empowerment and innovation among healers— is carefully analyzed in Irwin's  The Dream Seekers: Native American Visionary Traditions 
of the Great Plains (
8
). Healing is a central theme of the approximately 250,000 member Native American Church (
9
, 
23
) and other intertribal spiritual traditions, such 
as the Indian Shaker Church (
10
, 
24
).
Interpretive studies of the healing traditions of particular Native nations can be found in Bahr (
25
), Hines (
26
), Jilek (
27
), Lewis (
28
), Miller (
29
), Mooney (
30
), Powers 
(
31
), and Sander (
32
). Native American botanical medicine is surveyed in Vogel (
17
) and Moerman (
33
). Herbal traditions of specific nations are discussed in many 
works, notably Cochran (
34
), Croom (
35
), Curtin (
36
), Densmore (
37
), Herrick (
38
), Gunther (
39
), Gilmore (
40
), Hamel (
41
), Hungry Wolf (
42
), and Tantaquidgeon 
(
43
). Indigenous herbalism has also influenced popular EuroAmerican writers on herbal medicine; among the most useful for the clinician are those by Moore (
44
, 
45
). 
A great deal can be gleaned from the biographies, autobiographies, or works about Native American healers: Bear Heart (
46
), Black Elk and Lyon (
47
), Boyd (
48
, 
49
), 
Horse Capture (
50
), Jones (
51
), Lake (
52
), Lame Deer and Erdoes (
53
), Mails (
54
, 
55
), and Yellowtail (
56
). Indigenous healing is also explored in  Shaman's Drum: A 
Journal of Experiential Shamanism (
57
). Winds of Change magazine (
58
), published by the American Indian Science and Engineering Society, provides an excellent 
forum for discussion of Native American views of science, education, and culture. Readers are also directed to the journals  Akwesasne Notes (
59
), News from Indian 
Country (
60
), and the publications of individual Native nations for a broader understanding of the concerns of Native people today.
From the Western scientific perspective, Native American healing is documented only in scattered anecdotes and observations. Native healing methods have not 
been tested in controlled experiments, nor is this likely to change in the near future. It is impossible to administer “standard doses” in practices that may change from 
healer to healer and from case to case. Therapeutic methodology and outcome are generally not written down and are known only to individual healers or their close 
associates. In any case, unmeasurable and nonspecific factors so often outweigh the measurable and specific that it may be impossible to draw accurate conclusions 
about the efficacy of Native healing from the perspective of Western empirical science. Additionally, many Native Americans are suspicious of the motives of 
scientists. The results of research may serve political and economic ends that are not in the best interests of the Native American people. Physicist F. David Peat (
61
) 
and a former director of the Indian Health Services, Everett R. Rhoades, M.D. (
62
), offer stimulating overviews of the possibilities for dialogue between indigenous 
and Western science.
ETIOLOGY OF HEALTH AND DISEASE
Health and Wholeness
According to Native American medicine, a healthy person has a sense of purpose and follows the “original instructions”—i.e., the guidance written in the heart by the 
Great Spirit. He or she is committed to walking a path of beauty, balance, and harmony, keeping a Good Mind (Iroquois concept), good thoughts towards Creation. 
The essence of a healthy life—the Good Red Road, as some Native Americans call it—is gratefulness, respect, and generosity.
A basic principle of Native American culture is  wholeness. According to the Native American spiritual leaders gathered at the University of Lethbridge, Alberta, in 
1982, “All things are interrelated. This connectedness derives from the reality that everything is part of a single whole which is greater than the sum of its parts. Hence 
any given phenomenon can only be understood in terms of the wholeness out of which it comes” (
63
). The ultimate source of this wholeness is known by many 
names: Kitchi Manitou (“the Great Mystery,” Ojibway), Wakan Tanka (“the Great Sacred” or “Great Spirit,” Lakota),  Acbadadea (“Maker of All Things Above,” Crow), 
Shongwàyad hs:on (“the Creator,” Iroquois), or simply, God. The manifestation of divine spirit in living beings is life force, or divine breath; known as  ni in Lakota 
(
64
), nilch'i in Navajo (
65
), this concept is common to virtually all indigenous cultures. In 1896, Long Knife, a Lakota holy man, told physician James R. Walker, “A 
man's ni is his life. It is the same as his breath” (
66
).
Health “can only be understood in terms of the wholeness out of which it comes” (
63
). Thus, health and disease always have both physical and spiritual components. 
Speaking of Iroquois notions of disease etiology, Herrick writes, “Because each causal agent is thought to be influencing the balanced, yet constantly fluctuating life 
force of the individual, there is necessarily the element of spirituality involved in the treatment and diagnosis of  all illness” (
13
). Health means restoring the body, 
mind, and spirit to balance and wholeness: the balance of life energy in the body; the balance of ethical, reasonable, and just behavior; balanced relations within 
family and community; and harmonious relationships with nature.
Untreatable Conditions
Native American medicine, unlike Western medicine, tends to consider disease in terms of morality, balance, and the action of spiritual power rather than specific, 
measurable causes. Native American medicine is based on a spiritual, rather than a materialistic or Cartesian, view of life.
Native Americans believe that inherited conditions, such as birth deformities or retardation (including fetal alcohol syndrome), may be caused by the parents' 
unhealthy or immoral behavior and are not easily treatable. Native healers believe that, among adults, some diseases are the patient's responsibility and the natural 
consequence of his or her behavior; to treat these conditions may be to interfere with important life lessons. Similar to all health care providers, Native American 
healers encounter patients who, unfortunately, are unwilling to ask for help when needed. Native healers are bound by their professional ethics not to “missionize” 
healing, advertise their healing abilities, or in other ways coerce a patient to accept their services. In a certain sense, the  cause of a patient's ongoing disease may be 
his or her own stubbornness. However, if the patient is incapable of asking for help—a child, a person with Alzheimer's or mental incapacity, a coma patient—then the 
healer must ask his or her own intuitive sources of guidance whether he or she should help; this permission may be granted by  Spirit, a concept that embraces the 
human spirit, the spirits of the natural world, and the Great Spirit.
Some illnesses are not treated because they are considered “callings,” or diseases of initiation: physical and spiritual crises engendered by the breakdown of 
previous ways of being or by the acquisition of guardian-spirit power. Seneca elder Twylah Nitsch remembers “dying” as a young child. She suddenly and inexplicably 
stopped breathing. She was revived when her grandfather, the medicine man Moses Shongo, breathed on her to infuse her with healing power (personal 
communication, 1984). Similarly, Native healer Medicine Grizzlybear Lake (
52
), who offers one of the few detailed first-person accounts of medicine initiation and 
training, describes two death experiences, one from illness (rheumatic fever, polio, and pneumonia) and one from drowning, which occurred at ages four and nine. In 
both cases, he was healed when elderly Native spirits “doctored” him with songs, dance, smoke, and healing power represented by the bear. Lake explains, “The 
calling comes in the form of a dream, accident, sickness, injury, disease, near-death experience, or even actual death” (
67
). In the Pacific Northwest “power sickness” 
is caused when a spirit power pities someone who is sick, sorrowing, or in need of initiation (
68
). The spirit possesses the person and manifests in symptoms of 
“restlessness, fainting spells, uncontrollable crying, heavy breathing, sighing and moaning” (
69
). The illness is resolved when a shaman initiates the person in the 
winter spirit dance tradition, teaching him or her how to “bring out” the power through song and dance.
Many Native healers believe that people learn to heal best the conditions that they have experienced. When Cherokee elder Keetoowah Christie was questioned 
about becoming a medicine man, he replied, “I wouldn't wish that curse on anyone” (personal communication, 1978). He explained that during his life he had suffered 

from typhoid fever, emphysema, prostate cancer, heart disease, and spinal injuries.
Disease Labels: What's in a Name?
Many Native disease labels can only be understood within the context of their originating culture. For instance, in the Piman healing system (
25
), noxious substances, 
such as germs, heat, or pus, wander through the body and cause “wandering sickness” which is observed in symptoms such as skin sores, fever, and hemorrhoids. 
Wandering sickness generally is treated with herbs. The other major disease category among the Pimans is  ka:cim, or “staying sickness.” Staying sickness is the 
consequence of behaving improperly towards dignified, powerful, and potentially dangerous objects (e.g., hunting or killing an animal in a cruel or thoughtless 
manner, or using wood from a lightning struck tree).  Ka:cim “stays” in the body because the person has broken the established order, the sacred laws given to Pimans 
by the Creator. A patient afflicted with  ka:cim may demonstrate erratic, lethargic, or disturbed behavior and is returned to wholeness by appealing to the dignity and 
power of the object or animal offended. The shaman-healer sings and uses the mouth to literally blow in spiritual power or suck out pathogenic forces. He or she may 
also administer herbs.
Internal and External Causes of Disease
Disease etiology and diagnostic labels vary from tribe to tribe. However, it is possible to analyze many diseases in terms of two broad and interrelated categories: 
internal and external causes (
Table 13.1
).
Table 13.1. Causes of Disease
I
NTERNAL
 C
AUSES
According to the Cherokee medicine man Rolling Thunder, the major internal cause of disease is negative thinking:
Negative thoughts about oneself: shame, despair, worry, and depression
Negative thoughts about others: blame, jealousy, anger
According to Nootka healer Johnny Moses, “No evil sorcerer can do as much harm to you as you can do to yourself” (personal communication, 1991). Seneca elder 
Twylah Nitschemphasizes the dangers of self-doubt. When personal gifts—“medicine” in Native terminology—are not used, they rot inside, causing sickness. 
“Healing,” says Mrs. Nitsch, “is sometimes not a matter of taking something in—an herb or other medication, but of letting something out, having the confidence to 
express yourself” (personal communication, 1985). Native American healers frequently practice dream interpretation to help a patient discover repressed feelings; 
unfulfilled needs; or messages from spiritual helpers ( totems, an Algonquin term) that suggest new, healthier ways of behaving. Early Jesuit missionaries were so 
impressed by the Iroquois devotion to dreams that they said, “The Iroquois have, properly speaking, only a single divinity—the dream” (
70
). Native healers, like their 
colleagues in conventional Western medical practice, believe that psychological distress can cause or make one more susceptible to disease.
Negative thinking is a form of self-centeredness. “People get wrapped up in the past and in their thoughts about the past,” says Cherokee healer Hawk LittleJohn, 
“like a squirrel with a very long tail running through the woods and getting caught in the brambles” (personal communication, 1996). Rigid, obsessive thinking is 
frequently a sign of prioritizing one's own needs over those of the family, community, or natural world. Self-centeredness creates greed, stinginess, and wastefulness. 
The self-centered person hoards possessions instead of sharing or giving them away. Interestingly, in Native American communities, a person has a higher status if 
he or she has given more. An important life event—a birth, a naming, a healing, a good dream—is honored by the “Giveaway” ritual and feast, in which possessions 
are redistributed in the community. The honored healer often has the least and lives the simplest, most frugal life. In essence, self-centeredness is a definitive sign 
that one is negligent in following the original instructions.
E
XTERNAL
 C
AUSES
External causes of disease are pathogenic forces that invade the body, mind, spirit, or all of them. Native American medicine does not reject the theory that microbes 
can cause disease (
71
). “Germs are also spirits,” says a Lakota colleague Shabari Bird (personal communication, 1986). Like “harmful intrusions,” the subtle spiritual 
pathogens popularized in anthropological literature, germs take hold if the patient is susceptible because of the interplay of imbalanced living, negative thinking, and a 
feeble constitution. Native healers also recognize that in today's world, physical, environmental, and emotional stress also increase susceptibility to disease-causing 
agents. Thus the category external cause is relative and not absolutely distinguished from internal causes.
Negative Thoughts by Others
A loving, supportive family can greatly aid a person in recovery from disease. Loving thoughts and prayers have healing power, whether or not a patient is consciously 
aware of their existence. Conversely, negative thoughts of others, expressed or unexpressed, can cause disease. As Larry Dossey, M.D., implies, a physician who 
labels his patient  terminal may be creating a self-fulfilling prophecy, which is the essence of a hex (
72
). In Native tradition, the hex is considered more than a nocebo 
effect (i.e., the power of negative expectation). It is transcendent power used for evil purposes, transpersonal imagery
3
 that harms rather than heals. Hawaiian 
tradition recognizes both kahuna lapa'au, healers who use methods such as herbs, prayer, touch, and love ( alo-ha) to heal, and kahuna ana'ana, who pray people to 
death (
73
). In traditional Cherokee culture, healers, called  dida:hnvwi:sg(i), “curer of them, he,” have the ability to “conjure,” that is, pray, a person into a state of 
health with the aid of invocation and tobacco
4
 rituals. His antithesis, the sorcerer who uses knowledge and prayer for personal, unethical ends, is the  dida:hnese:sg(i), 
“putter-in and drawer-out of them, he.” The dida:hnese:sg(i) projects negative forces (perhaps disease-causing spirits that personify negative thoughts) or removes life 
energy from the victim (
74
). In many native societies, it is believed that sorcerers use physical objects to cast spells: stones; herbs; charms; or pieces of clothing, hair, 
or nails from the intended victim. Sorcery practices have been carefully documented in anthropological literature (
19
).
However, not all malevolent, pathogenic forces are products of human intent; some are encountered capriciously. Sorcerers, diseases, storms, the dead, certain 
charms, objects, events, or places may radiate evil influences, called utgo
n
 in Seneca. Merely being in the presence of these pathogenic forces can cause discomfort, 
pain, or disease.
Environmental Poisons
Environmental poisons cause disease by clouding the mind, weakening the spirit, and polluting the breath (the energy of life). Environmental poisons include impure 
air, water, and food. Unnatural foods (e.g., processed, contaminated, or not grown locally) have affected Native American health since the advent of government food 
rations and the loss of traditional fishing, hunting, foraging, and farming grounds. There is evidence that both Native Americans and European-Americans are 
genetically ill-adapted to assimilate the macronutrient ratios presented by the modern diet, particularly the increase in fat and refined carbohydrates (
75
). Alcohol has 
had a dramatic and devastating effect on the Native population. “Spirits” are antagonistic to Native American spirituality and, according to the elders, drive totems 

away, causing the mind to become disturbed and delusional. The most successful programs to treat this problem in Native communities are combinations of Western 
counseling, social work, and traditional Native American healing (
76
, 
77
).
Physical and Emotional Trauma
Physical and emotional trauma or shock cause illness by engendering psychological distress, loss of spiritual power, loss of soul, or all of them. For example, the 
psychological confusion and disorientation commonly experienced by head-injury patients, especially after a car accident, is a sign that identity is shattered, or the 
spirit is no longer whole. In accord with the metaphysics of Western psychotherapy, dissociated or repressed aspects of the self are believed to be hidden in the 
unconscious. In both Native American tradition and shamanism in general, these soul-fragments are commonly believed to be lost in inaccessible dimensions of a 
larger, alternate reality, a “lower world” that may include ancestors or spiritual beings (
78
, 
79
). Insight “talk-therapy” may be ineffective, because the healer is only 
talking to a conscious fragment of the original self, not to the part in need of integration. The Native healer must use ritual (
29
), physical gestures (e.g., blowing breath 
[
80
] or tobacco smoke [
81
] on the diseased area), or laying on of hands (
82
, 
83
) to physically return soul and power to the patient.
A shocking experience can cause the sudden loss of spiritual and personal power (including sense of control over one's life). Conversely, loss of power, perhaps 
resulting from negative thinking or childhood trauma, can make one more prone to accidents and misfortune. A balanced and harmonious lifestyle attracts the 
presence of guardian spirits that ensure improved decision making and transpersonal protection from injury.
Breach of Taboo
Breach of taboo, a frequently cited Native American category of disease etiology, has a much broader meaning than the violation of cultural mores. According to the 
Yup'ik people of southwestern Alaska, “People brought on disease by transgressing the rules for living, and only through correcting or confessing their offenses could 
they hope to heal their bodies” (
80
). These transgressions include neglecting to demonstrate proper respect towards an animal, person, place, event, object, or spirit. 
For instance, Native Hawaiians believe that certain  heiaus (“power places”) are kapu, or forbidden, to non-Hawaiians; these places are guarded by ancient spirits that 
can cause disease or misfortune to transgressors. Some tribes believe that powerful animals, such as the bear, must be addressed by special names, lest their spirits 
be offended (
84
). Totems are offended when their advice is not heeded or when a person is indiscreet in sharing the guidance they offer in sleeping or waking dreams 
(
85
). Discretion means not boasting or showing off and, sometimes, not revealing the identity of a dream helper.
Cruel words, abusive behavior, and violence are also taboo violations, causing disease in the person, community, and Nation. According to the Code of Handsome 
Lake, a major religion among the Iroquois, the Creator's law is broken when married people do not love and care for each other and their children or when they desert 
one another (
86
, 
87
). Ignoring the taboo against being in proximity to or eating food prepared by a menstruating woman can cause discomfort, weakness, pain, or 
disease; this result is not because menstruating women exude evil  utgo
n
, as some anthropologists believe (
88
). Instead, the taboo, widely accepted by Native men 
and women, is a recognition that women are more powerful during their “moon time”—engaged in their own cyclic ceremonies of purification as preparation for 
childbirth. The isolation of menstruating women and, in many tribes, their period of retreat and meditation in separate “moon lodges,” is a custom established by 
women to improve the physical, mental, and spiritual health of themselves and their communities (Lakota elder Grace Spotted Eagle, personal communication, 1984).
Healers have even more rules of conduct to follow than patients and can become ill because of improper care of ceremonial objects or errors in the performance of 
ritual. Because healers work with strong healing powers, small mistakes can have serious health consequences.