Visions Journal

Evan Adams, MD, MPH & Warren Clarmont

Reprinted from the "Indigenous People" issue of Visions Journal, 2016, 11 (4), p. 7

Dr. Evan Adams on the medicine of resilience

"Each generation of scientists stands upon the shoulders of those who have gone before," a Nobel Prize–winning physicist once said, referring to how knowledge and skills are built and improved upon, generation by generation.¹ This is true of any profession, and it's even truer in our personal lives. From our families of origin, we learn foundational life skills and ways of coping, inherit genes and knowledge, and much more. In this way, we figuratively stand on their shoulders as we keep building upwards. But what happens when the "shoulders" of one generation have been damaged by devastating experiences? How much does this damage matter to the success of future generations? And are there ways to mitigate the damage?

Some think that historical trauma, defined as "a cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma,"² dictates one's destiny. At the other end of the spectrum, there are those who dismiss historical trauma as “in the past” and consider personal responsibility paramount. The First Nations Health Authority takes a more balanced approach, acknowledging the damaging impacts of trauma on health while having great faith in the healing powers of resilience and cultural, spiritual and traditional knowledge and medicine. So we wholeheartedly believe that our vision for "healthy, self-determining and vibrant BC First Nations children, families and communities"³ can become a reality in spite of experiences of trauma.

For me, this belief is bolstered by the fact that I know many First Nations people who have managed to move past horrific trauma and live healthy lives. For example, when I was five, I saw my eight-year-old sister accidentally shot by a teenager who was playing with a gun. That incident, and my mother's subsequent long-term depression, greatly impacted my family. My mother had been through residential school, so she already had a lot to deal with emotionally. Now that I have children of my own, I understand her grief. My father was strong despite his pain; he had been raised on the land, traditionally, and had not attended residential school. He pushed us all to look forward, work hard and be strong. Today, my three sisters, my brother and I are all in the helping professions, and my parents have been married for more than 50 years. So we are blessed to have experienced the “medicine of resilience” in overcoming trauma.

There is a growing body of research on how resilience—the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress—is actually a life skill that helps people persevere and become healthy and well. In fact, a recent Harvard health blog about resilience called it a "mind-body medicine that reduces the need for health care."⁴ And happily, research has also found that resilience can be taught, learned and cultivated—it is not something that only the lucky or the brave possess. Ways to cultivate resilience include:

• focusing on the positive, maintaining a hopeful outlook

• making meaningful connections with others

• keeping things in perspective (not viewing crises as insurmountable)

• meditating, praying and other spiritual / cultural practices

• exercising, including walking in nature

• being adaptable and accepting that change is a part of living

• moving toward goals and taking decisive actions

At the First Nations Health Authority, we are paying close attention to this exciting research on resilience—especially given that other research, on trauma, has found abundant evidence that our lifetime emotional experiences profoundly impact us and are primary factors in myriad physical and mental illnesses, including addictions, depression, cancer, heart disease, Type 2 diabetes, PTSD, and more.⁵

One expert on addictions and stress, Dr. Gabor Maté, believes that disease in an individual "always tells us about the multigenerational family of origin and the broader culture in which that person's life unfolds."⁶ In other words, our grandparents' and parents' experiences affect us. For Indigenous peoples in Canada, intergenerational trauma is rooted in imposed social and legal injustices in the form of racist, colonial and genocidal policies such as the Indian Reservation System and the Indian Residential School System. These injustices are documented extensively in the report of the Royal Commission on Aboriginal Peoples/RCAP (1996)⁷ and the report of the Truth and Reconciliation Commission of Canada/TRC (2015),⁸ among others. These reports also document the consequences of these injustices, including geographic isolation, lack of opportunities, poverty, brokenness, and poor health outcomes.

Despite our traumatic collective past, First Nations people have shown incredible resilience and are making great strides to heal. The First Nations Health Authority is here because of those who have gone before us; we are standing on the shoulders of advisory bodies like the RCAP and the TRC, and we are a manifestation of many years of work on the part of First Nations toward self-governance, including establishing our own health care services and cultural supports. The motto of the First Nations Health Authority is, in fact, "Nothing about us without us." Together we work with, and on behalf of, BC First Nations, guided by our past experience, our present awareness and our future vision for First Nations health and self-determination. We know we are better together. And while we know that the path forward is long, winding and uphill, we also know that First Nations people are strong and well able to rebuild what has been damaged. Together, we can repair and restore the foundations of past generations so that our beloved children, the next generation, have something to stand on as they continue to build upwards.

Warren Clarmont on the role of Friendship Centres in Indigenous healing

Beginning in the early 1960s, with changes to the federal Indian Act and with the release of reports like that of the Truth and Reconciliation Commission in 2015,⁸ the impact of residential schools and colonization on Indigenous people has become an issue of more immediate concern to non-Indigenous people. Amendments to the Indian Act enabled First Nations people to leave their reserve without written permission from the government-appointed Indian agent. This led to a mass migration of First Nations people from reservations to towns and cities across British Columbia as they sought education, employment, clean drinking water and other amenities, or fled violence and trauma at home, taking the opportunity to make a new life.

Many Indigenous people carried significant trauma with them, as a result of violence and abuse experienced at home, passed on by parents and family members who were residential school survivors; with a lack of settlement supports and an unfamiliarity with urban life, Indigenous people often ended up on the margins of society. This is nowhere more evident than in places like the Downtown Eastside of Vancouver, where a disproportionate number of Indigenous people have ended up after leaving their home communities. Many have dealt with, and continue to deal with, their trauma by using drugs and alcohol and by engaging in other self-destructive behaviours, which have had dire consequences, including incarceration, poor health, even death.

To address this reality, Indigenous people formed their own gathering places in towns and cities, often in the basements or houses of those who could afford them. It was in these gathering places that Indigenous people found familiarity and a sense of family, where they could gather and work together to settle and build a life in this new environment. Soon these gathering places evolved into non-profit service organizations that catered to Indigenous people moving into BC's urban centres. These non-profit organizations became known as Aboriginal Friendship Centres. Their mission was to improve the quality of life for Indigenous people through the provision of programs and supports, while maintaining their original identity as gathering places. This collective soon formed an association in 1982 called the BC Association of Indian Friendship Centres, which later became the BC Association of Aboriginal Friendship Centres (BCAAFC). The purpose of this new association was to support collective negotiations with the federal and provincial governments and act as a unifying body for all member Friendship Centres.

Today, over 50% of status First Nations live off-reserve and in towns and cities. If we include non-status First Nations and Métis peoples in the total population, the off-reserve figure increases to 65-70%. The challenges for these individuals remain the same, however, and are in fact more pronounced than they are for individuals who live on-reserve due to racism and mainstream society’s perception that Indigenous people receive "entitlements." Aboriginal Friendship Centres have evolved over a number of decades to meet an increased demand for services and settlement supports due to this migration of Indigenous people. Friendship Centres also act as a bridge between Indigenous and non-Indigenous peoples in BC, creating awareness of the issues facing Indigenous people and creating partnerships with mainstream organizations and community entities with similar mandates.

Healing intergenerational trauma remains a core tenet of the work of Friendship Centres, in addition to their role as "hubs of reconciliation" between Indigenous and non-Indigenous people. From the perspective of Friendship Centres, supporting the health and well-being of Indigenous children and families is the solution to breaking the cycle of intergenerational trauma. Increased resilience and decreased dependence is the desired state for all Indigenous people; working together with non-Indigenous people through reconciliation is the means to achieve this.

The BC Association of Aboriginal Friendship Centres, in partnership with the First Nations Health Authority and other organizations in the province, is committed to this work of healing—and optimistic that together, we will succeed. Supporting Indigenous people, wherever they live in BC, is not only the right thing to do—it benefits all British Columbians and Canadians as well.