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“invited to your own wake”: marginalization (and health)

December 3, 2009

The posts I wrote yesterday got me thinking about marginalization–particularly of indigenous people, but certainly not stopping there. The specifics may be different, but marginalization is marginalization.

It occurred to me that my automatic perception that nobody else–save, perhaps, some very few people in similar boats–will be interested in reading what I have to write about a lot of topics comes straight from marginalization. Women’s issues, disability-related issues, neurodiversity, my particular set of racial and ethnic interests, how I see history and the ways of thought behind what’s happened in the world still playing out, human rights concerns for goodness’ sake: all these and more are marginalized. We’re supposed to think that they’re irrelevant, and nobody else is interested. We’re supposed to think that any interest we do have in these things is unusual, maladaptive, and very possibly crazy.

I was struck by the evidence of marginalization again, looking for various Native American–especially urban Indian, almost 2/3 of us now–health statistics for the Schizophrenia, epidemiologists, and race? Not a good mix. post.

What did I find?

It’s hard to tell how they get those figures other than for suicide rates, since “Native Americans are routinely omitted from many studies. Two major US prevalence studies—the Epidemiologic Catchment Area Study 1 and the National Comorbidity Survey 2—do not report data on Native Americans, or indicate that statistics on this group are difficult to specify (Duran et al., 2004). In the National Healthcare Disparities Report, only 42% of the measures could be used to assess mental health disparities among Native Americans (Moy et al., 2006).”# We are not even supposed to be around anymore, so there’s no need to study our health. If that’s not marginalization, I don’t know what is.

From the excellent Reconceptualizing Native Women’s Health: An “Indigenist” Stress-Coping Model, which helped me make an awful lot of connections when I read it a couple of years ago:

There are few comprehensive reviews of Native women’s health (e.g., Kauffman and Joseph-Fox1 and Joe11)…

However, Native women have higher death rates due to diabetes (45.4 vs 22.4), all types of accidents combined (38.1 vs 22.0), motor vehicle accidents (22.7 vs 10.5), chronic liver disease and cirrhosis (20.5 vs 6.1), alcohol abuse (20.3 vs 3.5), and suicide (5.2 vs 4.4). Native women are second only to African American women in terms of death rates due to homicide (4.8 vs 9.0) and drug abuse (4.7 vs 4.8).

So, again, most of the information available concerns our deaths. “The only good Indian…” lives on, if by now it’s morphed into “The only Indian…”, period. It’s harder to pretend a dead body is not right in front of you.

High rates of psychiatric problems and related comorbidity have been reported in many Native communities (with frequency estimates ranging from 20%–63% of adult populations), often higher than rates exhibited by non-Native groups. 20 Depression is among the most prevalent psychiatric disorders in Native communities,21 and it has been associated with living in urban areas and with substance abuse.22,23…

Although more than 60% of Natives live in urban settings, only a handful of studies provide any relevant data on the health-related concerns of such individuals, and none, to our knowledge, have focused specifically on women…

Absent a fourth world context, interpreting epidemiological data such as these leads to problematic interpretations of Native women’s health statistics. As noted by Browne and Fiske,27 failure to account for socioenvironmental contexts can lead to pathologized perceptions of Natives, reinforce power inequities, and perpetuate paternalism and dependency in regard to health care.28 Many of the behavioral health problems (e.g., diabetes, alcoholism) of Native women are directly connected to their colonized status and to associated forms of environmental, institutional, and interpersonal discrimination.

So, researchers don’t actually bother to find out what’s going on with us–not just with mental health, but straightforward physical stuff–yet still come up with all kinds of negative explanations for whatever problems we may be experiencing. BTW, I got irked at the inclusion of diabetes among “behavioral health problems”, which just tends to reinforce some of the too-common “you brought this on yourself, you fat lazy slob” thinking.

Moreover, problems associated with racial misclassification may result in serious underestimations of HIV rates among Native women.

It’s not just HIV rates. This is part of the reason there are so few health stats available.

Native people are not supposed to exist, for a variety of reasons, so any individual must be White, Black, Hispanic, Asian, Pacific Islander, etc. Pacific Islanders get lumped in with Asians, but there seems to be far more information available on the health of this composite group in the U.S. Most studies which focus on racial/ethnic/cultural differences and special concerns ignore American Indians. Even now that they’re starting to investigate racial differences in responses to medications, we are not included, nor do any “nonstandard” reactions get recorded much. (This is not to say that any of the other groups of people they do focus on have it good!)

I wonder why some groups of people have so much worse health outcomes, compared to the Default.

Disempowerment of Native women specifically was a primary goal of the colonizers, with the intent of destabilizing and, ultimately, exerting colonial domination over each indigenous nation…For example, among the Cherokee, a traditionally matriarchal society, the British decreased the power of women by “educating” Cherokee males in European ways, encouraging marriage to non-Native women, and privileging mixed-blood male offspring in nation-to-nation negotiations.

This is still happening, though the specifics have changed a bit. Rendering us invisible is a preferred tactic these days. Other marginalized groups get other tactics used against them, but it’s much of a muchness.

A post at Sociological Images also helped spotlight the particular Indigenous Women brand of marginalization: “Poca-Hotness” (NSFW). It’s hard to get away from that kind of thing, but it still makes me queasy.

Like one commenter, I do have to get darkly amused:

WOW. I’m kind of surprised they used an actual First Nations woman in this, I was expecting dark haired white chicks, however most of them look to be more … asian? Some kind of asian, I can’t say and I wouldn’t try.

It’s almost funny seeing my heritage get sexualized, because the rest of the time they’re calling First Nations fat and hideous.

Painfully accurate, that.

Thanks largely to decades of activism, blackface photo spreads and the like are generally seen as unacceptably offensive in the U.S. If nothing else, the people running media outlets are very aware that scads of people will complain, very visibly; it’s not good for business. They don’t expect us to be able to make as much fuss. Anybody who protests is an angry ghost, and probably an impostor at that.

The marginalization theme was also brought home recently by Kahentinetha Horn’s darkly hilarious and incisive account:

AT THE LAST MINUTE on Tuesday, 7 November, we Iroquois found out there was an exhibit opening at the Pointe-a-Calliere Museum in Old Montreal. It was on the “Mysterious Disappearance of the St. Lawrence Valley Iroquois.” They wish! Four of us from Kahnawake, Kanehsatake and Tyendinaga decided to go and look it over.

We were curious as to how they got the idea that we had “disappeared” or that there was any mystery to be solved. How would anyone feel if their so-called demise was advertised and put on exhibit? It’s like finding yourself invited to your own wake when you’re not dead. It really bugged us. Can you understand? It felt like a death threat. It reminded us of the way we were all told at school that our moms, dad, brothers, sisters, grandparents, everyone were all going to die out. We cried. By now we know a terrorist threat when we see one…

We were almost the first visitors there. Instead of welcoming us as the long lost Iroquois, they treated as though we were spoiling their party. The man at the front desk told us we had to pay $12 to go into the wake. We suggested that since we had disappeared and were ghosts in their eyes, we should be allowed in for free. Suddenly he started to speak only French to us. This is when we started to talk only in Mohawk to him.

She goes on to describe some of the dehumanizing ways in which you can present other people when you have convinced yourself that they aren’t able to contradict you: a theme which crops up anytime a group of people is marginalized.

Going back to yesterday’s posts, why might anyone develop mental health problems under these conditions? Also, why might anyone who does not hide the marginalized characteristics–which make them who they are–get perceived as crazy at a very high rate? Why might any anger or despair we show be interpreted as a need for numbing medications?

Might we suffer further health problems as a result of this? Bear in mind that “the life expectancy of those treated in community mental health centers has plunged to an appalling 25 years less than average”, attributed largely to heavy use of neuroleptics, which can directly cause diabetes and other problems. When you’re already prone to that kind of thing from chronic stress, you sure don’t need drugs that will cause the same health conditions. I’m sure that’s a frequently overlooked cause of physical problems, through more marginalization and stigma.

As Paula Gunn Allen put it, “Yes, this IS how it goes: I’m NOT crazy, I’m just Indian.”* I would extend this to being a woman, autistic, disabled, etc.

I’m not crazy, I’m just who I am. And I’m not some kind of inexplicably angry ghost.

Yesterday, I read a very good piece: Bruce Levine’s Liberation Psychology for the U.S.. Approaches more like this would probably help an awful lot of people.

All this comes back to a classic question: How do we resist being marginalized, besides refusing to be properly silent and doing our best to advocate for ourselves and other marginalized people? We need to figure out some approaches that work, with our own tools rather than the Master’s. It’s quite the conundrum, and it’s hard not to get bogged down in despair and frustration.

* This was in her foreword to Barbara Mann’s Iroquoian Women, which brought out the same response from me. Major consciousness raising, through witty analysis and an awful lot of information. That’s one of the reasons I keep mentioning this book.

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