Authors: Dr. Bob Chaudhuri (1), Melissa Crawford, MED-3(1), Gerry V Martin, Anishawbae(2). Affiliations: 1.Northern Ontario School of Medicine 2.Thunder Bay, Traditional Teacher

1. NAHO CONFERENCE
2009
OTTAWA, ON

2. Self-Esteem as a Culturally-Biased
Construct and Using of Narrative
Story-telling to enhance Resiliency
in First Nation Mental Health
 Authors: Dr. Bob Chaudhuri (1), Melissa
Crawford, MED-3(1), Gerry V Martin,
Anishawbae(2).
 Affiliations:
1. Northern Ontario School of Medicine
2. Thunder Bay, Traditional Teacher

3. Objectives:
 To understand the Historical Conception and
Critique of Self-Esteem
 To consider Self-Identity as an alternative
Method of Thinking about Self-Esteem
 To explore Narrative or Art Therapy to Treat
First Nation Trauma

4.  Ever since Antiquity, the concept of Self-Esteem or Pride [from the Latin, prodesse
meaning “to be good or beneficial for the self”]
 Before the Greeks, the Sumerians and Egyptians [circa 2100 and 1500 B.C. make
reference to pride.]
 However, it is Aristotle who speaks about pride and sets a standard, as life is
unliveable without pride, commenting on the subject, commenting on false
humility, hubris and vanity. However, his philosophical discussions omit women…
 In Western thought, with the rise of the Church, Pride becomes a Sin, in fact one of
the 7 Deadly Sins.
 As Pride and Vanity became subjects to the Catholic concept of Sin when the
Jesuits and Benedictines came to teach the “savage” Native Population example of
haircutting of students with long braids and hair –styles (i.e. The Blackfoot Nation)
was traumatic.

5.  We come to 1890, the Social Darwinists, Freud and William James who
essentially rename “pride” as “self-esteem”.
 The masculine and feminine discrimination still exists, as Self-Esteem
becomes subject to standards and “should” statements that differ between
men who are “higher” and women who are “lower” beings.
 Karen Horney, in the 1950s, on both concepts of pride and self-esteem,
writes that the Real Self needs neither; though later she links inflated self-
esteem with narcissism.
 Bem, in the 1970s, started a self-rating scale for self-esteem involving
socio-cultural ideals about men and women. Others followed with their
own scales and as all of them were criticized, no one asked the basic
question – what does low self-esteem really mean?

6.  However, Bem in her memoirs in the late 1990s she admits to
being surprised at how popular her view and scale became.
 Rosenberg summarizes the uses of Self-Esteem to Sociability,
Performance and Affect.
 Mrurk, in 1995, summarizes four points about self-esteem:
 1. it is complex often with contradictions
 2. it can be related to both good and poor mental health
 3. it has become a basic behavioural construct in trying to explain
human behaviour
 4. it may have social significance in understanding social problems

7. What does Culture have to do with this history of self-esteem when it comes to
First Nation’s (FN) People? The statistics (NAHO, 2003):
– 1 out of 4 FN children lives in poverty
– 33% of FN children live in overcrowded homes
– Over 50% of FN children are obese or overweight
– The rate of FN children with disabilities is 1 in 8; this is double the Canadian rate
– 1 out of 6 Canadian children lives in poverty
– Direct correlation between lower family income, overcrowding, poor nutrition, lower
levels of physical activity and educational achievement among FN children
– The cycle of poorer health and well-being of FN people is reflected in the RHS data
– Income and Education levels from the Present are linked to the Past
and to Future Funding for the Next Generation
– Overcrowding is linked to income and education levels
– Overcrowding impacts education outcomes
– Educational level is linked to employment
– Double the Canadian average rate for suicide
– Mental health issues from depression to substance abuse etc…
These stats are almost seven years old and most likely have become more
alarming for example, substance abuse has become more prevalent and with the
apology from the federal government with respect to residential school trauma
survivors have identified themselves more yet problems with inter-generational
trauma, which affects Native youth/children the most, has also increased.

8.  Given the dubious history of “Self-Esteem”, let us challenge the concept and
perhaps generate a new paradigm to uncover a First Nation or Aboriginal sense of
self-identity and re-discover origins and representations of their social suffering.
 Indigenous people throughout the world, not just North America, have been
exploited by colonial systems for several centuries. In Canada, the Residential
school system was a method of instilling a pervasive sense of inferiority.
 Cultural anxiety and maladaptive coping strategies that were defensive in nature
have overcome the more vulnerable who have severe issues with their mental
health.
 Personal Suffering in any individual must be understood through the person as past,
present and future; in terms of family, culture; as a socio-political being in
relationships with others; as having regular behaviours, having a secret life and
finally a spiritual or transcendent side beyond mind and body.
 Cultivating that person’s “Self” through discovery is part of this Resiliency of
Spirit.

9. Rethinking “Self-Identity”
For therapists to re-vitalize our efforts, a
secure “Sense of Self” must be promoted. A
healthy self-identity requires a good sense of
self-worth and concept of who one is.
Experiential and existential knowledge of
oneself through knowledge of the Indigenous
worldview, as divergent that it may be from
community to community, is helpful, as are the
processes of spirituality and healing. However,
every individual is different.

10. Example 1:
One grows in a more negative environment as mentioned
earlier. Because culture is a learned, experiential phenomenon
that begins at birth and can be modified by guides, schooling,
professions or an impoverished upbringing without hope and
being physically abused, self-silencing begins. This can lead
to self-fragmentation and confusion centering around who one
is, should be. Add the stigma of the dominant culture towards
Native population and maladaptation occurs, via anxiety,
depression, substance abuse and suicide. Those who make it
to counselling get either pills or lessons in CBT about self-
esteem, but the oldest tool in psychiatry, psychology, social
work, nursing etc. is Active Listening and history-taking, and
being patient: waiting for the story to emerge.

11. However, Indigenous health and
healing information and practices are
practically non-existent through the
mainstream health care system, which
is dominated by Western approaches.
Substance abuse such as, Oxycontin and
Percocet have taken over the current
Escape drug of choice.

12. Example 2:
 The reverse situation, has the Native child brought
by resilient parents, things aren’t always positive but
self-expression and self-exploration is allowed and
encouraged.
 Self-integration can then begin leading to a healthy
self-worth, concept and hopefully a strong identity.
 But, even these cases are fraught with challenges as
different familial links or that exploration into the
past is traumatic, and lead to anxiety rather than
cultural recovery

13.  In both examples the young Native child, depending
on the supports that they get, can either become
secure about themselves and their sense of self or
have issues of insecurity surrounding who they are
and what they should do.
 The child’s spirit of resiliency will be defined
somewhat as well by how it’s community responds to
poverty, violence, education, healthcare, and other
traditional Native practices.

14. Why use Narrative Therapy?
 Storytelling and narrative traditions run deep within
Aboriginal cultures. Artistic imagery and painting, wood-
crafts and sculpture also run deep within this culture.
 It should be used as a psychotherapeutic technique to try and
interpret and learn more about a client in need. This type of
relationship would initially have to be earned by meetings that
were face-to-face using a trust relational modality through an
interpreter.
 This trust could take several visits before perhaps video-
conferencing occurred. The aim is to take a client from self-
silencing and confusion to self-expression, exploration and
eventually a healthy sense of self.
 This type of therapy can be non-linear as the client is in charge
of the therapy and the therapist is merely a guide to help seek
balance fro the client

15.  This type of therapy may help front-line crisis workers in
under-serviced areas with some basic prevention tools that
they will need to be educated about, but they should also feel
free to call someone in an emergency situation.
 Mental health delivery to rural and remote regions for the
Indigenous peoples of Canada is needed now more than ever.
This novel modality can help, as it could become another tool
in the therapist’s workbook using a traditional approach via
story-telling and art as guides for the patient to tell us what
works for them specifically, by looking at history in a more
elaborate yet less intrusive manner. Trust relationship building
with each community is key.

16.  “Reality is that which, when you stop believing in,
doesn’t go away” - Phillip K. Dick
 Many survivors of Residential schools, or their
offspring, are trying to find their way towards some
sense of self, yet wake to the trauma of their own
cultural anxiety daily. This paper is hopefully a
springboard for new ideas and treatments.

17. Questions?
 Meegwetch, Nia:wen, Merci, Thank you