Ideas of Culture in an Urban American Indian Behavioral Health Clinic.

Abstract

The culture concept maintains an extended history of being taken up by diverse groups and ascribed different meanings to serve distinct agendas. This is certainly true of the ideas of culture circulating at the intersections of American Indian (AI) and behavioral health (BH) settings where popular culture concepts have been problematized by modern culture theorists yet continue to inform clinical practice. An afterthought in most BH settings, culture and its role in supporting the wellness of AI peoples is of primary concern for Indian Health Service sponsored BH clinics. As a result, I partnered with one such clinic in a Midwestern urban AI health organization to better understand the relations between culture concepts and clinical practice by conducting a clinic ethnography. Findings highlight a major disjunction between how service providers (SPs) talked about culture and clinical practice in abstract (cultural re-connection) and how they described and demonstrated clinical practice in concrete (cultural re-imagination). This disjunction reflects a major predicament facing the fields of BH wherein engagement with traditional cultures stands at odds with modern American cultural assumptions embedded in clinical training. Encouraged to engage with traditional AI cultural forms, SPs in this clinic—like their counterparts across fields of BH—did not abandon their modern clinical training. Instead, by adding symbols of cultural difference to otherwise standard, high quality clinical practice, they repackaged clinically familiar ideas, tools, and techniques as culturally different. Rather than immersion into a life-world familiar to AI ancestors ala cultural re-connection, then, SPs engaged clients in cultural re-imagination by using representations of AI culture in therapy to assist in fashioning positive modern Native identities to buttress against messages of devaluation encountered in modern America. While likely a therapeutic re-imagining of AI culture for distressed clients, concerns were raised around essentialism in representations of Indigeneity and socio-political processes of re-imagining AI peoples as populations demarcated by a circumscribed expressions of identity difference legible within contemporary BH. Finally, this work underscores the essential role of cultural analyses via ethnography for any rigorous science of clinical practice.