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57        Columbia Social Work Review, Volume IV 

Suicide and Soul Wound: Stress, Coping, and Culture in the 
American Indian and Alaska Native Youth Context  
 
Eleni Malka Zimiles 
 
 Suicide, the second leading cause of death for American 
Indian and Alaska Native (AI) youth ages 15 to 24, raises a criti-
cal issue for social work research and practice. This paper ar-
gues that AI youth suicide is a contemporary manifestation of 
“soul wound” and expands the definition of soul wound to in-
clude present stressors and coping mechanisms for youth that are 
characterized by a legacy of colonization and cultural oppres-
sion. While AI youth come from diverse communities, this paper 
will demonstrate the importance of examining youth suicide as 
part of the overall AI experience in the United States. Using an 
indigenist stress process model framework, it will subsequently 
examine four forms of stressors informed by the marginalization 
of the AI population: psychological strains of historical trauma, 
environmental stressors, quotidian stressors arising from socio-
economic factors, and adversity from personal and relational role 
conflicts. AI youth mediate these stressors through coping mecha-
nisms around social support and collective mastery. This paper 
will conclude with a call to develop an anti-oppressive, culturally 
relevant social work practice that supports meaningful identity 
development and collective efficacy.  

 
On December 21, 2012, members of the Pine Ridge In-

dian Reservation gathered for a candlelight vigil outside the 
Rushmore Plaza Civic Center in Rapid City, South Dakota. 
Bringing pause to the Lakota Nation Invitational Tournament of 
the same night, the vigil aimed to create awareness of and de-
mand attention to the youth suicides of Pine Ridge. Three years 
earlier, South Dakota State Senator Theresa Two Bulls declared a 
State of Emergency when the suicide rate of the area reached over 
10 times the national average. One hundred and twenty years ear-
lier, the Massacre of Wounded Knee took place at Pine Ridge, 
where soldiers of the U.S. 7th Cavalry Regiment killed over 150 
Lakota Sioux. From the Pine Ridge Reservation in South Dakota, 



Zimiles 

Columbia Social Work Review, Volume IV        58 

to the Mescalero Apache Reservation in New Mexico, to the 
Northern Plains of Alaska, American Indian and Alaska Native 
(AI) youth navigate a complex web of history and reality.  

Suicide, the second leading cause of death for AI youth 
ages 15 to 24, raises a critical issue for social work research and 
practice. The alarming constellation of AI youth suicide statistics 
complicates and problematizes current operational understandings 
of suicide in the U.S., highlighting the fundamental role of cul-
tural marginalization in self-injurious behavior. Suicide, defined 
by the Centers for Disease Control and Prevention (CDC; 2012) 
as a “death caused by self-directed injurious behavior,” is largely 
regarded by the mental health profession as a complication of a 
psychological disorder (Oquendo, Baca-Garcia, Mann, & Giner, 
2008, p. 165). This individualistic and pathological perspective 
ignores the socio-political and cultural dimensions of youth sui-
cide. This paper argues that AI youth suicide is a contemporary 
manifestation of “soul wound” (Walters & Simoni, 2002, p. 520). 
Native scholars (Brayboy, 2005; Evans-Campbell, 2008; Walters 
& Simoni, 2002) describe soul wound as the accumulation of un-
resolved grief stemming from colonization. Using Pearlin and 
Skaff’s (1996) stress model within an indigenist framework, this 
paper expands the definition of soul wound to include present 
stressors and coping mechanisms for youth that are characterized 
by a legacy of colonization and cultural oppression. Understand-
ing suicide as an expression of soul wound captures the complex 
relationship between the private and public spheres, allowing for 
an acknowledgement and opportunity to engage with the deep 
imprint left on a person and community by our historical narra-
tives.  

Although AI youth come from diverse and distinct com-
munities, the paper will demonstrate the importance of examining 
youth suicide as part of the overall AI experience in the U.S. Us-
ing an indigenist stress process model, the paper will subse-
quently examine four forms of stressors informed by the margin-
alization of the AI population: psychological strains of historical 
trauma, environmental stressors, quotidian stressors arising from 
socioeconomic disparities, and adversity resulting from personal 
and relational role conflicts. Next, the paper will explore how AI 



Suicide and Soul Wound 

59        Columbia Social Work Review, Volume IV 

youth mediate these stressors through coping mechanisms around 
social support and collective mastery—the ability of youth to un-
derstand their ability to confront hardships and marginalization. 
In conclusion, the paper will demand the development of an anti-
oppressive, culturally relevant social work practice that supports 
meaningful identity development and collective efficacy. 

  
Who Are American Indian and Alaska Native (AI) Youth? 

 
 The AI youth behind the statistics come from a heteroge-
neous population comprising distinct tribes across the U.S. In the 
2010 Census Bureau results, 5.2 million people identified as 
American Indian/Alaska Native (Norris, Vines, & Hoeffel, 2012). 
There are currently 565 federally recognized tribal nations across 
the country, and another 200 recognized within individual states 
(Kenyon & Hanson, 2012). The majority of AI communities live 
on federal- and state-recognized reservations and in low-income 
sections of metropolitan areas across the U.S. (Freedenthal & 
Stiffman, 2004). Such diversity manifests in dynamic cultures 
experienced uniquely by individuals and groups of different geo-
graphic and historical landscapes. 

Current AI youth suicide statistics comprise a birth cohort 
of the current adolescent and young adult generation ages 15 to 
24 that spans the distinct tribal nations. Census figures estimate 
that there are over 1.1 million AI people between the ages of 15 
to 24, making up approximately 20% of the total AI population 
(Dorgan, 2010). While the AI youth population is a small percent-
age of the overall population in the U.S., they are over-
represented in the welfare system. AI children constitute 1% of 
the U.S. child population; however, they make up 2% of children 
in foster care, and over 50% of the children in foster care in select 
states (Lawler, Laplante, Giger, & Norris, 2012). Living in com-
munities with chronically underfunded federal programs, AI 
youth live in households with an income less than half the na-
tional average and often without healthcare coverage. The dispro-
portionate challenges experienced by the AI youth population due 
to conditions of poverty necessitate the attention of the social 
work profession. 



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Columbia Social Work Review, Volume IV        60 

Defining an Indigenist Stress-Process Model 
 

 The conjunction of a stress-process model and a critical 
indigenist framework allows for an anti-oppressive, strengths-
based analysis of cultural identity and realities in relation to 
stressors and mediators experienced by young people. The stress 
process model, first introduced by Pearlin, Menaghan, Liberman, 
and Mullan (1981), contextualizes varying life strains in a move-
ment between exposure, mediators, and outcomes. Compared 
with an event produced from a single pathway, suicide sits within 
a more holistic and heuristic framework. Differentiating between 
stressors and coping mechanisms, the model highlights the com-
plex interactions between converging life dynamics.  

The danger of studying suicide as an outcome of stress 
exposure and response is the heightened possibility of oppressive, 
deficit-based analyses of cultural structures and human agency, 
particularly in application to ethnic minorities (Stiffman, 2007; 
Walters & Simoni, 2002). As stressors are “traced to the very 
boundaries of societies, their structures and cultures” (Pearlin et 
al., 1981, p. 338), they can quickly slip into analyses of patholo-
gies or cultural essentializations, instead of being placed within 
distinct socio-political and historical contexts. Walters and Si-
moni (2002) suggest applying an indigenist perspective on stress-
coping studies of populations to “acknowledg[e] the colonized or 
fourth world position of Natives in the United States and advocat
[e] for their empowerment and sovereignty” (p.520). This per-
spective recognizes that indigenous populations have been tar-
geted by federal policies embedded in imperialism and 
“intimately linked around the problematic goal of assimila-
tion” (Brayboy, 2005, p. 429). The indigenist framework orients 
its analysis within Tribal Critical Theory. Evolving from Critical 
Race Theory work, Tribal Critical Theory places the connections 
between colonization and contemporary experiences of socioeco-
nomic and political marginalization at the center of its analysis 
(Brayboy, 2005; Yosso, 2005). Using a critical indigenist para-
digm to re-frame the analysis of the stress-process model allows 
for a deeper analysis of the intimate relationship between suicide 
and soul wound.  



Suicide and Soul Wound 

61        Columbia Social Work Review, Volume IV 

The Stress Universe 
 

Stressors, according to Pearlin and Skaff (1996), are 
events, conditions, challenges, or experiences that adversely af-
fect an individual or group’s interactions with their environment, 
their understanding of self in relation to community, and their 
strategies for everyday life. Within the realities of AI youth, 
stressors are multi-layered and interconnected. The following 
analysis looks particularly at how indigenous cultural identity and 
experience characterize the “stress universe” (Walls & Whitbeck, 
2011, p. 417)—the amalgamation of primary eventful, ambient, 
and quotidian stressors, as well as secondary “role strain” stress-
ors (Pearlin & Skaff, 1996, p. 239). Examining the various stress-
ors within the stress universe facilitates an analysis of how cul-
tural marginalization informs and produces multiple life strains.  

Pearlin and Skaff (1996) define eventful stressors as un-
scheduled life events that cause adversity in an individual’s life. 
At the core of culturally influenced eventful stressors for AI 
youth is historical trauma. Historical trauma, as defined by Brave-
heart (1999), is the “cumulative emotional and psychological 
wounding over the lifespan and across generations emanating 
from massive group experiences” (as cited in Walls & Whitbeck, 
2011, p. 416). Youth experience historical trauma as a chrono-
logically nuanced example of Pearlin and Skaff’s (1996) 
“nonegocentric” (p. 240) eventful stressors. While past coloniza-
tion of AI lands, subsequent tribal displacement, and punitive fed-
eral policies of cultural repression were not directly experienced 
by present day AI youth, the effect of such trauma from their an-
cestors, families, and communities remains strongly felt. A proc-
ess that “extends through time” (Pearlin & Skaff, 1996, p. 239), 
stress spans across historical generations. Inherited collective ex-
periences and narratives derived from a deep legacy of coloniza-
tion influence youth’s individual exposure and reactivity to stress 
(Ong, Burrow, & Fuller-Rowell, 2009). In a study conducted by 
Walls and Whitbeck (2012), AI youth reported daily thoughts of 
historical and cultural loss. The events of European-American 
imperialism created a status of disequilibrium, which led to an 
extended “period of readjustment during which the system strug-



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Columbia Social Work Review, Volume IV        62 

gles to reestablish a homeostasis,” (Pearlin, 1981, p. 339). Such 
events left young people vulnerable to secondary stressors and 
stress proliferation, where the strains from multiple stressors ac-
cumulate to produce more drastic effects. 

Historical trauma refers to primary psychological 
stressors related to legacies of colonization; however, AI youth 
also directly experience a host of environmental stressors defined 
by Pearlin and Skaff (1996) as chronic “ambient strains” (p. 241) 
arising from years of federal neglect and abuse. Current figures 
cite 28% of AIs living in poverty (U.S. Census Bureau, 2012). 
According to the American Foundation for Suicide Prevention 
(2012), an estimated 33% of all AI individuals are without health 
insurance and are entirely reliant on Indian Health Services (IHS), 
one of several chronically underfunded programs established as 
part of the federal government’s trust responsibility to protect AI 
treaty rights, lands, and resources (Bureau of Indian Affairs, 
2013). As members of the U.S.’s poorest population of color, AIs 
are at a greater risk for psychological distress due to heightened 
exposure and reactivity to environmental stressors (Ong, Burrow, 
& Fuller-Rowell, 2009). AI communities have an overall lack of 
ready access to healthcare services, full-service grocery stores, 
resourced schools, recreational facilities, and other amenities 
(Fleischhacker et al., 2012). These deficiencies in social infra-
structure foster disheartening realities of soaring crime rates, high 
rates of substance abuse, extreme prevalence of obesity, and other 
stressors involving and/or affecting young people. 

Social and economic disparities produce adversity in AI 
youth’s daily strategies and routines, labeled by Pearlin and Skaff 
(1996) as “quotidian stressors” (p. 241). Depending on their par-
ticular locale, young people may confront challenges on a regular 
basis, such as getting to school, feeling safe at home and in their 
neighborhood, obtaining access to necessities such as food, and 
participating in enrichment and/or support services. Socioeco-
nomic disadvantages manifested in the local neighborhood affect 
the everyday levels of functioning and satisfaction of AI youth 
(Silmere & Stiffman, 2006). Increased neighborhood instability 
and material deprivation contribute to depression (Matheson et 
al., 2006). These hardships look different within each distinct 



Suicide and Soul Wound 

63        Columbia Social Work Review, Volume IV 

community due to local manifestations of poverty. The disparities 
realized within daily life are the social determinants of youth’s 
stress exposure, reactivity, and their ultimate health outcomes. 

Historical trauma and socioeconomic disparities intersect 
with adolescent development processes to produce “role strain 
stressors” (Pearlin & Skaff, 1996), which are defined as strains 
arising from the demands of one’s individual status and relation-
ships. A fundamental element of adolescence is the formation of a 
self-identity and recognition of role expectations within varying 
environments (Wexler, 2009). AI youth struggle with the process 
of self-actualization in the face of cultural loss and discrimina-
tion.  

Multiple scholars have documented the struggle youth un-
dergo as they encounter cross-cultural contradictions between the 
normative values of their tribal cultures and those of the dominant 
European American society (Brayboy, 2005; Johnson & Tomren, 
1999; Kenyon & Hanson, 2012; Walters, 1999; Wexler, 2009). 
Public schools and wider communities outside of reservations ex-
pose young AIs to systems of Eurocentric knowledge that devalue 
general tenets of indigenous beliefs, such as the dominance of in-
dividualist over collective modes of thinking and the depreciation 
of holistic conceptions of health and well-being (Kenyon & Han-
son, 2012). These experiences of cultural disconnection strain re-
lationships between youth, older family members, and non-AI 
peers, ultimately nurturing internalized oppression and hindering 
positive notions of self-worth and support.  

Between childhood and adulthood, Eurocentric and Native 
contexts, AI youth find themselves within a fragile and compli-
cated web of expectations. Role strain stressors arise from the 
biological and cultural liminal spaces that youth occupy. Strug-
gling to balance opposing systems of knowledge and visions of 
success, youth become vulnerable to a cultural anomie, a loss of a 
sense of personal identity and life purpose (Johnson & Tomren, 
1999; Walters, 1999). Self-incoherence leading to relational con-
flicts establishes cultural identity as a burden and source of over-
all life dissatisfaction and disappointment (Pearlin & Skaff, 1996; 
Wexler, 2009). 

 



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Columbia Social Work Review, Volume IV        64 

Healing Soul Wound: Developing Meaningful Coping  
Strategies 

 
Individuals and communities operate numerous interde-

pendent and multidimensional coping mechanisms to navigate the 
stress universe. The stress process model identifies coping as an 
individual’s cognitive ability to adapt to adversity (Pearlin & 
Skaff, 1996). Social support and mastery are two crucial media-
tors for young AI individuals in moderating the experience of 
soul wound stressors. “Shaped by the values the person holds as a 
consequence of social group membership” (Pearlin & Skaff, 
1996, p. 242), coping repertoires are intimately intertwined with 
the social fabric of many collective-oriented AI communities 
(Brayboy, 2005; Wexler, 2009). Successful mobilization of com-
munity resources and cultural capital is crucial to cultivate rela-
tionships and structures that encourage positive identity develop-
ment and tribal unity.  

Coping as a “management of meaning” (Pearlin & Skaff, 
1996, p. 242) must rely on building a relevant and coherent cul-
tural identity that reinforces agents of social support. Scholarship 
around the development of AI youth identity documents how re-
lationships with extended kin networks led youth to actively find 
ways to integrate AI identity into their lives, using indigenous 
values, traditions, and spirituality as positive sites for incorpora-
tion (Lucero, 2010; Strickland & Cooper, 2011). Youth narratives 
around cultural ceremonies and conversations with relatives fa-
cilitated the development of a meaningful identification with their 
tribal nation and the AI community at large.  

Having a strong connection to cultural identity, particu-
larly within a framework of one’s network, returns power to the 
individual and community at large. Pearlin and Skaff (1996) de-
scribe this “global sense of control” as “mastery” (p. 243), a cru-
cial mediator for harmful stress exposure. While mastery refers to 
the individual youth’s ability to understand their competence in 
facing difficult situations and internalized oppression, it also 
holds a strong potential for the tribal community in building col-
lective efficacy. In building strategies for suicide prevention, it is 
essential to capitalize on the collective orientation of AI commu-



Suicide and Soul Wound 

65        Columbia Social Work Review, Volume IV 

nities. For many suicide prevention programs in the U.S., the em-
phasis is on individual power and a singular sense of future 
(Gould & Kramer, 2001). Strengthening AI identity through col-
lective meaning-making and management can communicate “an 
empowered and empowering image of Indianness, and provid[e] 
Native Americans, particularly Native youth, opportunities for 
action and participation in the larger Indian cause [toward self-
determination]” (Wexler, 2009, p. 267). Revitalization and resis-
tance movements such as the Keetowah Society and the Red 
Power movement have provided tribes with a vehicle to combat 
cultural subjugation and to participate in linking historical and 
contemporary experiences of AI peoples (Walters, Simoni, & Ev-
ans-Campbell, 2002; Wexler, 2009). Community mastery culti-
vates a rich and nuanced cultural experience that utilizes multi-
generational realities and manifestations of cultures, and supports 
an individual sense of purpose and life-satisfaction. 

 
Conclusion 

 
Today, AI communities are actively engaging in grass-

roots-based suicide prevention measures. It would behoove social 
workers to connect with this work and reflect on how suicide and 
soul wound affects praxis with youth. Ultimately, this analysis 
calls for the development of anti-oppressive, culturally relevant 
programming that mobilizes the necessary resources to mediate 
stress exposure. These programs must mediate youth realities of 
historical trauma, social disparities, discrimination, and bicultural 
liminality through a cultivation of meaningful identity develop-
ment and a celebration of individual and collective mastery. Un-
derstanding suicide as a contemporary expression of soul wound 
relocates the phenomenon beyond an individual pathology and 
into a broader, more complex schema. With an eye on the individ-
ual in relation to systems, social work benefits from an engage-
ment with the realities of soul wound, allowing for a richer prac-
tice able to traverse past, present, and future socio-political narra-
tives.  

 
 



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Columbia Social Work Review, Volume IV        66 

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