CSWRFINAL_4.1.13 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. Zimiles 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- Zimiles 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). Zimiles 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. Zimiles Columbia Social Work Review, Volume IV 66 References Brayboy, B. M. J. (2005). Toward a tribal critical race theory in education. The Urban Review, 37(5), 425-446. Centers for Disease Control and Prevention. (2012). Definitions: Self-directed violence. Retrieved from http:// www.cdc.gov/violenceprevention/suicide/definitions.html Dorgan, B. L. 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