Ann N. Dapice, Ph.D., Clark Inkanish, ICADC, Barbara Martin, B.S., and Pam Brauchi, MHR, LPC

In the American Indian community, the experience of reading current Indian Health Service statistics on death and disease among Indians is similar to that of reading about a third world country in the news. Yet, since American Indians are such a small percent of the US population, these numbers are not "statistically significant" to the US as a whole and thus are seldom seen.

The numbers read, age group by age group, like a road map to disaster. What is less clear to most people is the relationship between these terrible numbers and their causes.

The effects are the result of complex interactions between previously adaptive survival mechanisms, pre-Columbian culture and diet, and include past and present US policy. Even though many know that Indians suffer greatly from alcoholism and Type II Diabetes, our work demonstrating the physiological relationship between the two was, unexpectedly, groundbreaking. The other high morbidity and mortality statistics can be understood in the same way.

Accidents, homicide and suicide kill Indian children and youth in far larger numbers than any other racial group. Later in life, heart disease, chronic liver disease/cirrhosis, and diabetes kill Indian adults greatly out of proportion to other groups.

Physiologically and socially, these causes of death are all related to alcoholism, smoking, and other addictions such as those to food. Lung cancer is increasing among Indians but even though Indians smoke more than any other group (Indians-40%, all races-25%), they have usually suffered and died of other maladies before developing lung cancer.

History and factors which provide background to the problem-

As noted in our article published in the Native American Times (See "Killing Us Slowly," June, 2001), conquest by Europeans resulted in genocide, great poverty and oppression for all Indians across the Americas, but until recently, diabetes and alcoholism were mainly seen as problems among Indians north of the US-Mexican border.

This was true even for tribes divided by the border. The present incidence of alcoholism and diabetes and related diseases among Indians are the continuing result of earlier European and US policy towards Indians from the beginning.

The physiological relationship between alcoholism and Type II Diabetes and the allergic response to grains brought to the Americas by Europeans affects Indians in great numbers. But it is important to note that these phenomena are not limited to indigenous peoples, since modern processed foods and addictions are becoming a scourge around the world to all people.

Genetic differences in alcoholism have long been noted. A number of researchers have demonstrated that EEG patterns are different in alcoholics and non-alcoholics. It has been determined that the differences are not that of alcohol use but that these differences are present at birth in identical twins.

Individuals at risk for alcoholism can be differentiated on the basis of their EEG alpha activity. Alcoholics have greater increases in slow alpha activity and greater decreases of fast alpha activity after use of alcohol. A reduced P300 wave is a good predictor of alcoholism.

Recent studies show that alcoholism relapse can be predicted by brain waves. Alcoholics are said to use alcohol, sugar, nicotine, and caffeine in vain attempts to quiet their irritable brain waves.

The impact of stress-

More recently understood however, is the reality of what happens to the body and brain during high or chronic levels of stress. The adaptive mechanism known as "fight or flight" that allows people to protect themselves in emergency conditions becomes destructive when people are not allowed to fight or flee, or when the stress becomes chronic. Cortisol, produced during these times, becomes toxic to the body and the brain, killing brain cells and leaving depression in its wake.

If such homeostasis isn't reset, debilitating illness results. When we are threatened, a series of responses occur-our physiological processes which have to do with conservation and restoration of energy are put on hold, and the processes which prepare us for fear, fight and flight takes over resulting in the release of cortisol into the bloodstream.

Once the threat is addressed, the body returns to homeostasis and the brain is relaxed through the inhibition of several chemicals (the neurotransmitters serotonin, norepinephrine and dopamine). If the threat is not removed, a stress cycle develops where more cortisol is produced causing further problems.

Now there is a permanent state of stress homeostasis which impairs our immune systems, decreases our bone density, weakens our muscles, increases heart and vascular diseases, and lowers our resistance to diabetes.

After prolonged exposure to severe stress the body secretes internally produced opium-like substances which inhibit pain and reduce panic. Memory is impaired in animals when they are no longer able to influence the outcome of a dangerous situation. The "freeze" response and panic interfere with memory processing-the internally produced adrenalin and opium-like substance interfere with the storage of experience in memory.

This protective mechanism may serve to keep the individual from consciously remembering an event but often results in confusion regarding related emotional pain and behavior. It can also prevent learning from the experience.

Post traumatic stress disorder, oppression and genocide-

Post traumatic stress disorder (PTSD) resulting from traumatic events continues the effects of the stress over time, continuing a cycle of cortisol production with ongoing depression. PTSD patients typically continue to re-experience a trauma, avoid stimuli associated with the incident and feel numb. They demonstrate hyperarousal, irritability, insomnia and inability to concentrate.

In circumstances where we are under someone else's power with little of our own-whether a child in an abusive family or in the extreme situation of genocide and slavery-we cannot fight or flee so stress becomes chronic and the levels of cortisol remain elevated. At some point in time we may no longer be able to produce the cortisol needed for times when it might actually help with fight or flight actions that are appropriate to a situation.

Not only can we ourselves become cortisol depleted, but children born to mothers with low cortisol levels have often been found to have low cortisol levels as well. The related behavioral effects can be seen in situations of hopelessness and poverty where people no longer seem to be able to fight for their survival, leading to assumptions that they are lazy and don't care-as opposed to depressed, hopeless-and cortisol-less!

When powerlessness has been sufficiently abusive and lasted for a long enough time, an individual develops an expectation of ongoing abuse and even when moved to a safer situation often has great difficulty responding in any other way. New situations are interpreted as the same as those in the past so that fear continues to stimulate what small levels of cortisol may still be produced.

Eduardo and Bonnie Duran, in their book, Postcolonial Psychology, write that American Indians experience intergenerational PTSD similar to that of survivors of the Jewish Holocaust. The authors note that not only did the survivors of the Jewish Holocaust suffer from PTSD but many of their children did as well-even though they had not directly experienced the events of the Holocaust.

Normal human development is "mutilated by the traumas of loss, grief, danger, fear, hatred, and chaos" write the Durans, and dysfunctional patterns of behavior come to be seen as part of Native American tradition-the alcoholism, child abuse, suicide, and domestic violence (p. 35).

Child abuse-

Harvard researchers Martin Teicher and Carl Anderson have demonstrated through brain imaging technology that there are three major changes observed in the brains of adults who were abused as children:

1) Limbic irritability with increased incidence of clinically significant EEG abnormalities.

2) Deficient development of the left hemisphere of the brain (throughout the cerebral cortex and hippocampus).

3) Deficient integration of the left and right hemispheres of the brain with diminished development of the middle portions of the corpus callosum that serves as a bridge connecting the left and right brain. These changes do not require actual physical damage to the head but are most often the result of neglect, emotional and sexual abuse.

Anderson found that repeated abuse affects the blood flow and function of the cerebellar vermis, a part of the brain implicated in the coordination of emotional behavior which is strongly affected by alcohol, cocaine, and other drugs of abuse and may help regulate dopamine, a neurotransmitter that is critically involved in addiction. Anderson and colleagues focused on this part of the brain because it is "exquisitely sensitive to stress hormones" and develops slowly. "Damage to this area of the brain resulting from neglect, emotional and sexual abuse may cause an individual to be particularly irritable and to seek external means, such as drugs or alcohol, to quell this irritability," said Anderson.

Stress and substance abuse-

As noted by the National Institute of Drug Abuse (NIDA), studies in the Journal Psychoneuroendocrinology indicate:

1) Stress and cortisol sensitize animals for drug-seeking behaviors and facilitate self-administration.

2) Animals that are under-aroused and have low levels of cortisol are more prone to develop drug-seeking behaviors.

3) Severe stress early in life induces a series of physiological, neurobiological, and hormonal events that result in dysregulation of biological reward pathways in the central nervous system and in stress response systems; these changes seem to prompt self-administration of drugs and alcohol later in life.

4) Prenatal exposure to stress and drugs predispose animals to drug-seeking behaviors in adulthood.

5) Post traumatic stress disorder is a risk factor for substance abuse.

6) The administration of cocaine to humans causes similar physiological reactions such as secretion of adrenalin and cortisol, and psychological reactions similar to arousal caused by stress.

Researchers at the Scripps Research Institute in California observed a few years ago that heavy drinking not only depletes the brain's supplies of substances necessary for feelings of wellbeing and pleasure (dopamine, serotonin, GABA, and opioid peptides), but it also promotes the release of cortisol. This release of cortisol causes tension and depression which in turn causes the individual to drink more which leads to an ongoing vicious cycle. In a similar way, carbohydrate craving is self medication, with resulting physical destruction.

Once adaptive, but no longer-

Like insulin, cortisol levels may be high or low. There are physical and emotional consequences to both. Chronic over-stimulation of insulin (from too many carbohydrates) and cortisol (from too much stress) may cause depletion with negative impact. The production of insulin and cortisol are both important mechanisms to survival.

The production of insulin in response to the ingestion of carbohydrates once allowed fat storage in the body for protection during long winter months or times of famine. In some parts of the world where famine still exists, this process still assists in survival. When refined fast foods are a constant, this is no longer the case. Similarly, the stress response was once important to survival, now that is rarely true.

Solutions-

We cannot change all the social and historical factors that have caused us disease and death in the past, but there are well researched, healthy and affordable solutions. We can now adjust our diets to the real needs of our bodies. We do now have the technology called cranial electrical stimulation demonstrated through research to balance the stress system and return the irritable brain waves to normal-without the use of addictive substances. We have other options- we don't have to fight and we don't have to run

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