Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Defining and servicing mental health in a remote northern community Harckham, Rebecca Clare 2003

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata


831-ubc_2003-0349.pdf [ 7.53MB ]
JSON: 831-1.0091109.json
JSON-LD: 831-1.0091109-ld.json
RDF/XML (Pretty): 831-1.0091109-rdf.xml
RDF/JSON: 831-1.0091109-rdf.json
Turtle: 831-1.0091109-turtle.txt
N-Triples: 831-1.0091109-rdf-ntriples.txt
Original Record: 831-1.0091109-source.json
Full Text

Full Text

DEFINING A N D SERVICING M E N T A L H E A L T H IN A R E M O T E N O R T H E R N COMMUNITY  By REBECCA CLARE HARCKHAM B.S.W., The University o f Calgary, 1998  A THESIS S U B M I T T E D IN P A R T I A L F U L F I L M E N T OF T H E R E Q U I R E M E N T S F O R T H E D E G R E E OF MASTER  OF SOCIAL W O R K In  THE F A C U L T Y OF G R A D U A T E STUDES S C H O O L OF SOCIAL W O R K A N D F A M I L Y STUDIES W e accept this thesis as conforming to the required standard  DrJ^TJardoJovel. External reader  Dyfr^k/.  /ester, second reader  Dr\. Paule M c N i c o I l , Advisor  In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission.  Rebecca H^-c%ii 1am  School of Social Work and Family Studies The University of British Columbia Vancouver, Canada  Date  ABSTRACT  O n a visit to the community o f Arviat that extended over two months o f spring o f 2001, interviews were conducted with community members on the subject o f mental health. In all, twenty interviews were recorded, documenting perceptions o f community members regarding definitions o f mental health, identification and discussion o f mental health problems, and evaluations o f Arviat's mental health services. Great disparity existed among definitions o f mental health. This lack o f a consistent definition o f mental health may be an obstacle faced by those extending or designing related services in remote Arctic communities. The participants o f the study provided a long list o f problems experienced by their community that they would classify as mental health problems. In their critical analysis o f formal mental health services, interviewees noted pressing problems, namely: scarcity, lack o f continuity, lack o f co-ordination, ineffectiveness, lack o f recognition o f community context, and cultural inappropriateness. Information offered by participants illuminated a need for further clarification o f definitions o f community wellness and o f mental health problems, inclusion o f the community in the development and maintenance o f mental health endeavors, and exploration o f alternatives or improvements to current systems o f mental health services.  ii  Table of Contents Abstract T a b l e d Contents... List o f Figures Acknowledgements  C H A P T E R I: Introduction to the Study 1  C H A P T E R II: Literature Review  2.1 2.2 2.3 2.4  Overview Colonialism Problem Analysis Service Analysis  '.  ••  1  C H A P T E R III: Theoretical Framework  3.1 Rationale 3.2 The Ecological Perspective -3.3 Critical Theory 3.4 Power and the Health Profession 3.5 Colonialism and Mental Health Services 3.6 Mental Health and Culture 3.7 Conclusion C H A P T E R IV: Method C H A P T E R V : Results  5.1 Overview 5.2 Stress: Internal and External 5.3 Definitions ofMental Health 5.4 Strategies and Coping 5.5 Problems and Stressors..... 5.6 Service Analysis 5.7 Suggestions for Improvement C H A P T E R 6: Conclusion REFERENCES  I 1 1 1  :  1 1 2 4 4 4 5 ...5 5'  5' 6: 6 8 9' H' 12 13  L i s t of Figures  Figure 1: M a p placing Arviat  2  Figure 2: Formal mental health related programs and services available to Arviat residents  4  Figure 3: A n ecological map of the systems relevant to the consideration o f mental health in northern communities  21  Figure 4: Areas o f discussion derived from interviews  61  Acknowledgements  I would like to sincerely thank the people o f Arviat for welcoming me into their community. It was my good fortune to have the opportunity to visit Arviat and learn about this northern community first hand between the months o f A p r i l and June 2001. The visit to the community was made possible by receiving a grant from the Northern Science Training Institute. David Ukutak was a great help by not only acting as an interpreter but also by arranging interviews and by facilitating this study. Thank you David! K u k k i k Baker also provided valuable assistance by acting as an interpreter. A great big thank you to Margaret Joyce who provided both a comfortable place to stay and great company. I would also like to thank Dr. Paule M c N i c o l l and Dr. Frank Tester for their assistance and guidance in the development o f this thesis. I would sincerely like to thank those who agreed to participate i n this study. I consider myself privileged and enriched to have had the opportunity to listen to what community members had to say about some difficult subject matters. It is my sincere hope that I have used the information that participants provided in a way that is sensitive and that is useful to the people o f Arviat.  C H A P T E R I: Introduction to the Study  The provision o f mental health services in Canada's Eastern Arctic has a short history. It is only in recent times that fixed settlements in the Eastern Arctic came into existence, let alone became 'serviced'. Communities i n Nunavut remain largely populated by Inuit, yet many o f the service providers are outsiders, hired from the south to provide treatment. Bjerregaard & Y o u n g (1998) write o f Inuit mental health, describing a "recent explosion o f mental health problems, visible above all in the steeply increasing rates o f suicide, substance abuse, and domestic violence" (p. 182). The presence and growth o f such serious problems in northern settlements prompts questions regarding the current methods o f their address and a call for the pursuit o f improvements through modifications and/or alternatives.  A report titled Emerging Trends in Research on Mental Health Among Canadian Aboriginal Peoples (Kirmayer, G i l l , Fletcher, Ternar, Boothroyd, Quesney, Smith, Ferrara, & Hayton, 1993) comments on the lack o f epidemiological information available regarding mental health problems o f Inuit as well as other aboriginal groups. The report cites a North West Territories (N.W.T.) survey reporting that nearly 50% o f women in the north suffer abuse i n their own homes. A further finding included i n the report is that sexual assault reports in the N.W.T. are 4-5 times higher than in the rest o f Canada. A s this report is dated 1993 these statistics include Nunavut Territory ( N T . ) . A 1999 report (Linn) regarding Inuit suicide includes the statistic that the rate of suicide in the N.W.T. (including N.T.) is 6 times greater than the rate in southern Canada.  1  This paper explores questions raised about the subject o f mental health in northern remote communities - using the community o f Arviat as a case example. While each community in Nunavut is unique both in history and in contemporary existence - the types of resources offered in each of the communities in the Kivalliq Region are largely 1  similar. Arviat is located on the west coast of Hudson's B a y and is one o f the most southerly settlements in the territory o f Nunavut.  To speak o f Arviat's history is to  speak o f starvation faced by some of the people who originally relocated or were 2  relocated to the area, and o f tuberculosis and other epidemics. Many o f the community's elders remember times o f desperation - o f long walks in search o f food, o f trauma induced by forced relocation, and o f endless years spent separated from family and friends in southern sanatoria.  Figure 1: Map placing Arviat (Source: Statistics Canada Internet Site, cfm?&SEARCH=BEGINS&lang=0&theme=csd&code=62 0501&Province=62, 5/18/2003)  Nunavut is divided into three regions, which are from East to West: Qikiqtaaluk Region, Kivalliq Region, and Kitikmeot Region. Tester and Kulchyski (1994) in their analysis of the relocation of Inuit to Arviat, suggest a causal relationship between forced relocation and starvation. 1  2  2  Arviat, like most Eastern Arctic communities, is a recent invention made by outsiders (Tester & Kulchyski, 1994). The settlement, originally housing an R C M P post, an Anglican and a Catholic church, and a Hudson's B a y Company store, began to develop i n the 50's and 60's as Inuit families ceased living i n camps and moved or were moved into a cluster around the settlement's services. The present day community o f Arviat supports a population o f approximately one thousand, six hundred people. This population is largely composed o f two groups: the Ahiarmiut who were traditionally inland Inuit and the Paallirmiut who were traditionally coastal Inuit. These groups had different experiences i n their contact with Qallunaat . Both the Ahiarmiut and the Paallirmiut experienced oppression associated with colonialism that took place i n throughout northern Canada, however the Paallirmiut have a longer history o f contact with Qallunaat whereas the Ahiarmiut had comparatively little prior to their relocation i n the 1950s. Marcus notes i n his book  Relocating Eden (1995)  that "the Ahiarmiut were considered b y the Whites to be among the most 'primitive' Inuit in the Canadian Arctic". The different experiences o f the Ahiarmiut and the Paalirmiut have impacted their relationships with both Qallunaat and their relationships with each other. In present day Arviat matchbox houses have given away to homes that have southern counterparts. The community's houses and buildings exist i n close proximity and are collectively surrounded by land and ocean. During the winter months when the ocean is frozen over the community is surrounded b y 360 degrees o f almost flat, ' uninterrupted white. During the late spring and summer the water o f the Hudson B a y  Qallunaat, variously spelled (Kaplunaq, Qallunaq, Kablunak etc.) is an Inuktitut term for a white person. For the purposes of this paper, Qallunaat shall be consistently used. 3  3  opens and the land around Arviat shows itself to be dotted with lakes. A great number o f birds and flowers also make themselves present during the warmer months. The community boasts amongst other services: two schools, a new health centre that was i n the process o f being opened during the time this research was conducted, and a social services office. Nunavut's efforts towards a decentralized government have located both the territorial Department o f Education and the Department o f Housing in the community.  Figure 2: Formal Mental Health Related Programs and Services Available to Arviat Residents  Current formal mental health related services are funded through the Territory's Department o f Health and Social Services. These services include a community wellness worker hired to provide alcohol and drug counselling and to make referrals to residential  4  alcohol and drug treatment programs located outside o f the community. This position is administered by the Hamlet o f Arviat. Arviat's Social Services Office employs two community social service workers to investigate concerns regarding abuse and to provide services to children and their families. A mental health specialist also works from Arviat's Social Services Office providing counselling to Arviat community members. This specialist is also responsible for supervising mental health workers in other K i v a l l i q communities and for providing front line service in those communities i n the region without mental health workers. Arviat's Health Centre provides mental health services by setting up appointments with psychiatrists who visit the community. Nurses employed by the Health Centre are responsible for making arrangements for community members to access mental health supports external to the community. These external supports include Churchill hospital and Selkirk hospital. Both hospitals admit individuals who are acutely distressed and thought to be a danger to themselves or to others. Selkirk hospital is located in-Selkirk, Manitoba and has a psychiatric unit. Churchill hospital does not have a psychiatric unit but employs a psychiatric nurse and has a room set aside for individuals i n acute distress. Arviat R.C.M.P. members become involved i n situations where a mental health concern has become a threat to safety. For example, i f an individual is threatening to commit suicide the R.C.M.P. would be contacted to assist with preventing the individual from harming him/herself and with providing safe transportation to a treatment facility. Undoubtedly R.C.M.P. and corrections services become involved i n situations that are mental health problems but are treated as criminal justice matters.  5  For this project interviews were held with community members o f Arviat on the subject o f mental health i n their community. Where physical health is more tangibly defined, mental health is a term with no direct translation i n Inuktitut (Kirmayer, 4  Fletcher, Corin, & Boothroyd, 1994). The term mental health has been introduced from the south o f Canada and, likewise, the services that have been introduced to deal with mental health issues are based on southern models. This paper is constructed from community comment about the following related areas: how mental health is defined, what are mental health problems, what are thoughts and feelings regarding contemporary mental health services, and what does the community include as suggestions toward the improvement o f these services. In an attempt to achieve further understanding regarding these subjects, both eco-systems theory and critical theory are applied to provide context and insight into broader contemporary issues. This thesis focuses on current realities pertaining to mental health described b y the people o f Arviat. Mental health is a broad subject matter and one that can be approached from a number o f different angles. A reason for focusing on mental health as presently conceptualized b y community members is that those interviewed had a lot to say about the subject matter. When I attempted to ask elders about traditional concepts related to mental health the answers were not as detailed. A goal o f this research is to be able to provide to the community suggestions for change based on community comment regarding mental health. Given this goal, it was logical to focus on what people had to say about present services and how they could be improved.  Inuktitut is the language spoken by Inuit of Nunavut. Dialects of Inuktitut vary from region to region, from community to community, and within communities.  4  6  This thesis does include the consideration o f how historical processes o f colonialism have effected the collective well-being o f the community o f Arviat. However, it does not include an exploration o f traditional values and practices o f Inuit culture related to mental health. This thesis does not incorporate the rich body o f ethnoanthropological literature regarding Inuit culture which could be examined co-jointly to add both insight and context to observations made by research participants. Examples o f this literature includes: Never in Anger (1970) by Jean Briggs (traditional Inuit family life, child-rearing practices, relationships, and emotional concepts),  Eskimo of the  Canadian Arctic(\968) edited by Valentine and Vallee (traditional aspects o f Inuit culture including economy, concepts o f time, religious belief and rituals, and legal concepts),  The People's Land (1975) by Hugh Brody (transition to settlement life,  relationships between Qallunaat and Inuit, and family life), and The Netsilik  Eskimo(\91Qi) by B a l i k c i (technology, camp life, family collaboration, dealing with social tensions and religion and spirituality). This study attempts to give voice to a community analysis o f mental health issues. Mental health problems are growing and placing strain on communities. This strain i necessitates a thoughtful review o f both the past and the present in the hope o f promoting suggestions geared toward a healthier future. The relevance to the field o f social work is evident as the profession aspires toward the greater well being o f all humanity. The Canadian Association o f Social Workers ( C A S W ) Code o f Ethics (199,4) defines the profession o f social work in the following way: The profession o f social work is founded on humanitarian and egalitarian ideals. Social workers believe in the intrinsic worth and dignity o f every  7  human being and are committed to the values o f acceptance, self-determination, and respect o f individuality. They believe in the obligation o f all people, individually and collectively, to provide resources, services, and opportunities for the overall benefit o f humanity, (preamble).  Particularly relevant to the study detailed in this paper is the profession's commitment to self-determination. The goal o f the research undertaken is to promote critical thought around mental health issues as this thought may eventually lead to the furtherance o f individual and community self-determination. The second point o f interest included in the above passage is the stated belief that all people are obliged to work toward the "overall benefit o f humanity". The interviews, the source o f this research, reveal a deep and genuine interest and care for collective well-being expressed by participants. This research taps into an ongoing stream o f thought and suggestion directed toward the improvement o f resources, services, and opportunities for the overall benefit o f the community. The research undertaken follows a loose framework put forward by Banks (1999) who suggests that community social work practice includes three precepts: the identification o f community needs (interviewing to identify local concerns), the identification o f locally perceived solutions, and the building o f a collective response. The research I undertook attempts on a small scale to work through the first and second o f these precepts. In this way, research conducted is o f and i n itself a piece o f community social work practice. The relevance to the profession is clear - the research aims to fulfill goals in line with the definition o f the social work profession put forward by the C A S W code o f  8  ethics. Further to this, the research is a piece o f social work practice and is relevant to the profession in its attempt to document and detail a segment o f an ongoing community development process. The knowledge gained from this research contains insights applicable to social work practice in the area o f mental health in northern remote communities.  9  C H A P T E R II: L i t e r a t u r e Review  2.1 Overview Three large and overlapping categories can be distinguished in the literature pertinent to the consideration o f mental health in northern isolated communities. The first category o f literature is compiled from those writers who focus on the history and aftermath o f colonization waged by a "western", hegemonic society upon Aboriginal peoples in northern Canada. A second category o f literature considers the manifestation o f mental health problems, especially the problem o f suicide, i n northern and remote communities. These articles set about the task o f problem analysis through either description o f problems or by theorizing regarding the causes o f problems. Regardless o f the approach, this literature is concerned with the explanation and prediction o f problems in the hope o f preventing further problems from occurring. A final category o f literature contains writing that focuses on service provision i n the north. These articles pursue a range o f issues pertinent to northern communities, but are unanimous i n their advocacy for increased community input and control.  2.2 Colonialism  Colonialism is a frequently touted word in northern literature - fingered as a cause for strife, and cultural disruption. The impact o f colonialism has been described as "acculturation", and some writers have equated Inuit migration and relocation into settlements with the demise o f Inuit culture. A s Matthiasson (1992) writes:  A t the time o f relocation, most observers took a pessimistic view, predicting that Inuit society would fall apart as the people settled into  10  settlement life. Demoralization and the erosion o f individual self-esteem were sure to be the consequences. Acculturation theory o f that period supported such a prediction, and the published studies provided many empirical examples. It was generally accepted that no human society could for long withstand the onslaught o f an alien and colonially oriented force. Aboriginal societies were thought to be no match for colonial systems, and seemed doomed to either assimilate into the larger society or disintegrate, (p. 159) To this day, social scientists continue with their prophecies o f doom in discussing the legacy o f colonialism. For example Sullivan & Brems (1997) write o f the situation facing the Native people o f Alaska: "Westernization o f all aspects o f life has led to a crisis among the young people that are at the brink o f extinction" (p. 42). The authors go on to remark on the extent o f the impact o f "westernization" on mental health: "The profoundness o f the psychological impact o f the changes i n Alaska on Alaska Natives is reflected in the vastness o f the mental health and substance abuse problems that exist among Y u p ' i k and Inupiat Eskimos today" (p. 43). Sullivan & Brems (1997) are joined by other writers from various time periods in their view that westernization, commenced by colonialism, is the major catalyst to mental health problems faced in northern communities at this present time (e.g., Arges & Delaney, 1995; Berry, 1999; Sampath, 1976; Schaefer & Metayer, 1976). K r a i & Minore (1999) a paper regarding wellness and suicide in the Eastern Arctic point to not only the extensive quantity o f change that has occurred i n the region but also to the remarkably  foreshortened timeline i n which this change has taken place - namely over the course o f the last 30 to 50 years. Other writers, such as Brody (1975) acknowledge the destructive effect o f colonialism, and yet perceive the Inuit as people who are not destroyed: Some commentators,, including many social scientists, see modernization as a series o f social changes that increase the similarities among different parts o f a larger society.. ..This process may be regarded as a reduction o f boundaries: the changing or acculturating group gradually loses its sense o f difference and discreteness, a change that facilitates or causes assimilation. The fact that this phenomenon is widespread has led many to expect that Eskimos, i n the course o f rapid modernization, w i l l lose or blur their ethnic boundaries. That expectation would, however, be radically incorrect: i n the case o f the Eskimos described in this book, their ethnic boundaries are strongly felt and have been generally maintained despite modernization. The assimilation of individual Eskimos b y White society is minimal. Most Eskimos are emphatic about the differences between themselves and Whites, (p. 161)  In his book Peoples' Land (1975), Brody acknowledges the impact o f the frequently troubled relationship between Inuit and Whites i n the Eastern Arctic on traditional ways o f life but disputes the perception that the changes that have occurred amount to assimilation. Similarly concerned with "western" domination i n the north, but also resisting the depiction o f Inuit as passive victims o f the process, Rasmussen (2000) reviews a history o f cross-cultural contact i n the north specifically in the areas o f education and economy.  12  Rasmussen concludes at the end o f his paper that what he has exposed are his own "European assumptions and attitudes" (p. 53). In reading Rasmussen's description o f the north and his critical account o f western ideology, a clearer picture emerges regarding the discrepancy between Inuit and Qallunaat cultures. Rasmussen does not attempt to understand Inuit culture; rather he focuses instead on the myth o f "civilization" propagated by a European worldview. Likewise other writers such as LaRocque (1996) and Harp (1994) take a critical look at the place o f Aboriginal people in Canadian society - examining the phenomenon o f colonialism as a more complex process than oppressor vs. oppressed. Both o f these writers call for a more sophisticated consideration o f the history o f colonialism and the consequences o f this history in current times. Fienup-Riordan (1990) writes extensively in her book Eskimo Essays about the creation o f the popular image o f the Eskimo i n Alaska. This popular image typically idealizes the past while simultaneously depicting modern Y u p ' i k Eskimos as a "people in peril", who are now "inauthentic" in terms o f their culture, and on the verge o f destruction. Such a depiction ignores and hampers current strategies toward change and wellness. A few o f the articles reviewed place mental health in a broader context - questioning the very term itself and potential indigenous, northern equivalencies. Kirmayer et al (1994) i n a report titled Inuit Concepts of Mental Health and Illness: an Ethnographic Study, point to a variance i n the term mental health which they distinguish by culture and language. In a paper presented in 1972 by Nickels and Kehoe titled Northern Communities: Mental Health and Social Adaptation, attention is drawn to the cultural determination o f mental health - and that "serious mental illness was frequently present,  13  o f course; but much o f the behaviour that was brought to the attention o f consultants was behaviour that annoyed local white residents" (p. 8). These articles are important additions to those on colonialism and acculturation in the north as they bring attention to the fact that the analysis o f the subject matter o f mental health itself imbued with definitions and assumptions that stem from a perspective rooted in culture. W h i l e no authors contradict the supposition that historical and contemporary exploitation resulting from cross-cultural contact in the north has residual impacts i n the i mental health o f Inuit and First Nations people, some writers resist the simplification o f complex relationships. Related to this literature centred on themes o f "colonialism" and "acculturation" is literature that examines in more detail the manifestation o f niental health problems i n northern communities.  2.3 Problem Analysis Although not extensive, this body o f literature explores problems in the north faced by Inuit i n contemporary society. The problem analyzed i n the most detail is that o f suicide, a mental health problem considered to be on the scale o f an epidemic in many communities o f circumpolar location. The literature exploring the problem o f suicide describes suicide in terms o f its correlates and the factors that may identify an individual who is "at risk". Examples o f this literature include: •  W i l k i e , Macdonald, & Hildahl (1998) who utilize a case example o f a small and isolated Manitoba community to further their understanding o f cluster suicide.  14  •  Kirmayer, Boothroyd, & Hodgins (1998) suggest potential correlates with suicide derived from research conducted i n northern Quebec. These researchers acknowledge that rapid change may have something to do with high levels o f suicide and also conclude "suicide attempters have higher rates o f psychiatric problems, substance abuse, and recent life events. Individuals at risk, therefore, can be identified and offered interventions to reduce substance abuse, depression, and dysphoria", (p. 821)  •  Isaacs, Keogh, Menard, & H o c k i n (1998) review both coroners' records and a Government o f NorthWest Territories suicide database to describe more fully the phenomenon o f suicide i n the north - they conclude "the causes o f suicide are complex", (p. 155)  •  O ' N e i l , Moffat, Tate, & Y o u n g (1994) conducted a study in the Keewatin (Kivalliq) region that identified risk factors associated with suicide.  •  Bjerregaard & Y o u n g (1998) i n their book titled The Circumpolar Inuit: health of a population in transition, attempt to provide a "comprehensive overview" o f Inuit health including the determinants o f health, mental health, and well-being. The authors draw attention to culture change i n the consideration o f mental health and write o f the increasing rate o f suicide and other mental health problems.  This collection o f literature increases knowledge by reviewing occurrences o f suicide taking place i n northern communities and b y exploring connections between suicide and  15  underlying issues effecting community living. W h i l e the literature included under this heading focuses on mental health problems, a final category considers the relationship between 'problems' and the method o f service delivery.  2.4 Service Analysis  Literature has been published that is relevant to the provision o f mental health services in northern remote communities. There exists a group o f articles specific to the delivery o f health and mental health services in the north (Katt, K i n c h , Boone, & Minore ,1993; Miller, 1994; O ' N e i l , 1981; Web, 1994; Wenzel, 1981; Young, 1993). These articles point to the shortcomings o f the mental health services that are the subject o f their review. Further relevant literature focuses on a variety o f service areas that impinge on mental health, including: social work education (Zapf, 1991), nursing in the north (Canitz, 1990), youth justice (Searles, 1998), welfare policy (Tester, 1993), and children's services (Kuptana, 1992). A final category o f literature espouses the benefits o f services intrinsically linked to the northern communities i n which they operate, using case examples to strengthen their point. K a m i n & Beatch (1991) describe a successful example of a community-based program addressing the issue o f spousal assault. Cassidy (1991) points to both the complexities and the benefits o f community control. Delaney, Brownlee, & Sellick (1995) equate northern social work with "community and community empowerment" (p. 3).  Tony (1990) describes a community based suicide prevention program launched  i n Alaska.  16  /  Regardless o f the specific mental health issue, all o f the literature included in this category emphasizes the need for community and local involvement in the planning and implementation o f services. Literature discussing colonialism and problem and service analysis frequently overlaps. M a n y o f the works cited above include discussion on each o f these related areas. The literature reviewed so far is specific to mental health in northern communities. Theoretical literature is also pertinent to the research being described i n providing a larger context in which to examine issues related to the community mental health o f Canada's remote north.  17  C H A P T E R III:  Theoretical F r a m e w o r k  3.1 Rationale Theory w i l l be approached i n the service o f two purposes: firstly, theory is^usefiil in the synthesis o f the subject, and, secondly, theory is useful in the critical examination o f the subject. A n ecological perspective derived from systems theory and applied to community comment illuminates patterns and relationships essential to a fuller, more holistic understanding o f mental health. Critical theory applied to the ecological construction o f mental health promotes an analysis o f power functioning within and between systems and promotes the case for structural change to occur.  3.2 The Ecological Perspective A n ecological perspective is derived from the identification o f patterned relationships. The predictability resulting from these patterned relationships in operation is important to our survival as a species as it supplies us with information we need to know in order to meet our needs. Global forces complicate the identification o f discrete systems. A s human beings our connectedness grows as does our technology. The social scientist employs an 'exceptional' ecological perspective specific to social phenomena when examining human relationships and forces affecting these relationships - a truly complex subject matter: Our knowledge o f the world acquired by science (and perhaps the world itself?) does seem to show symmetries, patterns, regularities. It would seem surprising i f social phenomena were not similarly patterned. Indeed on a common-sense inspection they obviously are, since social life would not be possible i f the behaviours o f our fellows did not i n general meet ,  18  our expectations. But given the 'messy' nature o f social phenomena as they appear to us, we can expect the findings o f a scientific approach to the investigation o f social reality to have certain characteristics which distinguish them from the findings acquired by the natural sciences' investigation o f the physical world. (Checkland, 1993, p. 68) The application o f systems theory in the development o f an ecological perspective o f human social reality is illuminating, yet the straight transference o f theory is neither useful nor possible. It could be argued that Checkland's observed separation between the 'scientific approach' to social reality versus 'natural sciences' investigation o f the physical world' is a fissure created by science itself. This fissure could harbour limitations especially in the small communities o f the north where the physical world and social reality are evidently transfused. The importance o f the above passage is i n the warning provided: patterns are discernible in social phenomena, however social scientists live in the messiest room in the house o f science. The application o f an ecological perspective to the Canada's remote north assists in the construction o f a model based on identified relationships. The reality upon which the model is based is an elusive subject too complex and dynamic to ever be wholly accurately rendered by the model. These limitations expressed - what is the use o f the exercise? The result o f the application o f an ecological perspective is a series o f proposals or hypotheses exploring relationships. Systems theory draws awareness to something more complicated than the assignment o f active and passive roles imposed by the world onto human kind: What is being argued is that we perceive the world through the filter o f -  19  or using the framework o f - the ideas internal to us; but that the source o f . many (most?) o f those ideas is the perceived world outside. Thus the world is continually interpreted using ideas whose source is ultimately the perceived world itself, i n a process o f mutual creation. (Checkland & Scholes, 1990, p. 20) The insight gleaned from the above comment is the importance o f not seeing individuals, families, or communities as pawns controlled by external forces o f the world. Change as a result o f mutual influence is constant. The world from a systemic vantage is a place o f reciprocity and human beings are a natural part o f this: through their perceptions, interpretations and actions, they contribute to the creation o f their world. When examining a northern community such as Arviat, Nunavut, a systems approach resulting i n an ecological perspective encourages a holistic exploration o f the topic extending into time and space. If the subject matter is 'mental health', the exploration w i l l include a positioning o f the individual, the family, the community, culture, and global world; past, present, and future relative to the subject. Germain and B l o o m (1999) refer to this 'positioning' as the transacting configuration: To understand any life event, we must put it into the full person: environment configuration, that is, we must consider all the relevant,systems and subsystems that may play a part i n the mutual adaptation. This includes subsystems o f the person.. .and subsystems o f the environment, particularly the primary and secondary groups, culture, society, and the physical environment, (p. 18) A mental health problem experienced by an individual living i n a northern remote village is not a discrete phenomenon but relates to a contextual reality that encompasses the  20  individual. Individuals experiencing mental health problems w i l l be further understood i f considered from the vantage point of their transacting configuration. Equally true, the individual providing mental health services can be better evaluated i f considered from a transacting configuration related to the individual, family and community they are providing service to.  Figure 3: An ecological map of the systems relevant to mental health in northern communities The most northerly communities of Canada share certain characteristics that pose a unique transacting configuration distinct from the environment in which current mental health services evolved: they are remote and transportation can be difficult, they have  21  small populations, and they have few o f the resources familiar to the south o f Canada. To understand i n a more holistic sense the current operation o f a northern village, it is important to understand the recent and bureaucratic creation o f these communities and the massive changes that have occurred within a brief time frame. A s evidenced by an exploration o f interviews held with community members o f the village o f Arviat, Nunavut - the pressures built from massive change within a few generations has amounted in disruption between generations. These pressures are forces acting within a transacting configuration. Germain and B l o o m (1999) write o f a societal context  of human behavior and  development, which includes the legal, political, and economic structures that are the pillars o f contemporary society. In our northern example, these societal structures are complicated by their source o f origin. The contemporary structures within northern remote communities were imported by western culture, arriving with missionaries and traders and rigidified through government bureaucracy. The historical introduction o f these structures, and the replacement o f structures that had evolved with and by the Inuit, have repercussions on individuals and whole communities in the Canadian north. The consideration o f transacting configurations and a structural analysis o f environment are useful applications o f systems theory which draw our attention to larger systems composed o f relationships. Applying systems theory has the advantage o f drawing our eye from the individual to the larger world i n which that individual plays a role in influencing and i n being influenced. W h i l e a useful theory to use while constructing a model o f the way things are, systems theory has limitations. Systems theory provides hypotheses that relationships exist, but the nature o f these relationships  22  remains to be interpreted. Systems theory has been criticized for its disregard o f the destructive exercise o f power that is part o f contemporary global economic relationships. Tester (1994) critiques Germain's construction o f ecological and systems theory as being essentially a 'passive' theory that speaks more to 'fitting i n ' or 'adapting to' the status quo rather than critiquing the structural problems associated with a global economy that subjugates the well-being o f individuals and environmental integrity to the profit and gain o f the'powerful'. Tester argues that rather than conceptualizing'power'as a 'psychological concept' that refers to individuals, power needs to be considered as " a structural problem inherent i n the forms o f production and consumption that are currently destroying the planet" (Tester, 1994, p. 76). Tester goes on to critique Germain's use o f the term adaptation:  "adaptation  carries with it the conservative connotation of fitting in through the exercise o f individual w i l l , ingenuity, and determination""(p 77). Tester argues that "fitting into a world where the pursuit o f production, consumption, material wealth, and individual initiative exercised at the expense o f fragile ecosystems - is the ultimate goal o f life, is something that must be challenged", and that "it is the behavior o f groups and classes o f actors within the predetermined logic o f increasingly global systems for organizing production and consumption, which require our attention" (p.77). In the consideration o f mental health i n northern remote communities, the argument articulated by Tester speaks to the importance o f including an examination o f how structured relationships o f production and consumption affect realities o f northern communities. The danger o f utilizing a systems approach, such as that constructed by Germain is the pathologization o f individuals for their failure to adapt. Mental health problems could be perceived as a  23  poor fit between individual and environment with the onus being placed largely upon the individual to 'fit i n ' better. Essential to an understanding o f northern mental health is the inclusion o f both a discussion o f the colonial abuse o f power that has shaped the present day north and a discussion o f the way in which northern communities are situated in relation to a global economy. W h i l e systems theory suggests considering the individual within their larger environment, it is important to explicitly and critically examine questions o f power. Systems theory has been criticized for 'tinkering' when a complete structural overhaul is required. Not only is a systems approach potentially complacent in the face o f an inherently flawed system, but it also draws short i n attempting to explain or predict social change: A 'systems' perspective is too static, for it lacks the dialectical viewpoint that would provide it with insight into the dynamisms o f social change. Systems theory o f itself does not account well enough for the elements o f opposition and contradiction which arise in any society and which can constitute an invitation to its further development. (Campbell, 1999, p. 37) Systems theory is descriptive and not prescriptive. However, when combined with a further body o f theory, it can become part o f a critical tool. The utilization o f systems theory necessitates the exploration o f a variety o f different levels o f analysis - from the individual to the global, and recognizes connections between these levels. Systems theory resists the imposition o f a singular hypothesis and provides a consistent reminder o f complexity. To take this theoretical analysis further and to probe the dialectical forces as they exist in a system it is useful to combine a further body o f theory to an ecological  24  perspective. A n application o f critical theory to the consideration o f mental health issues i n northern, remote communities encourages the inclusion o f discussion related to capitalism, colonialism, and culture.  3.3 Critical Theory Rigorous criteria should be followed in the application o f theory to mental health issues facing northern, remote communities. The application o f theory can enhance understanding but it can also over-simplify the challenges facing communities. Further to this, the application o f 'western' based theories in a different cultural setting can impose a hegemonic understanding o f reality onto diverse populations. The challenge is to utilize theory to increase understanding while remaining sensitive to issues o f complexity and o f diversity. The collection o f theory gathered below belongs under the heading o f critical theory. Agger (1998) describes treating critical,social theory as a "theory cluster", identifying features that these theories hold i n common. M u l l a l y (1997) also identifies commonalities shared by critical theory: Critical theory provides criticisms and alternatives to traditional, mainstream social theory, philosophy, and science. It is motivated by an interest in the emancipation o f those who are oppressed, is informed by critique o f domination, and is driven by a goal o f liberation. (Mullaly, 1997, p. 108). Critical theory attempts to describe injustice and then goes beyond this by suggesting alternatives to the status quo. W h i l e there are many streams o f critical theory, a commonality is their advocacy for change to take place at a structural level within  25  society. Critical theory is appropriately utilized in this paper because rather than blaming the individual or the family it shows how society is structured in a way that is pathological, a conclusion consistent with the research findings. Critical theory is universally applicable because it is sensitive both to culture and to oppression. In keeping with the role o f critical theory to "raise consciousness about present oppression and to demonstrate the possibility o f a qualitatively different future society" (Agger, 1998, p. 4) this analysis begins by placing a northern remote village within a global context. A n exploration o f the effects o f global processes upon the mental health o f northern peoples includes a discussion o f the expansion o f capitalism. This discussion o f capitalist expansion focuses specifically on two o f its inter-related practices: the practice o f establishing impersonal means o f production, and the practice o f compartmentalizing and commoditizing social functions and human services.  Moving  from the general to the more specific, the dynamic o f power and health professions w i l l be critically examined. Two further subject matters w i l l be discussed - how a history o f colonialism relates to the provision o f northern mental health services and how the rneaning o f the term mental health varies by cultural context. The selection o f subjects for critical analysis has been informed through systems theory, as this analysis is inclusive o f both global processes o f capitalism, as well as the more narrowly defined subject o f the individual mental health professional practicing i n the local community. These subjects o f critical analysis are relevant to both the consideration o f mental health issues facing Nunavut communities and also to the consideration o f what changes need to occur to improve the quality o f life o f northern peoples.  26  Capitalist expansion The 1998 book  Critical Theories: An Introduction by Ben Agger includes a chapter on  the critical theory o f the Frankfurt School. In this chapter, Agger describes how critical theorists o f Western M a r x i s m and o f the Frankfurt School distinguish late capitalism from its predecessor, early market capitalism. T w o changes are focused on by these theorists. The first is the increasing involvement o f the state "as a big spender and a source o f social security for the destitute in order to keep them spending and to prevent them from joining radical political causes" (p. 80). The second change is the increasing dominance o f an ideology o f everyday experience rather than an ideology focusing on an afterlife. Ideology rooted i n the experience o f everyday is "produced and reproduced i n various discourses such as popular culture and social science that suffuse the person with a sense o f society's inertness and inevitability" (p. 81). Given these changes i n the nature o f capitalism, "the purpose o f ideology critique in late capitalism, then, is to uncover and demystify reification, domination, and hegemony found i n people's everyday experiences and activities" (p. 81). I include comment regarding these two changes to draw attention to the current nature o f capitalism as distinct from its earlier form. Late capitalism is difficult to critique as it carries with it a sense o f inevitability. Furthermore change is challenging to envision as everyday life has a sense o f immutability that confounds the process o f imagining radical changes. Perhaps it is because o f the nature o f late capitalism that liberal theories such as that o f systems theory have become popularized as they do not seek radical change, and rather focus on adapting to an 'inevitable society'. H o w has the introduction o f late capitalism into the far north affected northern peoples? It is reasonable to suggest that its introduction has  27  been hard to resist due to the first characteristic o f late capitalism, that the state has been highly, involved in the Canadian Arctic, providing funding. This is not to say that government funding has been generous or that it has ameliorated colonialism in any sense, however, the provision o f goods and services by the state was a way o f introducing capitalism into northern lands and ensuring its survival. The second characteristic o f late capitalism, that it harbors a sense o f unchangeableness and inevitability, has made it difficult to resist or to organize against for populations world over, including northern peoples. A further pertinent observation o f modern capitalism is that it is a global process which does not distinguish or recognize differences between societies - it sells the same clothes, cars, soft-drinks, and therapy. Contact between societies has a standardizing rather than a diversifying effect. Jameson, i n his book o f an  The Seeds of Time (1994), writes  antimony o f current times: as things change at increasingly violent rate, so they  rapidly become standardized: "what then dawns is the realization that no society has ever been so standardized as this one, and that the stream o f human, social, and historical temporality has never flowed quite so homogeneously" (Jameson, 1994, p. 17). Human diversity has been the result o f the evolution o f different mechanisms for survival necessitated and born from environment. Standardization and disregard o f environment are current human tendencies. In reference to an ecological perspective, living disjointedly from the environment begs questions o f goodness o f fit and long term sustainability. The effects o f standardization are evident i n the north and are noticeable i n the discrepancy between modern and historical means o f production.  28  A shift i n the means of production A process introduced by early market capitalism that continues in late capitalism is the  replacement oflocalproduction for use by industrialized mass production. The establishment o f the industries o f capitalism world over is associated with reorganization in ways o f living as needs are met through distant and impersonal relationships rather than locally. Critical theorist, Ivan Illich (1975) writes about industrial outputs bringing associated benefits; however a society structured to facilitate capitalism's industry runs the risk o f 'disabling' its population: Autonomous production can be supplemented by industrial outputs. It can be rendered both more effective and more decentralized by using such industrially made tools as bicycles, books or antibiotics. But it can also be hampered, devalued and blocked by a rearrangement o f society totally in favour o f industry. Such rearrangement has two sides: people are trained for consumption rather than for action, and at the same time their range o f action is narrowed (p. 63). In Canada's remote north, for example, the introduction o f rifles among the Inuit may have increased the effectiveness o f hunting; however, the relocation o f semi-nomadic populations into settlements resulted in people being much more amenable to consuming from the market place than engaging in what Sahlins (1972) refers to as production for livelihood. Historically the economic system o f the north followed a practice o f valuing labour over tools, now the tool has become increasingly important. A s Sahlins (1972) writes:  29  For the greater part o f human history, labor has been more significant than tools, the intelligent efforts o f the producer more decisive than his simple equipment. The entire history o f labor until very recently has been a history o f skilled labor. Only an industrial system could survive on the proportion o f unskilled workers as now exists; in a similar case, the paleolithic perishes" (p. 81). Sahlins notes the irreconcilability o f what he calls "the domestic mode o f production" to the system o f capitalistic production. The irreconcilability o f these two systems resides i n the former's placement o f value on the person skilled in the art o f production versus the latter's emphasis on the machines o f production. The domestic mode o f production emphasizes the 'production for use' or for 'use value' whereas capitalism emphasizes 'exchange value'.  Sahlins notes how the domestic modes of production are  characterized by a finite number o f needs and by their systemic quality o f being 'antisurplus', two elements obviously not shared by capitalism. Colonialism has brought about an abrupt change in Inuit modes o f production. W h i l e production for use continues in arctic settlements, the majority o f needs are met through capitalistic production. These changes that have taken place in the last century i n the North can be seen in part as a 'training for consumption'. This 'training for consumption' has not successfully brought about a complementary 'training for production'. W h i l e the introduction o f a capitalistic market place has successfully convinced many northerners that they have more needs than they could previously have imagined, the disruption o f indigenous modes o f production has brought about a reliance on the government. The modes o f production entrenched in the south o f the country have  30  not been transplanted to the north. The result is a population o f people reliant on the 'benevolence o f a government system that hands out 'aid' while simultaneously 7  branding those who accept it as lazy or unintelligent.  Whether or not individuals possess  the skills relied upon for thousands o f years to produce the necessities o f life becomes irrelevant i n the eyes o f capitalism. Capitalism values nothing less than mass production; subsistence existence is a system that is far too self-contained and successful to generate profit based on needs. Northern people are being co-opted into a 'capitalistic dictatorship', whereby it is the market place o f late capitalism rather than the individual that dictates needs and how these needs should be met. Capitalism thrives on unmet needs and so constantly creates new needs., The perpetuation of unmet needs results i n underdevelopment, a manufactured mental state: Underdevelopment as a state o f mind occurs when mass need are converted to the demand for new brands o f packaged solutions which are forever beyond the reach o f the majority. Underdevelopment in this sense is rising rapidly even in countries where the supply o f classrooms, calories, cars and clinics is also rising. The ruling groups in these countries build up services which have been designed for an affluent culture; once they have monopolized demand i n this way they can never satisfy majority needs. (Mich, 1973a, p. 136) The transference that has occurred in the north from using the capitalist's market place to supplement the domestic mode o f production to using the domestic mode o f production to supplement the capitalist's market place is indicative of an immense psychological shift from self-sufficiency to dependence. The state o f underdevelopment is now  31  experienced in the north as well as i n the south o f the country, with the added twist that the majority o f northerners have less access to the trappings o f 'affluent culture' than those who live i n the south o f the country. I argue that the shift between two disparate modes o f production has had a huge impact on the psyche o f northern people. Self-sufficiency has been eroded. Skills once prized are now sometimes not prized enough to be passed down from one generation to the next. Welfare recipients are scorned by larger Canadian society and the north is seen as a burden to the south (unless the great natural resources o f the area can become further exploited - then perhaps the benevolent south can be compensated for all these years o f 'selfless' provision). Northern settlements are relegated to the position o f poor relative to the south o f the country, a positioning which has resulted in a restructuring o f the relationship between northern peoples and their environment: Industrialized societies can provide such packages for personal consumption for most o f their citizens, but this is not proof that these societies are sane, or economical, or that they promote life. The contrary is true. The more the citizen is trained in the consumption o f packaged goods and services, the less effective he seems to become in shaping his environment. His energies and finances are consumed in procuring ever new models o f his staples, and the environment becomes a by-product o f his own consumption habits. (Illich, 1973a, p. 133) In the south o f Canada, the average citizen has become dependent upon a complicated series o f systems dictated by a capitalistic economy to have his or her needs met. This dependency has amounted in a severance o f individual from environment. W h i l e northern citizens enjoy a much closer relationship between self and the environment,  32  packaged goods and services have insidiously created a northern market place.  Systemic  logic would suggest that the creation o f this market place affects the relationship between the person and the environment that previously was the source o f his/her domestic mode o f production.  T h e commoditization of h u m a n services The market o f capitalism does not only trade material goods but also buys and sells human services for profit. W i t h the propagation o f capitalism in the North, as elsewhere, what previously would have been performed as social functions have been commoditized. This commoditization has occurred through processes o f compartmentalization and institutionalization. A practice through which products and services create a niche in the market place is through a process o f compartmentalization. B y magnifying a single confined area, a wall is constructed between that area and surrounding areas. The solution: the treatment o f the confined area by a specialist or professional. The consequence: a disruption in entire patterns, or systems o f life: "The southern industrialized style o f compartmentalizing social functions and human services has contributed to the dissolution o f bonds which used to sustain Inuit civilization" (Rasmussen, 2000, p. 4). In reference to the preceding discussion o f systems theory - it is impossible to alter a single part o f a system without changing the entire system as a whole. The introduction o f a single product - whether a service or a good - w i l l alter relationships in ways that are more or less evident throughout the entire system. The compartmentalization o f need and related service confounds rather than enhances the meeting o f needs:  33  Dominant Western ideology fragments human thought into a multitude o f disciplines and sub-disciplines each o f which is developing along its own separate path. Human issues, needs and problems are segmented and social care is compartmentalized into too many programs, too many government departments, too many non-government organizations and too many occupations. (Cheers, 1998, p. 62) In the north, problems arising as by-products o f cross-cultural contact encouraged the multiplication o f services. Rasmussen cites in his work on the introduction o f westernized systems o f economy and education among the Inuit the following quote from Nunavik Inuit regarding the introduction o f compartmentalized services to Northern Quebec: W e had no experience with the southern institutional way o f doing things. Institutions handle complex activities by breaking them up into many smaller tasks and spreading them out among many people. Once institutions are set up (they) can be very difficult to control, and can cause people to lose sight o f wisdom, o f humanity, and o f what is really important i n life. Our people did not have any institutional immunity, just as we had no immunity to measles or alcohol. When these institutions came into our lives we had no way to deal with their poisonous side effects, their tendency to undermine wisdom, and our spirits slowly began to die. In our weakened conditions we attracted even more services and more rescuers, and the cycle got worse. (Nunavik Educational Task Force cited in Rasmussen, 2000, p. 27)  34  New, imported problems fostered reliance on imported solutions but these solutions had built within them mechanisms for multiplication and expansion. Rasmussen (2000) ' likens the compartmentalization o f services to an industrialized style o f production. Essentially compartmentalization expands the capitalist economy. What in the past would have been completed for and by ourselves, or for and by known others has become part o f our economy. Assigning a price tag to the meeting o f needs has become legitimized and has jeopardized, or at least altered, our social relationships. Human relations have to varying extents been broken into several pieces, each piece given its own name and price. A process that occurs commensurately with compartmentalization is institutionalization. Institutionalization as a process occurs when the activities o f living are placed within organized structures, which in themselves become endowed with power and importance. For example, education can be institutionalized through the development o f schools, colleges, and universities. M i c h (1973b) writes o f the trend for our institutions to be set up as i f they are industries producing commodities. This trend, Mich,argues, leaves us vulnerable to the erosion o f our values: The institutionalization o f values leads inevitably to physical pollution, social polarization and psychological impotence: three dimensions in a process o f global degradation and modernized misery.. .needs are transformed into demands for commodities; when health, education, personal mobility, welfare or psychological healing are defined as the result o f services or 'treatments', (p. 9) A s a 'westernized' view o f the world has spread, so to has the process o f institutionalization o f values. W i t h reference to Canada's remote North, education - a .  35  task performed historically within the structure o f the family - was assumed first by residential schools, and more recently by schools located within settlement communities. What was in the past an intimate process o f passing knowledge and wisdom from one generation to the next, has been 'formally' replaced by a foreign institution, staffed largely by educators from the south o f Canada. Likewise, in terms o f mental health and social functioning - means existed within northern groups to deal with social disruption. In current times, residents o f settlement communities are the recipients o f mental health services, social services, and justice services - services which both define problems and impose solutions. W h i l e traditional means o f managing social relationships and o f strengthening personal well-being continue to exist and evolve they have doubtlessly been impacted by the introduction o f these services. A n institution can disrupt and foil the very thing it was designed to provide. For example, the institutionalization o f education can disrupt traditional means o f education but also can be ineffective in providing an accessible alternative. This condition is what Illich (1975) labels as counterproductivity: Counterproductivity is something other than either an individual or a social cost; it is distinct from the declining utility obtained from a unit o f currency and from all forms o f external disservice. It exists whenever the use o f an institution paradoxically takes away from society those things the institution was designed to provide, (p. 209) A process similar to counterproductivity has been discussed by systems theorists who connect capitalist development, culturally constructed socialization subsystems, and the advent o f institutions in the following way:  36  Capitalist development also generates "cultural contradictions" in the socialization subsystem. Habermas points out that as market relations expand throughout a society traditional, or "natural," bonds such as family, church, and apprenticeship are increasingly ruptured by labor-market mobility and individualized competition. These "cultural gaps" are filled historically by state institutions such as schools and family-support programs. Thus, output deficits in the economic and political subsystems may lead to input deficits in the socialization subsystem because o f an insufficient allocation o f resources and services. Consequently, the crisis feedback loop is closed and cumulatively exacerbated while the socialization subsystem turns out insufficiently skilled workers that are also unhealthy, unmotivated, and anomic. (Barrow, 1993, p. 109) A systems approach shows existing relationships between cultures, institutions and economies, and also describes how these systems are self-reinforcing in their interaction. Institutionalization is a modern practice that functions to ensnare us within our organizations: "we have embodied our world view into our institutions and are now their prisoners. Factories, news media, hospitals, governments and schools produce goods and services packaged to contain our view o f the w o r l d " (Mich, 1973a, p. 132). This criticism has prompted various responses. One response is to engage in a restructuring o f institutions challenging traditional power structures and calling for institutions to become sensitive to input from a variety o f sources: A new form o f intervention would call for a restructuring o f our major institutions, so that they become answerable to the public rather than being strictly controlled by a relatively small class o f people composed primarily o f white  37  wealthy males. Without such transformation those social problems now experienced w i l l be perpetuated endlessly into the future, with bandaids being busily applied by a profession that should know better. (Carniol in Mullaly, 1997, p. 134) The profession Carniol refers to in the above citation is that o f social work. A way o f restructuring an institution could be for example to offer the public a different way o f interacting with institutional systems by including more possibilities for the public to give their input. This input would then become incorporated within the institutional system. In this way power relationships within institutions would be rearranged to reflect a more democratic and responsive form o f organization. In relation to northern mental health services one way to achieve a "healthier" structure may be to increase public control and input. Also, it would be important that continued public involvement be facilitated by some systemic measure to ensure that the institution continued to change in response to its population and to resist the rigidity that can permeate an institutional organization. Presently, professionals working in northern communities have little accountability to the communities i n which they work. Despite the changes that have come about with the Nunavut Government's emphasis on decentralization and on building community capacity professionals largely remain accountable to organizations and individuals physically located elsewhere. For example, the mental health specialist employed i n Arviat and supervising the K i v a l l i q Region reports to someone in Iqaluit working for the Department o f Health and Social Services. Depending on this individual's credentials the person employed in the position o f mental health specialist  38  may also be accountable to a professional body based in the south o f Canada. The northern professional is accountable to the government department through which they are employed and the profession through which they are licensed or registered but not directly to the populations with whom they work. Further to transforming institutions into being more responsive to the public is the additional suggested change o f making professionals locally accountable to the individuals and communities. W h i l e institutional reform may foster alternatives in service provision, such as the development o f publicly controlled mental health services in northern communities and elsewhere, some claim that institutional reform is an impossible goal to achieve. The claim is that the larger society i n which the institution is housed w i l l 'absorb' the institution within its body: Attempts to establish alternative institutions such as free universities or people's courts are doomed to fail as they are soon 'reabsorbed by the dominant structure' (232). If efforts at resistance are not coopted they are only temporarily successful. (Simons, 1995, p. 50) The above citation is an example o f how systems theory can be used as a powerful critical tool. Mapping institutions as parts o f larger societal systems makes clear the scope o f action that may be needed for institutional change. A s this thesis is an exploration o f the systems involved with mental health in northern settlements, it is useful to consider the health professional - the employee o f the institution - from a critical standpoint.  39  3.4 Power and the Health Profession Critical theorists have commented on the effects resulting from the introduction o f institutionalized health care upon the pre-existing ability o f populations to meet their own health needs. The institutionalization and expansion o f health care systems has resulted in the transference o f power from people to the institution: The cumulative result o f over-expansion in the health care industry has thwarted the power o f people to cope with challenges and to adapt to change in their bodies or change i n the environment. This loss o f autonomy is further reinforced by political prejudice. The politics o f health consistently place the improvement o f medical care above those factors which would improve and equalize ability for modern self-care. (Illich, 1975, p. 65) The ability o f individuals, families, and communities to provide care for themselves and for each other in a personalized manner is diminished and devalued as health care expands i n definition and in scope. What Illich refers to as "non-marketable use values" - the ability to care o f self and others - has been replaced by a marketable, institutionalized service o f health care. W i t h i n this institution it is the health professional who is deferred to. It is the health professionals who are able to diagnose, prescribe, and treat and they have been bequeathed these rights through educational institutions. The health care system is convoluted by layers o f bureaucracy developed to administer health care to patients. The health care industry does not limit itself to i l l health; instead, both prevention and illness are designated as legitimate areas o f intervention. The proliferation o f roles for professionals and bureaucrats and the expansion o f the boundaries o f the territory o f health cumulatively result i n a system o f monolithic  40  proportions. This system is indisputably adept at fostering a relationship of dependence by a population o f patients: The emergence o f a conglomerate health profession has rendered the patient role infinitely elastic. The doctor's certification o f the sick has been replaced by the bureaucratic presumption o f the health manager who arranges people according to the degree and kind o f their therapeutic needs. Medical authority extended to supervised health care, early detection, preventative therapies, and increasingly the treatment o f the incurable. The public recognized this new right o f health professionals to intervene i n the lives o f people on behalf o f their own health. In a morbid society the environment is so rearranged that for most of the time most people lose their power and w i l l for self-sufficiency, and finally cease to believe that autonomous action is feasible. (Mich, 1975, p. 63). Through a process o f colonization the expansion o f morbidity has come to the Arctic. Health clinics exist within settlements; as well, patients are flown to southern centres to see specialized professionals and to access specialized interventions which cannot be offered within the settlements. The area o f mental health is a perfect example o f the expansion o f the health industry. The abstractness o f the term mental health, its ability to be defined both positively and negatively, make its industry conducive to growth. Mental health specialists, professionals, and the associated health administration flourish i n their efforts o f diagnosis, prescription, and service provision. The effect o f these efforts on communities is the undermining o f natural capacities: "the so-called health professions have an even deeper, structurally health-denying effect insofar as they destroy the  41  potential o f people to deal with their human weakness, vulnerability and uniqueness i n a personal and autonomous way" (Illich, 1975, p. 26). The introduction o f the term mental health into northern remote communities has resulted in the "pathologizing" o f local populations. It is from the activity o f pathologizing that most health professionals, such as social workers, define their role and earn their income. Monetary gain accrues from . the carving o f a professional niche and health professionals experience power over the lives o f others. The imposition o f diagnostic labels and the prescription o f treatment are not innocuous processes. They are an exercise in the assertion o f a 'superior knowledge': This social division o f labour provides a plausible explanation for so many social workers being co-opted by our present social system that oppresses so many people. A s professionals, social workers are able to exercise their capacities through their university training and through the professional development that occurs throughout their careers. In addition, they are able to exercise considerable power over others and receive the respect that goes with the privilege o f professionalism. (Mullaly, 1997, p. 149) M u l l a l y points to the vested interest that social workers have i n maintaining the current social services systems. A radical systemic transformation may result in an associated decrease i n the power and income o f the social work professional.  This condition o f  'self-interested' profession is by no means confined to the profession o f social work. Health professionals vie with each other to claim their stake in the pathology o f humanity.  This competitive claim staking is part o f a larger process o f commoditization.  Services are developed and sold as commodities or as packaged solutions. Problems that  42  continue to exist despite (or because of) being serviced are perceived as outcries for more services: Rather than attack root social and economic causes o f mental illness and injury, that establishment attempts to patch up oppressive machinery, oiling the squeaks and adjusting the controls. The effect is to anesthetize the oppressed and allow the exploiters to carry on business as usual. The primary objective o f the mental health establishment is to make more jobs for themselves. Every problem identified calls for a familiar remedy; - more specialists. (Davis & Zannis, 1973, p. 129) A report prepared for K i v a l l i q Health and Social Services by a mental health consultant, Rosanne Rothenberg, illustrates the continued relevance o f the above passage cited from Davis and Zannis. Rothenberg, herself a psychiatric nurse, includes in her proposed action plan for the development o f a mental health service delivery model for the K i v a l l i q Region: Employ Registered Psychiatric Nurses as Managers (sic), Mental Health Services i n each o f the communities to establish, administer and case manage mental health services. (Rothenberg, 2000, p. 30) Elsewhere i n this same report, Rothenberg explains why psychiatric nurses are the employees o f choice: Registered Psychiatric Nurses were identified as the professionals o f choice within the integrated model and provide improved mental health services in the K i v a l l i q Region. Registered Psychiatric Nurses have a broad understanding o f medical issues and in-depth knowledge o f psychological'  43  and developmental problems and their treatments. Registered Psychiatric Nurses also have highly developed levels o f verbal, non-verbal and written communication skills. (Rothenberg, 2000, p. 3) Rothenberg's report, i n general, reads like an advertisement for psychiatric nurses rather than a reflective examination o f feedback generated from meeting with community members i n the K i v a l l i q Region. Reports such as this one, commissioned by K i v a l l i q Health and Social Services, point to the continued relevance o f the observation that the creation o f jobs for one's profession is a major motive o f mental health professionals. When considering the development o f mental health services in the north o f Canada it is important to consider how a history o f colonialism might have effected or shaped these services.  3.5 Colonialism and Mental Health Services Institutions have been brought to the remote north as part o f an effort to organize populations to be the recipients o f services. The introduction and imposition o f these services i n the North have been a form o f neo-colonialism coined as tutelage: Tutelage refers to the policy used by the federal government to establish administrative institutions i n the north over the last fifteen years, with the intention that through them the Inuit would acquire the experience to run their own communities. The actual result documented i n several studies.. .has been an entrenchment o f control by outsiders, primarily by bureaucrats. (Tanner, 1983, p. 2)  44  One o f the reasons small camps o f Inuit were relocated into settlements was to facilitate the process o f service delivery - such as the delivery o f education, welfare, and health care. Each o f these services had and continues to have power associated with its delivery and administration. In settlements where jobs are scarce, the positions tied to these services yield both income and power and are commonly held by non-Inuit. Even . with the advent o f the Nunavut Government in many northern settlements some key positions o f authority continue to be occupied by those relatively new to the north. The associated consequence is that service design and delivery, such as those related to mental health, are neither created nor controlled by local populations. A history has unfolded whereby northern populations have been administered from the south. Foreign structures were imported into the north and people were required to adapt first, understand later. The subjects o f this colonization became the objects of its political and economical structures. To lay a smooth foundation, it was necessary first to undermine cultural practices that may have stood i n the way o f "modernization" and "progress". This suited the purpose o f the colonizer who treated the north as a land o f untapped resources, a "hinterland" (Frideres, 1983). Critical theorists who write specifically o f the north fall in line with those who write about processes o f westernization in general. The north, as with many places in the world, provides a fitting example for what critical theorists describe as the attempted manipulation o f populations to create needs that i n turn create market expansion. Further to this, as Frideres (1983) notes, the north itself has always held the promise o f natural resources to be exploited, which, at least to some extent, necessitates the co-operation (coerced or freely given) of  r )  45  indigenous populations. The process o f imposing euro-centric interests and politics on northern people has historically been mostly unilateral and therefore colonial: It came about that Canadian interest i n the eastern Arctic had a typically colonial aspect: land, and people were incorporated into a growing political entity without regard to the people's wishes. Eskimos would indeed have found it hard to express wishes in the matter, for they had heard little o f the institutions and less o f the nation that was carrying out the process. (Brody, 1975, p. 18) Brody notes the lack o f familiarity on the part o f the Inuit i n regards'to what was being orchestrated i n the north through a southern administration. This lack o f familiarity is what the Nunavik Education Advisory Council described earlier as lack of institutional immunity. Relations o f power were altered and lifestyles dramatically changed. A s the process o f colonization advanced, life i n a small nomadic group gave way to life i n a settlement. The imposition o f a euro-centric lifestyle onto indigenous northern populations has repercussions for both Inuit and non-Inuit. Critical theory's acknowledgement o f the reciprocal effects o f the colonial relationship is congruent with an ecological perspective: It can be shown that the product o f a colonial relationship is dehumanization, then we must assume that the relationship is opposed to the development o f not only the colonized but also the colonizer. If human life entails acting out a uniquely human vocation, then the colonial relationship destroys rather than creates life. In this regard, the assumption that so-called 'social impact' relates only to the experience o f those who are unfortunate enough to be on the receiving end o f colonial projects is quite incorrect. The social impact can also be  46  determined i n the lives o f those who serve this dehumanizing process. (Puxley, 1977, p. 103) Colonialism has left northern inhabitants a legacy o f residual misunderstanding, mistrust, and anger. Oppression remains embedded within colonialist institutions introduced to the north: To understand the meaning and practice o f oppression Foucault (1977) suggests that we go beyond viewing oppression as the conscious and intentional acts o f one group against another. Instead, oppression is often found in such areas as education, the production and distribution o f goods and services, public administration, the delivery o f health and social services and the like. (Mullaly, 1997, p. 45) The creation and operation o f institutions is a way o f exercising power and control. Professionals who run the institutions perpetuate the oppression resulting from the establishment o f institutions. Professionals have in a sense become the new colonizers. This stance fails to recognize the diversity to be found amongst health care providers but it raises a critical point. Reality is more multi-dimensional than pitting 'oppressive' professionals against the communities they work for. However, professionals are influenced like everyone else by a global economy and likely have a certain amount o f self-interest. Critical theory suggests that the process o f decolonialization begins when control is given back to the colonized. When community control is achieved, the colonized are able to relocate their identity and recognize their abilities. The need for community control is paramount to mental health:  47  The struggle for survival is a struggle for identity. The group must view its past positively and maintain strong links with traditional customs and beliefs. It must also achieve political equality and look forward to a promising future. These processes can only be set i n motions at the grass-root level. If Natives are going to control their destiny, they must implement community control immediately. (Frideres, 1983, p. 313) Frideres implies that a shift i n power from colonizer to colonized w i l l be the impetus for increased well-being and community health. Critical theorists such as Illich (1976) and Jameson (1994) argue that contemporary, industrialized culture is becoming a global force with a totalizing force, increasingly difficult to resist. The shift to self-government and community control is a necessary step toward community well-being. However,  r communities w i l l be faced with the challenge o f maintaining traditional customs and beliefs while under the influence o f globalization.  3.6 Mental Health and Culture The genesis o f institutions and their importation into parts o f the world inhabited by different cultures is based on a western belief o f the supremacy o f science and rational thought. Indigenous ways and means o f achieving health, and the very definition o f health itself, have been regarded through a euro-centric filter. It is important to recognize the influence o f culture i n shaping the meaning o f health: Health is a task.. .Success i n this personal task is i n large part the result o f the self-awareness, self-discipline and inner resources by which each  48  person regulates his own daily rhythm and actions, his diet and his sex. Knowledge encompassing desirable activities, competent performance, commitment to enhance health i n others - these are all learned through example from peers or elders. These personal activities are shaped and conditioned by the culture i n which the individual grows up: patterns o f work and leisure, o f celebration and o f sleep, o f production and preparation o f food and drink, o f family patterns and politics. The existence o f long-tested health patterns which fit a geographic area and a technical situation depend to a large extent on longlasting political autonomy. They depend on the spread o f responsibility for healthy habits and for the socio-biological environment. That is, they depend on the dynamic stability o f a culture. (Mich, 1975, p. 168) The meaning o f health and the means o f achieving it have grown through people, their relationships with each other, and their relationships with their larger environment. The disruption o f these relationships through the influences o f colonialism and capitalism jeopardizes health. Definitions o f mental health are particularly defined by,culture. It is shared meanings and norms that prescribe indicators o f what is healthy and what is unhealthy behaviour: Each culture has its own threshold, which evolves with the configuration o f that culture; since the mid-nineteenth century, the threshold o f sensitivity to madness has considerably lowered in our society; the existence o f psychoanalysis is evidence o f this lowering in that it is an effect as well as a cause o f it. (Foucault, 1976, p. 78)  49  Professionals trained to seek out and treat 'mental pathology' w i l l tend to interpret mental pathology very broadly. The question becomes, how meaningful can services derived from western definitions o f health in different cultural contexts be, given that: "for a long time now, one fact has become the commonplace o f sociology and mental pathology: mental illness has its reality and its value qua illness only within a culture that recognizes it as such" (Foucault, 1976, p. 60). A second relationship between mental health and culture is observed in the effects on mental health that occur when people are estranged from the means o f controlling their lives through the intervention o f members o f an outside culture. The disruption o f indigenous meanings o f health held by northern populations occurred as cross-cultural contact evolved into colonial relationships. Questions regarding identity and freedom o f choice have emerged: Forced choices, or lack o f choice options due to external forces, real or imagined, give rise to the mere cog-in-the-wheel feeling o f powerlessness. Abdicating choices, one's own responsibility, contributes to a sense o f alienation or slipping away from meaningful connections.. . A n experience so fundamentally part o f human well-being as making choices, cannot be lightly cast aside without serious personal and/or community consequences. If freedom goes, responsibility goes. Personal and community well-being is rooted i n both. (Glick & Glick, 1981, p. 62) Northern histories are full o f stories o f lack o f choice: children sent away to residential schools without family consent and the forced relocation o f entire groups o f people are two examples. Institutions operating in northern settlement communities have  50  (  . . .  prescribed ways and means o f doing things and have largely denied alternatives. However, the road to health can only be built by including those whose health is in question.  3.7 Conclusion The relationship between mental health problems and mental health services is complex and multi-faceted. The application o f an ecological perspective and critical theory result i n a recognition o f histories and Of relationships that have defined problems and produced services. Critical theorists advocate for localized control o f resources. A n ecological model indicates that local control is a logical choice given the strong and direct relationships between individuals, families and community at the local level. Systems that are sensitive to feedback and that are reciprocal in nature are healthier, more resilient systems. Critical theorists recognize the environment created by capitalist societies as potentially harmful. These theoretical perspectives draw attention to the importance o f culture i n combating the depersonalizing forces o f globalization that propagate capitalism. Culture preserves meaning and facilitates the reconciliation o f the individual with the local environment. A source o f dissonance between various streams o f critical thought is in the appraisal o f how endemic the problems associated with globalization are and, consequently, how drastic the solutions need to be. One stream o f thought advocates that what is needed to begin addressing problems found within westernized environments is the transfer o f power to self-directed communities and the mobilization o f an increased  51  amount o f resources (Frideres, 1983). Jameson (1994) argues an alternative albeit neither hopeful nor directive: what is needed is beyond what can be imagined. Jameson's contribution is helpful, however, in its reminder that we cannot step out o f the system o f which we are a part. Our 'solutions' w i l l be informed by our understanding o f reality. The totalizing and standardizing system o f which Jameson writes is omnipresent and although we cannot stand apart from it we can become increasing conscious o f it.  Agger  (1998) writes that one o f the tasks o f critical social theory to challenge "false consciousness by insisting on the power o f agency, both personal and collective, to transform society" (p. 5). Illich (1975) proposes the need for radical change to reorder industrialized society. A n increase in resources and more community empowerment may be initiated but these measures w i l l not go far enough toward producing the larger structural changes required for meaningful change. W h i l e both systems theory and critical theory are useful in developing an understanding o f the way things are, critical theory has the added usefulness o f suggesting how things should be. Systems theory has been critiqued as being a liberal theory that does not challenge the status quo. Critical theory challenges the status quo and advocates for structural changes to occur that would transform society. Some o f these suggestions for change are simple reminders o f the importance o f addressing the basic needs o f humanity. For example, critical theorist Ivan Illich (1975) puts forward the ecological argument that the cause o f most health problems stems from an individual's environment and that the provision o f adequate housing, food and clean water w i l l , in many cases, result i n the necessary cure.  52  Implications for the practicing social worker are easy to discern. First and foremost social workers need to acknowledge that they are part of a health profession that benefits by gaining both financially and in the exercise o f power through the diagnosis and the treatment o f mental health problems. A conflict o f interest needs to be recognized between the social worker's advocacy for community control and the social worker's private interest. The social worker employed in the design or the delivery o f mental health services in a northern remote community needs to be active in soliciting the participation o f the community. The importance o f culture and identity has been emphasized throughout this theoretical review. A meaningful process toward community mental health and wellbeing is the 'rediscovery' o f how needs were traditionally met successfully for thousands o f years and how this changed through the process o f colonization. A n inquiry o f this type, undertaken by the community, may unearth competencies and strategies adaptable to the present day, as well as controversial challenges that may emerge as the past is viewed from the lens o f the present. A n ecological systems perspective is an excellent tool for constructing models to further understanding. Critical theories operate like engines, dynamically exploring relationships mapped out ecologically. The combination encourages recognition o f both structure and function, creating insights useful to social work practice. The goal o f enhancing mental health in northern communities is urgent - oppression is occurring that w i l l effect generations to come. The introduction o f professionals has not fixed problems, it would be nonsensical to keep on trying the same methods and expect  53  different results. Meaningful change requires an analysis that can be enhanced through the application o f theory.  54  CHAPTER IV: Method  This writer spent approximately two months i n the community of Arviat from A p r i l 24 , th  2001, to June 17 ' 2001. During this time, interviews were conducted with those th  community members interested i n participating i n the study. This writer's individual study is part o f a larger study conducted by Dr. Frank Tester and Dr. Paule M e N i c o l l  titled Historical Relations of Health Care in the Eastern Arctic: Health Care Policy Implications. Dr. Tester's and Dr. M c N i c o l l ' s research project is directed toward an exploration o f the relations and events o f the past which led to the development o f initial and current health services. The objective o f this historical exploration is to trace the development o f present day health services and to uncover possibilities for health policy alternatives for the future. T w o protocols were followed to ensure the appropriateness o f this research. Firstly, a social science, traditional knowledge and health research license endorsed by the Hamlet Council o f Arviat was obtained through the Nunavut Research Institute. Secondly, a certificate o f approval was granted by the University o f British Columbia's Behavioural Research Ethics Board upon reviewing the study. The findings reported i n this paper focus on the area o f mental health services i n a remote northern community o f the eastern Arctic. Questions asked during the interviews encouraged participants to consider past and present determinants o f mental health and how mental health services can be improved to foster an increased level o f well-being i n the community.  The questions used for the purpose o f the interviews were developed  after arriving i n the community and evolved through the process o f the initial interviews. A n initial list o f questions was established, put to participants, reviewed and then further refined by noting which areas o f inquiry generated the most discussion and which seemed  55  o f lesser import or interest. The objective o f conducting research that was qualitative and flexible was to be responsive to the areas emphasized by the participants rather than by the researcher.  The interviews were divided into two parts: the first part directed  questions towards a more complete understanding o f the term mental health, the second part turned to the examination o f mental health services. After the first initial interviews, it became evident that an important initial question to put to participants was: how do you define mental health? The reason for this question being placed at the beginning o f the interview was to be responsive to the range o f different topics that participants brought up i n association with the term mental health. Further questions were asked to participants to clarify the term mental health, asking them to speak o f their views on characteristics o f healthy individuals, families, and communities, as well as asking them to speak o f mental health's relationship to different aspects o f life. The second part o f the interview was initiated by asking participants to speak o f their view of mental health problems i n the community o f Arviat. After they told what they felt to be pressing mental health problems i n their community, participants were then asked to consider the mental health services available to them: were these adequate? H o w could they be improved? The outcome o f these interviews is a general review o f the term mental health, o f mental health problems and o f mental health services and suggestions for their improvement. Interview questions were exploratory, eliciting a range o f responses and areas o f agreement as well as those o f disagreement. Suggestions for improvements made toward the end o f the interviews reveal exciting possibilities o f areas i n which meaningful change can occur and which would be gainfully pursued.  56  The results reported in this paper are compiled from twenty interviews conducted with community members. A purposive sampling strategy was used to locate participants i n an attempt to be inclusive o f a range o f community members, including participants o f different ages and o f different cultural backgrounds. In this way the view o f an elder born and raised in a small, mobile camp is placed beside the view o f a young adult born and raised in the settlement, which in turn is placed beside the view o f a professional recently arrived in the community from the south o f Canada. Participants were recruited by the following methods: approached due to position in the community (e.g. mental health worker), approached by the interpreter, or, approached by this writer after informally meeting. Conclusions generated from the twenty interviews by no means speak for all the people o f Arviat; they do however represent a cross-section o f community opinion.  ,  ,  interviews were conducted both by this researcher alone, and in conjunction with Dr. M c N i c o l l and/or Dr. Tester. Interviews with elders were usually conducted with the assistance o f an interpreter so that they could be held in Inuktitut. A twenty dollar honorarium was offered to most participants excepting those who were participating in relation to their position o f employment. It should be noted that three participants refused the proffered honorarium, stating that their reason for participating i n the study was to benefit the community and not for remuneration. It was their feeling that the honorarium perpetuated a harmful and growing tendency in the community to participate for the sole reason o f material gain. A l l the interviews utilized for this paper, with the exception o f one, were recorded on audiocassette and then transcribed into written script. Written scripts were analyzed by a process o f reviewing  57  information provided by participants and by sorting the content o f the twenty interviews into different thematic categories. After different thematic categories were established, interviews were once more reviewed and comments from individual interviews were compiled under the different thematic headings.  In the presentation o f results two  objectives were considered: the first was to^include the, range o f opinion found in the results, the second was to emphasize those areas o f collective import to participants. In reporting results this way, both areas where there are differences o f opinion and general consensus were captured.  58  C H A P T E R V : Results  5.7 Overview  What emerged through interviews held with Arviat community members was the depiction o f a state o f mental health that intersected at many points with various areas o f community life. Mental health is multitudinously defined, meaning different things to different people. Mental health is itself invisible - its measure is the result o f exhibited behaviour that is attributed by a social group as being relative to either its presence or absence. Mental health can be perceived positively as the ability to deal with problems and/or stress by employing effective strategies o f coping. These abilities o f coping can be demonstrated by individuals, families, or by the community as a whole. Conversely, mental health can be defined negatively, as an inability to cope evidenced by problems and behaviours (or lack thereof). This lack o f ability to cope with stress can be located with the individual, the family, or generally amongst the entire community. This review o f results begins with an exploration of the sources o f stress identified by the sample o f community members participating in this study - what do they perceive as the pressures being applied to Arviat's collective mental health? From there, the term mental health is examined - what does it mean to lead a healthy life as an individual, as a family, and as a community? A s mental health can be located by both its presence and its absence, successful strategies for coping with stress are explored as are problems deriving from negative reactions to stress. The final two areas explored are: firstly ,an analysis o f current mental health services available to residents o f Arviat and secondly, suggestions for alternative ways to address mental health issues.  59  Using a process informed by qualitative analysis (Robson, 1993; Walker, 1985) the content analysis and discussion w i l l be presented jointly. In this paper each finding w i l l be demonstrated by a quotation, then described. The co-joint analysis and discussion o f these findings is elaborated upon and to some extent organized through the application o f both critical theory and systems theory. Participants reflected during the interviews, not only on the mental health individuals but also on the collective mental health o f families and communities, and how these mental health issues corresponded with larger systems that influence community well-being (for example - decisions made by the Territorial Government regarding spending). In this way an ecological framework is used to categorize some o f the results in order to recognize the various systemic levels addressed by participants. Critical theory is also integrated into analysis and discussion as participants' observations often illuminated an understanding o f the world from a critical bent. The inclusion o f critical theory furthers some o f these observations by extending them into a broader context.  60  STRESS : INTERNAL A N D E X T E R N A L  STRATEGIES/COPING  /  /  /  individuals families communities  PROBLEMS/STRESSORS  \  individuals  \  families  \  communities  SERVICE ANALYSIS  SUGGESTIONS F O R CHANGE  Figure 4: Areas of discussion derivedfrom interviews  61  5.2 Stress: Internal and External During the interviews held with Arviat community members regarding mental health little discussion took place on the topic o f organic causes o f mental health problems. Even health professionals only briefly mentioned classic diagnosis, focusing their discussion instead on social interpretations and social relationships pertinent to mental health. What was the cause o f stress and what emerged as a reaction to stress was a boundary that often became blurred during interviews. A s indicated in the diagram above by the arrows representing a two-way flow between mental health and stress, the label "mental health problem" often becomes i n and o f itself a cause o f stress. This was particularly perceived as being the case within families. Problems were identified as being transmitted across generations - the problems or abilities o f the parents would be passed on to the child: Family life is...a huge problem... very unhealthy lifestyles... not being able to raise z  your children properly just becomes a cycle ...when you grow up in a... very unhealthy family... that's what you know, you don't know any other lifestyles, so when you get your children, you 're going to raise them like you were raised... if you see your parents drinking or drunk all the time, abusing alcohol, then you 're going to follow them...when you get children maybe they'll see that...then your children are going to follow your's a cycle.. .(Respondent # 4, young adult male)  Participants frequently spoke o f the family rather than the individual i n their consideration o f the subject o f mental health. A common pattern o f behaviour is  62  perceived as emerging from within the family: a parent's abuse o f alcohol, regardless o f its cause, is stressful for a child, but it is also a demonstrated mechanism for dealing with life stress. The child develops an ambivalent relationship with alcohol - on the one hand it is stress-provoking as the child has seen problems exacerbated or caused by the abuse o f the substance, but also, the child has learnt from the parent that a strategy for coping with stress is substance use. A parent's drinking is the kind o f stressor that respondents mentioned when they were asked to talk about mental health problems. Individuals interviewed for the purpose o f this study were understandably tentative in tracing problems back to a single, original genesis. They did voice, however, their beliefs that many sources o f stress originate from things introduced to Inuit society through contact with the "western world". The world today is "different" from the world o f the past which established and was established by Inuit culture: Most of the problems we have today as a community are alcohol and drugs, and sniffing...back then my worries were where do we get the next meal, but today it's i  different cause there's all sorts of things today, compared to, my younger years...(Respondent  #12, female elder)  / think it comes from the past. I thinkpeople are angry with their loss of ...culture, their traditions and they feel they 're losing because now we 're living in homes like this, living in modern worlds, that wasn't in our blood...this is new to all of us's a new lifestyle for all of us. They don't know how to use what they were given...People are lost I say... (Respondent #6, young adult female)  63  Added to massive change is the complicating factor that the very condition o f living i n a settled community goes against cultural prescriptions for a healthy life that held small groups together i n nomadic existence. One elder commented:  I've got a pretty good idea of what's happening, what's happening within the community today. When dogs are bunched up, tied together, it's very similar now with the community...(Respondent #5, male elder) The sudden arrival i n Inuit life o f so many goods, commodities and services previously unknown and a fundamental change i n life-style have produced confusion i n identity and i n relationships. T w o individuals interviewed told abbreviated stories o f this history o f change and the repercussions o f such change i n the following manner:  You 're living a nomadic lifestyle, living off the 're not drinking alcohol, you 're not watching TV, you 're not playing video games, you 're not seeking a job to support your family know what needs to be done and suddenly overnight, that changes, that's no more...what do you do with all these things? It looks like fun at first but when you don't know what they really are, what it can do to you, how it can affect you... when people started moving into settlements, permanent settlements ...they didn't know how to ...adjust, how to adapt to that lifestyle in a healthy's like giving you all the tools to go hunting, taking you fifty miles out of town and leaving you there, what are you going to J o ? (Respondent #4, young adult male)  Today, with all these different kinds ofjobs that nobody even thought of back then it's like what do I do ? Where do I go ? And so they 're confused. ..they were  64  brought in off the land and dropped here like what are they supposed to do? They said they had to stay there so they built their tents and stayed here and then eventually they moved into houses and it's just a big culture shock...confused of their identities ...instead of asking for help...they take their anger out on who's ever around and that's usually their family... (Respondent #9, young adult female) Life i n a fixed settlement has its own sources o f stress. It is neither the life o f the south, depicted and transmitted to the people o f Arviat via satellite television, nor is it a life o f nomadic hunting largely maintained until 50 years ago. The purchase o f a healthy existence in the present is jeopardized by tensions between two different world views. Qallunaat and Inuit cultures have been described as being in conflict; subscription to one way o f life is perceived as the abandonment o f the other. Inuit culture is frequently located in the past, regarded as traditional, whereas Qallunaat culture is described as modern. The polarization between cultures and between past and present is stressproducing and impedes the establishment o f lifestyles built on a foundation o f Inuit culture which selectively incorporates elements o f western culture deemed as necessary or desirable. W h i l e some individuals describe being lost or trapped between worlds, others talk about choosing ways from each culture that suit them as an individual. A pervasive sense o f loss took shape in the words o f some interviews. W h i l e elders are held i n a respected and revered position within the community, they are not like the elders o f the past: What I've noticed over the years is my ancestors before me; I know that they know more than the elders today, cause back then some elders would predict weather days before the weather changed and they knew what young people were,  65  they experienced what it is to go through life but now today it seems like the weather's very different and it seems like the elders...we know but we do not have the knowledge that the people before us had... (Respondent #13, male elder) Stress exists between different members o f the community o f Arviat. It is as i f each individual i n the community aligns h i m or her self differently, accepting or rejecting various parts o f Inuit and Qallunaat cultures. The impression gleaned from interviews is that there are differences between various generations - their ways o f being, and how they identify themselves. This difference results i n a lack o f understanding and a generation gap. The most visible gap is between the elders and the youth, each speaking with uncertainty about the other:  The elders expect from the youth something of us and to help them, show them, guide them to the modern world but we expect something of them us about our past, our culture... (Respondent #6, young adult female)  I've looked for answers from the elders...I guess I looked in the wrong places, they 're not willing to answer my questions, they want it for their family, for themselves. It is stressful cause in the past it just dragged me down, I wanted to know a bit about my culture, but my friends were... ashamed of being Inuk, and I, I wasn't sure what to think or what to feel because I'm here...I'm Inuk and my Mom lived this, she lived this lifestyle I'm living...I'd like to know where I came from... (Respondent #6, young adult female)  66  Back then when they were told to listen they listened cause back then what I feared most was to be scoldedfor not listening so whatever we were told to do we would listen - if somebody told us to do something it would be like sticking to your word, and living up to your word...but today, you talk to today's young people and it's a very different life style where you tell the young person - they '11 say yeah, okay - and they just go on with what they 're doing - it's a big difference back then ' til today. Today is seems like the young people are not scared... (Respondent #13, male elder) Described above is a restructuring o f relationships established by countless generations gone before. The elders now turn to the youth with expectations o f being assisted with those things that are new or that have changed. In turn, the youth place expectations on the elders to answer questions about the past. A n interruption, caused by colonialism, has occurred which has affected the relationships that previously existed between young people and adults. The introduction o f new products and technologies have frequently placed those younger members o f the community i n possession o f greater knowledge than their elders. A reversal from a past which elevated elders as those i n possession o f knowledge necessary for survival and well-being. The disruption o f relationships through the imposition o f one culture onto another has eroded the sense o f security stemming from a certainty o f 'the way things should be'. The inundation o f western culture - through schools, through the health system, through television - systemically elevates the importance o f the ways o f the western world while devaluing alternative ways. Younger people are particularly exposed to western influences as they have been raised i n western institutions and are the target audience o f popular culture. The way  67  things 'were', has become sharply differentiated from the way things 'are'. Expectations are unmet on both counts- the youth expressing the perception that the elders are not willing to share their knowledge, and the elders expressing their perception that the youth are not listening. The young woman cited above accuses the elders that she has approached o f wanting to share their knowledge only with their family. This accusation raises further questions - has culture been likened to a commodity and has this effected it's transmission? The comment regarding feeling shame regarding being Inuk also identifies a potential barrier to the transmission o f culture. If younger people feel shame associated with their cultural identity does this alter elders readiness to share their cultural knowledge? One elder commented about his own feelings: I also thinks elders are not used as much as they were used before, like even myself at home, sometimes Ifeel useless, like the young people are different now...(Respondent #1, male elder) This sentiment o f a changed world, and the subsequent devaluation o f traditional knowledge is expressed i n the following comment made by a young person: I think that you have to be aware that... it's not going to work if your grandparents are teaching you very ...I guess irrelevant things to our lifestyle today...(Respondent  #4, young adult male)  Added to this, there is a feeling circulating around the community that today's young people are not as competent as i n the past. According to one elder: Today's young people, they constantly need to be fended for or taught, cause today's lifestyle is different, it's like everyday they 're writing, they 're focused on one thing, as opposed to focusing on everything else around them, and they've  68  forgotten the basic things to do...there's been a lot of changes over the years, all they want to do now is listen to music, and watch TV, or games...(Respondent #5, male elder) These feelings o f failed expectations on both sides are currents running through and between the people o f Arviat. The result is a lack o f cohesiveness that has deteriorated family bonds and has left individuals increasingly vulnerable to the various manifestations o f mental health problems. A s evidenced by the comments o f those interviewed, stress relates to change, to finding yourself, your family, and your community i n the midst o f massive change with no clear path o f what to do and o f how to relate to one another. W i t h such an undermining o f traditional ways o f being, predictions have been made regarding the inevitable collapse o f Inuit culture (Matthiasson, 1992) but this has not happened. W h i l e there is an abundance of influence and introductions from western culture, Inuit culture remains distinct. This distinctness necessitates locating alternatives to 'solutions' imposed from the south. Stressors exert pressure on community members and pose a challenge to mental health. M a n y o f the stressors described by the participants o f this study served to demonstrate both the mental health capacities and the mental health problems faced by the community o f Arviat.  5.3 Definitions of Mental Health Regardless o f formalized definitions o f mental health- it is necessary to identify how mental health is perceived locally by community members. Mental health is an elusive  69  concept not only i n northern remote settlements, but also in the south o f Canada, within urban centers. For the Inuit respondents cited i n this study, there is a recognition o f the complexity o f the term mental health which is further confounded by the term's lack o f fixedness when transferred from culture to culture. Strictly organic definitions o f mental health problems are questioned as the inter-relatedness between different aspects o f life is acknowledged. Inuit interviewed recognized a connection between mental health and physical health, and also a recognition that health can be measured not only singularly within the individual but within the family and the entire community, regionally or beyond. Mental health is not an original Inuit concept - the term was imposed on to the culture (Kirmayer et al, 1994). The closest parallel concept to mental health that arose from the interviews reviewed in this study was the concept o f "living a good life". Inuit culture has prescriptions for things that should be done, and things that should be avoided in order to lead a life that is good - a life that meets various needs and promotes harmonious interactions with others. B y exploring what is meant by living a life that is good , a picture emerges regarding a shared community understanding o f health. Rather than being a singular, agreed upon definition, the concept o f health contains varying points o f emphasis depending upon the individual whom is being asked. In answer to the question, how do you define mental health , the following considerations were offered.  j  70  •  Mental health is broad: it encompasses the totality of life  How we feel about our lives, about our environment, about our livelihood, overall... (Respondent #10, adult female) Participants paint mental health with broad strokes - something not to be located singularly or i n some remote part o f life - mental health is woven into the daily fabric o f life. Mental health is relatively present or absent within each individual, each family, and each community.  From words such as "all encompassing" and "overall" a feeling o f  enormity is imparted i n relation to the concept. While, it serves purpose to envision the concept i n a broad and inclusive manner it also presents the following difficulty: i f all problems fall under the heading o f mental health then the term has no inherent selectivity. The term's openness leaves it vulnerable to a variety o f interest groups who can stake claims i n order to be assigned funding dollars. The warning to heed, voiced i n critical literature, is that this openness can result in an exploitation o f the system by those with power and knowledge who may be working primarily towards self-interest rather than greater communal benefit.  •  Definite relationships exist between physical, mental, emotional, and spiritual health I see health as a very holistic thing. I don't think you can be physically healthy without being mentally healthy -1 think they 're very much linked and so mental health to me is...having a positive attitude toward life that means you can function fully in society... (Respondent #2, adult female)  71  This point ties i n with the first. Once again the breadth o f the term is alluded to i n the term "holistic". This point is included separately from the first as it raises the consideration o f overlap between different areas. If physical health and mental health are strongly related, then service providers and recipients need to consider ways o f increasing co-ordination between these areas. If on top o f that spiritual health is also depicted as connected b y community members, then recognizing this connectedness within service provision w i l l be o f benefit. The overlap o f different areas points to the relevance o f ecosystems being applied to this research as it fits with the descriptions o f relationships provided b y interviewees.  •  Mental health is intimately related to traditional knowledge  Mental health, I applying traditional knowledge...and when you 're dealing with people you have to deal with them very patiently and to be open to them and to understand them, talk to them, so that's how I view mental health... (Respondent # 1, male elder)  Interviews, especially those with elders, revealed beliefs that the prescription for mental health is available through Inuit culture. Traditional knowledge contains acknowledged practices for interacting with others i n ways which are conducive to health and wellness. One elder spoke about what he had learned from his ancestors i n regards to dealing with other people: Our ancestors from generation to generation have left us with this kind...mental frame of mind where you love the person no matter what he or she, what race or  72  position the person is love the person no matter what he or she looks like... (Respondent #5, male elder)  •  Mental health is exhibited in healthy interactions with other people / think mental health also has to do with the way you interact with other people...(Respondent  #4, young adult male)  During the interviews a clear picture emerged that mental health is socially exhibited. Mental health may reside within the individual, but its measure is exhibited socially through the individual's interactions with others. The inability to interact i n a healthy manner with others or to have healthy relationships with other individuals is described as a mental health problem. This consideration may overlap with the previous finding regarding traditional knowledge i n important ways. If Inuit culture and traditional knowledge regulate the relationship between people, then traditional knowledge does indeed have great importance i n terms o f mental health. Conversely, i f the relationships and interactions between individuals have been a site o f intense change due to cross-cultural influence and changing lifestyles, then mental health may be extremely sensitive to the effects o f westernization. If interactions between individuals, family members, community members are deeply altered by western/southern influence, and i f this influence runs counter to what is idealized i n traditional knowledge, then mental health w i l l be jeopardized. While the above have been general depictions o f mental health, further illumination came from participants commenting on the attributes o f a healthy individual, a healthy family, and a healthy community.  73  •  A healthy individual..  i.) Makes good decisions and has a sense of self-responsibility To use your mind wisely, in terms of making...good decisions... (Respondent #4, young adult male) If you want to help people achieve the good side, make them responsible for themselves...(Respondent #16, adult male) Tries to live a good life, they have a good life, they 're aware of what's good for you, what's good for your family... (Respondent #10, adult, female) Expressed clearly i n a few o f the interviews was the belief that an individual cannot be mentally healthy without taking responsibility for their actions, including decisions which affect their own well-being. Individuals may consult and meet with others when they are troubled, but ultimately it is they who both identify and resolve their own problems. A healthy individual also possesses the ability to distinguish between what is a good decision and what is a bad decision - not just i n terms o f self but also related to others, especially family. Could this point relate to the negative affects frequently associated with a colonialist history? There is a potential link between this point about the ability to make good decisions and critical theory. Colonialism has eroded a belief in self-sufficiency and encouraged a sense o f dependency upon the colonizer. A s this was done physically through the relocation o f groups o f people into fixed settlements, soft was done (or attempted) mentally - through the provision o f education and social services. This  74  erosion o f the belief in the ability to meet one's own needs leaves space for the entrance o f the professional, an individual who assumes the responsibility to f i l l the gaps previously met personally. This original ability to identify and meet needs, to take responsibility for one's own well being, is important not only for the individual but also for the family and for the community. What distinguishes a good decision form a bad decision? A t least i n part the outcome o f the decision. Health includes the ability to foresee or at least make logical predictions i n regards to the future repercussions o f decisions. H o w does this change as lifestyle and culture change? Is there enough information or knowledge available on which to base good decisions? This point is certainly complicated by change. Things may not be as predictable as they were i n the past with new and different variables being involved, complicating the ability to predict future outcomes.  ii.) Successful in adapting to settlement life - job and education Mentally healthy, it's like going to school, trying to have a job, trying to do things, for the goodness of themselves... (Respondent #10, adult female) This passage taken from an interview is indicative o f the adoption or incorporation o f introduced determinants o f mental health. Having a job and going to school are relatively new ideas i n the remote North. If mental health is defined i n part at least along these western lines, as well as along traditional lines then the term spans the range extending between the two cultures. The inclusion o f this point, alongside the one mentioned previously regarding traditional knowledge, speaks o f a vast range o f factors being incorporated under a single heading. This is not to suggest that having a job and  >  75  education are preclusive o f obtaining and demonstrating traditional knowledge. But what it does indicate is the presence o f two cultural streams at play i n a single community and a pressure imposed upon community members to conform to the expectations o f both.  •  Descriptions of a healthy f a m i l y Communicate, help with household chores, as a team group, and spend time together...(Respondent #6, young adult female)  {  I have to be careful how I am with my children because I know that they are watching me carefully ...I am always teaching and leading my children...(Respondent  #16, adult male)  Time and time again the family was invoked by participants as both the most important system o f relationships within the community and also the source o f great problems. A s the second passage indicates - family, alongside the school, is perceived as a site o f education. Children watch parents and learn from their parents. If the behaviour modeled by parents is destructive then children learn from this behaviour and, through exposure, run the risk o f eventually engaging i n the same behaviour themselves. Healthy families were described as systems with the ability to transmit learning through effective communication. A s the healthy individual was posited as one who is able to assume responsibility for self, so the healthy family was described as self-sufficient and as intrinsically possessing skills allowing the resolution o f problems: As Inuit we have lost a lot of family values because every time there is a problem we call social services or the RCMP, the health center. It is right to report but at  76  the same time it is healthier if a family problem is solving itself If the problem does not solve itself it will continue to grow...This is what I wish for my 9 year old daughter. I want her to grow up without fear and with security, I want her to grow up knowing she is going to be okay because she has family... (Respondent #16, adult male) A feeling o f cultural loss is imparted, this time specific to family values. Fingered as contributing to this loss are the very services put in place to resolve problems and improve family life. Over time, some families have grown reliant on these services and, in turn, have lost or suffered the diminishment o f the ability to resolve problems independently. Not resolving problems independently becomes a problem i n and o f itself - or at least acts as fertilizer exacerbating existing problems. One view evident in the community o f Arviat is that the amount and type o f problems are directly related to services provided and that services have a positive rather than a negative relationship with problems. What came first: the problem or the service? The two have become so intertwined that extricating one from the other is difficult. The family is perceived as the place where, in the past, problems would have been resolved. If healthy, the family is a source o f strength and security, a protective and fortifying system from which to encounter the rest o f the world.  77  •  Descriptions of a healthy community  i.) Presence of role models - healthy individuals make healthy communities / try to do things to help people within the community, especially the younger generation, so they won't go through the route I went through when I was a teenager ...encourage them for the better ...things,firstlook after myself make sure I'm ...okay, so people can look up to me and say, I guess...we '11 follow her cause she's got a great head over her shoulders and we need great models so we can have a healthier community, that's what I say... (Respondent #6, young adult female) A few o f the individuals interviewed identified a need to find and establish more role models within the community o f Arviat. The interviewees noted a lack o f people in the community who could be looked up to and emulated. This relates once again to culture change and transition. While elders may be revered, looked up to, and seen as a source o f wisdom, they do not provide the young people with information with how to negotiate their current worlds. Role models, people to emulate, were identified as important to a community's overall health. Role models are proof o f a community's ability to foster and support healthy lifestyles and choices.  78  ii. ) Ability to locate and implement community solutions to community problems What I see is that the community is quite actively involved in trying to find their own community solutions and I think that's really healthy... (Respondent #2, adult female) A s identified i n the depictions o f both healthy individuals and o f healthy families, a healthy community has the ability to meet its own needs, albeit, this ability might necessitate reaching outside o f the community for to obtain resources. The identification o f health as the ability to generate community-customized solutions reinforces the stance voiced i n the literature regarding the crux o f community empowerment. The whole territory o f Nunavut is abuzz with community empowerment strategies, at least i n name, that seek ways and means o f decentralizing power and resources as far and wide throughout the Territory as deemed possible. H o w authentic these community empowerment projects are remains to be seen.  iii. ) Unity of the community, supporting each other beyond the boundaries of family I think people need to support each other ...historically, Inuit people have always been very close to their families, although we may live in a community like Arviat, where people...have their own houses, their own little problems, but I think it's important that people interact with others in a healthy way ...when I was down south, I realized and I saw that people are in their own little world...but  79  here... although times have changed and people are further apart...there's still room for that family togetherness, that unity as a whole community... (Respondent #4, young adult male) In this cited passage there is recognition o f distinctness, or o f otherness, i n relation to the south. Practices and relations have shifted from the past and yet, the north is not the south on a smaller scale or i n a different setting - it is inherently different. The statement above is also an evaluation o f comparative health. This individual perceives a unity o f community - a sign o f strength and health that he has not similarly located i n the southern communities he has visited. In general, individual appraisals o f the role o f community identified it as a source o f strength, another protective system, like family, with the potential to strengthen and care for its members.  5.4 Strategies and Coping Mental health can manifest itself either negatively or positively. Positive attributes o f mental health are identified as abilities to deal with stress or problems that arise to confront community members. A s one participant voiced: We will always have problems, I don't think that problems will ever disappear, so my biggest hope is that people will learn to deal with their problems effectively in a healthy way, and if they can do that...they can teach other can live life with less stress...I think that's my biggest hope that people just learn to live be able to adapt to new things, to accept changes...(Respondent #10, adult female)  80  Problems are a natural part o f life. The ability to deal with problems effectively, to employ strategies with which to deal with problems, is acknowledged as indicative o f a state o f mental health. The following comments were prompted by the question: how do you deal with problems that arise in your life? Participants provided a range o f responses revealing different options available to Arviat community members to employ when dealing with the problems.  •  Using the Land  One o f the most commonly identified strategies utilized for alleviating stress or dealing with problems was the use o f the land surrounding the community. Participants spoke o f the land as a place removed from problems and a place o f tranquility. One woman interviewed spoke o f how she used the land when she had experienced a hard day: I love nature...for example, I'm having a hard everything is going wrong from since 8:30 to 5:00 today right? I'm ready to explode, I'm way down in the dumps...Ijust take the Honda, go out, go somewhere... maybe for a drive... I don't care what kind of weather...I stop the Honda and Ijust sit there and ...nature's there, I'm hearing the birds...I go there, I could be there for five minutes, half an hour, I don't care...I need to clear my head and it usually does...then all my hard day...away completely or it's not as bad as I thought...(Respondent #10, adult female) The problems o f the community are diminished by the vastness o f nature. This individual notes the unimportance o f time, five minutes or half an hour both produce the desired effect o f clearing the mind. Unlike the settlement communities which have  81  become regulated by a twenty-four hour clock and where adherence to a rigid time schedule has become an area o f cross-cultural conflict, the land is a place where time dictates itself. Access to the land possibly is a site of resistance - it diminishes the colonial culture which is the source o f so much stress, although now access to the land is often perceived as dependent upon the ownership o f the "access vehicles". This woman, for instance, does not walk out onto the land, she drives her Honda. Settlement communities are tiny dots engulfed by enormous environments.  The simple strategy o f  leaving the community and the ensuing peace that results by being engulfed by vast, open land demonstrates the relationship between mental health and the surrounding environment. Mental health strategies that are employed are partially determined by environmental context: When you're in a city it's a totally different thing...ifI'm in Toronto ...downtown, and I'm feeling down - where would I go —probably to a bar and have a drink...if I go to the park, I'm scared because I'm going to get mugged or something...we 're very close to the land, the animals...our whole being is close to the land I think because that's where we grow up, we hunt, and we camp...we have really that closeness to the nature so if that's the case...our mental being connected to the land...(Respondent #10, adult female) Others interviewed expressed feelings similar to the feeling expressed by the participant cited above that her whole being "is close to the land". This connection is not something that comes about suddenly. The connection described is the outcome o f a way o f growing up, o f being raised by your parents to hunt and to camp. The land is representative o f an older way o f life and o f a "goodness o f fit" evolved between an  82  environment and groups o f people over countless generations. When I was invited to j o i n a community member on a caribou hunt, we stopped a while and the hunter asked "can you imagine what it would have been like for them, living out here all year round?" I glanced at the gently undulating earth, the enormous sky, felt the bite o f the wind at my fingers and on my face and shook my head. The land is no relic, it is an active scene o f both life and death, but standing out there I felt a sense o f awe and antiquity that far outreached anything I have ever felt standing in a museum. Well for me, as being an Inuk, growing up, it's to escape from what we 're surrounded with, all theyucky things going on around in town...going out on the land is, not running away but a place to go for peace... (Respondent #6, young adult female) The land is identified by this young woman as a place to go to get away from "all the yucky things going on around in town". It is a place o f legitimate respite, "not running away".  If the community is the place which harbours what is unhealthy, then the land is  a place o f health. This relationship between people and land preceded the community and the lack o f contemporary health that is felt to have its genesis i n the advent o f settlement life. W h i l e the community can be small, ugly and dull, the land is alive and bright: Someone whose got problems, their minds look like water, it's a sickness in the body, even if you don't know that person, you'd know that they've got trouble on their mind. People should be friendly to that person, take that person out on the can see the water moving on the pond outside — then you look at your desk - and there's nothing, it's flat, but out there you can see all the ripples,  83  everything's moving, it's bright, it changes my mind and you go oh look there's a goose, and you go-oh-I'm so happy and here at your desk there's nothing and you 're very unhappy ...the land has smell, that the look, the feel and the smell of the land is like medicine. It's like medicine to our mind and it's so joyful that the smell, the sound, what you see really helps our lives... (Respondent #15, male elder) The elder cited above likens the land to "medicine to our mind", as capable o f producing joy. H e also notes i n his observations that the settlement habitat is flat, dull and evocative o f depression i n its very absence o f stimulus. This passage speaks o f the utilization and stimulation o f the senses by external environment - how the land is imbued with stimulus for the senses o f sight, hearing, and smell. The abundance o f stimulation is "joyful", its deficit is depressing. The positive relationship between mental health and enjoyment o f the land is an important consideration for the planning and implementation o f mental health programs and services i n Arviat.  •  Utilizing Culture I think today we are so wrapped up with today's society...we 're trying to hang on to our culture... we are barely in some ways...I think the more cultural we are the less mental stress we have because we would learn from our parents ...practice their coping skills...the way they used to do things...(Respondent #16, adult female)  Culture delivered from the past by "parents" is a source o f coping and o f dealing with hardships encountered during the course o f life. Culture provides a broader view o f the  84  world, one not "so wrapped up with today's society". Facilitating survival over a vast duration o f time has been the role o f culture. Culture seems to have an ambivalent relationship with mental health. Rapid cultural change is cited as a force capable o f jeopardizing the mental health o f the community: We 're so rapidly changing from our culture to upside down...when we go upside down we have nowhere to go...where do people go?... (Respondent #16, adult female) A s stated in previous sections o f this paper, feelings o f cultural loss have accompanied massive lifestyle change, and the disturbing intersection between Qallunaat and Inuit cultures. The stress from cultural difference is felt by all community members. People from Arviat talked about the positive relationship between mental health and cultural identity. One elder spoke about a camp he was involved in running for young offenders. This elder felt the camp was a success and had made a positive difference in the lives o f the young men who participated. He attributed this success to the use o f Inuit culture: We did it somehow through the Inuit culture, taught them through the Inuit culture. Using the Inuit culture they boosted up their self-esteem... (Respondent #15, adult male) A connection is drawn in the statements above between Inuit culture and self esteem. Another individual interviewed, a young man, also talked about a sense o f culture as instilling both a sense o f pride, identity and belonging: I think Inuit culture should never die. Culture and traditions are something that...keep us going. You have a sense of structure in your life...there is a  85  belonging, a knowing where you come from... that's what you take pride in...(Respondent  #4, young adult male)  In addition to this statement, this young man also emphasized that his time and his culture were different from those o f the past. In the statement which follows, he rejected a traditional, static vision o f what his culture must be i f he is Inuk, and stretched his definition o f culture, gathering from a variety o f sources. In so doing he stakes a claim for himself i n the present: Our culture has so rapidly changed over so little time...I don't know... because this is where I grew up, this is what I see, obviously culture, now has...there's money involved and there's jobs involved, this is my culture, my personal culture...I've never lived on the land, never lived off the land...this is how we grew up, this is what we saw, this has become our culture, so this is where our mental health will have to revolve around...we don't know what it was likefiftyyears ago, this is today... (Respondent #4, young adult male) This individual uses clear and possessive terms "my culture, m y personal culture". H e claims that he does not know what it was like fifty years ago. He has never lived a landbased existence, so how can his mental health revolve around a way o f life he has never experienced? While he recognized the importance o f culture and tradition to his sense o f identity and pride, he placed the changes that have occurred rapidly over the course o f the past fifty years i n the realm o f his culture, "this has become our culture". Illich (1976) put forth the idea that culture is the vehicle through which health patterns are established and communicated. Culture is the collective source o f information that advises the survival o f a group o f people. The role o f culture i n the case  86  examined i n this paper is complicated by the massive changes to life-style that have occurred in northern communities in the last half century. The function o f culture is i n this case to act as a life-preserver to mental health. Culture is vital as it has the capacity o f connecting the past to the present and o f emphasizing that which is conducive to survival. The challenge becomes retaining traditional cultural patterns while allowing enough mutability to incorporate outside influences that are useful. The man cited above refuses a static, historical view o f his culture. His culture allows him to maintain a sense o f identity and continuity from the past while playing an active part in current times.  •  Reading, Writing, Playing musical instruments - Creative Outlets  Another strategy for maintaining mental health is the fostering o f creativity. A few participants found release from problems when reading, writing, or engaging in some form o f artistic expression. One young man identified being taught by his teachers to utilize writing as a source o f problem solving:  I've been taught, especially by my teachers, that when I have something in my mind that it's good to write, to put them down on paper... (Respondent #4, young adult male) This same individual noted a discrepancy between his generation and the elders when it came to dealing with problems, noting that:  There's a huge difference...I'm able to write, my elders, the elders are not...(Respondent  #4, young adult male)  This discrepancy is questionable as one elder interviewed spoke through the interpreter about his practice o f journal keeping:  87  / write about everything, the weather, people being born, people passing away, what's on the news, what's happening in the community, everything. As soon as I learnt syllables, that's when I started writing... (Respondent #5, male elder) It is interesting to note that the young man interviewed depicts the elders as being illiterate, and does not recognize the elders' ability to read and write i n syllables. The inference is that the ability to read and write i n English is construed as literacy, whereas Inuktitut is not legitimized as a language o f written expression. Regardless o f the accuracy o f the cited statement - the perception that elders and youth utilize different strategies o f coping and problem solving skills does produce a barrier between these groups. To illustrate, I include further passages from each o f the two interviewees cited above. The young man identified his lack o f use o f Inuktitut: / use English more than Inuktitut, so it's often hard for me to translate...(Respondent  #4, young adult male)  The elder picked up on the diminished use o f Inuktitut within the community: We 're losing our language...some people have grown up in an environment where their mother tongue, native tongue is not really spoken...when they were living inland they would verbally teach their children, and what they said to the children the children would do and the language back then was a lot stronger than today. First thing in the morning when they woke up they would be , constantly learning from their parents... (Respondent #5, male elder) A strategy o f mental health maintenance is the utilization o f the written word along with other forms o f expression. Evident i n the words o f the elder cited above is how language  88  conveys culture. In the past children were taught by parents i n their 'mother tongue'. In the present day young people use the English language in the development o f their mental health strategies. This use o f the English language raises questions about how culture relates to mental health.  •  Prayer  The way I deal with my problems ...I pray about it...I believe in God and I read the bible, pray, cry about it, pray about it... (Respondent #12, female elder) Prayer, religion, the utilization o f the bible came up in more than one interview as sources o f strength - tools to be employed when dealing with the problems and stressors o f community life.  Most people will count on their faith to become healthier a sense it's like a tool to help you cope with your problems, with life around you...I think . religion here is even a necessity, because I think without religion...people would be lost, they'd be scrounging around looking for things to help them, ...I think religion is good for your mental health , if you know how to use it...but I also think lots of people will be mislead... will misunderstand what their religion is saying to them so, there's some disadvantages and advantages to religion... (Respondent #4, young adult male) Religion " i f you know how to use it", is a "tool to help you cope with your problems", however, i f not used properly there is the potential to become "mislead". Religion can be interpreted and utilized i n different ways and so can be either helpful or harmful when it  89  comes to the mental health o f the individual, family or community.  Arviat, although a  small community, has four separate Christian churches. The presence o f Christianity is strongly felt by community members and religious interpretations are often employed to explain a wide variety o f phenomena. Religion provides a way o f explaining the world and also a guide for how to live i n the world and i n conjunction with other people. One elder commented about his use o f the bible: With regards to physical and mental health I've been reading he bible and I know that it dates, it dates over two thousand years ago - from what I've read and living according to the word in the bible is what I've found is very healthy mentally, physically, emotionally...(Respondent  #13, male elder)  The bible is seen as a source o f wisdom and knowledge which provides direction for living a life that is healthy and good. Despite the bible's age - it "dates over two thousand years ago" - the truth o f the " w o r d " is the source o f what is "very healthy". However there are people who critically examine the role o f institutionalized religion i n remote northern communities. One concern shared was that as various churches compete for congregations, divisions are created within and between families: I've always seen the churches separate families, separate friends, separate people, cause ifyou belong to this church, and you're my cousin and I belong to the other church...our bond is already breaking ...sometimes I see churches competing with each other; that, to me, is very harmful to the mental health of the people... (Respondent #10, adult female) Mental health has been identified as dependent upon harmonious and healthy relationships with others. Four churches that place themselves against one another have  90  tremendous power to produce disruptions in relationships between community members. This woman says that by virtue o f belonging to different churches "our bond is already breaking", even i f we are related to one another. W h i l e no one spoke out against possessing faith, criticisms were launched by community members against the institutionalization o f religion into various factions which in turn produces conflict between community members. Another person interviewed pointed to a distinction made by different motivations an individual may have for belonging to a church: There's been a lot of hype about the end of the world and that scares people...people will use that to...attract you to say that if you are not one of us, i  you go to 're going to rot, you 're going to burn, that's one tactic I think some churches use to lure...people to them because there are four churches so they want people to go to their church...people go to church not because it's in their heart but because they 're scared... (Respondent #4, young adult male) In summary, while having faith, belonging to a church and utilizing the bible are identified as potential sources o f overall health and wellbeing, the operation o f four different churches operating within a single community produces conflict.  •  Time with others, especially elders I need to be with other people, people that I trust, people that I know love me...I'll talk to them or Ijust need their presence... (Respondent #4, young adult male)  The presence o f other people can be helpful i n times o f trouble. This individual points to his need for "their presence" - he does not say that he needs others to solve his problems for him, which would run counter to what was stated before about the 'self-responsible'  91  healthy individual. He also points to the qualities that he looks for in others during his times o f need - people that "I trust" and "that I know love me". In two other interviews the comment was made that it is helpful to spend time with elders, or at least people who are older than yourself when trying to solve problems. The elders o f the population o f Arviat are identified as a source o f wisdom. A traditional form o f help accessed both i n the past and in the present is to spend time with or to seek the wisdom o f the elders. In the past elders would have directed how to lead a life that was mentally healthy: The way the elders dealt with mental health was when it came to younger people, they were told to listen, they were advised that if you do this, if you do that you '11 have a good healthy life but if you do this or 're going to get more and more depressed and sad...(Respondent  #1, male elder)  The elders were available traditionally as a source o f guidance to the younger people. From their own experience they had gained the wisdom and knowledge needed to live a good and healthy life. Nowadays, with the shift i n culture and life-styles, the elders find themselves still consulted but not holding the same amount o f authority as they did in the past.  •  Time alone, away from big events and television Ijust try and stay away from television and ...big activities ...because if I'm  watching television or...getting myself involved in big activities then I'm not focusing on myself I'm paying attention to things around me, and that's not what I want to do, I want to deal with my anger, my sadness, the sorrows, so I stay away from the things that lure me away from dealing with myself... (Respondent #4, young adult male)  92  Just as spending time with others is deemed as necessary i n working toward mental health, so is time spent alone. Spending time alone provides the space and focus upon self, necessary to reflect on problems and to identify possible solutions. Time alone is also time to 'cool o f f , to calm down, to vent without jeopardizing relations with others. This particular individual sees noise and events as distractions that "lure" or tempt h i m away from a reflective process that w i l l enable h i m to deal with what needs to be dealt with. In a community that is similar to others both in the K i v a l l i q Region and i n the Territory o f Nunavut as a whole, time alone is hard to come by. Homes are crowded, there is a lack o f privacy that comes with living i n a small community. Individuals have no access to anonymity as they are known by all. Privacy is available only to those with relative power and/or means within the community. Individuals with jobs may be more enabled i n accessing relatively uncrowded housing, and may also be able to afford the means now popularly deemed as necessary to access the land - a Honda for example and possibly also a cabin out o f the community. People with money are also able to leave the community and travel elsewhere. The individual cited above points to the particular difficulty facing young people i n locating space where they can be on their own: They haven't had the opportunity to experience different ways of dealing with problems because...normally people have big families so it's hard to be on your own ...a lot of the time you end up helping your parents out or., .your relatives so...lots of the young people don't have that opportunity to be on their own and to discover their true selves, what they like and what makes them happy, what works for them...(Respondent #4, young adult male)  93  Western culture has introduced to Inuit communities the idea that the individual is important. In the past, families lived i n close and constant proximity to one another. N o w , i n settled communities, individuals are feeling crowded by their families and lacking the 'space' required to develop their identities. In the past privacy could be found walking on the land or even doing chores while others were away or occupied with other tasks. What is o f importance is to address the question: how can private space be accessed by more individuals, and especially by youth living i n communities where houses are overcrowded and where everyone, like many small towns, knows everyone else's business?  •  Problem Analysis/Problem Solving Skills  In a few interviews, individuals described their own methods o f problem analysis, their own techniques which enabled them to better understand their feelings and to better make decisions. These individuals said that they had learned these techniques from a variety o f sources - workshops or training they had undertaken, from their parents or grandparents, or something they had discovered for themselves. One woman described how she had combined strategies from a variety o f sources to locate what worked for her:  I've always tried to use what I learned from my parents, my grandparents and then what I've learnedfrom courses and stuff, combine it together, see which is...good and try to use both goods...(Respondent  #10, adult female)  This woman was taught by her parents and grandparents traditional ways o f coping with problems and, through courses, she has been exposed to western methods o f problem  94  solution. This woman, who finds herself between the generation o f youth and the generation o f elders, is able to draw upon the strengths o f both cultures:  My generation, we... learned that we were with our parents we were close, before all this came about...even though I went to school, I went to school in the south...I really give credit to us because we 're able to know both, we still have not lost that connection with our culture but we are also very much in the southern way of living...we...mentally taught ourselves or has been taught to take the good from both and say for example, if things go wrong for me today, I'm able to sit down and look at it and say okay — how am I going to get out of this...I'm able to do that, say for example my daughter, she's fourteen...she's never really known my grandmother...our whole if something goes wrong today, she's only going to cope with it the way she knows in today's environment, today's way of doing things... (Respondent #10, adult female) A n important observation from this passage, as emphasized by the woman interviewed, is the importance o f teaching the younger generations more than a single world view. One method o f problem solving provides a perspective that is too narrow. What is helpful is the continuation o f the traditional, the continued application and adaptation o f what was used i n the past i n current settings. 'Today's environment, today's way o f doing things' are not all that is needed. 'Today's way o f doing things' does not have a history to draw from or to support it. A broader perspective gives people an advantage and an increased ability to deal with all aspects o f life. There is a danger i n being consumed by what is new; the result is a narrow band o f perception.  95  •  Use of Services  Scarcely mentioned by those interviewed was the access o f formal help as a strategy employed to deal with stress i n their, lives. Only two individuals interviewed spoke o f accessing services as a way in which they had, i n the past, dealt with problems in their lives. Neither o f these two participants spoke o f accessing help on a regular basis. They had accessed services at times o f crisis - but these services were by no means a daily part o f their lives and were only contacted in times o f extreme duress. The day-to-day maintenance o f mental health was met by other strategies listed above. Limited inference can be drawn as the sample size is by no means representative o f the entire community o f Arviat. Further, even i f services were only accessed during times o f crisis, both o f these interviewees testified to their importance. This comment raises the question o f whether or not formal services are utilized in more than a crisis capacity? What does this mean for the development o f further mental health resources? Is there a way o f integrating preventative mental health services utilizing the suggestions made by community members about successful mental health strategies?  5.5 Problems and Stressors So far in this examination o f mental health I have looked at some o f the stress affecting or challenging the health o f the community o f Arviat. I have also looked at dimensions o f the concept o f mental health according to a variety o f individuals currently residing within the settlement. The last section examined the positive side o f things, how stress can be converted into positive coping strategies and skills identified and employed by those interviewed. Participants were also asked to share their perceptions regarding problems in their community that they related to mental health. Chasing the genesis o f  96  problems is an elusive endeavour. Participants spoke o f a 'problem drift': problems were perceived as flowing from one generation to the next. Coping mechanisms employed to deal with stress were identified as sometimes becoming problems i n and o f themselves - for example drugs and alcohol initially employed as stress relievers may become stress inducers. Locating roots o f problems is a challenge faced by community members including service providers. It is important to note before delving into an exploration o f various problems, that the result o f this section is not intended to be a compartmentalization, but rather a tracing o f relationships to arrive at an overall picture. Using an ecosystems perspective, different issues identified by community members w i l l be discussed in relation to one another, which, when considered collectively, provide a depiction o f the overall challenges to mental health faced by the community o f Arviat.  •  Gambling  ^  Another big problem now is gambling...we have lots and lots of gambling here... they'll sell everything in their house just to play bingo and Nevada. You'll walk into someone's house one week it will be fully furnished, the next week you walk in it's all gone, all they have is a couple of crummy's normal for kids to see all this furniture here today and then tomorrow it's all gone...that's how they grew up so that's how they 're going to be when they grow up...(Respondent  #9, young adult female)  This description o f gambling is closely tied into a western economy. Is the motivation for gambling the obtainment o f increased wealth? If so the obtainment o f wealth associated with most forms o f gambling is at the expense o f others in the community.  97  While one individual may walk away from an evening o f gambling, substantially richer, others w i l l leave with no money and often after liquidating their material possessions i n order to participate i n the activity. Important questions need to be asked regarding how gambling, perceived as endemic to the community o f Arviat, fits or fails to fit with Inuit values and beliefs. What is the history o f gambling - did it precede contact with western culture? H o w has gambling changed with the onset o f settlement life? What needs are being met through the activity o f gambling - socialization? Alleviation from boredom? H o w has gambling changed relationships between families and other community members? One woman interviewed for the purpose o f this study spoke at length regarding the problem o f gambling i n Arviat: They just want a fix or something...when they 're on the bad luck side they '11 say...feel sorry for me...they'11 make up excuses child wants decent food, my child wants foot wear or jeans and I love my child too much and I can't afford, when you hear these things too much you tend to have your heart harden because knowing that if we give this person money, he or she will go out and spend it on gambling...(Respondent  #8, adult female)  She spoke o f the guilt she felt o f not providing what was asked for, but simultaneously she recognized that she was being used b y friends and family i n the community. This woman felt a responsibility to give what was asked for, something she has always been taught to do, but this practice o f giving and sharing is being eroded by the social problem o f gambling. Obtaining money for gambling takes precedence over relations between family and friends. The effects o f problem gambling are felt by whole families.  98  Community members who are not problem gamblers are still dramatically affected b y it it drives them to question generosity, sharing and most o f all trust:  It's really bad here, when if you live in Arviat all your life you 're seeing the changes, it hurts more, when'they use their parents, when they use their children to cover up their bad get to see this person whose actually addicted become...a depressing person... (Respondent #8, adult female) Individuals interviewed pinpointed a potential root cause o f the problem o f gambling as being boredom. They also related gambling to other problems like drinking and suicide, also present i n their community.  •  Lack of Parenting Skills Family life is ...a huge problem...very unhealthy lifestyles...not being able to raise your children properly, there's lots of single mothers, you rarely ever see single fathers, lots of young people get children at a very young age...lots of people are left to do whatever they want on their life is a very big problem here, it just becomes a cycle... (Respondent #4, young adult male)  Lack of attention from...all these families no attention to their kids, due to gambling...(Respondent  #6, young adult female)  This problem, evidently ties into the first mentioned - that o f gambling. This individual notes that "people are left to do whatever they want on their own". If a young person has a parent, or parents who are pathological gamblers, they w i l l suffer the consequences o f a fractured parent/child relationship. Parents are frequently out o f the home, and children are not aware o f their whereabouts. The child is frequently betrayed b y the parent as  99  needs for food or clothing are situated as secondary to the parents need for fast cash. Gambling places a significant strain on family life. Aside from gambling, other stresses also place strain upon the relationships o f the family - the use o f alcohol or drugs for example. Further, the traditional family is being replaced by alternative family types - a large category consisting o f single teenage mothers. One woman commented on how she feels that the amount o f single teenage mothers is a problem currently faced by the community: One thing personally of concern to me and to other people in the community is the high birth rate and the low...large number of teenage pregnancies ...young girls having babies that aren 't really competent and able to care for them and...that's one of the big things because it carries on...mothers who have very few parenting skills raise children who have very few social skills and it just...gets worse and worse... (Respondent #2, adult female) One o f the elders also observed that when she looks to the future o f the community she worries about the high birth rate and the large number o f single mothers: There's going to be a lot of people in the coming years, with all these single mothers delivering babies ...the single mother's children that are going to be...will have different problems compared to the ones who do have yagers...(Respondent #12, female elder) The family structure o f Inuit culture is changing into something new and some i n the community are wary o f the changes and the repercussions they predict w i l l ensue. The shift i n gender roles that have taken place i n relation to lifestyle change have also  100  affected the structure o f the family. One individual identified that while men used to take responsibility toward family well-being, men are not currently filling this role: It seems to me like whenever women are happy — they are pulled down. That is what is wrong with this community. Mothers are running around trying to please children and the whole family — it should be the father doing this. Mothers or sometimes older sisters they suffer because of the husband - men are tearing down the stronghold of the family... (Respondent #16, adult male) This person felt that the problems experienced by families as a result o f anger expressed by men were related i n a complicated way to transitions o f lifestyle occurring at such a fast pace. The problems attributed to the modern Inuit family residing in Arviat may be the result o f culture change, and role and identity confusion. Brody writes in his book People's Land (1975) o f the changing gender roles as women became increasingly the providers i n the family. This change i n roles has affected the dynamics o f the family i n fundamental ways and effects the way that children are being parented.  •  Substance Abuse Drugs and alcohol and substance abuse are the worst problems here as a community that recently ...we just lost a young man due to sniffing propane, which was a tragedy...(Respondent  #12, female elder)  Like gambling, substance use often involves addiction. The well being o f the individual, the family, and the community is subverted to the need to obtain and utilize some form o f substance. Related to substance abuse is a series o f problems including family violence, gambling, and physical injury. For example, an individual abusing substances may be  101  more prone to be violent towards a partner, or, an individual is placed at increased risk for becoming physically injured i f they drive a snow machine while under the influence o f some substance. What emerges from these descriptions is the inter-related nature o f the problems so far listed. If one problem emerges it is likely that another w i l l emerge also. Alternatively, these problems could be conceptualized as different manifestations arising from similar sources o f stress. Although Arviat is a restricted community, i n terms o f alcohol and drugs, residents still feel there is a problem because alcohol is being illegally brought in or else distilled and distributed within the community. Sniffing is • another problem in the community o f Arviat that recently became apparent as a young man died after sniffing propane.  • Abuse  I know that there's a lot of abuse, hidden abuse going on...with families, mental abuse, physical abuse, sexual abuse, you name it, it's somewhere in at least every other house but it's hidden, people will hide it...people are afraid to go to the cops... they won't go charge them, they won't go get help, they '11 just keep it quiet and say, it will be done and over with sooner or later...(Respondent #9, young adult female) Although those interviewed were not sure o f the amount o f abuse going on in their community, they felt it to be a serious problem that affected all community members. Participants were unable to determine the source o f the abuse, but pointed to the transition and change in lifestyle, identity and role confusion that had come about over the past fifty years o f history in the area. A s well, as pointed to in the above citation, there is an unwillingness to turn to the formal services in place to deal with abuse.  102  People fear going to the R C M P or to Social Services. A n individual who would charge a family member may be scorned by others and put in a precarious position. The services in place are perceived as destructive to the family - i.e. remove the children from the home, or put an offender in a correctional center. Authoritarian measures do not fit well with Inuit values and thus there is resistance towards official agencies and even outside interference. One woman described her reluctance in approaching an elder to help her to heal from abuse she had experienced as a young girl: What had happened to me before when I was younger... that I didn't speak up with her because how would she understand me because she had lived them days my knowledge, them days ago, if anyone had done this to you, if you 're a little girl, you were asked to forget and forgive and not looking back again...(Respondent #8, adult female) This woman's inability to speak to an elder was obviously due to her prediction o f the response o f the elder. This woman shared her belief that the elder who she might have spoken to - "would not understand her", because she lived "them days ago"; the difference being a rift so wide, it is perceived as impassable. The silence o f the community on issues o f abuse may be reinforced by both sides - the Qallunaat and the Inuit. There is no apparent acceptable recourse o f action to be accessed by those experiencing abuse. This situation w i l l be examined further in relation to the analysis o f service provision.  103  • Suicide The last couple of years...there's been lots and lots of attempted suicides and lots of people contemplate suicide...four have committed suicide...there's no room for suicide...when somebody commits suicide... the community is your family, you 're affected by it, and then there's not enough people out there who can help so there's lots of people out there who are left alone without getting the help they need to continue living good, healthy lifestyles...(Respondent  #4, young adult  male) The effects o f suicide anywhere are devastating. The effects o f a suicide i n a small community like Arviat leave no person untouched. For many years Arviat had reported no suicides, and then in the last year and a half, four young people took their lives. Suicide may be a reaction to other stressors or problems and it results i n further serious problems. O f particular concern is the phenomenon o f cluster suicides, where one suicide can trigger a chain reaction resulting in a number o f further suicides. Cluster suicides are not isolated to single communities, but can spread across entire regions. Most people have friends and family scattered throughout the region and so are intimately connected with the events o f different communities. A s a result o f these connections, communities do not exist in isolation. Different reasons were put forward by those interviewed as to why individuals commit suicide: A lot of suicides today are caused by unemployment and too many drugs, and jealousy, people...thinking that they're bad people... (Respondent #15, male elder)  104  According to this individual, problems precede the suicide and can be fingered as causes provoking the suicide - an action which is both a reaction to problems and a problem in and o f itself. O f note is the message to those interested in furthering community wellness - the target cannot be focused singularly on suicide prevention without including a broader and deeper analysis o f other problems affecting the community. Another individual commented about a cause he associated with suicide:  A lot ofpeople who are depressed say this is so boring I want to kill myself- that causes a lot of problems... (Respondent #16, adult male) Like for gambling, "boredom" is put forward as a motivating factor for suicide, driving community members to engage in destructive behaviour. A n exploration o f what the term boredom means and how to address it as an issue facing community members is needed. The statement above - "this is so boring I want to k i l l m y s e l f almost seems like an exaggeration or a claim o f existential ennui - i s there something more implied by the use o f the term boredom? What are the relevant terms in Inuktitut? A s boredom is implicated as a root cause for both gambling and suicide, two exceedingly disruptive and damaging problems facing the community o f Arviat, more examination is required into what exactly this term means. A further contributing factor to the occurrence of suicide in the community is lack o f problem solving skills. Problems that arise are not dealt with effectively - they are perceived as insurmountable and so suicide becomes an exit:  Our young people want to be so cool... that's in their mind, so if something goes wrong today then they panic... if they only had been taught from their  105  elders...then if something goes wrong today then okay ...I have this am I going to deal with it, rather than, oh my goodness — I'm in trouble - bang! I kill myself! (Respondent #10, adult female) Suicide is predominantly taking place amongst the younger generations. The individual cited above notes that the young people are lacking problem solving skills and strategies that older generations possessed. The consequence o f poor parenting skills is that the young are unprepared and ill-equipped to handle stress. Another individual described the problem o f suicide: One of the most common causes of (suicide) seems to be relationship problems ...inability through a problem...someone having a problem with's not necessarily boyfriend-girlfriend relationships but it can also be parent-child relationships's just to want the pain to go away so badly that you 're willing to...make it permanent...(Respondent #2, adult female) The problems discussed under the heading o f poor parenting skills relate to this section exploring the problem o f suicide. Relationships with others are identified as not being healthy and when a problem emerges between family members or in other relationships an impasse is reached quickly. Competencies to deal with problems are not perceived as prevalent among young people. This individual, however, noted that, while relationships were the site o f many problems leading to suicide, a broader view should also be taken: It's part of a bigger systemic's not just about relationships, it's also about the system in which we live that's been created through the history of Nunavut and...working on the systemic problems is a bit more challenging...(Respondent  #2, adult female)  106  This woman's observation that a connection exists between problems emerging i n the community and historical and modern relationships between individuals i n the community and the administration o f the territory, can be addressed by critical theory which encourages the scrutiny o f relations o f power.  •  Cultural Pressure This cultural pressure, there's a pressure to be so cool and to be so Qallunaat and to be better at it than anybody else and...yet people, the young people have such a limited world view, like they can't put it into perspective all these influences that comefromthe south that they get through rock videos and music and television...(Respondent  #2, adult female)  I can't imagine what it's like to...grow up here and not understand what the rest of the world is like must give you a very warped view somehow of what... life is all about ...and I think young people deal all the time...with feelings of inadequacy, feelings of...I'm not good enough, I'm stupid because I'm Inuk and I think those things really exist and I don't think they 're talked about... in the high school for example, we don't have a single Inuk teacher there and the curriculum is so Qallunaat and everything there perpetuates the's what I call the myth of inferiority that exists in any sort ofpost-colonial...environment that somehow or other Inuks aren't quite as smart or as good as Qallunaats. So kids grow up with those feelings I think internalized and they don't know how to talk about them, the parents don't want to talk about them because they have the same  107  feelings and... .1 think it's something that I see as a real problem that affects mental health, definitely ...(Respondent #2, adult female) A k i n with the literature regarding colonization - a problem in the community appears to be the strong pulls o f two seemingly disparate worlds, especially upon the youth. W h y especially upon the youth? The woman cited above talks about the "limited world view" o f young people and their lack o f perspective to incorporate all the influences that are beamed via satellite into their arctic homes.  She also talks i n the second citation about  an education system and a curriculum which is so "Qallunaat", taught to them by Qallunaat. One young woman spoke about her experiences growing up, that her friends were "ashamed to be Inuk". A n d another woman spoke o f the pressures o f existing in a Qallunaat world: "we're i n a Qallunaat society now, our young people want to be so cool". There is a definite ambivalence expressed - on the one hand there is anger and resentment toward the Qallunaat and also anger toward the Inuit: I grew up hearing my sister and her husband putting the Qallunaats down... and I think they 're mad at the elders too for just sitting at home not doing anything with their talents, being greedy ... that's why I think the elders are being greedy...(Respondent  #6, young adult female)  There is generalized anger felt at not being included i n either world. Although this anger exists, young people w i l l try to fit into a western world from which they are physically and psychologically remote. Trying to fit in to something that you resent, that is also resented by your family and by your elders, is a problem. There are few role models representing successful fits, attaining a fine balance between cultures.  108  •  Lack of Options Unemployment is a stressor options for...young adults. For example, here's a community learning centre - we havefiftyapplicants forfifteenseats. Everyone of thosefiftypeople wanted to come to school and we can only take fifteen, and that's in each all those people who didn't get in -feel like failures or continue reinforces the idea that they're failures and that they 're not competent or able to get along...and it's simply lack of resources, the building can only take so many people, there's only so much money the college has for instructors and so on and so on... (Respondent #2, adult female)  Limited options and a lack o f opportunities result i n more than failing to access a program offered by a learning center. These limitations can also mean a reliance on income support, overcrowded housing, a poor diet, i n general - poverty. Poverty produces a cycle that is hard to break out of. A n d while existing i n a relative state o f poverty, the alternative, a materially rich life, is revealed faraway and obtainable only by a few i n the community. The few who do attain this life o f comparative material wealth are then perceived as different than those who do not. The community becomes increasingly stratified between the have and have nots. A pressure builds, directed toward young people i n the form o f expectations placed on them to go out there and do something with their lives; but realistically are they assisted i n this effort? A n d to what end anyway - to fit into whose society and to play by whose rules? The pressure that is applied is not commensurate with the means for meeting expectations. A young woman who shared the following opinion, which offers a different view to that diagnosing a scarcity o f resources:  109  Everything's there, people can go and reach for it, work for it, but they expect to get things free so it's hard...there's a lot of dysfunctional'things around . here... (Respondent #6, young adult female) This woman expresses her feeling that "everything's there", there are opportunities and options available to people in the community. The problem is found i n people's expectations, or their inability to, as she put it ,"go and reach for it, work for it". What has corrupted the community has been too many free handouts which have the end result o f producing inertia i n the community's residents. The difference o f opinions regarding opportunities deserves further inquiry. It is important to identify and assess what there is for the community to obtain and what is not available. If opportunities do not exist, how can they be developed, or i n the case o f the community learning centre, how can they be furthered? If opportunities do exist what is stopping people from accessing them and how can these obstacles be removed or the opportunities modified to produce greater accessibility?  5.6 Service Analysis W i t h the above construction o f the concept o f mental health offered by a cross-section o f community members i n the settlement o f Arviat i n mind, it is illuminating to turn to a discussion o f how formal mental health services are perceived by these same community members.  110  •  Description of Current Formal Mental Health Services  Mental health services are provided formally through a Social Services office. This office employs two local workers in addition to a mental health specialist who works directly in the community o f Arviat. The same office is also responsible for the partial provision o f mental health services to the other communities o f the K i v a l l i q Region. The community's Health Centre also provides mental health services, especially during times when it is not possible to refer problems due to a shortage o f staff in the Social Services Office. The Health Centre is the site where psychiatrists visiting from the south hold appointments with community members. The community's schools have counsellors who are available to students. Funding for community wellness is available from a variety o f proposal-based funding sources, including: Brighter Futures, National Crime Prevention Centre, and Healthy Children Initiative. Typically this funding is short term and is restricted to dollars spent only toward certain endeavours. For example, most funding sources w i l l not finance or contribute to the financing o f building new structures. If individuals require more intensive mental health services.- for example i f they are suicidal and it is felt they cannot be supported within the community - or i f they require intensive treatment for substance abuse, then they may be sent out to treatment facilities either in Manitoba or in the Northwest Territories. In addition to these formal services, two other sources o f mental health service provision by "non-professionals" were identified during the interviews. Several interviewees identified the churches as sources o f mental health for the community. More than one interviewee located a further source o f mental health service offered by  111  elders living i n the community. Local Inuit were aware o f individuals i n the community, usually elders or individuals older than themselves, who are available and willing to meet with them and to provide support. The focus o f this section w i l l be restricted to a critical look at the formal sector o f mental health service provision.  •  Participant Analysis of Formal Mental Health Resources  Lacking or adequate? Funding, facilities, and resources If we had money, facilities, and the people, on a full time basis, there's enough work in Arviat...have a big office called mental health...that's how much it's needed... (Respondent #10, adult female)  A lot of things were offered in this community and nothing has changed... (Respondent #6, young adult female)  I wish people could face the truth...we have to take what's out there, we have to see what's out there...don't always look to money or funding...we can do things without money as long as we look within ourselves... (Respondent #4, young adult male) Some participants talked about scarcity o f resources put toward mental health. Alternatively, other participants felt that it was the type rather than the amount o f resources that was inadequate. This brings up a difficult point regarding resources: i f more o f the same were offered would any positive change result?  Authors like Y o u n g  112  (1993) have put forward the question "is more better"?  It is a question which some  individuals i n the community o f Arviat have themselves put forward. Interestingly it was the two youngest participants i n this study who emphasized the need for something i n addition to more resources to really make a difference i n the community. Those interviewed were unable to locate useful resources to counter the flaws o f the services currently provided. I have a niece, she lives in Rankin now, used to live in Arviat, was very suicidal, I think she attempted suicide five or six times...who does she talk to? (Respondent #2, adult female) Despite the presence o f a mental health worker, school counsellors, social workers, a community wellness counselor, and informal resources available within the community, interviewees commented that there is no one to talk to. That feeling and the perceived lack o f resources available speaks about the appropriateness o f services currently i n place.  Staffing Issues: continuity and confidentiality There's one...guy...who was telling me —you guys come up here and ...try to change things for a few months, then you 're gone. Then another one comes along and tries to undo what you were doing and then he or she is gone...because if I'm doing it one way, and you...immediately start doing it another way you 're going to make some confusion...(Respondent  #14, service provider)  The formality of seeking help is a difficult barrier for people to overcome, particularly in small communities where everybody knows everybody else's  113  business and gossip - gossip, gossip, gossip -1 mean it's common in a small community that everybody likes or a lot of people like to engage in gossip, fairly malicious gossip at that...(Respondent #2, adult female)  As a social worker, even if you help somebody... there's a chain of things that could happen...if you 're helping a certain person and their family members find out...and they're afraid, maybe they did something wrong to this person...then they 're the ones who are going to become the's not just the professionals that are the barriers, it's going to be the regular, normal people to...(Respondent  #4, young adult male)  Zapf (1991) writes o f the high staff turnover in the north: Speculation on the factors associated with this turnover points to an uneasy fit between urban-based practice models and the realities o f northern communities. This poor fit manifests itself i n the field as a stressful choice perceived by the worker as he or she comes to view the approach o f the profession as incompatible with active membership i n the community, (p. 254) Those interviewed for the purpose o f this study were highly cognizant o f the difficulties facing the individual mental health worker. Participants independently lobbied for more local workers and yet pointed out the difficulties that hiring locally produces. The individual hired has to be "exceptionally good" to work in a small community. This individual worker is expected to be a model representing an ideal he or she is doomed to fall short of. Also, this individual is embroiled i n a tangle o f family connections that place h i m or her within a certain configuration alongside those with whom they work.  114  The alternative to the complications ensuing from a local hire is to import a worker from outside. One woman commented on the advantage o f a stranger from the south: Some people they want Qallunaats cause you guys aren't going to go out and ,  back stab them was my fear to talk to an Inuk social worker cause of her relatives, maybe she could tell them and that would have been embarrassing...(Respondent  #6, young adult female)  The interviews conducted lend credence to the passage by Zapf (1991) cited above regarding service provision i n the north and the difficulties o f staffing positions that place workers i n conflict with the larger community. Related to issues o f continuity is the current funding situation. Governments make money available for the development o f community-based initiatives. This funding is valuable i n allowing communities to develop their own strategies towards health and wellness, but those interviewed for this study were quick to point to some o f the problems imbedded i n this type o f funding strategy: I think it should be more than just bandaid kind of stuff...I thinkfunding should be available and on an ongoing basis to address some of the deep rooted issues that aren't going to go away by having a three month summer get some kind of commitment for two or three years you can actually build something that...goes a bit deeper than just the superficial, surface kinds of things... (Respondent #2, adult female)  115  One o f the difficulties brought up i n the comment above, is that the funding available for community projects is usually only for the short term, a significant limiting factor i n the types o f projects that can be developed. Staffing as well as the funding o f community projects are typically undertaken at the regional or territorial government level rather than at the local level. T o make funding and staffing decisions is to exercise power over the lives o f community members. The power vested i n decision making is retained by those already established i n positions o f authority, government bureaucrats and health professionals.  A s well as concerns  regarding the power relations exercised through these decisions, there is another area o f concern raised regarding the appropriateness o f the decisions made. A s those individuals who are making the decisions are not directly affected by the decisions made, the potential for a goodness or fit to function between the service and the community is diminished.  Erosion of self-sufficiency If I was king what I would do is take the R. C.M.P., Social Services, the Health Centre out for a while so that people affected could deal with their own problems. There are too many people dealing with the same problems and this makes things more complicated and difficult...let people deal with their own problems and sort it out themselves... (Respondent #16, adult male)  (  A few o f the participants interviewed for this study expressed their feeling that the overlap which exists between various community services produces confusion. The  '  confusion obscures recognition that individuals, families, and communities have  116  competencies that could be directed toward bettering situations. The confusion created by different services and agencies functions to transfer attention to these services. A s more resources are invested into these services, regardless o f whether they act to help or to hinder, the more difficult to dismantle they become. A s community members note the significant investment i n these resources, so they develop the belief that these services have greater capacities than they do to act toward increased health and well-being. The individual cited above put forward his belief that only by becoming responsible for meeting their own needs are Inuit able to achieve mental health. The involvement o f various other parties obscures truth and does not enhance the competency o f the individual, the family, or the community. This view is congruent with that o f Illich (1975) who wrote o f an erosion o f selfsufficiency that occurs as professionals usurp an independent ability to achieve and maintain health. The lack o f co-ordination noted by participants could amount to a form o f "professional colonialism", whereby each profession claims a stake o f government funding in a defined area. Co-ordination may require the elimination or reduction o f professionals from a lucrative area o f service. Community solutions talking and community dialogue I think they're all really important parts of ...finding a solution to the problem...but at the same time I also's part of a bigger systemic problem, it's not just about relationships it's also about the system in which we live that's been created through the history of Nunavut and ...working on the systemic problems is a bit more challenging... (Respondent #2, adult female)  117  A s indicated in the literature review, a significant drive in northern life today is toward community empowerment. Community members, academics, and service providers are recognizing the fallacy o f offering services that function discretely from the community. Without understanding how the community impinges.upon the individual, little can be done towards assisting an individual toward mental well-being. The community, as described by various community members, is double-edged: the panacea for community mental health and a source o f limitation. Communicated through the interviews was a sense o f "all for one and one for a l l " for better or for worse; an individual could not rise above alone without others rising also. Current mental health services that are primarily replicas o f western-based-individually-oriented models are debilitating in their narrow conceptualization o f both problem and potential solution. Those interviewed in the community o f Arviat spoke o f the need to develop mental health services more entrenched within the community.  Ineffectiveness To send our people out...not just out of the community but completely out of the region...they'11 go down to Selkirk and it's a completely foreign area oflocked\ doors... this being a very traditional community a lot of our people speak's very difficult for them being sent out... (Respondent #3, service provider) M a n y respondents questioned the effectiveness o f being sent out for help. To be removed from loved ones, social support, and one's own culture and daily language o f operation is disorienting to anyone, let alone those dealing with feelings o f suicide or  /  118  those attempting to overcome addiction.  A w a y from the influence and the association  o f daily surroundings, individuals may present as i f they have overcome their problems only to find that a return home places them right back into the crisis they had attempted to leave. The ineffectiveness o f treatment received while transplanted away from the community is compounded by a lack o f follow-up services i n place to assist people upon their return to Arviat. One woman who received treatment i n Churchill remarked on her feelings after realizing that no follow-up contact from the professional she had confided  in was forthcoming: "zY would have been good, just to know that they really did care for you know that they 're not [just] taking my Nunavut government money " (Respondent #8, adult female). This woman who had received mental health treatment three times i n her life said she was searching for somebody who could help, somebody who was preferably an Inuk woman a little older than herself with similar experiences to her own. The treatment given was jeopardized by this woman's perception that the professional's motivation was financial rather than personal care. Statements such as this one indicate a fundamental problem i n the current model o f care provided i n the K i v a l l i q Region. If trusting, personalized relationships are a prerequisite to increased mental health, then de-personalized, "professional" relationships are intrinsically flawed.  119  Lack of Cultural Fit We call [social services] the misunderstood's also a cultural thing. Not everyone understands what social service is services are seen as bad people that really interfere with your life, who break up your marriage, who break up your's not helping the community creates more problems in a community ...rather than eliminating the problem...(Respondent  #10, adult female)  Embedded i n this comment on the appropriateness o f the current system o f service provision is the recognition that a danger exists that goes far beyond ineffectiveness; namely, it has the potential to inflict harm. The connection between mental health and the effect o f colonialism on the well-being o f Inuit has already been suggested i n the literature review. Social services, a government department that provides much o f the mental health services i n the community o f Arviat is an instrument wielded throughcolonial power. Comments extracted from the interviews point to a need for recognizing the relations o f power that are currently operating to render services inappropriate and ineffective. The cultural inappropriateness o f current systems o f mental health service delivery is threaded throughout the other points o f analysis under review i n this paper. Cultural inappropriateness renders services ineffective and results i n a lack o f continuity. Culturally inappropriate services w i l l always be regarded as insufficient. N o matter the amount o f funding, these services w i l l forever be plagued b y issues o f scarcity while they r  operate i n ways that are i n conflict with the community and with culture.  120  5.7 Suggestions for Improvement  •  More local hire Inuit know a lot more about Inuit and it would be better if the Inuit help their own people. Because if the mental health workers come from down south...all they can see is what is written down on paper, they don't know their lives, they don't see the person. All they see is the paper and that's all they sec.dhe people who come in are supposed to know everything, but they don't know everything, even I can know more than they Jo...(Respondent #15, male elder)  A distinction emerges in the above statement between what is known from formal education and what is learned from lived experience. W h i l e western society places much trust and faith i n a formal education system that was developed to serve western purposes, Inuit ways o f knowing are based on lived experience. One woman who had accessed formal services found it difficult to talk to those who had read about rather than shared her experiences:  The people that were trying to help me, they were educated off books, not from experience...should I talk to them or not 'cause, well maybe if I talk to them they'll learn from my experiences and be able to help others, be able to understand others that are trying to askfor help...I was just an experiment to these counsellors, or doctors, or social workers, I was angry 'cause... they have a nice life...much easier than mine why couldn 't Ijust have what they have... (Respondent #6, young adult female)  121  Although this woman recognizes that receiving these services made a positive difference in her life, she is firm in her advocacy for more Inuit filling the positions that currently are most frequently occupied by southerners: Maybe it should be Inuit...we need more's not easy going up to a stranger asking for help...a Qallunaat, it's not easy to trust them, it's like are they understanding? We 're two different colored people, not to be prejudiced or anything but...for my own experience, being sent out for help to total strangers was the hardest thing I've gone through...(Respondent  #6, young adult female)  This woman points to the lack o f trust that she felt in accessing help from a "stranger". Compounded with this lack o f trust was her feeling that understanding one another across cultural divides poses challenges. This woman did not access help within the community, she was "sent out for help to total strangers", an experience which she presently describes as "the hardest thing I've gone through".  This woman concludes on  the strength o f her own intense experience that there is a need for more educated Inuit. Inuit i n helping positions would have the advantage o f understanding culture, language and community from an insider perspective. Inuit workers by virtue o f their life experience have a knowledge not attained by outsiders who frequently occupy community positions for only the short term. Inuit workers would know more than what is written and documented on paper, they know individuals, families, and relationships. Even i f Inuit worked i n a community different from their community o f origin, they would have at minimum an understanding o f language and o f culture which, while they might be different from their own, would overlap at various points. Inuit would have more than book knowledge. They would have an understanding based on lived  122  experience, an understanding valued highly by some o f those interviewed i n the community o f Arviat. Aside from an increase i n the quality o f the help received, other advantages would result o f more local hiring: an increase in the amount o f community control and an increase i n employment opportunities available to residents.  •  Systemic flexibility There's so many order for any department, any policies, work in a community up here in have to be flexible... (Respondent #10, female adult)  If you bring your policies and say, okay these are the policies...we'll use it as a guideline, but you come to a community and you work with your policies, and...the way the community 're going to have both, you 're going to be able to have all your policies that you believe should really be there but you have the community's input,, and then, my goodness, that's the answer...(Respondent #10, female adult) There is an awareness shown i n the statement above that strict rules and guidelines do not function well i n a northern remote community. The example given by this woman to illustrate her point was that o f travel plans frequently being delayed, requiring an environmentally imposed flexibility around time lines. There is also a recognition i n the above citation for a "goodness o f fit" to be reconciled between policies and the individual community derived through the obtainment o f the "community's input". A statement o f the need for increased systemic flexibility in areas related to mental health broadens the critical analysis beyond the scope o f the individual  123  community. Policies are usually developed and directed at a regional level and so change must occur at not only the community level but also at higher levels. The person cited above suggests an avenue for making this change by characterizing a policy as " a guideline", therefore avoiding rigorously adhering to policy at the expense o f community well-being. Her solution involves conceptualizing policies as guidelines and then encouraging community input which w i l l allow the creation o f policies that are tailor made to the life o f the community. When organizations design policies and rules to be followed without local input, the policies and rules are likely to be dislocated from the environments i n which they operate. The result is increased stress felt by those delivering front-line services as they are faced with fulfilling policy expectations, such as filling out an overload o f paperwork or trying to meet strict restrictions and deadlines, that are not realistic. One elder involved i n running a camp for young offenders voiced his feeling that their program was shut down as the organizers failed to stick to rules they felt were inappropriate:  The Hamlet gave us strict instructions to follow while we were at the camp (youth justice camp), but the rules weren 't like our cultural rules, so we bent the rules or went around the rules...(Respondent  #15, male elder),  This participant describes a situation where rules imposed through an administration are *  in conflict with rules prescribed by culture. If policies and rules where flexible i n nature, would it be possible to negotiate a middle ground to meet both administrative and cultural requirements?  124  •  Increased Community Involvement We need more support within our community, we need people that are trained in our community, our own people, Arviat's own people, trained to help themselves, support is greatly needed, support groups that train support people... the main person doesn 't need to be some professional... (Respondent #3, service provider)  Professionals i n the north are i n short supply, evidenced by high turn over rates and lengthy job vacancies. A s previously acknowledged, professionals imported from the south are often not the helpers o f choice. Suggestions for improvements or alternatives to the conundrum o f staffing professional positions i n the remote north point to an increase in community involvement. Community involvement goes one step further than local hire, it demystifies the act o f helping. Community members do not have to wait for positions to be filled to receive assistance. They are able to meet a great number o f their needs intrinsically - within the community. The goal o f increased community involvement is a dual process. First o f all, opportunities for local involvement need to be allowed and supported within the regional framework. Secondly, real involvement has to be undertaken by community members. Those problems identified as mental health problems produce challenges. A s already discussed, professional workers are often alienated from the rest o f the community as a function o f their working roles. The advantage o f a professionally hired worker is that a professional affiliation functions to alleviate the stress from the rest o f the community members. Professionals enable the community at large to avoid dealing with mental health issues directly. Real community involvement necessitates removal o f the "professional affiliation buffer" and dealing with  125  problems despite feelings o f alienation and controversy. O f course the more community members who are involved the better. It is easier to stand i n a group rather than standing alone.  •  Incorporation of traditional knowledge into services That's how it would work better. Talk with the social workers, not just anyone talking to the social worker but elders who have wisdom. We all have different knowledge, some people know a lot about the past from their parents and grandparents ...If the social workers got more help from the Inuit, a lot more would happen and they could help much better...(Respondent #15, male elder)  Evident i n the passage above is the perception o f a mutual exclusivity operating between Inuit elders and service providers. In actuality at least one o f the social workers i n the Arviat Social Services Office is Inuk, born and raised i n the community. The elder cited in the above passage advocates that it "would work better" i f the social worker talked to "elders who have wisdom". Elders possess "different knowledge", and i f they shared this knowledge with social workers and i f "social workers got more help from the Inuit" then "a lot more would happen" and "they could help much better". The felt division between social workers and Inuit elders - placed into two, disparate camps - is evident. This suggestion for the improvement o f mental health-related services does not go so far as to advocate for the filling o f social services positions by Inuit, but rather just the seeking out o f the knowledge o f elders and the inclusion o f this knowledge within the area o f service provision.  126  In addition to the identification o f the need for an incorporation o f traditional knowledge within service delivery models, there was the further suggestion arising i n several interviews that the service delivery model itself be informed by traditional knowledge. Specifically, it was a commonly repeated suggestion that camps out on the land could be used in the address o f a variety o f mental health problems identified by community members: A camp like that would be really nice for young people with different problems 'cause...when I go out into the land I...really enjoy it to a point where sometimes I'll just cry because of all the freedom I've got, all the open space, so I think camps like that are a good idea - alternative justice camps... (Respondent #12, female elder) The Elder who spoke in the above passage through an interpreter recognizes the healing power o f the land and the immense feeling o f freedom which she encounters in the midst of 'all the open space'. Currently, land camps are being utilized in various communities across Nunavut as an alternative and more culturally aware form o f addressing justice issues. The suggestion has arisen that land based camps be broadened to stretch beyond justice issues to be used for suicide prevention and for dealing with issues of drug and alcohol abuse. The land is a resource which many o f those interviewed connect with mental health. The land ties in with culture and has the ability to connect people across generations and yet the land is largely a resource untapped by the formal sector o f mental health service provision.  127  •  Increased resources diverted in the areas of social well being and education I'm hoping that they...don't lose their focus on their mandate, they put people first, community first, we 're going to work on our social issues, our education, you know all those nice things that they really said they were going to do when we become Nunavut... (Respondent #10, female adult)  The woman cited above speaks specifically about the Nunavut Government when she comments that she hopes that "they .. .don't lose their focus on their mandate". It is this woman's impression that "those nice things that they really said they were going to d o " should be done i n terms o f focusing on people and communities by addressing various social issues and the area o f education. These comments go beyond the community o f Arviat to the territory o f Nunavut as a whole: We need to improve education, health, justice, housing, all those...and start planning and...finding the funding to start going into, taking these to the communities...(Respondent #10, adult female) The mobilization and dedication o f resources to the broadly defined area o f mental health is perceived as a necessary precursor to community health and well-being. While more resources may be needed, a useful initial step i n the right direction would be the examination o f the current utilization o f resources - how effective is the deployment o f various funds at this point i n time? Is more funding required or is it the reinvestment o f funding into alternative endeavors which is required, or, possibly both? Communities, both individually and collectively, need to be involved i n the evaluation o f current services and the decision making process o f what w i l l be funded i n the future.  128  •  Increased co-ordination between various departments and services Something that can be done that would really help - put the agencies together make themfightit out...make them into one agency ...pick one agency who's going to decide what is going to happen. The more that are involved, the more complicated and stressful things get...(Respondent  #16, adult male)  Bureaucracy has unleashed upon the north systems o f stunning complexity. Given the small populations involved, the administrative structures and functions are remarkable. Albeit, environmental constraints have imposed a resistance toward the simple transfer o f "southern style" models onto the face o f the north. Factoring i n elevated costs, small populations rooted i n a different culture, and difficulties associated with Arctic travel, models o f administration have been adapted to the closest southern parallel achievable, given the circumstances. A n outcome o f the proliferation o f administrative systems is a lack o f clarity regarding who is responsible for what. The suggestion made by the individual cited above is "make them fight it out", collapse the many into one, thereby reducing confusion and increasing effectiveness. A s this man interviewed warns "the more that are involved, the more complicated and stressful things get", a statement directly pitched against the creation o f resources that w i l l further confuse things. M o r e is not necessarily better, and sometimes more is decidedly worse. Following up on this suggestion, it would be useful to clarify roles at the community, regional, and territorial levels - in order that both redundancy and gaps i n service provision might be addressed, simpler solutions might be arrived at, and education would be provided to the public regarding who is responsible for what.  129  •  More Positive Interventions I think to keep on selling the idea ofpositive intervention, and positive support and get out there... be seen to be doing good... (Respondent #14, service provider)  A s previously identified there exists the perception that social services, a major deliverer o f mental health services, is alienated from the Inuit culture i n which it is housed. The role o f social service worker is postulated not always as a positive role but one which instigates a disruption against the family life which is viewed as an integral part o f community well-being. The suggestion above notes that the social services office is i n need o f serious change. Positives interventions should be stressed and more readily implemented. Social services needs to be recognized as an agency that supports and assists rather than penalizes. To achieve positive recognition, positive interventions are necessary. Changing an image w i l l likely be a long process and one that w i l l potentially necessitate a review o f the larger social services system o f which Arviat's local office is a part. The image o f social services is not accurate. The earlier comment by an elder suggesting that social workers should talk more with Inuit relayed his perception that social workers were hired from outside the community while i n actuality at the time these interviews were conducted two out o f the three positions filled at the social services office were filled by Inuit workers. This misconception o f how the local social services office is staffed reaffirms the suggestion that workers need to become more visible i n the positive aspects o f their work.  130  •  Cultural training of non-Inuitprofessionals They are very much qualified to he a mental specialist, I'm sure, but...when they come to a community ...they need to be trained, they need a lot of training on the community side. Yes for the language, for the culture cause...they are dealing with people, and people's lives...when they come in and they don't know the culture, and how people do and think, and why they do things, if you don't stop and try to learn those you may make a decision that could be more harmful than good, to the person, to the family, to the community... (Respondent #10, adult female)  Non-Inuit workers are i n need o f training to supplement their professional expertise. W h i l e training obtained i n the south may be applicable to a northern setting, it may be i n need o f modification to maximize effectiveness i n this different cultural setting. A s the woman cited above comments about the need to learn about culture: " i f you don't stop and try to learn .. .you may make a decision that could be more harmful than good". Operating out o f ignorance is a potentially dangerous form o f practice that could do harm to people i n the community. There is no organized training regarding culture arranged for employees recruited from the south. Cultural training, provided b y elders as well as others i n the community, would provide an opportunity to establish connections between community members and professionals. The training would also provide a good opportunity to personalize the connection between professionals and community and possibly to boost community involvement.  131  •  Development of regional services I know the lady who worked here before me was asking about getting a treatment centre somewhere in the Kivalliq region which would be much easier I think. She got turned down saying that there wasn 't enough people who would get help but I think if it was here in our region, not far from home, people, a lot more people would go and get help and they get turned away from treatment centres being so far away...(Respondent #9, young adult female)  Northern, remote communities pose a problem to service providers. Communities with small populations obviously cannot offer the kinds o f services provided i n southern centres. Yet, with culture, including language, being very different between the south and north, it is not always appropriate to send people to an alien setting to receive services. For voluntary treatment, such as alcohol and drug treatment, individuals may elect to go without services, as traveling far from loved ones and the familiarity o f home may be too much o f a disincentive. The worker interviewed in the above passage makes the comment that those who are asking for help are probably a smaller percentage o f those who would benefit from help i f services were available within the region. The development o f regional or even territorial services should be explored with the understanding that effective services that are readily utilized are also fiscally sound. Services could also involve local communities and local strategies - for example, as already discussed, the use o f outpost camps.  r  132  •  More Youth Involvement We have to get what the young people want. Being a young person, your thoughts aren't always seen by the elders or the elders disagree with what the youth . want...ask the youth what they want, let them vote for it. Stuff that we never thought of would start showing. The community would get happier... (Respondent . #15, male elder)  Suicide, a mental health problem facing the community o f Arviat is much more prevalent with youth than with any other age group. Likewise, many o f the substance abuse problems directly involve youth. This being said, it is largely the adult population who design and implement mental health services. The elder cited above recognized a need for the further acknowledgement o f the voices o f youth. It is his feeling that i f youth were more involved i n decision making processes that the whole community would benefit and become happier as a result. This elder also makes the comment that different elders make different assumptions regarding what the youth need and want. However, it would be far clearer i f the youth were directly asked. Community decision making which involved members from various generations would provide forums for cross generation contact and communication.  133  CHAPTER 6: Conclusion  The interviews conducted for the purpose o f this study have important implications for the community o f Arviat, health policy makers and practitioners, as Well as for the profession o f social work. Community members o f Arviat have voiced their opinions that mental health services could be improved and have put forward ways i n which this might be done. The results are relevant to other communities that are i n the midst o f significant social and cultural change. These results are also put forward for consideration by community members o f northern settlements, as it is m y belief that what emerged from this research was a clear call for a less institutionalized understanding o f service provision, one that would not draw boundaries between service provider and service population. Researchers need to start addressing broader audiences rather than restricting themselves to their professional colleagues - a restriction which propagates elitism and division among professionals. The following suggestions aim at improved community well-being and conscientious social work practice.  •  Importance of critical stance and power analysis  Over time, a belief has been promulgated that professionals are the individuals o f choice to deliver mental health services to northern remote communities. After all this has been the belief developed and practiced i n the south o f the country. Community members questioned this belief as they noticed that professionals contain a book knowledge rather than a knowledge based on lived experiences. Community members also noted that professionals are often not aware o f language and o f cultural practices, an ignorance that  134  sometimes puts their practice i n conflict with the larger community. Could mental health services be expanded to include practices that are based on a community mental health model that would encourage local participation rather than making practice exclusive to the professional? If a mental health professional position is maintained, is there a mechanism which could be employed to link this individual with other natural helpers i n the community? A mental health professional might, for example, spend time training and being trained b y a group established for the improvement o f mental health i n the community that attempts to meld professional expertise with the capacities and knowledge residing within the community. The mental health professional, needs to be accountable to the local community i n a direct way. It is not enough for this individual to be responsible to a department or an organization. The mental health specialist needs to report to and receive instruction from the community. Local accountability is a natural check to the power o f the professional.  •  Further exploration of the meaning of terms  What became evident i n conversation with different community members was that mental health was a term with many definitions. The community o f Arviat does not share a uniform definition o f what mental health means. Likewise i n the rest o f the country, mental health is a term lacking a singular definition. W h i l e it is not crucial to unearth an agreed upon standard definition o f the term, it is important to recognize that it means different things to different people. A n essential starting place for social science research is an exploration o f the terminology currently used. When more than one language is being utilized while the research is being conducted then there needs to be the further  135  recognition that translation between two languages rarely happens without some occurrence o f loss or alteration o f meaning. Lastly, when viewed from different systemic levels, terms can take on different meanings. A finding o f this research is that the term mental health can be attributed not only to individuals, but also to families and communities and that these different systems exhibit characteristics or qualities that can be measured to gage levels o f mental health. The utilization o f systems theory can potentially yield a more thorough understanding o f terminology.  •  Further exploration regarding the connection between mental health and culture as specific to northern communities  This paper discusses the ambivalent role that culture has played i n relation to mental health i n the northern community o f Arviat. Cultural knowledge can be used to promote mental health. Acculturative stress has effected community well-being. Colonialism is a force that has disrupted the transmission o f culture from one generation to the next. Participants i n this study identified that cultural knowledge can improve the mental health o f their community and that the challenge is to retain a sense o f identity while understanding what it means to be Inuit at this present time continues to evolve. Culture cannot be articulated only in terms o f the past. Doing so alienates young people whose lives are very different from those o f their ancestors. Conflict exists in northern settlements between different generations. Further exploration o f this inter-generational conflict as well as how this conflict relates to a changing understanding o f culture is needed to reveal how culture can again become a unifying force that promotes survival. Lastly, there needs to be an examination o f how culture can inform the development o f  136  formal mental health resources. The north has largely been a site o f transplanted services !  based on southern models and yet northern communities are unique and distinct.  Mental  health services are not congruent with community culture and as a result are limited, both in terms o f appropriateness and effectiveness. H o w this condition o f insensitivity to culture can be rectified needs to be addressed conjointly by community members and b y professionals.  •  Include different systemic levels in consideration of mental health issues  A finding included i n the results o f this research is that considerations o f mental health are not confined to the individual. Families and communities are perceived as possessing both positive and negative indicators o f mental health and o f having roles to play i n the overall improvement o f mental health. Further to this, the territorial and national context i n which communities are housed are also perceived as relevant to community mental health. Given these relationships o f larger systems to community mental health, it is important to resist the tendency to become singularly preoccupied with treatment strategies that target only individuals. This implication is an important one, regardless o f whether working i n the area o f mental health i n Arviat, or i n a larger community i n the south o f the country. There is a tendency to pathologize individuals for their mental health problems rather than examining the larger systemic issues. Participants i n this study linked mental health problems to a lack o f opportunity, to a lack o f appropriate services, and to cultural upheaval faced by community members. Mental health problems were talked about as social phenomena rather than as organic maladies. Also, different manifestations o f behaviour linked with poor mental health such as the act o f suicide or pathological gambling are linked to common root causes, lending credibility to the  137  perception that these problems are largely socially based. Participants allude to systemic conditions underlying the separate manifestations o f mental health problems. . A s professionals frequently employed i n the field o f mental health, it is important for social i  workers to be conscious o f the social influences affecting mental health i n both their practice and research. A k i n to this is the recognition o f the importance for social workers to be active i n working with communities i n the realms o f advocacy and social policy design i n order to be active at both micro and macro levels o f practice.  •  The potential harbored in community capacity to improve mental health  Critical theory emphasizes the capacities held b y groups o f people to meet their own health needs, and cautions that institutionalized services can diminish rather than enhance community capacity. The distinct line typically drawn by formalized mental health  1  service sector between service provider and service population should be reconsidered. The very act o f addressing mental health concerns as a community w i l l , i n and o f itself, be o f service towards answering these concerns. This belief put forward b y critical theorists also emerged i n the comments made by participants. Some o f the participants cited i n this paper were adamant that self-responsibility was crucial to the pursuit o f increased well-being. Participants also shared beliefs that traditional knowledge contained truths about how to lead a healthy life. This paper has largely been restricted to a critical examination o f the formal sector o f mental health services, a limitation which has yielded only a partial account o f the forces affecting mental well being. T o increase the recognition o f community capacity researchers and community members should be conscious o f both the formal and informal resources available.  138  •  Examining scarcity and staffing issues from a critical perspective  Although not unequivocal, one o f the observations made by participants is that it is not a matter o f scarcity o f resources that confounds the improvement o f community well-being, but rather the manner i n which resources are being utilized is inherently flawed. There is a difference o f opinion raised i n interviews held with community members as to whether there needs to be more resources diverted toward the area o f mental health or whether a systemic revisioning o f services needs to be undertaken. Critical theorists make the argument that service provision is fundamentally self-interested, and as such service providers w i l l likely advocate for a furthering o f the same kind o f resources. If there is a failing i n the service, then it should be attributed to the amount rather than to the type. Services may be slightly altered, however, it is rare that changes take place on anything more than a superficial level. Social workers have an ethical obligation to examine their professional role and to conduct an honest evaluation as to how their role may be inhibiting or enhancing the well-being o f those with whom they work. This claim also relates to the finding that arose during interviews that the social worker's professional role was at times perceived as being adversarial. If a professional role consistently places the professional i n opposition to the community then this role needs to be questioned on a fundamental level. Social workers have an ethical obligation to work with communities toward communities' best interests rather than toward professional self-interest. H o w to do this warrants some honest and serious scrutiny. Considerations toward this end include developing service provision that is more flexible and that draws more from community based resources such as outpost camps.  139  •  The relevance of critical theory and ecological systems theory  Interviews with respondents confirm the applicability o f both critical theory and ecological systems theory. Respondents spoke o f colonialism and its impact on the mental health o f Arviat's population. Critical theory recognizes the importance o f analyzing the historical and present day oppression that has been brought about by colonial relationships. Respondents identified how things have changed from the past using words like 'lost', 'confusion', and 'anger' to describe the effects o f the attempted imposition o f a western hegemony upon northern populations. In line with critical theory, respondents spoke about the important role o f culture in providing the knowledge necessary to lead a healthy life. Respondents noted that culture was important i n terms o f providing a sense o f identity and also i n providing a source o f wisdom for living. Both elders and young adults agree that an understanding o f Inuit culture provides a means to mental health. Critical theory is sensitive to the changing nature o f society and recognizes that society's structures are dynamic rather than stable. Respondents spoke about the changing nature o f their culture both positively and negatively. Critical theory applied to the setting o f Arviat would suggest that community members examine the structures that make up their contemporary society and challenge any false consciousness that they are powerless to bring about change. More than one respondent noted that i n order for meaningful and positive change to occur that individuals needed to take responsibility for themselves. A similar observation is made by critical theorists who note that through self-responsibility, at the individual or at the community level, people recognize their abilities to meet their own  140  needs. Respondents spoke o f problems that make current services ineffective and the suggestion was made that until people recognized that they had the potential to do something to fix problems that services would continue to be inadequate. Critical theory encourages people to recognize the positive differences that they can make in their everyday lives. This process o f change occurs when people realize that they can make meaningful changes at the level o f everyday life and that these changes w i l l in turn effect changes o f "large-scale social structures"(Agger, 1998, p. 4). The dialectical nature o f change i n recognized by both critical theory and ecological systems theory.  Respondents  noted that Arviat is a community i n which community members do meet together for the purpose o f addressing their shared problems. Courses o f action that would be encouraged by critical theorists are already taking place. Critical theorists would likely advise that action at a local level be coupled with further analysis as to what changes need to made at a structural level. Ecological systems theory is congruent with comments made by respondents. Respondents noted the ways in which their mental health connected with their larger environment. Likewise, when speaking o f community mental health problems respondents spoke about the ways i n which problems were connected and how these problems had their roots in larger systemic issues. Some o f the criticisms regarding service provision are predicted through ecological systems theory. For example, respondents spoke about the dubious effectiveness o f sending an individual out for treatment and then returning them into unchanged environments. The application o f ecological systems theory would point to not just addressing the individual but also examining their environment.  Ecological systems theory also points to the risk o f  141  failing to establish a 'goodness o f fit' when external structures are imposed i n environments foreign to the environments that evolved these structures. Comments respondents made about the provision o f mental health services voiced concerns about a potential for inappropriateness occurring when professionals do not have an understanding o f the environment i n which they are practicing. Both ecosystems theory and critical theory enrich the understanding o f this body o f research by providing it with a larger contextual framework. Criticisms raised regarding the 'liberal' nature o f ecological systems theory are important to acknowledge and point to the importance o f using critical theory to mitigate this short-coming.  •  Moving toward changes that are needed  The following is a list o f suggestions for change emerging from this thesis. -Design mental health services that are sensitive to the family and community rather than primarily designed as 'individual-centred'. Design services around community definitions o f mental health. -Design mental health services that are sensitive to different generations and changing definitions o f culture. -Look at options and choices available to community members and develop further opportunities based on community input. -Support and develop mental health initiatives that include peer support and recognize local role models. -Evaluate and measure community empowerment strategies. -Develop community-based strategies for teaching life skills to younger generations.  142  -Utilize and recognize the community's creative resources in mental health initiatives. -Recognize informal mental health resources functioning in the community (i.e. traditional knowledge, the land, spirituality etc.) -Encourage critical thinking among community members regarding media from the south. -Examine the roles o f both crisis and prevention services in the area o f mental health how can prevention be strengthened to forestall crisis? -Complete a review o f services and policies through a cultural lens. -Explore the possibility o f developing 'mentoring' relationships between elders i n the community and mental health practitioners. The above suggestions contain strategies and ideas o f how mental health services could be improved or expanded at the community level. These suggestions are also relevant at the regional level as the comments derived from a single community are likely relevant to the region as a whole. The aim o f this research has been exploratory - to solicit a northern community's feedback regarding the broad subject matter o f mental health. Through the interviews held with community members it became clear that mental health referred to an individual, as well as a collective well-being, and that both obstacles and aids were apparent in Arviat. Northern, and other communities, need to unlock the potential o f community resources. A social worker can work as an ally in this process, but must be cognizant o f the limits to the professional role.  143  REFERENCES  Agger, B. (1998). Critical social theories: An introduction. Boulder, Co: Westview , Press. Alfonso, F. (1986). Empowering rural communities. In J.C. Ickis, E. de Jesus, & M . Rushikesh (Eds.), Beyond bureaucracy: Strategic management of social development (pp. 60 - 8 1 ) . West Hartford: Kumarian Press. Arges, S., & Delaney, R. (1995). Challenging the southern metaphor: From oppression ) to empowerment. In R. Delaney, K. Brownlee, & K. Zapf (Eds.), Issues in northern social work practice (pp. 1-22). Thunderbay: Lakehead University. Balikci, A . (1970). The Netsilik Eskimo. Prospect Heights, Illinois: Waveland Press. Banks, K. (1999). Community Social W o r k Practice Across Canada. In F.J. Turner (Ed.), Social work practice: A Canadian perspective (pp.224 - 236). Scarborough, O N : Prentice-Hall Canada Inc. Barrow, C . (1993). Critical theories of the state: Marxist, Neo-Marxist, Post-Marxist. Madison: The University o f Wisconsin Press. Berry, J.W. (1999). Aboriginal cultural identity. The Canadian Journal of Native Studies XLX(\),\-2>6. Bjerregaard, P., & Young, T . K . (1998). The circumpolar Inuit: Health of a population in transition. Copenhagen: Munksgaard. Briggs, J . (1970). Never in Anger. London: Oxford University Press. Brody, H . (1975). The people's land: Eskimos and whites in the eastern arctic. Harmondsworth: Penguin books.  }  144  Campbell, M . (1999). Critical theory and liberation theology: A comparison of the initial work of Jurgen Habermas and Gustavo Gutierrez. N e w York: Peter Lang. Canadian Association o f Social Workers (1994). Social work code of ethics. Retrieved 09/12/2002, from Canitz, B. (1990). Nursing i n the north: Challenge and isolation. In Crnkovich, M . (Ed.) "Gossip": a spoken history of women in the north, (pp. 193-213). Ottawa: Canadian Arctic Resources Committee. Cassidy, F. (1991, Summer). Organizing for community control. The Northern Review, 7(18), 230-247. Cheers, B. (1998). Welfare bushed: Social care in rural Australia. Aldershot: Ashgate Publishing Ltd. Checkland, P. (1993). Systems thinking, systems practice. Chichester: John W i l e y and sons ltd.  ^  Checkland, P., & Scholes, J. (1990). Soft systems methodology in action. Chichester: John W i l e y and sons ltd. Coates, K. & Powell, J. (1989). The Modern North. Toronto: James Lorimer & Company.  Davis, R. & Zannis, M . (1973). The Genocide Machine in Canada. Montreal: Black Rose Books. Delaney, R., Brownlee, K., & Sellick, M . (1999). Respecting community: Rethinking social work with rural and northern communities. In R. Delaney, K. Brownlee, & M . Sellick (Eds.), Social work with rural and northern communities. Thunder Bay: Lakehead University.  145  Fienup-Riordan, A . (1990). Eskimo Essays: Yup 'ik lives - how we see them. Rutgers, N J : Rutgers University Press. Fletcher, C. (1993). Inuit concepts o f mental health: Uitsalik/nuliatsalik and uuttullutaq. Paper presented at: CAMACAM annual meetings Y o r k University, Toronto, Ontario.  Frideres, J. (1983). Native People in Canada. Scarborough: Prentice-Hall Canada Inc. Foucault, M . (1976). Mental illness and psychology. N e w York: Harper & R o w Publishers Inc. (Original work published 1954)  Germain, C. (1979). Social Work Practice. N e w York: Columbia University Press.  Germain, C , & Bloom, M . (1999). Human behavior in the social environment. N e w York: Columbia University Press.  Glick, I.N., & Glick, M . (1981). Boom towns: A quest for well-being. Edmonton: Canadian Mental Health Association. Harp, R. (1994). Native by nature? In E . M . Godway, & G. Finn (Eds.), Who is this 'we'? Absence of community (pp. 45-55). Montreal: Black Rose Books. Hlady, W.G., & Middaugh, J.P. (1998). The underrecording o f suicides i n state and national records, Alaska, 1983-1984. Suicide and Life-Threatening Behavior, 18(3), 237-244. Hudson, P. (1997). Barriers to decolonizing First Nations child & family services. Issues in the North, 2(41), 97-106. M i c h , I. (1973a). Celebration of awareness: A call for institutional revolution. Harmondsworth: Penguin Books.  146  Illich, (I.) (1973b). Deschooling Society. Harmondsworth: Penguin Books. Illich, I. (1975). Medical Nemesis. Toronto: Bantam Books. Isaacs, S., Keogh, S., Menard, C , & Hockin, J. (1998). Suicide i n the Northwest Territories: A descriptive review. Chronic Diseases in Canada, 19(A), 152-156.  Jameson, F. (1994). The Seeds of Time. N e w York: Columbia University Press. Kamin, A., & Beatch, R. (1999). A community development approach to mental health services. In R. Delaney, K. Brownlee, & M . Sellick (Eds.), Social work with rural and northern communities (pp. 303-321). Thunder Bay: Lakehead University. Katt, M., K i n c h , P., Boone, M., & Minore, B. (1993). Falling through the cracks: Human resources and mental health i n the Nishnawbe-Aski First Nations. In B. Minore & C . Hartviksen (Eds.), Redressing the Imbalance: Health human resources in rural and northern communities. Thunder Bay: Lakehead University. Kirmayer, L.J., Boothroyd, L., & Hodgins, S. (1998). Attempted suicide among Inuit youth: Psychosocial correlates and implications for prevention. Canadian Journal of Psychiatry, 43(8), 816-822. Kirmayer, L.J., Fletcher, C , Corin, E., & Boothroyd, L. (1994). Inuit concepts o f mental health and illness. Report N o . 4. Prepared for: The Royal Commission on Aboriginal Peoples. Montreal. Division o f Social & Transcultural Psychiatry. Sir Mortimer B. Davis - Jewish General Hospital.  147  Kirmayer, L.J., G i l l , K., Fletcher, C , Ternar, Y., Quesney, C , Ferrara, N., & Smith, K. (1993) Emerging trends i n mental health research among Canadian Aboriginal peoples. Report N o . 2. Prepared for: The Royal Commission on Aboriginal Peoples. Montreal. Kirmayer, L.J., Malus, M., & Boothroyd, L. (1996). Suicide attempts among Inuit youth: A community survey o f prevalence and risk factors. Acta Psychiatrica Scandinavica, 94, 8-17. Krai, M.J., & Minore, J.B. (1999). Arctic narratives: Participatory action research on suicide and wellness among the Inuit. Presented at: The biennial conference of the society for community research and action, Y a l e University, June 1999. Kuptana, R. (1992). N o more secrets. Human Ecology: Issues of the north - occasional Publication Series No. 30 (pp. 49-58). Canadian Circumpolar Institute. LaRocque, E. (1996). When the other is me: Native writers confronting Canadian literature. In J. Oakes, & R. Riewe (Eds.) Issues in the North - occasional publication number 40 (pp. 115-124). Canadian Circumpolar Institute. Leenars, A., Brown, C , Taparti, L, Anowak, J., & Hill-Keddie, T. (1999). Genocide and suicide among indigenous people: The north meets the south. The Canadian Journal of Native Studies, XIX, 2, 337 - 363. Legare, A . (1998). A n assessment o f recent political development in Nunavut: The challenges and dilemmas o f Inuit self-government. The Canadian Journal of Native Studies, XVIII, 2, 271 -299.  148  Linn, M . (1999). Overview of treatment needs in Baffin and Nunavut in planning for the Apex healing centre. Addiction Services, Baffin Region Health and Social Services Board. Government o f Nunavut Territory. A p r i l . Logsdon, H., & Seto, D. (1992). Housing and northern lifestyles an historical overview. In R. Riewe, & J. Oakes (Eds.), Human Ecology: Issues in the North occasional publication series no. 30 (pp. 81-110). Canadian Circumpolar Institute & Faculty o f Home Economics University o f Alberta." Marcus, A . (1995). Relocating Eden. Hanover: University Press o f N e w England. Matthiasson, J.S. (1992). Living on the land: Change among the Inuit of Baffin Island. Peterborough, Ontario: Broadview Press. M c K a y , S. (1987). Social work i n Canada's north: Survival and development issues affecting aboriginal and industry-based communities. International Social Work, 30, 259-278. Miller, B. (1994). The northern mental health outreach project ( N M H O P ) : Historical and conceptual background for a demonstration project i n northern community mental health outreach. Arctic Medical Research, 53(2), 467-473. Mullaly, R. (1997). Structural social work: Ideology, theory, and practice. D o n M i l l s , O N : Oxford University Press. Nickels, J.B., & Kehoe, J.P. (1972). Northern communities: Mental health and social adaptation. Paper presented at: The Institute on Community Psychology, Canadian Psychological Association. University o f Montreal. June. O ' N e i l , J.D. (1981). Beyond healers and patients: The emergence o f local responsibility in Inuit health care. Inuit Studies, 5(1), 17-25.  149  O ' N e i l , J.D., Moffat, M., Tate, R., & Young, T.K. (1994). Suicidal behaviors among Inuit i n the Keewatin region, N.W.T. Arctic Medical Research, 53(2).  Puxley, P. (1977). The colonial experience. In M . Watkins (Ed.), Dene nation, colony within (pp. 103-119). Toronto: University o f Toronto Press. Rasmussen, D. (2000). Dissolving Inuit society through education and money: The myth o f educating Inuit out o f "primitive childhood" and into economic adulthood. Interculture (139). Robson, C . (1993). Real world research: A resource for social scientists and practitioner-researchers. Oxford: Blackwell Publishers. Rothenberg, R. (2000). Report and recommendations: Mental health service delivery model. Rankin Inlet: K i v a l i q Health and Social Services. Sahlins, M . (1972). Stone age economics. Chicago: Aldine Publishing Company. Sampath, H . M . (1976). Modernity, social structure, and mental health o f Eskimos i n the Canadian eastern arctic. In R.S. Shephard, & S. Itoh (Eds.), Circumpolar Health (pp. 479-489). Toronto: University o f Toronto Press. Sampath, H . M . (1992). The changing pattern o f Inuit suicide and attempted suicide. Seventh Inuit Studies Conference - looking to the future. Fairbanks, Alaska. Schafer, O., & Metayer, M . (1976). Mental health and culture change: Eskimo personality and society - yesterday and today. In R. S. Shephard, & S. Itoh (Eds.), Circumpolar Health (pp.469-479). Toronto: University o f Toronto Press. Searles, E. (1998). The crisis o f youth and the poetics o f place: Juvenile reform, outpost camps, and the Inuit identity in the Canadian Arctic. Inuit Studies, 2(2), 137-155.  150  Simon, M . (1998). Children and youth o f the Arctic: A critical challenge o f sustainable development. The Northern Review, 18, 70 - 78. Simons, J. (1995). Foucault & the political. London: Routledge. Sullivan, A., & Brems, C. (1997). The psychological repercussions o f the sociocultural oppression o f Alaska native peoples. Genetic, Social, and General Psychology Monographs, 123 (4), 411-440. Tanner, A . (1983). Introduction: Canadian Indians and the politics o f dependency. In A . Tanner (Ed.), The politics of Indianess (pp. 1-36). St. John's: Institute o f Social and Economic Research, Memorial University o f Newfoundland. Tester, F.J., & K u k c h y s k i , P. (1994). Tammarniit (Mistakes): Inuit relocation in the Eastern Arctic, 1939-1963. Vancouver: University o f British Columbia Press. Tester, F.J. (1993). Serializing Inuit culture: The administration o f "relief' i n the eastern arctic, 1940-1953. Canadian Social Work Review, 10(1), 109-123. Tester, F.J. (1994). In an age o f ecology: Limits to voluntarism and traditional theory i n social work practice. In M . D . Hoff, & J . G . McNutt (Eds.), The global environmental crisis: Implications for social welfare and social work. Aldershot, U K : Avebury. Thorslund, J. (1990). W h y do they do i t ? - P r o p o s a l s for a theory o f Inuit suicide. Seventh Inuit Studies Conference: Fairbanks, Alaska. Tony, P. (1990). The community-based suicide prevention program: Searching for community health through tradition, self-determination, and innovation. In C T . Griffiths (Ed.), Preventing and Responding to Northern Crime (pp. 191-204). Simon Fraser University.  151  Travis, R. (1990). Halbwachs and Durkheim: a test o f two theories o f suicide. British Journal ofSociology, 41(2), 225-243. Trott, C. (1997). The rapture and the rupture: Religious change amongst the Inuit o f North Baffin Island. Inuit Studies, 21 (1 - 2 ) , 209-228. Valentine, V., & Vallee, F. (1968). Eskimo of the Canadian Arctic. Toronto, Ontario: M c C l e l l a n d and Stewart. Walker, R. (1985). Applied qualitative research. Aldershot: Gower Publishing Company. Web, M . (1994). The evolution o f community-based mental health services to the Labrador Inuit. Arctic Medical Research, 53(2), 493-495. Wenzel, G.W. (1981). Inuit health and the health care system: Change and status quo. Inuit Studies, 5(1), 7-25. Wilkie, C , Macdonald, S., & Hildahl, K. (1998). Community case study: Suicide cluster i n a small Manitoba community. Canadian Journal of Psychiatry, 43, 823-828. Yakish, C. (2000). Education and employment in rural Alaska. Journal of Prevention & Intervention in the Community, 19(2), 29-32. Young, T.K. (1988). Health care and culture change. Toronto: University o f Toronto Press. Young, T.K. (1993). M o b i l i z i n g human resources for health: Is more better? I n B . Minore, & C. Hartviksen (Eds.), Redressing the imbalance: Health human resources in rural and northern communities (pp. 102-112). Thunder Bay: Lakehead University.  152  Zapf, K. (1991). Educating social work practitioners for the north: A challenge for conventional models and structures. The Northern Review, 7(Summer), 248-273.  153  


Citation Scheme:


Citations by CSL (citeproc-js)

Usage Statistics



Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            async >
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:


Related Items