‘What has happened to you?’ asks Dr. Mushquash
By Marci Becking
THUNDER BAY – One always learns something new from listening to Dr. Christopher Mushquash. He was the keynote speaker on Jan. 18 during Day One of the 7th annual Anishinabek Nation Health Conference with this year’s theme being: We’eni Masaadan Gibimaadziwin – Journey well as you walk your life.
Dr. Mushquash is a Canada Research Chair in Indigenous Mental Health and Addiction, and Professor in the Department of Psychology at Lakehead University and the Division of Human Sciences at the Northern Ontario School of Medicine. He is also the Interim Executive Vice President Research at the Thunder Bay Regional Health Sciences Centre and Chief Scientist at the Thunder Bay Regional Health Research Institute. His keynote focused on diagnosis and what it really is.
“What is Diagnosis? I have been trying to shift the conversation around diagnosis particularly in First Nations for about 15 years since I was a graduate student doing my PhD,” says Dr. Mushquash, citizen of Pays Plat First Nation. “Clinical psychologists are highly trained in terms of assessment, diagnosis, treatment and research. When I was doing that work as a kid from northwestern Ontario, learning about diagnosis and really thinking about what it really meant for First Nations people, I saw a lot of places where I thought that perhaps the conversations were really driven by diagnosis and rather than being driven by what people actually need.”
Unfortunately, as he explained, we live in a world where systems and services are diagnostic-specific so if someone has a lot of difficulty that requires support and services, that person must meet at least one of the diagnostic criteria for one of the things that unlocks those services and supports.
“You may not get access to them. [It is] unfortunate the way how the mainstream systems have arranged their services in a way that is until there is a clinical problem, there is nothing we can really do for you from a service provision standpoint. I think that is entirely incorrect. Think about wellness and cultural-based ways of healing and helping people in the community. We don’t wait until people are experiencing such significant difficulty that they’re having difficulties across many, many domains of life before we begin to support them in a meaningful way and provide them with the things they need in order to do well. It is a bit of a different orientation.”
Dr. Mushquash pointed out that diagnosis is two things. The first is a process by which doctors meet with people and try to understand from their perspective what’s going on in their life.
“This can include interviews – interviews with collateral people. If someone comes to me, there may be a reason where I may ask them for their consent to talk to their school, their spouse, or their parent, to understand with them from a number of different perspectives. It could include testing, screening questionnaires, structured activities that measure very specific things.”
The second part of diagnosis, he said, is the label – the name at the end.
“It’s sort of like providing someone with a name that is based on the things that are wrong, rather than providing someone with a name culturally in our communities. We view people with their identity around how it is they take their place within their families and communities.”
He said that diagnosis is a regulated Act, the Controlled Act of Communicating a Diagnosis, so under legislation, only a select group of people are able to issue diagnoses.
“I was speaking to an Elder in Alberta and he was saying that in his language, there is no real way of asking someone ‘What is wrong with you?’. Instead, the question translates to: ‘What has happened to you?’. I think that is a very important type of conceptual way of trying to understand what is happening in someone’s life. Often times in mental health, you hear things like stigma or you hear about bias or discrimination against people who are experiencing mental health difficulties. Sometimes, people can internalize as part of who they are – this idea that there is something wrong with them. It is important that the question is ‘What has happened to you?’. Very often the case is that when someone meets diagnostic criteria for some type of disorder as defined in the Diagnostic Statistical Manual, a tremendous [number] of things have happened to them and happened to them in a particular context. Social, psychological or even biological context. All those things are not independent,” said Mushquash. “Even the research literature is beginning to understand that somethings that our Elders have been talking about for a long, long time, you cannot remove these things and act an intervention as if they’re separate. Instead, they need to be understood in a manner that is connected.”
The other thing he said that he sees is self-diagnosis.
“Information is very accessible now. Good information and bad information and otherwise information. It’s more and more frequent that I see, particular in our younger people, people coming in or asking if they have a diagnosis or a specific diagnosis based upon things going on in their life. Information is very good to have, it is good that we have access to very high-quality information. The challenge is that we have access to very bad information or poor-quality information and people begin to try to think through their lives in the context of illness or pathology rather than in a place of strength, a place of capacity or resilience. These are things that we contend within our communities and that we have to support each other in.”
“Fundamentally, the base of our cultural approach is the importance of our identity of who we are as Indigenous peoples. From that place is from where wellness can develop. The Creation Story, how it is we got to this place and what the expectations were and what our responsibilities are and from all those things from there we build out. Biomedical medicine – they kind of understand us a little bit so what they say is if somebody smoked for 25 years and they’re going to have grandkids, then they quit smoking – ‘I don’t want to smoke around the grandkids’. They did that thing as a consequence of their identity as a grandparent and what they wanted for their grandkids. It was something fundamentally attached to who they were and their identity which is why they were successful.”
“Similarly, if you think of that athlete that injures themselves and requires surgery, she does every single thing the surgeon says and then she goes to physiotherapy and does every single thing that the physiotherapist says and then she goes to the trainer and does everything the trainer says because her identity is a runner and she’s going to get running as soon as she is able. She will do that and stick to it because it’s who she is. In our cultural approaches, if we can understand how this relates to who you are, it provides a pathway for you to manifest what it is that you want in your life and this is where your wellness is going to spring and these are the methods and the medicines, you’re going to use to help you with that versus take three smudges and call me next week. You don’t prescribe things like that. It doesn’t work like that. I think that’s sometimes what makes mainstream services a little less familiar and even less comfortable at times trying to understand because I think they think about things in terms of dose response. We think of things in an entirely different way.”