Ka Wai Ola - Office of Hawaiian Affairs, Volume 6, Number 4, 1 April 1989 — For Hawaiian Families [ARTICLE+ILLUSTRATION]

For Hawaiian Families

Cultural ldentity Fosters Mental Health

by Deborah Lee Ward Editor, Ka Wai Ola O OHA The need for culturally-relevant family mental health care for Hawaii's different ethnic groups was discussed last month at a "Culture and Family" conference sponsored by the Family Institute of the Pacific, St. Francis Medical Center. Approximately 275 mental health professionals attended the March 16 conference at the Halekulani Hotel, whieh was organized with the University of Hawaii Schoo! of Medicine psychiatry department. Participants included physicians, psychiatrists, psychologists, social workers, nurses, pastoral counselors, guidance counselors and family caregivers. UH faculty, community professionals and staff from the Family Institute of St. Francis Medical Center shared their expenenee with culture and its role in family mental health. Since the populahon of Hawai'i is so ethnically diverse, most of the day was spent identifying the unique cultural background and care needs of major ethnic groups in Hawaii — Hawaiian, Samoan, Chinese, Japanese and Filipino. The special needs of military and refugee families were also discussed. The first ethnic family group discussed that morming was the Hawaiian family. Charmaine R. Kinoiki'oewa Bissen, M.S. a social worker at Leeward Community Mental Health Center, based her talk on drawing ties between the socio-political history of Hawai'i and the resultant problems of Hawaiian society. Bissen began by quoting Hawaiian elder Harry Kunihi Mitchell: "Kau li'i makou. Nui ke aloha no ka 'aina. We are few in number, but our love for the land is great." She explained that the 'aina (land) was the material, spiritual and psychological foundation of Hawaiian culture. The loss of the 'aina, and the sovereignty, tradition and cultural identity it embodied, brought about an enduring "cultural mourning and spiritual devastation" whieh persists today, she said. She called this sense of dispossession a major factor whieh to this day is reflected in low Hawaiian self-esteem and social and mental health problems. The frustration of a people dispossessed in their native land has produced further problems, Bissen said. She quoted University of Hawaii Hawaiian Studies professor Haunani-Kay Trask, "Native

Hawaiians have 'that unique set of problems associated with the indigenous peoples living under a non-indigenous government. . ,some native Hawaiians perceive themselves as citizens of an unfairly defeated nation, and some see themselves as an oppressed people.'" The conflict between Hawaiian traditional values and lifestyle and the dominant modern American culture also produces mueh stress in Hawaiians, she said. She cited a Native Hawaiian Study Commission report in 1983 whieh said, "The Hawaiian family who wants to continue a Hawaiian lifestyle is often confused and disturbed by the contemporary, competitive and individualistic lifestyles associated with modern American life. . .Such conflicts and stresses foster mental and emotional disorders, among native Hawaiian families in particular." She noted that it is difficult to maintain a viable alternative to the dominant western culture. However, from the "Hawaiian movement" that began in the 1960s, Bissen said there is an awakening among Hawaiians of a shared sense of being a people. She said, "The Hawaiian family of the 1980s faces three major problems: 1) land and water, including problems of commercial and governmental encroachment on legai rights; 2) eultural expression, including the teaching of Hawaiian religion and its principles of protecting the land and people of the land; and 3) community health and education services that are cultura!ly

sensitive. The social diseases of unemployment, crime and family disintegration are results rather than causes of these three fundamental problems." She added, "The Hawaiian movement is looking at self-determination for the Hawaiian people. . .The Hawaiian family is beginning to raise issues of how Hawaiian land trusts ean be used for the benefit of all Hawaiians." Bissen pointed out that Hawaiian families today experience the same major concerns of their ancestors a hundred years ago — decline in Hawaiian culture and alienation from the land. They are further frustrated by inadequate housing, poor health, laek of community resources and the insensitivity of some state agencies. This is reflected in poor health statistics, and high rates of aleohol and drug abuse, child abuse among others, she said. She recommended that mental health professionals and elinie workers discard previously held stereotypes of Hawaiians and instead, develop a deeper understanding of Hawaiian values such as ho'okipa (hospitality), ho'okupu (gift-giving), ku'auhau (geneaology) andaloha'aina (love of the land and its people). She also noted that since Hawaiians strongly value a "sense of plaee," those who feel a laek of connection with an ancestral home may be encouraged to develop a sense of belonging to the plaee they now inhabit. Bissen gave therapists some suggestions for building rapport with and understanding Hawaiian families: First, she warned that it is difficult for many Hawaiians to talk about deeply held values or beliefs, or even personal family problems with "outsiders." She stressed that it is the therapist's job to show sensitivity in building trust, and to help the family regain "lokahi," unity and harmony among family members. She suggested therapists ask about family genealogy, where a family lives (for example, in a rural area or city), and whether they follow a traditional lifestyle, to better understand to what extent they practice and believe in Hawaiian customs. . .She encouraged her audience to find out more about ho'oponopono, a traditional Hawaiian method of conflict resolution still used by many families in conjunction with a kahu (minister). She said if possible, therapists should consider including the minister in the family's treatment. She also said families would benefit from holding counseling sessions somewhere beside the agency office, for example in the family home or neutral plaee. Include family visitors as well, she recommended. Bissen also suggested therapists read the twovolume set "Nana 1 Ke Kumu," by Mary Kawena Pukui, whieh contains valuable insights into Hawaiian beliefs and family problems. As an example, she said western-trained therapists tend to automatically class as mentally disturbed anyone who reports seeing, hearing or talking to a deceased relative. Bissen said it is not uneommon for Hawaiian families to do this, and that it is only a problem when the family does not understand or is disturbed by the apparition. However, she urged, "Do not assume they are mentally ill, but rather ask questions to help the family understand the message the aumakua is presenting." Since many Hawaiians recognize the extended family, or 'ohana, where the grandparent, or kupuna, is highly respected, she said it is wise for the family therapist to acknowledge the important role of the kupuna in family counseling. Bissen concluded, "The solution to the native Hawaiian's health, financial, and other problems may be found in kako'o (support) from other Hawaiians. Through fostering a spiritual and cultural identity, improved coping skills may then develop. lt is also hoped that tolerance, respect, understanding and support by non-Hawaiians would be available. Through the Hawaiian family's sense of pride and heritage, an elevated self-image will emerge to bond all Hawaiians together."

Charmaine K. Bissen