MSW 517 Medicine Wheel

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Medicine Wheel

STUDENT A

Master of Social Work, Chamberlain University

MSW517-XXXXX: Advanced Social Work Practice

Dr. McDowell-Porter

DATE

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Medicine Wheel

The purpose of this paper is to discuss the Medicine Wheel as it relates to KC. As we go

through the four quadrants one can see how physically, spiritually, emotionally, and mentally KC

experiences her untreated mental health issues through this particular lens. The Medicine Wheel,

Four Directions and Circles have been used as an effective and appropriate means and tools for

develop healing strategies. They offer a multilevel strategy that is circular in nature which has

been practiced for thousands of years (Absolon, 2010). Using the Medicine Wheel, one can

analyze conditions of oppression and create actions to combat discrimination. Using my client,

KC, I will use the four directions of the Medicine Wheel to provide insight as to why there is

bias towards mental illness in ethnic minorities.

Case Overview

KC is 44-year-old Afro-Latina woman who was born in New Jersey, then moved to

Massachusetts with her family as a child. She has resided in the same city since childhood. KC

lives in her city’s housing authority on a section 8 voucher, living off social security disability.

KC is formally diagnosed with low IQ, depression, PTSD, and anxiety. She has a boyfriend of 16

years, and two children. DCF has been involved since her first child was born, provided the

turbulent abusive relationship with her boyfriend. Throughout the 15 years, the children have

been taken into foster care at various times. Currently, KC lives in her own one-bedroom

apartment. Her boyfriend lives in a separate two-bedroom apartment with their eldest child. The

youngest child is currently in foster care, awaiting placement back into the boyfriend’s

apartment. Through assessment and observation, KC has been found unable to properly care for

her two children with disabilities. Since the traumatic experience of the family break up in 2017,

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KC has been experiencing delusions and psychosis relating to her downstairs neighbor. In the

past year, with her two children being placed back in foster care, these delusions have worsened.

Quadrant 1 North

The Native American Medicine Wheel views mental health as a concern that is

considered a misalignment with nature. In the situation with KC medicine wheel can bring

alternative healing to her mental health issues. The question to contemplate is, what are the

socio-economic costs of untreated mental illness in ethnic minorities? Looking at KC’s

circumstance, once can see that she suffers from the inability to hold down a stable job, leaving

her to reside on social security. This is financially constricting, as she relies on food stamps for

subsistence. KC is one of thousands who rely on government support to survive. Public stigma

against folks with mental illness are still highly prevalent and have been proposed to be a serious

obstacle to successful treatment, rehabilitation and inclusion of individuals with mental illnesses

in society. Unemployment, income loss, a limited social network, impaired self-esteem, isolation

and loneliness have been associated with stigma and discrimination (Hansson, et al., 2014).

While KC has applied to jobs in the past, she faces a barrier due to her IQ and stigma of mental

illness. One method of action is for KC to enter support groups for individuals with disabilities

and mental illness. KC would benefit from connecting with peers in her situation as well as

widening her social circle. Additionally, KC could enter a work training program funded through

the state. This curriculum can train KC in specific employment tailored to her ability level.

Quadrant 2 East

In the east, visioning signifies the theoretical foundations and principles from which

searching for knowledge begins. Commencement symbolizes recognition that Indigenous people

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are in a state of resurgence and revitalization and currently in our long history we are recovering,

reemerging, and reclaiming our knowledge base (Absolon, 2010). To use the Medicine Wheel to

comprehend why KC’s mental illness has gone untreated so for long, we must look at the history

of untreated mental illness in African Americans. In 1848 John Galt, a physician and medical

director of the Eastern Lunatic Asylum suggested that “blacks are immune to mental illness.”

Galt hypothesized that enslaved Africans could not develop mental illness because as enslaved

people, they did not own property, engage in commerce, or participate in civic affairs such as

voting or holding office (Uchenna, 2019). At the beginning of the 20th century, African

Americans who were said to have mental illness faced the eugenics movement, starting in Great

Britain in the 1920s. In California alone, African Americans made up 4% of the victims of legal

sterilization. By the 1970s some states in the South still sterilized a disproportionate number of

black women declared mentally defective by the courts (Uchenna, 2019). Acknowledging the

generational trauma this caused, it is understandable why mental illness often goes untreated in

African Americans. White clinicians must address this and move forward in creating non-

stigmatizing interventions for minorities. Breaking down these barriers is the start to the

decolonization process.

Quadrant 3 South

The Southern doorway encompasses the emotional and relational realms. It brings forth

teachings of life, relationships, people and growth and will cover literature relating to principles

of reciprocity and relationship (Absolon, 2010). We can use this doorway to understand KC’s

negative internalization of her mental health. The internalization of negative stereotypes about

mental illness occurs early and leads to self-stigma. Self-stigma exists on the individual level and

dorses negative stereotypes of social rejection and discrimination. This may be a response to

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experiences of public stigma and consequences of psychosocial life aspects (Hansson, et al.,

2014). In KC’s case, she has felt rejected and bullied since childhood. Her low self-esteem has

dictated much of her life choice’s and dependency on others. KC relies on her boyfriend, me, and

her parents to make decisions. She solely entered therapy to have visits with her children, not for

her wellbeing. She would benefit from more intensive therapy, empowerment interventions, and

mindfulness activities. KC spends much of her day watching television while experiencing active

delusions that cause extreme stress and anxiety.

Quadrant 4 West

The Western doorway brings forth teachings of the ancestors, the mind and respect. It

relates to respect of knowledge and knowledge of creation. It also calls for mental strength and

reason (Absolon, 2010). We can use this doorway to analyze why KC lacks knowledge and

treatment around her illness. To explain why mental health often goes untreated for African

Americans, we must look to policy. The social ascent in health, where those who are in low

socioeconomic status have worse health, provides one explanation. Health disparities arise

through disempowerment, the lack of control over one’s life. Individuals without economic,

social, or political capital are exposed to more risk factors that result in poor health outcomes.

These risk factors include lower education levels, low socioeconomic status, and food insecurity

(El Bouhaddani, et al., 2019). For example, people diagnosed with a psychotic disorder have a

decreased life expectancy of fifteen years compared to the general population (El Bouhaddani, et

al., 2019). KC, one of many, face this discrimination through disempowerment. She feels as if

her life is dictated through DCF and other governmental systems. Despite entering therapy, her

Medicaid only allows for a certain number of sessions. If she wanted to enter an inpatient

facility, her options would be limited. Many state funded facilities are understaffed and

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underfunded, creating disparities between those with and those without. This is a difficult issue

to address, as it involves much more than one social worker or one client. This involves the

effort of agencies, advocates, members in government roles, and increased funding allocations.

Center

At the center of the Medicine Wheel, we synthesize all quadrants (north, east, south, and

west) for a holistic health perspective. Each doorway applies to different aspects of the person, to

cumulate in an all-inclusive approach. By looking introspectively at the systems in place that

ensue in discrimination, it is understood that all factors are interdependent upon one another.

Recognizing the history, social and emotional effects, systemic barriers, and economic costs

permits us to view the dilemma in an interdisciplinary way. There is no single way to correct

prejudice against those minorities with mental illness, but now we can begin to decolonize our

thinking using the Medicine Wheel. Indigenous people have given us the gift of reflection devoid

of Western thinking, allowing for the process of decolonization to begin.

Process Commentary and Application

Across the process of introspection by responding to the four questions, I have reaped the

benefits of this non-Western intervention. Examining the issue of stigmatization of mental illness

has allowed me to develop my view outside of the clinical Western mindset. Never would I have

used an indigenous healing tool to analyze a concept such as this. This makes me fascinated to

research other similar non-Western interventions that address current issues. I believe that social

workers around the world can use this healing instrument to tackle any variety of matter with

colonized communities. This versatile tool can be used in a group, individual, or community

setting. In my field placement at the SOAP program in XXXX, I will ask my supervisor if we

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can use the Medicine Wheel in one of the groups. These clients face similar discriminatory bias

around substance abuse and self-stigma. I believe this tool will be quite useful to expand the

minds of the participants. One challenge I faced while meditating on these queries was the

feeling of devastation. I felt this because to initiate the decolonization process, much must be

done. Our systems are overtaxed and underfunded, even the homeless shelter I work for. We did

not have enough beds during the first COVID19 spike back in March 2020, leading to the deaths

of many clients. Even this week, we had to prioritize who is at greatest risk to receive the

COVID19 vaccination first. How can we say one client is more valuable over the other? These

are the thoughts that raced through my head during this process.

I felt that in quadrant one, KC internalizes the socio-economic costs of her untreated

illness. She struggles filling out job applications, finding secure employment, and providing a

living for herself. In quadrant two, KC is the pinnacle illustration of intergenerational trauma.

Although she understands mental health treatment is important, she feels as if it is not helpful to

her. This could come from her upbringing or unsuccessful treatment attempts within her social

circle. In quadrant three, KC suffers the direct emotional consequences of her untreated mental

illness. Daily she faces extreme distress from her delusions and chronic depressive episodes. In

quadrant four, KC luckily lives in a state that gives adequate insurance coverage for those on

disability. She can enter therapy and obtain medication with little to no copays. However, if she

wishes to enter a treatment center outside of her limited network, her insurance will not cover

such endeavors. Additionally, her insurance only covers minimal therapy sessions monthly.

Conclusion

This could come from her upbringing or unsuccessful treatment attempts within her

social circle. In quadrant three, KC suffers the direct emotional consequences of her untreated

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mental illness. Daily she faces extreme distress from her delusions and chronic depressive

episodes. In quadrant four, KC luckily lives in a state that gives adequate insurance coverage for

those on disability. She can enter therapy and obtain medication with little to no copays.

However, if she wishes to enter a treatment center outside of her limited network, her insurance

will not cover such endeavors. Additionally, her insurance only covers minimal therapy sessions

monthly.

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References

Absolon, K. (2010). Indigenous wholistic theory: A knowledge set for practice. First Peoples

Child & Family Review, 5(2), 74-87.

El Bouhaddani, S., van Domburgh, L., Schaefer, B., Doreleijers, T. A., & Veling, W. (2019).

Psychotic experiences among ethnic majority and minority adolescents and the role of

discrimination and ethnic identity. Social psychiatry and psychiatric epidemiology, 54(3),

343-353.

Hansson, L., Stjernswärd, S., & Svensson, B. (2014). Perceived and anticipated discrimination in

people with mental illness—An interview study. Nordic Journal of Psychiatry, 68(2),

100-106.

Uchenna, U. (2019) Black Past. Mental illness in the black community, 1200-2019: a short

history. Retrieved from https://www.blackpast.org/african-american-history/mental-

illness-in-black-community-1700-2019-a-short-history/

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Why is there discrimination against mental illness in ethnic minorities?

North

Physical

What are the socio-economic costs of untreated mental illness in ethnic

minorities?

East

Spiritual

What is the history behind untreated mental

health in ethnic minorities?

West

Mental

What policies are in place that create barriers for ethnic minorities to

receive mental health treatment?

South

Emotional

What is the emotional and social toll that untreated mental illness

brings to individuals?

Center