The legacy of historical trauma continues to plague Indigenous populations throughout the world. This theoretical dissertation describes how biology (neurodevelopment, neurobiology and endocrinology) and culture (inter-generationally learned behaviors) are intricately intertwined in the development of dysfunctional coping behaviors that contribute to stress-related chronic diseases (heart disease, obesity, type II diabetes mellitus, depression, neurodegenerative disorders and memory impairment) in some individuals. The primary impact of the many episodes of historically traumatic genocide has been post-traumatic stress disorder (PTSD) and the onset of dysregulation of the hypothalamic-pituitary-adrenal axis (HPA-axis). PTSD has had a profound impact on relationships and behaviors, while dysregulation of the HPA-axis is associated with pathophysiology. It is well documented that historical trauma has caused a cultural disconnect from traditional wellness and healing practices. Despite incredible resiliency, the result of this legacy has been a genesis of intergenerational, dysfunctional, coping strategies that have become subtly engrained in a viscous cycle of self-perpetuating, self-inflicting, dysfunctional behaviors that have been carried forward into the next generation as "toxic stress" - in the form of childhood abuse, domestic violence, interpersonal violence, and substance abuse. With time, the association to the initial traumatic assault erodes, leaving behind, collectively, a fragmented society that, in many places, has become the basis for a "cultural crisis". The approach presented in this dissertation is founded upon: 1) cultural acquisition theories that describe how existing cultural constructs and traditions are internalized by children and repeated throughout a life-time into the next generation; and 2) understanding the interaction of the autonomic nervous system (specifically, the HPA-axis and its activation by stress) and the neocortex, the basis for higher psychological processes associated with learning and cultural acquisition. This dissertation offers an explanation for the continued impact of historically traumatic events on the contemporary health and wellness of American Indian and Alaska Native people. It is hoped that this approach leads to specific intervention and prevention measures that are culturally relevant in addressing pathophysiology, cognitive-behavioral issues and the collective cultural changes that have ensued as a result of historical trauma.

abstract: American Indian literature is replete with language that refers to broken or hollow promises the US government has made to American Indians, one of the most prominent being that the US government has not kept its promises regarding health services for American Indians/Alaska Natives (AI/AN). Some commenters refer to treaties between tribes and the US government as the origin of the promise for health services to AI/AN. Others point to the trust relationship between the sovereign nations of American Indian tribes and the US government, while still others assert that the Snyder Act of 1921 or the Indian Health Care Improvement Act (IHCIA) contained the promise for health care. While the US has provided some form of health care for AI/AN since the country was in its infancy, and continues to do so through the Indian Health Service, the promise of health services for AI/AN is not explicit. Philosophers have articulated that a promise contains a moral obligation to fulfill it because of others’ expectations created by that promise. As the US government made its first promises in early treaties with AI/AN tribes and subsequently made promises in the years since, it is morally obligated to fulfill those promises, be they lying promises or not, because of resulting expectations. Yet, the US government has historically acted to restrict the rights of AI/AN—rights that include access to health services—through assimilation, separation, or termination policies. Further, the policies of the US government have kept the AI/AN populations socioeconomically impoverished, dependent on the US government for basic needs, and susceptible to health-compromising conditions. Using case studies, this dissertation looks not only at the policies and events that directly affected health services and health status, but also at how those policies and events contributed to health outcomes and the expectations of AI/AN. Given the history of the US government in fulfilling (or not fulfilling) its promises, this dissertation examines the expectations of AI/AN for their own future health outcomes under the policy of self-governance. / Dissertation/Thesis / Doctoral Dissertation Biology 2016