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  • ©2014 Kenneth S. Cohen

Etiology in a World of "All My Relations"

This is a selection from "Native American Healing" Chapter 108 in the medical school textbook, Wilderness Medicine ©Elsevier Publications, 7th Edition (2016) ed. by Paul S. Auerbach, MD. The complete chapter was a 54 page manuscript, 14 pages in fine print, with numerous reference and footnotes.

In an interconnected and interdependent universe, it is impossible to posit a distinct cause for any disease. An infectious agent requires a vulnerable host, and the degree of vulnerability is affected by many factors, including genetics, environment, emotions, cognitive habits, diet, exercise, timing, and previous health history. Native Americans accept this biomedical model but believe that illness and trauma may also have hidden precipitating causes. For example, was the climbing accident a result of lack of technical skill, simple carelessness, or perhaps not paying attention to warnings from the spirit world in the form of omens or dreams? Ethical and spiritual transgressions (e.g., a breach of taboo), such as disrespectful behavior in or toward nature, may also cause misfortune.

The powerful spirits of nature can be sources of curse or blessing. If one is in harmony with these spirits, even ordinarily dangerous or life-threatening events may cause little adverse effect. For example, a Cherokee medicine man deliberately entered a den of rattlesnakes and lived through 18 snakebites without medical treatment. This was a test issued by his mentor to see if the snake was indeed his helping spirit. If he lived, the answer was obvious. In another example, a young woman was stung multiple times by a box jellyfish that had wrapped around her leg. She suffered only a little discomfort, which she attributed to her connection with the local indigenous culture and the nature and ocean spirits. Conversely, I remember a striking example of how a person’s negative attitude can immediately affect health. While participating in a sweat lodge ceremony in Saskatchewan, Canada, a First Nations man vented anger about one of the other participants. Such a display is considered taboo during a sweat, where there is a strong emphasis on the power of positive words. This man was the only one to suffer burns during the sweat, a phenomenon I had never before or since witnessed. (Although, as is mentioned later, even relatively safe therapies can become dangerous in the hands of unqualified practitioners.)

Considering common aspects of North American Indian culture, there are four general categories of pathogenesis: biomedical, environmental, psychological/psychosocial, and spiritual. Diseases may be caused by any combination of these factors. Let's look at the first two: biomedical and environmental.


The biomedical category includes all of the etiologic factors recognized by modern medicine. Native American healers are part of the modern world and accept the scientific method as an important tool in the human search for truth. I have yet to meet a medicine man who would not go to a physician for diabetes management or for the treatment of a bacterial infection. Diseases may certainly result from biochemical, metabolic, and mechanical imbalances; from viruses, bacteria, and parasites; from habits of posture and breathing; and from the influences of heredity and trauma. However, from the traditional healer’s perspective, these are causal influences and co-factors rather than final explanations for disease. As one of my Native colleagues astutely commented, “Even germs have spirits.” It is admirable that Western science can measure and predict the influence of microorganisms. On a psychological level, this satisfies the human need for certainty. However, for Native American healers, life falls outside the intellectual grid imposed by Western philosophies. (Stethoscope photo from


When using the term environmental, I mean, very simply, that our connection with nature and nature’s cycles is a major influence on health and well-being. Other things being equal, people who spend more time outdoors in a natural setting are physically and psychologically healthier. Children today are missing the free-form and unstructured play that is the basis of creativity. “Where do you like to play?” a third grader from San Diego was asked. “Inside,” he replied, “because that’s where the electric outlets are.” Children who play in nature are more resilient and better at reading and problem solving. Nature has measurable effects on the human organism. The earth’s magnetic field regulates biologic rhythms and gives humans, like homing pigeons, a sense of direction and orientation. Regular exposure to natural sunlight and evening darkness promotes optimal vitamin D and melatonin levels, the latter a requirement for restorative sleep and dreams.

Clean air and pure food and water allow us to be refreshed each day. This simple formula for health is becoming increasingly difficult to follow, as the United States Environmental Protection Agency warns of more than 3.8 billion pounds of toxic chemicals being released into the environment during a typical year. In 2009, the Centers for Disease Control and Prevention’s Fourth National Report on Human Exposure to Environmental Chemicals measured 212 chemicals—including plastics, mercury, and arsenic—in blood and urine samples from 2400 U.S. citizens. Several industrial chemicals were found in nearly all participants, including polybrominated diphenyl ethers (fire retardants), bisphenol A (a component of epoxy resins), perfluorooctanoic acid (used in the manufacture of heat-resistant nonstick coatings in cookware), and the common gasoline additive methyl tert-butyl ether. Our health is also adversely affected by insecticides, herbicides, drugs, solvents, car and factory exhaust, electromagnetic fields, and ionizing radiation. There is clear evidence that toxic load is reaching a critical threshold after which further assaults result in increases in mortality and morbidity.

Wilderness, say indigenous people, is healing. The degree of healing power or influence may also vary, with some places having more or less—hence the customs of pilgrimage to and vision seeking at sacred sites. To spend more time in healing places is to enhance one’s ability to resist and recover from disease. It is also the basis for recognizing healing herbs and connecting with their spirits, a necessity in Native herbal medicine.

Note from the author: Students and colleagues have asked me if I would make this complete chapter available, thus avoiding the need to purchase the entire 2,848 page book. I wish I could. As is standard in peer review writing, authors do not receive any financial compensation or royalties and do not retain copyright (thus allowed to reprint only a small section of their own published work).

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