In the last 40 years, certain English words and phrases have become more acceptable to indigenous scholars, thought leaders, and elders for describing shared Native experiences. They include genocide, cultural destruction, colonization, forced assimilation, loss of language, boarding school, termination, historical trauma and more general terms, such as racism, poverty, life expectancy, and educational barriers. There are many more.

One might expect such words to be common within the mental health system in Indian Country. Yet the major funder and provider of Native mental health, the Indian Health Service (IHS), doesn’t seem to speak this language.

For example, the agency’s behavioral health manual mentions psychiatrist and psychiatric 23 times, therapy 18 times, pharmacotherapy, medication, drugs, and prescription 16 times, and the word treatment, a whopping 89 times. But it only uses the word violence once, and you won’t find a single mention of genocide, cultural destruction, colonization, historical trauma, etc.—nor even racism, poverty, life expectancy or educational barriers.

This federal agency doesn’t acknowledge the reality of oppression within the lives of Native people. Instead, it uses another powerful word, depression. For about a decade, IHS has set as one of its goals the detection of Native depression. This has been done by seeking to widen use of the Patient Health Questionnaire-9 (PHQ-9), which asks patients to describe to what degree they feel discouraged, downhearted, tired, low appetite, unable to sleep, slow-moving, easily distracted or as though life is no longer worth living.