Navajo Ceremony Project

Measuring Emotional Distress and Inflammation before and after a Diné Ceremony

The Diné (Navajo) are an American Indian tribe in Arizona with a population of approximately 250,000. The Navajo Nation is comprised of 110 chapters on the reservation spanning 27,000 square miles. The Diné have a rich history in healing through ceremony and this project is designed to capture clinical indicators which demonstrate the healing impact of a specific ceremonial practices.

Diné Purification Ceremony
The focus of the study was a Purification Ceremony or Chantway that is used by the Diné people to purify people of evil or ugly/unharmonious things. Michelle Kahn-John PhD (DIné) was awarded a grant by the University of Arizona to conduct a pilot study exploring the clinical effects of the purification ceremony on patients with a depression diagnosis. With help from the CSEE she was able to complete 25 ceremonial interventions as of May 4th, 2017. She is currently in the process of analyzing data and aims to have results in late summer 2017.

Method
Program participants were selected based on their clinical diagnosis (specifically symptoms of depression and corresponding/measurable inflammation) and their Diné origin. They are interviewed and provide saliva samples before and after their participation in the ceremony. This pretest-posttest single group design will be used to evaluate an intervention effect. Each participant will serve as their own control. The pretest-posttest will be performed to assess changes in PROMIS ED-D-SF8b scores and concentrations of salivary C-Reactive Protein (CRP) over time, at baseline and 30 days post the Diné ceremony. CRP levels fluctuate over time. Serial collection of CRP, with collection times a few weeks apart, is recommended when monitoring CRP as a marker of inflammation (Deodhar, 1989; van Leeuwen & van Rijswijk, 1994).

Initial Report

“You have no idea how grateful these individuals are for receiving a ceremony that they would not have received without the financial support and guidance provided by this project. I don’t know how I can convey their gratitude. The issues they had been dealing with included grief, relationship stressors, physical and psychological illness, loneliness, physical pain, sleep problems, lack of motivation, hopelessness, psychological trauma. A few of these individuals were in such despair during their initial interview and it’s amazing to see the hope that was restored through the ceremonial process. Again, it’s an honor to do this work and though difficult at times, it’s all been worth it to see the progress and hear the responses from the participants”

- Michelle Kahn-John, PhD, APRN, PMHNP-BC, GNP, University of Arizona

From participants:

“I wouldn’t have known how to access the help of a medicine person but, I’ve been told that I need this ceremony, Thank You”.

“I really need this and I know it’ll help me”.

“I was told to have this ceremony years ago but never could find the support to get it done and didn’t know who to ask, didn’t have a vehicle to go out to find a medicine person”.

From Michelle:

“ I had a goal to offer 24 ceremonies and we offered 25!! We have stopped recruiting and are now turning away people that are calling us and asking us if we can provide the ceremonial intervention for them. The opportunity to do this work has been quite rewarding. I’ve gained new insights into aspects of indigenous healing that I wasn’t fully aware of. A few highlights include:

• Navajo adults do want to receive Navajo healing ceremonies and they were eager to participate and so very grateful for the ceremony. (we’re still getting calls now for people that want to be part of the project and want to receive a ceremony).
• The preliminary survey results are showing some promise and reflect a decrease in emotional distress (30 days post the ceremonial intervention)---needs further analysis to determine actual significance before we can draw any conclusions.
• The following challenges to receiving Dine’ ceremonies were cited. Participants stated they “didn’t know how to access services offered by a medicine man/woman—they didn’t know what questions to ask to access ceremonial interventions” , “the ceremonies are too expensive”, “I didn’t know that a ceremony could help me with my depression”, “I couldn’t afford to have a ceremony” and “I didn’t have any family support to have the ceremony”.
• The inflammatory marker analysis (CRP levels) are pending so, we do not have that data yet.
• I learned that the work of indigenous healers is extensive and complex. The healers have to be physically fit to gather herbs, they have to have phenomenal spiritual strength, they must be compassionate, they also offer authentic/heartfelt prayer and song, they must be wise counselors, they must be able to offer meaningful answers and encouragement when patients have questions, they offer words/prayers/songs of hope and healing (powerful) and they dedicate so much of their personal presence, time and energy to the work of healing. It was quite beautiful to see and watch a healer in action…I now have a greater understanding of the role and responsibilities of a traditional healer.
• We offered a lot of teaching to the participants and their families on the etiquette and traditional protocols of seeking ceremony, ensuring they come with an offering for the medicine man, honoring the 4 days of reverence required after ceremony. We discovered that many of the participants had never received this cultural/ceremonial knowledge or had forgotten these traditional protocols. They were grateful to learn how to access traditional healing.

Michelle's hope is to, in the near future, submit grant proposals for similar studies and had thoughts about setting up an apprenticeship option for Dine’ healers. "In offering 25 ceremonies over a 4 month period, we learned it’s a perfect opportunity for apprentices to learn about traditional ceremonial healing. I certainly learned so much about this particular ceremony and about the many steps involved in the delivery of this ceremony/ritual. The medicine man I worked with suggested the idea to include in the next project, a plan to train interested apprentices. A few ceremonial interventions I’m considering include: Taacheeh (sweatlodge), Dziilth Nataoh (Mountain Tobacco Offering-Ceremony). I am also still pursuing the development of a Resilience Measure for American Indians to assess culturally based strengths and protective factors."

End Results: Studies showed that even up to 30 days after the ceremony, participants showed a modest reduction in inflammatory stress and reported improvements in sleep, appetite, energy, motivation, family connectedness, brighter outlook, increased hope, less pain, fewer nightmares, decrease in body cramps and increased ability to perform activities of daily life.

Traditional Diné ceremonies are health restoration systems that have been in place for generations. The ability to demonstrate effectiveness of ceremony within a scientific, ‘evidence-based’ approach encourages the acceptance of traditional indigenous wellness interventions to be considered acceptable and reimbursable healthcare practices by healthcare insurance companies.

Your contribution helped CSEE with the beginning studies of this project by funding 25 participants.

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