Quality in Interdisciplinary Critical Care Medicine

To improve the overall quality of care provided in critical care medicine, Curtis et al. (2006) promote a framework, as well as some key concepts, for measuring performance improvement outcomes within the critical care or intensive care setting. Curtis et al. introduce the reader to Donabedian’s (as cited in Curtis et al., 2006) model of improving the quality of healthcare, which focuses on “structure, process, and outcome” (p. 212). With quality improvement the focus of this article, Curtis et al. approaches the dynamics of interdisciplinary teams in the context of the multitudes of ICU variations available throughout the United States. Additionally, Curtis et al. recognize that high-quality care is dependant on both clinical and non-clinical processes, citing organizational management as a key requirement that has significant impact on overall patient care.

“Successful quality improvement programs require interdisciplinary teamwork that is incremental and continuous” (Curtis et al, 2006, p. 216).

In reading Curtis et al. (2006), I find that approaching patient care with a team approach addresses all of the available topics and more. Improving patient satisfaction requires improving performance which, in turn, creates efficiency and can improve reimbursement (especially under pay-for-performance models). On the other hand, addressing a requirement to increase reimbursement under a pay-for-performance model can ultimately lead to increases in patient satisfaction by improving inefficient processes. Overall, one of the largest benefits of operating within a team environment is the access to a larger knowledge-base, increasing the application of knowledge for all team members.


Curtis, J. R., Cook, D. J., Wall, R. J., Angus, D. C., Bion, J., Kacmarek, R., … & Puntillo, K.(2006). Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team. Critical Care Medicine, 34(1), 211-218. doi:10.1097/01.CCM.0000190617.76104.AC

Codes of Ethics

Of the three ethical codes presented by Lewis and Tamparo (2007), I align myself most with the Principles of Medical Ethics: American Medical Association (AMA). The AMA promotes honesty, integrity, compassion, respect, and most importantly, responsibility. In all manners of occupation, it is virtuous to remain honest; this is paramount in medicine. Physicians, nurses, paramedics, and other health professionals may make mistakes during their career, and it is important that these mistakes be corrected as soon as possible and understood to promote practices that may minimize the same mistake from happening. Honesty leads to integrity. Integrity is a hallmark of professionalism and, in conjunction with honesty, promotes trust. Having compassion and respect for patients regardless of political, societal, economic, or other divisions allows a provider to actually care for his or her patients rather than just deal with them. As a paramedic, I try to be as trustworthy and caring as possible to each and every patient I see. Ultimately, I understand my responsibility to my community, to fellow clinicians and technicians, to patients, and to myself. I hold ultimate responsibility for my actions and inactions, and I take care to not let these adversely effect the perception others hold of me as a professional. The AMA expects this of all physicians, and as an extension of the physicians I work for, I must strive to meet the same demands.

The Hippocratic Oath is dated in its language and demands. Though the oath can be approached as symbolism, the metaphor can be lost on some. I appreciate the Hippocratic Oath for what it is (a foundation for the ethical practice of medicine), but contemporary words, meanings, and application serve me better.

I find the Code of Ethics of the American Association of Medical Assistants lacking in context, applicability, and substance when adopted for paramedicine, my chosen occupation; therefore, I do not align as well with this code as I do with the previously mentioned codes of ethics.

Codes of ethics provide baseline philosophies that serve to direct the actions of groups. By ascribing to such, the professional belonging to such a group allows the code to guide moral judgments when the answer is unclear. In medicine, this is especially true. Medical professionals deal with life and death decisions which stretch the boundaries of personal moral beliefs. By ascribing to a notion of a slightly higher directive than one’s self, the professional can remove his- or herself from the situation with more clarity and less bias.

My personal ethics are bound by a sense of personal liberty and the responsibility of that liberty. Without responsibility, there are no consequences. Without consequence, there is no learning. I like to learn so that I may be the best paramedic that I can to the next patient in my care. For me, it is always about the next patient; they deserve the best that I can offer.


Lewis, M. A. & Tamparo, C. D. (2007). Codes of ethics. In Medical law, ethics, and bioethics for the health professional (6th ed.; pp. 241-243). Philadelphia, P.A.: F. A. Davis.

Understanding Cultural Disparities

Social programs are just that… social. In fact, the basis of any social program is to take part in society, both philanthropists and recipients. I think that we have forgotten what it means to be social. I like to think of a well-designed social program as an invitation extended to a marginalized community to partake in society as an equal member. Only when we see ourselves as equal in title and domain can we ever think to overcome racial and ethnical biases (not to mention other more generic stereotypes).

The Lakota Nation has certainly met with strife, both on and off the various reservations. I have always understood that they have unique problems stemming from our early misunderstandings and stereotypes of savage people. In fact, not all of us were victim to this view. It was the Iroquis, after all, after whom we modelled our constitutional governement, and it was a majority of the tribes of every Nation that have assisted us in battle even when feeling oppressed.

The Cheyenne River Sioux are affected by a poor economy, including poverty, elevated rates of unemployment, and a stagnant workforce. In addition, many Native Americans living on reservations are also prone to mental disorders, such as depression, substance abuse, and suicide. Native Americans certainly have it tough, and though many are able to find their way within and without the majority culture, whether through acculturation or community-wide boons such as gaming and resource development, many falter.

The fact that Native Americans are genetically prone to alcoholism, are sociologically prone to depression, and are overall prone to health disparities, suicide, and homicide reveals that there needs to be a solid and comprehensive approach to their problems. The Cheyenne River Sioux, however proud they might be of their culture, are not immune.

So, how do I help? First, examining the cultural and genetic aspects of Native Americans in the context of substance abuse allows me to educate myself on cultural specifics that may assist me in treating a Native American patient. Also, understanding their plight allows me to consider them politically, even from afar.

As much as I would like to hop on a plane (actually, I would probably drive, anyway) and assist the Cheyenne River Sioux hands-on, it is not practical. I do believe in charity, but I certainly do not have the resources to make a meaningful contribution. I will, however, remain a proponent from within the majority culture. I believe awareness of the problems that they face will be a key in allowing others to offer them the assistance to rise above their plights to seek happiness.

Precedence of Social Change in Print Media

An Analysis of the Precedence of Social Change in the Print Media

In a society as grand, as robust, and as diverse as America enjoys, it would be naïve to suggest that as a society we are perfect. Thus, change is necessary and inevitable. As a society, we not only have a right to pursue happiness, but arguably, an ethical responsibility to do so (Kymlicka, 2001; U.S. Const. amend. I). Although personal improvement is important, many times we achieve this through positive social change.

Positive social change indicates an effort by an individual or a group of individuals who attempt to influence a representative group of society to promote civic responsibility in a manner that might propagate beyond the initial effort to create a civic philosophy that improves the overall happiness of some percentage of society.

Emily Groves (2010), a writer for the Norwich Bulletin, wrote a recent article about the efforts of local community leaders, including Rep. Joe Courtney, to inspire civic responsibility and instill a greater understanding of the history surrounding the Constitution, the Bill of Rights, and the guiding principles and influences of the Founding Fathers. The program, “We the People: The Citizen and the Constitution” is a part of a national project of The Center for Civic Education.

In this front page article, Groves (2010) describes the positive impact that both Courtney and the program had on the participants. The high school students who participated were quoted to say that they have a higher appreciation of government and the role that they play as individual citizens.

Perhaps Rep. Courtney’s presence played a part in the article’s placement on the front page, but usually only the most dramatic of news stories find a home here, relegating good will stories to the back sections of the paper (Groves, 2010). The Norwich Bulletin, however, finds its readership located in what is commonly referred to the quiet corner of Connecticut. Good will articles are probably appreciated more here over the common drama of most mainstream newspapers. The Groves (2010) article shares the front page with a child welfare piece reporting an effort on improving conditions for children under the auspices of the Department of Children and Families (Rabe, 2010) and an article about a fundraiser to benefit a Catholic school that was closed (Scirbona, 2010). The Norwich Bulletin is certainly a community-centered newspaper.

If I were a regular subscriber to this newspaper, I would have read this article for a number of reasons. It is well written, well placed, and covers a subject of my interest. I am not, however, a regular subscriber to this or any other newspaper. Lately, I have found more value in searching for newsworthy topics on my own.

As I stated above, change is necessary and inevitable. Print media outlets, in my opinion, would serve their readership well by focusing on more of the positive strides that we take as a community and as a society. Just as we have a responsibility to pursue happiness along with the right to be able do so, the press has a responsibility to report truth, whether fact or opinion, along with the freedom to do so (Kymlicka, 2001; U.S. Const. amend. I).


Groves, E. (2010, September 18). Education: Courtney gives mock Congress real feel. Norwich Bulletin, 150(261), pp. A1, A7.

Kymlicka, W. (Ed.). (2001). The virtues and practices of democratic citizens. In Author, Contemporary political philosophy (2nd ed.; pp. 287-293). New York, NY: Oxford.

Rabe, J. (2010, September 18). Child welfare: Report: Abused children failed by DCF. Norwich Bulletin, 150(261), pp. A1, A7.

Scirbona, C. B. (2010, September 18). St. Mary Church fair: School closed, but Circle of Fun lives on. Norwich Bulletin, 150(261), pp. A1.

U.S. Const. amend. I.

Facing Alcoholism:

The Socioeconomic Survival of the Cheyenne River Sioux


  • Belinda Floyd
  • Monique Madison
  • Lisa Meador
  • Cheryl Nelson
  • April Oldenburg
  • Michael F. Schadone
  • Caprise Snyder
  • Melissa Torrey
  • Carlos Vargas


Alcoholism is an individual and social disease that affects people all over the world. It has varying degrees of severity based on the amount and length of consumption. There are risks associated with the use of alcohol that vary from social consequences to physical health risks (World Health Organization [WHO], 2010). Alcoholism has been linked to various acts of crime more often than illicit drugs (Lovekin, 2002). The causes of alcoholism vary, and include poverty, use as an escape mechanism, genetics, and societal pressure. Some people choose to use alcohol because of pressure from family and friends, and some just want to experiment. There are also some that just want to get away from painful emotions (Medicine.Net, Inc., 2010). Poverty is also often cited as a leading cause of alcoholism (Cedra, 2010).

Because of their ability to negatively impact those around them, those addicted to alcohol should not be ignored but rather, to be socially responsible, we must recognize the fact that their illness needs to be treated as a disease . World wide alcohol is related to the cause of 2.3 million pre-mature deaths, and is the 5th leading cause of premature disability and death. It is also the causative factor in over 4 percent of the worlds burden of disease (WHO, 2010).

Very few communities are immune to the problem of alcoholism and the Cheyenne River Sioux Tribe is no exception. Many tragedies have occurred from their alcohol addiction, including homicide, suicide, motor vehicle fatalities, and increased violence (Shepard, 2007). We will explore the causes and effects of alcoholism and its impact on the Cheyenne River Sioux Tribe. We will then make recommendations, and propose solutions to minimize the occurrence and negative effects of alcoholism in the community.

The Situation Today

The Cheyenne River Sioux Tribe is a Native American tribe located in South Dakota. They have a history thousands of years old, and great pride in the traditions of the community. They honor Mother Nature and the land that they live on, which has been a part of their culture from its beginnings. Like most Native American tribes they have had their ways of life tested by the world around them, and have uncountable injustices thrust upon them (Milbrodt, 2002; Swenson, 1994; White, 1978). The Cheyenne River Sioux Tribe has built a history and a homeland that they would like to preserve long into the future. While they fight to keep traditions alive and remain solid as a culture they also fight the modern difficulties that ensue (French & Hornbukle, 1980; Mizrach, 1999).

According to a report by the Department of Interior, Ziebach County, which is home to the Cheyenne River Indian Reservation, has a poverty rate of 54% (as cited in Ortman, 2010). The jobless rate among tribal members is 88% (Ortman, 2010). This tribe, like many others, is plagued by “alcoholism, suicide, crime and a sense of abandonment” (Ortman, 2010). This area was also hit by devastating storms during the past winter. The Chairman of the tribe, Joe Brings Plenty, questions why it must take a disaster of this magnitude to get the attention of a government that he feels has “broken its treaty obligations to care for Indians who gave up their land to make way for white settlers” (Ortman, 2010, para. 3) . It is our aim to investigate conditions and issues that surround this tribe. These very conditions and issues may well be at the root of the high rate of alcoholism among the members of this tribe. Alcoholism is a large social problem in the tribe, and finding ways to alleviate and educate members is an important need. Alcoholism is not a singular disease; it affects the culture and traditions as a whole (French & Hornbukle, 1980). It can compromise the future success of a person and the group they belong to (A.D.A.M. Inc, 2009).

It will be our goal to determine what conditions led to the alcoholism problem now experienced by the tribe, and what information, help, and programs are available, and to build upon that knowledge to provide whatever assistance we can with the disease of alcoholism in the tribe.


Poverty is both the cause and consequence of many of the problems that Native American communities face, like alcohol addiction. It is a vicious cycle which the current economic climate only makes worse. The standard response to poverty is economic development. However, poverty in Native American communities cannot be separated from its historical context. Native Americans live in places chosen for them by the American government, the result of an invasion designed to take over their lands. The Cheyenne Sioux Tribe website refers to the creation of the American West as we know it “after most Native American peoples were ‘safely confined’ on reservations” (Cheyenne River Sioux Tribe, 2009, para. 1). In time that overt hostility has turned into neglect, while poverty has become severely entrenched. Contrary to popular belief, most tribes are not wealthy from gaming.

While history may be a root cause of poverty in Native American communities, we are powerless to change history. We can only address the present and future, while acknowledging the past. Therefore, the development solutions that we recommend acknowledge the unique traditions and history of the Cheyenne River Sioux tribe. In Development as Freedom, economist Amartya Sen (2000) talks about freedom as an end and a way to create development. In this context, freedom is more than being free of negative circumstances, like freedom from oppression. Also critical to his notion of development, is the development of capabilities within individuals and communities – the freedom to do. In this case, our recommendation is based on economic development that permits the Sioux the freedom to live consistently within their beliefs and traditions.

Connection to the land is essential to Native American thought (Rodgers, n.d.). Creating economic development opportunities that are consistent with this connection allows the Sioux to live a holistic life, break out of the cycle of poverty and escape some of the pressures that lead to alcoholism. We recommend an initiative to support Sioux businesses that uphold traditional principles, such as the creation of a line of organic food products, the manufacture of biodegradable packaging or the marketing of solar energy. Also critical to the success of this effort would be encouraging education in relevant fields, and the establishment of high wage jobs that persuade young people to stay on the reservation.


When people talk about escaping from things that are going on in their lives, there’s only so far that they can get away from those things or problems. That is, people can physically remove themselves from a stressful area, like a home fraught with arguing family members, but they cannot physically remove the memories of those arguments from their mind. Many experiences make people want to escape or run away from or forget about those experiences, and there are a variety of ways that people attempt to do this. Those methods of escape can be both positive and negative; some people meditate to relieve stress, while others exercise. Unfortunately, one of the most common, yet severely negative escape routes involves the use and abuse of alcohol. Because of its effects on the person consuming the alcohol, such as lowered inhibitions and the euphoric effect which can seem to alleviate stress and worry, alcohol often succeeds in providing an escape that some people look for, but only temporarily. Afterwards, however, the stress and worry can return, propelling the user to consume more alcohol to prolong the escape, which often progresses alcohol use to alcohol abuse.

Native American communities are beset with a multitude of problems, which include poverty, racism and discrimination, high rates of unemployment, issues maintaining their ethnic identity in a country with a different dominant culture, depression, and suicide (Martins, Widoe, Porter, Chebon, & McNeil, 2006). While the aforementioned social problems do not constitute an exhaustive list of problems faced by many Native Americans, they certainly provide insight into the kinds of problems that some Native Americans may attempt to escape from when using or abusing alcohol. With poverty topping the list of social conditions that plague Native American communities, it is not surprising that between 2005 and 2008 36% of Native Americans aged 18 or older living in poverty binged on alcohol compared to the national average of 25% (Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2010). Unfortunately, the Cheyenne River Sioux Tribe is not immune to these social problems.

Attempting to reduce the high rate of alcohol abuse as a means of escape within the Cheyenne River Sioux Tribe, requires one to tackle the problems that the members of this community are seemingly attempting to escape from. Poverty, unemployment, and discrimination seem like insurmountable obstacles to overcome when trying to eradicate those social conditions that tend to lead to alcohol abuse as a means of escape or relief from stress and worry. With the current U.S. economy being unstable, poverty and unemployment have stricken several U.S. communities, not just Native Americans. With that said, solutions like creating jobs and improving the economy will take years for the positive effects to be felt. While this is a long-term goal, which will prove to eradicate poverty, alternative means of combating this problem are available, and may produce good results that are not contingent upon something that is out of the individual’s control, such as the economy. Promoting Alcoholics Anonymous programs, psychological counseling, and group therapy are some options for the Cheyenne River Sioux Tribes. The concern, however, is whether these solutions, typical of the dominant American culture, will be accepted or rejected by a community, which strives hard to maintain its separate and historical identity. Certainly, culture and tradition will have to play a role.


The disease of alcoholism can begin for many reasons (A.D.A.M. Inc., 2009). Factors range from genetics, poverty, familial and family patterns, and pressure from outside sources, such as peer pressure. In this section we will look at the link between outside pressure, and alcoholism in the Native American.

A person’s environment can have a dramatic link to the cause of alcoholism (A.D.A.M. Inc., 2009). A child may grow up with alcohol around them and see family members drinking and it may become familial (Milbrodt, 2002). A child may feel like it is a normal thing that adults do, and grow up emulating that family picture. It can make a child more prone to becoming an alcoholic later in life, because they have not been exposed to something different, and the peer pressure is harder to ignore. As a child growing up around the over- consumption of alcohol, it becomes harder to ignore peer pressure as they get older, even if it is something they have seen as a negative family pattern (Milbrodt, 2002). A article in the Journal of American Indian Education, linked peer pressure, alcoholism and family structure to illustrate the problem.

They are products of a society where alcohol abuse is not considered deviant behavior […] where poverty is the norm, where teenage pregnancy is sanctioned, where parents and relatives are often in trouble with the law, and where peer pressure takes the form of family pressures as well. (Bowker, 1992, “Results of the study” para. 5)

Although the causes of alcoholism are complex, there is a great deal of research determining how societal and peer pressure develop into such a damaging condition (A.D.A.M. Inc., 2009). Many of the factors that cause a dependence on alcohol include anger and dissatisfaction in life, unrelieved stress, and emotional difficulties, as well as social and peer pressure (A.D.A.M. Inc., 2009). Some people choose to use alcohol because of social factors such as pressure from their family, and others may feel peer pressure from their friends. Parents and family members may not realize the damage that alcohol can do, and how it can affect their family relations. Sometimes family has the power to make people feel the need for alcohol. Sometimes family members tend to criticize their own family members, which may lead the person to drinking. Sometimes consistent arguments, as well as influence from friends may lead to heavy drinking. The factors are numerous, but in the arena of stimulus from an outside source, the causes stem from pressure around the person deciding to drink.

Alcoholism is a serious problem. It is the leading cause of unintentional deaths (French & Hornbuckle, 1908). Children are affected by the alcoholic parent’s behavior. Sometimes this may lead to child abuse or child negligence (ChildAbuse.com, 2010). Family members of alcoholics often feel embarrassment, sadness and fear of their love one (Parsons, 2003). Children of alcoholic parents struggle with depression and confusion, often not knowing if their loved one is somewhere hurt (Parsons, 2003). There are times that family members become fearful of their love ones. Alcoholics may become violent to their family members. Children sometimes blame themselves for their parent’s drinking (Parsons, 2003).

Anxiety of Identity

In a historical overview of Native Americans it can be seen that loss of cultural identity, leading to low self esteem and identity anxiety, is a contributing factor in the high rates of alcoholism among this culture (French & Hornbuckle, 1980). Teresa Milbrodt (2002) writes that “Native Americans have been put at high risk for alcoholism due to a history that they cannot forget” (p. 7). She shows that the Lakota people have suffered a loss of culture through abuses of Native Americans by white settlers and governmental policies spanning hundreds of years. Current conditions are a result of past events that have created a breakdown of the traditional structure of the tribe. Changes such as federally run boarding schools that the children were required to attend, changes in the traditional gender roles, and shifts in family traditions have left the tribe culturally adrift.

Many of the students who were sent to these federal boarding schools returned to the reservations feeling ashamed of their cultural heritage. They then migrated to urban areas where they felt equally out of place. In their eyes they “had no place in any society” (Milbrodt, 2002, p. 8).

Gender roles also underwent severe changes when the Native Americans were forced onto reservations. Men were no longer able to hunt, and the government even tried to outlaw spiritual practices such as ceremonies, dances and warrior societies. Men felt unable to provide for their families. The hunt and the ceremonies also determined a man’s status within the tribe. Again, the changes in tribal structure left members feeling unsure of their place in society. Confined to the reservations, men “lost their status and cultural identity” (Milbrodt, 2002, p. 10).

Government policies also effected the family traditions. Policies were implemented to restrict travel and tribal members were unable to visit family and friends, which was an important way of keeping traditional stories and history alive, as well as reinforcing kinship identity. These family traditions provided an important support system. Tribal members note that when the family system is not strong enough, members do not get the support they need; “with the loss of family came the loss of the identity” (Milbrodt, 2002, p. 12).

History has, through the destruction of the social system, led to a lack of identity within the Lakota culture. It has been noted that “this loss of cultural identity is also one of the major contributions to the high rates of alcoholism on reservations” (Milbrodt, 2002, p. 14).

Underlying Issues

Alcoholism and related disorders are directly impacted by socioeconomic status, educational level and rates of unemployment (Shiraev & Levy, 2010). The Cheyenne River Sioux Reservation is an impoverished reservation in Zwiebach and Dewey Counties in South Dakota. The U.S. Census Bureau shows that Zwiebach’s poverty rate in 2008 was 54%, while the rate for Dewey was slightly lower at 38% (as cited in Ortman, 2010). The are many possible factors that contribute to this high rate of poverty.

The unemployment rate is extremely high at 88% (as cited in Ortman, 2010). Jobs are scarce in these counties, which are located some distance from urban areas. The infrastructure, the water and electrical systems, throughout the reservation are outdated and failing. This limits new growth, and therefore also limits new job opportunities. This infrastructure has been further impacted by the severe storms of the past winter, leaving the community even more distressed. Unlike many other reservations the reservation does not offer gambling, which provides many job opportunities for other reservations (Ortman, 2010).

According to Education Officials the extreme poverty of the reservations is impacting student success. The graduation rate among Indian students is only about 30%, as compared to the overall graduation rate throughout South Dakota of 75%. This is attributed to the poor physical condition of schools. Also of concern is the lack of qualified teachers, as well as outdated texts and limited supplies (Brokaw, 2010).

While all of these may be contributing factors in the issue of alcoholism, it is also important to look at the correlation aspect of this cycle. It is hard to determine which factor is causing which. Alcoholism is a vicious cycle that is hard to break. Does the poverty rate lead to alcoholism or does the alcohol rate contribute to the poverty level? Black Elk (2010), of the Oglala Lakota, describes the values of the Lakota nation as a circle:

You have always noticed that everything an Indian does is in a circle and that is because the Power of the World always works in circles, and everything tries to be round…The sky is round, and I have heard that the earth is round like a ball, and so are all the stars. The wind, in its greatest power, whirls. Even the seasons form a great circle in their changing, and always come back to where they were. The life of a man is a circle from childhood to childhood, and so is everything where power moves. (p. 6)

The cycle of poverty and alcoholism is one which we would like to help break.

Solution Proposal

According to Martins et al. (2006), “Native Americans have endured social, racial, and economic oppression but have persevered despite these struggles” (para. 39). Native Americans have experienced discrimination, oppression, disease, enslavement, and war, since the first European settlers arrived in North America. The negative treatment that Native Americans have been exposed to has created negative psychological effects that tend to be transmitted across generations, which creates a stronger cultural bond but promotes isolationist attitudes towards the majority culture, causing separation and marginalization. Co-opting the stresses of previous generations when they themselves are faced with oppression or marginalization, Native Americans, because of their unique cultural history, may suffer a form of intergenerational post-traumatic stress disorder. Some, however, are able to succeed in assimilation and integration, but this outcome requires effort and energy to maintain the acculturation. Native American youth who leave home to attend college tend to exhibit generalized anxiety, more so than those youths who attend college closer to home. This may be a manifestation of anxiety of identity when relating to the majority culture (Allen, 1973; Bowker, 1992; Martins et al., 2006, Milbrodt, 2002).

Native Americans are prone to certain health problems more than are other segments of the population. For example, there are high rates of type 2 diabetes, heart disease, obesity, and alcoholism among Native Americans. The rate of type 2 diabetes is four times the national average for American Indian elders, affecting one in five. Consistent with the general population, however, heart disease is the leading cause of death for Native Americans. In comparison to that of other racial and ethnic groups, the life expectancy of Native Americans is appreciably lower. According to the work of Everett Rhoades, reasons for this discrepancy may include poverty, greater risk of interpersonal violence, increased abuse of substances, vehicular accidents, and greater rates of disease (e.g. diabetes). (Martins et al., 2006, para. 19)

Native Americans share several mental health risks due to common sociocultural factors, such as poverty, poor health care access, and the isolation and lack of opportunity felt living on some of the reservations (Han et al., 1994; Martins et al., 2006, Milbrodt, 2002). The most common mental disorder among both children and adult Native Americans is depression, raising the risk of suicide tremendously, especially with concomitant substance abuse (French & Hornbuckle, 1980; Martins et al., 2006; Milbrodt, 2002; Ogden, Specter, & Hill, 1970).

Although the strong cultural and ethnic identity shared by Native Americans may contribute to stress and depression, participation in cultural and ceremonial activities may prove to be protective against the same stress and depression (Martins et al., 2006). Additionally, Martins et al. (2006) describes how the strong family emphasis that many Native Americans value may prove protective against psychological distress.

Substance abuse may also be combated with traditional cultural treatments, such as sweat lodges, the Red Road, and the Recovery Medicine Wheel (a 16-step program that utilizes a culturally important facet of circular attribution rather than linear progression; Martins et al., 2006). However, it is important to note that the problem is not entirely socioeconomic. According to growing genetic research, Native Americans are known to posses certain genetic variations that raise their risk of alcohol dependency (Edenburg et al., 2006; Ehlers, 2010; Mulligan et al., 2003; Spillane & Smith, 2007; Wall, Carr, & Ehlers, 2003; Wall, Garcia-Andrade, Thomasson, Carr & Ehlers, 1997). This fact may be detrimental to any substance abuse counseling if neither the counselor nor the patient understand the ramifications.

Economically, Vinje (1996) finds that although, focusing on governmental and private employment rates and promoting natural resource management and manufacturing typically fall short of economic goals, education is a sustainable mainstay requirement for reducing poverty levels. Gaming is certainly a viable option (Feinstein, 1994; Pommersheim, 1984), but as Vinje points out, it frequently “falls short in its objective” (p.427). Expandinging the economy should certainly remain a high priority goal as it will not only create a more comfortable life for those living on the reservation, but it will also decrease the psychological burdens to allow more happiness in their lives (Pickering, 2000; Pommersheim, 1984; Vinje, 1996).


The Sioux are a great people with a rich culture and expansive history. Unfortunately, some of the reservations, specifically the Cheyenne River Sioux reservation, find themselves battling elevated incidences of alcoholism, interpersonal violence, depression, and suicide. We feel that there is no singularity in this problem, and the focus and solution need to be comprehensive in order to be effective.

The Sioux tend to be marginalized, which is a lasting symptom of the intolerances and mistreatment that have been thrust upon them since the European settlement of North America. As the Sioux have been relegated to reservations of land that the United States government felt were of little use to the nation, it is understandable that the Sioux had a difficult time finding economic value in the land that was kept separate from the majority European culture. This, in addition to the misguided attempts at forcing the Sioux into acculturation, has continued to marginalize the Native American tribe to a point where a negative psychology is so pervading as to be transmitted from generation to generation. Depression is now prevalent throughout the Sioux tribe.

In order to provide an escape from the daily strife of a poor economy and lower sense of self, some may feel the need to turn to mind-altering substances. This reliance on drugs and alcohol may provide the psychological relief sought, but it does nothing to better the community and increases the incidences of violence, whether aimed at others or self-directed. Additionally, recent findings have suggested that Native Americans have a predisposition, genetically, to alcoholism. The addiction of alcohol in the company of mental distress usually leads to a singular conclusion: suicide.

As stated, the Sioux have a rich cultural history, and should rely on their knowledge of nature and the traditional values to create comprehensive programs which address these issues holistically (i.e. involving the whole person and their community). These programs, however, should not focus on preventing negative issues so much as they should promote a reacceptance of the traditional values, leading to a maximal appreciation of the life skills required to reinvest themselves in their community. The Sioux concept of family is one that promotes health and stability by encouraging a reliance on not only the community but themselves as well.

With more of the community involved in creating a better life on the reservation, there is a better chance of individual members creating their own personal economies, which in turn will better the economy of the reservation and other reservations surrounding them.

The answer is circular.


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Allen, J. R. (1973). The Indian adolescent: Psychosocial tasks of the plains Indians of Western Oklahoma. American Journal of Orthopsychiatry, 43(3), 368-375. doi:10.1111/j.1939-0025.1973.tb00807.x

Bowker, J. (1992). The American Indian female dropout [Electronic version]. Journal of American Indian Education. Retrieved from http://jaie.asu.edu/v31/V31S3ame.htm

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A Reevaluation of Social Responsibility

There are many facets to social responsibility, and it appears to me that many people confuse the social aspects and the responsibility aspects. Merely advocating for social programs without applying a sense of responsibility is dangerous to society however well-intentioned the program might be. After reading other’s thoughts on social responsibility, I find that my views have not changed much, if at all.

American society is guided by rights and responsibilities as enumerated in the U.S. Constitution and its Bill of Rights with the Declaration of independence setting the foundation. As we approach domestic national policies, we should always refer to these documents to guide our actions. In addition, when thinking or acting globally, we should also consider the rights and responsibilities that we enjoy as American citizens and apply them graciously to those abroad.

Domestically, race relations seems to be a continual problem (Banton, 2002). If the approach to this problem simply referred to the founding documents, we would not have furthered the social inequalities by introducing civil rights and affirmative action:

  • Age Discrimination in Employment Act of 1967;
  • Air Carriers Access Act of 1989;
  • Americans with Disabilities Act of 1990;
  • Architectural Barriers Act of 1968;
  • Civil Rights Act of 1866;
  • Civil Rights Act of 1964;
  • Civil Rights Act of 1991;
  • Equal Pay Act of 1963;
  • Exec. Order No. 11246, 1965;
  • Fair Housing Amendments Act of 1988;
  • Rehabilitation Act of 1973.

It has been argued, according to Fullinwider (1980), that adoption of affirmative action through the legislation of civil rights creates reverse discrimination, or a propensity to overcompensate discriminating against one subset of people by discriminating against another – usually the subset that was perceived to have benefit from the original discrimination. I do admit that the legislation, the public opinion and practices, and the judicial review do not aim to promote inequalities, but as a mere accident, they do. The solution should have been very simple: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness” (Declaration of Independence, 1776). By incorporating the virtues that this country was founded upon, there is only one reasonable and responsible expectation of the people within society, and that is to treat all people with respect and dignity. This is my view of how to be socially responsible. Walters (2002) echoes my position and writes:

What is personal social responsibility? Someone who is socially responsible, more often than not, recognizes that his behavior affects others, and holds himself accountable for his actions. The opposite may be someone who automatically blames an external source for his or her troubles, or whose behavior might consistently be perceived by others to be inconsiderate or rude. In a best-case scenario, a socially responsible person endeavors to have a positive effect on others, and enriches her environs. Such a person has the intention and takes action to ensure that his or her behavior makes a positive contribution, or at least is neutral and doesn’t “pollute” others or the social (or actual) atmosphere. (para. 2)

Additionally, there has been much discussion about our society’s role on the global level. What responsibilities do Americans have towards their global partners? No matter if we are discussing local issues, statewide or national issues, or international issues, my response remains the same: so long as you do not infringe on the rights of others, do as you will. This concept is what I believe to be the only logical conclusion when considering the sum of American societal values and responsibilities.

As mentioned, social responsibility can describe both active or passive roles. Civic engagement, on the other hand, is simply being socially active, though not necessarily responsible. Civic engagement, according to Michael Carpini (2010) of the Pew Charitable Trusts, is defined as “individual and collective actions designed to identify and address issues of public concern” (para. 2). These actions, typically honorable and ethical, may cause what I refer to as collateral damage. A good example of this is going green. Many of us appreciate the planet and want no harm to come to our environment, so some have advocated outlawing the use of Edison-type incandescent light bulbs, favoring compact fluorescent light bulbs (CFLs). In fact, as of 2014, all incandescent light bulbs will be outlawed in the United States (Energy Independence and Security Act of 2007). According to the EnergyStar website (“LightBulbs,” n.d.):

If every American home replaced just one light with a light that’s earned the ENERGY STAR[, or compact fluorescent light bulb], we would save enough energy to light 3 million homes for a year, save about $600 million in annual energy costs, and prevent 9 billion pounds of greenhouse gas emissions per year, equivalent to those from about 800,000 cars. (para. 1)

Sounds great, but what of the mercury? CFLs rely on a mercury vapor (in addition to argon) within the fluorescent tube, so if the bulb were to break, which they often do, mercury would leak into our environment. Mercury is not poisonous, right? Wrong! The National Institute for Occupational Safety and Health (2001) recommends an 8-hour time-weighted limit of exposure maximum of 0.025 mg/m3 (or, 25,000 ng/m3). According to a study by the Maine Department of Environmental Protection (2008):

Mercury concentration in the study room air often exceeds the Maine Ambient Air Guideline (MAAG) of 300 nanograms per cubic meter (ng/m3) for some period of time, with short excursions over 25,000 ng/m3, sometimes over 50,000 ng/m3, and possibly over 100,000 ng/m3 from the breakage of a single compact fluorescent lamp. (p. 7)

Many lighting fixtures, including chandeliers, can hold three, four, or more of these bulbs at a time, multiplying the mercury vapor concentration for each bulb broken. This legislation creates a hazardous situation that needlessly endangers lives and restricts our freedom to choose.

In conclusion, we as a society must understand that there are consequences to our actions, and we must take responsibility for our actions. We can certainly have disdain for the status quo as well as envision a Utopian civilization where there is no bad and only good. Unfortunately, we are bound by our physicality and our geography. So long as we must obey the laws of physics, we must understand that for every action there is an equal and opposite reaction. What, then, are the consequences of civic engagement? Honestly, there may be no negative consequence of activism so long as the activist remains socially responsible. The socially responsible person will ensure that the positive of action will outweigh the negative of inaction so long as the negative of action does not contribute to the negative of inaction. More simply stated, if it will hurt society more to change, then change is not the answer.


Age Discrimination in Employment Act of 1967, 42 U.S.C. § 1983 (West 1968)

Air Carriers Access Act of 1989, 49 U.S.C. § 1374 (c) (West 1986).

Americans with Disabilities Act of 1990, 42 U.S.C.A. § 12101 et seq. (West 1993).

Architectural Barriers Act of 1968, 42 U.S.C. §§ 4151 et seq. (West 1968).

Banton, M. (2002). Race relations. In D. T. Goldberg & J. Solomos (Eds.), A companion to racial and ethnic studies (pp. 90-96). Malden, MA: Blackwell.

Carpini, M. D. (2010). Civic engagement. Retrieved from http://www.apa.org/education/ undergrad/civic-engagement.aspx

Civil Rights Act of 1866, 42 U.S.C. § 1982 (a) (West 1998).

Civil Rights Act of 1964, 42 U.S.C. § 2000 (a) et seq. (West 1998).

Civil Rights Act of 1991, 42 U.S.C. § 1981(a) (b) (3) (West Supp. 1992).

Declaration of Independence. (1776).

National Institute for Occupational Safety and Health. (2001). Documentation of the threshold limit values and biological exposure indices (7th ed.). Cincinnati, OH: Author.

Energy Independence and Security Act of 2007, P.L. 110–140 § 321 (2007, December 19).

Equal Pay Act of 1963, 29 U.S.C. § 206 (West 2000).

Exec. Order No. 11246, 3 C.F.R. 339 (1964-1965), reprinted in 42 U.S.C.A. § 2000e app. at 28-31 (1982).

Fair Housing Amendments Act of 1988, 42 U.S.C. §§ 3601-3619 (West Supp. 1989).

Fullinwider, R. K. (1980). The reverse discrimination controversy. A moral and legal analysis. Retrieved from http://eric.ed.gov/ERICWebPortal/contentdelivery/servlet/ERICServlet?accno=ED292213

Light bulbs (CFLs) for Consumers. (n.d.). Retrieved from the EnergyStar website: http://www.energystar.gov/index.cfm?fuseaction=find_a_product.showProductGroup& pgw_code=LB

Rehabilitation Act of 1973, 29 U.S.C. § 794 (West 1998).

Walters, J. (2002, August). Taking social responsibility personally – Be the change you wish to see in the world. Retrieved from http://www.learningplaceonline.com/workplace/ethics/ personally.htm

Drawn into Politics

When I reflect on my realization that I had to be more politically and economically fluent, I recall a number of campaigns designed to urge the younger generation of voters to the polls. The most prolific one was Rock The Vote! (RTV!). In the midst of the current debates, I draw a correlation to how the younger voters were urged to the polls and how today’s Tea Party movement is drawing political commentary from the older and younger generations, alike.

RTV!, created at the Ministry of Sound nightclub in London in early 1996, has advocated comprehensive voter registration focusing on the younger demographics (Cloonan & Street, 1998; Hoover & Orr, 2007). The result, in some minds, is a prevalence of uneducated and uninvolved voters; however, according to Hoover and Orr (2007), the Rock the Vote campaign did little to increase the voter turnout within the 18 to 24 year-old demographic. Though I did vote following the RTV! campaign, I cannot say that the campaign had any effect on my likelihood to visit the polls. Instead, RTV! appeared to revive party politics by appealing to popularity-driven politicians in an environment of “the affection and admiration which audiences give to their idols” (Cloonan & Street, 1998, p. 36). RTV! may have reached its goal of 20 million votes from the younger demographic, but it was still only 10% of all voters as every demographic turned out in higher numbers for both the 2000 and 2004 elections (Hoover & Orr, 2007).

Though a bunch of individuals with their own ideologies, the Tea Party formed through a grass-roots movement to promote very simple founding principles of the American experiment: Constitutionally limited goverment, fiscal responsibility, individual liberty, and free markets (Tea Party Patriots, 2010). Discussing the impetus of the Tea Party, Marcuse (2010) counters that “if the displacement could be countered and redirected towards its actual causes, it might strengthen rather than conflict with progressive resistance” (para. 1). He seems to miss the mark.

In both instances, groups of individuals band together to promote a goal. For RTV! it is to maximize youthful voting. For the Tea Party, it is to underscore the purpose of our government. These are just two fine examples of individuals gathering together to have their voices heard in a way that might not be possible without the others. Whether you wish to change society or maintain its importance, groups are typically heard faster and louder than individuals, but integrity and honesty both demand that you act in accordance with your ideals, first, before rabble-rousing a group into action.


Cloonan, M. & Street, J. (1998). Rock The Vote: Popular culture and politics. Politics, 18(1), 33-38. doi:10.1111/1467-9256.00058.

Hoover, M. & Orr, S. (2007). Youth political engagement: why rock the vote hits the wrong note [Excerpt]. In D. M. Shea & J. C. Green (Eds.), Fountain of youth: strategies and tactics for mobilizing America’s young voters (pp. 141-162). Lanham, MD: Rowman & Littlefield. Retrieved from http://books.google.com

Marcuse, P. (2010). The need for critical theory in everyday life: Why the tea parties have popular support [Abstract]. City, 14(4), 355-369. doi:10.1080/13604813.2010.496229

Tea Party Patriots. (2010). Mission Statement. Retrieved from http://www.teapartypatriots.org/mission.aspx