Delocalized knowledges: Conceptualizing problem gambling in a Native American reservation community

Daniela Anezka Penickova
Dept. of Anthropology, University of Oregon
July, 2005


Recent studies suggest a significantly higher prevalence of psychiatrically defined problem gambling in Native American reservation communities compared to the U.S. mainstream population. Behavioral health care services for Native Americans are predominantly based on Western models of psychotherapy, which define problem gambling as an impulse-control mental disorder. A review of the histories of concepts of gambling in both Euro-American and Western Apache cultures reveals crucial distinctions which suggest that Western models may not be culturally relevant for either epidemiological or therapeutic efforts in Native American contexts. Drawing from both meaning-centered and critical approaches in medical anthropology, this study questioned whether Western conceptualizations of problem gambling provided an adequate basis for understanding similar behaviors in one of the Western Apache communities. Eliciting explanatory models through in-depth interviews, free listing procedures, and questionnaires, I found that, despite similarities in symptom recognition, there are fundamental differences in the underlying frames for interpreting excessive gambling across practitioners and community members. Although recognizing the limitations of individual therapy, the local practitioners have embraced the Western classification of problem gambling as a discrete and universally diagnosable malady, treatable by cognitive-behavioral therapy. The tribal members seem to be divided into four groups in relation to defining problem gambling. While one group, mainly consisting of members that obtained college education, follows the Western model arguing that individual
intervention is of a great importance, the remaining three groups (some of the elderly, who do not think of it as a problem or disease; those who understand it as an addiction but not a disease; and those who believe the sufferers choose/help such a disease 'to happen to them') place such a behavior and its treatment in the historical context of colonization and community dysfunction, while also emphasizing personal responsibility and the ability to make choices in one's behavior. By identifying hidden sources of ethnocentrism and hegemony in the delivery of health care in Native American communities, this work suggests the need to find ways to allow alternative understandings of addictions into clinical contexts that continue to be dominated by the individualizing and decontextualizing concepts of pathology.