MARY JANE LOGAN MCCALLUM

Starvation, Experimentation, Segregation,

and Trauma: Words for Reading
Indigenous Health History

Abstract: This article discusses the most important recent contributions in the field
of Indigenous health history. This scholarship implicates health and medicine in
the complicated work of the long and continuing project of colonization and the
building of a white settler nation in Canada. Four key terms in this work will be
discussed: starvation, experimentation, segregation, and trauma. I will show how
these terms, and the historians who use them, have sharpened the broader analytics
of race and colonialism in Canada as they operate in the field of Indigenous health
history.
Keywords: historiography, Canada, colonization, Indigenous health,
Indian health policy, starvation as policy, medical experimentation, racial
segregation, trauma

Résumé : Le présent article traite des récentes contributions les plus importantes dans le
domaine de l’histoire de la santé des Autochtones. Il met sur la sellette la santé et la
médecine dans le long et tortueux projet de colonisation et d’édification d’un pays de
colonisateurs blancs au Canada. Quatre thèmes y sont abordés : la famine, l’expérimen-
tation, la ségrégation et le traumatisme. L’auteure y montre comment ces termes, et les
historiens qui les utilisent, ont affiné l’analyse plus globale de la race et du colonialisme au
Canada tels qu’ils se manifestent dans le domaine de l’histoire de la santé des Autochtones.
Mots clés : historiographie, Canada, colonisation, santé des Autochtones,
politique sur la santé des Indiens, la famine comme politique,
expérimentation médicale, ségrégation raciale, traumatisme

introduction

When asked by the Canadian Historical Review editors to reflect on

recent developments in the writing of Indigenous health history, one
story came to mind. In 2003, in a sparsely attended lecture hall of the
University of Manitoba’s Faculty of Medicine, I presented a paper on

The Canadian Historical Review 98, 1, March 2017

6 University of Toronto Press
doi: 10.3138/chr.98.1.McCallum
 Words for Reading Indigenous Health History 97

images of Indigenous people in twentieth-century Canadian medical

and public health journals for ‘‘History of Medicine Day.’’1 It is a
meaningful place to speak about Indigenous health history since that
faculty played a critical role in the development and delivery of
modern health care services to Indigenous people in Canada. Also,
Dr Percy E. Moore, who served as director of the Indian Health Services
(ihs) from 1946 to 1965 (the longest-standing director of the ihs) and
charted the course of Canadian postwar Indian health policy, graduated
from this department.2 So too did E.L. Ross, R.G. Ferguson, T.A.J.
Cunnings, D.A. Stewart, and countless other doctors, health managers,
and researchers who operated the Indian health system and produced
a considerable body of knowledge about Indigenous health.3 Home to
a storied northern medical unit that sends health professionals out to
service ‘‘northern’’ and ‘‘remote’’ communities, this Faculty of Medicine
is located at the Health Sciences Centre, the province’s largest hospital
and a hub for services to Indigenous people throughout Manitoba and
parts of Ontario and the Arctic. The faculty is on Treaty 1 territory, in
the heart of the Métis Nation, as Elders consistently remind us so that
we put human-land relations at the forefront of our thoughts and so
that we do not erase Indigenous people and history in our work.
Organized by historians and medical doctors interested in history,
those in attendance for History of Medicine Day included those there
to reflect on, and perhaps memorialize, the progress of medical science
over time and those wanting to think critically about it. The latter had
the more difficult task, especially those of us who inquired about the
ways in which health care practice, health professions, and medical
science reflected and shaped racial, gender, and class inequalities. My
1 Mary Jane McCallum, ‘‘This Last Frontier: Geography and the Indian Health
Problem in Canadian Medical and Public Health Journals’’ (paper presented at
the University of Manitoba and University of Winnipeg History of Medicine
Day, Winnipeg, Manitoba, April 2003).
2 P.G. Nixon, ‘‘Percy E. Moore,’’ Arctic Profiles 42, no. 2 (1989): 166.
3 The University of Manitoba indeed holds an important place in Indigenous
health history; however, challenging Indigenous interventions into medical
education and health and administration by Barry Lavallee, Linda Diffey, and
Marcia Decouteau Anderson aside, this is a history that has yet to be critically
analyzed. See, for example, Barry Lavallee and Linda Diffey, ‘‘Teaching Medicine
on Stolen Lands: Interrogating Settler Knowledge in Undergraduate Medical
Education’’ (paper delivered at the International Network of Indigenous Health,
Knowledge and Development and the Manitoba neahr Conference, Winnipeg,
Manitoba, 6 October 2014). See also Linda Diffey and Barry Lavallee, ‘‘Is Cultural
Safety Enough? Confronting Racism to Address Inequities in Indigenous
Health,’’ oefd News (Office of Education and Faculty Development, Rady Faculty
of Health Sciences, University of Manitoba), 2–4.
 98 The Canadian Historical Review

paper argued that in medical and public health journals, doctors,

nurses, and public health experts wrote about Indigenous people as
‘‘isolated,’’ ‘‘primitive,’’ and ‘‘susceptible’’ and used images of ‘‘vast’’
and ‘‘empty’’ Indigenous territories to inspire a vision for colonial
health services that would efficiently integrate Indigenous bodies into
the nation through various means, including relocation, surveillance,
and assimilation. The image of isolated, unhealthy Indigenous bodies
also sanctified medical professionals working in the ihs and played an
important role in shaping knowledge about Indigenous people’s
health in Canada.4 I admit now that it was not a particularly compli-
cated piece of work, and it borrowed heavily from work already done
on anti-Indigenous imagery and the role of health and health care in
colonization in Canada and elsewhere. When I finished the paper,
however, the first response from the audience was a short statement
from someone clearly troubled by the paper: ‘‘[B]ut . . . wasn’t coloniza-
tion a good thing for the Indians?’’ My recollection of what happened
next is clouded by the many pithy responses I have thought of since,
but I am fairly certain that in reality I just said ‘‘no’’ really, really slowly.
The most important recent contributions in the field of Indigenous
health history seriously challenge the idea that colonization was a
‘‘good thing,’’ a benevolent thing, or even a neutral or natural thing and
that all of our lives are unequivocally and straightforwardly improved as a
result of it. This work implicates health and medicine in the complicated
nature and work of the long and continuing project of colonization
and the building of a white settler nation in Canada. Four key terms
guide this work: starvation, experimentation, segregation, and trauma,
and I intend to show how these terms, and the historians who use
them, have sharpened the broader analytics of race and colonialism
in Canada as they operate in the field of Indigenous health history.
My reading of Indigenous health historiography is shaped by my
experiences as an Indigenous graduate student in a settler history depart-
ment, as a research affiliate of the Manitoba First Nations Centre for
Aboriginal Health Research at the University of Manitoba, and as a
professional researcher, writer, and educator of Indigenous history at
the University of Winnipeg. Simultaneously, it is also shaped by my
experiences as a subject of ‘‘Indigenous health.’’ I live in a body that
is associated with particular kinds of racialized medical ‘‘problems’’
and disciplinary requirements – which is seen as evidence of a signif-
icant rupture and decline from the past and a special site of scientific

4 Mary Jane McCallum, ‘‘This Last Frontier: ‘Isolation’ and Aboriginal Health,’’
Canadian Bulletin of Medical History 22, no. 1 (2005): 103–20.
 Words for Reading Indigenous Health History 99

and social-scientific inquiry and intervention. Moreover, I access health

care as a political-legal entity subject to particular kinds of health
service rights and coverage determined by my status under the Indian
Act.5 Very little Indigenous health research is undertaken from this
subject position. As Kim Tallbear writes, ‘‘[t]he assumptions that under-
pin such research is that white people – usually heterosexual men – do
the research. Indians and other people of color, women, the disabled,
and the ‘‘perverse’’ get gazed upon, poked, prodded, measured, bled,
and written about. Techno-scientific knowledge and indeed the knowl-
edge production of the social sciences and humanities has clearly been
shaped by the eclipsed intellectual priorities of a Western mind that
has for so long ‘‘othered’’ indigenous peoples.’’6 Indeed, Indigenous
health historical research too is still often framed to speak about
Indigenous people as ‘‘others,’’ and the most important work in the
field is probably yet to be written.
Since the early 2000s, I have carried two Indigenous health history
books with me, from Trent University, to the University of Manitoba,
and now to the University of Winnipeg, where I still require research
assistants working on Indigenous health projects to read them. Mary-
Ellen Kelm’s Colonizing Bodies uncovers, documents, and names Cana-
dian medical and non-medical colonialism and its impact on Indigenous
bodies in British Columbia, and on systems of healing, both Indigenous
and Canadian. Her work on health in Indian residential schools and
mission hospitals in British Columbia was groundbreaking, as was
her explanation of how Indigenous health has been socially, politically,
and racially constructed.7 Maureen Lux’s Medicine That Walks examines
the social history of disease and medicine among Indigenous people
on the Plains, showing that disease pathogens did not work alone;
rather, they accompanied military, cultural and economic invasions,
losses of bison, white settlement, and Indian removal to reserves.8
The book made a critical intervention into a circular socio-medical dis-
course that framed Indigenous ill health as either ‘‘biological’’ or a

5 Indian Act, RSC 1985, c. I-5.

6 Kim Tallbear, ‘‘Anthropology, Genomics, and Whiteness,’’ in dna and Indigeneity:
The Changing Role of Genetics in Indigenous Rights, Tribal Belonging, and Repatria-
tion, Symposium Proceedings, Intellectual Property Issues in Cultural Heritage
(IPinCH) Project, edited by Alexa Walker, Brian Egan, and George Nicholas,
39–44 (Burnaby: Simon Fraser University, 2016), 39.
7 Mary-Ellen Kelm, Colonizing Bodies: Aboriginal Health and Healing in British
Columbia, 1900–50 (Vancouver: ubc Press, 1998).
8 Maureen Lux, Medicine That Walks: Disease, Medicine and Canadian Plains Native
People (Toronto: University of Toronto Press, 2001).
 100 The Canadian Historical Review

natural side-effect of an evolutionary battle with ‘‘civilization’’ and

showed how professional and state responses to Indigenous ill health
continued and expanded oppressive measures. Kelm’s work on the
colonization of health and Lux’s analyses of starvation and experi-
mentation have been foundational and inspirational to new work in
the field. Four key arguments came out of this literature: first, that
Indigenous people are not ‘‘naturally unhealthy’’ or ‘‘susceptible’’ to
disease; second, that ill health is not just a matter of germs but also
colonial policies and practices of the Canadian government; third,
that Canadian medicine served colonialist agendas that included at dif-
ferent times the elimination, coercion, and assimilation of Indigenous
people; and, last, that Indigenous medicine was never fully replaced
by an allopathic bio-medical model. These arguments remain central
to the field.

starvation

Lux’s and Kelm’s books were, in fact, part of a flourishing of critical

historical scholarship in the 1990s and early 2000s that included
work by Kristin Burnett, Myra Rutherdale, Paul Hackett, Kathryn
McPherson, Patricia Jasen, Hugh Shewell, Pat Grygier, Laurie Meijer
Drees, and others.9 Their work delved into a broad range of topics,

9 James B. Waldram, D. Ann Herring, and T. Kue Young. Aboriginal Health in

Canada: Historical, Cultural, and Epidemiological Perspectives (Toronto: University
of Toronto Press, 1995); Pat Sandiford Grygier, A Long Way from Home:
Tuberculosis Epidemic among the Inuit (Montreal and Kingston: McGill-Queen’s
University Press, 1994); Patricia Jasen, ‘‘Race, Culture, and the Colonization of
Childbirth in Northern Canada,’’ Social History of Medicine 10, no. 3 (1997):
383–400; Kathryn McPherson, ‘‘Nursing and Colonization: The Work of Indian
Health Services Nurses in Manitoba, 1945–1970,’’ in Women, Health and Nation:
Canada and the United States since 1945, edited by Georgina Feldberg et al., 223–
46 (Montreal and Kingston: McGill-Queen’s University Press, 2003); Kristin
Burnett, Taking Medicine: Women’s Healing Work and Colonial Contact in Southern
Alberta, 1880–1930 (Vancouver: ubc Press, 2010); Myra Rutherdale, ‘‘Nursing
in the North and Writing for the South: The Work and Travels of Amy Wilson,’’
in Caregiving on the Periphery: Historical Perspectives on Nursing and Midwifery in
Canada, edited by Myra Rutherdale, 158–80 (Montreal and Kingston: McGill-
Queen’s University Press, 2010); Laurie Meijer Drees, ‘‘Training Aboriginal
Nurses: The Indian Health Services in Northwestern Canada, 1939–1975,’’ in
Rutherdale, Caregiving on the Periphery, 181–209; Hugh Shewell, Enough to Keep
Them Alive: Indian Welfare in Canada, 1873–1965 (Toronto: University of Toronto
Press, 2004); John Milloy, A National Crime: The Canadian Government and the
Residential School System, 1879–1986 (Winnipeg: University of Manitoba Press,
1999); Paul Hackett, A Very Remarkable Sickness: Epidemics in the Petit Nord to 1846
(Winnipeg: University of Manitoba Press, 2002).
 Words for Reading Indigenous Health History 101

including colonial health policy, Indigenous nurses and midwives,

federal health care workers, the colonization of child birth, the politics
of disease epidemics and environmental change, the effects of social
and cultural dislocation on Indigenous health, and shifts in practices
and systems of medicine. James Daschuk’s award-winning 2013 book
Clearing the Plains: Disease, Politics of Starvation, and the Loss of Aboriginal
Life draws from many of these works and significantly expands their
chronological scale. Daschuk traces the ‘‘roots of current health dis-
parities’’ between Indigenous and non-Indigenous people from the
early 1700s to the end of the nineteenth century, and he sees them
being defined by two major phases.10 First, in an early, acute period,
new diseases resulted in unprecedented mortality. A second period of
devastation followed in the nineteenth century in the context of the
numbered treaties, the loss of the bison, and, as Daschuk asserts,
measured federal relief policy to manage widespread famine, mal-
nutrition, and starvation as part of a larger effort to ‘‘clear the plains’’
for white settlement. Starvation not only led directly to death but also
contributed to high mortality rates from diseases like tuberculosis.
Clearing the Plains puts Indigenous suffering and death at the heart
of the establishment of industrial capitalism and the modern Canadian
nation-state in the northwest. There is an alarming tone in Daschuk’s
writing, which may reflect his own shock, indignation, and outrage at
his research findings, and this is conveyed to readers. The University
of Regina Press provides a study guide with questions for readers of
the book and an open-source collection of original documents consulted
in the book in the hopes that readers will investigate these sources
and perhaps also begin research projects themselves.11 In other ways,
Clearing the Plains follows established patterns in Indigenous health
historiography. For example, the real subject of the book is the making
of the Canadian West, which is (with the Canadian North) the subject
of the vast majority of Indigenous health history. This is not to suggest
that other places do not have Indigenous health history but, rather, that
often the questions we ask about Indigenous health history inevitably
draw Western expansion into a conversation that usually ends with
Indigenous death, decline, and isolation. The writing of Indigenous
health history also tends to focus on the nineteenth century – a period
in the Canadian West that includes significant shifts: the decline of

10 James Daschuk, Clearing the Plains: Disease, Politics of Starvation, and the Loss of
Aboriginal Life (Regina: University of Regina Press, 2012), ix.
11 See University of Regina Press, http://www.uofrpress.ca/content/ctp-sources
(accessed 18 November 2015).
 102 The Canadian Historical Review

buffalo herds, the signing of the treaties, and the implementation of

policies favourable to white settlement. Yet Indigenous history does not
end in this period; indeed, the book is premised on explaining current
health inequities.12 Rather, Indigenous history and federal policy are
dynamic and ongoing, and we cannot understand the present systems
and inequities in health without closely and critically examining modern
twentieth-century Canadian medical history, including the expansion
of the federal ihs.
Daschuk’s phrase ‘‘politics of starvation’’ is crucial to understanding
new work in Indigenous health research. By naming and explaining
starvation and malnutrition as policy, and, more specifically, as policy
of the Canadian Pacific Railway and Prime Minister John A. Macdonald
to withhold food with intentional consequences, Daschuk asks readers
to reject the dominant understanding that ‘‘dying off ’’ was a natural,
inevitable thing for Indigenous people to do in the last few hundred
years. Interestingly, critical histories of Indigenous starvation on the
plains by John Tobias in the 1980s and Lux in 200113 did not garnish
the attention of Clearing the Plains, perhaps suggesting we are at a
time now when a broad Canadian audience is more willing to engage
deeply and sincerely with the history of nineteenth-century Indian
policy. At the same time, there is a tendency to remain reluctant to
acknowledge genocide, and, like many others, Daschuk chooses not
to use the term in his book. Robert Alexander Innes, however, makes
the crucial links between genocide, starvation policy, data on the
numbers of deaths, and their long-term impacts today. He analyzes
how in the 1990s the Cowessess band painstakingly tracked the loss
of band members in the 1880s from starvation – up to 33 per cent of
the band’s population – using annuity pay lists in order to arrive at
a more accurate population figure needed to resolve the band’s land
entitlement. Much more research and hard data on death figures from
starvation are needed, Innes argues.14
It is helpful to read histories of starvation policies alongside the
work of scholars like Jaime Cidro, Krista Walters, Kristin Burnett,
and others who study Canadian imperialism and Indigenous resistance
through concepts such as ‘‘food sovereignty’’ and ‘‘food security.’’ Their
12 See also Maureen Lux, ‘‘Review,’’ Social History of Medicine, 27, no. 2 (2014): 416.
13 John L. Tobias, ‘‘Canada’s Subjugation of the Plains Cree, 1879–1885,’’ Canadian
Historical Review 64 (1983): 519–48; Lux, Medicine That Walks.
14 Robert Alexander Innes, ‘‘Countering Canada’s Benevolent Narrative: The
Starvation Policy and Cowessess First Nation Treaty Land Entitlement Negotia-
tions’’ (paper presented at the 2016 Canadian Indigenous/Native Studies Asso-
ciation Conference, Regina Saskatchewan, 22 June 2016). See also Robert
Alexander Innes, Elder Brother and the Law of the People (Winnipeg: University of
Manitoba Press, 2013).
 Words for Reading Indigenous Health History 103

work highlights how Indigenous food and food cultures have been
studied, regulated, and colonized and to what ends.15 Altogether, their
work sheds light on the kernels of day-to-day life as well as broad
trends in national and global forces. Moreover, it compels a reckoning
of otherwise separate analyses of gender, place, culture, race, and
economics as well as the close relationship between Indian policy and
Canadian health science research.

experimentation

‘‘Experimentation’’ is a second important word for new scholarship

in Indigenous health. For Indigenous people, ‘‘experimentation’’ can
carry particular meanings related to first-hand experiences in federal
and mainstream health care settings in which information about
procedures, length of treatment, risks, and deaths was withheld. It is
also connected to an unsettling history of irresponsible and unethical
research. ‘‘Experimentation’’ is indeed a loaded term, and, in using it
in his article ‘‘Administering Colonial Science,’’ Ian Mosby forced
readers to think differently about the history of Indigenous health
research in Canada.16 Until this point, the terms ‘‘studies’’ or ‘‘research’’
15 Krista Walters, ‘‘‘A National Priority’: Nutrition Canada’s Survey and the Disci-
plining of Aboriginal bodies, 1964–1975,’’ in Edible Histories, Cultural Politics:
Towards a Canadian Food History, edited by Franca Iacovetta, Valerie J. Korinek
and Marlene Epp, 433–52 (Toronto: University of Toronto Press, 2012); Jaime
Cidro and T. Martens, ‘‘Eating Indigenous in the City: The Limited Scope of
Food Sovereignty for Indigenous People in Urban Contexts,’’ International
Journal on Biodiversity Watch 4 (2014): 55–64; Jaime Cidro et al., ‘‘Beyond Food
Security: Understanding Access to Cultural Food for Urban Indigenous People
in Winnipeg as Indigenous Food Sovereignty,’’ Canadian Journal of Urban
Research 24, no. 1 (2015): 24–43; Kristin Burnett, Travis Hay, and Lori
Chambers, ‘‘Setting the Table: Nutritional Education Initiatives and the (Re)
Colonization of Indigenous Bodies in Northern Canada,’’ Critical Race and
Whiteness Studies 11, no. 1 (2015): 1–18; Kristin Burnett, Travis Hay, and Kelly
Skinner, ‘‘Government Policy, Food Insecurity, and Indigenous People in
Northern Canada,’’ in Aboriginal History: A Reader, edited by Kristin Burnett and
Geoff Read, 2nd edition (Don Mills, on: Oxford University Press, forthcoming
2016).
16 Ian Mosby, ‘‘Administering Colonial Science: Nutrition Research and Human
Biomedical Experimentation in Aboriginal Communities and Residential
Schools, 1942–1952,’’ Social History 91 (2013): 145–92; Kim Tallbear, ‘‘Combatting
Colonial Technoscience: Lessons from the Frontlines’’ (paper delivered at the
Cold War Indigeneity in Science and Medicine Symposium, Yale University,
3–4 September 2015); and thanks to Adele Perry, University of Manitoba for the
conversation on the phrase ‘‘experimentation.’’
 104 The Canadian Historical Review

were more commonly used when referring to the work of health scien-
tists in the field of Indigenous health. ‘‘Experimentation’’ fixes our
attention on the role and influence of health knowledge production
about Indigenous people and, especially, the unique dimensions of
knowledge production in the postwar era. It was set in coercive condi-
tions, without consultation or consent, with little benefit to Indigenous
people, and intimately tied to government policies intended to eradicate
Indigenous populations through assimilation and integration.
As a scholarly journal article on Canadian history, ‘‘Administering
Colonial Science’’ received extensive media attention and was widely
read and commented on in social media. In particular, critically locat-
ing Indigenous health research within colonial schools and reserves
in the postwar era caught readers’ attention and made clear the links
between health science and the colonial project of Indian admin-
istration. Mosby’s article reveals how Indian residential schools and
reserves were used by health scientists in the 1940s as ‘‘ready-made
‘laborator[ies]’’’ complete with ideal ‘‘experimental subjects’’ for post-
war scientific studies of malnutrition. Mosby shows that suffering and
confined Indigenous populations prompted doctors, scientists, and
policy-makers not to seek structural interventions for improvement
but, rather, to ‘‘test’’ whether malnutrition, rather than ‘‘innate racial
characteristics,’’ was the root cause of ‘‘dependency.’’ If so, the argu-
ment followed that with the right diet and modern, scientific health
care, Indians would become self-sufficient, self-supporting, and modern
(assimilated) Canadian citizens. Thus, Canada’s ‘‘Indian problem’’ could
be solved with nutrition alone.
Colonial precepts permeated postwar social science research on
Indigenous people, and the word ‘‘experiment’’ was also used in dis-
cussions of Indian labour, education, and other welfare programs and
policies. The term suggested that the state legitimately wished to
identify and analyze significant inequities without saddling it with a
commitment to change. ‘‘Experiments’’ also brought Indigenous people
and societies into the realm of the knowable, manageable, and pre-
dictable – the term framed Indigenous people as ‘‘subjects’’ of the
state. In the end, Mosby finds, like many others, that such scientific
interventions had little value to Indigenous people, Indian policy, or
the broader scientific community at large. Experimentation, however,
did further the professional interests of scientists, which, sadly, was
an all too frequent and ongoing critique made by Indigenous com-
munities regarding research on Indigenous populations. New work
shows how widespread research and experimentation on Indigenous
people was connected to the development of separate paradigms of
 Words for Reading Indigenous Health History 105

care, separate Indigenous health research models, and the uneven

development of Canadian health systems. Moreover, this work locates
experimentation as foundational to concepts of ‘‘population health’’ as
well as Indigenous methodology and research ethics.17

segregation

Segregation – and, specifically, racial segregation and the administra-

tion of, and access to, health services – has been an important theme
in recent work. Naming racial segregation in institutions presented as
‘‘universal’’ or ‘‘equal,’’ and often uncritically celebrated, has prompted
important shifts in thinking.18 Race and racism are still often over-
looked in analyses of Indigenous health, and our histories of isolation
and segregation in Canadian health care are normalized as naturally
occurring or as a matter of jurisdiction, moral obligation, welfare, or
special philanthropy.19 Some very recent Canadian studies, however,
aim to make racism in the Canadian health care system visible by
highlighting Indigenous peoples’ experiences.20 First Nations, Métis,
and Inuit were foundational to the making and meaning of race and
segregation in Canada,21 and in examining the roots and expressions
of racial segregation in health care, we can uncover key assumptions
and rationales for inequality in health care access and delivery. Think-
ing through racial segregation draws Canada’s celebrated Medicare

17 See, for example, Lisa Stevenson, Life beside Itself: Imagining Care in the Canadian
Arctic (Oakland, ca: University of California Press, 2014); Mary-Ellen Kelm and
Kim Tallbear have ongoing research in this area.
18 See, for example, Heather MacDougall, ‘‘Shifting Focus: Medicare, Canadian
Historians and New Research Directions,’’ Canadian Bulletin of Medical History
26, no. 2 (2009): 547–58.
19 For example, the Brian Sinclair inquest recently failed to consider racism as a
factor in the preventable death of Brian Sinclair after being ignored for thirty-
four hours at the emergency department of Winnipeg’s Health Sciences Centre.
Brian Sinclair Inquest, 12 December 2014, https://cdn.metricmarketing.ca/
www.manitobacourts.mb.ca/site/assets/files/1051/brian_sinclair_inquest_-_
dec_14.pdf (accessed 9 December 2015). See also Bonita Lawrence and Enakshi
Dua, ‘‘Decolonizing Antiracism,’’ Social Justice 32, no. 4 (2005): 120–43.
20 See, for example, Billie Allan and Janet Smylie, First Peoples, Second Class
Treatment: The Role of Racism in the Health and Well-Being of Indigenous Peoples
in Canada, Toronto, on: Wellesley Institute, 2015 (copies of this report can be
downloaded from www.wellesleyinstitute.com).
21 Chris Andersen, ‘‘The Colonialism of Canada’s Métis Health Population
Dynamics: Caught between Bad Data and No Data at All,’’ Journal of Population
Research 33, no. 1 (2016): 62–82.
 106 The Canadian Historical Review

system into a conversation with the federal ihs, which is otherwise

often analyzed as a distinct and exceptional service of only fringe im-
portance to the nation. Unlike in the United States, where the history
of racial segregation (in education, in health) is well known, too few
Canadians are aware of the extent of segregation in the development
and delivery of health services in their own country. The Truth and
Reconciliation Commission has done significant work in raising aware-
ness about the impacts of segregated education, however similar work
has not happened in the area of health.
Maureen Lux’s newest book illuminates Canada’s national history
of segregated health care, underscoring the role of Indian hospitals
as ‘‘bricks and mortar’’ sites of segregation, isolation, and the under-
treatment, over-treatment, and mistreatment of Indigenous people in
the ihs system.22 Drawing primarily on archival records as well as oral
histories, film, photographs, and other sources, Lux uses theories
about citizenship and liberalism to argue that the Canadian nation-
state cultivated a ‘‘core of normal, healthy white citizenship by margin-
alizing and excluding Aboriginal bodies.’’23 Practices of racial isolation
and segregation in health systems in Canada, Lux reasons, are rooted
in the Canadian government’s failure to systematically acknowledge
the rights of Indigenous people to health care in Canada. She iden-
tifies and uproots the long-held policy that only the very poorest of
Indigenous people should have access to health care. She also describes
labour within the institutions, including regular nursing shortages, an
over-reliance on aides, as well as the relatively underpaid (and thus
often pious and overly controlling) doctors. She also recounts the patient
experience of segregation in health care and provides an excellent dis-
cussion of experimentation and consent. The book’s analysis of the
staffing and funding of Indian hospitals constitutes a major contribu-
tion and helps people to understand the economics behind the over-
crowding, unacceptable practices and outdated treatments that took
place in these hospitals. Lux’s book sheds new light onto the early
history of First Nations activism around their health care and hospitals
and connects it to the subsequent resurgence of Aboriginal politics in
the 1970s. She also asks readers to reconsider the mostly uncritical
histories of Medicare in Canada, arguing that it was not a universal or
watershed moment for everyone and (shockingly) involved no consulta-
tion with Aboriginal people. Indeed, it cemented unequal, segregated

22 Maureen K. Lux, Separate Beds: A History of Indian Hospitals in Canada, 1920s–

1980s (Toronto: University of Toronto Press, 2016).
23 Ibid., 7.
 Words for Reading Indigenous Health History 107

health care in Canada by increasing funding for a public health system

that excluded many Aboriginal people.
There is a long-standing tension in Indigenous health history, and
in Aboriginal history more generally, between histories that emphasize
colonial policy and coercion and those that argue such histories singu-
larly victimize Indigenous people, represent them as ‘‘passive clients,’’
and cannot adequately incorporate Indigenous perspectives. As histo-
rian Chris Dooley points out, critical colonial histories of Indigenous
health can seem ‘‘relentlessly negative’’ – a point that historians who
do primary research in this field know all too well.24 A recent book by
Laurie Meijer Drees, Healing Histories, offers a different approach that
Drees calls ‘‘storywork.’’25 This book shares the stories of sixteen people
who experienced the ihs system as employees or as patients. Her
‘‘bottom-up’’ approach allows readers to ‘‘grapple with the stories
directly as they are passed along from teller to listener, rather than
having accounts interpreted for them through a lens of colonial or
critical theory.’’ Drees’s focus is the ‘‘human side of Aboriginal health
care based in and on the voices and stories of the people who experi-
enced ihs’’ rather than on political or administrative aspects of this
history. This approach allows for particular aspects of this history to
be uncovered – for example, the stories convey a pride in overcoming
the legacy of the health system. Moreover, they show that traditional
healing practices were not subsumed and that different understand-
ings of medicine were practised at ihs hospitals despite the powerful,
overarching system designed to thwart them. Remarkably, many of
the stories by people who felt the ‘‘actual – rather than the theoretical –
workings of the system’’ convey a sense of optimism and determination
about health care, a theme that is reflected in the author’s choice of
photographs, which are almost entirely of content Indigenous patients.
Healing Histories brings to the fore one of the more troubling
aspects of researching primary records of the federal government and
other entities that administered, organized, and managed Indian health
and health care. Even while ‘‘reading archives against the grain,’’
archival records only inspire (and answer) certain kinds of historical

24 Chris Dooley, ‘‘Review: Healing Histories: Stories from Canada’s Indian

Hospitals,’’ Oral History Forum 33 (2013): 1–4.
25 Laurie Meijer Drees, Healing Histories: Stories from Canada’s Indian Hospitals
(Edmonton: University of Alberta Press, 2013); Laurie Meijer Drees, ‘‘The
Nanaimo and Charles Camsell Indian Hospitals: First Nations’ Narratives of
Health Care, 1945–1965,’’ Social History 43, no. 85 (2010): 165–91. Lux, Separate
Beds, 113.
 108 The Canadian Historical Review

questions; they are, after all, primarily produced by and for colonial
health administration. However, by framing the ‘‘storywork’’ research
methodology as ‘‘Aboriginal,’’ Drees’s work could subtly suggest that
such archival research – and, more importantly, colonial analysis – is
not Aboriginal. While colonial analysis has many problems, it still pro-
vides fundamentally important knowledge and tools. In addition, fail-
ing to acknowledge colonialism’s pervasive nature in our history risks
appeasing those who deny the larger and more significant impacts of
legal, territorial, linguistic, cultural, and economic dispossession. In
Lux’s words, ‘‘it is important that historical interpretations that stress
the people’s agency through narratives also provide the historical con-
text of the coercive nature of ihs policies and its close collaborations
with police and courts lest they imply that resistance and resiliency
somehow mitigated the damage done to communities and individuals.’’26

trauma

Historical trauma has become a significant tool for identifying and

theorizing the impact of histories of colonization on Indigenous health.
In Indigenous health research, the concept of historical trauma is often
used in otherwise quantitative studies of contemporary drug use, sexual
abuse, family breakdown, and the mental health of Indigenous people,
while in Indigenous historical research the term is applied when
sympathizing about the past’s hypothesized impact on Indigenous
people today. Two important new works insist on critically historiciz-
ing and contextualizing the concept of historical trauma. In her book
Therapeutic Nations: Healing in an Age of Indigenous Human Rights,
American Indian studies scholar Dian Million explains that the study
of trauma and the idea of ‘‘historical trauma’’ as articulated by Indige-
nous scholars have complicated origins in trauma literature by Holocaust
scholars and survivors, in international human rights law, in develop-
ment theory and practice, and in neo-liberal governance.27 As well,

26 Lux, Separate Beds, 187. See also Lux, Medicine That Walks; Maureen K. Lux,
‘‘Care for the ‘Racially Careless’: Indian Hospitals in the Canadian West, 1920–
1950s,’’ Canadian Historical Review 91, no. 3 (2010): 407–34; Kelm, Colonizing
Bodies; John S. Milloy, A National Crime: The Canadian Government and the
Residential School System, 1879–1986 (Winnipeg: University of Manitoba Press,
1999); Mary Jane Logan McCallum, Indigenous Women, Work and History, 1940–
1980 (Winnipeg: University of Manitoba Press, 2014).
27 Dian Million, Therapeutic Nations: Healing in an Age of Indigenous Human Rights
(Tucson: University of Arizona Press, 2013).
 Words for Reading Indigenous Health History 109

important texts from the 1980s and 1990s, including Maria Yellow
Horse Brave Heart and Lemyra DeBruyn’s ‘‘The American Indian
Holocaust: Healing Historical Unresolved Grief,’’ and two subsequent
key texts, Breaking the Silence: An Interpretive Study of Residential School
Impact and Healing as Illustrated by the Stories of First Nations Individuals
and ‘‘The Effects of Residential Schools on Native Child-Rearing Prac-
tices,’’ have linked trauma theory to Indigenous historical contexts, espe-
cially Indian residential schools.28
Million’s book takes seriously what Indigenous people have said about
how the past impacts Indigenous health and examines narratives of
Indigenous historical experience and recovery constructed in the present
day.29 The theory of trauma, Million argues, invokes the ‘‘enduring
nature of Indigenous injury across many generations’’ and links the
Holocaust with genocide in the Americas, especially in and through
boarding schools, relocations, and other state practices of mistreat-
ment (remarkably, the ihs and its policies are only rarely or tangen-
tially discussed in these studies).30 Million critically connects this
history to the efforts on the part of Indigenous women to articulate
and resist sexual and domestic violence. Trauma’s antidote, ‘‘Healing,’’
Million argues, should ‘‘be acknowledged as part of a language adopted,
articulated, and practiced among people determined to act on their
historical situation.’’ Those seeking reparation for historical trauma
did so, she argues, from ‘‘their desire for restored relations in family,
in community and in nation.’’31 Importantly, Million finds that the

28 Maria Yellow Horse Brave Heart and Lemyra DeBruyn, ‘‘The American Indian
Holocaust: Healing Historical Unresolved Grief,’’ American Indian and Alaska
Native Mental Health Research Journal 8, no. 2 (1998): 60–82; Assembly of First
Nations, Breaking the Silence: An Interpretive Study of Residential School Impact
and Healing as Illustrated by the Stories of First Nations Individuals (Ottawa:
Assembly of First Nations, 1994); Rosalyn Ing, ‘‘The Effects of Residential
Schools on Native Child-Rearing Practices,’’ Canadian Journal of Native
Education 18 (1991): 65–117.
29 Million, Therapeutic Nations.
30 Janet Smylie’s study of race and racism in contemporary health care is a case
in point. The work argues for the recognition of racism in health care, as faced
by Aboriginal people. Like many other studies, there is an understanding that
history – and, in particular, the experience of colonialism – has had, and
continues to have, a negative effect on Indigenous peoples’ health. The key
histories reviewed are legal regulation, education, and child welfare policies.
Interestingly, Indigenous peoples’ histories of hospitalization and medical and
nutritional regulation at the hands of the state were not considered, and I am
not sure why this is the case.
31 Million, Therapeutic Nations, 78, 96.
 110 The Canadian Historical Review

critical connections made by Indigenous people between trauma and

efforts toward self-determination have become largely severed.
In her article ‘‘Historicizing Historical Trauma Theory,’’ anthro-
pologist Krista Maxwell unpacks historical trauma’s twentieth-century
history. More specifically, she locates historical trauma as coming
out of two significant areas of thought: first, in older discourses on
Native healing that examine Indigenous social history in the context of
community restoration and, second, in professional discourse (signifi-
cantly social work, psychiatry, and psychology) that frames Indigenous
families as irrational and focuses on individual suffering and recovery.
Maxwell argues that singular and static understandings of the past
espoused by some trauma work, especially work on inter-generational
trauma, can actually perpetuate colonial discourses that stigmatize
all Indigenous parents and families as innately pathological. Such
one-dimensional histories fail to acknowledge the continuation of
colonial structures and trauma in our institutions today and can serve
to legitimate state-sanctioned intrusions into Indigenous family life.32
The premise that Indigenous suffering is inherited biologically, cul-
turally, socially, or psychologically has significant social implications,
she argues, not least of which is that it prioritizes individual profes-
sional mediation and sidesteps efforts for large-scale decolonization.
Historical trauma frameworks encourage us to recall histories of
suffering, arguing that awareness about our history can contribute to
healing and improved health.33 Yet studies of historical trauma tend to
be vague and unspecific about the past, generalizing what are in fact
32 Krista Maxwell, ‘‘Historicizing Historical Trauma Theory: Troubling the Trans-
Generational Transmission Paradigm,’’ Transcultural Psychology 51, no. 3 (2014)
404–35; Krista Maxwell, ‘‘Making History Heal: Settler-Colonialism and Urban
Indigenous Healing in Ontario, 1970s–2010’’ (PhD dissertation, University of
Toronto, 2011).
33 Cynthia C. Wesley-Esquimaux and Magdalena Smolewski, Historic Trauma and
Aboriginal Healing, Aboriginal Healing Foundation Research Series (Ottawa:
Aboriginal Healing Foundation, 2004); Terry L. Mitchell and Dawn T. Maracle,
‘‘Healing the Generations: Post-Traumatic Stress and the Health Status of
Aboriginal Populations in Canada,’’ Journal of Aboriginal Health 2, no. 1 (2005):
14–25; Elizabeth Fast and Delphine Collin Vezina, ‘‘Historical Trauma, Race-
based Trauma and Resilience of Indigenous Peoples: A Literature Review,’’ First
Peoples Child and Family Review 5, no. 1 (2010): 126–36; Jessica Ball, ‘‘Promoting
Equity and Dignity for Aboriginal Children in Canada,’’ Institute for Research on
Public Policy Choices 14, no. 7 (2008): 4–27; Marie Yellow Horse Brave Heart,
‘‘The Return to the Sacred Path: Healing the Historical Trauma and Historical
Unresolved Grief Response among the Lakota through a Psychoeducational
Group Intervention,’’ Smith College Studies in Social Work 68, no. 3 (1998): 288–
305; Cedar Project Partnership et al., ‘‘The Cedar Project: Historical Trauma,
Sexual Abuse and HIV Risk among Young Aboriginal People Who Use Injec-
tion and Non-Injection Drugs in Two Canadian Cities,’’ Social Science and
 Words for Reading Indigenous Health History 111

diverse histories that are specific to time, place, and people, and they
fail to engage in an analysis of the dynamics of change and continuity
over time. Trauma literature also problematically assumes that our
history is already known and easily knowable when in fact it is neither;
silences within and between families and generations have prevented
us from understanding our past and present, and archival research of
reliable, topical records is often inaccessible.34 Indeed, one of the
problems with historical trauma literature, and with the theory itself,
is that historical work is simply pressed into a trauma recovery narra-
tive – as if simply learning and thinking through our histories can and
will ‘‘heal’’ us. ‘‘Trauma’’ is also often understood as a singular episode –
for instance, ‘‘residential schools,’’ which is to be resolved, as anthro-
pologist Audra Simpson argues,

through an emotional performance of singular contrition – contrition that

attempts to ameliorate all forms of violence and move indigenous polities
out of the status of polities and into the space of suffering, minoritized and
incapacitated victims of a history that once acknowledged, are somehow
healed, or repaired and in this, whose variegated and violent histories are no
longer to be dealt with.35
Medicine 66 (2008): 2185–94; E. Duran, Native American Postcolonial Psychology
(Albany: State University of New York Press, 1995); B. Elias et al., ‘‘Trauma and
Suicide Behaviour Histories among a Canadian Indigenous Population: An
Empirical Exploration of the Potential Role of Canada’s Residential School
System,’’ Social Science and Medicine 74 (2012): 1560–69; Y. Iwasaki, J. Bartlett,
and J. O’Neil, ‘‘Coping with Stress among Aboriginal Women and Men with
Diabetes in Winnipeg, Canada,’’ Social Science and Medicine 60, no. 5 (2005):
977–88; D. Chansonneuve, Reclaiming Connections: Understanding Residential
School Trauma among Aboriginal People (Ottawa: Aboriginal Healing Foundation,
2005).
34 Adele Perry, ‘‘Historiography That Breaks Your Heart: Van Kirk and the Writing
of Feminist History,’’ in Finding A Way to the Heart: Feminist Writings on
Aboriginal and Women’s History, edited by Robin Brownlie and Valerie Korinek,
81–97 (Winnipeg: University of Manitoba Press, 2012); Allison Crawford, ‘‘The
Trauma Experienced by Generations Past Having an Effect in Their Descend-
ants: Narrative and Historical Trauma among Inuit in Nunavut, Canada,’’
Transcultural Psychiatry 51, no. 3 (2014): 339–69. Studies of historical trauma
have never fully accounted for histories of hospitalization. An important excep-
tion is Georgina Martin, ‘‘Drumming My Way Home: An Intergenerational
Narrative Inquiry about Secwepemc Identities’’ (PhD dissertation, University of
British Columbia, 2014).
35 Audra Simpson, ‘‘Reconciliation and Its Discontents,’’ abstract from Savage
Sates: Settler Governance in an Age of Sorrow (forthcoming 2017). See poster for
lecture at Nottingham University, 20 November 2016, https://www.nottingham.
ac.uk/home/featureevents/2016/reconciliation-and-its-discontents.aspx
(accessed 3 January 2017). See also Audra Simpson, ‘‘Reconciliation and its
Discontents,’’ Lecture at the University of Saskatchewan, 15 March 2016,
https://www.youtube.com/watch?v=vGl9HkzQsGg (accessed 3 January 2017).
 112 The Canadian Historical Review

conclusion

Currently, when Indigenous people encounter the health system in

Canada, they are racialized in at least three ways that are sometimes,
but not always, connected. First, if they are identified as Indigenous,
they are regularly branded as ‘‘high risk’’ and subject to a set of ill-
health data and treatment responses generalized to Indigenous people
in Canada. Second, Indigenous people confront the system as bodies.
If they are racialized as ‘‘Native’’ by appearance, assumptions will be
made not only about their state of health but also about whether or
not they belong in a hospital or even, as Sherene Razack argues in
her new book Dying of Improvement, if they deserve care at all.36 Third,
Indigenous people confront health systems as socio-legal categories
subject to different services, coverage, and treatment according to
whether or not the federal government recognizes them as First
Nations or Inuit people and also often depending on where they live.
Each of these forms of racialization is packed with meanings embedded
in historical struggles for legitimacy and access to power.
Indigenous public and community health research acknowledges
colonization as a ‘‘determinant’’ of health and even that ‘‘history’’ can
cause ill health. A great deal of research points to the disparities
between the health of Indigenous people and non-Indigenous people.
Yet as the broad public response to Mosby’s article shows, many Cana-
dians remain shocked and dismayed when confronted with this past
and with analyses that highlight the central role of colonialism and
racism in Canada’s past and present. On the one hand, one can hope
that this shock will be productive and educational; on the other hand,
this ‘‘shock’’ response is irritating and retrograde. In spite of the bare
facts of Indigenous dispossession, poverty, lower standards of living,
and higher rates of morbidity and mortality – and many, many dis-
senting voices challenging racism and social inequality writ large –
recent historical scholarship on race and colonialism is met with a
response that ultimately reflects denial, disinterest, and deliberate
ignorance. Four key concepts: starvation, experimentation, segregation,
and trauma help us to understand more about the historical roots of
mainstream health care systems, research practices, and health policies.
Moreover, it will, I hope, bring Indigenous lives into Canadian histor-
ical consciousness and demand equalization of health services for all
populations across Canada and the improvement of access, treatment,
and outcomes for Indigenous people.

36 Sherene Razack, Dying From Improvement: Inquests and Inquiries into Indigenous
Deaths in Custody (Toronto: University of Toronto Press, 2015).
 Words for Reading Indigenous Health History 113

mary jane logan mccallum is an associate professor in the Department

of History at the University of Winnipeg. She studies and teaches modern
Indigenous history and Indigenous state relations in ways that reflect on
the distinct nature of colonialism in Canadian history. Her current project
examines Indigenous histories of tuberculosis in Manitoba in the years from
1930 to 1970.
mary jane logan mccallum est professeure agrégée au Département
d’histoire de l’Université de Winnipeg. Elle étudie et enseigne l’histoire
contemporaine des Autochtones ainsi que les relations entre les Autochtones
et l’État d’une manière qui met en lumière le caractère distinct du colonia-
lisme dans l’histoire du Canada. Son projet actuel porte sur l’expérience de
la tuberculose vécue par les Autochtones du Manitoba de 1930 à 1970.

I would like to acknowledge Jill McConkey, Kristin Burnett, as well as the

anonymous reviewers for providing comments on earlier drafts of this article.
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