I asked about their experiences using foster family care for children. Apparently no special effort is made to find Indian foster parents. He reported that they have had good results with mixed parents. In the past about half the caseload had been referred to other areas of the state, particularly in the Aberdeen and Sisseton areas. Apparently more effort is now being made to keep children in their home areas and they have not found this to be a problem. They have tried to use relatives to a great extent, even some who might be classed as poor risks by some casework standards. Mr. Roselius believes they have developed more homes in the Pierre area than in some other areas, Cheyenne River for example.

As for this group's understanding of relationships between Pierre School and the Pierre community, the quick response was a questioning of whether the local citizens knew the school even existed. A more considered judgment was that the school was probably more often a topic of conversation as there was gossip to relate rather than information of a constructive nature to report. Asked what would help, Mr. Roselius replied he did not know what the problem was. One negative factor is that law enforcement officials (municipal and county) are upset by the large number of out of state children who get into difficulty while running away. Another harmful factor is that some of the children of Indian houseparents at the school are among the biggest "problems" in the community. At the same time, these same parents have been fine foster parents.

There is prejudice and denial of it from both Indian and nonIndian. The public high school does not teach a course in Indian culture. The quiet person tends to be ignored. If status is gained, for example, through athletic prowess at the public high school, acceptance is granted. Mrs. O'Connor stated she felt she was accorded acceptance in her role as a child welfare worker. At the Pierre school, the staff finds that children claim them, by name, even though they are not known to DCW. They believe the staff at the school is doing more about getting children out of the school during the summer. Even though many of these recent attempts at summer placement have been unsuccessful, they look forward to increased activity in this area. DCW is considering developing a group foster home. Mr. Roselius believes they have a good relationship with the Pierre BIA welfare branch; however, they find that situations have deteriorated more. before referrals are made, in contrast to Rosebud or non-Indian areas. As for psychiatric consultation, the Pierre DCW district office operates under the same handicaps which exist at the school.

In a discussion with John Madigan, Director of the State Commission of Mental Health and Mental Retardation, the idea of lack of a relationship was developed. Although a long-time resident of Pierre, Mr. Madigan reported he had never thought of the school in terms of attitudes local people might have toward it. He concluded that neither a positive nor negative attitude existed; rather, the relationship could best be described by the term "apathy." He recalled as a child that the swimming pool was always "dragged" the day after it had been used by the school. He wondered later about the appropriateness of Catholic Pierre Indian School children being bused to early services. His children enjoy the wrestling competition but he

questioned why the matches always seemed to be at the school rather than in town, and why the competition was limited to wrestling. (Matches are also held in town.) He thought a series of newspaper articles might be a positive step toward more active relationships between school and town, particularly if related to why the children were there. He asked in a questioning way whether the school served as an orphanage, then went on to state that orphanages had "gone by the board" in South Dakota, except for disturbed children. He hated to think they were all disturbed out there. Probably few people realized that the children were there year around. He thought the food was probably adequate but that the children probably lacked tenderloving-care.

I was referred to Reverend Edwin Bersagel, pastor of a Lutheran Church, because of his interest in the school. Reverend Bersagel stated there had only been one child with a Lutheran background and she had joined the Congregational Church to be with school friends. It became evident that he has thought about the school, however. His immediate response was similar to Mr. Madigan's. The relationship is neither positive nor negative. The school is there and taken for granted. Pierre residents do not do or think much about it. He cited the 42 students attending a local school for practical nurses as being in a comparable situation. Both groups come from the outside and should be treated as guests, made to feel at home; instead, the community is not aware of them, ignoring that there are visitors in their midst. Some of the activities that have been carried out include families taking children into their homes at Christmas, along with community support for gifts, parties, programs. These activities should be expanded to more visiting during the summer, for a week or all summer, for example, to further integration. Reverend Bersagel expressed dislike for the isolation of the students and suggested that if the school were to continue, its role might change to a boarding facility with the children attending public school in Pierre. He did not know how the community would react to the latter idea. In response to my question, he thought relationships might be improved if the community could share the facilities at the school. He thought the gymnasium might be shared. He wondered if youth groups could use the dormitories for retreats during the summer. He had discussed these proposals with the previous principal, who seemed accepting of these, but nothing had been accomplished. He noted, in closing, that Indian children often did not graduate from the Pierre public school system. He suggested inferior clothing, a feeling of "not being in it," and prejudice as possible factors for their seeming lack of success in public schools.

JOHN BJORK.

[Reprinted from the American Journal of Psychiatry, vol. 122, No. 8, February 1966] 4. SOME THOUGHTS ON THE FORMATION OF PERSONALITY DISORDER: STUDY OF AN INDIAN BOARDING SCHOOL POPULATION

(By Thaddeus P. Krush, M.D., John W. Bjork, M.S.W., Peter S. Sindell and Joanna Nelle)

Read at the 121st annual meeting of the American Psychiatric
Association, New York, N.Y., May 3-7, 1965.

Dr. Krush was Director, Mental Health Project for Indian Board-
ing Schools, and Clinical Director, Community Services Division, Ne-

braska Psychiatric Institute, Omaha, Nebr., until his death on October 19, 1965.

Mr. Bjork is Co-Director and Mr. Sindell was formerly anthropologist for the project. Requests for reprints should be addressed to Miss Nelle, who is Editorial Consultant, Mental Health Project for Indian Boarding Schools, and Coordinator, Mental Health Education, Community Services Division, Nebraska Phychiatric Institute, Omaha.

This work was supported in part by Public Health Service grant MH-00967 from the National Institute of Mental Health.

Much has been said on all sides as to culpability incurred in the actions of larger groups as they interact with smaller groups and vice versa. Mistakes are made and become historic. Witness thereof is given in the 200-year cycle of inhumane custody, humane isolation, distant treatment, dehumanizing penury, community concern, humanizationin our chosen field of psychiatry. A series of parallel problems has occurred in the same period, and this paper will attempt to explore some of their complexities.

For the moment let us imagine that several roistering, quarreling brothers traveling from the East chance upon a homestead of great plentitude, but already occupied in part by brothers about whom they were unaware. All are frightened of each other. All have a need for the land. All are disdainful of the rights of others until their own are secured. A fight ensues, but the resources and weapons are different and the strongest wins.

This brother, unlike Cain, has developed a code which stays his hand so that he does not destroy his conquered rivals. Having partially disposed of them, he assumes the prerogative of the head of the family. He makes contracts with these "younger" or subsidiary brothers which he breaks, usually describing such breaches as being in the best interest of the younger brothers. They in turn at first rebel, then grudingly accept. The strongest brother makes plans for the subsidiary brothers and then entices, cajoles, threatens and occasionally forces them to do it his way. That the plans might not be applicable to the younger brothers' way of life only fleetingly enters his mind. Only occasionally will he consult with them prior to instituting change because it causes such a fuss.

Plans are made to educate the younger brothers' children to the "better" way of older brother. But the younger brothers find that by seeming to agree, they are left to themselves with more time to do as they see fit. A contest for the minds of the children ensues in which each is accorded equal time to undo the work of the other-all the while averring that they are acting in accord with previous agreements made to last for as long "as the grass shall grow, the waters flow, and the sun shall shine."

A. "WARRIORS WITHOUT WEAPONS”

In the thirties, Gordon MacGregor and his associates (11) described the setting and conditions of the relatively isolated "warriors without weapons" of the great plains. Our study will begin to describe the composition of the off-reservation Indian boarding school population which has evolved since that time and will suggest trends of development in the mental health of the children so managed.

The background of health services for American Indians is set forth in a comprehensive report by the Public Health Service. Special atten

tion was given to the statement: "Further mental health studies, beyond the scope of this survey, are called for, not only with respect to mental illness as such, but in relation to the problems of intercultural conflict, alcoholism, child delinquency and truancy, and accidents and crimes of violence" (4).

At the request of the Aberdeen area medical officer of the Division of Indian Health, a pilot project was started at the Flandreau Indian Vocational High School in 1957. Material obtained by this small project team (1, 8, 9, 10, 22) served as the basis for a National Institute of Mental Health grant to study intensively and extensively three offreservation boarding school populations of the northern plains.

The study was designed to serve as a problem-defining effort that would stimulate a variety of alternative efforts in the management and prevention of mental illness. It is necessary to approach the problem of mental illness systematically and with operationally effective definitions. Mental illness is time- and culture-bound. For the purposes of this study mental illness may be said to exist in an individual when that individual repeatedly demonstrates by his behavioral pattern that he cannot solve his problems with his own resources.

The approach we used was to attempt to define and describe disorder from the viewpoint of different disciplines. The clinical research team consisted of a psychiatrist, social work supervisor, social worker, anthropologist, and sociologist based at Flandreau, with field social workers located at Pierre and Wahpeton. A social worker, anthropologist, and four psychologists served as consultants.

The areas of concern of the project team were as follows: The psychiatrist performed individual diagnostic interviews with selected cases. The social workers used individual and group casework techniques and visited the reservations to do selected family interviews. The anthropologist lived in the boys' dormitory for a year gathering data on student-staff interaction and, with the Kluckhohn value orientation scale, studied the student population and staff. The sociologist did classroom teaching and used social-educational devices to study the teachers and the students. The psychologists did testing in the classroom setting using a variety of devices: the Minnesota multiphasic personality inventory, California psychological inventory, QuayPeterson delinquency scale, time factor examination, student's sentence completion test, semantic-differential examination, and BowerLambert screening scale. A great deal of material has been gathered by these workers and this paper will present some of the preliminary findings.

One of the primary aims of the project team was to effect an epidemiological study of mental illness incident in a boarding school population of 1,200 and encompassing the first 12 grades. Selected for this study were two grade schools (grades 1 to 8) located in Pierre and Wahpeton, and a high school (grades 9 to 12) located in Flandreau. Both grade schools have an annual enrollment of approximately 300 each; Flandreau's annual enrollment is approximately 600. This paper will concentrate on the material gathered at the latter school.

The Flandreau school obtains its enrollment from an area generally consisting of the Billings and Aberdeen areas of the Bureau of Indian Affairs. Five States, Montana, Wyoming, North Dakota, South Da

kota, and Nebraska, 21 reservations and 18 tribes are represented in the school. Of the aggregate enrollment, approximately 33 percent are freshmen, 30 percent sophomores, 20 percent juniors, and 17 percent

seniors.

The facilities of a boarding school are usually looked upon from the standpoint of providing housing and accommodations for the student to live in a location where conventional academic or vocational schooling may be obtained. In this sense, the boarding facilities are secondary to the school or classroom services. The student lives at the boarding school rather than home due to the fact that he is unable to go to such a school in his natural home area.

However, at this school the reverse is the case. Here the boarding facilities are frequently looked upon as a means of removing a student from a socially complicated or disorganized environment to a setting where attention must be given not only to the traditional educational program but to every phase of social development as well.

What follows, then, is an attempt to narratively set forth the mental health problems encountered in a boarding school attempting to effect acculturation and ultimately assimilation of its charges. Certain impressions stand out and can to some degree be validated.

Several standardized objective psychological tests were used to assess the personality characteristics of the Flandreau students and to compare the findings with non-Indian normative groups (12, 14). The testing was done in the regular classroom period of 55 minutes.

Juniors and seniors were administered the Minnesota multiphasic personality inventory. This is mainly a pathology orientation test, with the subscales largely attempting to measure psychiatric diagnostic samples of various categories of disorder. In every case the scores earned by the Flandreau sample are higher than the scores earned by the ninth grade Minnesota (3) normative sample. While there is a difference in the elevation of the profile, the shape of the profile is highly similar. The results indicate that on all of the categories, with the exceptions of hysteria and hypomania, the Flandreau sample was higher. These students are more pathological. The MMPI also contains neurotic and psychotic triads. Here the difference for the Flandreau sample is the psychotic end of the scale. This does not mean that these persons are literally trending toward a psychotic configuration, but the movement is in the direction of disturbance in adjustment. The t test, an examination of differences of means, indicated an extremely high p value-.001 in eight of the 13 scales for the boys and seven for the girls. Two items for both sexes showed a p value of .01 and three items were not significant.

The California psychological inventory was given to sophomores, juniors and seniors. The CPI attempts to measure traits associated with normal functioning. The same results were evident, but in reverse. The Flandreau sample, in 15 out of 18 items, showed significant differences from Gough's normative high school groups (2). The t test indicated a p value of .001 in 12 of the 18 scales for both sexes. The Flandreau sample was lower on positive traits. The difference is in intensity, although again the profile was highly similar in shape to the normative groups. In effect the results appear to show that these youngsters are trending toward distress.