A woman and two children dressed in traditional First Nations clothing stand in front of a teepee structure

A mother and her two daughters dressed in traditional clothing during the Cree Gathering near Kuujjuarapik, Nunavik, Quebec. Photo by Iva Zimova/Panos


Language is medicine

For First Nations people, health is not a matter of mechanical fitness of the body, but of language, identity and belonging

by Erica X Eisen + BIO

A mother and her two daughters dressed in traditional clothing during the Cree Gathering near Kuujjuarapik, Nunavik, Quebec. Photo by Iva Zimova/Panos

Roughly 250 kilometres northeast of Alice Springs in Australia’s Northern Territory is a place called Utopia. Composed of a loose collection of sparsely populated clan sites in the inland desert, the area is the traditional homeland of the Alyawarr and Anmatyerr peoples, roughly 500 of whom still live in Utopia today. The area wasn’t settled by white colonisers until the 1920s, when a group of German pastoralists – ‘demented by the ferocity of the heat and dust’, as the veteran Australian journalist John Pilger put it in an interview for the online magazine Truthout – arrived at a place where the rabbits were so unafraid of humans that they could be caught by hand.

Beyond the women’s batik club, founded in Utopia in the 1970s, and responsible for producing some of the most prominent 20th-century artists in Australia, including Emily Kame Kngwarreye, who represented the country at the 1997 Venice Biennale, there is an important sense in which the territory seems to be living up to its idealistic name: a small body of relatively new scholarship has identified Utopia – where 88 per cent of the population speaks Alyawarr, and just 3.5 per cent report speaking exclusively English at home – as the site of an intriguing phenomenon, the link between the wellbeing of a language and the wellbeing of its speakers.

‘Language is medicine,’ state the authors who explore precisely this nexus in The Oxford Handbook of Endangered Languages (2018). Collectively, these authors are involved in documenting, teaching, researching and maintaining a diverse array of languages across what is now North America. Their striking observation, informed in many cases by scholarship in the authors’ own communities, crystallises the central claim of a small but growing body of research that insists that the declining health of a community’s language does not merely occur alongside sickness in a community but is itself the root of this sickness. If true, the opposite holds as well: namely, that strengthening the use of Indigenous languages offers a path towards physical and emotional healing for their speakers. As the language advocate X̱ʼunei Lance Twitchell put it in the opening to his Tlingit learners’ guide: ‘The Tlingit language is medicinal in its importance to Tlingit people.’ The title of his textbook puts matters more plainly: Haa Wsineix̱ Haa Yoo X̱ʼatángi – Our Language Saved Us (2016).

At a time when minority languages around the world face continuing pressures from dominant cultures to assimilate – something we witnessed clearly during the COVID-19 pandemics, when vital medical information was literally unavailable across the United States’ big cities in numerous languages spoken by minority groups – what can these perspectives tell us about how we define wellness? What might they add to our understanding of where the tongue ends and the body (corporeal and politic) begins?

Given that European settlers reached Utopia only last century, it was never the site of a religious mission, which would have converted Indigenous people to Christianity and then trained them to be manual labourers for white settlers. Nor did Utopia become a government-run reserve – its land designated for Aboriginal inhabitation, but where white managers often exerted extreme control. As a result, the experience of Utopia’s Alyawarr and Anmatyerr communities differs from that of other Native peoples across Australia, for whom the arrival of James Cook marked centuries of violence and dispossession. In a colonial coup de grâce, from 1905 until the 1970s, the Australian government pursued a policy of forcible child removal, with the goal of indoctrinating Indigenous children in white culture, severing their ties with their families, their traditions and their languages.

This long history of trauma, internalised, embodied and generational, helps explain why to this day Aboriginal and Torres Strait Islander people across Australia bear a disproportionate burden of disease compared with their non-Indigenous counterparts – a disparity that is compounded by structural racism in hospitals and other settings. The latest data, compiled by the Australian Bureau of Statistics between 2015 and 2017, shows a roughly eight-year life-expectancy gap between Indigenous and non-Indigenous Australians (a gap the government has pledged to close by 2030, although the Australian Human Rights Commission predicts that, if current patterns hold, this goal will not be met). The data further reveals that Indigenous Australians are at greater risk of suffering from health problems across the board – particularly cardiovascular disease, which accounts for almost a quarter of all Indigenous deaths in the country.

But in 2008 a decade-long study of health in Utopia turned up some intriguing results among the cohort of 296 local participants: there were significantly lower rates of hospitalisation and mortality from cardiovascular disease compared with other Aboriginal communities in the state, even when controlling for factors such as education, income and access to housing. To be sure, the authors acknowledge that part of the explanation might be the healthier lifestyle of rural outstations: more exercise, better diet, little access to alcohol (from 2007 to 2022, alcohol was banned in all Indigenous homelands in the Northern Territory). And yet, the Utopia study ran counter to conventional public health wisdom relating to Aboriginal and Torres Strait Islander people, which suggests that those living in remote areas are more likely to bear the brunt of health disparities. What’s more, Utopia today possesses high levels of unemployment and poverty – the kinds of markers, one might assume, that would be associated with worse health outcomes, not better ones.

Linguistic marginalisation is not merely a barrier to accessing care but a risk factor for disease in and of itself

The Utopia study’s authors conclude that the particular social environment fostered by Utopia and its historically high degree of autonomy – which has allowed for the kind of ‘connectedness to culture, family and land, and opportunities for self-determination’ (exemplified by the rich artwork of Kngwarreye, Minnie Pwerle and other Utopian painters whose work is world renowned) likely played a key role in the health findings. After white pastoralists laid claim to the area, they hired Indigenous people to tend to their animals, a form of employment that allowed workers to stay ‘on country’ and among their people. As such, the Indigenous residents of Utopia were able to maintain place-based traditions like foraging for local foods, gathering medicine, and visiting and caring for sacred places, until their legal campaigning to regain title to the land was successful in 1980.

Utopians were also more easily able to maintain the use of Indigenous languages, and it is the vitality of the region’s native tongues – which is particularly striking, given that colonialism has severely threatened if not extirpated so many other Aboriginal languages across the country – that has caught the eye of some academics and government officials as a protective factor worthy of exploring. The Australian Institute of Aboriginal and Torres Strait Islander Studies cited the Utopia study’s results in a 2014 report that recommended the government ‘include allocation of funding to language activities as part of health and justice programmes’ (emphasis mine). The Institute further encouraged regional health departments themselves to either fund or directly implement language-revitalisation measures. The implication here is pointed, in suggesting that linguistic marginalisation serves not merely as a barrier to accessing care (as, for instance, when public health messaging is available only in a dominant language), but that it is a risk factor for disease in and of itself – one that could be resolved by promoting (re)connection with or continued use of a heritage language.

Policy proposals aside, the Utopia study has become an important point of reference for wider research into the connections between revitalising minority languages and improving the health and wellbeing of their speakers. A 2014 study of First Nation communities in Alberta, Canada – where the burden of diabetes among Indigenous adults was more than double that of the general population at the time of publication – identified a correlation between high rates of Indigenous language knowledge and lower rates of diabetes within communities, even when taking socioeconomic differences into account.

Other researchers have examined the relationship between the state of a community’s language and its residents’ mental health, from self-esteem to an individual’s sense of belonging to depression. A 2007 study of First Nation communities in what is now British Columbia – which has one of Canada’s highest concentrations of Aboriginal languages at risk of disappearing – found that the erosion of traditional language knowledge was a strong predictor of elevated youth suicide rates, and to a greater degree than other cultural factors: First Nation communities where only a minority of members possessed conversational knowledge of an Indigenous language reported almost six times the number of youth suicides, compared with those communities where a majority of members were speakers.

Among those who have borne the brunt of attempts to suppress their native tongues, individuals will sometimes speak of lasting negative bodily reactions produced by the trauma of language deprivation. At residential schools – state-funded institutions of enforced assimilation that operated across North America – violence was routinely meted out by teachers against students caught speaking Indigenous languages, often leaving lifelong psychic scars. One residential-school survivor, Annie Johnston, one of the co-authors of the Oxford chapter mentioned above, describes the visceral physical sensations that speaking her ancestral tongue Tlingit – a language native to coastal areas of the Pacific Northwest – still provokes in her as a result of internalising these punishments: ‘You get the lump in your throat. Your stomach starts churning.’ Language oppression and revitalisation, in other words, are not abstractions. They are tied directly to the health experienced, subjectively and bodily, by speakers of oppressed languages.

In common parlance, the terms ‘endangered’ and ‘extinct’ are frequently used to talk about languages where the number of living fluent speakers is approaching, or has reached, zero. Cribbed from ecology, this framing inadvertently casts such disappearances as natural, even inevitable – the product of unfortunate but ultimately impersonal forces acting upon the world. A 2020 study of public attitudes in Australia towards Aboriginal and Torres Strait Islander language-revitalisation programmes found that more than 40 per cent of those canvassed viewed such work negatively, believing it to represent a vain attempt to prop up so-called ‘doomed’ languages, instead of focusing on the supposedly more practical matter of English education. Like Hittite or Latin, the thinking goes, some languages are merely fated to pass out of existence, and to resist such change is not only to deny modernity: it is to actively impede the forward march of history.

But comparisons with long-dead ancient tongues or classical languages that have a written rather than spoken afterlife (Latin, for instance, persists in liturgical contexts and, indirectly, in the form of its many Romance offspring) obscure the real and ongoing colonial violence behind the precipitous decline of so many Indigenous languages in the centuries since Christopher Columbus. These languages are not suns that set nor moons that wane. They are not things that simply enter and exit the world, absent of outside influence. Rather, they are actively minoritised, marginalised and pushed out to the fringes. They are banished from classrooms and radio broadcasts and government announcements, muscled out of the market, out of the public eye and ear, and forced to retreat into little corners of life where the authorities cannot go: into kitchen conversations and dreams. Or perhaps not even there.

Re-immersion in traditional language and lifeways is a kind of homecoming

The decision to adopt one tongue and stop using another is not neutral; it is tied, inevitably, to power and prestige. This is precisely why linguists and activists alike now reject the framing of ‘endangered’ and ‘extinct’ languages in favour of ‘oppressed languages’. This term sets the role that forces like colonialism play in coercing shifts in language use front and centre, and helps us see that the struggle against them is at bottom a political struggle. Language revitalisation is thus one part of a broader struggle for linguistic justice, which embraces the ability to thrive in one’s language of choosing, equitable access to information regardless of one’s native tongue, the redistribution of resources, and the fostering of esteem for all languages. Put another way, language is an easily legible banner of a people’s autonomy: the right to speak in the words you choose, with (and without) whom you choose, and to foster bonds of kinship and understanding not only with those around you, but with all past speakers of the same tongue, and those yet to be born. It can be said that the health of languages is deeply tied to the speakers’ feelings of rootedness (of being in, and in possession of, one’s homeland) and that languages themselves can become a kind of home, even in conditions of displacement; a safe refuge and site of belonging, where one can get to know and become one’s fullest self.

The Nêhiyawi (Cree) Nation has a long history of forced displacement, from the horrors of the residential schools to the Canadian state’s deliberate redirection of floodwaters towards Native land in 2011 to avert damage to valuable white-owned property. Yet the province of Alberta, where ongoing wildfires have forced more than 1,000 First Nations people to evacuate, is also the site of a community-driven initiative to support Nêhiyawi maternal and neonatal health. The programme recruited Elders to act as mentors for expectant parents, sharing their experiences, providing a listening ear, and encouraging cultural practices, including using the Nêhiyawi language. ‘The girl that is the mother today is … very removed psychologically, emotionally, mentally, physically – in all aspects of her being, from her culture, her values, and her belief system,’ one Elder in the programme explained. Her evocation of distance captures at once the literal forced relocation to which the Nêhiyawi have been repeatedly subjected, but also the idea that re-immersion in traditional language and lifeways is a kind of homecoming.

Indeed, the connection between language, land and the body finds resonance in the idea of health as conceived of by Nêhiyawi and other Indigenous peoples, which expands beyond the borderlines of a single body and single mind to encompass community, knowledge, and a rootedness in one’s identity and culture. In a 2010 study of how members of the Thunderchild First Nation conceptualise wellness, many respondents reported that they saw practising the Cree language as a way of maintaining their health, which they considered to encompass not just their bodily wellbeing, but their spiritual wellbeing as well. This idea finds an echo in the mno bmaadis – a concept shared by Cree and other Anishinabek peoples that emphasises the interconnectedness of physical, emotional, mental and spiritual states, as well as the cultivation of balanced relationships with the people and spirits around one. Similarly, Simon J Ortiz, a poet and an enrolled member of the Pueblo of Acoma (an Indigenous community native to what is now New Mexico), argues that language itself is what teaches us to have a healthy relationship with the world around us: ‘[I]n fact, language initiates and originates in the relationship we, as a human community, have with the land. … [W]ithout language, there is no verbal acknowledgment of relationships possible.’

These findings on language as a protective factor for Indigenous communities form one strain in a larger body of scholarship examining how ties to traditional culture and land foster the health and wellbeing of Native peoples. In 2012, Joseph P Gone, then a research psychologist at the University of Michigan, and Patrick E Calf Looking, director of a substance abuse treatment programme on the Pikuni (Blackfeet Nation) reservation in Montana, set out to provide proof of concept for the efficacy of Indigenous treatment methods – not just grafting traditional elements like sweat-lodge rites on to pre-existing Western models such as Alcoholics Anonymous (AA), but creating an entirely new treatment plan from the ground up. For the extent of their pilot programme, which took place not in a hospital setting but at a specially erected outdoor camp whose tepees were pitched near a creek on the reservation, a small group of clients immersed themselves in what Gone and Calf Looking called ‘culture as treatment’: foraging, hide-tanning, lodge-cover painting, visits to sacred sites, and other activities largely unfamiliar to participants prior to their enrolment in the trial.

Guiding them through it all were representatives from the Crazy Dog society, whose members are experts in the preservation and transmission of Blackfeet lifeways. Unlike the rigid patient-doctor relationship typical of Western medicine, the Blackfeet programme cultivated a non-hierarchical dynamic between those in treatment and those providing it, creating an ambience of supportiveness, non-judgment and egalitarianism. In post-trial feedback, participants pointed to this atmosphere of collaboration as part of what made the treatment camp stand out from other substance abuse programmes, in which their dominant impression had been one of impotence and lack of control – particularly given the AA directive of surrender to a higher power.

But no matter how effective they may prove to be, many ‘culture as treatment’ programmes struggle for funding. Those that depart starkly from accepted Western models of what medicine should look like are a hard sell for grant-disbursing bodies and peer reviewers of scholarly journals, especially when narrowly tailored to particular communities, rendering cherished norms of experimental design, such as random sampling, difficult. Gone and Calf Looking report that, after more than two frustrating years of searching, they sourced funds sufficient to mount only an abbreviated version of the treatment camp as it was originally conceived – less than half the duration they’d hoped for.

He started picking up Tlingit as a way of spending time with his sick grandfather

The bigger problem, as things stand, is that academic standards of proof often exclude Indigenous voices, while quantitative research on the relationship between language and health remains largely confined to analyses of correlation. But whether or not it is legible in a bar graph, there’s no short supply of feedback from Indigenous communities across the world that cultural continuity (including the vitality of Indigenous languages) is an indispensable part of health. As the authors of the 2007 study of First Nation communities put it: ‘The generic association between cultural collapse and the rise of public health problems is so uniform and so exceptionless as to be beyond serious doubt.’ As the Tututni linguist Jaeci Hall, one of the co-authors of the Oxford handbook, said about her own experience of language revitalisation on wellness: ‘Even if we’re only saying nouns here and there, it’s this endorphin rush, that we’re successful, we’re doing something that’s bigger than just us, that connects into healing the wounds of colonisation.’

It’s easy to see how the sense of rootedness that Hall invokes might speak to the links between language preservation and wellbeing. Fostering healing connections is often also what brings people to the work. Twitchell, professor of Alaska native languages at the University of Alaska Southeast, and the author of the aforementioned Our Language Saved Us, recently told Harvard International Review that he started picking up Tlingit as a way of spending time with his sick grandfather. Since then, he’s begun to lobby the state legislature to grant Indigenous languages official status, advocate for Tlingit-medium schooling, and study how successful revitalisation models in Hawai‘i and New Zealand might be transferred to Alaska. On his YouTube channel, Twitchell posts everything from beginner lessons to classes on oral history.

On the flip side, it isn’t difficult to imagine how the alienation and deracination of which language loss is both synecdoche and symptom can create a harmful feedback loop. ‘Kids who don’t know who they are don’t understand their culture – they feel lost and are much more likely to fall prey to the type of problems that are plaguing a lot of Native communities,’ said Robert Elliott, interim director of the Northwest Indian Language Institute at the University of Oregon when we spoke over Zoom at the height of the COVID-19 quarantine. Elliott’s father, who is Diné (Navajo), was taken from his mother when he was two years old; Elliott himself, who originally trained as an ESL instructor, got involved with Indigenous language revitalisation only when he was asked to help film something at the Institute that he would later head. But he worried that those unfamiliar with the concrete impact of language preservation might see it as expendable. Organisations that do such work, he told me, are coming increasingly under the microscope, with greater competition for grant funding adding further financial pressure. ‘I’m concerned about more funding drying up,’ Elliott told me. ‘That this won’t be a priority during a crisis time, that language will be viewed as a luxury.’

Linguistic oppression has a measurable body count. The trouble is that, in a world that caters primarily or exclusively to dominant-language speakers, those outside of the linguistic majority often cannot access crucial, even life-saving medical information and care. Care that becomes all the more imperative once you recognise that those who are linguistically marginalised are often in greatest need of it. This was glaringly apparent during the pandemic. In 2020, the Endangered Language Alliance (ELA), a nonprofit organisation that documents and supports the linguistic diversity of New York City, published a map that overlaid the city’s coronavirus hotspots onto a cluster chart showing the population’s linguistic distribution. ‘Multilingual immigrant communities have been among the hardest hit,’ the ELA concluded, pointing to severely affected areas in Brooklyn, the Bronx and Queens where many speakers of minority languages reside.

Part of the problem is the dearth of public health information that’s available outside more widely spoken languages – a problem that extends far beyond the city limits of New York. The Pakistani government’s official coronavirus response website, for example, was available exclusively in English, cutting off not only speakers of smaller languages, but those in the country’s larger linguistic communities as well. Official COVID-19 information provided by the government in Indonesia was mainly in Indonesian, but was heavily larded with English loanwords such as ‘lockdown’ that rendered it largely unintelligible to people in villages. Even organisations that are notionally in charge of safeguarding the wellbeing of Indigenous people fail at this task: FUNAI, Brazil’s department of Indigenous affairs, refused to disseminate any COVID-19 information in Indigenous languages. Such failures of states to recognise the potentially disastrous impact that linguistic oppression entails speak to the underlying and systemic marginalisation of minority groups in the very fabric of societies born of colonial hegemony.

However, translating public health information word for word is not enough. As the linguist Alejandra Hermoza Cavero pointed out in her article for the site Language on the Move in 2020, the fact that the Peruvian government made COVID-19 information sheets available in languages like Quechua and Aymara is all well and good, until one realises that their advice about proper handwashing techniques was impossible to execute for the many rural Andean villagers who lack access to clean running water. (Indeed, when COVID-19 struck Utopia in January 2022, a combination of flooded rural roads and inadequate phone lines made the situation ‘absolutely dire’, according to local health clinic staff.)

Real linguistic justice requires not just dictionaries and word lists but dismantling colonial structures

All of this points to the difficulty of untangling linguistic oppression from other forms of inequity. At what point does a discussion about language become a discussion about housing? About migration? About land rights and broken treaties? About health care? According to Ross Perlin, co-director of the ELA, the amplified impact of the pandemic on multilingual immigrant communities ‘gets to larger health disparities, which have existed for a long time’, and which are exacerbated by social problems; for example, ‘if they’re undocumented, whether or not people are insured, obviously income level, overcrowding’. In New York, the ELA supported mutual aid work – notably food distribution programmes that catered to Maya families from Guatemala as part of its pandemic response – alongside publishing audio diaries by speakers of languages like K’iche’ and Amdo.

Linguists coming from outside minority-language communities often make abstract, heady appeals to diversity when seeking to build support for their work. They argue that a language’s death is a loss for all of humanity. In this context, as the author Michael Erard has said, writing in the online magazine Undark in 2016, the topic of language ‘extinction’ can easily become fetishised in media produced by and for the mainstream – that is, non-Indigenous speakers of majority languages – with white linguists cast as heroes, and language loss understood as both inevitable and irreversible. It’s a depoliticised narrative that neglects to take into account both the structural violence that drives language marginalisation in the first place, and the fact that achieving real linguistic justice requires not just dictionaries and word lists but dismantling colonial structures.

It’s telling that such universalist ideas are less relevant to people on the ground seeking to revive their own heritage languages, and who are motivated less by some diffuse concept of universal heritage than by the more immediate and concrete desire to strengthen a personal sense of cultural identity, to foster community, and repair historic and ongoing harms. ‘Language revitalisation is prefigurative,’ writes the linguist Gerald Roche in Language on the Move, ‘in that it restores languages to a community and the world before broad-scale transformation has taken place, as a model of how the world could and should be.’ Or perhaps, to invoke the original meaning of the term utopian – a model of the no-place that is the good place, the key that allows us to, in the words of the Acoma Pueblo poet Ortiz, ‘recognise the relationships I share with everything.’ In 2021, a Utopian teenager translated an English book for young children into the Alyawarr dialect spoken in the area so that children younger than him could practise reading in their language. Time will tell whether efforts like his will succeed – and what effect ‘success’ will have on the bodies of the speakers.