Two-Spirit Identity and Indigenous Conceptualization of Gender and Sexuality: Implications for Nursing Practice

BACKGROUND

Within North America and internationally, the colonization of Indigenous peoples is recognized as a key determinant of health, profoundly affecting the health and well-being of Indigenous communities (Allan & Smylie, 2015). Colonial action and oppression resulted in the degradation of traditional practices and language, a loss of connection to the land, and a massive decrease in the population of Indigenous peoples (Aboriginal Nurses Association of Canada, 2009; Allan & Smylie, 2015). This devastating colonial history, its modern reiterations, and intergenerational sequelae have a deep impact on Indigenous peoples and their cultures, which has a direct impact on their health status and well-being (Mowbray, 2007). This effect can be observed when considering the social construction of gender and sexuality among Indigenous peoples and can be applied in such a way that furthers understandings around culturally safe care. Genocide and colonization oppressed and negated Indigenous understandings of gender and sexuality (Hunt, 2016). Through the cultural oppression of Indigenous peoples, Western understanding and social performance of gender and sexuality were forced onto Indigenous communities, challenging pre-contact views and understanding of gender roles and sexual identity (CBC News, 2015; Robinson, 2017; Sheppard & Mayo, 2013). Gilley (2006) and Robinson (2019) state that as a result of enculturation with Western values and Christianity, there are modern constructions of Indigenous gender roles that ascribe to a gender binary and reject variations in gender expression and sexual orientation. As a result, Indigenous individuals who are gender diverse or have a non-heterosexual sexual orientation may be aligned with traditional values and beliefs from their culture, but still experience homophobia or marginalization within their communities (Garrett & Barret, 2003; Robinson, 2019; Sheppard & Mayo, 2013). This marginalization is compounded by other forms of oppression that Two-Spirit individuals may face from outside their communities, such as racism and high rates of poverty.

Despite challenges that exist, Indigenous peoples and Two-Spirit individuals are incredibly resilient, and there is a movement in many communities to explore traditional cultural practices around gender and sexual orientations or, in some cases, to create language and terminology to embrace gender-diverse community members. For example, the word Two-Spirit was conceptualized in 1990 at the Native American/First Nations Gay and Lesbian Conference in Winnipeg, Manitoba (Deschamps & 2-Spirited People of the 1st Nations, 1998; Hunt, 2016). This term was created in order to replace colonially defined and imposed terms for diverse sexual orientations and gender identities (Deschamps & 2-Spirited People of the 1st Nations, 1998; Hunt, 2016; Robinson, 2019). Since the 1990s, the term Two-Spirit has been used by Indigenous peoples to describe identities that define, describe, and complicate gender, sexuality, and sex (Hunt, 2016). Two-Spirit is broadly defined as an Indigenous person who has both feminine and masculine spirits residing in their body (Sheppard & Mayo, 2013). However, a consistent theme in existing literature and community member accounts about Two-Spirit identity is that it is multi-faceted, fluid, and cannot be reduced to a universal definition (Hunt, 2016; Robinson, 2017; Sheppard & Mayo, 2013). Such a reduction would fail to account for community-specific conceptualizations and understandings of gender, sexuality, and spirit (Robinson, 2017). Although Two-Spirit is commonly used as an umbrella term to encapsulate Indigenous gender-diverse and non-normative sexual orientations, there is great diversity among Indigenous peoples across Turtle Island (North America) and worldwide. This is reflected in how nations and communities conceptualize gender, gender roles, and sexual orientation, as well as the terms used in traditional languages to describe these concepts.

Robinson (2017) states that Two-Spirit identity goes beyond gender and sexuality. Rather, Two-Spirit refers to a person's whole self and informs their entire identity (Robinson, 2017). That is, the Two-Spirit experience is a lens through which a person interprets the world; this lens has a profound impact on one's daily life (Driskill, Finley, & Gilley, 2011; Robinson, 2017). Many Indigenous communities worldwide acknowledge greater variation in gender identity than the widely accepted Western gender binary (Robinson, 2017; Sheppard & Mayo, 2013). In many nations, Two-Spirit people are revered, and occupy important and respected roles in the social structures of communities (Sheppard & Mayo, 2013). For example, in some communities Two-Spirit individuals have specific duties to perform and serve as healers, medicine people, or spiritual leaders (Deschamps & 2-Spirited People of the 1st Nations, 1998).

NURSING CONSIDERATIONS

The care received by Two-Spirit patients in the clinical setting is deeply affected by the assumptions of nurses and other health professionals, which can lead to both conscious and unconscious discrimination. Research suggests that Two-Spirit individuals and other members of the LGBTQ+ community experience discomfort in sharing information with their health-care team due to previous experiences of discrimination when accessing care (Fenge & Hicks, 2011; Pettinato, 2012). In addition, Two-Spirit individuals may experience barriers in accessing safe care, which can result in treatment being delayed or not sought out at all. Nurses have an opportunity to work with Two-Spirit people to improve health-care experiences and health outcomes by addressing their assumptions and working to dismantle systemic barriers that impact the care of this population.

It is important for nurses to consider the mistrust that stems from the racism and stigmatization that is uniquely experienced by Indigenous populations, if their goal is to deliver culturally safe care to Two-Spirit patients. Patients and families may experience ongoing intergenerational trauma as a result of racist and genocidal government policies, Indian Residential Schools (Canada) or boarding schools (United States), and the forced removal of children in the Sixties and Eighties Scoops (Daschuk, 2014). These experiences have a profound effect on health-seeking behaviors and can influence how community members access health care. In addition, the previous experiences of a person or their family member in the health-care setting will have an impact on how they feel when seeking health care. Many Indigenous peoples report racism and negative care experiences in the health-care system, and this discrimination can be compounded further for patients who are Two-Spirit, as they may encounter homophobia or be forced to enter unsafe spaces in order to receive care. It is paramount that nurses recognize the systemic barriers and racist policies that exist for Indigenous peoples seeking care, and work to critically examine their own nursing practice and institutional settings to mitigate these concerns. Consideration should also be given to how failure to develop policies that specifically attend to the unique barriers that Indigenous peoples experience in health care contributes to the denial of the injustices that negatively impact Indigenous health outcomes.

Another point of reflection for nurses working with Two-Spirit peoples is understanding the history of colonization and its impact on the health of Indigenous peoples. Nurses have an opportunity to enhance the therapeutic relationship by learning about local Indigenous communities where they practice, including local conceptualizations and words for gender and sexual orientation. Through learning about local Indigenous cultures and developing a baseline of knowledge, nurses can demonstrate cultural safety by fostering feelings of welcomeness and dismantling stress for Two-Spirit and other Indigenous patients. It is also key to recognize that many Indigenous people are affected by intergenerational trauma due to colonial processes such as residential or boarding school, day school, forced relocation, and high rates of apprehension of children by child protective services to be placed with non-Indigenous families. A trauma-informed approach to care is thus necessary to promote culturally safe environments when working with patients and families who have experienced these events.

In order to provide the best care to Two-Spirit patients, nurses must understand intersecting forms of oppression and their impact on holistic health. This involves recognizing diversity among Two-Spirit peoples and understanding that the experiences and care needs of patients are never exactly alike. It is imperative for nurses to practice in a person-centered manner, determining the needs of the individual in their care. This may involve asking the patient if they are comfortable with sharing how they identify, what their preferred pronouns are, and any other information they feel is important about their nation or community. Creating a safe environment for these conversations is key to ensuring that the patient has safe and supportive health care. Assumptions are an important factor to remember; not all Indigenous LGBTQ+ peoples identify with the Two-Spirit concept. For example, it should not be assumed that one who identifies as Indigenous and gay is Two-Spirit; they may prefer to use a word from their Indigenous language, or may use a Western descriptor for their gender or sexuality. Maintaining an open mind and being willing to learn about different patients, communities, and understandings of gender and sexuality will enable nurses to provide more equitable and culturally safe care.

CONCLUSION

Two-Spirit is a word that implies a person has both a masculine and feminine spirit within their body. This word is often used as an overarching term for Indigenous people who are gender diverse or are members of the LGBTQ+ communities. However, individual nations or communities may have their own language and conceptualizations of gender and sexuality, so it is not advisable for nurses to utilizea universal definition of Two-Spirit when working with this population. Two-Spirit patients experience oppression within health-care settings and in general society, but this population is resilient and vibrant. Many Indigenous communities are working to reestablish traditions around diverse genders and sexual orientations, as these practices were often eradicated or severely altered by colonial processes. Nurses who wish to operate in solidarity with Indigenous populations need to demonstrate competencies in providing culturally safe care. When working with Two-Spirit patients, nurses must examine and address their own assumptions and biases about Indigenous peoples and to dismantle barriers that exist for these patients when accessing health care. Further, nurses can improve their knowledge of Indigenous history and traditions in their local communities, which will allow for enhanced therapeutic relationships. By understanding the impact of colonization on this population and how determinants of health intersect to create health inequities, nurses can better refine approaches to patient care that address the unique needs of Two-Spirit patients in the clinical setting.

Disclosure

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

Funding

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.