Depression. Addiction. Chronic disease. Mistrust of medical professionals. The Killers of the Flower Moon movie, directed by Martin Scorsese and based on the non-fiction book by journalist David Grann, tells the tragic history behind the murders of members of the Osage Nation in the 1920s by white opportunists who coveted the oil-rich tribal land in Oklahoma. But themes of health issues that disproportionately impact the Osage and other tribes in the United States also appear throughout.
We spoke with Indigenous members of the Yale community about what the movie got right, and how historical traumas have led to persistent health inequities today.
“The movie was striking not just from a social and historical perspective, but also from a health perspective," says Layton Lamsam, MD, hospital resident in the Department of Neurosurgery and a member of the Osage Nation himself.
Movie portrays Osage members’ struggles with mental health and chronic disease
For Lamsam, the most emotional part of the movie is the depiction of 40-year-old affluent Osage rancher Henry Roan’s decline in mental health before he is murdered. After discovering his wife’s infidelity, he falls into a depression and turns to alcohol to cope. “You see little biopics of him and his preexisting mental health issues that were dramatically accelerated by his guardians and the folks around him, his social situation at the time, and by alcohol,” Lamsam says.
Shortly before he dies, Roan expresses to William Hale, the wealthy white mastermind behind the Osage murders played by Robert De Niro, that he is ashamed to be an Osage Indian and storms off. “To me, his outcry synthesized the impacts of the systematic destruction of cultural institutions by the federal government and the intentional destruction of the agency of the Osage people in this one individual,” says Lamsam.
Our connection to the Earth, the plants, and the animals is spiritual. When you sever that from an individual in such a forceful way and then put them in environments that are not conducive to being healthy, it can have long-term health impacts, including diabetes.
Patricia Nez Henderson, MD '00
Other prominent conditions in the film are diabetes and a “wasting disease,” implied to be in many cases undiagnosed diabetes, that takes the lives of many Osage people before they reach the age of 50. Mollie Burkhart, played by Lily Gladstone, is one of several Osage people who suffer with the disease. Much of the Osage community blames the disease on “the white man’s food.” In one scene, a doctor warns Burkhart that she will lose her feet to the disease if she continues to “eat like a white.”
As white colonizers pushed Indigenous communities like the Osage out of their homelands, they sought to eradicate their Indigenous neighbors’ sovereignty and culture. Previously, the Osage relied on hunting and farming vegetables for sustenance. But once European settlers moved in, their traditional diets were no longer accessible, and they instead had to turn to cheap, highly processed foods. Indeed, many researchers believe that both the chronic stress caused by colonization and forced assimilation and the rapid and drastic shift to a carbohydrate-heavy diet driven by government food commodities are major factors in the disease’s disproportionate impact on these communities.
“Our connection to the Earth, the plants, and the animals is spiritual. When you sever that from an individual in such a forceful way and then put them in environments that are not conducive to being healthy, it can have long-term health impacts, including diabetes,” says Patricia Nez Henderson, MD ’00, who was the first Indigenous woman graduate of Yale School of Medicine.
Born and raised in the Navajo Nation, the physician-scientist has dedicated her career to addressing social injustices in Indigenous communities. She recalls her own experiences being forced by the federal government to attend boarding school and eating commodity foods. “The spiritual connection we have to food is so critical. Colonization has had a huge impact on that relationship.”
The movie also highlights the history of deception and mistreatment of Indigenous communities by white physicians. Mollie Burkhart believes her husband, Ernest Burkhart, played by Leonardo DiCaprio, is caring for her health by giving her insulin injections for her diabetes. She later finds out, however, that he is conspiring with her doctors to try and poison her. “In the movie, the physicians who treated her are depicted as people who weren’t necessarily on her side,” says Lamsam. “There’s a whole discussion to be had about trust and the physician-patient relationship, and especially about how the sanctity of that relationship has been violated repeatedly in the history of American Indians and Western-trained physicians.”
Osage and other Indigenous communities face significant health inequities
The impact of these historical traumas persists today. Indigenous communities in the United States continue to experience disproportionately higher rates of mental health disorders, suicide, and substance use. They also face greater rates of chronic diseases and are twice as likely to have diabetes compared to other racial groups. “If you’re forcibly removed from your homeland, that creates stress and trauma, which in turn can lead to chronic disease,” says Nez Henderson.
These inequities are not only the result of extensive historical trauma, but also the ongoing oppression that still exists today. Indigenous communities face barriers to accessing physical and mental health care, experience high rates of discrimination within health care, and suffer high rates of food insecurity. “Health inequities for Indigenous people are cumulative in the fact that oppression has being going on for a long time, but there also are contemporary stressors that are rooted in colonization,” says Stefanie Gillson, MD, postdoctoral fellow in psychiatry at the Yale Child Study Center. Gillson is a descendant of the Dakota-Santee Sioux Tribe from Mni Sota Makoce (Minnesota).
Indigenous communities endure, despite challenges
But in spite of being underserved, Indigenous communities are incredibly resilient, Gillson adds. “Despite all these years of attempted genocide and colonization, Indigenous people are still here and thriving in so many ways.”
The resilience shown by Indigenous communities is due in part to “protective factors” that allow tribes to overcome inequities, says Ryan JJ Buckley, MD, instructor in emergency medicine and in pulmonary, critical care & sleep medicine, and a member of the Cherokee Nation. Protective factors are the cultural elements—including language, art, and traditional practices—within each Indigenous community that allow them to thrive despite the challenges they face. And research shows that cultural connectedness, family and non-familial connectedness, and other protective factors significantly improve rates of substance use, mood disorders, and other health outcomes.
“When I start to think of these inequities, when you look at just the numbers, it can be very overwhelming, depressing, and defeatist,” he says. “But cultural elements and practices have provided not only generations, but centuries and centuries of resilience and Indigenous strength. No matter what they encounter, these communities not only survive, but continue to thrive.”