Abstract The growing international trend toward greater community control of mental health programs in indigenous communities illuminates ongoing discursive and material pressures that shape the development of locally responsive and culturally relevant health services. In this article, I apply insights derived from practice theory and critical psychological anthropology to the ethnographic example of a substance abuse program on a Northern Plains reservation. This analysis suggests that by attending to how addiction and its psychotherapeutic transformation are represented in various community and institutional discourses impacting local services, ethnographers can accomplish two vital tasks: (1) documenting social, cultural, and psychological diversity within contemporary Native American communities, and (2) illuminating forces that undermine recognition of this diversity by federally funded mental health services. These forces include the often subtle but persistent power inequalities in relationships between local communities and federal health agencies. [mental health, substance abuse, Native North America]
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