Intercultural practices for preventing suicidal behavior in Indigenous communities of Antioquia,Colombia

Abstract

Suicidal behavior, which includes suicidal ideation, attempted suicide, and completed suicide, disproportionately affects Indigenous communities, exacerbated by factors like lack of education, limited job opportunities, access difficulties to basic needs, cultural identity loss, domestic violence, and substance abuse. Consequently, Indigenous communities have developed practices and processes that serve as protective factors, promoting mental health and preventing suicidal behavior. The aim of this article is to describe and analyze the practices that Indigenous individuals and communities have developed to address complex issues such as suicidal behavior. The study employed a qualitative approach using Community-Based Participatory Research, utilizing techniques and methodologies specific to Indigenous communities, with grounded theory for information analysis. Indigenous communities in the Department of Antioquia, northwest Colombia, have developed practices to address suicidal behavior, based on connection with the territory, family and community relationships, belief systems, and intercultural dialogue.

Introduction

Suicide is considered an important public health problem worldwide. The World Health Organization (WHO, 2023) estimates that approximately 700,000 people die by suicide each year. This situation is often framed as a pressing problem that continues to affect Indigenous communities disproportionately (Ansloos & Peltier, 2022). Therefore, there is an urgent need to understand the elements that influence this population and to develop timely prevention and care initiatives using comprehensive multisectoral strategies that are also culturally safe and valid (WHO, 2021).

In countries such as the USA (Nass et al., 2022), Australia (Heard et al., 2022), and Canada (Government of Canada, 2019), Indigenous suicide rates are significantly higher than the general population, with young people 15 to 24 years old being the most vulnerable. In Latin American countries, similar situations exist. For instance, in Brazil, the suicide rate among Indigenous Brazilians surpassed more than two and a half times the rate of the general population in 2020 (Paiva de Araujo et al., 2023). In Costa Rica, the majority of the total number of suicides and attempted suicides were among the Bribri, an Indigenous people from the Talamanca region in southeastern Costa Rica (Arroyo-Araya & Herrera-González, 2019). In Panama, 22.9% of one of the Kuna (an Indigenous group from the Guna Yala region along the Caribbean coast of Panama) communities, reported suicidal ideation (Walker et al., 2019).

Particularly in Colombia, in departments—first-level administrative divisions similar to states or provinces—such as Amazonas, Antioquia, Chocó, Guainía, and Vaupés, the situation is similar, with Indigenous adolescents being the most affected by both suicide rates and suicidal ideation. However, it is important to note that children and adults are also frequently impacted, although obtaining accurate figures has proven challenging due to significant underreporting (Montero, 2024). Some research suggests that suicide is related to structural causes, but it has also been explained by personal and community health factors, which include perspectives closely tied to spirituality. In Indigenous communities, spirituality is a fundamental part of their way of life, traditional practices, and beliefs, deeply connected to their territories and shaping their bond with community and individual life (Cano-Bedoya et al., 2023).

Some studies suggest that issues such as poverty, low socioeconomic status, limited access to education and employment opportunities, restricted access to essential goods, services, and rights, as well as loss of cultural identity, domestic violence, and alcohol and other substance abuse make Indigenous people more vulnerable to mental health problems and may explain suicidal behavior in these communities (Hus & Segal, 2024; Jakoski, 2021). Furthermore, colonialism and some historical events have had a pervasive impact on the health of Indigenous peoples, fostering social, political, and economic inequalities. These include the loss of territory and traditional subsistence activities, suppression of belief systems and spirituality, weakening of self-governance, racial discrimination, and marginalization, among other consequences (Government of Canada, 2019).

The above is not a foreign panorama for the Indigenous peoples of the Department of Antioquia, which is the territory where this research was carried out. Antioquia has four Indigenous ethnic groups, namely the Emberá (an Indigenous people of Colombia), composed of three subgroups—Emberá Eyábida (an Indigenous people mainly located in northwestern Colombia), Emberá Chamí (an Indigenous people of the Andean region of Colombia), and Emberá Dóbida (an Indigenous people traditionally settled in rainforest areas of Colombia); the Senú (an Indigenous people in northern Colombia); the Gunadule (an Indigenous people residing in the Caribbean coastal regions of Colombia and Panama); and the Nutabe (an Indigenous people originally from Department Antioquia). Among these groups, the Emberá and Gunadule retain their mother or original language, in addition to speaking Spanish. According to the projection of the population census conducted in 2018 by the National Administrative Department of Statistics of Colombia, there are approximately 40,908 Indigenous people (Departamento Nacional de Planeación, 2024). The Indigenous peoples are located in 32 municipalities across the subregions of Urabá, Occidente, Suroeste, Norte, Bajo Cauca, Nordeste, and Magdalena Medio—administrative divisions within the department that group municipalities based on geographical, cultural, and economic similarities. These communities are organized into 232 settlements and approximately 65 resguardos (collective territories), covering an area of about 350,000 hectares (Gálvez et al., 2002).

The Indigenous peoples of the Department have been integrated since 1985 in a regional organization of political character called Organización Indígena de Antioquia (Indigenous Organization of Antioquia) for the purpose of representation, vindication and visibility of ethnic diversity. Its work has focused on the defense of the fundamental rights—individual and collective, of the Indigenous people (Gálvez et al., 2002).

The current state of physical and mental health of the Indigenous peoples of the Department of Antioquia is deficient when compared to the general population, which shows a clear disadvantage. This is based on the high rates of malnutrition that mainly affect the infant population, the morbid processes resulting from the difficult conditions in which these peoples live and the general unsatisfaction of basic needs such as food, drinking water, and basic sanitation among others. In addition to the aforementioned conditions, which undoubtedly have a negative and direct impact on the nutritional and health status of the Indigenous people of Antioquia, other social and family problems that contribute to the deterioration, this time of mental health, should also be considered; in this way, the high incidence of cases of domestic violence, child abuse, neglect and negligence, sexual abuse, gender discrimination, consumption of liquor and psychoactive substances, suicides and suicide attempts should be mentioned (Gálvez et al., 2002).

Currently, many approaches to suicide prevention have focused on the individual rather than on building protective elements at the community level, such as community connectedness, a sense of belonging, and cultural revitalization (Ansloos & Peltier, 2022; Heard et al., 2022). It is, therefore, necessary to focus efforts on the prevention of suicidal behavior in Indigenous communities, fully considering scientific evidence, as well as cultural and local knowledge and wisdom as relevant to improving community, family, and institutional practices to enhance care and protection. Culturally appropriate and sensitive approaches to prevention strategies should also be included (Gobernación de Antioquia & Universidad de Antioquia, 2024).

The findings of this research propose to describe and analyze the practices that Indigenous people and communities in Antioquia, Colombia, have constructed to face complex problems such as suicidal behavior. To situate themselves in this research, the authors suggest reviewing a glossary of terms at the end of the manuscript to help understand the context in which the study was carried out.

Methods

The epistemological paradigm under which this research project was framed is the so-called social critical paradigm, defined as an approach that seeks to know to question, relativize and transform prevailing forms of society and propose alternatives for its change and improvement. In this sense, the research team assumed a constant position of self-reflection and self-criticism during the process to contribute to a just, dignified and equitable social transformation (Cifuentes, 2011). In addition, this positioning made it possible to build collectively with the other, to recognize in him or her a being who possesses valuable knowledge and who, on many occasions, has not been considered in a leading role in science, (Carabanta, 2011) so that the original constructions of the participants—emic, that emerged from this study deserved the same consideration and importance as those issued by the researcher—etic.

This study used a qualitative approach with a Community-Based Participatory Research design. This collaborative research approach allows scientific research to be conducted in communities with the help of community members, taking into account their participation in all project phases (Israel et al., 1998). Throughout the duration of the project (2022-2024), Indigenous personnel from the territory, including ancestral doctors and Indigenous promoters, were hired and actively participated, guiding and supporting the execution of the research process at all times, in addition to being interpreters in the different territories that speak their native language.

This participatory methodology seeks to transcend from research to action through the implementation of strategies and interventions that enable knowledge, the transformation of realities and social change to improve the health and quality of life of community members. Its principles are oriented to recognize the community as a unit of identity; it is based on the strengths and resources of the community; it fosters co-learning and capacity building of participants; it facilitates collaboration and equity in all phases of the research, involves empowerment and transformation of social inequalities; and it balances research and action (Israel et al., 2006).

This research collected qualitative information through participatory techniques such as knowledge dialogues, territory tours and community mapping, and methodologies framed in the knowledge and practices of Indigenous communities such as traditional medicine spaces, community assemblies or word circles, dance, and articulated with qualitative techniques such as documentary review, semi-structured interviews, discussion groups, photovoice, among others.

It should be noted that these collective and typical techniques of Indigenous communities allow the horizontal construction of new knowledge, the convergence between academic and ancestral knowledge, and the epistemic recognition of saberes otros (another knowledge). In addition, these collective tools provide the opportunity to deepen those key aspects not captured by individual techniques.

In this information gathering, which was conducted in both Spanish and the Indigenous languages, all municipalities in the Department of Antioquia participated, totaling 32, each reporting Indigenous populations in their censuses. These municipalities include communities from the Indigenous peoples Emberá Chamí, Emberá Dóbida, Emberá Eyábida, Gunadule, Nutabe, and Senú. In the Indigenous communities, convenience sampling was used to obtain a broader, contextual, and situated understanding of suicidal behavior in the Indigenous communities of Antioquia from the perspective of those involved in the territories. For the sampling, the most appropriate way to select the participants was agreed upon with the Indigenous healer and the Indigenous promoter of each territory hired by the research project. A total of 1,748 people participated in this study. This study was conducted between 2021 and 2024.

For data analysis, grounded theory tools were used (Strauss & Corbin, 2002), with line-by-line coding. A categorical matrix was constructed to define both pre-established categories and subcategories: “community life,” “family,” and “territory” as well as emerging ones: “ancestral practices and knowledge for life care” and “interculturality,” that arose during the analysis process. This process included open coding, understood as the segmentation of discourses, where descriptive labels were assigned to these segments. This coding constituted the raw material of the analysis (Coffey & Atkinson, 2003). Then, in a second phase of analysis, aimed at achieving a deeper understanding, categorization was conducted by grouping codes with similar themes to identify categories and subcategories aligned with the research objective. The information reached theoretical saturation and is presented in three analytical categories, supported by participants’ testimonies.

Processes of social appropriation of knowledge were generated with the objective of collaboratively and participatively sharing the knowledge produced by the project with Indigenous communities to facilitate its integration into local contexts and daily practices. Through this process, the importance of involving diverse actors, primarily the communities, in disseminating and applying the project’s elements was recognized. Similarly, to ensure the integrity, quality, and credibility of the information constructed in this research, validation meetings were held with Indigenous promoters and Indigenous healers. Subsequently, community spaces were created to gather feedback, questions, observations, and suggestions, which were then incorporated into the final results presented.

Regarding ethical considerations, the Ethics Committee of the National School of Public Health of the Universidad de Antioquia approved the research with written notice 21030002-0025-2022, corresponding to the ordinary session on February 18, 2022. Moreover, the research was conducted in accordance with the Declaration of Helsinki (World Medical Association (2008) and the Colombian laws for health research (Ministerio de Salud de Colombia, 1993). Community consultations were also carried out as a mechanism for socialization, analysis, and evaluation of actions impacting the communities; a consultation process was conducted with Indigenous authorities, where operational aspects were agreed upon. Thus, under the principle of autonomy, collective informed consent or community endorsement was achieved from the 32 municipalities (provided especially by the senior and local Indigenous authorities of the reserves and communities). All participants provided informed consent. Only the research team had access to the information collected.

Results

The Indigenous communities of the Department of Antioquia have practices to deal with suicidal behavior. These practices are based on connection and harmony with the territory, family and community relationships, belief systems framed in knowledge and practices, and intercultural dialogue of knowledge.

Weaving family, community, and territory

For the Indigenous peoples of Antioquia, weaving the territory means strengthening community and family ties and maintaining and preserving traditions, customs, and ancestral knowledge passed down from generation to generation. Weaving the territory implies caring for and protecting it as a fundamental part of their thinking. In short, it is an act of cultural, social, environmental, and ancestral affirmation.

In this sense, community support networks are fundamental. These values and principles define unity, solidarity, and respect, so the solutions to address suicidal behaviors are within the community itself. The Emberá have a strong connection to nature and their community, which gives them emotional support and a sense of belonging. Community life invites them to take care of their cultural identity and knowledge, which are closely related to the concept of individual, community, and territorial harmony:

We must work hand in hand, help those who are most in need, lend seeds for crops, create opportunities so that we all have plenty of food and thus have quality of life. (Participant, Emberá Eyábida community—Municipality of Mutatá)

Regarding territory and community life, Indigenous peoples agree that having a collective territory, a united and strengthened community, and a strong cultural identity is fundamental, as is taking care of Mother Earth. All of this constitutes well-being and buen vivir (good living):

When we have a home, we are in a territory at peace with nature. We help each other and work together. Everything is more bearable, and we achieve better things. (Participant, Emberá Eyábida community—Municipality of Turbo)

Community life is also central to the Nutabe culture. They value cooperation, solidarity, and teamwork. Community is at the core of their identity and is based on relationships of reciprocity and mutual respect. The territory is also very important to the Nutabe people. They consider it sacred and vital to their survival:

The territory of an Indigenous person is practically the life of that Indigenous person. An Indigenous person without a territory is totally helpless, an Indigenous person needs his territory. (Participant, Nutabe community—Municipality of Ituango)

The elements that enhance the community life of the Senú people are all those strategies that allow the articulation and unification of collective actions to ensure the participation, inclusion, well-being, and harmony of the entire community. Collective unity is fundamental because life is lived and cherished in a community:

We have always had this counseling from the Indigenous guard to solve problems in the community, to change the logic of learning, and this has allowed us to keep away bad thoughts. (Participant, Senú community—Municipality of El Bagre)

Similarly, support and assistance within the family environment are fundamental and critical in dealing with suicidal behavior in all populations. In this way, the Emberá people allude to the family environment as a scenario of prevention and resolution that is the source of happiness and the engine to continue living:

The family, the children, because they are the most important motives and the strength to continue fighting as a people. In the community, for which life is loved, it’s to continue strengthening the culture, defending the territory, and recovering the ancestral knowledge, and the strength to continue fighting, without leaving behind the uses and customs as Emberá people. (Participant, Emberá Chamí community—Municipality of Valparaíso)

In this sense, Senú communities tend to have strong family and community ties, which can facilitate early detection of warning signs and timely intervention in cases of suicidal behavior. These family support networks provide emotional support, practical assistance, and access to professional resources:

The family is everything, especially in difficult times, and for us, as a people, it’s fundamental to count on the family as an engine of encouragement. (Participant, Senú community—Municipality of San Pedro de Urabá)

Ancestral practices and knowledge for caring for life: returning to the origins

Indigenous peoples recognize skills to prevent suicidal behavior in their ancestral practices and knowledge. These practices are promoted and valued to improve the mental and emotional health of its members and foster a sense of belonging and collective well-being, essentially based on the care of life. These practices are based on the return to the origins, to the connection to the land, to the ancestors and to the cultural traditions.

The communities propose the need to return to the origin, to reconnect with their being, and to return to the strengthening of the seed, from the connection of the womb with the medicine and with their own knowledge, which will allow the Emberá to transmit their word, their knowledge, and their care to their peers in the future. Even the elders listened only to nature as a form of self-care and prevention:

The community must recognize its origins or roots that allow the strengthening of its cultural identity, as well as the constant performance of cultural rituals and traditional medicine. (Participant, Emberá Chamí community—Municipality of Pueblorrico)

The practice of ancestral medicine is one of the skills that all Indigenous peoples possess. They turn to their spiritual leaders, Indigenous healers, botanists, jaibanás (Emberá Indigenous healers), and curiosos (healers) who perform rituals of protection, healing, harmonization, or special ceremonies to help people in crisis find emotional and spiritual balance.

Some Emberá Chamí communities have considerably consolidated their ancestral knowledge through their own traditional medicine, which has various purposes such as harmonization, physical and mental healing, spirituality, and good energies. They also point out the importance of the assistance in this spiritual process of the authorities and wise men and women who guide the decision-making process related to the buen vivir of the territory’s inhabitants, such as the council of wise men and women:

Medicine is practiced for many healing purposes, both personal and communal. It’s where we leave the bad behind to receive the good. We turn to medicine to get the energy to continue fighting, and it’s through this that it helps us to heal, and through this that it identifies and diagnoses such illnesses. Plants are part of this healing method. (Participant, Emberá Chamí community—Municipality of Valparaíso)

The ancestral medicine of the Emberá Eyábida and Dóbida is considered a practice transmitted from generation to generation within the community. They use medicinal plants, rituals, and ancestral knowledge to treat illness and maintain physical, mental, and spiritual balance. They also perform rituals and ceremonies to invoke the protective spirits and ask for help to heal illness. These rituals include singing, dancing, and playing traditional musical instruments:

There are traditional jaibanás here that cure these diseases. There is a young lad who knows; he has always saved many lives. There are plants for bathing. For purification, it’s necessary to have baths with medicinal plants [chiduaba, kiuyá, kuiyí]. You must have baths with plants to protect yourself; it’s for protection. (Participant, Emberá Eyábida community—Municipality of Murindó)

In Senú ancestral medicine, rituals and ceremonies are also performed to invoke the protective spirits and ask for their help in healing:

If it is a spiritual illness, it’s enough for the pastors to pray in a prayer chain. If it’s a mental illness, one would look for traditional medicine to help the youth, the adult, the elders. (Participant, Senú community—Municipality of Caucasia)

The Nutabe people use herbal baths and rituals to cleanse the body and mind. Ancestral medicine for suicide prevention is based on holistic practices that seek to balance the body, mind, and spirit, as well as strengthen community ties and foster a sense of cultural belonging:

We, the Nutabe people, use a variety of medicinal plants to treat emotional and mental imbalances. These plants are used in the form of infusions, baths, or ointments, and it’s believed that they help calm the mind and spirit. We believe a lot in traditional medicine. (Participant, Nutabe community—Municipality of Ituango)

However, the communities express that the young population is not aware of ancestral medicine as a rigorous process characterized by perseverance and discipline. Similarly, traditional medicine must be practiced in the best possible way since an inadequate practice has a negative impact on the territory and the community. Therefore, it is important that generational handover takes place, and that all wisdom is transmitted in the best possible way, with life plans—communities’ own planning tool, playing a leading role:

Nowadays, young people want to be ancestral doctors temporarily, but they don’t want to continue, and if they don’t do it, what they’re doing is harming the people and the environment. (Participant, Emberá Chamí community—Municipality of Pueblorrico)

Intercultural harmonization: building territories of care

Intercultural harmonization implies a respectful dialogue between different forms of knowledge and active collaboration of interdisciplinary teams with Indigenous spiritual and community leaders who, from their cultural and ancestral practices, facilitate the processes of individual, family, and territorial healing, and harmonization. Therapeutic complementarity and knowledge dialogues are also made possible by such harmonization. Thus, creating territories of care implies the creation of safe and protective spaces where communities can feel supported and assisted. It is necessary to promote a comprehensive approach that combines respect for ancestral knowledge with the provision of specialized mental health services to ensure the emotional and psychological well-being of Indigenous communities. The stories reveal the urgency and necessity of recognizing the communities’ knowledge to establish a dialogue between their own medicine and the western model and to strengthen and formulate programs and policies that address and respond to the needs of Indigenous communities in a comprehensive and contextualized way. Reference is also made to the installed capacity of trained people within the territory, characterized by proactive participation and allowing the articulation of different knowledge within the Indigenous reserves called resguardos to contribute to the community’s well-being:

If the traditional doctors don’t heal, and it’s a kapunias disease, we have to look for a psychologist to be able to heal. For me, it would be important that both the ancestral doctor and a psychologist treat the people. If it’s jai [spirits], Jaibanismo [the magical-religious system of the Emberá] would heal it, and if it’s a mental illness, it would be treated with the psychologist. (Participant, Emberá Chamí community—Municipality of Ciudad Bolívar)

Another potentiality they express is the communal construction of houses of medicine or houses of thought as spaces for harmonization, healing, and sharing of the word and for training in ancestral medicine. In these spaces, there is an opportunity to cope with suicide since they allow strengthening the advice of wise men and women who guide spirituality processes as an element of protection from the physical, mental, and spiritual dimensions and, in addition, guide the decision-making related to buen vivir:

The guidance of the wise men and grandparents is the best way for our community to survive. (Participant, Emberá Eyábida community—Municipality of Urrao)

On the other hand, they argue that they want more job opportunities, since this lack of opportunities has caused families to leave the resguardo and the community to disintegrate. Therefore, they propose strategies to strengthen community economic activities, such as handicrafts and community gardens, which would contribute positively to the quality of life of all:

It would be good to have plant nurseries, a real startup in the resguardo. Strengthen family vegetable gardens to improve family nutrition and strengthen the practice of handicrafts. (Participant, Senú community—Municipality of Caucasia)

Among the infallible aspects of intercultural harmonization, there is an emerging and reiterated need for educational models at municipal level that propose guidelines according to needs and contexts, including a greater knowledge of rituals and preventive medicine for mental health by families and young people. This action requires the leadership of teachers who teach in their own language:

A teacher to teach us and the children to speak the language would help us fight against oblivion and the death of the community. (Participant, Emberá Chamí community—Municipality of Remedios)

Regarding the young population, they describe the urgent need to strengthen cultural identity and promote a sense of belonging. They allude to implementing programs aimed at adapting spaces for recreational activities, including music workshops and traditional games, dance, sports, and handicrafts. These spaces are intended to facilitate young people’s connection with their culture and instill a sense of purpose in their life plans. They also suggest strengthening spaces for comprehensive intergenerational dialogues that allow the creation of environments conductive to reflection based on the cultural and territorial context:

I can tell you that one of the needs is for all these young people to be able to share their thoughts, to be able to grow in community. It’s just that they can say that they can transform the reality of our culture or that they want to get back all the knowledge that our ancestors left us. (Participant, Senú community—Municipality of Arboletes)

In addition, they emphasize the need to appropriate new technologies as tools to create training spaces for campaigns, applications, contests, and other projects designed to generate content and encourage work on problematic issues related to mental health promotion:

We Indigenous youth, with so much technology and things that have come out in the world, we should learn to use it well to do things for our community, to get new knowledge that we can apply. (Participant, Emberá Eyábida community—Municipality of Chigorodó)

They describe with vehement interest the actions of their own government through the local council, arguing that the issue of suicide should be addressed within the community, including life plans, to promote the implementation of projects around this issue in constant coordination with different institutions, whether public or private. Provide more support for research projects since there are questions, problems, and difficulties that are not addressed in any collective space or by competent institutions:

First the community, second the team of the major cabildo [local decision maker] third we have to reach the mayor’s office or the OIA, who can manage, look for projects to address the issue of healing or identification of people carrying bad spirits. (Participant, Emberá Eyábida community—Municipality of Frontino)

They also mention that the most effective strategy is to hold community meetings and work with families to raise awareness, practice, and gain commitment; here, involving teachers and local cabildos will be essential. The priority mental health issues to be addressed in the family are alcohol and cigarette abuse, as these are closely related to abandonment, domestic violence, and malnutrition, as well as basic parenting patterns:

Care for nature, raising awareness about its protection, more support and assistance for the family, continuing to practice appropriate habits, avoiding the use of psychoactive substances, because this is the origin of domestic and community abuse. (Participant, Emberá Eyábida community—Municipality of Frontino)

As practices to cope with suicidal behavior, they also highlight recovering their own ancestral games, having self-sustainable projects, and receiving training for formulating, designing, and implementing projects that allow them to build installed capacity and social capital:

It would be very fundamental to be able to show traditional games in an activity, to come to do that, to play the spinning top, to play cucunubá (a traditional game), to play marbles, to play la cuarta (a traditional game), all those games that they know. (Participant, Emberá Eyábida community—Municipality of Urrao)

Finally, all communities agree that initiatives related to mental health and suicidal behavior require greater continuity over time to learn in detail the dynamics experienced by Indigenous communities and, in turn, contribute positively to the consolidation of cultural processes led by the community itself:

This government issue, I would like this project to continue, because it’s a nice thing that we talk about for 12 months and then it’s turning off, I wish it follows through with the families. (Participant, Emberá Chamí community—Municipality of Ciudad Bolívar)

Discussion

Three categories emerged from the present research that are central to the prevention of suicidal behavior in Indigenous communities. They outline a comprehensive course of action based on public policies, plans, programs, and projects that can be implemented and positively impact the problem.

Territory

As a category widely discussed by various authors, territory represents a core category in this research for understanding the problem, and it also links the following two categories. The uprooting from the territory, the lack of connection with it, and the intrusion of other agents into the sacred and ancestral space of the Indigenous peoples are precisely some of the most important causes of the current changes in the well-being and mental health of the Indigenous communities, especially of their young population.

It is important to clarify that territory per se is not understood from a material or capitalist point of view for Indigenous peoples. According to authors such as Ruiz-Serna (2017), the territory is the living integrity and maintenance of identity and harmony; therefore, as a result of the human action of present generations and ancestors, the territory shelters and develops life and represents the particular way in which the world is constructed. The territory suffers damage when it is violated or desecrated, and such violation tears the fabric of life and disharmonizes the integration of the community. Similarly, Westerman (2021) mentions the spiritual disconnection experienced by Indigenous peoples when they are displaced from their ancestral territories and how this affects their physical, mental, and spiritual health processes.

The Indigenous peoples of Antioquia have experienced the desecration of their sacred place, the place of connection with their ancestors and the one who gives them life. An important theme that emerges in each of the testimonies is the territory as a meeting place and community fabric, or what Aramburo-Siegert et al. call the possibility of social life, cultural reproduction, historical links, memories, and collective diversities (Aramburo-Siegert et al., 2018).

The territory, then, is not only the spatial place where the resguardo is settled, but it is part of life itself, of the roots and where community relations are woven, where language does not die because it is the propitious space for fruitful and transcendent conversations that give meaning to the existence of each person and each community. Therefore, when the territory is transgressed, not respected, not valued, the fabric of the community, its history, language, ancestral traditions, culture, and even, as the communities themselves point out, life itself begins to die because Indigenous peoples begin to feel that they no longer belong there. Here, it is crucial to mention Foucault’s reference to power. For him, there is a spatial exercise of power that, in the case of the Indigenous communities of Antioquia, has been exercised by illegal groups and persons outside the law, as well as other groups of power, such as national or multinational companies that have trespassed these territories. For Foucault, this situation is described by the concept of non-places, which produce traumatic experiences, emptiness, and loss of vital connection (Arendt, 2003; Foucault, 2000).

The loss of ancestral connection to territory, family, and community is precisely what leads to the loss of meaning in the lives of the members of these Indigenous communities. Non-places are those spaces that lead people to experience emptiness. In the same sense, Hannah Arendt’s concept of empty space appears; an empty space isolates people and exerts violence on each of its subjects, as did the concentration camps in Europe in the last century (Universidad Externado de Colombia, 2021). This emptiness is reductionist par excellence and leads people to dehumanization and a loss of sensitivity and spiritual connection to themselves and their community.

Therefore, it is imperative to protect the territory, the family, and the community because, in the territory, intercultural practices that give meaning and origin to the way of life of these Indigenous peoples emerge. In the territory, young people and elders, in the encounter with their ancestors and the spiritual world, keep the balance and walk through the construction of a community project that unites them and gives them meaning.

Practices and ancestral knowledge

At this point, the second core category comes in: those practices and ancestral knowledge that are made in the territory for the care of life that provide harmony, balance, and the native energy of the community. According to the Latin American Observatory on Human Rights and Business, ancestral or traditional knowledge is “an essential component of ethnic communities. Their knowledge, practices, and rituals give these communities their own identity, which characterizes them and distinguishes them from other cultures” (Universidad Externado de Colombia, 2021, p. 1). This study found that these millennia-old knowledge and community practices maintain social and spiritual order and balance, reconfigure the rhythm of the community, and give a particular identity to their culture and origins.

Studies, such as those conducted in Bajo Atrato, the Colombian zone, with Emberá communities, have shown that the entry of armed men into the territory has frightened away the wild animals and the spirits or enchantments that once inhabited the jungles and rivers surrounding the ancestral territories. Representatives of various Indigenous communities have stated that the mistreatment and desecration of their sacred territories have resulted in the spiritual fathers who live in the water, trees, stones, and plants being hardly perceived anymore (Ruíz-Serna, 2017). At this point, there is an intrinsic relationship with what has been said about an empty territory (Universidad Externado de Colombia, 2021). By not feeling their ancestors, their older brothers and sisters, and their spiritual parents, the members of the communities begin to lose the spiritual connection; the jai (vital energy) is altered, and they end up in an ojuemari (suicide), which for them is a deterioration of their ancestral cosmovision, given by the loss of their cultural affiliation, and which ultimately leads them to a loss of meaning, ending in suicide (Cassirer, 1997).

It is, therefore, important to recognize the spiritual practices of Indigenous communities and their traditional knowledge as an essential element in the prevention of suicidal behavior. In this regard, Cassirer (1997, p. 47) will say, “No longer in a merely physical universe, man lives in a symbolic universe. Language, myth, art, and religion are parts of this universe. They are the varied threads which weave the symbolic net, the tangled web of human experience.” In the testimonies presented, which align with the studies by Westerman (2021) spirituality emerges as an extremely important theme in the community’s life. Regardless of the practice of the ancestors, spirituality is full of good purposes, such as receiving healing, leaving the bad and receiving the good, gathering energy for the daily struggle, and treating illnesses and mental or emotional imbalances (Suarez-Luque & Del Carmen Rodríguez, 2018).

The practices and knowledge gleaned from and imbued with the ancestors’ wisdom have been passed down from generation to generation; they are values, rites, and practices transmitted within an endogenous communication system that contributes to the development and life of the community (De Sousa Santos, 2014). Community doctors, healers, jaibanás, curiosos, ancestral doctors, or whatever the identity and culture of each community call them are important figures. However, in the testimonies of this study, it was found that the new generations, having lost this sense of community belonging, do not want to be part of this knowledge transfer. In the best of cases, the new generations only want to participate temporarily, which, according to the community itself, alters the balance and harms the people (Pava-Laguna & Román-Montoya, 2021).

In the testimonies, it was also noted that, besides the uprooting from the territory and the loss of connection with it, there is also the inclusion of young people in the new capitalist dynamics and urban life; many communities are already very close to the territories inhabited by western men, as they referred. The western immersion dynamic has led young people to feel that their knowledge has no value and that their worldview is disregarded by the western world. Many of them have suffered rejection and bullying from their western peers, leading them into a cycle of violence that increases spiritual imbalance and makes them more likely to enter this ojuemari. In this regard, de Sousa (2014, pp. 16–17) says,

The diversity of the world is infinite. There are distinct ways of thinking, of feeling—of feeling through thinking and thinking through feeling—, of acting; different relations between human beings—different ways of relations between humans and non-humans, between humans and nature or what we call nature; . . . different ways of collectively organizing life and the provision of goods, of resources, from an economic point of view. For the epistemologies of the South, this great diversity is wasted because it remains invisible due to the hegemonic knowledge we have.

It is this invisibility that the western world has placed on cosmogonies of ancestral communities, their ways of being and feeling in the world, their spirituality, and their multiple and endless forms of transcendence. This position leads new generations to relegate or deny their spiritual lives and connection to their ancestors.

The possibility for new generations to carry on the legacy of the ancestral doctors in the territories is lost; it is another of the many deaths of cultural practices that Indigenous communities are experiencing. Now, more than ever, recognizing the value of spiritual practices in communities is extremely important. It is imperative to find ways for communities to return to their origins; educating and re-educating the new generations, especially the young people who believe that western culture surpasses the value of these practices and cosmovision, is vital. Their practices and worldviews are an ancestral source of millennium-long knowledge, understanding of the cosmos and origins, and connection to Mother Earth, essentially the vital sap of the older brothers and sisters.

Harmonization of the territory and the practice of care

The final core category is deeply intertwined with the previous two. The harmonization of the territory and the practice of care are fundamental to the survival of the community, the balance, and mental and physical well-being of each community member. Each community has its own intercultural care practices that give it identity, all of which are part of the buen vivir and life course; therefore, practices such as games, strengthening and caring for animals and vegetable gardens, Indigenous dances, language instruction, and many others can be found.

In this research results, the jaibaná (Emberá Indigenous healer) was found to be a central figure of care, essential in the care of all illnesses related to the jai. Other studies, such as one conducted in an Emberá Chami community, show how the jaibaná is a source of special care, but so are the Emberá mothers, the family, and ultimately the community (Fajardo-Gómez, 2006). Also, in this study, some communities mention the figure of the psychologist, who should work hand in hand with the ancestral doctor to address specific mental health issues in the community. However, the key would be to ensure that the support provided by these professionals is preventive rather than curative; that is, through immersion in intercultural practices, they manage to generate specific care to maintain the promotion of the community’s mental well-being.

The care pathway is also orally based, which is why maintaining and teaching the language is essential to community care. The language gives identity and allows the new generations to communicate with their parents and elders within the territory. One of the deaths that must be avoided to ensure mental well-being and prevent suicidal behavior is the death of language, the death of orality, because language allows knowledge to be transmitted from generation to generation. Fajardo-Gómez (2006) points out that Indigenous peoples preserved their cultural and literary heritage through oral transmission; this is how the history and practices of the ancestors are told in a symbolic way along with daily experiences, cultural experiences, and the harmonization of territories (Roy-Mooney, 2002).

It is, therefore, essential that both young people and their elders can share knowledge and grow as a community. The testimonies invite a fundamental reflection that is still somewhat unexplored but which is part of the world of life. In this era of technological revolution and sometimes inevitable interaction between these communities and the western world, it is necessary that technology also be at the service of the people so that the members of these communities know how to use it and use it well, that is, for their benefit and well-being. Ultimately, as Roy-Mooney (2002, p. 82) says, “It’s not the technology you should fear, but how you use it.”

Conclusion

Finally, there is an urgent need to develop policies that consider ancestry in the care of territories, communities, and the mental health of Indigenous peoples. The new generations are increasingly immersed in the dynamics of the West and capitalism. The disconnection, cycles of violence, identity crisis, drug issues, and the lack of value experienced by their elders lead to a steady erosion of their vital connection. They feel an alienation, a growing silence from their ancestors, and perceive their territory as an empty space. The result is a profound spiritual imbalance ensues. Together, these factors lead to a loss of mental well-being that tears at the social fabric of Indigenous communities, drives younger generations to suicide, and condemns to death many communities, all of them entrusted with profound knowledge and ancient wisdom.