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Substance Abuse as Child Abuse : THE BROKEN CORD <i> by Michael Dorris (Harper & Row: $18.95; 314 pp</i> .<i> ; 0-06-016071-3) </i>

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<i> Hammerschlag, former chief of psychiatry</i> ,<i> Phoenix Area Indian Health Service</i> ,<i> and lecturer in psychiatry, University of Arizona Medical School</i> , <i> is author of "The Dancing Healers: A Doctor's Journey of Healing With Native Americans" (Harper & Row)</i>

Having spent most of my professional life in Indian country, I have struggled to understand and deal with the overwhelming phenomenon that is alcohol abuse among American Indians. I am still filled with shame at my impotence before it and with rage at the destruction it wreaks, especially upon unborn children.

It is not enough to say that “The Broken Cord,” Michael Dorris’ new book about Indian alcohol abuse, is good. Written like a prayer from the heart of someone strong enough to share his pain, it tells a tale of crimes against Native American children that approach the dimensions of genocide.

Dorris--of Native American (Modoc) descent himself--is professor of anthropology and Native American studies at Dartmouth College and was among the first unmarried men in the United States to adopt a very young child. “The Broken Cord” is about the first of his three Native American adoptive children.

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Adam, born seven weeks prematurely, was severely neglected and abused by his biological mother, who died an alcoholic death before she was 35. Gradually, Dorris realized that Adam was learning very slowly and that time wasn’t improving his condition. It was not until the boy was almost 10 years old, however, that it became clear to his father that the constellation of his physical symptoms--unusual head shape, altered facial characteristics, seizures, skeletal deformities, attention deficit, behavioral problems and mental retardation--meant that he was suffering from Fetal Alcohol Syndrome.

That the recognition came slowly is no surprise: The first scientific article about birth defects in children born to alcoholic parents was not published until 1968, the year Adam was born. And not until 1973 were these observations at all widespread in the United States. There are now more than 2,000 contributions to the literature.

Fetal Alcohol Syndrome is not unique to Native Americans. It is a serious concern in Europe, Asia and Latin America. And yet for scarcely any group is it so great a problem as it is for American Indians. Neither smallpox nor tuberculosis nor any of the other European infectious diseases (for which Indians had no natural immunity), neither military defeat nor the ensuing neo-colonialism and racism has accomplished a comparable destruction of the native peoples. It is alcohol that may now be sowing the seeds of the “final solution” for Native America.

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The statistics and history of the problem are not the focus of “The Broken Cord.” By way of historical overview, though, consider that Adam is a Lakota child. The Lakota, whom we call Sioux, are a hunter-warrior group of complex religious and healing traditions and exquisite arts and crafts. In the beginning, the Lakota were willing to live and let live with the trickle of pioneers who first penetrated the Northern Plains. When gold was discovered, however, the trickle became a torrent; entrepreneurs, prospectors and hunters exploited the sacred Earth. War became inevitable.

By the 1880s, the nomadic hunters were restricted by martial law to reservations, the buffalo no longer roamed the Plains, and alcohol--first introduced by trappers at the turn of the 19th Century--had become a growing problem. Disconnected from a credible past, from those shared symbols and myths that sustain their culture, the Lakota were ripe for the demoralization of which alcohol abuse is a manifestation.

Fetal Alcohol Syndrome is a completely preventable disease. If mothers abstain from alcohol during pregnancy, their children do not become afflicted. But, in tragic numbers, the preventable goes unprevented. There are 7,500 reported cases of Fetal Alcohol Syndrome in the United States each year, and the number is probably dramatically under-reported. Those statistics don’t include most of the cases of Fetal Alcohol Effect, in which the symptomatic manifestations are less profound but no less debilitating.

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My own experience suggests that Dorris’ and others’ estimates that up to one-third of Indian youngsters are afflicted by Fetal Alcohol Effect may be too conservative. There are Indian communities where, if we include the morbidity from Fetal Alcohol Effect, the death rate exceeds the live birth rate.

The chilling fact is that alcohol is the most severe and widespread health problem among American Indians today. There is scarcely a single living Native American who is not directly or indirectly (through the extended family) plagued by alcohol. The alcohol-related death rate among Native Americans is 6 1/2 times the national rate. The suicide rate is 2 1/2 times the national rate and even higher among the Native American young. Whatever the theories of causation, alcohol is threatening to destroy 1.5 million contemporary Indian people. The annihilation is almost unimaginable.

Dorris gives all this a name, a face and a personal history that make it impossible for the reader to remain detached. His story is not the musing of a well-manicured academic with anthropological objectivity. The book may do little in fact to speed Dorris along on the academic fast track. Never pedantic, the author is unabashed about his own inflexibility and passionate in his exhortations and judgements.

“The Broken Cord” begins as the story of a 26-year-old doctoral student who wants a child. Dorris says: “Single parenthood had for generations been the practical norm in my family.” One would like to know more. Why not get married first? Is this some unresolved sexual thing? What are the unconscious dynamics? Dorris does tell us of his naivete, even the conceit of his certainty that whatever had been the noxious influences in his son’s early life, he would by dint of his own commitment and love offset them. Adam’s life would commence from the moment when the two of them came together.

Painfully, Dorris learns that nature is more important than nurture in predicting not just physical characteristics but behaviors as well. And he is willing to re-examine an idealistic confidence bordering on arrogance and look again at everything he once thought he knew.

Dorris is an unusual man. Not only does he adopt Adam knowing that his mental development has been quite slow, he also confronts Adam’s ever more numerous and life-threatening physical maladies. But, despite the fact that these co-opt much of his time and energies, Dorris proceeds to adopt two more children while still a single parent--all this while teaching, administering and publishing.

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Consider this scene: Adam is napping. Dorris returns from his teaching responsibilities to meet the social worker for the first official, post-adoption home visit. He proceeds to bake an apple pie from scratch, find the ingredients for a tomato-bacon soup lying around, squeeze lemons for lemonade and then sift flour for a double-Dutch-chocolate cake.

During the period covered by the book, Dorris publishes a novel (“Yellow Raft in Blue Water”), gets promoted to full professor and in between teaches high-impact aerobics. (I must be working one-quarter time or have a glandular condition.)

Ten years after Adam’s adoption, Dorris marries the distinguished, National Book Award-winning novelist Louise Erdrich. Erdrich writes an impassioned and sensitive foreword to “The Broken Cord.” Together they produce three more children while pursuing their distinguished careers.

I loved this book, and yet I found myself wanting to know more. What has it been like surviving as husband and wife in the face of such daily trauma and its explosive potential for divisiveness? Did they ever want to kill each other or at least run away? What impact have the afflictions of Adam had on their other children? What price the pursuit of their unique vision? I want to know more.

This hunger takes nothing away from the power of Dorris’ material, however, and probably bespeaks mainly my own need to come to peace with my history. You see, I also adopted a child, a 3-year-old boy. The experience has been the most painful and illuminating of my life, and I have not yet found the courage to write about it.

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