ANTHROPOLOGICAL PERSPECTIVES ON CROSS-CULTURAL
variation does not eliminate the importance of culture but, instead, requires a complex understanding of cultural infl uences. Acculturation produces change and differentiation among members of ethnic groups, creating intracultural variation.
Racial Concepts The application of the concept of race to intergroup differences is mis- leading if erroneously presumed to refl ect biological differences (see Chapter Seven).
Racial concepts refl ect racist traditions rather than genetic differences that distinguish mem- bers of groups. But the concept of race is important in clinical assessment as a statistically signifi cant marker for both genetic predispositions (high blood pressure) and socially induced health conditions (high blood pressure). We should not confuse individuals’ racial identity as refl ecting biological determinants. Racial concepts have clinical signifi cance because beliefs about races are refl ected in societal patterns of prejudice and discrimination affecting prenatal care, diet, exposure to diseases, diagnosis of conditions, and treatment.
Social Versus Cultural Effects Patterns of health behavior found in a culture may occur as a consequence of effects from institutions or groups external to the culture. These are social, as opposed to cultural, infl uences. Characteristics of minority groups in a multicul- tural society may be the consequence of economic and political relationships with other groups and societal institutions that have effects on their culture. Ethnic groups’ utilization of emergency services, lack of immunizations, and lack of preventive care may refl ect social class-related infl uences. This confusion is found in the concept of the so-called cul- ture of poverty, considered to be learned behaviors of the poor. But the culture of poverty may represent the social structure of poverty: characteristics that occur as a consequence of being a subordinated group. This includes relationships with health institutions and providers where experiences of discrimination shape health behaviors and interactions with providers, for instance, and lead to the avoidance of prenatal care.
Effective Cross-Cultural Adaptations
Cultural competency requires a range of learning experiences and personal adaptations. A variety of methods need to be employed as a basis for cross-cultural training, combining the teaching of general principles and cultural specifi cs with experiences and activities that pro- mote self-awareness, behavioral adaptations, and emotional transformations. Cross-cultural training procedures are available to learn how to adapt personally to situations one is likely to encounter (see Weeks, Pedersen, and Brislin, 1986; Kohls and Knight, 1994; Kohls and Brussow, 1995; Gropper, 1996; Seelye, 1996; Fowler and Mumford, 1999). Cognitive learning must add interactions with people in other cultures in everyday life, learning new behaviors. Personal changes include the development of cultural self-awareness, an attitude of willingness to change, the acquisition of skills for managing culture shock and associated emotional distress, and restraint of cultural projection tendencies.
Culture Shock Adaptation Cross-cultural contact produces stress, emotional reactions, and resistance to learning about and accepting cultural differences. Culture shock, a negative reaction to being exposed to another culture, is a major threat to intercultural success. Culture shock produces a dislike of another culture and a desire to leave it or even psychological disorders such as transient neurosis, paranoia, and acute psychotic
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breakdowns. Effectiveness in cross-cultural relations requires the recognition of culture shock and taking steps to manage it by developing a sense of self-effi cacy through cogni- tive and behavioral coping strategies (Winkelman, 1994). Adaptation to culture shock requires the management of these emotional reactions and stress, suspension of ethno- centric attitudes about one’s own culture, and acceptance of others’ perspectives. Physical stress management and maintenance of one’s physical well-being are important for cross- cultural adaptation. Culture shock management requires a knowledge of likely provoca- tive and distressing situations and the means of reducing stress and confl icts through cultural adaptations and maintaining self (Winkelman, 1994).
Personal Change and Transformation Developing cultural competence requires an effort to change personally, facilitated by an awareness of the benefi ts. Cross-cultural contact produces strong emotional reactions and resistance to learning about and accept- ing cultural differences. Developing cultural competency requires adopting a positive attitude about working through the diffi cult personal challenges of intercultural adapta- tion. Developing cross-cultural competency requires a deep personal passion and com- mitment that is shared with others and implemented in actions that interrupt oppression through proactive responses (Fukuyama and Sevig, 1999). Cross-cultural development produces changes in the self, a transformation process that leads to increasing identifi ca- tion with and internalization of others’ points of view.
Cultural Self-Awareness Cultural competence requires the recognition of one’s own cul- tural characteristics and infl uences, particularly one’s values, prejudices, and beliefs and their effects on behaviors and attitudes (see Exhibit 3.1.). Cultural self-awareness begins with the knowledge of one’s own culture and its effects on one’s self, identity, preferences, patterns of behavior, and the characteristics of one’s professional practice (e.g., see Chapter Five on biomedical and nursing professional cultures). Knowledge of one’s culture is most important because it underlies all of one’s behavior, personal and professional. Self- awareness needs to include consideration of the nature and sources of one’s attitudes toward other ethnic groups. Values assessments (see the self-assessment exercises at the end of this chapter) are an essential part of developing cultural self-awareness and cultural compe- tence, understanding how one’s cultural orientation affects relations with others. Cultural self-awareness provides a basis for anticipating the confl icts to be encountered with a for- eign culture and managing potentially confl ictive situations. Awareness of one’s cultural values helps suspension of the habitual tendencies to judge others, based unconsciously on our cultural assumptions, and facilitates acceptance and understanding of other cultures.
Cognitive Reorganization Cross-cultural effectiveness requires cognitive changes, that we suspend our habitual cultural assumptions about what is normal, reducing the normal cultural attribution or projection of values and assumptions. These “self-reference criteria”
involving the use of our own culture for understanding others’ behavior must be limited to reduce the judgmental intrusion of our culturally based values and beliefs. Instead, one con- sciously adopts the perceptual framework of cultural attribution (or cultural relativism), using the emic perspectives of the culture of the people one is trying to understand. These interactions require a knowledge of other cultures and interpersonal intercultural skills.
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