On Suffering: Pathways to Healing and Health

4. Suffering and Culture

4 * Suffering and Culture Cultural traditions have a profound effect not only on individuals’ idea of self but also on the identity of families and the community at large. Cultural traditions may augment not only the experience of suffering but also its expression. Insensitivity to transcultural issues can result in ineffective health care treatment outcomes, increased suffering of individuals, and an escalation of health care delivery costs. The purpose of this chapter is to: (a) review common definitions of culture, ethnicity, and nationality in contemporary society; (b) illustrate the difference between a patient’s idea of self and self-identity; (c) explore the dynamics of cultural identity and idea of self; (d) discuss the impact of cultural traditions on health; and (e) provide a case study in which cultural sensitivity and competency were important components of successful treatment outcomes. Culture, Ethnicity, Nationality Culture Culture has many definitions. It has been defined as a patterned behavioural response that develops over time. Giger et al. state that culture can be defined as the end product of an imprinting on the mind of patterned responses that occur through social, religious, intellectual, and artistic experiences and that it is also the result of acquired psychological mechanisms that are affected by internal and external stimuli (1). Values, beliefs, norms, and practices that are held in common among members of a group are what shape a culture. Culture guides an individual ’s thinking and doing and becomes a stereotypical expression of the person. Culture guides an individual’s actions and decision making while fostering ideas of self-worth and self-esteem. Others (2) define culture as a socially transmitted behaviour pattern that is based on the acceptance of beliefs, attitudes, language, and practices that are typical of a community at a give time. These authors argue that geographical, economic, and social segregation of any ethnic or racial group reinforces the culturally influenced behaviour pattern. When considering suffering in such groups, these points are of considerable importance. In health care, changes in usual patterns of behaviour may be regarded as evidence of pathology when, in fact, the person is simply retreating to a time and place of emotional safety because threats to his/her personal idea of self are perceived. 52 Suffering: What Man Has Made of Man Inthearenaofhealth,individualsmaybeforcedintoacultureofchronicillnessor disability. People with asthma, for example, may become part of a culture in which members advocate for clean air, the abolishment of smoking in public places, or a fragrance-free society. Others with physical disabilities may lobby governments for wheelchair-accessible buildings and subsidized public transportation. Other individuals may find themselves in an illness culture when lifesaving drugs are not subsidized by public resources. In many such examples, an individual may belong to several cultural groups. One may be based on illness, another on disability, and the third on ethnicity. The most useful definition, in clinical practice, is that culture is the sum of the beliefs, practices, habits, likes, customs, norms, and rituals that individuals learn from their families during their years of socialization (3). Culture is the mainstay of personhood; that is, it is how people live in society . Adherence to cultural traditions is a conscious experience and functions as a device for creating as well as limiting human choices. Cultural traditions not only determine the nature of personal identity but also can mold individuals’ ideas of self. When considering suffering as a perception of threat to ideas of self and personhood, it is important to acknowledge that in some cases, cultural traditions are not always compatible with an individual’s idea of self. Self-conflict and impaired interpersonal relationships, two characteristics of suffering, may be magnified when the patient is confronted with conflicting ideas of self. Conflicts may arise when the person’s idea of self based on past cultural teachings is incompatible with aspects of the self that are influenced by factors in contemporary life. While idea of self is determined by internal psychological stimuli, it is not always influenced by external cultural norms. Idea of self is an internal perception that reassures an individual of his or her uniqueness in the world. Culture is the external influence of others that shapes one’s identity in society . Factors such as ethnicity and nationality define cultural habits. Ethnicity and Nationality Ethnicity · Ethnicity often refers to a common and distinctive racial, national, religious, linguistic, or cultural tradition. People of a specific ethnic background usually have a common geographic origin, migratory status, race, language, and dialect. They...