Friday, December 3, 2010

Recognizing Culture

Hi Friends,

Ironic that my last post was about writer's block! I have been working through some of that with a new book I am co-writing. It's called "Getting Your House in Order" and it addresses some specific needs of African Americans facing end of life and healthcare decisions. Below is my opening thoughts about culture and how it informs us in ways we may not even recognize.

I hope you are all having a healthy and happy holiday season! Much love to you and yours!

Tiff

Culture. I have heard this word so often but I never took the time to stop and really think about what it means. When we use this word we might be referring to cultures of countries or certain large groups living within those countries. In the US, we often refer to "African American" or "Latin American" culture when we are trying to describe a certain section of the US American population. In some contexts, this may seem to be synonymous with stereotyping and add to the feeling of disconnect between a sub-culture and main stream "America."

In the proper context, however, framing things in the light of culture is a sign of respect and understanding. To acknowledge that not all communities of people think, act and view the world in the same way is the first step in giving and receiving the respect we all desire and deserve. Before we can move past barriers, we must understand each other in an effort to become closer.

The interesting thing about culture is how deep the layers go in our every day lives and how few of us are even aware when we are behaving out of our culture. We look around, assume we are the "norm," and puzzle over others and their silly ways. Or worse, judge others for their ignorant/stupid/strange (insert other adjectives here) ways. It is the judging that pulls us a part and keeps us from learning from each other's strengths. It is the judging that keeps us in a place of "us" and "them."

When Did You First Realize...?

Do you remember the first time you realized that your thoughts were not the same as everyone around you? Do you remember that first argument about something that seemed so obvious and true to you but someone else saw things completely differently? Where you frustrated? Amazed? Confused? Angry? Maybe, on some level, a little scared and taken aback?
Do you remember the first time you realized that other families didn't have the same religious beliefs or rituals as your family? Do you remember what it felt like to try and wrap your brain around the fact that your parents' beliefs were not "the gospel"? (Please excuse the pun.) What did it feel like to know that the world was filled with beliefs about God and the afterlife that were different than yours? How did you react?

Do you remember the first time you went to a friend's house or out in public and your table manners did match up with the people surrounding you? Did they look at you funny? Did they say something? Did you correct yourself automatically, because of your observations perhaps, or did you continue to do things "your way"? Were you embarrassed? Did you think you were "right" and they were "wrong"?

Almost everything we do and think in life has some footing in our culture. As children, we begin to learn that people do things differently. As adults we have the choice to honor these differences, try to change other people, or judge and shun those who think/act in a way that doesn't fit within our culture.

From the way we eat to the way we prepare food, from the way we work to the way we vacation, to the way we grieve to the way we rejoice, our culture has given us guidelines on how to engage the world. Your guidelines are not my guidelines. Before I can begin to understand your guidelines, I have to become aware of my own.

Where Did this Come From?

For the next few weeks, try this exercise on culture. Pay attention to the following "categories of life" and make notes about how you do things and when/where you remember learning this (if you can remember it at all.)

When possible, observe others who do things differently. If you can, ask them about when/where they learned to behave that way. Explore with them where they may have picked up the behaviors/attitudes/beliefs and their awareness of the cultural background. If possible, ask them the questions below and discuss your commonalities and differences.

Food:

What is your relationship with food? What does food mean to you? What kinds of food to you like? What kinds of food do you prepare? When you sit down to eat, who is with you (if anyone)? What do you like most about food? What do you like least?

Emotion:

How often do you show your true feelings? How often do you hide them? When you feel very happy, what is an appropriate way to express it? When you feel very sad or angry, what is an appropriate way to express it? Do you show your emotions differently depending on if you are in public or in a private setting? When you express your emotions, do you think about how it will impact those close to you?

Holiday Traditions:

What holiday is most meaningful to you? Why? What do you (and your family/friends) do to celebrate this holiday? In general, do you like holidays? Why or why not?

What other facets of life can you think of that are influenced by culture? Write your list and take notes!



Culture and Illness

When my grandmother was not told I had CF, I felt like my family culture was telling me that this disease was a burden too big for some to carry. When I didn't graduate from college because my genetic illness had become end-stage, it was my middle-class culture that told me I was a failure and not as worthy to speak up in certain conversations with "educated people." When I sat in the holding area before my lung transplant and felt the need to stay sunny and talk about everything other than my true fears, that was my Anglo-Saxon culture telling me to "keep my chin up." When I saw my Irish aunt screaming at the wake of her husband it was all of the cultures I had grown up in that made me so intensely uncomfortable with her way of grieving.

Illness and loss, perhaps more than any other life experience, brings out the bright lights and quiet shadows of our cultures and attitudes. Without being aware of it, we might be rubbing elbows with other cultures and people who are moving through this journey differently. At a time when our emotional skin is so sensitive, when are psyches are so vulnerable, this can cause for tension and misunderstandings.

Add to that, that we must also be functioning within a healthcare system that has its own culture and imposes a set of behavioral expectations on patients and families. Families grieving too loudly may be moved to another area. Families showing up in large groups might be asked to leave. Patients crying might be sedated. The culture of healthcare is often one that demands little outward emotionality and a submissiveness to the healthcare authorities.

As patient/family centered care begins to become a more popular ideal, this culture is truly shifting. However, it has not yet found solid footing when it comes to honoring the process and culture of a variety of individuals, families and ethnic groups. The past has caused hurt and distrust. The now is in a place of unfolding. It is a time of re-shaping our healthcare culture for a more inclusive and compassionate environment. This requires personal awareness, education and a commitment to compassion (on both sides of the healthcare curtain).

Are we ready for this? We have to be. There is no other time than today to begin working for the best healthcare experience possible.

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