Culturally sensitive care: the etic-emic controversy and endogenious knowledge systems

1. Culturally sensitive care: the etic-emic controversy and endogenious knowledge systems Symposium: Incorperating indigenous psychologies within cross-cultural psychology. XIXth International IACCP-Congress, BREMEN (2008)

2. Culture is defined as a dynamic concept, as a ‘creation’ and, like any other symbolical object, it is a social communicative construction interactionally emerging through a symbolical process. Gailly, A. (2008). IACCP-Bremen

3. The patient: culture-specific (culturally embedded) demand for help, his/her root and functional identity and conduct and societal functioning. • The therapist: a western scientific credo (professional identity), that also reflects a blueprint of the western world view Gailly, A. (2008). IACCP-Bremen

4. This leads to ethnic/culturally differences in: • expressions and explanatory models for feeling well or unwell; • The way in which help and what kind of help is looked for; • Problems in diagnostic work • and therapeutic compliance. Gailly, A. (2008). IACCP-Bremen

5. The modern western-centric way of thinking • The western modern scientific credo, • the western worldview, and • the western notion of alterity are based on the philosophical tradition of Descartes and the Enlightenment. • What are the consequences of a western-centric way of thinking for a CSC? Gailly, A. (2008). IACCP-Bremen

6. Cartesianism ‘Reductive way of thinking’: • A problem is to be solved by reducing the problem to infinite separate sub problems. • In such a segmental approach each individual as anatomico-fysio pathological object is reduced to a multiple and unlimited number of subdisciplines (e.g. the organisation of hospitals, so called multi-problem families, etc.) and each is supposed to solve a part of the into sub problems reduced complex problem (an unlimited number of specialities with a limited role of signifying). Gailly, A. (2008). IACCP-Bremen

7. The body-mind separation and analogously the separation between: subject/object; spirituality, belief/matter, ratio; human-/preterworld; individualism/collectivism Mechanistic view of life Materialistic concept of mind Illness in terms of ‘natural’ causes and/or biomedical change Gailly, A. (2008). IACCP-Bremen

8. The Enlightenment The ‘new world’, western modernity: • The authority of the church and religious tradition was substituted bi a faith in independent critical thinking and scientific investigation, • A belief in progress and that progress is inevitable and unending (‘La condition humaine’ would become progressively better), • The static, tradition bound culture was substituted by a belief in an unending progress, linear evolution Gailly, A. (2008). IACCP-Bremen

9. The critical thought of the Enlightenment is characterized by values such as: • Rationality and objective reality, • The right and freedom of choice, • Individualism, • Relativity, • The mastery and development of life, time, and space (leading to a continuous linear improvement of ‘la condition humaine). Gailly, A. (2008). IACCP-Bremen

10. The modern western human being is a self-made individual, the center • Responsible for his/her health and well being, for acting morally, for the ratio, and for progress and authority • Human beings are defined by quantifiable achievements • The sense for practical order that inspires objectivity, mastery, and manipulation affected mankind in his transcendental dimension and inner subjectivity. Gailly, A. (2008). IACCP-Bremen

11. The compartmentalising framing mirrors the modern scientific credo, and the western viri-centred, materialist, individualist, organicist views on the human being. It reflects the western world view and theories that give pre-eminence to the self above the group’s voice (or the ego-centred or narcistic subject above the socio-centred group responsible), rationality above emotion, and speech aboveinteriorisation. Gailly, A. (2008). IACCP-Bremen

12. A western-centric way of thinking leads to a psychologising ethos: • A pronounced cultural preoccupation with the individual self (considered as: analytic, individualistic, materialistic, and rationalistic) • that is represented in Western psychology/psychiatry as: - personal, subjective and autonomous - self esteem, integrity, ego boundaries - feelings of self depreciation, helplessness, guilt, desintegration, passivity, dependence and entangled family relations Gailly, A. (2008). IACCP-Bremen

13. The psychologisation of life-styles, life-conditions and life-events • A concern with the place of emotions in making sense of the social world • The emergence of therapists to guide the emotion-laden self through modern social life Gailly, A. (2008). IACCP-Bremen

14. The medical (re)interpretation of a growing number of experiences and behaviors through the disease model (i.e. then pathological definitions of addiction and disorder) • The cultural emphasis on the language of victimhood Gailly, A. (2008). IACCP-Bremen

15. Non-western - Social integration and harmony between person and environment, between famlies, within society and in relation to the preternatural, - Balanced functioning - Protection and caring Western - Self-sufficiency - Personal autonomy - Efficiency - Self-esteem Ideals of mental health Gailly, A. (2008). IACCP-Bremen

16. Non-western Acceptance Harmony Understanding by awareness Contemplation Body-mind (spirit) unity Western Control Personal autonomy Understanding by analysis, knowledge Problem-solving Body-mind separation Therapy Gailly, A. (2008). IACCP-Bremen

17. The western approach is confronted with different issues as: • How and where do we put a divide between multi-sense and ideosyncratic creation of meaning, paradoxes, confusion and unacceptable choices, nonsense and insanity? Gailly, A. (2008). IACCP-Bremen

18. How do we take into account: • The socio-centred personality when obligations refer to the social and family management of ethics and honour? • The mediterranean, passionate and matri-centred ethos of honour? • The culture specific interconnecting of illness, ill fate, ill feeling and evil (maladie, malchance, mal-être, mal)? • The individual’s dependence on his/her uncontrollable double, on his/her good or ill fate? • The humoural logic underscoring the views on sickness/illness, healthy food, places and activities, healing and good health? • Devinatory and oneiric hermeneutics? Gailly, A. (2008). IACCP-Bremen

19. Summary CSC should aim at espousing the patient’s endogenous rationale • The western exogenous nosology and anamnesis and • The western pragmatic and a-religious views underlying our formal care providing Gailly, A. (2008). IACCP-Bremen

20. The western-centred way of thinking differs from other local endogenous knowledge systems (The culturally embedded creativity for what participants develop as knowledge, epistemology, metaphysics, and world view). In this perspective, any form of knowledge, even western sciences, is local endogenous knowledge. Gailly, A. (2008). IACCP-Bremen

21. Understanding cultural idioms of distress needs a search for the cultural-specific sources of local endogenous knowledge systems. CSC needs an integration of different local endogenous knowledge systems. It is no longer either ‘traditional’ or ‘modern’ knowledge. Gailly, A. (2008). IACCP-Bremen