Culture, how we view human difference, and abuse
An e-mail conversation with another blogger helped get me thinking about the practical implications of some cultural differences again. In particular, differences in what is seen as a mental health/developmental problem to begin with, and how it’s appropriate to deal with other people. (More straightforwardly physical health stuff warrants a post of its own.)
Searching for something else entirely, I was interested to run across some material on cultural competence in health care. What I found, looking into that further, varied rather a lot in levels of understanding (less than surprising)–not to mention trying to cover a whole continent’s worth of cultures in one piece, as opposed to, say, treating the Hmong separately–but some of the stuff really helped illuminate my own experiences, and those of people close to me. It was good to find some of the things I’d observed explicitly written down by “experts”. Especially in the face of a history of invalidation and gaslighting which led me to identify very strongly indeed with Amanda’s Why I never expect to be right.
In that spirit, I’ll quote a block from Levanne R. Hendrix’s Health and Health Care of AMERICAN INDIAN AND ALASKA NATIVE ELDERS (which, ethnogeriatric focus aside, does not apply just to elders)–unless otherwise specified, quotes are from this:
Dementia and Caregiving. American Indians appear to have a lower frequency of dementia than other populations and are less likely to be institutionalized than older Whites or Blacks despite higher rates of chronic illness (Chapleski, Lichtenberg, Dwyer, Youngblade, & Tsai, 1997). Orientation to the present time, taking life as it comes, and a general acceptance of physical and cognitive decline as a part of aging ar believed to be contributing factors in caring for a cognitively impaired elder in the community (Ogrocki.,Welsh-Bohmer, & Allen, 1997). It has been suggested that AI caregivers differ from White caregivers in the use of “passive forbearance” as a coping strategy, which was not found with White caregivers. Also, AI caregivers did not expect to control or to be able to gain control of the situation of caregiving for a cognitively impaired elder, whereas the White caregiver did expect control, leading to anger and frustration (Strong, 1984)…
The concept of caregiver “burden” is unacceptable in many AI cultures, and behavior by a person with dementia that may be considered inappropriate in Euro-American culture, is accepted in the AI elder’s community without social stigma (Henessey & John, 1996b). AI caregivers from the southwestern Pueblos reported that they “often felt inadequate dealing with behavioral difficulties” such as stubbornness, resistance to caregiving regimens and repetitive requests. However, cultural respect for elders with or without dementia does not allow for the direct expression of anger toward the elder or for infantilization witnessed in Anglo settings (John et al., 1996). The cultural incongruence of caring for an elder with cognitive impairment and the cultural values of non-interference, individual freedom, non-directive communication and respect for elders may increase stress felt by the caregiver significantly. Culturally appropriate support systems would be important resources for providers to offer as resources to AI caregivers.
From an abstract Stress and Caring for Elderly Relatives: Interpretations and Coping Strategies in an American Indian and White Sample, with one keyword being “locus of control”:
In semi-structured interviews with 10 Indian and 10 white caretakers of ill elderly relatives in the rural northwest, 11 dimensions were used to define caretaking, with a focus on control. The results imply that cultural background influences the meaning of caretaking and that both variables affect the coping strategies selected.
Searching for a better idea of what Hendrix means by “passive forbearance”, I ran across another relevant abstract: The Infant Caring Process among Cherokee Mothers. (Passive forbearance must be described in the paywalled full text.) Some things mentioned? “using noncoercive discipline techniques, and vigilantly watching for the natural unfolding of the infant” Similar is also mentioned by North-Eastern Band of Cherokee Indians:
Cherokee mothers parented in a way that the harmony, or natural development of their children’s lives, was promoted through passive forbearance. The mothers did not parent in a way that controlled their children’s development, but rather parented in a way that enhanced their children’s natural development through unobtrusive, respectful behaviors like listening, observing, and being an example, or passive forbearance. Another Cherokee ethos is group support and collaboration instead of competition. Cherokee were matriarchal, matrilineal, and matrilocal before the European invasion.
I get the impression that “passive forbearance” is being used in about the way I thought, even if it seems like a very clunky (and loaded) descriptive term.
Overall, what pattern is showing up here? People are meant to be different, and it’s important to encourage and support them however they may develop. You may not understand why the person is the way they are, but that’s more likely your failure than the other person’s. There is some reason for it, whether or not you understand what that is–much less like it. Trying to make the other person be someone they’re not is destructive, and that kind of control cannot come from good motives.
You couldn’t change the other person even if you had a right to do so, so what are you going to do? That’s where the loaded “passive forbearance” comes in. You’d better learn to get along with them, because they are not magically going to change. And, again, you have no right to insist that they should. Better that you try to understand where they’re coming from. If you can’t, you’d better at least act civil toward them. Besides interdependence, pragmatism applies here: we’re looking for the best outcome for everyone involved.
This applies to everyone, and cultural differences are particularly evident in how a society considers it appropriate to deal with children, elders, and disabled people. I included the “matrilocal, matrifocal, matrilineal” (not patriarchy turned on its head) in context, because it seems to me that how a society treats children often indicates how it will treat elders and disabled people, even when it’s specifically staying away from the infantilization. In a society in which women strongly set the tone of interaction–and grandmothers were the closest thing to civil authorities!–I would really expect this to be the case.
As mentioned, people just don’t put their elderly (or disabled) family members into institutional settings, except in very extreme cases where there is just no way to care for them properly at home. (My Nana’s 96-year-old aunt, for example, who became bedridden on top of her dementia, with family members in their 70s-80s the main ones able to look after her. Not a good situation.) The very different approaches has something to do with this, too: if you have a reasonable expectation that someone you care about is going to be infantilized, treated with very little respect or dignity, and very possibly subjected to abuse, wouldn’t you avoid putting them into that situation?! Assuming, of course, that you have been taught that they are entitled to respect and dignity.
In this kind of cultural context, there is not much room for perceived burden–dealing with kids, elders, or disabled people. Where’s the burden? You could probably find some if you looked hard for it, but why do that?
These patterns also tie in nicely with my earlier Perceived locus of control, and suffering post. If you feel like you have a right/obligation to control people around you, you are more likely to suffer. Partly because it doesn’t work, and the other people get really upset and even less likely to do what you want (wonder why?).
What does this approach lead to?
Most cases of elder abuse reported in Indian country are for neglect, although financial abuse is probably more widespread, but clouded by the cultural norm of sharing one’s material possessions, food and housing with other family members…In addition, some AI/AN may not be aware that their behavior is considered abuse….the victim may not recognize the situation as abuse
Surprise: with these attitudes, you don’t get the overt and systematic abuse of elders and disabled people! Without the built-up frustration levels, perceived “burden”, and perceived right to control other people, there is no reason to behave abusively. This kind of approach does not encourage, say, murdering autistics, much less other people sympathizing with the murderers to the point that they are not charged properly. Parents (and the disabled people!) are more likely to have support, besides less perceived burden in the first place. The disabled people are highly unlikely to be viewed in negative terms, up to and including as soulless automata, with no empathy nor desire to communicate.
Recently, in a neighboring town/suburb, a mother made her autistic son drink bleach, telling him it was “medicine”; at least she has been charged , possibly because way she murdered him was so horrible. Still, ‘Neighbours said the boy was “severely autistic” and that his mother had been struggling to cope…Barking and Dagenham Council said: “This is a tragic incident. Our thoughts are with the family. A number of agencies have had involvement with them over several years, including the police, the NHS, and other local authorities.”‘ Still, there was plenty of caretaker burden, and the kid was left in a situation where he was eventually killed with bleach.
Back to the quote on elder abuse. I’d imagine that there is some real neglect going on, but I’ve seen firsthand some things that could be misinterpreted that way. My mother spent the last years of her life looking after my grandmother with dementia, eventually moving in with her at my grandmother’s insistence. (BTW, there’s some of your financial abuse that nobody involved sees as such. My mom was seriously disabled too, and really could not do paid work even if she had not been providing 24/7 in-home care. The same went with my stepdad, though there were other factors there. If taking care of family members were considered Real Work by our society, caregivers would not be left in such a bind.) On the perceived neglect front, if you do not feel like you have the right to force other people to do what you want, what can you do if another adult human being refuses to eat properly? What can you do if they resolutely refuse to go to a cardiac rehab exercise program? Can you wrestle your elderly mother into the bathtub if she does not want to bathe regularly? Can you shove pills down her throat like a cat, if she cannot be persuaded to take them? And so on.
From this perspective, the best you can do is try to understand what might be motivating the person, why they might be experiencing difficulties, and try to remove obstacles. You can prepare them a well-balanced meal and encourage them to eat it, but you cannot hold them down and force feed them. You can listen to them, try to make things easier, and jolly them along–and that’s about it. (And don’t take the behavior changes personally; that way lies madness and resentment galore.) Yes, all of these things arose dealing with my grandmother; helping out, I dealt with all of these scenarios personally. It’s a difficult balancing act, all around. While the results may sometimes look like neglect–especially if you’re working on a set of assumptions which encourage that kind of thing–it’s not the same.
An analogy occurred to me, though it’s more a demonstration of different applications of the same approach: letting a bear come in the house, as a companion animal. This used to be fairly common over a lot of North America. But, to do that, you’ve got to (a) recognize that you are dealing with a bear, not a dog or a raccoon, (b) recognize that this is a specific individual bear, with its own individual qualities and needs, (c) get to know those qualities, and figure out what those needs might be, (d) work with the bear. If you don’t do all those things, things are going to turn ugly pretty quickly–both for the humans in the house, and for the bear. (That does not make it a Bad Bear, mind you.) Trying to make the bear stop acting like a bear is both cruel and a fool’s game; everybody involved is liable to suffer. OTOH, if you respect and work with the bear, everybody is going to be happier and better behaved, and you are not going to get your head swiped off. The bear is much more likely to respect you and try to please you, and learn better how to deal with the humans involved. The same applies to dealing with other humans.
ETA 4/2012: Then there is Kevin Richardson, who I found through some photos shared on G+. (If you click through on that image to the gallery, there are a number with hyenas and big cats other than lions.) From the “About” page linked above: “[H]e uses love, understanding and trust to develop personal bonds with them. His unique method of getting to know their individual personalities, what makes each of them angry, happy, upset, or irritated-just like a mother understands a child-has caused them to accept him like one of their own into their fold.” Yeah. It’s just a shame this is considered such an unusual/impossible thing. /ETA
As I went into some in the Attitudes, disability, and violence post, respect is one of the best preventatives around for violent behavior, not to mention disability itself (under the social model; discrimination hurts).
Looking for something else entirely, I ran across a section of Transcultural nursing: assessment & intervention by Joyce Newman Giger and Ruth Elaine Davidhizar, dealing specifically with Appalachian cultures. It isn’t nearly as bad as it could have been, and I can see where the researchers they’re basing this on might have formed some strange interpretations*. Very much the same way as indicated by the reasonable observations that:
Because the dominant communication mode for Appalachians is high context and that for health providers is low context, opportunities for misunderstandings are maximized.
Nonverbal communication patterns may also vary. Although common among many groups, direct eye contact is often viewed by Appalachians as impolite or lacking good manners (Hicks, 1969; Mullen & Phillips, 1998) or even as aggressive and hostile behavior (Helton, 1995; Murray & Huelskoetter, 1991).
(Community health nursing: promoting the health of populations by Mary Albrecht Nies and Melanie McEwen, also mentions that “Asian, Native-American, Indochinese, Arab, and Appalachian clients may consider direct eye contact impolite or aggressive”.)
I was going to include more specific complications of communication failures and misinterpretations–some of them leading to poor assessments of mental health–but that will have to wait for a possible post of its own.
More relevant in this context, the authors draw on Tripp-Reimer’s identification of “four interacting Appalachian cultural patterns: independence, the ethic of neutrality, familism, and personalism”:
In his early ethnographic work, Hicks (1969) reported that Appalachians demonstrate what he termed an ethic of neutrality. This is evidenced in four behavioral imperatives: (1) avoiding aggression or assertiveness, (2) not interfering in another person’s business unless requested to do so, (3) avoiding domination over other people, and (4) avoiding arguments and seeking agreement. Consequently, there may be low tolerance for paternalistic or prescriptive behavior patterns.
Also mentioned is a tendency to orientation in the present (and on “being” more strongly than “doing”). “They have been described as believing that because tomorrow is not promised, they must live for today. While this has been interpreted as fatalism, it may also be interpreted as a realistic understanding of life circumstances.” This also shows up in the Hendrix paper.
Again, I’m not sure about some of the ways of describing this kind of public conflict avoidance, but the very different approaches here can lead to one hell of a lot of misunderstandings, bad feelings, and inappropriate medical treatment. This kind of thing is mentioned multiple times in the Hendrix paper I’ve been quoting heavily, including the preference for using family members as go-betweens if the health care provider does not seem to be paying proper attention to–or even understanding–what you’re saying. This may well get a post of its own, because it’s important stuff.
Again, stated a little differently, we’ve got non-interference, not trying to control other people, and trying hard to get along as cultural imperatives. There’s also an emphasis on not trying to motivate people through ridicule (which still amazes me as a tactic!), and on serious ridicule in general not being acceptable. I’m guessing that Hicks was mostly describing more public behavior, but all of that carries over into more private interactions.
Also, from Hendrix’s section on explanatory models for dementia**:
Dementia is a part of the Creator’s plan for that person’s ultimate learning and may not require intervention or help-seeking (“naturalization” of cognitive impairment and dementing behavior, with greater “tolerance” for a wide range of behavior than white communities) (Cherokee).
Again, I was glad to find this explicitly written down by someone outside the culture in question, even clunkily phrased. This does not just apply to dementia-related behavioral changes, but to human (and nonhuman, for that matter) behavior in general. It’s hard to overstate how important this conceptual difference is to mental health and neurodiversity considerations. It is not OK to dehumanize other people because you may not readily understand their behavior, and there is some reason for it even you never can figure out what that might be. This kind of approach to human diversity is not compatible with the Broke Brain Syndrome model Western medicine pushes these days.
Also, from a section on mental health:
Prevalence and manifestations vary depending on background difference and areas of residence (Manson, Shore, & Bloom, 1985). There is concern about the validity of using western measures of depression with American Indian populations due to vast differences in cultural beliefs about mental illness, cultural labeling of different emotions, variability of manifestations of depression (rarely DSM IV criteria), and conceptual language differences (Manson et al.).
See also The [Euro-]Americanization of Mental Illness, along with Do people suffer from psychiatric disorders/diseases or do people experience varying degrees of human suffering in their own idiosyncratic ways? — Tim Desmond, which offers a similar perspective.
Indeed, there is very little room for Broke Brain Syndrome, coming from the Tutelo/Cherokee perspective I’m familiar with. Very much like the example of grief, experiences which get called depression and depressive symptoms–along with other kinds of mental illness symptoms–are an indication that something is wrong in your life. You may have to look hard to find what’s wrong if you’ve been immersed in the same conditions for a long time (have experienced the “fish in water” phenomenon myself), but something is out of whack somewhere. Emotional distress is a natural reaction to things in your life being out of balance.
That may be as simple as a job you can’t stand or someone in your life not showing you respect. It may be coming from living in an abusive situation, or from trying to cope with otherwise getting treated like crap (all kinds of nasty -isms included). You may be caught up in multigenerational trauma. You may have suffered a traumatic brain injury, and be trying to adjust and cope; fatigue, etc. may also be direct results of your injury, and learning a different way of dealing with those symptoms might help.
If you’re in distress, something is out of balance, and it’s unlikely to be as simple as a neurotransmitter or two. (I went into this more in Balance in a Bottle?) There is also neuroplasticity; we’re all growing and changing all the time. Oversimplifying as complex a system as a human being is apparently very tempting, besides very dangerous. As complex as living beings are, the reasons for their distress are just at least as complex; if you’re simplifying things for better understanding (again with the locus of control), it’s important to acknowledge that you are building and examining a simplified model. Don’t confuse that with reality.
Keeping the earlier discussion of differences in approaches in mind, it’s not hard to see what kinds of stresses and imbalances might be showing up in your life if you’re autistic (or otherwise sufficiently “different”) and trying to cope in a society which pathologizes your differences. It can get oddly recursive, after a while, as your reactions to shoddy treatment get further pathologized.
But, as I’ve been finding more lately, even if you can’t completely get away from some of these stressors, you can work on balancing things out by recognizing and examining the way you’re reacting to them. Some circumstances really are well beyond your control, but your reactions don’t have to be. Again, I was very glad indeed to figure out that you really don’t have to buy into and engage with all sorts of petty, hurtful attitudes and behaviors. You can recognize that whatever problem exists is not always yours.
Not surprisingly, getting caught between these two different ways of looking at and understanding things can be very uncomfortable indeed. (And is fairly common, AFAICT, when you’re trying to function in two cultures at once.) Hearing two wildly different explanations of your “symptoms”/”what symptoms?!” can make it that much harder to figure out how to frame things in your own mind. I’m working on trying to untangle some of the very real damage these conflicting messages and expectations can do. Nowhere is this kind of thing more evident than where mental health is concerned.
In an explicit neurodiversity context, I can’t help but think of Morgan Wilburn, a.k.a. “vacuum boy”, from the Roanoke Valley, who got rather a lot of attention 10+ years ago when he was 7 or 8. The kid’s special interest was vacuum cleaners, especially Bissell water-cleaning models. When an article about him showed up in the Roanoke Times, he had 21 of them and a bunch of rug remnants to play with them on; after that attention, he ended up with 42 machines.(And a tour of Bissell HQ, along with a savings bond for college from them; their overall reaction made me more likely to buy their machines). Not surprisingly, he could go on for hours about different vacuum cleaner models.
A lot of people would consider this strange, and even intervene to try to break his “obsession”. His family apparently considered it a quirky hobby, but harmless enough, as long as he didn’t fill up the whole house with vacuum cleaners. Instead of seeking psychological help for the kid–or otherwise trying to convince him there must be something wrong with a person whose favorite playthings are vacuum cleaners–his family kept giving him more vacuums and encouraging offshoot interests. Everybody’s interests are different, and Morgan wasn’t hurting anybody. Even the newspaper managed to be fairly respectful, and not openly ridicule the kid or pathologize his behavior. I remember when he appeared on Letterman, and his parents seemed surprised and put off (no wonder!) by the fact that not everybody was laughing with him–much less that some obviously considered an interest in floor-cleaning appliances particularly inappropriate for a boy.
I can’t help but be glad to have come from a background in which people are expected to have a variety of interests–and in which they’re most likely to tell you about their scuba diving or jewelry making in response to the old “What do you do?” inquiry. The acceptable range is pretty broad, as long as the person is not doing any harm. It might be considered odd if you can’t talk about anything other than a strong interest, but just having one or more doesn’t come across as weird. Even if it does, people are entitled to be weird–again, as long as it doesn’t hurt anybody, which can include not being able to fulfill other obligations such as taking care of yourself. That’s when it becomes other people’s legitimate business; otherwise, it just falls into the “that’s just the way s/he is” category.
This comes down to a firm sense of boundaries, and noninterference. If you honestly feel entitled to tell another person what they should be interested in, you’re the one demonstrating a problem. The same if you project bad intentions, and assume the other person is doing things just to get on your nerves. Even if you don’t understand the other person’s thinking and motivations. Just because they strike you as odd does not place the onus on them. If their behavior and thinking come across as strange enough that you think they’re crazy, they need more consideration, not less. That applies whether you just think the other person might be mentally ill or developmentally disabled, or whether they really are.
That, in turn, is part of the huge philosophical difference between personal freedom rooted in a recognition of interconnection and interdependence, and the rugged individualism it’s sometimes confused with. Anybody reading this is probably very familiar with Western versions of individualism, which frequently gets set up in opposition to more collectivist approaches to running a society. That’s a pretty simplistic way of looking at things, anyway–this is yet another thing that looks more like a spectrum. But, as I’ve seen pointed out multiple times (in David Stannard’s American Holocaust, Barbara Mann’s Iroquoian Women, and IIRC John Mohawk’s Utopian Legacies, among others), a lot of North American societies managed to strike a rather unusual balance there. (Yes, duyukta also applies here!)
At least part of my take on this is that it’s hard to get full individual development going without firm support–and similarly difficult to get a strong, supportive society going without encouraging a wide range of individual differences and the freedom to develop them. (I won’t even go further into varying concepts of what a human society should be and how it should function.) The two things go together, and hopefully balance one another. From one perspective, an individual’s opportunity to act independently is constrained by relationships and obligations. From another, that framework of (voluntary) considerations helps discourage and temper selfish and/or harmful individual acts. The larger societal framework benefits from strong individuals working together, while it provides necessary support for these individuals to develop their potential. Not only does the society have access to a wide range of expertise, its members can more readily look toward seventh generation-type considerations.
Yes, this describes one very practical version of an egalitarian, anarchist setup in action. And, like the peace procedures*** that grow out of this kind of society, keeping this kind of balance up is an ongoing process. It may look easier in the short term to fall over on one side or the other, and just go around knocking other people in the head with various justifications–as leafing through most history books will demonstrate. Finding and maintaining better balance is very possible, though (she keeps reminding herself).
It’s hard not to start looking at larger-scale views of human interaction and organization, starting from as seemingly simple a point as “hey, people are different, how do we deal with this?”.
* Even to the point of perceiving a “basically patriarchal”* family structure, in which women are the ones mostly making health, food, etc. decisions for the household! If a patriarchal pattern is what you’re expecting to see, and aren’t used to protocol in the particular high-context culture, I guess it could look that way. I have sent Nigel to talk to male strangers asking nosy questions, and it had nothing to do with status nor who’s the “head of household” (does it need one?). And I’m not going to start loudly disagreeing with him in front of strangers, which has been misinterpreted as some form of deference. On the woman’s part, mind, since that’s what more observers are expecting, even though the unified public face goes both ways. This whole misinterpretaion looks like a smaller-scale version of how the very existence of women’s councils was missed in past. (And also goes along with the continued erasure of Native cultural influences within the region, at all–even when the authors could just as well be describing, say, Cherokee cultural traits.)
Hmm, could this also have something to do with that old “low tolerance for paternalistic or prescriptive behavior patterns”?
** Compare to Giger & Davidhizar’s description of Appalachian traditional health beliefs:
Illnesses are thought to result from the “will of God,” a natural imbalance, or the body’s response to personal habits, specific situations, or external exposures, particularly cold weather or “the cold” in general. Lack of “personal care” is an additional cause of illness. It includes (1) keeping the body strong, (2) eating right, and (3) taking fluids (Hansen & Resick, 1990).
This sounds like a clumsy way of describing a duyukta-based system. They left out the emotional factors in “personal care”, besides things like getting enough sleep and finding a not-so-stressful balance of activities. A lot of this model is not so strange; e.g., avoiding/treating “high blood” through working on stress levels and balanced eating habits, and not pickling yourself with salt–or the simple observation that you’ll sleep better and feel better overall because of it, if you work out resentments/worries and don’t drink coffee late in the day! In the language lessons through Cherokee Nation in OK, Ed Fields also mentioned the old “cold exposure accumulating over time in your bones” model of arthritis/rheumatism, which I’d heard before. Here, “the Creator” and the “will of God” are better understood as ways of describing the non-anthropomorphic “Great Mystery” to people less familiar with that concept–i.e., there’s probably some reason for it, and it’s serving some purpose, whether or not you ever figure out what these might be.
You have the power to make peace with an enemy only if you acknowledge that the enemy is human. To acknowledge that they are rational beings who want to live and who want their children to live enhances your power by giving you the capacity to speak to them. If you think they are not human, you won’t have that capacity; you will have destroyed your own power to communicate with the very people you must communicate with if you are going to bring about peace. . .
The Haudenosaunee Law of Peace assumes that peace is not achievable as a static condition, just as relationships between human beings are not static but are always unfinished.
What you can do is reach a place where you can work on resolving conflicts. You can find out why the two parties continue to have conflict and try to remove those irritants that have caused violence. You can reach enough of an agreement to take the conflict from warfare to a place where, as they used to say, thinking can replace violence, and where the conversation about peace is ongoing. . .
The hope is that the process of thinking and talking continues until it becomes normal that we don’t kill each other. But we have to remember that there is never an end to it.