Culture and Practice: What’s in a name?

A number of years back there was lots of discussion – I think it may have originated in nursing scholarship – about the need for practitioners to develop “cultural competence.” At the time I was working in project management and anthropological research in Guatemala, and my initial reaction was “Wow. It’s about time.”

As time went along, though, the concept began to seem inadequate to me for several reasons. There is, first, that “cultural competency” is an unlikely goal to be achieved by even the most dedicated of outsiders — or consciously recognized by even the most cosmopolitan and self-reflective of insiders.

“Culture” is just too dense, and too much the result of a lifetime of experience, for an outsider to gain “competence” by reading a few books, or spending a few weeks in a another society, or taking a course or two. In fact, my first dissatisfaction with “competence” as a guiding concept was that after spending years living and working with the Guatemalan Maya, I still never felt like I really “got it” when it came to cultural reflexes and priorities. So I was distinctly suspicious about the idea that some medical or social work practitioner could just sort of stick a toe in the cultural waters of any population and walk away with workable and helpful “competence.”

For the insider, meanwhile, culture is too bound up with conflicting worldview paradigms and unquestioned mythologies to easily gain an objective view of the rules, problems, and pathologies, not to mention the graces and beauties, of the cultural universes in which we live. This really struck home in my research in the summer of 2018, when I introduced long-time Maya colleagues in Guatemala to Transformational Collaborative Outcome Management (TCOM) psychosocial assessments. Together, we administered the Family Advocacy and Support Tool (FAST) to caregivers of a dozen rural Maya families, and the Child and Adolescent Needs and Strengths (CANS) assessment to more than a dozen specific children. I will be writing about this experience in future articles as our research continues, but suffice it for now to say that my colleagues had a Eureka Experience about their own culture and reality by using TCOM tools to dive into the lives of clients they thought they already knew well. And that their reaction in that respect was, in itself, a Eureka Experience for me, in terms of making clear how hard it is to scratch the surface of one’s own culture.

But of course the inability of members of a society to recognize the parameters of their own culture is not limited to exotic indigenous peoples. No indeed, I myself am continually baffled by more or less discrete social groups that surround me in my New York home, and I often don’t understand and/or guess wrong about the internal logic and basic cultural assumptions held by religious sects, African Americans, Latinos, LGBTQ, and even those outside my own political tribe.

Anyway, thank goodness the notion of “cultural competence” was pretty quickly replaced with the improved idea of “cultural sensitivity,” which has since been superseded by “cultural humility” as the compassionate and politically correct paradigm for intercultural practice.

Of the three, at least in some ways I like the notion of “sensitivity” the best. “Humility” too often is just a little too obsequious and forgiving for me. I am, I mean, a devout moral relativist when it comes to judging sins and crimes in other cultures. At the same time, I am not particularly humble or shy about pronouncing that one or another sociocultural practice is unproductive or just dead wrong from any acceptable moral perspective. There’s no way I’m going to accept gross mysogyny, or slavery, or child abuse, or addiction, for instance, as merely a manifestation of my own lack of awareness or arrogance in relation to the cultural norms of another group.

My attitude in that respect is absolutely relevant to social work, in which behaviors and cultural norms are often in direct conflict with child welfare laws. If “humility” means accepting the validity of sociocultural traditions and mores that make it OK to brutally punish children, or not to send them to school, or to leave pre-teen children in charge of younger siblings for extended periods of time, then humility is not even a legal, much less helpful, attitude and model for the social worker to embrace.

I am fully aware that my preference for “cultural sensitivity” over “cultural humility” is semantic rather than practical in nature. The real issue is that cultural arrogance and chauvinism are always to be avoided on moral grounds, and virtually always unproductive on pragmatic grounds. I also know, however, that questions of nomenclature are important in the way that words and titles frame concepts. And for the social worker, who by definition must enforce codified social norms, the essential element is that sensitivity, or humility, is useful as a way to help the worker maintain compassion while seeking the most effective plan for treatment or advocacy.

Where am I going with this?

I don’t really know at this point. But as mentioned, I will be writing more about my reserach in Guatemala in the near future. Meanwhile, in the interest of better recording my own journey, and hopefully at some point evoking discussion among new readers, I am going to use this blog to post further comments and links related to the subject of medical/social work practice and culture.

Please feel free to chime in if you have any reaction, comments, or thoughts you’d like to share.