“In all affairs it’s a healthy thing now and then to hang a question mark on the things you have long taken for granted.” — Bertrand Russell

Self-reflection is crucial to the cross-cultural learning process. Without understanding that everyone has a culture, and that knowledge of one’s own culture is crucial, we have a tendency to reduce learning about culture to a manual-based approach, applying lists of dos and don’ts too rigidly and thereby stereotyping. Self-reflection begins with gaining knowledge about dimensions of culture and learning to apply these informed generalizations to our own culture. We thus develop a baseline for making effective comparisons about cultural differences and understand better why we respond in different situations the way we do.
The meaning of “culture” has been widely debated and it can be defined in many ways. For our purposes in the medical field the following definition is useful:

Culture can be seen as an integrated pattern of learned beliefs and behaviors that can be shared among groups and includes thoughts, styles of communicating, ways of interacting, views on roles and relationships, values, practices, and customs. (Robins et al., 1998b)… Culture should not be considered “exotic” or about “others.” We all are influenced by and belong to multiple cultures that include, but go beyond, race and ethnicity. (IOM)

As humans, we develop our self-esteem and identity within a particular cultural context. Without a clear cultural identity, we would experience confusion and isolation. Our resistance to cultural difference is natural. It is important to recognize the resistance we feel, to see it as part of being human and avoid turning it into something negative. Resistance to cultural difference is a phase we pass through on the way to becoming more cross-culturally aware and skillful.

To begin moving beyond resistance, we first have to ask some basic questions. Do we see our own culture as the “one” that is central to reality? Do we assume our way of operating in the world is better, thereby trivializing difference automatically? In the field of intercultural communications, the terms ethnocentric and ethnorelative are often used. Ethnocentric means that we view our own culture as being central to reality. Ethnorelative means we can indeed experience our own culture within the context of other cultures. Moving through resistance means moving towards a place of comfort in the ethnorelative stage.

You might be thinking at this point, “OK, I understand the concepts here, but what can I DO to become more cross-culturally skillful. The answer may surprise you. The first step is learning more about your own culture – American culture and how it informs western medical culture specific to the US. Are you thinking, “We Americans don’t really have a culture because we are a melting pot of other cultures.” If so, you are in good company; many of your fellow Americans feel the same way. But you do have a culture, and it is a very specific one. Your culture is something people around the world are keenly aware of, so it’s a good idea to learn how others see you. Further, as a health care provider to multicultural populations, it is vital that you understand your culture as a baseline for comparing other cultures. Hopefully this feels like good news because an imbalance has been addressed. Instead of feeling charged with responsibility for learning about everyone else, you realize that you too are part of the culture game. You have something to learn about yourself first, and then, hopefully, learning about others will be more meaningful and more pleasurable. You’ll be able to replace the paralysis of political correctness with an intercultural playfulness. One day, you’ll even be able to laugh at yourself for behaving so darned American in a situation.

It’s worth addressing what we mean by “American” before we start exploring specific cultural dimensions in other cultures,  like time and its control, individualism and language use. Just what constitutes being an American? It’s a tricky question. There are Asian Americans, African Americans, Native Americans, etc. All of these “groups” are absolutely Americans. But for our purposes here, being very specific, we are addressing the styles of communicating, ways of interacting, values and beliefs that are rooted in what interculturalists often refer to as Americans of Western European descent. In other words, historically speaking, white middle class citizens of the US.

Based on the definition we are using here, if you think of yourself as an “American,” ponder the following questions. Go beyond a quick “yes, no” response – feel your answers as they arise in you. This is very important.

• Do you feel as if there’s enough time in your life to do all the things you want and need to do? Most Americans  think of time as a very important commodity. For many, time dictates much of their day.  Much more than other cultures.

• When you ask someone a question, do you expect a straight answer? If she gives a long story as an answer or “beats around the bush,” does it frustrate you? Americans tend to be very linear thinkers who value efficiency in most things, including conversation. “Get to the point.”

• How important is a person’s being direct? Do you depend on others to “say what they mean, and mean what they say”? Americans often are direct in their style of communication. They depend on the words they speak to convey the message they intend. Non-verbal cues are given less emphasis than in other cultures.

• Do you believe that hard work and determination will enable you to achieve your goals? Americans tend to believe in their ability to create the future they want for themselves. Americans place far less emphasis on the role of fate in life.

• Do you respect a person who knows his own mind and can think for himself and doesn’t need several other people to help? Americans commonly value what’s good for the individual over the group, and this is very evident in decision making.

• Do you believe in the ideal that everyone should be treated equally? Americans tend to be very informal and believe everyone should be treated the same. In many other cultures, status plays a greater role in social interactions.

• Do you believe that technology and science should be trusted to provide new solutions to replace the old solutions to common problems? Americans (especially medical people) believe in science providing new solutions that are better than old solutions. Most other cultures do not believe this as strongly as we do.

Check out the article titled “Eight Dimensions of American Culture” to learn more about this topic.

‘Understanding Your Own Culture First’ by Marcia Carteret. Copyright © 2011. All rights reserved.