Introduction to Philosophy of Culture

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Philosophy of CulturePhilosophy of Culture

Focus on Medicine as CultureFocus on Medicine as Culture

DefinitionDefinition

•• CultureCulture ((LatinLatin: : culturacultura, lit. "cultivation") is a , lit. "cultivation") is a term that has many different interterm that has many different inter--related related meanings. However, the word "culture" is most meanings. However, the word "culture" is most commonly used in three basic senses:commonly used in three basic senses:1.1.Excellence of taste in the Excellence of taste in the fine artsfine arts and and humanitieshumanities, ,

also known as also known as high culturehigh culture..2.2.An integrated pattern of human knowledge, belief, An integrated pattern of human knowledge, belief,

and behavior that depends upon the capacity for and behavior that depends upon the capacity for symbolic thought and social learning.symbolic thought and social learning.

3.3.The set of shared attitudes, values, goals, and The set of shared attitudes, values, goals, and practices that characterizes an institution, practices that characterizes an institution, organization, or group.organization, or group.


•• The The etymologyetymology of the modern term "culture" has a of the modern term "culture" has a classical origin. In English, the word "culture" is based classical origin. In English, the word "culture" is based on a term used by on a term used by CiceroCicero, in his , in his Tusculan DisputationsTusculan Disputations, , wrote of a cultivation of the soul or wrote of a cultivation of the soul or "cultura animi""cultura animi", , thereby using an agricultural metaphor to describe the thereby using an agricultural metaphor to describe the development of a philosophical soul, which was development of a philosophical soul, which was understood understood teleologicallyteleologically as the one natural highest as the one natural highest possible ideal for human development.possible ideal for human development.

•• Samuel PufendorfSamuel Pufendorf took over this metaphor in a modern took over this metaphor in a modern context, meaning something similar, but no longer context, meaning something similar, but no longer assuming that philosophy is man's natural perfection. His assuming that philosophy is man's natural perfection. His use, and that of many writers after him "refers to all the use, and that of many writers after him "refers to all the ways in which human beings overcome their original ways in which human beings overcome their original barbarism, and through artifice, become fully human".barbarism, and through artifice, become fully human".

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DefinitionDefinitionThe German philosopher The German philosopher Immanuel KantImmanuel Kant (1724(1724––1804) 1804) formulated an individualist formulated an individualist definition of "enlightenment" definition of "enlightenment" similar to the concept of similar to the concept of bildungbildung: : "Enlightenment is man's "Enlightenment is man's emergence from his selfemergence from his self--incurred incurred immaturity.immaturity.““ He argued that this He argued that this immaturity comes not from a lack immaturity comes not from a lack of understanding, but from a lack of understanding, but from a lack of courage to think independently. of courage to think independently. Against this intellectual cowardice, Against this intellectual cowardice, Kant urged: Kant urged: Sapere audeSapere aude, "Dare to , "Dare to be wise!" be wise!"


In reaction to Kant, German scholars such In reaction to Kant, German scholars such as as Johann Gottfried HerderJohann Gottfried Herder (1744(1744––1803) 1803) argued that human creativity, which argued that human creativity, which necessarily takes unpredictable and highly necessarily takes unpredictable and highly diverse forms, is as important as human diverse forms, is as important as human rationality. Moreover, Herder proposed a rationality. Moreover, Herder proposed a collective form of collective form of bildungbildung: "For Herder, : "For Herder, Bildung was the totality of experiences that Bildung was the totality of experiences that provide a coherent identity, and sense of provide a coherent identity, and sense of common destiny, to a people."common destiny, to a people."

DefinitionDefinition•• In 1795, the great linguist and philosopher In 1795, the great linguist and philosopher

Wilhelm von HumboldtWilhelm von Humboldt (1767(1767––1835) called for 1835) called for an anthropology that would synthesize Kant's an anthropology that would synthesize Kant's and Herder's interests.and Herder's interests.

•• It would be necessary for this purpose, It would be necessary for this purpose, Humboldt thought, to accord a positive value to Humboldt thought, to accord a positive value to human sensuality and give it a freer and more human sensuality and give it a freer and more creative rein. Consequently, he rejected the creative rein. Consequently, he rejected the traditional dualistic view of human nature with traditional dualistic view of human nature with its mind/body dichotomy and the Cartesian its mind/body dichotomy and the Cartesian notion of the human spirit as a kind of ghost in notion of the human spirit as a kind of ghost in the machine.the machine.

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•• Instead, he maintained, mind and body form a Instead, he maintained, mind and body form a vital unity and what we call spirit (vital unity and what we call spirit (GeistGeist) for him ) for him was nothing but was nothing but ““the finest ramification of the finest ramification of sensuality.sensuality.”” The path to selfThe path to self--determination that determination that Kant had demanded in his moral philosophy Kant had demanded in his moral philosophy must therefore proceed through the cultivation must therefore proceed through the cultivation of man's sensuality (of man's sensuality (SinnlichkeitSinnlichkeit).).

•• Hence the realm of aesthetics is granted a key Hence the realm of aesthetics is granted a key function in any attempt to overcome the function in any attempt to overcome the inherited mind/body dichotomy, in which inherited mind/body dichotomy, in which Humboldt saw a major obstacle in the path of Humboldt saw a major obstacle in the path of achieving individual selfachieving individual self--determination.determination.


•• During the During the Romantic eraRomantic era, scholars in , scholars in GermanyGermany, especially , especially those concerned with those concerned with nationalistnationalist movementsmovements——such as such as the nationalist struggle to create a "Germany" out of the nationalist struggle to create a "Germany" out of diverse principalities, and the nationalist struggles by diverse principalities, and the nationalist struggles by ethnic minorities against the ethnic minorities against the AustroAustro--Hungarian EmpireHungarian Empire——developed a more inclusive notion of culture as developed a more inclusive notion of culture as ""worldviewworldview." According to this school of thought, each ." According to this school of thought, each ethnic group has a distinct worldview that is ethnic group has a distinct worldview that is incommensurable with the worldviews of other groups. incommensurable with the worldviews of other groups. Although more inclusive than earlier views, this approach Although more inclusive than earlier views, this approach to culture still allowed for distinctions between "civilized" to culture still allowed for distinctions between "civilized" and "primitive" or "tribal" cultures.and "primitive" or "tribal" cultures.

DefinitionDefinitionIn 1860, In 1860, Adolf BastianAdolf Bastian (1826(1826––1905) argued for 1905) argued for "the psychic unity of mankind". He proposed that a "the psychic unity of mankind". He proposed that a scientific comparison of all human societies would scientific comparison of all human societies would reveal that distinct worldviews consisted of the reveal that distinct worldviews consisted of the same basic elements.same basic elements.According to Bastian, all human societies share a According to Bastian, all human societies share a set of "elementary ideas" (set of "elementary ideas" (ElementargedankenElementargedanken); ); different cultures, or different "folk ideas" different cultures, or different "folk ideas" ((VVöölkergedankenlkergedanken), are local modifications of the ), are local modifications of the elementary ideas. This view paved the way for the elementary ideas. This view paved the way for the modern understanding of culture.modern understanding of culture.

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•• In the nineteenth century, humanists such as In the nineteenth century, humanists such as EnglishEnglish poet and essayist poet and essayist Matthew ArnoldMatthew Arnold(1822(1822––1888) used the word "culture" to refer to 1888) used the word "culture" to refer to an ideal of individual human refinement, of "the an ideal of individual human refinement, of "the best that has been thought and said in the best that has been thought and said in the world.world.““ This concept of culture is comparable to This concept of culture is comparable to the the GermanGerman concept of concept of bildungbildung: "...culture being : "...culture being a pursuit of our total a pursuit of our total perfectionperfection by means of by means of getting to know, on all the matters which most getting to know, on all the matters which most concern us, the best which has been thought concern us, the best which has been thought and said in the world."and said in the world."

•• In practice, In practice, cultureculture referred to an referred to an éélitelite ideal and was ideal and was associated with such activities as associated with such activities as artart, , classical musicclassical music, , ect. As these forms were associated with urban life, ect. As these forms were associated with urban life, "culture" was identified with "civilization" (from lat. "culture" was identified with "civilization" (from lat. civitascivitas, city)., city).

•• Another facet of the Another facet of the RomanticRomantic movement was an movement was an interest in interest in folklorefolklore, which led to identifying a "culture" , which led to identifying a "culture" among nonamong non--elites. This distinction is often characterized elites. This distinction is often characterized as that between "as that between "high culturehigh culture", namely that of the ", namely that of the ruling ruling social groupsocial group, and ", and "low culturelow culture." In other words, the idea ." In other words, the idea of "culture" that developed in Europe during the 18th of "culture" that developed in Europe during the 18th and early 19th centuries reflected inequalities within and early 19th centuries reflected inequalities within European societies.European societies.

•• After reviewing the research on primate After reviewing the research on primate culture, culture, W.C. McGrewW.C. McGrew concluded, "[a] concluded, "[a] discipline requires subjects, and most discipline requires subjects, and most species of nonhuman primates are species of nonhuman primates are endangered by their human cousins. endangered by their human cousins. Ultimately, whatever its merit, cultural Ultimately, whatever its merit, cultural primatology must be committed to cultural primatology must be committed to cultural survival [i.e. to the survival of primate survival [i.e. to the survival of primate cultures]."cultures]."

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DefinitionDefinition•• Culture for McGrew is not a kind of knowledge. He Culture for McGrew is not a kind of knowledge. He

suggests that suggests that we view culture as a processwe view culture as a process..•• He lists six steps in the process:He lists six steps in the process:

1.1. A new pattern of behavior is invented, or an existing one is A new pattern of behavior is invented, or an existing one is modified.modified.

2.2. The innovator transmits this pattern to another.The innovator transmits this pattern to another.3.3. The form of the pattern is consistent within and across The form of the pattern is consistent within and across

performers, perhaps even in terms of recognizable stylistic performers, perhaps even in terms of recognizable stylistic features.features.

4.4. The one who acquires the pattern retains the ability to perform The one who acquires the pattern retains the ability to perform it long after having acquired it.it long after having acquired it.

5.5. The pattern spreads across social units in a population. These The pattern spreads across social units in a population. These social units may be families, clans, troops, or bands.social units may be families, clans, troops, or bands.

6.6. The pattern endures across generations.The pattern endures across generations.


PerbandinganPerbandingan pengertianpengertian kebudayaankebudayaantradisionaltradisional dandan postmodern.postmodern.Click Click didi sinisini

Medicine as Cultures Medicine as Cultures

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Thelma Hyman is 90 years Thelma Hyman is 90 years old, and she expects to old, and she expects to be called Mrs. Hyman be called Mrs. Hyman when she visits the when she visits the doctor's office. But when doctor's office. But when the black woman the black woman recently visited the office recently visited the office of a white physician, he of a white physician, he called her Thelma.called her Thelma.

"I'm not sure I'm going "I'm not sure I'm going back to him," says the back to him," says the resident of Washington, resident of Washington, D.C. "It's very important. D.C. "It's very important. Everyone has their own Everyone has their own feelings about how you feelings about how you need to address them."need to address them."

Thelma Hyman, 90, of Washington, D.C., who recently was disappointed when a physician referred to her by her first name. Researchers are studying cultural gaffes such as this to see if they are affecting health care disparities.

•• In 2005, New Jersey became the first state to In 2005, New Jersey became the first state to require culturalrequire cultural--competence education for competence education for physicians to get licenses. California requires physicians to get licenses. California requires continuing medical education for doctors to continuing medical education for doctors to include cultural and linguistic competency include cultural and linguistic competency training. training.

•• The federal government is financing studies The federal government is financing studies examining whether the training can help health examining whether the training can help health care workers get diverse groups to comply care workers get diverse groups to comply better with doctors' orders.better with doctors' orders.

•• But no study has proven cultural competency But no study has proven cultural competency training works, either by improving doctortraining works, either by improving doctor--patient relationships, increasing patient patient relationships, increasing patient compliance or reducing disparities.compliance or reducing disparities.

•• An example:An example:–– doctors with Native American patients to "ask doctors with Native American patients to "ask

if patients may seek a healer or medicine if patients may seek a healer or medicine man." It also recommends that doctors with man." It also recommends that doctors with Latino patients break the ice by asking them Latino patients break the ice by asking them their country of origin. their country of origin.

–– Indonesia: Indonesia: ““It is not allowed to go to the It is not allowed to go to the doctor before one has finished doctor before one has finished SasakSasak beliansbelians. . It is not allowed to mix them.It is not allowed to mix them.””

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•• CultureCulture refers to integrated patterns of refers to integrated patterns of human behavior that include the human behavior that include the language, thoughts, communications, language, thoughts, communications, actions, customs, beliefs, values, and actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or institutions of racial, ethnic, religious, or social groups. social groups.

•• the professional culture of medicine can the professional culture of medicine can be viewed as the language, thought be viewed as the language, thought processes, styles of communication, processes, styles of communication, customs, and beliefs that often customs, and beliefs that often characterize the profession of medicine. characterize the profession of medicine.

•• This may be a difficult concept for This may be a difficult concept for students to grasp initially because they students to grasp initially because they may not view medicine as a culture or may not view medicine as a culture or may view it as described by Taylor as the may view it as described by Taylor as the culture of no culture. Culture or civilization culture of no culture. Culture or civilization according to Edward Burnet according to Edward Burnet TylorTylor (2 (2 October 1832 October 1832 –– 2 January 1917) : 2 January 1917) : ““ ……complex whole which includes knowledge, complex whole which includes knowledge, belief, art, morals, law, custom, and any belief, art, morals, law, custom, and any other capabilities and habits acquired by other capabilities and habits acquired by man as a member of society.man as a member of society.””

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•• Students may find difficulty in viewing medicine as a Students may find difficulty in viewing medicine as a culture because the culture of medicine is not a topic culture because the culture of medicine is not a topic that is formally discussed in medical school education. that is formally discussed in medical school education. The culture of medicine is most often learned through The culture of medicine is most often learned through the hidden curriculum and through rolethe hidden curriculum and through role--modeling. modeling. Although it is not a part of the formal curriculum, the Although it is not a part of the formal curriculum, the hidden curriculum often dictates certain customs, rituals, hidden curriculum often dictates certain customs, rituals, and rules of conduct thereby, defining the cultural milieu and rules of conduct thereby, defining the cultural milieu of medicine. Incorporating topics that are usually part of of medicine. Incorporating topics that are usually part of a hidden curriculum into a more formal discussion on a hidden curriculum into a more formal discussion on cultural competence may help to overcome some of the cultural competence may help to overcome some of the challenges we identified above and may also provide a challenges we identified above and may also provide a framework for a formal discussion of the culture of the framework for a formal discussion of the culture of the medical profession.medical profession.

•• Traditionally, when discussing medicine as a culture, the Traditionally, when discussing medicine as a culture, the focus tends to be on reinforcing the virtues of medicine, focus tends to be on reinforcing the virtues of medicine, such as honesty, empathy, altruism, honor, and respect. such as honesty, empathy, altruism, honor, and respect. Although these attributes are the core of lectures on Although these attributes are the core of lectures on professionalism in doctoring classes, they may be professionalism in doctoring classes, they may be difficult for students who are just embarking on medical difficult for students who are just embarking on medical training to grasp. Applying the professional culture of training to grasp. Applying the professional culture of medicine as a framework for teaching about culture can medicine as a framework for teaching about culture can highlight elements within the culture of medicine that highlight elements within the culture of medicine that are more obvious and tangible to medical students who are more obvious and tangible to medical students who are in the early stages of their education. Examples of are in the early stages of their education. Examples of these elements include the white coat, a shared stylized these elements include the white coat, a shared stylized dress code among physicians; dress code among physicians; doctor talkdoctor talk, a shared , a shared language or unique pattern of communication among language or unique pattern of communication among physicians; and the physician explanatory model, a physicians; and the physician explanatory model, a shared system of beliefs regarding healthshared system of beliefs regarding health

•• The white coat is a symbol of the medical The white coat is a symbol of the medical profession and other health professions that can profession and other health professions that can be used as a tool in teaching about culture. be used as a tool in teaching about culture. Traditionally, it symbolized sterility, science, and Traditionally, it symbolized sterility, science, and healing, and it has now become a timehealing, and it has now become a time--honored honored tradition among physicians.tradition among physicians.

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•• Studies have shown that wearing a white Studies have shown that wearing a white coat is associated with patients' trust and coat is associated with patients' trust and confidence in their physician as well as confidence in their physician as well as their willingness to disclose personal their willingness to disclose personal matters to their physicians.matters to their physicians.

•• One study found that doctors who wore One study found that doctors who wore white coats were described by their white coats were described by their patients as being more hygienic, patients as being more hygienic, professional, authoritative, and scientific.professional, authoritative, and scientific.

•• The way in which physicians express The way in which physicians express themselves verbally, themselves verbally, doctor talkdoctor talk, is , is another element of the culture of medicine another element of the culture of medicine that is rarely taught explicitly. The lexicon that is rarely taught explicitly. The lexicon of physicians is characterized by statistical of physicians is characterized by statistical facts, presented in terms of probability, facts, presented in terms of probability, gradations of severity, and the use of gradations of severity, and the use of acronyms and medical terminology that is acronyms and medical terminology that is often unfamiliar to the patient.often unfamiliar to the patient.

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•• The use of doctor talk can also impact the The use of doctor talk can also impact the providerprovider--patient interaction. A number of studies patient interaction. A number of studies have shown that medical terminologies that are have shown that medical terminologies that are used by health care providers are often used by health care providers are often misunderstood by patients. Pointing out the misunderstood by patients. Pointing out the sometimes indiscriminate use of medical sometimes indiscriminate use of medical terminology may help to reinforce the terminology may help to reinforce the importance of linguistic competence and importance of linguistic competence and communication skills to students. Linguistic communication skills to students. Linguistic competency ensures that health information is competency ensures that health information is communicated either verbally or in writing in a communicated either verbally or in writing in a way that is understood by the patient.way that is understood by the patient.

TopicsTopics

1.1. Theoretical perspective on medicine and Theoretical perspective on medicine and society.society.

2.2. The body in medicine.The body in medicine.3.3. Representations of medicine, illness and Representations of medicine, illness and

disease in elite and popular culture.disease in elite and popular culture.4.4. The lay perspective on illness and disease.The lay perspective on illness and disease.5.5. Power relations and the medical encounter.Power relations and the medical encounter.6.6. Feminism and medicineFeminism and medicine

Documents

Introduction to Philosophy of Culture