A dilemma: When and how to use the concept of “culture” in medical anthropological practice?
On December 13th 2022, the Leiden University Medical Anthropology Network (LUMAN) had its first Learning Encounters discussion session. This afternoon, eleven medical anthropologists from four different faculties gathered in the Leiden University Medical Centre to tackle a dilemma in interdisciplinary collaboration: when and how to use the concept of “culture” . To medical anthropologists this is a core question, but also a challenging one.
Anthropologists have developed a fraught relationship with the concept of “culture” since the 1980s. Studying “culture” has been the bread and butter of anthropologists since the early days of the discipline and they continue to be associated with it today. At the same time, anthropologists have long since recognized the challenges of the concept – because of the risk of reducing behaviour to “culture”, the risk of essentializing and because it might draw attention away from more structural inequalities.
When collaborating beyond their own discipline, anthropologists are often brought on board as experts of culture. This creates dilemmas. How to deal with questions concerning “cultural dimensions” of illness experience, “intercultural communication”, or analyzing health care access for people with “diverse cultural backgrounds? When and how to engage with the very concept that anthropology is most associated with as a discipline, while also creating space for critique on the use of “culture” as explanatory tool in our interdisciplinary collaborations?
During the LUMAN Learning Encounters session, we discussed how each member navigates “culture” in their health-related collaborations. The interactive group discussions resulted in various insights, the most prominent being that all participants seek to avoid “culture”, yet acknowledge that sometimes we do need it as an explanatory concept or to mobilize people to recognize diversity.
How we criticize the use of the concept of “culture” or find alternatives
Essentialization was indeed recognized as one of the main challenges with the concept of “culture”. In clinical practice, this can have far-reaching consequences. If, for example, health care workers would define a patient as “belonging to culture X”, this may result in them drawing conclusions about the patients’ wishes based on what they know about that culture – even though the individual patient may have very different norms and values. We therefore concluded that we are more comfortable with a concept like “cultural sensitivity,” which denotes diversity of perspectives without immediately categorizing them. Avoiding essentialization, we may still learn about culturally-sensitive ways of communicating, in which we leave room for different kinds of knowledge and communication to coexist.
An alternative concept to culture that was brought up during the conversations and that may work better in some contexts is to look at “life worlds”. The concept of lifeworld inherently starts from the individual patient/person, rather than assuming any a priori characteristics based on the relation to a social group. It helps to start with questions about the other, rather than with assumptions about difference. Starting from questions is therefore a crucial tool that we use in our collaborations and in our approaches to cultural diversity and sensitivity.
How we dance with “culture”
We found that we do need “culture” sometimes to make our collaborators and our audiences, like policy makers, attend to the ways in which people have different perspectives and needs. In teaching (medical) students, discussing cultural diversity may be a great tool to make them aware that “culture” is something that belongs to all of us. Letting students examine their own norms, values and traditions and study how biomedicine itself is cultural can be incredibly revealing. The group shared examples of using adjectives to make these points, such as “academic culture,” “hospital culture.” A concept like “cultural dimensions” is a helpful tool as it makes us aware of implicit dimensions of behavior.
This does raise the issue of doing “anthropology at home.” Studying “culture” when you are assumed to be “from the same culture” may be awkward. Yet, wat remains interesting for medical anthropologists is also how the concept of “culture” figures in everyday use, for instance when “culture” is associated with “traditional medicine.”
Making our troubled relation with “culture” productive
In short, this Learning Encounter resulted not only in a productive discussion, but also in the conclusion that we should keep making our troubled relation with “culture” as productive as possible, which requires finding better concepts to bring into our interdisciplinary conversations. As one participant put it with the metaphor of dance: “we dance around the concept, sometimes we dance with it, and sometimes we dance away from it.”