Organizing Dialogue, Experience and Knowledge for Complex Problem-Solving

cultural frames of reference

October 22nd, 2007

One of Anne Fadiman’s strengths as a writer is stating the culturally obvious in equal and unequivocal terms.
Of course medical practitioners in the US would not know “that when a man named Xiong or Lee or Moua walked into [their office] with a stomachache he was actually complaining that the entire universe was out of balance” (p. 61). It seems to me that one must be a believer in quantum level effects at the scale of the humanly perceptible in order to even conceive of such a possibility. Yes, there may be many linear (diagnosable, predictable and therefore curable) causes of stomachache, but who is to say definitively that those local causes and operations in the universe have absolutely, decisively, no relation to each other?
Much of what intrigues in Fadiman’s story of a Hmong family’s dreadful encounter with extraordinarily competent and skilled physicians are the breakdowns in understanding: the inability of worldviews to find means of expression even remotely comprehensible to each other. Some of the most poignant pathos are in those instances when mutual understanding was assumed – by one party or another, if not both.
The absence of interpreters mark the earliest and most common meetings between the Lee family and the US medical system. The complaint echos loudly, whoever has “the time and the interpreters to find out” the relevant system of beliefs of persons from another culture? (p. 61)

When no interpreter was present, the doctor and the patient stumbled around together in a dense fog of misunderstanding whose hazards only increased if the patient spoke a little English, enough to lull the doctor into mistakenly believing some useful information had been transferred. When as interpreter was present, the duration of every diagnostic interview automatically doubled. (Or tripled. Or centupled. Because most medical terms had no Hmong equivalents, laborious paraphrases were often necessary. In a recently published Hmong translation for ‘parasite’ is twenty-four words long; for ‘hormone,’ thirty-one words; and for ‘X-chromosome,’ forty-six words.) The prospect of those tortoise-paced interviews struck fear into the heart of every chronically harried resident. And even on the rare occasions when there was a perfect verbatim translation, there was no guarantee either side actually understood the other…’The language barrier was the most obvious problem, but not the most important…the Hmong simply didn’t have the same concepts.’ (p. 68-69)

This framing of different languages as “a problem” is, itself, a worse problem than the fact of language difference. Letting go the matter of duration (just for a moment!), the obviousness of language difference is merely the easiest difference to latch onto and blame for everything else that requires effort. In fact, having different concepts is “a problem” only to the extent that a desire exists to impose one concept over another, or one’s version of a concept as more salient. The exigency of interpretation merely brings this natural process into unavoidable consciousness; it need not complicate the process of communication any further than is already typical (albeit conveniently unawares). I digress: clearly I value the co-creation of mutual understanding above the urgencies of haste, so-called productivity, and routinized/dehumanizing mass service.
Then there are the problems of non-assertive interpretation, such as the doctor who “would try to get an interpreter to ask a Hmong patient these questions [diagnosing pain], and the interpreter would just shrug and say, ‘He just says it hurts'” (p. 69). Now, it may well be that there is no precedent for answering these kinds of questions, but this does not exonerate the interpreter from using their own bicultural experiences to creatively instigate a dialogue.

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