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Essay Historic perspectives from . Reflections proposed to Transcultural Nursing

Cecilia Rohrbach Viadas1

Historic perspectives from anthropology. Reflections proposed to Transcultural Nursing

History brings together meanings related to earlier periods, being aware of the past as a panorama to reread the present. Madeleine Leininger presented in 1970 an implicit and respectful message to the Nursing Profession when introducing Nursing and Anthropology. Two Worlds to Blend. Implicitly: Nursing you disregard .

This article shows the absence of the and of nursing within Transcultural Nursing and it includes how education has influenced theoretic, methodological, and comparative approaches giving researchers the responsibility to decide their fundamentals. Berthoud (2001) has inspired the anthropological and historic perspectives of the author, thus universalism, relativism, and comparison are presented.

Key words: anthropology; nursing; transcultural nursing.

Perspectivas históricas desde la antropología. Reflexiones propuestas a la Enfermería Transcultural

La historia trae significados relacionados con periodos anteriores, reconociendo que el pasado es un panorama para releer el presente. 1 RN and , Ph.D. Professor, En 1970, Madeleine Leininger propuso un mensaje implícito a la Universidad Autónoma de la Ciudad de enfermería al introducir: “Nursing and Anthropologie. Two Worlds México, México. email: [email protected] to Blend”. Implícitamente: Enfermería: habéis descuidado la cultura. En este artículo también se hace referencia a la Received date: November 10, 2014. ausencia de la historia de la antropología y de enfermería dentro de la Enfermería Transcultural. El artículo incluye la influencia Approval date: April 30, 2015. de la educación sobre los enfoques teóricos, metodológicos y comparativos dando responsabilidad a los investigadores DOI: 10.17533/udea.iee.v33n2a20 de decidir sus fundamentos. La perspectiva antropológica e histórica de la autora se inspira en Berthoud (2007), presentando How to cite this article: Rohrbach C. Historic perspectives from anthropology. Reflections el universalismo, el relativismo y la comparación. proposed to Transcultural Nursing. Invest 374Educ Enferm.• Invest 2015; Educ 33(2):Enferm. 374-379. 2013;31(3) Palabras clave: antropología; enfermería; enfermería transcultural. Historic perspectives from anthropology. Reflections proposed to Transcultural Nursing

Perspectivas históricas desde a antropologia. Reflexões propostas à Enfermagem Transcultural

A história traz significados relacionados com períodos anteriores, reconhecendo que o passado é um panorama para reler o presente. Madeleine Leininger propõe em 1970 uma mensagem implícita à enfermagem ao introduzir: “Nursing and Anthropologie. Two Worlds to Blend”. Implicitamente: Enfermagem: descuidastes a cultura. Neste artigo também se fala sobre a ausência da história da antropologia e de enfermagem dentro da Enfermagem Transcultural. O artigo inclui a influência da educação sobre os enfoques teóricos, metodológicos e comparativos dando responsabilidade aos pesquisadores de decidir seus fundamentos. A perspectiva antropológica e histórica da autora se inspira em Berthoud (2007), apresentando o universalismo, o relativismo e a comparação.

Palavras chave: antropología; enfermagem; enfermagem transcultural. 20

With regard to universalism and thinking and judgment preferably to tradition, relativism they also suggested ideas detached from church tutoring guiding towards rational thinking. The A critical reflection far from closing a debate begins on the contrary by opening it. (Preiswerk Y) consciousness of this reflection inspires the unity of humanity as a fundamental inheritance transmitted Universalism develops in Europe during the from the philosophers of the Enlightenment and period named “The Enlightenment”, nurturing a recognized by , along with freedom significant philosophy during the XVII and XVIII and equality. The principles and norms surrounding centuries influencing Science, , Religion, as this period, shape the basis of modernity where well as everyday life. Whereas Relativism develops science is an essential element as well. Modernity around 1900-1920, opposing evolutionism, the appears both as adequate and incomparable considered theoretical framework of European because monarchies are discarded, and tradition anthropology at that time. is losing its . Anthropologists support somehow the evolutionist theory built up in earlier 2 The Enlightenment was formed by numerous years; ii) as well as throughout the seventeenth and European philosophers thinking again religious eighteen centuries, and what is more even later;3 convictions, traditions, art, literature, science with iii) a second definition of the Enlightenment may a mainstream of individuals participating to such contribute to its understanding: 2) “A European intellectual movement. Science and its compulsory intellectual moment of the late seventeenth and requirements were acknowledged for Natural eighteenth centuries emphasizing reason and Sciences with no between mathematics individualism, eluding tradition. It was heavily and law, or astronomy and sociology, Dr. Leininger influenced by seventeenth century philosophers referred as “received view”. This is the reason such as Descartes, Locke, and Newton, and why recognition is searched from authors involved prominent figures like Kant, Goethe, Voltaire, in Humanities. The Enlightenment (also known as Rousseau, and Adam Smith”.4 The Enlightenment Age of Reason) developed in a number of European encourages knowledge and its understanding countries (, , , Scotland, bearing in mind that such comprehension is Spain, and Russia, among others), and two brief reached by humans and not by God as believed up descriptions may simplify this historical period: 1) to that time. The Enlightenment was an intellectual challenge to authority on nearly every level:1 i) Philosophers Universalism or Rationalism opposed by Relativism proposed reason to cultivate individualistic and bringing reviewers to the evolutionist theory.

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Relativism also known as The understanding of Humanities and their was launched by (1858-1942). acknowledgment as Sciences becomes present This author was a famous German-American at this moment in order to remain faithful to the anthropologist equally known as the Founder of historic orientation of this article. Around 1890- . Franz Boas launched 1920, only Natural Sciences were judged to be Relativism around 1900-1920 challenging sciences, as previously specified. Throughout the evolutionism, the vogue theory around 1850- Enlightenment and even later, philosophers’ texts 1900 centered on progress and evolution. What enhanced rationality, and logic, within the scientific could be opposed? Boas contested evolutionism realm. However, an existing challenge concerning since there was no definite proof supporting the the requirements and thus the significance origin of humanity while advancing his main of science needed to be considered. Was it relativistic premise: “ are unique and applicable to appeal for the same fundamentals, must be interpreted within their own cultural the same criteria for all sciences? Science at the context 4”.Such , commonly shared end of the nineteenth century constructed theories by Relativistic anthropologists may be considered when explaining the phenomena under study and as a direction finder in American Anthropology. generating laws, when demonstrating statistical Boas sustained that “cultural relativism involves studies based on rigorous methods. specific epistemological and methodological prerogatives. Whether or not these claims This perspective demanded solid arguments necessitate a specific ethical stance is a matter if Natural Scientists were to be convinced of of debate.5 However, an ethical stance arises if Humanities value. On the other hand, the an anthropologist comes across studies describing philosophical, logical, and ethical background cultural practices opposed to her/his own values, gathered during the Enlightenment advanced one example is “sexual mutilations”, as observed those investigators who were authorities in in some African villages. The description of these Humanities and developed different theories practices6 becomes conflicting when confronting and methodologies. An author who spent his the theoretic premise of relativism previously life studying, analyzing, and publishing his cited.7 Those practices are not to be judged if the critical reflections on this subject was Wilhelm relativistic premise is to be respected. This living Dilthey8 (1833-1911), a German Historian, proof shows the ethical conflict within Relativism. Psychologist, Sociologist, and Hermeneutic Franz Boas taught, applied, and transmitted Philosopher. had a predecessor his vast knowledge and field experience to his in hermeneutics, Friedrich Schleiermacher (1768- disciples, most of them turned out to be famous 1834) a German theologian, and philosopher, soon after their studies: , Alfred considered the founder of modern hermeneutics. Kroeber, , , Melville Along with Schleiermacher’s previous thinking Herskovits, and many others. Boas premise bears and texts in hermeneutics, Dilthey was able to in mind cultural unity if the researcher respects differentiate Humanities from Natural Sciences. the observed cultural context. Around the end of the nineteenth century, Dilthey had to expose solid confirmations for challenging A regard towards the understanding of personalities evidencing an appropriate theoretic and methodological foundation for Humanities. humanities For Dilthey, human experience comprehends Consciousness is itself the structure built upon two boundaries: one, forthcoming from the this tenuous bridge between the two eternities natural world, requiring objectivity; and the of the unknown, and history is the record of later related to our inner experience. Dilthey what has taken place therein. Memory, in short, strongly rejected the unique model of Natural reveals the world as a process, and so makes its Sciences (Naturwissenschaften), and proposed data historical. (Shotwell JT) a distinct model for the Human sciences

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(Geisteswissenschaften). For this author the premises to apply. Comparison is a complex rationale for Natural Sciences explains phenomena process demanding anthropological and in terms of cause to effect, or else on going from methodological knowledge to understand the general to particular, a deductive thinking. Dilthey studied cultures. There are numerous theories contemplates comprehension within Human (evolutionism, diffusionism, functionalism, and Sciences as perceiving the measure at first, and ) where comparison is practiced. the whole later. He named this comprehensive The evolutionist theory is to be first examined for theory “Verstehen” in view of its applicability to its influence during the examined periods. Jean all sciences. The method is to observe first, to Poirier, anthropologist and editor of the Pleiades understand after, and to interpret later. This would French Encyclopedia, describes the ambiance of be a representative approach of Humanities, while the evolutionist theory (1850-1920): “there was Natural Sciences require explanations in order to a passion side in the rational aspect; one feels the elaborate laws. These two approaches may be attraction concerning the conviction of progress; it combined, as Max Weber, the famous German is part of the scientism heritage, who would like Sociologist, suggested. Dilthey confirmed: history, to shelter man into the logic of evolution”.10 philosophy, sociology, , communication studies, law, and , as Humanities, Evolutionism contemplates modern society as sciences requiring dissimilar methods to as holding a superior status and therefore as a investigate reliable problematic themes and guide for the called “developing ”.11 formulate research projects. This is an ethnocentric position although it rings the bell that the unity of humankind remains The challenge of Natural Sciences was thus to the major legacy from European philosophers; arrive at law-based explanations, on the other hand a fundamental patrimony today”12 because “no the fundamental commitment of the Humanities comparative reflection at any scales whatsoever was the understanding of human and historical is possible, without recognizing, in one way or 12 life, since history requires identifying present another, the unity of the human genre”. Let us constructions of our own experience together with remember as well, that the expression “Unity of being competent and experienced in objectively Humanity” needs to be elaborated and afterwards interpreting what others convey.9 Dilthey has put on paper. When one thinks of the Unity of heavily influenced the phenomenologist movement Humanity coming from the Bible, the Christian in Europe and in America, some of these authors origin confirmed views Indians and Spaniards are Paul Ricouer, and Hans Georg Gadamer. Dilthey and Indians placed at the same level. However, reflections on history and hermeneutics influenced to come to such decision took several years. also other philosophers of the twentieth century, There one may remember the human tendency to 12 like Heidegger and Ortega, demonstrating how be ethnocentric and to remain attentive and to analysis motivates and inspires the understanding have in mind a clear conception of comparison: of Humanities. On the whole these elements “Comparison within its universality is thus, the contributed to Anthropology’s acknowledgement as translation of a cultural domain into another one”, a science and confirmed by a happening: Edward and through the detour of the understanding of Burnett Tylor, an English researcher, was agreed the other, it finally allows a different regard on us. Professor of Anthropology in 1896 at Oxford What about Relativism? The main relativistic University becoming the first representative of this premise concerning uniqueness of each culture discipline in the world. limits comparison to its own context generating incompatibility to compare. To make it clear, in Comparing universalism and relativism spite of this incompatibility, relativists engage Comparative problems emerge when comparison comparison, not being acquainted with is applied, when the researcher selects the incompatibilities as shown”.13 How could a

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hierarchy of values be established if all cultures (my underlining). This relativistic premise if are unique? In this logic there are contrasting confronted with the history of anthropology could postures concerning objectivity among relativists. have been adopted with nursing arguments; Melford E. Spiro, an American researcher, however, there is a slight difference between opposes cultural relativism and contradicts Boas and Leininger premises. Franz Boas’ cultural other relativists as follows: “Even conceding that relativism mentions “interpret”, while Leininger nontrivial generalization and no vacuous theories indicates “evaluate” without explanation. It is are discoverable, epistemological relativism not the premise that changes; but the term rejects the conception of anthropology as a “evaluation”. Is caring evaluating cultures? Is the ‘scientific’ discipline not so much on pragmatic aim of caring to change cultures? Evaluation must as on principled grounds. The proper aim of necessarily be examined and if retained, justified. anthropology, it contends, is not explanation, but interpretation —the elucidation of symbolic Methodologically, cultural relativism means that ‘meanings’— that requires that it be conceived and while the anthropologist is in the field, he or she practiced not as a scientific but as a hermeneutic temporarily suspends (“brackets”) own esthetic 14 discipline”. (quotation marks in text). It is a and moral judgements. The aim is to obtain a major change proposed by Spiro who conceives certain degree of “understanding” or “empathy” epistemological relativism as the meaning given to with the foreign norms and tastes. Morally and cultural contexts, however, anthropology is more politically, cultural relativism means that other than hermeneutics and much more than purely cultures are respected and should be treated “as culture. Hodgen gives a relevant paragraph about good as” one’s own”.16 What is it that is borrowed the comparative approach: “However, to note and from Cultural Relativism in Transcultural Nursing, enumerate similarities and differences in manners is it the main premise? It is through debates that and customs is one thing; to grasp their historical reflection makes us become conscious of our or scientific meaning is another”.15 errors thinking of an ethical and human research. History and reflections for transcultural Bringing special thoughts for Trans- nursing cultural Nursing Dr. Leininger initial project proposed blending Madeleine Leininger understanding of the nursing and anthropology: Nursing and Culture Care Theory stipulates: “The purpose of Anthropology. Two Worlds to Blend. If the title was attractive its development declined. The the Culture Care Theory is to discover human absence of history of anthropology, as well as of care diversities (differences) and universalities history of nursing with no data concerning such (similarities) in order to generate new knowledge 15 absence may possibly help to elucidate and to guide nursing care practice.” Universalities understand this deficiency. A historic approach and “similarities” are unable to be differentiated. improves the process of theory building because How may a researcher decide of a similar the studied bibliography develops knowledge and or universal pattern when the same word arguments from other authors, allowing an ethical differentiates such patterns? Madeleine Leininger analysis of own positions and values, facilitating has been frequently recognized as the pioneer of orientations and implementing choices with solid culture care within nursing, in spite of the fact arguments. Cultural Relativism premise adopted that texts have been repetitively published, rather by Leininger raises another question: “Cultural than confirmed. Transcultural Nursing has been relativism has become a popular in preserved from critical thinking by expert nurses anthropology and Transcultural Nursing. It refers both in anthropology and transcultural nursing. It to the position that, cultures are unique, and must is not my intention to advance a thorough analysis be evaluated, according to their own values”.15 of a field that released richness for nursing.

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My modest purpose focuses on the lack of history 3. Berthoud, G. (2007). La comparison as previously mentioned, followed by suggestions anthropologique: ébauche de la méthode. Revue about cultural relativism application within européenne des sciences sociales. XLV-138. Lbrairie Droz. Transcultural Nursing. Dr. Leininger blending Nursing and Anthropology project may have 4. Stocking GW. Franz Boas y el concepto de cultura benefited from historic knowledge to demonstrate en perspectiva histórica. In: Race, Culture, and Evolution: Essays in the History of Anthropology. its pertinence and afterwards its complementarity, Chicago: The Press; 1968. and integration. History does not seem to attract p.195-233 nurses, as a famous Historian and French nurse, 17 5. Renteln A. Relativism and the Search for Human Marie-Françoise Collière.” confirmed it in a Rights. Arlington, VA: American Anthropological Nursing and History Congress in Switzerland: “I Association; 1988. was searching to elucidate the difficulties faced 6. Lefeuvre M. Le devoir d’excision. Revue du Mauss. by health professionals in the field. I positively 1988; 1:65-95. remarked just how the lack of historic knowledge damages nursing”. Is knowledge between America 7. Herskovits M. Cultural relativism: perspectives in cultural pluralism. : Vintage Books; and Europe so distant? 1973.

Knowledge about Universalism and Relativism 8. Dilthey W. Introduction to the Human sciences. Princeton, N.J: Princeton University Press; 1988. gives an ample basis to understand how science was assembled, what changes were possible, 9. Makkreel R. Wilhelm Dilthey. In: Zalta EN necessary to enter what I may call a “scientific (Ed). The Stanford encyclopedia of philosophy [Internet]. Summer Ed. Standford: University ethos”. It is not the “received view” that we must of Standford; 2012 [cited Feb 16, 2015]. oppose because of its “paternalism”; it is the Available from: http://plato.stanford.edu/archives/ reasoning of its principles, of its mistakes, and sum2012/entries/dilthey/ its richness that may be useful for investigating 10. Poirier J. Ethnologie Générale. Encyclopédie de la theories and methodologies. The question is not Pléiade. Paris: Gallimard; 1968. to accept or refuse knowledge, methods, theories 11. Rohrbach C. Soins et Anthropologie. Une coming from other disciplines, or from other démarche reflexive. Rech Soins Infirm. 2007; continents, it is to encounter and share the way (90):19-25. of thinking. 12. Berthoud G. Vers une anthropologie générale: modernité et altérité. Genève: Librairie Droz; 1992. Genuine historical knowledge requires mobility of character, a profound understanding of human 13. Boas F. The limitations of the comparative method in anthropology. Science.1896; 4(103): 901-8. existence – not detachment and objectivity. (Nietzsche F) 14. Spiro ME. Anthropological other or burmese brother? Studies in cultural analysis. Piscataway, N.J: London Transaction Pblishers; 1991. p.24. 15. Leininger M. Transcultural Nursing , References Theories, Research &Practices. New York: McGraw Hill; 1995. 1. Brown SC. History of Philosophy. Volume 5: 16. AnthroBase. Methods, Fieldwork, Ethics British philosophy in the [Internet]. [cited Feb 19, 2015]. Available from: [Internet]. New York: Routledge; 2004 [cited Feb http://www.anthrobase.com/Browse/Thm/Groups/ 12, 2015]. Available from: http://www.olimon. methods-fieldwork-ethics.htm org/uan/routledge_5.pdf 17. Collière M F. Difficultés rencontrées pour 2. Hodgen MT. Early anthropology in the sixteenth désentraver l’histoire des femmes soignantes. and seventeenth centuries. Philadelphia: In : Actes du Colloque de Sion, 22-23 novembre, University of Pennsylvania Press; 1964. p.17-44. 1991. Genève : Editions Zoé; 1992.

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