Humanistic and Conflict Theory
Cultural competence is an aspect that is difficult to comprehend as a skill and as expertise, yet it is viewed as necessary in delivering healthcare. Fadiman’s story of a patient named Lia highlights the shortcomings of medical treatment as a single-handed approach to addressing patients’ needs. Therefore, an outside-the-box strategy is needed in nursing. The humanistic school of thought and the conflict theory will be used to analyze Fadiman’s story ‘The Spirit Catches You and You Fall Down by Anne Fadiman.’ The humanistic theory will be applied to the micro-level analysis of the categorized doctors’ populations (Dr. Peggy and Dr. Neil) in the story.
On the other hand, conflict theory will be used to understand the population of Hmong in Fadiman’s story. These analyses will help determine whether Fadiman’s approach of intervention to address problems such as Lia’s in the story is appropriate. Besides, they will lay the foundation for how healthcare professionals can employ these theories to address patients’ needs and maximize patient outcomes.
PART 1: Identification and Definition of Humanistic Theory and Conflict Theory
Historically, humanistic psychology refers to a system or outlook of thought focused on humans instead of divine or supernatural insight. This outlook emphasizes that humans are intrinsically good, have an innate need to better the world and themselves, and that fundamental needs are essential to human behavior (Western Governors University, 2020). According to Bland & Derobertis (2017), this theory also assumes that people have free will to make life choices and are motivated to self-actualize to be satisfied. The humanistic theory further assumes that a person’s subjective understanding and perception are more important than objective reality, which is why sometimes this theory is referred to as the phenomenological approach (McLeod, 2020). This implies that a human personality is studied from the person’s subjective experience perspective. Humanistic psychology is also focused on finding rational ways to address human problems. Based on its roots, humanism psychology aims at human virtue. It has undergone several crucial historical movements, including Greek, Latin, Renaissance, and contemporary revivals. Humanistic theory is based on humanistic psychology. The leading scholars behind this theory are Abraham Maslow, James F.T. Bugental, and Carl Rogers in the 1900s (Western Governors University, 2020). Maslow and Rogers were American psychologists renowned for inventing Maslow’s hierarchy of needs and one of the founders of psychology’s humanistic approach, respectively. James Bugental was also a psychologist and a therapist who founded the theory.
Regarding nursing, the humanistic theory is based on three main concepts: dialogue, phenomenological, and community nursing (Lélis, Pagliuca & Cardoso, 2014). In this case, dialogue refers to a certain kind of intersubjective relation through experience sharing among individuals. It involves critical attributes for creating complete dialogue, including call and response, presence, relation, and meeting (Lélis, Pagliuca & Cardoso, 2014). Lélis, Pagliuca & Cardoso (2014) categorize relationships into three pillars, including the I-YOU (subject-subject) relationship, the I-IT (subject-object) relationship, and the WE relationship, which is the community among two or more people. When it comes to the concept of community is developed among two or more people when they find out the meaning of their existence through sharing and establishing a relationship with one another (Lélis, Pagliuca & Cardoso, 2014). Generally, then, the main themes of this theory are human dignity and values, and it suggests that people can resolve challenges using reason and science as opposed to looking at religious traditions (Cherry, 2020). The theory helps people live well, make the work conducive, and achieve personal growth.
The leading champion of conflict theory was Karl Marx, an 1818 to 1883 philosopher, economist, and social theorist (Kenton, 2021). His inspiration was derived from classical political economists such as David Ricardo and Adam Smith and has influenced the political economy and sociology (Kenton, 2021). The central assumption of the theory is that social order is usually maintained by power dominion as opposed to conformity and consensus (Hayes, 2020). This means that people with power and wealth try to hold on to them by all means possible, mainly by suppressing the powerless and the poor. Another assumption of this theory is that society’s people and groups will work towards maximizing their power and wealth (Hayes, 2020). Therefore, conflict theory focuses on the competition between and among groups in society over limited resources.
Moreover, as Marx argues, conflict theory concepts are based on the fact that society is divided into economic classes between the bourgeoisie and the proletariat classes. The later assumptions of the theory find that competition or conflict between groups in society is not just based on economic resources but also religious, social, and other lines. According to Hayes (2020), people compete for material and intangible resources such as social status, dominance, leisure time, and sexual partners. There is more competition than cooperation.
Conflict theory is widely used to demystify various social phenomena such as domestic violence, discrimination, poverty, revolutions, and wars. Most of its developments are based on human history, including capitalistic efforts to control masses of people, civil rights, and democracy (Hayes, 2020). The conflict theory principles are the concepts of division of resources, social inequality, and the conflicts between socioeconomic classes. Karl Marx believed that social conflict drives development and change within society. Conflict is essential to make indelible changes, mainly because society is divided into strata with conflicts between the bourgeoisie and the proletariats. In general, therefore, the themes of the theory are competition, revolution as an outcome of conflicts, structural inequality as those in power work towards maintaining their position, and war if conflicts between groups and individuals are growing or are cumulative.
Why the two Theories were Chosen
The humanistic and conflict theories are chosen because they give a viewpoint perspective from a micro-level and a macro-level, respectively, making the story’s approach more vivid.
Part II: Doctors as Micro Population and Humanistic Theory
Target of Analysis
The identified targets for the analysis are Lia’s doctors, Dr. P, eggy Philip, and Dr. Neil Ernst, who worked at the Mercy Medical Center Merced (MCMC). The doctors are family doctors in the area. The humanistic theory has helped identify the dimension of helping a patient recover from an epileptic condition. The theory believes that humans have the innate need to make the world a better place (Dubois & Wright, 2002). This is exemplified in the doctors as they used different combinations of drugs to assist Lia in controlling seizures. Another dimension that this theory helps bring out is human free will, and Lia should be examined from her subjective experience. Lia’s parents disagree with the doctors on the use of drug therapy to control her seizures (Fadiman, 2012). This results in the postponement of Lia’s treatment. This is because the doctors respected the standpoint of their patient’s family even though they knew Lia’s seizures could have been stopped at a critical point in her life. Since they had free will to choose, as described in the humanistic theory, the doctors also had to respect their human dignity, and therefore, they did not force their solutions on them.
The humanistic theory has also highlighted the dimension of scientific reasoning to address Lia’s problem. In American medicine, a biomedical model focuses on specialization and science. Medical knowledge lays the foundation of traditional and customary methodology, and doctors are more often taught and trained to diagnose illnesses using biological reductionism, whereby the illness is an error in the body’s functionality (Taylor, 2003). Taylor (2003) argued that medicine is a culture that has no culture because it contributes to a culture of subjugation and objectivity of patients. The objectivity of the patient ensures that treatment is neutral. From the viewpoint of the doctors, Lia’s parents, Lees, are highly mistaken for failing to provide drug treatment for Lia, which they consider a case of poor parenting and negligence (Fadiman, 2012). In some cases, this would be considered ignorance.
The other dimension that comes out clearly through the theory is helping people to find social services and health care. Lia was forced from her ‘toxic’ home temporarily and was put into foster care for six months because her family doctor Neil recommended it. The Supreme Court of California supported this decision. All this effort was for the good of helping Lia find proper healthcare as well as social welfare. Subjective experience: Li had progressive seizures. Therefore, upon studying her, Dr. Neil saw that it was the best decision to involve the proper authorities to get Lia the medication she needed. However, although their foster family continued to administer medical drugs to her correctly and consistently, her seizures did not cease.
Since the humanistic theory does not consider scientific research above the subjective and conscious experiences of the individual (Cherry, 2020), the other micro-level dimension brought about by the doctors includes Lia’s connection to her family, which is also essential for her social well-being. This is because the family setup is a fundamental environment that shapes an individual even as they grow up. Despite their continued administering of drugs to Lia in her foster home, her seizures were not getting better. Therefore, she was returned to her home with the Lees after six months in poor condition. In this case, Lia did not receive proper nurturing that worked holistically with the drug administration. According to Fadiman (2012), the lack of harmony between the two strategies negatively affected Lia’s health. If these two worked together harmoniously, the patient, Lia, would have received better care.
The dimension of cultural competence, which is a comprehension of the needs of various cultures, has proved to be a positive factor in health care because it increases understanding between the doctors and the patient’s family. This may also answer research questions that may result in inaccurate outcomes from the biomedical model, as Taylor (2003) argued. This proves the point of humanistic theory that objectivity is less crucial than an individual’s subjective viewpoint and understanding of the world (Schneider & Krug, 2010). The return of Lia to her family proves that the doctors studied her subjective experience to get her proper care.
From the cultural viewpoint, the significance of out-of-hospital care is well identified in the case study. Lia’s family’s love for their daughter assisted in the care process. This perspective builds on the ethnography’s role in having a qualitative study to examine the condition of a human being that accompanies patient care and allows the doctors to investigate more on the issues that affect the patient experience. It also highlights the significance of a support system such as a family and an external care source during stress, such as chronic disease. Therefore, cultural basis during a patient’s recovery from a disease is equally important in the medical model study.
Dimensions of the Target’s Story Emphasized by Humanistic Theory.
The life of Lia’s was not damaged by the doctors’ opinion of the drug administration or non-compliant parents but rather by cross-cultural misunderstanding. The biomedical model is a highly used theory in the West, focusing on the biological causes of illnesses (Deacon, 2013). In as much as this is important in diagnosing patients, cultural implications surrounding the patients are of equal importance. In this case, the doctors, Dr. Neil and Dr. Peggy are considered incompetent, not in the context of medical diagnosis, but rather in their incapability to view their patient’s seizures beyond medical contexts. Therefore, the dignity and needs of the patient and her family are part of their humanistic characteristics, and since they were overlooked, Lia’s health care was poorly executed, and this led to her permanent dilapidation.
The extent to which Humanistic Theory helps in seeing specific Characteristics of Doctors and Other Empirical Studies
Regarding nursing, the humanistic theory is based on three concepts: dialogue, phenomenological, and community nursing (Morley, 2019). As seen earlier, dialogue involves a three-dimensional relationship of WE, I-YOU, and I-IT relationships. Based on this perspective, the doctors in the story focused more on the I-IT relationship and overlooked the WE and I-YOU relationships. This is because the main focus of the doctors was to get Lia physically or biologically well, which is more objective than subjective. The WE represents the community, and the I-YOU, which represents the relationship between the patient, her family, and the doctors, are not featured in Lia’s care. This is why they clash in the proper treatment for Lia. This means that the perspective of the patient’s cultural background, her family, and the community in which she lived was overlooked in her care, which was a mistake in their care delivery.
Some empirical studies that have proved that humanistic care is essential are Lecocq et al. (2021) research studies because they found that registered nurses and students felt more competent when delivering comforting and humanistic care than relational and clinical care. These studies were conducted in a French-Belgian teaching hospital. Moreover, a study by Sadler (2003) found that surveyed students reported that the aspects that positively affected care competence were work experience and family in health settings more than academic curriculum.
The extent to which Humanistic Theory addresses Cultural Issues
The humanistic theory has helped in identifying the gaps in the care provided for Lia through the three-dimensional concept of dialogue, phenomenological, and community nursing. This has helped me recognize that cross-cultural care is needed in health care, especially with the patient Lia and her parents. However, this theory has failed to recognize the importance of deterministic laws of science. On the one hand, it argues that people have free will, and any approach to addressing their problems should consider this. On the other hand, it holds that human behavior is determined by how others treat them (Papathanasiou, Sklavou & Kourkouta, 2013). As much as it has helped identify the importance of cultural competence in health care, its free will concepts only extend to some level and not all the way. Thus, this theory does not address other essential elements that need to be considered in the story of Lia, such as biology. Besides, the subjective concepts highlighted by the humanistic theory are complex to test because human behavior is unpredictable and is affected by many changing external factors (Hutchison, 2018). Therefore, one cannot fully state that the cause of a problem emanates from a particular source without scientific proof or evidence. The basis of theory is based on human experiences, such as the fact that the people of Hmong have hardly experienced peace because they have constantly experienced hostility, persecution, and migration.
Part III: Hmong People as Macro Population and Conflict Theory
Target of Analysis
The target population for analysis is the Hmong people. The first macro-level dimension that conflict theory helps in understanding Hmong people as the target population for analysis is homelessness. According to conflict theory, social order is only maintained by those in power and domination instead of conformity and consensus (MacDonald, 2009). Fadiman (2012). Writes that the Hmong people have experienced a long history of non-conformity and limited peace because they have always responded to the pressures to assimilate by migrating or by fighting. This means they have been uncomfortable with the people in powerful positions suppressing them.
Conflict theory also holds that those with power and wealth try to hold on to power and wealth by all means they can by suppressing the powerless and the poor (Bartos & Wehr, 2002). Therefore, the poor and the powerless will work to try and maximize their power and wealth. This applies to the people of Hmong who were reportedly fighting their way from the persecution of oppressors such as Chinese people. Although their intention was not to rule the Chinese people, they felt they needed to protect their sovereignty because they oppressed them by treating them differently from other offenders. Rather than incarcerating them like other offenders, the Chinese executed Hmong people outright or tortured them by slicing off parts of their bodies. This battle continued for centuries until they decided to retreat from their rice fields in the Yellow and Yangtze Rivers towards higher altitudes, rendering them homeless (Fadiman, 2012). In other words, their oppressors were the cause of their displacement and homelessness.
Another macro-level dimension highlighted by the conflict theory in the story of the Hmong is cultural and national independence. After experiencing centuries of oppression by Chinese people, the Hmong people ended up living in the mountains after fighting their way until they decided to retreat. Conflict theory assumes that the oppressed or the poor will work towards trying to maximize their power and wealth. This is what the Hmong people did. They receded to the mountains, where they could preserve their autonomy amidst other people and maintain the customs, language, and ethnic spirit of their race (Fadiman, 2012). Fadiman writes that by 400 A.D., they established an independent kingdom in Hunan, Hupeh, and Honan. Even then, while living amidst a contemporary French missionary in Thailand, they were still resistant to any form of authority.
Another critical dimension the theory brings out is the hereditary kingship among the Hmong people. Conflict theory holds that society will always compete for limited resources (Hirshleifer, 2001). In this case, the limited resources may be presumed to be dominance, power, leadership, or social status. Fadiman (2012) finds that after 500 years of Hmong’s almost democratic kingdom, Chinese people crushed them, forcing them to migrate to the West, specifically to the Szechuan and Kweichow mountains. However, they were only contained but not controlled. This proves the conflict theory’s point that the conflict between those in power and those with less power shall always be continuous as long as there is unequal sharing of resources mentioned above. Besides, the conflict between the Chinese and Hmong people kept them transforming into kingdoms and occupying different geographical locations. This also validates the conflict theory’s theme of revolution, whereby Hirshleifer (2001) holds that a revolutionary event is a likely outcome when conflict happens between social classes.
The Extent of Conflict Theory helps in seeing specific Characteristics or Situations of the Hmong people.
The theory has helped to identify that the Hmong people are fearless, resilient, and determined to protect their culture, race, and sovereignty no matter the resistance and cruel persecution they have faced. The theory has also helped in noting that the outcome of the conflict is the revolution. The revolution is validated by the fact that about 5 million Hmong people live in China, their history oppressor, more than in any other nation-state (Fadiman, 2012). However, conflict theory fails to explain the fact that Hmong people are now living peacefully in China, yet it assumes that conflict remains part and parcel of multiple societies.
PART IV: How a Theoretical Understanding of Micro and Macro-level Dimensions Helps in Deciding who and How to Target intervention
The theoretical understanding of the micro- and macro-level dimensions helps determine the appropriate intervention and how to use it. This is because it provides a conceptual perspective from an individual and family point of view and a more significant point of view so that no gaps are left when addressing the problem in question. For instance, using the humanistic theory helps have a general idea of human characteristics in their own intrinsic right and within the society and their respective family. Should there be a problem involving a single individual, the surrounding factors, including the social environment and personal attributes, would be considered to address the individual’s problem because these factors shape the growth and development of the individual. In this case, as seen in the humanistic approach shortcoming, it isn’t easy to comprehend to what extent an individual may embrace their tradition or culture. Therefore, a theoretical understanding of macro and micro-level dimensions implies that this case will be addressed in a manner that would be different for any other patient.
ThMacroadiman used ethnography to create awareness regarding the advantages of cross-cultural medicine by examining the culture of the Hmong. She has also used the knowledge of the family. She has paired it with the medical model, understanding that doctors have been trained to cure and diagnose diseases for many years. In her perspective, she contemplated how much a family experience and knowledge burden a doctor from performing their role. In her analysis of micro and macro dimensions, she concluded that the doctors were incompetent in their ability to see Lia’s seizures beyond the medical context but were competent in medical diagnosis. Therefore, her intervention involved the theory of cultural mutualism. She suggested that the hospital use bicultural and bilingual interpreters, intensely involving family members in care, involving same-sex healthcare professionals for patients, and integrating traditional treatments in the care process. Jointly, the cultural allowances would lay a common foundation between two sides to speak from, as opposed to the dominating doctor who represents medical care and the sub-dominant patient, which is common in Western medicine. Fadiman has called this conjoint intervention treatment, where the Hmong traditions and Western medicine serve patients to heal them equally.
In conclusion, the humanistic approach and conflict theory have laid essential concepts for understanding proper interventions to address societal problems, including healthcare. The intervention chosen by Fadiman may prove to be a highly held egg in the society that is not supposed to be broken. As Newman (2000) argues, cross-cultural medical stakes are so high that when one fails one patient, one fails the entire community. Considering both micro and macro dimensions in the problem-solving process is challenging. However, this cultural competence, such as using a bicultural interpreter, may help reduce the anxiety of clashing cultures, which affected Lia’s treatment negatively, according to the story. Another shortcoming of using cultural competence strategy is that the idea implies that culture can be condensed to a technical skill for which healthcare professionals can be trained for their expertise development (Kleinman & Benson, 2006). This notion can result in stereotyping like this kind of culture, say African Americans do this and that, yet the blanket values cannot describe the entire ethnic group. Besides, it is hard to determine the extent to which an individual embraces their culture, especially in a world characterized by globalization, migration, and assimilation, among other features. Therefore, healthcare professionals must consider every patient’s case specific to the patient without generalization. However, having a clear understanding of the culture of the patient is vital in case the patient is a conformist to their culture and community norm.
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We’ll write everything from scratch
I was thinking about using the doctors at the hospital as the micro population and using the humanistic theory.
For the Macro, the Hmong people use the conflict theory. Part four: A strength-based approach, reframing the Hmong people’s thoughts or cognitive behavioral therapy. Macrobook is The Spirit Catches You and You Fall Down by Anne Fadiman. The textbook is Hutchison, E. (2019) Dimensions of human behavior: Person and environment. SAGE to use sparingly.
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