Eye on religion: cultural signs and caring for Chinese patients.

Confucianism has survived centuries of criticism and reform, and it is still the chief governing social force of modern Chinese. Sometimes, Confucianism is referred to as ethical humanism, due to its strong emphasis on societal living. Based on the premises that heaven and earth is one, and each individual is endowed by heaven with potentials, Confucian sages show an affinity toward education and character development. Motivated by the optimistic belief of human perfectibility, Chinese people strive to activate human potentials through a lifelong journey of self-cultivation: to succeed in life, one needs to pay attention to what lies within. At the same time, to sacrifice oneself for both one's family and society is deeply valued. A mature citizen in the Confucian sense is defined by the kinship networks that support filial piety, hierarchal relationship system, loyalty and caring.

For centuries, the idea of caring through customs and respect has been the chief responsibility of family members and relatives under a very complex web of relationship. Usually, the eldest sons and daughters assume chief leadership roles in the care giving. Failure to do so will result in shame and low self-esteem. (1)

This Confucian background has many implications for the ways in which Chinese people conduct their lives today. The most obvious way is to observe how Chinese people eat. As reinforced in Asian dietary tradition, Asians have never used individual plates, and food is never passed around; rather, all of the main dishes are placed at the center of the table and chopsticks are used. This demonstrates that Asian people are attentive to harmony. The ability to use chopsticks properly is a matter of a balancing act. To attain balance is a key Confucian virtue. (2)

The best Chinese dish is considered a mixture of all ingredients in one pot. It is to show that Asian cultures are find community to be of importance. The style of Asian eating is also illustrated by pointing out that Asians are optimistic people regarding human ability. If asked, "Why do we not pass the food around?" the answer would be, "Do you not have hands to pick it up yourselves?" Through the ways that Asians eat, a powerful Confucian ethical ideal is communicated: Work hard to obtain results for ourselves. This ethic might show the resilience of Chinese people around of the world. However, the emphasis on human perfectibility might also make Chinese people less likely to ask for help, unless it is unavoidable.

Honor and respect is given to anyone for the simple reason that any person stands on a "higher ground." The notion of a hierarchical relationship within the culture positively teaches people to understand their roles and assume responsibility while in that role. When participants in the relationship respect their responsibilities, peace and harmony are assured. For example, listening attentively to your superior is what the Chinese are taught throughout their childhood education, and the Chinese try hard not to upset this hierarchical relationship. The resulting tendency is that Asian people tend not to say very much while in public, especially to strangers. (3) Partly influenced by the Taoist thoughts, Chinese people consider that those who do not talk much are knowledgeable.

Within Confucian thought, the individual is a developing part of a continuing family lineage. Each individual is also part of the wider ethnic continuity, yet lives within the boundaries of the pre-established hierarchical relationships. Psychologists describe Asian people who share Confucian ethics as having a public, hierarchical self and a highly private, secretive self. As opposed to the Western "I-self," Asian people exercise a "we-self." These two selves are dialectically interconnected, and one cannot function or exist without the other. (4) The public self is concerned with performing societal expectations that are appropriate, largely defined by the ability to preserve the hierarchical relationship and structure. The private self is the seat of feeling, emotion, personal opinions, fantasy, etc. Feelings and personal opinion are expected to be internalized, not verbalized, especially in the presence of outsiders. This highly private self has to be kept tightly secret and is not to be intruded upon. As a result, recollection and reflection are two key spiritual virtues.

Since feeling, emotion and personal thought are seated in the private self, it is perceived by the Chinese as dangerous to express opinion since it comes from the most inner compartment of the person's psyche. A Chinese person will always ask himself or herself before speaking in public, "What if my opinion is rejected?" If the opinion is rejected, the person often feels it is not only the opinion being rejected, but himself or herself as well.

If the inner private self is rejected, Chinese people say the person has 'lost face.' But 'face' in Chinese context is not merely something external; it is deeply internal. The person who loses face loses integrity among his or her peers. He or she can no longer survive in the community as a respected member. That may be why many Chinese are extremely reluctant to give personal opinion in the public realm--to ensure that face is protected. This desire to protect face is the crucial social medium to control public behavior in the East.

Furthermore, the desire to protect one's face leads to a style of communication that is strategically unassertive and, in an indirect manner, leaves room for negotiation in the future or in private. The fear of being hurt by losing face becomes the crucial medium for social control. This means, being guided by the desire to save face, Chinese people tend to say "yes" to unwanted requests. This response is not the same as lying. It means, however, some triangulation is needed. For example, a caregiver may clarify the meaning of certain statements by conversing with family members and/or close friends. The history of care in terms of saving face in Confucian context demands the caregiver highly respects the internal longing to manage one's life from the perspective of the cared-for.

Freedom of expression in the West has come to be considered the norm of societal communication and functioning in a society that largely promotes an autonomous I-self. This society says a person has his or her own rights and is capable of governing his or her own self-interests in mutually consenting and contractual relationships. Most Chinese people find this individualistic and assertive form of communication overtly anti-community and offensive. Care through verbal exchange, albeit powerful in many ways, is a method heavily bound by cultural and political ideals. To avoid potential impasses and miscommunication, it is worth noting that nonverbal communication is extremely valuable as a means toward advancing further communication.

References

1. Ge Gae. Self and Other: A Chinese Perspective on Interpersonal Relationship. In: Gudykunst WB, Ting-Toomey S, Nishida T, eds. Communication in Personal Relationships Across Cultures. Thousand Oaks, Sage Publications, 1996.

2. Lai AKL. Dragon talk: providing pastoral care for Chinese Immigrants. J Pastoral Care Counsel 2003;57:45-52.

3. Lai AKL. Educating Chinese seminarians in North America: a cross cultural understanding of teaching and learning. Consensus 1999;25:69-92.

4. Doi Takeo The Anatomy of Self: The Individual Versus Society. Kodansha International, 1986.

The superior man is modest in his speech, but exceeds in his actions.
--Confucius, The Confucian Analects

Alan Lai, EdD

From the Department of Religious Education, Vancouver School of Theology, Vancouver, Canada.

Reprint requests to Alan Lai, EdD, Assistant Professor of Religious Education, Vancouver School of Theology, 6000 Iona Drive, Vancouver, BC, V6T 1L4, Canada. Email: [e-mail]