Problematizing Impairment: Cultural Competence in the Carolines

Abstract

This article examines Western concept of impairment by reference to ideas Micronesian (Caroline Island) atoll dwellers hold about personhood,(2) and contributes to growing anthropological attention to disability and related notions of handicap and impairment (e.g., Bruun and Ingstad 1990; Ingstad and Whyte 1995; Jenkins 1993; Susman 1994). Specifically, I suggest distinguishing between impaired parts and impaired persons. Influenced by such things as phenomenology, hermeneutics, and critical theory, most contemporary anthropologists define culture as socially constructed, learned communicative code based on shared system of meaningful signs. In order to acquire and manipulate this code, human beings everywhere rely principally on hearing and speech; culture learning is at once aural and oral. Thus human beings everywhere find that whatever interferes with normal hearing and development or maintenance of normal speech is threatening because it inhibits or even prevents cultural transmission. Persons without culture are genuinely disabled. In identifying common psychiatric themes in Polynesian and Micronesian cultures, Howard (1979:126) notes that the fear of social isolation, not only in sense of social rejection and withdrawal of support, but in literal sense of physically left alone constitutes a focal point of anxiety. Self-imposed isolation is common symptom of onset of mental disturbance in these societies, and isolating oneself from community, either socially or physically, carries particularly powerful message (1979:136). Polynesian and Micronesian communities are group-centered and their members are other-directed. The centrality of group over individual in social life is emphasized by virtually every ethnographer who has worked in these islands, as is importance of external social controls over internal personal controls in maintaining behavioral conformity (Howard 1979). The person in these island communities exists not so much as an autonomous self (as in West), but rather as part of larger community of selves (cf. O'Brien 1993). This group-oriented rather than individual-oriented view of person presents challenge to concept of impairment that is widely used in West: any loss or abnormality of psychological, physiological, or anatomical structure or function (WHO 1980:27). Taking lead from Alkire (1992), I will argue that Caroline Islanders do not see most physical impairments (impaired parts) as disabling, where disabilities are defined as any restriction or lack (resulting from an impairment) of ability to perform an activity in manner or within range considered normal for human being (WHO 1980:28). This is because in most such cases individual continues to participate in everyday web of social relationships, even if at limited or reduced level. Taking further cue from Peter (1992), I maintain that even serious physical impairment (e.g., paraplegia or blindness) is not necessarily disability in these island communities as long as impaired person can construct new roles that permit active contributions to household and community life. Drawing on my research on Namoluk Atoll and on work of colleagues who have conducted studies in other Caroline atoll communities, I argue that evidence favors limiting concept of impairment to those chronic or permanent conditions in which self is socially isolated--in which person either no longer wishes to be or no longer can be constructively enmeshed as an involved participant in community life. In these communities it is primarily various sorts of psychological or mental conditions that are disabling, and attention to psychological conditions leads directly to Caroline Islanders' concepts of personhood. The richest discussion of personhood in Caroline atoll communities comes from Lutz (1985, 1988). …