Boyd Davis

University of North Carolina at Charlotte

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Stylization, Aging, and Cultural Competence: Or, Why Health Care in the South Needs Linguistics

Stories told by older adults can help them hold on to their sense of self and to their sense of the cultural contexts that have shaped their lives. Shenk et al (2002) compare the role of place and the similarity of themes in life history narratives by two older rural Euro-American women. The first speaker independently reconstructs her life in terms of the rural values that shaped her, while the second speaker’s cognitive loss means that her story must be co-constructed. Themes of “closeness of family, hard work, ties to the land, and religious faith”(2002:1-2), and the ways they are presented, are similar, even though one has Alzheimer’s. Our examples for this discussion are from the ongoing stylization in reminiscences by CEP and EW, two older African-American men from the Carolinas, one of whom is significantly impaired by dementia. We draw on their ways of narrative sequencing and information packaging to illustrate our call for the development and provision of training in multiple levels of language awareness, about discourse style and cross-cultural rhetoric in first or second language, regional or social variety.

Recent studies in communications disorders, such as Mahendra et al(1999) and Ulatowska (2000), incorporate cross-cultural aspects of language into clinical testing and training (cf Dijkstra et al, 2002; Barker and Giles i.p.). However, both research and training in health care communications need expansion in order to include a range of dialectal and stylistic features. For example, CEP uses repetition both for signifying on himself and styling, expecting his interlocutor to understand that he is “enacting or reconstituting culture” (Coupland 2001:369) by the ways he presents himself. CEP is double-voicing: his two-track stories call his interlocutor to affiliate with shared cultural identity (Hazen 2002). CEP presents a man who has both suffered deeply from racism and who has survived, successful on his own terms. He plays among the features he selects to showcase both his metaphorical and his real, if masked, ‘identity.’ Significantly impaired, EW can no longer be loquacious, but he can use the stylistic device of incremental phrasal repetition, to signal cultural features of identity and invite involvement. Understanding how CEP and EW use language could alter diagnosis and services.

Learning to recognize discourse components and features such as culturally-preferred ways of telling a story is part of cultural competence. Discussing the speech of Texas women, Johnstone comments that “sounding like a Westerner can mean telling stories a certain way”(1999:316). And it s not just stories: Kirkpatrick (1991) shows how a radio station consistently overlooked requests in (English) letters from Mandarin speakers because of placement of the request. Teacher-expectations for cultural styles can be triggered by the use of a topic-associating style of narrating (Taylor and Matsuda 1988; cf Rickford and McNair-Knox 1996). New studies keyed to the 2000 Census, such as “Older Americans 2000,” analyze new patterns of immigration plus changing projections for increased lifespan and retirement in Southern states. We need to expand our analyses of language in the South to include medical education, in order to assure that health care workers for the aging can “tailor delivery to meet patients’ social, cultural, and linguistic needs”(Cultural Compendium 2003:6).

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