Invisible Lines, Sacrificial Children and Touchy Subjects: Ethics in Psychiatric Anthropology

‘What are the proper relations between the anthropologist and her subjects? To whom does she owe her loyalties, and how can these be met in the course of ethnographic fieldwork and writing, especially within the problematic domain of psychological and psychiatric anthropology where the focus on disease and distress, difference and marginality, over-determine a critical view?’ Nancy Scheper-Hughes

During my fieldwork with schizophrenia patients and their clinical caregivers, I was fortunate enough not to experience many ethically dubious scenarios. Having undergone a year of consultations and various types of clearances to be approved by three different Human Research Ethics Committees (HRECs), I was highly conscientious about my ethnographic conduct and sensibilities. Based between two clinical treatment settings, I wanted to make it clear that any risk of having me around was worthwhile. For both my research participants and authorities allowing me access to these ‘fieldsites’ that had never before had any ethnographers inside their doors. I tried to foster this level of confidence in my work, while still trying to be true to my anthropological bearings – not holding on closely to hypotheses spelled out in my research protocols, and encouraging participants to lead conversations themselves as much as possible (interviews were still, necessarily, semi-structured).

We – those overseeing my research, my participants and myself – were all learning together what this actually meant in practice, and that learning curve was the closest thing to collaboration that I’ve experienced as an ethnographer. Having now reached the end of my fieldwork, my ethical responsibilities to my participants – the humans who have become my thesis data – is still an open learning curve. But now I’m on my own. This blog post is an attempt to highlight the ongoing ambiguities and ethical responsibilities that anthropologists, particularly those straying into areas of ‘mental health’, must keep considering in order to make their own subjectivity a thing that actually becomes useful.

A fieldwork dilemma

On occasions, I worried that I’d mismanaged some conversations with participants. One day a man became suddenly angry with me. Having posed a (pre HREC approved) question about his family background, my participant scolded that I should never ask people, particularly men, about their families. My apologies were immediately emptied out; I’d already overstepped an invisible line. The interview ended on a prickly note, with him adding that clinical staff would say he is ‘aggressive’ and has a ‘personality disorder’, but that this was an ongoing misinterpretation of him. His defensiveness suggested to me that he, a) cared, and, b) was worrying that I would take the clinical stance too. So I tried to take his cue that I had misunderstood his grievances.

But it seemed like a huge failing on my part that I had upset him in any way. What could I have done differently? I told the nurse who had recruited the man for me that I was concerned, but they said not to worry or to take any of it personally. Still, I worried. At best, I thought, there would be no chance of a follow-up interview, or of him allowing me to sit in with him during his clinical appointments (to gain the thicker ethnographic perspective). At worst, he would make an official complaint about me.

As I was working under strict ethics guidelines to protect particularly vulnerable people, if this had been my first interview experience I might have just pulled the plug on my project myself. By this point, however, I’d started to learn how simultaneously necessary and arbitrary the HREC gaze can be; that there were no clear answers; that this one incident did not reflect all others; and that my responsibility was to be as honest as possible and to be mindful of all the different interests and needs. As a Statement of Ethics by the American Anthropological Association reads:

‘The responsibility is not to analyze and report so as to offend no one, but to conduct research in a way consistent with a commitment to honesty, open inquiry, clear communication of sponsorship and research aims, and concern for the welfare and privacy of informants’

As a trainee anthropologist, who was primarily working with males whose family situations continued to surface in subtle or giant ways (like they would for anybody), I made sure to tread lightly.  At first, I wondered if I could, somehow, simply avoid follow-on questions about family stuff altogether – redirect conversations, just in case. But my ethnographic sensibilities meant that I couldn’t just stop stories unfolding, stories that usually concerned social worlds, usually including family matters.

Time to stew, then renew

A month went by. No complaints. So, I thought again, perhaps I really was the one being sensitive. Perhaps it was all just a little glitch or amplification in my imagination. Perhaps I’d indulged in too much fear and even become paranoid, about this one man being so offended by my intrusiveness. It also occurred to me that he might not even remember the conversation at all – although this latter possibility of course brought even more angst about the ethics of me interviewing him in the first place.

When I saw him the following month in the clinic waiting room, I approached him nervously, ready to reiterate how sorry I was to have upset him. But before I could say anything, he apologised, quite profusely, to me. Like all participants, he also said that he just hoped he had been helpful for my research. He wasn’t up for another chat that day but said maybe next time. We did not get another opportunity that year.

When I returned the following year, another nurse told me that he had been asking quite insistently about my return, and if I was going to interview him. The nurse had got the impression, though, that I hadn’t interviewed him at all yet. Knowing that I would not be ‘recruiting’ any new participants upon my return (just doing follow ups), she told him she wasn’t sure if I was coming back – to avoid giving him a directly negative answer. I felt bad that I’d put her, too, in this awkward situation, and that I hadn’t been able to provide him with my return date (it had not been decided yet).

But I did get the chance to interview him again. We began by establishing that we’d both felt horrible about the previous year’s interview experience. He was still concerned that he had upset me, and then felt more concerned when I said that I’d worried about upsetting him. We let the cyclic guilt and apologies disperse. I am now really grateful for the whole experience.

By that later stage in my fieldwork, I could fully appreciate his initial ambivalences. Like many patients, he found it hard to trust people because he had been burned so many times throughout his life. Admittedly, I even felt kind of glad to have been some kind of ‘outsider’ outlet for his frustrations (‘transference’ seems too rich of a word for it as I was not his therapist). Perhaps he could, in this once instance, reconcile things, whereas many deeper relationships don’t get these second chances.

As researchers, we often forget that people can view the opportunity to participate as a positive thing, particularly when the goal is to improve understanding of their lived experiences. I wasn’t just ‘taking’ data.

Yet as I now write up my data, I’m representing people that I can no longer consult. I can only draw on the words they gave me and the unspoken elements that I observed. I would like to think that they would approve of anything I write. I know this is not, however, realistic.

Writing up other people’s stories

To what extent does it matter what our ethnographic participants think of us? In ethnography as in life, we can’t please everyone. Every ethnographic human data set will be full of contradictions, and the potential that people don’t say exactly what they mean or mean what they say. Then, there’s that element of subjective ‘selectivity’ – anthropologists look for overall ‘thematic’ consistencies, specific to time and place, and the way they experienced this time and place. Sometimes ethnographic findings come at a huge personal cost to the anthropologist.

When anthropologist Nancy Scheper-Hughes published her ethnography Saints, Scholars and Schizophrenics, about the rural village ‘Ballybran’ in Northern Ireland, she disappointed many of her ethnographic participants. Combining a range of psychiatric and social explanations for schizophrenia, one of her intentions was to extend anthropologist Gregory Bateson’s ‘double-bind’ theory to a wider cultural sphere. Bateson suggested that mixed messages given in family communication styles can, if not reconciled, result in cyclic misinterpretations of literal and metaphorical expressions of love and disregard between a parent and child – who may consequently develop schizophrenia.

Scheper-Hughes suggested that this situation (and condition of schizophrenia) could not just be explained by ambivalent family relations but also by ‘bad faith relations’ in ‘vulnerable communities’. In the rural and socioeconomically poor village  of Ballybran, she observed an unspoken need for parents to ensure that at least one child, usually the youngest son, would stay around while the oldest child would be supported in educational endeavours to pursue a more prosperous life elsewhere. ‘In collaboration with village teachers, shopkeepers and the parish priest, farm parents tended to create a ‘sacrificial child’ … a child who could never survive beyond the tolerant and familial confines of the village’. Further, this child would accept this fate, because they were made to feel needed at the same time as not good enough for anything else.

Somewhat inevitably, Scheper-Hughes’ ethnography, despite being held in very high regard by the academic community, was angrily contested by the community to whom it concerned. “We all have our weaknesses. But you never wrote about our strengths”, she was told upon her return to the field a whole 20 years later. Ballybran had been a home to Scheper-Hughes (and her own family as well) for the time she was there, but it was not, ultimately, her long-term habitat. For the intergenerational village dwellers, the bruises she did not mean to produce had not yet faded when she returned to try to make amends.

Two decades on, “the young mothers, here, they now go all out of the way to nurse their babies, and they are forever hugging them. Just to show you, I sometimes think”, one person revealed. Scheper-Hughes also received mixed messages of her own: ‘many fell back into the old habit of telling me poignant stories and catching me up’ but ‘words were as dangerous as hand grenades and bullets, as much for those who gave as for those who received them’.

She crossed the invisible line again when, despite not being there this time for ethnographic research, she did what most of us anthropologists do at any time – try to write a way through the uncomfortable experiences. But a sighting of her scribblings was soon misinterpreted; she could not escape her position as ‘that new species of traitor and friend, the anthropologist’. Her return came to an abrupt end: she had to leave at dawn the following morning, before the villagers woke up to be further conflicted by her presence, which could not yet be reconciled.

An Ethnographer’s open truth can still be ethical (even if not ‘PC’)

Reflecting on her situation, Nancy Scheper-Hughes posited:

‘How can we know what we know other than by filtering experience through the highly subjective categories of thinking and feeling that represent our own particular ways of being – such as the American Catholic-school-trained, rebellious though still ambivalently Catholic, post-Freudian, neo-Marxist, feminist woman I was in my initial encounter with the villagers of Ballybran. Both the danger and the value of anthropology lie in the clash and collision of cultures and interpretations as the anthropologist meets her subjects in a spirit of open engagement, frankness and receptivity. There was, I concluded, no ‘politically correct’ way of doing anthropology’.

I agree that we cannot aim for uncontroversial representations when it comes to writing up our ethnographic findings, so long as our findings are always taken to be our interpretations. The burden of truth is on us, and is ours to defend, more so than our ethnographic participants. If the man in my research had read what I wrote above, I realise he might well disagree with my version of our encounters. And while other researchers can reinterpret our data, too, the matter is more complicated than running a post-hoc analysis of findings.

We just have to try our best to keep up that ‘spirit of open engagement’. I will write what I believe to be my most considered interpretation, account for my subjective biases, made in a context and at a time by me, and remember that the human lives I am writing about may be thought about, and even experienced, differently as a result. This is part of attempting to understand better the deeper, messier, aspects of being a human researching other humans, which HREC insurances can only, like us, cover until we cross invisible lines and touchy subjects, requiring continually evolving interpretations.

[Image by Julia Brown]

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