AUTOETHNOGRAPHIC TECHNIQUES IN MEDICAL ANTHROPOLOGY

© 2016 Aleksandr Nikolaevitch MANUYLOV


Снимок экрана 2018-01-13 в 0.20.32Keywords: autoethnography, fieldwork, self, medical anthropology

Abstract: The main argument of the article presented here is relevancy of autoethnographic techniques to medical anthropology. In order to argue this the author appeals to history of Anthropology which is developing from the interest to abstract objects in social organization and culture of societies remote of Europe (so called ‘Others’), being constructed on the base of European equivalents, to the interest to a particular person and his/her life circumstances, being taken through a lens of ‘self’. In the article the foundations of autoethnography as both a field method and analytical tool are presented; brief thematic overview of autoethnografic work in the field of medical anthropology is given.


Anthropology: a few steps to human being

Anthropology develops intensively. Directions of this development are different. But the triad ‘theory – method – field’ remains a key element of this development. Therefore the most important turns touch upon all the parts of this triad.

Anthropology does not have such a thing that can be considered as a ‘main line’ or ‘mainstream.’ It is so polymorphous that some researchers (for example, Crapanzano 2010) tend to say about anthropologies and the development of some currents is in opposition to others. This creates intensive debates regarding theory, methods, fieldwork and many other things.

Anthropology began its first motion not to human being but ‘exotic societies’ inhabited the areas most remote from Europe. This motion was presented not by anthropologists but specialists of other professions who were engaged in documentation of Others’ life constrainedly or had their private interests. In the 1910s – 1920s, professional anthropologists took their place trying to occupy the field of contacts with Others and provided their professionalism with a specific importance (Clifford 1988: 24–25). However, the focus of their research had still been structures and functions, not persons. Their interest aspired to classify life of Others in the same order as life of European societies was classified. Let us remember the development of the concept of “basic needs” by Malinowsky (1960: 91–119) or “social sanction” by Radcliffe-Brown (1956: 205–211).

But after a while anthropology turned back to Europe. Initially, anthropologists had to justify themselves, explain why they out of the blue began to focus on European nations using methods and knowledge in the field of study of “primitive” and “indigenous” people. Ernestine Friedle, for instance, in her work about a Greek village of 1962 mentions that this turn started twenty years earlier and was carrying out from “primitive” to Near East societies and then to Europe. She argues that many anthropologists make such a turn «because of a conviction that the techniques and insights developed through the study of primitive societies are useful for the description and analysis of all societies. Although some anthropologists have ventured into the study of groups in urban centers, the majority of those interested in learning the ways of life of the co-heirs of the own civilization have concentrated of what have been called “folk” or “peasant” societies, or, to phrase it more descriptively, the rural populations of modern nations. Application of anthropological techniques to such groups has raised some new problems in method and interpretation» (Friedl 1962: 2–3).

In the late 1960s, Josef Aceves even got in awkward situation because of his aspiration to study a Spanish village. His informants being familiar with what anthropologist was (Aceves presented himself as an anthropologist precisely) accused him in that he made an equality between them and “primitive people,” “those in Africa,” because anthropologists according to them “studied primitives exclusively” (Aceves 1971: 5).

The study of European nations, or so called “anthropology at home,” accompanies by another phenomenon – “native anthropology.” Both terms are not characteristic to Russian ethnology/anthropology. The former term is usually used by European and American anthropologists in relation to study European and American communities correspondingly. The latter one as well as the term “indigenous anthropology” (Balzer 1995: 3) may be understood as study of non-European ethnic groups by local researchers. In the fact that this terminology is still active, one can easily detect the colonial heritage of anthropology in it. But in all this staff it is important to us that anthropologists screw their heads round to look at their own societies where they can be sources of information for themselves. The Other shifts into if not a researcher himself/herself but somewhere much closer to him/her, to his or her native community. According to the argument of Mariza G.S. Peirano (1999) during the twentieth century the distances between researchers and those they observed “have constantly decreased” (Peirano 1999: 105). As Clifford Geertz put it, “we are all natives now” equating those who live “across the sea” and “down the corridor” (Geertz 1983: 151).

The next stage of this process is the penetration of hermeneutics and various psychological methods into the anthropology. Now anthropologists are interested in person and personality; they analyze their field data through the lens of this person’s perception of the outer world. The case approach, where one case is considered as one person, has become prevailing. Since the distance between a researcher and his/her object has shortened and the relationships with an informant has turned into the important element of not only fieldwork but also ethnographies, the figure of a field anthropologist also raised the interest. So, we can see a particular trajectory from the descriptions of societies, their structure, culture, rituals, law, etc. to the descriptions of life, more preciously, fragments of life of different persons, their actions, emotions, expectations, preferences, uncertainties and fears.

«I and the Other» and «I as the Other»: fast facts about techniques

I do not suggest anything new, per se. Such a practice – a perception of surroundings by means of myself – is a rather allowable way of doing fieldwork. However, this practice does not have a form of “observing the observer” directed to multiplying field observations without changing them essentially. Surely, such a shift of attention to your own self is a drift to hermeneutics.

How can we determine the paradigm of autoethnography and, wider, anthropology of self? There is a rich body of literature on this topic published in different fields of knowledge where ethnography as a field method is acceptable (Adams, Holman Jones, Ellis 2015; Bochner 2014; Chang, Ngunjiri, Hernandez 2013; Pillay, Naicker, Pithouse-Morgan 2016; Reed-Danahay 1997; Rogozin 2015). But in this case I consider relevant to present this paradigm in terms of my personal experience.

First. If in the past I was interested in people, their practices and discourses in that environment and those circumstances they usually existed or situationally found themselves, then now I interested in myself among other people and that how this human environment forces me “to be such a person I’ve never been.”

Second. I drop to have trust in field descriptions which can be found in any anthropological publication. That is, I have never trust them knowing well how an anthropologist disturbs the field and how he or she eventually constructs it. But I have accepted these constructions as an element of creativity in our profession.

But now my mistrust is connected to another perspective of the fieldwork. An anthropologist in the field, despite the best of intentions to get into Others’ skin, to understand an Others’ culture, to pass through any initiations or rites of passage, remains, of course, anthropologist, i.e. a person who is not from this particular society, who earns salary not from locals, the target public of whom is not a local community but the community of the same researchers like he or she, speaking their own abstruse language.1 There is no point of no return here. There is no transformation of yourself in your informant, as there is no cease of a possibility to return to the office and classroom. I say here about a parallelism of two worlds, academic and secular. Anthropologist in the field is not a point of coincidence and not a point of identity, but only a point of intersection of these two worlds, even if it looks like a point of identity (if we study homo academicus, for instance). In the case of an autoethnographic description, the fieldwork coincides with both life and academia, turns out to be their perfect identity. It is clear now where my mistrust to publications of field materials have come from. Non-identical fields cannot speak the same language. What produced by an anthropologist on the base of his/her own field experience does not relate to lives of the people he or she has observed in the field. What the product of anthropologist is relevant to is academic discourse on fieldwork or to “a myth of fieldwork” as James Clifford put it (Clifford 1988: 24). How much better is my own self who has survived and continue to survive particular events having no chance to stop this movie and say: “Well, that’s enough, now I’ll come back to my university and think about what I can do with all this stuff”!

The identity of the anthropological field and the notion usually marked as life is not unique. I am familiar with a few cases when a researcher used his/her own life experience in order to describe that social milieu in which he/she has been involved in former times. They did it post factum. While those authors were beyond the academic field they did not have academic identity and did not mark their field as field.

Another factor determined the turn to the Self became that that I started to work on my Greek project from Norway. The topic of the research was formulated as identity construction of those Greek groups who migrated from ex-Soviet countries to Greece in the framework of the program of repatriation (Manuylov 2015).

Doing my fieldwork, I immersed myself in excitements and stories of migrants who with great difficulty and with great courage tried to appropriate contemporary Greek life and to be accepted by the Greek society. They suffered from incomprehension of the New Greek language and the lack of knowledge of rules and laws. But above all – from the fact that they were labeled as third sort people as anthropologists and sociologists repeatedly wrote (Triandafyllidou 2000; Triandafyllidou, Veikou 2002; Voutira 2006). This catastrophic, as Greeks prefer to consider it, experience added up as on a twice exposed film on my personal experience of migration to Norway began in 2008.

There is nothing new, nothing unusual in self-observation as well as in any form of self-communication. Reflection is probably common to all people. At least, to all anthropologists. Modelling of personal life as an anthropological field directed to a particular future work of analysis and interpreting of field materials accompanied by further publications and integration, say, in lecture courses is a powerful constituent of autoethnography. Caroline Ellis, Tony E.Adams, Arthur P.Bochner suppose that “when researchers write autoethnographies, they seek to produce aesthetic and evocative thick descriptions of personal and interpersonal experience” (Ellis, Adams, Bochner 2010: 14).

The practice of fieldwork changes dramatically in the case when you personally become your own object of research. Together with observation, the memory becomes the important field source. A researcher sets goals for his/her memory. And the memory produces images sublimating in texts due to discourses, and among them those discourses which were accepted later than those events images of which are summoned from the memory. The work consists in embedding of memory images into discourses, in giving a chaotic and contradictory tide of life a certain direction or even a meaning, which, perhaps, was not contained in the initial events. There is no violent constructing in that, there is no corruption of reality; this is just reality in any sense of the term. They are just ethnographic facts as we usually get them, as it seems us, from other people or by the medium of other people (I would say we produce them thanks to other people). The difference is just in that that you have a possibility to observe how this constructing is happening, to see the mechanism of creation of both text and meaning. It cannot be hidden from yourself. The old issues of understanding and explanation of connections between discourses and practices, between thinking and behavior go aside. They become irrelevant. This considerable advantage of autoethnography allows operating with such a concept as “open personality,” if to use as a prototype Karl Popper’s “open society.”

Another question is: what kind of elements and topics of the open personality can be demonstrated publicly. There are many factors working here; if to mention only few of them: the possibility not to be a witness against himself which is the basic element of human rights; relevancy to tasks in hand allowing to limit and filtrate data as early as on the stage of data production; limitations of a moral origin (which are shifting alongside with the dynamics of public morality and the development of field ethics), etc.

If to look at yourself as a field informant, the problem of anonymization appears as either an unachievable task or an issue of mystification. When you study and write about it as just about studying yourself, there is nobody to anonymize. And all difficulties of fieldwork connected to advocacy (see about it Hastrup et al. 1990; Kellet 2009) become irrelevant. If in studying yourself to write about yourself as about the Other, this is not a sort of anonymization, this is a sort of mystification, misrepresentation in respect of reader, since it is impossible to admit this mystification without revealing yourself. I would also consider as a sort of mystification the attempt undertaken by James D.Faubion when he describes one person constructed by him from different and even opposite-sex informants (Faubion 1995). Anyhow, the author informs us about it and his mystification is limited with the impossibility for reader to identify elements of different people in the constructed by Faubion multi-sex poly-personality.

What does the credibility of the anthropologist, who has come from the field and published his/her ethnographies, repose on? How to understand whether sources are falsified, are they understood correctly, what is demonstrated by the anthropologist and what he/she is silent about? No way. This credibility colleagues invest in the work of an anthropologist is simultaneously a sort of covering each other’s backs binding anthropologists and assigning a specific solidarity regarding the authenticity of the fieldwork to their community. The right to truth and presumption of truth-telling are integral elements of the discourse on identity ‘anthropologist.’ In sociology, for instance, the possibility to check the rightness of answers is assumed to be; it can be done through repeated attendances of people’s homes the interviewer had to be visited. In anthropology such kind of checking is a completely meaningless occupation. Moreover, the anonymization makes it impossible. Anthropology of Self puts everything in the proper way. It admits by its own existence that the author’s regime of truth may be of any kind and may be changed over time. And there are no reasons to accuse the author in anything as there are no reasons to accuse an artist in that he misunderstood himself/herself in his/her intention to write on his/her picture “this is not a pipe.” Anthropology, at last, is released from ethnographic authority, becomes understandable and available (the popularity of similar genres of memoirs, autobiographies, and diaries witnesses this).

Moreover, the rejection of ethnographic authority shows that anthropology is finally leaving the Procrustean bed of colonialism; it does not want and is not able to colonize more territories and minds, universities and souls. It becomes a free creativity to which it has always been aspired, perhaps, although it still demands in colonial and post-colonial training for anthropologists; without this training anthropology will lose its identity.2 If the perspective of Anthropology of Self for anthropology is now clear, what are the perspectives of self as an object of research for anthropology? This issue is more complicated.

Above all things its complexity concludes in that the field of the study of the Self is occupied by other academic disciplines, knowledge systems, and practices suggesting various commodities based on the work with the Self and an ordinary human reflection. In relation with the definitions of self, personality, memory, mind debating in that field, there is neither compromise nor unity. Therefore, it is not necessary to go far away from anthropology in order to define the Self as a field source, as an informant. Piety regarding informant common to anthropologists aligns those asperities the way to the object definition overflows with.

The turn to Anthropology of Self limits anthropologist with nothing. If he/she is traveling, meeting with different people, discussing various issues with them, participating in their life, it does not mean that all these people are not available for ethnography; rather on the contrary, they become available for description by a more natural way, by the same way if I would talk about them to my friends, children or wife. And I would talk about people I met during my fieldwork in terms of myself, as I have seen them, including in the description my doubts, typologies, stigmatization etc. However, as an object of my own fieldwork I, of course, will be asked about the causes and order of such a stigmatization or typology (what I perhaps would not ask not-myself about); I, of course, will have to explain the reasons of my doubts or assurances. This approach, thus, removes the complex of Malinowski who wrote the one in his publications, and the other in private diaries.3

What’s to be done with technical issues, with descriptions of technologies, processes, rituals? They will never suffer because the fieldwork supposes mastering all this knowledge both on the level of discourses and on the level of practices. A vivid evidence of that is Medical Anthropology.

Object of study – medicine? physician? myself?

What can be examined in the framework of Medical Anthropology and with the help of autoethnographic techniques?

a) Medicine. Call it an institute, a system or a branch – it does not matter. The main task is to make sense to the borders of the field and dominating discourses. In other words, to understand till when and how far a medical worker represents medicine in a private conversation of two or more friends. There are few important questions here. Among them the question of medical identity, one of the hardest professional identities, questions of privacy and publicness (see about them Manuylov 2012), segmentariness and hierarchy (Herzfeld 1985: xi–xii) and others. What kind of experience can be used for such a research? My own experience, first and foremost. It is easy to get a sight of the state through medicine. And then would be important to understand the parameters of state control and state care, the type of relation of the state to its citizen or subject, expected relation of a citizen/subject to the attention of the state expressed in medical practices. Etc. Here as everywhere in anthropology the comparative perspective is necessary. For example: the state medicine private medicine; the official medicine vs. witchcraft, etc. The study of intercrossing and cooperation of those sub-fields also gives interesting results (see: Kasyanova 2008).

b) Physician or physicians. Physician is a personalized element of a medical field, embedded in the field by his/her identity, labor, time spent for the profession, uniform, language (and even bilingualism including the national language and restricted form of Latin). We, as anthropologists, are mainly interested in physician as a human being. Nowadays, many functions of a physician yield to machines. And this tendency to mechanization of medical production needs to be analyzed carefully. Interactions with a physician may be restricted by a hospital ward or medical examination room, but may spread wider if to assign a task to study a physician in his/her private life, if to try to understand the circumstances when medical identity becomes obsolete.

c) Disease and health. A study of these topics is of course the study of discourses. But in a particular perspective, it can be said that the medicine produces diseases (as well as health). And if a disease is a commodity well defined in medical economy, health turns into utopia, since the whole toolkit of medicine is directed to and the meaning of physician activity consists in that to find a disease and identify it even if the patient has no complaints. Anthropological study of disease necessarily demands in anthropologist’s qualifications in the field of medical knowledge; in other case, it is barely possible to understand medical discourses on diseases. This is the important and essential problem of an anthropologist. It is no secret that many researchers who focus on the topics connected to special knowledge and demanded in a long training period for understanding at least the language of the field, received special degrees at universities. Paul Rabinow, for example, being a PhD in Anthropology had to get training in the field of Molecular Biology in order to conduct his anthropological research in this field.4

d) Self. As you already perceived, my priority is studying of myself in my interactions with medicine, physicians, diseases, and all those who may concern in it and, as a result, autoethnographic description of these experiences. I have already argued the paradigm change in contemporary anthropology and a few examples of anthropological work in the frameworks of autoethnography. A friend of mine, the anthropologist from India, studied the consequences of chikungunya epidemic in the state of Kerala. In particular, he was interested in question what kind of available in India healthcare systems is most popular among the families survived the epidemic. His field technique was as follows: he watched outside the building of a medical center and observed what kind of door entered people (those doors led to different specialists – in European medicine, in Ayurveda, in Chinese medicine, and in local witchcraft). Moreover, he tried to communicate with some people when they left their doctors with the hope to get information about their cases. I suppose that he focused his research irrelevantly to his tasks if not to be engaged in a marketing activity for one of doctors. Why did not he go to appointment to each of specialists personally? It would be helpful to sit among patients waiting for the appointment and talking about their problems. Indeed, he and his family were locals who had survived the epidemic, too; and perhaps they were also needed in health control.

Autoethnographic techniques are completely relevant to the tasks of medical anthropology because they make easier the access to fieldwork (sometimes extremely difficult in this part of anthropology) and possess as it was demonstrated a remarkable heuristic ability.

 

Notes:

*The hard copy of the article was published in Russian as a chapter of the book Valentina Kharitonova (ed.) Medical Anthropology in Instable Globalizing World, Moscow: Publicite, 2017.

1 As Jeffrey M. Keefer put it: “I need a community of researchers to support, challenge, and otherwise share my work. I am not productive or creative when working completely alone, outside this support structure. As autoethnographic elements are an increasing theme in my work, and while I feel research community support, I began to wonder how others navigate this contentious strategy of inquiry, and if they, too, rely on their own communities of practice” (Keefer 2010: 208).

2 Michael Herzfeld begins his work Anthropology through the looking-glass with a discussion regarding the importance for Anthropology to study Greece because in Greece “the labile boundary between the exotic and the familiar” allows to examine the issue of anthropological knowledge in its European-produced relation to the exotic in a new way (Herzfeld, 1987: 1). This topic is important here because it allows anthropological thinking to be removed from the framework of colonial usage by shifting its focus to the European borders not so much engaged in Eurocentrism. In my case I suggest to be shifted in other than spatial way. I mean the shifting which is a redirection of the object of our attention from the image of the Other to the image of the Self in a situation of and in connection with the contact between the Self and the Other.

3 Strictly speaking the Diary by Bronislaw Malinowski (it contains records of 1914–1915 and 1917–1918 and was published in 1967) has to be considered as the first autoethnografic document (Malinowski 1989). Raymond Firth notes that the diary “does indicate vividly how Malinowski thought about issues and about people – or at least how he expressed himself when he was writing only for himself as audience” (Firth 1989: xii).

4 http://anthropology.berkeley.edu/people/paul-m-rabinow

Библиография

Aceves, Joseph (1971) Social Change in a Spanish Village, Cambridge, Mass.; L.: Schenkman Publishing Company, xii, 145 p.

Adams, Tony E., Stacy Holman Jones and Carolyn Ellis (2015) Autoethnography, Oxford; N.Y.: Oxford University Press, xii, 203 p. (Ser. Understanding Qualitative Research)

Balzer, Marjorie Mandelstam (1995) ‘Introduction: What’s “Native” About Non-Russian Anthropology?’ in: Balzer, Marjorie Mandelstam (ed.) Culture Incarnate: Native Ethnography in Russia, Armonk, NY: M.E. Sharpe, pp. 3–28.

Bochner, Arthur P. (2014) Coming to Narrative: A Personal History of Paradigm Change in the Human Sciences, Walnut Creek, Ca.: Left Coast Press, Inc, 350 p.

Chang, Heewon, Faith Wambura Ngunjiri and Kathy-Ann C. Hernandez (Eds.) (2013) Collaborative Autoethnography, Walnut Creek, Ca.: Left Coast Press, Inc, 200 p.

Clifford, James (1988) The Predicament of Culture: Twentieth-Century Ethnography, Literature and Art, Cambridge, Mass.; L.: Harvard University Press, xiv, 381 p.

Crapanzano, Vincent (2010) ‘The End – the Ends – of Anthropology’, Paideuma, Bd. 56, pp. 165–188.

Ellis, Carolyn, Tony E. Adams and Arthur P. Bochner (2010) ‘Autoethnography: An Overview’, Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, vol. 12, no 1, Art. 10. Available at: http://nbn-resolving.de/urn:nbn:de:0114-fqs1101108 (15.05.2016).

Firth, Raymond (1989) ‘Introduction’, in: Bronislaw Malinowski, A Diary in the Strict Sense of the Term, With a New Introduction by Raymond Firth, transl. by Norbert Guterman, L.: The Athlone Press, pp. xi–xix.

Friedl, Ernestine (1962) Vasilika: A Village in Modern Greece, N.Y.: Holt, Rinehart and Winston, xviii, 110.

Geertz, Clifford (1983) Local Knowledge: Further Essays in Interpretive Anthropology, N.Y.: BasicBooks, viii, 244 p.

Herzfeld, Michael (1985) The Poetics of Manhood: Contest and Identity in a Cretan Greek Village, Princeton: Princeton University Press, xx, 313 p.

Herzfeld, Michael (1987) Anthropology through the looking-glass: Critical ethnography in the margins of Europe, Cambridge: Cambridge University Press, xii, 260 p.

Kasyanova, Alexandra (2008) ‘Tselitel’nitsa? Net, – ved’ma! Trasformatsiya predstavleniy o “professii” v sel’skikh soobschestvakh Krasnodarskogo kraya,’ Zhurnal sotsiologii i sotsial’noy antropologii, vol. XI, № 2, pp. 67–79 (in Russian).

Keefer, Jeffrey M. (2010) ‘Autoethnographer Communities of Practice,’ in Dirckinck-Holmfeld, Lone, Vivien Hodgson, Chris Jones, Maarten de Laat, David McConnell, Thomas Ryberg (eds) Proceedings of the Seventh International Conference on Networked Learning 2010, Lancaster: Lancaster University, pp. 207-214.

Malinowski, Bronislaw (1960) A Scientific Theory of Culture and Other Essays, N.Y.: Oxford University Press, x, 228 p.

Malinowski, Bronislaw (1989) A Diary in the Strict Sense of the Term, With a New Introduction by Raymond Firth, transl. by Norbert Guterman, L.: The Athlone Press, xxxiv, 315 p.

Manuylov, Alexander (2012) ‘The Practices of ‘Privacy’ in a South Russian Village (a Case Study of Stepnoe, Krasnodar Region)’, Baiburin, Albert, Catriona Kelly & Nikolai Vakhtin (eds.) Russian Cultural Anthropology After the Collapse of Communism, London; New York: Routledge, pp. 130–154.

Manuylov, Alexander (2015) Russian Greeks / Greek Russians: Parameters of Identity, Bergen: University of Bergen.

Peirano, Mariza G. S. (1998) ‘When anthropology is at home: the different contexts of a single discipline’, Annual Review of Anthropology, 27, pp. 105–28.

Pillay, Daisy, Inbanathan Naicker and Kathleen Pithouse-Morgan (Eds.) (2016) Academic Autoethnographies: Inside Teaching in Higher Education, Rotterdam; Boston; Taipei: Sense Publications, xii, 200 p.

Radcliffe-Brown, A.R. (1952) Structure and Function in Primitive Society: Essays and Addresses, Glencoe, Ill.: The Free Press, viii, 219 p.

Reed-Danahay, Deborah E. (Ed.) (1997) Auto/Ethnography: Rewriting the Self and the Social, Oxford; N.Y.: Berg, xiv, 277 p.

Rogozin, Dmitriy (2015) ‘How autoethnography works?’, Sotsiologicheskoye Obozreniye, vol. 14, № 1, pp. 224–273 (in Russian).

Triandafyllidou, Anna (2000) ‘‘Racists? Us? Are You Joking?’ The Discourse of Social Exclusion of Immigrants in Greece and Italy’, King, Russell, Gabriella Lazaridis, and Charalambos Tsardanidis (ed.) Eldorado or Fortress?: Migration in Southern Europe, New York: Palgrave Publishers, pp. 186–206.

Triandafyllidou, Anna and Mariangela Veikou (2002) ‘The hierarchy of Greekness: Ethnic and national identity considerations in Greek immigration policy’, Ethnicities, 2:2, pp. 189–208.

Voutira, Eftihia (2006) ‘Post-Soviet Diaspora Politics: The Case of the Soviet Greeks’, Journal of Modern Greek Studies, 24, pp. 379–414.

This article is  available in full version in Russian

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