Psychological Anthropology and Psychotherapy - Conducting Participant Observation During Therapy?
Text by Anna-Lena Fuchs (Freie Universität Berlin)
© Lea Rebecca Minow
I started to find it remarkable, even kind of funny, to be honest, that scholars of psychological anthropology do not get tired to underline how much they value interdisciplinary cooperation between anthropologists, psychologists and psychiatrists. In seminars, lectures, papers and discussions, we hear and read a lot about how beneficial it is to join hands and what we can learn about humankind, society, culture if we combine the perspectives and methods and so on. What I use to perceive as the main focus of anthropology nowadays is to criticize and to identify any existing blind spots. Anthropology can identify the blind spots in psychology and psychiatry of course. It is the specialty of the discipline: We can point the finger at what is missing and what is going wrong.
From my first seminars at university about psychological anthropology I remember to have picked up mainly what is going wrong in the health sector and how patients are labelled and pressed into categories, using the DSM and ICD (as criticized by Davies 2017). Although I have always found issues concerning the human psyche extremely interesting, I came to develop a defensive attitude towards psychiatry as well as any forms of psychotherapy (which I all threw into one pot). It results from the critical perspective towards health care systems, categorization and allegedly biased therapists I got to know at university combined with some negative experiences of close friends and relatives. Positive stories were there, too, and it would not be fair to say that what I learned and learn in seminars and lectures is simple bashing of another discipline. But I knew the shortcomings, the blind spots, the challenges, the problems still to be solved. I am sure I am not the only one with this attitude. After having discussed the critical power position of the pharma industry and circumstances under which diagnostic criteria have been put together, I remember a conversation with one of my fellow students saying that regarding all this information she could never imagine herself consulting any kind of psychotherapist. The influential medical anthropologist Byron Good (2012, 32) describes a “popular anxiety” towards psychoanalysts, who read your mind and know better about yourself then you do or ever will. I really find myself in this statement. Thinking about the rising attention given to the role of self-reflection and emotions in the field of anthropology, I think that someone claiming to know better about oneself is even more likely to collide with the pride of the recent anthropologist.
When discussing mental health issues at university (and generally, regarding any topic) we need to consider that we are by no means the neutral, objective scholars and students, floating above reality and elaborating about what we see in the lives of others. Talking about health issues is a perfect example because who of us has never been the patient?
When I found myself in a psychological crisis some months ago, I did not find it easy to take the step towards finding a psychotherapist who I was willing to trust. When I was about to decide for a therapy and a particular therapist, for the sake of my personal well-being, I wanted to be as careful as possible. I became anxious and confused.
In my first few therapy sessions I started thinking about how beneficial it would be to regard any setting as transcultural, like me sitting in front of the therapist – two people who don’t know each other, with two different backgrounds, stories, lives, trained in different but related disciplines. I was very sensitive towards being reduced to just a few characteristics or even stereotypes, for example when I was asked about my parents (“Please don’t see me as just another academic child!”), what I did the last years (“Yes, I spent some time in India but please don’t see me as some kind of spiritual hippy!”), where I come from (“Working class town – What does this even tell you?”) and so on.
These conflicts came up when I was at least lucky enough to finally get to talk to someone in person. I shortly want to give vent to the anger I felt when noticing how many phone calls it can take, how many boxes in questionnaires one gets to tick, how little helpful a health insurance can be, how many strangers in old armchairs one gets to talk to about one’s feelings … Well, it can be like that or one can be a little luckier. As an anthropology student, trained in qualitative research and since years reconstructing my worldview in the sense of not putting people into fixed categories, for me, it feels like a duty to reject multiple-choice questions about personal experiences. Maybe this rejection is even stronger while I am still in the middle of an intensive learning process. I was longing for some kind of Arthur-Kleinman-like therapist who would be listening to my illness narrative from the first second on and skip the paperwork (I am referring to psychiatrist and medical anthropologist Arthur Kleinman who wrote the influential book The illness narratives (1988)). Thankfully I am better at being angry at ‘the system’ than at people (I guess many of my anthropologist fellows can relate to that) and I have saved my curiosity and openness until eventually, I found a person I felt comfortable with. And thankfully ‘the system’ (in the form of my health insurance) agreed to pay this person because the diagnosis labelled me as ‘sufficiently ill’, as I read the form I was given several times .
Now, I am really glad and thankful that I took this step for some reasons I want to explain here.
Firstly, anthropologists have increasingly become aware of the importance of emotions in the field. I found Meera Seghal’s Essay The veiled feminist ethnographer particularly intriguing in which she describes the emotional dynamics of her fieldwork among Hindunationalist women (Seghal 2009). Very openly, she analyses the emotions she went through, trying to identify the conflicts and how she had started to embody parts of the ideology herself. She writes: “An ethnographer needs to recognize her own emotions, seeing them as “data”, in order to gain insight into the social life of the research setting” (Seghal 2009, 322). In his book The professional stranger. An informal introduction to ethnography, Michael Agar (1980) provokingly compares ethnographers to psychoanalysts. The latter have to go through analysis in order to understand themselves and to consciously distinguish what they personally bring into the therapy setting from what their patients express. He further writes: “Ethnographers, on the other hand, are allowed to go into a situation with no awareness of the biases they bring to it from their own cultures and personalities. This simply does not make good sense” (Agar 1980, 92). I found this view a bit exaggerated, but okay, the book was published in the ’80s and I think some things have changed since then. I think we learn quite a lot about our biases, but I’d say we learn about these biases based on categories we repeatedly place ourselves in. We learn what it means to be “W.E.I.R.D.” (i.e.: Western, educated, industrialized, rich, democratic, as analyzed by Henrich, Heine and Norenzayan 2010), we reflect upon our eurocentric worldview, our academic knowledge, our privilege while putting labels on ourselves but we hardly go further. In an anthropology class, there is not much space for individual life stories. We barely dig deeper, and of course, there are reasons. We are studying anthropology and not engaging in a group therapy session. Still, I think Michael Agar makes an important point. Talking to different kinds of psychotherapists I know, I always kind of envy these people for the deep self-reflection they had to go through as part of their training. In the case of anthropologists, engaging with different kinds of people during fieldwork and getting to know oneself in unknown settings not only teaches us about other people’s lives but at least as much about ourselves – which can be a lot to digest without any assistance.
I also sometimes envy psychotherapists for their skills in talking to people and listening. This leads me to my second point which I found encouraged by Byron Good (2012) in his essay Phenomenology, Psychoanalysis, and Subjectivity in Java. He describes the benefits of conducting interviews accompanied by a psychoanalyst from Java with his different “kind of listening, a different sort of intuition” (Good 2012, 31). Also, he describes how fruitful psychological models can be for anthropology. He writes that “anyone who has engaged in relatively long-term psychoanalytically oriented psychotherapy develops respect for just how difficult it is to understand that which is hidden” and for “the difficulties of truly understanding the subjectivity of others” (Good 2012, 27). I cannot say much about what it is like to go through a psychoanalytical therapy but I think that any kind of therapy for mental health (some less, some more) results in a deeper understanding of the self and brings to light what has been hidden before. I think we as anthropologists can learn a lot from the methods and this intuition – it is indeed quite inspiring. At the same time, psycho therapists could learn a lot from anthropologists,
Thirdly, as an anthropology student about to conduct fieldwork for my master thesis, I must be aware of how challenging this can be. Steve Vanderstaay has written about the ethical dilemmas and emotional stress he went through while and after conducting fieldwork with criminal youths, resulting in what he describes as “secondary trauma” (2005, 374). Of course, there is no need to pick the most devastating topics and settings, but you never know what you come across. Engaging with any topic, any person can touch us more than we might have expected. Also, we need to be open and sensitive towards others. We need to be able to observe and listen. Some months ago, my head was so full of my own stories, emotions, questions that I could not imagine listening to others with the concentration needed, let alone building empathy for the told and feeling into a new situation. Meera Sehgal (2009, 343) describes how her emotions not seldomly became a barrier during interviews. She was struggling to find the right strategy of dealing with them that would allow her to continue her fieldwork while staying psychologically and physically healthy. Thinking about all this I would say that conducting fieldwork in a healthy, stable condition pays off and I am not just talking about the outcome of useful data and a good master thesis. As anthropologist, we need to be conscious of our own emotions and at the same time be empathic towards other people’s experiences and stories. Fieldworks gives us a lot of input to digest, we need to be prepared for this.
This leads me to my last point I want to make: I can be critical, and I can have doubts and I can see myself as a strong person who can solve problems alone, but I am glad I accepted the help of therapy. I would encourage anyone thinking that it might be helpful for them to consider the same and put the doubts aside. We have learned that we do not know better than those we are studying and while therapy is not fieldwork, we also do not necessarily know better than psychotherapists when it comes to assessing personal experience, suffering and well-being. Most therapists are trained to accept their patients as they are and to not play the role of a teacher to lecture the patient about their inner condition but to assist during an open learning process. When we make judgments about diagnostic criteria and the health care systems, we have not said much about therapists as individual people who can be much more flexible and empathic than what we might expect if we have just looked at questionnaires and manuals. That is not the full story. To me it is important to learn to be open to this kind of help. I chose this way because I believe I can benefit from it. Lastly, I quite like feeling well and happy and full of energy.
What I can certainly say is that I find it challenging to study psychological anthropology and doing a psychotherapy parallelly. While the situation hinders me to look at some topics, it widens my view for others. What I am learning during this process is how it is never professional to think one can keep one’s different roles apart - me being a patient and me being an anthropology student fuses within the same person. Still, it is important to recognize that university or even research is not primarily about getting to know oneself and therapy is not participant observation. But both need to be given their own time and space.
Agar, Michael. 1980. “The Professional Stranger: An Informal Introduction to Ethnography.” New York: Academic Press.
Davies, James. 2017. “How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).” Anthropology & Medicine 24 no. 1: 32-46.
Good, Byron J. 2012. “Phenomenology, Psychoanalysis, and Subjectivity in Java.” Ethos 40 no. 1: 24-36.
Henrich, Joseph, Steven J. Heine and Ara Norenzayan. 2010. “The Weirdest People in the World?” Behavioral And Brain Sciences 33 no. 2/3: 1-75.
Sehgal, Meera. 2009. “The Veiled Feminist Ethnographer: Fieldwork among Women of India’s Hindu Right.” In: Women Fielding Danger: Negotiating Ethnographic Identities in Field Research, edited by Martha K. Huggins and Marie-Louise Glebbeek, 325-352. Lanham: Rowman & Littlefield Publishers.
Vanderstaay, Steven L. 2005. “One Hundred Dollars and a Dead Man: Ethical Decision-Making in Ethnographic Fieldwork.” Journal of Contemporary Ethnography 34: 371-409.