Thursday, November 26, 2009

Reflections on Fieldwork at the Clinic

Tomorrow marks the end of my fourth week of research. And after twenty mornings of observation, 4 different wards, and more than 50 typed pages of field notes, I’m more excited than ever about this project.

I start each day at the réunion de staff, a meeting in which the residents and professors get together to discuss all new admissions of the day before. Afterwards I head to one of the wards, where I observe the daily goings-on. I sit in on medical consultations or meetings between nurses. I participate in recreational activities for patients, walk around the ward, look at the schedules and announcements posted in the nurses’ office, get a sense of the way in which records are kept, listen to doctors discussing treatment options with one another, or simply sit in a chair and watch. I have informal conversations with the staff, in which I’ll ask them about their method of diagnosis, their protocols for treatment, or about the backgrounds of their patients, and they’ll ask me about my research plans.

For the moment I am simply an observer; apart from these informal conversations I’m not engaging in any actual interviews yet. But even just these brief mornings of watching have produced more data than I had ever expected at this stage of research. Everything I see and hear at the Clinic is material. I’m picking up data and learning new things at multiple levels, all at the same time. I’m learning linguistically: I write down the French terms for disorders, symptoms, and other phenomena. I’m becoming so used to being in a francophone hospital environment that I’m beginning to have trouble thinking of the English equivalent for words like prise en charge (care), sevrage (withdrawal), or infirmier chef (head nurse?).

At the same time, I’m learning on a medical level: I’m becoming familiar with psychiatric symptomatology, its clinical presentations, and its biological consequences. I frantically write down every snippet of general medical information that I glean from my observations, and spend most of my afternoons googling the names of medications I’ve seen prescribed, the workings of different neurotransmitters, or the DSM-IV description of personality disorders.* I’m learning about the Clinic’s procedures for admission, treatment, and discharge, as well as national laws governing hospitalizations, and am getting a sense of how clinical observations are recorded and communicated between doctors and nurses.

And finally, I’m gathering ethnographic data. I observe how residents interact with their professors, how doctors talk to nurses, and how staff communicate with patients. I’m getting a sense of how patients express their symptoms, and how doctors listen to these explanations. I’m taking note of the gender balance and how this affects the relationship between patients and staff. I’m beginning to get a sense of how psychiatric theories interact with popular belief in spirits and magic, how medical knowledge is imparted to students, and of how medical expertise lends power.

All of this data makes for almost incessant note-taking, and a bit of internal conflict sometimes about what to write down, and what to let slide. In that sense I’m also learning about myself as an observer – about what I pick up on and what I miss, what I consider important, and how I position myself vis-à-vis the people among whom I am doing research. I spend a fair amount of time talking to two other foreign women spending some time at the hospital – a student of clinical psychology and a psychiatrist. As we exchange impressions and reflections, I find a lot of my observations reinforced, but also curiously take note of differences in interpretation, or of interesting bits of information I had completely missed. Their viewpoint is valuable to me – the extra eyes and minds add more data to my notes, but also allow me an additional dimension of reflection on what I’m seeing. Their experience of clinical practice in France provides me with a valuable comparison for the things that strike me about psychiatry here, and provide me with a sounding board on which I can test some of my own budding interpretations.**

This wealth of input only makes me hungry for more, and I’ve never felt more motivated or energetic about my project. At the same time, however, the wealth of sensory input gets a little overwhelming sometimes. There is so much to take in that I feel as though I’m left without enough time to process it all, to wrap my head around it and make sense out of what I’m seeing. As far as my ethnographic work is concerned, this might not be something to worry too much about. There’s something to say, perhaps, for just diving in at this stage of the project – of immersing myself completely and just letting it all flood over me. It might even be too early to try and distill some interpretations or theories out of what I’ve seen – if I draw conclusions now, perhaps I’ll blind myself to new evidence that might contradict what I think I’ve learned?

But personally, it’s difficult sometimes to relinquish that sense of control, that sense of knowing what’s going on. And for the purposes of this blog, I do wish that I were a little bit more able to distill a few coherent ideas out of my field notes, just enough for a post or two. There is so much I want to write about – the communication between doctors and patients, the concept of ‘psychiatric expertise’ and the way in which it shapes that communication, the notion of hysteria (so outdated a term in Europe and the US, but so commonly used here), the role of gender in shaping interactions, treatment plans, and diagnoses. All of these ideas are floating around in my mind, but I just can’t seem to find enough clarity to pin them down with adequate, descriptive words. Hopefully I’ll find a bit of coherence in due course. I’ll try to keep posting about once a week – and I’ll try to return to writing about things other than my research, as well.

* This level of learning has made me particularly conscious of how much I miss medicine. How intrigued I am not just by the human mind, but by the human body as well. I don’t want to use the word regret because I don’t for a moment regret choosing anthropology, but I do regret making a choice in general; I regret having decided at some point that I wouldn’t be able to do both medicine and anthropology. It’s never too late, I suppose, and in theory I could apply for medical school once I finish my PhD. When that time comes, I guess I’ll have to ask myself what I’d rather do: start another rigorous four years of education when I’m in my early thirties, or spend the rest of my life knowing that a part of me will always miss medicine?
** In addition, I’m finding it incredibly valuable to be able to talk about what I’ve seen with others who have shared the experience. I’m observing at the Clinic’s emergency room this week, and a few of the people who’ve come in for psychiatric help have really struck me in their sadness and hopelessness. More so than on the other wards, observation this week has affected me emotionally, and it’s been helpful to talk about these observations with others who were there.


Anonymous said...


Dr. Charlotte M.D. has a nice ring to it. :-)


Heidemarie said...

Medecine or anthropology ... this sounds very much like the "Roads Taken and Not Taken" section in the Progoff Intensive Journal. For sure,this writing method would be extremely interesting in your expat-observing-writing it all down and trying to make sense of it situation. Have a look at! Besides I shall give a talk on the Intensive Journal at the Churchill Club in Casablanca on Thurdsday, December 3rd at 10.00 - welcome!

Evelyn aka Jackie said...

That's so interesting that Moroccan psych uses DSM-IV. For some reason I had assumed that only the US uses this guideline. So I learned something new today! Thanks, Charlotte! :0) I love your enthusiasm for your fieldwork. You reminded me of all the reasons I loved my grad school fieldwork, too. You never know what job you may find after getting your PhD. I know one medical anthropologist who works for the VA Hospital doing research, so she's still in medicine in spite not having the MD! And I work in a community health clinic, so it really is possible! Look forward to reading more about your fieldwork!!

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Anonymous said...

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