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.
Showing posts with label anthropology. Show all posts
Showing posts with label anthropology. Show all posts
Thursday, November 26, 2009
Thursday, September 3, 2009
The Power of Language
Over the course of my conversations with the psychiatrists I interviewed last month, each practitioner explained that individuals mostly come to see them in search of la parole. Rather than a pill, in other words, patients consult a psychiatrist in private practice in the hopes of procuring a ‘talking cure.’
I found it interesting to hear that Moroccans – many of whom, according to my observations so far, seem very eager to solve an instance of bodily malaise with a quick pill – would prefer lengthy psychotherapy to pharmaceuticals. I found it surprising that there seems to be less stigma attached to counseling than there is to medication, as these psychotherapists claimed.
But what also struck me, and what I want to write about today, is the psychiatrists’ choice of the word ‘parole’. This French word can be translated as ‘speech’, or ‘spoken word’. Of course, ‘talking’ has been widely proven to be an effective form of psychiatric treatment. But what interests me here is the fact that ‘parole’ suggests such a strong emphasis on the linguistic dimensions of that activity. I don’t think that these psychiatrists ignore the myriad other dimensions of communication, but in general, I am getting the sense that Moroccan psychiatry focuses heavily on the issue of language.
Any time these psychiatrists spoke about establishing a sense of mutual understanding – and the importance of having a shared discourse on which to base that understanding – they would mention the importance of defining certain words, of ‘speaking the patient’s language’. In his writings about the history and practice of psychoanalysis in Morocco, Dr. Jalil Bennani even conceives of cultural beliefs as a kind of ‘language’. He suggests that a particular way of understanding and experiencing illness should be understood as a particular language, used to express feelings that are ultimately universal:
“Il convient d’accorder à la tradition magico-religieuse la place qui lui est due en interprétant celle-ci comme un effet de langage et non pas comme un effet ethnique. Il convient de reconnaître dans le discours magico-religieux du patient le signe d’un autre discours afin de réussir à dépasser la frontière stérile du magico-religieux et du rationnel et déplacer les conflits en vue de faire retrouver au sujet une capacité de liberté par rapport à sa propre parole."
Freely translated, he says the following: “we should see magico-religious tradition for what it is, conceiving of it as an effect of language, rather than an effect of ethnicity. We should recognize the patient’s magico-religious talk as marker of a different kind of speech,* so as to enable ourselves to transgress the sterile boundary between the magico-religious and the rational and to dissolve their conflict, so as to allow the subject to recover a capacity for liberty with regard to his own speech.”
I’ve noticed this psychiatric focus on language before – at the Clinic, for instance, when Dr. Rachidi lamented that with so few diagnostic tools available in Moroccan Arabic, doctors and patients forever risk getting stuck in a cycle of mistranslation. And this focus makes perfect sense, given the particulars of the Moroccan context.
Mutual understanding is always a crucial issue in psychotherapy. Doctor and patients may come from different (cultural, educational, economic) backgrounds, may ascribe to different ideologies, and may explain experience (and illness) in very different ways. Therapy is effective only if communication is; and in order to truly communicate, it is always important that these two participants understand the framework of assumptions and beliefs that the other is speaking from. In Morocco, where an incredible heterogeneity of beliefs characterizes not just society in general but most doctor-patient interactions as well, a difference in cultural background is often accompanied by a difference in language. Whereas the professional language of Moroccan psychiatry (and biomedicine) is French, the average patient who interprets his or her experiences as a form of spirit possession will not master this language, and will choose to explain said experiences in Moroccan Arabic – or in Tamazight, Tashelhit, or Tariffit.
Communication training manuals, or books about interviewing techniques, often emphasize the immense importance of understanding messages that are communicated nonverbally. The ‘indexical meaning’ of a message (Briggs, 1986) – facial expressions, gestures, tonal inflections, and so on – carry important clues about the ‘real’ meaning of whatever is expressed in words. But as much as it is true that we shouldn’t underestimate the necessity of heeding this more easily forgotten layer of communication, these Moroccan psychiatrists suggest that we should also not forget what’s right under our ears.
The same was suggested in a recent article that appeared on CNN. It reported on a study conducted by medical journal The Lancet, which found that online psychotherapy may be as effective as actual, in-person counseling. A group of patients was given a remote form of psychotherapy: they communicated with their therapist online, through instant messaging. In comparison with a control group that received no form of counseling, this indirect form of therapy seemed to have as high a success rate as ‘traditional’ therapy does. This would suggest either that nonverbal cues may not be so necessary in establishing a therapeutically effective level of communication between doctor and patient, or that online therapy has a particular advantage that might make up for that lack. A therapist interviewed for the interview suggests that the lack of nonverbal communication may in fact be liberating for the patient. Through this indirect form of interaction, stripped of any social context, an individual might be less worried about the social repercussions of things he or she wishes to say. In his words I read the suggestion that a solely linguistic form of interaction – in which social norms, contextual factors, and other cues that alter the meaning of spoken words, do not come into play – may provide the patient with a therapeutic sense of agency, of power. Agency and power so often hide in the ability to be heard, and for one’s words to be accepted. If nonverbal aspects of an interaction make a patient feel as though his words are not openly accepted, even if a psychiatrists words do their best to convey that feeling, perhaps a strictly verbal interaction does create more openness.
So what does all this imply about the nature of communication? What does it imply about the way in which we connect to one another, and by extension about the nature of our interpersonal relationships? How important is listening, exactly, and how do listening (to verbal communication) and observation (of nonverbal messages) relate to one another in the process of (effective) communication? And, perhaps above all, how does each form of communication affect the power relationship between the two speakers? These are questions I would really like to explore further in my research. I want to examine the role of language in Moroccan psychotherapy: I’m interested in the importance of words in creating a sense of understanding or shared meaning. I hope to explore psychiatrists’ and patients’ conception of the role of language in communicating, in understanding, and more fundamentally in structuring personal experience. Most of all, I’m interested in the power of language – the role that linguistic (mis)communication plays in structuring power relationships between psychiatrist and patient within this Moroccan context, in which ideologies and accompanying languages constantly vie for dominance. I will need to study Jacques Lacan, the French psychoanalyst who used Ferdinand de Saussure’s structuralist theories of language to explain psychic structures and processes, and who has had a major impact on French – and thus Moroccan – psychoanalysis.
And I’ll need a methodology that creates room for the subtleties and conflicts of language. I’ll be using the format of person-centered interviews – a lengthy, open-ended and very unstructured genre of interviewing that, like Moroccan psychiatrists, assumes the power of words. It’s a psychodynamically oriented kind of interviewing, in which the point is not only to learn something from the interviewee about the cultural phenomenon you’re studying, but also to learn something about how the interviewee personally reflects on that phenomenon; what role it plays in his experience. The interviewee is thus not only informant, but also respondent, and person-centered interviews require heavy analysis of the meanings that do not lie immediately at the surface of the interaction. But aside from looking for nonverbal clues to those meanings, the trick is also to look for linguistic ones. Person-centered interviews encourage the respondent to structure the direction and content of the discussion, and to reflect on her experiences in her own words. The trick is to analyze the respondent’s choice of language, his “personally organized statements – clumping of themes, slips of the tongue, obvious defensive maneuvers, evidence of emotion, fantasy, and speculative thinking” (Levy 1973:xxii). Why did the respondent discuss that issue at this particular moment? Why did he choose that particular word, and the connotations it carries, to express that experience? What does all that suggest about the respondent’s feelings about the matter?
It is thus crucial for anyone hoping to carry out person-centered interviews to learn the language of her respondents. There is no way you will pick up on the subtleties of certain linguistic choices if your level of competence in that language is merely conversational. I have a lot of work ahead of me in that regard. I’m beginning to establish a kind of feeling for the subtleties in French (even if I myself haven’t actively mastered them yet), but I have a long way to go for Moroccan Arabic. I’m considering this post a re-dedication to that endeavor. I’ve created a bit of structure in my work life, and hope that this will create some time for renewed language study. And perhaps I’ll find some time for that psychoanalytic reading, as well…
* the French discours is not the same as the english discourse
I found it interesting to hear that Moroccans – many of whom, according to my observations so far, seem very eager to solve an instance of bodily malaise with a quick pill – would prefer lengthy psychotherapy to pharmaceuticals. I found it surprising that there seems to be less stigma attached to counseling than there is to medication, as these psychotherapists claimed.
But what also struck me, and what I want to write about today, is the psychiatrists’ choice of the word ‘parole’. This French word can be translated as ‘speech’, or ‘spoken word’. Of course, ‘talking’ has been widely proven to be an effective form of psychiatric treatment. But what interests me here is the fact that ‘parole’ suggests such a strong emphasis on the linguistic dimensions of that activity. I don’t think that these psychiatrists ignore the myriad other dimensions of communication, but in general, I am getting the sense that Moroccan psychiatry focuses heavily on the issue of language.
Any time these psychiatrists spoke about establishing a sense of mutual understanding – and the importance of having a shared discourse on which to base that understanding – they would mention the importance of defining certain words, of ‘speaking the patient’s language’. In his writings about the history and practice of psychoanalysis in Morocco, Dr. Jalil Bennani even conceives of cultural beliefs as a kind of ‘language’. He suggests that a particular way of understanding and experiencing illness should be understood as a particular language, used to express feelings that are ultimately universal:
“Il convient d’accorder à la tradition magico-religieuse la place qui lui est due en interprétant celle-ci comme un effet de langage et non pas comme un effet ethnique. Il convient de reconnaître dans le discours magico-religieux du patient le signe d’un autre discours afin de réussir à dépasser la frontière stérile du magico-religieux et du rationnel et déplacer les conflits en vue de faire retrouver au sujet une capacité de liberté par rapport à sa propre parole."
Freely translated, he says the following: “we should see magico-religious tradition for what it is, conceiving of it as an effect of language, rather than an effect of ethnicity. We should recognize the patient’s magico-religious talk as marker of a different kind of speech,* so as to enable ourselves to transgress the sterile boundary between the magico-religious and the rational and to dissolve their conflict, so as to allow the subject to recover a capacity for liberty with regard to his own speech.”
I’ve noticed this psychiatric focus on language before – at the Clinic, for instance, when Dr. Rachidi lamented that with so few diagnostic tools available in Moroccan Arabic, doctors and patients forever risk getting stuck in a cycle of mistranslation. And this focus makes perfect sense, given the particulars of the Moroccan context.
Mutual understanding is always a crucial issue in psychotherapy. Doctor and patients may come from different (cultural, educational, economic) backgrounds, may ascribe to different ideologies, and may explain experience (and illness) in very different ways. Therapy is effective only if communication is; and in order to truly communicate, it is always important that these two participants understand the framework of assumptions and beliefs that the other is speaking from. In Morocco, where an incredible heterogeneity of beliefs characterizes not just society in general but most doctor-patient interactions as well, a difference in cultural background is often accompanied by a difference in language. Whereas the professional language of Moroccan psychiatry (and biomedicine) is French, the average patient who interprets his or her experiences as a form of spirit possession will not master this language, and will choose to explain said experiences in Moroccan Arabic – or in Tamazight, Tashelhit, or Tariffit.
Communication training manuals, or books about interviewing techniques, often emphasize the immense importance of understanding messages that are communicated nonverbally. The ‘indexical meaning’ of a message (Briggs, 1986) – facial expressions, gestures, tonal inflections, and so on – carry important clues about the ‘real’ meaning of whatever is expressed in words. But as much as it is true that we shouldn’t underestimate the necessity of heeding this more easily forgotten layer of communication, these Moroccan psychiatrists suggest that we should also not forget what’s right under our ears.
The same was suggested in a recent article that appeared on CNN. It reported on a study conducted by medical journal The Lancet, which found that online psychotherapy may be as effective as actual, in-person counseling. A group of patients was given a remote form of psychotherapy: they communicated with their therapist online, through instant messaging. In comparison with a control group that received no form of counseling, this indirect form of therapy seemed to have as high a success rate as ‘traditional’ therapy does. This would suggest either that nonverbal cues may not be so necessary in establishing a therapeutically effective level of communication between doctor and patient, or that online therapy has a particular advantage that might make up for that lack. A therapist interviewed for the interview suggests that the lack of nonverbal communication may in fact be liberating for the patient. Through this indirect form of interaction, stripped of any social context, an individual might be less worried about the social repercussions of things he or she wishes to say. In his words I read the suggestion that a solely linguistic form of interaction – in which social norms, contextual factors, and other cues that alter the meaning of spoken words, do not come into play – may provide the patient with a therapeutic sense of agency, of power. Agency and power so often hide in the ability to be heard, and for one’s words to be accepted. If nonverbal aspects of an interaction make a patient feel as though his words are not openly accepted, even if a psychiatrists words do their best to convey that feeling, perhaps a strictly verbal interaction does create more openness.
So what does all this imply about the nature of communication? What does it imply about the way in which we connect to one another, and by extension about the nature of our interpersonal relationships? How important is listening, exactly, and how do listening (to verbal communication) and observation (of nonverbal messages) relate to one another in the process of (effective) communication? And, perhaps above all, how does each form of communication affect the power relationship between the two speakers? These are questions I would really like to explore further in my research. I want to examine the role of language in Moroccan psychotherapy: I’m interested in the importance of words in creating a sense of understanding or shared meaning. I hope to explore psychiatrists’ and patients’ conception of the role of language in communicating, in understanding, and more fundamentally in structuring personal experience. Most of all, I’m interested in the power of language – the role that linguistic (mis)communication plays in structuring power relationships between psychiatrist and patient within this Moroccan context, in which ideologies and accompanying languages constantly vie for dominance. I will need to study Jacques Lacan, the French psychoanalyst who used Ferdinand de Saussure’s structuralist theories of language to explain psychic structures and processes, and who has had a major impact on French – and thus Moroccan – psychoanalysis.
And I’ll need a methodology that creates room for the subtleties and conflicts of language. I’ll be using the format of person-centered interviews – a lengthy, open-ended and very unstructured genre of interviewing that, like Moroccan psychiatrists, assumes the power of words. It’s a psychodynamically oriented kind of interviewing, in which the point is not only to learn something from the interviewee about the cultural phenomenon you’re studying, but also to learn something about how the interviewee personally reflects on that phenomenon; what role it plays in his experience. The interviewee is thus not only informant, but also respondent, and person-centered interviews require heavy analysis of the meanings that do not lie immediately at the surface of the interaction. But aside from looking for nonverbal clues to those meanings, the trick is also to look for linguistic ones. Person-centered interviews encourage the respondent to structure the direction and content of the discussion, and to reflect on her experiences in her own words. The trick is to analyze the respondent’s choice of language, his “personally organized statements – clumping of themes, slips of the tongue, obvious defensive maneuvers, evidence of emotion, fantasy, and speculative thinking” (Levy 1973:xxii). Why did the respondent discuss that issue at this particular moment? Why did he choose that particular word, and the connotations it carries, to express that experience? What does all that suggest about the respondent’s feelings about the matter?
It is thus crucial for anyone hoping to carry out person-centered interviews to learn the language of her respondents. There is no way you will pick up on the subtleties of certain linguistic choices if your level of competence in that language is merely conversational. I have a lot of work ahead of me in that regard. I’m beginning to establish a kind of feeling for the subtleties in French (even if I myself haven’t actively mastered them yet), but I have a long way to go for Moroccan Arabic. I’m considering this post a re-dedication to that endeavor. I’ve created a bit of structure in my work life, and hope that this will create some time for renewed language study. And perhaps I’ll find some time for that psychoanalytic reading, as well…
* the French discours is not the same as the english discourse
Thursday, August 13, 2009
Making Headway...
For all the frustration at the state of paralysis from which my research seemed to suffer in the past months, it has been unexpectedly easy to jump-start my project.
After deciding to pursue interviews with mental healthcare practitioners around town, I spent a day collecting names, phone numbers, and email addresses. I made myself an Excel spreadsheet, then bit the bullet and started making phone calls.
Of the five psychiatrists I called over the course of an hour, two actually picked up the phone, and both agreed to a meeting. These meetings, both very brief, each produced an hour-long follow-up appointment for an interview. One takes place tonight, and one next week.
These two scheduled entretiens are an addition to the interview I conducted last night, with the prominent psychoanalyst I met with two weeks ago. I have thus gone from nothing to three interviews within the course of a week, and in the process have proven to myself that all of this, this research, may actually be doable.
What I have noticed so far, over the course of my brief meetings with three different psychiatrists, is the diversity that characterizes psychiatric practice(s) here in Rabat – and this alone proves that pursuing these interviews was a good idea; that limiting myself to the psychiatric practice of the Clinic would have produced a skewed, one-sided picture of reality. Every time I mentioned to the psychiatrist I was meeting with that I was interested in interviewing them as a way of broadening my understanding of psychiatric practice in Morocco, I received an instant nod in agreement. Good idea, they’d say: there’s such a variety in approaches and philosophies here, that it’s important to expand your scope. Interestingly, they all characterized practice at the Clinic as ‘Americanized’: as very ‘biomedical’ in its approach. Despite the fact that they all seemed to strongly approve my choice to conduct research there, I got the sense that this characterization was not necessarily positive; the tone implied limitation. It makes me curious to know more about how these independently practicing psychiatrists characterize their own brand of mental healthcare (and whether they will associate this with a particular region of the world, as well).
In general, I’m curious to know how this emphasized variation in practices will be reflected in the interview data I gather over the course of my conversations with these psychiatrists. But a curious diversity that has struck me so far, in visiting these three practices, is a considerable variation in the material wealth expressed by the office décor. Whereas the prominent psychoanalyst with the downtown office is housed in bright, breezy, sleek and chic quarters, the doctor I spoke with yesterday, for instance, sees patients in an old, dilapidated apartment building in my own neighborhood. His walls are bare; his furniture is old, plastic, and mismatched. Despite French doors that open out to a balcony, the air was hot and stuffy. I wonder what this variation is suggestive of. I see it as a reflection, if anything, of psychiatry’s under-funding by the state. This kind of variation in wealth is possible, I think, only because these psychiatrists receive nothing from the government, and are dependent on their own wealth and income. Is the state of their office then a measure of their success as a psychiatrist? Or, if (as the prominent downtown psychoanalyst suggests) psychiatrists receive patients from all walks of life and charge them on a sliding scale according to means, is it indicative of the kinds of patients they receive?
What all three practitioners had in common, though, was a great friendliness and hospitality toward me. My initial meetings with them were brief, but all expressed an interest in reading my proposal, and agreed to schedule more time for an actual interview. If this is characteristic of all mental healthcare professionals in Rabat, doors may be flying open a lot more easily than I had anticipated…
Last night, then, I conducted my actual first real interview, with the prominent downtown psychoanalyst. We met in his psychoanalytic office, a room I hadn’t seen before. The two meetings I had had with him had been conducted in his ‘office’ – a white-and-gray room dominated by a huge desk. He had sat on one end and I had sat on the other, and it had made me wonder how he was able to conduct psychoanalysis there. This question only deepened as I visited the other practices, which – despite simpler décor – did feature actual Freudian divans. I had just begun to wonder if, perhaps, the prominent psychoanalyst’s practice was larger than I had initially thought when, indeed, I was ushered through a door I hadn’t noticed before and let into a large but intimate room, featuring the requisite psychoanalytic couch.
I didn’t come close to finishing the list of questions I had brought with me, but obtained a wealth of information (that I will process and perhaps write about here, once I have listened to the recording again). As I had noticed during our first meeting, prominent downtown psychoanalyst likes to talk. He is, and very much sees himself as, a pioneer and rare expert on the practice of psychoanalysis in Morocco. He has distinct theories about how cultural specificities relate to universal psychic processes, writes countless books about issues in ‘cross-cultural psychology’, and took a lot of my questions as diving boards into a presentation of his arguments on this topic. After the interview, I noted down in my field notes that he had been in an explanatory or demonstrative mood, rather than a reflective one. He had an agenda in speaking with me, he wanted to convey a message to me. I wonder if he will ever make the transition to more reflectiveness if I continue to speak with him – but whichever state he was in, I learned a lot. I asked more questions this time around, directed the conversation a bit more, but also left him to take my questions in whatever direction his free association took him; I wanted to know what my questions made him think of.
I’m still curious to see him psychoanalyze someone. As someone so eager to talk, I have a difficult time imagining him as a quiet listener. Seeing him in his actual psychoanalytic office last night made the image a bit more tangible, but even there, and despite his immediate framing of this meeting as my turn to direct the conversation (“je vous écoute”, he told me as soon as we sat down), he was the dominant conversation partner.
I left the psychoanalyst’s office on an absolute high, last night. I felt as though I had crossed a crucial hurdle. I had taken the first step, and it would all be easier from that point on. Nevertheless, I’m nervous for my second interview, tonight at 6. In theory I am excited about the process, about these new opportunities, about the fact that I am finally engaging in actual researcher-activities. But emotionally, I’m not quite caught up with that excitement yet. I still feel nerves. I still tend to look up at the precipice of the mountain that is my research and, realizing I am still at the bottom, feel a bit of vertigo.
I’m guessing it will take a bit of time to get over the initial nerves and gain a bit of confidence in my abilities as a researcher, and as a French-speaker. But I’ll get the hang of it. The important thing to focus on is that I’ve (finally) gotten started. And that, despite the daunting presence of the mountain ahead of me, I’m putting one foot in front of the other and making slow progress…
After deciding to pursue interviews with mental healthcare practitioners around town, I spent a day collecting names, phone numbers, and email addresses. I made myself an Excel spreadsheet, then bit the bullet and started making phone calls.
Of the five psychiatrists I called over the course of an hour, two actually picked up the phone, and both agreed to a meeting. These meetings, both very brief, each produced an hour-long follow-up appointment for an interview. One takes place tonight, and one next week.
These two scheduled entretiens are an addition to the interview I conducted last night, with the prominent psychoanalyst I met with two weeks ago. I have thus gone from nothing to three interviews within the course of a week, and in the process have proven to myself that all of this, this research, may actually be doable.
What I have noticed so far, over the course of my brief meetings with three different psychiatrists, is the diversity that characterizes psychiatric practice(s) here in Rabat – and this alone proves that pursuing these interviews was a good idea; that limiting myself to the psychiatric practice of the Clinic would have produced a skewed, one-sided picture of reality. Every time I mentioned to the psychiatrist I was meeting with that I was interested in interviewing them as a way of broadening my understanding of psychiatric practice in Morocco, I received an instant nod in agreement. Good idea, they’d say: there’s such a variety in approaches and philosophies here, that it’s important to expand your scope. Interestingly, they all characterized practice at the Clinic as ‘Americanized’: as very ‘biomedical’ in its approach. Despite the fact that they all seemed to strongly approve my choice to conduct research there, I got the sense that this characterization was not necessarily positive; the tone implied limitation. It makes me curious to know more about how these independently practicing psychiatrists characterize their own brand of mental healthcare (and whether they will associate this with a particular region of the world, as well).
In general, I’m curious to know how this emphasized variation in practices will be reflected in the interview data I gather over the course of my conversations with these psychiatrists. But a curious diversity that has struck me so far, in visiting these three practices, is a considerable variation in the material wealth expressed by the office décor. Whereas the prominent psychoanalyst with the downtown office is housed in bright, breezy, sleek and chic quarters, the doctor I spoke with yesterday, for instance, sees patients in an old, dilapidated apartment building in my own neighborhood. His walls are bare; his furniture is old, plastic, and mismatched. Despite French doors that open out to a balcony, the air was hot and stuffy. I wonder what this variation is suggestive of. I see it as a reflection, if anything, of psychiatry’s under-funding by the state. This kind of variation in wealth is possible, I think, only because these psychiatrists receive nothing from the government, and are dependent on their own wealth and income. Is the state of their office then a measure of their success as a psychiatrist? Or, if (as the prominent downtown psychoanalyst suggests) psychiatrists receive patients from all walks of life and charge them on a sliding scale according to means, is it indicative of the kinds of patients they receive?
What all three practitioners had in common, though, was a great friendliness and hospitality toward me. My initial meetings with them were brief, but all expressed an interest in reading my proposal, and agreed to schedule more time for an actual interview. If this is characteristic of all mental healthcare professionals in Rabat, doors may be flying open a lot more easily than I had anticipated…
Last night, then, I conducted my actual first real interview, with the prominent downtown psychoanalyst. We met in his psychoanalytic office, a room I hadn’t seen before. The two meetings I had had with him had been conducted in his ‘office’ – a white-and-gray room dominated by a huge desk. He had sat on one end and I had sat on the other, and it had made me wonder how he was able to conduct psychoanalysis there. This question only deepened as I visited the other practices, which – despite simpler décor – did feature actual Freudian divans. I had just begun to wonder if, perhaps, the prominent psychoanalyst’s practice was larger than I had initially thought when, indeed, I was ushered through a door I hadn’t noticed before and let into a large but intimate room, featuring the requisite psychoanalytic couch.
I didn’t come close to finishing the list of questions I had brought with me, but obtained a wealth of information (that I will process and perhaps write about here, once I have listened to the recording again). As I had noticed during our first meeting, prominent downtown psychoanalyst likes to talk. He is, and very much sees himself as, a pioneer and rare expert on the practice of psychoanalysis in Morocco. He has distinct theories about how cultural specificities relate to universal psychic processes, writes countless books about issues in ‘cross-cultural psychology’, and took a lot of my questions as diving boards into a presentation of his arguments on this topic. After the interview, I noted down in my field notes that he had been in an explanatory or demonstrative mood, rather than a reflective one. He had an agenda in speaking with me, he wanted to convey a message to me. I wonder if he will ever make the transition to more reflectiveness if I continue to speak with him – but whichever state he was in, I learned a lot. I asked more questions this time around, directed the conversation a bit more, but also left him to take my questions in whatever direction his free association took him; I wanted to know what my questions made him think of.
I’m still curious to see him psychoanalyze someone. As someone so eager to talk, I have a difficult time imagining him as a quiet listener. Seeing him in his actual psychoanalytic office last night made the image a bit more tangible, but even there, and despite his immediate framing of this meeting as my turn to direct the conversation (“je vous écoute”, he told me as soon as we sat down), he was the dominant conversation partner.
I left the psychoanalyst’s office on an absolute high, last night. I felt as though I had crossed a crucial hurdle. I had taken the first step, and it would all be easier from that point on. Nevertheless, I’m nervous for my second interview, tonight at 6. In theory I am excited about the process, about these new opportunities, about the fact that I am finally engaging in actual researcher-activities. But emotionally, I’m not quite caught up with that excitement yet. I still feel nerves. I still tend to look up at the precipice of the mountain that is my research and, realizing I am still at the bottom, feel a bit of vertigo.
I’m guessing it will take a bit of time to get over the initial nerves and gain a bit of confidence in my abilities as a researcher, and as a French-speaker. But I’ll get the hang of it. The important thing to focus on is that I’ve (finally) gotten started. And that, despite the daunting presence of the mountain ahead of me, I’m putting one foot in front of the other and making slow progress…
Monday, August 3, 2009
On Otherness
A few weeks ago, as we discussed a recent blog post I had written, my mother mentioned that some of my pieces seem to suggest a great preoccupation with my conspicuous otherness here in Rabat. Why did I focus on my foreignness so much, she wondered?
I did not have an immediate answer to that question. She was right, but why was I so preoccupied with my own foreignness? What was this sense of Otherness, and what brought it about? Was that preoccupation just me, or was it an inevitable part of the expat experience? Did I feel as foreign now, as a NIMAR employee with her own apartment, as I did when I lived with my Moroccan host family? Over the next week, my mother’s question continued to float around in my head. It wasn’t until the following weekend, as I discussed this same subject over breakfast with a new friend, that I began to realize more clearly how to answer those questions.
The thing is, that if you’ve grown up ethnically white in an American or Dutch middle class neighborhood, Otherness is probably not a feeling you are accustomed to. I’m not talking about that sense of ‘being different’ that we all experience from time to time, or that feeling of just not being able to ‘connect’ to any other individual in our environment. What I am referring to is not an internal feeling, but rather an externally imposed sense of difference. A perception of Otherness in the eyes of our social environment that is based on unchangeable (and often inborn) aspects of our appearance, and that we ourselves are unable to control or change. That sense of Otherness that anyone who has grown up as part of an ethnic minority will be overly familiar with.
Being seen as Other is an almost paradoxical form of being labeled on the basis of your appearance; it means that you are being categorized as falling-outside-of-all-culturally-established-categories. And as happens with any application of a stereotype, being ‘otherized’ forces you to confront difficult questions about who you are. About how you relate to the label you have been given, how your self-perception matches the way you are perceived by others – and about how you as a designated ‘outsider’ relate to the categories that are part of the socio-cultural establishment.
I have been an immigrant for much of my life, but until I came to Morocco, I never looked (or sounded) different from the majority in my environment. It wasn’t unless I myself chose to verbalize my non-American cultural background, that those around me would ever see or treat me as ‘different’. In Rabat on the other hand, it is not I, but rather my environment that chooses to underscore my difference. My status as an outsider is continuously and inescapably made explicit, regardless (it seems) of what I do or say. This Otherness is new to me, and I must admit that it is one of the aspects of expat life in Morocco that I have found most difficult to grow accustomed to. It makes me feel a little powerless, and I miss the anonymity of blending in with my environment.
I know that I do not look like a tourist. Most likely we are all sensitive to the little markers that tell you where a person is from, and what he or she is doing in their current location. You can tell by the way they walk, and the way they look around at their surroundings. It’s their dress, their choice of bag, and the style of nonverbal communication. All of these things can clue you in about a person’s nationality, or the length of their stay here in Morocco. But as much as it seems clear to people on the street that I am not a holiday traveler, I will nevertheless always be instantly recognized as an outsider, a visitor. Again, it’s in little things that this perception hides.
It’s in the things men choose to say to me as I walk past the table where they sit with their coffee and newspaper. All women receive attention on Moroccan streets, but I doubt a Moroccan woman is told in syrupy slick English that she is “very niiiiiice,” or that he “likes your size.”
It’s the fact that, after walking up and down the same streets for nine months, men still wish me “bienvenue au Maroc” when I am on my way home from work in the afternoon.
It’s the fact that I will never be able to rent a house for the same price as a Moroccan tenant (and that a landlord will always be more eager to rent to me), or get as low a price on a set of handmade cedar side-tables as my Moroccan colleague.
It’s in the fact that taxi drivers in Marrakech will persistently address me in English, even when I speak to them in (broken) Arabic.
And it’s in the fact that my French teacher had trouble remembering a few students’ names until the end of the course, but knew mine from the moment I introduced myself. In a strange and stubborn effort to refuse special treatment, I remember once waiting around along with everyone else at the end of class while the teacher called roll, not wanting to leave until he’d noted me as ‘present’. When he finally did come to my name, he looked at me with a slightly patronizing smile. Why did I wait around, he asked? Wasn’t it obvious that he’d noticed my presence? Didn’t I know that there was no point in me waiting around ‘just like the others’?
Aside from inescapable conspicuousness, being Other also means being judged by different standards. On one hand it means being afforded a greater lenience when it comes to abiding by the norms of social interaction. Foreigners are not expected to understand the rules, perhaps, and they are therefore more easily forgiven for trespassing the boundaries of propriety. But with that lenience also comes a different set of expectations. It is often assumed, for instance, that I have (lots of) money, that my rules of sexual or romantic propriety are radically different from those upheld in Morocco, that I harbor certain Orientalist impressions of Morocco, that I do not know how to cook, that I am Christian.
In the sense that all foreigners receive this particular kind of attention, I do think that the experience of Otherness is an inevitable part of expat life. But I am sure that my preoccupation goes a bit further than ordinary levels of awareness. It may in part be the newness of the experience that makes it so acute for me, but it might also simply be the fact that I’ve been preoccupied with the question of otherness ever since I first left the Netherlands as a 7-year old. Ever since that moment, I’ve been intrigued by questions like what it means to be an ‘insider’, how it is possible to combine two or more identities within a single ‘self’, or why it is that once you’ve uprooted yourself, you will never again be the ‘insider’ you once were. I think it’s because these questions are so central to the practice and theory of anthropology that this discipline appeals to me so much.
And most of the time, I can smile at this sense of Otherness. Given my pre-existing intrigue with the issue, the experience of it is interesting; it is a part of being in Morocco, and of being an anthropologist in general. I even think that this externally applied Otherness played a large role in helping me come to terms with the internal experiences of Otherness I’ve had for most of my life. But there are moments, more than I’d like there to be, when I am tired and give into frustration, when I become a little overwhelmed by the sense of powerlessness this constant perception of foreignness elicits in me. At those moments, my attempts at fitting in – at learning the language, dressing appropriately, abiding by the local rules of conduct – seem so futile, and a real inside-understanding of Morocco seems impossibly unreachable. At those moments, I want to retreat to my apartment, to the comfort of familiarity, and complain about Morocco’s own foreignness to me.
But for every person who reminds you that you are an outsider, there is someone else who embraces you and all your efforts to integrate. Such as the woman on the street who once asked me for directions in Arabic. Or the friendly shopkeeper at the mini marché across from my apartment, who always chats with me in Darija. Or a Fassi friend who refers to me as a Rbatia. And it is these brief little moments that make all those others seem very, very unimportant…
I did not have an immediate answer to that question. She was right, but why was I so preoccupied with my own foreignness? What was this sense of Otherness, and what brought it about? Was that preoccupation just me, or was it an inevitable part of the expat experience? Did I feel as foreign now, as a NIMAR employee with her own apartment, as I did when I lived with my Moroccan host family? Over the next week, my mother’s question continued to float around in my head. It wasn’t until the following weekend, as I discussed this same subject over breakfast with a new friend, that I began to realize more clearly how to answer those questions.
The thing is, that if you’ve grown up ethnically white in an American or Dutch middle class neighborhood, Otherness is probably not a feeling you are accustomed to. I’m not talking about that sense of ‘being different’ that we all experience from time to time, or that feeling of just not being able to ‘connect’ to any other individual in our environment. What I am referring to is not an internal feeling, but rather an externally imposed sense of difference. A perception of Otherness in the eyes of our social environment that is based on unchangeable (and often inborn) aspects of our appearance, and that we ourselves are unable to control or change. That sense of Otherness that anyone who has grown up as part of an ethnic minority will be overly familiar with.
Being seen as Other is an almost paradoxical form of being labeled on the basis of your appearance; it means that you are being categorized as falling-outside-of-all-culturally-established-categories. And as happens with any application of a stereotype, being ‘otherized’ forces you to confront difficult questions about who you are. About how you relate to the label you have been given, how your self-perception matches the way you are perceived by others – and about how you as a designated ‘outsider’ relate to the categories that are part of the socio-cultural establishment.
I have been an immigrant for much of my life, but until I came to Morocco, I never looked (or sounded) different from the majority in my environment. It wasn’t unless I myself chose to verbalize my non-American cultural background, that those around me would ever see or treat me as ‘different’. In Rabat on the other hand, it is not I, but rather my environment that chooses to underscore my difference. My status as an outsider is continuously and inescapably made explicit, regardless (it seems) of what I do or say. This Otherness is new to me, and I must admit that it is one of the aspects of expat life in Morocco that I have found most difficult to grow accustomed to. It makes me feel a little powerless, and I miss the anonymity of blending in with my environment.
I know that I do not look like a tourist. Most likely we are all sensitive to the little markers that tell you where a person is from, and what he or she is doing in their current location. You can tell by the way they walk, and the way they look around at their surroundings. It’s their dress, their choice of bag, and the style of nonverbal communication. All of these things can clue you in about a person’s nationality, or the length of their stay here in Morocco. But as much as it seems clear to people on the street that I am not a holiday traveler, I will nevertheless always be instantly recognized as an outsider, a visitor. Again, it’s in little things that this perception hides.
It’s in the things men choose to say to me as I walk past the table where they sit with their coffee and newspaper. All women receive attention on Moroccan streets, but I doubt a Moroccan woman is told in syrupy slick English that she is “very niiiiiice,” or that he “likes your size.”
It’s the fact that, after walking up and down the same streets for nine months, men still wish me “bienvenue au Maroc” when I am on my way home from work in the afternoon.
It’s the fact that I will never be able to rent a house for the same price as a Moroccan tenant (and that a landlord will always be more eager to rent to me), or get as low a price on a set of handmade cedar side-tables as my Moroccan colleague.
It’s in the fact that taxi drivers in Marrakech will persistently address me in English, even when I speak to them in (broken) Arabic.
And it’s in the fact that my French teacher had trouble remembering a few students’ names until the end of the course, but knew mine from the moment I introduced myself. In a strange and stubborn effort to refuse special treatment, I remember once waiting around along with everyone else at the end of class while the teacher called roll, not wanting to leave until he’d noted me as ‘present’. When he finally did come to my name, he looked at me with a slightly patronizing smile. Why did I wait around, he asked? Wasn’t it obvious that he’d noticed my presence? Didn’t I know that there was no point in me waiting around ‘just like the others’?
Aside from inescapable conspicuousness, being Other also means being judged by different standards. On one hand it means being afforded a greater lenience when it comes to abiding by the norms of social interaction. Foreigners are not expected to understand the rules, perhaps, and they are therefore more easily forgiven for trespassing the boundaries of propriety. But with that lenience also comes a different set of expectations. It is often assumed, for instance, that I have (lots of) money, that my rules of sexual or romantic propriety are radically different from those upheld in Morocco, that I harbor certain Orientalist impressions of Morocco, that I do not know how to cook, that I am Christian.
In the sense that all foreigners receive this particular kind of attention, I do think that the experience of Otherness is an inevitable part of expat life. But I am sure that my preoccupation goes a bit further than ordinary levels of awareness. It may in part be the newness of the experience that makes it so acute for me, but it might also simply be the fact that I’ve been preoccupied with the question of otherness ever since I first left the Netherlands as a 7-year old. Ever since that moment, I’ve been intrigued by questions like what it means to be an ‘insider’, how it is possible to combine two or more identities within a single ‘self’, or why it is that once you’ve uprooted yourself, you will never again be the ‘insider’ you once were. I think it’s because these questions are so central to the practice and theory of anthropology that this discipline appeals to me so much.
And most of the time, I can smile at this sense of Otherness. Given my pre-existing intrigue with the issue, the experience of it is interesting; it is a part of being in Morocco, and of being an anthropologist in general. I even think that this externally applied Otherness played a large role in helping me come to terms with the internal experiences of Otherness I’ve had for most of my life. But there are moments, more than I’d like there to be, when I am tired and give into frustration, when I become a little overwhelmed by the sense of powerlessness this constant perception of foreignness elicits in me. At those moments, my attempts at fitting in – at learning the language, dressing appropriately, abiding by the local rules of conduct – seem so futile, and a real inside-understanding of Morocco seems impossibly unreachable. At those moments, I want to retreat to my apartment, to the comfort of familiarity, and complain about Morocco’s own foreignness to me.
But for every person who reminds you that you are an outsider, there is someone else who embraces you and all your efforts to integrate. Such as the woman on the street who once asked me for directions in Arabic. Or the friendly shopkeeper at the mini marché across from my apartment, who always chats with me in Darija. Or a Fassi friend who refers to me as a Rbatia. And it is these brief little moments that make all those others seem very, very unimportant…
Thursday, July 23, 2009
Participant-Observation Reconsidered
I want to pick up on the thought I ended my last blog post with: where does the research end, and where does my life begin?
This question has come up in my blog posts before. I struggled with it when I returned to Morocco this past January, and found that I was now personally part of the daily life I tended to write about. It blurred the lines between observation and participation,* and I found that I had to re-think the tone and purpose of this blog. Months later I am much more comfortably settled here, but the issue remains; the question still sits there in the back of my mind, pressing ever so subtly against my brain’s centers for speech and reflection.
A friend of mine recently questioned the possibility of balancing work and private life in one of her blog posts. Sharing both her own experiences and those of some she knows, she wrote about the importance (and difficulty) of setting limits and making sure that work does not swallow up your private life. She emphasized how crucial it is that you guard the time you have for relaxation, for rejuvenation, and all other things that sustain your mind and body – but how easy it is to forget about these necessities when a deadline approaches. Her story made me think about my own situation in a new way, and I wondered if my ‘issue’ might simply be solved by being a better guard at the border between ‘work’ and ‘private life’.
The thing is, I’ve never thought of my research as ‘work’. In San Diego, ‘work’ was my teaching job. The development of my research proposal and everything that involved, that was me. Sure, it was difficult at times, there were externally imposed deadlines to keep, and I had moments of utter frustration – but that project was my creation, constructed through a smelting together of the questions, ideas, and geographical regions that I have had a passion for as long as I can remember. Developing that research project felt as much like work as playing the piano, or writing in my journals. And it still feels that way – perhaps even more so, now that I am ‘in the field’, as anthropologists are wont to say. I ‘work’ at the NIMAR, but my research? That’s me.
In reality, of course, that research is my work – it’s the foundation for my career, I’m being paid to do it, and it’s what I (hopefully) will be making my money from for a long time to come. And I am utterly fine with the fact that in that sense, the border between my ‘work’ and my ‘private life’ is a large and undefined gray zone. This is the nature of academia, where people personally identify with the research they do to such an extent that it becomes an inseparable part of them (sometimes to an unhealthy extent, perhaps), and it suits me. I’m a workaholic by nature. This may or may not always be good for my health, but at least I have a ‘job’ where I set the hours as well as the pace – and where I can thus take a break for an hour at any time I choose, to eat a healthy meal, go running, relax with a book or movie… or buy furniture for a new Moroccan apartment.
So my issue isn’t this. It is not the porosity of the border between work and personal life that bothers me. I don’t mind the fact that I sit behind my desk at home working on ideas for my project until late at night, or that an hour’s relaxation at a café in the city suddenly becomes fodder for observation when I engage in an interesting conversation with a Moroccan friend.**
What I do mind – and this is what the issue comes down to – is that the gray zone of work/personal life creates a constant sense of role confusion. The question that I began this post with (where does the research end and my life begin?) ultimately comes down to this more fundamental question: am I, and is my personality, an involved part of my daily life and the relationships I build, or not?
We’ve accepted the fact that one cannot ever be fully ‘objective’, and that all anthropologists observe and interpret from their own personally and culturally constructed vantage point. We even refer to our primary method of data collection as ‘participant observation’, the idea being that you cannot truly come to ‘know’ how something works unless you yourself participate in the act. But despite all this acceptance of subjectivity, the goal remains to preserve at least a kind of neutrality in your engagement with the field. This neutrality is necessary, I think, to ensure that informants will feel free to share their personal opinions with you, a stranger, without concern for judgment – but it still sets the participating and subjective anthropologist apart from members of the community in which he or she is conducting research.
In other words, an anthropologist behaves differently than an ordinary ‘participant’. And being in Morocco full-time, where any situation can turn into an opportunity for data collection, I am confused sometimes as to whether I should act as the anthropologist, or as a ‘person’. Let me illustrate.
Earlier this week I had a brief exchange with another student during our French class. Having just heard me mention that I did research on psychiatry, the young man asked me what I thought were the main differences between psychiatry in Morocco, and that in France or the United States. I responded by telling him that that was exactly what I intended to find out. He took this as cue to share with me his own opinion on the matter. The difference was, he explained to me, that there is no market for psychiatry in Morocco, because individual sufferers are able to solve their problems within and by virtue of their familial support network. Westerners on the other hand, who live individual lives cut off from any form of social support, will need a professional to help them solve their problems.
I reacted as an anthropologist. I told him that was an ‘interesting viewpoint’ and would have asked him how exactly that “soulagement” (relief) within the family circle worked, had monsieur Aziz not changed the subject and reminded us that we were in a class with twenty other students.
But the exchange left me frustrated. As monsieur Aziz talked, I reflected: had I not felt the need to react in an anthropologically correct manner, had I decided to engage as a regular student in the class (which I am, after all), I would have responded so differently. I would have reminded him to bear in mind that the ‘western world’ is not so radically different from Morocco on this count: we are not as extremely individualistic as some like to think, and for that matter, I don’t think the average Moroccan network of family support is as soft and springy as it is sometimes made to seem. Plus, what about the other side of collectivism: that sometimes suffocating form of social control, the fact that people are judged on the basis of their behavior, the fact that people are afraid that one black sheep will taint the entire family’s reputation? Couldn’t those issues lead to a whole new range of psychological troubles from which we lone cowboys of the West are blissfully spared?
When I act as an anthropologist, I leave myself and my opinions out of the interaction. My goal is to learn what Moroccans think, and any clearly voiced disagreement on my part would certainly not encourage them to freely share their thoughts with me. However, personal relationships are impossible to build on this kind of mental distance – you can’t forge a personal relationship (not a satisfying one, at least), if your personality is completely left out of the equation.
At my primary research site, it is clear what kind of situation I am in, and which role I am to play. But what confuses and sometimes frustrates me are these other contexts of social interaction. As I’ve said, any situation is potentially an opportunity for data collection. But does that mean that I am always supposed to be the (subjectively) neutral anthropologist? If I take a French class in Morocco, am I supposed to behave like an ethnographer and swallow my personal disagreements because I happen to be in Morocco? Or do I let myself be just-another-student – and if so, what do I do when a topic of interest to my project comes up?
For that matter, who am I supposed to be when I interact with the Moroccans I meet at the NIMAR? Like that female researcher working on gender issues. Do I try to be her friend, and hope to finally establish my first real friendship with a Moroccan woman, or is she someone who could help me in my research?
Then again, establishing a ‘real’ friendship with a Moroccan woman – the kind of friendship based on personal connections and openness – may not be as easy as I’d like it to be anyway. I’ve written before about the issues many of us foreign women have in connecting to our Moroccan counterparts. We seek personal connections, only to find out that there often isn’t a lot of room for our personalities in these relationships. Pleasant exchanges and meetings for tea go a long way in keeping loneliness at bay, but the true sense of mutual understanding that I sometimes crave is hard to find.
Seeing as there is no point trying to change this situation, perhaps the best thing to do is see this as an answer to my issue of confusion. To consider the guarding of certain opinions as my standard modus operandi, and thus free myself from worry about overstepping boundaries, falling out of character, and misjudging situations.
If there are any anthropologists among the few who read this blog, I’d love to know whether you’ve felt this same issue – and if so, how you dealt with it.
* I’ll get into the notion of ‘participant-observation’ a little later on, so hold that thought.
** My project concerns the institution of mental healthcare, but that does not mean that my ‘work’ ends at the hospital doors. Since I am interested in how these practices of mental healthcare relate to and are affected by larger socio-economic dynamics that dominate Moroccan society, any given setting or conversation provides me with data, in a sense.
This question has come up in my blog posts before. I struggled with it when I returned to Morocco this past January, and found that I was now personally part of the daily life I tended to write about. It blurred the lines between observation and participation,* and I found that I had to re-think the tone and purpose of this blog. Months later I am much more comfortably settled here, but the issue remains; the question still sits there in the back of my mind, pressing ever so subtly against my brain’s centers for speech and reflection.
A friend of mine recently questioned the possibility of balancing work and private life in one of her blog posts. Sharing both her own experiences and those of some she knows, she wrote about the importance (and difficulty) of setting limits and making sure that work does not swallow up your private life. She emphasized how crucial it is that you guard the time you have for relaxation, for rejuvenation, and all other things that sustain your mind and body – but how easy it is to forget about these necessities when a deadline approaches. Her story made me think about my own situation in a new way, and I wondered if my ‘issue’ might simply be solved by being a better guard at the border between ‘work’ and ‘private life’.
The thing is, I’ve never thought of my research as ‘work’. In San Diego, ‘work’ was my teaching job. The development of my research proposal and everything that involved, that was me. Sure, it was difficult at times, there were externally imposed deadlines to keep, and I had moments of utter frustration – but that project was my creation, constructed through a smelting together of the questions, ideas, and geographical regions that I have had a passion for as long as I can remember. Developing that research project felt as much like work as playing the piano, or writing in my journals. And it still feels that way – perhaps even more so, now that I am ‘in the field’, as anthropologists are wont to say. I ‘work’ at the NIMAR, but my research? That’s me.
In reality, of course, that research is my work – it’s the foundation for my career, I’m being paid to do it, and it’s what I (hopefully) will be making my money from for a long time to come. And I am utterly fine with the fact that in that sense, the border between my ‘work’ and my ‘private life’ is a large and undefined gray zone. This is the nature of academia, where people personally identify with the research they do to such an extent that it becomes an inseparable part of them (sometimes to an unhealthy extent, perhaps), and it suits me. I’m a workaholic by nature. This may or may not always be good for my health, but at least I have a ‘job’ where I set the hours as well as the pace – and where I can thus take a break for an hour at any time I choose, to eat a healthy meal, go running, relax with a book or movie… or buy furniture for a new Moroccan apartment.
So my issue isn’t this. It is not the porosity of the border between work and personal life that bothers me. I don’t mind the fact that I sit behind my desk at home working on ideas for my project until late at night, or that an hour’s relaxation at a café in the city suddenly becomes fodder for observation when I engage in an interesting conversation with a Moroccan friend.**
What I do mind – and this is what the issue comes down to – is that the gray zone of work/personal life creates a constant sense of role confusion. The question that I began this post with (where does the research end and my life begin?) ultimately comes down to this more fundamental question: am I, and is my personality, an involved part of my daily life and the relationships I build, or not?
We’ve accepted the fact that one cannot ever be fully ‘objective’, and that all anthropologists observe and interpret from their own personally and culturally constructed vantage point. We even refer to our primary method of data collection as ‘participant observation’, the idea being that you cannot truly come to ‘know’ how something works unless you yourself participate in the act. But despite all this acceptance of subjectivity, the goal remains to preserve at least a kind of neutrality in your engagement with the field. This neutrality is necessary, I think, to ensure that informants will feel free to share their personal opinions with you, a stranger, without concern for judgment – but it still sets the participating and subjective anthropologist apart from members of the community in which he or she is conducting research.
In other words, an anthropologist behaves differently than an ordinary ‘participant’. And being in Morocco full-time, where any situation can turn into an opportunity for data collection, I am confused sometimes as to whether I should act as the anthropologist, or as a ‘person’. Let me illustrate.
Earlier this week I had a brief exchange with another student during our French class. Having just heard me mention that I did research on psychiatry, the young man asked me what I thought were the main differences between psychiatry in Morocco, and that in France or the United States. I responded by telling him that that was exactly what I intended to find out. He took this as cue to share with me his own opinion on the matter. The difference was, he explained to me, that there is no market for psychiatry in Morocco, because individual sufferers are able to solve their problems within and by virtue of their familial support network. Westerners on the other hand, who live individual lives cut off from any form of social support, will need a professional to help them solve their problems.
I reacted as an anthropologist. I told him that was an ‘interesting viewpoint’ and would have asked him how exactly that “soulagement” (relief) within the family circle worked, had monsieur Aziz not changed the subject and reminded us that we were in a class with twenty other students.
But the exchange left me frustrated. As monsieur Aziz talked, I reflected: had I not felt the need to react in an anthropologically correct manner, had I decided to engage as a regular student in the class (which I am, after all), I would have responded so differently. I would have reminded him to bear in mind that the ‘western world’ is not so radically different from Morocco on this count: we are not as extremely individualistic as some like to think, and for that matter, I don’t think the average Moroccan network of family support is as soft and springy as it is sometimes made to seem. Plus, what about the other side of collectivism: that sometimes suffocating form of social control, the fact that people are judged on the basis of their behavior, the fact that people are afraid that one black sheep will taint the entire family’s reputation? Couldn’t those issues lead to a whole new range of psychological troubles from which we lone cowboys of the West are blissfully spared?
When I act as an anthropologist, I leave myself and my opinions out of the interaction. My goal is to learn what Moroccans think, and any clearly voiced disagreement on my part would certainly not encourage them to freely share their thoughts with me. However, personal relationships are impossible to build on this kind of mental distance – you can’t forge a personal relationship (not a satisfying one, at least), if your personality is completely left out of the equation.
At my primary research site, it is clear what kind of situation I am in, and which role I am to play. But what confuses and sometimes frustrates me are these other contexts of social interaction. As I’ve said, any situation is potentially an opportunity for data collection. But does that mean that I am always supposed to be the (subjectively) neutral anthropologist? If I take a French class in Morocco, am I supposed to behave like an ethnographer and swallow my personal disagreements because I happen to be in Morocco? Or do I let myself be just-another-student – and if so, what do I do when a topic of interest to my project comes up?
For that matter, who am I supposed to be when I interact with the Moroccans I meet at the NIMAR? Like that female researcher working on gender issues. Do I try to be her friend, and hope to finally establish my first real friendship with a Moroccan woman, or is she someone who could help me in my research?
Then again, establishing a ‘real’ friendship with a Moroccan woman – the kind of friendship based on personal connections and openness – may not be as easy as I’d like it to be anyway. I’ve written before about the issues many of us foreign women have in connecting to our Moroccan counterparts. We seek personal connections, only to find out that there often isn’t a lot of room for our personalities in these relationships. Pleasant exchanges and meetings for tea go a long way in keeping loneliness at bay, but the true sense of mutual understanding that I sometimes crave is hard to find.
Seeing as there is no point trying to change this situation, perhaps the best thing to do is see this as an answer to my issue of confusion. To consider the guarding of certain opinions as my standard modus operandi, and thus free myself from worry about overstepping boundaries, falling out of character, and misjudging situations.
If there are any anthropologists among the few who read this blog, I’d love to know whether you’ve felt this same issue – and if so, how you dealt with it.
* I’ll get into the notion of ‘participant-observation’ a little later on, so hold that thought.
** My project concerns the institution of mental healthcare, but that does not mean that my ‘work’ ends at the hospital doors. Since I am interested in how these practices of mental healthcare relate to and are affected by larger socio-economic dynamics that dominate Moroccan society, any given setting or conversation provides me with data, in a sense.
Monday, July 20, 2009
Communication Francophone
Two weeks ago, I started a month-long French class. Every Monday to Friday at four PM, I now head over to a language school across from Jour et Nuit (a coffee house and well-known landmark on this side of the medina’s Bab Chellah) for a two hour cours de communication. My teacher, monsieur Aziz, is a self-proclaimed thespian in his fifties who loves Molière and Hugo. Every afternoon he attempts to animate his weary students with larger-than-life gestures and facial expressions, walking back and forth across the front of the classroom as though it is a stage from which he attempts to enthrall a difficult audience.* Occasionally he coaxes us out of our seats for some creative play of our own, in which we awkwardly participate, as he reminds us that games are not about winning, but about sharing – and communicating, of course.
I had decided long ago that it was time for a class to ignite the francophone cells in my brain (I know they’re there! I’m just too nervous to ignite them on my own, not knowing for sure that they’ll work the way they’re supposed to), and three weeks ago I took a placement test at this school. As the consultant grading my test remarked that I seemed to have all the grammar down, I explained that I just wanted to learn how to speak sans devoir réfléchir – without having to think about it – and that it wouldn’t hurt to expand my vocabulary. The consultant seemed to know exactly what I was looking for, and enrolled me in this course.
I must admit that it is a different kind of cours de communication than I had expected. Focused less on linguistic barriers than psychological ones, we work on things like learning how to speak without getting flustered by attention from others, discerning the purpose or intent behind a communicative message (the acte illocutoire), and evaluating each other’s efficiency in getting a message across. The goal of this course is, in monsieur Aziz’s words, nothing less than a change in our sense of self, and the elimination of certains sentiments négatives.
This is not precisely what I had had in mind; this course is not so much about learning how to speak sans réfléchir, but rather about how to effectively turn what you want to say into an actual expressed message. But in the end, I figure, communication is communication – does it really matter what the nature is of the barriers that keep you from living up to your potential? What I needed is a push in the back, an environment where I was forced to speak up – and that’s essentially what I’ve gotten. And I do notice some difference. I seem less worried about just speaking, and am discovering that I can make myself perfectly understood in almost any situation. The only barrier I have left is the intimidation I feel around my very adeptly francophone co-workers…
My fellow students are, for the most part, timid high school graduates stuck in that liminal phase between puberty and adulthood, where you suddenly realize that your decisions not only matter, but can affect the entire course of your life. As we went around on day one to introduce ourselves, they all very un-timidly attested to a desire to overcome their shyness, and I imagine that, faced with the weighty decision of what-to-do-next, these young adults are perhaps attempting with this course to turn themselves into direct and fearless go-getters. Timidity is a theme they repeatedly bring up themselves. As we subjectively evaluate each others’ efforts at communication,** students constantly remark that the speaker’s main problem seems to be shyness. “Is this a problem you often encounter?” they’ll ask in therapeutic voices. “Do you have the same trouble when you speak Arabic?”
There is an intimate atmosphere, a sense of we’re-all-in-this-together, that seems to put everyone at ease and invites everyone to speak. However, this intimacy gets disturbed once in a while by my presence. I am clearly an outsider, being the only non-Moroccan in the room, the only one who seems to already be familiar with the communicative theories monsieur Aziz enlightens us on (he even gave us a basic tutorial on semiology – I had an instant déjà-vu of my days as a first-year anthropology grad student…), and the only one who seems to be here for linguistic improvement. Monsieur Aziz takes advantage of this sometimes, and uses me as a kind of stick behind the door to remind everyone to do his or her best.
“If you don’t speak up and share a story,” he will say, “what will Charlotte here think about Moroccans and their ability to communicate? Do you want to give her the impression that Moroccans cannot express themselves about this particular subject?”
The students will then smile, they’ll look at me, their timidity will re-emerge, and I’ll feel as though I’ve become part of the ‘other side’, an onlooker and observer, rather than a fellow student.
This happens at other moments here and there, too – like when we’re asked to prepare a presentation as a group, and the other members in my circle begin to speak the Arabic they’re ultimately more comfortable with. There’s always a moment where they’ll suddenly stop in their tracks, look at me, and begin apologizing. I’ll then tell them that it’s ok, mashi moushkil (no problem), that I understand what they’re saying – and they’ll smile a bit at my budding knowledge of Arabic and continue, but the intimacy is gone and I can see that their self-consciousness is back.
And I do it myself, too. There are moments, when monsieur Aziz explains a theory I’m already familiar with, for example, when I step back and transform from participant to observer. I’ll look at the ways in which our teacher interacts with the students, and the way they react to him. I’ll notice how students’ comments seem very crafted, full of buzz-words they know are important in this class (like “timide”), very catered toward what they think the teacher wants to hear. I’ll remark how very few people seem just to say what they think – very few apart from the teacher, that is, and I’ll notice how the students get a little flustered when monsieur Aziz brings up topics that are not commonly discussed in public. Like how you met your first boyfriend, or how it’s possible to be an atheist.
And so I put myself on the outside, trying to be the ethnographer, hoping to get an insider’s view of a Moroccan classroom. I will go quiet, waiting to see how others respond to a question thrown into the room by monsieur Aziz, smiling at his expectant expression. Until I realize that I am thereby thwarting my own success as a student in this class – which is ultimately the role I signed on (and paid) to play.
But I’m enjoying myself – I like the class, I observe with interest as the tone of the session shifts between ‘intimate’ and ‘performative’, and I’m even a little intrigued at how I myself morph from participant into observer, and back. It’s a new kind of hybridity that I’m feeling constantly as I set up my own life here in Rabat – as I try to figure out which parts of my experiences here are research, and which are just that, life.
* there is an argument to be made for the idea that teaching is a kind of performance, of course… and vice versa, that performance is a kind of teaching?
** it took the teacher at least twenty minutes to explain what he meant by such subjective evaluation, and how it worked. The students seemed to have a very difficult time understanding that there is not simply one correct way, and one wrong way, to communicate. That it is ok, and sometimes better, to evaluate without passing a definitive judgment. That there may be no such thing as a completely accurate and objective judgment in the first place.
I had decided long ago that it was time for a class to ignite the francophone cells in my brain (I know they’re there! I’m just too nervous to ignite them on my own, not knowing for sure that they’ll work the way they’re supposed to), and three weeks ago I took a placement test at this school. As the consultant grading my test remarked that I seemed to have all the grammar down, I explained that I just wanted to learn how to speak sans devoir réfléchir – without having to think about it – and that it wouldn’t hurt to expand my vocabulary. The consultant seemed to know exactly what I was looking for, and enrolled me in this course.
I must admit that it is a different kind of cours de communication than I had expected. Focused less on linguistic barriers than psychological ones, we work on things like learning how to speak without getting flustered by attention from others, discerning the purpose or intent behind a communicative message (the acte illocutoire), and evaluating each other’s efficiency in getting a message across. The goal of this course is, in monsieur Aziz’s words, nothing less than a change in our sense of self, and the elimination of certains sentiments négatives.
This is not precisely what I had had in mind; this course is not so much about learning how to speak sans réfléchir, but rather about how to effectively turn what you want to say into an actual expressed message. But in the end, I figure, communication is communication – does it really matter what the nature is of the barriers that keep you from living up to your potential? What I needed is a push in the back, an environment where I was forced to speak up – and that’s essentially what I’ve gotten. And I do notice some difference. I seem less worried about just speaking, and am discovering that I can make myself perfectly understood in almost any situation. The only barrier I have left is the intimidation I feel around my very adeptly francophone co-workers…
My fellow students are, for the most part, timid high school graduates stuck in that liminal phase between puberty and adulthood, where you suddenly realize that your decisions not only matter, but can affect the entire course of your life. As we went around on day one to introduce ourselves, they all very un-timidly attested to a desire to overcome their shyness, and I imagine that, faced with the weighty decision of what-to-do-next, these young adults are perhaps attempting with this course to turn themselves into direct and fearless go-getters. Timidity is a theme they repeatedly bring up themselves. As we subjectively evaluate each others’ efforts at communication,** students constantly remark that the speaker’s main problem seems to be shyness. “Is this a problem you often encounter?” they’ll ask in therapeutic voices. “Do you have the same trouble when you speak Arabic?”
There is an intimate atmosphere, a sense of we’re-all-in-this-together, that seems to put everyone at ease and invites everyone to speak. However, this intimacy gets disturbed once in a while by my presence. I am clearly an outsider, being the only non-Moroccan in the room, the only one who seems to already be familiar with the communicative theories monsieur Aziz enlightens us on (he even gave us a basic tutorial on semiology – I had an instant déjà-vu of my days as a first-year anthropology grad student…), and the only one who seems to be here for linguistic improvement. Monsieur Aziz takes advantage of this sometimes, and uses me as a kind of stick behind the door to remind everyone to do his or her best.
“If you don’t speak up and share a story,” he will say, “what will Charlotte here think about Moroccans and their ability to communicate? Do you want to give her the impression that Moroccans cannot express themselves about this particular subject?”
The students will then smile, they’ll look at me, their timidity will re-emerge, and I’ll feel as though I’ve become part of the ‘other side’, an onlooker and observer, rather than a fellow student.
This happens at other moments here and there, too – like when we’re asked to prepare a presentation as a group, and the other members in my circle begin to speak the Arabic they’re ultimately more comfortable with. There’s always a moment where they’ll suddenly stop in their tracks, look at me, and begin apologizing. I’ll then tell them that it’s ok, mashi moushkil (no problem), that I understand what they’re saying – and they’ll smile a bit at my budding knowledge of Arabic and continue, but the intimacy is gone and I can see that their self-consciousness is back.
And I do it myself, too. There are moments, when monsieur Aziz explains a theory I’m already familiar with, for example, when I step back and transform from participant to observer. I’ll look at the ways in which our teacher interacts with the students, and the way they react to him. I’ll notice how students’ comments seem very crafted, full of buzz-words they know are important in this class (like “timide”), very catered toward what they think the teacher wants to hear. I’ll remark how very few people seem just to say what they think – very few apart from the teacher, that is, and I’ll notice how the students get a little flustered when monsieur Aziz brings up topics that are not commonly discussed in public. Like how you met your first boyfriend, or how it’s possible to be an atheist.
And so I put myself on the outside, trying to be the ethnographer, hoping to get an insider’s view of a Moroccan classroom. I will go quiet, waiting to see how others respond to a question thrown into the room by monsieur Aziz, smiling at his expectant expression. Until I realize that I am thereby thwarting my own success as a student in this class – which is ultimately the role I signed on (and paid) to play.
But I’m enjoying myself – I like the class, I observe with interest as the tone of the session shifts between ‘intimate’ and ‘performative’, and I’m even a little intrigued at how I myself morph from participant into observer, and back. It’s a new kind of hybridity that I’m feeling constantly as I set up my own life here in Rabat – as I try to figure out which parts of my experiences here are research, and which are just that, life.
* there is an argument to be made for the idea that teaching is a kind of performance, of course… and vice versa, that performance is a kind of teaching?
** it took the teacher at least twenty minutes to explain what he meant by such subjective evaluation, and how it worked. The students seemed to have a very difficult time understanding that there is not simply one correct way, and one wrong way, to communicate. That it is ok, and sometimes better, to evaluate without passing a definitive judgment. That there may be no such thing as a completely accurate and objective judgment in the first place.
Thursday, July 2, 2009
A Psychiatric Tower of Babel
I was first introduced to the cultural dimension of healthcare and illness by a lecture at the Academic Medical Center in Amsterdam. It was 1999, I was a first year medical student, and I absolutely loved the curriculum. I listened with rapt attention at every lecture on biochemistry, microbiology and physiology, and I adored the anatomy lab sessions in which we explored a female body with scalpel and tweezers. But what really, truly awoke a passion was a single comment during a brief class on primary care medicine. The lecturing doctor mentioned that it is important to keep in mind that patients of immigrant backgrounds often have a tendency to explain their symptoms in ways that may be different from the ‘average’. That this is due to their cultural backgrounds – their ways of understanding illness, and the taboos that exist within their framework of reference. And that a Moroccan woman, for instance, may explain her gynecological symptoms to a male doctor as a stomachache – but that this should not be taken as a cue to start thinking about appendicitis.
This was the point when things changed for me. When I realized that medicine alone was not enough for me – that it was the socio-cultural side of medicine that I really had a passion for, and that I was missing a greater focus on this dimension in my medical education. I became a pre-med after my transatlantic move to Chicago, but drifted more and more toward the Division of Social Sciences, pulled in by classes with titles like “Mental Health and Healing Across Cultures.” A new world opened up before me as I realized that our American or Dutch way of conceptualizing illness is by no means ‘objective’. The fact that we imagine neurological issues as the short-circuiting of an electrical system – and a disorder of the urinary tract as a problem with our ‘plumbing’ – is as much culturally determined as someone’s belief that epileptic symptoms are the manifestation of spirit possession. Even the definition of ‘pathology’ is in a sense contrived: who determined that 200 mg/dL of cholesterol in your blood is the boundary between ‘normal’ and ‘risky’, and why is it not, say, 225, or 231? I was mesmerized by this disappearance of objective truth even from such a scientific discipline as medicine – and intrigued to no end by questions such as these: do illnesses like schizophrenia really occur in every corner of the world, and do they always manifest themselves in the same way? Does a different way of explaining illness just mean a different way of experiencing the same biological problem, or is the illness itself inherently different? If patient and doctor work with different models of explaining illness, how does that affect the course of treatment? How does the inherent inequality of power that characterizes the doctor-patient relationship (because the doctor is always the authority figure) affect treatment? To make a long story short, I quit the pre-med program and became a PhD candidate in medical anthropology.
The answer to the above questions, basically, is that of course all of these things affect medical treatment. Because what these issues all come down to is, in very basic terms, a barrier of communication. Simply put, doctors and patients are often each monolingual in their own language. Their tongues may sound similar – but deceptively so, because it only obscures the fact that translation is necessary. In any case, you can imagine how a resultant miscommunication might lead to problems: a wrong diagnosis, a misunderstanding about the dosage of medication, or a lack of trust in a doctor who just doesn’t seem to hear you, can all seriously hinder the success of treatment.
If most problems come down to barriers of communication, most research in this field aims at calling awareness to the need for translation – at developing dictionaries and universal languages to improve the effectiveness of patient-doctor dialogue.
This was the goal of a workshop that I attended this week at the Clinic.* Three psychologists from the University of Amsterdam had come to Morocco to speak with psychiatric residents and psychologists here about the development of an interview questionnaire that would be multiculturally valid. The rationale for this, as they explained, was their frequent work with teens of immigrant backgrounds in the Netherlands. They found that the existing self-report questionnaires that are used to assess teen functioning often didn’t produce useful results with this population, because these questionnaires work with scales of ‘normalcy’ that are based on very Dutch cultural assumptions.
The goal of this workshop was, then, to develop a self-report questionnaire that would work for teens of Moroccan origin in the Netherlands, as well as teens here in Morocco itself. It gave rise to a productive cooperative effort in which the Moroccan residents, as the Dutch researchers had hoped, actively participated. But although some great headway was thus made to bridge a communicative gap between Moroccan and Dutch cultural contexts, the workshop itself simultaneously brought to light two communicative barriers unique to the Moroccan context, that I think the researchers had not quite been aware of. One was cultural, the other linguistic.
The researchers had come prepared for the Moroccan-Dutch linguistic barrier. Although two of them spoke only English, the third spoke a beautiful French and translated the others’ presentations. Even this interpretation became a cooperative affair, as she asked her audience for assistance with the translation of technical psychological terms; a request the residents eagerly obliged. But as they did so, they brought to light another linguistic barrier that might problematize their use of this questionnaire with Moroccan patients. Like most other standardized questionnaires that are used at the Clinic, this one was to be composed in French. French is the language in which psychiatrists are educated, and it is the tongue in which they and other highly educated Moroccans converse comfortably – it may even be the language they prefer, when they talk about their work. However, statistically speaking the majority of Moroccans are not as highly educated as a doctor, and thus are far more comfortable explaining their symptoms in Moroccan Arabic.** The already difficult task of reducing your complex experience of symptoms into words that correspond to some kind of diagnostic standard is thus made even more difficult by requiring you simultaneously to translate that reduction into a foreign language.
I later asked Dr. Rachidi about this, and she confirmed: this barrier between French and Arabic is a constant issue in the communication with and treatment of patients. Only about 10% of their patients, she told me, speak French well enough to work with one of these questionnaires. A Moroccan psychiatrist is perfectly able to speak with a patient in Moroccan Arabic. However, without the convenience of a biological test for mental illness, linguistic assessment must be substituted for blood work or an MRI; and the only diagnostic tools a Moroccan psychiatrist has at her disposal are in French. Somewhere, a translation has to be made – but whether it be the psychiatrist or the patient who makes that effort, there is always the risk of mistranslation. And as all literature lovers know, a translation is never quite the same as the original…
The other barrier that became apparent is cultural. One thing the Dutch researchers may not have been entirely aware of is the infinite cultural heterogeneity within Morocco itself. Without even mentioning the different cultural practices of Arabs, Berbers, and Jews, and without even trying to parse out which cultural elements come from sub-Saharan Africa and which originated in the Middle East, there is a particular duality that seems lately to preoccupy the collective Moroccan mind – and it was brought out spontaneously and quickly by the Moroccan residents. When the researchers asked the group of residents to itemize typical characteristics of parental behavior in Morocco (this was to be the main topic of the questionnaire), they produced two separate lists. One applied to the “old generation,” while the other characterized the “new.” There are two different value systems in Morocco, the residents explained, pointing to items that presented these two generation of parents as polar opposites of one another. Where the old generation valued the family (“c’est vraiment de la vénération des parents,” one resident explained), the new strove for individualism. And where traditional parents enforced a strict authoritarianism, modern ones actually listened to their children.
The contrast between ‘tradition’ and ‘modernity’ seems to be on everyone’s mind in Morocco, and it resonates through nearly every dimension of public and private life imaginable. It’s a big issue also in Moroccan psychiatry: for one, their allegiance to modernity is psychiatrists’ way of distancing themselves from what they see as the dangerous practices of ‘traditional’ healing. My own research actually deals very directly with the question of how this duality of modernity and tradition (or a seeming duality, because I think the Moroccan verdict on their compatibility isn’t in yet) affects the way in which people think about mental illness and different forms of treatment. And so I was intrigued, when the residents suggested that the questionnaire under construction may not be universally applicable at all. And if they were right that there was such a great difference between these two generations, they were right that certain questions would have very different meanings for each. Each question represented a statement, and respondents would be asked to indicate on a scale of 1 to 5 to what extent they think the action in that statement is important. A ‘traditional’ parent would score “giving more allowance to a boy than to a girl” as very important. However, a ‘modern’ family wouldn’t know what to do with this question. They would completely disagree with this discriminatory practice, the residents hypothesized – but filling in “not important” is very different in value from indicating that you disagree with the statement. Well, one of the Dutch researchers suggested pragmatically, couldn’t we change the wording of the phrase to something more neutral that applies equally to both old and new generation?
Moving on to the next problematic item on the questionnaire, the residents never responded.
Is there even an answer to this question? I’m tempted to wonder if complete universality is ever actually possible in medicine – and I’m tempted to say no. But why should there be? The beauty of life may very well be that there is no objective truth, and thus that nothing is universally valid. So why doesn’t medicine do what anthropology tries to do, and celebrate the diversity in human experience? Because a lack of objective truth by no means suggests that everything is untrue. To the contrary: it means that all different views on life are equally true. All we need to do is be aware of the fact that we don’t all speak the same language, and enjoy the process of learning others’ foreign tongues.
* It’s been a while since I last mentioned this place, but the Clinic is the (pseudonym for the) psychiatric treatment facility where I will be doing half of my research.
** Not to mention the universal truth that the less fortunate among the population are always more likely to get sick and need a doctor (read Paul Farmer for more on this), meaning that the percentage of low-educated, non-francophone individuals should be even higher among patients at the Clinic than it is in society overall.
This was the point when things changed for me. When I realized that medicine alone was not enough for me – that it was the socio-cultural side of medicine that I really had a passion for, and that I was missing a greater focus on this dimension in my medical education. I became a pre-med after my transatlantic move to Chicago, but drifted more and more toward the Division of Social Sciences, pulled in by classes with titles like “Mental Health and Healing Across Cultures.” A new world opened up before me as I realized that our American or Dutch way of conceptualizing illness is by no means ‘objective’. The fact that we imagine neurological issues as the short-circuiting of an electrical system – and a disorder of the urinary tract as a problem with our ‘plumbing’ – is as much culturally determined as someone’s belief that epileptic symptoms are the manifestation of spirit possession. Even the definition of ‘pathology’ is in a sense contrived: who determined that 200 mg/dL of cholesterol in your blood is the boundary between ‘normal’ and ‘risky’, and why is it not, say, 225, or 231? I was mesmerized by this disappearance of objective truth even from such a scientific discipline as medicine – and intrigued to no end by questions such as these: do illnesses like schizophrenia really occur in every corner of the world, and do they always manifest themselves in the same way? Does a different way of explaining illness just mean a different way of experiencing the same biological problem, or is the illness itself inherently different? If patient and doctor work with different models of explaining illness, how does that affect the course of treatment? How does the inherent inequality of power that characterizes the doctor-patient relationship (because the doctor is always the authority figure) affect treatment? To make a long story short, I quit the pre-med program and became a PhD candidate in medical anthropology.
The answer to the above questions, basically, is that of course all of these things affect medical treatment. Because what these issues all come down to is, in very basic terms, a barrier of communication. Simply put, doctors and patients are often each monolingual in their own language. Their tongues may sound similar – but deceptively so, because it only obscures the fact that translation is necessary. In any case, you can imagine how a resultant miscommunication might lead to problems: a wrong diagnosis, a misunderstanding about the dosage of medication, or a lack of trust in a doctor who just doesn’t seem to hear you, can all seriously hinder the success of treatment.
If most problems come down to barriers of communication, most research in this field aims at calling awareness to the need for translation – at developing dictionaries and universal languages to improve the effectiveness of patient-doctor dialogue.
This was the goal of a workshop that I attended this week at the Clinic.* Three psychologists from the University of Amsterdam had come to Morocco to speak with psychiatric residents and psychologists here about the development of an interview questionnaire that would be multiculturally valid. The rationale for this, as they explained, was their frequent work with teens of immigrant backgrounds in the Netherlands. They found that the existing self-report questionnaires that are used to assess teen functioning often didn’t produce useful results with this population, because these questionnaires work with scales of ‘normalcy’ that are based on very Dutch cultural assumptions.
The goal of this workshop was, then, to develop a self-report questionnaire that would work for teens of Moroccan origin in the Netherlands, as well as teens here in Morocco itself. It gave rise to a productive cooperative effort in which the Moroccan residents, as the Dutch researchers had hoped, actively participated. But although some great headway was thus made to bridge a communicative gap between Moroccan and Dutch cultural contexts, the workshop itself simultaneously brought to light two communicative barriers unique to the Moroccan context, that I think the researchers had not quite been aware of. One was cultural, the other linguistic.
The researchers had come prepared for the Moroccan-Dutch linguistic barrier. Although two of them spoke only English, the third spoke a beautiful French and translated the others’ presentations. Even this interpretation became a cooperative affair, as she asked her audience for assistance with the translation of technical psychological terms; a request the residents eagerly obliged. But as they did so, they brought to light another linguistic barrier that might problematize their use of this questionnaire with Moroccan patients. Like most other standardized questionnaires that are used at the Clinic, this one was to be composed in French. French is the language in which psychiatrists are educated, and it is the tongue in which they and other highly educated Moroccans converse comfortably – it may even be the language they prefer, when they talk about their work. However, statistically speaking the majority of Moroccans are not as highly educated as a doctor, and thus are far more comfortable explaining their symptoms in Moroccan Arabic.** The already difficult task of reducing your complex experience of symptoms into words that correspond to some kind of diagnostic standard is thus made even more difficult by requiring you simultaneously to translate that reduction into a foreign language.
I later asked Dr. Rachidi about this, and she confirmed: this barrier between French and Arabic is a constant issue in the communication with and treatment of patients. Only about 10% of their patients, she told me, speak French well enough to work with one of these questionnaires. A Moroccan psychiatrist is perfectly able to speak with a patient in Moroccan Arabic. However, without the convenience of a biological test for mental illness, linguistic assessment must be substituted for blood work or an MRI; and the only diagnostic tools a Moroccan psychiatrist has at her disposal are in French. Somewhere, a translation has to be made – but whether it be the psychiatrist or the patient who makes that effort, there is always the risk of mistranslation. And as all literature lovers know, a translation is never quite the same as the original…
The other barrier that became apparent is cultural. One thing the Dutch researchers may not have been entirely aware of is the infinite cultural heterogeneity within Morocco itself. Without even mentioning the different cultural practices of Arabs, Berbers, and Jews, and without even trying to parse out which cultural elements come from sub-Saharan Africa and which originated in the Middle East, there is a particular duality that seems lately to preoccupy the collective Moroccan mind – and it was brought out spontaneously and quickly by the Moroccan residents. When the researchers asked the group of residents to itemize typical characteristics of parental behavior in Morocco (this was to be the main topic of the questionnaire), they produced two separate lists. One applied to the “old generation,” while the other characterized the “new.” There are two different value systems in Morocco, the residents explained, pointing to items that presented these two generation of parents as polar opposites of one another. Where the old generation valued the family (“c’est vraiment de la vénération des parents,” one resident explained), the new strove for individualism. And where traditional parents enforced a strict authoritarianism, modern ones actually listened to their children.
The contrast between ‘tradition’ and ‘modernity’ seems to be on everyone’s mind in Morocco, and it resonates through nearly every dimension of public and private life imaginable. It’s a big issue also in Moroccan psychiatry: for one, their allegiance to modernity is psychiatrists’ way of distancing themselves from what they see as the dangerous practices of ‘traditional’ healing. My own research actually deals very directly with the question of how this duality of modernity and tradition (or a seeming duality, because I think the Moroccan verdict on their compatibility isn’t in yet) affects the way in which people think about mental illness and different forms of treatment. And so I was intrigued, when the residents suggested that the questionnaire under construction may not be universally applicable at all. And if they were right that there was such a great difference between these two generations, they were right that certain questions would have very different meanings for each. Each question represented a statement, and respondents would be asked to indicate on a scale of 1 to 5 to what extent they think the action in that statement is important. A ‘traditional’ parent would score “giving more allowance to a boy than to a girl” as very important. However, a ‘modern’ family wouldn’t know what to do with this question. They would completely disagree with this discriminatory practice, the residents hypothesized – but filling in “not important” is very different in value from indicating that you disagree with the statement. Well, one of the Dutch researchers suggested pragmatically, couldn’t we change the wording of the phrase to something more neutral that applies equally to both old and new generation?
Moving on to the next problematic item on the questionnaire, the residents never responded.
Is there even an answer to this question? I’m tempted to wonder if complete universality is ever actually possible in medicine – and I’m tempted to say no. But why should there be? The beauty of life may very well be that there is no objective truth, and thus that nothing is universally valid. So why doesn’t medicine do what anthropology tries to do, and celebrate the diversity in human experience? Because a lack of objective truth by no means suggests that everything is untrue. To the contrary: it means that all different views on life are equally true. All we need to do is be aware of the fact that we don’t all speak the same language, and enjoy the process of learning others’ foreign tongues.
* It’s been a while since I last mentioned this place, but the Clinic is the (pseudonym for the) psychiatric treatment facility where I will be doing half of my research.
** Not to mention the universal truth that the less fortunate among the population are always more likely to get sick and need a doctor (read Paul Farmer for more on this), meaning that the percentage of low-educated, non-francophone individuals should be even higher among patients at the Clinic than it is in society overall.
Wednesday, January 28, 2009
Going, going, back, back...
For six weeks, I struggled to think of anything I might write a blog post about. Geographically removed from my purported subject of analysis, my inspiration was lost. Nothing I thought about seemed relevant, and nothing that was relevant, seemed interesting enough.
But today, as soon as I set foot in the airplane that was to take me on the first leap over water toward Morocco – my flight from Chicago to Madrid – the words instantly came flooding back. I spent most of my waking hours on the flight writing notes to myself in the blank margins of the pages in Iberia’s in-flight magazine. Notes on how different this journey felt from the one I undertook in September. Notes that looked ahead and made plans, and notes that reflected on the past and tried to learn from it. Notes that fantasized, and notes that pulled me back into reality.
It is a new world, this time around, both inside and out. Instead of alone, I feel strong and confident. Instead of afraid and unsure, I am full of excitement. I remember the dread I felt in September – the sheer inability to even imagine having the energy to get off the plane in Casablanca, get myself admitted into the country, pick up my bags, and haul myself onto a train. I also remember how I felt three months later, in December – I remember that I wasn’t ready to leave, and that I had started to love being in Morocco. And it is that flow of energy that I am still riding on today. I dread hauling that same huge black bag onto two trains and up several flights of stairs, but other than that I am bouncing with energy, excited to speak Arabic to the customs officials, and make them smile once again when I tell them I’m studying Moroccan Arabic. I’m excited to arrive at the Nimar, at the apartment where I will be living for the next month, to start work, to see my friends again, to walk around Rabat, to travel around the country, to speak French and Arabic.
Looking back at Chicago as it got smaller and smaller underneath us, tranquilized by a muting white and hazy blanket of snow, I did feel acutely how much I was going to miss being ‘home’. I did feel a bit of apprehension. I already miss the comforts of home, the ability to take certain things for granted, the not-having-to-wonder-how-things-work. I already feel the nervousness of an approaching unknown – because many new issues will arise this time around, with my living circumstances being so different, and my rise upwards on the ladder of independence. And (as always) I am nervous about my French and Arabic, because despite my best intentions I’ve been unable to prevent my comfort level with both from lapsing significantly. But with this energy and motivation I feel, all that ‘unknown’ seems much less threatening already.
I can’t help but think that apart from my increased familiarity with Moroccan life and the headway that I made this past fall, this new positive outlook has been engendered also by the new sense of hope in which Obama has swept up (most of) the United States. I’ve definitely been pulled along with it all and I have high hopes that, even if nothing major changes any time soon, at least we all have once again found the energy to work on improvement of our world. After a little bit of disillusionment on this issue last November [link], I’ve convinced myself once again that real cross-cultural communication perhaps is possible, after all – and that I want to contribute at least to seeing if that’s true.
In that respect, I think these next four months will strike a slightly different tone from the preceding three. I hope to resume my efforts to establish a kind of inside-understanding of Morocco, to come to know its own internal logic. But rather than pursuing research and total immersion, I will be working within a European frame of reference. Rather than trying to blend in (as impossible as that may be in Morocco, sometimes), I will be explicitly representing an outsider’s point of view. Rather than looking in on the lives of others, I will be attempting to build up my own version of life in Morocco.
I wonder how I will experience that shift of perspective – if it will even change anything about my experience, at all. To anyone else here in Morocco, native and foreign, I’m fairly sure there is no real difference between the status of an anthropologist, and that of someone working for a European cultural organization. Either way, there is an a priori assumption of difference, no matter how fervently anthropologists may wish to transcend it. As much as I tried to blend in, I cannot pretend for a minute as though that assumption was ever absent during those three months I spent with Khadija, Lahcen, and their children.
But I wonder what it will do to my own perspective. Like any other anthropologist I did try, at least in part, to transcend that sense of difference. Disillusioned with the realistic possibility of ever succeeding, I chose not to give up and underscore my otherness, but instead to be silent on those aspects of my identity and outlook that did not seem to fit into any Moroccan framework of reference. It frustrated me not to be able to ‘be myself’ (even if I did, truly, enjoy myself in the process of this immersion), but I was there on a mission to learn about Moroccan ways of thinking, not to contrast them with my own. I think ‘anthropologist’ has become a state of mind for me rather than a concrete job description, and I don’t believe I’ll be able to turn it off this spring. Nevertheless, I am going back to Morocco not to immerse myself, but to be a Dutch employee, representing a Dutch cultural organization. To underscore and highlight my difference, so to speak. Will that encourage me to ‘be myself’ more toward the people I am trying to learn about Morocco from? And if so, will I experience that as a good thing, or will it hinder my learning process? And come to think of it, how will it affect my already existing sense of hybridity? Will I begin to emphasize my Americanness more, now that the Dutch part of me is put in the foreground?
But as much as it feels like a highlighting of my difference to come back to Morocco in this new position, it may also be a position from which I have an underscored responsibility to engage in cross-cultural dialogue and try to facilitate a measure of cross-cultural understanding. That idea appeals to me. And that, perhaps, will be my way to bridge the gap I sometimes perceive between an anthropologist’s state of mind and this outsider’s position.
But today, as soon as I set foot in the airplane that was to take me on the first leap over water toward Morocco – my flight from Chicago to Madrid – the words instantly came flooding back. I spent most of my waking hours on the flight writing notes to myself in the blank margins of the pages in Iberia’s in-flight magazine. Notes on how different this journey felt from the one I undertook in September. Notes that looked ahead and made plans, and notes that reflected on the past and tried to learn from it. Notes that fantasized, and notes that pulled me back into reality.
It is a new world, this time around, both inside and out. Instead of alone, I feel strong and confident. Instead of afraid and unsure, I am full of excitement. I remember the dread I felt in September – the sheer inability to even imagine having the energy to get off the plane in Casablanca, get myself admitted into the country, pick up my bags, and haul myself onto a train. I also remember how I felt three months later, in December – I remember that I wasn’t ready to leave, and that I had started to love being in Morocco. And it is that flow of energy that I am still riding on today. I dread hauling that same huge black bag onto two trains and up several flights of stairs, but other than that I am bouncing with energy, excited to speak Arabic to the customs officials, and make them smile once again when I tell them I’m studying Moroccan Arabic. I’m excited to arrive at the Nimar, at the apartment where I will be living for the next month, to start work, to see my friends again, to walk around Rabat, to travel around the country, to speak French and Arabic.
Looking back at Chicago as it got smaller and smaller underneath us, tranquilized by a muting white and hazy blanket of snow, I did feel acutely how much I was going to miss being ‘home’. I did feel a bit of apprehension. I already miss the comforts of home, the ability to take certain things for granted, the not-having-to-wonder-how-things-work. I already feel the nervousness of an approaching unknown – because many new issues will arise this time around, with my living circumstances being so different, and my rise upwards on the ladder of independence. And (as always) I am nervous about my French and Arabic, because despite my best intentions I’ve been unable to prevent my comfort level with both from lapsing significantly. But with this energy and motivation I feel, all that ‘unknown’ seems much less threatening already.
I can’t help but think that apart from my increased familiarity with Moroccan life and the headway that I made this past fall, this new positive outlook has been engendered also by the new sense of hope in which Obama has swept up (most of) the United States. I’ve definitely been pulled along with it all and I have high hopes that, even if nothing major changes any time soon, at least we all have once again found the energy to work on improvement of our world. After a little bit of disillusionment on this issue last November [link], I’ve convinced myself once again that real cross-cultural communication perhaps is possible, after all – and that I want to contribute at least to seeing if that’s true.
In that respect, I think these next four months will strike a slightly different tone from the preceding three. I hope to resume my efforts to establish a kind of inside-understanding of Morocco, to come to know its own internal logic. But rather than pursuing research and total immersion, I will be working within a European frame of reference. Rather than trying to blend in (as impossible as that may be in Morocco, sometimes), I will be explicitly representing an outsider’s point of view. Rather than looking in on the lives of others, I will be attempting to build up my own version of life in Morocco.
I wonder how I will experience that shift of perspective – if it will even change anything about my experience, at all. To anyone else here in Morocco, native and foreign, I’m fairly sure there is no real difference between the status of an anthropologist, and that of someone working for a European cultural organization. Either way, there is an a priori assumption of difference, no matter how fervently anthropologists may wish to transcend it. As much as I tried to blend in, I cannot pretend for a minute as though that assumption was ever absent during those three months I spent with Khadija, Lahcen, and their children.
But I wonder what it will do to my own perspective. Like any other anthropologist I did try, at least in part, to transcend that sense of difference. Disillusioned with the realistic possibility of ever succeeding, I chose not to give up and underscore my otherness, but instead to be silent on those aspects of my identity and outlook that did not seem to fit into any Moroccan framework of reference. It frustrated me not to be able to ‘be myself’ (even if I did, truly, enjoy myself in the process of this immersion), but I was there on a mission to learn about Moroccan ways of thinking, not to contrast them with my own. I think ‘anthropologist’ has become a state of mind for me rather than a concrete job description, and I don’t believe I’ll be able to turn it off this spring. Nevertheless, I am going back to Morocco not to immerse myself, but to be a Dutch employee, representing a Dutch cultural organization. To underscore and highlight my difference, so to speak. Will that encourage me to ‘be myself’ more toward the people I am trying to learn about Morocco from? And if so, will I experience that as a good thing, or will it hinder my learning process? And come to think of it, how will it affect my already existing sense of hybridity? Will I begin to emphasize my Americanness more, now that the Dutch part of me is put in the foreground?
But as much as it feels like a highlighting of my difference to come back to Morocco in this new position, it may also be a position from which I have an underscored responsibility to engage in cross-cultural dialogue and try to facilitate a measure of cross-cultural understanding. That idea appeals to me. And that, perhaps, will be my way to bridge the gap I sometimes perceive between an anthropologist’s state of mind and this outsider’s position.
Friday, November 14, 2008
Generalizations
In the interest of literary style and a little ethnographic weight, I’ve been talking a fair amount about “Moroccans” as a general population in this blog. And in a sense, what I am trying to do here during these three months of pre-fieldwork is to establish a basic understanding of the general characteristics and dynamics of this society and its citizens. I am trying to create a base of general comprehension, before I begin to focus very specifically on a small part of this society (that being mental healthcare, of course).
I think it is important to get a sense of the larger dynamics and characteristics of a society, because without knowing those, it will be impossible to come to know its smaller sub-components. But I have also been worrying lately that I may be generalizing a bit more than I should, and I may be referring to “Moroccans” in general, a bit too easily. Generalization has been on my mind lately: Noureddine’s anti-West campaign, more intensive sharing of experiences with fellow foreigners, and the past week’s debate at the Nimar have made me a little more aware of what I myself am doing.
I don’t want to be a generalizer. I don’t believe in generalizing, and I think that if anthropology stands for anything, it is for the richness of human diversity, both between and within cultures. I remain focused on establishing a general understanding of Moroccan society, but I want to do so without losing sight of its internal heterogeneity.
Because if there is one thing one could generalize about when it comes to Morocco (and even here one should be careful), it’s that nothing is as simple as it seems. Morocco cannot be described in a few words, because there are too many histories, ethnicities, languages, traditions, and beliefs that come together here. As I have written in earlier posts, there is a duality that runs through nearly every facet of Moroccan society. This duality means that for every characteristic of society, every identifiable social dynamic that I write about, there is a large group of Moroccans to whom it does not apply, and for whom things work in an entirely different way. There are many others who write blogs about Morocco, and their observations are often completely different from mine. This does not mean that either of us has it wrong; it simply means that we are observing different sides of this complex society and drawing different conclusions.
And so when I write about Moroccan attitudes about marriage, I do not mean to claim or even imply that there are no Moroccans for whom this may be different. The same goes for what I’ve written about medicalization, the practice of Ramadan, masculinity, the psychological importance of the Western Sahara, and so on. I am recording my observations and indulging in my own analytical pleasure – and I will keep doing so. But I may, from now on, stress this perpetual presence of heterogeneity a little more, and try a little harder to avoid suggesting that any of the theories I devise applies to all residents of this country across the board.
I also may begin to revisit a few of the issues I’ve been writing about. I often write my posts early on in my thinking process, enthusiastic as I am about getting to know a new facet of Moroccan society. But – because nothing is ever simple in this country – as time passes, my analyses of these issues deepen, I discover deeper complexities, added factors, exceptions to the rule, and I begin to wish I could go back and edit all my posts; in my efforts to avoid generalization, I want to highlight these complexities. Suddenly my posts begin to seem a little superficial, as though they are only scratching the surface. A surface I desperately want to see right through… but that always takes time, I guess.
I think it is important to get a sense of the larger dynamics and characteristics of a society, because without knowing those, it will be impossible to come to know its smaller sub-components. But I have also been worrying lately that I may be generalizing a bit more than I should, and I may be referring to “Moroccans” in general, a bit too easily. Generalization has been on my mind lately: Noureddine’s anti-West campaign, more intensive sharing of experiences with fellow foreigners, and the past week’s debate at the Nimar have made me a little more aware of what I myself am doing.
I don’t want to be a generalizer. I don’t believe in generalizing, and I think that if anthropology stands for anything, it is for the richness of human diversity, both between and within cultures. I remain focused on establishing a general understanding of Moroccan society, but I want to do so without losing sight of its internal heterogeneity.
Because if there is one thing one could generalize about when it comes to Morocco (and even here one should be careful), it’s that nothing is as simple as it seems. Morocco cannot be described in a few words, because there are too many histories, ethnicities, languages, traditions, and beliefs that come together here. As I have written in earlier posts, there is a duality that runs through nearly every facet of Moroccan society. This duality means that for every characteristic of society, every identifiable social dynamic that I write about, there is a large group of Moroccans to whom it does not apply, and for whom things work in an entirely different way. There are many others who write blogs about Morocco, and their observations are often completely different from mine. This does not mean that either of us has it wrong; it simply means that we are observing different sides of this complex society and drawing different conclusions.
And so when I write about Moroccan attitudes about marriage, I do not mean to claim or even imply that there are no Moroccans for whom this may be different. The same goes for what I’ve written about medicalization, the practice of Ramadan, masculinity, the psychological importance of the Western Sahara, and so on. I am recording my observations and indulging in my own analytical pleasure – and I will keep doing so. But I may, from now on, stress this perpetual presence of heterogeneity a little more, and try a little harder to avoid suggesting that any of the theories I devise applies to all residents of this country across the board.
I also may begin to revisit a few of the issues I’ve been writing about. I often write my posts early on in my thinking process, enthusiastic as I am about getting to know a new facet of Moroccan society. But – because nothing is ever simple in this country – as time passes, my analyses of these issues deepen, I discover deeper complexities, added factors, exceptions to the rule, and I begin to wish I could go back and edit all my posts; in my efforts to avoid generalization, I want to highlight these complexities. Suddenly my posts begin to seem a little superficial, as though they are only scratching the surface. A surface I desperately want to see right through… but that always takes time, I guess.
Saturday, November 1, 2008
Clinical Ethnography!
Yesterday morning, I was awoken from my restless sleep by the banging of plastic sheets against the outside wall. On the side of the terrace adjacent to the room where I sleep, the courtyard wall does not reach all the way up to the plastic roof. Two vertical plastic panels stretch across this gap, but one of them has become unfastened at one end. When it is windy, like it is today, this panel tends to be pulled back away from the wall with one gust of wind, and then slammed back by the next.
And so I got up a little earlier than I had planned, to get myself ready for my big appointment – with Dr. Chikri,* the director of the psychiatric clinic where I hope to do my research. I was not in the most ready of moods; after a restless night I felt a little on edge, without bread to be found anywhere I left the house hungry, and nervous about the meeting – and about finding the place, first of all – I left too late, forgetting first to brush my hair, then to brush my teeth, then to fetch my keys from my other bag.
But all went well – better than I could have hoped for, in fact. First of all, the Clinic has proven very, very easy to find. The bus I had been told to take stops right by the entrance, and picks up from there as well. It takes no more than 15 minutes – which left me there about 45 minutes early. I had taken a wide window of time: without existing bus schedules, having seen the traffic at that hour in the morning, and not knowing precisely where the clinic (let alone the doctor’s office) was, I had decided to play it safe. Spotting the entrance to the clinic right away, I walked around the area a bit to kill some time and survey what else was around here (mostly outpatient clinics and pharmacies, it seems), then headed back for the Clinic to find the doctor’s office.
The meeting itself went smoothly and perfectly. Sitting across from each other on comfortable couches in the doctor’s large and well-decorated office, I explained to him the basic gist of my research. I had just gotten about halfway through an overview of my research questions when I mentioned that I was interested in exploring what makes people choose for either psychiatry or traditional forms of healing, and he interrupted me with a confident, single word: “ignorance.” So I probed further – was this really the answer to this issue? Absolutely, he said. The entire problem was an issue of what he called “pedagogie sanitaire de masse” – public health education, basically. The Moroccan public is simply ignorant of the appropriate treatment for both physical and mental problems – ignorant also of the dangers of traditional healing practices – and unaware of the medical facilities available to them. Unlike many other countries with cultural healing traditions, not enough effort is made in Morocco to educate the public about issues of health and hygiene. I wanted to ask him more: does he think there is a responsibility here for psychiatry, as a discipline, to help raise this awareness, or is this the government’s job? How would one go about raising such awareness? And what about the other factors I’ve heard or read play into people’s choice for care – such as the issue of stigma, or the simply unavailability of medical care? But the doctor had already urged me to continue my spiel, and I decided there would be time to ask these questions at a later date; I was here now to sell myself.
I think that this perception of “ignorance” among the public explains Dr. Chikri’s interest in my research. Frequent media discussion about the state of psychiatry (and other specialties as well) in Morocco leads me to the impression that the collective discipline is working hard to raise awareness – not only among the public, but within government echelons as well – of the dire state the discipline is in, and the great need for better psychiatric care. Only 350 psychiatrists in Morocco for 300,000 mentally ill, a newspaper headline cried out a few weeks ago. 1900 beds for 100,000 psychiatric patients in Casablanca alone, lamented another, while a third pointed out that psychiatry is accorded a mere 1% of the health department budget.
This means that my research may come at a good time. My project will not be decrying the dangers of traditional healing practices – a strategy often used in these media reports about psychiatry – and this may be a point of debate with the psychiatrists I will be working with, but I am receiving very positive responses so far. Dr. Chikri, on his part, not only gave me permission to conduct extensive research at the Clinic (!) but even mentioned that he would like his clinic to be involved somehow, because this kind of research is important to them as well. For me, this is beyond perfect. Not only do I get to carry out an in-depth clinical ethnography for the psychiatric side of my research, but I also get a certain kind of institutional affiliation and cooperation; something that will, I hope, seriously help strengthen my case with grant foundations, as well as my American university’s human subjects review board.**
And so I floated back to the bus, back to Rabat, and back home to a steaming hot dish of couscous*** – happy, excited, and a little confident again that I’ll actually be able to do this project. All that remains to be done now is prepare interview protocols, work very, very hard to learn as much Arabic as I possibly can, submit an application to the IRB, and hope beyond all hope that the next grant-related news will be positive…
* This name, too, has been changed; from now on I will also refer to this clinic simply as ‘the Clinic’.
** Every university has a human subjects review board, or IRB (institutional review board). A university is liable for any research conducted in the university’s name – and this includes any PhD research like mine. The IRB therefore critically reviews all projects proposed by university-affiliated researchers in order to ensure the maintenance of ethical standards, and to minimize the risk of legal action. For a project like mine, that proposes to interview patients with mental illness, getting approval can be difficult – and means convincingly explaining why the benefits of this research are greater than the potential risks for those involved in participation.
*** The first couscous served at home, incidentally. Now that all women are (finally) done fasting, we have returned to the routine of “sksou” every Friday…
And so I got up a little earlier than I had planned, to get myself ready for my big appointment – with Dr. Chikri,* the director of the psychiatric clinic where I hope to do my research. I was not in the most ready of moods; after a restless night I felt a little on edge, without bread to be found anywhere I left the house hungry, and nervous about the meeting – and about finding the place, first of all – I left too late, forgetting first to brush my hair, then to brush my teeth, then to fetch my keys from my other bag.
But all went well – better than I could have hoped for, in fact. First of all, the Clinic has proven very, very easy to find. The bus I had been told to take stops right by the entrance, and picks up from there as well. It takes no more than 15 minutes – which left me there about 45 minutes early. I had taken a wide window of time: without existing bus schedules, having seen the traffic at that hour in the morning, and not knowing precisely where the clinic (let alone the doctor’s office) was, I had decided to play it safe. Spotting the entrance to the clinic right away, I walked around the area a bit to kill some time and survey what else was around here (mostly outpatient clinics and pharmacies, it seems), then headed back for the Clinic to find the doctor’s office.
The meeting itself went smoothly and perfectly. Sitting across from each other on comfortable couches in the doctor’s large and well-decorated office, I explained to him the basic gist of my research. I had just gotten about halfway through an overview of my research questions when I mentioned that I was interested in exploring what makes people choose for either psychiatry or traditional forms of healing, and he interrupted me with a confident, single word: “ignorance.” So I probed further – was this really the answer to this issue? Absolutely, he said. The entire problem was an issue of what he called “pedagogie sanitaire de masse” – public health education, basically. The Moroccan public is simply ignorant of the appropriate treatment for both physical and mental problems – ignorant also of the dangers of traditional healing practices – and unaware of the medical facilities available to them. Unlike many other countries with cultural healing traditions, not enough effort is made in Morocco to educate the public about issues of health and hygiene. I wanted to ask him more: does he think there is a responsibility here for psychiatry, as a discipline, to help raise this awareness, or is this the government’s job? How would one go about raising such awareness? And what about the other factors I’ve heard or read play into people’s choice for care – such as the issue of stigma, or the simply unavailability of medical care? But the doctor had already urged me to continue my spiel, and I decided there would be time to ask these questions at a later date; I was here now to sell myself.
I think that this perception of “ignorance” among the public explains Dr. Chikri’s interest in my research. Frequent media discussion about the state of psychiatry (and other specialties as well) in Morocco leads me to the impression that the collective discipline is working hard to raise awareness – not only among the public, but within government echelons as well – of the dire state the discipline is in, and the great need for better psychiatric care. Only 350 psychiatrists in Morocco for 300,000 mentally ill, a newspaper headline cried out a few weeks ago. 1900 beds for 100,000 psychiatric patients in Casablanca alone, lamented another, while a third pointed out that psychiatry is accorded a mere 1% of the health department budget.
This means that my research may come at a good time. My project will not be decrying the dangers of traditional healing practices – a strategy often used in these media reports about psychiatry – and this may be a point of debate with the psychiatrists I will be working with, but I am receiving very positive responses so far. Dr. Chikri, on his part, not only gave me permission to conduct extensive research at the Clinic (!) but even mentioned that he would like his clinic to be involved somehow, because this kind of research is important to them as well. For me, this is beyond perfect. Not only do I get to carry out an in-depth clinical ethnography for the psychiatric side of my research, but I also get a certain kind of institutional affiliation and cooperation; something that will, I hope, seriously help strengthen my case with grant foundations, as well as my American university’s human subjects review board.**
And so I floated back to the bus, back to Rabat, and back home to a steaming hot dish of couscous*** – happy, excited, and a little confident again that I’ll actually be able to do this project. All that remains to be done now is prepare interview protocols, work very, very hard to learn as much Arabic as I possibly can, submit an application to the IRB, and hope beyond all hope that the next grant-related news will be positive…
* This name, too, has been changed; from now on I will also refer to this clinic simply as ‘the Clinic’.
** Every university has a human subjects review board, or IRB (institutional review board). A university is liable for any research conducted in the university’s name – and this includes any PhD research like mine. The IRB therefore critically reviews all projects proposed by university-affiliated researchers in order to ensure the maintenance of ethical standards, and to minimize the risk of legal action. For a project like mine, that proposes to interview patients with mental illness, getting approval can be difficult – and means convincingly explaining why the benefits of this research are greater than the potential risks for those involved in participation.
*** The first couscous served at home, incidentally. Now that all women are (finally) done fasting, we have returned to the routine of “sksou” every Friday…
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