Being There

Early Career Medical Anthropologists’ Perspectives on Contemporary Challenges in the Field

in Anthropology in Action
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Francesca Cancelliere Institute of Social Sciences, University of Lisbon, Portugal f.cancelliere@hotmail.com

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Ursula Probst Institute for Social and Cultural Anthropology, Freie Universität Berlin, Germany ursula.probst@fu-berlin.de

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Conrad W. Watson describes fieldwork as ‘a period of particular heightened intensity’ (1999a: 2) in the introduction of Being There (1999b). The authors of this volume were by far not the first, nor the last, anthropologists questioning and critically reflecting on what it is that they are actually doing when being there in their respective fields. For Watson and others (Borneman and Hammoudi 2009; Geertz 2004; Hollan 2008), this was primarily an epistemological question, following ruptures in the discipline's identity after the Writing Culture Debates of the late 1980s. Forced to rethink their fieldwork practices, anthropologists saw their understandings of theory-building and knowledge production follow suit. However, the complexities and challenges of ethnographic fieldwork also confronted and still confront many anthropologists with intricate questions of inequalities, power structures and violence that not only need to be theorised but also navigated in the everyday practice of fieldwork.

Conrad W. Watson describes fieldwork as ‘a period of particular heightened intensity’ (1999a: 2) in the introduction of Being There (1999b). The authors of this volume were by far not the first, nor the last, anthropologists questioning and critically reflecting on what it is that they are actually doing when being there in their respective fields. For Watson and others (Borneman and Hammoudi 2009; Geertz 2004; Hollan 2008), this was primarily an epistemological question, following ruptures in the discipline's identity after the Writing Culture Debates of the late 1980s. Forced to rethink their fieldwork practices, anthropologists saw their understandings of theory-building and knowledge production follow suit. However, the complexities and challenges of ethnographic fieldwork also confronted and still confront many anthropologists with intricate questions of inequalities, power structures and violence that not only need to be theorised but also navigated in the everyday practice of fieldwork.

This broad range of epistemological, ethical, methodological and practical questions related to ethnographic fieldwork and anthropologists’ direct engagement in the everyday lives of different communities has shaped the current state of the discipline. And yet, with its many subfields and various traditions, different answers and approaches have emerged. Since the 1980s, in the field of medical anthropology everyday confrontations with matters of life and death have prompted the emergence of critical medical anthropology (Scheper-Hughes 1995; Singer et al. 2019; Taussig 1987), which in turn has inspired medical anthropologists to take a more active role in shaping the conditions of their field sites (Biehl 2009; Dilger et al. 2015; Farmer et al. 2013; Nguyen 2010). The forms of engagement developed in the context of critical medical anthropology foregrounded how the ‘particular high intensity’ (Watson 1999a: 2) of fieldwork is not just an epistemological but also a moral question, and how a critical analysis of power imbalances, marginalisation and vulnerabilities does not have to be a purely theoretical matter (Scheper-Hughes 1995).

However, this call for an active engagement in the struggles of the communities that medical anthropologists work with was not only met with praise but also with justified criticism. As Hansjörg Dilger and colleagues remind us, these approaches also incorporated ‘sometimes simplistic attitudes and analytical perspectives toward groups of persons with whom we engage’ (2015: 4), reducing complex power relations and their ambiguities to generalised statements about ‘the poor’ or ‘the powerless’ (2015: 4) and sometimes lacking a critical reflection of anthropologists’ entanglements and positionalities within these structures. This self-reflexion of medical anthropologists in action can be connected to a somewhat greater attention to feminist, postcolonial and Indigenous scholarship in recent years, which has long called into question the role(s) of anthropologists in the field and the discipline as a whole (Segato 2006; Smith 2013; Wolf 1996).

Especially as coordinators of the Medical Anthropology Young Scholars (MAYS) Network—an early career scholars’ network based in Europe, we have to acknowledge anthropology's entanglements with colonial projects and the current power imbalances in anthropological knowledge production both within academic spheres as well as in our field encounters. Western medical anthropologies certainly still have a lot of work to do to overcome these legacies, and often it is graduate students and early postdoctoral researchers who get caught up between an impetus to improve the current conditions of anthropological fieldwork and the limits and limitations of working in a hierarchical academic system that rarely holds space for inclusion and nuanced discussions of their perspectives. To create such a space was the motivation for founding the MAYS network over ten years ago, which since then has brought together early career scholars of medical anthropology to discuss contemporary theoretical, methodological and ethical challenges of fieldwork on health and illness.

New Challenges to Old Debates in Medical Anthropology

The discussion amongst us illustrated that the core questions behind these decade-long debates – how we can or should engage with our field and its actors, and how knowledge around health, illness and healing is produced in these encounters – remain. As early career scholars embarking on their first ethnographic fieldwork endeavours, we prepare from and build on the extensive literature about positionality, reflexivity and engagement in medical anthropological research. However, as the world keeps changing, today's graduate students often encounter situations very different from the fieldwork contexts of our teachers and mentors. Shifting power relations on global as well as local levels might have reduced some, but also created new fault lines that need to be carefully navigated when entering certain fields for the first time (Faubion and Marcus 2009). In the field of medical anthropology, the debate on global health (Biehl 2016) has created new fields of study and possibilities for medical anthropologists to engage beyond theoretical analyses (Farmer et al. 2013; Janes and Corbett 2009; Nguyen 2012). However, the relationship between global health and medical anthropology has also been a complicated one (Dilger and Mattes 2018), with anthropology being both deeply involved and highly critical of the developments of and in global health such as the demand for fast research on complex issues (Adams et al. 2014) or the neoliberal underpinnings of the global health project (Keshavjee 2014).

Additionally, our modalities of engagement with our fields have undergone stark changes (Fainzang 2007; Fassin 2006; Gable 2010), not only due to the necessary reflection on positionalities, but also because of the widespread institutionalisation of ethics reviews in the social sciences. While this increased attention to the ethical dimensions of ethnographic fieldwork was an important step in improving anthropological practices in the field, the often rigid and formalised criteria of ethics reviews as well as an uncritical adaptation of procedures from natural sciences to social sciences has created new conflicts and problems for carrying out ethnographic fieldwork (Von Unger et al. 2016). Moreover, the effects of climate change, pollution and environmental crises which affect the livelihoods and health of many communities across the globe urge us to rethink not only our engagements in the field, but also our academic habits beyond the field which often rely on air travel and other environmentally unsustainable practices.

Furthermore, the ongoing digitalisation of life and the expansion of virtual realms call into question what both ‘being’ and ‘there’ in the field can mean. The urgency of this question became apparent in early 2020 when the emergence of the SARS-CoV-2 pandemic required anthropologists to rethink their fieldwork practices and quickly adapt to a changed environment. For long before the pandemic, however, anthropologists have studied the emergence of telemedicine, the use of digital platforms by patients or care-takers, the building of digital therapeutic communities for healthcare and advocacy, and other effects of an ongoing digitalisation in the field of health, illness and healing. Seminal research on digital worlds in the field of medical anthropology has urged the development of new methodologies and understandings of how (and where) ethnographic fieldwork can take place, adding another dimension to questions of positionalities and ethics in the field (Berning and Hardon 2019; Pink and Lanzeni 2018; Sinha 2000).

The recent pandemic has also shed light on other contemporary and pressing issues for medical anthropologists, such as the effects of healthcare privatisation, frictions between global issues and rising nationalisms, and bringing to the forefront the need for analysing the socio-cultural dimensions of pandemics. While the articles in this issue stem from a time before the SARS-CoV-2 pandemic and therefore do not refer to these most current developments, they do show the social worlds that would soon enter states of emergency, with the many precarities and vulnerabilities involved, including those of healthcare providers and the researchers themselves.

Precarities and Communities: Highlighting Early Career Scholars’ Perspectives

Directly in and from the field, today's early career medical anthropologists provide innovative theoretical and methodological approaches to these challenges, both old and new. However, their perspectives and experiences are also often shaped by new precarities and vulnerabilities in the context of a continuous flexibilisation, privatisation and commercialisation of higher education that also heavily affect graduate students and postdoctoral researchers (Lynch and Ivancheva 2015). Some graduate students continuously struggle to secure sufficient funds to carry out fieldwork in the first place and therefore have to adapt scope and modalities of ethnographic engagement according to their financial capacity, or simultaneously work outside of academia to secure a living. Subsequent delays or unconventional fieldwork paths might be frowned upon and can negatively affect career prospects, while the potentials of utilising professional experiences gathered outside of anthropology in fieldwork are rarely addressed or seen as an asset.

Additionally, the broader attention to possibilities of practical engagement in the field and the sub-sequent critical assessment of anthropologists’ positions within activism has left many engaged scholars questioning whether to stay in academia, because academic structures and activist engagement are not always compatible. These questions also particularly affect early career scholars, as they are often both deeply involved in their fields and in academically precarious positions that do not allow them certain freedoms that tenured senior academics might be able to use to combine research and activism. Furthermore, navigating different requirements, expectations, obligations and precarities in everyday fieldwork practices also poses emotional challenges for anthropologists which only recently have started to receive attention as an analytical asset in making sense of our field encounters (Stodulka et al. 2019).

Often, these issues are exacerbated by the fact that fieldwork and dissertation writing are mostly solitary endeavours that give little opportunity to connect with peers and share opinions and experiences with similar problems. Whereas established scholars could rely on various professional networks and associations, it often remains unclear whether or how graduate students could become an active part of them. While we could observe an increased openness of academic associations for early career scholars reflected in the introduction of specific positions for PhD students or precariously employed early career anthropologists in recent years, this was not the case a little over 10 years ago when the MAYS network was created as a subgroup of the (then) Medical Anthropology Network (now: Medical Anthropology Europe), one of the networks of the European Association of Social Anthropologists (EASA). Founded by Susann Huschke and Claire Beaudevin in 2008, MAYS quickly developed as a dynamic and active network for graduate students and early postdoctoral researchers. In the last 12 years, MAYS successfully organised 12 conferences and workshops in ten cities in Europe, which gave its members an opportunity to connect and share ideas amongst peers, and created a space in which to discuss urgent and emerging issues for early career scholars that did not yet receive (enough) attention in our training and programmes.

Workshops and conferences organised by the MAYS network have explored different topics, including emotions in the field, perspectives on age and ageing, and arts-based research methods. They have connected early career medical anthropologists from all over Europe and beyond. In this special issue, we aim to bring the experiences, perspectives and concerns of MAYS members to a broader academic audience. In a sense, this issue represents the result of a long journey that started over 10 years ago with a mailing list which, in time, became a network connecting over 600 students and postdoctoral researchers with an interest in questions related to health, illness and healing.

Apart from common thematic interests and discussions of current concepts and theories, a recurrent topic during the annual MAYS meetings was the nature of fieldwork and its challenges. The questions on this topic inspired the theme of the 10th anniversary Annual Meeting in Turin in 2019, where early career medical anthropologists were invited to reflect on the main challenges they encountered during fieldwork. This special issue originates from this meeting. While the articles cover a broad range of geographical and ethnographic contexts, all represent reflections on the authors’ first experiences with ethnographic fieldwork and its contemporary challenges.

However, we do not see this special issue as an endpoint of these discussions, but rather as an opening for further dialogue between scholars at different stages, from different geographical regions, and from diverse backgrounds. Tackling the contemporary challenges of fieldwork in medical anthropology that are addressed in this issue requires a collective effort – an effort that also has to overcome academic hierarchies and include also those at the beginnings and/or margins of academia.

Overview of Articles

In her article, Maria Concetta Lo Bosco takes us on a genuine journey through emotions in fieldwork. As mentioned above, recently anthropologists have begun to criticise the long-standing habit to confine the emotional aspects of fieldwork experiences to personal anecdotes or even secrets (Davies and Spencer 2010). Following this vein and drawing on her recent research on the parent-led autism advocacy movement in Lisbon, Portugal (Lo Bosco 2018), the author explores some of the emotional challenges experienced in her fieldwork and how she addressed them. Her article contributes to the reflections on the crucial role of emotions for the understanding of both our research experience and professional training as anthropologists. In particular, Lo Bosco argues that facing the emotional implications of the fieldwork elicits unexpected and creative strategies of coping. To illustrate this point, she employs fieldnote excerpts of great methodological importance for understanding the emotional work of an ethnographer. The different episodes provide prompts to reflect on the multiple emotional challenges that we face during fieldwork and, by revealing different emotional states, they illustrate the intricate ways of auto-reflexivity.

Despite the importance of emotions in the field, as Lo Bosco points out, there is no established pre-departure training that prepares early career anthropologists for the inevitable emotional challenges of fieldwork. Lo Bosco, as a result, argues for long-term methodology courses, follow-up support (before, during and after fieldwork) and collaborative workshops gathering colleagues in different career stages who are willing to share knowledge they have gained from their field experiences and strategies they have implemented to overcome the emotional struggles they have faced.

Based on her experiences during her study of infertility and assisted reproduction technologies (ART) in Mozambique, Inês Faria introduces us to fieldwork as a process of navigation. In her article, she focusses on the pragmatics of the fieldwork process and on how she navigated through them. Combining theory and practice, Faria opts for a more descriptive and informal tone rather than a strictly analytical language, not only because she argues that flexibility, improvisation and informality, as long as they are ethically sound, are key parts of ethnographic fieldwork processes, but also because this kind of reflexive and more pragmatic account, which is not often available, was of instrumental support during her empirical research. Between negotiating the way towards ethics approval, (not) getting access to ART users, and knocking on clinic doors that often were not ‘open’ for her research, Faria had to learn to move carefully through different fieldwork terrains and rely on improvisation. This kind of apparent disorder during fieldwork is, in a way, characteristic of ethnography, where there has to be time to prepare the research, plus time to ‘get to know’ and be familiar with the informants, the studied terrains and their changes (Barley 2000; Davies 2008). Faria's work contributes to reflections on the role of unexpected events when arriving in the field.

Federico Reginato explores ‘silence’ as a social object that he encountered when doing fieldwork on the relations between colonial history, health politics and social representations in the Moroccan Rif. Reginato shares a brief reflection about how silence was a peculiar thread throughout his fieldwork, taking different shapes, both practical and ethical, and becoming both an issue of positionality and an epistemological space. Shifting between political silences and silencing, historical burdens and social stigmatisation that surrounded life in the Rif, and his experiences with the unsaid in an oncological centre in Al Hoceima, Reginato considers silence as something that is ‘made powerful precisely by its being left unsaid’.

Finally, Francesca Morra's article analyses the challenges posed by carrying out ethnographic fieldwork with migrants experiencing mental distress while living in conditions of multiple marginality. Drawing on the notion of crisis (De Martino 1977), Morra considers experiences of distress during fieldwork as an ethnographic object in which the individual and the collective intersect. Through encounters with Lily, an Iranian refugee woman, and her efforts to make a foreign space familiar, the author illustrates how personal experiences of suffering can provide a critical angle on the social and political circumstances in which they take place. Morra suggests that to understand the transformative potential of crises ethnographers should analyse how crises resonate across the social space, of which they are also representatives. The ethnographic investigation of crisis should therefore start from the ethnographer's crisis – that is, how fieldwork's encounters affect, upset and change researchers.

Conclusion

Both regionally and thematically diverse, the articles in this special issue demonstrate how methodological questions, long-asked in medical anthropology, have far from lost their urgency. In many ways, they point towards changing dynamics between medical anthropologists and their fields, namely the effects of growing scepticism about research and further institutionalisation and formalisation of field access. Going beyond the old (and eternal) questions about how to enter the field and gain rapport with its communities, the articles highlight the complexities of navigating expectations, different ethical standards and procedures as well as complex histories in everyday encounters. As the articles of Faria and Reginato illustrate, this becomes especially pertinent in research in clinical settings, where different epistemologies and understandings of research in the medical and social sciences can come into conflict with each other, and Lo Bosco's reflections on working with parents of patients and their frustration with researchers highlight another dimension of these negotiations. All three articles show what Faria called jogo de cintura, the need for flexibility and ‘having the moves’ to navigate through different terrains in fieldwork, and offer an honest account of the struggles of being there in the field, which they (despite related frustrations) do not conceptualise as a nuisance but an important part of gaining analytical insights.

Additionally, Reginato's and Morra's articles display how seemingly minor encounters and things said or unsaid can reveal the complex web of histories, traumas and intersubjective experiences that shape our encounters in the field. While the first experiences with these complexities and multiplicities can be overwhelming, an awareness of the intricate relations, power structures and colonial legacies creates the possibility to not only struggle with silences or crises, but to productively engage with them on both theoretical and practical levels. In this regard, Morra's article also demonstrates how different roles and trainings, in this case as a psychologist, not only create further need to reflect on positionalities or conflicts of interest, but can be used to enhance the analysis of field encounters.

Another common thread connecting the articles and a broader discussion within the MAYS community is the need to demystify first-time ethnographic fieldwork in preparation and training. Agreeing with Faria's observation that ethnographic fieldwork always entails the necessity to carefully navigate and improvise and that it cannot be fully planned in advance, Lo Bosco and many other participants at the MAYS meetings have also drawn attention to the need for adapting anthropology students’ training to yet hardly explored issues like emotions in the field and providing spaces and mentorship for discussing the problematic, unpleasant or maybe even dangerous aspects of fieldwork. This change of perspective would also mean a move away from understanding first-time fieldwork simply as a rite de passage for early career scholars on their way to becoming ‘proper’ anthropologists, and a move towards seeing the work of graduate students as academic contributions in their own right.

Acknowledgements

We would like to thank all previous MAYS co-ordinators and members of the network for their engagement in creating this community of early career scholars and the discussions it inspired. In particular, we want to thank the participants of the 10th MAYS Annual Meeting at the University of Turin for laying the groundwork for this special issue, as well as Roberto Beneduce and Simona Taliani for offering their support in organising the meeting. Additionally, we want thank Hansjörg Dilger, Bernhard Hadolt, Natashe Lemos Dekker and Rikke Sand Andersen, who as Board members of the EASA Medical Anthropology Europe (MAE) network supported us in proposing this special issue, as well as Anthony Rizk for his valuable advice on this introduction.

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Contributor Notes

Francesca Cancelliere is a psychologist of childhood and development. She is a PhD Candidate in Anthropology at the Institute of Social Sciences of the University of Lisbon (ICS-ULisbon) and a Member of the Italian Ethnological Mission in Sub-Saharan Africa of the University of Turin. Her doctoral research concerns HIV-positive children and adolescents in Maputo (Mozambique) and how the politics of adherence to anti-retroviral therapy shape youths’ lives. She is also part of the Integra project Between Biomedicine and Local Therapies: Cross-Views on Mental Health in Mozambique. She co-ordinated the MAYS network between 2018 and 2020. Her multidisciplinary approach encompasses the fields of anthropology and ethno-psychology, and her research interests concern medical and psychological anthropology, anthropology of childhood and disability, mental health, and migration studies. E-mail: f.cancelliere@hotmail.com

Ursula Probst is a PhD Candidate and a Member of the Medical Anthropology and Global Health research group at the Institute for Social and Cultural Anthropology at Freie Universität Berlin. Her research interests include (labour) migration, sexual economies, German and European healthcare policies and the social production of bodies. In her PhD, she is analysing the sexualised and racialised dimensions of neoliberal Europeanisation processes and their effects on the lives of migrants from Eastern European countries who engage in sex work in Berlin. E-mail: ursula.probst@fu-berlin.de

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Anthropology in Action

Journal for Applied Anthropology in Policy and Practice

  • Adams, V., N. J. Burke and I. Whitmarsh (2014), ‘Slow Research: Thoughts for a Movement in Global Health’, Medical Anthropology 33, no. 3: 179197, doi:10.1080/01459740.2013.858335.

    • Search Google Scholar
    • Export Citation
  • Barley, N. (2000), The Innocent Anthropologist: Notes from a Mud Hut (Long Grove, IL: Waveland Press).

  • Berning, M., and A. Hardon (2019), ‘Virtual Ethnography: Managing Pharmacological Risk and Uncertainty in Online Drug Forums’, in Researching Risk and Uncertainty: Methodologies, Methods and Research Strategies, (ed.) Anna Olofsson and Jens O. Zinn, (Cham, Switzerland: Springer International Publishing), 77101.

    • Search Google Scholar
    • Export Citation
  • Biehl, J. (2009), Will to Live: AIDS Therapies and the Politics of Survival (Princeton, NJ: Princeton University Press).

  • Biehl, J. (2016), ‘Theorizing Global Health’, Medicine Anthropology Theory 3, no. 2: 127142, doi:10.17157/mat.3.2.434.

  • Borneman, J., and A. Hammoudi (2009), Being There: The Fieldwork Encounter and the Making of Truth (Berkeley: University of California Press).

    • Search Google Scholar
    • Export Citation
  • Davies, C. A. (2008), Reflexive Ethnography: A Guide to Researching Selves and Others (London: Routledge).

  • Davies, J., and D. Spencer (2010), Emotions in the Field: The Psychology and Anthropology of Fieldwork Experience (Stanford, CA: Stanford University Press).

    • Search Google Scholar
    • Export Citation
  • De Martino, E. (1977), La fine del mondo: contributo all'analisi delle apocalissi culturali [The end of the world: Contribution to the analysis of cultural apocalypses] (Turin: Biblioteca Einaudi).

    • Search Google Scholar
    • Export Citation
  • Dilger, H., and D. Mattes (2018), ‘Im/mobilities and Dis/connectivities in Medical Globalisation: How Global Is Global Health?’, Global Public Health 13, no. 3: 265275, doi:10.1080/17441692.2017.1414285.

    • Search Google Scholar
    • Export Citation
  • Dilger, H., S. Huschke and D. Mattes (2015), ‘Ethics, Epistemology, and Engagement: Encountering Values in Medical Anthropology’, Medical Anthropology 34, no. 1: 110, doi:10.1080/01459740.2014.960565.

    • Search Google Scholar
    • Export Citation
  • Fainzang, S. (2007), ‘Anthropology and Medicine: Empathy, Experience and Knowledge’, in Facing Distress: Distance and Proximity in Tmes of Illness, (ed.) E. van Dongen and R. Kutalek (Vienna: LIT Verlag), 120.

    • Search Google Scholar
    • Export Citation
  • Farmer, P., A. Kleinman, J. Kim and M. Basilico (2013), Reimagining Global Health: An Introduction (Berkeley: University of California Press).

    • Search Google Scholar
    • Export Citation
  • Fassin, D. (2006), ‘The End of ethnography as Collateral Damage of ethical Regulation?’, American Ethnologist 33, no. 4: 522524, doi:10.1525/ae.2006.33.4.522.

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