Abstracts

“Suicide: reflexions on Medical Anthropology research of suffering” (India)

Stefan Ecks
South Asia Institute, University of Heidelberg

In the last decades suicide has become one of the main causes of death world-wide. It especially concerns people over 60 years of age and young people (for the age group of 15- to 34-year-olds suicide is among the three most common causes of death globally). Hardly any other topic, however, presents such great difficulties for Medical Anthropology research. Many methods that normally are standard for Medical Anthropology studies have to be radically re-evaluated when researching suicide: What role, for instance, does “participant observation” play in the context of extreme “tabooisation” on the part of the relatives? When is it acceptable to talk with relatives, how much time must have gone by? Also the ethical aspects of such research are enormous: Trauma, shame and speechlessness turn direct interviews into an ethically questionable method. How can suffering caused by suicide be examined as phenomenon in social context? The hitherto almost complete silence of anthropologists concerning the problem of suicide can be essentially explained by the apparently insurmountable methodical and ethical difficulties. My paper will reflect mainly on the topic of “suffering”, especially with regard to the social suffering debate in Medical Anthropology.

“Subjectivity and reflexivity in qualitative research. A study on organ transplantation in Germany”

Vera Kalitzkus
University of Göttingen

Die Chance qualitativer Forschung zu Gesundheit, Krankheit und Tod – The opportunity of qualitative research in the field of health, illness and death – especially in contested areas – lies in its potential, to draw a very complex picture of reality and its sometimes incompatible components. Using the example of my research in the area of organ transplantation in Germany I would like to illustrate the potential („thick description“ and near-to-lifeworld analysis) and risks (tightrope walk between emotional involvement and distant analysis) that can be involved in qualitative research in a socio-political field of conflict and on an topic charged with emotions . Only personal involvement allows a thick, near-to-life description. Insights into the socio-cultural context of suffering, the social suffering of the affected, however, can only be gained by a distant scientific analysis. Main focus of this paper is on the various forms of methodological reflexion that allow analysing the subjective, individual experience in terms of its socio-cultural components. Among these are: detailed field notes also of personal character about the research context, detailed preparation and follow up of interviews or fieldtrips as well as supervision of the research process from data collection to analysis that allow for professional reflexion and support.

“Action and research. Methodological consequences of “imperative action” in Medical Anthropology” (Ecuador)

Michael Knipper
Justus-Liebig-Universität of Giessen

The contact with sick, suffering people asks for action, also in the context of research in medical anthropology: Encountering sick informants, or their suffering family members, every medical anthropologist faces a situation in which he is able to provide help of more or less professional form. Medication from one’s own pharmaceutical travel kit, financial or logistical help for the visit of a hospital or another therapeutic authority or also only advice from ones own “medical” experience – often overestimated by the interlocutor – can hardly be refused. At the same time, the problem-orientation of many approaches in medical anthropology implies the more or less explicitly formulated claim to decrease ailments and to improve medical supply for the concerned people. By doing so, however, the researcher may intervene in the social processes around illness and medicine he aimed to observe. Only “participating” turns into “treating” observation, and from a methodological perspective, the corresponding activities of the researcher may be seen as a disruptive factor that substantially changes the research setting. In the framework of the presentation, I will discuss the methodological consequences of this act of inclination that is very relevant in the research context of Medical Anthropology. It should be considered as an example of a researcher being in an “extreme” situation of a double role as a physician doing ethnographic research. I will talk about the alleged imperative act itself, and above all address the question whether and in what way interventions in a therapeutic process or other kinds of helping “disturb” the observation of social processes and thus influence the results. My main argument which I underline with various examples is that aspects, first appearing disruptive to the scientific work can in the end be used in a methodologically creative way.

“Discourse analysis and Medical Anthropology” (Deutschland)

Elsbeth Kneuper
University of Heidelberg

Discourse analysis has implications for the ways in which data is gathered. Basically, it is a process of data analysis. Its relevance for Medical Anthropology lies in the fact that it demotes the question of the effectiveness of healing. Obviously this is a provocative statement, particularly for biomedicine which is very much fixed on effectiveness. This biomedical fixation on effectiveness, however, can easily overlook the fact that „effectiveness“ can only be a defined category in terms of defined and ethically justified aims and procedures to verify its success. The method which biomedicine offers is sampling, or to be precise, statistics. This conceptual pre-decision leads individuals in biomedically influenced society to relate potential illnesses in terms of statistical risk to themselves. The consequence is that a discourse analysis of data must seek to understand „risk“ on one hand as part of medical discourse and on the other hand to balance the discursive function of the concept risk with the representation of risk in the data. This demonstrates that there is considerable variation in the interpretation of risk. Although the concept of risk involves all individuals in the same way into medical discourse, what they understand by risk varies. For biomedicine, this has the thought provoking consequence that that there is no consensus on how its therapeutic success can be understood. The methodological gain of this insight is twofold. On one hand this finding justifies the bracketing of questions of therapeutic effectiveness. On the other hand one aspect of discourse analysis in a Foucaultian sense is questionable: The idea that the subject is at the same time an artefact of discourse without any independence can hardly be reconciled with the, in part, very independent perspective of the users of biomedical systems. Consequently this paper considers the question of how individuals as a product of discourse articulate subjectivity and experience and what methodological implications a consideration of genuine subjectivity has for medical anthropological research.

“Participant observation put to test: how to overcome limits in research about HIV/AIDS” (Malawi)

Angelika Wolf
Institut für Medizinmanagement und Gesundheitswissenschaften der Universität Bayreuth

Participant observation quickly comes to its limits in research about HIV/AIDS. Even speaking the indigenous language which is a substantial tool to communicate and share experiences in everyday life does not help considering the unspeakable dimensions and the often inexpressible experiences in the face of the epidemic. Since the topic frequently is considered to be taboo and people with HIV/AIDS all too often are stigmatised, one speaks about the illness not directly but in disguised forms, also in Africa. As occurs frequently in the case of crises and epidemic diseases an abundance of metaphors are used to paraphrase it . If emotional or cultural borders make it difficult to collect data, special attention is required not only during the field research. Also the analysis of data and its evaluation call for special reflection. During this process of analysis decodings on several levels must be made. Here techniques of recognizing metaphors that concern not so much the process of data collection itself, but rather methodological questions of their analysis, play a special role.

If illness is seen as possibility to understand how a society deals with crisis, metaphors can provide an insight into cultural processes. Issues of the human body are of special interest when it comes to methodology: if the body is being regarded not only as object and symbol for something, but in the sense of Csordas as subject and as an actor, the analysis of metaphors does not remain limited to the cognitive level. Then, it not only is analysis of metaphors about the body, but also from the body.