By Allison Bloom, PhD Candidate, Rutgers University
Anthropology has much to contribute to current debates about mental health in the United States. Within the current political climate, mental health has been enveloped into many contentious conversations, from gun control to school violence to sexual assault. Thus, ethnography has brought anthropology’s study of mental health far beyond basic examples of cultural competency into complicating factors like the structural causes of health inequalities (Metzl and Hansen 2014).
In this increasingly dark era for immigrants in the U.S.—one of detention centers, deep insecurity and devastating immigration policy—we must keep this emphasis on mental health at the forefront of ethnography. No longer just the purview of medical and psychological anthropologists, it is the duty of all ethnographers studying immigrant communities in the U.S. to consider the physical, psychological, emotional, and spiritual components of living under these conditions (Martínez Pincay and Guarnaccia 2007; Reina et. al 2014; Postmus 2014).
Yet ethnography on mental health among potentially vulnerable populations is sensitive research that requires vigilance and conscientiousness that not all graduate students are taught through their doctoral programs. Here I seek to provide some insight into my own methodological quandaries when working with Latina survivors of domestic violence at a crisis center in the U.S. to provide other graduate students with some valuable lessons that I learned along the way.
While I had the great fortune of taking a comprehensive methods course and working with an advisor and committee members well versed in this type of research, I also learned the parameters of my research and contemplated methods as I went along. When initially seeking IRB approval at my university, I emphasized my prior training in mental health and certification in domestic violence work. I highly recommend undergoing some type of formal training relevant to your research—not only will this lend a layer of sensitivity to your research, it will also provide you with first-hand insight into the ideologies behind Western mental health services. I also obtained a Certificate of Confidentiality from the United States Department of Health and Human Services (DHHS). With this Certificate, I could not be forced (for example by court order or subpoena) to disclose information that would identify an informant in any federal, state, local, civil, criminal, legislative, administrative, or other proceedings.
Secondly, while conducting research I had to make decisions about the best way to record observations and interviews in the most sensitive way possible. While observing support groups, for the initial phase I was a less active observer, and wrote down my observations after each session. After building several months of rapport—when clients had a clear sense of who I was, what I was there for, and their level of confidentiality with respect to my work—I began taking hand-written notes during these groups and participating more regularly in their conversations. Out of respect for the dynamics of these groups and the quality of this supportive space, I never audio recorded their sessions. Alternatively, I did take notes and audio record interviews, when the purpose of the conversation was explicitly for my research. When spending time with clients outside the crisis center, it was important to respect the center’s boundaries around confidentiality and avoid disclosing any association between myself and the client in connection to the center. Thus, for the safety of the client, I limited the types of interactions I had with clients out in the community and was particularly vigilant about how I framed the nature of our relationship.
To write up my findings, I also had to decide how to best represent the center and these clients. All clients were given a pseudonym, which I used in my records as well as in my dissertation, publications, and conference presentations. I also worked to eliminate any overly-identifying and unnecessary details. Alternatively, many ethnographers choose to create composites of people encountered in their fields sites. Because of my desire to convey the diversity of my informants, I did not choose this option. To further protect client identities as well as the agency itself, I also gave pseudonyms to the agency and its staff members. This was important so as not to encourage unwanted attention to the agency from abusers or other antagonistic audiences.
Working with these women, I came to understand their complex usage of local health and social service providers, and the savvy ways they would toggle together fragmented resources to best meet their needs. While I was careful not to speak about any individual client to outside service centers, I followed their service paths to these other locales, tracing their routes to healing while gaining a comprehensive view of all available resources. This also gave me a sense of the gaps in these services, and how clients attempted to fill them through spiritual practices and beliefs. Thus, these women serve as an example of what anthropology can contribute to the study of mental health, and what it has left to learn. Their agility within these different service spaces was striking, and highlights the necessity of ethnography for understanding mental health for these immigrant communities in the U.S. I encourage all graduate students to continue with this line of inquiry, and maintain an ongoing conversation about how best to methodologically approach this type of research.