upon the use of ethnographic methodology and methods underpinning this study. The logistics of field work are additionally discussed in respect to the crucial forging of relationships with participants, and finally, ethical considerations in fieldwork.
Chapter Three critically scopes the literature devoted to the historical background of evolving psychiatric services in the West, colonial territories in the Indian subcontinent and elsewhere, and subsequently Malaya and Borneo.
The findings of the study commence in Chapter Four, by locating Hospital Tranquillity within a historical, geographical, social and cultural context. Following this, a discussion of the routines, rituals and the socialisation process of life in the ward environment is offered.
Chapter Five concentrates on the hierarchical socialisation of individuals and relationships between patients. This concludes with an examination of the nature and utilisation of patient labour structured on stereotypical gender divisions.
In Chapter Six methods of patient control are reviewed, such as treatment programmes that include electro-convulsive therapy. The chapter concludes with a ‘service user’ view of how medication is used at the hospital.
Subsequently Chapter Seven considers how women patients are subject to stringent control in terms of freedom of movement consistent with patriarchal stereotypic notions of gender and mental illness.
The following chapters are devoted to issues of staffing. The conditions of work at the hospital are considered in Chapter Eight, where professional practice and career opportunities are viewed against a backdrop of the national policy debate on service delivery. In Chapter Nine, staff strategies of control and containment of patients are explored, along with staff perceptions of risk and violence in working with psychiatric patients.
Finally, Chapter Ten draws the findings together in a concluding discussion.
2
Fieldwork and field relationships
Social science studies that engage directly with the issue of culture, both as conceptual and overlapping social construction, as well as ‘culture’ enacted as a unfamiliar and factual reality, such as is the case here, have typically been classified as essentially anthropological in essence. Classic anthropological ethnographies have almost invariably taken place in locations far removed from the home environment of the researcher, such as those of Malinowski in New Guinea (1922) or Mead in Samoa (1943). These locations have often been perceived as exotic or in some other sense removed from the familiar. Nancy Scheper-Hughes, for instance, leaves the United States of America and chooses rural Ireland, which appears to represent a sharp contrast to her own cultural background; subsequently writing an account of anomie, social and, arguably, cultural stagnation and mental illness (Scheper-Hughes, 1982). Sue Estroff, by contrast, emphasises that her ethnographic study of mental illness in Wisconsin takes place in her own hometown. Although this was a study from home, she conveys the polarisation between the underground existence of a deeply marginalised group of people and the privileges of the comfortable, conventional living standards that she is familiar with (Estroff, 1985). Scheper-Hughes also offered an account of neonatal mortality in impoverished communities in Brazil. This locates the mature author as a foreigner from the First World, but whose association with the country and rationale for research has been formed through the influences of a period of residence there as a young voluntary worker (Scheper-Hughes, 1992).
My own particular situation approximates in some ways to that of Scheper-Hughes in the latter example, in that Malaysia was my home for some years. This resulted in my ambivalent position of being both familiar with, as well as being a stranger to, the region. My status, however, was that of a non-permanent resident with no citizen rights and subject to the terms of temporary employment. I was therefore only partially assimilated with tenuous ties and commitments, which I was aware would begin to atrophy with my departure. The identification I felt were filtered through the conditions of being a foreign alien; and therefore, as John Clammer (1987) notes, my fieldwork experiences were mediated through layers of belonging, with all the associate problems of immersion in a new cultural context. Nonetheless, I would not claim that this work belongs exclusively to the anthropological oeuvre, although it resonates with that discipline as much as it does with medical sociology. Perhaps its best defence is to claim the exciting territory of the fault line between the two, as well as drawing inspiration and illumination from psychiatric historiography, and accordingly it stands unapologetically as a robust and painstaking interdisciplinary study.
The research process
In terms of the methodology underpinning this study, ethnography, once the preserve of anthropologists, this has been adopted across a range of social science disciplines, and beyond. It is arguably the method par excellence for undertaking an in-depth inquiry into the otherwise esoteric world of ‘cultures’, to use the term once more in its wider sociological meaning. Commensurately, the aim of ethnography, is, as van Maanen (1988: 4) pithily suggests, to ‘decode one culture while recording it for another’. Furthermore, much has been written about ethnography as both a methodology and a method of data collection, a large corpus of which has been published as guidance for the novice researcher, as well as making an important contribution to philosophies of knowledge. Accordingly, this well trodden path will not be revisited here in any detail. Suffice to say, therefore, that the bulk of data collection took place over a sixteen-month period, reaching a culmination in 2000, with periodic updates taking place up to 2009.
During the intensive data collection period dozens of interviews took place with both patients and staff, as well as other prominent mental health service providers, together with some focus group discussions held in the hospital and at a ‘halfway home’: a community-based supported lodging scheme for ex-patients. Interviewing methods varied in type and style depending upon my participants and the circumstances – from in-depth but unstructured, individual or group discussions to intensive semi-structured, recorded interviews. Other data collection methods that I commonly used included critical observation and the use of statistical records from the hospital archives. The utilisation of all these different methods, typical of the flexible ethnographic approach, ensured a degree of triangulation against which to test my findings and developing hypotheses.
So much for methods, which were embedded in established ethnographic technique. In relation to methodology, ethnography naturally stands as a form of epistemology where, in keeping with its postmodernist, relativistic roots, one evolutionary branch has given rise to ‘critical ethnography’. This is fundamentally emancipatory in its general aims, and seeks to make the necessary links between the narratives and lives of participants and the structural constraints of wider society, in relation to issues of disenfranchisement and disempowerment of the individual (DeLaine, 1997). Emancipatory ethnography, therefore, is overtly embedded in what Ortner (1995: 173) describes as an enterprise of ‘intellectual and moral positionality’, and this formed the bedrock for my work. However, it is also one where, like generic ethnography, for want of a better expression, a critical scrutiny of a wider audience beyond the researcher is needed to evaluate how rigorously and scrupulously research has been carried out and conclusions drawn. To this end, ethnographers need to take into account that they are necessarily part of the social study and cannot be omitted from their accounts (Hammersley and Atkinson, 2010).
Consequently, gender issues are closely considered here, where the experiences of men have been used for comparative purposes with those of women (Stanley and Wise, 1993). This inclusion avoids distortion of a phenomenon that is shared in multiple ways by men and women patient participants at the hospital, but also permits points of difference to emerge. An attempt has been made to seek an understanding of the lives of ‘patients’ as they are informed by gender and this acts
