the general consent by the director to fieldwork, these examples clearly show the power held by informal gatekeepers to enable or block research activities through fairly simple but highly effective human strategies. Whilst of course, as Shaffir (1991) notes, knowing that this provides useful and additional insights for research, the discomfort generated by being made to feel something approaching a pariah acts as a significant handicap that needs to be constantly addressed and overcome. Through episodes like these I became deeply familiar with the almost ever present and heart-sinking sensations Van Maanen aptly refers to as caused by the ‘stigma of the research role’ (Van Maanen, 1991: 32).
I do not think that this feeling of stigma ever quite disappeared; and the discomfort and embarrassment of imposing myself in situations, where sometimes my welcome was qualified by many interwoven issues from many directions. All this made fieldwork fraught with nuance and expectations from patient and staff participants that often left me uncertain and anxious. Overt rejection from participants, such as the day I was spat upon by a patient, did not lower my spirits over much on reflection. More worrying was the feeling of guilt, helplessness and loss of control in the face of so much pathos and so many direct appeals for my help, my understanding or my allegiance, according to the agenda of my interlocutor. My own attitude to fieldwork was therefore often ambivalent, and there were days when only stringent self-discipline drove me forward, regardless of how experience had shown me I might feel by the end of a working day in the field, sometimes elated, satisfied, angry or depressed.
Planning the research campaign
Having formulated my research focus the next step was to consider how to study the institution. After due consideration I decided to concentrate primarily on four wards: two acute and two long-stay wards. Of these four wards, two were allocated to female and two to male patients; the latter were used to provide comparison for the purposes of my study. The long-stay wards and the private wards were used for orientation and comparative purposes and, along with the occupational therapy department, were visited many times. This department provided some relief from the wards, where I gained some extremely useful insights into gender stereotyping and patient labour. Finally, other wards such as the forensic ward, Bunga Raya, a floral epithet for a ward exclusively for male offenders, attracted my interest as did, although to a lesser extent, the sick ward.
The acute wards, Female Ward 1 and Male Ward 1, and the long-stay wards, Female Ward 2 and Male Ward 2, were chosen on the basis of a combination of factors. The acute wards provided an interesting basis for comparison with the long-stay wards, in view of the fact that the selected long-stay wards were not exclusively but generally more likely to be the eventual destination of acute patients later perceived to be chronically afflicted. The daily routines, recreation and patient and staff interactions were livelier on the acute wards with the exception of the forensic ward. On the wards selected most of the patients enjoyed comparative youth compared with the remainder of the long-stay wards; and therefore, to generalise, were more likely to be able to communicate with me as opposed to wards where there were a greater number of elderly and mentally infirm patients.
Overt observation techniques provided the major part of the data I gathered in which I made no pretence to on-lookers to be there for any other purpose than that of observation. This strategy conformed closely with that described by Tim May (1999: 140) in which the ‘participant as observer’ role is a public one. This involves not only observation but also the development of working relationships with participants as informants for the study. Information duly gathered in this way proved sufficient to obtain good insights into particularly interesting phenomena, such as methods of control or the use of patient labour on the wards. This also enabled me to make an informed decision regarding which wards should eventually be selected for closer scrutiny, as well as drawing my attention to those individuals whom I felt I could approach and those who might represent a threat to the study, or more prosaically, to myself.
In the early days, however, my method of observation was closer to that of a ‘shotgun’ approach in which interesting people, events and activities were noted down with little discrimination and less understanding, in a small, handy notebook on site. As the study progressed my comprehension of events taking place around me increased and allowed me to target certain phenomena on the ward. Patient mealtimes, medication routines, bedtimes and awakenings were just some of the events I sought to observe at certain times of the day and night. I therefore made myself present for early morning breakfast rounds on the wards, and mid-morning snacks; present for soporific afternoons and patient siesta time, and occasionally kept a night-time vigil with the staff night shifts. These latter shifts proved to be the most sociable and companionable, with staff most amused by my persistence and supportive of my endurance. On these occasions I could rely on coffee and mee goring (fried noodles) to be liberally supplied to keep tired eyes open, including mine.
At first, I had felt grotesquely conspicuous on the wards and felt that staff in varying degrees were self-conscious when going about their everyday business under these artificial circumstances. After a considerable amount of time and personal discomfort had lapsed I eventually manage to achieve a certain level of invisibility where everyone, staff and patients alike, apparently ignored my presence albeit on brief occasions. These occasions were punctuated by activities in which individuals would regularly engage me in conversations. Over time my explanations that I wanted to see what it was like on the wards began to be accepted by participants with less suspicion as to my exact motives.
In this way, therefore my observations narrowed down over time from a broad sweep of noting everything and anything that caught my attention to a narrow, and hopefully, more acute focus (Bannister, 1999). Through the use of observation techniques employed in a comparative exercise, I found that data from observations both informed and synthesised my developing hypotheses in a rigorous and synergistic relationship (Burgess, 1995).
Observation strategies on the wards allowed me freedom to adjust to situations taking place and consequently I would often engage or be approached by patient and staff informants. In common with Shaffir’s (1991) experiences, most of these were informal conversations on a particular topic that I wanted to explore further. These interviews being ‘unstructured’ and ‘flexible’, informants often initiated the conversation from the outset (Lee, 1993). Here my interviewing strategy tended towards a deconstructive manoeuvre of attempting to uncover hierarchal distinctions through an appearance that was casual, with informal language and mannerisms, and generally trying to avoid with varying degrees of success the attitude and appearance of an orang puteh (White) lady visitor. Conversations with patients were fluid and spontaneous with participants joining in and departing from the discussion at hand as they pleased. This less formalised approach meant that patients chose the location to discuss matters and involved various settings. Occasionally we sat on stools under trees, or on the open veranda that most wards had, sometimes in the canteen or otherwise just sitting on beds inside the ward or in the rather bare recreation room. Some conversations took place in the occupational therapy department with patients chatting to me while they worked. Sometimes patients, usually men, would approach me to ask for a cigarette, which I did not have, or money, which I concealed, and then following this overture a discussion might be struck up. Similarly casual conversations with staff took place at the nursing station on wards, in private offices during tea breaks or while carrying out duties.
At other times, interviews were more formal when I wanted to discuss a range of issues based on a semi-structured interview guide that I had prepared earlier. The only criteria used for these interviews with patients were that they were willing to talk to me and fit enough to be interviewed; and here I relied on advice from the ward staff on the patient’s state of health and lucidity. Semi-structured interviews with patients, as opposed to informal discussions, took place in the treatment room at the end of the wards. This room was separated from the main ward by a grill gate and was about the only private place that could be allocated to me. Nonetheless, interviews were often inadvertently interrupted by the nursing staff, cleaners or other patients who wandered in. Interviews would then be momentarily
