Current concerns in contemporary critical medical ethnography: resisting a structural anaemia in respect to a new politics of evidence 
Ciara Kierans (University of Liverpool)
Katie Bristow (Univeristy of Liverpool)
Jude Robinson (University of Glasgow)
Stranmillis Conference Hall
Start time:
15 April, 2010 at 9:00 (UTC+0)
Session slots:

Short Abstract:

To explore how the writing of ethnographic texts in the field of health, medicine and social care is constrained and constructed by competing political, ideological, interdisciplinary and economic pressures and how this impacts on our ability to retain a critical ethnographic voice.

Long Abstract

Health and medical ethnography are intricately tied into a range of bio-political fields, where the ethnographic researcher is often caught as arbiter between the moral, local and oft-times invisible worlds of human suffering and an increasing range of institutional demands, such as the provision of a 'useful' evidence base as aid to intervention, medical practice and governance as well as the production of academic articles as grist to universities competitive and market advantage. It is becoming more difficult to promote a critical ethnographic voice that moves beyond the constraints of these multiple constrained fields.

Our relationship to powerful interests has generated a series of theoretical and practical concerns in the politics of ethnographic evidence, summarised as:

• Whose evidence counts in the production of ethnographic texts and how is this evidence generated?

• In whose interests are ethnographic texts produced?

• What do we mean by accountability; to whom are we accountable and how do we analytically demonstrate this?

• In what respect can texts be described as 'sites of resistance' (Schepper-Hughes 1992), and does this produce an obligation to take the readings of our work outside the 'academic factory'?

We invite papers that elaborate on analytical challenges underpinning the politics of interviewing in ethnography, involving a repositioning of what we mean in data analysis as we strive to articulate issues of social justice, human rights, and the experiences of the invisible, abstract or typified social actor and avoid the apparent inevitability of anaemic or bloodless ethnographic analyses (Willis, 1981).

Accepted papers:


Sue Lewis (Durham University)
Andrew Russell (Durham University)

Paper short abstract:

Ethnographers of health face interesting challenges of practice and product; how is a critical voice established whilst remaining “on message” with health programmes, and how does the ethnographic approach survive in a research context that favours the interview as its preferred source of evidence?

Paper long abstract:

This paper addresses some of the dilemmas faced by the engaged ethnographer working in the field of health and medicine. How is a meaningful ethnography practised, when it is the interview, transcribed and systematically analysed, that is considered the prime evidence-generating tool in qualitative health research? Analytically, can interviews with senior managers and healthcare professionals sit comfortably alongside "conversations with a purpose" with members of the public? How can one stay true to the ethnography in dissemination, particularly in the media interview, without countering the (political) messaging demanded in contemporary public health campaigns? And how can the critical ethnographic voice survive when it must compete with the insistent demands of the collaborative, action-focused, formative but also politically sensitive project it must speak about?

The empirical source for these queries is research conducted with a then unique organization in public health, Fresh Smoke Free North East (Fresh). The first dedicated office for tobacco control in the UK, its aim is to reduce the region's high levels of smoking. Research objectives included describing the negotiated relationships of the organization with its partners, and to study public perceptions of smoking. This paper will highlight some of the challenges faced by the research team. Among others, how, if at all, was "impact" achieved and a critical edge established and voiced whilst remaining "on message" with Fresh's programme? And how was the promise to use an ethnographic approach fulfilled, in a research context that continues to favour the interview as its preferred source of evidence?


Alexandra Greene (University of Aberdeen)

Paper short abstract:

The interview, with its focus on subjective perceptions, experiences and the contextual detail of social interaction has, in the past, been seen as oppositional to other quantitative, evidence-based methods used in randomised controlled trials (RCT). Similarly, in health services research (HSR), notions of hierarchies exist between the ‘gold standard of evidence’ – the RCT - and observational studies (Rawlins, Lancet, 2008). As anthropologists have increasingly become more applied and RCTs have increasingly been developed to tackle ‘real world’ questions through complex and pragmatic designs, the contribution of anthropology has begun to be viewed as an important part of a more integrated approach to trials.

Paper long abstract:

Attaching labels of 'evidence' to particular types of 'knowing' is a political act, which is complex, shifting and ambiguous (Nutley et al (2007). This is understandable as groupings jostle for power and challenge the way others judge and construct their own truths (Engelke 2008). Trialists for example, maintain serious concerns that the inclusion of interviews in RCTs might sabotage their research, which can lead to schemes that ensure that the 'effects' of the interview are minimised.

This presentation describes an anthropologist working alongside clinical trialists in a study to develop a national screening programme. Her role was to interview providers of services about such a screening programme. When she began her research she noticed that the trialists were determined to contain the interviews by writing the interview script for her, as a questionnaire, and restricting who she was able to speak to. The anthropologist's emersion in the trialists' arena uncovered these fears and with them a better understanding of how to circumvent these constraints and mediate the scripted questions with a more flexible approach to give the providers a chance to speak up and have their say.


Diana van Bergen (The Netherlands Institute for Social Research)

Paper short abstract:

The paper discusses how conflicting political and feminist interests relate to the ideological quest for the engagement of the researcher with the successful prevention of suicidal behavior of young immigrant women.

Paper long abstract:

The phenomenon of suicidal behavior attracts deep-felt concern by the public, politicians as well as researchers. In the paper I discuss the interplay of feminist knowledge creation, political interests and mental health promotion during the course of my PhD project that focused on the origins of suicidal behavior of young immigrant women in The Netherlands. Based on life story interviews with South-Asian Surinamese, Moroccan and Turkish young women I demonstrated how suicidal behavior was influenced by the ability and right to act autonomously with regard to strategic life choices, as well as by the questioning of cultural norms that valued self-sacrifice and honor protection. In addition, feelings of personal inadequacy and a lack of connection within the family emerged as important influences to their suicidal behavior. The study was undertaken in the Netherlands at a time that the public and political discourse in the country had shifted from being in favour of cultural diversity to opposing multiculturalism. Ambivalence emerged over the knowledge creation that pointed at the symbolization of a suicide attempt as originating from victimhood amidst oppressive conditions. How does this relate to feminist theories of agency? Moreover, there were potential risks that the results would be captured by right wing politicians as evidence of backwardness of Islamic culture resulting in restrictions of immigration or immigrants' rights, and be counterproductive to women's mental health. Furthermore the results could be considered a backlash to immigrant women who had never experienced oppressive conditions and for whom hostility toward their religion or culture and stereotyping may be underscored.


Megan Wainwright (Durham University)

Paper short abstract:

This presentation discusses how the politics of writing-up were shaped not only by my obligations towards various stakeholders but also by contradictions inherent in combining narrative and ethnography. The use of NVIVO audio coding, instead of transcribed text-coding will be critically explored.

Paper long abstract:

This presentation discusses the politics of writing-up research done in one of the only two clinics in England specialised in "functional" Constipation. This process was shaped not only by my sense of accountability towards various stakeholders but also by contradictions inherent in combining narrative and ethnographic approaches. While combining narrative-interviews and ethnography is sound in theory, in the practice of knowledge "production", in this case producing a written piece of work, I was unable to satisfy either of the approach's norms for analysis and visual representation of knowledge. My failure to satisfy a narrative-analysis approach was also due to my exclusive use of audio-coding using NVIVO, thus renouncing the traditional use of written transcripts. In this study of patients' illness experiences and relationships with healthcare professionals, I describe how the final piece of written work was influenced by this new technology and represented conciliation between competing obligations. On the one hand was a commitment to doing justice to patients' participation by making visible their life-experiences (in part with the aim of advising the clinic on how to improve their service), on the other trying to maintain participants' invisibility/confidentiality in written work to be read by staff and patient-participants. Ethical issues such as these are particularly acute in medical anthropology wherein interviews or participant-observation with people living with disease will elicit stories that in certain settings (i.e. medical consultations) are treated as confidential, or, as was the case in this research, aren't shared with health professionals at all.