Associated with issues of objectivity, the representation of the accounts of participants raises other issues. Linda Alcott (1991: 6-7) points out that the social location of the speaker affects the ‘meaning and truth’ of what is said, in addition to the concealed dangers inherent in speaking on behalf of less privileged groups. The discursive problematics of speaking for and speaking about are brought to the foreground, where the latter can be dangerously conflated with the former. All, however, is not lost, a way forward is proposed:
It is possible (and indeed desirable) to speak of ‘others’ but only when the reader can clearly see where the speaker is ‘coming from’. Autobiography (read as self-identification) becomes the basis upon which white feminists authenticate speech, such that failure to identify speaker location is potentially racist and classist and sexist. While the act of ‘identification’ may precede equally oppressive practices, it nonetheless signals a more ‘honest’ beginning (Lyons, 1999: 6).
What Lyons (1999), following Aull Davies (1999) is proposing therefore is a methodological stance grounded in self-reflexivity, whereby the focus revolves around the location of the speaker. In this study self-reflexivity also pivots around the issue of accountability and emancipatory goals, as well as clarity. Accordingly, the specific properties of gender, ethnicity and class, for instance, that characterise the researcher are considered, as inherently forming a personal/political/cultural lens through which the phenomena is studied, and of which the reader should be rightly be aware (Burman, 1999).
Thus the researcher appears in these analyses not as an invisible, anonymous, disembodied voice of authority, but as a real, historical individual with concrete, specific desires and interests – and ones that are sometimes in tension with each other (Harding, 1987: 32).
Self-reflexivity, therefore, creates a space in which a critique of authorship, authority and cultural representation can be constructed (Hirsch and Olson, 1995). Despite the scepticism of critiques, such as that offered by Patai (1991) the self-reflexive strategy effectively responds to a question posed by Pettman, of how ‘dominant group women address their whiteness’ in relation to cultural difference, a question germane to this study in relation to the postcolonial context of research and my own cultural heritage (Pettman, 1992: 155). Self-reflexivity therefore creates a legitimate way of addressing how neo-colonialism in developing regions impact upon ‘First World’ researchers – an issue especially germane to this study (Visweswaran, 1988).
Before leaving the topic of research methods altogether, a brief explanation of the process of data analysis is advisable. In ethnography data analysis does not occupy the discrete, hygienic position of analytic processes in the hard sciences, but runs parallel and continuously alongside data collection. This permits the researcher to thereby change tack in a timely fashion: abandoning paths that have led to barren cul-de-sacs, while pursuing more fruitful ones. Typically, therefore in my own research, daily observations and interviews were noted by hand and coded by computer-aided software into single instances or recurring ones that were later developed into themes (Brewer, 2000; Tesch, 1991). Once no further patterns emerge from the study, saturation has been reached and data collection can be completed. The next step is normally withdrawal from the study site – by no means, an easy process, due to the difficult human elements of being obliged to dismantle edifices of close contact, arduously built up in the interests of creating good, and often quite intimate relationships with participants, as will be further discussed in Chapter Ten.
Gatekeepers and participants
Hospital Tranquillity stands in a certain amount of isolation compared to policy developments, funding and political focus, which are concentrated in Peninsular Malaysia, despite it being an important regional resource. Currently the hospital is facing the dilemma of how to address the practicalities of ideological developments in health care within the context of contemporary political debate in Malaysia. This in turn represents significant challenges for the future direction of the hospital and its community services - critical issues that were revisited in conversations with staff on several occasions during the fieldwork process.
In commencing fieldwork permission was initially sought from the Jabatan Kesihatan Negeri X (the State Department of Health), but it was the Director’s personal consent as the main gatekeeper that would prove crucial for work to proceed. I am doubtful whether my position as a foreigner actually assisted in the facilitation of this process of consent, as Punch (1993) discovered in his study of an Amsterdam police force, although it is clear that my status as a local lecturer was quite definitely helpful. Fortunately the Director of the hospital, Dr T.W., was already known to me from my previous research projects, and furthermore we both served on the committee of a local mental health NGO (non-governmental organisation). Burgess describes how an attempt to return to a previous field site for further studies was not welcomed by the principal gatekeeper (Burgess, 1991). By contrast, in my own case I found that the Director was amenable to further work at the hospital, since familiarity with my prior activities worked in my favour, and proved to be very valuable in allaying concerns about my integrity and ability as a researcher.
This alliance proved to be extremely helpful on numerous occasions in smoothing the path of obstacles in relation to access to wards and interviews. In his role as the main gatekeeper of the site, Dr T.W. was in a position to grant a general consent on behalf of his staff, and to a large extent in practical terms those of his patients as well. This proved to be less helpful than I anticipated in terms of ethics and practical assistance. Roger Homan for instance raises issue with the ethics of such generalised consent, the right of consent by, for instance, individual staff members is effectively withheld (Homan, 1991). Pragmatically Burgess points out that even where the consent of main gatekeepers is obtained this does not remove the need to negotiate terms with individual staff informants as informal gatekeepers who may otherwise provide blocks to adequate research (Burgess, 1995).
Naturally, responses to participation varied, many patients expressed positive opinions, although others were clearly quite indifferent to my reasons, but just welcomed the chance for a chat with an outsider. A small minority rejected my advances outright and in keeping with the experiences of other ethnographers, some participants became close allies and main contributors of insider knowledge (Glick, 1998: Punch, 1993). After all my precautions regarding confidentiality and consent I was fairly surprised at first that few patients seemed particularly bothered by this. More important to most patients on the ward was my ability to keep a secret when it came to whispered confidences about a particular ‘scam’ or an incident of abusive behaviour from a certain member of staff.
Gaining consent for interviews with individual patients did not completely ensure a smooth passage to fieldwork and here problems were threefold. First of all the director’s consent was generally broadcast via a memorandum that apparently was not circulated to all members of staff, and therefore my presence needed to be explained, clarified and re-checked on numerous occasions throughout the field-study period. It was quite common for my credentials to be inquired into time and again, and occasionally pointed inquiries were made about whether the Dr T.W.’s permission had really been granted.
Secondly, this form of generalised consent from a superior did not necessarily guarantee willing participation from respondents, exemplifying the simple observation by Miles and Huberman, that ‘weak consent leads to poorer data’ (1994: 291). This could additionally be seen when initially, in a bid to be helpful, some members of staff tried to coerce patients into cooperating with me. Although I quickly discouraged such practices, I was also aware of a possible double game being played by staff, in that this could also act as an effective strategy of diversion away from them.
Finally, and connected to the point of weak consent, despite the director’s consent, it was nonetheless quite difficult to engage in a further process of negotiation with staff members acting as ‘gatekeepers’ to their wards. I often found that staff were reluctant to discuss terms with me and seemed to prefer this to be confined to my