crackedmirrors and angelpie

I had already thought about the ethics of autoethnographic writing, and discussed it in a research ethics seminar. However, yesterday’s writing made me think all over again.

My husband was clearly put out by my comments that ‘he had understood the film from beginning to end’ and obviously felt that I had somehow portrayed him in a negative manner. Oh the delights of marital miscommunication! I had intended nothing of the sort – in fact quite the opposite. I thought that if anyone could be seen in a negative way then it was I, who was too dumb to understand the film. My actual point was that the film could be interpreted in myriad ways, that it offered many readings, many different understandings.

We talked about it and hopefully clarified things, and that was that. But it left me wondering again about the ethics of what I’m doing. My writing refers to whatever interests me on a particular day; whatever resonates with me and strikes a chord for whatever reason. I’m not aiming to be psychoanalytical about it – at least not at the time of writing, and I don’t intend to use psychoanalytic methods when I write up my research. Superficial research ethics suggest that where the researcher and the research participant are the same then ethical concerns are not great.

It just isn’t that simple though. If I write in a personal diary, kept under lock and key, then I can be reasonably certain that whatever I write is unlikely to have an impact on the people that I write about (as I am not a celebrity and nobody is likely to know that I write a diary, still less try and find it). However such a diary would be useless for my research. The purpose of research is to develop knowledge, and that cannot be done by keeping one’s research locked away, unavailable to anyone.

Publishing in academic journals ensures that one’s work reaches a limited readership, and moreover a readership that mostly understands ‘the rules’ of publication. This is not the time to go into the finer details of publishing autoethnographic research, but although such publishing will form an essential part of my postgrad research, I don’t consider it the best way of developing new knowledge. The very nature of the journals restricts their readership, in exactly the same way as if I write for mental health groups. One of my aims is to be able write about a wide variety of things without worrying about the different categories that my topics fall into, or the classification of the readership. The underlying drive for my research is to explore the boundaries that get erected, and which mutually exclude free readership and free thinking.

So, back to ethics. As I live in the UK in 2014 the obvious medium to use for my writing is a blog. Blogs tick the box for potentially uncategorised and uncensored readership, quite possibly running into thousands and not restricted to the UK. Equally my blog could be as private as my personal diary, with nobody at all reading it (except that I already know that a few people including my husband have read some of it).

I am married (already inadvertently divulged) and have children. I am registered at a university, live on the outskirts of a city in the UK – in short I am not a recluse. I encounter other people every day. I read the newspapers, listen to current affairs, watch TV, go to the cinema, go to the gym and to football matches. All these involve other people in one way or another, some as casual, brief encounters, some as intimate exchanges. It would be impossible for me to embark on this writing project without other people coming into my writing.

In an ideal world the purist ethicist might ask that everyone who appears in my writing should have the opportunity to read what I have written and consent to it before I published it in my blog. This would, in practice, be completely impossible even if I thought it desirable.

There doesn’t seem to be a clear answer to this ethical problem, other than to be sensitive and mindful in my writing. I made a decision to use pseudonyms or first initials when writing about close family and friends – they will still be identifiable to my immediate circle of friends but a degree of anonymity will be preserved for a wider audience. I’m sure that I will still get it wrong!

On a slightly different topic I was moved to read Henning Mankell’s latest interview with the Guardian. He makes the importance of the doctor-patient relationship very clear. I have always believed that establishing a good therapeutic relationship is a vital part of the healing process, and have often been appalled by previous colleagues who fell that the ‘touchy-feely stuff’ doesn’t really matter these days. Mankell is quite clear that it does – not touchy feely, but a trusting relationship. How can you possibly establish trust when, as a patient, you see different doctors each time you attend clinic?

Mankell speaks in the context of oncology and radiotherapy treatment, but I think that his sentiments are equally important in the mental health arena. Here the newly diagnosed patient is facing a lifelong diagnosis, with a huge number of uncertainties. Never is trust more important (not least because your psychiatrist ultimately has the power to deprive you of your liberty for a very long time). In mental health there are many blurred lines – diagnostic criteria, drug treatment, different types of psychotherapy, advice about pregnancy, driving, holidays – none of these have clear answers. A good trusting relationship that continues over years is essential but rarely offered (certainly not within the NHS).

The depressing thing about this is that Sweden used to be held up as model of good care, yet Mankell’s report suggests that it now has similar problems to the UK. In an era of financial stringency and randomised controlled trials, the importance of the doctor-patient relationship ranks very low.