ANTHMETHGRP4-2425-BANDHUKAVI-PALAKAWONGSA NA AYUDHYA

[Last modified: November, 29 2024 12:03 PM]

I chose the case of Pakistan women who are survivors of domestic abuse.

This case has multiple issues of ethics: obtaining informed consent in writing during the first publication was problematic, and ethical research maintains documented consent, especially with publications involving identifiable participants; further, verbal consent is never going to be enough, as noted earlier, in this highly sensitive context of survivors of domestic violence. (Even though it is understandable that they knew them, but I think let’s get formal consent would be better) This is really a situation that has to be sorted out by retrospectively getting consent, with real awareness of the implications of this publication of her story. Secondly, data protection is a big issue since the woman’s identifiable information and traumatic experiences were publicly shared. It is arguable that a woman wanted her name to be in the public, but in this case, I think the consent was not informed properly. She deserves to know the transparency and procedure of the research so she can decide properly. The data in the future should be anonymized and well-stored. Another thing is Power dynamics and coercion: Survivors of domestic violence may feel obligated to comply with the student due to perceived authority or gratitude, compromising voluntary participation. The participants are very vulnerable, and the subject is sensitive. Any research in this context needs to be done with extreme caution to avoid retraumatization. Approval should go beyond the Anthropology Ethics Committee to the UCL Research Ethics Committee, given the high risk due to the involvement of vulnerable participants and sensitive topics. Future research must adopt rigorous ethical safeguards, including informed consent, confidentiality, and trauma-informed practices.

If I were on an ethics committee, I would guide the student to address several critical ethical considerations in order for her research to meet the highest ethical standards. First and foremost, informed consent is a non-negotiable requirement. Retrospective informed consent shall be sought from the woman whose case was published. She must be fully informed of possible implications arising from the publishing of her name and personal experience with all possibilities of potential harm and stigma. In all future cases, informed, voluntary consent in writing, ensuring the research purpose and freedom to withdraw, with assurance on the protection of privacy, should be obtained. The principle of confidentiality and anonymity is taken as important; the student must anonymize all data used within the dissertation, except when a participant has consented in writing to a named reference-even in previously published accounts. Given that domestic violence is sensitive in nature, a trauma-informed approach would involve taking necessary care to be sensitive to participants‘ emotional safety and avoiding their retraumatization; access to support services will be provided should there be a need. It is also very important to consider power dynamics; survivors in a refuge may participate because they feel the student is an authority, or as a way of being thankful to the refuge. The student should make sure that participation is completely voluntary and specifically say that their refusal to participate would not affect services extended to them. Given the vulnerability of the participants and the sensitive nature of the topic, this project represents a high-risk study and must be reviewed by the UCL Research Ethics Committee, which has the capacity to rigorously evaluate the complexities involved. She should also work closely with the NGO running the refuge to ensure that her research is in line with their policies and does not jeopardize the safety or trust of the women in their care. Furthermore, strict adherence to UCL‘s data protection policies and GDPR requirements is necessary for safely storing and managing research data, with appropriate measures to prevent unauthorized access. By following this, the student will be able to conduct ethically robust research that upholds the dignity, safety, and autonomy of all participants, while addressing the sensitive nature of the topic responsibly.

[Last modified: November, 29 2024 11:45 AM]

Multimodality is an interesting concept that has the potential to make research more creative. During the immersion activity before the tutorial, my friends and I roamed around UCL Main Quad. Other than observing people around there, we also tried to do something multimodal. I was so lucky that I brought my camera to the campus. So we took photos around the main quad, and then we came back to the tutorial for discussion. One thing that I shared with my classmate is about the strengths and weaknesses of incorporating photos into research. I shared with my classmate that the photo cannot capture all of the feelings on the site. It can remind us, of course, which makes us recall our memories better, but taking a photo has a similar concept to a vignette that we learned only. We need to consider the angle at which we took photos. Photos can tell stories, but of course, they cannot tell us all about what happened there; the motions are stopped, and the perspectives are limited. In my case, I went to the main quad and noticed that the weather was so cold and people were shivering. However, my camera captured a different tone. The photos were warmer, and when people saw them, they might interpret that the atmosphere of that day was not that cold. This was from the camera’s trickery; because it was autumn and leaves fell down, the camera perceived the surroundings to be warmer due to the color of the fallen leaves. Even though this was a minor error, it also can tell us how everything has its own limitations regardless of potential creativity. We can use this lesson to apply multimodality with more awareness, which can complement our research and make it more valid. Photos also allow us to capture time, but at the same time, they also limit how we can interpret that capture.

[Last modified: November, 15 2024 01:51 PM]

Body in quotidian context

As a Bangkokian who feels lost in a big city like London, I have noticed a lot of things about bodily experience. One feeling that came to my mind was that I was so nervous about everyone around me; this city is so big, and people walk so fast. First, I think it is because I was not used to London at first. The word “so big”, for me, does not mean that London is bigger than Bangkok. They are similar in size. But maybe the big thing for me in this case is that there are a lot of things to explore and to do in London. It is such a sleepless society. I did not know what to do at first when I arrived, so I just followed what I had researched about London before arriving and also tried to recall my summer experience when I studied at UCL Summer School two or three years ago.

I noticed that when I navigate around London, I try to be reserved. Reserved, in this case, means I tried to avoid making myself like a tourist. I noticed from my experience that British people do not like people to be acting explicitly and rashly. This is similar to Thailand, where acting rashly is considered to disrupt social harmony or sometimes mannerless. So, when I walk in London, I think I keep my hands in my pocket and try to avoid eye contact. But sometimes, some of my automatic responses just occurred naturally. For instance, when I am on my campus, and I see my professors, my hands just come up and greet them. (In Thai, we call Wai – which consists of a slight bow, with the palms pressed together in a prayer-like fashion) every time I meet and leave them. It was like regardless of how long I stayed in London, I still practiced my Thai culture automatically even though I knew that they would not understand why I “Wai” them. Another thing that I also notice about Londoners is they tend to, at all costs, avoid eye contact with strangers. I mean, it is a universal bodily rule that we should not stare at each other. In Thai, we also do not do that, but it is ok if we accidentally make eye contact; let’s say on the metro, where it is unavoidable to look around, and suddenly, you accidentally meet eye contact with a passenger across you. But in London, when I use the tube, I notice that if I accidentally do that, a person will just spark and immediately react by turning their face away from me. I know that we should not look into the eye for too long, but in London, they are just like they are being electrocuted when someone suddenly looks at them.

Nevertheless, I embody Thai culture with me, but at the same time, I also learn what British people do to fit in their society. Our has its own way of learning to ensure our survival, and that makes body ethnography interesting.

[Last modified: November, 1 2024 12:37 PM]

My project asks, “How do psychiatric training materials and educational experiences shape psychiatrists’ approaches to patient care and understanding of mental health in Thailand?”

The political dimensions of this pilot research project would revolve around the dynamics of power, professional ideologies, and systemic structures within psychiatric training that shape approaches to patient care and mental health in Thailand. This project inherently critiques the hierarchical and perhaps reductionist frameworks often present in medical education, which may prioritize biomedical perspectives over holistic, socially-informed approaches to mental health. This critical stance is also politically oriented, even while academically so, inasmuch as it challenges established authority within Thai psychiatry because calling into question whether current training promotes a biased or stigmatizing attitude in patient care is at stake.

My positionality as an emergent anthropologist and as a Thai societal member in these political dimensions is multithronged. Personally, I bring Thai cultural contexts: respect for medical authority and a complex landscape of mental health stigma. What drives my interest in uncovering stigmatizing structures within psychiatric training is a cultural and professional motivation to advocate for mental health reform in Thailand. It could incur the promotion of a bias through anticipation of stigmatization in both the training materials and interview responses, calling for reflexive practice throughout this research-to critically reconsider my interpretations and reduce assumptions.

This may well mean that the political consequences of this research could go beyond academic discourse to further influence policy in public mental health and psychiatric training in Thailand. Findings may be used to advocate for systemic changes toward a more inclusive, patient-centered approach, with an emphasis on the role of social determinants in mental health, through findings about whether social factors are integrated or overlooked in psychiatric training. Results from such studies feed into broader discussions about mental health stigma and thereby may result in calls for reforms in psychiatric training. Given the political nature of these elements, the methodology has also been modified to allow multiple definitions of the impact of psychiatric training on attitudes. For instance, I look only indirectly for stigma when directly asking psychiatrists questions in interviews, and use a broad thematic analysis of curriculum materials in order to capture both positive and negative themes. In addition, the reflexive component involves logging and reflecting upon my own presumptions in order to ensure that the interpretation of findings is balanced and nuanced. This makes research sensitive to the complexity and political charge of the issue of mental health and psychiatric training in Thailand without presupposing stigma; thus, rigor and neutrality are increased.

[Last modified: October, 25 2024 05:02 PM]

As my research topic is about medical literature, the perception of doctors, and stigma in mental health, it is very difficult to conduct an observation in the medical education settings. Therefore, I shift my attention to a temporary observation around the UCL Campus. As I am Thai, I would say that there are some different vibes around the campus area, and I find it strange for me.
My main theme would be social, particularly unwritten rules that I encountered around the campus. I observed for about one hour, and here are the exciting things that I found out.

I first started my journey by walking out of the Anthropology department and then turned around at Gordon Square Park. I spent 5 minutes there, and I found out that people around this park enjoyed reading a book, listening to music, chit-chatting with each other, or just sitting and chilling on a bench. This is quite different from the Thai campus vibe because people do not usually sit on a bench in a park near the university. Instead, people sit and chill during the evening. I think this different vibe stemmed from the Thai vs British climate. In Thailand, it is impossible to sit anywhere in the park due to the high temperature, and in fact, it is quite dirty.

Secondly, I observed that when I walked around the campus, people tended not to use their phones while walking, and if people used them, they would use them in the corner privately. I would say that one thing that I think stemmed from this culture may be the notorious fame of London being a city of pickpockets and thieves. This made many people vigilant when they used their phones in public. In Thailand, I would say it is pretty safe to walk and use the phone at the same time.

Another thing that I noticed when I walked around the campus was that people were walking very fast. It was faster than normal Thai people would walk. I think this is because we are in London, but I also think that it has something to do with Western culture, where people tend to be very individualistic as well. This might be the reason that they are walking really fast, to reach their destination as soon as possible. In Bangkok, we have heavy traffic congestion, and walking faster would not help them to reach their destinations faster anyway.

After some time, I reached Gower Street, and I saw that many people were not waiting for the green light to cross the road. Instead, when they saw no car incoming, they would just cross the road. Even if a car was coming, it would eventually stop, allowing people to cross first. This is quite interesting because, in my culture in Thailand, drivers tend not to respect pedestrians; crossing is like a survival game to cross a single road.

These are some of my observations. I think there are some differences in terms of unwritten rules in British society that I need to learn more about.

[Last modified: October, 18 2024 01:42 PM]

What is the reason that this research particularly interests me?

My deep interest in this research arises from a convergence of personal experience and academic engagement with psychiatric anthropology and critical psychiatry. Being a psychiatric patient in Thailand, I have encountered considerable judgment and stigmatization—not just from society at large but also from the very doctors who were meant to provide care and support. These experiences have not been positive; they have exposed me to the systemic challenges and biases that exist within the psychiatric field in Thailand. The traumatic encounters I’ve had have propelled me to question the legitimacy of certain psychiatric practices and how they relate to individuals seeking help. This personal journey has ignited a passion to explore these issues more systematically. I am driven to understand the underlying factors that contribute to stigmatization and to critically examine the power dynamics at play between psychiatrists and patients. By conducting research in this area, I hope to shed light on these concerns and contribute to meaningful discussions that could lead to improved practices. Ultimately, my direct personal experience serves as a catalyst for this research, fueling a desire to advocate for change and to foster a more compassionate and understanding approach within the field of psychiatry.

What are my preconceived ideas?

I hold the preconceived idea that psychiatry, particularly within Thai society, can function as a form of social control and oppression. This perspective is deeply influenced by my own harrowing experiences within psychiatric institutions, where I felt subjected to practices that were more punitive than therapeutic. My critical and anti-psychiatry stance stems from witnessing firsthand how psychiatric practices can perpetuate stigma rather than alleviate suffering. In Thailand, mental illness is heavily stigmatized, and societal norms often discourage open discussions about mental health. This stigmatization extends into professional realms, where psychiatrists may unconsciously reinforce societal biases through their attitudes and treatment approaches. I am driven to reveal how these professional attitudes contribute to the broader stigma associated with mental illness in Thai society. By scrutinizing the impact of professional training on psychiatrists’ attitudes, I aim to uncover the ways in which educational curricula, cultural norms, and institutional pressures shape these professionals’ perceptions and potentially lead to judgmental or oppressive behaviors toward patients. My research is thus positioned to challenge existing paradigms within Thai psychiatry, questioning whether current practices truly serve the best interests of patients or inadvertently maintain systems of control.
Will my lived experience inform the way you will inform the participants?
My lived experience as a former patient who has endured what I perceive as torture and harassment within psychiatric settings profoundly informs how I will engage with participants in this study. Recognizing that these psychiatrists hold significant power within the mental health system, I approach them not just as research subjects but as individuals who embody the authority and control that impacted my own life. This perspective will inevitably influence the dynamics of our interactions. I anticipate that my conversations with participants will be robust and critically deconstructive, as I seek to challenge and unpack the underlying attitudes that contribute to stigmatization. Emotionally, I may grapple with viewing psychiatrists as adversaries or even villains, given my past experiences. (Which, well, scientifically and methodologically, not good) This could lead to a heightened emotional intensity during interviews, which I acknowledge and plan to navigate with professional integrity. My goal is to delve deeply into their training and thought processes to understand how professional education shapes their attitudes toward patients. By bringing my personal experiences into the research process, I aim to foster a more candid and revealing dialogue, one that might uncover aspects of psychiatric practice that are typically overlooked or unaddressed.

How do my identities affect the interpretation?

My identities—as a Thai individual, someone diagnosed with a mental illness, and a former psychiatric patient—are integral to the interpretation of my research findings. These identities provide me with a unique insider perspective, allowing me to connect more intimately with the subject matter and offer insights that might elude an outside observer. Being mentally ill and having navigated the psychiatric system myself means I can empathize with the experiences of patients who feel judged or stigmatized by professionals. This personal connection may render my results more vivid and emotionally resonant, capturing the nuances of stigmatization as it is perpetuated by psychiatrists. Additionally, my cultural background enables me to understand and interpret the subtle ways in which Thai societal norms and values influence both patient experiences and professional attitudes. However, I am also cognizant of the potential for my identities to introduce bias into my interpretation. It is essential for me to remain reflexive, continuously examining how my perspectives shape the analysis and striving for a balance between personal insight and academic objectivity. Ultimately, my identities enrich the research by adding depth and authenticity, contributing to a more comprehensive understanding of how stigmatization functions when doctors convey or enact it within the Thai psychiatric context.

[Last modified: October, 11 2024 01:45 PM]

Experience on my observation of psychiatry textbooks in the UK

As my research topic is about evaluating the perception of mental illnesses from psychiatrists and their textbooks in Thai, it is difficult to implement in this class. I cannot just go directly to the doctor and ask them about their perception. They might be occupied with their patients. So, I visited Toby and asked him about what I should do if I had a project title like this. He gave me a very good suggestion. He said that maybe I should start from the library to see how psychiatry textbooks can imply their experience and perception that can be embedded in their mindset. So, I temporarily scaled down my project from the Thai context to the UK context, omitted the psychiatrist’s interviewing part, and focused on their materials instead.

I started by going to the Cruciform Library, as there is a specialist collection about every branch of medicine. I looked for psychiatry textbooks. I found one from Oxford University. My first impression when I opened that book was that I was surprised by how they organized the chapters. They started the chapter with the concept of labeling and how it can be useful and harmful at the same time. They also challenged psychiatric practice by empowering the rights and dignity of the patients. On the next page, they talked about the stigma that labels can give to patients. The text also invited professionals to challenge their own prejudice, particularly in some disorders where they are really sensitive and controversial, like personality disorders, which in Thai are very stigmatized by healthcare providers. One thing that I liked about the Oxford textbook was they also admitted themselves that psychiatrists are not the know-it-all persons in every mental illness. Some doctors still have different ideas about specific disorders. So, in this case, they presented themselves as dynamic and flexible doctors rather than authoritative healers. Next, I also found that there was a section dedicated to Anti-psychiatry, which I found it fascinating as I am also one of the Foucauldian scholars. This showed us how British psychiatry has also given the importance of alternative thoughts in psychiatry. When I kept scrolling through the section on personality disorders, I found that they were also skeptical about what a normal personality is. They tried to justify the pathology as well as provide the controversies of personality disorders, which I think is a good practice in psychiatry as psychiatric knowledge is a little bit unstable and surrounded by debates according to society and time.

In the end, from 30 minutes of exposure to psychiatric materials in the UK, I found it really opened my mind about how British people try to capture the essence with caution and care. The attempt of destigmatizing is prevalent here, unlike in Thailand, where it is biomedical deterministic. I am glad that the UK has a critical approach toward their practices, and I look forward to seeing what the doctor’s response would be about their perception of mental illness.

 

 

[Last modified: October, 11 2024 01:46 PM]

Topic: Stigmatization in the Thai Psychiatric System

Title: Impact of professional training on psychiatrist’s attitude toward patients in Thailand

RQ: To find how curriculum and training experience contribute to psychiatric attitudes toward patients

Method: Mixed method?

Part 1

• Try to find some medical literature that psychiatrists use for their training.
• Identify some potential bias and stigmatized contents
• Look at the curriculum and materials and how they represent the image of mental health

Part 2

• Interview the psychiatrists
• Identify some themes from their interview, how they look, or judge the patient based on what they have been trained.
• Ask them about how their training impacts or shifts their attitude
• Interpret their cultural and personal reflection on attitudes

Potential Outcome:

I am not sure if I am a little bit biased or not, but I think I would find negative results (but respectable), such as stigmatized content from doctor’s training, and also some implications of how Thai psychiatrists are being trained with the hierarchical, prejudiced, egocentric, and non-emphatic based perspective along with some medical discourses that can be reflected from doctors and materials such as the discourse of biodeterminism and reductionism which show that many doctors tend to ignore social determinants and humanization.

The First Set of Questions

What themes are you interested in?

The thoughts, experiences, and perspectives of psychiatrists and patients on systemic oppression and stigmatization, labeling, and diagnosis.

What is interesting about this topic, why is it important?

It might not be that important but it is interesting as we can have an opportunity to empirically explore the stigmatized experience of patients through the doctor’s lens.

How is this topic anthropological or ethnographic?

I think it is because the project will need to collect both data from learning materials and interviewing people so I can understand their training and how it affects patients more. This allows me to see the relationship between psychiatrization and society.

The second set of Questions

Your proposed research questions

So my research questions would be “How do curriculum and training experience contribute to psychiatric attitudes toward patients?”

Are they open questions?

I think it is open as it allows many possible answers that I can get. I can see stigmatization clearly from materials (This is what I just hypothesized by myself) and maybe it has nothing to do with it.  

Are they anthropological and ethnographic?

My method is both anthropological and ethnographic as I will explore doctor’s perspective and perception after they have been trained.

Are they actionable? (i.e. can you answer them through ethnographic research?)

I mean, I still question that. It sounds feasible but also a bit hard to implement, especially finding some samples like interviewees for my project. Psychiatrists are usually busy and, in Thai, they tend to distance themselves from outsiders. They might do not want to reveal their real feelings.

Third Set of Questions

1. What methods you are considering

As my project is divided into two parts, so there should be two methods. The first is to find and interpret their learning materials. The second part is to interview them, asking them about their perception of patients from a medical-informed lens.

1. Why they might be useful

Interpreting their literature and interviewing them allowed me to see the correlation between their training and their answers. This also allows me to see some discrepancies in their thoughts; not all doctors might follow what they have been trained.

What kind of data they will produce

A qualitative perception of doctors and how it links to their trained materials.

Ask each other if the methods are appropriate to the topic, question and context.

I did not have an opportunity to ask my peers; I do not know how to start conversation with them.

Thank you

[Last modified: October, 1 2024 06:27 PM]

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