Abstract
In this article, I illustrate reflexive embodied ethnography with applied sensibilities as an approach for performing, interpreting, and applying qualitative research. I argue that we enter the field as embodied beings hoping to find significant insights with the potential to connect with other persons’ lived experiences, which in my work involves searching for answers to health conditions. Reflexive embodied ethnography: a) recognizes that each field experience potentially changes how we come to perceive, understand, and act in the world; b) receptively approaches our own and others’ responses to experiences that transcend language; and c) enhances our awareness that we also re-constitute worlds with our words. Applied ethnographic sensibilities include: a) reconstructing our social world through storied reflections grounded in our bodies; and b) revealing meanings that move us towards social action through examining discourse and ‘extra’ discourse-in-use.
It is Saturday, January 28, 2012, my one-year Anniversary with Walk with a Doc (WWAD). A familiar voice mumbles to me, ‘It’s snowing outside.’ William, a friend, member, and proselytizer of the WWAD program, always worries about my long drive. But today, I worried about him. His new escort is a cane. As an avid golfer who enjoyed walking the course, I could imagine that this might upset him – but golf season is a long way off. I kept my worry to myself and watched as my husband and William slowly faded out of sight while I stayed behind. During our drive home that morning, the image of William, with a cane, preoccupied my thoughts and undermined my usual frantic scribbling of observations. I questioned my husband, ‘Why did William look sad this morning?’ and then pressingly answered, ‘It was the cane, wasn’t it?’ ‘You don’t understand,’ he said and continued, ‘It is and is not about the cane. William’s close friend passed away within a year after he was unable to walk the golf course.’ ‘Oh,’ I gasped.
It is and is not about the cane. Just as we are and are not our bodies. But learning how to cope when our bodies limit our physical abilities for the first time can be frightening as in William’s case. Shortly thereafter, I recognized that bodies leak meanings and these meanings are important for the ethnographer to comprehend. At research locations, we are neither bodies alone nor are we solely minds. Rather, we interconnect our physical sensations and mental activity as embodied subjects who create meaning. Together they serve as ‘a platform for interpreting the ‘stuff’ of our lives, from the simple act of digging up a sweet potato, nursing a baby, or seating oneself in a chair, to the launching of rockets to the moon’ (Brady, 2004: 624). As I entered the field as an embodied other, I was faced with acknowledging how others, like William, positioned me. My relationship with William shaped my role as a researcher as I too became an embodied co-participant who immersed myself and responded to stories that reified meaning(s) in our lives. During the final stage of my methodological orientation, I co-constructed a reality by embodying writing as an applied method of inquiry that highlights another’s existence in ways that are important to them, and as a result myself. For William, the cane became a symbol of his immobility tied to his own mortality and grief over the recent loss of his dear friend.
The purpose of this article is to advance a methodological orientation I term reflexive embodied ethnography with applied sensibilities. My interest in the applied value of embodied meanings arose from reflecting on the ethnographic and autoethnographic sensibilities shaping my yearlong field study of an integrative health promotion program, WWAD. My definition of embodiment is guided by Merleau-Ponty, who insisted that ‘I regard my body, which is my point of view upon the world, as one of the objects of that world’ ([1945] 1962: 81). This understanding of embodiment highlights ethical ways of knowing that are inseparable from the knower’s concretely lived activities (Ellingson, 2017; Hamington, 2012; Hartstock, 2006; Merleau-Ponty, [1945] 1962; Pink, 2015). As my ethnographic fieldwork progressed, I began to recognize and embrace the significance of my own embodied presence from the perspective(s) of other participants involved in WWAD (c.f. Davis, 1997; Sandelowski, 2002; Shilling, 1993). Such events tangibly affected my own understandings of how specific persons’ meanings for health were negotiated and/or reconciled. Through spending time and taking part in ‘health walks’ with fellow vulnerable bodies, I became a welcomed ‘other.’ In Merleau-Ponty’s words, I felt included as a ‘body-subject’ in another’s known world, which is an experience so often taken for granted in our roles as researchers (Friberg and Ohlen, 2010; Gale, 2010; Sharma et al., 2009).
In addition, I discuss how applied ethnographic sensibilities influence my methodological interpretations. Our work as ethnographers not only generates knowledge from thick descriptions, but offers insight into strategic action, a precursor for transformative change (Hymes, 1974; Philipsen 1997; Sprain and Boromisza-Habashi, 2013). Embodied ethnography implicates the intersubjective nature of sense-making, which allows us to take stock of patterned meanings-in-context informed by everyday life (Coffey, 1999). This combination of embodied and applied sensibilities advances an integrative approach for analyzing multiple forms of engagement with participants in a particular social setting. Such practice provides even ‘thicker’ descriptions (Geertz, 1973), more ‘faithful’ interpretations (Blumer, 1986), enhanced ‘fidelity’ (Atkinson et al., 2008), and a richer exploration of ethnography as an ‘artful-science’ (Brady, 2004).
Description of the case study
This essay explores my embodied ethnographic accomplishment of the meanings I attributed to the health conditions of participants involved in a program called, Walk with a Doc (WWAD). WWAD is a program where community members can interact with healthcare professionals and each other while engaging in non-scripted health discussions. WWAD, founded in 2005, brings together community members, physicians, medical students, and healthcare professionals who take steps to encourage an active lifestyle. The WWAD program offers an integrative approach (WHO, 2008), including individual motivation, social support, and public access to walking trails. WWAD is a voluntary organization integrating both curative and preventive practices in the public sphere. An integrated model of health, unlike biomedical or biopsychosocial, introduces unique and novel forms of communicative practices that combine how we conceptualize our self as a healthy person and what we do to maintain our health. To this end, my overarching research objectives included: (a) examining from a socio-cultural perspective how the WWAD program provides a bona fide alternative environment for exploring the communicative aspects of health organizing; (b) investigating how naturally occurring conversations between healthcare providers and participants – in conjunction with their spoken reflections on the process – might enhance our understanding of how culture affects health communication in minimally hierarchical, non-institutional contexts; and (c) exploring the ways integrative health care interactions can transform patient-participant power structures within health promotional campaigns, thus providing insights to improve healthcare practices. For this piece, these research objectives are attended to as I focus on the process of how my methodological orientation guided me to examine my role as an embodied other informing my field note observations, analysis, and interpretations.
Using ethnography and narrative interviewing as my methods of inquiry, I studied the situation specific meanings among participants at WWAD events. After receiving IRB approval and renewal, I attended WWAD events. Throughout this project, I participated in the walks. I logged a total of 56 hours of involved observation over a two-year period. At a later date I conducted a total of 26 narrative interviews with my fellow participants in the walks. The interviews lasted on average from forty-five minutes to one-hour – ranging from the longest interview of 4 hours to the shortest of 40 minutes. I use pseudonyms in this document to protect the confidentiality of all participants and organizers of WWAD.
Reflexive embodied ethnography
Ethnography involves the process of analytical description where ethnographers explore in detail values dwelling deep within lived experiences (Carbaugh, 2007; Geertz, 1973; Leeds-Hurwitz, 2005; Lindlof and Taylor, 2002). I eventually realized that such meaning making in terms of ‘descriptive writing’ demands more than simply echoing what was said within the various transcripts I collected. Instead, I was recreating a scene while becoming ‘the reader of a mystery’ (Goodall, 1994), with characters, including myself, and a plot full of unfolding events exploring meanings concerning the world we live in anchored in symbolic social constructions (Brady, 2004). In doing so, I embodied emotions, feelings, and thoughts about health that others shared with me just as they too embodied mine. The more I recognized how affecting and intimate my relationships with others were becoming, the more I desired to express in words what often is excluded from research. As Finlay asserted, ‘The ultimate aim of phenomenological research is to explicate and express in language embodied experience, and to do so in a way that captures the ambiguous layers of meaning as fully as possible’ (2014: 10). Because of these convictions, I was motivated to express embodied ways of knowing, being, doing, and becoming in words by immersing myself physically and mindfully into the field (Gale, 2010; Pollock, 2006). I was relearning how to learn a different kind of language – this language ‘is a challenge to the social scientist to explain with words that which is taught without’ (Gale, 2010: 218). Accordingly, such reflexive embodied ethnography: a) recognizes that each field experience potentially changes how we come to perceive, understand, and act in the world; b) receptively approaches our own and others’ responses to experiences that transcend language; and c) enhances our awareness that we also re-constitute worlds with our words.
Reflexivity, foremost, is concerned with how the researcher herself comes to interrogate her own standpoint and interpretive perspectives (Alvesson and Skoldberg, 2000; Friberg and Ohlen, 2010). Meanwhile, embodied reflexivity challenges us to take seriously our efforts to write our embodied responses back into our research while we remain committed to responding empathetically towards another (Burns, 2003; Ellingson, 2012; Finlay, 2005; Gale, 2010; Sharma et al., 2009). I realized Finlay’s extension of phenomenological awareness during the research process, in that, ‘the researcher’s capacity to understand can be enhanced through this reflexive awareness’ (2005: 277). When we are aware, we understand how others position us during this reflexive process. Embodied reflexivity involves a mutual and reciprocal communicative exchange of knowledge, perception, and bodily actions in each other’s presence whereby our intentions change as we begin to see ourselves differently through another’s gaze. I became a member of this group because other walkers accepted me – in the corporeal flesh. This palpable experience therefore challenged the ways I perceived, understood, and acted in the world. My body chronicled these interactions, and thus I became an extension for meaning making as an embodied subject who must account for my own positionality as a co-participant.
This re-examination of who I was in relation to other walkers in the program led me to re-evaluate what I believed was important about the program. I was not an invisible figure or disembodied other; rather I was ‘present’ in the eyes of other walkers. I became receptive to how others viewed me as well as my embodied responses to another. Burns described this type of embodied reflexivity as ‘extra-discursive’ effects and advocated for an approach that constructs, deconstructs, and reconstructs our embodied subjectivities (2003: 234–235). In the field, we begin to alter our own embodied subjectivity based upon how others perceive and act towards us informed by our engagement in localized histories of another. We therefore negotiate another participant’s gaze by repositioning ourselves appropriately to offer consultation, concern, and most importantly gratitude for inviting us into their embodied space.
Finally, reflexive embodied ethnography prompts us to consider how we are re-constituting worlds with our words, that is, we are writing the experience of bodily presence back into our social discourse. Alvesson and Skoldberg summarized this idea when they wrote: The research process constitutes a (re)construction of the social reality in which researchers both interact with the agents researched and, actively interpreting, continually create images for themselves and for others. (2000: 6)
Reconstituting the world with our words involves an ethical, embodied, and co-constructed framework listening to and caring for participants of the program (Frank, 2000; Kruks, 2001). I followed what Kruks referred to as attending to ‘immediate intersubjective, moral, and emotional dimensions’ which is an immediate response to another’s well-being as opposed to ‘moral deliberations’ often regarded as silent contemplation before responding to one’s need (2001: 148–149). For instance, at times I felt compelled to silently serve as a witness for someone sharing a health story stopping to make eye contact and offering a nod as immediate nonverbal feedback to what they were saying. In addition, participants sometimes seemed to need direct verbal confirmation that I orally expressed by answering questions I felt called to provide. I noticed that active listening and an ethic of care offered a space for taking stock of mutually meaningful interactions. At the same time, they enabled thicker descriptions of our immediate embodied responses to each other in the moment that I otherwise might take for granted. And these thick descriptions, although always partial, allow for multiple layers of interpretation and perspective. In its dedication to palpable moments of responding to each other, reflexive embodied ethnography is a methodological orientation emphasizing not only what is said, but what is felt – yet often forgotten.
Applied ethnographic sensibilities
Reflexive embodied ethnography creates a space where embodied presence becomes a part of our social discourse elucidated in our daily written reflections. Low described this space as that which is ‘the location where human experience and consciousness take on material and spatial form’ (2003: 10). We are constantly performing and recording what these embodied spaces mean to our participants and ourselves. For example, a widowed mother and member of WWAD utilized this public space as a place where she simultaneously coped with grief while cultivating human connections to form renewed social bonds. In recognizing such needs, applied ethnographic sensibilities offer knowledge that enables an understanding of social worlds critical for meaningful, social change. According to Sprain and Boromisza-Habashi, applied ethnographic work helps us to reveal ‘the means of communication and their meanings to those who use and experience them’ (2013: 182, original emphasis). Applied ethnographic sensibilities include: a) reconstructing our social world through storied reflections grounded in our bodies; and b) revealing meanings that move us towards social action through examining discourse and ‘extra’ discourse-in-use.
Atkinson, Delamont, and Housley claimed, ‘Narratives, stories, and accounts are – or should be – fundamental sources of data for the ethnographer of everyday life’ (2008: 90). Stories are invaluable for reconstructing who we are, empathizing with our participants, and reflecting upon what we have been doing together in the field. During my time as a co-participant at the walk, I learned to listen to the stories walkers shared with me. Stories move us to do things. Some stories have no endings, while other stories offer chosen moments that elicit defining insight. Applied ethnographic sensibilities obligate me to be answerable to another during the process of storytelling by recognizing what is meaningful in the life of an individual walker (Frank, 2000). Accordingly, I attended carefully to narratives both while participants voiced them during our walks and following the walks when I sat down with participants and asked them to share their story with me. Listening to stories is an active and fully embodied activity. It requires a person to receive how stories are lived and told from the standpoint of the storyteller, which in my research offered crucial meanings about the teller’s world contributing to their experiences of available health practices.
First, we must pay attention to how we reconstruct the world through our storied reflections and accounts in an effort to understand the selection and significance of the narrated events (Hymes, 1974; Leeds-Hurwitz, 2005). Second, once we decipher the importance of the meanings created in storytelling (Warren, 2002), we begin to examine the capacities of discourse to produce consequences for social action. Studying discourse is both studying language-in-use (Alvesson and Skoldberg, 2000; Gee, 2011; Hymes, 1974) and extra-discursive practices-in-use (Burns, 2003). Knowledge creation using applied ethnographic sensibilities is thus guided by both embodied and written interpretations. It draws upon the connections among doing, being, and narrating in meaningful ways to offer practical implications of the social activities under consideration (Gee, 2011). Stories draw a listener or reader into their symbolic worldview and these worlds have practical implications. Ethnography with applied sensibilities recognizes how communicative strategies can help us manage conflicting meanings we may experience (Carbaugh, 2007). This process of application drives us to continually refine our questions to focus on socially edifying results. Why is this story meaningful to another? In what ways are the actions of another in this moment significant for other possible outcomes? What are the consequences of our practices in the field for the people living in it?
My methodological orientation involving reflexive embodied ethnography with applied sensibilities – guided my observations in ways that allowed me to remain open while also attending to and probing more deeply into the values the walkers I met placed upon their own health. My understanding of these underlying values provided me with a new appreciative lens for understanding why the WWAD program was meaningful for my co-participants.
Methodological Reflections
The following section highlights three interrelated aspects of my ethno- and autoethnographic journey, namely: entering the field as an embodied other, becoming an embodied co-participant, and writing as an applied method of inquiry. I hope to illustrate further the ways reflexive embodied ethnography with applied sensibilities guided my observations and interpretations at different stages of the research process. This section emphasizes how the researchers’ role(s) are imbricated in the research process from the beginning and more importantly that knower and known are not separate from our observations in and out of the field. By detailing how my methodological dispositions guided my observations, I become answerable to my processes of interpretation (Alvesson and Skoldberg, 2000; Ellingson, 2009; Richardson and St. Pierre, 2005). Accordingly, I share moments of vulnerability as well as moments of reassurance, moments of isolation and moments of belonging, and finally moments of feeling lost and then again found.
Entering the field as an embodied other
In this section I further reveal my insecurities as a novice researcher exploring topics/ideas for an ethnographic study that would later evolve into two years of observation. I recognized early on how my emotions and ‘gut’ reactions informed my decision to select a dissertation topic and stay with it (Ellingson, 2012; Woodward, 2009). I recall paying close attention to the ways I embodied these feelings with others, which ultimately swayed my decision to follow the walk program – even in the midst of anxiety, uncertainty, messiness, and clutter that clouded my understanding of a foreign place I was entering for the first time.
Upon entering my second year as a doctoral student, I enrolled in a critical ethnography class. I had no formal training prior to this course and only little knowledge about ethnography as a research method. When our professor announced that we were required to conduct an ethnography with alive, breathing people, an uneasy twisting and churning feeling settled into the pit of my stomach. I shuddered at the thought of exploiting others, knowing we can only ever understand another in terms of our own experience(s); there is no such thing as ‘going native.’ Meanwhile, we don’t want to misconstrue another person’s reality by unduly privileging our own perspective, or ‘naval gazing.’ Filled with fear and hesitation, I suspect I did what others did – I asked for help. I consulted with professors, classmates, and finally the Internet for a sign that might calm the knots forming in my belly. I received plenty of feedback, yet after every suggestion, my stomach remained helplessly irritable – an indication for me to explore more possibilities. After scanning websites and articles, laboriously viewing YouTube videos, and reading uninspiring organizational mission statements dedicated to promoting healthcare delivery in the Midwest US, I timidly reached out, via email, to the founder of the WWAD program. This was a test in my mind to gauge receptiveness, while also serving as an innocent and eerie query: Do you want someone watching you?
What an impersonal way to introduce myself, I thought, as I clicked the send button. I assumed the founder would say no or at least counter this awkward negotiation with follow-up questions. His surprisingly, enthusiastic, ‘yes’ had not even crossed my mind in contacting him. What does this mean? I thought to myself. How long did he contemplate welcoming an outsider into his sacred space and place? My initial suspicion had been met with affirmation. Why am I being welcomed? I wondered. Then, I began to experience more reservations consumed by the insecurities I carried with me as a novice researcher about to enter into the field for the first time.
The above reflection illustrates how my bodily reactions shaped my thoughts from the outset of my research pursuits – which calls to mind two points. First, the researcher does not simply conceive of an idea without tangible feelings and emotions. Our ideas come from an embodied position in our world as opposed to a detached and objective state of mind externally experienced and acted upon (Hartstock, 2006; Lincoln and Denzin, 2000). Above, I disclose moments of trepidation and vulnerability (e.g., occupying the space of a novice researcher), despair (e.g., when considering commentaries and ideas not all that appealing), and arousal (e.g., heightened curiosity driven by the lack of hesitation from the founder of the walk program). Yet, I felt like an imposter.
Second, these embodied sensations compose the pre-reflective processes informing the decisions we make about the passions driving us to select an organization to study. We therefore act upon these embodied feelings, slowly beginning to recognize how our perceptions and localized histories further alter how we view our role as a researcher and co-participant. My personal history involving years of commercial work in the healthcare field moved me to join an organization where a doctor committed time serving his community beyond what was required of his profession. These are what Ellingson refers to as ‘living spaces’ that are both transitory and tied to our ontological understanding(s) of being-in-the-world (2017). I was, therefore, inspired to follow an organization dedicated to making a difference in the world by offering a space for transformative change particularly in regards to how we understand ourselves as healthy beings and practice healthy choices with an emphasis on social companionship. I also became aware that I myself was an ‘outsider,’ and this was both internally and externally experienced through my bodily ways of being with others (Finlay, 2005). Below I offer additional examples of how my body registered these new feelings, emotions, and perceptions as I recall others’ responses to my nonverbally expressed nervousness around persons I met for the first time.
On Saturday, January 29, 2011, I selfishly dragged my husband out of bed at 5:30 in the morning. I didn’t want to attend my first walk event alone. During the two-hour long drive to the event, I miserably drowned my thoughts in uncertainty and doubt about my role as a researcher to occupy the time. My edgy anticipation numbed me more than the frigid air sweeping up against my body before we entered into the mall food court. Fried food, antithetical to health, permeated my sense of smell while the color red for epilepsy overwhelmed my vision. Meanwhile, Billy Joel’s, It’s Still Rock and Roll to Me, is blaring in the background. Though noxious, the sights, sounds, and smells familiar to a mall food court clamoring consumerism on a busy Saturday morning brought me comfort. Feeling aimlessly out of place, my husband and I took refuge in a conversation we started with three women who appeared just as awkwardly conspicuous as we were. One of the three women asked, ‘Are you the doctor?’ At which point my husband in jest graciously replied, ‘Yes.’ Only she didn’t realize he was kidding. This comical scene performed by my husband helped break the tension. We laughed as we continued small talk while uncomfortably shifting our bodies in all directions to figure out where people gathered for the walk. Finally, one of the ladies spotted people congregating in a corner of the food court. This vulnerable space full of uncertainty we occupied together would later reunite me with these women – who eventually disclosed devastating stories about gaining equitable access to healthcare.
In single file, we followed each other and then dispersed among the crowd of strangers. And that’s about the time I felt the uncomfortable gaze of a middle-aged woman in a WWAD tee shirt staring curiously at my husband and me. In an attempt to disrupt the uneasy stare down, I blurted out, ‘Are you Dr. Brooke’s wife?’ ‘No, I am Kym, the Executive Director of the walk,’ she said with an unhesitating smile. Immediately, I felt embarrassed about my inaccurate characterizations of her. Then I introduced myself almost forgetting my husband, at which point, Kym remarked, ‘Oh, yeah. You are the ethnographer.’ My face turned three shades of red matching the red-covered walls surrounding the food court that morning. First, I was not remotely ready to be called an ethnographer. I was still learning what ethnography is and what an ethnographer does. ‘What if I cannot fulfill this role?’ I thought to myself. Second, my desire to remain anonymous, not that I had previously made the decision, ceased soon after Kym made her announcement. I would no longer be able to covertly observe the rules of the organization and individuals’ nuanced behaviors while familiarizing myself with these new surroundings. I felt vulnerable as my role as a researcher was exposed. Finally, I thought to myself, ‘What if I decide not to come back? Will they assume I abandoned them?’ If nobody knew who I was, I could easily disappear into the abyss never to be seen of or heard from again. But that was not going to happen.
So here I was the ethnographer, whatever that means, with her husband at our first walk. Voices suddenly quieted as Dr. Brooke, the founder, gathered everyone around for a health talk. He began with, ‘Dr. Winter broke her leg’ which was followed with a big empathic ‘Aww,’ from the audience. I immediately realized I was the outsider, a stranger in a group who seemed to know more about my place there than I did. After he finished his talk, he encouraged the crowd to walk. My husband and I began to walk. We walked alone that morning, and I remember commenting that it felt lonely. We were occupying the space of an outsider, stranger to the program. Time seemed to drag as we found our way back to the meeting place where the walk began. We sat down at a table in the food court. At that moment Dr. Brooke approached us, extended his hand and said, ‘We’ve never met before, right?’ ‘Right,’ I said. I introduced my husband and then myself. ‘Oh yeah, you are the ethnographer,’ he said. ‘What is ethnography?’ he asked. ‘I am still in the process of answering that question myself,’ I mumbled under my breath.
Soon after this experience, I realized that if I wanted to be taken seriously I needed to have answers to these questions reflecting how others perceived me. Questions such as: Who am I? What am I doing here? What is it that I want to learn? I also realized that I wanted to be seen as more than ‘the researcher who merely observes others.’ I wanted to be regarded as a human being who was concerned about my own presence with the people there. Thanks to Kym and Dr. Brooke, I was not given the opportunity to conceal my identity as a researcher and therefore my intentions, and looking back I learned to appreciate these interactions. I am thankful because this unplanned disclosure meant that I needed to be answerable to the role that I and other persons perceived me as occupying. It becomes an important turning point when your own frame of reference changes after you begin to perceive yourself differently in light of what others say and do in the field. It was not long after that first walk most of the participants knew who I was and what I was doing there; and shortly thereafter, I became the one asking the questions.
Entering the field for the first time is an intimidating process, especially when we as human beings yearn to belong. During my first walk, I held onto the sights, sounds, and smells that were familiar to me. I became aware and drew meaning from my senses because this new experience frightened me. I even hauled my husband out of bed that morning so I could feel safe and secure. As I attended each walk thereafter, I slowly surrendered my longing for certainty and embraced new experiences that altered the ways I perceived, understood, and acted in the world. When we enter the field, we are not just our bodies but we become our bodies shaped by how we interact with others, who with us, construct material realities that help to inform our sense of self as an embodied subject (Ellingson, 2017). The process of recognizing these changes are complicated by a dialectic among remaining open to new sights, sounds, smells, and stories that interact with a familiar past taken up in memory and recorded in our field notes.
As a vulnerable imposter, I struggled with my identity, feeling at times that I was both present and absent informed by whether my role as a researcher met the expectations of how others perceived me. Even so, I continually challenged these emotions in an effort to be answerable to others and myself as an embodied subject (Merleau-Ponty, [1945] 1962). As Antelius (2009) suggested, our bodies are uniquely positioned in time and space, which informs how we are able to see ourselves and act in our surrounding environment. I learned several lessons from accepting and appreciating my position as a vulnerable imposter. First, I uniquely experienced and embodied the vulnerabilities anyone might expect when joining the walk program for the first time. As a result, any time I met a new member thereafter, I receptively approached another’s anxiety by recollecting and drawing on the feelings I had once experienced. I responded compassionately by listening to another share with me their story that led them to join the program. As time passed, I learned that both Dr. Brooke and Kym had personal reservations about agreeing to invite me to study their program (Field-Springer and Stephens, 2017). Second, my willingness to remain vulnerable stymied some but perhaps not all of the preconceived notions or assumptions we as researchers attempt to avoid when making sense of meanings expressed by our co-participants. An ethnographer interprets and analyzes meaning as Gale suggested with ‘careful and reflective observation, listening, and embodied participation as well as verbally confirming the nature of others’ experiences in similarity or contrast to one’s own when practicable is key’ (2010: 215). Keeping this in mind, the most difficult lesson for me involved how to balance remaining reflexive yet responsible for the observations I interpreted. This challenge included figuring out answers to who I was, what I was doing, and what I wanted to learn from a given experience. This reflexive dimension concerning the interpretative process prompted me always to ethically reevaluate the ways I interpreted and recorded meanings. For I was composing insights both lived and told from the embodied standpoint of my participants (Frank, 2000), as well as from my own experiences that were informed by my participants’ frame of reference.
Becoming an embodied co-participant
In this section, I offer ethno- and autoethnographic reflections about becoming an embodied co-participant in the walk program. Becoming a co-participant involves realizing meanings from the embodied perspectives of other persons, who share and perform details of their life with me at the same time I am disclosing myself during the activities we engage in together (Lindlof and Taylor, 2002). A stance of co-participation embraces a reflexive approach where fellow participants’ perceptions become as important as mine. As Merleau-Ponty once imagined, ‘It is as if the other person’s intention inhabited my body and mine his/[her]…There is mutual confirmation between myself and others’ ([1945] 1962: 215). Thus, what my participants felt, I tried to feel. What my participants prioritized, I tried to prioritize.
It is Saturday, February 5, 2011, my 30th birthday. Some celebrate it as a milestone. But my celebration was curtailed as I wearily pulled myself out of bed at five o’clock in the morning. My husband abandoned me this time and I had no choice but to drive to the walk alone. Following the unsettling events that transpired last week during my first day at the walk, I decided I would take myself more seriously as an ethnographer and shadow the doctor, hoping to record provider-participant interactions. Plans change. Shortly after I arrived, a stranger asked me about the college logo printed on my fleece jacket. He then shared with me a story about this familiar place we have in common. Dazed and somewhat agitated by his amiable disposition, I forced myself to smile. After the doctor concluded the health talk, he turned to me and asked, ‘Well, should we get walking?’ ‘Sure,’ I grudgingly replied.
I spent the first couple of steps surveying him with a gaze fitting for toddlers but not adults. He stood tall yet frail, easily pushing 90-years old. His gentle eyes enhanced by the wrinkles between his brows made me wonder how so many years on this earth altered his perspective on life. He was a people-person I learned, a veteran in sales; we did a lot of talking that morning about life as I struggled to keep up with his steady pace. Then I asked the colloquial phrase often repeated by doctors, ‘What brings you here today?’ Agony swept across his face as he transported himself back to a painful memory. ‘I suffered a heart attack five years ago. Dr. Brooke was the Cardiologist who treated me. I underwent angioplasty surgery, where they insert a stent to open up blockage,’ he said. Now, consumed with the fear and vulnerability he embodied, I mustered up the empty words, ‘I’m sorry.’ He continued, ‘Dr. Brooke made me realize that I’m not thirty anymore and I had to start making changes to my lifestyle. I’m here because he encouraged me to start walking.’ And then, he asked me the same question I posed him, ‘What brings you here today?’ I shared with him my story, even the self-doubts I had about becoming an ethnographer.
We walked in silence while our bodies registered each of our personal vulnerabilities. Overwhelmed by his story, I couldn’t help but think about my own mortality and the recent loss of my father and mother-in-law. They both died suddenly at the age of 61 and within one year from each other. I was standing face to face with another who understood my own ghosts. Denial and grief haunted me still. We tend to deny or push aside death from the day we are born. It is inevitable; yet, we continue to do what we can to elongate our lives. I lost myself in thought—we don’t fear death; we fear erasure. As Ellingson suggests, ‘doing bodies as a concept shifts the focus of analysis from ‘having a body’ to ‘being a body’ in specific circumstances such that identity goes from fixed to practices that constitute selves’ (2017: 5). Thus, our bodies submit to each other’s emotions in response to positive and/or negative circumstances and we enfold their grief and fears into our own.
William and I formed a bond that day. I served as a witness, not only by listening to his story, but also as a person walking next to him who glanced back with a sincere expression of affirmation. Honored by his entrusting me with his story – I shared with him the misgivings and uncertainty I felt as a novice researcher. By the end of our conversation, his actions and our mutual attentiveness provided me with a real answer to ‘why’ I was doing this, for which I am forever grateful. From that day forward, William greets me upon arrival, explains to everyone how long I drive to attend the walks, and shares how he spent the morning of my 30th birthday with me.
Saturday, June 25, 2011. Summer had arrived and the walks were now located outside in a beautiful meadow. We gathered underneath a pavilion full of picnic tables and benches. Dr. Brooke’s dark, thick curly hair was buried deep under a grey baseball cap. His workout clothes concealed his identity, as did his wife, children, and the giant black poodle that accompanied him. He looked like one of us. He brought donuts and joked that he didn’t receive a discount. ‘I’m a Cardiologist bringing donuts,’ he said, ‘Can’t I get a break?’ It was his wife’s birthday and we all pitched in singing ‘Happy Birthday to you.’ William, alone on this morning, invited me to walk with him.
A black raspberry bush caught our attention and we sparked a conversation about gardening and canning – a hobby no one seems to have time for anymore. Then, I asked him how he was doing. He extended his arms in front of us as we walked. Bruised with deep shades of blue and purple, his arms were as black as the raspberries we just passed. Feeling protective of him and angered, I asked, ‘Does it hurt? What’s going on? ‘I take aspirin every day because of my heart attack. I think it’s thinning my blood. I don’t even have to bump into something and my arms turn black and blue,’ he sighed. ‘Because I see Dr. Brooke every week at the walks, he gave me permission to skip one aspirin every ten days,’ he said.
I now understood the ways in which Dr. Brooke and William’s relationship extended beyond the cold, sterile walls of a physician’s office. William, in relating his emotions across the mutually embodied moments of their walks together, communicated his palpable fears about health and aging – just as he had with me. WWAD afforded him a space to create meaning and negotiate healthcare in a humane, emergent, and contextual manner with a medical professional. Dr. Brooke explained that the walk is: Superficial, relative to an office visit, but sometimes it is enough in a lot of circumstances. Half of the time, I can answer something and sometimes I can’t. I can say, ‘That’s important you need to call your doctor on Monday,’ or ‘I could say no you don’t need to call right way it’s good’. . . . You want to take away the fear because I think there is way too much fear in medicine.
Yet for William, the walk was not superficial at all. From walking with them, my awareness of Dr. Brooke and William’s relationship enhanced my ability to reconstruct their storied interactions. Further, I was party to conversations revealing that for WWAD physicians like Dr. Brooke, ‘the body is not the object and focus of their restorative work, but it is also a human subject and a distressed other who has come for care’ (Hamington, 2012: 65).
For William, the walk provided consummate companionship and learning how to constitute a voice for his healthcare experiences. Reflexive embodied ethnography offered me definitive moments for perceiving my own and other’s bodily ways of being in the world, which led me to refine my own questions in accounting for their voices. I became a part of a WWAD story where our moments together produced learning about alternative possibilities for understanding our health practices and caring for oneself and others.
Writing as an applied method of inquiry
Thus far, I have offered reflections about my positioning as an embodied presence in performing fieldwork. I now turn to the applied sensibilities involved in writing up fieldnotes, conducting narrative interviewing, transcribing data, and analyzing materials. I illustrate how an ethnographer carries embodied knowledges with her in order to generate knowledge from the field. I also explore how reflexive embodied ethnography and applied sensibilities inform each other during the process of inscribing events.
A researcher’s relationship with fieldnotes varies; putting it mildly, I experienced a love-hate relationship during the process of inscribing my fieldnotes (Jackson, 1990). As mentioned, I selfishly manipulated and entrapped my husband to come along with me during my trips to the field. His driving allowed me time to write during the commute while his participation as a male golfer, for example, offered insight into lived experiences discussed by walkers that differed from my own. My fieldnotes became a combination of observations, participants’ stories, and personal reflections concerning immediately lived experiences that otherwise would be forgotten (Agar, 1996). If I travelled alone to the walk, I later struggled to create a vivid account of events that transpired earlier in the morning. Apart from my own physical exhaustion from the various roles I assumed as an instructor, student, and researcher, the process of imagination and empathy that guided my descriptions, feelings, and reflexivity, was both draining and invigorating.
Besides my ethnographic observations and information gathering I invested time with members of the walk to conduct one-on-one narrative interviews. Qualitative interviews typically are constructed in an effort for the researcher to thematize areas of interest (Warren, 2002). Yet specific questions emerged because of my close involvement with participants in the field. For example, during our interview I asked William about the cane that assisted his mobility and he described in depth his medical journey and the fears that accompanied the experience. I seldom held myself to the traditional back and forth question and answer interview format. Rather, I approached these interviews as more interactive, reflexive, and conversational where I also shared my own perceptions and interpretations (Ellis and Berger, 2002). At times, I often found myself answering specific questions that a participant had for me engaging in dialogue or the mutual ‘telling’ of stories (Reissman, 1993).
Our opportunities for dialogue blurred the lines between storytelling and ethnography. As a result, my written reflections included a combination of my accounts of joint stories emerging in situ during our walks together and explanations of participants’ narratives in terms of their meanings for health (Gubrium and Holstein, 2008; Lindlof and Taylor, 2002). This combined writing process revealed meanings that helped me to make connections among ‘study-related’ information shared, spontaneous actions, and performed identities from an applied ethnographic perspective (Gee, 2011; Sprain and Boromisza-Habashi, 2013). For instance, I learned several members experienced a health scare prior to their participation at the walk. For them WWAD served as a safe space to reinvent the self in light of a past illness, seek companionship with others who had similar illnesses, and bring into existence a more informed sense of self.
When I left the field to focus on writing, at first I felt ambivalent about abandoning my friends; yet, I realized the separation was needed. Distance helps us to (re)discover our ideas/thoughts/conceptions, and hopefully keener perceptions. As I typed up my fieldnotes, I tried to pay particular attention not only to the descriptions I wrote, but also to my personal reflections about them and to the original questions guiding my observations. In doing so, I followed the advice of Richardson and St. Pierre who suggested, ‘writing is thinking, writing is analysis, writing is indeed a seductive and tangled method of discovery’ (2005: 967). Although writing is key for ethnographers, the process of discovery becomes more complex when attempting to write about embodied experiences that have contributed to transformative personal changes, especially when our corporeal bodies have left the field.
After all my transcriptions and fieldnotes were typed, I began to engage in a close reading of the discourse. Because stories blur, I forbade myself from conducting separate analyses distinguishing between fieldnotes and interview transcripts. Rather, I read all the materials in one sitting from cover to cover in an effort to identify especially meaningful occurrences, such as fragments in conversations or emotional instances where unexpected contingencies disrupted our everyday lived experiences (Sprain and Boromisza-Habashi, 2013). Meanwhile, given my particular research interests, I also paid close attention to described events suggesting transformative change that might redefine what the patient-provider relationship could look like (Philipsen, 1997). Later, during my second reading of the material, I began to identify rich points or storied accounts that would further guide my interpretative account of what the WWAD culture looks, feels, and sounds like – in hoping to contribute to social change for those unfamiliar with the program (Agar, 1996). The questions I entertained during these later readings engendered a pragmatic turn to developing knowledge I could share pointedly with WWAD. This reading was guided by the following questions: ‘What health values are participants attributing to certain events, people, and places?’ ‘What health meanings do I or other participants agree with, disagree with, or feel indifferent about during our conversations at the walk?’ ‘What am I learning now that differs from what I thought I already knew?’ ‘And in what ways does this program contribute to health communication (e.g. what works, what doesn’t work, what alternatives are available)?’ I regarded WWAD as a place where providers and participants were rewriting a different script about healthcare, a script that did not underestimate embodiment accompanied by social interaction (Field-Springer and Striley, 2018). As William storied: In the private office, I always feel there is a time restraint. Very seldom will a doc sit back in his chair and just talk. Usually they are standing up and ready to go out the door with the diagnosis or what they think is wrong. The walk is more of a friendly atmosphere, like talking to a friend, and I look upon him [Dr. Brooke] as a friend.
Throughout my time in the field, I became a co-participant in the mission of these walks. WWAD is a program that carves out a space where ongoing relationships between healthcare providers and participants are fostered. Taking these walks together contributed to empowering ourselves actively through community to become the healthy persons we desired to be (Field-Springer and Striley, 2018).
The significance of reflexive embodied ethnography with applied sensibilities
This article has explored the three goals of reflexive embodied ethnography with applied sensibilities as a methodological approach for understanding situated human activity during various stages of the research process. First, reflexive embodied ethnography recognizes that each lived experience changes how we come to perceive, understand, and act in the world. In my methodological reflections, I shared how I initially embodied insecurities as a novice ethnographer who struggled to figure out how to become answerable to participants and myself while in the field. These insecurities strengthened my process of observation, that is, I used my bodily senses as a familiar mechanism for understanding my own and other’s embodied interactions. I established an awareness and need to interrogate my own and others’ descriptions, assumptions, and transformations of embodied selves in the field early on during the research process, due to my own embodied self-doubt and partly due to the mission of the program that directed bodies to become healthy (Field-Springer and Striley, 2018). For instance, as my relationships deepened with participants, I recognized the importance of bodies in flux (Deleuze, 1994), and how meanings that my participants and I inscribed about embodied interactions with each other changed over time and through space. When we begin to question the limits of our bodies, we become vulnerable. When we become vulnerable we become more imaginative about our capabilities. The turning point that called forth my own transformation occurred when I had an answer for the question, what brings you here.
Second, reflexive embodied ethnography receptively approaches our own and others’ responses to both spoken and extra-discursive experiences. Our bodies register tacit knowledge and thus become vital extensions of meaning-making in the field. I reciprocated care and this ‘attentiveness and engrossment of caring not only have an affective dimension that can communicate well-being and concern, but also act as a form of inquiry’ (Hamington, 2012: 56). For example, during my walk with William I felt his fears as he shared his near-death experience with me, and I responded by listening attentively to his story. In silence, we both occupied a space that inquired about what it means to live when faced with our own mortality. During the process of becoming a co-participant, I recognized the need to understand multiple meanings historically and uniquely lived by my participants. I questioned what experiences informed the ways participants made meaning that led them to actively join a health program. This process led me to further examine how embodied meanings, that may enable and/or constrain possibilities for social action, could be re-imagined in an effort to understand what it means to become healthy.
Finally, reflexive embodied ethnography enhances our awareness that we are re-constituting worlds with the words we produce to render them for others. In my description of events, I discussed my awareness between remaining open to fellow participants by occupying the space of an outsider while also answerable to my own interpretations of observations from being a familiar insider. The process of remaining reflexive of embodied interactions both lived and told may prohibit the false demarcation of mind/body duality often reproduced in research as well as the premature foreclosure of possible health meanings. As Hamington argued, ‘In treating the body as an object rather than holistically care for the person, medicine plays out the estrangement of mind and body found in the history of Western philosophy’ (2012: 57). It was through William’s embodied interactions with me that I linked the localized history he carried with him to the relational dimensions he had with the provider who managed the health program. A health program where participant’s agency in understanding their own health is embraced, thereby, resisting hierarchal power structures often defined in traditional patient-provider scripts.
I have acknowledged applied ethnographic sensibilities as attending to the ways we might reconstruct our social world through our storied reflections/reconstructions. Sharing and reconstructing stories from the field allowed me to dig deeper into the meanings my co-participants shared about their health experiences that led them to join the walk program and to note their implications for altering healthcare practices. Qualitative interviews provided additional insight into connections among informing (e.g., sharing health stories), action (e.g., practicing healthy behaviors), and identity (e.g., becoming the healthy person one so desires). Thus, applied ethnographic sensibilities aspire to understandings that move us towards social action through examining both discourse and ‘extra’ discourse-in-use. Accordingly, I offered insight into how the layered and iterative reflections composing my analysis led me to refine the questions I addressed when writing up my descriptions of events. Questions, such as, in what ways does this program contribute to health? Without documenting embodied descriptions and interactions of myself and others in the field, the reader of my research may not fully grasp the implications of what it means when a healthcare provider looks like one of us. Western medicine is defined by institutionalized rules, rituals, and norms often present during typical physician office visits. When these norms are broken, participants are offered an alternate way of re-imagining their own agency in patient-provider relationships. It is through such an applied mode of thinking that we generate questions and insights concerning how human practices can be understood, sustained, or challenged in an effort to positively influence social action (Sprain and Boromisza-Habashi, 2013).
Reflexive embodied ethnography with applied sensibilities is significant for ethnographers interested in being fully present with another in shaping our possibilities as human beings. As Warren suggested, the work of ethnography ‘is that of lived experience, set in an eternal present’ (2002: 85). Thoughtful and attentive descriptions of embodied experiences lead to what Sharma et al., endorse as ‘connection and, as a result, serve as a heuristic approach to generating new insights into social relations’ (2009: 1648). Attending to embodied experiences furthers our understandings involved in understanding localized and situated meanings for achieving social change. This is a strength of reflexive embodied ethnography because when we embrace the positionality to reciprocate care for co-participants in the field, we are perhaps better able to understand or imagine their health experiences and practices. Thus, reflexive embodied ethnography with applied sensibilities offers a dedicated methodological orientation that embraces and examines our visceral and susceptible ways of being in the world while emphasizing their potential for accomplishing meaningful social change in the context of health practices.
Footnotes
Acknowledgements
The author would like to thank Dr. William Rawlins for his generous feedback and support in preparing this manuscript.
Declaration of Conflicting Interests
The author declares that there is no conflict of interest.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.