A method for understanding eating disorders in India
“I want to know about you.”
“What do you want to know?”
“Everything. Every. Thing.”
I arrived to this place,
expecting to conduct a number of interviews,
and here I am, the inspiring interviewer,
giving more answers than I manage to obtain.
Extract from fieldnotes, March 4, 2011
Eating disorders have been widely discussed in western countries in both medical and social science literature, and the explanations of causes as well as discourses on the topic are numerous (Malson 1998). One type of eating disorder is anorexia nervosa, characterized by refusal to maintain one’s body weight at or above a minimally normal weight for a specific age and height; intense fear of gaining body weight or becoming fat; distorted experience of body weight and shape; and amonorrhea or the absence of at least three consecutive menstrual cycles (APA 2000: 583-584).[note 1]Other categories include bulimia nervosa, referring to recurrent episodes of binge eating followed by vomiting (APA 2000: 590), and Eating Disorders Not Otherwise Specified (EDNOS), such as binge eating disorder with an essential feature of overeating (APA 2000: 786-787).
The discourse relating anorexia nervosa to distorted body image first emerged in Europe and North America where the media, particularly television and fashion magazines, have been claimed to propagate the image of the ideal thin body, leading to the vicious circle of low self-esteem and dieting especially among young women (e.g. bordo 2003 ). It has been suggested that the western ‘thin ideal’ is spreading around the world and becoming internalized by some individuals, thus increasing the risk for eating disorders (jung & Lee 2006; Van Hoeken et al. 2010).
There are, however, only a few studies of eating disorders in India (e.g. Srinivasan et al. 1995, 1998; khandelwal et al. 1995). Interestingly, the majority of cases described in these studies have little to do with the glorification of thinness, but are rather what Lee (1994) describes as atypical non-fat-phobic anorexia. This paper is based on an ethnographic case study of just such a non-fat-phobic eating disorder in rural India. I came across this phenomenon not by actively looking for it, but through a friendship I established while volunteering for two months in the region. In February 2011, I travelled to a small, remote village I will call Tolpur,[note 2]To secure the anonymity of my informants, the names of people, places, and organizations mentioned in this paper have been changed or omitted. Quotations, originally in English, have been edited for minor language mistakes to enhance reading and comprehension.
under the Himalayan mountains in uttarakhand, a state in north India bordering china and Nepal, to ‘see what was there’ worth examining for my Master’s thesis in medical anthropology. I was hoping to discover some problem that was unique to the region by spending time with the local people. For this reason I volunteered at a large local non-governmental organization (NGO) that has been carrying out projects related to health as well as women’s empowerment and development. I joined their branch office in Tolpur where the staff focused on bringing biomedical doctors and pharmacists to deliver health services to the poor rural inhabitants. In this way, I was able to gain access to many villagers, but I actually spent most of my time with my Indian co-workers.
One of my co-workers was Rachna, a 24-year-old unmarried allopathic pharmacist from a middle class brahmin family who was also engaged by the same NGO and who was experiencing considerable difficulties with eating. As the outcomes of my ethnographic case study showed, Rachna’s eating disorder included several different, yet interrelated aspects, indicating that her condition was highly complex and also specific to the place and time in which she lived. In the context of her Hindu religion, food refusal can be understood as a form of resistance, but also as a way of renouncing. More strikingly, however, Rachna’s story shows that disturbed eating may also be related to the recent development and modernization of the region, particularly through the introduction of western style education and the higher possibility of employment for women. These social changes interact with the Hindu beliefs about food sharing and residence, two crucial aspects in the construction of personal identity. My case study showed that the disruption of these principles may negatively affect one’s eating habits, leading to harmful consequences for one’s general health and well-being.
Rather than the results of my fieldwork, however, this article focuses on the methodology of friendship that I used in the process of trying to understand Rachna’s thinness and weakness. I based my research on a single case study as the length of time for my fieldwork (two visits of ten weeks in total) was relatively short and not sufficient to find other girls with disturbed eating in the region and conduct ethnographic research with them. Instead, I decided to investigate one case in as much detail as possible. Ethnographic case studies are particularly useful in allowing researchers to better comprehend the particularities and complexities of a single case in its context (Stake 1995). As beveridge (in kuper & kuper 1985: 95) notes, “[m]ore discoveries have arisen from intense observation than from statistics applied to large groups.” Moreover, ethnographic case study methods have proved to be especially useful in studying women and their emancipation from a feminist, post-structuralist point of view (Gallant 2008). The multivocality, fluidity, and heterogeneity which arises through personal narratives is acknowledged in the study of Indian Hindu women in particular (Lamb 2000; Gold 1994; Sax 1994). In this article, I describe and reflect on the way in which the friendship between my informant and I unfolded and how it intertwined with my role as a researcher. Specifically, I want to demonstrate how friendship was a particularly useful approach for the study of eating disorders in their locally and culturally specific context.
Friendship in construction: The beginnings
Choosing the research topic through friendship
The first time I met Rachna was when she visited the NGO office in Tolpur, where I was also based, in order to participate in a staff meeting. Her task as a pharmacist was to overlook a dispensary clinic, a small, cold room, full of various allopathic medicines, pills, lotions, and bandages, in an even remoter village high above the main road running through the valley. She worked there, by herself, from 9.00 in the morning to 2.00 in the afternoon, every day except Sunday. She generally spent her afternoons alone, in a rented room without a television, where she tried to read texts by Shakespeare and Eliot for her Master’s degree in English. In rural India, where a woman of her age is usually already married, engaged or in the process of finding a husband through arranged marriage, to live and work alone in a village where she has no relatives is a very unusual situation. Patriarchy remains strong and women, especially when they are young, thus “remain subordinated in local and regional gender hierarchies” (Dyson 2008: 165; cf. Sax 1991; klenk 2003). Rachna’s lifestyle was therefore quite atypical in comparison to the lifestyles of her peers.
what I found most striking about Rachna were the many contrasts she embodied. Despite her occasional shyness, something in her behaviour expressed determination, even bold stubbornness to act and think differently from the majority of other people I met in uttarakhand, particularly when it came to the position of women in that society. Such an impression of Rachna’s personality contrasted sharply with her shadow-like figure. I could hear the sound of her low, yet unusually high, heels; I could see her huge, fluttering suit; but I was stunned at her thin wrists, sunken cheeks, and a waist that appeared almost non-existent. Although she was shy at first, I could feel her presence moving persistently into my field of vision. we took time to approach each other but in retrospect it seems that we were both determined from the very beginning to build a friendship. The people I met in uttarakhand were all very curious about foreigners and I also learnt from my informants that hosting a foreigner in one’s home brings some prestige for the host as well (cf. barrett 2008). Not surprisingly then, almost everybody I came across was interested in being close to me. but this young woman was obviously looking for something more than a brief and superficial encounter. Later, I realized she was hungry for a deeper connection, a friendship that I would value enough to return to this faraway place for. That was indeed what happened and this is how, before I even knew it, my informant, and thereby my research topic, chose me as much as I chose her.
In September 2011, I returned to India to stay at Rachna’s home for another month. She was recovering from typhoid fever which has caused her to stop working several months earlier and return to her parent’s house where they could take care of her. I came to her village as both a friend and a researcher. I had decided I would focus my research on her problems with food and eating for two reasons. Not only was I looking for a research topic for my thesis, but I was becoming increasingly involved in the friendship, and hence my concern for Rachna’s health and well-being also grew. Rachna’s doctors, all trained in western biomedicine, treated her with antibiotics but also with appetite stimulants. when I discussed Rachna’s health problems with several biomedical doctors in Slovenia, all of them suggested that she suffered from anorexia nervosa, which was most likely the cause of her weakened immune system, too. but Rachna’s condition seemed to have little in common with anorexia nervosa as known in the west, especially in terms of disordered body image and fat-phobia, neither of which she expressed. I wanted to explore this issue further. what does it mean “to be so thin and weak,” as Rachna herself and others described her, for a young woman in contemporary rural India? could Rachna’s state indeed be described as anorexia nervosa, given that her doctors gave her appetite stimulants? Or was Rachna’s condition somehow specific to her culture and environment?
To answer these questions, I chose to focus on Rachna’s personal narrative of her life story. Rachna became my main informant while I supplemented what she told me with my own observations of her relationships and behaviour at work and in her home. Validity and reliability of personal accounts additionally increase when different parts of one’s story are confirmed through the process of triangulation whereby different methods such as observation, interviews, and document review are used (Stake 1995: 114). Accordingly, the parts of Rachna’s story that were most important for my analysis, such as the time when she first started losing weight at the age of 19 as a student of pharmacy, have been verified by her family members or co-workers. The reviewed literature on the region (e.g. Sax 1991, 2002, 2009; Polit 2006) was an invaluable source that added significantly to my understanding of practices and the worldview of the people in uttarakhand, especially since my fieldwork was so short. but the most important method I used to gain the information about Rachna’s life, concerns, struggles, decisions, fears and relations significant to her eating disorder was friendship.
Finding the self in the other: Crossing the cultural borders through friendship
According to Rawlins (1992: 271), a close friend is defined as “somebody to talk to, to depend on and rely on for help, support, and caring, and to have fun and enjoy doing things with.” In the social sciences, friendship as a category of interpersonal relations has not been as scrupulously investigated as, for example, marriage, perhaps because in contrast to marriage it does not have religious or legal grounding (Rawlins 1992). Thus, friendship is “the most fragile social bond” (werking 1997: 18) which is founded, maintained and dissolved in the most informal way and on the basis of common interests, sense of union, and emotional attachment (weiss 1998). However, friendship also provides a resource for one’s own identity and adds in significant ways to the formation, reinforcement and changes of self and other through one’s relationships (Tillmann-Healy 2003). As such, friendships “confirm more than contest conceptions of self because we are prone to befriend those who are similar to ourselves, those more ‘self’ than ‘other’” (Tillmann-Healy 2003: 731). Friendship is an important part of childhood when young persons typically seek friends among persons of the same age, gender, and physical characteristics, and adolescents form relations with those who belong to the same or similar school grade and social standing (Rawlins 1992).
This is also true in India, but in rural uttarakhand adolescents, and girls in particular, rarely have opportunities to meet their friends outside school; the time spent with friends, trying out each other’s new saris, writing letters, singing and dancing, becomes even more restricted after marriage. As Polit (2006: 80) explains, in contrast to a married woman who is surrounded by her relatives and whose relationships with other women are based on mutual obligations and restrictions, friendships between unmarried girls in uttarakhand are characterized primarily by mutual trust. Married women, according to Polit (2006), are in a hierarchical relationship to other women in their village, but unmarried friends are not in such a relationship since they do not have any commitments to each other and they know they probably will not see each other often once they marry and leave their village to live with their husbands and in-laws.[note 3]Friendship is also related to gendered performative practices. In uttarakhand, friendship among adolescent boys, who always remain inhabitants of the village in which they were born, differs greatly from that among girls; as their friendship is potentially important for political reasons, financial support, assistance in times of need and so on, boys and men are always in a hierarchical relation to each other (Polit 2006: 80).
If one tends to form friendships with people who are in some way similar to oneself, what was it that drew Rachna and me together? After all, we come from completely different cultural backgrounds (South Asian and west European), speak different mother tongues (Hindi and Slovenian), hold different religious beliefs (Hindu and atheist) and so on. we are of similar age, with me being slightly older, but during my fieldwork I met many other girls in their twenties with whom I did not establish such a close friendship. Interestingly, Rachna told me her best friends have always been foreigners, specifically two or three persons from abroad she has met through her volunteer work in a school, founded by the same NGO that employed her three years later as a trained pharmacist. It is telling that Rachna was not keen on making friends with other Indians, especially once she completed her schooling, but was exceptionally prone to establishing friendly relations with foreigners. Here is what she told me:
I had three friends when I was in college. we shared a room. One is married now and expecting a baby, the other two are somewhere in uttarakhand now. we don’t talk much, very rarely … but in my last year of college, I became less social. I found out that I don’t mind being alone. I can stay in my room alone the whole day, but other people here can’t do that. … Here, in the village, I can’t talk to people. I don’t know what to say to them. My sisters always chat, about this and that, but I don’t know how to do that. My sisters constantly scold me for this, they tell me I’m not sociable enough and that’s not good. I know I should talk to people, but … You can’t make true friendships with Indians. You only get to know them through one relation or another, but never just like this, because you feel good around them. with foreigners it’s different. They’re very nice to me. I like them, my best friends are foreigners.
As other members of her family and also neighbours confirmed, she was indeed the only one in the village to ever bring foreigners, including me, to visit her village and stay at her home.
From my part, I found Rachna interesting right away for several reasons. Her English proved to be far better than anybody else’s around me, but that was not all. As the thirty-something year old man in charge of the project Rachna and I were both working on described her, Rachna’s “thinking [was] different.” The project manager and his assistant, a hardworking young man, both agreed about this and pointed out to me on several occasions that she was trying to evade the social rules of the rural Indian society, for example by resisting the authority of men at work. “I don’t like,” concluded the project manager, from which I was unable to discern whether he referred to Rachna as a person, to her attitude, or perhaps both. These men at Rachna’s workplace declaratively embraced the socially defined gender roles whereby the women are subordinated to men first as daughters, then as wives. but what they saw as misconduct and a breach of generally acknowledged rules of behaviour, I found extraordinary and courageous. Only later did I realize that my informant was actually quite similar to me in character, but more importantly, in personal struggles and actions. Similarly to Rachna, I was, especially at her age, under pressure to live in a certain socially expected way – acquire my own housing, marry and have a family as soon as possible after finishing my studies. It is what people in Slovenia, where I come from, usually do. However, the life of an anthropologist, which I wanted for myself, demands more flexibility, with frequent traveling and even living in different countries. It took a lot of determination for me to persevere in my chosen career path, which differed greatly from the expectations of those closest to me.
Through my friendship with Rachna, I thus came to understand that the struggle of (often, but not necessarily) young women to carve out their individual path in the face of mainstream society is both culturally specific, due to the sheer diversity of societies around the world, but also universal. when a daughter asks her parents for support, her intentions, wishes, fears, and efforts, are very different if she is canadian, Slovenian, or Indian, and so are the consequences of this action for her, her family and the wider social circle. On the other hand, however, women all over the world are trying to assert themselves against the expectations of their social environment. The fact that Rachna and I experienced a similar endeavour represented a solid ground for our friendship as well as for my increasing wish to understand the circumstances of her physical weakness in the context of her culture and the social changes that she faced.
My friendship with Rachna therefore contrasts sharply with those described by Rabinow (2007 ) in his Reflections on fieldwork in Morocco. According to Rabinow (2007: 161), a different culture can only be grasped when the anthropologist meets an informant, a friend who is “profoundly Other” to the researcher. Rabinow’s ordering of informants according to the level of increasing ‘otherness’ emphasizes the essential difference between ‘us’ and ‘them’ and implicitly supports the Orientalist discourse in academia (beal 1995). In contrast, I would argue that the political and historical context, which unquestionably shapes the fieldworker’s encounter with a certain society, should rather be considered without underlining the separation of self and other. To do otherwise simply maintains the stereotype of the latter as inherently incompatible and unknowable. For me, reaching across differences of class, gender, religion and so on, discovering a connection (however blurred it may seem at first), and establishing friendship, has been a far more productive way of understanding the other in ethnographic research. In the following section, I further discuss the significance of personal narrative which may be revealed through a close friendship as a particularly useful method in the study of eating disorders in general and in India in particular.
Eating disorder in India revealed
Friendship is inherently subjective and therefore this method could be critiqued by a science which is historically grounded in the positivist paradigm (uberoi 1978). However, friendship as a method can be defended when reinterpreted within the framework of feminist and postmodernist theory. Feminists have largely criticized positivism and discredited the idea of objective scientific inquiry (e.g. Harding 1991). Haraway (1988: 583) thus argues that “[f]eminist objectivity is about limited situation and situated knowledge, not about transcendence and splitting of subject and object.” when validity is understood as always socially constructed and situated (Scheurich 2001 ), friendship can no longer be questioned as a valid qualitative method. Furthermore, the tension between epidemiological reliance on counting and anthropological understandings of the world as dynamic, incoherent, and relative is particularly pronounced in medical anthropology (Littlewood 2007). However, since epidemiology isolates individual variables but does not account for the links and frictions between them, it is itself much more illusory than is often recognised (Mol & Law 2004). That is why, as Mol and Law (2004: 58) suggest, ethnographic recounting, which produces rich narratives, is a more appropriate technique than epidemiologic accounting for examining problematic concepts related to health. I suggest this is especially true when it comes to exploring eating disorders.
Rather than using surveys, questionnaires or formal interviews, the information I obtained during fieldwork was gathered through friendly conversations, daily interaction, empathy and compassion. Through such a dialogue, in which both Rachna and I were involved as subjects instead of Rachna being treated as my research object, I joined my academic knowledge to her everyday experience and practice in order to come to profound new understandings of disordered eating. kumar (1994: 1-2) argues that women’s perspectives in South Asia are frequently “glossed over” by male ones, especially as their marginalization may be double, based on both gender and class. Investigation of Rachna as a thesis subject responds to kumar’s (1994: 3) complaint that research on the implicit forms of protests through small changes in daily life among South Asian women has been limited. However, I must emphasize that I never treated Rachna as an ‘object’ of my study. I do not see myself as ‘giving voice’ to a powerless Indian woman who is incapable of representing herself. Instead, I adopt Polit’s (2006: 5) view that “Garhwali women can represent themselves very well.” Although I report Rachna’s story within a framework of my choice, based on my personal and academic background, I try to convey her story as faithfully as possible, the way it was unveiled to me through our everyday conversations. Towards this end, I agree with kumar’s (1994: 4) view that women can only be conceptualized as subjects by exploring the structures within which they live and which seem to control them while observing how they subtly exercise their agency yet still manage to exist as a part of the repressive normative order.
Moreover, case studies containing “a substantial element of narrative” (Flyvbjerg 2011: 311) have been claimed to be particularly important in both shaping and trying to comprehend a disorder such as anorexia nervosa. As Gillett (2003: 140) argues, the phenomenology of anorexia can only be understood through the sufferer’s narrative and discourse about herself. In order to grasp actions of those with eating disorders we thus need to engage in a discursive pattern of explanation in which empathy plays the central role (Gillett 2003: 150). Similarly, kirmayer (2000: 154) maintains that narrative, often “broken” into separate reports of symptoms and senseless behaviours that become coherent only during the course of psychotherapy, is a way people form an intelligible, morally valued identity and sense of self which are importantly linked to the occurrence and meanings of disordered eating. The construction of Rachna’s narrative, broken into bits and pieces of self-reflection that she provided during our conversations, is thus the most effective way to demonstrate this connection. To make sense of these numerous fragments, however, it proved particularly useful to construct three timelines which I then combined in order to understand the progress of Rachna’s eating disorder against the events that were going on in her life. Along the first time line, I arranged the main events related to her education, changes in place of residence, and work from age 18 to 24. On the second time line, I noted what was Rachna’s greatest concern in each of those years. On the last time line, I noted the changes in Rachna’s weight which fell from 55 kilograms at the age of 19 to 38.5 kilograms at the time of my fieldwork. The drawing of these time lines enabled me to arrange Rachna’s broken narrative into a clearer picture of her life and illness.
Finally, the conversations Rachna and I had also made her reflect on her own situation, personal development and the decisions that she had taken in the past five years since her problems with eating first started. As she told me, she discussed some very sensitive issues, for example her relationship with her father and other family members, for the first time in her life when she was trying to explain the family dynamics to me. by expressing her concerns about some of her closest family members as well as feelings of self-insufficiency (as she was not able to provide work or income due to her physical weakness for several months), she was able to come to terms with her psychological weaknesses. Rather than maintaining the status quo of Rachna’s situation, our friendship provided for a high degree of what Lather (1986: 67) calls “catalytic validity” as it enabled her to become empowered and self-conscious through the research process. At the most concrete level, this meant our discussions helped her understand her own behaviour and her family better and thus enabled her to take a step towards recovery. Shortly after my fieldwork, she left her home again, returned to work and slowly started gaining weight.
Ethical concerns and power relations within friendship
As Tillmann-Healy (2003: 737) observes, friendship as a method can facilitate depths of understanding that other scientific methods by themselves cannot deliver, for researchers learn about informants not only by reading literature on the historical and political background of their society and by observing their actions, but may, through compassion and care, experience them emotionally and spiritually as well. For that to happen, the friendship should take a natural pace, but my fieldwork was very brief. This could be problematic since some details of a life history may only come to light after several years of friendship with the informant (Parry 2004: 285). Furthermore, my inquiry touches important ethical issues. As Tillmann-Healy (2003: 745) claims, “[c]onfidentiality and informed consent become ongoing negotiations” when using friendship as a method since this involves the same risks as any friendship. kiesinger (1995), for example, describes how her ethnographic study of disordered eating through friendship forced her, the researcher, to examine her own vulnerabilities and her relationship with food. but I was more worried about how to explain my double role to Rachna. How do I obtain answers to very personal questions which I would probably not ask were it not for my research? After all, we only knew each other for several months and deep trust may take much more time to develop.
However, once I was in Rachna’s home, I was struck by how rapidly the events, stories, and confessions started to unfold. by undertaking the second long trip from Europe just to spend time with Rachna and her family I implicitly confirmed that our friendship was valuable. Yet when I explained to Rachna that my visit was twofold, since I was returning both as friend and researcher, and asked for her consent to participate in my study, I was not certain that she had understood what this implied. The confirmation came unexpectedly about two weeks later when Rachna suddenly asked me why I was conducting this research at all. I then explained my own story to her and described the struggles that I myself had to face when deciding about my career, particularly the tensions my choices caused in relationships with my extended family. It brought a smile to my face when she exclaimed, “but that’s like me!” As I was hoping, she was able to identify with my explanation. This consequently led to both a strengthening of our friendship and Rachna’s increased awareness and preparedness to reveal details about herself. Her trust and openness undoubtedly helped improve the validity and reliability of my research. It also indicated, however, that our friendship was not an ordinary one, characterized only by the time you spend together having fun. we talked about some parts of her life in great detail in order to understand her condition, and this was work. Rachna also reminded me that the test of our friendship was yet to come. while we certainly became friends at our first encounter, well before my more formal research began, it is also very likely that I would not have returned to her so quickly, in the same year, had it not been for my study. So when I was assuring Rachna and her family that I really enjoyed staying with them (which I did) and that I would otherwise surely not have come back at that time (which is true, although I would probably have done so later), she smiled and said, “when you come the next time, then I will know that you really like it here.”[note 4]I have not yet returned to Rachna’s village following my fieldwork there, but we have been in regular contact over the phone and e-mail.
The final concern that friendship as method raises is related to power relations. As I mentioned above, my aim was to create a relationship between two subjects, thus not a hierarchical one between the researcher and her subject. whether this is possible at all has been questioned in anthropological literature. crick (1992), for example, argues that the relationship between a researcher and informant is always marked by differences in power, culture, and class. Similarly, El-Or (1992: 71) claims that the intimacy of friendship “offers a cozy environment for the ethnographic journey, but at the same time an illusive one” since in her view, intimacy and working relationships go against each other. Hendry (1992), too, suggests that the researcher can only pretend to be a friend of the informant because their relationship is constantly at stake due to the potential role conflict, disagreement and offence. However, as Tillmann-Healy (2003: 744) notes, field relationships are generally characterized by the power imbalance between the two involved parties and while this may lead to colonization and exploitation, it is exactly friendship as method that seeks to prevent this.
Nevertheless, it remains true that I was the one to determine what I would write in my thesis about Rachna, whether or not I would use pseudonyms, and how the information would be arranged, analyzed and interpreted. whatever I write about Rachna is thus not a true co-authorship and as such the hierarchical difference between us cannot be denied (cf. Tillmann-Healy 2003: 746). The motivation Rachna and I had to establish a relationship were therefore different: I had my professional agenda (producing a good Master’s thesis), but she might also have had her own agenda. Rachna could have been proud to have a foreign friend who returned to uttarakhand with the only purpose of visiting her. As I already mentioned, foreigners are highly respected in rural India and being in contact with them, and hosting them as guests especially, may increase one’s respect in the eyes of one’s relatives and neighbours.[note 5]Sharing food and residence is of special importance in the Hindu religion as food and place are importantly related to the substances that influence and construct one’s personal iden- tity, character, appearance and health (Polit 2006: 62). In relation to food sharing barrett (2008: 123) explains that “[w]hen receiving food from another, a spiritually sensitive person such as yourself will absorb some of the qualities of the person who serves you.” Since the inhabitants of rural India express a great desire to become developed and modernized (Sax 2009: 236), it makes sense to assume that by having a guest from the developed world in one’s house might relate to the hope rural Indians have to become somewhat closer to the lifeworld to which they aspire; furthermore, this may also increase the respect they receive from their community.
could Rachna have manipulated the impression I had of her and tried to represent herself and her eating disorder in such a way that I would find her interesting enough to return to her village?
while that is a legitimate concern, I do not believe that was the case. First of all, when Rachna and I first met, we were not in a researcher-informant relationship and I did not know at that time that I would study eating disorders or include Rachna in my anthropological inquiry. Our friendship was thus established before Rachna became my informant. Moreover, Rachna herself was not well acquainted with the western concept of anorexia nervosa nor was she aware of the various factors that were likely to play a role in her problems with eating. These only became clearer to both of us during our extensive conversations and although I continually tried to be critical and reflexive I never had the slightest suspicion that she would want to manipulate her answers in order to please me. Finally, what drew Rachna and I together was indeed more important than my thesis. These were the similarities between us described above which can be summarized by the statement that we were both ‘thinking different’ from those around us. Our friendship was thus strong not because it originated from fieldwork, but because it was based on similar genuine, challenging, and important shared experiences.
Friendship is an ambiguous relationship even in everyday life, especially in comparison to other relationships with relatives and in-laws that are more distinctly defined, established and maintained. It is therefore not surprising that friendship in the field, between a researcher and an informant, is laden with a number of difficulties. The degrees of friendship are “determined by varying levels of familiarity, rapport, respect and emotional attachment,” but this relationship is also “problematized due to reasons of professional motivation, power imbalance, cultural differences, inequalities in purpose and potential gain” (Taylor 2011: 8). Thus, the meaning of friendship is subject to variation and context. However, when this is kept in mind during fieldwork and when the ethics of friendship (Tillmann-Healy 2003) are observed, I suggest that friendship may represent an indispensable qualitative method, especially in the field of medical anthropology.
In this article, I described how friendship served as a valuable method for my research of a case of non-fat-phobic eating disorder in rural north India. I presented an account of how my friendship with Rachna, my informant whose life story represented the basis for my ethnographic case study, was formed and how it developed. In contrast to seeing my informant as “profoundly Other” (Rabinow 2007), I found Rachna strikingly similar to me in both personal characteristics and life circumstances, particularly those that had to do with individual choices and decisions made against the general expectations of our respective mainstream societies. The basis of our relationship was thus not my research, but a sincere friendship that was grounded in common experience. It was only possible for me to realize this after a deep self-exploration, an approach which has been on the one hand called for in anthropology (clifford & Marcus 1986), but on the other hand critically referred to as “narcissistic” (bourdieu 2003: 287) and even “diary disease” (Geertz 1988: 89). In contrast to the latter views, I illustrate in this article that self-exploration is not a mere end in itself, but has significant methodological and analytical relevance.
while friendship as method has been criticized for being too subjective and problematic as a research tool, it proved to be a highly useful technique during my field-work. I was invited to Rachna’s home as a friend and I was also well received as a researcher. Rachna made an effort to answer my questions and to help me understand her condition as she tried to grasp it herself at the same time. Despite the possibility of my informant manipulating our relationship to follow some hidden agenda, I would never say that she tried to misrepresent herself in order to attract my interest. Friendship thus offered me a way to gather a large amount of significant information in a very short time. It also helped me avoid feelings of fieldwork as an exploitative endeavour because of its high catalytic validity which was beneficial not only to me, but also to my informant. During our extensive conversations, Rachna was able to reflect on her life and health condition which eventually led to her empowerment and even towards the beginning of what seemed to be recovery.
The choice of method is always intrinsically related to the research question, but also to the circumstances of fieldwork. In my study, however, the bits and pieces of Rachna’s broken narrative, obtained on a number of different occasions and in the different settings available to me as her friend, were complemented by my own observations as well as by information supplied by Rachna’s family members and co-workers. coupled with relevant literature, this provided an important insight into a case of eating disorder in India in which personal characteristics and family dynamics are entwined with the Hindu tradition and the changes being brought to the region by development and modernization. No method other than friendship could be more helpful in this endeavour.
Tanja Ahlin obtained a Master’s degree on Health and Society in South Asia (MAHASSA) from Heidelberg university, Germany. Her interests include medical anthropology, particularly in relation to mental health, gender, language, technology, and the Internet. correspondence address: firstname.lastname@example.org.
The author wishes to thank the editors Sjaak van der Geest, Flore Aaslid, and Trudie Gerrits for their comments and the possibility of publishing in this journal; johannes Quack and Lianne Holten for their thorough reviews; Andrew Russell for his ‘finishing touch’; Harish Naraindas for encouraging me in self-reflection and to publish on this topic; bianca brijnath and Patricia junge for friendship and generous sharing of academic knowledge and experience; and Priya Satalkar and other participants at the symposium Ethnography and Self-exploration that took place in Amsterdam on November 19 and 20, 2011, for reading early drafts of this article and commenting on them.
The article is partially based on Chapter 2: On validity of a friendship in science: A note on methodology of my Master’s thesis entitled Diagnosis: Atypical: A Case Study of Eating Disorder in Uttarakhand, India, submitted to Heidelberg university in February 2012.
APA (American Psychiatric Association) 2000 DSM IV-TR: Diagnostic and statistical manual of mental disorders, Fourth edition (Text Revision). New York: Routledge chapman & Hall.
2008 Aghor medicine: Pollution, death, and healing in Northern India. berkeley, Los Angeles and London: university of california Press.
Beal, E.A. 1995 Reflections on ethnography in Morocco: A critical reading of three seminal texts. Critique of Anthropology 15 (3): 289-304.
2003 Unbearable weight: Feminism, western culture, and the body. berkeley, Los Angeles & New York: university of california Press. 
Bourdieu, P. 2003 Participant observation. Journal of the Royal Anthropological Institute 9 (2): 281-94.
Clifford, j. & G.E. Marcus
1986 Writing culture: The poetics and politics of ethnography. berkeley: university of california Press.
Crick, M. 1992 Ali and me: An essay in street-corner anthropology. In: j. Okely & H. callaway (eds.), Anthropology and autobiography. London: Routledge, pp. 175-92.
2008 Harvesting identities: Youth, work, and gender in the Indian Himalayas. Annals of the Association of American Geographers 98 (1): 160-79.
1992 Do you really know how they make love? The limits on intimacy with ethnographic informants. Qualitative Sociology 15 (1): 53-72.
2011 case study. In N.k. Denzin & Y.S. Lincoln (eds.), The SAGE handbook of qualitative research. Thousand Oaks, cA: Sage, pp. 301-16.
Gallant, M. 2008 using an ethnographic case study approach to identify socio-cultural discourse: A feminist post-structural view. Education, Business and Society: Contemporary Middle Eastern Issues 1 (4): 244-54.
1988 Works and lives: The anthropologist as author. Stanford: Stanford university Press.
2003 Form and content: The role of discourse in mental disorder. In: b. Fulford et al. (eds.), Nature and narrative: An introduction to the new philosophy of psychiatry. Oxford: Oxford university Press, pp. 139-54.
Gold, A.G. 1994 Gender, violence, and power: Rajasthani Stories of Shakti. In: N. kumar (ed.), Women as subjects: South Asian histories. charlottesville & London: university Press of Virginia, pp. 26-48.
1988 Situated knowledges: The science question in feminism and the privilege of partial perspective. Feminist Studies 4 (3): 575-99.
Harding, S. 1991 Whose science? Whose knowledge? Thinking for women’ s lives. Ithaca, NY: cornell university Press.
1992 The paradox of friendship in the field: Analysis of a long-term Anglo-japanese relationship. In: j. Okely & H. callaway (eds.), Anthropology and autobiography. London: Routledge, pp. 163-74.
Jung, j. & S.H. Lee 2006 cross-cultural comparisons of appearance self-schema, body image, self-esteem, and dieting behavior between korean and u.S. women. Family and Consumer Sciences Research Journal 34 (4): 350-65.
khandelwal, S.k., P. Sharan & S. Saxena
1995 Eating disorders: An Indian perspective. International Journal of Social Psychiatry 41 (2): 132-46.
Klenk, R. 2003
Broken narratives: clinical encounters and the poetics of illness experience. In: c. Mattingly & L.c. Garro (eds.), Narrative and the cultural construction of illness and healing. berkeley, Los Angeles & London: university of california Press, pp. 153-80.
“Difficult work”: becoming developed. In: k. Sivaramakrishnan & A. Agrawal (eds.), Regional modernities: The cultural politics of development in India. Stanford: Stanford university Press, pp. 99-121.
Kumar, N. 1994 Introduction. In: N. kumar (ed.), Women as subjects: South Asian histories. charlottesville & London: university Press of Virginia, pp. 1-25.
Kuper, A. & j. kuper (eds.)
1985 The social science encyclopedia. London: Routledge & kegan Paul.
2000 White saris, sweet mangoes: Aging, gender and body in North India. berkeley: university of california Press.
Lather, P. 1986 Issues of validity in openly ideological research: between a rock and a soft place. Interchange 17 (4): 63-84. Lee, S.
1994 The definition of anorexia nervosa. British Journal of Psychiatry 165 (6): 841-42.
Littlewood, R. (ed.)
2007 On knowing and not knowing in the anthropology of medicine. walnut creek, cA: Left coast Press, Inc.
Malson, H. 1998 The thin woman: Feminism, post-structuralism and the social psychology of anorexia. London & New York: Routledge.
Mol, A. & j. Law
2004 Embodied action, enacted bodies: The example of hypoglycaemia. Body & Society 10 (2-3): 43-62.
Parry, j.P. 2004 The marital history of ‘a thumb-impression man’. In: D. Arnold & S. blackburn (eds.), Telling lives in India: Biography, autobiography, and life history. Delhi: Permanent black, pp. 281-318.
2006 Keep my share of rice in the cupboard: Ethnographic reflections on practices of gender and agency among Dalit women in the central Himalayas. Heidelberg university: open access. Available at http://archiv.ub.uni-heidelberg.de/volltextserver/ volltexte/2010/10671/. Accessed january 10, 2012.
Rabinow, P. 2007 Reflections on fieldwork in Morocco. berkeley & Los Angeles: university of california Press. 
1992 Friendship matters: Communication, dialectics, and the life course. New York: Aldine de Gruyter.
Sax, W.S. 1991 Mountain goddess: Gender and politics in a Himalayan pilgrimage. New York, Oxford: Oxford university Press.
1994 Gender and politics in Garhwal. In: N. kumar (ed.), Women as subjects: South Asian histories. charlottesville & London: university Press of Virginia, pp. 172-210.
2009 God of justice: Ritual healing and social justice in the central Himalayas. Oxford: Oxford university Press.
Scheurich, J. J.
2001 Research method in the postmodern. London: Routledge Falmer. 
Schwandt, T.A. 1994 constructivist, interpretivist approaches to human inquiry. In: N.k. Denzin & Y.S. Lincoln (eds.), Handbook of qualitative research. Thousand Oaks, cA: Sage, pp. 118-37. T.N., T.R. Suresh, V. jayaram & M.P. Fernandez
Srinivasan, 1995 Eating disorders in India. Indian Journal of Psychiatry 37 (1): 26-30.
Srinivasan, 1998 Emergence of eating disorders in India. Study of eating distress syndrome and development of a screening questionnaire. International Journal of Social Psychiatry 44 (3): 189-98. Stake, R.E.
1995 The art of case study research. Thousand Oaks, cA: Sage. Taylor, j.
2011 The intimate insider: Negotiating the ethnics of friendship when doing insider research. Qualitative Research 11 (1): 3-22.
Tillmann-Healy, L.M. 2003 Friendship as method. Qualitative Inquiry 9 (5): 729-49.
Uberoi, J.P.S. 1978 The other mind of Europe: Goethe as a scientist. Oxford: Oxford university Press.
Van Hoeken, D. et al. 2010 The incidence of anorexia nervosa in Netherlands Antilles immigrants in the Netherlands. European Eating Disorders Review 18 (5): 399-403.
1997 We’re just good friends: Women and men in nonromantic relationships. New York: Guilford.