The intersubjective as analytic tool in medical anthropology

Marian Tankink, Marianne Vysma

Abstract

If a person can only apprehend reality by way of his own constructions of this reality, how is it that the anthropologist can presume to understand the informant? This question forms the foundation of the current article, which considers the influence of the subjectivity of the anthropologist on the research process, in particular in the context of the intersubjectivity with the informant. The authors maintain that increased scrutiny on intersubjectivity would provide insight into the process of knowledge-production by throwing light on the role of the researcher. Subjects that are considered as part of the exploration of this topic include: intersubjectivity as a conceptual framework and the relationship between intersubjectivity and the ‘cultural other’. In addition, there is a discussion on how intersubjectivity, in terms of transference and counter-tranferential processes, can be used as an analytic tool in anthropology. Finally, this article hopes to inspire readers to participate in the symposium on this topic on 18 January 2007. (See for call papers under ‘berichten’)

People would not have anything to say to each other if they were not different, but they would not understand each other if they were not the same (Arendt 1958: 155)

How does personal experience with the topic you are researching influence the research process? In other words, what effect does your own subjectivity have on the various parts of the research process, from the choice of topic to the conducting of the interviews to the analysis of the data to the writing of your articles and even to selecting and using literature?

This question has occupied us for some time and we have individually and together spent considerable effort in trying to determine how our own subjective experiences color our research process. And, on the other hand, how our own history is an impetus for us to engage in our research.         

As an attempt to expose our own subjective position, we will here briefly introduce our research and ourselves. Marian Tankink, a former community psychiatric nurse, is a medical anthropologist at the Leiden University Medical Center and is working on her PhD thesis on research among refugee women from Afghanistan, Bosnia, and South-Sudan who experienced sexual violence as part of the conflict in their countries of origin or during their flight. She is primarily interested in the differences and similarities in meaning production and health-seeking strategies. In addition, she has done fieldwork in Uganda on the role of Pentecostal churches in the working through of war-trauma. Marianne Vysma is an analytical psychologist in private practice, as well as a medical anthropologist who has done research on the role of dreaming as part of recovery from war-trauma and is now doing research on spirit possession as an idiom of distress.  Interviewing people with traumatic experiences puts us into close contact with the effects of the destructive side of human nature and in order to cope with that confrontation, issues of subjectivity and intersubjectivity, distance and proximity, as well as (counter-)transference are brought into sharp relief.         

We are not interested in these questions in order to eliminate subjectivity from the research process in an attempt to imitate the exact sciences which in any case we believe to be impossible; rather, we are interested in exploring these questions because it would increase the insight into the production of knowledge by adding transparency to the ‘black box’ of the research process: the researcher him/herself. Because intersubjectivity is a contextual-related dynamic interaction, we are of course aware that the researcher is a pawn in the game of the respondent as well; nonetheless, we will limit ourselves in this paper to exploring this issue from the side we know best: the researcher because it is our contention that the first step to gaining insight into this ‘dynamic interaction’ is to take a look at your own subjectivity.           

As part of this exploration we pose a question that is fundamental to anthropological research: How is it that the anthropologist can presume to understand the informant? How is it that an anthropological researcher can be reasonably certain that he can grasp the meaning of a behavior or utterance of another?  How is it, in short, that the anthropologist and the informant collaborate and together construct meaning?          

A person is only able to know reality by his own constructions and own reasoning; this subject-based experience, or subjectivity, is always partly individual and partly collective, that is: given by the culture and history, as well as the social and familial environment, and shared by others. Any one person’s individual subjectivity, even where there is much that is shared with another, in the normal course of life often comes up against the differences of another’s subjectivity. These differences are mediated through communication, which allows one person to share his subjective experience with another thereby creating moments, or spaces, of intersubjectivity.  By communication we do not only mean language, but also non-verbal communication, such as body-language, clothing, and smell.          

Also on a collective level, the concept of intersubjectivity presumes that society comes to agreements about shared meaning and values that can be articulated through language. Such collective agreements do not have the status of objective truth, but merely mean that people use the same framework, standard, or procedure when communicating with one another. Knowing and knowledge are therefore not solitary issues, but social manifestations.           

We will explore our question as to how we understand and know each other in terms of the concept of intersubjectivity and along the way consider such attendant issues as: transference and counter-transference and with it distance and proximity in order to get insight in one’s own part of the intersubjective space.           

We begin with a brief overview of the conceptual framework of intersubjectivity, including as it has been expounded on and theorized about in the past century. Then we will discuss how the concept of intersubjectivity is used to construct and de-construct the idea of the cultural other. Then we will consider how experience of intersubjectivity is constructed – and lost – in terms of (counter-) transferential reactions. Finally we will present some discussion points and end with a number of open questions.

Intersubjectivity

Intersubjectivity is a complex concept. In this article we will use it in two ways. Sometimes we use it as a noun, to indicate that symbolic space that is created when two subjectivities meet and a shared reality comes into being; when we use it in this way, by symbolic space we mean an emotional reality characterized by the conviction/sensation that the ‘I’ understands and is understood by the other. We have all experienced those ‘aha!’ moments in the research process.             

At other times, we will use intersubjectivity as an adjective, to indicate the dynamic character of this symbolic space: intersubjectivity, as we will attempt to show, is something that – in the normal course of things – is lost and regained all the time.  When intersubjectivity is ‘lost’, there is subjectivity, a state of singularity that on one extreme is characterized by absolute, crystal clear certainty, and at the other is typified by total chaos.  Either extreme state of subjectivity serves as a drive towards ‘intersubjectivity’ (an outward movement) just as, in turn, the experience of ‘intersubjectivity’ stimulates a more inward return to a new subjectivity. In the writing of this paper, for instance, we had moments where we felt we knew: Yes! Intersubjectivity means this! And when we rushed to share it with colleagues, we were met with questions or comments that punctured and deflated our conviction, but that, after a period of disorder brought new insights and understanding. Sometimes it was the other way around, when we despaired of ever having opened this can of worms, and then it was again interaction with colleagues or literature or our own reflections/memories – moments of intersubjectivity – that gave the energy to continue.          

The concept of intersubjectivity in this way can be used as an analytic tool by the anthropologist in his/her research process on several different levels: as a way of reflecting on one’s own assumptions during the selection of the topic, reading of the literature and analysis of the data; to remain aware of one’s own and the other’s subjectivities during the dynamic interaction of the interview process; and as a participant in the professional discourse with one’s colleagues and audience.

Theoretical conceptions of intersubjectivity

In Western societies many philosophers and psychologists have theorized about the concept of intersubjectivity and one common theme is that the other can be recognized through the self that is constructed. Intersubjectivity is a condition sine qua non for human societies and for understanding people within and between cultures because it reduces the distance between I and the other. We will first give a short overview of the different approaches of intersubjectivity.           

The current western philosophical/psychological theory of being considers a person to be a ‘self-constituted unit’ independent of ‘the other’. Husserl brought the concept of intersubjectivity into the spotlight by putting the accent on the importance of the “intersubjective experience for each and every form of knowledge of self and the other”

(Coelho & Figueiredo 2003: 194). In other words, we can only understand an other person in terms of ourselves and ourselves in terms of another. Husserl’s concept of ‘intentional consciousness’ was the tool for many scholars to overcome the problem of the dualities of ‘I—other’ and ‘subject—object’. In Husserl’s early work a person can only know the other through his own consciousness, thus in a mediated form.           

Most philosophers and psychologists/psychiatrists built further on Husserl’s ideas. We order them in three main streams of intersubjectivity in which dimensions of otherness are differently organized: (1) intercorporal (2) intrapsychic and interpersonal; and (3) social. We will look at each of those three streams briefly by discussing their major exponents. It is important to realize that those matrixes of intersubjectivity as described below cannot be seen separately but have to be seen as simultaneous paths in different processes of the formation and explanation of intersubjectivity.  The different dimensions are considered as being supplemental to each other in such a way that together they can be considered a whole.

Intercorporal intersubjectivity

The intersubjective framework of Merleau-Ponty goes to the primal maternal condition – i.e. the existential human experience of a receiving consciousness in its earliest phases of life, such as in the womb and for a post-natal period before the emergence of consciousness – in which the other is a subject of experiences and not of opposition.           

Merleau-Ponty rejects the ‘disembodied, transcendental ego’ of Husserl; for him it is the body that is in contact with the world, through the hand, skin, nose, voice, ears and eyes. Thus, without the body it would not be possible for a person to have experiences. For him the ‘experienced self’ starts with the bodily organism. ‘I’ am the body, it is me who picks up the pen and writes things down and it is me who feels my sadness in my body (Abrams 1997: 45).           

For Merleau-Ponty the origin of intersubjective relationship is based in the body that is in contact with the world and in contact with other bodies. The body is porous and experiences are on the sensory level and are what he terms ‘intercorporal’. Merleau-Ponty speaks about “intercorporality: a general thing, halfway between the spatio-temporal individual and the idea, a kind of incarnate principle which produces a style of being wherever a part of it is found” (Coelho & Figueiredo 2003: 201). It contains the mutual condition of the oppositions in an existential, empirical environment, consisting of an endless “reversibility between a body that touches another body and is touched by it” (Coelho & Figueiredo 2003: 201). In this intercorporal relationship differences are almost eliminated. But at the same time distance is a characteristic of a lived body in the world and in the relations with other bodies. For Merleau-Ponty distance does exist because seeing is touching at a distance. With my body I can touch and be touched and this is because there is distance and differences between bodies. In this way, distance is essential in constructing an individual separate from others.           

However, seeing and touching are important and full of meanings because differentiation and in-differentiation occur simultaneously. The in-differentiation occurs because we all have the same element flesh “in the body and in the world”; on the other hand, there is a differentiation because how do I know that what I experience is the same as what another feels or sees? For example, Tankink often felt bodily tensions just before a woman in her research revealed that she experienced sexual violence. Her interpretation of this phenomenon is that her body felt the bodily tensions of her informant and her own body had transmitted information about the informant.  But what are the bodily sensations telling her? Are the feelings the same as those the informant experiences? Are those feelings connected with revealing the traumatic or are they connected with the re-experiencing of the traumatic event?            

For Merleau-Ponty the body is the only means a person has to “reach the essence of things, making me the world and making the other ‘flesh’” (Coelho & Figueiredo 2003: 201).  There is an orientation to the absolutely other in me, because nothing could be experienced beyond myself. There is an ongoing interaction between my body and things/people around me. Abram (1997: 520) calls it “silent conversation”, which is often independent of my verbal interaction and awareness.

Intrapsychic intersubjectivity

To fully understand intrapsychic intersubjectivity, it is important to appreciate the psychoanalytic assumption that the mind must not be seen as a singularity but as a multiplicity based on the relation between the ‘I’ (ego) and the unconscious and the constant presence of mental conflict.  The concept of object relations refers to the psychic internalization and representation of interactions between self and objects (Benjamin 1995). These inner objects were at one point real external persons – i.e. the mother and father and others who people the early environment of each of us subjects – but in the process of internalization they have become mental objects with their own functions and laws that are not related to the original external subject. Notions of identification, introjection and incorporation are not to seen as ‘fantasies’ but are felt as reality. In other words, that which can be seen to be subjectivity to the observer is felt to be objectively real to the experiencing subject.        

Intersubjectivity is defined as the field of intersection between two subjectivities, the interplay between two different subjective worlds to define the analytic (and any other relational) situation (Benjamin 1995). Although this idea has been implicit in psychoanalysis from the beginning (most notably in Winnecott’s idea of ‘transitional space’: that space where the subjectivity of the analysand meets that of the analyst) it has only in the past few decades received serious theoretical standing. The theory of intersubjectivity postulates parallel processes between intra-psychic development (i.e. object relations) and interpersonal (i.e. intersubjective) development. These two sets of processes are interrelated and interdependent but are nevertheless theoretically distinguishable, which allows them to be observed and traced as separate analytic categories.        

Intersubjectivity comes into being through the baby’s gradual recognition of the mother as a separate ‘other’, with her own wishes and desires that sometimes are the same as the baby’s and sometimes different. In other writings this developmental process is known as a ‘theory of mind’: the realization that the world is peopled with ‘others’ who have intentions that while different can be understood. Such understanding is part and parcel of the development of language (both its symbolic and verbal forms), which is used to communicate one’s own wishes to the other and vice versa, and which thereby allows for relationship. Intersubjectivity in this way is both an intrapsychic quality in that, by being aware that I am one among others, I become aware of my own subjectivity, making it possible for me to come to know myself. And intersubjectivity has a relational aspect: I understand that the ‘other’ has his own different but potentially understandable way of experiencing me (to him I am ‘the other’), and that together we create our intersubjective (shared) reality.        

This comes close to the philosophy of Levinas, regarding our ethical responsibility to ‘the other’. Levinas, who was deeply influenced by Husserl and Heidegger, maintained that our own subjectivity was formed through our ‘subjected-ness’ to the other. The full recognition of the ‘other’, which he described in terms of a face-to-face encounter with the other, triggers at one and the same time two mutually exclusive subjective intentions: the desire to murder the other (and so continue the primacy of the self), as well as the immediate recognition of one’s inability to do so. The way out of this dichotomy, according to Levinas, is to place the other in the role of teacher and oneself as student, with the primary ethical responsibility being to learn to know the other. Such obligation is a foundation of our subjective being-in-the world by giving it a meaningful direction and orientation. In this way, intersubjectivity – the learning of the other’s subjectivity in relation to one’s own – is integral to meaning-production.        

For instance, when Vysma was interviewing a man with a deeply painful story about the violent death of his son during the Chechnyan war, she had the persistent feeling that telling the story was so unbearable painful for him that it might re-traumatize him, and she repeatedly offered to stop the interview. He, however, declined her offer, and later told her that the telling of it had given him some relief.  She then realized that while she thought she wanted to stop because of him and his pain, it was actually because she herself could hardly stand to hear the story. Although to use the terminology of Levinas might sound dramatic in this context, actually having stopped the interview might have been the symbolic equivalent of killing the part of the informant who needed to tell this story. In continuing, she learned something about herself (intersubjectivity on an intra-psychic level); and she and the informant met in a moment of understanding (interpersonal intersubjectivity): in the sharing of the pain neither was, if only for a moment, alone with it.

Social intersubjectivity

Jürgen Habermas developed a theory of intersubjectivity in reaction to the positivist, anti-humanist, abstracting tendencies of objective science, arguing that first of all they ruled out of bounds the rational discussion of meaning, values and experience; and secondly, that positivism misunderstands the role of psychological or social structures in constraining our mode of thought, and often sees “disinterest” where a more acute analysis would reveal the force of the unconscious or the domination of ideology (Grady & Wells 1986). The question for him became: how, in a subjective world, do we communicate in such a way that we do not sink into a morass of relativism that comes from competing idiosyncrasies.           

In answer he invoked hermeneutics as an alternative to scientistic procedures for understanding human behavior and society. In order to grasp the motives, values, emotions and thoughts of others we work in a hermeneutic circle, in a dialectical movement from our observation of various aspects of society to our interpretation, checking it against our observations, and then modifying our interpretation, in a silent dialogue of one subjectivity with the projection of another.        

For Habermas, a theory of intersubjectivity contrasts with theories that base truth and meaning on individual consciousness. While an individual may arrive at knowledge through a sudden flash of insight, Habermas insists that such knowledge enters the intersubjective sphere only by being translated into rational, accessible discourse. The sphere of intersubjectivity is not the creation of a single individual psyche, but is a medium of communicable knowledge, created and maintained through the interaction of many subjectivities. In this, what is meant is not only the understanding given by such symbolic systems as natural science and philosophy, but also what is often termed supernatural realities such as ancestor worship, totemic and other spirits, as well as all levels of divinities. As such, the intersubjective sphere has an autonomous existence, beyond any one individual, and must be entered through socialization, especially language acquisition. Of course, to learn the language of intersubjectivity is to create it again, since the language is constantly changing.        

This autonomous intersubjective sphere corresponds to the idea that symbolic systems are not additive to human existence, they are constituent of it (Ortner 2005).  Anthropologists have theorized in various ways about the interaction of the individual with this collective level. Structuralists argued that this level was rooted in biology that left almost no room for individual subjectivity. Bourdieu’s proposed the concept of habitus, the deeply internalized and largely unconscious nature of social knowledge in the acting subject. Geertz held the view that cultures are public systems of symbols and meanings, texts and practices that both represent a world and shape subjects in ways that fit the world as represented. And Ortner (2005) suggested that this symbolic level is not a closed system but leaves room for individual subjective interpretations and this very subjectivity is the basis of agency.           

Habermas elaborates his ideas most fully in his theory of communicative competence (which can be seen as an aspect of human agency) which holds that in a successful act of communication, the hearer agrees to five implicit claims: that the utterance is true, that the speaker is sincere or truthful, that the utterance responds to the appropriate values, that communication fits the relation between speaker and listener, and that it is comprehensible.           

The social intersubjectivity that has been constructed in one culture differs from that of another culture. In all cultures the social sphere includes a religious dimension. In our own, this religious dimension is, for many people, no longer a shared reality, but has become more and more a matter of private choice. For the full understanding of the other, it is relevant to be aware of the various social levels (including spiritual or religious ones) a person considers him/herself to be part of.          

Is it possible, for instance, for us as western, academically-formed persons studying violence, to see systematic suffering of one group of a population at the hands of another, and to not see it in the context of a victim/perpetrator dichotomy, but instead to understand it in terms of punishment by ancestral spirits?  Products, as we all are, of a post-colonial world, is it possible to be free of colonialism? I.e. when we want to help a person or group of persons, are we not engaging in a form of colonialism; or alternatively, can considering compassion/eagerness to help as a form of colonialism not also be an excuse to look away, to not help? When we say, yes, but people themselves have said this, and we can point to actual words on a tape (often enough – always? – rendered into our language, either by the informant him/herself speaking a common language [English], or by use of a translator, or by translating an acquired second language into our own ‘mother-tongue’), how can we be so sure that what we heard was what they meant and  that we are not ‘hearing’ something in terms of our own symbolic system?

Intersubjectivity and the ‘cultural other’

If an anthropologist wants to understand what is specific in other cultures or groups and if anthropology is considered sharing knowledge, then intersubjectivity is of some concern. Although intersubjectivity is culture specific, it is not that we do not have any overlap in observations, concepts, notions, standards or problems. In those overlapping regions intersubjectivity becomes possible. According to Richters (1991: 231), there is a distinction between commensurability and comparability. Commensurability requires a neutral language and universal framework, which do not exist in the human sciences. Incommensurability means, according to Kuhn (in Richters 1991: 231), that there is no single universal framework and that this is preferable  because incommensurability means openness to new information. According to Fabian, objectivity in anthropological investigations lies, “neither in the logical consistency of a theory, nor in the givenness of data, but in the foundation (Begründung) of human intersubjectivity” (1996: 9).           

The first methodological task of anthropological research is identification of the subject to be studied.  As such, anthropological research starts with a theoretical hypothesis about a social entity of a society or group different from ours. But this is also where the pitfalls of subjectivity lurk most insidiously, as numerous recent anthropological critiques have shown over the years[note 1]For instance, feminist anthropologists who challenge the gendered conclusions, i.e. what seems collective ‘man’ is masculine, excluding the feminine. Or post-colonial writers who have charged that the collective assumptions of for instance structuralism continue a project of intellectual domination where what was deemed universal was merely western (Ortner 1995).
. Cahoone explains it thus: “What appears to be a cultural unit, that is: human beings, words, meanings, ideas, philosophical systems, social organizations, are maintained in their apparent unity only through an active process of exclusion, opposition and hierarchicization” (Cahoone 1995). Research, in other words, starts with the subjectivity of the researcher.           

We learn about each other through “participation in a collectively constructed and collectively upheld social life that people come to have understandings of individual others” (Moghaddam 2003: 230). For instance: for us, this table is merely a table, a life-less object to be used in a variety of different ways. However, that it is ‘only’ an object is, on a deep, unconscious level, an agreement between us, part of a collective agreement, a given, in the culture we share. But for other groups, this table can also be inhabited at unexpected times by a spirit. The dominant agreement in our culture is to call people who believe that the table can be animated ‘psychotic’.           

Getting to know the other thus means also trying to understand what he considers so obvious as to no longer question it – and also to examine those assumptions you yourself hold. This process is part of the intersubjective space.            

Intersubjectivity is an epistemological condition, and may be used as a way in which we order our reflections, before, during and after the fieldwork. Intersubjectivity is not only between the anthropologist and the informant but also between anthropologists, or scientists in general.  According to Kloos (1984) intersubjectivity between scholars is reached by making basic assumptions more explicit and by creating an agreement about the way perception is defined and used.           

Intersubjectivity in anthropology is not only a condition, but also a tool. Anthropology puts the emphasis on the communicative interaction and allows itself interpretation as an analytic method. According to Fabian (1996: 199), confrontation is an integral part of anthropology. The anthropological learning has a negative starting point because the accent is on ‘being different’ and therefore it denies equality. Furthermore, it has also the tendency to deny coevalness by seeing the other in an earlier state of development and/or technology. By doing so the other becomes an object of history (Richters 1991: 252). The moment intersubjectivity is acknowledged it becomes more difficult to deny coevalness and equality.           

If an anthropologist does not want to use intersubjectivity – that is: to actively gain insight into his own not fully conscious part of the interaction between him and his subject – he runs the risk of producing mere categories of social facts with doubtful historical and intellectual significance (Fabian 1996: 9). For example, to look at the rapid growth of Pentecostal churches in Uganda, and to conclude that is due to dissatisfaction with established organized colonial denominations such as the Catholic and Anglican churches, one runs the risk of missing entirely the intellection and emotional processes that influenced the people who chose the newer churches.          

Research on social relations shows, according to Moghaddam (2003: 244)), that those who have more power influence the way the world is understood by those who have less power, this is not only on the interpersonal level, but also on the inter-group level. Collective agreements are especially important in contexts were members of different groups meet. While people will over time be able to develop shared understandings, the changes are always connected with power; the minority group will often partly adapt worldviews of the majority group.  This pattern is in the social sciences often discussed as a concept of ‘false consciousness’ (Moghaddam 2003: 226). For anthropological researchers it is important to remain aware that this can limit the possibility of intersubjectivity between individuals of different groups.           

Anthropologists, however, also do research ‘at home’. In the classic way of doing research abroad the anthropologist seeks proximity in order to understand the others’ worldview, but doing research in your own society demands a distancing of yourself culturally. Reis (1998) did research in Swaziland and in The Netherlands on perceptions of epilepsy and she noticed that she needed two different approaches: in Swasiland she needed to overcome being an outsider, while in The Netherlands she had to compensate for being an insider, especially emotionally, in the identification with the mother of a handicapped child. But she noted that in her attempt at distancing herself from being an insider, she ran the risk of losing contact. While in Swasiland she had to work harder at creating a fully intersubjective space on the emotional level, in the Netherlands emotions, based upon comparable experiences, threatened to overwhelm the intersubjective space. According to her, it is necessary, and possible, to deal with those processes in a conscious way (Reis 1998: 307).            

In order to get more insight in the personal part of intersubjectivity we will consider the concepts of transference and counter-transference at this point because it is our argument in this article that intersubjectivity is constructed – and lost – in terms of (counter-)transferential reactions. The transference (as the transference and counter-transference combination is known) is in this way an integral analytic tool for understanding intersubjectivity.

Transference and counter-transference

The process that in the psychoanalytic canon is known as transference is, in its most generalized form, the way in which we form relationships with others. Any interaction with another person, from the most fleeting or casual exchange to the deepest or most long-term relationship, has a conscious and an unconscious component. For reasons which we usually only gradually become aware of or assign a meaning to, we like or dislike another person, or feel comfortable or uncomfortable in his presence, or have an open or defensive attitude towards him. Transference is the unconscious part of the encounter.           

Transference in its narrowest definition is a concept named and developed by Freud  (1900) and integral to psychoanalysis in which the analysand experiences the analyst as an aspect from his/her past and reacts to him accordingly (often also referred to as a ‘transference neurosis’). The analyst then, during the analytic hours, ‘becomes’ the depressive mother or the persecutory father who failed the analysand in his childhood, and, in turn, the analysand again ‘becomes’ the hurt or abandoned child (regression). Counter-transference is the parallel intra-psychic process in the analyst, where the analyst might have thoughts and feelings in the presence of the analysand’s regressive behavior that derive from his/her own life. Ideally, the analyst, familiar with the loci of his/her own development by way of a training analysis, will be able to become conscious of the meaning of those thoughts/feelings/ideas and use the counter-transference reactions to be able to understand and appropriately respond to the analysand’s feelings of love and aggression, bringing the conflicts to consciousness and allowing a healing to take place.           

But how is it that such a process called ‘transference’ can take place between two individuals in the first place? Jung conceived of a much more universal energy that drives humans, a sort of ‘instinct for relationship’, a binding force which he named ‘kinship libido’ (Jung 1946), of which the transference in a psychoanalytic setting is merely a particular instance Kinship libido also includes such diverse human phenomena as the inborn affection that family members feel towards one another; sexual and romantic passion; religious fellowship (and its derivative, political ideologies); and which is culturally channeled in hospitality rituals towards strangers.           

Anthropologists have effectively used this more general meaning of transference, referring to “thoughts, feelings, or fantasies research subjects have towards their investigators” (Tobin 1986). Tobin argues that those reactions of the anthropologist to his informants should not be designated by the term counter-transference because to “semantically and conceptually equating the anthropologist with the psychoanalyst and the people visited by the anthropologist with psychoanalytic patients” is ethnocentric and theoretically confusing.

 

In the traditional fieldwork setting it is in fact the lonely, confused, culture-shocked anthropologist who is in the higher state of tension and who is more likely to fall prey to the vicissitudes of transference than are his or her hosts who are living among friends and family in a familiar culture in a relatively low state of tension. (Tobin 1986: 124).

 

Tobin has a point here, although this is more true in the earlier phases of an anthropological enterprise (i.e. during the choice of topic and the fieldwork itself) than the later phases (i.e. during analysis and writing, when the work of the anthropologist and the psychoanalyst move closer again). However, we will not follow Tobin for practical reasons and we will speak of ‘counter-transference’, indicating the direction from the anthropologist on to his informant and ‘transference’ indicating the direction from informant to anthropologist.

Transference and counter-transference in anthropological research

Little anthropological research has been done on the influence of culture and gender on transference and counter-transference processes. Good et al. (1985: 196) caution that transference and counter-transference are significant aspects of cultural phenomena in all anthropological encounters and are connected with the groundedness “of [an] individual’s interpretation of reality and [his] encounter with others in multi-layered personal webs of meaning”.         

Anthropologists try to listen to their informants in an empathic and non-judgmental way, in order to create a context in which the informant feels safe to express his/her feelings/ideas/ vulnerabilities. Empathy, however, is a complex venture because the anthropologist has to be aware of his own partial identification with the phenomenological framework of the informant. According to Wilson and Lindy (1994: 8), empathy, identification, transference and counter-transference, distance and proximity are interrelated processes. The empathy and identification have to be in a dynamic position in case of transference and counter-transference, however, it is also possible for an anthropologist to get over-involved or over-identified with the informant. Their affective relationship can become so intense in a positive or negative way that it can lead to empathic strain.           

Wilson and Lindy (1994: 15) have constructed a scheme of reaction styles for understanding the different positions of empathic strain in therapy with traumatized patients. We present this scheme here because we believe it to be applicable to anthropological research as it throws in sharper relief various positions a researcher can, often unconsciously, be drawn into. They describe four styles of reaction (see figure), and, although the researcher may often  experience one style of reaction more than others, it is possible to experience more or even all positions both in a single interview, or over the period of the research project.

source: (Wilson and Lindy 1994: 15)source: (Wilson and Lindy 1994: 15)

Empathic withdrawal can occur when the anthropologist experiences frightening, confusing or unpleasant affective and or cognitive reactions, and retreats in order to avoid those reactions because they are difficult to deal with. For example: imagine you are a feminist researcher working on gender issues and you are interviewing a man whose opinion is that his wife’s obedience can be enforced through beating her. On a visceral level you may reject these ideas, while on an intellectual level you believe that it is your responsibility as a researcher to remain neutral. In the resultant inner conflict, you put up a blank screen façade but may lose empathy for your informant and the contact between you may be lessened or even lost.

For the empathic repression a similar process develops, but here the personal unsolved conflicts or concerns in the life of the researcher are reactivated. To continue with the example mentioned above, if the researcher has a personal history of abuse, it is possible to react to the informant as to the earlier abuser. The subjective reaction of the researcher is thus associated with those personal issues resulting in an unintentional withdrawal and a denial of the full significance of what the informant has presented.          

In the empathic enmeshment the researcher becomes over-involved and over-identified with the informant. In this mode the researcher often goes beyond the context of the research.  The personal history of the researcher plays an important role in this mode. Unconsciously the researcher re-enacts personal issues through the contact with the informants and runs the risk of blurring boundaries and becoming a helper. One of Tankink’s informants told her that because the Dutch immigration services had refused to believe her story of sexual violence, she had not told anyone else of her experiences until the interviews with Tankink, which, the informant told her, gave her some relief. Tankink, moved by the plight of her informant and with vicarious anger at the immigration services, scheduled more interviews than was necessary for her research.           

The last position is the empathic disequilibrium. We think that this position is immediately recognizable by most anthropologists, especially when they go for the first time to their research field. This strain indicates feelings of insecurity and uncertainty even sometimes feelings of somatic discomfort as to how to deal with the informants. The researcher might have feelings of being overwhelmed, vulnerable, tense and uncertain of his/her own capacity. Arriving in a new city in Afghanistan where both authors were supposed to do research on family violence, we met the security man of the organization that facilitated us. The evening before an employee had been badly battered and robbed of his car and computer. The security man was upset and urged us to be very careful. His insecurity infected our own. What is careful behavior? Would it be possible to discuss such sensitive issues as family violence with men or could it be dangerous? We considered avoiding it. As it turned out that the people we interviewed were very friendly and open, we were able to discuss the issue of family violence with all informants, but the projection of our own fears on to an unknown situation meant we might have missed an important research opportunity.           

It is important to note that the Wilson and Lindy scheme only considers counter-transference reactions in cautionary terms, i.e. when there is potential loss of intersubjective space due to the therapist (or researcher) being overwhelmed. These same reactions – as well as their normatively ‘positive’ counterparts, such as sympathy or identification, just to name two – can also be used constructively as a way of exploring what might be in fact taking place in the intersubjective space. For example, when, during an interview about experiences of torture and violence the informant opens up and by way of imaginal language allows the researcher to see (and therefore, following Merleau-Ponty, to be touched by) his or her pain, the researcher might feel overwhelmed by the almost unbearable-ness of it, and in an almost instinctive reaction, draw back. It is possible that such withdrawal could be a loss of intersubjectivity. On the other hand, it might also be a signal that the informant is close to drowning in his/her own pain, and a withdrawal – assuming this is also at the same time put into words – could be a way of maintaining the intersubjective space.

Discussion and call for papers

Because the purpose of this article is to encourage anthropological researchers to consider the aspects of intersubjectivity we mentioned (or those we might have missed), we will not draw any conclusions, but will instead formulate questions as a starting point for further discussion, in the hope of inspiring readers to participate in the symposium of Medische Antropologie in January 2007 (see information under ‘ Berichten’ in this issue).           

What is the effect in an interaction if one person is a member of a majority group of a society and the other a member of a minority group? What implications does it have in the current global political tensions, if one person is a Muslim and the other a Christian or Jew? Not to mention differences in gender, skin color, education or social position? What does it mean that you are the researcher and the other the object of study? How do all those aspects influence intersubjectivity?  Research on social relations shows, according to Moghaddam (2003: 204) that those who have more power influence the way the world is understood  by those who have less power, not only on the interpersonal level, but also on the inter-group level. For example, the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) is increasingly becoming the standard for the world.           

Another discussion point is how nonverbal forms of communication affect intersubjectivity. How to evaluate interviews that are recorded or videotaped in the context of intersubjectivity? How to dress and when to accept food? Is it possible to have shared experiences without words? What is the influence of touching, laughter, tears? What, in short, is the value of nonverbal communicative tools for creating intersubjective space?  During our research in Afghanistan we realized that we did not know how to wear a veil ourselves, but far more important was how to evaluate for instance a woman, who during the course of the interview kept on rearranging her veil, tightening it and covering more of herself each time?           

Can the anthropological rite of passage of participant-observation be seen as a reflective non-verbal way to develop a kind of intersubjectivity, i.e. that the immersion in an other culture is a way of breaking down the outside layers of one’s own symbolic system, and in that, the process of examining in detail the injury – and the repair – one learns not only about the other’s subjectivity but also about one’s own?           

Another aspect of importance is that the Western concept of the self is regarded as an organizing principle and as a concept of how people experience themselves, as well as themselves in relation to others. In many non-western cultures people experience themselves not so much as an individual in the Western sense of the term but more, as Roland in Ramanujam (1992: 126-127) states, as a ‘family-self’; a concept that  is based on the “relational model which envisions intense emotional relationships within the family”. In contrast to the Western sense of self this is a ‘we-self’ based on strong identification with values of the families and the social/ethnic group. Because the emphasis is on ‘we’ rather than ‘I’ the experiences are considered more, as Jackson (2004: 53) describes, on the interpersonal rather than intrapsychic level. Van Tienhoven et al. (2001: 2) decribe that working as a therapist with people with a family-self showed that people from those cultures express more “multiple and pluriform transferences” which can easily be mistaken for “suboptimal individuation”; for instance, a diagnosis of personality disorder could be given to a person of another culture who is considered to be ‘too involved’ in a family conflict.           

In the west, as part of the scientific paradigm, we are trained to look at events in a linear (often historical) cause and effect construction; how does this influence the way we hear the other’s story? While we in this paper have limited ourselves to exploring these issues from the point of view of the researcher, any discussions on the ways in which we acknowledge and evaluate subjectivity of the informant would deepen our understanding of this concept.           

We hope that we have made clear that intersubjectivity keeps discussions dynamic and lively and gives space for critical commentary. Do you have critiques of the theory or how we presented it?  Do you have examples of encounters where it was impossible to create an intersubjective space or in which the transference – counter-transference interactions brought you in an empathic strain? And how did you cope with it? Do you disagree with what we have said or do you have other ideas? Does it make any differences if your research is in your own country but with special groups like children, elderly or migrants? How to pay attention to those issues in your writings? If you have anything to say about these questions we put in this article or about other relevant aspects, we invite you to participate in the symposium in January 2007.           

One final important note: it has been our intent to show that intersubjectivity is a process, and not an end in itself. It is the dynamic of developing and recovering intersubjectivity that is important, and of knowing when it is lost and finding (or creating) it again. Paraphrasing the psychoanalyst Jean-Marie Spriet:  It is unavoidable that we see the other through our own lenses. Let us however not reduce him to our own vision (Spriet 2004).

Notes

Marian Tankink is community psychiatric nurse and medical anthropologist. She is presently writing a dissertation on “Sexual violence in the context of armed conflict and post-conflict situations: meaning production and health strategies among refugee women in the Netherlands” at the Leiden University Medical Centre in The Netherlands.

E-mail: M.T.A.Tankink@lumc.nl

Marianne Vysma is an analytical psychologist in private practice and a medical anthropologist studying possession syndromes. E-mail: marianne.vysma@gmail.com

We would like to thank for their comments on earlier drafts of this article the reading group ‘Trauma, Memory, Violence and Narrative’ of the Department of Public Health and Primary Care, Discipline group: Medical Anthropology, Leiden University Medical Center, in particular Rob van Dijk and Annemiek Richters. Their comments on earlier drafts of this article were very useful. We also like to thank the reviewer for the fruitful remarks.

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