Ethnographical study methodology and applications

Ethnographic Study

Shahin is a sixteen-year-old female from Bombay. She moved to the United States with her parents and her older brother three years ago. Since last year, Shahin has lost twenty-five pounds and now weighs 85. Shahin is visibly emaciated and her 5'3" frame now appears bony.

When Shahin first saw doctors, her parents assumed she suffered from a physical ailment. Doctors performed requisite tests including EKG readings but eventually concluded that the teenager was struggling with anorexia nervosa. Shahin is recommended to a psychologist. After two weeks, her family physician calls Shahin as part of a follow-up routine and discovers that she has not yet made an appointment to see the psychologist. The doctor speaks with Shahin's parents, who tell the doctor they have been busy and will make the appointment as soon as possible.

Two weeks later, Shahin returns to the doctor, having lost several more pounds. The doctor admits her to the hospital, where she is given a feeding tube and given high-calorie liquid meal supplements. During her stay as an in-patient, doctors consult with Shahin's parents. They admit that they do not understand what anorexia nervosa is and simply want their daughter to be healthy again. The doctor finds a counselor who can work with the parents while taking into account the role that culture plays in their reaction to their daughter's condition. The counselor is trained in cross-cultural competence and is especially familiar with South Asian concerns.

Not eating is viewed as highly disrespectful in Shahin's native India. Eating is a family activity, a social event. Moreover, eating well is a luxury for many Indians and therefore refusing to eat has become largely a violation of cultural norms. Thinness is also a sign of poverty and sickness in India: not of glamour. Only recently has the Western cultural ideal of a svelte figure become moderately popular in Bombay. Because of their cultural perspective, Shahin's parents find it easy to blame Shahin for her disrespect. They view her condition as a direct insult to them, and they are ashamed that their parenting skills have failed her.

Shahin is caught between two worlds. She misses her friends from home and found it difficult to fit in when she first enrolled in the public school, in which she is only one of a handful of students from Indian descent. Shahin feels a lot of pressure from her parents to do well in school, as they view her education as a key to her future success. They want Shahin to be a doctor or a lawyer, but Shahin wants to be a graphic artist. She is a good student, and excels in school but does not have a rich social life. Shahin lost interest in food soon after moving to the United States and when her friends started to complement her on her skinny body, she capitalized on their praise as a means to earn valuable social affection.

Shahin is open to seeing the psychologist but her parents feel that psychology is an American luxury: at best a substitute for having friends and family for support. Most Indians do not see psychologists for their personal problems. For them, seeing a psychologist signals a severe mental disorder, and they shun the stigma associated with mental illness.

They strongly believe that Shahin will change by talking her into eating more. After they read recommended literature on anorexia nervosa the parents realize that Shahin is not intending to show disrespect. Her discomfort in her new surroundings and her inability to find a stable sense of self are core issues that she will address during family therapy sessions. Currently, Shahin and her parents attend family therapy sessions twice a month, and Shahin sees a therapist weekly.

Explanatory Model

This mini-ethnography reveals the challenges many immigrants face. On the surface, Shahin's problem is her weight. Her physical health will suffer if she does not attend to her nutritional needs. Yet as with most anorexic clients, Shahin is not as concerned about her physical symptoms as her loved ones are. Her self-deprivation is a sign of internal struggles. When interviewing Shahin, we talked about her perspective as well as her family's. As Kleinman & Benson (2006) suggest, an explanatory model encourages inquiry into fundamental beliefs about health and healing. How Shahin and her parents label the problem, what they feel its causes and effects are, and what they fear most about the condition were focal points of the interview.

What Shahin's parents saw in their daughter is the dramatic weight loss. Their focusing on the physical aspects of the condition is common and is not directly related to cultural perspectives because all parents should be worried about the immediate health ramifications of dramatic weight loss. However, culture played a huge role in shaping their reaction to the diagnosis of anorexia nervosa. The condition is uncommon in India, but malnourishment is an issue that is deeply feared and associated with poverty and low social status. To see their daughter grow thinner means much on a psychic level for Shahin's parents. They viewed her inability to eat as an affront to their ability to parent her properly. Taking their cultural perspective into account was essential in offering the best quality of care for Shahin. Connected to their sense of responsibility for her illness, her parents truly believed that she could be disciplined into eating more.

Interviews with Shahin showed that she shared her parent's core values and beliefs. She denied having a problem during the early phases of the diagnosis and treatment. When she became aware of the physical ramifications of her low body weight, she seemed surprised at first and then guilty for having disappointed her parents. She believed that the cause of the problem was a combination of her inability to fully assimilate into American society, her desire to look, think, and be like her peers, and her strong need to fulfill her parent's wishes. Their pressuring her to enter careers she had no affinity for was also something Shahin noted as psychological root causes for the problem: all significant insights that the explanatory model brought to light and helped offer the best care for the whole family.