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In terms of the methodology underpinning this study, ethnography, once the preserve of anthropologists, this has been adopted across a range of social science disciplines, and beyond. It is arguably the method par excellence for undertaking an in-depth inquiry into the otherwise esoteric world of ‘cultures’, to use the term once more in its wider sociological meaning. Commensurately, the aim of ethnography, is, as van Maanen (1988: 4) pithily suggests, to ‘decode one culture while recording it for another’. Furthermore, much has been written about ethnography as both a methodology and a method of data collection, a large corpus of which has been published as guidance for the novice researcher, as well as making an important contribution to philosophies of knowledge. Accordingly, this well trodden path will not be revisited here in any detail. Suffice to say, therefore, that the bulk of data collection took place over a sixteen-month period, reaching a culmination in 2000, with periodic updates taking place up to 2009.

During the intensive data collection period dozens of interviews took place with both patients and staff, as well as other prominent mental health service providers, together with some focus group discussions held in the hospital and at a ‘halfway home’: a community-based supported lodging scheme for ex-patients. Interviewing methods varied in type and style depending upon my participants and the circumstances – from in-depth but unstructured, individual or group discussions to intensive semi-structured, recorded interviews. Other data collection methods that I commonly used included critical observation and the use of statistical records from the hospital archives. The utilisation of all these different methods, typical of the flexible ethnographic approach, ensured a degree of triangulation against which to test my findings and developing hypotheses.

So much for methods, which were embedded in established ethnographic technique. In relation to methodology, ethnography naturally stands as a form of epistemology where, in keeping with its postmodernist, relativistic roots, one evolutionary branch has given rise to ‘critical ethnography’. This is fundamentally emancipatory in its general aims, and seeks to make the necessary links between the narratives and lives of participants and the structural constraints of wider society, in relation to issues of disenfranchisement and disempowerment of the individual (DeLaine, 1997). Emancipatory ethnography, therefore, is overtly embedded in what Ortner (1995: 173) describes as an enterprise of ‘intellectual and moral positionality’, and this formed the bedrock for my work. However, it is also one where, like generic ethnography, for want of a better expression, a critical scrutiny of a wider audience beyond the researcher is needed to evaluate how rigorously and scrupulously research has been carried out and conclusions drawn. To this end, ethnographers need to take into account that they are necessarily part of the social study and cannot be omitted from their accounts (Hammersley and Atkinson, 2010).

Consequently, gender issues are closely considered here, where the experiences of men have been used for comparative purposes with those of women (Stanley and Wise, 1993). This inclusion avoids distortion of a phenomenon that is shared in multiple ways by men and women patient participants at the hospital, but also permits points of difference to emerge. An attempt has been made to seek an understanding of the lives of ‘patients’ as they are informed by gender and this acts as an important but not exclusive category of analysis, forming what Sandra Harding refers to as the ‘problematics’ of the study (Harding, 1987: 30).

The construction of any ethnography, however, does not stand on findings alone, but is viewed as the subjection of data to a process of ‘textualisation’. Here, to utilise van Maanen’s (1988: 95) definition, data are subjected to the process of atomisation and classification, where they are sifted and reorganised through analysis (Aunger, 1995: 97). As Hammersley and Atkinson observe:

It is now widely recognised that ‘the ethnography’ is produced as much by how we write as by the processes of data collection and analysis (Hammersley and Atkinson, 1993: 239).

However, as van Maanen (1988: 1) and Ortner (1995) argue, for the researcher the ethnographic process equally involves serious moral responsibility, particularly in relation to the representation of phenomena and participants. This counters the typical stance of classical ethnography where the influence of the researcher upon the study was fundamentally discounted in the text. This Olympian stance has subsequently raised contentious issues regarding the validity of ethnographic accounts, which have in turn served to raise some very fruitful debates and the development of new epistemological strategies.

The question of whether this particular study offers a truthful account of lives can be viewed from at least two points of view. Firstly, as Berg states, ethnography is an inexact science whereby hypotheses can be evaluated in terms of plausibility but not in terms of validity (Berg, 2007). As the reliability of the theory can be evaluated prima facie by the frequency of similar occurrences noted within categories, the critical reader might conclude that it is not unreasonable to accept this particular theory based on these particular observations (Hammersley, 1990b). Furthermore (self) reflexivity, therefore acts as a form of epistemology that serves to make the ontological ‘social’ world that exists independently of us, known (Aull Davies, 1999: 17).

Associated with issues of objectivity, the representation of the accounts of participants raises other issues. Linda Alcott (1991: 6-7) points out that the social location of the speaker affects the ‘meaning and truth’ of what is said, in addition to the concealed dangers inherent in speaking on behalf of less privileged groups. The discursive problematics of speaking for and speaking about are brought to the foreground, where the latter can be dangerously conflated with the former. All, however, is not lost, a way forward is proposed:

It is possible (and indeed desirable) to speak of ‘others’ but only when the reader can clearly see where the speaker is ‘coming from’. Autobiography (read as self-identification) becomes the basis upon which white feminists authenticate speech, such that failure to identify speaker location is potentially racist and classist and sexist. While the act of ‘identification’ may precede equally oppressive practices, it nonetheless signals a more ‘honest’ beginning (Lyons, 1999: 6).

What Lyons (1999), following Aull Davies (1999) is proposing therefore is a methodological stance grounded in self-reflexivity, whereby the focus revolves around the location of the speaker. In this study self-reflexivity also pivots around the issue of accountability and emancipatory goals, as well as clarity. Accordingly, the specific properties of gender, ethnicity and class, for instance, that characterise the researcher are considered, as inherently forming a personal/political/cultural lens through which the phenomena is studied, and of which the reader should be rightly be aware (Burman, 1999).

Thus the researcher appears in these analyses not as an invisible, anonymous, disembodied voice of authority, but as a real, historical individual with concrete, specific desires and interests – and ones that are sometimes in tension with each other (Harding, 1987: 32).

Self-reflexivity, therefore, creates a space in which a critique of authorship, authority and cultural representation can be constructed (Hirsch and Olson, 1995). Despite the scepticism of critiques, such as that offered by Patai (1991) the self-reflexive strategy effectively responds to a question posed by Pettman, of how ‘dominant group women address their whiteness’ in relation to cultural difference, a question germane to this study in relation to the postcolonial context of research and my own cultural heritage (Pettman, 1992: 155). Self-reflexivity therefore creates a legitimate way of addressing how neo-colonialism in developing regions impact upon ‘First World’ researchers – an issue especially germane to this study (Visweswaran, 1988).

Before leaving the topic of research methods altogether, a brief explanation of the process of data analysis is advisable. In ethnography data analysis does not occupy the discrete, hygienic position of analytic processes in the hard sciences, but runs parallel and continuously alongside data collection. This permits the researcher to thereby change tack in a timely fashion: abandoning paths that have led to barren cul-de-sacs, while pursuing more fruitful ones. Typically, therefore in my own research, daily observations and interviews were noted by hand and coded by computer-aided software into single instances or recurring ones that were later developed into themes (Brewer, 2000; Tesch, 1991). Once no further patterns emerge from the study, saturation has been reached and data collection can be completed. The next step is normally withdrawal from the study site – by no means, an easy process, due to the difficult human elements of being obliged to dismantle edifices of close contact, arduously built up in the interests of creating good, and often quite intimate relationships with participants, as will be further discussed in Chapter Ten.