Using Cultural Anthropology Concepts to Understand Residency and Healing Systems
Physician burnout is increasingly discussed in the popular media and in residency programs. A little over a year into psychiatry residency, I have found that perspectives provided by anthropology have helped me in moments where I felt close to burnout.
Medical anthropology is a subfield of anthropology (which is, broadly, the study of humankind). In medical anthropology, there is an emphasis on culture, or a community’s way of life. Healing systems are also viewed as having a culture of their own, and conversely,culture itself is an instrument of healing – for example, ceremonies and rituals have long been used by many societies to help individuals heal from trauma.
Understanding psychiatry as a cultural healing system has helped me many times during my early years of residency. One of the main research methods of anthropology is participant-observation, meaning that the anthropologist seeks an insider’s understanding of the culture through participating in community life while simultaneously maintaining a distance as a scientific observer.
The intern year of residency is a rite of passage for all physicians, and there were moments for me that the learning curve felt unbearably steep. During those times when I felt close to exhaustion, taking the position of a participant-observer helped me to cope. I started to think of psychiatry as a culture into which I was being initiated. Moving back into that position of participant-observer, rather than being fully emotionally/mentally immersed in the moment-to-moment difficulties of residency, allowed me to keep a broader perspective in mind. It reminded me that I was still a novice in this new cultural healing system, that I needed to be patient with myself, and that learning was part of the process. Rather than worry about how I was performing as an intern, in my best participant-observer moments, I would stop to curiously observe, without judgment, the clinical circumstances before me. I would ask myself, what could I have learned from that patient interaction? How does the feedback my attending is giving help enrich the broader cultural schema I am building as a junior psychiatry resident entering the profession/community?
Taking this participant-observer role also gave me an appreciation for all the gifts of internship. In cultural anthropology, mundane, daily experiences of community are understood to be a rich source of data about culture. As an anthropologist, then, I appreciate and seek meaning in every day clinical experiences. In stepping back to be a participant-observer in my residency, I realized that everyone I interacted with was a teacher, a key informant in the culture I was studying. Every single patient care experience was an opportunity for me to grow as a clinician. Each time I reflectively observed myself as a new participant within the culture of psychiatry, I realized I was growing and changing. And it was the close mentoring I was receiving from senior residents and attendings that was responsible in my growth.
Many books have been written in anthropology about how healing systems are learned and taught in different cultures. A common thread is that of apprenticeship. Over many generations, healers have learned from one another, passing down wisdom gained in their own lifetimes of clinical practice. Internship was my chance to be part this legacy, to be trained as an apprentice the way doctors have learned their trade for eons. I was an apprentice to many fellows, senior residents, and attendings. Understanding residency as apprenticeship, as a way to become acculturated and proficient in a healing system, gave me a deep sense of gratitude for my teachers. I felt like a small link in this vast chain of healers over time. As an intern, I often stopped in the middle of a day thinking, how lucky am I to be training as a healer? How thankful I was to receive the everyday gifts of knowledge from experienced doctors who took me under their wings. Mentoring from senior physicians was what I treasured most about my internship. Although my internal medicine and neurology rotations also operated on an apprenticeship model, it was in my psychiatry months that I worked most closely with attendings, one on one, to learn their approach to caring for patients. It was during those rotations that I remembered why I had chosen to specialize in psychiatry.
Many aspects of residency are challenging for young physicians. Insights from anthropology about biomedicine as a cultural healing system, and residency as a time of acculturation, rite of passage, and apprenticeship, may help young physicians to keep a broader picture in mind and to appreciate the everyday experiences of clinical training. I remain grateful for both my anthropological and medical perspectives, and feel these two different ways of looking at the world have enriched my learning experience as a new psychiatrist.
U Penn resident Puneet Sahota, MD, PhD