This study was carried out while I was employed as a psychiatrist at ‘Ridgehaven Hospital’. I experienced a tension between my two roles—ethnographer and psychiatrist—similar in kind to that experienced by most anthropologists when they participate in the social group they are observing. Perhaps I felt it more keenly than most because the role of a psychiatrist was so conspicuous in Ridgehaven Hospital.

My education and professional training have oscillated between anthropology and psychiatry. After graduating in medicine and working as an intern in a general hospital, I completed undergraduate studies in anthropology. This period was followed by postgraduate training in psychiatry. After that I began working part-time at Ridgehaven as specialist psychiatrist and undertook this study as part of a doctoral programme in anthropology.

I thus brought to the study a fluency in the language of medicine and psychiatry. It was an undoubted asset but also an impediment; my familiarity with the world of the psychiatric hospital and its language often made it difficult for me to perceive the taken-for-granted assumptions on which that world was built. It was only with the assistance of my anthropologist colleagues, who continually insisted that I maintain a sense of curiosity about what I normally regarded as self-evident, that I was to make use of my cultural competence in an analytic way.

Being a member of the staff facilitated my entry into fieldwork. It gave me access to the clinical sphere of hospital life from which a nonclinician might have been excluded on grounds of confidentiality. I was also drawn quickly into administrative domains of the hospital. Once it became known that I was interested in studying how people wrote in case records I was press-ganged into chairmanship of the hospital's medical records committee, a position that thrust me into the interface between the administrative and clinical divisions of the hospital, an area of conflicting pressures. As the same time, because I was already identified as a psychiatrist, I had to work hard to establish myself as an anthropologist, which involved bridging the social boundaries that separated the various professional and occupational groups. I found it fairly easy to undertake field-work with psychiatrists, psychiatric nurses, and social workers; but it was only by persevering that I gradually gained the trust of domestic cleaners and pantry maids.