What’s in a Refusal? Methodological and Ethical Notes from an Ethnography of Mental Health Care in Rural Ghana

Drawing on fifteen months of ethnographic fieldwork conducted between 2013 and 2022 on experiences of madness and practices of mental health care in rural southwestern Ghana, in this paper I propose to take as a point of departure, a specific episode in which the relatives of Fadhila—a girl I had first met at the psychiatric unit, where she was diagnosed as “psychotic”—refused to give consent to record an interview with me. The refusal was motivated by the strict instructions that Fadhila and her family were given by the traditional healer who was taking care of her: among many other things, the girl was not allowed to come close to any electronic device and her family felt it was unsafe to record an interview at their house. The refusal had to do with Fadhila being a “patient” as much as it had to do with another refusal: that of drugs and psychiatrisation. Indeed, the refusal had to do with spirits, the spirits that occasionally possessed Fadhila and were trying to make her a healer, according to her, her family members, and the traditional specialists they had visited. The refusal, however, may also have been a polite, indirect way to “withdraw consent”—to use the jargon of informed consent forms and ethics review committees. Though Fadhila and her family kept inviting me to their place, welcomed me warmly in subsequent occasions, and conversed with me about many things including the girl’s “condition,” that episode pushed me to reconsider the limits of formal consent and the need to constantly question it and re-establish it—a complex dynamic that sometimes the bureaucracy of “ethical clearance” processes in academia may contribute, paradoxically, to erase. Analysing this ethnographic episode in light of the powerful concept of ethnographic refusal introduced by Audra Simpson, I propose a reflection on the ethical and methodological implications of considering people as “sources” in ethnographies of madness and mental health. ; Cet article se fonde sur quinze mois de recherches ethnographiques menées entre ...