Reimagining Clinical Ethnography Through Cultural Formulation in Mental Health: Thinking With and Against Clifford Geertz

What makes any clinician-led interview in a mental health setting ethnographic if it is not part of participant-observation where informants live? And how can clinicians assemble information during medical appointments into an anthropological formulation? In this essay, I argue as a psychiatrist and social scientist that clinicians can practice anthropology through ethnographically-inspired techniques without mischaracterizing their work as thick description or participant observation, as researchers often do in taking inspiration from Clifford Geertz. I review scholarship on cultural formulation as an approach that researchers have developed from clinically applied medical anthropology in mental health settings. Drawing on my own participant-observation in mental health clinics across New York City, I outline differences in anthropological participant-observation and clinical ethnography. I turn to Geertz’s classic essay “Thick Description” to think with and against him about applying ideas related to ethnography in clinical settings. Finally, I introduce clinical ethnographic interviewing, description, and interpretation as techniques for clinicians to practice anthropology in mental health settings. I propose that clinicians create formulations based on applied medical anthropological theories such as semantic network analysis, the cultural construction of clinical reality, and the intersubjective cultural formulation.