Managing uncertainty by adopting a hybrid way of knowing: investigating the mangle-ish approach of ICU patients’ caregivers

ABSTRACT

The participant observation that I conducted during late 2013 through early 2014 in a Taiwanese medical center guides me to acknowledge the hybrid way of knowing that intensive care unit (ICU) patients' caregivers adopt to cope with illness. On the one hand, ICU patients' caregivers rely on modern medicine to understand their family member's circumstances; on the other, they depend on folk-religious beliefs to tell them what happened, is happening, and even what should be expected to happen to their family member's life situation. Moreover, other caregivers' experiences and knowledge also play an important role for them. I point out that ICU patients' families perform a “dance of agency” to improvise a “collage” to manage uncertainty by hybridizing. By providing a thick description of caregivers' case, this article echoes the implicit tradition of conceptualizing hybridization in the social sciences and advances understandings of the epistemological hybridity of laypeople.

KEYWORDS:

• Medical knowledge
• folk-religious belief
• hybridisation
• mangle
• ways of knowing

Acknowledgement

I am grateful to Jacqueline Ramey for her comments on drafts of this article and to the editor and anonymous reviewers for their very helpful feedback. I also greatly appreciate Yi-Xiong Yeh, Feng-Yeh Feng, and Yu-Chun Hsieh for inspiring me and motivating me to write this article. The article is entirely the responsibility of the author.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 Studies that emphasise hybridisation in medicine usually discuss the role of traditional medicine, complementary and alternative medicine (CAM), and the domination of biomedicine. Most of these studies have focused on the CAM practitioners’ hybridisation.

2 To be specific, the dates I stayed are: 20 October to 7 November and 16–27 November in 2013 and from 12 to 15 February in 2014.

3 Interestingly, since the professionals (nurses and doctors) cover all the significant aspects of caring, the three-time-visiting routine provided a chance for many caregivers to execute “ritual procedures”. More details will be provided in the following sections.

4 In addition to the three visiting times, caregivers bringing meals (breakfast around 7:00 and dinner around 17:00) according to the doctor’s advice can enter the ICU ward. (Lunch should be provided during the 11:00 visit.) These visits provide an additional two time periods in which caregivers can personally interact with and check the patients. Since there is a strict time schedule for entering the ward, caregivers must press the bell and inform the nurses that “I am bringing a meal to patient XXXX!”; then the gate will be opened from the inside. In meal deliveries, only one caregiver is allowed to enter the ICU.

5 Once having decided to analyse this phenomenon systematically, I obtained consent forms from caregivers, nurses, and doctors; people who did not have a chance to sign the consent forms and/or did not agree to be covered in my study were excluded from the descriptions and analysis. I also obtained official permission to conduct this investigation from the medical centre. Two reasons explain why I conducted this project using ethnography: On the one hand, close investigations of caregivers (and the daily written-down field notes) provided me with details and high-quality information on my topic; on the other hand, it was difficult to schedule in-depth interviews with ICU patients’ caregivers, but fairly easy to find sporadic time periods to have informal short talks and interactions with them.

6 Being both a caregiver and a researcher, I made efforts to maintain my objectivity in this project. Admittedly, becoming a caregiver myself motivated me to delve into this topic (and it was definitely value-laden to decide to work on this project); nevertheless, it was still possible for me to seek to be as objective as possible in the data analysis. For instance, my arguments are not based only on my own observations but also depend on my conversations and interactions with my subjects. Moreover, all the gathered data are treated equally and play a role to guide my understandings of this issue and no evidence or information is deleted and/or muted due to not fitting into my framework.

7 Existing studies had already pointed out that Taiwanese people have multiple systems for medical care (Chang, 1983; Kleinman, 1975). Nevertheless, in this article, I use a different classification of sources for understanding illness than the given studies. Moreover, I examine a distinct social context (ICU ward) as an example of people’s hybridisation of ways of knowing. Last, the emphasis of this article is on how ordinary people indeed adopt a hybrid way of knowing to manage uncertainty in various circumstances: The ICU is merely a case to reveal it.

8 Among others, how people’s accumulated and embodied experiences influence their making sense of social world (in this case, the illness) is left unmentioned in this article.

9 The bed numbers in my analysis are not the exact bed numbers found in the medical centre. I reassigned them to give all the actors anonymity.

10 It is highly possible that 28012’s story will lead other caregivers to confirm one thing more strongly: Listening only to doctors’ suggestion (who represent modern scientific knowledge) is far from sufficient and even dangerous.

11 While “faith healing” (Village, 2005) is one possible label to describe these practices, I prefer not to use it to allow for more variations.

12 In this article, I wittingly lump various folk-religious beliefs together since Taiwanese people usually adopt a fairly practical attitude toward folk religions (Chang, 1985; Lee, 1978). Consequently, it is difficult to draw a clear boundary line between different folk religions in people’s daily practices, and Taiwanese people tend to mix all “gods” under one big religious label.

13 Here, “people” indicates profane medical knowledge; “gods” refers to sacred religious beliefs.

14 Nevertheless, caregivers still looked for a lot of “prestigious” temples to visit and prayed for the recovery of patients outside the medical centre.

15 Caregivers of one patient sometimes held different attitudes toward information from various sources: Some gave priority to scientific medicine, some put more emphasis on folk-religious beliefs, and still others believed more in other laypeople’s experiences and alternative therapies. Nonetheless, caregivers usually tried hard to tolerate the inconsistent priority-setting: After all, the most significant goal was the patient’s recovery.