Autoethnography and Severe Perineal Trauma

An Unexpected Journey From Disembodiment to Embodiment

Holly S. Priddis

Disclosures

BMC Womens Health. 2015;15(88) 

In This Article

Results

As Researcher as Woman as Researcher

The use of autoethnography can be seen as both a strength and limitation in conducting qualitative research. Whilst being a member of the marginalised group provides an "insider" opportunity as researcher when recruiting and interviewing participants, a limitation is that the research process can be too confronting for the autoethnographer as the process of conducting research and the necessary reflection upon one's personal journey is similarly confronting, leading to feelings of vulnerability and emotional pain.[25,28,41] To address the potential for bias from the authoethnographer dominating, in presenting research from an analytic autoethnographic perspective, it is important that the researcher is visible, reflexive to ensure objectivity and authenticity, and committed to theoretical analysis.[21]

As I remained constantly mindful that my experiences were not those of the women, and that each story stood alone, I was often struck by the similarities of our stories. As I reflected upon the coping mechanisms adopted by the women, I - in turn, reflected upon my own. In the process of conducting this study, this level of critical self-reflection was both confronting and upsetting. This level of reflection revealed that I had moved towards a "completely different normal" by compartmentalising the perineal morbidity and associated long term symptoms. This theme was also identified by the participants in one of the studies I undertook.[35] However in order to be reflective and analytic during the process of thematic analysis, this coping process of compartmentalising needed to be pulled aside so that I could become fully immersed within the data. Viewing the damaged perineum from a mechanistic viewpoint, as a faulty object, a disembodied or component part, had been protective and safe, while the paternalistic discourse of the feminine body as weak and inferior was confronting and upsetting. Autoethnographers have explored this dualistic role of autoethnographer and self, with Olson (,[50] p. 7) stating: "The dualistic role of a personal survivor and an academic is a reflexive one, each informing the other, never separate from one another".

The relationship that I developed with the women who participated in the study, following full disclosure of my own experience, fostered a closeness that remains to this day. Many of the women have remained in contact with me to report follow up assessments and test results, subsequent babies and general wellbeing. This has been a double edged sword as although I am humbled that these women have taken me into their hearts as a confident, it has been accompanied by an emotional burden that has weighed heavily on my heart.

Reflections: Autoethnographic Discoveries

My understanding of what it is to be an insider and an autoethnographer, and the enormous impact this has had on me personally is best represented by sharing my personal field notes or "reflections". These reflections included the use of a personal online journal, and a summary of emails that were sent to my primary research supervisor as I attempted to make sense of my experience. This is one of the first reflections that I completed:

(21st November, 2011)

Five interviews so far. I expected to find this journey challenging, however I am finding it difficult in different ways than what I expected. I thought that hearing the stories told by women would make me reflect upon my own ongoing experiences and that that would be confronting. However, what I am finding distressing is that women have experienced pain, incontinence and feelings of distress around their birthing experience….

Within this same reflection my beginner level understanding too of what autoethnography was is apparent here:

Threading autoethnography throughout the interviews does not always feel appropriate to me. When a woman is distressed, or has experienced extensive physical and psychological ramifications—I feel it is inappropriate to tell my story, that it takes away from the woman's own experience.

Three days later I had completed 8 interviews and my perspective was slowly shifting:

(24th November, 2011)

During this time I became more aware of my own body, my inadequacies (as I perceived them) were magnified, and I was more aware than ever of my pain and the inability of my body to function as it should. Although I felt relief for the women who participated in my study who did not experience any symptoms following SPT, at times I felt a sadness, and to this day wonder why my body just would not heal as theirs had. I share their sorrow, their fear and understand why they try to dismiss these feelings as being 'all in the mind'.

There is then a gap of nearly a full 12 months between my recorded reflections, and the next reflection describes why:

(6th December, 2012)

I had expected that the challenge would be in interviewing women that I would be confronted by their distress and that would be the most challenging part of my doctoral journey. Whilst I empathised and sympathised with these women, I left each interview a little saddened but mostly inspired to represent these women honestly and with respect, to advocate and instigate change.
One afternoon that changed. My own personal symptoms had been exacerbated as a result of stress of my parenting/academic workload, and one afternoon as I was doing preliminary coding of transcripts, I became overwhelmingly upset and cried. And cried and cried. This crying continued for weeks, into months, and I assumed that this occurred as a result of my workload and transcript coding. I took a temporary breather to refocus and explore why I had responded this way.

Crisis Point—the Process of a Break Down

I was given the amazing opportunity of being invited to present my research in Canada, a trip and opportunity I was extremely excited about. However, when I arrived in the first airport following the long haul flight I became extremely physically unwell with severe gastric symptoms that lasted the duration of my time in Canada. While I was still able to present my research I spent the majority of my time on, or near, a toilet. During this experience I was highly anxious and I remained unwell on the return home, and for the following months. I lost a substantial amount of weight due to chronic gastric problems, and a loss of appetite. I was restless, depressed and became increasingly withdrawn. I was unable to focus on work due to the restlessness and overall physical exhaustion due to the weight loss, and was unable to present my work at conferences at which I have been invited to speak.

Following many appointments with medical professionals, and surgery to identify the cause, it was found that I had not only been unwell as a result of a parasite when travelling, this stress had initiated a physical response, meaning I was now intolerant to gluten and lactose. This had further been the catalyst to trigger an overwhelming emotional response; I was experiencing depression and anxiety. I felt helpless and overwhelmed, in a state of panic each day. I was truly frightened by what was happening, I thought I was simply going crazy. On any given day my body was constantly "humming"—preparing me for fight or flight. This constant humming meant I need to be moving or standing at all times, trying to keep my body as busy as my brain, as it bounced from one thought to another unable to keep still or focussed. My house was spotless as I crawled around on the floor cleaning skirting boards at six in the morning!

So the anxiety then became a cycle—my body felt fearful or anxious, and my gastric system became upset. Then I became concerned that if I was out somewhere, away from a toilet, I would have a gastric episode and so then that triggered the anxiety. I admit, when I was in the darkest of places, that death looked attractive. However to clarify, I was not suicidal but merely considered the peace that would come with death as a reprieve from the chaos, whenever death happened.

Disembodiment, Embodiment and Coping

In reading the stories told by the women, and undertaking my meta-ethnographic synthesis I became interested in exploring the concepts of embodiment versus disembodiment, whereby the dysfunctional component of the body is identified as being either part of the person or as a separate (disembodied) entity.[7,51,52] Research has explored how the separation between mind and body contributes towards the disconnection and disembodiment some women may experience at birth.[43,51] At the moment when a woman gives birth and the baby and placenta are born, there is both a physical and emotional opening of the self to the other, a transition of the boundaries between the internal and external occurs.[13,52] For women who sustain SPT at birth, there is a continuation of this physical trauma through the perineum that distorts the boundaries of the known body. While research suggests that childbirth is a "conclusion", where women undergo a transition to a new self, for women who experience ongoing urinary, flatus and/or faecal leakage, the boundaries between the internal and external are permanently altered, challenging both physical and emotional closure for women.[51,52]

Through reading, and my own personal journey as I attempted to rediscover my sane self, I realised that for the past 14 years since the birth of my daughter, my coping strategy was based upon disembodiment, separating my traumatised perineum from my personal self. This allowed me to continue with my life and multiple commitments, as a doctoral candidate, mother of four children including one with a disability and running a business, without my ongoing morbidities affecting me on a personal, intimate level. The women I had interviewed also described this disembodiment I had not realised that this is what I had also done to survive.

On reflection, I recalled days when I experienced varying degrees of incontinence or pain I would describe them as my "bad bottom" days to those close to me, externalising the "bad bottom" and placing it as an object, clearly disembodying from the process.

Whilst this strategy of coping had served me well practically, a strategy I was comfortable with, that is being disembodied would not allow me to truly delve amongst the research and represent the stories of the women that I interviewed as I needed to. I had subconsciously adopted an embodied view of my severe perineal trauma and was not coping at all. I had uncovered a part of myself, a vulnerability and depression, which placed me in an uncomfortable place—confronting, dysfunctional. My ability to multi task my crazy life was lost, I jumped from one task to another trying to keep on track (unsuccessfully). I did not like the part of me that had emerged, I felt vulnerable and weak, and this conflicted directly with my role as a strong, efficient, perfectionist working mother.

Re-emerging as the Embodied/Disembodied Woman

I knew that I had work to do. Completing my PhD within my timeline and representing the women's stories with honour and respect was important to me. So I started working again, on other things—I avoided the interviews for a while. All the de-identified interviews sat in a blue zip up folder, I found it difficult to be near or look at this folder which I kept in my study. Then, after time, I was able to carry the folder with me to research supervisory meetings, but was unable to open the folder, and to this day I feel physically unwell whenever I see that folder which has now been stored away. I transitioned my focus to the quantitative component of my research and reading autoethnographic literature. It was important to me to find others who had travelled a journey similar to mine to understand how they survived this process:

(23rd May, 2013)

….and then I turned to autoethnography literature. I surrounded myself with the works of others who had travelled the autoethnographic path. And in doing this, I discovered a sense of camaraderie, a support group of researchers around the globe who too had travelled this journey and confronted their own personal demons. Their words wrapped around me and provided warmth and comfort for my saddened soul.

The solace I found in the works of these amazing autoethnographers[23,25,53] not only provided me with strength to complete my work, but ignited in me a true passion for what autoethnography is. I have always been a writer but to write in this way has been such an incredible privilege for me.

Caring for the Autoethnographer

In documenting this experience it has highlighted for me the ethics of undertaking autoethnographic work, specifically caring for the self. When researchers prepare to undertake qualitative work, we go through a rigorous ethics approval process to ensure the participants are well supported and protected from any potential risk of harm. While ethical consideration is extended to the individual conducting the research, self-care strategies are more difficult to develop and put in place when the person at risk is yourself. As an autoethnographer conducting research not only do I have to be mindful to apply ethical considerations to the participants of the study, but must develop a way to protect myself, and my significant others, from risk of harm.[29,54] Allen and Piercy (,[49] p. 156) state: "By telling a story on ourselves, we risk exposure to our peers, subject ourselves to scrutiny and ridicule, and relinquish some of our sense of control over our own narratives.".

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