Alison Hamilton

As an anthropologist in the public sector—and in VA health services research in particular—I find that I am constantly in some type of bridging situation: bridging disciplines, disorders, services, identities. I have learned that my version of a clinically informed anthropology can only go so far, for there are not only the limitations of my knowledge, but there are also other forms of knowledge that have specific, legitimized places within complex social systems such as the VA.

For years I have mainly been interested in co-occurring disorders, which necessitate multiple bridges in order to understand and treat them. Co-occurring disorders fly in the face of many institutional arrangements, such as those that keep mental illness and substance abuse conceptually, professionally, and often even spatially separate, despite overwhelming evidence of their co-morbidity. In working for many years with a residential facility for “dually diagnosed” Veterans (Veterans with co-occurring mental health and substance abuse conditions), I was continually struck by the providers’ challenges of bridging their respective paradigms in order to meet the needs of the residents, who themselves were proud of their dually diagnosed identities. As one resident told me, “I’m not just an addict. I’m dually diagnosed and I want to be treated like that.” The implications for providers have been vast in terms of additional training and transformation of the care environment into one that embraces the residents’ experiential multiplicities.

Similarly, in studying homelessness among women Veterans, I have heard many women describe multiple interrelated life circumstances and adversities that could never be sufficiently addressed by one discipline or type of service alone. Women I have interviewed have wondered why services are not more connected, why the burden has been on them to build bridges between multiple institutions in order to begin to meet their needs. Some even described having to embellish their experiences in order to obtain the needed services, e.g., feigning a substance abuse problem in order to gain access to a facility that only treats individuals with substance abuse disorders. These efforts at managing life’s complexity are ripe for the anthropological gaze, but more than anthropology is needed to address the complexity. Bridges are needed, in and between minds, disciplines, and institutions.

Public anthropology often seems to push us practitioners toward bridging experiences, and even bridging identities. Anthropologists do not hold the most familiar, legitimized places in the health services field. When I was introduced by a colleague as a “psychiatric anthropologist,” I remember feeling a twinge of excitement that my training in psychological and medical anthropology had been subtly anointed with a (relevant) familiar clinical edge. With mental health clinicians, the identity works; it seems to signify an anthropologist who “gets” psychiatry, or perhaps a physician who gets anthropology, though I have to be quick to point out that I am in the former camp. With others, the identity of “medical anthropologist” usually suffices though often still raises eyebrows. I wish that there was a nice, neat title that combined medical and psychological anthropology and mental health services research. “Psychiatric anthropologist” comes close but still prioritizes one school of thought about the mind (psychiatry) over another (psychology). Working among both psychiatrists and psychologists, I have learned that these distinctions really matter, and fortunately, that there is a place for the bridge to anthropology.

I try to bring to the institutional table ways of understanding and framing co-occurring phenomena that are distinct from but still complementary to the approaches of my clinical health services colleagues. Fortunately health services research, and implementation research in particular, is inherently messy, with each setting being different from the next, each patient and provider being different from the next. So there’s a place for the anthropologist who gets fascinated by the persistent drive to mitigate messiness with tropes like “benchmarks” and “standards of care.” The health services researcher in me, however, says that I need to think not first and foremost in terms of tropes, but instead investigate the very real pressures that people are grappling with on a daily basis in order to ensure their livelihoods and institutional sustainability. The latter, perhaps less esoteric pursuit is the one that compels me in its relevance to real-time change.

I have realized, in serving as a publically funded anthropologist, that the choice to work in health services is indeed a choice to be involved in bridging different ways of understanding the challenges that come along with improving quality in complex social systems. In this sense, my disciplinary identity matters much less than my ability to do work that helps to make sense of the messiness.

The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Alison Hamilton is a Research Health Scientist at the VA Greater Los Angeles Healthcare System and an Associate Research Anthropologist in the Department of Psychiatry and Biobehavioral Sciences at UCLA. She received her PhD in Anthropology from UCLA in 2002, and her MPH in Community Health Sciences from UCLA in 2009. She was also an NIMH/VA Implementation Research Institute fellow from 2010-2012. Dr. Hamilton leads the Qualitative Methods Group at the VA HSR&D Center of Excellence for the Study of Healthcare Provider Behavior. Her primary areas of interest are women’s health, mental health, implementation science, and quality improvement. Her current research focuses on health services for women Veterans and Veterans with serious mental illness, as well as homelessness and HIV risk behaviors among women Veterans.

Sarah Ono, Heather Schacht Reisinger, and Samantha L. Solimeo are contributing editors of Anthropology in the Public Sector.

Public anthropology often seems to push us practitioners toward bridging experiences, and even bridging identities.