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The Transparent Body
A Cultural Analysis of Medical Imaging
Jose Van Dijck
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eBook - ePub
The Transparent Body
A Cultural Analysis of Medical Imaging
Jose Van Dijck
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From the potent properties of X rays evoked in Thomas Mann's Magic Mountain to the miniaturized surgical team of the classic science fiction film Fantastic Voyage, the possibility of peering into the inner reaches of the body has engaged the twentieth-century popular and scientific imagination. Drawing on examples that are international in scope, The Transparent Body examines the dissemination of medical images to a popular audience, advancing the argument that medical imaging technologies are the material embodiment of collective desires and fantasies--the most pervasive of which is the ideal of transparency itself. The Transparent Body traces the cultural context and wider social impact of such medical imaging practices as X ray and endoscopy, ultrasound imaging of fetuses, the filming and broadcasting of surgical operations, the creation of plastinated corpses for display as art objects, and the use of digitized cadavers in anatomical study. In the early twenty-first century, the interior of the body has become a pervasive cultural presence - as accessible to the public eye as to the physician's gaze. Jose van Dijck explores the multifaceted interactions between medical images and cultural ideologies that have brought about this situation. The Transparent Body unfolds the complexities involved in medical images and their making, illuminating their uses and meanings both within and outside of medicine. Van Dijck demonstrates the ways in which the ability to render the inner regions of the human body visible - and the proliferation of images of the body's interior in popular media - affect our view of corporeality and our understanding of health and disease. Written in an engaging style that brings thought-provoking cultural intersections vividly to life, The Transparent Body will be of special interest to those in media studies, cultural studies, science and technology studies, medical humanities, and the history of medicine.
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Wissenschaft AllgemeinCHAPTER 1
MEDIATED BODIES AND THE IDEAL OF TRANSPARENCY
THE TRANSPARENT BODY IS A CULTURAL CONSTRUCT MEDIATED BY MEDICAL INSTRUMENTS, MEDIA TECHNOLOGIES, ARTISTIC CONVENTIONS, AND SOCIAL NORMS. IN THE PAST FIVE CENTURIES, A HOST OF TECHNICAL TOOLS HAVE BEEN USED TO VISUALIZE THE INTERIOR BODY. BUT HAS THE BODY, AS A RESULT, BECOME MORE TRANSPARENT? TRANSPARENCY, IN THIS CONTEXT, IS A CONTRADICTORY AND LAYERED CONCEPT. IMAGING TECHNOLOGIES CLAIM TO MAKE THE BODY TRANSPARENT, YET THEIR UBIQUITOUS USE RENDERS the interior body more technologically complex. The more we see through various camera lenses, the more complicated the visual information becomes. Medical imaging technologies yield new clinical insights, but these insights often confront people with more (or more agonizing) dilemmas. Behind the alluring images hide ethical choices, and medical interventions are often stipulated by artistic inventions. The mediated body is everything but transparent; it is precisely this complexity and stratification that makes it a contested cultural object.
Between the early fifteenth and the early twenty-first century, a plethora of visual and representational instruments have been developed to help obtain new views on, and convey new insights into, human physiology. From the pen of the anatomical illustrator to the surgeon's advanced endoscopic techniques, instruments of visualization and observation have mediated our perception of the interior body through an intricate mixture of scientific investigation, artistic observation, and public understanding. Each new visualizing technology has promised to further disclose the body's insides to medical experts, and to provide a better grasp of the interior landscape to laypersons. The mediation of human bodies, both historically and contemporarily, has occurred primarily by way of two types of technologies: medical imaging and media technologies.
Ever since the Renaissance, looking into the body's interior has constituted the empirical imperative of medical science. Physicians and scientists gained knowledge about health and disease mainly through dissection and close inspection of cadavers. The emergence of modern imaging technologies coincided with the introduction of a new medical gaze: in 1895 Wilhelm Röntgen became the first to discover a technique for inspecting the living interior body without having to cut it open. Little more than a century after this revolutionary invention, the human body has become highly accessible and penetrable by optical and digital tools. Corporeal transparency is thus primarily a consequence of an increasing number of sophisticated medical imaging technologies, enabling the doctor's eye to peer into the human body.
Apart from medical tools, media technologies have also substantially contributed to the body's transparency. Mass media show us images of the tiniest and most private aspects of the human interior. Documentaries on viruses, photos of a fertilized egg, moving pictures of a fetus in the womb, films of complex neurological operationsâis there anything left to hide from view? In recent decades, the body has acquired a pervasive cultural presence, fully accessible not only to the doctor's professional gaze, but also to the public eye. Indeed, impressive medical imaging technologies have enabled this new transparency, but the mass media, engaged in an equally successful effort at permeating our social and cultural body, gratefully pay lip service to the eagerness of doctors and technicians to bring their ingenuity into the limelight. The media's insatiable appetite for visuals has undoubtedly propelled the high visibility of the interior body in modern-day culture.
Mediated bodies are intricately interlinked with the ideal of transparency. Historically, this ideal reflected notions of rationality and scientific progress; more recently, transparency has come to connote perfectibility, modifiability, and control over human physiology. The ideal of transparency is not simply pushed and promoted by medical science. The transparent body is a complex product of our cultureâa culture that capitalizes on perfectibility and malleability. In our contemporary world, the interrelations between medicine, media, and technology are all but perspicuous.1 After some preliminary remarks about the role and function of medical imaging techniques, I will look closely at their relation to media technologies, and end with an elucidation of the transparent body as a social and cultural construct.
MEDICAL IMAGING TECHNOLOGIES
Before the discovery of X rays, doctors depended primarily on their senses (sight, touch, hearing) in order to imagine the interior body. Direct sensory perceptions are still important diagnostic means for physicians, even though they depend increasingly on the optical-mechanical eye.2 Since the nineteenth century, doctors have used mechanical instruments to translate bodily movements or sounds into readable, visual graphics; the French engineer Etienne-Jules Marey, for instance, invented the electrocardiogram (ECG) and a host of other inscription devices.3 Marey also systematically deployed photography to minutely register the movements of limbs and muscles in order to obtain a rudimentary knowledge of human kinetics.
Although a number of visualizing techniques have their roots in eighteenth- and nineteenth-century optics or mechanics, the discovery of X rays ushered in the era of modern imaging technologies. Since then, we have witnessed the introduction of numerous other techniques. Ultrasound, a visual diagnostic practice based on the physics of sound, has gradually become a routine screening instrument for fetuses. The endoscope, featuring a mini-camera attached to a flexible cable, is inserted into the body via a tube and sends video signals to a monitor in the operating theater. Computed tomography (CT) utilizes X rays to produce ultra-thin cross sections of the body; a large number of digital cross sections can be recombined to form three-dimensional representationsâfor instance, of organs. Magnetic resonance imaging (MRI) produces similar slices, but uses magnetic fields, rather than X rays, to penetrate even bone material. Positron emission photography (PET) is based on the use of radioactive isotopes, which, when injected into the patient, allow the researcher to study brain functions in vivo. The electron microscope (EM) gives visual access to the tiniest organic units, such as molecules, which can be magnified up to half a million times.4
The development of medical visualizing instruments is commonly viewed as a technological evolution, occasionally accelerated by revolutionary leaps; technicians point to digitization as the latest optical-information revolution.5 Sociologists and historians of technology have produced quite a few case histories of single imaging instruments, relating their invention and innovation to emerging professional specialties, such as gynecology or radiology, or to specific industrial contexts.6 Most scholars restrict their attention to the medical domain, focusing primarily on the instrument's technological refinement or its implementation in medical practice. By contrast, some historians of science account for the way in which medical images become part of the texture of modern life. Yet if they do, they often assume a self-evident, causal relationship: medicine develops instruments such as X-ray machines and endoscopes, after which the resulting images are disseminated in other domains, such as art, politics, or popular culture. In her history of medical imaging techniques, Bettyann Holtzmann-Kevles exemplifies this approach by tracing âthe technological developments and their consequences in medicineâ before turning to âthe impact that this new way of seeing had upon society at large.â7
It is widely assumed that medical imaging technologies reveal the body's interior in a realistic, photographic manner and that each new instrument produces sharper and better pictures of latent pathologies beneath the skin. Traces of this belief resonate in Holtzmann-Kevles's metaphorical claim that as technology improved, âphysicians gradually pushed back the veil in front of the internal [body].â8 Although there is an obvious kernel of truth in this way of thinking, it also reduces a host of complicated, multidirectional processes to a single straight-arrow story of technological progress. Of course, every new medical imaging apparatus provides more knowledge about health and illness, but the same technologies do much more: they actually affect our view of the body, the way we look upon disease and cure. Holtzmann-Kevles's assertion typifies the Western ideal of fully transparent and knowable bodies. The myth of total transparency generally rests on two underlying assumptions: the idea that seeing is curing and the idea that peering into the body is an innocent activity, which has no consequences. Popular media reflect and construct this myth, the ideological underpinnings of which are deconstructed below.
Common belief in the progress of medical science relies in part on unswerving confidence in the mechanical-medical eye: that better imaging instruments automatically lead to more knowledge, resulting in more cures. From visualizing to diagnosing seems a minor stepâa doctor just needs to âseeâ in order to find a remedy. Every newly developed technique appears to lift the veil of yet another secret of human physiology. If we combine all computer-generated images into one comprehensive scanâthe digital integration of CT, X ray, electron microscopy, PET, and MRIâmight we ultimately be able to âmapâ each individual body? It is a truism that X rays have been a crucial element in the diagnosis, prevention, and cure of tuberculosis; it is equally common knowledge that ultrasound technology has enabled doctors to recognize fetal defects at an early stage of pregnancy. However, not every disease or aberration is visible or âvisualizable.â The idea that, by combining all imaging technologies, we can create an ultimate map of a human body is as presumptuous as the claim that we can find the meaning of life by mapping the human genome. And yet, patients often blindly trust the panoptic nature of the mechanical-clinical eye.
Despite the equation of seeing and curing in popular media, better pictures do not automatically imply a solution. Medical scans often show irregularities or abnormalities, the progression of which doctors cannot predict, or for which there is no cure. Innovation in medical imaging technologies is the result of a constant attunement of machines and bodies, of procedures and images, of interpretations and protocols.9 We can never assume a one-to-one relationship between image and pathology: looking at a scan, medical experts may identify signs of potential aberrations, but their interpretations are not necessarily univocal. To a certain degree, medical-diagnostic interpretation of a scan is always based on a consensus between specialists; it may take years before consensus transforms into a reliable heuristic protocol, and even after applying a technique for several decades, its images may still give rise to different interpretations.10 Reading X rays, endoscopic videos, or MRI scans involves highly specialized skills that require substantial training and practice. In addition, with each new instrument or innovation, doctors have to readjust their reading and interpretation skills. While advanced machines render our bodily interior seemingly more transparent all the time, the images they produce hardly simplify our universe.11 Seeing often leads to difficult choices, multifarious scenarios, and thus complicated moral dilemmas.
The other important implicit assumption involving imaging technologies is the belief that looking into the body is an innocent activity. This belief allows for reasoning such as âwe can always take a look and if we don't see anything, nothing happens,â or âbodies remain untainted if we only touch them with our gaze.â Philosophers and sociologists of science have already sufficiently countered this axiom.12 Ian Hacking, for instance, argues that every look into a human interior is also a transformation-âseeing is interveningâ-because it affects our conceptualization and representation of the body.13 Medical imaging technologies not only shape our individual perceptions, but also indirectly contribute to our collective view on disease and therapeutic intervention. The definition and acknowledgment of a disease often depend on the ability of medical machines to provide objective visual evidence, and insurance companies may not cover diseases unless they are visually substantiated.14
Relying on the mechanical-clinical eye has direct and indirect consequences: it directly influences a patient's medical treatment and indirectly structures healthcare policies. For instance, more advanced ultrasound machines show more fetal defects at an earlier stage of pregnancy; the technical ability to detect rare fetal abnormalities becomes the technical imperative to offer such scans to all pregnant women. Mapping the human genome, far from being an âinnocentâ exercise in charting all possible genetic sequences, is bound to affect future viability decisions (and insurance policies) about whether a fetus's genetic vitals warrant gestation and birth. New imaging techniques are often initially deployed as individual diagnostic tools before becoming screening instruments; in the process, they contribute to the creation of risk groups. Looking into a body and mapping its organic details is never an innocent act; a scan may confront people with ambiguous information, haunting dilemmas, or uncomfortable choices. This predicament, including its ethical, legal, and social implications, does not simply arise as a consequence of new medical imaging technologies, but it is intrinsic to their very development and implementation.
It goes without saying that new medical imaging technologies have greatly advanced medical diagnostics and research; sophisticated tools help medical professionals to detect disorders at a much earlier stage, or they assist them when planning intricate operations. In this book, I intend neither to hail the triumphs of modern medicine nor to detract from its achievements. My aim is to provide a cultural analysis of medical imaging, to unfold the cultural complexities involved in medical imaging instruments and products as well as their uses and meanings, both inside and outside medicine.15 Every year, approximately 250 million scans are made in American hospitals alone.16 According to a report by the Blue Cross and Blue Shield Association, diagnostic imaging is approaching a $100-billion-a-year business in 2004, about a 40 percent increase since just 2000.17 Most people view the ultrasound scanner, endoscope, or CT scanner as medical-technological appliances and consider the images they produce expendable, their significance beyond the walls of the clinic being close to zero. Yet, in recent decades, these machines and images have rapidly become an integral part of our visual culture. Medical imaging technologies have attained a prominent cultural presence in their own right, but there are significant overlaps with other technologies and cultural processesâin particular, those involving the interests and values of the mass media.
MEDICAL IMAGES AND MEDIA TECHNOLOGIES
Visualizing instruments used for medical diagnostics are related to media technologies on at least three levels. First, their technological developments tend to go hand in hand, meaning that innovations in one domain benefit technical advancements in the other domain. The invention of X-ray films in the 1950s, for instance, designed to record patients' lung movements, was made possible by the invention of the image intensifier; although the medical application never caught on, the image intensifier gave a boost to the production of television. Endoscopy's various stages of development have been closely connected to advances in media technology, such as (color) photography in the 1960s and television and video technology in the 1980s. The imagery produced by the mini-camera a surgeon inserts into the body of a patient ends up on a television screen. Cardiovascular scanners employ a technique that is used in compact-disc players, while MRI and CT scanning would be impossible without advanced computers. Digitization in general has caused medical and media instruments to merge. In the future, image processing, management, communication, and analysis will all coalesce in a computer-mediated system, further reducing the distinctions between media and medical technologies.
Secondly, in addition to their technological coevolution, media soon began to function as an intermediary for medical knowledge. After Wilhelm Rontgen discovered X rays in 1895, the technology gradually became standard in clinical settings. Similarly, the invention of film in that same year caused the burgeoning of cinema as a popular attraction at fairs and traveling shows. These two developments intersected in the first decades of the twentieth century, as X-ray images appeared on big cinema screens in tuberculosis-prevention campaigns.18 This new way of disseminating interior-body imagery among the public at large has undoubtedly contributed to a rising public interest in medical issues; large-scale displays of pictures revealing hitherto unseen mysteries generated excitement and were considered attractive and aesthetically pleasing by many. It is no coincidence that today we are still bombarded with images of fetuses, beautifully colored PET scans, or black-and-white shadows of ultrasound pictures; the abundant use of medical imagery in newspapers, movies, television, and magazines suggests that these media ventures are all eager to cash in on this phenomenon.
One could safely assume that the visualizing trend in medicine was promoted by mass media eager to exploit the power of fascinating, authoritative images. But the opposite is equally true: doctors and hospitals, keen on public relations, recognized the enormous publicity value of intriguing bodily images. In the modern welfare state, health tops the list of public concerns, and, understandably, the media cater to this popular priority. Whether the growing presence of medical images in mass media is the result of more and better medical imaging technologies, or the consequence of the ubiquitous, all-pervasive camera in private affairs, is hard to tell. The âmediationâ of medicine is part of a more general trend to allow cameras into our intimate lives.19 Media's ubiquitous presence in the rituals of our individual, private domains has blurred the boundaries between what used to be separate spheres.
Thirdly, as the above already suggests, medical and media technologies converge in their production of visual spectacleâdisplaying the inside of a human body. Shortly after the invention of film, doctors started to deploy the camera to record surgical interventions. More than a century later, the presence of cameras in operating rooms hardly raises eyebrows; recently, a delivery of triplets by cesarean section in a Dutch hospital was broadcast live on the Internet.20 Public interest in medical procedures, however, preceded the introduction of film. The tradition of publicly displaying cut-open bodies dates back as far as the late Middle Ages. In sixteen...