| Ever since the discovery of X-rays in 1896, imaging technologies have become crucial instruments in everyday medical practice: they visualize the insides of a living human body without having to substantially damage its skin. Ultrasound, endoscopy, magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET) and related technologies have become indispensable tools in contemporary medicine, where they are both deployed for diagnostic purposes and for surgical navigation. Beyond the obvious clinical results of the use of these imaging technologies, an important philosophical question arises. If we take serious the program s conjecture that visualizations of the body, and the technologies with which body images are produced, are no transparent intermediaries between knowledge and reality, but that they mediate and therefore transform knowledge and the object of knowledge, then we must ask the following questions. 1. How are readable images (i.c. endoscopic and ultrasound images) constituted in the clinic? 2. How do medical imaging technologies, and the images they produce in the clinic, affect the human body both as a (professional, personal and cultural) object of visualization and as an entity that is experienced subjectively? Ad. 1. Far from being simple depictions of a given body, medical images are produced in clinical settings, by technologies that already carry specific historical and cultural trajectories. Institutional contexts, the histories and cultural images of the technologies, as well as the intellectual, tactile and technical knowledge of clinicians, all contribute to the ways in which medical images depict a body and to the specific ways in which they are read. Every new imaging technology requires new interpretative frames, new ways of matching bodies with the imaging apparatus, new reading and cognitive skills to be developed. Images do not contain implicit meanings that radiologists must "learn to decode," as historians of medical imaging technologies have often assumed (Brecher & Brecher 1969, Kevles 1997). The readability of endoscopic or ultrasound images is a hermeneutic process, resulting from the intricate work of disciplining and codifying bodies, apparatuses, specialist and lay skills, and institutional protocols. A precise analysis of this complex web of disciplining forces within which images of the body are produced and which informs their eventual reading, will be the project s first theoretical challenge. (cf. Pasveer, 1992; Lerner, 1992). Ad. 2. Endoscopic or ultrasound images signify a body both as an object of medical knowledge, and as a subject of the patient s personal experience. An ultrasound picture signifies something profoundly different in the perception and experience of a pregnant woman than in that of the gynecologist. Somehow the same image mediates two different (perceptions of) bodies because the visualization process follows partially different trajectories, each inscribed with its own mediations and transformations. At the point of the actual production of an image, the body as object of the gaze may prevail both for clinician and for patient. For the patient, though, the image necessarily also informs her perception/experience of a body. As a result, the double mediation of the body as subject and object prompts a philosophical reflexivity that has not been theorized so far, and which is not sufficiently explicable in terms of the subjective experience of one s own interior body image, or exclusively in terms of psychological effects. Although this project aims at theorizing the medico-visual mediation of the body in general, it will narrow down its scope to two imaging technologies in particular: ultrasound and endoscopy. Ultrasound has its roots in the physics of sound; the apparatus registers stronger and weaker echoes coming from diffuse spaces between internal organs, and records them in subtle shades of gray. (cf. McNay and Fleming, 1999). The technique itself is known as non-invasive no need to damage skin to obtain an image; and diagnostic an image may inform a therapeutic trajectory, but in itself it only contributes to the establishment of a diagnostic judgement. Video-endoscopy provides rather different images than ultrasound: interior cavities or organs are recorded on video by bringing a mini-camera into the body through a tube, which has been inserted via a natural or artificial opening. Video and computer-assisted endoscopy is more than a medium for the observation and detection of pathologies (tumors, cystes, stones): the techniques enable the surgeon to operate directly inside a body without necessarily having to make a large incision in the skin. (Lauridsen, 1998) We have chosen to focus on ultrasound and endoscopy for specific reasons. Most importantly, both procedures allow patients to watch (moving) images of their own interior and hence fit the project s aim of theorizing the mediated body as an object of knowledge and as a subject of experience. Moreover, both ultrasound and endoscopy operate within the realistic trope of live television, implying a strong tendency to read the resulting images as unmediated representations of reality. The confrontation of a patient s realistic reading with a clinician s interpretation yields above formulated questions of embodied subject versus medical object. These two imaging technologies are case studies: the project aims at a philosophical analysis of mediation in the context of medical imaging technologies in the clinic. Although medical imaging techniques increasingly define the way we perceive, understand, treat and have/are the human body, little philosophical research has been dedicated to the topic of seeing and representing the body's interior, as it is related to the modern high-tech medical setting. There is a fair amount of research in the history of medicine concerning the introduction of new visualizing instruments, particularly on the development of X-rays in the nineteenth and early twentieth century (Pasveer 1989; Lerner 1992, Bynum 1997; Reiser 1978). From a (social) constructivist angle, Pasveer (1989) and Blume (1992) have theorized the various aspects of the relationship between visualizing technology, medical diagnosis, professionalization, and its effect on clinical practices. Cartwright (1995) and Holtzmann-Kevles (1997) have explored the interrelations between medical and cultural practices resulting from the introduction of new imaging technologies. With regard to specific theories on ultrasound and endoscopy, most researchers adopt an anthropological or sociological perspective. Taylor (1996) and Price (1996) argue that the use of ultrasound in a birth clinic significantly affects how women see their fetuses, and how they adjust their behavior and apprehension vis-à-vis their pregnancy. Various cultural critics have analyzed how ultrasound images have modified the representation of the fetus in Western culture (Cf. Petchesky 1987; Duden 1993). The nature and significance of the endoscopic gaze has hardly been a subject of serious investigation. Shohat (1998), in a limited research project, examines how endometriosis patients retrospectively watched endoscopic videos of their own surgery, which helped them understand and cope with their disease. Van Dijck (2000; forthcoming) argues that the various levels of mediation (social, cultural, psychological) are inextricably intertwined in the signification process. What is lacking in these studies, is a systematic philosophical reflection on the meaning of (endoscopic and ultrasound) images for the representation, perception, and experience of the body s interior. We propose two major methodological venues to tackle the research questions. For a theoretically informed analysis of the institutional context in which images are produced, the researcher will have to use methodologies common in the anthropology of science. (cf. Latour, 1998; Hirschauer, 1991; Lynch and Woolgar 1985) Thus she will have to observe a series of image-making sessions in the clinic and analyze how the different participants interrelate when they produce such images. A (radically) constructivist approach departs from analyses of the mediated nature of embodiment. The philosophico-empirical approach, holds that techniques modify the matter of our expression, not only its form (Latour, 1994: 38). A constructivist analysis focuses on the reconstruction of the collectives of people and machines within which the body is visually mediated. It holds that mediations always imply transformations of all participants to the collective: of their goals, their characteristics, their competencies. This approach requires the researcher to anthropologically observe the constitution of collectives within which bodies are (visually) mediated. Rather than privileging human interpretations of what happens to (their) bodies, the focus will be on processes of mediation/translation. (For examples of constructivist inspired work on mediation, see Latour 1993; Coopmans 2000; Cussins 1999; Hirschauer 1991; Akrich & Pasveer 1996, forthcoming; Hutchins 1995; Rabeharisoa & Callon, forthcoming). The second, (post-)phenomenological approach focuses on processes of perception and interpretation of patients and doctors: how are their perceptions of the body as object and subject of knowledge and experience (in)formed by the visual mediations the(ir) body is subjected to? Methodologically, this approach requires the researcher to have access to people s perceptions and interpretations of medical imaging technologies, either during or after the imaging process. The researcher will have to study imaging practices in detail, and on the basis thereof, interview patients and clinicians as to their experiences of the bodies visualized. (For examples of phenomenologically inspired work on (medical) technology, see Ihde 1996; Verbeek 1999; Dipert 1993). Together, these methodological and theoretical venues will lead to a description of how the apparatus produces readable images, how this apparatus and its constituent parts are informed by their specific historical and cultural roots, and how they inform the various interpretative trajectories of patients and doctors. |
