Biomedicine on Display

A couple of weeks ago, I wrote about neurophysiologist and Nobel Prize winner Ragnar Granit’s essay on the distinction between discovery and understanding as two separate modes of scientific work, which, he suggested, are differentially distributed throughout a scientist’s life-course — young researchers are impatient to discover something new, whereas older scientists are more interested in getting insight, he suggested.

Even more interesting, in my view, is Granit’s thoughts about how researchers ‘keep track’ and ‘take care’ of their identity in order to achieve understanding and insight:

By “keeping track of one’s identity” I mean cultivating the talents of listening to the workings of one’s own mind, separating minor diversions from main lines of thought, and gratefully accepting what the secret process of automatic creation delivers.

In all creative work, including scientific work, Granit said, there is ”need for a good deal of time for exercising the talent of listening to oneself”, and this self-listening is “often more profitable than listening to others”. Listening to oneself is at any rate more important than going to scientific seminars and conferences, which the ageing neurophysiologist thought was a pretty overrated activity:

There are so many of these meetings nowadays that people can keep on drifting round the world and soon be pumped dry of what is easier to empty than to refill.

Granit was aware of the possibility that some colleagues might regard his notion of ’keeping track of one’s identity’ as idiosyncratic. But he also knew others, who, like himself, when looking back on their lives, might recognise ”a main line of personal identity in the choice of their labors”. And maybe these colleagues would also agree with his own conviction that “if one can take care of one’s identity, it, in turn, will take care of one’s scientific development”.

Today, such ideas seem largely anathematic. Any graduate school programme will tell their students how important it is to engage with others, go to seminars, attend conferences, and read the literature systematically. Period. Few, if any, graduate school programmes would tell their students to listen to their own selves and take care of their scholarly identity.

The reason I find Granit’s idea of ‘keeping track’ and ‘taking care’ of oneself interesting is that it is pretty close to the ancient notion of ‘care of self’. I don’t know if Granit read Socrates or the Stoics or about the Epicureans. But his ideas are close to the notions of ’spiritual excercises’ and ’souci de soi’, which have been reintroduced into contemporary philosophy by Pierre Hadot, and later by Michel Foucault.

Such ideas — whether expressed by French philosophers or Finland-Swedish medical Nobel Prize winners — are definitely not on the agenda of present-day research governance agencies, who view researchers in more neo-liberal terms. It’s also a far cry away from the contemporary tradition of social studies of science, which shuns the idea of researchers taking their destiny in their own hands.

Prompted by a recent guest blog post on the Scientific American site, I’ve just revisited an almost 40 year old essay titled “Discovery and understanding” by the Finland-Swedish neurophysiologist and Nobel Prize Winner Ragnar Granit.

Growing out of a talk (see video here) that Granit gave at the Lindau Nobel Laureate Meeting in 1972, the essay was published in the Annual Review of Physiology later the same year. I remember dimly having read it when I was a PhD student a few years after it was published, but apparently I didn’t really appreciate it then — and didn’t understand the deeper significance of the message either.

But now I think I’ve got it. And it’s quite interesting for discussions about the culture of science, especially the contemporary political emphasis on scientific competition and race for publication.

The thrust of Granit’s argument is the distinction between discovery and understanding (and later insight) as two separate modes of scientific work that are differentially distributed throughout a scientist’s life-course. Discovery is all-important in the younger, passionate, phase of a scientist’s life, he suggests, whereas understanding and insight is the mark of more mature and detached scientists (which is probably why I didn’t understand the deeper significance of his essay when I was 30).

Young scientist are, he writes, characterised by an “impatient passion” to make discoveries. They want to ”see something that others have not seen”. They are on the outlook for what’s new, unexpected, and exciting, they are ”ruled by ambition”, they crave for “immediate satisfaction” and “instantaneous excitement”.

It’s easy to believe, he continues, that this passionate quest for discovery is the goal of science, partly because discoveries perpetually initiate new lines of experimental work, but partly also because they are more visible through popular media: “It catches the eye and, in the present age [1972] is pushed in the limelight by various journals devoted to the popularization of science”.

But even if the history of science is full of important discoveries that have “led to major advances”, they are nevertheless not what science is fundamentally about; they are just the means for the “real goal” of scientific work, which is “to try to realize some fundamental ideas about biological structures and their functions, that is to promote understanding”. And “gradually understanding will ripen into insight”.

If Granit had lived today he would probably have been horrified by the fetishisation of long publication lists, impact factors, and bibliometrics:

This attitude [understanding and insight] toward scientific work has the advantage of permitting the experimenters to devote themselves quietly to their labors without filling various journals with preliminary notes to obtain minor priorities

Was the distinction between discovery and understanding valid back in 1972? If so, is it still valid? Is there still a divide between the young postdoc’s passionate quest for rapid discovery and fast publication, on the one hand, and the older professor’s slower and more detached search for insight, on the other? And if so, is it only a question of psychology and individual ageing, or are there other, structural, factors at play?

Two weeks ago I mentioned that the Museums Journal had published Ken Arnolds and my Dogme 95-style manifesto for creating science, technology and medicine exhibitions, first presented last September at a conference organised by Medical Museion in Copenhagen. We have now received the journal’s permission to publish the full version of the manifesto. Enjoy and/or criticize!

Just over 15 years ago, Danish directors Lars von Trier and Thomas Vinterberg spearheaded Dogme 95, a manifesto to purify the art of film-making.

The aim was to engage audiences more profoundly and make sure they weren’t distracted by over-production. The Dogme manifesto ruled out special effects, post-production changes and other tricks in order to focus on the story and the performances.

Since then, writers, theatre directors and other arts practitioners have all found inspiration in Dogme 95’s back-to-basics philosophy. Dogme has been criticised, as have some of the films made according to its rules, but as exhibition producers, this classic vow of chastity has inspired us as a way of guiding and sharpening the creative practice of making science, technology and medicine exhibitions.

These rules have been written and published with almost indecent speed. They are deliberately provocative prompts for further discussion. This manifesto is not a definitive set of working proposals, but a draft, which will no doubt be modified and sharpened through challenge and feedback.

And anyone who knows the institutions we are based at will be aware that the exhibitions we have presided over have often not followed one or more of these rules.

This manifesto is almost reference-free, but this does not mean we think the ideas are purely our own. There are vast bodies of literature on science communication, exhibition making, art history and museology; we have read some of this literature and been influenced by it. We also have learned much from the museums we have visited.

1. Exhibitions should be research-led, not a form of dissemination

Curators should use exhibitions to find things out (for themselves and for their visitors) and not just regurgitate what is already known. Good curators are inspired and imaginative researchers who find and then build on the investigations of experts and colleagues, juxtaposing varied understandings about their chosen topic. They add their own insights and gradually come up with new ideas and perspectives.

2. A scientist should always be involved in the exhibition, a technologist if it is about technology

Don’t shy away from drawing on real expertise in interpreting a topic or finding exhibits. But this is not to say that the aim of the exhibition is simply to give voice to the views of these experts. They are not, nor should they be encouraged to see themselves as, the curators, but it is vital that their perspectives are present in the final exhibition.

3. Be clear about exhibitions being “multi-authored”

Exhibitions emerge from curatorial collaborations between experts and designers. But a show’s funders, the institutional context and other stakeholders have a bearing on the final outcome; it should be possible for exhibition visitors to find out about these influences.

The project teams who make exhibitions deserve to be credited. Those responsible for the show not only need to take a bow, they also need to be held responsible for its contents and impact.

4. Use only original material

Exhibitions should engage audiences with original material rather than reproductions and props. If you cannot illustrate a topic with original artefacts, images and documents, ask yourself if an exhibition is the best way to make the point. Models, replicas and reproductions can be shown, but only if this is the point of showing them.

Reproductions of artworks should not be used, unless the work’s natural medium is “facsimile” – for example, digital photographs. The use of scientific and medical images raises complicated questions, such as what is the “original” format of a microscopic image of a cell?

Most scientific images today are minted as digital data, and their final appearance invariably owes much to enhancements and cropping. How this material should be displayed and labelled needs consideration. It is often better to leave it out all together.

5. Never show ready-made science

Focus on the processes of science: science in the making; the triumph of discovery; the frustration and blind alleys explored along the way. Also, look at the social and cultural processes of scientific ideas becoming accepted and embedded.

6. Jealously guard a place for mystery and wonder

Exhibitions provide opportunities to explore topics in ways that bring new light to sometimes forgotten or less-well understood aspects of medicine, science, technology and their histories. But this urge to demystify subjects should not be allowed to render exhibitions earnestly didactic.

Deliberately include some exhibits about which less, rather than more, is known – curious exhibits that just cannot completely be accounted for. Visitors should leave exhibitions wanting to find out more.

7. Reject most exhibition ideas

Exhibitions represent the meeting point between subjects and material culture, and can be approached from either end – themes or objects first, or a mixture of the two. But often, topics that seem promising will not be worth developing because there simply aren’t good enough objects with which to explore or support them.

Similarly, many areas of material culture end up just not being interesting enough to make a show about. Too often, exhibitions are made from empty ideas of stupid objects. It is worth searching for a topic and a set of objects that harmoniously amplify and mutually enrich each other.

8. Leave out as much as possible

Less is usually more in exhibitions. Visitors will remember and enjoy looking at 10 carefully chosen things more than a 100 that are reasonably well selected.

The most important aspect of an exhibition is its outer boundaries, which keep out the mass of distractions that lie beyond. In the digital era, a core value of a museum exhibition is that it makes its point through displaying a few selected original objects.

9. Embrace the showbusiness of exhibitions

Audiences come to exhibitions in their leisure time and deserve to be lifted out of themselves. They will respond to the drama of the best exhibits, displays, design, writing and lighting.

Make sure that all of this is done well and given the greatest polish. This will enhance the presence of the objects and the impact of the ideas. Don’t be ashamed to admit that making exhibitions is, in part, a matter of putting on a show.

10. Celebrate the ephemeral quality of exhibitions

Catalogues, web-presence and filmed versions of exhibitions can lengthen the shadows cast by exhibitions, but they will never come close to keeping alive the actual experience of visiting a show.

This is an important part of the magic of exhibitions. Like good pieces of theatre, they gain much of their energy by being around for a limited time and then disappearing. The fact that they are time-limited gives their makers a degree of freedom to experiment and be daring. Grasp it!

11. Make exhibitions true to the geography of their venues

The principle is that knowledge is “situated” – the context in which we contemplate and acquire it can seem as important as the ideas or facts themselves. Exhibition makers need to think hard about how to work with the “place” of an exhibition.

Consider what is lost in touring an exhibition where the subject becomes detached from the local context. The country, the city, the venue, the room, and the set and design of an exhibition, even the showcases and the orientation of individual objects – all have a bearing on the meanings that audiences derive from them.

12. Avoid artificial lighting

Use natural light where possible. Start with the light available and build up from it. If possible, reveal the windows and keep the doors open. Let the natural layout of the building be apparent, make it clear where you have introduced false walls. This will enable visitors to keep a sense of where they are.

And don’t fall into the trap of imagining that the background for an exhibition has either to be a neutral black box or a pristine white cube. Ideally, a show should look and feel very different on a midsummer morning to a winter evening.

13. Always involve more than one sense

It is impossible for visitors to turn off their non-visual senses in an exhibition – they will hear, touch and smell things no matter what. So make sure that some of the tactile, audio, or olfactory experiences of an exhibition are curated. Exhibitions work by teasing their visitors into thinking that they could get close enough to what they see to touch it, even while making sure they don’t.

But curators should think about how to introduce at least a few objects that visitors can touch. Never use artificial sounds or odours, but try hard to find ways to enhance the audio and olfactory qualities of the original objects, getting visitors to use their ears and noses.

14. Make exhibitions for inquisitive adults

If you aim at educationally under-achieving primary school children, it will be impossible to engage anyone else (and you are unlikely to engage even your target audience). Many children and teenagers are keenly attracted to adult culture, but very few adults see the attraction of young material.

Never make exhibitions for educational purposes – other media and methods are more effective. It’s also worth bearing in mind that exhibitions are, by their nature, a “childish” medium, bringing out playfulness in all of us. This should be encouraged, but to focus deliberately on young audiences reaps diminishing returns.

15. Remember that visitors ultimately make their own exhibitions

Some visitors might not be interested in reading what the curators write, while others might not look at many objects. Some will be interested in aspects of a topic that the curators might not have come across.

Because of this, when an exhibition opens, it is only ever the second or third draft of an idea that will, through revision, reach maybe its eighth or ninth incarnation by the time it closes.

Exhibitions should be alive, and change is a vital part of life. Even in the most “stable” shows, lights will need adjusting and labels redrafting. An exhibit might even have to be removed or replaced. More radically, some exhibitions should be deliberately half-finished, or set up so that updates can be added halfway through.

16. Make exhibitions the jumping off place for further engagement

Good exhibitions are the point of departure for a longer relationship. The value of exhibitions should only partly be judged by analysing how many people come, how long they spent in a show and what they think of it. On this basis alone, most exhibitions are foolishly expensive ventures, particularly in these cash-strapped times.

Don’t forget that, just occasionally, exhibitions can really change visitors’ lives and this is worth a lot. Effective exhibitions can also bring in new objects to museums, have an impact on recruitment, add to shop sales, improve the organisation’s reputation, and provide a context for corporate celebrations. There is a virtual avalanche of cultural capital that can flow from them: this should be valued from the start.

17. Don’t be afraid to bend, break or reinvent the rules

At last month’s conference, Jan-Eric Olsén talked about the tendency in contemporary medicine and society in general to constantly monitor our own health.

Jan-Eric pointed to the fact that there is a fine line between monitoring and surveillance, and that patients should be aware of that before uncritically embracing these new technologies. Read Jan-Eric’s full abstract here.

In the discussion afterwards it was pointed out that some patients can actually gain personal freedom from a smart textile t-shirt taking over the constant monitoring of their vital signs. One person said that she wouldn’t have been able to attend the conference, if it hadn’t been for these very technologies helping her monitor her diabetic child over a great distance.

On the other hand, many of these products are advertised for people without a diagnosis, to constantly reassure them that they are healthy. What are the consequences of constantly monitoring your own health? Some suggested it might lead to some sort of universal hypochondria.

The discussion (at the end of the video clip) included comments from Lucy Lyons, Karen Ingham, Jim Garretts, Danny Birchall, Wendy Atkinson, John Durant, Nurin Veis and Ken Arnold.

See a list of the abstracts here. Read more about the EAMHMS video clip project here.

Most medical museums live in the safe past. Exhibitions rooms are filled with beautiful 19th and 20th century medical instruments and scary pathological body parts in formaldehyde. The present and the future body and its instruments are hardly visible in medical museums.

How, for example, shall medical museums handle the fusion of bodies and instruments made possible by bio-engineering and human enhancement:

Living bacteria with artificial DNA, supercomputers designed to function like a real human brain or robots showing human-like emotions. Biology is increasingly engineered in much the same way as technology, while technology is becoming more and more life-like. These two engineering trends intensify current debates about the desirability and acceptability of genetic engineering and human enhancement. They also raise novel issues, like who’s in control of machines with a life of their own?

Quoted from an invitation to a meeting titled ‘Making Perfect Life’ (about the social and political consequences of these two bio-engineering trends) in the European Parliament in Brussels on Wednesday 10 November. Speakers include stem cell scientist Stephen Minger, neurosurgeon Veerle Visser-VandeWalle, Artifical Intelligence expert Brigitte Krenn, philosophers Mark Bedau, Roger Strand and Jutta Weber, sociologist Andrew Webster and others.

See here for final programme and registration (before November 2nd). Conference attendance is free.

Founded in 2002, the Association for Medical Humanities (AMH) aims to promote, within the UK and the Republic of Ireland, the medical humanities in education, healthcare and research. It has links with the BMJ journal Medical Humanities and has organized annual academic conferences since 2003. Courses on Medical Humanities are increasing in the UK and can be found at University College London, Durham University, King’s College London, University of Aberdeen, University of Leicester, University of Glasgow, University of Bristol, Birkbeck College University of London, and University of Swansea.

On Monday 5th July the AMH 2010 conference titled ‘Humanities at the Cutting Edge: Conversations between surgery, pathology, the humanities & the arts’ opened in Truro, Cornwall, with an evening reception and talk. There were already two options, either attend a keynote talk by heart surgeon Francis Wells on his research into Leonardo da Vinci at the ‘Knowledge Spa’ Truro, or attend artist David Cotterrell’s keynote talk about medicine in conflicted spaces at Tate St Ives. I wanted to go to both.

After a plenary and coffee on Tuesday morning, presentations were split into workshops and papers. The choice was between two workshops and a dizzying array of 21 presentations grouped into three themes. Theme 1 was Surgery, pathology and identity; Theme 2 was The ‘pathological’ and the ‘normal’; and Theme 3 was Humanities and arts as health interventions. Each theme had two or three groups of three speakers in each group. So already before lunch on the Tuesday, 21 people had presented papers and two groups of people had run workshops.

Some of the interesting presentations I missed included art in hospitals, patient communication through theatre, the wonder of pathology and workshops on drawing the body and documentary filming of surgery. I listened to three very good papers in a group from Theme 3. After lunch I attended a useful practical workshop run by the editor of Medical Humanities and missed hearing any of the 18 papers presented that afternoon. On Wednesday the same problem occurred with two workshops running at the same time as 18 speakers’ presentations. The workshop I wished to attend the most ran at the same time as my presentation. It was about pop up surgical theatres and allowing surgeons not just to practise but to rehearse.

There were just too many parallel sessions, too many themes and groups within themes and simultaneous workshops. Some delegates gave presentations to empty rooms with no one else but the other two speakers present. At least people came to my talk. There were many interesting themes, viewpoints and areas of research but too many to hear.

At the plenary on Tuesday morning a psychiatrist presented research on coding and categorizing that was welcomed by medics and greeted with dismay by artists. Her method of labeling patients in distress using a process of narrative writing had the appearance of berating creativity and imagination by placing patients within a negative category of behaviour. Perhaps this is where the notion of subjectivity and adaptability to take into account the uniqueness of people in different situations may have helped.

However two papers given by medics saw creativity and subjectivity as positive. One, a mature graduating medical student discussed the tricky subject of finding cancer beautiful. Emotive and well researched it was fascinating to hear concerns from a medic that would usually be heard amongst artists. In another talk a GP discussed art being so important in his life he took a PG Cert in Fine Art and then an MA in medical humanities. He confessed to having spent years using a pseudonym and creating an underground comic depicting the dark humour and cruelty of his experiences in his surgery. Believing art to be a great way to express and communicate medical issues, he has left his job to become a full time artist. He recently organized the ‘Comics and Medicine: Medical Narrative in Graphic Novels’ conference at UCL and runs a website dedicated to Graphic Medicine.

The best part for me was the Wednesday plenary presentation. This was a performance by Peggy Shaw, a cross dressing, lesbian grandmother in her sixties working in collaboration with the Clod Ensemble, three musicians playing violin, cello and keyboard. Her show, ‘Must: the inside story’, saw Peggy dressed in a man’s suit and intoning poetic dialogue, some in beat with the accompanying music about her body’s history and experiences. Her deep New York accent described her mother’s mental illness and treatments, her own experience of giving birth, and sensations of touch and significance of bones. She lyrically chanted and sometimes sang in front of screens depicting cells and X-rays and other medical imagery. Engaging and vulnerable I had not expected to find her performative method of description and exploration of the body so powerful and enjoyable.

The AMH 2010 conference gave an opportunity for disciplines across the breadth of medical humanities to meet and talk and importantly listen to research and work undertaken from within fields of surgery, visual arts, pathology, clinical practice, creative writing, poetry, history, sociology, philosophy and general practice. Sometimes this worked and sometimes there were slight clashes or moments of misunderstanding. Medical doctors and artists and writers expressed concerns. Some felt incapable of reading arts & humanities articles without adequate knowledge of the art cannon or knowledge of Heidegger for example. However, researchers and practitioners in arts & humanities have often had to immerse themselves in the language of medical articles and find out the meanings for themselves.

There were diverse practical workshops, a breadth of visual and literary arts on display and a wide range of academic papers. I really wanted to see more as the papers I saw were good and the people I spoke to where diverse and fascinating. I wish I hadn’t missed other presentations and workshops which also sounded really interesting.

It’s hard to escape the impression that the humanities (including medical history, medical humanities, etc.) are living a wobbly existence, balancing on a fine line over the two abysses of social reductionism and biological reductionism. Are patients and their diseases social constructions or bags of biochemical reactions? Do these reductionist trends have any room left for the kind of books reviewed in the TLS ?

A forthcoming conference at the University of Copenhagen 16-17 September on ‘The Humanities Between Constructivism and Biologism’ will “explore the options for a coherent conception of Man as neither a mere biological species, nor a mere social construction. It is a conception of Man as both a producer and a product of history and culture, and thus as a shaper of himself”.

Not an entirely new or radical conception, I guess, but it deserves being repeated as an antidote to the two usual reductionisms (and I should remind the organisers that some women also feel they should be included in this coherent conception :-):

Humanistic studies as traditionally conducted are currently under pressure from two sides within academia itself: On one side, by a constructivist stance, which declares man to be a social construction. This robs the humanities of the natural focal point of their activities, the study of Man, and leaves them as an odd motley of disciplines with no unity and no shared vision. From the opposite side, the humanities are under pressure from evolutionary biology, which has no reservations about accepting the existence of such a thing as Man, who after all is a natural, biological species among others. In combination with affiliated approaches within neurophysiology and cognitive science, evolutionary psychology purports to explain every aspect of man’s behavior as a result of his genetic inheritance, as manifested in his brain and other cognitive apparatus. This leads to a heavily reductionist picture of man.

Speakers include: Ronald Schleifer (University of Oklahoma), Steve Fuller (University of Warwick), Robert Markley (University of Illinois), Nikolaj Zeuthen (University of Aarhus), Torben Kragh Grodal (University of Copenhagen), Finn Collin (University of Copenhagen), and Jan Faye (University of Copenhagen). Shall be interesting to see what position the unpredictable Steve Fuller will take on this!

No registration is needed. For complete programme and location, contact David Budtz Pedersen: davidp@hum.ku.dk

The Wellcome Library is announcing a vacancy as Head of Discovery and Engagement. The successful applicant is supposed to play a pivotal role in making the Library’s outstanding collections accessible, help revolutionise the Library’s web presence and reading-room services, and lead its outreach, communication and marketing activities. For more info, see here. Closing date is 10 May.

On several occasions we have had the pleasure to organise events together with Scandinavian literary scholars Frederik Tygstrup (Copenhagen) and Knut Stene-Johansen (Oslo); for example, Frederik spoke at the opening of our temporary exhibition ‘The Face of Disease’ (Sygdommens Ansigt) in 2006, and Knut sat on the committee that evaluated Adam Bencard’s PhD-thesis in February 2008 (and I’ve been giving a seminar on ‘presence effects in contemporary biomedicine’ in Oslo).

Knut and Frederik organised a Nordic research network called Infectio, which has resulted in a couple of meetings and now also an anthology titled ‘Illness in Context’ on Rodopi, which focuses on the literary perspectives of medicine and illness:

The reading practices highlighting the clinical, phenomenological and archeological approaches to illness take as their point of departure the living text, that is, the literary experience mediated and created by the text. Literature is seen not solely as a medium for the representation of experiences of illness, but also as a historical praxis involved in the forging of our common understanding of illness. In contrast to traditional literary analysis – primarily oriented toward the interpretation of the literary work’s meaning – the project will emphasize description and understanding of how literature itself performs as a means of interpretation of reality.

More here.