Thursday, March 8, 2007

Squier: response to Andrew Solomon's post

From: Susan Squier
Date: Thu, 08 Mar 2007 19:24:58 -0500

I want to pick up on Andrew's wonderful discussion of the ways that colorful fMRIs condense and fictionalize numerical data. Andrew, you suggest that "physicality is an alternative vocabulary for psychodynamic processes, which are always brain-based." While I agree that these images can give us another way to represent and discuss brain-based processes, I worry that the vocabulary they offer is an insidiously limiting one. The images omit, or to be more accurate they black-box, the factor of time. If they don't actually do so in the way the images are made (they can be taken over a span of time, or at a number of different instances), they certainly do so in the way the images are usually shown to the public as part of a persuasive presentation.

Seems to me that the rhetorical power of fMRIs also smuggles in a pressure to replace the slow, unseen intervention that is talk therapy with the instantaneous intervention of deep brain stimulation, in part precisely because it can be captured by the 'snapshot' visualization of this new technology. In its turn to evidence-based treatment, psychotherapy is finding ways to use the power of fMRI imagery to express its own ability to produce change. Presumably that will give psychology some leverage to argue for longer term interventions. If there's anyone in this conference (Brad Lewis?) who can chip in here, I'd love to hear from them.

However, in the interim seems to me we also need to mark the power such images have to shift not only the modes of psychiatric treatment, but the time-frame in which medical treatments are expected (permitted) to occur. This is emphatically not to argue that talk therapy is the only or even a preferable option in cases of intractable depression. But it is to encourage awareness of the fact that such images may also have powerful secondary rhetorical effects, such as catalyzing our gradual reorientation from a temporal to a spatial model of biomedical treatment. Or, to put it in other words, they may give more impetus to the institutional medical tendency to cut down treatment time.

Susan Squier
Brill Professor of Women's Studies, English, and STS
The Pennsylvania State University

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3 comments:

Dolores Hangan Steinman said...

I apologize for barging in, but I wanted to introduce the point of view of the bio-medical imager, with a clinical background. One advantage of the computer-generated medical images is that they decipher the “biological cryptogram” and make the unseen seen. They do not compete with data collected by the clinician but supplement them. As a research group, we are interested in the relationship between blood flow dynamics and vascular disease and the ways to convert this complex phenomenon into a mathematical description (or model) using Computational Fluid Dynamics (CFD), The reason we study haemodynamics is the fact that plaques and aneurysms tend to develop at sites where haemodynamics are most complex and the success of vascular surgery depends on positively “sculpting” (manipulating) the haemodynamic environment.
Another advantage of the computer-generated images is the “viewing” of and organ as a whole, thus presenting the organ and its functions in the context of its interactions with the rest of the organism, and providing a better understanding.
It is also important to note that since the images are generated on the computer, there is no invasion of the body (neither of its function /non-invasive technique, nor of the privacy of the patient- see, for example Mona Hatoum’s “Corps etranger” and threat of invasion and violation that experienced by the subject). Of course, one can argue that images become the person and simulations are yet another way of dehumanizing the patient.
As scientists and educators we are also aware of need for “truth” in these images and appreciate the difference between the scientific recording of data seen as documentary (and, as such, supposedly being safe of any manipulations) versus the scientific computer-generated simulations (created from patient-collected data that have undergone two conversions: once from the individual patient to numerical data (binary code), and then from numerical data thus obtained into images).
Hope this helps a bit with the argument in favour of medical imaging.

Susan Squier said...

Thanks so much for the added perspective on medical imaging, which really needs very little argument in its favor, seems to me. Its capacities are stunning. And yet when you say "they do not compete with data collected by the clinician but supplement them," I would suggest you are speaking of the goal and the best case scenario, but not always the reality. Consider two frames from Brian Fies's graphic novel, Mom's Cancer (2006): these images convey the gap between the complex understanding of medical imaging available to the biomedical imager, and the flattened reception in the medical encounter. And as for the use of images to dehumanize the patient, Fies's panels say it all in the ironic gap between the verbal message and the counter-intuitive, ungraspable meaning of the math behind the visual image.

I'd love to see a discussion of the role of graphic fiction in talking back to medical imaging, in fact: one set of visual images for another. Take the comic panels, with their complex grammar and vocabulary (see Scott McCloud's works) and the medical images (with the rich grammar and syntax you discuss in your posting.) It would be great to have a conversation between the two sorts of imagers: graphic novelists and bio-medical imagers.

http://i119.photobucket.com/albums/o149/jtalasek/squierFies2.jpg

http://i119.photobucket.com/albums/o149/jtalasek/squierFies1.jpg

Andrew Solomon said...

Thanks to those who have responded here. I should emphasize that I think these images are very useful and that I am by no means opposed to them. They are useful in political contexts, as I've said; they are useful for patients who are trying to understand their own illness or that of their friends and relations; and they are useful for scientists because the logic of visual representation is important to various kinds of conceptualization. I am interested in the issues of artifice and of representation and so on, but I would not want to seem to disparage non-invasive imaging, which is one of the most important developments in medicine today. As I said in relation to Helen Mayberg's work, imaging is providing unanticipated solutions to what had seemed to be unsolvable problems. This is but one example of the remarkable progress that has been made. Still, the practices are misunderstood and literalized by the public, and it is important to examine the dynamics of those processes.