A 4: Tutor submission CS

A 4: Tutor submission CS

CHALLENGING MEDICAL DOMINANCE IN VISUAL CULTURE: A DISCOURSE ANALYSIS

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LIST OF ILLUSTRATIONS

Figure 1: BBC News Special: Coronavirus Update 15/02/2021 (2021) Directed by BBC. 15/02/2021; 32.06mins. At: https://www.bbc.co.uk/iplayer/episode/m000ssfg/bbc-news-special-coronavirus-update-15022021?page=4 (Accessed  16/03/2021).

Figure 2: BBC News Special: Coronavirus Update 15/02/2021 (2021) Directed by BBC. 15/02/2021; 38.05mins. At: https://www.bbc.co.uk/iplayer/episode/m000ssfg/bbc-news-special-coronavirus-update-15022021?page=4 (Accessed 16/03/2021).

Figure 3: Fildes, L. (1891). ‘The Doctor.’ [Oil paint on canvas] 1664 x 2419mm.: Tate. At: https://www.tate.org.uk/art/artworks/fildes-the-doctor-n01522. (Accessed 12/11/2020).

Figure 4: Smith, E. (1948a) W. Eugene Smith | Country Doctor Dr Ceriani operating on Lee Marie Wheatly, a two and a half year old child who needed emergency surgery after having been kicked in the head by a horse. Kremmling, Colorado, USA. 1948. W. Eugene Smith. [Photograph] At: https://www.magnumphotos.com/newsroom/society/w-eugene-smith-country-doctor/attachment/par108033/(Accessed  17/06/2020).

Figure 5: Lenestan (2021). ‘Portrait of confident female doctors standing with arms crossed at the medical office.’ At: https://www.shutterstock.com/image-photo/portrait-confident-female-doctors-standing-arms-1078984250 (Accessed 18/01/2021).

Figure 6: Frare, T. and Toscani, O. (1992) Man dying of AIDS. [Poster] 299mm X 422mm.: V&A Museum. At: https://collections.vam.ac.uk/item/O76080/man-dying-of-aids-poster-frare-therese/ (Accessed 10/02/2021).

Figure 7: ‘Three Oncologists (Professor RJ Steele, Professor Sir Alfred Cuschieri and Professor Sir David P Lane of the Department of Surgery and Molecular Oncology, Ninewells Hospital, Dundee).’ Ken Currie 2002, Scottish National Portrait Gallery. Oil on canvas. 195.58 x 243.84 cm. (Accessed 12/11/2020). https://www.nationalgalleries.org/search?location%5B36062%5D=36062&location%5B36105%5D=36105&location%5B36114%5D=36114

Figure 8: Screenshot of the “UUmwelt’ exhibition by Pierre Huyghe, (3 Oct 2018 to 10 Feb 2019). https://www.serpentinegalleries.org/exhibitions-events/pierre-huyghe  Serpentine Gallery, London. Retrieved, 12th January 2020.

Figure 9: Assemblage image No 1: From my ‘Body of work’ series which is untitled. Morris Gallagher, 28/06/2021.

Figure 10: Assemblage image No 8: From my Body of work series which is untitled. Morris Gallagher, 28/06/2021.

ABSTRACT 

This paper examines how and why medical institutions dominate and control images of health care and investigates photographic challenges to medical hegemony. 

The focus will be on how medical dominance is established, exhibited, and challenged in visual culture, particularly in the representation of doctors.

My literature summary shows limited recent research examining how medical dominance is established, particularly in online images, and even less about how it this is challenge in visual culture. This paper contributes to that gap in knowledge.

This discourse analysis examines visual and other ‘texts’ which help to delineate structures, practices and power relations, as in doctor and patient roles. Foucault’s writings on power will be my partner in this work, but Hall, Goffman, Barthes, Baudrillard and other writers contribute to my theoretical framework. 

First, we examine power relations and practices in the UK government’s coronavirus briefings of 2020-21. Next, we investigate why and how medical dominance is formed by analysing images from the 19th, 20th and 21st century, that reveal the genesis and growth of medical institutions, that control medical training and ideologies, and related societal changes.

The final section of this paper looks at images or artworks that challenge medical culture and power, medical institutions, doctor representations, and ideas about surveillance and control of the body. The framework used is taken from Foucault’s writings on resistance to power.

In my discussion I examine three questions: is it desirable to challenge medical dominance; what are the constraints of that challenge; and what would a future visual culture look like that incorporates challenges? 

I conclude that medical power has a social utility in doctor patient relations, but challenges to medical ideology and power is imperative to power relations, from those who can learn to be ‘reactive,’ and that is challenges to medical power are cumulative, uncertain and temporal rather than radical.

CONTENTS

Chapter 1: Introduction and methods

Introduction

Literature summary

Methods

Chapter 2: Medical dominance in the ‘coronavirus press briefing.’

Displays

Myths and truths

Challenges

Chapter 3: The formation of medical ideology and power

A painting: Fildes’ ‘The Doctor’ (1891)

A photograph: Eugene Smith’s ‘The Country Doctor’ (1948)

An internet image: The doctor as icon (2021)

Chapter 4: Challenging medical dominance in visual culture

Challenging culture: Benetton and the man dying of AIDS (1992)

Challenging the institution: Currie’s “The Three doctors” (2010)

Challenging surveillance: Pierre Huyghue’s ‘UUmwelt’ (2018)

Challenging power: ‘Responses to coronavirus’ (2021)

Chapter 5: Discussion

Chapter 6: Conclusions

Chapter 7: References and Bibliography

References

Bibliography

CHAPTER 1: INTRODUCTION, LITERATURE AND METHODS 

“…ruling groups…attempt to fashion the whole of society according to their own world view, value system, sensibility and ideology. So right is this world view for the ruling groups that they make it appear (as it does to them) as ‘natural’ and ‘inevitable’ – and for everyone – and as far as they succeed, they establish their hegemony. (Dyer, 1977;30)

1.1 Introduction

This paper examines how and why medical institutions dominate and control images of health care and investigates photographic challenges to medical hegemony. 

Starr defines medical dominance as “the power of doctors to control the actions of others through commands and cultural authority deriving from the value accorded to medical knowledge” (Starr, 1982). With the help of Foucault and other writers I will examine how medical power is founded on the professionalisation of medicine and practices of knowledge, training, and certification. My focus will be on how medical dominance is established, exhibited, and challenged in visual culture, particularly in the representation of ‘doctors’ of which I am one. 

Hegemony can be defined as “the dominance of one group over another,” and is based on the writings of Antonia Gramsci (D’Alleva, 2013; Rosamond, 2021). Today, we view hegemony as a ‘natural’ and hidden dominance of ideas, and images, that maintain this hold on power and discourage alternative representations (Rosamond, 2021). We will examine how that hidden power is formed and displayed in Chapter’s 2 and 3, and artistic challenges to medical hegemony in Chapter 4 (Hall et al., 2013;344).

Literature summary

Medical culture has not always been dominant. In Roman times medicine was seen as a “low grade occupation” (Starr, 1982; 6). By the 18th-century doctors were unpopular, categorised as “bloody” (surgeons) or “non-bloody” (physicians), and operating on “parts” and not people (Weisberg, 1995). A seismic change in doctor status began at the end of the 18th-century (Foucault, 1996;xii). The reasons for this change are complex, but are related to the professionalisation of medicine and ‘new’ relationships with patients and society, which are explored in Chapters 3 and 4 (Foucault, 1996; Preface).

Visual ‘texts’ that evidence the growth of medical dominance are medical portraits from 1660 to 2018 (Jordanova, 1999, 2018). They show how doctor identity, and the reputation and power of medical institutions, were constructed through symbols in doctor paintings. Our first ‘hero’ doctor, Sir Edward Jenner (1749-1823), of smallpox fame, is represented in oils, and other paintings that show the transition of women from midwives to medical school ‘approved’ doctors of the mid 19th– century, and exhibited by medical and other institutions (Jordanova, 2018:87; Riedel, 2005 Jordanova, 2018, 1999; John Singer, 1900). These institutionally formed images are the dominant representation of doctors in visual culture, from Rubens engraving of Hippocrates in 1638 until the 1950’s and the arrival of newspaper, magazine and television culture (Rubens, 1638; Smith, 1948b; Cosgrove, 1948). 

The largest study of doctor representation analysed 5157 Australian press images, and concluded that there is a high level of ‘medical dominance’ (control) of imagery of doctors (Lupton and McLean, 1998;957). A similar Slovenian study found that doctor representations were less positive, suggesting that perception of medical dominance is culturally determined (Kovačič and Karmen, 2011).

Research on TV doctors is extensive and falls into three areas: content analysis of programmes (Chory-Assad and Tamborini, 2001; Solange, 2005); analysis of changing public perceptions of doctors (Turow, 2010; Quick, 2009; Hoggart, 2000; Feasey, 2008); and comment (Kiesewetter, 2020; James, 1989; Gazur, 2017; Verhoeven, 2008). They conclude that: doctors are represented positively; they educate viewers about health care; and the trope of the ‘Jekyll and Hyde’ and troubled hero doctor persists (Turow, 2010; Hoggart, 2000). They also recognise important variables, such as the role of institutions, control of production and audience readings which shows that viewers make sophisticated contextual reading of what they view (Turow, 2010; Solange, 2005).

Surprisingly, there is little substantive research about online doctor images. Women and ethnic minorities continue to be under-represented, and ‘doctor bashing’ in the media is a subject of study, but these are small scale content analyses (Kocemba et al., 2015; Heer-Stavert, S, 2020, 2019b; a; Wilkinson, 2021).

Contemporary research about ‘medical dominance,’ as a subject, examines cultural and societal changes that challenge the autonomy and power of doctors, and the democratisation of doctor-nurse relationships (Allsop, 2014; Whitehead and Davis, 2001). Key writers identify how the ‘sovereignty’ and control of medicine and the power and influence of doctors is being eroded by competition, governmental legislation and (financial) control (Lupton, 2003; Starr, 1982; Allsop, 2014).

In summary, there is limited recent research examining how medical dominance is established, particularly in online images, and even less about how it this is challenged in visual culture. This paper contributes to that gap in knowledge.

Methods

This is a medical discourse analysis using frameworks by Rose and Dijk (Dijk, 1993; Rose, 2016a; b). Medical discourse “refers to the special language of medicine, the forms of knowledge it produces and the professional institutions and social spaces which it occupies” (Nead, 1988). 

My discourse has two elements, textual and contextual. I examine visual and other ‘texts’ which will help us to delineate structures, practices and power relations, as in doctor and patient roles. I will also explore how social, political, and cultural factors affect the production and consumption of visual media, with an emphasis on how that creates and sustains medical ideology and hegemony. We will also examine institutional practices, their ‘spaces of observation,’ the ‘day to day’ work of doctors, and compliance by patients, that enact and reinforce a systems of health care that subjugates “docile bodies,” of doctors and patients, and maintains medical and governmental power (Foucault, 1977;135).

Foucault and his discourses will accompany us throughout this paper. He comments, “There is no power without the correlative constitution of a field of knowledge, nor any knowledge that does not presuppose and constitute at the same time, power relations” (Foucault, 1977;27).

“In power relations we see the application of institutional knowledge as ‘regimes of truth,’ or accepted practices, that determine what knowledge is valued and promoted” (Foucault, 1980;131). 

Hall, Goffman, Barthes, Baudrillard and other writers also contribute to my theoretical framework (Hall et al., 2013; Goffmann, 1956; Barthes, 1957, 1977; Huang, 2019).

CHAPTER TWO: MEDICAL DOMINANCE IN THE ‘CORONAVIRUS PRESS BRIEFING.’

Displays

Do institutions control people’s responses to medical images and knowledge?  Figures 1 and 2 are images from a televised ‘Coronavirus Press Briefing’ (BBC News Special: Coronovirus Update 15/02/2021; 32.05,38.05 mins, 2021). This was shown after the second wave peak of cases when 15 million people had received their first vaccine.

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Figure 1: Screensave of BBC News Special: Coronovirus Update 15/02/2021, 2021; 32.05 mins

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Figure 2: Screensave of BBC News Special: Coronovirus Update 15/02/2021, 2021; 38.05 mins

The denotative aspects of this video are that three people enter a room to stand behind wooden lecterns with placards that say, “STAY HOME – PROTECT THE NHS – SAVE LIVES.” Screen texts inform us that this is the ‘Prime Minister, Mr Boris Johnson,’ flanked by the ‘Chief Medical Adviser, Dr Chris Whitty,’ and ‘Chief Executive Officer of the NHS, Sir Simon Stevens.’ The Downing Street logo fills a TV screen to the left of the room and a suited man is signing speech to the right. The room is wood-panelled, with elaborate light holders, a bright patterned carpet in front of the speakers and unfurled Union Jack flags visible in an anteroom (Fig 1).

The connotative aspects are of these scenes are that three institutions orchestrate a display. The first institution is a broadcasting company where “Governments set the terms under which it operates, they appoint its most senior figures, …it hardly amounts to independence in any substantive sense” (Mills and Sinclair, 2017). While the BBC continues to promulgate its ‘independence’ and role as ‘truth teller,’ it also pursues nationalistic ideals and actions where “nation shall speak truth unto nation” (Boaden, 2011).

Next, the institute of government is represented by its prime politician and two senior medical doctors, who represent medical institutions and are answerable to politicians. This is a display of governmental, media and medical power; power within power, within power. 

This is a lecture about managing covid-19 where Dr Whitty employs the ‘technology’ of graphical images to re-enforce his knowledge credentials, but speech as well as setting and presentation matter. My content analysis of participant’s speech identified two main themes; “the vaccine rollout is going well’ and ‘there is still a threat.’ The commonest word used after “vaccine” was “high” or “very high;” Prof. Chris Whitty used the latter word five times. The Prime Minister’s celebrates “powering past the target’s we have set,” helping “vulnerable people” (the third most used phrase) and being cautious for the future. The context of this briefing is that it pre-dates a “road map” for reducing pandemic constraints amidst pressure from conservative politicians and sections of the media to release social restraints; they are the target audience for this briefing. 

Myths and truths

Several myths are coded in this tableau of signs (Barthes, 1977;33-35). The first myth signified is ‘war briefings’ from the 1940’s, with signifiers of the Union Flag, panelled room, and “No 10” text, that reference past war successes. This analogy is inferred yet understood by viewers; “The meaning is already complete, it postulates a kind of knowledge, a past, a memory, a comparative order of facts, ideas and decisions” (Barthes, 1957). The Prime Minister ‘wrapped’ in the Union Jack signifies past glories of when Britain was ‘Great,’ (Johnson, 2014). It also references the success of British technology to produce a successful vaccine. These ideological systems, whose meanings and messages are orchestrated here, are founded on culture, knowledge, and history, and are read and understood by viewers.

A counterpoints to myth is truth; can the audience know that what is presented is truthful? Goffman, in his analysis of behavioural performances discusses inauthentic performances or ‘false fronts,’ which he defines as “a discrepancy between fostered appearances and reality” (Goffmann, 1956;66). ‘Front,’ refers to the setting, and performers’ appearances and manner. Goffmann says that we can infer falsity and ‘secrets’ from what is said but we are unlikely to be able to define its substance if the performance is well constructed and ‘believed’ by presenters and audience (Goffmann, 1956;77). He concludes that, “…the real secret behind the mystery is that there really is no mystery” or indeed the “chief secrets are petty ones” (Goffmann, 1956;76). Perhaps that is the case with Boris Johnson’s attempt to defend his aide Dominic Cummings, about breaching Covid-19 regulations, in a Covid  briefing in May 2020? (Duncan, 2020). There was a ‘secret’ reason for Cummings’ strange behaviour, which was later revealed to be ‘prosaic’ information about personal security: a far cry from an explantion about ‘driving blind’ in Bishop Aukland (Shaw, 2021).

Challenges

One might argue that medical and political dominance in Covid-19 policy is a ‘preferred’ response; it is natural, ideological, and hegemonic. The problem is that not everyone shares an ideological view which leaves little room for disagreement, challenge, or counter narratives, such as anti-masking, no lockdowns and criticism about coronavirus deaths. 

Foucault comments that systems of power are usually strategic and always include plans to nullify dissent, “every relationship of power tends, both through its intrinsic course of development and when frontally encountering resistances, to become a winning strategy” (Foucault, 1994a;346). There are three elements to Foucault’s conception of ‘strategy:’ a description of means to achieve a certain end; to consider how the audience will react; and to design procedures “to reduce him to giving up the struggle” (Foucault, 1994a;346-7). It is this last strategy of a carefully constructed question and answer section in this briefing, where strident questions from journalists are neutered so that control remains with the presenters and “Stable mechanisms replace the free flow of antagonistic reactions” (Foucault, 1994a;346-7). The leaders of this meeting vigorously control what is sayable and ignore or reflect disagreements, while superficially giving the appearance of public accountability. 

To summarise, in this Covid-19 briefing we see a regime of representation with visual and textual practices about medical knowledge of how to manage a pandemic, rules about talking about the pandemic and resisting counter narratives, and practices for with dealing with people – its polities. In the remainder of this essay, we will explore how we have arrived at these polities and representations and examine challenges to medical dominance in visual culture.

CHAPTER 3: THE FORMATION OF MEDICAL IDEOLOGY AND POWER

Foucault marks a paradigm shift in medicine at the end of the 18th- century, when old ideas about medicine were challenged by “an essential mutation in medical knowledge,” with resultant radical changes in health care, doctor behaviour and social relationships (Foucault, 1996;xviii). Medical knowledge changed from a ‘mythological’ understanding of disease to one based on evidence of disease that could be observed, measured, and debated; a world of “constant visibility” (Foucault, 1996;x). Practices of studying pathological anatomy took place within a new institution, “the clinic,” where hitherto poorly trained and paid doctors were inculcated into the ‘new’ observational medicine and certified as fit to practice by new institutions – medical schools.

In this chapter we analyse images from the 19th, 20th and 21st century, that show the genesis of medical institutions and practices that control medical training, ideologies, that manifest themselves in visual media of their times.

A painting: Fildes’ ‘The Doctor’ (1891)

Weisberg argues for a pivotal moment in medical portraiture in French painting in 1880 when portrait conventions changed from “blood” surgeons and “non-bloody” physicians to being at the patient’s bedside (Weisberg, 1995; Michelena, 1887). Fildes painting ‘The Doctor’ (Figure 4) is an example of this new genre (Fildes, 1891). 

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Figure 3: Fildes, L. (1891). ‘The Doctor.’ [Oil paint on canvas] 1664 x 2419mm.: Tate. At: https://www.tate.org.uk/art/artworks/fildes-the-doctor-n01522. (Accessed 12/11/2020).

In Fildes’ picture we see a well-dressed man contemplating an ill child at their ‘bedside’ which is composed of two chairs. The child’s arm is stretched out to the doctor but there is distance between them. A father looks on from the shadows with one hand on his wife’s shoulder. On the table is a bottle of medicine, cup, and spoon. A crumpled paper lies on the floor and there is water and a bowl on a trestle at the head of the bed. 

The connotative aspects of this scene are that this a vigil of a doctor in a patients home. The furrowed brow of the doctor references iconic images of Asclepius and Hippocrates (Rubens, 1638). The half-full medicine bottle and filled prescription paper signify that this physician is a trustworthy dispenser of medicine and not a ‘quack.’

In the early decades of the nineteenth century there continued to be a blurred boundary between legitimate physicians and those “peddling illegitimate medicine and false knowledge” (Morrison, 2016). Foucault remarks on the effects of the new medical institutions on doctors, “supervision would be exercised over the doctors themselves, abuses would be prevented and quacks forbidden to practice, and, by means of an organised, healthy, rational medicine, home care would prevent the patient’s becoming a victim and avoid exposure to contagion of the patient’s family” (Foucault, 1996; 19-20). In this painting we see the first glimpses of the self-monitoring of doctors from an approved institution, the application of rationality and new knowledge to disease, and a desire to place health care in the patient’s home. 

A paradox of medical and governmental changes in France and the UK is that ridding society of quacks and unproven medicines created a medical elite with increased power over medicine and health care and people’s bodies (Morrison, 2016).

Foucault describes two “great myths” driving medical change after the French Revolution of 1789-9; the nationalisation of a medical profession that will improves man’s bodies, and being able to eradicate disease and restore health (Foucault, 1996;31-32). Both myths medicalise a society staffed by “priests of the body,” and health monitoring “in a corrected, organised, and ceaselessly supervised environment” (Foucault, 1996;32). These myths continue today as powerful ‘hero’ doctors ‘battling’ the disease, and organisation that monitor patient adherence to regimes of care, as in the case of diabetes mellitus, in constructed and controlled physical and virtual spaces. 

This painting, commissioned by Tate is problematic because it is an advertisement for a ‘new kind of doctor.’ The high-status doctor depicted would not have visited this cottage, it would more likely have been a poorly paid physician. Working people, in local community medical contracts, had good access to doctors, while the middle and upper classes paid fees for services, and successful doctors prospered from patronage. The myth of this painting is of “a common child being treated like royalty by an agent of modern magic, the ‘Doctor of Medicine’” (Morrison, 2016). 

A disadvantage of this new medicine was that it brought an objectification of the body and person that divided illness and behaviour into ‘normal’ and pathological. “The constant division between the normal and the abnormal, to which every individual is subjected…the existence of a whole set of techniques and institutions for measuring, supervising, and correcting the abnormal brings into play the disciplinary mechanisms to which the fear of the plague gave rise” (Foucault, 1977;199-200). Foucault take this further in his concepts of “biopower” and “biopolitics” which describe “an entire series of interventions and regulatory controls: a biopolitics of the population. (Italics in original) (Foucault, 1976;139-40). 

An example of ‘biopower’ from the 1800’s is the formation of societal perceptions of female sexuality and venereal disease (Nead, 1988; Price, 2005). In 1840 the surgeon William Tait wrote an ‘ideological’ text, based on his observations, laden with statistics and tables that constructed prostitution as a “deviant femininity” (Nead, 1988;146). This ‘mythological’ construction was rapidly adopted by others as the ‘naturalised’ view of prostitution. Foucault’s new priests of the body apply power by constructing knowledge which is accepted by others. 

A photograph: Eugene Smith’s ‘The Country Doctor’ (1854)

In contrast to Fildes’ construction of the doctor and patient relationship, and institutional power, Smith’s photojournalistic image of a similar scene (Figure 5) displays new features of power relations (Smith, 1948a).

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Figure 4: Smith, E. (1948a) W. Eugene Smith | Country Doctor Dr Ceriani operating on Lee Marie Wheatly, a two and a half year old child who needed emergency surgery after having been kicked in the head by a horse. Kremmling, Colorado, USA. 1948. W. Eugene Smith. [Photograph] At: https://www.magnumphotos.com/newsroom/society/w-eugene-smith-country-doctor/attachment/par108033/ (Accessed  17/06/2020).

In this image four people, two women and two men, intently observe something out of frame. The anchoring text tells us that Dr Ceriani is operating on a child that has been kicked in the head by a horse. The doctor and other participants are dressed alike and a man in background, perhaps the father, wears a Stetson hat. Unlike Fildes’ painting the family are not in shadow but dominate the space of this picture. Like Fildes’ painting it reflects a change in the medical gaze from scientific model of ‘expert’ towards a narrative where patient and family are included and the images and accompanying text evidence (Moore, 2008; Foucault, 1996). In this case that intention appears from the multiplicity of images and text, that this has become a reality.

The denotative aspects of this image are of an intimacy of spatial and personal relationship engaged to health care. The setting suggests a clinic rather than the patient’s home, the site of the technology of operations. Dr Ceriani is shining a light at what we presume is the child; this is the gaze of examination and on this occasion is shared by everyone in the frame. Conventional signs such as the stethoscope are absent although using an examination light demonstrates that this is not merely ritual show but an exploration of a huge facial wound. Armstrong sees power much less in structures, but in “the rash displayed, the hand applied to the abdomen, the stethoscope applied closely to the chest. This is the stuff of power. Trivial perhaps but repetitive, strategies to which the whole population at times must yield” (Armstrong 1987). 

An internet image: the doctor as icon (2021)

Figure 5 is an image from the media company ‘Shutterstock’ (Lenestan, 2021). It includes iconic objects that denote ‘doctor;’ stethoscope, scrubs, nametag, white coat, and portable computer.

A person wearing a stethoscope around her neck

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Figure 5: Lenestan (2021). ‘Portrait of confident female doctors standing with arms crossed at the medical office.’ At: https://www.shutterstock.com/image-photo/portrait-confident-female-doctors-standing-arms-1078984250 (Accessed 18/01/2021)

From its invention by Laennec in 1816 the stethoscope became an icon signifying ‘doctor’ (Reiser, 1993). We see it draped around George Clooney’s neck in the TV drama ‘ER,’ as visual shorthand that signifies the role of Doctor Ross (Kiesewetter, 2020). For Foucault “The medical gaze is now endowed with a pluri-sensorial structure. A gaze that touches, hears, and moreover, not by essence or necessity, sees” (Foucault, 1996;164). This is an epistemological change in knowledge where the invisible heart and lungs of the body in made audible, and hence visible to our senses; a demonstration of  “invisible visibility” (Foucault, 1996;165).

The stethoscope can also be viewed as a performative object that demonstrates doctor identity, skills and status, intrinsic to the ‘habitus’ of doctors (Rice, 2010; Lau, 2004; Barcelos Neto, 2003; Miller, 2005; Huang, 2019). ‘Habitus,’ a concept by Bourdieu, “expresses, on the one hand, the way in which individuals become themselves‘ – develop attitudes and dispositions – and, on the other hand, the ways in which those individuals engage in practices” (Webb et al., 2002;xii-xiii). It is not unusual for me to auscultate a patient’s chest even when I know that it will have no diagnostic value; it is a ritual of my ‘practice’ of medicine that signifies that I have done a ‘proper’ examination.

That and other practices of how doctors interact with patients has been modelled by medical schools for the last 200 years. This is the “socialising function” of medicine where beliefs and knowledge about diagnosing illness and responding to patients are absorbed (Lupton, 2003;127). Bourdieu, in his concept of ‘Cultural capital,’ identifies the influence of social networks and economic advantage which, in this context, are formed in the social, professional and power relationships of doctors training in medicine (Huang, 2019). 

This image is ‘anomalous’ because women doctors, particularly older women, are less represented in visual media than men (Shilcutt and Silver, 2018; Jordanova, 1999). It challenges the dominance of images of male doctors, although it also exploits women by presenting them as a commodity to purchase for display to media and other audiences (Hall et al., 2013). 

CHAPTER 4:  CHALLENGING MEDICAL DOMINANCE IN VISUAL CULTURE

Foucault describes a symbiotic relationship between power and its critique, “Where there is power, there is resistance, and yet, or rather consequently, this resistance is never in a position of exteriority in relation to power” (Foucault 1976:95). 

What does that resistance look like and where might it occur?

Resistance to power, like the application of power, is seen in Foucault’s practices of ‘discursive resistance,’ ‘techniques of self,’ and ‘reversed’ discourse (Lilja, 2018). Discourse resistance can be defined as ‘everyday’ actions, like a complaint about a doctor, that collectively challenge power. The four images in this chapter, together, are an example of ‘collective resistance.’

“…there is no single locus of great Refusal, no soul of revolt, source of all rebellions, or pure law of the revolutionary. Instead there is a plurality of resistances, each of them a special case: resistances that are possible, necessary, improbable…” (Foucault, 1976;96).

 ‘Techniques of self’ are about individuals enabling themselves to resist by “Not wanting to be governed…” (Foucault, 2007;46-7). ‘‘Reversed’ discourse’ refers to reactions to particular discourse, such as the construction of homosexuality as an ill, as in our next section (Foucault, 1990:101-2).

Foucault suggests multiple domains where resistance to power relationships may occur. These include cultural differences, institutional structures and surveillance of the body (Foucault, 1994b;344). These three areas, and an example from my Body of Work (BOW), are my framework for examining challenges to medical dominance. 

Challenging culture: Benetton and the man dying of AIDS (1992)

Figure 6 is Toscani’s poster of a man dying of AIDS,  which was part of an advertising campaign in by the clothing company United Colours of Benetton in 1992, strongly challenges medical and advertising culture (Frare and Toscani, 1992).

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Figure 6: Frare, T. and Toscani, O. (1992) Man dying of AIDS. [Poster] 299mm X 422mm.: V&A Museum. At: https://collections.vam.ac.uk/item/O76080/man-dying-of-aids-poster-frare-therese/ (Accessed 10/02/2021).

To the left of the image is a dying man lying in a bed, whose head and arm are cradled by a man’s head and arm and another person out of frame. To the right of the frame a woman views the scene and embraces the body and head of a young girl, mirroring the embrace of the dying man. The logo ‘United Colours of Benneton’ occupies the bottom right-hand corner of the frame. This poster was originally titled “Final Moments” confirming that this is a death scene. 

What are the denotative aspects of this image that caused “howls of protest and prohibitions” here and abroad? (Cooter and Stein, 2011). This is a photograph of the death of the American AIDS activist David Kirby. He looks like the face of a dying Christ, witnessed by an icon of Jesus with hands outstretched above him directing us to the scene. We begin to view this as a religious tableau as when Jesus’ followers comforted the ‘sacrificial lamb’ and Mary and others looked on (THB, 1991).

Replacing Christ with a gay man dying of an illness and “unnatural sex” was shocking as it crossed religious, moral and gender boundaries. It shattered conventions of that time about advertising and medical representations about AIDS. Foucault sees this as a “’reverse’ discourse: homosexuality began to speak on its own behalf, to demand that its legitimacy or ‘naturality’ be acknowledged, often using the same vocabulary, using the same categories by which it was medically disqualified” (Foucault, 1990:101-2). 

Hitherto most public health advertising focussed on creating of fear rather than the people involved. Little was known about AIDS for several years; ‘biopower’ from health institutions and pharmaceutical companies and ‘biopolitics’ from governments had few answers. That void was filled by gay men who challenged negative narratives and images of gay men and governmental responses to HIV, as shown in the film ‘Dallas Buyers Club’ (Dallas Buyers Club, 2013). We witness a challenge to “relationships of political power which actually control the social body and oppress or repress it” (Chomsky and Foucault, 1971). We will see more of ‘biopower’ in our next images.

Challenging the institution: Currie’s “The Three doctors” (2010)

A painting that challenges painterly conventions about doctor representation is Currie’s ‘The Three Oncologist’ (Ken Currie: Three Oncologist, 2010). 

A group of people in a dark room

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Figure 7: ‘Three Oncologists (Professor RJ Steele, Professor Sir Alfred Cuschieri and Professor Sir David P Lane of the Department of Surgery and Molecular Oncology, Ninewells Hospital, Dundee).’ Ken Currie 2002, Scottish National Portrait Gallery. Oil on canvas. 195.58 x 243.84 cm. (Accessed 12/11/2020).

https://www.nationalgalleries.org/search?location%5B36062%5D=36062&location%5B36105%5D=36105&location%5B36114%5D=36114

The denotative aspects of this image are that three ‘spectral’ looking characters pull back a curtain to blackness. The iconic surgical gowns, white coat, masks, surgical-caps, and bloodied gloves signify that they are two surgeons and a physician. Their faces are haunted; these are not newspaper images of smiling ‘hero’ doctors or of the ‘powerful’ institutional gaze of Victorian portraiture. The gloves and gowns reference the ‘bloody’ surgeons of Rowland’s time, but there are also the new ‘technologies’ of the endoscope and notepad. The image title tells us that these are named oncologists from Dundee.

The connotative aspects of this image are that these doctors occupy a liminal space between ‘life-giving’ and death (and cancer). They appear as Foucault’s “priests” (Foucault, 1996;32). Their expressions reveal that this journey is harrowing and not heroic. They also take with them knowledge (notepad), technology (endoscope), surgery skills (bloodied gloves) and their humanity. The background darkness signifies ‘death.’

Does this painting challenge medical hegemony? The doctors’ gazes communicate weariness and not omniscience and counter the medical portrait convention of a smartly dressed doctor’s that emphasise doctor status. We also see the apparatuses of “biopower,” but not the exultation of their status and mastery of illness (Foucault, 1996;31-32). These doctors know that the power to eradicate and restore people’s health, one of the driving forces of a re-configuring health care in the 18-19th-century, is not something that they can control (Foucault, 1996;31-32). 

Challenging surveillance of the body: Art from MRIs (2018)

Foucault comments, “…the body is also directly involved in a political field; power relations have an immediate hold upon it; they invest it, mark it, train it, torture it, force it to carry out tasks, to perform ceremonies, to emit signs” (Foucault, 1977;25). This “hold’ on the body is exercised daily when a patient enters a GP surgery; the receptionist ‘checks’ their arrival, they sit ‘still’ in rows of uniform seating, like others, in a waiting room, and awaits a summons to a ritualistic ‘body’ consultation with ‘the doctor.’ 

The receptionist also observes from a desk which looks “like the bridge of the Starship Enterprise” (Gallagher, 2003;150). My experience as a patient visiting the surgery is that I am observed and regulated. This is a central experience of Foucault’s analysis of ‘panopticons’ where a person’s behaviour is modified by the organisation of power and associated surveillance (Foucault, 2008). “He who is subjected to a field of visibility, and who knows it, assumes responsibility for the constraints of power; he inscribes in himself the power relations in which he simultaneously plays both roles; he becomes the principle of his own subjection” (Foucault 1978: 202-3).           

A ‘new’ challenge to ideas and images of the body was exhibited in 2018-19 by Pierre Huyghe, who used MRI data from people who viewed a series of images to create an artwork called ‘UUwelt’ (Huyghe, 2019). The data was uploaded to a neural network and computers remade these into “digital canvases’ “dreamlike, timeless lucidity…a state of …flow” (Ings, 2018). 

A picture containing wall, indoor, dark

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Figure 8: Screen-shot of the “UUmwelt’ exhibition by Pierre Huyghe, (3 Oct 2018 to 10 Feb 2019). https://www.serpentinegalleries.org/exhibitions-events/pierre-huyghe  Serpentine Gallery, London. Retrieved, 12th January 2020.

These images appear to have no connection to a body. Flusser might say that this is a challenge to the limitations of the photographic ‘apparatus’ (Flusser, 2016). They subvert the technology of surveillance of the body to an artistic end that it was not designed for, re-configuring our relationship with the body. This is the antithesis of “high tech instruments and apparatus of Western industrial capitalism  have been regarded as…dangerous forces enlisted in a program of social control” as technology is transmuted to beauty (Cartwright, 1995a;221). This epistemological challenge to our knowledge of what we know about the body is an example of “technological countercultures within institutional discourses” (Cartwright, 1995a;235).            

Challenging power: ‘Responses to coronavirus’

My BOW is a response to power relations in the Covid-19 pandemic. In my research into ‘images of Covid-19’ I was struck by the absence of anger and criticism about our national response in institutional commissioned and curated images of the pandemic (Historic England, 2020; Format21, 2021). I wanted to challenge governmental narratives of the pandemic. My tutor Gary Clarkson, influenced my choice of assemblage, as in the work of Man Ray and Sarah Lucas, as the vehicle of expression (Man Ray, 1944; Lucas, 2019).

Figure 9 contrasts with Figure 1. We see the iconic Union Flags of ‘Great Britain’, and ‘Nipper,’ of ‘His Masters Voice’ gramophone company, beside the lectern. We are not sure what his reaction is to the invisible lecturer. 

A dog with a flag

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Figure 9: Assemblage image No 1: From my Body of work series which is untitled. Morris Gallagher, 2021.

In Figure 10 we see small and large torches with a pile of ashes. I am shining a light on Covid-19 deaths, but the viewer might read something different into this still-life. The recent parliamentary enquiry into the covid pandemic has been small, as signified by that small light, but not as illuminating as that which could come from a big light source. 

A picture containing kitchen appliance

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Figure 10: Assemblage image No 8: From my Body of work series which is untitled. Morris Gallagher, 2021.

These challenge institutional influence and power. We will see how this work evolves in these next few months as I bring together my BOW and Contextual Studies. 

In summary, we have seen four examples of images that challenge visual representations of health care, and challenge medical, media and governmental institutions, and images that question contemporary notions of the body and its surveillance.

DISCUSSION

Three questions arise from my paper: is it desirable to challenge medical dominance; what are the constraints to that challenge; and what would a visual culture look like that incorporated challenges?

Is challenge necessary? 

We could conclude from this paper that medical dominance is harmful, but Foucault concludes that in the organisation of “social order and conformity” in power relations are necessary, “productive and not coercive” to fulfil the expectations of both patients and doctors (Lupton, 2003;121). Doctor patient consultations depend on a differential of power between the patient and the doctor as discourses and practices of medicine “rest on the doctor remaining in the position of expert” (Lupton, 2003;121). 

To counter this Foucault also sees an “imperative” to challenge power relations (Chomsky and Foucualt, 1971; Lupton, 2003;121). That challenge is intrinsic to power relations, so much so that institutions strategise or plan, as we have seen in the analysis of a covid briefing, to nullify expected dissent (Foucault, 1994b: 95). 

The primary function of heath care systems, like the NHS, is to control, classify and monitor disease, with regimes of control established over 200 years, that ‘manage’ patients and frame patient doctor/nurse interactions. Individual ‘reactions’ to this health care ‘system’ include the growth of self-care, self-help groups and rejection of technology such as vaccination (Lupton, 2003). The NHS institutional also employ strategies aimed at helping patients to ‘challenge the organisation,’ such as patient surveys and Patient Forums. The evidence is that these validate care decisions, but also restrict knowledge to impair effective patient contribution (Currie et al., 2018). As Foucault has shown us, the impetus of institutions is to control and dissipate dissent.  

Online media and special interest groups is where patient criticism and resistance are most clearly expressed (Snowdon, 2020). Here, people openly express their feelings about care, and sometimes ‘pressure’ groups influence mainstream care, as in the recent contaminated blood scandal (Factor8, s.d.). For the most part this resistance does not impinge on ‘regimes of truth,’ that determine what knowledge is valued and promoted in health care, which continues to boost “the status of those who are charged with what counts as true,” the government and NHS (Foucault, 1980;131).

What are the constraints of challenge?

Photographic challenges to power seem to centre around the body, medical ‘gaze’ and surveillanc, and are less likely to overtly challenge medical or institutional power. Perhaps this choice of the ‘body’ challenge is related to its immediacy as an object for observation and exhibition, and ‘hidden’ institutional power is by nature opaque and not easy to show visually. Another reason for avoiding ‘necessary’ institutional challenge is that those institutions are prepared to ‘push back’ on that challenge.

My experience of photographing a group of ‘challengers,’ NHS whistleblowers, has been sobering. I interviewed a group of whistleblowers for a previous OCA module, all of whom had complained about patient safety. They were all ‘punished’ with counter allegations and expensive litigation from powerful hospital Trusts (sic) (Gallagher, 2018). I decided not to publish my work because I was at risk of the same litigation and opprobrium; the NHS ‘Goliath’ can be ruthless at protecting their hegemony (Francis, 2015; Armstrong, 2018).

Challenge is also reactive, as is my BOW on Covid-19, which is an example of ‘Reversed discourse;’ so by nature it has ‘waits’ for an abuse of power or concern about power relations to happen, as in the case of the covid-19 pandemic (Foucault, 2007;46-7). 

A responsive visual culture

Could the paradigm shift in health at the end of the 18th-century, described by Foucault and which continues to affect us today, recur? (Foucault, 1996;xviii). Could there be an inversion of power so that, for example, unrepresented patients issues have visual prominence on TV and is social media alongside images of doctors, nurses, and politicians? There are echoes of this change in media as we now see more women doctors in visual media, and representatives from minority or pressure groups have their say in news media. 

For Foucault there are “no great radical ruptures…more often one is dealing with mobile and transitory points of resistance, producing cleavages in a society that shift about, fracturing unities and effecting regroupings, furrowing across individuals themselves, cutting them up and remoulding them, marking off irreducible regions in them, in their bodies and minds (Foucault, 1990;96). 

The nature of resistance to medical hegemony in visual culture is that it is cumulative, uncertain, and temporal, but visible and sometimes rarely transformative.

CONCLUSIONS

Power is embedded in media, governmental and medical institutions, and practices. That ‘hidden’ power is expressed in paintings, magazines, newspapers, on TV and in video and artworks, some of which have been discussed in this paper. 

This power is the result of institutions and elites that control through creating and sustaining their knowledge and training institutions and cultural capital. Institutional and personal practices of media, government and medical organisations continue to be enacted in daily clinic performances, on television and in medical consultations and clinics today, that re-enforce medical dominance. 

Challenges to power are intrinsic to power relations, and institutions strategise to manage dissent and nullify criticism. 

We have looked at four challenges that disrupt medical ideology and power, in visual culture, institutions, and surveillance of the body. Collectively they show a diversity of response to power.

Foucault tells us that power in medical relations has a social utility but encourages us to challenge issues wherever they are. There are no limits to complaint although visual challenges to power are less common that textual forms on social media. Challenges to institutional power are also more difficult than those about the body. This resistance is enabled by those who learn to challenge power or react to social and medical changes that challenge their and other people’s ideologies. 

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