This post exemplifies my approach to research; image (and textual) research and selection, thinking and reflection, mapping and theoretical framework development, and writing for the literature review at A2.

Learning Objective

LO1: undertaken research and study demonstrating comprehensive knowledge of your area of specialisation and built a theoretical framework for your creative practice

Link to Learning Log

Visual and textual research: Images of doctors

Visual and textual research: Images of doctors

10th November 2020

1. My approach

Aim:

To find images, and to a lesser extent text and ideas about ‘doctors,’ that will form my literature review and final essay.

Objectives:

1. To identify images for my essay; currently the issue is ‘doctor representations.’
2. To identify ideas, themes, works, and references that will help the literature review at A2.
3. To identify relevant theory for my conceptual framework.

Research sources: UCA Library search, ResearchGate, BMJ Journals, Google and Google scholar, Wellcome  Collection.

Search terms: ‘doctor – image – photograph – newspaper – covid – representation – media – heroes’ alone as a general approach with the use of AND to drill down on the images selected.

Management of content:

• Save and download images – keeping note of copyright for display – new file on my computer.
• Save citation to Zotero – by hand or the export function
• Enter ideas as notes in draft Word essay document that I have created on this theme; this will become the literature review. 
• Some writing and analysis straight away but more grouping of content and ideas on the Word essay document to form this part of the literature review
• Bookmark papers not cited, downloaded or printed but which I may come back to
• Key papers printed for later detailed reading, highlighting  or review
• Books or papers ordered as needed.
• At some stage I will map this out to look at the overall structure of this area.

2. Research findings

A. Potential images for my essay

1. Country Doctor

This is a ‘mass media’ example from Life magazine – an ideal doctor?

2. Quacks from 1736

It’s clear that doctors did not held in high repute at this time; I am not clear when that changed, but it should become clearer as I research images and text.

3. The powerful physician of 1809?

I think that this is a more dynamic image of the behaviour of doctors from this time and the power differential between patient and doctor.

4. Plague doctors

While I was exploring the Wellcome Collection for the earliest recorded images of doctors I came across the plague doctors with their iconic ‘beak’ masks. I may use it and talk about masking as an old and new technology.

5. Hippocrates x 2

This is by Rubens in the 17Century – where did he get his reference point for that image as Hippocrates had been dead for centuries? Is it a myth?

Is this the reference point? I suspect that unless a statue or artefact has survived then there is not an authentic visual representation of even a famous person. The issue is about the construction of identity and the role of artists in creating that. I know that Erasmus controlled the images made of him on medals and in books ruthlessly; it’s no different today as we present our selfies on Facebook. Today, there must be many images of us in digital media and maybe will we live forever as a meme or in disembodied form?

B. Research, notes and text development

These are notes of my preliminary image and idea research. I will map this out if it gets large so that I can see what is prominent or missing. I am conscious that this is primarily visual and not theoretical research.

The primary care doctor

An iconic image depicting a ‘family’ doctor is Eugene Smith’s photo essay ‘Country Doctor’ (Cosgrove, 1948). What was remarkable was that this landmark photo essay laid bare the life of an overworked rural family doctor; it is not a portrait of an eminent doctor. 

Cosgrove’s analysis of this image is that they are “unsettlingly intimate pictures.” Charlotte says that “he is alone” and Quinn that “His gaze is the gaze of failure” (Smith, 1948) Cosgrove, Charlotte7178, 2018, (Quinn, 2012). I am not sure about that.

Berger sees the GP, in ‘A Fortunate Man’ as a healing force but it is the images in the book by Jean Mohr from the 1960s that speak more eloquently about the work of a GP, at least to me (John Berger, 2016) (Vurmay, 2019). I have ordered the book.

Gender and ethnicity

Lots of group pictures of white male doctors in my research (Sinclair, 1994). Women are less represented as is ethnicity. (Heer-Stavert, 2019a)(Hemanth Rao, 2014). Also huge Australian research paper on how doctors are represented – positively (Deborah Lupton, 1998). 

Perceptions of doctors and patients

How doctors see themselves – searching on Instagram (Heer-Stavert, 2020, Heer-Stavert, 2019b)

Question: Do doctor presentations and perceptions matter? They do to me as I think that they influence how patients treat doctors and how doctors behave.

Visual representations of doctors

“At present the body of the doctor is a sort of proto-space, into which can be projected the existential pain of patients and the organisational strain of the health care system, providing a location for both intuition and stress and a field upon which the conflict between the personal and the professional can be played out.”

(Matthew Gothill, 1999)

Armstrong, a Foucauldian scholar working in health care, suggest that the body of the doctor, and by that he means the image, is a “proto-space.” I think it is a developmental space on which society can project their “existential pain” about health care and anxieties and ambivalence about doctors – good and bad. (Mansell, 2016)

It is back to the function of doctors and how they influence others.

TV and film depictions

Medical power 2010 – definitive work on societal influences (Turow, 2010).

TV Drama usually gets the reassurance, while the fear and loathing go to current affairs. The result is that the TV image of doctors has always been a Jekyll and Hyde split between Dr Findlay and Dr Shipman.

(Hoggart, 2000)

A content analysis conducted in this work indicates that television’s physician portrayals are less positive than they were in 1992. Contemporary genres differ in their physician depictions, and television’s doctor portrayals do not differ according to sex or race (Chory-Assad, 2001).

Health issues and medical science receive a lot of attention on television. Of all the sciences, the European public is most interested in medicine, and the public uses television as their main source of information on science. There has been hardly any empirical research, however, into the historical development of the representation of medical science on television. The development of medical television was explored by carrying out a content analysis of Dutch non-fiction medical television programs spanning a period of 40 years. The speaking time allotted to experts has decreased over the years, while that allotted to laypeople has increased. We are seeing fewer references to sources and science and more expression of emotion and tension. The results suggest three periods of medical television: a scientific, a journalistic and a lay period. Medical television in 2000 shows a personified picture of patients against an instrumentalized and symbolized medical backdrop.

(Verhoeven, 2008).

It looks as if there is a huge amount of research looking at TV doctors and a lot less about doctors on the internet (next section).

Internet

In times of universal access to the Internet virtual reality is no longer a reflection of the real world, but is beginning to influence people’s behaviour in the real world and their views. The definition of medical professionalism therefore is also changing and doctors, who may be judged on the basis of their Internet image and whose knowledge can be verified more easily these days, face new challenges. This represents both a risk and opportunity; therefore, it is worth investigating the status of research into this issue conducted to date. In this work we present world data demonstrating an increase in social media activity of doctors and patients, including on Facebook, which is the second most frequently visited website. We also point to risks involved in sharing personal data on the Internet (real name, surname, date of birth, photograph). By sharing their private information online, the doctor allows for confronting their professional image with their private life. A patient who can see private photographs of their doctor may begin to doubt the doctor’s professionalism and competences and thus lose confidence in them, which will inevitably compromise the therapeutic process. We also provide a number of rules laid down by medical associations from many countries, which one should bear in mind when posting content on the Internet (the main rule is: “We should not post anything on the Internet that we would not say in a crowded lift”). We also describe the benefits for the doctor that can be derived from sensible use of Facebook and we summarise studies on creating a professional, coherent Internet image of the doctor. 

(Piotr Kocemba, 2015)

This is limited descriptive work which does not get to how doctor’s use social media. My experience is that doctors meet in private doctor only groups that the patient will never be invited to. I used to belong to a support group for stressed doctors and this was controlled and confidential. Perhaps it is the equivalent of the Edwardian dining room where doctors met to complain about their practice and try to put the world to rights.

Newsmedia

(Melita Poler Kovačič, 2011) Excellent research – analysis of 420 images in five most-read Slovenian daily newspapers – 34% represented negative scenarios of lazy greedy doctors – quantitative content analysis and critical discourse analysis – younger doctors seen as self-sacrificing and hardworking but not the lazy older ones.

The history of television’s doctors speaks loudly of the character of the public’s present and future conception of real doctors as well as their faith in the aims and institutions of modern medicine. Unfortunately, abstracted from our viewing of series over time is a fractured bond between doctor and patient that began as a mutually rewarding human relationship and devolved into the individual and bifurcated pursuit of base ends: of immediate and perfect cures for patients and of power and its spoils for doctors.

We began with doctor shows sanctioned by medical associations wherein a doctor could do no wrong. As Turow noted, “It came back to bite them” (3). In today’s doctor shows, the doctor is far from “priest-like.” The genre began by fusing the public’s fascination with technology to a conception of the doctor that was unsustainable for several reasons. First, the supercharged expectations engendered by television doctors as curing and caring beings could not be supported by real doctors who were constrained by time and their own human foibles. Second, beginning with the Vietnam War, as confidence and faith in public institutions waned, doctors were not immune. Third, as the public became more familiar with medical technology, they began to demand it, rendering doctors into intermediaries for technology (23). Furthermore, the triumph of managed care and patient autonomy will likely support for some time the two types of dissonance between patient and doctor depicted in today’s shows.

The persistent demand for doctors on TV, however, also represents a persistent fascination with the doctor’s craft, science, and character. The opportunity for a positive change is there. If the history of this genre has taught us anything, it ought to be that it is and always has been in a state of flux, responding to extremes with corrections as needed. 

https://go-gale-com.ucreative.idm.oclc.org/ps/i.do?p=AONE&u=ucca&id=GALE%7CA238270918&v=2.1&it=r&sid=summon

Feasey book v good  Masculinity and Popular Television examines the ways in which masculinities are being constructed, circulated and interrogated in contemporary British and American programming, and considers the ways in which such images can be understood in relation to the common-sense model of the hegemonic male that is said to dominate the cultural landscape. Male hegemony –

Increasingly, the glory of the doctor as a person fades, while his scientific practices magic operate simultaneously and in a complementary manner. The gaps in the body of rational, tested tech-glow with promise. Far from being seen as completely unique individuals, doctors are coming to be regarded as niques are filled in by magic, which is the expression of interchangeable because they all have approximately the hope and desire. In the face of uncertainty, magic enables man to proceed with confidence – to overcome anxietysame training – a belief, incidentally, which is self-con- sciously fostered by medical groups and institutions that and despair. By ritualizing man’s optimism and enhanc- socialize the practice of medicine. This is precisely what ing his faith, magic enables him to believe in the de- Weber called the routinization of charisma, the gift of sired outcome, and so continue his life with equanimity grace being transferred from the man to his position. The it is the science that he applies which is the final author- part of the patient, his chances for recovery are greatly and a sense of potency. doctor is not accorded unquestionable authority, rather Without such an attitude of hope and belief on the ity. As medicine comes to be regarded as more science reduced. In most societies, it is felt necessary that he than art, it follows that doctors are felt to be made rather have faith in his doctor and believe in the certain success than born. (Barbara G. Myerhoff, 1965)

Media image patient views negative (Jańczyk Magdalena, 2020)

3. Mapping where I am today

I can see that I have moved from looking for images to original research and some theory but I think that is the exploratory nature of research.

Creating a conceptual map will help me to see the shape of what I have and what I need. The domain I am most interested in today is ideas about doctors outside the binary view of them as heroes or villains, which is one of my preliminary hypotheses that there is a third classification of doctors, but perhaps that will change as I read and research more.

Mind node of images

A preliminary summary of where I am having looked for some images and texts.

This was helpful as several images and areas stand out

• The iconic ‘Country Doctor’ image by Eugene Smith, which has been referred to several times in different OCA modules, may find itsway into my essay. There is a reason why that is iconic and it is a powerful image.
• ‘Portraits of the Great and Good.’ I have been to formal functions at many medical institutions. You are observed by the ‘watching’ white, male, celebrity doctor portraits, which are everywhere! The message is ‘We are the top people’ and we ‘wield influence and power.’ There may be ‘missing’ or underrepresented groups, such as Asian and women doctors. I will look at that area in the future.
• There is a huge area of social media representation which I need to explore.

REFLECTIVE NOTE: This is the preliminary research for my literature review. It is a construction about how I go about my research, but in practice, my process is to start with writing the essay using snippets of research and personal comment and only summarise the research separately. It is messy and involves and a lot of writing and ‘ruthless’ editing, but my experience is that it works well; this is an iterative and non-linear process. The process is NOT – Research, notes, reflections – then write. It IS MORE – Research, write, notes, reading, research, reflect, write, edit, research etc.

The next section is an example of what my essay looks like a few months later as I start to shape the preliminary essay and include and edict research.

4. The first draft of my literature review

14th January 2020

Morris Gallagher 513748

Photography 3: Contextual Studies

Medical identity, ideology and iconography: A literature review 

Structure 

Introduction

What is the doctor?

Identity

Iconography

Asclepius

Plague doctors

Painting 

Mass media image

Discussion

Conclusions

Summary of findings

Areas of controversy

Questions that need further research

Strengths

Weaknesses 

1. Needs application of theory to generate a theoretical framework
2. More images and illustrations

References

Introduction

“This review examines the role of medical iconography in creating doctor identity. I will examine how symbols are to construct meaning systems that support the ideology of medical culture. 

Publications are from medical, medical anthropology, sociology literature and image libraries, and popular media. 

A doctor is “qualified in medicine and treats people who are ill” (Greetham, 2018, Collins, 2020). This raises two questions, ‘What is medicine?’ and ‘What is their relationship with patients?’ Shaping that identity largely focuses on feelings and relationships and on the rituals and symbols that reflect ‘doctor’ identity.

Gods and icons

The earliest known image of a ‘healer,’ created about 120000 BCE, is a cave drawing of a shaman, part man and part beast, communicating with animal spirits and practicing healing (Norman, 2020). Millenia later in 3000 BCE we see the iconic statuette of Imhotep as the first ‘doctor’ who after his death he elevated from a lay position to that of a “God of Medicine’ and healer:” we will see more of this ‘deification’ of doctors in this paper (Barton, 2016). The assertion of Imhotep. rather than Hippocrates. as the founder of modern medicine was made by the medical luminary Sir William Osler in 1928. It is conjecture, as archaeological artefacts do not support this myth, but it illustrates the power of institutional figures to promote mythologies within cultures (Brien, 2014).

Modern medicine is founded on Greek medical culture and the myths of the god Asclepius, son of Appolos, and relatives such as Hygeina the goddess of cleanliness. Health care was expressed through a network of healing temples called asclepeions (Hayes, 2018). In ancient Greek art Asclepius is portrayed with a full beard and holds a staff (the bakteria) with a coiled snake around it. (The State Hermitage Museum, 1st-2nd Century). Pottery images and sculptures from the 4th century BCE to the 3rd century CE attest to his popularity (Cartwright, 2013). (Fishwick, 1983). Romans adopted the iconic ‘serpent-staff’ signifier in their artworks, (Hayes, 2018).

One image that still circulates in medical culture is iconic is the serpent and staff of  Asclepius; it forms the current British Medical Association logo  (Britannica, 2019) (Fishwick, 1983). It is stated that The Romans incorporated these images and ideas, Imhotep and the Roam/Etruscan god Vediovis, into their health framework and also adopted the iconic ‘serpent-staff’ signifier in their artworks (Hayes, 2018). 

There appears to be an indexical link to the rod of Asclepius, but it is interesting that other symbols are created is the staff of Hermes, depicting a stick entwined with two snakes and surmounted wings – symbol of modern medicine in India. (Shetty et al., 2014). US army – Hermes god of transitions and boundaries. 

This explains the Rubens portrait as a revival of Greek culture and Ascelepus and his staff. As the author of 70 books outlining the principles of disease management Hippocrates (460 – 370 BC can claim to be the founder of modern medicine. His oath is still said at most medical graduations (Green, 2017). In contrast to his many writings, there is only one image a mosaic of him entwined with Ascepelius serpent greeting Hippocrates and a contested statue from the island of Kos where he lived (Garrison, 1996)(Hippocrates, 2nd Century)(Asclepius arrives in Kos being greeted by Hippocrate, 2nd-3rd C BE)(Yapijakis et al., 2013). We are not sure what Hippocrates looked like but it is future artists like Paul Rubens in 1638 that in an engraving imagine him as a wise old doctor with a beard, wrinkles and with hair styled as in the representation of the gods Jupiter and Asclepius of the time (Rubens, 1638). Garrison commented in 1996 that this image is “the exemplar of that flexible, critical, well-poised attitude of mind…the very essence of the scientific spirit.” (Garrison, 1996). That is conveyed by his “God-like hair, crinkled brow, large brain in the image “His figure… stands for all time as that of the ideal physician,” (Singer et al., 1962). It is likely engravers like Rubens have invested these attributes into their become. It has become iconic of him and his fatherly place in medicine. Even though the referent is present it is probably not modelled on the image of Hippocrates (Manget, 1652).

One of the problems with researching visual culture during the period of prehistory to Roman times is that few artefacts and images remain. It is only those that are known about that shape our consciousness of what was there – there may be many more illustrations that we do not know about. But the continuation of health care shaped by divine creations and gods is a theme where that is reflected and evidenced in those images and texts and medical legacy that we know about. What has been constructed by us

Plagues and masking

An iconic presentation of doctors is shown in this 17th-century lithograph of a physician dressed in a plague costume (Manget, 1652) The beaked masks, stuffed with herbs and perfumes, were thought of as technology to ward of plague as they prescribed protective concoctions (Blakemore, 2020). 

Mask have visual, iconic and transformative roles not related to their function. We can also see them as displaying and shaping identity, transformation, as in our shaman ritual, and as disguises (Pollack, 1995) They are part of “semiotic systems” that shape identity through their iconicity and indexicality (Pollack, 1995). The plague doctor was feared as his costume signified a deadly pestilence as “potent symbols of existential risk”  (Lynteris, 2018). Lyntaris, in an excellent review of ‘masking’, considers that mask-wearing is complex and reflects cultural values, perceptions of control, beliefs, politics and other variables. 

We are perhaps aware of this more now given the prominent role of ‘anti-maskers’ in face coverings in the UK and other cultures. Research in the USA, Brasil and Poland suggests that this is largely related to sociopathic personality disorder (Stieg, 2020). This suggests a counter interpretation to the dominant one of mask=risk=protection to one that the mask signifies loss of personal freedom and restrictions. The mask identifies an actor who accepts the cultural norm. In this sense, the mask wearer has a transformed identity from someone not at risk of coronavirus to someone who is and adheres to social norms. This mask as a symbol is a referent to Lyneris. 

Medical masks as we know them first appeared a single layer in 1897 (Spooner, 1967). While there were competing mask technologies it is the Manchurian plague and images that shed light on the ideologies about illness with masks and white helmeted, white soldiers – imperialism. Luntaris’ thesis is that masks have a technical role and are primarily icons of agonistic medical rationalisation (Lynteris, 2018). I think that is correct but his oft-quoted paper neglects performative and connoted aspects such as fear that are prominently signified (Mant, 2020)(Pollack, 1995)

This image has resonance in 2020 in the Covid 19 pandemic (Blakemore, 2020)(Mant, 2020). The hazmat suitThis is seen as frightening was in the ebola epidemic and issue about not seeing the gaze of the person it. They are alienating, but as Kale point out they also signify the hope that rationality is prevailing against an unpredictable and deadly foe. (Kale, 2020)

Issues here in the Pollard paper or Lynteris’ paper about race, and the Wu paper about using symbols 1742 to boost the gendered healing power of doctors using Taoist symbols to illustrate cosmological power and masculinity of doctors (Wu, 2008)(Wu, 2008). In the book of images of plague doctors in China in 1911, we see the white-capped, white-masked white-gowned fighting black elements of illness. (Wu, 1911)

The stethoscope

Rice asserts that the stethoscope is the icon of ‘doctors’ (Rice, 2010). He frames it as an intrinsic feature of the ‘habitus’ referencing ideas by Bourdieu and identifying types of ‘agency’ that doctors apply to it in the performance of their duties (Lau, 2004) (Rice, 2010)(Barcelos Neto, 2003). Rice’s observation research in a cardiology clinic  is sound. What this review does not explore how and why this icon is displayed for effect. Often in my clinical work, I take up my stethoscope as an instrument of the therapeutic laying on of hands to listen to someone’s chest not because I need that ausculatoeroy knowledge but because I want them to see it as a confirmation of my knowledge and skill. 

From its invention in 1816 by Laennec (Reiser, 1993). But why how and why has this become iconic so that when we see it draped around George Clooney’s neck in the US drama serial ER signifies that he is being ‘doctor’ on-screen even if there is no use of the object which has been largely supplanted by digital imaging (Kiesewetter, 2020).

But how and why is this worn displayed and used object has this become iconic. Miller, employing theories A key critique employed by Rice is that Miller says it is the materiality of this object that embodies the particular knowledge and skill set employs to use it with the ‘becoming’ and identifying as a doctor (Rice, 2010; Miller, 2005). It is clear from my own experience that doctoring is performance and this is one of many performative objects.

The ‘medical’ portrait

We have already seen iconic images of mythological and real ‘doctors’ as in Asclepius and Hippocrates at the from Greek and Roman times, after which we see few images of doctors. 

Wlcox and Whitham attribute this to the advent of Christianity and the rise of the Catholic church, with their preferred icons and statues of saints, symbol again until after the Reformation (Wilcox and Whitham, 2003). (Rubens, 1638) Doctors were unpopular and often showed doctors as “bloody” (surgeons) or “non-bloody” (physicians), who operated on “parts” and not people ” (Weisberg, 1995). 

The revival of the medical portrait dates from the early 17th Century. Portrait onventions of that time would have the doctor dressed in academic robes,  military uniform or jacket and tie; they could have had any role (Weisberg, 1995). Sometimes busts of Hippocrates, images of Asclepius and text such as the bible, Galen and Celius were included in the painting to mark the ‘anonymous’ participant as a doctor (Fransen, 2012). 

Jordanova Ludivalla’s comprehensive collection of medical portraits 1660-2000 charts the evolution of doctors and medical institutions through medical portraits (Jordanova, 1999). The weakness of this is her…  (Jordanova, 2003)

A pivotal moment in medical photography is 1880 are the popular French salon paintings of medical portraiture and practice (Weisberg, 1995). They marked a departure in practice from and “blood” surgeon or anonymous person in the frame, without accompanying medical paraphernalia, such as the stethoscope, to a doctor at the patients bedside. That was radical; the patient and family had joined the doctor.  

A key painting showing this change in medical portraiture is Fildes painting of 1891 ‘The Doctor’ which sold over a million copies (Birchall, 2003). The image represents the GP Dr Murray and recalls Fildes own experience of the death of his first son from typhoid. The converntional symbols associated with doctors were stethoscope, sphygmomanometer, microscope and thermometer (Moore, 2008). These icons are rejected and reflect Foucaults observation of a change in orientation of the medical gaze from the scientific model of ‘expert’ doctors towards a narrative where the patient was included; a growing theme in medical discourse during the 19^th and 20^th Centuries (Foucault, 1996). Another thing is the image has the studious doctor with furrowed brow (a recurring motif), a half empty potion bottle and discarded prescription on the floor. There also structural factors at workThere are several structural factors; The institution of surgeons wanted to establish a “professional monopoloy’ p 16 and medical discoveries took part in hospital where “elite doctors sished to be associated with such scientific progress. The salon awarded medals, the public liked this new view of doctors in relation to people and new painters developed

Power and control of production – In the 1880s “The oil paintings of doctors showing them
at work that were exhibited at the Salon after the mid- 1880s seemed to served their need for an effective device to transmit certain ideas to the public. “The medical community, too,” assert Ann La Berge and Mordechai Feingold, “needed stable channels through which to transmit and diffuse medical ideas.(Weisberg, 1995)

This image of doctors caring for patients continues to be theme of doctors with patient and embedded within specific local cultures in the photo-essays of ‘The Country Doctor ‘ of 1948 and the little-changed 1960’s version “A fortunate man.’ (Cosgrove, 1948; John Berger, 2016). This scene is now played on TV doctor soaps and in national press.

Arturo Michelena’s genre painting, L’ENFANT MALADE [5] which shows the family physician at the patient’s own bedside. (Weisberg, 1995)

Ludmilla Jordanova’s medical portraits 1660-2000 supports a National Portrait Gallery Exhibition of 2000 (Jordanova, 1999). This is an erudite book shows the replacement of medical character with personality and … It reminds us that repersentations are dependant on cultural knowledge and expectations. It will take us to from painting to mass media. The growth and expression of feminism and ungendered power. 

Mass media

The image and portrait as a way of establishing identity but there is also commonifiaction began with with images of Ascepilus on Roman coinage with copies of Filde’s painting ‘The Doctor’ selling over a million copies (Tagg, 1988)(OCRE, 2020)(Birchall, 2003). But it is the arrival of the mass-produced photograph and digital media, and their ‘engines’ of reproduction in news and television media where we see less a proliferation of the paraphernalia of doctors but of the doctors as icons themselves.

A key idea here is that the formation of medical culture is not isolated or controlled by doctors but medical and other structures, such as newspapers, processes of distribution and symbols (Hall, 1975). We can see images of doctors and their paraphernalia or symbols as ‘objects’ that code doctoring – they are a communication exchange – something that the producer may not have much control over. 

It is in mass media that the image becomes the icon, this may be the iconic image of a bearded and bedraggled villainous doctor such as Harold Shipman or the hero doctor working in ITU in Italy during the Covid 19 pandemic. (Coyle, 2018; Moore, 2008)

Medical Culture TEXT BIN – not sure where that goes yet.

Lupton Mclean – medical culture 

A key writer on medical culture is Deborah Lupton (Lupton, 2003). She charts the evolution of the sociology of health and illness from functionalism, the political economy and social constructivism (Lupton, 2003). Functionalism dates from the 1950’s with concepts of participant having a well-defined role, such as the illness role, ‘malingering’ and the benevolent doctor. Its weakness included failure to recognise the inequality of power relationships in therapeutic encounters. The political economy perspective in the 1970’s. influenced by Marxist theory, asserted the role political and other systems in shaping illness and heatlh care and includes concepts such as medicalisation and interest in socio-economic determinators of health. Ideas from both these frameworks continue in health care, but the dominant theory informing health care since the 1980s is social constructivism. It is ideas from this approach to medical culture that largely inform this essay.

Within the social constructivist approach which date from the 1980’s, but include earlier ideas are the historical writings of Foucault about how power in medical institutions is formed, cultural studies looking at how medical knowledge and doctors are represented in mass media and their audiences/ Within cultural studies is the concept of medical discourse where we look at the language of medicine and how that creates identity and meanings (Rose, 2016). 

Lupton focuses on the iconogramphy or health and illness but not on the iconography of doctors or health care workers despite the continuing concerns about the power of doctors and their iconography and how culture is spoken in codes and symbols power is exercised (Hall, 1980). It is that missing element that is the subject of this essay.

How doctors are represented depend on understanding medical culture. Foucault argues that there is not an ‘objective’ single view about medical culture, rather that it is embedded in social, cultural and historical attitudes the health and medicine (Foucault, 1996). The post-structuralist theorist Hall argue that Postmodern theory suggests a “circuit of culture” model for examining medical culture. (Lewis, 2007; Hall, 1980). The conceptual framework loosk at “distininctive moments – production, circulation, distribution/consumption, reproduction…as a ‘complex structure of dominance’” (Hall, 1980). Lewis applies this framework examining a medically themed issue of Newsweek (Lewis, 2007). The production of medical images begins with medical ideologies and institutional agendas (Heck, 1980). This ideology created in structure is defined by Althusser as  “Ideology represents the imaginary relationship of individuals to their real conditions of existence” This is an imaginary rather than ‘real’ representation about what we might want to look like or be represented (Felluga, 2015)

Ideology and myth Roland Barthes Mythology – doctors appear like a mythical people and images are coded to show that (Connell, 2005) (Heck, 1980.)

There is an ideological view which “constructed definitions in dominance “which “contributes to their dominance by working them into the fabric of its explanations and by granting to them the status of what ‘many’ or ‘most’ people think” (Connell, 2005)

Let’s look at our binary view of doctors – for example, a person illness can be seen in terms of binary notions of “normal” and “pathological” or biological or social (Lewis, 2007). Hall calls these cultural representations “maps of social reality (Hall, 1980). What model is chosen depends the fact that knowledge and power are critically related; “there is no power without the correlative constitution of a field of knowledge p27” Foucault. There is not a straight reading bu tends toward a preferred reading of messages. Consumption: Decoding by an institution is not the same as audience decoding. The most likely reading is to be the dominant one, but there are oppositional and other readings (Hall(Hall, 1975). Identification: Postmodern theory rejcts reasing base on biological premises but understands in ta s a” cultural process.” (Lewis, 2007) As Hall points out identitites are “contstantly in the process of change and transformation” is a response to media and other influences (Hall and DuGray, 1996).

Seale – this papers comments on the role of audiences (Seale, 2003)

Also, comment on “feedback loop” p516, where audiences became, produces as on discussion of health matters and producing alternative views as anti-vaccinators. 

Onset of photography 

The world’s first application of photography to medicine was in 1839 by the French physician and cytologist, Alfred François Donné (1801-1878), credited for the first photomicrograph.² Donné got wind of the process after Daguerre presented his photography methods to the Academy of Sciences the 

The world’s first application of photography to medicine was in 1839 by the French physician and cytologist, Alfred François Donné (1801-1878), credited for the first photomicrograph.² Donné got wind of the process after Daguerre presented his photography methods to the Academy of Sciences the

Depicting ‘the doctor’

What do images of a doctor ‘look like? They are certainly ubiquitous, particularly during the Covid-19 pandemic, but are they homogeneous and predictable or diverse and arbitrary? Does depiction depend on the nature of the medium; photographs, including the ‘art’ image, film, television, newspapers and social media? And does it matter how doctors are depicted?

Photographers 

                        Collective approaches 

                        Individual work 

                        My work

Media – TV, film, newspapers, social media

The marriage of context, text and platform

Does depiction matter?

Theory

Constructing meaning from images is important because “we find contradictory impulse and opposing aims” in the frame (Bolton, 1990). But it is the intention behind the work that drives “contributions to both domination and the liberation of social life.” (Bolton, 1990). An example of the positive impact of the Farm Security Administration marketing project, and photographs like ‘Migrant Mother’ by Dorothea Lange to effect government reform (Lange, 1936, Robert Hariman, 2007). The converse might be the 

Allan Sekula describes the operation of a “double system” of representation to  (Sekula, 1986) where photographs can be used to repress and inflate people, acting as a vehicle to compliment “the bourgeois self” and to ‘delimit the care of the other.’  

Testing the hypothesis that doctor depictions are binary.

At first sight, the presentation of doctor images appears to be complimentary or condemnatory, but does the evidence support that?

Evidence for heroes

Evidence for villains

Evidence of a third domain

Comments on this very first draft of the literature review

1. My research into the history of doctors has found its way into the beginning of this essay making it more a historical review which I am uncertain about.
2. There is some discussion about the training and culture of doctors in this research and Jordanova’s books about institutional doctor portraits.
3. I am not sure at this stage how the review develops.
4. There is a lot more research expressed in this essay than is declared here. My notes are in my research diary and on draft Word pages unless it is a specific subject such as Photo-voice where there is extensive summaries of research. The example of my evolving research databse is shown below and is from September to November 2020.

5. Recent reflections on this post and my research

13th December 2021

It is a year on from this post which permits an assessment about its place in writing my final dissertation.

Reflections

• This post is a snapshot of some of my research and a first draft of my essay for the literature review (A2). It summarises a lot of research and papers downloaded and read. It is very far from my final essay about medical image power and culture but the foundation of research about doctors’ images is there and summary of that found its way to my final introduction.
• ‘The Country Doctor’ image, actually a more pertinant image from the series, is in the final essay, but Fildes ‘The Doctor’ has not been identified as are other images which came from a further image search later on. Other images came from more reading, creating my own images and one from my tutor “Three Oncologist” by Currie. Choosing images become much more about serving the ideas in the essay.
• This literature review formed to be a historical summary of the iconography of medical images which did not meet my intention. There is some research about medical culture and Hall’s work on ‘Circuits of Culture’ is identified, but it did not find its way into the literature as I was not clear where I should be writing about medical culture. The focus changed at A3 and was a response to my tutor’s feeback on A2 – that is was missing the point and needed more analysis.
• Foucault is not prominant as a theoretical framework yet. He finds his way into A3 after my tutor advised me to decide who informed my work. I spend several weeks studying Foucault’s works and making notes which helped me a great deal in shaping the essay and commenting on power relations.

References

BARBARA G. MYERHOFF, W. R. L. 1965. The Doctor as Culture Hero: The Routinization of Charisma https://www.jstor.org/stable/44125128 Human Organization 24, 188-191.

CHORY-ASSAD, R. M., AND RON TAMBORINI. 2001. “Television Doctors: An Analysis of Physicians in Fictional and Non-Fictional Television Programs. Journal of Broadcasting & Electronic Media, 45.

COSGROVE, B. 1948. ‘Country Doctor’: W.Eugen Smith’s landmark photo essay. https://www.life.com/history/w-eugene-smiths-landmark-photo-essay-country-doctor/ [Online]. Liife magazine: Life.com.  [Accessed 22nd July 2020].

DEBORAH LUPTON, J. M. 1998. Representing doctors: discources and images in the Australian press. Soc. Sci. Med, 46, 947-958.

HEER-STAVERT, S. 2019a. The ethnicity of doctors in photos online [Online]. BMJ.  [Accessed 3rd October 2020].

HEER-STAVERT, S. 2019b. What does Dr. Google look like? [Online]. https://unexaminedmedicine.org/2019/06/23/what-does-dr-google-look-like-2/: uenexaminedmedicine.org.  [Accessed 3rd October 2020].

HEER-STAVERT, S. 2020. Google images, M.D. (Class of 2020) [Online]. https://unexaminedmedicine.org/2020/08/08/google-images-m-d-class-of-2020/: Unexaminedmedicine.org.  [Accessed].

HEMANTH RAO, H. S. 2014. The representation of women doctors in children’s picture books. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265110/. Journal of the Royal Society of Medicine, 107,480-482.

HOGGART, P. 2000. The television image of doctors has always been a Jekyll and Hyde split between Dr Findlay and Dr Shipman; Television.  . Times, 30 Sept. 2000, p. 32.

JAŃCZYK MAGDALENA, S. I., BATOR DAMIAN, DĄBROWSKA JUSTYNA, WÓJCIK MAGDALENA, MILANOWSKA JOANNA 2020. Perception of the media image of health care in society. DOI http://dx.doi.org/10.12775/. Journal of Education, Health and Sport. , 10, 286-295.

JOHN BERGER, J. M. 2016. A Fortunate Man: The Story of a Country Doctor. (First published in1967 by Allen Lane, The Penguin Press, London), Edinburgh, Canongate Books Ltd.

MANSELL, P. 2016. Paralysis, Un-seen., Blurb Books, Blurb.co.uk.

MATTHEW GOTHILL, D. A. 1999. Dr. No-body: the construction of the doctor asan embodied subject in British general practice1955–97. Sociology of Health & Illness 21, 1–12.

MELITA POLER KOVAČIČ, K. E. 2011. The image of doctors in the Slovenian daily press: White mafia or hardworking altruists? https://vestnik.szd.si/index.php/ZdravVest/article/view/427/319. Zdranvniski Vestick – SLOVENIAN MEDICAL JOURNAL, 80, 182-7.

PIOTR KOCEMBA, M. L., NATALIA HALINA SROKA, WOJCIECH FELESZKO 2015. Facebook-based medicine, or the doctor’s professional image on the Internet. DOI: 10.15557/PiMR.2015.0032. Pediatr Med Rodz, 11.

QUINN, J. 2012. Country Doctor. BMJ, 334.

SALKELD, R. 2014. Reading Photographs: an introduction to the theory and meaning of images, London, Bloomsberry Publishing 

SINCLAIR, N. 1994. Eminent physicians: photographs by Nick Sinclair, 1994-96 [Online]. https://www.npg.org.uk/collections/search/set/131/Eminent+physicians%3A+by+Nick+Sinclair: National Portrait Gallery.  [Accessed 3rd October 2020].

SMITH, E. 1948. W. Eugene Smith. Dr. Ernest Ceriani made a house call on foot, Kremmling, Colorado, USA 1948. . https://www.magnumphotos.com/newsroom/society/w-eugene-smith-country-doctor/: Magnum Photos.

TUROW, J. 210. Playing Doctor; Television, storytellin, and medical power, https://ebookcentral.proquest.com/lib/ucreative-ebooks/detail.action?docID=3414960, University of Michigan Press.

VERHOEVEN, P. 2008. Where has the doctor gone? The mediazation of medicine on Dutch television, 1961—2000. https://doi-org.ucreative.idm.oclc.org/10.1177%2F0963662506075352. Public Understanding of Science, 17, 461-472.

VURMAY, M. A. A. 2019. The Idea of Healing in A Fortunate Man: The Story of a Country Doctor. https://dergipark.org.tr/tr/download/article-file/945838. Gaziantep University Journal of Social Sciences,19, 11-22.