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Medicine Unboxed: Students – Call for Participation

29 Jul, 14 | by Deborah Bowman

Medicine Unboxed aims to examine medicine from the perspective of the arts and humanities, and arises from the view that good medicine demands more than scientific and technical expertise, also requiring ethical judgment, empathy, and an understanding of human experience. Last year saw the first Medicine Unboxed: Students meeting at which students of the arts, health and medicine came together to share, explore and discuss drawing on the unique perspective and experience of being a student or in the early stages of a profession.

Medicine Unboxed: Students 2014 is curated by Prof. Deborah Bowman and Dr. Lucy McEllan and takes place at the Parabola Arts Centre, Cheltenham on the afternoon of Friday 21st November from 2-5 p.m. The theme for both Medicine Unboxed andMedicine Unboxed: Students is ‘Frontiers’.

We are seeking proposals for participation. Medicine Unboxed thrives on diversity and inclusivity. We are particularly keen to welcome students (undergraduate or postgraduate) from all backgrounds, including (but not limited to) art, drama, music, medicine, literary studies, philosophy and allied health subjects. You can submit a proposal, interpreting the theme ‘Frontiers’, in one of four broad categories:

1. Provocations and Debates – proposals are likely to focus on a contested aspect of health, illness and its treatment and/or to explicitly engage with multiple points of view;

2. Exhibitions and Performance – submissions in this category are likely to be creative e.g. poetry readings, monologues, excerpts from plays, creative writing, musical performances, stand-up comedy, art exhibits, short films etc.

3. Workshops and Interaction – proposals may include experiential activities such as drawing, creative writing, singing and voice activities, improvisation etc or an interactive approach to a question or concept.

4. Conversations – submissions in this category are likely to take the form of short papers or prompt material presented to, and discussed with, the audience.

Proposals may be from individuals or groups. They should be no longer than 500 words and include the i) title, ii) format, iii) names and affiliations of the people involved and iv) a summary of the contribution proposed. You should also indicate in which category you would like your proposal to be considered. Please email your proposal by 1 September 2014 to Prof. Deborah Bowman (dbowman@sgul.ac.k). All proposals will be reviewed by the advisory group for Medicine Unboxed: Students and decisions will be communicated by 15th September 2014.

If you would like to attend Medicine Unboxed: Students but prefer not to submit a proposal for participation, you will be most welcome to join us as an audience member. Tickets for Medicine Unboxed: Students cost £5 and you can register your interest by emailing Dr. Lucy McEllan (lucymclellan@nhs.net).

Follow: @medicineunboxed and @MUstudents

Explore: http://mustudents.wordpress.com/

Join: https://www.facebook.com/groups/175072369272118/?fref=ts

 

The Artist in Theatre: On the Primacy of the Subjective Narrative by Jac Saorsa

8 Jul, 14 | by BMJ

Drawing Women’s Cancer explores the lived experience of gynaecological illness through a unique interrelation between art and medical science. Based in Cardiff and supported by Cardiff University and Cardiff and Vale University Health Board, the project began in 2012 as a collaboration between myself and Amanda Tristram, gynaecological surgeon. Since then it has produced two major exhibitions and several presentations both national and international.

Drawing Women’s Cancer project builds on the premise that philosophy, medical science and visual art all involve an inclusive, and often passionate form of ‘seeing’, and that they are brought into mutual relation through the equally inclusive concept of language. The concept of inclusivity here emphasises the idea that although language is the root and branch of dialogue, and indeed of narrative, neither of these phenomena are necessarily bound to the word.

As an artist and a writer, my concept of language constitutes far more than simply words, and as such it is the language of practice – and its corollary, process – that most concerns me. Consequently I understand both dialogue and narrative as practices and processes in their own right, both ‘creative’ and both profoundly and intimately immersed in experience, wherein language is evident and influential in all its forms. The Drawing Women’s Cancer project, which constitutes an in-depth exploration of experience, is therefore fundamentally and methodologically driven by a hermeneutic approach that embraces a multidisciplinary concept of language in order to delve deeply into areas of subjectivity that can often be felt impossible to express in verbal form.

Narrative language is a vital part of Drawing Women’s Cancer wherein personal narratives as related to me and transcribed either verbatim or in note form provide the foundation for the research as a whole. These are the bedrock of the experimental approach and, together with written narratives that reflect my own feelings about my encounters with women patients, and my experiences in theatre, they underpin the combination, the conceptual superimposition of word and image, verbal and visual, that is engendered through the creative process – itself unashamedly steeped in subjective experience. The creative process thus reflects and perpetuates the dialogical process that characterises my conversations with patients in a continuing dialogue between myself and drawings as I work on them. At the same time the process also responds to a further dialogue, one that speaks to my experience of the ‘Others’ experience of illness. Narrative here shakes off the strait jacket of monologue. It refuses to be confined to any prescribed spatial and temporal dimension. Narrative here becomes polyvocal and takes primacy as the vehicle by which the project as a whole continues and extends.

When a drawing is complete the story is far from over, indeed it has only just begun, and a drawing’s inherent communicative force lies in its capacity as an autonomous art object to maintain a dialogical character even beyond the relationship with its creator. As a work of art a drawing can simultaneously express and provoke emotional significance in an inter-subjective relation with the viewer, who in turn can creates his or her own narrative on ‘seeing’ in it the voices of those suffering the impact of illness, and this leads, ultimately, to the instantiation of what I want to call the meta-language, a form of communication beyond dialogue, beyond narrative and even beyond itself in terms of the expression of subjectivity. It is on the basis of narrative then, and its dialogical implications, that creative representations of the lived experience of gynaecological cancer can open up a ‘discursive space’ wherein a deeper understanding of the relation between a disease diagnosis and the overall existential impact of illness can potentially stimulate further conversations between patient and physician, between patients and their carers, and within the public arena in terms of awareness and acceptability.

So, in the true spirit of interdisciplinary practice in the Medical Humanities the Drawing Women’s Cancer project offers a direct challenge to the rationale of an uncompromising ‘art-science’ dichotomy by demonstrating that, in practice, neither can be disassociated from our understanding of humanity and the manner in which, as human beings, we engage or disengage with the society in which we are a ‘person’. Art, medical science and philosophy are all inescapably entangled here in a web of our own being and are constituent parts of the same overall human project, but visual art perhaps has the more obvious capacity to ‘bear witness’ to the trials that are often borne in the pursuance of being…in our physical enactment and psychological representation of life. Drawing Women’s Cancer is not only about disease, or medical intervention, or suffering, or the impact of illness; it is about all of these things. It is about, as Radley notes, what it feels like when ‘all sense of normality, and all the expectations of a future that accompany good health, suddenly become less real’. It is about the experience of illness, where that experience overrides all others. It is about creating a language that has the power to speak, not necessarily for the women whose personal stories are taken as the point of departure, but rather because of them, so that they may return.

For the rest of this post I would like to offer one of my own written narratives, an account of a recent opportunity to witness a gynae-oncological operation. I have attended various operations during the course of the project and all of the women who have allowed me to witness this part of their experience do so with the conviction that it will help me understand more profoundly what they are going through. Having, to borrow a term from legal channels, an ‘appropriate adult’ seems also to help sometimes as they try to deal with the natural anxieties that such an experience brings on.

Body in Flux

The image accompanying this post is a painting rather than a drawing. It is an ‘autoethnographic’ image that represents a similar operation to the one that the narrative below refers to. It serves, I hope, to demonstrate how visual language, even where there is no attempt to necessarily create an objective representation of the scene, can nevertheless communicate autonomous and coherent expressions of profound experience.

The painting is called Body in Flux. The narrative is called, simply, The Op.

Twenty minutes ago I was talking with her while she waited to be called down to theatre. She had smiled at me but it was a weak, anxious smile and there was fear in her eyes. We had a brief conversation – she seemed to appreciate the company. Hers is a difficult history, when she began to notice something was wrong she had tried to ignore the symptoms, ‘for the children’. She convinced herself it was just something minor, no need for a doctor, but she got tired of pretending she was OK and in the end she did go for help. As she lives in West Wales, she went to the local hospital and to her relief they told her there that it was nothing serious after all – ‘just abnormal cells’, nothing too much to worry about. They did however organise an appointment for here at the clinic here in Cardiff, for a biopsy. This was unusual, and even though they said not to worry, she did anyway. She worried about being in the city, she worried about her two small children at home, she worried she might die.

It is cervical cancer, quite advanced. She is to undergo a radical hysterectomy. The whole of her uterus and the surrounding tissue, the cervix and the upper part of her vagina are to be removed. The ovaries too, probably.

Reality hit hard a few weeks after the biopsy. It came suddenly, in a phone call. It was the shock! The word ‘cancer’ still makes her cry. She has no partner. She said she wasn’t ‘active in that way’ – not for ages – so she hadn’t been for Pap test for years. She had thought there was no need. She said she felt ‘stupid’ now. She is a primary school teacher; they had called her on her mobile as she was walking the kids to the classroom. They had the results of the biopsy. They told her that she had a tumour, that she had cancer. Now, here, waiting to go down to theatre, her eyes well up as she whispers the word. ‘It was the shock’, she says.

She is asleep now under the lights in the theatre. The lights are not harsh, just very strong. The huge circular structures from which they descend are acutely and disturbingly present, not just here in the room, but even more powerfully in my memory. The monstrous size of them and the pitiless, piercing illumination they provide still haunts me, despite my efforts to exorcise the horror of my own experience in the weeks that followed in paint on canvas.

I am anxious then, for her, for me, for us both. This operation is one that remains very close to the surface of my own consciousness and my presence here has psychological connotations that I cannot ignore or supplant with more rational thought, so deeply are they rooted. This is a test then to the personal limit of my focus on subjective experience. Amanda, the surgeon, knows this. She asked me when we arranged this visit, “Are you going to be OK with this one?” I felt the same way I did when she asked the very first question, the one that kick-started the whole Drawing Women’s Cancer project; she had said “Can you draw what it feels like to have gynaecological cancer rather than just what it looks like?” I knew then that I wanted to try.

Jonathon, the surgeon working with Amanda, reaches up to angle the bulbs. They are covered in their own protective ‘gloves’ so that he doesn’t burn his hands. His hands are so very important. I stand behind Amanda who is pushing paper wadding into the vagina – ‘packing’ it so that it doesn’t ‘move’ during the operation. There is so much paper left over on the floor between her feet. It is to ‘protect the excess’. The pushing, packing, continues and she says, “I pushed too hard once. I was in training and I was so scared of the consultant… we noticed that there was a lot of blood just dripping out onto the floor!”

Amanda goes to a side room to attend to the paperwork and Jonathon is left to make the first cut. Firm and certain. Vertical, from the navel to the pubic bone. He draws the diatherm slowly, painfully, through the skin of the belly and it trembles around the small part of it that is taut and stretched between his fingers. “A cut needs tension”. I am surprised that he uses a diatherm for this initial cut, deep and long as it had to be, so I ask. “Yes”, he replies, “it’s the way we do it now, but some surgeons do still use a scalpel.”

The edges of the cut sizzle and blacken. Smoke and the acrid smell of burnt flesh arise from the wound that becomes bigger, deeper as he works. He cuts down, confidently and deftly through layers of fat. My artist’s eye focuses on how the colours that move through the wound, from the skin, through the fat, to the fleshy muscle, are aesthetically beautiful in harmonious juxtaposition. First the hues of red: crimson, napthol, and the brightest perylene mingle with tiny glimpses of green and blue, the colours of shadows on the flesh, and then on through the spectrum of yellow, from the deepest cadmium to the palest, ‘prettiest’ lemon, the colours of the daffodils that are blooming outside and carry so much significance here in Wales. Cenhinen (kenHINen) means leek in Welsh, while cenhinen pedr means daffodil, or St Peter’s leek. Over the years the two became confused until the daffodil was finally adopted as a second national emblem of Wales. The cenhinen pedr then are blooming today, even as the wound is opened and the fat gives way and melts under the surgeon’s hand.

I think of Chroma, in which Derek Jarman, painter and filmmaker, extends Melville’s view that we ‘learn’ colour whilst not necessarily understanding it. It is understanding that I am seeking here, in subjective form, and in the wound as I watch it open, the red of the initial cut becomes Jarman’s ‘moment in time…quickly spent. An explosion of intensity.’ Further on, as the diatherm moves down through the soft tissuethe red ‘burns itself. Disappears like fiery sparks into the gathering shadow’. Jarman imagined four stages distinguishable in alchemy: the blackening of MELANOSIS, the whitening of LEUCOSIS, the yellowing of XANTHOSIS and the reddening of IOSIS. For me they appear here, but in a different order as I watch the diatherm cut beyond borders, deeper into the body, opening up and invading its private, once autonomous spaces. I feel the sting, but as Jarman says, Painters use red like spice’.

Amanda is back. She brings more even wadding to ‘mop up the excess’. The excess: ‘an amount of something that is more than necessary, than is permitted, or is desirable’. Excess here then, even beyond the metastasising cancer that in itself is excess to the normal cell structure.

I stand on a stool, watching as Jonathon cuts deeper into the muscle. The rectus abdominis yields to the unrelenting diatherm and allows him access to the peritoneum and the abdominal cavity. There it is, the uterus, itself now become ‘excess’. Amanda holds it in her hand. “Look” she says as she gently lifts it towards me, “and here are the ovaries”.

Fat, organs, tissue, all spill over the edges of the now gaping wound. Colours mingle at all levels of the ‘warm’ scale. I am shocked – no, not shocked – more bemused to witness what appears as a mess, a fluid ‘jumble’ of organs that belies the naïve impression that I now realize I have always held that inside we are very orderly and self-contained. Art takes precedence over science here as the boundary between order and disorder becomes confused. Either way the relationship between the two is here emphatically demonstrated through the idea of structure, the structure of the body in this case, which becomes simultaneous with function through the overall concept of process.

Jonathon and Amanda push the organs around with their hands, bullying them into compliance as they try to force them into the chest and pelvic cavities in order to isolate the uterus. But the organs keep spilling back out as if defending, even nurturing the one that is the object of attention. Yet more wadding is pushed in to hold back the tide, up into to the chest and down into the pelvis. Finally, with his arm up to the elbow inside the passive form Jonathon, like Canute, pushes and shoves with a physical force that promises a painful recovery. I am stunned by the seeming violence of it all, the brutality, the deeply and bloodily visceral reality of scene. The edges of the wound are pulled wider open with clamps that grasp the bloodied flesh and become bloodied in their turn. Now, the diatherm, held lightly first in Jonathon’s hand, then in Amanda’s probes and cuts on respective sides of the pelvic cavity, now an empty space devoid of organs and ‘excess’, save the hapless uterus, the one, which is soon to become the other. It sits isolated, bounded by smooth, ‘slippery’ walls that shine and appear translucent and yet opaque at the same time. It looks so small, so vulnerable under the threat of the diatherm, and the ovaries, white and tiny, are hiding, sheltering, in the darkness of the void.

The violence of the procedure is salutary in terms of my understanding. The pushing, the shoving, the manipulation of the bodily structures and organs, bloodied tools that are first discarded, then retrieved, then put into service to cut, to staple, to open and to close, all this is played out in front of me in sanguine ritual. The same blood pools in the crevices on the body and on the floor at Amanda’s feet, small bits of the flesh that it once made red are thrown up onto the green sheet, or down onto the floor. This is not clean, not clinical; this is raw, visceral, almost primeval. It feels… it feels. This is the unadulterated, non-sugar-coated authenticity of surgery; the cutting, the slicing, the pushing and the pulling, the packing, the mopping up… and it is all the raw bloodiness of real flesh, real wounds; nature rent and protesting. The body, once a closed space of quietude and privacy, now wide open, stretched, clamped and ‘mined’ for the tumours that threaten its very existence as they create of the acting Self (that part of being human which here, in this theatre, is absent) Sontag’s ‘non-self’.

I draw nearer to see as best I can while careful to avoid any contact with the green sheet that protects the human being who has become subject to – or is it object to –this therapeutic violation. Standing beside Amanda, I have a clear view of how she works, now with force, now with gentleness, but always with dominance. The body submits. Once the surface and the underlying defences have been breached there is little to resist the relentless subjugation of its autonomy. The chest is rising and falling gently however, normality and regularity at least in this respect confirmed by the anesthetist who watches the fluctuations of his parallel and multi-coloured digital lines.

Carefully now, the surgeons begin to work more slowly and delicately. Brutality is replaced – in the details – by the sensitivity that must dictate the smallest and most intimate of incisions. They need to explore, to single out the pelvic lymph nodes, the arteries the nerves. They are suspicious. The cancer may not have settled only in the cervix, there may be subsidiaries, so, like Selzer’s ‘predators’ on the prowl they move quietly, deliberately, stalking the prey, the obscure ‘lumps’ of flesh that have become firm to the touch and thus differentiated from the soft masses within which they hide.

And so they delve with life-preserving precision into the depths of the body, first one side then the other, moving slowly, constantly aware of how far they can to go before breaching a physical boundary impossible to cross with any hope of returning. The main tumour will be taken coldly and cleanly with the uterus, an eradication of the very taproot of the cancer’s existence, but its morbid potentiality may lie in the lymph nodes. Carefully then they search, steadily and without pity, isolating, feeling, cutting, debating, and moving on. They take various samples, all of which ‘feel’ benign, and then, there it is. A tiny lump of bloody flesh is dropped into a plastic vial and a phone call is made. This sample they are not so sure of, they need to do a ‘frozen section’. The operation has to be delayed while they await the result of the analysis because, they tell me, if it is positive there’s no point in going on. I feel suddenly cold although it is very warm in the theatre. They switch off the lights.

She is under anaesthetic for eight hours. I have to leave, and Amanda does another operation, the next lady on the list, while her first lies covered with the wound open but packed with the endless wadding paper while the sample is sent to the lab. I receive a text later in the evening. The sample was negative and they completed the hysterectomy. They left one ovary.

 

Jac Saorsa

July 2014

Dr Ahmed Rashid: “Diseases of the heart: Where theology meets cardiology”

6 Jul, 14 | by Ayesha Ahmad

Associations between religion and health have been debated for many years. This interest has been paralleled in the medical literature and has led to the inclusion of religious, cultural and sociological topics into medical school curricula, encouraging future clinicians to adopt a more holistic approach to understanding patients and their behaviours.

Much of the research focus has been into church-going populations in North America although the cosmopolitan nature of the modern world means that most clinicians are likely to encounter patients from any world religion. Islam is the second largest religion in the world after Christianity, but consideration about the potential impact it may have on health behaviours has rarely been considered.

He [will prosper] who brings to God a heart protected and pure.” (Quran, 26:89)

more…

Deborah Bowman in conversation with Leslie Jamison, author of ‘The Empathy Exams’

22 Jun, 14 | by Deborah Bowman

 

 

Join the Editor of Medical Humanities, Deborah Bowman, in conversation with Leslie Jamison as they discuss her acclaimed essay collection ‘The Empathy Exams’ and more. Leslie’s work questions how we understand each other and the concept of empathy, drawing on her time as an actor working with medical students and her own experiences of illness and vulnerability. It promises to be a fascinating evening and a rare opportunity to meet an author described by the New York Times as ‘extraordinary’.

This is a free public event, open to all and part of the St George’s, University of London series The Art of Medicine.

Details:

Date: Monday 7th July at 5.30 p.m.

Venue: Boardroom H2.5 Hunter Wing
St George’s, University of London Cranmer Terrace,
London SW17 0RE

Register via e-mail: events@sgul.ac.uk

Hope to see you there.

 

5th International Symposium on Poetry and Medicine at the Royal Society of Medicine, Wimpole Street, London on Saturday 10 May 2014

17 May, 14 | by BMJ

Reflections from the 5th International Symposium on Poetry and Medicine by Clare Best

 

This year’s Symposium invited us to focus on how we might begin to define the term ‘medical poetry’ and asked if that is even a useful aim. Michael Hulse started the day with a thought-provoking talk proposing that the Romantic ego has evolved and survived in the area of medical poetry whereas it is now rare in other contemporary poetry. He argued that the natural successors of the Romantic poets, those foregrounding the self in extremis, are concerned with what he terms ‘primary medical poetry’ –  in which a person writes about his/her own experience of illness or treatment from the point of view of an existential self. ‘Secondary medical poetry’ is the term Michael used to describe poetry written about medical experiences happening to a close other. He saw ‘tertiary medical poetry’ as including poetry that stands at another remove from the medical experience, being more engaged with scientific, historical, ethical and other aspects of medicine.

 

Michael’s talk was a helpful starting point, and throughout the day speakers came back and back to the different kinds of medical poetry he had suggested. After years of hearing nothing but the term ‘confessional poetry’ used in reference to poetry of extremis written in the first person, I liked Michael’s idea of affirming ‘a central literary site’ for the Romantic ego.

 

A particular highlight of the Symposium, for me, was Sandy Goldbeck-Wood’s beautifully fluent and convincing presentation of her work on how biography drives biology. I have always been interested in how the body expresses adverse experiences as symptoms, and I found myself nodding as Sandy spoke about how ‘both poetry and psychosomatic illness might be seen to be forms of embodied feeling or knowledge, both resisting “purely conscious” forms of communication’. Yes!

 

There were many, many other highlights, including Alan Beattie’s warm and generous account of Norman Nicholson’s life and poetry, Ahmed Hankir’s powerfully dramatic rendition of his ideas around the wounded healer, and Jens Lohfert Jorgensen’s brilliantly engaging presentation of the Danish poet Morten Sondergaard’s Wordpharmacy (do have a look at http://www.wordpharmacy.com) – I’ll be ordering my copy immediately.

 

Then there was poetry itself of course: poems of medicine and surgery, remedy and reverie, diagnosis and prognosis, all kinds of poems to make you laugh and cry. I was honoured to present some of mine from Self-portrait without Breasts alongside Rebecca Goss reading vivid and beautiful poems from Her Birth and Lesley Saunders reading from her stunning collection Cloud Camera.

 

Philip Gross gave gorgeous readings from Deep Field and Later, leading us on into the final part of the day which celebrated the winning and commended poets in the three categories (Young Poet, NHS and Open Awards) of the 2014 Hippocrates Prize for Poetry and Medicine. Conor McKee won the Young Poet section with ‘I Will Not Cut for Stone’, Ellen Storm won the NHS section with ‘Out of Hospital Arrest’ and Jane Draycott won the Open section with ‘The Return’. Many congratulations to all the winning and commended poets.

 

I came away from the Symposium once again inspired and uplifted by the truth and power of poetry that addresses medical subjects. I came away knowing that in the face of extreme and threatening medical events, in situations where our identities are challenged and even deconstructed or changed forever, poetry can excite us into new appreciations of life and of who we are and can be. As I see it, the more science probes and uncovers the physical and medical experiences of our lives, the more we need poetry to interpret and express these experiences. Poetry and medicine are perfect companions.

 

Thank you Donald Singer, Michael Hulse, Nicola Williams and all the others including the judges Sarah Crown, Robert Francis QC, Philip Gross and Kit Wright, who made Saturday happen. It was a wonderfully rich day. I’m already looking forward to next year’s Symposium.

 

Find out more about the Hippocrates Initiative for Poetry and Medicine at: www.hippocrates-poetry.org

 

Clare Best

www.clarebest.co.uk

http://selfportraitwithoutbreasts.wordpress.com

 

 

Dr Nikesh Parekh: Film Review The Lunchbox- ‘Letters, chillies, and memories’

4 May, 14 | by Ayesha Ahmad

Set between an apartment block in suburban Mumbai and a modest office floor, The Lunchbox is a film of understated elegance exploring human emotions and connections. Ila (played by Nimrat Kaur) is a young, middle-class Indian woman who is desperately trying to rekindle a waning marriage by preparing her husband delicious lunches that are delivered by the ‘Dabbawala’ system that is widely acclaimed for its efficiency; Dabbawala is an Indian word for men who deliver vast numbers of lunchboxes hanging off the sides of their bicycle in Mumbai and some other cities in India.

more…

Beautiful Science at the British Library: A Review by Isobel Elstob

3 May, 14 | by Deborah Bowman

 

We are delighted to publish this guest review by Isobel Elstob who visited the Beautiful Science Exhibition at the British Library for Medical Humanities. The exhibition is showing until 26 May 2014.

 

Review of Beautiful Science: Picturing Data, Inspiring Insight

Folio Society Gallery, British Library

20th February – 26th May, 2014

 

Isobel Elstob

Correspondence to: izzyelstob@hotmail.com

 

 

How do we represent the material – and immaterial – world visually? This is the question that underpins the Folio Society’s exhibition Beautiful Science at the British Library. The Folio Society Gallery, in which the exhibition is displayed, is a small and awkward space that functions vertically and can be entered from two sides. This is important because such a space has very little to offer the curators in terms of dictating a visitor’s viewing route. The result of this is a non-linear viewing experience that the curators have counteracted through a thematic, rather than chronological, display of objects.

 

The themes that the curators have selected for representation are ‘Weather and Climate’, ‘Public Health’ and ‘The Tree of Life’. Within each of these sections, too, there is less a sense of chronology than the ambition to compare like-with-like pan-historically; in fact, the desire to demonstrate either the accuracy or the usefulness of past methods of visualising phenomena by displaying them beside recent, most often computerised, models. A particularly attractive example of this approach is the inclusion of HMS Rochester Ship’s Journal from the early eighteenth century (1709-12) displayed dialogically beside the UK Met Office’s computerised and interactive two-dimensional globe on which bright pink and blue lines shift and shimmer. These lines represent weather data collected along the spice trade routes between the continents, such as that laboriously recorded by the Captain of the Rochester. This relationship between two examples of data collation and representation demonstrates the intelligent contemporary exploitation of the documentation of information historically. But it reveals something more problematic, too, for an exhibition that seeks to contrast the sophistication of our technology with the originality of our predecessors: the finely-rendered tabulated descriptions found in the Rochester‘s captain’s journal are more beautiful – to use the exhibition’s own choice of word – than the impressive computerised globe etched with brightly-coloured streaks. Beauty is not simply in the eye of the beholder. Beauty is inherently a natural phenomenon, and, therefore, one that exists – and that we will find – in our own, human, creations. The page of the Rochester‘s journal that has been selected for display demonstrates this – beautifully. Perched amongst the looping, precise handwriting of the ship’s captain, that describes ‘Moderate gales of Wind and fair Weather’, sits an ink drawing of a small, speckled bird. The captain, we are told, frequently interspersed his tables of data and description with similar sketches of ships, wildlife and places that he observed throughout his voyages. In such pages, then, are represented two aspects of this man’s – and all men’s – approach to the world: the objective and the subjective. The interaction and relationship between these two ideals permeates this exhibition. Before the mid-nineteenth century the concept of objectivity, as we understand its meaning today, did not exist. Rather than science requiring the removal of human agency in the representation of natural phenomena, it was experience, not self-effacement that had counted previously. We can see this in the words of Edmond Halley, whose 1686 map, An Account of the Trade Winds and Monsoons, is exhibited. Halley writes: ‘It is not the work of one, nor a few, but a multitude of Observers, to bring together their experience requisite to compose a perfect and complete History of these winds.’ The change in attitudes might be traced in Luke Howard’s 1847 Barometrographia, which we are told is amongst the earliest consistent scientific observations recorded, and, more than that, is, in part, mechanically drawn by a self-recording barograph over which Howard subsequently plotted the phases of the Moon. Mechanical objectivity in its genesis is thus displayed.

 

Objectivity today relies on the satellites and the supercomputers that are now at the disposal of scientists. But the representations that such methods produce may well still be beautiful, such as the NASA map depicting the ocean surface currents between 2005 and 2007 that is shown at one of the exhibition’s entrances. One wonders, however, if it is not the subject – our blue and swirling oceans as seen from space – rather than the method of representation, that makes such computerised renderings so appealing. A direct comparison can be drawn between paper and screen within the ‘Public Health’ section, which includes Florence Nightingale’s ‘Rose Diagrams’ depicting the causes of mortality in the ‘Army of the East’. Professor David Spiegelhalter of Cambridge University has taken Nightingale’s engraving and made it interactive to help the viewer better understand its purpose. Such an appropriation is a productive method, too, for highlighting the ‘Lady with the Lamp’s’ work as a statistician in her own right, rather than merely an attendant of wounds. Furthermore, whether it be the Rochester voyaging in gales along the spice routes, or Nightingale sourcing her data from the military field hospital through which she paced, many of the historical documents in Beautiful Science invoke a far wider cultural context than the particular information that they describe. John Graunt’s Natural and Political Observations upon the Bills of Mortality (1662), for example, is a collation of sixty years of London parish records on causes of death. Within the table we find that the number of people in the capital who died due to being ‘Burnt or Scalded’ was three in the year of 1647, and rose to eleven in the year of 1651. Medical conditions such as French Pox, Rickets and Worms are listed alongside causes of death such as ‘Hanged and made with themselves’ and even ‘Frighted’ (of which nine people are recorded to have died in 1660).

 

But it is Beautiful Science‘s exploration of the motif of ‘The Tree of Life’ that is the most poignant section of the exhibition (this is also borne out, perhaps, by the fact that this area appears to attract a far greater concentration of viewers). Interactive technology here, in the form of the One Zoom Tree, allows the viewer to discover the evolutionary links between thousands of species of mammals, birds, reptiles and amphibians. Interestingly, these, very modern, representations of our own – and many other creatures’ – location within the animal kingdom is depicted as a sprawling tree, with branches emerging intermittently from a central trunk. Life on earth has been represented in the form of a tree across the ages and across multiple civilizations. From Mayan to Nordic culture, to the tree from which Eve plucked the apple, this organic life form has functioned pan-historically and pan-culturally as the most apt metaphor for visualising the force and centrality of Life on our planet. Beautiful Science reveals this tendency through some remarkable inclusions. Ernst Haeckel’s The Pedigree of Man (1879) is displayed beside Charles Darwin’s On the Origin of Species by Means of Natural Selection (1859), which is open at the only page within the publication that contains an illustration: a lithograph by William West that depicts the relationships between various species and their descent from common ancestors in what has become known as ‘The Tree of Life’ diagram. At once more problematic and more affecting, cultural attempts to depict the very nature of life will always be more personal to us than representing ocean current patterns or even epidemics of disease. For what is being represented in such imagery is our selves. Beside the historical publications of Haeckel, Darwin and Jean-Baptiste Lamarck is displayed a pair of back-lit black panels that contain a series of brightly-coloured circular diagrams – each one shining with a luminosity that is indeed beautiful to behold. These Circos Visualisations of Genomic Data compare the human genome with those of the chimpanzee, the dog, the opossum, the platypus and the chicken. Within each circular frame these comparative diagrams rise and descend and swirl and ebb like a collection of precise but abstract paintings. Perhaps technological representation is most striking when it represents the essence of us and how it is that we slot into nature’s own material manifestations. In contrast to the evolutionary implications of Haeckel’s and Darwin’s diagrammatic representations of life stemming from a unifying central source, the curators also show us an example of the way in which the relations between creatures had been visualised in Western culture prior to evolutionary theory’s successful claim of the mantle for understanding the natural world. Robert Fludd’s 1617 The Great Chain of Being depicts an hierarchical pyramid encircled by the cosmos, with Sophia the Goddess of Wisdom represented in human form standing for the pinnacle of natural perfection: us. A human-centric model such as this has Aristotelian roots, and monopolised cultural interpretations of the natural realm right up until the nineteenth century. It is not only possible but probable, therefore, that the ‘Tree of Life’ itself will be replaced with what will be considered to be a more suitable model at some point in the unforeseeable future.

 

The question that Beautiful Science most explicitly asks is how have we represented the world around us. But perhaps a more intriguing thesis might be why do we possess the compulsion to represent it at all? It is clear from this exhibition that the motivations behind visualising data and information have been as numerous as the methods invented to do so. The ways in which such visualisations have been accomplished suggests that science is not yet (and may never be) entirely objective. Indeed, Beautiful Science demonstrates, rather, that the human, subjective desire for beauty is as strong as the human, objective desire to possess information, and that our thirst for images is as compulsive, perhaps, as our thirst for knowledge. But let us hope that the technological age in which we live does not alienate us from nature to such a degree that we consider ourselves once more to be Gods of Wisdom, superior and dissimilar to all that surrounds us.

Review: “Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals.”

28 Apr, 14 | by gbelam

We have another great review today, of Lori A Brown’s book “Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals.” It’s by Sophie Jones of Birkbeck College, University of London, and considers aspects of architecture, landscape & design, and wider ideas about feminism and attitudes to women’s health in the USA.  Looks like a fascinating area for discussion. 

- Georgia Belam

 

Review: “Contested Spaces: abortion clinics, women’s shelters and hospitals.” by Lori A Brown

By Sophie Jones

 

‘Is it possible to build non-sexist neighborhoods and design non-sexist cities? What would they be like?’[1] Posing these questions in 1980, Dolores Hayden vocalized the utopian impulse of feminist architecture. A generation of women architects were convinced that Hayden’s question had an affirmative answer. Their plans for housing complexes with integrated childcare centres and cooperatively-run kitchens were not merely isolated amendments to the world as they knew it, but blueprints for a materialist feminist revolution. In Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals, Lori A. Brown brings this heritage of feminist architecture to bear on contemporary approaches to these charged sites. Brown asserts, ‘Space matters. Space is at stake. Control over geography is being legislated by those who want to eliminate a woman’s right for reproductive choice.’[2] Her proposals, which include bullet-resistant windows and abortion clinics in shopping malls, bespeak a different political climate: these are constrained negotiations, not revolutionary demands.

 

Brown’s research into the spatial politics of abortion clinics—and, to a lesser extent, women’s shelters and hospitals—is primarily focused on the United States, with some comparative analysis of Canada and Mexico. The author, an architect based at Syracuse School of Architecture, announces her project as a dual intervention, correcting her discipline’s lack of social engagement while drawing public attention to the feminist politics of the built environment. Debates about abortion often prioritise the subject of time, dwelling on the abstract question of when the foetus acquires a right to life. Contested Spaces marks a welcome turn to the spatial, as growing numbers of women across North America face harassment outside clinic doors, if and when they manage the long, expensive journey to their nearest abortion provider. Brown has transformed these hostile landscapes into diagrams punctuated by sobering statistics. On one map, a stark black line represents a 404 mile journey across South Dakota to the only clinic in Sioux Falls—a route served by no public transportation.

 

The book, which Brown positions ‘somewhere between theory and practice’, is concerned not only with the siting, accessibility and security of buildings, but also with the way architecture manifests social antagonisms.[3] This approach makes sense, but the abrupt shifts between registers are telling. A section about Dr. George Tiller, the Kansas abortion provider shot to death by a terrorist in 2009, segues awkwardly into a recommendation that clinics install meditation rooms for quiet reflection. The story of Paulina del Carmen Ramírez Jacinto, who was refused an abortion at the age of 13 after being raped during a break-in at her family home in Baja California, is followed by a consideration of the importance of lighting and paint choices in reproductive healthcare facilities. Noting the disjunction here is not a matter of policing the boundary between the serious and the trivial. Rather, it is to pay attention to the conditions that interrupt feminist blueprints for the future before they become reality.

 

Women, as Contested Spaces demonstrates, have historically found ways to repurpose structures designed to enclose them. In the 1960s and early 1970s, California’s Army of Three and Chicago’s Jane Collective helped women to access ‘menstrual extraction’ procedures, often in domestic spaces. Brown notes that, for these underground collectives, ‘Domestic space became the space of choice, liberation, security and safety from the law.’[4] Meanwhile, the Netherlands-based initiative Women on Waves dodges national abortion laws by providing terminations at sea. As Brown astutely observes: ‘Connected with neoliberal policies, this project exploits the idea of free trade zones and International waters and exists because it plays against hegemony’s own system through legal loopholes of globalization.’[5] A similar intervention occurred recently in South Dakota when, faced with a prospective ban on almost all abortions, Cecilia Fire Thunder proposed opening a clinic on her reservation, which was beyond federal jurisdiction. In mapping the coordinates of a world without punitive borders, these projects testify to the potential scope of feminist spatial theory.

 

Yet the visions for feminist space projected by past generations of abortion rights activists seem woefully truncated by contemporary compromises. Among these are the ‘bubble laws’ adopted in some US states, which institute ‘zones of protection’ around clinics and the patients entering them. For Brown, the difficulty of enforcing these laws lends their name an ironic resonance: the translucency and fragility of bubbles mirrors the precarious status of abortion access. Her interviews with private clinics in the most restrictive US states—which include Mississippi, South Dakota, and Utah—uncover inventive tactics for grappling with government pressure and anti-abortion hostility. Clinics have developed an impressive repertoire of strategies for combating the harassment of their patients: installing sprinkler systems outside clinics, scheduling landscaping work to spray demonstrators with grass, and setting up speakers to drown out protest noise with music.

 

With the battle lines drawn, the project of drawing up blueprints for revolutionary feminist health spaces appears simultaneously urgent and remote. Few clinics have the freedom to choose their location because many landlords refuse to let space to abortion providers. Meanwhile, renovation proposals attract excessive levels of scrutiny from public officials beholden to the anti-choice movement. Is it better to be a free-standing clinic, with the autonomy to install tight security at entrances and exits, or to be absorbed into a multi-unit complex, where patients and workers have more anonymity? When making design decisions such as these, providers feel trapped between a rock and a hard place.

 

Brown writes, ‘Reproductive healthcare facilities have become twenty-first century equivalents to medieval cities where walls and moats were once used for security from intruders.’[6] There is, perhaps, an alternative to this state of enclosure. One of the clinic directors told Brown that abortion needs to become part of a larger movement for social justice, linked to campaigns for childcare, education, and health. This is the insight of the reproductive justice movement, instigated by women of colour in the US who have drawn attention to the problems of isolating abortion as a single issue.[7]

 

Contested Spaces opens with a synoptic journey through feminist geography and architectural theory, taking in Nancy Fraser on subaltern counterpublics, Iris Marion Young on pregnant embodiment, Homi Bhabha’s notion of a third space, and Elizabeth Grosz on the mutual constitution of bodies and cities. In her conclusion, however, Brown risks collapsing this nuanced discussion of space into a question of location. She writes:

 

I advocate for clinics to become more centrally located in our daily spatial lives. They need to be front and center in our society, not hidden away and difficult to access. Locate them in shopping malls where protests cannot happen due to malls not being public space.[8]

 

Brown goes on to argue that terminations should be provided not only in mainstream hospitals but in shopping malls, military bases, jails, prisons, high schools and churches. Grouping these institutions together as elements of our ‘daily spatial lives’ evades the important distinctions between their modes of funding and management. It is odd that Brown does not consider the stake shopping mall abortion clinics might have in a privatised healthcare system, given the centrality of abortion to debates over the Obama administration’s Affordable Care Act. Meanwhile, the nuances of reproductive healthcare in prison are ill-served by the proposal for jail-based abortion clinics, particularly in the wake of revelations that California prisons subjected female inmates to forced sterilisation as recently as 2010. A tension between pragmatism and utopianism animates Contested Cities, and its conclusion appears to decide in favour of the former. Meanwhile, Hayden’s challenge – ‘What would a non-sexist city look like?’ – reverberates, as a reminder of way the architecture of reproductive justice can be integrated into a broader vision for social change.

 

 

[1] Dolores Hayden, ‘What Would a Non-Sexist City Be Like? Speculations on Housing, Urban Design, and Human Work’, Signs, Vol. 5, No. 3, S170-S187.

[2] Lori A. Brown, Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitals (Farnham: Ashgate, 2013), p. 101.

[3] Contested Spaces, p. 37.

[4] Contested Spaces, p. 78.

[5] Contested Spaces, p. 82.

[6] Contested Spaces, p. 185.

[7] See http://www.sistersong.net/index.php?option=com_content&view=article&id=141&Itemid=81

[8] Contested Spaces, p.

“The One-Sex Body on Trial: the Classical and Early Modern Evidence” – a new review by Brandy Schillace

23 Apr, 14 | by gbelam

We are thrilled to be able to publish here a  wonderful review by Brandy Schillace, of Helen King’s book “The One-Sex Body on Trial: the Early and Modern Evidence.” (Surrey: Ashgate Press 2014.) Thank you so much to Brandy for her contribution to the blog – I will very much look forward to other pieces from her in the future!

- Georgia

The One-Sex Body on Trial: The Early and Modern Evidence

In so many important ways, I’ve been long anticipating this book. Where there is a lack, a need, we naturally look for satiety—and there has been a considerable gap in studies of the sexed body since the (pardon me) seminalwork of Thomas Laqueur: Making Sex. I do not mean to suggest a lacuna where none exists; certainly plenty has been written on the one-sex/two-sex body since the early 1990s. However, as Helen King herself points out, none of these works have, in a meaningful way, challenged—or even added to—Laqueur’s original analysis. If anything, they have solidified it, casting it as the background upon which all else must be built rather than as a concept or theory in its own right. Twenty years after its publication, Making Sex was still described as the standard, and as a graduate student I was given a copy as the potential foundation of my dissertation on women’s education and women’s bodies in the 18th century. There was only one problem: I found that I did not agree with aspects of Laqueur’s premise. It did not ring entirely true to what I was finding in women’s writing about their own bodies and minds in the eighteenth century.

That happens frequently, does it not? And any reasonable student seeks out the next text, and the next, to gain a broader perspective. But for me, in 2007, there were no other options. Or rather, all other options likewise returned me to the original as to the foundation, the blank background from which I was to begin. To be so statically conceived is unhealthy for any idea, no matter its worth. Closed to inquiry, its kernels harden. In The One-Sex Body on Trial, Helen King, historian and professor of classical studies at Open University, at last provides the counterpoint. Gracefully acknowledging the value of Laqueur’s work, she also offers its first real challenge. With her usual depth of perception, careful research, and immanent readability, King elaborates the other side of the one-sex/two-sex story.

One of the greatest strengths of King’s work related to her “storied” presentation. The medical humanities, though multiple and varied in definition and mission, largely seek to divine the human narrative behind medical meanings. Rather than asserting or denying the ‘one-sex’ body, King provides a reading of two key classical texts that problematize a single narrative of progression away from one model or towards the next. Close reading provides a new means of perceiving the terms in context, reminding us that in holding too close our own cultural understanding, we miss significance—or worse, misrepresent data. Using the story of Phaethousa (a woman and mother who seems to undergo masculinization) and Agnodice (a woman who wears male costume in order to become a physician), King demonstrates the variety of ways in which connotation and denotation collide. Even so common a thing as Agnodice’s calling card refuses to parse properly—to be “the WOMAN physician” can imply either that she is a woman and a physician, or a physician of women (she was, in fact, both).

In part one of King’s book, she assembles the classical evidence not of a strict adherence to the one-sex model, wherein women are men turned inside out with organs of generation that neatly correspond, but rather of a two-sex model that existed at times alongside but always in contention with the one-sex version. King does not argue for linear progression, however; rather than insisting that the one-sex to two-sex revolution happened, but happened earlier, she makes it clear that there was a range of models of the body. Vesalius, for instance, retains some of the earlier understanding of the body, such as the heart-shaped womb, but clearly departed from Galenic descriptions. The reading of Vesalius becomes clear only when the full context is considered. The question, whether Vesalius ascribed to the Galenic one-sex or Hippocratic two-sex model, is partly answered by close reading the images but also the text and the captions (frequently omitted in Laqueur’s work). Why is the abstracted womb shown without the female testicles? Because it is not an homage to Galen, of whom Vesalius claims “not even in his dreams did Galen ever see a woman’s womb” (57). Rather, it is, as King describes, the “womb and its constituent parts” –a thing unto itself and not the inverse of the male organs (59). King also describes the work of Laurens in 1593, who finds the vagina-as-penis idea frankly absurd—and Jane Sharp’s The Midwives Book of 1671, where Sharp claims that despite certain similarities, male and female organs can never be considered the same. By a careful marshalling of evidence, close-reading and analysis, and copious footnotes, King makes clear the problems with Laqueur’s sweeping pronouncement that the two-sex revolution arrived in the 18th century. King’s first two chapters also serve as excellent reminders that history is complicated and close reading within a cultural context remains our safest guard against anachronism. However, the second part of King’s book departs from the usual means of explication and proof and offers an exploration of the two classic tales mentioned in the introduction. In her masterful engagement with these, King seeks to ask broader questions that remain deeply important and even foundational for the medical humanities—namely, on what authority does medical knowledge depend. Whose stories matter, and who gets to tell them?

In the second part of King’s work, we once again examine the story of Phaethousa, the woman who, after previously birthing children, stops her menses and grows a beard after (or possibly in response to) the exile of her husband. The chapters in this section highlight the frequently confusing contexts in which such stories appeared, asking us to re-evaluate their role as “true” case histories. To what extent does she represent a medical construct? Her name and place of abode would have had metaphorical relevance to readers; has she been included as proof of the Hippocratic two-sex model? She dies, after all, and does not fully change into a man. If anything, the beard is a sign of illness, possibly related to her inability to conceive children after the loss of her husband. Here, Phaethousa is at risk because she is, in fact, too womanly, too reliant upon pregnancy for health. Later contexts (and later centuries) reinterpret her story, however; she appears in Wit’s Theatre as a fully functioning male, having undergone the inversion successfully. Surely this usage supports the one-sex model wherein male and female organs are interchangeable with the proper heat. And yet, she also appears in lists of hermaphrodites in the early modern period. What do such changes in context and, indeed, meaning represent? The story represents a “blank canvas,” a place where divergent and overlapping understandings of sex and gender might be enacted and analyzed, and reading this broader context allows us to go beyond Laqueur’s dichotomy and to recognize the variety of markers that made sex apparent, such as beard, menses, and generative ability. Part three of King’s book, which provides a similarly close reading of the Agnodice story, likewise challenges Laqueur’s straightforward picture of the classical and early modern world. “True sex” means different things in different versions (and for different audiences) of these narratives.  Agnodice’s story, particularly, does not fit into a single genre; the “voice” shifts and the text is offered up both by Agnodice’s supporters and her enemies.

King’s chapters on Agnodice, which close the book, render explicit the role of interpretive context: Agnodice as assertive and active heroine; Agnodice as shameful woman from which no woman should learn, Agnodice as the pretender—not to be trusted, Agnodice as agent of change. To what extent does the story represent reality? To what extent myth and fiction? How are we to read her role or even her name (chaste before justice), considering she saves herself from accusations of philandering with her woman patients by exposing her genitals in the courtroom? Even more complex, if possible, than the tale of Phaethousa, the story of Agnodice toys with the Galenic one-sex model while depending upon the two-sex model for its happy conclusion. More importantly, as King remarks, “the reason why the story is being told affects how it is constructed” (206). In her final chapter, wherein she ties the two tales together, King returns again to the markers of sex. What is it that makes a woman a woman? Or a man? Even Galen’s one-sex model is not as simple as it first appears. Rather, King’s extensive research reveals a much more fluid history, where different models of the body existed simultaneously and possibly on a spectrum wider still.

King’s work does, at many points, contradict Laqueur, but at no time does it set itself up as antagonistic to it. In many respects she agrees, particularly with Laqueur’s point that what was “seen” depended much more on expectation than anatomy. However, where Making Sex relied heavily on a smaller selection of sources, and these occasionally out of context, King widens the scope of source material for a richer and more meaningful engagement. Applying specific labels—either one-sex or two-sex—“obscures the complexity of the different interest groups, readers and tellers,” whereas our consideration of cultural and chronological specificity allows us to engage not just with meaning, but with meaning-making.

Guest Blog Post by Poet and Writer, Clare Best, Part 2: On Scars and Memories

21 Apr, 14 | by Deborah Bowman

Guest blog for BMJ Medical Humanities by Clare Best

 

Recently I’ve been thinking about cutting/editing and scars/memories. In two linked pieces for the BMJ Medical Humanities blog, I take a look at my own relationship first with knives and cutting and then with scars and memories.

 

Part two: Scars and memories

 

If I, as a former artist-craftswoman and as a writer and editor, am some kind of surgeon, then surgeons are also editors and writers. They arrange and rearrange our anatomies, cutting away what is not healthy, what is no longer required, repairing what is not working as it should. They invent and create new mechanisms and implant them into our bodies. The aim of most surgery, it seems to me, is to alleviate suffering and allow bodies and human beings to function as fully as possible. Surgeons facilitate – as far as they are able to – our wholeness. Our bodies, subjected to their hand work, become altered and edited versions of our earlier, or first draft, selves. Surgery is one agency in the mutability of human experience.

 

My own body has been revised and edited in many ways, as of course have all human bodies – by growth, by accidents, by disease, by ageing and even by self-harm, as well as by surgery of various kinds. In my case, the most dramatic revision and editing happened in 2006 when I underwent elective double mastectomy as a way of reducing my risk of contracting a hereditary breast cancer in my mother’s family.

 

I have written elsewhere about the decision-making journey leading to my surgery, as well as about the creative processes that sustained me before, during and after surgery – the creative processes which later developed into the project Self-portrait without Breasts (http://selfportraitwithoutbreasts.wordpress.com). Here, I want to think about scarring as evidence and reminder of trauma and loss. And I want to raise questions about the ways in which scars are read and interpreted – both as signs of surgery and as memorial sites.

 

The surgeon who operated on my mother was a kind and gentle man who nonetheless believed in radical mastectomy, which involved removing not only all the breast tissue but also much of the underlying muscle of the chest wall, and all the lymph nodes. Considering that the particularly aggressive nature of inherited breast cancer was not recognised in the 1970s (when my mother’s cancer was first found) she was lucky to encounter a surgeon who believed in this approach. Her radical mastectomies five years apart, following multiple primary tumours in both breasts, almost certainly gave her the additional twenty-five years of life she enjoyed until she died in her early seventies. But the resulting scars, both visible and invisible, were terrible to her. She never wanted them to be known about, let alone witnessed. She and I were very close, and yet throughout the many times I nursed her, and right up to the end of her life, she made enormous efforts to keep her morbidly scarred torso and upper arms from my sight. I saw the scars only twice, on both occasions by accident.

 

My mother was not unique in her shame and suffering. Although we now find it hard to imagine a world in which the words ‘breast cancer’ were unspeakable, that was the world my mother, and countless other women, inhabited. With the prominent outer features of their gender and sexuality invaded by disease and/or surgically removed, women with breast cancer struggled to maintain a sense of identity. But by the same token there was no language in which to talk about their loss and fear, and the scars had to remain unseen, both literally and metaphorically.

 

So taboo was this disease, in the world and in our family, that when my first cousin was diagnosed with aggressive ductal carcinoma in the mid-1990s, she had no knowledge of her aunt’s (my mother’s) experiences, even though her own mother (my mother’ sister) had also developed breast cancer. It was only when my cousin and I began to correspond about our mothers’ breast cancers that the extent of the deeper family scarring became visible and tangible. We began to read the scars and interpret our own situation, the risks we faced. We could also finally perceive the scars in our mothers’ generation as the memorial sites they were – places where loss and pain should have been respected, remembered and properly grieved, instead of turned away from and covered up.

 

The good news is that the current climate around surgical scarring is much more open. This has to be a very positive change for individuals and for society. Some of the mainstream breast cancer charities such as Breast Cancer Care are now running campaigns that address body image issues with photographs of women at ease with, and baring, their scars. The recent Under the Red Dress project has drawn a groundswell of support for making scars visible, even legible, and the project clearly links that legibility with raising awareness of breast cancer. My own work explores and extends the ways we tell the stories of our bodies; in speaking out through poetry and photographs, I speak for other women in my family and beyond.

 

But there is more work to be done. If scars are both evidence of cutting/editing and sites of memory, we are presently at risk of overemphasising the evidence whilst sometimes failing to properly acknowledge the memories. A recent statement from Judy Kneece, sent around social networking sites by the (American) National Breast Cancer Foundation, asserts that ‘Breast cancer has invaded my body, but it need not invade my spirit. There may be scars on my chest, but there need not be scars in my heart.’ Apart from the use of the stale military terminology by which all experiences of cancer seem to be set up as battles to be lost or won, the core of the message is, I think, distressing in its denial of the need to admit inner wounding and thereby begin to integrate trauma and loss. Of course the scars are in the heart as well as on the chest – how could it be otherwise, and what is wrong with that?

 

We should seek to accept the hand work – the cutting – where it is necessary, and treat with tenderness and care the consequent scars and the memories they represent. Surely this honouring of the memory as well as the scar, the material edited as well as the knife and the cut, makes the move towards true healing both more imperative and more likely.

 

Clare Best is a poet and writer with particular interests in writing body and landscape. Her poems are widely published in magazines including The Rialto, The London Magazine, Magma, Resurgence, Agenda and The Warwick Review. A chapbook, Treasure Ground (HappenStance 2009), resulted from her residency at Woodlands Organic Farm on the Lincolnshire fens. Breastless – poems from the sequence Self-portrait without Breasts with photographs by Laura Stevens – came out with Pighog in 2011, and Clare’s first full collection, Excisions (Waterloo Press 2011) was shortlisted for the Seamus Heaney Centre Award. She teaches Creative Writing for Brighton University and the Open University, and lives in Lewes, Sussex.

www.clarebest.co.uk

http://selfportraitwithoutbreasts.wordpress.com

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