Digitized bodies, virtual spectacles

Futures 32 (2000) 103–120 www.elsevier.com/locate/futures

Digitized bodies, virtual spectacles Nina Czegledy1,*, Andre´ P. Czegledy2 Department of Social Anthropology, University of the Witwatersrand, Private Bag 3, WITS 2050 Johannesburg, South Africa

Abstract The magnitude of recent advances in biomedical technologies has contributed to a significant shift in the common perceptions of the human body. This visual revolution has been achieved through the combination of prosthetic science, simulation technologies, genomics, informatics, biomedical engineering and—most importantly—advanced visualization techniques that include entirely new vectors of bodily image enhancement. Digital manipulations have contributed to a dramatic change in the relationship(s) between humans and machines and even those between humans themselves. While the theoretical, ethical and practical features of these developments permeate practically every aspect of our daily lives and have extended our understanding of communication with respect to the human body, the consequences for the future are obscure.  2000 Elsevier Science Ltd. All rights reserved.

1. Introduction “The future is clear” claims the lead sentence of a striking advertisement for Applied Imaging, a biomedical technology company whose new product is an integrated DNA probe reagent for RX Fish Chromosome Analysis. The product advertisement, which appeared in the March 1998 issue of the distinguished Nature Genetics Journal, artfully combines this conclusive statement with powerful imagery and a positivist, explanatory text. The backlaid image shows a colorful chromosome karyotype arranged against a black background. The neon colors of the karyotype echo the implicit message of corporate creativity just as their contrast with the black-

* Corresponding author. Tel.: +1-416-929-9383; fax: +1-416-929-9383. E-mail address: [email protected] (N. Czegledy) 1 Nina Czegledy is an independent artist, curator and writer. 2 Andre P. Czegledy is Senior Lecturer in the Department of Social Anthropology, University of the Witwatersrand, South Africa. 0016-3287/00/$ - see front matter  2000 Elsevier Science Ltd. All rights reserved. PII: S 0 0 1 6 - 3 2 8 7 ( 9 9 ) 0 0 0 7 0 - 1

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ness around them suggests Science as a solution to the metaphorical blackness of a previous era’s limitations. The high contrast of the karyotype colors is paralleled by the white starkness of continuing text whose message is that the espoused technology is part of the “only” method by which we might realize “pioneering solutions for life”. Such text and imagery illustrate post-industrial society’s current fascination with biomedical technology as well as confirming the force of enhanced imaging systems and visualization technologies in creating a fundamental shift in how images of the human body are being (re)produced in terms of the social imagination. The investigation of certain unresolved issues regarding the body politic, objectification of the individual, bodily ethics and the sometimes contradictory discourses surrounding certain experimental technologies seems essential to reinterpreting the place of the individual as a corporeal entity in society. How can we decipher the ambiguities surrounding the documented data body? Simultaneously, how can we obtain precise information about ourselves, particularly in the coded terms of medical science? How can we preserve our individual integrity without becoming mere electronic spectacles held fast under what Scheper-Hughes and Lock have termed the “controlling gaze” [1] of modern medicine? Perhaps more importantly, how will the prospects of increased visualization affect our very future as social beings? A critical discourse extended to artists working through scientific and biomedical concepts (related to the imaging technologies), may shed some light on the answers to these elusive questions. It is in the contemplation of this decidedly creative (and admittedly speculative) commentary on the transforming body vis-a`-vis the manifestations of the digital revolution that we might gain a better understanding of both changing perceptions and future trajectories. This paper deals with the subject of advanced biotechnologies, current biomedical practices and considerations of their impact on human society in the near future. Instead of thinking of the body as a “socially informed” whole in the meaning of Bourdieu [2], or from the perspective of cultural definition in the vein of classical anthropology [3], it will be examined primarily in terms of technological objectification and to a lesser extent, artistic expression. There is nothing novel about nudity, neither in private nor public circumstances of expression/representation. The nude has an important place in art history and has been celebrated throughout the ages by magnificent representations. The naked, stripped subject of this essay, however, differs greatly from the sometimes erotic yet abstract distance of conventionally mediated representations and anatomical studies. It is, instead, a post-modern body divorced from its own reality; one which attracts curiosity, centers on persistent anxiety, and is simultaneously a subject of exploration and analysis. Of first consideration will be the issue of spectacle in connection with shifting perceptions of the human body via advanced biomedical technologies of visualization. Secondly, the paper will interrogate some of the recent developments in molecular modeling and virtual reality programming in terms of their significance for bodily perceptions. Next, we will consider the impact of the sort of digital imaging technologies that are now intrinsically linked to many of the new forms of visualization. Fourthly and fifthly, the themes of invasiveness and distance are reviewed in

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conjunction with changing notions of spatiality (bodily and otherwise) in reference to visualization technologies. Rather than concluding the discussion in the conventional manner of a summary, leading examples of artistic expression in relation to the social play of such technology will be examined—particularly those relationships linked with the interconnected issues of bodily alteration and corporeal invasiveness. What will become clear upon closer inspection is that the significant technical advances in the biomedical sciences are inalterably constructing new human vulnerabilities in contemporary society just as they open our eyes to new visions of ourselves.

2. Technology and the spectacle of the body The confluence of medical science with the dimension of spectacle constitutes neither a complex nor convoluted history. As early as approximately 300 B.C. Herophilos is thought to have conducted a dissection of the human body for the first time in full public view. It is not known whether the sense of presentation accruing to this event fell within the secular or sacred perspective of ancient Greek sensibility— although the possibility exists (given then held cultural understandings of the cosmological place of the body in society) that such a differentiation was not in evidence at the time. What is clear is that by the 16th and 17th centuries, when medical practitioners and amateur anatomists were dissecting corpses in front of open audiences, such events were considered a valid form of popular scrutiny as much as an opportunity for anatomical examination conducted in the name of scientific advancement [4]. Without question, the human body was by this time an accepted part of the public domain of inspection and spectacle in the sense of formal exhibition and titillating display. This display (for whatever purpose) was, however, still very much a matter of direct sight. Until recently in human history, the body was solely viewed through the naked eye or (since the 17th century) via elementary mechanical magnification in the terms of compound lensed microscopy. These two means—one natural in the sense of immediate anatomical potential and the other aided through simple optical technology—allowed little room for image distortion. Although the latter form of sight may be said to have significantly changed our way of perceiving biological scale (especially that related to ourselves as complex continuums of organic activity), both of these sources of visualization traditionally carried limited possibilities for visual reproduction and, moreover, manipulation. Except for the later intrusion of clinical photography, they depended upon a critical temporality of visual access that connected the viewer with the viewed object as an immediate physical presence (in part or whole). This temporality ensured that control of the material body included a large measure of control over its life-like image in the gaze of others. With the advent of the modern era and the development of advanced biomedical technologies which put the use of bodily imaging at the center of diagnostic medicine, this and a host of other relationships no longer seem to pertain. Today, we consider our bodies through the thick filter of scientific fact, an imposing edifice that provides an objective seal of approval thoroughly consonant

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with the Enlightenment tradition of rationalist thinking. Here is entrenched the Cartesian idea of philosophical introspection, a simultaneous separation of mind from lived-in body which has dominated Western thought for the last three centuries. To this idea may be added the further—social—separation of the person as patient– object vis-a`-vis the medical establishment, a hyper-patient relationship which reinforces our lack of certitude with respect to the self-knowledge of our own bodies. The only place where this relationship seems to (but partly) break down is in the area of bodily image, more specifically, in our increasing access to scientific knowledge. The visual material of our bodily reality is now supplied not simply through the personal sensory realm of experience and self-judgement but it is augmented by way of an overwhelming stream of information from a variety of quarters—albeit many of them arbitrated by the medical establishment. From physics and (bio)chemistry through astronomy, to neuroscience, molecular genetics and even cosmetic surgery, technological imaging is thus changing the way we see ourselves as much as the world around us: it tells us what we are and how we really look (like). Some technologies have had greater influence than others. Wilhelm Roentgen’s 1895 discovery of X-rays led to seeing the human body through the primacy of corporeal density. M. Kroll, Ernest August and Friedrich Ruska’s construction of the first electron microscope in 1932 opened entirely new vistas of material structure and scale, thereby unalterably changing the way in which we visualize the architecture of the physical. Over the last three decades, in particular, the wide-spread use of high-resolution electron microscopy has provided powerful micrographic images on a molecular level. These images have further extended the range of visualization, working to separate it from the very fabric of life. Recently, the FISH technology noted in the Introduction above has “profoundly altered the aspect of genome research and molecular diagnostics” [5] by allowing the visualization of individual genes on chromosomes. Formerly, chromosomes were analyzed manually, by way of an extremely time-consuming and labour-intensive methodology. FISH has changed all that. Now the analysis of DNA has been extended via computer-aided technologies to the examination of chromosome metaphases such that formerly invisible diagnostic and research areas have opened up our notions of bodily mapping. Other technical advances related to enhanced visualization include: TI (Thermal Imaging), MRI (Magnetic Resonance Imaging), CT (Computed Tomography X-ray imaging) and PET (Positron Emission Tomography). The extensive use of these technologies has contributed to a radical shift in bodily thinking involving a bifurcated path. On the one hand, the conceptual space of the corporeal has become greater than ever before: there is literally more of it to see in a quantifiable, voluminous fashion. This radical shift in perception has resulted in no less than a re-drawing of the human body in terms of its essential nature. Where before it was just flesh and bone; now it is a mass of various readings, each one giving a different character to the whole. On the other hand, the new technologies have produced a dimensional multiplication of how the human body is conceptually and visually recognized. Simply said, we now see the body in plural ways: via electronic pulses, magnetic cadences, ther-

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mal signatures, etc. Such differing forms of visualization signal a qualitative difference in bodily understanding by way of technological mediation; one which fundamentally restructures the historical conclusiveness of independent visual ability while cornering the mind into a new cage of cognitive dependency.

3. Molecular modelling and the virtual body Before the advent of the latest visualization technologies, the French philosopher Maurice Merleau-Ponty noted that: Our own body is in the world as the heart is in the organism: it keeps the visible spectacle constantly alive, it breathes life into it and sustains it inwardly, and with it forms a system. [6] It is entirely possible that the new technologies can mediate this perspective on the primacy of the sensory consciousness by providing an opportunity to divorce ourselves from the conventional cognity of bodily-determined knowledge. In their provision of direct sensory liberation, we now find ourselves possessed of the ability to increasingly visualize far beyond what is called “normal” sight. In particular, advances in computer visualization and user interface programs carry with them the widening prospects of 3D modelling. These developments have also encouraged the growth of increasingly sophisticated virtual reality (VR) programs which allow their users to interact with objects (including objectified bodies) in completely simulated, artificial environments. In this way, medical researchers (students included) may soon be able to explore the minutiae of the human body without even coming into sensory contact with it. The level of programming complexity may not be able to duplicate the living detail—nor introduce the element of chance—which we find in the real world of our direct bodily experience. Nevertheless, it is already clear that the power of the mind to fill in the gaps between sensory data, coupled with the increasing potentialities of AI (Artificial Intelligence), leaves considerable room for the increasing rewards (and pitfalls) of simulation. This evolving technical faculty is not without direct importance for the development, transmission and application of both codified and experiential knowledge. In technological terms at least, it is now possible to say that the computer-generated and digitally-enhanced images produced by the modern forms of visualization not only permit the representation of completely abstract phenomena such as mathematical concepts and formulae crucial to the field of molecular genetics, but also allow for the representation of medically conceptual phenomena (such as the nervous and circulatory systems of the human body). Now we are able to visualize the thinkable body, including states of motion which would be impossible to naturally capture otherwise. If the prospects of existing virtual reality computer programs allow the viewer to explore the simulate corporeal as if s/he were a molecular astronaut in the human body, then it becomes apparent that the very concept of physicality—let alone the

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body—is being undermined by the new technologies of visualization. One can now float via computer programs through the vascular system and slide in and out of the body’s musculature with as much ease as it takes to push a computer mouse along the table. Although the creation of this sort of artificial bodily realm is as much a part of the art of computer generation as the actual reproduction of any given body through visual imagery, it nonetheless incorporates a radical shift in bodily perspective. Not only is the corporeal become visually unstable but, with the touch of a button, the body can appear and disappear; it can be pulled and pushed, mutated into impossible agglomerations with a totally new plasticity. In conceptual terms at least, such plasticity paints the viewer/interactor with the controlling brush of the divine(- like) while echoing in bodily terms the post-modernist cant of the immateriality of spatiality, what is now called “hyper-space” [7]. Diagnostic telemedicine—widely used in a variety of medical disciplines—is an example of remote visualization techniques where the individual human body itself becomes transparent from a wide range of visual perspectives. Indeed, telediagnostic conferencing has a tremendous potential for the future practice of medicine [8]— and corporations promoting the related equipment are fully aware of this. A recent British Telecom advertisement [9] extolling the company’s involvement in advanced ISDN technology shows an ultrasound image with the caption: “The ultrasound examination was conducted by a specialist in London, the patient was in the Isle of Wight”. The advertisement aptly illustrates how the human body has not only became transparent, even remote, due to recent technologies—but that it is presently being used as visual spectacle for blatantly commercial purposes. The process of divorcing material artefact from lived reality involves both the technology itself and a veritable industry of malleable replication underpined by commercial rather than altruistic interests. Delving even deeper into the realms of minute scale, a long list of molecular modeling software programs ranging from “Babel” to “XMol” are currently being advertised on the Internet. Many of these programmes are intended for maximal distribution—a direct corollary of the sort of market commercialization which dominates scientific efforts of all kinds in contemporary society. The advertisement for the molecular visualization freeware “Rasmol”, for example, intentionally seeks a broadly based clientele; it entices prospective customers with “a little basic biochemistry [knowledge] . . . to get lots of molecules” because “learning how to use [RasMol] is easy and fun” [10]. This ideology of access—a psychological commercialism which hides behind the facade of democratic access—is reinforced by the corporate website on the Internet, which reads: Rasmol and Chime Molecular Visualization Freeware [our emphasis] This is the Rasmol Home Page visited by 250,000 people from 115 countries/Two million accessioned per year. The proliferation of the new bodily imagery in the public domain (primarily through the media of popular cinema and commercial advertising) has paralleled contemporary trends in visual culture, a development that returns us to the issues of spectacle. The strong emphasis on imagery in contemporary—particularly Western—

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culture has contributed to a visually privileged society in more than one way: privileged in the terms of access to technology and/or its images, and privileged in respect to the social valuation of the human senses. Of these two dimensions, it is the second which has particular bearing upon our discussion at hand. The contemporary domination of the visual in society has occurred at the expense of our other senses, especially the olfactory, but including that of tactility. Touching implies intimacy [11,12]—a controversial notion in an age when direct contact is increasingly replaced by systems of remote control. We mean to imply here that technical means have increasingly allowed for the spread of complex, yet disembodied communication practices such as voice-mail and other forms of indirect interaction. These practices transmit received knowledges in a fashion much like the new visualization technologies: by way of technical separation and technical restructuring. The resulting (re)constitution, whether that of vocality or the (image of) physical presence, has brought into sharp prominence an increasingly virtual, rather than a temporal, point of view. In her influential volume, Body Criticism, Stafford has gone so far as to argue that the gradual process from a text-based to a visually dependent culture has not simply revolutionized our perception of the world in general and the human body in particular, but that we live in a predominantly service economy which is predicated on “televising and videoing constructed, antisensual, and intangible somatic experiences rather than manufacturing tangible objects” [13].

4. Digital imaging of the body Via the aid of digitization processes, current images of the body are manipulated, processed, communicated, stored, compressed and archived. These processes are accomplished to the point where it is difficult—if not impossible—to ascertain their precise origin, as well as determine the source from a legal point of view because of its essentially intangible nature [14]. Has the image of the human body in medicine changed significantly over time? Medical practice in the Medieval Ages consisted mainly of homeopathy, some of which was rooted in pagan traditions of curing and then adjusted to suit the doctrines and cultural sensibilities of European Christendom [15]. During this time, medicinal maps of the body featured both organs and fluids. The functions of each organ were correlated to the heavenly constellations and, in a similar fashion, the body’s differing fluids were depicted as linked to the heavenly elements. This vision of bodily connectedness reflected the primarily religious coloration of the European imagination at the time, a system of influenced knowledge which would not be fully challenged until the Reformation and Enlightenment. By the 18th century, however, much had changed. Medical records from Germany studied by Barbara Duden present us with a very different conception of the body, one completely at odds with current conceptions: a body in which substances we would not now recognize were deemed to find corporal pathways which we would regard as anatomically impossible [16,17]. Nevertheless, contemporary illustrations of the body were by then already precisely executed in a manner which foreshadowed the scientism of today.

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By the end of the century, Lomas informs us, representations of the body put great emphasis on delineation and detail: Anatomical illustration flourished in the latter part of the eighteenth century as the emergent medical sciences laid increasing stress upon empiricism. Art lent to medicine not just the prestige of high culture but, more vitally, a repertoire of realist tropes designed to convince the viewer of the truthfulness of unimpeded sight [18–20]. The peculiar artfulness of these images contributed to the prestige of the medical profession in the eyes of the wider scientific community and received the added attention of an interested public [21]. Both of these audiences were to follow the further course of medical visualization for some time, including the crucial discovery of X-ray imaging. This brings us to the current day, for, according to Stafford: If the late nineteenth century developed the photographic sounding of the living interior through endoscopy, gastroscopy, cystoscopy and most dramatically Xrays, the late XXth century revealed its dark core three dimensionally through MRI scans [22]. MRI technology is highly dependent upon digitization technology, and among the new biomedical technologies currently being developed, it is the variants of digital imaging which are fast becoming star performers for profit-minded institutions and enterprises. This is a nascent bio-science which utilizes the power of computer analysis to visually isolate parts of the body picture by as much as molecular picture— and then reconstitute them into a whole which is subject to intense digital evaluation prior to diagnosis. Given the development of computer sophistication, a real question in this specialized field is whether (in time) the eventual diagnosis will continue to be conducted by human or machine? As a separate subfield of commercial science, digital imaging technologies are one of the fastest growing industries of the current decade. They generate close to 10 billion dollars in annual revenues and involve a projected growth rate of 55% per year [23]. The commercial expansion of these technologies has reshaped biomedicine in ways that would have been barely imagined a decade ago: Although the inroads made by imaging technologies are occurring throughout science, they are most pronounced in biomedical research, where radiology departments have been rebaptized as departments of Medical Imaging, where entire issues of journals are devoted to imaging technologies and where a prominent publication—the New England Journal of Medicine—now carries a regular feature on medical imaging [24]. These and similar ramifying developments have significantly contributed to the institutional shift from mono-visual views on the body to the sort of multiple visualiza-

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tions which are increasingly part of the technological hyper-world of our social imagination. At the heart of digital image management and communication lies the image itself, a picture whose scale can be manipulated with astonishing ease. Whether it be fetal heart changes or the CT (Computed Tomography X-ray imaging) diagnosis of human remains, minute details of the human body can be technologically surveyed and then, via computer analysis, evaluated on a level of sophistication previously unavailable to the medical and biological sciences. This is apparent in recent applications of CT technology which include its use in the research of Lewin et al. [25] who, since 1977, have been using two-dimensional CT images to study ancient Egyptian mummies held in the collections of the Royal Ontario Museum, Toronto. Since 1984, Lewin’s forensic and medical team has extended their pioneering imaging techniques by developing a three-dimensional serial X-ray tomography imaging system to study the cranium of one of the specimens. The three-dimensional scans have revealed a wide variety of internal bodily information ranging from the specific mortuary techniques used in the preparation of the corpses to aspects of individual dietary condition—without the use of invasive forensic techniques which would have irrevocably damaged the valuable specimens. It is not only in forensic archeology where unprecedented changes have taken place as a result of the new visualization technology. In fetal cardiology, the dramatically improved image resolution of echocardiographs has enabled scientific and medical professionals to see and diagnose cardiac abnormalities in fetuses as early as 17 weeks of gestation [26]. This has dramatically changed the comprehension of fetal cardiac physiology in terms of diagnostics and, via videotaping, has been extended to medical education and family counseling programmes. The latter community outreach activities are not without considerable import; they extend the experience of the new visualization technologies far beyond the medical and scientific communities and into the layperson’s realm of popular knowledge and discourse. In this way, through (especially) the familial chains of society, the surface (image) of visualization technology is broadly disseminated—although the actual techniques remain a part of the specialist’s protected domain of arcane expertise and control.

5. Invasiveness and the bodily spatial Until very recently, the practice of surgery was a purely manual skill not least touched by the idea of artistic dexterity. Today, the intrusion of technology into even basic surgical techniques may be producing an entirely new—and considerably more technical (as in technological)—sensibility. With image-guided, stereotactic navigation in tumour surgery, the localization technology is combined with real-time video to permit the visualization of medical imaging data as a video overlay during the course of the surgical procedure [27]. In the process of such relay and transmission, the transformed biotechnical body can be virtually (i.e. digitally) dissected, fragmented into a plethora of arbitrary and component parts which may or may not respect the bounds of physiological reality.

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The notion of bodily malleability in which such imaging processes are rooted has important cultural considerations with respect to our social desires to conform to beauty stereotypes by way of bodily adornment and, in the more extreme cases, actual alteration. At the far end of this spectrum, visualization technologies invite the imagination to loose the connection between one’s natural (i.e. birth) body and one’s self-desires by way of the possibilities of physiological reconstruction. Such reconstruction goes well beyond the transformative vertices of body-building [28] to arrive at a point of veritable bodily exchange. There is no better illustration of the conceptual elasticity involved here than to refer to the growing industry of cosmetic surgery and its use of computer modeling programs which generate composite faces intended to show the clientele their new appearance after the work is done. What is striking about this use of visualization technology is not so much its encouragement of visual licence but what it has to offer for our future understandings of individuality: essentially, an ebbing of bodily grounded uniqueness via the prospects of physiological replication in first visual, and then practical, terms. Some of the latest visual surgery techniques (in tandem with compound laser instruments) allow physiological interference by which it is not even necessary to physically cut into the body. This sort of technologically-oriented surgery relies ever more on the precision of non-human elements, a development which points to the diminution of the surgeon as the Ultimate Authority. Further, it contributes to the fetishization of technology in medical practice, a sensibility which parallels wider cultural mores in (especially) the Euro–American world. The term “non-invasive” technology refers not to the elimination but to the minimization of physical intervention. The corollary issue of a scalar dimension thereby invites a rhetorical question: are these non-invasive technologies truly non-invasive? On the contrary, it seems our bodies are increasingly scrutinized, recorded, evaluated, penetrated and ruthlessly appraised (by other than traditional means). MRI, PET and similar techniques have revealed our bodies in terms of hitherto unseen detail. Whereas previously the body had to be stripped away layer upon layer to reveal its core of hidden structure, the inner body is now apparent at the quickest of glances— just as the classical anatomical diagrams (which draped a strict succession of organs, musculature and skin onto the human skeleton) are being replaced by the translucent images of computer generation: The computer-mediated milieu renders the body nakedly public. Using radiowaves and magnetic fields, this technique for painlessly exploring morphology, nonetheless raises the specter of universal diaphaneity. It conjures up visions of an all powerful observer, who has instant visual access to the anatomy, biochemistry and physiology of the patient [29].

6. Distance The issue of translucency (noted above) leads to questions of distance. Informatics and the new visualization techniques have both contributed to a minimization of

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distance itself, an alteration of bodily spatiality which changes fundamental notions of proximal relationship based on the separation of internality from externality. This has been accomplished not simply by the technological erasure of surface but by the very dissembling of bodily space as constructed by the relationship between surface and depth. The collapse of space, for instance, has become an excellent facilitator for cybersex. “Computer technologies as well as the widespread use of the internet have played a challenging role” representing both escape from the physical body and fulfillment of erotic desire [30]. In essence, depth no longer exists within us (as constructed by the new forms of visualization). As Stafford puts it: These medical technologies destabilize the already precarious borders between the exterior and the interior as they visualize the invisible [31]. The idea of distance is also invoked by the recent application of more established visualization technologies in terms of their negation of spatiality. Telesurgery involves a surgical procedure aided by exterior means: the counsel of an off-site surgeon who is in constant contact with an operating colleague via a real-time video link. Apart from its reliance on technology as an intrinsic element, telesurgery’s social importance lies in the dislocation of the surgical service itself. Here is a situation where much of the practical surgical knowledge is removed from the very person who (physically) conducts the procedure. This breaks the traditional service chain between the physician-originator of medical knowledge and the patient such that the latter may never meet the person who dictates the surgical procedure. Quite clearly then, telesurgery involves an inversive couplet of proxemic relationships. Firstly, it hermetically negates the gulf of physical distance between patient and consulting physician during the operational procedure itself. Secondly, it allows for a complete separation between the two persons in terms of their social contact before, during, and after the surgery. This second spatial turn spells far more for the patient than for the consulting surgeon who may yet reserve their right of physical access to a given medical case (patient). It is the patient who must deal with the bureaucratic and psychological consequences of a profoundly altered doctor–patient relationship wherein bodily intimacy is visually granted to the consulting surgeon yet the traditional, reciprocal right of social intimacy (direct communication) is not necessarily in evidence. While consulting physicians have complete access to the patient’s visually objectified body, the consulting surgeon(s) can remain hidden behind the screen of technological and institutional mediation. The new visualization technologies not only see the body in different ways and devise new spatial relationships to itself, but their triumphs have had a tendency to push to the side issues of a non-technical nature in the increasingly technologycentred world of leading edge biomedicine. In these terms, the new forms of visualization provide splendid sights but a shuttered vision, forging new paths of science but seeming to lack the similar progress in their discussion of the ethical and other social dimensions involved. Consequently, in spite of the advantages which such

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visualization has given us in seeing the body, other aspects of these technologies yet remain to be addressed in more conclusive terms. For example, while the noninvasive, visualization technologies used in the mummy projects of the Lewin team (noted above) finally allowed a forensic team to conduct subsurface diagnosis without disturbing the mortal remains, it remains less than clear whether or not such investigation constitutes an invasion of the dignity—never mind the sanctity—of the bodies themselves (in the terms of their cultural conception). In addition to image adjustments, the new visualization techniques have contributed to a loss of physical and conceptual reference points. Both Walter Benjamin [32] and Paul Virilio [33] have discussed at length the intervention of technology in human nature, specifically the spatial distance between the observer and the observed. Kim Sawchuk, the communication theorist, coined the term “biotourism” [34] to describe investigations of the interior space of the body, a passage from light into the dark, from the well-known to uncharted territories. For Sawchuk, this bodily passage evokes in us a longing for a time when we felt less naked, less exposed, less vulnerable. Her conception, resting as it does at the junction of current scientific research, critical discourse and popular culture, uses the authorial narrative of prowling into formerly hidden spaces—a metaphorical journey into the panorama of the bodily interior—to explore the stranger in ourselves. She adds that contemporary techniques such as MRI imaging profess a safer, less invasive means of touring within the body. This relatively benign perspective has been recently turned into an unusual aesthetic and artistic experience by Mona Hatoum whose Turner Prize exhibition “Corps e´trangers” (“Foreign Bodies”, 1994) shown at the Tate Gallery, London (1995) and the New Museum of Contemporary Art, New York (1997), featured the imagery of keyhole surgery as a camera travelled through the artist’s own body. A soundtrack of the magnified sounds of body organs was part of the video loop, while the degree of visual magnification was heightened by the position of the viewer standing over the projected image of the body interior [35] contributing to the unusual experience. Many other artists in addition to Hatoum have added their commentary to the growing artistic discussion of the new visualization technologies. In the next and final section of this paper, we will examine some of them as a way of coming to grips with the new visualization technologies.

7. Art and the visualization technologies

We are a culture consumed by medicine. The patient is a consumer of medicine, who also is in a metaphorical sense consumed. Due to advances in information and visual media technologies the penetration of biomedicine into every aspect of our daily life became much more accessible and at the same time more intimidating, more mysterious [36]. The range of social discourse drawing upon recent advances in biomedicine is

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considerable. Readings of popular culture often include references to the new visualization techniques themselves. In the medical profession, however, the critical discourse by artists working with scientific and biomedical concepts is little recognized. This dimension to the relevant commentary is of some importance. In contrast to scientifically trained personnel concerned with the narrowed rigour of their professional disciplines—artists generally work within a broader context and seek to make connections between seemingly disparate areas of human activity on a larger scale. They embrace aspects of life experience such as action, memory and sensation, seeking reciprocity between art, creative power and (in this case) biomedicine. Artists often foreshadow the message of societal, cultural and technological developments well before the impact of social transformation actually occurs. What can they tell us? By the terms of its very nature, the notion of Art incorporates the dimension of spectacle—most often that of its most public variants in the sense of exhibition and audience forming an intrinsic part of the aim of expressive activity. The relationship between mediated, visual representation and medicine is one of long and intricate standing. From films, through videos, to art installations and variously appropriated medical images, the moral and ethical aspects of recent advances in biomedicine ranging from the treatment of HIV/AIDS to cloning—have all been challenged and provocatively interpreted by contemporary artists. While this discourse on the objectification of the human body is discussed and represented in traditional art forms, it has also become a subject of special concern in multimedia forums and net-based projects. It is impossible to fully enumerate the expanding list of internationally known artists and artistic events dealing with biomedical aspects within the scope of this paper. However, in the interests of the present discussion, we would like to highlight a few points related to artists whose work is directly pertinent to the issues at hand concerning the exponential growth of biomedical visualization technologies and their consequences. While the presentation and interpretation of medical images has an established history in the arts, a new trend has emerged of late, one which veers away from perspectives of surface to focus on the general theme of the human body itself— particularly as seen through the history of medicine or under the light of the new visualization technologies. The trend involves what might be called the “direct representation” of appropriated biomedical images, organs and bodily performances. The 1996 “Beyond Ars Medica: Treasures of the Muetter Museum” show exhibiting medical specimens at the Thread Waxing Space, New York serves as an illustrative example in this regard [37]. This unusual presentation of objects included both pathological and anatomical artifacts: medical instruments, bones, archival drawings, photographs and a variety of documents. Drawn together, these objects articulated distinct professional perspectives on the body and successive technologies for viewing it as a separate architecture of the corporeal, an artifact quite separate from the sentient person since objectified by medical science. Although the Museum was established in the middle of the 19th century for purely educational purposes, this exhibition had another dimension: that of popular spectacle in the sense of a viewing

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public interested in the aesthetics of the pieces on display as well as in their intrinsic meanings. Individual artists take a different, and far more personal tack. They often use their own bodies to emphasize the intellectual discourse on current issues surrounding biomedicine. In addition to Mona Hatoum (noted above) some of the best known artists in this category are Orlan, and Stelarc, each of whom has chosen to directly engage with the new technologies of the body (visual and otherwise). Since 1990, the French performance artist Orlan has undergone a public series of plastic surgeries in order to alter her face, in order to fashion a new being and to create what she terms “Carnal Art”. Orlan is not her given (birth) name but what can only be considered an artistic pseudonym taken on in reflection of the artificiality of her changing features. The main questions which this act of will symbolize, rest on the cognitive parallel between body and identity. To what extent is her todayface her real face? Have these bodily alterations changed her relationship to herself in terms of primary identity? Conducted as performance art, the surgical operations have been guided by a computer-generated image to which her face is (re)cut. In many ways, the deliberateness, precision and irrevocable conclusiveness which she invests in the process of her surgeries is entirely consonant with the subject matter of her artistic themes; for Orlan is specifically interested in those advanced biomedical technologies that question the very status of the human body as a corporeal ‘given’. In her work she challenges concepts of selfhood and questions the status of the body versus current biomedical technologies of transformation, temporary and otherwise. Not surprisingly given the commercial imperatives which hover throughout the technologies under her consideration, Orlan also markets films of her surgeries as well as (preserved) body parts labeled: This is my body this is my software [38]. These products of seemingly fundamental bodily self not only satirize the commerciality of biomedicine but also bring into the foreground the issues of post-modern interchangeability. Like the idea of indistinguishable “non-places” (cash-machine kiosks, airport terminal lounges, etc.) postulated by Auge [39], will the human body become but a question of paltry experience without a determined sense of (bodily) identity? By replacing several of its functions, the flesh-body might become obsolete or is already obsolete. This notion is argued by Stelarc, the Australian performance artist whose current work focuses on the “post-biological body and its relationships to cyberspace”. While his Ping-body performance has utilized the internet as an energy source (in electrical connection with his body), it is the artist’s ‘Stomach’ performances which are more relevant to this paper [40]. In the ‘Stomach’, Stelarc inserts a micro-camera into his mouth, slowly lowering it through the passageway of his esophagus and into his stomach. The vivid, living images captured by the camera are simultaneously projected onto a large screen seen by the audience. This performance has been categorized by a recent commentator as one of artistic sacrifice, for:

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The inside of his body offered itself to the artefact which transmitted the picture of the internal spaces of his body with the help of video technology. So, there are no secrets left anymore [41]. “Possessed”, the installation by Louise Wilson [42], takes a different tack to our relationship with the body. It does so by way of linking art with artist through the experience of medical research itself. In order to obtain her primary material while reaching deeper into medical processes, Wilson has volunteered herself as a test subject for biomedical research and thereby gained access to her own body in terms of the new visualization technologies. The installation subjects the viewer to a visual panoply of both MRI and PET images of the artist’s physiology as linked with an audio component. Like her oeuvre as a whole, this work seeks to convey the perceptions gained in the course of her experiences. At the same time, it makes the pointed suggestion that just as increased specialization means greater isolation and subdivision of knowledge, the imagery of the medical industry becomes more and more removed from its human context. The sense of separation which is the result of such technology is closely paralleled by two of the primary emotions which patients experience in the course of contemporary medical treatment: alienation and anonymity [43]. It has been suggested that, in addition to anxiety, in an investigation of authenticity there exists an implicit eroticism which is contained in artistic works dealing with the newly forming spectacle of the body [44]. John Baturin has been using external and internal images of the body as metaphors to investigate how truth is constructed [45]. How do we manipulate images, data, bodily facts? How do we manipulate the truth of ourselves as socially constructed individuals?—he asks. In his series Enemies Within, Baturin seeks to evoke these issues by his depiction of bodily arbitrariness, feeling that such provocation by artists calls into question practices that are both political and scientific, and that might involve cultural dimensions. The multimedia artist Nell Tenhaaf has been deeply involved in what she sees as an uninvestigated link between the rarified arena of science and that of popular culture at large. “Artists . . . ” says Nell Tenhaaf, “can bring a broader framework to scientific research to counterbalance the very strong bias that has been shown to genetics” [46]. In her opinion there remains a critical need to find a greater area of common language with scientists—an act or process of exploration which she considers a mutually informative action. In her art, as in her textual work, Tenhaaf has sought to play a key role in this process: I’m trying to make sense of contemporary science and its burgeoning technological infrastructure. As an aficionado in this domain, I feel regularly bombarded by specialized information, that usually has a science fictional and even apocalyptic ring to it [47]. While the body itself might be obsolete in the opinion of doomsayers such as Marilouise and Arthur Kroker [48,49], or we might already be cyborgs, fabricated hybrids of organism and machine as suggested by Donna Harraway [50], the value of human

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existence remains supported by others such as Kathy Ackers [51]. The relative truth of this philosophical tension may very well lie in the middle ground between these two perspectives. To quote Roy Boyne in his article “The Art of the body in the discourse of post modernity”: If the separation of the subject and object was the achievement of the age of reason, and the de-subjectification of the world was the secret of modernism, then post modernism marks the return of the subject [52]. But we might add: virtually dissected, fragmented, fractured, scrutinized, packaged and when necessary reassembled. Among the questions which remain, how will we reconcile this newly formed human body? How do we accommodate the digital spectacle? In spite of the argument elaborated in our discussion above, is there any hope for a humanizing of the new visualization technologies increasingly used in leading edge biomedicine? Researchers and software companies have invested a considerable effort to develop software agents and digital proxies on our behalf. It is thought that these agents will appear as “living” screen entitites rather than the commonly used icons of today [53]. For example, the ALIVE system developed by the MIT Media Laboratory, “allows, wireless, full body interaction between a human and a rich graphical world inhabited by autonomous agents” [54]. It illustrates how digital tehnologies have contributed to a dramatic change and a new affinity in the relationship between humans and machines. The resulting sense of intimacy is reinforced on a thoeretical level by experimental theories which claim that consciousness is an electromagnetic component of ionic currents generated by the human brain in the course of its functioning. Curiously some of these holistic theories have historical antecedants; many of them can be traced back to the turn of the century and Nicola Tesla’s [55] studies of electromagnetic energy and its relationship to human consciousness. It remains to be determined what is the true significance of increased visualization in the medical sciences and the use of “artistic” scientific images by the industry. If it is true [56] that a key switch from modernism to post modernism involves a shift from epistemology to ontology, from knowledge to experience, from theory to practice resulting in a replacement of the plurality of interpretation by the investigation of multiple realities—then who better than the contemporary Artist to interpret the future?!

Acknowledgements The authors wish to thank James Leach and Jeremy Squire for their comments on ideas expressed in this paper. Nina Czegledy would like to express her thanks to Sean Cubitt for his support. Andre´ Czegledy’s contribution is indebted to Marilyn Strathern for her established commentary on medical technologies.

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