Uniqueness and Novelty in Phenomenological Inquiry

Illustrating Insights: Antenatal Ultrasound Imaging

Phenomenology as a collection of “qualitative” methods orients to inceptual experiential meanings as they are embedded and arise in human existence. Let me give a concrete example with the experience of antenatal ultrasound. Antenatal ultrasound is the common medical practice of prenatal imaging using sound waves to “look through” the pregnant body. Ultrasound imaging is routinely offered to pregnant women in North America as part of normal obstetrical care. While early scans may be conducted to assess viability or confirm dates, it is the ultrasound exam centered at 18 to 20 weeks gestation that is performed to look for progressions and potential anomalies. A mother recounts her experience of this medical procedure:

The technician and I looked at the screen while she was sliding the probe across my belly. I knew that this was supposed to be one of those magic moments of pregnancy, a chance to see my baby. However, I could not really make out the contours of the baby that the technician was pointing at. She was pleasantly chatty: “Here is the head. Here the legs. You can see the hands next to the face. Do you see? Oh, wait a minute . . .” Then the technician turned silent. I realized that she saw something, and I am not really sure that she knew what she was looking at. She just kept taking more pictures. I kept staring at the last still picture on the screen: a dark blurry image. Is that my baby? Next, without saying anything, the technician left the room, and shortly after came back in again, only to take more and more pictures before leaving and returning again.

I was totally confused, as she said, “You can get dressed now, your doctor will discuss the results with you. He should have the report by tomorrow. Phone his office. He should be able to see you right away for something like this.”

I walked back to my car outside the hospital. What could I tell my husband? How will I be able to sleep tonight? Already waiting for the doctor tomorrow seems like an eternity. As I opened the car door I cried uncontrollably.

The lived experience description by this pregnant woman is unique in two senses. It is unique in the sense that it is the experience of this particular woman. Every experience always uniquely belongs to a particular person. And it is also phenomenologically unique in that it differs essentially from other diagnostic medical tests and procedures.

But the reader may first be touched by the psychological, emotional nature of the story. Quite apart from the qualitative methodological question, the woman who tells her story must be listened to. It turns out that her ultrasound experience is far from “magical,” as she had hoped. If this were a qualitative perception study, or a qualitative study employing life stories, or a qualitative case study, or a study of hospital procedures, then the researcher might be primarily interested in turning to the expectations, confusions, anxieties, uncertainties, disappointments, emotions, and stresses experienced by this particular pregnant woman in this specific hospital.

And yet, the confusion, anxiety, pain, and worry expressed in this story are not the immediate topics of phenomenology. Phenomenology is interested in the second sense of uniqueness. It wants to understand what are the unique aspects that belong to the phenomenon of the ultrasound experience? What is the experience of ultrasound in its distinctiveness that makes it possible to use emotive language to describe it? How is the experience of ultrasound singularly unique?

Actually, the experiential account of the expectant mother offers several potential topics for phenomenological reflection: There is the primal experience of the ultrasound technology. The ultrasound lets one see on the screen the pre-born infant inside the womb of the mother. What is it like to have this audio-visual technology-mediated experience? Then, there is the experience of diagnosis. What is it like to experience a (protracted) diagnostic judgment? And, there is the phenomenology of waiting, waiting for a medical diagnostic outcome. What kind of waiting is this?

For the expectant parent, ultrasound provides visible proof that a baby is in there! The audio of the scan can fill the room with the sound of a baby’s heartbeat. And of course, the ultrasound imaging offers the first possibility for the parents to actually “see” or perceive the screen image of their child.

The ultrasound operator may even be able to discern whether it is a boy or a girl, and then share this information at the parents choosing. The phenomenologist Peter-Paul Verbeek (2008) describes the modality in which an ultrasound shows the fetus as individuating. Whereas the mother’s womb and the fetus are still an integrated physiology, the ultrasound breaks through this unity:

Ultrasound imaging constitutes the fetus as an individual person; it is made present as a separate living being, rather than forming a unity with its mother, in whose body it is growing. (p. 16)

Verbeek suggests that the phenomenology of seeing the child’s image inside the womb has an experiential effect on the relation between mother and preborn child: They become individuated and separated. For the medical professional, too, the mother becomes an environment and the infant a patient by virtue of the mediation of the medical ultrasound technology. Yet, ironically, the obtained fetal images may appear stereotypical rather than necessarily identifiable as the parents’ child in his or her uniqueness. For example, the popularized image of the fetus, often described as a child’s “first photograph,” is far from a detailed likeness of the fetus’s actual face. Instead, two-dimensional ultrasound produces the fetal face as a profile, an outline of scalp, forehead, nose, mouth, and chin, complemented by the shadowed features of the brain, tongue, and other interior structures. Still, the pregnant mother may have a hard time actually making out the infant on the screen. For the expectant mother, discerning the fetal details of the ultrasound image is not necessarily easy or intuitive. Shaped by the processing of the echoing pulses of high frequency sound waves, the picture on the screen may appear as resembling a snowstorm or a haze to the untrained eye. And so, when something unexpected is observed, as in the account of the mother above, we realize that there is more to this technological mediation.

The phenomenological insight of this account is that although the ultrasound individuates the fetus—brings forth the fetus as a child—the technical experience of ultrasound imaging turns out to be relational in an enigmatic sense. Ultrasound imaging is an experience of someone rather than something looking inward such that the experience of ultrasound imaging is also an experience of seeing the sonographer and indirectly the presence of the child (who may be healthy or in trouble). When an anomaly or other medical issue is identified, ultrasound imaging is revealed in its sociality, temporality, and diagnostic complexity.

And so, the ultrasound experience may also be the experience of a certain kind of medical diagnosis. The term diagnose means “to know thoroughly, to distinguish, discern, determine” (Klein, 1971, p. 209). Ironically perhaps, an ultrasound diagnosis involves literally seeing through the body to the interior parts. While in the above situation, the technical procedure of the ultrasound was not meant to be a formal diagnosis yet (from the point of view of hospital or clinic policy); nevertheless, the mother experienced the procedure as wanting to know (diagnostic). She well may have said, “they did not tell me anything.” The phenomenology of medical diagnosis is a modern and technological kind of experience that underscores the highly developed technological nature of modern medicine. A diagnosis yields “knowledge,” and the patient wants to “know” with some kind of certainty what may be wrong or anomalous. Indeed, the overriding concern and worry of new mothers (and fathers) is that the baby is all right.

Another phenomenological aspect of the above lived experience description is “waiting” for the diagnostic result. A phenomenology of waiting can easily become the focus of a major study. Waiting is a temporal experience. We may experience several kinds of waiting: Waiting for the elevator is different from waiting for a flower to grow; waiting for rain to replenish the garden is different from waiting for a child to learn to tie a shoelace. Some kinds of waiting can be calculated while other waiting is subject to contingent and chance factors. We can influence waiting for a child by helping and teaching the child how to tie a shoelace. So, what kind of phenomenology of waiting is part of the ultrasound experience—waiting to speak with someone who has consequential knowledge about your child?

People may respond to waiting for the diagnosis of what is unexpected in a myriad of ways: anxiety, fear, confusion, denial, or indifference. And a diagnosis may be given with more or less certainty, understanding, and certainly sensitivity. Yet, regardless of a patient’s emotive response and how the waiting for a medical judgment is experienced, the essence or unique meaning of “waiting” as a phenomenon or event is not dependent on emotional reactions. The meaning of waiting for a medical outcome is a phenomenological topic in its own right. A phenomenology of ultrasound aims to understand how the ultrasound is experienced in its meaningful, relational, technological, and unique aspects; this is also true for a phenomenology of waiting, and for a phenomenology of diagnosis. These could be approached as separate but intertwined medical phenomena for the patient and also for the medical practitioner.

The lived experience description and reflections above show that the meaning of a phenomenon is embedded in the experiential givenness of a phenomenon or event such as the ultrasound experience and that this meaning has to be reflectively recovered. This recovering of meaningfulness of lived experience is the accomplishment of phenomenological inquiry. Indeed, the entire purpose of phenomenological method is meaningful insights, which may assist the medical professional in the conduct of medical practice. So, to reiterate, researchers interested in ultrasound experiences could certainly take other approaches to explore the practice and experience of prenatal ultrasound imaging. Narrative methods could reveal ultrasound experiences in a storied way within the richness of individuals’ lives; ethnographic inquiry could focus on social and scenic languages and expressions that shape cultural stories; perception studies could explore the views and opinions of patients with regard to ultrasound policies and practices in hospital settings; and so forth. But the orientation of phenomenology is to reflectively explore experience in its originary experiential givenness.

Concluding Thoughts

Phenomenology as a form of human science inquiry thrives on its relationship to established and contemporary philosophical traditions of the various phenomenological movements in which notions such as “lived experience,” “prereflective and reflective consciousness,” “lifeworlds” have been developed and deepened. The works of philosophical figures such as Husserl, Heidegger, Merleau-Ponty, and Sartre, and of contemporary writers such as Nancy, Casey, Lingis, and Serres, continue to be studied and further developed in the tradition of phenomenological movements. A reader of these phenomenologies and phenomenologists will quickly realize that as a tradition, phenomenology cannot help but continually return to the question of its own beginnings to discover and articulate anew how meaning originates in its existential inceptuality. From this perspective, phenomenology constantly rediscovers itself anew to unsettle its established truths. And as readers engage with such writings, it may become clear that the margins and divisions among phenomenologists are not always clear-cut, just as the distinctions between phenomenology as a form of human science inquiry and phenomenology as a philosophical tradition are intertwined.

And yet, we need to recognize that the purpose of phenomenology is to explore the existential or inceptual meaningfulness of human experiences. Qualitative reflections are ultimately drawn from an engagement with descriptive experiential material such as an account of ultrasound imaging. Concrete material is the ground of phenomenological inquiry. Researchers working with concrete descriptive material will recognize the importance of working with interviews, observations, and other sources of experiential material to develop novel insights. In this way, the ground of phenomenological inquiry is always already uniquely innovative, and yet, it is this ground that is a source for reflection.

Those who pursue phenomenology in the name of professional practice seek to gain insights into the meaningfulness of human experiences “to contribute to more thoughtful practice” (van Manen, 2001, p. 458). As professional practitioners, we recognize that others such as our patients, students, children, and families are all unique with varied life experiences, predicaments, core values, and so forth. The nurse, doctor, teacher, social worker, or other caring professional needs to be sensitive to the variety of ways that these others may experience their worlds. In other words, practitioners need to be other-oriented to reflect and wonder what lifeworlds may be like for the individuals who dwell in them. Our contemporary society appears dominated by a preoccupation with the self—witness the present popularity of tweets, selfies, blogs, and other auto-activities. As researchers, we have a responsibility to look beyond our “selves” to the worlds of others, the others we serve.