Abstract
Joy Fuqua’s and Kirsten Ostherr’s recent works on the role of television (TV) within medical cultures are examples of a new generation of medical humanities scholarship that has become increasingly interdisciplinary in its attention to the manifold media practices that can inform medicine and health. Studies of this kind, following quickly on the back of Joseph Turow’s Playing Doctor (2010), another monograph on the role of TV in representing the socio-politics of medicine, offer fascinating new contextualizations of the place of TV within particular kinds of institutional space. In doing so, they not only enrich TV studies but also make a valuable contribution to our understanding of the mediatization of medicine.
Kirsten Ostherr’s Medical Visions offers an extraordinarily thorough and extensively researched assessment of the role played by medical film and TV through the 20th and 21st centuries. Her thesis is that in film and TV we can uncover the evolution of a series of medical ways of seeing, which have been obscured by an overwhelming focus, in medical humanities scholarship, on issues of narrative. To focus instead on visual culture is, for Ostherr, a different way of asking how medicine and culture give each other meaning as well as revealing interesting alternative influences on patient–physician interactions. These are urgent questions, since such visualizations of medicine ‘continue to shape our expectations for the preventative and curative effects of medical media interventions’ (p. 25).
Ostherr presents such a range and number of film and TV examples, all admirably synthesized and aimed towards her key arguments, which becomes clear that here is a story that is fresh, unique and long overdue. It is a narrative that moves chronologically from medical film-making’s earliest days in the 1920s via contemporary medical reality TV and finally to engagements with medicine’s second screen in online environments. Ostherr’s dense historical scholarship is one of the most impressive aspects of the book, and if there is a tendency towards describing that history rather than theorizing its significance at times, that is entirely understandable given the amount of new material with which she is working. What is clear, certainly, is that Medical Visions is going to be a pivotal book for anyone wishing to research medical TV, most especially in the North American contexts on which it is almost exclusively focussed. Certainly it puts comparable works on medical TV in the shade: making, for example, Jason Jacobs’s book on British medical dramas, Body Trauma TV (2003), look slight by comparison.
The first two chapters (of six) focus on medical film-making in the pre-war period. Ostherr shows how film-makers, a mix of film industry professionals and medical experts, attempted to negotiate the tricky balance between scientific objectivity and entertainment. Different forms of medical visualization were employed to achieve this: live-action film, animation and illustration all formed part of the corpus of medical film-making in the 1920s and 1930s. Valuably, Ostherr shows how an increase in the visualization of the human body – which may have been expected to lead audiences to better understanding of the body’s operation – actually led to a greater disconnect between the film and its audiences (not ideal in medical education). For Ostherr, this effect was due to the loss of a recognizable human subjectivity in the close visualizations of the human body: ‘the more fully the body is visualized,’ argues Ostherr, ‘the more distant the patient’s subjectivity seems to become’ (p. 80).
Later chapters consider medical TV of the kinds that are perhaps most familiar to TV scholars: late 1960s dramas and documentaries experimenting with different stylistic tropes from realism to surrealism. Ostherr ties the emergence of medical TV to the birth of the mass-mediated consumer-patient (p. 153). Through an extended set of examples, Ostherr argues that these TV shows illuminate the ‘politics of medicine’ and its influence in post-war medical-visual culture. The argument rather languishes in a lengthy survey of 1970s and 1980s realist medical dramas, but does return with some strength in a concluding chapter dealing with medicine and the Internet.
This final substantive chapter looks closely at medical reality TV and associated and adjunct Internet sites. For Ostherr, the new phenomenon of ‘socially mediated medicine’ (p. 202) fundamentally changes the clinical encounter by providing alternative spaces where medical information might be shared and contested. This is the keynote to the book’s final sections, which highlights how modern medicine’s visual culture has radically changed the hierarchical structure of medical film-making, where it had been the role of the professional medic to teach the ignorant layperson and thereby also to control how medicine is mediated and received. Ostherr concludes that the lack of restriction on medical data now leads the scholar to ask very different questions of medicine’s visual culture than they would have done of film and TV only a few years ago.
Ostherr’s medical humanities approach to her subject is enriching. Her historical sensibility, which led her into the archive and give the book its depth and character show how much can be done to contextualize contemporary TV and what new insights can be gained by undertaking that work. Having said that the book does have its weaknesses. Most striking is the inadequate assessment of imaging technologies themselves. Whilst Ostherr claims that her work on digital cultures should be seen as an examination of imaging technology, it is a detailed interrogation of the meanings – as well as the cultural and clinical significance – of medical imaging tools such as functional magnetic resonance imaging (fMRI) and computed tomography (CT) scans that is expected of a work that includes imaging technologies in its title. It is striking, then, that there is no such examination of the kind that Catherine Belling (1988) does so well in her article on The Operation (1993–2001), tellingly omitted from Ostherr’s bibliography. Additionally, the book does at times fall into describing rather than analysing the films and TV programmes that it discusses. These criticisms should not, however, detract too much from what is a rich and valuable study which TV scholars will find provocative and productive.
By contrast, Joy Fuqua’s Prescription TV is more problematically ahistorical, yet also more provocatively political. The focus of Fuqua’s creatively conceived book is primarily the TV within spaces of medicine – hospital rooms and doctor’s offices, for example – but also the medical infotainment received via the TV in domestic spaces. As Fuqua writes in her introduction, the keynote of the book is ‘that TV has been critical to three key transformations in the rise of the medical marketplace: the deinstitutionalization of the hospital, the medicalization of the home, and the development of what I call the consumer-patient’ (p. 3). Fuqua explores this triumvirate across a lengthy, sometimes anecdotal, introduction, followed by five discrete chapters. In turn these deal with hospital entertainments prior to the era of TV, TV within the modern hospital, the spaces within which TVs function in hospitals, broadcasting aimed at patients and medical commercials (with Pfizer’s advertisements for Viagra as a case study). Whilst the first two chapters appear to be historically oriented, the pre-television era is conceived of as only post-World War One, indeed largely the 1920s onwards, whilst the second deals almost exclusively with the 1950s and 1960s via the professional periodical The Modern Hospital. Thereafter, the chapters tend to focus attention very much on the contemporary period of the late 20th and 21st centuries.
There is a great deal that is entirely original in Fuqua’s analysis. Indeed, as she points out, no scholarship has dealt specifically with TV in hospitals, preferring instead to focus on hospitals depicted on TV. The careful work of the first three chapters proves how valuable an approach this is: time after time fresh nuggets regarding the placing of TV within particular hospital spaces, or TV’s use as a monitoring device within patient rooms (in a very Foucaldian reading, admittedly) emerge from the close examination of hospital records, architectural manuals and administrative publications. The rich data allow Fuqua to ask a series of important questions about the therapeutic role that TV might have played in the history of institutional medicine as well as its use as a medium of control and subjugation.
One downside to what are a series of very rigorous arguments is the growing sense of the huge differences between healthcare in the United States (Fuqua’s sole focus) and its equivalents elsewhere in the Western world. It becomes increasingly apparent to a British reader that the analysis Fuqua offers is simply not translatable. The various descriptions of TV within patient rooms (single rooms!) or being watched by a group of patients and medical staff (together!), or even being used to order additional hospital facilities (facilities!) is so far from any experience of the National Health Service (NHS) as to be nothing but contrast. Fuqua might have considered a UK hospital as a way of thinking through the uniqueness of the hospital cultures she depicts: there is no recognition on her part that she might be representing a special case nor that the US healthcare system is in any sense unique. Certainly, it would be interesting to see a counter-study with a focus on British and European healthcare. At the same time, however, Fuqua’s critical engagement does allow for a politicized analysis to emerge that is much more familiar to British scholars of both TV and medicine. She asks important questions about access to health and medicine, about wealth and health and about the political will of the US government to ennoble or to monetize healthcare.
Unfortunately, the second half of Prescription TV does not match the strengths of the first. As Fuqua turns to the consumer-patient, so the originality and specificity that marked the three opening chapters give way to vagueness and a mystifying historical amnesia that undermines Chapters four and five. The key problem here is that Fuqua seems to believe that her construction of the patient as a consumer of medicine (via TV) is new. ‘Consumer-based advertising from pharmaceutical companies began in the 1980s’, she argues at the start of Chapter four (p. 97), ignoring the extensive work that historians of medicine have done on advertisements for various medicines across the 19th century. The evasion of the long history of patients as consumers entirely undermines Fuqua’s claims to be doing something original in these last chapters. Yet it would only have enriched her analysis to be able to provide a longue durée view that was brought into the present with a consideration of TV marketing. It is a disappointing end to a book that had begun with panache and verve. Luckily, the conclusion – with useful insights into the role of the body and the self (pp. 141–143) and a fascinating (although far too brief) consideration of body makeover reality TV – brings about a certain equilibrium and returns to the form of the opening chapters. It reminds us that this is a work of some excellent scholarship, marred by inaccuracy and a failure to attend to the past. It does, though, make for a balanced pairing with Ostherr’s more carefully contextualized, but less explicitly political analysis.