Some three months ago I got involved in a conversation with colleagues at the University of Bologna about medical humanities grants and, in relation to those, about the possible contribution of media studies, and television in particular (if allowed, not to mention, approved of), to the research on the cultural iconography of medicine.
What sparked off this conversation was a message a friend of mine posted on their Facebook timeline: it said that their application for a medical humanities research grant was rejected after the evaluation board ruled that ‘questions [had been] raised as to whether TV programmes can reasonably be used as accurate indicators of shifting attitudes’ of the public towards trends, practices, and policies in healthcare providing and medicine. Needless to say, the question whether or not television as cultural production is ‘an (in)accurate indicator’ of social reality, that is, of shifting discourses and controversies surrounding a number of issues including healthcare, generated a lengthy thread of comments. Some were rather instinctive and vehement, some, after a careful assessment, tried to offer constructive advice, and some voiced stoic resignation, sarcastically proposing that ‘we (i.e. media studies scholars) all should just give up and go home…’
Of course, this is not the place to assess the policies and preferences (academic or other) underlying the awarding of research grants, nor is it my purpose to engage in a gratuitous polemic by replicating the discourse on the socio-cultural impact of television. Medical humanities research does incorporate specific methods and findings of work done on audience studies, cultivation and performance theories and participatory culture to account for the ways medical reality shows, docu-dramas and fictional representations influence doctor-patient interaction, and to assess the educational and information value of these programmes. In an article, for instance, Brian L. Quick writes about the ‘role of entertainment programmes in cultivating patients’ predispositions about medical doctors’ (38), and analyses the correlation between the viewing of medical dramas, doctor’s perceived competence and patient satisfaction. It seems to me that in most approaches to the subject-matter, the emphasis falls on the explication of what directly translates into educational and information value, on factors that produce currency for therapeutic practice, communication, and policy making. What seems to be slightly overlooked, however, is the cultural impact of television AS television, the ways the much discussed televisuality contributes to the (de-)construction of the – yes, I will write that down – somewhat self-inflating Myth of Medicine. By and large, medical dramas present doctors in positions of power and authority. But, ironically, criticisms of inaccurate and unrealistic portrayals of diseases, procedures, policies or codes of conduct inadvertently re-inscribe forms of separation into the discourse on medicine: these criticisms perpetuate ideas that access to medical knowledge is subject to initiation, and end up cementing real-life doctors in the very same positions of power and authority.
The initial context, therefore, necessitates not so much the re-thinking of what television studies can offer for the medical humanities, or how the space within which the study of television unfolds could be negotiated. Rather, it prompts us to ask (again) the somewhat naïve and obsolete questions – what is medical television really, and what does its study amount to? How do we negotiate the impact of, and engagement with, popular representations of the medical profession and its socio-cultural and political contexts? What is the specificity of these programmes? Are they just another conglomerate of interrelated genres, themes, codes, registers and styles, or do they stand out in some peculiar way?
Beyond doubt, medical and health related content broadcast on television has always been a sure winner as regards (relatively) high ratings and popularity. Medically oriented programmes come in multiple forms, and have a history almost as long as that of television itself. Their educational, informative, and entertainment values might vary to a great extent. But their persistence, diversity and impact can (and should) be regarded as an indicator of medicine being not only science and practice, an ‘art’ (of healing), a composite of techne and episteme in its own right that has always excited the minds of the public, but also an effective conduit for the social and political structures and controversies of a given historic time. In other words, images of illness and disease, and the ‘language’ of medicine are particularly conducive to the ways political power exerts itself, and to reflections on socially sensitive topics like questions of subjectivity, otherness, altruism, hospitality, gender and race, poverty and power, and individual and collective responses to trauma, to name just a few. This is, of course, not something that television invented, but it is something the television of the 21st century can successfully capitalise on. To borrow the arguments of McGowen (677), just like the human body, the figure of the physician has also been prone to constant symbolisation and re-appropriation in a political sense. Foucault in the Birth of the Clinic writes that ‘the first task of the doctor is […] political’ (38). Reversing this logic, Evans et al. accentuate the significance of the ‘introduction of suggestive metaphors’ in the construction of symptom, diagnosis and patient (2). And in a recent book, Kristen Ostherr emphasises that the purpose of medical humanities education and research is precisely to ‘foster habits of discourse on social and moral issues in medicine’ by ‘drawing on literature, religion, ethics, philosophy of medicine, film, history, social and cultural anthropology and jurisprudence’ (7). Consequently, the relevance of medical television in this regard would reside in its ability to effectively engage with specific aspects of the therapeutic process, offering insight into the ways in which the doctor and the patient are produced within the medical apparatus.
This engagement, paradoxically, imposes an apparent constraint on the programmes: the imperative to adhere to specific codes of verisimilitude, or at a minimum, to create a simulacrum that accommodates viewers’ needs to be provided with authentic content while being entertained. How ‘realistically’ these shows present diseases, procedures, doctor-patient interactions, technologies and institutional structures still counts as a pivotal factor in assessing their impact. There appears to be a correlation between the quantifiable popularity of a programme (ratings, the size and activity of fan base, etc) and its perceived credibility, which, retroactively, influences production modes as well: Ostherr writes that, for instance, ‘the medically accurate narratives that offer compelling storylines’ of Grey’s Anatomy (ABC, 2005-) and House (Fox, 2004-2012) owe their lasting popularity, at least in part, to successfully blending education, information and entertainment (212).
But what does authenticity imply? How do we negotiate the apparent discrepancies between the educational ambitions of these programmes, and the fact that, in the end, they present fabrication (Brodzinski, 174)? Upon closer inspection, one realises that fictional dramas and medical reality programmes these days appear to be much closer to one another in regards to their underlying iconographies and compositional logic. The uncanny resemblance between the head surgeons of the docu-dramas Casualty 1900s (AKA London Hospital, BBC, 2006-9) and The Knick (Cinemax, 2014-), or the ways in which the screen identities of the doctors of the medical reality programme Hopkins (ABC, 2008) are constructed so as to ‘mirror’ specific character dynamics of Grey’s Anatomy (ABC, 2005-) as their more credible, real-life counterparts, are just two examples of practice. Although Grey’s Anatomyand House are cited as fictional, heavily stylised dramatisations mobilising specific sets of narrative and representational codes and a compositional logic that pioneers transgression and stylistic excess, it would also be relatively easy to identify similar traits in medical reality programmes like Hopkins (ABC, 2008), Boston Med (ABC, 2010), Embarrassing Bodies (Channel 4, 2007-), or Keeping Britain Alive (BBC, 2013-). Just like medical dramas, reality programmes also ‘uphold the supremacy of the clinical practice’ and ‘reinforce the doctor’s centrality and authority’ (Brodzinski, 174). We are presented with physically appealing doctors and images of high-tech machinery and spectacular advanced procedures. Doctors and patients alike constantly give testimonies by voicing their experiences. Like Grey’s Anatomy or House, these programmes construct the identities of doctors via showcasing their skill, determination, empathy, courage and innovative attitude, which is achieved by almost exclusively presenting extreme and serious cases of illness, and complicated procedures like organ transplants, cardiothoracic, or brain surgeries. The creators ostensibly also factored in the unpredictable and the uncontrollable, in the form of small accidents (blood sprinkles into the eyes of Dr. Quinones-Hinojosa while performing brain surgery), and minor glitches (in the organisational structure of OR-management). These elements all ‘enhance the impression of unscripted liveness’ (Ostherr, 193), but in actuality they render these shows more akin to fictional dramas rather than to documentaries.
The resulting depiction is what I would call perceived objectivity. This becomes apparent when one compares the ways reality programmes and fictional representations accommodate viewers’ presumptions and expectations, and offer narratives of disease that culminate in (and conclude with) the patient’s recovery, or, at a minimum, the mitigation of their condition. Both formats are heavily reliant on the thematisation of closure, a therapeutic solution that, although containing a potential element of risk, still offers a calculable outcome. And although House constantly subverts the linearity of the ailment process by its repeated recourses to differential diagnoses and experiments with diverse therapeutic solutions (that more often than not endanger the life of the patient), the product of this somewhat sadistic guessing game is almost always a triumphant rehabilitation of medicine – and of the patient.
Consequently, reality programmes seem to be better equipped to see viewers’ hopes and fantasies of closure fulfilled. The compositional logic of fast paced narrative, filmed usually with a hand-held camera reminiscent of the cinéma vérité style, or the appearance of real-life doctors and patients on the screen make it easier for the viewer to attribute more realism to these shows, and to identify more easily with the characters on the screen (cf. Ostherr, 202). But while reality programmes are much more confined to a linear, relatively straightforward presentation of cases, their fictional counterparts have the ability to render the complexity of illness, therapy and the dynamics of doctor-patient interaction in a more engaging albeit fictional and dramatised fashion due to their more flexible and more expansive narrative structure.
To paraphrase the words of Bran Nicol, television ‘does not function as a kind of second-order process of reflecting and recording what goes on in the wider world, but [it] actually intervenes in everyday reality and helps shape it’ (3). Therefore, I believe that perhaps it would make sense to shift the focus of attention from appeals to ‘realism’ and degrees of credibility to the repositioning of authenticity; an authenticity that is predicated on the logic of supplementation: where the question is not whether or not medical television is able to faithfully re-present a reality external to it, but rather whether television is capable of conveying and recycling in an accessible manner the complexity of the underlying scientific, technological, ethical, social, and therapeutic aspects of medicine. Put differently, authenticity would reside not so much in adhering to the requirements of an objectively verifiable documentary realism (which, we know, is never possible anyway (Grierson) but rather in the ability to find means (a poetics of formats, registers, modes) to render the ethos of medicine in a given historic moment in ways contemporary audience can relate to. Rather than thinking of how representation informs our perception of medical episteme, then, we should think of how the interrelation of medicine and television can generate authentic representations that unravel key discourses in medicine. The problem of the authenticity of representation is therefore an ethical one. For a long time television was posited as extraneous to medical discourse as a mere conduit for episteme. The consequence of these conceptual changes is the understanding of television as a medium that also produces, not just circulates episteme. More importantly, perhaps, such conceptual changes recognise that medical discourses are not free or separate from this episteme, but rather are deeply intertwined with its production.[1]
The programmes in question dramatise the engagement with the elusive nature of the medical ethos through a specific narrative pattern, the doctor’s learning curve. Since in the 1990s ER shifted the focus from the single heroic doctor to storylines about medical teams of residents, interns and attending physicians, the pattern became a standard. The pattern allowed television to ‘deconstruct’ and abandon the image of the physician as an infallible and powerful health care professional, and lead to the re-discovery of concept of the ‘doctor-in-the-making’. This change also facilitated the implementation of more complex plotlines and more complex narrative structures: personal rivalry and competition, conflicts, and, of course, the team members’ love lives all emerged as platforms on which the symbolism of health and disease, symptom and diagnosis, therapy and healing could be explicated (as Meredith’s [Ellen Pompeo] heavily allegorised voiceovers on Grey’s Anatomy amply demonstrate). The introduction of the learning curve coincided with the success and emerging prominence of the long form, which enabled creators to develop (personal) story arcs that bridge through multiple episodes and seasons. Thus, medical drama found a narrative and stylistic format in which it was possible to explore much disputed issues like the question of learning through failure, discrimination, communication with patients, malpractice, or the ‘bracketing out’ of the patient’s subjectivity in favour of the positing of disease as an abstractable set of symptoms. These circumstances enable dramas to condense and symbolically render ideas about an evolving, ever-expanding, self-reflexive medicine through the figure of the physician who, in return, becomes the product of his or her context. In this way, the characters’ personal and professional growth corresponds to the self-determination of medicine as episteme, as an ever-expanding body of more and more sophisticated knowledge that co-evolves with the social, technological, philosophical and cultural dimensions of history.
Casualty 1900s for instance, which is not simply a medical, but also a historical drama, embodies much of the major characteristics of the self-determination of medicine. Based on accounts taken from the hospital records and Ward diaries, the show takes a look at the social and medical history of the London Hospital in the East End of the beginning of the twentieth century. It accentuates technological innovation, including surgical procedures, and the proliferation of X-ray as a new imaging technique that would radically change the face of diagnosis; it follows the introduction and development of regulatory schemas governing practices ranging from sanitary measures to proper and normative modes of doctor-patient and doctor-nurse interaction; it revisits social and political factors that shaped policy making from securing funding to catering for the needs of the poor to questions of prestige and growth; and it also dramatises controversies related to the duties, responsibilities and career prospects of women in a hospital context. The respective career paths of nurse Russell (Sarah Smart) who assumes responsibility for the management of the hospital’s Wellington Ward, and nurse Bennett (Charity Wakefield) who secretly studies to be a doctor, or head surgeon Henry Dean’s (Paul Hilton) struggle with his addiction to cocaine, are just a few plausible examples of this pageant-like representation of the complexities that characterised medical practice in the 1900s. The programme’s success resides in the effective blending of the compellingly executed representation of medicine with the social and historical context of the East End, and situating it within the tradition of reimagining the past.
Of course, I realise this blog was only able to scratch the surface of the problem of medical television. The themes I touched upon have as much to do with the scholar’s predisposition towards method, that is, analytical tools and critical stances, as with the political and cultural space within which the complexity of the discourse on medicine (and television) unfolds. But perhaps these considerations might have valuable reverberations which provide useful points for consideration for the study of the cultural history of medicine, the history of response, or media archaeology. I am tempted to think of these programmes not simply as meta-narratives or testimonies that reflect the cultural, ethical, and epistemic complexities of medicine, but also as symptoms of an elusive cultural pathology…
David Levente Palatinus holds a lectureship in Contemporary Literature and Culture at the University of Ruzomberok. He is currently a post-doctoral researcher at the Institute of Advanced Studies of the University of Bologna. He has published on forensic crime fiction, corporeality, the representation of the body, and violence and deconstruction. He is currently working on a booklength project called “The PathologEthics of Culture.”
[1] My thanks are due to Elke Weissmann for her insightful comments on this argument.
