Imagining the Human Body

How are medical imaging technologies changing the patients’ relationships to and expectations of their doctors and bodies? Are the doctor and patient necessary to the diagnosis and treatment of disease?

Your stomach hurts. You sit before your computer and enter data describing your symptoms into your doctor’s Web-based diagnostic service. You receive an email with an appointment for a body scan. You drive to your local radiology practice where a technician ushers you into a room and then into a machine, which captures an image of your abdomen. You go home. The computer analyzes your scan and electronically transmits a diagnosis of Crohn’s disease to your doctor’s computer. Your doctor (you assume) emails you information about Crohn’s disease, along with your scan, and proposes a course of drug treatment. He suggests that you not worry. He transmits a prescription to your pharmacy. You go through a series of emotions about having a chronic, painful, incurable disease, and then you print and frame and hang your abdomen scan on the wall by your front door. An art dealer happens by and purchases the image for $5,000. People in Tokyo ponder your bowels. You take your pills and you feel better, though your stomach still hurts. Later, you sit and wonder whether your doctor really existed. Across town, your doctor wonders if you did.

Images reveal the secret lives of our bodies. Advances in radiology – including uses for magnetic resonance imaging (MRI), computed tomography (CT or CAT) scans, nuclear medicine, and ultrasonography – give doctors a window into the body that shows objective evidence of disease and decreases their reliance on the patient’s subjective complaints. The time when doctors had only their five senses and the patient’s own observations to diagnose ailments has long gone. The stethoscope, which remains a symbol of authority, hangs on a doctor’s neck now more than it is pressed to a patient’s chest. With technologies that allow a view of the human body from the inside out, images provide the doctor with more information than the patient himself. While both the patient and doctor currently remain necessary at some level, the imaging technologies make their location time and place less relevant, and lessen the significance of physical human interaction. At some point, the machine must analyze the patient and the doctor must analyze the machine’s analysis, i.e., the images, but we face the possibility that never the two shall meet.

Looming death, the promise of healing, and perhaps ultimate transcendence compel us to allow the shift in medicine from human-driven to device-driven. If we are the deconstructed, postmodern society as suggested by Jean- François Lyotard, Jacques Derrida, and others, it’s conceivable that the radiographic image, or at least the perception brought about by the imagery of our inner selves, helped take us to that place. The capture of reality in an image has always fascinated us. It preserves us indefinitely; there is no doubt we existed, if for just that moment. According to Lyotard, the photographic and cinematographic productions gave us something that we wanted; they preserved "various consciousnesses from doubt" (74). We must exist. The radiographic image – which we could consider the uber photo, if a photo at all – might do the same. Understanding something of the x-ray, CT scanning, and MRI helps us to see how the technologies have affected society over the past century, and how the mere possibility of the images may affect our consciousness.

Physicist Wilhelm Conrad Röntgen devised the x-ray machine in the late nineteenth century, receiving the Nobel Physics for the discovery in 1901. Antoine Henri Becquerel aided the development of the x-ray with his discovery of the phenomenon of natural radioactivity, leading to the science of nuclear medicine (Becquerel). The technology fascinated scientists and the public. In 1895, physicist Joseph John Thomson, discoverer of the electron, spoke about the significance of the "Röntgen rays" at Cambridge University. "This discovery, as you see, appeals to one of the most powerful passions of human nature, curiosity, and it is not surprising that it attracted an amount of attention quite disproportionate to that usually given to questions of physical science," states Thomson (100). In a headline, the science publication Nature hailed x-ray as "a contribution to the new photography" (Lockyer 101). While science was giving birth to radiology, views of the body began to change. People could see beneath the surface of a living person. Scientist William Lockyer describes the result of the first x-ray image, that of Mrs. Röntgen’s hand:

The flesh becomes transparent.

A historical sidebar: Earlier in the nineteenth century, even before Röntgen’s discovery that would ultimately lead to the field of radiology and an understanding of the human body, Charles Babbage was taking steps to create an infallible machine. In The Difference Engine, Doron Swade tells the story of Babbage’s quest to build the first computer in the early 1800s. He describes Babbage’s motivation. "The ‘unerring certainty’ of mechanism would eliminate the risk of human error to which numerical calculation was so frustratingly prone. Infallible machines would compensate for the frailties of the human mind and extend its powers," states Swade (1). Over a century later, those infallible machines would eventually merge with imaging technologies to change modern medicine.

Amidst the development of the x-ray, the world was discovering electricity, telephones, automobiles, air flight, the vacuum cleaner, the teddy bear, and experiencing the inexorable march of technological progress. Yet, the x-ray captivated people’s attention. Ian Smith, M.D., professor at the Department of Internal Medicine at the University of Iowa Hospitals and Clinics, says that in 1897, x-ray images were used to find bullets in the Balken War, and that some believed the technology could "transmit thoughts, restore vision to the blind, [and] raise the dead." It took years – actually until around 1970 when the practice totally went out of use – before the side effects of radiation convinced the public that they did not need to x-ray their children’s feet to insure a set of well-fitting shoes. The importance of x-ray has been recognized as a major achievement. "Dr. Roentgen has allowed us to see into the living body of 10 million Americans each year so that operations are less invasive, biopsies sometimes unnecessary, and the results enable some patients to stay out of the hospital," says Smith.

At the same time CT scanning came into wide usage, magnetic resonance imaging was in its early stages. MRI uses a giant magnetic field – with strength of more than eighty-thousand times that of the earth’s magnetic field – rather than radiation to peer into the previously impenetrable. Jim Feeney, author of "Magnetic Resonance Imaging – A Window into the Human Body," offers a technical description:

This is the human body: a chemical concoction. While scientists have understood, relatively, the basic composition of the body for generations, medical imaging provides visual evidence. The MRI, for example, breaks us down to our nuclei, our smallest known part. It performs the ultimate deconstruction. One of the most exciting applications of MRI is the study of the human mind. In contrast with other imaging technologies, MRI lacks the health hazards of radiation, and actually has no known negative side effects at this time (except for the patient whose body contains any type of metal). The medical community met the development of MRI with skepticism, but it has since emerged as a very powerful and widely used imaging tool (Feeney).

In a traditional MRI machine, the patient lies on his back and slides inside the machine. Patients with claustrophobia often have great difficulty remaining still in such close confines. Now, MRI machines are available that allow the patient to position himself in open space, rather than lying within the bore of a giant magnet. Radiology Associates, a practice based in Daytona Beach, Florida, recently purchased a new stand-up MRI machine. Dan Miles, a radiologist for the practice, describes this machine as like "a small room." Miles estimates that perhaps 20% of patients get an MRI because they suffer from pain of unknown origin. Their complaints are not specific enough for the physician to identify the problem. A patient may feel pain when bending over, but not when laying flat. "With this particular scanner, if they have pain when they bend over, you have them bend over," Miles says. The stand-up MRI is just one of many advances that give us more reasons and ways in which to utilize medical imaging.

Doctors have dozens of other radiological technologies at their disposal. Mammography and sonography are the most common. Sonography uses sound waves to construct an image. A 1999 study of the types of procedures used by diagnostic radiology practices showed that 95% of those surveyed used mammography, and 94% performed sonography (Sunshine). Both of these systems are used primarily for wellness checks; mammography evaluates for breast cancer and sonography is most commonly used to view a fetus in utero. The technologies are often serving a healthy population, who wants to stay that way, but see their demise on the horizon. A November 2004 study by Royal Philips Electronics estimates that 79% of Americans believe that they are currently in good health, but almost 90% expect to face a potentially serious health condition in the next five years. For these healthy people, technology offers insurance against the insidious advance of disease in the body. Other technologies include PET scanning and applications in nuclear medicine, and many subspecialties and variations of the primary radiological functions. "Radiology and imaging has become an integral part of the diagnosis of disease in a patient’s work up," says Miles. "There is no question that as the technology has improved, there’s been a significant increase in the use of imaging." Ultimately, medical body imaging allows doctors to see inside our bodies without piercing the skin.

In the past, radiology departments had darkrooms that developed each film and produced a physical image, and many still do. These films have to be manually carried from place to place, and stored for years. Lost films are not uncommon. The transition from film to digital storage makes using the images easier, cheaper, faster, and more efficient. Miles explains how not only the prevalence, but also the capabilities of radiology have increased, partially as a result of the transition from film to digital imaging. "The technology of the CT scanner, for example, has improved so we can take thinner and clearer images than we could before," Miles says.

It is true that some doctors may now order a scan before seeing a patient. One medical professional describes a time when a spouse suffered from headaches and called for an appointment with a neurologist. The neurologist suggested that the patient get a CT scan before the office appointment. Harry Black, assistant medical director for surgery for Florida Health Care Plans in Daytona Beach, says that such a situation is atypical, and we are not on the cusp of eliminating the doctor or patient. "I don’t think we’re anywhere close to taking the clinician out of the picture," Black says. He uses radiological results to aid in his decision-making process, but that the technology is nowhere near being self-sustaining – the machines aren’t thinking yet. "It helps clarify for me something that I may have operated on routinely ten or fifteen years ago," says Black. "Now on the basis of the scan, I figure out now if I need to operate. It doesn’t take the physician out of the decision-loop and it doesn’t take the patient out, either."

To the patient, doctors and their technologies are becoming integrated, their powers pooled. The doctor or a technician instructs a patient to sit, squat, bend, lay, or squeeze into a large machine, and the patient does so willingly, often with trepidation but willingly nonetheless. Like the church, the technology uses fear of pain and death to convince us that we need it, and receives our reverence in exchange for its power. The CT scanning machine and other equipment have become a gateway to health. In many cases, the patient endures the radiating of her body so that the machine may light up the cancer, heart murmur, blockage, or various other ailments. "[O]ne result of the new noninvasive imaging technologies in the area of medicine is the capability of turning a person inside out … It conjures up foreboding visions of an all-powerful observer who has instant visual access to the anatomy, biochemistry, and physiology of a patient," says Victoria Vesna, an artist and professor at UCLA (qtd. in Wilson 152). Vesna questions access to areas that used to be private, but are now open for unprecedented surveillance (152). The public seems willing to sacrifice access to their most private places in exchange for life. We don’t want to die. If we submit to God, salvation awaits us and we will love forever in a heaven filled with wine and roses. If we submit to the machine, we may beat death for a little while longer.

While doctors have always used technological tools, the power and possibilities of seeing inside the living human body through radiation, ultrasound, and magnetic resonance gives them a divine authority that exceeds historical precedent, and paradoxically, makes them less germane to the patient/doctor relationship. Patients’ expectations of doctors are shifting. With the development of computer-aided diagnosis, algorithms that detect abnormalities, and technicians evaluating images, the doctor becomes technically less relevant, but more mysterious – a God-like entity behind-the-curtain. The opportunity to accept the role of an omnipotent power has always been tempting. German physician and professor, Linus Geisler, says that doctors must resist the temptation to play God. In Doctor and Patient, Geisler states:

The patient’s role in diagnosis of her disease has traditionally been one of acquiescent contributor, but now may be less relevant to her diagnosis. Traditionally, a patient described her symptoms, disrobed, and submitted to a physical exam. "Back when I trained, you listened to what people said and examined the patient," Dhand says. "A neurologist might not see a patient now until they see a scan of the head." Despite an acknowledgment that medical technologies are vast, impressive, and change the practice of medicine, most doctors strongly contend that neither the physician nor the patient is irrelevant to the process of diagnosis and treatment. Black says that while imaging technologies are an integral part of medicine, they have not superceded the patient’s own voice. "You’re not going to do the test unless the patient complains," says Black. "[The scan] helps define the complaint in a more complete way. The patient interaction is very important, because it helps the doctor hone in on what tests can be useful in making the diagnosis."

While some doctors may hide behind the curtain, the curtain of the human body opens, and this is changing what we expect of our body and its infirmities. Geisler says that our repression of suffering, an agnostic society, and the human effort to become God-like, "coupled with a fixation on the dazzling possibilities raised by high-technology medicine" has changed the way we approach illness. In addition, as a society, we feel that we have a right to health, which Geisler says is illusory. He cites a hospital chaplain, W. Stroh, who states that "Life is not a court where one can prosecute one’s claim to health." Perhaps now those claims to health may be processed through insurance companies rather than some existential entity. Patients have access to the machines that may be intended as insurance against suffering and death. If we can only see the problem, certainly it can be eliminated. What we cannot see frightens us the most.

With technologies that can peer behind skin, through bones, into body organs and even brains, a patient can literally observe his disease. Previously, a doctor might feel a lump or diagnose a clogged artery based on the patient’s symptoms, but now disease poses for the camera. There are few places to hide. A doctor shows the patient an MRI of her right breast and circles in red the whitish mass identified as cancer. The tumor that might kill her in six to eight months appears as a small twinkle on a computer monitor. With a few mouse clicks in Adobe Photoshop, the patient herself could wipe out the offending cells. With machines the size of rooms and computer systems that hold more knowledge about metastatic breast cancer than a thousand physicians, with laparoscopy, radiation therapy, a massive assortment of drug choices, and the progress of interventional radiology, would the patient be unreasonable to expect cure post haste? Cure or not, the patient has now seen inside herself, assuming her doctor has allowed her access. The patient now has a textual version of herself, concrete and immutable, disease and all.

In Orality and Literacy, Walter Ong describes writing as having structured our consciousness as a society. The form that writing takes – a book or other text – cannot be refuted, because the author has removed herself from the work. "There is no way directly to refute a text. After absolute and devastating refutation, it says exactly the same thing as before. This is one reason why ‘the book says’ is popularly tantamount to ‘it is true’," says Ong. Ong goes on to point out Plato’s contestation of writing over orality. "Writing destroys memory. Those who use writing will become forgetful, relying on an external resource for what they lack in internal resources," says Ong, summarizing Plato’s argument (78). The medical image of a tumor offers that irrefutable proof; the interpretation may be wrong, but the image remains irrefutably a freeze frame of our body in time. Ong also contends a close connection between writing and death. "The paradox lies in the fact that the deadness of the text, its removal from the living human lifeworld, its rigid visual fixity, assures its endurance and its potential for being resurrected into limitless living contexts by a potentially infinite number of living readers," Ong states (80). Ong believes that technology is manifestly artificial, and that its artificiality is natural to humans, but that the artificiality serves us well. "The use of technology can enrich the human psyche, enlarge the human spirit, and intensify its interior life," he states (82). Medical body imaging literally radiates the interior life of our bodies, and offers us proof that we are complex, exceptional creatures.

The human spirit, or at least the human, wants more than anything to exist. "Hear me! For I am such and such a person. Above all, do not mistake me for someone else," states Nietzsche (217). Currently, that existence as we know it relies heavily on the human body. Most of us have not yet found a way to be outside of it. What is the purpose of medical imaging technology above and beyond finding heart defects and secret, festering tumors? "To fuse the machine and the visceral, and ultimately to challenge mortality and prolong life […] Scanning devices such as MRI, PET, and electron microscopy present fascinating interior landscapes never seen before," states Michele Theunissen, curator of an exhibition on art, medicine, and the body. Theunissen questions whether the technology will change the way we imagine ourselves, or whether we will "remain foreigners to the medical depiction of our bodies" (qtd. in Wilson 193). These machines offer us the truth, and despite that most of us have an utter lack of understanding about how they work, we have great faith in their results.

Radiological equipment shows the human as it has never been seen before. Yet, an MRI, CT, or x-ray image shows nothing that looks even remotely like flesh and blood. It offers a pixilated version of the body. Consider Seltzer’s poetic description of what a surgeon sees after just opening a living body with a scalpel. "And there is color. The green of the cloth, the white of the sponges, the red and yellow of the body. Beneath the fat lies the fascia, the tough fibrous sheet encasing the muscles. It must be sliced and the red beef of the muscles separated," says Seltzer. He goes on:

The idea of the human body as a mechanism is old; Leonardo da Vinci, for example, described the body as a machine and created magnificent art by interpreting its machinations. Radiological images reinforce the idea of the body as a machine and as art, and offer us new views into ourselves. These images change the way we see ourselves and our diseases. The images may be a digital representation of the human form; or, perhaps the digital is real and flesh represents us outside of the computer. Whatever the case, we do not see flesh in a CT scan. We see intricacy, nuance, circuits, and bursts of color, and we also see hollowness. Where is the ghost in the machine? Stephen Pinker, author and psychology professor at MIT, asserts that no ghost or mystical spirit resides within us, and that that idea bothers people. "It can indeed be upsetting to think of ourselves as glorified gears and springs. Machines are insensate, built to be used, and disposable; humans are sentient, possessing of dignity and rights, and infinitely precious," states Pinker in The Blank Slate. He explains that regardless of our religious faith – or lack thereof – most Americans choose to believe in some type of immortality or soul, and the idea that our body is a machine upsets our beliefs about human purpose, such as love and art. "And of course if the mind is separate from the body, it can continue to exist when the body breaks down, and our thoughts and pleasures will not someday be snuffed out forever," Pinker states (10). We want everlasting life.

Nietzsche describes the "internalization" of man and man’s development of a soul. "The entire inner world, originally as thin as if it were stretched between two membranes, expanded and extended itself, acquired depth, breadth, and height, in the same measure as outward discharge was inhibited," Nietzsche states (84). Nietzsche contends that no order exists in reality, and it is the purpose of art to make that order. Medical body images have moved into the realm of art, and make order of what we are closest to – ourselves – but have never seen. Artists are using the images produced by the machines (perhaps even the machines themselves) to give order to the human, just as artists have always done through painting, sculpture, and photography. "More than making visible the invisible, art needs to raise our awareness of what firmly remains beyond our visual reach but which, nonetheless, affects us directly," says artist Eduardo Kac (qtd. in Wilson 91).

Tsiaras states, "This is where art meets science" (qtd. in Squires). He uses images that are hundreds of times higher in resolution than typical medical images, and constructs them in three-dimensions. Tsiaras and his colleagues produced one image that shows a body’s range of motion by taking a spiral, whole body CT scan and removing the muscles, fat, and other body tissue, leaving the skeleton. They then merged that image with a performance of a fast motion dance, creating a remarkable representation of the human in motion. Some of his pieces show only body parts. "Twisted vines that snake along a forest’s strange and spongy floor are actually capillaries running through the thyroid gland," states Squire. "What appear to be irregular stacks of wooden planks are the building blocks of collagen and bone." Tsairas describes the work of creating this art as "looking at God’s puzzle" (qtd. in Squires). A puzzle is meant to be solved, or at least indicates that a solution exists. Medical imaging takes the puzzle of our bodies and attempts to find a solution.

We do recognize the power of medical technology over our lives, in that it can seek and destroy disease, and lengthen our lives. It cannot at this time, however, offer us freedom from suffering or immortality. It cannot do exactly what we want it to. Pinker says that "images are said to have insidious power over our consciousness" (213). He describes a postmodern view that we inhabit a world of images rather than a real world with images in it: "In other words," states Pinker, explaining a theory that he ultimately disagrees with, "if a tree falls in the forest and there is no artist to paint it, not only did the tree make no sound, but it did not fall, and there was no tree there to begin with" (213). Few would assert that if we did not have a representation of our inner selves, we would somehow exist less or fail to exist at all. But medical imaging does offer us more of an understanding of ourselves, and how our bodies function. The images show us that we are not special and that we are. The ability to see inside ourselves, at all of our body’s gears, wires, and pumps that keep us functioning on earth, helps us understand the secret lives of our bodies, ourselves.