Becoming an Image

Every Body is an Archive, by Liz Orton

Being a patient today increasingly means being an image. Liz Orton’s new artist’s book, Every Body is an Archive, takes the medical image as a site of critical enquiry to explore questions of ownership, language and power within the clinical encounter. Polyphony editor Fiona Johnstone met with Liz Orton to talk about the book, the centrality of image-making to medical practice, and how right now is a radical moment for the clinical gaze.

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FJ: The book Every Body is an Archive is one of the outputs from your five-year Wellcome-funded project Digital Insides. What inspired you to undertake a major project on medical imaging?

LO: I’ve been teaching medical students for a number of years, using the photographic image as a way of thinking about power within the doctor-patient relationship. Photography acts as a metaphor for many of the things I am interested in, like consent, trust, ownership, language and power, and the idea of the gaze is vital for both photography and medicine. In my artistic practice I often take up the image as a way to understand disciplinary thought.

FJ: You take the medical image as a site of enquiry for interrogating questions around power within the doctor-patient relationship, and also the photographer-participant relationship.

LO: That’s right.  I’m also interested in how medical images shape our understanding of the body. For example, the X-ray enabled a quite radical shift in the way the human body was understood and defined, undermining the established notion of the subject by collapsing the inside and the surface of the body into an image. Medical technology plays a formative part in our understanding of what the body actually is.

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FJ: Why did you feel this topic could be addressed in an interesting way by an artist; what did you think that you could offer that another discipline could not?

LO: I think being an artist gives you certain privileges, to dip into other disciplines, but also to stand outside of them.  Medical images are usually assumed to be robust, objective and neutral.  I’m interested in asking questions about such assumptions by putting the image at the centre of things, as opposed to instrumentalising the image for other arguments. Medical images are often treated as a window onto the body, claiming to show some kind of pre-existing reality of the body, as if the body always precedes the image, whereas I am interested in how bodies are constituted through images. And how that makes possible certain material approaches to or interventions in the body.

FJ: That’s a hugely important point!

LO: Historically, for example, the representation of the body in medical illustration as dry, bloodless, passive, fragmented, objectified etc. enabled certain kinds of medical interventions, often quite violent, to take place on bodies. Language is also part of it. The term ‘medical body’ I see as quite problematic, as it secures the idea that an ill body is separate or different from a social or cultural body. As if our body is somehow different inside hospital from outside it.

FJ: You have written that “being a patient today increasingly means being an image”. Can you expand on that sentence and say how you involved patients in what you were doing?

LO: Images are now the single most important diagnostic tool in medicine. And every medical intervention is preceded by, enabled by, and verified by the image. Imaging is increasingly part of treatment too. Interventional radiology, for example, directly treats tumours by navigating very fine wires through the body, guided by imaging. The increasing reliance on images at least in part reflects the promise of visual evidence. It’s invested with an objective authority that perhaps the other senses, such as touch and listening, are thought to lack. It seems to come back to the dominance of vision in medicine.

FJ: Can you describe what you see as the effects of this dominance of vision?

LO: The patient can become marginalised from the process of diagnosis. The image can stand in for the body, enable its absence from decision-making. Radiologists, who are the key interpreters, very rarely meet patients, and patients rarely see their own images. Images produce gaps and disconnections.

FJ: Were you working with a specific clinical group, or a particular type of imaging technology?

LO: It was never about a particular region of the body, or one technology more than others. I was interested in broader questions about image systems, and in bringing some light to the black-box of medical-image processing. Few of us know what we are seeing when we look at medical images. They aren’t optical in the way that photographs are, they aren’t a visual record of something in front of a lens, but visualisations of data. For example, CT is a measurement of density, MRI a measurement of radio waves, and those measurements are interpreted, transcribed, translated into images for human eyes. It all comes back to vision.

FJ: Could you say a bit about why the project resulted in a book, as opposed to another format?

LO: The book as a form is such an important part of medical history, and I was interested in taking up the problem of translating the depth of the body on the surface of the page. There is also something about the way radiologists scroll through sequences of images that mirrors the gesture of turning pages in the book and I liked that echo.

FJ: Can we discuss the different types of image in the book? These fall into three categories: medical software-generated images, re-appropriated images from old medical imaging textbooks, and contemporary photographs of patients and collaborators. Shall we start with the software images?

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LO: I co-opted medical image viewing software and mis-used it in a way that I hoped to would make visible the workings of the algorithmic or machine gaze. I reconstructed sequences of 2D images slices into 3D moving visualisations, using screen-grabs to create the still images.  My subject really is the software itself, which I use to render the digital surface of the body, which is also a refusal of the conventional spectacle of the inside. There is no real or embodied reference for what we are seeing, which is a sampling of data that includes skin, hair, water, tissue, blood and air. And the machine can’t distinguish between the body and artefacts such as zips and clasps, and even the bed on which the body lays, so everything is seen.

FJ: It doesn’t understand what a body is.

LO: Exactly. It’s just data, it’s just pixels. There is no judgement, only calculation. The images are a gesture towards a machine vision, or a machine aesthetic of the body.

FJ: There is something exciting about disassembling and reassembling the body; there is a sculptural quality to the process that really comes across in your images.

LO: I think the sense of sculpture comes from the way the software simulates lighting: we can read these bodies having depth and form because the software adds highlights and shadows. And the reference for that is the photographic body: the images are constructed not only from the raw material of data but from cultural traditions of representing the body.

FJ: How do these contemporary algorithmic images relate to the old medical photographs that appear in your book?

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LO: The re-appropriated photographs come from Clark’s Positioning which is a key text for radiographers. I worked with two editions, published in 1973 and 1984.  These images seem like statements about the subordination of the body to the machine, the conceptualisation of bodies as geometric objects, as quantifiable spaces made up of surfaces and angles.

FJ: The images are curious in that they’re quite aesthetic … the women are wearing make-up, they look like fashion shoots, and some are quite surreal.

LO: Yes, I agree, they completely exceed their scientific designation. They can’t be contained by science; the cultural influence of fashion, women’s magazines, surrealism, and comedy, is all in there.

FJ: Have you altered the images at all?

LO: No, I selected some and re-photographed them. I’m interested in the idea of re-exposure that happens as part of appropriation. The act of re-printing an existing image in a different context opens it up to new questions, new forms of cultural and ethical enquiry.

FJ: It strikes me that the whole project is about appropriation.  How did you go about making the re-enactment photograph, and what was the impetus to do this?

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LO:  I developed the framework of restaging after listening to patients describe the process of becoming an image in intricate detail. But the images are not made directly with the patients, but other subjects I met. It’s about interpretation rather than direct recreation.

FJ: It’s not just about individual personal experience, it’s about layering all these experiences into something richer.

LO: Yes, some of the project involves a prolonged or deep engagement with patients, but these photographic collaborations are more fleeting. The starting point was someone else’s experience or an image, which develops into imagined movements. I’m not trying to accurately show something, or be true to an event. These photographs are more about me and my process as an artist. In the selection of the image, usually from a long sequence, I am asserting my authorship. I started to think of these subjects as being like phantoms, which are synthetic anatomical bodies used to calibrate and test medical image machines.

FJ: Historically photographic re-enactment has often been used for people who have been through something quite traumatic. I’m thinking of Jo Spence and photo-therapy but also Andres Serrano, who photographed former prisoners and torture victims in the positions in which they were tortured – obviously he wasn’t doing this as therapy, it was an artistic output, but there was clearly something therapeutic enough about it for those people to want to do it.

LO: That’s something I’ve thought about a lot. The therapeutic potential of the photographic process is interesting but artists are not therapists and we have to work carefully and know how to create a safe space with the right consent processes. I didn’t seek to work directly with people’s trauma as material.

FJ: We sometimes refer to the primal scene of the medical humanities as the encounter between clinician and patient, but I think you have identified a different primal scene, which is the patient-image encounter….

LO: I think where others are interested in the vulnerability of the patient, you might say I am interested in the vulnerability of the representation.

FJ: Can we talk about language? The book contains enigmatic fragments of text printed in yellow ink so that they are barely visible.

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LO: The yellow is hard to see, and the viewer has to work to read it. That was an artistic and conceptual decision. The yellow is sampled from something called the Repulsor Tool in the medical image software.  The text felt to me like the riskiest element of the book, because it’s not explained, and is completely different in tone from the images. I enjoyed the uncertainty of that and the playfulness of these almost non-sensical passages. But the text is attributed at the back of the book. It was really important to me that the reader can understand those words have bodies, that they have a documentary or a factual basis.

FJ: Did these phrases came out of your conversations with patients?

LO: Yes, they came out of long dialogues with participants. There is a process of extraction in taking words from their original context. Words are anatomised in the way bodies are anatomised, I was aware of mirroring aspects of medicine in how I worked. I was nervous when I asked for consent to do this, because this cutting of words feels quite violent, so I was surprised when they liked it.

FJ: We are invited to understand these phrases as metaphors for experience.

LO:  Yes, because as patients we don’t have a visual language to describe our insides, so we have to invent one, and in doing this we reach for other images. It was a struggle for patients to find the words. That comes across in how disconnected the words seem, which is another metaphor for medicine. Language is a really big part of what separates a patient from their body in medicine, because its exclusive, and expertise and authority is vested with doctors.

FJ: You’re working with the patient voice, but what I find interesting is that you are not doing it in a way that prioritises the individual narrative, it’s treating the concept of voice in a very different way, and I find that really fruitful and exciting.

LO: I’m definitely not using the idea of patient voice in the usual sense.

FJ: The other thing I wanted to ask about is accessing patients and their data. I remember you saying that you felt certain aspects of the project required ethics approval, but the Hospital Trust didn’t, because it didn’t conceptualize what you were doing as research.

LO: That’s very true. I did go through governance with UCLH, but not the ethics committee. The process of accessing patient data was very complicated: it took me about 2 years to get a process that I felt ethically happy with and that worked for the hospital. You can’t get consent to use data retrospectively, so there was no question of me accessing anything from the past.

FL: It strikes me that we are at a really interesting juncture in terms of how we handle patient data, including images…

LO: Yes, this is a totally radical moment for the clinical gaze, because the body is no longer based exclusively in the clinic! It’s to do with how the body-as-code can be crossed with other code, and how suddenly the medical image is profitable, with the potential of image data to be combined with financial data, economic data, insurance data, consumer data…

FJ: That’s an incredible thought to end on!

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Liz Orton is a visual artist working with photography, text and film to explore the relationship between images, knowledge and authorship. Her work engages with archives, both real and imagined, to explore the tensions between personal and scientific forms of knowledge. Digital Insides was a collaboration between Liz Orton and radiologist Steve Halligan, supported by the Wellcome Trust. https://www.lizorton.co.uk

Every Body is an Archive was published in 2019 in an edition of 300. Copies can be purchased here: https://lizorton.co.uk/shop/product/every-body-is-an-archive

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