‘A little more than a year ago during my month serving as the attending physician on the pediatrics ward of the University of California, San Francisco, I ran across a dying boy who, together with his mother, reminded me, as I often am reminded, of the troubled, myopic vision so characteristic of the medicine I have learned and practice. He was a relatively young boy (I will call him Blake), no more than seven years of age and afflicted with a terminal, disfiguring version of mucolipidosis. This is a genetically based storage disease involving the pathological accumulation of complex carbohydrates in many tissues of the body, including the bones and joints, the heart, eyes, liver, spleen, and brain. It is a disease that is slowly progressive, usually ending in death from heart or lung failure within the first decade of life.’
‘Glasgow artist Jacqueline Donachie has been appointed lead artist on the design team for the Centre for Health Science, which is currently under construction in Inverness. Selected by Inverness, Badenoch and Strathspey Enterprise (INBSE), Donachie will coordinate art projects throughout the building, both her own and those of other contributing artists. (Highlands and Islands Enterprise website)’
‘Over the years of Blake’s short life, the unabated metabolic hoarding of carbohydrates had severely deformed and retarded him. His eyes were clouded and protruded from his face as did his tongue, like the over-stuffed contents of a pastry shell too small to contain it. The gums surrounding his peg-like teeth were similarly engorged and frequently bled when disturbed. His massively swollen heart was failing, and he perennially threatened to drown in the secretions that flooded his airway. His chest and belly, glutted with a liver and spleen many times their normal sizes, had together become a single, reddened, congested globe from which four largely useless limbs projected. He was, in short, a small, grotesque tomato-of-a-boy whose appearance turned away even the most forgiving eyes.’
‘The Centre for Health Science is a purpose-built, multi-user bio-medical research, education and business incubation facility which will be located next to Raigmore Hospital and adjacent to LifeScan Scotland Ltd. The first phase of the Centre for Health Science is due to be completed in autumn 2006 and will house Stirling University’s department of nursing and midwifery, the post-graduate medical centre for NHS Education for Scotland and the new chair of health sciences for the UHI Millennium Institute, sponsored by Lifescan Scotland. (Highlands and Islands Enterprise website.)’
‘Blake also was not overly grateful for the abundant, cutting edge medical care being provided for him. I think he somehow sensed that he was nearing the end of his time, and he had decided that the sticks and pokes and serial examinations did almost nothing to allay the other torments that his disease had long prolonged. So, the approach of doctors, nurses, technicians, and all the other assorted hospital personnel was greeted abruptly with a raspy incoherent grunt and a flailing motion of his arm that meant, indisputably, “Get out of my face!” … My own ability to humanly care for Blake also was compromised by the physical sight of him and by his stolid indifference or antagonism to my best efforts on his behalf.’
‘The second phase, expected to be ready by autumn 2007, will provide accommodation for a variety of other public and private sector organisations, including the University of Aberdeen’s Centre for Rural Health, In Veritas Medical Diagnostics (IVMD) and Lifescan Scotland. A third phase is currently being considered. (Highlands and Islands Enterprise website.)’
‘One July evening, held in the hospital late by a series of unanticipated events, I approached Blake’s room at an unaccustomed hour. His young, single mom, who was at her own place of work for the daylight hours of most days, was sitting on the edge of the bed, deeply immersed in a conversation with Blake. I paused, and then settled at the door, transfixed by the scene before me in the darkened hospital room. Blake’s mom was talking to him. In hushed and comforting tones she spoke of the day, wondering how things had gone, asking him about his new nurse, reviewing for him the events of her own day at work. As she spoke, leaning over her son, her hand stroked his forehead and hair in a mundane gesture that filled the room with her love for the boy.’
‘One of Jacqueline’s early decisions was also to purchase ‘Ecbolic Garden, Winter’ (2001), an existing work by Christine Borland, another established artist with a strong interest in medicine, and install it in the first phase of the building. Art will permeate the building in every way, and will provide a unique and creative working environment. (‘Invision’, newsletter of the Inverness City Partnership, Issue One, June 2006)’
‘Blake’s eyes, moist and utterly devoid of his stern resistance, looked up into his mother’s face, absorbing every moment, every piece of her presence there with him. Relaxed and more peaceful than I had ever seen him, Blake seemed to melt into his mother’s eyes. She stroked his round, swollen face and said to him, “Oh, my beautiful, little boy.”’
‘For “Ecbolic Garden, Winter”, Christine Borland found an old story about a Scottish doctor, Mark Jameson, from around the year 1550. Dr Jameson had an idea of planting a most specialised botanical garden at the university in Glasgow. Among other things, he wanted to plant a number of plant species known to induce abortions, even though they often involved a great risk for the women in question. Thus the name of the work: ‘Ecbolic Garden’, ‘ecbolian’ meaning abortion provoking. We do not know if Dr. Jameson ever planted his garden and what he intended to do with it. Were his intentions with the project of a good or evil kind? We will never know, but Christine Borland’s work calls our attention to the complicated process of obtaining knowledge—and the fact that this process often is possible only because of other people’s sacrifices. (From Aarhus Art Society of 1847 website)’
‘Suddenly I understood what I had not understood: When this mother gazed at her bloated, dying son, she physically saw a person I had never seen. Transformed by her eyes’ willingness to see the child beyond the disease, Blake had become a different being, an individual no longer diseased and distorted, but a frightened child visibly changed by his mother’s love.’
“Ecbolic Garden, Winter” 2001, features 50 glass womb-shaped containers suspended from the ceiling that hold the bleached ‘skeletons’ of plants preserved in alcohol that were once used as abortifacients. These plants—larkspur, juniper and the like—were found to be part of a 16th century garden close to the original university in Glasgow, and Borland speculates on the potential use of these by the medical school. In effect, a kind of ghost garden is created, denuded of colour and life. (British Medical Journal, April 28, 2001)’
‘In the months since that night and since his death later in that same year, I often have thought of Blake and his mother. I have thought of how limited my vision of my patients has been, of the peculiar and short-sighted lenses through which so much of our vaunted medicine is conducted. I have thought of how mysteriously my own way of seeing Blake was irreparably changed by the experience of watching his mom truly see him and respond to him for who he, finally, was.’
Emotive and tendentious, perhaps, but the splicing of these two preceding narratives—one derived primarily from press releases, the other taken from Patricia Benner’s moving personal account, ‘Seeing the person behind the disease’, in The American Journal of Critical Care, 2004—is intended to draw attention to two fundamentally incongruous discourses. This evident disparity between public announcement and private experience betrays a crisis, and that crisis provides a frame for Donachie’s and Borland’s works for the new Centre for Health Science in Inverness. These works are, admittedly, driven by different imperatives, and arise from differently articulated interests. Where Donachie’s is immediate and pragmatic, originating in response to the local and particular circumstances of the new centre, Borland’s is historically evocative and speculative, relating closely to her 2001 commission for a sculpture in the grounds of Glasgow University, ‘To Be Set And Sown In The Garden’. They nevertheless share a common concern with issues arising from the assimilation of institutionalised medical practice into the patterns of everyday life, especially insofar as these determine attitudes towards the patient’s body.
The gradual modernisation of western medical practice since the 16th century (beginning with the works of Fracastoro, Vesalius and Paracelsus, for example), its increasing professionalisation, specialisation and accommodation to scientific methods and research procedures, has entailed losses as well as gains. Among these losses has been the reduction of the patient from a socially complex individual into an abstract entity, an accumulation of notes and observations, a ‘case history’. For Michel Foucault, this fundamental shift can be detected in the increasing centrality of what he terms ‘the clinical gaze’. Observation had been central to medical practice since the time of the Hippocratic school in the fifth century BC, but these early practitioners did not use ‘tools’ (such as stethoscopes and microscopes) to aid their inspection, nor did they probe into the interior of the body. The dissection of the human body, in fact, was largely taboo. It was also considered unnecessary, because these ancient physicians could derive sufficient information from their observation of how patients looked and lived, as well as by studying their diets and excretions. But with the adoption of the autopsy to study disease, Foucault argued, a radical change in the language and style of medicine emerged. The practice of autopsy was itself informed by the Cartesian proposition of a mind/body dualism. Having philosophically separated these two opposing ‘substances’, it was then possible to believe that the mind could observe and examine the body as something external and ‘other’. ‘Making the body external in this way, however, turns the body into a purely objective body, leaving it dehumanised, mechanical, thing-like, “mine” because I can control it, but visible and observable like anything else.’
The scientific foundations for modern medical practice thus placed great emphasis upon the kind of empirical evidence verifiable by sight. But this bias rendered other kinds of knowledge non-admissible. The problem here is that, as Holmes has pointed out, ‘an evidence-based, empirical world view is dangerously reductive insofar as it negates the personal and interpersonal significance and meaning of a world that is first and foremost a relational world, and not a fixed set of objects…’ To offset this reductive drive, Holmes and his co-authors suggest instead an exploration of ‘the multiplicity of what Foucault describes as subjugated forms of knowledge…’ These forms of knowledge are often disqualified for being unscientific, naïve and generally inferior, arising from ‘below’ rather than imposed from ‘above’. Such knowledge is ‘a particular knowledge, a knowledge that is local, regional, or differential’. It is, perhaps, a form of knowledge known to certain practices of art.
In producing unassuming utilitarian objects that may even be overlooked as ‘art’ (outdoor planter tubs—heated by excess energy from refrigerators in the research area—on which patients can sit and rest; door handles designed with disabled users in mind) Jacqueline Donachie redirects attention to the wider physical environment inhabited by the centre’s users, reasserting the importance of relational experiences within this setting. In attending to the internal and external physical environments (she had also designed flower-beds and outdoor wheelchair areas) Donachie also makes the patients newly visible as individual agents, rather than objects of enquiry. Released from the scrutiny of the ‘clinical gaze’, they are encouraged to inhabit and interact with the grounds of the centre with relative ease and freedom. Here they may be seen by the scientists and researchers who also occupy the building. Thus the demands of medical science and the patterns of daily life are reconnected through a kind of aesthetic management of the wider environment that encourages a casual, informal exchange of glimpses, glances and incidental moments of seeing. In this sense, Donachie is perhaps reclaiming something of the ‘subjugated knowledge’ from the lost world of traditional or folk medicine, in which patients were treated in an environment that is familiar, comfortable, and non-threatening—typically, the patient’s home with family and friends present to provide support. In contrast, doctors often report that patient blood pressure measurements in their offices are higher than normal. This ‘white lab-coat phenomenon’ is very likely a result of increased patient anxiety brought about by the intimidating environment and situation.
Christine Borland’s ‘Ecbolic Garden, Winter’ might also be thought of in terms of a partial return to ‘subjugated knowledge’, to the world of herbal medicine in particular. Ecbolic plants are those known by herbalists to be capable of provoking an abortion, and Borland’s work was inspired by notes made by the aforementioned Rev Mark Jameson in the mid-16th century on the back of his pocket version of Fuch’s ‘Herbal’ First published in 1542, Leonhart Fuchs’ Great Herbal (De historia stirpium commentarii insignes ) is noteworthy for its wood-engraved illustrations. As William Ivins has suggested, it was the ability of the printing press to produce such ‘exactly repeatable pictorial statements’ that revolutionised the spread of technical and scientific knowledge, especially—thanks to the printed herbal—in the field of medicine. It also meant, however, that such knowledge became standardised, universal and transferrable into any situation.
Jameson’s notes suggest that he was planning to plant a physic garden at Glasgow University, which, if carried out, would have been the first of its kind in the United Kingdom. At the time (1555) Jameson was a student who served as Rector’s Deputy, when the University was situated close to Glasgow Cathedral, thus Borland’s work locates the question of abortion and the control of women’s reproduction at a point where the powers of the Church and the University converge. The potential for another form of ‘subjugation’ is thus suggested here, one deeply rooted in history. During the early Middle Ages, apparently, there were as many women involved in medicine as men. But the professionalisation of medicine in the later medieval period, and the development of university faculties of medicine excluded women from the profession. After the 14th century, women continued to operate within the field, but usually as midwives. The only qualification required was a statement from a parish priest declaring that she was of good character.
Fuch’s ‘Herbal’ marked the beginning of the end of ‘knowledge that is local, regional, or differential’. The exactly repeatable pictorial statement enabled precision, consistency and efficiency in the transfer of knowledge (thereby enabling its subsequent ‘professionalisation’), but in addressing itself to the ‘cool’, detached, assessing medium of sight (Marshall McLuhan), it was ally to the objectifying power of the clinical gaze. Four and a half centuries later, and the implications still reverberate in Patricia Benner’s candid and disarming admission; ‘My own ability to humanly care for Blake also was compromised by the physical sight of him.’
John Calcutt lectures at Glasgow School of Art
Jaqueline Donachie, lead artist at the Centre of Health Science, talks about the artist as lateral thinker on public projects
‘I have a great interest in how people physically interact in public spaces, and how people socialise with each other. It’s the way my work’s gone for the past ten years. Pretty much all the things I do are in some way informed by a social event, whether it includes two or 200 people.
Often what I make looks quite minimal, but there’s always the intention that it will be used by people in some way or other, which I prescribe by having an event. The work comes from a feeling I would like other people to share. In Darnley (Glasgow, 1999), for example. I wanted people to dance on a hill with the sun going down, and the sculpture and everything else came from that feeling.
An installation at Spike Island in Bristol (2002), came out of the fact that the building, which houses artists’ studios, is so cold in winter. I’d worked at typical artists’ studios, which are freezing in winter, with everyone huddled round their own Calor gas fire in their own room. So I wanted everyone in Bristol to stretch out. What could I make that would give this form? It’s important what the thing looked like, as it couldn’t be a nice, cosy common room. Like the disc at Darnley, this was also quite minimal, but the whole thing is about it being indestructable and beautiful yet heated and warm, something to stretch out on in that big, cold space.
I made the benches for the Hunterian Museum exhibition to encourage people to sit down in small groups and talk. I had become interested in genetics and felt that people needed to discuss genetic disease quite directly. Families need to talk. They need to tell you what’s happened to their sister, or mother or brother. My interest in genetics stems from when my own family were all diagnosed with a genetic illness about eight years ago and I wanted to look into how people socialise around genetics and medicine. I realised that the individual can be diagnosed medically, but that the bigger picture of the family tree and history are important too. You need to trace family members and collate the data. That was the side I was interested in. In my head I tried to marry that medical angle with the sculptures I’ve always been interested in—sets and and stages, all quite minimal, no props, no people. The Hunterian exhibition was the first stage in that process, the Inverness project the next.
The Inverness project isn’t specifically related to genetics, but has a scientific/medical angle because the building is being used for research and medical training. I have focused on the main social areas, which can be overlooked in a building with specialist use. Different parties who use the building to do their own thing come together in these areas. My interest in genetics made me realise that doctors speak to patients and scientists, but patients don’t often speak to scientists. There isn’t a threeway communication. Because of that, the scientists just seea cell sample, not a person. They are strictly looking for a cure, and that can take a heartbreakingly long time. The ability to isolate human genes in the 1980s only opened the door to more long roads of discovery. The Eureka moment is rare, so scientists only see the bleakest picture. They miss the good things. Take my niece. Her cells are terrible, but she’s walking, going to school, chatting. Her long term prospects aren’t great, but she brings everyone such joy right now.
We all need to make sure we see what other people are doing in their lives. I’m a big supporter of comprehensive education, public transport, all the things that take you out of your car or your house and stop you from hanging out only with people like yourself. In medicine too, people should cross-communicate as much as possible. In Inverness I’ve been a filter for that—the one who goes to all the meetings and is independent. I can say, ‘Why don’t we make that cupboard a kitchen for staff,’ or, “Why don’t we make our own furniture rather than order it from the National Health Catalogue.’ I’ve got a budget and can spend it on improving the building in a variety of visual/social ways. This Centre serves the whole of the Highlands, so it’s important that the doctors, nurses, students, scientists and individuals have spaces which allow crossover with each other. Then I can add art in a more conventional way. Christine Borland’s work is maybe not quite what they expected to get, but a lot of people really like it.
It’s a good idea to hire an artist to be the lateral thinker on a project.