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Medical drama on TV has never been more popular – or more bloody. Jerome Monahan reviews a new book which offers some explanations and analysis of this controversial genre: Body Trauma TV.
Medical dramas are in the news. One controversy centres on the new Channel 4 series No Angels, which depicts the lives and loves of nurses at a Leeds hospital with dark humour. It has so upset the Royal College of Nursing that its general secretary has condemned it for potentially contributing to the current staffing crisis in the NHS where there are 25,000 nursing vacancies. TV doc Phil Hammond subsequently praised it in the Radio Times, suggesting that the nurses warming up a dead body to hide how long it had been neglected on a ward may have a basis in truth. On the other hand, he was disappointed by the way the series depicts the working relationships between nurses and doctors, suggesting these are far less adversarial in reality. The Guardian’s resident doctor Ben Goldacre has also recently been on the warpath – this time concerning the general level of inaccuracy in TV hospital dramas and soap operas ( www.guardian.co.uk/health/story/0,3605,1144519,00.html ). He was prompted to write by a recent story strand in EastEnders involving a character receiving an ‘emergency kidney transplant’ following a stabbing – a procedure that no hospital would approve after difficult life-saving surgery and one, he felt, which would inevitably confuse the public. The vehemence with which these issues are debated suggests an intriguing link between such fictions and popular perceptions of medical and hospital realities. They also beg the question why is it that medical dramas have come to rank among the most popular on television? For the answer to this question and the ideal launch pad into your own investigations of the genre, you need look no further than Jason Jacobs&Mac226; Body Trauma TV. If excessive media theory and jargon throws you, don’t worry – Jacobs is keener to explain his ideas than to impress upon the reader how clever he is. There are some conceptually difficult discussions, but he clearly explores the social and economic factors that have guided the evolution of these dramas. He provides, for example, a direct link between the kind of cheap reality-style documentaries that emerged in the period of economic downturn in the early 90s, and the edgy, roaming camera style characteristic of ER that studios were prepared to fund when their financial circumstances improved. Representations of medics His analysis of the changing philosophical outlook represented by the key medical drama series of the past forty years is also extremely useful for anyone wanting to tackle the dominant outlook prevailing in current series. For Jacobs&Mac226; the earliest TV medical dramas such as Dr. Kildare were keen to represent medical professionals as caring and committed individuals – dedicated scientists for whom romantic engagement with patients would be both distracting and unprofessional. Such dramas, while banishing any sight of actual bloody medical procedures out of frame, were instrumental in introducing the combination of glamour and morbidity (attractive doctors and nurses involved with the care of those whose bodies are broken or diseased), which is still a key component of the genre today. It is Jacobs’s view that the roots of ER’s world-weary outlook lie in the hugely popular satiric drama that ran from 1972-1983, M.A.S.H., which depicted the trials and tribulations of a battlefield surgical station during the Korean War. M.A.S.H consolidated the idea of the ‘ensemble cast’ and of a kind of absurdist outlook born of the surgeons’ roles – patching up the wounded so they can live to fight (and be killed or injured) another day. The same vision of medical practice occurring in a space just beyond a combat zone is especially true of those ER story strands in which emergency care is required to save the lives of young gang members. Once healed they too are destined only to return to the mean streets for subsequent destruction. Jacobs examines the larger social phenomena which lie behind the ‘morbid gaze’ of current medical dramas. In today’s shows, the camera is rarely pulled away to save us from the sight of incisions, projectile blood or vomit or, as in the case of Doctor Romano, actual dismemberment by helicopter blade. Even the dead are not taboo, deserving their time as part of the mise-en-scène. It is here that the analysis may become a bit demanding, but Jacobs makes interesting connections between our current fascination with the body, and our reluctance to get involved with the social and economic problems facing society. Today, in the face of the complex forces that shape our lives, the individual’s body has become the centre of most people’s lives – their site of control (dieting); conflict (self-harm) and celebration (conditioning). It is hardly surprising, says Jacobs, that audiences are enthralled by fictions that examine the body in all its frailty and weakness – a vision offset only by the beauty of most of those shown practising medicine. So if you are thinking of making medical dramas the subject of a special study, grab your teacher or librarian and insist that Body Trauma TV is a must-have buy. Some key medical drama conventions and exercises The opening sequences of hospital dramas are highly revealing and should reward detailed analysis. In Body Trauma TV, Jason Jacobs devotes a sizeable section to an extensive exploration of the opening credits of an
Trauma TV, Jason Jacobs devotes a sizeable section to an extensive exploration of the opening credits of an earlier ER series – the overall look of which has been retained in subsequent seasons. Using his approach, try your own analysis of the current series. In particular, what do the brief sequences illustrating the main characters suggest about both them and their relative importance? Jacobs&Mac226; is perhaps a little super-subtle in detecting a pattern between the depiction of Mark Green – sliding back on chair with quizzical expression on his face – and the overall visual mode of the programme: observational and gliding; characteristic of the extensive use of steady-cam. Jacobs makes a fascinating case for the central importance of teaching as part of many hospital dramas. As well as allowing periods of reflection and analysis between the frantic action, he also explores how often it is we that are educated in these scenes alongside the depicted medical student. Thus it is that we are instructed in aspects of hospital policy and procedure, which in turn equips us to judge subsequent medical sequences and emerging conflicts between individuals and the overarching structures they are expected to conform to. Jacobs also usefully charts the visual style of hospital dramas. In ER, for example, he traces a kind of camera usage with roots in seminal cops shows such as Hill Street Blues and NYPD Blue. He suggests that often the camera appears not to be examining a predictable mise-en-scène, but ‘happening upon’ events. It is as if the camera is being taken by surprise, in a way that greatly enhances the sense of tension in an audience already expecting things to go wrong at any time – the explosion of patients through the doors on a gurney or the eruption of a fountain of blood from a seemingly stable patient. You could also borrow from Jacobs’s analysis of the role of patients in these shows. The two archetypes he identifies are the ‘toxic’ type and the ‘reflector’. On the whole the former is the medical refusnic, who due to bolshiness, fear, drunkeness or madness seems to be incapable of taking the good things on offer from the medical staff. ‘Reflectors’ on the other hand are those patients that manage to mirror something crucial occurring to the medical staff around them. Any comparison of medical dramas should quickly throw up the key narrative and stylistic differences between them. Symptomatic of the enormous sums of money each episode of ER commands is the fact its makers can afford a kind of highly textured mise-en-scène, with activities going on both front and back frame of central scenes or exchanges. It is just such a ‘layered’ look that Jacobs detects in the opening credits of the show. However, while ER conducts its business at breathless speed, it does tend to keep its focus squarely on the claustrophobic interiors of County General Hospital. Casualty, however adopts a ‘montage’ approach; giving us a ringside seat to both the hospital spaces and those beyond its walls in which we witness the build up to the medical crises with which the hospital staff will have to cope. In Body Trauma TV, Jacobs charts the way in which there has been a steady ‘medicalisation’ of the schedules, with detective programmes, documentaries and other shows increasingly acquiring the same bodyconscious/procedure-focused priorities of the hospital dramas. This is an intriguing suggestion and one that might make a good coursework case study.
This article first appeared in MediaMagazine 8, April 2004
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