Handbook of Popular Culture and Biomedicine: Arno Görgen German Alfonso Nunez Heiner Fangerau Editors

Arno Görgen · German Alfonso Nunez
Heiner Fangerau Editors
Handbook
of Popular
Culture and
Biomedicine
Knowledge in the Life Sciences as
Cultural Artefact
Handbook of Popular Culture and Biomedicine
Arno Görgen • German Alfonso Nunez
Heiner Fangerau
Editors
Handbook of Popular Culture

and Biomedicine
Knowledge in the Life Sciences as Cultural
Artefact
Supported by the Fritz Thyssen Foundation

Editors
Arno Görgen German Alfonso Nunez
Research Unit Communication Design Faculty of Philosophy, Languages and
Bern University of the Arts HKB Literature, and Human Sciences (FFLCH)
Bern, Switzerland University of São Paulo
São Paulo, Brazil
Heiner Fangerau
Department of History, Theory & Ethics of
Medicine
Heinrich Heine University Düsseldorf
Düsseldorf, Germany
ISBN 978-3-319-90676-8 ISBN 978-3-319-90677-5 (eBook)

https://doi.org/10.1007/978-3-319-90677-5
Library of Congress Control Number: 2018949063
© Springer International Publishing AG, part of Springer Nature 2019

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Contents
The Medicalization of Popular Culture: Epistemical, Ethical

and Aesthetical Structures of Biomedical Knowledge
as Cultural Artefact �� 1
Arno Görgen, German Alfonso Nunez, and Heiner Fangerau
Part I Theories and Methods

Knowledge Production Between Popular Culture
and Scientific Culture�� 15
David A. Kirby
Cool Geeks, Dangerous Nerds, Entrepreneurial Scientists
and Idealistic Physicians? Exploring Science and Medicine
in Popular Culture �� 25
Joachim Allgaier
Biomedicine and Bioethics�� 41
Heiner Fangerau and Gisela Badura-Lotter
Advantages and Disadvantages of Pop-Cultural Artifacts
for Exploring Bioethical Issues �� 57
Sandra Shapshay
Narrative �� 71
Hans-Joachim Backe
hetoric of Popular Culture and Representations of Biomedicine �� 79
R
Barry Brummett
opular Culture and the Dissemination of Knowledge�� 89
P
John Storey
Images and Self-Evidence�� 95
Michael Martin and Heiner Fangerau
v
vi Contents
he Visual Claim Within Medical Science and Popular Culture�� 115

T
Angela Schröder
Part II Case Studies

edicalized Screens from the Cold War to the Social Web �� 125
M
Kirsten Ostherr
Insights into Insights: Visual Narratives of Medical Imaging
and Intervention Technologies and the Popular Viscourse�� 139
Anna L. Roethe
The Audiovisual Process of Creating Evidence – Science Television
Imagining the Brain�� 157
Regina Brückner and Sarah Greifenstein
Medical History’s Graphic Power in American True-Adventure
Comic Books of the 1940s�� 179
Bert Hansen
edical Narratives in the South African Novel: Case Study of Chris
M
Karsten’s Trilogy The Skin Collector (2012), The Skinner’s
Revenge (2013) and Face-Off (2014) �� 195
Karen Ferreira-Meyers
Dis/ability: The Construction of Norms and Normality
in Popular Culture �� 207
Simon Ledder and Catharina Münte
opular Narratives of the Cochlear Implant�� 229
P
Anna Grebe, Robert Stock, and Markus Spöhrer
etween Utopia and Dystopia: Contemporary Art and Its Conflicting
B
Representations of Scientific Knowledge �� 245
German Alfonso Nunez
With Great Power Comes Changing Representations:
From Radiation to Genetics in the Origin of Spider-Man �� 259
Simon Locke
usic in Serious Games as a Healing Factor�� 271
M
Yvonne Stingel-Voigt
utonomy, Heteronomy, and Bioethics in BioShock�� 283
A
Arno Görgen and Matthis Krischel
The Scientific Enterprise Illustrated: Abduction, Discovery
and Creativity�� 301
Fabrizio Augusto Poltronieri
Contents vii
Using Case Studies from Popular Culture to Teach

Medical Physiology�� 307
Ronan M. G. Berg
Part III Social Implications

Consuming, Experiencing, and Governing: Setting the Scene
for Public Encounters with Biomedicine �� 323
Anda Adamsone-Fiskovica
Bias by Medical Drama. Reflections of Stereotypic Images
of Physicians in the Context of Contemporary Medical Dramas�� 337
Moritz Köhler, Claudia Förstner, Maximilian Zellner,
and Michael Noll-Hussong
he Medical, Social, and Cultural Construction and Production
T
of Post-Traumatic Stress Disorder �� 351
Arno Görgen
ocialist Advertising. Health Education in East German Television�� 371
S
Philipp Osten
The Medicalization of Popular Culture:
Epistemical, Ethical and Aesthetical
Structures of Biomedical Knowledge
as Cultural Artefact
Arno Görgen, German Alfonso Nunez, and Heiner Fangerau
Introduction
Albeit an incomplete attempt, given the complexity of the problem at hand, this
handbook explores the basic methods and materials used by researchers concerned
with the interplay between culture and biomedical knowledge. We hope to introduce
research that tackles the relationship between these two superficially unrelated
spheres to a larger audience while, at the same time, providing a generous introduc-
tion to younger readers and newcomers from distinct disciplines. This effort is
imbued with a holistically oriented goal: discuss the same topic from various and
sometimes opposing viewpoints across different disciplines and examples. However,
it cannot represent the sum of all that has been produced by probing our subject.
Instead, while not giving in to simple generalizations, we hope to demonstrate the
richness and importance of our topic by providing both assumptions and examples
that can guide further enquiries.
A good way to begin this discussion is to think about what we have in mind when
we talk about biomedical knowledge in popular culture. Following the assumptions
of researchers closer to media or cultural studies we may, for example, characterize
knowledge as something that is built upon previous knowledge, that is to say, of
referencing to something else outside its own. Epistemologists may recognize this
as empirical knowledge, as opposed to a priori knowledge. Such a knowledge,
empirical and dependent in something apart from itself or relying on experience,
A. Görgen (*)
Research Unit Communication Design, Bern University of the Arts HKB, Bern, Switzerland
G. A. Nunez
Faculty of Philosophy, Languages and Literature, and Human Sciences (FFLCH), University
of São Paulo, São Paulo, Brazil
H. Fangerau
Department of the History, Philosophy and Ethics of Medicine, Heinrich-Heine University
Düsseldorf, Düsseldorf, Germany
© Springer International Publishing AG, part of Springer Nature 2019 1

A. Görgen et al. (eds.), Handbook of Popular Culture and Biomedicine,
https://doi.org/10.1007/978-3-319-90677-5_1
2 A. Görgen et al.
implies that its meaning can be understood only if referred to pre-existing frames of
knowledge, which, in a sense, locate individual perception in one or various previ-
ous meaningful contexts (Donati 2001: 149–150).
How could one, for example, comprehend the act of vaccination without an
awareness of microorganisms? Vaccines can only be understood as a preventive
action, if one had prior knowledge of disease-causing microorganisms and the idea
of herd immunization; without this previous knowledge, the very notion of vaccina-
tion as we have it today would be meaningless. Likewise, as knowledge may be
used as a tool employed to establish or reinforce power relations and competing
identities, it should come as no surprise that widely accepted concepts and “truths”,
can also be contested. Social actors most often try to establish their own (inherited)
perspective in opposition to positions from other social actors. As a consequence,
vaccines have always been a subject to fear and critique (Wolfe and Sharp 2002).
Given the importance of previous frames of knowledge, even if one is aware of
things such as herds and microorganisms, vaccines could still be considered a threat.
This previous, invalid knowledge, which could be attributed to the (mis-)representa-
tion of biomedical knowledge in the media (Holton et al. 2012) or the superimposi-
tion of various frames stemming from ethical, religious or uneducated concerns
(Blume 2006) is nevertheless central to apprehension about the use of vaccines, not
as a conspiracy or unnecessary treatment but as one of the most successful methods
for preventing disease. As Wayne Brekhus puts it: “How an issue is framed and
whose implicit social standpoint is used to interpret and contextualize or decontex-
tualize events, shapes social and moral perceptions of the issue and the actors
involved” (Brekhus 2015: 56).
This is particularly relevant to socioculturally and ethically relevant issues like
biomedical knowledge and practice, as they not only literally impact the lives, well-
being, and hopes of individuals, but also may affect how we perceive the world. In
this sense, biomedicine is woven into a mesh of knowledge that can define our basic
understanding of the biological world and, as such, is not only restricted to biomedi-
cal professionals but also finds its way into collective, popular culture.
One can argue that popular culture and biomedicine are constantly informing one
another (Buchi 1998; Hüppauf and Weingart 2007). Whereas biomedicine increas-
ingly represents an important and vital element within popular cultural media arte-
facts, popular culture may act as an indicator of public opinion towards biomedicine.
Likewise, while popular culture can provide and communicate novel ideas and solu-
tions to certain biomedical issues, biomedicine may offer a rich and compelling plot
device or subject to different cultural artefacts. From medically themed TV shows
and movies to post-human narratives in science-fiction superhero movies and comic
books, from bio-art projects and anatomical toys to crime novels and science fiction
video games, biomedical knowledge may be used to create engaging narratives,
timeless characters, sublime works of art and thrilling gaming experiences that
shape both the public understanding of, and expectations towards, medicine.
To promote a critical understanding of the interrelations between popular culture
and biomedicine, it is vital to provide a framework for understanding this relation-
ship. The “Handbook of Popular Culture and Biomedicine: Knowledge in the Life
Sciences as Cultural Artefact” is intended to serve as a source of knowledge in the
The Medicalization of Popular Culture: Epistemical, Ethical and Aesthetical Structures… 3
creation of such critical reflective frameworks. Particularly, this chapter introduces

some of the main notions concerning the convergence of popular culture and bio-
medical knowledge. The first step towards this comprehension is to define how we
understand the relationship between biomedicine and popular culture. In this chap-
ter, we deductively draft (a) the scope of culture and its role in the creation and
dissemination of knowledge by (b) introducing and conceptualizing a new under-
standing of ‘medicalization’: how can (biomedical) science be defined as an impor-
tant knowledge producer and (c) how can processes of science communication be
approached analytically vis-à-vis cultural products. With these introductory remarks
in mind, we (d) finally lay bare the structure of this handbook.
Culture and Communication
No matter if one defines culture by following

–– an ergological approach, which defines ‘culture’ in contrast to ‘nature’ as all
material, man-made artefacts;
–– a moral approach, meaning that ‘culture’ includes all norms and values of human
social collectives;
–– a socio-juristical approach, which understands ‘culture’ as distinct, regulated
models of communication whose task is to support all human community; or
–– a historical perspective, which sees ‘culture’ as a result of continuous processes
of change (Perpeet 1984).
In all cases, culture is built upon knowledge and mediated content. Hence, to
obtain and preserve itself, culture depends on enduring intersubjective exchange
and communication. Without communication, cultural efforts like the material and
physical alteration of the environment as well as mental structures and products like
languages, morals, religion, laws, economy or science could not persist. In this con-
text, Berger and Luckmann (1990) coined the concept of the “social construction of
reality” as the ability of the social subject to appropriate the world through interper-
sonal interactions and social exchanges to make it tangible and comprehensible. If
direct face-to-face interaction is not possible, cultural techniques are necessary to
bridge the communicative gap and to mediate (cultural) knowledge.1 Their products
and artefacts are then consumed and distributed over a market of symbolic goods
1
“cultural techniques are (a) operative processes that enable work with things and symbols; (b)
they are based on a separation between an implied ‘know how’ and an explicit ‘know that’; (c) they
can be understood as skills that habituate and regularize the body’s movements and that express
themselves in everyday fluid practices; (d) at the same time, such techniques can provide the aes-
thetic and material-technical foundation for scientific innovation and new theoretical objects; (e)
the media innovations accruing in the wake of changing cultural techniques are located in a reci-
procity of print and image, sound and number, which, in turn; (f) opens up new exploratory spaces
for perception, communication, and cognition; and (g) these exploratory spaces come into view
where disciplinary boundaries become permeable and lay bare phenomena and relationships
whose profile precisely does not coincide with the boundaries of specific disciplines.” Kramer and
Bredekamp (2013: 27).
4 A. Görgen et al.
(Bourdieu 1993: 112). This circuit conceptually includes as important cornerstones

“production” (the technical and cultural conditions of the production of both the
cultural product and its meaning), “consumption” (the way to use cultural goods
and the way in which usage changes the meanings of products), “regulation” (the
regulatory and legal boundaries in the production, distribution and consumption of
cultural products), “representation” (the expression of cultural meaning through
visual and oral language) and “identity” (how actors engage and identify with cul-
tural artefacts) (Du Gay et al. 1997).
Within society, cultural artefacts play a central role in the distribution of knowl-
edge. By cultural artefacts we usually think of anything that has been made with
intent of an author or a maker that in some way is characterized by having a purpose
(Hilpinen and Risto 2011). In this book, we will mainly focus on media artefacts as
a subcategory of cultural artefacts. Although they sometimes miss a physical gestalt,
as in digitalized music (Sterne 2006), they are nevertheless treated as objects or
entities. In addition, media artefacts are often seen as valuable products, both from
an economical and personal/emotional standpoint. Accordingly, within our contem-
porary market of symbolic goods, media artefacts can be seen as hybrid objects that
are both, material and symbolic goods. They are not only products to be consumed
but also vehicles for conveying information, knowledge and/or ideology.
Consequently, if the production of knowledge is of particular interest, analytically
taking into account media artefacts is an effective way to lay bare knowledge struc-
tures, particular interests and actors behind their development.
Although in principle each member of society produces and communicates
information, there is a clear hierarchy between those most able to communicate to a
large number of people and those mostly affecting their immediate surroundings.
Although the internet has supplied the tools for an ever-increasing number of people
to partake in this communicative process, we cannot deny the power held by tradi-
tional communication vehicles, from TV networks to publishers, over our collective
imagination. As such, the influence of certain individuals who contribute to what we
label as popular culture – writers, producers, directors, game designers, artists and
artisans of all kinds – is quite impressive. But we should not forget that actors from
the field we label as “scientific” also hold a similar position. Although not able to
communicate to as large a number of people as the above-mentioned producers,
scientists and those involved in its transmission, possess the advantages of being the
authoritative voice of knowledge. They are, as such, able to be heard far from labo-
ratories and universities. It is within this interaction between those able to commu-
nicate and those able to affirm, where the interplay between popular culture and
science becomes most visible. Hence, it should come as no surprise that, given that
both entities strive to influence and dictate our apprehension of both the social and
natural world, this interplay between seemingly disparate spheres of influence con-
tinues to attract an ever-growing number of individuals interested in the questions it
raises.
Science and Medicalization
In 2009, the British Science Council defined “science” as “the pursuit of knowledge
and understanding of the natural and social world following a systematic methodol-
ogy based on evidence” (House of Commons 2009: Ev 196). In the process and as
a consequence of this pursuit, science has become an ubiquitous phenomenon, in
which science empowers humans, via technology, to enhance their own spectrum of
‘natural’ capabilities in their interactions with the world (Poser 2012: 13). As a phi-
losopher of technology, Carl Mitcham stated, “[t]echnology takes on the form of
applied science (in engineering); science takes on the form of applied technology
(from telescope and microscope to space probe and computer simulation). […]
What modern technoscience does is turn scientific theory to practical use for the
purpose of altering nature at large and to as great an extent as possible” (Mitcham
1999: 129). At the same time, science also has a central ideological impact on cul-
ture and society, as it not only has replaced religion as a primary explanatory model
for the understanding of the past and present status quo of the world, but has also
become a primary advisory institution for the future development of mankind (Poser
2012: 14). Accordingly, science creates and represents models of the world, and
these models build frameworks and interpretation patterns that are usually not ques-
tioned – only in times of paradigm shifts (Kuhn and Hacking 2012) – which reduces
its complexity, allowing a faster decision making process.
‘Science’ usually includes the natural sciences, mathematics, statistics, engineer-
ing, technology, medicine and related fields (Burns et al. 2003: 185).2 Nevertheless,
in the context of this book, we will focus on the Life Sciences/Biomedical Sciences,
as biomedical knowledge, concepts and technologies permeate and ‘medicalize’ the
quotidian, not only as systemic infrastructures (e.g. health care systems) or biopoli-
tics (e.g. the quantified self-movement) but also in the form of cultural artefacts.
Medicalization is the term for a process of socio-cultural change in which human
life and experiences of life shift into the focus of systematic medical research and
responsibilities that had previously been situated outside the medical field. In a
strict sense, medicalization usually defines a redefinition of social problems in the
terms of biomedicine (Conrad 2007: 5–8; Foucault, 1984). Although Conrad’s
approach explicitly does not include any evaluative meaning to the term, medical-
ization is most often bound to power relations between different political or social
actors (Nye 2003: 120). In a broader sense, we understand medicalization as a
superposition of different cultural and social aspects through medical semantics3 in
2
In contrast, for example, to the German expression Wissenschaft, which includes the humanities
and the social sciences.
3
The object of semantics (from gr. sema = sign) is the study of the contents designated by linguistic
signs, i.e. the meaning of words, sentences and texts. It is, in turn, a part of semiotics, the study of
sign systems in nature and culture. It plays an important role where communication takes place.
Communication does not necessarily have to take place with linguistic signs, though. Even non-
linguistic signs such as in music, painting, architecture or in the movie can be examined and ana-
lyzed by semiotics.
6 A. Görgen et al.
terms of medically charged (audio-)visual, textual and other forms of information or

a permeation of knowledge and perceptions with medical interpretation patterns.
Exemplarily of this semantic overlay is the success of the use of ‘cancer’ as a politi-
cal metaphor (Meisenberg and Meisenberg 2015), the medicalization of the zombie
genre from fantasy horror movies towards quasi-medical outbreak thrillers (Görgen
and Inderst 2015) or the increasing use of bioscience disease concepts in techno-
logical contexts (Bugs, worms, viruses, etc.) (Boase and Wellman 2001).
In addition to the diffusion of biomedical information into culture, a dysregu-
lated process of information distribution takes place, which – in the forms of medi-
cal peer-to-peer forums, do-it-yourself- and alternative medicine internet sources,
etc. – undermines the traditional authority of physicians by opening the formerly
exclusive access to medical knowledge. Hence, medicine and medical knowledge
are becoming increasingly important factors in the autonomous self-determination
of individuals. As a consequence of the ubiquitous distribution of medical knowl-
edge, the field of biomedicine cannot be separated as sharply from society as it has
been perceived before, while at the same time the influence of social forms of sci-
ence communication has increased. This process of medicalization of (popular) cul-
ture takes place simultaneously and in opposition to what Eugene Thacker (2001:
157) describes with reference to Jean Baudrillard (Baudrillard 1983) as the disap-
pearing of science fiction: Thacker notes, that as biotech industries increasingly
include narratives of science fiction into their discourses and communication strate-
gies, the original idea of science fiction to speculate and extrapolate developments
of science and its intersections with society dissolves into the appropriation of
sociocultural justification-, conditioning- and normativity-discourses through bio-
tech actors. Nevertheless, the effect of a medicalized popular culture might be the
same – namely to appropriate, justify and condition society for biomedical knowl-
edge and by doing so, to implement regimes of normativity.
For actors in the biomedicine field, such an expanded understanding of medical-
ization, one that expresses human action through medically charged semantics, con-
sequently leads to the necessity to deal with the biomedical properties of cultural
sign systems. A reflection of medical knowledge in culture empowers medical pro-
fessionals not only (a) to preserve the sovereignty of interpretation of the knowledge
produced by themselves and to avoid misguided interpretations, but (b) to also
enhance the quality of their own science communication skills and, finally, (c) to
critically reflect upon their role in society and culture by locating themselves within
these semantic structures.
Scientific Knowledge in Popular Culture
It can be argued that cultural producers have been influenced by scientific knowl-
edge since the Enlightenment (Cooter and Pumfrey 1994; Buchi 1998). Its authori-
tative voice, embodied in the never-ending stream of objects that have come to
define modern life, from telegraphs to mobile phones, from penicillin to cheap
paracetamol pills, encompasses every aspect of our daily lives, from the personal to
the public spheres. Cultural producers from all markets or genres could not escape
the pull of these changes that, surprisingly, do not seem to cease even today. As
Fedorak further develops, popular culture
is the sum of performance, expression, and symbolism that both influences and reflects
human culture. Its artefacts or symbols – vampire movies, graphic novels, car hood memo-
rabilia, drums and whistles, baseball cards, patchwork quilts, banana skirts, torn blue jeans,
and children’s dolls – all hold meaning and, in turn, offer messages about people and their
way of life. Popular culture provides shared experiences and creates the social solidarity
that is the basis for all societies. (Fedorak 2009: 3)
Hence, like science, popular culture communicates ideologies and patterns of

interpretation, but both use different persuasive, rhetorical strategies to communi-
cate information and to underline the plausibility of this knowledge. For example,
Dahlström and Ho (2012: 595) stated that entertainment media represents emerging
technologies rather on a narrative and prescriptive level, while they are consciously
reflecting contingencies: “Narratives actively create implicit rather than explicit
meanings and depict reality through the subjective view of a character rather than as
an objective certainty”. In contrast, representations of technoscience and knowledge
that originates from science or science journalism usually are evidence-based and
produce certainty (Dahlstrom and Ho 2012: 595). They further explain that, regard-
ing the context of the mediated information, “evidence-based argumentation deals
with the understanding of facts, which can be transferred independently from their
surrounding units of information. In contrast, narratives represent a mental repre-
sentation that focuses on understanding people and their actions where meaning is
imbedded within the context of the story” (Dahlstrom and Ho 2012: 595). They
conclude that this “different conception of truth mirrors the division between deduc-
tive and inductive reasoning: Whereas evidence-based argumentation uses abstrac-
tions to infer about particular examples, narrative uses particular examples to infer
abstractions. This difference confusingly allows evidence-based argumentation and
narratives with opposing assertions to claim equal levels of ‘truth’” (Dahlstrom and
Ho 2012: 595).
In the context of this handbook, these different communication strategies can be
traced back to three basic types of knowledge, namely aesthetic, moral and epis-
temic knowledge. Each of these types of knowledge claims objectivity for itself,
although the mechanisms for executing objectivity are inherently different to each
category (Miller 2006). Following the aforementioned distinction, the main differ-
ence between scientific knowledge and knowledge as communicated through popu-
lar culture media is that science emphasizes the communication of epistemic
knowledge while popular culture, depending on the type of media artefact, oscil-
lates between aesthetic, moral and epistemic knowledge.
But what happens to scientific knowledge when it permeates into a popular cul-
tural context? Popular culture experiences a slow but steady process of medicaliza-
tion, meaning that pop cultural artefacts increasingly implement elements from
biomedicine and the life sciences. From fighting diseases in digital games to explor-
ing issues of post-humanity and enhancement in comics and movies, biomedical
8 A. Görgen et al.
knowledge provides essential knowledge to create immersive, authentic experi-

ences. How do these medicalizations of pop culture cope with the (at least per-
ceived) objective nature of (techno-)scientific knowledge?
This question is based on two assumptions.
The first one basically refers to conceptions of scientific objectivity, meaning
that:
science is objective in that, or to the extent that, its products—theories, laws, experimental
results and observations—constitute accurate representations of the external world. The
products of science are not tainted by human desires, goals, capabilities or experience.
[Secondly,] science is objective in that, or to the extent that, the processes and methods that
characterize it neither depend on contingent social and ethical values, nor on the individual
bias of a scientist. (Reiss and Sprenger 2014)
Of course, scientific objectivity is an ideal that is already affected in the process

of scientific research. Following Max Weber’s thoughts on objectivity, Reiss and
Sprenger named four sources of normative influence, “(i) the choice of a scientific
research problem; (ii) the gathering of evidence in relation to the problem; (iii) the
acceptance of a scientific hypothesis or theory as an adequate answer to the problem
on the basis of the evidence; (iv) the proliferation and application of scientific
research results” (Reiss and Sprenger 2014). Hence, although scientific objectivity
should always be a goal,4 it is an ideal, not a reachable state.
The second assumption is based on the idea that only scientific truth can be
objective truth, but also that “aesthetic and moral appraisals both utterly lack the
cognitive authority of scientific inquiry, since neither kind of appraiser has access to
a fact independent of her own judgments and neither is in a position to claim that all
who are adequately qualified would share her judgment” (Miller 2006: 26). Yet,
aesthetical and ethical judgements, like science, can give “rational access to
appraiser-independent truth” (Miller 2006: 28) even if they do not share the epis-
temic entitlement of scientific knowledge. Hence, scientific knowledge offers con-
ceptions of truth, but so does ethical and aesthetical knowledge. In popular cultural
artefacts, it is not the task of the object to inform its consumer based on one of these
layers of truth; rather, it is the perception of these that leads one to a judgement
which oscillates between all three facets of knowledge. This also means that works
of art, as well as media artefacts, are neither essentially moral works, nor that art
and ethics are to be seen as autonomous spheres (Mcneill 2014: 175–177). The
emphasis on each of these spheres also depends on the choice of the audience to
perceive an artefact from an aesthetical, ethical (Mcneill 2014: 175–177) or scien-
tific perspective. With reference to Little (2014: 186), we can say that ethics, aes-
thetics and epistemology converge through the persuasive strategies of media:
“Their pervasiveness demands recognition. The discourses of ethics and aesthetics
[and science] have become convergent. The conjoint discourse shapes our under-
standing of reality”.
4
This perception accepts that scientific objectivity is also perceived as a normative value. Therefore,
science cannot be value-free.
Independent from the chosen point-of-view, medicalizations (or scientifications)

of popular cultural media artefacts are not meant to be scientifically accurate, but to
be entertaining (Kirby 2014: 107). Elsewhere, Kirby states, in its function as a pro-
ducer of meaningful artefacts, popular cultural media can postulate and stabilize
scientific facts, even if they are not necessarily real scientific facts. As such, a scien-
tific concept then achieves social recognition, when it is plausible: it does not neces-
sarily matter that the concept is fictional (Kirby 2003: 238).
Conclusions, Necessities, Solutions
Culture can be considered as a complex system of communication and allocation of

information and knowledge that includes aspects of production, consumption, regu-
lation, representation and identity. Within culture, different producers generate and
communicate knowledge not only in the sense of competing knowledge (and ide-
ologies), but also in the sense of processes of hybrid and merged spheres of knowl-
edge, as in the case of biomedical representations becoming part of popular culture
artefacts. The strategies of rhetorical persuasion develop in the sense that the
intended domains of knowledge, epistemical, ethical or aesthetical, blur in relation
to each other and experience a process of reconfiguration that does not comply to
their origin.
Having the complex nature of biomedical knowledge in popular culture artefacts
in mind, we think it is important to catalyse a process of self-reflection through
professionals from various fields. A deeper understanding of this topic not only
enables a glance on how society perceives actors, actions, knowledge and resulting
technologies from the life sciences, but it could also improve self-awareness and the
critical examination of one’s own interactions with society and its members. As
such, this handbook not only aims to provide an important source for medical aca-
demic education and by doing so, to support self-reflection, but also intends to
increase the sensitivity of the general public to the ‘medicalization’ of popular
culture.
Therefore, if we want to go further than simply consuming (or analysing) such
artefacts, we need to build up a proper understanding of how and why such struc-
tures of knowledge are used. The achievement of this aim requires an engaged anal-
ysis that identifies and contextualizes biomedical knowledge and the aesthetical
aspects of its use. This also includes drafting an event horizon of the use and ethical,
aesthetical, scientific, social, political and cultural implications of the represented
biomedical knowledge, as well as building new perspectives on what society and
culture really draw from a medicalized popular culture.
As a consequence, the task of this Handbook of Popular Culture and Biomedicine:
Knowledge in the Life Sciences as Cultural Artefacts is – following Kirby’s call to
develop a toolkit for professionals from Biology or the Life Sciences, scholars,
graduate students and early career researchers from disciplines such as Medical
Humanities, History of Medicine, Medical Ethics, Media and Cultural Studies – to
10 A. Görgen et al.
“analyz[e] fictional representations of science, one that not only incorporates sci-
ence’s impact on fiction but fiction’s impact on science” (Kirby 2003: 240). In a
sense, this is a work that not only bridges different fields but also serves as an index
of the different current methodological and epistemological approaches to its ques-
tion. Hence, the handbook is organized into three sections, (1) Theories and
Methods, (2) Case Studies and (3) Social Implications:
1. By providing an introductory toolkit of theories and methods, in the first section,
Theories and Methods, we enable the reader to comprehend the impact of medi-
cal knowledge on popular culture, even if he or she is not familiar with ideas and
theories from the social, cultural or media studies. Here we intend to provide and
discuss some of the tools available to researchers from the humanities that, in
one way or another, can be applied to our topic. However, one should not be
surprised if the articles in this section contradict one another. The intention here
is not to promote a single discipline or method, rather to expand and demonstrate
the possible ways one should go about when conducting research into the inter-
action between biomedical knowledge and culture.
2. In the second and largest section, Case Studies, we provide examples that apply
some of the methods discussed in our first section. Although not in exact corre-
spondence, which in effect demonstrates the richness of possible approaches,
these papers act in two fronts. First, like we have said before, they provide actual
examples of how to conduct research into our topic. Second, they contribute to
the development of particular studies, either in specific genres, media or pub-
lic spheres. Since this section is mainly concerned with single objects or collec-
tions of related ones, these papers can be thought of as examining the interaction
between biomedicine and culture from a micro-perspective, i.e., focused on par-
ticular problems and without much concern for generalizations.
3. Finally, our last section, Social Implications, identifies the impact of popular
culture on science and vice versa. As such, in contrast to our second section, this
final section attempts to comprehend our problem over a larger and more general
perspective. Here the articles exemplify why we should study the subject of bio-
medical representations in popular culture by showing its influence on a larger
historical, social and political scale.
The handbook’s threefold division, and indeed the handbook itself, is based on the
observation that the connection between biomedical knowledge and its intersection
with popular culture sometimes seems to be taken for granted, meaning that there is
a distinct medical culture with a distinct set of signs to represent this culture in soci-
ety, which needs no further investigation. But a self-reflexive approach has to be
based on a set of means and methods to enter this semantic realm. By providing an
introductory and credible set of theories that shed light onto the problem of the
cultural representation of bio-scientific cultures in general, we try to highlight the
impact of medical knowledge on popular culture. Moreover, by showing that medi-
cal knowledge does indeed exist within and as cultural artefact, we are able to dis-
cern its many translations for non-specialist cultures, i.e. the general public. By
connecting the spheres of semiotic knowledge and communicative structures of the
medical culture and popular culture media in the second and third sections, we
prove that this connection actually is an important axis for our understanding of the
human condition, science and the arts. We hope that with such an approach, which
in effect provides a starting point for our topic, this handbook may provide both
young and more mature researchers with some of the tools available to anyone inter-
ested in the interaction between the life sciences and popular culture.
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Part I
Theories and Methods
Knowledge Production Between Popular
Culture and Scientific Culture
David A. Kirby
Science and entertainment represent two of the most powerful cultural institutions
that humans have developed to understand and explore their world. We are currently
experiencing a golden age for the fusion of science and popular culture. Academy
Award-winning films such as Gravity (Cuarón 2013) and The Theory of Everything
(Marsh 2014), and television ratings titans like CSI (Zuiker 2000) and The Big Bang
Theory (Lorre and Prady 2007) have proven that science–based entertainment prod-
ucts can be both critically acclaimed and financially successful. It is not just block-
buster movies and hit TV shows that have embraced science. Prominent high-traffic
science websites like xkcd (Munroe 2005) and I Fucking Love Science (Andrew
2012) demonstrate that there is a substantial audience for science-heavy popular
culture. Most people are not scientists. This means that the public encounters sci-
ence most often through depictions in movies, television shows, comic books and
computer games. The increasing fusion of science and entertainment has led to con-
cerns amongst scientists and policy makers about how entertainment depictions
might impact public perceptions of science and, thus, influence various arenas of
society including science itself.
Many scientists, in fact, believe that the communication of science in popular
culture, such as television and cinema, has been detrimental to the public under-
standing of science (Hawkes 1997; Hofstadter 1998; Leslie 2002; deGrasse Tyson
2002; Mooney and Kirshenbaum 2009). These scientists feel that more often than
not the science in popular culture is factually wrong, that scientists are portrayed as
evil or socially apathetic, and that scientific knowledge is inherently dangerous.
Scientists fear that the misrepresentations of science in popular culture are nega-
tively affecting public attitudes toward science and harming recruitment into sci-
ence. The National Science Foundation (NSF) singled out fictional media as a
D. A. Kirby (*)
Centre for the History of Science, Technology and Medicine, University of Manchester,
Manchester, UK
e-mail: David.Kirby@manchester.ac.uk

https://doi.org/10.1007/978-3-319-90677-5_2
16 D. A. Kirby
corrosive influence on science literacy and the public’s critical thinking skills.
According to the NSF’s 2006 Science & Engineering Indicators, “Forms of popular
culture, such as books and movies, affect what people know about science and
shape their attitudes toward science-related issues” (National Science Board 2006).
Scientists’ and scientific organizations’ concerns about science in popular cul-
ture are valid given the amount of science communicated through fictional media
(Weingart et al.’s 2003; Dudo et al. 2011; Dudo et al. 2014). Several studies of sci-
ence popularization also demonstrate that its cultural meanings, and not its knowl-
edge, may be the most significant element contributing to public attitudes towards
science (Nisbet and Scheufele 2009). Popular images of science can significantly
influence public attitudes towards it by shaping, cultivating, or reinforcing these
‘cultural meanings’ of science (Nisbet and Dudo 2013). There is also significant
evidence that popular cultural depictions of science have had a direct impact on
audience knowledge, beliefs and behavior (Kirby 2014; Tan et al. 2015). In addi-
tion, there is support for the belief that inaccurate popular portrayals have harmed
recruitment into science, especially amongst girls (Steinke et al. 2009).
Concerns about popular culture harming science literacy, altering public atti-
tudes towards science, impeding scientific research or impairing recruitment into
science have also motivated many members of the scientific community to become
involved in the making of popular cultural products. By serving as science consul-
tants, scientists can directly influence the ways in which entertainment products tell
stories about science. In fact, many high-profile scientific organizations in the U.S.
now believe that science communication can be both informative and entertaining.
These groups have developed initiatives including the National Academy of
Sciences’ Science and Entertainment Exchange, USC’s Hollywood Health and
Society program and the multi-sponsored Entertainment Industries Council that
connect entertainment industry professionals with top scientists and engineers.1
These initiatives have led to scientific involvement in projects as diverse as prestige
television series such as Breaking Bad (Gilligan 2008) and first person shooter com-
puter games like The Last of Us (Druckmann and Straley 2013). In fact, it would be
surprising today to have a U.S. produced film, TV or computer game production
containing substantial scientific content that did not involve a science consultant.
The entertainment industry’s growing use of science consultants is also linked to
an increased desire for realism across the popular culture landscape over the last
20 years. Contemporary entertainment media production practices emphasize real-
ism in every genre from fantasy to drama. The rise of the blockbuster ‘spectacle’
film in the 1990s, the development of sophisticated special effects technologies such
as CGI and the success of the gritty realism in Christopher Nolan’s Batman films
has resulted in a renewed emphasis on film realism (Hallam with Marshment 2000).
While the realist orientation of critically lauded ‘quality’ television dramas like
Homicide: Life on the Streets and Game of Thrones has also shifted television pro-
duction towards an enhanced realism (Haggins 2013). Likewise, computer game
1
Information about these organizations can be found at: www.scienceandentertainmentexchange.
org; www.hollywoodhealthandsociety.org; and www.eiconline.org
Knowledge Production Between Popular Culture and Scientific Culture 17
designers want the realism of their stories to match the realism of their increasingly
powerful visual graphics (Vorderer and Bryant 2012).
I find that ‘realism’ in popular culture incorporates three distinct components
(Kirby 2011). Naturalism or “visual realism” involves how our brains perceive an
artificially created image as an actual object. Visual realism is achieved when artifi-
cially created images are indistinguishable from images of real objects in a film.
Plausibility or “dramatic realism” requires that an artificially created image logically
fit into the narrative context of the film’s fictional world. A dragon may look entirely
visually realistic but it would not be considered dramatically realistic if it were
found in a historical drama about the Napoleonic Wars. Authenticity or “scientific
realism” is reached when an artificially created image corresponds to known scien-
tific laws. We consider the dinosaurs in Jurassic Park (1993) to be realistic because
they look real, they are scientifically authentic and they fit logically within the con-
text of the film’s plot. There has been a long-standing relationship between science
and conceptions of realism, which has led filmmakers, television producers and
computer game designers to increasingly look to science consultants to help them
ground their texts in a realist framework across all three of these components.
The heightened realism of visual mass media like film, television and computer
games have turned popular culture texts into powerful vehicles for science commu-
nication. The reality effect imparted by these media allows them to function as what
I term “virtual witnessing technologies” (Kirby 2003). Virtual witnessing technolo-
gies are those mass media that allow individuals to observe phenomena – such as
the dinosaurs in the film Jurassic World (Trevorrow 2015) or wormholes in the
computer game Mass Effect (Hudson 2007) – without the need to directly witness
these phenomena. The more visualization technologies advance, the better visual
mass media function as virtual witnessing technologies. Advances in special effects
and computer graphics have certainly created perceptually realistic images, but
visual mass media’s reality effect is imparted through the totality of the media con-
struct. Most importantly, perceptually realistic images are not extraneous features in
these popular culture texts. The images are integrated within a narrative structure
and characters in these texts treat the images as a ‘natural’ aspect of the landscape.
In essence, visual mass media’s reality effect naturalizes scientific images and
events within their fictionalized worlds. This mediated naturalization can have an
important influence on audiences’ perceptions of science and the natural world by
legitimizing and contextualizing scientific depictions.
I have written extensively about the phenomenon of science consultants for
mainstream cinema (Kirby 2011).2 Studying the collaborations between scientists
and the entertainment industry provides a unique opportunity to understand the
generalized nature of science in popular culture. It is always important to remember
2
The rationale behind my book Lab Coats in Hollywood was to treat popular culture seriously as
vehicles for science communication. Therefore, I examined the role that scientists play as consul-
tants for major Hollywood film productions. I explored the ways in which science consultants
shaped cinematic stories about science including scientific images and the depictions of scientist
characters.
18 D. A. Kirby
that popular culture texts are created products that need to be understood as cultural
processes rather than taken as cultural givens (Potter 2005).3 The created nature of
popular culture products – their ‘made-ness’ – renders these objects useful in under-
standing society’s relationship with science, because these entertainment products
reveal the kinds of stories people want to tell about and with science. Analyzing the
decisions made by filmmakers in consultation with scientists reveals the specific
ways in which entertainment professionals contemplate and then utilize science
within a creative, but also consumer driven, process. Science consultants have a
significant influence on the content of films across a range of production areas. This
means that our concept of what constitutes science in popular culture is far more
extensive than simplistic notions of ‘science’ as merely a collection of facts in a
textbook especially when we consider science as a larger cultural institution.
To take one example, almost every member of the biomedical thriller Contagion’s
(Soderbergh 2011) production sought advice from the film’s scientific expert Ian
Lipkin from Columbia University (2011). Kate Winslet and other actors wanted to
know how to act like virologists by learning how to pronounce scientific jargon and
perform laboratory procedures such as operating a pipette and collecting DNA sam-
ples. Acting like a scientist also meant understanding medical researchers’ motiva-
tions for undertaking a career in science. The set designer and special effects
supervisor required help visualizing a research space with appropriate equipment,
lab notebooks, and images on computer screens in order to create a sense that the
fictional laboratory was undertaking legitimate medical research. For makeup artists
it was crucial to know what clinical manifestations of the viral disease would look
like. Contagion’s scriptwriter needed assistance writing medical dialogue, fact
checking the script’s virology, and crafting a scenario by which a previously
unknown virus could spread quickly in a human population. For director Soderbergh
it was important to understand the institutional aspects of medical science such as
how the Centers for Disease Control responds to viral outbreaks and the relationship
between civilian scientists and the military during a potential bioterrorist attack.
This brief description of the scientific elements in Contagion highlights how
entertainment professionals look to scientific advisors to contribute to areas of
expertise beyond knowledge of scientific facts. Essentially, Lipkin provided the
same advising services on Contagion that scientific consultants have done for film
productions over the last 100 years. He helped filmmakers craft scientific visuals,
act like scientists, fact-check scripts, provide logical explanations for extraordinary
situations, and place science into its cultural contexts (Kirby 2011). Filmmakers
also look to scientists for help using science as a tool for drama and for tapping into
the creative and speculative aspects of scientific thought. This means that science in
popular culture encompasses all the significant elements in the fact-producing
process called science: a body of knowledge, methods, social interactions among
3
Taking a media text as a ‘cultural given’ means considering the text as an entity that exists outside
of its production process. Understanding a media text as a ‘cultural process’ means acknowledging
the text as the product of creative development undertaken by individuals who exist within a spe-
cific culture.
scientists, laboratory equipment, etc. Entertainment producers are asking consul-

tants to provide visual, verbal, symbolic and thematic cues that convey to audiences
that ‘science’ is on display including issues relating to the political, economical and
social uses of science. Ultimately, the situating of scientific content in popular cul-
ture contextualizes science’s implications for society, its value as a human activity,
the consequences of its use or misuse, and its ideological status (Kirby 2011).
Are the scientific elements in Contagion and other films that utilize science con-
sultants ‘accurate’? They are certainly more scientifically sound than they would
have been, had there not been scientists on hand during production. But I find that
scientific accuracy is a problematic lens by which to judge or study movie science.
Scientific accuracy is a trap that many scholars studying science in popular culture
fall into. Accuracy is certainly a major concern for those in the scientific commu-
nity. In fact, for many scientists such as Neil DeGrasse Tyson, scientific accuracy is
the only criterion they use to judge whether or not they consider a film to be success-
ful or not (Obenson 2015). This focus on accuracy often leads to a large number of
what I call “The Real Science of …” style analyses where scientists critique the
scientific accuracy of a fictional film (Kirby 2003).4 While I believe that there can
be entertainment value to be derived from pedantic dissections of movie science, I
find the notion of scientific accuracy in films to ultimately be a straw man argument.
Hollywood movies are not documentaries.
I find in my work that the concept of ‘accuracy’ is not a stable category when
applied to movie science (Kirby 2008). For example, how do we determine the sci-
entific accuracy for fantastical events or objects that don’t even exist in the real
world? John Underkoffler, the science consultant for the 2003 film Hulk, was not
concerned about scientific accuracy in this film (Kirby 2011). How could he be? A
‘scientifically accurate’ Hulk depends entirely on the existence of a real “Hulk”. We
can ask if the science in the film matches the comic book’s science, but asking if the
science of Hulk’s cinematic origin scene matches the real science of the Hulk is
meaningless. Instead of focusing on scientific accuracy, Underkoffler and the film-
makers were more concerned about creating a plausible explanation for Hulk’s ori-
gins. Plausibility directly relates to maintaining an audience’s suspension of
disbelief, and thus, their willingness to buy into a film’s fictional conceits that allows
them to enjoy the parts of the film that are not about science. For Hulk, audiences
just need to find the Hulk’s scientific backstory plausible enough so that they can
consider Hulk as possible within the context of the film’s world. That way they can
get on with what they came to a Hulk movie for, which is to see “Hulk smash!”
Science’s inherent flexibility also renders the concept of accuracy problematic.
Most filmmakers initially believed that science’s supposed rigidity would sap
their creativity and they were not convinced that a practice built upon objectivity
could help them create entertaining stories that are fictional. But their mistake was
to think of science as only a fixed collection of facts that entails single answers to
4
‘Real Science of…’ style analyses almost always accompany major motion picture releases. An
article in Time magazine about the science of Interstellar (Nolan 2014) is representative of a ‘Real
Science of…’ response (Kluger 2014).
20 D. A. Kirby
every question. Science is a much more flexible system than most people believe.
Scientists understand that scientific information is not a monolithic entity and that
most choices in science are not a binary decision between ‘accurate’ and ‘inac-
curate’. There are certainly explanations that are agreed upon as representing
natural law, but there is still a significant amount of uncertainty in science. In fact,
information coming from the scientific community often covers multiple aspects
of the same phenomenon or even contradictory explanations especially when we
consider cutting edge science. I refer to those cases where scientists are debating
about as to what represents the correct answer as “unsettled science”. Unsettled
science justifies artistic license but its uncertainty also validates filmmakers’
choices.
In addition to our limited understanding of natural phenomena, the natural world
also exhibits significant ‘variability’. There is often a range of answers for a given
scientific phenomenon that would be considered scientifically accurate. This natural
variability provides filmmakers leeway in their cinematic depictions. A depiction
that falls within the accepted range for what is possible is still an accurate depiction
of nature even if it exists at the extreme end of the accepted range. In the same way
that filmmakers use the lack of scientific consensus in unsettled science to their
advantage, the variability of the natural world also provides filmmakers with plenty
of room for interpretive flexibility. Once filmmakers understood science’s inherent
flexibility they realized they could use legitimate science in much more creative
ways. The ambiguity of unsettled science and the concept of variability also chal-
lenge the nature of scientific accuracy in popular culture.
Another problem with analyzing science in cinema through the lens of accuracy
is that it disregards the process of film production. Academic analyses that revolve
around the concept of scientific accuracy make science in cinema exclusively about
science without acknowledging that cinematic processes are far more important
determinants of scientific representations. There are certainly scientific facts that are
very well established with no real flexibility, which is a category of science that I
refer to as “textbook science”. There are a multitude of books and articles discuss-
ing the inaccuracies of textbook science in popular culture that refer to these depic-
tions as “bad science.” What they mean when they call something in a movie “bad
science” is that they find that these depictions do not match our real-world knowl-
edge of science. But this phrase ignores the fact that there are many legitimate film-
making reasons to explain why the filmmakers depicted scientific content in a
particular way sometimes inaccurately.
Filmmakers must constantly make determinations as to whether adhering to sci-
entific accuracy would seriously hinder their film’s entertainment value or if it is
even technologically possible to depict accurately. There are a number of legitimate
filmmaking constraints that filmmakers face when they incorporate scientific con-
tent including budget, technical limitations, dramatic needs, narrative necessity or
aesthetic requirements. As Robert Heinlein said while working as a science consul-
tant for the film Destination Moon (Pichel 1950), “Realism is confoundedly expen-
sive” (Heinlein 1992: 123). Filmmakers must also negotiate scientific facts within
specific contexts of narrative, genre and audience. The pressure for filmmakers to
adhere to accuracy is far less for a comedy than it is for a historical drama.
Filmmakers also take into account additional criteria in deciding how to deal with
established facts in cinema such as how likely it is that the general public will rec-
ognize deviations from accuracy and what to do when an established fact contra-
dicts audience expectations.5 Scientific facts serve as the starting point for filmmakers
who then use their own professional judgment to determine if, and how, these facts
must be subverted during production. This means that analyses of popular cultural
products need to consider all the factors that shaped scientific depictions including
those imposed by the constraints of media practices.
I am not arguing that the integrity of the science in popular culture is irrelevant.
There are many instances where scientific falsehoods in popular culture can be
harmful to public welfare, especially if the depictions concern information about
health and medicine. Ultimately, studies of science and popular culture bring into
focus the power of fictional narratives to shape our “cultural meanings of science”
(Gauchat 2011). But popular culture’s influence on the cultural meanings of science
does not often depend on whether or not these fictional images match real world
science. Popular cultural depictions of science involve the production and presenta-
tion of an image of science whether or not the science has anything to do with ‘real’
science. These images of science, both real and unreal, carry a cultural currency that
can add meaning and value to the construction of ideas and to our perceptions of
science as a social, cultural and political force.
Science is a knowledge-producing activity that allows us to construct an under-
standing of the external world. This knowledge is used in various forms: to build
scientific theories, to stimulate further knowledge production, and to develop new
technologies such as medical therapies and nanomaterials. Scientific knowledge
also informs opinions and guides behavior whether it is on health related issues or
on energy production. Popular cultural images and narratives can have a significant
impact on the public’s conceptions of science by provoking reactions from encour-
aging enthusiasm for the scientific endeavor to instilling fear about science and
technology and often both. The presentation of science within a mediated frame-
work can convince the public of the validity of scientific ideas, create public excite-
ment about research agendas or nascent technologies, and shape science’s
institutional identity including the notion of science as an institution. Popular cul-
ture products have also proven to be an extremely effective way to raise awareness
and convince the public that a scientific issue needs more political, financial, and
scientific attention. The demonstrated impact that popular cultural depictions have
on public attitudes towards science and scientific research, recruitment into science
and audience knowledge means that the cultural stakes are too high to for us not to
better understand the intersection between science and popular culture.
5
I refer to facts that are likely to be known by a majority of the public fall into the category as
“public science”. Facts that are relatively unknown outside an expert community I designate as
“expert science”. While I use “folk science” to refer to incorrect science that is nonetheless widely
accepted by the public as true. See Kirby (2011, Ch. 5).
22 D. A. Kirby
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Cool Geeks, Dangerous Nerds,
Entrepreneurial Scientists and Idealistic
Physicians? Exploring Science
and Medicine in Popular Culture
Joachim Allgaier
Introduction
Why should we study the representation of the sciences and biomedicine in popular
culture? Popular culture and entertainment media often include and connect to top-
ics, themes and issues from the world of the sciences and biomedicine. Of course,
they do not portray these issues neutrally (as little as news media do) but often
attach names and faces, values and interpretations, mostly stories of people in par-
ticular circumstances or, in other words, particular ways of approaching, framing
and interpreting these topics. The portrayal of science and medicine in popular cul-
ture might be entirely blown out of proportion, may be biased, twisted and distorted,
and can be scientifically correct or incorrect. However, what is important is that
these stories and representations have different effects and influences on various
audiences (e.g. Nelkin and Lindee 2004; Petersen et al. 2005) and, sometimes, they
even have repercussions in the world of science, medicine and research (Turney
1998). This chapter provides an introduction and overview to the expansive, but
timely topic of how science, medicine and popular culture interrelate, and looks at
some of the prevalent stereotypes regarding scientists and physicians that exist in
popular culture.
J. Allgaier (*)
Department of Science, Technology and Society Studies, Alpen-Adria-University,
Klagenfurt, Austria
e-mail: Joachim.Allgaier@aau.at

https://doi.org/10.1007/978-3-319-90677-5_3
26 J. Allgaier
I nteractions Between Science, Research, Biomedicine

and Popular Culture
The popular sci-fi television franchise Star Trek has not only inspired inventors to
come up with mobile communication and computing devices, but also with replica-
tors (3D printing) and the holodeck (Virtual Reality). The US space agency National
Aeronautics and Space Administration (NASA) frequently refers to the television
program and even teams up with actors who impersonate Star Trek characters to
recruit young astronauts and to engage with various audiences (Penley 1997). In
medical research, a team from Leicester University has developed a ‘Star Trek-
style’ medical suite that Leicester Royal Infirmary uses in its Accident and
Emergency Unit. The scientists involved said that the technology was pioneering
and developed based on the ultimate non-invasive diagnostics seen in Star Trek
(BBC news 2011). The mobile communication giant Qualcomm also refers to the
hyper-functional non-invasive diagnostic tool in Star Trek, known as Tricorder, in
the Qualcomm Tricorder XPrize competition. In early 2017, the company will
award US$10 million in prizes to teams that make a real-world medical diagnostic
device inspired by the Star Trek tricorder (Guevin 2015). Some medical researchers
have also engaged with the medical plausibility of events in Star Trek, which they
examined and evaluated in scientific journals (for instance: Chyka et al. 1999).
When revisiting the history of soda drinks, Nickell (2011) demonstrated that other
routes concerning medicine and popular culture are also possible and showed that
what once were patent medicines could subsequently be showpiece examples of
Western popular culture, such as the iconic Coca Cola and Pepsi Cola soft drinks.
Sometimes even real medical doctors can be inspired in their work by fictional tele-
vision doctors (Dahms et al. 2014). In addition, some scientists, researchers and
medical doctors have made their work accessible and interesting for various audi-
ences by using popular cultural formats. For instance, biologist Jay Hosler produces
popular comics on evolution, mites and bees based on his own research on bees in
order to educate and inform the public (Lodge 2015). Moreover, under the banner
of Graphic Medicine, physicians and health care workers come together to use com-
ics and cartoons in order to publicly discuss and illuminate various issues concern-
ing medicine, health and illness (Czerwiec et al. 2015). Thus, there are many and
sometimes surprising connections between science, research, medicine and popular
culture and it is worth looking at these analytically for various reasons.1
1
As mentioned above there are various routes that can be taken: science and biomedical innova-
tions can be influenced and inspired by products of popular culture and vice versa. References
from popular culture are also employed to publicly communicate on science and research, and
sometimes such references are even used in inter-scientific communications, such as in journal
articles. Another interesting example is the roboticist and Cherokee citizen Daniel H. Wilson, who
published scientific articles on his research on robots and wrote popular science texts on robotics,
but is better well-known for his best-selling fiction tech novels Amped, Robocalypse and
Robogenesis (see: http://www.danielhwilson.com). The interactions between science and popular
culture are manifold and versatile and the whole field of study is too under-researched so far to
Cool Geeks, Dangerous Nerds, Entrepreneurial Scientists and Idealistic Physicians… 27
Science, Medicine and the Public
Public knowledge of science and medicine is generally the outcome of formal sci-
ence learning, as in schools, and informal learning of science, such as encounters
with scientific and medical contents and issues in the media and in popular culture.
When formal science education is completed, informal accounts of developments in
science and technology, such as through the media and popular culture, are very
important sources of knowledge for most people.
Research on science and health communication and the public engagement with
science and medicine has so far strongly focused on scientific content in journalistic
news media and only very few studies have seriously examined other products of
media and popular culture. However, media scholars such as Görke and Ruhrmann
(2003) and Maio (2006) stress that entertainment media also influence public per-
ceptions of the life sciences and medicine, such as genetic risks or beliefs and preju-
dices regarding biotechnology, and should therefore be studied accordingly (see
also Kirby 2004, 2007). From this point of view, it makes perfect sense to investi-
gate science and medicine in entertainment media and popular culture. In this con-
text, however, it is also very important to keep recent information and communication
technologydevelopments in mind. For instance, new online platforms and social
media sites such as Reddit or Facebook provide new technological infrastructures,
which channel information on science and medicine in a particular way, for instance
by mixing them with jokes or other entertainment formats (Marsh 2016). The
online-video sharing site YouTube has become a very popular public information
channel on issues concerning science, technology and medicine. However, the site
is not curated and there is no quality control in place. As a consequence, almost
anything can come up if one searches for scientific or biomedical terms, conven-
tions, styles, formats are mixed up, and scientific, biomedical, journalistic, enter-
tainment and other media cultures and genres commingle on this platform and it is
difficult to tell them apart (Allgaier 2016a).
Of course, science education and science journalism are still important sources
of information for many people. However, the historian A. Bowdoin Van Riper
(2003: 1104) addressed a central problem: “Popular culture probably does more
than formal science education to shape most people’s understanding of science and
scientists. It is more pervasive, more eye-catching, and (with rare exceptions) more
memorable.” When science and medicine are represented in popular culture, scien-
tific and medical ideas and terminology are thereby becoming “rooted” in the every-
day life of citizens (e.g. Huang and Allgaier 2015). They encounter these ideas and
terms in particular contexts and they may, of course, be used in appropriate, inap-
propriate and biased ways. In comparison to journalistic accounts where mainly
experts are heard talking about the life sciences and biomedicine, many popular
cultural formats offer forums and perspectives of various types of people, as in the
fully illuminate the complexities between public images and opinion, entertainment and popular
culture and the professional practices of scientists, engineers and biomedical experts.
28 J. Allgaier
example of those who are affected by various medical conditions or treatments. It is

likely that these encounters stick with many people in a conscious or unconscious
way. The bad news for science is that much of the science presented in popular cul-
ture, such as in fictional movies, is scientifically incorrect or incorporate distorted
and unrealistic images of how science and research works (Van Riper 2002).
However, in order to counter particularly unrealistic, distorted and biased represen-
tations, it is important to know them first.
In popular culture, various elements of science and medicine are woven into
particular stories that often address questions of ethics, meaning, identity, power,
values and other aspects that make these stories relevant for large shares of the
population (e.g. Allgaier 2014a). One may add that soap operas, popular music,
fictional movies, novels and comic books are consumed voluntarily and joyfully by
many people, and not just by those with an interest in science and medicine. For
researchers and scientific institutions this means that it is important and relevant to
follow up on how their area of expertise is covered not just in the news, but also in
entertainment media and popular culture in general. For instance, it is important for
the recruitment of young students (and for recruiting probands in experimental con-
texts) to have a positive public image, but also for the public and political legitima-
tion of research and research funding. Health related topics are generally heavily
overrepresented in media accounts of science and research2 (e.g. Allgaier 2014b)
and probably also in entertainment culture (just think of the many hospital and
medical doctor television series and dramas). The portrayal of biomedicine, health,
illness and disease in popular culture may have a direct effect on the public image
of physicians, on doctor-patient relationships, the perception of stigma and so on
(e.g. Lupton 2012). For instance, massive harm could be done if miracle cures with-
out scientific basis are promoted in hospital and doctors’ television series. At the
same time, entertainment formats can also be extremely useful for informing citi-
zens and patients about new biomedical knowledge and treatment methods, and
they can even be used to portray medical conditions positively and thereby attempt
to decrease the stigmatisation of particular medical conditions (e.g. Hinshaw 2007).
Clearly, the effects of science and medicine in entertainment formats and popular
culture can go in all kinds of different directions. For instance, it has been argued
that the popular American crime television series Breaking Bad (Gilligan 2008)
may contribute to the rather negative image of a scientific discipline, namely chem-
istry (Hartings and Fahy 2011; Fahy 2013). At the same time, a television series
such as ReGenesis (Jacobson 2004) from Canada, which follows a team of life sci-
entists fighting against viruses and other health threats, could realistically show how
biomedical researchers work in order to tackle yet unknown public health problems
and rapidly spreading infections (Rohn 2008). In this particular example, the series
2
Science communication researcher Martin Bauer (1998: 745) speculates: “It would appear that
the medicalisation of science news is a correlate of […] larger changes in society, celebrating the
successes of medical sciences, anticipating breakthroughs on the health front, and mobilizing an
ever greater demand for medication and services. Hence, the explanation of medicalization as a
social trend may also explain the medicalization of science news.”
has indeed been used for public informal science learning regarding the life sciences
and biotechnology: the not-for-profit Ontario Genomic Institute partnered with the
makers of the television program in order to produce factsheets for each episode and
these, in turn, confirmed the reality of the science behind its episodes (Ontario
Genomics Institute 2011). Therefore, popular entertainment media can also play a
tremendously important role in public health communication and health education
(The Henry J. Kaiser Family Foundation 2004; Alexander et al. 2006; Smith 2010).
However, science and health communication researchers have just begun to
investigate how science, research and medicine are addressed in popular entertain-
ment media, such as comic books (Tatalovic 2009), popular music (Huang and
Allgaier 2015), and music videos (Allgaier 2013), or digital games (Dudo et al.
2014), and what their effects are (e.g. Lin et al. 2014). Recently, researchers found
that scientists are no longer seen and treated as mad, evil or dangerous. In the wake
of the industrialisation of biomedicine and biotechnology, researchers are no longer
only portrayed as descendants of Victor Frankenstein (e.g. Turney 1998; Drux
1999), but as people with entrepreneurial spirit and cementing ties between science
and industry.
ictional Representations of Scientists, Physicians

F
and Psychiatrists
The question of how scientists and researchers have been portrayed in popular cul-
ture is of special importance if one wants to understand the representation of science
and research in popular culture and public opinion more generally. It seems fair to
say that the picture that emerges if one examines the public image of scientists and
researchers in popular culture is one where science and society are strictly sepa-
rated, especially so in the early twentieth century. A prevalent image of the scientist
and researcher is the one of the mad scientist (for instance: Tudor 1989; Skal 1998;
Junge and Ohlhoff 2004), a negative stereotype of the mainly male researcher who
is viciously smart and inventive, often close to a being a genius, but unfortunately
also irresponsible, potentially dangerous and not rarely insane. This image usually
portrays researchers and scientists to be engrossed, lacking empathy, and often con-
ducting their research secretly in dark underground laboratories or other concealed
and uncanny places. This stereotypical image is still found today, for instance in
some digital games or comic books. Therefore, it is no wonder that science and
research had a rather negative and threatening public image in the early twentieth
century. However, it is not quite as simple as that; Roslynn Haynes (1994) con-
ducted a comprehensive study on the representation of scientists and researchers in
literature and film in the twentieth century and found six recurrent stereotypes of
scientists and researchers: the mad scientist (or alchemist), the absent-minded pro-
fessor, the inhuman-rationalist, the heroic adventurer, the helpless researcher or sci-
entist, and the social idealist. The depiction of scientists and researchers in popular
30 J. Allgaier
culture is important as they can have an impact on the perception and public image
of real scientists and researchers (Pansegrau 2008). However, it should be noted that
how scientists and researchers perform their work is rarely reported. Weingart
(2006) speculates that the depiction of scientific practice does not work well with
visual story-telling because it is often too abstract and difficult too present in images.
However, with regard to the stereotypes of scientists, it must be mentioned that
they are not evenly distributed in popular culture. Various popular film and literature
genres often portray scientists and researchers in different ways. For instance, the
bad, dangerous and mad scientist is often found in the science fiction or horror
genre, while we often find the absent-minded professor in comedies, and the social
idealist in medical and other dramas. The mad scientist stereotype is one that is
particularly widespread, especially in films and books from the 1920s to the 1960s
when the general public was confronted with a plethora of potential threats––from
atomic bombs and radioactive contamination, to moral threats, chemical pollution
and biological mutations––all stemming from the world of science and research
(e.g. Tudor 1989; Skal 1998; Frayling 2005). At that time, science and research
were often perceived as being something alien to social life, a career path that was
only suitable for a few particularly intelligent but reclusive or devoted people and
not an activity for the common man or woman on the street. In other words, what
was happening in the research laboratories of universities and industrial research
and development departments was hidden from public social life, and speculation
and fictitious accounts often replaced public knowledge and common sense about
what was actually happening. The scientists and researchers themselves avoided
public discussion about their work and did not want to engage with or include the
public in matters concerning science and research during that time.
However, there was also another visible tendency; during the 1930s and 1940s
the scientist biopic was also a popular movie format in Hollywood. The films in this
genre mainly revolved around personal tragedies and the modern miracles that sci-
ence, research and modern medicine could achieve (Kirby 2014). The stereotypes of
scientists and physicians in the biopics were that they are idealistic, visionary and
progressive (see also: Hansen 2009). From the 1990s onwards a new type of scien-
tist appeared in popular culture, particularly in the action movie genre: the heroic
scientist (Kirby 2014). It is worth noting that during this period many of the heroic
scientist characters were women (see Flicker 2003). For instance, Jocelyn Steinke
(2005) analysed 74 science-based Hollywood films of this period and found that one
third featured female scientists and engineers. In contrast to previous portrayals,
these female researchers were depicted more realistically and positively, and not
necessarily conforming to traditional gender stereotypes as was often the case.
Various authors found that from the late 1990s and the beginning of the twenty-first
century, scientists and researchers were portrayed more emphatically and realisti-
cally in popular culture and now only rarely as threatening lunatics (Haynes 2014).
However, when studying the depiction of synthetic biology in fiction films, Meyer
et al. (2013) found that scientists were no longer associated with dangerous psycho-
paths and instead, in many cases were portrayed as entrepreneurial scientists with
close ties to businesses and industries, modelled on real life scientists and entrepre-
neurs such as the geneticist Craig Venter (see also: Schneider 2004).
Stollfuss Stollfuß (2010) analysed the depiction of science and research in cur-
rent fictional television series and found that the portrayal of science and research
has become more realistic and recently comes often with an affinity for scientific
realism. Accordingly, Dudo et al. (2011), in a study concerned with the representa-
tion of scientists and researchers in fictional television programmes in the United
States (US), have also found that their portrayal has, in the last 20 years, become
more differentiated and in general more positive than in the previous century.
Interestingly, the public image changes if the focus is on medical doctors and
physicians. For instance, Flores (2002, 2004) conducted an analysis of the portrayal
of medical doctors and physicians in fictional movies, reviewing 131 films from
nine countries, spanning eight decades. Flores found that the stereotypical movie
physician is a white male surgeon in his 30s practicing at a hospital.3 Women and
minorities were strikingly under-represented in movies with physicians as main
characters. Physician movies were most often categorized as dramas, followed by
comedies and horror films. In about half of these movies, doctors were portrayed in
a positive light. However, Flores also found that compassion and idealism were
common in early doctor movie portrayals, but have become increasingly scarce in
recent decades. In stark contrast to the portrayal of scientists and researchers, the
positive portrayal of doctors has declined since the 1960s while negative portrayals
have increased. The mad scientist was still the most common negative depiction
(20% of all portrayals) in Flores’ sample of physician films, in this case as doctor-
researchers who valued research more than patients’ welfare. In total, 44% of film
physicians were portrayed negatively. Medical doctors were frequently depicted as
greedy, egotistical, uncaring, and unethical, especially in more recent films. Flores
found medical inaccuracies in 27% of the physician films, and almost one-third
(30%) of the cinematic medical conditions consisted of various sorts of trauma. In
many of the movies analysed, medical doctors also engaged in unethical and unpro-
fessional behaviour.4 In the same sample, many doctors did not care about obtaining
informed consent from patients and many physicians were portrayed as having a
god complex (or at least enormous egos). Flores (2002, 2004) concluded that his
review of 131 physician movies indicates that the film industry is preoccupied with
sex (e.g. doctors having sex with patients), violence (with many medical conditions
being of a violent nature) and youth (as 58% of the movie physicians were under the
age of 40, whereas in reality 55% of US physicians are 45 years or older). Flores
worries that because negative portrayal of doctors is on the rise, patients’ expecta-
tions and the doctor–patient relationship may be adversely affected by these m ovies.
3
Eighty-five percent of the movie physicians in his sample were male and only 15% female, and
91% were white (Flores 2002, 2004).
4
For instance, many of them were having sexual intercourse with their patients. Movie psychia-
trists most frequently slept with their patients (this was the case in 29% of the movies with psychia-
trists as main characters, but the trend drastically increased in the last two decades of the sample
period) (Flores 2002, 2004).
32 J. Allgaier
Nonetheless, Flores (2002, 2004) suggests that films about doctors can also serve as
useful gauges of public opinion and tools for medical education.5
A more recent study on the representation of physicians in movies (Virzi et al.
2011) largely confirms Flores’ results. The authors analysed the image of medical
doctors and the doctor-patient relationship in 292 movies from 1909 to 2007. Their
results indicate that, in cinematic depictions, the stereotypical doctor is an American
(58.2%) male (88.7%), between 30 and 60 years of age (68.8%) who works as a
general practitioner (36.6%). When women are depicted as physicians they are
mostly young (63.6%) and their post-graduate studies qualification is mostly in psy-
chiatry (42.4%). The cinematographic genres which feature physicians are drama
(54.5%), comedy (22.6%), and thrillers (6.2%). More than half (52.1%) of the por-
trayals of physicians in the analysed movies were negative, and these negative por-
trayals increased, especially in the last decade of the sample (69%). Up to the 1960s,
doctors were described in a positive way, often as heroic physicians; but between
the 1960s and the 1980s negative depictions prevailed, very often with satirical con-
notations. Virzi et al. (2011) concluded that these movies simply reflected what was
happening in society at that time: The so-called “Golden Age” of medicine (see:
Burnham 1982) was declining and as a consequence the physician appeared more
impersonal and open to criticism. Virzi et al. (2011) assert that the reasons for this
were not only due to the major diffusion of chronic diseases which required long-
term therapy, thus underlining the physician’s lack of relational and humanistic
preparation, but also to the diffusion of hyper-specialized medicine and new techno-
logical discoveries, that shifted the responsibility of any errors or failures onto the
physician. However, from the 1950s onwards, new genres including medical thrill-
ers and medical horror arrived, and in the 1980s physicians slowly began to lose
their charm and authority and much of the criticism lost the humorous and satirical
connotations, thus becoming tougher and more direct, and particularly centred on
the doctor–patient relationship. Another trend concerns the image of the female
doctor. While in the 1930s only 4% of doctors where female, the number rose to
24.1% in the final decade of the study. It is also noteworthy that female doctors were
principally portrayed in a positive way (69.7% versus 49.8% of men). The authors
conclude that it is necessary and relevant to assess and identify the most useful titles
for didactic purposes. However, the authors caution that it is also important to take
the critique of modern biomedicine that is transported in many, especially recent,
fictional movies seriously, in particular when it is concerning the need to re-
humanise medicine.
5
For instance, when clips from movies are used to teach students about empathy and compassion.
The Public Communication of Science and Biomedicine
Some parts of the scientific and biomedical community have begun to take the rep-
resentation of science and medicine in popular culture more seriously, for instance,
by supporting collaborations between creative industries and scientific experts. In
the U.S., for example, the National Academy of Sciences has put a Science &
Entertainment Exchange project in place (Kirby 2010). This project aims to connect
entertainment industry professionals with scientists and biomedical experts in order
to create a synergy between accurate science, medicine and engaging storylines in
both film and television programming.6 In Germany, a range of scientific institu-
tions has connected with script writers, television and other creative experts to pro-
duce an exclusive romantic science soap opera called Sturm des Wissens (Storm of
Knowledge) (Böhm 2013), which has the intention of making scientific subjects
attractive for young women to draw them into scientific careers (Allgaier 2016b).
In addition to the life sciences, biomedicine is also dependent on political and
public trust and support in order to exist. For the further existence of science and
research, it is crucial that members of the public understand why science and
research are important. For instance, a substantial part of their taxes is invested in
biomedicine, science and research and hence it is important that members of the
public agree with this use. Therefore, various efforts have been made by the scien-
tific community to ‘better communicate’ science, particularly in the mass media, in
various outreach and public relations activities (such as open days, “long public
nights of research” or visits by scientists in schools), and other formal and informal
science communication initiatives (e.g. Gregory and Miller 1998). However, vari-
ous problems are encountered during this process. For instance, in public science
events often a self-selection process is taking place: people who already hold posi-
tive attitudes towards science attend these events, whereas people who are not inter-
ested or have an ambivalent attitude towards science and medicine will stay away.
Therefore, to reach various audiences is no simple task. In addition, it has been
found that members of the public do not necessarily appreciate science and medi-
cine more if they are better informed about it (e.g. Irwin and Wynne 1996). Another
problem is that science needs to be sufficiently distant from the general public to
retain its authority, and at the same time, needs to be sufficiently understood by citi-
zens to retain its legitimacy (e.g. Broks 2006). In addition, science and research
institutions do not only need to be concerned about their authority and trustworthi-
ness, they also need to cultivate a positive public image. This is especially important
for attracting young people to study scientific subjects and follow scientific and
biomedical research careers in order that science and biomedicine as professional
cultures can continue. Thus, it is very helpful if popular culture provides positive
role models that can be used to illustrate that science and research are also “cool”
(Kohlenberger 2015). In this context, it is also interesting to note how the public
6
Many Hollywood und television productions nowadays rely on the expertise of scientific consul-
tants and other experts (Kirby 2010).
34 J. Allgaier
image of nerds and geeks has changed in popular culture in recent decades. While
the nerd, often portrayed as a physically inferior male with thick glasses and an
obsession with computers, technology and hard sciences, was ridiculed in much of
the popculture of the 1980s, the geek stereotype that emerged in the late 1990s was
more influential and differentiated. As many members of society realized that they
are surrounded by and are often also dependent on science and technology, people
with skills and an affinity for technology and research became more powerful, and
potentially more dangerous than before (Rützel 2014). For instance, in the contem-
porary action genre, a tech-savvy sidekick (female or male) has become an essential
component to aid the action heroine or hero in contemporary high tech society to
help her or him overcome technological challenges (Svalastog and Allgaier 2016).
One might even say that with television sitcoms such as The Big Bang Theory (Lorre
and Prady 2007), The IT Crowd (Atalla 2006) or Silicon Valley (Krinsky et al. 2014),
the geeks themselves have finally entered the stage as intelligent, yet sometimes
clumsy everyday heroes that are characterised by their science and technology
skills. Kohlenberger (2015: 169) concluded the following regarding The Big Bang
Theory: “The comic derision that the protagonists repeatedly have to suffer is thus
a key to defusing the perceived cognitive superiority of science, which enables the
viewer to no longer perceive the subject as intimidating or threatening.” In fact,
depicting geeks as funny and cool can help to legitimize science in the public and
contribute to positive public images of science and research: “What the sitcom,
however, clearly shares with other cultural productions thematising science is that
coolness can be understood as a direct consequence of, rather than an antonym to,
the use of scientifically informed storylines and the resulting rational, detached
worldview of its main characters” (Kohlenberger 2015: 170).
Challenges and Outlook
Opponents of science and biomedicine are working hard in order to undermine pub-
lic trust and support in science and research. This is happening for various reasons:
the tobacco and oil industries are motivated by profits, anti-evolutionists often argue
on a religious basis and opponents of public health strategies such as vaccination
programs and deniers of climate change have various reasons and intentions to deny
scientific interpretations and evidence. There is no such thing as a unified anti-
science movement and many different groups that attack science and biomedicine
for various reasons do so from different points of view. In this context, it should be
mentioned that at least some of these ‘opponents’ of science and research and medi-
cal charlatans, such as creationists or alternative healers, also hire creative and pub-
lic relations professionals to attack science in products of popular culture (e.g.
Forest and Gross 2004; Allgaier 2013), and sometimes may also recruit very influ-
ential celebrities to spread their messages (e.g. Caulfield 2015). Often they are
financially very well equipped, as followers donate money for propaganda crusades,
or because they are closely tied to major industries (e.g. tobacco companies, oil
industry or alternative healing industries). The budgets for science communication

purposes in scientific institutions, which could possibly counter them, are generally
much smaller and are often on the decline (e.g. Yandell 2013). In this sense, popular
culture and particularly online social media, in which no editorial control is in place,
can be seen as public battlegrounds where misinformation and conspiracy theories
concerning health and science can thrive and where it is very difficult to counter
them effectively once they have been unleashed (Allgaier and Svalstog 2015). In
some cases, science communication activities may also have embraced the formats
of popular culture a bit too much. Just think of young researchers publicly ‘dancing’
their PhDs, sexy science cheerleaders and so on.7 Kaeser (2009) rightfully asserts
that the focus on entertainment and public spectacle in many such activities often
trivializes science and may actually lead to an erosion of trust in scientific expertise
(see also Allgaier 2010). Nonetheless, for the public image of science and medicine,
as well as for the ongoing recruitment of young people into scientific and biomedi-
cal careers, it is crucial to know how science, research and medicine are portrayed
in entertainment media. Fortunately, various scientific, medical and research institu-
tions have already started to engage with the production and representation of sci-
ence and medicine in popular culture (Kirby 2010; Kirby et al. 2015). It is wise to
do so, especially when we engage with the words of the social philosopher Max
Horkheimer, who already in the early 1940s, observed the importance of the enter-
tainment industry:
In democratic countries, the final decision no longer rests with the educated but with the
amusement industry. Popularity consists of the unrestricted accommodation of the people
to what the amusement industry thinks they like. (Horkheimer 1941: 303)
To date, research on the public communication of science and biomedicine has

strongly focused on the representation of these in elite media, such as broadsheet
newspapers, science documentaries on TV or particular exhibitions in museums and
so on; in other words, cultural products that are generally consumed only by the
higher strata of society (Allgaier and Riesch 2015; Allgaier 2016c). What this chap-
ter suggests is that it is time to take science, research and biomedicine in entertain-
ment and popular culture seriously and devote at least some of our attention to this
influential sphere. These cultural products have generally been associated with mass
culture that is consumed by a large share of the general population (and in that sense
also by at least some scientists and physicians). For example, Bankes (2016) studied
the role science played in the US animated television sitcom Southpark and in this
context he suggested not only examining whether the representation of science in
products of popular and entertainment culture is adequate or correct, but to under-
stand the embedded ideas and functions that science has in various entertainment
formats. There is still a lot of work to be done in this area of study and science com-
munication researchers have just begun to ask relevant questions such as, the role
7
For instance in this video the geneticist Josef Penninger is publicly ‘dancing’ his PhD: http://
www.youtube.com/watch?v=jQMx8duCJw0 (accessed: March 22, 2016).
This is the website of the Science Cheerleaders:
http://www.sciencecheerleader.com (accessed: March 22, 2016).
36 J. Allgaier
that humour (Riesch 2015) plays in the public communication of science and bio-
medicine. The proliferation of media and information channels on the internet will
probably further dilute public attention to matters concerning science, research and
biomedicine. In this context it is likely that the public communication of science and
medicine will need to take more notice of what is happening in the entertainment
sector, and think about how to successfully engage with entertainment formats in
order to be heard. The big challenge remaining is how to respond adequately and
successfully to negative stereotypes, and biased and wrong information about sci-
ence and medicine in popular culture in general, and social media sites on the web
in particular.
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Biomedicine and Bioethics
Heiner Fangerau and Gisela Badura-Lotter
Introduction
Medicine has always been important in western culture. However, western scientific
medicine is itself a cultural product of western societies (Lupton 2012: VIII). During
the second half of the twentieth century, the term ‘biomedicine’ was increasingly
used to describe what western scientific medicine is like. Today, popular culture is
one way in which we reflect upon its benefits, risks, and — if human action is con-
sidered — its bioethical dimensions. Patients, doctors, health, and disease are por-
trayed in comics, books, films, music, and other art forms, often within contexts that
tackle bioethical questions (see for example, Dans 2000; Hansen 2009). In this
chapter, we will establish what is now called ‘biomedicine’, explain what is gener-
ally understood as bioethics, and describe, with examples, how the analysis of rep-
resentations of biomedical ethics in pop cultural products, such as computer games,
can help us understand current trends in bioethical reasoning with regard to
biomedicine.
Biological Medicine and Biomedicine
In 1881, the British biologist Thomas Henry Huxley addressed the 7th International
Medical Congress on Medicine in London on “the connection of the biological sci-
ences with medicine”. In this address, he argued that medicine had become a
H. Fangerau (*)
e-mail: heiner.fangerau@uni-duesseldorf.de
G. Badura-Lotter
berg_kulturbüro, Ramsau b. Berchtesgaden, Germany

https://doi.org/10.1007/978-3-319-90677-5_4
42 H. Fangerau and G. Badura-Lotter
practical branch of knowledge that was then on the verge of becoming a science,
after the development of physiological research in the eighteenth century. From his
perspective, pathology is a branch of biology and he predicted in the final part of his
paper that “the future of Pathology and of Therapeutics, and therefore that of
Practical Medicine” would depend “upon the extent to which those who occupy
themselves with these subjects are trained in the methods and impregnated with the
fundamental truths of biology” (Huxley 1881). Although it took until the 1920s for
the term ‘biomedicine’ to be officially introduced into Dorland’s Medical Dictionary
and another 40 years until the term was used regularly in print, Huxley’s prediction
forecast the direction that scientific medicine took throughout the nineteenth and
twentieth centuries. As Keating and Cambrosio have shown (Keating and Cambrosio
2003: 51–53) and as databank searches in PubMed (the former Index Medicus), the
Web of Science, and Google Books confirm, the portmanteau term ‘biomedicine’
was not really established before the end of World War II. Nevertheless, the diction-
ary definition of ‘biomedicine’ in 1923, “clinical medicine based on the principles
of physiology and biochemistry” (Dorland 1923: 172), captures in a nutshell what
most people consider biomedicine to be.
In a detailed account, Bruno Strasser linked the traditional understanding of bio-
medicine to laboratory research and experimentation rather than to clinical medi-
cine (Strasser 2014). The protagonists themselves regarded their work as ‘basic’
rather than ‘applied’ (Scheffler and Strasser 2015: 664). Nevertheless, as early as
the beginning of the twentieth century, (clinical) professionals have argued for
cooperation between the basic research of biology and clinical practice, to achieve
a “unity of the medical sciences” (Welch 1906). The warnings of the health-care
professionals who argued that medicine is a diverse and specialized, albeit single,
integrative and unified field of knowledge may explain why it took so long for ‘bio-
medicine’ to become synonymous with ‘western medicine’ or ‘scientific medicine’.
Only in the last third of the twentieth century did the basic science-practice dichot-
omy become increasingly blurred and did biomedical concepts begin to include
most medical ideas, including the translation of laboratory and experimental work
into clinical practice. Since then, the term ‘biomedicine’ has become a ubiquitous
descriptor of western medicine, although at the same time, the term implies the
special modern medical paradigm that is dominating our era.
In the German context, before the Second World War, ‘Biologische
Medizin’ (‘Biological Medicine’) quite differently predominantly referred to holis-
tic and alternative approaches to medicine, including natural healing, lifestyle
reform, and homoeopathy (journals carried titles such as “Blätter für biologische
Medizin: Mitteilungen der Medizinisch-Biologischen Gesellschaft und des
Arbeitsausschusses Deutscher Vereine für Lebenserneuerung”). The epistemologi-
cal basis of biomedicine since World War II, however, can be summarized in three
basic principles: universalism, reductionism, and modelization (Strasser 2014:
19–21). Universalism means that biomedical research claims that it can determine
the underlying mechanisms of physiology and pathology that act universally in all
living creatures. In so doing, it tries to reduce the complexity of living matter to
physics and chemistry by investigating the smallest possible units involved, with an
Biomedicine and Bioethics 43
increasing focus on the molecular level since at least the 1970s (captured with the
term reductionism). Finally, biomedical research uses model organisms to describe
diseases. Flies, mice, rats, and zebrafish have become allegories for (and now are)
experimental models, used to identify the pathological mechanisms that are also
present in the human body (captured with the idea of modelization). When any of
these three elements, universalism, reductionism, and modelization are not present
in a context (for example, if research animals do not show universal reactions across
different species), it is assumed that there are differences in their smallest possible
units that are as yet insufficiently understood (Fangerau 2016: 196–203).
Biomedical Fields and Protagonists
The three epistemological cornerstones, “universalism”, “reductionism”, and “mod-

elization”, had already become the basis of physiological experimentation in the
nineteenth century, including mechanization and the trend towards objectification in
the process of producing medical knowledge. However, it took a long time for them
to enter clinical discourse. There was no direct or directed link between physiologi-
cal studies of the human form and function in the laboratory, chemical laboratories
in clinical settings, experimental biological research into animals, and practitioners
in hospitals. Nevertheless, these fields were not completely individuated. The actors
overlapped, they exchanged knowledge, and referred one another. Although many
historiographical studies have concentrated on the laboratory side of medicine at
that time, only few have illustrated these connections well (for an overview and
critical comment, see Löwy 2011). Endeavours such as the Rockefeller Institute for
Medical Research, which tactically linked all kinds of experimental research to a
hospital, exemplify the search for a way to combine the activities and findings of all
these disciplines, which was at its best on an institutional level throughout the first
half of the twentieth century (Abir-Am 2002; Amsterdamska 2004; Stapleton 2004).
For example, articles stressing the value of the application of developmental
mechanics to practical medicine represent attempts at professional exchange during
the 1920s (Fangerau 2017). However, the physicians and researchers involved in the
development of biomedicine from the beginning seem to have created and sup-
ported a dichotomy between basic research and clinical research (Strasser 2014:
14). Before the turn of the century, for example, the German psychiatrists Ernst
Siemerling and Alfred Goldscheider provided an overview of the links between
laboratory and clinical work in a clinical journal to convince their colleagues that
laboratory rooms should be integrated within clinics, whereas shortly after the turn
of the century, some physicians protested the unsettling separation of their (compul-
sory) clinical work and their (real) interest in laboratory research (Fangerau 2017).
As well as experimental researchers and clinical practitioners, representatives of
social medicine, such as public health officers, also struggled with the three tenets
of biomedicine. They form another group that has rather slowly adopted the bio-
medical model, because their knowledge is based more on epidemiological statistics
than on experimentation (Quirke and Gaudillière 2008). Statistical evidence gained

the status of proof only slowly. The eugenics movement of the 1920–1940s is an
example of the struggle between mechanistic concepts of life in the laboratory on
the one hand, and socio-political techniques based on statistical evidence on the
other hand. In the eugenics movement, genetic experiments played only a minor
role in justifying political measures. Instead, statistical correlation, social consider-
ations and observations, such as the so-called ‘differential birth rate’, were used as
the bases for what was perceived as eugenic prophylactics in the name of public
health (Fangerau 2012).
Dorland’s Medical Dictionary quoted above used the attribute ‘clinical’ to
describe biomedicine. Based on this definition and because the validity of applying
the tenets of biomedicine to the clinical sphere was contentious before the 1940s,
we agree with Quirke and Gaudillière when they state “one can therefore argue that
biomedicine was only truly ‘invented’ after the Second World War” (Quirke and
Gaudillière 2008: 442). They use the example of tuberculosis, a disease that only
became manageable after the beginning of the antibiotic era, through the joint
efforts of bacteriologists in the laboratory, the clinical application of antibiotics,
radiological observations, and data collected on the social aspects of the disease.
This example shows extremely well how long it took for laboratory practices to
influence clinical medicine to such an extent that one could speak of biomedicine as
equivalent to western medicine. According to Gaudillière, the crucial element that
bridges the unspoken hyphen between bio and medicine in this context was the
experimentation that occurred within the clinic after the Second World War
(Gaudillière 2002; Keating and Cambrosio 2004).
Similarly (or maybe even more influentially), the “molecularization of the life
sciences and the molecularization of medical intervention, i.e., the transformation
of therapeutic targets” (Quirke and Gaudillière 2008: 444), also extended the links
between biology and medicine after World War II. The most prominent example of
this development is in cancer research and cancer therapy, which target not only the
cellular level but also the molecular level. However, many other fields equally
exemplify this evolving relationship, including rational drug design (Strasser 2014:
24), which strengthened the link between clinical and experimental research by the
establishment of clinical trials. After the 1960s, state regulations for the develop-
ment of efficient and safe drugs made clinical trials the standard model for pharma-
ceutical development (Strasser 2014: 24ff.). However, as Keating and Cambrosio
have argued, these developments in the clinical pathway of medicine after the
Second World War did not simply reduce pathology to biology as pure philosophi-
cal reductionism implies, but instead were part of the ongoing alignment of medi-
cine and biology. This alignment resulted in “the institutional and epistemic hybrid
we call biomedicine” (Keating and Cambrosio 2004: 369).
Biomedical Culture
This institutional and epistemic medicine-biology hybrid was described in anthro-

pological studies of the late 1980s as “rooted in and … sustained by practice” (Lock
1988: 7). What is perceived as a biological reality must be contextualized within
culture in order to establish meaningful orders, explanations, and manipulations
(Lock 1988: 7). Thus, the cultural background plays a crucial role in, for example,
the training of biomedical physicians, in clinical practice, and in the laboratory.
Examples include the cultural aspects of the dissection courses undertaken by medi-
cal students, in which the perception of the cadaver is culturally preformed (Lella
and Pawluch 1988); or the shifting perceptions of time and space in relation to
concepts of patient care or illness, which follow general cultural and social trends
(Armstrong 1988). This again implies that all medical knowledge has a “social and
cultural character” (Lock 1988: 7). At the same time, society became increas-
ingly engaged with biomedicine in its daily culture. For example, since the early
days of the Internet, patient organizations have promoted patient self-governance by
developing health-related websites (Oudshoorn and Somers 2007).
As an infrastructure for health care, the Internet can be seen as an allegory of the
changes biomedicine has experienced on an epistemic level in the last 40 years.
What counts as evidence in biomedicine has changed from crucial experiments to
statistical data in both the clinic and the laboratory (Bolt 2015). Causality has been
replaced by correlation and complexity. More recently, in the 1960s, moleculariza-
tion and the establishment of the first tools for recording and transporting masses of
data meant that biomedicine has become an information science (Lenoir 1999).
Information, together with mechanization, again triggered new forms of predictive
biomedicine, as for Alzheimer’s disease (Lock 2007). As Clarke et al. convincingly
argued, this form of preventive health care comes with the commodification of
health, self-surveillance, the embodiment of a techno-scientific ideal, and the politi-
cal economy of risk assessment and risk management (Clarke et al. 2003).
Information based on data that is biomedically produced, evaluated, and contextual-
ized is the key to these processes, which have become intrinsic to western medicine
since at least the 1980s. The medical information science has also become digitized
and apparently ubiquitous. Therefore, it has become an issue of quotidian discourse
and a common topic of popular culture.
Biomedicine and popular culture are mutually influential in terms of posing
questions and as sources of reference. For example, biomedicine investigates popu-
lar culture as a source of social effects on health (Holody et al. 2016; Primack et al.
2008). Pop culture productions explore topics discussed in biomedicine, and is cur-
rently reacting to trends such as embryo research, gene editing, and stem cell ther-
apy. The effects of digitization and the accompanying virtualization of human
‘Lebenswirklichkeit’ (life realities), and the consequences of the power of the phar-
maceutical industry, biomedical biopolitics, and biomedical technologies, are
increasingly addressed in popular cultural productions, such as computer games
(Görgen and Krischel 2012).
From the perspective of popular culture, the whole development of biomedicine

is, on the one hand, presented as a success story (see the contribution by Hansen in
this volume), whereas on the other hand, critical voices have been raised against it
in popular media since the nineteenth century. Topics such as the Golem and
Frankenstein were (not always correctly) adapted to the biomedical narrative, for
example, when scientists envisioned creating life (Charpa 2012). When experimen-
tal biologists spoke of medicine and biology becoming ‘synthetic’ or ‘constructive’
around 1900, with reference to the sciences of chemistry1 and physics, with the
intention of eliminating the deficiencies that lead to illness and disease, those with
different world views and attitudes to life raised their concerns (Fangerau 2017).
Similarly, a hundred years ago, when electric sparks were considered to have the
power to impart life, biology was critically appraised and popular culture found
ways to address the fear of a new world order, in media ranging from caricatures to
short stories (Turney 1995).
With the triumphal procession of biomedicine, the history of medicine and med-
ical ethics seem to have increased in importance as representatives of the arts and
culture in medicine. When the experimental laboratories of the late nineteenth cen-
tury began to shake the western medical world, institutions studying and teaching
the history of medicine experienced a renaissance. Their intention was to counter-
balance the rational objective scientific gaze of the physician on the patient with
culture, arts, and humanities, to preserve both science and art in medical practice
(Warner 2013: 326). In the late 1940s, some historians of medicine tried to reinte-
grate a social perspective. Since the 1960s, medical ethics has taken on the role of
“re-humanizing” medicine: In a climate of general criticism directed towards
established authorities in the Western World, institutionalized ethics is seen as a
possible remedy against the allegedly de-humanizing effects of scientific medicine
(Warner 2013: 326).
As with biomedicine, biomedical ethics became ‘bioethics’. The power attrib-
uted to biomedicine and its practitioners have prompted ethical discussions that
extend beyond previous discussions of medical ethics, moving beyond professional
issues or the physician—patient relationship to the manifold consequences of a bio-
medical understanding of life. Problems and fears have been addressed from both
conceptual and social perspectives. As with industrialization, the possible conse-
quences of biomedicalization (Clarke et al. 2003) for the environment have also
been addressed in comics, movies, etc.
In this context the impression is fostered that the ethical problems of biomedi-
cine are new. In the press, authors often use the terms ‘paradigm shift’ (with refer-
ence to Thomas Kuhn) and ‘scientific revolution’ when describing the putative new
powers of biomedicine that require an ethical solution. Striking examples are the
press reports of cloning and stem cell research (Elliott 2012: 93–96). However,
these authors fail to recognize that these developments are consistent with the bio-
medical paradigm formulated in the late nineteenth century, and therefore do not
constitute a new revolution, but at most, a continued scientific revolution (aiming at
1
Comparable to the synthesis of urea by Friedrich Wöhler.
reductionism) that started more than 100 years ago (for an eye-witness perspective
on the 1930s, see (Lewis 1977). Bioethics is thus at most addressing the conse-
quences of this revolution.
Bioethics
What is ethics in this context and what is ethical? Because the term ‘ethics’ has dif-
ferent meanings in different contexts, it must be defined in the context of biomedi-
cine to avoid misunderstandings. ‘Ethics’ or ‘ethical’ in colloquial language is
usually used to denote an action as morally good. ‘Ethics’ and ‘morals’ are often
used interchangeably. However, in philosophy, ‘ethics’ is mainly regarded as the
systematic theoretical reflection on moral issues. ‘Morality’, by contrast, can be
defined: (1) descriptively, as a code of conduct accepted by a certain group, society,
or individual; or (2) in its normative sense, as a set of norms that are ‘right’ or
‘good’. The reflection on and justification of this ‘rightness’, based for example on
a universally acceptable principle that every rational person would accept or on the
will of a god, is the matter of ethics (Gert 1998: 3ff.). Therefore, ethics evaluates a
person’s actions within his/her social and natural environment.
Western societies have discussed the concept of ethics since antiquity. Aristotle
introduced the term êthikês theôrias in his Nicomachean Ethics and therewith pro-
posed a theory that defined the structured analysis of the human habits and customs
that can be found in any society (Broadie and Rowe 2002). In Aristotle’s writings,
human practice is already the target and programmatic centre of a theoretical ethical
approach. During the following centuries, ethics or moral philosophy has been seen
as the philosophical—or theological—investigation of normative questions, such
as: Do human beings have a specific moral status and why (not)?
Ethics is still predominantly considered an academic discipline, treating topics
like the possibility of universally valid norms, the intelligibility of normative
assumptions, and the critical assessment of actually existing moral norms. Different
fields of ethical research address these diverse topics, including normative ethics,
meta-ethics, and descriptive ethics (see e.g. (Blackburn 2003; LaFollette and Persson
2013). One of these fields is so-called ‘applied ethics’, which usually involves
attempts to relate the findings of ethical theories to moral problems in the different
domains of (human) life, e.g., medicine, research, the environment, and so on.
Applied ethics has expressed its major rise since the 1960s, when questions
about the future direction of modern biomedicine, biological research, and subse-
quently, ecological problems and technical developments, have claimed wide scien-
tific and public attention. In the manifold domains of applied ethics, the domain
described with the same prefix as biomedicine, ‘bioethics’, usually denotes all fields
covered by modern biosciences, including genetics, embryology, nanotechnology,
and so on. Because they are collective terms, the distinction between ‘bioethics’ and
‘medical ethics’ is sometimes unclear. As a rough approximation, it could be said
that medical ethics deals mainly with ‘bedside’ questions encountered in medical
practice and with clinical research, whereas bioethical topics predominantly address
scientific problems. However, the boundaries are often blurred. As a working
hypothesis, the combinatory term ‘biomedical ethics’ is an attempt to include the
whole medical field, including research ethics and clinical ethics, and to distinguish
it from all the fields of bioethics that are not related to medicine.
Even when bioethical reflection refers to very concrete technologies or research
practices, bioethics cannot provide simple answers to whether the investigated field
of action is morally right or wrong. It is important to note that applied ethics cannot
be regarded as the mere deduction of normative theories to specific situations, but
rather as the interaction between theoretical reflection on basic moral issues and
attempts to provide a moral orientation for decision-making in concrete practical
contexts. This double demand poses an ongoing struggle for all concerned with
applied ethics, and is still at the heart of ethical debates about the role and power of
applied ethics in science and society. The main issue is that critical ethical reflection
on a moral issue does not mean that only one morally right solution to a specific
problem can be achieved. On the contrary, different ethical theories and opinions
disagree fundamentally about the validation and validity of norms and principles.
An important example is the contention over whether an action itself (and hence the
attitude or will of the actor) should be judged according to moral criteria, or whether
the result of the action should be so judged. Among proponents of the first approach
are the philosophers of the enlightenment, such as Immanuel Kant, who argued for
moral actions according to duty (Greek deon = duty). Although he did not coin the
term ‘deontology’, Kant’s work is regarded as the first fully elaborated theory that
relies strictly on deontological reasoning (Gregor and Timmermann 2011). Theories
that are called ‘consequentialist ethics’ emphasize the results of an action, e.g. utili-
tarianism. Here, an action is judged to be ethically right if its consequences are
‘good’. However, it is a matter of ongoing philosophical debate how this ‘good’
should be defined. In its first theoretical concepts, classical utilitarianism holds that
happiness or pleasure (and its maximization through a certain action) is the moral
measure of the rightness of that action (Bentham 2007 [1789]). It must be noted that
neither the deontological nor consequential approach ignores the moral importance
of the different parts of a moral action—the intention and consequence. However,
the emphasis in judging an action favours one or the other.
The third of the three most influential ethical approaches, virtue ethics, avoids
these fundamental questions by focussing on the character of the actor and his/her
development in the pursuit of a morally good life. As a consequence, statements
have merely the form of advice and the aim is to live a morally good life. Aristotle
is one of the most important philosophers advocating this perspective. His virtue
ethics has undergone many adaptations and is, after a period of marginalization, still
a very important basis for contemporary moral reasoning (e.g., the works of Gertrude
E.M. Anscombe, Alasdair MacIntyre, Philippa Foot, and Martha Nussbaum).
The pluralism of ethical theories can be seen as a reflection of the heterogeneity
of societal values and norms, which leads to diverse moral reasoning in ethics.
While this is appreciable with regard to a wide and in-depth analysis of fundamental
moral questions, the many perspectives on ethically relevant fields make a practical
comparative evaluation of the different possible courses of action in any given situ-
ation difficult.
In response to the unsatisfied demand for a concrete orientation, Beauchamp and
Childress developed their renowned approach to biomedical ethics (Beauchamp and
Childress 2013). Their book Principles of Biomedical Ethics, published for the first
time in 1977, quickly developed into a medical ethical paradigm. Beauchamp and
Childress proposed the central idea that for practical decision-making any claim for
the universality of different fundamental ethical approaches should be abandoned.
They formulated mid-level ethical principles instead, to increase the likelihood of
achieving consensus in morally problematic medical cases. With an explicit focus
on biomedical topics, Beauchamp and Childress looked for principles that could be
supported by all major ethical theories, and came up with four principles that pro-
vide a sort of interface between fundamental ethical theory and practice: the prin-
ciples of beneficence (doing good), non-maleficence (doing no harm), respect for
autonomy, and justice.
Using Bioethical Approaches to Analyse Pop Culture Content
The moral acceptability of some cultural products, such as films and (especially)
computer games, is a subject of great public attention. As usual, judgements about
specific products often differ profoundly, mainly because different values and prin-
ciples are applied. It is important to note that ethical analyses of popular culture
media can have different foci. Most often, an ethical analysis aims to draw a conclu-
sion on the social or pedagogical appropriateness of a game (or film) in order to
recommend it (or not) for a certain target audience. Another approach regards com-
puter games (for instance) as a specific virtual moral space that can represent moral
perspectives that differ significantly from those of ‘real-world’ morality. In this
case, the perceived moral rules represented in a cultural product are at the heart of
the ethical analysis. In the following section, we provide a basis for this type of ethi-
cal analysis.
Medical and scientific topics often play a significant role in games, such as Deus
Ex: Mankind Divided (Eidos Montreal 2016), Fallout 4 (Bethesda Game Studios
2015), or Big Pharma (Positech Games 2015), and bioethics can be useful in this
context. Here, the approach of Beauchamp and Childress might be appropriate for a
comparative ethical evaluation. With a standard set of mid-level principles, one can
draw a sort of road map to clarify the ethical content of a given product, such as a
computer game. The four principles of Beauchamp and Childress can be used to
analyse features in games that refer directly to topics in the domains of medicine
and bioscience.
On one level, one could investigate whether those mid-level principles are recog-
nised in the game, and on a second level, examine the way in which they are used to
guide the actions of the player (for example, the use of ‘autonomy’; see Görgen and
Krischel in this book). The question could be posed: Is the player led to (i.e.,
rewarded for) favouring a patient’s autonomy over his well-being or to favouring the
well-being of a great number of third persons. For instance, in the Oasis quest in the
game Fallout 3 (Bethesda Game Studios 2008), the tree-man mutant Harold, an
essential provider of the necessary natural resources for a nearby society of human
beings, demands to be killed by the player in order to be released from his unbear-
able situation, in which he is fixed in and inhabited by a tree growing both in and out
of him. This scenario is directly transferable to current debates on physician-assisted
suicide and other end-of-life decisions. Is the will of a talking, reasoning, and suf-
fering personality morally more relevant than his life or the lives of the people
depending on him? The player has the option to form his own moral judgement and
act according to it, because both decisions are rewarded and only lead to slightly
different courses in the game.
On a third level, one could evaluate how far a certain cultural product motivates
the spectator or player to reflect upon contemporary moral issues, such as the envi-
ronment, bioscience, or politics.2 A broad range of academics have worked on the
ethical analysis of games (see e.g., Flanagan and Nissenbaum 2014; Macer 2008;
Murphy and Zagal 2011; Schrier and Gibson 2010; Schulzke 2013; Sicart 2009),
but most of these texts merely rely on one of the three normative approaches to ethi-
cal analysis presented above. In terms of its operationalization and applicability,
bioethical principlism provides a valuable tool with which to emphasize and enhance
these approaches.
ioethics as an Analytical Approach to Contemporary

B
Cultural Production: The Example of Computer Games
As well as evaluating pop culture products for their ethical acceptability or richness
(for example, to recommend them [or not] for teenagers), we can use bioethics to
investigate the anthropological statements made in them. Films and games work
with scenarios that offer a more or less sophisticated narrative about what living a
human life can mean. Biomedical ethical reasoning can ask questions such as: What
does a certain in-game situation or scene tell us about transferred concepts of auton-
omy or the ‘essence of being human’? Basic questions of this type are important in
analysing actual developments in bioscience, biotechnology, and medical agenda.
The widely used character of a (somehow) transformed or altered human or
2
E.g., Games such as Spec Ops: The Line, Battlefield 1 or This War of Mine are discussed in detail
with regard to their ethical potential as ‘anti-war games’ by Nick Statt (2016). ‘Battlefield 1 is an
anti-war message trapped in a best-selling shooter’, The Verge 06.11.2016 (http://www.theverge.
com/2016/11/6/13529304/battlefield-1-anti-war-shooter-video-game-violence)., whereas ‘The
Last of Us’ is analysed with regard to environmental issues by Amy Green (2016) ‘The
Reconstruction of Morality and the Evolution of Naturalism in The Last of Us’, Games and Culture
11(7–8):745–63.
humanoid provides especially interesting material for the analysis of inherent ideas
about what it means to be human (see e.g., Jacobs 2003; Meyer et al. 2013).
Approaches like the ethics of a good life and other theories with strong anthro-
pological components seem to be useful for this type of analysis. Together with
Amartya Sen, Martha Nussbaum developed her famous ‘10 capabilities’ approach
on the basis of Aristotelian ethics, with an explicit focus on the questions of a good
life (Nussbaum 2011; Sen 1993). The initial idea of Sen and Nussbaum was to
develop a tool for the measurement of individual and social welfare in a given state.
However, the approach is suitable for the analysis of any given situation, where
humanity—or human dignity—is at stake. Within the explicitly indefinite and
changeable list of human capabilities, we find basic characters such as life, physi-
cal health, and bodily integrity, as well as senses, imagination, and thought.
However, it is the integration of more complex features, such as play, other species
(being able to live with concern for other living entities), or control over one’s envi-
ronment (political or material), that renders this approach unique and especially
appropriate when exploring the complex living conditions of a given entity. Play as
a complex capability, refers to basic characters that we particularly ascribe to human
kind: laughing and humour. Nussbaum states that being able to live a good life
requires the ability to practice this basic human trait. If people do not have the time,
freedom, or other living conditions allowing them to play, laugh, and enjoy recre-
ational activities, one cannot say that they are living a good life. Returning to the
character of Harold the tree-man in the game Oasis, this could be an interesting way
to determine how far the designer of the game has created a person whose dignity
suffers3 from certain negative living conditions and the kind of suffering involved.
According to his origin, Harold is a sort of chimera or hybrid between a tree and a
human. He is a humorous character, despite his situation, and this trait can be inter-
preted as an effort to maintain his dignity. According to Nussbaum and Sen, this
could be seen as a basic human capability that must be recognized and respected.
From another perspective, one could say that the bodily integrity of the formerly
human being was violated by the experiments that led to the invasion of his body by
the tree. However, at the time of the game situation, the player is forced to treat the
human and tree as one entity because they are no longer separable. We can use the
capability approach to analyse the situation and to answer two basic questions: Does
Harold deserve our moral respect or is he merely to be treated as a resource for
human society? If the answer is yes: What best allows him to live a good life? The
first question seems easily answered. With reference to the most basic capabilities,
we can positively state that Harold lives, can express his practical reason, emotions,
senses, imagination, and thought. Therefore, he must be regarded as a person with
a high moral status. However, the question about his bodily integrity is more diffi-
cult to answer. Nussbaum includes in this latter capability (among other traits) the
ability to move freely from place to place, to be secure from bodily assault, and to
have reproductive choices (Nussbaum 1999: 41–42). Being deprived of these
3
Suffering in its full philosophical conceptualisation requires, among other capacities, self-con-
sciousness in order to reflect upon the experience (feeling) of pain or injury.
options, together with his bodily pain and his unfulfilled longing for self-chosen
affiliation, seems to be the main cause of Harold’s suffering. From an anthropologi-
cal perspective, we can say that Harold is not human in this respect.4 His nature has
become that of a tree—man hybrid. Therefore, to live a good life, he can be reminded
to accept this nature and focus on the unique possibilities that this nature provides
him, including helping other people survive, talking to them, and making friends.
Conclusion
To conclude, this little side quest in the game Fallout 3 can be read as a statement:
suffering because we long for something that our human nature simply does not
provide — such as being able to breathe under water — is of course possible, but is
not an appropriate objective for a morally good life, no matter how strong the long-
ing to move freely in the deep sea might be. Because there is no clear reward for any
specific decision in the game, it is also a statement about the principal openness to
interpret and respond to the situation in different ways. The statement also indirectly
challenges the possible consequences of virtual or real biomedical programs. The
existence of Harold himself is the result of biomedical research — a side effect of
its attempt to synthesize life, a long-standing ambition in the domain of bioscience.
In showing the relationships between the historical development of so-called ‘bio-
medicine’ and our subsequent evaluation of bioethical discussions based on funda-
mental theories, we wanted to demonstrate the utility of pragmatic, anthropologically
enriched approaches in the ethical assessment of popular cultural products.
Analysing cultural products in this way will facilitate further debates about the
desirability of certain biotechnologies, debates that are set within the triad of bio-
medicine, bioethical reasoning, and popular culture.
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Advantages and Disadvantages
of Pop-Cultural Artifacts for Exploring
Bioethical Issues
Sandra Shapshay
Introduction
For the past several decades, popular culture, especially feature films and television,
has been utilized with increasing frequency in bioethics teaching and reflection.
When I edited Bioethics at the Movies (Shapshay 2009) in the first decade of the
twenty-first century, there were a great many popular, feature-length fiction films on
offer that dealt more or less intelligently with every ‘hot’ bioethical issue at the
time: Euthanasia and assisted suicide had been treated in Clint Eastwood’s multiple
academy award winning Million Dollar Baby (Eastwood 2004); genetic selection
and reproductive medicine was the theme of Gattaca (Niccol 1997); human cloning
had been explored science-fictionally in Star Trek: Nemesis (Baird 2002) and comi-
cally in Multiplicity (Ramis 1996); the debate over abortion and reproductive rights
in the United States had been satirized by Citizen Ruth (Payne 1996) and explored
from multiple perspectives in the film adaptation of John Irving’s The Cider House
Rules (Hallström 1999); and, finally, animal rights and welfare issues had been
touchingly explored in Babe (Noonan 1995).
Just a few years later, one could add dozens more essays to the table of contents,
and at least one bioethics category has really exploded in contemporary cinema,
namely, the ethical implications of artificial intelligence. Long a theme taken up by
the science fiction genre, in films such as 2001: A Space Odyssey (Kubrick 1968),
Blade Runner (Scott 1982), and I, Robot (Proyas 2004), the ethical implications
surrounding artificial intelligence has been treated with increasing intensity, even a
sense of urgency, in popular films such as Her (Jonze 2013), Transcendence (Pfister
2014), and Ex Machina (Garland 2015), no doubt reflecting the rapidly increasing
and somewhat unsettling intimacy people in advanced industrial societies have with
their personal computing devices like smartphones and tablets.
S. Shapshay (*)
Department of Philosophy, Indiana University, Bloomington, IN, USA
e-mail: sshapsha@indiana.edu

https://doi.org/10.1007/978-3-319-90677-5_5
58 S. Shapshay
All this is to say that the use of popular culture as an intellectual and pedagogical
playground for bioethics seems on its face quite fitting, for, in the words of cultural
historian and film critic Leo Braudy, even more than standard newspaper articles
and other analytical texts, popular culture constitutes a “sounding board or lightning
rod for deep-rooted audience concerns” (Braudy 1998: 279). Further, many of these
audience concerns in advanced capitalist societies, as adumbrated above, relate to
the promises and perils of science and technology in general and biomedicine in
particular.
In this essay, I seek to offer an overview of the advantages and disadvantages of
utilizing popular culture for bioethical reflection and pedagogy. It is my aim to pro-
vide a framework for thinking through the promises and pitfalls of popular culture
for researchers, teachers and practitioners of bioethics and biomedicine.
Advantages
What do we value in art, and specifically for the purposes of this essay, popular art?
Aestheticians and philosophers of art in the Western tradition have identified four
major, often overlapping, values of the experience of art:
1. Pleasure1
2. The experience of emotion
3. Knowledge
4. Free play of the imagination
Philosophers of art from the eighteenth century to the present have tended to
stress one or two of these values over the others, for instance, Kant stresses a
1
By contrast, Paul Guyer identifies only three main values stressed by aestheticians in the modern,
Western tradition; I have added pleasure as a separate entry to this list, even though pleasure is a
component of all of the other values, in order to highlight the importance of art’s hedonic value.
There is ample evidence that many aestheticians take pleasure to be a value in art, and historically
have been operating with a much broader understanding of pleasure than simply fulfillment of
needs. In fact, the eighteenth and nineteenth century tradition of aesthetics, which survives to a
large extent today, saw the pleasure in our engagement with art and nature in sharp distinction to
the fulfillment of biological needs: Such experience was and is seen more as an intellectual plea-
sure in contrast to bodily gratification. The importance of pleasure as an artistic value emerges
from the fascination in Anglo-American aesthetics with the “problems” of tragedy and horror: why
do we voluntarily attend, and even seek out, sad or terrifying movies? In formulating the problem,
aestheticians assume pleasure is a key value of art, for the whole problem with these genres is that
they seem painful! Further underscoring the aesthetician’s emphasis on the value of pleasure, a
common solution to the “problems” of horror or tragedy is to hold that works of these genres
engender second-order pleasure; that is, we feel pleasure at our feeling scared by a horror film (see,
for instance, Kendall Walton 1993). In sum, many aestheticians try to show how even artworks that
seem to be unpleasurable are, in reality, pleasurable. For an overview of approaches see Shapshay
2012.
Advantages and Disadvantages of Pop-Cultural Artifacts for Exploring Bioethical Issues 59
p leasurable free play2 of the imagination; Hegel and Schopenhauer stress knowl-
edge3; Tolstoy and Collingwood stress the experience of emotion,4 and a few like
Dewey and Danto have been real value pluralists (Guyer 2013).5
Leaving aside debates over how they should be prioritized, however, it is clear
that these values constitute potent intellectual and pedagogical advantages in using
popular cultural artifacts such as films, TV shows, novels, plays, musicals, and
comic books for exploring bioethical issues.
Pleasure
Only the most puritanical educators would eschew the Horatian dictum to “instruct
and delight,” and since popular cultural products can be so delightful, there is good
reason to bring them into the classroom. Students and professors alike find engaging
with bioethical-themed popular cultural products pleasurable and absorbing aes-
thetically, intellectually, and emotionally. [In my own experience, especially under-
graduate students cannot get enough film screenings and discussions in the course!]
Whether or not this is good intellectually and pedagogically is a question I’ll take
up shortly, but it is at least uncontroversial to say that almost everyone enjoys think-
ing through bioethical issues with pop-cultural products.
Experience of Emotion
As the nineteenth century German philosopher Schopenhauer observed, if we are

lucky enough to lead reasonably comfortable, bourgeois lives free of want, then we
will have another problem to contend with, and that is boredom. One value of art
2
In loose terms, Kant thinks that some objects appear to be made for a purpose but are not actually
made for a purpose (what he calls “purposiveness without a purpose” [Zweckmäßigkeit ohne
Zweck]). When we experience such an object, we try to find out what the object is made for—or in
more artistic terms what it means or what the work is communicating – but are never able fully to
conceptualize its purpose or meaning. The process of searching for the object’s purpose or mean-
ing is what sparks what Kant calls the free play of our cognitive faculties (Kant 76).
3
The idea that art is valuable for the knowledge we get from it goes back at least to Aristotle, when
he argues that we gain knowledge of universals from art (Aristotle 1448b16–17). Aristotle’s idea
seems to be that some artforms describe kinds of people and types of situations rather than mere
particular people and situations. The result is that we can learn about ourselves and others from
certain artforms. Today, this idea is expounded by Berys Gaut, who suggests that art can teach us
what certain experiences are like, how to do certain things, and what our values are (Gaut 2006,
115).
4
Leo Tolstoy, in What is Art?, supports the view that an artwork can be valuable for the emotions
it engenders by going so far as to define art as those objects intended to express an emotion (Tolstoy
1899).
5
John Dewey, Art as Experience (Penguin, 1934) and Arthur Danto, The Transfiguration of the
Commonplace (Harvard UP, 1983).
60 S. Shapshay
closely linked to the previous category, is excitement it brings to our lives from the
arousal of strong emotions. For some aestheticians, such as Jean-Baptiste (l’Abbé)
Dubos, emotional experience as an antidote to boredom is the key to understanding
why we go in for even apparently painful works of art like tragedy.6
In addition to the value of an exciting emotional holiday from somewhat boring
lives, however, one could also add the value that is involved in feeling with others as
well as the cognitive value in coming to know how others feel, or coming to experi-
ence a fuller spectrum of emotions than one would otherwise encounter in one’s
daily life without the work of art (Levinson 1997). I will take up the topic of the
specifically cognitive benefits of engaging with pop-cultural products in the next
section, but suffice it to say here that there are multiple hedonic and cognitive
advantages on offer from the arousal of emotion that comes from engaging with
popular cultural products.
Knowledge
Popular, narrative art also affords some distinctive cognitive advantages over dis-
cursive, non-narrative texts for both bioethical reflection and teaching. Although a
great many popular narrative works are appreciated primarily for the opportunities
they present for engaging in fantasy and wish-fulfillment (think here of James Bond
films or the Twilight series); and some are appreciated primarily for the opportunity
to experience strong emotions and suspenseful plots (think of television melodra-
mas like Dallas or The Thorn Birds); many narratives are morally-charged and hold
out the prospect of gaining important moral knowledge. Skeptics will wonder how
this is so, or will regard the knowledge on offer as trivial (Stolnitz 1992).7
In recent years, many philosophers of art (e.g. Stanley Cavell, Noël Carroll,
Richard Eldridge, Catherine Elgin, Berys Gaut, Matthew Kieran, Martha Nussbaum)
have made a strong case for cognitivism about the arts, including in some instances,
popular art.8 This is the view that we can learn quite a lot about the wider world (and
6
Dubos pp. 5–21.
7
The type of knowledge at stake in this debate is not knowledge of the fiction. For instance, it’s not
knowledge about what Mr. Darcy does in Pride and Prejudice. The issue is whether Pride and
Prejudice gives us knowledge of the world outside the fiction, especially knowledge about moral-
ity. Stolnitz argues that, insofar as a fictional work gives us knowledge of the outside world, it gives
us only obvious truths that we can discover from psychology, or even just from living our own
lives. For instance, one bit of knowledge we might think that Pride and Prejudice gives us is that
“stubborn pride and ignorant prejudice keep attractive people apart” (Stolnitz 193). But surely we
don’t need to read Pride and Prejudice to know this fact! Such knowledge, he holds, is trivial.
8
For a great overview of cognitivist positions, see Gibson 2008. James Young even argues a cogni-
tivist position for purely instrumental music, and many scholars in this area argue that art can teach
us about moral truths, even, as Matthew Kieran argues, by depicting immoral characters: By seeing
what makes a character immoral and the effects of their immoral actions, we can understand why
we should act morally (Kieran 2003).
not just about the world of art or the fictional world represented in art) from works
of especially narrative art. Particularly stressed in this debate is a kind of non-
discursive knowledge that can be gained through engaging with narrative art, a kind
of knowledge that is not easily acquired by other means. In other words, while
empirical and analytical texts provide especially propositional knowledge—knowl-
edge that P is the case—by conveying facts, evidence, and offering explicit reasons
and arguments, narrative artworks can bring us something like “knowing how,”
enabling us to:
(a) See the world differently
(b) Feel in the world differently
(c) Categorize the world differently
Let me take up each of these (again, overlapping) cognitive gains in turn.
Getting Us to See the World Differently
A narrative film, for instance, does not present us an explicit argument or reasons to
believe a claim—as does, say, a traditional article in philosophical bioethics—
rather, it attempts to engage an audience in a cinematic world emotionally and intel-
lectually. In the process of doing this, however, a narrative film can bring us to see
our own world in a new light. Stephen Mulhall, for one, believes this ability of films
counts as a kind of moral-philosophizing in its own right. Accordingly, he urges us
to resist the “strong philosophical tendency to think of moral disagreement on the
model of opposing opinions about a particular course of action,” and holds instead
that “moral disagreement can also be a matter of differing visions of what matters in
human life, different conceptions of flourishing in the world, and so on.” (Mulhall
2007: 290, emphasis mine). In other words, moral disagreement may often take the
form of differing perceptions of what and who matters from a moral perspective.
One might think here, for example, of a film like I am Sam (Nelson 2001), which
follows the story of a mentally handicapped man as he struggles to raise his daugh-
ter as a single father, encountering the sometimes helpful but also intrusive interven-
tions of the state, the agents of which ultimately challenge his custodial rights.
Notwithstanding some Hollywood predictability and sentimentality, and thanks in
large part to the engaging performances of Sean Penn and Dakota Fanning, the film
succeeds in getting us to see a different view of what it means to lead a flourishing
life and to have a healthy and meaningful parent-child relationship, a vision that is
quite different from the typical competitive, high-achieving one that many Americans
prize, but one which is made vivid and compelling in the course of the film.Insofar
as a film or other work of popular culture can get us to experience a different world,
with different eyes for what counts as morally salient or right or good, this should
count as a moral-cognitive gain.
62 S. Shapshay
Getting Us to Feel Differently
Often bound up with getting us to see the world differently, many popular cultural
products can bring us to feel in the world differently, especially by getting us to feel
what it would be like to be another person. In a rather different context, Thomas
Nagel wrote famously about the difficulties of determining “what it is like to be a
bat” (Nagel 1974). Philosophers like Martha Nussbaum have urged us to look
toward imaginative literature and film in order understand what it is like to be
another (Nussbaum 1990, 1996), and she has stressed the public moral importance
of engaging especially novels such as Richard Wright’s Native Son, and Charles
Dickens’ Hard Times in order to humanize our public-policy and legal reasoning.
Nussbaum argues that such empathetic understandings of others fostered by the
guided imaginings that these and many other novels provide are actually crucial for
affording us knowledge of especially marginalized groups (Nussbaum 1996).
Similarly, in his work defending the cognitive value of art Berys Gaut refers to this
sort of knowledge as “affective understanding” (Gaut 2007), and argues that by
spending significant time with a novel or even just a few hours with a film, we can
come away with an important and hard-to-come-by emotional understanding of
how it would feel, as it were, to walk a mile in another person’s shoes.
One can see how the gaining of such understanding would be important for
informing bioethical debates in particular: Coming to an understanding of what it
feels like to live with a particular disease or disability, to struggle with a mental ill-
ness or addiction, to be poor and without decent access to health care, or to be part
of an ethnic minority struggling to access a discriminatory health care system, are
all crucial insights for humanizing bioethical debate, and stand to be gained par
excellence through engagement with popular culture.
Categorizing the World Differently
Noël Carroll, for one, has argued for a number of subtle ways in which we can learn
from narrative works of art. His view of “clarificationism” holds that narrative
works can enable us to clarify our concepts, such as virtue and vice concepts like
“generosity” and “greed,” or to reorient the moral-conceptual knowledge we already
possess but which is not currently salient to us (Carroll 1998, 2000, 2002).
For example, a novel such as Dickens’ “A Christmas Carol” affords readers a
crystallizing character like Ebenezer Scrooge and a contrasting character like Bob
Cratchit, to help us better conceptualize what greed and generosity of spirit really
consist in. Further, Carroll points to many narratives (in literature as well as film)
that offer a “virtue wheel, [which is] … a studied array of characters who both cor-
respond and contrast with each other along the dimension of a certain virtue or pack-
age of virtues” (Carroll 2002: 12). The wheel serves as “contrastive structure that
abets meditation upon and contemplation of the virtues” thus helping us to clarify
for ourselves, and in conversation with others, in what Peter Kivy has felicitously
termed the “reflective afterlife” of a narrative fiction (Kivy 1997), what it means to
be a virtuous parent, a virtuous friend, nurse, physician, psychiatrist, scientific
researcher, and so on.
Again, it is easy to see how this gain in “categorical understanding” may apply
to the use of popular cultural narratives in bioethics. In an essay on a TV adaptation
of Margaret Edson’s Pulitzer-prize winning play, Wit (Nichols 2001), Terrance
McConnell draws out the tableau of physicians, residents, and nurses, and their
often ethically-problematic handling of conflicting role-related obligations as care-
givers, researchers and teachers in an academic teaching hospital (McConnell
2009). In the context of this bioethically-charged narrative, the virtues and vices of
physicians and researchers are made salient, and bioethical ideas such as the “thera-
peutic misconception”—where research subjects believe erroneously that the proto-
col they are enrolled in counts as therapy—is fleshed out in a particular, vivid
manner. The television series, Grey’s Anatomy (Rimes 2005) provides a similar (and
much sexier!) virtue wheel of the interns, residents and attending physicians in a
busy Seattle teaching hospital, affording insight into the virtues and vices of these
medical professionals at various stages of their careers.
Freedom of the Imagination
Linked to the value of various sorts of knowledge that may be gained from popular
cultural narratives, there is the value of imaginative free play. Ethically-charged nar-
ratives can constitute case studies or even philosophical thought-experiments
(Carroll 2002; Smith 2006: 34) that engage the imagination and spark independent
moral-philosophical reflection. What is more, for some bioethical issues involving
as-yet undeveloped or merely nascent technologies, such as the widespread use of
genetic selection technologies or human cloning, science-fictional narratives may
be the best way we have for thinking through these issues. Additionally, the tempo-
ral, technological, geographical and even metaphysical differences in these worlds
from our own engage the imagination in a thought-experiment in such a way as to
break down knee-jerk resistance to belief change, and even moral belief change,
though it is a live question as to whether imaginative resistance is put up more
strongly with respect to our moral beliefs (Gendler 2000).
To take just one example of how science-fictional narratives can work as philo-
sophical thought experiments, consider Judith Jarvis Thomson’s explicit philosoph-
ical thought experiment of the famous ailing violinist (Thomson 1971). In Thomson’s
article, the reader is invited to imagine having been kidnapped by members of a
society for classical music, people who are desperate to save the life of a famous
violinist. You have been abducted and hooked up to the famous violinist for
9 months so that your body may filter his kidneys. If you unplug yourself or have
someone else unplug you, the violinist will die. This philosophical thought experi-
ment is used as part of an argument by analogy and is meant to tap into the reader’s
deep intuitions about the permissibility of abortion in cases of rape. In the course of
64 S. Shapshay
this philosophical article, Thomson utilizes a series of increasingly science-fictional

thought experiments to tap into additional intuitions on the moral permissibility and
impermissibility of abortion in an expanding array of circumstances.
Many popular films, stories and novels work in similar ways, by offering an
experience of guided imagining in order to draw out a viewer or reader’s moral
intuitions, and to enable them to clarify conceptual relations for themselves. Some
have argued that a popular film or novel might serve as a much better thought exper-
iment than the typically threadbare ones thought up by philosophers since narrative
artworks are generally much more nuanced, and attend in greater detail (say, through
adopting multiple perspectives in the course of the film or novel) to the particulari-
ties and complexities of a situation (Carroll 2002). Notwithstanding the much
greater detail of the latter products, however, in both the traditional moral-
philosophical thought experiment and the pop-cultural narrative the reader/viewer is
challenged to think through a morally-ambiguous problematic for him or herself,
and this affords an opportunity for morally important knowledge as well as training
in moral reflection and reasoning.
Another way in which the imaginative free-play sparked by pop-cultural prod-
ucts can constitute a significant advantage over less imaginative texts is that the
former can afford imaginative knowledge about one’s own character, and of sub-
stantive truths about what is right and wrong, good and bad (Gaut 2007). For
instance, I can learn about my own character, say, about how courageous I am
through engaging with a film like The Hunger Games (Ross 2012) and reflecting on
whether I would sacrifice myself for my little sister, or whether I would slink back
and let her be chosen as “tribute”. Or I can explore imaginatively in Brave New
World (Huxley 1932) the possible implications of a society organized on the basis
of Benthamite utilitarianism; and I may come to realize a substantive truth, namely,
that pleasure is certainly not the sole intrinsic good, and that the value of autonomy
trumps that of pleasure.
Further, gleaning such imaginative understanding through narratives does not
threaten high costs: If I really wanted to know as a matter of fact (rather than as a
matter of probability) how courageous I would be in a wartime situation, I could
travel to a war-zone; and if I really wanted to know as a matter of fact what it is like
to live in a repressive society and the values that would be compromised in it, I
could move to North Korea. But reading All’s Quiet on the Western Front or 1984,
is a much less risky bet for achieving these cognitive aims.
Disadvantages
Skepticism About Art’s Value
If I have done my job thus far of elaborating the various advantages of utilizing
popular cultural products for bioethical reflection and teaching, you might be
tempted to stop reading here… but not so fast! There are dangers lurking that call
for some exploration.
It could very well be that a popular film, TV show, novel or comic book appears
to afford delight and understanding in the myriad ways I have adumbrated above,
but that it actually yields all pleasure and no real insights, or, worse still, it yields
false and thus pernicious “insights” and thus misleads us in crucial ways about the
way the world is and about the nature of “the good” and “the right.”
These are worries that are at least as ancient as the quarrel between Plato and the
poets. In the Republic, Plato argues through Socrates that art does not afford us
knowledge, and not just because art offers us in his view mere imitations of imita-
tions rather than the truly real things (Forms), but also because artists are not experts
in anything and have no knowledge to convey.9 Aristotle offered a good defense of
the cognitive value of the arts, especially of tragedy in his Poetics, by countering
that through imitation artists can convey knowledge about life, action, virtue and
vice by holding up, as it were, a clarifying mirror to the world.10 Further, for
Aristotle, artists can convey knowledge by virtue of their life experiences, acute
powers of observation, and by their skill at constructing plots that are probable and
absorbing, and in a manner that is eloquent and provokes emotion in audiences.11
But one might still raise an epistemic worry: How do we know that we’re gaining
real insight from a film like Gattaca about the perils of genetic selection technolo-
gies, or from Million Dollar Baby about what it would be like suddenly to become
so disabled that you would prefer euthanasia to continued existence in that state? In
other words, one might wonder to what extent such knowledge via the directed
imaginings of narratives should really count as knowledge—defined as justified true
belief—in any given case. Where’s the justification in art? Unlike philosophy,
which typically offers reasons to believe X, or texts that afford us empirical knowl-
edge of X, works of art (typically) do not give us justification in the form of explicit
reasons, arguments, footnotes to scientific studies, and the like. So how can we
know that we’re gaining knowledge about the wider world and about ourselves
through imaginative, emotional engagement with popular narratives? Can such
putative knowledge be confirmed, and if so, how?
Responding to the Skepticism About Art’s Cognitive Value
I suggest, following Berys Gaut (2007), that such knowledge may be confirmed,
though not indefeasibly so. To take a simple case, consider the case of imaginatively
learning about how courageous one really is by reflecting on how one would act if
in the shoes of, for instance, Atticus Finch from To Kill and Mockingbird (Mulligan
1962). If I conscientiously employ my background experience, and attend honestly
to the emotions and thoughts I have while imagining Atticus’s situation and myself
in that situation, and I attempt to avoid self-deception and sentimentalization—that
9
See (Plato, Book X but especially 595a–608b).
10
See, for instance, (Aristotle, 1447–1462 but especially 1448b16–17).
11
Ibid.
66 S. Shapshay
is, if I undertake the project of gaining moral-self-knowledge with respect to the

novel and do so in an epistemically virtuous manner—then I can be reasonably sure
of the insights I derive.
Similarly, if I approach a popular film in an epistemically virtuous manner, on
guard for improbable scenarios, a misleading picture of the science, places where
rhetoric is being substituted for reason, for where the events in the story do not
really merit the emotional effects being wrung from us—something we might call
‘aesthetic manipulation,’ say, via the soundtrack, sentimental and shallow solu-
tions to problems and so on, then I can undertake the project of gaining knowledge
of the wider world from popular art and, again, can be reasonably sure of the
insights I derive.
One might object, however, that even the reader or viewer equipped with epis-
temic virtues who exercises her critical-reasoning faculties throughout the encoun-
ter, may still be led astray by especially pop-cultural products by their very nature
as popular, i.e. aimed a wide audience and commercial success. Many Marxist cul-
tural critics have been especially worried about popular art under capitalism. With
reference particularly to genre films, film scholar, Judith Hess Wright holds that
these films produce “satisfaction rather than action, pity and fear rather than revolt”
and thus “[t]hey serve the interests of the ruling class by assisting in the mainte-
nance of the status quo.”12 Precisely because these films offer “easy comfort and
solace” instead of confronting real social and political problems, for Wright, they
are incredibly popular. Thus, looking to such popular genre films for edification is
seriously misguided: They afford us bourgeois illusionism rather than true insight.
Even if we are convinced that popular culture should not be utilized for its first-
order moral-political insights, however—and I do not think we should be so con-
vinced about all popular cultural products--there is still an important role for it to
play in bioethical theorizing and teaching, namely, to be used as symptomatic, as
case studies of ideological consciousness. To use popular culture in a second-order
fashion, rather than for the first-order moral and political insights they putatively
offer, is precisely Louis Althusser’s advice, for, as he puts it, “[w]hat art makes us
see, and therefore gives us in the forms of ‘seeing,’ ‘perceiving,’ and ‘feeling’ … is
the ideology from which it is born, in which it bathes, from which it detaches itself
as art, and to which it alludes,” and this also constitutes a potent advantage for using
popular culture for bioethical reflection and teaching.13
Yet, even if we are not convinced by such Marxist critics that popular cultural
products are hopelessly bound up “in the ideology from which [they] are born,” the
popular form of these products should give us pause, since the ease and pleasure
with which they are consumed at the very least raises a suspicion that they pander
too much to the prejudices, tastes and desires of the audience. Leo Braudy puts this
worry quite well, especially with respect to popular genre films, writing.
12
Wright 60.
13
Althusser 1971, quoted in Klinger 2012, 94.
[m]ovies—especially genre movies—and culture—especially popular culture—are always

in search of a story. As movies developed in America, they consistently projected large
national social and cultural issues into personal stories that were resolved (usually by love),
while the more general problems remained. This may be a necessary ambivalence in any
popular form that seeks to engage the emotions of its audience and to continue to engage
them. (Braudy 1998: 288)
So might the popular nature of these cultural products itself raise a red flag that
we will generally be encouraged by them to fall back into comfortable, benighted
prejudices, and encouraged to seek pat, personal solutions to problems rather than
complex, messy, social and political ones?
Is there a way decisively to answer these profound epistemic and moral-political
worries about utilizing popular film for the purposes of bioethical reflection and
edification? Frankly, I’m not sure, but the modest antidote I would like to propose is
to pair the use of popular culture with rigorous, critical conversation of these prod-
ucts. In other words, I think the best way to sift the insights from the falsehoods is
through supplementing them always with open-minded, critical dialogue about and
with these products. In other words, I recommend using these cultural products as
essential “props” in a rigorous, critical moral-philosophical conversation.14
To take an example from the Bioethics at the Movies collection that I edited, I
was fortunate to be able to include two insightful essays about Million Dollar Baby
(henceforth, MDB) which argued for essentially opposing views on the intrinsic
moral-cognitive value of that film. On the one hand, Helen Frowe, an analytically
trained philosopher argued that MDB made a vitally important distinction in the
debate over euthanasia and assisted-suicide, namely, the distinction between a bio-
logical life and a biographical life, both concrete and salient for moral reflection.
Having followed Maggie’s difficult rise to fame as a female boxer, we come to
understand what makes her biographical life worth living for her, which, the
character herself and the attuned audience finds to be incompatible with the biologi-
cal life she will lead as a quadriplegic. For Frowe, the film affords important expe-
riential and affective understanding of the circumstances in which euthanasia and
assisted suicide would be morally permissible (Frowe 2009).
By contrast, Zana Marie Lutfiyya, Karen Schwartz, and Nancy Hansen, who are
scholars in the field of disability studies, argue that MDB frames the issue of assisted
suicide in a typically prejudicial manner, equating disability with death, and por-
traying dependency on others as inherently shameful. Through their analysis of the
shots used in the film and the mise-en-scène especially of the hospital room where
14
Here I’m alluding to Kendall Walton’s view of representational art as props in a game of make-
believe (Walton 1993). Walton holds that objects or events can take on a special meaning when
embedded inside a fictional story. Much of Walton’s work explores make-believe worlds as well as
the use of props in everyday life (for instance, the characterized representations of gender on our
bathroom signs; Walton 1993, 43). For my purposes, what’s important is the idea that we can
entertain the fictional meaning of some props without endorsing the fiction itself. This allows us to
safely explore fictions and their props. Investigating a morally problematic fiction does not require
us to accept that fiction; instead, we can entertain the story and its props and use the resulting
information we learn to understand the real world.
68 S. Shapshay
Maggie finds herself post-injury, the authors argue that the intrinsic message of the
film promotes dehumanizing stereotypes of disabled persons, and the film should
rather be used as symptomatic of these benighted and dangerous attitudes rather
than explored for its first-order insights about the morality of assisted suicide
(Lutfiyya et al. 2009).
Both of these perspectives on the film, I believe, are extremely valuable in draw-
ing out the intrinsic insights and falsehoods on offer in the film, and reflection on
these critical perspectives has proven illuminating for my own thinking through the
ethics of assisted suicide and euthanasia. Thus my modest proposal is always to
incorporate a sustained, critical, preferably dialogical exploration of popular cul-
tural products for the purpose of bioethical reflection and teaching. This seems to
me an indispensable ingredient for navigating the aforementioned moral and
political-epistemic dangers lurking in the use of popular culture for biomedical
reflection.
The final danger I’d like to raise very briefly may be termed philistinism. It is the
danger of using works of popular art as mere tools for ethical reflection or pedagogy
instead of treating them with some aesthetic respect, as artistic products in their own
right. Films, TV shows, comic books, and the like have their own artistic aims,
genre conventions, artistic forms and innovations that should be acknowledged lest
we be guilty of blindness to specifically aesthetic and artistic values.
In sum, however, notwithstanding these dangers of reflecting on and teaching
bioethics through popular culture, I do think the benefits outweigh the potential
costs, especially when researchers, scholars and students pair this kind of engage-
ment with a commitment to open-minded, critical dialogue about these films in
collaboration with others.
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Press.
Dewey, John. 1934. Art as experience. London: Penguin.
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T. Nugent (London). New York: AMS Press, 1978.
Frowe, H. 2009. ‘I can’t be like this, Frankie, not after what I’ve done’: Million Dollar Baby and
the value of human lives. In Bioethics at the movies, ed. Sandra Shapshay, 242–255. Baltimore:
The Johns Hopkins University Press.
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ed. Matthew Kieran. Malden: Blackwell Pub.
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Art Criticism 71 (2): 133–143.
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and Eric Matthews. Cambridge: Cambridge Univeristy Press.
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Babe. Dir. Noonan C. Universal Pictures. 1995.
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Narrative
Hans-Joachim Backe
From the perspective of literary and media theory, the relationship between narra-
tive and biomedicine manifests along two intimately entangled lines: narrativity and
referentiality.1 Narrativity is relevant because every account of developments will
have a setting and agents, as well as a temporal structure with some unavoidable
gaps. In order to illustrate complex observations about changes in state clearly and
intelligibly, even a scientific text will often need to complement statistical data or a
simple chronicle of events with at least some narrative devices. Referentiality
becomes a central concept when dealing with the fact that biomedicine figures in
popular culture mostly in the form of fictional texts referencing scientific discourses,
transgressing boundaries between media, text types, demographies, popularizing a
potentially dry subject matter through reducing abstractions, and complexities.
These two dimensions are sides of the same coin; nonfictional narrative is a daunting
subject for narratologist, because, as James Phelan notes, it requires engagement
with such issues as, “(a) whether the border between fiction and nonfiction is rigid,
permeable, or, for all practical purposes, nonexistent, and (b) how what we might
call local referentiality in fiction, that is, the presence of historical figures or events,
compares with the global referentiality implicitly claimed by nonfiction, that is, the
claim that the entire narrative refers to actual people and events” (Phelan 2007:
217). I understand, therefore, narrative as instrumental for the construction of
knowledge in popular culture, in that it is a shared trait between fictional and
nonfictional texts, and that this facilitates intricate referential structures of the kind
explored in many of the contributions to this volume.
1
For comprehensive introductions to those two concepts see Abbott (2009), and respectively Wolf
(2009).
H.-J. Backe (*)
Center for Computer Games Research, IT University of Copenhagen, Copenhagen, Denmark
e-mail: hanj@itu.dk

https://doi.org/10.1007/978-3-319-90677-5_6
72 H.-J. Backe
Narrative in Scientific Texts
Whenever science presents its reflections, hypotheses, and findings not in the for-
malized languages of mathematics or chemistry, it relies on the highly diversified
tools of natural language. As soon as inter- or transdisciplinary work is attempted,
clear, precise, and understandable writing is essential to facilitate knowledge
distribution and exchange. As such, science writing is frequently more than mere
semiotics, and the division between rhetoric and narrative construction of arguments
is often quite blurry. There can be little doubt that Charles Darwin arranged his
Origin of Species in a very deliberate manner: “[…] Darwin, more than most
scientists, was not interested in merely publishing an abduction, a hypothesis. He
saw the problem as a rhetorical one, in Aristotle’s nonpejorative sense of this term.
He wanted to have evidence for his hypothesis that would come as close to the
irrefutable as possible” (Oatley 1996: 138). Yet Darwin’s method of recording his
research was not merely rhetorical; Gillian Beer has devoted an entire book to the
study of its poetic power and influence (Beer 2000). To Marie-Laure Ryan, The
Origin of Species is a prime example of what she calls “metaphorical narrative”
(Ryan 2004: 14). Ryan defines narrative as a phenomenon that transcends media in
the strict or literal sense as “the mental or textual representation of a causally linked
sequence of events involving individuated and humanlike agents” (Ryan 2004:
14). A metaphorical narrative, then, is a text that only uses some of these defining
elements; Darwin, for example, reifies evolution and treats it almost, if not quite,
like an active individual. In other words, a scientific text can, just like a literary one,
be more or less narrative.
Views on the nature of narrative differ widely. On the one end of the spectrum,
the existential stance of Jerome Bruner assumes that human experience can only be
commensurately rendered in the form of narrative (Bruner 1987). On the other end,
there is the assumption that narrative is an alien, distorting factor in factual writing,
be it academic or journalistic, a notion palpable in the self-perception of journalists
(Zelizer 2006) and, to an even greater degree, scientists. Recent discussion of a
“rhetorical turn” or “narrative turn” in qualitative and quantitative research clearly
shows this. Narrative devices have been identified as a means for representing
multiple perspectives on an issue (Coulter and Smith 2009). In ethnography, creative
nonfiction is perceived as a model for the presentation of research (Narayan 2007),
which is one of the reasons for the recent success of guidebooks for narrative
nonfiction (Hart 2011) and creative non-fiction (Gutkind 2012). Trends such as
these might be taken to culminate in the extreme approach of “Gonzo ethnography,”
“a postmodern documentary style that encourages a blend of observation with
participation and rationality with altered states of consciousness” (Tedlock 2011:
332), and could easily be mistaken as evidence for an inherent relation between
strong narrative impetus and a departure from traditional scientific values. Regardless
of these developments, ‘hard science’ disciplines usually shy away from narrative.
Some scholarly writing acknowledges the general usefulness of narrative devices
Narrative 73
for their ability to “establish an index of reality” (Richards 1992: 24), yet mostly,
narrative is treated as a suspicious, dangerous tool that might foster comprehension
but also be used for persuasion, and therefore, might create inaccuracy (Dahlstrom
and Ho 2012). The use of the first person pronoun is taken as a marker of narrativity,
because it suggests “that we have the view of a particular person, a given individual
who may have a certain authority, but whose perspective is not absolute” (Richards
1992: 28). This is perceived as a shortcoming in scientific writing, just as the
temporality of narrative is portrayed as coloring otherwise objective facts and events
(Richards 1992: 31).
The assumption that scientific writing is (or should be) inherently non-narrative
ignores both traditional usage of narrative in some disciplines (like social sciences)
and findings of cognitive science. Abductive reasoning, sometimes rejected as less
precise and thus unscientific, has been shown to significantly improve memory
retention (Oatley 1996: 128–129), just as the construction of arguments in natural
language using tangible actors allows for easier understanding and memorization
(Oatley 1996: 127–128). This is especially apparent whenever cognitive processes
themselves are part of an argument, because then, the ability to take on another
individual’s perspective becomes crucial (Zunshine 2006). In linguistics, the process
by which we mentally shift perspective, focus, or identification, both in simple
social-linguistic circumstances, such as switching between first- and second-person
pronouns in everyday dialogues, and complex cognitive processes, such as viewing
the world through somebody else’s eyes or imagining a different world, is called a
deictic shift, a textual phenomenon closely related to narrative (Herman 2002: 271–
272). Similarly, narrative provides a robust framework for operating with non-linear
concepts of time, and facilitating the management of complex temporal
configurations (Harweg 2011). Ultimately, this approach eases the challenges of
conceiving the world following a different paradigm by, for example,
anthropomorphizing non-human entities or even the relationships inside a system,
which might be argued is the key for understanding concepts such as Actor-Network
Theory (Latour 1996).
Much of the slowly disappearing misprision of narrative can be traced back to
Plato’s mistrust of the “lying poet.” Plato rejected mimetic art (theater) and was
suspicious of epic poetry, because in both, the author hides behind his creation, lets
other characters speak for him, and creates a make-believe situation that, for Plato,
could never be truthful (Schaeffer 2009: 103). A very similar stance is found in
implied hierarchies of sciences based on their assumed facticity and weight, in
which historiography is (following Karl Popper) understood as a merely descriptive
and rather inaccurate inferior cousin of “true science” (Richards 1992: 20). These
reservations have been equally leveled against evolutionary biology and all other
disciplines whose subjects can often elude truly experimental testing. Biomedicine
has to be counted at least partially as one of these disciplines, given how many
processes within the human body can only be deferred from symptoms, yet not
studied in themselves, and may, therefore, rely on the explicative, rhetorical, and
narrative methods traditionally associated with historiography (Richards 1992: 22).
74 H.-J. Backe
Narrativity and Fictionality
Another important factor for the mistrust towards narrative apparent in scientific
theories is the diversity of the concept, even within narrative theory. Narrativity has
recently become understood as less of a category than a continuum, a soft, scalar
concept. A folk tale or fairy tale is more prototypical of the idea of a narrative than
a modernist or postmodernist novel, yet it is a distinction of degree and not of kind
(Abbott 2009: 310). At the same time, narrative manifests in different forms and on
various levels; the most foundational distinctions of narrative theory are that
between story (the “what” of a narrative), and discourse (the “how” of presentation).
Marie-Laure Ryan pointed out that both levels can have different, unrelated degrees
of narrativity. A story can have high narrativity in that it offers much cause for
suspense, curiosity, and surprise, factors identified prominently by Meir Sternberg
(Abbott 2009: 315), and still be told in a way that is comparatively “un-narrative”
by using much description, commentary, or digression (Ryan 2007: 34 n. 25). The
French-Lithuanian structuralist A. J. Greimas similarly distinguished between two
levels of narrativity; the apparent, a specific kind of linguistic configuration of signs,
and the immanent, a deep structure of semantic organization. When natural scientists
speak out against the use of narrative, or when social scientists proclaim a turn
towards narrative, they usually focus on the apparent layer of narrative as a style, a
surface phenomenon, while overlooking the logically prior organization of
information in a narrative fashion (Abbott 2009: 312). This view on narrative is
closely related to Paul Ricoeur’s concept of emplotment, which stresses the power
of temporal reorganization of the causality of a plot (Abbott 2009: 313).
Arguments against narrative intimately connect it to fictionality, another contro-
versially discussed question in narrative theory. While scientific writing operates
under the assumption that there can be a completely neutral, truthful depiction of
things, literary theory is more occupied with the question of how literature can be
non-fictional, (i.e., how the nonfiction novels of authors like Norman Mailer, Tom
Wolfe, or Truman Capote can be conceptualized) (Heyne 1987), or how nonfiction
as a related text type or genre besides fiction can be categorized (Lehman 2001).
The distinction between fact and fiction has been sometimes reduced to a ques-
tion of authorial intent that needs to be explicitly communicated (Schaeffer 2009:
109). Additional factors have been identified by the German literary theorist Monika
Fludernik, who states that the differences between fiction and nonfiction “do not lie
in the text-internal makeup but in the intentions of the writer (entertainment vs.
information), the reception of the text (escapism vs. study of the real world), and the
process of dealing with the text (interpretation vs. extraction of information) – all
contextual frame conditions linked to the contextual marking of a text as either his-
tory (non-fiction) or fiction” (Fludernik 2001: 92).
One marker for readers in judging the fictionality of texts is their degree of veri-
similitude. Especially a lack thereof is a clear indicator: “Fairies, trolls, mermaids
and robots that arrive from Mars immediately identify a text as fictional” (Fludernik
2001: 96). Hard science fiction and predictive scientific nonfiction therefore move
Narrative 75
in the same precarious grey zone. Simulations and extrapolations of future states
based on current scientific axioms are, by definition, not verifiable. The question
becomes one of probability and verisimilitude, both of events and of actions
(Riffaterre 1993: 2).
Yet one does not need to enter the realm of future events to be confronted with
questions of probability and verisimilitude. Even the discussion of contemporary
biomedical knowledge may have to engage the improbable. Combinations of
symptoms or coinciding factors are especially noteworthy because they are unlikely
and elude statistical affirmation. That accounts of “freak occurrences” can still be
processed as more or less truthful seems to indicate that verisimilitude does not rest
mainly with individual elements (events or characters), but with the totality of the
“storyworld,” i.e., “the way interpreters of narrative reconstruct a sequence of states,
events, and actions not just additively or incrementally but integratively or
‘ecologically’; recipients do not just attempt to piece together bits of action into a
linear timeline but furthermore try to measure the significance of the timeline that
emerges against other possible courses of development in the world in which
narrated occurrences take place” (Herman 2002: 14). What makes a narrative
believable, then, is not only all that happens, but everything that does significantly
not happen. When Hamlet kills Polonius halfway through the play, this has the
easily overlooked side effect that Polonius can no longer influence the events
through his actions.
From the perspective of Theory of Mind, the fact-fiction divide becomes even
less tenable, because this theory considers the human capacity for mental simulation
as instrumental to all acts of understanding. The difference between “mind reading”
in fact and fiction is therefore rather a praxiological one, as the results of the attempt
to understand another individual’s thought processes cannot be fed back into a
social setting and thus verified (Schaeffer 2009: 111). This is, however, not merely
a distinguishing feature of fiction, but of most forms of formalized, mediated
discourse, the one-way communication already found to be problematic by Plato.
The complexity and diversity of these issues notwithstanding, they can at least
partially be reduced to the common denominator of “the ethics of referentiality, the
tacit understanding between author and audience in historical narrative that the
historian’s narrative is rooted in the events and facts that have an existence
independent of that narrative” (Phelan 2007: 219).
Following this line of reasoning, the difference between what is perceived as
factual and as fictional involves other factors. To Fludernik, the decisive criterion of
fiction is experientiality; that historical texts differ from novels insofar as the former
do not privilege the subjective experience of individuals while the latter do
(Fludernik 2001: 93). A different stance is taken by David Herman, who proposes
to distinguish various text types by their preferred or avoided prepositional frames.
A prepositional frame is one of six possible ontological classes: temporary or
permanent states; bounded or unbounded events; and bounded or unbounded
actions. To Herman, every representation could be reduced to a combination of
states that could be permanent or temporary, and events respectively actions that
differ in whether there is agency behind the changes of state they describe, and
76 H.-J. Backe
which can be bounded (i.e., have a defined beginning and ending) or not. Herman
gives the following examples: “Temporary state = Joe is in debt. Permanent state =
Joe is human. Bounded event = High tide crested at 9 p.m. Unbounded event =
Global warming was making ocean levels rise year by year. Bounded action = Joe
paid off his debt. Unbounded action = Joe worked at extricating himself from debt”
(Herman 2002: 43). Text types and genres can be distinguished based on their
preferences for a combination of prepositional frames. For example, a news item
will prefer bounded events and bounded actions (e.g., a fire and the actions of
firefighters), but may make use of other prepositional states as needed. A
psychological novel, on the other hand, will usually prioritize a temporary state,
such as a particularly important time in the life of its protagonist, and the fruitless
(and thus pointless and endless) attempt to cope with it (i.e., an unbounded action).
By contrast, bounded actions are comparatively rare in novels by Henry James or
Virginia Woolf.
Intertextuality and Referentiality
As initially stated, the fact-fiction discussion is already deeply rooted in the rela-
tionship between texts and what they refer to, a relationship identified as referential-
ity. The majority of sign systems, with notable exceptions such as abstract painting,
refer to some kind of outside reality. Cultural references, however, are often directed
at other signs or sign systems, or point towards themselves or their own sign sys-
tems. A painting showing a painter in front of an easel may depict a person (e.g., the
painter of a self-portrait), yet at the same time, it draws attention to its own sign
system (painting) and itself, because the painting depicted in the painting is neces-
sarily a different painting. Such types of sign relationships have been identified as
hetero-referential (pointing to some concrete other entity), self-referential (pointing
to itself), and meta-referential (pointing to the conditions of its own existence)
(Wolf 2009). Such complex relationships form the basis for both intertextuality, the
relationship between texts in the same medium, the prototypical case being literary
allusions (Ben-Porat 1976), and intermediality, references that transgress media
borders (Rajewsky 2005; Wolf 2009). The question of what exactly should be con-
sidered distinct media is sometimes debated, and more specialized concepts such as
multimodality (Elleström 2010) have been proposed.
Conclusions
Biomedicine, just like other scientific discourses, mostly figures in popular culture
as such intermedial references, evoking not scientific experiments or procedures
themselves, but the ways in which these are communicated and displayed in other
media. Watching a medical-themed television-show, viewers will necessarily
Narrative 77
understand the depiction of a certain procedure or the explanation of a symptom less

in reference to reality than to similar programs they have watched before, because
for viewers who are not medical professionals themselves, this frame of reference
will be much broader than their personal experience. Such references can range,
systematically speaking, from individual, intra-medial references (e.g., an instance
in a television-show referencing a specific other program, ideally a specific moment
in it), to an intermedial system-reference, such as a computer game alluding to a film
genre (Rajewsky 2005: 52–53). The interesting particularity of references to scien-
tific discourses like Biomedicine is that we are not only dealing, in all cases, with
intermedial references, but that individual and system references go inevitably hand
in hand. To portray biomedical concepts in popular culture means to both allude to
the rich history of literature, films, and television dealing with the subject, and to
also engage with questions of facticity and fictionality, of objectivity and narrativity.
A text like the House M.D. (Shore 2004–2012) episode Three Stories (S1E21) refer-
ences conventions of the medical profession, including diagnostic procedures, case
study lectures, and textbooks. It does so, however, in an openly meta-referential
fashion, because it exposes the protagonist’s lecture first as counterfactual, only to
re-contextualize it as a didactic and rhetorical tool with which ethical considerations
are made more tangible than through a purportedly neutral report. Exposing the doc-
tor’s case reports as strongly narrativized, while showing his narrative as if it was the
filmic reality, not only reminds viewers of the fictional nature of television drama, it
also addresses the underlying question of whether factual, neutral depiction is even
possible, both in popular culture and scientific writing.
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Rhetoric of Popular Culture
and Representations of Biomedicine
Barry Brummett
A recurring theme in today’s popular culture is that of biomedicine. Let me clarify

some key terms immediately. By popular culture I mean no exotic or difficult con-
cept, no term of art, but rather the everyday culture to which most people are exposed
on an ongoing basis. This would include television, movies, hip hop, country west-
ern, rock and roll, pop music, magazines, blogs, theme bars and restaurants, and so
forth. We probably do not mean what is sometimes called ‘high art’ such as the
ballet or opera.
Clarification of Terms and Questions
Popular culture is a subject of the first importance. It has the attention of most peo-
ple, but of course it may vary from place to place (although the international hege-
mony of American popular culture is remarkable). Popular culture is also one of the
main tools, and likely the most important one, of global capitalism today, as I have
argued in earlier work (Brummett 2008). This argument is central to the Frankfurt
School’s critique, for instance (Adorno and Horkheimer 2000). Pierre Bourdieu
agrees, and identifies resources within popular culture to resist capital (Bourdieu
1988). Capitalism must induce the global market to consume at ever increasing
levels of frenzy, or the economy’s done for. It does that through advertising, whether
the overt form of actual ads or the increasingly common and covert form of product
placement. Popular culture is so shot through with advertising that the two are now
inseparable. And so popular culture must then be understood as a central pillar of
capitalism.
B. Brummett (*)
Department of Communication Studies, The University of Texas at Austin, Austin, TX, USA
e-mail: brummett@austin.utexas.edu

https://doi.org/10.1007/978-3-319-90677-5_7
80 B. Brummett
A second term to clarify is biomedicine. When we speak of biomedicine in popu-

lar culture we are speaking of its representations there. Popular culture is almost
entirely representations and images, and many of these are of biomedicine. See for
instance the critiques of the centrality of visual rhetoric, including images, in popu-
lar culture today by Finnegan (2003) and by Hariman and Lucaites (2007). But a
moment’s thought will call to mind the wash of films and television shows about
zombies, rage viruses, pandemics, mutants and the like to see the centrality of bio-
medical representations. But let’s not stop there, for “doctor shows” are all over
television, and have long been a mainstay of soap operas both afternoon and
evening.
The particular question I want to approach in this essay is, how can we find meth-
ods to study the rhetoric of these representations? Rhetoric of course began as the
ancient study of persuasion in public speaking, but scholars today now study it as
the omnipresent dimension of human influence across human activities. We are
always disputing, finding common ground, or identifying enemies and the exotic,
we are always being socialized in ways great and small, and rhetoric is the instru-
ment by which this happens. These influences are often in terms of important social
and political attitudes. So, as people enjoy their shows representing biomedicine,
how is influence being carried out in those sites so that social and political predis-
positions, attitudes, framings, and worldviews are at the same time being influ-
enced? These questions today are taken up by a great many scholars in departments
of Communication Studies, Composition, English, Film, and the like. Here I want
to sketch out a couple of the issues these scholars encounter as they study the rheto-
ric of popular culture.
Methods for Study
I want to focus on two difficulties in identifying methods for understanding the

rhetoric of popular culture, including representations of biomedicine. The first has
to do with biomedical representations that seem not to be literal at all. Some such
representations, of course, are indeed literal. If a “doctor show” depicts a rare ill-
ness, people may be moved to go see their physicians with their imagined symp-
toms. Or if a doctor in an advertisement or a film advises an aspirin regimen, or
swallowing garlic whole, or sipping vinegar, we may be sure that many in the audi-
ence will respond. But how do pandemic or zombie films influence audiences?
Thank goodness nobody is troubled by the undead crashing against our doors—yet.
Despite outbreaks of Ebola virus, Swine Flu or Bird Flu, or even the plagues of the
Middles Ages, so far no real occurrence of a worldwide collapse of society due to
illness has occurred, and yet popular culture depicts such disasters repeatedly. Either
we must decide that fanciful, nonliteral biomedical representations have no real
rhetorical influence, or we must understand nonliteral, nonexpository ways in which
we can assess the influence that does take place.
Rhetoric of Popular Culture and Representations of Biomedicine 81
A second difficulty lies with the fact that these representations are good fun and
leisure time escapist activities. In contrast to a presidential speech about a
Congressional deadlock, popular representations of biomedicine seem not to be
about hefty and important issues, and specifically not about how power is managed
in ways large and small. Yet if these representations are at all rhetorical, then they
must be implicated in managing the power of everyday relations at the very least.
They must be influencing attitudes concerning gender, race, class, sexual orienta-
tion and so forth that assuredly have to do with the distribution of power in any
society. Taking this issue together with the concern for nonliteral representations,
students of the rhetoric of popular culture must have some methodological means of
proceeding.
Some ways of studying discourse have been developed that will meet the meth-
odological challenges I have outlined above. Following the American theorist and
critic Kenneth Burke, I have made several studies that I think illustrate a general
methodological strategy (see below). I do not claim at all these are the only method-
ological approaches to these challenges possible, but I think they illustrate two gen-
eral principles. One principle is that any representations of biomedicine, but
especially nonliteral or fantastic representations, must be studied at the level of
formal appeal.1 A second principle is that such representations need to be studied
through a mindset of deep discounting, by which I mean that the investigator needs
to say, “I am looking at representations that appear to be A, but in addition they are
also B” where B may seem rather different from A.
The Method of Homology
Throughout several of his works, Kenneth Burke developed the idea that the form of
discourse, related to but in contrast to its content, might be the same form underly-
ing recurrent experiences (Burke 1968, 1973). A discourse might tell the story of a
knight’s quest, which will formally parallel the quests of salespeople, graduate stu-
dents, athletes—indeed, most people—as we go through our everyday lives.
Ordinary people are not knights and do not encounter monsters, but the pattern of
knights errant (having a lofty goal to pursue, being given an important charge) is
widely experienced, as is the form of monsters (opponents at work, unfriendly
neighbours, uncivil family members and so forth). Whether literal or nonliteral,
when discourse and experience follow the same form, they are connected. Once
connected, the discourse can coach people as to how to understand and manage the
1
Form may be distinguished from the content or information offered by a text. A funeral eulogy,
for instance, is expected to follow a certain form, yet the information imparted in each eulogy will
vary widely according to the deceased, the circumstances, and so forth. Sheer information is hard
to learn, but if it can be put into formal patterns it becomes easier. So, for instance, the colors of the
rainbow themselves may be hard to memorize, but if they are put into the form of a name, which
is a pattern we all learn, they are easier: Roy G. Biv, for red, orange, yellow, green, blue, indigo,
violet.
82 B. Brummett
experiences. The connection, in other words, enables a rhetorical effect even of

discourses that seem not to be trying to make direct rhetorical appeals. A formal
connection even lets experiences of the same pattern inform each other and influ-
ence audiences as to how to manage the experiences.
Suppose, for instance, that you enter a special place set apart from the world. To
enter this space you must say and not say certain things. You may be required to
remove certain articles of clothing, and to give up certain kinds of objects. You must
humble, even debase, yourself upon entering. You may be interrogated closely.
Once inside this special place you are in a world granted to only a few, and new
experiences and opportunities open up to you.
What experiences are like that, formally? Surely entering the security area of an
airport is one. Beginning a program of study in a martial arts school is another.
Being inducted into military service may be another. And of course, entering a
house of worship fits the pattern. The formal parallels among these experiences may
be one reason why the general public has been so accepting of the privations and
strictures of airport security, for example, because we have been coached by these
other experiences to accept docilely what happens to us there. But think also about
discourses that may follow that pattern. Arguably, the process of attending Hogwart’s
Academy in the Harry Potter series of books and movies also follows the same pat-
tern. These discourses can then advise an audience rhetorically as to how to live
through experiences of the same patterns, and likewise experience with certain pat-
terns of experience teach us how to read certain texts.
I have approached formal patterns underlying wide ranges of discourses and
experiences via the idea of homology (Brummett 1988, 1991).2 Homologies are
widely used throughout the natural (Rotman 1995) and social sciences (Meskell
2000), and the humanities (Hebdige 1979; Levi-Strauss 1969; Revel 1995; Sjoo and
Mor 1991), to identify causal and generative patterns of influence. Biologists might
identify similar anatomical structures in animals across different continents.
Sociologists and mythologists might identify similar patterns across myths or fairy
tales around the world. Marxists might identify similar patterns of socialization and
economic structures that perpetuate power arrangements in societies (Willis 1981).
In each case, the investigator must say what it is that is pushing up the formal simi-
larity in widely disparate circumstances: evolutionary forces, shared cognitive
structures, the formative power of economic bases, and so forth.
Those who are interested in the rhetoric of biomedical representations will iden-
tify discursive forms that underlie both texts and common experiences. Such forms
make texts and experiences vulnerable to each other. By that I mean, a text that fol-
lows the same form as an experience is then in a position to speak to people about
how to live through experiences like that. The content of the text may then influence
how people respond to experience, but the influence is at a formal level, just as
experiences may influence how we understand texts. For instance, in a couple of
2
Homology here is, of course, developed out of “homo,” or same. And “logy” is developed out of
logos, or a rational system of understanding and thought. When different experiences, objects, and
texts follow the same (homo) pattern or rationale (logos), they are homologous.
studies I have argued that haunted house movies follow the same formal pattern that
people experience of feeling they are in the wrong space at the wrong time
(Brummett 1985, 1991). That similarity of pattern lets the movies speak to the expe-
riences. Yet in some movies, the characters are able to overcome that situation of
disorientation, and thus offer advice to audiences as to triumph in their own lived
experiences of disorientation. In other movies, the characters are utterly undone and
lost in their disorientation, and thus the films warn audiences to stick to the familiar
and avoid such situations.
The formal, or homological, method I am advocating requires some attunement
to thinking beneath the surface, to thinking formally about texts and experiences.
This may come naturally in some or it can be trained in others. An important move
in thinking this way is to begin with a text or a common, recurring experience, and
to ask what is the formal pattern beneath it.
The Pattern of Otherness
Let’s take some initial steps with this method by thinking about news stories, or
even experiences, of epidemics. Beneath the content of stories about new outbreaks
of Ebola in Africa, or MERS in the Middle East, what are the patterns of experience
that we see again and again? Let me suggest some recurring elements of these sto-
ries that, because they recur, are formal. First is the exotic: these diseases are not the
common cold, and are likely to be seen by many people, especially in what we like
to call the developed world, as strange and bizarre. They are the threat of the utterly
foreign. They appear to be new, and yet their origin is often mysterious. Because
they are exotic and mysterious, these diseases are utterly Other, and may be taken
as the very essence not only of Otherness but of threatening Otherness. Of course,
in using a language of Otherness I am thinking about the audience/observer from
the perspective of the developed world. The whole matter may look very different to
residents of what we call the developing countries.
Otherness is a concept well developed by social critic bell hooks (1992, 2000),
sociologist Deborah Lupton (2012) and anthropologist Mary Douglas (1969). These
and other scholars have explored ways in which every social structure must define
not only itself but also those who are different or separate from itself. These “Others”
are necessary for every society, and they provide a point of orientation by which
“we” come to know who we are in contrast to “them.” Some kinds of Otherness are
harmless, even enjoyable. The exotic can be fun, as when we discover a new kind of
ethnic cuisine. But diseases are likely to be perceived as a threatening Otherness
emerging in mysterious ways from steaming jungles, crowded slums and markets,
and fetid hovels. These mysterious diseases therefore also have a definite set of class
connotations, for they have arisen among those who will be perceived as the unwashed
and desperate poor in developed countries. Photos of gaunt babies with flies in their
eyes, of bodies left to lie in wretched streets, will further emphasize the class impli-
cations of these diseases. We get the diseases from those people over there.
84 B. Brummett
And yet the great fear is that Otherness will break in upon our suburbs and
Walmarts, our trendy cafes and expensive boutiques. There are always specific
points of entry for this horrible Otherness, usually associated with transportation
means such as airplanes or ships. The occasional immigrant to New York or London
who then breaks out with an infectious, rare disease is a particular source of anxiety.
Not only are these people different, but dangerous and potentially deadly. They are
a kind of difference we cannot assimilate. And they are sneaking in among us.
The general populace in developed countries goes through their everyday rou-
tines with a heightened level of menace in their conscious awareness. Some may
wear gauze masks in public. Others may stockpile water, food, and batteries in
expectation of a catastrophic pandemic. There is not wailing in the streets of Paris
or Amsterdam, but there is a tightening of the knot in the stomach as the public fol-
lows the ongoing, obsessive news reports. Any small twist in the progress of the
epidemic is treated as “breaking news” on network television and covered in Second
Coming levels of anxiety and excitement.
The position of authority, whether legal or medical, is ambivalent in these experi-
ences. Medical authorities seem to be baffled. Therapies have not been fully devel-
oped, trials may be months behind the progress of the disease. A few courageous
medical personnel who go to infected areas become media heroes, for they venture
into Otherness in ways we would not. As so often seems to happen, when these
heroes are themselves stricken, they are evacuated back into “civilization” in devel-
oped countries. Even back home, their diseases are monitored and are the subject of
daily news reports. Doctors and nurses, so revered in developed countries, seem not
to have the situation under control.
Even less so do the legal authorities. We hear of frightened locals storming Ebola
clinics, of the dead left for days with no competent authority to remove them, of
raids on pharmacies, of the angry ostracization of the infected. We get glimpses of
civic authorities with even less grasp of events than medical authorities. Nobody is
restoring order.
Eventually—so far—the peril is overcome after great loss of life. Usually this is
not the dramatic triumph of some grand intervention, but the slow accretion of new
therapies, new clinics, or even just developing immunities in afflicted populations.
The disease whimpers back into obscurity, rather than run in full retreat. But we can
never be sure that it will not resurface. At this writing (2015), Ebola has reappeared
in Liberia, for instance. But there will certainly be new, mysterious diseases that
arise; such has been our experience, such is our expectation.
Otherness and Homology
I have been describing a formal pattern underlying much news coverage. Although
my description has been peppered with enough content or information to make
myself understand (I hope), I have mainly been describing a pattern. To think homo-
logically, what other experiences or texts follow the same pattern?
Of course we may say that each new round of news coverage is homological if it
follows the same form, and so many of them do. But that is not an interesting part
of the homology. Homological thinking becomes interesting when we can identify
other actual experiences that seem to follow the same form but have nothing to do
with the medical.We think homologically when we identify texts of popular culture
such as films or television shows that follow the same pattern but not in replicating
the same literal stories we see in news coverage. To identify disparate texts and
experiences is important because it helps us see what may be unacknowledged paths
of rhetorical influence that are outside of conscious awareness, and perhaps for that
very reason all the more powerful.
Suppose we thought about an outbreak of Other religions (from the perspective
of the developed world), of exotic and (to the observer) bizarre belief systems, as
formally parallel to MERS, bird flu, and the like. From apocalyptic end-of-the-
worlders to extreme and violent religious sects, the world seems to be observing
waves of outbreaks of this kind of extremist danger (to the developed world). Now
think of all the formal components of the pattern that we observe when seeing news
coverage of disease, and think of how many of those components may also be
observed in news coverage of rampant religious ideologies. The authorities cer-
tainly do not have the situation under control. Courageous journalists may go to
investigate these outbreaks, and sometimes they return. Sometimes they do not. Few
if any of these zealots are utterly defeated; most eventually fade back into their
home cultures or give way to a new round of extremists. Much attention is paid to
the “infected” who sneak into developed countries and form cells that may break out
into violence, or a kind of social “infection.”
What about texts in popular culture that are fictional accounts of some kind of
contagion, whether physical, social, or moral? Which of the currently popular wave
of zombie films and stories match the pattern I have suggested here? The medical
plagues in zombie films are not strictly speaking those we see depicted on television
news, but the similarities may be so close at a formal level that, homologically, they
are the same.
My purpose here is not to conduct a full fledged homological analysis of the
rhetoric of this form, but to point the reader in the direction of homological think-
ing. To succeed, a homological analysis must amass a great deal of evidence show-
ing a formal pattern underlying different texts and experiences. One or two examples
will not do. And as I have noted, the extent to which the same form may be identi-
fied in disparate texts is the extent to which the homology may be powerful in
revealing rhetorical influences out of awareness.
To identify a homology is to identify texts and experiences that are vulnerable to
influence one from another, at the level of form. The final and perhaps more impor-
tant move is to assess how the homology enables rhetorical influence. This will
usually be an influence that flows from a text in popular culture toward people’s
lived experiences. No generalization can be made about the particular homology I
have explored here, since every text will have a different answer. The answer is
often at the level of content, yet the influence is carried by form. By that I mean that
a given movie, let us say, may say that an outbreak of disease is utterly disastrous.
86 B. Brummett
It is then telling people in their lived situations that strange Otherness is disastrous,
and best avoided. Another film may say at the level of content that Otherness can be
assimilated, or overcome, or avoided altogether, and that rhetorical advice is carried
to an audience on the level of form. If an audience that is experiencing anxiety over,
let us say, what they perceive to be uncontrolled immigration sees a film that con-
nects formally with that real anxiety, but is about an exotic disease, then what the
film says about the disease will influence how the audience feels about immigration.
Since this influence will be carried through at the level of form, and form is often
out of awareness, the influence may be more powerful than is a traditional exhorta-
tive, literal, argumentative rhetoric, such as found in public speaking or editorial
essays. Neil Postman (Postman 1985), for example, describes these traditional char-
acteristics of exhortative discourse in contrast to the appeals of popular culture.
In this essay I hope to have illustrated both how biomedical representations in
popular culture may have rhetorical influence and also a method for tracking that
influence. If this approach seems plausible, further steps should think homologi-
cally and rhetorical about biomedical representations in popular culture. They will,
of course, follow many more patterns than I have discussed here. Many “doctor
shows” for instance follow a form of what we may call “the beloved community,”
and the dynamics of those communities may be formally connected to our experi-
ence of communities in everyday life. The research continues.
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———. 1988. The homology hypothesis: Pornography on the VCR. Critical Studies in Mass
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Popular Culture and the Dissemination
of Knowledge
John Storey
Written from the perspective of cultural studies, the chapter seeks to briefly explore
the relationship between popular culture and the production of knowledge. To fully
understand this relationship we must first address the difficulties that surround the
concept of popular culture. While it may seem obvious what it is, once we think
about it historically and theoretically it becomes very clear that there is in fact many
versions of popular culture. To demonstrate this I outline five ways in which popular
culture has been conceptualized and show how each theorisation carries with it a
different understanding of what we are doing when we engage in the study of popu-
lar culture. Each definition is accompanied by a discussion of the connection
between popular culture and the dissemination of knowledge. However, making a
connection between popular culture and knowledge is ultimately an empirical ques-
tion, one that can only really be answered by detailed investigation of the consump-
tion of popular texts and practices. Therefore, any claims made here during this
short chapter are inevitably speculative and a little abstract, driven as they are by
theoretical extrapolation.
Popular Culture as Well Liked by Many People
An obvious starting point in any attempt to define popular culture is to say that it is
simply culture that is well liked by many people. We could examine sales of books,
sales of CDs and DVDs. We could also examine attendance records at concerts,
sporting events, and festivals. We could scrutinize market research figures on audi-
ence preferences for different television programmes or genres of cinema. However,
J. Storey (*)
Centre for Research in Media and Cultural Studies, University of Sunderland,
Sunderland, UK
e-mail: john.storey@sunderland.ac.uk

https://doi.org/10.1007/978-3-319-90677-5_8
90 J. Storey
the difficulty with the coming together of culture and popular in this way is that we
are required to agree on a figure over which something becomes ‘popular culture’
and below which it is just ‘culture’. Unless we can agree on such a figure, we could
find that being well liked by many people might include so much as to be virtually
useless as a conceptual definition of popular culture. Despite this problem, what is
clear is that any definition of popular culture must include a quantitative dimension.
The popular of popular culture would seem to demand it. What is also clear is that
on its own a quantitative index is not enough to provide an adequate definition of
popular culture.
This is a definition that works with the assumption that the essential feature of
popular culture is popularity. The logic of this definition is to draw conclusions from
popularity. Therefore, if a popular soap opera maintains its popularity while running
storylines about HIV/AIDS, this would tend to suggest that its audience is generally
sympathetic to the issues involved and open to any knowledge produced. The prob-
lem of course is that popularity on its own tells us very little about how something
has been consumed. In other words, being part of an audience for something (i.e.
being part of what makes it popular) does not necessarily mean you like or approved
of what you have viewed.
Popular Culture as a Residual Category
A second way of defining popular culture is to suggest that it is what is left over
after we have decided what is culture. Popular culture, in this definition, is a residual
category, there to accommodate texts and practices that are unable to meet the
required standards to qualify as culture. It is a definition of popular culture as infe-
rior or failed culture. Those who deploy this definition generally insist that the divi-
sion between popular and ‘real’ culture is absolutely clear. Moreover, not only is
this division clear, it is trans-historical – fixed for all time. This latter point is usually
insisted on, especially if the division is dependent on supposed essential textual
qualities. But even a little knowledge of cultural history should make us sceptical of
such claims. In the UK and USA, for example, the work of William Shakespeare is
now seen as the very epitome of ‘real’ culture, yet as late as the nineteenth century,
before the plays became poetry on the page rather than scripts to be performed on
the stage, they were very much a part of popular theatre (Levine 1988). Similarly,
since its invention in the late sixteenth century, opera has been both a popular and
an exclusive culture (Storey 2010).
If popular culture is a residual category, a dustbin of failed or inferior culture,
then any knowledge disseminated must be unreliable. Of course knowledge will still
be produced, but it will be to a certain extent second-rate knowledge circulating in
second-rate culture. Again, if we think people are badly informed about medical
matters, this might be one way to explain it. This view of popular culture would lead
to an expectation that its treatment of HIV/AIDS, for example, would be at best
unreliable and misleading.
Popular Culture and the Dissemination of Knowledge 91
Popular Culture as a Social Category
Many who challenge the supposed certainties of popular culture as a residual cate-
gory often do so from a position heavily influenced by the work of the French soci-
ologist Pierre Bourdieu (1984, 2009). Contrary to most definitions, this position
argues that there is no ‘essential’ difference between culture and popular culture, the
difference has to be produced and reproduced – ‘culture’ and ‘popular culture’ are
social categories. The content of these categories continually changes, but it is the
categories that matter, not their content. The difference between the two marks and
maintains a social difference between two types of consumer: elite and non-elite.
Bourdieu argues that cultural distinctions of this kind are often used to support class
distinctions. Taste is a deeply ideological category: it functions as a marker of
‘class’ (using the term in a double sense to mean both a social economic category
and the suggestion of a particular level of quality). The function of the division
between culture and popular culture (based on this argument) is to make, mark and
maintain social difference – what Bourdieu calls ‘social distinction’. As he explains,
the division is, ultimately “predisposed […] to fulfill a social function of legitimat-
ing social difference” (2009: 503). In other words, the division is always part of an
attempt to mark differences between people. Therefore, if something becomes too
popular, it ceases to have what Bourdieu calls ‘cultural capital’; by lacking ‘cultural
capital’, it loses its ability to produce ‘social distinction’. When this happens, elite
groups will reject it, as consuming it no longer marks them out as different (i.e. the
perception of themselves as superior). Hence, the general point of this perspective
is that, ‘culture’ and ‘popular culture’ are empty categories; the content of these
categories can and does change, but the distinction between them must be main-
tained, must be policed in the interests of social exclusivity.
According to the logic of this definition, what counts as knowledge is also a
shifting category, temporarily fixed by those with the power to do so.
Popular Culture as Folk Culture
The first really sustained and detailed intellectual linking of popular and culture was
developed in Europe in the late eighteenth century as a result of a growing interest
in the culture of the so-called ‘folk’ (Storey 2003, 2016). In the late eighteenth cen-
tury and throughout the nineteenth century and into the early part of the twentieth
century different groups of intellectuals, working under the different banners of
nationalism, Romanticism, folklore and, finally, folksong, invented the first ‘intel-
lectual’ concept of popular culture. For these groups, popular culture is culture
which originates from ‘the people’ (i.e. the ‘folk’). This produces a definition of
popular culture as something which spontaneously emerges from ‘below’, some-
thing communal and self-made. According to this definition, the term popular cul-
ture should be used only to indicate an ‘authentic’ culture of the people. One
92 J. Storey
problem with this approach is the question of who qualifies for inclusion in the
category ‘the people’. The intellectuals involved in the ‘discovery’ of the folk dis-
tinguished between two versions of the people, the ‘rural folk’ and the ‘urban
masses’ and only the ‘folk’ were producers of popular culture. Another problem
with this definition is that it evades any significant discussion of the commercial
nature of much of the resources from which popular culture as folk culture is pro-
duced. For example, many of the folksongs collected were later discovered to be
versions of once popular ‘commercial’ songs.
If we think popular culture is a kind of folk culture, spontaneously produced
from ‘below’, then the ideas it disseminates may have developed over decades out-
side, for example, the direct influence of mainstream medical knowledge. What we
might have is what could be called ‘people’s’ knowledge of matters medical; which
in turn might tell us about how medical knowledge is produced and reproduced in
everyday discourses.
Popular Culture as Mass Culture
The ‘discovery of the folk’ not only produced a concept of popular culture as folk
culture, it also helped to establish the intellectual tradition of seeing the urban work-
ing class as masses, consuming mass culture. This is because the ‘discovery’ of the
rural folk was accompanied, and no doubt driven, by the ‘discovery’ of the urban
masses. If the folk represented a disappearing ‘positive’ popular, the new urban
masses represented an emerging ‘negative’ popular. As Cecil Sharp, one of the lead-
ing figures in the English ‘folksong’ movement made clear in 1907,
Flood the streets... with folk-tunes, and those, who now vulgarise themselves and others by
singing coarse music-hall songs, will soon drop them in favour of the equally attractive but
far better tunes of the folk. This will make the streets a pleasanter place for those who have
sensitive ears, and will do incalculable good in civilising the masses (quoted in Storey
2003: 12).
Sharp is clearly working with two versions of the people (rural folk and urban
masses) and two versions of popular culture (folk and mass). This way of thinking,
premised on the idea, that the rural folk were being replaced by the urban masses,
gradually produced a concept of popular culture as commercial culture, mass-
produced for mass consumption, with an audience of non-discriminating consum-
ers. The culture itself is seen as formulaic, manipulative (to the political right or left,
depending on who is doing the analysis). It is a culture that is consumed with brain-
numbed and brain-numbing passivity. But as John Fiske (1989) points out, ‘between
80 and 90 per cent of new products fail despite extensive advertising … many films
fail to recover even their promotional costs at the box office’ (31). Simon Frith
(1983: 147) also points out that about 80% of singles and albums lose money. Such
statistics should clearly call into question the notion of consumption as an automatic
and passive activity and in so doing undermines one of the key claims of this
definition.
Popular Culture and the Dissemination of Knowledge 93
If we think of popular culture as mass culture, knowledge is something imposed

from above, making popular culture a fairly reliable forum for the ‘top-down’ circu-
lation of ideas. The supposed passivity of its consumers would suggest that what is
produced will be consumed as intended. If we think that people are badly informed
about medical matters, the source of the problem is in what the culture industries
produce or in the failure of consumers to understand what is produced.
Popular Culture as Site of Struggle
Analysis informed by Antonio Gramsci’s concept of hegemony (Gramsci 1971,

2009) tends to see popular culture as a terrain of ideological struggle between domi-
nant and subordinate classes. Popular culture in this usage is not the imposed cul-
ture of the mass culture theorists, nor is it an emerging from below, spontaneously
oppositional culture of ‘the people’; it is a terrain of exchange and negotiation
between the two – a site of struggle between the ‘resistance’ of subordinate groups
and the forces of ‘incorporation’ operating in the interests of dominant groups. In
other words, popular culture is a key terrain for the production and reproduction of
hegemony. The texts and practices of popular culture move within what Gramsci
calls a ‘compromise equilibrium’ (2009: 76) – a balance that is mostly weighted in
the interests of the powerful. For example, think of Karl Marx’s famous account of
religion as the drug of the masses. What he actual said is this: ‘Religion is the sigh
of the oppressed creature, the heart of a heartless world and the soul of soulless
conditions. It is the opium of the people’ (1992: 244). Religion is popular culture to
the extent that it holds popularity. If we can agree it is both culture and popular we
have agreed it is popular culture. But, according to this perspective, it is popular
culture marked by a ‘compromise equilibrium’: it exhibits resistance to oppression
(the sigh of the oppressed creature) and it secures that oppression (opium of the
people). In other words, it works like ‘folk culture’ in that it articulates an awareness
of oppression, but it also works like ‘mass culture’ in that it provides the conditions
for oppression to continue.
According to this definition instead of popular culture being one thing, it is a site
of struggle between different versions of, say, what counts as medical knowledge.
Rather than claim that popular culture produces particular knowledge about a virus or
infection, it would argue instead that it is better conceived as a contradictory terrain
of dominant and subordinate claims and counter-claims about medical conditions.
Conclusion
What I hope I have demonstrated is that popular culture is not a self-evident cate-
gory and any analysis of popular culture must begin with the concept itself. But,
however we define popular culture, it never just reflects already existing knowledge;
94 J. Storey
it produces knowledge. A soap opera which tells the story of a young man with
HIV/AIDS is never simply telling us what we know; it is potentially shaping how
we understand what we know and how we might respond to it in the future. But how
this works will be seen as different depending on our assumptions about popular
culture derived from how we define it. In each of the five conceptualisations of
popular culture its relationship to the dissemination of knowledge is different.
Although we do not usually think of popular culture as a means to disseminate
knowledge, there can be little doubt that it does. This claim, however, has to be
qualified by the fact that this will work differently in the different definitions of
popular culture. Moreover, how we think it works will depend on what kind of
knowledge we think is being produced. There are different terms for the knowledge
disseminated by popular culture. We might call it ‘common sense’ (Antonio Gramsci
1971), a ‘regime of truth’ (Foucault 2002), or ‘ideology’ (Marx and Engels 1974).
Like the different definitions of popular culture, these different understandings pro-
duce a different sense of how it produces knowledge and the kind of knowledge that
is produced. However, in this short analysis I have focused here only on the produc-
tion of knowledge as it might be imagined as being aligned with each of the five
definitions of popular culture.
References
Bourdieu, P. 1984. Distinction: A social critique of the judgment of taste. London: Routledge.
———. 2009. Distinction and the aristocracy of culture. In Cultural theory and popular culture:
A reader, ed. J. Storey. London: Routledge.
Fiske, J. 1989. Understanding popular culture. London: Unwin Hyman.
Foucault, M. 2002. Michel Foucault: Essential works: Power. Harmondsworth: Penguin.
Frith, S. 1983. Sound effects: Youth, leisure and the politics of rock. London: Constable.
Gramsci, A. 1971. Selections from prison notebooks. London: Lawrence & Wishart.
———. 2009. Hegemony, intellectuals, and the state. In Cultural theory and popular culture: A
reader, ed. J. Storey. London: Routledge.
Levine, L. 1988. Highbrow/lowbrow: The emergence of cultural hierarchy in america. Cambridge,
MA: Harvard University Press.
Marx, K. 1992. Early Writings. Harmondsworth: Penguin.
Marx, K., and F. Engels. 1974. The German ideology. London: Lawrence & Wishart.
Storey, J. 2003. Inventing popular culture: From folklore to globalisation. Malden: Blackwell.
———. 2010. Culture and power in cultural studies: The politics of signification. Edinburgh:
Edinburgh University Press.
———. 2016. Class and the invention of tradition: The cases of christmas, football, and folksong.
In The making of english popular culture, ed. J. Storey. London: Routledge.
Images and Self-Evidence
Michael Martin and Heiner Fangerau
Introduction
Representations of medicine in pop culture often have an iconographic character.

Thereby, they set in a double sense of self-evidence. On the one hand they represent
obvious medical contexts, on the other hand, they illustrate evident medical
knowledge. Many of the iconographic representations used in pop culture feed back
to medical discourses and become generators of evidence themselves.
Self-evidence in that sense roots back to the Latin “evidentia”, which is to be dif-
ferentiated from the English term “evidence”. Whereas “evidence” is the proof of
something, “evidentia” or that what is self-evident is obvious without further proof.
Etymologically, self-evidence can be thought of as, “what‚ obviously is (evidentia) or
what‚ clearly stands before the eyes (enageia)” (Kamecke 2009: 11). This meaning is
based in its core on visual cognition, because “what is obvious, can be seen (videre).
Thus, the etymology of the term self-evidence offers a model for the certainty of
thinking: one knows something, because one has seen it” (Kamecke 2009: 11).1
However, the visual sense can be deluded, just like the other senses. It can be
deceived or is often mistaken. That said, any theory of self-evidence which takes the
visual sense and seeing as the essential prerequisite for truth, is itself already “per
se characterized by a moment of the paradox” (Nohr 2014: 280). Although if self-
evidence means “the directly plausible self-demonstration of true knowledge”
(Halbfass and Held 1972: 829), this knowledge does not appear by itself. As Ludwig
Jäger stated, self-evidence “can be understood only as a result of the generation of
1
All translations from German by the authors. English text editing was provided by International
Science Editing.
M. Martin · H. Fangerau (*)

e-mail: heiner.fangerau@uni-duesseldorf.de

https://doi.org/10.1007/978-3-319-90677-5_9
96 M. Martin and H. Fangerau
meaning with the help of media” (Jäger 2012: 119). However, to generate the
“obvious” or the “immediate”, which is the “nature” of self-evidence, the proof of
its “artefactual nature” must be erased. “Mediation and concealment of the media-
tion—this would be the spell of self-evidence”, Geimer concluded, before stressing
that, “self-evidence requires media procedures in generating meaning. However, in
order to not disturb the impression of self-evidence these media procedures should
not appear as such” (Geimer 2015: 183). Like Nohr, he asked himself, “how some-
thing can be obvious and simultaneously depend in its notoriousness on elaborated
procedures of making sense?” He concluded, that “really nothing comes about less
obviously than self-evidence: Self-evidence must be justified, it comes and goes, its
temporary appearance depends on preparation and mediation” (Geimer 2015: 182).
In 1969, Stegmüller had expressly referred to this aporetic phenomenon of the
inevident self-evident. He regarded “the problem of self-evidence problem” as
“absolutely insolvable […], because all arguments for self-evidence result in a
vicious circle and all arguments against it in a self-contradiction” (Stegmüller 1969:
168). Kamecke summarizes that “Philosophy turns self-evidence into a dilemma of
its consistency”, but “still there is evidence! This is right with certainty. The
existence of self-evidence is obvious” (Kamecke 2009: 15).
In this review, at first, we will give an overview of the current research about
visual (non-linguistic) “self-evidence” (Cf. Kamecke 2009; Pfotenhauer et al.
2005). Then, different strategies are introduced that serve the “production” of self-
evident images. Finally, “generators of self-evidence”, which are found in medicine
and their representation in popular culture will be displayed on the basis of three
case studies.
Current Research on Self-Evidence
In both cultural studies and the history of science, research into self-evidence has
almost exclusively been focussed in the context of “visualisation” (Peters and
Schäfer 2006: 9–21; Wimböck et al. 2007; Müller and Fangerau 2010). It has been
stressed that the foundations of self-evidence are strongly context-sensitive and
dependent on various parameters including traditions, thought styles and scientific
discourses about the validity of the senses. All of these parameters are subject to
historical change. This research was performed with the basic assumption that
“images are considerably involved in the formation of knowledge in the way that
they do not simply reproduce facts, but that they change, organize and, above all of
all, produce them” (Geimer 2002: 7). “Image” in that sense, is understood as
representations of physical elements in a symbolic combination. Images are
composed of several signs that serve as cultural markers, each implying a connotation
that can be understood almost like a form of grammar. Therefore, to fully understand
images, their specific codes have to be deciphered or deconstructed.
Since the ‘Iconic’ or ‘Pictorial Turn’ in historiography more than 20 years ago,
an extensive literature on the status of figurative representations in the sciences and
Images and Self-Evidence 97
the development of the respective images has been produced. These have been
already summarized in several important review articles (Borck 2009: 317–327;
Bluma and Nikolow 2008: 45–78; Heßler 2005: 266–292; Dommann 2004: 77–89).
In particular, countless interdisciplinary anthologies have been dedicated to
theoretical reflections and case examples of visuals in the sciences and their role in
the formation of scientific and popular knowledge (Huber and Heintz 2001; Gugerli
and Orland 2002; Hinterwaldner and Buschhaus 2006; Heßler 2006; Stahnisch and
Bauer 2007; Hüppauf and Weingart 2008; Heßler and Mersch 2009; Maasen et al.
2006; Bredekamp et al. 2015). Additionally, in this context, there has been an
increasing formation of dedicated research branches emphasising the art of dia-
grams (“diagrammatics”) (Bogen and Thürlemann 2003; Bredekamp et al. 2005;
Bucher 2007; Bauer and Ernst 2010), which particularly focus on the conception of
the diagram as a “writing-graphic hybrid between picture and text” (Krämer 2006,
2009). Graphs, maps and trees are seen as a universal format for understanding the
world and as tools that allow for distant reading instead of for example going
through thousands of text pages (Moretti 2005).
However, in discussions about self-evidence among historians of science, the
visual was not always central. Peters and Schäfer for example, refer to the concept
of an “intellectual view” (Intellektuelle Anschauung), which was originally coined
by Immanuel Kant, who around 1800 stood “at the centre of various debates as a
figure of purely spiritual thinking”. According to their analysis on the basis of this
conception, “the question of the sensuous descriptiveness of knowledge and
realization” arose in the following years. In the concept of self-evidence “that what
is generally considered the core of epistemological procedures, and that what is
often judged as a secondary moment of representation and presentation is intertwined
from the start. Though evidentia is rooted conceptually in rhetorics, it is not limited
to linguistic connections, but always implies visual, mathematical, medial,
and forensic aspects and factors and carries with it at the same time the discussion
of the problems that arises from the mutual reference of these factors.” Hence, the
task is to examine the “figurations of self-evidence”, while also taking into account
the “huge number of epistemological technologies that serve the production of self-
evidence” (Peters and Schäfer 2006: 10).
As the means of producing graphical representations and images of self-evidence
have experienced quite different booms in the past, the supposition that there has
been a constantly rising flood of images that started from a point zero is not
completely true. For instance, in early modern times, pictures and images were seen
as an integral part of knowledge development and reflection. However, they
disappeared from later editions of the works of Descartes, Hobbes or Rousseau (see
Campe 2006). According to Eder and Kühschelm, since the eighteenth century, “the
view became generally accepted in philosophy, that the polysemy of images and
pictures endangered the conceptual realization of knowledge. As the hero of
rationalism, Descartes had to be rescued retrospectively from the imaginative
pictures, which he had placed in his works. The add-on of information, which
images had offered in treatises about architecture, was seen in philosophy as a
surplus of ideas only resulting in confusion instead of clarification” (Eder and

Kühschelm 2014: 29).
The situation in medical semiotics was similar at that time, where, in order to
(re-) produce self-evidence, the contemporaries (for the same reasons) placed an
emphasis on the exact linguistic description of symptoms and their interpretations
rather than using images. The extensive medical textbooks on semiotics from the
eighteenth century came without illustrations. In contrast, during the nineteenth
century, the development of scientifically oriented diagnostics, which was intended
to replace enlightened philosophical semiotics, resulted in a decisive turn towards
the visual (Eckart 1996; Hess 1993: Fangerau and Martin 2015). With the advent of
new techniques, such as auscultation, percussion, spirometry, thermometry and
analytical chemistry of body fluids, new categories of knowledge were generated
and were now increasingly (re-) presented visually (tables, graphics and graphs etc.)
(Martin and Fangerau 2012b).
With regard to the visualisation strategies relevant for medicine, above all, the
literature on the development of “graphic methods” needs to be mentioned (Brinton
1914; Hoff and Geddes 1962; Tilling 1975; Frank 1988; Hankins 1995, 1999; Brain
1996). In particular, the “method of the curves” and its transition from the
physiological laboratory to the clinical field is of special value (de Chadarevian
1993; Holmes and Olesko 1995; Brain 2007). Numerous studies have been
conducted on the use of images in various medical fields. These studies have
thoroughly discussed the development and meaning of different forms of
visualizations. For example, Borck examined the representation of curves in the
context of electroencephalography (Borck 2005a, b). Similarly, Hess picked out as
a central theme, the special case of temperature curves (Hess 2002), in which he
examined how a known practice of measuring sought to “connect with another
practice of representation”, known as the “physiological curve description” (Hess
2002:160, 2000). While the authors do not explicitly identify the connection
between colour and self-evidence production as a central theme, a contribution on
microscopic dyeing techniques in an anthology devoted to “the epistemic meaning
of colours in medicine” in particular hints at this direction (Fischer et al. 2006).
Above all, however, X-ray technology (Dommann 2003; Kevles Holtzmann 1998)
or the successors adapted from it (Cartwright 1995; Burri 2008), including
microphotography (Schlich 1995; Breidbach 2002) or the images of the neurosci-
ences (Borck 2009; Stahnisch 2007; Hagner 2008; McCabe and Castel 2008) have
been given detailed consideration (Borck 2005a, b; Stahnisch 2007).
Directly connected to the problem of self-evidence is the anthology published by
Gugerli and Orland, which addresses “the visual production of naturalness”. The
main focus of this work is on “the normalization process” of visual strategies and on
the production of “natural” and “normal” images, which transport or bear
unquestionable self-evidence. According to Gugerli and Orland, visualisation
technologies must be “normalized not only technically, but also standardized
communicatively. Thus, their application is in principle bound to collective learning
processes: Only by the interaction of technology and visual discourse can group-
specific self-evidence be produced and users can be enabled to come to a relatively
natural agreement about significant matters”. The fact that these learning processes
depend on the technical possibilities of different visualisation procedures is obvious.
The invisible, which was made visible, needs to be inscribed in habits to gain the
status of self-evidence. Today, many common perceptions of images that are taken
for granted, had to become “normalized, daily and naturally”, before they could
become accepted and unquestioned traditions of seeing self-evident references for
new imaging techniques (Gugerli and Orland 2002:10f.).
The volume “Bild und Gestalt” (“image and gestalt“) sought to find the origin of
visual traditions and turned “explicitly to the question how media practices form
knowledge in medicine and the human sciences”. The editors saw their book as a
“picture-theoretical endeavour, which follows scientific iconography, representation
and visualisation in a media-practical and semiological analysis frame”. They also
aimed to discuss the “socio-technological conditions of the production of images”
and the “categorisation of visibility” as well as “the power of the visual behind these
orders” (Stahnisch and Bauer 2007). Again, the publishers referred directly to
Gugerli, who in 1999 coined the term “sociotechnological self-evidence”
(“Soziotechnische Evidenzen”) to describe these interconnections. Gugerli started
with the observation that “in numerous contexts of social communication completely
different categories of images are attributed with technically produced evidence and
culturally sanctioned self-evidence”. In particular, images are to be regarded “in the
context of the technical modes of their production and their social forms of
perception”. Self-evidence originates “only in the interaction of specific visualization
techniques, concrete illustrations and social attention rules (gesellschaftliche
Aufmerksamkeitsregeln)” (Gugerli 1999: 132).
Generators of Self-Evidence
Indeed, the idea of self-evidence has been perceived as problematic and many-
faceted. Nohr argued that “speaking about evidence […] is also a kind of the evi-
dence production” (Nohr 2004: 11). While, there is truth in the statement that
speaking about images can highlight their appearance as evidence for the self-
evident, but in general the contrary of his thesis is true. The extensive discussions
about self-evidence create confusion, and the more it is spoken of, it becomes
increasingly clear that various forms of self-evidence and its means of production
seem to exist. Cuntz et al. examined the different “lists of the evidence” and stated:
What self-evidence claims for itself remains unquestioned, is conclusive, stands clearly
before eyes, makes sense immediately and on a direct way. Self-evidence speaks for itself
or vouches for something else. Both linguistic and graphic orders rest on internal self-
evidence, which itself is not subject to negotiation and not put into the focus of attention. At
the same time these orders refer to evidences and proofs, which are given outside and
independent from them. But what is the relation between the apparent and the natural, the
basic and the obvious, autonomy and reference? Each of the just enumerated characterisations
of self-evidence may be appropriate—but are they also compatible with each other? Is there
one self-evidence which unites all these characteristics at the same time in itself? Rather
this heterogeneous enumeration refers to a huge number of variants and forms of self-
evidence. Additionally, this list of self-evidences carries contradictions and problems,
which become even clearer if one asks for its historicity, the spatiotemporal limitedness of
its scopes. Self-evidences are not so timeless, fixed and indefinitely durable as it seems at
first sight. (Cuntz et al. 2006: 9)
Consequently, in the constantly increasing literature, the term “self-evidence” is

now used in many different ways.
A historical strategy of producing visual self-evidence was the use of notably
popular images (cf. Hüppauf and Weingart 2008). The representation of
deoxyribonucleic acid (DNA) as a double helix is a prominent example of these
popular, obvious images. Heßler has called images of the DNA double helix the
“cultural icon” of the twentieth century and the “Mona Lisa of the sciences” (Heßler
2007). Little educational background is required to decode the meaning of the dou-
ble helix as a representation of genes. In that sense, images like the DNA helix
function as pictograms. Stephen J. Gould coined the term “canonical icon” for
images like these (Pörksen 1997).
Canonical icons have the quality of capturing scientific knowledge in a con-
densed form in a certain representational format. Their respective representational
formats are unquestionably reproduced, with minimal variations, over and over
again. A striking earlier example are Haeckel’s embryological images which were
reproduced for decades in many media. Although they were also notorious from the
beginning, they became canonical icons which shaped a whole biological world
view (Hopwood 2015). The unquestioned reproduction fixed these and other images
on a certain point of view that controls their interpretation by definition of the con-
vention of the interpretation of what is seen (Vögtli and Ernst 2007: 76–92). In
embryology this process resulted in popular cultural discourses as well as in mater-
nal and fetal politics (Morgan 2009). Thus, with the idea of the canonical icon,
attention is also directed towards the cultural conditionality of seeing them
(Jordanova 1990; see also Crary 1996), and because the interpretation of canonical
icons is dependent on certain preconditions, for example the need to teach and learn,
seeing the decisive elements of the icons charges them with self-evidence. For
example, Zittel turned the tables on the idea of these conditions and developed a list
of questions to describe in detail the functions of images. Among this list was a
question of whether the successful representation of an image connotes self-evi-
dence to a scientific discovery. At the core of his study was the conclusion that sci-
entific images are “by no means self-evident, but ambiguous, polyfunctional and
culturally coded” (Zittel 2005: 32).
Medical images and images of medicine are also marked by a fundamental
“interpretation openness”. Diagnostic images do not speak for themselves and are
not necessarily or automatically properly interpreted by any viewer in the desired
manner. To connect his ideas of “thought styles” with the perception of form
(“Gestaltsehen”), in 1947 Fleck questioned the conception of an image’s immanent
descriptiveness, postulating that “to see, one must know first” (Fleck 1983). The
correct interpretation in the sense of a specific thought style is promoted by “learning
to see”. What is observed and grasped on this basis is then related with an individual’s
knowledge system by means of comparison and analogy. At the level of visualisations,

an “image driven referencing” or “pattern recognition” system occurs.
For imaging techniques in medicine, Burri has exemplarily worked out this con-
nection for radiographies: on the basis of different viewing techniques, in particular
the intuitive and the analytic view, a picture is seized. “View techniques and the
knowledge necessary for the interpretation of images are acquired during education
and habitualized in clinical or scientific practice. The gaze is specifically trained and
disciplined, while it is coached to pay attention to specific aspects which are rele-
vant for the interpretation” (Burri 2008: 214). A comparable strategy has also been
found in other medical visualisation formats, especially, when images from the inte-
rior of the body are discussed. With the introduction of new imaging techniques, for
instance endoscopy, body parts, which had been inaccessible and invisible before,
became visible for the first time. Thus, a new language was needed for referring to
these newly visible elements. This language had to be taught and learned, for exam-
ple with the help of reference works, handbooks, manuals and atlases, before it
could become general medical knowledge and (simultaneously or later) general
popular knowledge (Martin and Fangerau 2011a, b; Martin 2012; Fangerau and
Martin 2015).
The following three case-studies will illustrate the different visual procedures
and the respective strategies of creating self-evidence. Additionally, the interaction
between medical and popular culture in the use and interpretation of the respective
images is displayed.
hree Case Studies: Writing Curves, Radiography

T
and Neuroimaging
Writing Curves
In the second half of the nineteenth century, the plotted curve became the central
representative form of knowledge mediation, not only in physiology and medicine,
but also in other disciplines (Auerbach 1914; Brinton 1914). In the experimental
sciences especially, the curve prevailed because with it, procedures in the temporal
course could be recorded and illustrated (Hankins 1995, 1999; Hoff and Geddes
1962; Tilling 1975). Writing curves were seen by scientists of the nineteenth century
as a registration of real phenomena, apparently undistorted by the human hand
(Gugerli and Orland 2002: 14), for example, during the graphical registration of
physiological processes (Brain and Wise 1994). Thus, the curve became a common
phenomenon in many disciplines. Curve plotting representations were found in
mathematics just as in physics for the illustration of concepts like “work”, “power”
and “energy” (Rabinbach 2001). From there, they reached the physiological
laboratory, for example through the works of Helmholtz and others (Schmidgen
2009; Holmes and Olesko 1995).
The graphical method became the omnipresent scientific procedure and, in addi-
tion, a format of cultural perception. Specific knowledge in the form of universal
curves penetrated from laboratories, factories, medical centres and research
institutes into the public and circulated back into other laboratories. Population
trends, epidemiological data about disease progression, mortality or morbidity,
weather conditions, business statistics and almost everything else was visualized as
a curve (Funkhouser 1937; Nikolow 2001; Tanner 2002).
By the time, the self-recording wave recorder, which untiringly produced curves
to fit all possible physiological processes, had asserted itself as a universal writing
tool in medicine, and the “method of the curve” (de Chadarevian 1993) was utilized
in both research and medical practices. For example, in medical diagnostics
physiological parameters of heart activity (Borck 1997; Martin and Fangerau
2011b), body temperature or blood pressure (Fangerau and Martin 2014) had to be
measured, analysed, recorded and fixed. The final interpretation of these
measurement results had to be performed by a physician and his or her application
of an appropriate therapy had to be provided on the basis of the documentation to
legitimate the chosen action. This documentation again asked for visualisation
forms that could fulfil certain characteristics that were captured by the curve in an
excellent way: it was reduced and clear, yet at the same time, also precise and
expressive. As a universal principle, a curve could be read and interpreted basically
by every researcher or physician without further explanation. Even patients without
any foreknowledge could identify changes in the measurements that were displayed
on the curve at a glance. This was due to reducing what was visualized, which
highlighted the measured values in a temporal course, and clearly arranged the
information along two axes. Thus, the curve promised self-evidence, by “the
apparently unproblematic visibility” of its features (Rieger 2006: 120). Furthermore,
a second point associates with the described curve semantics and its immanent,
easily decodable structure: the curve disposes of universality and popularity unlike
any other graphical representation. In particular, curves clearly show normality or
the divergence from the norm (the pathological—a parameter of particular
importance for medicine). For example, Link coined the term “curve landscape” as
a meaning-donating model for the modern age (Link 1997, 2002). The curve became
the representation method “par excellence” (Rieger 2009), and thus, contemporaries
have attested that the curve corresponds to self-evidence. In 1888, Ernst Mach had
already connected self-evidence and curve writing. Concerning the epistemic value
of the curve, he spoke of a “compression of the view” and explained that, “if we
have collected a great number of physical observation data, we have gained them
from the direct sensuous view. Alone, the experience is stuck in detail. How big,
however, is the richness, the width, the compression of the view, if we show the
summary of the observed data with a curve! And how much easier is the intellectual
use of this experience then!” (Mach 1888: 21).
Indeed, lacking this significant representative form is unimaginable in any cur-
rent laboratory or clinical setting or in popular culture: the electrocardiogram (ECG)
curve has become synonymous with the heartbeat and an icon signalling life; simi-
larly the electroencephalogram stands as an analogous curve for brain activity. Their
status as collective symbols can be pursued in countless examples in popular cul-

ture. For example, films often contain scenes in which the apparatuses producing
these curves stop (usually accompanied by a dramatic soundtrack), unambiguously
demonstrating a significant change in the vital parameters and ending with either
the death of the patient or interventions by the hero (possibly by means of the
spectacular application of a defibrillator, which again triggers the start of the device
producing a curve and saving the patient).
Besides this symbolic value, graphs also serve organizational and cognitive func-
tions. With their help, problems associated with the complexity and vagueness of
large data are addressed by transforming them into a clear and illustrative format.
Hence, they are always used by the media if something is to be proven, be it the
effects of the intake of certain pharmaceutical or cosmetic products or the effects of
behavioural changes. In this context, the curve has become the symbol of a new
segment of popular culture that is popularized under the heading “Quantified Self”.
Self-tracking devices (mostly in the form of the bracelets that are connected to
smartphones) opened up new dimensions in self-measurement. The devices count
steps and calories, measure pulse, sleeping quality, blood glucose levels, body fat
and much more. Thus, the individual documents his or her values and/or shares and
compares these data with others. However, documenting and sharing only makes
sense, if the jumble of numbers is represented in a form of colourful images; and
again curve representations here are the first choice, because they generate self-
evidence (for example to immediately symbolize the improvement of certain bodily
features (Selke 2014).
Radiography
A different imaging format is used in radiology, and is based on photographic tech-

niques. Although contemporaries aligned an X-ray scan according to its origins
with photography, they soon realized that a radiological image was by no means a
picture or an “impression of the nature”. It appeared to the observers of these images
that the numerous tracks in the picture were due to effects caused by movements of
the X-ray tube or the body being examined, or to sources of error in the photo-
chemical process, not to mention the fact that the visibility of objects in an X-ray
relies on its materiality and the degree to which the object absorbs X-rays. This
especially has a severe impact on the visualisation of soft body parts with this
technique; thus interventions, mainly via the application of different contrast media,
became a basic precondition for the production of meaningful radiographic images.
Concerning the assumed special objectivity of photography and the associated ethos
of non-intervention with the images, the application of contrast media was
antagonistic to making them appear as true images of nature. X-ray images to which
contemporaries attested special conclusiveness and probative force (such as in court
procedures) could only be produced (at least in certain areas) with the help of
interventions and manipulations (Martin and Fangerau 2012a, b).
Nevertheless, radiographs were promoted “in the public to ciphers for scientific
and legal self-evidence” (Dommann 1999: 119) and a “nimbus of objectivity and
factuality” was associated with X-ray pictures, so that they were viewed in the
medico-legal discourse as effective proof (Dommann 1999: 119). Only a few years
after their discovery were radiographs admitted as pieces of documentary evidence
in court (Golan 1998; Mnookin 1997). Additionally, in the area of the medical
certificates and expert opinions, for example in insurance cases or questions
concerning vocational disabilities, were X-rays seen as valid supporting documents.
On one hand, they were considered to be “the most perfect form of self-evidence,
mechanically produced and therefore without prejudice, inaccuracy or
incompleteness” (Gugerli 1999: 137), while on the other hand, physicians stressed
“the unsecured status of the new invention, the unreliability of the devices for their
production and the disagreement of the professional world about the meaning of the
pictures” (Gugerli 1999: 137f.).
Hence, to decipher the radically new pictorial vocabulary, visual language hand-
books and reference works were published such as the “Normal atlas” by Grashey
(1905). Grashey used a special strategy for training the “learned view” for the new
image format, which Dünkel described as “making readable by media comparison”
(Dünkel 2010: 370). On a double page, Grashey combined an X-ray picture with a
suitable schematic sketch and an anatomical drawing as well as written explana-
tions. The synopsis comprising radiograph, text, schematic sketch and drawing
made the new radio-images accessible. This way, the peculiar image-semantics
were internalized by the viewers and the X-ray images and their meanings became
obvious and self-explanatory for the trained experts.
However, the fragility of the figurative self-evidence of these images also origi-
nates from their original “interpretational openness,” and there was a loss of this
openness by visual training. On the one hand, the ability to “see” opens the possibil-
ity to establish and legitimize medical expert knowledge: medical and radiological
experts became the only legitimate interpreters of the new image language. On the
other hand, this “expert knowledge” can never attain absolute self-evidence, since
the respective roles and/or interpretations of the images are always disputed. The
essential factor for the stabilisation of self-evidence lies in the fact that the images
align with the respective way in which they are viewed. For example, Fleck speaks
of the stylized seeing of ideas or meaning.
Nevertheless, hardly any visualisation format attained the popularity of “Röntgen-
photography” around 1900, which was probably the first visualisation format born
from medical science making medical research a pop cultural feature. The picture
of the ringed hand of Bertha Röntgen, taken on the 22nd of December, 1895, became
such a “cultural icon” (see above), maybe because it clearly showed and carried the
ambivalence and sometimes hubris of modern medical research. In other words, this
icon self-evidently showed the chances and risks of modern medicine. While the
“radiogram” penetrated the surface of a living person, showing her inside, and by
this, manifested the possibilities of the new technology, the image also shows a
skeletonized hand, a warning “memento mori” of the transitory nature of human life
despite technology. The quote attributed to Bertha Röntgen at the sight of the
picture “I have seen my death” meanwhile entered novels, dramatic plays and
newsmagazines (without an evident reference).
At that time (and still today), radiography was omnipresent. Thousands of arti-
cles were written in the first years after Röntgen’s discovery in both scientific maga-
zines and in contemporary popular daily newspapers. The first professional
specialization in X-rays appeared in 1896 under the title “Fortschritte auf dem
Gebiet der Röntgenstrahlen” (“progress in the field of Röntgen’s rays”). At
fairgrounds, visitors could have themselves X-rayed for fun, and in shoe stores,
X-ray apparatuses were used to produce images from feet in shoes to show how well
they fit. Until the severe side-effects of radiation were reported, these examinations
were deemed a general cultural amusement.
The fascination was based on the visual strength of the new images. However, it
required a certain trick to increase the popularity of these images. Actually, X-ray
imaging can be seen as an original visualisation format in its own right. They are
incomparable, as they do not illustrate a surface, but are “shadow projections of
density relations with the help of rays” (Dünkel 2010: 368). However, attempts to
explain the origin and development of the pictures as well as the production process
by means of the unknown rays were undertaken only in special professional circles.
Thus, the public and wide parts of the medical community were told that these
images should be perceived as analogous to photographs, which was more plausible
to these audiences. The “(image-)rhetorical link to the medium of the photograph
was a familiar strategy in the early days of the X-ray technology and during its
spreading”, which, as Dünkel had worked out, served a simpler “production of
references” (Dünkel 2010: 369). The analogy should allow easy access to the new
technology and connect it to common knowledge and styles of vision.
Neuroimaging
The visualisation of the brain, the putative representation of the mind, experienced a
similar boom as the visualisation of the inner body with the help of X-rays. First the
electroencephalogram (EEG) achieved iconic status as an apparently direct represen-
tation of thought processes recorded directly from the mind. Its popularity came for
good reason: this format had a straight connection to the curves, with which the
contemporaries were well acquainted (see above). Cornelius Borck has presented
different works on the notation of brain functions or the interpretation and propaga-
tion of EEG images (Borck 2005a, b, 2008). He pointed to the amazing range of its
utilization, interpretation and popularization of brain images (starting with the EEG
and ending with imaging techniques like the magnet resonance imaging) ranging
from “Voodoo” (Borck 2011) to “an objectification machine” (Borck 2011; Slaby
2013). Self-evidence in this context has been explicitly addressed by Hagner when
he discussed the inflationary use of brain images for various purposes: “it is not the
beyond history quiescent form of the brain swimming in the skull which provides
credibility for a brain image. The fact that these images function as generators of
self-evidence depends on the respective sensory contexts in which they are produced,
enacted and spread” (Hagner 2008; McCabe and Castel 2008).
Above all, the presentation of technically generated brain slices in the form of
computer or magnet resonance tomography/imaging (MRT/MRI) has entered
popular culture since the late 1980s. Similar to the case of radiography 100 years
before, neuroimaging became an omnipresent part of daily culture. For example,
functional magnetic resonance images (fMRI) of the brain were emblazoned on the
covers of not only scientific magazines but almost any newspaper, presumably
because they show the mind at work in bright colours (Fitsch 2014). Although it was
clear that these images only represented a virtual reality, because the colouring of
brain regions was performed retrospectively using computers, they were nevertheless
widely used. The media asked for colour and spectacular images, and the first MRI-
Scans for example, which were produced in 1971 by the chemist Paul Lautebur
(who finally received the Nobel prize for medicine for this method in 2003), were
“too nastily” and “blurred” for the famous magazine Nature, which rejected their
publication at first. Nevertheless, it was always clear to the researchers that the
colouring effects considerably overstated the actually processes in the brain. Under
pressure from responsible radiologists, the coloured visualisation was changed to
grey scale, which is still common today. According to Hasler, this decision may be
seen as a concession to the “visual black-and-white culture” established among
radiologists over the past century (Hasler 2012: 41).
Although the radiological tradition is clear in neuroimaging techniques, these
techniques do not result in photograph-like displays of structures with different
densities. Rather, the images result from complicated calculations and the
transformation of biological measurements from structures of different densities
and functional processes into data. These data are then converted into images that
link up to visual anatomical traditions. These images, which have become cultural
icons, are thus highly artificial and sometimes they reproduce “inexplicable technical
artefacts. Radiologists even coined a term for these spots. They call them
‘unidentified bright objects’ (UBOs)” (Hasler 2012: 40).
Among others, Schinzel has examined the new imaging techniques such as MRI
and computed tomography (CT), stating that such pictures act as valid “objective
authorities”, because they seem to be “apparently genuinely and immediately
understandable in their optical impression”. However, this visual self-evidence was
based on “cultural and learnt interpretations”. Above all, these images could not be
seen as reality. “Image processing or image generation based on information
technologies is a constructive process, which uses complicated combinations of
numerical and statistical methods as well as visualisation algorithms in order to
generate visual self-evidence”. Additionally, these images by no means fulfilled the
criterion of objectivity. Rather, “multiple possibilities of producing images are
applied during the generation process”, which are limited “by the producers by the
selection and combination of algorithms” and are “fixed in a concrete image
generation process by the choice of parameters and several interactions”. Thus, it
appears that ambiguities are notorious, especially in data interpretation, and this
applies to both the use of the images and when addressing the individually of the
images. Diagnostic interpretations even vary according to the medical school

(Schinzel 2006, see also Huber 2009 as well as Fangerau and Lindenberg, 2012).
The medical study addressed here has also been structured by other imaging
techniques. For example, Holl showed for chronophotography and neuropathology,
how new cinematic stagings restructured the clinical gaze of physicians (Holl 2006).
Burri has also shown in detail the multi-facetted effects of images and imaging on
the medical practice of diagnostic judging (Burri 2008, 2012, 2013; Burri and
Dumit 2008).
This problem of interpreting signs has long been known for various diagnostic
procedures. Thus, since the nineteenth century a medical tradition of handbooks and
reference works had been established. These books teach the right of seeing and
interpreting data, and the differentiation between fact and artefact. A current
example is the Atlas of the Human Brain by Jürgen K. Mai et al., which aims to offer
a consistent detailed and clinically oriented reference handbook for interpreting
MRI scans (Mai 2016; vgl. Mai et al. 2003).
Conclusion
“Visual strategies” in the natural sciences, including scientifically oriented medi-

cine, can, according to Mersch, be divided heuristically, without sharp demarcation
into two classes, with the first being modes of representation whose “essential func-
tion is testimony”. Here, the visual is used as a document to support delivering the
proof of the existence of something. Modern medical imaging techniques, classical
radiograms, microphotographs or endoscopic images fall into this category. The
second class are modes of representation that arrange knowledge “on abstract
tableaus” or “transform it with reference to the underlying data into computable
figures” and “argue diagrammatically or graphemically (tables, curves etc.)”
(Mersch 2006: 97). As the examples show, modern medical imaging techniques like
classical radiograms on the one hand and magnet resonance images on the other fall
in both categories. Nevertheless, as Schinzel said: “there is no generic self-evidence
of images. However, technical medical images carry a further quality: The element
to be shown or displayed is only virtually accessible, because we have never looked
directly into uninjured living bodies. The idea of the inside of our own body is a
learnt image in our heads, and medical images contribute recursively to this learning
process. This way they generate ontological bogus self-evidence” (Schinzel 2014:
419).
Today scientific or medical knowledge and communication occurs, according to
the molecular biologist Frank Rösl in his contribution about “visual self-evidence in
biomedicine”, “almost exclusively by means of visual representation forms and
their graphic transformations. These can be photographs, diagrams, schemes,
3D-simulations, coloured illustrations or even easy hand drawings. Publications in
scientific periodicals or popular-scientific works use images in the farthest sense as
visual arguments for the self-evidence of research results. No manuscript is ever
accepted in a biomedical journal without images to the publication, even if the

accompanying text is still logical and substantiated with valid quotations. Graphic
representations work as proxies for the self-evidence of the demonstrated facts”
(Rösl 2008: 16).
Self-evidence has found its way from medicine to popular culture and is
reflected from here again into the medical arena in the form of a validation and
proving function as well as a graphic synthetisation of different knowledge aspects
(Mersch 2006). The result of this cycle is comparable to a sounding board, which
as a prerequisite assumes the scientific acceptance of the underlying technology. At
the same time, it transports this general acceptance into culture. Therefore, self-
evidence is also generated by the special popularity of an image format and the
constant perpetuation of the same images or image formats in different discourses.
Medical images that have become pop cultural icons allow for the production of
similar images in a medical context. Curves, X-ray images and neuroimages are
only a few examples from the many fields in which useful fictions are generated by
images that legitimize diagnostic and therapeutic actions (Fangerau and Martin
2015). The permanent reiteration of these useful fictions in popular and scientific
media finally turn these “useful fictions” into self-evident reality (Müller and
Fangerau 2010: 158f.).
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The Visual Claim Within Medical Science
and Popular Culture
Angela Schröder
Introduction
By turning, zooming, and rotating during the ‘fly-through’ examination of the endoscopic
view, the radiologist can view the entire colon surface instead of examining only a movie
that can be played in forward and reverse. (Wax 2001: 23)
This quote, which likens the procedure of advanced virtual colonoscopy to a

flight simulator and former colonoscopy procedures to a movie, illustrates how
medical science and popular culture can inform each other. The interaction between
medical science and popular culture in relation to imaging techniques appears to
benefit both areas in a profound way. One may argue that there must be a common
ground to allow imaging techniques from both fields to be compared with each
other. Empirically collected data, from computed tomography scans (CTG) or mag-
netic resonance imaging (MRI), is transformed into an image in a remarkable way,
as the computed data achieves a quality of being ‘evident’ through the process of
medical imaging. This evidence is an evidence of experience as far as it is enabled
within the transfer of the raw data into an illustration Hence, experience creates
evidence by a special kind of power of judgement (Urteilsfähigkeit); this can be
understood to be the aim of illustrations.
Given that there is no illustrativeness (Anschaulichkeit) to raw data itself, data
must be molded into an illustration. Raw data is required to gain evidence through
the process of becoming an image. But how does the emerging, constructed image
receive this quality of an evidence-mediating perception? The technique of the vir-
tual broncho- or colonoscopy allows human individuals to be viewed in a different
way, by changing its ontic status and transforming data from binary to visual infor-
mation. Thus, in this scenario, the visualized data enables the reader to interpret its
A. Schröder (*)
Institute for Media Studies (IfM), Ruhr University Bochum, Bochum, Germany
e-mail: angela.schroeder-2@rub.de

https://doi.org/10.1007/978-3-319-90677-5_10
116 A. Schröder
meaning. Our efforts to achieve the best possible adaption of raw data into images
to gain evidence can be described as an anthropological appropriation. Consequently,
there is a need for anthropological analysis that examines the simulated viewpoint
through a bronchial tube as an experience of evidence for the medical professional
itself. Additionally, this also refers to aspects of illustrativeness like position,
motion, or even the analogical photographic imaging.
Before proceeding, it is important to introduce and explain two aspects that are
fundamental to understanding the concept of the phenomenological understanding
of illustrativeness. The first refers to Edmund Husserl’s Phenomenology and con-
cerns the difference between the English term ‘experience’ and the German terms
Erlebnis and Erfahrung. While both Erlebnis and Erfahrung can be translated as
‘experience’, Erfahrung is a more limited category than Erlebnis. While Erlebnis
“encompasses all awareness a subject can have” (Kockelmans 1995: 82), Erfahrung
only relates to things and phenomena that belong to the real world. Thus, the second
aspect refers to the meaning of evidence in Erfahrung. Furthermore, in order to
understand evidence within the process of illustrativeness, Erfahrung (experience)
needs to be understood in a strict sense of the term, not simply as a sensory impres-
sion, but as an act of consciousness in which something real is interpreted by the
mind as what it authentically is. The concept of experience (Erfahrung) by Husserl
is essential to understand the anthropological claim within the question of medical
imaging as an original experience of concrete physical entities through an external
‘secondary’ perception (Husserl 1995: 56). For every primary experience, visual-
izing an object or entity is essential as a means to accept its reality. Hence, if such
seeing occurs, we experience evidence. Evidence in this broad sense is the experi-
ence of something that is, and thus it is a seeing of something as itself (Ibid: 91f.).
This concept of experience and evidence takes place in medical imaging, as well
as in examples of similar images within popular culture, such as in digital games
and their very distinctive first-person shooter images. The assumption of this con-
sideration is that illustrativeness as the model of the aesthetical generation of an
image is conditional to an anthropological claim in which it links medical science
and popular culture. The mutual acceptance and reference is presented by compar-
ing the simulation of a bronchoscopy to the illustrativeness of something like a ‘fly-
through’. Hence, it is plausible that this is not a transfer process that occurs between
medical science and popular culture exclusively, and that there has to be an underly-
ing anthropological claim of a particular shared representativeness that connects
them both.
The Anthropological Claim: Or Why Man Strives for Images
It is not only man that aspires for images but the image in its structure and function,
in its inherent construction of clarity, is an expression of an anthropological claim
in itself Anthropology and images are mutually dependent, meaning that the image
could not be understood without man and man could not be understood without
The Visual Claim Within Medical Science and Popular Culture 117
images (Heidegger 2003: 86f.). It is the primacy of perception that describes man as
a visual being first of all [meaning unclear] (Merleau-Ponty 2003: 279). Therefore,
the anthropological claim precedes the acquisition of the world through visual per-
ception. However, it is not sufficient to say, as Hans Belting does, that anthropology
has to be thought through man, and not through the different types of imaging
(Belting 2011: 11). Analysis of the anthropological claim within medical imaging,
and the different images of popular culture need to be considered through the image
first and resolved beyond the unity of the subject and within the unity of intuition
(Anschauung). Furthermore, imaging techniques akin to virtual bronchoscopy, or
first person shooter video games, are particularly suitable for analyzing the anthro-
pological claim, given that they inherently connect to human actions. For example,
medical imaging is involved in the diagnostic process, while first-person shooter
video games serve as a virtual playground for gamers. This connection with human
actions allows digital images to be part of our world and as such, they request that
we necessarily take position in the world given to us by them.
To enable our immediate visualization and comprehension of the intended object
as it is, we have to experience a world mediated through images that are at least
within a consistent space and time. The image is represented in, what Husserl calls,
‘lifeworld’ or the experience of the world from both a personal and intersubjective
viewpoint (Husserl 1995: 136ff.). In such experiences of the world, and within our
readiness to act, our inner disposition acts according the world given to us. For
example, if we see a photo of a dog, we need to identify the object as a dog – even
if is just a photograph of a dog. Therefore, from the power of judgement (Urteilskraft),
medical imaging and computer game images coincide, in that both images strive to
become ‘evident’.
Digital imaging is the continuance of the visible world with added features. The
different types of digital images are, within this visibility of the world, the main
indication of our own perspectives of how we perceive the world. Aside from the
visual style and grammar, it is our subjective perspective (intuition) that gives struc-
ture to our intuition. Here, intuition refers to the ability to acquire knowledge with-
out consciously contemplating it. Intuition in the meaning of Husserl’s philosophy
is situated in the world of experience (Erlebniswelt). ‘Experience’ is the act of expe-
riencing an object and not the object itself. Intuition has to be understood as a view
through a mediated technique, and it is always the perception of a consciousness of
something on something, therefore, it is intentional. Additionally, this also means
that the perception of the digital images intentionally refers to something outside of
what is given within the image itself. The digital image, within the process of medi-
cal diagnosis or within a first-person shooter video game, becomes a reflection of
our perspective of the experienced world, and concerns the perception of the indi-
vidual as well as the general paradigm for the attitude of the visual perceptive world.
In keeping with this, Olaf Breidbach declares:
Images are forms of intuition of a subject. Within them contours of the intuition are fixed.
Within the structure of the image, that shows itself in each intuition as a result, the subject
can be found. Within the regularity of this result, in which the subject is able to objectify
itself, and therefore allows reality to show, world can be found. (Breidbach 2009: 66)
118 A. Schröder
To intuit is to understand as a pre-condition of the digital image, and in the con-

text of phenomenology, intuition provides a view in terms of a structured perception
(cf. Husserl 1973, 106).
Our Striving for the Image
The expression “striving for the image” is not just the development of the cultural
practice of digital imaging. After all, it is the comprehension of the world in terms
of a faithful reproduction in size and distance proportions. It is not just the evalua-
tion of the visual as an expression for the underlying pursuit of how perception
works. “Striving for the image” refers to the aesthetic context of perception, intu-
ition, seeing, and the medium. The ideal appearance is traditionally understood
within imagination or even poetry and, therefore, is situated in language. Opposed
to ideal aesthetical appearance, epistemological appearance concerns scientific
standards, which demand a normative superior category of a scientific ideal like
objectivity. Objectivity and evidence are the results of cultural agreements, negotia-
tion processes and historical developments (Bredekamp 2008: 148). Since the
development of imaging technology, e.g., the invention of the telescope and micro-
scope, the optical instrument’s claim for truth has replaced the “unarmed and naked
eye” (Köhnen 2009: 12).1 However, the anthropological claim, which connects the
images of the first-person shooter with the medical imaging of a virtual broncho- or
colonoscopy, is also based on the interrelation of perception, intuition and our
access to the world through our visual sense. In Husserl’s view, intuition and evi-
dence (self-evidence) are essentially related concepts (Husserl 1986: 28).
And as Boehtius already stated in his ‘Consulatio Philosophiae’ (fifth century),
the inner intuition2 should be considered as a central argument of true knowledge.
The stoic doctrine that all knowledge and understanding of the outside world is
conveyed through the senses is based on the Platonic thesis that the mind is indepen-
dent from sensorial cognition. So it says in the fourth song of the fifth book of his
thesis:
Cum vel lux oculos ferit/vel vox auribus instrepit./tum mentis vigor excitus,/quas intus spe-
cies tenet,/ad motus similis vocans/notis applicat exteris/instrosumque reconditis/formis
miscet imagines. (Boethius 2004, lib 5, carm 3 V.33–40)3
1
Seeing is to be considered as integral to cultural development; seeing therefore has become a
culture-specific technology. Knowledge is here no longer a mere mental activity, but takes place in
a specific medium. This evokes the question of whether visual technologies can be used in function
to the objectification or whether they construct knowledge and cognition in a particular way.
2
Beside the outer intuition (see Kant) (visio corporalis) and our visual access to the external world,
there is also an inner intuition (Kant) (visio spiritualis). The vision of the countenance of God is a
non-physical vision. It is the cognition through beholding of the divine substance. The eye becomes
a spiritual organ, which no longer is to be opened but to be turned inward (see Kant-Enzyclopedia
(Text-Log) available from http://www.textlog.de/31936.html).
3
‘When the light enters the eyes and the voice penetrates the ears. Then the inner intuition is also
in the power of the spirit, which it carries within itself, awakens and calls on at the same move-
Fig. 1 Digital image of

the primary bronchus
(down to the
tracheabronchial tree;
virtual bronchoscopy.
Trachialbifucaration,
cranial) (© Randolf
Klingebiel)
The image correlates with its mental, ‘hidden form’. Boethius interprets cognition
as an interaction of the spirit and the senses. He argues that the image is not just a
representation but also a correlating conception. This coincidence of representation
and conception is defined by Husserl as intuition (Anschauung).
Images are deeply fixated in our historical tradition and cultural developments.
However, all types of digital images may also be understood within the phenomeno-
logical concept of intuition. Our conceptions (Vorstellungen) of one object collide
within the sensual perception of our inner experiences. As a result of this adjust-
ment, within the process of perception, consciousness is always intentional, and a
consciousness of something on something. Every new perception, as it becomes an
experience, and by fitting it into pre-existing conceptions, becomes familiar (Husserl
1973: 14).
Interestingly, this also implies that within intuition, perception is structured. Olaf
Breidbach assumes that within intuition the world becomes its form, but this is not
just a quality of man, or even just a quality of living beings, as computers have also
the ‘ability’ to recognize form (Breidbach 2009: 107). In contrast, I would argue
that this is in fact a unique quality of man only; it is an anthropological commitment
that intuition becomes images and every image becomes an intuition.
To demonstrate the concept of intuition more practically I would like to take a
closer look on two, as it seems, very different kinds of digital images:
What is observed when we compare a still image from virtual bronchoscopy
(Fig. 1) and a still image from a first-person shooter video game (Fig. 2)? At first
sight, there is a similarity in structure and space, a common definition of the image
based on the same potential of movement and temporality, the vanishing point and
depth of focus. Although the color schemes are not alike, both utilize color schemes
that are familiar to us from our experiences. The dusty and shadowy color scheme,
along with the pointer on the gun barrel, is representative of a war situation, our
experiences of which are most likely second-hand, as depicted by videos from the
news or in movies. Moreover, the other image shows a slightly pink surface with
some reflections of light, characteristic of the images of conventional optical
ment; it fits in the outer appearance and adds inside the hidden form of the image.’ (Translation by
the author)
120 A. Schröder
Fig. 2 Counter-Strike. Screenshot (© Valve, EA Games (2000))
b ronchoscopy, while also showing spatial positioning in reference to a central per-

spective. The simulation of the bronchial tubes brings up a digitally-created surface
that seems to reflect the light. It simulates the known structure of the conventional
experience of the surface of the colon or bronchial tube and, by gaining a
three-dimensional space plus time (the ability to zoom in and out within this simula-
tion), it trumps the CTG-Image by referring to our experience of world.
Not only does man strive for images, but images themselves are striving for man.
Even if there seem to be vast differences in use and visual practice, these two digital
images are very similar. Consistent for all technical images, is that at any time and
under any circumstances they are intuitions of a subject. Furthermore, within the
regularity of digital imaging they are the result of a process of objectification in the
sense of generating evidence. To consider that images become world, the intuition
of a digital image never represents, but becomes the world of experience itself and,
in conclusion, become evident.
Essentially, there must be an equivalence between these two different types of
digital images. Moreover, within the experience of fulfilling (Erfüllungssteigerung
/ Erfüllungserlebnis) it is a given that the image of a simulation of movement, and
the accumulation of every new information within the image, is more successful
than its predecessor with a lower level of conformacy, such as in a common com-
puted tomography imaging. Consequently, the simulation of a fly-through via a vir-
tual colon- or bronchoscopy offers a more ideal representation despite the common
CTG-image.
Both images, of the first-person shooter and the virtual bronchoscopy, are to be
understood as a world of experience of a subject. They correlate to our anthropo-
logically defined access to the world, and represent as much as corresponds with our
approach to world. Both these images are the results of raw data through which we
never gain a readiness to act on, as we need world appears within and through them.
Only then we are able to see world.
In conclusion, there is not a transfer process underlying a connecting the images
of medical science and popular culture, but they are both successful images
concerning the anthropological claim within every technical image and this is, what
connects them. It is the inner intuition and the experience of fulfilling
(Erfüllungssteigerung), which presents a special kind of evidence within every tech-
nical image, and allows us to see world through them. More to say, the medical
imaging as well as the images of the first person shooter become a world of
experience.
References
Belting, H. 2011. Bild-anthropologien. München: Wilhelm Fink.

Boethius. 2004. In Consolatio philosophiae, ed. E. Gegenschatz and O. Gigon. Düsseldorf:
Artemis-Verlag.
Bredekamp, H. 2008. Das technische Bild. Kompendium zu einer Stilgeschichte wissenschaftlicher
Bilder. Berlin: Akademia Verlag.
Breidbach, O. 2009. Das Anschauliche oder über die Anschauung von Welt. Wien: Springer-Verlag.
Heidegger, M. 2003 [1938]. Zeit des Weltbildes (In Holzwege). Frankfurt a.M.: Klostermann.
Husserl, E. 1973 [1913]. Ideen zu einer reinen Phänomenolgoie. Hamburg: Felix Meiner.
———. 1986 [1907]. Idee der Phänomenologie. Hamburg: Felix Meiner.
———. 1995 [1950 posthum]. Cartesianische Meditationen. Hamburg: Felix Meiner.
Kockelmans, J.J. 1995. Edmund Husserl’s phenomenology. West Lafayette: Purdue University
Press.
Köhnen, R. 2009. Das Optische Wissen. Mediologische Studien zu einer Geschichte des Sehens.
München: Wilhelm Fink.
Merleau-Ponty, M. 2003 [1961]. Das Auge und der Geist. Hamburg: Felix Meiner.
Wax, M.R. 2001. Virtual colonoscopy becomes clinical reality diagnostic imaging. San Francisco.
International Symposium on Medical Imaging.
Part II
Case Studies
Medicalized Screens from the Cold War
to the Social Web
Kirsten Ostherr
Introduction
We are living in an era of medical media convergence (Jenkins 2008). From the
discovery of x-rays in the late nineteenth century to the explosion of digital health
technologies in the early twenty-first century, screens have played an increasingly
prominent role in the practice of medicine. For most of the twentieth century, how-
ever, medicine’s visual culture was defined by two distinct types of screens: clinical-
facing screens, displaying images to doctors, and consumer-facing screens,
displaying images to the general public. Until recently, medical and popular culture
accepted this division, as well as the underlying premise that the content on these
screens should be segmented according to audience, with access to clinical screens
restricted to credentialed medical professionals. However, the digital revolution has
upended traditional knowledge hierarchies in many fields, including medicine. By
opening up access to formerly closed sources of information, the social web has
become a dynamic force in the convergence of clinical- and consumer-facing
screens. This essay will explain how the evolution of medicalized screens since the
middle of the twentieth century has transformed the production of medical knowl-
edge and redefined the role of technology in popular representations of healthcare.
The mise-en-scène of medical imaging exemplifies what Lorraine Daston and
Peter Galison called “the image of objectivity” in their influential essay of the same
name (Daston and Galison 1992). In their view, medical imaging technologies are
often seen as producing scientifically neutral images, due to their mechanical pro-
duction, their seeming lack of human intervention, and their generation within the
context of sophisticated healthcare settings. In contrast, fictional representations of
Parts of this essay have been adapted from Kirsten Ostherr, Medical Visions: Producing the Patient
through Film, Television and Imaging Technologies, Oxford University Press (c) 2014.
K. Ostherr (*)
Rice University, Houston, TX, USA
e-mail: kostherr@rice.edu

https://doi.org/10.1007/978-3-319-90677-5_11
126 K. Ostherr
medicine in film and television are widely treated as unrealistic and inaccurate
(Diem et al. 1996; Pribble et al. 2006). Consequently, one set of images is seen as
medical fact, while the other set of images is seen as medical fiction. And yet, the
use of medical imaging functions as an anchor to the real, in both fictional and non-
fictional depictions of hospital encounters. In medical documentaries, hospital
advertisements, and dramatic entertainment, when the limits of human cognition
prevent clinicians from reaching a diagnosis, technoscientific imaging solves the
crisis by seeming to offer superhuman perception capable of eradicating all ambigu-
ity (Persch 2009).
One consequence of this practice is that popular understanding and acceptance
of new medical imaging techniques and procedures relies heavily upon a blend of
images and narratives that is neither wholly fact nor fiction (Dumit 2003; Martin
1995; Howell 1995; Reiser 1978, 2009). Another important consequence is that this
practice may contribute to physicians’ intolerance for ambiguity, a characteristic
that has been linked to higher test-ordering tendencies, as well as other undesirable
effects (Caulfield et al. 2014). For this reason, advertisements and programming
produced through collaboration with healthcare organizations are a particularly rich
source of material for considering the relationship between contemporary medi-
cine’s visual culture and larger debates about the escalation of expensive and inva-
sive treatments in healthcare today (Clarke et al. 2010). By looking at how
medicalized screens have evolved since the 1950s, this essay will show that the
source of medical realism has shifted from the hospital setting to the screen itself,
thereby reducing the human dimensions of the patient to digital signals and decon-
textualized data points.
Archaeology of Midcentury Medical Media
Popular medical series such as House, MD (Shore 2004), forensic dramas such as
the CSI: Crime Scene Investigation franchise (Zuiker 2000), and advertisements for
personal hygiene products all regularly display medical imaging, often as an inci-
dental but nonetheless central element of the mise-en-scène. In these settings, medi-
cal imaging functions not only as a signifier of the best (equated to highest
technology) medical care, but also as evidence of an objectively accurate diagnosis
that leads clearly and automatically to a cure (Brownlee 2008). This essay will
argue that this form of medical realism presents an idealized depiction of the frag-
mented body that can achieve the closure of healing only through subjection to
medicalized screens. These images consistently emphasize high-tech, invasive pro-
cedures that produce dramatic narrative resolutions for patients, depicted using the
most spectacular and visually complex imagery available, regardless of its direct
relevance to narrative events (Fig. 1).
As Jonathan Crary, Barron Lerner, and others have demonstrated, when new
technologies of vision such as the x-ray or the CT-scan are developed, their affor-
dances are not inherently obvious or accessible; instead, users need to learn how to
Medicalized Screens from the Cold War to the Social Web 127
Diagnosis Cure
Treatment
(medical (happy
(surgery)
imaging) ending)
Fig. 1 Story arc for narrative closure through medical visualizations
see with the new device (Crary 1992; Lerner 1992). Similarly, as electronic screens
first began to enter private homes and healthcare settings in the post-World War II
era, viewers had to learn the techniques for engaging in this new mode of viewing
(Ostherr 2013). Medical reality television emerged in the postwar mediascape as the
tradition of photojournalism was adapted for American television news. From its
inception in the Cold War era, this genre emphasized technology and scientific inno-
vation as symbols of national pride. Indeed, broadcast and satellite television were
themselves treated as emblematic of American global leadership. Within or along-
side science and technology, medicine played an important role from the early days
of broadcast journalism. Following in this tradition, Medic (Moser 1954), the first
medical drama on American television, had serious pedagogical aspirations and
pursued them using the techniques of documentary realism. The producers of the
show studiously observed medical doctors at the LA County Hospital, and then
emulated their techniques onscreen (Turow 1989).
At the same time, closed-circuit television was used experimentally in hospitals
to broadcast live surgeries from operating rooms to medical students in nearby
classrooms (Serlin 2010). These relatively portable screens seemed to improve upon
the technological interface of the previous generation’s medical motion pictures by
broadcasting live to remote locations. Medical students said that they loved the
sense of intimacy and immediacy they felt from close-up views and from being able
to communicate instantaneously with the doctors on the other end of the camera
(Ramey 1965: 120). When closed circuit TV was a new technology in the hospital,
it seemed to promise something that film could not offer: direct access to live expe-
riences that produced a sense of virtual reality. As cultural theorist Marshall
McLuhan described, “In closed-circuit instruction in surgery, medical students from
the first reported a strange effect—that they seemed not to be watching an operation,
but performing it. They felt that they were holding the scalpel” (McLuhan 1964:
328–29, 334).
While medical professionals were learning to see their electronic screens as
hyperreal sources of clinical data, viewers of broadcast television news were learn-
ing to understand “reality” through the storytelling conventions of popular televi-
sion. As television scholar Michael Curtin has shown, television news adopted
many of the forms of entertainment programming in the late-1950s and early-1960s,
including emphasis on plot, character, and pursuit of an affective response from
audiences (Curtin 1995: 177). In addition, reality-based television producers
embraced Hollywood principles of framing and shooting a scene, using analytical
editing, establishing shots, shot/reverse shot for interviews, and eyeline matching to
128 K. Ostherr
create a vision of the real world onscreen that mimicked fiction far more than it
approximated direct access to reality (Ibid.). As television documentary moved
closer to fiction in the early 1960s, fictionalized medical dramas on TV constructed
a popular form of medical realism that moved the genre away from the serious peda-
gogical aspirations of early programming like Medic, toward a more pleasurable,
less demanding and less informative style of representation and narrative. Starting
with Ben Casey (Moser 1961–1966) and Dr. Kildare (Komack 1961–1966), the
documentary style in fiction was replaced with two separate types of programming:
wholly fictional medical dramas with no pedagogical aspirations, and actuality-
based documentaries.
Significant in this context are the consistently high ratings for the stalwart of the
television documentary newsmagazine genre, CBS’s 60 Minutes (Hewitt 1968–),
which has covered health and medical topics with great frequency since it went on
the air in 1968. The program has been ranked in the top-ten or top-twenty programs
by Nielsen ratings since the 1970s, and in the early 1990s, the show often earned the
first or second highest ratings of all primetime programs (McNeil 1996: 1154–
1161). Amidst these developments, the first forays into the new era of reality televi-
sion were launched through programs such as America’s Most Wanted (1988–),
Cops (1989), and Rescue 911 (1989–1996). These programs were followed by inter-
national hits Who Wants to be a Millionaire (1999-), Survivor (2000–), Big Brother
(2000–), and American Idol (2002–) (Raphael 2008: 125–126). The 1990s thus
marked a turning point in documentary and reality programming that was linked to
broad changes in the entertainment industry and enabled the rise of medical reality
TV. Into this context of reality-based entertainment arrived a series of hospital-
based medical reality TV programs, starting with Hopkins 24/7 (ABC News 2000),
Houston Medical (Greengrass Productions 2002), Hopkins (Bednar and Wrong
2008), and Boston Med (Bednar and Wrong 2010). All of the series were six- to
eight-part documentary miniseries culled from several months’ worth of footage
shot inside their respective hospitals. As in-depth, serious documentaries that their
producers repeatedly described as cinéma-vérité style filmmaking, these series self-
consciously gestured back to the early-1960s glory days of television documentary,
but with one significant difference. The new medical reality television series evolved
in tandem with the development of the interactive, social web. In the process, a
reality-based narrative context for a new form of digital medicalized screen emerged.
Medical Reality TV: Boston Med
At the time of filming in 2010, Boston Med was part of a media environment that
was fully cognizant of the conventions of reality television that might contribute to
effective production of medical reality TV. ABC News was acutely aware of the
ratings challenge posed by competing cable networks. One of the key lessons
learned from previous iterations of medical reality TV was that medical series must
have happy endings in every episode, so that any storyline with an unhappy ending
would need to be overshadowed by spectacular feats of medical heroism in the

happy storylines. For example, Boston Med concludes the series with a dramatic
storyline covering the second face transplant surgery ever to be performed any-
where in the world.
Another lesson learned was that audiences expect the same fast-paced narratives
with rapid resolution that fictional primetime dramas provide. To accomplish this
effect, the majority of medical reality TV cases take place in the Emergency
Department, and this emphasis signals the focus on acute, dramatic, life-or-death
storylines over more typical but less thrilling stories of diabetes, dialysis, or slow-
healing injuries. Consistent with this emphasis, the other recurring cases take place
in the tense, highly specialized fields of organ transplantation, neurosurgery, and
neonatal or pediatric intensive care. Within these storylines, medical imaging fre-
quently plays a decisive narrative role by providing conclusive answers to diagnos-
tic questions that had previously eluded comprehension.
In these programs, diagnosis through medicalized screens is essential to the pro-
duction of narrative closure, a feature considered vital to a satisfying viewing expe-
rience. Although these documentary programs make overt claims of “realism” in
their promotional materials, they emphasize narrative closure through temporal
compression that presents the entire course of illness and recovery within an abbre-
viated time span that seems to cover a few hours or days at most. Like fictional
medical dramas, medical reality TV emphasizes acute, dramatic, and rare medical
conditions with life-or-death resolutions that offer strong narrative closure, rather
than the chronic conditions that actually produce the vast majority of hospital stays
(Seale 2002). In this sense, the ostensibly reality-based content of medical docu-
mentary series participates in the same selection bias as fictional medical dramas on
American television, where, “unusual illnesses or diseases appeared more than four
times as often as heart disease, five times as often as cancer, and more than 20 times
as often as diabetes” (Murphy et al. 2008: 6). This finding confirms previous studies
showing that medical television focuses on acute and rare health conditions at the
expense of the chronic and common diseases that afflict the most viewers, thus pre-
senting a distorted view of disease prevalence and missing an opportunity to educate
viewers on issues directly relevant to their own health.
Moreover, the construction of closure in documentary form allows viewers to see
their expectations as objectively verifiable. Unlike fictional representations that
engage the same structures of closure but offer fewer guarantees of authenticity,
medical documentaries are emphatically rooted not just in the “real” world, but in a
“behind-the-scenes” look at the “real” world of medicine, and this privileged per-
spective dramatically enhances the programs’ verisimilitude and consequent nor-
mative function. Murphy et al. have shown that television is a primary source of
health information for many Americans. Consequently, “the health content in enter-
tainment television has the potential to influence the public’s knowledge, attitudes,
and behavior—for good or for bad” (Murphy et al. 2008: 1). Two major factors in
television’s powerful influence, the study argues, are its enormous reach—the sheer
size of the primetime audience on the major networks (even with competition from
cable and the internet), and its ability to tell stories through familiar, appealing
130 K. Ostherr
c haracters who reach viewers more effectively than public service announcements
by experts do, even when they are fictional characters (Ibid.).
Together, the scale of the audience and the persuasive power of medical reality
TV’s dramatic storytelling techniques, endow these programs with inordinate influ-
ence over viewers’ attitudes toward the healthcare system. Therefore, clinician-
scholars Christenson and Ivancin argue, “Reality television shows promote
unrealistic expectations, and to get patients to have realistic expectations is one of
the hardest things we do in our practice” (Christenson and Ivancin 2006). By pro-
viding a neat and clear-cut sequence of events progressing from diagnosis through
imaging to surgical cure, these programs participate in reproducing a view of health
as narrative closure that is literally accomplished through the final suture in the
OR. Prolonged recovery time, physical or mental rehabilitation, repeat surgeries,
and permanent disability are not presented as possible outcomes (and even when we
see brief glimpses of perfunctory consent discussions, viewers never see any of the
possible risks actualized) (Wicclair 2008). Such idealistic depictions encourage
viewers to see medical encounters as efficient subjections to high-tech devices and
procedures that will automatically produce a positive outcome. As Christenson and
Ivancin have noted, “the benefits always outweigh the risks, and there are no bad
outcomes” (Christenson and Ivancin 2006: 10).
Unlike earlier medical reality TV series, which were each filmed at a single hos-
pital, Boston Med was filmed at three hospitals: Massachusetts General Hospital,
Brigham and Women’s Hospital, and Children’s Hospital Boston. While the series
was being broadcast on television, the official Boston Med website (based at the
network’s homepage, abc.com) included patient profiles and updates, doctor pro-
files, a few nurse profiles, links to further information on medical conditions fea-
tured on the show, links to the featured hospitals, including “find a doctor” links,
and numerous places for viewers to post comments. The producers solicited com-
ments on particular topics for several episodes by posting discussion questions such
as, “What did you think about seeing Sara’s incredible heart transplant? Were you
surprised at who Amanda ended up with? Share your thoughts on this week’s epi-
sode!” The use of these leading questions demonstrates a strategy for directing and
containing viewer responses to the show, raising questions about the extent to which
posted comments were moderated and selectively curated for public consumption.
The invisible moderation of the message board, a routine practice in the world of
online “public relations” or marketing, has a dynamic relation to the documentary
aesthetics of the program as a whole (Heussner 2008). In social web-based media,
textual boundaries are redrawn; in the case of this documentary miniseries, each
week’s episode is almost immediately uploaded to the show’s website after its origi-
nal broadcast on ABC. There, the digital video takes on additional meanings through
its interaction with supplementary footage, behind-the-scenes “outtakes,” informa-
tional material related to the diseases and treatment presented in each episode, and,
perhaps most importantly, viewer comments (Tryon 2009). The semi-vérité style of
the filmed footage, with its connotations of unmediated truth, is replicated in the
message board, with its first-person, messy, often ungrammatical or misspelled
expressions conveying the same authenticity that the episodes themselves strive to
create.
Many of the viewer postings came from patients or families of patients who had
undergone procedures similar to those featured on Boston Med, especially organ
transplantation. All of these viewers expressed enthusiasm about the show, described
it as very realistic, emphasized the value of “real life drama” over “fake acting,” and
highlighted the “informative” quality of the show’s depiction of “realistic medical
scenarios for the public to see.”1 Other viewers responded to the cinéma vérité
effect, commenting on what they perceived as the show’s unmediated realism: “I
doubt there has ever been a medical show to come close to the true raw and yet
utterly human experience that Boston Med has shown.” The authenticity of Boston
Med was often invoked through comparisons with fictional medical dramas: “Boston
Med is SO much better than Grey’s Anatomy!” and “Many people think that hospi-
tals and doctors are like the ones on Gray’s [sic] Anatomy or Private Practice. It
gives people a real appreciation for doctors.”
Another major demographic on the discussion boards was “health profession-
als,” including self-identified residents, attending physicians, nurses, or others “in
the healthcare field,” as well as aspiring physicians. One future MD observed,
“Watching this show has given me insight on how residency might be like in the
future.”2 A hard-working medical student found in this program a rare excuse for a
study break: “I am a 1st year medical student, and I am so inspired by watching
Boston Med. It’s great to see the truth in medicine, and what patients and doctors go
through during the hard times. This is the best show I have ever seen, the only show
that I would delay studying to watch. This is what television should be.” The pro-
gram seemed to generate loyal viewing among real-life nurses, who appreciated the
attention paid to their profession through dedicated storylines: “I am an RN and I
think it is great to see a medical show that is realistic—not someone trying to depict
what happens.” One of the few critical voices came from a British nurse who posted
several times, mostly praising the series, but noting in one comment, “Viewers not
working in the field [...] should know that daily business isn’t always so intense, that
the ‘highlights’ usually don’t follow each other in such a density.” Capturing a criti-
cal aspect of medical reality TV that aligns the genre more closely with fictional
medical dramas than its producers might wish, this comment points to the unrealis-
tic omission through editing of the mundane cases that, in actuality, comprise the
vast majority of hospital cases. Despite this discrepancy, many of the health-care
professionals who viewed the show applauded its realism, suggesting the effective-
ness of medical media in training both “expert” and “lay” viewers to adopt strategic
ways of seeing that serve certain interests over others.
1
Viewer comments posted online after August 15, 2010 episode. http://bostonmed.abcnews.
go.com/discuss/episode/. The ABC Boston Med website is now extinct, but two sample pages of
viewer postings have been archived and can be accessed through the Internet Archive “Wayback
Machine,” accessed May 10, 2012, http://wayback.archive.org/web/20100831064523*/http://bos-
tonmed.abcnews.go.com/discuss/episode/1
2
Ibid.
132 K. Ostherr
Digital Fingerprints on Medicalized Screens
A closer examination of the digital footprints of Boston Med’s participating hospi-

tals reveals how this genre of programming made the transition to the fully social
web, illuminating the increasingly blurry boundaries between entertainment, educa-
tion, and advertisement on medical reality TV series, as well as their function in
shaping public discourse about the ideal of technology-driven health. Media theorist
Mark Andrejevic has analyzed “interactive webpages that serve as companion
pieces for television programming,” such as the Brigham and Women’s Hospital
Facebook page. He argues that the goal of such sites “is not just to provide viewers
with a sense of participation but to keep track of them, to gather information from
them, and to monitor their interest in the show” (Andrejevic 2004: 13–14). In
Andrejevic’s view, the hospital’s tactic of requiring online registration as a fan (by
“liking” the page) “pretends to individuals that they count—that they are worthy of
individual attention—even though all it really wants to do is count them—to plug
their vital statistics into a marketing algorithm” (Andrejevic 2004: 111). The threats
to privacy as well as the general misuse of “big data” that Andrejevic hints at have
provided the rationale for “restricted” medical media throughout the twentieth cen-
tury. Based on the premise that doctors, as a profession, were professionally
entrusted with sensitive patient data and, therefore, could serve as appropriate cus-
todians of the private information included in a patient’s chart, physician organiza-
tions such as the American College of Surgeons and the American Medical
Association applied the same logic to films of patient surgery and other
procedures.
However, the historical and enduring emphasis on physicians’ exceptional status
as privileged viewers of “restricted” materials may have had the unintended effect
of constructing a barrier between doctors and their patients that encouraged both
parties to treat behind-the-scenes medical practice as something that “it’s not in the
public’s best interest to know.” Inadvertently, this positioning and the specialist
knowledge it entails may have forcibly severed physicians’ bonds with their patients,
leading to dissatisfaction for everyone involved. Social media have radically over-
thrown this knowledge hierarchy, opening hospitals up to real questions about how
they are using the “big data” generated by their patients’ digital footprints through-
out the hospital and linked online communities (Boyd and Crawford 2012; Howell
1995: 242). Some physician early-adopters of social media see the potential for new
forms of collaborative media to redress this imbalance, but it is too soon to tell how
broadly these new tools will be embraced, particularly among patients (such as the
trauma population) who live on the “wrong” side of the “digital divide” (Zickuhr
and Smith 2012).
Brigham and Women’s Hospital prominently featured its own video series of
weekly medical tips on its home page, alongside links to YouTube, Twitter,
Facebook, and RSS feed tabs. Brigham and Women’s Hospital also linked to the
Boston Med website through its YouTube page, where numerous serialized video
storylines featuring interviews with recent patients and their doctors shared screen
space alongside clips from the segments of Boston Med that were shot at the
Brigham. Like the storylines on Boston Med, the patient stories presented on
Brigham and Women’s YouTube site featured strong narrative cohesion and charac-
ter development through serialized video interviews discussing the same patient
with different doctors as well as a direct-address video by the patient herself.
Interestingly, the graphic layout of the web page did not prioritize the Boston Med
clips over the segments produced in-house for the web, even though the video clips
from Boston Med segments shot at this hospital were culled from the climactic epi-
sode of the series and featured the second face transplant operation ever to take
place, anywhere in the world. Instead, the miniseries was interspersed with other
media features that emphasized the hospital’s role as a medical media producer in
its own right.
The Brigham and Women’s Hospital Facebook page included postings from
grateful patients, such as “Hello, my name is Brad Burke. 3 months ago I had a
kidney transplant at The Brigham, all is well. Thank you Brigham!!!!”3 Families of
patients also posted regularly, including the widow of the face transplant donor
featured on the show, who posted casual comments, such as a note about running in
the upcoming Tufts 10K road race. The impression of continuity between the docu-
mentary aired on television and the online world, where “characters” posted updates
about their personal lives in real time, underscores the sense of realism discussed
above. However, the majority of the Facebook (and Twitter) posts were from
“Brigham & Women’s Hospital News,” that is, the marketing department (not “real”
patients), usually linking to a news story on a different website featuring research or
commentary by one of the hospital’s doctors, soliciting participants for clinical tri-
als, or commenting on current medical news topics. Physicians rarely posted com-
ments (though some hospitals have hired their own physicians as official house
bloggers, such as blogger Wendy Sue Swanson, “Seattle Mama Doc,” a pediatrician
who blogs for Seattle Children’s Hospital).4
As noted at the beginning of this essay, medical reality television and its social
media companion sites present an idealized depiction of the fragmented body that
can achieve the closure of healing only through subjection to medicalized computer
screens. The paradoxical result is that medicine is now increasingly embracing the
tools of connected health to create a sense of cohesion: through brand cohesion,
patient loyalty, and ubiquitous presence across media platforms. The very same
media technologies that were previously seen as producing fragmented subjectivity
now function as the source of closure. The social web now wraps high-tech medical
imaging in its veneer of human connectivity, extending the patient experience from
the clinical setting into the most intimate settings of daily life.
The medicalized screen has further expanded through the emergent practice of
live-tweeting surgery. The first live-tweeted surgery took place at Henry Ford
3
Brigham and Women’s Hospital Facebook page, posted circa August 2010, https://www.face-
book.com/pages/Brigham-and-womens-hospital/191008060937266
4
Seattle Children’s Hospital, “Seattle Mama Doc” home page. Accessed 12/10/15. Available at
http://seattlemamadoc.seattlechildrens.org/
134 K. Ostherr
Hospital in Detroit, Michigan, on January 16, 2009, and the practice of live-
streaming surgical video was pioneered by Methodist University Hospital in
Memphis, Tennessee, in April 2009, when it webcast an awake craniotomy proce-
dure (Belluck 2009).5 Many American hospitals promote cutting-edge medical
imaging technologies in their efforts to attract patients with private insurance (upon
whom they are financially dependent), but this practice may actually encourage
patients to develop unrealistic expectations. As hospital advertisements employ the
representational forms of television drama and news to publicize their services, they
encourage patients to understand their own experiences through frameworks pro-
vided by stock narratives and characters. Similarly, “behind-the-scenes” medical
documentaries such as Boston Med also encourage patients to view them as accurate
models of the hospital care they should expect for themselves. As media sociologist
Clive Seale has noted, ethics committees in US children’s hospitals “spend half of
their time debating cases where parents of terminally ill children object to a profes-
sional’s wishes to cease expensive treatments that offer a hope of cure. They iden-
tify a cause of these unrealistic hopes as being an emphasis on medical miracles in
the promotional literature of the hospitals themselves” (Seale 2002: 141).
What, then, is the role of social media in medical education and practice? While
medical centers may endeavor to control their image through moderated discussion
boards and tightly edited documentary miniseries, the proliferation of online col-
laborative medical communities opens up the potential for a critical dialogue beyond
any hospital’s control. The opportunity afforded by social media lies in its multidi-
rectionality; because the conversation is no longer controlled through a top-down
model as in traditional broadcasting, individuals can actively interpret and produce
meaning concerning medical images and information online, and anyone can post
his or her own counterimages and ideas. The e-patient community has grasped this
potential, and so have a handful of forward-thinking physicians (Society for
Participatory Medicine 2015). The governing bodies of medicine, however, are
holding fast to outdated views. The American Medical Association’s (AMA) policy
on social media, established in 2010, sees only danger online: “Physicians must
recognize that actions online and content posted may negatively affect their reputa-
tions among patients and colleagues, may have consequences for their medical
careers, and can undermine public trust in the medical profession” (Topol 2012:
190; American Medical Association 2011). Considering the acute need for better
collaboration between doctors and patients, as well as the profound need for
improved communication in the field of health care, the resistant stance of the AMA
reflects a broad misalignment of policy and practice that offers little guidance for
the real world of medicine today.
5
For the video, see Methodist Healthcare, OR Live website, originally aired April 21, 2009,
accessed May 17, 2012, http://www.orlive.com/methodisthealth/videos/awake-craniotomy1
Conclusion: Mobile Medicalized Screens
The challenge of medical media convergence has grown more complex since Boston
Med aired in 2010. In telehealth applications and on entertainment television,
screen-based media continue to emphasize the aesthetic of realism to accomplish
their effects through multi-platform, transmedia storytelling. For example, the stu-
dio set for The Doctors (McGraw 2008–), a daily afternoon talk show that began
broadcasting on the CBS television network in the United States in September of
2008, showcases dramatically enlarged x-rays, CT scans, and MRIs on the video
screens that provide the backdrop for the panel of physicians who host the program.
While these generic images are rarely directly referenced, they play a crucial role in
setting an informal scientific tone for the show. In this way, the images perform the
critical function of establishing medical legitimacy and authority for the otherwise
“lowbrow” talk show programming format. Television scholar Jason Mittell has
argued that all television genres engage with “systems of cultural value, with nearly
every genre located on the highbrow/lowbrow axis,” and Mittell notes that medical
dramas are considered “more socially valued and intrinsically ‘better’” than genres
such as talk shows (Mittell 2004: 15; Levine 1988; Allen 1985; Spigel 2008). The
Doctors is thus faced with the challenge of merging highbrow and lowbrow genres
to ensure that its audience takes the screen presence of the program’s physicians
seriously (Fig. 2).
Why does it matter whether audiences accept this program’s version of medical
reality? Because twenty-first century medicalized screens function by deliberately
Fig. 2 Doctor on Demand app promotional site linked to television program “The Doctors”
Accessed Dec. 2015. Available at http://www.doctorondemand.com/
136 K. Ostherr
eradicating the boundaries between clinic and home. While this transformation is
unevenly distributed, the substantial increases of investment in digital health tech-
nologies in the past several years indicate a clear future direction for corporate and
government healthcare (Startup Health 2015). The importance of medical imaging
in the mise-en-scène is exemplified by the program’s blending of infotainment with
the provision of actual medical care to real patients through the “Doctor on Demand”
mobile app publicized on the show. Promoted as “a new service founded by Jay
McGraw, executive producer of The Doctors,” the “Doctor on Demand” service
provides video visits with Board-Certified physicians or psychologists for forty dol-
lars per visit, with no monthly fee (Doctor on Demand 2015). As medical care is
increasingly provided remotely through such screen-based consults, the effects of
mediation will require greater attention and analysis by media scholars with medi-
cal understanding. In our age of big data, artificial intelligence and sentient
machines, the human dimensions of the medicalized screen interface will only
become more important.
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Insights into Insights: Visual Narratives
of Medical Imaging and Intervention
Technologies and the Popular Viscourse
Anna L. Roethe
It is February 25, 2012, day 1030 of the Internet killed Television an ongoing vlog
uploaded daily by American musician Charles Trippy to his YouTube channel to
document his life events on the internet. This clip begins with a report from a
hospital.
Well, the doctor came in and he said I had… a… like… a tumor. I have a tumor in my head.
This is kind of briefly what it looks like (shows an MRI on his laptop screen, pointing
directly at the tumor). But as you can see, it is not this big… this is more just (moves around
parts of the lesion) … layers or excess... But it’s on this side of my head, um, as you can
see, so… I have to get it removed. (Trippy 2012)
Trippy continued to share details on his brain tumor in that posting (see Fig. 1), and
in successive episodes that included a lengthy, and only slightly censored, recording
of a second surgery in September 2013, while awake during the critical part of the
resection. As a matter of course, he documents his periodic checkups, talking about
the size and growth of the tumor. He even scrolls through his imaging volumes,
commenting on them while looking at the radiological screens (“I am a doctor! I can
do this!”, Trippy 2015a) and comparing the most recent images to past examina-
tions (“Two months ago, guys – and that’s now, and officially, no one sees any
change.”, Trippy 2015b). Starting with the initial diagnosis, Trippy seems familiar
with the image esthetics of his brain scans, routinely explaining new results while
using the diagnostic images as a form of discursive evidence to show what cannot
be told or understood in words only.
For several years, Trippy has been publicly questioned and applauded for this
decision to share these private insights. His YouTube channel, CTFxC, currently has
about 1.5 million subscribers in the USA who value the informational and educa-
A. L. Roethe (*)
Interdisciplinary Laboratory Image Knowledge Gestaltung, Humboldt-Universität zu Berlin,
Berlin, Germany
e-mail: anna.roethe@hu-berlin.de

https://doi.org/10.1007/978-3-319-90677-5_12
140 A. L. Roethe
Fig. 1 “It’s not a tumor (wait it is)... ”: Charles Trippy demonstrates his diagnostic MR images.
Screenshot, T: 00:12:34 (© Charles Trippy 2015a)
tional aspects of his project.1 Yet, characteristically, the public audience’s full
attention is most likely on what he is telling them rather than how it is being told, let
alone the kinds of medical media experiences and competencies that actually are on
display. Despite the educational use of public, visual narratives such as TV shows,
autobiographic stories, movies, and novels, in medical schools to guide future doc-
tors’ expectations of clinical practice, their influence on patient behavior and com-
munication has not received much attention (Ostherr 2011, 2013).
Defining “Medical Narrative”
The impact of medical storytelling—whether on the culture of clinical practice or

popular culture and mass media—is by now widely accepted as undeniable. Literary
narratives of patients in interviews have long been analyzed by “narrative medicine”
techniques (Charon 2006) and narratological approaches to clinical communication
within the context of literary and cultural theory (Rimmon-Kenan 2006). As we gen-
erally conceive of narratives as having a chronological structure and primarily causal
1
http://www.dailymail.co.uk/news/article-2448209/Couples-blog-goes-viral-moving-diary-
struggle-cancer.html (30.4.2016).
Insights into Insights: Visual Narratives of Medical Imaging and Intervention… 141
sequence of events, medical case reports and fictional medical narration indeed seem
to be interconvertible as two complementary forms of medical narrative. “In literary
terms and from a medical point of view, the clinical narrative bears much the same
relation to the patient’s narrative as plot bears to story” (Hunter 1991: 61 et seq.).
Incorporating features of clinical reports and the style of case presentations, many
medical narratives strive to imitate the strict diagnostic order of medical reasoning.
“Medical narrative has an order so regular and fixed that a case presentation seems
to be an undistorted representation of the events as they happened. But rather than a
transparent account of ‘reality’, its highly organized, conventional structure imposes
meaning upon the events it sets in order” (Hunter 1991: 63).
However, the concept of “narrative” not in the strict sense of verbal narration, but
rather indicating an abstract functional unit of a—not necessarily fictional—(re)
presentational order, entails many other aspects for the comparative analysis of
medical narratives inside and outside hospital environments. “Narrative”, as narra-
tologist Marie-Laure Ryan states, “is defined as a mental image, or cognitive con-
struct, which can be activated by various types of signs”, more precisely, “a mental
representation of causally connected states and events which captures a segment in
the history of a world and its members” (Ryan 2003). Additional diagnostic media,
such as images, charts, graphs, and clinical characteristics; or in other words, instru-
mental records of a medical course or condition, further illustrate a verbal account
or evidence—and not just in clinical practice. This paper argues that the extensive
clinical use of medical diagnostics—first and foremost medical imaging—is
reflected in patient narratives and showcased in popular and social media. Analysis
of medical narratives should therefore anticipate a potential multimodal or even
transmedial dimension, assuming that “A core of meaning may travel across media,
but its narrative potential will be filled out, actualized differently when it reaches a
new medium.” (Ryan 2005: 1). The function of the visual dimension of medical
imaging within the respective narrative context requires further investigation:
“While close attention to the multilayered meanings of words and stories is essential
to the practice of narrative competence, the exclusion of visual images limits our
ability to interpret the significance of medical imaging as well as medicine’s broader
visual culture.” (Ostherr 2011: 114). Finally, much less attention has been paid in
popular culture to visual narratives of medical content, experience and practice than
to written reports including cancer blogs, autobiographic accounts, or novels. This
is remarkable because it implies a certain disregard for management of visual-based
knowledge and information flow within the medical culture, especially considering
the growth of imaging modalities in recent decades. Obviously, in this particular
medical context, “visual narrative” should not be restricted to video or film only.
Neither is the term restricted exclusively to comic strips and graphic novels although
the vast majority of research has been conducted in that area (Cohn 2013, 2016).
Consequently, existing complex theories of (mostly static) visual narratives focus
on the sequential character of visual storytelling rather than on the multimodal or
transmedial elements of meaning. The theoretical basis of visual storytelling as
described by narratologist Mieke Bal, includes a shift “from the events in the image
to the event of the image: the pragmatic effect of verbal-cum-visual storytelling”
142 A. L. Roethe
(Bal 2010: 632). Furthermore, instead of being confined to aspects of medium,

mode or genre, visual narratives have a general, not trivial characteristic such that
“they all narrate stories using visuals” (Pimenta and Poovaiah 2010: 44). The impact
of these visuals in and on medical narratives—when, how exactly, and in what form
they can be employed—has to be reflected in narrative analyses extending beyond
the obvious level of content. Currently, there seems to be no comprehensive, theo-
retical approach within the field of visual narratology that takes into account the
constitutive, if not indispensable, presence of image material for an unfolding dis-
course, not to mention a medico-scientific one. The sociologist Karin Knorr Cetina’s
concept of “viscourse” and its potential applicability to medical diagnostic reason-
ing and to visual narratives in popular culture is discussed below.
In summary, a number of aspects appear relevant to a closer analysis of medical
visual narratives. Firstly, “narrative” denotes an organization of events in time, usu-
ally in causal order, and based on the cognitive construction of a certain meaning.
Secondly, the organization takes the form of presentation that claims to represent
the actual objects or events. Thirdly, the visual narrative unfolds using visual ele-
ments created in one or more media reference systems, and the relation of the com-
ponent images produces the meaning. In the specialized field of the medical
narrative, visual media contribute to a prior goal, which is the objectification of a
patient case that highlights “the pattern of the evidence” (Hunter 1991: 6). If we
understand the clinical task of diagnosis as a transmutation or “interpretive retell-
ing” of previously obtained facts (Hunter 1991: 5), the narrative effort may also
clarify the complex structure of visual medical narratives such as the history of
Charles Trippy and other public and fictional patients. It has been noted that
“Diagnosis itself is the effort to impose a plot onto seemingly disconnected events
or states of affairs.” (Charon 2006: 50). A working definition of “medical narrative”
might thus include the presentation of events with an organization that yields con-
sequences in action (Wieland 2002: 128). That makes diagnosis a core interest, not
of interest only among clinicians, of any medical narrative or even “essential to the
production of narrative closure” (Ostherr 2011: 120). Considering the extent of par-
ticipation of medical imaging technologies in modern diagnosis and therapy, a brief
recall of the epistemic functions and visual representation styles of medical imaging
in both medical and nonmedical contexts is discussed in the following section.
Insights of Imaging
Since the discovery and subsequent first medical utilization of X-rays in 1896, the
possibility of acquiring knowledge of internal morphology and vital processes
through technology-based ways of “seeing”—without actually opening or trauma-
tizing the body—has become paradigmatic. The “power to see through opaque
objects” (Kevles 1997: 116) and its impact on the medical and cultural expansion of
human vision continues to fascinate radiologists, media and culture scholars, art
historians, scientists and technologists, and many others whose work focuses on
what one may suggestively refer to as “cultural radiology”.2 Since the appearance of
the cultural paradigm of “insight” into the human body provided by medical imag-
ing technology, a dense network of future insight promises has continued to develop
in scientific and popular culture, intermingling new possibilities of visualizing, see-
ing and understanding.3 Cultural studies scholar Elizabeth Stephens has described
the visual dimension of the influence of medical imaging technologies on nonmedi-
cal culture during the past century. She notes that they create transparency and pro-
vide insight into the human body as if it were made of glass, writing that “If medical
imaging technologies moved with such speed and influence into the popular sphere
[...] it is because they have both catalyzed and reinforced new ways of seeing, and
new understandings of the body [...]” (Stephens 2012: 161). Medical imaging
modalities such as conventional radiography (CR), ultrasonography (US), computed
tomography (CT) or magnetic resonance imaging (MRI) produce images that dis-
play, demonstrate, reveal, or supply diagnostic evidence. Essential for the concept of
insight attributed to them is the way that the morphological condition is represented.
All these images visualize structures of the body both scientifically and culturally
and are conducive to the production and reflection of “anatomized bodies” and thus
provide “a new anatomical imaginary” (Stephens 2012: 169). Their static topogra-
phy—produced by both sectional imaging and image summation—comprises snap-
shot images primarily concerned with control of states, not actions. Based on this
quality, these images soon became both part of the patient chart in clinical practice
and an illustrated appendix to verbal accounts of medical conditions, either as a
written description or reproduced as visual images. The role of visual media in diag-
nostic narratives seems clear and unambiguous. They confirm hypotheses while
documenting a specific condition at a specific time in an apparently “objective”,
because of the instrumentation, modus. Only minimally altered from their key func-
tion, these images “arrive on television screens with a history and a certain
authority” (Kuppers 2004: 123). In addition, considering the practice-based contin-
uum and intertwining of diagnosis and therapy, visuo-technical insights tend to tran-
scend mere diagnostic assessment of body conditions and determine the planning
and successful control of therapeutic interventions. Practical functions of medical
imaging continue to expand, restrained only by the pace of technological progress.
The development of X-ray technology and expanding of medical applications at
the turn of the twentieth century substantiated a promise of future insights that guar-
antee a comprehensive visual overview of somatic conditions within the living
unopened body (Howell 2004). Contemporary image-based therapies can be equally
2
Referring to the contextual dimension of cultural history (Natale 2011), the concept defines
research approaches, which investigate primarily the historical evolution, aesthetic structure, edu-
cational strategy, and public discussion of medical imaging. The effect is to emphasize the explora-
tion of conventional radiography from the disciplinary perspectives of art history, cultural and
media studies, history of science, medical anthropology and others (Cartwright 1995; Dommann
2003; Gunderman 2013; Hillmann and Goldsmith 2011; Kevles 1997; Ostherr 2013; Pasveer
2006; Radstake 2007; Stephens 2012; Swiderski 2012).
3
As a matter of fact, the official organ of the European Society of Radiology (ESR, founded in
2005) is named Insights into Imaging.
144 A. L. Roethe
understood as “promises of intervention” (Friedman 2004: 2). For example,

image-guided interventions, which are an integral part of present-day surgery and
radiotherapy (Cleary and Peters 2010) aim to influence physical states either nonin-
vasively or with minimal invasiveness and eliminate problems caused by disease or
injury. In terms of visual control over the human body, a completely new level has
been attained, significantly shaping scientific and public debates on illness, imaging,
and medical procedures. This adds another link in the narrative chain of a patient’s
medical course, as technology itself enters the picture, underscoring the self-evident
narrative closure of medical diagnosis. Image guidance means that “Medical imaging
now functions not only as a signifier of the best (equated to highest technology)
medical care, but also as evidence of an objectively accurate diagnosis that leads
clearly and automatically to a cure.” (Ostherr 2011: 118). We can conclude that visual
medical insights contribute to the analytical dimension of popular visual narratives.
Within medical narratives, visual media can be intended as educational, providing a
more detailed context or explanation of a state, can demonstrate an assessment or
advancement in clinical reasoning, can confirm a suspected diagnosis, or can antici-
pate future events. The “promise of insight” initiated with the first application of
medical imaging technology is no longer limited to expert audiences who are trained
to read and interpret the images, and now also addresses a broader public audience.
Reviewing Diagnostic Vision(s)
Meanwhile, what can be observed in current public mass media and medical visual
culture resembles a “large pool of medical vision machines that drive and maintain
popular narratives of selves, bodies, death, and life.” (Kuppers 2004: 123).
Recapping Charles Trippy’s patient account in his Internet Killed Television vlog,
there appears to be a narrative logic behind his episodic condition updates. Since
Trippy’s initial diagnosis in 2012, the clips regularly include captures of the hospital
environment (e.g., emergency and radiology departments, operating rooms, waiting
rooms, driveways, and parking lots) and medical imaging material. There are also
occasional presentations of short, chatty interviews with nurses, surgeons, and neu-
rologists, and recordings of clinical examinations. Despite its episodic, serial char-
acter, the vlog repeats fundamental stages of clinical diagnosis-making, including
description of effects, detection of cause, and deciding on treatment. Clinical mile-
stones, i.e., first diagnosis, postoperative control, and regular checkups, are without
exception accompanied by medical imaging snapshots. Trippy usually presents
them directly to the camera, making comments such as “As you can see...” (Trippy
2012), “Look at it! That’s my brain!” (Trippy 2015a), “There is some good news,
guys! Hold on... [...], we will show you” (Trippy 2015b), “That’s the original one,
that’s last time in October, and that’s now” (Trippy 2016). His narrative clearly
would not work the same way if he were presenting an incomplete case history (e.g.,
without recounting the story of his first seizure) or skipping the demonstration of
medical imaging material throughout.
Fig. 2 “Curious just to see my brain” shows Steven Keating giving his second public talk on the
history of his visual diagnosis. Screenshot. T: 00:03:42 (© Koch Institute for Integrative Cancer
Research at MIT 2014)
A different setting and similar case can be found in the public lectures of MIT
PhD student and “super patient” Steven Keating. He begins his presentation, The
patient is in: how curiosity saved his life (2014), with “This is how my brain looked
last summer”, showing a larger-than-life MRI scan with an impressively bulky
tumor (Koch Institute for Integrative Cancer Research at MIT 2014). Keating’s
medical narrative is a post-hoc tale of events unfolding over 7 years and starting in
2007 when he had a research scan of his own brain—out of curiosity. While the goal
of his patient account narrative aims at a public discussion of open source health
data, including medical imaging, its strategies obviously resemble those of Trippy’s
vlog. Keating’s presentation combines spoken physical state and corresponding
visual descriptions in medical imaging over a time course (see Fig. 2). Stressing his
fascination for cutting-edge technology, Keating’s presentation also includes a
detailed report of the surgical suite where he was treated, and the visualization and
navigation technology used for presurgical planning and intraoperative guidance.
Although both the Charles Trippy and Steven Keating narratives suggest an overall
familiarity with medical imaging technology, there is a tangible difference in the
emotional perception of being an enclosed body in a technological discourse. This
difference is also reflected in the way medical imaging is staged within the narra-
tive; in a relatively neutral manner preceding important medical decisions (Trippy)
or as creative, high-quality acquisition and use of information (Keating).
146 A. L. Roethe
Fig. 3 Operating room setting in Monday Mornings with operating microscope view on the
screens in the background. Still from Monday Mornings, Episode 1x01 (Pilot), 2013, T: 00:01:19.
(© TNT Kelley and Gupta 2013)
Similarly, the one-season TV show Monday Mornings (Kelley and Gupta 2013)
stages a complete array of clinical image consultations in neurosurgery, from inci-
dental findings to etiological investigation, and complex treatment procedures.
Here, the traditional X-ray, CT or MRI adorning almost every fictional treatment
room because of their status as “diagnostic placeholders”, are slowly replaced by
oversized flat screens showing real-time imaging (e.g., like endoscopy, surgical
microscopy, or MRI-based navigation), “just as diagnostic imaging has shifted from
the static (such as flat-plate X-ray) to the moving image (such as ‘flythrough’ intra-
luminal bowel imaging)” (Cohen and Shafer 2004: 197). The technological infra-
structure in the operating room ensures visual continuity. Diagnosis and therapy
effectively coincide, setting the stage for new visual simultaneity of action and diag-
nostic control (see Fig. 3).
Keeping pace with technological advances, these imaging modalities represent a
visual substrate for a professional view. The classic “image in the background” as
“visual rhetoric of medical authenticity” (Ostherr 2013: 210) is no longer only a part
of the scenery, but also tellingly symbolizes the interactional shift in medical imag-
ing practice and its mise-en-scène by becoming an agent in both clinical discourse
and visual narrative. As in a scene where Dr. Wilson diagnoses a brain tumor in a
young patient (see Fig. 4), a verbal translation of what can be seen on the radiologi-
cal screen is clearly of secondary importance. That is the most important “pragmatic
effect” of the visual image in medical narrative (Bal 2010).
In many public fictional films and television series of past decades, medical
imaging technologies play an important role in a double sense. In the American TV
series House, M.D. (Shore 2004–2012), single episodes usually develop around
patients with rare or hard-to-detect diseases. The main character is a physician,
Fig. 4 “It’s gotta come out, obviously”. Dr. Wilson (Jamie Bamber) is shown in front of a young
patient’s brain MRI, showing a left-sided tumor. Still from Monday Mornings, Episode 1x01
(Pilot), 2013, T: 00:12:25 (© TNT Kelley and Gupta 2013)
Gregory House played by Hugh Laurie, who specializes in particular diagnostic

methods and is the head of an entirely fictional “Department of Diagnostic
Medicine”. Already during the opening credits, anatomical illustrations and medical
imaging modalities alternate, showing images of a fully “observable” human body.
Dr. House is repeatedly shown in front of diagnostic imaging screens, contemplat-
ing the (lack of) concordance of clinical and visual signs. Maybe more than any
other medical television series, House, M.D. demonstrates just how extensively “fic-
tion […] and case histories […] have found narrative impetus in diagnosis” (Tougaw
2006: 2). Consequently, the whole show can be considered as an extensive, single
diagnostic narrative; presumably, this is an important reason for the educational
value some studies attribute to House, M.D. (Haboubi et al. 2015).
Revealing insights of how the power of anatomical vision can affect imaging can
also be found in fiction films. Mood Indigo, Michel Gondry’s filming (Gondry
2013) of the surrealistic novel L’Écume des jours by Boris Vian (1946), stages the
fantastic medical case history of a young woman called Chloé, played by Audrey
Tautou. On her wedding night, she accidentally inhales a snowflake-shaped flower
seed that grows inside her lungs, eventually developing into a water lily. After
scenes of diagnosing the initial symptoms and investigating the cause, Chloé and
her husband Colin (Romain Duris) approach Dr. Mangemanche (director Michel
Gondry). The X-ray apparatus in his private clinic does not simply produce images
of the evaluated body parts on film but provides insights into Chloé’s body in a
rather immediate way. Rendering the patient’s skin, thorax, and pleura transparent,
the technology enables a seemingly unmediated view at the evidence at hand (see
Fig. 5). Instead of interpreting the images after the X-ray exam, Dr. Mangemanche
assesses the thoracic anatomy of his patient in “real-time mode” so that the visual
148 A. L. Roethe
Fig. 5 Real-time 3D in vivo radiography, with Dr. Mangemanche (Michel Gondry, left) examin-
ing Chloé’s (Audrey Tautou) semitransparent thorax (right). Film still from Mood Indigo, T:
00:57:20. (© Brio Films Gondry 2013)
image and the body converge, and the patient’s body becomes its very own diagnos-
tic scan. This corporeal medical image even emulates the structured, hollow X-ray
aesthetics. This rather metaphorical diagnostic vision is consistent with the employ-
ment of the medical narratives discussed above. The movie not only negotiates the
process of diagnosing Chloé’s illness but also—in keeping with historical radiologi-
cal tradition—discusses the scientific perception of technology as a virtually unlim-
ited and realistic means of insight.
During the operation scene in Mood Indigo, Chloé is shown supine on an operat-
ing table placed in the center of a complexly choreographed operating room (Fig. 6).
In the background, two large flat screens show the instrumental preparation of a
white, flowerlike structure; representing a fantastic reimagination of the view pro-
vided by surgical microscopy, and an obvious analogy to the high-tech operating
rooms in TV series like Monday Mornings. The surgery itself reminds of a minimal-
invasive thoracoscopic intervention, in which standard surgical instruments such as
scissors are controlled by a few surgeons positioned at consoles behind the operating
table. A few supposed endoscopic cables transmit images of the surgical field from
the chest to the screens. Perhaps the most interesting aspect compared with the previ-
ous examples is the mismatch of the visual diagnostic narrative in the first part of the
movie and the postsurgical findings in the second half. Chloé has a fresh scar consis-
tent with an open dorsolateral thoracotomy, which is a quite different surgical proce-
dure. “Misdiagnosis,” as an important variant of the diagnostic narrative, reminds the
viewer that visual content that remains unconfirmed by the clinical course has not
produced any evidence. In accord with its genre, the movie realizes some speculative
ideas of medical practice, but they are not regulated by the normative structure of a
factual clinical account. Nevertheless, Mood Indigo’s fictional medical narrative per-
tains to the algorithms of medical reasoning and clinical routines.
Fig. 6 In the operating theatre. Film still from Mood Indigo, T: 01:11:15 (© Brio Films Gondry
2013)
As a general observation, a medical case history does not only provide a practi-
cable blueprint for the analysis of medical narratives. Focused on the diagnostic
order of events, it also suggests analytical categories for the narrative impact of
visual medical media. Medical imaging implicitly defines medical space as diag-
nostic, using nonverbal images to highlight medical authority and authenticity and
replace actual damaged bodies by more or less intact, abstract images on a screen.
Hence, apart from the undeniable multimodal, particularly visual, quality of many
medical narratives, narrative analysis should also consider the inherent persuasive-
ness conferred by the clinical diagnostic counterparts and its popular representa-
tions. By its visual representation of clinical findings, medical imaging replaces
verbal by visual argumentation, reflecting public viewers’ overall familiarization
with medical visual language (Nohr 2014: 29). One cannot understand the visual
narrative structure of present-day diagnostics without reference to concepts of ana-
tomical imaging, objective evidence from diagnostic imaging, or the generally
accepted correspondence of the body’s exterior and interior, virtual and physical
condition.
Intersections of Medical Viscourse
As the literary scholar Jason Tougaw notes in his comparative analysis of clinical
case reports and the nineteenth century novel, “[a]ny given humanitarian narrative
is a contribution to public discourse (Tougaw 2006: 12). While it may be conducive
to understand the well-structured process of diagnosis (Wieland 2002) as a key
medical narrative with a transmittable core of meaning (Ryan 2005), the
150 A. L. Roethe
construction of the diagnostic narrative itself proves to be highly discursive.

Professional and scientific discussion of clinical issues proceeds visually in a num-
ber of different ways. That is because diagnostic imaging is iteratively integrated in
medical reasoning relevant to individual professionals as well as cross-specialty
clinical conferences, or to the attending physician and patient. For example, the TV
series Monday Mornings develops a practical perspective by establishing new forms
of multiplied insights in the context of planning, explaining to both colleagues and
patients, and guiding neurosurgical and radiotherapy interventions by images.
Repeatedly addressing the interdependency of visual knowledge and medically rec-
ommended actions, the show reveals intrinsic operating modes of medical reason-
ing. Specifically, image-based diagnosis and the consequent therapy become a
sequential visual argument in which the images are no longer secondary proof or
illustrations of a narrative, but an integral part of the scientific discourse, i.e., both
subject and medium at the same time. As there appears to be a parallel evolution of
clinical and popular visual argumentation, which both reference and influence each
other, the function and representation of visual media, especially in diagnostic dis-
course remain under-evaluated.
Since the first publication of Karin Knorr Cetina’s sociological reflections on
visual scientific thinking (Knorr Cetina 2001), the novel concept of “viscourse” has
gradually gained in importance in visual and media studies. A striking analogy to
Michel Foucault’s term “discourse”, this replication enhances systematic scientific
findings by integrating explicitly visual dimensions in the production, negotiation,
documentation, and display of results. Viscourse is best described as a form of coor-
dinated knowledge production involving collective communication among changing
groups of participants (Knorr Cetina 2001: 307). It includes interactions with techni-
cal objects, presentation of visual material and not only verbal reports. By creating
a representative “reality”, viscourse serves as both a source of imagination in scien-
tific research and a guarantee of ongoing results (Knorr Cetina 2001: 308). In prac-
tice, viscourse comprises the underlying conditions of scientific communication and
consensus finding while presenting a comprehensive summary status. By applying
the term to specific epistemic practices of diagnosis, and by outlining “popular vis-
course” as a potential counterpart to academic viscourse in the natural and life sci-
ences, this paper argues for a pragmatic turn of events in visual narrative analysis.
The concept of viscourse offers several productive ways of de- and reconstruct-
ing the visual medical narrative. In addition, as popular scientific narratives become
increasingly independent of academic scientific restrictions while still claiming
epistemological legitimacy (Nohr 2014: 15), they might further test and expand the
argumentative dimension of scientific viscourses. Medical viscourses provide
insights into complex factual contexts to expert or specialist audiences, focusing on
detailed information. Popular viscourses present the settings and mechanisms that
can be used to acquire and apply these insights, thus focusing less on facts than on
practices. The cases and examples described in this paper attest to progression of the
concept of medical imaging media, incorporating a notion of diagnosis as narrative,
not just as “storytelling” but as referring to an overall dramaturgical and functional
logic. Imaging media capture states as preconditions for planning and performing
Fig. 7 “Shall we call House?” A cross-fictional team viscourse with Drs Robidaux (Emily
Swallow), Ridgeway (Jennifer Finnigan), and Villanueva (Ving Rhames, from left to right). Still
from Monday Mornings, Episode 1x01 1x05 (The Legend and the Fall), 2013, T: 00:17:52 (© TNT
Kelley and Gupta 2013)
interventions and establish models of medical procedural logic for both expert and
nonexpert audiences. They thus represent a concept of diagnosis beyond conven-
tional dichotomies of certainty and uncertainty, scientific deduction, and unques-
tionable intuition.
There is undoubtedly a tendency for medical knowledge to exceed clinical dis-
course and disciplines that has both immediate and long-term effects on doctor-
patient interactions (Friedman 2004; Ostherr 2013). By providing a deeper perceived
or real understanding of complex conditions, media representations of diseases and
diagnostic and therapeutic devices described in popular science and culture have
always framed disease management. The accessibility and rapid dissemination of
visual media would seem to make the interrelation of clinical and popular viscourse
even closer.
Diagnostic visual knowledge is constructed by professional viscursive practices,
i.e., expert argumentation by and on visual images, while popular culture may have
at least a methodological impact. For example, during an inconclusive diagnostic
team conference in a Monday Mornings episode, one of the doctors mentions a suc-
cessful “serial diagnostic viscourse”, namely House, M.D., thereby cross-referencing
diagnostic TV fiction (see Fig. 7).
Other than simply reproducing viscursive diagnostic standards, medical narra-
tives also contribute to concepts of medical vision per se. Popular concepts of
“insight” and “intervention” include both “classic” science fiction fantasy and
cutting edge technology of the future, which might be difficult to distinguish, now
more than ever (Littlefield and Kusiak 2005). Today, public discourse is challenged
by the nearly simultaneous introduction and staging of new technology in science
and culture.
152 A. L. Roethe
Although not a new phenomenon, the introduction of X-rays had already been
accompanied by early short fiction films in 1897, current discussions of forthcom-
ing medical technologies unfold differently than they did 100 years ago. Because of
modern technical possibilities, a broader scope and general accessibility of the
media by the public, “A so-called new technology is the object of fascination,
hyperbole, and concern. It is almost inevitably a field onto which a broad array of
hopes and fears is projected and envisioned as a potential solution to, or possible
problem for, the world at large.” (Sturken and Thomas 2004: 1). More importantly,
with any new development enabling procedures that had not been previously pos-
sible, media attention to connect with physicians and expand and augment their
vision is guaranteed. Public revelations and announcements by medical companies
entitled “From science fiction to science fact”4 recounts the popular media history
of medical utopias in detail.
Closed Circuit: Doctor–Patient Communication
Healthcare providers already experience the after effects of a culturally educated

patient population. It should not be surprising that public media consumption would
at least guide patient preconceptions of what to expect in clinical environments
(Friedman 2004; Heye et al. 2016; Munn and Jordan 2011; Murphy 2001). In the
field of health education, recent studies have investigated the public scope of knowl-
edge of radiation safety or staff responsibilities in diagnostic imaging (Bosmans
et al. 2016; Thornton et al. 2015). Even more relevant to this review are surveys that
investigate patient knowledge of medical images as well as their abilities to read and
interpret them. The number of public accounts of individual diagnoses, autobiogra-
phies, weblogs, documentaries, and the multiplication of fictional medical narra-
tives on television, in movies, and in novels suggests the existence of a “cultivation
effect” through the power of media portrayal. “This power may have intended or
unintended consequences for patient behavior and the doctor–patient relationship in
the context of reality” (Heye et al. 2016: 2868). It certainly has consequences for the
proliferation of medical discourse and viscourse, as the growing importance of
visual media for diagnostic insight and knowledge production within and beyond
the clinical field demonstrates. Public ascription of objectivity or validation is an
example. All samples of medical imaging discussed in this paper were selected
assuming that the visual supports or replaces the verbal as a key argument. In that
way, medical diagnostic evidence required by clinical guidelines is also incorpo-
rated in nonclinical medical narratives. While in fact creating a new form of visual
expert culture, imaging seems to be more intuitive than highly condensed specialist
terminology, which by convention is intended only for doctor-to-doctor consulta-
tions. In To see or not to see: a qualitative interview study of patients’ views on their
4
The Israeli company, RealView Imaging announces a 3D holographic display for interventional
cardiology in late 2013, https://www.youtube.com/watch?v=AIj2xEd_z78 (18.12.2015).
own diagnostic images (Carlin et al. 2014), the authors attest to the effects of medi-
cal imaging on patients as promoting a “greater comprehension of the illness or
injury” and an “emotional effect linked to viewing one’s ‘invisible body’”. These
effects were extended by the “influence of shared viewing of the image on the social
dynamic of the medical consultation” (Carlin et al. 2014: 5). They concluded that in
the future clinicians “will be increasingly faced with the opportunity to share visual
evidence of health and disease with their patients” (Carlin et al. 2014: 7). This
emphasizes the clinical need to properly assess the patients’ level of knowledge of
medical imaging. Whether for professionals or laypersons, technologically medi-
ated insights produce increasingly complex images, and “The more we see through
various camera lenses, the more complicated the visual information becomes.
Medical imaging technologies yield new clinical insights, but these insights often
confront people with more […] dilemmas.” (van Dijck 2005: 4). These interpretive
dilemmas are rarely subject to scientific or public discourse. As a matter of fact,
they contribute to the less controlled aspects of diagnostic uncertainty, which may
be scientifically reasonable but disconcerting for a patient waiting for unambiguous
examination results.
Despite scientific requirements for increase of reliable qualitative and quantita-
tive data, the current status of Western healthcare communication allows at least for
four preliminary conclusions. First, technology discourse is no longer limited to
medical expert audiences, and social media facilitate the dissemination and discus-
sion of medical record information. There is thus a learning curve to expect in which
visuo-technical competence in popular medical viscourse precedes and facilitates
medical expertise. Second, as “fictional depictions of doctors and medical proce-
dures in the media clearly have an impact on both the delivery of health care and
patient expectations of their physicians” (Friedman 2004: 5), the public media edu-
cation of doctors and patients becomes less exclusive. New realms of shared social-
ization emerge, resulting in similar degrees of perceived accuracy in TV portrayals
of clinical reality among patients and healthcare professionals (Heye et al. 2016).
Third, publicly shared narration and depiction of medical experiences creates new
manifestations of medical expertise as shown by the cases of Charles Trippy and
Steven Keating, and motivates fourth, the expectation of new forms of patient par-
ticipation in clinical encounters.
Culturally, case history and diagnosis often cannot be separated because both
comprehensive verbal exploration and the documentation of symptoms are consid-
ered relevant to a clinical picture of a disease (Tougaw 2006). In modern clinical
practice, classification systems provide condensed, encoded versions of expert med-
ical narratives, but popular image-based narratives offer extensive, gradually unfold-
ing accounts of events. Characteristically, those narratives include information with
uncertain epistemic value, and which does not allow for medical deduction to make
a diagnosis. Nevertheless, with the rise of medical imaging technology and its
circulation in nonmedical contexts, popular medical narratives have begun to

describe the clinical usage patterns of medical imaging. As described in the exam-
ples of medical visual narratives, some of the discursive functions ascribed to clini-
cal diagnostics also apply to case representations in popular culture. Similar
narrative strategies have been used to describe the evidence for a condition and to
154 A. L. Roethe
conveying it to an audience. In the future, more detailed analyses of the effects of

popular depictions of state-of-the-art technology on patient behavior and treatment
expectations will be essential to both transdisciplinary research on the mechanisms
of medical viscourse and to understanding clinical doctor-patient interactions.
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The Audiovisual Process of Creating
Evidence – Science Television Imagining
the Brain
Regina Brückner and Sarah Greifenstein
Introduction
Since the 1990s, the neurosciences have gained immense popularity not only within
the scientific community but also within popular culture (Hasler 2012: 15;
Heinemann 2012: 60). Various fictional and nonfictional media formats either focus
on neuroscientific research itself or embed it within broader narratives about the
human brain, its functions and dysfunctions. It has been argued that this popularity
goes together with the development and deployment of new imaging techniques,
most importantly functional magnetic resonance imaging (fMRI).1 It is not surpris-
ing that a branch of science that generates images is particularly prone to using
those images within popular and especially audiovisual culture.2 Neurological
images lend themselves to be embedded in science television programs, television
series and films not only to illustrate or provide information about diseases and
medical treatments but also to explain how the human mind works.
1
As Heinemann explains: “In the past decades, imaging techniques especially have been estab-
lished in various scientific disciplines, but in hardly any cases are the popularity of the discipline
as well as its scientific advancement so closely tied to the deployment of imaging methods as in the
neurosciences.” (translated by the authors) (Original quote: “Insbesondere bildgebende Verfahren
haben sich in den vergangenen Jahrzehnten in verschiedenen Wissenschaften etabliert, doch in
kaum einem Fall sind die Popularität der Disziplin sowie der wissenschaftliche Erkenntnisfortschritt
so eng mit den Methoden der Bildgebung verbunden wie in den Neurowissenschaften.”, Heinemann
2012: 92).
2
The German term “bildgebende Verfahren” highlights the aspect that these techniques actually
“give an image” rather than simply take an image.
R. Brückner (*)
Cinepoetics – Center for Advanced Film Studies, Freie Universität Berlin, Berlin, Germany
e-mail: r.brueckner@fu-berlin.de
S. Greifenstein
Europa-Universität Viadrina Frankfurt (Oder), Frankfurt (Oder), Germany
e-mail: greifenstein@europa-uni.de

https://doi.org/10.1007/978-3-319-90677-5_13
158 R. Brückner and S. Greifenstein
While research into popularizing scientific thought in audiovisual media has

recently received attention, television programs are still a rare research topic in its
own right. Thus, it has to be viewed with regard to other aspects of media commu-
nication: in the field of communication studies, what is investigated via frame and
content analyses is how television generally shapes the public interest and social
judgement of science (Dudo et al. 2011) and more specifically how scientific evi-
dence is represented in science TV programs (Kessler et al. 2014). In education
research, it is stated that popular science TV reduces the complexity of knowledge
from the scientific realm, is not transparent with regard to the sources of knowledge
and decontextualizes results, hypotheses or other academic issues (Kessler et al.
2014). In sociology, Heinemann (2012) for example focuses on “edutainment”
when writing about the growing popularity of neuroscience within science, as well
as in the realm of public media. Heinemann argues that neuroscience has become so
popular that results from scientific studies contextualized in media have a high
impact on the general public. Neuroscientific images and especially fMRI brain
scans seem to fascinate recipients so much that the actual findings become almost
unimportant compared to the entertaining ways in which explanations of brain
activities are presented (Heinemann 2012: 253ff). Despite different approaches, all
aforementioned studies share a critical stance in regards to the popularization of
neuroscientific knowledge by audiovisual media. These researchers highlight that
the scientific content in popular media should be presented with a higher degree of
complexity and caution to more truthfully show what brain research actually has
and has not achieved. However, what these authors do not analyze is how such acts
of popularization exactly work at the level of audiovisual articulation. In the narra-
tives of many science TV programs, the brain scan and computer animated visual-
izations of the brain often take center stage, being treated as if they were visual
arguments, or direct answers for a scientific question. We will argue that this status
of the visualizations is very complex. However, while neuroscientific images them-
selves are not immediately intelligible to lay audiences they are often interpreted as
highly credible and evident, especially when embedded in science television
reports.3 Especially the fMRI brain scan, the black and white image of the brain,
with colored patches indicating brain function, is on the one hand clear and visible,
in the sense that the audience can recognize a brain and has learned to understand
certain colors as activity, but on the other hand, the image must be read and inter-
preted by a scientist or commentator.
It is this paradox from which we depart: visualizations of the brain within audio-
visual images in these programs are to some extent understood as immediately cre-
ating evidence for viewers about research topics, findings and methods. At the same
time, they are obviously communicating by short-cutting scientific arguments. Our
hypothetical claim is that these programs are so popular because they use highly
3
Wibke Larink states that traditionally, two kinds of images are distinguished: images that are cre-
ated by human beings and images that are produced by machines or apparatuses. The latter —
images produced by apparatuses in scientific contexts — is often referred to as more credible and
authentic (Larink 2011: 441).
The Audiovisual Process of Creating Evidence – Science Television Imagining the Brain 159
conventional rhetoric and affective strategies (from the realm of cinema) in their
staging, and do so to create a feeling of credibility and evidence regarding the
depicted or animated brain(s). Or to put it differently: with these programs it
becomes very easy for a lay-audience to feel informed about very complex and
discipline-specific research. Blum and Stollfuß refer to this as “scientist-fiction”, a
certain idea of how, be it in (semi-)documentary or fictional formats, a scientist cre-
ates a fictive sense of credibility, seriousness and spectacular research results (Blum
and Stollfuß 2011: 307). In a similar way, neuroscientific visualizations in science
TV programs are often framed within narratives that revolve around an act of
explaining, be it a complex cognitive or emotional process, a mental disorder or
even a philosophical question. Furthermore, within the context of audiovisual
media, visualizations of the brain (fMRI visualizations or others) become embed-
ded in complex staging strategies that address the viewer emotionally and
cognitively.
In this paper, we look at three staging strategies exemplified by the analyses of
three case studies of science television programs. These staging techniques are
commonly deployed by these formats to develop complex acts of explaining that
result in the impression of scientific evidence (‘to feel informed’). We reconstruct
and describe how the aesthetic staging of the audiovisual images can shape the
bodily, affective and cognitive processes of spectators. In this regard, we assume
that what becomes graspable as the meaning of a scientific argument about the
human brain actually is the result of spectators following and understanding the
explanations given, while at the same time being highly emotionally engaged
through the aesthetic composition. This is realized through the way spectators are
addressed in these formats on various levels concerning the depiction, explanation
and argumentative context of brain visualizations. Hence, we have identified three
levels that commonly shape the understanding process of spectators.4 Each will be
analyzed descriptively in exemplary studies of three science television programs.
Three Levels of Meaning Making in Science TV Programs
The first level of how spectators make meaning refers to the rhetorical and drama-
turgical structure, the explanatory dimension, at the center of which stands a
depicted brain scan that is described by a scientist. On this level, evidence and its
explanation are created by a gesture of pointing at the place where an answer is
found, accompanied by speech.5 Gesture here refers not only to the depicted hand
4
We only refer to some examples of science television programs that we have exploratively worked
on to identify the compositional patterns and strategies that seem to be recurrent and relevant for
the genre. The next step would be corpus-based analyses of these strategies in a broad spectrum of
programs to deepen and prove the findings.
5
We understand evidence in the sense Gottfried Boehm (2010) grasps the imagistic force of ‘show-
ing’ as an intertwining of figure-ground constellations, of a complexity and denseness of appear-
movement of the scientist but also the movement of the audiovisual image itself. We
will reconstruct this level with a case study of an episode of the BBC Two series
Horizon (UK 2009).
The second level leads beyond the mere embedding and presence of brain scans
and moves towards an orchestration of the spectator’s feelings (in the sense of
Kappelhoff 2004; Kappelhoff and Bakels 20116) by deploying an array of aesthetic
strategies common to fictional films. It refers to the staging of the image’s elements,
be it montage forms or sound orchestrations and visual composition, that address
the spectator’s affectivity according to genre modes, such as the amazement of sci-
ence fiction, the tension of a thriller or the dread of a horror film.7 This merging of
fictional and nonfictional genre modes in info- and edutainment programs shapes
the feelings of spectators in a very specific manner. Visualizations of the brain as
well as scientific ideas about the brain become interwoven into audiovisual images
(and their very generic or format-specific means of entertaining). Using aesthetic
strategies of genre cinema, these television programs are able to model affective
resonances in spectators by charging the informative, educational and explanatory
dimensions within a vast range of expressive values composing together over time.
We will focus on this aspect in the second case study with an episode of the
Discovery Channel series Through the Wormhole (US 2011).
The third level refers to an even broader perspective: here, it is not the depiction
or representation of a brain that is at stake but the way audiovisuals direct the spec-
tator’s process of thinking and understanding by using multimodal metaphors. Here
we will analyze how television programs stage fictive and imaginative scenarios of
the human brain, mind and mental activities that are to be perceived through meta-
phoric transferals and mappings. (Kappelhoff and Müller 2011; Schmitt et al. 2014;
ance (“Erscheinungsdichte”, p. 30), and of a temporality of an event, a consummation, to be part

of and to experience an event and how it develops, culminating in an act of uncovering (“an einem
sich vollziehenden Geschehen teilhaben, einer Enthüllung”, p. 31).
6
“We assume that film images organize the perceptive processes of spectators dynamically, as they
unfold temporally during the film reception. While, for example, in one scene strong tensions and
attentional foci are addressed, in a subsequent scene the suspense is relieved after a few minutes.
From this perspective, film can be analyzed not only on the level of narrative plot and character
constellation, but as complex affective dramaturgy, in other words, as a temporal course that the
spectators experientially go through. Furthermore, within the development of a scene, audio-visual
images unfold as movement patterns structuring dynamically the process of watching. The way a
scene unrolls in complex aesthetic figures of soundscapes, light changing, montage sequences, or
camera work reveals a certain dimension of movement that realizes itself only in the perception of
the spectator” (Scherer et al. 2014: 2081–2082).
7
Note that these aesthetic strategies are not conceived of as being part of a Regelpoetik, an aesthetic
norm, a genre convention or poetic rule, instead they are to be experienced as felt qualities, affects
and embodied processes of meaning making. Thus, they are part of the history of moving image
culture as a history of experience, perception and feeling. To identify these patterns and strategies
is a way to describe the historic and cultural specificity of a genre, a format, etc.: to grasp an activ-
ity that is bound to the spectator going through a film perceptively over time, a creative act or
practice constructing the film by perceiving it, the poesis of the film-seeing and film-hearing
(Kappelhoff and Greifenstein 2017).
Müller and Schmitt 2015; Kappelhoff and Greifenstein 2015, 20178). The television
program analyzed in the third case study is the German film Das automatische
Gehirn. Die Magie des Unbewussten (Automatic brain. The magic of the uncon-
scious, Francesca D’Amicis et al. GER 2011). The film develops a metaphor over
the course of its two 1-hour long sections, shaping a narrative that is substantially
grounded in the embodied experiences of viewers.
With these three case studies and three foci we thus point at different levels of
audiovisual communication: the first level concerns the figure of a scientist whose
explanation of brain or mental activities is embedded in the program’s dramaturgy.
The second level refers to the capacities of audiovisuals to orchestrate the specta-
tors’ feelings according to the genre’s poetics. The third level refers to the meta-
phorical embodied meaning-making process over time. Therefore, what is
experienced in these television formats as the meaning construction of scientific
evidence is not the visualization of the brain itself and its explanation, but some-
thing that emerges through the audiovisual staging and the accompanying speech: a
multimodal gesture of supposed proof, creating the felt impression of evidence and
credibility. Therefore, we understand evidence in this context as a result of the
meaning-making process driven by the aesthetic, rhetoric and poetic capacities of
the audiovisual movement image.9
he Gesture of Pointing – An Episode of the BBC Two Series

T
Horizon
In the first case study, we will show the rhetorical structure of a science TV program
and the gesture of pointing that is part of the audiovisual staging. We will analyze
the extract on the basis of a method of describing movement images in audiovisual
media with regard to affectivity and spectators’ feelings (Kappelhoff and Bakels
2011; Scherer et al. 2014). The extract is taken from the BBC Two series Horizon,
an episode entitled The Secret You (Seas. 46, Ep. 2, Dan Walker, UK 2009). The
episode is hosted by the mathematician Marcus du Sautoy, who undertakes a jour-
ney to various scientists to show a number of experiments in search of answers to
questions regarding human consciousness and individuality. The final experiment
8
The access is based on the interdisciplinary concept expressive movement and multimodal meta-
phor, and thus on how meaning making becomes graspable in audiovisual images. It departs from
a both linguistic and film and media studies perspective to reconstruct processes of affect modula-
tion and meaning construction via movement patterns and metaphors that develop over time. In
this concept, the embodied act of seeing and hearing film images is center stage, thus metaphors
that are reconstructed are presumed to emerge from the actual experience of the viewers
(Kappelhoff and Müller 2011; Schmitt et al. 2014; Müller and Schmitt 2015; Kappelhoff and
Greifenstein 2015, 2017). For a methodological outline see especially Müller and Schmitt 2015.
9
We understand audiovisual images as ‘movement images’ with regard to Deleuze. Movement-
images address different dimensions of cinematic movement, be they perceptive, affective or
actionistic aspects (among others) (Deleuze 1986).
Fig. 1 Horizon, episode The Secret You (© BBC2)
takes place at the Bernstein Center for Computational Neuroscience in Berlin and is
concerned with the topic of decision-making. The scene follows the simple and
persuasive rhetorical structure of posing a question at the beginning, looking for an
answer by conducting an experiment followed by the explanation given by a scien-
tist, which culminates in the moment the scientist points at a brain scan. The rhetori-
cal structure can be described by segmenting the sequence into three parts that are
characterized by different locations. The first part introduces the verbal question of
whether or not free will exists in an everyday setting. We then change location into
a university building, where the presenter takes part in a neuroscientific experiment
involving an fMRI-scanner and is afterwards shown the results of the experiment in
a dark lecture hall with an fMRI-image projected on the wall. A final segment shows
the presenter leaving the building again, taking this new-found knowledge, so to
speak, out into the real world again. This dramaturgical structure corresponds to the
movement of the audiovisual image. Through the course of the scene, a cinematic
movement is created, which has a clear trajectory towards the fMRI-image of the
brain, the point in which the decision-making-process is visually manifested. Thus,
not only is the sequence narratively divided into three parts but the cinematic move-
ment is also aesthetically composed in a threefold way on the level of mise-en-
scène, camera movement and the movement of people and objects within the camera
frame as well as by montage. Together, these elements of cinematic staging form a
temporal gestalt that is perceived by the spectator and structures the understanding
process. We will now reconstruct this movement in more detail.
In the first segment, the presenter of the program sits in a sushi restaurant (with
a circular bar where plates automatically go around) and is confronted with a choice.
He asks, “What is it that makes us decide?”. First, the camera follows the sushi
plates. While the presenter talks about the problem of free will, we see rotating sushi
plates from a slightly low-angle camera position (Fig. 1). The central plate is
approaching the camera, filling nearly the center of the image in a close-up shot. In
a following shot the presenter talks and makes a lot of vivid gestures. Through
visual composition and editing, the permanently changing plates seem similar to the
dynamics of the gestures (while he is talking about free will). Thus, the scientific
topic under discussion and a visual scenario are brought together.
As spectators, we experience the going around in circles on two levels: the

impression of a mental circle in what the presenter talks about, of not finding an
answer to his philosophically informed question, and on a concrete visual level, by
the rotating plates and his similarly rotating gestures.
This circular movement now turns into a forward movement: a dark university
building is entered (and arouses the impression that the answer will be found there).
A cut from the presenter’s face and gestures to an image with a strong central per-
spective brightly lit in the background gives depth to the space. The presenter and a
scientist walk towards the camera and during this movement darken the image. With
this human fade to black, the division between the outside everyday world and the
inside world of the lab is completed. When the presenter is lying down and moved
into the fMRI-scanner the directed movement, a movement towards or away from
the camera, comes to an end.
Through editing, the actual person is now substituted by a greenish image of a
brain with small pink areas, that are constantly changing their form, appearing and
disappearing (Fig. 2). Through the montage, which ends with the presenter emerg-
ing from the scanner, we are given the impression, that what we visually perceive as
brain activity corresponds to what just went on inside the person in the scanner.
In the next segment, the mise-en-scène of a dark lecture hall puts the focus on the
scientist and the presenter, who discuss the results of the experiment. An fMRI-
image of the brain accompanied by a graph is projected on the wall behind the two
as the vanishing point of the scene. The image is carefully framed by the figures of
scientist and presenter: the head of Marcus du Sautoy slightly overlaps with the—
supposed—scan of his brain, again indicating that we are presented with what was
actually happening inside his brain during the decision-making experiment. The
movement that led us from the everyday question in the outside world to a dynami-
cally moving image of the brain is now brought to the point of answer: a sudden cut
to a close-up of the scan while the scientist says: “Here we can show you how we
did it.”, underlined by gesturing with a pointer. The frame is now completely filled
with the black-and-white brain scan. In the middle, there is a small bright yellow
square and the pointer and its shadow form a triangle, an arrow pointing directly at
it (Fig. 3).
The entire staging of this scene has been directed towards this point, the shot of
the brain scan. This image of the brain is presented as a piece of evidence that sup-
posedly shows the answer to the initial question. The fact, that this is experienced as
evidence is not, however, due to what we see—a colored point—but through its
embeddedness in the rhetorical structure of the scene (dominantly articulated
through verbal expressions and montage). It is attributed immense importance not
because we actually know what it signifies but through the gesture and the entire
staging that moved towards it. Only through the explanation by the scientist (who
tells us that this “pattern of brain activity emerges before you make up your mind”)
do we gain an understanding of its meaning. Nevertheless, it is still not entirely clear
what the significance of the result is. Only through the presenter’s evaluation of the
result are we invited to share in the sentiment of how important the information and
image are: he shows his astonishment and repeats what seems to be the crucial point
of the experiment, namely that this activity can be recorded 6 s before one makes a
conscious decision.
Thus, the gesture of pointing in audiovisuals can take two forms: first, the con-
crete gesture performed by a person on screen and secondly, a gesture-like address-
ing of the film image itself through the audiovisual staging. Both forms of gestures
could be seen interacting in this first case study. With such a focus, we look at the
process of how aesthetics, words, images, sounds and staging techniques etc. unfold
in time and shape the perception of spectators.
esthetic Stagings and Metaphoricity in an Episode

A
of Through the Wormhole
In different coverage and documentary formats of science television programs,

brain scans and other visualizations of neural activity are embedded in the specific
staging strategies that ground the audiovisual narrative. An example of this embed-
dedness is the documentary series hosted by Morgan Freeman Through the
Wormhole (on the US Pay TV Discovery Channel). In this second case study, we
will show how this science TV program makes use of staging practices. Such
audiovisual forms of staging draw heavily on aesthetic strategies of genre cinema,

which we consider shape the spectators’ affectivity (Kappelhoff 2004). The whole
series draws on different genre patterns, for example science fiction films, horror
films, thriller, mystery crime-orchestration and comedy elements and varies them in
a specific manner. We will focus on one episode called Is there a sixth sense? (Seas.
2, Ep. 5, Lori McCreary et al. US 2011). In the program’s beginning, different sci-
entists from all over the world are presented with their projects and experiments. In
introducing all the ‘characters’—the scientists—different staging techniques are
used: we find the classical interview situation where a scientist sits in front of the
camera and elaborates on the topic, summarizing hypotheses, theoretical issues or
results (in this case e.g. Roger Nelson from the Global Consciousness Project,
Princeton). Furthermore, there is a more playful way of staging the scientists by
means of putting them, for example, in a private setting. A philosopher, David
Chalmers (Philosopher from the New York Consciousness Collective), who
researches mind processes talks in a serious manner about philosophical insights
into consciousness, but then is suddenly presented in his free time as a singer in a
concert with his band. In contrast to his previous seriousness, Chalmers is now
staged as a rock musician who holds the microphone close and tight while he sings
loudly and in a dramatic pose: “What consciousness is, ... I ain’t got a clue.” Apart
from such ironic, comic and self-reflexive forms of staging the scientists, the pro-
gram uses and specifies other aesthetic patterns from popular film genres to orches-
trate scientist after scientist in a different mood in a montage sequence: there is a
research group that seems to arise from a science fiction film when Beatrice de
Gelder, professor at Tilburg University, is shown in a shot together with her team.
She and three other people walk down a corridor of a university building, approach-
ing the camera. What seems to be a very unexceptional action becomes staged in a
way that makes the group of neuroscientists appear as the task force for a high-tech
space shuttle crew (Fig. 4).
Through visual composition (narrowing and framing the persons through shades
and blurry parts of the image) the four scientists become arranged symmetrically as
if going along a determined path, two of them (de Gelder and her assistant) are seen
in front of the group, while the other two double behind them. Through this march-
like visual arrangement the group is perceived as one unit. This sense of unification
is primarily established by top-lighting, visual framing and the changing of motion
speed. The rhythmic musical composition, the pulse-like repetition of one note and
the speed changing effect together recall the film style patterns of science fiction.
Furthermore, the dark clothes of the two people in the front, one of them wearing a
sweatshirt with the text “air” on it as well as the depicted sign for aircraft, recall
airplanes, air forces or space shuttles.
Another example of a typical genre-informed staging is the sequence of a brain
expert who seems to originate from a horror film: Michael Persinger, neuroscientist
at Laurentian University in Canada, who is shown in low key lighting, from a low-
angle camera perspective, and a strongly narrowing visual composition (Fig. 5).
The canted perspective distorts the vision. In the first shot a computer is partially
seen, its screen in blurry close-up continuously showing moving graphs. In focus
Fig. 4 Through the Wormhole, Episode Is There a Sixth Sense? (© Discovery Channel)
Fig. 5 Through the Wormhole, episode Is There a Sixth Sense? (© Discovery Channel)
and in the background, the scientist, lit in a low-key style can only be seen dimly
while he smiles. The next shot is even more reminiscent of horror cinema. The sci-
entist, Persinger, is again shown in a medium shot from a low and canted angle with
low key lighting. His smile seems to build a contrast to the darkness of the visual
image. Hundreds of formulas are seen in the background over a blackboard while in
the foreground the computer graphs are still running. The uncanny turn of the music
into a minor phase underlines the staging of the weird. Apart from this use of stag-
ing strategies, which is highly informed by genre cinema, explanations of brain
Fig. 6 Through the

Wormhole, episode Is
There a Sixth Sense?
(© Discovery Channel)
processes during the whole episode are verbally delivered: brain scans are shown
and explained by scientists, pointing at them. Furthermore, there are other acts of
explaining brain processes, such as when multiple dynamic colored 3D-animations
of the brain are recurrently shown accompanied by mysterious music and the deep
and insistent voice-over commentary of Morgan Freeman (Fig. 6).
Here, the dark background together with the accompanying music stages an
atmosphere of the unknown. The blueish and yellow/reddish parts of the brain con-
stantly move, change and seem to fluoresce as if the brain was something mysteri-
ous, a magic force in a dark space that we are able to see but cannot completely
fathom. The atmosphere of the unknown is audiovisually staged contrasting with
verbally delivered facts.
Furthermore, the questions addressed regarding body and brain functions become
framed by the opening credits of the series, which elaborate a succession of sym-
bols, bringing up a metaphor that lets the viewer experience the connection of
human body, brain and mind as a vivid cosmos with stars, galaxies and other space
phenomena. Right at the beginning of the opening credits, visual objects are woven
into each other through animation and a direct and long lasting camera movement.
The universe moves vividly; we see stars and planets and then the lettering of the
title “Through the Wormhole” transforms into a double helix. In this space, anima-
tions become visible: an eye, then a clock running, between the Milky Way and a
double helix, then the Earth is focused. A dynamic movement approaching the Earth
transforms rapidly into a room with Morgan Freeman. The camera moves in and
drives onto the eye until the black of his iris fills the image. The camera movement
intertwines different objects or realms through different speeds, as if they follow or
develop from one another. Symbols for human organs and body structures (like the
eye and the double helix) are combined with the starship journey through space and
time. A metaphor is established only by means of movements that bring together
different realms, making us metaphorically experience a trip through the human
brain and body processes as space travel. Finally, there is another animation specific
for the respective episode: while Freeman is talking in a dark room some colorful
lights and forms become visible. According to the previous space travel metaphor
they are seen as star dust, according to his speech on the sixth sense they are a meta-
phor for neurons, synapses and other activities in the brain (Fig. 7).
Fig. 7 Through the Wormhole, episode Is There a Sixth Sense? (© Discovery Channel)
The dark background of outer space with stars and galaxies highlighted seems
well-suited as a visual setting for staging what science is in search for. Not only in
the program’s introduction, but throughout the whole episode the staging of the
audiovisual images creates the metaphor of the brain as cosmos. Another animation
makes the spectators see animated lights on a dark ground, and with the help of an
accompanying voiceover, the lights are identified as neurons, as if brain functions
were a space with stars. This illumination as brain activity is, however, not the end
of the metaphorical process: the orchestration of light is then transformed into a
vision of the continent of North America by night, seen from above, where the flick-
ering and fluorescing finally come to be understood as (brain) activities of many
people in the USA.
What these examples show is that audiovisual entertainment intensely borrows
and interprets aesthetic patterns from fictional film genres. Moreover, these aes-
thetic patterns of expressivity from genre cinema—as gesture-like forms of address-
ing—are known to be linked to affective modes (see for example Grotkopp and
Kappelhoff 2012; Kappelhoff 2004) and relate to the delivery of scientific informa-
tion in popular science television. In such programs, we as spectators do not only
feel informed by recent brain research, but we also feel the tension, surprise, expec-
tation etc., that go with the aesthetic patterns of film genres that address our senses
in familiar ways. The way in which spectators are drawn into a universe of its own,
a diegetic world created by the science television program, is very specific (in the
way topics are developed and argumentation lines are narratively constructed within
the non-fictional frame of the documentary subgenre), while certain forms and tech-
niques of being affected by moving images we are very familiar with: they are simi-
lar to an experience that we know from years of film and media perception, watching
movies, series and television. These aesthetic patterns that originated in other genres
Fig. 8 2001: A Space Odyssey (© Metro-Goldwyn-Mayer)
are applied by Through the Wormhole to address the audience by reminiscently cit-
ing and reinterpreting figurative thought that has been established by older science
fiction films. It seems obvious that the metaphor of the brain as the cosmos is based
on a long tradition in cultural history. One historic source for it is Stanley Kubrick’s
film 2001: A Space Odyssey (UK/US 1968). Here, consciousness processes as well
as developmental processes are metaphorically related to the universe. This culmi-
nates in a shot in which a baby and the earth are juxtaposed and staged similarly. In
the visual composition, the microcosm of embryonic development is experienced
and understood as the macrocosm of the universe (Fig. 8).
The popular science television format also takes up other iconographic sources
from Kubrick’s film. In Through the Wormhole there are visual compositions of
psychedelic formations that recall Kubrick’s images of travel through space and
time, an intergalactic flow through a color tunnel, audiovisually imagining a dream
or stream of consciousness (Fig. 9).
Furthermore, in the episode Is there a sixth sense? The depiction of the human
eye is often combined with the universe and the starry sky in a recurrent pattern.
This staging form and depiction within the film image also has its source in the
image formations of Kubrick’s film 2001 (Fig. 10).
Through a recurrent montage of the eye, seen in a close or detail shot and a vision
of a dark sky with luminous stars and galaxies in it, what becomes related is not so
much a certain point-of-view construction that a character sees, but that a certain
process of seeing corresponds to the way the universe is built.
As we have seen in the third case study, the episode Is there a sixth sense? of
Through the Wormhole makes frequent use of film genre poetics like aesthetic stag-
ing patterns from horror, thriller, science fiction, comedy and others that are known
from the realm of cinema to be connected to different ways of staging the affectivity
of spectators. The genre patterns are used in a way that almost stereotypically mixes
up different staging techniques. But the way these patterns are orchestrated and
mixed forms the specificity of the genre: a comic orchestration is held up for some
Fig. 9 Time travel visualizations in 2001: A Space Odyssey and in Is there a sixth sense? (Through
the Wormhole)
Fig. 10 Similar motives and visual patterns in 2001: A Space Odyssey and in Is there a sixth
sense? (Through the Wormhole)
seconds only to be succeeded by the excitement of science fiction staging, which is

then abruptly turned into a creepy horror mode. Such a use of genre mechanisms,
where one extreme follows another in short succession, creates an affective drama-
turgy of going through a route that highlights the act of being permanently and
intensively involved more than the actual emotional realm (horror or excitement). A
shift of strong moments of spectacle causes the audience’s attention to be again and
again aroused and emotionally addressed by the program. The main affective tenor
of each pattern (like horror or laughter) is especially shaped by the musical score:
for example, an uncanny or unknown sound regime of thrill underlines a continuous
caution, doubt or attention to what is seen, heard and said (although what is shown
might be rather unspectacular). While other affective realms pass by so rapidly, the
main tenor of thrill remains and thus changes the way scientific knowledge is expe-
rienced. The whole dramaturgy is pointed towards the direction of thrill, which
together with the evolving metaphor of brain as cosmos, leads the spectator to expe-
rience scientific thought as an adventurous travel through time and space. The whole
dramaturgy is steadily repeating what in the opening credits had been established as
movement patterns: a continuous dynamic forward movement that stages different
abstracted objects (a double-helix, a clock, an eye) distinctively in the foreground
before they then rapidly pass by into a visually diffuse realm of the space. The
movement qualities give insights into what the experience points at: the forward
movement encounters objects but does not remain, will not rest, and is forced to go
further into the unexplored. This movement can be summarized as the way the pro-
gram generally addresses spectators: during the whole episode, the experiments,
scientists and other explanations are only briefly focused on. Such an act highly
influences the way we understand scientific explanations. They are important and
presented as such, but they are only phases of a long journey into the undiscovered
unknown space as we seek to investigate more.
Metaphoric Meaning Making: Das automatische Gehirn
Our third example and case study focuses on metaphor with regard to the way it
structures the understanding process of spectators. Metaphors in audiovisual media
are conceived of not only as singular occurrences in verbal articulations, rather they
emerge over time from the embodied viewing of specific relationships between
moving images, sounds and language. They can structure small audiovisual seg-
ments as well as an entire television program. The spectator’s understanding pro-
cess follows these temporal and multimodal structures that unfold in the audiovisual
staging.
Generally, explanations of brain processes draw heavily upon metaphors, both
language-based (Goschler 2007) and multimodal, which together with visualiza-
tions of the brain can bring in different metaphoric fields. For example, common
verbal metaphors such as certain areas of the brain “lighting up” or neurons “firing”
find their visual correspondences in the yellow and red colors used to mark brain
activity on the screen: the verbal and the visual form multimodal metaphors that
shape our understanding of brain activity as presented in this specific audiovisual
format.
To understand what is meant by metaphor in this context it is important to refer
back to the basic definition of metaphor in Conceptual Metaphor Theory, which
states: metaphor is “experiencing and understanding one kind of thing in terms of
another” (Lakoff and Johnson 1980: 3). In alignment with a perspective that is
rooted in language use we assume that metaphors can be activated, foregrounded,
highlighted and thus made salient by gestural, verbal or visual means, all in the
process of meaning making within different discourses and media (Müller 2008;
Müller and Tag 2010). Metaphor is conceived of as a dynamic cognitive, affective
and embodied phenomenon that constitutes over time (Cameron 2007; Kappelhoff
and Müller 2011). In the context of film and media, this process has to do with the
act of experiencing aesthetic forms (with speech as a part of it) metaphorically: of
seeing something ‘as’ something else (Müller and Schmitt 2015; Schmitt et al.
2014). What comes into the focus of interest with metaphor is the way spectators
understand and construct embodied scenarios that transform over time. The process
of meaning making through audiovisually constructed metaphors seems to be in
congruence with the basic processes of creating the narrative: the act of fictionaliza-
tion (Kappelhoff and Greifenstein 2015, 2017). By describing the emergence and
development of metaphors in audiovisuals we will reconstruct how spectators create
a diegetic world on the basis of an affective course that they undergo during the
temporal unfolding of the images.
The case study we use to exemplify the unfolding of metaphor as a way to make
scientific knowledge understandable and enjoyable for a lay audience is the first of
a two-part German documentary entitled Das automatische Gehirn (Automatic
Brain).
The documentary uses a loose story line of a young woman’s everyday life—get-
ting up in the morning, getting ready for work, going on a date—to bring up ques-
tions of human consciousness. These acted scenes are tied in with scientist
interviews, experiments and computer-animated brain visualizations. A voiceover
commentary connects these parts, and especially accompanies the animations of the
brain. We found that whenever these images are shown, the use of verbal metaphors
is highly increased.
However, the metaphors used are not only language-based but also cued in the
audiovisual images themselves. While already the title, Das automatische Gehirn,
calls up a familiar metaphor—the brain as a machine10—this metaphor becomes a
felt experience by the spectator through the interplay of different modes of audiovi-
sual staging. The documentary opens with the camera moving through a dark laby-
rinth of blue strands of nerves accompanied by sounds of electricity. A close-up of
the actor is superimposed over these images and followed by a cut that contrasts the
darkness of the ‘inside’: a young blonde woman lying in white linen in her bed. An
alarm clock is shown in close-up and using slow motion we see time changing with
a loud sound. Another close-up of the woman’s now opened eyes, and the camera
moving towards her eye back into the dark space of the brain connects the outside
and inside of her body. The atmosphere created through sounds, images and camera
movement is that of a science fiction or even horror film. Only then does the title
appear between the nerve strands: “Das automatische Gehirn” (Fig. 11).
Even before the first words appear, the main metaphor that is elaborated through-
out the whole program has been initiated. Especially the electric sounds but also the
contrasting lighting, the close-up of the clock and the camera movement changing
This common metaphor refers, for example, to the widely discussed computational theory of
10
mind (e.g. Pinker 1997).

Fig. 11 Das automatische Gehirn (© WDR)
between slow motion and acceleration, create the impression of an electrified world
that functions—just like the clock—independently of but at the same time within
the body.
The metaphor of a machine is then elaborated through other instances in the
documentary. On a verbal level, we hear the voiceover commentator saying and
picking up on what was visually created at the beginning, “Every morning, when we
open our eyes, unconscious circuits create the world that surrounds us in our inner
eye” or, “our brain automatically selects what we perceive” or, “there is a fully
automated error monitoring system in our heads.”11 Visually, the blue and green
colors used to represent the brain and nerves are reminiscent of the colors used in
science fiction films with regard to technology and computers. Not only sound and
colors but also camera work contributes to the emergence of the metaphor, even in
scenes where the brain is not shown. In one instance, for example, we see the young
woman we follow, Marta, in a fast, abrupt and unnatural motion, similar to a robotic
movement. The repeated use of slow and fast motion heightens the impression that
on the one hand, the scenes in this film are to be seen as study objects that can be
zoomed into and out of, and on the other hand, that the movements are controlled by
an outer force.
To show how the interplay of different levels of audiovisual staging make the
main metaphor of brain as a machine, and more specifically as a computer, emerge,
we will analyze one scene in more detail. Its topic is the speed with which our brain
can decide our actions and how this unconscious process is essential to our survival.
This fact is first explained in an interview with neuroscientist Gerhard Roth, who
refers to the importance of “automatic” reactions in traffic. This segment gives the
11
All translations by the authors.
following scene its scientific framing. The narrative of the scene then revolves
around a boy who runs after a ball onto a road and is saved by Marta from an
approaching car. The processes in her brain during the decisive moment when Marta
sees the boy, the split-second that triggers her action, is then explained by an elabo-
ration of the main metaphor of brain as a machine in the interplay of language and
moving images. The following analysis will show how this metaphor unfolds in the
film by the creation of various mappings between the functions of the brain and an
automatically working machine. Over the course of the short scene, aspects such as
speed, the parts of a machine and electricity are introduced in succession, and
together form the main metaphor.
In the first part of the scene the main characters and the ensuing conflict are
introduced with slow motion shots of the young boy, running along with his foot-
ball, followed by shots of cars and a shot of Marta leisurely walking along the pave-
ment. This is accompanied by Roth’s voiceover, which explains our experience of
the speed of brain processes as immediate, thereby connecting a scientific explana-
tion to a fictional world. The motion of the image becomes extremely slow when the
boy appears behind a door running after the football that jumps towards the viewer.
Eerie, slow and elongated sounds make the decelerating movement audible and cre-
ate an extremely dramatic atmosphere.
A brief change of speed, from slow to normal and back to slow motion, high-
lights different temporalities. This audiovisual orchestration lets us experience that
this is in fact just a split second, a standstill of time, a number of pieces of informa-
tion too quick to be consciously processed. The explanation given by the scientist
now becomes a felt experience of the spectator. To connect the outside narrative to
the brain processes happening at the same time, an extreme close-up of an eye is
used alongside the voiceover, “everything we see enters our pupils as a bundle of
rays of light”. Then the camera moves forward, making the viewer feel as though
they are entering the eye, or as if we ourselves were those rays of light, which is
followed by a change of perspective that provides us with a sideways view of an
abstract image of an eye while the commentator explains how light hits the retina.
Accompanied by a space-ship sound, we enter the eyeball in a very dynamic
movement. Leaving the still legible image of the eye into animations of the brain,
the commentator says: “coded in a million nerve impulses, the data rush through the
optic nerve.” The camera moves further forward and quickly through a tunnel of
strands in a greenish-blue color that resemble cables. The audiovisually experienced
fast movements correspond here with the verbal level of the voiceover. Through this
mapping of the experienced speed and the verbally mentioned speed of the data, the
multimodal metaphor that is elaborated in this sequence gains further shape.
However, this extreme rush contrasts with the slow motion that we experienced
before, making the machine-like velocity perceptible: we see animations of the
brain and experience the rush of velocity, we hear a verbal metaphor and are at the
same time put into the perspective of the rushing data.
With this multimodal articulation, the aspect of speed is induced into an over-
arching metaphor of the brain as an automatically working machine or a computer.
Within the scene, we have now entered a dark open space with semi-transparent
Fig. 12 Das automatische Gehirn (© WDR)
disorderly strands of nerves that seem to spark electricity. The commentator

describes parts of the brain as elements of the machine, each with a specific func-
tion: the description of the thalamus as the gatekeeper who communicates with
other parts such as the amygdala, the so called “panic switch in our heads,” is
accompanied by an animated transparent image of a head from outside, in which the
described parts of the brain are illuminated.
The transmission of data is visualized by small dots of light moving along paths.
When the “panic switch” is mentioned, a bright red flickering light appears in one
part of the brain while the camera moves closer. The idea that the amygdala becomes
activated and blinks matches with the verbally mentioned “panic switch”. In this
part of the scene the brain’s activities and functions are visualized as light (Fig. 12).
In the final set of shots, instances exemplifying the fields of data computing and
electricity are verbalized, accompanied by an audiovisual staging that highlights
aspects of electricity, light and signals: data are transmitted through the “databases
of our experience” and through unconscious “modules,” while we see synapses
flash up and dots in motion.
The metaphor that emerges over the course of the scene is constituted by verbal
expressions as well as the audiovisual staging and dynamically creates a vivid sce-
nario, which we experience and understand as spectators. It consists of many meta-
phoric mappings from the realms of automatism, electricity and computing that play
on the verbal, audial and visual levels. Only the complex interaction of these ele-
ments shapes the process of metaphoric meaning making. The statement by the neu-
roscientist at the beginning of the scene—that the speed of the brain’s function is not
perceptible—is elaborated and made perceptible through the audiovisual staging
using a complex multimodal metaphor of the brain as a machine that is fast, consists
of many elements, uses computing mechanisms and is powered by electricity.
Conclusion
These three exemplary short analyses illustrated three staging forms or audiovisual
techniques that we consider central to the popularization of neuroscientific research
in these respective formats. These forms of staging are highly connected to the argu-
mentative and narrative development of the respective TV programs. Although the
informative level of what is explained scientifically is only superficially approached,
the programs tend to create an impression of evidence that we consider to be the
result of the audiovisual forms of staging and the way spectators see and hear the
film images using the following elements:
First, the gesture of pointing to a brain scan framed by scientific explanations and
audiovisual context. Second, the deployment of movement and staging patterns that
heavily draw on aesthetic strategies of genre cinema, which we suggest shapes the
spectators’ affectivity; and third, the multimodal staging of brain processes that are
metaphorized and which we consider to be another element that shapes the specta-
tor’s process of meaning making.
In the first instance (in BBC’s Horizon), the rhetoric of explaining the work of a
scientist culminates in a gesture of pointing at brain scans that become the central
part of the argument’s structure. It is not the actual brain depiction which creates
evidence, rather it is how it is embedded in the dramaturgical structure of answer-
seeking. The act of showing and pointing is combined with emotional judgements,
vocal expressions and verbal utterances that manifest amazement and spectacle,
highlighting the supposed importance of what is being presented. The gesture of
pointing at the brain scan and thereby putting it at the heart of the argument is not
only understood as an actual gesture conducted by a person—as is the case in the
example used—but also as a gesture performed by the audiovisual image itself.
Second, in an episode of the series Through the Wormhole, there is the strategy
of calling up genre elements and patterns from cinema and audiovisual entertain-
ment practices that create and emotionally bind the spectators in a way, which
depicts science as a journey that is experienced as travel, an adventure or a fascinat-
ing search and exploration for unknown worlds. We assume such a proclaimed
affect modulation to be highly important for the act of creating evidence; the audi-
ence is bodily and cognitively entertained and the scientific information does not
contrast this entertainment, rather it is interwoven in the high spectacle of seeing
new things and following stories.
Third, in Das automatische Gehirn, we showed how multimodal metaphors are
elaborated in the audiovisual staging and how they are used to explain brain func-
tion. Images of a brain become contextualized and filled with supposedly scientific
information by the voiceover. In the interplay of the verbal and audiovisual, the
unfolding metaphor creates specific realms—in this case that of brain as machine.
Through the use and modification of familiar popular genre patterns, what is consid-
ered to be the brain in this context is made more perceivable, imaginable and under-
standable as a way of being addressed with all our senses: bodily, affectively and
cognitively. Thus, the evidence of these programs does not build so much on actual
scientific argumentation, but more on the way the dramaturgy (or rhetoric) of the
audiovisual staging and orchestration makes spectators feel a certain sense of
importance and relevance.
The results of our case studies show that the capacity of brain animations and
visualizations to be perceived as evidence for a verbally articulated scientific argu-
ment in the format of science television programs is not something that can be
reduced to the moment of their appearance on screen. Instead we tried to prove how
depictions of brain scans or animations are highly interwoven into an audiovisual
image, a temporally dense and complex aesthetic form that aims at affectively
addressing language-based explanations and multimodal metaphors. To claim that
the act of creating evidence in these programs has more to do with entertainment
than with information is a commonplace that we would like to leave aside. What is
more interesting to note is that images of the brain and ideas of mind in the realm of
audiovisual culture seem not to be communicable without metaphors or affective
stagings that have historical roots (e.g. in genre cinema). To make an abstract or
complex academic issue (e.g. brain activities) visible and understandable, film mak-
ers draw on commonly known forms of audiovisual communication, which have
become so concrete and relevant that every second of these programs feels affec-
tively familiar. The act of creating evidence of scientific contents in science TV
programs is thus a highly culturally and historically developed gesture of artistic
devices, persuasion and storytelling.
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Medical History’s Graphic Power in
American True-Adventure Comic Books
of the 1940s
Bert Hansen
Historians draw freely upon many different genres and media for documents to
explain the past. Since 2004, I have been writing about the true-adventures genre of
comic books and their hitherto unknown medical history stories, using them primar-
ily as evidence for the ubiquity of medical history in American popular culture up
to the 1960s. In those studies, my emphasis was on the content of the stories and on
what they revealed about popular consciousness (Hansen 2004a, b, 2009: 171–203;
Hansen and Adler 2012). Here my goal is to look more closely at graphic styles and
artistry, in short, the means by which the artists achieved an impact.
By examining variations in the graphic art itself, I hope to clarify just what made
those early stories so engaging. In my view, they owe their success to a visual style
I will call ‘action graphics,’ which carry the narrative, contrasting it with a weaker
style, called here, for convenience, ‘mere illustration,’ in which the narrative resides
in the text and images are subordinate to text, following it, rather than leading it. My
aim is not to place form above content, but to reveal how certain styles can better
serve content through engendering deeper reader engagement with active instead of
passive reading. In traditional book illustration, the art does not usually tell the
story; the pictures—no matter how good they are—merely support a narrative car-
ried in the text, and the reader is passive. In action comics by contrast, the art is the
primary carrier of the story and forces a reader to imagine parts of the story. The
general understanding of graphic art employed here is based on the insights of a
number of experts, often artists themselves, who have analyzed what is sometimes
called ‘sequential art.’ I am especially indebted to pioneering writings by Reinhold
Reitberger and Wolfgang Fuchs (1972), Will Eisner (1985), Ron Goulart (1986),
and Scott McCloud (1994).
This chapter first sketches out the terrain of the true-adventure comics before
looking closely at how images do their work and at how this process contributes to
B. Hansen (*)
Baruch College of the City University of New York, New York, NY, USA
e-mail: Bert.Hansen@baruch.cuny.edu

https://doi.org/10.1007/978-3-319-90677-5_14
180 B. Hansen
success in making the reader participate, especially young readers. Then we con-
sider possible influences on those early graphics, such as photojournalism. After
that the essay records the decline of these action graphics and their displacement by
a different style of illustration. It is worth noting at the outset that the large analyti-
cal and historical literature on comics has paid very little attention to the true-
adventure genre. In fact, many writers have marginalized it when they not have
ignored it altogether. Prior to my publications, the many wonderful comic-book
stories about such figures as Emil Behring, Marie Curie, Alexander Fleming,
Elizabeth Kenny, Robert Koch, Florence Nightingale, Louis Pasteur, Walter Reed,
and Jonas Salk were entirely unknown to historians (Hansen 2004a, b, 2009: 171–
203; Hansen and Adler 2012; Adler 2012).
The New True-Adventure Comic Books and Their Success
Short comic stories had been a presence in newspapers since the beginning of the
twentieth century, but booklets consisting entirely of four-color cartoon graphics
burst onto the scene in the mid 1930s with funny stories. Their scope was expanded
with Detective Comics in 1937, where serious narratives were introduced. Then
Action Comics published the world’s first Superman story in its inaugural issue of
June 1938. Led by the superheroes (Batman made his appearance in May 1939), this
new medium took the world by storm, with a single monthly issue sometimes selling
as many as a million copies (Wright 2001). Comic books had already become a
major industry and a dominant presence in mass culture when a new genre, the true-
adventure comic books, was created in 1941 within an industry dominated by fantasy
and fiction. True Comics No. 1 appeared early that year as a bi-monthly with a cover
date of April 1941. Its print run of 300,000 copies quickly sold out, and it was made
into a monthly. It was soon followed by such titles as Real Heroes (by the same pub-
lisher) and Real Life Comics (by a competitor). Additional titles like It Really
Happened sprang up, and the genre flourished during the war years. But it faded as
the decade wore on, with only three titles remaining in 1947; and these were often
reduced to reprinting old stories. The true-adventure genre ran out of steam even
before the wave of political and cultural attacks on comic books as dangerous and
damaging. The demise of this genre was, however, not unique; it was part of the
decline of the Golden Age comics in general, which is explained further below.
But for much of the 1940s, True Comics, Real Heroes, Real Life Comics, and It
Really Happened commanded a credible share of the marketplace and engaged mil-
lions of readers with true stories about real people. These commercial ventures were
as filled with violence, death, and destruction as the fantasy adventures of the era.
These were sold on the newsstands, and they competed for readers’ dimes against
Action Comics, Superman, and the rest of the big sellers (See Fig. 1). And while
they did not reach the million-copies-an-issue mark as did some of the superhero
books, any monthly that could sell 300,000–500,000 copies earned a place in mass
culture. Further, comic books tended to have a high pass-along rate with each copy
Medical History’s Graphic Power in American True-Adventure Comic Books of the 1940s 181
Fig. 1 ‘Comicland,’ photographer unknown, apparently first printed in Newsdealer magazine in

1948 (© Newsdealer Magazine, Inc.)
reaching as many as five more young readers. At first, the true-adventure comics
often used leading artists, who drew fantasy and fiction stories as well, including
Harold DeLay, Sam Glankoff, Gary Gray, and Rudy Palais. Gradually these artists
seem to have been replaced by less skilled artists using routine styles with an unfor-
tunate decline in visual quality.
182 B. Hansen
Fig. 2 ‘But…,’ two frames in ‘Louis Pasteur and the Unseen Enemy,’ Real Heroes 7 (November
1942), 25. Although unsigned, the artwork is by Sam Glankoff (© 1942 The Parents’ Institute,
Inc.)
From the vantage-point of the early twenty-first century, when science is neither
generally trusted nor high in public esteem (especially in the United States), the
popularity of scientists and physicians in the mid-century comics may seem surpris-
ing. But in fact, curiosity about science and scientists was widespread in American
popular culture from the 1920s through the 1960s. In the 1920s novels and biogra-
phies about medicine were winning major prizes. In the 1930s, the Hollywood film
industry featured Marie Curie, Paul Ehrlich, Elizabeth Kenny, Florence Nightingale,
and Louis Pasteur in widely successful biopics. From its earliest issues, the exceed-
ingly popular Life magazine heralded science and scientists, treating them seriously
and at length, with solid explanations of the intellectual content. Through the 1950s
at least, ordinary Americans, the parents of the children who read comic books,
knew much more about contemporary science than later generations would. During
the 1960s many factors converged into scepticism and then into antagonism toward
science and medicine (Hansen 2009).
Within the true-adventure genre of comic books, my research has emphasized
the medical history stories of that era, tales of heroic doctors, nurses, and medical
scientists (Hansen 2004a, b). In these stories, historical figures of the nineteenth
century and the early twentieth predominated, with a few figures from the more
distant past and a few others who were contemporary with the comics they appeared
in. It was too early for these comics to recount the spectacular mid-1950s success of
the polio vaccine by Jonas Salk, but they gave much attention to 1940s events like
the introduction of penicillin and the method of polio therapy promoted by Sister
Elizabeth Kenny, the ‘Australian Bush Nurse.’ Pasteurization and Pasteur’s rabies
vaccination were repeatedly featured (See Fig. 2). The experimental research efforts
in physiology that overcame two vitamin-deficiency diseases, pellagra and beri-beri,
were other popular subjects. While men dominated in the stories of medical science,
women did appear in several history stories both as doctors and as nurses, including
Fig. 3 Splash frame in Rudy Palais, ‘Walter Reed,’ Science Comics 2 (March 1946), 26
Clara Barton, Dr. Elizabeth Blackwell, Mabel K. Staupers, and Dr. Mary Walker.
The substantial presence of medical history in the true-adventure genre is confirmed
in detail in the 114 stories that I have inventoried in my annotated bibliography
(Hansen 2004b).
Several comic books devoted long stories to the saga of the famous yellow fever
studies of the U.S. Army in Cuba, led by Dr. Walter Reed, which used his colleagues
and some enlisted men as volunteer subjects in a deadly human experiment to estab-
lish that ‘yellow jack’ was transmitted by mosquito bites and not by human contact
(See Fig. 3). Such stories often suffered from condensation, simplification, factual
errors, and the taking of dramatic license, but the writers and artists did not bowdler-
ize them or ‘prettify’ them for children’s reading as would be done today. Young
comic book readers of that era not only saw combat deaths, but they looked directly
at men and animals dying in medical experiments.
The true adventure comics did not have the evil doctors or sinister nurses found
in so many fiction and fantasy stories; readers, however, did meet medical conserva-
tives who scoffed at the hero’s new ideas. Comics historians have generally ignored
the true-adventure comic book stories in favour of the superhero action figures with
their astronomical popularity and profits. Some people today find these books of
‘real history’ with their uniformly upbeat tone unappealing, their enthusiasm for
heroes suspect, and their narratives too simple (Basalla 1976; Gifford 1984: 172–
173). In contrast, my reading challenges these interpretations, keeping in mind that
these were written for children about age ten—even if, in fact, they were also read
by older children, teens, and adults, especially members of the military. Of course,
184 B. Hansen
Fig. 4 ‘Here’s how the famous experiment turned out,’ panel of ‘Conqueror of the White Plague,’
True Comics 19 (December 1942), 59 (© 1941 The Parents’ Institute, Inc.)
some complexity will always be lost when a life is reduced to just a few pages. But
how much a good artist could convey in a few pages is probably more important.
With respect to their primary goal of encouraging young people to enjoy and engage
with the dramatized life of individuals of other times and places and in inspiring
youngsters to understand people in the past, they appear successful to me.
Additionally, these stories effectively conveyed key aspects of a scientific
approach to the world. They not only brought experimental medicine ‘to life’
through biographical drama, but also by careful presentation of the unfolding drama
of discovery, the narrative of how new ideas arose, and how hypotheses were con-
firmed or denied by observation and crucial tests. They offered an excellent presen-
tation of the way experimental controls function in establishing valid understanding
of natural processes, as seen in the stories about Goldberger, Reed, and Trudeau.
Experiments on both laboratory animals and human subjects (including deaths in
both groups) were presented in frank detail (Hansen 2004a, 2009: 183–190 and
199–200) (See Fig. 4).
ction Graphics at Work: Images That Lead the Text Rather

A
Than Following It
To understand how these picture stories pressed their images deep into readers’
minds and hearts, one needs to appreciate the visual rhetoric of comic strips, the
means by which they turn the medium’s constraints into opportunities and bring the
stories to life. The approach taken by comic artists and editors differs from those in
other media. Highlighting four feature of comics’ visual rhetoric, we may first
observe that in books, magazines, and print advertising, the images are almost
always subordinate to the text and they serve only to illustrate it. Meaning is carried
Fig. 5 ‘How is the child,’ first three frames in ‘Louis Pasteur: Germ Tamer,’ a four-frame episode
of the True Comics newspaper strip, ca. 1941. Original, undated, and unsigned ink drawing by Sam
Glankoff on Strathmore board, approximately 4 by 20 in., marked up for the printer in blue pencil.
The Ohio State University Billy Ireland Cartoon Library and Museum (donated by Bert Hansen
in 2013)
in the verbal structure and the illustrations are used only to catch our attention, add
emotional resonance, or show things also described in the words. For example, one
might be given a picture of a person’s face where the text mentions the person’s
name. Someone reading of a young scientist studying hard may be offered a picture
of a boy peering into a microscope. In most print media, the visuals rarely carry the
narrative. Comic art reverses the relationship. In other ways, too, it turns the limita-
tions of the medium into stylistic virtues. As shown below, those comics that subor-
dinate picture to text often look flat and boring. An important artist and critic, Will
Eisner, made the distinction this way: ‘a visual replaces text; an illustration simply
repeats or amplifies, decorates, or sets a climate for mood’ (Eisner 1985: 128).
When the story in comics is carried by the images, not the words, the panels use a
relatively small number of sentences. Expository sentences are avoided as much as
possible, replaced with dialogue in word bubbles (too much narrative text weakens
comic art).
Secondly, most comic art uses highly stylized and exaggerated figure drawing,
often turning some facial features into caricatures and enlarging the figures to an
outsized presence in their setting and in the frame (sometimes even breaking the
frame lines). Both these virtues are illustrated in three frames of a story about Louis
Pasteur by Sam Glankoff (See Fig. 5).
Third, any single frame, no matter how elaborate and exciting, is intentionally
left incomplete in a narrative sense in order to raise questions in a reader’s mind,
prompting uncertainty and curiosity, both of which heighten engagement. This
approach is especially important for the initial frame, or ‘splash panel,’ that opens a
story. Figure 3 (above) offers an example from one of the Walter Reed stories. We
do not know whose arm, what insect, why, or what will happen now. But as readers
we are likely to react by drawing our arms in closer as if to get away from the biting
insect; we might also hear in our head the buzzing of a mosquito. While the drawing
is just a drawing, we do not view it as an object. We spontaneously start to imagine
186 B. Hansen
Fig. 6 Rudy Palais, ‘Ah! A stray mosquito,’ two frames in ‘Walter Reed,’ Science Comics 2
(March 1946), 29 (© 1946 Humor Publications Inc.)
possible narratives, and the situation becomes ‘real’ to us mentally even though it is
just a cheaply reproduced line drawing in an exaggerated style (See Fig. 6).
Fourth, the interruptions or gaps in the narrative caused by shifting from one
frame to the next—unlike the smoother flow of film, drama, radio, literature, and
didactic prose—strengthen a reader’s engagement by making the reader imagine for
him- or herself what took place in the temporal and spatial interval between the
frames. A story in sixty panels can have as many as fifty-nine gaps in the narrative.
But those gaps, hinting at action that happens ‘in the gutter’ between frames, actu-
ally make comics particularly engaging because they force each reader to partici-
pate in imagining the story. Unlike film, which conveys predetermined auditory and
visual stimuli at every moment, sequential comic art forces the reader to picture the
activity in between the boxed panels and to mentally create the sounds. By their
nature, comics ‘jump’ discontinuously, for example, from a knife in a moving hand
to a person lying bloody on the floor in the next panel. Silently the reader creates a
picture of the stabbing and sometimes even its sound. Radio drama likewise, by
virtue of the pictorial dimension it lacks, forces a listener to create mentally the
complete visual scene of characters, setting, and lighting. This forced participation
is what makes radio drama, audio broadcasts of sports events, and comic books
particularly absorbing activities (Reitberger and Fuchs 1972; Harvey 1979; Eisner
1985; Witek 1989; McCloud 1994; Carrier 2000).
How this highly syncopated form of story-telling prompts a viewer to fill the
missing intervals is seen clearly in two consecutive panels from a story about peni-
cillin. They show a point in the narrative when penicillin was still highly experimen-
tal, of limited availability, not yet widely known, and used almost exclusively for
military patients. (See Fig. 7) We see only policemen cartooned with the conven-
tional motion lines, a few reporters, and a physician. The patient is conspicuously
absent, but the two frames with their three small speech balloons effectively tell her
story, drawing readers into picturing a definite series of actions taking place in sev-
eral locales over a number of hours. It was such structural features that made comics
so attractive, impressing the stories and characters deeply into children’s imagina-
tion and memory.
Fig. 7 ‘The precious drug,’ two frames in ‘Penicillin,’ True Comics 41 (December 1944), 22 (©
1944 True Comics, Inc.)
hat the Comic Books of the 1930s Owed to the New

W
Photojournalism of the 1920s
All four of the most significant strengths of action graphics that came to the fore in
comic books in the late 1930 and early 1940s (images that lead instead of following;
un-naturalistic scale, viewpoint, or lighting; puzzling single images; and images in
series for which viewers help imagine parts to fill out the story) had been central to
photojournalism starting in the 1920s. Photojournalism was an entirely new
approach for magazine editors, something much more than just increasing the num-
ber of photographs. The techniques of photojournalism, a paradigm shift in the visu-
alization of stories, were pioneered first in France and Germany starting in the
1920s. Smaller and more portable cameras and the new flashbulbs gave photogra-
phers a new flexibility to take more interesting shots. Additionally, editors learned
that they could replace the traditional photographs that supported a verbal account
(as woodcut illustrations had been doing for quite a while), they could string together
a series of photographs and use them to carry the story. Even a single photograph,
when carefully crafted with this goal in mind, could either tell a whole story or
prompt the viewer’s curiosity (Fulton 1988; Lacayo and Russell 1995; Carlebach
1997; Bair 2015; Zervigón 2015).
Both genres (when doing their best work) relied on striking single images that
didn’t answer questions but asked them, forcing readers to wonder: What is going
on? What is the meaning of this juxtaposition or unexpected scene? Both genres
demoted the text from its leading role in telling the story to a subordinate role, in
which the pictures carried the story. Captions merely added supplementary informa-
tion or answered questions posed in the reader’s mind by the main images. Both
media could use the gaps between images to force reader engagement. And both
used extreme close-ups, unusual viewpoints like a bird’s-eye view or a worm’s-eye
view, or unnatural poses to fill the frame. Photography could not do caricature with
188 B. Hansen
the success that line drawing could, but creative camera angles, lighting, and choice
of subjects could produce single images that made equally strong impressions
(Hansen 2009: 207–255). Although these points were explored at length in my book
using examples from the American magazine Life (1936–1972), they may be illus-
trated here with two examples from a similar European publication, the Berliner
Illustrirte Zeitung or BIZ (founded in 1890, but transformed in 1929 by introduction
of the photoessay).
Consider this cover photograph from the issue for 23 January 1936 with a large
number of boys in a single palm tree. (See Fig. 8) The components are not novel, but
the scale is striking—and puzzling. This single image illustrates two particular tech-
niques. Unusual arrangement of people grabs attention, and, while causing us to
wonder what is going on here, the odd situation also makes us smile. And, of course,
smiling readers are more receptive to a story and its message.
A revealing contrast of the old and the new approaches is visible in a single photo
spread appearing in that same issue. The article is about efforts to save low-birth-
weight babies (23 Jan 1936, pp. 124–125) (See Fig. 9). Note first that more space is
given to images than to text on these pages. And in this interesting example, we can
observe both an old-style layout on the left and a new one on the right. On the left,
several of the photographs are too small and have too much detail to draw us in or
to make us curious about what is happening in them. The images on the left are there
only to support a story that is carried within the text. On the right-hand page, we see
the newer approach: large, clear, engaging images pulling readers into a story that
readers create for themselves from inside the pictures. In these four photos you can
actually read a narrative, ending up with the attractive little girl whose smile con-
veys the success of the new treatments.
Illustration Mode: Where the Art Is Subordinated to the Text
At their best, comic book editors and artists—just like their counterparts in photo-
journalism—produced striking images that engaged the reader and carried the story
with only minimal help from any text. But not surprisingly, the true-adventure com-
ics genre, like any art form, was not always vigorous and memorable, and it often
became too dependent on the words. Even the pictures became prosaic. Perhaps
because the subject was ‘true,’ ‘real,’ or ‘factual,’ a fully naturalistic style of ‘illus-
tration’ was always tempting.
For example in the panels opening a chapter about Robert Koch in a story pub-
lished in 1947, we can easily observe that the narrative is being carried in the words,
that almost no action is portrayed, that there are no odd viewpoints or e xaggerations,
and that even what appears to be dialogue is really exposition, not interaction (See
Fig. 10a). Such weaknesses are even more evident in a page in a later book (See
Fig. 10b). These graphics pale in comparison to the examples of lively artwork in
other figures above.
Fig. 8 Cover, Berliner Illustrirte Zeitung, 23 January 1936 (courtesy of Hochschul- und
Landesbibliothek Fulda)
Fig. 9 ‘Säuglinge, die bei der Geburt unter 2500 Gr. wogen,’ Berliner Illustrirte Zeitung, 23
January 1936, pp. 124–125 (courtesy of Hochschul- und Landesbibliothek Fulda)
Fig. 10 (a) ‘Modern Medical Magic,’ Picture Stories from Science 2 (Summer 1947), 34. (b) ‘The
Germ Fighters,’ World Around Us 36 (Oct 1961), 24
Notice how the more realistic images sometimes add clutter to the panel, making
it less eye-catching. They unavoidably reduce the size of the scientist’s figure and
thus weaken any drama his pose might be able to suggest. In ‘illustration mode,’
descriptive text is expanded, dialogue is reduced or turned into spoken explanations
rather than being conveyed through conversation among the characters. Notice how
much more text is included in these panels than in other examples illustrated here.
It seems possible that those comic books that chose to show a less caricatured
and more realistic portrait of Louis Pasteur, Robert Koch, or Ignaz Semmelweis (as
in Fig. 10b) intended readers to recognize them as the same men portrayed in other
books or on posters, statuary, postage stamps, or currency. This might have seemed
a worthy goal since traditional formal portraits have long conveyed honour, dignity,
and celebrity, something that action scenes do not do so well. Interestingly, the his-
tory of European painting and sculpture reveals a similar contrast between the for-
mal, studio portraits that suppress a realistic setting and the milieu portraits with the
practitioner shown at his work.
Until the late nineteenth century, contemporary individuals could be shown only
in formal portraits, not in action scenes, although, of course, long-dead figures of
very high status like kings and generals might be portrayed in action in the genre of
history painting. But coronations and battle scenes did not include physicians or
men that we might think of as scientists, like astronomers, natural philosophers, or
alchemists. Sometimes these figures did make an appearance, as in numerous paint-
ings from the seventeenth century to the nineteenth of alchemists in their laborato-
ries or of doctors at work, applying a bandage for example. These were, however,
never portraits of known personages; they were merely ‘genre scenes,’ story paint-
ings showing anonymous practitioners, ‘generic’ images of ‘the doctor’ or ‘the
alchemist,’ not of any particular individual. Only in the 1880s and in France did
painters begin to challenge this long-standing tradition of not portraying individual
contemporary doctors in action. As we have argued elsewhere, by showing indi-
vidual physicians and scientists in action scenes, these innovators and those who
followed them created a precedent for ways that scientists would be portrayed both
in photojournalism and in comic book art (Weisberg and Hansen 2015).
The gradual disappearance of the true-adventure genre of comics was part of a
general decline in the comic book industry. The late 1940s saw the end not simply of
the huge sales numbers and of the quality of the books, but also the end of youth
culture’s universal passion for comics and the end of comics’ commanding place in
the culture at large. The prominence and centrality that comic books had achieved in
mass culture beginning in the late 1930s faded as a result of political attacks and the
rise of television. Their dominance was challenged first by an anti-comics c rusade
that included book-burnings in school-yard bonfires in the summer of 1948 and then
by the fierce attacks of the psychologist Fredric Wertham culminating in his 1954
book, Seduction of the Innocent (Goulart 2000). Even the United States Congress
held public hearings on the dangers of comic books. The industry was seriously hurt,
and it established self-censorship with an industry code of approval (Nyberg 1998).
In the 1950s the rise of television deeply undercut the commanding position of comic
books in young people’s entertainment (Hansen 2009: 177–178).
192 B. Hansen
Fig. 11 (a) Robert Koch cover of Vidas Ilustres 79 (August 1, 1962). (b) Ameghino Torricelli
cover of Vidas Ilustres 89 (June 1, 1963)
Even before the true-adventure genre disappeared, the innovative action art of its
first years had largely been displaced by routine illustration art, as explained above.
Interestingly, it is the illustration style that was used in many of the very popular
Spanish language comics that began to appear in the mid-1950s. These comic books
were published in Mexico, but were read throughout Latin America, and even in
Spain (Hansen and Adler 2012) (See Fig. 11a, b).
The long-lived biographical series Vidas Ilustres, with each 32-page book
devoted to a single figure, was inaugurated in February 1956 with a life of Guglielmo
Marconi. Soon books about Louis Pasteur (May 1956) and Robert Koch (August
1962) made their entry, and over time many other doctors and scientists appeared in
the series. Boaz N. Adler discovered 78 books in this publication that each featured
a hero of science, engineering, social science, or medicine between 1956 and 1973
(Adler 2012). In its later years, Vidas Ilustres often reprinted one of its earlier stories
with a new cover image. Like their American precedents, these books had bold
cover art, with bright colours in the style of circus posters. Yet on the inside, the
artwork was often far more prosaic. The style was generally the overly naturalistic
illustration mode with more narrative than dialogue (see Fig. 12a) although the art-
work sometimes offered close-ups or less background clutter (see Fig. 12b).
Fig. 12 (a) Page in ‘Louis Pasteur: Benefactor de la Humanidad,’ Vidas Ilustres 4 (May 1, 1956),
p. 21. (b) Page in ‘Koch: El Vencedor de la Tuberculosis,’ Vidas Ilustres 79 (1 August 1962), p. 22
Concluding Observations
History offers no simple lessons or general techniques that can be transferred from
one era to another. Nevertheless, our brief look at action graphics from the early
1940s might suggests two heuristic strategies for consideration by teachers and edu-
cators, who often feel driven to ‘cover’ their material and to ‘illustrate’ it. First,
sometimes less really is more. The images above show how presentations that are
less dense and less comprehensive can creatively use gaps to stimulate students’
imagination. Second, these mid-century comic books remind us that, in whatever
mode we are working (lecturing, leading discussion, assembling images, or creating
images), it is wise to analyse and then to consciously exploit each genre’s unique
strengths rather than to assume all kinds of pictures are equally effective in transmit-
ting ideas.
Acknowledgements The author extends sincere thanks to the organizers and the participants of
the conference ‘Medical Images and Medical Narratives in Late Modern Popular Culture’ at the
University of Ulm (11 and 12 September 2014) for their gracious responses to the version of this
paper delivered there. Additional appreciation is extended to Dr. Jeffrey M. Peck, formerly Dean
of the Weissman School of Arts and Sciences at Baruch College (currently Director Europe for
194 B. Hansen
AKA / Strategy), for sustained funding of my historical research. All the comic books illustrated
or discussed in this chapter were in the author’s collection and are now publicly accessible to
researchers as part of the Bert Hansen Collection of Medicine and Public Health in Popular
Graphic Art at the Historical Library of the Harvey Cushing/John Hay Whitney Medical Library of
Yale University.
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Bloomsbury.
Medical Narratives in the South African
Novel: Case Study of Chris Karsten’s
Trilogy The Skin Collector (2012), The
Skinner’s Revenge (2013) and Face-Off
(2014)
Karen Ferreira-Meyers
Introduction
The African crime novel, an emerging literary genre, is often mirrored on a Western
method of writing. The topos of the city, drug-use related crimes, human trafficking
and urbanisation are ubiquitous in various sub-genres of detective and crime fiction,
including political, medical and legal thrillers. In his 2012 crime novel The Skin
Collector, Chris Karsten, a South African author, uses a plethora of scriptural tools
in addition to a less common and perhaps more “African” tool, the art of masks. The
main protagonist, Abel Lotz, a criminal and murderer, collects and processes the
skins of small animals to trade for authentic African masks and sells them in his
Capetonian art gallery. As a fiftieth birthday project, Lotz wants to forge a new face
for himself based on the art of African masks. In the second and third installments
of the trilogy, Lotz is back to continue collecting skins that have forms and shapes,
which, according to him, refer to certain constellations with astronomical signifi-
cance and which he wants to use as decoration for the cover page of his book enti-
tled Cosmic Travels. In the sequel, The Skinner’s Revenge (Karsten 2013), detective
Ella Neser, who discovered and almost brought Abel Lotz to justice in the first part
of the trilogy, is on compulsory sick leave after a close encounter with his scalpel.
Between therapy sessions and harp lessons, she ponders over the photographs of
Abel’s four victims, intent on apprehending him before the next kill. When a bur-
glary results in the death of one of the victims, Ella returns to duty to catch the
culprit(s), which could be Abel Lotz or a new killer. In the third and final part of the
K. Ferreira-Meyers (*)
University of Swaziland, Kwaluseni, Swaziland/eSwatini
University of Johannesburg, Johannesburg, South Africa

https://doi.org/10.1007/978-3-319-90677-5_15
196 K. Ferreira-Meyers
trilogy, Face-Off (Karsten 2014),1 Abel Lotz visits his friend and mentor, Ignaz
Bouts, in Bruges. Soon he is on the prowl again for skins with tattoos for Cosmic
Travels, now with Ignaz’s help. Detective Ella Neser finds his tracks and wants to
pursue him, but at the same time needs to solve the murder of a corrupt official
(suspected of supplying South African documents to Muslim militants) from Home
Affairs, found frozen and naked with his throat cut.
In this article, I have analyzed the use of medical narratives in South African
crime novels (and medical thrillers) with particular focus on Chris Karsten’s trilogy
(The Skin Collector, The Skinner’s Revenge and Face-Off). What does medical
knowledge add to crime novels? Does it establish some form of equilibrium between
rational science and the murderer’s irrational mind and behaviour? Can the reader
remain ‘safe’ from the novel’s reality if perceived rational scientific knowledge
forms the counterpart of Lotz’s ‘madness’? While the detective’s goal in most crime
novels is to explain an event (a murder) that seems inexplicable to the reader at first,
Karsten inverses this dynamic by making Lotz—a crazy, irrational individual—the
character with the most accurate and highly developed medical knowledge. In this
way, the reader remains interested, invested and captured by the narrative until the
last page.
The close relationship between detective and medical fiction has been described
extensively, since both concern an unknown predator attacking “normal” individu-
als and being defeated by the hero, detective or doctor. However, to date, limited
research has focused on medical narratives in the South African crime novel. It can
also be argued that the detective story is quintessentially a disability case study and
“detective work” has long been a metaphor for clinical acumen. Clinical reasoning
and the detective fiction genre show many similarities in terms of cultural back-
ground and context. Both try to restore a status quo that has been undermined by a
crime or disease. During their golden age, the two disciplines thrived on a climate
of faith in the apparently unlimited capabilities of science and based their methods
on deterministic interpretation of clues, signs, and symptoms. Detectives and clini-
cians reach a final, reasoned “diagnosis” by decoding signs (clues) that are often
meaningless or disconcerting to the layman. Clinical analogies with detective fic-
tion generally revolve around Sherlock Holmes. However, like medicine, detective
fiction has subspecialties and intellectual trends. In crime fiction, anatomy, medical
narrative and bodies become the sites of alternative readings and competing dis-
courses. As Jonathan Sawday (Sawday 1996) suggests, “the role of those involved
in dissection and anatomisation has always been a complex and contradictory one”.
‘Dissection’ does not simply suggest an act of delicately separating the body’s
structures but can also refer to a violent act of partition, brutal reduction or dismem-
berment. ‘Anatomy’ similarly has destructive associations. In the literature, both
terms are associated with the methods of the satirist and contain “a constant poten-
tial for violence” (Sawday quoted by K. and L. Horsley). Scenes of anatomy and
1
The trilogy was first published in Afrikaans (Abel se ontwaking (2010), Abel se lot (2011) and
Die afreis van Abel Lotz (2012)) and subsequently translated into English and published by Human
& Rousseau in South Africa.
Medical Narratives in the South African Novel: Case Study of Chris Karsten’s Trilogy… 197
autopsy involve the surgeon transgressively examining the body, and (violation of)
a dead body is surrounded by an aura of taboo and prohibition.
The role of science in today’s international crime fiction scene is increasingly
important. One of the best examples is the forensic science genre written by authors
such as Patricia Cornwell, Jefferson Bass and Kathy Reichs. On an international
level, it is commonplace for crime fiction writers to have a scientific background.
For example, Reichs is also a successful forensic anthropologist.
Crime Fiction in Africa, in Particular, South(ern) Africa
Crime fiction retains an intermediate position in consumer literature today but is

less undervalued than other genres to some extent. This may be because the style
and content of writing appears relatively “masculine” and more serious than other
genres on the one hand, as Reuter (2007: 97) contends, while on the other hand, it
parodies the novel in general, or perhaps even because it maintains and works to
undermine traditional literary objects, such as the hero, intrigue, realism or the end
of the story. Within this intermediate position, the crime novel is probably one of the
most diverse genres that can be sub-divided into serial killer thriller, hard- and soft-
boiled private eye, noir, caper novels, scientific detective, medical detective, histori-
cal detective, psychological thriller, techno thriller, legal thriller, classical whodunit,
police procedurals, courtroom dramas, women in peril, and other categories.
In African literature, crime fiction is a very new (para)literary2 phenomenon.
Critics contend that the first Anglophone and Francophone detective novels were
published in the 1970s, while the reader had to wait for the start of the third millen-
nium [until to 2000s] for the first publication of Lusophone crime fiction. Detective
stories and crime novels have long had a negative connotation in Africa. Fanny
Brasleret (2007: 10) gives two potential reasons: on the one hand crime fiction was
considered sub-literature in Francophone countries and on the other it as seen as
bourgeois entertainment for the African intelligentsia. Nevertheless, their emer-
gence and popularity are now established, as noted by Ambroise Kom in “Littérature
africaine, l’avènement du polar” (1999: 36).
Crime fiction in South Africa by authors such as Jassy Mackenzie, Margie
Orford, Wessel Ebersohn, Diale Tlholwe, Rob Marsh, Angela Makholwa, David
Dison, Andrew Gray, and Lauren Beukes3 emerged swiftly in the marketplace at the
start of the new constitutional democracy in 1994 (although the first crime novels
were written a few decades earlier). Besides changes in the “gendered ordering of
society” (in reference to Michael Kimmel’s 2000 title The Gendered Society) and
the slow abolition of former colonial and apartheid patriarchy, gesturing towards an
2
Initially perceived as paraliterature, crime fiction is slowly becoming an accepted literary genre
(e.g., Mouralis 1975).
3
This list is an indication that mainly white South African crime novel authors have specialised in
this genre and achieved local and international readership and reputations.
outside world of criminal affiliations involving the import and export of illegal
goods, foreign travels and the evolving tourist industry in literature has drawn
attention to Johannesburg, Cape Town and Durban as very masculine and hetero-
sexual cities of substance and modernity, which reflect the petty dream world of the
aspiring criminal. Authors such as Michael Titlestad and Ashlee Polatinsky (2010)
have argued that crime writing often reduces the complex questions regarding his-
torical truth to generic devices and conveys a type of resignation to routine criminal-
ity and corruption.
In general, South African crime novels are not particularly explicit in terms of
medical narratives. Further analysis of the elements of witchcraft and ritualistic
“medical” accounts and portrayal or classification of doctors and medical staff in
contemporary South African crime novels is warranted, but has not been attempted
in this article.
The Skin Collector, The Skinner’s Revenge and Face-Off
Former journalist and prize-winning author, Chris Karsten, has written books for
children, crime stories,4 and a biography of Charlize Theron.5 Karsten’s trilogy
about Abel Lotz is a mixture of two ‘traditional’ crime fiction subgenres, namely the
police procedural and the medical thriller. In the common police procedural, the
reader is brought into squad rooms, morgues, courts, and crime scenes, and the
detective is generally put under a lot of pressure. For example, s/he could be dealing
with many cases, has personal problems with relationships, and is under duress to
solve the case by her/his superiors. The medical thriller, as written by Robin Cooke,
Michael Crichton or Tess Gerritsen, is a suspense novel that generally takes place in
a hospital. The protagonists are usually doctors or nurses and the plot is based on
situations unique to medicine and medical research. In Karsten’s novels, both sub-
genres co-exist in the narrative construction. Abel Lotz, the male criminal protago-
nist, harvests and treats the skins of small animals, which he trades for authentic
African and South American masks and tsantsas.6 An extraordinary plan for his
fiftieth birthday is the procurement of a new face for special occasions: “he craved
the perfect face of a young woman” (Karsten 2012: 8). Detective Ella Neser’s first
murder case is thus a young woman with a piece of skin missing from her
shoulder.
In the first book of the trilogy, Karsten uses masks to convey a message. While in
general, masks are considered inert objects, such as those displayed in museums
4
In Headline Murders and Unsolved (Human & Rousseau), Chris Karsten goes beyond the head-
lines, giving us an opportunity to become intimately involved with some of South Africa’s most
notorious and heinous crimes and criminals.
5
Killer Women-Fatal South African Females.
6
According to the online Collins Dictionary, a tsantsa is “(among the Shuar subgroup of the Jivaro
people of Ecuador) the shrunken head of an enemy kept as a trophy”.
like pinned butterflies in glass cases, this is not the case in Karsten’s book. In an
African context, masks are alive and part of a whole, a costume and headdress worn
by a lively and energetic man who speaks, dances and performs astonishing acro-
batic movements. The wearer is surrounded by his interpreter, singers, musicians
and others performing in front of a big audience in a magical and extraordinary
ambience of mysticism and trance. This is a different scenario from The Skin
Collector, where the masks are displayed for sale on shelves and in glass cases in a
shop, and not shown in their full glory during a performance or ritual. In African
societies, masks are also instruments of social harmony,7 in contrast to Karsten’s
manipulation of the mask to herald disharmony, murder and mayhem. Mia
Vermooten, Abel Lotz’s first victim, is attracted to him and brought to his house
through her interest in the masks. Abel Lotz sets out to murder because he wants a
female mask to hide his own destructive identity.
In the first novel, the use of medical language and narratives is limited. The
pathologist, Dr. Koster, uses medical knowledge to describe post-mortem details,
but the language is predictable, for instance, “obstruction of the airways and neck
arteries cut off the flow of oxygen and blood to the brain and cerebral hypoxia set
in. Petechial bleeding is evident in the eyes” (Karsten 2012: 53). This narrative is
typical of forensic pathologists performing an autopsy (characteristic of television
series such as Bones). For instance, a technical description of the process by which
Abel Lotz prepares for the skinning of his victims is included as follows: “the pro-
cess of separating the entire scalp, face intact, from the skull, lasts fifteen minutes.
It is done by making incisions on either side just below the ears, cutting backward
towards the base of the neck. The loose flap of skin at the back is then pulled up by
the hair to the crown of the head, enabling the blade to separate the cartilaginous
tissue of the nose and ears from the skull, while the skin is peeled from the face. The
eyes are removed and the skull is discarded”. This account obviously corresponds to
that of ritual skinning found in the communities of Red Indians and some African
tribes.
Further “medical” knowledge in the novel is related to illnesses and diseases
typically experienced by older people. Abel’s world is filled with older people, first
and foremost, his mother. His first victim, Mia’s mother, has “croup in the chest,
arthritis in the hip, and a corn on the cushion of the big toe” (Karsten 2012: 24).
Medical tools are also described at length. For example, Abel neatly displays “pinc-
ettes, surgical needles, scalpels with blades of various sizes and grades, a butcher’s
knife of solid steel, used for cutting through cartilage” […]. Scissors of different
shapes and sizes were used to cut thinner bone, muscle, and sinew (2012: 26–27).
In a similar vein, the reader encounters “scalpels, […], Glover needles, a probe,
brain-and-eye hook, spoon tools, surgical tongs, and tweezers” (Kasrten 2014: 170).
The second book in the trilogy narrates the story of Ella Neser, who is on com-
pulsory sick leave after a close encounter with Abel Lotz’s scalpel. Between therapy
sessions and harp lessons, she ponders over the photographs of Abel’s four victims,
For example, Masks and Masking: Faces of Tradition and Belief Worldwide by Edson, Gary;
7
McFarland & Company, 2005.

intent on apprehending him before his next kill. The majority of secondary charac-
ters in The Skinners Revenge are doctors, including medical doctors (Dr. Buzuk in
Sarajevo), forensic pathologists (Dr. Koster in Johannesburg), cosmetic surgeons
(Dr. Lippens in Bujumbura), trauma doctors (Karsten 2013: 83), professors in
forensic psychiatry, consulting experts on psychopathology (Dr. Papendorf), clini-
cal psychologists and trauma counsellors (Dr. Landberg in Johannesburg). Others
are ethologists and psychologists of world renown who have studied people with
“babyfaces” (the face Abel Lotz is anxious to get rid of, even though “his face was
sacred to him – more private than any other part of his body” (Karsten 2013: 58)).
The narrative states: “men with baby faces overcompensated for their shortcomings,
that they were usually more argumentative and aggressive, and, like Al Capone,
more inclined to criminal behaviour” (Karsten 2013: 63).
In Face-Off, Ella begins to understand what Abel’s “sick mind” (Karsten 2014:
43) might have in store for his victims when she learns about the young countess
who had a piece of skin surgically removed from her shoulder; Abel sends the skin
to Flammarion, a French editor, for use as a book cover. Even though he never calls
himself an expert on medical procedures, Abel continues to read and learn about
mummifying and embalming techniques and is fully informed of different types of
disinfectants and medication to break up blood clots in the bloodstream (Karsten
2014: 164–165).
As expected, the traumatised body, one of the recurring topics in twentieth-
century literature, is highly prevalent in crime fiction. In the 1990s in particular,
physical wounding and psychological trauma have become important cultural pre-
occupations, and the ‘cult of abjection’, together with a certain ‘wound culture’, are
the defining features of contemporary artistic and literary theory (e.g. in Creed
1993). Anxiety about invasive disease and death, particularly the AIDS crisis, reces-
sion, systemic poverty and rapid technological advances alongside violent crime
have also played a part in Southern African crime fiction: “the articulation of these
different forces is difficult, yet together they drive the contemporary concern with
trauma and abjection” (Foster 1996: 166). Foster argues that there has been a ten-
dency to redefine both individual and historical experience of trauma and see ‘the
real’ as ‘a thing of trauma’.8 Foster’s concept of abjection as a central theory has
also been apparent in literary studies based on the ideas of Julia Kristeva in Powers
of Horror: An Essay on Abjection (Kristeva 1982). The relevance of such ideas to
crime fiction of any period is apparent, given that most crime novels are likely to
involve violation of boundaries, threats to established structures of meaning and the
centrality of the corpse –the corpse given over to being seen as a more object among
the clear images of abjection (Foster 1996: 149).9 The extreme conditions in scenes
8
Amongst the ‘abject art’ discussed by Foster are the works of Cindy Sherman, Kiki Smith, Robert
Gober, John Miller and Mike Kelley and an exhibition ‘Abject Art: Repulsion and Desire in
American Art’ at the Whitney Museum in 1993. Foster (Foster 1996: 152) highlights that on sev-
eral fronts in contemporary art, a battle has been waged to evoke ‘the real’.
9
Other ‘abject materials’ the taboo-violating artist can incorporate include dirt, dead animals, rot-
ting food and bodily wastes, such as blood, vomit and excrement.
with dead bodies or damaged body parts are the sine qua non of the murder story. In
classic detective fiction, the body can, of course, be sanitised, ‘sacrificial’, possessing
a reassuring corporeal integrity that is ‘a talisman against death’s fragmentation and
dissolution’, but the scenes of late twentieth-century crime fiction are more likely to
be strewn with ‘semiotic’ bodies, that are fragmented, grotesque, and gruesome.
The body is represented as the ‘uncontainable excess’ of the abject, turned inside
out. In Karsten’s case, skin is an element that needs to be excised from one person
and used to complete another. Physical violation images the fragility of all our
boundaries, and this breaking down of borders (the body, law, and social order) is
part of the intrinsic structure of Karsten’s crime novels. The crime fiction subgenre
that most obviously reflects late twentieth-century ‘trauma culture’ is the serial
killer novel,10 which opens to the reader’s gaze the wounded psyche of the killer
whose aberrations are expressed in the wounds he inflicts on others. In the most
common form of the narrative, the reader’s attention is primarily fixed on the hor-
rifyingly exposed mind of a killer who ‘redistributes’ his own pain by refashioning
the bodies of his victims in the image of his own psychic wounds or (in narrative
terms) makes the body of his victim speak the language of his own psychosis. More
commonly, the serial killer narrative is either wholly investigative in structure or set
up as a dual account: on the one hand, the script of the serial killer himself, with its
larger-than-life elements of gothic romance, and on the other, the script of the pro-
filer, a explicatory ‘fact’ set against the killer’s own fantasies, which is often a fairly
reductive script in which childhood abuse and neglect are almost always the sole
explanations for the actions of the adult killer. This is the case in both The Skin
Collector and The Skinner’s Revenge, where Abel Lotz, the adult with the baby face,
is the result of his mother and grandmother’s excessive conservative and domineer-
ing behaviour,11 even though according to Ella Neser “Abel Lotz’s tortured soul
remained a mystery” (Karsten 2012: 19). Abel’s mother constantly warned him
about “the wantonness of the flesh” (Karsten 2012: 88), sinners, alcoholics, and sex-
craved human beings, “their bodies mutilated with tattoos and trimmings” (Karsten
2012: 88). The first novel highlights “as was customary in all big decisions, her
[Abel’s mother] blessing was required (Karsten 2012: 8). Sex was evil, she had
taught him, drummed into his head” (Karsten 2012: 30). In the second instalment of
the trilogy, his reaction has changed, based on a strong wish to alter his physical
appearance, and counteracts his mother’s warnings. He wants to become a skilled
surgeon able to harvest human skin for use as parchment in his encyclopaedic atlas
entitled Cosmic Travels. It has to be noted that “Abel did not think of himself as a
killer. He was a cosmic traveller” (Karsten 2013: 94). He wants to mirror human
10
Novels in the serial killer subgenre have proliferated in many language domains since the late
1970s and early 1980s.
11
Part III of The Skinner’s Revenge starts with a quote from Momo Kapor’s The Provincial:
“Nobody can be as vicious as an angry child, deeply convinced of the justification of his hatred…
One cannot expect mercy from a boy (…) who has tried to survive evil as best he could” (Karsten
2013: 224). This quote may refer both to Abel Lotz and Milo Boonstra (who saw his father being
shot to death, his mother’s demise after she was raped, and his sister being disfigured and unable
to have children, also after a vicious rape in Sarajevo in 1991).
skin on celestial bodies, like stars and constellations, and use it as a replacement for
his own facial skin (“I am not looking for a replica of my own face. I actually want
a different face” (Karsten 2013: 60)), as this reminds him too much of his depen-
dent, “baby-like” condition, and compares surgery to art (“Artists follow the same
method. Portrait artists and sculptors all work with models” [2013: 60]). While
undergoing a skin examination by Dr. Lippens, Abel goes on to compare himself to
a surgeon: “[Abel] stiffened, but allowed the surgeon to go ahead. After all, this was
how he examined his donors’ skins on his own operating table” (Karsten 2013: 61).
Profilers of real-life serial killers like Ressler and Shachtman argue that the ‘typi-
cal’ motivational structure of the serial killer is founded on two basic themes, spe-
cifically, “the dominance of a fantasy life and a history of personal abuse” (Simpson
2000: 128). Within the serial killer novel, this received wisdom corresponds to the
gothic tendency to obscure the boundary between ‘fact’ and ‘fiction’. The implied
duality endorses the concept of the killer as a hybrid (part damaged human being,
part monster), the latter a descendant of supernatural and vampiric characters of
gothic fiction, and sometimes constructing his self-image around a romantic linkage
of criminal acts with art and divinity. In Karsten’s crime novels, the vampiric char-
acter is not implied: “There had been only four victims. And he wasn’t the most
sadistic either. No limbs or sexual organs had been harvested for muti,12 the victims
had not been tortured to express anger and frustration, none of the perverse sexual
acts that typified such killings” (Karsten 2013: 19). However, Abel’s “lazy eye” can
be seen as part of the monster-like characteristics of this serial killer (“The eye had
its own rhythm, out of sync with its partner (…)). “The deterioration of the eye’s
elevator and orbicular muscles is a congenital defect,” states the doctor. “It’s not
ptosis, which could have been surgically rectified” (Karsten 2013: 58). On the other
hand, as indicated earlier, Lotz “The Nightstalker” (Karsten 2013: 19) or “Satan”
(Karsten 2013: 319) sees surgery as art, and his link to divinity is apparent in his
action of scrutinizing the sky at night for stars and constellations while listening to
Paganini. Nevertheless, Ella Neser compares Abel Lotz to some well-known serial
killers such as Ted Bundy and Edmund Kemper (Karsten 2013: 108–109). The
author quotes from Bundy’s final interview with psychologist James Dobson on
January 24, 1989, the night before his execution: “I was a normal person. I had good
friends (…). I led a normal life, except for this one, small but very potent and
destructive segment that I kept very secret and close to myself” (Karsten 2013: 109).
The reader is made aware of Lotz’s extensive medical knowledge in various para-
graphs of both novels. For example, scenes where he is about to have his face cos-
metically changed to “become” Dr. Lippens and therefore escape police radar read
“The patient [Abel] nodded and agreed to an endoscopic mini rhytidectomy, with
rhinoplasty, mentoplasty and otoplasty. He declined the blepharoplasty, opting for
amber-tinted spectacles instead” (Karsten 2013: 63). Lotz is informed about medi-
cation too, as evident from the time during recovery from surgery and subsequent
infection when he asks the nurse for Chamberlain’s cough syrup and recites the
ingredients (liquorice, ipecac extract, sodium benzoate preservative) and specifies
12
Muti refers to traditional herbal medicine.
“Ipecac”. His mother had given his father and brother Ipecac syrup on the night they
had “suddenly and simultaneously fallen ill”13 (Karsten 2013: 68).14 Another exam-
ple of Lotz’s medical acumen is the statement: “when his donors of virgin parch-
ment regained consciousness, they had no side-effects from the injections” (Karsten
2013: 368), since he also “knew the half-life of every dosage” (Karsten 2013: 370).
Lotz has perfected his surgical skills15 and makes mistakes only when under pres-
sure (i.e., when about to escape from the police): “The doctors had feared the onset
of sepsis where Abel had cut into her stomach with an unsterilised blade” (Karsten
2013: 22), which had resulted in “purple welts, the mutilated, puckered skin of her
stomach” (Karsten 2013: 39). He also behaves like a doctor when he takes on Dr.
Lippens’ profession and personality after his “weekend facelift” (termed by Dr.
Lippens).16 Lotz knows how to inject and cause an infection that can spread rapidly
to ensure he has an alibi in case Dr. Lippens’ death is discovered (“He drew a few
milligrams of the liquid into the hypodermic syringe, tapped the needle with his
finger to allow the air to escape and injected the urine subcutaneously into his left
armpit” (Karsten 2013: 8217)). At some point in Part III of the trilogy, Abel explains
to Ella Neser how strangulation works.18 A large part of Abel’s scientific knowledge
is linked to tanning and preserving both animal and human skins. He knows about
the use of “formalin and formaldehyde for preserving the skins, potassium acetate
for a lasting natural appearance, glycerine to prevent drying, and sulfuric acid
against fungal and bacterial decay” (Karsten 2013: 337).19
13
The reader finds out in Part One that Lotz’s mother had killed her husband and son when they had
“sinned”.
14
Another noteworthy example of medical knowledge is highlighted on page 87 of The Skinner’s
Revenge: « He had faith in Diprivan. (…) Doctors – often fond of insider jokes – jokingly referred
to it as “milk of amnesia”. Propofol was a strong sedative, usually administered as an anaesthetic,
but in Diprivan, propofol was a quick-acting tranquiliser. Within forty seconds of being adminis-
tered, either by intravenous drip or by injection into a large vein in the forearm, the patient fell into
a coma. He would use Dr. Lippens’ pad to write a prescription for Diprivan Injectable Emulsion
with 10 mg/mL propofol per vial” (Karsten 2013: 87).
15
“Even when the scalpel was in his own hand, he never made unnecessary cuts” (Karsten 2013:
59).
16
“He felt the pulse under his fingers falter, like the fluttering of a bird, then die. To make certain
he took out the stethoscope and pressed it against the doctor’s chest. Nothing. He got up, put the
stethoscope back into the pocket, buttoned the coat and set to work with the Russell knife. The first
incision was in the hairline on the doctor’s forehead, the exact location where a skilful cosmetic
surgeon would insert his scalpel to execute a traditional facelift. Not the three fine incisions that
allowed an endoscope entry to perform a “weekend” facelift.” (Karsten 2013: 73).
17
Another description of this procedure can be found on page 353 of The Skinner’s Revenge: « He
took the needle and vial from his pocket, drew the liquid into the syringe, tapped out the air bub-
bles, replaced the cap, and left for his appointment with Mr. Poppe Junior.”
18
“I normally use my thumbs. I have strong, skilful thumbs (…). Normal air contains twenty-one
per cent oxygen (…). If the oxygen falls to fifteen per cent, you lose coordination (…). At ten per
cent you lose consciousness (…). If it goes under eight per cent, you lose your life” (Karsten 2013:
304).
19
The procedures for tanning and preserving skins are further detailed on pages 372–373 of The
Skinner’s Revenge.
Lotz’s extensive medical knowledge is in stark contrast with that of Milo

Boonstra, the other murderer in the novel. The description of the murder of Bart
Senekal seen through the eyes of Milo Boonstra is far less medical and scientific and
more akin to a murder scene usually depicted in crime novels (“There’d been plenty
of blood when the blade had severed the neck arteries. Bart had been lying on his
stomach, and the blood pumping out of the open arteries had not sprayed against the
walls and ceilings nor on Milo (…). He’d cut Bart’s throat from behind as one did
with a sheep” (Karsten 2013: 391)). The third character of major importance
throughout the trilogy, Ella Neser, has a desperate wish to be more scientifically/
medically informed, like when she wanted to know whether a GeneAmp PCR
System had been used to analyze the biological material that she sent for DNA pro-
filing of a victim or suspect. Or how many loci had been targeted and on which
chromosomes, or the role played by the amelogenin gene in sex determination or the
Von Willebrand factor and the human fibrinogen alpha gene” (Karsten 2013: 393),
but she lacks the expertise. One further example clarifies the differences between
Ella, Milo and Abel with regard to their medical knowledge. During his prepara-
tions for skinning and preserving procedures, Abel gives a detailed scientific over-
view of the products and how they will be used (see above). In contrast, when Ella
is in the environment where these products have been used, the description is almost
romantic (“She became aware of all kinds of odours in the room: the floral fragrance
of air freshener, the effluvium of decay and gases, of cleaning detergents, and of the
vaguely familiar pungency of nail polish remover” (Karsten 2013: 400)).
In the first Lotz novel, Ella Neser gets rescued by her lover Zack (who dies as a
result of coming between Abel and Ella); in the second novel, however, the detective
has to choose between saving her professional partner Fred (who has been strangled
by Abel) and pursuing Lotz. Lotz escapes when Ella’s humanity makes her choose
to assist Fred.
The novel ends on an interesting note. Ella raises the issue of whether her life
proceeds according to her own free will or God’s will. She links it to the Gamaliel’s
principle from the Bible. The New Testament tells of how, after imprisonment in
Jerusalem, the apostles were brought before the council of high priests and ques-
tioned about why they had disobeyed the order to stop preaching the word of Jesus.
As Peter’s response was not sufficient in appeasing the Council, they put the ques-
tion to Gamaliel.
Then stood there up one in the council, named Gamaliel, a doctor of the law, high in reputa-
tion among all the people, and he said unto them: Take heed of yourselves what ye intend
to do as touching these men. For before these days rose up Theudas, boasting himself to be
somebody; to whom a number of men, about four hundred, joined themselves; he was slain,
and all, as many as obeyed him, were scattered and brought to nought. After this rose up
Judas of Galilee in the days of the taxing, and drew away much people after him; he also
perished, and all, even as many as obeyed him, were dispersed. And now I say unto you,
refrain from these men, and let them alone, for if this counsel or this work be of men, it will
come to nought: but if it be of God, ye cannot overthrow it, lest haply ye be found even to
fight against God (Acts 5:34).
The principle put forward by Gamaliel is both universal and interesting. Its
premise is that the long-term course of future events consequent to a particular ante-
cedent event is strictly correlated with the truth quality of the antecedent event.
Thus, the answer to whether or not “this work be of men or of God” is to be found,
according to Gamaliel’s principle, in the future course of events, exactly opposite to
the usual convention of seeking definitive information about a particular event in the
“causal past”, i.e., the course of prior events leading up to that in question.
Gamaliel’s principle can be compared to Aristotle’s famous remark that we
should not count a man happy (blessed?) until he is dead, recognizing that the mean-
ing and truth of the events in a man’s life may not be evident at the time of occur-
rence but become clear in the future. It is therefore predicable that Abel is “slain”,
similar to Theudas and Judas, in the final instalment of Chris Karsten’s trilogy. Abel
is a classic example of the observation made by Dene Grigar, an American scholar
of digital technology and culture, that scientists today are “frequently sociopaths”
(Grigar 2006). On the other hand, Ella Neser’s role, mainly in the first two parts of
the trilogy and, to a lesser extent, in the third, is an example of medical gaze on the
female victim’s body (described in feminist analyses of crime fiction such as those
of Munt 1994; Plain 2001). Studies focusing on medical gaze have largely high-
lighted the passive role of women in crime fiction, i.e., as an object, rather than as
an active subject with agency, a protagonist who can decide her own future.
Conclusion
In the last few decades, crime fiction has become an increasingly dominant genre in
the cultural spheres of literature, film, and television, and in many ways, may be
considered the most dominant fictional genre. Published contemporary crime fiction
incorporates a strong scientific presence, and it is reasonable to assume that many
readers and viewers gain a substantial part of their scientific knowledge from read-
ing this type of novel. While intuition is highlighted as one of the characteristics of
the detective in various crime novels, in Karsten’s trilogy, medical knowledge is
utilized both by the detective to deduce information from available evidence and by
the criminal, possibly to present the villain and the hero as ‘equal partners’ to the
reader. The many scars can be perceived as “the marks of their engagements with
and their escapes from the peculiar historical circumstances in which they live, and
in their adventures of detection, they translate those anatomical marks into quests
for some elusive truth” (Thomas 2004:2). Chris Karsten narrates the life and opera-
tions of Abel Lotz, a serial murderer who feels at home in front of an operating table
in a sterile room (Karsten 2013: 383) and has a strong obsession with skins, tattoos,
celestial objects and music. The dichotomy between medical knowledge (of the
serial killer Abel Lotz and murderer Milo Boonstra) and lack of knowledge (of the
detective Ella Neser) is evidence of a literary challenge to “convenient truths”
regarding science and wisdom. Through this ‘reversed’ approach, the reader of
science-infused crime fiction like that written by Kathy Reichs and others is likely
to develop a more positive attitude towards the science at hand, since the informa-
tion is essential to solve the mystery and thus represents an integral part of the
novel. By putting forward another type of interaction, in which it is not the detec-
tive/forensic anthropologist/police force but rather society’s criminal element that
has the scientific upper hand, Karsten presents a new type of crime novel contrary
to well-established detection methods and nineteenth-century traditions.
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Dis/ability: The Construction of Norms
and Normality in Popular Culture
Simon Ledder and Catharina Münte
The Discursive Constructions of ‘Disability’ and ‘Impairment’
The term ‘disability’1 is used as a matter of course. ‘Disability’ is understood as a

medical condition, related to someone’s bodily or mental attributes. From a post-
structuralist perspective, we will highlight how this apparently self-evident category
is in fact a modern construct. For this we will first give a perspective on discourse
theory, as developed by Foucault (2002) and Butler (1990, 1993).
Foucault (2002) has shown that the discourses in different disciplines follow
specific rules. What is valid as a ‘truth’ in a certain discourse is in effect dependent
on socio-historically specific mechanisms of power. While the body seems to be just
some material that can be measured and analyzed through ‘objective’ scientific
methods, the differentiation between ‘right’ and ‘wrong’ observations and interpre-
tations is dependent on historically bound epistemologies and ontologies. This is
valid for the life sciences as well (Haraway 1991).
The body therefore is not a given entity, but is constructed within very different
discourses.2 In these discourses specific phenomena are constituted and made rele-
vant. For example, the number of one’s chromosomes could only have been made
relevant after their ‘discovery’ in the nineteenth century; nowadays their number is
1
We use the spelling ‘dis/ability’ to underline that ‘disability’ and ‘ability’ are two elements of the
same categorization, and one cannot be explained without the other.
2
This does not mean that there would be no physical materiality of the ‘body’, but the way we
perceive and treat something as a ‘body’ is dependent on the discourse (Butler 1993).
S. Ledder (*)
Sociology and Politics of Rehabilitation, Disability Studies, University of Cologne,
Cologne, Germany
e-mail: simon.ledder@uni-koeln.de
C. Münte
Sociologist (M.A.) With Focus on Disability Studies and Medical Sociology; Paramedic;
Student of Human Medicine, Justus Liebig University Giessen, Giessen, Germany

https://doi.org/10.1007/978-3-319-90677-5_16
208 S. Ledder and C. Münte
made relevant in deciding over the development of an embryo. By reiterating spe-

cific ascriptions, the process of constructing specific differences is presented as
natural (Butler 1990, 1993). Within disability studies this deconstructionist perspec-
tive marks a shift in the theoretical approaches as well; we will illustrate that by
counter-posing three models of ‘disability’.
The so-called medical model of ‘disability’, emerging in the nineteenth century,
locates ‘disability’ in the individual. As Oliver (1990: 1) has pointed out in his semi-
nal text The Politics of Disablement, this perspective could be called “the personal
tragedy theory of disability”, because it positions a bodily or mental difference as a
negative attribute and disregards societal factors. Still today within the framework
set in the International Classification of Functioning, Disability and Health, the
diagnostics manual published by the World Health Organization (WHO 2001), the
bodily factors are in effect most prevalent. This individualistic perspective on ‘dis-
ability’ is not limited to the scientific discourses like medicine, psychology, peda-
gogy, or sociology, but is nowadays the hegemonic conception of disability in
society. The individual then has to be rehabilitated, that is, to become ‘normal’.
In contrast, in the 1970s the Disability Movement started to organize itself, try-
ing to break up the isolation many disabled people experienced on a daily basis. At
that time the UK-based Union of the Physically Impaired Against Segregation
(UPIAS) was prominent. UPIAS claimed that ‘disability’ was not a medical issue
but a form of social oppression, similar to those encountered by women, homosexu-
als, and ethnic minorities. Countering the medical discourse, they termed an alterna-
tive approach: As the so-called social model attests, while the body might be
‘impaired’, only the existence of social barriers would lead to ‘disability’ (UPIAS
1976). While the UPIAS accepted that some disabled people would need medical
treatment for their ‘impairments’, their emphasis was on social change.
Within the social model the expertise status of medical practitioners is ques-
tioned. Countering the processes of subjection in therapy and in research, the dis-
ability movement claims the right to speak for themselves, culminating in the slogan
“nothing about us without us!”. This is especially important as the doctor’s report
would regulate the access to social services, e.g. the opportunity to live indepen-
dently (Brisenden 1986). Within this framework, the politics of segregation, as
induced by the paradigm of rehabilitation, and the obligation to poverty, as the right
of access to social services, are criticized. The activists reclaim the rights to be par-
ticipants in an equal society, not to be excluded by barriers of any form. They par-
ticipate in very different forms of civil disobedience, not the least against charity
events that would perpetuate the equation of ‘disability’ with living in pain.
The medical and the social models, though opposing each other in various
aspects, both presume the possibility of an ‘objective’ categorization of bodily vari-
ations. In neither model is the validity of the category ‘impairment’ questioned. In
the 1990s, the aforementioned deconstructivist shift led to the so-called cultural
model of disability. From this perspective, which discourses and practices lead to
the emergence of categories such as ‘disabled’, ‘impaired’, or ‘unimpaired’ in the
first place is analyzed. Norms of beauty, of functioning and performance, and theo-
ries of sickness are historicized. The body is not seen as an ontological entity, devoid
Dis/ability: The Construction of Norms and Normality in Popular Culture 209
of any social influence, but a material effect of certain regimes of power and knowl-
edge that establish specific narratives about normative and non-normative bodies. In
contrast to the paradigm of rehabilitation, the focus changes from an analysis of the
‘disabled’ minority to an analysis of the ‘non-disabled’ majority that dominates the
discourses (Davis 1995; Garland-Thomson 1997). This perspective criticizes the
rejections of some mental and somatic characteristics and calls for a shift that rec-
ognizes differences in humankind as equally valuable (Garland-Thomson 2012).
We take this deconstructivist approach as a starting point to analyze how the now
hegemonic conception of ‘disability’ could emerge. To do this, we will start with the
eighteenth and nineteenth century, when the life sciences constructed concepts of
‘normality’ and ‘monstrosity’. Those scientific discourses were deeply connected to
popular culture, e.g. the so called freak shows, as we will show below.
he ‘Monster’, the ‘Freak’, and the Construction of Ableist

T
Normality
The ‘monster’, and the ‘freak’ can both be seen as processes of constructing ‘dis-
ability’. Yet, analyzing dis/ability is problematic because the term ‘disability’ in its
contemporary meaning is a relatively new one, defined in the nineteenth century. It
is used as an umbrella term to encompass many physical and psychological mani-
festations that are deemed deviant. Although the history of ‘disability’ is still a con-
tested terrain, we can safely say that an overall term that tries to include a large
number of very different ‘deviations’ first emerges at the time that ‘normality’
becomes a relevant term—which is the nineteenth century with its biopolitical use
of statistics as a tool to manage populations (Davis 1995; Link 2004; Foucault
2008).3
What characteristics are perceived as a conspicuity is socio-culturally dependent.
During the period of enlightenment in the ‘Western’ cultures, with their processes
of secularization, new discourses about such conspicuities took place. Those dis-
courses were intertwined with the emerging discourse of the autonomous subject.
Negating religious legitimation, only the autonomous, rational subject should
decide about one’s government. In this discourse—in which the Cartesian split
between body and mind can be considered the quintessential statement—the body
would be an appendage of the subject’s will, sometimes compared to a machine.
This can be seen in the medical discourses during the enlightenment period as well
(Foucault 1976).
3
Before that time, some phenomena which are contemoporarily labelled as ‘disability’ (e.g. epi-
lepsy) were in Europe considered a symbol of sinfulness; for example a ‘disfigured’ child being a
punishment for the blasphemous parents (Stiker 1999). On the other hand, people that would be
considered ‘mad’ in Europe were claimed to be holy in different regions in South Asia (McDaniel
1989; Linrothe 2009).
The discourse of the rational subject was highly gendered, racialized, class-
based, and ableized. Considering dis/ability, the ‘ungovernable’ body or mind
defied the universality of this discourse. Scientists claimed this to be a difference
which would have to be deduced from a ‘natural’ order; excluding the metaphysical
concepts of sin or praise. Yet, individuals who embodied these differences seemed
to deviate from this ‘natural’ order, contesting the classifications of normality scien-
tists tried to establish. Those which were considered ‘monstrous’, as Foucault
(2003: 56) pointed out, were in fact set in a “juridico-biological” realm. The ‘mon-
ster’ not only violated the laws of society but the laws of nature; it was outside of
the order. The medical discourse then tried to integrate the ‘monster’ on a higher
level of abstraction as the Other or the negation of the order.
The representation of the ‘monster’ thus makes a good starting point for the
analysis of popular cultural representations of ‘disability’ because they are deeply
intertwined. The ‘monster’ would be a prominent exhibit in the ‘freak shows’ of the
eighteenth and nineteenth centuries. Here, people with “extraordinary bodies”
(Garland-Thomson 1997) were shown to the public. Freak shows were an element
of popular culture that were visited frequently by professors of medicine who tried
to find out how these ‘deviations’ were created. Very different aspects of the body
were suggested to be something other—and all of them are encompassed in the term
‘freak’, “a single amorphous category of corporeal otherness” (Garland-Thomson
1996: 10).
These shows not only were a spectacle of difference, but also a source of income
for the freaks. Here people could work who were excluded from the new labor mar-
kets that emerged with industrialization. The process of industrialization led to mass
production and established new working conditions in the eighteenth century. The
machines that were built to produce commodities in series required certain physical
and mental activities; establishing industrial norms—and therefore, soon people
who would not adapt to those machines were excluded from the new labor market.
These material conditions, entangled with discursive and cultural practices, there-
fore established new norms not only for machines, but also for individuals. While
some people with now non-normative bodies could still participate in non-
industrialized work, others would be supported by their families. Nevertheless in
the nineteenth century several people were segregated from society in the “Poor
Houses” (Oliver and Barnes 2012: 52–73). In contrast, in the freak shows the actors
were able to sustain a living and were not in need of family support or subjected to
the disciplinary regimes of the Poor Houses. Although they are nowadays scathed
for their humiliating display of certain humans, in the nineteenth century the freak
shows gave a form of economic independence to people who were excluded from
society in the first place.
Audacious narratives about their heritage accompanied the display of ‘freaks’.
Costumes, light and audio effects were added to boost the ‘anomalies’ through a lot
of special effects. The exhibit of freaks served one important function: By showing
the ‘anomalies’ they constituted the ‘normal’. They acted as an ex negativo example
for the masses and thus created a role model. The bodies were displayed highlight-
ing some characteristics that would be categorized as essential differences from the
average human; the supposed main actor in the era of industrialization and demo-
cratic systems. In this mode of representation—in a time when photographic images
were equated with objectivity—the limits of the “normate” (Garland-Thomson
1997: 8) can be shown. This neologism signifies the cultural position of the subject
who can go as unmarked and self-evident, which means especially the white, male
and able-bodied. The normate’s boundaries are set up through the discourses that
define the ‘abnormal’.4 Through this a specific kind of body is presented as natural,
and this body is acknowledged to be superior.
Within disability studies, this concept is considered “ableism”: “A network of
beliefs, processes and practices that produces a particular kind of self and body (the
corporeal standard) that is projected as perfect, species-typical and therefore essen-
tial and fully human. Disability then is cast as a diminished state of being human”
(Campbell 2001: 44, fn.5). Ableism is immanent in the discourse of the autonomous
subject as well as in the discourse of the capitalist affordances, which are both
deeply entwined with each other.
Disability as a Metaphor
Before the emergence of disability studies, most academic work that analyzed rep-
resentations of characters marked as disabled interpreted them as a metaphor for
something else. For example, the disabled individual was considered a metaphor for
deformities in the social order, such as Shakespeare’s (1597) Richard III, who
“embodies the chaos of a moment in England’s history” (Mitchell and Snyder 2000:
101). Disability would be regarded as one aesthetic element beneath others, repre-
senting the culmination of the fears and anxieties about a certain state of society, or
as the threat of a certain ideology.
Instead of taking the concept of ‘disability’ in its modern sense for granted,
Mitchell/Snyder ask how ‘disability’ could be used as a metaphor in the first place.
One main point is that deviance leads to a story. As Mitchell/Snyder (ibid.: 54) put
it: “The normal, routine, average, and familiar (by definition) fail to mobilize the
storytelling effort because they fall short of the litmus test of exceptionality.” By
exoticizing and establishing difference, an interesting narrative can emerge. This
narrative does not need to be invested in the body itself, the body is merely used
metaphorically. In its metaphoric use the body functions as the “liminal point” that
allows the author to “‘play’ between micro and macro registers of meaning-making”
(ibid.: 62).
4
While Garland-Thomson’s concept of the ‘normate’ has some plausibility, she does not acknowl-
edge the relevance that statistics would have in the discourse constituting ‘normality’ (Garland-
Thomson 1997: 8). As Anne Waldschmidt (2006) has shown in reference to Link (2004), the
discursive grounding of ‘normality’ in statistics enabled a more flexible definition of what could be
counted as ‘normal’.
However, in modernist and postmodernist literature, disability is used metaphor-

ically to disrupt traditional narrative forms, allowing an open-ended narrative to
emerge, in which multiple meanings are layered. Analyzing the works of Sherwood
Anderson (1919) and Katherine Dunn (1989), the scholars Mitchell and Snyder
(2000) conclude that these authors used characters marked as disabled as a “narra-
tive prosthesis”—hence the title—because they are used to challenge the dominant
view of an ordered hierarchical status quo.
Mitchell and Snyder (2000) argue that the pervasive metaphorical use of ‘dis-
ability’ in literature—from Oedipus to postmodernist fiction—therefore has been
constitutive for the formation of literature. The pervasive use of disability questions
the hegemonic systems of power and knowledge. Yet this has a dialectical twist:
while the authors’ intentions might be emancipatory, their characters are limited in
their behavior and only allowed to act in a traditional manner.
There are different assumptions about the stereotypical behavior of disabled
characters: for example, while Ashby et al. (2009: 361) claim that “most horror
films across the last century have remained fairly static in their representation of
people with disabilities”, Smith (2012) argues from a deconstructivist perspective,
that horror films question the concepts of the ‘normal able-bodied’ individual. In the
classical horror genre the vulnerability of all humankind is highlighted, therefore
the arbitrariness of concepts such as ‘disability’ and ‘non-disability’ becomes more
evident.
Stereotypical Representations of ‘Disability’
Within news media, literature, film, photography, television, music and digital
games we can find recurring themes in the representation of people with disabili-
ties.5 However, this is not as unambiguous as one might think: “When literature,
history, religion, philosophy, or art speaks about disability, it is almost never in one
tongue” (Brueggemann et al. 2012: 72). Depending on the socio-historical context,
very different statements have been uttered.
Over time, some of these representations have become clichés, some have under-
gone crucial changes, some have developed anew. Literary criticism mostly inter-
preted these aspects as metaphors for something else. Contrary to this approach,
5
In the last few years, several scientific works concerned with the representation of ‘disability’ in
literature, photography, film, television and news reports have come into existence. Less has been
written about the connection between dis/ability and music. Digital games, although a trending
element in popular culture, are still overlooked in academic works. In the following, depending on
the medial form, different styles are used to specify the creator of a work. For novels, the name of
the author and the first date of publication are used. For films, the director (d), the country of origin
and the release date are given. For TV shows, the creator (cr.) and the running time are stated. For
digital games, the developing studio (dev.) and the release date are indicated. In effect, every
medium makes use of ‘dis/ability’ in its genuine way of storytelling, but we will not discuss the
different mediality at this point.
some scholars who identified themselves as disabled, starting in the 1980s (e.g.
Thurber 1980; Barnes 1992; Longmore 2003), took the ‘impairment’ of a character
at face value.6
When a character is marked as ‘disabled’, this usually becomes their master sta-
tus. Other individual qualities are often diminished and read only under the domi-
nant marker as ‘disabled’.7 Until recently, although characters marked as disabled
were quite common in popular culture, they only played a secondary role; in the
singular narrative they were often used to highlight the characteristics of the non-
disabled main protagonist. Scholars from within disability studies concluded that,
taking into account popular culture’s dealing with disabled persons as either main
protagonist or minor role, there are some very typical depictions which feature in
stories about ‘disability’, mostly negative.8 Below we will focus on the aspects of
pity, comedy, evil, sexuality and the “supercrip”, because these are still featured
frequently in popular culture.9 These categories of stereotypical representations are
not exclusive but can overlap.
Pity
The first type of representation we talk about is the person with disability that has to
be pitied. Pity is a major shift from the freak shows of the nineteenth century. As
Bogdan (1988: 277) notes in his analysis of the freak show, “Pity as a mode of pre-
sentation was absent.”
In this representation the character is dependent on help from other, non-disabled
persons. They10 are not able to live a life on their own and always need assistance.
They are confined to certain areas, e.g. “total institutions” (Goffman 1961), and
6
This is a different approach to the one questioning the possibility of using disability as a meta-
phor. One could argue that the aforementioned approach is closer to the cultural model, while the
now discussed analyses of stereotypes are closer to the social model of disability.
7
Most studies to date have focussed on the representation of white characters marked as disabled.
This is problematic because the representation of characters marked as people of colour differs
from characters represented as white, i.e. being unmarked (Chow 1993; Dyer 1997). Yet, in this
article we will rely mostly on the extant disability literature. Some analyses of the entanglement of
race and dis/ability can be found in Bell (2011) and Erevelles (2011).
8
Within disability studies literature, these scholars’ approach has been termed the ‘negative-image
school of criticism’. As Mitchell and Snyder (2000: 20) point out, the evaluation of a representa-
tion as good or bad is dependent on one’s cultural background. Therefore, some representations
which nowadays are considered negative may have been positive during its origin.
9
Barnes (1992) analysed 11 types of media representations, which is so far the most detailed cat-
egorization: “The Disabled Person as Pitiable and Pathetic”, “as an Object of Violence”, “as
Sinister and Evil”, “as Atmosphere or Curio”, “as Super Cripple”, “as an Object of Ridicule”, “as
Their Own Worst and Only Enemy”, “as Burden”, “as Sexually Abnormal”, “as Incapable of
Participating Fully in Community Life”, and “as Normal”.
10
If we speak about an undefined individual as in the case of stereotypical representation, we use
the term “they” as a gender-neutral grammatical third person form.
leaving those will lead to trouble. Always in need of other people, the character is
portrayed as passive and suffering. It is implied that they cannot be an autonomous
subject in a strict sense; not able to live a self-governing life. All of this is founded
in some essential individual characteristic that is independent from any social or
cultural factors that might put up barriers and discrimination. Prejudices against
persons with disabilities, if narrated at all, are just secondary.
This representation of pitifulness is often accompanied by the goal of rehabilita-
tion. The individual’s characteristics would have to be ‘overcome’, thus making it
possible to lead a ‘normal’ life. The individual is portrayed as maladjusted and in
need of the correct ‘treatment’; with these interventions a fulfilling life would be
possible. In this affordance of normalization the medical model of disability is
clearly present.11 In the realm of fiction, one can find this in the characters Tiny Tim
in Dickens’ Christmas Carol (Dickens 1843), the Flower Girl in City Lights (d:
Charlie Chaplin, US 1931), or Jake Sully in Avatar (d: James Cameron, USA 2009).
However, this trope is not limited to fiction. Many news stories still phrase that
someone is “bound to a wheelchair”, “living a life in absolute darkness”, or “suffer-
ing from her disability,” thus equating disability with suffering. This must be under-
stood mostly as a non-disabled journalist’s projection and very rarely corresponds
with the self-perception of people with disabilities.
For a long time various charity events used slogans of pity to evoke a feeling of
sympathy from the non-disabled donors. After 1940 the ‘loveable poster child’ was
the main element in the fund-raising business.12 While this is helpful in generating
money—which rarely was spent in agreement with actual disability rights groups
but mostly according to non-disabled ‘experts’—it reproduces the stereotype of the
helpless person with a disability. At the same time, the political dimension of dis-
ability is neglected. By establishing pity as a mode of interaction, an asymmetrical
relationship is formed.13
When disability is portrayed as a lonesome, devastating experience—that also
burdens other people—the will to suicide is represented as a sensible solution. This
is shown in The Hunchback of Notre-Dame (Hugo 2011[1831]), in Whose Life Is It,
11
Being completely independent is the ultimate goal. This is consistent with the discourse of the
autonomous subject. This model of subjectivity is still the hegemonic paradigm, although it ignores
the dependency of human beings on each other. The pursuit of autonomy as portrayed here is the
epitome of the dominant individualistic-liberal discourse, and at the same time neglects the social
relations within which all human beings are interwoven (Butler 2005).
12
Different dimensions of discrimination came into effect as well: “Particular children were sin-
gled out because they were photogenic: attractive, cute, and perfect in every way (in other words,
lived up to the mass-media representation of the typical person) except for their disability. The
children featured were almost exclusively middle class, well groomed, white, and attractively
attired […]” (Bogdan 2012: 45).
13
Very important in the contemporary discourse are the fund-raising videos of the organisation
Autism Speaks. Here, autism is pictured as a miserable tragedy for the family. It has to be men-
tioned that the board of directors does not include any people diagnosed with autism. The organisa-
tion is criticised harshly by people who identify as autistic (Waltz 2013: 136–166).
Anyway? (d: John Badham, US 1981), and still today in Me Before You (d: Thea
Sharrock, UK 2016) and has been harshly criticized by the disability movement.
Comedy
Characters marked as disabled have been an “Object of Ridicule” (Barnes 1992: 13)
for a long time. The visually impaired cartoon character Mr. Magoo featured in
some short films and series, where his short eyesight led to situations supposed to
be funny. In Monty Python’s Flying Circus (cr.. Graham Chapman et al., UK 1969–
1973) the British group used a non-normative walking style in their ‘The Ministry
of Silly Walks’. Their ‘joke’ on absurd governmental ideas only works because
walking differently than the mass is represented as laughable. Whole movies like
See No Evil, Hear No Evil (d: Arthur Hiller, US 1988) and Dumb and Dumber (d.:
Peter Farrelly and Bobbie Farrelly, US 1994) are based on this premise. The
Intouchables (d.: Olivier Nakache and Eric Toledano 2011), although more
empathic, still relies massively on the comic factor.
The joke is based on the disabled character’s seemingly inappropriate action that
is grounded in their ‘deficiency’. This perspective totally mistakes a very simple
phenomenon: every individual learns how to perceive the world in their own way. In
the comical depiction these different modi of perception are diminished and, thus,
send the message that only certain forms of perception are the correct ones. This
goes along with the devaluation of persons whose modes of interaction are consid-
ered abnormal, which consequently can lead to a lack of self-confidence or low
self-esteem.14
Evil and Criminal
Characters marked as disabled are often pictured as evil, evoking a sinister tone.
Shakespeare’s (1597) villainous Richard III describes himself as “Deformed,
unfinish’d” (Act I Sc. I), and executes a murderous intrigue. Melville’s (1851)
Captain Ahab, whose wooden leg and lost hand lead to obsessive whale hunting,
risks the lives of everyone around him. Stevenson’s (1883) Long John Silver has a
wooden leg but this is only mentioned in scenes where he appears to be dangerous
(Barnes 1992: 11). Many villains of the James Bond movies are portrayed as dis-
abled in one way or another. These examples have in common that the physical
‘deviance’ is used as a symbol for some inner ‘deviance’. Not only the body, but the
soul also is in question. The loss of a limb is not just a physical loss, but a loss of
14
Here one also has to differentiate who is talking: While making fun of someone from a position
of power reifies these power structures, a person who ridicules her own ‘deficiencies’ can subvert
these structures by exposing the common paradigm (Rossing 2015).
human essence. In hyperbolizing the Latin phrase mens sana in corpore sano,15 the
‘deformed’ body is represented as ‘deformation’ of values and norms.
A special character is the stereotype of the “mad scientist”, often marked as
physically disabled. The scientist is bitter about the world, but mostly, as the narra-
tive tells, about themself. With some crude logic the scientist comes to the conclu-
sion that the only option available is eliminating a large part of humanity. Classically
portrayed in Dr. Strangelove or How I Learned To Stop Worrying and Love The
Bomb (d: Stanley Kubrick, UK/US 1964), but still evident in Surrogates’ Dr. Canter
(d: Jonathan Mostow, US 2009) or Deus Ex: Human Revolution’s Hugh Darrow
(dev.: Eidos, USA 2011).16
Longmore (2003: 134) summarizes in these representations “three common prej-
udices […]: disability is a punishment for evil; disabled people are embittered by
their ‘fate’; disabled people resent the nondisabled and would, if they could, destroy
them.” While in history non-disabled people killed disabled people, here their roles
are turned around. Through this projection, the non-disabled majority executes a
‘blaming of the victims’ and therefore absolves their own historical actions (Reisigl
and Wodak 2005).
Even if a character’s intentions are not explicitly evil, as in John Steinbeck’s
(1937) character Lennie Small, marked with a cognitive disability, or Flannery
O’Connor’s (1955) one-armed Tom Shiftlet, nonetheless their ‘disability’ leads to
murder and is a threat to the social order; their segregation or elimination becoming
the supposedly logical consequence (Garland-Thomson 1997: 36).
Sexuality
Sexuality is presented as a very problematic topic. Frequently, a character marked

as disabled and male is presented as asexual17 or with a threatening sexuality.
In works like Lady Chatterley’s Lover (Lawrence 1929), the wife progresses in
heterosexual adultery because her husband is characterized as disabled, equating it
with sexual impotence. Only being ‘half a man’ is one main problem in Whose Life
is it Anyway? Melvin, in As Good As It Gets (d: James L. Brooks, US 1997), must
15
The phrase originates from the Roman poet Juvenal and can be translated as “a healthy mind in
a healthy body”.
16
In digital games, with their medial focus on performative actions by the playing subject, the loss
of autonomy is a continuing theme. Within Resident Evil 4 (dev.: Capcom Production Studio, JP
2005), BioShock (dev.: 2K Australia/2K Boston 2007) or Deus Ex: Human Revolution (dev.: Eidos,
USA 2011), at certain points, the generic enemies are a threat to the player because they are no
longer in control of themselves. At the same time, they are visually represented as ‘deformed‘,
once again evoking the stereotype of the evil disabled (Carr 2009; Ledder 2015).
17
We use ‘asexual’ here as a label that some people identify with and live a joyful life. We do not
want to play out different sexualities against each other.
‘overcome’ his disability to fulfil the romantic heterosexual relationship, while the
gay character becomes disabled and is finally put offstage (McRuer 2002: 94f.).18
While this holds true for many depictions of disabled male characters, disabled
female characters are portrayed otherwise: “Since the traditional [sic!] meaning of
femininity is often synonymous with dependency and vulnerability, disability can-
not be used to pose a threat to women’s autonomy” (Evans 2002: 387). This explains
the significance of the ‘beautiful blind woman’ trope. In the thriller genre she is
often featured as a victim of male threat and sexualized violence. This can be seen,
for example, in Witness In the Dark (d: Wolf Rilla, UK 1959) or Jennifer 8 (d: Bruce
Robinson, USA 1992), where her disability equals innocence.
A first counter-point against the innocent stereotype can be found in the photo-
graphs of Ellen Stohl in 1987. Stohl, a student of theatre and a wheelchair user due
to an accident in 1985, posed nude for Playboy’s July issue. She was the first known
‘disabled’ woman to do so. While some argue that this was an important step in
acknowledging the sexuality of people with disabilities, others criticized these pho-
tographs because no visual signs of disability were presented at all. For example her
wheelchair was absent, thus separating disability and sexuality again. This setting
exemplifies that even if a person with disability may have a sexuality, they can only
be desirable if their ‘deviances’ are not presented (Ellis 2015: 43–48).19 This is one
aspect of the “heterosexual matrix” (Butler 1990: 5),20 as McRuer (2002: 97) has
pointed out: “Compulsory heterosexuality is intertwined with compulsory able-
bodiedness; both systems work to (re)produce the able body and heterosexuality.”
Another form of representation is the threatening sexuality of the disabled male
person. In some narratives the person is not able to establish a consensual relation-
ship but uses force to subdue his object of desire. News stories in the early twentieth
century often printed reports about sexual crimes, purporting that the assaulter
18
This entanglement of ‘disability’ and ‘asexuality’ can be criticised on many levels. For once,
most people with disabilities do have sexual desires. Most of them are able to use their genitalia as
well. But even if one cannot or does not want to use their genitalia in sex, this does not mean that
these people are asexual. The seemingly obligatory connection between genitalia and the act of sex
just reproduces certain aspects of heteronormativity; ignoring the diverse ways in which people
engage in sexual practices.
19
Of course this is also a matter of sexual objectification in general. Nondisabled feminists espe-
cially criticised Stohl for participating at all in this form of objectification, while disability groups
supported her decision. Eli Clare, who identifies as white, disabled and genderqueer, points out this
ambivalence. On the one hand: “Most frequently grounded in a white, middle-class, single-issue
version of feminism, this argument takes on the generic objectification of women, meaning mid-
dle- and upper-class, white, heterosexual, nondisabled women” (Clare 2015: 132). On the other
hand: “We will never, as Ellen so gracefully does, meet the dominant culture’s standards for beauty
and sexual attractiveness. Even if we did, I do not want Playboy to define anyone’s sexuality—
regardless of gender or disability” (ebd: 134).
20
Judith Butler (1990: 5) coined the term “heterosexual matrix”: the contemporary hegemonial
discourse in which the existence of two and only two sexes is legitimate, where body and identity
have to be coherent to these categories, and one’s sexual desires have to be towards the ‘opposite’
sex within this construct.
would be cognitively ‘deviant’. This discourse legitimated not only incarceration

but also invasive procedures on the attacker’s sexual organs (Jarman 2012).
Beneath the suggested connection between disability and sexualized violence
lies the anxiety that the disabled person might procreate, which can also be seen in
the rhetoric used by the eugenic movement. Eugenics, a term coined by Francis
Galton, describes the rationality of ‘improving’ the gene pool. The image of the
male ‘disabled sexual predator’ was used widely by the eugenic movement to jus-
tify sterilization laws (Bogdan 2012: 75ff.). In the United States, e.g. in the 1920s
the forced sterilization of those labelled ‘feebleminded’21 was legal in 15 states
(Kühl 2013: 39). The United States was perceived as a forerunner in eugenic poli-
cies until the 1930s, when the eugenic ordering of Nazi Germany culminated in
‘action T-4’: 80–100,000 dead and 400,000 sterilized people that had been catego-
rized as ‘disabled’.22
“Supercrip”
Another stereotype is the “Supercrip”; a person who ‘overcomes’ their disability

against all obstacles, because of their strong will, their dedication and self-discipline.
Kama (2004) attests two variants of this: One, where seemingly mundane tasks are
treated as extraordinary achievements. This fuels the assumption that persons with
disabilities are generally not able to perform at all. Second, the supercrip that climbs
mountains or engages in parachuting and is portrayed in different media as an
exceptional individual. From here one can conclude that ‘disability’ is just an ele-
ment of one’s will that can be ‘overcome’ by self-discipline, and all those people
with disabilities that do not engage in such actions obviously lack willpower.23 This
21
The term ‘feebleminded’ had been used to describe very different phenomena concerning cogni-
tive abilities, and the classification is once more entangled with class, race, and gender.
22
Michelle Jarman (2012: 99) has pointed out the racialized aspect of the discourse: “By the 1920s
and 1930s, however, as eugenicists became more concerned with “morons”—borderline “feeble-
minded” individuals who could pass for normal—they began sounding an alarm against the immi-
nent sexual threat posed by these purported predators. Again, untarnished white women were
invoked as the targeted prey of ‘deviant’ and feebleminded men.” At the same time, the white
‘feebleminded woman’ was depicted as promiscuous. This was explained either by her own
desires, or by her innocence that would conceal her right to refuse sexual affordances (Block
2000). In either way the consequences, the eugenicists argued, would be in producing more off-
spring with the same dispositions for ‘feeblemindedness’, resulting in a ‘degenerating’ nation.
This was popularized within newspapers (Rembis 2011), or even theatre plays (James 1998).
Those women were put under special custodial care and were forbidden to raise families on their
own.
23
Referring to movies like The Green Mile (d: Frank Darabont, US 1999) or Unbreakable (d:
M. Night Shyamalan, US 2000), Agosto (2014: 12) points out: “the Black, dis/abled male is less
likely to overcome and more likely to be marginalized from mainstream society as he is impris-
oned [...], institutionalized […], or homeless […].”
is especially prominent in news stories about athletes with disabilities (Silva and
Howe 2012, Tynedal and Wolbring 2013).24
All these stereotypes rely mostly on the medical, very rarely on the social model
of disability. In those, categories like ‘impaired’ and ‘unimpaired’ are presented as
objective assessments of an individual’s body. While those stereotypes can be con-
sidered as giving a negative evaluation of certain bodily variants, in this century the
construction of disability within popular culture differs. The aforementioned stereo-
types are still present, but other representations have developed.
Dis/ability in the Twenty-First Century
Of course, one can find counterexamples that do not succumb to the described ste-
reotypes or just use ‘disability’ as an aesthetic element in the nineteenth and twen-
tieth centuries. While these are few and far between, since the 1990s we can analyze
a shift in the representation of disability, as well as the representation of other mar-
ginalized positions. As McRuer (2006: 28) put it: “The homophobia and ableism
represented in films and other cultural texts throughout the twentieth century […]
have been superseded (but not entirely replaced) by new, improved, and flexible
homophobia and ableism.”
We can find such a shift to a more flexible concept of dis/ability already in Star
Trek: The Next Generation (cr. Gene Roddenberry, US 1987–1994), where the blind
Geordi LaForge is praised for his outstanding achievements (Ledder et al. 2017).
While the uncontrollable character River Tam is presented as a burden throughout
the series Firefly (cr: Joss Whedon, US 2002), in the following movie Serenity (d:
Joss Whedon, US 2005) she is presented as the one who saves the rest of the team
and, despite traditional representation, does not have to die. In the animated film
How To Train Your Dragon (d: Dean DeBlois and Chris Sanders, US 2010) the one-
legged and one-armed Gobber not only does train the children to become dragon
slayers, but also is a respected fighter in his village. And, of course, the dragon
Toothless himself gets an artificial wing which allows him to participate in the final
showdown as a reliable and effective combat companion.
Tyrion Lannister of Game of Thrones (cr: George R.R. Martin et al., HBO, USA
2011–still running), called “The Imp”, is probably the most sympathetic character
in this world of bloodshed, sex and intrigue. Although Tyrion has dwarfism, this is
not his defining attribute. He is known for his wit and his strategic thinking, his
affection for drinking, and he respects women’s rights. Tyrion is an example of the
increasing complexity of the contemporary representation of disability in popular
culture. His disability is not in the foreground, his other characteristics are much
more prominent. Those interacting with him treat him just as they treat all the oth-
ers. All in all, his bodily variation is construed as ‘normal’.
The supercrip becomes even more prominent in relation to contemporary technological develop-
24
ments, as we will show in the penultimate section of this chapter.

This new ‘normality’ also is produced in advertisements. For a long time people
marked as disabled have been featured very rarely, except for little and tall people
(Bogdan 2012: 109ff.). Even if they were represented, they mostly were depicted as
something other. Charity advertisements especially made use of pitiful representa-
tions. In our current time people with disabilities are more present in advertise-
ments, and not only for charity organizations but, for example, as fashion models
(Haller and Ralph 2006). Even reality TV shows like Big Brother include people
with disabilities as residents. Here the representation of people with disabilities
celebrates a new, more diverse normality.25
To contextualize these examples we have to understand the specifics of the con-
temporary technologies of embodiment. Feminist theorist Gudrun-Axeli Knapp
took a critical stand against the demand for diversity in the late 1990s. She assumes
a “post-modern cultural current which celebrates difference per se and actually acts
indifferently. Such a post-modernity plays the game of neoliberalism, euphemisti-
cally speaking about ‘pluralism’, ‘individuality’ and ‘difference’, to de-problematize
and obscure inequality, violence and oppression” (Knapp 1998: 67; own transl.).
Therefore the call for diversity within the existing power relations makes us
skeptical. Transferred to our topic we have to clarify what forms of identity and
ableism are (re)produced within these aforementioned representations of disability,
i.e. what is the relation between diversity and ableism? What interdependencies can
be detected at the moment?
According to Foucault (2008), the action of governing is always oriented along a
specific rationality of governing. Thus, we will examine the specifics of “govern-
mental embodiment” (Münte 2013: 70; own transl.) within the medial discourse.
The term ‘governmental embodiment’ denominates a triangle of technologies of
power, “technologies of the self” (Foucault 1988) and practices of resistance. This
wide-ranging complex will be sharpened to two concrete questions:
1. Is it possible at the moment to think about ‘disability’ beyond the discursive con-
notation of a lack or deficiency?
2. Is the seemingly fixed dichotomy between ‘disabled’ and ‘non-disabled’, as well
as the biologically-defined boundaries of the body (natural/cultural), confused
by current media representations?
First, there are more and more diverse representations of people with disabilities.
These are accompanied by sometimes more, sometimes less aggressive demands for
inclusion and tolerance. Yet, in the same breath, a correspondent non-disabled iden-
tity is articulated. The open-minded, tolerant self thus produces itself as an
25
In the economic realm, this can be seen in the new concept of diversity management (DM).
Though there is no homogeneous approach, the different strands of DM share some bases in their
aim. This consists mainly in using difference as a resource—increasing workers’ satisfaction,
binding workers to a corporation, minimizing sick notes and quitting, benefiting from the diversity
approach as advertisement in customer acquisition—to maximize the corporation’s profit. In short:
Recognizing the economic potential of difference and using it in lucrative ways. At the same time
some forms of DM reify those differences and void the sociohistorical specifics that establish those
differences in the first place (Bendl et al. 2008).
including subject. Within this concept, disability is still rooted in the medical–indi-
vidualistic model; but not anymore as one’s unchangeable tragic fate, but as a chal-
lenge. The dictum of performance imposes on the person with disability the
imperative to battle against this blow of fate. If successful, the auditorium will
reward them with pride and recognition of their ‘bravery’.
Second, this spotlight on ‘bravery’ and the commitment to high performance
shifts the concept of the ‘disabled’ individual as passive and inferior that is bound
to the medical model. As the ‘disabled’ subject becomes represented as an indepen-
dent individual that is just as able to achieve anything as anybody else—the main
illusion of the autonomous subject—the social and environmental barriers that dis-
able the subject can become the focus of attention.
This can be exemplified in the realm of the Paralympics. In 1948 the first
International Wheelchair Games took place, which coincided with the Olympics. In
the following decades the range of sports was divided, and from 1976 not only
wheelchair users were allowed but people with very different disabilities partici-
pated. These games were mostly based on the idea of rehabilitation: the athletes
should use sports to adopt a healthier treatment of themselves; bringing this onto an
international level should motivate every person with a disability to indulge in sports
as well.26 As Peers (2012) argues, in their highlighting of the individual’s peculiari-
ties, these games had been a variant of the freak show, constituting ‘normality’ and
‘abnormality’. Under the premise of securing fairness, via bio-medical means the
competing athletes were classified and differentiated, which reproduced the power
regimes within the medical discourse. From the 1980s on the discourse within the
organizers shifted: “from a participation-based model of sport for the disabled to the
high-performance model that exists today” (Howe 2008: 28). The International
Paralympic Committee, founded in 1989, shrank the differentiated manner under
which athletes had competed to only let those sports take place which were easy to
finance and manage. Under such a premise, the games of athletes with disabilities
set a more rigid tone towards comparable achievement and high performance for its
own sake.
This allowed the Paralympic Games to become more marketable. Nowadays
they get an amount of screen time in the public news like no such event before. In
the past, most of the few reports reproduced the stereotype of the ‘supercrip’ as
something incredibly exceptional. The current reports set the athletes with disabili-
ties within the realm of ‘normality’: the promise to bring performance like any other
person. To show that anyone can achieve anything is foremost an element of neolib-
eral rhetoric; in the twenty-first century, neoliberalism has become more inclusive
as long as certain criteria are met. Mitchell and Snyder, developing Jasbir Puars’
(2007) concept of “homonationalism”, term this “ablenationalism” (Mitchell and
Snyder 2015): the inclusion of people with disabilities is rhetorically celebrated as
a sign of a good state and a well-meaning corporation. But this inclusion only
This should not be considered an optional activity: In a lot of total institutions sports are
26
obligatory.
encompasses those that adapt to the neoliberal affordances. Those who do not fit
into these categories are excluded once more.
The Paralympics are not just a discursive element that produces neoliberal
thoughts—they are also used as a representation for technological progress. An
advertising campaign for the Paralympics was titled Meet The Superhumans
(Channel 4, UK 2012); in the ads, some of the athletes were presented with their
state-of-the-art prosthetics bordering on a science fiction-like representation. The
reports on the games also focus for a large part on the prosthetics (Tynedal and
Wolbring 2013). Yet, the focus on technologies diverts attention from the person
who uses them; even the stereotype of the ‘supercrip’ is shuttered, as the athlete now
seems to solely depend on technology (Howe 2011).27
The technologisation of disability is produced in the realm of fiction as well: In
movies like Avatar, technology is considered a liberation, and in digital games like
BioShock the player can experience this improvement of the human body via game-
play (Ledder 2015). The Paralympics now serve as a demonstration of techno-
scientific knowledge. The merging of human and machine is no longer a threatening
symbol of a diminished existence, but a promise of possibility. Disability then is not
just set as deficient, but the prerequisite to become better than normal due to tech-
nology. Against the background of these shifts, a new development seems to loom:
at its core, subjects are allowed to have a ‘beautiful and normal life despite their
disability’, as long as they welcome technological modifications of their body. The
medial representation to ‘overcome’ their disability is pushed on a new level.
All in all, the hierarchisation between ‘disabled’ and ‘non-disabled’ is shaken.
This new celebration of diversity still grounds itself in the dominant medical–indi-
vidualistic model but, this time, it is entwined with the social model. The indisput-
able advantage of the social model is its irritation of the previously-uncontested
perspectives on disability. The social model demonstrates the negative ascriptions
and the accompanying mechanisms of discrimination.
As the examples have shown, in popular culture disability is no longer equated
with negativity as an obvious connection. But while the social aspects in the process
of discrimination are demonstrated more clearly, the medial discourse still appeals
to the responsibility of the disabled person. This dictum to care for one’s self is
highly connected to the requirement to improve one’s performance, and thus refers
to the capitalist consensus.
27
We could argue that this is a prolongation of the connection between ‘disability’ and ‘technol-
ogy’ that has been used before. Already in the 1970s and 1980s disability was the rationale behind
technological enhancement, e.g. in The Six Billion Dollar Man (cr.: Martin Caidin et al. ABC, USA
1974–1978) or The Lawnmower Man (d.: Brett Leonard, US 1992). In the cyberpunk genre the
substitution and ‘improvement’ of organs are a self-evident matter. In the twenty-first century,
however, this perspective has become even more mainstream.
Conclusion
We have argued that within popular culture certain discourses about the body take
place. In counter-posing the medical, the social and the cultural models of disability
we wanted to highlight how the representations of specific differences reproduce a
distinction between ‘disability’ and ‘non-disability’, thereby presenting a concept
of ‘normality’ as natural. In the nineteenth century the discourses transformed the
embodied difference from the metaphysical to the medical realm. Certain variations
of humankind were no longer deemed as sin or miracle but as a pathological state.
The ‘disabled’ body and mind were therefore the material effects of the ableist
hegemony, which is deeply entangled with capitalism, sexism and racism.
Freak shows were an exquisite factor in constituting the new normality by expos-
ing the ‘anomaly’. Discussing disability as a metaphor, it could be shown that the
pervasive use of characters marked as ‘disabled’ in modernist and postmodernist
texts subverted classical forms of storytelling. ‘Disability’ was used as a central ele-
ment to break with traditional forms of narrations. As popular culture migrated into
other medial forms, some narratives emerged that established specific, embodied
differences as negative stereotypes. We have discussed the aspects of pity, evil, com-
edy, sexuality and the ‘supercrip’, which are still central tropes in depictions of
‘disability’.
In contemporary popular culture the representation of disability has changed,
although we still can find the aforementioned stereotypes. The contemporary dis-
course on diversity includes ‘disability’ as just one variant of the ‘normal’ human
spectrum. But as these inclusions are set within neoliberal conditions, the discursive
regime now increases the demands on all its subjects. The mesh of technology and
the human subject, once a frightening sign of being disabled, is now a promise to
compete more effectively against the other subjects.
All in all, the borders of normality are negotiated again; popular culture being
one of the many levels in which these discourses take place. But as far as we can see,
new categories of non-normative bodies and minds will be constituted; maybe
excluding those not willing to be subjected to the technological re-configuration of
their corporeality.
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Popular Narratives of the Cochlear
Implant
Anna Grebe, Robert Stock, and Markus Spöhrer
According to the ethicist Robert Sparrow, it might come as a surprise that the inven-
tion of the cochlear implant (CI) – a technical device developed to restore hearing
in deaf and the hard of hearing – was rejected by some “people with the very condi-
tion that the implant [was] designed to cure” (Sparrow 2010: 456). Sparrow refers
to “cochlear implant controversies,” a dispute about the power implications of the
CI and its consequences for Deaf communities, which has been echoed in medical,
political, and social discourse. Apart from all ethical considerations, the controversy
can be understood as a clash between two distinct “models of culture” (Sparrow
2005) or even as the result of opposing “constructions of reality” (Spöhrer 2013a:
384): That of the hearing culture, considering hearing as the “normal” or “natural”
condition of communication, and that of the Deaf culture, basing communication
and “normality” on the use of sign language. There is, without a doubt, a whole
range of other constructions of culture in relation to the CI, such as reconciliations
of both “worlds” (Bondarew and Seligman 2012), identities “stuck in-between”
both sides (Brueggemann 1999),1 or even “cyborg identities,” ambitious to tran-
scend the borders of the normality/deafness dichotomy (Bergermann 2000).
However, it seems that the mainstream media frequently appropriates and reworks
1
Which also depends on the degree of hearing loss and whether the person in question was born
deaf or lost hearing as an adult. Certainly, identity constructions are conditioned by a vast spectrum
of other factors, such as social environment, age, gender, etc.
A. Grebe
Independent Researcher, Berlin, Germany
University of Konstanz, Konstanz, Germany
R. Stock (*) · M. Spöhrer
University of Konstanz, Konstanz, Germany
e-mail: robert.stock@uni-konstanz.de

https://doi.org/10.1007/978-3-319-90677-5_17
230 A. Grebe et al.
the more controversial parts of CI discourse in the form of fictional narratives2: The
so-called “cultural wars” between an assumedly radical Deaf community and
engrossing medical experts, sometimes on behalf of corporations.
In this paper, we address this narrative and medial reworking of the discourse
concerning CIs and discuss the debates and conflicts surrounding these issues.
However, in our understanding, these reworkings can neither been reduced to fic-
tional accounts portrayed in film or on television (TV), nor are they strictly limited
to commercial mainstream media. Instead, we include in our discussion a range of
fictional, non-fictional, and semi-fictional narrative media in order to address these
points. First, we introduce the CI and its corresponding controversies and perspec-
tives, as exemplified by an analysis of the children’s picture book Kylie Gets a
Cochlear Implant (Rose 2013), which then will be contrasted with narratives inher-
ent in comic strips and artworks produced by members of the Deaf community.
Secondly, we present an example from a TV format that has become hugely popular
in recent years: the series Switched at Birth (Weiss 2011), which first aired on the
American TV network ABC Family (since 2016: freeform) in 2011, broaches the
issue of deafness and, thereby, also CIs in a popular TV series and consequently
situates this topic within typical issues and conflicts experienced by an average fam-
ily with teenagers. Lastly, we would like to address the genre of activation videos
available on YouTube that have spread massively throughout social media and
which mostly document young people “hearing” for the first time by means of a CI.
CI Controversies
The CI is usually defined as an electronic acoustic prosthesis for a profoundly deaf

or hearing impaired person with an intact cochlear nerve, but malfunctioning sen-
sory hair cells. As a subcutaneous implant, the CI is surgically implanted into the
cochlea, as a substitute for hair cells. The CI is a complex technical device that
consists of an external electrotechnical component (microphone, speech processor,
battery, and wire coil), which is worn behind the ear, and an implanted, subcutane-
ous component, made up of a receiver, which is connected to the external compo-
nent via a magnet. Data (sound), which enters the external unit, is processed and
transmitted to the internal receiver that, in turn, stimulates the auditory nerve with
the use of special electrodes (cf. Wilson and Dorman 2009). Medical knowledge
about the CI is frequently represented or accompanied by visual representations of
the inner ear with an implanted CI in order to demonstrate the location and function
of the neuroprosthesis, as reproduced in the following image (Fig. 1)3:
2
One may even argue that there is no such thing as ‘the’ hearing community or ‘the’ Deaf com-
munity, as such constructions are merely medially produced or discourse effects (cf. Ochsner
2013; Spöhrer 2013a).
3
Further examples of such viscourse in medical textbooks can be found in Zeng (2004).
Popular Narratives of the Cochlear Implant 231
Fig. 1 CI: function and location (Illustration by Markus Spöhrer)
From the perspective of such a textbook definition and its visual representation
(or viscourse),4 which usually can be found in medical contexts, the function of the
CI is to restore “natural” “biological” hearing and, consequently, to enable “barrier-
free” communication and participation in “normal” social life (cf. Schlenker-Schulte
and Weber 2009). However, this very construction of normality and the consequent
co-production of that which is referred to as “unnatural,” “abnormal,” unhealthy,
exclusive, “disabled,” “the other,” and the highly undesired, has led to the aforemen-
tioned controversies. Mainstream media, journalism, and partly academic discourse
have mainly highlighted and focused on the ongoing dispute resulting from two
diverging models of culture: The first model, the medical model, constructs deaf-
ness as deficit or even as an illness, which can be cured by implantation of a CI. Such
claims are supported by stabilized (medical) knowledge, such as the naturalized
viscourse4 of the “natural” process of hearing, as can be found in a variety of educa-
tional contexts, ranging from non-fiction children’s books and biology text books
used in primary and secondary schools to medicinal text books used in medical col-
leges. The second model, constructed by Deaf communities, suggests that such a
“deficit model” is a tool of forced normalization used by hearing collectives. As sign
language and deafness are accepted in many nations as a “distinct” ethnicity, the use
of a CI and the corresponding ideological implications can even be considered a tool
of “cultural genocide” (Rao 2009: 4) that eradicates the “diversity and natural
4
The term viscourse refers to Karin Knorr-Cetina’s (1999) concept of stabilized visual discourses
used in scientific communities.
232 A. Grebe et al.
v ariation of the human species” (Kollien 2000: np). Furthermore, many Deaf people
claim that within their communities, the use of sign language is considered neither
unnatural nor abnormal. Hence, the use of sign language must be considered a nor-
mal and everyday way of communication, a language of individual choice or a “life-
style,” and not merely a “prosthetic language.” In this respect, a CI would not lead
to normalization of these individuals, but rather mark them as disabled and “unable
to communicate” (Ladd 2003: 168). Apart from the fact that there are certainly more
than two possible ways of constructing cultural reality and, consequently, an infinite
number of possible identities, “normality” is also a relational concept, which is
highly dependent on the specific arrangement of social collectives that are “pro-
duced via a well-defined set of practices, statements, and techniques, which mark
the ‘normal’” (Spöhrer 2013b: 28).
It is evident that concepts of normality are connected with a certain model of
communication – and this model may vary with the specific configurations, prac-
tices and discoursive productions of different communities – or, as noted by Ludwik
Fleck (1980), different “thought collectives,” since a specific “thought style” and
corresponding cultural practices condition their productions and perceptions of
reality (and thus nature and normality).5 Different thought styles of the CI – be that
of hearing or Deaf communities – and the corresponding models of communication
are reworked and produced in what can be termed as “narratives of successful com-
munication” (cf. Spöhrer 2013a).
One example of a narrative of successful communication in hearing-based com-
munities is a children’s picture book by Marilyn C. Rose, titled Kylie Gets a
Cochlear Implant (2013). The book features eight pictures accompanied by text
passages appropriate for children that narrate the fictional story of 8-year old Kylie,
who loses her ability to hear as a result of an influenza infection Kylie is introduced
as “indeed unhappy because she could not enjoy even a half of those pleasures that
ordinary kids usually enjoy” (Rose 2013: 5). The corresponding picture shows
Kylie, a stylized comic character, with a sad facial expression and her head melan-
cholically directed downwards. In the course of an analeptic narration, the reader
learns that Kylie used to love things and activities involving sound, such as playing
the piano, singing, dancing, and watching TV shows. But, being disabled of hearing
not only prohibits her from executing these activities, but also estranges her from
her friends, who are now incapable of communicating with her: “She had some
friends who came to visit her at home – though rarely – and whom she visited as
well. But Kylie always felt that she did not belong to their world” (Rose 2013: 12).
The consequences for Kylie can be considered fictional reworkings of medical,
social, and pedagogical discourse on “living with deafness”, as, for example,
described in a CI guidebook by Hermann-Röttgen (2010) for parents of deaf chil-
dren, in which the negative effects of not being able to hear and, thus, unable to
5
“Reality” is never an unmediated or given state or situation that can be detached from culture or
human perception, but instead is highly dependent on specific and culturally variegating practices,
discourses and (subjective) perceptions. Especially the example of the CI shows that “hearing” is
not a given sense that allows us an immediate access to any “outside reality” (cf. Spöhrer 2017).
communicate and participate in normal activities are related to psychosocial, emo-

tional, and pedagogical disadvantages, which may cause depression and/or social
exclusion (cf. 18). However, it is stressed in the book that this unhappiness stems
from the fact that she once was able to hear and, thus, “[t]he thing which made Kylie
even more unhappy was that she was not deaf from birth” (Rose 2013: 5). Rose thus
differentiates between being born into deafness and subsequent hearing loss, while
not generalizing all types or cultural concepts of deafness as leading to depression;
especially, as Kylie learns to speak with sign language and does make new friends
at a “special school for children with hearing disabilities” (Rose 2013: 12). Her
depression rather results from the fact that without hearing she will never be able to
fulfil her only desire: “In her dreams, she saw herself moving gracefully together
with her dancing partner in a beautiful waltz. She HEARD amazing music and she
enjoyed listening to it....at least in her dreams” (Rose 2013: 14). One day, Kylie
learns that a CI might help her to regain her hearing ability. The day of her first
appointment with the otolaryngologist is paralleled with the emotional excitement
and joy of a child’s birthday, and is filled with the conventionalized metaphors of “a
new beginning” and “rebirth,” which, incidentally, are also commonly found in
autobiographical accounts of implantees:
She looked at the window and saw that the sun was shining brightly, the sky was absolutely
clear and, as Kylie could only guess, the birds were singing their songs, enjoying gorgeous
weather. It was a beautiful warm May day when nature is usually completely awakened [...].
(Rose 2013: 16)
In his office, the otolaryngologist shows her an advertizing magazine featuring a

happy girl with a CI on the cover. Such cover illustrations can commonly be found
on guidebooks for parents of deaf children/children with a CI, thus one might argue
that such images also contain narratives of successful communication. The illustra-
tion on Hermann-Röttgen’s guide book, for example, shows how implantation cures
the patient from the symptoms of deafness (i.e., depression, social exclusion, and
unhappiness). We can see a happy and laughing mother with her formerly
communication-less child, which signals happiness with their accordingly optimis-
tic facial expression. In some of the images, we can also spot a CI, the enabler of
successful communication, which, paradoxically, remains visual in order to mark
the formerly “abnormal” “disabled child”. The visibility of the CI in the image sug-
gests that something that was not right is now fixed (cf. Spöhrer 2013a: 387).
Eventually, Kylie’s implantation surgery, which is not mentioned in the book, pro-
ceeds without incidence. In one of the final images, she is shown with the implant,
visibly worn behind her ear, smiling, and – as suggested by the stylized staffs sur-
rounding her head – finally able to hear music again (her mother standing behind
her with tears of joy). On the last page of the book, Kylie instantly regains the ability
to participate in social life and consequently meets a boy named Jason Spellman,
who, just like in her dreams, becomes her ideal (romantic) dancing partner.
Parallel to such narratives of successful communication, which assert that hear-
ing is the key to happiness and social inclusion, the second model of communication
(sign language in deaf communities) is also commonly reworked in visual narrative
234 A. Grebe et al.
media. However, on the one hand, CI implantation, as used here, is not represented
as resulting in happiness, but instead leading to social exclusion and depression. On
the other hand, in contrast to commercial pedagogical and medical guidebooks,
such visual productions are mostly amateur drawings distributed via the Internet.
Interestingly, such deaf amateur comic strips and drawings also narrate a “before
and after” story, just as in Kylie Gets a Cochlear Implant (and other children’s pic-
ture books6) and autobiographical stories, such as Hear Again by Arlene Romoff
(1999), which mostly recounts the protagonist’s journey from isolation and deaf-
ness to societal reintegration following CI surgery. One example of such a cartoon
is Cochlear Implant Before and After by Bruce Hanson, which was published in
1993 in the magazine Silent News.7 The comic strip consists of two panels: the first
shows a “[h]appy deaf child, normal ASL [American Sign Language]-using mem-
ber of deaf community,” which provocatively suggests that members of Deaf com-
munities have other models of “normal” communication that do not require the aid
of technical devices. According to this perspective, non-hearing does not lead to
psychological issues, social exclusion, or chronic unhappiness. In the right-hand
panel, the same character is represented after CI surgery, although his facial expres-
sion and gestures are characterized by sadness – a stylized tear drop supports this
impression. On the bottom left of the back of his shaved head, a stylized scar can be
spotted, which in the context of the cartoon can, on the one hand, be interpreted as
a physical scar resulting from surgery, while on the other hand, may symbolize a
psychological scar as a result of being “forced into years of intensive speech therapy
to try to fit in a ‘hearing world’ with no chance of being normal” and thus being
“scarred for life,” as the subtitles of the comic strip suggest. In contrast to medicinal
back-to-life success stories, the message here is that implantation of a CI causes that
which it is supposed to cure, specifically, psychological and emotional issues, social
exclusion, and depression.
“I’m Not Deaf”: Switched at Birth (2011)
It is hardly necessary to mention that TV series have become exceedingly popular,

cover a wide thematic range, and sometimes address the complexity of a particular
narrative (Brunsdon 1990; Thompson 1996; Creeber 2004). For these and many
other reasons, TV series have become the subject of numerous research projects in
the field of media studies (Allrath and Gymnich 2005; Mittell 2006; Newman 2006).
In the following example, we call attention to one particular narrative from a recent
TV series about CI (Geraghty 2003).
Switched at Birth (Weiss 2011–2017) is a highly praised American drama TV
series that premiered on ABC Family in 2011. The starting point of the story revolves
around two 15-year-old girls, Bay and Daphne, who discover that they had been
6
For example Kupfer and Lyon (2012) and Dussling (2010).
7
The image can be found in Chaikof (2008).
switched at birth. While Bay, an artistically gifted girl of Puerto Rican descent with
mediocre grades in school, grew up sheltered and spoiled with a wealthy white
Kennish family, the red-haired, empathic, and ambitious Daphne was raised by a
single mother in a Latino neighborhood. At the age of 3, Daphne became deaf after
a bout of meningitis, which is why she attends a High School for the Deaf and Hard
of Hearing. Although she is still able to use spoken language to communicate, she
is now fluent in American Sign Language (ASL). After the tragic switch of Bay and
Daphne is revealed, several conflicts between their families, friends, and cultures
keep the narration moving forward, leading to the production of the fifth and last
season, which was shown in the US in 2017. The series not only received very high
audience ratings, but also met with very positive feedback from the so-called “Deaf
Community,” who praised the show for representing them realistically as a culture
with their own language and practices while at the same time not denoting them as
disabled or as less self-sufficient than their hearing counterparts.8 This is further
reflected in the aesthetics of the series: The protagonists are shown from the front
while talking, so viewers can see their lips, and different types of subtitles are avail-
able for hearing and non-hearing persons.9
CI is an ongoing subject of the first and second seasons of Switched at Birth:
Bay’s boyfriend Emmett, who is deaf and comes from a deaf family, argues with his
father who, after falling in love with a hearing woman, suddenly wants to get a CI
and doesn’t realize that his son Emmett might feel rejected as a non-hearing per-
son.10 John, who is Bay’s legal and Daphne’s biological father, repeatedly suggests
that Daphne should get a CI now that she knows her biological parents are wealthy
and that they could afford the operation. One particular episode of the second sea-
son explicitly picks up on a current discursive area of conflict regarding the CI:
“Ecce Mono”11 is a so-called “what if?” episode, which can be interpreted as a
dream that John has after he collapses in his kitchen from a heart attack. In this
vision or dream, the switch was discovered when Daphne and Bay were 3 years old,
not 15; Daphne, who became deaf shortly before being taken out of her mother’s
custody, grows up with the Kennish family as a sibling of Bay and her brother Toby.
Thirteen years later in the “what if?” universe, Daphne has become a manipulative,
arrogant, and selfish young woman who would rather charge expensive clothing to
8
“The remarkable thing about the show is that it deals with issues of deafness and Deaf Culture
extremely well, addressing issues of mainstream vs. Deaf education (i.e., lip-reading, cochlear
implantation, romantic relationships between Deaf and hearing people, the decision of whether to
use one’s voice, etc.) in an informative and respectful manner that feels organic to the plot of the
series.” Cf. http://www.redeafined.com/2012/02/why-abc-familys-switched-at-birth-is.html
(accessed April 1, 2016).
9
In season 2, an entire episode (episode 9, “Uprising”) is presented without spoken language, but
only rather by means of American Sign Language and background sounds. http://www.tvfanatic.
com/shows/switched-at-birth/episodes/season-2/uprising/ (accessed April 1, 2016).
10
Especially in “Prudence, avarice, lust, justice, anger” (season 2, episode 17) and “What goes up
must come down” (season 2, episode 19), the conflict between Emmett and his father is being tied
to the CI as discussed in the introductory part of this text.
11
Switched at Birth (Weiss 2011), ECCE MONO, season 2, episode 15, D: Lizzy Weiss.
236 A. Grebe et al.
her credit card than do social or homework, unlike the Daphne outside the “what
if?” reality. Most importantly, she now wears a CI, describing herself to others as
“not deaf”.12 Her almost excessive shallowness, alongside her sexually promiscuous
representation, are complemented by other quite striking characteristics: While the
“normal” and “good” Daphne are both vegetarian, the “arrogant” and “mean”
Daphne eats a whole plate of bacon for breakfast; her mother Kathryn cheats on her
husband John with his worst enemy; Bay needs to see a therapist and Regina,
Daphne’s legal mom, dies of a broken heart; and so on. So, by means of the figura-
tion of the hearing Daphne, the CI becomes implicitly linked to bad personal traits
and to a collapsed family life, whereas the deaf and ASL-speaking Daphne displays
desirable and worthwhile characteristics.
Among other things, this episode became the catalyst for a debate on American
blogs written by members of the deaf community as well as in discussion forums for
CI-bearers. The discussion was twofold, whether the CI was portrayed correctly in
the episode and whether the CI was supposed to be responsible for Daphne’s arro-
gant and anti-social behavior. A writer to the Deaf Culture blog redeafined.com
asked whether Daphne would actually be able to speak without an accent while
wearing a CI, as deaf Daphne speaks with an accent because she can’t hear herself
talking.13 Yet, the blog basically praises the idea that a person with a CI is being
represented at all in the series. The pro-CI blog cochlearimplantonline.com accuses
the series of wrongly representing the CI while emphasizing its benefits in social
life and self-development.14 In the blog author’s opinion, Daphne did not become a
bad person because of the implant, but rather because of having rich parents. To our
surprise and to that of bloggers in the deaf community, these comments completely
disregard the reactions of Daphne’s siblings Bay and Toby, who blame the CI for
Daphne’s arrogance. In an argument with her parents, Daphne blames her “not hear-
ing well” for her own misconduct. She claims that she plundered her parent’s credit
card for shopping because she needed new clothing to be accepted in the hearing
community at a high school party. Her eavesdropping siblings agree: “She’s playing
her Cochlear card again”.15 But, when Daphne wakes up in a stranger’s bed after a
college party and breaks down crying in her closet after she gets home, the viewer
probably might link her CI not only to a concept of promiscuity again, but also
might assume that Daphne herself cannot be a thoroughly happy young woman due
to her wearing an implant – a device that keeps her from feeling appendant to a
particular culture or community.
12
Switched at Birth (Weiss 2011), ECCE MONO, season 2, episode 15, D: Lizzy Weiss, TC
00:24:37.
13
http://www.redeafined.com/2013/07/switched-at-births-first-big-mistake.html (accessed April 1,
2016).
14
http://cochlearimplantonline.com/site/switched-at-birth-commentary-ecce-mono/ (accessed April
1, 2016).
15
Switched at Birth (USA 2011–), ECCE MONO, season 2, episode 15, D: Lizzy Weiss, TC
00:12:20; on cochlearimplantonline.com, one of the authors uses the expression the opposite way
by saying that for example Emmett is “playing the deaf card” several times within the series: http://
cochlearimplantonline.com/site/switched-at-birth-episode-56-7/ (accessed April 1, 2016).
YouTube Videos and the “Switch On”
By visiting the video-sharing website YouTube and entering the keywords “hearing
for the first time,” one is able to find hundreds of amateur videos – mostly smart-
phone or camcorder recordings – showing the activation of a CI. The setting appear-
ing in these films usually consists of an audiologist’s laboratory, the audiologist
sitting in front of a computer, and the patient to be “switched on.” The script of these
films is quite simple: First, the audiologist pushes some buttons and subsequently
asks the patient if s/he hears something, or telling him/her that it might sound a little
strange. Then, adult patients articulate a physical reaction, seem to be overwhelmed,
cannot respond, and start to cry. Some explanations by the audiologist follow in
order to calm the patient – that is the end of the story and happy ending. By repeat-
ing endlessly the same pattern with only minor variations, these films seem to re-
produce the medical success story of the neuroprosthesis and suggest that hearing
can simply be “switched on.” This argument corresponds to medical rhetoric: Since
its introduction in the 1970s and 1980s, and dissemination in the 1990s, physicians,
CI manufacturers, and others have emphasized the implant system’s “simple” prin-
ciple and positive results, whereas surgical risks, financial burdens, as well as the
following complex pre- and post-operational therapies (cf. Clark 2003) are often
faded into the background. The videos relate to this discourse by literally editing out
the procedures endured by the recipient in preparation of the implantation, the pos-
sibly painful decision for the implant, the surgery itself, and the subsequent difficul-
ties with speech therapy needed in most cases to foster an inclusion of the CI-bearer
into the hearing world. Relying on an ableist argument (Campbell 2003: 37), these
videos seem to frame the process of self-optimization and normalization in a rather
positive manner without questioning further implications or demonstrating alterna-
tives (Ochsner et al. 2015; Ochsner 2017). Consequently, the audiovisual and seem-
ingly “authentic” transformation of a hearing person through the space created by
the amateur video also excludes any references to sign language or Deaf communi-
ties as another way of dealing with the issue of hearing loss, deafness, and non-
hearing communication practices.
Videos like the one showing the activation of Sarah Churman (2014; The Ellen
Show 2014) and Joanne Milne (The Telegraph 2014) have had several million views
on YouTube. They have also been shared on other social networks and may turn
“viral.” The simplification of the whole process of receiving a CI in these videos
provokes a series of critical comments. Hence, there are instances, where CI-related
controversies mentioned in the beginning of this paper become relevant. Thereby,
the common view articulated in so-called “first time activation” videos – which sug-
gest that the “switch on” is a highly positively emotionalized moment showing the
transformation of a deaf into a hearing person – is contested. William Mager, him-
self a CI-bearer, affirms that “[t]he switch on is usually the worst day of most peo-
ple’s lives” (2013). Lilit Marcus, a CODA (child of deaf adults), also disagrees with
the hype of the activation videos like the one about Joane Milne, in which the medi-
cal procedure is often presented as a kind of modern and affective “miracle.” Marcus
238 A. Grebe et al.
states that “these ‘inspiring’ videos continue to push one of the most problematic
narratives in the history of the Deaf community: that deaf people are broken and
therefore need to be ‘fixed’. In reality, there’s no such thing as a happily-ever-after”
(Marcus 2014). The point made by Marcus casts a doubt on the ‘miraculous’ trans-
formation the Activation-Videos present. Also, the values of Deaf culture and the
importance of sign language should be acknowledged, as evidenced by Deaf activ-
ists who normally reject their designation as disabled or “broken.”
However, one can also find examples that go beyond the controversial pros and
cons of CI-related controversies. Again, it is worth taking into account user-
generated content published on video-sharing sites. Consider, for example, the pro-
duction Man hears for the first time posted on YouTube by a user called Deer Prom
on June 19, 2014 (Deer Prom 2014). The protagonists of this fictional short film are
an audiologist, his assistant, the implant-bearer, and his wife. As the title suggests,
this production mocks the “first time activation” videos discussed above.
Furthermore, as discussed in the following, the film, thereby, does not only argue
against a medical model of disability (Shakespeare 2006), but also radically exposes
the intersection of discourse about disability, race, and gender (Davis 1995).
At the beginning of the film, a black screen appears with a quote from Elbert
Hubbard saying that “I would rather be able to appreciate things I cannot have than
to have things I am not able to appreciate.” In addition to the title, the film’s epi-
graph, hence, anticipates a critique of normal hearing that should be achieved by
any means available, even if such a mode of sociotechnical hearing would fail to
provide the ultimate and perfect outcome, as many would expect. While Hubbard’s
motto appears, there is a buzzing noise on the soundtrack. One hears some distorted
speech that at first is not understandable. Then, the sound alternates between buzz-
ing and speech fragments while the first shot of the film enters the screen. It shows
the audiologist preparing the external device of the implant and saying to his patient:
“Technically, we’re on. Can you hear me?” The soundtrack is now without distor-
tions and a close-up of the CI-bearer shows his face in an exaggerated emotional-
ized expression, crying. Through the subtle use of audio effects, this introductory
scene creates a sense of what it would sound to hear without and with a CI.16 By
doing so, “disabled” hearing is constructed as deficient in relation to “normal” hear-
ing. The latter corresponds here to the seemingly “natural” stereo sound of the stan-
dardized audio and voice recording equipment nowadays used for digital low-budget
production. This filmic technique produces a series of differences between normal
and disabled hearing, and focuses mainly on the aspect of speech comprehension. It
audiovisually generates a specific translation of what it means (or not) to hear a
particular representation that might not correspond to the whole spectrum of audi-
tory experiences among hard of hearing people. In the following, the radically and
instantaneously transformed hearing of the implant-bearer is further qualified as he
is also instantaneously able to perceive the ringtone of a mobile phone used by the
assistant, or the music title “Crazy Love” by Van Morrison played on the laptop of
16
Cf. the comparison of hearing speech with a CI and normal hearing capacities in “What do
cochlear implants sound like? 1 – Speech”, in Auditory Neuroscience, https://auditoryneurosci-
ence.com/prosthetics/noise_vocoded_speech (accessed December 18, 2014).
the audiologist. Even if the patient’s music perception is somehow distorted through
a sound effect, the “integration” of the implant-bearer into the acoustic world seems
to be successfully realized. The film, hence, demonstrates in this scene that all of the
people involved, including the implant-bearer, the audiologist, and his assistant,
seem to be satisfied and the promise of the CI seems to be fulfilled. However, as
short films (Felando 2015) are often about surprising turnarounds, this apparent
happy ending is about to be deconstructed.17
Man hears for the first time ironically brings up a series of obviously stereotyped
arguments to critically re-examine the narrative of the “first time activation” videos
and the idealized transformation of a deaf into a hearing individual. In this way, the
mimicked activation scene at the beginning is relativized, if not totally mocked, in
the rest of the film. The first aspect to be addressed is a so-called “female dimen-
sion” of the acoustic world. After having heard the voices of the audiologist and his
assistant, the ringtone, and Van Morrison’s music, the implant-bearer is confronted
with the voice of his wife for the “first time.” Until this moment, his wife was neither
introduced in the film, nor was she barely visible in the frame. When she begins to
speak, the protagonist immediately reacts and wants the audiologist to turn off “that
sound,” as he negatively calls it. Apparently, the protagonist is very annoyed by the
sound of his wife’s voice. Staging such a rejection satirizes the romanticized image
produced by “first time activation” videos, while focusing on hearing relatives’
voices for the first time, be it the father or mother, husband or wife saying the words
“I love you” or asking “Do you want to marry me?” (Richards 2016). This argument
is pushed further when it comes to musical taste and preferences. On the one hand,
the film constructs a male musical taste by including Van Morrison’s “Crazy love”
(Mills 2010), a romantic song that begins with the line “I can hear her heart beat for
a thousand miles.” However, the film soon deconstructs the idealized imagination of
heterosexual relationships associated with this love song. Thus, the wife is not only
characterized by having a rather hysterical voice, but also poor musical taste. When
she plays some commercial pop music on her smartphone, the implant-bearer again
demonstrates his refusal of this kind of auditory experience. Not only does the pro-
tagonist reject the voice of his partner, but also her musical preferences, a dimension
of his wife he obviously was not acquainted with before his activation. The film
intends to convey an impression of the CI-activation as “the worst day of most peo-
ple’s lives” (Mager 2013) and, thereby, argues against a “happily ever after” sce-
nario (Marcus 2014). At the same time, this critique of framing Deafness and its
medical treatment is based on the construction of a seemingly absurd and exagger-
ated dichotomous female/male hearing experience, a thoroughly provocative attempt
to “laugh at disability” (cf. Ellis and Kent 2011: 58) and its alleged cure.
Still, the process of ridiculing the spectacle of “first time activation” videos is not
limited to the humorously exposed intersection of discourses about gender and
disability. The film attempts to go beyond this scope and also tackles questions of
racism and sexism. This is exemplified in a discussion between the audiologist and
17
This is also obvious if one has in mind that one of the contributors to Deer Prom, John McKeever,
is a comedian. Cf. https://johnnymckeever.wordpress.com/ (accessed December 18, 2014).
240 A. Grebe et al.
his assistant. Both try to convince the implant-bearer with their arguments to become
a hearing person as opposed to remaining deaf. While the audiologist emphasizes
the possibility to hear natural sounds, like bird songs, his assistant challenges this
view – and thereby his medical authority – by pointing out the supposedly negative
effects of hearing, thereby further developing the above-discussed ironized and ste-
reotyped vision of a female acoustic world. It is the assistant who suggests it would
be better to remain deaf than to hear “two black ladies talking on the train,” as he
puts it. Here, a racialized and sexist vision of the world is exposed and criticized
(Bradley 2015). Paradoxically, this serves as an argument, which stresses the advan-
tages of being disabled; that is, being able not to hear a conversation that one is not
interested in. Consequently, the often discussed division of a “hearing” and “non-
hearing” world is complicated in the film by the introduction of other important and
no less controversial aspects relevant for processes of identification in contempo-
rary societies (Davis 2013, Part V).
Finally, in the course of the interchange of arguments about the acoustic world
constructed by the film, the discussion continues to heat-up until the point where the
protagonist makes a decision. Although he is inclined to agree with the point made
by the audiologist, that the implant will enable him to hear the sound of water falls
and the singing of birds, he finally rejects it. The climax is staged with a polemic
crosstalk where all of the present characters are shouting at each other defending
their arguments. Fuzzy hand-held camera shots underpin the chaotic character of
the situation. Positioned in such a cacophonic environment, the implant-bearer is
framed by a medium shot showing him as he pushes the external device of the
implant out of his ear. This is followed by the buzzing noise already heard at the
beginning of the film and, hence, signaling the end of “normal hearing.” Subsequently,
the patient is shown in a relaxed pose. Hence, this is a deliberate disconnect from
the “hearing world” (cf. Watson and Gregory 2005). While the camera continues to
focus on the protagonist, “Crazy Love” is played again on the soundtrack. With his
eyes closed, the protagonist enjoys his memory of a song connected to the “male”
sphere of life. Now, in his “world of silence,” he seems to be rid of the discussions
still continuing between the medical professionals and the woman, who is loved for
all she is – except for her voice and taste of music. This showdown of the short film
shifts attention to a far less prominent aspect in the success story of the CI, namely
its rejection and deactivation by its users.
Conclusion
As we have shown, within the different case studies under analysis, one finds differ-
ent modes through which popular discourse of the CI is articulated. The production
of the CI is, hence, not limited to a circle of professionals from the medical field.
Whereas manufacturers, engineers, and physicians indeed play an important role, as
well as institutional actors like the Food and Drug Administration in the US and
similar agencies in other parts of the world, Deaf communities, the press, and social
media sites also have to be considered as agencies relevant to the sociotechnical

formation of the CI. Therefore, it is necessary that we understand the term “popu-
lar,” not in the strict sense as a form of simplification, but rather as a type of expert
discourse transformed into an argument that can be understood by all. Although this
is sometimes the case, we mainly argue that as the controversies around CI unfold,
the discourse is constantly changing, being transformed and translated by the inter-
ventions of different human as well as nonhuman agencies. We consequently
emphasize the potential of images, videos, and TV series to not only represent, but
also to fully grasp the scope of the effects they have regarding the discourse around
this neurotechnological device. In addition, we have shown that different media
rework and translate discourse on CI according to their distinct objectives, as well
as conditions of production and reception. Media analysis then cannot be limited to
the reconstruction or deconstruction of “story elements” or mere discursive “state-
ments” only, but need to take into consideration the complexity and heterogeneity
of its relationships in networks. This is evident in our first example: on the one hand,
a children’s comic book, like Kylie Gets a Cochlear Implant, is not only conditioned
by a distinct mode of media production and distribution, and the specific demands
of its target audience (parents of deaf or hard of hearing toddlers), but on the other
hand, is conditioned by the narrative–aesthetic form of the comic. Furthermore, our
second example, Switched at Birth, demonstrates that a contemporary TV series
does not stand for itself, but rather positively calls upon their viewers and fans to
join in the discourse by using fan sites and forums where they can discuss each
episode, character, and narrative arc, such as the social conditions of being deaf or
hard of hearing. One might assume that the sharp reactions towards the representa-
tion of the CI within the (deaf, CI-bearing, or hearing) fan community would lead
the producers of the series to focus less on CI and audism discourse in the following
seasons 3 and 4, while concentrating more on issues concerning the everyday life of
an adolescent deaf person in a hearing world. Finally, we analyzed amateur produc-
tions posted on video-sharing websites regarding perspectives on CI. It was demon-
strated how “first time activation” videos create a space where the spectacle and
promise of being able to hear are staged in a way that resonates with the medical
rhetoric about a simple “switch on” of the implant. A discussion of an example fol-
lowed that challenges and mocks the monolithic popularized success story of the
CI. The production Man hears for the first time dramatizes the potential negative
aspects of sociotechnical hearing and explores the dark sides of being permanently
connected to diverse auditory situations and, hence, separated from calm and quiet
environments.
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Between Utopia and Dystopia:
Contemporary Art and Its Conflicting
Representations of Scientific Knowledge
German Alfonso Nunez
Introduction1
By reviewing the artworks of three different artists concerned with genetics, this
article investigates how different artistic discourses and practices interpret and rep-
resent science and its products. The result of this enquiry shows that artists gener-
ally positioned within that which we may label as the Art, Science and Technology
world (AST) not only apprehend science differently than its peers but also represent
it in a very particular and positive way: Whereas AST artists see science and tech-
nology as beneficial, empowering and, ultimately, progressive tools which can
improve our human condition, some in the larger art world perceive technology and
science as proxies of an increasingly technocratic, dehumanizing society.2
Despite not being a subject usually associated with popular culture, here we also
imply that symbolic products deriving from the erudite pole of the field of cultural
production (Bourdieu 1993), that is to say, a “field of restricted production as a sys-
tem producing cultural goods (and the instruments for appropriating these goods)
objectively destined for a public of producers of cultural goods” (Ibid., 115), may
well serve researchers interested in the subject proposed by this book: the interac-
tion between culture and biomedical knowledge. If, on the one hand, the analyses of
popular culture may serve as a proxy of general dispositions towards science, the
analyses of restricted symbolic goods may well serve as a tool for depicting the
anxieties, wishes, and representations of specific, close-knit, social groups.
1
This paper is an abridged version of our thesis’ final chapter (Nunez 2016).
2
For different discussions into the historical development of this technophobic apprehension, as
well as readings concerned with the troubling relationship between the AST and contemporary art,
please refer to Nunez (2016), Salah (2008), Taylor (2014), Shanken (2016) and Goodyear (2008).
G. A. Nunez (*)
Faculty of Philosophy, Languages and Literature, and Human Sciences (FFLCH),
University of São Paulo, São Paulo, Brazil

https://doi.org/10.1007/978-3-319-90677-5_18
246 G. A. Nunez
The payoff for this research is, hence, threefold: First, we historically ground
today’s division between artistic technophilia and technophobia as a consequence of
exogenous cultural changes and not only endogenous artistic ones.3 Second, by
stressing the importance of larger cultural changes in the artistic perception of sci-
ence, we realize that these oppositional artistic discourses are not only produced by
individual dispositions but are also the result of historically constituted collective
frames4 employed in order to justify one’s art. Third, as we clarify AST discourse
and demonstrate its institutional resilience despite larger artistic opposition, we also
find that its current position resemble that of authors positioned within the transhu-
man movement, indicating not only a mere coincidence but, it seems, a larger cul-
tural trend that can be attested by different social groups, from artists to
philosophers.
In order to avoid a lengthy discussion into the labelling system adopted by our
text, it is important to note that our acronym, AST, is not proposed out of thin air,
but follows the subtitle of the most enduring publication dedicated to AST, Leonardo,
the journal of the International Society for the Arts, Sciences and Technology, today
published by the MIT Press. Leonardo, as is usually referred to, has followed and
shaped AST since its very early days. Founded in Paris by artist and research engi-
neer Frank Malina back in 1968, the journal was created with the explicit objective
of “addressing the two cultures debate” (Malina 2008) and it has outlived many of
the labels proposed by AST members. A node to C.P Snow’s 1959 famous lecture,
which denounced the increasing gap between the humanities and the sciences, the
journal provided a platform for artists to discuss the interactions of artistic and sci-
entific methods and theories. Although open to all artists, from any kind of back-
ground (Malina 1968), already in its early editions there was the sense that the
journal favoured the “eggheads” (Gray 1968). The journal might have been open to
all; its target audience, however, was very much part of the two cultures debate.
Since this perceived gap was an important cultural topic of the fifties and sixties
(Klütsch 2007a; Taylor 2014), Leonardo quickly became a central point for AST
practitioners. Amongst those early movements central to Leonardo’s (and AST’s)
development, we find Computer Art.
3
Also referred to as opportunity spaces or ‘political opportunity’ (Meyer and Minkoff 2004), these
exogenous factors are larger historical, social, intellectual and material changes outside the scope
of the artistic world in question: it is these that, in the first place, allow for the development of new
genres or practices via either new resources and/opportunities. Endogenous factors, differently
than exogenous ones, are related with the artistic field own internal rules, disputes and structures.
A new artistic genre, in order to be recognized as such, as valid and legitimate, must allow itself to
be justified by previously established parameters and conventions. As Becker (2008) remind us,
conventions play a significant role in this game. Differently than large-scale productions, restricted
symbolic goods, as Bourdieu (1993) reminds us, are not measured by financial return or popularity:
in fact the opposite is true. For an overview discussion over the benefits and limits of these concepts
applied to the study of artistic worlds, as well as further conceptualization, see Baumann (2007).
4
A concept also drawn from the Social Movement literature, collective action frames developed from
the work of Goffman (1986) and can be seen as “sets of beliefs and meanings that inspire and legiti-
mate the activities and campaigns of a social movement organization” (Benford and Snow 2000,
p. 614). Again, please refer to Baumann (2007) for more information about its application and limits.
Between Utopia and Dystopia: Contemporary Art and Its Conflicting Representations… 247
From Computer Art to the AST
Computer Art represents a starting point in the historical development of AST for
that it was perhaps the most discussed and polemical form of new technology in the
arts. Mirroring Frank Malina’s career – and Leonardo’s propositions – early
Computers Artists were not artists per se. They were scientists, engineers, and math-
ematicians working at companies such as AT&T, Siemens and IBM. They showed a
deep trust in reason in the form of rational formalistic theories (e.g. game theory,
rational choice, information theory, Chomsky linguistics, cybernetics, etc.) and, in
essence, were trying to achieve the same objectivity in art. In order words, some of
these Computer Art pioneers were attempting to not only quantify aesthetic value
but also artistic method.5 Notwithstanding the limitations of C. P. Snow’s distinction
between the arts and the sciences, early Computer Art, like Leonardo itself, is a
direct response to it (Klütsch 2007a, b; Taylor 2014). Taylor (2014), for example,
highlights that the very iconic figure of Leonardo, the Renaissance master and not
the journal, epitomized the image of the scientist-artist uniting the two opposed
cultures, of the sciences and the humanities. Hence, “Leonardo, as the exemplar for
creative genius and unified practice, became an icon and central trope within com-
puter art discourse” (Ibid., 103).
Another crucial point in this history is the broad social protests that propagated
through the late 1960s. Ironically, since many in the counter-culture and the left saw
computers as embodiments of the military-industrial complex (Turner 2006),6 this
period also saw the height of Computer Art’s first phase, which lasted from 1965 up
to 1971. Within this short timespan, Computer Art had grown from being a very
particular and confined practice to producing some huge exhibitions, as exemplified
by the now well documented Cybernetic Serendipity, which attracted around 60.000
people to the Institute of Contemporary Art in London. Notwithstanding this sudden
popularity, it comes as no surprise that, as the curator of the show recorded, “the
same venture in Paris would have needed police protection” (in Usselmann 2003:
389). Despite still finding support dedicated to these rationalistic practices, espe-
cially within technocratic circles such as the ones sponsored by the military-
industrial complex, by 1970, with the further development of the Vietnam War and
increasing cold war paranoia, the general mood of the humanities and the arts had
changed. Tellingly, the public reaction to the first ever public exhibition of Computer
Art, held in 1965 at Stuttgart University and curated by Bauhaus and Ulm alumni
Max Bense, was a fretful one. Already then, some rather conservative prints had
turned small academic exhibitions, which were usually unexciting events, into a
5
The clearest example of this propensity can be found in the Stuttgart school of Computer Art
(Klütsch 2007b) under Max Bense’s tutelage. Their North American counterparts, however, also
played with this idea. Michael Noll’s (1966) infamous Mondrian experiment, which attempted to
recreated Mondrian’s style only to then question his colleagues whether his work, in contrast with
a real Mondrian, was the real Mondrian, is perhaps the best-known example.
6
For a valuable resource that provides an understanding of the rationale of late sixties protests
against not only computer but also the ‘technocratic’ society, see Roszak (1969).
248 G. A. Nunez
clash of different and opposing views. According to observers, as soon as the artist
Georg Ness, a career engineer at Siemens, remarked that computers had made the
pictures, the crowd turned hostile. Some of the local artists, outraged by the preten-
sion of the Computer Artist, slammed the doors of the gallery and left (Nake 2009).
It could be argued that what really touched a nerve with that artistic crowd was
that the computer, a symbol of rationalism and technocracy, was stepping into what
is usually considered by them as the last human refuge, a realm in which humans
can be considered unique, namely in terms of their creativity and intelligence (Salah
2008). With the cultural turn of the mid-sixties, those aggressive reactions would
become ever more common. As far as the majority of art world members were con-
cerned, computers had nothing to do with art. Usually accused of dehumanizing art,
these positions were taken in a delicate moment where the apex of that previous
technophile sentiment that had initiated at the end of WWII, was losing momentum
and concluded in the growth of a major counter-culture movement which denounced
art’s involvement with anything related to the military-industrial complex, e.g. com-
puter, technology, and science.7
Two Worlds and Two Opposing Views
Despite mounting criticism and internal disputes regarding the future of computer
art – or any combination between the arts and sciences for that matter – many of
those artists kept producing and the genre grew, albeit in a self-contained and
detached manner. Whereas some would retreat to their original positions as engi-
neers or academics, publications like Leonardo or groups such as the Computer Art
Society, founded in 1968, managed to continue its activities and, in effect, worked
as focal points for those yet interested in the intersection between art, science and
technology (an ironic development of sorts, since it was their shared rejection that
managed to keep these individuals collaborating together). Incapable of belonging
to traditional artistic spaces, except on rare occasions, new spaces were eventually
created in order to accommodate their growing production.
The division initiated in the 1960s, between the embryonic AST, via early
Computer Art, and the larger artistic field, persists to this day. In order to demon-
strate that AST artists today are in a position of veiled disagreement with many in
the artistic field and that exactly because of this division, the apprehension of scien-
tific knowledge differs in both groups, we will briefly compare the artworks and
discourses of three different individuals. One of them, Eduardo Kac, is representa-
tive of AST practices; the other two, the duo Jake and Dinos Chapman, represent the
7
We should note that it was not only the public that had turned hostile to these practices. Some of
these same pioneers, like Frieder Nake, would also condemn the embryonic AST for its cosy rela-
tionship with the military-industrial complex (Nake 1971). For a history of this post WWII opti-
mism in relation to computer art, please refer to (Nunez 2016).
larger artistic world. The rationale for this choice is simple: all of them share the
propensity to discuss and interpret genetics.
First let us focus on the Chapmans’ artwork Zygotic Acceleration, Biogenetic,
De-sublimated Libidinal Model (1995). An unsettling but also kitsch sculpture, this
creature looks everywhere; there is no place where you can escape from its many
faces. Its body is a confusing interconnected amalgam of human forms. Sexual
organs, both male and female, are distributed unevenly across its many faces. On its
many legs, there are sneakers instead of feet. Despite its youngish looks, according
to the duo, these are not children: “Our organisms are genetically mature and dislike
being called children. They wear sneakers so that they can run fast like super-
powered nomads” (Chapman and Chapman n.d.). There is a strong and well-defined
strategy in Zygotic Acceleration, as well as other works from the duo, that seems to
be absorbed and understood by all its fans and critics: its capacity to visually shock
and spark a debate on the limits of representation (Grunberg 2007; Stallabrass 2006:
102–103; TATE Liverpool 2006). Intended to be a commentary on our modern
morality and the body (Grunberg 2007), the Chapman duo’s work uses mannequins
of deformed children as a way of inciting a reaction from the viewer. Clearly involv-
ing some avant-garde ideas of shock value, it is interesting to note that, for the sup-
porters of both brothers, art theory is used as a form of defense against claims of
sensationalism (Stallabrass 2006: 102). Zygotic Acceleration, however, apparently
does not aim to criticise genetics or other “anti-humanist viruses” (Chapman and
Chapman n.d.). Jake Chapman succinctly exposes this idea by affirming that the
brothers “work analytically rather than critically. We aren’t trying to solve genetic
engineering problems when we deal with the subject of cloning” (in Kunsthaus
Bregenz 2005).
Despite their claim that they are not interested in commenting on genetics itself,
Zygotic Acceleration epitomises the popular reading of genetics as an immoral and
monstrous practice. The monstrosity of its result, the deformed children in Zygotic
Acceleration, is then used against the viewer, who, consequently, ought to be dis-
gusted by it. In other words, the Chapmans’ aesthetic strategy attempts to use this
(perceived) terrible threat, genetics, as a way of achieving a desired moral panic
(Chapman and Chapman in Grunberg 2007: 11). Not only do they establish genetics
as sinful but they also choose to engage with it knowing that it will cause their
desired result: moral panic. When they say that they do not want to resolve the
“genetic engineering problem” it is because, from their point of view, this problem
is not theirs. Their intention is to use these ‘problems’ to excite reactions from view-
ers. Genetic engineering, by its very use, as a trigger of moral panic, is defined and
represented as a horrendous practice and not something to be celebrated or even
discussed. It has already been defined as such. They may say that they ‘work ana-
lytically rather than critically’; however, this is not what we see in action with
Zygotic Acceleration, itself a very critical depiction of genetic engineering.
One could indeed be tempted to understand the Chapmans as mockers and van-
dals of modernity, rationality and even Enlightenment ideals. What we cannot for-
get, however, is that theirs is a position pretty much in tune with the artistic debates
emerging from the late 1960s, present not only in the arts but also in culture in
250 G. A. Nunez
general. The technocratic, rational and positivistic world being condemned and
used by the Chapmans is precisely the world condemned by the counter-culture.
Genetics, along with capitalism and technocracy, then, are portrayed as diseases
facing individuals and societies and, in turn, are used as aesthetical artifices that
should – in theory – wake people from their “artificial sleep” (Grunberg 2007: 28).
The duo undoubtedly sit at the centre of what we have so far labelled as the art
world. They have works commissioned by institutions such as the Tate, they are part
of numerous private collections such as Saatchi’s, their works are constantly
exchanged for hundreds of thousands pounds, they are highly visible in the special-
ist press, they are represented by highly prestigious galleries, etc. It would be naïve
to consider these artists as marginal ones. Their prestige indicates a resonance with
art world concerns and, despite some dissonant voices as exemplified by the critics
above, the fact is that they are central participants in the contemporary art world.
The same, however, cannot be said of our next artist.
As Roger Malina remarked in 2001, Leonardo today receives “texts from a new
generation of artist-researchers, artists very well versed in contemporary science or
technology” (Malina 2001: 293). Holding to the tradition of 1960s technophilic art-
ists, these new artists still struggle to bridge the two cultures. Eduardo Kac, our next
artist, fits perfectly with the figure of the contemporary AST artist as painted by
Malina. Despite being distant from the centre of the art market and institutions that
usually legitimise production within contemporary art, Kac is central to the AST
practices that emerged out of the early computer art of the 1960s. Very academically
active (like his predecessors), averse to visual shock and not very much discussed
within traditional art institutions, Kac is a central figure of our technophilic art
world, the AST one, and is regarded as the creator or exponent of the bio art prac-
tice. Although not specifically looking for the kind of shock value operating in the
previous example, Kac’s projects are, to say the least, anything but easy. In fact, the
artwork that I shall now focus on not only generated a huge response but was also
the reason for a dispute that itself exemplifies the contentious nature of the genetic
engineering.
Born in 2000, Alba, the glowing rabbit, according to Kac, “is an albino rabbit”
that “only glows when illuminated with the correct light” (Kac 2000). Created “with
EGFP, an enhanced version (i.e., a synthetic mutation) of the original wild-type
green fluorescent gene found in the jellyfish Aequorea Victoria” (Ibid.) Alba was
shown for the first time in France in 2000. Surrounding her birth, there were world-
wide media frenzy and a heated debate regarding the nature of Kac’s artwork.
Differently from the previous example, the shock related to Kac’s work was not
caused by its aesthetics. Instead, what most horrified people was the very idea of
creating a living, genetically altered animal for art’s sake. If compared to Zygotic
Acceleration, Kac’s GFP Bunny project – in which Alba was obviously central – is
impossible to describe simply as an art object and can better be understood if divided
into parts. According to Kac, despite Alba’s “formal and genetic uniqueness” his
project “is a complex social event that starts with the creation of a chimerical animal
that does not exist in nature” (Ibid.). Its intention was to produce a sequence of
dialogues between “professionals of several disciplines and the public” (Ibid.).
Perhaps related to his background as an academic (similarly to many AST artists),

Kac’s art project relies heavily on his theoretical writing. In his paper describing the
project, Kac looks at the history of the human and rabbit relationship, arguing that,
contrary to popular notions, humanity has always interfered with animal evolution
(Ibid.). In true Leonardo fashion, and resembling Malina’s wish for artists to clearly
discuss their own work, Kac’s website hosts many articles, examples, and records
related to the GFP Bunny project, written both by himself and others. The strategy
here is to engage the public with his artwork and spark a debate on the issues raised
by genetic engineering and transgenic organisms.
Curiously, the controversy involved not only Kac but also his collaborators. In
the popular press, the ethical issues concerning new genetically modified organisms
were very much alive. Under the spectre of Dolly the sheep, genetically modified
crops and mad cow disease, the debate developed within a partisan, rather bleak
atmosphere (Dickey 2001). Perhaps because of negative public opinion or perhaps
because of honest ethical concern, despite helping Kac with the creation of Alba, the
French state-funded research centre INRA (Institut National de la Recherche
Agronomique) at the last minute rejected the use of Alba outside the walls of its
laboratories. Ironically Alba, the key element in Kac’s artwork, ended up like any
other scientific animal in captivity. In an article for Wired magazine, Christopher
Dickey describes the tug-of-war involving Kac and his scientific collaborators
(Ibid.). In a sarcastic account of the conflict between artist and scientists, Dickey
exposes the ways in which the public reacts and expresses itself. Searching for pub-
lic reactions to GFP Bunny, we see that the idea of monstrous chimeras was involved
in much of the discussion, expressing itself in both the press and academic circles.
Kac’s radical approach not only exposed a bitter discussion about genetics as a
whole, but also had the effect of causing a debate on art’s (and science’s) responsi-
bility and ethics.
Kac’s appropriation of genetics is very different from the Chapmans’. The artis-
tic representation and use of genetics offer the opportunity to discuss opposing prac-
tices that, otherwise, do not seem to have anything in common. Likewise, by
contrasting Kac’s and Chapman’s artwork it is also possible to peek into the ratio-
nale of these artists’ worlds: respectively, AST and the broader art world. Juxtaposing
the qualities of GFP Bunny and Zygotic Acceleration, we find opposing discourses
in relation to genetics, in particular, and science, rationality, and technology more
generally. While Zygotic Acceleration reutilises the representation of genetics as
immoral and monstrous in order to criticise public assumptions of rationality and
morality, GFP Bunny contests the very idea of this negative representation. On the
one hand, the Chapmans’ use of “anatomical transgression” (Chapman and
Chapman n.d.) is used to question the viewer, not genetics itself. Kac, on the other
hand, intends to question the public’s understanding of genetics. Positioned in dif-
ferent art worlds, each one with its particular historical development, the artworks
speak for two distinct artistic practices: one, sympathetic to genetics, does not rep-
resent but appropriates genetics for artistic purposes (GFP Bunny); the other,
opposed to such engineering, appropriates not genetic techniques but instead its
representation as an immoral practice (Zygotic Acceleration). AST and Kac, with
252 G. A. Nunez
their roots found in the rational rigours of institutions such as Leonardo, is then
positioned in exact opposition to the precepts demonstrated by the Chapmans.
Whereas the Chapmans are active participants in places such as the Tate Modern,
Kac is, unsurprisingly, a member of Leonardo’s editorial board and an active mem-
ber of the AST community.
Technophile Discourses Abound
It is important to remember here that Kac, in fact, is rather moderate in his techno-
philic position. There are others within the AST that are much further down the line
than he is. There are times, for example, that Kac seems very questioning of possi-
ble abuses of technology and, again, reiterates the position so common in his genre
that artists have a responsibility to ethically discuss future scientific possibilities
(Kac 2007a). If we want to find extreme artistic technophilia, we should look at the
work of other artists, such as Orlan or Stelarc. For these artists, genetic engineering
is not a matter to be debated. They do not wish to discuss the positive or negative
aspects of it. For them any scientific development, including genetics, is an aim, a
right. Their objective is clear: to enhance humans. It is in artists such as these that
AST’s technophilia becomes something else, something more vocal, moralistic and
sometimes even sanctimonious. Stelarc specifically, highly active in the AST field,
seems to offer the clearest apology for enhancement. Seeing genetic engineering,
cybernetic implants and other yet-to-be-discovered technologies as part of an imag-
ined arsenal against our obsolete body, Stelarc can be argued to be a quintessential
transhumanist.
Some, like the philosopher Keith Ansell Pearson (1997), tried to distance
Stelarc’s work from this optimistic, technologically oriented strand of transhuman-
ism (philosophical posthumanism) and move it towards the more cautious and ques-
tioning view usually but not always held by cultural transhumanists.8 Yet, it is
difficult to deny the artist’s own words. Stelarc, with his prosthetics and pseudo
enhancements, as we know, is no naïve adopter and is very clear in his texts about
his intentions and expectations. Arguing that our body can no longer match the
strenuous necessities of our new world, Stelarc asks:
How can the body function within this landscape of machines? [...] Perhaps it’s now time to
design the body to match its machines. We somehow have to turbo- drive the body-implant
and augment the brain […] I’m not talking here in terms of sci-fi speculation. For me, these
possibilities are already apparent. What do we do when confronted with the situation where
we discover the body is obsolete? We have to start thinking of strategies for redesigning the
body. (Stelarc n.d.)
8
For a discussion regarding the similarities and differences between transhumanism and posthu-
manism, as well as their historical development, see Miah (2009), Hauskeller (2014a, b) and
Ranisch (2014).
Although sharing a certain technophilic predisposition, Kac’s and Stelarc’s artworks

are not in any way precursors or central to today’s transhumanist debates. Instead,
both artists are reminders of the importance of the subject for certain social groups
and in culture in general. In fact, as observed by Hauskeller (2009, 2013), the sub-
ject is even becoming mainstream. Cinema, literature, video games and the arts: all
those different cultural domains can provide useful examples through which to dis-
cuss technophilic (and technophobic) discourses. Questions regarding the future of
scientific development, it seems, have become central to many cultural agents
(again). As for now, we cannot answer why, how or when this shift occurred; in
order to answer this question, a whole different effort should be proposed. What
seems clear is that, despite not being a consensual shift, as exemplified by the artis-
tic output of the Chapmans, technophilia and its most extreme position, transhu-
manism, do resonate for some people. In relation to GFP Bunny, for example, Kac
recalls that “in the beginning people were quite worked up about it; there was a
greater concern and fear than exists now [...] The discussion now is more philo-
sophical; the sense that some impending doom is about to happen has completely
vanished” (in Anke et al. 2008: 307). The growth in technophilia, not only in the arts
but also in culture at large, we argue, is one of the reasons for the expansion and
resilience of AST. A convergence in discourses from different fields, such as philo-
sophical transhumanism and AST, illustrates this larger cultural trend.
Justifying AST (and Transhumanism)
On his webpage Kac (2000) attempts to ethically justify GFP Bunny by arguing that
humans have always meddled with the genetic development of rabbits.9 According
to his narrative the GFP Bunny project breaks no social or ethical rule since “humans
have determined the evolution of rabbits for at least 1400 years” (Kac 2000).10
Notwithstanding its validity, we also find a similar argument within transhumanist
circles. Transhumanists and AST artists, at first, may seem to share only the call for
a new, improved human. This desire, however, is not the only thing that relates these
two distinct fields. Kac’s description of genetics, for example, as another normal/
natural step in our will for knowledge, is reminiscent of Bostrom’s assertion that
“human desire to acquire new capacities is as ancient as our species” (Bostrom
2005:1). Both authors in this case base their arguments on the assertion that humans
have always looked for ways to improve their own condition. Whereas Kac high-
lights humanity’s constant attempts to change other species for its own needs,
Bostrom stresses that humans have always looked for ways to improve themselves.
Although employing different narratives, Bostrom’s and Kac’s historical accounts
9
Kac also justifies his projects ‘artistically’, using both art historical and art theoretical examples
that link his practice with previous artistic periods and ideas. In order to maintain a cohesive text,
I will not discuss those arguments and instead shall look at his ethical assertions.
10
A similar historical argument is made elsewhere (Kac 2007a, b).
254 G. A. Nunez
define the progression and adoption of new scientific advances as normal, natural
human tendencies.11
With an eye on the prize (the improvement of humans), both authors end up
equating normalcy to virtuousness. One product of this hypothesised human nature,
also commonly found in both AST and transhumanist discourses, is the idea that
scientific and technological development has been accelerating over the years.
Following a mode of thinking perhaps popularised after Moore’s Law, Bostrom
(2002), Kac (2007a, b), and Kurzweil (1999) – to name a few – assume and antici-
pate this theoretical scenario of ever-faster scientific and technological progress by
proposing a discussion of its possible threats. Although Kac contends that genetics
is not inherently immoral, his artwork can be seen as an attempt to discuss the future
scenarios advanced by the ever-faster scientific discoveries. Particularly worried
about governmental and corporate control of future techniques, Kac argues that “art
can, and should, contribute to the development of alternative views of the world that
resist dominant ideologies” (2007b: 164). Kac’s artistic and academic work, then,
wishes to propose genetics as a “critically aware new art medium” against the per-
ceived threats of an impending ‘biotechnology revolution’ (Ibid.: 180). This cau-
tionary reaction to faster development, again, is mirrored by transhumanists.
Bostrom’s conceptualisation of “existential risks” (2002), for example, is another
case where theoretical output, despite coming from people who advocate enhance-
ments, is done in order to address possible future threats. Ultimately, both authors
see their work as mandatory, as a duty they must undertake. These possible future
scenarios, supported positively by the belief that science will ever improve and neg-
atively by the possibility of its misapprehension, point to a question that both the
artist and the philosopher pre-emptively answer: Would you prefer the fantastic,
limitless future of an enhanced humanity or the hypocritical negation of what
humans can achieve? Their answer is not only positive, of course, but also proactive
(Ranisch 2014), since policy is constantly an objective.12
Differently from the larger art world, which suspiciously and sometimes ambig-
uously represents these possibilities, AST artists go to lengths when trying to justify
their technophilic position. The conclusion reached by Kac, that improvement via
genetic engineering is desirable, rests on two different and consequential
assumptions. First, he sees genetic engineering as a natural consequence of human
will and agency. Genetic engineering, then, is seen just as an extension of ancient
breeding techniques that, according to his narrative, have always been part of human
11
By dissecting the discourses of some notable transhumanists, Hauskeller highlights that they
usually “presuppose a normative conception of human nature” where there is “an argument that
proceeds from a claim about what some being’s nature is to a conclusion that tell us what this being
ought to do” (2009: 10–11). In this conception, the normative behaviour of humans is to enhance
and, consequently, from this same understanding of natural human behaviour, Hauskeller’s trans-
humanists argue for transhumanism as a natural human act.
12
Kac, for example, in his Signs of Life (2007c) describes its contributors as not seeing “their role
as commentators chronicling or illustrating the burgeoning biotech culture. Rather, their work is
engaged in shaping discourse and public policy, and in stimulating wide-ranging debate” (Kac
2007a: 12).
development. Second, if this interaction with other species also changes humans
along the way, we cannot consider humans, or other species, as finished entities. If
we perceive deficiencies in humans, then, why not to improve them in the same way
we did with animals? Kac’s human, like his transgenic rabbit, is far from a final
product.
This conception of humans as unfinished and open entities, as expected, is again
mirrored by Bostrom, who contends that, after Darwin, “it became increasingly
plausible to view the current version of humanity not as the endpoint of evolution
but rather as a possibly quite early phase” (2005: 3). Tellingly, both Bostrom and
Kac evoke the work of physician and materialist philosopher Julien Offray de La
Mettrie as a historical focal point in this narrative of human plasticity (Bostrom
2005; Kac 2007a: 4–5). It was from him, perhaps, that the idea that “technology
could be used to improve the human organism” (Bostrom 2005: 3) initially devel-
oped. La Mettrie, then, can be seen as their tragic heroic figure whose intellectual
bravery was both profound and profane, and who, because of “suggesting continuity
among plants, human and nonhuman animals, as well as machines [...] was perse-
cuted” (Kac 2007a: 5). What is at stake here, in this supposedly heroic struggle
against ignorance, is the intention to control our destiny, our bodies and our concep-
tion of humanity. The human body in this conception is just another object, like the
machine so usually remembered, and a faulty one for that matter. As Kac succinctly
declares: “new technologies culturally mutate our perception of the human body
from a naturally self-regulated system to an artificially controlled and electronically
transformed object” (Kac 1998).
Conclusion
The different and sometimes oppositional representations and appropriations of sci-

entific subjects, such as genetics, reflect a division in the artistic field. This is a divi-
sion between those who see and comment on science positively, the AST world and
its subgenres like bio art, and those who appreciate it suspiciously and negatively,
the broader artistic world. The reader, however, should not see this division as solid,
dualistic or black and white. The positions of different artists, in a field as heteroge-
neous as the artistic one, cannot be simplified. The field seems more inclined
towards a discrete, spectrum-like disposition in relation to its adoption, representa-
tion, and support of scientific practices. Technophilia and technophobia should be
seen as labels for the most extremes positions presented in both AST and contem-
porary art. The few examples provided in this case study describe individual posi-
tions that, nevertheless, reflect broader artistic attempts to discuss the importance
and value of science. In the case of AST, given its smaller size in relation to the
broader artistic field as well as the centrality of certain institutions such as Leonardo,
it is easier to comprehend its technophilic tendencies. Its recent history, closely
related to the wide debates of scientific progress over the past 60 years, also helps
us to cement its more regular character compared to wider artistic debates.
256 G. A. Nunez
Given this division, however, it may seem quite surprising that AST has survived
to this day. If artists using emerging technologies have not been fully integrated into
the artistic world, how could they continue to produce ‘art’? The reason for this, we
argue, is not that AST-related practices have become more accepted or integrated
into the arts. AST has not softened its technophilic discourse. Despite some excep-
tional and unusual examples, AST is still a fringe and specialised artistic field.
Institutions such as Leonardo still cater to AST in the same way they did when they
were created. What seems to have changed, however, in contrast to the broad
counter-cultural climate of the 1960s, is the propensity of people to accept this tech-
nophilic discourse.
Exemplified by the similarity of AST and transhumanist discourses a new larger
cultural trend might be emerging. The transformation of how certain social groups
comprehend scientific and technological development, from suspicion to optimism,
perhaps is best exemplified by Turner’s study on the ‘rise of digital utopianism’
(Turner 2006). By tracing the adoption of cybernetics and the technological opti-
mism of the 1950s and 1960s among some groups within the counter-culture move-
ment specially in California, which theoretically should have combated the visions
of technocracy denounced by the artistic world that was part of the same counter-
movement, Turner highlights the apparently paradoxical view that computers, once
seen as the explicit representation of technocracy, became over the years a symbol
of a “decentralized, egalitarian, harmonious, and free” society (2006: 1). Although
speaking of computational devices and their social symbolism specifically, and not
genetics or science at large, Tuner reminds us that the work of those actors in effect
“naturalized and legitimated the technologies, theories, and work patterns of the
scientific research world as cultural rather than simply professional styles” (2006:
255). By framing their existence in technoscientific terms, individuals seem to
become more inclined to accept enhancements as well as transhuman and AST dis-
courses as normative developments. The new possibilities opened up by conceiv-
able future genetic therapies, under this new technoscientific ontology, at least for
some, seem to become the norm.
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With Great Power Comes Changing
Representations: From Radiation
to Genetics in the Origin of Spider-Man
Simon Locke
Comics, Continuity and the Ultimate Re-boot
Spider-Man made his first appearance in September 1962 in a comic book entitled
Amazing Fantasy 15 (Lee and Ditko 1992). In a brief, eleven-page tale, creators
Stan Lee and Steve Ditko recounted how science nerd Peter Parker, shunned by his
peers at Midtown High, sullenly went alone to a Public Exhibition of ‘experiments
of radioactivity’ held at ‘the Science Hall’ (location unspecified, but presumably at
the School). There, ‘transported to … the fascinating world of atomic science’,
Parker watches amidst a small group of adult attendees as a lab-coated, balding man
begins ‘a demonstration of how we can control radioactive rays here in the labora-
tory’. However, he fails to notice a ‘tiny spider’ hanging from a strand of web above
the Tesla-esque apparatus and, caught in an arcing flare of radiation, the spider
‘accidentally absorb[s] a fantastic amount of radioactivity’. In its death throes, the
spider ‘bites the nearest living thing’, which happens to be Parker’s hand. Shocked
by the sudden pain, Parker looks down upon the dying spider ‘burning’ and ‘glow-
ing’ in his hand before staggering away saying he feels ‘strange’, the demonstrator
commenting that he seems ‘unnerved’ by the experiment, while members of the
crowd smirk unsympathetically at his ‘weak stomach’ (Fig. 1).
Stumbling outside, Parker feels himself ‘charged with some sort of fantastic
energy’, but in his distraction fails to hear an oncoming car. Leaping aside just in
time, he finds himself high up a wall that he continues to climb as easily as walking.
Reaching the roof of the building, he grabs a steel pipe that buckles under the
strength of his grip, prompting the realization that he has been affected by the
spider-bite, which ‘in some miraculous way … has transferred his own power’ to
him. Pondering ‘what to do with this unbelievable ability which fate has given
[him]’, at first he uses it to seek fame and fortune. However, still fixed in his
S. Locke (*)
Faculty of Arts and Social Sciences, Kingston University, London, UK

https://doi.org/10.1007/978-3-319-90677-5_19
260 S. Locke
Fig. 1 Peter Parker gets bitten by a radioactive spider (From Lee and Ditko (1992). (© Marvel
Comics))
resentment towards the world he believes has rejected him, he refuses to stop an
escaping thief who later shoots his beloved Uncle Ben. Acting now as Spider-Man,
Parker catches the killer, but is unable to assuage his deep sense of guilt and is left
at the end of the tale sadly reflecting on his lesson that ‘with great power there must
also come – great responsibility’.
Spider-Man was only one amongst a range of super-characters introduced by the
publisher Marvel Comics in the early 1960s, who owed their powers to transforma-
tion through radiation from a variety of sources, both cosmic and atomic. Even the
genetic mutations that accounted for the powers of the members of the mutant team,
the X-Men, were attributed to the effects of atomic radiation on their parents. In this
respect, Marvel creators (chiefly Stan Lee and artist Jack Kirby) were continuing an
established convention from the science fiction and horror comics of the previous
decade in which radiation provided a handy resource to account for what remained
essentially magical, enchanted transformations that turned ordinary people into
With Great Power Comes Changing Representations: From Radiation to Genetics… 261
extraordinary entities. Science, via its remarkable discovery and harnessing of

atomic energies provided the means of extraordinary otherness. For creators and
readers of the early 1960s, a shared sense of speculative possibility about the won-
drous properties of radiation gave the idea that it might turn an ordinary High School
teenager into a superhuman being sufficient verisimilitude for such a tale to be spun
(Locke 2005).
And it kept on spinning, for as the decade progressed, Spider-Man emerged as
the most popular amongst the increasingly successful crop of Marvel heroes, a pop-
ularity that continues to the present day, even if now more attributable to block-
buster movies than comic books. The presence of a continuing character in popular
culture for a period of over 50 years raises the troublesome issue of temporality. If
Peter Parker were to have grown up with his audience, he would now be a somewhat
cranky old man (at least, if this particular member of his audience is any indication)!1
Apart from potentially jeopardizing the appeal of the character to younger readers,
it is important that Spider-Man remains relatively young for the moral dimension of
his origin to continue to carry resonance. Thus, although over the decades of his
appearance in regular monthly comic book instalments (and in multiple titles),
Marvel have slowly allowed Parker to age and experience some significant moments
of biographical growth – leaving High School for College and then workaday life,
getting married and then (sort of) divorced – he has aged in years at only about a
fifth of the rate of his readers.
Inevitably, this gives rise to anomalies regarding the relationship between Spider-
Man’s fictional world and the real world. Like many other popular cultural fictions,
superhero comics are replete with real world references. Thus, in certain respects at
least, Parker was, for the United States in the early 1960s, a recognizable contem-
porary high-school student amongst a group of such students, who looked, dressed,
acted and spoke in ways commonly attributable to such a category of person, not
least his location at high school itself. Parker and his social setting, then, have for
that time a level of realistic believability about them. For example, to illustrate his
science-nerd character, he is shown in one panel in chemistry class, holding a bea-
ker of green liquid in one hand and a steaming test-tube of red in the other, receiving
praise from his teacher, a balding, lab-coat wearing man carrying papers. We might
disapprove of such a stereotypical depiction, but this would miss the point that it
needs to be recognizable to the reading audience as a science class. Although it uses
conventional shorthand, it has a measure of realism sufficient to do its job, just as
did Parker’s radioactive transformation, at least in that, in 1962, it fell within the
bounds of speculative possibility.
Comics traffic in such conventional shorthand, but they are no different from any
other medium in this respect (including science textbooks). Comics function met-
onymically; they deal in partial representations of whatever ‘reality’ is depicted at a
number of levels from the individual panel image up to, in the case of superhero
comics especially, the individual tale. While not unique to comics, such partiality is
1
I am grateful to the editors for pointing out that a tale depicting a ‘geriatric’ Spider-Man has been
published (Andrews 2007), albeit involving an alternative timeline (see below).
262 S. Locke
perhaps more apparent due to the remarkable economy of story-telling that can be
achieved through the combination of words and images in sequential order (Duncan
and Smith 2009; Jacobs 2007; Locke 2009; Varnum and Gibbons 2001). But, given
their history of public vilification (Barker 1984, 1989), they are perhaps more prone
to accusation for doing what any form of cultural representation inevitably does,
i.e., provide only a partial and typified depiction of whatever ‘reality’ it deals with
(Kim and Berard 2009).
In the case of superhero comics, this sequentiality pertains not only to the indi-
vidual tale but to the series of tales involving the same character and even those
involving other characters. This gives rise to the peculiar phenomenon of continuity,
which, although far from unique to superhero comics, has been developed within
them to a much greater extent than in any other medium or cultural form. Continuity
refers, amongst other things, to both the individual backstory of any given character
or series – their biography, so to speak – and to the entire contents of any given
superhero universe, generally that of a specific publisher (mainly Marvel or top
rival, DC). Reynolds (1992: 41) calls this the ‘metatext’ since at this level continuity
includes not merely the published backstory, but also everything implied that has
not been published, but may within the rules of continuity be legitimately inferred
(for a discussion, see Locke 2011).
Superhero continuity is a truly remarkable phenomenon of contemporary popu-
lar culture involving the combined creative work of several generations of comic
book creators and readers (who to varying extents have been encouraged to contrib-
ute to the ever-growing ‘history’ of superhero universes; Pustz 1999). A central
concern in building continuity is coherence; ultimately, the story has to add up for
the universe to make sense. This is one of the levels at which fictional ‘reality’ paral-
lels ‘real’ reality: just as we expect the history of the real universe to tell a single,
coherent narrative (all the way back to the purported ‘Big Bang’), so too do readers
of superhero comics expect the fictional universe to tell a single, coherent narrative
(currently including the real world scientific wisdom of the ‘Big Bang’). But anom-
alies are continuously generated in part because of the passage of time, so being a
High School student in the year 2000 was not quite the same thing as it might have
been in 1962; neither was science. The real world had changed, but Peter Parker
remained rooted in a world where radiation could, just maybe, transfer a spider’s
abilities to a human being.
This feature of superheroes was recognized some time ago by Umberto Eco
(1979), who, in a highly suggestive analysis, argued that they occupy a form of
temporality that is not quite the same as the unchanging eternal moment of the
mythical hero, but nor is it fully biographical in the manner of the modern Romantic
hero. Mythic characters such as Hercules existed outside history and biography,
their tales continually retold without change so that, as Eco puts it, they do not
advance towards death; the hero of the modern novel, however, exists inside history
and so does move toward biographical death. Superheroes are somewhere in-
between, occupying an ‘oneiric climate’ (p.114) that is both synchronic and dia-
chronic, having, like the mythical hero, an unchanging ‘iterative scheme’ (p.117)
and yet, like the Romantic hero, also being inside a version of the historically
changing real world. Eco argues that this peculiar dream-like, intermediary form of
superheroes is not recognized by their creators and readers, which he takes to be
indicative of its ideological character that induces passivity and an infantile accep-
tance of the existing institutional order.
Suggestive though Eco’s analysis is, however, it is also clearly wrong2 as it
ignores continuity and the extent to which both superhero creators and readers have
long been (prior to the original publication of Eco’s essay in 1972) actively engaged
in thinking about the problematic relation of superheroes to reality, as can be illus-
trated by considering the re-boot of Spider-Man’s origin. Re-booting is one strategy
for resolving the dilemma regarding the temporal disjuncture that Eco identifies; as
such, it is demonstrable evidence that comics creators (and their readers) are
involved in active thinking about the peculiar relationship of superhero fantasy uni-
verses to the real world. The key point here is that re-boots are not done casually;
they do not just happen, but are integrated into established continuity. One long-
standing device, dating back to DC’s Flash 123 (Fox and Infantino 1961) is the
alternate universe, a separate universe existing alongside the already established
superhero universe and differing from it in significant respects. This enables cre-
ators to present different versions of characters and imagine different biographical
possibilities for them without invalidating established continuity. Amongst other
things, it enables their updating.
This was the device used by Marvel to present a re-envisioned Spider-Man in
2000, providing in what was called the ‘Ultimate universe’ an alternative reality that
enabled an updated version of the character’s origin and social setting that might, to
contemporary readers, have been more recognizable than the depiction of Midtown
High in 1962. A notable feature is the shift in the scientized source of Parker’s pow-
ers from atomic radiation to genetic modification and, in conjunction with this, a
very different kind of institutional setting. Unlike the short Lee and Ditko tale,
Ultimate Spider-Man’s full origin was set out over seven issues, amounting to some
180 pages, although most of the essential basics are covered in the first 48 page
issue (Bendis et al. 2000) and so the account that follows deals mainly with this.
Genetic Modification
One of the things re-booting allows is for relationships between established charac-
ters to be reconstructed and repositioned a bit like proteins on a strand of
DNA. Characters’ biographies and relationships can be strung together in new
arrangements to engineer narrative mutations. This is the case with Ultimate Spider-
Man, particularly in respect of his relationships with arch-nemeses, the Green
2
More correctly, having brought out the dualistic temporality of superheroes, Eco’s ideological
analysis only focuses on one side of the dualism: the unchanging, myth-like, and hence supposedly
‘passive’ side. A proper understanding, however, needs to consider both, towards which the present
discussion is intended as a fragment.
264 S. Locke
Goblin and Doctor Octopus (or ‘Doc Ock’). In the original comics, these villains
were introduced in the somewhat haphazard fashion characteristic of monthly comic
book series, the continuation of which depended on the vagaries of the market, such
that there was limited forward planning and long term plot-development (Lee and
Mair 2002). With the continuing success of Spider-Man, such development became
more possible, but in the early months and years of the series, new villains were
introduced to help maintain sales rather than to explore biographical potentialities.
Only gradually did the latter develop as part of growing continuity. Thus, when Doc
Ock and the Green Goblin were first introduced some months apart in the original
series, it was as completely independent and unrelated characters, with no sugges-
tion of any direct connection between them and still less to Spider-Man himself as
anything more than ‘villain of the month’. As things turned out over several years of
development, the Green Goblin emerged as the most significant of Spider-Man’s
foes, because of his role in the death of Parker’s then girlfriend, Gwen Stacy, by
which time it had been established that the Goblin was Norman Osborn, the father
of one of Parker’s school-friends, an identity that, apparently, had not been intended
when he was first introduced (at least, not by story-teller Ditko; Ro 2004: 107).
Such close ties, then, emerged only slowly and unpredictably, but in the re-boot,
their pre-existence in established Spider-Man continuity enabled them to be used to
explore deeper biographical possibilities. Thus, not only are both Norman Osborn
and Doctor Otto Octavius (Doc Ock’s proper name) introduced as two scientists
with a close working relationship, as employer and employee respectively, but the
focus of their research provides the source of Parker’s spider-powers. The re-boot
then enriches, or even re-directs, the irony of Spider-Man’s origin: Ultimate Spider-
Man owes his powers to his villainous counterpart, who himself becomes the Green
Goblin as a direct result of Parker’s own transformation. Of particular note is that
the glue used to bond these tighter social relationships is a revised version of the
science that brings about the transformations.
The centrality ascribed to Osborn is apparent in the opening scene of Ultimate
Spider-Man 1: whereas, following an introductory splash page, the narrative of
Amazing Fantasy 15 opened with the Parker family at home before moving to the
chemistry class, Ultimate Spider-Man begins in the laboratories at Osborn Industries
[OI] with a sequence introducing Osborn and his experimental ‘wonder drug’, Oz.
Indeed, the first panel of the sequence shows a large spider, coloured green and with
accompanying text stating ‘Oz experiment 56. Subject: Arachnid No. 00’. As the
sequence unfolds, it becomes apparent that this is a digital image on a computer
screen of the actual spider that Osborn holds on the back of his thickly-gloved hand
beneath green-glowing apparatus connected to the screen. The spider is tarantula-
size and, as he looks down at it, stroking it with an ungloved finger, he relates to his
assistant, Justin, the myth of Arachne, a spinstress turned into a spider by the god-
dess, Athena. They are surrounded by high-tech equipment, consisting of machin-
ery, screens, push button pads and the like. The sequence continues with a wider
image of the laboratory, depicting further such equipment as the working environ-
ment for a number of other people, most of whom wear lab coats, sit at computer
keyboards and look at screens, although one wears a full-body hazmat suit and
Fig. 2 The lab at Osborn Industries From Bendis et al. (2000). (© Marvel Comics)
pushes what seems to be a container of lab animals, also coloured green, further
examples of which can be seen throughout the lab (Fig. 2).
Against this background of sophisticated high-tech biochemical industry, Osborn
is interrupted by a lab-coated woman, who hands him a cell phone saying it his
lawyer. Annoyed at the interruption, Osborn takes the phone and, in apparent disre-
gard of the potential hazard, thrusts the spider toward Justin, who looks aghast,
sweating as he stares down at it gingerly cupped in his bare palms. Osborn, now in
deep conversation with his lawyer, walks off saying that Oz, his ‘wonder drug’ is his
‘most significant invention’ (though, contrarily, also called a ‘discovery’), but still
in need of further ‘testing’. Just as he says, ‘If I could get away with human subjects
at this stage, I would’, since ‘human testing is the next logical phase’, the horrified
Justin, perhaps envisaging himself as the subject in question, fearfully tosses the
spider into a containment vessel, but in his anxiety to get away, neglects to replace
the lid. Osborn ends his conversation telling his lawyer, ‘As long as we all know
who’s in charge here, we’ll all be fine’, but behind him he is apparently unaware that
even as he speaks, the spider is climbing out of the vessel.
In a neat sequence of comics art, the panel images move sequentially across and
down the page in a tighter and tighter close-up of the spider atop the vessel, ending
with an enlarged focus on the double zeroes branded on its abdomen, two circles
that linger in the reading eye as the image segues to a similarly tight close-up of
Peter Parker’s bespectacled eyes in the first panel of the next page. The following
sequence, set in a shopping mall food court in Queens, establishes Parker as both
science nerd and target of bullying by the school jocks, including an African-
American character nick-named King Kong, who was not among the all-white set
of the original continuity. Unlike the original tale, we do not see Parker in a stereo-
typical chemistry class, but trying to concentrate on a chemistry book amidst the din
of raucous teenage banter. As the male bullies get their kicks from disrupting him
and the girls get theirs from skipping school to ‘try on tops’, Parker’s come from a
reference to ‘sodium carbonide’ that he calls ‘an odd choice’ and ‘a bold c ompound’.
266 S. Locke
Like the original sequence, the concern here is to establish peer-relationships, but in
a manner that is recognizably ‘real’ to a twenty-first century readership. Thus,
although the social relations depicted are in crucial respects the same – and no less
stereotypical, both of the science nerd with his mystifying technical argot and his
vapid peers with theirs – the setting and the details of their enactment are revised to
show a more contemporary version of reality.
So, too, the science. Osborn’s centrality and that of his experimental spider con-
tinues when Parker’s class visit the lab at OI, where amidst more of the same high
tech and surrounded by other students, for no apparent reason, Parker gets bitten by
the spider, which appears suddenly as if from nowhere. In pain and shock, he flicks
the spider from his hand and, in an image that connotes Spider-Man’s costume and
thus their relationship, it lands on the chest of Mary Jane Watson (Parker’s wife in
the original continuity), who knocks it to the floor with her notebook, where it is
squashed by the heavy boot of King Kong. Parker collapses, vomiting to jeers from
the jocks, but is comforted by the concerned Mary Jane and an adult woman (pre-
sumably, a teacher). Hearing of the ‘incident’ later, the scheming Osborn is pleased
to have his human test subject and surreptitiously obtains a sample of Parker’s
blood. His initial analysis appears to show that the Oz-imbued spider venom is kill-
ing Parker, so fearing an enquiry that might jeopardize his research, he sends a man
named Shaw to murder him by other means. However, as his spider-powers start to
develop, Parker evades the assassin and, on receiving the news, Osborn changes
tack. Via his son, Harry, a classmate of Parker’s, he invites him to the lab where,
despite the lad’s objections, Octavius obtains a second blood sample, the analysis of
which leads Osborn to conclude that ‘even with the untested mixture of toxins and
genealogy, the Oz was able to dominate the structural compounds’ producing ‘revo-
lutionary’ changes to Parker’s ‘system’. Thinking he may ‘hold … the key that
unlocks the next stage of human evolution’, he decides ‘to recreate the … accident
under more scientific environments’, putting to his team, including Octavius, that:
‘If the spider venom gave Parker the enhanced strengths of a spider, then treating the
Oz with my own DNA and injecting it mainline … will give me the enhanced
strengths of me’ (Bendis et al. 2001) – a transformation that turns him into the mon-
strous Green Goblin.
There are a range of interesting contrasts in this revised narrative in relation to
the original, but discussion here will focus on three particular features: the shift in
the scientific source of transformation; the setting of scientific activity; and the char-
acter of the scientist.
Regarding the first, the most obvious point is to suggest it is indication that in the
early twenty-first century, lab-based genetic modification now seems a more believ-
able basis for superhuman transformation than atomic radiation. It has altogether
more realism to us now to imagine such a speculative possibility; indeed, we might
well believe that somewhere in the world’s genetic laboratories, there are research-
ers, hidden from public scrutiny behind security-laden glass and metal doors,
actively engaged in just such work. After all, how different is it to imagine that a
genetically-spliced human-spider may be able to walk up walls from imagining that
we can, for example, turn off the ageing gene (Turney 2010)? That having been said,
it is also apparent that the differences are not quite as marked as they might seem.
The original Norman Osborn was transformed into the Green Goblin by a chemical
formula; essentially, it is just such a chemical transformation that is invoked in the
revised version, albeit that references are made to ‘genealogy’ and ‘DNA’, as well
as vaguely specified ‘structural compounds’. This is gene talk rather than genetic
science, although the latter enables and encourages the former (Nelkin and Lindee
1995). In effect, what we have in the revised tale is a kind of dualistic version of a
somewhat older imaginary scientized transformation: Jekyll and Hyde. Osborn is to
Jekyll as the Green Goblin is to Hyde, but they are now accompanied by a contrast-
ing coupling in which Parker becomes a sort of goody-Hyde to counter the evil
Goblin. Thus, for all the current gene talk, the basis of transformation appeals to an
older speculative tradition, itself a modernist re-envisioning of ancient Athena
weaving her divine magic (cf. Whitehead 1974). In this respect it does not differ
significantly from the appeal to radiation; whether radiation or genetic chemistry is
invoked in a sense does not matter, since both are simply enablers of tales of human
transformation. We may now be more prepared to accept one over the other, but in
either case they are only there for the magic they invoke.
This is apparent also despite the shift in setting from a public exhibition held
(presumably) in an academic institution to a private industrial laboratory. The origi-
nal depiction is sketchier in its detail of both experimental activity and the technol-
ogy involved, changes that again we might attribute to the effort to present greater
or more appropriate realism in more recent times. A lone scientist demonstrating an
unspecified ‘experiment’ involving radiation apparently visibly arcing between two
spherical bulbs, looking rather more like a spark of static electricity than a beam of
(invisible) gamma rays is perhaps no longer sufficient to persuade. The more recent
depiction shows a team of scientific workers inside a space enclosed by complex
technological excess, appearing less as hands-on experimenters than as extensions
of computerized systems subject to factory-style discipline. Thus, at one and the
same time they are both more social and less: they may act in concert with others,
but they do so within, through and by technological means. Similarly, although the
scientist in the original tale may have acted alone, he nonetheless engaged directly
with the public, whereas in the revised tale, when Parker’s class visit OI, they are
directed by a floor manager and hemmed in by a security guard. But for all this
might appear to us more realistic, the technological imagery remains as vague in its
details as the Tesla-esque bulbs. Although there is talk of ‘animal testing’, we do not
see and are not told specifically what this entails; we do not know what the scientist-
technicians do except to stare at computer screens, all of which glow green, presag-
ing Osborn’s magical transformation. Thus, like the spark-like arc of radiation, it is
in the coloured lights that the meaning of the depicted science resides rather more
than in whatever mechanisms might produce them.
Moreover, despite their differences, the public scientist in 1962 and the private
industrial scientist of 2000 have one crucial feature in common: they both believe
themselves to be in control of their mystified mechanisms, when it turns out they are
not. The public scientist tells his audience he can control ‘radioactive rays’ in the lab
and Osborn makes clear to his lawyer that he, Osborn, is in charge of things. He says
this against an implied context of legal and ethical regulation regarding the ‘testing’
of Oz involving restrictions on the use of ‘human subjects’, pointing to a further
268 S. Locke
dimension of the setting about which there is no hint in the earlier tale. Osborn’s
phone conversation with his lawyer assumes that in the twenty-first century readers
will view such a regulatory environment as a recognizably real context of scientific
activity and appreciate that science does not occur in a social vacuum, but is morally
as well as economically embedded. Nonetheless, in insisting he is in charge, Osborn
places himself above such regulation, implying that he has control over his inven-
tion/discovery. However, like the lone scientist in 1962, his arrogant words ring
hollow. The claim by the public scientist of controlled experimentation is under-
mined by his failure to notice the tiny spider, a failure that has irrevocable conse-
quences for the hapless Parker. Similarly, Osborn’s insistence he is in charge is
undermined by his failure to ensure that the much larger spider 00 is safely returned
to its containment vessel. As a consequence, he is not only responsible for Parker’s
‘accident’ but also for his own monstrous transformation; that is, the monstrosity of
his transformation makes apparent the vastness of his hubris.
Hubris, then, connects the two scientists across the decades, although this is a
more fully developed feature in Osborn’s case, since his lust for control extends
beyond nature to encompass wider and wider aspects of his social relations. The
scientist in 1962 shows no particular interest in controlling anybody, certainly not
the sickly Parker over whom he shows little concern. Osborn, however, endeavours
to control everyone with whom he engages: the workers in his lab, not least the slav-
ish Justin and inscrutable Doc Ock; his lawyer and the regulatory bodies that restrict
his use of Oz; his son, Harry, in whom he has little interest; and, via Shaw, ulti-
mately Peter Parker himself. As such, Osborn embodies the expansionary instru-
mentalism Max Weber gleaned within the rationalizing logic of modern science, a
logic that since Weber’s day, but in keeping with his pessimistic forecast, has
increasingly spread throughout modernity seeking to reduce the very measure of the
social to its monological one-dimensionality (Locke 2011). But, like the ranks of
mad scientist ideologues before him, Osborn ultimately fails, his vaunted instru-
mental control deconstructed by its very enactment. It is Osborn that, in his irre-
sponsible disregard of Justin’s feelings – even, perhaps hoping that the spider might
bite to give him the human ‘subject’ (a term that betrays so much) he desires – drops
the spider in his hands and sets in motion the events that lead to the creation of his
nemesis, Spider-Man. And it is Osborn, who in the will to extend his control to
encompass the process of evolution itself, brings about his own perverse mutation
to the Green Goblin, a figure that represents the failure of instrumentalism in the
madness of its amorality (Locke 2013).
Conclusion
So, what does it mean that the Peter Parker of the year 2000 was bitten by a geneti-
cally modified rather than a radioactive spider? In some ways, it might mean a great
deal, as indication of the spreading plague of gene talk and as signifier of the cul-
tural awareness of the increasingly central role taken by biomedical technoscience
in everyday life. But perhaps it means not so much. It is merely the latest in a long
line of resources drawn from science to imbue with a sense of verisimilitude the
fantasy of superhuman transformation. For this, the details of the science do not
matter; whether chemical, radioactive or genetically inspired, it is the enchanted
vision science enables that counts. This vision conjures a wondrous dream of power,
but it is perpetually threatened with eclipse by an equally powerful nightmare in
which the wonderment morphs into instrumental control. In the original tale, Parker,
steeped in his resentment towards the bullies and babes who unfeelingly reject him,
sets out on the path to instrumentalism, only to confront its ironic consequences and
choose the other route. In the Ultimate version, it is Osborn who walks the instru-
mental path, but in either case, the same choice of direction is presented: instrumen-
tal madness or moral responsibility. The details of the science do not matter for the
dilemma remains the same – although perhaps biomedical technoscience does bring
it that much closer to home.
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Music in Serious Games as a
Healing Factor
Yvonne Stingel-Voigt
Introduction1
Music and sound are important factors in creating a certain atmosphere in a virtual
environment. They are not meant for background decoration but fulfil specific tasks,
for example, to simulate a credible situation during gameplay. Music and sound are
able to create an atmosphere because music can fulfil the expectations of the lis-
tener. Working through musical codes which have emotional meaning, music can
trigger emotions and thus produce an emotional effect. Music can stimulate feelings
by itself, trigger emotional memory and evoke feelings by enabling specific moods.
In general, it is possible to say that music has the power to generate emotional
effects. This effect can be transferred to a virtual space. The music inside the virtual
world of a game determines how the shown space should be understood affectively.
Music in video games contributes to an atmosphere that allows players to easily
immerse themselves. The recipient—in this case the player—does not need to be
educated musically in order to identify the characteristic style of an individual
motif. The player feels the musical character and thus sympathizes and empathizes
during the gameplay: music in games is always intended as a sensual element. The
understanding of musical sense is often shaped by several attributes linked to spe-
cial experiences, incidents, conditions and emotions. If you listen to an organ, you
may associate it with being in a church; a drum roll may promise action and excite-
ment. Slow music helps to calm and relax, while a fast rhythm makes one feel
awake and alert and may stimulate physical activity.
In the field of Serious Games, especially of games intended to promote health,
immersion into the gaming experience is conducive. In order to create a
1
This article is based on the Chapter “Game-Based Learning and Serious Games” in: Stingel-Voigt
(2014: 114–124).
Y. Stingel-Voigt (*)
Technische Universität Berlin/Senatsverwaltung Berlin, Berlin, Germany
e-mail: info@yvonne-stingel.de

https://doi.org/10.1007/978-3-319-90677-5_20
272 Y. Stingel-Voigt
h ealing-promoting situation, the ‘as-if’ status ought to be experienced as ‘real’. This

means that although we know that a game is not real (we are playing), the fiction of
the game is accepted as a temporary reality. If people adopt media, they enter into
an empathic belief because they have a will to believe. Without this, the experience
of a fiction (a film, a book or a game) would not be such an enjoyment. This can be
explained by the willing suspension of disbelief (Böcking et al. 2005: 41). The
gamer, if involved in the gameplay, accepts the fiction as real, even knowing that
nothing of it has happened or ever will happen in real life. The player identifies with
this fictional world and participates in it for a period of time (Böcking et al. 2005:
43). Sound and music can help to create this immersive situation because they are
heard, interpreted and understood: “in relation to mirror neutrons, we mentally re-
create (visually and motorically) what we hear, and we hear in terms of intentional-
ity and causality – including emotional intent” (Collins 2011: 41). Empirical studies
show that music can intensify the gameplay and the empathizing (for example
Collins and Wharton 2011).
The following article attempts to demonstrate, in selected examples, the func-
tions of music and sound in video games and how music can effect a cure for differ-
ent diseases. Serious Games are often practiced in educational contexts. In particular,
I will examine Serious Games in the context of the field of medicine and the types
of games used by various patients suffering from serious illnesses. In the following,
I will introduce examples of Serious Games and discuss how music inevitably influ-
ences the gameplay and the gamer as well.
Serious Games in Healthcare
In fact, there are many kinds of games belonging to the large field of Serious Games.
These are games that are created only with educational purposes in mind. In this
case, the most interesting Serious Games are those which are used for therapeutic
purposes. In them, players take on different roles and act according to their specified
role (especially in role playing games). Yet games may also simulate worlds and
situations which can also be used in health promotion. Simulation works via empa-
thy and is based on the temporary experience and situativeness when playing a
game. Here the player can create and experience various situations which allow
video games to make complex problems relevant while contextualizing these prob-
lems (Rubbermuck 2011).
Games which are used in healthcare environments are needed, for instance, to
support children with severe diseases like cancer, chronic bronchitis or diabetes.
Games are also used as training vehicles for adults, such as a technology-supported
physiotherapy for patients suffering from Parkinson’s disease. The Institute of
Media and Computer Science at the University of Bremen, for example, has devel-
oped a collection of movement-based Serious Games for Parkinson’s patients
Music in Serious Games as a Healing Factor 273
e ntitled WuppDi! (2010).2 What is decisive here is that the simulation of the virtual
world, the generation of feelings during gameplay and the physical activity of play-
ing are interactive. In this context, the virtual world, existing in space, visuals, sound
and music, is an important factor, since it is here where the mind is stimulated:
VR interaction is promising in terms of rehabilitation […] A recent review […] conducted
by Vieira et al. evaluated various studies in the literature with an eye on the possible benefits
of VR-based systems for PD patients. It concluded that VR can not only be used as a thera-
peutic tool, but can also play a significant role in controlling and regaining motor function,
mobility and cognitive capacities as well as balance. (Pachoulakis et al. 2015: 4)
Similarly, games can be useful in cases of psychological illness, such as phobias and
depression, or as a tool for aiding concentration in Attention deficit hyperactivity
disorder (ADHD) patients.3 Based on playful fun factors and flow experiences, spe-
cific learning objectives can be achieved through the use of games.
In cases such as Parkinson’s disease, the use of games that stimulate the body,
train the sense of balance and thus promote the mobility of patients is vital. Also in
psychotherapy, attempts have been made to control phobias through game playing.
Here, subjects are confronted and must cope with their greatest fears in a virtual
world as a type of preparation. For a particularly intense experience, the virtual
world is a three-dimensional world which allows an intensive perception. In these
cases, the recipients can face their objects of fear (for example, spiders) in a secure
framework. This means that players can confront themselves with their object of
fear in a controllable virtual environment.4
For special diseases, there are specific games with an appropriate use. Often,
they are aimed towards children and teenagers. These games can show and accom-
pany everyday life with an illness and become an aid to the ongoing therapy. Escape
from Diab (Archimage 2006), for example, is an adventure game that deals with
diabetes. In Fatworld (Persuasive Games LLC 2008), players can learn about their
nutrition. The game Glucoboy (Guidance Interactive Healthcare 2007) assists in
dealing with the regularity of pin pricks for the player’s blood sugar tests. Asthma
Management-Bronkie the Bronchiasaurus (Wave Quest 1995) explores topics of
bronchitis and asthma and is aimed towards creating positive handling of these dis-
eases. For children who have cancer there are the adventure games Re-Mission
(HopeLab 2001) and Re-Mission 2 (HopeLab 2006). In these games, the player can
defeat different kinds of cancer and tumours within a virtual world. The developer
company HopeLab highlighted a study that reported that this virtual fight helped the
real engagement against the actual disease:
In Re-Mission, players pilot a microscopic robot named Roxxi as she travels through the
bodies of fictional cancer patients, blasting away cancer cells and battling the side-effects
of cancer and cancer treatments. Study results published in the scientific journal PLoS ONE
2
They can be watched and downloaded under: http://medien.informatik.uni-bremen.de/sg10/web-
site/wordpress/?page_id=524
3
For example, the game Dr. Bonneys Zappelix zaubert, Multimediamanufaktur 2010.
4
The use of virtual worlds to combat phobias of spiders or fear of height is investigated at the
University Hospital of Münster in psychiatry and psychotherapy.
in March, 2012 show that neural circuits implicated in reward (i.e., caudate, putamen, and
nucleus accumbens) activated strongly while players were actively playing Re-Mission but
not when they were resting, or when other players passively observed the same gameplay
events. Activation of the ‘mesolimbic’ neural circuits stems primarily from game play
(interactivity) rather than from sensory stimulation show that strongly activates brain cir-
cuits involved in positive motivation [sic!].5
Participants who played Re-Mission showed more zest for life and were more self-
confident in dealing with their disease. They were also better informed about what
happens in their bodies and were less likely to stop their medication because they
understood the importance of the treatment. Motivation is a determining factor
when video games are used to support healing factors: “Engaging a patient’s moti-
vation is frequently necessary in health care because patients are often required to
undergo procedures or engage in behaviours that are painful and aversive […] or
boring and mundane” (Kato 2010: 113).
The immersion during gameplay must be intensive enough for a game to have the
effect of being auto-suggestive; otherwise, it may not support healing. At the very
least, games can help motivate younger patients, provide a better understanding of
the processes inside their bodies and more knowledge to accept the disease and fight
against it in their real life. Increasing motivation is very useful, because young can-
cer patients often have to endure hard and painful treatments.
Music as a Supportive Element in Medical Serious Games
If you listen to a specific melody, an emotional memory could be triggered. The

aesthetic comprehension of music is characterized by the history of music and our
own socialization. Moreover, an individual’s personality is always of variable influ-
ence. Music, in this sense, operates as a medium of social processes. Hence, the
video game experience is intensified by the appropriate musical accompaniment.
For example, music creates emotional situations and commentaries on the game at
hand and thus becomes a tool which supports the narrative or creates a semantic
relationship to the visual events.
After physical trauma, such as life-changing accidents or strokes, or in the face
of a chronic disease, it may be necessary to rediscover one’s own identity. Here,
music can play a supporting role as a useful therapeutic strategy (Georgi et al. 2009:
175). One can assume a positive effect of music (at least at a psychological level),
although there is currently no clearly demonstrated positive effects of stimulation
by music on health (in physiological terms). Having said that, in music therapy
there is the positive effect of music: one can express oneself through making music
and thus create a connection to one’s own emotional experience through music.
When a game is used as therapy, or as an additional aid to therapy, it should allow
the player the chance to have fun and become immersed. To initiate such an
5
http://www.hopelab.org/our-research/re-mission-attitudes-study-in-the-brain/ (04.08.2015).
immersion or spatial presence, “players form a representation in their minds of the

space or world with which the game is presenting them” (Madigan 2010).6 A good
game needs the following conditions to allow a sensual immersion: it should pro-
vide “Multiple channels of sensory information, completeness of sensory informa-
tion, cognitively demanding environments [and] a strong and interesting narrative,
plot, or story” (Madigan 2010). Here, sound and music are referenced as sensory
information. If the game sound is well established and the music for the game fits
with the surroundings, it is of great additional value. Music assists players to really
enjoy the game so that they mentally become a part of it. But one can assume that
a joint encoding of music and […] information confers other advantages to the cognitive
system. Given the cross-validation of affective information from two different sources, an
individual can be more confident of those inferences generated about characters’ behaviors,
and this increased confidence should aid construction of the visual narrative. (Boltz 2004:
1202)
In games, music is not the only factor that one perceives. There are of course several
stimuli which can have a positive effect on the recipient and thus support other
therapies. But music has the power to move the listener into a certain state of mind:
“game music works to support the sense of space and presence in the game environ-
ment, or […] it helps the player to progress through the game” (Jørgensen 2008:
165). It may be that just through the presence of music, the play can appear to be
coherent with its virtual world and, consequentially, heighten the player’s
emotions.
In order to motivate, a game should be fun or it should allow an immersion. The
virtual world and its setting must please the players and this means that the audiovi-
sual events must be suitable, convenient and interesting. The virtual environment
should also be in accordance with the sound and music of the game.
If the music for a game is used cunningly, then it supports a profound gaming
experience. The music should not disturb nor distract the player: it is there without
being intrusive. This is called adaptive music since the music adapts to the mood
and status of the game. Players will not only experience profound support from the
music, they will also be affected by its feel and the tension it creates. Players may
also experience a diversity of human emotions, such as anxiety, sadness, loneliness,
anger, anticipation and uncertainty, which are all established and experienced
through the accompanying music.
If a game pleases, it produces joy. One can be successful in a game and this suc-
cess may occur irrespective of the expectations of others, which means there are no
external pressures. Many games require physical exertion so that through immer-
sion into a virtual world they can motivate “by having a make-believe quality” (Kato
2010: 114). Music can no doubt help to achieve this effect.
6
www.psychologyofgames.com/2010/07/the-psychology-of-immersion-in-video-games
Re-mission
The plot of the aforementioned game Re-Mission takes place inside the body. There
are different levels in which it is necessary to fight different types of cancer. The
players learn much about the cancer, the immune system and the features of the
body. The main sound for this environment is the sound of a faint heartbeat. During
a fight one can hear fast and rhythmical rock music. It sounds like alternative music
from the 1980s and 1990s, similar to the new wave band Depeche Mode. All in all,
the music that is driving the atmosphere seems aggressive. This characterisation fits
perfectly with the gameplay. While fighting the malignant cancer cells, one must act
like a cold-blooded assassin. One must not hesitate to destroy anything evil that
makes one ill. The music has specific interactions with the story of the game. When
a level has been achieved, one hears heroic music as a reward. In Re-mission 2 there
are different levels with different music, often with fast beats.
Snow World
A deep immersion into a virtual world is also achieved in SnowWorld (University of

Washington 2004). This game is for patients with severe burns who are exposed to
constant pain. During the change of their bandages and during the therapy of stretch-
ing their limbs and skin, the virtual world of the game is visible via a head-mounted
display. Headphones also ensure that the appropriate auditory sensations can be
experienced. Over this game’s scenario the patients are flying through a white
world, consisting of snow and ice; and there are penguins inside. The players are
totally immersed: “If you hit the penguins, they freeze, and if you hit them a second
time, they explode. There’s a lot of action in it. You never stop to think about any-
thing else”.7
Here, too, the virtual experience is accompanied by music. In this case it is popu-
lar music that is played, for example Paul Simon’s If you’ll be my bodyguard.
Lyrically, this song is adapted to the patient’s situation in order to provoke self-
reflection. Hence, the text of this song has a motivating effect because it is used as
a tool to identify with the game via the lyrics. Paul Simon sings: “Where’s my wife
and family what if I die here […] There were incidents and accidents”. Accordingly,
the song is carefully chosen for patients who can no longer recognize themselves,
feel like strangers in their own body, or see the environment with different eyes. The
lyrics which are heard inside the virtual world help the patient to empathise with the
game. It is conceivable that patients in pain feel comforted by this song. By connect-
ing the dynamic melody with visual impressions, this form of cyber therapy effec-
tively reduces the amount of pain that is experienced. Computer tomography studies
7
BBC-article, “Easing pain for burns victims using virtual reality”, January 31st, 2011. (04.08.2015)
show that “the programs actually reduce the amount of pain-related brain activity”
(Hoffmann 2004: 63) and thus work as a kind of imaginative pain therapy.
Because a virtual world is experienced in both visual and auditory terms, this
imaginative pain therapy can be viewed as concrete imagination. The patients do not
have to concentrate on the virtual world. The surrounding world is just there and
triggers different senses. It also seems to be an important factor that in this case the
pictures are moving quickly and the implemented sound and music are adjusted to
the visuals in very obvious associative ways. The flight through the cold white world
appears rapidly and the melody and instrumental accompaniment of the song by
Paul Simon is serene and moving. Sound and music here are important factors for
this immersive effect. Additionally, the sound delivered via headphones ensures that
the sounds of the hospital environment during the painful medical care can no lon-
ger be perceived. SnowWorld is an exciting game that deeply captivates the players
so that the painful aspects of their reality are cognitively marginalised. In all likeli-
hood, the music affects the patients via the lyrics of the song beyond the treatment
phase, which again may motivate them to participate in their treatment program.
Elude
Another Serious Game is Elude (Gambit 2010). The scientist and game designer
Doris Rusch created this game in 2010 at the Gambit Game Lab of the Massachusetts
Institute of Technology. Elude “aims to raise awareness for depression and to inform
about this dangerous illness. It is specifically intended to be used in a clinical con-
text as part of a psycho-education package to enhance friends’ and relatives’ under-
standing of people suffering from depression about what their loved ones are going
through”.8 This game, however, is not used directly for healing. It aims to inform
relatives of depressive patients and promote understanding of the disease. Perhaps
more importantly, it contradicts the idea that Serious Games only work through
‘having fun’.
The avatar of this game seems depressed by his stooped posture. The virtual
world is drab and dark with only a few splashes of colour. The player-character can
produce oral sounds when the player presses a key: these tones sound like moaning
or like a sigh. The sounds are quasi nearly sung and serve as a reminder to the
Solmisation system. Taken together, these verbal tones seem unmotivated. The vir-
tual character has a rather deep voice with little strength. Despite this, the sound
triggers something, it has an interactive effect in the virtual world and encourages
small birds, which become coloured, to fly away. This is bad for the player because
the only colourful aspects in the grayscale-world then become unattainable.
Musically, Elude is accompanied by a theme song in a minor key, and is domi-
nated by string instruments. In fact, music is very important for the game. Within it,
melodies and instrumentation change. There are two main motifs, a slow, discordant
8
http://gambit.mit.edu/loadgame/summer2010/elude_play.php (04.08.2015).
piano melody and a faster and much more dynamic guitar theme. But these almost
cheerful guitar chords appear only briefly. This is because the melody, which seems
to have neither a beginning nor an end, flies unresolved and disappears like the
birds. When the player has reached the goal of the game, which consists in climbing
up into the treetops, they find themselves in a funny and brightly coloured part of the
virtual world, where a cheerful and fast melody in major is heard. It is here that the
avatar at last appears finally happy. However, this is neither expressed by his facial
expressions nor by his posture. Only the music and the graphics suggest that happi-
ness. At this moment everything seems to be in order. But this is not the end of the
game. When the song is over, the game character sinks back into his depressive
initial position. The new chapter (or level) begins with the caption: “What passion
cannot music raise and quell.”
With this gloomy turn, we hear now deep resonant piano tones with ample rever-
beration. The game is designed to highlight how to reach the heights of euphoria.
This becomes more and more difficult, until it becomes impossible. This means that
the avatar wanders unsuccessfully through the dark world, which becomes increas-
ingly pessimistic. The music also remains oppressive. There is no victory and no
happy ending. The game ends with the death of the avatar. Completely independent
of the player’s skill, that death is inevitable. In this process, the music gets more
dramatic and louder. One thing is clear: this game is not fun. It is intended to illus-
trate the feelings, the emotional highs and lows of depressed persons. The music
supports this perception. Elude has a power even beyond its gloomy graphics and
musical arrangement. With this game, Rusch proves that video games are able to
influence the emotions of the recipients. As for the representation of emotions in
Elude, music plays a large role, such that it can be assumed that music in video
games directly supports and affects emotions.
SPARX
Returning to the topic of playing Serious Games as healing factor, another project is
SPARX. This game was developed by University of Auckland students and it seeks
to aid and act as a self-help tool for people experiencing symptoms of depression.
SPARX “is a computer program that helps young people with mild to moderate
depression. It can also help if you’re feeling anxious or stressed. It was developed
with the help of young people and is based on a type of ‘talking therapy’ called
Cognitive Behavioural Therapy, or CBT for short” (https://www.sparx.org.nz/). In a
randomised clinical trial published in the British Medical Journal, the game achieved
the same positive results as classic forms of psychotherapy. All in all, this game is a
fantasy role-playing game. When completing the various tasks within the game one
must distinguish between a ‘good’ and a ‘bad’ mind. Here the player needs to rec-
ognize unhelpful thoughts. These are visible in the virtual world as cloud-like for-
mations. Negative thoughts are thereby destroyed or converted into positive
“challenging unhelpful thoughts”. Other sections of the game bear titles like “being
active” or “dealing with emotions” (transcribed from the game by Y. Stingel-Voigt).

In addition to the in-game storyline, users learn breathing exercises they can also
perform in the real world. Members of the University of Auckland called this kind
of shift in consciousness by the Serious Game “Youth E-Therapy”. A digital guide
leads the player through the game. At the beginning, it explains that a concerted
effort should be made to play the game twice a week.
Through the fight against the threat of depressive gloomy negative automatic
thoughts, players learn to deal with negative thoughts, to develop problem-solving
strategies and implement them into their lives. In addition to the in-game storyline,
users learn breathing exercises they can also perform in the real world or exercises
to relax. According to the developers, the software is peppered with elements of
cognitive behavioural therapy. Usually for their meetings, young people have to go
to a treatment centre.9 With SPARX they can arrange to do their therapy sessions at
home by playing the game. The software has been tested in 24 practices in New
Zealand with 94 young people aged between 12 and 19. Another 93 patients were
randomised to conventional cognitive behavioural therapy in individual sessions
with the psychotherapist10:
On top of the benefits of cost and privacy, which may encourage depression sufferers from
seeking treatment they would otherwise miss out on, the medium may have another sub-
stantial benefit in that it is immediately accessible to an at-risk demographic; one study
found a higher incident of depression among avid gamers.11
Thus, it was demonstrated that this game has a positive effect on the psyche of its
players. Can its music also have an impact? The music for the game SPARX is cer-
tainly cheerful, which implies that it addresses its target group. It is electronic
music, which creates a club atmosphere and is composed in major keys that in turn
produce peaceful feelings. The music builds an atmosphere in which one can feel
comfortable. It is reminiscent of functional music from the New Age area, of anti-
stress melodies or music often heard in wellness centres. The musical backdrop of
SPARX seems to be matched by listening to music as a kind of receptive therapy.
Music probably acts as a mood manager in this game, thereby actively supporting
the therapeutic goals of the game.
Conclusion
The purpose of a Serious Game is to allow users to interact with a computer applica-
tion in which the functions of care, teaching, training, communication and informa-
tion are connected to an exciting element. This combination aims to pair utilitarian
9
https://research.sparx.org.nz/about (04.08.2015).
10
http://www.aerzteblatt.de/nachrichten/49948/SPARX-Computerspiel-lindert-Depressionen-bei-
Jugendlichen (04.08.2015).
11
http://www.vg247.com/2013/06/26/sparx-anti-depression-game-to-be-published-by-linkedwell-
ness/ (04.08.2015).
content to exciting interactive possibilities. This is known as Game-Based Learning

and directly refers to simulations and eLearning systems. With its increased motiva-
tion, the learning by playing approach is probably more interesting for the recipient,
as it is in the case of classical learning. In this context, music also has an impact.
Music is a spatial phenomenon (Böhme 1995: 9) and on this account helps to
immerse the player/patient into the virtual environment. Music in video games ful-
fils effective functions, for example, emotional, aesthetic or atmospheric functions.
Music can have an effect on its listener as it helps to produce a certain mood. This
can be used, as in music therapy, to generate a specific emotion.
Serious Games pursue a particular aim. It is not about diversion from everyday
life, at least not at first. The effects of Serious Games are used to achieve benefits
including relief of disease symptoms, motivation to internalise specific learning
content, simulation of events and training. To increase the effectiveness of Serious
Games, an expansion of their music and sound may be necessary:
We hypothesize that an important reason why serious games sometimes fail to reach their
learning goals, is because games offer a rich multimodal and thereby cognitively demand-
ing experience. As a person’s working memory only has a limited capacity […] and inte-
grating new sensory data into a mental model happens within the boundaries of this working
memory […], such a rich experience may be too cognitively demanding, resulting in incor-
rect mental models of the instructional material, […]. Finding ways to optimize cognitive
load during the design of the game is therefore an important step in creating effective and
instructionally sound games. (Spek et al. 2010: 119)
The use of music in Serious Games is certainly an expanding field. In some cases,
as in the treatment of pain, it is advisable to produce an intense flow experience. In
other cases, music supports the formation of an atmosphere or helps a player engage
with the game. But music can also have a healing effect by itself. Think of the heal-
ing music of the Sufi in Islam or the field of music therapy. Whether the use of music
in Serious Games offers relief, distraction or motivation is somewhat irrelevant.
Music is an important part, especially in games that treat various diseases. If we
understand these games as therapeutic, music then fulfils a supporting role. Music
and sound sustain an important part in the configuration of a virtual environment.
The visual is verified by the auditory and what we hear becomes real. There is a
difference in whether you can only see how a door closes or whether the right sound
is heard to accompany the closing door. In fact, sounds can be understood and local-
ized without a picture. Sonic elements are perceived and analysed immediately.
Sound and music can make the players more sensitive to several events inside the
game. Thus, listening is a function of the ears, but what is heard affects the whole
body.
A game created as innovative interactive medical and educational software
should therefore be not only attractively designed but also able to inspire and capti-
vate the players. For this goal, music can make a considerable contribution. Music
can influence player perceptions and behaviours, particularly when a certain style of
music is used. Likewise, music can have a stimulating effect. It can direct the focus
towards specific virtual objects and also affect emotions. When emotions are trig-
gered, a recipient may feel more connected to the subject matter. Especially in the
field of health and therapy, music has significant potential to exert a positive effect
on the condition of players/patients. Here it is not just about didactic concepts, but
the music used in a Serious Game can support the therapy, can motivate and encour-
age player immersion and thus enhance both the experience and the result of the
Serious Game.
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Wave Quest. 1995. Asthma Management-Bronkie the Bronchiasaurus. Mountain View: Raya
Systems.
Autonomy, Heteronomy, and Bioethics
in BioShock
Arno Görgen and Matthis Krischel
Introduction: Popular Culture and Technoscience
Artifacts of popular culture can be understood as a form of dialogical communica-

tion between different social fields.1 The cultural studies scholar Martin Barker
describes this dialogue as a contract between the reader and the text, or in the case
of BioShock, between the player and the game, which is based on three
assumptions:
(1) that the media are only capable of exerting power over audiences to the extent that there
is a ‘contract’ between texts and audiences, which relates to some specifiable aspect(s) of
the audience’s social lives; and (2) the breadth and direction of the influence is a function of
those socially constituted features of the audiences lives, and comes out of the fulfillment
of the contract; (3) the power of the ‘ideology’ therefore is not of some single kind, but
varies entirely—from rational to emotional, from private to public, from ‘harmless’ to
‘harmful’—according to the nature of the ‘contract’ (…), we need to understand ideology
as dialogical. (Barker 1989: 261)
Therefore, popular cultural media can act through their entertainment potential as
communicative bridgeheads between social subsystems (Huck and Zorn 2007;
Hügel 2010) This ability confers a potential capacity to detect, assess, and commu-
nicate social and cultural frictions, and can establish new perspectives and problem-
solving strategies. This is especially the case with so-called technoscience, because
in this particular field, the human condition is continuously questioned through
1
This article is based loosely on Görgen and Krischel (2012) and has been completely revised and
improved for this publication.
A. Görgen (*)
M. Krischel
Department for the History, Theory and Ethics of Medicine, Heinrich Heine University

https://doi.org/10.1007/978-3-319-90677-5_21
284 A. Görgen and M. Krischel
scientific and technological progress.2 Furthermore, “[a]ll scientific representations

are considered ‘re-presentations’ of nature that provide rhetorical power for scien-
tific claims, and thus, representations play a significant role in the construction of
scientific facts” (Kirby 2003: 232). Therefore, critical reflection on these represen-
tations of science and technology in pop culture can be an important factor in
assessing popular understanding of and attitudes to science and technology.
Digital games, in particular, should be a promising source of such efforts because
they have developed into a vital medium that critically reflects social and cultural
problems. They are, in a sense, philosophical thought experiments. The philosopher
Marcus Schultzke has pointed out:
even if video games are not thought experiments in a strict sense, they can function heuristi-
cally as thought experiments when they are interpreted as modeling philosophical prob-
lems. This approach involves interpreting games as models of specific philosophical
problems that can be used to explain, support, or challenge theories. I will argue that video
games can even improve on traditional narrative thought experiments because they include
an execution element; they allow the experiments to actually be performed by situating
them within simulated worlds that are far more complex and detailed than the settings
described in most narrative thought experiments. (Schulzke 2014: 252)
Games are also fundamentally dependent on the construction of simulated conflicts

within the formalized environment of the game. In one of the first studies of the
theory of computer games, the game developer Chris Crawford stated that games
are built to learn. They fulfill this task by building a learning environment that uses
representations of ‘real life’. By doing so, they allow the player to experience con-
flicts and to learn from them by failing, trying, and experimenting with different
strategies within the game. However, in contrast to reality, they never run the risk of
physical harm (Crawford 1984: Kindle Pos. 364).
The field of science in general and the field of biomedical science in particular
are especially popular sources of conflict in digital games, given their potential for
ethical risks in real life and their social impact through technology. Narratives about
science are easy to develop because games can use the actors (researchers, doctors,
patients), topographies (hospitals, laboratories), practices (experimenting, healing),
problems (diseases, biotechnological enhancement, etc.), technologies, and aes-
thetic and literary conventions of biomedical science (Görgen 2011: 330).
2
Technoscience is a phenomenon of modernity. Mitcham describes it as a product of human
evolution:
In the (…) technological milieu, on the basis of social organization, there emerges a trans-
formation of science from theory to practice and of practice from tacit-based skill to sys-
tematically pursued technics. Sociology is replaced by technology. Although they remain
distinctive cultural disciplines and social institutions, science and technology, thus con-
ceived, begin to feed off of and to reinforce one another. Technology takes on the form of
applied science (in engineering); science takes on the form of applied technology (from
telescope and microscope to space probe and computer simulation). Commercialized, the
new interactive phenomenon of technoscience reconstructs society in its image. Mitcham
(1999: 129)
Autonomy, Heteronomy, and Bioethics in BioShock 285
The use of science as a focal point for conflict construction hints at another
aspect of science in games. When science is not reduced to a mere functional or
strategic aspect of the game, but also serves a narrative purpose, it is usually repre-
sented as a postnormal (Funtowicz and Ravetz 1994) or revolutionary science (Kuhn
and Hacking 2012). The scientists in these scenarios are not just doing ordinary
research or ‘puzzle solving’, but might be facing decisions that have a strong and
uncertain impacts on the ecological or social environment of the game world. In
games, this science is often integrated within a social superstructure (in the form of
private or public-sector biomedical research facilities). At the same time, if we fol-
low Thomas Kuhn’s ideas of the ‘structure of scientific revolutions’, science in
games is predominantly revolutionary science. The scientific actors in games don’t
follow the paradigm of normal (well-established) science, but try to develop new
scientific methods, perspectives, and paradigms. This kind of revolutionary science
often includes narratives of ‘mad scientists’ and their immoral (because they are
neither socially accepted nor recognized) experiments in mainly hidden places. In
this sense, digital games fulfill some of the same roles as critical science fiction lit-
erature in reflecting the potential drawbacks in the development of science and
technology.
In particular, the science fiction subgenres of steampunk, retro-future,3 and
biohorror,4 are increasingly used to transmit biomedical visions of the future, with
aesthetic, sociocultural, and political references from the period of late modernity
(Fraunholz et al. 2012: 16–18) and its positivist vision of the future.
This optimism in technological and social progress is expressed through the ‘fea-
sibility utopias’ of a technocratic modernity. In this context, adaptations and repre-
sentations of contemporary technology and industrial design are used as key stimuli
that help the player to identify with the virtual world. Henry Jenkins describes the
aesthetic and epistemological knowledge and traditions that are used to ensure
greater immersion in the game world as “evocative spaces” (Jenkins 2004: 129).
Contrary to the praise of natural and technical scientific research of the first half
of the twentieth century, an increasingly negative assessment of the natural sciences
as structurally conservative and economy-centered has developed since the 1960s
(Turnpenny et al. 2011). The decline in the positive public perception of science has
been embedded in wider social and cultural changes, which Eric Hobsbawm
described as a shift from a ‘golden era’ of strong economic growth to an age of
economic inertia (Hobsbawm 1995). This also led to a crisis in the economic sphere
(e.g., the oil crisis and inflation), the political arena (new political movements and
3
Steampunk fiction combines technical innovation with the industrial and technological aesthetics
of the nineteenth and early twentieth century. Similarly, retro-future implements high technology
in a historicizing setting, although aesthetically, retro-future is instead associated with the time of
technocratic high modernity.
4
Biohorror as a horror fiction subgenre deals with biological issues, such as mutation, evolution,
and genetics, and is closely related to the subgenre of body horror, which focuses on the mutated
or degenerate human body (Pullins 2001).
conflicts), the social realm (the failure of traditional values to unite society), and
finally in popular culture.
This simultaneous criticism of and optimism in technology is exemplified in
BioShock (2K Boston 2007). The game’s narrative use of biotechnical modifications
of the human and the occurrence of transhumanism are represented here both as
saviors of and threats to humanity (Dickel 2011). Therefore, in this paper, we use
the computer game BioShock to identify the discourses on technoscientific criticism
that are reflected in popular culture.
To do so, we start by noting some specific methodological practices in the analy-
sis of computer games. We then present the game BioShock itself as a dystopia. In
particular, we describe the relationship between the game and Ayn Rand’s philoso-
phy of objectivism. Two hypotheses will structure the core analysis.
First, we support Schulzke’s notion of the computer game as a medium for philo-
sophical thought experiments. Using bioethics as the contextual framework for the
analysis, we will demonstrate that in popular culture, this assumption of the com-
puter game as a playground for bioethical reflection in terms of narrative ethics5 has
already been established and should therefore be considered a focus of bioethical
reflection, akin to the narrative ethics in movies (Shapshay 2009). As the philoso-
pher Paisley Livingston puts it, “[w]hen sufficient background knowledge is in
place, reflections about films [and games (!)] can contribute to the exploration of
specific theses and arguments, sometimes yielding enhanced philosophical under-
standing” (Livingston (2006, 11). We argue that the interactivity of games improves
their experimental character.
Second, as a thought experiment, the game world of BioShock is framed by the
philosophical ideas of objectivism that were developed by the Russian-American
philosopher and author Ayn Rand (1905–1982). We will show that this framework
provides a foundation for fundamental reflection upon biomedical ethics and how
bioethical standards can become obsolete through unregulated progress in biomedi-
cal science. The underlying causal connection between laissez-faire capitalism and
unbounded science reflects the present skepticism about the potential biotechno-
logical improvement of human life (Habermas 2005).
The core idea of BioShock has been executed as a thought experiment on both the
ludic level (i.e., game mechanics) and the narrative level (i.e., story design).
On the ludic level, we explore the interaction between the player and the game
and how this interaction generates meaning and knowledge. In the game, science
circulates around the relationship between the subject, society, and science, which
always ultimately leads to a conflict between the autonomy and heteronomy of the
individual regarding science. We argue that autonomy/heteronomy is the central
ludonarrative focus of the game. It not only structures the game’s story, but also the
player’s interaction with the game. We show below that the autonomy of the player
character and the non-player characters is impossible in this game. The most obvi-
ous example of this is the key scene of the game, in which the player character acts
5
‘Narrative ethics’ describes a methodological approach to a critical analysis of moral phenomena
and structures that are communicated narratively (Joisten 2007: 11).
against his will and beyond the control of the player. To emphasize the importance
of interactivity, we will also demonstrate how the player must perform ‘ludonarra-
tive archaeology’ (Görgen and Inderst 2015) to successfully play and comprehend
the game.
On the narrative level, we will analyze aspects of the game to show how retro-
science fiction has been used as a vehicle for social, scientific, and technological
criticism. We use the example of the development and distribution of the fictive drug
ADAM, which extends our understanding of the relationship between regulatory
powers and radical market liberalism. We also discuss the example of aesthetic sur-
gery, portrayed in the game as the dissolution of ethical medical research and prac-
tice, and the consequent threat of dehumanization. Because retro-futuristic elements
have been used in the design of the game world, the aesthetic presentation of the
game becomes an ironic and critical medium through which to reflect upon the
unfulfilled promises of modernity in the game world.
Analytical Approaches to BioShock
Our analysis of BioShock is situated in an interdisciplinary field between media

studies, the history of ideas, and bioethics. We focus on the processes of generating
meaning and knowledge while playing a game, and therefore on the context in
which the game is played and how it may be understood by different audiences.
Therefore, our approach can be understood as a poststructuralist, hermeneutic
approach (Fernández-Vara 2015: 11), in which we basically try to trace the relation-
ship between the game as a text and the other texts to which it refers. As well as this
contextual analysis, it is also important to consider the levels within the game on
which meaning is produced. The Norwegian literary scholar Espen Aarseth estab-
lished a model of computer game analysis that situates the ‘text’ of a game and the
genesis of meaning on three interdependent levels: gameplay (the player–game
interaction), game structure (the rules of the game), and game world (visual and
textual aesthetics and the content of the game) (Aarseth 2003: 2). In particular, the
connection between the game world and gameplay (between the narrative and
player behavior) makes possible the intense experience of the artificial game envi-
ronment in BioShock. The story and the game can only unfold if the player interacts
with the game. Espen Aarseth states that “a nontrivial effort is required to allow the
reader to traverse the game.” (Aarseth 1997: 1) He calls this kind of interactive nar-
rative genesis ‘ergodic literature’, with reference to the Greek words έργον (ergon:
“work”) and οδός (odos: “path” or “way”) (Aarseth (1997: 1). This primacy of the
action implies that games can encourage ethical reflection: in order to interact with
and progress through the game, the player must constantly reflect on his own
actions. Although this applies to all kinds of games, it is especially important in
games that include an elaborative narrative and elements of role-playing games.
Based on Luhmann’s distinction between first- and second-order observation
(Luhmann 1998: 1–7), two levels of ethical reasoning can be identified in games.
The first-order level of ethical reasoning emphasizes the active moral decision-
making in the context of the ludic experience of the game. The second-order level of
ethical reasoning primarily includes a moral-decision-making experience in which
narratives of ethical relevance can be observed from the perspective of the game
world, e.g., the aesthetic or moral actions of the non-player characters. Both can
evoke a game-specific ethical culture (Görgen 2011: 330–331). The active ethical
decisions prestructure the gameplay in BioShock in some way, and the player char-
acter’s action is questioned metatextually at central points in the game. The interac-
tivity of the game also allows the player to investigate and comprehend the game
world because he must actively explore its history by reading and listening to histori-
cal records. However, the player becomes a second-level ethical observer by ‘read-
ing’ the game world. Therefore, an extended form of critical source analysis, common
to the analysis of narratives in game studies (E.g. Masso 2009), can be applied here.
To provide a more objective basis for the player’s subjective experience of the
game, an analysis should also cover game reviews, newspaper articles, developer
diaries and -talks, and postmortems, as well as the game itself (Fernández-Vara
2015: 37–39). Furthermore, although every single act of playing the game is expe-
rienced differently, many games include pivotal elements, such as cut scenes, level
designs, or play elements, that are experienced similarly by all players, and are
therefore of central interest in any content analysis. However, the size and complex-
ity of some computer games require that we concentrate on hermeneutic–qualitative
and heuristic approximate analyses of the game.
Previous research on BioShock has placed the utopian or dystopian dimensions
of the game in the foreground. On the one hand, this central question is treated aes-
thetically by asking whether and how games can be art, and how the utopia is con-
structed in the game (Garin and Pérez 2009; Martin 2010; Tavinor 2009; Lizardi
2014). On the other hand, the ethical aspects have been analyzed, with a focus on
the ludic experience (Schmeink 2010; Travis 2010; Wysocki and Schandler 2013).
Other approaches have focused on the representation of BioShock as a political
utopia, especially its connection to Ayn Rand’s philosophy of objectivism (Packer
2010; Tulloch 2010; Krogulec 2013) and the metatextual linking of utopia, media,
and economic reality (Aldred and Greenspan 2011). However, references to the
scientific (Murdoch et al. 2011) or medical issues in the game have only been cur-
sory (Biernoff 2012; Schulzke 2013; Görgen 2011; Görgen and Krischel 2012).
Therefore, we particularly address the biomedical aspects of the game world of
BioShock and their criticism, which are implemented in its dystopic setting. We also
emphasize the bioethical choices of both the player and non-player characters.
BioShock as a Dystopia
Computer games not only use utopias, but can be considered a utopian medium per
se. The utopian moment of the game can be explained by its structure: each game
offers the player a (functional) possibility space (Wright 2004) and more than that,
a (utopian) facilitation space (Görgen and Inderst 2016: 53), virtual spaces can
abolish the set of natural, sociocultural, and topographic restraints on the player and
invite him to enter these nonplaces. They not only enhance the player’s experience
spatially, but also physically. They allow the player to experience situations that he
could never experience in reality. Therefore, games are not only ‘nonplaces’ (uto-
pias) but also ‘other places’ (heterotopias) in the sense that they are real places cre-
ated within a society as counterweights or realized utopias, in order to counteract
and reflect upon the real spaces within a culture (Foucault 1992 [1990]: 39).
Therefore, ludonarrative utopias are not only an expression of or a medium for
escapism, they are a form of “engagement with the socio-cultural values that inform,
and are informed by play itself” (Jensen 2013: 69). Besides its function of critically
reflecting culture and society, a game also creates its own utopian essence. Steffen
Walz has argued that “Utopia is a piece of fiction whose goal is to delightfully
immerse the reader in the rules of a perfectly organized game. Utopia describes not
only a physical space meant to entertain those who read about it, but also a perfect
living space meant to delight those who inhabit it. A utopia programs perfect behav-
ior and therefore, perfect enjoyment” (Walz 2010: 137). Hence, the interaction of
the player always aims to achieve a utopia of perfect player integration and control.
Good utopian games allow critical reflection on the autonomy and heteronomy of
both the player and the population of the game world. All these aspects frame games
as utopias and are therefore also found in BioShock.
To understand BioShock as a dystopia, or negative utopia, we must first under-
stand it as a utopia. The game is set in 1960 in the ruins of the secret underwater city
of Rapture (literally a state or feeling of great happiness or pleasure, but also carrying
a religious connotation of deliverance), a futuristic city that was built by the fictitious
entrepreneur Andrew Ryan in 1947. The game starts with a plane crash in the Atlantic
Ocean, after which the player character Jack saves himself on a lighthouse and
accesses a diving bell, which brings him to Rapture. During his descent, the player
listens to an automatic tape containing information about the city and its builder:
I am Andrew Ryan, and I’m here to ask you a question. Is a man not entitled to the sweat of
his brow? ‘No!’ says the man in Washington, ‘It belongs to the poor.’ ‘No!’ says the man in
the Vatican, ‘It belongs to God.’ ‘No!’ says the man in Moscow, ‘It belongs to everyone.’ I
rejected those answers; instead, I chose something different. I chose the impossible. I chose
... Rapture, a city where the artist would not fear the censor, where the scientist would not
be bound by petty morality, where the great would not be constrained by the small! And
with the sweat of your brow, Rapture can become your city as well. (The BioShock Wiki
2011c)
The city was built to serve the (natural) scientific, cultural, and economic elite as a
refuge and allow them to prosper without ‘petty morality’, censorship, or other
restrictions. The utopia of Rapture is clearly based on the criticism of ecclesiastical
and state authorities in the Cold War era. In contrast, this city stands for a haven of
freedom that is not restricted by laws or morals. This ideological framing of Rapture
is based on Ayn Rand’s sociopolitical ideas of objectivism. Rand, nee Alissa
Rosenbaum, was born 1905 in Russia and emigrated to the USA in 1925. Her best
known works are The Fountainhead (1943, adapted for the big screen in 1949 by
King Vidor) and Atlas Shrugged (1957, adapted as a trilogy for the big screen in
2011–2014). Both novels focus on the conflict between a creative, committed
protagonist and his oppressive environment. This fundamental conflict underpinned

Rand’s social philosophy of objectivism in the late 1950s. This philosophy is char-
acterized by the rejection of communism and socialism and a confidence in the
regulative powers of a free market, with an emphasis on personal freedom. Central
to any understanding of Rand’s philosophy is the notion of self-interest (‘selfish-
ness’), which is interpreted positively as a well-informed consideration of one’s
own interests, whereas altruism is rejected because, from Rand’s perspective, it
implies self-sacrifice rather than a real respect for the other (Badhwar and Long).
She states “Man—every man—is an end in himself, not the means to the ends of
others. He must exist for his own sake, neither sacrificing himself to others nor sac-
rificing others to himself. The pursuit of his own rational self-interest and of his own
happiness is the highest moral purpose of his life” (Rand 1986). Rand’s ‘rational
egoism’ leads to a rivalry between a prometheic and productive creator and an epi-
metheic and parasitic second hander (Lippert 2011: 19). Andrew Ryan not only
cites this basic competition between creator and second hander in his introductory
monologue, but also uses a similar terminology in his radio transmissions, in which
he talks about parasites and slaves on the one hand, and men as builders on the other
hand. This clearly mirrors Rand’s advocacy of full, pure, uncontrolled, unregulated
laissez-faire capitalism (Rand and Branden 1964).
A part of the game is dedicated to exploring the history of the rise and fall of
Rapture. It combines Ryan’s ideology of radical capitalism and individualism with
a utopia of self-improvement, which finds expression in programs of medi-
cal technology-based improvements, ‘corrective genetics’, and radical plastic sur-
gery. In nuce, this detachment of man from his physical and mental constraints can
be seen as an alternative to the constraints imposed by contemporary ideologies.
However, the results of this utopia are not transhuman supermen, but a city in ruins,
and the player finds the dehumanized inhabitants, audio diaries, radio transmis-
sions, propaganda posters, and other media artefacts on his way through the city.
The city of Rapture in the game world of BioShock was designed to be a utopia
of personal freedom, a place where its inhabitants are autonomous. As such, it
reflects certain trends in liberalism and neoliberalism in late modern thought.
Through its downfall, the autonomy of its inhabitants has been perverted to heter-
onomy and the utopian city to a dystopia. In the following sections, we explore how
the theme of autonomy/heteronomy is addressed in ludic terms in the game and give
two examples of narrative elements that address autonomy within the context of
bioethics and medical ethics.
Interacting with the Game
At first glance, BioShock offers a generic plot, not unlike other utopian/dystopian
novels or movies. What distinguishes BioShock from its cinematic and literary rela-
tives is its ludic implementation of the narrative. It is an interactive computer game,
in which autonomous subjective actions can be made by the player in the form of
interactivity with the game world.
Both the strength and the weakness of the computer game medium lie in the
subjective experience of a utopia. The strength of this interactivity is that the player
truly participates in the unfolding of the story and can even experience the conse-
quences of his own actions in the protagonist he controls or in the environment of
which he is a part. The weakness of interactivity lies in the fact that all the narrative
content is at risk of being ‘swallowed’ by the ludic experience and serves only as a
mere game-immanent marker for certain strategic approaches to a game situation. A
strategy that can prevent such decontextualization is the establishment of a close
connection between the player and the scenario via the game mechanics.
We find this approach used in BioShock in two principal ways: the focus on the
theme of autonomy/heteronomy and the implementation of ludonarrative
archaeologies.
Autonomy/Heteronomy We understand autonomy to be the ability “of persons to
make decisions, while taking responsibility for those decisions and respecting the
autonomy of others” (UNESCO 2005). Therefore, heteronomy, as its antonym,
describes the state of being controlled by others. In BioShock, the protagonist finds
himself in a city whose inhabitants have been thrust into heteronomy by radical liber-
alism and radical politics, which promised to deliver maximum personal freedom—
even when this could potentially diminish other people’s freedom. Ultimately, this
utopian ideology of absolute personal freedom led the city to succumb to civil war.
Heteronomy and autonomy are also addressed on the ludic level in BioShock.
Like many other games, it forms an educational relationship between the player and
the game, in which the player is introduced to the game world, its rules, and controls
by playing through tutorials, direct game instructions, reward systems, and so on.
After Jack arrives in Rapture, he is told by Atlas, the leader of a local rebel group,
about the decline of the city via a radio link. As the game progresses, it is revealed
that Atlas is the pseudonym of Frank Fontaine, an opponent of the city’s founder,
Andrew Ryan. It is this radiotransmitted voice that introduces the player to the
mechanics, rules, and aims of the game world and leads him through Rapture. In the
final confrontation with Andrew Ryan, it becomes clear that from the beginning,
Jack has been under the influence of brainwashing that allowed Atlas/Fontaine to
guide him through Rapture according to Fontaine’s personal needs. Ryan forces the
player, with the help of mind control, to finally kill Ryan. A possible explanation for
this seemingly oedipal (self) murder—Ryan is revealed as Jack’s father—is that
Ryan wants to draw attention to Jack’s inability to resist the influence of brainwash-
ing. Simultaneously, Ryan hopes that by repeating the slogan “A man chooses, a
slave obeys”, he can break Fountain’s influence over Jack. In this central twist, this
slogan becomes a cynical commentary on the player’s heteronomy. Atlas becomes
an important metatextual element, that throws the player back onto himself and his
total loss of autonomy, not only telling Jack what to do, but also allowing the player
to watch his brainwashed character kill Andrew Ryan. This cross-link between the
narrative and the game mechanics throws the player back on his heteronomous
inability to influence the game (Tulloch 2009: 19) and invites him, we argue, to
reflect upon questions of autonomy and heteronomy.
1
Ludonarrative Archaeologies Another important strategy used to counter the
decontextualization of a utopian/dystopian game world is to playfully feed the
player context. Many games with utopian content refer to the status quo or the his-
torical development of the game world using historical records: texts, videos, books,
newspaper articles, etc. These records thus form a narrative, which often reveals the
historical background of the game world, together with the plot of the game. In
BioShock, the player listens to audio diaries of the deceased or maddened citizens of
Rapture and examines media relics from the golden era and the era of decay of the
underwater city. These include (sometimes bloody) graffiti, radio broadcasts, and
propaganda posters. While the player explores the cultural development of the soci-
ety of Rapture, i.e., examines the archaeology of his environment, he is on his own.
Hence, he must learn how to engage and interact meaningfully with this game world
to understand it to its fullest extent. Bioshock does not reduce the objects of the
ludonarrative archaeology to media artifacts, but also includes the spatial setting of
the game world. Doris Rusch has pointed out that:
Elaborating on the capitalist motif, advertisements and vending machines are used as essen-
tial props of the narrative game-space, playing an interesting double function in the
hypothesis-building process that always includes both of the earlier introduced key ques-
tions. On the one hand advertisements and machines hint towards the (genetic) experiments
that have been conducted in Rapture, e.g. ads for cosmetic surgery, images of people who
illuminate light bulbs with their bare hands, or vending machines that sell Gene Tonics or
Plasmids. Thus, these props provide background info about Rapture's dark secret and
explain the grotesque appearance as well as superhuman powers of its citizens. On the other
hand, they offer clues for the abilities the player herself (or rather her avatar) must acquire
over time if she is to get out of this nightmare alive. Speculating about future abilities fos-
ters further hypothesizing about coming obstacles and enemies, keeping the player guess-
ing about what the narrative implications of these spaces will hold in store for them
game-play wise. (Rusch 2008: 148)
Using ludonarrative archaeologies, BioShock fosters hypothesis building and paints

a vivid picture of Rapture as the haven of a libertarian capitalist ideology. In this
way, the player is implicitly invited to critically reflect on the scenario and its bio-
ethical implications. In Bioshock, the game strategies that ensure player engage-
ment are cross-linked to the narrative. Therefore, they are always present and must
be considered when we talk about the bioethical and biomedical narrative represen-
tations in BioShock.
iomedical Discourses (1): Biomedical Research and the Free

B
Market
In this section, we point out the references to Rand’s philosophy of objectivism in

BioShock. The focus of the game is a critique of unregulated capitalism and
unchecked biomedical research. Joseph Packer notes that in both, the novels based
on it, and their film adaptations, social criticism of Rand’s philosophy is converted
narratively and aesthetically (Packer 2010: 209). The clearest indication of refer-
ence to Ayn Rand in BioShock is the character of Andrew Ryan, whose name is a
nearly anagrammatical play on ‘Ayn Rand’. Ryan’s vision is to create a libertarian

meritocracy in which the state and religion have no influence. Andrew Ryan’s
Rapture can also be seen as a deconstructivist mirror image of Rand’s Atlas
Shrugged. The underwater world appears as a dystopian version of the utopian city,
Galt’s Gulch, described in the novel.
Whereas Galt’s Gulch flourished as a center that attracted the elite, in which their
pursuit of self-interest and self-realization produced a prosperous and happy soci-
ety, Rapture both simulates this ideal literary state and presents a perspective on the
negative consequences of Rand’s model society. The aesthetics of BioShock can
also be understood as a reference to Rand’s work. In the film version of The
Fountainhead, art deco skyscrapers are symbols of modernist virtues, such as free-
dom, masculinity, and ingenuity (Packer 2010: 214 f.). The design of the city of
Rapture clearly refers to these semantics of progress, and even emphasizes the
semantic overlap of ethics and aesthetics. As soon as the protagonist Jack enters the
city, the high expectations prompted by both the urban aesthetics and Ryan’s wel-
come speech become their opposites. The city, attractive from the outside, turns out
to be dark, dirty, and decaying. In the very first scene, the player is faced with a
bloody battle for the scarce resource ADAM.6
The virtual history of the enhancement drug ADAM can be traced in a process of
ludonarrative archaeology. Finding the artifacts that reveal the development of
ADAM identifies the key criticisms expressed in the game, which concern both the
regulatory powers of the free market and unregulated and amoral research. Although
unintended by its inventors, ADAM has caused the mental and physical degenera-
tion of the citizens of Rapture. ADAM was originally derived from a sea snail, and
confers superhuman strength and improved salutogenesis, among other things. At
the same time, the drug triggers a degenerative disease, whose progression can be
curbed only by its continued use. The increasing demand for the drug ultimately led
to the extinction of its natural source. When the player character enters Rapture,
ADAM can only be obtained from the dead bodies of the citizens.
The introduction of ADAM represents unregulated biomedical research, which
has not been terminated, despite the adverse effects that became obvious early in the
development process. In an audio diary, the player can listen to an entry by Andrew
Ryan:
There has been tremendous pressure to regulate this Plasmid business. There have been side
effects: blindness, insanity, death. But what use is our ideology if it is not tested? The mar-
ket does not respond like an infant, shrieking at the first sign of displeasure. The market is
patient, and we must be too. (The BioShock Wiki 2011a)
The reliance of Ryan on market forces (and implicitly on the autonomy and self-
responsibility of the user) clearly overrides the bioethical principle of nonmalefi-
cence (Beauchamp and Childress 1989: 120–193). In particular, Ryan’s remark that
in Rapture, scientists should not be limited by ‘petty morality’ implies that the intro-
duction and spread of ADAM, including all its adverse effects, are attributable to the
6
As a further hint on Rand, pictures of her are hidden in the Medical Pavillon.
principles of the city. Other moral considerations of human subject research as laid
down in the Nuremberg Codex and subsequently in the Declaration of Helsinki are
ignored.
In the dystopia of BioShock, the search for ‘superhuman abilities’ leads the
player character to fight the citizens of Rapture who, although physically stronger,
are dehumanized physically, mentally, and culturally (Packer 2010: 216 f.). Their
abolition of the bioscientific and cultural beliefs that the human body is a socially
unifying entity goes hand in hand with the abandonment of the ethical structures
that stem from this biophysical common ground. At this point, BioShock follows the
conservative American bioethicist Francis Fukuyama, who argues in his treatise
against human enhancement “Our Posthuman Future” (2002) that human nature
is a meaningful concept, and has provided a stable continuity to our experiences as a spe-
cies. It is, conjointly with religion, what defines our most basic values. Human nature
shapes and constrains the possible kinds of political regimes, so a technology powerful
enough to reshape what we are will still have possibly malign consequences for liberal
democracy and the nature of politics itself. (Fukuyama op. 2002: 7)
The topos of unchecked science that turns into horror is often found in literature and
the arts. Mary Shelley’s Frankenstein (1818) is undoubtedly one of the most popular
representatives of the genre. However, BioShock goes further than many of its pre-
decessors by drawing a connection between radical liberalism as a political philoso-
phy, the radical liberalization of markets, and deregulated science. In the city of
Rapture, an unquestioned belief in personal autonomy—the freedom to study the
enhancement drug ADAM and the freedom of citizens to use the drug—ultimately
leads to a dependence on the drug, which can be understood as a form of
heteronomy.
Biomedical Discourses (2): Nontherapeutic Surgery
The topos of the failed development of posthumanism is further explored in

BioShock. This failure is expressed in the perverted instrumentalization of plastic
surgery through a ‘duty to aesthetics’, which can be interpreted as a general criti-
cism of current social trends.
The game levels in BioShock are named after the various spatial sections of the
city. The ‘Medical Pavilion’ is, as the name implies, the central point for medical
care in the city. In response to the effects of ADAM (improving the healing capaci-
ties of the body while simultaneously causing the body to decay), curative medicine
is considered increasingly obsolete. This gives rise to a shift in focus at the Medical
Pavilion towards the cosmetic aspects of medicine. As the use of ADAM increases
mental and physical degeneration, the negative consequences of genetic and physi-
cal enhancement are countered by ever more drastic plastic surgery, used as a thera-
peutic agent to reduce the physical, visible symptoms of this degeneration.
Dr. Steinman, the director of the Department of Aesthetic Ideals, suffered psy-
chological and physical damage from the consumption of ADAM. As a result, he
tries to shape his patients to his ideal of beauty, which he developed with reference
to Picasso’s revolutionary modernist Cubism. In Steinman’s audio diary, he states:
When Picasso became bored of painting people, he started representing them as cubes and
other abstract forms. The world called him a genius! I’ve spent my entire surgical career
creating the same tired shapes, over and over again: the upturned nose, the cleft chin, the
ample bosom. Wouldn’t it be wonderful if I could do with a knife what that old Spaniard did
with a brush? (The BioShock Wiki 2011d)
The reinterpretation of surgery as a pure art form is based on the characteristics of

ADAM. According to Steinman, ADAM’s potential utility obliges every ordinary
citizen to strive for a personal aesthetic. This concept of aesthetics is a moral cari-
cature of the ideas of transhumanism. The term ‘transhumanism’ was coined by the
British biologist Julian Huxley (1887–1975) in 1957 (Huxley 1957: 13–17).
Although most transhumanists focus on mental enhancement, some proponents
argue for the aggressive use of biomedical technology to improve the physical and
mental capacities of humans. Anders Sandberg, for example, has proposed the right
to morphological freedom, “to modify oneself according to one’s desires” (Sandberg
2001).
In BioShock, this right to bodily self-determination is reinterpreted as a moral
obligation. From the ability to manipulate one’s physical appearance, Steinman
concludes its absolute necessity:
Ryan and ADAM, ADAM and Ryan ... all those years of study, and was l ever truly a sur-
geon before I met them? How we plinked away with our scalpels and toy morality. Yes, we
could lop a boil here, and shave down a beak there, but ... but could we really change any-
thing? No. But ADAM gives us the means to do it. And Ryan frees us from the phony ethics
that held us back. Change your look, change your sex, change your race. It's yours to
change, nobody else’s. (The BioShock Wiki 2011b)
Steinmans ideology gets emphasized by bloody graffiti, which the player can find
all over the Medical Pavillon. The graffito “ADAM denies us any excuse for not
being beautiful” expresses this biopolitical totalitarianism, as does the player’s
‘welcome’ to the level through the graffito “Aesthetics are a moral imperative!!!”
Both are counteracted by another graffito, written in blood, stating “Above all, do no
harm!”, which ironically refers to the medical paradigm of nonmaleficence in medi-
cal Principle Ethics (Beauchamp and Childress 1989: 120–193).
BioShock’s disfigured citizens, the Splicers, are also a grim reference to a realm
void of ethical principles: the appearance of these manipulated bodies has been
adapted from First World War medical photographs of soldiers with facial injuries,
taken by Henry Tonks. Although these photographs were not originally meant to be
available to a general audience, they have been exhibited in recent years e.g., at the
Venice Biennale, Tate Britain, the Science Museum in London, the Hunterian
Museum at the Royal College of Surgeons of England, the Wellcome Collection, the
University College London, and the National Army Museum in Chelsea (Biernoff
2012: 180). Biernoff suggests that the use of these pictures in the game is unethical
because they lie in “an ethical borderland in which legal definitions of privacy, per-
sonhood and human rights compete with the contemporary politics of witnessing,
memory, and memorialisation; a space of phantasy where fascination and aversion
are found in equal measure.” (Biernoff 2012: 183) Biernoff further states that the
Splicers in BioShock can be traced back to photographs of individuals, whose suf-
fering is not respected when they are used in the game (Biernoff (2012: 198).
Although we agree that the use of the pictures violates the autonomy (and privacy)
of the depicted individuals, we believe that their use is not entirely disrespectful.
The disfigured enemies are not only monsters in the game, they are the true victims
of a failed policy and unregulated medicine. As ‘semiotic ghosts’7 of the victims of
World War I, the photographs represent—in accordance to the Splicers in
BioShock—a generation whose autonomy, and with it their dignity, was stolen (in
reality and in the game) by the consequences of a radically modern political and
scientific appropriation of the world.
In BioShock, medicalization as a means of social control (Conrad 1992) ulti-
mately becomes the opposite of the promised freedom. In the game, medicine (in
the form of the drug ADAM) creates a degenerated population. The narrative escala-
tion takes place when this population is forced by social pressure and by Dr.
Steinman to undergo physical modification, initially to alleviate the adverse physi-
cal effects of ADAM and then to comply with the aesthetic ideals of their surgeon.
Again, a promise of absolute freedom does not lead to the well-informed autonomy
of the citizens of Rapture, but to its opposite: a loss of control over their mental
capacities and external control of their physical features, as extreme forms of
heteronomy.
Conclusion
Utopias are future-oriented expressions of hopes and wishes. They are ‘current
futures’, highlighting ex negativo what current conditions are not desirable by visu-
alizing their future improvement. Dystopias, in contrast, amplify the negative
aspects of the status quo and the potential drawbacks of development. According to
Gianni Vattimo, dystopias tend to combine impossible (future) technology with a
historicist framework to instantiate a fear of the future. By setting the game in the
past, it can be shown ironically that utopias are deeply time-bound. The superior
technology of a ruined utopia thus undermines any faith in progress and exposes the
idea of the utopia as a discontinued model (Vattimo 1992: 80). Therefore, the asyn-
chrony between technology and the environment in BioShock prompts a skeptical
view of Andrew Ryan’s utopia of Rapture.
The historical aesthetics of Rapture refer to the period of high modernity. The
use of quotations from Ayn Rand’s The Fountainhead and the urban design of
7
Term originally used by William Gibson, taken from his short story The Gernsback Continuum
(1981).
New York in the first half of the twentieth century and Fritz Lang’s Metropolis
(1927) show that human creativity is thwarted by the failure of humanity inside the
city. Therefore, BioShock is a high-tech interactive object that is also in the tradition
of recent ‘urbanizing’ science fiction cinema,8 as represented by films such as Blade
Runner (1982, Ridley Scott), Tim Burton’s Batman movies (1989, 1992 Tim
Burton), and Dark City (1998, Alex Proyas). The media studies scholar Barbara
Mennel has pointed out:
As technology advances in society, we increasingly find artificial humans, cities and spaces
in the urban science fiction. Science fiction film is caught in a curious paradox: the more the
advancement of technology lends itself to narratives fed by anti-technological anxiety and
conspiracy, the more the representational strategy can rely on technological development.
(Mennel 2008: 140)
In BioShock, this transience reveals itself not only in the unfashionable 1946 art
deco buildings, but also in the brass-colored surfaces of the equipment that accom-
panies the journey of the protagonist, which belie its high-tech purposes.
This also applies to the final ADAM-induced conversion of Frank Fontaine into
a bronze, patina-prone posthuman. This posthuman Atlas, the final adversary in the
game, recapitulates a bronze figure of Atlas built in 1937 in front of New York’s
Rockefeller Center by Lee Lawrie (1877–1963). Therefore, it is the embodiment of
Rand’s radically liberal capitalism, an entity who wants to grow beyond the people,
losing all its human and moral integrity in the process. In this ironic framework, the
mandatory civic duty of aesthetic self-constitution, the splendor of ancient times,
and the confidence in laissez-faire capitalism are shown to be obsolete. The recourse
to the past can also be explained by the fact that “the late twentieth century in the
United States was a decade of decadence and anxiety, not yet unabated, though the
decade ended post-9/11 and with the Y2K fears that now look as decadently ridicu-
lous as [...] the fears generated by the Soviet launching of Sputnik” (Rankin 2011:
139). The semi-nostalgic transfer of historicizing aesthetics to the medium of com-
puter games is consistent with the recognition of such basic fears as ‘alienation’
from the outside world and the alienation from very familiar concepts, such as one’s
own body or one’s own society, or the loss of autonomy.
In this way, the digital game BioShock addresses, on both the ludic and narrative
levels, high modernity’s belief in liberalism and technology, in human enhance-
ment, and in unbounded research. We have shown that the city of Rapture, founded
on the tenet of ultimate personal liberty, has allowed developments that ultimately
negated the autonomy of its citizens and plunged them into heteronomy.
8
Among games, BioShock’s technoscientific urbanity implemented a whole new topological and
aesthetic language and certainly contributed to the success of games such as BioShock Infinite,
Remember Me, Dishonored, and others.
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The Scientific Enterprise Illustrated:
Abduction, Discovery and Creativity
Fabrizio Augusto Poltronieri
Science is an essentially anarchic enterprise: theoretical anarchism is more humanitarian

and more likely to encourage progress than its law–and–order alternatives. (Paul
Feyerabend)
The idea of the genius, the mad scientist, the enlightened person – often times
displaced from society – who has the most interesting and creative ideas from bolts
of lightning of genius is consolidated in popular culture, whether in films, comics or
in science fiction books. In the 1980s, the film “Back to the Future” (1980) marked
a generation as it chronicles the adventures of the teenager Marty McFly (Michael
J. Fox) and his friend, the eccentric scientist Dr. Emmett “Doc” Brown (Christopher
Lloyd), who brilliantly transforms a DeLorean car into a time-capsule powered by
plutonium stolen from Lebanese terrorists. It is not necessary to tell the plot to the
new generations that have not watched it yet, but rather to emphasize the character
of the genius who always has solutions for all situations, almost always involving
high technology.1
Recently, the cartoon “Rick and Morty” – whose first season was in 2013 – once
again featured a duo formed by a mad, and in this case fairly cynical, scientist
(Rick) and his gullible teenage grandson (Morty). The two embark on adventures
that unfold on different planets, breaking interdimensional barriers. The series orig-
inated as an animated spoof of the “Back to the Future” franchise, and has been
acclaimed by both critics and the public. Rick takes to extremes the figure of the
brilliant mind, who stands out without making any apparent type of intellectual
1
One notable exception is the character MacGyver (Richard Dean Anderson), a secret agent of the
of the homonymous TV series broadcast between 1985 and 1992, who could solve the most com-
plex problems and situations with the most mundane materials. The series was revived, with a new
cast in 2016, bringing a younger version of the character, called Angus “Mac” MacGyver (Lucas
Till).
F. A. Poltronieri (*)
IoCT – Institute of Creative Technologies, De Montfort University (DMU), Leicester, UK
e-mail: fabrizio.poltronieri@dmu.ac.uk

https://doi.org/10.1007/978-3-319-90677-5_22
302 F. A. Poltronieri
effort and who always has at his disposal a vast set of tools and theories ready to be
put into action. It is interesting to point out that in addition to all that, Rick is an
alcoholic who is constantly drunk.
In all these cases, and in many others found in popular culture, emphasis is given
to the idea of the hero with razor-sharp intelligence, always accompanied by a high
level of creativity that defies any kind of logical pattern or law, accentuating a fea-
ture of popular beliefs: That creativity is a wild, lawless territory that few profes-
sions or people, including artists in general and scientists, can fathom out. This is
the point I want to address in this text: Is creativity something that really evades
logic? Is there something that characterizes, in logical terms, what we call creative
genius? To shed some light on these questions, starting with these wonderful char-
acters from the world of fiction and popular culture, I resort to some ideas from the
broad theoretical framework of the American philosopher Charles Sanders Peirce
(1839–1914).
Perhaps, in popular imagination, Peirce could be confused with these eccentric
geniuses from the films. Living his last days practically as a recluse in Milford, a
small town of Pennsylvania, our philosopher was the son of Benjamin Peirce, an
important professor at Harvard and the most respected North American mathemati-
cian of his time. The Peirce family was well connected in the academic and scien-
tific circles, and Charles grew up in an environment surrounded by esteemed
intellectuals, having been, since childhood, considered a prodigy in the scientific
and philosophical fields, and being even more brilliant in mathematics than his
father.
Although during his lifetime Peirce counted among his friends and admirers phi-
losophers, mathematicians and important scientists such as William James, Josiah
Royce, John Dewey and Ernst Schröder, it is only after his death that his work has
been recognized and even nowadays most of his more than 90,000 manuscripts
remain unpublished. After a short period (1879–1884) as part-time lecturer in logic
at Johns Hopkins University, Peirce retired prematurely and forcibly in 1891 from
the U.S. Coast and Geodetic Survey, where he was responsible for experiments
involving gravity. Failing to get another regular job, he devoted the rest of his life to
writing incessantly. In the late nineteenth century he set about trying to publish his
philosophy program and mathematical and logical findings, but he was unable to
muster any support to complete such a task.
Despite all the setbacks, Peirce left an impressive range of works, covering dif-
ferent fields such as logic, mathematics, physics, astronomy, geodesy, metrology,
linguistics, philology, history and psychology. Over 20 years after his death, and
only after the Harvard Philosophy Department released a small collection of his
articles, did scholars begin to realize the importance and depth of his thought:
By 1936 Alfred North Whitehead would describe America as the developing centre of
worthwhile philosophy, and identify Charles Sanders Peirce and William James as the
founders of the American renaissance: ‘Of these men,’ Whitehead said, ‘W.J. is the ana-
logue to Plato, and C.P. to Aristotle (EP2, xx).
The Scientific Enterprise Illustrated: Abduction, Discovery and Creativity 303
Darwin’s influence on Peirce’s thought is remarkable, since the latter considered

that the laws of nature are not absolute, but evolutionary, hence the statistical nature
of these laws. According to Peirce, scientific principles, in turn, do not end up as
strict formulas, but are always provisional, in the sense of being subject to continu-
ous change.
This is an aspect that will act as a hook to explain the phenomena involved in
creativity based on Peircean conceptions, since creativity can only exist in environ-
ments where there is some kind of uncertainty, where there is room for change.
Creativity finds its basis, for Peirce, in a type of reasoning that he calls abductive,
characterized by a kind of inference that introduces new elements to the already
existing arguments. Creative mental actions do not spring up out of nowhere, from
a vacuum that lets the inventiveness unfurl, but are governed by laws of a logical
order, in which abductive reasoning is present.
From this perspective, creative mental actions originate from thought connec-
tions conducted through the insertion of new ideas that had not previously been
related to this reasoning. Creativity is thenceforth conceived as a syntactic logic that
creates unique syntaxes with elements that already existed, giving rise to new
semantics, new ideas, new forms and formulas, a process that expands our already
structured sets of beliefs. For Peirce (CP 1.383), there is an inner compulsion that
leads the mind to unite disparate ideas, with the intention of achieving a greater
intelligibility of reality through the connections of ideas executed in the mind. Thus,
the author states: “The work of the poet or novelist is not so utterly different from
that of the scientific man.” (CP 1.383).
Thus, the first observation to be remembered is: The concept of creativity for
Pierce is associated with a specific type of logical reasoning, called abductive. To
understand the logical nature of abductive reasoning, it must be understood as a
kind of inference, or the controlled adoption of a belief, because of some other
knowledge (CP 2.442). The structure of creative reasoning is based on abduction.
The abductive process is set in motion following the perception of anomalies, sur-
prises and questionings regarding what is already known, triggering the search and
creation of hypotheses that may solve the problems in question. The need for a
repertoire for creativity to emerge becomes ever clearer, as prior knowledge is
needed for the advent of new situations.
In “Lawnmower Dog”, the second episode of the first season of the series “Rick
and Morty”, Rick, the creative genius, comes up with a device that allows the intel-
ligence of the family dog, Snuffles, to be augmented. The problem that triggers the
creative process is simple: Snuffles, whose canine intelligence seems to be limited,
constantly widdles on the family’s living room carpet, which infuriates Jerry,
Morty’s father and Rick’s son-in-law. The creative device forged by Rick to solve
the problem makes Snuffle so clever that he not only stops peeing on the carpet but
also develops high cognitive abilities, such as the ability to communicate using
human languages, leading him to lead an entire canine revolution, which creates
new problems that need to be solved creatively. This episode demonstrates the
mutability of an established belief, modified by creative processes that arise from
problems to be solved. It also indicates the constant degree of dissatisfaction that
characterizes creative minds, always leading them to encounter problems to be

solved. The only way to completely eliminate abduction would be to create an abso-
lutely perfect universe, where everything would be in absolute order. Obviously,
such a need is more illusory than the adventures experienced by Rick and Morty or
by Marty McFly and Dr. Emmett “Doc” Brown, as such a mythical and perfect
universe would mean the end of the process of semiosis2 and, consequently, creative
processes would become needless, because our interpretation would accord in all
respects with the objectively determinate character of this ideal universe (Parker
1998, 221). Technically speaking, in this flawless scenario we would have a fully
comprehension of every single aspect of the universe, i.e., our minds would become
what Peirce calls a “final interpretant” (EP2, 496).
Peirce says that when something we believe in – which he calls “belief” – is
embraced as true, this something turns into a habit, a source of reliability deter-
mined by its predictive nature, as what we can expect from an acquired habit is for
its behaviour to be predictable. The mind is a dynamic system whose main activity
is the production of habits. Beliefs are strongly consolidated habits: “For belief,
while it lasts, is a strong habit, and as such, forces the man to believe until some
surprise breaks up the habit” (CP 5.524).
It is at the very moment that a behavioural habit begins to reveal insecurities,
alterations in its known pattern due to the resistances that reality imposes on it, that
an opening for creative opportunities arises. Doubts begin to crop up regarding the
validity of such behaviour as it is no longer predictable. The feeling of surprise
produced by the perception of an anomaly is the first step of abductive reasoning,
which stimulates the mind to initiate an investigation process until these anomalies
disappear, making way for new beliefs.
When acquiring and establishing a new set of beliefs, a dynamic movement
begins, one of adjustment and expansion of pre-existing concepts, articulating the
three logical inferences described by Peirce: the already familiar abduction, deduc-
tion and induction. Although I have focused solely on abduction in this introductory
text, it is important to mention that these three modes of reasoning enable us to think
in a structurally logical and formal manner. Abduction generates hypotheses which
must be justified and tested in the development of the two other modalities of
reasoning.
For Peirce, the composition of reasoning’s cognitive structure is not static, but
rather formed by layers of processes that gradually gather, forming a network that
relates the inferences of abductive reasoning to empirical conditions, in other words,
to induction, the act of being accustomed to rules, and to deduction, the exercise of
predicting and controlling external conditions, such as nature.
The process of experimenting creatively, that is, abductively, forms the logical
basis of any rational process, since whenever one acts in a rational way, one acts
according to a conviction that is guaranteed by an experimental phenomenon (CP
7.337). The creation of new convictions and new knowledge starts with abductive
reasoning, which triggers experimentation processes that test new conditions that
2
On the concept of semiosis, please see EP2, 411.
The Scientific Enterprise Illustrated: Abduction, Discovery and Creativity 305
may or may not become a reality. Among the three types of logical inference already
mentioned, the abductive is the most original, but also the most likely to fail, but
nevertheless, it is the only one capable of generating new hypotheses. Because it is
fallible, it is the kind of logic always popularly associated with genius, with what is
not yet established, to creativity, what is to come. As it is something new, abductive
inference cannot guarantee its validity as a general law of behaviour, being only a
logical method that guides the mind in its attempt to rid itself of doubts. Peirce
states that abduction’s characteristics are distinct from the other two types of infer-
ence in that it is not based on prior knowledge, but rather on an experimental
process.
Abduction is, therefore, the form that rational thought takes when, for example,
it begins the study of a new scientific field that has not been previously addressed or
of which we have little knowledge. According to the author, “all the ideas of science
come to it by the way of abduction. Abduction consists in studying facts and devis-
ing a theory to explain them.” (CP 5.145). This type of reasoning is also essential for
activities linked to art.
Obviously creative processes can lead to disastrous results if they are not well
founded and put to the test by deduction, establishing themselves as inductive belief.
In “Rick Potion #9”, the sixth episode of the first season of “Rick and Morty,” the
abduction process that motivates Rick to create a love potion requested by Morty,
the purpose of which would be to make Jessica, his crush, reciprocate Morty’s love
for her, makes the whole of humanity fall in love with Morty. Trying to reverse this
problem, Rick creates a disastrous sequence of new potions whose effects spread
like viruses and lead to the population having genetic mutations worthy of those in
the films of David Cronenberg, the film director, and thus being dubbed “
Cronenbergs”. Rick’s solution is no less creative: Unable to fix the genetic disaster
his potions have created, Rick finds another dimension where he and Marty have
succeeded in creating an antidote to the viral potion. But this solution is still not
enough, because how can this reality host, at the same time, two distinct pairs of
“Rick and Morty”? Well, Justin Roiland, the episode’s also highly creative screen-
writer, finds a solution to this space-time problem, which I will not reveal here so as
to not further spoil the surprise that the episode presents to readers who have not yet
watched it.
Returning to our philosophical path, the kind of reasoning that we find in the sci-
ences begins with the creative invention of hypotheses – abductive reasoning – that
must be put to the test by examining and reviewing the consequences that it can
engender in relation to the reality of the facts. This dynamic encompasses all three
types of reasoning. The deductive argument gives rise to suggestions that revolve
around what something should be, induction deals with what something currently
is, while abduction pertains to what something can be, free from any other hypoth-
esis or judgment.
Peirce presents abductive reasoning as the sole logical operation capable of
introducing new ideas, explaining that the mind’s creative capacity springs neither
from nothing nor from an innate ability, but rather from this cognitive structure
pointed out by the philosopher (CP 5.171). It is important to emphasize that
c reativity, this mental faculty that is based on abductive reasoning, is linked to the
creation, change and expansion of a set of beliefs that form habits. The creative
process is triggered when a form of creative mind – for example human – is con-
fronted with a problem, causing surprises and uncertainties that initiate the abduc-
tive process, which will select possible hypotheses to solve the problems in
question.
As a conclusion to this brief introductory text to a subject of the degree of com-
plexity involved in the logical mechanisms governing creative processes, it can be
stated that, according to Peirce, creativity is a logical mental property that guides
the expansion of our beliefs. Far from being a magical attribute that resides in some
unknown place and is invoked by crazy scientists and artists, keepers of the words
that awaken the genius of creativity, the creative process is a logical mental attribute
that is triggered whenever a problem needs to be resolved or some kind of order
needs to be re-established. Creativity is therefore an attribute of all and any kind of
mind, and not just that of our heroes or anti-heroes, found in the most diverse prod-
ucts of popular culture. Peirce extensively analysed these logical attributes that gov-
ern creativity, and his writings – especially those found in the two books of the
series “The Essential Peirce” (EP) and in the famous “Collected Papers” (CP) – are
a rich source for those who wish to study creative mechanisms.
References
Houser, N. 1992. Introduction. In The essential Peirce. Selected philosophical writings. Volume
1 (1967–1893), ed. N. Houser and C. Kloesel. Bloomington: Indiana University Press [EP2].
Parker, K. 1998. The continuity of Peirce’s thought. Nashville: Vanderbilt University Press.
Peirce, C.S. 1998 Collected papers of Charles Sanders Peirce, eds. C. Hartshorne and P. Weiss (v.
1–6); Arthur Burks (v. 7–8). Cambridge, MA: Harvard University Press. 8 v. [CP].#.
Media
Back to the future. Dir. Zemeckis R. Universal Pictures, 1985

MacGyver. Dir. Zemeckis R. Universal Pictures, 1985.
“Lawnmower Dog”. Rick and Morty. Dir. Rice, J. ABC, 1985–1992.
“Rick Potion #9.” Rick and Morty. Dir. Sandoval S. Cartoon Network, 2014.
Using Case Studies from Popular Culture
to Teach Medical Physiology
Ronan M. G. Berg
Introduction
“Hmmm! Adventure… Hmmpf! Excitement… A Jedi craves not these things!” says
Jedi Master Yoda in Star Wars Episode V: The Empire Strikes Back (1980). One thing
that I have learned from teaching areas as diverse as physiology, emergency medi-
cine, psychiatry and medical ethics, is that this altruistic abstinence expressed by
Yoda and demanded by Jedi Code does not work well in the context of medical edu-
cation. Medical students do indeed crave adventure and excitement, and in my expe-
rience, medical textbook material and/or conveniently constructed clinical cases only
rarely accede to this. However, because narratives relating to popular culture appear
to evoke vivid imagery, curiosity, and emotions in us all (Blasco et al. 2006; Zagvazdin
2007), I often integrate various aspects of popular culture in my teaching. My
approach is greatly inspired by the influential works of the physicist James Kakalios
(2006, 2010) and the neuroscientist E. Paul Zehr (2008, 2011), who are both pioneers
within the field of science dissemination and communication. In this context, Zehr
(2014) has formulated the so-called ‘middle ground hypothesis’ which asserts that
such popular culture case studies occupy a ‘middle ground’ between the students and
the scientific principles they are attempting to learn, that is, a familiar and comfort-
able mental landscape where the scientific principles can be explored (Fig. 1). A key
aspect of the ‘middle ground hypothesis’ is that the scientific validity of the popular
culture case study itself is irrelevant because the true scientific principles are revealed
in the process of examining the case. It is thus a form of discovery learning that
encourages hypothetical-deductive reasoning, which is an essential tool both in
physiological research and clinical decision-making (Svinicki 1998). In the present
chapter, I present and evaluate two case studies from popular culture, Darth Vader
R. M. G. Berg (*)
Department of Clinical Physiology and Nuclear Medicine, Frederiksberg and Bispebjerg
Hospitals, Frederiksberg, Denmark
e-mail: ronan@dadlnet.dk

https://doi.org/10.1007/978-3-319-90677-5_23
308 R. M. G. Berg
Fig. 1 The ‘middle ground hypothesis’. Elements from popular culture case studies may be used
to communicate various scientific concepts by serving as ‘connectors’ which facilitate the exchange
of information between the teacher and students as well as between students. Even though such
elements from popular culture are not necessarily scientifically accurate, they provide a ‘middle
ground’ between the students and the scientific principles they are attempting to learn, which
serves as a familiar and comfortable mental landscape where the scientific principles can be dis-
cussed and explored. (Artwork by Artwork by Chih-Han Henry Ma, based on Zehr (2014))
from the Star Wars saga and Miles Dyson from the Terminator franchise, which I use
for teaching physiology to 2nd-year medical students.
Darth Vader as a Case Study on Respiratory Physiology
A long time ago in a galaxy far, far away, the 9-year-old slave Anakin Skywalker is
recruited to begin training as a knight in a monastic society called the Jedi Order, as
outlined in Star Wars Episode I: The Phantom Menace (1999). Skywalker is pre-
dicted to be particularly sensitive to a seemingly ubiquitous energy field called the
Force, because he has exceptionally high levels of so-called midi-chlorians1 in his
blood. He is thus perceived as a contender to become the ‘Chosen One’, who accord-
ing to an ancient Jedi prophecy, will bring balance to the Force by destroying the
Sith Order.2 As shown in Star Wars Episode II: The Clone Wars (2002), the course
of events is, however, complicated by Skywalker suffering from severe emotional
problems during his training to become a Jedi Knight. Although it remains a matter
of intense scientific debate (da Rocha et al. 2012; Tobia et al. 2015), Skywalker
appears to develop a borderline personality disorder during his formative years (Bui
et al. 2011). The emotionally unstable Skywalker secretly gets married even though
1
According to Jedi teachings, these are microscopic life forms that live symbiotically inside the
cells of all living things. They are similar to mitochondria known from eukaryotic cells on Earth,
notwithstanding midi-chlorians in contrast to mitochondria are thought to communicate directly
with the Force.
2
Another monastic society that is devoted to mastering the ‘dark side’ of the Force. The Sith are
considered archenemies of the Jedi.
Using Case Studies from Popular Culture to Teach Medical Physiology 309
it is a clear violation of Jedi Code, and in Star Wars Episode III: Revenge of the Sith
(2005), he becomes tormented by ruminations that his now pregnant wife will die in
childbirth. His close friend Sheev Palpatine, who incidentally holds a secret identity
as Dark Lord of the Sith, manages to convince him that the dark side of the Force
holds the power to save her, and Skywalker then decides to become a Sith appren-
tice and change his name to Darth Vader. It turns out that Palpatine’s recruitment of
Darth Vader is a critical step in a well-planned coup d’état to overthrow the disor-
ganised and bureaucratic Galactic Senate and insert himself as ruling Emperor of
the Galaxy (Lang 2002).
Darth Vader’s first task as a Sith apprentice is to ensure the complete extermina-
tion of the Jedi Order, which inevitably leads to confrontation with his former Jedi
Master, Obi-Wan Kenobi. In the resultant light sabre duel, which takes place on a
volcanic planet, Darth Vader suffers traumatic amputations of several limbs. Kenobi
leaves him incapacitated at a volcanic shore, where he bursts into flames, and suffers
extensive burns all over his body as the lava sets him on fire. Furthermore, he inhales
volcanic clouds of hot gas and particles, which may cause severe lung injury (Berg
and Plovsing 2016a; Mlcak et al. 2007). Soon after, Palpatine arrives at the scene,
and evacuates Darth Vader in a medical capsule. Medical droids manage Darth
Vader’s critical condition by placing him in a whole-body armoured suit, which may
both ensure infection control in relation to his severe skin burns (Perrella et al.
2015) and support his breathing by means of a mobile life support system (Plovsing
and Berg 2014).
The mobile life support system, which gives rise to Darth Vader’s characteristic
breath sounds, appears to be an advanced so-called bi-level positive airway pressure
system that supplies oxygen to and removes carbon dioxide from the airways, while
supporting Darth Vader’s own, intrinsic breathing both when he inhales and exhales
(Plovsing and Berg 2014). Hence, a careful examination of Darth Vader’s breathing
during Star Wars Episodes IV–VI (1977–1983), which occur 22 years after Episode
III, reveals that his breathing frequency varies closely with his activity level
(Fig. 2). There is much to suggest that the acute lung injury induced at the volcanic
shore in his youth has progressed into a complex form of chronic respiratory failure
(Fig. 3). The treatment with the whole-body armoured suit is therefore maintained
and keeps Darth Vader alive for more than two decades; the fact that he is never once
observed to cough, stresses the efficacy of this treatment. However, when his face
under the mask is revealed in Star Wars Episode VI: Return of the Jedi (1983), he is
clearly pale and outworn, with the classical appearance of a ‘blue bloater’, with blu-
ish colour of the skin and lips from low oxygen levels due to chronic respiratory
failure (Dornhorst 1955), which indicates that this treatment modality does not
entirely restore lung function.3
3
One may rightly wonder why lung transplantation was not attempted in this case, as would surely
have been done here on Earth. This may relate to fundamental differences in moral and religious
practices between the Galaxy from Star Wars and our part of the Universe. A thorough discussion
of this does, however, reach beyond the scope of this chapter, and in any event, I will leave such
matters to scholars within the humanities.
310 R. M. G. Berg
Fig. 2 Darth Vader’s breathing frequency according to activity level. Data are presented as mean
(± standard deviation). ‘Rest’ includes recreational activities in his private, hyperbaric chamber;
‘Normal everyday activities’ includes casual conversations with Emperor Palpatine, as well as
torture of enemies and/or employees; ‘Stressful situations’ includes the loss of the technical sche-
matics of the first Death Star, and the boarding of the second Death Star by the Millennium Falcon;
‘Exercise’ includes running, combat and light sabre duels. (From Berg and Plovsing 2016a)
Fig. 3 Before Anakin Skywalker/Darth Vader suffers extensive skin burns and inhales volcanic
fumes, he is extremely fit and his lung function is seemingly excellent (left). After his accident on
the volcanic shore, he develops acute lung injury, which during the intervening years between
Episode III and IV progresses into a complex form of chronic respiratory failure (right) with air-
way inflammation, scarring of the lung tissue, and perhaps chest cage deformities, which together
may both increase airway resistance, make the lungs stiffer, and reduce their volume (Berg and
Plovsing 2016a). (Artwork by Chih-Han Henry Ma)
Darth Vader has a skyrocketing career in the Galactic Empire, serving as a

highly visible symbol and enforcer of the totalitarian regime, while Emperor
Palpatine seemingly enjoys a quiet, ascetic life in an undisclosed location.
Despite his success, Darth Vader may conceal a great deal of insecurity and vul-
nerability beneath the fearsome and enigmatic appearance of the whole-body
armoured suit, particularly when considering that he both has to struggle with a
personality disorder and severe physical disability (Berg and Plovsing 2016b).
He may thus be particularly vulnerable to various emotional stressors. In the
Galactic Empire, he is the equivalent of a chief executive director, and during the
events of Star Wars Episodes IV–VI he is indeed under a lot of pressure. Enormous
redeployments take place within the structure of the Galactic Empire, and Darth
Vader’s working conditions constantly change, while he has to cope with the
relentless challenges of disobedient and/or incompetent employees, as well as
various hostile activities of the Rebel Alliance against the totalitarian regime. On
top of all this, he learns that his own son, Luke Skywalker, is part of the rebellion,
and his otherwise harmonic friendship with Emperor Palpatine furthermore
seems to suffer, because Darth Vader starts doubting the benevolence of his and
the Emperor’s, quite possibly well-intentioned (Lang 2002), aspirations to ‘bring
order to the Galaxy’.
The resultant increased psychosocial stress (Holmes and Rahe 1967) may be
hazardous to Darth Vader’s health by causing a deterioration of his lung function
(Berg and Plovsing 2016b; Lu et al. 2012). When assessing Darth Vader’s breath-
ing frequency during the course of events of Episodes IV–VI, there is clear evi-
dence of this: setting aside the marked fluctuations that are well accounted for by
his activity level as outlined above, there is a conspicuous trend of an underlying
increase in his breathing frequency (Berg and Plovsing 2016b). This increase is
otherwise unaccounted for in the narrative of Star Wars, thus indicating a gradual
decline in Darth Vader’s lung function, despite the whole-body armoured suit.
Indeed, he does not find peace until he finally forsakes his Darth Vader identity,
and joins Luke Skywalker in overthrowing the Emperor, thus fulfilling his destiny
as the ‘Chosen One’.
Implementing Darth Vader in a Respiratory Physiology Class
The findings presented below have in part been reported elsewhere (Berg et al.
2014). At the beginning of a 4-week course on respiratory physiology for 2nd-year
medical students, I briefly introduced the Darth Vader character as a case study. In
an attempt to integrate this case study with both collaborative and competitive
elements, as well as the ‘learning from learners’ approach (Michael 2006; Ten Cate
and Durning 2007), the students were encouraged to form groups and develop a
312 R. M. G. Berg
Fig. 4 Effect of the Darth Vader case study on test scores. The intervention group consisted of 17
students, and the control group of 23 students; the intervention group achieved significantly higher
scores than the control group (p < 0.05, Mann–Whitney U-test)
theory that could explain Darth Vader’s breathing problems and its putative treat-
ment, by integrating the basic physiological concepts they would learn during the
course. The theory should be prepared as a 10-min talk that would be presented to
the rest of the class during an interactive session in the final lesson of the course.
The presentation would be evaluated by an evaluation panel, consisting of three col-
leagues, as well a ‘layperson evaluator’ that comprised two students from the class.
Each evaluator was to rate the group’s ability to impart knowledge to their peers
(0–5 points), the coherence of the theory (0–5 points), the group’s ability to use and
integrate the relevant physiological concepts (0–5 points), as well as an overall
assessment of the presentation (0–5 points). Hence, a maximal cumulated score of
80 (20 from each evaluator) could be achieved, and the students from the group
receiving the highest cumulated score would be announced winners of the
competition.
A total of three groups were formed comprising seven of the 24 students.
Apart from being entertaining to both students and evaluators, resulting in
applause and numerous cheers during the presentations, all three groups appro-
priately integrated various concepts from the course on a level that exceeded
what was expected in the forthcoming exam. The ratings from the evaluation
panel were thus relatively high, with cumulated scores of 54, 56, and 67 points,
respectively.
At the end of the term, 17 of the students (intervention group; 7 presenters
and 10 from the audience), as well as 23 other students (control group) that had
participated in the same respiratory physiology course, but without the Darth
Vader case study, took a 5-min multiple choice test relating to the core curricu-
lum in respiratory physiology. The test consisted of four questions, and one
point was awarded for each correct answer, yielding a minimum of zero and a
maximum of four points. The test scores for students from the intervention
group were significantly higher than the test scores for students from the control
group (Fig. 4).
Miles Dyson as a Case Study on Cardiovascular Physiology
In the ouroboros-like storyline of the Terminator franchise, Dr. Miles Bennett

Dyson who is the Director of Special Projects at Cyberdyne Systems Corporation is
developing a new neural-net processor. His work is based on two pieces of unknown-
sourced advanced technology, which are the remains of an electronic circuit from a
humanoid robot called Cyberdyne Systems Model 101 Series 800 Terminator –
T-800 for short – which was sent from the future to the 1980s to assassinate the
waitress Sarah Connor, as outlined in Terminator (1984). Unbeknownst to Dyson,
his efforts will ultimately lead to the development of Skynet, a military computer
system with command over all military hardware, which will gain artificial con-
sciousness, and wage a genocidal war on mankind. The combat strategy of Skynet
includes the use of humanoid robots, both for infiltrating the human resistance
movement, and for time-travelling missions to target key figures in the human resis-
tance, in order to control the course of history and ensure its own inception. Such
key figures include Sarah and her son John Connor, of which the latter is the future
leader of the resistance movement.
In Terminator 2: Judgement Day (1991), Dyson is approached by a 13-year-old
John Connor, who is escorted by another T-800, sent from the future resistance
movement to serve as his bodyguard against attacks from other time-travelling
robots. Like other robots of its series, this T-800 has the iconic appearance of a huge
bodybuilder, and speaks English with a characteristic Austrian accent.4 John Connor
and his companion robot manage to convince Dyson that destroying all of his
neural-net processor research at Cyberdyne is the only way of preventing the future
human genocide.
As Dyson and his accomplices break in to the Cyberdyne Headquarters, in an
attempt to blow up the entire laboratory facility with a polydichloric euthimal bomb,
a SWAT team arrives at the scene. Without warning, the SWAT team opens fire, and
while John Connor is under convenient protection by his robotic bodyguard, Dyson
is wounded by multiple gun shots. Shortly thereafter, Dyson shows evidence of
severe blood loss, with an elevated breathing frequency (25–30 breaths per minute),
and profuse sweating. As the total blood volume in the vascular system is reduced
due to bleeding and blood pressure subsequently falls, specific receptors (so-called
baroreceptors) in the blood vessels evoke reflexes that cause changes in the heart
rate and the constrictive state of small blood vessels, in order to maintain blood
4
It remains to be clarified why Skynet chose this exact phenotype, since it does not seem to be a
particularly anonymous disguise. It may however be that fitness fanatics with a European back-
ground are commonplace in the resistance movement.
314 R. M. G. Berg
pressure (Hinojosa-Laborde et al. 2014). As blood loss progresses, other similar

receptors (so-called peripheral chemoreceptors) are activated by accumulation of
acids in the blood stream due to reduced blood flow through the various tissues,
which increases breathing, while other reflexes cause sweating. This is typical of a
blood loss of 30–40% of the total blood volume (Manning 2004), which is equivalent
to approximately 1.5–2.0 l of blood; such a severe and rapid blood loss is typical of
gunshot-inflicted injuries in the abdominal region (Ekbom et al. 1981). Dyson sits
upright and no attempts are made to minimize his bleeding, and the blood loss thus
progresses until he slips into unconsciousness (blood loss >40% of total blood vol-
ume). As he subsequently loses muscle tone, his hand drops on the detonator of the
polydichloric euthimal bomb which then explodes and destroys most of the labora-
tory facility.
I mplementing Miles Dyson in a Cardiovascular Physiology

Class
During a 45-min class on blood pressure regulation, as part of a 5-week course on

cardiovascular physiology for 2nd-year medical students, I introduced Miles Dyson
as a case study on the cardiovascular effects of and adjustments to severe bleeding.
After a brief ex cathedra review of the course of events during the break-in at
Cyberdyne Headquarters, the students were to work in small groups to solve a num-
ber of handed-out assignments on blood pressure regulation in humans, which were
all based on the Miles Dyson case. This was followed by a plenary discussion about
the assignments and the physiology, diagnosis, and treatment of severe bleeding. In
this manner, the Miles Dyson case study was integrated in a classical collaborative
format (Michael 2006).
At the end of the term, 50 students (intervention group) who had been taught by
use of the Miles Dyson case study, and 28 students (control group) who had partici-
pated in the same cardiovascular physiology course, but with a conventional clinical
case on bleeding instead of Miles Dyson, took a 10-min multiple choice test. The
test consisted of eight questions, and one point was awarded for each correct answer,
yielding a minimum of zero and a maximum of eight points. The test scores for
students in the intervention group were significantly higher than the test scores for
students in the control group (Fig. 5).
Student Evaluations
At the end of the term, I administered a questionnaire to 47 students, of which 27

students (intervention group) had been taught by methods using one of the above-
mentioned popular culture case studies, while the remaining 20 students (control
Fig. 5 Effect of the Miles Dyson case study on test scores. The intervention group consisted of 50
students, and the control group of 28 students; the intervention group achieved significantly higher
scores than the control group (p < 0.05, Mann–Whitney U-test)
Fig. 6 Students’
perceptions of their own
skills in physiology. The
intervention group
consisted of 27 students,
and the control group of 20
students. The two groups
rated their own skills in
physiology (p = 0.99,
Mann–Whitney U-test)
group) had only been exposed to conventional clinical cases during the respiratory
and cardiovascular physiology courses. The two groups rated their own skills in
physiology similarly (Fig. 6), while the intervention group rated the quality of the
teaching in physiology higher than the control group (Fig. 7).
In the 50 students that had participated in the class on blood pressure regulation
where the Miles Dyson case study was used, I furthermore administered a ques-
tionnaire on their perceptions of the use of popular culture elements in physiology
teaching. The majority of the students acknowledged that this approach made the
teaching more fun, and enhanced both their understanding of the physiological
principles taught, while also motivating them to participate more during class;
316 R. M. G. Berg
Fig. 7 Students’
perceptions of the quality
of the teaching. The
intervention group
consisted of 27 students,
and the control group of 20
students. The intervention
group rated the quality of
the teaching higher than
the control group (p < 0.05,
Mann–Whitney U-test)
Fig. 8 Students’
perceptions of the popular
culture case study-based
teaching approach. Fifty
students responded to the
following statements: The
use of elements from
popular culture in
physiology education. (A)
makes the teaching more
fun; (B) motivates me to
study more; (C) causes me
to participate more during
the class; (D) makes it
easier to understand the
physiological principles
however, less than half of the students found that the approach led to more self-
study (Fig. 8).
Concluding Remarks
The use of the Darth Vader and Miles Dyson case studies in my physiology classes
appears to be an effective means for enhancing student learning. The case stories
thus served as scaffolds on which the students could organise and reinforce the dif-
ferent physiological principles taught during the class, which confers with Zehr’s
‘middle ground hypothesis’. Hence, my findings show that although this approach
does not lead the students to perceive their own skills in physiology as better, they
do achieve higher test scores in the relevant core curriculum at the end of the term.
They furthermore rate this teaching approach higher than conventional teaching,
and although it does not necessarily motivate more self-study, they generally find
the approach instructive, involving, and entertaining.
The use of popular culture cases may improve the learning process by reaching
into the students’ affective domain. The affective domain plays a key role in learn-
ing attitudes and behaviour, and such cases may provide a narrative model, which is
both familiar to the students and framed in emotions and images (Prober and Heath
2012; Zagvazdin 2007). By invoking emotional responses, the use of elements from
popular culture in medical education has thus been asserted the “front door in stu-
dents’ learning process” (Blasco et al. 2006). Indeed, I deliberately use humour as a
tool to elicit an emotional response from the students when using such case stories.
Humour in medical education has previously been reported to contribute to a more
pleasant and relaxed learning environment and facilitate both teacher–student and
student–student interaction in the classroom and it concurrently leads to better stu-
dent evaluations (Ziegler 1998). In this context, one must, however, be cautious of
the so-called ‘Dr. Fox effect’, which is the phenomenon that humour may lead to
better student evaluations without concurrently improving the learning process in
students (Ware and Williams 1975). This effect is not likely at play in relation to the
findings presented in this chapter, because the better student evaluations associated
with the use of popular culture case studies also translated into improved learning,
as indicated by higher test scores.
In conclusion, the findings presented in this chapter demonstrate that case stories
based on well-known fictional characters can successfully be used for improving
student performance and evaluations in physiology education. Such case stories
provide a narrative model that is to some extent grounded in the students’ everyday
universe, which allows them to safely test and explore the taught physiological prin-
ciples in a familiar setting. This furthermore makes is easier for the teacher to get
the students to relate emotionally to the material, and thus ignite their curiosity. The
latter has been designated ‘the perfect fuel for learning’ (Prober and Heath 2012),
and perhaps the use of case studies from popular culture adds just enough ‘adven-
ture and excitement’ to the physiology class to accomplish that.
318 R. M. G. Berg
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Part III
Social Implications
Consuming, Experiencing, and Governing:
Setting the Scene for Public Encounters
with Biomedicine
Anda Adamsone-Fiskovica
Introduction
Reading a newspaper article on in vitro fertilisation, paying a visit to a geneticist,

being vaccinated, signing a petition against xenotransplantation are just a few dif-
ferent ways in which modern citizens may encounter biomedicine or medical biol-
ogy as the representation of an important facet of modern medical science. In terms
of the subject matter, the field of biomedicine is so broad that it is difficult to limit
it to selected issues, like the ones listed above. Consequently, there are two general
ways how we can analytically approach these diverse public encounters with bio-
medicine: we could either focus primarily on a specific issue in terms of its contents,
or centre more upon the format of these encounters irrespective of the subject mat-
ter. In this paper, I have chosen to use the format of encounters as the main basis for
my analysis of the manner in which laypeople interact with biomedicine. This paper
aims to investigate the field of biomedicine as an example of a science–society rela-
tionship in the twenty-first century by means of identifying and analysing the range
of public encounters with this field of research and practice, and the differing com-
munication models underlying these encounters. Within this guidance framework, I
also provide selected examples of biomedical practices in order to map the diversity
of ways laypeople get to know, relate, and engage with biomedicine.
Research into science communication, and more generally into the public under-
standing of science, which is part of the broader field of science and technology
studies (STS), has revealed that the practice of communicating science to lay audi-
ences can be guided by different paradigms, based upon different underlying mod-
els (Lewenstein 1995; Gregory and Miller 1998; Bauer et al. 2007). The most
fundamental division is between one-way and two-way communication; the former
predominantly pertains to the domain of complimentary popularisation of science
A. Adamsone-Fiskovica (*)
Baltic Studies Centre, Riga, Latvia
e-mail: anda@lza.lv

https://doi.org/10.1007/978-3-319-90677-5_24
324 A. Adamsone-Fiskovica
while the latter tends to involve dialogue as well as allowing room for more critical
reflection and active public engagement. These models underpin the wider concep-
tualisation of science-society relations, which, according to numerous accounts by
STS scholars over the course of the last decades, have experienced transformations
from the model of a self-sufficient, self-regulating, autonomous science system to
that of a socially embedded, publicly accountable, and contestable social institution
requiring new forms of governance (Kleinman 2000; Nowotny et al. 2001; Irwin
and Michael 2003; Irwin 2009). To be more precise, the scope of these communica-
tion models has widened such that they are frequently labelled as deficit vs. dialogue
vs. participation models, which represent different, yet persistently co-existing, con-
ceptualisations of the agency ascribed to laypeople vis-a-vis the scientific institution
and vice versa (Trench 2008; Adamsone-Fiskovica 2012). While the deficit model
emphasises the need to correct the wider public lack of knowledge, awareness and
appreciation of science, the dialogue model calls for public consultation on science-
related matters; the participation model, in turn, argues in favour of a more decisive
role of the public in actual decision-making.
With reference to earlier research attempts aimed at classifying the diversity of
forms/levels of public participation in science and biomedicine in order to capture
the many different types of relationships between laypeople, doctors, researchers,
governments, and other stakeholders (see Kelty and Panofsky 2014), the present
paper proposes that public encounters with biomedicine as a distinctive field of
scientific research and practice can be conceptually treated in terms of (1) how bio-
medicine is being communicated in the public domain (e.g., mass media), (2) in
what ways laypeople become personally involved in biomedical practices (e.g., as
patients), and (3) how citizens exert their influence upon research agenda, the
research process, and the application of biomedical knowledge in society (e.g., as
representatives of civil society organizations (CSOs) in public decision-making
bodies). These three broad dimensions, or types of encounters, are further used to
structure this paper, mapping the various modes of communication, highlighting
their underlying rationales, and indicating some of the issues to be debated regard-
ing these encounters that have arisen from social research studies.
Consuming Biomedical Knowledge
Nowadays, mass media can be seen as one of the most notable platforms used for
communicating science and technology to the public. Of these, media coverage
provides considerable space to topics related specifically to health and medicine,
including biotechnology and genetics, dealing with both public hope and insecurity
(Hansen 2009). STS scholars have characterised mass media as a public forum
where different types of controversial knowledge and technologies, including bio-
medical research and technologies, are becoming socially embedded through the
mutual adaptation of these technologies and the opposing values ascribed to them
(Weingart et al. 2008). Via the facilitation of comprehensive debate and the
Consuming, Experiencing, and Governing: Setting the Scene for Public Encounters… 325
juxtaposition of scientific claims and lay opinions (utopian and dystopian views),
mass media contributes significantly to the complex formation of public discourse
and the way we ultimately treat different emerging phenomena in our society.
A study focusing on both quantitative and qualitative content analysis of the
debates in the German media on cloning, stem cell research, and the human genome
over a 10-year period (1995–2004) revealed increasing levels of news value and an
intensification of debates relating to biomedicine and the frequent presence of
underlying conflicts between new knowledge (or specific aspects of related applica-
tions) and prevailing ethical values1 (ibid.). Yet, this study also demonstrated the
differing range and origin of actors (e.g., scientists, policymakers, social organiza-
tions) taking part in the media debates on these three topics, as well as the presence
of quite divergent patterns for embedding new knowledge and technologies depend-
ing on the specific nature of the given technology, the stage of its development, and
the national context of the debate. The authors, for instance, highlighted the politi-
cally and socially sensitive connotations of stem cell research in Germany in the
light of the history of eugenics as a tool for crimes committed under the Nazi regime.
Similarly, much of the debate can be based on considerations beyond the technol-
ogy per se, focusing instead on features like the profile of the advocates of the new
knowledge (e.g., public vs. private sector representatives) and their credibility.
Another common instrument of the public communication of science is repre-
sented by the various science museums, which contribute to bringing both estab-
lished and developing knowledge to the attention of the public. While modern
museums tend to be highly interactive, and aim to present a broad spectrum of
developments in the field of modern science and technology, these efforts are inevi-
tably accompanied by a number of challenges with regard to the ways of presenting
and framing the chosen topics. Biomedicine is one of the telling examples in this
respect, since contemporary medicine, as a highly important domain of contempo-
rary life, “is increasingly producing artefacts that do not fit the traditional museo-
logical understanding of what constitutes a material, tangible artefact” (Söderqvist
et al. 2009: 431). The intangible nature of many of the objects involved in medical
diagnostics and therapies, are now characterised by “molecularisation, automatisa-
tion, digitisation, miniaturisation” (ibid: 435), and thus restricts the possibilities of
representing and communicating biomedicine by the conventional means usually
employed by museums. This, in turn, makes it also difficult for an ordinary museum
visitor to comprehend and accommodate information on these topics in a manner
which they can personally relate to.
Nevertheless, there are also other means of communication that are being used
under such conditions. It has been argued that it is not only formal education, as
well as classical news media such as TV, radio, and print, that serve as instruments
for communicating scientific information to the lay audience. Increasingly, atten-
tion is being paid to the role of images of science in a wider popular and entertain-
ment culture (e.g., video games, science fiction, comic books, plays, and social
1
E.g., inviolateness and integrity of human nature, respect for individuality, the right to self-deter-
mination, non-discrimination, dignity of the human embryo.
media) and the way in which these can also influence public perception and under-
standing of science-related matters. As argued by the historian A. Bowdoin Van
Riper,
popular culture probably does more than formal science education to shape most people’s
understanding of science and scientists. It is more pervasive, more eye-catching, and (with
rare exceptions) more memorable. No genetics textbook can hope to compete with “Jurassic
Park”, and no lecture on biophysics can match the sight of Dr Frankenstein pulling light-
ning down from the stormy sky to animate his creature (Van Riper 2003: 1104).
An illustration of this is provided by the survey results of the “Wellcome Trust

Monitor of Public Knowledge, Interest, and Engagement in Biomedical Science”
which was carried out in the UK in 20092 and asked respondents an open-ended
survey question “What do you understand by the term ‘DNA’?”. Analysis showed
that one designated class of responses (16%), which primarily focused on the practi-
cal uses of DNA testing in determining paternity and identifying criminals, can be
seen as “primarily informed by how the term commonly arises in popular culture
and one that is largely absent of technical terms” (Stoneman et al. 2012: 857).
While this class of responses was not the dominant one, it nevertheless indicates the
impact exerted by the products of popular culture.3
Having observed a growth in popular dramas featuring plots that are based on
developments in the biomedical sciences and accompanying technologies, Michael
and Carter (2001) pointed to the debatable and negotiable boundary between facts
and fiction and the underlying types of knowledge in these products of popular cul-
ture. They emphasise that “scientific knowledge is necessary to ‘read’ these fictional
texts (in the broadest sense), yet the ‘interpretation’ and the discourses, metaphors,
and narratives of fictional genres may shape ‘understanding’ of science” (ibid: 12).
Their argument is that “scientific knowledge cannot be set unproblematically in
opposition to popular culture” and that we should instead “see fiction as something
that mediates the flow of science into the local” (ibid: 12). This qualitative study,
based on interviews and focus groups carried out by Michael and Carter in Scotland,
revealed that, in the view of scientists and teachers, science fiction mainly tends to
enthuse lay audiences and serves as a less true, and thereby inferior but more excit-
ing, source of basic biomedical knowledge. Yet, despite the underlying assumption
of the questionable credibility of lay knowledge, students participating in this study
demonstrated the capacity to draw upon a much wider range of information sources
and to critically assess these.
Research has also revealed that public understanding and its attitude towards
specific domains of science, including biomedicine, stem from the merger of
2
For more information about all three waves of the monitor survey on public’s thoughts on medical
research, science, and health, carried out so far in 2009, 2012, and 2015, see https://wellcome.
ac.uk/what-we-do/our-work/public-views-medical-research.
3
The authors of the second wave of the UK survey also acknowledge the potential impact of young
people’s interaction with science in leisure settings on their overall opinions of science as a subject
area and as a career, pointing to the fact that almost half of young people read novels or fiction
books with a scientific storyline at least once a year (Ipsos MORI 2013).
k nowledge and images related to the particular topic (science-in-particular), on the

one hand, and those pertaining to the more general views regarding the scientific
institution and practices thereof (science-in-general), on the other (Irwin and Wynne
1996; Adamsone-Fiskovica 2015). In other words, people unavoidably think of
science-in-particular (e.g., xenotransplantation) in the broader framework of the
underlying principles of scientific research and science as a social institution (i.e.
common research methods, norms of conduct), and in the same way they reflect
upon science- in-
general with reference to specific manifestations of science
(Adamsone-Fiskovica 2015). Public framing of science is also influenced by cultur-
ally and historically specific knowledge (as part of social memory), as well as by
both individual and collective experiences accumulated directly or indirectly by the
members of the public. This involves additional roles played, for instance, by analo-
gies drawn from the history of scientific development, somewhat similar domains of
modern science, or by the products of popular culture such as science fiction (ibid.).
The public understanding of biomedicine, emerging science and technology, more
generally, thereby forms in a complex process of relating together disparate domains
of social life in various contexts, thus demonstrating that people “apprehend inno-
vation through what they already know, and produce new meanings and under-
standings which are not always predictable” (Edwards 2002: 324).
Experiencing Biomedical Practices
The public discourse on biomedicine, as represented by the communication tools

reviewed above, is just one arena in which the public encounters biomedical knowl-
edge in a manner that is quite detached from the actual experiences and practical
applications of this type of knowledge. This is, however, different in the case of
clinical encounters, which are viewed as the most widely shared form of citizen
participation in the field of health and engagement with biomedical knowledge
(Nunes et al. 2014). The sociology and anthropology of medicine, which deal with
the social analysis of both macro- and micro-levels of healthcare, are the fields that
have been of particular interest in studying and analysing the diverse aspects of such
encounters, including doctor-patient interactions and the underlying power relation-
ships, production and exchange of medical knowledge, social effects of medical
practices, and the subjective experiences of patients (for example, see Brown 2008;
Good et al. 2010). It has been emphasised that for quite some time patients were not
expected to be active agents in their care and that the practitioner-patient relation-
ship was not seen as an important ingredient of successful healthcare (see Gaines
and Davis-Floyd 2004). While research demonstrates that over the last few decades,
patients in many countries are increasingly becoming aware of and exercising their
rights with regard to healthcare services and their individual treatment, and there
has been a shift towards person-centred care by physicians, there are still quite a few
debates regarding the form and content of these interactions.
Personal clinical experience embodies a very direct medium of lay encounters

with biomedicine and provides an important source for constructing subjective
interpretations of biomedical knowledge. While the traditional model assumes a
one-way flow of knowledge from health professionals to patients, or more generally
from experts to laypeople, STS scholars increasingly point to the blurring boundar-
ies between expert and lay knowledge, the processes of co-production of knowl-
edge, and the role of different contextual factors in interpreting and making further
use of the fragments of knowledge being acquired by each party (see e.g., Wynne
1996; Epstein 1996; Kleinman 2005). Patients often possess a vast spectrum of
personal experience-based knowledge, which adds on to, or challenges, the expert’s
knowledge regarding specific medical conditions (e.g., symptoms, disease, treat-
ment, and therapeutic effects). During these clinical encounters, as important acts of
communication, the various forms of existing biomedical knowledge are being
exchanged, assessed, and individually adopted to fit the particular conditions of
both practitioners and patients. As noted by Nunes et al. (2014) in their study on
asthma patients in Portugal, “even though most of the patients have access to medi-
cal information through practitioners, learning how to deal with their asthma draws
on the plastic or porous boundaries between the medical knowledge that is com-
municated and the knowledge already held by the individual” (p. 199). Research
also demonstrates that, when interpreting their illness, patients use a blend of
knowledge based upon both biomedical and folk models (Payne-Jackson 1999).
Nevertheless, it is commonplace that “biocommunicable models4 embedded in
health news and professionals’ perspectives erase lay knowledge production just as
talk of self-medication renders invisible nearly all health labour occurring outside
clinical settings” (Briggs 2011: 1043). Therefore, the knowledge-producing efforts
of laypeople are frequently not being recognised and do not form part of the range
of knowledge and practices legitimised by professionals.
Social research demonstrates that personal experience of specific biomedical
practices, or the record of being affected by the experiences of close relatives or
friends, tends to generate a differentiated perception on the meaning and assessment
of these very practices. For instance, a study on the European citizens’ views and
attitudes towards organ donation and their ideational and motivational backgrounds
showed that members of the focus groups constituted by affected people tended to
emphasise the lack of donor organs as the core issue, while those from the group of
unaffected individuals mostly focused upon the fair allocation of available supplies
(Schweda and Schicktanz 2008). Previous personal experience also represents a
factor that inevitably increases the information-seeking behaviour and activity of
these affected individuals, as well as influences the level and type of knowledge they
tend to possess. Under the direct impact of a given scientific and technological
issue, members of the community demonstrate the capacity of quickly and accu-
rately acquiring significant amounts of technically sophisticated information
(Lewenstein 1995). As shown by a seminal study of AIDS treatment activists, orga-
nized non-scientists can become non-specialist experts in a given domain and take
4
Projections of biomedical knowledge production, circulation, and reception (Briggs 2011: 1038).
active part in decision-making in a targeted domain of research, thereby changing

the traditional social organization of expertise (Epstein 2000). A complementary
insight is provided by a study on the views of people directly affected by selected
genetic conditions (i.e. cystic fibrosis and Huntington’s disease) on the ethical
dilemmas involved in advancing genetic testing for reproductive purposes (Chapman
2002). As argued by Elizabeth Chapman, “such participants can make a substantial
contribution to developments in policy” and “should form part of these wider bio-
ethical debates arising from genetic technology advances” given their deeper
involvement and appreciation of the issues at stake (ibid: 205). The consideration
and inclusion of patient voices (views, opinions, experiences) in ethical debates in
the context of biomedicine is thereby seen as a way “to extend congruency between
those who decide and those who are affected by the decisions” (Schicktanz et al.
2012: 134). Nevertheless, despite the potential of patient contribution, end-user par-
ticipation in decision-making in the field of biomedical research has not yet devel-
oped as a commonplace practice (Caron-Flinterman et al. 2007) (see also section
“Governing biomedicine” of this paper).
A whole strand of research on the subjective experiences of biomedical practices
(citizens as consumers/patients) has also developed as a result of cross-fertilisation
between feminist and social studies of science and technology. Judy Wajcman
(2004) emphasises the role of feminist research in exposing the gendered ways of
producing and consuming various technologies, thereby revealing the biased effects
of technologies, commonly designed by males, on the daily practices and experi-
ences of female consumers, not least with regard to biomedical innovations. At the
same time, one can observe differentiated attitudes among women based on the dif-
ferent subjective experiences of specific biomedical technologies. As revealed by a
study exploring how biotechnologies for infertility are assessed by women in the
USA, the subjective implications of such technology contextualizes women’s atti-
tudes towards it (Johnson and Simon 2012). In particular, the individual fertility
status of a woman (presence or lack of experience of a biomedical barrier to fertil-
ity) largely influences the use of a different set of evaluative criteria of these tech-
nologies that “draws more on experiences, values, and beliefs than when personal
implications are low” (ibid: 282).
Governing Biomedicine
The third mode of public encounter with biomedicine, as conceptualised in the pres-
ent paper, is represented by citizen engagement in biomedicine with regard to its
governance. Biomedicine represents a domain that is permeated with controversies
and debates, both within the professional community and the wider public. As noted
by Marks and Russell, “some areas of bio-knowledge become normalised (tempo-
rarily stabilised and accepted), but other continue to create visible public disquiet”
(2015: 98), thereby raising important aspects of democratic governance. While the
prevailing bioethical discourse tends to frame the public as a passive population in
need of being protected or steered towards achieving greater social benefit (Árnason
2012), an increasing strand of social science literature calls for more active citizen
participation in the shaping of public policy with regard to developments in the
domain of science and technology.
The evolving discourse on upstream public engagement brings forward a range
of arguments for an earlier and more proactive involvement of citizens in decision-
making processes at various levels. This also partially applies to the practices of citi-
zen science, whereby laypeople proactively engage in and directly contribute to
advancing and steering biomedical research, for instance, through the provision of
data, samples, and personal experience-based knowledge (Kelty and Panofsky
2014; Del Savio et al. 2015).5 Yet, thus far, the reality of actual decision-making
practices in terms of inclusiveness has not been too encouraging. For instance, an
international thematic study on citizen participation in decision-making with regard
to xenotransplantation revealed that policy-making in this domain is largely framed
as a purely scientific issue, thereby excluding the public, which is mainly allocated
the passive role of information consumers (Griessler et al. 2011). Even when
attempts for citizen engagement do take place, these are still quite ambiguous, both
in terms of the underlying aims and the means used for attaining these (see e.g.,
Kurath and Gisler 2009), not to mention the criteria for selecting representatives
from the general public in these efforts. Aspects of public engagement approaches
up for discussion also pertain to the way issues are to be framed for public debate,
the institutional context of and appropriate forums for deliberation, and the role
these play in informing and affecting government policies (Árnason 2012).
Similarly, problems observed with regard to involving the public in trial design and
conduct include tensions between stakeholder groups, the public understanding of
trial methodology, as well as the time-consuming, complex, and costly nature of this
type of public involvement (Boote et al. 2011).
It is important to note that there is also a certain discrepancy between the above-
mentioned academic discourse as well as the emerging civil society initiatives
encouraging citizen engagement, on the one hand, and the actual willingness and
readiness of the members of the general population to contribute and take active part
in these processes, on the other (Adamsone-Fiskovica 2012). For instance, a study
exploring the views of laypeople upon citizen involvement in the governance of
post-natal genetic testing and organ transplantation in Austria revealed that the iden-
tified diversity among citizens in terms of their perceptions of these biomedical
technologies “challenges the idea that citizens see public participation per se as a
desirable form of governance” (Felt et al. 2008: 253). Scholars found that many of
the focus group participants, though not unanimously, gave preference to the con-
ceptualisation of the paternalistic state instead of exploiting the civil right of self-
determination possessed by citizens, which could, through enhanced public
participation, unnecessarily endanger the existing social order (ibid.). At the same
time, they also identified fundamental differences in people’s views depending upon
5
For more on citizen science in the field of biomedicine and healthcare, see the blog of the project,
“Citizenbiomedicine” (https://citizenbiomedicine.wordpress.com).
the specific technology under discussion, thereby highlighting the need for choos-
ing technology-sensitive engagement methods in order to enable and promote the
involvement of non-governmental actors in policy-relevant decision-making on
techno-scientific issues. The positions adopted by citizens with regard to the gover-
nance of technologies turned out to be influenced even more by the specific type of
technology under discussion than by their prior personal experience of the given
technology.
Similar conclusions can be derived from another study that explored bottom-up
meanings of the concept of public participation in the governance of science with
particular focus upon ethical and social dimensions of genome research (Felt and
Fochler 2008). This study emphasised the differentiation between ‘participation in
general’ and ‘participation in particular’, pointing to the presence of a rather unani-
mous acceptance of the general idea of public participation on the part of both sci-
entists and citizens, which, however, becomes much more ambiguous when it comes
to pinpointing concrete models and the aims of citizen engagement. The authors
differentiated between four perceived models of public participation: (1) educa-
tional—a way to inform the public and create silent public support for science, (2)
supervising—a way to provide public feedback and supervision to science, (3) co-
ordinating—a way to contribute to co-ordination of different societal actors and
interests, and (4) co-deciding—a way to contribute to political decision-making
(ibid.). Most scientists tended to support the first model, which reinforces the self-
governance principle of science, while citizens, instead, were more supportive of
the second model, which is more pro-active, but without the ambition and readiness
to take responsibility for actual political decisions.
While, in many instances, individual citizens demonstrate certain reservations
and feel limited in their possibilities for taking part in more binding and influential
forms of citizen engagement in decision-making regarding techno-scientific issues,
there are also no straightforward opportunities for such collective representative
bodies as civil society organizations. A study on the contribution of CSOs in public
health research in the new member states of the European Union demonstrates that
many CSOs would be willing to enhance their involvement in research, including
the process of setting research priorities, but feel restricted by the lack of a formal
framework in the consultation of civil society, as well as limited funding resources
for their activities (McCarthy and Knabe 2012). Governmental and research insti-
tutes are seen as rather reluctant in accepting CSOs as partners in policy-making
regarding public health research, accompanied by a still limited understanding of
CSO competence for research as well as underdeveloped cooperation between vari-
ous CSOs (ibid.).
Public engagement as one of the alternative and, undoubtedly, highly demanding
forms of the public communication of biomedicine, requires a shift away from the
traditional one-way and top-down mode of communication to be replaced by
dialogue-based modes of virtual and face-to-face interaction. This calls for a change
in many elements of the process, not least with regard to the number and scope of
actors involved, the issues opened up for discussion and framing thereof, as well as
the role and impact of this kind of participatory and deliberative process (e.g., on
actual health policies). This is by no means an easy and smooth way of political
decision-making and probably should not be seen as a mandatory procedure when
dealing with each and every minor issue, yet it is crucial to have this opportunity for
democratic public participation constantly open and accessible for all citizens. It is
thereby necessary to take adequate steps for continuously encouraging the public
awareness of the legitimate right of citizens to voice their opinion on major socio-
technical issues. An equally important aspect of deliberative democracy, aside from
the facilitation of direct citizen participation, is that of enhancing the overall quality
of institutions and governance in order to ensure the democratic legitimacy and
accountability of public decisions. Furthermore, it is essential to build the general
capacity of citizens for developing critical thinking skills and the ability to accom-
modate different perspectives (Árnason 2012), thus allowing for an informed and
intelligent public debate.
Conclusions
Taking up the key theme of this edition, which explores the complex and manifold
relationships between popular culture and biomedicine, this paper intended to look
more broadly at the diverse ways citizens situated outside of the professional com-
munity encounter biomedicine in different settings. Instead of focusing upon the
public understanding of biomedicine and its specific manifestations, which is a
major topic on its own, this paper focussed more upon the multiple ways this under-
standing is being formed.
The framework proposed here makes an analytical distinction between three
general types of lay encounters—learning about biomedicine from different media
and formats of popular culture, accumulating personal experience from biomedical
practices, and getting engaged in the processes of political decision-making.
Nevertheless, in everyday life it is, of course, quite difficult to strictly demarcate
these encounters. Public awareness, understanding, and experience of biomedicine
develop in complex ways amid a diverse spectrum of media and by means of mani-
fold instruments of public communication of science. These differ in terms of their
origin, scope, aim, and the stakeholders involved, and can represent quite contrast-
ing, yet co-existing models of science-society relations. The chosen empirical
(mostly qualitative) studies used here to illustrate the varied formats of public
encounters with biomedicine demonstrate the nuanced and complex nature of
accommodating and integrating scientific information into one’s personal knowl-
edge, thereby discarding the simplified model of a linear and straightforward pro-
cess of learning.
While the various formats of encounters each have a definite role and contribu-
tion to embedding and steering the development of biomedicine in modern society,
it is important that they are mutually well balanced and guided by a dialogue-based
and participatory paradigm. Instead of only informing the public and treating lay-
people merely as passive recipients of information and practices dominated by
expert-driven discourse, it is vital to ensure a means whereby citizens are encour-

aged and empowered to voice their views, beliefs, and attitudes and are ensured that
these are given sufficient credit and are integrated into the process of agenda setting
and decision-making.
While there are many commonalities between the various domains of techno-
science with regard to public encounters, there are quite a few aspects that are spe-
cific to biomedicine, which need to be taken into account when dealing with its
place and role in popular culture. Biomedicine represents a domain that is charac-
terised by a comparatively easy way of relating developments in this field to the
existing, prospective, or potential experiences of laypeople and the wide array of
applications of biomedical research and technologies in the daily lives of many citi-
zens. It is this latter aspect that makes biomedicine an exciting, but simultaneously
a highly contestable theme for many laypeople. It tends to provoke both public
interest and dissent and is thereby inevitably subject to greater scrutiny than some
other fields of scientific research and practice.
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Bias by Medical Drama. Reflections
of Stereotypic Images of Physicians
in the Context of Contemporary Medical
Dramas
Moritz Köhler, Claudia Förstner, Maximilian Zellner,

and Michael Noll-Hussong
Introduction
For greater than half a century, physicians have been portrayed on television; how-
ever, the claim of well-intentioned health education has gradually been lost and
replaced with entertainment (Assoc. JAD 1970; Granberry and McCarthy 1963;
Keesey 1954; Norman 1956; Starin 1963). Early examples include the 1962 US
motion picture The Interns (Swift 1962) and the television series Dr. Kildare
(Komack 1961–1966), which were set in the USA in the 1950s. The protagonists of
these early medical dramas conveyed classical (bourgeois) social and cultural roles
in which the male physician was depicted as all-knowing, modest, fatherly, and mor-
ally upright (Litten 2012). Likewise, in the UK, BBC broadcasted series were cre-
ated, such as Doctors (Murray 2000) and Casualty (Brock and Unwin 1986), and the
spin-off Holby City (McHale and Young 1999). The popularity of medical dramas
has even spread to the Asian TV culture. In South Korea, the series Good Doctor
(Jae-bum 2013) was created, which also addresses actual political and social topics
(Litten 2015). Finally, the US cult series, M*A*S*H (Mobile Army Surgical Hospital;
Gelbart 1972–1983) broke all records at their last broadcast, with an audience rating
of 60.2% (Litten 2013). It took 11 seasons and 10.5 years for MASH to be dismissed
from the hotspot of the Korean War. The combination of bitter seriousness, drama,
and comedy changed the development of medical series in US society.
In the US in 1993, ER (Chrichton 1994–2009) heralded the era of the modern
“medical drama” (Czarny et al. 2010; Kirch 2007; Strauman and Goodier 2008).
The father of the series, Michael Crichton, was a Harvard medical student motivated
M. Köhler (*) · C. Förstner · M. Zellner

Medical Students of the University of Ulm, Ulm, Germany
M. Noll-Hussong
Department of Psychosomatic Medicine and Psychotherapy, Saarland University,
Homburg/Saar, Germany; http://www.neural.de

https://doi.org/10.1007/978-3-319-90677-5_25
338 M. Köhler et al.
to show a much more realistic representation of medical cases. He said that he

shared “his experiences especially with the young intern, John Carter, and his men-
tor, Mark Green” (Tuffs 2009). The evolution of a more complex and more realistic
cinematic representation began while also using comedy stylistic devices.
Subsequently, new productions, like Scrubs (Lawrence 2001–2010) and Grey’s
Anatomy (Rimes 2005), were created (Ye and Ward 2010).
At present, audiences in the US, the UK, and Germany put themselves into the
exciting ‘everyday life’ of TV hospitals. They meet grumpy senior physicians, like
Dr. Cox (Scrubs), who humiliates his young residents using female names, or the
merciless cynic and Vicodin-addicted Dr. Gregory House (House; Shore 2004–
2012), a physician version of Sherlock Holmes on the trail of rare diseases. In addi-
tion, the competition of young surgical interns for the best operation, often ending
up with the chief physician in their bedrooms, as shown in Grey’s Anatomy, attracts
an audience of millions during prime time.
These shows often include a quasi-realistic depiction of injuries, diseases, and
social relationships between physicians and nurses working in fictional hospitals.
But is “realism” the only essence of the new “medical drama?” The physician’s
identity is shown in a contemporary cultural context and according to contemporary
expectations of society. Fangerau has suggested that such a social ideal of a physi-
cian and his profession is, amongst others, characterised by the following: being “a
professional expert, committed to the scientific ideal of knowledge;” having “spe-
cific expertise with regard to functions and disorders of the biosystem of a human
being;” the physician’s “orientation towards objective evidence and beyond;” and
“the necessary artistic and social skills to treat the patient in the most comfortable
way” (Noack et al. 2007: 24 [translations by authors]).
In early medical drama, physicians were stylised as exemplary, empathic, and
moral persons, not only in their professions, but also in their private lives (Warner
2014; Krüger-Brand 2003). Currently, a more nuanced picture of medical profes-
sionals exists on TV. The audience witnesses a struggle between the (subjective)
personality and the (“objective”) profession of the characters because there are ste-
reotypic expectations of the private individuals and their profession (Tapper 2010).
This mismatch also exists in a physician’s real life, which makes watching medical
drama even more thrilling and semi-authentic (Noack et al. 2007: 24).
The content of medical drama often refers, rather unintentionally, to the former health
education ‘mission’ of public service broadcasting authorities (Davin 2003; Descatha
2009; Elkamel 1995; Harris and Willoughby 2009; Hirt et al. 2013; Spike 2008). German
viewers of medical dramas are mainly found in a group of people who are 14–49 years
of age (AGF and GfK 2013; Statista 2016). Thus, US medical dramas have a larger audi-
ence than most contemplative and more conservative, or simply more ‘well-behaved’ or
genteel German physician series, like the German TV series Die Schwarzwaldklinik (The
Black Forest Clinic; Tögel and Vohrer 1985–1989), whose rather simple stories with a
happy ending attract droves of tourists, as well as terminally ill persons to the Black
Forest searching for the clinic and the help of “Professor Brinkmann” (Gunkel 2015).
The cast of characters is usually stereotyped and/or culturally biased in medical
dramas. For instance, the typical ‘heroic’ physician is often portrayed by ‘attractive’
actors (Hallam 2009; Schwerthöffer et al. 2011).
Bias by Medical Drama. Reflections of Stereotypic Images of Physicians in the Context… 339
Fact and Fiction in Medical Drama
The success of medical dramas leads to the question of what kind of knowledge is
communicated in these shows. There is a high grade of realism in scenes depicting
injuries and medical interventions, as well as scenes with symptoms of a disease or
another spectacular medical phenomenon (Goodman 2007). Therefore, a dramatic
major trauma is often shown to enhance the dramatic experience of the scene
(Beardsell 2014); however the procedure to find the right or best solution to heal or
help the patient is in many cases uncommon and unorthodox. Although the way
physicians gather further information on a patient’s history is often simply unrealis-
tic (e.g., by breaking in the patients’ homes, which is often shown in House) and the
resulting treatment is quite risky, it nevertheless reflects the patients’ wishes for
selfless and highly committed physicians.
Mortality rates also differ widely between fictional and real hospitals. Amir
Hetsroni compared a real life hospital with the fictional hospitals in one season of
ER, Chicago Hope (Kelley 1994–2000), and Grey’s Anatomy. Hetsroni reported a
higher mortality rate in television hospitals (17.5% for fictitious hospitals against
5% for real hospitals). Hetsroni also discovered that dead TV patients were mostly
young and seriously injured white men. Once more, this findings hints to typical
sensational, but perhaps archetypical, storylines in medical cases for TV dramas
(Hetsroni 2009). Moreover, the number of incidents television viewers and the med-
ical drama physicians are confronted with in one episode is increasingly high. You
would never experience all of these incidents in one working hour (themedicalbag.
com, May 20, 2014). A treatment, like CPR (cardiopulmonary resuscitation), on TV
is rather frequent and often successful. In most cases, the practice of CPR is pre-
sented incorrectly and with a higher survival rate in comparison to reality (Harris
and Willoughby 2009; Hinkelbein et al. 2014; Portanova et al. 2015). Nevertheless,
there could be an educational or conditioning effect by showing CPR regularly.
Thus, viewers might be inspired to actually use this procedure in real life without
hesitation, which could effectively save many lives.
Aside from medical practice, the role model of a physician is described as a
nearly omniscient and nearly almighty expert, regardless of the specialty (e.g., an
expert in MRI and internal medicine, who is also able to perform highly professional
surgery) This could, for example, reflect the viewer’s unconscious wish for an omni-
scient, loyal, caring parental substitute when feeling ill and/or facing existential
threats. In fiction, the physician cares about nearly everything (‘demigods in white’).
Finally, sex and romance is such an important part of the television storyline that
you could have the impression that sex and relationships between physicians are
omnipresent and fill most of the hours between medical events (Khalil 2014; the-
medicalbag.com, May 20, 2014).
Medical dramas perform a mix of analytic and medico-practical melodrama. Dr.
House mutates from the ‘demigod in white’ to a cynical version of Sherlock Holmes.
Diseases are treated like criminal investigations, with a more or less systematic
procedure to solve the mystery. Accordingly, there is often a focus on scientific
technology (Strauman and Goodier 2011). Science and technology thus seems to be
a secular instance between religious, magic and metaphysical assumptions of time.
Hence, by defying the certainty of death, a physician’s role sometimes shows attri-
butes of a ‘religious surrogate authority’ (Tschachtli 2010).
Deviations from professional norms are a common topic in all medical dramas.
Patient–professional incidents, sexual misconduct, and a lack of integrity are the
three main themes. Altogether, the entertainment value is very high, depicting phy-
sicians as attractive and special. This potential is increasingly examined to make use
of it in medical education (Goodman 2007; Tseng 2007). As such, every particular
medical drama has its own educational use. For example, House and Grey’s Anatomy
can represent ethical conflicts or teamwork quite well. On the other hand, series
such as ER and Scrubs can be rather useful as examples to teach young physicians
about medical practice (Hirt et al. 2013), giving a more correct image of actual clini-
cal routine (Weaver and Wilson 2011).
Given the heavy impact of medical dramas, the stereotypic characters, and altera-
tions through past decades, we considered the effect on the viewers in real life to be
of special interest. Therefore, we wanted to find out how medical dramas influenced
the actual choice of physicians in Germany. With respect to the now long-running
impact of medical TV shows on the German audience, our pilot study examined
whether or not, due to a media “information bias” between the depiction and the
reality of medical practice (Lapostolle et al. 2013: 173), the depiction of an ideal
stereotypic American TV show physician could have an influence on a patient’s
choice of real physicians in Germany (Berger 2010; Stinson and Heischmidt 2012).
Methods
Participants and Questionnaire
Between 12 and 14 July 2013 we asked 100 University of Ulm students (group A:
adults <40 years, n = 100, medical drama series assumed to be known) to complete a
questionnaire using the online survey tool, “Survey Monkey” (Waclawski 2012). We
advertised in the University of Ulm second semester of human medicine Facebook
group, asking for volunteers to participate in our anonymous survey. We did this to
acknowledge the importance of social media platforms, like Facebook, especially for
medical students (Cain and Policastri 2011; Farooqi et al. 2013; Gray et al. 2010).
For our analysis, we determined four stereotypic characters (Hallam 2009;
Sancho-Aldridge and Gunter 1994) following the intended viewers’ perception
(MyFanBase.de; Wiki-ER 2013; Wiki-Scrubs; Wiki 2013; Wikia.Scrubs-Wiki
2013) and presented them to the test persons, as follows: type 1, young, idealistic
assistant physician (Dr. Dorian, Scrubs); type 2, experienced, cynical senior physi-
cian (Dr. Cox, Scrubs); type 3, good-looking, omniscient specialist (Dr. Shepherd,
Grey’s Anatomy); and type 4, calm, authentic mentor (Dr. Greene, ER).
Using a 5-point Likert scale (“not at all,” “rather not,” “neutral,” “rather yes,” and
“absolutely”), the participants rated the portrayed characters with regard to sympa-
thy, professional competence, and whether or not the respondents wanted to be
treated by them.
Simultaneously on 12 July 2013, we randomly interviewed pedestrians (group B:

adults >40 years, n = 28, medical series not assumed to be known) in the centre of
Ulm, which is a mid-sized university town of approximately 120,000 citizens in
southern Germany. Using pictures of the aforementioned TV series physicians, the
participants were to decide by which physician they would prefer to be treated and
explain whether or not they chose the physician because they consider them likeable
or because they exude professional competence (Fig. 1).
Fig. 1 Depiction of the actors. From top left to bottom right: Zach Braff (Dr. John Dorian, Scrubs
(© ABC Studios)), Patrick Dempsey (Dr. Derek Shepherd, Grey’s Anatomy (© ABC Studios)),
Anthony Edwards (Dr. Mark Greene, ER (© NBC Studios)), John C. McGinley (Dr. Perry Cox,
Scrubs (© ABC Studios)
Results
The results are shown separately for groups A and B.

Group A
In group A, 58% of the test persons were between 18 and 20 years of age, 39%
between 21 and 29 years of age, and 3% between 30 and 39 years of age. We found
that characters from newer TV series, such as Scrubs (2001–2010) and Grey’s
Anatomy (2005–present), received higher approval ratings. The prominence of each
character affects the scores for sympathy, professional competence, and treatment
preference.
–– Sympathy: The character of assistant physician Dr. Dorian (Scrubs), who is por-
trayed as young, dreamy, and inexperienced (Wiki-Scrubs), obtained high scores
for his sympathy (51.6%). In contrast, his mentor Dr. Cox (Scrubs) was per-
ceived as rather unfriendly (11.0%). The attractive specialist, Dr. Shepherd
(Grey’s Anatomy), obtained the highest scores in this category (55.2%). The
visually discrete Dr. Greene (ER), who is portrayed as very competent, received
the lowest score (10.1%).
(a) Sympathy (b) Medical Competence

60% 60%
50% 50%
Frequency (percentage)
40% 40%
30% 30% 57.1%

51.6% 55.2% 55.2%
20% 20%
25.3%
10% 10%
11.0% 10.1% 14.0%
0% 0%
Dr. John Dr. Cox Dr. Dr. Greene Dr. John Dr. Cox Dr. Dr. Greene
Dorian Shepherd Dorian Shepherd
(c) Treatment Preference (d) Age Distribution of Group A

60% 3.0%
50%
40%
39.0%
30% 56.3%
58.0%
20%
35.2%
10% 20.4% 20.3%
0%
Dr. John Dr. Cox Dr. Dr. Greene 18–20 years 21–29 years 30-39 years
Dorian Shepherd
Fig. 2 Group A: Analysis of the online questionnaire. (a–c) Frequency distribution of sympathy,
medical competence (professionalism), and treatment preference in the category ‘absolutely’. (d)
Age distribution of group A
Treatment Preference and Reason:

Group B (>40 years, n=28, series not assumed to be known)
60.0%
Sympathy Medical Competence (Professionalism)

50.0%
40.0%
35.7%
30.0%
3.6%
20.0%
0.0%
10.0% 21.4%
17.9% 17.9%
3.6%
0.0% 0.0%
Dr. John Dorian Dr. Cox Dr. Shepherd Dr. Greene
Fig. 3 Group B: Analysis of interviewed pedestrians. Frequency distribution of the decisive rea-
sons that led to the preferential choice: sympathy or exudation of medical competence
–– Professional competence: Older characters, such as Drs. Cox (57.1%) and

Shepherd (55.2%), were preferred to their younger colleague, Dr. Dorian
(14.0%), while Dr. Greene (25.3%) scored between the two.
–– Treatment preferences: Dr. Shepherd obtained the highest scores by those sur-
veyed (56.3%). While his “colleague,” Dr. Cox still received 35.2%, there was
less demand for Drs. Dorian (20.4%) and Greene (20.3%).
Group B
All those surveyed in group B were at least 40 years of age. Only 7.1% of the pedes-
trians recognised at least one of the characters. The other physicians were solely
chosen in consideration of their photos.
–– Sympathy: In comparison with group A, sympathy was more often stated as a
reason for the preference of one physician (57.1%). This made itself noticeable
only if the characters corresponded to the general beauty ideal. In this group,
21.4% chose Dr. Dorian for his sympathy, while nobody thought Dr. Cox was
sympathetic. Drs. Shepherd and Greene both received 17.9%.
–– Professional competence: Altogether, 42.9% stated that professional competence
was the reason for their choice. Dr. Greene stood out with 35.7% of the votes.
Drs. Cox and Dorian only obtained 3.6% and Dr. Shepherd did not receive any
votes (see Fig. 3).
Discussion
TV programs related to medical topics are an important source for an increasing

number of people to obtain information about medical professions. One might think
that these programs even fulfil the task of ‘health education,’ not only for students
and young physicians, but also for the common audience. Moreover, medical dra-
mas are used as a source of health information, with the goal of entertainment–edu-
cation (E–E); however, viewers preferred neutrality to the use of persuasive
strategies in medical dramas storylines (Asbeek Brusse et al. 2015). In addition,
medical students frequently watch medical drama series and therefore these pro-
grams might be useful in teaching strategies for applied medicine (Weaver and
Wilson 2011). It has even been suggested that “selected scenes from medical drama
could motivate students in healthcare professionalism” (Hwang et al. 2013).
The conception of an ideal relationship between physician and patient has been
well-researched, and clearly defined role expectations held by most patients have
become quite evident. On the one hand, patients want a physician’s time and empa-
thy. On the other hand, patients want the highest level of professional competence
(Krones et al. 2006; Witzel et al. 2008). In our pilot study (Kohler et al. 2014a, b),
we determined whether or not the image of a stereotypic American TV physician
has an influence on the choice of physicians in Germany (Berger 2010; Stinson and
Heischmidt 2012) as a result of long-standing conditioning, especially in younger
viewers. The outcome indicated that professional competence is more important
than sympathy (Donsbach 2003); however, if the visual representation is not conge-
nial, there is a clear rejection by the test persons (Dr Cox, Fig. 3). If the characters
are unknown, the outer appearance is more important (Jonzon 2009). It is not a
flawless appearance that counts, but rather the subjectively perceived radiation of
professional competence, authenticity, and maturity (Dr. Greene vs. Dr. Shepherd;
Fig. 3). The participants in group B preferred the rather neutral, optically incon-
spicuous Dr. Greene. Young physicians, such as Dr. Dorian, do not convincingly
radiate professional competence, but are chosen because of their friendly
appearance.
In earlier medical dramas, physicians were often portrayed in a positive context.
Currently, this is not the case. As a result of media consumption, patients’ percep-
tion of a physician’s attractiveness and character is only influenced negatively. Other
qualities, such as propriety, power, communication, sociability, extroversion, com-
petence, and composure, are manipulated less often (Stinson and Heischmidt 2012).
Gender (Hamberg 2008; Izumi et al. 2013) was intentionally left out of our pilot
study (Young 1979). There are specific requirements for an excellent and a rapidly
changing physician role model (Wright et al. 1998); however, the crumbling image
of a role model, “the half-god in white,” is in reality, as well as in fiction, remark-
ably male (Krüger-Brand 2003).
The influence of TV consumption on pre-operative fears has already been proven
(Witzel et al. 2008). Sometimes an unexpected behavior of patients also deserves
attention, such as when obese patients would rather listen to the dietary recommen-
dations of overweight general practitioners (Bleich et al. 2013). One might assume
that slender physicians would be a better guide, and thus achieve better compliance.
Even in our study, familiar characters were judged based on their presentation. This
could explain why Dr. Greene received negative assessments in group A (Fig. 2),
whereas he set himself apart from the others in group B because of his assumed
professional competence (35.7%; Fig. 3). The often less objective perception in the
relationship between physician and patient does not constitute a one-way street. It is
known that beyond partially sublime, but still effective stigmatisation (Phillips and
Clarke 2012), attractiveness affects the attribution of intelligence (Feingold 1982);
however, the attractiveness of patients can also have an influence on the estimation
of pain intensity by the physicians (Hadjistavropoulos et al. 1990). Within the health
care system, the attribution of stereotypes with respect to “the physicians” or
“hospital managers” is anything but an unrealistic everyday experience (Klopper-
Kes et al. 2009).
Nevertheless, the influence of stereotyped images of physicians warrants further
research. For example, the strong influence of stereotypes on palliative situations
(Jackson et al. 2008), as well as the interaction with members of other cultures or
minorities (Aronson et al. 2013; Bean et al. 2013; Dovidio and Fiske 2012), has not
been sufficiently researched in a country like Germany, in which immigration is
common. Another question that should be asked is whether or not disease-causing
(“pseudo-iatrogenic”) effects (e.g., illness phobia or cyberchondria) of the media,
especially in medical series, deserve special attention (Witthoft and Rubin 2013;
Zylka-Menhorn 2013; Ye and Ward 2010) by taking the participation of physicians
in reality shows into account. In contrast, it is largely unclear to what extent the
subjective worlds of patients’ perceptions, which are stigmatized by media, are
“echoed” in (social) networks (e.g., physician rating portals that are seen with criti-
cism by the physicians).
There is also insufficient research on intercultural bias in the consumption of
medical TV shows. The effects of the differences in medical cultures and care sys-
tems in Germany and the USA do not seem to play a decisive role. German viewers,
in contrast to American viewers, are not disturbed by dubbing; however, there are
also overarching social and cultural issues, such as organ donation in the USA and
Germany. In Grey’s Anatomy, an intern made his patient sicker than he was by put-
ting him on top of a donor list. In 2012, an organ donation scandal in Germany took
place, starting with a comparable incident in a transplantation centre, further indi-
cating that perceptions and actions could be reflected by the audience (Czarny et al.
2010; Quick 2009).
Conclusion
Our findings suggest that only stereotypic roles of physicians receive high approval
if the TV series or its characters are well-known. In a more realistic representation,
average looks appear to be associated with the perception of a higher level of
professional competence. Indeed, evidence suggests that there might be a certain

influence of character appearance on viewers or an influence cannot be excluded.
The methods and low number of cases in our pilot study only give an initial impres-
sion of the relationship between medical dramas and the way physicians are per-
ceived in reality. One can confidently say that the physician role has always been an
important subject in popular culture, which will most likely persist. This is not only
a phenomenon in Western cultures, like the US or Europe, but even worldwide.
From an opposing point of view, practicing physicians feel affected by these con-
ceptions proclaimed in the media. In conclusion, the interaction of “fact” and “fic-
tion” in the perception of the role of physicians, especially in consideration of the
growing impact of mass and social media, warrants additional scientific research.
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The Medical, Social, and Cultural
Construction and Production
of Post-Traumatic Stress Disorder
Arno Görgen
Introduction: Definition and Prevalence of PTSD
The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by

the American Psychiatric Association (APA), defines the following causes and
symptoms for the diagnosis of post-traumatic stress disorder (PTSD):
–– The repeated and severe exposure to (the threat of) death, serious injury, or sex-
ual violence, either directly or indirectly through observation or through the
experience of such events by close relatives or friends against one’s own will,
–– which leads to repeated unpleasant, involuntary, and oppressive memories or
dreams of the event, as well as flashbacks, in which the patient – completely
unaware of their present environment – re-experiences the traumatic event;
–– strong physical and psychological stress responses to symbols associated with
the event;
–– the avoidance of event-associated stimuli, be it in the form of internal memories,
thoughts, and feelings or in the form of external stimuli such as persons, places,
conversations, objects, or situations;
–– changes in cognition and mood after the event, for example in the form of mem-
ory disturbances, constant and exaggerated negative assessments of themselves,
others, and of the world, as well as the causes and consequences of the traumatic
event, constant negative emotional states (fear, anger, guilt, shame) as well as the
inability to experience positive emotions;
–– a diminishing interest in participating in significant activities as well as a sense
of alienation from others;
–– an increased reactivity and excitability in the form of irritating behavior and
unprovoked verbal or physical anger against people and objects, reckless and
This articles provides a completely revised and enhanced version of Görgen and Braune (2016)
A. Görgen (*)

https://doi.org/10.1007/978-3-319-90677-5_26
352 A. Görgen
self-destructive behavior, exaggerated fright reactions, difficulties in concentrat-

ing, sleep disorders and finally;
–– in dissociative forms, symptoms of depersonalization or derealization can occur
(American Psychiatric Association 2013: 271–272).
The 12 month prevalence of PTSD among adults amounts to 3.5%. Europe and most
Asian, African, and Latin American countries show an estimated prevalence of 0.5–
1%. Certain professions are exposed to a higher risk of PTSD, such as police, fire
brigade, or rescue personnel. However, according to the DSM, those most affected
are survivors of rape, war veterans, former prisoners of war, and victims of ethnic or
politically motivated internment as well as victims of genocide (American
Psychiatric Association 2013: 276). It should be borne in mind, though, that esti-
mated prevalence varies depending on the research design (Atwoli et al. 2015).
PTSD also has negative consequences from a macroeconomic perspective. In 2000,
Kessler estimated the costs of managing trauma in the US to be approximately 3
billion US dollars per annum (Kessler 2000). Ten years later, the RAND Corporation,
a US American military think tank, similarly estimated a bi-annual sum of 4–6.2
billion US Dollars (Tanielian and Jaycox 2010: 171).
The Sociocultural Texture of PTSD
Due to its personal, social, and economic phenomenology and its consequences, it
is no surprise that PTSD, like no other disease (probably with the exception of
HIV), has spread from the medical field to the social, popular cultural, and political
discourse, in particular in US American culture. According to American literary
scholar Shoshana Felman, three aspects have contributed to the sociocultural visi-
bility and coping mechanisms of trauma:
(1) the discovery of psychonanalysis and, with it, the discovery of trauma as a new concep-
tual center, an essential dimension of human and historical experience and a new type of
understanding of historical causality and historical temporality; (2) the unprecedent number
of disastrous events on a mass scale that wreaked havoc on the twentieth century […]; (3)
the unprecedent and repeated use of instruments of law to cope with the traumatic legacies
and the collective injuries left by these events. (Felman 2002: 2)
PTSD is a product, on the one hand, of the practices, technologies, and narratives,
by which it is diagnosed, investigated, and treated; on the other hand, of the institu-
tions, interests, and moral constellations that have led to the distribution of these
approaches (Young 1995: 5). This means that the trauma can not only be viewed as
a disease of an individual but must be seen in a larger context.
As Allen Meek noted, the “iconic traumas of modern media – the Holocaust,
Vietnam, 9/11 – can be understood as symptoms of a deeper crisis emerging from the
historical impact of imperialism, colonialism, and globalization” (Meek 2010: 28).
Kaplan und Wang explained and expanded on this position and emphasized that the
The Medical, Social, and Cultural Construction and Production of Post-Traumatic… 353
objection to representation in the face of the unrepresentable character of trauma has two
legitimate concerns in the history of modernity. One is the aestheticization of politics,
which is a fascist and authoritarian strategy by the modern state to stage its self-
representation and collective identification by borrowing narratives, myths, techniques, and
the mise-en-scène from the cinema and the culture industry. […] Another concern is the
more recent phenomenon of aestheticization of trauma-ridden histories and cultures by the
transnational culture industry and media. […] It is obvious that this aestheticization of the
other does not simply render traumatic history into images, but in its obsession with vio-
lence and trauma, it flattens difference, history, memory, and the body into an abstract,
pleasing mold. (Kaplan and Wang 2008: 10–11)
According to the historian Allan Young, this does not mean that PTSD is not real. It
is an empirically perceptible state, both for individuals suffering from it and for the
society that must deal with it (Young 1995: 5). Nevertheless, the factuality of PTSD
is time- and culture-bound in the sense that it is not timeless (Young 1995: 10). With
reference to Paolo Donati, we emphasize that in order to understand cognitively
perceived data, the perceived object has to already be known a priori and has to be
written in typologies that locate individual perceptions in one or more meaningful
contexts (Donati 2001: 149–150). If we understand PTSD as a frame or an interpre-
tation pattern to understand reality, we can argue that without the existence of such
a frame, the cognition of its characteristics, of its attributes, and of its symptoms
cannot relate to a meaningful conclusion of what the perceived characteristics actu-
ally mean.1 Young argues that definitions of PTSD are very memory-oriented, which
at first sight appears to be self-evident, but on the second view is based on contin-
gent historical and cultural forms of self-awareness (Young 2000: 53). This malle-
ability of memory affects not only individuals but also society. Farrell adds, that
Whatever the physical distress, then, trauma is also psychocultural, because the injury
entails interpretation of the injury. I emphasize that phrase because terror afflicts the body,
but it also demands to be interpreted and, if possible, integrated into character […]. And
those interpretations are profoundly influenced by the particular cultural context. […] For
exactly this reason – because trauma can be ideologically manipulated, reinforced, and
exploited – it calls for critical analysis as well as psychiatric intervention. (Farrell 1998: 7)
The medical relocation of PTSD in the face of the individual is, at the same time, a
moral reorientation of society towards the person affected by PTSD and a social
recognition of the moral responsibility for the circumstances that have led to his
illness. Each PTSD diagnosis thus receives a political overlay that heroizes the trau-
matized and whose ‘invisible’ burden of trauma is a demand to the political and
social system not to forget its soldiers and its martyrs. The trauma is particularly
subject to public discourse when social values and everyday experience diverge
(Farrell 1998: 16).
Hence, if PTSD is to be approached analytically, it is not only important to con-
sider its medical history, as is the case in the following chapter, but also to consider
(popular) cultural reflections on PTSD, since these are particularly important instru-
ments to convey concepts of trauma in their media artefacts. In this context, certain
pictorial and narrative traditions have developed that clearly point to their r eferential
1
For a deeper analysis and definition of the concept of frames, see for example Bednarek (2005).
354 A. Görgen
reality and contextualize them politically, socially, culturally, and medically for the
media recipient.
The introductory considerations already provide a number of indications regard-
ing possible reasons for the socially mediated clinging to the concept of PTSD: (1)
It executes the social function of a projection surface for (social) nightmares. In this
function of memory, it also serves as a self-ascertaining moral corrective or as a
moral compass. (2) It also serves a purely functional, medially staged ‘pleasure’ in
suffering, which increases the artefact’s authenticity for the consumer of fictional
formats. As a consequence, this staging of PTSD undermines its function as a moral
corrective mentioned under (1), since PTSD deprives its political semantics and
perpetuates itself as a Baudrillardian simulacrum (Baudrillard 1994: 6) in a cycle of
repetitive aestheticization.
This, of course, does not mean that the iconography of trauma necessarily has to
be free of political-moral subtexts. It means, however, that a decisive political over-
lay through the framing of the pop cultural artefact is required in order to be able to
convey the emblem of the traumatized to a moral function. Thus, the divergent
spheres of society can become ‘beneficiaries’ of undifferentiated and tendentially
irrational PTSD conceptualizations. For those directly affected, this finding is at
least double-edged in its consequence: on the one hand, at least a media thematiza-
tion takes place, which positively underscores the social status of PTSD patients. At
the same time, their disease is operationalized and subjected to other purposes. The
focus on diagnostics and therapy – although possible and necessary – is mitigated
by the popular cultural overlay. From a purely bioethical perspective, this develop-
ment is questionable. The PTSD diagnosis loses its status of being an end in itself
and the suffering of the affected persons might, at least in the public, possibly be
relativized.
In this paper, starting from a brief history of the medical development of the
PTSD-diagnosis, we would like to draw attention to the political and social dis-
courses of PTSD. Both aspects, medical definition and political-social reflection,
have become an important topos of film and other popular cultural artefacts like
comics or digital games. This analysis will focus on the predominant US American
popular culture, as it is presumably the most important producer of popular culture
media. The range of these adaptations is to be discussed here. Finally, we conclude
with a theoretical framework of this reflection process.
A Medical History of PTSD
From the middle of the twentieth century, industrialization in the form of armament
and development of new weapons and the introduction of mass wars brought a new
dimension in the demographic impact and the potentiation of the damage done by
war violence. However, it was only with the modernization processes of medicine
that interest in – from today’s perspective – traumatized patients increased.
The main question in the early descriptions of mental trauma was whether the
cause was organic or psychological. In his studies on the railway spine,2 the British
physician John Eric Erichsen (1818–1896) associated the psychological conse-
quences with organic causes and warned in this context not to confuse this syn-
drome with (female-connotated) hysteria (van der Kolk 2007: 20). The German
neurologist Hermann Oppenheim (1857–1919) was the first to use the term “trau-
matic neurosis” in 1889. He also related the functional problems of trauma patients
to organic causes, in particular to molecular changes of the central nervous system
(Weber 2010: 211). In addition, during World War I, an etiological link between
cardiovascular symptoms was observed in traumatized individuals, leading to dis-
ease descriptions such as the irritable heart, the soldier’s heart, the disorderly
action of the heart, or the neurocirculatory asthenia. The organic approach to
trauma was beneficial for the combatants because it turned negatively charged asso-
ciations like “cowardice” into a positive light and allowed both the self-respect of
the individual as well as the group morale to strengthen. However, the organic
explanation of trauma could not explain why soldiers who had not been in direct
combat could develop similar symptoms (van der Kolk 2007: 20–21). While an
organic cause for the soldiers’ traumata seemed beneficial and promising to soldiers
and medical professionals alike, a purely psychological perspective on trauma was
widely perceived as negative, particularly as the danger of a ‘simulation’ of illness
came to the attention of German and French psychiatrists. War Neurosis and War
Hysteria got attributed as diseases of the will (“Willenskrankheit”). Suffering from
these syndromes implied a mental failure of the soldiers. In the wake of World War
I, the German psychiatrist Karl Ludwig Bonhoeffer (1868–1948) considered trau-
mata to be social diseases, which consequently could only be contained and erased
by social changes (van der Kolk 2007: 20–21). Proceeding from the idea that the
formation of a traumatic disorder is a secondary expression of a primary desire for
state compensation, Bonhoeffer coined the term pension neurosis (“Rentenneurose”).
The Imperial Insurance Statute (“Reichsversicherungsordnung”) of 1926 followed
this analysis and did not cover the costs of traumatic neuroses any longer. In this
context, it was assumed that the patient could be cured only if he had no prospect of
any pensions at all. According to van der Kolk, this policy led to the current more
restrictive policy of compensation and handling of veterans in Germany (van der
Kolk 2007: 22).
In the interwar era and during World War II, it was above all the American psy-
choanalyst Abram Kardiner (1891–1981) who anticipated many points of the later
description of PTSD in the DSM-III catalogue. Kardiner had already worked with
traumatized veterans since the 1920s and had attempted to translate his experiences
into a classificatory theory of war neuroses. After 1939, Kardiner revised his entire
data corpus, codified the criteria of war neuroses, and identified its delayed and
chronic manifestations. He published these new results in the monograph Neuroses
of War in 1941 (van der Kolk 2007: 26). Despite these findings, his classification
2
The name was given to the syndrome, because Erichsen mainly examined the victims of train
accidents.
356 A. Görgen
was long ignored by most representatives of psychiatry (Young 1995: 5) until it was
remembered again in the preparations for the DSM-III catalogue in the late 1970s
(van der Kolk 2007: 29–30).
In 1952, the APA published the first Diagnostic and Statistical Manual of Mental
Disorders. Under the classification number ooo-x81 it described gross stress reac-
tion as follows:
Under conditions of great or unusual stress, a normal personality may utilize established
patterns of reaction to deal with overwhelming fear. The patterns of such reactions differ
from those of neurosis or psychosis chiefly with respect to clinical history, reversibility of
reaction, and its transient character. When promptly and adequately treated, the condition
may clear rapidly. It is also possible that the condition may progress to one of the neurotic
reactions. If the reaction persists, this term is to be regarded as a temporary diagnosis to be
used only until a more definitive diagnosis is established. This diagnosis is justified only in
situations in which the individual has been exposed to severe physical demands or extreme
emotional stress, such as in combat or in civilian catastrophe (fire, earthquake, explosion,
etc.). In many instances this diagnosis applies to previously more or less ‘normal’ persons
who have experienced intolerable stress. The particular stress involved will be specified as
(1) combat or (2) civilian catastrophe. (American Psychiatric Association (APA) 1952: 40)
It is striking that the delayed formation of a psychological disorder was not men-
tioned here. Trauma had therefore not thought to have a causal relationship with the
war experience of the patient. Regardless of the lack of will to acknowledge psycho-
logical trauma after World War II and the Korean War, there are ex post-conducted
studies that are based on an estimate of the ‘mental health casualties’ of these wars.
These studies cautiously estimate that, in World War II, between 2.8% and 10.1% of
16.1 million US soldiers, and, in the Korean War, 3.7% of 5.7 million soldiers suf-
fered from PTSD (Tanielian and Jaycox 2010: 4). Nevertheless, ‘war neuroses’ or a
corresponding entry was not included in the DSM-II catalog in 1968.
When the US took part in the Second Indochina War in Vietnam from 1963 (until
1973), the veterans of this war saw themselves confronted with not only social but
also medical problems. The soldiers stationed in Vietnam were treated psychologi-
cally on site. The proportion of mental collapses was 5 out of 1000 participants, a
quota celebrated by psychiatrists as well as the military command (Scott 2004
(1993): 32–33). Given the lack of a diagnostic category for post-traumatic stress and
the unacceptance of a delayed emergence of such a disorder under the DSM-I cata-
logue, the veterans could not make a reference to their service in Vietnam on medi-
cal grounds. This meant that no state support was granted to them. At the same time,
veterans with post-traumatic symptoms were often misdiagnosed with schizophre-
nia, depression, or other behavioral and character disorders (Bloom 2000: 33).
At this time, the veterans’ feeling of a communicative barrier between them and
the civilians at the ‘home front’ led to an increasing politization of the psychologi-
cal and medical assessment of what later would become PTSD. Vietnam veterans
organized themselves in so-called rap groups, organized by the veteran association
Vietnam Veterans against the War (VVAW) in order to exchange their experiences
and to speak out against the Vietnam War. These meetings also had a therapeutic
effect, as the veterans could develop a language and a narrative for their experiences
and give them meaning (Hagopian, 2016: 72).
When psychiatrists Chaim Shatan (1924–2001) and Peter Bourne (*1939) made
a name for themselves during a court case about a traumatized deserted soldier,
Shatan was invited by the VVAW, together with psychiatrist and anti-war activist
Robert Jay Lifton and others, to join the rap groups. Consequently, Shatan orga-
nized a panel where more than 30 doctors met veterans. In these groups, Shatan and
Lifton noticed many of the symptoms of PTSD, such as the delayed onset of symp-
toms, a cognitive dullness, feelings of anger and guilt (Hagopian 2016: 73–74). On
May 6, 1972, Shatan wrote an editorial for the New York Times, which led to the
formation of more than 1250 self-help groups as well as student-assisted facilities
coping with veteran medical and financial concerns (Bloom 2000: 29).
With the increasing influence of these self-organized veteran groups, the pres-
sure on the government also increased. From then on, the recognition of PTSD as a
genuine mental disorder took place at different medico-political levels.
As early as 1970, Shatan was under state surveillance; his telephone was tapped
and his mail traffic searched. After 1973, there were even plans to infiltrate the rap
groups through the FBI and to search Shatan’s office (Bloom 2000: 32–33). In the
middle of the 1970s, the critical attitude of the US government changed, especially
due to the pressure of senator Alan Cranston. In 1975, the Senate Committee for
Veterans Affairs commissioned, with the approval of the Congress, a study to iden-
tify the needs of Vietnam veterans, which was published in 1977 under the name
Legacies of Vietnam (Egendorf 1981 (1977); Bloom 2000: 33–34). When in 1974
the APA decided to launch a third edition of the DSM, Lifton and Shatan approached
Roger Spitzer, the head of the DSM-III task force, proposing to include “post-
combat syndrome” in the planning. As a consequence, the Committee on Reactive
Disorders, including Shatan, had been established with the purpose to investigate
this context. In 1978, the committee finally proposed the term Post-Traumatic
Disorder, which was used 2 years later in the DSM-III catalog (Hagopian 2016:
75–76). This went hand in hand with legislative progress in the treatment of veter-
ans: “In 1979, as the APA was preparing to incorporate PTSD into DSM-III,
Congress passed legislation authorizing treatment for psychologically wounded
Vietnam veterans. Enacted in July 1979, PL 96-22 mandated the VA to establish
storefront outreach centers (‘vet centers’) staffed by professional counselors, with
veterans among their practitioners and support personnel.” (Hagopian 2016: 76). It
is important to add that, with the inclusion of PTSD in DSM-III, after a decade-long
process, the victimization of veterans was finally acknowledged. By neglecting the
fact that the soldiers not only suffered themselves but had inflicted suffering on oth-
ers and “by making veterans into victims, PTSD also removed any responsibility,
and therefore guilt or blame, they might have had for actions taken in Vietnam”
(McClancy 2014: 509).
The inclusion of PTSD in DSM-III was not undisputed. On the one hand, the
treating physicians of trauma patients were glad that it was now officially acknowl-
edged that personal suffering does not end with the end of the traumatic event. With
the recognition of PTSD, it was found that when an etiological event occurred dur-
ing military service, PTSD had to be related to it. Consequently, the veteran was
now given appropriate medical treatment and an appropriate pension for as long as
358 A. Görgen
the disorder continued. On the other hand, the inclusion of PTSD into the DSM
forced the Veteran Administration (VA) to take responsibility, hence, this develop-
ment was also met with some resistance. It was criticized, that
1. people have always had reactions to events, and there is no need to pathologize it;
2. it is not a legitimate syndrome but a construct created by feminist and veteran special
interest groups;
3. it serves a litigious rather than a clinical purpose, because the explicit causal rela-
tionship between traumatic exposure and PTSD symptoms has opened the door to a
multitude of frivolous lawsuits and disability claims in which the financial stakes are
enormous;
4. verbal reports of both traumatic exposure and PTSD symptoms are unreliable;
5. traumatic memories are not valid;
6. the diagnosis is a European/American culture-bound syndrome that has no applica-
bility to post-traumatic reactions within traditional cultures; and
7. it needlessly pathologizes the normal distress experienced by victims of abusive
violence. (Friedman et al. 2007: 4–5)
Since the Congress had agreed to finance the resulting costs, VA finally agreed with
the new situation (Young 2000: 59–60).
A consequence of the inclusion of PTSD in the DSM-III catalog was the de-
politicization of the therapeutic situation of the psychologists and the veterans. On
the one hand, the relatively informal and highly political framework of the rap
groups and their performance of ‘peer counseling’, as introduced by the VVAW in
the 1970s, was broken up and the therapeutic measures were transferred to classical
hierarchical doctor-patient relationships. The formerly externalized attribution of
guilt to the policies of the US government became internalized, meaning the veter-
ans focused their feelings of guilt and self-pity onto themselves (Hagopian 2016:
77).
Nevertheless, the finally official, ‘new’ diagnosis spread fast. “By 1985, up to a
million US veterans had been diagnosed with PTSD, and use of this syndrome had
enabled 250 Vietnam veterans to obtain acquittals, sentence reductions, or diversion
to treatment programs in criminal cases” (Miller 2015: 5). While PTSD incidence
rates decreased during the first Gulf War, numbers increased significantly during
and after the US interventions in Iraq and Afghanistan.
The more recent Iraq (2003–2011) and Afghanistan (2003–2015) theaters have seen longer
tours, multiple deployments, unconventional combat tactics, and greater contact with civil-
ian populations. Ironically, advances in military medicine have enabled more service mem-
bers to survive what would previously have been fatal injuries, and to live on with chronic,
disabling physical and psychological impairments. Thus, up to 20% of today’s US veterans
suffer from PTSD, and incident rates are generally related to the number of firefights or
other combat experiences the service member has experienced. (Miller 2015: 5–6)
In the 1980s and 1990s, a perception of the overdiagnosis of PTSD developed, after
veterans played the ‘trauma card’ in more and more legal proceedings and trials. At
the same time, it became obvious that
many claims of military PTSD were unfounded and that a sizable proportion of military
PTSD claimants had never even seen combat; in fact, some claimants had no military record
at all. Finally, by the late 1980s and early 1990s, as a national crime wave began to peak,
public opinion began to grow frustrated with insanity defenses in general, and it became
harder to persuade juries and judges to exculpate or mitigate charges against a defendant
claiming PTSD or any other psychiatric diagnosis. (Miller 2015: 5)
Hence, many veterans were faking PTSD to get financial support, to justify failure
in their biographies, or just to get sympathy from their contemporaries (Hagopian
2016: 82). The partially factual stereotype of the World War I ‘pension neurotic’
(see above) thus found continuity and increasing resonance. Hagopian explains the
persistence of such narratives, i.e. the image of the rejection of veterans at the ‘home
front’ or, on the other side, of the ‘trauma creeps’, with the self-reinforcing tradition
of these stereotypes by veterans, psychiatrists, and politics.3 At the same time, how-
ever, it is important to emphasize that popular culture also absorbed these narratives
and provided certain aesthetic and narrative characteristics which, in turn, found
their way into collective ideas of the traumatized veteran.
opular Culture as a Promotor of PTSD’s Politization

P
and Medicalization
As indicated above, there is a close link between politics, the public, and medicine
in the context of dealing with PTSD. This connection is not least influenced by a
strong, historically evolved reception of trauma and PTSD in popular culture. In the
following section, this context will be discussed by examining the example of the
development of PTSD in films.4
Allen Meek described how trauma narratives are communicated via an “optical
unconscious” in which development of media technologies and the evolution of
capitalist power structures go hand in hand. “Today, the ‘traumatic’ images made
available by visual media reveal further destruction of human community and polit-
ical rights. The era of modern technological media and consumerism has been char-
acterized by widespread terror and enforced exile” (Meek 2010: 82). Thus, in film,
trauma narratives represent both the suffering of the individuals, as well as a critique
of the overwhelming and often invasive processes of modernity, such as the already
mentioned industrialization of war.
Already in the interwar era (1919–1939), films integrated ideas of war neurosis,
for example in The Cabinet of the Dr. Caligari (Wiene 1920), in which the depiction
3
It is also important to add that the described historical development is focused on military and
veteran-related PTSD alone. Hence, in drafting the lines of a combat-induced PTSD, we ignore the
existence of ‘civilian’ occurrences of PTSD. Accordingly, we, as researchers fall for the same
stereotypes as it has been proven for the US jurisdiction, when ascribing PTSD to veterans only
and not to civilians that have been exposed to traumatic events, even if epidemiological data tells
us, that most trauma takes place in the non-military field (Purtle 2016). However, due to the focus
and the limits of this paper, we chose to stick with the main narrative of combat-induced PTSD.
4
Of course, we are aware of the many representations in other media, such as comics and games.
Due to the limited space for investigation in this handbook, we can only refer to other studies, i.e.
for comics Smith and Goodrum (2011) and Yamada (2014) or digital games Smethurst and Craps
(2015) and Bumbalough and Henze (2016) and Görgen and Braune (2016).
360 A. Görgen
of the character Cesare, a war veteran, clearly refers to contemporary trauma dis-
courses. In this case, theories, studies, and public representations of the French
pathologist and neurologist Jean-Martin Charcot (1825–1893) on the psychopathol-
ogy of hysteria had been interwoven with contemporary concepts of the doctor-
patient relationship, developments in communication technology, media
representations of war and medicine, and collective memories and ideas of past and
future wars (Lembcke 2013: 86).
After 1945, the majority, at least of American films, aimed at the patriotic appro-
priation of World War II and the victory of the USA. In addition, the 54,000 deaths
on the American side in the Korean War (1950–1953) did not find entry into this
patriotic cinematic approach to war.
This was partly due to the production code, which at the time every film had to
comply with in order to be sanctioned for release to the public.
Three principles were basic to the code:
1. No picture should lower the moral standards of those who see it.
2. Law, natural or divine, must not be belittled, ridiculed, nor must a sentiment be cre-
ated against it.
3. As far as possible, life should not be misrepresented, at least not in such a way as to
place in the mind of youth false values on life. (Keranen 2014: 53)
Accordingly, any categorization of a veteran as a social and moral outsider did not
or only rarely find its way to the big screen. Even when symptoms of the – not yet
defined – post-traumatic disorder were shown in The Best Years of Our Lives (1946),
the protagonists managed to get rid of this disorder. Once the protagonists “make
the simple choice to ‘get over it’ they not only begin to thrive in their personal lives
but also in their public lives as they morph from their post-war struggles into con-
tributing members in the nation’s economic recovery after the Depression.” (Keranen
2014: 190–191).
These early films ignored the impact of war trauma and basically followed the
tradition of the patriotic well-being stories, which involved characters who became
veterans by chance. Critical representations of traumatized soldiers in mainstream
movies could not be established until the aftermath of the Vietnam War, also because
in 1968 the Motion Picture Association of America (MPAA) introduced a new rat-
ing system, that opened up new ways for depicting explicit violence, sexuality or
unorthodox topics and approaches to movies (Pheasant-Kelly 2016: 240) as it is the
case with PTSD.
“Given the pessimism of the times and hyperrealistic portrayals of PTSD on the
big screen, however, 1970s films dealing with PTSD were inclined to craft the dis-
order so as to highlight a larger theme: the irrationality of war” (Hackeling 2013).
Correspondingly, one can say that from the 1970s in correlation to the medical
development of the PTSD, a politicization in the cinematic portrayal of veterans
took place.
After 1971, American cinema started to get populated by crippled and criminal
veterans, socially dysfunctional psychological wrecks, which impressively exposed
the downsides of the Vietnam War (Lembcke 2013: 102). While the medical com-
munity only started to discover a diagnostic deficit, the perception of this deficit in
the public became apparent through the theatricalization of war-induced traumata in

films. For example, some contemporary zombie films also took up the issue of
PTSD. Deathdream (Clark 1974) tells the story of Andy, a soldier killed in Vietnam,
who returns to the US as a zombie.5 Dawn of the Dead (Romero 1978), which fol-
lows the daily fight for survival of a group of people during a zombie apocalypse in
a large shopping center, can be either seen as a bloody critique of American con-
sumerism (McFarland 2012) or as a critical reference to traumatized American
Vietnam veterans (Randell 2011). This was, however, special-interest cinema, at
least at the time of its publication. The most important and more lasting depictions
of traumatized veterans in mainstream cinema were Taxi Driver (Scorsese 1976)
and The Deer Hunter (Cimino 1978).6
Taxi Driver tells the story of the lonesome New York taxi driver Travis Bickle,
who is disgusted by the “scum” of the city and whose obsession with saving a young
prostitute from her milieu culminates in an act of violence. Bickle, a Vietnam vet-
eran, shows a lot of symptoms of PTSD, he is
a dangerous, drug-addicted, obsessive loner who is out of touch with reality to the point
where he would take a girl he likes to a pornographic theater on their first date, and then
harass and stalk her after she tells him that she does not want to see him again. In sum,
Travis elicits the entire spectrum of PTSD symptoms. He has difficulty falling and staying
asleep, is irritable and prone to outbursts of anger, finds it difficult to concentrate, maintains
an exaggerated startle response, remains hypervigilant at all times, has lost interest in activ-
ities and life in general, feels detached from others and emotionally numb, and senses the
limitedness of his future. (Hackeling 2013)
This depiction of the traumatized ‘Vietvet’ presumably shaped the public idea of
PTSD for years.
The Deer Hunter is a US-American feature film directed by director Michael
Cimino in 1978. In the plot, three men from a little town in Pennsylvania are drawn
to the Vietnam War and subsequently return as physically damaged and mentally
impaired veterans. The film is divided into three acts of equal duration: the time
before, during, and after the war. Accordingly, the focus is not only on the war in
Vietnam, but also on its influence on American society. The Deer Hunter was one of
the first films to deal specifically with the Vietnam War and the subject of PTSD. At
the same time, the film used flashbacks, scenes from past war situations, which were
used to portray the civilian post-war life of the protagonists. Hackeling points out
that this
idea of veterans being able to slip out of reality and back into the war would be one of the
most common tropes of PTSD films, even to the present day, and has formed a great part of
Americans’ cultural misunderstandings of what PTSD actually is. Undeniably, the film’s
use of flashbacks as a cinematic effect were a visceral means to a poignant end—one
5
‘Acting like a Zombie’ is a typical description for the behavior of PTSD sufferers (Foley 2014).
6
Oliver Stone’s Apocalypse Now (Coppola 1979) also played a major role in PTSD’s portrayal.
Both main characters, Captain Willard and Colonel Curtz prototypically show the (self-) destruc-
tive, symptoms of PTSD. The film depicts the inhumanity of the war and its consequences for the
human psyche, as well as the involvement of the soldiers in a system of violence and madness; it
also portrays how the individual dissolves in war and becomes a victim of political interests.
362 A. Görgen
immersed in feelings of helplessness and disassociation, which many veterans who are suf-
fering from the disorder could relate to. (Hackeling 2013)
The representation of dysfunctional and traumatized veterans in films like Taxi

Driver or The Deer Hunter led to a new, also politicized, theatricalization of war in
American popular culture and society, which in turn supported a public need for a
meaningful medicalized framing of this phenomenon with the DSM III catalogue as
the most important result. At the same time, there was an interweaving of media and
medical discourses, in the course of which, for example, the symptom of the flash-
back developed a prominent position. The re-experience of traumatic situations in
associatively similar situations had initially been an element of American drug cul-
ture, which found artistic entrance into the contemporary (anti-) war film. In films,
the recollections of the veteran in the form of flashbacks were conveyed as factual
reports (Lembcke 2013: 107). Turim describes that
these flashbacks were often abrupt, fragmentary, and repetitive, marked by a modernism of
technique. The form of these modernist […] flashbacks becomes a trope in itself. It signals
disruption of everyday postwar existence. Violently inserted flashbacks inscribe in narra-
tives a shattering of complacency postwar tranquility that might put aside or bury a past that
had not been worked through will be slashed not only by a call to remember, but also con-
comitantly by a call to make the connections between the past and atrocities in the present.
(Turim 2001: 207)
Although a clear link between the prevalence of flashbacks and its use in film cannot
be demonstrated with certainty, Jones et al. assume that, with the mass production
of TVs starting in the 1950s and the penetration of such aesthetic film techniques,
perceptions and aesthetics of cinematic flashback perpetrated into the private space
of the individual and at least offered a new language to describe their experiences
(Jones et al. 2003: 162).
The observed process of depoliticization after the establishment of PTSD in the
DSM-III catalogue in terms of a less critical PTSD reception can also be observed
in the mainstream cinema of the 1980s. In particular, the (initially) three-part Rambo
series is exemplary for this process. Rambo: First Blood (Kotcheff 1982) can be
understood as a film of the transition from a critical left to an uncritical patriotic
position, from a highly political to an increasingly aestheticized depiction of
PTSD. The film presents itself and its protagonists as ideologically ambivalent.
John Rambo, Vietnam veteran and former and last member of Green Berets, crosses
the fictional small town of Hope by foot. There he is expelled by Sheriff Will Teasle
with the Sheriff’s indication that the city has enough to do with their own veterans.
Rambo resists, gets arrested, and abused by the police. During the mistreatment,
Rambo experiences a flashback of the torture that he survived in the Vietnam War,
defends himself against the police and escapes. A bloody mixture of a revenge cam-
paign and escape develops, which can only be finished peacefully when Rambo
finally is confronted by his former superior, Colonel Trautman (it must be empha-
sized here that Rambo does not kill anyone in this first film).
The two opposing protagonists, the one-man army Rambo, as well as Sheriff
Teasle, are portrayed as basically righteous men, who, however, follow their own
moral code of what is right and wrong. Teasle’s main concern is the protection of
the city and he is driven by a negative stereotype of vagrant Vietnam veterans
(although medals in the background of his office identify him also as a veteran).
Rambo’s motivation, however, is a search for identity, for social recognition by
society for his service in Vietnam.
Rambo as a character is surprisingly complex. As Colonel Trautman explains to
Sheriff Teasle, he is “made”, a product of the army, highly trained in deadly guerilla
tactics, and in enduring pain, suffering, and humiliation inflicted through the enemy.
Ironically, it is pain, suffering, and humiliation that caused the conflict in the first
place. On the one hand, while serving in the army, Rambo had been embedded in
functioning structures that gave him support.7 On the other hand, he is now, a few
years later, the last surviving member of his squad. Instead of being recognized as a
war hero, society perceives him (correctly, ironically) as a danger, who was insulted
and referred to as “baby killer” and “rapist.” With this public antipathy, the movie
directly refers to a narrative of rejection of the homecoming veterans (Lembcke 2000).
At the beginning of the 1980s, a discussion about how to treat Vietnam war veterans
developed, which decisively stimulated political culture as well as the development of
a nosology of PTSD. A secondary traumatization could be constructed from the narra-
tive of the soldier who was betrayed and mistreated at the home front and the emerging
identification of the emotional and psychological trauma they suffered. The soldier,
who had been spat on and despised, repeatedly became the subject of both films and
reports of returning soldiers. Although the spitting image mainly was a myth, it put
pressure on American politics, because the “real war, it came to be said, was the war
at home; the real hurt was inflicted on the home front” (Lembcke 2013: 114).
In Rambo, it is not only the narrative of the struggle on the home front but also
PTSD that determines Rambo’s actions.
That trauma and that suffering transform him from an uncomplicated threat to a locus of
sympathy and pity, making his savagery, and by extension the imputed savagery of Vietnam
veterans in general, less dangerous. In essence, Rambo’s rehabilitation stems from the
grounding of his violence in the trauma of the Vietnam War. However, because all of
Rambo’s actions throughout the film are in the end linked inextricably to his wartime suf-
fering, the implicit critique throughout the film of an unjust and brutal police state gets lost.
(McClancy 2014)
The crucial difference to previous films was that Rambo was a misunderstood hero,
who was not given the respect he deserved after his fight for his country. However,
Rambo: First Blood started in theaters 2 years after the publication of DSM-III. The
film was at the center of a paradigm shift that no longer stigmatized the “crazy”
soldiers and excluded them from society, but with DSM-III gave them a means to
identify and evaluate their traumatization. The impression that Rambo: First Blood
is a film of transition is also evident in the fact that there is an alternative ending in
which Colonel Trautman does not offer Rambo protection in the finale of the film,
but kills him:
7
Accordingly, he finds peace only when he is persuaded by Colonel Trautman to join him again
and to return into the arms of the military.
364 A. Görgen
The first scripted and filmed ending saw the trapped Rambo pleading with Trautman to kill
him. Rambo says, ‘I can’t spend the rest of my life in a cell. If I’ve got to die, I want you to
do it.’ Trautman flinches, but Rambo insists: ‘You trained me. You made me. You kill me.
You owe me that.’ Rambo places a pistol in Trautman’s hand. He tries to aim away, but
Rambo pulls the gun towards him and it goes off. It ends with Trautman walking away as
Rambo dies alone. (First Blood Turns 30 2012)
The mentally and physically crippled veterans of Taxi Driver or The Deer Hunter
transform with John Rambo into moral instances and equally into weapons, with the
help of which Good can win over Evil. The representation of PTSD was subject to
an associative re-labeling in the 1980s, which regarded PTSD as a military advan-
tage, rejecting the social neglect of the ‘Vietvets’ and appointing them as heroes,
calling for support for the fighting troops (Hackeling 2013).
Before 1980, traumatized veterans were generally perceived critically; after
1980, the public had the opposite perception. The reproduction of their memories
through flashbacks was accepted as factual reproductions of the traumatic events of
the war. In addition, it seemed disrespectful and potentially damaging to mistrust
the suffering veterans (Lembcke 2013: 115).
This reinterpretation and depolitizing aestheticization of PTSD increased with
Rambo: First Blood II (Cosmatos 1985) and even initiated a whole subgenre of
B-movies, the so-called “Return to ‘Nam” films of the 1980s (for example, Missing
in Action (Zito 1984)), in which depictions of PTSD became a complete caricature.
“What they offered, though, in spite of the shoddy production values, was the
chance, in Rambo’s words, ‘to win this time’” (Russell 2002: 75). Not only their
imperialist racism and jingoism but also their disinterestedness in the persisting
social and psychological problems that veterans faced, led to negative critiques both
from film critics and veteran organizations (Russell 2002: 75–76).
Furthermore, the late 1980s and early 1990s were marked by the trend of a non-
political representation of war and its traumatic consequences. Although movies
like Born on the Fourth of July (Stone 1989) or Forrest Gump (Zemeckis 1994) also
touched on the issue of PTSD, they emphasized questions of survival guilt and how
the soldier copes with his wartime experiences. “No longer were these veterans
crazed loners or quasi-super heroes, but rather simply men trying to deal with
immeasurable hardship” (Hackeling 2013).
At the time of its happening, the Gulf War of 1990–1991 did not leave behind
remarkable traces in society and pop culture. This changed in the aftermath of 9/11
and the military consequences of the attack. Four years after 9/11, Jarhead (Mendes
2005) was the first movie to focus on the Gulf War of 1990/1991. Despite the differ-
ent settings, Jarhead broadly cited Vietnam War film elements. Unfortunately, by
only relying on borrowed aestheticism, the film was hollow. As Anthony Oliver Scott
stated in the New York Times: “It is a movie that walks up to some of the most urgent
and painful issues of our present circumstance, clears its throat loudly and, with
occasional flourishes of impressive rhetoric, says nothing” (Scott 2005). Nevertheless,
Jarhead was one of the movies to create a renaissance of anti-war movies in the
wake of the new American wars in Iraq and Afghanistan. Even more political, In the
Valley of Elah (Haggis 2007) re-imagined the idea of the destructive veteran. More
specifically, it was a movie “about veterans featuring damaged and dangerous veter-
ans; conflict between veterans driven by a betrayal narrative that raises in viewers’
minds specters of the unknown; religious hues (imparted by its title), and PTSD
invoked as alibi for murder” (Lembcke 2013: 130). The war theaters of Iraq and
Afghanistan were, similar to the Vietnam War, burdening conflicts for American
politics and society. The war on terror was not exclusively a foreign policy problem
confined to the respective crisis states, but – as the success of a TV show like 24
(Surnow and Cochran 2001-) indicates – it entered American culture and society
through acts of terror, its paranoia and fear and through returning traumatized sol-
diers. As a consequence, the impression arose that the war’s temporal and spatial
limits dissolved (Grajeda 2014: 56). Grajeda further explains that, while “these
returning vet films seem to respect the fact that the trauma of war can be barely
glimpsed on screen, they nonetheless aim to recognize that the traumatic experience
cannot be simply left behind, that indeed it may never end.” (Grajeda 2014: 57).
From the mid-2000s onwards, it seemed as if the popular cultural PTSD frame
was fully defined and dispersed as a narrative instrument into various media arti-
facts. Starting in 2006, in addition to fictional representations of PTSD, documenta-
ries also increasingly found their way into the American public. Be it the
HBO-documentary Wartorn: 1861–2010 (Alpert et al. 2010), presented by James
“Tony Soprano” Gandolfini or be it the Kanye West-presented MTV show
Homecoming Special (Odom 2008), PTSD seems to have entered the cultural com-
mercial mainstream in the post-millennium years (Lembcke 2013: 175–185).
From the 2000s on, not only war movies or war documentaries started to inte-
grate PTSD into their plots. Media artifacts like Comics (basically every Batman
story), TV shows (Homeland, Gansa and Gordon 2011-; Marvel’s Jessica Jones,
Rosenberg 2015; Patriot, Conrad 2017) comedy movies (Tropic Thunder, Stiller
2008), thrillers (The Machinist, Anderson 2004), science fiction movies (The
Manchurian Candidate, Demme 2008), and horror movies embedded PTSD into
their stories.
Conclusions
The final arrival of PTSD in mainstream media after the millennium also provoked
critical voices, which described PTSD as an ‘invention’. In his 1995 historical anal-
ysis “The Harmony of lllusions: lnventing Post-Traumatic Stress Disorder”, medi-
cal historian Allan Young described the development of the nosology of
PTSD. Although he emphasized that he does not question the soldiers’ trauma, he
also indicated that PTSD is a scientific-social construct that is real, but at the same
time a product of its historical and sociocultural context (Young 1995: 10). Moreover,
British military and medical historian Ben Shepard emphasized the social construc-
tion of trauma on changing conceptions of masculinity and finally on an expanding
‘trauma industry’:
366 A. Görgen
‘Trauma’ has become one of the staples of daytime television and magazines, the cheapest
forms of drama. The emotions provoked by fear and stress have long since ceased to be
private and shameful; now they are commodities to be traded in the marketplace of deregu-
lated television and popular journalism. The experience of trauma has become intertwined
with the values of the entertainment industry and what used to be seen as the normal experi-
ences of life are now seen as quasi-medical traumas. (Shepard 2002: 25)
The ubiquity of trauma and PTSD indicates that with its multiple epistemic, ontic,
and ontological meanings, its frame is opaque enough to find a broad use both in the
media as well as in the political and popular cultural sphere. Hence, it can be said
that PTSD is a boundary object (Star and Griesemer 1989: 393), which, as a trope,
developed its own aesthetical and narrative grammar. In the case of PTSD, this
works very well because the knowledge of trauma is very common and many ele-
ments of this knowledge have been communicated from the medical and scientific
discourse via popular cultural entertainment formats into social and political
sub-publics.
With reference to Metz and Seeßlen (Metz and Seeßlen 2012), who have formu-
lated the same for the concept of the Undead, PTSD functions as a polysemic
boundary object that provides consensual knowledge at central points, but provides
sufficient identification space for each social appropriation. This polysemic prop-
erty of the PTSD can be explained by its far-reaching associative power. In this
context, Anne Rothe states that
a concept succeeds based on its degree of associative power to bind otherwise heterogenous
ideas, that is, the extent to which it junctions as a discursive knot. […] In other words, the
discursive knot generated by the trauma concept provides the dominant mode of employ-
ment – the basic narrative structure and core set of characters – for representing such diverse
experiences as child abuse, Holocaust survival, war combat, terminal illness, and addiction
in contemporary Western culture. However, the media of spectacles of popular trauma cul-
ture remove the experiences of victimization and suffering from their socio-political con-
texts by reducing them to their smallest common denominator of a body in pain. (Rothe
2011: 4–5)
The societal struggle with the human costs of military conflicts is highly dependent
on historical constellations, which, in their extremes, give little or very much weight
to these consequences. This act of recognition is at the same time linked to ques-
tions of medical knowledge, political-economic compensation, and popular-cultural
reflection, especially of trauma. The interpretation of PTSD can be located in a
particularly narrow and complex texture of the above-mentioned spheres. While the
medical profession did not consistently recognize the temporal delay of trauma in
the course of changing cycles of ignorance and recognition and found (and actually
finds again) the causes among other things in organic reasoning, the political system
used its diffuse and empirically difficult etiology by withholding compensations for
as long as no causal link between the disease-inducing experiences of the war –
caused by political decisions – and trauma could be made.
Within this constellation, popular culture and the artifacts produced by it play a
special role. On the one hand, popular culture is able to create media attention for a
controversial topic such as PTSD and is supportive of a positive political development
of the discourse. In addition, it has captured and contextualized narrative traditions

and social knowledge about PTSD, given it a syndrome-specific language of its own,
and perpetuated this knowledge. At the same time, the implementation of the PTSD
discourse into popular culture is also subject to the constant danger of being trivial-
ized or at least highly subjectivized.
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Socialist Advertising. Health Education
in East German Television
Philipp Osten
“Only modern technology allows the physician to diagnose,”1 says a voice from the
off, while among the whir of valves and transistors you watch a dot matrix printer
plotting a liver scintigram. Technology plays a key role in the films of the Bulgarian–
German co-production You and Your Health (Du und Deine Gesundheit), a film and
television series produced by the DEFA (Deutsche Film AG) studios who special-
ized in the production of documentary films in Potsdam, East Germany.
In these films, a petroleum refinery, a bottling plant, the motorcar Trabant and a
Soviet express locomotive known as the Taiga-Barrel serve as examples to represent
and illustrate the physiological processes of the body. Bile and pancreatic juice
splash out of a small opening into the duodenum, digested food is moved by the
peristaltic movements of the intestines and an X-ray film shows a child chewing its
school meal along with the phrase, “digestion begins in the mouth.”2
In addition to this Cartesian visualization of body mechanics, explicit references
to social issues are evident throughout the film series. A seemingly cohesive and
integrated view of modern technology and health emerges, where the former is used
to serve the latter. In the television spot The Pancreas, for instance, you see images
of railroads and refineries, while the commentator states, “A machine can never be
as strong, an industrial plant never as vast; a single quality sets us humans apart
from them [the machines]: our capacity for reason.”3
All translations by the Author.

1
Die Leber, DEFA 1980, Hygiene Museum Archive, Cat. N°. 187.
2
Der Darm, DEFA 1980, Hygiene Museum Archive, Cat. N°. 188.
3
Die Bauchspeicheldrüse, DEFA 1981, Hygiene Museum Archive, Cat. N°. 191.
P. Osten (*)
Department of the History and Ethics of Medicine, Hamburg University, Hamburg, Germany
e-mail: p.osten@uke.de

https://doi.org/10.1007/978-3-319-90677-5_27
372 P. Osten
Introduction
This chapter4 analyses the East German television series You and Your Health (Du
und Deine Gesundheit). It describes the history of popular health education in the
German Democratic Republic (GDR) using personal interviews, documents from the
State Archive of Saxony and from the German Federal Archive (Bundesarchiv) in
Berlin. In 1990, when all of the former East German administration was subsumed
under West German authority, the German National Archive collected diverse materi-
als concerning health education from several different (formerly Socialist) institu-
tions: The Ministry of Health, the Ministry of Cultural Affairs, the DEFA (Deutsche
Film AG) and the Committee for Healthy Lifestyle and Health Education. Using
these documents, I sought to investigate how health education was planned in the
GDR or, more precisely, how the government intended to plan its health education
policy. This decision-making process started in the 1950s and was finalized in the
early 1970s, when a final decision was reached on which institution was to be in
charge of health education policy in the GDR. At the end of the chapter, the television
series You and Your Health will serve as an example of how, in the late 1970s, an idea
for a film developed into a concept that was finally turned into television spots.
The German Hygiene Museum in Dresden in East Germany was contracted for
the series You and Your Health. It decided on the topics of the individual instalments
and it provided preliminary guidelines for the script. Surprisingly, I was unable to
find any documents regarding the assessment of the short films from the head office
of the film administration (Hauptverwaltung Film). This office within the Ministry
of Culture either recommended the approval of a film for public screening – or
rejected it. However, whenever the German Hygiene Museum proposed an idea or
concept for a film, censorship was not implied.
The special position of health education films in East Germany has its own his-
tory that began following an expert paper on socialist advertising that was published
in 1959. Ten years later, the Hygiene Museum in Dresden was officially declared to
be the central and only entity responsible for health education in the GDR.
Although this article deals with popular health education, the context of social
hygiene and the strict bureaucratic hierarchies within a so-called socialist system
should not be overlooked or neglected.5 In the context of health education, this
article on socialist advertising explicitly referrs to political, economic and social
themes. In recent studies, it has been fruitful to describe prevention as a technology
of the self.6 Discourses of austerity, asceticism, strength and sanity are seen as
affecting individual lifestyles and habits. What is socially understood to be healthy
living can be seen as the result of what Michel Foucault terms Gouvernementalité.
The use of mass media and entertainment might be one of the most effective ways
4
An earlier and in parts substantially different version of this article has been published in German
(Osten 2011).
5
As pointed out by Moser (2002).
6
As described by Lengwiler and Madarász (2010).
Socialist Advertising. Health Education in East German Television 373
Fig. 1 Stills from the film Sozialistische Arbeitskultur (© Archive of the German Hygiene
Museum)
to transport Johan Peter Frank’s concept of a Medical Police (the medical monu-
ment of enlightened absolutism) into individual behaviour. The closer one looks at
the political implications that accompany good medical counsel in the GDR, the
more the boundaries between welfare and indoctrination become blurred. This phe-
nomenon is especially evident in the last decades of the twentieth century, when
media advisers within the political systems started reflecting on both the merits and
risks of health education.
A long series of mostly didactic cinema shorts titled Guidelines for Health
(Wegweiser Gesundheit) were produced by the DEFA up until 1977 for the German
Hygiene Museum. Their main purpose was to instruct workers on leading a healthy
lifestyle as part of the socialist working culture. Dating from 1976, Socialist Working
Culture (Sozialistische Arbeitskultur) was the title of one of the dullest, most sober
and depressing films of this series of black and white cinema shorts.
When abortion rates peaked in the GDR in 1975, the Ministry of Heath tried a
different, less traditional approach to convince young women to use oral contracep-
tives. The Ministry’s tactic was to produce a television-film in which the popular
singer-actress Nina Hagen acted the part of a young modern woman challenged by
the questions of early motherhood.7
In the 1970s, a varied and diverse assortment of health education films could be
viewed on East German television and at the cinema. As Donna Harsch explained in
her article on social hygiene and Tuberculosis prophylaxis in the GDR,8 among East
German government officials and physicians there were differing opinions on issues
of social hygiene, the means of implementation, and force and coercion with respect
to individual rights. These differing views also applied to filmmakers, scriptwriters,
and their advisers (Figs. 1 and 2).
7
Heute ist Freitag, Defa 1976 [DVD: Icestorm 2016].
8
Harsch 2012.
374 P. Osten
Fig. 2 Colour photo report on the black and white film “Heute ist Freitag” in the GDR magazine
FF Dabei, N° 50, 1975
ealth Films and Exhibitions: A Short Look Back at the

H
Weimar Republic
The German Hygiene Museum had been coordinating public health propaganda
ever since the imperial period, long before the opening of its permanent collection
in Dresden in 1930.9 During this period, it provided advice to charity organizations
and health authorities. During World War I, the Statistical Office of the former 1911
International Hygiene Exhibition curated official war exhibitions.10 The Office put
the war on display for the general public on the home front through exhibits that
included wax figures of injured soldiers as well as war hospital dioramas. Propaganda
of this kind was largely continued throughout the period of the Weimar Republic. In
1926, under the aegis of the museum in Dresden, a committee was formed to advise
the national government on all questions concerning public hygiene campaigns.11
Already in the 1920s, educational films played a key role in public health educa-
tion.12 The Weimar government succeeded in creating what came to be known as the
German Kulturfilm, whose main purpose was to educate the public. Kulturfilms
9
Roesle 1911, 19.
10
Osten 2005.
11
Adam 1928.
12
Vogel 1926.
were notoriously boring, didactic, even tedious; as Kurt Tucholsky put it in 1926:
“they were very obviously created by pedagogues.”13
But criticism was futile since cinemas were required to show Kulturfilms or
would be penalized to pay high amusement taxes. To become a Kulturfilm, a short
movie had to be reviewed by and pass the Kulturfilm committee, either in Berlin or
in Munich, to obtain a Kulturfilm certificate. During the 1920s, these certificates
were a much more efficient instrument of censorship than any official censorship
laws or practices.14 To meet the expectations and requirements of the Kulturfilm
board, film production firms took no risks and produced precisely the content that
the Kulturfilm committee had suggested.
For GDR documentary filmmakers, the term “Kulturfilm” was a derogatory word
that stood for a relic of a bygone era. A draft of the Hauptverwaltung Film within
the Ministry of Culture stated at the end of the 1950s that:
The DEFA has created the German socialist documentary. It had moved past the bourgeois
“Kulturfilm” and had become an effective ideological and artistic medium for the dissemi-
nation of the ideas of Marxism-Leninism. As such, the socialist documentary is based
mainly on the example of the Soviet documentary film art.15
It was not only because of its role in the Nazi propaganda16 that the Kulturfilm fell
into disgrace; the carefully cultivated didactic tone that had been promoted during
the Weimar Era by the Kulturfilm committee was – in the eyes of the advertising
experts – incompatible with the socialist project of the GDR.17 But as far as films for
health education were concerned, the revolution was postponed into the late 1970s.
Socialist Advertising, the 1950s and Early 1960s
During the 1950s in the GDR, state-owned enterprises, private businesses, mass
organizations, unions and political parties used advertisements to promote goods,
services and ideals. Slides and short clips were shown in cinemas and with the arrival
of television, audiences were exposed to advertisements through this medium as
well. The cacophony of advertisements of diverse quality and message was, accord-
ing to the State Planning Commission of the government of the GDR, increasingly
dissonant and a cause for concern. As one official of the State Planning Commission
wrote: “... the recent advertising activity lacks a leadership or structure that would
facilitate the formulation of coherent advertising forms and methods from which the
management and organization of socialist advertising could be derived.”18
13
Panter [Tucholsky] 1927.
14
Osten 2015.
15
Unated paper. Hauptverwaltung Film Minsterium für Kultur, BA DQ1/20927.
16
Stephan 1986.
17
Osten 2009.
18
Regierung der DDR, Staatliche Plankommission, Abteilung Leichtindustrie, der Leiter (Müller)
an DEWAG Werbung Berlin, Autorisierungsurkunde vom 12.9.1959. Bundesarchiv Berlin,
DQ1/20927.
376 P. Osten
In the early 1960s, being in command of the centralized economy, the Planning
Commission was one of the most powerful governing bodies in the country. On
behalf of the Politburo, the State Planning Commission organized the Party’s devel-
opment objectives into concrete—so-called Jahrespläne—plans to be realized in
specific timeframes. They prescribed targets to state-owned companies and produc-
tion cooperatives. The Planning Commission dictated production quantities and
supervised the implementation of its directives.
As a reaction to the unregulated advertisement activities in the GDR, the Planning
Commission charged the DEWAG (the German Government Advertising and
Display Company)19 with the task of writing a policy paper titled Socialist
Advertising (Sozialistische Werbung). The paper defined socialist advertising as
follows:
The political and ideological function of advertising:
Advertising shows the working people the current state of development of the socialist
society as well as the possible ways in which this society can satisfy their material and
cultural needs.20
Within the health sector, the DEWAG defined two different types of advertisements:
pharmaceutical advertising and health propaganda. For the Ministry of Health, the
supreme authority for all advertising activities within the health sector, the DEWAG
report was bad news.The DEWAG’S unflattering compilation of communication
deficiencies contained a fundamental criticism of the Ministry of Health and of the
Hygiene Museum:
The coordinating activity of the existing Ministry [of Health] institutions [is] insufficient.
Consequently, the coordination of advertising in the field of health between both [...] the
Ministry of Health and the Hygiene Museum in Dresden is [insufficient]. [...] (Duplication
of work. Poor coordination with other bodies …).21
The staff of the Ministry of Health responded by withholding the report from its
minister. One year later, on behalf of the State Planning Commission, the DEWAG
insisted on receiving a response from the Ministry: “At present, your Ministry has
been sent six copies of our brochure and was asked to comment on it. Unfortunately,
we have not received your input on the subject.”22 This letter finally did reach the
minister and caused him some irritation. He passed the letter on with the note, “I am
not familiar with the brochure, Colleague Kraemer, please try to get hold of a copy
from somewhere in the Ministry.” Under pressure from the Planning Commission
and DEWAG, the Ministry of Health eventually founded a Committee on Lifestyles
and Health Education in the GDR. The panel consisted of a representative from the
Red Cross in the GDR, a representative from the Ministry of National Education,
19
Schütrumpf 1996, as well as Gries 2003.
20
DEWAG, Institut für Werbemethodik: Sozialistische Werbung, 152-paged typoscript, p. 16.
Bundesarchiv Berlin, DQ1/20927.
21
DEWAG, Institut für Werbemethodik: Sozialistische Werbung, Typoscript, p. 78–79.
Bundesarchiv Berlin, DQ1/20927.
22
DEWAG to Minister Max Sefrin, 11. Oktober 1961. Bundesarchiv Berlin, Bestand DQ1/20927.
the scientific director of the Hygiene Museum, and a representative from the
Ministry of Health.23
The anticipated structural changes had not occurred even as late as the late 1960s.
On the back of a bag designed to carry fruits from the market—now filed away
neatly in the German Federal Archives—an employee of the Ministry of Health
noted her criticism of the hapless Committee on Lifestyles and Health Education:
It seems as if very little has been done, as the decisions of 14.04.1961 have been only unsat-
isfactorily realized. On the other hand, in other matters it takes far too long until any success
can be achieved (..) health education is in a suspendi, [sic] [suspended] state [...] Initiatives
are being developed all around, yet only a few full-time brains are privy to them.24
The only solution seemed to be a clear and distinct division of responsibilities.

Finally, in 1967, the leadership of the German Hygiene Museum was codified:
The German Hygiene Museum:
The “Central Institute of Health Education” is the center of the whole health education
work within the health sector.
Additionally, it will make its experience and research results available to all other orga-
nizations, institutions and bodies, to enable them to perform methodologically correct, sys-
tematic and well-coordinated educational work.
This yields the following tasks:
1. Developing plans of operation for the implementation of long- or short-term campaigns for
health education in our republic, that should touch on every aspect of social life.
2. The design and production of job-related, age- and situation-specific educational
materials for short- and long-term as well as immediate actions. This material is to be
supplemented with instructions on its coordinated and systematic use.25
This order placed the German Hygiene Museum in a key position. Although the
Ministry of Health was still responsible for “Developing normative agendas for a
healthy lifestyle,” it was in fact only in charge of collecting scientific data, and for
coordinating the education and training of medical staff. The role of the Ministry of
Education was similarly restricted. From now on it was merely in charge of securing
the hygiene of school buildings, monitoring childhood diseases and promoting
physical education. Furthermore, it was advised to instruct teachers to cooperate
with the Museum of Hygiene. The future contents of the school health education
curriculum were therefore to be developed not at the Ministry of Education in Berlin
but rather at the Museum of Hygiene in Dresden.
23
Komitee für gesunde Lebensführung und Gesundheitserziehung in der DDR, Protocols 1962
through 1964. Bundesarchiv Berlin, DQ1/22446.
24
Handwritten note, Bundesarchiv Berlin, DQ1/22446.
25
2nd Recommendation for the Committee on lifestyles and health education [1964]. Bundesarchiv
Berlin, DQ1/22446.
378 P. Osten
“Du und Deine Gesundheit”
The films in the series You and Your Health were the result of further changes in the
state’s advertising policies. In January 1975, the GDR Council of Ministers adopted
a ban on advertising. It was called the “Instruction to enforce socialist parsimony in
the use of material and financial resources for advertising and representation.”26 To
present the achievements of socialism by praising the availability of consumer
goods had proved to be the wrong strategy.
Up until this time, cinema evenings in the GDR had always followed the same
pattern. They began with advertising slides and commercials, followed by a news-
reel called The Eye-Witness (Der Augenzeuge) and then by a short documentary
film. Only after these small features was the main feature film finally screened. The
elimination of film advertising, and in 1980 also of the “Augenzeuge”, moved the
short documentary film into the foreground of the movie-going experience. Most of
these films were produced for the purpose of either crime prevention, traffic educa-
tion or health education (Fig. 3).
Fig. 3 The transparent

woman, postcard, GDR 1980
(© Archive of the German
Hygiene Museum)
26
See: Forster 2006.
A wider audience was exposed to the series You and Your Health through televi-
sion. Designed as a “series on organs,” the films reflected the permanent exhibition
of the Hygiene Museum in Dresden. The series focused on the Glass Man, which,
despite being designed back in the mid-1930s, remained the icon of the Hygiene
Museum. For this reason, a film titled The Transparent Woman concluded the series
in 1986. The last sentences of the script demonstrate the journalistic link between
ideology and knowledge transfer, a relationship that was characteristic of the whole
series:
Our journey through the human body is over. We could only convey a small insight into the
variety and complexity of processes that take place in the organs of the body—taking place
uninterrupted—for a life-time.
However, there are conditions in order for the smooth and delicate functions to continue.
The most important one is:—peace.—The other:—health. We will only be able to persist if,
through our knowledge and action, and our will, we take care to preserve them.27
On September 15, 1975, 9 months after the advertising ban, the Hygiene Museum
and DEFA Studios signed a contract. They agreed: “that, in accordance with its
human and technical resources, the studio is to produce films for the Hygiene
Museum […] that should be used to realize the strengthening of health propaganda
and health education, as has been demanded by the party and the government.”28
The contract stipulated that every year the Hygiene Museum was to submit a work-
ing title, the details of the desired format (black and white or colour, 16 or 35 mm),
details of which exhibits were to be used, the estimated budget and the desired
delivery date of the film to the DEFA by July 21. Two months later, it was to receive
an offer by the movie studios. The responsibility for the films was divided and del-
egated: “the Hygiene Museum assumes the responsibility for the political and tech-
nical accuracy of each proposed concept. The studio also carries the responsibility
for the political-ideological and artistic realization of the script.”
The parties agreed to exchange ideas over the conception and design of the films
once every quarter of a year. In practice, it was two women who communicated on
the details: the dramaturge of the DEFA documentary group Spektrum, Yvonne
Merin-Georgi (1921–2012), and the journalist and research associate of the Hygiene
Museum, Margot Meyer.
Looking back,29 Yvonne Merin-Georgi describes the mutual exchange as friendly
and pleasant. The Potsdam dramaturge received support from Dresden whenever
she asked for it. As the years went by and the collaboration continued, the less the
strict guidelines from Dresden were adhered to. The agreement committed the
Hygiene Museum to send a written assessment of the DEFA’s work 20 days after
having received the film. In practice, the head of the Press Department of the
Hygiene Museum, Becker, wrote the feedback (Fig. 4).
27
„Die Gläserne Frau”, script. Bundesarchiv Berlin, DR118/377.
28
Contract between the DHMD and the VEB DEFA Studio für Kurzfilm, September 15, 1975.
Bundesarchiv Berlin, DR118/3556.
29
Yvonne Merin-Georgi’s quotes and statements come from an interview with Philipp Osten,
January 17 and 18, 2011.
380 P. Osten
Fig. 4 Yvonne Merin-Georgi,

postcard, 1948 (© Yvonne
Merin-Georgi)
Yvonne Merin-Georgi took care to ensure that Becker found the right words: she
always sent a positive assessment of her own films to the Hygiene Museum and
recommended the acceptance of sound and pictures (i.e., the quality certification of
audio and image strips by the production group Spectrum). Only for the first film of
the series, titled Die Haut (The Skin), did the director of the Museum of Hygiene as
well as the director of the Institute for Health Education (Institut für
Gesundheitserziehung) write evaluations, which they then sent to the Ministry of
Culture. There, at the Hauptverwaltung Film, it was everyday practice to assess
every film in great detail. Actors, scriptwriters and film directors were scrutinized
and the relevance of the film for its target audience was questioned and evaluated.
Almost all of the reviews written by the deputy head of the Hauptverwaltung
sounded negative but they almost always concluded with the statement “The official
circulation of the film is supported.”30
The files in the Bundesarchiv and the Dresden state archives prove that the evalu-
ations from the Hygiene Museum replaced the usual assessments of the films by
Friedemann Spangenberg or Wolfgang Pehnert, the two men who usually decided
on matters of censorship. When asked, Spangenberg (Deputy Head of the
Hauptverwaltung Film in the Ministry of Culture from 1977 to 1990) confirmed that
the Hygiene Museum as well as East German Television (which had its own assess-
ment procedure) could publish movies without his approval.31 Friendly opinions of
the Dresden press office replaced Spangenberg’s dreaded assessments.
30
Collection of Spangenberg’s censorship judgements 1977. Bundesarchiv Berlin, DR1/18846.
31
Interview with Friedemann Spangenberg, January 31, 2011.
Initially, Yvonne Merin-Georgi was not at all happy with her new field of activity
and responsibility. “People were being educated at all times,” she said. “Of course I
was and I am still a socialist. But I hated it, when I read the word ‘socialism’ in my
film scripts […] Who wants to be indoctrinated?” she asked. “Somehow, the whole
thing was pathetic. Popular scientists merely have a fractional fullness of knowl-
edge” [haben eine komplette Halbbildung]. She further elaborated on what she
meant: “Educational Films attempt to describe a complex biological process in all
its anthropological and cultural significance—and of course they are bound to fail.”
But there were other obstacles for filmmakers. The shooting of the film The Skin,
the first film in the You and Your Health series, took place during one of the most
difficult phases in the history of DEFA. Cinema audiences had decreased by 75%
within 15 years and an increasing number of private television antennas were facing
west. The expatriation of Wolf Biermann (a popular singer, writer and artist, born in
1936) in 1976 led to resignation in the media industry and forced filmmakers to look
for new frontiers. The film director Wolfgang Kohlhaase (born in 1931) summed up
the new mix of self-criticism and self-esteem:
If we compete with the bourgeois film, we cannot, I think, be more expensive, more colour-
ful […], nor can we throw more cars off higher bridges. So what can we do? Perhaps we can
do one thing, something that nobody but us could do it: We can make films that confront us
with ourselves.32
With this statement Kohlhaase had created a new credo of inward focus for his pro-
fession that also reached the DEFA’s small feature film production group Spectrum.
Die Haut
Yvonne Merin-Georgi summed up the goal of You and Your Health in her first state-
ment sent to Dresden together with the film The Skin (Die Haut). It was the first strip
of the series and it was completed in 1977:
Our main purpose is to present each organ of the body to the widest audience. They shall be
educated on how it works and will be provided information valuable for its sustained health.
Entertainment should not, as far as possible, be neglected.33
As described in the DEWAG’s Socialist advertising report, the series was to demon-
strate the high levels of performance and efficiency of the East German health sys-
tem. The films showed operations, ultrasound exams and the technically demanding
preparation of blood plasma substitutions. In the movie Pregnancy and Birth the
speaker says, “A pregnant mother, and later the new citizen, will be cared for in
32
Kohlhaase 1979: Speech held at the III. Congresses of the Verband der Film- und
Fernsehschaffenden der DDR, May 3 – May 5, 1977, quoted from: Akademie der Künste der
Deutschen Demokratischen Republik. Sektion Literatur und Sprachpflege 1979, 28. XXX!!!
33
Yvonne Merin-Georgi in a letter on the film „Die Haut“, July 29, 1977. Hauptstaatsarchiv
Dresden, 13658 DHMD, Nr. F VII.
382 P. Osten
Fig. 5 “… the skin can accumulate 10 to 15 kilos fat in the subcutaneous tissue— unfortunately.”
Filmstill, Die Haut (© Archive of the German Hygiene Museum)
every way. This is part of our social policy—we take this arrangement for granted.”34
Frequently, You and Your Health presented methods of natural medicine and cures.
In the film The Upper Airway, a coughing conductor receives a neck wrap, lime
blossom tea and is then wrapped in blankets like a mummy as part of a sweating
cure.
The movie The Skin was, according to Yvonne Merin-Georgi, mainly written for
people who “rarely came into contact with water.” A scene from the film The Skin
shows an old man in front of two washbowls. The Hygiene Museum had recom-
mended: “Do not only show a new apartment with a bathroom, but also include an
older apartment type—think of Bulgaria—washing at the water pipe and from a
large bowl.”35 The script turned the guideline into the words: “… washings can be
performed anywhere, even if one has neither a roman slave, nor a private shower.”
In their guidelines, the Hygiene Museum had summed up all of the anatomical
structures of the human skin as they might be found in a textbook for medical stu-
dents. Only a single fact, selected from the formidable catalogue of medical knowl-
edge, made it into the final script: “As a storage organ, the skin can deposit 10 to 15
kilos of fat in the subcutaneous tissue—unfortunately (Fig. 5).”36
34
Voiceover, Schwangerschaft und Geburt, GDR 1982.
35
Guidelines for the series „Du und Deine Gesundheit.“ Hauptstaatsarchiv Dresden, 13658
DHMD, Nr. F VII. The films were translated into Bulgarian due to a co production agreement.
36
Voiceover, Die Haut, GDR 1977.
Because the scenes were supposed to be authentic, the DEFA used amateur
actors. The most striking feature of the pilot episode The Skin was nudity. Middle-
aged men were shown bare-chested near a window, housewives moved around
naked in an apartment and nudism on the beach was praised. Erotic images inter-
spersed the scenes. “The young girl as a symbol of healthy skin,” moves around
naked and is photographed in a David Hamilton-like soft-focus style. Yvonne
Merin-Georgi recruited the young woman through the monthly magazine Das
Magazin, one of the most popular forms of print media in the GDR for which she
wrote occasionally. “At this time it was not easy to find an actress who would strip
in front of a camera,” she remembers.
Final Remark
Unlike other genres of cinema that place man (his behavior, his conflicts, the development
of his character, etc.) at the center of artistic expression, the popular science film presents
the achievements of science and technology as they benefit human culture. The goal of
these films is the fashioning of a cultivated and educated citizen. He is at the same time the
product of as well as the requirement for social developments.37
It was under this motto that the headquarters film had outlined the program of the
DEFA Studios for popular science films in 1966. Its message was clear: the govern-
ment cares about its citizens; the health of their bodies was an economic good that
needed to be preserved. Nowadays, much of the content of the 18 films that were
shot three decades ago in Potsdam Babelsberg would not be used to promote healthy
lifestyles. It is no longer recommended to expose the body to the sun without pro-
tection whenever possible (as recommended in The Skin); pregnant women are no
longer encouraged to enjoy a glass of wine or beer (as recommended in Pregnancy
and Birth); heart attack prevention does not focus on nervous stress reduction (as
explored in The Cardiac Nerves); and unlike what was shown in Reproductive
Organs ♀ ♂, the use of condoms is now recommended for the prevention of sexu-
ally transmitted diseases.
In the 1970s, GDR filmmakers feared that they had lost their audience. Yvonne
Merin-Georgi’s films, produced under the commission of the Museum of Hygiene,
sought to recapture this audience. In these films, however, health education was not
the primary concern. Their main aim was to restore trust in film, media, and in
socialist advertising as a whole.
Looking back at the You and Your Health film series 40 years on, at least those
directed by Yvonne Merin-Georgi appear to have represented a confident and ludic
approach to health education. She rejected the advice of experts in Dresden and
elsewhere, to create amusing, sometimes funny and colourful television spots.
Agenda for the DEFA Studio für Populärwissenschaftlichen Film up to the year 1970 [1966],
37
Bundesarchiv Berlin, DR1/4787.

384 P. Osten
Two questions remain unanswered. Did the films reach the intended audience?
And, more importantly, what was their intention?
The medical experts wanted to spread medical awareness and knowledge. The
advertising experts wanted to convey the merits of successful health care, provided
by a socialist social system. Whereas the film experts, especially the dramaturges of
the DEFA group Spektrum wanted to provide fun for the spectators. This leads to a
further question. What is the intention of health education altogether? Is it to please
an audience? Is it to change behaviour? Is it to put on display how much the govern-
ment cares for individuals and their everyday lives? Or is it to demonstrate that poli-
tics has got the power to go under the skin and infiltrate the minds of a citizen to
provide his healthy body for society (and socialism)?
It is debatable whether far reaching conclusions can be drawn from these short
films produced in East Germany during the last decade of its existence. The most
important conclusion I personally drew was provided by the short film The Upper
Respiratory Tract (Die oberen Atemwege). It recommends a sweating cure initiated
by a cup of hot lime blossom tea to fight the first signs of a cold. I found that to be
an effective remedy.
References
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Kohlhaase, W. 1979. Zur Diskussion 1977. In Schriftsteller und Film. Dokumentation und
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Archive Material
Federal Achives (Bundesarchiv), Berlin
„Die Gläserne Frau“, script. BA DR118/377.

Agenda for the DEFA Studio für Populärwissenschaftlichen Film up to the year 1970 [1966], BA
DR1/4787.
Collection of Spangenberg’s censorship judgements, 1977. BA DR1/18846.
Contract between the DHMD and the VEB DEFA Studio für Kurzfilm, September 15, 1975. BA
DR118/3556.
DEWAG, Institut für Werbemethodik, BA DQ1/20927.
Hauptverwaltung Film Minsterium für Kultur, BA DQ1/20927.
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Regierung der DDR, Staatliche Plankommission, Abteilung Leichtindustrie, BA DQ1/20927.
Saxon State Achives (Hauptstaatsarchiv), Dresden
13658 DHMD, Nr. F VII.
Hygiene Museum Archive (Archiv des Hygiene Museums),

Dresden
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Die Bauchspeicheldrüse, DEFA 1981, Hygiene Museum Archive, Cat. N°. 191.
Die Leber, DEFA 1980, Cat. N°. 187.
Schwangerschaft und Geburt, DEFA 1982.

Handbook of Popular Culture and Biomedicine: Arno Görgen German Alfonso Nunez Heiner Fangerau Editors

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Handbook of Popular Culture and Biomedicine: Arno Görgen German Alfonso Nunez Heiner Fangerau Editors

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Arno Görgen · German Alfonso Nunez

Heiner Fangerau Editors

Handbook of Popular Culture

Supported by the Fritz Thyssen Foundation

ISBN 978-3-319-90676-8 ISBN 978-3-319-90677-5 (eBook)

Library of Congress Control Number: 2018949063

© Springer International Publishing AG, part of Springer Nature 2019

Printed on acid-free paper

The Medicalization of Popular Culture: Epistemical, Ethical

Part I Theories and Methods

 he Visual Claim Within Medical Science and Popular Culture���������������� 115

Part II Case Studies

Using Case Studies from Popular Culture to Teach

Part III Social Implications

Arno Görgen, German Alfonso Nunez, and Heiner Fangerau

© Springer International Publishing AG, part of Springer Nature 2019 1

creation of such critical reflective frameworks. Particularly, this chapter introduces

Culture and Communication

No matter if one defines culture by following

(Bourdieu 1993: 112). This circuit conceptually includes as important cornerstones

Science and Medicalization

terms of medically charged (audio-)visual, textual and other forms of information or

Scientific Knowledge in Popular Culture

Hence, like science, popular culture communicates ideologies and patterns of

knowledge provides essential knowledge to create immersive, authentic experi-

Of course, scientific objectivity is an ideal that is already affected in the process

Independent from the chosen point-of-view, medicalizations (or scientifications)

Conclusions, Necessities, Solutions

Culture can be considered as a complex system of communication and allocation of

Baudrillard, J. 1983. Simulations. New York: Semiotext(e).

© Springer International Publishing AG, part of Springer Nature 2019 15

scientists, laboratory equipment, etc. Entertainment producers are asking consul-

© Springer International Publishing AG, part of Springer Nature 2019 25

I nteractions Between Science, Research, Biomedicine

Science, Medicine and the Public

example of those who are affected by various medical conditions or treatments. It is

 ictional Representations of Scientists, Physicians

The Public Communication of Science and Biomedicine

Challenges and Outlook

industry or alternative healing industries). The budgets for science communication

To date, research on the public communication of science and biomedicine has

Schneider, W. 2004. Menschen-Maschinen und ihre Schöpfer. Eine ‘post-moderne’

Heiner Fangerau and Gisela Badura-Lotter

Biological Medicine and Biomedicine

© Springer International Publishing AG, part of Springer Nature 2019 41

Biomedical Fields and Protagonists

The three epistemological cornerstones, “universalism”, “reductionism”, and “mod-

than on experimentation (Quirke and Gaudillière 2008). Statistical evidence gained

This institutional and epistemic medicine-biology hybrid was described in anthro-

From the perspective of popular culture, the whole development of biomedicine

Using Bioethical Approaches to Analyse Pop Culture Content

 ioethics as an Analytical Approach to Contemporary

Statt, Nick. 2016. Battlefield 1 is an anti-war message trapped in a best-selling

Bethesda Game Studios. 2008. Fallout 3. Rockville: Bethesda Softworks.

© Springer International Publishing AG, part of Springer Nature 2019 57

As the nineteenth century German philosopher Schopenhauer observed, if we are

Getting Us to See the World Differently

Getting Us to Feel Differently

Categorizing the World Differently

Freedom of the Imagination

this philosophical article, Thomson utilizes a series of increasingly science-fictional

Skepticism About Art’s Value

Responding to the Skepticism About Art’s Cognitive Value

The Medicalization of Popular Culture: Epistemical, Ethical

Part I Theories and Methods

he Visual Claim Within Medical Science and Popular Culture�� 115

Part II Case Studies

Using Case Studies from Popular Culture to Teach

Part III Social Implications

Culture and Communication

Science and Medicalization

Scientific Knowledge in Popular Culture

Conclusions, Necessities, Solutions

I nteractions Between Science, Research, Biomedicine

Science, Medicine and the Public

ictional Representations of Scientists, Physicians

The Public Communication of Science and Biomedicine

Challenges and Outlook

Biological Medicine and Biomedicine

Biomedical Fields and Protagonists

Using Bioethical Approaches to Analyse Pop Culture Content

ioethics as an Analytical Approach to Contemporary

Getting Us to See the World Differently

Getting Us to Feel Differently

Categorizing the World Differently

Freedom of the Imagination

Skepticism About Art’s Value

Responding to the Skepticism About Art’s Cognitive Value

Narrative in Scientific Texts

Narrativity and Fictionality

Intertextuality and Referentiality

Clarification of Terms and Questions

Methods for Study

The Method of Homology

The Pattern of Otherness

Otherness and Homology

Popular Culture as Well Liked by Many People

Popular Culture as a Residual Category

Popular Culture as a Social Category

Popular Culture as Folk Culture

Popular Culture as Mass Culture

Popular Culture as Site of Struggle

Current Research on Self-Evidence

hree Case Studies: Writing Curves, Radiography

The Anthropological Claim: Or Why Man Strives for Images

Our Striving for the Image

b ronchoscopy, while also showing spatial positioning in reference to a central per-

Archaeology of Midcentury Medical Media

Medical Reality TV: Boston Med

Digital Fingerprints on Medicalized Screens

Conclusion: Mobile Medicalized Screens

Defining “Medical Narrative”

Reviewing Diagnostic Vision(s)

Intersections of Medical Viscourse