Narcissus's New Mirror: Body Images and Meaning

Henrik Enquist
Division of Rehabilitation Engineering
Department of Design Sciences
Lund University

Abstract. The wish to see beyond the horizon of the human biological eye is one of the major driving forces in the development of medical imaging technology. This essay discusses the implications technology has on the ability to see, and consequently know, more about the body. Further, the potential of merging art, rehabilitation engineering and medicine to develop and use images specifically designed to create meaning for the afflicted individual is proposed as a future research topic. The key question is how alternative (i.e., non-clinical) perspectives can result in different experiences of well-being, or even improve the health of the individual. There are two main aspects of this future research: one practical and technological, concerned with the tools and methods to be used, the other an epistemological venture, aimed at disseminating knowledge and understanding of visual communication in a medical context.

The Technological Eye

The human has a tendency to view himself as the measure of all things – homo mensura.* This narcissistic tendency, also present in the history of medical images, has its origin in the fact that people in most cultures throughout history have been fascinated by looking at and depicting themselves and each other. Cave paintings and carvings are in fact examples of the first way of storing symbolic knowledge outside the brain, and the oldest cave paintings are estimated to be as much as 30,000 years old [35]. This kind of image production could have been part of various social rituals, with the images acting as religious, decorative or instrumental artefacts. The seemingly universal human ability to recognize visual representations is a part of the evolution of the unique symbol-learning capability of the human brain. Terrence W. Deacon writes: ‘The origin of “humanness” can be defined as that point in our evolution where these tools (stone and symbolic tools) became the principal source of selection on our bodies and brains. It is the diagnostic trait of Homo symbolicus’ [9, p. 345]. The usage of symbols, for example images, thus seems to be unique for the human as a species. Most people can almost automatically recognize a face, a pair of eyes or an entire body in different objects: the shape of a cloud, the arrangement of some random objects or even in an abstract painting. Whether biologically innate or socially imprinted, the fact remains that people tend to see images of themselves everywhere. The evolutionary and social advantages of having this capacity for symbolic communication could be manifold: identifying predators or other enemies, strengthening the ties between members of a group through cultural and religious acts, as well as sharing and preserving knowledge.

‘Ours is a visual age,’ writes Ernst Gombrich, and vision could even be considered the dominating sense in society today [14]. Images exist almost everywhere to entice, seduce, inform, warn, enlighten, frighten, confuse, entertain and show us. Some images have merged with the collective consciousness to the point of becoming memes in a universal language, while others are exclusively private and anonymous [4, 8]. Only a few images are so intimidating and alienating that we do not know how to interpret or relate to them. From a layman's perspective, medical images are mysterious, and in many cases terrifying, in their enormous potential and fateful powers. At the same time, they have become a fast-growing part of the historical saga about the human being, both in the collective sphere for mankind as a species, but also in the individual and private sphere.

Images are, in other words, artefacts encoded with meaning, a term used here for describing a correspondence between two things, literal or otherwise. This correspondence could be of many different types. In the case of medical imagery, the X-ray plate of a tumour could have the metonymic meaning of (possibly curable) cancer for the doctor, whereas for the patient it could have the symbolic meaning of ‘pain’ and ‘death.’ Meaning is a question of creating an understandable relationship between the depicted and the image. How then, has technology changed the meaning of medical images?

Since the revolutionary discoveries of Wilhelm Konrad Röntgen in 1895, the body has been opened, exposed and made accessible to the public in profoundly new ways, of which some are discussed below [32]. Medical imaging technology has since then undergone an amazing development due to the exploitation of newly discovered physical phenomena and technological advancements. X-ray and later innovations, such as magnetic resonance imaging, nuclear imaging and sonography, contrast in very sophisticated ways with earlier times' more direct relationship with the inside of bodies and function as technological extensions of the human eye. As the Australian artist Stelarc puts it: ‘The skin no longer signifies closure’ [1]. The quest to depict smaller and increasingly more complex details with higher resolution, faster resampling, more vivid colouring and a greater sense of realism is a direct consequence of the faith in the abilities of the visual.

In general, the (photographic) image has lost some of its historical connotations of truth and authenticity, in part due to the possibility of digital manipulation [27]. In medicine, however, the tradition of images as true reflections of reality is still predominant and in most instances considered untouchable, partly due to the doctors' authoritative power. There is a tacit prohibition against manipulating the images in a way that information is lost or distorted, this to prevent incorrect diagnoses, deaths and legal consequences. These conventions can be both treacherous and useful. If unaware of what the images as such really are, it is easy to be led to believe that they are what they portray – the organ or the disease itself. What is seen is in fact only what the machine is constructed to depict, including malfunctions and embedded weaknesses in the apparatus itself, and the abstract image on the screen has, in many respects, very little in common with the examined biological body. For example, the information presented to radiologists is de facto distorted, partly in the passage through the circuits of the equipment, where tissue and bodily fluids are converted to electronic signals. It is not a visual reality we are seeing, but a more or less arbitrary and conventional reconstruction and representation.

The amount and quality of the information is also restricted by the fundamental limitations of the physical and biological phenomena on which the imaging techniques are based. We can only see what the specific phenomenon is producing. In X-ray, we see a shadow that is dependent on the difference in density between different tissue types. In magnetic resonance imaging, the image produced is the result of radio waves sent out by spinning hydrogen atoms. The radio signals are then processed by powerful computers and reconstructed as visualized data sets. These are more-or-less anatomical image techniques, trying to depict what is there. Another type is the so-called functional imaging. This approach is focused on what is happening in the body, for example temporal distribution of nuclear substances, or metabolism of glucose.

A problem with many of the imaging techniques are the so-called artefacts, unwanted effects in the image, which do not have a physical/biological origin in the patient's body. It is thus not always apparent what is depicted. What you see is not necessarily what you have got.

The body is also seldom depicted as a whole but rather as parts and details. As the image resolution is improved, the depicted parts become smaller, and as a result, the body becomes increasingly more fragmented, and the observed part is even further distanced from the living person. The whole is thus set aside for the benefit of the part, which is equally true for imaging as for treatment. This pars pro toto attitude could be experienced as unnatural and alienating by the patient: ‘It is not the heart that is sick, it is me!’ This could be important to remember when trying to treat the patient, taking into account the lived situation and not only the medical information.

The interpretation of the presented image also is a form of aberration. Knowledge, expectation, experience and emotion filter the information and affect the result. Interpretation is based on training and education; it is hard to see things that are previously unknown, since you do not know what to look for. At the same time the context in which the observer is placed, professional and/or personal, biases the attitudes towards the image.

Medical images bridge the gap between the seemingly rational mind and the irrational body by providing physical artefacts of what is within. These artefacts can be seen as parts of a distributed body and should be recognised as autonomous manifestations, or actants, using Latour's terminology, rather than passive projections of the inside in the outer world [21]. The machines function as extensions of the biological senses, and the images supplant the body and achieve an autonomous existence independent of the body in space and time, which makes the interior tangible and changeable [25, p.86]. This simulacrum of the body, now in the shape of data, can be processed, manipulated and transformed to any given form and can also be readily stored or transmitted electronically or physically all over the world without affecting the biological body. One example of this is the Visible Human Project, in which the bodies of one man and one woman have been physically sliced (post mortem) and then digitized into sets of digital information.

The Aesthetics of the Open Body

Throughout western history, the body was cut open in order to reveal the wonders of the organism, a procedure demanding volunteers, corpses or, later, sedation and anaesthetics. Often, and regardless of the method used, this has been associated with discomfort, disgust or pain for the persons involved. An example of what an actual public display of the inside can lead to in our so-called modern and enlightened era is the public agitation and uproar in connection with the first public autopsy in England since the 1830s. In November 2002, Günther von Hagens dissected and demonstrated a male corpse in London. This induced strong feelings among the public, media and various officials, and the show was even threatened with legal measures [15]. The emotions stirred surely had several different origins, ethical as well as medical, but underneath all the rhetoric was arguably the often unarticulated and unconscious opinion that autopsy as a method is not sufficiently refined and elegant to be shown in public in our technologically advanced salons. Many questioned the necessity of the procedure for the declared purposes of education and information; some critics referred to modern advanced imaging technology rendering the physical opening obsolete. Is this reaction technological snobbery, or is there a modern fear of the tangible physical aspect of the human body, especially its inside? Has the technological eye, in such a distinct and effective manner, made the organic so artificial and abstract that we cannot stand seeing the real thing? The blood is not as sticky on the screen as on the operation or autopsy table and hence not as repulsive and frightening. The more advanced technology, the less one has to meddle with the abject and repulsive inside of flesh and blood [20]. One artist who has treated this subject is the French performance artist Orlan. In her Carnal Art, she uses her own body as raw material and transforms it with modern cosmetic surgery. She writes about perception:

I can observe my own body cut open, without suffering!... I see myself all the way down to my entrails; a new mirror stage. ‘I can see to the heart of my lover; his splendid design has nothing to do with sickly sentimentalities’ – Darling, I love your spleen; I love your liver; I adore your pancreas, and the line of your femur excites me. [28]

What is it that makes the artificial and virtual opening of the body so appealing and captivating? A specific notion of aesthetics and beauty is used as an explanatory model. Beauty was defined by Baumgarten in his work Aesthetica as phenomenal perfection as perceived by the senses, with aesthetics pertaining to the beautiful [3]. In Kritik der Urteilskraft, Kant separated the two, with beauty as an exclusively sensuous phenomenon and aesthetics as a broader science of the conditions of sense perception [18]. Below, these terms are expanded and used in a more postmodern and conceptual way, not focusing on the sensuous phenomena alone.

The most obvious aspect of the aesthetics of medical imagery is the medical beauty, which to its nature is practical and empathetic. Diagnostics, research, therapy and medical education have direct applications for improving the conditions of the suffering human. There is a fascination for the complexity and apparent sense of purpose of the body and its parts which has been used by some as an argument to prove the existence of a conscious Creator or God.

The sensual beauty of medical imaging is readily apparent. The lack of pain and physical injury in the technologically advanced imaging process spares the senses the strain of a more direct depiction. A technological and artificial opening hence avoids both the direct physical and psychological pain as well as helping to relieve the pain caused by the illness and its symptoms – this is partly the aesthetics of anaesthetics. Sensual beauty also originates in the aesthetic appeal of many medical images. This aesthetics is more obvious concerning images of smaller details, distant from all comparison with slimy organs and physical deviations, since the format in itself protects the observer from a too direct and uncomfortable recognition.

The aesthetics of within is also constituted of a technological beauty. In technology lies an inherent striving for beauty and elegance which is not necessarily associated with an aesthetic design or visual appearance, but rather lies in the technological rationale itself and in the elegance of the achievement [23, 29]. At its best, when the mediating technology itself is transparent, the images produced can elicit strong emotions and inspire intellectual achievements. The fact that the body in many cases does not have to be opened or penetrated, sometimes not even touched, creates an almost magical aura around these images and reflects mental and physical distance as such as an aspect of beauty.

A major driving force behind the development of medical images is the desire to see beyond the horizon of the human biological eye. The ability to see the inner universe and disclose what before was hidden holds a great intellectual beauty. This intellectual aesthetics derives from adding knowledge to a greater whole as a part of the modern project of progress, development and knowledge and is based on the human's firm belief in her own capacity. The ancient Greek conception of hubris is not considered relevant in modern medicine, but lurks in the future with retroactive accountability for side effects and long term consequences.

Consequently, medical images demand much of us and confront us with new questions, both collectively and individually. We have to learn either to like what we see or correct what we dislike, be it an aesthetical outside or a clinical inside (or even, an aesthetical inside!). These reflections, cast by this new technological mirror, have both cognitive and emotional implications for the individual. They confront us with new challenges in the field of self perception and stress individual and social needs and various intellectual and economical interests as well as stimulating new experiences and evoking emotions, which have cognitive, educational and emancipatory possibilities.

The Artistic Body in Medicine

One difference between the artistic and the medical image is that the former (ideally) is free of restrictions, has many levels of interpretation and is more focused on questions and debate, whereas the latter tries to document a state or condition with the aim of answering and clarifying certain hypotheses. Modern medicine, though, has several intersections with art when it comes to images of the human [11]. Both touch on the origin and substance of human beings and our existential conditions and situation in the world, as well as manifesting ideas and questions and presenting a variety of suggestions on how to answer the problems facing us in life. Primarily, medical images are not considered as works of art, but they might be. Placed in the metaphysics of Plato, in which art objects (and everything else in our physical world) are more or less true imitations of universal forms, medical images are in many respects the truest depictions of the body. As such, they could be held as the best art works of the body, i.e. the least distorted representations of bodily ‘form’ [30].

In the tradition of art as aesthetic judgement, some medical images could be held as the foremost aesthetic achievements of our times [5]. On the other hand, in more recent times, medical and scientific images could be considered as art for other reasons: according to Danto, in their function within a context (e.g., presented at an art gallery) [7] or, as Dewey states, simply because it was intended by the image maker/artist that the images should be works of art [10]. By saying this, it is not necessarily so that all images in science and medicine are works of art. Felice Frankel, a well-known photographer working within various fields of science, stresses that her photographs are illustrations of scientific results and not works of art.

The subject matter in medical imagery is also one of the oldest and most exploited throughout what we today call the history of art. The most known example of a person concerned with the study and depiction of the interior of the human body is probably Leonardo da Vinci. He has been regarded as the epitome of a Renaissance man, combining knowledge and practice in what today is known as anatomy, art, science, etc. His illustrations of dissected corpses are well known, and his efforts in illustrating and explaining the anatomy of inner organs are still making a difference in today's practice of medicine. Surgeon and da Vinci specialist Francis Wells reported a surgical procedure breakthrough by studying Leonardo's drawings of a heart valve [6].

Another pioneer in the field of independent and methodical study of the interior structure of the human body was Andreas Vesalius, whose dissections destroyed the foundation of the teaching of Galenism. His major work, De Humani Corporis Fabrica contains over 220 wood-cuts, presumably made by the renowned Venetian artist Jan Stephan van Calcar, pupil of Tiziano Vecelli, Titian [36]. The publication contained the most comprehensive and accurate texts on anatomy to date and began the era of modern medicine.

This tradition of depicting the interior of the human body is now subject to a baffling metamorphosis due to the new methods, angles, dimensions, perspectives and questions that modern medicine and science explore. Medical images are shifting the foundation of the perception of the human body and its beauty in a way only vaguely discernable today and with a striking power envied (and utilized) by many artists. The body and its interior has been the subject of numerous interdisciplinary exhibitions.** Some of these exhibitions were primarily focused on the artistic aspects of the theme, whereas others were more intended for informative and educational purposes. Several contemporary artists are using medical images in their work. A striking example of this is the cooperation between the photographer Joel-Peter Witkin and the doctor and collector Stanley B. Burns [42]. Using historical medical images from the Burns Archive, Witkin has created astonishing artwork. Stelarc's Stomach Sculpture is an example of how medical technology (in this case gastroscopy) could be used for works of art. His intention was:

to design a sculpture for a distended stomach. The idea was to insert an art work into the body – to situate the sculpture in an internal space. The body becomes hollow, with no meaningful distinctions between public, private and physiological spaces. The technology invades and functions within the body not as a prosthetic replacement, but as an aesthetic adornment. One no longer looks at art, nor performs as art, but contains art. The hollow body becomes a host, not for a self or a soul, but simply for a sculpture. [33]

There is a tendency in several countries to include visual arts within the curriculum of medical education and also to use artistic perspectives and approaches in some specific healthcare programmes [22, 24, 34, 37, 38, 39, 40]. This could mean that some of the obstacles for using art in the domains of medicine and rehabilitation are getting smaller and that (visual) art could be incorporated constructively, adding values such as subjectivity, experienced health and the creation of meaning for the afflicted individual.

Images of Meaning – a Future Research Area

Images of the body, clinical or other, could be seen as reflections cast by a mirror of knowledge and emotions. What then do we look for in this new mirror? In the clinical context, the reflections function as symbols of health in which the medical professionals are searching for the divergent. Medical images are, in this respect, representations and signs of abnormalities and could be interpreted as portents of future suffering and death. As Barthes puts it, ‘each photograph contains this imperious sign of my future death’ [2, p.97]. These gruesome connotations cast a gloomy shadow over the images, and the constant focus on disease and malignancy promotes and enhances their fateful and judgemental aura. ‘Do I really want to see?’ actually means ‘Do I really want to know?’ If I cannot see it, it does not exist, and then everything is OK. Or is it? The emotional implications medical images have on non-professionals are not extensively studied but are largely underestimated in modern healthcare. Clearly, the distinct separation between the clinical interpretation of medical images and the subjective experiences and emotions related to them do not have to be in conflict with each other. Could it rather be that there are several different and equally important ‘truths’ which could benefit from each other? The non-professional has limited, if any, medical knowledge and a different perspective when looking at medical images. In place of the professional's skill, the individual brings trust or faith, and the individual's subjective experience and personal emotions substitute for the objective interpretation and expert knowledge of the professional.

What do we mean exactly by the term emotion? According to Harland, an emotion consists of five elements: arousal (instigating stimuli), sensation (physiological correlates), construction (physical systemic coherence), appraisal (cognitive evaluation) and volition (motivational impulse) [16]. An emotion is hence something more or less different from a feeling, sensation, mood or state. This differentiation makes it apparent that emotions are closely related to the concept of meaning. Emotions are thus more than mere responses to external or internal stimuli, since they incorporate reflection and some sort of impulse towards action.

How could these different aspects of emotions be considered useful in healthcare? The proposed topic for future research concerns images, based on emotions, meaning and subjectivity, within the context of rehabilitation engineering and design. It involves a practice of routinely creating and using images in healthcare, which starts and ends in the specific needs and capabilities of the individual. This includes a specific design strategy and methodology which should be considered as an additional and contributing aspect to the medical-clinical [17]. By engaging the patients as participatory and subjective parts in the making of these personal images, they would contribute with their own aspects of the content, meaning and use of the produced artefacts. The images can be integrated in everyday life and focus on positive or desirable aspects of well-being to support and help the individual outside hospitals and medical institutions. To have images as communicative, informative, emancipative and emotional tools enhances the individual's ability to participate actively in the recovery and rehabilitation work as well as gaining in knowledge and empowerment. It is a matter of designing for a higher quality of life [13, 19].

A cross-disciplinary approach could be fruitful and function as a provocative and challenging factor in stretching the limits of the acceptable, possible and desirable in healthcare. In the context of emotions as meaning, art and artistic thinking would contribute to medicine and rehabilitation engineering design by introducing alternative ways of addressing the different elements of well-being. Art could be useful in visualising and diversifying health as experienced, as well as providing tools, methods and attitudes that science and medicine today do not make use of. For a comprehensive collection of intersections of art and technology which could be of interest for this kind of approach, see Stephen Wilson's book Information Arts [41].

From the patient's emotional perspective, the question of creating meaning involves both what is important for the individual and how one can understand and adapt to a diagnosis or impairment. This implies interaction with the context of experience, personal history, memories, dreams, abilities and knowledge. In the end, it is a matter of being closest to yourself and having a personal knowledge of your own health and well-being, one not readily exchangeable with clinical assessments. This can be achieved using simple tools and without any prior experience of the users. A design approach could be to use image boards, single-use cameras, collages and other creative techniques with active participation of the patient/individual [12]. The images could later be included in the medical journal as a kind of patient-provided portfolio as a complement to the clinical images.

The emotional impact of medical and other images on the perception of the self and health as it is experienced should not be underestimated, but rather be used constructively. Art as a field of knowledge has a long history of working with images of the body and would add emotional and personally meaningful aspects to images in healthcare. Through meaning, not only the experience of a medical condition but also the healing process itself could be altered. This effect, meaning response, is described by Daniel Moerman, ‘Meaning can make your immune system work better, and it can make your aspirin work better too.’ [26, p.20]


‘Man is the measure of all things,’ attributed to Protagoras from Abdera by Socrates in Plato's Theaetetus [31].
Such exhibitions include: Under Your Skin: A Voyage Through the Human Body at the Deutsches Museum in 2001; Digitized Bodies – Virtual Spectacles Online Exhibition, presented by the InterAccess Electronic Media Arts Centre in Toronto; Inside the Body: Walk-in Sculptures at the German Hygiene Museum in 1999; Spectacular Bodies at the Hayward Gallery in 2001; Laura Ferguson: The Visible Skeleton at the National Museum of Health and Medicine in Washington, DC in 2004; The Royal Society 2001 Summer Science Exhibition Looking Inside the Body; Gunther von Hagens' Body Worlds; and The New Anatomists, presented by the Wellcome Trust at Two10 Gallery in London in 1999. Stephen Wilson has compiled a comprehensive list of exhibitions dealing with the body and medicine.


The author acknowledges the financial support of The Swedish Association of Neurologically Disabled (NHR) which has funded the research on which this paper is based.


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About the Author

Henrik Enquist works at the Division of Rehabilitation Engineering Research in the Department of Design Sciences at Lund University, Sweden. He holds a MS in Engineering Physics from the Faculty of Technology, Lund University and a BA in Fine Arts from University of Bergen. His work concentrates on visualisations of body and health from perspectives in engineering, design and art.

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