Much has been written from a cinematic and cultural studies perspective about medical imaging and films of operations, but the principal focus has been on the medical interpretation of such imaging and the use of documentary film by the medical profession, rather than what will be the concern here - the televised screening of such material to a lay audience. Both Lisa Cartwright (1995) and José van Dijck (2002), notable scholars in the field, have published historical studies of early medical documentary films which detail how any 'spilling over' of such material into popular exhibition was considered a scandal or at the least a misuse. More generally, writing on medical and health issues on television (apart from that concerned with drama) tends to look at traditional documentaries and focus on the utility of the information conveyed and the degree of support exhibited for medical personnel (see for example Hodgetts and Chamberlain 1999, Belling 1998). The touchstone is overwhelmingly the medical informational part of the proceedings, with Catherine Belling, for example, approving televised operations despite her warnings about their constructedness, because of their role in demystifying patients' understandings of the insides of their own bodies (1998: 19). An exception to this perspective is provided by studies of surgery to separate conjoined twins, which despite the rarity of such surgery, comprise a significant proportion of writing in cultural studies concerned with non-fictional medical operations. David L. Clark and Catherine Myser, for example, are largely concerned with matters of embodiment and the way in which surgical considerations are shown as unquestionably primary in issues relating to decisions about separation, compared even to psychiatric ones (1996: 346-8).
I want to consider both the televisual site and the content involved when comparatively unexceptional medical sequences become part of ordinary non-fiction infotainment television, not to consider how well medical data is conveyed, but how it is framed for popular consumption. How is it that serious and arguably gruesome operations performed on ordinary people have become part of the regular content of domestic infotainment television? In such programmes, medical œ matters are the focus and the assumption is that viewers come to know more about o the issues at hand, but the pill is sugared by various entertaining devices which may n well be far more to the (televisual) point than data about the human body. What I does it mean that we can sit in our living rooms and observe catheters being d inserted into a stranger's heart through a vein in the thigh and regard this as just 1 part of an evening's viewing? 5
I will be arguing that one of the ways in which entertainment is produced is by the generation of spectacle, but that the informational component means that programmes showing 'real' medical operations on ordinary television produce a distinctive spectacle and need also to contain the extent of the eruption of spectacle. In this, I am running counter to the customary way in which the term spectacle is used in television studies. The normal use is to cover programmes which are anything but ordinary television; rather they are special events, news or media events, to use Dayan and Katz's terms (1992). Spectacles of these kinds -both pre-planned and (hastily) scheduled media ones such as Royal funerals or unanticipated news spectacles that suddenly disrupt the schedule, such as September 11th - are extended, given space to signify their importance, which the very act of disrupting regular programming indicates. Even when the news event itself takes only a matter of moments, its coverage is open-ended and the salient moments are repeated into excess. The long durée is precisely the point of the coverage. An alternative possibility for television studies would be to use 'spectacle' to talk of special effects within television dramas, especially now that science fiction has returned as a popular televisual dramatic form. This does not appear yet to be a common usage but might be more viable when a higher proportion of the population have very large widescreen sets with digital capability and commensurate sound.
It is my belief that non-fiction televisual spectacle is currently of a different order, one more in keeping with the comparatively small scale of the image and its domestic location. It is possible that televisual spectacle compensates for its inability to overwhelm the viewer on a cinematic visual and aural scale by seeking an intensity focussed around the reality or actuality of what is being displayed, whether the rare destruction of skyscrapers or the more frequent medical incursions into the bodies of ordinary people. What I am suggesting in the medical televisual instance is that viewers might be paying a mundane, perhaps only desultory, amount of attention to a non-fiction program (this is certainly a common mode of viewing television programmes generally; see Ellis 162), the people being followed more or less engaging, when suddenly the modal quality of the programme shifts. Bloody flesh or normally concealed body cavities fill the screen and the viewing engagement becomes of a different order as we enter what Clark ro and Myser call the 'theatre of surgery' (1996: 339). In this theatre, although the ^ spectacle is mediated, the actuality of the event is stressed; we are assured, often ~ repeatedly, that this is not a fiction, that what we are shown really happened to a real
5 person. But because it is just an uneventful part of the regular schedule, Is ordinariness must be maintained and the spectacular reasonably quickly
This is part of my continuing work on British and Australian 'ordinary television' -popular non-fiction programming covering a somewhat larger field than that designated either by the rather old term 'light entertainment' or the newer 'infotainment'. This televisual growth area looks at mundane matters, uses ordinary people on-screen and is characteristically of the long-run form - rather than being either one-off or short prestige series of the kind that, in the realm of medicine, are presented by Robert Winston (Bonner 2003). At the time of writing, there were few dedicated medical examples on British television that focused on people, although the popularity of programmes about vets meant that animal health and animal operations were commonly to be found. A late night Channel 4 series entitled Under the Knife with Miss Evans did show operations in the manner discussed here, but atypically produced its entertainment frame through a disjunction between the type of operations and the manner of the surgeon. As a urinary-genital surgeon, Miss Evans conducted penis enlargement and sex-reassignment surgery as well as operations to deal with prostate cancer, but the sensationalism inherent in televising her specialism was undercut (or perhaps estranged) by her gruff, down-to-earth approach and her Home Counties delivery.
At the same time, Australian television had far more instances of ordinary medical programming during prime time, including Good Medicine, the Tuesday edition of the ABC (public broadcasting) magazine, New Dimensions, and the one I will focus on here, RPA. This latter was modelled on Jimmy's, a highly popular British series which had a long run on ITV during the 1980s and 90s (and could readily be revived), following the surgical experiences of patients at the St James Infirmary in Leeds. RPA is a similarly high-rating Australian networked commercial series based in the Royal Prince Alfred hospital in Sydney which usually follows, over several episodes, the experience of three or four patients from diagnosis to discharge. The core of the coverage is the operation or the principal investigative procedure, but the significant time spent with the patients and their families before and after the procedure ensures that viewers are not watching anonymous bodies being observed and treated but seeing the organs and flesh of people with known histories and personalities. Whether or not dedicated shows are present, in both the UK and Australia, medical segments are common on programmes such as morning and talk shows and the operations which are my main concern can easily be found across many of the types of ordinary television.
That not all viewers want to see operations, or that perhaps there is something particularly shocking about viewing the 'opened' body, is usually made quite apparent. Operations have long been televised to much larger audiences than can w be assumed to have immediate or even long-term need of the information they o convey, and for an equally long time, viewers have been warned about them. Belling n begins her study of the US series The Operation by quoting as an epigraph the I televised warning that the program was not for everyone since it showed a real d medical operation (1998: 1). Such warnings happened even before the standardised 1 contemporary system which simply announces that the programme about to follow 7
contains 'medical operations' in the same terms that it would warn that it contains strong language or nudity. This reflects the change in censorship practice from one based in the dominance of a singular expression of morality to one that accepts the existence of a range of audience positions. 'Offence' can be triggered by a wider range of material, some of which may not have a particular moral component. Operations, despite being designed to cure or to heal, might be regarded as offensive to watch, because of their ability to shock - that is to produce an excess of affect.
Despite the possibility of its showing of medical procedures causing offence, the popularity of ordinary television, and of its presenters, makes them ready conduits of medical information. While not all ordinary television programmes can incorporate medical matters directly, promotional work in newspapers and magazines, across a range of other programmes on the same network, ensures that health issues have the opportunity to be discussed somewhere suitable. John Burgess, an Australian game show host, allowed footage of his face-lift operation and a discussion of his reasons for having it, to form a component of the health magazine programme Good Medicine's 1998 special on cosmetic surgery. The network's publicists' judgement was that this would attract more viewers to his own programme than would be offended either by the spectacle of the operation itself or the revelation of male vanity.
The popularity of ordinary television makes it especially attractive to public health campaigners wanting to inform the general public about particular medical issues. A good example of this is the case of American daytime presenter Katie Couric, who was credited with prompting a 20 per cent increase in the number of Americans having colonoscopies when, following the death of her husband from colon cancer, she agreed to have a live on-air colonoscopy. This was the 'cornerstone' of a five-day public health campaign, so could be argued to be purely informational, but it was the entertainment component of Couric's persona that was held to have made the difference (Dobson). Roger Dobson's article on the subject focuses on the medical consequences (unsurprisingly since it was published in the British Medical Journal). The story is of the increase in real-world procedures, not of the way the colonoscopy was presented or why people were watching it. Dobson pays no attention to the spectacle of the public display of some of the most private parts of a major American celebrity, yet this surely was instrumental in many people's decision to watch.
¿s To investigate further the way infotainment television presents medical operations, a. I want to consider in detail two procedures screened on a single episode of RPA
^ broadcast during 2002. One is of invasive orthopaedic surgery on the leg and the
~ other a non-invasive investigation of a case of bleeding in the upper bowel. As was
2 indicated earlier, in both cases the programme follows its usual practice of introducing the patient during his (both patients are male, as are their surgeons) initial consultations, allowing viewers thereby to become familiar with them and the problem with which they have presented.
The orthopaedic surgery patient had been injured many years earlier during service in the Vietnam War (the passage of time has meant that the socially divisive aspects of Australia's involvement in the war in Vietnam no longer inhibits the representation of soldiers from this conflict as war veterans equal to those from battlefields less marked by domestic debate). He had a severe limp caused by a fusion of hip and thighbone and had presented hoping for a hip replacement to return a degree of mobility to his right leg. Investigation revealed that this would not be possible, but some improvement in his gait was promised by an operation to remove a wedge of bone and realign the thigh.
The camera spends more time during the operation looking away from the operating table, filming the surgical team and giving long shots of the anaesthetised patient on the operating table, than in close-up on the area being manipulated, but it is this blood, bone and marrow that dominates the screen. The apparently primitive procedure, starting with the incision then following with a cutting away of the flesh to reveal first the fused hip and then the part of the upper thigh from which the wedge will be removed, looks more like a butcher boning a dead carcass than any instance of surgical precision. It fills the screen and tests the viewer's capacity to deal with bloody images insistently marked as 'real' by their location and the surgeon's words, even if the 'reality' of the person to which they are attached seems, for this segment, absent. A V-shaped section of bone is removed, the surgeon leans on the patient's leg to force the gap created to close (there is an audible crack) and then a plate is attached to hold the bone in its new position. The final scene of the operation involves the screws on this plate being tightened with a tool looking and sounding remarkably like a handyman's electrical screwdriver, producing a particularly uncanny conjunction of the medical and the mundane. The comments about the violation of the body that pervade cultural studies of medicine appear especially apt, yet the programme cuts rapidly to the patient recovering in his hospital bed, his wife by his side, and then to his first (painful but already less lurching) steps. Clark and Myser comment on the documentary coverage of the separated conjoined twins that 'this is the accelerated hyperreality of television, in which medical crises are by convention resolved within a miraculously compressed temporality' (1996: 349). Certainly the narrative of the man's arrival with a medical problem and its partial w alleviation has proceeded quite swiftly and its logic pulls the viewer on, but the o visceral affective power of the operation scenes lingers, perhaps especially because n there has been no complete cure and so closure is not quite complete. I
Intercut with this is the second case, which concentrates on diagnosis. The patient 1 had a suspected disorder of the upper bowel - apparently beyond the investigative §
reach of a colonoscopy - which is examined by a swallowed miniaturised camera whose broadcasts are picked up and screened on a computer monitor. This leads to a very different representation. The patient remains much more present during the procedure since he is conscious throughout. The actual staging is initially very similar to the previous sequences, introducing the patient and his problems. Instead of being marked by bloody flesh, the procedure part of the case is marked by the display of technology; the patient swallows the miniaturised camera and his marvelling at the technology (echoed by the doctor) is designed to parallel that of the viewer. Although it is for a much shorter time than for the orthopaedic patient, he too disappears for the 'money shot', when we look inside his body and are guided by the doctor in what we are seeing. This is much less a test or challenge for the viewer since the body is observed from the inside, rather than cut open with the inside exposed and then reconfigured. Here we actually have to be told which part of the image is blood. The violation is so much less dramatic and the patient so consciously present, that it may be difficult to argue that violation has occurred, though it has. The sense of wonder that is generated here is an intellectualized one, focussed on the capabilities of the technology.
In both instances I want to argue that we are being presented with spectacles, but that unlike the case with cinematic special effects spectacles, here televisual requirements act to ensure that any suspension of the narrative to marvel at the representation is minimal. Most importantly, the commentary holds us close to the continuing stories, especially through emphasising the reality of what we are watching. Television is predominantly an aural medium and the words we hear ensure that we are reminded that this primitive butchery is actually happening to a real person, and that this sequence of shots is actually of the insides of a real man's intestine as he is standing in a doctor's rooms, and that it has been taken by a piece of technology smaller than the man's fingernail. The commentary itself is part of this reality; presented not in voice-over, but by the doctor speaking to the man about his condition and the surgeon speaking to his operating team (ostensibly; he seems to be giving information designed for a lay audience, although directed at his fellows). The distracted viewing that typically characterises our engagement with television, in comparison with the greater attention given the cinematic image, is part of this - made possible by the aural information being so rich and also ro meaning that sequences when the visual comes to the fore are rendered ^ comparatively more compelling. In addition to these consequences of televisual ~ location, programmes such as these are rarely longer than a commercial half-hour
5 (i.e. 22-23 minutes) so the total time available is quite short. For the most part, and is certainly for RPA, more than one story is being told in the individual episodes and
6 these are more often intercut, as here, than placed sequentially. The intercutting & keeps the viewer from falling too far into the spectacle, since we are only briefly q present at each site.
Yet despite the brevity of the sequences showing the procedures and their spectacular character, the mechanisms of engagement that they offer are very different. The operation is comparatively unmediated; the television camera shows us the body opened, violated and displayed and challenges us to watch or look away. The diagnosis is much less challenging, especially since much of our attention is focussed on the wonders of the technology.
To consider this further, I want to go back to the matter of the early medical films scandalously screened to the general public. Van Dijck discusses the case of the 1902 French film of a separation of conjoined twins. The intention of the surgeon, Eugène-Louis Doyen, in having the operation filmed was that it would be used to instruct other doctors and that it would never be screened without a surgeon providing a commentary, but his assistant circulated copies more widely. Doyen sued the assistant and the distributor Pathé to reclaim the copies and prevent them being shown to the general public as entertainment (2002: 543-4). Van Dijck's argument is about the continuity of the screening of the operation with the freak show, a general feature of writing on conjoined twins (see Clark and Myser) that can be applied to varying extents to representation of other medical or medicalised conditions. The context, however, is that in which Tom Gunning's analysis of early film as a 'cinema of attractions' can be applied. Both the film as an example of the marvels of the cinematograph and the content showing the marvels of nature and of science would have been fascinating to the audience of a hundred years ago. It is also worth recalling Gunning's comment that people went to see demonstrations of the cinematograph machines 'as they did for other technological wonders such as the widely exhibited X-rays' (1994: 42); medicine, or at least anatomy, was thoroughly imbricated with entertainment, then as now.
In my examples, these two aspects are more separate, though the intercutting ensures we shuttle between them rapidly. For the operation, the visual technology seems irrelevant, as viewers confront and are confronted by the 'reality' of the violated, revealed body (though as I have suggested above the almost domestic nature of the medical technology involved may draw the attention). For the diagnosis, the visioning technology takes precedence and viewers are invited to marvel at it and what it can do. The fascinations which can be hypothesised are more visceral and, despite the commentary, more visual in the first instance and more intellectual and aural in the second. Discussing the fascination of the Visible Human Project, Catherine Waldby calls on Stephen Heath's term 'machine œ interest', which he used before Gunning to describe the initial appeal of the o technology of the cinematographic apparatus. Walby argues the term's usefulness n to describe 'instances where technologies become [...] objects of cultural attention I over and above their specific products' (1997: 4). While I acknowledge that one d could trace the whole panoply of the medical institution whose operations RPA and 1
other programmes display as just such a technology, I do not want to do this since it obscures the distinction between the two examples.
The 'machine interest' so evident in the diagnosis is unavailable in the operation, though this is not always the case; far from it. I chose to examine an orthopaedic example precisely to separate out components that much televised heart surgery, for instance, would collapse. Of recent operations with advanced (visualizing) medical technology, van Dijck has noted how the 'convergence of media and medical technology results in an enhanced sense of the real, the suggestion of increased transparency, when it comes to capturing the activities and anxiety involved in medical operations' (2002: 548). I believe the juxtaposition of the two chosen instances enables this to be taken a little further. Not only does the increased transparency enhance our sense of the real in the case of the swallowed diagnostic camera, but a similar enhanced sense of the real is produced from mediated medicine without much in the way of medical technology, when it presents the blood work of low-tech surgery. The real can be enhanced in more than one way. Only the convergence of technologies provides this through increased transparency, however; it is the primitive arresting power of blood that testifies in the other case.
There remains the matter of the way the two terms 'spectacle' and 'real' interact with televisual infotainment, in both its informational and entertainment aspects. It would be wrong to suggest that the 'real' speaks to the informational while spectacle provides the entertainment, since it has already been shown how central the revelation of the 'real' is to the production of spectacle, both through the indexical exhibition of blood and bone and through the technological marvels of visualising technologies that allow viewers to see the actual functioning of hidden parts of the body without invasion to bring them physically to the surface.
Even though both may be thought to interrupt narrative, both spectacle and information are embedded in narratives which provide much of the entertainment. Standard health narratives have no difficulty in following the classical narrative pattern, as is evident in the outline in which an equilibrium disrupted by the discovery of symptoms is explored before treatment brings "rô closure with a return to equilibrium. Thus while the orthopaedic patient does not ^ receive the desired hip replacement, his condition is still sufficiently improved ~ for the story to end happily. Very few programmes involving operations are
5 broadcast live; there is time for producers to be selective so viewers can be is assured that the overwhelming majority of outcomes of televised medical œ procedures screened will be positive. Every now and then a programme will
6 return to a person who had been pronounced cured or left with alleviated ^ symptoms, to reveal a worsening of the condition. Instances like this tend to shift ^ the programme more fully into the melodramatic mode, where emotions such as sorrow and pity are more readily encompassed; it is rare for these to feature spectacle.
Even stronger is the convention that patients whose operations are displayed continue to live. Jimmy's did once include an instance of a patient who died, but whose relatives were persuaded to grant permission for the case to be broadcast for its instructive value to potential patients and their families. The emphasis on the instructive (on information) was in keeping with the genesis of Jimmy's in a programme designed to show children facing hospitalisation what the experience would be like. The popularity of this initial short series led to its expansion to deal with adults as well. However common it may be in hospital dramas, death is not at all common in non-fiction medical television.
Despite these exceptions, both dedicated and occasional medical television are dominated by the trajectory from ill-health to cure, with the operation providing the key punctuation. It is worth examining this through the structure of the most pervasive of recent ordinary televisual genres: the makeover. This highly popular ordinary television type follows the case of a person with a problem who, thanks to skilled intervention, becomes a person with the solution. Obviously medical stories differ from 'secret' makeovers, such as those conducted in the gardening programme Ground Force, but in many regards the formula is the same. The major difference is located in what those producing makeover shows call 'the reveal', when the transformed situation is shown to the person concerned and viewers observe their reaction. This provides the climax and the affective high point of the programme (Bonner 2003: 130-6). While televised operation stories frequently conclude with the patient revealed as restored to health, providing the pleasure of happy closure, this is not the affective, nor often the dramatic high point; that is here the intervention, the operation, with all its blood, gore and technology. The cured person is the person returned to equilibrium, which is much less exciting, and calls for less viewer affect, than the testing under the knife.
The operation serves as testimony to both the authenticity and seriousness of the experience. There are some actual medical makeovers, where cosmetic surgery produces a transformed individual. Once this would have involved the simple presentation of 'before' and 'after' shots, but this is now less common than items that include intermediary footage of the body under the knife. A British example of this from 2002 occurred in the light documentary Vain Men, which inserted w graphic footage of the insertion of pectoral and other implants to separate a man's o earlier statements of dissatisfaction with his body from his later happier state. The n operation shots functioned both to give an element of spectacle and to reduce the I extent to which the man could be seen as just a figure of fun. Operations d conventionally serve as indexes of pain and the body under duress, so the inclusion 1 of procedures in which the body is exposed, bleeding and violated indicates that 3
viewers are to take the man's dissatisfaction more seriously than might otherwise be the case. The frequency with which cosmetic surgery is shown being performed using the same televisual devices as surgery to treat diseases or rectify the consequences of injury, acts to place it in the same register, making it harder to dismiss as the indulgence of the vain. The televised operations can in these cases be seen as acting in part to promote more widespread adoption.
In conclusion, then, I want to argue that ordinary television provides instances that create a (small scale) spectacle of the real and that arguably the most dramatic of these happen during the operations which are at the core of non-fiction medical television, whether these are invasive or not. Both kinds of televised operation encourage viewers to remind themselves that the events by which they are transfixed actually happened. The invasive examples do this by providing sufficient gore and exposed flesh to produce a spectacular, if gruelling, viewing experience. Those procedures that enter the body without cutting into it rely on visioning technologies that are themselves part of the spectacle at the same time that they provide a view of the actual functioning of normally invisible bodily processes. However the camera gets its pictures, they carry the stamp of authenticity that comes from looking where ordinarily we are forbidden - inside the skin of a living fellow human being.
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Cartwright, Lisa (1995) Screening the Body: Tracing Medicine's Visual Culture. Minneapolis: University of Minnesota Press.
Clark, David L. & Catherine Myser (1996) 'Being Humaned: Medical Documentary and the Hyperrealization of Conjoined Twins' in Rosemarie Garland Thomson (ed.) Freakery: Cultural Spectacles of the Extraordinary Body. New York: New York University Press, 338-355.
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Dijck, José van (2002) 'Medical Documentary: conjoined twins as a mediated spectacle'. Media Culture and Society 24.4. 537-556.
_ Dobson, Roger (2002) 'Broadcast of Star's Colonoscopy Boosts Screening'. British Medical
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13 Heath, Stephen (1980) 'The Cinematic Apparatus: Technology as Historical and Cultural Form'
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Hodgetts, Darrin & Kerry Chamberlain (1999) 'Medicalization and the Depiction of Lay People 2 in Television Health Documentary'. Health 3.3, 317-33.
Walby, Catherine (1997) 'Revenants: The Visible Human Project and the Digital Uncanny'. Body and Society 3.1. 1-7.
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