Art and Medicine

Art and Medicine 2020

At our Family Medicine Residency Program, we are starting a Medical Arts and Humanities Fellowship in collaboration with the Intermedia Program at the University of Maine.  In order to fully participate as a faculty in this program, I felt I needed to participate in some of the courses our fellows would be taking; hence, I find myself this semester in Intermedia 501 – the History and Theory of Intermedia.  Our first subject is Dick Higgins, the person who coined the term intermedia, and a person whom our professor, Owen Smith, knew well.  Owen delivered a lecture of Higgins at his memorial celebration.

Higgins wrote a book entitled Horizons, which was published originally by Roof Press in 1998, and republished by /ubu editions in 2007.  He opens with an interesting quote by art critic, Rosalind Kraus, spoken at the University of Iowa in April 1981.  She said, “I am devoted to the idea of burying the avant-garde.”  Later Higgins wrote about the important role of the avant-garde in exploring the fringes of what may become, so I found it curious that he would open with a critic who wants to destroy them.  We have the avant-garde in medicine, too – those who imagine a different future than the status quo and try to make it so. I have been in that fringe – those who imagine moving what was fabulous about indigenous medicine into our future.  We also talked about implementing a psychobiosocial model or a holistic model or an integrative model, but we were all careening and ricocheting in an obscure future in which we cannot imagine what will ever become.  Higgins talks about this for art – the role of the avant-garde in exploring what might become.  Comets are worlds that didn’t quite form.  They have their own beauty as they rush around the universe, but they are not planets. Some of the avant-gardes are destined to be comets.  Some will become planets. Only the future will know. It is the same in medicine, though its avant-gardes have fared less well than those of art.

Higgins said that avant-garde thought minimizes conventional forms and thereby tends to be an active, dialogical interrelationship between the form which a work assumes and the material of which it consists. He says that the avant-garde focuses upon the “up-to-now-this-wouldn’t-have-been possible.”  I see this as well in medicine and psychology, though each of these movements stand in direct risk of annihilation.  The mainstream, like Star War’s Empire, is strong.  It is all too easy to destroy a few rogue rebels.  So, we toil quietly in the shadows of the mainstream, slipping beneath the gaze of Big Pharma, hoping to acknowledge what is good about conventional medicine and to discard that which is solely commercial or anti-human. 

Higgins contrasts the avant-garde with the pop-garde, which is the follow-the-leader world of charm, including fashionable but safe dissent and high style.  Within medicine, yoga has entered the arena of pop-garde.  Yoga, itself, of course, is fabulous, and anyone can and should do it, but pop-garde yoga is chic and expensive and full of beautiful, rich people.  It’s not the yoga for the people, for example, that is advocated by Diamond Dave Phelps (DDP-Yoga) who worked with decrepit wrestlers (Jake the Snake, for example) and crippled former paratroopers, to bring them back to function.  It is the yoga taught in the fancy studios of New York and Los Angeles and Kripalu.  The pop-garde co-opts the discoveries of the avant-garde for profit.

Next, Higgins discusses conservative artists, who stick to the tried and true.  These constitute the bulk of the art world as they do the world of medicine.  They do what they’re told.  They follow the algorithms without question.  They faithfully implement the guidelines, whatever they are, without questioning the origin of these guidelines.  These are conservative doctors, similar in attitude to conservative artists. Higgins distinguishes between conservative artists who use materials in prescribed ways with avant-garde artists who allow the unique characteristics of the material to speak to them. The parallel for this in medicine is the application of the same algorithm to all patients while avant-garde physicians allow the being of the patient to guide and shape the treatment.

Higgins continues to define a good critic.  He says that a good critic points out the implications of the material and the work, forming a relationship with the material and the work in which any theory developed arises from the ensuing dialogue.  In medicine, we have no good critiques.  We are expected to mindlessly follow the dictates of the various professional organizations who rule the roost.

Higgins creates a term, “exemplative art,” in which the work is not a definitive realization of something, but one example of a sample of possibilities.  His term “allusive referential” refers to a displacement between what one expects to see or what one would logically regard as normative and what one does, in actuality, see or hear or read.  This displacement factor can trigger all the emotional responses associated with art independent of the artist. We have that in medicine. I am reminded of a 96-year-old man who was snow-blowing his driveway and got exhausted and bent over and passed out.  That would seem ordinary to me, but in our algorithmically driven Emergency Department, it triggered a $30,000 stroke work-up. The man was already on anticoagulants for his atrial fibrillation, so our work-up would not have changed anything in his treatment, but it is required by a protocol which we must blindly follow.

Instead of the modern/postmodern division (which Higgins places in the mid-1950s), Higgins prefers to make a cognitive/post cognitive distinction with the term “cognitive” referring to the sense of self or personal identity of the artist or the viewer of the art. I take this to mean that around the mid-1950s, the opportunities for creating identity dramatically multiplied. Before the mid-1950s, people’s identities were largely constructed by their context and rarely did people leave that context (family, community, church/temple).  Around the mid-1950s, people began to be more mobile.  In North America, we witnessed the birth of the car culture in which most people had one or access to one.  People became able to leave the context in which they had grown for a context of their own choosing. The rise of technology created jobs that had never existed previously.  The manufacturing and mining/farming industries began to decline in relation to the service/technology industries.  This has only continued until the present time.  If identity is more fluid and we can have agency in constructing and even changing our identity or holding several identities for the multiply different contexts in which we find ourselves, one could say we are post-cognitive, because our identity is no longer fixed and immutable. Higgins says that a post-cognitive perspective allows us to journey backward into works from the past without having to make elaborate justifications for doing so.  As someone outside the art world, I would not have known that such justifications were required in a modernist or cognitivist perspective.  Higgins says a post-cognitive perspective allows us to put the artists into a neater lineage as to how they feed into contemporary avant-garde practices. In medicine, a post-cognitivist perspective allows us to see the folly behind many of our algorithms, but that perspective is not rewarded.

Higgins uses the cognitive/post-cognitive distinction regarding the material of an artwork.  The cognitive artist uses expression to reveal his or her subjective persona.  The post-cognitive artists allow the material of the artwork to express itself. The parallel in medicine is that the cognitive physician imposes him or herself on the patient.  The post-cognitive physician is patient-centered and listens to the patient to collaboratively create a point of view.

Higgins says that the desire to fuse seems to be a part of our biological nature as living beings.  Certainly, we are all seeking that sense of belongingness and opiates work most powerfully on the neural circuitry of social relations and belongingness along with oxytocin (the social relations hormone). A number of religions seek a transcendental fusion with divinity or a spiritual realm.  We all need to belong and in an intensely connected way.  People fuse, he says, not just when they have sexual intercourse, but merely by being in love, and certainly a clinical literature exists on the dangers of fusing while in love and losing one’s own personal boundaries.  Historically, this tended to be more common for women than men due to differences in socialization to the roles we play in love relationships, and this is also currently in flux.  Higgins says that people even fuse in friendship to some extent, with the give and take of relationships and the deep involvement people have over the course of a lifetime. Higgins says that this desire for fusion is a basic hunger within us, which reflects how important belonging is for survival.  Humans survived by banding together in groups.  Without groups, we are vulnerable and easily defeated. We are incomplete without belonging. This need for fusion exists everywhere, and medicine can either contribute to it or detract from it. Conventional biomedical medicine detracts; patient-centered medicine contributes.

Higgins next criticizes structuralist and post-structuralist theory and cultural criticism.  He believes they lack any scientific validity and calls them science-as-metaphor rather than science-qua-science. I think Higgins lacks an understanding of what happens behind the scenes in science; that so many of the elaborate explanations are simply metaphor disguised as truth.  He elevates science-qua-science perhaps inappropriately. We are all trying to invent a story to explain “what is,” and science provides just one more story as does Levi-Strauss, Jacques Lacan, and Roland Barthes.  Higgins criticizes Barthes for writing about one work, a short story by Balzac, but Higgins also talks about exemplifying work, which provides an example of a type of work, which is just what Barthes is doing. I read Higgins as emphasizing keeping theory grounded in “the thing itself.”  When it becomes too abstract, theory suffers.  He criticizes the pretentions and limitations of academic thought and art criticism. He opines that the critic can contribute by identifying works that are unique and characteristic of our current era, because the only art we will ever know firsthand is the art of our current era, with avant-garde art containing the art of the future, albeit indeterministic of what it shall be.  This brings us to what he is calling intermedia, art that falls between established and conventional media.  He mentions concrete and visual poetry as an example.  He turns to painting, which was the elevated art of the past, which has migrated off the canvas in the world of visual arts, entering the world outside of itself, interacting and fusing with other media to form visual poetry, visual music, and more.  Higgins calls for a pluralistic approach, recognizing that a horizon has many points along with it, perhaps even an infinite number of points. 

Next Higgins returns to history, writing that the concept of the separation among media arose in the Renaissance. He says that the social problems that characterize our time, as opposed to the political ones, no longer allow a compartmentalized approach.  He thinks we are approaching the dawn of a classless society, which I reject.  Class seems stronger in America today, than during Higgins's time.  Pop art for Higgins is dead, bland and pure, but impotent.  The notion of a pure medium is depasse.  He invokes Duchamp’s pieces as being truly between media, between sculpture and something else, while a Picasso is readily classified as a painted ornament. The ready-made or found object is intermedium because it was not intended to conform to the pure medium, and therefore suggests a location in the field between the general area of art media and those of life media.

Higgins talks about how painters of the 1950s began to make work that adds or removes, replaces or substitutes or alters the components of a visual work but placing increasing incongruous objects in the work.  For example, Rauschenberg called his constructions “combines,” and went so far as to place a stuffed goat-spattered with paint and with a rubber tire around its neck onto one.

Higgins then turns his attention to the theatre.  He wants a theatre in which time and sequence can be utterly suspended, not by ignoring them, but by systematically replacing them as structural elements with change. Lack of change, he says, would cause his pieces to stop. He mentions his 1958 work, Stacked Deck, in which any event could take place at any time, as long as its cue appeared, provided by colored lights. This led to a happening, in which external events controlled the cues. The happening was an uncharted land that lay between collage, music, and the theatre, not governed by rules, each work determined by its own medium and form according to its needs.  In intermedia, the visual element (painting) is fused conceptually with the words. 

Higgins says there is always avant-garde in the sense that someone, somewhere is always trying to do something unique which adds to the possibilities for everyone else. These artists question established forms and media.  But if avant-garde is successful, it will become the new medium for its great significance, becoming truly important to large numbers of people. He says that one regrets the adherence of an artist to a set of dogma. 

Higgins's explorations of art can help us explore medicine.  Many of the same forces are at play.  The dialogue between the powerful and the powerless remains. The forces of the establishment and the radical extremes remain. The avant-garde exists in every field, trying to determine what will come next, though the orthodoxy usually prevails. Ultimately, the stakes are lower in art.  No one dies. Art, therefore, is allowed more possibilities which is why we in medicine should study it.