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.

What is Art?

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I have been taking a course at the University of Maine on creative concept development.  In this highly political and charged times, it seems appropriate to ignore CNN and consider the definition of art.  In Art as Experience, John Dewy, a philosopher of aesthetics who gave the first William James Lecture at Harvard, makes the distinction between an object of art (a painting, a statue, a film, an installation) and the work of art.  He says that the work of art is active and experiential whereas the art object is physical and potential.  This spoke to me in the sense that the course has inspired me to the work of art even if the products I produce are not necessarily objects of art in the sense that I would put them on a wall and offer them for sale.  The exception is my poetry, which I have written throughout my life as my own reflective exercises in the sense recommended by Rita Charon for physician self-practice.  However, the course has convinced me to put my poetry on display as art objects whatever that means.  Not, however, necessarily my drawings and paintings; regardless of how much I enjoy making them. 

Dewey uses metaphors from physics to define a work of art.  He talks about the force of an object, which is interesting in that I had learned that objects have mass, but force is work done on an object.  Force is a vector, a verb, and not a thing.  He talks about energies issuing from experience which also seems odd, for it seems to me that it is energy that we experience and that moves through us, upon us, and around us.  He talks about mutual affinities and antagonisms working “together to bring about a substance that develops cumulatively and surely (but not too steadily) toward a fulfilling of impulsions and tensions (pp. 168-169).” That metaphor just didn’t work for me. For me, the act of making art is a way of exploring my world through means that are otherwise hard for me to access.  Poetry, for example, can capture a situation far more astutely and completely sometimes than prose.  A painting or a drawing can communicate an experience beyond the capacity of words.  However, the making of art is the making of a relationship.  It is a relationship between some of my internal characters with each other and with (sometimes) external beings (if we can ever understand the boundary between internal and external).  The visual arts in North America are a means of recording and communicating experiences without words.  When I communicate my experience to you, you have an experience.  The force lies in the communication and not necessarily in the object of art.  It’s a cultural artifact that people buy and sell these artifacts of communication, whether they be visual or verbal or otherwise.  We have constructed an entity which calls itself the art world in which people participate and decide what objects will be called art and bought and sold and what objects will be ordinary and valueless.  This is different from my reflective communication through whatever media of my experience in the world (including other dimensions).

Dewey says that the work of art is perception, and to this, I would add communication and reflection.  I recently asked a client who had been traumatized by the experience of two policemen coming to her door to serve her a subpoena to draw the scene.  She wanted to know why.  So you can fully experience it, I said. “You talk around it in a way that avoids integrating it into your life.  If you draw it, you will enter into it in a way that you understand it better.”  I showed her some drawings from William Kentridge, the South African artist, that are dark, done in black and white and grays with thick lines and an intensity that grabs one.  “These are what I imagine your scene with the police to be,” I said, “though you may represent them quite differently.” 

It’s also odd to me that her first response when invited to participate in an experience is to ask why.  Despite what I said above, I don’t fully know why.  I know that drawing evokes new perspectives and emotions for me than talking about an experience or writing about an experience.  I see it differently in the visual mode.  I can’t predict what the difference will be until I do the drawing.  I do understand that the various media in which we can represent and dialogue with our experiences and the beings, internal and external, who constitute our non-local selves give us different perspectives depending upon the media.  Since I have begun drawing and painting again, after a hiatus of many years in which I believed I was not sufficiently talented to be allowed to draw and pain, I have been noticing the details of the world differently.  In England, I drew sheep (which are everywhere).  I began to notice subtle details about their ears and the angles that their ears can form.  I began to notice the length of their legs compared to the height of their bodies. My perception had changed.  I also began to experience how different the world that we see is from the world of the drawing we render.  A relationship exists clearly, but it is not a one-to-one correspondence.  The world in the drawing is never the same as the world we see.

Dewey uses the metaphor of rhythm to take us deeper into the experience of perception that is a work of art.  Hee says that art depends upon and is grounded in the rhythms of nature.  He says that rhythms are “the conditions of form in experience and hence of expression (p. 169).”  He says that these rhythms become esthetic when the become a rhythm in experience itself. In this I didn’t really follow her.  Aesthetic philosophy can be dense and probably, to give credit to Wittgenstein, could be spoken more plainly.  We could just say that we call something an esthetic experience when we have a powerful communication with it, when it evokes emotions and meanings within us.  We probably don’t need the metaphors of physics to understand this, however fun they are to us.

Here is my poem. It was a response to her saying that non-art is a situation in which all the individual parts are floating in chaos and confusion because they are not integrated into a whole. I tried to describe that poetically but ended with a whole.  So, I disagree that it is possible for parts to be separate from the whole. 

The lamp floats above the wing of the plane and it’s all random where things go or stay and the man’s hands shake as he pours his coffee for perhaps he didn’t realize the separateness of it all especially the coffee.  It’s all coffee. Coffee is curiosity, tension, years of cultivation, the nemesis of Andrew Weil who thought it was evil. What would have happened had he found this exotic bean that could be brewed to awaken people in the mornings to their full senses and to participation in the world though I have stopped drinking coffee after the morning realizing that it’s water I need to stay awake and not stimulants in the coffee variety.  Eyes float above the coffee. People forget them as they rush to their jobs and their appointments leaving their eyes briefly cruising above the newspaper but how will they find their way to their trains subways trams taxis ubers lyfts and footpaths without their eyes which seem so crucial to urban navigation but that’s what happens when you’re in a hurry and can’t be bothered. As for myself I see the parts of the plane floating in the sky the jet engine the fuselage the cockpit the nose of the plane the wheels and the hydraulic brakes all those things that become a unified whole when appreciated as a plane but individually they’re just so many components.  I have been the same height for many years but I remember my acquaintances as taller. By the light of the sun and the moon everyone is intimidating me even those who have no right to make such a claim. I am seeking peacefulness in my daily interactions yet the parts of the room keep floating off and the tables go one way and the chairs another and the chalkboard starts to rise spilling the chalk on the floor and the coffee is rising.  Kindness seems to come with a price.  Love comes with ultimatums anger is our dominant emotion flowing forth like lava from an Hawaiian volcano in this moment now the floating parts of the airplane don’t frighten me as they once did.  I no longer fear walking down the floating jetway to the separated fuselage which has departed from its engines. The anger has left the boarding process though the eyes are still there security cameras operative scanning the crowd the pilots and the flight attendants flitting past the waiting crowd and it’s all so scattered. This world was not gentle to my father. But if only he had had the good fortune to meet me it might have mattered for us to converse. Our conversation might have made him softer. The airplane would not tremble in separate disconnected parts as it now does. The oxygen masks would have dropped down much later into the flight. The parts would come together into a smooth flight and visit. 

-       Or not.

The separation

Of all the parts

From the whole

Does not make

It real beyond

The illusions of

Your white picket

Fence mind

That boxes us into

Definitions like

-       What is art?

Blind epistemology is causing your philosophy to rot

Because you hide behind the language of the smart

I’m begging.  I’m pleading.  Why can’t you see that art is the people.

Art will resist ever effort to define it, will persist like the Berlin Wall

Which fell 30 years ago but remains a part of global consciousness.

Art is that which pierces the darkness with morning light

Art is the fleeting moments of ecstasy amidst the constancy of despair

Art is the clarity that overcomes our sight

In the dawn in the dusk in the twilight in the moonlight.

Art is your last breath and the compromise you make in that moment

Art is the sunset as your soul rises amidst the chaos of the world

                        Please don’t die a slave to philosophy.

A desperate unfinished poem sent to the God of Art when I was 17 and didn’t know that he was out on the town banging Persephone.

Art spends what should be a childhood

Pushing it forward into womanhood

So that it can be conceived and born again

Bearing the pain of childbirth to recover itself

Art is a man who can’t bear to watch its rebirth

The one who hides in the corner while the women

Do their work and when all is said and done

Art is called the weaker sex

            Irony

            In deference to science.

There has been a dead bird lying flattened in defeat on the corner of college avenue and bathhurst where the street care stops.  Many days have gone by and how many people have passed it wondering how it died and thinking someone should really clean up that bird but it shouldn’t be me and it should be some unnamed part of City Government such as the department of cleaning dead birds off the street, whereas I wonder why I haven’t been the one to remove the remains of that bird, at least into the bushes of the funeral parlor or the Anglican Church down the block or perhaps into the gutter or the sewer but I have not stooped so low and I have not sullied my hands to do the deed and I have breathed away the guilt as any good yoghini for

That bird is art.