In 2016, just before I began my dissertation fieldwork, a trio of young medical illustrators presented a panel on “Normativity and Diversity in Healthcare Imagery” at the annual meeting of the Association of Medical Illustrators (AMI). According to those who were at the meeting, the presentation was well-attended, but contentious. Among other statistics, the presenters pointed out that although the profession and the organization are at least 70% women, men often dominate awards and positions of power, and the vast majority of members are white. The panel’s presentations addressed not only the demographics of the profession but also social inequalities arising from the prevalence of the “able-bodied, attractive/thin, young, cisgender” white male body as “standard” in medical images. In a moment of informal conversation that fall, a friend of one presenter told me that they had been convinced that the “Diversity” presentation would likely result in cutting ties with the organization altogether. She gestured dramatically, coupled with a sound effect as though dropping a bomb.
Although it was certainly controversial, the talk did lead to the formation of a “diversity task force,” which was enshrined as a more permanent committee in 2018. Published on the organization’s website, the task force’s “Diversity and Inclusion” statement proclaims a commitment to “reflect the richness of our whole society both in our members and in the images we create.” Although the statement enumerates “color, race, age, sex, gender expression and identity, sexual orientation, appearance, religion, ethnicity, nationality, and disability,” most discussion focuses on race and the recruitment of new illustrators from more varied ethnic and socioeconomic backgrounds. The approach hypothesizes that expanding the pool of qualified illustrators will, over time, result in a diversification of perspectives and of representations more generally. However, given the ample criticism that has been aimed over the years at medical images of women’s bodies, despite the gender demographics of the field, that logic warrants further examination. In this post, I explore kinship discourse as a mode of professional self-fashioning that reinforces normative relationships and representations in medical illustration.
Picturing Expertise and the Limits of Kinship Discourse
My doctoral project examines the practices, pedagogy, and professionalization of biomedical image-makers, colloquially known as “medical illustrators.” Drawing on archival materials, interviews, and participant observation in three North American graduate programs, my dissertation focuses on the role of disciplinary narratives and kinship metaphors in the training and professionalization of medical illustrators. In a very literal sense, biomedical images play a key role in how medical personnel and laypeople alike learn to see bodies. However, the erasure of the material labour involved in the creation of such images creates an understanding of medical images as unfiltered representations of the scientific truth of bodies, as if arising naturally from “the body” itself. When particular kinds of bodies become naturalized as normal, others are also marked as abnormal and in need of correction or elimination. Thus, the creation of biomedical images has material consequences in the lives of those who fall outside those norms. In order to understand the role of biomedical visualizations in science, medicine, and society it is necessary to understand the social, material, and historical conditions that both constrain and enable their creation.
A number of scholars including Sara Ahmed, Himani Bannerji, Chandra Mohanty, and Banu Subramaniam have critically examined discourses of “diversity” as well as the ways in which hierarchies and relations of power both create and are sustained through discourses of human variation and difference. Regardless of intentions, the concept of diversity as it is used within institutions can easily obscure the relations of power that such initiatives putatively seek to correct, the same relations that have installed a certain kind of human body as the standard from which all others deviate in the first place. Ahmed asserts that “the story of diversity thus becomes the story of diversity’s inclusion into the terms of an institution” (Ahmed, 2012, p.9). In order for diversity initiatives to be put into place, they must be made commensurable with the existing institution and with the larger ideological space within which it operates, which can diminish their ability to change those structures in any fundamental way.
Claims to expertise on the part of medical illustrators hinge on the capacity to understand, interpret, and accurately convey complex biomedical information and concepts to a wide range of audiences. The professionalization of medical illustrators over the last century has depended on their ability to make claims to expertise both discursively, by aligning their work with the more stabilized expertise and epistemic values of “content experts” such as physicians, surgeons, and biomedical researchers, and bureaucratically, by establishing legible forms of professional organization. At the same time, the specificity of the medical illustrator’s domain within the biomedical “system of professions” (Abbott, 1988) lies in the capacity to render that information visually, allying them with the rhetorically opposed realm of “art.” This expertise is stabilized by emphasizing the scientific elements of their practice and by positioning medical illustrators as interpreters and communicators of knowledge produced elsewhere.
Both within the profession and in other fields, the work of biomedical visualization tends to be construed as subservient to that of content experts. The majority of STS literature related to visualization focuses on the making of images by scientists and their instruments or on the circulation of such images beyond their originating milieux (Burri & Dumit, 2008; Coopmans, Vertesi, Lynch, & Woolgar, 2014). In their highly influential study of scientific and anatomical atlases, historians of science Daston and Galison (2007) propose that evolving concepts of objectivity in science are intimately tied to representational practices. However, the names and labour of illustrators themselves remain quite literally a footnote, quickly subsumed under those of the anatomists, surgeons, and researchers with whom they work.
The majority of historical work on medical illustration in the twentieth century has been undertaken by medical illustrators themselves. Knowing the predominance of women in medical illustration when I began my research, I was surprised to find that professional story-telling tends to focus on the role of “great men.” Internalist accounts of the profession’s history tend to reinforce canonical values and idealized figures, particularly through the disciplinary origin story of Max Brödel, who is invariably framed as “The Father of Medical Illustration.” Following Brödel’s death in 1941, women practitioners were able to partially circumvent gendered norms through bureaucracy and institutionalizing efforts, but this inclusion was limited mainly to white and upper-middle class women and many of their achievements remain largely unrecognized. Through genealogical narratives of a “founding father” and his metaphorical children, family becomes an organizing metaphor for the professional community.
Beyond Family Resemblance
Ideas of family and community (and the discursive slippage between the two) are embedded forms of social boundary-making, the same processes that permit the exclusion of those who do not “fit in.” As Janet Carsten points out, “hierarchies and exclusions … are part of what kinship enables” (Carsten 2013, p. 250). Discourses of kinship work to establish a cohesive professional identity that ‘fits’ within established biomedical practice through emphasis on normative resemblances and traceable lineage. Patrilineal professional genealogies and references to professional peers as “family” assert authority and relation through provenance, aligning the profession with markers of authority and credibility in science. Further, narratives of epistemic hybridity, “Like art and science, together” (Interview S18), and emphasis on the interpretive epistemic status of medical image-making elide the agential role of medical illustrators in the production of knowledge. Kinship discourses render inclusion as a form of resemblance and fashion acceptable forms and paths to belonging as those which can be articulated within the established normative boundaries of biomedicine.
The persistence of patriarchal genealogies and normative images, even in a female-dominated field, suggests that demographic diversity is no guarantee of representational diversity. The recent emergence of “diversity” as a topic of investigation and activity within the profession signals the potential for a more concerted and widespread effort on the part of practitioners to re-evaluate their own knowledge practices and representational idioms. However, the persistence of particular representational forms and practices is part of a complex web of social, material, historical, political, and economic arrangements within which the profession of medical illustration is precariously situated. While efforts to improve demographic diversity are laudable, it does not necessarily follow that such efforts will result in changes to medical illustrations themselves. Further, this logic places the burden of challenging conventions on the shoulders of the illustrators whose power and position within the field is least secure.
Medical illustration is an embodied, material-technical process that defines and enshrines relationships of space, time, and category as both scientifically and socially salient. Substantive change in the form of biomedical visualizations and communications requires practitioners to move beyond “diversity’s inclusion into the terms of an institution” (Ahmed, 2012, p.9) to confront the exclusionary organization of professional discourse and practice and to acknowledge their own agency and epistemic power. Such epistemic change is a long process. In an informal chat with a Black female medical illustrator at the last AMI, I expressed frustration at the lack of progress, “It’s 2019!” She looked me in the eye and said calmly, “It’s only 2019.”
Abbott, A. D. (1988). The system of professions: An essay on the division of expert labor. Chicago: University of Chicago Press.
Ahmed, S. (2012). On being included: Racism and diversity in institutional life. Durham ; London: Duke University Press.
Burri, R. V., & Dumit, J. (2008). Social Studies of Scientiﬁc Imaging and Visualization. In The handbook of science and technology studies (Third Edition, pp. 297–317). Cambridge, Mass.: MIT Press.
Coopmans, C., Vertesi, J., Lynch, M. E., & Woolgar, S. (Eds.). (2014). Representation in scientific practice revisited. Cambridge, Massachusetts: The MIT Press.
Daston, L., & Galison, P. (2007). Objectivity. New York; Cambridge, Mass.: Zone Books; Distributed by the MIT Press.