Feature: Flex and Ply
4 August 2009. By Penny Bailey
The body can mean different things to different people. To the pragmatic medic who has become somewhat inured to the emotional meanings of the body after years of exposure to death and disease, it can become an object to be assessed and treated. To the patient, the body is part of his or her identity, something vital and precious that, when it is violated or treated with disrespect, can arouse feelings of embarrassment and resentment.
Man, aged 43: "They told me to go into a cubicle, take off all my clothes, and put on a hospital gown. Then I had to go back to the X-ray waiting room and wait there. The hospital gown didn't meet at the back…but even worse was the fact that the waiting room was full of people in their outdoor clothes".
Woman, aged 27: "I'd actually gone in with food poisoning…and this young doctor came and gave me a breast examination. He didn't give me any explanation, just came over and started doing it. I felt…violated."
A range of views are being explored by the Flex and Ply collaboration, funded by an 18-month Wellcome Trust Large Arts Award and led by Professor John McLachlan, a scientist and medical educator at the Durham University, with textiles researcher Professor Karen Fleming at the University of Ulster. The team is looking at four ways of looking at the body: the aesthetic, erotic, symbolic and scientific 'discourses'.
They are particularly interested in the overlaps between the 'scientific' or medical discourse and the aesthetic and symbolic meanings of the body (the latter being the idea of the body as identity and its emotional significance to the patient). Using textile creations, body painting and projection, they aim to bridge the gap between these discourses, and to challenge culturally constructed views of the body.
The Incisions Gown
Traditional methods of teaching anatomy with human cadavers have their limitations - the living body, and communication with living, sentient patients, are central to medical practice. Professor McLachlan has been seeking to develop less 'desensitising' methods of teaching anatomy, so the Flex and Ply team has developed the Incisions Gown, made of transparent white silk and resembling a hospital gown with ties at the back. The gown is covered with zips with medical labels, such as 'median thoracotomy', 'transverse abdominal' and 'nephrectomy incision', representing the major sites of operation incisions.
Professor McLachlan uses the gown routinely when teaching medical students at Durham. Students take turn to wear the gown, and the group talks through the incision sites, opening and closing the zips at each site. "I ask, why is there a cut here? What's it for? Where would you cut to remove a kidney?" he explains.
While the gown has proved to be a fun and memorable way of learning where surgical incisions are made, it also resonates with symbolic meanings. The feel of the material can be used to discuss living flesh, which is very different from the feel of a preserved cadaver. "Students react with shock and dismay when I suggest cutting or slashing the gown, or spilling ink on it. Yet we cut skin and spill blood during surgery - and the body is more precious than silk," says Professor McLachlan.
Similarly, the ties at the back - similar to those on a hospital gown - can provoke discussion about embarrassment and exposure the patient might feel. The gown therefore encourages students to preserve and develop their intrinsic empathy - to consider the violent and intrusive nature of surgery (represented by the zips, which open to reveal jagged slashes), and the importance of clothing as a buffer against the vulnerability of nudity.
The gown has featured in a number of exhibitions in venues that include the Museum of Science in Boston, the Palos Verdes Art Centre in California and the Science Museum in London.
Body painting and hidden maps
Another approach Flex and Ply uses to explore the overlap between the aesthetic and scientific is body painting. As part of their learning, medical students and radiographers at Durham University and the University of Ulster respectively paint different parts of the internal human anatomy onto live models.
Such painting is a vivid experience that stays in the mind, and is therefore an aid to long-term retention of anatomical details and structures. "Your lungs actually go up to your neck," says Professor McLachlan. "Once the students have painted the collarbone, then painted in the lung, then they won't forget it because they've done it. It's more helpful and engaging than textbook anatomy."
The body also contains hidden maps that physicians have to learn to recognise. Such maps include the dermatomes - spinal nerves that snake around our sides to meet in the front. The dermatomes are responsible for the pain that people feel with shingles and other forms of abdominal, side and back pain, and are important in anaesthesia, especially for epidurals delivered to the spinal nerve.
When the team painted these hidden maps onto living bodies, they found some unexpected inconsistencies in the translation from two-dimensional diagrams in anatomical textbooks to three-dimensional bodies. Often the textbook diagrams showed only front and back views, with no indication of what happens on the side of the body. As a result, students painting those map onto living bodies found they had a mismatched 'side-seam'.
"These diagrams are impossible dimensionally," says Professor Fleming. "We made lots of phone calls to Professor McLachlan asking where the front and back should meet." Professor McLachlan says "I didn't know that I didn't know the answer,". "You have a picture of something, you think it's information, then find you can't use it to construct something. The implication is that there's a truth and science owns it. But there isn't and it doesn't."
The team found inconsistencies in diagrams between different textbooks - and sometimes between different diagrams within the same textbook. This is partly due to the traditional use of two-dimensional diagrams that tend to ignore three-dimensional reality - and partly because many textbooks used widely in medical education use diagrams copied and adapted from earlier texts, with the result that small distortions - often made in order to reflect changing cultural norms - become magnified over time.
This finding, says Professor McLachlan, is a key role of science-art collaborations. "It shows the role of the artist is to challenge, change and provoke science." To follow it up, Professors McLachlan and Fleming are undertaking academic research into the cultural shifts in anatomical representations of the body over time.
They also plan to undertake a crossover study of two cohorts of medical students to quantify the impact of these kinaesthetic and haptic methods of learning on retention and memory, and compare the results with traditional textbook methods.
The work is already catching on. Lecturers and students at the University of Western Australia in Perth, where Professor McLachlan had a visiting professorship, and other UK medical schools are already developing new interactive and aesthetic teaching methods.
Finally, there has been another benefit from the project - this time for the teachers of arts and textiles. "In the UK about 3000 fashion designers are trained every year," says Professor Fleming. "As in most fields, professionalism, conscientiousness and people skills are key employability factors - raw talent is often not the marker of the successful graduate. So it has been fascinating working with the medics and allied health professions, and seeing how these career skills are assessed in other disciplines."