Media Medica

The origins of The Doctor Who Wasn’t There are inescapably tangled with The Distance Cure—tangled in cords of telephone wires. The telephone was both the subject and object and medium of our meeting. I had been noticing the iterative updates to the electronic health record in the community health center where I practiced, watching my clinical colleagues alternate between breathless anticipation or (more frequently) exhaustion in the face of the rapid shifts in the digital mediation of healthcare we were witnessing well before the COVID pandemic.  And I had a sliver of insight that the medical history of the telephone, which had only ever been glancingly approached by historians of technology and medicine, might frame the beginning of a much broader history of electronic media in health.  Look at all the kinds of care, for better and for worse, that were only made possible through new affordances the telephone provided, like the anonymous hotline.  I was lucky: some well-placed colleagues saved me from a path that could only have led to humiliation, since Hannah Zeavin was already working in this space, assembling the call-logs of unorthodox practitioners and building a far more creative archive of hotlines than I could even conceive.  We spoke by telephone, and I have been in regular conversation with Hannah and her work ever since.

As Hannah was already exploring the telephone hotline as a new medium of care in mental health, I pivoted to explore the telephone as a medium of general practice.  I found a host of tele-practitioners of the past whose fixated their hopes and fears on the telephone as a crux that would either elevate the form and content of clinical care or thoroughly alienate patients and medical practitioners from the humanity of the healing encounter.  These visions of a future that did not quite come to pass were themselves forged in the social context of a past which itself has been selectively and iteratively forgotten.  As Hicks, Virdi, Grimaldi, Guenther, and Ostherr demonstrate in this forum, there are many ways to draw the differences as well as the similarities between our two works: user vs. practitioner, lay vs. expert, psyche vs. soma.  But read together they complement, and to my read today still enrich each other in new ways. Or at least, I can attest I still learn new things every time I pick up The Distance Cure.

Jai Virdi and Mar Hicks ask a pair of related questions of access and expertise that link the two books. How do new media enable access to care for some, while disabling it for others?  How do new media center or decenter the role of expert control or vs. lay and community advocacy?  Virdi, who has done so much to demonstrate what disability studies perspective can brings to the conjunction of media, technology, and health, attends to the mediation of care as a process which can enable or disable access for some users and not for others, based on both explicit and tacit elements built into the systems which mediate our care.  Mar Hicks, who has been a guiding voice in critiquing the reproduction of power dynamics within computational systems, asks in turn, how our histories might work to more actively de-privilege the voice of the self-proclaimed expert technologists in the spheres of health care.  As Virdi and Hicks—and Grimaldi, Ostherr, and Guenther—point out, each new technology of medical communications offers a new possibility to reduce the steep asymmetries of power and privilege which medical professionals and technologists often claim through expertise.  

When does a technology disrupt, or not disrupt the power dynamics built into care?  How do modes of technology which claim liberatory potential also offer means for those with means to further consolidate their control?  These are fundamental questions for historians of technology, and need to be repeatedly placed front and center in our prospective analyses of how we adjudicate, regulate, invest in, or place demands on new technologies as a polyglot and multivocal society.  As Katja Guenther points out, the very statement and restatement of these questions make these work inescapably political books about medical media.  Guenther’s recent work has delineated the role of media technologies in the making of the mind sciences, where the spectres of liberation and control are always lurking.  New tech always seems to promise to be liberatory—and can be used by agents of liberation—but all too often in the field of medicine seems to replace one form of paternalism (medical) with another (tech-bro).  This is not the opposite of paternalism but its analogue: technology all too often promises liberation but delivers a form of substituted paternalism.

Our books might look like specific histories of telemedicine or teletherapy, but really both are histories of the media and mediation of care.  They pull open windows into the broader intersection of media studies and the history and ethnography of science, medicine, and technology:  an incipient field, which has many antecedents but has not to date been properly understood as an area of scholarship in its own right.  And yet as Carmine Grimaldi points out, the history of new media iteratively and reflexively form the media through which history is researched, written, circulated, and discarded.  This invocation of new media to invert the ethics of the historian in and out of the archives is especially arresting: why do we feel no compunction about reading other people’s mail, but pause at the prospect of tapping their phones, watching their home videos?  Grimaldi’s own work in the cultural history of videotape inverts our understanding of archives in disturbing and productive ways.  Attending to media history, as he suggests, helps us attend to infrastructural elements of the ethics of history that our own normative practices as historians too easily allow ourselves to elide and forget.   Each of the authors of these essays, in their own works, have also explored the stakes of media history for health and medicine in unnerving ways: in addition to Grimaldi’s work on medical videography, Jai Virdi’s work on the hearing aid, Katja Guenther’s work on the media of mind sciences, Kirsten Ostherr’s work on AI, social media, medical film and television, and Mar Hicks’ mediation of computing all do this as well.  In other words, the themes read across this book forum represent a group of insights from scholars who take seriously the apposition of media, technology, and health—and sketch out many more possible areas for this scholarly conjunction.

For there is much, much more work to do here.  One criticism which I was surprised not to see among these generous and insightful critiques, is the evident observation that these two books are so very American (or at best “North Atlantic”) in their scope and source base. This could be considered especially ironic given the claims of electronic media to connect disparate geographies, to annihilate space.   I am not offering an apology here: I did what I could to write a book during a pandemic, as did Hannah. But it should be, I hope, an encouragement that there is an open field, and an urgently important field, for other authors to explore.  There is so much more to be written about the mediation of care across geographies, of the mediation of care as a means that links and connects transnational geographies, of the role of electronic media in motivating the global health imagination, of the differential uptake of older and newer media of care, and their re-appropriation and recombination into innovative forms at sites which are often elided in histories of innovation. I am excited to see the kinds of works that might take these questions forward in connected and transnational context. These are histories for others to write, and which will inevitably surpass the vision which our two books have cobbled together in their own limited scope.

Both of us, I think, hope to see a scholarly field of the media history of health and medicine that can move laterally, to other places, other practitioners, other voices, and reframe so many other forms of care in terms of a constellation of media medica. At the same time, as Ostherr reminds us from her own pragmatic perspective in building the field of critical medical humanities, the focus on medical mediation offers immediate practical engagements today as well. These books both document the risks, the losses, and the failures that emerge from accepting either the techno-critic or the techno-optimist at face value, when old media were new, and as new media become old. This historical framework is urgently necessary as we approach the multiple new medical media of the present and near future. How do we find the precedents for a sequence of putatively unprecedented media of care in the now and the near-future, to ensure, as Ostherr points out, an opportunity for meaningful dialogue between contemporary critics and techno-optimists before, not after, investments in new technologies are made? Here the urgency of history in the present cannot be minimized: to ensure that even as new medical media will never by themselves cure the social and structural disparities that limit our care, they might at least be approached with an eye towards harm reduction.

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