Seeing and Unseeing

To read these two brilliant books side by side is an exhilarating experience—they not only offer new historical and theoretical insights into the role of media in clinical care, but they point towards unique (and uniquely thorny) historiographic questions. For as these media wended their way through medical and therapeutic treatments, they also left peculiar types of records for the archivist and historian, records that have and will shape the types of stories we tell about them. As Lisa Gitelman has put it, the writer is “always already being ‘done’ by the media she studies.”[1] I’d like to use this space to think alongside Greene and Zeavin so as to understand more clearly what is being done, and what limitations and new possibilities these peculiar records might present.

I’m particularly curious about how historians should read, hear, and see patients of the past, and how this is inflected by expectations of anonymity and privacy. In his introduction, Greene nicely sums up the prying practices of historians, writing that “we [historians] read other people’s mail”(Greene, 11). As I went on to read his and Zeavin’s histories on the many ways that media has shaped medical and therapeutic practice—phone, pagers, radio, video and audiotape, mainframes, and AI—I  returned to this earlier metaphor: If Greene had written, “we tap other people’s phone lines,” or “we watch other people’s private videos,” we (or at least, I) would pause, feel a pang of anxiety, and wonder, wait, do we do that? Why these differing intuitions? It seems there are at least two reasons, latent in metaphor of “mail”: first, the word implicitly distances us temporally from the writer and recipient (for who really communicates via mail these days?); and second, it keeps us firmly in the legitimacy of history’s traditional practice of textual research, rather than the potentially more invasive and intimate realm of sight and sound.

Regarding the temporal distance, it goes without saying that the further back in time we go, the fewer qualms we have rummaging through private lives: it would, for example, be entirely different to include identifying details about a Little Hans born 20 rather than 120 years ago. And it is the period that both Zeavin and Greene focus on—within the penumbra of the dead and the living—that feels most anxiously charged. It is certainly history, but barely. As Zeavin writes when discussing the logs of a suicide hotline: “It may be that the most troubling work I did in this project was wading through the call logs of a suicide hotline… I doubt very much that anyone calling a suicide hotline in the 1970s thought that in giving their information to a counselor, it would end up in an archive that was publicly accessible within their lifetime, if ever… Part of doing this work involved seeing documents and then working to unsee them” (Zeavin, 23-24).

This dilemma of seeing and unseeing points to the second puzzle that comes with media histories of medicine during this period: what does it mean when the archive is not written down, but preserved on audiovisual records of the people themselves—when the archive presents the bodies and speech of the patients in all their physical intimacy? To focus on a medium that appears in both books, the possibility of audio and videotape recordings pose a double bind: in addition to a history of the inventors and doctors who implemented media, we also want to capture the experiences of the patients; but to do so, we often have to look at records not intended for us, to attentively scrutinize another’s way of being—their expressions, gestures, intonations, embarrassments—and violate an earlier promise of discretion. I imagine I’m not alone in feeling that there is something substantially different between reading a transcript of a therapeutic session and watching a tape of it. Had there been audio recordings of these suicide hotline calls, would Zeavin have listened to them, and if so, what practices of listening and unlistening should the historian develop? And, were there incidental videotapes or kinescopes of the telehealth meetings between patients and doctors in Omaha and Boston, would Greene have watched them? In general, it’s been my experience that anthropologists and documentary filmmakers have been much more anxious than historians about the ethics of observation. This distinction may ebb, however, as (or maybe I should write “if”) these historical media are increasingly preserved in the archive, and we are able to perceive people from the very recent past with greater vividness and immediacy. (That I can plausibly write “immediacy” and “vividness,” words that could have been similarly used by a character from one of these two books, suggests another way we are still in the penumbra of this history. Perhaps this basic intuition that these media present unique ethical challenges vis-e-vis written documents is something that itself should be historicized?)

And I doubt very much these questions can be resolved into general rules for individual historians to follow: we work with particular archives, each with peculiar qualities, and the historian will inevitably have to make judgment calls that are unique to their research and subject.[2] But it’s important to grapple with these questions—rather than defer them, or simply accede to the specificity of individual practice—because how we try to answer them will have ramifications on the way electronic media are preserved and thus the kinds of history we can write. Obsolete electronic media are astoundingly difficult for archives to preserve: they’re expensive to store and process; they require obsolete equipment that’s hard to find and technical expertise that’s even harder; and they come with the same ethical conundrums that face the individual historian, multiplied onto the institutional scope. While many of these records were never made or no longer exist, many do, somewhere, languishing in attics and storage sheds and supply closets with little interest in curating or preserving them. (As one example, I recently tried to help the descendants of an early practitioner of videotape therapy find an archival home for their large collection of clinical tapes. We fruitlessly contacted institutions over nine months; not one evinced even the slightest interest.)

These two books make a strong case both in favor of expanding this type of archive, and of allowing them to fall into desuetude: the former, because the two books so compellingly establish the centrality of media in medical history and open up so many new and generative areas of research, and the latter, because they have managed to study their subjects so skillfully without the use of extensive records from the inscribing media themselves. I’m not sure that watching hundreds of individual mundane medical encounters would radically transform the story we tell. And if it did, it’s not obvious it would always be for the better: as I read Greene’s chapter on telemedicine, for example, my initial curiosity about what an extant recording of these meetings might reveal through its form began to ebb as I read his astute observation that these aesthetic decisions were motivated by proxemics, the theory that interpersonal familiarity was directly linked to physical distance, and that much of the contemporary discussions of the framing and lens length “should be read as a broader indictment of the blinkered view and outsized aspirations of medical sociology in the 1960s, and its relative inability to address the structural racism in healthcare”(Greene,  134). It is easy to imagine historians—frankly, I can easily imagine myself—becoming seduced by the televisual record that seems to offer a direct window into the experiences and relationships between doctor and patient, and in placing undue interpretive weight on it, inadvertently adopting the very priorities of those who should be radically historicized.

With this risk in mind, if we believe a more concerted effort of preservation is worthwhile and ethically defensible, we should consider developing a historiographic practice that both accounts for privacy and creates a generative distance from the media and its subjects. In this context I found inspiring Zeavin’s discussion of the many ways that therapy has productively embraced forms of anonymity, whether it’s the “underfeatured” privacy of call-in radio, the “double anonymity” of the suicide hotline, or the diary’s “fantasy” of privacy (see, respectively, Zeavin, 85, 183, 156). Like the therapeutic practices Zeavin recounts, perhaps we can also create intentional structures and practices to not simply work around these gaps, but to create these distances and occlusions, whether in the way we structure archives or the way we aesthetically intervene in the records. We could learn a lot from filmmakers and artists that are uninhibited by traditional historical methods: Kamal Aljafari, Bill Morrison, Rania Stephan, and New Red Order, to name just a few, all embrace distortion, remediation, and vandalism to uncover aspects of history that are obscured through the purportedly more objective original version. As both of these books have shown so well, distance can generate new forms of proximity. We historians often work tirelessly to close historical distance. But perhaps, at times, we can paradoxically bring the past nearer by pushing it further away.

[1] Lisa Gitelman, “Always Already New: Media, History, and the Data of Culture (Cambridge, MA: MIT Press, 2006), xi.

[2] At the moment, there are no consistent regulations in the US that oversee this area of research. One could, perhaps, choose to apply to the IRB under the category of “non-human subjects,” but unlike other categories of research, this one notably has no basis in federal law and is primarily sought when an individual archive or academic journal requires it.

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