Once Upon a Time, Long Ago and Far Away: A Short History of Removal, 2022, performative lecture, installation, and video 45 to 50‘

Combining a tabletop sculptural work of back-lit medical imaging displayed on modified Tupperware domestic containers, projection and a spoken word performance of fiction and non-fiction elements, this work dwells in the liminal space of the patient as an often-transitory player in the stratified world of the practice of medicine. The audience are encouraged to be participants in the dimly-lit, hushed, intimate space, reminiscent of a hospital ward. As Fiona speaks, the audience moves around the table in formation, viewing each vessel and slide in turn, mentally stitching together the static objects in one narrative, embodying the moving image. Considering the images’ ambiguities, each person makes their own personal connections and meaning from the collection of works. This unique experience offers audiences the opportunity to reflect, and question the nature and meaning of the seen and unseen, the observed and the experienced, in this liminal space.

This is the introductory text for the performative work.

In this performance I am bringing together three frameworks. – the violence of medicine, Svetlana Alexievich’s way of writing between fiction and non-fiction and a focus on re-centering the patient.  

A patient being held down, as without anaesthesia their shattered or gangrenous limb is being amputated is a powerful easily understood example of the violence of medicine in action. A more subtle example from the same historical period is how the practice of bloodletting became the default response offered by medical practitioners for a broad range of illnesses and was undertaken even when the removal of blood from the patient was detrimental to the wellbeing of the patient. In both examples the intention is benevolent. The American academic Johanna Shapiro in her 2018 seminal essay, “Violence” in medicine: necessary and unnecessary, intentional and unintentional, (Shapiro, 2018) relied on the World Health Organisation’s definition of violence - ‘the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.’ (WHO 2002) This definition does not consider motive.  Shapiro then applied this understanding to violence in medicine and established a framework categorising where ‘violence could not only be a physical perpetration but also be an act of power”. Shapiro’s categories were violence to the body, structural violence, metaphoric violence, and bureaucratic or organizational violence. Shapiro asserts that to call these actions a form of violence is to overcome the relative ease with which such events are ignored, dismissed, or trivialized as it is a conscious way of highlighting a continuum of violence that we would prefer to ignore.Shapiro’s essay had been preceded by an earlier chapter in a book (Kothari et al, 1988) that focused on locating the violence of medicine in economic, philosophical, environmental, and social contexts. The authors queried the medical industries focus on making money, on overprescribing drugs, on overusing surgical interventions after over diagnosing.  

The specific categories of the violence of medicine that I focus on are: - surgery/going under the knife, wearing the uniform of the patient, using the language of war, systems of discrimination or alienation and being the chosen one or not. 

The second framework is the example of the writing of Svetlana Alexievich. In her books, she has edited lengthy interviews into tiny fragments, placing them one by one into a complex but coherent narrative.  Allowing her subjects to speak for themselves, she has progressively minimized her own role as interpreter or commentator.  The effect of her work has been compared variously to a mosaic or a choral symphony, in which many voices are heard, creating a detailed panoramic picture of a given era in history. More recently She has written up witness accounts of Soviet children in the Second World War also called the Great Patriotic War. The title is Last Witnesses: Unchildlike stories.   

Now to the third framework, for this performance I start with a focus on surveillance of the patient.  In hospital, surveillance of the body of the patient at its most basic can be thought of as consisting of direct and indirect observation, collection of data and the visualisation of that data including through medical imaging. As observations are increasingly coded and translated into alphanumeric data or its equivalent, these initial processes of surveillance have replicated the body as data and facilitate the creation of “data doubles” as a perpetual manipulable record of that surveillance. During training of the AI algorithm and in the process of developing recognition of patterns within machine learning, the patient is currently deidentified and their story removed. However various research papers speak of the increased importance in the third wave of machine learning of focusing on the context of the data, the lives and experiences behind the data, understanding the people behind the data and creating a platform for engagement and empathy. Maybe a re-centering of the patient.

 The format of this performance is a series of nine fairy tales separated by short segments of academic text and oral histories that bring in the voice of the participant.