stuff of nightmares part 2
Apologies for continuing with the experiential renderings, but sometimes our own interactions with people and their machines can prove very interesting indeed….
In the follow up to my sleep study, I was told by my doctor that I have “sleep architecture that displays several indicators of depression”, and he proceeded to try to convince me that I am depressed despite my assertions to the contrary. In some ways this resonates with the discussion of the convincing power of visual data in Modeling Proteins, Making Scientists. Studies of sleep architecture may not produce models per se (though like Morrison and Morgan’s ‘renderings’ (quoted on page 64), its legitimacy is derived from its performance), but through these visualization practices, they do produce convincing data that is taken for the thing in itself (at least by this particular doctor) rather than the product of a certain experimental apparatus statistically correlated with particular experiences.
If you follow the link below, you will find an interactive graph depicting the sleep architecture of a “normal” individual:
http://www.osrmedical.com/en/themes-lies-au-sommeil/
By way of contrast with this “normal” subject, a depressed person has short REM latency (they go into REM sleep more quickly – which, while presumably undesirable as far as these researchers are concerned, is intentionally cultivated by “sleep hackers” like this guy: http://dustincurtis.com/sleep.html through intentional sleep deprivation). Other such indicators include: i) sleep continuity disturbances (e.g. prolonged sleep latency, nocturnal awakenings, and early morning awakening); ii) diminished slow wave, delta sleep (stages 3 and 4); and iii) an altered intranight, temporal distribution of REM sleep, with increased REM sleep time and REM activity earlier in the night (Reynolds and Kupfer 1987). Another indicator to add to this list is time spent sleeping, with those with unipolar depression sleeping less per night than either “normals” or those with bipolar depression. I’m sure anyone who read my previous post would be surprised if I didn’t have at least some of these (especially those dealing with REM – though dreams and REM sleep aren’t as correlated as we’re usually told to believe), after my descriptions of the experimental apparatus, how difficult that made it to fall asleep and the nightmares and frequent awakenings that resulted. These patterns were not understood as resulting from the particularly fraught intra-action that I described previously, but were taken to be indicative of how I sleep generally, and by consequence of previous studies into mental illness and sleep, what my moods are. As such, I question in what ways diagnostic practices serve to animate the charts and statistics produced through research. It strikes me as dangerous that charts and statistics regarding structures of sleep can be taken as more authoritative as to the suffering of the patient than the patients own experiences. Such presumptions not only subordinate the patients experiences to medical categories, but, through equating prediction with certainty (roughly 70% of those with these features are depressed according to Fleming), serves to homogenize the experiences of all individuals with features of this architecture.
Joseph Dumit’s 2003 ethnography, Picturing Personhood, elaborates on how “normal” subjects are selected for PET scans according to gender, race, handedness, age etc such that women, racial and sexual minorities, lefties, and those not within a particular age group become eliminated from the category of “normal” (61-63). Graduate students (regardless of how white, male, heterosexual and righthanded), I suspect, would fail the ‘normal’ test too.
Dumit, Joseph
2003 Picturing Personhood: Brainscans and Biomedical Identity. Princeton NJ: Princeton University Press.
Fleming, Jonathan
1988 Sleep Architecture in Depression: Interesting Finding, or Useful? In Progressive Neuropsychopharmacology and Biological Psychiatry 13: 419-429.
Myers, Natasha
(forthcoming) Modeling Proteins, Making Scientists: Rendering Molecular Life in the Contemporary Biosciences.
Reynolds, CF. And Kupfer DJ
1987 Sleep research in affective illness: State of the art circa 1987. Sleep -1 0: 199-215.
February 24, 2010 at 8:34 pm
I am consistently surprised at my own surprise when research like the sleep architecture-depression correlations you reference are applied as proscriptive and causal, while the individuality of the case, the actual patient’s narrative and experiences, are brushed aside.
working from a diffraction, a series of shadows cast by the patient onto a sheet of paper in the form of squiggly lines, your dr tries to render the 3-dimensional reality of your experience. instead, s/he presents you with a model as mangled as those student attempts that Natasha’s participant Diane describes. on the surface, viewed from one 2-D angle, everything matches up, but as soon as you turn, or enter the model, it no longer fits.
February 25, 2010 at 10:11 am
I was really struck by your comment when you said,
“As such, I question in what ways diagnostic practices serve to animate the charts and statistics produced through research. It strikes me as dangerous that charts and statistics regarding structures of sleep can be taken as more authoritative as to the suffering of the patient than the patients own experiences.”
I feel like this observation of the seduction of the image really gets at the patient-client’s frustrations when they “feel” or “experience/sense” when something is “wrong” or “different” with the way they usually embody/experience their body. Just because a test result is negative does not make it a positive in the opposite direction. What does that last mess of a sentence mean? This past year I was diagnosed with a stomach ulcer without a positive diagnosis, meaning they never actually found it. 4 of 5 doctors, having performed lots of blood work looking for organ malfunction, parasites, bacterial infections, and stress responses asserted that despite my experience of symptoms (stomach pain bloating, digestion issues), nothing was wrong me. In a sense, a negative test result was taken as a positive diagnosis of good health. When each test result came back negative I was assumed to not have “anything” instead of not having what the test tested for. I became suspicious of these doctors and the seduction of the lab report. But I also felt that these specific doctors expected their expertise to also be seductive. At gateways to treatment, their authority in many ways gives meaning to the tests and instruments used to measure and visualize.
I think your post really gets at this and I really appreciated your electrode picture (you should wear them more often :p).
February 25, 2010 at 10:39 am
Wow, what a strange experience. And under different circumstances I would also say that they “wired look” from your previous post is a good/really cool one (but obviously the problems which got you to the clinic in the first place preclude the complementary power of such a comment).
That being said, I’m interested in how EEG, EOG, EMG, ECG, readouts function as maps or cartographies of body parts. Haraway takes up the fetishization of maps in “Pragmatics” in which she describes maps as being “models of the world crafted though and for specific practices of intervening and particular ways of life.” (Haraway, 135)
I’ve also recently come across Jean Baudrillard’s ideas of maps and territory in Sumathi Ramaswamy’s book “The Lost Land of Lemuria: Fabulous Cartographies, Catastrophic Histories” (2004) where she explains his notion that “The map has come to precede the territory. Rather than the map being a product of the territory, as it is usually understood, coming only after it–both temporally and conceptually–and remaining answerable to it, there has been a curious reversal.” “Debates,” she says, are now “conducted in terms of the map rather than the territory itself.” (Ramaswamy, 287)
I’m interested to see if this idea can be extended into medical mapping like the graphs and charts created during your experience in the clinic. I think this might speak to your concerns over how “charts and statistics regarding structures of sleep can be taken as more authoritative as to the suffering of the patient than the patients own experiences.”
February 25, 2010 at 11:06 am
I also like your comment about how “charts and statistics regarding structures of sleep can be taken as more authoritative as to the suffering of the patient than the patients own experiences.” The role of standard biomedical model and the acquisition of the patient role is something I am interested in exploring in my own studies on mental anguish (suffering that falls between clear diagnostic criteria) and psychological ontologies. It’s pretty shocking when medical authority intervenes to supersede that of the individual’s own subjective understanding. This enters the fascinating arena of risk management and contemporary preoccupation with ideas of susceptibility which brings potential futures into the present and tries to make them the subject of calculation and the object of remedial intervention. I agree with you that this is best described as “dangerous” – existentially healthy people are now asymptomatically or pre-symptomatically ill with invisible and unfelt pathologies.
February 25, 2010 at 10:30 pm
Really interesting food for thought in each of these comments, thanks guys! Jordan, thanks for the reference
Eric, if you haven’t already read it, you might also find Dumit’s argument that we are moving from a model of health in which illnesses are interruptions in an otherwise healthy body to the body as “inherently-ill” which he discusses in this paper: http://molinterv.aspetjournals.org/content/2/3/124.full very much along the same lines as the presenting of futurity you discuss. I wonder how much of that was going on in this scenario, or if the psychological presumptions were based on my gender (us emotional women!), the doctors areas of interest (though he’s actually more interested in using meditation to realign chakras as a treatment for various sleep disorders – super interesting juxtaposition there!!!) or simply a presumption based on how unhappy I tend to look when i haven’t slept
Regardless, there seems to be a lot to untangle in this world. Being intrigued by medical research practices makes this kind of situation far more enjoyable for me than it would be for the average patient dealing with the discrepancy between their experiences and their treatment by the medical establishment.
As such, any jokes about my new look will not be discouraged
February 26, 2010 at 4:57 pm
Thanks for the article suggestion!
I saw this in the NYT and thought you might enjoy: http://www.nytimes.com/interactive/2010/02/25/opinion/26Schottimg.html