Abstract: This paper explores the capacity of theatre to complicate, multiply and extend the dynamic of looking and caring, as this is reflected in two recent productions, devised by the author. Bloodlines (2012-16) follows a patient undergoing treatment for life-threatening blood cancer, subjecting him to an anatomical strip-tease through the use of medical images with a “surprisingly emotional” effect (audience response to performance at the Science Museum, London). Careful (in development, since 2016) follows five over-stretched nurses as they care for their patients, putting the audience in the position of those patients. The piece allows subject positions to be blurred, so that “I and you becomes I am you” (Spiro et al. 1993).
Keywords: medical performance, spectatorship, medical gaze, empathy
Introduction: Looking and Caring in Medicine and Theatre
Both theatre and medicine are characterised by a dynamic of looking at and caring for others: the audience attends to the performer, the medical professional attends to the patient. However, despite this shared orientation, theatrical and medical looking tend to be starkly distinguished. In historical, sociological and cultural studies of medicine that form part of a Foucauldian legacy, the “medical gaze” is construed as an objectifying, even violent, force. For,
to look in order to know, to show in order to teach, is not this a tacit form of violence, all the more abusive for its silence, upon the sick body that demands to be comforted, not displayed? Can pain be a spectacle? (Foucault 2003: 102).
For Foucault, this gaze reaches its most oppressive form with the emergence of dissection as a clinical practice. Today, it is medical imaging that is equated with a similar anatomo-clinical way of seeing that, in its ever-closer attention to the interior of the body, divorces the medic from the patient and her subjectivity. For scholar Devan Stahl, who lives with multiple sclerosis, the medical scan “participates in medicine’s cold culture of abstraction, objectification and mandated normativity,” so that “patients seek medical care in order to be made whole, only to have themselves fragmented and objectified by the physician” (2013: 53-5). By contrast, “the peculiar acts of looking demanded in theatres” (Johnson 2012: 22) are often conceived of as empathic, a vehicle through which the spectator takes in the subjective experience as well as the bodily composition of those she looks upon. Looking enables a process of identification: of imaginative and vicarious participation in the suffering of another and, with this, the possibility of catharsis. This illustrated essay explores how such medical and theatrical gazes might be blended and blurred in an emerging area of cultural practice that I follow Kuppers in calling “medical performance,” one that surrounds and engages with “medical systems and bodies” and the “social and personal realities that open up” in response to these (2007: 1).
Bleeker conceives of theatre as a “vision machine,” as an event that organizes “the relation between those seeing and what they see, mediating in a specific relationship between the two” (2011: 2). Here, I reveal how these relations and relationships were orchestrated in two medical performances: Bloodlines (2012-16) and Careful (ongoing since 2016). These works, both devised by the author, play with the equivalence that might be drawn between the subjects and objects of theatrical and medical gazes. In other words, they ascribe to their audience members the subject position of the medic or patient, inviting them to adopt a certain way of seeing in relation to the patient or medic characters that they look upon. In doing so, they seek to complicate dichotomized characterisations of medical and theatrical looking. Moreover, acts of displaying and looking at others in medical performance are also suggestive of how we construe the “specific relationship” between medicine and theatre. Discussion of these two small-scale medical performances opens up to larger questions about how the distinct disciplines of theatre and medicine might be oriented to each other.
Examining the Patient: Bloodlines as Pathographic Performance
Bloodlines (2012-16) is a performance-lecture that integrates theatre, dance, visual projections and music, to track a patient undergoing treatment for acute lymphoblastic leukemia, a deadly blood cancer. Although not strictly autobiographical, it draws on the personal experience of supporting my brother through diagnosis, and the long and high-risk treatment for leukemia and of acting as his bone marrow donor (2007-08). Milton Mermikides, a music composer and researcher, subsequently created the sound tracks for both performances discussed here.
Because of this autobiographical aspect, Bloodlines can be situated within the field of pathographic performance delineated by Brodzinski, in which the presentations of the once/still sick patient on stage, offers insights into “the patient experience from the standpoint of those undergoing/having undergone treatment” (2016: 97). The practice exploits the analogous relation between patient and performer as the object of the gaze. One of Brodzinski’s case studies is performance artist and cancer activist Brian Lobel, who describes solo performance as “the perfect metaphor for being sick: one body was on stage, isolated and vulnerable” (2016: 88). Here, the role of patient and performer are elided. Likewise, the spectator in works such as Lobel’s BALL assumes the subject position of the physician surveying the medical “case” presented before her.
For Brodzinski, pathographic performance promotes a process of empathic engagement, it issues “a call to the audience to engage in an exploration of suffering and shared sense of vulnerability” (2016: 97). The assumption, I believe, is that this aspect of empathy is excluded from the medical encounter it mirrors. However, my premise in creating Bloodlines was that such empathic identification with the patient is inherent to medical looking. This standpoint derives from the medics I met during Milton’s year-long treatment, and during the making of Bloodlines (which involved close collaboration with medics at three hospitals.) I was particularly struck by witnessing pathologists diagnosing and monitoring patients with serious haematological disorders, for they showed and described strong affective responses towards people known to them only through bone marrow biopsies and hospital numbers. In this case, observation of the patient’s bodily composition did not necessarily blind the viewer from their subjectivity.
Likewise, in the medical educational contexts where Bloodlines was sometimes performed, it became clear that showing, teaching and knowing about “cases” did not necessarily preclude feeling, nor empathetic engagement with suffering. In Bloodlines, then, the spectator is offered the vantage point of the medic (in the first scene, they are addressed as though they are medical students), looking upon a patient who is “on stage, isolated and vulnerable.” Through the technologies of imaging and didactic discourse, the spectator is granted the pathologist’s or anatomist’s ability to see inside the body. And, yet, these “medical” ways of seeing and knowing enable an empathic response.
Scene 6: Dr Law outlines negative complications of stem cell transplant as a bone marrow donor is sought for the patient. Film by Kingston University media services
Scene 12: the post-transplant period (days 0-30) where patient is most at risk of graft-versus-host-disease, a potentially fatal immunological response to the donated cells. Film by Kingston University media services
A Nurse-like Gaze: Careful and the Feeling Nurse
Careful exemplifies another branch and context of medical performance: the theatre arm of arts-based medical and healthcare educational practice. Creative Health (an important report by the UK’s All Parliament Group of Arts and Health) recognizes the recent rise and professionalization of art-based medical/healthcare education as a welcome development, able to “address deficits in patient care by . . . promoting patient-centred approaches and empathic doctors and creating an intellectual culture within healthcare which values critical thinking and social engagement” (2017: 113). As such, it represents the latest incarnation of a discourse, rooted in the emergence of the medical humanities in the late nineteen eighties, that saw the arts and humanities as an education in empathy for the “humanistic physician” (Spiro et al. 1993: 7-8). In Spiro et al’s Empathy and Practice of Healthcare, empathy is “evident when ‘I and you’ becomes ‘I am you’ or at least ‘I might be you’” (7). This process of identification, which, he argues, underlies both the Aristotelian notion of catharsis and the ideal medical encounter (8), might equally describe theatrical looking.
While the empathetic education of doctors continues to be a matter of public concern, it is currently the turn of nurses to have their affective capacities put under question. This is due to the public and policy response to the failures in care across the Mid-Staffordshire NHS Trust exposed by the Francis Report in 2013. The response of healthcare education has been to develop and adopt a framework built around the values of “compassionate care.” Author and researcher Mark Radcliffe suggests that such policies and practices do not fully take account of nurses’ lived experience of caregiving in workplace contexts that are not always conducive to their well being.
In a paper on the “traumatized nurse”—a key influence on the Careful project—he alerts us to an overlooked fact in current nursing research, policy and debate: that “nurses feel” (Radcliffe 2015: 27). He calls for a more “helpful and sympathetic—one might say nurse-like way of thinking . . . about the human experience of the nurse” (26). Careful responds to this call by placing its nurse characters as the object of a spectators’ “helpful and sympathetic” gaze. The show follows five nurses in their deliberately mundane interactions with patients, interlacing these short encounters with sections of choreographic movement. It hints that there can be limits to nurses’ capacity to care or to do so without emotional cost to themselves.
As well as positioning the nurse as the object of the spectators’ gaze, the performance projects the role of the patient onto the spectator. In its first public performance in a fully-equipped, hyper-realistic hospital ward used for nursing education, audience members were made comfortable in the patient beds and visitor chairs. In both this site-specific version, and subsequent performances in theatres, spectators are interpellated as patient through direct address:
Bloodlines drew a simple corollary between spectator/medic as subject of the gaze, and performer/patient as its object. In Careful, however, subject positions are more playfully layered, and gazes more reciprocal. In moments such as this, when we are called by another’s name, we become supremely aware of ourselves as ourselves, in a way that runs counter to our normally recessed position in the darkened auditoria of the theatre. The effect of being looked at by the nurse character and by our fellow patients/spectators, is to simultaneously make us conscious of ourselves while also inhabiting, to some degree, the patient who is projected upon us.
Furthermore, we are also being invited to identify with the nurse before us: with Nurse Phil who needs to insert the canula into you as the reluctant child or Nurse Thalia as she greets you as her first patient. The choreography that accompanies some of these nurse-and-patient encounters reflects these simultaneous or layered subject positions so that, for example, the slouch that characterizes teenage diabetic Julian and the furrowing of Nurse Dom’s brow, are incorporated into the same sequence and are embodied by multiple performers.
Nurse Dom warns Julian about the health risks of drinking too much. Film by Anna Tanczos, from a performance at the Ivy Arts Centre, Guildford, 2016. The performers are Helena Rice (blue tunic), Archana Ballal (lilac scrubs), Thalia Papadopoulos (green tunic), Dominique Vannod (white tunic) and Philippa Hambly (light blue scrubs)
Nurse Phil checks Darren’s port-a-cath site
In different ways, Bloodlines and Careful seek to unsettle too easy a distinction between the positions of looker and those who are looked upon as the subject and object of empathy, compassion and care; between processes of “medical” objectification and “artistic” humanization, and, ultimately, between dichotomized concepts of medicine and the arts.
The ability of medical performance to create complex layered experiences of illness and of medical encounters merits the attention of theatre and performance scholars. In addition, as an interdisciplinary practice, medical performance would also reward further study by those who are concerned with the “specific relationship” between medicine and biomedical science, on the one hand, and the arts and humanities, on the other. There has been renewed interest in this relationship in recent years, particularly within the critical medical humanities—and the urgency of the debate has been emphasized by a landmark article in the British Medical Journal of Medical Humanities, by eminent cultural scholar Julia Kristeva. In this, Kristeva et al urge us to avoid thinking of the humanities as “an instrument of ‘repairment’” or a “‘soft’ supplement” to a stable body of “objective” biomedical and scientific knowledge (2018: 56).
Given a climate of economic austerity that requires those in the arts and humanities to justify their relevance and, in research circles, their “impact,” it is tempting to fall into the sort of position against which Kristeva warns. This is a particular risk for projects like Careful that have an educational or applied intent in relation to the medical or healthcare sector: it is all too easy to be construed as an “instrument” designed to plug supposed “deficits” in healthcare provision.
However, what I have sought to demonstrate through these relatively minor examples of medical performance, is how practices that sit at the intersection of theatre and medicine might support Kristeva’s project. They suggest, I hope, that the contribution that our discipline can make to these debates lies less in providing a “subjective” antidote to medical objectivity, than in challenging this dichotomised way of thinking.
Both performances sought to challenge dichotomized concepts of medicine and the arts by unsettling too simplistic a distinction between the positions of looker and those who are looked upon as the subject and object of empathy, compassion and care; and between processes of “medical” objectification and “artistic” humanization. They indicate that those who engage with theatre and performance understand that it is possible to simultaneously inhabit epistemologically distinct positions, and to orchestrate relations between people and between disciplines, in which looking at and caring for the other is a mutual activity. Through this, we might surpass binary positions that artificially distinguish objectivity from subjectivity; knowing from feeling; understanding from empathizing; self from other—and, along the way, medicine from theatre.
Stahl, D. “Living into the Imagined Body: How the Diagnostic Image Confronts the Lived Body.” Medical Humanities 39.1 (2013): 53-8. Print.
Radcliffe, M. “Storying, Fiction and Philosophy: Turning Our Attention to the Traumatised or Damaged Nurse.” Medical Humanities 42 (2016): 26-30. Print.
Kristeva J, Moro MR, Ødemark J, et al. “Cultural Crossings of Care: An appeal to the Medical Humanities.” Medical Humanities. 21 Sept. 2017. Web. doi: 10.1136/medhum-2017-011263
Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. 3rd ed. London: Routledge, 2003. Print.
Kuppers, Petra. The Scar of Visibility: Medical Performances and Contemporary Art. Minneapolis: U of Minnesota P, 2007. Print.
Brodzinski, Emma. “The Patient Performer: Embodied Pathography in Contemporary Productions.” Performance and the Medical Body. Ed. Alex Mermikides and Gianna Bouchard. London: Bloomsbury Methuen, 2016. 85-97. Print.
Bleeker, Maaike. Visuality in the Theatre: The Locus of Looking. New York: Palgrave McMillan, 2011. Print.
Spiro, Howard et al. eds. Empathy and the Practice of Medicine: Beyond Pills and the Scalpel. New Haven: Yale University Press, 1993. Print.
“Creative Health: The Arts for Health and Wellbeing.” All-Party Parliamentary Group on Arts, Health and Wellbeing, Inquiry Report. All-Party Parliamentary Group (July 2017).
Johnson, Dominic. Theatre and the Visual. London: Palgrave Macmillan, 2012. Print.
 I use “patient” as a blanket term to refer to a certain social role, occupied by those who are the object of medical attention. Similarly, I use the term “medic” for the medical equivalent of this role. In both cases, the terms cover a range of social and professional roles that might not be referred to in this way in their local contexts.
 These were the haematology departments at Antwerp University Hospital, St. George’s Hospital and Hammersmith Hospital (where we were treated). Our main collaborator in Antwerp, Dr Ann van de Velde, performed in the debut production of Bloodlines.
 These includes performances at Antwerp University Hospital (to former patients and medics), at the Belgium Haematological Society conference (to specialist oncology nurses), at St.George’s Hospital (to newly diagnosed patients) and to medical students at Hammersmith and St. Bartholomews Hospitals.
 The article is positioned as being in line with the Lancet Commission on Culture and Health, arguing for a need to “to fundamentally question the cultural distinction between the objectivity of science and the subjectivity of culture” (55).
*Alex Mermikides leads the doctoral programme at Guildhall School of Music & Drama, which specializes in artistic research in the performing arts. Her own research also bridges scholarship and practice. She has published on contemporary theatre-making (particularly devised and interdisciplinary performance) and the interface between theatre and medicine in the UK. Her edited books include Devising in Process (Palgrave 2010) and Performance and the Medical Body (Methuen Bloomsbury 2016), and she is currently working on a monograph on theatre, medicine and concepts of the human. She runs Chimera, an arts/research network founded in 2012, with an award from the Arts and Humanities Research Council. Through this, she creates performances on medical themes, often working in collaboration with medical specialists and patients. Her current project, Careful, was supported with public funding by the Arts Council England.