Notes for Joseph Dumit Picturing Personhood: Brain Scans and Biomedical Identity

Chapter 1
Introduction
(4) The result is a “picture” of the molecular flow in the body. This description is, of course, very general and overlooks many qualifications, assumptions, and variables in PET. This description is also not neutral. It will take the rest of the book to explain how each description of PET by different PET researchers is part of an ongoing attempt to define the meaning and purpose of PET and PET images, to make claims of invention and contribution, and to give ontological structure to the brain.
(4) On the basis of my research, I have identified an area of PET signification that I believe is critical in debates over the roles of PET in the world today:
the visual effect of PET brain images. . . . While representing a single slice of a particular person's brain blood flow over a short period of time, one scan can also represent the blood flow of a type of human, be used to demonstrate the viability of PET as a neuroscience technique, and demonstrate the general significance of basic neuroscience research.

Popular Brain Images
(5) We should try to become as aware as possible of the people who interpret, rephrase, and reframe the facts for us (the mediators). We should also critically assess the structural constraints of each form of representation – peer review, newsworthiness, doctor presentations to patients (the media). In the case of the brain, these processes of fact translation are caught up in a social history that includes how the brain came to be an object of study in the first place, and what factors – conceptually, institutionally, and technically – were part of its emergence as a fact.
(6) The cultural and visual logics by which these images persuade viewers to equate person with brain, brain with scan, and scan with diagnosis are also the subject of this book.

Not sure if this is really to quote I was reading last year when I first read this book.

(7) We might call the acts that concern our brains and our bodies that we derive from received-facts of science and medicine the objective-self. The objective-self consist of our taken-for-granted notions, theories, and tendencies regarding human bodies, brains, and kinds considered as objective, referential, extrinsic, and objects of science and medicine. . . . With received-facts, we fashion and refasion our objective-selves.
(9) All of this is to say that what we come to receive as facts about ourselves are analyzable from a number of perspectives. We might look at the cultural salience of categories like mental illness and gender. We might look at the fundability of different approaches to brain scanning. We might attend to the available metaphors for thinking about brains and people. Through this may seem critical of science, these perspectives are the same ones from which scientists talk and debate about their work and its dissemination.
(9) These flows enable and constrain science at every level of fact conception, experimentation, publication, and dissemination, and reception, but this does not imply that science
is culture. There is an interplay between popularization processes and scientific inquiry. Science produces facts in spite of and because of these constraints – laboriously, continuously, and creatively. And we fashion our objective-selves with the fruit of this labor in the form of received-facts in our own continuous and often creative manner, no matter how skeptical we are. This way of living with and through scientific facts is our form of life.

Methods: An Ethnography of Images
(10) My model was Appaurai and Kopytoff's ethnographic approach to the “social life of things” (Appadurai 1986; Kopytoff 1986). Meaning, from a cultural anthropological perspective, is a lived relation among cultural actors, and to the extent that things such as images and technologies are attributed agency, they, too, participate in cultural exchange.

The meaning that people attribute to things necessarily derives from human transactions and motivations, particularly from how those things are used and circulated. The contributors to this volume examine how things are sold and traded in a variety of social and cultural settings, both present and past. Focusing on culturally defined aspects of exchange and socially regulated processes of circulation, the essays illuminate the ways in which people find value in things and things give value to social relations. By looking at things as if they lead social lives, the authors provide a new way to understand how value is externalized and sought after. They discuss a wide range of goods - from oriental carpets to human relics - to reveal both that the underlying logic of everyday economic life is not so far removed from that which explains the circulation of exotica, and that the distinction between contemporary economics and simpler, more distant ones is less obvious than has been thought. As the editor argues in his introduction, beneath the seeming infinitude of human wants, and the apparent multiplicity of material forms, there in fact lie complex, but specific, social and political mechanisms that regulate taste, trade, and desire. Containing contributions from American and British social anthropologists and historians, the volume bridges the disciplines of social history, cultural anthropology, and economics, and marks a major step in our understanding of the cultural basis of economic life and the sociology of culture. It will appeal to anthropologists, social historians, economists, archaeologists, and historians of art. [Cambridge UP summary of The Social Life of Things]

Imagine doing virtual community diagram with the microcomputer through present FOSS communities.

(11) The “field” of an ethnographic study of images must include, then, not only their “biographies” but also what can be called their “virtual community.” By using the term virtual community, I am borrowing Alecquere Stone's notion of communities that include technologies as vital participants.
(12 Figure 1.2) Virtual community diagram.
(13) My position within the virtual community of PET scans is as an anthropologist and historian. I want to evoke the effective and affective
power that these images, as visual facts, come to have in different arena of social life, hospitals, mental-illness communities, courtrooms, scientific meetings, laboratories, and in the mass media. And I want to provoke discussion regarding this power.
(14) Two key issues in all big science are money and credit. Grants and publications are the oxygen and glucose, respectively, of research life. They are, of course, both administered through peer review. Alternate forms of funding are both less prestigious and controversial. On the one hand, the PET community is small enough that it is impossible for me to relate specific histories of funding and publication without entering into the local controversies and violating anonymity requests. On the other hand, to tell these histories without the controversies is potentially to perpetuate and/or exacerbate these problems.
(14) Each of these chapters juxtaposes interview material, semiotic analyses, ethnographic observations, and theoretical reflection.

How This Book Is Organized
(15) Brain-imaging technologies like PET offer researchers the potential to ask a question about almost any aspect of human nature, human behavior, or human kinds and design an experiment to look for the answer in the brain. Each piece of experimental design, data generation, and data analysis, however, necessarily builds in assumptions about human nature, about how the brain works, and how person and brain are related.


Interlude 1
Thinking about Reading
(20-21) But why is it that when we find a reading correspondence in the brain we are satisfied that were are in the right place? Because, suggested Wittgenstein, that is our form of life, our local culture. At certain points (and not others), we no longer ask for an explanation or a test of its truth; explanations come to an end.


Chapter 2
Metaphors, Histories, and Visions of PET

PET Popularity and Phrenology
(23) A frequent observation made about PET brain imaging is its apparent proximity to phrenology, an eighteenth-century theory of brain localization. A quick survey of popular articles on PET confirms this suspicion. PET experiments are discovering and mapping functional regions corresponding to a moral circuit, reasoning, anxiety, social skills, sexuality, intelligence, learning, language, word generation, color perception, form perception, and various kinds of memory. These are similar to the kinds of faculties mapped by the phrenologists.
(24) Plasticity, however, is still a relatively minor phenomenon in both popular and PET theorizing. Instead, circuits are described as hard-wired connections of neurons, clustered together.

History and Definition of PET Scanning
(25) PET researchers often describe their differences as being from different paradigms. . . . PET research often has to simultaneously deal with explaining theories and hypothesis using data and by defining what counts as data. Kuhn described fields of this kind as “pre-paradigm,” in which various schools of thought are in creative competition.
(26) What is at stake in these contests over PET? How do they set the conditions of possibility for thinking and doing interdisciplinary science work? And how do these contests impact the kinds of questions we ask of ourselves in order to understand ourselves?
(27) Reading and listening to these histories, one must appreciate the role that metaphors and narrative frames play in defining projects one way rather than another. These histories are thus ethnohistories, perspective-dependent accounts told within a contested field.

PET Scanner: A History in One Thousand Words
(29) The precipitating event for the PET scanner was the announcement of the CT scanner by EMI, which demonstrated the feasibility of solving the computational problem of how to filter tomographic data using a computer. . . . Coincidence detections thus substituted electronic collimation for the physical lead-shield collimators used in gamma cameras.
(30) The usefulness of PET depended equally on radiopharmaceutical constraints and on technological ones.
(31) Courtrooms have recently been faced with the issue of PET's admissibility as scientific evidence in head trauma and insanity cases, as well as the vexing question of the possibly prejudicial status of PET images for juries.

Toward an Ethnohistory of PET
(31) At first it appeared as if the matter could be solved simply by deciding who was right, who really invented PET. But instead of a mystery, I found multiple stories and heteroglossia. The anthropologist in me soon realized that I was actually dealing with competing ethnohistories. Ethnohistory is itself a contested branch of anthropology and history. Gewertz described it as “fundamentally taking into account the people's own sense of how events are constituted, and their ways of culturally constructing the past” (Gewertz and Schieffelin 1985).
(32) To investigate the variability of this history, I chose three key researchers who each have their own ethnohistory of PET and who have all been described as fathers of the field, keeping in mind that there are many more who might also be chosen.
(34) What follows is a set of accounts of PET by [Michael E.] Phelps, [Michel M.] Ter-Pogossian, and [Henry N.] Wagner [Jr.] drawn from oral histories, published interviews, and scientific articles (Latour 1987; Shapin and Schaffer 1985). . . . Rather than telling a story of scientific development as an agonistic struggle between scientists who compete by amassing more powerful allies than anyone else, one of my purposes is exploring the contested narratives of history and science put forward by these scientists.

MICHAEL E. PHELPS, PH.D.
PET AS TECHNOLOGICAL BREAKTHROUGH, SCIENCE AS RATIONAL REVOLUTION
(34) For Phelps (in abstraction), PET is the imaging technology that broke the “4-minute mile” in nuclear medicine [the “Banister phenomenon”]
(35) PET, for Phelps, is thus a unique technology that provides information desired but unattainable by other means. The operative metaphor here is one of an obligatory point of passage (Latour 1987).
(36) For Phelps, then, the history of PET involves three stages: the techniques and technologies developed before PET, the actual making PET work (showing what can be done), and then the development of uses for PET.
(36) While the run is public and clearly acclaimed, the device is private and must be proven over and over before skeptical audiences.
(39) Proving a new technique to an unreceptive audience is not easy, however. Often it is the source of controversy. Controversies have long been used in STS [] to gain insights into the practice and maintenance of science and discovery (Nelkin 1979). Among scientists, stories of controversies have a similar function, to pass on insights about the real practice of science.
(41) [Phelps] Despite the grand happy family approach, everyone in academia has to deal with the bottom line, which is first author and intellectual property rights. How do you divide up an experiment that is intrinsically dependent on so many individuals?

MICHEL M. TER-POGOSSIAN, PH.D.
PET AS FIELD OF RESEARCH, SCIENCE AS NATURAL PROGRESS
(42) Where Phelps highlighted the creative and hard work of tinkering to bring about a practical convergence in the form of a working machine, Ter-Pogossian interpreted an accumulation of thoguht work, a gene pool rather than a progenitor, an impersonal convergence in place of a triumphant Banister.
(43) Science is described as a steady process of work needing an occasional kick, or reorientation, such as when an important path is missed.

HENRY N. WAGNER JR., M.D.
PET AS A HANDY TOOL, SCIENCE AS CREATIVE INSIGHT
(45) Notice how Wagner reframes PET from a technology or technique into a problem that needed solving. In doing so, PET becomes secondary to the scientists who solve primary problems.

So . . . Toward a Historiography of PET
(48) Represented in these three individuals are three kinds of deterministic histories – technology, scientific principles, scientific research. PET is either a critical invention, a crucial application of an insight, or one among many tools at hand.
(48) If I follow Wagner (my particular abstraction of Wagner), then a history of PET is not even a true project.
(48) To adopt Phelps's perspective, on the contrary, would be to focus on political economy and politics, the day-to-day specifics of how work actually gets done or gets suppressed in institutions.
(48-49) Ter-Pogossian's perspective would also involve political economy, but not as much politics. A scientific history would require attending to directions in science, to insightful proposals for research, and directions lost and regained.
(49) Each of these historiographical approaches raises fundamental questions about the definition and purpose of both PET and of science. Each also would highlight different kinds of documents and emphasize different people. Like many websites on the Internet, the history of PET is “still under construction.”


Interlude 2
Reading Function


Chapter 3
Producing Brain Images of Mind
(53-54) for potential researchers looking for insight into the brain at work, functional brain imaging offered an unbelievable opportunity: to extract information otherwise impossible to get from a living brain while correlating this information with the activity of the person.
(56) Such an experiment requires a degree of interdisciplinary cooperation uncommon in research. It is a delicate balancing act in which each hypothesis can be tested only by assuming that the other hypotheses are not significant to one's results.
(57) Despite this profound interdisciplinary complexity, brain-imaging data is presented in a particularly simple and compelling manner: PET images appear to be discrete, readable, and colorful. Similarly, because the process appears to produce clean pictures of functional brain activity, many simple diagrams of the PET process have been displayed as shorthand illustrations of it. Figure 1.1 makes PET seem almost as simple and as automatic as taking a snapshot.

Creating Experiments: A Difficult Task
STAGE 1: EXPERIMENTAL DESIGN
(61) often the only way to corroborate the findings of PET study is with another PET study. There is no easy end to possible confounding variables.
(61) creating baseline definition of normals is both a physiological and a social judgment.
(62) Possible confounders remain: Are men sufficiently different from women to study separately, or are they sufficiently similar to women so that they can be averaged together? Such characteristics as age, ethnicity, handedness, culture (refugee status), sexuality, familial histories, past head trauma, and medical history are all still unknown confounders raised as questions in meetings during presentation of results.
(62) By choosing only men for these studies, the researchers implicitly assume that gender matters. But by treating the results of the experiments as applicable to normal humans in general, they risk the consequence that a gender difference may appear as an abnormality.
(63) To eliminate this potentially confounding variable, however, race is often excluded from the sample altogether by using only whites.
(63) Even once these lifelong or
trait characteristics are accounted for, temporary or state characteristics remain.
(64) PET scanning maps rates of flows of molecules in the brain over a relatively small period of time. Consequently, correctly characterizing and understanding a person's behavior, mood, and cognitive activity is essential to understanding the meaning of the flows.
(64) With PET, in other words, one is always performing a task (Figure 3.2). Baseline states are all confounding variables to consider in designing a task to be studied.
(65-66) Most PET tasks are in the tradition of cognitive psychology or cognitive neuroscience (see Plates 5 and 6). The assumption in these tasks is that complex mental functions are the aggregation of simpler component operations.
(68) In sum, during the design stage, the basic terms of human nature are already built into the experiment. Subject selection defines a concept of the normal human being in the form of an ideal (super)normal. Abnormal categories, such as mental illness, are likewise normed as ideals. . . . Similarly, task design must assume that the specific task behaviors correspond to discrete mental “functions.”

STAGE 2: MEASURING BRAIN ACTIVITY, FROM TRACER-MOLECULE TO CONCEPTULA DATASET
(69) A PET image, in so many ways, is not like any other image. Not only is the physiological, functional nature of the underlying data a problem conceptually for most of us, both doctors and laypersons but, also, the quantitative dataset itself is dynamic and always imperfectly represented visually.
(70) Nuclear chemists working in “hot chemistry” labs can replace atoms of regular molecules with radioisotopes, creating radiolabeled molecules. These radiotracers behave
exactly as their nonradioactive siblings do.
(71) This story, part of the lore of nuclear medicine, is often repeated in books and in talks. Combining the elements of a detective story with creative scientific insight, the tale functions as a symbolic reference for the nuclear medicine community's purpose.
(71) Because the trace is what is emitting the radioactivity, an image of “brain activity” is really an image of glucose consumption, oxygen flow, Prozac flow, and so on. . . . The concept of “brain activation” is thus a problem of “chemical resolution” in which the activity of a single type of molecule is substituted for the brain process.
(71-72) Positrons are positively charged electrons that travel quite randomly 1 to 7 millimeters before colliding with an electron, resulting in the annihilation of both and the emission of two gamma rays shooting off almost 180 degrees apart. Millions of positrons are released every minute, and each release results in two gamma rays (figure 3.5).
(73-74) When two detectors are triggered at almost exactly the same time, as measured by a “coincidence circuit,” the scanner presumes that a positron must have been emitted on or very near the line between the two crystals (see Plate 3 [steps 1 through 3]). Very fast crystals and electronics can also measure the microsecond difference between the two triggers and make a good guess as to where on the line the presumed positron was.
(75) The angle of the head in the scanner introduces another aspect of the brain slice: At different angles, different brain structures lie together on the same slice (figures 3.8, a and b).
(77) Finally, the architecture of the scanner affects the form of data gathering in each brain slice. Each different scanner shape – thin ring, thick doughnut, hexagonal, fixed, or rotating – is better at detecting some areas than others.
(78) This division of the brain slice into voxels creates a new concept: a
functional brain region that is given to represent the average amount of brain activation in that box of the brain over the period of time of the scan.
(78) The physical theory of PET concludes that only structures larger than twice the size of the resolution, or “full width at half maximum (FWHM)” can be properly measured. Structures smaller than this are so affected by surrounding ares that they cannot be reliably interpreted.
(79) Functional brain regions do not exist in the brain where neurons are in constant cross-talk with each other using a variety of electrical, chemical, and physiological means at spatial scales of nanometers and time scales of nanoseconds. Instead, the PET apparatus produces the functional brain region as a discrete, measurable, locatable, and ideally nameable time-space voxel of the brain that can be correlated with the person's state or trait.
(80) The process of brain imaging always ends with this result: that the brain is knowable as a set of combinatorial states. According to media philosopher Vilem Flusser, this mode of knowing/perceiving begins with the photograph. . . . The picture's dots express the concepts of grayscale, a pixellated discrete world, and a combinatorial universe (Flusser 1984).
(80) The dataset is discrete, volumetric, and timeless. Despite early attempts to make brain imagining into movies (Wagner, etc.), the movies were too hard to read.

STAGE 3: MAKING DATA COMPARABLE

(81) The next stage of the process of producing a brain image consists in first adjusting and transforming the dataset so that it corresponds to some other brainset, either the subject's own MRI, for instance, or a reference brainset. . . . As Anne Beaulieu describes in “The Space Inside the Skull,” this process presumes the meaningful and practical possibility of a generalized human brain, and then produces it (Beaulieu 2000).
(82) Unfortunately, there is disagreement between many labs over the proper reference brain – the Talairach atlas, for instance, was generated from a woman in her sixties who died shortly after having an MRI.
(82) Significance in PET brain imaging is usually defined as regional differences in activation between two brainsets – for example, the set of voxels corresponding to the basal ganglia are more active in this brainset of an anxious person than in the brainset of the same person when calm.
(83) Because all that can be determined is correlation, this kind of study cannot prove that the brain region is involved or responsible for the function of color processing. Instead, PET scanning is often described as “hypothesis-generating” (suggesting brain regions that might be involved in an activity) rather than “hypothesis-confirming.”
(83) Activation is also conceptual, understood as linear: More is better – more activation means more participation in the function. The corollary of this assumption is that voxels that do not differ between two brainsets are not involved in the task or comparison.
(84) Conceptually, subtracting one image from another assumes that regions of the brain that show no overall change in activity are not directly involved in the task or condition. This is an assumption similar to that with a computer's hardware, where the math coprocessor heats up only when algorithms needing certain functions are run. However, in computers without a math coprocessor, the same functions can be programmed into regular RAM (random-access memory). . . . Consequently, an “image” of the latter computer would not detect the role of the RAM program in performing the algorithms because the functional difference is “hidden” as a difference in coding within a constant-use unit, not “present” in a specific, dedicated unit.
(84) A different paradigm that competes with the concept of participative activation is that of individual differences and learning.
(85) The functional brain map of cognitive neuroscience tends to be a map of those functions for which there is little or no learning.
(85) The average brainset is intriguing because it has conceptualized significant activity as only the subtracted activity that is most common to the set of individual brainsets.
(87)
Difference between brain images is another one of the words, such as significance, whose multiple meanings often ambiguously and productively play off of each other.

STAGE 4: PRODUCING INTERPRETED IMAGES
(90) Although the resulting image is two-dimensional, the brainset is actually three-dimensional, where the third dimension is typically represented using color or brightness (see Plate 9).
(90) Peter Galison describes a historical process in which mechanical objectivity – the insistence on the natural transfer of the real objects to image – gives way to an improved object: the interpreted image (Gallison 1997).
(91-92) The coloring process is very important, as the final images look very different depending on how they are colored, even if they are based on exactly the same brainset. The data is thus dynamic even after all of the transformations have been accounted for. One effect of colorizing is that new areas appear as discrete and sharply bounded, rather than diffuse.
(92) Choosing a set of colors to represent linear activity values is therefore an arbitrary choice. Because these colors do not correspond to the real colors of the brain, they are known as pseudo-colors.
(93) As with other aspects of PET, different labs have different preferred color schemes.
(93) It must be emphasized that the criticism here is part of the aporia of visual representation of data: To make the activity visible in itself to readers, and not simply a representation of activity in general (the way that electroencephalograms often appear), there is a necessary addition of supplementary meaning.
(94) Despite having fixed numbers for each pixel, the ability to choose a coloring and windowing scheme allows one to use them to “signify whatever you when them to signify.” [Ter-Pogossian]
(95) Their discussions highlight the tension between what semiologist Jacques Bertin has referred to as
elementary (and intermediate) readings of graphic images – in which the image is analyzed internally for relations between elements or groups of elements – and the overall reading, in which the image is apprehended as a whole, a gestalt impression, or in gross comparison to another image.

Extreme Images
(95) The image is one part of an argument that necessarily includes a textual component.
(96) For example, in looking at PET images in a scientific article, I was struck by the way extreme images were presented as iconic proof of significance in an experiment.
(98) It should be noted that though choosing to print extreme images appears to be standard practice, in practice such a choice is almost never stated.
(99) The images presented in these popular and scientific articles are then
not to be carefully interpreted pixel by pixel. The displayed images should not be measured; they are not meant to be. Rather, they are consciously selected to enhance the textual argument. They are crafted to undergrid, teach, and illustrate the process of discursive and statistical persuasion.
(99) Despite such qualifications, however, it is precisely these simplified “illustrations” that are valorized when these images travel from the laboratory into articles and into popular culture. In textbooks, as well, extreme images can have cultural effects. Used as illustrations of types of brains, these images become “classic” expressions of pathology, or “textbook images.”

PET as a Difference Engine
(100-102) Significant in terms of the virtual community of images is the way in which, though the brain scans of the diagnosed normal volunteers are labeled normal controls, the brain scans of the diagnosed schizophrenics are labeled schizophrenia. The image is thus labeled as showing the “disease” itself, rather than a correlate symptom of someone found to have schizophrenia. Hence, the symptom has been collapsed into the referent.
(103) However much they disagree about what is important about schizophrenia and what is important about the brain, they share the
Idea that the brain must be in some fundamental way the person.

Sublime Brains, Sublime Scans
(103) In the mystery of divergent brain findings about schizophrenia, then, I suggest that neuroscience researchers find a sublime object, which Kant would describe as producing negative pleasure: “In presenting the sublime in nature, the mind feels agitated . . . this agitation can be compared with a vibration, ie, with a rapid alternation of repulsion from and attraction to, one and the same object.” Negative pleasure imposes a feeling of admiration and respect.
(104) For the PET researcher, the scan shows what the researcher cannot yet imagine. The scan holds a key to the mystery of schizophrenia, but the researcher cannot yet grasp it. Facing this challenge, then, taking on the job of turning contradictory results into complex understanding, might be said to be the negative pleasure of the neuroscientists.
(105) During the next several decades, we can expect to identify the abnormalities in brain geography and topography that define the various types of mental illnesses. Once this is accomplished we will know where the enemy is. The techniques of molecular biology will give us the capacity to do precision bombing, while our maps of brain terrain will give us the targets at which to aim.” (Andreasen 2001, p. 320).


Interlude 3:
Who Can Read Other Minds?
(107) That seems to be one of the questions with PET scans: If they are an expert image, if they are an image that takes a lot of expertise to look at, how much does the image show, looking at it from the jury standpoint and the lay public standpoint?


Chapter 4
Ways of Seeing Brains as Expert Images

The Use of Scans in the Trial of John Hinckley
(112) What Judge Parker in the Hinkley trial intuited and Kulynych acknowledged, but did not focus on, is the difficult problem of the undue persuasiveness of visual images, especially that category I want to call “expert images.” Expert images are objects produced with mechanical assistance that require help in interpreting even though they may appear to be legible to a layperson. The paradox of expert images in a trial is that if they are legible, then they should not need interpretation, but if they need interpretation, then they probably should not be shown to juries.
(112) By providing a survey of historical instances in which images were granted admission or censored in one way or another, a theory of the
power to make images objective can be developed.
(113) At stake is the particular form of objectivity that an image comes to have: Is it part of an expert's
opinion, does it indicate a probable relation to a fact, or is it a direct picture of the truth?

X-Rays in the Courtroom
(115) for the course in the late nineteenth century, faced with a nascent but popular x-ray community in which photographers were early adopters and photography was the dominant cultural metaphor, X-rays seemed tailor-made to fit into the analogy of photos and maps as demonstrative evidence (Golan 1998).

CT Images Are Like X-Ray Images
(117) However, as histories of the x-ray image have shown, even images that today seem obviously recognizable were themselves the subject of acculturation. Eco (1979) stated this problem succinctly: “Similarity does not concern the relationship between the image and its object, but that between the image and a previously culturalized content” (p. 204). . . . That recognition is a social process and not inherent came as a surprise, for example, to the marketing department of EMI, the company that first developed the CT scanner.
(118) To see something new, some people must figure out how to see it and then teach others. The cultural salience of the CT scans of the brain went further, however, because it traded also on the equation of the brain with psyche. For the first time (outside of large tumor detection), there was the possibility of seeing an abnormal brain rather than diagnosing an abnormal mind. The slippage between these two forms of recognition is tricky because the first necessarily relies on the second.
(119) The desire, of course, is for the machine-imaged brain to replace the psychiatrically diagnosed mind, the “holy grail” of biological psychiatry.

Demonstrating Objective Brains
(120) The process prescribed for the medical expert [in Houts 1985] is one of positioning oneself as subjective guarantor of objective evidence, as fallible witness of an infallible device.
(120) This is an explicit example of what Greimas and Courtes (182) called
planar semiotics, “the ways in which relative to a given culture, certain signs [are judged] to be 'more real' than others” (pp. 150-151). Semiotics is “the study of how physical properties of bodies are assumed as signs, as vehicles for social meanings” (de Lauretis 1987, p. 25). Using semiotics, we can study the material and cultural ways in which codes, bodies, and technologies are intrinsically bound up with each other.
(121) [Theodore] Porter examines how, within policy studies, the ability to produce quantitative results provides a rallying point within a bureaucratic democracy. Numbers do this work because they are repeatable and because they are nonsubjective and thus disinterested.
(122) Every possibility of subjectivity
must be eliminated to produce something reliable – that is, something real, something known. The hero in this story is automation, which stands as the opposite of interactivity.

Insanity by Machine
(124) To put it explicitly, experts do not brainwash jurors the way that machines do.
(127-128) Even more than the social and cultural stereotypes of mental illness that Gilman has so ably documented, digital brain images promise that an objective – that is culture-free – machine can distinguish
them (the mentally abnormal) from us (Gilman 1988).

The Functional Brain in Courtrooms

Prejudicial Images
(132) This does not mean that neuroimaging does not aid in forming an opinion about a person regarding schizophrenia or other mental illnesses or neurological diseases. It can and does, and therefore should be admitted as evidence aiding in making a diagnosis. It does mean, however, that showing these expert images to a jury literate in only popular images of absolute differences and medical journal images of extreme and admittedly exaggerated differences is potentially prejudicial, because the jury's eyes are cultural ones, not expert ones.


Interlude 4
Reading into Images
(135-136) For these neuroscientists, it was not enough that gender was an explanation of their social differences; they now wanted a biological explanation of (this kind of) gender.
(138) Depending on one's position, then, this research is either fascinating or abhorrent, promising or abusive, or simply and troublingly silly.
(138) The ease with which we all learn to “see” these oddly shaped images as photolike pictures of the brain derives from an implicit faith in penetrative powers of X-rays and in technological reproduction. The Gurs seem caught up with the possibility of “really” knowing who we are through the miraculous agency of these new digital prosthetics of vision.


Chapter 5
Traveling Images, Popularizing Brains

Normal Encounters
(141) Because “none of us really come as strangers to the brain, since the foundational metaphors of brain science pervade popular culture, and have for some time” (Star 1992, p. 205), news and journalism can help shape our notions of “accepted medical knowledge” and even our categories of the patient as person. . . . [Facts never travel alone] Instead they are packaged in the form of stories, explanations, and experiences; as authorized or unauthorized; and as facts, which include definitions of human nature.
(141) I am fascinated and horrified by the
possibility posed here, of a world in which technology can tell me who I truly am. . . . Some researchers call this ability “biotechnopower”: the attribution to technologies of measurement the authority to decide to which categories we essentially belong (Foucault 1978; Haraway 1991; Rabinow 1992).

Toward a Semiotics of Popular Brain Images
(142) This relationship between image and text is a direct structural reversal of their relationship in the scientific practice described by every researcher with whom I talked, where images were chosen to elaborate textual and quantitative proof. An analogy would be the way in which graphs illustrate textual arguments in scientific articles but are often the sole argument presented in newspaper articles.
(143) In the popular arena, in magazines, newspapers and on television, PET images become the principle message. The images and their immediate labels stand as proof, which is then elaborated in textual commentary.
(143) This aspect of analysis focuses on the constellation of codes of “objectivity,” “normality,” “automaticity,” and “veracity” at work within these images. In other words, this strategy tracks the ways in which we learn to see, and learn to believe in seeing. This is a combination of cultural studies, anthropology, and semiotics at the heart of much recent work in cultural studies and feminist studies of science – historical and social. This work draws much inspiration from that of Donna Haraway, Evelyn Fox Keller, Barbara Stafford, and Susan Leigh Star.
(144) [Anne] Barry's insight was that even if perceiving an image is primary to, or does not even need, its caption, it nonetheless is always a contextual, narrated practice, drawing on and drawing together concepts.
(145) Being “caught” refers to the anthropological analyses of Jeanne Favret-Saada (1980), Susan Harding (1987, 1991), and Lorraine Kenny (1992). . . . In Susan Harding's term, drawn from the language of evangelical faith, it means being “under conviction.”
(145) In its popular usage, a brain image is akin to the simplified reality of a graphic cartoon, which Scott McCloud (1993), in his fascinating analysis,
Understanding Comics: The Invisible Art, has described as “a form of amplification through simplification that focuses our attention on an idea” (pp. 30-31).
(146) As laypersons, we do not know how much we do not know about scientific and medical truths, yet we, like Leo, are caught up in the possibility of explaining ourselves through them.
(147) I suggest that these neuroscientific facts compel such reworking because they provide authoritative starting points along with combinatory possibilities. Like Levi-Strauss's totem animals and Turkle's computers, they are good and solid and fun to think with, lively facts with provocative connotations (Levi-Strauss 1963; Turkle 1984).

Expert Selves, Anxious Measures

Your Brain on Ecstasy
(148-149) Four kinds of escalating rhetoric describe the same study of MDMA users. . . . the images published with the study were of one individual from each group, each looking extremely different.
(149) As the study results traveled outside the medical journal, the stated implications intensified.
(149-150) When the images traveled to the U.S. Senate Caucus on International Narcotics Control, however, the director of the National Institute on Drug Abuse used them to proclaim not only absolute causality but diagnostic ability as well. . . . It should come as no surprise, then, that the NIDA 25-year poster took the further step of creating a single didactic image about the ecstasy brain images (see Plate 17).

Images of Rampage
(150) I believe it represents the first use of PET in a Hollywood movie.
(151) The words of the doctor - “these are abnormal patterns without a doubt . . . consistent with schizophrenia . . . pictures of madness” - concatenate a history of struggle and controversy within the medical and legal communities regarding a host of relationships: PET scan to brain, brain to schizophrenia, schizophrenia to insanity.
(151) Not one of these connections, however, is settled in the scientific and medical community, in the legal community, or in my own mind.
(152) Faced with novel facts in this movie, we may indeed stumble over accepting them. Hollywood movies, along with best-selling novels written by physicians and our own doctors' advice, help to shape our notions of “accepted medical knowledge” and thus help shape our categories of the person.
(152) In spite of this unreliability for regular clinical work, in some places PET has nevertheless been heavily supported, including financially, by mental-illness activists, that is, organized families of people with mental illness. Here another set of contests emerges. Should researchers look for biological correlates of schizophrenia, and how should such correlates be interpreted? What do the facts mean? Surprisingly, the meaning of these facts does not emerge solely from the research community; the whole virtual community must be examined.
(153) Early PET thus functioned as a promise that mental illness was not “in the head” but in the brain. The medical imaging advantage was measured in two ways. First, it allowed correlation between brains and diagnosis among living humans, thus permitting anew the equation of
brain=illness. Second, medical imaging promised to provide early warnings of the onset of mental illness, one of the largest problems in its treatment and prevention.

Selling PET
(154) Supporting PET research became a means for these families to empower their participation within science, stay informed, and come to understand their role as accountable to, but not responsible for, the fact of familial schizophrenia. Along with the National Alliance for the Mentally Ill (NAMI), these families advocated a biological redefinition of mental illness and actively helped to produce facts about the nature of personhood and mental illness.

Using PET to Sell
(155) The power of brain images to directly interpolate their viewers is often explicitly used as a technique of persuasion.
(155) Treatment – whether drugs or psychology – lends itself to images demonstrating cure (see Plate 15).
(155) These paired images of self and possible future self can be understood as participating in the larger tropos of “before and after” pictures, as discussed by Dorothy Smith.
(156) The “before” and “after” images contain the coordinates of a course of action and between them, a gap, which is desire, created by the negativity of one and the positivity of the other.
(156) Many PET images of abnormal and normal participate (willingly or unwillingly) in this public discourse of before and after.

Toward a Dynamic Category of the Person

Part of dividual includes parceling personhood among expert discourses.

(157) In anthropological terms, I am interested in how facts come to play a role in our everyday category of the person.
(157) Medical anthropologists have long faced the relation between what Merleau-Ponty called our objective body and our lived body, or our person, with a variety of more subtle analyses. . . . These approaches understand the objective body to vary with the development (positive or negative) of technoscientific culture, attending to how the historical-cultural category of the person (via politics, economics, etc.) influences the evaluation of the objective body.
(159) The very category of the person has become, in part, parceled out among expert discourses.
(159-160) My sense is that the fact exploits the incompleteness of our categories of people, that there is much that is either unaccounted for or contradictorily accounted for in our categories, and that each fact provides material “good to think with,” in Levi-Strauss's memorable coinage.
(160) Kramer's work [
Listening to Prozac] illustrates how at least in the United States, expert scientific and medical facts play a key role in how we experience our selves, our bodies, and others. In other words, there appear to be many objective bodies that we inhabit consciously, in part through adjusting our categories of persons to account for compelling facts.

Embodiment: Facing Brain Facts
(162) Thompson's account illustrates three critical aspects of objective-self fashioning for our purposes. First, there is a tremendous flexibility and openness of explanation of the objective-self.
(162) The second aspect of objective-self fashioning we need to highlight is the need for a nuanced, complex cultural, historical, and institutional – as well as scientific or biomedical – understanding of context.
(162-163) The third aspect of objective-self fashioning is the fundamental connection between the
brain as objective-self and one's own personal identity. . . . We can note here that brain images further confuse the part with the whole – even though brain images show only a slice of the brain, they show the slice as representing the whole brain, which in turn is the person.
(163) Faced with a brain-type, a person is doubled as both being the brain-type and having it. Brain-types can conversely be said to
express themselves in the person and as the person.

Objective Self-Fashioning
(164) The objective self is an active category of the person that is developed through references to expert knowledge and invoked through facts. The objective self is also an embodied theory of human nature, both scientific and popular.
(164) This latter case emphasizes social and disciplinary production of selves, whereas the former emphasizes cultural presuppositions build into concepts and practices.
(165) Both Martin and Rapp have called for a reader-response analysis of our relation to science, medicine, and other facts of life.
(166) The reconfiguration of mental illness as biological through the use of PET scans becomes part of a personal reconfiguration of one's own category of person. . . . The diseased brain, in this case, becomes a part of a biological body that is experienced phenomenologically but is not the bearer of personhood. Rather, the patient who looks at his or her PET brain scan is an innocent sufferer rationally seeking help.
(167) The “both/and” approach to psychiatry, popularized by books such as
Listening to Prozac, involves realizing that the brain can be altered by the social environment and by genetic development and drugs. The kindling theory, for instance, suggests that repeated abuse during childhood can build up depressed reactions until the depression is neurologically self-sustaining.
(167) Dr. Wu's “both/and” approach to psychodynamic and biologic explanations of mental illness arises, I suspect, from his taking patients' perspectives into account. Patients can participate in social and medical reform by participating in research that might produce facts implying a category of person who suffers from a physiological rather than a psychologic disturbance.

Conclusion
(168) When PET researcher Henry Wagner said that “in PET, we now have a new set of eyes that permits us to examine the chemistry of the human mind” (Wagner 1986, p. 253), he was pointing to a particular kind of humanoid: a cyborg whose experience of vision includes the physiology of the brain as witnessed through PET scanning.
(169) The challenges of how to understand the continuing and increasing presence of biotechnopower require close attention not only to the multiple uses of facts-in-the-world but also to their deployment within discourses of objectivity and to the ways that they have built-in, presupposed notions of human nature. The point is that science and medicine turn out to be our business on a daily basis. We are involved in them, they involve us, and they draw on the ways in which we configure the person. My hunch is that this process will reveal much about the multiple circuits of theory transfer from laypersons to experts and back again to laypersons via all kinds of mediators – movies, magazines, personal physicians, and anthropologists. These circuits of fact distribution and presupposition are worth understanding if we want to play a critical role in our own understanding of our selves.


Interlude 5
Living One's Images


Chapter 6
Conclusion: Here Is a PET Image of a Person That Shows Depression
(172) This book could have begun with the following declaration: Here is a PET image of a person that shows depression. The book could have taken off from there and described the consequences for theories of depression and human nature on the basis of scan results. As an anthropologist of science and technology, however, I was compelled to write a book that first took apart, unpacked, and analyzed each aspect of the declaration and its relation to the world.
(173) How to juggle approaches to brain imaging and philosophies of human nature remains a most elusive and yet crucial problem for the neurosciences.
(174) Norbert Weiner, for instance, suggested that “the stored information of the mind lies on many levels of accessibility and is much richer and more varied than that which is accessible by direct unaided introspection; that it is vitally conditioned by affective experience” (Weiner 1961). Cross-cultural studies of both emotions and emotional and mental abnormalities must also be consulted. Regional and national differences also cannot be ignored.
(177) As mentioned earlier, PET researchers have often pointed to phrenology as a key historical period when the right questions were being asked with the wrong technology. For these contemporary function mappers, or network trackers, then, the functions that they decide are possible to delimit will determine the nature of human nature that they discover. Steven Kosslyn, for example, in his book
Wet Mind: The New Cognitive Neuroscience, attended to them in the following manner. Out of 422 pages of his text, he devoted 91 percdnt to traditional cognitive neuroscience: [tables] . . . Kosslyn's emphasis was clearly on what we might call clear cognitive processing, as opposed to unclear – gray – social matters.
(179) We can imagine intelligence working like a computer, but we cannot imagine a program for sadness. In fact, the computer is often pointed to precisely as the embodiment of emotionlessness! Likewise, the sensorium is based on a model of information-processing and is conceivable as a set of programs for analyzing and distinguishing objects, though, of course, we have to work hard to make pain fit this metaphor.
(179) How are the simple-mechanism studies emphasized and popularized by cognitive psychology related to thinking about the brain as an emotionless computer?
(179) PET scans, as currently conceived, inherently seem to show only activity on a one-dimensional scale: either more or less activity than normal.
(181) The metaphor on which all of these technologies depend – an equation of quantity of information with size of the potential – he [postdoctoral PET researcher] notes, is based on a historically situated technology: electrical information in telephone wires. Which came first, he wonders, the metaphor or neuronal activity or the neuronal activity of the metaphor? The solution, he concludes, is not to look for a conclusion now, but to further break down the problem, get to work, and look forward to the future.
(182) The ease with which either a network or mood can be spoken of within neuroscience as
regulated belies a long history within and without physiology on this concept. Canguilhem, the historian and philosopher of science, has followed this conceptual history of “regulation” and how it entered physiology. . . . The notion of a dynamic, self-regulating system, Canguilhem notes, predates the autoimmune system and should also be seen as ontologically at odds with notions of coding errors.
(184) These two metaphors of autoregulation and coding are not necessarily opposed, as Phelps suggested at the end, but each implies different consequent interpretations of data results, and even of automatic programmed data analysis. For instance, the former involves multiple neurotransmittter regulations, actions, and reactions, whereas the latter is more amenable to a brain-mapping, interrupted-circuit interpretation. . . . The answer, I suggest, lies in the analysis of specific problems with specific technologies (and at specific institutions). Each brings with and build into the results layers of tropes and kinds of personhood.
(184-185) A further issue . . . is how to justify stopping the set of significant communicating systems at the skin. The environment and sociality have to be seen as also in communication with these systems “in the brain.”
(185) Understanding a PET image of a person with depression requires, then, reflection on categories of people and metaphors of the brain, as well as imaging technologies and practices. . . . There are obligations and accountabilities regarding imaging practices as much as there are regarding selection procedures and consent forms.
(185) I would like to claim, or propose, that with brain function imaging, we, in the United States, may have entered a space of active negotiation of the basic terms of our categories of the person. This is a negotiation already underway with respect to ultrasound, the human genome project, HIV testing status, amniocentesis, and so on, but with a new emphasis on didactic images.


Dumit, Joseph. Picturing Personhood: Brain Scans and Biomedical Identity. Princeton, N.J: Princeton University Press, 2004. Print.