One way to address the question of what it means to be human is to begin with the observation that we have a world and inhabit a world. The inquiry unfolds under its own weight from this point, with the next set of questions necessarily having to do with how worlds (for they are always multiple) are constituted, what it means to have them, and precisely how we inhabit them. In contemporary society biotechnology, one of the central concerns of the present volume, is increasingly implicated in transforming the very bodily conditions for having and inhabiting any world. This is doubly the case when biotechnology includes sophisticated computer applications, since computers and computer networks are recognized as having enormous transformative potential. Indeed, Sherry Turkle (1995) has suggested important modulations of the self are in the making, and the philosopher Michael Heim (1993) has suggested that the computer is leading to a major ontological shift - a modulation in the structure of human reality itself.
Elaborating the cultural consequences of biotechnology applications of the computer with respect to the having and inhabiting of worlds requires, in my view, what can be called a cultural phenomenology (Csordas 1990, 1994a, b). For present purposes, the critical feature of such an approach is focus on the interplay between cultural representations and cultural modes of being-in-the-world. Much recent cultural analysis privileges the pole of representation, with culture understood as constituted by symbols, signs, and images. From this standpoint, textuality is the most prominent metaphor guiding the interpretation of culture, and the world is not so much inhabited as represented in a way that can be read. While interpretively powerful, however, the notion of textuality is less apt for specifying cultural modes of being-in-the-world -- that is, the the kinds of engagement and participation of humans in our worlds -- than is the complementary notion of embodiment. This notion places us at once at the most general and limiting condition of our existence. Our bodily existence, or embodiment, is from this standpoint understood to have a range of potential experiential modalities in relation to features of cultural and historical context.
The interplay between representation and being-in-the-world, and the complementarity between textuality and embodiment, is precisely at issue in biotechnology applications of the computer. First, the human body is the objective target of technology. By being taken up into the technological environment it is represented and, I would suggest, has its being-in-the-world altered. Second, the computer user is the embodied subjective manipulator of the technology. In this capacity a person encounters representations of the body and again, I would suggest along the lines of Turkle and Heim cited above, has its being-in-the-world altered. The example I offer in this paper involves the use of computer-generated virtual reality to create so-called "virtual cadavers" that are used for purposes such as the teaching of human anatomy and in computer-assisted surgery. The following discussion takes up these issues as they are being played out in the "Visible Human Project," and concludes with a reflection on their consequences for embodiment with respect to representation and being-in-the-world.
The Creation of Computerized Cadavers
The creation of the "Visible Human" cadavers was an extraordinary technological feat, achieved with funding from the federal government. National Library of Medicine director Donald Lindberg notes that the Visible Human Project originated with his observation in 1987 that "the medical school community needed a better way to teach anatomy." In 1991 the NLM awarded a contract for development of the proposed data set to the University of Colorado Center for Human Simulation, with a subcontract for creation of three-dimensional volumetric visualizations of the computerized cadavers to the Visualization Group of the Scientific Computing Division of the National Center for Atmospheric Research. The first step was to find a suitable cadaver, beginning with a male. In 1993, after two and a half years of searching for a fresh cadaver that was "'normal' and within guidelines of size and age," a qualified thirty-nine year old Texas death row inmate named Joseph P. Jernigan agreed to donate his body to science in exchange for being allowed to die by lethal injection rather than electrocution. This suited the researchers' purposes well, since electrocution alters the tissues in ways that would defeat the purpose of having as lifelike a body as possible.
The second step was creation of three matching sets of images composed of transverse sections or "slices" of Jernigan's body. The first two sets were obtained by magnetic resonance imaging (MRI) and computed tomography (CT). Next the body was encased in gelatin, frozen to minus 160 degrees Fahrenheit, and cut into four sections. It was then sectioned into 1,878 transverse slices each 1mm thick, corresponding exactly to the MRI and CT images. High-resolution color digital photographs were taken of the block after each slice. By the time a female cadaver - a fifty-nine year old woman who died of heart disease and whose family insisted she remain anonymous - was subjected to the same procedure a year later, the researchers decided they could achieve greater detail and higher resolution by making the slices one-third the thickness. Consequently she was sectioned into 5,189 transverse slices. For both, the MRI and CT images were created from the whole body prior to freezing. The photographic images were of the face of each section not as it was planed away by a custom-designed laser-guided cryogenic macrotome. The physical remains thus became a collection of frozen shavings, which were then cremated, such that their digital remains now have, in some yet to be understood sense that we will explore shortly, a more concrete existence.
Each of the three types of transverse images was digitally captured at 2,048 x 2,048 x 42 bits, and aligned with its companion images and with images of adjacent slices. The combined datasets are astronomically large: the male takes up a total of 15 gigabytes and the female occupies 39 gigabytes. These data are stored on an FTP site, and with a free license can be downloaded directly from the Internet. Donald Lindberg, Director of the National Library of Medicine, states that "With the Visible Human Project, we are returning to the idea that a library holds the knowledge of a profession - not just reprints, journals, and books. The advent of technology gives us the opportunity to store knowledge electronically and distribute it, virtually instantaneously, throughout the world." A NLM project report from 1996 notes that already the Visible Human data "are being applied to a wide range of educational, diagnostic, treatment planning, virtual reality, artistic, mathematical, and industrial uses," and by the end of the year over 700 licenses had been issued to users in 27 countries.
Let us explore the capabilities of the two virtual cadavers for producing computer images of the human body. The basic form is the transverse section (each in its own computer file), but because the images are precisely aligned, it is possible as well to produce vertical and horizontal sections through virtually any plane. More sophisticated programs are able to produce three-dimensional representations by stacking slices and isolating sites corresponding to particular internal or external anatomical structures. For example, the accompanying male and female heads, generated by William Lorenson of the General Electric Corporation, are not photographs but reconstructions of surface features from the slices (215 physical slices for the male, 209 CT slices for the female). Manipulating and combining these images using state-of-the-art visualization programs makes it possible to penetrate the body - giving the sense of walking or flying through (as in walking through walls, or superhero "x-ray vision"). Different levels of depth or systems (skin, muscles, skeleton) can be superimposed to be viewed simultaneously, and discrete anatomical structures can be isolated. Further, these images can be rotated to be viewed from different perspectives, not only in successive still images but in computer animations. Currently these have advanced to the point of allowing surgical simulations - to be discussed in somewhat more detail below - similar to flight simulations used in training pilots. In one easily available demonstration from the Center for Human Simulation, one can watch a computerized scalpel make an incision in a thigh sliced off from the body above and below the knee, the incision gradually opening to reveal muscle and fat, and the section then rotating in mid-screen and moving to a closeup to show several views of the incision. Developers of these methods promise that their animations - one is tempted to say reanimations - will eventually include blood coursing through veins and around organs, and breath pulsing through lungs. Beyond that is the prospect of transformations that will simulate the processes of aging (as well as, of course, growing young again) and pathology (as well as its reversal). All this in the context of the technical aspiration to render future candidates into ever thinner slices to enter into ever larger databases. One can imagine a race of reanimated virtual cadavers faithful to their human form to the cellular level, infinitely mutable, able to be subject to many simultaneous surgical procedures and healing processes, capable of reanimation and regeneration in whole or in any part.
Simuloids, Avatars, and Shades
Virtual cadavers are phenomena in and of cyberspace and virtual reality. Let me clarify my understanding of how these terms are related. A person who sends E-mail or peruses sites on the World Wide Web is tapping into cyberspace, but not in a strong sense entering a virtual reality. Here the computer is a communicative tool, a cybernetic enhancement of mail and media. A person outfitted with data glove and data goggles involved in an advanced computerized simulation is entering a virtual reality, but is not in cyberspace. Here the computer is an aesthetic tool, a cybernetic enhancement of dramatic and performative techniques by which we create imaginative terrains. To put it more formulaically, cyberspace is an intersubjective medium constituted socially (constituted by interaction among participants in the communicative medium), while virtual reality is the subjective sensory presence in that medium (constituted by interaction between individual user and technology). The intersection of the two is full sensory and bodily engagement in a virtual reality that is also fully networked and plugged into cyberspace - in other words, the full blown, Gibsonesque, science fiction version of virtual reality within cyberspace. This intersection is important to identify because, I would argue, it is precisely the cultural locus of the virtual cadavers.
What do we mean by "cultural locus" in this instance? Let us accept the metaphor of cyberspace with sufficient literalness to conceive it not as a "cultural domain," but as a distinct "ethnographic terrain," so that it is legitimate to talk about an ethnography of cyberspace. Indeed, there has very recently been a florescence of work along these lines in anthropology, and the number of sessions devoted to related topics at the last several meetings of the American Anthropological Association indicate a groundswell of interest. The most prominent concept in this area is that of "virtual communities," or networks of social interaction with fluid boundaries and varying degrees of apparent permanence, composed of actors whose agency is expanded to the point of controlling and manipulating their own identities as pure forms of representation, and who interact with ambiguous others whose identities are never certain. While there is thus a clearly articulated concern with the kind of relationships that exist in cyberspace, taking the metaphor of cyberspace literally as an ethnographic terrain allows us to formulate a parallel concern with the kind of beings that inhabit cyberspace. We can then propose a preliminary inventory of such beings, with the caveat that the "cyborg" is not among them, for a cyborg is by definition a creature of the technological interface. We are cyborgs whenever our bodily capacities are technologically altered or enhanced, including when we have our noses pressed up against the window of cyberspace by virtue of booting up. The goal here is an inventory of beings that exist wholly on the hither side of the interface, in the ethnographic terrain marked by what we just now identified as the intersection of cyberspace and virtual reality.
Accordingly, my preliminary inventory consists of three types of beings: simuloids, avatars, and shades. Simuloids are software-generated entities that have no sentient counterpart in actuality. In the language of the industry, these are referred to variously as humanoid technologies, virtual humans, human-modeling systems, computer-generated humanoids, or autonomous creatures. Simuloids are described as "autonomous" not in the sense that they have agency in their own right but in the sense that they are independent of human agency: they are software-controlled rather than human-controlled. They are also autonomous from any necessity to conform to concrete actuality, and thus their features may transcend the human - they can as easily be animal, machine, or monster. However, a great deal of attention is currently being devoted to the development of virtual humans per se, defined as "computer-generated people that live, work and play in virtual worlds, standing in for real individuals or carrying out jobs that real people cannot do." The news service story that carries this definition also quotes Sandra Kay Helsel, editor of VR News, as pronouncing that "Virtual Humans will be the growth industry of the 1990s!" Characters in computer games are simuloids, as are the characters Max Headroom, the computer HAL from the film "2001, A Space Odyssey," and the villainous cyberman in the movie "Virtuosity." The most advanced simuloids include the virtual humans developed by Nadia Thalmann with her "Marilyn" program that can simulate Marilyn Monroe and Humphrey Bogart as well, and includes characteristics such as emotional expression, speech, clothes, hair, and the ability to respond to computer users. Norman Badler's "Jack" system of human modeling is based on a figure designed to the specifications of the average American male that is capable of articulated motion including balance modification and collision avoidance, gesture and facial expressions, natural language processing, and transformation in size and color.
The term avatar is already in popular usage, and is sometimes applied to what I have called simuloids, but I want to restrict its meaning to virtual incarnations of human actors on the hither side of the interface that are directly controlled by those actors. It is worth playing out some of the cultural connotations of the notion of avatar because of the implications regarding self, agency, and being that can be read into it. The primary meaning of the term, of course is the incarnation of a Hindu deity in actual human form. By extension, on the one hand the human computer operator is analogous to a kind of deity that manipulates the computerized avatar in virtual human form. On the other hand, the extension inverts the meaning of the Sanskrit term in a subtle way: whereas the Hindu avatar is an incarnation of a deity into an earthly form, the computer avatar is a virtual apotheosis of an earthly being into an imaginative realm of fantastic powers and shape-shifting. A more secularized use of the term offered by Webster's dictionary suggest that an avatar can be an embodiment, as of a concept or philosophy, usually in human form, a definition which prompts the observation that what is being embodied by the computer avatar is the human form itself.
Another, more thoroughly abstracted definition from Webster's has the avatar as "a variant phase or version of a continuing basic entity." This one prompts the question of whether the avatar is best considered a representation of a person, a cybernetic extension of the person, a projection of a person into cyberspace, or indeed a "variant phase or version" of a person, for
certainly the avatar is much more than a computerized double or simulation programmed to act like a person. Indeed, in February 1996 a virtual wedding took place in Los Angeles in which vows were exchanged on-screen via avatars while the participants remained in separate geographical locations in actuality. What varies from a technical standpoint is the degree of sensory engagement of operator in avatar. In practice, avatars can be imagined forms described to other users by typing in text, as in the interactive computer sex networks where people become animals or creatures endowed with the most amazing and creative types of sexual organs and multiple genders. Avatars can also be visual "body icons" that can be manipulated and come into the virtual presence of the body icons of other users, but are now often little more than "grim-looking peg-doll shapes" lacking faces or feet. The most advanced include multisensory feedback in which it is experientially the case that the avatars are not so much representations of the user as projections of the user into virtual space. Such projections are themselves customized computer-generated forms, but may in principle also be computer-animated video images as is pioneered in the "synthespian" technology developed by Jeff Kleiser and Diana Waczak.
To summarize the distinction between types of beings that I've drawn here, "simuloids" are computer-generated stand-ins for people with no connection to any actual person, while "avatars" are projections of living people as digitized persons. To draw on vivid popular-culture examples, the computer-generated villain of the movie "Virtuosity" is a simuloid that crosses the interface from virtuality into actuality and becomes embodied; the character Jobe in the movie "Lawnmower Man" is a human who crosses from actuality into virtuality to literally become his avatar and abandon his body. The purpose of this contrast is to introduce what is quite a distinct third type of being indigenous to cyberspace. The computerized virtual cadavers produced by the Visible Human Project of the National Library of Medicine are what I'll call "shades," derived from the use of that word to refer to a spirit in the netherworld. There are only two such beings at present, a male and a female, but their existence has profound consequences that we are just now barely beginning to work out. These shades are "in" cyberspace and virtual reality in a sense distinct from either simuloids or avatars. Like a simuloid, the shade can operate as a stand-in for a person, but unlike a simuloid it is a distillation of an actual person that can be digitally superimposed on another actual person. Like an avatar, the shade is a projection of a real person into cyberspace, but unlike an avatar that person is not only dead but has been dissolved as a physical being. It thus exists solely on the hither side of the interface, where it is not an animation but a reanimation - a new kind of being entirely. Let us elaborate this analysis by briefly examining the biotechnological and symbolic structure of shades.
Adam and Eve in the Virtual World of the Dead
When the first images of the Visible Human male were presented, the regents of the NLM broke out in spontaneous applause, prompting a comment by project director Ackerman quoted by the Denver Post: "It was sort of like applauding at the end of a movement in a concert. It was inappropriate, and the decorum is not that way. But it was a clear indication of how excited people are." Given the excitement generated by this biotechnological juggernaut, let us pose the following question: what is the relation between Joseph Jernigan, the housewife from Maryland, and the datasets they have become? In other words, what constitutes their cultural status (being) as shades? For a preliminary answer I take as data representations of the event in newsletters of the National Library of Medicine and approximately 55 articles from the popular media.
One way of thinking about the change in cultural status is most evident with Jernigan, whose fate was the more public. Here there is a sense of "through the looking glass" with respect to representation of his personhood. The first mention of Jernigan is in retrospect rather eerily incognizant of his subsequent posthumous celebrity. It is a typical article furnished by Reuters in the NYT of August 6th, 1993 reporting that he was executed by lethal injection after having admitted to killing a homeowner who surprised him during a burglary. Such deaths by execution are routinely reported in the news media, and the article's significance does not go beyond the observation that because the reinstitutionalization of capital punishment in the United States remains at least a back-burner issue of public discussion, executions remain newsworthy. By April of 1994 his previous existence was a distorted footnote. A bylined article on the forthcoming release of the Visible Human Male data set picked up by several Knight-Ridder papers described the cadaver as a "drug overdose victim" (this incredibly bad article also referred to the film "Fantastic Voyage" as "Incredible Journey."), as did articles in 1994 and 1995 in the Denver Post. The Denver Post in 1994 mentions the project in an article on "cryonics," the practice of freezing dead diseased individuals in hopes of bringing them back to life when medical technology has advanced sufficiently to cure them, with the concluding comment that "the project doesn't aim to revive the subjects." Nevertheless one is left with the titillating image of a person, whose personal identity is rather beside the point, who is in some sense capable of being reanimated.
The sense of "through the looking glass" that defines the cultural status of shades is most evident in a series of metaphors invoked to describe them. There are four sets of metaphors, one describing the shades as Adam and Eve, one in images of birth or immortality, another as they are a virtual terrain to be mapped, and one that invokes Leonardo da Vinci. The Adam and Eve metaphor is doubtless the most symbolically charged. This is evident in that it was the original intent of the project directors to use these as the formal titles for their shades instead of the markedly more awkward "Visible Human Male" and Visible Human Female." The plan had to be abandoned in the face of threatened legal conflict with a company that had already named itself and its interactive anatomy software program "A.D.A.M.," an acronym for Animated Dissection of Anatomy for Medicine. The competition - never mind that the A.D.A.M. company is now itself licensed to use the Visible Human shades in its product development - indicates that something rather existential might indeed be at stake in the advent of shades.
A sampler of these metaphors will give a flavor of what I mean. The Philadelphia Inquirer (4/14/94) refers to the shades as a "'perfect couple' -- an Adam and Eve for computer immortality." The Denver Post (6/6/94) calls them the "first couple," the Baltimore Sun (11/29/95) announces that the female shade is a "Partner for 'Visible Man,'" and the Times (11/29/94) reports that NLM was "on the look-out for a female donor to share his life on the wire." The Economist (3/5/94) goes yet further in its reference to "A new family -- Adam, Eve, and their embryonic offspring," pairing the Visible Humans with the Visible Embryo Project at the Armed Forces Institute of Pathology . Elsewhere in the piece they are referred to as "Adam, Eve, and little Cain," and the National Library of Medicine as their "electronic Garden of Eden." Referring to plans to increase the inventory of shades, the San Diego Union-Tribune 3/15/95 notes that "The future might also bring Visible progeny, Grandpa and Grandma, or a younger pre-menopausal woman."
The Adam and Eve metaphor cannot be written off as either tritely cute or opportunistically commercial - the metaphor is simply too good a fit with contemporary gender symbolism (see also Treichler 1998). Although there was no more of a relation between Jernigan and the Maryland housewife than between any two cadavers donated to medical research, there is evident appeal in transforming them into a mythical first couple in a new virtual world, digitally reanimated and capable of necrosexual procreation of a family or species of shades. Conveniently, this time around Adam and Eve are both white. Naturally the male was created first, and the female second, though this time not from Adam's rib. As is the case generally in contemporary society, the male is guaranteed an identity (though fortuitously because his cause of death was public, court-ordered), while the female remains anonymous (though on the hither side of the looking-glass that anonymity was understood as a right). The image of Adam rendered in 1mm slices is rougher, while Eve is more refined or, in a pun spun by one journalist, she "looks sharper" than her male counterpart. Stated otherwise, in the Foucauldian idiom of bodily surveillance, if the male can be scrutinized the female can be scrutinized more thoroughly. The male was an evil victimizer killed by lethal injection, the woman was an innocent victim who died of a heart (as in "bless her heart") attack. Adam is sufficient in his own right, indeed a magnificent specimen who pumped iron, while word is that Eve needs to be supplemented by pre-menopausal counterpart - we can expect polygyny in cyberspace.
The second set of metaphors has to do with birth and immortality. On the one hand, a 1996 World Wide Web self-description of the UCHSC Center for Human Simulation by its staff observed that their anatomical imaging laboratory has "given birth to the Visible Human - Male and Female," while the Times (11/29/94) reported "Executed killer reborn as 'visible man' in Internet." On the other hand, the National Library of Medicine newsletter (1995:50:6) reported that the visible humans are "immortalized on the Internet." The Independent (11/29/94) announced that "A killer was yesterday let loose on the Internet computer network," and NetGuide magazine (4/1/95) that "A killer... has been immortalized..." Life Magazine (2/97) refers to "electronic afterlife," the Baltimore Sun (11/29/95) stated that the shade "...has won a measure of computerized immortality," and the Denver Post (6/6/94) that the project "promises eternal life for the participants." These metaphors are neither idle nor contradictory, but reflect views from different sides of the looking glass. The humans are in a sense immortal in their new form, their shades are in a sense born again beings of a new space.
Two rather less developed metaphors that yet indicate something of the cultural status of shades can be identified. One is the elevation of the shades in a celebration of the human form that places them alongside the renderings of Leonardo. A group at University Hospital in Hamburg, Germany that has developed an impressive 3D Atlas called VoxelMan draws a direct historical line from Leonardo to the development of x-rays, on to the invention of CT and MRI technology, and thence to the Visible Humans. A group of artists in Japan is explicitly juxtaposing Leonardo's representations with representations of the Visible Human shades. Implicit is the ideal of approaching reality via virtuality, a connotation that is also evident in the slightly jarring phrase of the Baltimore Sun (11/29/95) referring to "real bodies on a computer."
The final image, which I found only once in a quote from one of the project coordinators, is telling in its appeal to the inanimate. This was in a reference by project director Ackerman to the need to label each site and segment of the Visible Humans, since "Right now, looking at them is like looking at a road map with no street names." Here the shades are understood as a terrain to be traversed - not an unknown virgin territory, but a map not yet useful because not yet labeled.
Taken together, I would suggest that these sets of metaphors disclose the workings of a deep essentialism that constitutes the cultural status of shades. The Adam and Eve metaphors point to gender essences defined by the heterosexual reproductive couple - the two shades could have been defined as siblings, or even, given their age difference, as mother and son. The immortality metaphors define a moral essence, whether conceived as an untainted being prior to the Fall or to a redeemed being in the guise of a born-again convict. The Leonardo metaphor outlines an aesthetic essence of the apotheosized ideal man - notably without female counterpart. The map metaphor implies a cosmic essence by assimilating the body to a terrain, but in particular one that still needs to be charted. The positing of essences in these popular metaphors is implicitly a strategy of identity, made all the more compelling by two features. First, positing the essence of the other (the not-me, the shade) is a double-edged act of self-definition either by denial (me as the opposite of not-me) or by desire (the wished-for me). Second, the force of this double-edgedness is enhanced by the paradoxical condition of the shades as virtuality in actuality, their apparent existence as "real bodies on the Internet." But how can all this be so?
The Meaning of Metaphor: Virtual or Actual?
Two methodological points can help assess the consequences of the foregoing discussion of popular metaphors. First, the discussion assumes that such metaphors offer an interpretive opening to cultural meaning. The analysis can only be valid, for example, if the metaphoric description of the first shades as "Adam and Eve" is accepted as nontrivial, more than an eye-catching journalistic ploy. It was certainly common enough - only the sober British Daily Telegraph consistently reported on the project without recourse to metaphor. Once accepted, this assumption allows the implications of the metaphors to be spun out and regarded as data about the "cultural imaginary," which is further assumed to be as consequential as what we could call the "culturally literal," that is the language of technology and its application. In this context, the cultural imaginary is the realm of possibility, desire, and fear in which we participate passively insofar as it lurks anxiously beneath conscious awareness (compare Ragland-Sullivan 1986: 138-62 on Lacan's notion of the imaginary) and in which we participate actively by the exercise of imagination, the "capacity to articulate what used to be separate...which allows one either to make a new move or change the rules of the game" (Lyotard 1984: 52). Looking at a text from the standpoint of the culturally literal, one could argue that a metaphor is only a colorful analogy to help clarify an objective relation or function - the metaphor is discursively subordinate to the function. Regarding metaphor as an opening into the cultural imaginary grants it a far more important role, one in which the cultural imaginary has an equivalent status with - indeed is in a dialectical relation with - the culturally literal. From the glass half full perspective this dialectic is one in which they mutually constitute one another. From the glass half empty perspective it is one in which they mutually destabilize one another. At the very least, one could say that the cultural imaginary provides the context by means of which the existential implications of the technical innovation can be examined, while the culturally literal leaves discussion at the level of policy implications.
The second point is the importance of identifying the social origins and destinations of the cultural meanings that are spun into the gossamer fabric of a cultural imaginary. In the case of computerized cadavers, the sense-making process that accompanies the technological development originates principally from the Visible Human Project coordinators, from groups developing project applications, and from public media that disseminate information about the project. A fourth source is the metadiscourse of cultural analysts - we must reflexively include, for example, the metaphorical offering of "shades" to define the computerized cadavers. Members of each group participate both passively and actively in the cultural imaginary, but each has a socially positioned take on the relation between the cultural imaginary and cultural literality. The appeal to the literal through the use of technical and policy language is given greater or lesser weight by project coordinators whose audience is government funding sources, potential database users, and the media; developers of application whose audience is a potential market for those applications; the media whose audience is the general public; and cultural analysts whose audience is academia. Each is thoroughly ensconced in the dialectic between imaginary and literal, and that dialectic is constituted by the sum of their social positionalities.
This understanding of the relation between the cultural imaginary and the culturally literal remains somewhat strained unless it takes into account what I regard as an orthogonal distinction between representation and being-in-the-world. Cultural analysis will always be subject to suspicions of whether it is dealing with reality if it is cast entirely in terms of representation, or analysis of representation. The popular metaphors surrounding the Visible Human shades, and the images themselves, are necessarily of limited consequence if they are analyzed on the representational level alone. The metaphors are indeed frivolous unless they are interpreted as hinting at or disclosing a subtle shift in our mode of being-in-the-world, and the remarkable images with all their combinatorial possibilities bear no more intimate connection to the original people-cum-cadavers than a photograph torn up and taped together again unless they do the same. My intent in introducing the notion of a "shade" is to push us into thinking beyond representation and toward being.
Yet when dealing with such a general notion as being, it is important to think globally in order to avoid essentializing a cultural particularity. Thus the disposition of the actual bodies might not appear much more radical to a North American than that of a medical cadaver or a cremated dead person. Consider the integrity of being required in a Buddhist society like Japan, where one cannot take one's place among the ancestors or expect a higher reincarnation if one goes to the grave lacking a part of one's body. From that standpoint, would one react with complaisance regarding the moral import of creating shades? Final cremation aside, what might be the cosmological status of a human who has been ground into dust? On the other side of the existential looking-glass, once transformed into a shade, what might be the status of one who can be divided into chunks repeatedly? On a more mundanely North American ethical level, what about anonymity and privacy? A conventional cadaver used in anatomy training is both anonymous and lacks identity. A shade is not anonymous, for even the woman from Maryland might be recognized by an acquaintance who saw her reconstituted visage. Project director Ackerman has said "We're hopeful that if she is recognizable, that people will respect her anonymity. There is nothing we can do" that wouldn't compromise the data (Baltimore Sun 11/29/95). Moreover, a shade retains identity, for even Jernigan at least in some sense remains who he was whether or not he comes to be called "Adam" instead of Joseph.
All things considered, the argument about the being of shades would remain rather disingenuous if we were not clear that the primary concern was our own being in relation to them, or in other words how the technological innovation induces a subtle modulation in our own embodiment and hence in our own culturally situated being-in-the-world. Subjectivity and intersubjectivity are bodily phenomena, and thus the question becomes the potential transformation of subjectivity on the part of those who use the technology, and especially with regard to physicians, in the intersubjective relation formed with those bodily being who are their patients. In this light, let us briefly consider the two most immediate sites of impact, namely anatomy training for medical students, and computer-aided surgery.
"It Empowers Us"
At the fourth annual conference on "Medicine and Virtual Reality" in January of 1996, Michael Ackerman and Victor Spitzer, director of the project at NLM and director of the contracting group at UCHSC, received the Satava Award, named for Col. Richard Satava, a pioneer in VR telesurgery. Helene Hoffman, herself director of the anatomy curriculum using Visible Human data at UCSD medical school, observed that "This data set has become the new standard for human physiology education. For example, 30 to 40% of the papers presented at this year's conference alone relied on this data set." A variety of medical schools are actively developing anatomy curricula based on Visible Human data. The primary debate is over whether these methods are to be used to complement or to replace conventional dissection in anatomy education. Traditionalists are resistant to the idea that medical students would not have the hands on experience of work with real bodies in what is implicitly sacrosanct as a rite of passage in medical training. Innovators point out that actual cadavers are increasingly short in supply in comparison to the infinitely reusable shades, and that in any case most physicians other than surgeons will never have occasion to work on the insides of their patients.
The potential consequences with respect to embodiment for both medical students and their future patients must be understood with respect to the already profound phenomenological transformation wrought in conventional training. In his ethnographic study of medical students, the anthropologist Byron Good has observed that the dimensions of the world of experience built up in their training were "more profoundly different from my everyday world than nearly any of those I have experienced in other field research" (1994:71). Reminiscent of the map without street signs metaphor I mentioned above, students learning anatomy are "as geographers moving from gross topography to the detail of microecology" (1994: 72). Good repeatedly refers to the intimacy with which medical students come to know the body, and describes the anatomy lab as a kind of ritual space in which the reconstitution of experience takes place. The accustomed body surfaces that define personhood are drawn back, revealing an "interior" that consists not of a person's inner emotional life but a complex three-dimensional space with planes of tissue that are separated to distinguish the boundaries of gross forms and fine structures. As one student said, "Emotionally a leg has such a different meaning after you get the skin off" (1994: 72). The new way of seeing beneath the surface that is central to the medical gaze can usually be turned on and off, but also bleeds over into the student's everyday perception of other persons, as they are constituted and reconstituted - translated and retranslated - between the perceptual languages of medicine and everyday life. Good observes that this training is profoundly visual, and the profundity of phenomenological transformation can only be enhanced by the new anatomy curricula based on virtual reality. The penetration to increasingly minute levels of biological hierarchy (epidemiological - clinical - histological - cellular - molecular/genetic) will be complemented by a penetration based on transparency, the sense of "x-ray vision."
A preliminary glimpse of the potential change comes from a reflection by a medical student who attended the introduction of the Visible Human Female in 1995. Referring to the Visible human as a prime example of high performance computing as applied to biomedical science, he writes "It empowers us. We students know that a world of information is out there at the touch of our fingertips" (Roberts 1996). He was impressed by the fact that brain sections would not fall apart as they sometimes do in dissection of a real cadaver, that one can isolate sections of the body rather than "deal with the whole daunting thing," that the circulatory system would appear like a real 3D loop rather than flat as in a textbook, that the database could be reformatted to change body characteristics, that the images could be rotated, dissected, and resected, and that some day he would be able to call up these images in his offices to help educate patients about illnesses and procedures.
Several questions arise concerning the ultimate experiential consequences of applying this technology. What will be the consequences of isolating body parts for detailed, intensive work? Will it enhance the sense of intimacy noted by Good or will it initiate a more fragmented, objectified sense of the body? What will be the consequences of digital dissection that is both exceedingly neat and comfortably reversible in comparison to actual dissection, in much the way word processing allows easy deletion and substitution in comparison to writing or typing? Will it introduce a sense of arbitrariness of biological process, or enhance the understanding of meticulous detail? Finally, what will be the consequence of empowerment as it is alluded to by the medical student rapporteur. Will it be the power of humanizing intimacy and compassion, or that of apotheosizing omnipotence and objectification of one's fellow beings? Will it refine the sensibilities of physicians as a flower blossom unfolding to reveal its intimate recesses rather than having to be sliced open or peeled apart petal by petal?
"From Blood and Guts to Bits and Bytes"
Beyond the training of medical students, shades will increasingly play a role in the development of surgical training and what is called "telepresence surgery." The title of this section is a favorite phrase of Col. Richard Satava, M.D., one of the leading figures in this area, in referring to a major paradigm shift in which the blood and guts of conventional surgery is replaced by the bits and bytes that will facilitate the work of a new generation of "digital physicians" and "Nintendo surgeons." Virtual reality surgical simulations are already available for prostrate, eye, leg, and cholycystectomy procedures. Telepresence surgery allows the physician to project himself or herself to a remote location via video and audio monitors, with computer-controlled instruments controlled from the remote site with dummy handles able to provide "force feedback" that gives the surgeon - or surgeons collaborating by network from different geographical locations - a sense of tactile immediacy.
Satava distinguishes between artificial and natural virtual reality, the former completely synthetic and imaginary as in the simulation of being inside a molecule, the latter a situation that could physically exist as in surgery on a realistic recreation of a human body (1992: 360-61). Both surgical simulation and telepresence surgery are forms of natural virtual reality, though obviously only the latter is performed on actual patients. Yet Satava says that "the day may come when it would not be possible to determine if an operation were being performed on a real or computer generated patient... the threshold has been crossed; and a new world is forming, half real and half virtual" (1992: 363). He and his colleagues are working on just such a system, in which the operator can fly around the organs and travel through the digestive system (Key Words: 935), and use of shade data is allowing them to move from a cartoon-like visual display to an increasingly life-like one. Likewise, the overlay and enhancement of live CT/MRI data with shade data promises to augment the vividness of telepresence surgery, as the immediacy of the electronic image and remote manipulation come to "dissolve time and space" (Key words:939).
The development of shade-enhanced telepresence surgery has consequences for embodiment with respect to the skills it requires of the surgeon - as what Marcel Mauss (1950) called a "technique of the body" - and with respect to its applications on the bodies of patients. With respect to the former, the emerging field of "Human Interface Technology" dictates that a system have sensory intuitiveness - that it "should feel and be used as naturally as possible." As Satava observes, telepresence surgery has the same eye-hand axis as open surgery insofar as the surgeon looks down at a monitor, thus preserving the correspondence of visual with proprioceptive and kinesthetic senses. Contemporary laparoscopy requires visually looking up at a video monitor, while surgical simulation requires wearing a virtual-reality helmet such that the surgeon must learn the tool rather than the tool accomodating the surgeon (1994: 819-20). With respect to patient care, the new technology will allow comparing normal and abnormal organs by substituting images, simulating the biomechanics of muscles and joints to make more effective replacment joints, demonstrating projected treatment courses for patients. Military applications - one of Colonel Satava's ultimate interests - of shade-enhanced simulation would include plotting the path of a bullet before treating a bullet wound, and applications of telepresence surgery would include "to metaphorically project a surgeon into every foxhole" (n.d.:12)
At least two questions are posed by these developments. The first comes from considering that both surgical simulation and telepresence surgery pose a paradox of simultaneously increased remoteness and enhanced intimacy. Simulation is remote from living persons and telesurgery is geographically remote; both partake of the intimacy afforded by the technologically enhanced medical gaze. What will be the consequences of this paradox, and what the limits of access to the inner recesses of biological process? The second question arises in considering Drew Leder's analysis of the typical disappearance of the body from awareness in everyday life as it "not only projects outward in experience but falls back into unexperiencable depths" (1990: 53). Leder argues that it is the body's own structure that leads to its self-concealment and to a notion of the immateriality of mind and thought that is reified as mind-body dualism. Could it be on the culture-technological horizon that shade-enhanced virtual reality will make the intimate core of bodily processes accessible in a new way, offering the possibility of transcending this Cartesianism of the natural attitude?
Frozen Representation and Virtual Being-in-the-World
I want to return to the broader question of the cultural significance of shades not in terms of the relation between the cultural imaginary and cultural practice, but in terms of the relation between representation and being-in-the-world. The notion of representation holds a virtual hegemony over contemporary cultural analysis, hand in hand with the associated methodological metaphor of textuality. This extends to cultural analysis of the body, so that scholarly works are filled with phrases like the body as text, writing on the body, bodies of writing, the inscription of meaning on/in the body, representations of the body, reading the body. A less prominently articulated tradition understands culture from the standpoint of embodiment as our fundamental and culturally conditional mode of being-in-the-world. As bodily beings we inhabit the world in terms of the space and extension of our bodies, we engage in movement and experience resistance to that movement, we incorporate and explore the world via our senses, we interact with others or find ourselves in solitude. The modes of representation and being-in-the-world are intimately intertwined in practice, for example in the way their relation can be superimposed on the relation between subject and object: if the body is conceived as an object, representations of the body are the site of subjectivity; if the body is conceived as subject, representations are objectifications of the body.
I would argue that understanding the interaction between the body as representation and the body as being-in-the-world is critical to cultural analysis in general (see Csordas 1994b), and furthermore that this interaction defines the cultural process that is critically at stake in the existential analysis of the shades created by the Visible Human Project. From the standpoint of Jernigan and the Maryland housewife, are their shades no more than hypertext versions of a photographic representation, no more connected to their particular essences than a snapshot that could be torn to bits then reassembled with tape and glue? Or is there something of the transformation of quantity into quality in the degree of specificity with which their physical beings have been digitalized, some way in which they have gone "through the looking glass?"
Indeed, it is possible to indulge a debate about whether even a simple photograph captures something essential about a person (and anthropologists know that in some societies this is thought quite literally to be so), or is better understood as an arbitrary and momentary simulation that can be repeated without limit to the ultimate degradation of meaning, similar to what might happen to the meaning of the word "egg" if it is repeated a hundred times. However, the question of the shades' being-in-the-world in itself is academic insofar as, the tool of science fiction placed aside, there is no question of personal subjectivity for them. What is all the more at issue is the subjectivity of the rest of us - specialist medical students and surgeons to be sure, but also the coming generation. Indeed, UCHSC's Spitzer has said "I think in the future, kids will grow up with him" (certainly an improvement on Barney). More importantly, while by the same token there is no question of defining intersubjectivity between shades and users, there is all the more a question of how, given the premise that intersubjectivity is also grounded in our bodily being, it may become transformed, enhanced, or distorted by the existence and application of shades. What will interpersonal relations be like when I can casually visualize your skeleton as we converse, and you can feel your way around inside my brain?
Finally, if the biotechnological innovations in virtual reality of which shades are only one example are indeed pointing toward a modulation of embodiment, it may be so only because of the historical condition in which culture now exists. Daniel Boorstin wrote in 1961 that the contemporary world is already one "where fantasy is more real than reality, where the image has more dignity than its original. We hardly dare face our bewilderment, because the solace of belief in contrived reality is so thoroughly real" (quoted in Kearney 1988: 252). This is to say that what we are describing is not a technological determinism of embodiment, but a highly specific way of incorporating a technological development into the postmodern condition of culture. Understanding this process will require a cultural phenomenology that can capture the essence of the particular in an embodiment constituted in the existential space between virtual and actual, between the cultural imaginary and culturally literal, between remoteness and intimacy, and between representation and being-in-the-world.
1. Among these are the University of California at San Diego Medical School, Loyola University Stritch School of Medicine, Johns Hopkins in collaboration with the National University of Singapore, SUNY Stony Brook, University of Pennsylvania Medical Center, Washington University Medical School, the University of Chicago in collaboration with Argonne National Laboratory, Columbia University Medical School in collaboration with the Stephens Institute of Technology. Outside the United States, projects are underway at the University of Hamburg School of Medicine, the Keio University School of Medicine in Tokyo, Australian National University, and the Queensland University of Technology.
2. Visible human images presented here are available on the Internet at the following addresses: General Electric (http://www.crd.ge.com/esl/cgsp/projects), UC San Diego (http://cybermed.ucsd.edu), and University of Hamburg (http://www.uke.uni-hamburg.de). Each of these can be accessed via the National Library of Medicine (http://www.nlm.nih.gov). An impressive array of images based on the Visible Human can be found in Tsiaras 1997.
Csordas, Thomas J.
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n.d. The Modern Medical Battlefield: Sequitur on Advanced Medical Technology. Unpublished ms., Advanced Research Projects Agency, Arlington, VA
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[After Post-Modernism Conference. Copyright 1997.]