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Sketching Brains. Introduction to the Research Project

“When I draw with pen and paper in front of my patient the brain, the tumor, and how we are going to remove it, (…) I have the impression that something happens: we can really exchange about the situation and make a better decision together.”

Published onJun 16, 2022
Sketching Brains. Introduction to the Research Project

Introduction to the ethnographic project Sketching Brains ©Maxime Le Calvé, camera Theo Thiesmeier, with brain images by Lucius Fekonja

The surgeon turned to me with a smile: “When I draw with pen and paper in front of my patient the brain, the tumor, and how we are going to remove it, (…) I have the impression that something happens: we can really exchange about the situation and make a better decision together.” Geographers call this practice “sketch mapping”[1]. It is a mapping performed in front of its recipient, and tells the story of a journey, enacting it with the hand before or after walking it. It is the ‘glue’ that holds together the storyteller, their audience, ideas and information, as well as an open scope of possibilities and questions. The concept of sketch mapping was forged in opposition to the modern cartographic arsenal, which intends to capture the world with an objective precision imbued with technoscientific authority[2]. The quote above refers to a conversation I had with one of my research partners at Charité, the neurosurgeon PD Dr. Thomas Picht. It came as we were discussing the efficacy of drawing in comparison with other types of brain pictures – brain scans in particular. Sketching is a plural mode of going at things rather than a single skill or technique. It is key to many making and thinking processes, connecting, gathering, and creating new loose ideas and fragmentary hypotheses. However, sketching is not really valued in our contemporary digital and rationalized working environments. Computerized imaging technologies have revolutionized the practice of medicine, as well as commonsense notions of the body[3]. This revolution has also provoked a fundamental transformation of the surgical theaters, introducing new actors peeking over the shoulder of the surgeons, invading their territories, and possibly even challenging their authority[4]. These technologies have completely modified the way bodies are mapped out and performed: the bodily presence of human surgical performers is slowly being undermined by a takeover of imaging devices spurned on by the disciplines of computational neurosciences[5]. The current digitization of medical decision processes isn’t devoid of ethical dilemmas: in the name of economic efficiency, the humanistic process of caring for and healing patients has been radically reconfigured. Students who learn based on 3D images neither confront the material palpability of bodies nor death and don’t have the opportunity to build up the compassionate skills necessary for the humanistic practice of medicine[6].

The perfect maps of fiber tracks inside of the brain, calculated by probabilistic algorithms based upon dMRI datasets and visualized on screens, are also looked upon as sketches in another way by the neurosurgeons – but this time in the negative informal meaning of the word. That is, as “sketchy” – as if the picture was too good to be true. The French philosopher of science and medical doctor Georges Canguilhelm famously observed that models that are too good can be dangerous because they have the propensity to stop the surgeon’s thinking in motion: « the models which have the chance of being the best are those which halt our latent tendency to identify the organic with its model »[7]. This could be an explanation for the distrust on the part of doctors when it comes to integrating the latest imaging technologies into their surgical routines. In contrast, and because they are deliberately fragmentary, quick hand-jotted sketches can “function as a kind of glue with which one can connect dissimilar things and, in this way, create orders and formulate hypotheses” – a glue that works at the collective level as well.[8] Following the neuroanthropologist Terrence Deacon, one could say that this kind of productive “absence” in the sketch, in which incompleteness acts as a “lure for the possible”[9], goes hand in hand with the inherent “absentiality” of neuronal life[10]. Possibilities of what hasn’t happened yet are fundamental to the emergence the cognitive functions, and they come to light with the displacing of habits, as a permanent re-wiring of embodied and interactive minds[11]. Sketching is a radical way for surgeons to come into correspondence with neural tissues, bridging the gestures of the hand with the fuzzy logic at work behind the functioning of the brain – and making them visible and graspable again for their apprentices, for the patients and for the public. As a multimodal social scientist who sketches and draws in order to create and communicate anthropological knowledge, I am struck by the way modes of describing impact collaborative ethnographic thinking. Sharing drawings immediately drive relations to a different place and triggers new conversations: sketching is that kind of glue.

This project provides a rare opportunity to merge artistic methods with social sciences and medical practice, which brings with it completely new ideas about the arts of relating to living materials. “Sketching Brains” is about the new possibilities to retrieve and reinvent the powers of sketching in the everyday practice of neurosurgery. It comes at a particularly important critical point in history, in which images produced, rendered, and read by computers are superseding centuries-long experience and understanding between doctors and patients. The practice of sketching in image-based surgical planning cannot only improve the efficacy of the diagnosis and the emergence of shared knowledge and trust between clinicians and their patients. It introduces back into medicine the tactile and improvisational necessity that is required for conducting delicate and insightful interventions and advancing clinical knowledge. Building on the seminal idea of science studies scholar Annemarie Mol[12] that bodies are performed in multiple ways by different people and different technical apparatus, I want to ask (and resolve) the question: What difference does it make to perform the brain in the mode of sketching, rather than on the modes offered by computational neuroscientific? How can we implement new spaces to think, reflect, and to understand in the streamlined workflow of contemporary medical practice? What kind of medical and human knowledge can be produced by introducing the process of sketching into neuro-surgical practice? Might human-generated material engagement[13] complement the increasingly distanced world of medicine brought on by digital technology?

The “Sketching Brains” project will explore the potential of sketching (in 2D and in 3D) as a technique of communication, visualization, and a knowledge practice – also within ethnographic research – in a collaborative design anthropology fieldwork, in which we will examine various dimensions of (embodied) neurosurgical knowledge. An interdisciplinary team of neurosurgeons, computer scientists, anthropologists, and designers, we will research, develop, test, and evaluate a new set of tools – interfaces that combine digital and human drawing processes, with the manipulation of scan images on flat mobile screens and on Head-Mounted Displays (HMD). They will enable the surgeons to collaborate locally and remotely, with colleagues and with patients. Taking neurosurgical practice as a limit case, we will reassess the seriousness of sketching as a mode of shaping our attention to things and people in an increasingly challenging and predating digital working and living environments. Sketching Brains also envisions making these attempts visible to the public and to the community through the curation of exhibitions and design workshops focusing on the research process rather than on the results.

[1] Ingold, Lines, 84.

[2] Latour, “Visualisation and Cognition:Thinking with Eyes and Hands.”

[3] Burri, Doing Images; Dumit, Picturing Personhood.

[4] Hirschauer, “The Manufacture of Bodies in Surgery.”

[5] Duffau, “The Dangers of Magnetic Resonance Imaging Diffusion Tensor Tractography in Brain Surgery.”

[6] Prentice, Bodies in Formation, Chap. 2.

[7] Canguilhem, “The Role of Analogies and Models in Biological Discovery,” 517.

[8] Wendler, “Zu einer Unschärferelation der Modelle. Präzision und Produktivität mehrdeutiger Modelle in der Gestaltung,” 140.

[9] Debaise, Nature as Event.

[10] Deacon, Incomplete Nature.

[11] See Massumi, “Envisioning the Virtual.”

[12] Mol, The Body Multiple.

[13] Malafouris, How Things Shape the Mind a Theory of Material Engagement.

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