l~TION

I J^ M A T I O N Series
Series

Series Editor
Series Editor
PAUL
P RABINOW
aul R a b in o w

A list of
A of titles in
in the series
series appears
appears at the back
back of the book
book
 GGN S2S30

Picturing Personhood
Picturing Personhood
Brain Scans
Scans and Biomedical
Biomedical ldenti1y
Identity

Joseph
Joseph Dumit
Dumit

PRINCETON
PRINCETON UNIVERSITY
UNIVERSITY PRESS
PRINCETON
PRINCETON AND
AND OXFORD
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Copyright © 2004 by Princeton
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Library
Library of Congress Cataloging-in-Publication
Cataloging-in-Publication Data
Dumit,
Dumit, Joseph.
Picturing
Picturing personhood:
personhood: brain identity/Joseph Dumit.
brain scans and biomedical identity/Joseph
p. cm. —- (In-formation
(In-formation series)
series)
Includes bibliographical
bibliographical references and index.
ISBN 0-691-11397-1
0-691-11397-1 (doth:
(cloth: alk. paper)
ISBN 0-691-11398-X (pbk.: alk. paper)
ISBN 0-691-11398-X
1. Brain —Tomography. 2. Brain
Brain-Tomography. —Tomography —Social
Brain-Tomography-Social
aspects. L I. Title. II. Series.
Series.
QP376.6D8J
QP376.6D85 2004
155.2-d
155.2-dc21c21
2003042884
2003042884

British Library Cataloging-in-Publication

Cataloging-in-Publication Data is available

This book
book has been composed
composed in Sabon

Printed on acid-free paper. “oo

i www.pupress.princeton.edu
www.pupress.princeton.edu

Printed
Printed in the United States of America

10 9 8B 77 66 55 4 4 3 3 2 21 1
10

V 5
r
I
'

To my parents,
parents, for
for everything
everything

'
[

J
 Contents

List of
List of Illustrations
Illustrations ix
ix

Acknowledgments
Acknowledgments xi
xi

Chapter
Chapter 1 Introduction
Introduction 11
Interlude l1 Thinking about
about Reading 19

Chapter 2 Metaphors, Histories,

Chapter Histories, and Visions
Visionsaf
af PET
PET 22
Interlude 2 Reading Function so
50

Chapter 3 Producing
Chapter Producing Brain
Brain Images
Images of M
Mind
ind 53
Interlude 3 Who
W ho Can
C an Read
Read Other Minds?
Other M inds? 106

Chapter 4 Ways
W a y s of Seeing
Seeing Brains
Brains as Expert
Expert Images
Images 109
Interlude 4 Reading into Images 134

Chapter 5 Traveling
Chapter Traveling Images,
Images, Popularizing Brains
Popularizing Brains 139

Interlude 5 Living One's Images 170

Chapter 6 Conclusion: Here Is

Chapter Is o PET of
Image of
PET Image
o Person
Person that Shows
Shows Depression
Depression 172
 1

CO N TENTS
CONTENT S

Notes
Notes 187
187

Bibliography
Bibliography 209
209

Index
Index of
of Names
Names 235
235

General Index
Index 242
242

viii
f
I

List ooff Illustrations

List Illustrations

,,

Figures
Figures

1.1.
F i g u r e 1.
FIGURE Principle of positron
1. Principle positron emission
emission tomography
tomography (PET) 22
Virtual community
F i g u r e 1.2. Virtual
FIGURE community diagram
diagram 12
12
human brain
F i g u r e 1.3. Active human
FIGURE brain 20
20
F i g u r e 2,1.
FIGURE 2.1. News
News versus
versus tales
tales 51
51
procedure in progress
F i g u r e 3.1. PET procedure
FIGURE progress at Johns
Johns Hopkins
Hopkins 58
58
University Medical
University Medical Center
Center
Apprehensive versus
F i g u r e 3.2. Apprehensive
FIGURE versus relaxed
relaxed 65
65
cylcotron
F i g u r e 3.3. CTI cylcotron
FIGURE 70
70
FIGURE Automated isotope
F i g u r e 3.4. Automated isotope production
production 72
72
Coincidence detection
F i g u r e 3.5. Coincidence
FIGURE detection 73
73
3.6, Four
F i g u r e 3.6.
FIGURE Four early
early PET scanners,
scanners, called
called PETT
PETT (positron
(positron 74
74
emission transaxial
emission transaxial tomography)
tomography)
Brain imaging
F i g u r e 3.7. Brain
FIGURE imaging 75
75
Brain slice angles
F i g u r e 3.8. Brain
FIGURE angles 76
76
Gray scale differences
F i g u r e 3.9. Gray
FIGURE differences 92
92
Aging graph
F i g u r e 3.10. Aging
FIGURE graph 97
97
Schizophrenia extremes
F i g u r e 3.11. Schizophrenia
FIGURE extremes 101
101
from normal
F i g u r e 4.1. Scans from
FIGURE normal and
and schizophrenic
schizophrenic patients
patients 127
127
Ecstasy users'
F i g u r e 5.1. Ecstasy
FIGURE users’ brain
brain graph
graph 149
149
Henry N. Wagner,
F i g u r e 5.2. Henry
FIGURE Wagner, M.D.,
M.D., shown
shown in PET scanner
scanner 171
171
at Johns
at Johns Hopkins
Hopkins University
University
Normal and
F i g u r e 6.1. Normal
FIGURE and depressed
depressed states
states 174
174
 LIST
LIST Of
OF llLUSTRATIONS
ILLUSTRATIONS

Color
C olor Plates
(following
(following page 160)

PLATE Positron emissions tomography

P l a t e 1 Positron tomography (PET) (PET) scans from Vogue
PLATE
P l a t e 2 PETPET scans
scans of of different
different functions
functions and and traits,
traits, from
from Newsweek
Newsweek
P l a t e 3 Illustrations
PLATE Illustrations of of the
the PET
PET scanner
scanner process
process
PLATE
P l a t e 44 PET scans illustrating
illustrating the subtraction
subtraction and averaging
processes
PLATE
P la te 5 5 PET scans sc a n s illustrating
illu stra tin g "na1ve,"
“ n a iv e ,” "practiced,"
“ p r a c t ic e d ,” and
a n d "novel"
“ n o v e l”
tasks
ta sk s
PLATE
Plate 6 PET PET scans
scans illustrating the auditory illustrating
systemthe auditory system
PLATE
P late 7 PET PET scans
scans of IQ test of IQ test
PLATE
Plate 8 Screen Screen capture
capture of the Image Viewer Applet (ePET) (ePET)
PLATE
Plate 9 Three-dimensional
Three-dimensional PET scans of normal normal and schizophrenic
schizophrenic
brains
PLATE
P l a t e 10 Xenon blood flow scans, Niels Lassen
1 0 Xenon
PLATE
P 11 PET scans of “"brain
l a t e 11 brain phantoms,”
phantoms," showing evolution evolution of PET
PLATE
P l a t e 1122 Identical PET scans illustrating
illustrating pseudo-color
pseudo-color choices
PLATE
P l a t e 13 Paperback cover design of The Broken
1 3 Paperback Broken Brain
PLATE
P l a t e 14
1 4 Cover design of Mapping Mapping the Brain and its Functions
PLATE
P l a t e 15
1 5 PET scans of a patient patient with
with obsessive-compulsive disorder,
showing the brain before and after therapy therapy
PLATE
P l a t e 16 P E T scan of the brain of a heavy user of M
1 6 PET MDMA
DMA
("ecstasy"),
(“ecstasy” ), compared
compared with with the scan of a normal normal control
control
subject
PLATE “ Plain Brain/Brain after Ecstasy"
P l a t e 17 "Plain Ecstasy”
PLATE 18
P la t e 18 PET scans of a patient with attention-deficit
patient with hyperactivity
attention-deficit hyperactivity
disorder
disorder (ADHD), compared compared with with the scan of a normal normal
control subject
control

, I
I
I
Acknowledgments
Acknowledgm ents

book has traveled

This book traveled a long way withwith me and would not not have been
possible without wonderful help of my mentors
without the wonderful mentors and advisors: Sharon
Traweek, Donna
Traweek, Donna Haraway,
Haraway, Gary Lee Downey, Susan Harding,Harding, Paul Ra-
Hayden White,
binow, Hayden White, Ramunas
Ramunas Kondratas,
Kondratas, Byron Good,
Good, Mary-Jo Del-
Good, and Michael Fischer.
vecchio Good, Fischer, The manuscript
manuscript has benefited from
comments, critiques,
comments, critiques, and invaluable
invaluable camaraderie
camaraderie along the way from
Marianne de Laet, Warren
Marianne Warren Sack, Jennifer
Jennifer Gonzales, Ron Eglash, Karen-
John Hartigan,
Sue Taussig, John Hartigan, Angie Rosga, Lorraine
Lorraine Kenney, Chris Kelty,
Kelty,
Hannah Landecker, Kim Fortun,
Hannah Fortun, Mike Fortun,
Fortun, Anne Beaulieu, Simon
Cohn, Nathan
Cohn, Nathan Greenslit, Wen-Hua
Wen-Hua Kuo, Kaushik
Kaushik Sunder Raj an, Regula
Rajan,
Marissa Martin,
Burri, Marissa Martin, Amit Prasad,
Prasad, Jake Reimer, Nancy
Nancy Boyce, Sanjay
anonymous reviewers who helped me immensely. Still, all
Basu, and two anonymous
the mistakes and elisions are still mine. Groups,
the Groups, conferences, and semi­
semi-
intellectual home, and for this project
nars have been my intellectual project in particular
particular, I
want to acknowledge
want acknowledge the Galveston
Galveston Workshop
Workshop on Scientific
Scientific Visualiza­
Visualiza-
American Research
tion; the School of American Research Seminar on Cyborg Anthropol­
Anthropol-
Committee for the Anthropology
ogy; the Committee Anthropology of Science,
Science, Technology, and
Computing (CASTAC);
Computing (CASTAC); George Marcus Marcus and the Late Editions groups;
students of my Brains &
and the students Sc Culture
Culture classes. Support
Support for this proj­
proj-
Smithsonian National
ect has come from the Smithsonian National Museum
Museum of American His­ His-
National Institute
tory, the National Institute of Mental
Mental Health,
Health, the National
National Science
Science
Foundation, the Dibner
Foundation, Dibner Institute,
Institute, the Center
Center for the History
History of Physics.
thanks to the Dean's
Special thanks Dean’s Office at the School of Humanities,
Humanities, Arts,
and Social Sciences,
and Sciences, and the Program
Program in Science,
Science, Technology, and Soci­
Soci-
supporting the color plates in this book. And the re­
ety, at MIT, for supporting re-
would not
search itself would not be possible without
without the PET researchers,
researchers, techni-
ACKNOWLEDGMENTS
ACKNOWLEDGMENTS

cians, graduate
graduate students,
students, and journalists,
journalists, plus many others who talked
talked
with
with me, gave me tours, granted me their time, and tolerated
tours, granted ques­
tolerated my ques-
tions over the years on and off the record. And above all, Sylvia Sensi-
Sylvia Sensi-
per has supported,
supported, tolerated,
tolerated, motivated,
motivated, and loved me through
through this
project
project more than
than I can ever repay.
Portions of this book are expanded
Portions expanded versions of previously published
published
works. My essay,
essay, “PET Scanner,” originally appeared
"PET Scanner," in Instruments of
appeared inlnstruments of
Science: An Historical
Science: An Historical Encyclopedia, Robert Bud, ed., in the series Gar-
Encyclopedia, Robert Gar­
land Encyclopedias in the History
History of Science, copyright © 1997; it is
Science, copyright
reprinted
reprinted here by permission
permission of Routledge,
Routledge, Inc., part
part of the Taylor &c
Francis Group.
Group. Another
Another essay,
essay, “Digital
"Digital Image of the Category
Category of Per-
Per­
son”
son" is taken
taken from Cyborgs & Citadels:
Citadels: Anthropological
Anthropological Interventions
Interventions
in Emerging
Emerging Sciences
Sciences and Technologies, edited by Gary Lee Downey
and Joseph Dumit; it is copyright
copyright © 1997 by the School of American
Research, Santa Fe, and is reprinted
reprinted here by permission.
permission. I have also
incorporated material written
incorporated material written by me for two other
other previously published
published
essays:
essays: “Twenty-first-century
"Twenty-first-century PET: PET: Looking for mind and morality morality
through
through the eye of technology,”
technology," originally published
published in Technoscientific
Imaginaries: Conversations,
Conversations, Profiles,
Profiles, and Memoirs,
Memoirs, edited by George E.
Marcus,
Marcus, and published
published by the University of Chicago Press in 1995; and
from "Objective
“ Objective Brains, Prejudicial Images,” published in Science in
Images," published
Context,
Context, volume 12, no. 1 (1999).

xii
Picturing Personhood
Personhood
 Chapter
Chapter 1
Introduction

Probably one of the most

Probably most important
important initiatives
initiatives we have ever
undertaken is our support
undertaken support for positron
positron emission tomogra­
tomogra-
intriguing new research
phy (PET), an intriguing research technique.
technique ..... . . With
With
PET we will be able to examine
examine what
what happens
happens functionally,
human brain,
in the living human brain, when
when a person
person speaks, hears,
thinks. The potential
sees, thinks. potential payoffs from this technique
technique are
enormous.
enormous.
—Dr. Donald
-Dr. Donald B. Tower, Director
Director of the National
National Insti­
Insti-
tute for Neurological
tute Neurological and Communicative
Communicative Disorders
Disorders
NIH Record,
(from the NIH Record, 1980)

In art and in life, only that

science, just as in art that which is true
to culture true
culture is true to nature.
nature.
—Ludwig Fleck
-Ludwig

paneled conference
Sitting in a paneled conference room
room at the University
University of California,
California, Los
with framed
Angeles, with framed brain
brain images on the wall, I am talking
talking with
with Dr
Dr.
Michael Phelps, one of the fathers
Michael fathers of positron
positron emission tomography
tomography
scanning (figure 1.1). As I explain
(PET) scanning explain my project
project on the history
history and
anthropology of PET brain
anthropology brain images, he interrupts
interrupts to turn
turn the question
question
back to me:
b_ack
PHELPS: What is it? If I am just an ordinary
P h e l p s : What ordinary person
person and I ask you,
“What is PET?"
"What
D u m iT : It is
DuMIT; that is
is a device that lik e a CT [computed
is like [computed tomography]
tomography] scan­
scan-
ner butbut isn't.
isn’t. With
With PET, you take
take some molecule or drug that
that you
 CHAPTER I1
CHAPTER

►Tomographic
image
♦ kinetic
Tracer ~
econstruction model

I'
i
Plasma FOGaad ) TTomographic
om ograph ic image
im ag e
glucose concentrations ooff cerebral gglucose
lu cose
metabolism
m etabolism

i g u r e 1.1.
FIGURE
F Principle of positron
Principle
\
positron emission
enuss10n tomography
tomography (PET)
(PET) using example
example of
18
F-fluorodeoxyglucsoe (FDG) to
18F-fluorodeoxyglucsoe to image glucose metabolism
metabolism in the human
human brain.
(Michael E.
(Michael E, Phelps 1991)

want to image-water
want image —water or glucose, for example. You attach attach a radio­
radio-
active isotope
isotope to it and inject it into your body, and what what you im­im-
age is where
where the tagged molecule or drug goes. You image the ra- ra­
dioactivity through time; you capture
dioactivity through capture it with
with a ring of detectors.
detectors.
What
What you get is an image of a slice and are able to reconstruct reconstruct
where
where the radioactivity
radioactivity is in one slice that
that gives a cross-sectional
cross-sectional
view of where
where something
something is through
through time. You can use it to find out
where
where in the body and with with what
what amounts
amounts the molecule is.
PHELPS: You
Ph e lp s : Y ou know, another approach the explanation
another way to approach explanation is to
about PET initially and focus on the problem:
forget about That is to be
problem: That
able to take a cameracamera and just watch.
watch. Inside the body is all this
biology thatthat we know
know is going on. You take food in, you eat it, and
it becomes nutrients
nutrients for your cells.
cells.
Your body looks like it is a physical, anatomical
anatomical substance,
substance, but
inside there
there are all kinds of cells that metabolizing things,
that are metabolizing things, or
around and
moving around doing things,
and doing things, signaling to each other. We'dWe’d like
to be able to watchwatch this action.
action. That
That is the objective. You know know the
activity is there,
there, and you’d
you'd like to be able to build a cameracamera that
that
watch it. Well, one way to do that
can watch that is first to say, "Well, if I was
say, “Well,
really little, I could go in there,
there, move around,
around, and watchwatch those

i
~
(·"

INTRODUCTION
INTRODUCTION

things.” But since you can't

things." can’t go in there,
there, you can send a messenger.
messenger.
So you do that. that. You say, "Well,
“Well, I want
want to look at one portion
portion of
this.” So you take a molecule that
this." that will go and participate
participate in that
that
portion. The molecule will go through
portion. through that that process. You take that that
molecule and
molecule and put
put a source on it that
that will emit back to you. So you
inject it intointo your
your bloodstream,
bloodstream, and it goes on this journey. It goes
throughout your body with
throughout with the flowing blood,blood, and depending
depending on
that molecule, it will go into
• that into some organorgan that
that uses it. And you have
camera and can sit there
a camera there now
now and watch watch that
that molecule, watch
watch it
through the blood
go through blood supply, go into the brain,
brain, go into the tissue of
the brain,
the brain, and
and actually
actually go through
through the biochemical
biochemical process. So you
have a cameracamera that
that allows you actually
actually to watch
watch some of that, that,
watch the biology of the body. So
watch So that
that is really the objective. Forget
about the particulars
about particulars of the instruments.
instruments. I know know that
that inside this
being therethere is a whole
whole bunch
bunch of stuff going on, the biological activ­ activ-
ity of the body, the body'sbody’s chemistry. It gives me a way to watch watch
that.
that. This is really what what PET does. It reveals to us somethingsomething that
that
we knowknow is going on inside your body, but but that
that we can’t
can't get to.
And it does it in such a way that that does not not disturb
disturb the biology of the
body’s chemistry. This molecule
body's molecule is in such trace amountsamounts that
that it
it-—
body—goes on about
the body-goes about its business. The molecule is apparent apparent to
but transparent
us but transparent to the
the body.
D u m it : Like an ideal participant
DUMIT: participant observer.
PHELPS: observer that
P h e l p s : It is an observer that doesn't
doesn’t disturb
disturb you. That
That is, what
what hap­
hap-
pens wouldwould happen
happen with
with or without
without that that observer
observer there. If you are
observer at the
an observer the presidential
presidential conference
conference and bother bother the president,
then you distort
then distort what
what would
would have taken taken place had you not not been
there. But this molecule is given in such trace quantities
there. quantities that
that it
disturbance. Whatever
makes no disturbance. Whatever happens
happens would
would have happened
happened
whether you were there
whether there or not.
not.

generated by an incredibly
PET scans are generated incredibly complex,
complex, expensive, and
interdisciplinary set of techniques
deeply interdisciplinary techniques and technologies.
technologies. An experi­
experi-
mental PET brain
mental brain scanner, including
including a requisite
requisite cyclotron
cyclotron to produce
produce
radioactive nuclides, costs about
radioactive about $7 million to purchase.
purchase. A PET re­ re-
project also needs the expertise
search project expertise of physicists, nuclear
nuclear chemists,
mathematicians, computer
mathematicians, computer scientists, pharmacologists,
pharmacologists, neurologists.
neurologists. The
physiological: to gain information
aim is physiological: information about
about the patterns
patterns of molecu­
molecu-
lar flow in the body at specific places over a specific
specific amount
amount of time.
scanning is the solution
PET scanning solution to the problem
problem of howhow to follow a molecu­
molecu-
substance like water, oxygen, sugar, or Prozac
lar substance Prozac and see where in the
how much
body it goes, how much goes there,
there, and whether
whether it stays or circulates
out of the area. With
out With the use of a cyclotron,
cyclotron, radioactive
radioactive isotopes of one

I
 ,
CHAPTER 1
CHAPTER

common biological atoms (carbon, nitrogen,

of the four common nitrogen, oxygen, and
fluorine, the latter
latter standing
standing in for hydrogen)
hydrogen) are substituted
substituted for the orig-
orig­
inal atoms in the molecule of interest. This radiolabeled
radiolabeled molecule func­ func-
normal molecule. As it decays, the radioactivity
tions exactly like the normal radioactivity is
captured by the scanner
captured scanner and reconstructed
reconstructed in a map of the flow rate of
the molecule. The resultresult is a "picture"
“ picture” of the molecular
molecular flow in the
body. This description
description is, of course, very general and overlooks overlooks many
qualifications, assumptions,
qualifications, assumptions, and variables in PET. PET. This description
description is
also not neutral. It will take the rest of the book to explain how each
not neutral.
description of PET by different
description different PET researchers is part part of an ongoing
attempt to define the meaning and purpose
attempt purpose of PET and PET images, to
invention and contribution,
make claims of invention contribution, and to give ontological
structure to the brain.
structure brain.
As an anthropologist,
anthropologist, I have observed and interactedinteracted with
with various
community for over 3 years, and I feel PET to be an
facets of this community
important and increasingly powerful
incredibly important technique for producing
powerful technique producing
images of living humanhuman brains. On the basis of my research, I have
identified an area of PET signification that that I believe is critical in debates
over the roles of PET in the world today: today: the visual effect
effect ooff PET
PET brain
images. By attending
attending closely to PET images, I have chosen the most
mobile aspect of PET experiments.
experiments. These images travel easily and are
meaningful. Because
easily made meaningful. Because they are such fluid signifiers,
signifiers, they can
serve different
different agendas and different meanings simultaneously. While
representing a single slice of a particular
representing particular person’s
person's brain blood flow over
short period
a short period of time, one scan can also represent
represent the blood flow of a
o f human,
type of human, be used to demonstrate
demonstrate the viability
viability ooff PET as a neuro­
neuro-
science technique,
technique, and demonstrate
demonstrate the general significance ooff basic
neuroscience research.
neuroscience
book, we will be exclusively discussing PET brain images of
In this book,
personhood, which
mind and personhood, which are the most
most prominent
prominent PET images in the
However^ they are only one small part
media. However, part of PET’s
PET's usefulness. In
addition to imaging the brain,
addition brain, PET is used clinically to image the heart, heart,
determine the ability of the heart
to help determine heart to withstand
withstand a heart-bypass
heart-bypass
operation. PET is also extremely useful in whole-body
operation. whole-body and specific
specific or­
or-
gan scanning to detect different cancer types by using a radiolabeled radiolabeled
tracer that
tracer that is attracted
attracted to metastatic
metastatic and not benign tumors tumors {e.g.,
(e.g., it has
approved for Medicare
been approved Medicare and Medicaid
Medicaid coverage to help stage breast
cancer).11 PET is also used in neurosurgery
cancer). neurosurgery to identify the precise loca­ loca-
tion of epileptic foci. These otherother uses of PET are not subject to the
kind of critique
same kind critique we will be applying to PET brain-type brain-type images.
This is because these otherother uses of PET can be calibrated
calibrated directly with
referent. The heart,
their referent. heart, for instance, can be looked at surgically, and in
comparison with
comparison with the PET image one can learn exactly what signals reg­ reg-

4
 INTRODUCTION
INTRODUCTION

correspond with
ularly correspond with different tissue states. But in the case of mental
brain-types, there
activity and brain-types, there is no corresponding
corresponding calibration.2
calibration.2 In spite
research into schizophrenia
of decades of research schizophrenia and depression, for example,
there are no known
known biological markers
markers for either one (Andreasen 2001
2001),),
though with Alzheimer's
though Alzheimer’s disease, we may be close. Thus in many cases,
though we can say that
though accurately identifies the location
that PET accurately location of the
radiolabeled molecule in the brain,
radiolabeled brain, we cannot verify that
cannot verify that the additional
additional
oxygen flow through frontal cortex
through the frontal cortex is a symptom
symptom of schizophrenia.
schizophrenia.

Popular Brain Images

Popular Images

The brain scans that that we encounter

encounter in magazines and newspapers,
newspapers, on
television, in a doctor's
doctor’s office, or in a scientific journal
journal make claims on
colorful images with
us. These colorful with captions
captions describe brains that that are certifi-
smart or depressed or obsessed. They describe brains that
ably smart that are
clearly doing something,
something, such as reading
reading words,
words, taking a test, or hallu­
hallu-
cinating. These brain images make claims on us because they portray portray
kinds
kinds of brains. As people with, with, obviously, one or another another kind of
brain, we are placed among the categories that that the set of images offers.
To which
which category do I belong? What What brain type do I have? Or more
nervously: Am I normal? Addressing such claims requires an ability to
critically analyze howhow these brain
brain images come to be taken taken as facts
about the world-facts
about world —facts such as the apparent
apparent existence and ability to
“ diagnose” of these human
"diagnose" human kinds. Behind our reading reading of these images
further questions of how these images were produced
are further produced as partpart of a
experiment, and how they came then to be presented
scientific experiment, presented in a pop­
pop-
ular location
location so that
that they could be received by readers
readers like us.
readers, all of the processes of translation
As readers, translation of facts, from one loca- loca­
tion and form of presentation another, should
presentation to another, should be imagined when we
critically assess
assess a received fact. We should try to to become as aware as
people who interpret,
possible of the people interpret, rephrase,
rephrase, and reframe the facts for
mediators). We should also critically assess the structural
us (the mediators). structural con­
con-
straints of each form
straints form of representation
representation — - peer review, newsworthiness,
newsworthiness,
doctor presentations
doctor presentations to patients
patients (the media). In the case of the brain,
these processes of fact translation
translation are caught
caught up in a social history
history that
that
how the brain came to be an object of study in the first place,
includes how
what factors -—conceptually, institutionally,
and what institutionally, and technically
technically-—were
part of its emergence as a fact. When
part When did it first become possible to
think of the brain
think brain as having distinct
distinct areas that
that can break or malfunc­
malfunc-
How and when
tion? How when did the brain
brain come to have “circuits”
"circuits"?? How did
techniques technological metaphors
techniques and technological metaphors like telegraphs
telegraphs and and electricity
make it possible to pose the problem
problem of brain
brain imaging? In turn, turn, what

5
 CHAPTER 1

disciplinary and
disciplinary and institutional
institutional fundingfunding mechanisms were available to
questions posed answerable?
make the questions answerable?33 Some human human kinds that that we are
starting to take
starting take for granted,
granted, such as “"depressed
depressed brains,”
brains," require
require attend­
attend-
broader social and institutional
ing to broader institutional forces in orderorder to understand
understand
how it is that
how that we look to the brain brain for an answer.
appearance in the popular
An early appearance popular media of brain brain images can be
seen in a 1983 article in the fashion fashion magazine Vogue (see (see Plate 1). Enti­
Enti-
“High-Tech Breakthrough
tled "High-Tech Breakthrough in Medicine: New Seeing-Eye Seeing-Eye Machines
. , , Look Inside Your Body,
... Body, Can Save Your Life,” Life," the piece was accom­
accom-
panied by a simple graphic: three similar, oval-like blobs each filled with
panied
patterns of bright
dissimilar patterns bright colors (Hixson 1983). 1983 ). Above each shape is
a white word word in bold font standing standing out from the black background:background:
n o r m a l , SCHIZO,
NORMAL, d e p r e s s e d . The article does not
s c h i z o , DEPRESSED. not need to be read to be
understood. The juxtaposition
understood. juxtaposition of words words and images brings home quite
forcefully thatthat the
the three
three colored ovals are brain brain scans, and that that the three
scanned are different. These images insist that
brains scanned that there are at least
three kinds
three kinds of brains.
brains. Presumably, these brains belong to different peo­ peo-
ple—who
ple -who are three three different
different kinds of persons because their their brains are
not the same. The cultural
not cultural and and visual logics by which these images per­ per-
suade viewers to equate equate person
person withwith brain, brain with with scan, and scan
with diagnosis are also the subject of this book.
with
Facing the brainbrain images in Vogue, there appears to be something something intu­
intu-
itively right aboutabout a brain-imaging
brain-imaging machine being able to show us the
I,
between schizophrenic
difference between schizophrenic brains, brains, depressed brains,
brains, and normal
normal
ones. This persuasive force suggests that that we ignore the category
category ques­
ques-
whether three
tion of whether three kinds of brains means three kinds of people. How
there not
could there not be a difference in these three three kinds of brains if there are
such differences in the three kinds of people, schizophrenics, schizophrenics, depressed,
and normals? And after seeing the different different brain images, how could
not perceive a difference between these three “kinds”
one not "kinds" of people?
The images with with their
their labels are part part of the process of reinforcing
reinforcing our
assumptions of difference and
assumptions and making
making them seem obvious and normal. normal.
Rationally, we may still remember remember that that this is a category
category mistake, a
substitution of a small set of scan differences for the universal assump­
substitution assump-
tion of differences in kind. Thus, the effect of such presentation
tion presentation of im­ im-
produce an identification
ages is to produce identification with with the idea that
that there is a categori­
categori-
between three
cal difference between three kinds of humans
humans that
that corresponds
corresponds essentially
three kinds of brains -—or brain-types. So
to the three So we see, too, that that in our
encounters with
encounters with brain
brain images we come face-to-face with with an uncertainty
uncertainty
regarding our own
regarding own normality
normality and "kinds" “kinds” of humans
humans that
that we and others
are. Alongside the social and institutional institutional components
components of brain-fact
brain-fact pro­
pro-
duction, we must
duction, must face this question question of how cultural
cultural identification
identification and

6
 INTRODUCTION
INTRODUCTION

intuition coincide with

intuition with these representations
representations of reality
reality so that
that we are
persuaded to take
persuaded take them
them as true.
true.
What
What does it mean encounter “"facts"
mean to encounter facts” like brain
brain images in popular
popular
media? HowHow are "received
“received facts"
facts” like these used in other other contexts
contexts and
other people —in
by other courtrooms, in doctors’
- in courtrooms, doctors' offices, before Congress?
The labels and stories accompanying
accompanying the image may be far removed
from the careful
careful conclusions of the original
original scientific journal
journal article, and
the news story may include comments comments deemed deemed “indefensible”
"indefensible" by the
original researchers.
original researchers. Nevertheless,
Nevertheless, popularization
popularization is not not a simple one­
one-
corrupting by dumbing
way process of corrupting dumbing down down a scientific message. In
many cases, the researchers
researchers will continue
continue to to participate
participate with
with journalists
journalists
in constructing
constructing these stories because there there are notnot many
many other
other ways to
get the facts out. Publicity in all of its forms,
forms, with
with all of the transforma­
transforma-
tions conducts on the facts, is how
tions it conducts how we come to to know
know facts about
about
ourselves (Myers 1990; NelkinNelkin 1987; Prelli 1989). In any case, like sci- sci­
entists, as scientists, we supplement
supplement our knowledge
knowledge with with facts, knowing
knowing
full well that
that the facts almost always have qualifications.
qualifications. This does not
incorporating these facts, however, and from assuming
stop us from incorporating
them and acting on them
them them (Hess 1997; MartinMartin 1994).
Many researchers have pondered
Many researchers pondered how how risks, danger, and stereotypes
(notions of human
(notions human kinds) are best explained
explained in cultural
cultural terms. Ranking
Ranking
uncertain dangers, acting in the face of contradictory
uncertain dangers, contradictory facts, and imagin-
imagin­
ing human
human kinds and attributes
attributes are culturally
culturally and historically
historically variable
practices Wildavsky 1982; Gilman
practices (Douglas and Wildavsky Borrowing a
Gilman 1988). Borrowing
term psychology and semiotics, we can characterize
term from psychology characterize our relation-
relation­
ship to.
to culture
culture as identification.
identification. Rhetorician
Rhetorician Kenneth
Kenneth Burke defined
identification as the “ways
identification which we spontaneously,
"ways in which spontaneously, intuitively, even
unconsciously persuade
unconsciously ourselves” (Burke 1966, p. 301). As in analyses
persuade ourselves"
of ideology, the rightness
rightness of facts seems to emerge from our our own experi­
experi-
ence.4 This notion
notion of self-persuasion
self-persuasion helps us keep in mind both the
mind both
persuasive action
action of received facts (e.g., from from a magazine) and the form form
in which
which we often (but not not always) incorporate
incorporate them them as facts.
We might
might call the acts that concern our brains
that concern brains and our our bodies that
that we
derive from received-facts of science and objective-self. 5
and medicine the objective-self.-
The objective-self consists of our taken-for-granted
taken-for-granted notions,notions, theories,
and tendencies regarding human
tendencies regarding brains, and kinds considered
human bodies, brains, considered as
objective, referential, extrinsic, and objects of science and
referential, extrinsic, and medicine.
That
That we “know”
"know" we have a brain brain and that
that the brain
brain is necessary for our
self is one aspect of our objective-self. We can immediately
immediately see thatthat each
of our objective-selves is, in general, dependent on how
general, dependent how we came to
know
know them.
them. Furthermore,
Furthermore, objective-selves are not incom­
not finished but incom-
plete and
and in process. With received-facts, we fashion fashion and refashion our
and refashion
objective-selves. Thus it is we come to know know certain
certain facts about
about our

7
 1
!

CHAPTER 1

endangered by poisons
body as endangered poisons like saccharine, our brains as having a
“reading circuit,"
"reading circuit,” and our fellow humanhuman beings as mentally ill or sane
borderline.
or borderline.
Objective-selves always pull at issues of normality, and with with brain
powerful semiotics of what
scans there is a powerful what counts as normal.
normal. However,
normality can be a variety of things. In the history of science and medi­
normality medi-
Canguilhem has described the many different
cine, Georges Canguilhem different ways in
which the "norm"
which “norm” has been crafted.
crafted. What
What is normal
normal has been defined as
population, as a typical member, as an ideal type (Can­
an average in a population, (Can-
guilhem 1978). In the case of the PET images in Vogue, normal normal does not
“ healthy”; it means “nonschizophrenic”
necessarily mean "healthy"; "nonschizophrenic" and “non­ "non-
depressed.” In other
depressed." other words,
words, if you have a test to diagnose an illness,
testing positive for the illness usually means you have it, and testing
negative usually means you do not; it does not not mean that that you do not
have any illness. The qualifier usually must be emphasized, emphasized, because
conditions are not
most tests for biological conditions not 100 percent
percent accurate. They
often have both both a false-positive rate and a false-negative rate.
understand what
Before we can understand what the labels NORMAL, DEPRESSED, and
NORMAL, DEPRESSED,
s c h i z o really mean, we have to know more about
SCHIZO about how they were
experimentally. Was NORMAL
defined experimentally. n o r m a l derived by taking
taking a number
number of
healthy individuals
healthy individuals and averaging their brain brain patterns
patterns together? If If so,
matter how
does it matter how many individuals
individuals were used, or if they were all right-
handed, or all male, or all of college age?
handed, age? Likewise, as critical readers or
consumers of depression-industry
consumers depression-industry products
products and services, we would like
to know
to know what what criteria
criteria were used to select individuals as “"depressed."
depressed.” In
addition to demographic
addition demographic criteria
criteria (gender,
(gender, handedness,
handedness, etc.), who or
what decided that
what that those individual
individual were depressed? Were they depressed
for a long time or only recently? Were they actively depressed while
they were being scanned? Had Had they ever takentaken antidepressant
antidepressant medica­
medica-
Regarding the image shown, how many of the individuals
tion? Regarding individuals had
brain images that that looked like it, and what what was the variation
variation in images
of depressed people?
individual images, we also notice how together
Turning from the individual together they
argue thatthat there
there are three different
different kinds of brains that that correspond
correspond to
three kinds of brain
the three brain images. Because the images are so clearly differ­ differ-
ent from each other, they make the additional additional argument
argument that that each brain
distinguishable, and thus they promise
kind is easily distinguishable, promise thatthat a PET scan
can make a diagnosis -—of schizophrenia, depression, and normality, in
of schizophrenia,
this case. If If we pay close attention
attention to the shape of the images and know know
that PET images are pictures
that pictures of "slices"
“ slices” of brains, then
then we notice thatthat
three images appear
the three appear to be different slicesslices of the brains,
brains, or at least
that the three
that three brains are very different
different in shape and size.size. In this case we
might expect
might expect that
that they would, of course, look different. However, we

8
 INTRODUCTION
INTRODUCTION

would wonder
would wonder whether, if we took the same slice in each “kind” "kind" of
brain, the PET images would
brain, would look so different. Perhaps each slice has
been chosen to emphasize the part part of the brain
brain implicated
implicated in the condi­
condi-
tion. How
tion. How could we tell this? And what what slice would be implicated
implicated in a
“ normal brain,"
"normal brain,” then?
then?6 6

All of this is to say that that what

what we come to receive as facts about about
analyzable from a number
ourselves are analyzable number of perspectives.
perspectives. We might look
cultural salience of categories like mental
at the cultural mental illness and gender. We
might look at the fundability
might fundability of different
different approaches
approaches to brain
brain scanning.
might attend
We might attend to the available metaphors
metaphors for thinking
thinking about
about brains
Though this may seem critical of the science, these perspec­
and people. Though perspec-
tives are the same ones from which which scientists talk and debate about
their work
their work and its dissemination.
dissemination. Scientists continually
continually have to deal
with not
with not only the recalcitrance
recalcitrance of their
their instruments
instruments and the resistance of
world but
the world but also disciplinary
disciplinary constraints,
constraints, funders
funders and patrons,
patrons, com­
com-
students in training,
petitive colleagues, students training, social mores and values, and lay
interpretations.7 Everyday notions
interpretations.7 notions of human
human kinds help shape what what
questions scientists are allowed to ask and what
sorts of questions what sorts of selec­
selec-
tion procedures
tion procedures they enact on their their subjects. Idioms and metaphors
metaphors
efficiency, circuitry, and inhibition)
(e.g., flexibility, efficiency, inhibition) are produced
produced in part part
cultural uses and travel back into laboratories.
by cultural laboratories. It is out of this busy
intersection of technical, social, and cultural
intersection cultural flows that
that scientists at­ at-
tempt to stabilize and conduct
tempt conduct their
their experiments,
experiments, and it is back into the
intersection that
intersection that their results mustmust go.
go.8B
These flows enable and constrain constrain science at every level of fact concep­
concep-
tion, experimentation,
tion, experimentation, publication,
publication, and dissemination,
dissemination, and reception,
reception,
but this does not
but not imply that that science is culture.
culture. There is an interplay
interplay
popularization processes and scientific inquiry. Science
between popularization Science pro­
pro-
duces facts in spite of and because of these constraints constraints — laboriously,
-laboriously,
continuously, and creatively. And we fashion
continuously, fashion our
our objective-selves with
the fruit
the fruit of this labor
labor in the form of received-facts in our own contin­ contin-
uous and oftenoften creative manner, no matter matter how
how skeptical we are. This
way of living with with and through
through scientific facts is our our form of life.5
life.9
book, we will investigate brain images as they are presented
In this book, presented in
a variety of settings, in order order to become better-informed
better-informed science
science readers
and, some of us, betterbetter scientists. MuchMuch of the disciplines of the history
of science and science and technologytechnology studies (STS)
(STS) concentrate
concentrate on teas­
teas-
ing out the difficulties of establishing facts in a particular particular place and
10
time.1
time. 0 These scholars show show howhow creatively and laboriously
laboriously science is
put
put together. Thus, we will need to investigate the production
production of images,
including specific machines and experiments,
including experiments, in order to understand
understand
assumptions are made. We need to understand
how, why, and when assumptions understand thatthat
there are different
there different kinds of assumptions:
assumptions: (1) necessary assumptions
assumptions in

9
 CHAPTER I1
CHAPTER

the absence of settled answers;

answers; (2) efficient assumptions
assumptions in the face of
practical
practical and economic constraints; and
economic constraints; and (3) provisional
provisional assumptions
assumptions be­
be-
cause the experiment
experiment itself is hypothesis-generating. cultural an­
hypothesis-generating. Using cultural an-
thropology, addition to examining
thropology, in addition examining how how brain
brain images are painstak-
painstak­
ingly put
put together,
together, we will also study how they travel
study how travel from setting
from one setting
(e.g., a lab) to
to another
another (e.g., a magazine)
magazine) andand what meanings they both
what meanings both
lose and pick up in the process.
process. Thus
Thus we will learn
learn to pay attention
attention to
received facts and to to how
how brain
brain images are put put to persuasive
persuasive use in
specific contexts.
contexts.
The lack of ultimate
ultimate clarifications
clarifications as to what
what brain
brain images mean
mean —in
- in
abstract
abstract or in a particular
particular use -—is is a consequence
consequence of our our considering
considering
them
them in use (and potential
potential reuse and thus reinterpretation).
and thus reinterpretation). Objective-
Objective-
selves, received-facts, and brain-types
received-facts, and brain-types are thus
thus “not
"not terms that
that avoid
ambiguity,
ambiguity, butbut terms that clearly reveal the strategic spots at whichwhich am­
am-
biguities necessarily arise"
arise” (Burke 1945,1945, p. xix; emphasis
emphasis in original).
original).
Following
Following Kenneth
Kenneth Burke,
Instead
Instead of considering
considering it our task to dispose of any ambiguity
ambiguity by
merely disclosing the fact that
that it is an ambiguity, we rather
rather consider
consider it
our task to study
study and
and clarify the resources of ambiguity. . . . For in
ambiguity .•..
the
the course
course of our work,
work, we shall deal with
with many
many kinds of transforma-
transforma­
tion—and
tion - and it is in the areas of ambiguity
ambiguity that
that transformations
transformations take
take
place. (Burke 1945,
1945, p. xviii; emphasis
emphasis in original)

Methods:
Methods: An Ethnography
Ethnography of Images
Images

How
How should neuroscientists be acco_untable
should or can neuroscientists accountable for their
their speculations
speculations
as they travel into print
travel into print and
and into courtrooms ? How
into courtrooms? How can we account
account for
these speculations,
speculations, andand are these speculations
speculations in fact grounded
grounded in a
shared
shared cultural
cultural notion
notion of personhood
personhood and and human
human difference? How How do
we, can we, might
might we respond
respond to these conclusions
conclusions regarding
regarding ourselves?
Questions
Questions of how how brain function in the world
brain images function world and how we are
and how
accountable
accountable to themthem have no simple answer. Investigating them requires
Investigating them requires
a combination
combination of cultural
cultural anthropology,
anthropology, STS cultural studies, and
STS cultural and his­
his-
tory. This project interdisciplinary investigation
project began as an interdisciplinary investigation into
into the
process
process .ofof producing,
producing, disseminating, incorporating PET experi­
disseminating, and incorporating experi-
ments into
into our
our lives. My model
model was Appadurai
Appadurai and and Kopytoff’s
Kopytoff's eth­
eth-
nographic
nographic approach
approach to the the "social
“ social life of things"
things” (Appadurai
(Appadurai 1986;
I ICopytoff 1986). Meaning,
Kopytoff 1986). Meaning, from
from a cultural
cultural anthropological perspective,
anthropological perspective,
I
is a lived relation
relation among
among cultural actors, and
cultural actors, and toto the
the extent that things
extent that
I
such as images and technologies
technologies are attributed
attributed agency, they, too,
too, partici­
partici-
pate
pate in cultural
cultural exchange. My intention
intention was to trace
trace the various
various ways in
which
which experiments
experiments were designed with with assumed
assumed categories
categories of people,

10
10
 INTRODUCTION
INTRODUCTION

how they were carried

how carried outout and
and interpreted,
interpreted, published
published in technical
technical and
popular literature,
popular literature, and readread and
and incorporated
incorporated into further
further experiments,
experiments,
patients’ lives, and
patients' and everyday notionsnotions of personhood.
personhood. Focusing on the
images, I set out out to study how how these scans were desired, laboriously laboriously
generated, selected, captioned,
generated, captioned, published,
published, read,
read, interpreted,
interpreted, argued over, over,
referred to, and
referred and forgotten.
forgotten.
primary mode of fieldwork
My primary fieldwork was to to “"follow"
follow” the images around. around. I
started with both
started both images in the media and with with image producers.
producers. I con­ con-
ducted extensive oral histories
ducted histories with
with key PET researchers
researchers at six different
PET labs in the United United States. I interviewed
interviewed many others, others, including
graduate students
graduate students and
and postdoctoral
postdoctoral scholars,
scholars, watched
watched experiments
experiments be­ be-
conducted, and
ing conducted, and observed
observed day-to-day
day-to-day practices.
practices. I studied
studied the prac­prac-
writing research
tices of writing research grants,
grants, attended
attended conferences and public lec­ lec-
tures, interviewed
tures, interviewed science editors editors and otherother mass-media
mass-media producers,
producers,
looked at the use of brain
looked brain images in courtrooms,
courtrooms, and talked
talked to patients
patients
and patient-activists
and patient-activists about
about their
their experiences
experiences with scans. 111
with scans.1
with this approach
Difficulties with approach arose
arose immediately. As a complex,complex, mul­ mul-
tidisciplinary enterprise,
tidisciplinary enterprise, PET has multiple,
multiple, competing
competing identities.
identities. PET
unitary history, nor
also has no unitary nor even a definition
definition to which
which a majority
majority
Newsweek, for example,
agree. In a single article for Newsweek, example, each PET image
included was disavowed
included disavowed by other other researchers
researchers appearing
appearing in the same ar­ ar-
not very meaningful.
ticle, as not meaningful. In addition,
addition, PET’s
PET's controversial
controversial use in
courtrooms, contested
courtrooms, contested clinical status,
status, and diverse potential
potential in mental­
mental-
communities made
illness communities made it a very fluid object object of study. The challenge
account both
became to account both for the multiplicity
multiplicity of PET’s
PET's meanings and
practices and
practices and for the powerful
powerful circulation
circulation of the images into different
social arenas.
“field” of an ethnographic
The "field" ethnographic study study of images must must include, then,
not only their
not their "biographies"
“ biographies” but but also what
what can be called
cal1ed their
their “virtual
"virtual
community” By using the
community" the term
term virtual community,
community, I am borrowing
borrowing Al-
Stone’s notion
lecquere Stone's notion of communities
communities that that include technologies
technologies as
participants. These communities
vital participants. communities are dispersed
dispersed in space, and al­ al-
though each participant
though participant is not not necessarily connected
connected directly to every
other one, they all interact
other interact indirectly
indirectly with
with each other
other via technologies
technologies of
communication (Stone 1992). There
communication There are popular
popular theories of person person and
that are also the basis of science theorizing.
science that theorizing. In terms of PET, PET, all
those who
those who meaningfully
meaningfully interact
interact with
with PET images are part part of the virtual
community. There
community. There are laboratories
laboratories and granting
granting agencies; therethere are jour­
jour-
and publishing
nals and publishing apparatuses;
apparatuses; therethere are machines,
machines, brains and people.
there are definitions and
Finally, there and demarcations
demarcations of authority
authority thatthat inter­
inter-
these—science
weave all of these (popular) culture,
- science versus (popular) culture, technology
technology versus
normal versus not
society, normal not normal-
normal —demarcations
demarcations that that are shorthand
shorthand
the ways in which
for the which attributions
attributions of agencies, functions,
functions, and types are

l1
CHAPTER 1
CHAPTER 1

F ig u r e 1.2. Virtual community diagram. Heuristic diagram o f the “ virtual com­

FIGURE 1.2. Virtual community diagram
munity”
munity"ofofPET brain images. Actors are. Heuristi c diagram
distributed roughlyofinto
the "virtual com-
four quad­
PET brain images. Actors are distributed roughly into four quad-
rants. The point of this diagram is not to reify the various actors,
rants. The point of this diagram is not to reify the various actors, but to help us
keep but to help us
keepininmind
mindthe wide range of them and their interactions.
the wide range of them and their interactions.

distributed,
distributed, disputed,
disputed,and constrained. In particular, I am working to
and constrained. In particular, I am working to
locate
locate contests over the truenature
contests over the true of human nature, sites where meta­
nature of human nature, sites where meta-
phors
phors are incomplete or excessive andwhere
are incomplete or excessive and they are changing. I am
interested wheretheir
they are changin g. Ithe
am
interested in the mechanisms of these shifts, theiruneven
in the mechanisms of these shifts,
uneven
spread,
spread,
coexistence the
coexistence ofofopposing
opposing discourses, local existences, and conflicts that
discourses, local existences, and conflicts that
involve PET scans.
involve PET scans.
Because
BecauseI Iam aminterested
interestedininthe introduction of new facts about biolog­
the introduction of new facts about biolog-
ical
ical bodies and brains, I needed totofind
bodies and brains, I needed a way to talk about how the
find a way to talk about how the
culturally
culturally constituted bodily experiences mightchange
constituted bodily experiences might (Grosz 1994). In
chapter change (Grosz that
1994).
PETIn
chapter 4 ("Ways of Seeing Brains as Expert Images"), Iargue
4 (“Ways of Seeing Brains as Expert Images” ), I
argue that
scans PET
scans are
are farfar better
better suited to show differences and abnormalities than
suited to show differences and abnormalities than
they
they are
are to show that someone is normal or that there are no significant
to show that someone is normal or that there are no signific
differences ant
differences between
between groups, and that this inherent preference has pow­
groups, and that this inherent preference has pow-
erful
erful consequences
consequences when these scans are used in courtrooms. In chapter
when these scans are used in courtrooms. In chapter
55 (“Traveling
("Traveling Images, Popularizing Brains”
Images, Popularizing ), I use the concept of objec­
Brains"), I use the concept of objec-
12
12
 INTRODUCTION
INTRODUCTION

fashioning to look at how facts from science are experienced

tive-self fashioning experienced as
objective. In each case, I argue thatthat the consequences
consequences of these practices
meaning do, in fact, matter
and contests over meaning matter to us. They make impor­ impor-
tant differences in the world.
tant
know that
I also know that these contests are notnot simply about
about expert scientists
reach consensus over technical
trying to reach technical issues. Instead, these contests
embedded across spheres of activity: mass-media
are socially embedded mass-media science
journalism, mental-illness activism, courtroom
journalism, courtroom admissibility, and wide­ w:ide-
spread readership
spread readership of published
published speculations,
speculations, as well as neuroscientific
research. Each of these spheres has its own historieshistories and political
political econ­
econ-
evaluation and
omies of the evaluation and dissemination
dissemination of scientific information.
information.
Each of these spheres also has different kinds of stakes in the reproduc­ reproduc-
tion of information
tion information about
about the biological makeup humans. 122
makeup of humans.1
interdisciplinary ethnographer,
As an interdisciplinary ethnographer, my interest
interest is in discovering
how these different stakes relate to each other, and how these different
how
connected with
spheres are connected with and interdependent
interdependent on each other. My aim is
interdependencies and intervene
to help evoke these interdependencies intervene in the ongoing con­ con-
meaning. My position
tests over meaning. position within
within the virtual
virtual community
community of PET
anthropologist and historian.
scans is as an anthropologist historian.1133 I want
want to evoke the effec­
effec-
power that
tive and affective power that these images, as visual facts, come to have
hospitals, mental-illness communities,
in different arenas of social life, hospitals,
courtrooms, scientific meetings, laboratories,
courtrooms, laboratories, and in the mass media.
want to provoke
And I want provoke discussion regarding
regarding this power. I have been
position to locate struggles over meaning
using this position meaning and powerpower that
that
boundaries of expertise and that
cross boundaries that seem to involve questions of mul­ mul-
accountability between
tiple accountability between groups {who
(who do not, themselves, explicitly
acknowledge such accountability).
acknowledge accountability). Given thatthat the process and outcome
matters to me personally
of these struggles matters personally (as an informed
informed layperson
within the virtual
within virtual community
community of these scans), one aim of this book is to
participate in, and in some cases create,
participate create, conversations
conversations thatthat explain
explain for
multiple accountabilities
these multiple accountabilities (Downey and Dumit Dumit 1997b).
both the critical significance of the scientific, technical,
By respecting both
and medical expertise and and the the implication
implication of public cultural
cultural catego­
catego-
outside of these defined areas of expertise, this book
ries in spheres outside
strives to make clear some of the stakes sharedshared-—or at least contested
contested-—
participants in PET.
by all participants PET. Second, I hope
hope to foreground
foreground specific
specific current
current
directions of interdisciplinary
directions interdisciplinary and intersocial
intersocial negotiations
negotiations over the
meaning and status of PET images in popular
meaning popular media, mental-illness
communities, and
communities, and courtrooms,
courtrooms, in order
order to raise questions
questions of how these
practices might
practices might become social problems
problems and begin a discussion on how
they might be otherwise.
they
work is perhaps
This work perhaps best seen as a kind of window window into the move­move-
ments of PET scans in the world: part part cultural
cultural studies and philosophy
(What are PET scans, and how
(What how do they function
function in the world?), part part

13
13
CHAPTER 1

history
history (How did they arise in these ways?), and part part anthropology
anthropology (How
are they meaningful
meaningful to different communities
communities of people?}.
people?). As such, it lays
the groundwork
groundwork for more specific cultural projects in the future.
specific cultural future. In the
conclusion,
conclusion, I lay out one such project,
project, looking functional brain
looking at the PET functional
studies of emotions
emotions -—in particular,
particular, sadness and depression.
Two key issues in all big science are money and credit. Grants Grants and
publications are the oxygen and glucose, respectively, of research
publications research life.
They are, of course, bothboth administered through peer review. Alternate
administered through Alternate
forms of funding both less prestigious
funding are both controversial. On the one
prestigious and controversial.
hand, community is small enough that
hand, the PET community that it is impossible for me
to relate specific histories of funding and publication without entering
publication without
into controversies and violating anonymity
into the local controversies anonymity requests.
requests. On the
other
other hand,
hand, to tell these histories without the controversies
histories without controversies is potentially
potentially
to perpetuate and/or exacerbate
perpetuate and/or problems.1144
exacerbate these problems.
Throughout this book
Throughout book are excerpts from interviews I have conductedconducted
with PET researchers,
with researchers, from lab leaders to graduate
graduate students. Most
Most of
transcribed quotations
these are transcribed quotations from taped interviews
interviews that
that have been
edited by both
both the speaker
speaker and myself for readability
readability and accuracy.
Others are fieldnotes recorded
Others conversations. In many cases,
recorded by me after conversations.
I do not identify speaker and have edited out
identify the speaker out identifying remarks.
remarks. I
have chosen this anonymity
anonymity to protect
protect those who wished not not to be
quoted
quoted directly and also to evoke a range of positions positions within
within the PET
community
community on different issues.
Each of these chapters juxtaposes interview material,
chapters juxtaposes an­
material, semiotic an-
alyses, ethnographic
ethnographic observations,
observations, and theoretical
theoretical reflection. They are
written
written to intervene by engaging. Their Their tone exploratory. Like PET
tone is exploratory.
neuroscience
neuroscience studies, they are hypothesis-generating,
hypothesis-generating, notnot hypothesis-
Interspersed between
confirming. Interspersed between most chapters
chapters are interludes
interludes -—conver­
conver-
sations between
between myself and researchers
researchers highlighting both the nature
highlighting both nature of
questioning and the richness of their answers. In general, I prefer
my questioning
long quotations shorter ones. Long quotations
quotations to shorter quotations preserve muchmuch more
of the multiple that researchers constantly
multiple stakes that negotiate, as well as
constantly negotiate,
their explicit awareness of the philosophical,
philosophical, epistemological,
epistemological, and prac­
prac-
tical aspects of their
their work.
work.1 5
15

How This
How This Book Is Organized
Organized

CHAPTER
CHAPTER 2: METAPHORS,
METAPHORS, HISTORIES,
HISTORIES, AND
AND VISIONS
VISIONS OF
OF PET
PET

Chapter 2 provides
Chapter provides an overview of the many definitions of PET scan-scan­
different histories
ning and, consequently, the many different histories of PET that
that can be
told. On the basis of interviews with three key researchers,
with three researchers, PET is vari-
vari­

14
14
 INTRODUCTION
INTRODUCTION

pathbreaking technological
ously defined as a pathbreaking technological invention,
invention, as a significant
direction of research,
direction research, and as one among many neuroscience
neuroscience tools. Each
conceptualizes the brain
of these stories of PET conceptualizes brain in different ways and
therefore the kinds of experiments
therefore experiments that
that PET is suited for. With
With these
different basic conceptual
different conceptual notes of what
what can be studied with
with PET come
different notions
different notions of normality,
normality, of functions
functions in the brain,
brain, and of objec-
history and embodies different notions
tive-selves. Each story is also a history notions
progress, as well as the relative central­
of good science and of scientific progress, central-
personal contributions.
ity of personal contributions. The purpose
purpose of chapter
chapter 2 is to juxtapose
juxtapose
different perspectives while accounting
different how these views are op­
accounting for bow op-
order that
posed, in order that a more objective account
account might
might be achieved.

CHAPTER
CHAPTER 3:
3: PRODUCING
PRODUCING BRAIN
BRAIN IMAGES OF MIND
IMAGES OF MIND

produced for a variety of reasons,

Brain images are produced reasons, often contradictory.
contradictory.
with all natural
As with natural human
human science, they contain
contain assumptions
assumptions from a
whole apparatus
whole apparatus but appear
appear simple and represent
represent types because of the
imaging process. In mostmost cases, PET brain-type
brain-type research is triangulating
triangulating
between (1) groups of subjects selected according
between according to often accurate
accurate but
behavioral criteria; (2) the small sampling of the selected pop­
imprecise behavioral pop-
ulations under
ulations under study, usually between
between 4 and 20 people per group; and
“functional” (flow rate) anatomy
(3) a "functional" anatomy of the brain
brain that
that is also impre­
impre-
extent unknown
cise and to some extent unknown at the millimeter
millimeter level. The resulting
generated at the intersection
PET images, generated intersection of these three imprecise refer­
refer-
paradoxically the most
ents, are thus paradoxically most concrete,
concrete, analytical
analytical data
data available
whether a behavioral
as to whether behavioral criterion
criterion (e.g., a schizophrenia
schizophrenia diagnosis) or
remembering a number)
task (e.g., remembering number) is reliably handled
handled differently than
than
other subjects (e.g., normals)
by the brains of other normals) or by the same subjects
task (e.g., resting
doing a different task resting quietly). The miracle is thatthat we are
repeatedly get any precise locational
able to safely and repeatedly locational data
data at all about
brain functions
brain functions in living subjects. Historically,
Historically, no other
other technique
technique ex­ex-
tomographic imagers (functional
cept PET and similar tomographic (functional magnetic reso­
reso-
[fMRI] and single-photon
nance imaging [£MRI] single-photon emission computed
computed tomogra­
tomogra-
[SPECT]) has given quantitative
phy [SPECT]) quantitative locational
locational information
information about
about brain
function.
function.
Brain-imaging technologies
Brain-imaging technologies like PET offer researchers
researchers the potential
potential to
question about
ask a question about almost
almost any aspect of human
human nature,
nature, human
human behav­
behav-
human kinds and design an experiment
ior, or human experiment to look for the answer in
experimental design, data generation,
the brain. Each piece of experimental generation, and data
analysis, however, necessarily builds in assumptions
assumptions about
about human
human na­na-
about how the brain works,
ture, about works, and
and how person
person and brain are related.
researcher denies this. In fact, they constantly
No researcher constantly discuss assumptions
assumptions

15
15
 CHAPTER
CHAPTER 1

as obstacles to be overcome and as trade-offs

trade-offs between specificity and
generalization. The aim of this chapter
generalization. chapter is to systematically outline how
and where
and where these assumptions
assumptions are built in so they can be tracked
tracked as the
images travel.
Properly representing
Properly representing results of these experiments
experiments is another
another balanc­
balanc-
ing act. This time the balance is between the many kinds of audiences
who will encounter
who encounter these complex images: fellow brain-imaging
brain-imaging re­ re-
searchers, other
searchers, other neuroscientists,
neuroscientists, science journalists,
journalists, and the public. For
those publishing
those publishing brain
brain images, the question is often how to balance the
persuasiveness of the visual scans of simple difference
difference with the desire
represent the significance of the experimental
for those images to also represent experimental
data.
constructing images for publication
This practice of actively constructing publication is neither
surprising nor
surprising nor new,
new. Similar issues have been observed concerning
I
I graphs, tables, digital astronomical
graphs, astronomical images, and physics’
physics' images (Jones
I,
' et al. 1998; Lynch 1993; Lynch and Woolgar 1990). Images are pro­ pro-
duced andand selected for publication
publication to make particular
particular points and to
illustrate the argument
illustrate argument and other
other data presented,
presented, not
not to stand
stand alone.
other words,
They are, in other words, explicitly rhetorical.
rhetorical. This is, one could say, say,
present images.
the only way one can present
Researchers in the same field know
Researchers know this and read each others’
others' images
right to the data,
very critically. They go right data, methods,
methods, qualifications,
qualifications, and
statistical results, and they
statistical they adjust
adjust these depending
depending on genre and audi­ audi-
granting agencies, journals,
ence: granting journals, interdisciplinary
interdisciplinary forums, and the gen­ gen-
Observing this practice,
eral public. Observing practice, I am concerned
concerned with
with the ways in
which brain
which brain images and
and their interpretations
interpretations as referring
referring to brain-types
brain-types
appropriated and transformed
are appropriated transformed for further
further use at each stage of image
production, selection, and dissemination,
production, dissemination, scientifically and popularly.
Among scientists, this includes looking at how they design their their ma­
ma-
and experiments,
chines and experiments, how they appropriate
appropriate each other’s
other's work
work across
disciplinary lines, and
disciplinary and how
how they cooperate
cooperate and compete. With With each ap­ap-
propriation and subsequent
propriation subsequent translation,
translation, the content
content of the image, its
qualifications and brain-type
qualifications brain-type referent,
referent, changes.

CHAPTER
CHAPTER 4: WAYS
WAYS OF
OF SEEING
SEEING BRAINS AS EXPERT
BRAINS AS EXPERT IMAGES
IMAGES

chapter looks at how

This chapter how American courts have appropriated
appropriated brain
incorporating them into the legal category
images as useful evidence by incorporating
demonstrative illustration.
of demonstrative illustration. Surveying the history
history of the court’s
court's use of
photographs to X-rays to computed
images, from photographs computed tomography
tomography (CT) and
understand how
PET, we can begin to understand how none of these images were imme­
imme-

16
~
I .
!
I
INTRODUCTION
INTRODUCTION

diately persuasive or understandable.

understandable. Each kind kind of image required
required a
“"learning
learning to see,"
see,” by scientists and doctors doctors as well as laypersons.
The persuasiveness and truth truth status
status of these learned
learned images before
juries is an ongoing concern
concern of the court.
court. Digital brain images are often
presented
presented as automatic,
automatic, computed,
computed, and objective illustrations demon­
illustrations demon-
strating insanity and incompetency. PET images thus seem to have a
strating
persuasive power that
persuasive power that is out proportion to the data
out of proportion data they are present­
present-
ing. The scans become visual truths, truths, presenting
presenting themselves as facts about about
people and the world
world such that that even their own producers
their own cannot refute
producers cannot
them. My suggestion is that that the courtroom
courtroom use of PET images, which
researchers dislike so much,
most researchers much, is actually
actually enabled
enabled by the way the
images are presented
presented by them them in journals. Intrascientific communica-
journals. Intrascientific communica­
other words,
tion, in other words, is notnot a closed world world at all but participant in
but a participant
human nature,
contests over human nature, rationality,
rationality, and cause and effect with with the
rest of society.
society.
We will pay particular
particular attention
attention to how images are recaptioned,
to how recaptioned, de-
contextualized,
contextualized, and recontextualized,
recontextualized, and how how they are presented
presented in re­re-
lation other images. We do not
lation to other not have to suspect the accuracy of the
underlying experiments to recognize that that the visual appearance
appearance of "graph-
“graph­
ically”
ically" different
different brain-type
brain-type images is produced,produced, in part,
part, by a choice to
visualize the data
data as very different in color. Comparative
very different Comparative images are one
of the most powerful,
powerful, persuasive presentations
presentations of brain-type
brain-type data. If
nothing
nothing else, they visually convey clear-cut graphical graphical difference thatthat can
be easily read in some situations referring to clear-cut statistical
situations as referring statistical dif­
dif-
ference or even absolute difference in populations
populations and brain-types.
brain-types. Thus,
they can help produce,
produce, in some situations,
situations, the identification
identification of groups
as brain-types.
brain-types.
We must emphasize the word word can, and the form form and location
location of these
readings,
readings, because we need to be constantlyconstantly wary of easy assignments of
blame for (mis)readings. Scientists take great great pains to qualify the mean­
mean-
ing of their
their images (e.g., schizophrenic
schizophrenic and normal)normal) and make sure that that
the conclusions they present
present do not overstep
overstep their data.
data. In this, they are
appropriate with the culturally
appropriate culturally accepted norms norms of their disciplines. Many
of these scientists clearly state in their their articles that
that there
there is no way, yet,
to go from scan to diagnosis, that that the correlation nowhere near being
correlation is nowhere
established.
established. Yet most of these same scientists explicitly hate the fact that that
PET images of schizophrenics
schizophrenics can be shown shown to help persuade
persuade juries that
that
a person
person has schizophrenia.
schizophrenia. This chapter chapter thus
thus investigates how the vi­ vi-
sual practices of PET researchers—how
researchers-how they they produce,
produce, choose, and pub- pub­
lish images -—enables many of these appropriations
appropriations thatthat the researchers
so abhor.

17
17
n 7
CHAPTER 1

CHAPTER 5: TRAVELING
CHAPTER 5: TRAVELING IMAGES,
IMAGES, POPULARIZING
POPULARIZING BRAINS
BRAINS

Chapter
Chapter 5 builds on all of the preceding
preceding chapters
chapters to enter into another
another
set of contested
contested meanings involving PET scans. Defining and treating treating
mental
mental illness has a long and troubled
troubled history
history of conflicts, accusations,
and accountabilities
accountabilities between
between biologists, psychotherapists, neurologists,
psychotherapists, neurologists,
psychiatrists, criminologists,
psychiatrists, criminologists, mothers, fathers, families, genes, drugs,
mothers, fathers,
communities, and patients.
communities, patients. PET scans weigh into into these contests as vi-
vi­
brain
sual evidence of brain differences between those with
with mental
mental illness and
without it. PET often enters as proof
those without proof of the biological existence of
mental illness in the brain. Chapter
Chapter 5 follows some of the ways in which
this evidence is generated,
generated, presented,
presented, debated,
debated, and incorporated
incorporated into
people’s Attending tO
people's lives. Attending to many
many issues involved in the po1itical
political econ­
econ-
omy of PET research
research as well as mental-illness diagnosis and treatment,
treatment,
it raises issues regarding
regarding concurrent
concurrent positive and negative effects of PET
demonstrations today. In the case of mentally
demonstrations mentally ill patients their fami-
patients and their fami­
lies, the ability of PET to show biological differences promises an under-under­
standing of biological origins and the promise of a cure in the long
standing
term. In the short term, this “proof”
short term, "proof" of biological origin both
both empowers
some families to face mental
mental illness as a disease and not a failure of will
and has potentially
potentially disempowering
disempowering effects for those who depend depend on
community-based
community-based mental-health
mental-health institutions.
institutions. Blame and accountability
accountability
are not easily assigned. But an ethnographic
ethnographic approach
approach to the virtual
virtual
community of PET scans has the potential
community to bring •different
potential to different perspec-
perspec­
tives into conversation,
conversation, and it can highlight some of the unintended
unintended
cultural equations
effects of cultural equations and scientific practices.

CHAPTER
CHAPTER 6: CONCLUSION
6: CONCLUSION

In effect, each of these chapters

chapters is a slice through virtual community
through the virtual community
of PET scans. Each brings some members of the community community into rela-
rela­
tion
tion with each other
other and ignores others. Collectively,
Collectively, these chapters
chapters aim
to evoke the busy intersection
intersection between
between culture in its popular, forensic,
and activist manifestations, neuroscience; to
manifestations, and neurosdence; to watch
watch its traffic and
borrowings;
borrowings; and to drawdraw some lines of accountability
accountability between what
what
appears to
appears to be gulfs, ultimately, of expertise, of knowledge,
knowledge, and of conse-
conse­
quences.16 I am interested
quences.16 interested in PET because itit is not
not over-it
over—it is still being
defined; its purpose
purpose is still under
under debate—
debate - because it is part
part of the re­
re-
writing of our received-facts about
writing about ourselves as biological, sentient
beings.

18
 Interlude 1
· Interlude 1

Thinking about Reading

Reading

Intrigued
Intrigued with
with brains and the meaning of machines
machines that
that might be able
to record
to record thought
thought processes in the brain
brain (figure 1.3; see Plate 14). Phi-
Phi­
losopher
losopher Ludwig Wittgenstein,
Wittgenstein, in 1936, considered problem of
considered the problem
whether and how we can objectively tell when
whether when someone is truly
truly reading.
He surmised that
that perhaps
perhaps there
there is no way to tell:

isn’t that
But isn't that only because of our too slight acquaintance
acquaintance withwith
what nervous system? If we had
what goes on in the brain and the nervous had a more
accurate knowledge
accurate knowledge of these things we should should see what
what connexions
were established by the training,
training, and then
then we should be able to say
when we looked
when looked into his brain: "Now
“Now he has read this word,
word, now
now the
reading connexion
reading connexion has been set up." up.” —And presumably must
-And it presumably must be
like that
that -—for
for otherwise how could we be so sure that
otherwise how that there was such
a connexion?
connexion? ThatThat it is so is presumably
presumably a priori-
priori —or
or is it only proba­
proba-
ble? And how probable
probable is it? Now ask yourself: what what do you know
about these things?-But
about things? —But if it is a priori, that
that means that
that it is a form of
account which is very convincing to us. (Wittgenstein
account which (Wittgenstein 1986,
1986, §158)

Wittgenstein’s
Wittgenstein's exploration
exploration of the boundaries
boundaries of the meaning of a pri- pri­
ori brings him to culture: We know know these things because we have read
them in textbooks
textbooks and heard them from adults whom
heard them whom we tru~t.
trust. “"How
How
do we know,”
know," he was fond of asking, “"that that we have a brain,
brain, if we have
it?" 17
never seen it?” 17We have, he suggested, a kind of certainty
certainty that
that seems a
priori, intuitively
priori, intuitively self-evident: "Of
“ Of course, it must be like that.”
that." This
kind certainty would
kind of certainty would be learned
learned (because we are not not born
born knowing
knowing
about our brains),
about brains), and yet logical. In order
order to further
further explore
explore the limits
 INTERLUDE 1

THE ACTIVE HUMAN BRAIN

REM EM BERING WORKING

FFIGURE 1.3. Active

ig u r e 1,3. CLA School of M
UCLA
Active human brain. PET studies from the U Medi-
edi­
function of the brain when healthy
cine showing changes in glucose metabolic function
1991)
volunteers are asked to perform different tasks. (Michael E. Phelps 1991}

of our certainty, consider a variation

variation on Wittgenstein’s
Wittgenstein's thought
thought experi­
experi-
ment. What
What if a research team published
published an article demonstrating
demonstrating that
that a
specific,
specific, reliable change in the blood flow of the big toe was correlated
correlated
with a person’s
person's learning to read? This would be greeted skeptically at
best, and if it were repeated in person
person after person,
person, we would not say,say,
“"Okay,
Okay, reading
reading is
is a function
function of the toe.”
toe." Instead, we would ask, “Well,
"Well,
what
what causes the blood flow in the toe?”toe?" And if we eventually located a
correspondence
correspon·dence between an area of the brainbrain and the big toe, even if the
brain “"signal"
signal” were weaker and less reliable thanthan the toe “"signal,"
signal,” this
I would then nevertheless confirm to us that that reading was in the brain
brain and
that
that the toe flow was a “"symptom"
symptom” of the brain
brain process. But why is it
.ii
:,!
that
that when we find a reading correspondence
that
correspondence in the brain we are satisfied
that we are in the right place? Because, suggested Wittgenstein,
Wittgenstein, that
that is
our form of life, our local culture. At certain points (and not others), we

20

J
 THINKING
THINKING ABOUT
ABOUT READING
READING

explanation or a test of its truth;

no longer ask for an explanation truth; explanations
explanations
come to an end.
grounds, however, justifying the evidence, comes to an end; —
Giving grounds, -
but the end is not
but not certain
certain propositions'
propositions’ striking us immediately as
true, i.e., it is not
true, not a kind of seeing on our part;
part; it is our acting, which
bottom of the language
lies at the bottom language game.1
game. 188 (Wittgenstein
(Wittgenstein 1991, §204)

21
 I

Chapter
Chapter 2
Metaphors,
Metaphors, Histories,
Histories, and Visions PET
Visions of PET

PET
PET Popularity
Popularity and Phrenology
Phrenology

PET was thethe first noninvasive

noninvasive technology
technology to permit
permit direct quantitative
quantitative
assessment of regional
assessment brain. 1 In terms of
regional physiological processes in the brain.1
the quest for information
information about
about the brain, this was unprecedented
unprecedented and
I therefore worth
therefore investigating.11 Being complex and ambiguous,
worth investigating. ambiguous, PET al- al­
lowed scientists to make exacting measurements
measurements of blood flow, glucose
uptake, and dopamine-receptor
uptake, uptake. Yet fundamental
dopamine-receptor uptake. fundamental questions re­ re-
mained. What
mained. What did these measurements
measurements actually about the purpose
actually imply about purpose
and status
status of the brain
brain and the person?
To put
put this another
another way, the human
human subject can be carefully charac-charac­
terized from the outside-demographics,
outside —demographics, physical health, health, genetic his-
his­
nutritional state,
tory, medical history, nutritional state, mental/emotional
mental/emotional state, and be­ be-
'i With the development
havior. With development of PET,PET, these characterizations
characterizations could be
correlated with
correlated with measured information from the brain
measured information brain via a PET scanner.
assumptions about
In the process, however, assumptions about two crucial relationships
relationships
remained: the relation
remained: measurement to the brain
relation of the measurement brain and the relation
relation
of the brain
brain to the person.
This is the view of Newsweek
Newsweek science editoreditor Sharon Begley:
Begley:
Well, I think
think it does touch
touch a lot of people’s imaginations. The idea
people's imaginations.
that
that you can quote-unquote
quote-unquote “"see"
see” what
what a brain
brain is doing during
during a
particular
particular task,
task, that
that does intrigue
intrigue people. So
So apart
apart from what
what you can
learn
learn scientifically,
scientifically, about
about where
where glucose is being used in a brain, yes,
it does have a sort
sort of man-in-the-street
man-in-the-street appeal: “Wow, that’s a brain
"Wow, that's brain
 METAPHORS, HISTORIES,
METAPHORS, HISTORIES, AND VISIONS
VISIONS

work, and I can see how it's

at work, it’s different when
when it thinks about
about an
animal and when
animal when it thinks
thinks about
about a mathematics
mathematics problem.”
problem."

Begley’s insight
Begley's insight is that
that with
with very little prompting,
prompting, it is possible to
conjure up a fascinating
conjure fascinating possibility, and
and that
that this invokes a sublime re­ re-
action—“Wow”
action - "Wow" -—aa tense combination
combination of imagination
imagination and challenging
reason. She notes that
reason. that it is the idea of seeing the brain
brain working
working thatthat
intrigues people. Apparently
intrigues Apparently because the idea is already
already desired, the ac­ac-
tual presentation
tual presentation appears
appears as already
already known,
known, as familiar.
William Oldendorf
The late William Oldendorf Sr.,
Sr., neuroscientist
neuroscientist and innovator
innovator in CT
scanning, authored
scanning, authored a book called The Quest Quest for an Image ooff the Brain,
which put
which put into historical
historical perspective the medical-scientific desire for any
information about
information about what
what was going on in the brain, a notoriously
notoriously refrac­
refrac-
tory organ
tory organ3 3
(Oldendorf 1980). From
(Oldendorf From lesion studies to painful
painful angiogra­
angiogra-
phy to CT scanning, he traced traced attempts
attempts to draw
draw conclusions
conclusions from traces
of the brain. In one of his last lectures, he even notednoted the historical
historical shift
that accompanied
that accompanied increasing knowledge
knowledge about
about the brain. Showing a
photograph of Boris Karloff
photograph Karloff as Frankenstein,
Frankenstein, he commented
commented that that
whereas when
whereas when Mary
Mary Shelley
Shelley wrote
wrote the original
original manuscript
manuscript in 1818 she
devoted only half a page to the construction
devoted construction of the creature,
creature, James
Whale’s Frankenstein, which appeared
Whale's appeared in 1931, devotes half the film to
it! He interpreted
interpreted this as a growing
growing fascination
fascination with
with how we are put
together biologically.
together
frequent observation
A frequent observation made about
about PET brain
brain imaging is its apparent
apparent
proximity to phrenology,
proximity phrenology, an eighteenth-century
eighteenth-century theory
theory of brain
brain localiza­
localiza-
tion. A quick survey of popular
tion. popular articles on PET confirms this suspicion.
experiments are discovering and
PET experiments and mapping
mapping functional
functional regions corre­
corre-
sponding to a moral
sponding moral circuit, reasoning,
reasoning, anxiety, social skills, sexuality,
language, word
intelligence, learning, language, word generation,
generation, color perception,
perception,
perception, and various kinds of memory. These are similar to the
form perception,
phrenologists.44 Interestingly, despite
mapped by the phrenologists.
kinds of faculties mapped
their disdain
their disdain for the complex speculative
speculative conclusions
conclusions of certain
certain PET
researchers do not
articles, PET researchers not denigrate
denigrate phrenology
phrenology but rather
rather cele­
cele-
brate it.
brate

Phrenology has often been criticized as a pseudoscience because

Phrenology
there was absolutely
there absolutely no scientific reason
reason to believe that
that bumps on the
related in any way to the brain
skull were related brain tissue that
that underlay
under.lay them.
usually overlooked
But its critics usually overlooked that
that phrenology
phrenology was based on an
admittedly crude, of the thought
analysis, admittedly thought processes and behaviors of
our daily lives.
our lives. (Posner and Raichle 1994, p. 11)
However erroneously, Franz Joseph
However Joseph Gall and his fellow phrenolo­
phrenolo-
attempting to map the locations
gists were attempting locations of brain
brain functions. Princi-

23
 CHAPTER 2

pies from
ples from other
other sciences, such as mechanics and electricity, were ap­
ap-
medicine. (Andreasen,
plied to medicine. (Andreasen, 1984, p. 148)
purely fantastic
The purely fantastic phrenological
phrenological theories
theories of Gall and Spurzheim
stimulated studies that
stimulated that established
established the concept
concept of the
the localization
localization of
cerebral functions
cerebral functions ...
. . . (Premuda
(Premuda 1986)
neuroscientists are stating
In essence, these neuroscientists stating that
that the phrenological
phrenological
movement raised
movement raised the right
right questions,
questions, but withwith the wrong
wrong technology.
Other psychologists
Other psychologists and philosophers,
philosophers, however, appear
appear to be more reti­ reti-
cent to describe phrenology
cent phrenology positively. Jerry Fodor Fodor begins his Mod­ Mod-
ularity of
ularity o f Mind:
Mind: AnAn Essay on Faculty Psychology
Psychology with
with the following
“ Faculty psychology
sentence: "Faculty psychology is getting to be respectable
respectable again after
hanging around
hanging around with
with phrenologists
phrenologists and otherother dubious
dubious types”
types" (Fodor
1983).
contemporary image culture;
In contemporary culture, the value of PET images is still being
debated, partly
debated, partly because fundamental
fundamental questions
questions about
about the brain
brain are still
unanswered. In particular,
unanswered. particular, the significance and weight
weight to be accorded
accorded to
individual and
individual and group
group variation
variation has yet to be decided or even properly properly
prominent PET researchers
raised. Some prominent researchers include in theirtheir presentations
presentations
pictorial examples
pictorial examples of intense
intense variation
variation among normal
normal individuals and
plead for caution
plead caution with
with regard
regard to generalizations.
generalizations. Plasticity,
Plasticity, for example,
that the brain
is the idea that brain is a dynamic
dynamic functional
functional network
network that
that can “re­
"re-
wire” itself from
wire" from standard
standard layouts
layouts to adapt
adapt to injuries and other other non­
non-
standard obstacles.
standard obstacles. Plasticity, however,
however^ is still a relatively minorminor phe­
phe-
nomenon in both
nomenon both popular
popular and PET theorizing.
theorizing. Instead,
Instead, circuits are
described as hard-wired
described hard-wired connections
connections of neurons,
neurons, clustered
clustered together. His­His-
torian
torian of brain research,
brain research, Anne Harrington
Harrington has suggested that
that these lo­
lo-
.I calization
calization models have survived so well in plasticity, in spite of evidence
I
,1
contrary, because they are “"easy
to the contrary, easy to visualize and to teach” teach" 55
(Harrington 1992, p. 307).
(Harrington
Overturning the age-old axiom
Overturning axiom that
that a picture
picture is worth
worth a thousand
thousand
words, perhaps
words, perhaps these PET images require millions of words words to be under­
under-
.1 stood! In this way, PET research
research is actually
actually a quest to characterize
characterize and
understand what
understand what these PET pictures
pictures might mean in all sorts of dimen­ dimen-
starting point,
sions. They are the starting point, rather
rather than
than the culmination
culmination of this
investigation.
investigation.

History and
History and Definition
Definition of PET
PET Scanning

Consider the following

Consider following three
three descriptions
descriptions of PET scanning:
“Positron emission
"Positron emission tomography
tomography (PET) is a unique
unique medical imaging
that takes pictures
device that pictures of the body’s
body's chemical systems in living
humans.” (Phelps 1991, p. 347)
humans."

24
r
''

METAPHORS, HI5TORIES, AND

METAPHORS, HISTORIES, AND VISIONS
VISIONS

“"Positron
Positron emission tomography (PET) is a nuclear
tomography (PET) nuclear medicine imaging
modality that
modality that consists of the systematic
systematic administration
administration to a subject of
a radiopharmaceutical
radiopharmaceutical labeled with with a positron-emitting
positron-emitting radionu-
radionu­
clides.” (Ter-Pogossian 1992, p. 140)
clides."
“"In
In fact, I really don’t distinguish between PET and SPECT as being
don't distinguish
different things. It’s
two different It's just a question
question of different
different tracers. Every­
tracers. Every-
thing is the same except the tracers.”
thing (Henry N. Wagner Jr., M.D.
tracers." (Henry
1993, interview).

Starting with just these three notions

notions (and there
there are more) of PET,
PET, the
would-be historian
would-be historian is already
already faced withwith a dilemma;
dilemma: should
should he or she
consider
consider PET as a specific important technological achievement (a de-
important technological de­
vice) as an ongoing process of physiological measurement with
physiological measurement with positron
positron
emitters (an application
application of a technique)
technique) or as part
part of a set of relatively
interchangeable nuclear medicine tools being used to investigate bio­
interchangeable nuclear bio-
chemistry?
PET’s history
PET's history is interior
interior to its definitions. Debates going on in the
1990s include the usefulness of collecting data with various
data with various radio-
radio­
ligands (fluorodeoxyglucose [FOG] [FDG] vs. oxygen-15 [0-15] [0-15] vs. labeled
neurotransmitter
neurotransmitter agonists), how to to register data
data (same-subject only, in-in­
tersubject
tersubject averaging, and between
between groups; as well as how how toto build a
normal
normal reference), and thenthen how
how to analyze this data.
data. These are scien­
scien-
tific issues, but I am not
not sure they can be directly decided. In each case,
there
there is more than
than the interpretation
interpretation of data at stake. The opponents
opponents in
these various debates often have very different conceptions
conceptions of the nature
nature
of data
data about
about the mind and brain. They might might be called paradigms,
paradigms,
after the work
work of Thomas
Thomas Kuhn. PET researchers
researchers often describe their
differences as being from different paradigms.
paradigms. Kuhn's
Kuhn’s notion
notion of para­
para-
digm, however, describes a scientific field in which which basic questions
questions re­
re-
garding nature of data and relations
garding the nature relations between
between basic elements are
mostly agreed on by the practitioners
practitioners (Kuhn 1970). With PET brain
studies, this is not
not the case. PET research
research often has to simultaneously
simultaneously
deal with
with explaining
explaining theories
theories and hypothesis
hypothesis using data and by defining
what counts as data.
what counts data. Kuhn described fields of this kind as “pre-para-
"pre-para-
digm,”
digm," in which
which various schools of thought
thought are in creative competition:
competition:

Being able to take no common common body of belief for granted,

granted, each
writer . . . felt forced to build his field anew
writer ... anew from its foundations.
foundations. In
doing so, his choice of supporting observation and experiment
supporting observation experiment was
relatively free, for there was no standard
standard set of methods
methods or of phe­
phe- ·
nomena that
nomena that every ...
. . . writer
writer felt forced to employ and explain. Un­Un-
der these circumstances, the dialogue
dialogue of the resulting
resulting books was often
directed as much
much to the members of other other schools as it was to nature.
nature.
That pattern is not
That pattern unfamiliar in a number
not unfamiliar number of creative fields today,

25
25
 3
CHAPTER 2

nor is it incompatible
nor incompatible with
with significant discovery and invention.
invention. (Kuhn
1970, p. 13)

Kuhn’s description
Kuhn's description of researchers
researchers explaining
explaining their
their approaches
approaches over
explanations, often to actually opposed
and over, and directing these ~xplanations,
characterization of PET.
colleagues, is an apt characterization PET. PET researchers are con­ con-
stantly inventing
stantly inventing new
new scanner architectures,
architectures, new analysis techniques,
tracers, and
new tracers, and new ways of connecting
connecting data
data to the brain
brain and to be­ be-
inventions are not
havior.6 These inventions not simply incremental
incremental improvements
improvements but
fundamental changes in the
often fundamental the meaning of the results of PET experi­ experi-
ments -—and they often render render results across different scanners and tech­ tech-
7
niques incomparable.
incomparable.7
history of PET, then, one must first come to terms with
To compile a history with
definition of PET.
the definition PET. My introduction
introduction described the trajectory
trajectory of PET
experimental studies but left unexplicated
experimental unexplicated what
what PET is (where PET ends
other concepts begin), and PET’s
and other PET's historical
historical status (its place in the
history of science and medicine), and its purpose
history purpose in the world.
world. At first
glance, these seem like moot moot questions: PET is simply a set of tech­ tech-
niques and technologies that that permit
permit in vivo functional
functional imaging with with
positron-emitting radionuclides.
positron-emitting radionuclides. But as I shall show, this general defini­ defini-
tion satisfies no one; it explains neither
tion neither PET’s
PET's place in the worlds
worlds of
and medicine nor
science and nor its limits. Rather, there are many concurrent,
concurrent,
competing definitions of PET,
competing PET, each with notnot only ontological
ontological and tele-
but moral
ological but moral and practical
practical consequences as well.
Primarily using the voices and and writings of researchers,
researchers, this chapter
chapter
questions. My aim is to lay the groundwork
investigates each of these questions. groundwork
informed history
for an informed history of PET. In Kantian
Kantian terms, I am sketching out
conditions for the possibility of a history
the conditions history of PET.
PET. I do this by asking
the following questions: What What is at stake in these contests over PET? PET?
How do they set the conditions
How conditions of possibility for thinking
thinking and doing
interdisciplinary science work? And how do these contests impact
interdisciplinary impact the
questions we ask of ourselves in order
kinds of questions order to understand
understand ourselves?
chapter I present
In the rest of this chapter, present four different stories of PET scan­ scan-
that illustrate
ning that illustrate fundamentally
fundamentally different notions
notions of the meaning of
PET and of its history. The first is a short short overview of the history
history and
scanner that
definition of the PET scanner that I wrote
wrote for the Encyclopedia
Encyclopedia for the
History of
History o f Scientific Instruments.
Instruments. In technical
technical and dense language,
language, it
attempts to capture
attempts capture the complexity of PET scanning within within its multi­
multi-
development. This is followed by three accounts
disciplinary development. accounts based on
life-history interviews with with key scientist-participants
scientist-participants as well as their
published accounts
published accounts of PET,PET, its development,
development, and its definition and pur­ pur-
(Thompson 1988). The three
pose (Thompson three interview
interview subjects presented
presented here are
Michel M. Ter-Pogossian, Michael
Michel Michael Phelps, and Henry Henry N. Wagner Jr.

26
 METAPHORS,
MITAPHORS, HISTORIES, AND VISIONS
HISTORIIS, AND VISIONS

They were chosen in partpart for their

their clear roles in the development
development of PET
and
and for their
their very different
different disciplinary orientations. They make it clear
disciplinary orientations.
that
that the history is a way of defining what
the act of telling a history what counts as an
event and what
what does not.
not. Reading
Reading and listening
listening to these histories,
histories, one
must appreciate
must appreciate the role that metaphors and narrative
that metaphors narrative frames
frames play in
defining projects one way rather than another.
rather than another. These histories
histories are thus
ethnohistories, perspective-dependent
ethnohistories, accounts told
perspective-dependent accounts told within
within a contested
contested
field.
PET Scanner: A History
History in One
One Thousand
Thousand Words*
PET is an acronym positron emission tomography,
acronym for positron tomography, a set of tech- tech­
niques and technologies obtaining tomographic
technologies for obtaining tomographic images (slices)
(slices) of
molecular biological activity in living beings. In contrast
molecular contrast to CT scan­scan-
which provides
ning, which provides structural information about
structural information about bodies (e.g., bone
density), PET provides functional,
functional, time-dependent
time-dependent images of the rate
of flow of specific
specific molecules through
through a particular
particular area of the body.
PET thus provides
provides a solution
solution to the problem
problem of how
how to obtain
obtain useful
information about
information about biochemical processes taking
taking place in relatively in- in­
accessible sections of living organisms
organisms (e.g., the heart
heart and
and brain). The
information that
information that PET presents both quantitative
presents is both quantitative and
and visual, de- de­
manding careful measurement
manding measurement and complex
complex physiological
physiological modeling in
order to be interpreted.
order interpreted.
currently used in a variety of clinical studies, including
PET is currently including heart
heart
tissue viability, epilepsy focal localization,
localization, bone and breast breast cancer
detection, and head
detection, trauma diagnosis.
head trauma diagnosis. It has also been used in psy-
chophysiological studies
chophysiological —correlating oxygen blood
studies-correlating blood flow in specific
specific
regions of the brain
brain with
with motor movement, visual attention,
motor movement, attention, and cog­cog-
nitive tasks, as well as moremore complex
complex cognitive skills. In psychiatry,
Seymour Kety, David Ingvar, Monte Monte Buchsbaum,
Buchsbaum, and and Jonathan
Jonathan
Brodie each led teams that that conducted
conducted extensive studies of schizo­ schizo-
phrenia. Other
phrenia. Other mental
mental disorders
disorders have also been imaged. These have
stimulated speculation
stimulated speculation on possible biological
biological or molecular
molecular explana­
explana-
tions of these disorders,
tions disorders, but
but diagnostic investi­
diagnostic ability still eludes investi-
gators.
gators.
PET is located
located at the intersection
intersection of a number
number of disciplines and
technical paradigms.
technical paradigms. Though
Though they
they are numerous,
numerous, it is perhaps
perhaps better
better
toward the complexity
to gesture toward complexity than
than exclude, outright, vital partici-
exclude, outright, partici­
pants. One strand
pants. fundamental to functional
strand fundamental functional imaging
imaging is the
the biological
tracer technique
tracer technique for which
which Georg von HevesyHevesy was awarded
awarded the NobelNobel

•1 This material
material is adapted
adapted from
&om an essay entitled
entitled “"PET
PET Scanner,"
Scanner,” by Joseph Dumit,
which appeared in Instruments
which originally appeared off Science:
Instruments o Science: An
An Historical
Historical Encyclopedia, Robert
Robert
Bud, ed,,
ed., in the Garland
Garland Encyclopedias in the History
History of Science,
Science, copyright
copyright © 1997; it is
reprinted here by permission
reprinted permission of Routledge, Inc., part & Francis Group.
part of the Taylor 8C

27
 CHAPTlR
CHAPTER 2

prize in 1944. Hevesy detailed the means whereby whereby a radioactive

radioactive iso-
iso­
tope of a molecule could be used in place of that that molecule because it
indistinguishable, yet its radioactivity
is chemically indistinguishable, radioactivity can be tracked.
This technique
technique was used in medical physics and later later in nuclear
nuclear medi­
medi-
cine, first to follow molecules and later to image their distribution. distribution.
Unlike X rays, which which are produced
produced externally transmit-
externally in tubes and transmit­
ted through
through organisms in order order to reveal their
their structure,
structure, these radio­
radio-
active tracers
tracers emit their within. Early detection
their rays from within. detection of the path­
path-
ways of these tracerstracers was with Geiger-Mueller (gas discharge) tubes,
and later through
through scintillation
scintillation counters
counters — crystals that
-crystals that react to radia­
radia-
tion by discharging photonsphotons or light that then converted
that is then converted to electric­
electric-
ity where
where it is measured. A significant advantage advantage in data gathering
gathering
was the rectilinear
rectilinear scanner
scanner by Benedict Cassen in 1949, which which rapidly
and precisely tooktook measurements
measurements over a bodily area in a zigzag fash­ fash-
ion. Around
Around the same time, Harold Harold O. Anger introduced
introduced a scintilla­
scintilla-
tion camera
camera consisting
consisting of multiple scintillation
scintillation tubes simultaneously
simultaneously
collecting data.
data. Both of these devices producedproduced images on film con- con­
sisting of spots, either darker darker or lighter relative to the quantity
quantity of
emission. Improvements
Improvements on Anger’s Anger's gamma camera
camera were followed by
scintillation counters,
devices using more scintillation arranged and collimated
counters, arranged
provide better
(filtered) to provide three-dimensional specificity.
better three-dimensional specificity.
Another
Another strand
strand of innovation concerned developing better
innovation concerned better and
more specific tracers.
tracers. Chemists, nuclear chemists, and physiologists
were seeking to follow specific specific biological processes and needed to tag
certain
certain molecules (chemicals such as water water or pharmaceuticals)
pharmaceuticals) either
with radioactive
with radioactive isotopes of constituent
constituent atoms or with with close analogs
of those atoms. One class of isotopes is known known as positron
positron emitters
because its constituents
constituents decay radioactively
radioactively into positrons
positrons that
that travel
a few millimeters, collide with with an electron, and result in a mutual mutual
annihilation, producing two 511-KeV (kiloelectron
annihilation, producing (kiloelectron volt) gamma
gamma rays
that travel almost
that travel almost exactly 180 degrees away from each other. These
positron
positron emitters (carbon-11 [C -ll], nitrogen-13,
(carbon-11 [C-11], nitrogen-13, [N-13], oxygen-15,
and fluorine-18
fluorine-18 [F-18]) were initially explored
explored around
around 1939, by Mar- Mar­
tin Kamen and Samuel Ruben, Ruben, who then then discovered carbon-14
carbon-14 (not
a positron
positron emitter) and stopped stopped investigating the others. The posi- posi­
tron
tron emitters were difficult to work work with
with for a number
number of reasons.
instance, they have very short
For instance, (C —11 == 20 minutes;
short half-lives (C-11
00-15=2
—15 = 2 minutes; F —18 = 2 hours) and they must be produced
F-18=2 produced
with the aid of a cyclotron,
cyclotron, and bound
bound or tagged onto onto molecules
before being introduced
introduced into the organism.
The postwar
postwar policy of the Atomic Energy Commission Commission (AEC)(AEC) pro­
pro-
I moting the peaceful use of radioactivity
moting radioactivity was the context exploring
context for exploring
positron emitters within
positron within medical research. In 1951, Frank Frank R. Wrenn

28
 METAPHORS, HISTORIES,
METAPHORS, HISTORIES, AND
AND VISIONS
VISIONS

and colleagues proposed

and proposed that
that the two gamma rays produced produced could
detected simultaneously
be detected simultaneously to provide
provide very accurate
accurate location
location of the
tracer —for instance,
tracer-for instance, to localize brain
brain tumors.
tumors. In 1953, Gordon Gordon L. L.
Brownell and William H. Sweet at Massachusetts
Massachusetts General
General Hospital
Hospital
built a positron
built positron scanner to do just that. that. In the early 1970s, James S. S.
Robertson at Brookhaven
Robertson Brookhaven National
National Laboratory
Laboratory built the first positron
positron
with detectors
camera with detectors arranged
arranged in a ring. In the same year David
and R. 0.
Kuhl and O. Edwards
Edwards at the University of Pennsylvania developed
tomographic imaging device for single-photon
a tomographic single"photon (gamma-ray) emis­ emis"
sion. These set the stage for fully developed PET scanning.
work with
Physiologically, work with positron
positron emitters
emitters was carried
carried out by
Ter-Pogossian and colleagues at Washington
Michel M. Ter"Pogossian Washington University in
St. Louis in the 1950s and 1960s, using 0-15 0-15 gas ((00 2)
2 ) for respiratory,
brain, and
brain, and cancer studies. These lead to the installation
installation of a cyclotron
Washington University Medical
in the George Washington Medical Center in the mid- mid"
1960s, with
1960s, with support
support from bothboth the AEC and the National
National Institute
Institute of
Health (NIH).
Health (NIH). In the late 1970s, Louis Sokoloff, working working at the NIH
and building on the work work of Seymour Kety, contributed
contributed the auto­ auto"
radiographic technique
radiographic technique using deoxyglucose as a tracer tracer, which allowed
them postmortem
them postmortem to "see"
“ see” oxygen flow in the brainbrain precisely.
precisely.
precipitating event for the PET scanner
The precipitating scanner was the announcement
announcement
of the CT scanner by EMI, which which demonstrated
demonstrated the feasibility of solv­ solv-
computational problem
ing the computational problem of how to filter tomographic
tomographic data
using a computer. WithWith this inspiration,
inspiration, Michael
Michael E. Phelps and Ed­ Ed"
ward J. Hoffman,
ward Hoffman, along with with Jerome
Jerome R. Cox, Donald
Donald L, L. Snyder, and
Nizar A. Mullani,
Nizar Mullani, developed the first practical
practical PET scanners, the
Positron Emission Transaxial
PETT series (for Positron Transaxial Tomograph),
Tomograph), under the
leadership of Ter-Pogossian. These devices consisted of a hexagon
leadership hexagon of
scintillation detectors
scintillation detectors that
that were electronically
electronically linked so thatthat they sent
when two opposite
a positive signal only when opposite ones detected
detected a gamma ray
When this happened,
at the same time. When happened, it could be assumed that that there
positron-emitting molecule somewhere
was a positron"emitting somewhere along the line between
two detectors. These signals were stored in a computer
the two computer and then
mathematically using first an iterative algorithm
processed mathematically algorithm and later
Fourier transforms
Fourier transforms to reconstruct
reconstruct a two-dimensional
two-dimensional (tomographic)
radioactivity. Coincidence detection
slice of the radioactivity. detection thus substituted
substituted elec­
elec-
tronic collimation
tronic collimation for the physical lead-shield collimators
collimators used in
gamma cameras. This improvement
gamma improvement provided
provided significantly more sensi­sensi-
improvements in this technology
tivity and accuracy. Critical improvements technology included
practical discovery, by Z. H. Cho, of bismuth
the practical bismuth germanate
germanate (BGO) (BGO)
better detector
crystals for better detector resolution
resolution and the use of a stationary
stationary ring
rather than
of detectors rather than a moving hexagon, which which provided
provided for easier
engineering.

29
 CHAPTER 2
CHAPTIR

To be used medical1y,
medically, however, this data data had to be further pro­
further pro-
cessed in terms
terms of the complex complex relationships between the
relationships between the molecular
molecular
circulation in the
circulation the body, radioactive
radioactive decay, and and the process
process to be stud-
stud­
ied (e.g., the relationship
relationship between oxygen concentration
between oxygen concentration in blood,
blood,
bloodflow in specific areas of the brain,
bloodflow brain, and
and cognitive
cognitive processes). This
parametric calculation/estimation
parametric calculation/estimation is known known as tracer-kinetics.
tracer-kinetics, The re-re­
sultant
sultant image is called functional
functional because it purports
purports to show rate
show the rate
of flow of a molecule,
molecule, its concentration
concentration through
through time in a set of regions.
usefulness of PET depended
The usefulness depended equally
equally on radiopharmaceutical
radiopharmaceutical
constraints and
constraints and on technological
technological ones. Much Much research
research with
with PET con-
con­
centrated on ligand
centrated ligand work, developing ways to
work, developing to rapidly
rapidly tag complex
complex
molecules, such as pharmaceuticals,
molecules, pharmaceuticals, to show show howhow and where
where they are
used in the body, especially where where they are absorbed
absorbed in the brain.
brain. A
advance came in 1979,
significant advance 1979, when
when Joanna
Joanna S. Fowle^
Fowler, Alfred P. P.
Wolf, andand David
David E. Kuhl synthesized
synthesized and used 18-FDG, 18-FDG, an analog
analog of
approximate glucose consumption
glucose, to approximate consumption in the brain. brain. This has
'
I become the the most-used radiopharmaceutical in PET. Another
most-used radiopharmaceutical Another signifi­
signifi-
!,
cant advance
cant advance was the demonstration
demonstration of the the ability
ability to image human
human
dopamine receptors,
dopamine receptors, carried
carried outout by Henry
Henry N. Wagner
Wagner Jr. and
and Michael
Michael
Kuhar at Johns
Kuhar Johns Hopkins University in 1983.
Hopkins University
Following
Following the the development
development of the PETT devices, commercial commercial PET
scanners were developed,
scanners developed, first by EG&G EG& G OrtecOrtec (which became CTI).
1979, the NIH
In 1979, NIH funded
funded seven PET centers centers under
under a program grant,
program grant,
initiating PET as a subfield. In spite of this boost,
initiating boost, PET did not not enter
enter
clinical medicine in the explosive way that that CT did. Rather,
Rather, because
PET required
required a tremendous interdisciplinary and financial
tremendous interdisciplinary infrastruc­
financial infrastruc-
ture, including an on-site
ture, including on-site cyclotron,
cyclotron, andand because its data data was not not
immediately applicable
immediately applicable for clinical solutions,
solutions, the the procedure
procedure became
first a scientific andand medical-experimental
medical-experimental technique. Nonetheless, by
technique. Nonetheless,
1983, the number
1983, number of PET centers centers in the world exceeded
the world exceeded forty. The
mid- to late 1980s found found established
established medical
medical device providers
providers Sie-
Sie­
mens and and General
General Electric, taking taking over the marketing
marketing of the PET
devices of the two largest PET providers,
two largest providers, CTI and Scanditronix,
Scanditronix,
respectively.
PET, along
along withwith SPECT, is located located in an interdisciplinary
interdisciplinary space
contested
contested by radiology
radiology and nuclear nuclear medicine.
medicine. These new new imaging
imaging de­de-
vices have also facilitated
facilitated new new disciplinary
disciplinary formations,
formations, such as medi-medi­
cal imaging and and molecular pharmacology —the latter
molecular pharmacology- latter understood
understood as
the tracer-imaging
tracer-imaging counterpart
counterpart of molecular
molecular biology.
In popular
popular culture,
culture, PET’s
PET's ability provide pictures
ability to provide pictures of the brain
brain in
action, as a person
action, person performs
performs a cognitive task, task, and to image different
different
I kinds of brains
kinds brains (diseased,
(diseased, disturbed,
disturbed, disabled)
disabled) have captivated
captivated the
,' i imaginations of science journalists
imaginations journalists and Hollywood
Hollywood screenwriters.
screenwriters.
'
I'
!'
30
r Courtrooms have recently been faced with
Courtrooms
METAPHORS,
METAPHORS, HISTORIES, AND

with the issue of PET’s

VISIONS
AND VISIONS

admis­
PET's admis-
sibility as scientific evidence in head trauma
trauma and insanity
insanity cases, as
well as the vexing question
question of the possibly prejudicial
prejudicial status
status of PET
images for juries.
In the early 1990s, efforts were under
under way to make PET a "clini- “clini­
cal” technique,
cal" technique, which
which means having insurers,
insurers, especially the Health
Health
Care Administration (which administers
Care Financing Administration administers Medicare
Medicare and
Medicaid)
Medicaid) cover the cost of procedures
procedures done with PET. Although
with PET.
there was progress
there progress in this regard,
regard, the issue of coverage depends on
cost as well as on clinical efficacy:
efficacy: Will enough
enough hospitals
hospitals be able to
afford PET so that
afford that everyone has access to approved procedures? The
approved procedures?
cost of a PET scanner
scanner is around
around U.S.
U.S. $2 million dollars,
dollars, the same as
for a cyclotron. maintenance and personnel
cyclotron. Yearly maintenance cyclotron
personnel costs (a cyclotron
crew, chemistry
chemistry and PET crew) can cost $300,000
$300,000 to $700,000
$700,000 per
year. Some of this cost might be reduced
reduced with introduction of
with the introduction
regional cyclotrons delivering radioisotopes
regional cyclotrons radioisotopes to groups
groups of nearby hos­
nearby hos-
pitals. Additional
Additional challenges are being worked
worked out at the regulatory
regulatory
level, with
with the U.S.
U.S. Food and Drug
Drug Administration
Administration (FDA)
(FDA) trying to
decide the status of radiolabeled
radiolabeled molecules. Finally, therethere are other
other
techniques
techniques of imaging bodily and brain functions (e.g., SPECT and
brain functions
£MRI),
fMRI), which
which overlap some of PE PET’s
T's strengths.8
strengths. s

Toward an Ethnohistory
Toward PET
Ethnohistory of PET

history represents
The above history attempt to abstract
represents my attempt abstract (1) a concept of
PET as a scientific instrument,
instrument, (2) the involvement
involvement of a number peo­
number of peo-
ple with
with its development,
development, and (3) the current
current status
status of PET and its role
in social issues. According to the editorseditors of the Encyclopedia
Encyclopedia for the
History o f Scientific Instruments,
History of Instruments, I had to write the history
history using less
than
than nine thousand
thousand words. The article appearsappears as an objective, histori-
histori­
cal narrative,
narrative, in the third person, past
third person, past tense.
However, as I conducted research, I found
conducted my research, found that
that the more people I
talked
talked with,
with, the more people I should have talked with. with. It quickly be-
be­
came clear that to write a history
dear that history of PET was to take sides in whatwhat PET
really is and should be. At first it appeared
appeared as if the matter
matter could be
solved simply by deciding who was right, who who really invented PET. But
invented PET.
instead
instead of a mystery, I found multiple stories and heteroglossia.
found multiple heteroglossia. The
anthropologist in me soon realized that
anthropologist that I was actually
actually dealing with
competing ethnohistories. Ethnohistory
competing ethnohistories. Ethnohistory is itself a contested branch
contested branch
of anthropology
anthropology and history. Gewertz
Gewertz described it as "fundamentally
“fundamentally
takjing]
tak[ing] into account people’s own sense of how
account the people's how events are consti­
consti-
tuted, and their
tuted, their ways of culturally
culturally constructing
constructing the past”9
past" 9 (Gewertz and

31
31
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CHAPTER 2
CHAPTER

Schieffelin 1985). In fact, scientists are quite aware of their

their histories as
strategic modes of storytelling:

,, D u m i t : That
DuMIT: That is why I have to talk with a number number of people.
I P h e l p s : And
PHELPS: it makes sense. This is not a unique unique situation,
situation, this is
I: one more of science. You know know we were all in Cologne, Germany,
,,·
I'

last year, where all of us were on the program. program. And part part of the
program was "History
program “History of PET."
PET.” There is an older group, group, you
know, Al A1 Wolf, MikeMike [Ter-Pogossian], people in the generationgeneration be-
be­
fore me. They got up and went went through
through things. Ter-Pogossian took
it from —and
- and you know know this was his own choice, he chose where to
start and cut
start cut-—he took it from his work
he took work in introducing
introducing the cyclo­
cyclo-
tron
tron into medicine, developing the initial positron-labeled com­
positron-labeled com-
pound
pound studies. He did not
not show that
that he developed PET. Now ev-
PET. Now ev­
erybody there knows
erybody there knows he didn’t
didn't dare do that.
that. But he contributed to
contributed
PET. Without
PET. Without these things that that came before me me-I—I mean, I came
into a lab that that he developed; he developed a lot of this -—had he not
done that,that, would
I would not have gone on to do my part.
part.
DuMIT: That is the challenge of writing
D u m i t : That writing history-
history —trying to figure out
not only how to be fair but
not but [also] figuring out out where
where to cut, whatwhat
kinds of stories of causation
causation and seeds and so on.
P h e l p s : You know, science tends to be an evolutionary
PHELPS: evolutionary concept. It
depends on one's one’s religious beliefs. I mean, therethere is supposedly
supposedly only
one creation.
creation. Truly from nothing
nothing before to now, but science doesn't doesn’t
typically do that. that. That
That is a religious experience if it is really truly
an absolute
absolute creation.
creation. You knowknow there are things that other people
that other
did before you. And there are certain certain benefits thatthat come to you
from the influence of people on what what you are doing. Then Then there
there are
certain portions
certain where you put
portions where put it in, and that's
that’s your contribution.
contribution.
when laid out
But when out in the evolution
evolution of science, you know know you are
just pieces in this.
To investigate the variability
variability of this history, I chose three
three key re­
re-
who each have their own ethnohistory
searchers who ethnohistory of PET and who
who have
all been described as fathers of the field, keeping in mind that
that there
there are
chosen.1100
many more who might also be chosen.
Michael E. Phelps
Michael
PET was originally developed by Dr. Michael E. Phelps, Jennifer
Jones Simon Professor, chief of the division of nuclear
nuclear medicine and
director of the Crump
biophysics and director Institute; and by Dr. Edward
Crump Institute; Edward
Hoffman, professor
Hoffman, professor of radiological
radiological sciences. (Harris
(Harris 1990, p. 16)1
16) 111
Michel M
Michel M. Ter-Pogossian
positron emission tomography
The first useable positron tomography (PET)
(PET) instrument
instrument
for human
human studies was developed in the early 1970s by a team of

32
r
! researchers
researchers led by Michel
University’s
METAPHORS,
METAPHORS, HISTORIES,
HISTORIES, AND VISIONS

Mis;hel M. Ter-Pogossian, Ph.D., at Washington

Washington
University's Mallinckrodt
Mallinckrodt Institute
Institute of Radiology
Radiology in St. Louis. (Welch
(Welch
and Gold 1989, p. 2)
Michel M. Ter-Pogossian, Ph.D., professor
professor of radiation
radiation sciences, is
affectionately known as “"the
the father
father of PET.”
PET." (Welch
(Welch and Gold 1989,
p p . 66-7)
pp. -7 )

Henry N. Wagner Jr.

Although
Although the field’s
field's forefathers,
forefathers, Glenn Seaborg, Benedict Cassen,
and Emilio Segre,
Segre, have passed away, many many of the founders
founders of nuclear
medicine as a scientific and medical specialty remain vital and involved.
remain
No one better
better defines
defines this founding
founding role than Henry
than Henry N. Wagner, Jr.,
M.D.,
M.D., whose career nearly spans nuclear
nuclear medicine’s “"second
medicine's second 50 years,”
years,"
as he termed
termed the period in a 1996 account
account of the field,
field. Present at the
origins of nuclear medicine as a defined sector of medicine, Wagner has
sustained
sustained the momentum
momentum of discovery that that began in the 1950s and
1960s. He has promoted
promoted nuclear medicine at key U.S. teaching teaching and
research centers around
around the world, including
including his own Johns HopkinsHopkins
School of Medicine, where he continues
continues to serve as a professor
professor of
environmental
environmental health
health sciences. (“Biography Wagner" 1122))
("Biography of Dr. Wagner”
The first two, Phelps and Ter-Pogossian, were both both at Washington
Washington
University in the early 1970s, and both have been called inventors of
PET;
PET; both received awards to that
that effect by the same societies, and both
headed
headed PET programs.1
programs. 133 But Phelps was once a postdoctoral
postdoctoral candidate
candidate
working
working for Ter-Pogossian during
during the time that
that the first PETT scanners
were developed. Without
Without exception,
exception, every researcher
researcher alluded to the
competitiveness of the field and mentioned
mentioned that
that at times it had been
quite destructive.
e s e a r c h e r : I’m
RESEARCHER:
R I'm sure you are getting a sense, because you are doing
it historically
historically and talkingtalking to a number
number of people, of the intense
competition.
competition.
u m i t : Some of it.
DuMIT:
D it.
e s e a r c h e r : It is like with
RESEARCHER:
R with Watson and Crick, who for all intents
intents
and purposes left out the contribution
contribution of Rosalind
Rosalind Franklin. Listen­
Listen-
ing to the story of Ter-Pogossian and Phelps is very reminiscent.
I’ve
I've heard them give their history of PET talks, and well well-—are
are we
talking
talking aboutabout the same discovery?!
discovery?!
u m i t : Right. I’ve
DuMIT:
D I've learned
learned enough about
about the situation
situation that
that when
they talk,
talk, I can hear differences, some of the silences, the reluctance
reluctance
to talk about
about the otherother person.
e s e a r c h e r : From what
RESEARCHER:
R what I understand
understand it was a difficult time.
The carefully crafted sentence in my thousand-word
thousand-word history dealing
with this set of events reads:

33
 CHAPTER 2
CHAPTER

With this inspiration,

With inspiration, Michael
Michael E,
E. Phelps and Edward
Edward J. Hoffman,
Hoffman,
with Jerome R. Cox, Donald
along with Donald L. Snyder,
Snyder, and Nizar
Nizar A. Mullani,
Mullani,
developed the first practical
developed practical PET scanners, the PETT series (for Pos­
Pos-
itron Emission Transaxial
itron Transaxial Tomograph),
Tomograph), under
under the leadership of Ter-
Pogossian.
What
What follows is a set of accountsaccounts of PET by Phelps, Ter-Pogossian,
and Wagner drawndrawn from oral histories, published
published interviews, and scien­
scien-
(Latour 1987; Shapin and Schaffer 1985). My aim here is to
tific articles (Latour
unpack PET as a scientific project
unpack project from the points of view of many of its
practitioners. I will abstract
practitioners. abstract their
their visions to use them
them as extreme images
represent some of the diversity of definitions and consequences of
to represent
PET. These are all stories of PET,
PET. PET, but they are also weighty stories. They
matter for what
matter what PET is, for how it is practiced,
practiced, and for whatwhat kinds of
meanings are produced
meanings produced through
through it. Rather
Rather than
than telling a story of scien­
scien-
development as an agonistic struggle between
tific development between scientists who com­com-
pete by amassing more powerfulpowerful allies than than anyone else, one of my
purposes is exploring
purposes exploring the contested
contested narratives
narratives of history
history and science put
forward by these scientists.1
forward scientists. 144 I am interested
interested in the insinuation
insinuation of PET
practicing neuroscience
into the fabric of practicing neuroscience and psychiatry, as well as into
practices of objective self-fashioning. Finally,
the practices Finally, these distinctions
distinctions will
understanding some of the debates over clinical and forensic
aid in understanding
that are taken
usefulness that taken up in the rest of the book.

MICHAEL
MICHAEL E.
E. PHELPS,
PHELPS, PH.D.
PH.D.
PET
PET AS
AS TECHNOLOGICAL
TECHNOLOGICAL BREAKTHROUGH,
BREAKTHROUGH,
SCIENCE AS RATIONAL
SCIENCE AS RATIONALREVOLUTION
REVOLUTION

r the "4-minute
the
abstraction), PET is the imaging technology
For Phelps (in abstraction),
“4-minute mile"
mile” in nuclear
nuclear medicine:
technology that
that broke

Within his remarkable

Within remarkable capacity
capacity to summarize the entire content
content of
annual meeting of the Society of Nuclear
the annual Nuclear Medicine,
Medicine, Dr. Henry
Henry
Wagner, at the 1980 meeting, described the “Banister
"Banister phenomenon,”
phenomenon."
ran the 4-minute
Before Banister ran 4-minute mile, everyone said it couldn’t
couldn't be
However, once Banister did it, the recognition
done. However, recognition that
that it was possi­
possi-
ble allowed others to notnot only equal but exceed Banister’s
Banister's accom­
accom-
plishment. Thus, once a task is recognized to be within
plishment. Thus, within our capa­
capa-
bilities and is worthy
worthy of the effort, it can become a matter
matter of practice.
The development
development of x-ray CT showed that that an enormous
enormous mathemati­
mathemati-
problem and a precise physical measurement
cal problem measurement could be achieved in
both a fundamental
both fundamental and
and practical
practical manner. With the recognition
recognition that
that
and with
it could be done and with the importance
importance of the information
information it pro­
pro-

34
 METAPHORS,
METAPHORS, HISTORIES, AND
AND VISIONS
VISIONS

vided, x-ray CT has become commonplace.

commonplace. It would
would now appear that
appear that
we are beginning to recognize the Banister phenomenon
phenomenon in PT [physi­
[physi-
ologic tomography, Phelps’s acronym
tomography, Phelps's acronym for PET],
PET]. The technique of PT
is unquestionably
unquestionably more difficult than
than x-ray
x-ray CT, but the type of func-
func­
tional information
tional information it can potentially provide has never been more ac-
potentially provide ac­
cessible before in studies of man. (Phelps 1981, pp. 47-48)
47-48)
Drawing on the example of a breakthrough
Drawing breakthrough demonstration,
demonstration, Banister’s
Banister's
running of a 4-minute
running 4-minute mile, Phelps likens scientific progress
progress to a series
of such demonstrations.
demonstrations. Without
Without them, science slows to a crawl; with with
them, it leaps ahead. The primary
them, primary agents of scientific progress in
Phelps’s
Phelps's narrative
narrative are methods
methods of gathering information, specifically
gathering information, specifically for
measuring
measuring biochemical activity in humans.
humans. He begins his introduction
introduction
to PET (called emission computed
computed tomography,
tomography, or ECT) in the 1981
Seminars in Nuclear Medicine
Medicine with
with a characterization
characterization of nuclear
nuclear medi-
medi­
cine as a discipline of information that is being threatened
information that threatened by new infor­
infor-
mation technologies
mation technologies from another
another discipline, radiology.
Nuclear medicine originated
Nuclear originated from the efforts of scientists develop­
develop-
ing methods that used the
methods that the. principles of tracer
tracer kinetics to study physi-
physi­
ologic processes with compounds labeled with
with compounds with radioactive
radioactive isotopes.
that time nuclear
Since that nuclear medicine has grown
grown into a successful diagnos-
diagnos­
tic discipline through advancements in radiopharmaceuticals,
through advancements instru­
radiopharmaceuticals, instru-
mentation, understanding
mentation, understanding of human
human physiology
physiology and disease processes,
unique type of information
and the unique information provided
provided by this specialty.
However, the recent
recent development competitive diagnostic
development of competitive modal­
diagnostic modal-
ities such as x-ray
x-ray CT, ultrasound,
ultrasound, and other
other techniques
techniques such as nu­
nu-
resonance (NMR),
clear magnetic resonance (NMR), along with with the desire for self-im­
self-im-
provement, is providing
provement, providing the incentive to look for new ways to employ
unique capabilities
the unique capabilities of nuclear
nuclear medicine. This is bringing together
together
multidisciplinary components
the multidisciplinary components of nuclear
nuclear medicine to employ the
fundamental principles of their
fundamental their disciplines to
to new technologies. (Phelps
1981, p. 32)
polemical motivating
The polemical motivating agents in this passage
passage are technologies from
other disciplines that
other that have encroached
encroached on nuclear
nuclear medicine's
medicine’s diagnostic
turf. Nuclear
turf. Nuclear medicine's
medicine’s response has been to develop new technologies
of its own. This saving technology, for Phelps, is PET, which draws on
PET, which
CT, tracer
CT, tracer kinetics, and new positron-labeled
positron-labeled tracers.
tracers. Phelps continues
highlighting why PET technology
by highlighting technology is so important:
important: It provides a new
kind of information.
information.
Where the importance
Where importance of the tomographic
tomographic delineation
delineation of overlap­
overlap-
structures is most often
ping structures highlighted; it is the fact that
often highlighted; that the tech-
tech­
nique allows a type of measurement
measurement that
that was not
not possible before that
that

35
I
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l
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CHAPTER 2

probably its most

is probably most important
important facility, that
that is, the capability
capability to mea­
mea-
radioactivity concentration.
sure the local tissue radioactivity concentration ...., . . Thus, ECT pro­
pro-
noninvasive approach
vides a noninvasive approach toto apply the principles of tracer
tracer kinetics
man for the assessment of local biochemical
to man biochemical and physiologic func­func-
tion if appropriate
tion appropriate labeled compounds
compounds and tracer
tracer kinetic models are
employed. approach will
employed. This approach will be referred
referred to as physiologic
physiologic tomogra­
tomogra-
phy. If this goal can be realistically
realistically achieved, nuclear
nuclear medicine will
provide a method
provide method of investigation
investigation in man that
that has, for the most part,
part,
eluded other
eluded other modalities.
modalities. (Phelps 1981, p. 33)
unique technology
PET, for Phelps, is thus a unique technology that
that provides
provides informa­
informa-
tion desired
tion desired but
but unattainable
unattainable by other
other means. The operative
operative metaphor
metaphor
obligatory point
here is one of an obligatory point of passage (Latour
(Latour 1987). Before
anyone could advance
anyone advance beyond
beyond the barrier
barrier of the 4-minute
4-minute mile, some­
some-
had to
one had to show that
that it really could be done. From then then on, all scien­
scien-
and must
tists can and must pass through
through this point
point in order
order to pursue
pursue research
research
work of tinkering,
along these lines. The work tinkering, striving, making
making something
something
actually work
actually work becomes the truetrue gift of a scientist to his or her field.
following passage, taken
In the following taken from an interview
interview with
with Phelps, he
how learning
describes how learning about
about the brain
brain is dependent
dependent on the technology
technology
available. From this observation,
available. observation, he is able to characterize
characterize the nature
nature of
progress of science:
the progress
activation studies -—brain
The activation brain mapping
mapping —are
- are a program
program that
that says
would like to just understand
we would understand the macroscopic
macroscopic way ..... . the brain
brain
organized and how
is organized how it works.
works. SoSo both
both PET and MRI are developing
and pursuing
and pursuing ways to to just map out how how the brain
brain does what
what you
know it does. In fact, the first brain-mapping
know brain-mapping studies were that that [point­
[point-
publication in Science. That
ing to display on the wall] publication That was in 1984
’8 3 ,1
or '83, think. In fact, when
I think. when the cover of Science had the MRI MRI on it,
that was 10 years to the day. And
that And that
that is a science study where
where it says,
“We’d like just to know
"We'd know howhow the brain
brain is organized
organized and functions.”
functions."
Over on the other
Over other side is the issue dealing with
with the merger
merger of biology
and imaging. You use the techniques
and techniques you have to learn learn about
about things
and then
and then go develop new techniques
techniques to learn
learn things that
that you have
known before.
never known
greatest turning
The greatest turning points
points in science come by the development
development of
new instrument
a new instrument to allow one to to look at things that
that you have never
seen before, or a newnew theory
theory that
that says, “I
"I have collected all the under­
under-
standing and knowledge
standing knowledge of this and I have built a way to make it
make sense. It is within
make within this framework,
framework, now, that that you can collect
data and interpret
data interpret it and understand
understand what
what it means. So, theories
theorie·s and
instruments. Of course,
instruments. course, around
around all of that
that are good scientists that that
work every single day to use them
work them to understand.
understand. And they aren’taren't
focused on the instrument
focused instrument butbut on its use.

36
 METAPHORS, HISTORIES,
METAPHORS, HISTORIES, AND VISIONS

Instruments effect great changes in science because they change the

Instruments
kind and amount
amount of information
information available, and theories
theories effect changes
by providing
providing paradigms within which
paradigms within which to understand
understand the data. The ac-ac­
tual understandings
understandings are up to the scientists who apply these fundamen-
fundamen­
tal technologies and theories
theories to the world.
world. For Phelps, then,
then, the history
history
of PET involves three
three stages: the techniques
techniques and technologies
technologies developed
PET, the actual making PET work
before PET, work (showing what
what can be done),
and then
then the development
development of uses for PET.
PET. I asked him about
about the place
of PET in history:
D u m it:
DUMIT: I am trying to envision different
different ways of telling the develop­
develop-
ment of PET, PET, in terms of different
different disciplines, different
different uses of it.
PHELPS: Yes. Its development:
P h e l p s : Yes. development: there
there is a basic technology
technology developed,
and thenthen there
there is the development
development of its use in various problems.
problems.
You know, before PET imaging really came about, about, there was a need
accelerators, cyclotrons,
for accelerators, cyclotrons, to come into medicine, and for the use
positron-labeled compounds
of positron-labeled compounds to be of some value. Ter-Pogossian
contributed
contributed a great deal to that. that. When
When it comes to the PET scanner
and imaging, that that begins with
with mine and Ed [Hoffman]'s
[Hoffman]’s efforts to
do that.
that. And there
there were some predecessors to just imaging with
predecessors to
positrons:
positrons: Gordon
Gordon Brownell and a numbernumber of people. But whenwhen it
comes to PET, that we did.
PET, that
And thenthen you look at the brain,
brain, and you say, "What
“What are the
major events in the use of PET?"
major PET?” One of themthem was the develop-
develop­
ment of the deoxyglucose technique. There you come to the fact
technique. There
that Brookhaven National
that Lou Sokoloff, Brookhaven National Lab and University of
Pennsylvania,
Pennsylvania, came into it. JoannaJoanna Fowler and Alfred Wolf found a
way to make a PET form of deoxyglucose. That major event.
That was a major
There is no compound
compound used as often in PET as fluorodeoxyglucose,
fluorodeoxyglucose.
Phelps was one of the people to stay up nights pondering,
pondering, tinkering,
tinkering,
constructing a device that
and constructing that would
would make computed
computed tomographic
tomographic
measurements of positron
measurements positron tracers.
tracers. Along with
with Edward Hoffman, Phelps
Edward Hoffman,
15
that what
showed that what had been envisioned could really be done,done.15 He broke
the 4-minute Phelps’s story highlights the technologies
4-minute mile. Phelps's technologies and tech­
tech-
niques that
that enabled PET to be built
built and then
then the uses to which
which PET was
put.
In the following passage, Phelps reveals a difference
difference between breaking
the 4-minute
4-minute mile and building a new scientific instrument.
instrument. While the
run is public and clearly acclaimed, the device is private
run private and must be
proven over and over before skeptical audiences:
proven
P h e l p s : Quite frankly, in those early days we had done things driven
PHELPS:
by our imagination
imagination and our ideas. We had worked
worked day and night.
In fact [pointing at a photograph
photograph on the wall], that
that first scan with
with
'
37

l
 CHAPTER 2
CHAPTER

PETT III we took Cook at fivefive in the morning.

morning. It was supposed to be a
w as supposed
circle,
circle. We were excited about about it, but it didn't turn out to be a circle.
didn’t turn
D u m it: It was a phantom.
DuMIT: phantom.
PHELPS: Yes, it was a phantom
P h e lp s: Yes, phantom-we —we knew the right right answer; we didn’t
didn't
quite get it. But it was the first image we got on the PETT III. Then
I went
went out into the world
out into world to preach
preach this idea. With
With a great
great deal of
belief and confidence in it but with very little data.
but with data. And I was met
l'i with a world
with world notnot ..... . ready for this.
'll,,
1;'
DuMIT:
D u m it : Where did you go?
PHELPS: Oh, I went
P h e lp s: Oh,
go?
went to a greatgreat many scientific meetings. I gave the
first scientific paper
paper on PET that that was ever given, ironically, here in
San Diego. I mean nobody had
mean nobody had ever heard
heard of PET before, at that that
time.
You know, everybody
everybody talks aboutabout how great creativity and origi-
great creativity origi­
nality
nality is, but
but the dark
dark side of creativity destruction. If you create
creativity is destruction.
something new, you are going to displace or replace something
something something old.
You begin with with the majority
majority of people in the old and and a minority
minority of
people in the new, and they don't don’t like it. What
What comes then then is the
struggle thatthat is a necessary partpart of any original
original development.
development. You
have to struggle [ ..... . ] to give birth,
birth, to nurture, mature, and bring
nurture, mature,
forward your ideas, realizing that
forward that a majority
majority of people are op­ op-
posed.
historical turning
The historical turning point
point or scientific catalyst
catalyst will be the new
information and
source of information and the device that
that provides it. The challenge to
inventor is to gain the recognition
its inventor recognition for it from peers who are not
prepared
prepared to change their
their perceptions
perceptions or their
their stakes to accept this new
information. In fact, Phelps describes most
information. most of science in this vein of
revolution:
difficult revolution:
P h e lp s: Although
PHELPS: Although we did the first brain
brain mapping,
mapping, we didn't
didn’t pursue
pursue it
that much. So there
that there is an initial thing
thing that
that we did with
with PET,
PET, to
that it could
show that could be done; but
but Mark Raichle [at Washington Uni­
Washington Uni-
versity] really pursued brain mapping
pursued brain mapping devotedly.
then you look at the ligands to identify
And then identify neurotransmitter
neurotransmitter
receptor systems in the brain.
receptor brain. When
When we all started
started with that, every-
with that, every­
body said it is not
not possible, that
that the concentrations
concentrations of the receptors
receptors
are way too low.
DuMIT: Not possible in terms of the NIH
D u m it: Not NIH saying there
there is no funding
for this?
P h e lp s: The scientists were saying it is not
PHELPS: not going to happen,
happen, and you
are not
not going to get any money
money to do it.
But even though
though receptor
receptor concentrations
concentrations are extremely
extremely low, one
of the values of PET is that
that we can assay very, very low concentra-
concentra­
.·i
38
38
 .
r
.

METAPHORS, HISTORIES, AND

AND VISIONS
VISIONS
!

tions. We have that

that label put on a very sensitive signaling ap­ ap-
proach.
proach. We don't
don’t disturb
disturb the system, and we can see very small
numbers. But even we
numbers. —all of us in PET-had
we-all PET —had a question
question about
about
whether
whether we would
would be able to do it. And there
there Johns Hopkins [un­
Hopkins [un-
der Henry
Henry Wagner] played a major
major role. They really built
built the ap­
ap-
proaches and demonstrated
proaches demonstrated for people that
that it could be done. Hop­
Hop-
kins did that,
that, a really powerful
powerful thing.
The technology
technology of PET is difficult to demonstrate,
demonstrate, and it is equally
difficult to demonstrate technique that
demonstrate each new technique that makes use of it. For
Phelps, proof
proof of the technological achievement of PET and of the tech­
technological achievement tech-
niques that
that followed it lies in the fact that taken them
that people have taken them up
and pursued
pursued them.
Proving a new technique
technique to an unreceptive
unreceptive audience
audience is not
not easy,
easy, how-
how­
ever. Often
ever. Often it is the source of controversy. Controversies
Controversies have long been
used in STS
STS to gain insights into the practice
practice and maintenance
maintenance of science
and discovery (Nelkin 1979). Among scientists, stories of controversies
controversies
have a similar function,
function, to pass on insights about
about the real practice of
science.
The controversy
controversy narrated
narrated below by Phelps concerned
concerned the meaning of
deoxyglucose activity in the brain,
brain, specifically whether
whether or not it was a
reliable, precise, and accurate consumption. 16 It ap­
indicator of glucose consumption.^
accurate indicator ap-
17
pears to have been resolved in Sokoloff's
Sokoloff’s favor,1
favor, 7 but
but continues
continues to be
raised as an example of PET's
PET’s and/or
and/or FDG’s unreliability.1188
FDG's possible unreliability.
You know, when
when Lou Sokoloff developed the deoxyglucose auto- auto­
radiography technique
radiography technique for animals,
animals, it was a phenomenal
phenomenal break- break­
through. But there
through. there were many people that attacked the method-
that attacked method —and
attacked Lou —
attacked with lots of different agendas.
-with agendas. He went through a hell
went through
of a struggle. When
When he went
went into the National
National Academy of Science Science —
-
you have to give a talk on youryour work
work-—and one of the laureateslaureates of
physics got up and said that didn’t know
that he didn't know much
much about
about deoxyglu-
deoxyglu­
cose, but
but he was curious whether
whether the technique
technique had been used to
teach us about
about behavior
behavior and its relationship
relationship to the brain.
brain. And Lou
paused
paused for a minute,
minute, and he said, "Well,
“ Well, I'm
I’m not
not sure how much the
deoxyglucose technique taught us about
technique taught about behavior, but I’ll that
I'll tell you that
developing it has certainly
developing certainly taught
taught me a lot about
about behavior!
behavior!"” Because
Because
the more and more successful it became, and the more popular, the
there were people who didn't
more there didn’t want
want it, who
who attacked
attacked him. And
that is the way of it. Anything
that that grows
Anything that grows and is a success is going to
come under greater and greater
under greater greater attack. Now that
attack. Now that is a partpart of the
success, succeeding through
through the struggle. It is a way that that eliminates a
lot of lesser people and lesser things. It also eliminates some good
things, some good people. But it is necessary to not not only derive the

39
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I
CHAPTER 2

principle but be able to deal with the practicality realization.

practicality of its realization.
That
That can get pretty
pretty tough.
Having a new insight, a new technique,
technique, or a new technology is there­
there-
fore not
not enough, in Phelps’s
Phelps's view,
view, to constitute
constitute an advance in science.
science.
The true scientist must also take on the challenge of convincing his or
that there
her peers that there is an advance.
advance. The hard
hard work
work of making the case is
almost
almost as important
important as making the instrument.
instrument.
Related to the issue of building the technology
technology and convincing others
of its value is the issue of receiving credit for this work. For Phelps, this
is a particularly
particularly sore point: The first article on the PET technique, then
called PETT, he felt should have had his name first. Ter-Pogossian, as
director
director of the lab, and perhaps
perhaps with
with a different notion
notion of both PET and
of scientific progress,
progress, insisted on his own name being first. For Phelps,
this was not only improper
improper but enough reason to leave the lab and start
a new PET program
program elsewhere (at the University of California, Los An­ An-
[UCLA]). The blow, he felt,
geles [UCLA]). was to his name:
h e lp s: Every development
PHELPS:
P development in science
science is
is more complicated
complicated than
than
some would
would make it out out toto be. In fact, it is not necessarily more
complicated;
complicated; it is that
that there
there is more to it. Internally in science, we
are forced to try and simplify how something something happened
happened and who
did it. It
It is not
not done to ignore what contributed
what individuals had all contributed
to it, but we’re
we're forced
forced-—by by promotions,
promotions, by awards and prizes in
science —to
- to say thatthat this person and this person contributed,
contributed, but
this was the most fundamental
fundamental contribution.
contribution. It is an awkward
awkward and
difficult thing for us to do. But in the end, that that is why when you
think about
think about DNA you think think about
about Watson
Watson and Crick. They didn’t
didn't
collect one piece of data, data, but there were many people contributing,
contributing,
and they put put together
together the information
information in a way that that made sense
that was the double helix. But there are many people contributing.
that contributing.
u m it: Yes,
DuMIT:
D Yes, that
that is one of the things I am trying to account account for, the
many people contributing
contributing to this whole development.
h e lp s: Yes.
PHELPS:
P It is an awkward
Yes. It contribution is more
awkward thing to say this contribution
important
important thanthan that
that one, or really to be able to come to the point point
that
that you can say that that clearly this was more, this was the original
idea and from whom whom it came. It is a tough,tough, tough
tough thing.
problem that
The problem that Phelps raises is a common
common one in science.
science. Many
Many
fundamental
fundamental disagreements in science revolve around par-
around credit, and in par­
ticular
ticular first authorship.
authorship. Researchers all acknowledge the continual
continual chal­
chal-
lenge of collaboration.
collaboration. PET’s
PET's experimental
experimental and multidisciplinary
multidisciplinary nature
nature
requires
requires an especially intense attention
attention to these issues. One PET re­re-
searcher observed the following:

40
 METAPHORS, HISTORIES,
METAPHORS, HISTORIES, AND VISIONS

work requires complete cooperation

This kind of work cooperation among people
who aren't
who aren’t in the same department.
department. We are all in this together. De­ De-
grand happy
spite this grand happy family approach,
approach, everyone in academia has to
with the bottom
deal with bottom line, which
which is first author
author and intellectual
intellectual prop­
prop-
How do you divide up an experiment
erty rights. How experiment that that is intrinsically
intrinsically
dependent on so many individuals? It
dependent It is one of the most difficult parts
parts
think it is one of the reasons why politically there
of this endeavor. I think
problems with
are more problems with PET scanning
scanning than
than many otherother arenas (al­
(al-
though PET is not
though not unique), because you can’t can't do it alone. It is the
nature of the beast. Unfortunately,
nature Unfortunately, the system of rewards
rewards in academia
doesn’t recognize that
doesn't that you can have six authors
authors and they all partici­
partici-
pated equally. One person
pated person is forced to the front
front of the line.
line, How do
contribution? It
you really convey the degree of contribution? It is tough.
tough.
In sum, for Phelps, PET is a watershed
watershed information
information technology. ItIt is a
paradigm shift that
paradigm that makes new data
data available
available that
that then
then has to be cham­
cham-
pioned. Building a working
pioned. working PET device was a crucial technological
technological
achievement, and convincing the scientific community
achievement, community that
that this was so
required a difficult marketing
required marketing practice.
practice. In the end, PET enabled new
work to be accomplished.
kinds of applied work accomplished.

MICHEL
MICHEL M.
M. TER-POGOSSIAN,
TER-POGOSSIAN, PH.D.
PH.D.
PET
PET AS
AS FIELD
FIELD OF
OF RESEARCH,
RESEARCH, SCIENCE
SCIENCE AS NATURAL
AS NATURAL PROGRESS
PROGRESS

With these words

With words in mind, let me now
now awkwardly
awkwardly turn
turn to Michel M.
M.
Ter-Pogossian. Like Phelps, he has also been called the inventor
inventor of PET,
PET,
“ father of PET."
even "father PET.” I asked him about
about this:

DuMIT:
D u m it: I saw in one article that that you were quoted
quoted as being the father
PET. Are there
of PET. there many fathers
fathers of PET?
TER-PoGOSSIAN:
T e r -P o g o ssia n : Well, I'mI’m glad that
that you are saying that. that. Because
Because
when somebody
when somebody referred
referred to me as the father
father of PET,
PET, I said, “I’d
"I'd
rather be the mother
rather mother of PET,
PET, because manymany offspring
offspring have many
fathers, and only one mother. As a matter
fathers, matter of fact, some offspring
have no fatherfather at all!"
all!” Of course there
there are many fathers.
fathers. And I
think that
think that if you look at the first slide that that I showed
showed you, [it’s
[it's
obvious that J
that] there
there are masses of fathers of PET.
PET.
important point
Again, the important point is -—I’m
I'm not
not suggesting that
that to you; it
probably obvious -—is again the convergence of so many different
is probably
development of the scintillation
disciplines. The development scintillation counter, artificial
radioactivity, and so on. It appears
radioactivity, appears that
that we are going back prettypretty
far -—but
but you have to go far when when doing history
history —to
- to the radon
radon

41
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L
CHAPTER
CHAPTER 2

reconstruction, for instance,

reconstruction, which had nothing
instance, which nothing whatsoever
whatsoever to do
with
with medicine.
Ter-Pogossian’s comments reveal a different conception
Ter-Pogossian's conception of PET and a
different conception of science. Where highlighted the creative
Where Phelps highlighted
and hard workwork of tinkering
tinkering to bring about
about a practical
practical convergence in
the form of a working
working machine, Ter-Pogossian interpreted
interpreted an accumula­
accumula-
thought work, a gene pool rather
tion of thought rather than
than a progenitor, imper­
progenitor, an imper-
sonal convergence in place of a triumphant
triumphant Banister.
Banister.
metaphor of convergence, however,
The metaphor however does notnot have the same force
epistemologically as a technological innovation. It does not
technological innovation. anything
not do anything
not produce
in itself; it does not produce compelling pictures and elegant quantita­
quantita-
tive information.
information. In Ter-Pogossian’s
Ter-Pogossian's view, PET requires a team on a
scale:
small scale:
Well, at that
Well, that time, we had quite a group
group of people involved just in
general in the utilization
utilization of the short-lived
short-lived radionuclides.
radionuclides. We had Mi-Mi­
chael Welch; we had Mark Mark Raichle; we had two two chemists, Michael
Phelps and Ed Hoffman,
Hoffman, who later on were deeply involved in pos- pos­
itron
itron emission tomography.
tomography. And we had an electronic
electronic engineer by the
name of Nizar Mullani
Mullani who continued
continued being interested
interested in the field of
positron
positron emission tomography.
tomography. We were working
working as a group.
group. All of
these people contributed
contributed to the development
development of the probe that
probe system that
we used and later on configured it indeed to the development
development of the
type of PET devices that
that we use here. So it was a fairly large group
group at
the time, again, of chemists and physicists. The mathematics
mathematics contri-
contri­
bution came mostly from Biomedical Computing Laboratory, al­
Computing Laboratory, al-
though we all were involved up to a certain
though certain degree. So there
there were a
number of people involved. I think
number think it is very important
important to recognize
that it is very much of a team effort.
that
Ter-Pogossian emphasized that
that PET is the product
product of teamwork
teamwork in the
field of short-lived radionuclides.
field radionuclides. In an early 1981 article defining PET
also published
published in Seminars in Nuclear Medicine, Ter-Pogossian de­ de-
scribed essential areas of work
work that
that are integral to PET.
PET. He began by
noting
noting that
that the critical components
components of PET are the physiological proper-
proper­
ties of the positron-emitting
positron-emitting radionuclides.
radionuclides. Carbon,
Carbon, nitrogen,
nitrogen, and oxy­
oxy-
gen are common
common in almost
almost every molecule in our bodies; therefore,
therefore,
tracers using their
their isotopes can image almost any biologic process.
process.1 5
19

A crucial component utilization of positron

component in the utilization positron imaging in biol- biol­
ogy and medicine is the fact that
that four radionuclides
radionuclides 13N, 150, 15 0 , and
18F, which
18F, which possess chemical properties
properties of particular
particular value in biologic
investigations, decay with
investigations, with the emission of positrons
positrons...... . . It is proba­
proba-
ble that
that if it were not
not for the existence of the above "physiologic"
“ physiologic”
radionuclides, the reconstruction
radionuclides, reconstruction process used in positron
positron emission

42
 METAPHORS, HISTORIES,
METAPHORS, HISTORIES, AND VISIONS

tomography
tomography would have found
found little value in biology and in medicine;
conversely, the effective utilization
utilization in many “physi­
many studies of the "physi-
ologic” radionuclides
ologic" radionuclides antedates
antedates the PET reconstruction
reconstruction process. (Ter-
(Ter-
Pogossian 1981, p. 13)

The core aspect of PET for Ter-Pogossian is the the use of the physiologi­
physiologi-
cal properties
properties that
that predate actual PET device. Also, note the imper­
predate the actual imper-
sonality of the historical
sonality historical narrative.
narrative. PET’s
PET's value hinges on a coincidence,
that positron-emitting
that happen to be physiologic ones. These
positron-emitting nuclides happen
properties were Ter-Pogossian’s
properties Ter-Pogossian's special area of study from the 1950s
onward and were considered to be his triumph
onward triumph over naysayers. In an
article on the history of PET,
PET, he narrates
narrates it this way:

Between the middle 1940s and the early 1950s, the interest interest in using
11-C, 13-N, and 18-F in biomedical studies dwindled. dwindled ...., . . For practi­
practi-
cal purposes,
purposes, short-lived,
short-lived, cyclotron-produced,
cyclotron-produced, positron-emitting
positron-emitting ra­ ra-
dionuclides became inconsequential
inconsequential in biomedical
biomedical research
research between
the middle 1940s and the middle 1950s, thus ending the first phase of
PET.
PET.
In the middle 1950s, Ter-Pogossian and Powers rekindled rekindled at Wash-
Wash­
ington University an interest
interest in using, in spite of their short
short half-lives,
short-lived radionuclides
short-Jived radionuclides for physiological studies. . . . These early
experiments stimulated
experiments stimulated active work work with short-lived, cyclotron-repro­
short-lived, cyclotron-repro-
duced radionuclides, particularly gases, at the Hammersmith
radionuclides, particularly Hospital
Hammersmith Hospital
London...... . . Encouraged
in London Encouraged by these early results in the decade fol­ fol-
lowing the 1960s, the scope of the use of these short-lived
short-lived physiologi­
physiologi-
radionuclides grew slowly at first. This use then grew more rap­
cal radionuclides rap-
number of centers.
idly in a number centers ..... , . (Ter-Pogossian 1992,
1992, pp. 142-143)
142-143)

then, PET consisted not

For Ter-Pogossian, then, invention but of a
not of an invention
recognition —his
recognition that in fact positron
- his noticing that positron emitters would
would be useful.
The pieces of the convergence did not just fall into
into place anonymously;
anonymously;
they had toto be recognized as important.
important. In his narrative,
narrative, science pro­
pro-
ceeds far more smoothly
smoothly than
than in Phelps's;
Phelps’s; interests
interests are kindled,
kindled, they
stimulate further
stimulate further work,
work, then
then the work
work rapidly
rapidly grows,
grows. Science
Science is de-
de­
scribed as a steady process of work
work needing an occasional
occasional kick, or reor-
reor­
ientation,
ientation, such as when important path
when an important path is missed. Indeed, Ter-Pogos­
Ter-Pogos-
sian’s
sian's definition of PET was specifically
specifically expanded
expanded beyond
beyond the scanner:

Thus, the term "PET"

“PET” most often encompasses,
encompasses, in addition
addition to the
reconstruction "per
image reconstruction “per se,”
se," the utilization of "physiologic"
the utilization “physiologic” radio­
radio-
nuclides. In the context,
nuclides, context, this definition
definition will be used for PET, is
PET, and it is
useful to emphasize that
that some facets of the present
present study would not
would not
apply to a narrower
narrower definition of the term.
term. (Ter-Pogossian 1981, p.
13)

43

l
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 7
CHAPTER
CHAPTER 2

PET, in this view of science, is a path,

PET, path, a path that both
path that both includes the
convergence of other
other paths and participates
participates in them. The development
development
of the actual
actual PET scanning device, although
although necessary, was also inevita-
inevita­
ble and therefore
therefore secondary to the advancement
advancement of ways of capitalizing
on the central
central fact of recognition
recognition of the value of the short-lived
short-lived cyclo­
cyclo-
tron-produced,
tron-produced, positron-emitting radionuclides. The pains taken
positron-emitting radionudides. taken here to
make dear
clear the scope of PET and the proper view of history
history are worth
worth
noting.
noting. In the following interview excerpt, Ter-Pogossian restates his
interview excerpt,
'.I
!
position
position on the definition of PET and on the role of recognition
recognition in the
advancement
advancement of science:
So
So this is, in my opinion,
opinion, the important
important turning
turning point which led to
point which
iii
111
the development positron emission tomography.
development of positron tomography. The term
term positron
positron
!1
emission tomography,
tomography, as it is, refers to the tomographic
tomographic reconstruc­
reconstruc-
tion
tion process. But I do believe
believe that
that the most important
important concept
concept is
nature of the molecules used. If, for example, the
really the chemical nature
nature of positron
chemical nature positron emitters did not not include oxygen-15, ni­
oxygen-15, ni-
trogen-13, carbon-11,
trogen-13, carbon-11, and fluorine-18,
fluorine-18, positron
positron emission tomography
tomography
would never have been developed. The reason
would reason for the development
development of
positron emission tomography
positron tomography was indeed to image these nuclides of
physiological importance.
importance.
Again, without
without these four nuclides, nuclear
nuclear medicine tomography
tomography
certainly would
certainly would have existed, because it had been developed in the
earlier days by David Kuhl and his coworkers,
coworkers, and as you know, it is
widely used [today] in the form of SPECT.SPECT. But positron
positron emitters-the
emitters —the
only reason
reason for using positron
positron emitters is because of the chemical
nature
nature of these nuclides which
which makes themthem so flexible in physiological
experiments.
experiments. Of course, therethere is another
another advantage: There
There is the emis-
emis­
sion of annihilation
annihilation radiation,
radiation, which
which allows a muchmuch greater
greater precision
and sensitivity than
than in SPECT.
SPECT. So essentially I think
think the crucial point
point
in positron
positron emission tomography
tomography was the-if the —if you want
want to [call it
that]—the
that]-the recognition
recognition of the usefulness of these physiologic nuclides.
Ter-Pogossian’s
Ter-Pogossian's contribution, then, was the rescuing of the once-lost
contribution, then,
path
path of exploring
exploring the value of physiologic nuclides. His work
work from the
1950s to the 1970s concerned
concerned expanding
expanding the uses for these nuclides. To
this end, he brought
brought the first cyclotron
cyclotron to be installed
installed in a medical
school. 200 Without
school.2 Without this path
path being established,
established, he was saying, there
would PET:
would be no PET:
There is an amusing aspect from an historical
There historical perspective: A num-
num­
Nobel laureates
ber of Nobel laureates have contributed
contributed to PET.
PET. As far as the discov-
discov­
ery of radioactivity
radioactivity is concerned, Joliot and
concerned, of course it is Frederic Joliot
Irene Curie. The invention
invention of the cyclotron
cyclotron is Ernest Lawrence. And

44
44
 METAPHORS, HI5TORIES,
METAPHORS, HISTORIES, AND VISION5
VISIONS

development of tomography,
as far as the development tomography, it is Godfried
Godfried Hounsfield
Cormack. So you see, PET essentially consists of putting
and Allan Cormack. putting
together these different
together different building blocks, including
including all of these areas.
Ter-Pogossian’s historical
Ter-Pogossian's historical metaphor,
metaphor, then,
then, is not
not one of obligatory
obligatory
points but
passage points but one of building blocks, with
with science working
working slowly,
slowly,
down paths.
but surely, and steadily down paths.

HENRY
HENRY N. WAGNER
WAGNER JR.,
JR., M.D.
M.D.
PET
PET AS
AS HANDY
HANDY TOOL,
TOOL, SCIENCE
SCIENCE AS
AS CREATIVE INSIGHT
CREATIVE INSIGHT

Henry Wagner presents

Henry presents a quite different view on PET.
PET. Wagner is a long­
long-
standing leader and advocate in the field of nuclear medicine, and his
standing
work concentrates
work concentrates on studying neurotransmitters
neurotransmitters with
with PET and other
nuclear medicine modalities.
nuclear modalities.
following is an exchange I had
The following had with
with him over the history of PET.
PET.
Notice how
Notice how Wagner reframes PET from a technology
technology or technique
technique into
problem that
a problem that needed solving. In doing so, PET becomes secondary
secondary to
who solve primary
the scientists who primary problems.
problems,
D u m it:
DUMIT: I’m working
I'm working backwards,
backwards, looking
looking at the history
history of what are
problems that
the problems that PET came about
about to solve. What
What got these differ­
differ-
together to produce
ent disciplines together produce PET?
PET?
WAGNER:
W ag n er: Good question. How How did PET come about? about? I’ll
I'll give you
some key events. Claude BernardBernard invented
invented the seeds of the dynamic
constituents. Georg [von] Hevesy invented
states of body constituents. invented the tracer
tracer
cyclotron was used to produce
concept. The cyclotron produce carbon-11,
carbon-11, and very
interesting studies were done investigating
interesting investigating photosynthesis
photosynthesis and the
metabolism of carbon
metabolism carbon monoxide.
monoxide. But then,then, when
when the reactor
reactor got
invented and
invented and carbon-14
carbon-14 came on the scene, people forgot about about the
cyclotron because it was too complicated,
cyclotron complicated, and they were applying
tracer principle
the tracer principle of Hevesy to study the physiological
physiological principle
cyclotron was put
of Claude Bernard. The cyclotron put on the back burner
burner and
biochemistry was developing. Okay, then
biochemistry then Kety and Sokoloff began
making human
making human measurements;
measurements; they began studying brain blood
studying brain
flow. And they began studying brain blood
blood flow and behavior in a
global sense. And they triedtried to study things like schizophrenia
schizophrenia and
anesthesia and things like that.
anesthesia that. And they carried
carried out some studies
radioactive tracers
using radioactive tracers to measure
measure global blood flow.
flow. Then a par­
par-
path was imaging, which
allel path which began basically withwith the thyroid,
thyroid,
regional function
studying regional function of organs
organs such as the thyroid
thyroid gland, and
imaging was being developed. And [Sokoloff’s [Sokoloff's group], they were
trying to show some brain chemical process going on in association
association

I 45

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CHAPTER 2

with activation,
with activation, and they used autoradiography
autoradiography to show that that you
could stimulate
stimulate a cat and get an activation
activation in the brain. This turned
turned
everybody on. Then Then chance came into the picture —chance plays a
picture-chance
tremendous
tremendous role in all of these things. By chance, Martin Martin Reivich
working
was working at the NIH
NIH with Sokoloff and Rety,
Kety, and he went
went up to
Pennsylvania,
Pennsylvania, where they had a nuclear
nuclear medicine guy,
guy, David Kuhl.
They thenthen said, “We "We are going to extend the autoradiographic
autoradiographic
studies of Sokoloff to humanhuman beings."
beings.” And that
that is exactly whatwhat we
did here [at Johns Hopkins
Hopkins University]. I saw the autoradiograph
autoradiograph
studies of Michael Kuhar and said, "We “We are going to translate that
translate that
into human
human studies.”
studies."
So PET arose to translate the autoradiograph studies ofKety of Kety and
Sokoloff to human
Sokoloff human beings. ThatThat was the event. These things are are
obviously a chain reaction, but
obviously but every now
now and then you get an
event where you can put
event put a mark at that particular event. That
event was the Kety and SokoloffSokoloff part [italics mine].
Now you are saying that that this is different. [But]
[But] there [with Kety
and Sokoloff] is a problem!
problem! They said thatthat there
there is some chemical
process going on in your your brain,
brain, electrical activity is related be­
related to be-
havior, they wantedwanted to to relate chemistry to behavior. That's That’s the
·•1'1 problem. Why did you say that
problem. that you are working
working in the opposite
I'
direction?
!
I D u m it: The stories that
DUMIT: that I have seen of PET,
PET, described in articles and
,..I so on, describe PET as the product product of a number
number of technical
..·Ii
!: achievements such as computers,computers, small cyclotrons,
cyclotrons, new tracer
methods. These things came on the scene and people were basically
methods.
waiting for new things to
waiting to happen
happen such as new algorithms.
algorithms. When
this happened,
happened, then ..... .
WAGNER:
W That is ridiculous.
ag n e r: That ridiculous. I don’t understand. There
don't understand. There is a series of
that happened,
events that happened, and these events all went went in that
that direction.
direction. I
don’t understand
don't understand how people were waiting waiting for something
something to hap­ hap-
What were they doing while they were waiting? They were
pen. What
there waiting-for
sitting there waiting —for someone to open up the door and an- an­
nounce something?
nounce
stopping point.
D u m it: A stopping
DUMIT:
WAGNER:
W ag n er: No, No, that
that is not true.
true. Research is based on taking
taking the instru­
instru-
ments...... . . I read a really good description,
ments description, in a history
history of neuro-
neuro­
written by Hodgkin,
sciences written Hodgkin, and he pointed
pointed out thatthat discoveries
are made by curious people who use the equipment equipment thatthat is available
at the time, and they will find out something
something based on almost almost any
equipment that
equipment that is present. And major
major discoveries were made using
unbelievably primitive equipment.
unbelievably equipment. So the idea that that somebody's
somebody’s sit-sit­
there waiting for something
ting there something to be invented, some measuring

46
 METAPHORS,
METAPHORS, HISTORIES,
HISTORliS, AND
AND VI5ION
VISIONSS

device to be invented to solve theirtheir problem,

problem, is not correct. What
What
you have are parallel paths
paths and inventions.
inventions. And long before we had
these inventions, computers,
computers, people were doing tomography.
tomography. I
mean Dave Kuhl did back-projection
back-projection in 1963. I mean, it depends.
It is a continuum,
continuum, and every now and then then something out-
something is so out­
standing
standing it sort of stands out, but it is a continuum.
continuum. Let’s
Let's say you
have a coming together
together of all these things. I mean, PET would
would not
be in the state that
that it is today
today if it had not
not been for parallel devel-
parallel devel­
opments
opments thatthat were happening.
happening. So to say that
that people were waiting
for it to happen
happen is malarkey. Creative people were making making the best
use - pure science is creative, curious people making do with what what
they have, beginning with theirtheir eyes,
eyes, Darwin
Darwin had his eyeballs. Isn’t
Isn't
that
that right? He wasn’t
wasn't waiting around
around for computers
computers to be devel­
devel-
oped, the tracer
tracer principle to be invented.
Claude Bernard was not sitting there there waiting
waiting for the tracer prin­
prin-
ciple to carry out his studies. He was trying trying to do an impossible
thing;
thing; he was making an observation.
observation. It takes a curious person to
solve a problem. So PET was a chain of events. So two absolutely
outstanding
outstanding people in it were Bernard
Bernard and Hevesy, thenthen there were
regional
regional measurements
measurements made of the thyroid thyroid gland. Thyroid
Thyroid scan­
scan-
ning started
started because of nodules in the thyroid. wanted to
thyroid. They wanted
know whether
whether they were functional
functional or not
not functional;
functional; they had a
spatial
spatial problem.
For Wagner, science
science follows problems.
problems. Science progresses because
there are creative thinkers practical problems,
thinkers who struggle with practical medi-
problems, medi­
cal problems.
problems. Neither
Neither part
part of the Phelps— Ter-Pogossian difference (tech­
Phelps-Ter-Pogossian (tech-
nological invention
invention or path
path recognition) scien..;:e.
recognition) succeeds in propelling science.
They are valuable sideshows to the progress of thinkers.
thinkers. Wagner’s
Wagner's his­
his-
tory
tory might be represented
represented as paradigms
paradigms shifting by insights.
The significance of problems with with both instrument
instrument and nuclides is
best illustrated
illustrated in the following comment,
comment, in which Wagner refocused
my interest
interest in PET onto the kinds of problems
problems and domains
domains with
with which
21
he is working.1
working. 1
In fact, I really don’t
don't distinguish between PET and SPECT SPECT as being
two different things. It’s
It's just a question
question of different tracers. Every­
Every-
thing is the same except the tracers. SoSo basically, some of the biggest
advances in cancer were not not with a PET agent but with with a SPECT
SPECT
agent that
that is a gross suppresser substance.
substance, And we know know that
that many
cancers are associated
associated with
with an increase in somatostatin
somatostatin receptors,
receptors,
where somatostatin
somatostatin is something that
that tells cells to stop secreting and
stop dividing. When you find an up-regulation,
up-regulation, or an increase in the
receptor, you look for a deficiency in the messenger. And that’s that's what
what

47

i
L
n CHAPTER 2

it’s
it's turning
turning out to be in the case [of]
ple, there
[of] certain
certain brain tumors.
there is a deficiency in the production
tumors. For exam-
production of a chemical that
exam­
that tells cells
to stop secreting and stop dividing. So all cancer [research] is being
transformed into a molecular
transformed molecular approach;
approach; it is being defined in a mo­
mo-
lecular domain.
domain.
In one fell swoop,
swoop, in one sweeping sentence, Wagner's
Wagner’s view of the
!ii problem
problem of PET sidesteps the views of both both Phelps and Ter-Pogossian:
“"II really don't
don’t distinguish
distinguish between PET and SPECT as being two differ-differ­
ent things."
things.” The crucial components their claims appear
components of each of their appear in-
in­
terchangeable
terchangeable with with other
other components-Phelps's
components—Phelps’s scanner
scanner for SPECT,
SPECT,
Ter-Pogossian’s physiological positron
Ter-Pogossian's positron emitters for single-photon nu­
single-photon nu-
Neither was crucial. They were important,
clides. Neither important, maybe, butbut not criti-
criti­
cal, and certainly
certainly not
not obligatory. Wagner is not
not interested
interested in the me­
me-
chanics of the tools, thoughthough he knows them. Instruments
Instruments are tools
purpose is to vanish into the background
whose purpose background of science. The ques-
ques­
tion of PET tracers he hears as one about
tion about tracers in general, which
which is
part of the solution
part solution to a problem about cancer, which
problem about which in turn
turn is about
about
thinking through
thinking through the process of cellular communication
communication and growth.
growth.

So .•••
. . Toward
Toward a Historiography
Historiography of PET
PET

Represented in these three

Represented three individuals are three kinds of deterministic
deterministic
histories -—technology, scientific principles, scientific research. PET is ei-
ei­
ther a critical invention,
ther invention, a crucial application
application of an insight, or one
among
among many tools at hand.
What is a historian
What historian to do with
with all this? If I follow Wagner (my partic-
partic­
abstraction of Wagner), then
ular abstraction then a history
history of PET is not even a true
project.
project. I might write history of the solution
write a history solution to the problem
problem of auto-
auto­
radiography
radiography in humans,
humans, perhaps, but in any case, it would
perhaps, but would be a history
history
with politics and political economy
of ideas and insights, with entering only
economy entering
provide color and chance.
to provide
To adopt Phelps’s perspective, on the contrary,
adopt Phelps's would be to focus on
contrary, would
political economy and politics, the day-to-day
political day-to-day specifics
specifics of how work
work
actually gets done or gets suppressed in institutions.
institutions. A Phelpsian history
history
would highlight the hard
would highlight hard work
work not only of creatively making
making something
work,
work, but also of marketing
marketing it, and where
where marketing would mean
marketing would mean not
demonstrating that
only demonstrating that it works
works effectively butbut also convincing others
Paradigms would be shown
of this effectiveness. Paradigms shown to be the result of
lobbying as much
lobbying much as of insight.
Ter-Pogossian’s perspective would
Ter-Pogossian's would also involve political economy, but
not as much politics. A scientific history would
not would require
require attending
attending to
directions
directions in science, to insightful proposals
proposals for research, and directions

48
 METAPHORS, HISTORIES, AND
AND VISIO NS
VISIONS

lost and regained. It would

would highlight an army of tireless, careful re­ re-
searchers but also attend
attend to skill in promoting
promoting research
research directions
directions and
building programs
programs with vision.
Each of these historiographical
historiographical approaches
approaches raises fundamental ques-
fundamental ques­
tions about
about the definition and purpose
purpose of both
both PET and of science.
science. Each
also would
would highlight different kinds of documents differ-
documents and emphasize differ­
ent people. Like many websites on the Internet, history of PET is
Internet, the history
“"still
still under
under construction.”
construction."

49
49
 Interlude2
Interlude
Reading Function
Function

DuMIT:
D u m it: I was w as just thinking
thinking of functional
functional im images.
ages. I am still w working
orking
at understanding
understanding how a function, function, or som something that happens
ething that
through represented in a PET picture.
through time, is represented picture. Because
Because it looks like
one instant
instant in time, [like a photograph],
photograph], even though though for m ost PET
most
pictures
pictures it is two tw o minutes,
minutes, maybe twenty minutes.
m aybe twenty
TER-POGOSSIAN:
T er -P o g o s s ia n : Sure, but that not· the im
that is not important portion at all.
portant portion
DuMIT:
D u m it : What
W hat would
w ould you say is is the im
important portion?
portant portion?
TER-POGOSSIAN: function itself. And the function
T e r - P o g o s sia n : It is the function function itself is
derived through
again derived through the application
application of a physiological
physiological model,
which is certainly
which certainly not
not instantaneous
instantaneous at all. In some cases, the in­ in-
stantaneous image is perfectly
stantaneous perfectly all right. LetLet me give you a specific
specific
accumulation of FDG in a brain
case: the accumulation brain tumor. Well, thatthat is an
instantaneous phenomenon.
instantaneous phenomenon. But if you are trying to measure measure actu­
actu-
metabolism by FDG, an instantaneous
ally the glucose metabolism instantaneous picture
picture
really is not not going to give you anything,
anything. I mean you have to take a
measurements, you have to plug into measurements
series of measurements, measurements blood
reconstruct a completely different
activities, and very often reconstruct different image
from the one that
from that you obtained
obtained instantaneously,
instantaneously, taking
taking into ac­ac-
count the other
count other factors.
DuMIT:
D u m it: WithWith the oxygen studies, it is the sam samee thing.
TER-POGOSSIAN: Yes. The image itself doesn’t
T e r - P o g o s sia n : Yes. doesn't show anything.
anything. In fact,
we1often don't
we,often don’t show the images. You show an image if you want want to
show the
.show the morphology
morphology [anatomical
[anatomical structure]
structure] in a given portion
portion of
heart. And
the heart. And putput a square
square and put put a number, and that that number
number
indicates the bloodflow
indicates bloodflow in that
that portion
portion of the myocardium,
myocardium, which
 FUNCTION
READING FUNCTION
READING

F ig u r e 2.1. News versus tales. Original

FIGURE caption reads: “"Typical
Original caption corresponding
Typical corresponding
cerebral
cerebral glucose metabolism
metabolism (^imol/100
(µmol/100 g. per minute) normal
minute) PET images of normal
right-handers
right-handers during auditory stimulation,
during verbal auditory interest-
with one listening to interest­
stimulation, with
ing news and the other
other to boring
boring tales, showing
showing differential lat-
activation and lat­
differential activation
eralization
eralization of 'Wernicke’s
Wernicke's area response (arrowheads)." (Pawlik and Heiss 1989)
response (arrowheads).'”

is calculated
calculated on the basis of a series of images, as a mattermatter of fact,
plus the blood activity.
activity, And the blood
blood activity in cardiac studies is
cardiac
usually taken
taken out of one of the ventricles.
But in certain
certain cases, indeed you have purely morphological
morphological images.
The FDG accumulation
accumulation in a brain
brain tumor
tumor is purely morphological
morphological [be­
[be-
cause they are interested
interested not in how
how fast
fast the tumor
tumor accumulates
accumulates FDG
but only in the anatomical
anatomical location
location of the tumor
tumor that
that accumulates

51
51
 INTERLUDE
INTERLUDE 2

FDG much much faster

faster than
than any other other area in the brain]. ThatThat is not
not the
• strength
strength of PET. PET,
DuMIT: Activation images, though,
D u m it: Activation though, wouldwould be kind
kind of in between?
TER-POGOSSIAN: Activation images [figure 2.1] are in between;
T e r - P o g o s sia n : Activation between; you
right. But you see an activation
are right. activation image-really,
image —really, to interpret
interpret an
activation image, you really have to calculate
activation the flow, and
calculate the the cal­
and the cal-
culation of the flow is a dynamic
culation dynamic process.
process. That
That is probably,
probably, inciden­
inciden-
tally, the reason
reason for the relative
relative difficulty in interpreting
interpreting PET im­ im-
ages. The complexity —perhaps not
complexity-perhaps not the difficulty —is something
difficulty-is something
that has slowed down
chat down the development
development of PET. In clinical practicepractice
you don’t
don't like to do that that at all. And for very good good reasons:
reasons: You
don’t
don't have time for that. that.
DuMIT:
D u m it : Because it takes a lot m more
ore time to go through
through and m ake
make
sure the physiological
physiological [parameters
[parameters and calculations
calculations are correct]?
correct] ?
TER-POGOSSIAN:
T e r -P o g o ssia n : Well, yes. It requires requires all the measurements,
measurements, the
blood activity
blood activity as a function
function of time. That That means
means you have to take take
samples in some way and and measure
measure the samples. And then then you have
to sit down
down withwith a computer
computer and apply apply a model
model of some sort to
make sense out of that.
make that. It is muchmuch easier to look look at a picture
picture and
say, “"You
You know,
know, it is right
right there.”
there." That
That is not
not the way you do
things
things in PET.
That
That is not not completely
completely true,
true, because under under certain
certain circumstances
circumstances
that is just what
that what you do do...... . . Let me putput it this way: If I look at an
image, or at numbers,
numbers, I am more more concerned with what it represents
concerned with represents
1,,1 than how it represents
than represents it. I don'tdon’t know
know whether
whether that
that answers
answers your
your
,·'I
1

question. But I am trying.

question. trying. WhenWhen I see a hot hot area
area on an image or a
series of numbers,
numbers, I try to to think
think of whether
whether it is an accumulation,
accumulation,
or whether
whether it is an inertinert process of some sort occurring, occurring, whether
whether it
is necrotic
necrotic tissue-absorbing
tissue-absorbing activity. Yes, Yes, in general, this is whatwhat
stimulates
stimulates my thinking.
thinking.
u m it: So
DuMIT:
D So images or numbersnumbers —it -it doesn’t
doesn't matter;
matter; it is the pro­pro-
cess.
cess ..... . .
e r -P o g o s sia n : It is the process,
TER-POGOSSIAN:
T process, yes, underlying
underlying it.

52
 Chapter 3
Producing Images o\
Brain Images
Producing Brain of Mind

know we need hype to sell our

We know our research;
research; let’s
let's try to
keep it out
out of the results!
-Louis
—Louis Sokoloff, giving a plenary
plenary talk at a Society for
Neuroscience
Neuroscience national
national meeting

researchers are clearly torn

PET researchers torn between conflicting visions of PET. PET. A
part of each researcher
part researcher wants
wants to impress the world
world with
with the great prog­
prog-
brain’s functions
ress made in discovering the brain's functions as well with his or her
mastery of the complexity
own great mastery complexity of the brain. Another
Another part
part wants
world to know
the world know how difficult this task is, how many assumptions
assumptions
and equipment
and equipment limitations
limitations have to be carefully balanced,
balanced, and how
experiment actually
tricky pulling off a successful experiment actually is.
is. But the most com­
com-
researcher is to turn
pelling desire of each PET researcher turn off all of this world
concern and
concern and just dive into the exciting mysteries of the brain, using this
fascinating, innovative,
fascinating, innovative, challenging technology. Understanding
Understanding a PET
experiment requires understanding
experiment understanding how these threethree desires of the PET
researcher are carried
researcher carried out together
together in every experiment
experiment and in every
publication.
publication.
understanding of the mind-brain
Coming to a deeper understanding mind-brain relationship
relationship is
neuroscientists went
why many neuroscientists went into science in the first place. From the
technological perspective, the brain is a seriously difficult nut
technological nut to crack.
It is protected
protected by a skull, it is unimaginably
unimaginably complex
complex and interconnected
interconnected
(100,000 neurons
(100,000 neurons in a cubic millimeter),
millimeter), and all of these neurons
neurons and
about their
synapses are going about their business at the same time. Therefore, for
potential researchers
potential researchers looking
looking for insight into the brain
brain at work,
work, func­
func-

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tional brain imaging offered an unbelievable opportunity:

tional brain opportunity: to extract
extract in-
in­
formation otherwise
formation otherwise impossible to get from a living brain while cor­ cor-
relating this information
relating with the activity of the person.
information with person. Peter Fox de-
de­
scribed, in an interview, the thirst
thirst for knowledge:
I was in medical school [in the 1970s, and] that that was at the time
that the Scientific American
that o u t..... . showing
American article came out showing brain
brain map­
map-
with xenon
ping with xenon blood flow [see [see Plate 10] techniques
techniques in Den-
Den­
mark. ..... . For four years in a row, I [had been working
mark. working on] a thesis
on epistemology and wanted know how the brain
wanted to know brain lets us know
know
how it is we perceive the world,
world, and how the brain is organized
organized to
allow us to to have knowledge
knowledge of our environment.
environment. And it was imme- imme­
diately apparent,
apparent, [as]
[as] people were mapping
mapping this and arguing at that that
about the role of SMA [supplementary
stage about [supplementary motormotor area] and how
high a processor
processor it was ..... . at any rate,
rate, at that
that time people were
getting very excited by it, and it was clear that that you could map the
brain.
brain. I was debating
debating at that whether to go into
that time whether into psychiatry
psychiatry or
neurology, and at that
that point,
point, seeing the emergence of brain brain mapping
mapping
techniques,
techniques, decided to go into neurology.
point to the rise of PET technology
We can point technology in the mid-1970s,
mid-1970s, butbut the
development of PET is still ongoing in the twenty-first
development twenty-first century. A short
list of the disciplines involved in PET experiments
experiments include physicists,
chemists, nuclear chemists, biologists, computer
computer scientists, electrical en­
en-
psychologists, psychiatrists,
gineers, psychologists, psychiatrists, neurologists,
neurologists, oncologists,
oncologists, nuclear
medicine specialists, neuroanatomists,
neuroanatomists, mathematicians.
mathematicians. These specialists
cooperate extensively with
must cooperate with each other
other to understand
understand how each
area of expertise depends on the results of everyone else'selse’s areas, as a
researcher said to me:
senior researcher
The thing
thing with
with all of PET scanning is thatthat it is an unusual
unusual kind of
research, because it requires intense collaborative
research, collaborative participation
participation from
people from very diverse scientific viewpoints.
viewpoints. Usually in science,
you’re a physiologist
you're physiologist or you're
you’re an anatomist;
anatomist; you are in a lab, you
have your experiment,
experiment, all nicely and neatly self-contained.
self-contained. For the
part you don't
most part don’t need direct participation
participation from disciplines that
that are
removed
removed from what what you do (although
(although collaborations
collaborations across related
disciplines are common),
common), whereas the most successful PET labs have
been those that
that have been able to capitalize on the symbiosis of very
diverse groups of investigators
investigators —- chemists, physicists, theoretical
theoretical mod­
mod-
elers, clinicians, neuroscientists,
neuroscientists, psychologists, linguists, etc. The boss
needs to facilitate
facilitate the interaction
interaction of scientists who have little to no
training in specific
training specific brain
brain mechanisms
mechanisms [and] clinicians or behaviorists
who may have no clue about about the intricacies of the technology. PET

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PRODUCING DRAIN
PRODUCING MIND
OF MIND
IMAGES OF

requires the close cooperation ordinarily would have

cooperation of people who ordinarily
no reason to interact
interact with one another
another in a research endeavor. No
one person can do it without
without the others.
At a recent Society of Nuclear
Nuclear Medicine
Medicine meeting, for instance, papers
were presented
presented by physicists and mathematicians
mathematicians proposing
proposing new archi­
archi-
tectures for scanners, new compounds
compounds. for detector
detector crystals, and new
algorithms
algorithms for better
better correction
correction ooff errors in reconstruction.
reconstruction. Chemists
presented
presented work
work on better radioligands
radioligands to specify more more. precisely what
the brain
brain is doing during scans. Tasks were critiqued
critiqued by psychiatrists,
neurologists,
neurologists, and psychologists. Patient-selection
Patient-selection procedures,
procedures, scan reso­
reso-
lution,
lution, and statistical analysis were all subject to to intense scrutiny. In­ In-
deed, there were no aspects within
within the entire PET apparatus
apparatus that
that were
not contested
contested or shown to be contestable.
contestable.
At the same time, there were specific
specific results presented
presented for neurologi­
neurologi-
cal, psychiatric, psychological, cardiological,
cardiological, and oncological studies
done with
with PET.
PET. In order to evaluate the meaning of the results, the
presenters
presenters pragmatically
pragmatically had to act as if theirtheir PET apparatus
apparatus worked
worked
unproblematically.
unproblematically. Each individual
individual researcher
researcher is often limited in the as­ as-
pects of the experiment
experiment he or she can critique or even follow. Paper
presenters
presenters are often asked questions
questions to which their
their response
response is: “I’m
"I'm not
sure; another
another researcher
researcher handled
handled that
that part
part of the experiment.”
experiment." Whether
Whether
these presenters
presenters are psychiatrists
psychiatrists who do not not know how the brain brain im­
im-
ages were normalized
normalized to a “reference
"reference brain,”
brain," or chemists who are not
sure how normal
normal control
control patients
patients were chosen, or computer
computer scientists
who do not not know how specifically
specifically the radiopharmaceutical
radiopharmaceutical binds to to a
particular receptor questions are often left hanging and questioners
particular receptor, questioners are
left frustrated
frustrated by their
their inability to deconstruct
deconstruct the presented
presented data into
data
data relevant
relevant to their
their own interests.
Another
Another downside
downside of PET’s
PET's complexity cooperation is
complexity and requisite cooperation
that
that each expert participant
participant is also responsible
responsible for a successful career
path,
path, publications,
publications, leadership, and credit. Thus, despite the practical
achievement of complex cooperation
cooperation in PET in many centers, disputes
still arise over the ultimate meaning and usefulness of the data, data, both
among labs and between
between, groups of researchers
researchers at the same lab. Often,
different groups within
within the same center use PET in paradigmatically
paradigmatically
different
different ways, and they find it difficult to communicate
communicate with each other.
D u m it: I have wondered
DUMIT: wondered if there has been a tension
tension in PET between
the image as qualitative
qualitative and the image as quantitative.
quantitative. PET seems
seems
to be a great difference engine. It can produce
produce a difference between
different kinds of people or different kinds of traits
traits and states.
h e lp s: Yes.
PHELPS:
P Yes. Of course, part
part of that
that is also conflict built into PET,
PET, in
that
that there are many different
different people involved in PET.PET. There are

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conflicts between those whowho use it qualitatively

qualitatively and superficially
and those
and those who
who use it analytically, by their nature.
nature. There can be
who are trying to use it to do some clinical research,
people who research, or deal
with the limitations
with limitations in people. You know
know you can’t
can't be doing their
biochemistry by other
biochemistry other techniques,
techniques, pulling out their tissue and an­ an-
paradigms, the research
alyzing it. So the paradigms, research paradigms,
paradigms, are quite dif­
dif-
exploring the relationship
ferent. So they can be exploring relationship between the brain
behavior in the domain
and behavior domain that
that they normally
normally work
work in. And the
neurochemist involved in PET will say, “"II don’t
basic neurochemist don't like that;
that; you
don’t know
don't know what
what you are talking
talking about.
about. What
What are the units of your
depression on this axis versus color on this axis?”
data, depression axis?" So there
are a lot of different factions within
within PET,
PET, because it does go from
basic chemists and biologists to clinical investigators,
investigators, and their cri­
cri-
experiment are quite different.
teria of an experiment
Each of these stages involves both both necessary assumptions
assumptions about
about per­
per-
brains, and in many experiments
sons and brains, experiments each part
part of the experimental
experimental
innovated and
process is being innovated and tested at the same time. In the same
experiment, then,
experiment, then, a physicist may be testing a hypothesis
hypothesis regarding
regarding a
scanner architecture,
new scanner architecture, a pharmacologist
pharmacologist may be testing a hypothesis
regarding the action
regarding action of a drug on a speech impediment,
impediment, a neurologist
neurologist
where in the brain the speech impediment
may be testing where impediment is “located,”
"located,"
and a computer
and computer scientist may be testing a new algorithm
algorithm for defining
locations in averaged brain
significant locations brain scans. Such an experiment
experiment re­
re-
interdisciplinary cooperation
quires a degree of interdisciplinary cooperation uncommon
uncommon in research.
balancing act in which
It is a delicate balancing which each hypothesis
hypothesis can be tested only
by assuming that that the other
other hypotheses
hypotheses are not significant to one’s
one's re­
re-
sults.
Another senior researcher
Another researcher described how these different
different research
around the same machine:
agendas can coexist around
structured system. But each one of these
We never really had a very structured
subgroups,
subgroups, and you know
know we had subgroups,
subgroups, developed their own
interests, and they developed their own grants.
interests, grants. So
So little by little, we
had a series of PET subgroups,
had subgroups, or groups,
groups, working
working relatively harmo­
harmo-
not specifically as one monolithic
niously together, but not monolithic institute
institute in the
European sense of the
European the word.
word. As a matter
matter of fact, this balkanization
balkanization of
PET, certainly
PET, certainly in our institution,
institution, is very strong
strong now. There really is a
subgroups working
whole series of subgroups working on their own, with with their own
ideas. They are on good terms with other other people and from time to
time seek help or give help. But otherwise
otherwise they have their own source
funding and their own interests. The cardiologists
of funding cardiologists very seldom talk
neurologists. This is not
to the neurologists. not out of any kind of dislike; they just
their own interests. PET has become something
have their something a little bit like a

56
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PRODUCING BRAIN

microscope, if you will. And the chemists also have their own inter­
ests. They spend their time making more and more complicated
inter-
complicated mole­
mole-
MIND
OF MIND
IMAGES OF
BRAIN IMAGES

cules and labeling them in specific

specific positions.
positions.
The ability of PET researchers to work work together
together is crucial, and yet
sharing credit is a continual
continual source of tension. BeingBeing the first author
author on
published prestigious. 1 For an experiment
published articles is the most prestigious.1 that tests a
experiment that
new scanner
scanner withwith a new radioligand
radioligand on patients
patients with ill-
with a psychiatric ill­
ness, for instance, the leading psychiatrist,
psychiatrist, chemist, and physicist often
will each present
present a paper at different disciplinary
disciplinary conferences and/or
and/or
publish
publish an article in different journals.
journals. However, this practice of multi­
multi-
plying first-authorship
first-authorship is not perfect, and credit remains a difficult issue,
especially as domains of responsibility shift.2
responsibility shift.1
Although
Although this necessary cooperation
cooperation may be a source of great concern
and frustration
frustration of PET researchers, it is ironically one of the reasons
why they like the field so much. “"II was bored doing organic chemistry,”chemistry,"
said one chemistry researcher, “With "With PET,
PET, you have to know so much
more about
about whatwhat is going on, it is exciting.”
exciting." Another
Another chemist concurred
concurred
and emphasized
emphasized the increased significance his discipline has within PET:
within PET:
“"PET
PET is probably
probably one of the few fieldsfields where chemists have sway over
the M .D.’s. If they don’t
M.D.'s. don't respect you, you don’t
don't give them isotope!”
isotope!" AsAs
we will see, the same increased significance is true
will.see, true for each specialist in
a PET experiment.
experiment. They all become vital to the success experi-
success of the experi­
ment. In other
other words,
words, each person is responsible
responsible to a whole consisting
of many experts who are each not just important important but critical to the final
production
production and interpretation
interpretation of data.
Despite this profound
profound interdisciplinary
interdisciplinary complexity, brain-imaging
data
data is presented
presented in a particularly
particularly simple and compelling manner:
manner: PET
images appear
appear to be discrete, readable,
readable, and colorful. Similarly,
Similarly, because
the process appears to produceproduce clean pictures
pictures of functional
functional brain activ­
activ-
ity, many simple diagrams of the PET process have been displayed as
shorthand
shorthand illustrations
illustrations of it. Figure 1.1 makes PET seem almost as sim­ sim-
ple and as automatic
automatic as taking a snapshot.
snapshot. This .leads
leads not only to enthu­
enthu-
siasm for brain imaging but to misplaced recruitment recruitment as well, as one
researcher
researcher explained:
It is kind of funny: I have had many people express an interest in
using PET,
PET, typically established
established scientists in many fields
fields who may be
on a downhill
downhill curve of their career. Very overtly they express that that
PET is such a high road
road to science that
that they’re
they're willing to get involved
now. They kind of held back before, but now they are willing to get
involved because it is obviously so easy!
easy! They lack an understanding
understanding
of what
what is entailed, I think,
think, because the data
data comes outout as pretty
pretty
pictures. You put up these slides that
that show the brain
brain turning
turning on and

l 57

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CHAPTER
CHAPTER 3

FIGURE procedure in progress

F ig u r e 3.1. PET procedure Johns Hopkins
progress at Johns University Medical
Hopkins University Medical
Center. A research
research doctor, assisted by two technicians
technicians in the room
room and another
another
one in the computer
computer room
room behind
behind shielded draws blood and monitors
shielded glass, draws monitors the
patient. (Marcus
patient. (Marcus 1995)

turning off. They just don't

turning don’t understand
understand the work
work that
that is involved in
making these experiments
experiments happen.
It is crucial, therefore,
therefore, to unpack
unpack the kind
kind of complexity
complexity required
required to
produce
produce and understand
understand PET images (Figure 3.1) as well as to under­ under-
stand
stand the social function
function and efficacy
efficacy of such simple diagrams.
The remainder
remainder of this chapter
chapter examines how the data data produced
produced in a
PET experiment
experiment is visualized as an image of a living brain slice, and
how
how those images are produced
produced in the lab, selected, and published
published to
make meaningful,
meaningful, factual claims about
about the world. My thesis is that
that the
visuality of these images, their
their apparent
apparent familiarity, and their transpar­
transpar-
ency with
with regard to the brain
regard to brain all contribute to the potency
contribute to potency of PET
claims. PET researchers acknowledged the difficulty of properly
researchers have acknowledged properly
producing
producing and understanding
understanding these images, and have warnedwarned that
that "we
“ we
must understand
understand our tools before we can hope to understand
understand our re­re-
sults” (Perlmutter and Raichle 1986). I am arguing
sults" (Perlmutter arguing that
that the processes of
producing, selecting, and presenting
producing, presenting images in bothboth scientific articles
and in public arenas require the same sort of understanding.
arenas require understanding.

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PRODUCING BRAIN
PRODUCING BRAIN IMAGES OF MIND
MIND

Creating
Creating Experiments:
Experiments: A Difficult Task

Creating
Creating experiments
experiments based on this work work demands
demands a tremendous
tremendous team
thing one realizes when
effort. The first thing when entering
entering a PET lab is thatthat the
scanner is only one piece of a large-scale technical system. Technical
scanner
descriptions
descriptions of the scanning process only begin to define the work work of
conducting an actual experiment,
conducting experiment, however;
however; they describe the stage and
not the play. Heuristically, we can break the whole process
players, but not
into four stages: design, measure,
measure, manipulate,
manipulate, and visualize.
1. Experiment
Experiment design: The first stage of the process involves choosing
participants
participants for the study and designing their their state and behavior in the
criteria for participant
scanner. Defining criteria participant inclusion
inclusion requires delimiting
the boundaries
boundaries of "normal
“normal human" purposes of the study. Is a
human” for purposes
chronic smoker or coffee drinker
chronic drinker normal
normal enough? How How about
about someone
who
who hadhad been found
found to have depression
depression 10-10, years ago and has taken
Prozac for 6 months
months -—or or someone whose brother brother is schizophrenic?
Likewise, if the study is comparing groups, the experimental
comparing two groups, experimental group
must also be characterized.
must characterized.
purpose of the scan is to detect brain function,
Because the purpose function, every part
part
of the person's
person’s state of mind and brain needs to be controlledcontrolled for. This
includes what
what each subject eats or drinks drinks beforehand,
beforehand, how rested or
anxious
anxious the subject is, and whatwhat exactly the subject does inside the scan­scan-
ner. The more precise the state can be defined and calibrated,
calibrated, the easier
compare results with
it will be to compare with those
those of other
other experiments.
experiments.
Measuring brain
2. Measuring brain activity: The second stage covers the scanning
process proper. The radioactive
process radioactive molecules must be prepared prepared and then
injected into the person. The scannerscanner must properly
properly collect the data,
then a computer
and then computer must algorithmically
algorithmically reconstruct
reconstruct the data into a
three-dimensional map of activity, based on assumptions
three-dimensional assumptions about
about the
scanner and brain
scanner brain activity. The result is a dataset
dataset keyed to the individ­
individ-
ual’s brain activity, a brainset.
ual's brainset,
Making data
3. Making data comparable:
comparable: In stage 3, the individual
individual brainsets are
transformed
transformed and normalized
normalized so that
that the individual’s brain
individual's brain locations can
correlated with
be correlated with those of others. With
others. With the use of MRI data
data and digital
brain atlases, anatomical
brain anatomical areas corresponding
corresponding to the brainset can be
Next, different
found. Next, different brainsets
brainsets can be combined
combined and checked for statis­
statis-
subtraction, averaging, and other
tical significance using subtraction, other forms of data
manipulation. The result
set manipulation. result is a collective group
group brainset.
Making comparable
4. Making comparable datadata presentable:
presentable: Finally, in stage 4, the brain­
brain-
are. used to substitute
sets are made visible. First, colors are. substitute for the numbers
dataset, and second, specific colored
in the dataset, colored brainsets
brainsets are selected toto be
·,
59
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1

CHAPTER 3
CHAPTER.

produced and
produced and published. Coloring involves transforming
published. Coloring transforming numeric varia-
varia­
tion into
tion into a contour map, highlighting
contour map, highlighting some differences at the expense of
others.
Turning
Turning then
then to the postproduction
postproduction events for images, particular
particular im­
im-
ages are selected for publication presented in journals.
publication and presented journals. At the heart
heart
of this process
process is a common,
common, standard,
standard, and often encouraged
encouraged practice of
extreme images. This is an acknowledged,
selecting extreme acknowledged, troubling practice,
troubling practice,
necessary for scientific work and yet increasingly problematic
work and problematic as these
images travel
travel outside
outside of expert
expert circles and into popular culture,
into popular culture, where
new, less-qualified labels are applied.
Each of the stages andand substeps within
within them
them is hotly
hotly debated,
debated, and
along the way therethere are many
many assumptions
assumptions about human anatomy,
about human
human physiology, and human
human human nature.
nature. As discussed above, however,
rather than
rather than exploding
exploding the
the coherence of the PET experiment,
experiment, each as- as­
sumption
sumption can become the grounds
grounds for a different
different discipline's
discipline’s article. The
complexity
complexity and theory-ladenness of the PET experiment
and theory-ladenness experiment is thus
thus incredi­
incredi-
productive of scientific results.
bly productive

STAGE
STAGE l:
1: EXPERIMENTAL DESIGN
EXPERIMENTAL DESIGN

Subject Selection and Injection

Subject

A senior PET researcher described subject selection:

researcher described
Collaboration
Collaboration is fine. Share data,
data, collaborate,
collaborate, talk about it, work
talk about work it
out. But just having
having it in a base where
where somebody
somebody can pull it out, I
think,
think, creates a lot of chaos. One of the difficulties is [that] too many
people have access to the databases
databases and can make changes that that you
would never know
would about. So when
know about. when I go for normal controls, I go to
normal controls,
our normal
normal control
control database,
database, but
but I have to be very careful going
through it. Just because they are labeled normal
through normal controls doesn’t
controls doesn't
mean they are. I tend
mean tend to use normal controls that
normal controls that I have generated
generated
myself in my own
own studies. I don’t
don't take generated in other
take the ones generated
people’s
people's studies in the
the same group,
group, because I don’t
don't really know
know what
what
they did. But I don’t think that
don't think that that
that is a major
major impediment
impediment to the
science.
Choosing scanned for a study
Choosing people to be scanned study can be one of the most
difficult procedures.
procedures. In extreme
extreme cases, such as finding schizophrenics
schizophrenics
who are drug-naive
drug-naive (who have never taken
taken medication
medication or illegal drugs),
the work
work of actually locating
locating and validating
validating proper
proper subjects can consti­
consti-
tute grounds
tute grounds for claiming first authorship
authorship on the published
published article! The
problem,
problem, as I have come to understand
understand it, involves group
group and
and individual
individual
definition of variability
definition variability and constraint:
constraint: To what
what extent
extent is an individual
individual

60
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representative of a group,
representative
terized? These problems
terized?
and to what
group, and what extent
problems are exacerbated
PRODUCING BRAIN
PRODUCING

extent is the
the group
exacerbated or exaggerated
IMAGES OF
BRAIN IMAGES OF MIND
MIND

group well-charac-
well-charac­
exaggerated because PET
often
often involves very small study
study sizes (four to twenty
twenty subjects) because of
cost, radioactivity,
radioactivity, and
and time constraints,
constraints, and
and because PET often often pro-
pro­
information for which
vides information which there
there is no independent
independent verification.
verification. This
means that
means often the
that often only way
the only way to corroborate findings of PET study
corroborate the findings study
is with
with another
another PET study. There
There is no easy end possible confounding
end to possible confounding
variables.
variables.
there was no other
Because there way to verify the
other way the data
data that
that PET produces,
produces,
one of the first tasks
tasks of PET researchers
researchers was toto characterize normals
characterize normals
(Mazziotta
(Mazziotta andand et al. 1981; Mazziotta
Mazziotta and 1985; Raichle
and Phelps 1985; Raichle 1994a).
1994a).
Only then
Only then could non-normals be compared.
could non-normals compared. However,
However^ creating
creating a base-
base­
line definition
definition of normals
normals is both
both a physiological and a social judgment.
physiological and judgment.
The following
following description provides a list of the
description provides the tests used to characterize
characterize
persons as normals
persons normals in one study:
The
The normal
normal population consisted of 20 males
population consisted males aged 19-59
19-59 years.
Inclusion the study
Inclusion in the study was determined
determined by the the absence
absence of medical,
medical, neu­
neu-
rological,
rological, and psychological pathology.
and psychological pathology. Medical
Medical reasons exclusion
reasons for exclusion
were
were a history
history of severe head head trauma,
trauma, chronic hypertension, signifi­
chronic hypertension, signifi-
cant
cant vascular
vascular disorders,
disorders, diabetes
diabetes mellitus, thyroid abnormalities,
mellitus, thyroid abnormalities, andand
a history
history of psychiatric
psychiatric illness. Gross psychopathology
psychopathology was identified
identified
with the Structured
with the Structured Clinical
Clinical Interview
Interview (SCI), an inventory
inventory of 17 yes-
or-no
or-no items filled outout by thethe examiner during a 20- to 30-min.
examiner during 30-min. inter­
inter-
view. The SCI can also be scored scored for 13 overlapping
overlapping scales: anger,
hostility, conceptual dysfunction,
hostility, conceptual dysfunction, fear, worry,
worry, incongruous
incongruous behavior,
incongruous
incongruous ideation,
ideation, lethargy, dejection, perceptual dysfunction,
dejection, perceptual dysfunction,
physical
physical complaints,
complaints, self-depreciation,
self-depreciation, and and sexual
sexual problems.
problems. Any
score significantly beyond the
significantly beyond norms on any SCI component
the norms component automat-
automat­
ically excluded
excluded the candidate. Neurological
the candidate. Neurological and neurophysiological
and neurophysiological
screening included
screening included medical
medical history
history and testing for intelligence
and testing (WAIS
intelligence (WAIS
[Wechsler Adult Intelligence Scale]), anterograde
Adult Intelligence anterograde memory
memory [Randt-
[Randt-
NYU Memory
Memory Test (Randt (Randt 1980)], perceptual-motor function
1980)], perceptual-motor function and
and
structure (Bender Visual-Motor
structure Visual-Motor Gestalt and handedness
Gestalt Test), and handedness [Edin­
[Edin-
burgh Handedness
burgh Handedness Inventory
Inventory (Oldfield
(Oldfield 1971)].
1971)]. Subjects also under­
under-
went a comprehensive
went comprehensive laboratory
laboratory work-up,
work-up, a brief brief neurological
neurological
screening examination,
screening examination, CT (to provide provide scans which
which could
could be corre­
corre-
lated with
lated with PETT), computerized
computerized EEG [electroencephalography],
[electroencephalography], and
testing of visual and
testing and auditory
auditory evoked potentials (John et al. 1977).
evoked potentials
(Brodie et al. 1983,
1983, p. 201)
The tremendous
The tremendous amount
amount of work
work put into finding
put into finding such “"normal"
normal” sub­
sub-
jects was done
done with
with the intent of avoiding
the intent avoiding "noise"
“noise” in the resulting data.
resulting data:.
Georges Canguilhem's
Georges book The Normal
Canguilhem’s book Normal and the Pathological
Pathological traces

61
61
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1

CHAPTER 3

the history
history of the terms normal, abnormal, pathological,
normal, abnormal, pathological, and anoma-
anoma­
through various sciences and medicines. Canguilhem
lous through Canguilhem noted
noted that
that
normal has been a polyvalent
normal polyvalent term
term that
that in
in different
different texts meant
meant "typ-
“typ­
healthy” ·(what
ically healthy" (what the patient
patient desires to be), “"quantitatively
quantitatively aver­
aver-
age,” “not
age," anomalous,” or "ideal"
"not anomalous," “ideal” (in the sense of being not not at all
pathological or unhealthy)
pathological unhealthy) (Canguilhem
(Canguilhem 1978). Medical characteriza-
characteriza­
tions of diseases are historically
historically defined from a therapeutic
therapeutic perspective;
one is diseased if one is not healthy and seeks therapeutic
not typically healthy therapeutic care.
with brain
Initial studies with brain images are based on selections of "ideal"
“ ideal” sub-
sub­
jects, or "supernormals"
“ supernormals” who have no probable
probable pathology.
Normal age-matched
Normal controls have ·been
age-matched controls been studied in conjunction
conjunction
with this project. Healthy
with Healthy controls
controls best consist of persons
persons selected to
‘super­
minimize the possibility of covert pathology. These so-called 'super-
normals’ are individuals who have been observed to be symptom-free
normals'
ii
j: number of years, have no personal
for a number personal or family history
history of psychi-
psychi­
disorders, and are not
atric disorders, not users of substances known
known to influence
mood. (Phelps and Mazziotta
mood. Mazziotta 1985, p. 459)
The complexity project is part
complexity of the project of the difficulty of mental-illne~s
part ofthe mental-illness
research psychological research
research and psychological research in general. Directly measuring
measuring the
brain adds an additional
brain additional factor. Possible confounders
confounders remain: Are men
sufficiently different from women
women to study separately, or are they suffi­ suffi-
ciently similar to women
women so that that they can be averaged together?
together?33
Such
characteristics as age, ethnicity, handedness,
characteristics handedness, culture
culture (refugee status),
sexuality, familial histories, past
past head trauma,
trauma, and medical history are
all still unknown confounders raised as questions in meetings during
unknown confounders during
presentation
presentation of results.
PET brain
brain studies almost always use right-handed
right-handed male subjects, un­ un-
less gender is specifically being studied
studied or a disease is being studied that that
is significantly more prevalent
prevalent in females than than in males. Although
Although the
reasons for this exclusion — cleaner data because of the lack of possible
-cleaner
interference from gender or handedness
interference handedness differences
differences-—“may
"may be viewed as
practical from a financial standpoint,
practical standpoint, it results in ..... . a lack of informa-
informa­
about the etiology of some diseases in women"
tion about women” (Rosser 19941994).4).4 By
choosing only men for these studies, the researchers implicitly assume
choosing
that gender matters.
that matters. But by treating
treating the results of the experiments
experiments as
normal humans
applicable to normal humans in general, they they risk the consequence
consequence thatthat
a gender difference may appear
appear as an abnormality.
For large-scale studies of schizophrenia,
schizophrenia, withwith over fifty people being
studied, race is often recorded, though
often recorded, though not
not consistently. In PET studies
where
where the extreme expense of the procedureprocedure and the time involved re- re­
sults in very small samples, typically between
between four and twenty, race has
almost never been mentioned.
almost mentioned. Analogous to the circumstances
circumstances for gen-gen­

62
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I PRODUCING BRAIN IMAGES

PRODUCING BRAIN MIND
Of MIND
IMAGES OF

der, the assumption

assumption is that that there probably
probably are significant population
population
differences in brain
brain chemistry and: and anatomy
anatomy between different races. To
eliminate this potentially
potentially confounding
confounding variable,
variable, however, race is often
excluded from the sample altogether
altogether by using only whites. Financially,
for the experimenters,
experimenters, this is the only course of action that that makes sense.5
Even once these lifelong or trait characteristics
characteristics are accounted
accounted for,for,
temporary
temporary or state characteristics
characteristics remain. For some studies, normals normals are
only those who have not had caffeine that day.6 Use of nicotine, vita­
that day.6 vita-
mins, or other
other drugs must also be monitored.
monitored. Debates go on about about
proper
proper cooling-off
cooling-off periods for drugs and medication.
medication. Also, questions
remain
remain as to the value of “"normalnormal databases”
databases" based on such exclusion­
exclusion-
ary definitions of normal.
normal.
Because
Because there are so so many different definitions of normal, normal, of who
could be included as a normal normal control,
control, and how explicitly their attrib­attrib-
utes should be noted,
noted, attempts
attempts to standardize
standardize a database
database have so far
failed (see
(see Beaulieu 2000 for more).
At the 1995 meeting of the Society of Nuclear Nuclear Medicine,
Medicine, a new con-
founder
founder was introduced:
introduced: One lab reported
reported that
that the time of of day during
which
which the scan took took place significantly and regionally
regionally affected PET re­ re-
sults (Diehl and Mintun
Mintun 1995). This means that that a scan taken per-
taken of a per­
son in the morning,
morning, when
when compared
compared withwith a scan of the same person
taken
taken under
under the same conditions
conditions but in the afternoon,
afternoon; might show a
difference in certain areas of the brain and not
the.brain not others. The authors sug-
authors sug­
gested that
that time-of-day differences might account account for specific
specific differences
among labs. Certainly, this finding adds to the difficulty of replicating
PET findings.
Yet, because the assumption
assumption behind
behind this decision to exclude popula­popula-
tion
tion differences is that
that these differences probably production
probably matter, the production
of generically unmarked
unmarked images with with labels such as normal
normal and schizo­
schizo-
phrenic {rather
(rather than,
than, e.g., white
white U.S.
U.S. right-handed
right-handed male schizophrenics)
means that
that we should assume that that nonwhites
nonwhites will probably
probably notnot look
normal.7
normal.7 When
When we combine this analysis with with the practice of choosing
“extreme”
"extreme" images for publication
publication (where normal
normal is chosen because it is
farthest
farthest away from that
that particular
particular group of subjects with
with schizo­
schizo-
phrenia),
phrenia), we can see yet anotheranother reason why the nonsampled
nonsampled nonwhite
nonwhite
could more easily be found to be not not normal.
(Types ooff Scans and Confounders)
Task Design (Types

Once the subjects have been selected, they must be injected withwith the
radioisotope.
radioisotope. What
What the subjects do or think,
think, once injected, makes task-
selection fundamental
fundamental to the PET data produced,
produced, even when
when the task is
not
not the object of the study. This is one area where PET is completely
I different from CT or MRI, which image structure.
structure. Structure
Structure does not
I
I' 63
63

l
CHAPTER
CHAPTER 3

from moment
change from moment to moment.
moment. PET scanning
scanning maps rates of flows of
molecules in the brain brain over a relatively small periodperiod of time. Conse­
Conse-
correctly characterizing
quently, correctly characterizing and
and understanding
understanding a person’s
person's behavior
behavior,
mood, and cognitive activity is essential to understanding
mood, understanding the meaningmeaning
the flows.
of the
Once injected withwith the radiotracer,
radiotracer, the patient
patient is now
now “"on on display.”
display."
His or her body is emitting
emitting radioactivity.
radioactivity. During
During this time, especially for
brain studies, what
brain patient does
what the patient —moving, thinking,
does-moving, thinking, hearing
hearing-—bears
greatly on the final PET scan data.
greatly data. For instance, one classic study
compared seeing
compared seeing words
words versus hearing
hearing words.
words. During
During the seeing-words
task, subjects watched
task, watched video screens where words words were flashed up.
During the hearing-words
During hearing-words study, subjects listened to differentdifferent words.
words.
proved to be sensitive to different
PET has proved different cognitive activities, and
discovering the
discovering the regional
regional differences in brain activity during during these
often the aim of these studies.
activities is often
the aim of the
Even if the the study is to characterize
characterize disease states, however
however,
the behavior
behavior of the subjects still must be controlled
controlled for.
for. “"Resting"
Resting” turns
turns
out
out to be a complicated
complicated task (Mazziotta
(Mazziotta et al. 1981). Should one rest
with eyes closed or open? With
with With ears blocked, in silence, or listening
to music? Does havinghaving an injection
injection in one arm focus attention
attention there?
Anxiety has been studied,
Anxiety studied, for instance,
instance, in part
part because the PET scan
procedure itself might cause anxiety
procedure anxiety (e.g., at being motionless
motionless in a
scanner for 30 minutes
scanner minutes or being injected with with a radioactive
radioactive substance)
(Reiman 1988; Reiman
(Reiman Reiman et al. 1989; Wu et al. 1991). Anxiety levels are
measured before and
usually measured and after
after studies. With
With PET,
PET, in other
other words,
words,
performing a task
one is always performing task88
(Figure 3.2). Baseline states are all
confounding
confounding variables
variables to consider
consider in designing a task to be studied.
Depending on the half-life of the tracer used, the subject
Depending subject will carry
out the task either before getting
out getting into the scanner
scanner or while strapped
strapped
With FDG, for example,
inside. With example, the critical uptake
uptake time is the first 40
minutes after injection. During
minutes During this time, the brain
brain traps
traps almost
almost all of
radiotracer in different
the radiotracer different cells and keeps it there,there, emitting
emitting radio­
radio-
about another
activity, for about another hour. After the 40 minutes,
minutes, the subject is
scanner and a picture
placed in the scanner picture of the trapped,
trapped, still-radioactive
still-radioactive
analog is taken.
glucose analog taken. With
With oxygen, which has a 2-minute2-minute half-life,
the subject
the subject must
must already
already be in the scanner
scanner when
when injected. Scans are
performed during the first 2 to 5 minutes,
performed during minutes, while the subject is perform­
perform-
ing the task.
task.
Task design is itself one of the most active areas of studies. Studies
cognitive task comparisons
include cognitive comparisons (looking at words),
words), states compar­
compar-
anxiety or sadness, or cued-state
isons (such as anxiety cued-state studies such as showing
addicts a video of drug use), resting trait
cocaine addicts trait comparisons
comparisons (patients
with Huntington's
with Huntington’s disease vs. those those without
without it), task-trait
task-trait comparisons
comparisons

64
 PRODUCING BRAIN IMAGES
PRODUCING BRAIN MIND
OF MIND
IMAGES OF

Apprehensive versus relaxed.

F ig u r e 3.2.
FIGURE Apprehensive relaxed. Original caption reads: “"Matching
Original caption Matching
cerebral glucose metabolism
cerebral metabolism (µ,moV100
{junol/lOO g per minute)
minute) PET images of a healthy,
71-year-old man
71-year-old man in apprehensive
apprehensive versus relaxed resting state, eyes closed, ears
relaxed resting
unoccluded.” (Pawlik and Heiss 1989)
unoccluded."

(patients with
(patients with schizophrenia
schizophrenia who
who are hallucinating rest9), neu-
hallucinating versus at rest5),
r©transmitter binding
rotransmitter binding studies (dopamine,
(dopamine, serotonin,
serotonin, etc.), and challenge
drug is given and the
studies (where a drug the brain’s
brain's reaction studied).
to it is studied).
reaction Jo
problem in designing
The key problem designing a particular
particular study
study of any one of these
types (table 3.1) is finding a way to keep the other interfer-
other types from interfer­
ing.10
ing.10
Most PET tasks
Most tasks are in thethe tradition
tradition of cognitive psychology or
cognitive psychology

65
 CHAPTER 3
CHAPTER

Table 3.1
Table 3.1
Dimensions of Scanning Experiments
Dimensions Experiments
Indiv1dual Group property
Individual activity or Group property
Variability in activity or Shared properties
Variability properties
Current
Current state of person
person or Long-term
Long-term trait
trait
“"Normal" Condition (disease or life stage)
N orm al” activity or Condition
Acute Condition Nonacute Condition
Condition or Nonacute Condition
Condition at rest or Challenged
Condition Challenged by task or drug
Duration ooff scan (2
(2-30
-3 0 minutes)

cognitive neuroscience
cogmt1ve neuroscience (see Plates 5 and 6). The assumption
assumption in these
tasks is that
that complex
complex mental functions are the aggregation
mental functions aggregation of simpler
component operations.
component operations. In designing a PET experiment,
experiment, then, “ the con-
then, "the con­
trol state and
trol and the stimulated
stimulated state are carefully chosen
chosen to isolate, as far
as possible, a single mental
mental operation” 1990).1111 Articles often
operation" (Raichle 1990).
begin with
with this assumption
assumption of discrete modules
modules or components,
components, each
responsible for a different
responsible different type of cognitive activity. For instance:

Since the brain

brain consists of large numbers interconnected sub-
numbers of interconnected sub­
structures, damage to one structure
structures, structure or its interconnecting
interconnecting fiber bun­bun-
dles will also result
result in functional
functional effects at multiple
multiple sites throughout
throughout
any given network.
network. PET has revealed this distributed
distributed organization,
organization,
leading to a more comprehensive
comprehensive view of human functional brain
human functional brain sys­
sys-
12
tems in health
health and
and disease. (Phelps and Mazziotta
Mazziotta 1985)
1985)1 1

For cognitive neuroscientists,

neuroscientists, used to large sample sizes, PET added added a
new challenge: how to controlcontrol for as manymany dimensions variability as
dimensions of variability
possible, A simple-sounding
possible. simple-sounding task like recognizing words words might
might reveal a
host of confounding
host confounding variables,
variables, each correlating with a different
correlating with different set of
-j!
brain regions: the size of the displayed
brain displayed words
words (how much of the visual
field is consumed
consumed in the recognition
recognition process), the brightness
brightness of the word,
word,
::iii: the rate of presentation
presentation (which in iii fact turned
turned out to produce
produce very differ­
differ-
"'I·
:1
.,, ent brain activations), the language of the word
brain activations), more ideographic
word (is a more ideographic
· I
'i,' language
language like Chinese processed
processed differently from English?),1
English?), 13
3 educa­
educa-
tional level, effects on attention,
attention, novelty and learning.
learning. (Are there
there effects
i iJ from simply having to repeat repeat a very simple task task over and over that that are
I,
ii different from purposeful
different purposeful recognition
recognition of words? Is proofreading
proofreading a dif­ dif-
ferent activity from reading?)—these
ferent reading?)-these are in addition addition to designing the
series of tasks so thatthat a particularly
particularly desired component
component of language is
isolated. If
being isolated. I f the underlying
underlying presumption
presumption of modularity
modularity is correct
correct
and the task
task correctly
correctly isolates the component
component simple mental operation,
mental operation,
then "from
then “ from such data
data emerges a map of the distributed
distributed modular
modular organi-
organi­

66
 PRODUCING BRAIN
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IMAGES OF
OF MIND
MIND

zation of the brain

zation brain underlying
underlying normal
normal human
human cognition
cognition and emotion”
emotion"
(Raichle 1990).
There are debates
There debates in psychology
psychology over whether
whether the modularity
modularity hypoth­
hypoth-
tested with
esis itself can be tested with PET at all, or whether
whether it must
must just be
assumed.14 Philosopher
assumed.14 Philosopher Jerry Fodor
Fodor summarized
summarized one of the issues as a
resources and the value of different
very serious struggle over limited resources
questioning:
lines of questioning:
quite see why anyone
I quite anyone whowho cares how how the mind
mind works
works might rea­ rea-
sonably care about
sonably about the argument
argument between
between empiricism
empiricism and rational­
rational-
and why anyone
ism; and anyone who
who cares aboutabout the argument
argument between
between empiri­
empiri-
rationalism might
cism and rationalism might reasonably
reasonably care whether
whether different
different areas of
brain differ in the mental
the brain mental functions
functions they
they perform,
perform ..... . . But given
that it matters
that matters to both
both sides whether,
whether, by and large, mental
mental functions
functions
characteristic places in the brain,
have characteristic brain, why should
should it matter
matter to either
where the places are? ...
side where . . . what
what is the question
question about
about the mind- mind-
brain relation
brain relation in general, or about
about language
language in particular,
particular, thatthat turns
turns
where the brain's
on where brain’s linguistic capacities
capacities are? And if, as I suspect,
none does, why are we spending
none spending so much much time and money trying to
find them? (Fodor 1999)
(Fodor 1999)15 15
·

Another form of dispute

Another dispute concerns
concerns the
the significance of individual
individual vari­
vari-
researcher Richard
ability. PET researcher Richard Haier
Haier calls himself an “individual
"individual differ­
differ-
psychologist,” which
ences psychologist," which means he is interested
interested specifically in tasks
which
for which people differ in their performance.1166 If this is the case, then
their performance. then he
correlation between
can look for a correlation between performance
performance and some _brain brain mea­
mea-
comparing his work
sure. He begins by comparing work to cognitive psychology.
HAIER: know what
H a ie r : You know what cognitive psychologists
psychologists do? They ask you to
button when
press a button when you see an M or an N. Either it is presented
presented in
this visual field or thatthat visual field. They use very simple stimuli to
complex processes. The idea of using something
get at complex something like Raven’s
Raven's
Advanced Matrices
Advanced Matrices1 7 is just outrageous.
17
outrageous. Even the idea of individual
individual
psychology is not
differences in cognitive psychology not a very big idea. Cognitive
psychologists almost
psychologists almost by definition
definition are not
not interested
interested in individual
individual
differences.
interested in how
DumiT: They are interested
DuMIT: how people share certain
certain characteristics.
characteristics.
HAIER: That is right.
H a ie r : That right. So the variance
variance in people’s
people's reaction
reaction times is
regarded as error
regarded error variance
variance by cognitive
cognitive psychologists.
psychologists. They want
want a
task that
task that minimizes that.that. They don't
don’t want
want a task that
that has a wide
range of performance,
range performance, they want want everyone to do about
about the same, so
they can discover "the" “the” process. We took took a completely
completely different
point of view.
point view. It is not
not that
that our point
point of view is better
better or worse —it
- it
different starting
is just a different starting point.
point. This is common
common in psychology.

67
 CHAPTER
CHAPTER 3

Haier another dimension

Haier is describing yet another function. In this
dimension of brain function.
“ individual differences”
"individual dimension, humans
differences" dimension, humans vary in their performances
performances
on tasks and in their
their brain
brain activation
activation during performances.
performances. Video game
experiments,
experiments, for instance,
instance, use a task that
that people got better at. Most
PET studies in the last twenty
twenty years have minimized this dimension,
concentrating on tasks presumed
concentrating presumed to be relatively similar in performance
performance
brain activity across humans
and brain humans and in time.
In sum, during
during the design stage, the basic terms of humanhuman nature
nature are
already built into the experiment.
experiment. Subject selection defines a concept
concept of
the normal human being in the form of an ideal (super)normal.
normal human Abnor­
(super)normal. Abnor-
categories, such as mental
mal categories, mental illness, are likewise normed
normed as ideals.
This process takes types of humans
humans (or the generalized human
human as a type)
as given, not
not to be discovered through experiment but only to be
through the experiment
correlated with
correlated with brain
brain activity. Similarly,
Similarly, task design must assume that that
the specific
specific task behaviors correspond to discrete mental
behaviors correspond “ functions.” It
mental "functions."
might be suspected that that if results are found indicating that
found indicating that different
brain activity is correlated
brain correlated with each task or group,
group, this verifies
verifies the
human or task typology. This assumes, however, that
human that the contrary
contrary- —
finding no significant difference -—would would be meaningful.
meaningful. Instead, the
finding of no significance is interpreted
interpreted as a need for better
better equipment.
Psychiatrist and neuroscientist
Psychiatrist Nancy Andreasen
neuroscientist Nancy Andreasen stated this very clearly
in a 1997 review of the field:
field:
There are, at present,
present, no known
known biological diagnostic
diagnostic markers
markers for
any mental
mental illnesses except dementias such as Alzheimer’s
Alzheimer's disease.
to-be-discovered lesions that
The to-be-discovered remainder of mental ill-
that define the remainder ill­
nesses are likely to be occurring complex or small-scale levels
occurring at complex that
levels that
are difficult to
to visualize and measure”
measure" (Andreasen 1997, pp. 1586-
1586-
1587).

STAGE
STAGE 2:
2: MEASURING BRAINACTIVITY,
MEASURING BRAIN ACTIVITY, FROM
FROM TRACER-MOLECULE
TRACER-MOLECULE TO
TO
CONCEPTUAL DATASET
CONCEPTUAL DATASET

D u m it: I am interested
DuMIT: interested in howhow you read images. There is a lot of
literature
literature on how how radiologists
radiologists read X-rays, but there isn't isn’t that
that
much
much on what what it means to read a PET scan. Just because it is a
functional
functional image, you seem to have to to know
know a lot more about
about how
this particular
particular image was done to look at it.
TER-POGOSSIAN: think in many instances-not
T e r -P o g o ssia n : I think instances —not in all instances, but
in many instances -—it it is very fundamentally wrong to try and read
fundamentally wrong
a PET image the way you read a radiologicalradiological image, because of the
fact that
that if you read a PET image that that way, well, instinctively you
know
know thatthat what
what you are looking
looking at is not morphology
morphology but, as you

68

1 i .I
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MIND

function. But sometimes, if you are an individual

said, a function. who is
individual who
acquainted with
acquainted with x-ray pictures, you tend
tend to think
think in terms of mor­
mor-
phology, and that
that is a profound
profound mistake
mistake if you do that. hot area
that. A hot
may represent
represent living tissue; on the other
other hand,
hand, it may represent
represent
dead tissue just as well. The sooner
sooner you get away from the mor­ mor-
phology
phology concept, the better off you will be. You do have to relate
your images to morphology;
morphology; you have to to know
know which
which organ you
are in and which portion
portion of the organ
organ you are in. But beyond that that
. . . this is one of the reasons why there
... there has been a divergence
between radiologists internists in nuclear
radiologists and internists nuclear medicine. Radiolo­
Radiolo-
gists are very,
very, very morphologically
morphologically inclined. Internists
Internists are much
more physiologically inclined, biochemically inclined. An internist
internist
knows the biochemistry.
knows

A PET image, in so many ways, is not not like any other

other image. Not
Not only
is the physiological,
physiological, functional
functional nature
nature of the underlying
underlying data
data a problem
problem
conceptually
conceptually for most of us, both both doctors
doctors and laypersons
laypersons but,
but, also, the
quantitative dataset itself is dynamic and always imperfectly represented
quantitative dataset represented
visually. The layers of construction
visually. construction making
making up the image can literally
“"make
make it up.”
up."
The PET scanner itself is only one of the many technologies
technologies needed to to
gather and process the data. First, the radioactive
gather radioactive substance has to be
made. PET scanning relies on a specificspecific type of radioactivity, positron
radioactivity, positron
emission, which
which is produced
produced by a limited set of isotopes. positron
isotopes. These positron
emitters,
emitters, however, include carbon-12, oxygen-15, nitrogen-13,
carbon-12, oxygen-15, nitrogen-13, and fluo-
fluo­
rine-18. Carbon,
Carbon, oxygen, nitrogen,
nitrogen, and hydrogen
hydrogen are the basic building-
block atoms of life. Because fluorine can substitute
substitute for hydrogen
hydrogen atoms
in molecules, almost any molecule of significance for studying the brain
can be made radioactive
radioactive and its activity can be tracked
tracked in a PET scan-
scan­
ner. Crucially, these positron
positron emitters have relatively shortshort half-lives,
meaning that
meaning that they do not not stay radioactive
radioactive in the body too long (unlike
carbon-14,
carbon-14, which
which lasts for centuries). Table 3.2 lists the most common
positron emitters.1
positron emitters. 18s

Table3.2
Table 3.2
Half-Lives of Positron
Positron Emitters
Radionuclide
Radionuclide Halflif£
Half-life (minutes)
Carbon-11
Carbon-11 20.4
Nitrogen-13
Nitrogen-13 10.0
Oxygen-15 2.1
Fluorine-18
Fluorine-18 110.0

69

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 1111,

,I CHAPTER 3
CHAPTER

FIGURE
F cylcotron. (From Techniuzl
ig u r e 3.3. CTI cylcotron. Introduction.- EC
Technical Introduction: ECAT
A T Scanners;
Scanners; re-
re­
produced permission of Siemens Medical
produced by permission Medical Solutions
Solutions USA, Inc.)

The short
short half-life of these isotopes is a drawback,
drawback, though.
though. It means
that the isotopes must be produced
that produced on-site or very nearby. They also
need to be produced
produced in a cyclotron,
cyclotron, which accelerates protons
protons fast
enough
enough to cause target
target atoms to lose electrons and become radioactive
radioactive
isotopes (figure 3.3). Cyclotrons
Cyclotrons are fairly large, requiring
requiring a medium-
size room
room shielded for radiation;
radiation; are quite expensive (about
(about $1million
$1 million
to $2 million); and require expert technical
require expert technical assistance to run.1
run. 199 The ne­
ne-
cessity of a cyclotron
cyclotron is one of the factors thatthat limit more widespread
widespread
scanning. 200
PET scanning.2
Once the isotope is produced,
produced, it is still not ready to be used. Because
Because
a PET scanner
scanner can theoretically
theoretically trace
trace any life molecule, a crucial de­ de-
cision in all PET experiments
experiments is which molecule to track. Nuclear
track. Nuclear
chemists working
working in “hot chemistry” labs can replace atoms of regular
"hot chemistry"
radioisotopes, creating
molecules with radioisotopes, radiolabeled molecules. These ra­
creating radiolabeled ra-
diotracers
diotracers behave exactly as their nonradioactive do. 211 The idea
nonradioactive siblings do.2
of labeling with
with radioisotopes
radioisotopes goes back to Georg von Hevesy, who
won a Nobel
Nobel prize in 1934 for discovering the tracer tracer principle. Henry
Henry
Wagner Jr. described it to me this way:
Do you know
know how the tracer principal
principal was invented? Hevesy worked
worked
for [Ernest] Rutherford
Rutherford as a Ph.D. student,
student, and he was given the proj­
proj-
I ect of separating
separating radioactive
radioactive lead from stable lead. That
That was his
! I

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 PRODUCING BRAIN
PRODUCING BRAIN IMAGES
IMAGES OF MIND
MIND

thesis, to separate those two. But he found

found that
that no matter what he
matter what
tried, physical or chemical, he couldn’t
tried, couldn't separate
separate them. So instead
instead of
this being a total failure, he said, “This
"This will be a tracer
tracer of lead.”
lead."
Because it has exactly the same physical and chemical properties,
properties, it is
separate them.
impossible to separate

part of the lore of nuclear

This story, ·part nuclear medicine, is often repeated
repeated in
books and in talks.2
talks. 222 Combining
Combining the elements of a detective story with with
creative scientific insight, the tale functionsfunctions as a symbolic reference for
the nuclear medicine community's
community’s purpose.purpose.
The actual preparation of the radiotracer
actual preparation radiotracer involves makingmaking sure of its
purity, chemically combining
combining it with with other
other molecules to produce
produce the ra­ra-
target molecule, and packaging
dioactive target packaging it to be used. In the case of
standard molecul~s
standard molecules such as water water and glucose, this process has been
automated (called a black box) and is often a part
automated part of the cyclotron
(figure 3.4).
Theoretically, the tracer
tracer principle molecule —oxygen gas,
principle allows any molecule-oxygen
carbon
carbon dioxide, glucose, and drugs such as Prozac and cocaine — - to be
through physiological
labeled and its activity through physiological and chemical transforma­
transforma-
followed. 233 As Phelps explained
tions to be followed.2 explained in the introduction,
introduction, a radio­
radio-
tracer is an ideal participant
tracer participant observer because it behaves exactly like its
nonradioactive counterpart.
nonradioactive counterpart. A more precise analog analog of the radiotracer
radiotracer is
a surveillance bug that that transmits
transmits the position and/or conversations
position and/or conversations of
the person
person being bugged.
Because the tracer is what what is emitting
emitting the radioactivity,
radioactivity, an image of
“"brain
brain activity"
activity” is really an image of glucose consumption,
consumption, oxygen flow,flow,
Prozac flow, and so on. Debates over tracer concerned with
tracer choice are concerned
the ability of different tracers to stand stand in for and represent
represent neuronal
neuronal or
brain activity. There
brain There are cases, for example,example, in which' glucose consump­
consump-
tion and oxygen flow “"decouple,"
tion decouple,” meaning
meaning that that they do not behave the
during the same task,
same during task, posing a problemproblem for comparing
comparing results of
“"brain
brain activation"
activation” across different tracers. tracers. The concept
concept of "brain
“ brain acti­
acti-
vation” is thus
vation" thus a problem
problem of "chemical
“ chemical resolution"
resolution” in which the activity
of a single type of molecule is substituted
substituted for the brainbrain processes.
production of the radiotracer
The production radiotrac.:er has to be coordinated temporally
coordinated temporally
with the preparation
and spatially with preparation of the subject to be scanned and the
scanner. In the case of fluorine-18,
fluorine-18, the subject must must be ready for injec-
injec­
tion and testing; in the case of oxygen or carbon, carbon, the subject must be
radiotracer, once injected, flows'through
already in the scanner. The radiotracer, flows'through the
regular molecule, but it emits radioactivity
body just like the regular radioactivity in the form
positrons. Positrons
of positrons. Positrons are positively charged electrons electrons that
that travel quite
randomly 1 to 7 millimeters
randomly millimeters2 4 before colliding with
24
with an electron, resulting
in the annihilation
annihilation of bothboth and the emission of two gamma rays shoot-

71
71

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CHAPTER 3

FIGURE
F ig u r e 3.4
3 .4 Automated
Automated isotope
isotope production.
production. “"Fluorodeoxyglucose
Fluorodeoxyglucose (FDG) syn­ syn-
module from CTI, Inc. This particular
thesis module particular device uses the radioisotope
radioisotope Flour-
ine18 (18-F) produced
produced by the cyclotron through various
cyclotron and through various chemical
chemical reactions,
reactions,
produces
produces sterile, chemically
chemically pure
pure FDG. Several chemical reactions
reactions occur, and the
takes about
typical synthesis takes about one hour
hour from the delivery of the 18-F.”
18-F." (From
Technical Introduction: ECATECA T Scanners;
Scanners; reproduced
reproduced by permission
permission of Siemens
Medical
M edical Solutions
Solutions USA, Inc.)

almost 180 degrees apart.

ing off almost apart. Millions of positrons
positrons are released
minute, and each release results in two gamma rays (figure
every minute, (figure 3.5).
scanner itself looks like a large metal doughnut
The PET scanner doughnut standing
standing up,
with a table running
with running through
through the middle of it and wires trailing
trailing off the
bottom. The early PETT III scanner
bottom. scanner had its guts visible (see
(see figure 3.6).
procedure involves radioactivity,
Because the procedure radioactivity, the scanner room
room also
must be shielded. The subject lies down
must down on the table, and his or her her

72
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BRAIN IMAGES
PRODUCING BRAIN
PRODUCING MIND
OF MIND
IMAGES OF

Annihilation Coincidence circuit

F ig u r e 3.5. Coincidence
FIGURE Coincidence detection.
detection. (Posner and Raichle
Raichle 1994)

head is aligned and firmly fixed. The slightest movementmovement of the head
during the scanning process will cause artifacts
artifacts in the resulting scan. 255
resulting scan.2
The inside of the doughnut
doughnut consists of hundreds
hundreds of special crystals
that
that are capable of capturing
capturing gamma rays. Gamma Gamma rays that that enter a
crystal have a good chance of colliding with with an atom in it and releasing
a photon
photon of light. There are different crystals to choose from, each a
different trade-off
trade-off between stopping
stopping power, speed of multiple captures,
durability, and cost. The photon
photon of light then
then travels through
through the crystal
to a “photomultiplier
"photomultiplier tube,”
tube," which magnifies the light power power so that
that it
detector. 166
can be registered by a light detector.2
The crystals and light detectors are arranged
arranged in a doughnut
doughnut fashion
fashion to
take advantage
advantage of the fact that
that the gamma rays travel almost directly
opposite
opposite each other. When
When two detectors are triggered at almost exactly
the same time, as measured
measured by a “"coincidence
coincidence circuit,”
circuit," the scanner pre­
pre-
sumes that
that a positron
positron must have been emitted
emitted on or very near the line
between the two crystals (see(see Plate 3 [steps 1 through
through 3]). Very fast

73

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CHAPTER 3

FIGURE Four early PET

F ig u r e 3.6. Four PET scanners, PETT (positron
scanners, called PETT (positron emission
emission transaxial
transaxial
tomography).
tomography). These scanners
scanners were produced
produced at Washington
Washington University, St.
Louis. (Courtesy
(Courtesy of Michael
Michael Phelps)

crystals andand electronics

electronics can also measure
measure the microsecond
microsecond difference be­ be-
tween the
tween the two
two triggers and
and make
make a good guess as to where
where on the line
the presumed
the presumed positron
positron was.
positron is only a "presumed"
The positron “presumed” positron
positron because there
there are a num­
num-
factors that
ber of factors that add noise to the data
data collection
collection process. The first
occurs because of the high number number of positrons
positrons released: Two positrons
positrons
result in two
may result two pairs of gamma
gamma rays striking crystals at about
about the
time, causing false coincidences to be detected.
same time,
Gamma rays can also be deflected or absorbed
Gamma absorbed while still in the head,
misaligned coincidences. Finally, a gamma
causing missed or misaligned gamma ray can
through a crystal
pass through crystal into
into the adjacent
adjacent one. In each case, there
there is no
possible way to know
possible know that
that a coincidence
coincidence is false. But the high number
number
actual coincidences from
of actual from most
most regions is usually enough
enough to assume
that these spurious
that spurious ones can be treated
treated as reducible
reducible noise. The net result
that the radioactivity
is that radioactivity that
that hits the doughnut
doughnut is assumed to be the
result of radiotracer
result radiotracer emission locations
locations on the lines between
between the crys­
crys-
tals.
tals.2277

doughnut, shape of the scanner collects its data

Spatially, the doughnut data in the
form of "slices"
form “slices” of the brain
brain (Figure 3.7). Like bread
bread slices, these brain
thickness, here due to the thickness
slices have a thickness, thickness of the crystals. Thick-

74
 PRODUCING
PRODUCING BRAIN IMAGES OF MIND
MIND

F ig u r e 3.
FIGURE 7. Brain slices. The four
3.7. four images at the right
right were generated
generated using different
techniques
techniques for imaging the brain. Starting
Starting at 9 o’clock
o'clock and moving clockwise, the four
techniques
techniques are standard
standard photography,
photography, x-ray
x-ray computed
computed tomography
tomography (CT), positron
positron
emission tomography,
tomography, and
and magnetic
magnetic resonance
resonance imaging.
imaging. N ote first that
Note that each technique
technique
makes different
different structures
structures visible, and then
then note
note second that
that the slice itself has a neces­
neces-
sary thickness
thickness that
that each technique
technique flattens
flattens (erases or averages) in different
different ways.
(Posner and Raichle 1994)

that the emission activity in the slice is lumped

ness means that lumped together.
reduce the
Smaller crystals can reduce the slice thickness
thickness but would
would collect fewer
counts, making
counts, making noise a bigger concern.
concern.
head in the scanner
The angle of the head scanner introduces
introduces another
another aspect of the
brain slice: At different
brain different angles, different
different brain
brain structures
structures lie together
together on
the same slice (figures
the (figures 3.8, a and b). The kindkind of angle used differs by
different reference
lab because labs use different reference brain
brain atlases to locate and corre­
corre-
structures with
late physical structures with the imaged ones. There
There is no ideal angle or
atlas,
atlas, but
but the different
different standards
standards are one of the things that that makes read­
read-
ing another
another lab’s
lab's scans so difficult.
where to start
The choice of where start and
and stop the angled slices introduces
introduces an
anatomical cutoff
anatomical cutoff as well. In figure 3.8b,3.86, the slices
slices end above the
bulblike cerebellum
bulblike cerebellum at the bottom
bottom of the brain.
brain. Nancy
Nancy Andreasen
Andreasen has
observed that
observed that this kind
kind of choice builds in key assumptions
assumptions about
about which
brain could
regions of the brain could be involved in the activity:

75
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CHAPTER.

F ig u r e
FIGURE 3.8. Brain slice angles. These images were taken taken from two different
different
books on brain
books brain imaging. They represent
represent competing
competing standard
standard ways of slicing the
brain. The different
brain. different angles create
create differently
differently shaped
shaped images, and on those im­im-
ages different
different brain
brain structures
structures appear drawn from Andreason
appear together. (Images drawn Andreason
and from
1984 and from Posner
Posner and Raichle 1994)

Although early PET studies simply cut off the cerebellum, based on
Although
assumption that
the assumption that it could not
not be doing anything
anything of interest
interest to stu­
stu-
cognition and emotion,
dents of cognition emotion, more recent studies have indicated
indicated
that it is used in many different kinds of mental activity ..... . (An-
that
2001, p. 72)
dreasen 2001,
within which the crystals collect the gamma
Also, because of the angles within
not, in fact, uniformly
rays, the slices are not, uniformly thick the way that
that bread
bread slices
slices
are; they are bulged in the middle. Said a senior PET researcher:
I don’t think
You don't think of a slice that
that is infinitely thin,
thin, the way, say, a
'1
would approach
physicist would approach it, or a thermodynamicist
thermodynamicist would
would say it has
no meaning until you go to an infinitely thin slice.
slice. No, I’m
I'm always

11 76
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 PRODUCING BRAIN
PRODUCING BRAIN IMAGES
IMAGES OF
OF MIND
MIND

interested in the fact that

interested that if I’ve
I've got a one-centimeter
one-centimeter cube, first of all,
what
what is the function that cube? And then,
function of that what is the
then, what the biochemistry
biochemistry
going on in that
that cube, and
and why?

Finally, the architecture

architecture of the scanner
scanner affects the form of data gath­
data gath-
ered in each brain brain slice. Each different scanner shape-thin
different scanner shape—thin ring, thick thick
doughnut, hexagonal, fixed, or rotating
doughnut, hexagonal, rotating -—is better at detecting
is better detecting some
areas than others.
areas than others. For instance,
instance, some scanners collect better
scanners collect better data
data from
the center
center of the brain,brain, with
with the periphery having more
periphery having more noise, whereas
whereas
other scanners have the opposite
other scanners opposite trade-off.
trade-off. Each of these different spa­
different spa-
tial collection
collection issues is still being studied studied by PET researchers,
researchers. Each con- con­
tributes
tributes to the concept
concept of the “"brainbrain slice activity”
activity" as a representation
representation
of the collected
collected coincidence
coincidence counts.
counts.
A difficulty oftenoften noted
noted by researchers
researchers is the the extreme
extreme differences of
appearances of PET images from
appearances from different institutions. C. L. Grady
different institutions. Grady ex­ex-
amined the differences in data
amined data produced
produced by two two different
different machines
machines and
discovered
discovered thatthat even for the the same person,
person, “there
"there was no simple interac­ interac-
tion between the complex
tion between structure of the
complex structure the brain
brain and differences in per- per­
formance
formance characteristics
characteristics of the the two
two tomographs"
tomographs” (Grady (Grady 1991). This
finding illustrates
illustrates the problem
problem withwith PET being uniquely
uniquely able to measuremeasure
brain molecular
brain molecular flow rates rates at this level of resolution.
resolution. Because it provides
provides
information
information unobtainable
unobtainable from from other
other measures, there is no way at pres-
measures, there pres­
ent confirm the results.
ent to confirm results. “If
"If [such a large] difference
difference ... . . . can be ob­ ob-
tained
tained on the same subjects subjects with
with the same injection
injection using different
different to­to-
mographs,
mographs, then then apparent
apparent differences in metabolic
metabolic rates rates reported
reported by
different groups should
different groups should be interpreted
interpreted withwith caution”
caution" (Grady
(Grady 1991).
The next
next conceptual
conceptual dimension
dimension of data collection is time. Scanning
data collection
takes
takes time: 2 minutes
minutes for oxygen
oxygen scans and and 30 minutes
minutes for FDG, for
example.
example. Radioactivity
Radioactivity rates rates decrease by half half each half-life, so activity
during
during the latter
latter part
part of a scan must must be modified
modified to account
account for this
fact. In addition,
addition, the process being measured, measured, brain
brain activity, is dynam­
dynam-
ically changing
changing duringduring this period.
period. Thus
Thus the data collected consist
data being collected
of aa "slice
“ slice of time” that is necessarily lumped
time" that lumped together
together into
into 'aa “"state
state of
activation.
activation. ”2"828

At this point,
point, then,
then, data
data has been collected
collected on millions of coincidence
coincidence
conceptual brain
lines in conceptual brain slices over a period period of time. All this data
is collected
collected into compute^ and
into a computer, mathematically "recon-
and the lines are mathematically “ recon­
structed” into a slice-shaped
structed" into slice-shaped dataset
dataset of emission
emission data,
data, a graphically
graphically or­ or-
ganized
ganized array
array of numbers.
numbers. As in the rest of PET research, research, there
there are a
number
number of competing
competing approaches,
approaches, in this case to the algorithms
algorithms used to
solve the problem
problem of the most most likely dataset
dataset that
that could
could have resulted
resulted in
the actual
actual data
data received (see Plate 3 [steps 4 through through 9]). 9}). The result
result

77
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CHAPTER 3
CHAPTER

which each box in the grid represents

is a grid of activity in which represents numerically
reconstructed amount
the reconstructed amount of activity for a small section (or voxel)
voxel) of the
brain slice over the period
brain period of the scan.
This division of the brain brain slice into voxels creates a new concept: a
functional brain region that
functional that is given to represent
represent the average amount
amount of
brain activation
brain activation in that
that box of the brain over the period
period of time of the
scan.2
scan. 5 For any voxel, the accuracy
29
accuracy of the count number
number is subject to
what is called the partial
what partial volume effect, however, which is the spillover
adjacent voxels that
into a voxel from adjacent that have significantly higher radioac­
radioac-
resulting in a number
tivity, resulting number of voxels thatthat will be represented
represented as having
more activity
more activity than
than they
they should
should have. A related
related issue is the overlooking
radioactivity that
of regions of high radioactivity that are much smaller than than the voxel
size. Here the voxel will be registered at a lower average rate, and the
area of high activity will be missed.
uniqueness is also a problem
This uniqueness problem for researchers with with the newest and
best-resolution tomographs
best-resolution tomographs who report
report activation
activation in structures
structures no other
institution can even measure
institution measure (see
(see Plate 11). The physical theory
theory of PET
concludes that that only structures
structures larger than
than twice the sizesize of the resolu­
resolu-
tion, or "full
tion, “ full width
width at half maximum
maximum (FWHM)”
(FWHM)" can be properly
properly mea­
mea-
Structures smaller than
sured. Structures than this are so affected by surrounding
surrounding areas
that they cannot
that cannot be reliably interpreted
interpreted (Karp et al. 1991; Mazziotta
Mazziotta
and Phelps 1985).
and
obtained, the procedure
Once an image is obtained, procedure to extract
extract regional values
regional quantitation.
will also affect the regional quantitation. The mostmost common
common pro­
pro-
anatomical area into the PET scan images
cedure is to delineate an anatomical
then obtain
and then obtain its average value. The size and and geometry of the re­re-
interest [ROI]
gion of interest [ROI] will affect the quantitative
quantitative values obtained.
obtained. Size
Size
important because in order to obtain
is important obtain adequate
adequate quantitation
quantitation the
dimensions of the ROI should
dimensions should be at least twice the spatial resolution
resolution
brain studies attempting
of the system. In brain attempting to quantify
quantify gray matter
matter
introduce a source of error
activity, this will introduce error because the mean width
width
cortex is 3 mm. Cortical
of the cortex Cortical regions will include activity from
surrounding areas. (Volkow et al. 1991, p. 133)
surrounding
resolution reveals a whole new world
Each increase in resolution world of structures.
structures.
kind of ideal PET machine
One kind machine would
would have a resolution
resolution small enough
neuron, but no one knows
to show each neuron, knows what
what these pictures
pictures would
would even
to look like.
begin to
reconstruction of the slice into voxels deter­
Brain slice thickness and reconstruction deter-
what is called the "spatial
mine what “ spatial resolution"
resolution” of the PET scanner, defined
resolution directly determines
as the voxel size. Spatial resolution determines what
what scale of
brain activity is detected
brain detected and
and represented
represented and what
what scales are ignored.

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MIND

manner the time resolution

In a similar manner, resolution of the device determines
determines activity
that consistently over the time-slice of data
that registers consistently data collection and ig-
ig­
nores shorter-in-time
shorter-in-time peaks and valleys of activity in voxels as well as
that happen
longer changes that with the
happen to overlap with specific time slice cho-
the specific cho­
sen. The net result is the concepts of a "functional
“ functional brain region,” "acti-
brain region," “ acti­
vation,” and a “"functional
vation," functional map of the brain's
brain’s activity"
activity” that
that are always
apparatus.33°
produced by the PET apparatus.
produced 0 Functional
Functional brain
brain regions do not exist
in the brain
brain where neurons
neurons are in constant
constant cross-talk with each other
cross-talk with
using a variety of electrical, chemical, and physiological
physiological means at spa-
spa­
tial scales of nanometers
nanometers and time scales of nanoseconds.
nanoseconds. Instead,
Instead, the
PET apparatus
apparatus produces functional brain
produces the functional brain region
region as a discrete, mea-
mea­
surable, locatable, and ideally nameable
nameable time-space
time-space voxel of the brain
that can be correlated
that correlated with the person's
person’s state or trait.
trait.
To recap, the steps in creating brainset are as follows:
creating a brainset
1. A one-to-one
one-to-one mapping
mapping of a data set of quantities
quantities onto
onto a three-
dimensional voxelized model of the brain
dimensional brain is done.
2. The dataset
dataset is the result of a simulation
simulation of flow rates of the radio­
radio-
pharmaceutical in the brain.
pharmaceutical
3. The flowrates are reconstructed
reconstructed by a mathematical algorithm on
mathematical algorithm
the decay counts.
4. The decay counts
counts are statistical
statistical indicators
indicators of the spatial
spatial and tem-
tem­
poral distribution
poral distribution of the radiopharmaceutical.
radiopharmaceutical.
5. The radiopharmaceutical
radiopharmaceutical is presumably
presumably tracing
tracing a significant bio­bio-
logical process.
6. The biological process is hoped
hoped to be significantly related
related to brain
activity, which in turn,
activity, which turn, is hoped
hoped toto be related
related to cognitive and
behavioral tasks.
behavioral
These six relationships each treated
relationships are each treated as the referent
referent of PET images in
different
different scientific
scientific articles, depending,
depending, for instance,
instance, on whether
whether the au­
au-
thors
thors are involved in chemically producing
producing the tracer, calculating the
flow rate, or providing
providing the task.
All of these processes of data data collection have been ,continually
continually cri-
cri­
tiqued and revised since the 1980s. Each revision of scanner
tiqued scanner and re-
re­
construction software
construction software often involves trade-offs
trade-offs between
between sensitivity or
efficiency, spatial
efficiency, spatial resolution,
resolution, and speed. Each of these trade-offs empha­
trade-offs empha-
radiotracer activity being measured,
sizes a different aspect of the radiotracer measured, which
then implications for the assessment of the
then has implications the brain
brain activity being mea-
mea­
with greater
sured. For instance, with greater spatial
spatial resolution,
resolution, researchers
researchers might be
able to image smaller brainbrain areas, thus producing
producing more detailed
detailed maps
functional circuits. With
of functional With greater
greater sensitivity, however, tinier amounts
amounts
radioactivity are needed to make accurate
of radioactivity accurate images, allowing either

79
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greater differentiation
greater differentiation of levels of activity in different different regions or greater
greater
resolution, images of shorter
time resolution, shorter duration
duration that
that possibly emphasize
emphasize dif­
dif-
ferent kinds
ferent kinds of brain
brain processes.
debates hint
These debates hint at the the tremendous
tremendous difficulty of addressing
addressing the
brain as a whole
brain whole through
through the the measurement
measurement of a tiny tiny subset
subset of its parts.
parts.
the same time, it is precisely through
At the through such assertion
assertion of measures
measures and
the reasoned
the reasoned critiques
critiques of o f them
them thatthat new notions
notions andand measures
measures of brain
brain
activity are invented
activity invented (Danziger 1990b). 1990b). In thethe end, thethe ideal for the rest
experiment is that
of the experiment that the
the whole
whole of stage 2 is standardized,
standardized, or at least
black-boxed in the
black-boxed the absence of settling
settling it.
1,
In sum, in stage 2, measuringmeasuring a brain brain entails reconstructing
reconstructing it as a
iJli
I'! dataset. The process
dataset. process of brain
brain imaging
imaging always ends with with this result: that
that
the brain
the brain is knowable
knowable as a set of combinatorial
combinatorial states.
states. According
According to
media philosopher
media philosopher Vilem Flusser, this mode mode of knowing/perceiving
knowing/perceiving be­ be-
with the
gins with the photograph.
photograph. Both PET and and the photographic
photographic apparatus
apparatus
understood as containing
can be understood containing an incredibly
incredibly large yet finite set of
possible products:
possible products: pictures
pictures viewed as different
different combinations
combinations of colored
cola.red
grayscale dots.
or grayscale dots. The number
number of combinations
combinations may not not be imaginable,
imaginable,
but it is not
but not infinite. Flusser's
Flusser’s insight
insight is that
that an apparatus
apparatus like this de­de-
combinatorial space that
fines a combinatorial that is conceptual:
conceptual: The picture’s
picture's dots ex­
ex-
the concepts
press the concepts of grayscale,
grayscale, a pixellated
pixellated discrete world,
world, and
and a com­
com-
binatorial universe
binatorial universe (Flusser 1984). 1984),
With regard
With regard to brainbrain imaging,
imaging, and PET scanning scanning in particular,
particular, under­
under-
standing the
standing the apparatus
apparatus in Flusser's
Flusser’s manner
manner allows us to identifyidentify the
concepts that
concepts that replace
replace thethe biological
biological brain
brain in the images: The datasetdataset is
volumetric, and
discrete, volumetric, and timeless. Despite early attempts attempts to make brain brain
imaging into
imaging into movies (Wagner, etc.), the movies were too hard hard to read.
The images are discrete in that that a quantitative
quantitative amount
amount of hits is under­
under-
stood as a "level
stood “ level of activity"
activity” represented
represented by a single number. This num­ num-
three-dimensional location
ber is defined by a three-dimensional location in the space of the skull,
and the
and the location
location of the the number
number is a voxel, a three-dimensional
three-dimensional box
2000).
(Beaulieu 2000).
Different scanner
Different scanner architectures,
architectures, crystal
crystal counting
counting techniques,
techniques, and
and cor­
cor-
rection algorithms
rection algorithms resultresult in different
different datasets
datasets on the “"same" same” brain.
brain.
There is no ideal scanner
There scanner or isotope
isotope because the brain brain does not not have
voxels or levels of activities or discrete events. The overall conceptual conceptual
produced by the
object produced the apparatus
apparatus of the PET scanner scanner is a three-dimen­
three-dimen-
sional space filled with
sional with discrete, adjacent
adjacent boxes, each containing
containing a single
number for each state
number state in time. This conceptual
conceptual object takestakes the place of
the brain
the brain in subsequent
subsequent stages. We note, note, though,
though, that
that the final concep­
concep-
tual object,
tual object, thethe brainset, is analogous
analogous to the cognitive
cognitive neuroscience
neuroscience as­as-
sumption that
sumption that the
the brain
brain itself
itself is analyzable
analyzable into
into separate
separate module-like
module-like
components
components that that are differentially
differentially active in a state-like
state-like manner. The

80

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1:I ,I
 PRODUCING BRAIN
PRODUCING BRAIN IMAGES OF MIND
IMAGES OF MIND

PET apparatus
apparatus builds these neuroscience
neuroscience assumptions
assumptions into its architec­
architec-
ture
ture and thus can appear to confirm them,
them, while necessarily reinforcing
them.

STAGE
STAGE 3: MAKING DATA
3: MAKING DATACOMPARABLE
COMPARABLE

methods called "image

Using methods “image processing” . . . the computer
processing" ... computer
acts as an extension
extension of the eye and the brain by selecting
information the scientists cannot
information cannot see. (Blumenthal 1982)

The scanner
scanner has now producedproduced a brainset,
brainset, an apparently
apparently stable set of
numbers
numbers that represent the flow rate of the tracer
that represent tracer and apparent
apparent activa-
activa­
tion.
tion. The next
next stage of the process of producing
producing a brain
brain image consists
in first adjusting
adjusting and transforming
transforming the dataset
dataset so that
that it corresponds
corresponds to
some other
other brainset,
brainset, either
either the subject's
subject’s own MRI, for instance, or a
reference brainset.
brainset. In the first case, the PET data is computationally
computationally
combined,
combined, or “"registered,"
registered,” with
with the MRI information
information so thatthat the
the activ­
activ-
ity voxels can be given anatomical
anatomical locations.
locations. Often
Often this is combined
with
with the process of then transforming or warping
then transforming warping the the subject’s
subject's brainset
brainset
standardized human
into a standardized human brainset
brainset or "atlas."
“ atlas.” As Anne Beaulieu de- de­
scribes in “The
"The Space Inside the Skull,”
Skull," this process presumes the mean-mean­
ingful and practical
practical possibility of a generalized
generalized human
human brain, and then
produces
produces it (Beaulieu 2000).
The following discussion of differentdifferent brain
brain atlases by MRI imager
Matthew
Matthew Brett, illustrates
illustrates some of the difficulties:
The MNI
MNI [Montreal
[Montreal Neurological
Neurological Institute]
Institute] defined a new standard
standard
brain by using a large series of MRI scans on normal
brain normal controls.
controls. Recall
that the Talairach
that Talairach brain
brain is the brain
brain dissected and photographed
photographed for
the famous Talairach
Talairach and Tournoux
Tournoux atlas. The atlas has Brodmann’s
Brodmann's
[anatomical] areas labelled, albeit in a rather
[anatomical] rather approximate
approximate way. In
fact, what
what the authors
authors did was to look at pictures of the Brodmann Brodmann
map and estimate where
where the same place was on their brain. brain. To quote
from the atlas, p. 10: "The
“The brain
brain presented
presented here was not not subjected to
histological
histological studies and the transfer
transfer of the cartography
cartography of Brodmann
Brodmann
pictured in two-dimensional
usually pictured two-dimensional projections
projections sometimes possesses
uncertainties.”
uncertainties."
MNI wanted
The MNI wanted to define a brain that is more representative
brain that representative of
population. They therefore
the population. therefore did a large number number of MRI
MRI scans on
normal
normal subjects [305 of them], and did a simple linear match of each
brain to the brain in the Talairach
brain atlas...... . . The problem
Talairach atlas problem introduced
introduced
MNI standard
by the MNI that the MNI
standard brains is that MNI linear transform
transform has not
matched
matched the brains completely to the Talairach
Talairach brain. As a result, the

81
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MNI brains
MNI brains are slightly larger
than the
longer) than the Talairach
larger (in particular
Talairach brain.
particular higher, deeper and
brain. The differences are larger
larger as you get
l
further from
further from the
the middle
middle of the
the brain,
brain, towards
towards the outside,
outside, and
and are at
maximum in the
maximum the order
order of 10mm. (Brett 1999)3
1999) 311

There are many

There many techniques
techniques for transforming
transforming and mapping mapping the three-
dimensional PET and
dimensional and MRIMRI data
data onto
onto each other. Various warping warping tech­
tech-
include (1) finding standard
niques include standard landmarks
landmarks and “"stretching"
stretching” the
dataset3
dataset 2;; (2) registering
32
registering thethe data
data to the subject’s
subject's magnetic
magnetic resonance
resonance
and then
image and then transforming
transforming the image to match match the atlas, (3) warping
warping
on the
on the basis of the the surface
surface of the the brain,
brain, and (4) performing
performing a nonlinear
nonlinear
three-dimensional warping
three-dimensional warping of brain brain structures.
structures. Each of these methods, methods,
course, has trade-offs,
of course, trade-offs, and is still being debated debated and adjusted.
adjusted. The
resulting compound
resulting compound image (MRI (MRI ++ PET) combines
combines high-resolution
high-resolution an­ an-
atomical information
atomical information with with quantitative
quantitative physiological
physiological data.3
data. 333 Each of
methods trades
these methods trades off precision
precision in one realmrealm for accuracy
accuracy in another.
another.
net result
The net result is that
that all the brainsets
brainsets are rendered
rendered comparable
comparable to
other and
each other and each activity
activity voxel can be locatedlocated within
within the atlas and
more or less precise anatomical
given a more anatomical location
location (e.g., in the basal gan­ gan-
Unfortunately, there
glia). Unfortunately, there is disagreement
disagreement between
between many many labs over the
proper reference
proper reference brain-the
brain —the Talairach
Talairach atlas, for instance,
instance, was generated
generated
from a womanwoman in her her sixties who who died shortly
shortly after having
having an MRI.
Consequently, brain
Consequently, brain data
data located
located on one atlas is not not easily comparable
comparable
with other
with other atlases without
without significant
significant work
work (Beaulieu 2000; 2000; Talairach
Talairach
Talairach and
1957; Talairach and Tournoux
Tournoux 1988).
Brainsets often
Brainsets often must
must be normalized
normalized to each other other in activity
activity levels. In
people, the overall
some people, overall flow in each hemisphere
hemisphere is slightly different.
different. To
comparing regions
assist in comparing regions between
between the two two hemispheres,
hemispheres, they are often
adjusted so that
adjusted that they
they are of the same average overall overall activity. Then,
Then,
activity measures
because voxel activity measures are dependent
dependent on total total isotope
isotope emission
emission
people with
activity, people with higher
higher metabolisms
metabolisms will tend tend to have higher
higher overall
brain blood
brain blood flow. Because most most labs are interested
interested in regional
regional activity,
the relative
the relative difference
difference in activity
activity in one voxel comparedcompared with with another,
another,
total overall
the total overall amount
amount of voxel activity is usually adjusted adjusted so thatthat
comparisons can be made across individuals.
comparisons individuals. In this case, the the absolute
absolute
activity is defined as not
activity not relevant
relevant to the study.3
study. 344
Once the the brainsets
brainsets are mademade intointo comparable
comparable brainsets,
brainsets, the work
work of
extracting significance from them
extracting them can begin. Significance in PET brain brain
usually defined as regional
imaging is usually regional differences in activation
activation between
two brainsets
two brainsets -—for example,
example, the set of voxels corresponding
corresponding to the basal
ganglia are more
ganglia more active in this brainsetbrainset of an anxious
anxious person
person than
than in the
brainset of the
brainset the same person
person when
when calm. As discussed earlier, these dif­ dif-
ferences can be betweenbetween the the brainsets
brainsets of an individual
individual doing one task

82
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PRODUCING BRAIN
PRODUCING MIND
Of MIND
IMAGES OF

and the same individual

individual doing anotheranother one, between
between two two individuals
doing
doing the same task, task, between
between an individual
individual withwith a condition
condition (like
schizophrenia)
schizophrenia) and one without, without, or between
between two groups
groups of individuals.
individuals.
In each case, the emphasis is on determiningdetermining which voxels of activity
which voxels
differ enough
enough between
between the two brainsets
brainsets to suggest that anatomical
that the anatomical
location
location of these vvoxels,-a
o x els^ a specific brain brain region
region-is—is “involved”
"involved" in
whatever
whatever defines the comparison.
comparison. For example,example, brainsets
brainsets of an individ­
individ-
ual looking
looking at a colored
colored pattern
pattern compared
compared with with brainsets
brainsets of the same
individual
individual looking
looking at the same pattern pattern in black
black and
and white
white reveal thatthat a
set of voxels identified
identified as located
located in partpart of the visual cortex cortex had 10
percent
percent more activity. The suggestion of this data data is that
that part
part of the
visual cortex
cortex is “correlated
"correlated with with seeing color”
color" or withwith “"color process-
color process­
ing.”
ing." Because all that that can be determined
determined is correlation,
correlation, this kind of
study cannot
cannot prove that that the brainbrain region is involved or responsible
responsible for
the function
function of color processing.
processing. Instead,
Instead, PET scanning
scanning is often de­ de-
scribed as “hypothesis-generating"
"hypothesis-generating" (suggesting brain brain regions that that might
be involved in an activity) rather rather than
than “hypothesis-confirming.”
"hypothesis-confirming."
This example
example also demonstrates
demonstrates that that PET mustmust conceptually
conceptually assume
that
that activation
activation change
change is significant and and represents
represents the “participation”
"participation"
of the “"area"
area” (set of voxels) differentially
differentially activated
activated in the correlated
correlated
task. Activation
Activation is also conceptual,
conceptual, understood
understood as linear: More More is bet­
bet-
ter —
- more activation
activation means more participation
participation in the function.
function. The cor­cor-
ollary of this assumption
assumption is that that voxels that
that do notnot differ between
between two
brainsets
brainsets are not involved in the task or comparison. comparison. In the living brain, brain,
all areas are “"constantly"
constantly” active, except the areas that that are dead due to, to,
for example,
example, stroke.
stroke. All of the neuronsneurons are in use, oxygen and glucose
I are being consumed,
consumed, and neurotransmitters
neurotransmitters are being released released and taken
taken
in.
m.

I When
When images are colored colored (discussed later) only the voxels that
are given colors, and the other
ments made to the effect that
other voxels are often
that “"no
no other
often rendered
that differ
rendered black. Com­
other areas were active”
active" point
Com-
point to the
visual and conceptual
conceptual acceptance
acceptance of the brainset
brainset as the brain.brain. These are
shorthand
shorthand phrases
phrases that
that fill in for “"were
were differentially
differentially more active,”
active," but
they act to reinforce
reinforce the notion
notion that
that the other
other areas of the brain brain could
uninvolved, because they were “"off."
be uninvolved, off.”
Methods
Methods of comparing
comparing images and determiningdetermining significance vary from
lab to
to lab. (It may seem tedious tedious to repeat
repeat yet another
another reminder
reminder of pro­pro-
cess differences between
between labs, but but there
there is no other
other way to demonstrate
demonstrate
the complexity
complexity of the interacting
interacting layers of assumptions
assumptions underlying
underlying a
PET image and how how each of these assumptions
assumptions is not not standard
standard within
within
the PET field but contested.)
contested.) The example
example just described
described involved sub­ sub-
traction.
traction. The value of each voxel in the black-and-white black-and-white brainset
brainset was
subtracted
subtracted from the corresponding
corresponding voxel in the the color brainset.
brainset. Ideally,

I 83
83

l
CHAPTER
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most corresponding
most corresponding voxels will will have been equalequal in value, subtracting
subtracting to
zero, implying
implying that that the brain
brain activity in thatthat voxel was not not affected by
the difference between
between the the tasks.
tasks. The resulting
resulting brainset thus highlights
brainset thus
those voxels that
those that differed (see Plate 4, top top row).
Conceptually, subtracting one image from another
Conceptually, subtracting another assumes that that re-
re­
gions of thethe brain
brain thatthat show
show no overall change change in activity are not di­
not di-
rectly involved
involved in the the task
task or condition.
condition. This is an assumption similar to
assumption similar
that with
that with a computer's
computer’s hardware,
hardware, where
where the mathmath coprocessor
coprocessor heats up
only when algorithms needing
when algorithms needing certain functions are run.
certain functions However, in
run. However,
computers without
computers without a math math coprocessor,
coprocessor, the same functions
functions can be pro-pro­
grammed into
grammed into regular
regular RAM (random-access memory). In this case,
(random-access memory).
there is no overall
there overall difference
difference in any particular
particular component
component when when the
computer performs
computer performs the algorithms.
algorithms. The RAM is criticallycritically involved
involved in
directly responsible
and directly responsible for those functions, but
those functions, but it is also involved
involved in
database manipulations
database manipulations and and Internet
Internet surfing at the same intensity. Con- Con­
sequently, an “"image"
image” of the latter latter computer
computer would
would notnot detect
detect the role
of the RAM programprogram in performing
performing the algorithms
algorithms because the func­ func-
tional difference
tional difference is "hidden"
“ hidden” as a difference in codingcoding within
within a constant-
constant-
unit, not
use unit, “ present” in a specific, dedicated
not "present" dedicated unit.
A second analogy
analogy will further constrain this concept
further constrain concept of activation.
activation.
Assume thatthat we wantwant to detect the top top tennis
tennis players
players in a country
country but
but
are able to measure
measure only general intensity of its inhabitants.
general muscle intensity inhabitants. We
might try to correlate
might correlate the intensity
intensity of activity withwith tennis tournaments
tennis tournaments
and hypothesize
and hypothesize that that the top tennis players will be more
top tennis more active during
during
tournaments than
tournaments than not. But what what if these tennis
tennis professionals
professionals also spend
every day practicing
practicing at great great intensity? Then even if they do the
intensity? Then the work
work of
playing tennis
playing tennis for the country,
country, they will not detectable through
not be detectable through cor-
cor­
relation with
relation with tennis Analogously, we might
tennis events. Analogously, wonder about
might wonder re­
about re-
gions of the
the brain
brain that “practice” analyzing
that "practice" patterns of color during
analyzing patterns during the
that they
time that they are not not actually
actually analyzing
analyzing newnew color input.
input.
different paradigm
A different paradigm that that competes
competes withwith the concept
concept of participative
participative
activation is that
activation that of individual
individual differences and learning.
learning. Richard
Richard Haier,
for instance,
instance, designed a study study of people
people playing
playing the computer
computer game
which scans were done of people
Tetris in which people (1) just
just learning
learning to play, (2)
as they were becoming
becoming more skilled, and (3) when when they could
could play the
game consistently
consistently at its highest highest level. Correlating
Correlating these images, he
claims to have found found that
that some specific regions of the brain brain were more
more
when learning,
active when learning, then then got less active as the person person became more
skilled, and
and finally were less active than than at rest when
when the
the person
person was
playing as an expert.
playing expert. He He described
described this datadata as conforming
conforming to an “effi­
"effi-
ciency hypothesis,”
hypothesis," in which which a brainbrain region
region is very active when
when adapting
adapting
to a new tasktask and then then over time the region becomes very streamlined streamlined
that task
or efficient at that task and
and therefore
therefore needs less and and less activity to carry
carry

84
 PRODUCING
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OF MIND

it out. In the final instance,

instance, one can imagine the region region on a kind kind of
autopilot,
autopilot, less active even than than when
when it is notnot performing
performing the activity at
all (and perhaps
perhaps participating obliquely
participating obliquely in other
other tasks).
The efficiency
efficiency hypothesis
hypothesis is useful to highlight
highlight the particular
particular design of
most
most cognitive science tasks. They are specifically chosen as those kinds
of tasks that
that people do not
not tend
tend to get better
better at. Thus, they are suited to
repeating
repeating over and over with with the same person person and and-—it it is hoped
hoped-—to to
causing
causing the same response
response behaviorally
behaviorally and neurologically
neurologically each time.
Equally, they allow many many different
different people
people to be tested
tested without
without worrying
worrying
about
about how how good they are at the task. task. The functional
functional brain
brain map of cog­ cog-
nitive neuroscience
neuroscience tends to be a map map of those
those functions
functions for whichwhich there
is little or no learning.
learning. This abstraction
abstraction of the range range of human
human functions
functions
is common
common to much much of psychology
psychology todaytoday and has captured
captured much of PET
scanner
scanner research.
research.
Having
Having clarified the paradigms
paradigms of isolation
isolation of tasks in brainsetsbrainsets of
individuals
individuals through
through subtraction,
subtraction, we can now attend attend to how these results
can be combined
combined withwith each otherother to produce
produce results in groups. groups. The
basic method
method is one of averaging
averaging (see Plate 4, middle middle and and bottom
bottom rows).
In the case of the color-seeing task, task, the subtracted
subtracted brainsets
brainsets of each of
five individuals
individuals are normalized
normalized to each other other as described: Their average
activity level is altered
altered to the same average, and the brainsets brainsets are de­de-
formed
formed to the same absoluteabsolute reference
reference brain
brain atlas. Now Now the same voxel
value in each normalized
normalized brainset
brainset can be added added together
together and divided by
the total
total number
number of brainsets
brainsets to provide
provide the average group group voxel value.
Repeating
Repeating for each voxel, the end result is a new “"average average group
brainset.”
brainset."
This average brainset
brainset is intriguing
intriguing because it has conceptualized
conceptualized sig­ sig-
nificant activity as only the subtracted
nificant subtracted activity that that is most
most common
common to
the set of individual
individual brainsets.
brainsets. Subtracted
Subtracted activity that that is common
common to
only one or two is redefined from from being potential
potential “"individual participa-
individual participa­
tive activity”
activity" to “noise.”
"noise." This individual
individual variability
variability is often not repre­repre-
sented
sented at all in the resultant
resultant average brainset,
brainset, being rendered
rendered black.
This is intentional.
intentional. Individual
Individual differences
differences are treated
treated as noise in cogni­ cogni-
tive psychology, whosewhose mission is to discover the baseline mental mental func­
func-
tions that
that are common
common to (most) normal normal people. What retained as
What is retained
significant in the averaged
averaged brainsets
brainsets are those
those regions that that can be said to
participate in the task in most
participate most individuals.
individuals.

The study
study of patients,
patients, toto investigate
investigate the recovery
recovery of language
language func­
func-
tions,
tions, raises further
further problems,
problems, in particular
particular whether
whether it is appropriate
appropriate
to average patient
patient data.
data. The answer
answer in many
many cases is likely to be that
that
it is inappropriate
inappropriate ..... . mixing the results
results from patients
patients reveals only
common
common features,
features, and individual
individual differences of great potential
potential inter­
inter-

85
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obscured. However,
est are obscured. However, the comparison
comparison of an individual
individual patient’s
patient's
with grouped
results with grouped normal
normal data,
data, to look for significant regional
regional dif­
dif-
relatively insensitive
ferences, is a relatively insensitive technique,
technique, and one thatthat is open to
problems of interpretation
problems interpretation -—for example,
example, does the patient
patient show
show a re­re-
gional difference
gional difference from
from normal
normal subjects because of an adaptive
adaptive change
the neural
in the neural networks
networks processing
processing the task,
task, or because of an irrelevant
irrelevant
stimulus such as discomfort
stimulus discomfort from
from a full bladder
bladder of which
which the investi­
investi-
gator was unaware
gator unaware at the time the patientpatient was studied? Irrelevant
Irrelevant
stimuli are likely to be randomly
stimuli randomly distributed
distributed amongst
amongst a group
group of nor­
nor-
mal subjects,
subjects, and
and therefore
therefore conveniently
conveniently “lost”
"lost" during
during inter-subject
inter-subject
averaging. (Wise et al. 1991)
averaging.

Turning back
Turning back now
now to the the example
example figure (Plate 4), another
another conceptual
conceptual
abstraction can be discovered.
abstraction discovered. The five subtracted
subtracted brainsets
brainsets each have a
fairly lateralized
lateralized activation
activation in the visual cortex, cortex, meaning
meaning that that the left
significantly more
side is significantly more active than than the corresponding
corresponding right right side, or
vice versa. The average brainset,brainset, however, is prominently
prominently bilateral,
bilateral, with
both
both the left and and right
right side of the visual cortex cortex showing
showing high (white)
subtracted activity. Thus,
subtracted Thus, thethe process of averaging
averaging here produces
produces a new
quality in the
quality the average brainset
brainset that
that is not
not present
present in any of its source
brainsets. When
brainsets. When I have discussed this image with with other
other brain-imaging
brain-imaging
researchers, the most
researchers, most common
common response
response has been, “Yes, "Yes, thatthat is right,
but if you think
but think that
that is bad, let me tell you a story story ..... . ”" The point
point of
their stories
their stories is that
that there
there are many
many such inherent
inherent but well-known
well-known risks
algorithm... The key is keeping
in every algorithm keeping them
them from endingending up in the
results section
results section of the journal
journal article, not not· in keeping them them out out of the
images (see below under “Extreme Images”
under "Extreme Images").).
Averaging can be also be done before subtracting subtracting images. A group group of
brainsets of schizophrenic
brainsets schizophrenic patients
patients might
might be averaged together,
together, and thenthen
averaged brainset
an averaged brainset from a groupgroup of normal
normal controls
controls can be subtracted
subtracted
from it. InIn this case, the difference between between the normal
normal subjects’
subjects' brain­
brain-
and the
sets and the differences between
between the schizophrenic
schizophrenic subjects’
subjects' brainsets
brainsets
filtered out
are filtered out as noise first, and and only the group-shared
group-shared intensities
intensities are
subtracted. This result
subtracted. result is thenthen interpreted
interpreted as potentially
potentially specific to
“ schizophrenic brains."
"schizophrenic brains.”
two-step process.
This is a two-step process. First, the selected (super)schizophrenic
(super)schizophrenic pa­ pa-
tients are scanned
tients scanned andand their
their brainsets
brainsets averaged,
averaged, creating
creating an “average
"average
schizophrenic subjects-group
schizophrenic subjects-group brainset.”
brainset." Already, the presumption
presumption to be
meaningfully average together
able to meaningfully together a group
group of schizophrenic
schizophrenic subjects
into the
is sliding into the notion
notion of a "schizophrenic
“ schizophrenic brainset.”
brainset." This is to be
compared
compared with with the "average
“ average (super)normals-group
(super)normals-group brainset,”
brainset," inter­
inter-
preted as a "normal
preted “normal brainset."
brainset.” In the second step, the normal normal brainset
brainset is
subtracted from the
subtracted the schizophrenic
schizophrenic brainset,
brainset, with
with the result
result suggesting a

86
 PRODUCING
PRODUCING BRAIN
BRAIN IMAGES
IMAGES OF MIND
MIND

“ brainset of schizophrenia
"brainset schizophrenia itself"
itself” -—that
that is, the disease is presented
presented as
“ only” difference between
the "only" between the two two groups,
groups, all other
other difference,
difference, it is
hoped, having
hoped, having been eliminated
eliminated as noise.
between brain
Difference between brain images is another
another one of'
of the words,
words, such as
significance, whose
significance, whose multiple
multiple meanings
meanings often ambiguously
ambiguously andand produc­
produc-
Here the difference
tively play off of each other. Here difference (as nonsimilarity}
nonsimilarity) be­
be-
tween the
tween the two
two groups
groups is layered
layered on toptop of the difference
difference (as the result
result of

r arithmetic subtraction)
an arithmetic subtraction) between
Identifying areas
Identifying areas of the
between the
the averaged
the two
two brainsets.
averaged brainset
brainsets.
brainset that
that are significant is the
province of computational
province computational algorithm
algorithm writers
writers who debate
debate the relative
merits of each system.
merits

PETER
P e t e r Fox:
F o x : I started
started playing
p lay in g around
aro u n d wwith
ith the first sp spatial normaliza-
atial n o rm aliza­
tion routines,
rou tin es, with
w ith Talairach
T alairach anda n d figuring oout ut h how use skull
o w to use
landmarks
lan d m ark s as ways w ay s to normalize,
n o rm alize, anandd ddeveloped schemee ooff it th
evelop ed a schem that
at
I could
c o u ld do
d o with
w ith a ruler and an d a calculator.
calculator. I presented
presented it at a lab
meeting,
m eeting, and an d everybody like it. SSo Joel
o Jo [Perlmutter]
e l [Perlm utter] sasaid
id ththat
at he
would
w o u ld be willing
w illin g to code it. He did,, an
H e did andd every
everybody
bod y u used
sed it. It w was
as
the laboratory
lab o rato ry standard.
stan d ard .
terms of] developing
[In terms developing the the averaging,
averaging, [Mark] Mintun Mintun and [Eric [Eric
Reiman and
M.] Reiman and myself talked
talked about
about it a lot. Then Then we began kind
arguing out
of arguing out the steps, because averagingaveraging sounds easy, but but there
are a lot lot of steps involved. You have to mask the data, data, and there
are a lot of interim interim steps. So we would would argueargue through
through the steps,
then code it, then
then then test it. We kept kept playing
playing with with it —the automatic
it-the automatic
search routine,
search routine, the local maximamaxima searching
searching —so - so when
when you have this
cluster of pixels that
big cluster that you can talk about about it in some more precise
way. That That algorithm
algorithm developed
developed by sitting
sitting andand fooling
fooling around
around withwith
region and
a region and kindkind of floating
floating a region
region around
around in 2-D to see how
reproducible it was to find a center
reproducible center of mass based on a moving
region. It turned
region. turned outout that
that it was reproducible,
reproducible, and I sat down down and
figured out
figured out how
how to do it in a third third dimension,
dimension, again with with paper
paper and
pencil, and
pencil, and then
then took
took that
that to Mintun.
Mintun. I said, “"II can reduce reduce these to
three-dimensional center
a three-dimensional center of mass between
between slices,”
slices," and I had had the
data. I collected
data. collected thethe data
data and showed
showed him how how reproducible
reproducible it was
between subjects. So he then
between then did some computercomputer simulations
simulations and
tested the
tested the robustness
robustness of it, and and demonstrated
demonstrated really elegantly how how
precisely thatthat could be done. Then Then again,
again, thatthat was moremore software
software
that we then
that then applied
applied to the data.
data.
We wentwent and and talked
talked to statisticians
statisticians on and off and and found
found them
generally struggling
generally struggling with with the problem
problem and not not understanding.
understanding ..... . .
different from
It was so different from anything
anything that that they
they had
had done that that they
didn’t have much
didn't much to say. So ultimately,
ultimately, withwith a lot of the statistics
statistics —-
I
87
r
CHAPTER 3

and the same is true

and true for [KarlJ
[Karl] Friston
Friston and the SPM [statistical
parametric mapping]
parametric mapping] -—it was developed by the people who wanted wanted
to and then
Co use it, and then it was critiqued
critiqued by the statisticians.
statisticians. If you go to
Chem -—again, fairly universal
them universal experience — -youyou go to a statistician
statistician
and say we have this problem,
and problem, our data structurestructure is like this and
our question
our question is this, they'll
they’ll say: “Wow,
"Wow, that that is a hard
hard problem.”
problem."
You say, "I “ I know. What
What is the solution?”
solution?" They say, “"II don’t don't know.”
know."
If you [could have caught] their their interest,
interest, maybe they they could have
solved it.
what happened
But really what happened is that
that people got out statistics text­ text-
books and started
books started reading
reading and started
started learning
learning about
about probability
probability
theory and
theory and the central-limit
central-limit theorem
theorem and began trying to see how ·
apply
to apply those principles
principles to our datasets.
datasets. Friston
Friston wasn’t
wasn't a statisti­
statisti-
Friston is a psychiatrist,
cian. Friston psychiatrist, b u t... . .
but
DuMIT: had a problem
D u m it: He had problem to solve .... . .
Fox: He had had a problem
problem to solve-that
solve —that is exactly right. And got
deeper and
deeper and deeper intointo the statistical
statistical theory
theory and coded all of that that
himself. I mean, all of that that SPM stuff, Friston personally
personally coded. He
learned how
learned how to use MATLAB [software [software for data analysis], and he
generated
generated it all.

There are different

There different assumptions
assumptions built into each kind of statistical
statistical al­
al-
gorithm. Most
gorithm. Most algorithms
algorithms always highlight
highlight one or more brain
brain regions — -
highest peaks,
they choose the highest peaks, for example. As such, they they cannot
cannot be
disconfirm the premise
used to disconfirm premise that
that there
there are active brain
brain regions (Uttal
2001, p. 185). The fundamental
2001, fundamental pointpoint of contention
contention between different
approaches is that
approaches that there
there is no other
other method
method of proving
proving what
what significant
brain activation
brain activation should
should look
look like. Should a set of voxels be interpreted
interpreted
center-of-mass algorithm
via a center-of-mass algorithm as Fox described or using SPM as Friston Friston
activation approach
uses or via a field activation approach as Per Roland
Roland argues in Brain
Activation} (Roland
Activation? (Roland 1993). At the presentpresent time, these are all competing
competing
approaches to analyzing
approaches analyzing brainset
brainset data
data for significance.
data on individuals
Finally, data individuals from
from different machines
machines and different
different in­
in-
stitutions can be combined
stitutions combined into into a large database
database of “"human
human brain anat­
anat-
function.” The Institute
omy and function." Institute of Medicine set up a National
National Neural
Neural
Circuitry Database
Circuitry Database Committee
Committee in October
October 1989 to evaluate
evaluate how
how such a
database might
database might be constructed.
constructed. This committee’s
committee's difficulty with
with levels of
brain data
analysis of brain data led to the publication
publication of a set of priorities
priorities and
recommendations for pilot
recommendations pilot studies, Mapping
Mapping the Brain and Its Func­ Func-
Integrating Enabling
tions: Integrating Enabling Technologies into Neuroscience
Neuroscience Research
(Pechura andand Martin
Martin 1991), a book book which
which features four PET scans on
its cover (see Plate 14). The Human Human Brain Project
Project is another
another project
project
funded as a result
funded result of this effort,
effort, and
and it includes grants
grants for BrainMap
BrainMap and

88
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PRODUCING
PRODUCING BRAIN
BRAIN IMAGES
IMAGES OF MIND
MIND

the Probabilistic
Probabilistic Atlas (National
(National Institutes
Institutes of Health
Health 1993). BrainMap
BrainMap
is a distributed
distributed computer
computer program
program (distributed
(distributed across several physical
locations
locations and connected
connected through
through the Internet)
Internet) that
that integrates
integrates informa­
informa-
tion
tion from peer-reviewed
peer-reviewed studies of the functional
functional brain
brain so they may
be cross-referenced
cross-referenced by anatomical
anatomical location
location (Beaulieu 2000;2000; Fox and
Woldorff
Woldorff 1994). The Probabilistic
Probabilistic Atlas is an attempt
attempt to correlate
correlate scales
of information
information about
about the brains
brains of normal
normal subjects matched for handed­
matched handed-
ness, age, and gender with with variability
variability across different
different populations
populations
(Mazziotta
(Mazziotta et al. 1995).3
1995). 355
These techniques
techniques of averaging,
averaging, subtracting,
subtracting, and databasing
databasing are both
very powerful
powerful andand very tricky
tricky in terms of evaluation
evaluation and significance.
These techniques
techniques emphasize similarities
similarities across individuals
individuals and treattreat dif­
dif-
ferences between
between them
them as “noise”
"noise" (irrelevant
(irrelevant information).
information). They neces­neces-
sarily presume
presume that
that there
there is no significant anatomical
anatomical variability
variability in the
functions
functions being studied (Fox and Pardo Pardo 1991). These techniques
techniques have
been successfully and prominently
prominently used in the study of language, language, for
instance,
instance, in spite of studies that that have shown
shown widespread
widespread individual
individual
variability:
variability: ·
Mapping
Mapping of cortical
cortical language
language sites by stimulation
stimulation studies of the
surgically exposed
exposed dominant
dominant hemisphere
hemisphere demonstrates
demonstrates that
that there
there is
tremendous
tremendous inter-individual
inter-individual variability
variability in the location
location of essential lan­
lan-
guage areas.
areas ..... . . Many
Many of these areas fall outsideoutside the classically delin­
delin-
eated Wernicke’s
Wernicke's and Broca’sBroca's areas. Furthermore,
Furthermore, any specific zone
within
within Wernicke’s
Wernicke's or Broca’s
Broca's area was found found to be essential for lan­
lan-
guage in less thanthan half of the cases.
cases ..... . . It is apparent
apparent that
that the vari­
vari-
ability of language organization
organization is so greatgreat that
that a mapping
mapping procedure
procedure
must
must be carried
carried out in each individual
individual for whom whom language
language localiza­
localiza-
tion
tion is important.
important. (Martin
(Martin et al. 1990, citing Ojemann Ojemann 1979 and
Ojemann
Ojemann et al. 1989)
The issue of variability
variability is not
not unaddressed
unaddressed within
within most
most PET articles,
but
but it is subordinated
subordinated to PET’s
PET's ability to generate
generate statistically
statistically significant
results. Calling attention
attention to this subordination,
subordination, one editorial
editorial was enti­
enti-
tled, “"Can
Can Statistics Cause Brain Damage?”
Damage?" (Ford 1983). This is not not the
place to examine
examine critiques
critiques of PET statistics
statistics but to simply acknowledge
acknowledge
that
that these issues are undergoing
undergoing lively debate
debate within
within the corridors,
corridors, dis­
dis-
cussions, and appendixes,
appendixes, of the PET community.3
community. 366 The most most significant
conceptual
conceptual concern
concern seems to be whether,
whether, andand where,
where, PET shouldshould be
used as inferential
inferential (hypothesis-confirming)
(hypothesis-confirming) or or exploratory
exploratory (hypothesis-
generating).
generating). Rapoport
Rapoport reports
reports on the “heated”
"heated" discussion
discussion of this issue
at a 1989 workshop
workshop on PET data data analysis, relating
relating to “whether
"whether it is
better
better to avoid type I errors
errors (where a statistically
statistically significant positive
finding proves erroneous)
erroneous) rather
rather than
than type II errors
errors (where statements
statements

89
 CHAPTER 3
CHAPTER

statistical insignificance prove erroneous)”

of statistical (Rapoport 1991,
erroneous)" (Rapoport 1991, p.
A142).3377 Rapoport
Al42). Rapoport appeared
appeared to lean toward
toward the exploratory
exploratory use of PET,
where results
where presented that
results are presented that may be wrong but that
wrong but that can spark
spark fur­
fur-
ther studies.
ther

STAGE
STAGE 4: PRODUCING INTERPRETED
PRODUCING INTERPRETED IMAGES
IMAGES

Inferences drawn
Inferences drawn from
from qualitative
qualitative in vivo measurements
measurements ..... .
must be viewed with
must with extreme
extreme caution
caution despite their
their intuitive
intuitive
visual appeal.
appeal. Unfortunately, sort of inference
Unfortunately, this sort inference is the
rule rather
rather than exception.
than the exception.
(Perlmutter and
(Perlmutter and Raichle 1986).

Parenthetically, the [PET scan] pictures

Parenthetically, that are
pictures that
particularly attractive
particularly attractive that
that you have seen in general are
fairly heavily doctored,
doctored, in the sense of making
making them
them more
attractive than
attractive than they should
should be,
be.
-—Michel
Michel M. Ter-Pogossian

correlated difference, having

Significant, correlated having been determined
determined in the form
form of
voxels, now
now must
must be made
made visible. This dataset
dataset of quantitative
quantitative results
now be mapped
can now mapped ontoonto a spatial
spatial coordinate displayed on
coordinate system and displayed
computer screen as a brainset
a computer brainset (Wolf 1981a). Although the
1981a). Although the resulting
resulting
two-dimensional, the brainset
image is two-dimensional, brainset is actually
actually three-dimensional,
three-dimensional,
where the
where the third dimension is typically
third dimension typically represented
represented using color or bright­
bright-
ness (see Plate 9).
Peter Galison
Galison describes a historical
historical process in which mechanical ob-
which mechanical ob­
jectivity—the insistence
jectivity-the insistence on the natural
natural transfer
transfer of the real objects to
image —gives
- gives way to an improved
improved object: the interpreted
interpreted image (Gal-
(Gal­
ison 1997,
1997, p. 349). The interpreted
interpreted image is seen as a more “realistic”
"realistic"
process because it can be recognized
recognized by nonspecialists. “For the image
nonspecialists. "For
purely ‘natural’
to be purely to become, ipso facto, as obscure
'natural' was for it to obscure as the
nature it was supposed
nature supposed to depict"
depict” (p. 351).
i
i,, DuMIT:
D u m iT: One of the strengths
One strengths of PET is that
that it gives you quantitative
quantitative
data.
data. And at the same time you produce
produce visual, qualitative
qualitative images.
How
How do these two things
these two things work together? Can you read
work together? read images?
ag n e r: There
WAGNER:
W There is a tremendous
tremendous amount
amount of data.
data. When
When you say
quantification,
quantification, you are talking about numbers,
talking about and these spatially
numbers, and spatially
oriented
oriented studies, these four-dimensional
four-dimensional studies, three
three dimensions
dimensions
in space andand one dimension
dimension in time, can only be abstracted
abstracted and
displayed
displayed in a meaningful
meaningful way in the form
form of images. Otherwise
Otherwise
there
there are too many
many numbers.
numbers. Your brain
brain can’t handle more
can't really handle

90
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PRODUCING &RAIN
PRODUCING BRAIN IMAGES
IMAGES OF MIND
MIND

than a couple
than couple of variables
variables at one time if they are quantitative,
quantitative, so
you have to have abstractions.
abstractions. And images are a very, very nice
abstracting quantification.
way of abstracting quantific~tion.

Starting with
Starting normalized brainset
with the normalized brainset or withwith the averaged
averaged subtracted
subtracted
brainset, the primary
brainset, primary problem
problem is how how to makemake sure the readerreader can un­un-
derstand both the location
derstand both location of the voxels of significance and the meaning
and the meaning
the (relative) activity values. The "simplest"
of the “ simplest” method
method is to assign each
number a shade of gray, starting
number starting with
with black for 0O and ending with white
ending with
assuming that
for 100, assuming that the values rangerange from
from Oto
0 to 100. Because it is not not
always possible or desirable,
desirable, however, to present present 100 shades of gray- gray­
scale, decisions have to be made as to how how to group
group different
different values
together into
together into different
different shades.
shades. This process of grouping
grouping is called "win- “win­
dowing,” meaning that
dowing," meaning that one range
range of values (e.g., 0-10)0-10) will be assigned
to black,
black, another
another range (11-20) to dark
range (11-20) dark gray, and
and so on (figure 3.9a}.
3.9a). If
most of the variation
most between two
variation between two images takes place between between 40 and
50, however, this will render render the two two images nearly
nearly identical.
identical. In this
the windows
case, the windows can be adjusted adjusted so thatthat perhaps
perhaps 1-351-35 = black, 35- 35-
40 = darkest
darkest gray, and most of the the variation
variation in color takes place along
color takes
the bands 41-42,
the 41-42, 43-44,
43-44, 45-46, 47-48, and 49-50,
45-46, 47-48, 49-50, withwith 50-55
50-55 being
lightest gray and 56-100 56-100 being white white (figure 3.9b). This windowing
windowing
scheme makes the difference between between the two two images stand
stand out clearly,
conceptually it makes the close similarity
and conceptually similarity of the two two brainsets
brainsets ap-
ap­
pear not
not to be very similar at all. Similar to to the way thatthat voxels define a
specific scale of spatial
spatial resolution
resolution andand invent
invent brain regions, here the
brain regions,
different windows
different windows define activity resolution and invent invent a set of discrete
activation levels,
levels, visually eliminating
eliminating the variability
variability with
with the levels.
Voxels have become pixels.
more elegant
A more elegant solution
solution to the windowing problem is to use colors
windowing problem
rather than
rather grayscale. The use of color
than grayscale. display differences in
color scales to display
intensities in brain
intensities brain images was pioneeredpioneered by Louis Sokoloff at the N a­
Na-
tional Institutes
tional Institutes of Health
Health (NIH).
(NIH). He explained
explained thatthat in digital auto­
auto-
radiography
radiography (one of the precursorsprecursors of PET), the researcher's
researcher’s eye could
not
not see all the shades of gray that that could displayed (Sokoloff 1986;
could be displayed
Sokoloff et al. 1977). Color Color was introduced
introduced to make make subtle distinc­
distinc-
tions
tions visible. This consists of assigning to each subrange subrange of numbers
numbers
(the full range
range of whichwhich varies from, from, say, 1 to 100) a specific color
1-10 = black, 11-40=blue,
(e.g., 1-lO=black, 11-40 = blue, 41-60=green,
41-60 = green, 61-70 = red, 71-100
61-70=red, 71-100
= yellow). Now
=yellow). Now thethe brainset
brainset can be presented picture, either
presented as a picture, either three-
three-
dimensionally
dimensionally or by slice. slice. The coloring
coloring process is very important,
important, as the
final images look very different different depending
depending on how how they are colored,
colored,
even if they are based on exactly the same brainset. brainset. The data data is thus
dynamic even after
dynamic after all of the transformations
transformations have been accounted accounted for.

91
91
CHAPTER 3
CHAPTER

F i g u r e 3.9. Gray scale differences. Figures (a) and (b)

FIGURE (b) have the same numerical
numerical
data
data set behind them, but
behind them, colored according
but they are colored according to two different
different tables of
black, gray, and white capture of the Image Viewer applet
white rules. (Screen capture applet (ePET).
(ePET).
developed
developed by Val Stambolstian, reproduced courtesy
Stambolstian, Ph.D., reproduced courtesy of the Interactive
Interactive
M edia Group,
Media Group, Crump
Crump Institute
Institute for Molecular
Molecular Imaging)

One effect of colorizing

colorizing is that
that new
new areas appear
appear as discrete
discrete and
and sharply
sharply
bounded, rather
bounded, rather than diffuse. 388
than diffuse.3
The effect can be profound.
profound. Color not a simple linear
Color is not linear or even two-
dimensional
dimensional array
array of values. It is best represented
represented by some form of
three-dimensional
three-dimensional model.
model. Choosing
Choosing a set of colors to represent
represent linear
linear
activity
activity values is therefore
therefore an arbitrary
arbitrary choice. Because these colors do
not
not correspond
correspond to the real colors of the brain,
brain, they are known
known as pseudo-
pseudo­
Michel Ter-Pogossian
colors. Michel Ter-Pogossian explained
explained it this way in an interview:
Pseudo-color exaggerates
Pseudo-color exaggerates and
and may distort
distort the information that is in
information that
data. There
the imaged data. number of color scales, like the heated-
There are a number heated-
object color
object color scale or color mapping
mapping that
that the visual system knows
knows
enough about
enough about the relation different colors
relation of different colors to each other
other to be able
to say, “Well, that color
"Well, that represents a hotter
color represents object than
hotter object than the other
other

92
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PRODUCING BRAIN IMAGES OF MIND
MINP

colors.” So you can order

colors." order the colors. Whereas
Whereas howhow do you order
order a
pseudo-colored object? You can't-you
pseudo-colored can’t —you can't
can’t tell whether
whether blue is
more or less than
than green. It is a two-dimensional
two-dimensional color
color space anyway,
and how
and wander around
how you wander around in that
that color
color space is not
not well defined.
As with other aspects of PET,
with other PET, different different preferred
different labs have different preferred
color
color schemes. The ePET applet applet is revealing
revealing in this because in addition
addition
to descriptive
descriptive names for various
various color
color schemes such as “"Black Black on
White,” “"Hot
White," Hot Metal,"
Metal,” and
and “Rainbow
"Rainbow 1," 1,” there
there is also a location
location name
"UCLA"
“UCLA” (see Plate 8).
debates over various
The debates color schemes concern
various color concern clarity
clarity versus a no­ no-
tion of fidelity. Many
tion Many color
color schemes, such as the rainbow rainbow one, shift
from
from bright
bright to dark bright again while changing
dark to bright changing colors.
colors. This can
create
create a significant visual shift, rendering change in numerical
rendering a small change numerical
value as a solid boundary
boundary between
between what
what now appears to be two
now appears two distinct
distinct
regions. In this case, the spatialized
spatialized brain
brain regions
regions of the brainset
brainset com­
com-
bine with the activity resolution
with the resolution .of the windowing
windowing to create create a visible
“functional anatomy,"
"functional anatomy,” regions defined as contiguous
contiguous voxels all having
the same color of activity. The arbitrariness
the arbitrariness of the colors
colors reinforce
reinforce the
sense that
that these regions
regions are internally
internally coherent,
coherent, separate
separate fromfrom their
their
neighbors,
neighbors, and therefore able to adequately
and therefore adequately represent
represent the “functioning
"functioning
of the task”
task" in question.
question.
It must emphasized that
must be emphasized that the criticism here is part
part of the
the aporia
aporia of
visual representation
visual representation of data:
data: To makemake the activity
activity visible in itself to
readers, and not
readers, not simply a representation
representation of activity
activity in general
general (the way
that electroencephalograms
that electroencephalograms often appear), there
often appear), there is a necessary
necessary addition
addition
supplementary meaning.
of supplementary meaning. PET researchers
researchers readily
readily describe
describe their
their strug-
strug­
with this problem.
gles with problem.
D u m it; One of the things
DuMIT: that I am interested
things that interested in is the color
color pictures
pictures
in terms
terms of the different
different things
things that
that they can signify. In one case,
they can signify that
they that there
there is a lot of activity
activity going on here.
TER-POGOSSIAN: whatever you want
T e r -P o g o s sia n : Well, yes, they signify whatever want them
them to
signify. This is the pitfall, course. You can emphasize,
pitfall, of course. emphasize, for exam­
exam-
ple, a given phenomenon
phenomenon very artificially, if you want want to do it with
with
color. It is misleading,
misleading, too.
too. You have to be very careful
careful when
when you
are using it.
D u m it: Now
DuMIT: when there
N o w when there is purple,
purple, that
that is going outside
outside of the
boundaries
boundaries of the person's person’s head there. Is there
head there. there any significance to
the mottle that
the mottle that is going on?
e r - P o g o s sia n : No,
TER-PoGossrAN:
T No, this is noise.
noise. That
That purple,
purple, that
that is noise; this is
reconstruction
reconstruction noise. The reason reason why you see lines is thatthat they are
really reconstruction
reconstruction artifacts.
artifacts. And you see that
that in any reconstruc­
reconstruc-
tion
tion scheme, including
including CT scanning. However, very often
scanning. However, often you erase

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CHAPTU

that
that by just windowing
windowing it out. put. In other
other words,
words, these represent
represent very
low values,
values, as seen on this scale. So all you have to do is put put a
cutoff
cutoff limit and it is removed.
removed. But that that is what
what it is. And this, you
see, this is a reconstruction
reconstruction artifact.
artifact. Parenthetically,
Parenthetically, the pictures
pictures
that particularly attractive
that are particularly that you have seen in general
attractive that general are
fairly heavily doctored,
doctored, in the sense of making
making them more attractive
them more attractive
than
than they shouldshould be.
So to answer
answer your question,
question, no, to the knowledge
the best of my knowledge
there
there is no standardized
standardized scale. People have a tendency, of course, course, to
use the
the scales that that emphasize what they like to emphasize.
emphasize what emphasize.
DuMIT: Yes, I have been struck
D u m it: Yes, struck that
that each different
different institution's
institution’s pic-
pic­
tures tend to look very different
tures tend different from each other. It seems very, very
difficult to compare
compare PET scans from different different institutions.
institutions.
T e r -P o g o s sia n : It is very difficult. It is very, very difficult indeed.
TER-PocossrAN: indeed. It is
misleading to just
misleading just use purely aesthetic values.
purely aesthetic
Ter-Pogossian here describes one of the
Ter-Pogossian the more
more surprising
surprising aspects of the
brainset. Despite
brainset. Despite having
having fixed numbers
numbers for each pixel, the the ability
ability to
choose a coloring windowing scheme allows one to use them
coloring and windowing them to
“ signify whatever
"signify whatever you want
want them signify.” The brainset
them to signify." brainset is thus
thus highly
dynamic -—so dynamic,
dynamic dynamic, in fact, that
that Brian Murphy,
Murphy, the director
director of com-
com­
puting and the
puting the PET clinical physicist
physicist in the Department
Department of Nuclear
Nuclear
Medicine at the
Medicine the State University
University of New York, at Buffalo produced
produced the
stunning set of images in Plate 12 as a cautionary
visually stunning cautionary visual expla­
expla-
nation for PET physicians.
nation physicians.
What’s the difference between
What's between the 40 images [in Plate 12]? Which Which
normal, which
is normal, tumor, and which
which has a tumor, which has indications
indications of stroke?
Actually they’re
Actually they're all the
the same image of a healthy normal volunteer
healthy normal volunteer -—
displayed with
just displayed with different
different color scales. The effects createdcreated by var-
var­
color scales may be visually dramatic
ious color dramatic but but may also cause one to to
distinct boundaries
see distinct boundaries where there are none.
where there none. With
With so much
much image
occurring on the computer,
analysis occurring computer, where dialing up any color
where dialing color scale
you like is relatively
relatively easy, it is possible to make make almost
almost any feature
feature
stand out
stand out with
with the right tweaking (affectionately
right tweaking (affectionately referred
referred to as “"dial-
dial­
ing a defect").
defect” ). For this reason,
reason, it is important include a color scale
important to include
legend somewhere
somewhere on these images if they’re they're going to be shared
shared with
with
others so that
others that viewers will have some idea of how underlying
how the underlying
image intensity
intensity is being represented
represented (1st and and last image are presented
presented
with a linear
with ramp gray scale).
linear ramp
Note: The full series of images below appeared
Note: appeared on the the December
December
1996 cover of the Journal
Journal o off Nuclear
Nuclear Medicine Technology. One of
Medicine Technology.
the motivations
the motivations for creating
creating these images (aside from from their
their artistic
artistic
merit) was to illustrate
merit) illustrate that
that different “ interpretations” are possible
different "interpretations"

94
r
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.
.
.

for the same image under

PRODUCING
PRODUCING BRAIN
BRAIN IMAGES
IMAGES OF MIND

under the simple artificial manipulation

manipulation wrought
wrought
MIND

adjusting the color

by adjusting additional potential
color scale. An additional potential source of inter-
inter­
pretation error
pretation error was added
added at the time of publication
publication -—image orienta­
image orienta-
tion. One
tion. One must
must be extremely careful when
when viewing artifi­
viewing images in an artifi-
when they are upside down
cial color scale, especially when down and left/right
left/right
reversed.
reversed ..... . .
Pay particular
particular attention
attention to the hot
hot spot at the base of the image
and note
note how it can appear
appear “hot,”
"hot," “"cold"
cold” or “"disappear"
disappear” depending
depending
on the color scale used. (Murphy
(Murphy 1996)
Murphy
Murphy and Ter Pogossian both both describe the danger
danger in attempting
attempting to
actually
actually read a PET image out out of context. Their discussions highlight
context. Their highlight
tension between
the tension between what Jacques Bertin has referred
what semiologist Jacques referred to as
elementary (and intermediate)
elementary intermediate) readings
readings of graphic
graphic images -—in which the
in which
internally for relations
image is analyzed internally relations between
between elements
elements or groups
groups of
elements —and the overall reading,
elements-and reading, in which
which the
the image is apprehended
apprehended
as a whole,
whole, a gestalt impression,
impression, or in gross comparison
comparison to another
another
image. An elementary
elementary reading
reading of a PET image, for example,example, would
would in­
in-
volve attempting
attempting to determine
determine the flow rate for a particular
particular anatomical
anatomical
area, by attempting
attempting to read the value for a particular
particular pixel as the flow
rate for the voxel. An intermediate
intermediate reading
reading would
would involve comparing
comparing
hemisphere with
one hemisphere another, or the value of a ROI in one image with
with another, with
the same ROI in another. These distinctions
distinctions in reading
reading practices
practices concern
concern
how "technologies
how “technologies of representation"
representation” are deployed
deployed by scientists and
others to build persuasive
others persuasive accounts
accounts about
about the structure
structure of natural
natural and
worlds. This is what
social worlds. what Lynch and Edgerton
Edgerton called aesthetics,
aesthetics, "the
“the
very fabric of realism: the work work of discriminating
discriminating difference, ..... . and
establishing
establishing evident relations”
relations" (Lynch and Edgerton
Edgerton 1988).i9
1988). 39 PET is a
particularly
particularly good case to examine in this regard regard because the data it
provides is so interdisciplinary
interdisciplinary and expert,
expert, yet its images also appear
appear
quite convincing to nonexperts
nonexperts as well. In addition
addition to color
color schemes,
there
there are also completely different
different conventions
conventions for representing
representing the data
data
as brain
brain images. The examples
examples in thethe color plate section give an idea of
color plate
the difficulty of reading
reading images across labs.

1
, Extreme
Extreme Images
Images

Once the data

data has been condensed
condensed into a series of images and analyzed,
the researchers
researchers must decide which
which images to publish.
publish. In the following
discussion,
discussion, a researcher
researcher comments
comments on the process
process of using PET images
in his own articles. The image is one part
part of an argument
argument that
that neces­
neces-
sarily includes a textual
textual component.
component.

95
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DuMIT:
D u m it: W hen you do an article on PET for a journal
When journal ..... .
TER-PocoSSIAN:
T I'm working
e r - P o g o s sia n : Pm working on one right
right now!
D u m it: And you are trying
DUMIT: trying to select images for the article to demon­
demon-
strate
strate one way or another another what
what is going on. It looks to be be.. the
case —- and I can’tcan't tell because often there is not that that much informa­
informa-
tion presented
tion presented about about why
why these two two images were chosen — -itit looks
to be thethe case thatthat the most
most extreme
extreme images are chosen.
T e r -P o g o s sia n : Sure.
TER-PocossIAN:
D u m it: I’m
DUMIT: I'm curious
curious about
about this. Is this a kind kind of heuristic
heuristic idea, that
that
these images display display the difference that that is being talked
talked about? Are
they representative?
representative?
e r -P o g o ssia n : Well, it varies. It depends
TER-Pocoss1AN:
T depends on how you show the im­ im-
ages. For example,
example, if indeed
indeed you wantwant to to emphasize a difference,
you show the extreme extreme cases. However, in any responsible
responsible article, it
behooves
behooves you to emphasize emphasize also the overlapping
overlapping areas —and these
areas-and
are in any kind of study that that involves, say,
say, the comparison
comparison of some­some-
thing another —it
thing or another- it behooves
behooves one to use a statistical
statistical analysis. In
most
most instances
instances we have a statistician
statistician on the staff and we [ask][ask] him,
“How
"How do we present present the data?”
data?" And he in general has his own
approach;
approach; I’m I'm not
not a very good statistician
statistician myself. And he gives you
that
that data.
data.
But to get back to what what you are saying, very often indeed, in
most
most instances
instances you are going to select images that that emphasize
emphasize your
case, sure. But also, you might, if you so wish, show images that that on
the contrary
contrary show a false positive. It depends on what what you want
want to
do. But yes, you select the images that that prove your
your case. However,
the
the case is also proven,proven, supposedly,
supposedly, in your text.

Ter Pogossian
Pogossian emphasizes
emphasizes howhow extreme
extreme images — - images that
that look the
most
most different
different from
from each other —may be used to imply that
other-may that there
there are
significant differences that
that are demonstrated
demonstrated in the text. Alternately, an
image may be used to imply that that in spite of a significant finding, there
remains
remains a strong
strong possibility
possibility of mistaking
mistaking a normal
normal case for an abnormal
abnormal
one. In spite of this, as he indicates,
indicates, extreme
extreme images are often used.
For example,
example, in looking
looking at PET images in a scientific article, I was
struck
struck by the way extremeextreme images were presented
presented as iconic proof
proof of
experiment. In this experiment,
significance in an experiment. experiment, an attempt
attempt to measure
measure
the effects of aging on the brain, forty normal
brain, forty normal volunteers,
volunteers, ages 18 to 78
years, were scanned
scanned with
with PET (figure 3.10a).
3.10a). A series of graphs accom
graphs accom­ 0

panied
panied the article
article produced
produced as a result of this experiment.
experiment. The caption
caption
reads: “The
"The degree of metabolic
metabolic hyperfrontality
hyperfrontality varies considerably
considerably
among
among normal
normal subjects,
subjects, but
but on average declines gradually
gradually with
with age”
age"
(Kuhl et al. 1982). The graphs graphs show that although
that although the averages for

96
 PRODUCING BRAIN
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IMAGES OF
OF MIND
MIND

._. so
50 1 Glucose
' c 40
..... •..• •
•
C
40- (Kuhl)
a: .E fc
.. .• .
°' -
:::E~
40-
40 •
uI: 0obi
I
Ill 0
20-
20 • • • • •
CII -
:Eao • •• •
fc 10
E y=
= 32 - 0.128x;
0.128x;
10- SD = 5.7; =
=L
E: SD=5.7; n =40
0T
0 10
10 20 30 40
40 so
50 60
60 70
70 80
80
Age
(years)

FIGURE
F i g u r e 3.10
3.10 (a).
(a). Aging Graph.
Graph. "Graph
“ Graph showing decline in cerebral
showing decline cerebral glucose
glucoseutili­
utili-
zation (CMRglu)
(CMRglu) with age
age is
is the same
same in mean overall cortex,
mean overall cortex, caudate-thalamus,
caudate-thalamus,
and white
white matter.
matter. Each
Each data point represents average measurements
represents the average measurementsfromfrom 5
normal subjects.
subjects. Error bars represent
represent 1 standard deviation.”
deviation." (From
(From Kuhl
Kuhl et al.
al.
1982,
1982, with permission)
permission)

groups of five subjects does decline, the typical

groups typical variation
variation for any age
category actually
category actually overlaps
overlaps the
the averages of every other
other category. In other
other
words, given another
words, another PET scan of an unknown
unknown subject
subject near
near any of the
averages, there
averages, there would
would be no basis for deciding
deciding which
which age category
category that
that
person belongs
person belongs in.
constraint, exactly
In spite of this constraint, exactly two
two PET images are presented
presented in
the text
the text that
that look
look quite
quite different
different from
from each other;
other; one is of a 27-year-
old and
and the
the other
other is of a 75-year-old 3.10b). They were chosen
75-year-old (figure 3.10b).
not because they
not they represented
represented the
the youngest
youngest and the oldest
oldest in the set, nor
because they
because they were
were the
the average, but
but because
because they
they were the
the most
most extreme
extreme
the "extremes
cases, the “extremes of [the}
[the] ratio"
ratio” (Kuhl et al. 1982). In this case, the
two most
two most visibly different
different images of a set are presented
presented as if representa­
representa-
two different
tive of two different types brains.4400 I asked one of the researchers
types of brains. researchers
about this:
about

D u m it:
DuMIT: the article,
In the article, there
there are only two images shown,shown, and
and it says
underneath that
underneath that these images were chosen chosen because theythey were the
most extremely
most extremely different.
different. Is that
that a standard
standard practice,
practice, to choose the
most extreme
most extreme images rather rather than,
than, say, the
the average for each?
PHELPS: Yes. What
P h e lp s: Yes. What is maybe not not so common
common a practice
practice is to point
point out
that you did that
that that...... . .
Right.
D u m it: Right.
DUMIT:
P h e lp s: Well, yes. If you are honestly
PHELPS: forthrightly trying to show
honestly and forthrightly
something
som ething in the article, you try [to] take the data and the images
and process them to to point
point that
that what know to be true you can
w hat you know

97
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CHAPTER 3

F
F F

}
i
I
FIGURE
F i g u r e 3.10
3 . 1 0 (b). Extreme
Extreme images of aging. “The"The hyperfrontality
hyperfrontality index wwasas the
\I ratio
ratio of cerebral
cerebral metabolic
metabolic rate for glucose in the surperior
surperior frontal
frontal cortex
cortex (F)
(F) to
the average rate rate in the superior
superior parietal
parietal cortex
cortex (P).
(P). Extremes
Extremes of this ratio
ratio were
at 1.22 in a 27-year-old
27-year-old subject
subject (left) and 00.82 75-year-old subject (right).”
.8 2 in a 75-year-old (right)."
(From Kuhl et al. 1982, with with permission)
permission)

extreme cases for the readers to be able to see

see. So we take the extreme
them.
them. You have the tabulated data
tabulated data to look at all cases. It is fine.
Embedded in his explanation
Embedded explanation is a twofold
twofold critique: On the one hand,
having carried
having carried out
out the experiment,
experiment, the expert
expert knows thatthat there is aa·
data. He or she can see it in the numbers,
significant finding in the data. numbers, yet
others, nonexperts,
others, nonexperts, cannot.
cannot. The expert,
expert, however, can produce
produce a picture,
data, that
using some of the data, that illustrates what
what the data
data as a whole show
show-—
represent a statistical
an ideal to represent statistical trend.
trend. On the other
other hand, this re­re-
searcher is careful to note a potential
searcher potential abuse lurking in this practice, that
that
part may be taken
the part taken for the whole. In this case, without
without the careful
caption and
caption and without
without the accompanying
accompanying data graphs, it would would be easy to
that younger
conclude that younger brains are simply
simply quite distinguishable
distinguishable from
should be noted
older ones. It should noted that
that though
though choosing to print
print extreme
appears to be standard
images appears standard practice,
practice, in practice
practice such a choice is al­
al-
most never stated.
most stated. Researcher, Richard
Richard Haier
Haier concurred:
concurred:
publish group
We always publish group statistical
statistical data
data-—usually analysis of vari­
vari-
ance, sometimes multiple t-tests. That That is always reported
reported in detail in
Our conclusions
the paper. Our conclusions are based on the statistics. Most Most of the
although not
time, although not all of the time, we include a color picture,
picture, because
journals like color pictures,
journals pictures, everybody likes color pictures —and that
pictures-and that
what they remember. When
is what When we do that,that, we select images that
that illus­
illus-
trate the group
trate group statistical
statistical finding. It is not
not the other
other way around.
around. SoSo
picture that
the picture that was in Newsweek,
Newsweek, I just took took the person
person with
with the
person with
highest score and the person with the lowest score [see
[see Plate 7]. And

98
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MIND

it looked so compelling, but that’s

that's what
what the effect was, that
that is why it
was so compelling. I took the best exemplar, I tooktook the best pair, to
exemplify that.
that. That
That is true. But I don’t
don't see anything
anything wrong
wrong with that.
The images presented
presented in these popular
popular and scientific articles are then
not to be carefully interpreted
interpreted pixel by pixel. The displayed images images
should not be measured; they are not meant meant to be. Rather, they are
consciously selected to enhance the textual argument. They are crafted
textual argument.
to undergird,
undergird, teach, and illustrate
illustrate the process of discursive and statisti­
statisti-
cal persuasion.
persuasion. One researcher has commented
commented that
that
Functional
Functional information
information is communicated
communicated very approximately
approximately by
images and requires quantification
quantification to be meaningful.
meaningful. Thus the imag­
imag-
ing capabilities of PET,
PET, which derive from the mode of data collec­
collec-
tion, can at best serve as an aide memoir, or illustration,
illustration, of much
more detailed data pertaining
pertaining to a variety of cerebral functions.
(Frackowiak
(Frackowiak 1986, p. 25}
25)
Despite such qualifications, precisely, these simplified
qualifications, however, it is precisely'these
“"illustrations"
illustrations” that
that are valorized when
when these images travel
travel from the lab­
lab-
oratory
oratory into articles and into popular
popular culture.
culture. In textbooks,
textbooks, as well,
extreme
extreme images can have cultural illustrations of types
cultural effects. Used as illustrations
of brains, these images become “"classic"
classic” expressions
expressions of pathology, or
“"textbook
textbook images.”
images." In the “"Chairman's
Chairman’s Corner,”
Corner," an editorial
editorial spot in the
journal
journal Investigative Radiology, comments on social
Radiology, Melvyn Schreiber comments
conditioning
conditioning with which medical students learn to identify “"beautiful"beautiful”
pictures:
We don’t
don't mean that
that it’s
it's pretty
pretty but
but rather
rather that
that it is exquisitely repre­
repre-
sentative of the classic expression
expression of the disease. When When our
our mental
conception
conception of the textbook
textbook picture
picture of an abnormality
abnormality is reproduced
reproduced
perfectly in life, we describe the image as beautiful,
beautiful, largely out of
appreciation
appreciation for its verisimilitude and partly
partly out recognition of the
out of recognition
ease with which the diagnosis can be made when when all of the necessary
elements are present
present and recognizable, as they so rarely are. (Schrei­
(Schrei-
ber 1991, p. 771)
The verisimilitude that ob-
that Schreiber refers to is the fidelity of the ob­
served image to the textbook
textbook image. The practice
practice of producing
producing extreme
images is also encouraged
encouraged by regulatory pharmaceutical
regulatory agencies and pharmaceutical
companies. One researcher
researcher who had worked pharmaceutical
worked at a large pharmaceutical
company, for instance, told
told of how he had to search “until
"until the ends of
the earth”
earth" to find two images, one normal
normal and one pathological,
pathological, which
could clearly show the difference to the FDA. Another
Another researcher
researcher com­
com-
mented on these and other
other popular
popular uses of difference images:

99
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put a lot of emphasis in trying to

Well, we put to get pharmaceutical
pharmaceutical con­
con-
tracts when
tracts when we started.
started. And I think
think it was our experience in general
that they weren't
that weren’t terribly
terribly interested.
interested. They were only interested
interested at cer­
cer-
tain stages of development.
tain development. If they thought
thought it would
would help them get
through the FDA, then
through then they would
would be interested,
interested, but
but we found
found that
that
most of our pharmaceutical
most pharmaceutical contracts
contracts really came through
through the PR
departments, the advertising
departments, advertising departments,
departments, not
not through
through the science de­de-
partments. And they were after pretty
partments. pretty pictures to putput in the ads,
which apparently
which apparently worked,
worked, and worked
worked well.
I cite these examples in orderorder to demonstrate
demonstrate the persuasiveness of
practice of exemplary
this visual practice exemplary images whose purpose
purpose is easy recogniz-
rarity of such recognition
ability (in spite of the rarity recognition in practice), yet whose
function is often one of proof
function proof of difference.
that these picture
The risk that picture pose, I am arguing, lies in their multivocal
readings. They are bothboth veridictory
veridictory graphs
graphs and emphatic
emphatic illustrations.
illustrations.
appears in stark
This risk appears stark outline
outline in courtrooms,
courtrooms, as discussed in chapter
chapter
(“Ways of Seeing Brains as Expert
4 ("Ways Expert Images”
Images"),), where the exemplary
images of the most
most normal
normal and most abnormal
abnormal can be transformed
transformed into
into typical
types, into typical representatives
representatives of normal
normal and abnormal,
abnormal, to “make
"make
difference.” Such a process, although
clear the difference." although scientifically and legally
sanctioned, risks making it appear
sanctioned, appear as if one could go from single scan to
picture to
diagnosis, from picture to text.

PET as a Difference
PET Difference Engine

presentation of the search

In the presentation search for biological correlates
correlates of schizo­
schizo-
phrenic diagnoses, this collapse of scan to diagnosis seems to predomi­
phrenic predomi-
when the correlates
nate when correlates are located
located in the brain. Even though
though research
shown many relationships
since the 1970s has shown relationships between this diagnosis
symptom relief through
and symptom through pharmacological
pharmacological treatment,
treatment, visual presen­
presen-
tation of "schizophrenia"
tation “ schizophrenia” seems to promise much more (Buchsbaum et
3.11, taken
· al. 1985). In figure 3.11, taken from a book
book chapter
chapter on functional
functional imag­
imag-
brain images shown
ing, again the brain shown are the most extreme, leaving a vi­ vi-
differentiation of normal
sual sense of clear differentiation normal people and those with with
schizophrenia, even though
schizophrenia, though there
there are many schizophrenic
schizophrenic people whose
look like those
brains look those of normal
normal people, and normal normal people whose
people. 411 Significant in terms of
schizophrenic people.4
brains look like those of schizophrenic
virtual community
the virtual community of images is the way in which, though though the brain
diagnosed normal
scans of the diagnosed normal volunteers controls,
volunteers are labeled normal controls,
brain scans of the diagnosed
the brain diagnosed schizophrenics are labeled schizo­ schizo-
phrenia.42
phrenia.42 The image is thus thus labeled as showing the “"disease" disease” itself,

100
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PRODUCING
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BRAIN IMAGES
IMAGES OF MIND
MIND

A Normal Controls

Schizoph renia

B Normal Controls
Normal Controls

Schizoph ren ia

i g u r e 3.11.
FIGURE
F Schizophrenia supraventricular slices (a), and PET
Schizophrenia extremes. PET supraventricular
intraventricular
intra ventricular slices
slices (b),
(b ), for three normal subjects and three
three normal patients with
three patients
schizophrenia.
schizophrenia. (From Buchsbaum
Buchsbaum et al. 1985; reproduced with permission)
reproduced with

101
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rather
rather than
than a correlate
correlate symptom
symptom of someone found found to have schizo­
schizo-
phrenia.
phrenia. Hence, the symptom
symptom has been collapsed into the referent.
The important
important danger
danger of this collapse is that
that the symptom,
symptom, the brain
should have a very complex referent.
scan, should referent. The following is a list of
confounders, or variables that
possible confounders, that are often
often not
not taken
taken into
into account
account
but might
might affect the results of the study significantly.
significantly. This list was gener­
gener-
ated from a short
short list of articles on PET and mental
mental illness4
illness433::
Time of day, failure to controlcontrol for gender and age differences, degree
of handedness,
handedness, position
position of females in their
their menstrual
menstrual period,
period, varia­
varia-
tions in diagnostic
diagnostic criteria
criteria [Diagnostic and Statistical Manual
Manual ooff Men­
Men-
tal Disorders,
Disorders, third
third edition
edition (DSM, III), vs. Research Diagnostic
Diagnostic Cri­
Cri-
teria
teria of Spitzer et al. (1975)], exclusion principles for comorbid comorbid
conditions, behavioral phenomenology,
conditions, behavioral phenomenology, small subject populations,
populations,
psychotropic drug effects, differing experimental
psychotropic experimental designs, state versus
trait distinctions,
trait distinctions, metabolic
metabolic and modeling assumptions,
assumptions, resolution
resolution
versus size of anatomical
anatomical areas of interest,
interest, data collection, image
analysis, metabolic
metabolic consequences of experimental
experimental conditions
conditions (resting,
stimulations),
stimulations), definitions of resting, accuracy precision precision and repro­
repro-
ducibility of reconstructed
reconstructed data,
data, head positioning,
positioning, assumptions
assumptions of di­ di-
rect coupling
coupling of blood flow and energy metabolism,
metabolism, assumption
assumption that
that
these latter
latter two measure the same processes, assumption
assumption that
that subjects
with illness exhibit
exhibit a pattern
pattern of regular
regular energy metabolism
metabolism that
that can
distinguish them
distinguish them from "normal
“ normal subjects,"
subjects,” acute/chronic
acute/chronic differences in
schizophrenia, positive and negative symptoms, duration
schizophrenia, duration of illness,
premorbid adjustments,
premorbid adjustments, attentional
attentional and cognitive deficits, cycling pat-
pat­
terns of psychosis/relative normality
terns normality may notnot be captured
captured or repro-
repro­
ducible with with 30-minute
30-minute glimpses of metabolism,
metabolism, effects
effects of diet and
stress ..... .
The status
status of these confounders
confounders in PET experiments
experiments for PET re­ re-
searchers is rhetorically
rhetorically the contrary
contrary of that
that used by critics of schizo­
schizo-
phrenia
phrenia research. Critics such as Estroff (1993), Boyle (1990), Szasz Szasz
(1987), and Rose et al. (1984) use the existence of confounders
confounders to argue
against explanations of schizophrenia.
against the coherence of biological explanations schizophrenia.4444 By
By
that statistically significant results could have originated
showing that statistically originated from
instead of genes, for instance, these
selection or sociological factors instead
critics contend
contend either thatthat there is no proof
proof yet of biological schizo­
schizo-
phrenia
phrenia or that
that there is in fact no such coherent
coherent category of “"schizo-
schizo­
phrenia.”
phrenia."
Were these critics to turn
turn their
their analytical skills to PET studies, they
would
would find their
their work
work already done for them. Review articles on schizo­
schizo-
phrenia
phrenia list not
not only different findings but also contradictory
contradictory ones!4
ones!455 In
some studies, for example, “"hypofrontality"
hypofrontality” is found, that the
found, meaning that

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front part
front part of the brain
brain is less active than
than the rest. In other
other studies, “hy-
"hy-
perfrontality” is found,
perfrontality" found, meaning that that the frontal
frontal lobes are more active.
And in yet other
other studies, no difference in the frontal
frontal lobes was found.
“"No
No consistent, reproducible finding has been reported
consistent, reproducible reported in over fifty
studies,”
studies," the critics might “ clearly here is as much proof
might argue; "clearly proof as possi­
possi-
ble of the incoherence of the category, or of its social and not not biological
cause. ”4(
" 46
Such reasoning,
reasoning, however, is not likely for neuroscientific researchers.
However much they disagree about
However about what
what is important
important aboutabout schizo­
schizo-
phrenia and what
phrenia what is important brain, they share the Idea that
about the brain,
important about that
the brain must be in some fundamental
fundamental way the person. 477 The questions,
the person.4
o
off course, are: How
How much of the personperson is discoverable from studying
the brain what ways does the person
brain alone? In what person exceed his or her brain?

Sublime Brains, Sublime Scans

Sublime

Once we are able to insert

insert a molecule inside the brain,
brain, and
watch what
to watch what happens
happens to this molecule, basically the sky's
sky’s
the limit. I believe that
that PET’s
PET's the reason
reason why conventional
conventional
medicine is going to transform
transform into molecular
molecular medicine.
—
- Researcher

I use the word

word Idea above in the Kantian
Kantian sense of a schema through
through
humans understand
which humans understand the world.
world. I am interested how Kant
interested in how Kant con­
con-
conceptual processes with
nected conceptual with affective ones. In the mystery of diver-
diver­
brain findings about
gent brain about schizophrenia, then, I suggest that
schizophrenia, then, that neuro-
neuro­
researchers find a sublime
science researchers sublime object, which would describe as
which Kant would
producing negative pleasure: "In
producing “ In presenting
presenting the sublime in nature,
nature, the
mind feels agitated
agitated ...
. . . this agitation
agitation can be compared with a vibration,
compared with vibration,
i.e., with
with a rapid
rapid alternation
alternation of repulsion
repulsion from and attraction
attraction to, one
and the same object"
object” (Kant 1987, p. 257). Negative pleasure
pleasure imposes a
admiration and respect. If this is the case, we can imagine the
feeling of admiration
frustration
frustration and disgust with which PET researchers
with which researchers face the current
current in-
in­
ability to reproduce results with
to reproduce with schizophrenic
schizophrenic subjects and at the same
time the exciting challenge presented inability to rationally
presented by this inability rationally com­
com-
prehend
prehend how schizophrenia
schizophrenia is working
working in the brain.
brain.
The quality
quality of the feeling of the sublime consists in its being a
feeling, accompanying
accompanying an object, of displeasure about our aesthetic
displeasure about
power
power of judging, yet of a displeasure
displeasure that
that we present
present at the same
time as purposive.
purposive. What
What makes this possible is that
that the subject’s
subject's own
consciousness of an unlimited
inability uncovers in him the consciousness unlimited ability

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which
which is also his, and that
that the mind can judge this ability aesthetically
only by that
that inability. (Kant 1987, p. 258)
For the PET researcher, the scan shows what what the researcher
researcher cannot
cannot
yet imagine. The scan holds a key to the mystery of schizophrenia,
schizophrenia, but
the researcher
researcher cannot
cannot yet grasp it. Facing this challenge, then,
then, taking
taking on
the job of turning
turning contradictory
contradictory results into complex
complex understanding,
understanding,
might be said to be the negative pleasure
pleasure of the neuroscientists.
neuroscientists. This
might help in understanding
understanding their response to their so far
to their far inadequate
inadequate
results. The following,
following, for example, is the conclusion of an article listing
many of the confounders
confounders cited above:
With all of the caveats and criticism noted
noted above, we still believe
that the application
that application of PET technology
technology to psychiatry
psychiatry has its brightest
brightest
moments ahead. This is because we are dealing with
moments with a biochemical
tool which is limited mainly by the ingenuity
ingenuity of the practitioners
practitioners and
their skill at isolating a particular
their particular brain function
function in an experimental
experimental
paradigm. (Smith and Brodie 1986, p. 46)
paradigm.
The confounders,
confounders, in other
other words,
words, become reasons for the contradic-
contradic­
tory
tory results. The challenge lies in lining them up so as to comprehend
comprehend
the whole picture,
picture, the whole scan. In some cases, the researchers
researchers substi­
substi-
tute the truth
truth of the image for the truth
truth of the categories they
they started.
started
with. Critiquing
Critiquing the specificity of DSM-III-R (DSM-III,
(DSM-III, revised) and the
Diagnostic and Statistical Manuals in general, for instance,
instance, Faulstich
and Sullivan (1991) suggested that
that
patient heterogeneity
Significant patient heterogeneity can exist within
within diagnostic catego­
catego-
ries.
ries ..... . . In
In the future,
future, diagnostic subtypes based on PET datadata should
be considered.
considered. Patients
Patients with a particular
particular characteristically abnormal
characteristically abnormal
PET profile could be studied for patterns
patterns in genetic, biochemical, and
symptomatic presentations. Groups selected in this way may be more
symptomatic presentations.
homogeneous
homogeneous and may be more likely to have the same biological
etiology than than patient
patient groups
groups obtained
obtained through
through standard
standard diagnostic
criteria.
These PET-selected groups homogeneous in their
groups will be more homogeneous their brain
metabolisms.
metabolisms. If this leads to better treatment response prediction,
better treatment prediction, then
then
this might
might be a good approach.
approach. In any case, the brain has become for
them
them a receding horizon
horizon of answers.
answers.4488 Or, as another
another researcher
researcher put
put it,
connecting
connecting progress in techniques
techniques to progress in solving the brain,
[u]sing the in vivo tools of modern neuroscience, we can create com-
modern neuroscience, com­
parison maps of brain terrain
parison terrain for diseases such as schizophrenia,
schizophrenia, bi-
bi­
polar major depression,
polar disorder, major depression, Alzheimer’s
Alzheimer's disease, panic disorder,
autism, disorders, or attention
autism, eating disorders, hyperactivity disorder
attention deficit hyperactivity disorder

104
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BRAIN IM AGE5 OF
IMAGES MIND
OF MIND

(ADHD). As has been described [in this book] this process is already
well underway. During the next several decades, we can expect to
identify the abnormalities
abnormalities in brain geography
geography and topography
topography that
define the various types of mental
mental illnesses. Once this is accomplished
we will know
know where the enemy is. The techniques
techniques of molecular
molecular biol­
biol-
ogy will give us the capacity to do precision
precision bombing, while our maps
of brain
brain terrain
terrain will give us the targets at which to aim.”
aim." (Andreasen
2001,
2001, p. 320)
Where critics see proof
proof of no proof,
proof, neuroscientists
neuroscientists see the need for
more research.
In summary, PET images thatthat appear
appear must meet a contradictory
contradictory set of
demands
demands that
that are satisfied by images and their
their justifications:
•• Images are shown because they can be shown, shown, because they are
maps as much as statistics, because they symbolize and index
location.
• Images are shown
shown to illustrate
illustrate the statistics, not
not as proof
proof of types,
but
but as examples of the trend
trend and as harbingers
harbingers of the kind of results
that
that can be achieved.
•• Images are icons of the ability to get information
information out of the brain.
In the face of so many unanswered
unanswered and unanswerable
unanswerable questions at
this time, scientists need to show the ability to get results. Some
thing must to be shown, as indicating
indicating current
current success and as indi­
indi-
cating progress.
•• Images are shown
shown to sell
sell the process —to
- to get grants, to demonstrate
demonstrate
ability before the public, to show that that better results are “"on
on the
way,”
way," given more research.
In the next chapter, we will begin to look at how images circulate
beyond the lab and beyond the scientific journal
journal article. Given images of
difference, what
what do these images mean to to nonproducers,
nonproducers, to laypeople?
What
What kind of authority
authority and objectivity do they have, and where? HowHow
are they read?

105
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1
 Interlude3:
Interlude 3:
Who Can Read
W ho Can Read Other
Other Minds?
Minds?

D u m it : Some of the places where violence [as

DuMIT: [as biologically caused]
comes up are in courtrooms
courtrooms where PET scans have just started started to
make their appearance.
appearance.
WAGNER: Well, there are certain
W ag n e r: Well,'there certain general patterns
patterns that
that are true histori­
histori-
cally. First of all, some physicists have said, and I think
cally. think quite
that every time a physical measurement
frankly, that measurement is made and a
learned, physicians try to apply it to diseases, they
physical fact is learned,
try [to] relate it somehow
try somehow or otherother to diseases, either models or
think that
things. And I think that every time you make a correlation
correlation between
behavior and mental
behavior mental function,
function, you are going to find people that that are
context of free will or lack of free will. And I think
using it in the context think it
probably abused
is probably abused more thanthan it is being used; it is probably
probably being
misused. Some people believe that
misused. that you really don’t
don't have much free
will, and will defend people on that that basis. And therefore
therefore they
anything that
search for anything that can be used to support
support that
that position.
position. They
think it is more from a philosophical
may be right. I think philosophical basis thatthat they
are arguing, using that that as a basis, as a tool, rather
rather than
than that
that is a
great discovery. I mean, I'm
great I’m [more] willing to believe that that the per­
per-
can’t really control
son can't control their
their behavior
behavior as a result of their past expe­expe- ,
rience or genes thanthan I am to say because their corpus corpus collosum is
percent thicker
20 percent thicker than
than anybody
anybody else’s,
else's, that
that that
that is the reason
reason why
they are doing all of these things. So
they So it’s
it's a gimmick.
D u m it : So have you testified in court?
DuMIT:
 WHO
W HO CAN READ MINDS?
READ OTHER MINDS?

ag n e r: I’ve
WAGNER:
W I've been asked to do it. Usually we get a call here —some
here-some
lawyer calls up and wants wants us to do a study on some person, person, a head-
trauma
trauma patient
patient or something like that,that, and I refer him to somebody
else.
else.
D u m it: One of the fascinating cases that
DuMIT: that I found,
found, one of the early
trials using X-rays in the early 1900s, the argument argument before a state
supreme court court was: Should X-rays be shown shown to the jury? The claim
by radiologists
radiologists was that that X-rays were their their professional
professional domain,
one had to be trained
trained to be able to read a radiological
radiological image. Why
should the jury see the image? Because then then they will eventually
decide on what what they think the image looks like. That That seems to be
one of the questions
questions with PET scans: If they are an expert image, if
they are an image that that takes a lot of expertise to look at, how
much does the image show, looking at it from the jury standpoint standpoint
and the lay public standpoint?
standpoint?
ag n e r: Well, you raise an interesting
WAGNER:
W interesting question.
question. I was raising the
question
question of should you use the data or should should you notnot use the data,
and you are asking who should interpret interpret the data,
data, and thatthat is a
very interesting
interesting thought.
thought. Again it is not not a question
question of black or
white.
white. I thinkthink there are some things that that are so obvious that that you
don’t
don't need more expertise than than the average layperson
layperson can have to
interpret
interpret it. A guy who has a broken broken leg is an example.
D u m it: Even though
DUMIT: though [in the early 1900s] it [was] [was] precisely the broken
leg that
that [was]
[was] at issue [in one of the first trials where X-rays were
used]
used]??
ag n e r: Okay. So
WAGNER:
W So I think
think that
that there are some technical data that that it
doesn’t
doesn't take more than than the average person’s
person's intelligence to see
whether
whether it shows what what is claimed to be shown. So I think
So think you
definitely should show it to the jury. It is like anything anything else —you-you
don’t understand
don't understand English, you don’t
don't understand
understand a person’s
person's confes­
confes-
sion. It’s
It's like saying only English majors majors should
should be able to hear
confessions. I said something, did the person person really confess or not
confess —it - it depends on the meaning
meaning of their
their words. Since
Since English
teachers are experts on the meaning meaning of words,
words, you have to be a
semanticist
semanticist to tell the jury what what the person
person says. All that
that I think
think is
that
that you should not be limited in what what you should show to the
jury.
jury..... . . It should be up to them,them, whether
whether they believe the expert
or not, whether
whether they can see it for themselves or whether whether they have
to take the expert’s
expert's word
word for it. And the judge helps them do it.
D u m it: The counterargument
DUMIT: counterargument that that was proposed
proposed was thatthat instead of
English majors, it was that that the juries were non-English
non-English speakers
who were taughttaught English in the courtcourt so that
that they could understand
understand

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INTERLUDE 3

the confession. How How much nuclear

nuclear medicine do you have to be
taught to understand
taught understand the image?
W ag n e r: It depends on the study and the result for how complicated
WAGNER: complicated
it is for the jury to be instructed
instructed properly
properly by the experts. And
whether
whether theythey are taking
taking it on faith or whether
whether they can really see it.
“ You see that
"You that this is bigger than
than that,"
that,” and they have criteria
criteria for
length and they
size and length they take it on faith that this is not
faith that not supposed
supposed to
be bigger thanthan that.
that. But anyway, I think
think that
that you have to be very
conscious that that you don’t that information.
don't misuse that information. That what is
That is what
happening right
happening now with DNA in this morning's
right now morning’s paper, that
that DNA
probably going to be getting a lot of people out
is probably out of jail that
that
probably,
should be out of jail. But probably, because of errors variance,
and variance,
there are going to be some people that,
there that, by luck, are going to be
able to get out out of jail because of the fivefive percent
percent of the cases that
that
fall outside of the two standardstandard deviations. So it is like anything
else -—it abused or not
it can be abused not used-
used —and think I would
and I think would be very
cautious that
cautious that there [are] sufficient data.
data. I think mind­
think it is clearly a mind-
set of trying to find anything
anything that
that it really is an argument
argument of free
responsible or not responsible.
will or no free will, responsible
Yes, one philosopher
D u m it: Yes,
DUMIT: philosopher phrased that the law's
phrased it that law’s assumption
assumption is
that
that everyone has free will and science's
science’s assumption
assumption is that
that there
there is
a cause for everything. Plus they added the fact that that after you have
competing
competing experts in the courtroom,
courtroom, the court towards
court will defer towards
independent third-person objective "measurement"
independent or third-person “ measurement” to help the
court decide.
court
W That is a very interesting
ag n e r: That
WAGNER: interesting way to put put it.

i.
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 Chapter
Chapter 4
W Brains as
ays of Seeing Brains
Ways Images
Expert Images
as Expert

Struggles over what

what will count
count as rational
rational accounts
accounts of the
world see.
world are struggles over how to see.
(Haraway
(Haraway 1991, p. 194)

The Use of Scans

Scans In Hinckley
in the Trial of John Hinckley

In 1981, in an apparent
apparent attempt
attempt to impress actress Jodie Foster, John
Hinckley shot President
Hinckley Pres.ident Reagan and five five other
other people. In 1982, he was
brought to trial, and his attorneys
brought attorneys mounted
mounted an insanity
insanity defense. As part
part
of this defense they petitioned
petitioned to include CT scans, to show that that Hinck­
Hinck-
ley had an abnormal
abnormal brain. CT scans are computer-generated
computer-generated digital
visualizations
visualizations of a slice through
through the brain. In this case, the attorneys
wished to show that
that the CT scans revealed Hinckley’s
Hinckley's brain as “shrunken”
"shrunken"
and “having
"having enlarged sulci.”
sulci." They wished to use these images to help
prove that
that he was mentally diseased and therefore
therefore not responsible for
his actions (Caplan 1984). They argued that that their psy-
their expert witness, a psy­
chiatrist,
chiatrist, used the scans among otherother tests to diagnose Hinckley’s
Hinckley's condi­
condi-
tion and therefore
therefore the scans had to be admitted evidence,
admitted as evidence.
The judge presiding
presiding over the case treated
treated these scans as potent
potent ob­
ob-
jects. He initially denied their admittance
admittance as evidence. The defense attor­
attor-
neys persisted for 10 days, and eventually
eventually the judge relented,
relented, deeming
the scans relevant. In Hinckley’s
Hinckley's trial, the judge admitted (one
admitted two scans (one
taken
taken immediately
immediately after the shooting
shooting and one a year later), but he took
many measures to prevent
prevent their
their potency
potency from being realized:
II
ii
;' CHAPTER 4
CHAPTER

After weeks of legal wrangling,

wrangling, and his ultimate
ultimate decision to admit
the scans, the judge did all he could to neutralize
neutralize his decision. He
refused to dim the courtroom
courtroom lights during
during the display, and he in- in­
sisted that
that the slides Hinckley’s scans be projected
of Hinckley's projected on a small
screen set up across the large room room from the jury. The performance
performance
had
had the impact
impact of a short, poorly
short, poorly rehearsed,
rehearsed, and annoying farce. In
annoying
washed-out colors, the scans looked like slices
washed-out slices of bruised and mis­
mis-
shapen fruit. Clutching a yard-long
yard-long stick, the radiologist
radiologist who pointed
pointed
out what
what was “strikingly
"strikingly abnormal”
abnormal" about
about the scans made the pre­pre-
sentation even stranger. She shuffled to the screen in slippers and
sentation
spoke in a trembling
trembling voice. By the end of the interlude,
interlude, it was not
likely that
that anyone in court
court had seen the scans as the clincher, closing
the case with
with final proof
proof of John
John Hinckley's
Hinckley’s disorder. (Caplan 1984,
p. 85)
The judge's
judge’s actions,
actions, the equivalent
equivalent of "you
“you may peek, but but do not
not
look,"
look,” demonstrate
demonstrate a strong
strong belief in visual and scientific persuasive­
persuasive-
ness. He clearly decided thatthat though
though he could not
not deny their
their admission,
he also could notnot rely on tempering
tempering instructions
instructions to the jury alone. In­In-
stead he took
took direct action on the appearance
appearance of the images, on how
they should
should be shown,
shown, to offset what
what he felt were potentially
potentially prejudicial
effects.
effects.
As lay readers,
readers, the powerful
powerful promise of images of the brain brain is that
that
they purport
purport to tel1
tell us about
about the mind. To the extent
extent that
that such images
are clear and reliable, we are tempted
tempted to take them
them for a fact and to let
them
them help us decide aboutabout the person
person whose brain
brain (and mind) is im-im­
aged. The use of brainbrain imaging scans done withwith CT, MRI, PET,PET, and
SPECT in courts is increasing (Ader 1996), though though as Rose (2000)
observed,
Present evidence thus suggests that
that biological and genetic defenses
have largely failed to displace operative
operative conceptions
conceptions of responsibility
responsibility
within the practice
within practice of the criminal
criminal law in any jurisdiction,
jurisdiction. (p. 12)
trend, especially with
This trend, with regard
regard to claims that
that the images can aid
jurors in deciding issues of insanity, competency, and
jurors and neurotrauma,
neurotrauma, is
opposed by most neurologists
opposed neurologists and other
other experts
experts (Kulynych 1997; May-
Rojas-Burke 1993). Ter-Pogossian commented:
berg 1992; Rojas-Burke commented:
I’m
I'm not
not a judge. But showing those pictures—I
pictures-I mean PET images—
images---:-
now to a jury, it doesn’t
doesn't make any sense whatsoever.
whatsoever, I mean if who­
who-
ever shows these pictures was given a stack of twenty
twenty pictures
pictures of
perfectly normal
normal subjects and twenty
twenty pictures
pictures of schizophrenics,
schizophrenics, and
then you shuffle the pictures,
then pictures, [that
[that person] wouldn’t
wouldn't be able to stack

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unscramble them. Nobody

them, to unscramble Nobody can. There are some areas, hypo-
frontality, which
frontality, which seem to be associated sometimes with
with schizophrenia,
schizophrenia,
but it is a minefield.
but
Neuroimaging experts
Neuroimaging experts insist that
that scans cannot
cannot diagnose. Jennifer
Kulynych, in the first legal review of neuroimaging
neuroimaging in courts,
courts, argued
that these images should be used only very conservatively
that conservatively alongside psy-
psy­
chiatric testimony. She found that
chiatric that there
there is often little empirical
empirical evidence
in terms of prior
prior published
published results for the kinds of inferences that that psy-
psy­
chiatrists would
chiatrists would like to attribute
attribute to neuroimages.
neuroimages. Nonetheless,
Nonetheless, she noted,
psychiatric testimony
psychiatric testimony is usually granted
granted admission,
admission, and therefore
therefore some
method must be found
method found "to
“to manage the testimony, short
short of disallowing it
likelihood of undue
altogether, so as to minimize the likelihood undue prejudice"
prejudice” {Ku­
(Ku-
lynych 1997, p. 1268). Her suggestion was that that the court adopt
court should adopt
“ social framework"
a "social framework” approach
approach in which assesses available
which the judge assesses
empirical evidence and explicitly instructs
instructs the jury as to whatwhat the evi­
evi-
dence shows so as to counteract
counteract the
the prejudicial
prejudicial effects of the testimony
testimony
demonstrative evidence.
and demonstrative
Nancy Andreasen
Nancy Andreasen (2001) appeared
appeared to stake out out a similar caution
caution in
Brave New Conquering Mental
New Brain: Conquering Mental Illness in the Era of o f the Genome:
Do [brain imaging technologies] help improve people's people’s lives by
making accurate diagnoses or by guiding treatment?
making more accurate treatment?
moment the value for either of those purposes
At the moment purposes is relatively
limited. MR and functional
functional imaging scans cannot
cannot be used to make a
diagnosis, and we have no definitive laboratory
laboratory markers
markers or genetic
tests, even for Alzheimer's
Alzheimer’s disease. Most
Most of these technological
technological ad-
ad­
vances are still research
research tools, useful for probing
probing into the brain
brain or the
molecular
molecular mechanisms of illnesses. All the data data marshaled
marshaled to date
from imaging and electrophysiology
electrophysiology are group
group comparisons.
comparisons. Groups
of people with particular
particular diagnosis are compared
compared to healthy
healthy volun-
volun­
teers, and group
group differences are found. Such studies are very informa-
informa­
tive in telling us something
something about
about the brain
brain mechanisms
mechanisms of an ill­ ill-
ness—that
ness - that they may affect the frontal
frontal cortex,
cortex, that
that they may involve
distributed
distributed circuits, that
that they may suggest a neurodevelopmental
neurodevelopmental ab- ab­
normality. But these studies cannotcannot make any specific predictions
predictions
about
about an individual.
individual. They can only make predictions
predictions about
about the group.
Thus, when
when neuroscientists
neuroscientists or psychiatrists
psychiatrists speak about
about the hypo-
frontality
frontality or ventricular
ventricular enlargement schizophrenia, they
enlargement in schizophrenia, they are not
implying that
that every person withwith schizophrenia
schizophrenia will have decreased
frontal metabolic activity or big ventricles. Thus these findings are
frontal metabolic
not
not useful at the moment
moment either as screening or diagnostic tests. tests, (pp.
158-159)
158-159)

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CHAPTER 4
CHAPTER

Andreason
Andreason then then went
went on to say that that some clinicians think think that
that it
helps.
What Judge Parker
What Parker in the Hinckley
Hinckley trial
trial intuited
intuited and Kulynych ac- ac­
knowledged, but
knowledged, but did not focus on, is the difficult problemproblem of the undue
persuasiveness of visual images, especially that that category
category I wantwant to call
“ expert images."
"expert images.” Expert
Expert images are objects produced produced with with mechanical
mechanical
assistance that
that require help in interpreting
interpreting even though
though they may appearappear
to be legible to a layperson.
layperson. The paradox
paradox of expert
expert images in a trialtrial is
that
that if they are legible, thenthen they should
should notnot need interpretation,
interpretation, but if
they need interpretation,
interpretation, then
then they probably
probably should not not be shown to
juries.
Junes.
In the next
next chapter, we will look at the circulation
circulation of brain
brain images as
expert
expert images in popular culture. However, the effectiveness
popular culture. effectiveness of these
images, their
their effects and how how they are read by magazine readers, readers, movie
viewers, and Web site visitors, is very difficult to assess, assess. In this chapter,
we use the courtcourt as a privileged site of explicit lay reasoning.reasoning. We ac­ ac-
knowledge
knowledge with with Rose that “ biological arguments
that "biological arguments seem to enter enter the
courtroom
courtroom not not because legal personhood
personhood has become biological, but but be-
be­
cause defense lawyers, especially in the US, utilize anything anything they
they can to
their clients”
defend their clients" (Rose 2000,
2000, p. 13). Judges, lawyers, and juries are
laypeople with
with respect to brain
brain images. They have little or no familiarity
familiari'ty
with
with the complex
complex processes discussed in the previous chapter or with
previous chapter with
functional anatomy.
functional anatomy.
This chapter
chapter focuses on court court decisions because this is the one area
where the power
power of brain
brain images to persuade
persuade people of form and where
fact has to be delineated.
delineated. Although
Although there are many specific differences
within the U.S. judicial system, between
within between federal and state courts, courts, and
different
different kinds of trials, we can also understandunderstand the courts courts as a place
where the persuasive, authoritative,
where authoritative, and reifying powers of images are
explicitly defined and debated
debated in rigorous
rigorous ways. By providing
providing a survey
of historical
historical instances in which
which images were granted granted admission
admission or cen­
cen-
sored in one way or another,another, a theory
theory of the power to make make images
objective
objective can be developed.
As we will see, even x-ray cannot be simply
x-ray images cannot apprehended —
simply apprehended-
even by radiologists.
radiologists. One must learn to see them them as representing
representing the
unseen, and then then one can learn
learn to interpret
interpret them
them for their content.
content. In a
courtroom, however, where
courtroom, where a nonexpert
nonexpert audience is told what what the im­
im-
age shows, that that audience is going to be told that that it illustrates
illustrates a state of
affairs. Here the image’s
image's apparent picture-like status and manufactured
apparent picture-like manufactured
threatens to overwhelm
objectivity threatens overwhelm its interpreted
interpreted nature.
nature. In the court­
court-
room,
room, as in popular
popular culture,
culture, the familiarity
familiarity of the image, its apparentapparent
legibility, must
legibility, must be accounted
accounted for. These expert expert images are presented
presented as
doubly significant: both both scientific data
data and socially full of meaning.

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Facing images produced

produced under
under scientific authority,
authority, a judge must first
take into account
account how he or she is persuaded
persuaded him- or herself of their
meaning,
meaning, and then how a jury might be persuaded. persuaded. The judge must
often make an argument
argument as to why or why not not a particular
particular image may
be shown
shown to a jury, how it may be presented
presented and by whom,whom, and what
what
referents may be attributed
attributed to it. At stake is the particular ob-
particular form of ob­
jectivity that
that an image comes to have: Is it part part of an expert's opinion,
expert’s opinion,
does it indicate a probable
probable relation
relation to a fact, or is it a direct picture
picture of
of
the truth}
truth?
mechanisms by which images per­
Courts thus directly debate the mechanisms per-
suade and,
and, in so doing, provide us with a set of frames for describing
the visual power
power of brain images, and how reliant reliant the images are on
their context
context and form of presentation.
presentation. The specific
specific use of expert im­im-
ages I am concerned
concerned with in this chapter
chapter are brain images when they are
used in psychiatric
psychiatric testimony. To understand
understand how and why they play
such an important
important role today,
t,oday, however, it is important
important first to look at
the emergence of the category of expertexpert images in the court
court in the early
twentieth
twentieth century
century with
with photographs
photographs and x-rayx-ray images, then
then to see how
this notion
notion of expert
expert image comes to be applied to CT CT images and PET
scanning.
scannmg.
Brain imaging’s
imaging's power
power comes to be a combination
combination of scientific and
medical authority,
authority, machinic and now now digital objectivity, as well as cul­cul-
tural
tural norms and social desirability. In many cases, ironically, this per­ per-
suasiveness comes to exceed the authority
authority and even ability of the im­ im-
age’s
age's authors:
authors: The very experts who made them can no longer delimit
what
what they mean. This situation
situation is produced,
produced, in fact, by the extreme
imaging selection practices outlined
outlined in chapter
chapter 3.

X-Rays
X-Rays in the Courtroom
Courtroom

In 1896, X-rays defined the expert image of an invisible world.

world. What
What is
a jury supposed
supposed to do with
with such an expert
expert image, however? Supposedly,
Supposedly,
as laypersons, jury members have never seen it before, nor anything
anything like
it. Yet in the courtroom,
courtroom, they are guided by exceedingly simple instruc­
instruc-
tions, such as: Note how this part
part looks bigger,
bigger, looks like a fracture, is
shrunken,
shrunken, or has more holes. What
What I want
want to do is query the history of
attempts
attempts to deal with
with this strange new creature, visualization of an
creature, a visualization
invisible world
world that
that half familiar and half alien.
Immediately popular,
popular, X-rays attracted
attracted an intense interest
interest both
both inside
and outside the courtroom
courtroom (Golan 1999). In the first case in the United
States, the question arose as to whether
whether a radiograph
radiograph or X-ray purport­
purport-
ing to show a hip fracture
fracture could be admitted.
admitted. The defendant’s attorney
defendant's attorney

113
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argued against
argued against it, saying that, “the radiograph
that, "the radiograph was a photograph
photograph of anqn
object unseen
unseen by the human
human eye. There
There was no evidence that photo­
that the photo-
graph
graph actually portrayed and represented
actually portrayed represented the object pictured” (Halperin
pictured" (Halperin
1988, p. 640). In accepting the visual photographic
photographic metaphor,
metaphor, however,
the attorney
attorney seemed to have sealed his fate. Judge Lefevre responded
responded to
this argument
argument by deferring
deferring both
both ontologically
ontologically and epistemologically
epistemologically to
question of history:
the question
We [the court] have nothing
nothing to do or say as to what what [the radio-
radio­
graphs] purport
purport to represent; that will, without
represent; that doubt, be explained
without doubt, explained
by eminent
eminent surgeons. These exhibits are only pictures
pictures or maps,
maps, to be
used in explanation
explanation of a present
present condition,
condition, and therefore second­
therefore are second-
ary evidence andand not
not primary.
primary. They may be shown shown to the jury as
illustrating making clear the testimony
illustrating or making testimony of experts.
experts ..... . . Modern sci­
Modern sci-
ence has made
made it possible to look beneath
beneath the tissues of the humanhuman
body, and
and has aided surgery in telling of the hidden
hidden mysteries. We
believe it to be our
our duty
duty in this case to be the first, if you please, to so
consider admitting in evidence a process known
consider it, in admitting known and and acknowl-
acknowl­
edged as a determinant
determinant science. The exhibits
exhibits will be admitted
admitted as evi-
evi­
dence. (Smith v. Grant 1896; see Halperin
Halperin 1988, p. 640)
In essence, the judge decides to defer the meaning x-ray images
meaning of the x-ray
experts while nonetheless
to experts nonetheless allowing
allowing these images to be shown shown to juries
in the manner
manner of pictures
pictures or maps. In this sophisticated
sophisticated deferral,
deferral, x-ray
imaging is fused to the twotwo most powerful imaging discourses: photo-
most powerful photo­
graphy and cartography.
graphy cartography.
Jennifer
Jennifer Mnookin
Mnookin (1998) has traced traced how
how this precise category
category of
“"demonstrative
demonstrative evidence”
evidence" arose in the context
context of photographs
photographs in the
courtroom. Demonstrative
courtroom. Demonstrative implies that that the evidence is secondary
secondary and
not primary
not primary and therefore
therefore can be used only to illustrate
illustrate the testimony
testimony of
experts. Mnookin
experts. Mnookin showed
showed how
how photography,
photography, in fact, challenged
challenged courts
to come up with
with a conceptual
conceptual place that acknowledged the persuasive
that acknowledged
power of the photos
power photos but
but kept them
them off the central
central stage of deciding the
facts of the matter. Photos
Photos were stuffed into an older analogy analogy of maps
and diagrams
diagrams and
and granted
granted the ability
ability to illustrate.
illustrate. In fact, however, they
often corroborated
corroborated and persuaded. Photography’s mechanical,
persuaded. Photography's mechanical, objective
nature
nature exceeded the analogy of illustrative
illustrative diagrams,
diagrams, and this overflow
had no accountability
accountability with
with the court,
court, except for the acknowledgment
acknowledgment of
such unduly
unduly prejudicial
prejudicial photos
photos as these of murder
murder victims and pornog­
pornog-
raphy
raphy (Hensler 1997; Selbak 1994),
1994).
course, X-rays do more
Of course, more than
than photographically represent what
photographically represent what a
human
human being might
might have seen. X-ray images purportpurport to represent what
represent what
no human could see. More
human could than that,
More than that, they produce
produce a visible image as if
it were of a potentially
potentially visible scene, even though
though the scene involves

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) . SEEING BRAINS AS EXPERT

SEEING EXPERTIMAGES
IMAGES
I

seeing everything on top of one anotheranother (an x-ray

x-ray image is the sum of
the densities of all of the materials that that the rays pass through).
through). X-ray
then, and still are today, difficult to interpret
images were then, interpret precisely be-
be­
cause they are not
not like photographs.
photographs.
However, for the courtcourt in the late nineteenth
nineteenth century, faced with
with a
nascent popular x-ray community
n~scent but popular community in whichwhich photographers
photographers were
early adopters
adopters and photography
photography was the dominant
dominant cultural
cultural metaphor,
metaphoi;
X-rays seemed tailor-made
tailor-made to fit into the analogy of photos
photos and maps as
demonstrative
demonstrative evidence (Golan 1998). According to Judge Lefevre, as
objects produced
produced by a “modern
"modern .... , . determinate
determinate science,
science/” X-rays reveal
mysteries to experts who alone can explain their their meaning. At the same
time, as secondary demonstrative
demonstrative evidence, like photos
photos and maps, they
are allowed to be shown to juries in the minor, neutral neutral role of merely
illustrating making clear the expert's
illustrating or making expert’s words.
words. They are thus allowed in
as doubled.
doubled. They make clear what what is unclear^
uncleai; but they do not make it
clear to everyone.
The photographic
photographic analogy was overwhelming.
overwhelming. A nonvisual
nonvisual object,
x-ray attenuation,
attenuation, was translated
translated into
into a visual one. The result was a
special kind of photograph
photograph thatthat all could see but
but only some could read.
The Supreme Court
Court of Tennessee ruledruled that
that
New as this process is, experiments
experiments made by scientific men ..... .
have demonstrated
demonstrated its power
power to reveal to the natural
natural eye the entire
structure of the human
structure human body, and its various
various parts
parts can be photo­
photo-
graphed as its exterior
graphed exterior surface has been and now
now is. And no sound
reason was assigned at the bar why a civil court
reason court should
should not
not avail itself
of this invention,
invention, when
when it was apparent
apparent that
that it would
would serve to throw
throw
light on the matter
matter in controversy. (Bruce v. Veall
Veal! 1897, 41:455,
41:455,
quoted in Halperin
quoted Halperin 1988, p. 640).
manner, the jurors
In this manner, jurors were asked to accept the visualized land- land­
scape of the interior
interior as a simple object: an aid to the commentary
commentary of an
expert. however, compete uneasily for attention
expert. Image and text, howevei; attention and
Though
priority. Though the court intended
court intended the radiographs
radiographs as secondary evi­
evi-
dence, to be used as an aid to "illustrate
“ illustrate or make clear the testimony
testimony of
experts,”
experts," semiologists have noticed historical reversal concerning
noticed a historical pho­
concerning pho-
tographs: “ the image no longer illustrates
tographs: "the illustrates the words, words
words, it is the words
which, structurally,
structurally, are parasitical
parasitical on the image”
image" (Barry 1997; Barthes
1987, 1984 ). It is as if the picture,
1987, p. 14; Flusser 1984). picture, authorized “ex­
authorized by "ex-
perts,”
perts," no longer needs them. Indeed, the legibility of radiographs
radiographs was
attacked unsuccessfully in two opposing
attacked opposing ways.
According to some attorneys, though the radiograph
attorneys, though radiograph was like a pho-
pho­
tograph,
tograph, no one seemed to think that it spoke for itself (in the presumed
think that presumed
manner of photographs),
manner photographs), nornor especially thatthat it could diagnose by itself.

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In courts, the photograph

photograph is upheld as evidence on three grounds: first
when accompanied
accompanied by a living witness to the scene, it is said to illustrate
what
what the witness attests to. Second, the photograph
photograph can be a silent wit­ wit-
ness, testifying on its own behalf as if it were the eyes
eyes of witnesses, to be
interpreted
interpreted in turn
turn by the jury. Third,
Third, the photograph
photograph can be a construc­
construc-
tion
tion produced
produced to look like a scene but without without originary
originary presence
(Guilshan 1992; Hensler
Hensler 1997; Mnookin
Mnookin 1998; Selbak 1994).
The x-ray image could not not witness in any of these manners,
manners, because
in spite of its privileged access to the interior
interior of the patient,
patient, it still pro­
pro-
vided only signs or symptoms,
symptoms, notnot the injury itself. It showed previously
unavailable
unavailable information
information about
about the patient,
patient, but the significance of this
information
information was up to the expert. Some therefore asked why
attorneys therefore
Some attorneys
a jury composed
composed of nonexperts,
nonexperts, of laypersons, should see the radio­ radio-
graph at all. Appearances
Appearances might be significantly misleading. Citing the
wide and significant variations
variations in the x-ray images obtained,
obtained, depending
on precise alignment
alignment of angles, magnifications, and screens, attorneys
attorneys in
another
another case argued thatthat
there is really no more reason
reason why a jury should see the skiagram
[X-ray] than
than that
that there should be exhibited
exhibited to them
them the clinical ther­
ther-
mometer, stethoscope,
stethoscope, measuring
measuring tape, and chemical apparatus,
apparatus, etc.,
used in cases which become subjects of judicial investigation.
investigation. (Stover
1898, cited in Halperin
Halperin 1988, p. 642)
The skiagram
skiagram or radiographic
radiographic image is here equated equated not with the
injury, which would
would be immediately relevant, but with instrument read-
instrument read­
ings and streams of numbers.
numbers. In other
other words,
words, the radiograph
radiograph is argued
to be a code; and codes can be deceptive. Jury members, members, might decide
that
that something
something that that looked
looked like a fracture,
fracture, for instance, to their un­ un-
trained
trained eyes might be a fracture.
fracture. Though
Though codes might appear appear to be cog­cog-
nizable objects, these code-images can be deciphered and interpreted interpreted
only by experts. They do not merely magnify or make the invisible visi-
visi­
ble; they are transforming
transforming or translating
translating a nonvisual set of relations into
relations
a specialized visual object.
Other
Other attorneys
attorneys posed the opposite analogy, arguing that that radiographs
radiographs
are not
not so deeply coded. Perhaps x-ray images are simply better eyes,
eyes,
rather than
rather than different ones. If the code is not
not so difficult to master, then-
then
perhaps
perhaps jurors’
jurors' judgment
judgment can be partially
partially severed from that that of the ex­ex-
perts. In a leg-fracture
leg-fracture case in 1896, attorneys
attorneys “argued
"argued thatthat the expert
witness should
should only have been allowed to explain what, what, in general, con­ con-
stituted
stituted a fracture
fracture on a radiograph
radiograph and leave it for the jury to determine
from the exhibited
exhibited film whether fracture was present”
whether or not a fracture (Hal-
present" (Hal­
perin 1988, p. 641). Here they treated radiograph like a photo­
treated the radiograph photo-
graph,
graph, one thatthat the jury is able to read and understand
understand with with minimal

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orientation. If jury members

orientation. members can be taught,
taught, however, then
then the expert
should step aside and let the jury members
should members form theirtheir own opinions
opinions as
the meaning
to the meaning of the object portrayed.
portrayed.
two critiques
These two critiques of the use of X-rays as expert
expert images founder
founder on
the instability
the instability of the
the category
category of demonstrative
demonstrative evidence as merely
merely illus­
illus-
trating and making
trating making clear the testimony
testimony of experts.
experts. On the one hand,
hand, if
the image is readable
readable with
with minimum
minimum orientation,
orientation, like a map or a photo,
photo,
then
then the jury should
should be allowed to draw draw its own
own conclusions
conclusions as to the
relation between
relation between the image and the testimony.
testimony. On the other
other hand,
hand, if the
image is legible only to a highly trainedtrained expert,
expert, the only function
function of
showing it to the jury would
showing would be to play on its commonsensical,
commonsensical, but
wrong, notions
wrong, notions as to what
what the image should
should look
look like. The courts
courts re­
re-
both of these arguments,
jected both arguments, insisting on the scientific guarantee
guarantee of
veracity of the process of representation
the veracity representation that
that produced
produced the radio­
radio-
graph. This guaranteed
graph. guaranteed veracity
veracity produced
produced them
them as mere aids and illus­
illus-
trations to the
trations the text,
text, and as such, it was agreed thatthat they
they were not
not harm­
harm-
ful but
but were in most
most cases helpful.
This discussion
discussion of X-rays makes clear some parameters
parameters of visual per­
per-
suasion contests over the power
suasion at stake in contests power of visualization.
visualization. For the rest
of this chaptei;
chapter, I will be considering
considering contemporary
contemporary imaging technolo­
technolo-
scanning, whose status
gies, CT and PET scanning, status in court,
court, in clinical medicine,
and in many
and many disciplines of science is still being debated.
debated.

CT
CT Images
Images Are Like X-Ray
X-Ray Images
Images

Looking today
Looking today at CT scans in the the mass media,
media, we find familiar
familiar the
brain-like
brain-like shapes in black and white.
white. Henry
Henry Wagner described the ar­ ar-
rival of the CT scan in terms
terms of the “ shock of recognition”
the "shock recognition" of seeing the
brain
brain (Wagner 1986). Most Most contemporary
contemporary understandings
understandings of the CT
unproblematically represent
scan assume it to unproblematically represent the structure
structure of the brain,
not do so as well as MRI in most
even if it does not most cases. However, as
histories of the x-ray
histories x-ray image have shown,
shown, even images thatthat today
today seem
obviously recognizable
obviously recognizable were themselves the subjectsubject of acculturation
acculturation
(Pasveer 1989; Reiser 1978; Reiser and and Anbar
Anbar 1984).
1984), Eco (1979) stated
stated
problem succinctly: "Similarity
this problem “ Similarity does not
not concern
concern the relationship
relationship
between the
between the image and
and its object, but
but that
that between
between the image and a
previously culturalized
previously culturalized content”
content" (p. 204) This insight is not
not always ob­ob-
vious. That
That recognition
recognition is a social process
process and not
not inherent
inherent came
cai:ne as a
surprise, for example,
surprise, example, to the marketing
marketing department
department of EMI, the com­ com-
pany that first developed the CT scanner:
pany that
Phelps-.
PHELPS: extreme case was when
An extreme when the CAT [computerized
[computerized axial to­
to-
mography] scanner
mography] scanner came out. The entire marketing
marketing department
department of

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EMI, whowho made the CAT scan, went through through a terrible
terrible frustration,
frustration,
Professor Bole, from London, had gone around
because Professor around showing
people CAT scans of the brain that that were quite remarkable,
remarkable, but
didn’t think
people didn't think very much
much of it. And so John John Bole came to
America; he had had to build the commercial
commercial success
success of the CAT scan­
scan-
ner in America. He went went around
around to all these radiologists
radiologists showing
CAT scans. He could see tumorstumors and hemorrhages,
hemorrhages, strokes,
strokes, and he
appalled by the fact that
was appalled that the radiologists
radiologists didn’t
didn't respond
respond that
that
whole group
well. And in fact a whole group of purported
purported leadership
leadership of radiol­
radiol-
that early time projected
ogy in that projected that
that the world
world market
market for CAT CAT
scanners was seventeen units and that that it would
would take ten years to get
there. Seventeen units!
D u m it: So
DUMIT: radiologists didn't
So radiologists didn’t grasp the significance of CAT scans? scans?
PHELPS:
P h e lp s: No. They had had never seen the brain. Neurosurgeons
Neurosurgeons had.
opened up the skull and
They opened and they looked in there. They looked at
the CAT scan and they said, “I "I know
know I’ve
I've seen that.
that. That
That is the
there is a lesion in reference to all these major
brain. And there major sulci.”
sulci."
They could see the ventricles noninvasively. “These "These are all the clas­
clas-
landmarks, and
sical surgical landmarks, and here is a lesion in relation
relation to them.
incredible.”
This is incredible."
Drs. Robert
Ors. Robert Ledley and JohnJohn Mazziotta
Mazziotta had to put put together
together a
that time, showing cut sections of the cadavers
very limited atlas at that ,-
whole-body ACTA [automatic
and whole-body [automatic computerized
computerized transverse
transverse axial]
although rudimentary,
scans of them. And although rudimentary, it was a great accom­ accom-
plishment. Anytime that
plishment. that you look at something
something different [from
what] you've
what] you’ve ever seen before, you’ve
you've got to learn what what it looks
like. And you have to learnlearn what
what the norm
norm looks like, before you
“This is not
can say, "This not normal."
normal.” (Michael Phelps, August 4, 1993,
conversation with
conversation with the author,
author, University of California,
California, Los An­ An-
geles)1

Here then
Here then is an important
important cultural
cultural lesson in seeing, and in seeing
what is "normal"
what “normal” and what
what is "not
“not normal.”
normal." To see something
something new,
must figure out
some people must out how
how to see it and then teach others.
others. The
cultural salience of the CT scans of the brain
cultural brain went
went further,
furthei; however,
traded also on the equation
because it traded equation of the brain
brain with psyche. For the
tumor detection),
first time (outside of large tumor detection), there was the possibility of
abnormal brain rather than
seeing an abnormal brain rather than diagnosing an abnormal
abnormal mind.
The slippage between these two forms of recognition
recognition is tricky because
the first necessarily relies on the second.
cannot, for instance, actually see mental
One cannot, mental illness in the brain; one
variations in different brains and attempt
can see only the large variations attempt to cor­
cor-
certain kinds of brains with
relate certain with certain diagnoses —- normal,
normal, schizo­
schizo-

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G BRAIN5 EXPERTIMAGES
IMAGES

phrenic, depressed, and so on. The desire, of course, is for the machine-
phrenic,
imaged brain
brain to replace the psychiatrically
psychiatrically diagnosed
diagnosed mind, the “"holy
holy
grail"
grail” of biological psychiatry.2
Thus,
Thus, even though
though the brain images are produced
produced by people, they are
coproduced
coproduced by scientific machines,
machines, and it is the machines, especially
computers, that
computers, that leave their mark. Scientists, as demonstrated
demonstrated by many
researchers in science studies, increasingly attempt
attempt to remove their
marks
marks from the image, even though though they must still provide the text
(Daston and Galison 1992; Star 1989, 1992). At
(Daston At the crux of this rela­
rela-
tionship between the image that
tionship that (objectively) speaks for itself and the
expert who (subjectively)
expert (subjectively) reads its lips is a desire by the court
court and by
everyone else to reduce ambiguity, to make make things clear, and clearly
acceptable.
with the possible prejudice
Uneasy with prejudice intrinsic
intrinsic to such capricious
capricious and
judgmental
judgmental factors, the courts
courts have looked
looked to science to provide
provide more
solid insights into human
human behavior.
behavior ...., . . Belief in the power
power of science
hard facts shapes decisions about
to provide hard about the proper
proper disposition
disposition of
responsible for criminal behavior. And, scientific evidence is in­
those responsible in-
creasingly valued as a means to enhance
enhance the efficiency
efficiency and effective­
effective-
overcrowded courts.
ness of overcrowded courts. (Nelkin and Tancredi
Tancredi 1989, p. 134)
The risks of such an emphasis on clear and efficient demarcation
demarcation of
subjective expert
expert and objective machine
machine are that
that any of the compo­
compo-
nents—the
nents expert interpretation,
- the imaging process, the expert interpretation, or the concept
concept of
brain and
the brain and disease
disease—are ambiguous or multi
- are themselves ambiguous multivocal
vocal and
thus prematurely
thus prematurely closed off by efficient measurements.
measurements.

Demonstrating
Demonstrating Objective
Obiective Brains

Be sure to spend adequate

Be adequate time with your
your [expert
medical] witness to work
work out your approach and format
your approach format for
knowledge on this
elevating the jury from a plane of zero knowledge
technique to a plane of adequate
technique adequate knowledge
knowledge so that
that they
interpret the demonstrative
can interpret demonstrative evidence which
which you have to
offer.
offer. Remember, these newer techniques
techniques (such as the CAT
CAT
scan)
scan} may be your
your only objective, demonstrative
demonstrative “proof”
"proof"
that
that add weight to the subjective
subjective opinion
opinion of your medical
witnesses. This being true, make the most of it! Whether
Whether
the jury accepts your “"objective"
objective” evidence may determine
determine
the outcome of your entire case.
(Houts 1985, p. 22)

119
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I

CHAPTER 4
CHAPTER

Houts’s text,
Houts's text, the first instance I found
found of explicit instructions
instructions to attor­
attor-
neys for effectively using digital brain images, emphasizes the veridic-
tory weight
tory weight of scientific images. The process prescribed
prescribed for the medical
expert is one of positioning
expert positioning oneself as subjective guarantor
guarantor of objective
evidence, as fallible witness of an infallible device.
device.
example of what
This is an explicit example what Greimas and CourtesCourtes (1982)
semiotics, "the
called planar semiotics, “ the ways in which relative to a given culture,
certain signs [are judged] to be 'more
certain ‘more real’
real' than
than others”
others" (pp. 150-151).
150-151).
“the study of how physical properties
Semiotics is "the properties of bodies are as­as-
sumed as signs, as vehicles for social meanings”
meanings" (de Lauretis 1987, p.
25). Using semiotics, we can study the material
material and cultural
cultural ways in
which codes, bodies, and
which and technologies
technologies are intrinsically
intrinsically bound
bound up with
popular and
each other. In U.S. popular and court
court culture,
culture, machine
machine images, experts,
and diagnosis are bound
and bound together
together in a hierarchical
hierarchical manner. For instance,
questions was suggested by Harry
the following series of questions Harry Rein, M.D.,
attorneys to pose to jurors when
J.D., for attorneys when employing medical images in
courtroom:
a courtroom:

there a difference between

Is there between objective and subjective, and if so,
what is that
what that difference? Is a thermogram
thermogram objective? Would it help the
understand your answers if you showed some of the thermo­
jury understand thermo-
those to the jury. (Rein 1986, p. 119)
grams? Please describe those

attorneys to define for their juries different levels of

Rein called for attorneys
then to situate
realness and then situate images, people, and processes in relation
relation to
them. In the case of these scientific medical visualizations,
visualizations, objectivity
must first be presented
must presented as different
different from and even the opposite
opposite of sub­
sub-
jectivity. Second, objectivity must must be presented
presented as better
better than
than subjec­
subjec-
visualizations must be connected
tivity. Finally, scientific visualizations connected to the former
and divorced from the latter.
What these passages make clear is that
What that medical images are seen by
attorneys as capable of demonstrating
attorneys demonstrating far more
more power, objectivity, and
truth than
truth than the "mere
“ mere illustration
illustration and making clear”
clear" of demonstrative
demonstrative
Expert brain images come to be seen as making the facts visi­
evidence. Expert visi-'
and being the only objective "proof"
ble and “proof” that
that grounds
grounds rather
rather than
than sup­
sup-
expert’s truth.
plements the expert's truth. Semiotically, we can see that that rather
rather than
than
there being a need for agreement
there agreement on the chain of representations
representations before
and rationality
logic and rationality can be secured, the rationality
rationality and logic of the
digital images are being invokedinvoked to secure agreement. Ted Porter, for
instance, has studied
instance, studied the forms of trust
trust that
that quantification
quantification enables in
different settings. Drawing
different Drawing on science studies work, work, including Steven
Shapin andand Simon Schaffer's
Schaffer’s Leviathan
Leviathan and the Air-Pump
Air-Pump (Shapin and

120
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SEEINGG DRAINS
BRAINS AS EXPERT
EXPERT [MAGES
IMAGES

Schaffer 1985), Porter

Porter described one of the relationships
relationships between a
democratic state and quantification
democratic quantification in the following manner:
following manner:
not by accident
It is not accident that
that the authority
authority of numbers
numbers is linked to a
particular government, representative
particular form of government, representative democracy. Calculation
Calculation
which a democracy
is one of the most convincing ways by which democracy can reach
an effective
effective decision in cases of potential
potential controversy,
controversy, while simul­
simul-
taneously avoiding coercion and minimizing the disorderly
taneously disorderly effects of
vigorous public involvement. (Porter 1992, pp. 28-29)
vigorous 28-29)
Porter
Porter examines how, within
within policy studies, the ability to produce
quantitative
quantitative results provides a rallying point
point within
within a bureaucratic
bureaucratic de­
de-
Numbers do this work
mocracy. Numbers work because they are repeatable be­
repeatable and be-
they are nonsubjective
cause they nonsubjective and thus disinterested.
disinterested.
[T]he crucial point
point is that
that faith in the objectivity
objectivity of quantitative
quantitative
methods is not
methods not quite the same thing
thing as the acceptance
acceptance of the validity
their conclusions. The "objectivity"
of their “ objectivity” of quantitative
quantitative policy studies
has more to do withwith· their fairness and impartiality
impartiality than
than with
with their
truth.
truth. (Porter 1992, p. 29)
In this planar
planar semiotics of democracy, truth truth depends at least as much
on social consensus as on true true correspondence.
correspondence. The fair, impartial
impartial ob­
ob-
jectivity of numbers
numbers is more persuasive, or “"harder,"
harder,” than
than the partial
partial
subjectivity of an expert
expert -—harder,
harder, potentially,
potentially, than
than even the expert
expert who
produced numbers, because the expert's
produced those numbers, expert’s subjectivity is inherently
inherently
“ expert” brain
linked to bias. Some "expert" brain researchers
researchers are quite excited by this
possibility in the courtroom:
possibility courtroom: "Another
“Another advantage
advantage of 'behavioral
‘behavioral imag-
imag­
ing'
ing’ [based on algorithmic detection of abnormalities]
algorithmic detection abnormalities] is the reduced
need to rely on experts who were hired by one of the parties” parties" (Gur
{Gur and
Gur 1991, p. 181). Despite their their optimism
optimism regarding
regarding this automatic
automatic re­
re-
placement
placement of expertise with with programming,
programming, the Gurs note note that
that no spe­
spe-
cific
cific pattern
pattern has been established
established for any psychiatric
psychiatric disorder. Nonethe­
Nonethe-
less, they
they state that
that “when
"when such diagnostic
diagnostic markers
markers are established
established [for
schizophrenia], diagnosis of insanity
schizophrenia], insanity could be made on the the basis of more
than is possible today"
objective data than today” (p. 180). They thusthus paradigmati-
paradigmati-
cally conflate schizophrenia
schizophrenia withwith insanity.
tainting scientific results often
The suspicion of subjectivity as tainting often extends
all
all the way down researcher him-
down to the researcher him- or herself, where
where this suspicion
serves as motivation
motivation to act. One PET researcher
researcher described the process of
designing software to analyze PET images:
When
When you saw an area of increased activity in a PET scan, it wasn’t
wasn't
clear whether
whether it was noise or not. And, there was enough
enough variability
variability
in location
location from person
person to person,
person, that
that it raised the possibility of

121
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data. That
fudging the data. That is, you could pick a hot that
hot spot over here that
was noise, and in the nextnext subject, here is a little bit of noise over
here. And if you went
went through
through and always picked the hottest
hottest spot, in
any subject, kind
kind of in a ballpark
ballpark vicinity, you could then
then show that
that
activated. And so my motivation
any area activated. motivation was always to try [to] find
a way to remove the potential
potential to bias the data. That was a substantial
data. That substantial
risk, and the more that
that the processing could be automated
automated and made
noninteractive,
noninteractive, the more reliable it would
would be, and the more replicable
would be. Since it doesn't
it would doesn’t seem that know anything
that we know anything unless
somebody else can replicate
somebody that was steadily a big push, to auto­
replicate it, that auto-
mate the processing.

Here, the presence of subjectivity creates a gap between the research

Here,
structure of the researcher’s
and reality. This gap becomes the structure researcher's desire,
motivating
motivating him to eliminate the appearance
appearance of subjectivity through au­
through au-
tomating
tomating all the tasks he presently is involved in. This researcher illus­
researcher illus-
trates the taboo
trates taboo nature
nature of subjectivity in science; subjectivity is seen as
polluting the process of progress. Every possibility of subjectivity must
polluting
eliminated to
be eliminated to produce
produce something —that is, something
something reliable -that something real,
something known.
something known. The hero
hero in this story automation, which
story is automation, which stands as
opposite of interactivity.
the opposite
kind of automation
The kind automation that
that the researcher
researcher turns
turns to is computing,
computing, or
“embodied calculation"
"embodied calculation” in Porter's
Porter’s terms. The computer
computer can reduce bias
therefore produce
and therefore produce consent
consent because it is so "dumb."
“ dumb.” In the language
of democracy, if “"even
even a thing
thing as stupid as a computer"
computer” (Porter 1992, p.
644) can produce
produce the image, thenthen there
there can be no individual
individual advantage
advantage
or subjective bias involved. The resulting image is therefore
therefore neutral
neutral and
produce democratic
can produce democratic consensus.
Mark Mintun,
Mark Mintun, PET researcher
researcher at Washington
Washington University, stated:
Lots of people talk about
about PET being able to map the brain brain...... . .
They take a single picture
picture of the brain at rest or doing something, and
they say, You see this area over here? This is what what I think
think is going
on.” The science is very weak. It’s
on." It's nice for pictures, but the real boh
bot^
tom line is it’s guesswork. (Froelich 1987, p. 17)
it's guesswork. 17)
then goes on to state how
He then automated the process so that
how they automated that
“there’s no question
"there's question whether
whether you see it or whether
whether the person
person re-
re­
sponded. It's
sponded. It’s just not guesswork
guesswork anymore.”
anymore. " 33
concluding this section, I must note that
In concluding that I am not
not trying to throw
throw
suspicion on the process of automation.
suspicion Instead, I am attempting
automation. Instead, attempting to
reconstruct the consequences of this particular
reconstruct particular objective, normalizing,
normalizing,
and democratic notion of automation.
democratic notion automation is inherently
automation. This automation inherently
antisubjective and antivariable,
antisubjective antivariable, and ironically, it therefore anti­
therefore becomes anti-

122
f".

j::'
.

particularly difficult anti-expert

expert. One particularly
SEEING BRAINS
SEEING BRAINS AS EXPERT
EXPERTIMAGES

anti-expert bind comes up in malprac-

IMAGES

malprac-
tice suits involving machines. For instance, Gagliardi (1988} (1988) com­
com-
mented, "I
mented, “I mourn
mourn the damage done to the profession
profession by those who
started describing CT scanners as being first generation
started generation or second gener­
gener-
ation. The implication
ation. implication of superiority, regardless of skill of the operator,
apparent” (p. 1988, 636). Inferior
is apparent" Inferior (because a machine
machine is older or has
lower resolution)
lower resolution) translates
translates too easily into inferior
inferior care and inferior
inferior ex­
ex-
perts in a manner
perts manner analogous
analogous to automatic
automatic machines equaling supreme
4
expertise.4
expertise. expert craft at the base of scientific practice and the
The expert
experienced art
experienced art at the base of neuromedical
neuromedical interpretation
interpretation are covered
denigrated in the name of neutral
over and even denigrated clarity.5
neutral clarity.3

Insanity by Machine
Insanity Machine

Today CAT scans and NMR NM R scans and drug therapies

therapies
are used in the diagnosis and treatment
treatment of behavioral
behavioral
concept of a sick brain
disorders. The concept brain replaces that
that of the
mind...... . . I argue that
sick mind that behavior
behavior is controlled
controlled by the
brain, even those behaviors
brain, behaviors with
with which
which lawyers deal, and
must reinterpret
we must reinterpret such legal concepts
concepts as insanity
insanity and
neurological concepts. Medical
free will into physical, neurological
must replace legal definitions.
definitions must
(Jeffery 1994, pp. 172, 174)

adjudication of insanity by the courts

The adjudication courts is a long-standing
long-standing and vexing
problem. At issue are social as well as individual
problem. individual causes of humanhuman ac­ac-
tion, and the relation
tion, relation of the causes to the legal questionquestion of guilt or
Evil or Ill?,
innocence. Evil III?, Lawrie Reznek's
Reznek’s masterful
masterful review of the pro­ pro-
through which
cesses through which judges and and juries determine
determine guilt and innocence
when the quality
when quality of the defendant's
defendant’s mind is questioned,
questioned, reveals a sur­ sur-
prising conclusion. Despite the long debates, debates, treatises,
treatises, hearings,
hearings, and
matter of how
laws on the matter how to define andand prescribe
prescribe the determination
determination of
and juries often decide not
insanity, judges and not on rules but but on everyday
notions: did the person
notions: person know
know what
what he or she was doing? Further, juries’ juries'
regarding insanity are mediated
decisions regarding mediated by their
their assessment of the
character of the defendant.
character defendant. Reznek terms this “"evil ill." In practice,
evil or ill.”
defendant is guilty but
he claimed, if the defendant but basically good, then then he or she
found "ill"
is more likely to be found “ill” (insane). If however, he or she is guilty
then juries will tend
and evil, then tend to find them
them not
not ill but just plain evil and
guilty (Reznek 1997).
Underdiscussed by Reznek is the role that
Underdiscussed that might be played by biolog­
biolog-
determinations of mental
ical determinations mental disorders,
disorders, especially those biomedical

123
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techniques
techniques that
that appear unbiased and unmediated
appear unbiased unmediated by the beliefs of a
psychiatrist.
psychiatrist. Legally and socially, therethere is no necessary connection
connection be-
tween
tween an abnormal
abnormal brain
brain and an insane person
person (Morse 1988; Perlin
1990}, However, popular
1990). popular portrayals
portrayals of the brain
brain continuously
continuously reiterate
reiterate
the chain of associations
associations that
that an abnormal
abnormal brain implies mental
mental illness,
which
which implies insanity (Gilman 1988; Dumit Dumit 1997),
1997). Lelling (1993), for
example, has shownshown how
how the legal model of insanity is dependent
dependent on
both the medical-biological
both medical-biological model of mentalmental illness and also popular
popular
models. Drawing
Drawing on the work work of Reisner and Slobogin, Lelling noted noted
how the medical model presumes that that “"mental
mental states result primarily
primarily
from organic or chemical conditions within the human
conditions within human body” (Lelling
body" (Lelling
1993, n,n. 80; Reisner et al. 1999). The medical presumptions,
presumptions, which
conclude
conclude (1) thatthat the cause of behavior
behavior lies within
within the person,
person, (2) that
that
the cause is in principle
principle verifiable, and (3) that
that the medical model is
generally accepted,
accepted, all accord well with the desires of the court. court. Lelling
further noted that
further noted that biological notions
notions of insanity depen­
insanity are themselves depen-
dent on folk psychology, on the idea that that the brain
brain is integral
integral to reason
and volition
volition and thatthat the brain
brain is both
both conditioning
conditioning and irresistible
(Lelling 1993).
(Lelling
In court,
court, the claim by a psychiatrist
psychiatrist that
that a person’s schizophrenia is
person's schizophrenia
biologically based is still a claim or opinion
opinion that
that can be countered
countered by
another psychiatrist. Should evidence be proffered,
another psychiatrist. proffered, however, showing
showing a
“ defect” or a “visible
brain "defect" "visible abnormality,” there arises the additional
abnormality," there additional
concern that
concern that such evidence might provide “ misleading aura of cer­
provide a "misleading cer-
tainty” (Huntington
tainty" (Huntington v. Crowley 1966). Here judges are distinguishing
distinguishing
between
between different kinds of persuasion
persuasion and their relative force. Thus,
even as “experts
"experts with impressive credentials” (People v. Kelly 1976) are
credentials" (People
debated regarding
debated regarding their
their effect on juries, machines and graphic
graphic evidence
come in for even greater
greater caution:
When
When a witness gives his personal
personal opinion
opinion on the stand-even
stand —even if he
qualifies as an expert —the jurors
expert-the jurors may temper
temper their
their acceptance
acceptance of his
testimony with
testimony with a healthy
healthy skepticism born
born of their
their knowledge
knowledge thatthat all
human beings are fallible. But the opposite
human opposite may be true when when the
evidence is produced
produced by machine: like many laypersons, jurors jurors tend
tend
inordinately high degree of certainty
to ascribe an inordinately certainty to proof
proof derived
from an apparently
apparently “"scientific"
scientific” mechanism,
mechanism, instrument,
instrument, or procedure.
procedure.
Yet the aura
aura of infallibility that often surrounds
infallibility that surrounds such evidence may
well conceal the fact that
that it remains
remains experimental
experimental and tentative.
tentative. (Peo-
(Peo­
ple v. MacDonald 1984)
v. MacDonald
To put it explicitly, experts do not
not brainwash
brainwash jurors
jurors the way that
that
machines do. “"Expert
Expert testimony
testimony does not
not seek to take over the jurors'
jurors’

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 SEEING BRAINS
BRAINS AS EXPERT
EXPERT IMAGES

task of judging credibility nor nor does it tell the jury that that any particular
particular
witness is or is notnot truthful
truthful or accurate"
accurate” (People v. v. Gray 1986). The
point of these court
point court decisions is that
that in some cases, technology
technology appears
take over not
to take not only seeing butbut judging as well. The evidence no longer
presents itself nor
presents nor is received as data
data to be interpreted
interpreted but but as veridictory
veridictory
statements about
statements about the organization
organization of the world.
world.
relationship of machine to psyche first came to a head with the
The relationship
Frye decision involving whetherwhether or not a polygraph,
polygraph, or lie detector,
admitted into evidence (Frye v.
could be admitted v. United
United States 1923). The Frye
and then
case and then Daubert
Daubert v. Merrell Dow Dow Pharmaceuticals, Inc. are famous
setting out
for setting out criteria for adequate
adequate scientificity of evidence. There is an
reason to exclude polygraph
added reason polygraph evidence, however. Hensler, in his
comprehensive review of the admissibility
comprehensive admissibility of polygraphs
polygraphs before and af­ af-
Daubert, documented
ter Daubert, documented how how countless courts
courts have excluded poly­ poly-
graph evidence because the prejudicial
graph prejudicial impact
impact of admitting
admitting the results
substantially outweighs
substantially outweighs their probative
probative worth
worth (Hensler 1997, n. 225;
notes 193-195).
see notes 193-195). Federal Rule of Evidence 403 states that that “Although
"Although
relevant, evidence may be excluded if its probative
relevant, probative value is substantially
substantially
outweighed by the danger of unfair
outweighed unfair prejudice."
prejudice.”
question of prejudice
The question prejudice arises in the case of the polygraph
polygraph whenwhen the
jury’s judgment-making
jury's judgment-making ability is taken taken from them. Undue prejudice is
Committee’s Note to Rule 403 as “"an
defined in the Advisory Committee's an undue
tendency to suggest decision on an improper
tendency improper basis, commonly, though though
not necessarily, an emotional
not emotional one"
one” (Hensler 1997, citing Federal Rule of
advisory committee
Evidence 403 advisory committee notes). In addition
addition to being unreli­ unreli-
though potentially
able, even though potentially helpful, “expert
"expert polygraph
polygraph evidence is dis­ dis-
tinguishable from such techniques
tinguishable techniques as DNA testing
testing ..... . in that
that only poly-
graphy goes directly to the ultimate
graphy ultimate issue at trial: the defendant’s
defendant's guilt
innocence. If believed by the jury, the expert
or innocence. expert polygraph
polygraph testimony
testimony
case” (Hensler 1997, pp. 1293-1294).
decides the case" 1293-1294). Henseler
Henseler came down
hard on the admission
hard admission of polygraphs
polygraphs into
into the court.
court. Even if they should
doubted), they should
Daubert (which he doubted),
satisfy Daubert should then
then be excluded as
prejudicial under
prejudicial under Rule 403.
CT scan images of the brain that that purport
purport to be about about insanity
insanity or
competency of a person
competency person may also be seen to go to the ultimate ultimate issue of
trial, in this case to a person's
the trial, person’s responsibility
responsibility for his or her actions.
Whether the brain
Whether brain image might
might be prejudicial
prejudicial is also a cultural
cultural question
whether a person's
of whether person’s brain
brain status
status can be equated
equated with
with his or her mental mental
status and personhood-
status personhood —that that is, whether
whether the jury feels that that abnormal
abnormal
brain —mentally
brain= mentally ill=
ill = not
not responsible. (See
(See Masters
Masters and McGuire McGuire 1994
debate on this issue.) In the case of the CT scans in Hinckley’s
for one debate Hinckley's
trial, once the scans were accepted as representing
representing brains,brains, and once

125
CHAPTER 4
CHAPTER

brains were accepted as representing

representing states of personhood,
personhood, then
then it was
w'as a
simple, logical step to read Hinckley’s rationality from the scans.
Hinckley's rationality
Nancy Andreasen's
Indeed, Nancy Andreasen’s 1984 account
account of Hinckley
Hinckley and schizo"
schizo­
phrenia reveals exactly this sort
phrenia sort of logic. Her besr.selling
best-selling book,
book, The
Broken Brain: The Biological Revolution
Broken Revolution in Psychiatry, with
with a PET scan
on the cover;
cover, compellingly argues for the visibility of mental illness
through
through brain
brain imaging (see
(see Plate 13). In the following example, she
concisely argues that
that many schizophrenic
schizophrenic people have enlarged ventri­
ventri"
cles
des and so did Hinckley and that that therefore,
therefore, Hinckley
Hinckley was probably
probably
schizophrenic:
schizophrenic:

[Figure 4.1] shows a much more common abnormality observed in

common abnormality
schizophrenic patients.
schizophrenic patients. This CT scan shows two cuts from the brain
twenty-eight-year-old man
of a twenty"eight"year"old man...... . . The ventricles in this man's
man’s brain
are relatively enlarged for his age age..... . .
Both of these findings indicate that that the patient’s
patient's brain
brain has shrunk
shrunk
and withered.
withered ..... . . These types of CT-scan abnormalities,
abnormalities, particularly
particularly
ventricular
ventricular enlargement,
enlargement, are relatively commoncommon in patients
patients suffering
from schizophrenia.
schizophrenia. JohnJohn Hinckley, the young man who attempted attempted to
assassinate President Reagan, had very similar abnormalitiesabnormalities on his
CT scan.
Thus many psychiatrists
psychiatrists have begun to order order CT scans frequently
frequently
patients in whom
for those patients whom the diagnosis of schizophrenia
schizophrenia or demen"
demen­
likely.... Many
tia is likely Many of these patients
patients will have completely
completely normal
normal CT
abnormalities of the type shown
scans, but some will have the abnormalities shown [here].
When these abnormalities
When abnormalities are noted,
noted, they indicate
indicate that
that the patient's
patient’s
symptoms
symptoms are probably
probably due to a structural
structural cause in the brain. Since
Since
ventricular
ventricular enlargement
enlargement is relatively commoncommon in schizophrenia,
schizophrenia, this
finding may also help confirm the diagnosis of schizophrenia.schizophrenia. John
Hinckley’s
Hinckley's abnormal
abnormal CT scan suggests quite strongly strongly that
that he suffers
from schizophrenia:
schizophrenia: Behind his abnormal abnormal behavior is an abnormalabnormal
brain. (Andreasen 1984, pp. 169-171)
169-171)
Andreasen’s emphasis in her book was on alleviating suffering and
Andreasen's
reducing the stigma of mental
reducing mental illness, but her argument
argument might as well be
court presentation
a court presentation of the semiotics of CT scanning
scanning and schizophrenia.
schizophrenia.
We should
should note here the puzzling confusion
confusion over false negatives (schizo­
(schizo-
phrenic
phrenic patients
patients with
with completely normal
normal CT scans) and false positives
(normal people with
with abnormal
abnormal CT scans).6
scans). 6 In claiming that
that “"Hinckley's
Hinckley’s
abnormal
abnormal CT scan suggests quite strongly that that he suffers from schizo­
schizo"
phrenia,”
phrenia," Andreasen
Andreasen appeared
appeared to be concluding
concluding causality from correla­
correla-
tion. In her argument,
argument, the correlation
correlation of person
person and measurement
measurement
seemed to require
require that
that conclusion.

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 SEEING BRAINS
BRAINS AS EXPERT
EXPERT IMAGES

Normal brain Abnormal

Abnormal brain

i g u r e 44.1.
FFIGURE .1 . Scans
Scans from normal Andreasen 11984)
normal and schizophrenic patients. (From Andreasem 984)

Judge Parker’s
Parker's actions in the Hinckley trial
trial-—not
not allowing the theory
theory
relating
relating shrunken
shrunken brains to schizophrenia
schizophrenia because of lack of evidence
and allowing the scans only at the far end of the room — - demonstrate
demonstrate an
awareness of the power of this kind of visual logic. The nonethe-
judge nonethe­
less
less allowed the scans to be shown
shown to the jury as relevant. “But
"But relevant
to what?”
what?" queried Sander Gilman, testifying before Congress in the af­
af-
termath
termath of the case:
case:
There was certainly
certainly no link between brain
brain size and schizophrenia
schizophrenia
shown
shown by psychiatry
psychiatry at this time. Even the defense acquiesced to this
fact. Why then
then was it necessary to introduce Because it
introduce this material? Because
showed that
that there was a potential
potential physical cause of Hinckley’s
Hinckley's action,
within
within his biology, not his psyche. (National
(National Commission
Commission on the In­In-
sanity Defense 1983)
Crucially, Gilman stated that
that all a brain scan needs to show is a po­ po-
tential
tential cause, and that
that thereafter cultural division
thereafter jurors might make the cultural
between biology and psyche. The element of the CT scan images crucial
to their potency is their visuality. They purport
purport to show the difference
between a normal
normal and abnormal
abnormal brain, between a normal
normal person and
an abnormal
abnormal person,
person, and they purport
purport to do so scientifically and objec­
objec-
tively.
tively. Simply put,
put, because most of us think
think that
that the brain
brain of an insane
person
person should
should somehow
somehow be different
different from a sane person’s, that
person's, we hope that
there is a way to detect this difference. Even more than than the social and
cultural
cultural stereotypes of mental illness that that Gilman has so ably docu­
docu-
mented,
mented, digital brain images promise that that an objective—that
objective-that is, culture-

127
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CHAPTER 4
CHAPTER

free —machine can distinguish

free-machine distinguish them
them (the mentally abnormal)
abnormal) from us
(Gilman 1988).

The Functional Brain in Courtrooms

Brain scans can help convince a jury that something is

that something
wrong
wrong with a defendant’s
defendant's mind. “Most
"Most juries feel that
that most
mental patients are really faking,”
mental patients explained Dr. Bernard
faking," explained
Diamond. "If you show them the X-ray, they’re
Diamond ..... . . “If they're
convinced.”
convinced." But prosecutors
prosecutors fear the colorful
colorful pictures PET
scans and some EEGs produce
produce may dazzle jurors.
jurors ..... . . [One
attorney]
attorney] said he was concerned
concerned jurors “would
"would be staring at
these pretty
pretty pictures . . . and just equate all the red colors
pictures ...
with
with crazy colors.”
colors."
(DeBenedictis 1990, p. 30)

PET scans have been and continuecontinue to be controversial

controversial in courtrooms
courtrooms
(Nelkin and Tancredi 1989; Stipp 1992). PET represents represents cutting-edge
science; it is both
both experimental
experimental and a sign of progress. In addition, be­
addition, be-
cause its visualizations
visualizations may purport
purport to show “"dramatic
dramatic evidence of
brain damage”
damage" (Martell 1992, p. 324), they they are also potentially
potentially prejudi­
prejudi-
cial. Unlike CT scanning or MRI, which which show the structure
structure of the brain
brain
and are relatively stable over time, PET’sPET's portrayals
portrayals of brain functions
can vary from day to day or momentmoment to moment,
moment, depending
depending on whatwhat a
person
person is doing, feeling, or taking. Consequently, the ability to isolate a
specific kind of impairment
impairment — - mental
mental illness, incompetency, or difficult
to define neurological
neurological damage
damage-—is is subject to challenge on a number
number of
grounds.
grounds. These include the specificity of the scan (Can it demonstrate
demonstrate a
connection
connection between this person
person and the impairment?),
impairment?), the presence of
confounders
confounders (Is the person adequately normal
person adequately normal in all other
other respects?),
and timeliness (Is the person’s
person's brain now
now the same as it was during the
crime?). On these grounds,
grounds, most PET researchers
researchers firmly oppose the use
of PET scans in a courtroom.
courtroom.
Because the category
category of expert
expert medical image is applied
applied to PET,,
PET,.the
operative criterion for legal admission
operative criterion admission can shift from "Is “Is it scientifically
acceptable?”
acceptable?" to "Can
“ Can it be legitimately used by a doctor
doctor to help make a
diagnosis?" In this section, I want
diagnosis?” want to show how under
under this criteria,
criteria, PET
is often admissible if care is taken
taken in matching
matching the subject to the pub- pub­
literature and'to
lished literature normal control
and· to a normal control group. In the next section, I
argue that
that the crux of the matter
matter is acknowledging
acknowledging that
that these are expert
expert
images that
that are simply not
not readable
readable by nonexperts
nonexperts and thatthat they
they are
deeply misleading and prejudicial
prejudicial to show to juries.
As discussed in the previous chapter, a PET image is dynamic, manip- manip-

128
 SEEING
SEEIN G BRAINS
BRAINS AS EXPERT
EXPERTIMAGES
IMAGES

ulable, and difficult to decipher even for an expert. expert. Yet showing it to
jury members would
would most likely appear appear to help them them understand
understand how
and why a doctor
doctor was able to use the PET scan in making making a diagnosis.
In cases in which what is at issue is a disease or disorder
which what disorder well discussed
in the medical literature
literature — - Alzheimer’s
Alzheimer's dementia
dementia or epilepsy-
epilepsy —this is rel-
rel­
unproblematic. In a number
atively unproblematic. number of cases, however, PET images have
admitted even when
been admitted theory connecting
when the theory connecting the images to either
mental
mental illness or insanity
insanity has not. In People v. Weinstein, a case before
the Supreme Court
Court of New York involving the use of PET scans for an
insanity defense, Judge Carruthers
insanity Carruthers excluded
excluded all theory
theory but that
but allowed that
the jury should be shownshown the scans. He further further held that
that "relevant evi-
“relevant evi­
that does not meet the Frye standard
dence that standard may still be admissible on
issue of sanity."
sanity.” Citing both both Section 4.07(4) of the Model Model Penal Code
and Section 60.55(1) of New York’s York's Criminal
Criminal Procedure
Procedure Law, Judge
Carruthers
Carruthers noted
noted that psychiatrists and psychologists
that psychiatrists psychologists may ~ay use "relevant
“relevant
and reasonable"
reasonable” technical and scientific material material to form diagnostic
opinions that
opinions that have not been accordedaccorded general acceptance
acceptance within
within their
that these materials
discipline and that materials may be shown shown to the jury (People v.
Weinstein 1992). This decision led to a plea. Kulynych,
Weinstein KuJynych, writing
writing against
neuroimages courtrooms,
the use of neuroimages in courtrooms, accused Judge Carruthers of per-
Carruthers per­
haps “ being
haps "being seduced by defense rhetoric
rhetoric and the high-tech glamour
high-tech glamour of
neuroimaging"
neuroimaging” (Kulynych 1997, p. 1263). Her Her claim was that that neuro­
neuro-
imaging is not
not diagnostic and therefore should
therefore should not not be evidence.
The problem with this line of arguing
problem with arguing is thatthat it again confuses the
kind of evidence thatthat PET presents for psychiatrists.
psychiatrists. Especially in cases
involving medical doctors,
doctors, there is wide latitude
latitude granted
granted to tests that
that are
reasonably
reasonably relied on to help form an opinion subject-in
opinion on the subject —in this
case, diagnosis (Federal Rules of Evidence 403). Most Most neurologists
neurologists and
psychiatrists familiar
psychiatrists familiar with
with PET wouldwould agree thatthat it can aid in making a
differential diagnosis even though
differential though it is not
not in itself a reliable indicator
indicator of
morbidity or normality. In People v. Weinstein,
either morbidity Weinstein, Judge Carruthers
Carruthers
sympathy with
made clear his sympathy auxiliary use of PET as an aid in
with the auxiliary
determining a diagnosis, even if the use was purely negative, only to
determining
rule certain other possibilities.
certain other
In each of these cases, to the extent extent that
that PET met Daubert
Daubert criteria in
connection with
connection with their
their aid in making diagnoses, they they were admitted
admitted into
evidence.7 In terms of scientificity,
scientificity, it will be increasingly hard hard to deny
admission of neuroimaging
admission neuroimaging data, data, especially whenwhen the presenters
presenters are
about using “"consistent
clear about consistent with” pointing out how
with" language and pointing how use­
use-
ful PET is in excluding
excluding other other diagnoses. On the basis of my ethno­ ethno-
graphic and cultural
graphic cultural studies approach
approach to neuroimaging,
neuroimaging, however, I
would like to strongly
would strongly suggest a careful evaluation
evaluation of the prejudicial
prejudicial
nature of showing brain
nature brain images to a jury. In this final section, I argue
that these expert
that expert images are not not simply potentially
potentially manipulated
manipulated and

129
CHAPTER 4

dynamic but
dynamic but that
that their
they are received
they
their cultural
received in the
cultural familiarity
familiarity merits close scrutiny
the courtroom.
courtroom.
scrutiny of how
how
1
Prejudicial Images
Preiudicial Images

told that
I was told that one judge, in pretrial,
pretrial, decided
decided that
that he
would admit
would admit PET scanning.
scanning. No judge has decided that thar he
wouldn’t, but
wouldn't, but this judge decided that that he wouldn’t
wouldn't allow the
jury to see any
any of the
the pictures.
pictures. He would
would just allow
allow the
testimony about
testimony about what
what was in the the pictures
pictures because he felt
that the
that the pictures
pictures in themselves
themselves were prejudicial.
prejudicial. This strikes
absolutely true.
me as absolutely true. This seems to me to be a very wise
decision. Because those
decision. those pictures
pictures are very compelling,
compelling, and
what I told
what told the
the superior
superior court
court justices is that
that if you wanted
wanted
manipulate PET, it was very hard
to manipulate hard to fake it by saying,
“What can I think
"What think now
now to activate
activate my left anterior
anterior
thalamus?” But as an operator,
thalamus?" operator, I can choose the colors colors on
the scale and
the and I can choose
choose the interval
interval on the scale, and I
can make
can make a lot of areas black. And that that would
would look very
dramatic. That
dramatic. That is about
about the worst
worst thing
thing I think
think one can do
make a visual presentation
to make presentation that
that was notnot entirely
entirely
accurate.
accurate.
(Richard Haier,
(Richard Haier, quoted
quoted in Dumit
Dumit 1995b,
1995b, p. 67)

Haier emphasizes
Haier emphasizes thethe difference between
between describing
describing a brainset
brainset and
and por­
por-
traying it in color. The latter
traying latter risks overestimating
overestimating the differences in­ in-
and therefore making
volved and therefore making a slightly ambiguous statistical correlation-,
ambiguous statistical correlation"'
appear to be clear and
appear and dramatic.
dramatic. Three
Three issues mustmust be unpacked
unpacked in this
description: (1) the status
description: status of the
the referent
referent of PET images, (2) the kind kind of
objectivity of PET scanning,
objectivity scanning, andand (3) the persuasiveness
persuasiveness of such images
for viewers. These issues define the the kind of message that that a PET scan
popular culture
becomes in popular culture and
and in the courtroom.
courtroom.
the customary
First, recall the customary practice
practice of publishing
publishing extreme
extreme images out­out-
the previous
lined in the previous chapter.
chapter. As an illustration
illustration of the
the kinds
kinds of problems
problems
that these extreme
that extreme images pose,
pose, consider
consider the following
following hypothetical
hypothetical sce­
sce-
nario: In an experiment
nario: experiment comparing
comparing people found found to have schizophrenia
schizophrenia
with people
with people whowho have no history
history of mental
mental illness in their
their family (these
supernormals in the
are called supernormals the literature),
literature), data
data is generated
generated that
that shows
much overlap
much overlap between
between the
the two
two groups
groups butbut enough
enough statistical
statistical difference
warrant publication.
to warrant publication. In other
other words,
words, though
though there
there is clearly no way
diagnosis, there
to go from scan to diagnosis, there are certain
certain areas of the brain
brain that
that
more activity
have more activity in more
more people with with schizophrenia
schizophrenia than than in supernor-
supernor-

130
 BRAINS AS EXPERT
SEEING BRAINS EXPERT IMAGES

mals. Imaging software is used to process the brain brain data

data so as to high-
high­
schizophrenia-elevated areas. To make clear the difference to
light those schizophrenia-elevated
nonexperts, the supernormals
nonexperts, supernormals are used to establish
establish a baseline set of
color ranges, and the average of the images is then produced. This pro­
then produced. pro-
cess of averaging suppresses the many individual variations among
individual variations among the
supernormals and produces
supernormals smooth image of "normal."
produces a fairly smooth “ normal.” The
average image of people with schizophrenia will have, because of the
with schizophrenia
color ranges chosen, enough of a variation
variation in a few regions to be visibly
different. The schizophrenia
schizophrenia image will thus appearappear to look like the
normal
normal image but withwith visible "defects"
“ defects” standing
standing out, areas usually col­ col-
ored yellow, red, or black.
approach to selecting images for display would
One approach would be to take the
supernormal with
supernormal with the most smooth
smooth scan and to publishpublish it as n orm al
NORMAL
next
next to the scan from the person
person with
with schizophrenia
schizophrenia whose brain re- re­
gions were most different and to label that that one as SCHIZOPHRENIA.
sch izo p h ren ia. The
visual gestalt would
would be one of a clear difference between the different
types of persons
persons and the clear visual
visual implications
implications thatthat (1) almost
almost anyone
could see schizophrenia
schizophrenia with
with neuroimaging,
neuroimaging, (2) that that schizophrenic
schizophrenic peo-peo­
ple have a certain
certain kind of brain, and (3) thatthat schizophrenic
schizophrenic people are
normal people. Implications
clearly biologically different from normal Implications like these
are routinely
routinely displayed in the mass media, where accompanying text
where the accompanying
often asserts what
what the pictures show, not not what
what the data data originally
indicated.
indicated.
Now comes a semiotic problem
Now those researchers,
problem for those researchers, such as Ter-
Pogossian, who want want to argue that
that one cannot schizophrenic
cannot diagnose schizophrenic
images or sort them
them from normal
normal ones. They want want to argue that that brain
cannot (yet) demonstrate
imaging cannot demonstrate a correspondence
correspondence between
between a subject's
subject’s
scan and a diagnosis of schizophrenia.
schizophrenia. However, they are up against a
claimant who argues that
claimant that the image shows clearly visible difference,
that
that it is an abnormal
abnormal scan, defined as such for the jury by the rules of
invention:
We may define as invention
invention a mode of production
production whereby
whereby the
producer of the sign-function
producer sign-function chooses a new material continuum not
material continuum
yet segmented for that
that purpose
purpose and proposes
proposes a new way of organiz-
organiz­
ing (of giving form to) it in order
order to map within
within it the formal perti­
perti-
nent element of a content-type.
content-type ..... . . The sign producer
producer must in some
way posit this correlation
correlation so as to make it acceptable.
acceptable. (Eco 1979, p.
245)
The claimant’s
claimant's task is to posit that
that this new material continuum, the
material continuum,
brain
brain scan, is either visually dissimilar ((or other brain
or similar) to other brain scans,
that this dissimilarity is related
and that related to abnormality.
abnormality. On the face of it,
this position
position seems quite acceptable: brain
brain scan type A goes with
with person

131
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CHAPTER
CHAPTER 4

type A, and brainbrain scan type B goes with with person

person type B. We might note
that the popular
here that popular media practice
practice of publishing
publishing simply labeled brain
images of extreme cases makes this interpretation
interpretation all the more conven­ conven-
tional, and hence acceptable.
tional,
claimant who
The claimant who suggests that that an "abnormal
“ abnormal scan equals abnormal abnormal
person” is able to define a simple, elegant organization,
person" organization, and one that that
is eminently
eminently visualizable: yellow blob versus no yellow blob. The re- re­
searcher
searcher whowho disputes this organization
organization is in the difficult position position of
arguing that the scan, despite appearances, is not
arguing that not simply readable
readable (as
opposed
opposed to simply not readable).
simply not readable). He or she must argue that that the scan is,
in fact, an expert
expert image requiring
requiring context
context and reflection, not not reflexive
speculation.
speculation. The researcher
researcher must argue that that even though
though it looks differ­
differ-
ent from an “"average
average normal”
normal" scan, there may be no (significant) differ- differ­
ence in the person
person at all.
all.88 He or she is caughtcaught here in the sublime di- di­
lemma of brain imaging, attempting attempting to argue that that the yellow blob or
any other “ abnormality” might nonetheless
other "abnormality" nonetheless mean that that the person
person is
“"completely
completely normal."
normal.”
This kind of image publishing
publishing practice routine in the life
practice is routine life sciences
sciences
and is in fact demanded
demanded by journals, grant agencies, and the FDA. All of
journals, grant
institutions, if they are to look at images, want
these institutions, want images that that are
visually distinguishable,
distinguishable, images that that do not not require one to be an expert expert
to see a difference. In courtrooms,
courtrooms, however, one of the side effects of
these publishing
publishing practices is that that many normal
normal people, especially those
who do not meet the criteria for supernormal,
who supernormal, will look more abnormal abnormal
than not. Normal
than Normal variation
variation will have a tendency tendency to stand out out from
supernormal and look more like the published
the averaged supernormal published abnormal
abnormal
images.
Furthermore, despite the tremendous
Furthermore, tremendous work work being done with brain brain im-
im­
aging and mental
mental illness, there remains
remains much difficulty in interpretinginterpreting
individual
individual scans. There is as much, if not not more, difficulty diagnosing
scans than
than diagnosing schizophrenia
schizophrenia using traditional psychiatric eval-
traditional psychiatric eval­
uations.
uations. This does not not mean that that neuroimaging
neuroimaging does not not aid in forming ·
an opinion
opinion about
about a person regarding schizophrenia or other
regarding schizophrenia other mental ill- ill­
neurological disorders. It can and does, and therefore
nesses or neurological therefore should
be admitted
admitted as evidence aiding in making a diagnosis. It does mean,
however, thatthat showing these expert expert images to a jury literate literate in only
popular
popular images of absolute differences and medical journal journal images of
extreme admittedly exaggerated differences is potentially
extreme and admittedly potentially prejudi­
prejudi-
cial, because the jury’s
jury's eyes are cultural
cultural ones, not expertexpert ones.
If popular
popular and extreme images accord accord with with our cultural-common-
cultural-common-
sense notions
notions of the differences between between them (abnormals) and us (nor­
them (abnormals) (nor-
mals), as Sander Gilman
Gilman has argued, how how can we look at expert expert images
brain and not
of the brain not engage our prejudices as to what what we thinkthink mental

132
~
I SEEIN
SEEINGG BRAINS
BRAINS AS EXPERT
EXPERT IMAGES
IMAGES

expert images in the courtroom

illness looks like? The use of expert courtroom is fraught
fraught
with difficulties like these, stemming from our
with our current
current cultural
cultural semiotics
that privileges machines over experts in terms of objectivity, and biology
that
agency. Recognizing this means recognizing that
over social causes in agency. that
the legibility and
and meaning of expert
expert images is notnot easily contained
contained and
that
that the unstable
unstable category of demonstrative
demonstrative evidence is at the pointpoint of
breaking when
breaking when "mere
“ mere aids to illustrate
illustrate testimony”
testimony" become “"an an expert’s
expert's
proof.”
only objective proof."
When
When one judge decided to minimize the effect of the CT scans in
Hinckley’s trial, or another
Hinckley's another judge decided to admit PET evidence but
not to allow the jury to see the scans, they were acknowledging
not acknowledging some of
these consequences,
consequences, that
that the images can speak louder than than the experts
who are and can be their interpreters.
who interpreters. The risk is that
that the images no
longer function
function as mirrors
mirrors of the scientific process or even of reality but
instead as "a
instead “ a binding
binding of fantasies to images and meaning”
meaning" (de Lauretis
1987, p. 53). These include fantasies of automation
automation without
without automat-
automat-
without the craft and
ors, objectivity without and art
art and messy humanness
humanness of scien­
scien-
neutrality without
tists, and neutrality without acknowledging
acknowledging the struggles over human human
normality, mental
categories like normality, mental illness, insanity, and even variability. In
short, these digital images risk producing
short, producing a democracy
democracy without
without people.

133
133
 Interlude4
Interlude
Reading into Images
Images

PET scanning has appeared

appeared in newspapers,
newspapers, popular
popular magazines, and in
popular
popular science magazines. To begin considering
considering the role these PET im­
im-
ages can play in our own lives, Ed I'd like to reflect for a moment
moment on a
stunning
stunning article that
that appeared
appeared in the industry
industry magazine, Advance
Advance Radi­
Radi-
ology (Hatfield 1995b}.
19956).
More Than
PET Shows Female Brain Has Evolved More Than Male's
Male’s
already presumes a priority
The article title itself already priority of the technology
technology of
vision -—“"PET
PET Shows ..... . ”" The statement
statement is one of fact, of an order
order in
the world
world revealed by a science and a technology, and the factual order
contains
contains categories of significant personal
personal difference (female versus
male), a moral
moral hierarchy
hierarchy of personhood
personhood (female as more evolved), and a
location
location of personhood
personhood (evolution lies in the brain).
brain). As I picked
picked up the
issue of Advance
Advance that
that carried that
that article title, at a meeting of the Soci­
Soci-
ety of Nuclear
Nuclear Medicine, and showed it to different researchers,
researchers, I found
found
fascination, surprise,
expressions of fascination, “Wild claims
surprise, disgust, and humor. "Wild
hallmark of this field,"
are the hallmark field,” one researcher
researcher said to me. "Look
“ Look here at
poster -—II could have written
my poster written ten pages of conclusions
conclusions if I had
wanted
wanted to, butbut I would
would have been making it all up!" up!” The article in
question has no such constraints:
question constraints:
Positron
Positron emission tomograph
tomograph (PET)
(PET) has revealed a majormajor finding:
The brains of most men and women
women are different and womenwomen may be
slightly more evolved than
than men.
The study also sheds more light on the theory
theory thatthat human
human behavior
is biologically controlled rather than
controlled rather than learned
learned...... , .
,,,,
I READING INTO IMAGES
READING

Dr. Gur brought

brought up a graph
graph on his computer.
computer. The graph
graph charted
the differences in metabolic
metabolic activity in the brains of men and women.
Its base is the PET research
research Dr. Gur had done with with his colleagues,
including his wife Raquel,
Raquel, a neurologist psychiatrist.
neurologist and psychiatrist.
The graph
graph referred
referred to by Dr. Gur represents
represents a study of 37 male and
24 female, right-handed
right-handed volunteers
volunteers who underwent PET.
who underwent PET. During
scanning, which
which was conducted
conducted in a dimly lit room,
room, the subjects were
instructed remain quiet and relaxed,
instructed to remain relaxed, but
but to try not
not to close their
eyes
eyes or fall asleep. Radiolabeled
Radiolabeled glucose was administered
administered intrave­
intrave-
nously
nously and each was positioned
positioned in a custom-molded
custom-molded head
head holder
holder dur­
dur-
ing image acquisition.
acquisition.
Glucose metabolism
metabolism studies also showed that that women
women have more
activity in the front
front area of the brain,
brain, which
which is associated with plan­
associated with plan-
ning, abstraction
abstraction and mental flexibility. In this area, men have lower
mental flexibility.
activity and lose brain cells
cells three
three times as fast as women,
women, he said.
That women lose less brain cells and have higher
That women higher rates of blood flow
longer^ Dr. Gur
may suggest why they live longer, Gur added.
added. Such activity is also
prevalent
prevalent in schizophrenic patients, who have become a prominent
schizophrenic patients, who prominent
part
part of the Gur’s
Gur's research. (Hatfield 1995b)
19956)
First let us note that
that “men”
"men" and “women”
"women" are being studied
studied in their
statistical
statistical sense. Their
Their average metabolism
metabolism is different,
different, which
which does not
necessarily imply anything about individual
anything about women. Nonethe-
individual men or women. Nonethe­
less, on the basis of this average difference, Dr. Gur feels free to talk
talk as
if the study has implications how all men and women
implications for how women differ in their
daily interactions.
interactions. Also reporting
reporting on the same study
study by the Gurs, News-
News­
week notes parenthetically
week parenthetically that
that
. . . ((the pair got into the field of sex differences when
the pair when they were
struck
struck by their own temperamental
temperamental differences. He is more intrigued
intrigued
numbers and details, she likes to work
by numbers work with
with people; he reacts to a
setback by taking
taking a deep breath
breath and moving
moving on, she analyzes it.)
(Begley 1995)
(Begley
Note
Note the circularity wherein the Gurs claim to have taken
circularity wherein taken their own
noticed differences as instances or examples of gendered
noticed gendered differences: a
cultural noticing of a particular
cultural particular kind. Obviously
Obviously they knew
knew of notions
notions
of such differences before, but without attributing
but without attributing significance. At some
point, then,
point, then, they
they found
found themselves (one or both) explaining
explaining themselves
via this difference. In other
other words,
words, idiosyncratic,
idiosyncratic, individual,
individual, or personal
personal
expressions were reframed
reframed as expressions of biological type. The form
of the type then
then remained
remained unknown:
unknown: Was this due to genotype, phe­ phe-
notype, or chemotype? They therefore
notype, therefore were motivated
motivated to explore these
differences further. For these neuroscientists,
neuroscientists, it was not
not enough that
enough that

135
135
INTERLUDE
INTERLUDE 4

gender was an explanation their social differences; they now

explanation of their now wanted
wanted
a biological explanation
explanation of (this kind of) gender. Clearly, it must be
pointed out, they
pointed they were not
not going to be disappointed.
disappointed. We can safely
imagine that
that if their
their experiment not display any significant differ­
experiment did not differ-
ences between
between the men and the women women tested, they would
would not have
rethought their
rethought their first gendered
gendered explanation
explanation of their differences. Rather,
would have assumed that
they would their machines had not had
that their had enough
enough reso­
reso-
lution.
lution.
“There,” he said, moving his finger across the blue-gray image on
"There,"
computer screen, pointing
the computer pointing out where metabolic activity is the
where metabolic
same in the brain both sexes. "And
brain of both “And here is where
where it switches,”
switches," he
denoting another
said, denoting that he called the cingulate gyrus.
another area that
according to Dr. Gur, is located
The cingulate gyrus, according “ new
located in the "new
limbic” part
limbic" part of the brain.
brain. Together with “ old limbic,"
with the "old limbic,” the parts
parts
make up the overall limbic system of the brain, where where emotion
emotion is
processed.
As explained
explained by Dr. Gur, women
women have more metabolic
metabolic activity in
the new limbic area, which
which is more developed in advanced
advanced species,
species,
such as monkeys. Men, he said, have more metabolic
metabolic activity in the
old limbic area, which controls
controls more primitive
primitive ways of responsive­
responsive-
ness. “The
"The old limbic, also called the temporal-limbic
temporal-limbic system, is al- al­
ready quite well developed in the brains of reptiles.”
reptiles."
So, does this mean that
that the female brain
brain is more evolved than that
than that
in males? “Yes
"Yes and no,” answered Dr. Gur. “The
no," answered "The no part
part is that
that we ,.
both have more activity in the highly evolved part
both part of the brain. So,So,
maybe women
women are a half a step ahead of men."
men.” (Hatfield 1995b)
Look at the bonus,
bonus, the excess, which
which comes as a result of this discov­
discov-
ery: speculation
speculation in the form of an explanation.
explanation. There is not not only simple
difference (if difference could ever be simple) between men and women, women,
but hierarchical
but hierarchical difference. Cleverly,
Cleverly, and clearly whimsically, Gur
patched together
patched together Paul MacLean's
MacLean’s popularized
popularized triune
triune theory
theory of the brain
brain
with these new findings to conjure a truly
with truly oxymoronic
oxymoronic "fact"
“ fact” (might we
factoid?) —“women are more evolved than
say factoid?)-"women men.” 99 Gur stated
than men." stated this
as if evolution
evolution is a quantity MacLean and most biologists, mam­
quantity (for Maclean mam-
“ later” than
mals evolved "later" than reptiles but are not
not therefore
therefore “"more"
more” evolved,
because evolution
evolution is about
about fitness within
within a particular
particular environment)
environment) and
as if women
women and men are two different species, so absolutelyabsolutely different
as to be on separate
separate evolutionary
evolutionary tracks.
Philosopher examining the concept
Philosopher David Hull, in examining concept of "biological
“ biological spe-
spe­
cies,” has noted
cies," noted that
that it connotes
connotes natural
natural kinds, which
which are “"eternal,
eternal, immu-
immu­
discrete,” even though
table, and discrete," though for evolutionary
evolutionary biologists they are
none of these. Clearly, the Gurs are researchers
none researchers who relish playing with with

136
 READING INTO
READING INTO IMAGES
IMAGES

popular connotations.
popular connotations. Ironically, their
their previous work found
previous work found handedness
handedness
stronger regional
to have significant and even stronger regional activation
activation effects ((Gur
Gur et al.
1982; Reivich and Alavi 1985). By the logic of the above arguments,
arguments, left­
left-
handers should
handers should be viewed as a biological group
group different and potentially
potentially
than right-handers.
more or less evolved than right-handers.
Let us skip over the further
further wild speculation
speculation on the meaning of the
remembering that
discovered differences, remembering that the experiment
experiment had no hy- hy­
potheses regarding
potheses regarding specific
specific areas to begin with
with and ostensibly was able
to discover that the two groups
groups were different. The end of this article
reveals the biggest surprise. Within
Within this data
data set that
that proves the differ­
differ-
ence between
between men and women,
women, there are "outliers,"
“ outliers,” men who do not
look like the other
other men, women
women who do not not look like the other
other women.
Of his most recent study, Dr,
Dr. Gur said the patterns
patterns of activity were
reversed in two of the women
women and 12 of thethe men. This, he said, may
have a correlation
correlation with
with findings of a new study out of the University
of Chicago, called Sex in America: A Definitive
De-finitive Study,1
Study, 100 which
which is
available in book form from Little, Brown and Co. The study sug- sug­
gests that
that there
there are twice as many gay men as women
women in the nation.
nation.
“"This
This explains why there are more men that that show the female pat- pat­
tern,”
tern," he said. Referring to the dozen male volunteers which showed
volunteers which
activity in the brain
brain that
that was similar to females, Dr. Gur said: "Con-
“ Con­
ceivably, these men could be homosexual."
homosexual.”
Such findings would
would contradict
contradict the belief that
that homosexuality
homosexuality is a
result
result of one’s environment. "Some
one's environment. “ Some people think
think sex differences are
environmental,” he said. “They
entirely environmental," "They become really upset when
they are shown
shown differences in the way brains
brains behave. They say it can’t
can't
be.” (Hatfield 1995b)
be." 19956)
Out of thirty-seven
Out thirty-seven men, twenty-five (or 68 percent) looked identical
percent) looked
enough to be called a type, and twelve (or 32 percent) did not look
enough
anything like them. These twelve in fact looked
anything looked like the majority
majority female
type. (How did they look like the majority
majority women? Exactly? Statis-Statis­
tically significant? Does it really matter, at this point,
point, to us, or Dr. Gur?)
conclusion from this appears
The conclusion appears so beyond
beyond sense and dignity that that
readers
readers can only laugh very nervously. Perhaps,
Perhaps, Dr. Gur replies, dearly
clearly
not having asked them, these twelve men are gay. Presumably, the other
not
twenty-five are heterosexual
heterosexual (again, a presumption
presumption made without
without the
men having been asked). The twelve would would be gay, then,
then, not
not because of
sexual preference or orientation,
orientation, but
but because of a feminine brain
brain pat­
pat-
tern? Homosexuality
Homosexuality here returns
returns to a historically aberrant definition as
historically aberrant
mechanical inversion
mechanical inversion (Fausto-Sterling 2000).
2000).
Newsweek story treats
The Newsweek treats the same data
data as a significant problem
problem for
drawing any conclusions at all from the study. “Not
drawing "Not even the re­ re-

137
 INTERLUDE 4
INTERLUDE

searchers are sure what

searchers what this means. For one thing,
thing, 13 men and four
women showed
women showed activity more like the other
other sex”
sex" (Begley 1995) 111 De­
(Begley 1995)1 De-
pending on one's
pending one’s position,
position, then, this research is either fascinating or
abhorrent, promising
abhorrent, promising or abusive, or simply and troublingly
troublingly silly.
silly. .
with which
The ease with which we all learn to “see”
"see" these oddly shaped images
photolike pictures of the brain
as photolike brain derives from an implicit faith in pene­
pene-
trative powers
trative powers of X-rays and in technological
technological reproduction.1
reproduction.122 The Gurs
caught up with
seem caught with the possibility of “really”
''really" knowing
knowing who we are
through the miraculous
through miraculous agency of these new digital prosthetics
prosthetics of vi­
vi-
and others
sion. These articles, and others published
published by and about
about the Gurs, are
interventions into the facts of PET and the facts of personhood
interventions personhood (Gur et
al. 1995; Gur et al. 1994). For PET they provide a thumbnail
thumbnail sketch of
diagnostic and
diagnostic and speculative power. With regard to personhood,
personhood, they reify
circumscribe types of humans
and circumscribe humans and relations
relations of cause and effect,
effect.
Reading these articles, one confronts
Reading confronts these facts and is drawn
drawn into the
virtual community
virtual community of PET images.

i
Ii
i;

138
 Chapter 5
Traveling Images, Popularizing Brains
Traveling Brains

. . , Even if any given terminology

... terminology is a reflection of reality,
by its very nature
nature as a terminology
terminology it must be a selection of
reality; and to this extent
extent it must function also as a deflec­
must function deflec-
tion of reality.
(Burke 1966, p. 45)

Normal
Normal Encounters

PET images appear

appear as computer-generated, technologically objective
computer-generated, technologically
scans of particular
particular brains at particular moments. In popular
particular moments. popular arenas,
these brain
brain images are highlighted
highlighted in frames with
with very simple, often
one-word that emphasize differences between
one-word labels that between the subjects rather
rather
than
than qualify them.1
them. 1 The frame of PET images in Plate 2 is from a News-News­
week article on mapping
week article mapping the brainbrain (Begley
(Begley 1992). In a box are three
pairs of images, which
which the captions
captions describe as brains of specific
specific per­
per-
sons—for
sons -for example, “The "The brain
brain of a clinically depressed person
person shows
less activity (right) than
than that
that of a healthy person.” These captions
healthy person." captions and
the labels, however, transform
transform these individual
individual persons
persons into types of
humans: novice, practiced, depressed, healthy, retarded, and, above all,
humans:
normal. As readers,
readers, we are faced withwith pairs of markedly
markedly different
different im­
im-
ages and labels that
that tell us that brain scans show us that
that these brain that these
persons
persons are significantly different in their brains. More More than
than that,
that, be­
be-
cause these are pictures of their
pictures of their brains
brains and the labels are about
about mental
CHAPTER 5
CHAPTER

two together
life, the two together purport
purport to demonstrate
demonstrate how and why these types
different kinds of humans.
of people are different
Having looked
Having looked at many articles in Newsweek
Newsweek and otherother mass-media
mass·media
magazines, I hadhad decided that
that the articles were written
written precisely to cap­
cap•
potent transparency
italize on the potent transparency and familiarity
familiarity of these images of
difference. Surprisingly to me, the editor of the Newsweek Newsweek article,
Begley, did not
Sharon Begley, not share my conclusion,
conclusion, nor my analysis. Echoing
researchers, Begley
the PET researchers, Begley estimates that
that the text
text of the story compen­
compen•
sates for the immediacy of the scans. She is as aware of the dangers of
scan-likeness as the researchers
scan•likeness researchers she interviews, and like them,
them, she em­
em•
point with
phasizes her point with visual clarity over complexity:
illustration, the “PETting
D u m it: From the illustration,
DuMIT: "PETting the brain”
brain" box, the impli­
impli•
cation I see is that
cation that if not
not now, then soon, PET will be able to tell us
different kinds of people.
the difference between different
don’t know. Maybe
B e g le y : Well, I don't
BEGLEY: Maybe that
that is an inference that that people
drew. ThatThat implication
implication was notnot intentional.
intentional. I think
think we are looking
microcosm. The point
at a microcosm. point was to take known known cases; in other other
words, these were not
words, not diagnostic
diagnostic or predictive. These were: you
identify the two poles going in, and then
identify then you take take PET scans of
these people. And then then you can, lo and behold, see differences.
Which is not
Which not to say, that
that if you PET scan the brains of a hundred hundred
walking outside this door, that
people walking that you can get something
something as
striking, or that
striking, that these hundred
hundred people will fall into these two sepa­ sepa•
rate groups.
rate groups. The diagnostic
diagnostic possibilities of PET are something
something that
that v,
didn’t address,
I didn't address, because I don't
don’t think
think thatthat they are really there.
And I really dislike erecting a strawstraw man and knockingknocking him down.
I’d rather
I'd rather just not
not open that
that subject at all. I think
think it is silly wasting
space thatthat way.
Yes. That
D u m it: Yes.
DuMIT: That is, however, the first thing that that jumps to people’s
people's
head whenwhen I show them them these. Or an instant instant critical reaction:
“ These pictures can't
"These can’t really show that.
that. Why does it look like they
can?"
can?” ·
B e g le y : Well, see, in this case they could, but that
BEGLEY: that is because the
diagnosis had had been made by other criteriacriteria beforehand.
beforehand. Again, the
point was-whatever
only point was —whatever you have, a mentally retarded retarded person or
schizophrenic, and
a schizophrenic, and then
then a non•whatever,
non-whatever, then you can see differ­ differ•
Which is not
ences. Which not to say that
that in all cases you can. I mean you will
get false positives and false negatives.
Chapter 4 established
Chapter established how
how courts assume the task of identifying ab­ab·
normality through brain technologies.
normality through brain technologies. They did this through
through the notion
notion
“expert images"
of "expert images” that
that promote
promote difference and type. This chapter
chapter
how brain images travel
looks at how travel many places beyond courtrooms,
courtrooms, and

140
 TRAVELING IM AGES, POPULARIZING
IMAGES, POPULARIZING BRAINS

how
how their persuasive power and objective authority authority over human human nature
nature
is used in many arenas — - science journalism,
journalism, movies, criminality, mental
illness, patient
patient activism, doctors’
doctors' offices.
offices. Each of these arenas is invested
with specific
specific notions
notions of “normal”
"normal" and “"abnormal,"
abnormal,” and running
through
through each of these are the manifest manifest assumptions:
assumptions: mind mind == brain,
brains have types, these types are people. These assumptions assumptions make up
truth, or topoi. Each of the three
the grounds of truth, three locations
locations corresponds
corresponds
to a point
point of view thatthat make different
different uses of this same “truth” "truth" in
different
different ways. In the popular
popular press — - through
through hope, hype, stigma, and
play
play-a—a “normal
"normal observer”
observer" whowho is also a “good citizen" is situated.
"good citizen”
Within
Within expert
expert culture,
culture, attempts
attempts are made to control
control abnormality through
abnormality through
prediction,
prediction, surveillance, and intervention.
intervention. Finally, the subjects of brain
images—patients
images - patients —inhabit
- inhabit types, living with abnormality.
abnormality. Their point
of view is of an abnormal
abnormal observer, specifically different
different from the normal,
normal.
Because “none
"none of us really come as strangers
strangers to the brain, since the
foundational
foundational metaphors
metaphors of brainbrain science pervade popularpopular culture, and
have for some time"
time” (Star 1992, p. 205), news and journalism journalism can help
notions of “accepted
shape our notions "accepted medical knowledge”
knowledge" and even our cate­ cate-
gories of the patient
patient as person.2
person. 2 In the rest of this chapter, I follow this
shaping
shaping process, examining
examining how facts travel in the world, world, but also how
they never travel alone. Instead
Instead they are packaged
packaged in the form of stories,
explanations,
explanations, and experiences; as authorizedauthorized or unauthorized;
unauthorized; and as
facts, which include definitions of human human nature.
nature.
Two important
important questions arise for me, one intellectual
intellectual and one per­ per-
sonal. The first is:is: What proclaimed in print
What is the status of these facts proclaimed
under
under expert technological
technological and scientific authority?
authority? This question asks
about
about the difficult unevenness of knowledgeknowledge in the world: How is it
produced and verified, and how does it reach me?
produced
The second question
question is: What
What if they are true? This question trips me
up, catches me off guard, posing a sublime moment moment of reflection: What What
do I believe (what
(what do I know) about about mental
mental illness, sexual difference,
sexuality difference, my own cognitive abilities, brain patterns, patterns, and
identity? I am fascinated and horrified
horrified by the possibility
possibility posed here, of a
world
world in which technology
technology can tell me who I truly am. An article on
Ruben
Ruben Gur’s
Gur's work
work with schizophrenia
schizophrenia is headlined
headlined “"PET PET may someday
help screen for criminal behavior,
behavim; says PhD”PhD" (Hatfield 1995a). It pre­ pre-
sents a world in which technology
technology can tell who is responsible or sane or
rational,
rational, and who is not. This article presents “"aa view of the world that that
might
might well be different”
different" from my current
current one (Martin
(Martin 1987). Some re­ re-
searchers call this ability “"biotechnopower":
biotechnopower” : the attribution
attribution to technol­
technol-
ogies of measurement
measurement the authority
authority to decide to which which categories we
essentially belong (Foucault 1978; Haraway Haraway 1991; Rabinow Rabinow 1992).
Thus, like Emily Martin,
Martin, I find myself stumbling
stumbling “over [these]
"over accepting [these]

141
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CHAPTER 5
CHAPTER

statements as truth"
scientific medical statements truth” (Martin
(Martin 1987, p. 10). The ques­
ques-
tion of the mass media reframes the question
tion question of truth,
truth, however, calling
examination of the ways in which
for an examination which “new
"new facts”
facts" and new worlds
worlds
and people are produced,
and produced, distributed,
distributed, and incorporated.
incorporated. ·

Toward
Toward a Semiotics of Popular
Popular Brain Images

One obvious solution

solution to the floods of data is to rely on
dimensions, shadings, and color
images, whose spatial dimensions,
codings can easily express large amounts
amounts of data ..... . yet in
attractions, or perhaps
spite of their attractions, perhaps because of them,
images create dangers for both
both clinicians and researchers—
researchers-
intimately entwined
dangers intimately entwined with
with the benefits that
that imaging
technologies confer. One such benefit is the illusion of
technologies
familiarity. Unlike a table or a chart
chart or graph,
graph, an image
often seems to be “transparent,”
"transparent," giving us the depicted
object directly rather
rather than
than through
through the mediation
mediation of fallible
instruments that
instruments that incorporate
incorporate certain
certain types of information
information
and leave out
out others -—perhaps
perhaps equally important—kinds
important- kinds of
data. An image can delude us into thinking
thinking we know
know an
graph never can.
object in a way a graph
(Crease 1993, p. 561)

relationship between
This relationship between image and text text is a direct structural
structural reversal
their relationship
of their relationship in the scientific practice described by every re­ re-
searcher withwith whom
whom I talked,
talked, where images were chosen to elaborate
textual
textual and quantitative
quantitative proof. An analogy would would be the way in which
graphs illustrate textual
graphs illustrate arguments in scientific articles but are often the
textual arguments
argument presented
sole argument presented in newspaper
newspaper articles.3
articles. 3
Images in texts speak throughthrough their
their captions,
captions, which constrain
constrain their
interpretation. The relationship
interpretation. relationship between image and text text in this context
context
is far from simple, however. Historically, accordingaccording to semiologist Ro­ Ro-
land Barthes, text text represents
represents the authoritative
authoritative voice behind the jumbled
or incomplete
incomplete appearance
appearance of the visible form, structuring
structuring perception,
perception,
telling you howhow to attend
attend to it, what
what to attend
attend to in it, and so on. Text
does this by reinvigorating
reinvigorating the information
information of the picture: Even if pic­ pic-
tures look the same, the text
tures text tells you how it is different and why it is
worthwhile
worthwhile to look at (Barthes 1983). Barthes points out how in fash­ fash-
ion magazines, the reader reader needs the text to explain bow how to appreciate
appreciate
the value of the the newest
newest style. In examining
examining the role of press photos,photos,
performed a contrary
however, Barthes performed contrary analysis, proposing
proposing that
that in some

142
 TRAVELING IMAGES,
TRAVELING IM AGES, POPULARIZING BRAINS
POPULARIZING BRAINS

cases, the image overtakes

overtakes the text, overturning the authority
text, overturning authority of the
Here the picture
text. Here picture provides the compelling anchor:
compelling anchor:
text constitutes
The text constitutes a parasitic intended to connote
parasitic message intended connote the
image, i.e., to “"enliven"
enliven” it with one or more secondary signifieds. In
secondary signifieds.
other words,
other words, and this is an important historical reversal, the image no
important historical
illustrates the words; it is the words
longer illustrates words which,
which, structurally,
structurally, are
parasitic on the image. This reversal has its price: in the traditional
parasitic traditional
“illustration,” the image used to function
modes of "illustration," function as an episodic
return denotation, starting
return denotation, starting from a principal
principal message (the text), which
was perceived as connoted,
connoted, precisely because it needed an illustration;
illustration;
in the present
present relation,
relation, the image does not not come to illuminate
illuminate or “re­"re-
alize”
alize" the words;
words; it is the words
words which come to sublimate, patheti- patheti-
cize, or rationalize
rationalize the image. (Barthes 1988,1988, p. 14)
Extending Barthes's
Extending Barthes’s argument,
argument, this chapter proposes that
chapter proposes that scientific
scientific vi-
vi­
sualizations,
sualizations, such as PET images, participate
participate in this reversal of veridictory
veridictory
authority.
authority. They do so especially when when they leave the close community
community of
researchers
researchers who daily deal with their semiotic complexity
with their complexity and are aware
of their
their illustrative
illustrative rather
rather than
than veridictory
veridictory use in scientific presentations.
presentations.
Outside
Outside of this community, I am interestedinterested in how PET images can
sometimes become the central argument, with
central argument, with the text
text as supplement.
supplement. In
the popular arena, in magazines, newspapers
popular arena, newspapers and on television, PET
images become the principle
principle message. The images and their their immediate
stand as proof,
labels stand proof, which
which is then
then elaborated
elaborated in textual
textual commentary.
This aspect of analysis focuses on the constellation
constellation of codes of “"ob- ob­
jectivity,” "normality,"
jectivity," “ normality,” "automaticity,"
“ automaticity,” and “veracity”
"veracity" at work
work within
within
these images. In other
other words,
words, this strategy
strategy tracks
tracks the ways in which
which we
learn to see, and learn
learn to believe in seeing. This is a combination
combination of
cultural
cultural studies, anthropology,
anthropology, and semiotics at the heartheart of much recent
work
work in cultural
cultural studies and feminist studies of science —historical
- historical and
social. This work
work draws
draws much inspiration
inspiration from that
that of Donna
Donna Haraway,
Haraway,
Evelyn Fox Keller,
Keller, Barbara
Barbara Stafford, and Susan Leigh Star. These schol­ schol-
ars wade into the tropics
tropics of discourse in order
order to locate and analyze
ongoing struggles over the fabric of meaning.
Viewed as signs, PET images in popular popular culture
culture raise questions of
reference and representation
representation —producing
- producing the world
world they
they are produced
produced
by and are part part of. They may, building
building the analysis of the previous
chapter, be analyzed within
within semiotics.
The project of semiotics should
should be such mapping
mapping [of the discon­
discon-
tinuity
tinuity between discourse and reality]: how
how the physical properties
properties of
bodies are socially assumed as signs, as vehicles for social meanings,

143
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CHAPTER 55

how these signs are culturally

and how culturally generated
generated by codes and subject to
historical modes of sign production.
historical production, (de Lauretis 1984, p. 25)
chapter 4, seeing a multicolored
As discussed in chapter multicolored blob as a brain image
result of a learning
is the result learning to see. Semiotically, the familiarity
familiarity engendered
by images of the the brain
brain cannot
cannot be simply
simply apprehended.
apprehended. After all, very
few people have ever seen a brain, brain, much less a slice of a brain.
brain. Yet, as
Hacking has argued,
Ian Hacking argued, "likeness"
“likeness” — the similarity of one thing to an­
-the an-
other—can
other- can stand alone. Looking at an artifact artifact recovered from an ar­ ar-
chaeological dig, Hacking
chaeological Hacking noted
noted that
that though
though he did notnot have any idea
what was is supposed
what supposed to be like, he nevertheless knew that that it was a
something —it was a figure (Hacking 1983). Are PET scans
likeness of something-it
likenesses in the same way?way?4 4
Do we see an image as “''likelike a brain”
brain"?? For
whom are they likenesses?
whom
Ernst Gombrich
Ernst Gombrich (1973) has developed a more processual processual description
description
which the perceived similarity
in which similarity between
between the actual referent
referent and the
result of the process
image is more the result process by which we -interpret
interpret both
both of
them than
them than of any correspondence
correspondence between the two. Anne Barry (1997)
elaborated this further, noting
elaborated noting thatthat we “pick
"pick out concepts from the im­ im-
age” like we do from the world.
age" world. Learning to see forms results in a
“ meaningful image that
"meaningful that contains
contains a story”
story" (p. 139). Barry’s
Barry's insight was
that
that even if perceiving an image is primary
primary to, or does not
not even need, its
caption, nonetheless
caption, it nonetheless is always a contextual, narrated practice,
contextual, narrated practice, draw­
draw-
drawing together
ing on and drawing together concepts:
world, to grasp the meaning of a drawing,
To perceive the world, drawing, and to
create a satirical
create satirical image: each of these depends
depends on the grasp of essen­
essen-
characteristics and
tial characteristics and the implications
implications of these as symbolic —that is,
symbolic-that
relationships or tell a story. (Barry 1997, p. 79)s
as they suggest relationships 79)5
powerful, memorable
Brain images are powerful, memorable condensers
condensers of cultural
cultural content
content
concepts of human
and concepts human nature
nature in this manner. Two adjacent
adjacent images that
that
different ask to be seen as the essential characteristics
look different characteristics of the labels
that describe them.
that them. Philosopher
Philosopher Nelson
Nelson Goodman
Goodman provided
provided an excellent
description of two kinds of classification work
description work taking
taking place with these
(Goodman 1973; Star 1992). On the one hand,
images (Goodman hand, there is the as­
as-
signment of people to presumably
signment presumably preexisting
preexisting groups: This person
person is
category "normal"
placed in the category “normal” and that
that person
person into “"depressed."
depressed.” On
other hand,
the other hand, different
different kinds of groups are being defined on the basis
relations of mutual
of relations mutual difference: Normal
Normal people are shown to share a
characteristic that
characteristic that is different
different from those of depressed people. Reading
accompanying text
the accompanying text reveals a heroic story of the technological
technological quest
produce a beautiful
to produce beautiful and
and interpretable
interpretable image of the brain in action,
action, a
that is in the process of being fulfilled.
quest that fulfilled, I am interested
interested in the fact

144
 TRAVELING IM AGES, POPULARIZING
TRAVELING IMAGES, POPULARIZING BRAINS

that it is quite difficult to look at these framed

that framed images and not not be caught
with the possibility of showing, once and for all, neutrally
up with neutrally and objec-
objec­
tively, the true
true difference between these "types"
“types” of persons.
Being “caught”
"caught" refers to the anthropological
anthropological analyses of Jeanne
Favret-Saada Harding (1987, 1991), and Lorraine
Favret-Saada (1980), Susan Harding Lorraine Kenny
(Kenny 1992). In examining
examining witchcraft,
witchcraft, fundamentalist
fundamentalist Christianity,
and middle-class female adolescence, respectively, these ethnographers
ethnographers
watched
watched themselves and others face situations
situations that
that are initia11y
initially alien but
that draw
that draw on existing inclinations,
inclinations, desires, and other
other cultural
cultural aspects of
their personhood
their personhood to draw them into a new viewpoint.
draw them viewpoint. Being "caught"
“ caught”
means finding yourself wondering just how
yourself wondering how truetrue some fundamental
fundamental
about the world
claim about world and yourself
yourself might
might be—
be-it it means being on the
fence, undecided but tipping
tipping toward
toward a worldview
worldview that that is not
not quite yours
. . . yet. In Susan Harding’s
... term, drawn
Harding's term, drawn from
from the language of evangeli-
evangeli­
cal faith,
faith, it means being “under conviction.”" 66
"under conviction.
Being "caught"
“ caught” by a brain
brain image is a particular
particular form of identification.
In its popular
popular usage, a brain akin to the simplified reality of a
brain image is akin
graphic
graphic cartoon, McCloud (1993), in his fascinating
cartoon, which Scott McC1oud fascinating anal-
anal­
ysis, Understanding
Understanding Comics: The Invisible Art, Art, has described as “"aa form
of amplification
amplification through
through simplification that
that focuses ourour attention
attention on an
idea” 30-31). McCloud
idea" (pp. 30-31). McCloud pays particular attention to the manner
particular attention manner in
which cartoon drawings
which cartoon drawings achieve indentification:
indentification:
Just as our awareness of biological selves selves are simplified conceptual
conceptual
images —so too is our awareness of these extensions
images-so extensions [to cars, clothing,
simplified...... . . Our
tools] greatly simplified Our identities
identities belong permanently
permanently to the
conceptual world.
conceptual world. They can't can’t be seen, heard,
heard, smelled, touched
touched or
tasted. They’re
tasted. They're merely ideas and everything
everything else-
else —at the start-
at the start —be­
be-
world, the world
longs to the sensual world, world beyond
beyond usus...... . . By de-emphasiz-
de-emphasiz­
appearances of the physical world
ing the appearances world in favor of the idea of
cartoon places itself in the world
form, the cartoon world of concepts. . . . When
cartoons are used through
cartoons through a story, the worldworld of that
that story may seem
with life. (pp. 39-41)
to pulse with 39-41)

Our identity, as biological, as personalities,

personalities, and in relationships,
relationships, is
here shown open to conceptual
conceptual revision. Cartoon
Cartoon are especially good,
McCloud
McCloud has suggested, at inviting
inviting one to inhabit
inhabit them:
When you look at a photo
When photo or
or realistic drawing
drawing of a face—you
face -you see it
as the face of another. But when enter the world
when you enter world of the cartoon
cartoon -—
you see yourself
yourself.. ...
. . . The cartoon
cartoon is a vacuum
vacuum into
into which
which our iden-
iden­
tity and awareness are pulled . .. . . an empty shell thatthat we inhabit
inhabit
which enables us to travel in another
which another realm.
realm. We don't
don’t just observe the
cartoon,
cartoon, we become it! (p. 36)

145
CHAPTER 5
CHAPTERS

Cartoons or other
Cartoons abstract images, amplified through
other abstract through simplification
like brain
brain images are, provide conceptual bridge, a connecting
provide a conceptual connecting self,
self, a
human nature, and a set of categories,
human nature, categories. The difference between a fic- fic­
tional cartoon
tional brain image is that
cartoon and a brain that the realm of the latter
latter is sci-
sci­
concepts thus subtend
ence, and its concepts subtend rather
rather than
than extend our everyday
identification.
identification.
An example
example of a brain-difference
brain-difference fact may help emphasize this con- con­
frontation
frontation between a reader
reader and a brain
brain image. In an editorial U.S.
editorial in U.S.
News &
News & World Report entitled
entitled “Sex: It’s All in Your Brain,"
"Sex: It's Brain,” writer
writer
John Leo launched
John launched into a diatribe against those who have “a
diatribe against "a curious
refusal, based on politics, in spite of a large body of evidence,,,-
evidence,” to ac­ac-
knowledge that
knowledge that men and women
women just are biologically, and hence so- so­
cially, different,
cially, front-page story in the New
different. Citing a front-page New York Times on
functional magnetic resonance,
functional resonance, he wrote:7
wrote: 7
The photo
photo that
that ran
ran with week’s study may help break
with last week's break down
this resistance. It's
It’s a magnetic resonance
resonance image of a male brain and a
female brain attempting the same task-
brain attempting task —sounding
sounding out words.words. The im-im­
age -—apparently
apparently the first graphic,
graphic, visual proof
proof of difference in the
brains—shows
brains that the male used only a small part
-shows that part of the left side of
the brain,
brain, while the female used both
both sides
sides...... . . Some scientists think
think
explain the male's
this may help explain male’s famous inability
inability to express emotion:
Information flows less easily from the right side to the verbal, left
Information
side. (Leo 1995)

Although
Although Leo seemed to think think the article clarified the issue, many'
many
unpacked in this media intervention.
issues must be unpacked intervention. The article mediates
between experts
between experts who
who presumably
presumably provided
provided the details of brains and
brain images and us layperson
brain layperson viewers.
viewers.38 Though
Though some might
might want
want to
claim that
that there is a set of accepted medical truths
truths (and unfortunately
unfortunately
that there
that there are some unacceptable
unacceptable lies that
that get taken
taken up), the purpose
purpose of
chapter and this book is to work
this chapter work with
with a notion
notion of uneven flows of
knowledge and contradictory
knowledge contradictory versions of acceptability legitimacy.
acceptability and legitimacy.
laypersons, we do not
As laypersons, not know how much
know how much we do not not know about sci­
know about sci-
truths, yet we, like Leo, are caught up in the possi­
entific and medical truths, possi-
bility of explaining through them.
explaining ourselves through
McCloud provided
McCloud provided a useful summary through
summary of the semiotic process through
which cartoons
which cartoons -—and,
and, by extension
extension brain images -—in popular culture
in popular
work (McCloud
work (McCloud 1993, p. 46):
Complex ➔ Simple
Simple
Realistic ➔ Iconic
Objective ➔ Subjective
Specific
Specific ➔
-» Universal

146
 TRAVELING
TRAVELING IM AGES, POPULARIZING
IMAGES, POPULARIZING BRAINS
BRAINS

The key point

point for brain imaging is that
that as the image becomes more
simple and iconic, it also becomes more subjective (personally invested
in) and universal (generalizable to human
human nature).
nature). I suggest that
that these
neuroscienctific facts compel such reworking
reworking because they provide au­ au-
thoritative
thoritative starting
starting points along with
with combinatory
combinatory possibilities. Like
Like
Levi-Strauss’s
Levi-Strauss's totem
totem animals and Turkle's
Turkle’s computers,
computers, they are good and
solid and fun to think
think with, lively facts with provocative
provocative connotations
connotations
(Levi-Strauss 1963; Turkle 1984).9
(Levi-Strauss 1984).9

Expert
Expert Selves, Anxious
Anxious Measures
Measures

The logic was straightforward. thought or

straightforward. Behind every thought
feeling, there was a molecular
molecular reaction
reaction in the brain. Behind
every molecule in the reaction,
reaction, there was an enzyme that
that
created
created the molecule; behind every enzyme was a gene.gene.
If the gene was defective, the enzyme would
would be defective;
if the enzyme was defective, so would
would be the molecule; if
the molecule was defective, so would be the chemical
reaction
reaction and so, inevitably, would thought the
would be the thought
reaction
reaction produced.
produced. Or, as one scientist simplified it, in a few
words with
with many levels
levels of meaning, “"Twisted
Twisted molecules
lead to twisted thoughts.”
thoughts."
(Franklin 1987, p. 146)
The rhetorical
rhetorical image of the brain expert is one
brain as viewed by the social expert
of anxiety. The normal
normal brain
brain is taken
taken as a baseline of social norms, but
if the brain is perturbed,
perturbed, it goes only one way, down,
down, into abnormality,
into personal
personal and social problems.
problems. In this world
world of constant
constant brain risk,
the job of the brave new science of molecular
molecular psychology is to predict,
surveil, and intervene whenever brains deviate.
Aggressive
Aggressive behavior
behavior seems to be built into humanhuman genes, and is
encouraged
encouraged daily by environmental
environmental forces. Linked to that
that aggression
is fear.
fear. Both emotions are thought
thought to be reflected in measurable
changes in the chemistry of the brain. . . .
During
During the 1960s and 70s, attention
attention shifted toward
toward socioeconomic
factors, such as poverty
poverty and lack of education,
education, as important contribu-
important contribu­
tors to aggressiveness or criminal
criminal behavior. Today the pendulum
pendulum
swings back and forth
forth in the nurture
nurture vs. nature
nature debate as more new
information is brought
information brought to light. The question
question remains whether
whether envi­
envi-
ronment
ronment or heredity human behavior.
heredity is the main cause of aggressive human
With PET imaging, we can begin to explore the degree to which bio­ bio-
logical and social factors affect brain
brain chemistry. Perhaps one day we

147
147
CHAPTER 5
CHAPTER

will speak of an individual's

individual’s brain chemotype as well as his or her
brain chemotype
genotype and phenotype.
phenotype. (Wagner and Ketchum 1989, pp. 171-172).
171-172).
Metaphors, narratives,
Metaphors, explanations abound
narratives, and explanations abound as to what
what the brain
works, and its implications
is, how it works, implications for our minds and the minds of
others. Lived metaphors—embodied
metaphors -embodied in documents
documents and technologies
technologies —
-
are here treated
treated as the contestable
contestable terrain
terrain of the social world.
world. These
methods foreground
methods foreground the processes by which
which categories and relationships
relationships
such as objectivity and normality
normality are produced maintained.1100 Wag-
produced and maintained. Wag­
ner said, in an interview:
My present
present research
research with
with PET scanning is concerned
concerned with investi­
with investi-
gating chemical reactions
reactions constantly
constantly taking
taking place inside the humanhuman
brain, and how reactions affect how we think,
how these reactions think, feel and act a c t ..... .
how they affect whether
how they whether we are afraid,
afraid, violent or destructive
destructive...... . . Per­
Per-
haps we will be able to learn enough about about the brain chemistry of
brain chemistry
fear, violence, and destructiveness to save ourselves from the prob­ prob-
lems of interpersonal
interpersonal violence and war.
Built into Wagner’s approach
into Wagner's approach to the brain
brain is a notion
notion of human
human nature
nature
which violence is the product
in which product of brain chemistry.
chemistry.1 1 Other
11
Other notions
notions of
human nature,
human nature, whether
whether drawn
drawn from capitalism, patriarchy, or religion,
capitalism, patriarchy,
point to violence as socially and/or
point morally caused. Wagner's
and/or morally Wagner’s notion
notion of
violence and destructiveness also presumes a particular
particular configuration
configuration and
explanation
explanation of rationality.
rationality. Rational
Rational violence, or even violence as a ratio­
ratio-
nal response to social conditions,
conditions, is probably
probably oxymoronic.1
oxymoronic. 122 In his viewi_
view,
violence is bad, violence is destructive,
destructive, and violence is irrational.1
irrational. 133Before I
get carried
carried away, however, I want
want to note that
that there are many compelling
facts and reasons to assume and act on this notion
notion of human
human nature.1
nature. 144My
point
point here is to flag the powerful
powerful explanatory
explanatory consequences accompany-
accompany­
ing experiments
experiments on the brain.

Your Brain
Brain on Ecstasy
Ecstasy

Four kinds of escalating rhetoric

rhetoric describe the same study of MDMA
(3,4-methylenedioxy methamphetamine,
(3,4-methylenedioxy methamphetamine, or ecstasy) users. In 1998, a
PET study was done of 14 people who who used MDMA
MDMA heavily compared
compared
with
with 15 nonusers.
nonusers. The results were significant both
both mathematically
mathematically and
socially.
socially. The study concluded:
..... . these data
data suggest that
that human
human MDMA
MDMA users are susceptible to
MDMA-induced
MDMA-induced brain brain 5-HT neural
neural injury.
injury..... . . Our
Our data
data do not
not al­
al-
low conclusions about about reversibility or permanence
permanence of MDMA-
induced changes in brain
brain 5-HT transporter. (McCann
5-HT transporter. (McCann et al. 1998)

148
i
I 0
TRAVELING IM
TRAVELING AGES, POPULARIZING
IMAGES, POPULARIZING BRAINS
IIRAINS

6
0o
o
0
o0
cu
5- §
E
E
:I
4
l
..
C
.9:
:::,
3

..
.0
·;:
Iii
:a: 2

.5'
1 - 0o

o
0J
Control
Control 100
100 200
200 300
300 400
400
Number of
Number of times
times MDMA
MOMA used

F i g u r e 5.1. Ecstasy user's

FIGURE user’s brain graph. (From McCann, Szabo, Scheffel,
(From McCann, Scheffel, et al.
al.
1998)

publication in Lancet was followed by the appearance

Its publication appearance of a series of
question the parameters
letters calling into question parameters and generalizability
generalizability of the
study. Included in the article was a series of scans, charts, and graphs
illustrating how
illustrating how the range
range of neurotransmitter
neurotransmitter activity differed among
groups. Among other
the two groups. other problems,
problems, the range overlapped
overlapped so much
that if the
that data were in fact generalizable,
the data generalizable, one might
might be able to make a
but certainly
guess but certainly not
not a diagnosis of someone’s
someone's past
past drug use on the
Nonetheless, the images published
basis of a scan (figure 5.1). Nonetheless, published withwith the
individual from each group,
study were of one individual group, each looking extremely
different. It appeared
different. appeared as if they were, in fact, the extremes (see (see Plate 16).
traveled outside
As the study results traveled outside of the medical
medical journal,
journal, the stated
implications intensified. In the newsletter
implications NIDA Notes,
newsletter NIDA Notes, staff writer
writer
Robert Mathias
Robert Mathias described the broadbroad outline of the study and discussed
competent manner
the overall results in a competent correlation. 155 In the cap­
manner as a correlation.1 cap-
tion to the image included
tion included with
with the article, though,
though, he claimed it
“Dark areas in the MDMA
showed causality: "Dark MDMA user’s
user's brain show damage
chronic MDMA
due to chronic MDMA use." use.”
When the images traveled
When traveled to the U.S. Senate Caucus on International
International
Narcotics Control,
Narcotics Control, however, the director
director of the National
National Institute
Institute on
Drug Abuse (NIDA) used them them to proclaim
proclaim not
not only absolute
absolute causality
but diagnostic
but diagnostic ability as well: "Through
“Through the use of positron
positron emission

149
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tomography (PET), we can actually see that

tomography that the brain
brain images on top I
belongs to an individual
individual who has never used MDMA. MDMA ..... . . Clearly the
brain of the MDMA
brain MDMA user on the bottom altered.”" 116*
bottom has been significantly altered.
At this point,
point, the extreme images of two people were being used to
ground a strong
ground strong biosocial claim, not to illustrate
illustrate a weak
weak one, as they
did in the
the Lancet
Lancet article. It should
should come as no surprise, then, then, that
that the
25-year poster
NIDA 25-year poster took further step of creating
took the further creating a single didactic
about the ecstasy brain
image about brain images (see
(see Plate 17).
17}.
Building on the “"your
your brain on drugs"
drugs” campaign,
campaign, this poster
poster visually
argued that
that twisted
twisted drugs lead to twisted
twisted brains (and(and therefore
therefore to a
twisted
twisted self). The poster
poster also went
went a step too far. As if the choosing
choosing of
color scales, windowing
windowing ranges, and extreme images is not not enough, in
combining
combining the right half of a “normal
"normal brain”
brain" with
with the left half of a “"brain
brain
on ecstasy,” graphic artists actually
ecstasy," the graphic inverted the color scale of purple
actually inverted
and black. The result is an even more stunning
stunning and tragic looking
looking drug-
ravaged
ravaged brain, but at the expense of putting
brain, but putting forth
forth a visual lie.

of Rampage
Images of
Images Rampage

Considering the role these images can play in our own lives from a
Considering
different angle, the following
different following is an example of PET as depicted in a
popular film about
popular schizophrenia, violence, and insanity. What
about schizophrenia, What follows
is my transcript
transcript of the final four minutes of Rampage (1988), directe_p
directed
by William Friedkin. I believe it represents
represents the first use of PET in a
Hollywood movie. At this point
Hollywood point in the film, Charles Reese has commit­
commit-
ted six grisly murders
murders and is about
about to be found
found guilty of them
them by a jury.
In a courtroom.
courtroom.
DEFENSE a t t o r n e y : [whispering to his client, Charles
D e fe n se ATTORNEY: Charles Reese, just
convicted
convicted ooff six brutal first-degree (premeditated)
(premeditated) murders] We still
have a shot to save your life. We can still show the jury that that you
weren’t responsible.
weren't
Cut to the judge’s judge's chamber.
chamber.
DEFENSE a t t o r n e y : Your honor, I'm
D e fe n se ATTORNEY: I’m going to request
request that
that a PET
scan be performed
performed as part part of a defense to show the jury that
that he is
mentally ill, during the penalty
mentally penalty phase.
P r o s e c u t o r : A PET scan purports
PROSECUTOR: purports to show only a patient's
patient’s brain
chemistry at a certain
chemistry certain moment
moment of time. In this case it is after the
crime is committed.
committed.
d g e : A PET scan is a form of medical imaging which
JUDGE:
Ju which is used in the
diagnosis of epilepsy, some Alzheimer's,Alzheimer’s, as well as mental
mental defi-
defi­
ciency. Depriving Mr. Reese of putting putting this in front
front of the jury—
jury-

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r o s e c u t o r : [interrupting]
PROSECUTOR:
P [interrupting] It’s
TRAVELING IMAGES,
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It's only another

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another gadget to hide Mr.

BRAINS
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Reese’s
Reese's responsibility.
u d g e : [pausing,
JJUDGE: [pausing, contemplating] Well, we’re
we're going to err on the side
of caution. I’m I'm going to order the test. We’llWe'll let the jury evaluate it.
Nobody
Nobody knows what what it will show.
Cut to medical laboratory.
laboratory. Charles
Charles Reese is scan-
is put in the PET scan­
ner. A rotating
ner. rotating skullskull is shown, computer generated, peeling back to
shown, computer
reveal a rotating
rotating brain in red, then green. green.
Two scans come up side by side. One says “Normal Control"
"Normal Control“
under it; the other says “Reese, "Reese, Charles.”
Charles." The scans look very visi-
visi­
bly different.
MEDICAL
M DOCTOR:
e d ic a l d abnormal
Reese'ss scan] These are abnormal
o c t o r : [pointing to Reese’
patterns
patterns without
without a doubt. doubt.
t t o r n e y : What
e fe n se aATTORNEY:
DEFENSE
D What does that
that tell you?
MEDICAL
M e d ic a l d o c t o r : Well, this yellow-green area here is consistent
DOCTOR:
with schizophrenia. What What you are seeing is a computer-enhanced
computer-enhanced
image of the chemistry
chemistry of the brain. And what what it shows is a picture
of madness.
Cut to the courtroom
courtroom again.
again.
JJURY
u r y fo r e m a n : Your honor, based on the new scientific evidence, we,
FOREMAN:
the jury, find that that the defendant
defendant should go to a state mental
hospital.
hospital.
At
At the end ooff the movie, words: “Charles "Charles Reese has served four
years in a state mental mental facility. He has had one hearing to deter­ deter-
mine his eligibility for release.
release. His next months.""
next hearing is in four months.

In the microcosm
microcosm of this movie, a convicted brutal murderer is not
brutal murderer
put into prison
put but is treated
prison but treated as a mentally
mentally diseased subject who may be
released in the near future.
future. The sole element presented
presented to account
account for
the jury’s scan. 177 The words
jury's decision is a PET scan.1 words of the doctor "these are
doctor-— “these
abnormal
abnormal patterns
patterns without
without a d ou bt..... . consistent
doubt schizophrenia
consistent with schizophrenia
..... . a picture
picture of madness”
madness" —concatenate
-concatenate a history
history of struggle and con­
con-
troversy within
within the medical and legal communities
communities regarding a host of
relationships:
relationships: PET scan to brain, brain brain to schizophrenia,
schizophrenia, schizophrenia
schizophrenia
to insanity. In the movie, the PET scan stands as the fact, the linchpin
referent,
referent, that
that holds the chain of connections
connections together, convincing a jury
that an abnormal
that abnormal brain scan is an abnormalabnormal brain is an abnormal
abnormal per­per-
son who does not not bear responsibility
responsibility for murder.
Not
Not one of these connections,
connections, however, is settled in the scientific
scientific and
medical community, in the legal community,
community, or in my own mind.1 mind. 188 Med­
Med-
ical anthropologist
anthropologist Horacio
Horacio Fabrega has discussed the reluctance of
Anglo-American
Anglo-American society to accept a theory theory of illness-caused deviance.
He suggests that that this is primarily
primarily due to a need to have the will be

151
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socially or rationally motivated: "In

rationally motivated: “ In essence, mental
mental illness as a defense
l
I
of homicide requires a suspension
homicide requires suspension of our attribution personhood if
attribution of personhood
latter equated
the latter is equated with willful symbolic behavior”
behavior" (Fabrega 1989, p.
592). Although
Although I think
think that
that this argument
argument makes sense in general when
comparing societies, I am interested
comparing interested in the ways in which
which the attributes
attributes
personhood in the United States are continually
of personhood continually contested
contested using bat-bat­
teries of facts. Rampage
Rampage is an intervention
intervention into the facts of PET and the
presenting as it does a definition of PET, a set of presump-
facts of life, presenting presump­
about imaging and mental
tions about mental illness, and a possible scenario of PET's PET’s
use in a court.
court. As with reading a magazine article on brain imaging, in
with reading
watching the movie one is faced with
watching with facts about one’s objective self.
about one's self.19
19

Faced with
with novel facts in this movie, we may indeed stumble over
accepting them. Hollywood
Hollywood movies, along with with best-selling novels writ-writ­
ten by physicians and our our own doctors'
doctors’ advice, help to shape our no- no­
tions of “"accepted
accepted medical knowledge"
knowledge” and thusthus help shape our catego-
catego­
ries of the person.
When
When I have shown shown the movie clip from Rampage Rampage and pictures of
PET scans during
during talks,
talks, some people with
with social constructionist
constructionist tenden-
tenden­
cies and some with with strong
strong feelings about
about the social or psychodynamic
psychodynamic
nature of schizophrenia
nature schizophrenia have been upset over the biosocial totalitarian
totalitarian
implications of this apparently
implications apparently seamless presentation
presentation of clear difference
“them” and “us.”
between "them" "us." I want
want first to note
note that
that despite constant
constant
work on PET and schizophrenia
work schizophrenia since the 1980s, there there is still much
disagreement over whether
disagreement whether PET is ready yet for clinical work with men­
work with men-
tal illness. As discussed in chapter
chapter 4, most of the PET community
community furi-
furi­
ously opposes the use of PET for the insanity defense. In spite of this
unreliability for regular
unreliability regular clinical work,
work, in some places PET has neverthe-
neverthe­
less been heavily supported,
supported, including financially, by mental-illness ac­
mental-illness ac-
that is, organized
tivists, that organized families of people with with mental illness. Here
another set of contests
another contests emerges. Should researchers
researchers look for biological
correlates of schizophrenia,
correlates schizophrenia, and how shouldshould such correlates
correlates be inter-
inter­
What do the facts mean? Surprisingly, the meaning
preted? What meaning of these
facts does notnot emerge solely from the research
research community;
community; the whole
community must be examined.
virtual community
In the late 1970s and into the 1980s the increasing availability
availability of new
techniques such as CT and PET scanning contribued
diagnostic techniques contribued greatly
notion of mental
to the notion mental illness as a biological disease or defect. These
techniques
techniques offered different and exciting ways of examining examining living
brains (Pardes and Pincus 1985). Early on, it was realized that that many
head injuries, strokes, and epilepsies leave the structure structure of the brain
unchanged but
relatively unchanged but show up with with different degrees of clarity on
PET scans. In biological psychiatry, such proof proof of pathology talked
pathology is talked
about as a “"holy
about holy grail."
grail.” One biological psychiatrist,
psychiatrist, for instance, began

152
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a review of PET with

with the statement
statement “"In
In the 1970s, the antipsychiatry
antipsychiatry
movement almost had us ... , but now
movement almost now we have proof"
proof” (Kuhar 1989).
For this subdiscipline, eager to demonstrate
demonstrate the physiology
physiology of mental
illness, images of brain
brain differences between
between mentally
mentally ill patients
patients and
non—mentally
non - mentally ill control that implied that
control subjects were facts that that a full
biological explanation
explanation of mental disease was only a matter
matter of time.
Much optimism
Much optimism has been generated
generated in those
those who feel that
that the only
reason organic bases for the various
reason various psychiatric
psychiatric syndromes
syndromes have not
been elucidated has been the lack of a suitable
suitable investigative tool. ..... .
It is probable
probable that
that PET is the investigative technique
technique of choice for
research of such hypotheses in man. (Frackowiak
research (Frackowiak 1986)
Early PET thus functioned as a promise
thus functioned promise that
that mental
mental illness was not
not
“ in the head"
"in head” but in the brain. The medical imaging advantage
advantage was
measured
measured in two ways. First, it allowed correlation
correlation between
between brains and
humans, thus permitting
diagnosis among living humans, permitting anew the equation
equation of
brain = illness. Second, medical imaging promised
brain= promised to provide
provide early
warnings
warnings of the onset of mental
mental illness, one of the largest problems
problems in
its treatment prevention.
treatment and prevention.

Selling PET
Selling PET

The positive side of the expert

expert image in popular culture is the promise
popular culture
understanding and future
of understanding future cure. This, too, mediated by anxiety,
too, is mediated
however.
To illustrate
illustrate the ongoing negotiation
negotiation of personhood
personhood and illness and
call attention
attention to the wider virtual
virtual community self-fashion­
community of objective self-fashion-
ing around
around PET,
PET, I turn now to one site of my fieldwork,
turn now fieldwork, the Brain Imag­
Imag-
ing Center at the University of California,
California, Irvine. This center
center was unlike
most PET centers in two important
important respects. First, it was located in a
psychiatry department, not
psychiatry department, not in a chemistry, nuclear
nuclear medicine, or radiol­
radiol-
department. Second, for a PET center, it was extremely under-
ogy department. under­
Other major
funded. Other major PET centers have received either either Department
Department of
National Institutes
Energy or National Institutes of Health
Health program
program grants
grants to support
support the
multimillion-dollar costs of laboratories
multimillion-dollar laboratories in nuclear
nuclear medicine or radiol-
radiol­
ogy. This center's
ogy. center’s program,
program, in constrast,
constrast, was started
started in a psychiatry
psychiatry
department, and the scanner
department, scanner and cyclotron
cyclotron were purchased
purchased with
with bank
Monthly payments
loans. Monthly payments were dependent
dependent on an external
external fee schedule
that dampened
that dampened free operation.
operation. In the words
words of one researcher, Dr. Jo Jo-­
psychiatrist at the University of California,
seph Wu, a psychiatrist California, Irvine:
think we were sort of an upstart
I think upstart ...
. . . because other
other places that
that
better endowed
have PET centers are much better endowed than
than we were. We were

153
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CHAPTER 5
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sort of the scrappy, come-from-behind,

come-from-behind, shoestring
shoestring budget kind of
guys. And we did things on a budget that
that is probably
probably one-tenth
one-tenth of the
that Hopkins
budget that [have] for their
Hopkins [and] UCLA [have] their PET centers. They
endowed and they
are very well endowed they support
support their PET centers
centers in a maxi-
maxi­
think that
mum way. I think that we have a much more sort sort of guerrilla-type
guerrilla-type
operation. We are unconventional
operation. unconventional in that
that we did so many things on
our own, but I think
think we were fairly productive.
productive.
This PET center
center operated
operated from such a precarious
precarious financial position
position
that
that its researchers
researchers spent much time doing local community
community outreach,
outreach,
and they found
found a ready alliance with the mental-illness community
community in
Orange
Orange County, especially with
with families who had schizophrenic
schizophrenic chil­
chil-
dren. As Haier
Haier detailed below, the psychodynamic
psychodynamic approach,
approach, while sup­
sup-
porting the social nature
porting nature of schizophrenia,
schizophrenia, often localized this causation
causation
in the family and, more specifically,
specifically, in the mother.
contributed $250,000
[One family] contributed $250,000 to help pay for our scanner. By
that
that time, the scanner had arrived and we were making making pictures. They
had schizophrenia
schizophrenia in their family,
family, and they were very interested
interested in
it. They knew
knew our emphasis was going to be on schizophrenia.
schizophrenia. We
always approach
approach it that that in the long run,
run, the main help will come
through research. Probably
through Probably not
not for people who currently
currently have it, but
because there
there is a genetic component,
component, there
there are still the grandchildren
grandchildren
to worry about. And families find this compelling. Remember, even i.!l
worry about. in
’80s, the public
the late '80s, public was just coming out
out of the idea of the schiz-
ogenic mother, that that schizophrenia
schizophrenia was somehow
somehow induced
induced because the
mother was doing something
mother something wrong.
wrong. Virtually every set of parents
parents
that we talk
that talk to now, when schizophrenics are now in their their twenties
and their
their thirties,
thirties, almost every parent
parent has had the experience of going
to a psychologist
psychologist early on and getting the idea that that somehow
somehow they
were at fault. So So it is all in their memory. And the idea that that it is
biological has caught on real fast over the last five five or eight years.
Family groups have organized
organized around
around this to support
support biological re­re-
search, and imaging is obviously at the heart heart of that.
that. So it is kind of a
natural sequence of events.
natural
Supporting PET research became a means for these families to em-
Supporting em­
power
power their
their participation
participation within
within science, stay informed,
informed, and come to
understand their
understand their role as accountable
accountable to, but not responsible for, the fact
of familial schizophrenia.
schizophrenia. Along with the National
National Alliance for the
Mentally 11
Mentally Ill1 (NAMI), these families advocated
advocated a biological redefinition
of mental
mental illness and actively helped to produce
produce facts about
about the nature
nature
of personhood
personhood and mental illness (Office
(Office of Technology Assessment
1992). Objective self-fashioning here is a strategy without
without which
which such
research
research might notnot get done.

154
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Using PET
PET to Sell

Identifying brain activity associated

associated with depression and the
changes that
that result from treatment
treatment and the patient’s
patient's
improved mood
mood will help to destigmatize
destigmatize the illness, a
disease of the brain.
—
- National
National Institute
Institute of Mental
Mental Health
Health Web site

There is yet another

another purpose
purpose for PET scans in contemporary
contemporary biomedical
America: public relations.
relations. The power
power of brain
brain images to directly inter­
inter-
polate
polate their
their viewers is often explicitly used as technique
a technique of persuasion.
mental disorders on the Web site of the National
Almost all of the mental Insti-
National Insti­
tute of Mental Health
Mental Health and in its pamphlets
pamphlets embody the sentiment
sentiment ex-
pressed in the quotation
quotation above. Through
Through paired
paired brain images of normal
people and of those with disorders, and through through images of a treatment’s
treatment's
effect on the brain, people may be persuadedpersuaded that
that mental
mental illnesses are,
in fact, biological. Brain images are here the ground proof of the
ground of proof
claims (see
(see Plate 18).
In an interesting
interesting counterpoint,
counterpoint, Jeffrey Schwartz used PET images on
the back of his self-help book Brainlock
Brainlock for obsessive-compulsive disor­disor-
der to demonstrate/prove
demonstrate/prove that that cognitive behavioral
behavioral therapy
therapy can alter the
brain
brain as much as drugs. Treatment—whether
Treatment-whether drugs or psychology
psychology-—
lends itself to images demonstrating
demonstrating cure (see(see Plate 15).
These paired
paired images of self and possible future
future self can be understood
understood
as participating
participating in the larger topos of “"before before and after”
after" pictures, as
discussed by Dorothy
Dorothy Smith. Smith unpacked
unpacked the discourse of femi­ femi-
ninity
ninity by focusing in part part on fashion images in women’s
women's magazines. She She
notes that
that these images must be carefully understood context
within the context
understood within
of their use; they are embedded
embedded within
within texts that
that apparently
apparently contain
contain
descriptions of how to make oneself over, to look and feel and be better.
In this context,
context, the fashion image works works to construct
construct the reader as a
“"subject"
subject” for betterment.
betterment. The reader becomes an imperfect subject vis- vis-
a-vis the ideal one pictured,
pictured, but one who can potentially
potentially become better
through
through remediation.
remediation. In other words,
words, a diverse array posi-
array of aesthetic posi­
tions are collapsed into two poles, ugly (undesirable) and beautiful beautiful (de­
(de-
sirable), with
with the implication
implication that
that the reader
reader is either the former or the
latter.
Smith described how the subject is thus entered entered into a discursive or­ or-
ganization
ganization of desire,
desi~e, a desire that
that exists, she noted,
noted, even when
when the sub­
sub-
paradigmatic images in this
ject has no hope of achieving the ideal. The paradigmatic
regard
regard are the “"before"
before” and “"after" "Before identifies for the
after” images. “Before
looker the critical state from which to begin to produce produce the self or other

155
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end-state, after"
body into the end-state, after” (Smith 1990). The “"before"
before” and “after”
"after"
contain the coordinates
images contain coordinates of a course of action and between them,
which is desire, created
a gap, which created by the negativity of one and the positivity
of the other. The positive one becomes the ideal.
Many PET images of abnormal
Many abnormal and normal
normal participate
participate (willingly or
public discourse of before and after. By
unwillingly) in this public By showing
between two states, these images appear
extreme differences between appear to collapse
array or continuum
a diverse array continuum of people into two kinds. They simul­ simul-
taneously offer PET as the remedial technology
taneously technology that
that can clearly make
distinction between
the distinction between these twotwo kinds. In the context
context of medical scien­
scien-
transformed not only into the idea of a
tific images, these differences are transformed
diagnosis2
perfect diagnosis 0 (Stafford 1991) but
20
but also into
into the possibility of a cure
(Ginsburg and Rapp 1995). In each of these cases, the PET images work
present possibility of differentiating
to create the present differentiating between two states. In
hardens and reifies these states. These verifications
the process it also hardens
Visualizations used in this extreme and exemplary
also impel action. Visualizations
fashion thus
fashion thus function
function as powerfully
powerfully potent
potent transformers
transformers of statistical
norms into ideal and abhorred
norms abhorred qualities.

Toward a Dynamic
Toward Dynamic Category
Category of the Person

must learn
We must learn to distinguish
distinguish it [the body which I live and
experience, just as I live and experience it] from the
forth in works
objective body as set forth works on physiology. This is
not the body which
not which is capable
capable of being inhabited
inhabited by a
consciousness.
—Merleau-Ponty211
-Merleau-Ponty2

Marcel Mauss
Marcel Mauss and others
others following him argued that that the basic human
human
unit, "the
unit, “the person,"
person,” is a cultural
cultural category
category with
with different attributes
attributes — for
-for
rationality, agency, participation,
example, rationality, participation, gender divisions — - for differ­
differ-
cultures in different
ent cultures places. 222 For Mauss and his succes­
different times and places.2 succes-
sors, the person is a category
category stuffed into a physical body but but indepen­
indepen-
dent of the body's
dent body’s physicality. They argue as if each culture
culture or historical
historical
period has its own category of the person. Other
period Other anthropologists
anthropologists have
troubled by the findings of medicine and neuroscience. For
been more troubled
instance, Victor Turner
instance, Turner once expressed great difficulty in keeping up
with the latest findings: "This
with “This is because I am having to submit
submit to ques­
toques-
tion some of the axioms anthropologists
tion anthropologists . . . were taught
taught to hallow.
axioms express the belief that
These axioms that all human
human behavior
behavior is the result of
conditioning. Clearly a very great deal of it is, but
social conditioning. but gradually
gradually it has
borne home to me that
been borne that there
there are inherent
inherent resistances to condition­
condition-

156
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ing” (Turner 1983, p. 211). Turner

ing" Turner was describing
describing how new facts from
medicine andand neuroscience
neuroscience disturbed
disturbed his notion
notion of personhood
personhood and per­ per-
sonal behavior. Facing these facts requires requires reimagining
reimagining whatwhat kinds of
persons humans
persons humans are. How How do we as anthropologists
anthropologists and other other scholars
understand our bodies? How
understand How do we put put together
together the facts of science
science
and medicine, as we read read them
them in the NewNew York Times and receive them them
from ourour doctors,
doctors, with
with the role of culture
culture in our
our constitution?
constitution? In an­an-
thropological terms, I am interested
thropological interested in how
how facts come to play a role in
our everyday category of the person.
Medical anthropologists
Medical anthropologists have long faced the relation relation between whatwhat
Merleau-Ponty called our objective body
Merleau-Ponty body and our lived body, or our
person, with
person, with a variety of more subtle analyses. For clinical medical an­ an-
thropology, oriented
thropology, oriented around
around the question
question of efficacy,
efficacy, the lived body
(cultural) andand the objective body (physiology) have initially different
mutually influence each other
causes but mutually other throughout
throughout development.
development. For
example, physiological diseases are often inseparable
inseparable from cultural
cultural vari­
vari-
23
diet.1
ables such as diet, 3 In spite of this flexibility, each culture is ultimately
“body” that
assigned its "body" that is lived and explained
explained in relation
relation to an objec­
objec-
which provides the touchstone
tive body, which touchstone of cross-cultural
cross-cultural comparison
comparison
and criticism. Change in the category of the person person is notnot well identi­
identi-
Instead, categories are often explained
fied. Instead, explained as a reflection of changes in
other spheres of society: economics, politics,
other politics, colonization, religion. 244
colonization, and religion.2
Within other
Within other medical anthropologies,
anthropologies, some sociologies of medicine,
history of science and medicine, a different
and the history different approach
approach is taken.
Instead of the experience of health
Instead health and illness as variable, the “"objective
objective
body” is taken
body" taken as culturally
culturally and historically
historically contingent.
contingent. The body is
understood as the object of a scientific and medical gaze that
understood that changes
with the times, the discipline, site, culture
with circumstance. 255 These
culture and circumstance.2
approaches understand
approaches understand the objective body to vary with with the development
development
(positive or negative) of technoscientific culture, culture, attending
attending to how the
historical-cultural category
historical-cultural category of the person
person (via politics, economics, etc.)
evaluation of the objective body.2
influences the evaluation body.266 The objective body and
the experienced body remain remain side by side, both
both variable but analytically
separate.2277
separate.
that local mutations
Is it possible that mutations in categories of people take place
that they are contested
daily, that contested within
within American
American cultures
cultures because they are
and not
lived and not just known? The exampleexample of the Gurs,
Curs, and the following
example from popular
example popular psychiatry, will help to proposepropose a dynamic no­ no-
tion of the category
tion category of the person.
nonfiction bestseller,
In his 1993 nonfiction bestseller, Listening
Listening to Prozac, the author,
authm; psy­
psy-
chiatrist Peter Kramer, began with
chiatrist with the following story,
story. Kramer
Kramer was vis­ vis-
patient, Sam, who suffered from
ited by a patient, from a brooding
brooding depression
depression follow­
follow-
death of his parents.
ing the death parents. Kramer
Kramer first prescribed
prescribed an antidepressant
antidepressant

157

i •.
CHARTER 5
CHAPTER
l
I

I
that did not
that not seem to have an effect. Feeling that
that a different kind of
antidepressant might
antidepressant might help, Kramer proposed
proposed Prozac, which Sam agreed
to try.
The change, when when it came, was remarkable:
remarkable: Sam not not only recov­
recov-
ered from his depression, he declared himself “"better better than
than well,”
well." He
unencumbered, more vitally alive, less pessimistic. Now he could
felt unencumbered,
projects in one draft,
complete projects draft, whereas
whereas before he had sketched and
sketched again. His memory memory was more reliable, his concentration concentration
keener. Every aspect of his work work went
went more smoothly. He appeared appeared
more poised, more more thoughtful,
thoughtful, less distracted.
distracted ..... . . Though
Though he enjoyed
sex as much much as ever,
ever, he no longer had any interest interest in pornogra­
pornogra-
phy...... . . He experienced
phy experienced this change as a loss. The style he had nur­ nur-
tured and
tured and defended for years now now seemed not not a part part of him but
but an
What he had
illness. What had touted
touted as independence
independence of spirit was a biological
particular, Sam was convinced that
tic. In particular, that his interest
interest in pornography
pornography
had been mere physiological obsessionality
had obsessionality...... . . This one aspect of his
disconcerting, because the medication
recovery was disconcerting, medication redefined what what
was essential and what what was contingent
contingent aboutabout his own personality
personality-—
and the drug agreed with
and with his wife whenwhen she was being critical. Sam
under the influence of medication
was under medication in more ways than than one: he had
allowed Prozac not not only to cure the episode of depressiondepression butbut also to
tell him how how he was constituted
constituted...... . . Though
Though I had never taken taken psy­
psy-
chotherapeutic medication,
chotherapeutic medication, I, too, seemed to be under under its influence.
(Kramer 1993, p. xi)
attentive, happy, adjusted,
Sam became more alert, attentive, adjusted, and “"successful''
successful”
than ever before in his life. Kramer
than Kramer also saw this about
about Sam, and real­ real-
that both
ized that both he and his patient
patient then
then understood
understood the “"real"
real” Sam to be
that Prozac revealed, and the former Sam to be a biological
the one that
Kramer had
sickness. Sam and Kramer had "listened
“listened to Prozac”
Prozac" rather
rather than
than to Sam’s
Sam's
three decades of life. Because Prozac is a biological drug, Sam
previous three
must in some sense have been cured by it, freed at last from his strange
must
psychophysiological disease and able to be his true
psychophysiological true self, and his true
true self
something that
became something that was perhaps
perhaps revealed only with with Prozac. That
That
took Prozac and then
Sam took then behaved differently
differently (and better),
better), I want
want to
note as a fact-in-the-world,
note fact-in-the-world, to help keep in mind that that facts do not just
our consciousness. Facts have to find us, and we have to incor­
pop into our incor-
porate them
porate them as facts.
Sam’s story
Sam's story is not
not just an anecdote-it
anecdote —it is an apparently
apparently objective ac­ ac-
count made as part
count part of a psychiatrist's
psychiatrist’s case history. We know
know this “"fact"
fact”
about Sam only through
about through the story told by Peter Kramer, M.D. I almost
want to call this "fact"
want “ fact” a factoid
factoid to call attention
attention to the specific
specific ways
that we learn the fact, that
that that we attend
attend to all of the cultural
cultural aspects of our

158
 TRAVELING IM
TRAVELING AGES, POPULARIZING
IMAGES, POPULARIZING BRAINS

learning: the objective voice, the authorship

authorship of a psychiatrist,
psychiatrist, doctor,
book>writer, the way in which
scientist, book-writer, which Kramer's
Kramer’s discussion of his own
disconcertedness
disconcertedness and surprise allows us to share these feelings as part part of
the novelty of this fact.
fact.2283 This story
story is a challenge for us, to deny it or fit
it into our categories of people. These are ways in which which the story
makes sense to us, as possible, even as it pushes pushes our notions
notions of what
what is
possible.
We are the sorts of people who who take facts seriously, but but how
how do we
them so? How
take them How do we incorporate
incorporate them them into
into ourselves -—especially
that shape who
the ones that who we are but that that we ourselves are not equipped
equipped
to test? Even if we can test them, them, the fact also comes along with with a
contextual delineation
contextual delineation of human nature. In other
human nature. other words,
words, is it possible to
ask how
how facts become these sorts of things for us, without without getting in­ in-
volved immediately
immediately in questions
questions over the truth truth value of them?
Facts usually imply relationships
relationships between things that that are notnot bound
bound
to time and space and culture; they simply are. Facts are not not untethered,
untethered,
however; facts are facts-in-the-world.
facts-in-the-world. My project project is to understand
understand how
the meaning of facts change — - how
how we are never simply handed handed the facts
but are continually
but continually faced with with facts-in-the-world
facts-in-the-world and continually judg­
continually judg-
ing the status
status and relative worth
worth of them ourselves.2295
them for ourselves.
Facts are bits of mastery
mastery in an expert
expert culture. Expert culture
culture. Expert culture is about
about
being extremely knowledgeable
knowledgeable about about a very few things. We are all peo- peo­
ple who
who know about quite a lot of things,
know a little about things, but, in their
their entirety,
the facts are beyond reach. The very category category of the person
person has become,
in part,
part, parceled out out among expert
expert discourses. All facts contain,contain, imply,
or exclude categories of people, and calling the case of Sam a fact-in-
the-world attempts
the-world attempts to mnemonically
mnemonically maintain
maintain the perspective that that a
particular category
particular category of the person
person is at stake in the “"fact,"fact,” and that
that this
fact has traveled.
We must ask ourselves, however, why this Prozac story story can be so
compelling, and why we consider consider it authoritative.
authoritative. One objection
objection to the
above description
description might be that that Sam experienced
experienced a new self, and it was
compelling that
so compelling that he simply adopted
adopted it as his true true self. Kramer and
Sam’s
Sam's friends did the same because they experienced a different
experienced different Sam as
well. This does not not account, however, for my feelings and others' others’ on
hearing about
about Sam. In discussing this case, I have been struck struck by a
double response. On the one hand, hand, there
there is a desire to have it not not be
true, to deny the fact of the transformation
true, transformation and assert a less mutable mutable
category of the person.
category person. On the other hand, there
other hand, there is a desire to know
know
more about
about the stories, to begin to play with with the fact and ca11 call into
question
question one’s
one's own category of the person. person. My sense is that that the fact
exploits the incompleteness of our categories of people, that there is
people, that
much that is either unaccounted
much that unaccounted for or contradictorily accounted for in
contradictorily accounted

159
CHAPTER 5
CHAPTER

categories, and that

our categories, that each fact provides material
material “good
"good to think
think
with,” in Levi-Strauss's
with," Levi-Strauss’s memorable coinage. 300
memorable coinage.3
What makes Listening
What Listening to Prozac fascinating
fascinating and recommended
recommended read­read-
that Kramer
ing is that Kramer was well aware of the cultural cultural nature
nature of his under­
under-
standing of Sam's
standing Sam’s self, andand he was bothboth frightened
frightened and eager to work work
with it. He went
with went on to consider
consider more borderline
borderline cases —for
- for instance, a
woman who has been "spacy
woman “ spacy and flaky”
flaky" all her life. When
When taking
taking Pro­
Pro-
zac, she becomes a faster and more articulatearticulate speaker. A businessperson
businessperson
taking Prozac becomes less sensitive to all the possible problems
taking problems in pro­
pro-
and therefore
posals and therefore more risk-taking
risk-taking and successful. These examples
raise the dilemma of what what Kramer
Kramer calls “"cosmetic
cosmetic psychopharmacol-
psychopharmacol-
ogy,” people who are taking
ogy," taking Prozac to become
become better
better than
than their “nor­
"nor-
31
mal” selves.
mal" selves.3 1 At stake in these stories are contrasting
contrasting categories of
persons -flakiness
persons —flakiness and eloquence, risk-taking
risk-taking ability and self-depreca­
self-depreca-
tion -—as neurochemical
tion neurochemical on/off switches. These in turn turn alter how we feelfeel
about the drugs: "Once
about “ Once these medicines have colored our view of how
constituted, our
the self is constituted, our understanding
understanding of related
related ethical issues inev­
inev-
affected” (Kramer 1993).
itably will be affected" 1993 ).
Kramer’s work
Kramer's work illustrates
illustrates how
how at least in the United States, expert exflert
and medical facts play a key role in how we experience our
scientific and
selves, our bodies, and others.others. In other
other words,
words, there
there appear
appear to be many
objective bodies that that we inhabit
inhabit consciously, in partpart through
through adjusting
persons to account
our categories of persons account for compelling facts. Of course this
not a one-way
is not one-way imposition
imposition of science on laypeople. Scientific
Scientific facts af­
af-
but we are not,
fect us, but not, as Roger Cooter
Cooter has pointed
pointed out, passive lay­
lay-
(Cooter 1984). We participate
people (Cooter participate in the instantiation
instantiation and legitima­
legitima-
tion of facts. In the next
tion next sections, I consider our role in the business of
producing and maintaining
producing maintaining facts. For now I want want to concentrate
concentrate on
how we incorporate
how incorporate facts into our our lived experience.

Embodiment: Facing Brain Facts

Embodiment: Facts

remarkable passage is from a memoir, The Beast: A

The following remarkable
Reckoning with
Reckoning with Depression, written
written by journalist
journalist Tracy Thompson.
Thompson. Ex­
Ex-
tremely depressed, having failed to commit suicide, and in a mental
institution, she reacted
institution, reacted as follows to a book on the history
history of de­
de-
pression:
depression as a definable illness, documented
The idea of depression documented for mil­
mil-
. . . Depression,
lennia, was new [to me.] ... Depression, then, was a kind of disease,
I’d even said that
an illness. I'd that myself on occasion. But even that had
that had
not clarified the confusion;
not confusion; illness was another
another concept
concept that
that had
meaning. [The first was a real disease with
layers of meaning. with visible effects.]
effects.]

160
 P ictu rin g P
Picturing e rso n h o o d
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PLATE Positron emissions tomography
1. Positron (PET) scans in Vogue; see p. 6 (from
tomography (PET)
“ New Seeing-Eye Machines
"New your body, can save your
Machines ..... . look inside your life,"
your life,”
by Joseph
Joseph Hixson,
Hixson, Vogue, July 1983)
l a t e 22.. PET sscans
PLATE
P c a n s of different
different functions traits, in Newsweek;
functions and traits, p.139
Newsweek; see p.139
(from “"Mapping
M apping the brain Story)," by Sharon
brain (Cover Story),” Newsweek
Begley, in Newsweek
Sharon Begley,
1992 vol. 66)
I P ictu rin g P
Picturing e rso n h o o d
Personhood

1. Rings
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block detectors
detectors surround
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are recorded.
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coordinates {anglevs,
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points.
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in a
a sinusoidal
sinusoidal plot
plot
of
of LORs
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point and
and
Is
is referred
referred to as
as a
a sinogram.
sinogram.

7.
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The result
result is
is a
a sinogram
sinogram which
which is
is B.Following
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acquistlon, filtered
filtered back
bach 9.
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the final
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is then
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ready for
for
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PLATE
P Illustrations of th
Illustrations
l a t e 33.. thee PET scanning
scanning process;
process; see pp. 773, 7 {repro­
3 , 777 (repro-
duced with
duced with permission
permission from Siemens Medical
Medical Solutions USA,
USA, Inc.)
 Picturing Personhood
P ictu rin g P e rso n h o o d

S tim u la tio n Co ntrol D iffe re n ce

P l a t e 4. PET scans illustrating

PLATE subtraction and
illustrating the subtraction and averaging
averaging pro­
pro-
cesses; see pp. 86-88
86-88 {Posner and Raichle
(Posner and Raichle 1994)

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P l a t e 5. PET scans of three vertical slices
slices through
through the brain dur-
dur­
ing a word-generation
word-generation experiment,
experiment, illustrating
illustrating the
the unprac-
unprac­
ticed nai've) subject,
ticed (or naive) subject, the practiced subject,
the practiced subject, and
and the sub-
sub­
ject performing
performing the task
task with
with a novel
novel set of words;
w ords; see p.
66 (Posner and Raichle 1994)
 ,
P ictu rin g Personhood
Pi~turing P e rso n h o o d

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P l a t e 6. PET scans illustrating
P E T scans illustrating the
the auditory
auditory system;
system; see p.66
(Phelps
(Phelps 1991)
1991)

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P l a t e 8. capture of the Image
Screen capture
Matrices intelligence test, from
vanced Matrices Viewer applet (ePET)
(ePET) developed by
Sharon Begley's
Begley’s "How
“How to Tell if You're
You’re Val Stambolstian, Ph.D.; see
Val see p. 93
Smart-See
Smart—See Your Brain Light Up," Up,” in (courtesy of the Interactive
(courtesy Interactive Media
Newsweek
Newsweek 1988 (vol. 64); seep.
see p. 66 Molecu.
Group, Crump Institute for Molecu­
(reproduced
(reproduced courtesy
courtesy of Richard
Richard lar Imaging)
I-Iaier, M.D.)
Haier,
 P ictu rin g P
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PLATE99..
PLATE Three-dimensional normal” and “"schizophrenic
Three-dimensional PET scans of “"normal" brains";;
schizophrenic brains”
see p. 90 (Wolf 1981a; reproduced
seep. reproduced with
with permission Brookhaven N
permission from Brookhaven Nat-
at­
Laboratory)
ional Laboratory)

l a t e 10.
PLATE
P Xenon seep.
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permission)
permission)

PLATE
P PET scans of “"brain
l a t e 11. brain
phantoms,”
phantoms," showing the
evolution of PET scanners
evolution
(origi-
at UCLA; see p. 78 (origi­
nal slide provided by
Phelps)
Michael Phelps)

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 P ictu rin g Personhood
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P l a t e 12. Identical
Identical PET scans illustrating
illustrating pseudo-color choices; see p. 94 (courtesy
pseudo-color choices; (courtesy of
Brian
Brian Murphy)
Murphy)
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PLATE 1 3 . Paperback
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PLATE The cover of Mapping
Mapping the
for The Broken Brain, by Nancy Brain and its Functions,
Functions, by Con-
Con­
C. Andreasen; see p. 126 stance Pechura and Joseph Martin;
Martin;
(Andreasen 1984)
1984) see pp. 19, 88 (Pechura and
Marin
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Change
Change your
your own brainchemistry!
own brain Schwartz'sgroundbreaking
chemistry!Schwartz's groundbreaking studies have
studies have
shown byusing
shown that by using his
his.Four-Step program you
Four-Step program you can actually "rewire"your
actually "rewire" your
brain
brain and modify
modify your geneticdisposition.
your genetic disposition.

CHANG■ IN ENERGY
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WITH DR. SCHWARTZ'S
OF
OF A TYPICAL PERSON Wffll
TYPICAL PIUON OCD
WITH OCD FOUR-STEP MftNOD
FOUR•STIP METHOD

PLATE
P l a t e 15. PET scans of a patient with obsessive-compulsive
patient with obsessive-compulsive disorder, showing
showing
Lock:
the brain before and after therapy; from the back cover design of Brain hock:
Free Yourself
Free Yourself from Obsessive-Compulsive
Obsessive-Compulsive Behavior: A Four-Step Self-Treat
ment Method to Change Your Brain Chemistry,
ment Method Chemistry; seep.
see p. 155 (courtesy of
Jeffrey Schwartz,
Schwartz, M.D.)
 P ictu rin g P
Picturing e rso n h o o d
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P l a t e 16. PET scan of the brain
brain of a PLATE
P late 17. "Plain Brain/Brain after
“ Plain Brain/Brain
heavy user of MDMA
M D M A ("ecstasy")
(“ ecstasy” ) Ecstasy";
Ecstasy” ; an illustration
illustration for the
compared with
compared with the scan of a nor­
nor- Twenty-fifth Annivrsary Poster NIDA
mal control subject;
subject; see p. 149 (National
(National Institute
Institute of Drug Abuse);
(McCann, Szabo, Scheffel,
Scheffel, et al., see p.150
p.150 (courtesy
(courtesy of NIDA)
1988; reproduced
reproduced courtesy of
George Ricaurte,
Ricaurte, M.D.)

Z a m e t k i n et. a l. 1 9 9 0

Section on Clinical Brain Imaging, LCM, NIMH

PPLATE
l a t e 18. PET scans of a patient with attention-deficit
patient with attention-deficit hyperactivity
hyperactivity
disorder
disorder (ADI-ID),
(ADHD), compared with the scan of a normal
compared with normal control
control sub-
sub­
ject; see p.155 (courtesy of the National
National Institute of Mental
Mental Health)
 TRAVELING IM
TRAVELING AGES, POPULARIZING
IMAGES, POPULARIZING BRAINS
BRAINS

. . . Then
... Then there
there was another
another kind of illness, as in, “"God,
God, she’s
she's a sick
person,” "How
person," “How sick,"
sick,” "This
“This is a really sick idea.”
idea." The second kind
carried the weight
carried weight of moral
moral blame. . . .
what if depression
But what depression was an illness of the first kind? Then it
would be an incorrect
would incorrect functioning
functioning of my brain. I could say, There is
something wrong with my brain. That
something That was a different
different thing from
saying, There is something
something wrong with me. The second was self-pity­ self-pity-
ing; the first was a simple, factual
factual statement.
statement. It
It was a subtle nuance,
grasped that
easy to miss. But as I grasped that difference —
- and it was slippery, I
kept losing it at first-
kept first —other
other doors began to open in my mind:
Depression is an illness. I am sick. I need to be here [in this mental
Depression
institution] because I'm
institution] Pm defective, notnot because I’m
I'm a moral
moral leper,
leper, not
I’ve fallen from grace or turned
because I've turned my back on God, but for one
simple reason: because I am sick.
there my thinking
But there thinking stalled. So I was sick. But this was my brain brain
talking about,
I was talking about, not
not my gallbladder
gallbladder or my kidneys. It had some
mysterious
mysterious property
property called “consciousness.”
"consciousness." It produced
produced behavior, the
total of which
sum total which was somehow
somehow me. If I wanted
wanted to say simply thatthat
my brain
brain was sick, I could stop there there and disavow responsibility
responsibility for
that sickness -—but if I did that,
that that, I would be giving up my idea of
autonomy in the world. I would
autonomy would be simply a product
product of some chemi­
chemi-
abnormality in a lumpy gray organ
cal abnormality organ between
between my ears. . .. .. It It
seemed to me that that if the first approach
approach was too simplistic, its opposite
(Thompson 1995, pp. 189-190)
might be as well. (Thompson 189-190)

with the fact of her

Faced with her brain
brain being sick, Thompson
Thompson is caught. In
some very real sense, she knows too much much about
about her brain. Like Witt­
Witt-
genstein, she would
would be able to make sense of it if a connection
connection were
seen in her brain
brain while reading. This also means, however, that that if her
brain
brain is sick, she must be sick, too. HowHow can she disavow her depres­
depres-
without disavowing her self?
sion, then, without self?
solution Thompson
The solution Thompson eventually discovers is not not to disavow either
alternative
alternative but
but to create a new type of human,
human, a depressed human,
human, who
is also a type of brain,
brain, a depressed brain. The invention
invention in this case is
carried
carried out
out against
against her
her slippery notion
notion of an ill person,
person, but
but also morally
sick, disgusting person. Out
Out of this purely
purely negative notion
notion of sick (as
not healthy
healthy and not
not good), she forges a positive identification
identification with her
own brain-illness. She is a depressed person
person because she has a depressed
brain. cultural alternatives
brain. The too-simple cultural alternatives of either being responsible
brain are complicated.
for her sickness or not being her brain complicated. She is her brain
against her brain: She is now
against now a person
person with
with depression
depression fighting that
that
metaphor, she is forever more wary of the Beast
depression. In her own metaphor,
who travels with
who with her. In this manner, given the stark choices of respon­
respon-

161
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 CHAPTER

identity
5
CHAPTER S

sibility and autonomy,

autonomy, she enacts a powerful
identity politics. She comes to see herself as —
powerful form of self-invention:
- and becomes -—a particu-
particu­
l
person, a kind she shares with
lar kind of person, with others whowho also have depres­
depres-
sion and are people with with depression. Beyond a shared shared affliction, all of
these people share a brain-type
brain-type thatthat is a necessary response to social,
historical, and institutional
historical, institutional factors in the concerning
concerning the ongoing stigma
attached to mental
attached mental illness. Suffice
Suffice it to note here the crucial enabling
played by both
role played both the NAMI
NAMI in shaping researchresearch directions
directions and public
perceptions of mental
perceptions mental illness as biological disease and of the Twelve-
Step movement
movement (an outgrowth Anonymous) in establish­
outgrowth of Alcoholics Anonymous) establish-
ing the positive identity
identity of afflicted individuals
individuals as people who who share a
unique
unique experience and are stronger stronger for fighting it.3 2
it.32
Thompson’s
Thompson's accountaccount illustrates
illustrates three
three critical aspects of objective-self
fashioning for our purposes.
fashioning purposes. First, therethere is a tremendous
tremendous flexibility and
openness of explanation
explanation of the objective-self. Even in the face of specific specifiC
received-facts about about ourselves, there room for negotiation
there is room negotiation and re- re­
definition. Sociologists and anthropologists
anthropologists of psychology have called
this the “"pandemonium"
pandemonium” of folk psychology. They also note, however,
', that
that even as we can play with with mind and brain, motivation and behavior,
brain, motivation
we also ultimately
ultimately must satisfy local commoncommon sense (Lutz 1988, p. 185).3 185). 333
For Thompson,
Thompson, the commonsense constraint consists in having to come
commonsense constraint
with a responsible
up with responsible relation
relation toward
toward her depression without without being re-re­
sponsible for for it. Attending
Attending to the active use of explanatoryexplanatory flexibility
allows us to understand
understand how "models“ models serve social relations
relations as much or
more than than social relations
relations follow models"
models” (Holland
(Holland and QuinnQuinn 1987}.
1987).
The second aspect of objective-self fashioning fashioning we need to highlight
highlight is
the need for a nuanced,
the nuanced, complex cultural, historical,
complex cultural, historical, and institutional-
institutional —
as well as scientific or biomedical-understanding
biomedical —understanding of context. context. Objective-
self fashioning
fashioning is an ongoing process of social accounting accounting to oneself and
others in particular
others particular situations
situations in which function as partic-
which received-facts function partic­
powerful resources because they bear the objective authority
ularly powerful authority of
location of social accounting
science. As the location accounting changes -—to to a lab, to a
courtroom, to a doctor's
courtroom, doctor’s office,
office, to someone’s
someone's home—the
home -the relative force
changes. 344
particular received-facts also changes.3
of particular
The third
third critical aspect of objective-self fashioning
fashioning is the fundamen-
fundamen­
connection between the brain as objective-self and one's
tal connection one’s own per-per­
sonal identity. When
sonal When genes are invoked as the cause of one’s one's objective-
self and aspects of one's one’s personality,
personality, they can become a synecdoche for
one's identity. If one has a gene for depression, one can fear becoming
one’s becoming
depressed. More More troubling
troubling for Thompson,
Thompson, to the extent extent that
that it can be
characterized and measured,
characterized measured, the brain brain seems to be be one's
one’s personal iden­
personal iden-
tity.3
tity. 355 We can note here that that brain
brain images further
further confuse the part part with
the whole -—even though brain
even though brain images show only a slice of the brain,
they show the slice as representing
representing the whole brain, brain, which turn is
which in turn is the

162
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TRAVELINGIM
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AGES, POPULARIZING BRAINS

person.
person. This contrast
contrast between genes and brains brains can be illustrated
illustrated by
reactions
reactions to images of the two. Emily Martin Martin and Deborah Heath have
Deborah Heath
noted
noted that
that people with
with genetic afflictions hiss and boo at pictures of
genes or enzymes thought
thought to cause these afflictions (Heath
(Heath 1997; Mar- Mar­
tin 1994, p. 16). Sufferers of mental
mental illnesses do notnot react negatively to
brain
brain images of depression
depression or schizophrenia. Rather, the reaction
schizophrenia. Rathei; reaction to
brain
brain images is often one of care and concern,concern, much more akin to the
reassurance
reassurance and bonding
bonding experienced between
between parents
parents and ultrasound
ultrasound
images of fetuses. The brain image appears
appears in this setting to be an image
of the suffering of the afflicted, as well as an image of the affliction.3
affliction. 366
The kind of brainbrain that
that Thompson
Thompson comes to understand
understand is one that that
helps locate her Beast as a brain-type. Brain-types can stand stand for the
human
human kind or state as their fix, and with
their reality. Brain-types -fix, with imaging
show, what
what is otherwise
otherwise difficult to see, contested,
contested, or comes and goes. goes.3 7
37

Faced with
with a brain-type,
brain-type, a person
person is doubled
doubled as both
both being the brain-
type and having it. Brain-types can conversely be said to express them- them­
selves in the person
person and as the person.
person.
The relationship
relationship between Thompson
Thompson and her brain brain appears
appears to be a
form of embodiment,
embodiment, but one not not well studied
studied in anthropology.
anthropology. Re­ Re-
search on embodiment
embodiment and the medicalized body have tended tended to oppose
the two,
two, with
with the lived, active body in opposition
opposition to the passive, objec­objec-
tive, medical body (Becker 1995; Csordas
Csordas 1994a;
1994a; Csordas
Csordas 1994b; Mer-
leau-Ponty
leau-Ponty 1964). In the case of the brain brain in biomedical
biomedical America, PET
scan brain-types
brain-types reveal a medicalized but but active, unruly, and almost al- al­
ways irrational
irrational brain. Ironically, the "normal"
“ normal” brain-type
brain-type is the one that that
is, so to speak, passive and lets the real self talk talk though
though it.it.3388 The de-
de­
pressed brain-type,
brain-type, however, substitutes
substitutes itself for the real self and
speaks instead,
instead, providing
providing us with such an expression
expression as “That
"That was my
illness speaking, not not me,”
me," or in Thompson’s
Thompson's terms, “That "That was the
Beast." The brain-type,
Beast.” brain-type, although
although objective, is simultaneously
simultaneously subjective,
lived by the person
person as well as against
against the person.
person.

Objective
Obiective Self-Fashioning
Self-Fashioning

which the fields of molecular

Given the explosive rate at which
neurobiology are expanding,
genetics and neurobiology expanding, it is inevitable
that
that the perception
perception of our own nature,
nature, in the field of sex as
in all attributes
attributes of our physical and mental
mental lives, will be
increasingly dominated
dominated by concepts
concepts derived from the
biological sciences.
sciences.
(LeVay
(LeVay 1993, pp. 137-138)
137-138)

Within this broad

Within broad sketch of three
three symbiotic actors—experts,
actors-experts, layper­
layper-
sons, and mediators,
mediators, each drawing
drawing on and reconfiguring
reconfiguring the presupposi-
presupposi­

163
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tions of the others

others —I- I am going to concentrate
concentrate my attention
attention on the
aspect I call objective self-fashioning. The objective self is an active cate­ cate-
gory of the person
person that that is developed throughthrough references to expertexpert
knowledge invoked through
knowledge and invoked through facts. The objective self is also an em­ em-
bodied theory
theory of human nature, both
human nature, both scientific and popular. Objective
self-fashioning calls attention
attention to the equivocal site of this production
production of
new objective knowledge
knowledge of the self. self. From one perspective, science pro- pro­
that define who
duces facts that who our selves
selves objectively are, and which which we
then accept. From anotheranother perspective, our selves selves are fashioned
fashioned by us
out of the facts available to us through through the media, and these categories
of people are, in turn,turn, the cultural
cultural basis from which which new theories
theories of
human nature
human nature are constructed.
constructed.
Objective self-fashioning is thus an acknowledgment
acknowledgment of local muta­ muta-
. tions in categories of people highlighting
highlighting the active and continual
continual pro­
pro-
./ cess of self-definition and self-participation
self-participation in that that process. Objective
self-fashioning is how we take facts about about ourselves
ourselves-— (about
(about our bod-bod­
ies, minds, capacities, traits,traits, states, limitations,
limitations, propensities,
propensities, and so
on) -—that
that we have read,read, heard,
heard, or otherwise
otherwise encountered
encountered in the worldworld
and incorporate
incorporate them
them into our lives/9lives.39 As anthropologists
anthropologists and other
scholars, we are most often in the mediator
scholars, mediator role, casting theories
theories of
selves out of our own categories of the person.
objective selves
point to two interrelated
These cases point interrelated meanings of objective self-fash­
self-fash-
ioning: (1) how
how we come to understand
understand ourselves as subject
subject to the scien­
scien-
tific, medical, and technical
technical discourses of objectivity, and (2) (2) how
how these
discourses choose "us"
discourses “ us” as their object of study. The difference between
the two meanings is a matter matter of point
point of view.
view. On the one hand,
hand, these
point to the ways in which
cases point which we fashion
fashion our selves—person,
selves - person, body,
brain, and mind-
brain, mind —out ready-made objective types, and therefore
out of ready-made sub­
therefore sub-
ject ourselves to the disciplines of science and technology, expertise and
machines. This kind kind of self encounters
encounters objectivity in the form of resis­ resis-
who we are is a product
tance; who networks and technologies
product of discourse networks
over which
which we have little control
control (Kittler 1985). On the other hand, the
other hand,
practices of science, technology, and medicine fashion fashion selves
selves as objective
facts through
through scientific experimentation,
experimentation, subject selection, and medical
taxonomic
taxonomic exercises. This latter case emphasizes social and disciplinary
production of selves, whereas the former emphasizes cultural
production cultural presup-
presup­
positions built into concepts and practices.
positions
Attending
Attending to the categories of the person person built into facts, and to facts-
in-the-world
in-the-world as facts, will enable us to see more clearly how how medical
and scientific claims, along with with our own, are as much about dividing
much about
persons as they are about
persons about describing them. Here, Here, along with
with Emily Mar-Mar­
tin, I believe we should also “"acknowledge
acknowledge the varieties of ways in
which experience resists science and medicine”
which medicine" (Martin
(Martin 1987). More

164
 TRAVELING IM
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POPULARIZING BRAINS

specifically, the question

specifically, question of objective self-fashioning
self.fashioning raises the issue of
creativity with
creativity with regard
regard to facts. Rayna
Rayna Rapp,
Rapp, for instance,
instance, has followed
different ways in which people incorporate
the different incorporate the possibilities and re· re­
sults of amniocentesis
suits amniocentesis into their lives —for one mother, the fact of a
lives-for
genetic defect means a decision to abort,
abort, whereas another, it means
whereas for another,
preparing to take proper
preparing proper care of a challenging
challenging baby (Rapp 1999). Both
Martin and Rapp
Martin Rapp have called for a reader-response
reader-response analysis of our rela·
rela­
tion to science, medicine, and other
tion other facts of life.
life.
There are exceptions to this relief, of course. One senior PET re·
There re­
searcher expressed his own fears regarding
searcher regarding diagnosis by scan. Armed
with detailed knowledge
with knowledge of how difficult it can be to produce
produce an accu­
accu·
rate image, he easily externalized
externalized the fact·producing
fact-producing technique
technique from
about himself:
facts about himself:
We’ve worked
We've worked as hardhard as we can to make everything quantitative
everything quantitative
because almost
almost everything you do to make it quantitative
quantitative makes it a
good picture,
picture, too. You don't
don’t have funny
funny blobs. I don’t know if you
don't know
are familiar with
with some of the other
other kinds of imaging, but most of the
images are just funny blobs that that do not
not represent,
represent, in my mind, [the
What you should see is a perfect
brain]. What perfect image of the brain thatthat has
blurred. If that
been blurred. that is what
what you see, that that you are doing it
that means that
right. When
When you see funnyfunny blobs that not part
that are not part of it, you know
know
they are screwing something
something up beyond
beyond having poor
poor resolution.
resolution.
I find it difficult to have myself diagnosed
diagnosed by something
something like that.
that.
I’d
I'd be worrying
worrying that
that the blob on the right photomultiplier
right was a bad photomultiplier
on the system and it wasn’t
wasn't really a problem.
problem. I guess there
there are some
cases where the problem
problem is so big and gross, a huge area missing, that that
you can do that.
that. But I have to realize that
that everybody can't
can’t afford to
do PET. that a lot of medicine, and a lot of tests, really are
PET. It is scary that
not all that
not that great.
Within the daily practice of clinical psychiatry, these brain-imaging tech-
tech­
niques have also helped sufferers deal with
with the fact of mental illness
illness symp­
symp·
toms. The following excerpt is from an interview with
with Dr. Joseph Wu:
DuMIT:
D Doo you show the patients
u m it: D patients their
their PET scans?
Wu: Oh yes. We try and show them them the PET scans, and thenthen some of
patients will refer them
these patients them out to people.
people. I have a part-time
part-time pri­
pri•
vate practice
practice with some of them, them, and they
they may like to continue
with me.
with
u m it: Does it help them overcome part
DuMIT:
D part of the stigma of mental
illness?
Wu: I think
think so. I think that [it]
think that [it] definitely [does]. One of the intrinsic
messages is that
that the depression
depression isn’t something to be ashamed
isn't something ashamed of; it

165
CHAPTER
CHAPTER 5

is an illness which
which needs to be understood.
understood. And it is notnot something
that
that is their
their fault.
I think
think that
that there
there is a destigmatization that occurs with
destigmatization that with the bio-
bio­
logical emphasis. It is a fine line, because there
there are some arenas of
personal responsibility
personal responsibility that
that people can and should
should assume for their
their
feelings. But I think
think it is a very narrow
narrow and tricky
tricky balance. It is
important not
important not to think that it is all biology; that
think that that it can lead to a
certain eschewing of what
certain what is appropriate
appropriate for one's
one’s own role in un-
un­
derstanding one's
derstanding one’s emotions. On the other
other hand,
hand, I think that people
think that
can go overboard,
overboard, and say, "Gee,
“ Gee, I’m
I'm entirely at fault for how
how I
feel.” [It is important]
feel." important] to try and understand one’s
and understand one's role in helping
to monitor
monitor one's
one’s emotions
emotions without
without being unnecessarily harshly
judgmental
judgmental of oneself.
reconfiguration of mental
The reconfiguration mental illness as biological through
through the use of
PET scans becomes part personal reconfiguration
part of a personal reconfiguration of one’s cat­
one's own cat-
egory of person.
person. A strict division between the biological self and the
personal not at issue here. Rather, the relations
personal self is not relations between
between the two
selves are redistributed
selves redistributed so that
that although
although the patient
patient must continue to
must continue
experience the illness and live with
with it, she or he no longer has to identify
with
with it. The diseased brain, in this case, becomes a part part of a biological
body that
that is experienced
experienced phenomenologically
phenomenologically but is not the bearer bearer of
personhood. patient who looks at his or her PET brain
personhood. Rather, the patient brain scan
is an innocent
innocent sufferer rationally
rationally seeking help.
help.4400
Other researchers who have also shown
Other researchers shown patients
patients their
their scans have
agreed that
that especially in cases of neurological
neurological and mental
mental diseases, which
are often accompanied
accompanied withwith self-disgust or a sense of failure, both both the
scan and the process help legitimate the problem.
problem. They make it something
something
41
that explored."1
that can at least be explored. patients (and their
These patients their families) want
want
schizophrenia
schizophrenia and depression to be medicalized, to have a single cause or
explanation,
explanation, even if there is no solution
solution or cure for them.
them .
Anthropologists of medicine have long explored
. Anthropologists explored this kindkind of effect as
a crucial aspect of every health-care
health-care system. Jean JacksonJackson discussed the
failure of culture
culture to come to grips with with chronic
chronic pain (Good et al. 1992;
Jackson
Jackson 1994; Jackson
Jackson 2000). tension Jackson
2000). The tension Jackson described involves
the social devaluation
devaluation of mental
mental versus physical pain. Chronic Chronic pain suf-
suf­
ferers seek out, even hope
hope for, positive test results. They even hope for
cancer, because then
then there would
would be something
something to point work on
point to and work
to solve the problem.
problem.
Regarding depression, Dr. Wu concurred
Regarding concurred with interpretation
with this interpretation
when about the history
when I asked him about history of psychiatry.
DUMIT:
D u m it : Dr. Wu, Nancy Andreasen
Andreasen has written
written about
about the biological
revolution
revolution in psychiatry. You were in medical school during
during this
time. Did you also get the other
other side of psychiatry?

166
 IMAGES,
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AGES, POPULARIZING

Wu: Oh, very muchmuch so. I would

would say that
that most of the psychiatrists
psychiatrists in
department are still analytically, dynamically
this department dynamically focused. I would
that biologically oriented
say that oriented psychiatrists
psychiatrists still make up a minority
minority
Maybe thirty
of the faculty. Maybe thirty to forty
forty percent,
percent, as opposed
opposed to the
psychodynamically oriented
psychodynamically oriented people,
people, [who] are fifty to sixty percent.
DuMIT:
D u m it: Do both of these sides come into play in your
D o both your work?
Wu: Somewhat. For me, when when I do a study of depression,
depression, there is a
part of me, a whole human
part human dimension,
dimension, that
that really tugs at my heart.
Part of me feels moved by the pain of the patient
Part patient that
that we work
with. I am also moved by the courage courage and the willingness that that
participate in this study, even with
many of these people have to participate
depth of their
the depth their emotional
emotional pain
pain and anguish. I think
think we try to
them the gratification
offer to them gratification that
that comes with
with knowing
knowing that
that they
contributing to the fund
are contributing fund of knowledge
knowledge that
that will eventually help
hope, eliminate
to, we hope, eliminate depression
depression or mitigate
mitigate it. And that
that is some­
some-
thing
thing that
that many of these people find appealing,
appealing, because there
there may
be some greater
greater purpose
purpose to their
their suffering. It is a way of reconnect­
reconnect-
ing in some sense with the broader
broader community. It is a way of mak­ mak-
personal meaning out
ing a personal out of the emotional
emotional pain that
that they suffer
biological aspect as not
from. For me, I see the whole biological not being contra­
contra-
dictory or mutually
dictory mutually exclusive from the psychodynamic
psychodynamic aspect. I
complementary and synergistic with
really see it as complementary with the dynamic
aspect. There are some people that that see it as “"either/
either/ or.”
or." I see it
more as a "both/and"
more “ both/and” type of proposition.
proposition.

research into
PET research into mental
mental illness has thus become an area of study
worthy
worthy of community
community support
support and patient
patient contribution.
contribution. The “"both/
both/
and"
and” approach popularized by books
approach to psychiatry, popularized books such as Listening
Listening to
Prozac, involves realizing thatthat the brain
brain can be altered
altered by the social
environment
environment and by genetic development and drugs. The kindling the­
development the-
ory, for instance, suggests thatthat repeated
repeated abuse during
during childhood
childhood can
reactions until the depression
build up depressed reactions depression is neurologically
neurologically self-
self-
sustaining.42 The brain becomes "rewired"
sustaining.42 “rewired” as if the person
person had been
born that
born that way. In the same vein, both both psychodynamic
psychodynamic talk therapy
therapy and
psychopharmoceutical drug treatment
psychopharmoceutical treatment can change brainbrain chemistry
chemistry and
rewire the brain
rewire brain toward
toward freedom
freedom from depression. Note Note that
that the brain
remains the bearer
bearer of mental
mental illness but
but in treatment
treatment becomes an inter­inter-
section for social and biologic influences.
Wit’s "both/and"
Dr. Wu's “ both/and” approach
approach to psychodynamic
psychodynamic and biologic expla­ expla-
nations of mental
nations mental illness arises, I suspect, from his taking
taking patients’
patients' per­
per-
account. Patients can participate
spectives into account. participate in social and medical
reform by participating
reform participating in research
research that
that might
might produce
produce facts implying a
person who
category of person who suffers from a physiological
physiological rather
rather than
than a psy­
psy-
disturbance.
chologic disturbance.

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If we see that
that responsibility
responsibility and causations part of our categories
causations are part
of people, this example demonstrates
demonstrates the flexibility and contestibility
contestibility of
these categories. Patients and activists are actively getting getting together
together to
support
support and promote
promote research
research on the shared
shared biologic nature
nature of mental
mental
illness because of their
th,eir desire to see the results and their hope for cures.
Paul Rabinow
Rabinow has called this grouping
grouping on the basis of biologic com- com­
monality
monality “"biosociality" (Rabinow 1992). A key point
biosociality” (Rabinow remember here
point to remember
is that
that the facts of biology around
around which
which these groups are organizing
are not
not necessarily fully decided withinwithin the scientific community. Yet
they provide
provide the means for social action,action, justifications
justifications for support
support of
certain
certain kinds of research,
research, and arguments
arguments for a biologic understanding
understanding of
mental
mental illness. The facts enable the groups to further further promote cate-
promote a cate­
gory of the objective person that that does not, in their
their view, prejudge them
them
and condemn them to blame and guilt. This involves understanding
condemn them understanding the'the;
many very different ways facts (science,
(science, technology, nature)
nature) and experi­
experi-
ence (subjectivity, personality,
personality, culture) are constantly
constantly shaping and trip­trip-
ping over each other. These people are working working creatively to refigure
responsibility for mental
responsibility mental illness, in this case to biology, in an attempt
attempt to
gain control
control over this part
part of their world.
world.
The challenge here is not not just to the social construction
construction of mental
mental
illness. This is not
not a simple story of the gradual
gradual emergence of the right
depression, schizophrenia,
view of depression, schizophrenia, and PET scanning. Biologic psychia­ psychia-
instance, can lead to deinstitutionalization
try, for instance, differential ac­
deinstitutionalization and differential ac-
cess to medication,
medication, which
which burdens
burdens lower-income communities more
lower-income communities
than upper-income
than upper-income ones. This story story is not
not one of victims and blame,
however. By tracing
tracing facts-in-the-world
facts-in-the-world throughout
throughout the virtual
virtual commu­
commu-
nity of PET images, I hope that that responsibility
responsibility for these situations
situations might
be multiplied
multiplied-—that
that accountability
accountability might
might adhere to experts,
experts, mediators,
mediators,
and laypersons
laypersons alike for their
their participation
participation in objective self-fashioning.

Conclusion

When PET researcher

When researcher Henry
Henry Wagner said that “ in PET,
that "in PET, we now
now have a
new set of eyes that
that permits us to examine the chemistry
chemistry of the human
human
mind”
mind" (Wagner 1986, p. 253), he was pointing
pointing to a particular
particular kind
kind of
humanoid:
humanoid: a cyborg whose experience of vision includes the physiology
of the brain
brain as witnessed
witnessed through
through PET scanning. Some of us may shud- shud­
der at the alienation
alienation implied in selves
selves mediated
mediated by radiotracers,
radiotracers, new
pharmaceuticals, and multimillion-dollar
pharmaceuticals, multimillion-dollar bioscience. Others
Others may breathe
breathe
a sigh of relief at not being blamed for personally
personally constructing
constructing schizo-
schizo­
phrenic children,
phrenic children, at finally being respected as having wonderful
wonderful children
children
who happen
who happen to have a visible and therefore brain dysfunction.
therefore real brain dysfunction. Still

168
r others may wonder
others wonder when
when and how
abnormal, or even if this binary
abnormal,
TRAVELING IMAGES,
TRAVELING IM POPULARIZING
AGES, POPULARIZING

how they will be classed as normal

binary categorization
BRAINS
BRAINS

normal or
categorization will finally prevail.
conclusion, I have tried
In conclusion, tried to point
point out some of the ways in which
contemporary biomedical
contemporary biomedical and scientific practices
practices are culturally
culturally situated.
practices are participating
These practices participating in ongoing negotiations
negotiations not
not just of spe­
spe-
brain-behavior-mind links but
cific brain-behavior-mind but also of the nature
nature of human
human nature
nature
human differences. I have tried to show both
and the significance of human both the
complexity of the process of producing
complexity producing contemporary
contemporary neuroscientific
numerous ways in which
facts and images and the numerous which practical
practical considera­
considera-
often build in assumptions
tions often assumptions aboutabout human
human nature
nature with
with undesirable
undesirable
and socially unequal
and unequal consequences. My purposepurpose is not to point
point a finger
particular sets of people or techniques.
at any particular techniques. I think
think it is necessary to
recognize the social andand cognitive benefits of these practices for many,
many people. Rather, I am seeking to find a language to talk about about
multiple accountabilities
multiple accountabilities between the diverse communities
communities engaged with
PET.
PET.
The challenges of howhow to understand
understand the continuing
continuing and increasing
biotechnopower require
presence of biotechnopower require dose
close attention
attention not
not only to the mul­
mul-
and arenas of
tiple uses and of. facts-in-the-world
facts-in-the-world but
but also to their deployment
deployment
within discourses of objectivity and
within and to the ways that
that they have built-in,
presupposed notions
presupposed notions of human
human nature.
nature. The point
point is that
that science and
turn out to be our business on a daily basis. We are involved
medicine turn
in them, they involve us, and they draw draw on the ways in which we con­ con-
person. My hunch
figure the person. hunch is that
that this process will reveal much aboutabout
multiple circuits of theory
the multiple theory transfer
transfer from laypersons
laypersons to experts and
laypersons via all kinds of mediators
back again to laypersons —movies, maga­
mediators-movies, maga-
personal physicians, and anthropologists.
zines, personal anthropologists. These circuits of fact
distribution and presupposition
distribution presupposition are worth
worth understanding
understanding if we wantwant to
understanding of our
play a critical role in our own understanding our selves.
selves.

169
169
 Interlude5
Interlude
Living
Living One's Images

W ag n e r: You see, one of the appeals of activation

WAGNER: activation studies is thatthat it
makes it possible to focus on particular
particular parts
parts of the brain
brain for carry-
carry­
ing out whatwhat PmI'm interested which is the neurochemistry,
interested in, which neurochemistry, the
molecular reactions
molecular reactions that
that are going on. So therefore
therefore the activation
activation
studies are very interesting
interesting and very helpful. But from the example
circuit diagrams,
of circuit diagrams, of what
what is connected what, what
connected to what, what activates X
is less interesting
interesting to me than
than the molecular
molecular approach.
approach.
How
D u m it : H
DUMIT: would you define the difference between these two
ow would
kinds of studies?
WAGNER:
Wagner : Well, one is the area of molecular intercellular and intra-
molecular intercellular intra­
cellular communication.
communication. It’s It's at the molecular
molecular level rather
rather than
than at
the regional
regional level. So So the activation
activation lets you know thatthat part
part of the
temporal
temporal lobe is activated
activated when you speak, and that that another
another part
part
of the brain
brain is activated
activated and associated with that. I think
with that. think this is
important
important and very interesting,
interesting, and very useful in terms of focusing
on what
what is going on.
But then want to see exactly how information
then you want stored in
information is stored
your brain
your brain (figure 5.2). I think
think people are-I
are —I know
know I certainly
am -—more
more conscious of the effects of molecules on your your brain
brain than
than
we ever have been before. People’sPeople's way of thinking
thinking becomes auto­ auto-
think people realize that
matic. I think that chemicals are affecting your
your brain
all of the time. I'm Pm conscious of the fact thatthat if you feel a certain
certain
way at a certain
certain time, [then] if you wait
wait a little while, these chemi-
chemi­
cals are going to be makingmaking adjustments,
adjustments, just as neurotransmitters
neurotransmitters
are going to be leaving receptorsreceptors and they will be available for
more stimulation.
stimulation. You see, I am much more conscious now now of
chemistry going on in my brain,
chemistry else’s brain, than
brain, and everybody else's than I
when we started
was when started doing this.
 LIVING ONE'S
LIVING O N E'S IMAGES

F
FIGURE Henry N.
5.2. Henry
ig u r e N . Wagner, M
M.D.,
.D ., shown
shown in PET scanner. His
H is brain image
(above) shows dopamine
dopamine receptor
receptor density. (Original slide provided
provided by Dr.
Wagner)

171
171
 Chapter
Chapter 6
Conclusion:
Conclusion: Here is
Is a PET
PET Image of
Person That Shows Depression
a Person Depression

This book could have begun with with the following declaration:
declaration: Here is a
PET image of a person person that
that shows depression. The book could have
taken off from there
taken there and described the consequences for theories of
depression and human
depression human nature
nature on the basis of scan results. As an anthro­
anthro-
pologist of science and technology, however, I was compelled to write a
pologist
book that
book that first took
took apart,
apart, unpacked,
unpacked, and analyzed each aspect of the
declaration and its relation
declaration relation to the world.
world.
The reference of “PET”
"PET" had to be examined
examined historically, in terms of
what
what PET is and does (chapter
(chapter 2). Before a PET image could be “"here,"
here,”
it had to come from somewhere else, from an experiment,experiment, and for it to
be an "image
“image of"of” something,
something, a visual semiotics had to be explored
(chapter 3). For a PET image to “"show"
(chapter show” a truth
truth about
about a person,
person, a
interrogation of the social contract
interrogation contract of technological
technological human
human measure­
measure-
ment had
ment had to be set forth
forth (chapter
(chapter 4).
4 ). For there to be an image “of "of a
person,” the nature
person," nature of personhood
personhood had, at least, to be interrogated
interrogated in
relation
relation to knowledge
knowledge production
production and dissemination.
dissemination. Finally, for a men­
men-
tal illness like depression
depression to be the object of such a technological
technological mea­
mea-
surement, the social actors and consequences involved in such a process
surement,
had to be explored (chapter 5). None
explored (chapter None of these projects is completed,
completed, but
each has been started
started in such a way that
that cultural
cultural connections
connections among the
long list of actors
actors in the virtual
virtual community
community of PET images may be ac­ ac-
counted for. A rich history
counted history of the contests
contests over PET and its objects can
now be begun and a rich
now rich inquiry
inquiry into a particular
particular set of experiments
experiments
initiated.
can be initiated.
r
.

anthropologists and historians

As anthropologists
community of PET,
community
historians relatively informed
PET, we could now tracktrack how
informed about
CONCLUSION
CONCLUSION

about the virtual

how in these experiments
virtual
experiments the
PET scanner
scanner was justified, the experiment
experiment was designed, the patients
patients and
normal control
normal control subjects were selected, the data
data were generated,
generated, the im­
im-
ages were selected and then
then argued for, and what hypotheses were gener-
what hypotheses gener­
ated or confirmed about
about the nature
nature of depression
depression and human
human nature.
nature. In
doing this, however, we must go further than noting
further than noting the assumptions
assumptions
about human
about human nature, brain, and mental
nature, the brain, mental illness being invoked. Each of
assumptions has its own histories
these assumptions histories and contests that are difficult to
contests that
bring into focus so long as the content
content of PET remains
remains opaque. How to
opaque. How
approaches to brain
juggle approaches brain imaging and philosophies
philosophies of human
human nature
nature
remains aa.most
remains most elusive and yet crucial problem
problem for the neurosciences.
For the rest of this conclusion,
conclusion, I would
would like to explore
explore the nature
nature of
such an inquiry, beginning with the statement
statement “Here
"Here is a PET image of a
person that
person that shows depression.
depression."” The following
following comments discus­
comments from a discus-
sion with neurologist and medical imaging researcher
with neurologist researcher Helen Mayberg
Mayberg
offer a starting
starting point.
I have always been surprised
surprised that
that there haven't
haven’t been more studies
on depression, because it is such a common
common problem.
problem. Even though
though I
myself do not
not suffer from depression,
depression, I feel a real empathy
empathy and curi­
curi-
osity about
about depression and mood. Everybody has moods. moods. And they
can be so incapacitating.
incapacitating. Everybody experiences grief, everybody has
disappointments in life. What
disappointments What are these? Even when
when you knowknow what
what
is going on, you can't
can’t shake it. What
What is that?
But then
then to actually look at sadness — - depressed people are sad,
normal people are sad
normal —how do these things interact?
sad-how What is the
interact? What
circuitry that regulates just the experience of sadness? This circuitry is
circuitry that
interesting
interesting both
both as a confound
confound to the disease and as partpart of a bigger
picture. We are trying to hammer
hammer out
out what distributed network
what the distributed network
that
that regulates mood looks like, whether
whether it be a normal
normal or [an] abnor-
abnor­
mal mood.
Mayberg, depression is both
For Mayberg, both a disease (not part
part of normal
normal life)
life) and
emotion
an emotion (sadness, part normal
part of normal life), so her experiments
experiments have to be
appropriate components
designed to discover the appropriate components of each; How
each: How might
normal emotion
normal emotion mask a disease, and how how is the disease itself a kind of
abnormal
abnormal emotion? In other words, is sadness continuous
other words, continuous or discon-
discon­
tinuous with
tinuous with depression? Is depression, for example, being normally
example, normally sad
but for too long, or too deeply or inappropriately?
inappropriately? Or is it a different kind
of sadness from normal
normal sadness? Might
Might there
there even be depression without
depression without
sadness?11 These questions,
sadness? pointed out, require
questions, she pointed require the biological and
cultural nature of emotions
cultural nature emotions —in circuitry or distributed
-in this case, the circuitry distributed
network regulating
network regulating moods —to
- to be delineated (figure 6.1).
delineated (figure 6 .1).

173
173
CHAPTER 6

N o rm a l sta te
35 ‘
33
31 9
3U
28 4

24 .8
23.lv
121.3
19 5
17.7
16.0
14 2
12.4
18,6
8. 9
m
D e p r e s s e d st a t e : * "?

F i g u r e 6.1.
FIGURE 6A . Normal
N orm al and depressed states. Original caption reads: "Images
“ Images oob-
b­
tained with the NeuroECAT tomograph using the fluorodeoxyglucose
NeuroECAT tomograph fluorodeoxyglucose (FDG)
(FDG)
method
method to measure local cerebral glucose metabolism. The gray scale is propor- propor­
tional
tional to the glucose metabolic
metabolic rate with
with the black being the highest. The top
row of images is from an age-matched control control subject. The bottom
bottom row of im­
im-
ages is from a patient unipolar depression. In the patient
patient with unipolar patient study, note the
left-to-right
left-to-right metabolic asymmetry of the perisylvian frontotemporal
frontotemporal cortex,
which extends to the superior
superior temporal
temporal zone. This pattern
pattern of glucose metabo­
metabo-
lism has been seen in some but not all patients with unipolar
unipolar depression."
depression.” (From
Phelps et al. 1975, reproduced
reproduced with permission)

Already histories and cultural

cultural categories of mood
mood and emotions,
emotions, and
sadness and depression
depression must be investigated.2
investigated. 2 Are emotions
emotions being op-op­
rationality and practical
posed to rationality practical reasoning3
reasoning 3 or are they included as
aspects of all activity, providing
providing reason
reason and action
action their
their colors? Norbert
Norbert
Wiener, for instance, that “the
instance, suggested that "the stored information
information of the mind
lies on many
many levels of accessibility and is much
much richer and more varied
than that
than which is accessible by direct unaided
that which unaided introspection;
introspection; that
that it is
conditioned by affective experience"
vitally conditioned experience” (Wiener 1961, p. 149 quoted
quoted
in Heims 1991, p. 150). Cross-cultural
Cross-cultural studies of both
both emotions
emotions and
emotional and mental
emotional mental abnormalities
abnormalities must also be consulted.4
consulted. 4 Regional
national differences also cannot
and national cannot be ignored.5
ignored. 5

If mood is to be delineated
delineated in itself (as a distributed
distributed network),
network), what
what

174
 CONCLUSION
CONCLUSION

moods
moods are to be included? Greimas and Fontanille’s
Fontanille's Semiotics of Pas­
Pas-
sions might provide a useful grid or taxonomy
taxonomy for unpacking
unpacking pathemic
components
components specific
specific to U.S.
U.S. sadness. They explicitly raised the real
problem
problem of the epistemology of passions,
passions, distinguishing
distinguishing modalities of
mood
mood-—sentiment,
sentiment, emotion,
emotion, humor, likeliness, inclination,
inclination, temperament,
temperament,
and character
character —via
-via different combinations
combinations of disposition
disposition (permanent,
(permanent,
,,.
I
durable, temporary),
durable, manifestation (continuous,
temporary), manifestation (continuous, episodic, isolated), mod-
alization
alization (knowing, being-able, wanting,
wanting, mixed), and competence (ac­ (ac-
knowledged,
knowledged, supposed,
supposed, negated).6
negated), 6 They explicitly note thatthat “"[n]omen-
[nomen­
clature
clature is, in a sense, a first draft,
draft, an intuitive
intuitive product
product of history, of a
theory
theory of passions developed withinwithin a culture”
culture" (Greimas and Fontanille
1993, p. 52).7
52). 7 Consulting
Consulting Irigaray and Descartes,
Descartes, we might ask whether
whether
“"wonder"
wonder” is to be considered the first passion or, instead, instead; the key to
rationality
rationality led by curiosity8
curiosity8 (What
(What of the feeling of the sublime?) Key Key to
this kind
kind of analysis would be understanding
understanding the possibilities and prob­prob-
lems various types of tasks evoke in culturally
culturally embodied persons. Parts
questioning are pursued
of this line of questioning pursued by Mayberg:

a y b e rg : An important
MAYBERG:
M important experiment
experiment is to examine what happens in
what happens
the brain
brain when
when normal
normal people are sad, whether
whether their
their brains change
in the same ways ways that
that brains
brains of depressed people do. There have
been several reports
reports on this. Jose Pardo,
Pardo, when he was at Washing­
Washing-
ton
ton University, foundfound certain
certain areas of the brain had increased blood
flow in normal
normal people thinking
thinking sad thoughts.
thoughts. And Mark
Mark George, at
[the National
National Institute
Institute of Mental
Mental Health],
Health], reported
reported something very
similar in normal
normal people thinking
thinking sad thoughts
thoughts while looking at
sad faces.
We used a different tactic. We felt that that to see brain changes spe­
spe-
cific for mood,
mood, you had to separate
separate out the cognitive component
component
from the experiential
experiential component.
component. As you design a PET scanning
experiment,
experiment, you are trying to compartmentalize
compartmentalize behavior
behavior into its
component
component parts parts as best you can [on[on the basis of] the scientific
scientific data
that
that is available. If you can, you always try to have a stepwise
progression
progression of complexity. Or the alternative
alternative is that
that you take com­
com-
plex behavior and you try to break break it down into its individual be­ be-
havioral
havioral parts.
parts. So
So how do you know know when you have the most basic
pieces?
pieces?
u m it: No factors left.
DuMIT:
D
a y b e rg : Exactly. My collaborator,
MAYBERG:
M collaborator, Mario
Mario Liotti, M.D.,
M.D., Ph.D., and
I decided, “"Look, Look, we don’t
don't want
want a scan of just thinking
thinking sad
thoughts
thoughts-we —we want
want a scan of sadness,”
sadness." So
So our design was to avoid
doing a scan while they were thinking;thinking; we wanted
wanted to get them into
the “"altered
altered state,”
state," if you will, and then do the scan. And we got

175
CHAPTER 6

the opposite
opposite of what
what has been reported
reported [by both Pardo and George].
both Pardo
Our
Our “"normal
normal people being sad"
sad” looked
looked like "depressed
“ depressed people.”
people."
down in the same regions, and it is very selective.
The flow goes down selective.
There are also some areas that
There that go up, the most interesting
interesting being in
the anterior present
anterior cingulate. Those areas are the focus of our present
work.
work.
Two paradigms
paradigms of sadness are presented
presented here: thinking thoughts
thinking sad thoughts
and being sad. In the experiments
experiments done at Washington
Washington University, for
think deeply about
instance, subjects were asked to think about sad events and rated
rated
themselves on howhow sad they became. Holding
Holding off for a moment who is
moment who
selected and what
what is meant
meant by “"sad,"
sad,” already an extreme difference has
been located.
located. Scanning normal who “"are
normal people wh_o are sad"
sad” and therefore
therefore in
an "altered
“ altered state” produces a kind of opposite
state" of mind produces opposite effect from nor­
nor-
mal people who think sad thoughts.
who think thoughts. Each is distinct,
distinct, and each is differ­
differ-
ent. In one of the “thinking thoughts” experiments,
"thinking sad thoughts" experiments, some re- re­
considered the possibility of taking
searchers considered taking sad thinking
thinking to its limits.
thought of getting method
They thought method actors,
actors, who theoretically can think
who theoretically think
themselves into being sad.9 Each of these experiments
experiments now becomes a
different piece in a growing
growing puzzle.
Each of these experiments,
experiments, by studying all of these different things
related mood, you start
related to mood, start to ..... . it's
it’s like you have these transparen­
transparen-
cies that
that overlap in some areas but but not others, and you keep laying
down these layers, one experiment
down experiment after the other. All of a sudden,
you start
start to get some overlap and you also start start to see some things in
some areas that hadn’t even suspected. That
that you hadn't That has led us to build-
build­
ing a model of a distributed
distributed network
network regulating
regulating mood thatthat can ex­
ex-
plain the sort of co-morbid
co-morbid presentation
presentation of mood and attentional
attentional def-
def­
icits in depressed people, and how to potentially potentially compartmentalize
compartmentalize
these clinical features. Because depression has cognitive elements.
What that mean? Obviously
What does that Obviously normalnormal sadness taps intointo memory,
taps into attention, taps
into attention, taps into a lot of things. It is no big surprise that that
when you whack
when out part
whack out part of that
that system, withwith whatever
whatever causes de­de-
pression, that
pression, that you are going to have an impact impact on much more than than
just being sad. And what what is that? How is sadness different different in de­
de-
pressed people and nondepressed
nondepressed people? This is where where we are now
in terms of the work.
As Mayberg
Mayberg and her colleagues'
colleagues’ models of sadness and depression
depression
develop through
through these experiments, branch out “visually”
experiments, they branch "visually" (via the
images of brain locations activated
brain locations activated by sadness), into “"attention,"
attention,”
“memory,” and so on. By being careful, Mayberg
"memory," Mayberg is also required
required to
become a full-fledged philosopher,
philosopher, developing her own philosophical
philosophical (or
physiological) anthropology.1
anthropology. 100 This of course, has been an underlying
underlying

176
 CONCLUSION
CONCLUSION

theme of this entire book: To perform experiment is already to be

perform a PET experiment
engaged in a philosophical
philosophical anthropology.
anthropology.
Projects that
that study human
human functions
functions or powers
powers or faculties are as old
medicine. 111 As mentioned
as medicine.1 mentioned earlier, PET researchers have often pointed
to phrenology
phrenology as a key historical
historical period
period when the right questions were
being asked with the wrong
wrong technology. For these contemporary
contemporary func­
func-
tion mappers,
tion mappers, or network
network trackers,
trackers, then,
then, the functions
functions that
that they decide
are possible to delimit will determine
determine the nature
nature of human
human nature
nature that
they
they discover.
discover. Steven Kosslyn, for example, in his book Wet Mind: The
New
New Cognitive Neuroscience,
Neuroscience, attended
attended to them in the following man­ man-
ner. Out
-ner. Out of 422 pages of his text, he devoted 91 percent traditional
percent to traditional
cognitive neuroscience:

6.1 a
Table6.1
Table
Wet Mind
(,
Chapter Titles
Chapter Num ber ooff Pages
Number Percent
Percent ooff Pages
Computation
Computation 35 8
Visual Perception 76
76 18
18
Visual Cognition 39 9
Reading 44
44 10
10
Language 75 18
18
Movement
Movement 55 13
13
Memory 60
60 14
14

In his final chapter, “"Gray

Gray Matters,”
Matters," Kosslyn explored
explored what
what he left out
earlier:

6.1 b
Table6.1
Table
Mind, Continued
Wet Mind, Continued
Subsection
Subsection Titles Num ber ooff Pages
Number Percent
Percent ooff Pages
Reasoning 77 22
Arithmetic 5 1
Cerebral Lateralization
Lateralization 13
13 33
Consciousness 77 22
Emotion 22 0.5
0.5
Rehabilitation
Rehabilitation 4 1

Kosslyn’s
Kosslyn's emphasis was clearly on what
what we might call clear cognitive
processing, as opposed
opposed to unclear
unclear —gray matters. The section
- gray-—social matters.
on consciousness is devoted to whether
whether consciousness exists or not, and
how it might exist. Presumably
Presumably (though
(though he did not talk about
about them),

177
177
CHAPTER 6
CHAPTER

curiosity, sexuality, violence, caring, friendship,

friendship, religiosity, play, and so
on fit somewhere
somewhere under
under “"emotion."
emotion.” I asked Mayberg
Mayberg about
about my percep-
percep­
tion of these kinds of projects:

D u m it: I was just reading

DuMIT: reading Kosslyn’s book, Wet Mind, looking at
Kosslyn's book,
these cognitive neuroscientists
neuroscientists who play with PET. PET. In this book he
has 420 pages on the brain brain and two pages on emotions, forty pages
emotions,
on visual cognition,
cognition, seventy-five on perception.
perception. The more I looked
around,
around, the more it struck struck me [that
[that for] these cognitive neuroscien­
neuroscien-
tists, [[so much of] their
so much their view of whatwhat the person
person is comes downdown to
microprogram notions
these microprogram notions of cognition.
cognition. I guess what
what I was won­ won-
dering whether
whether this difference is due to who who had access to PET
first.
M ay b erg : N
MAYBERG: No,o , I don’t think it is. I think
don't think think that
that in classical thinking,
thinking, .
theories about
theories about emotions
emotions are are very noncompartmentalized.1
noncompartmentalized. 122The idea
of a brain
brain localization
localization for emotions
emotions is very unsettling
unsettling to many peo­ peo-
ple. I used to get into fights when would talk about
when I would what I wanted
about what wanted
to study, because people don't don’t necessarily like the idea that that some­
some-
thing like emotion
thing emotion can be compartmentalized
compartmentalized to some spot spot or
group of spots in the brain. Just the idea that
group personal
that very, very personal
behaviors have some kind of neuron-to-neuron
behaviors neuron-to-neuron analoganalog is somehow
disconcerting.
disconcerting.
More of an issue though,
More though, I think,
think, is that
that in terms of classical,
cognitive neuroscience,
neuroscience, you deal with that can be broken
with things that broken
down into component
down component parts.parts. Successful
Successful cognitive neuroscience
neuroscience is
able to do that.that.
Emotions experiments
Emotions experiments are just harderharder to put
put into the
the cognitive
neuroscience model. Emotions
neuroscience don’t easily fit into these constructs.
Emotions don't constructs.
confounded by memory, attention,
They are confounded attention, motion
motion behaviors,
behaviors, and
so on. So it becomes: "I “I don’t
don't think
think I can design a good experi­ experi-
ment, and I don’t
ment, want to be a loser, and I don't
don't want don’t want
want to produce
produce
meaningless or uninterpretable
uninterpretable results.”
results."
Many of the people who do study emotion
Many emotion look at descriptive
phenomenology, even if they have very well-constructed
phenomenology, well-constructed paradigms.
paradigms.
Unfortunately,
Unfortunately, there is not not a lot to hang your hat hat on. With
With vision
experiments,
experiments, it is very different. We know know about
about shapes; we know know
about
about color; we know know about
about movement.
movement. The researcher
researcher can say, say,
“"Okay,
Okay, nownow we have to look in the various visual fields; now now we
have to look at directed
directed attention;
attention; now
now we have to look ... . . . "” One
can start
start to add together
together these individual components. With
individual components. With emo- emo­
tion, it is hard
hard to get a handlehandle on where
where to start. What
What has hap- hap­
pened
pened is that
that we've
we’ve pretty
pretty much jumped
jumped in feet first and are starting
starting
to sort
sort out
out the details.
There certainly
certainly are a lot of people who emotion. But in
who study emotion.

178
 CONCLUSION
CONCLUSION

terms
terms of having paradigms
paradigms that
that can be easily and successfully trans-
trans­
lated into an imaging experiment,
experiment, I think
think it is harder
harder to do than
than for
other behaviors
some of these other behaviors like vision, motion,
motion, and language.
emotions?1
Artificial emotions? 3 Mayberg
13
Mayberg raises two two fascinating cultural issues
fascinating cultural
about
about personhood.
personhood. One is that that we [who?] do not think of emo­
not easily think emo-
tions (in particular)
particular) or emotion
emotion (in general) along the same lines of com­ com-
partments or programs,
partments programs, thatthat we do with rational action
with rational action and sensation.
We can imagine intelligence working working like a computer,
computer, but
but we cannotcannot
imagine a program
program for sadness. In fact, the computer
computer is often pointed
pointed to
precisely as the embodiment
embodiment of emotionlessness! Likewise, the sensor-
ium is based on a model model of information-processing
information-processing and is conceivable as
a set of programs
programs for analyzing and distinguishing
distinguishing objects,1
objects, 144 though,
though, of
course, we have to work work hard
hard to make pain fit this metaphor.1
metaphor. 155
Regarding emotions,
Regarding emotions, one must eventually
eventually make some sort of human human
function argument,
function argument, often dependent
dependent on an argument
argument from an evolution­
evolution-
purpose (or evolutionary
ary purpose evolutionary side effect). WhyWhy did humans
humans evolve with with
emotions? It is here where where various
various anthropologies
anthropologies (biological, archae­ archae-
ological, physical, cultural,
cultural, medical) are often
often employed as facts to ex­ ex-
data.1166
plain the data.
Mayberg’s other
Mayberg's other observation about the difficulty of locating
observation about locating and
studying emotions in the brain
studying brain is located
located specifically and historically
within cognitive psychology. As historians
within historians of statistics have shown, the
functions emphasized
functions emphasized have been those easy to isolate and repeat repeat-—
those, in other
other words,
words, that
that could be made produce bell curves.17
made to produce curves.17
What connection, we might ask, between
What is the connection, between these two difficulties?
difficulties?
How are the simple-mechanism
simple-mechanism studies emphasized
emphasized and popularized
popularized by
cognitive psychology related to thinking thinking about
about the brain emotion­
brain as an emotion-
computer? One aspect of computer
less computer? computer networks,
networks, for instance,
instance, is thatthat
the faster they work,work, the better. Theoretically,
Theoretically, they take no time: In an
neural-network model of vision, for instance,
ideal neural-network instance, a bunch
bunch of colored
contrast gradients are recognized (immediately) as a picture
dots and contrast picture of
Emotions, however, make sense only within
a horse. Emotions, within time. Heidegger
described moods as that that state which
which one is always already "thrown “thrown
into." 18
into.” 18 In this sense, emotions
emotions are more easily conceived of by the anal- anal­
ogy to a disease —a - a change in the state of a person—than
person- than by the anal­ anal-
ogy to a computer
computer network.
network. This distinction
distinction between
between being sad and
thinking
thinking sad thoughts, however, is one already made by Mayberg
thoughts, howevei; Mayberg et al.
metaphor of a network
Still, the metaphor network that
that processes or transmits
transmits informa­
informa-
tion remains
tion remains confusing. PET scans, as currently currently conceived, inherently
inherently
seem to show only activity on a one-dimensional
one-dimensional scale: either more or
less activity than
than normal.
normal.
D u m it: It is interesting
DuMIT: interesting how when
when these results go from the experi-
experi­
ment
ment and the scientific article, where
where everything
everything is very careful, to

179
179
CHAPTER 6
CHAPTER

popular media, the question

the popular question of what what is being studied trans­
studied gets trans-
formed. It seems to me quite difficult to convey what what is being de- de­
picted in these images.
o st d o c t o r a l PET RESEARCHER:
POSTDOCTORAL
P r e se a r c h e r : Yes!
Yes! The things that that we are mea­mea-
suring, it is not not necessarily that that glucose utilization
utilization is directly related
related
at all to oxygen consumption,
consumption, nor that that these two parameters
parameters are
directly related
related to electrical activity. And even if they were related,
it is not
not necessarily true true that
that electrical activity is related related to the
amount
amount of information
information that that is transmitted neurons. It is not. If
transmitted by neurons. If a
neuron is firing more, it does not mean that
neuron that it is transmitting
transmitting more
information,
information, because in epilepsy, for example, the neurons neurons are fir-fir­
ing a huge amount.amount. It is meaningless to think think of firing in terms of
information. If you are looking
information. looking for neurons
neurons in terms of informa­
informa-
tion, you have what what are called "spiking
“spiking neurons."
neurons.” You have regular
striking
striking and you have bursts. Spiking neurons neurons are those that that if you
give them
them a stimulus, a square pulse, of a certain certain length, they will
give a single action potential. potential. Regular striking striking [ones], you give
them the same pulse, you get four or five action potentials.
them potentials. They
appear at a frequency of twenty
will appear twenty to thirty
thirty Hertz. With bursting
bursting
neurons,
neurons, they will give you a burst potentials, which
burst of action potentials, which will
depolarizing wave. So if now
ride on a kind of depolarizing now we are trying to ask,
“Where
"Where do I have more information?" information?” the common common idea is that that
with bursting
with bursting neurons
neurons you have less informationinformation transmitted than
transmitted than
with spiking ones. But again, it is a kind of question
with question which
which is just a
hypothesis.
hypothesis. We are just able to measure action potentials. To
action potentials. To try to
convert compare it to signals that
convert it, or compare that are coming through tele­
through a tele-
phone cable ...
phone . . . maybe it is true! No doubt doubt it is quite effective,
effective,
because this guy is living in a world world with telephone cables [refer-
with telephone [refer­
ring to Roger Sherrington's
Sherrington’s famous metaphor metaphor of the brain brain like a
telegraph].
telegraph]. It doesn’t
doesn't mean that that there
there is something
something we know know about
about
the brain. The brain brain was created some millions of years before tele- tele­
phone
phone cables were created. Who Who knows,
knows, maybe we created created tele-
tele­
phone
phone cables just because in our mind, maybe our brain works works like
this! All of these things are just hypotheses. I wouldn't wouldn’t even jump
conclusion. First of all I would try to define what
to the conclusion. what learning
[is].
[is]. Then beyond that,
that, do exercises affect development of the
development
brain? I think
think thatthat is a good question.
question. But to go beyond this kind
thing . . . think that
of thing ... I think that in the future
future we will have a lot of studies,
very clever kinds of studies, that that will try to give us better better answers
about
about intelligence and that that sort of thing.

In a fascinating
fascinating and dizzying trail of thoughts,
thoughts, this researcher
researcher works
backward
backward from PET scan to neuronal
neuronal activity to some of the original

180
 CONCLUSION
CONCLUSION

studies for defining and measuring

measuring this activity (evoked potentials}.
potentials). The
metaphor
metaphor on which all of these technologies
technologies depend equation of
depend-—an equation
quantity
quantity of information
information with
with size of the potential —he notes, is based on
potential-he
a historically
historically situated
situated technology: electrical information
information in telephone
wires.1
wires. 199 Which came first, he wonders,
wonders, the metaphor
metaphor of neuronal activ-
neuronal activ­
neuronal activity of the metaphor?
ity or the neuronal metaphor? The solution, he con­ con-
cludes, is not to look for a conclusion
conclusion now, but to further
further break down
the problem,
problem, get to work,
work, and to look forward
forward to the future.
Many
Many layers of metaphors
metaphors are embedded
embedded in notions
notions of information
information as
quantifiable,
quantifiable, as something
something that
that is communicated
communicated via a code that that can be
cracked,
cracked, and as the substrate
substrate of language and social information
information that
that is
is
processed. Unpacking
Unpacking the implications
implications of these notions
notions that
that underlay
theories of the brain should be a central central part
part of the kind of project
proposed
proposed in this chapter.
With
With emotions,
emotions, of course, neurotransmitters
neurotransmitters play a bigger role than
with
with traditional psychology. 200 Each neurotransmitter
traditional cognitive psychology.2 neurotransmitter has its
traditional faculty. Henry
traditional Henry Wagner spoke to me about about some of the pros
and cons of this legacy withwith regard
regard to using neurotransmitter
neurotransmitter experi­
experi-
ments to think
think about
about diseases:

To divide the brain

brain function
function up into cognition
cognition and emotion
emotion and
movement
movement is again an example of categorization
categorization that probably not
that is probably
too helpful with depressed patients.
patients. Alzheimer’s patients can be de­
Alzheimer's patients de-
pressed, and depressed patients
patients have trouble
trouble thinking,
thinking, and schizo­
schizo-
phrenic
phrenic patients can have trouble trouble moving —they can become cata­
moving-they cata-
broad categories. And I personally
tonic. These are very broad believe that
personally believe
putting anything
putting anything into a category should be done not
category should not because there is
some kind of intrinsic
intrinsic truth
truth to it but because it is useful. My philoso­
philoso-
phy is pragmatic.
pragmatic. And therefore
therefore when
when you say that person has dis­
that a person dis-
ease X, it should be because puttingputting him in that
that pigeonhole makes a
difference in some way. These are man-made
man-made categories: abstractions
abstractions
are man-made
man-made simplifications of an unbelievably
unbelievably complex external
world. Therefore,
Therefore, to say thatthat dopamine
dopamine has to do with movementmovement-it —it
has a lot to do with
with movement,
movement, but it has a lot to do with other
things as well.
What
What science does is try to make everything more and more simple,
[to] try
try and get more common factors to get it simpler. But right now,
common factors
in the area of mental function and mental
mental function mental disease, it is not very sim­ sim-
ple. So
So the goal is to try and come up with some kind of simple
explanation
explanation for these things. Right now, you say you have a simple
explanation
explanation where serotonin
serotonin is related
related to mood
mood and dopamine
dopamine is re­re-
lated to movement
movement and acetylcholine is related related to learning or intel­intel-
ligence. But to say that
that acetylcholine is intelligence, serotonin
serotonin is mood,

181
181
CHAPTER
CHAPTER 6

and dopamine
and dopamine is movement
movement is a gross and unhelpful simplification, a
counterproductive simplification. Although
counterproductive Although it is true that
that blocking the
dopaminergic system has been one way that
dopaminergic that it has been found
found to help
patients with
some patients with schizophrenia,
schizophrenia, and blocking
blocking the serotonin
serotonin uptake
uptake
inhibiting monoamine
site or inhibiting monoamine oxidase has been one way of helping
patients become less depressed. If it helps, it helps. It helps solve
patients
problems. The world
problems. world is surrounded
surrounded with problems;
problems; people are sur­ sur-
rounded with
rounded problems. If
with problems. If an abstraction helps them
them —the
- the best inven­
inven-
o f all is language. I think
tion of think that
that the most
most important
important part ooff con­
con-
sciousness and memory
memory is language,
language, because it translates the past into
the present.

philosophical anthropology
Once again, philosophical anthropology must be brought brought explicitly
into the discussion in order
into order to proceed. We could here set Henri
Bergson’s (1988) reflections on physiology, memory, and language side
Bergson's
with Wagner's
by side with Wagner’s and
and read
read both
both through
through Friedrich Kittler’s
Kittler's (1985)
{1985)
turn-of-the-nineteenth -century attempts
analysis of turn-of-the-nineteenth-century attempts to map the lan­ lan-
subconscious using traditional
guages of the subconscious traditional cognitive psychology
psychology or
through contemporary
through contemporary PET experiments
experiments mapping
mapping “language”
"language" (usually
Indo-European) and "memory."
Inda-European) “ memory.” 2121
Finally, let us look at one more aspect of Mayberg’sMayberg's description,
description, the
that she is looking
idea that looking into "the
“the distributed
distributed network
network that
that regulates
mood.” The ease with
mood." with which
which either
either a network
network or mood
mood can be spoken
within neuroscience
of within neuroscience as regulated belies a long history history within
within and
without physiology
without physiology on this concept. Canguilhem,
Canguilhem, the historian
historian and phi­
phi-
losopher of science, has followed this conceptual
losopher conceptual history
history of “regula­
"regula-
tion” and how
tion" how it entered
entered physiology. For medicine in particular,
particulai; it made
“people became ill and recovered all the time ..... . [pro­
sense, because "people [pro-
viding] a sense that that the body hid inherent
inherent restitutive
restitutive powers”
powers" (Can­
(Can-
guilhem 1988). This notion notion of a dynamic,
dynamic, self-regulating
self-regulating system, Can­ Can-
noted, predates
guilhem noted, predates the autoimmune
autoimmune system and should also be
ontologically at odds with
seen as ontologically with notions
notions of coding errors.
errors. Coding-
error models presume
error presume that
that an error
error leads to poor
poor regulation.
regulation. Recovery
error becomes the problem.
from error problem. On the self-regulatory
self-regulatory model, how­ how-
ever, recovery from error
ever, presumption.2222
error is the presumption.
researcher I talked
One researcher talked to whowho studies neurotransmitters
neurotransmitters described
brain as having
the brain having two functions. “"IfIf any one is up or down,
two million functions. down,
then it is dysfunctional."
then dysfunctional.” However, he said, the most important important thing to to
adaptive functions
study is the adaptive functions of the brain. When one neurotransmitter
neurotransmitter
agonist is introduced,
agonist introduced, another
another system immediately kicks in, and another.
The only way to study the brain brain is to try to capture
capture each of these micro­micro-
reactions. "It
reactions. “ It makes for very frustrating
frustrating nights,”
nights," he confessed, “but "but it is
much more
also much more exciting."
exciting.” Regarding
Regarding depression, he elaborated
elaborated a specif­
specif-

182
 CONCLUSION
CONCLUSION

autoregulatory model in which

ically autoregulatory which the environment
environment was an important
important
component. “For
component. with depression,
"For everyone with there are many, many more
depression, there
with the same kinds of brain
with brain but who
who have adapted.” that
adapted." He suggested that
depression is perhaps
depression perhaps a failure of or loss of the ability to adapt.
adapt. Depres-
Depres­
sion as a state, then,
then, is something
something that
that we might
might be continually
continually cycling
in and out of rapidly, our brains adapting
adapting with myriad systems of self-
with myriad self­
regulation. Becoming depressed, however, means not
regulation. that something
not that
happened, or there has been a breakdown,
special has happened, breakdown, but rather
rather there
is no longer the ability to so adapt
adapt quickly to these same conditions
conditions that
that
“normal” ebbs and flows.
before were "normal"
Other researchers
Other researchers who
who also subscribe to molecular
molecular and neurochemi­
neurochemi-
23
cal views of the brain
brain use the more current
current metaphor
metaphor2 3 of a coding
error:

D u m it : In some sense, with

DuMIT: with this new department,
department, from this inter­inter-
disciplinary program,
disciplinary program, you are trying
trying to cement
cement a new kind of disci­disci-
pline together.
P h e l p s : That
PHELPS: That is right. It is called the
the Department
Department of Molecular
Molecular and
Medical Pharmacology.
Pharmacology, This is a very natural
natural thing,
thing, you know,
when
when you think think about
about it. Pharmacology
Pharmacology as a discipline began to fail
in many ways as a discipline. If you go back about about three
three decades
pharmacology began, the major
ago, [when] pharmacology major activity in pharmacol-
pharmacol­
ogy was neuropharmacology.
neuropharmacology. It was a time of grind and bind, do­ do-
ing assays of neurotransmitter
neurotransmitter systems. That
That is how neuropharma­
how neuropharma-
cology became very popularpopular and very productive.
productive. It was teaching a
lot of new things aboutabout the brain,
brain, and drug companies
companies had focused
on the brain and were developing drugs for the brain. And phar- phar­
macology became the acting accountant
accountant for that.
that. But then
then neuro­
neuro-
science was born,born, and neuroscience
neuroscience in a decade went went from a group
of maybe twenty-five, thirty
df thirty people to fourteen
fourteen thousand.
thousand. And to
neuroscience, it went
form neuroscience, went into physiology
physiology and said, "Give “ Give me
neuroscientists.” It went
your neuroscientists." went into anatomy
anatomy and pharmacology
pharmacology and
collected out out the neuroscience pharmacology, that
neuroscience people. Well, in pharmacology, that
particularly devastating,
was particularly devastating, because the best and the majority
majority of
neuroscientists. So they
people were neuroscientists. they left, they went
went out. And phar­
phar-
started to lose its way. And that
macology started that was kind
kind of ironic, be-
be­
cause out out in the real world
world the drug industry had recognized a
drug industry
great opportunity
great opportunity in modern biotechnology for the de-
modern biology and biotechnology de­
velopment of new drugs. And in fact, a lot of academic people
velopment
recognized the opportunity
opportunity to deliver something
something important
important to the
public and also make a lot money doing doing it. So they
they took
took ideas and
formed startup
formed startup companies —Genentech, Amgen—and
companies-Genentech, Amgen-and now many
companies have driven biology and biotechnology
biotechnology to develop new

183
CHAPTER 6

that had
drugs. Well, that had a very fundamental
fundamental basis, actually, because
out
out of all this biology, they they were shifting emphasis onto basic
mechanisms
mechanisms by which which the genome producesproduces proteins,
proteins, produces
those
those proteins
proteins organized
organized into
into a biochemical system to run run itself.
But while they were doing it, people were coming in, finding the
errors
errors of disease, fundamental
fundamental errors. So then then the concept
concept started
started
to develop to understand
understand the molecular regulation of the cell, iden­
molecular regulation iden-
tify the molecular
molecular errors
errors of disease and develop molecular
molecular correc­
correc-
That is, if there
tions. That there is an error
error in the genetic code, knock
knock it out.
If there
there is an error
error in a message that that is being transcribed
transcribed by the
messenger RNA, then then develop a drug to block that that message. So So
now a whole
now whole new class of drugs were being developed that that would
whole new set of protein
focus on a whole protein targets,
targets, and now a generation
generation
would
would be born
born that
that would
would master molecular corrections
master molecular corrections of disease.
they’re drugs. The industry
Well, they're industry was moving a lot faster than than
pharmacology was. It was lagging behind.
pharmacology
than that.
But it is more than that. Everything
Everything originates
originates and is carried
carried out
through chemistry
through chemistry and biology. What What you think think is structure
structure is
that portion
really that portion of biology thatthat says we have to build and main­ main-
framework, and
tain a framework, and within
within this framework
framework we will go and do
things. If you look at disease, all disease startsstarts by an error
error in the
chemical process. All disease. And it typically goes about about eroding
away the reserves, and and compensatory
compensatory capability
capability of that
that biological
accommodate that
system to accommodate that normal
normal process. But eventually, if the
person becomes symptomatic,
person symptomatic, it has erodederoded away the reserves;
there is no further
there further way to compensate.
compensate. So So now the cellular function
function
begins to fail. But like any system, it is designed to accommodate
accommodate a
lot of changes.

two metaphors
These two metaphors of autoregulation
autoregulation and coding are not not necessarily
opposed, as Phelps suggested at the end, but each implies different
opposed, different conse­
conse-
quent interpretations
quent interpretations of data results, and even of automatic
automatic programmed
programmed
data analysis. For instance,
data instance, the former
former involves multiple neurotransmitter
neurotransmitter
regulations, actions, and
regulations, and reactions, whereas the latter is more amenable
amenable
brain-mapping, interrupted-circuit
to a brain-mapping, interrupted-circuit interpretation.
interpretation. One of the ques­
ques-
that must
tions that must be addressed
addressed is the continued
continued coexistence of these differ­
differ-
ent metaphorics.
ent metaphorics. This is no simple or even complicated
complicated historical
historical change.
The answer, I suggest, lies in the analysis of specific
specific problems
problems with
with specific
specific
technologies (and at specific
technologies specific institutions).
institutions). Each brings with
with and builds
tropes and kinds of personhood.
into the results layers of tropes personhood.
further issue, related
A further related to all of these metaphors
metaphors of interrelated
interrelated cir­
cir-
cuits or systems, is how to justify stopping
stopping the set of significant commu­
commu-
nicating systems at the skin. The environment
nicating environment and sociality have to be

184
 CONCLUSION
CONCLUSION

communication with
seen as also in communication with these systems "in “in the brain."
brain.”
Rhythms, especially diurnal
Rhythms, diurnal and seasonal
seasonal patterns related to light, are
patterns related
just one place to examine such interaction.
interaction. The field of psychoneuroim-
psychoneuroim­
munology has proposed
munology proposed an entire paradigm
paradigm of illness based on elabo­
elabo-
socio-environmental circuits of communication
rate socio-environmental communication (Levin and Solo- Solo­
mon 1990).
mon

Understanding a PET image of a person

Understanding person with depression requires,
with depression requires, then,
reflection on categories of people and metaphors
metaphors of the the brain,
brain, as well as
technologies and practices. Suffice
imaging technologies Suffice it to acknowledge
acknowledge here the
tremendously rich and potent
tremendously potent work
work being done with with PET scanning:
troubling. I hope I have made it
careful and speculative, exciting and troubling.
clear in this book that much reflective work
that much work remains
remains to be done as PET
popularly, scientifically,
grows clinically, popularly, scientifically, and forensically. There are ob­ ob-
ligations and accountabilities
accountabilities regarding
regarding imaging practices as much as
there are regarding
there regarding selection procedures consent forms.
procedures and consent
At the 1991 meeting of the Society for Neuroscience,
Neuroscience, a plenary
plenary talk
was given by Louis Sokoloff, one of the fathers fathers of nuclear
nuclear medicine. He
began his talk with a wry acknowledgment
talk with acknowledgment and and admonishment regard­
admonishment regard-
power of functional
ing the power functional images: "We “We know
know we need to hype to get
our grants. Let’s try to keep it out
grants. Let's out of our results!"
results!” The "hype"
“ hype” sur-
sur­
rounding these images must
rounding must be understood
understood as consonant
consonant with
with the fact
that PET functional
that functional brain
brain imaging is still a basic research
research project (as
opposed to an applied one), and therefore
opposed therefore survives on its ability to mar-mar­
ket its potential particular audiences.
potential to particular audiences.2244 The meaning
meaning and presentation
presentation
of these images are not at all decided among among the “ experts” ; and
the imaging "experts";
their debates deal directly with the issues I have been raising, if not
their
always in the same terms. Questions about the significance of human
Questions about human
brain variability
brain variability-—and whether
whether to present
present typical images or average im­ im-
ages or subtraction
subtraction images -—are thoroughly about mind-brain
thoroughly about mind-brain philoso­
philoso-
phies and the significance of human human kinds. In functional brain imaging,
functional brain
brain causation,
the concepts of brain causation, human distinction, and mind functions
human distinction,
are in flux and being actively renegotiated
renegotiated out out of past
past and popular
popular
conceptions.
conceptions.
would like to claim, or propose,
I would that with
propose, that brain function
with brain function imaging,
we, in the United States, may have entered entered a space of active negotiation
negotiation
of the basic terms of our categories of the person. person. This is a negotiation
negotiation
already underway with
already underway with respect to ultrasound,
ultrasound, the human
human genome proj-proj­
ect, HIV testing status, amniocentesis,
amniocentesis, and so on, but but with
with a new em­em-
25
phasis on didactic images.
images.21 court battles over the admissibility of
The court
these images are just beginning. The use of these images in thinking thinking
about
about ourselves is in its infancy. We are at stake in this work. How can
work. How
not afford
we not afford to risk jumping
jumping in and studying
studying it?

185
 I

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! 5

1
£ !

i
!
I

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i;

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 Notes

Chapter
Chapter 1

1. The best source forfor clinical PET information

information is the Academy of Molecular
Imaging (http://www.ami-imaging.org),
(http://www.ami-imaging.org), especially the InstituteInstitute for Clinical PET
within
within it.
recent book Clinical
2. The recent Clinical Positron Emission Tomography
Tomography (PET):
(PET): Correla­
Correla-
tion with
with Morphological
M orphological Cross-Sectional Imaging bears out this observation.
observation. In
addition
addition to chapters
chapters on coronary
coronary artery
artery disease and various cancers, it contains
only three chapters
chapters on clinical PET imaging ooff the brain: brain tumors,
tumors, epilepsy,
epilepsy,
and dementias (Schulthess 2000).
3. The new history
history of the brain is just beginning. Classics include Harrington
Harrington
(1987) and Star (1989) on localization;
localization; Jeannerod
Jeannerod (1985); Smith (1992); and
Deleuze (1989) on philosophy.
4. Unlike explicit ideologies of o f blame, hegemonic
hegemonic ones are difficult to trace to
human
human agents. This notion
notion of ideology is similar to Althusser (1984, 1976),
especially as extended
extended by Pecheux (1982).
5. We keep a hyphen in objective-self
objective-self because we need to highlight the fact
that
that it refers to how we are to ourselves and to society an object of science and
medicine, not
not how we "objectively"
“ objectively” are to science and medicine. Our concern
around the object of science and medicine, not
thus centers around not their mmethods - not
ethods—not
what
what justifies mental
mental illness, but
but how it is specified
specified by a set of practices, docu­
docu-
ments, institutions
institutions that
that enable it to be "objective."
“ objective.” On the study of the object of
science and medicine in this manner, see Rajchman Rajchman (1985).
6. The caption
caption for the images reads: "Looking 'slices' of the brain in ac­
“ Looking at ‘slices’ ac-
tion: pictures made by the latest radiology miracle-machine PETT VI (Positron
radiology miracle-machine
Emission Transaxial Tomograph), right. These brain scans sh
Transaxial Tomograph), show-graphically-
ow —graphically—
how a normal
normal brain's
brain’s function
function compares
compares with that that of a depressed or schizo-
schizo-
 l
NOTES TO CHAPTER 2

Even with
with fifty million dollars,
dollars, you couldn't
couldn’t do all things that
that were needed
by everybody, you couldn't
couldn’t satisfy the needs of the neuroscientists
neuroscientists who
wanted
wanted to look at micron-sized objects, and at the same time satisfy the
objectives ofo f people who wanted
wanted to look at the brain as a whole and map
the functions
functions and the anatomy
anatomy...... . . So
So I think
think that
that there was that
that tension.
There was also tension with the people who were interested interested in the behav-
behav­
ior of
o f individual
individual neurons
neurons and how a synapse works. Therefore,
Therefore, if they do a
brain m map,
ap, they want
want something at a micron and submicron
submicron resolution.
resolution.
7. Comparability
Comparability is also the subject o off much debate. For instance, see Poeppel
(1996) andand the
the discussion
discussion in this
this text
text that
that follows over the the question
question of o f what
what
constitutes
constitutes overlapping
overlapping results in the brain. Beaulieu (2000) discusses the at­ at-
tempts to create collective atlas-based
tempts atlas-based databases
databases of results.
8. See Andreasen (1989), Kereiakes (1987), Phelps (1991), Reivich and Alavi
See Andreasen
(1985), and Ter-Pogossian (1992).
9. Gewertz is quotedquoted in Krech (1991). Krech reviews the contested history history of
ethnohistory, revealing a host
ethnohistory, host of different meanings and approaches.
approaches. I cling
most strongly to the cultural
cultural anthropological
anthropological definition outlined in the following
quote: “"ToTo decipher history, one must appreciate appreciate the different
different ways people
'imagine
‘imagine the past';
past’; one must
must be attentive
attentive to narratives
narratives ...
. . . one must understand
understand
history 'is
how history ‘is both
both a metaphor
metaphor of the past and a metonymy
metonymy of o f the present’
present'
(75:2); and one must be aware o off the perspective-dependent
perspective-dependent and contested
contested na- na­
ture of
o f histories (159, 241) or of the variety of invented traditions.traditions ..... . . Today
scholars are more concerned
concerned than
than ever before about
about 'how
‘how knowledge is arrived
at' (302:76-77)
at’ (302:76-77) and about about how the past is perceived"
perceived” (Krech 1991, p. 363, 36 3,
quoting Derring
quoting Dening 1988, p. 75; Keesing 1990, p. 159; Price 1983, p. 241; and
Tomkins 1986, p. 302).
10. Those others are indicated
indicated in my encyclopedia article in the preceding
section.
11. Also, "In“ In the 1970s, a more advanced tomography technique was devel-
tomography technique devel­
oped by Michael
Michael Phelps and Edward Hoffman, Hoffman, a pair of biophysicists from the
UCLA School of o f Medicine. Their technique,
technique, called positron
positron emission tomogra-
tom ogra­
phy (PET)
(PET) ...
. . .”" (Travers and Muhr
Muhr 1994).
12. From http://www.conference-cast.com/snm/2001/biography.htm,
http://www.conference-cast.com/snm/2001/biography.htm, last ac- ac­
cessed March
M arch 22, 2003.
13. Dr. Michel M. M . Ter-Pogossian passed away on June 19, 1996.
14. See
See Bruno Latour's
Latour’s work for examples and on analysis of the history history of
science as a warwar game (Latour 1987; Latour Latour 1988) SomeSome alternate
alternate histories of
medical sciences can be found in Cartwright Cartwright (1995), Kaplan (1983), and Koch
(1990).
(1990), Anthropologist Michael Fischer has begun characterizing
Anthropologist Michael characterizing the poetics of
scientific
scientific autobiographical
autobiographical discourse (Fischer 1995).
15. His coworkers
coworkers in this tinkering
tinkering include Nizar
N izar Mullani,
Mullani, John Hood,H ood, Jer­Jer-
ome Cox, and Don Snyder. Snyder.
16. Hawkins
Hawkins and Miller (1978), Huang Huang and VeechVeech (1982), Sacks et al.
(1983). This controversy
controversy w was
as made public with Fox (1984).
17. Gjedde and KuwaharaKuwabara (1993), and Nelson et al. (1985).
18. Powers and Raichle (1985), Raichle (1985), and Wagner (1985).

190
190
 NOTES TO
TO CHAPTER
CHAPTliR 3

19. Fluorine-18 is radionuclide because it can

is also considered a physiological radionuclide
easily substitute for hydrogen.
Hammersmith was the first for medical use, but St.
20. Hammersmith St. Louis as
Louis was the first as
part of a medical school.
a direct part
earlier.
21. Partially quoted earlier.
21.

Chapter 3
Chapter

1. Authorship
1. Authorship actually varies quite a bit by discipline. Sometimes as
Sometimes a listing as
author is
the last author privilege. In some cases, the authors are
is presumed to be a privilege.
(see Biagioli
alphabetically (see
listed alphabetically 1988).
Biagioli et al. 1994; Galison 1997; and Traweek 1988).
introduction of physical scientists into the medical world is
2. The introduction is modifying
clinical practice in various ways. The most striking change lies intro-
lies in the intro­
ex-
distribution of ex­
duction of new responsibilities and modifications in the distribution
physician's role in many
tha,t physicists now share the physician’s
isting ones to a point that
therapeutic, and rehabilitation
diagnostic, therapeutic, proc.esses. Thus, after some 40
rehabilitation processes.
contributions, the physicist is
brilliant contributions,
outstanding progress with brilliant
years of outstanding is
no longer considered a “"back back room boy,” unknown to the patient and
boy," unknown
accessory. The in­
another paramedic accessory.
regarded to many clinicians as just another in-
innovations in medicine has
troduction ooff physicists and technological innovations
troduction
been shown to have also a more direct impact on clinical practice. The
innovation process in
every step of the innovation
clinicians themselves are involved in every
the creation of new methods and devices profes-
devices and their diffusion at a profes­
1).
level (Franconi 1983, p. 1).
sional level
3. These problems remain unresolved at the level general.
level of clinical trials in general.
M arks 1997 and also Rosser 1994.
See Marks
See
4. I have adapted
adapted this quotation argument found in Sue
broader argument
quotation from a broader V.
Sue V.
Rosser’s comprehensive review essay of androcentric
Rosser's Rosser's
androcentric bias in psychiatry. Rosser’s
entire book,
hook, a series
series of review essays treatment for
essays on clinical research and treatment
women in the United States, is relevant to the questions I am raising regarding
producing population data.
producing medical population
5. Robins (1990) has provided a history of epidemiological sampling for psy­ psy-
chiatric illness.
illness. He emphasized the difficulty of accounting for minority groups
because if counted at all, they often are oversampled, leading to an
if they are counted
overestimation ooff their difference from the -majority
majority group.
6. That
That would alsoalso imply that this book w was produced by
as produced ab-
by aa potentially ab­
normal “caffeinated”
normal "caffeinated" mind.
7. A different but telling example w as cited by David Hull regarding blood
was
{A, B,
types (A, B, O) populations: “"A
0) in indigenous populations: is common in Europe, Scan­
A is Scan-
dinavia, Japan and Australia, rare in Africa, totally absent in South America. B B
is common in Asia, Africa, parts of Europe, absent everywhere else. 0 is
else. O preva-
is preva­
lent in North
North and South America, fairly common in Africa, rare elsewhere” elsewhere"
(Hull 1992, p. 59).
8. “"All
All PET studies—whether
studies-whether while resting or doing a specific task-are
specific task acti-
—are acti­

191
191

L
NOTES
NOTES TO
TO CHAPTER
CHAPTER 3

vation studies because the brain continues continues to work even during nonspecific stim­ stim-
ulation
ulation during
during resting"
resting” (Metter 1991 1991).).
9. The difficulty of o f actually imaging schizophrenic patients patients while they are
hallucinating
hallucinating has been noted as a confounder. The typical imaged schizophrenic
patient
patient is selected for being able to to submit to a lengthy and delicate scan pro­ pro-
cedure (see,
{see, e.g., Metz 1989).
10. See
See Frith
Frith (1991), especially the discussion following the article (pp. 191- 191-
196), for a discussion of some of o f these issues.
issues.
11. Another
Another researcher
researcher commented
commented that that “"it
it must be assumed that that all individ­
individ-
uals use similar cognitive processes during the task. This is not always the case” case"
(Mazziotta
(Mazziotta et al. 1982; Metter Metter 1991).
12. Another
Another researcher
researcher begins an article entitled “"Exploring Exploring the Mind with with
Dynamic Imaging"
Imaging” similarly: "Substantial supports the hypothesis that
“ Substantial evidence supports that
the human
human brain
brain is structurally
structurally and functionally
functionally m modular"
odular” (Raichle 1990).
13. The only PET studies as of 1994 that that examined the issue of language
difference directly were done at McGill University in Montreal, Montreal, Canada.
Canada. The
group examined
examined English with French as a fluent second language and decided:
"We
“ We find no evidence ... . . . that
that a language learned later in life life is represented
represented [in
the brain}
brain] differently from the native language” language" (Editorial 1995; Klein et al.
1994; Klein et al. 1995). However, see see also the Kanji studies of Sakurai et al.
1992.
14. "'If
“ ‘If modules exist, then ... . . . double dissociations are a relatively reliable
way of uncovering
uncovering them. Double dissociations exist Therefore
dissociations do exist. Therefore modules ex­ ex-
ist.'
ist.’ Presented in this form the logical fallacy is is obvious”
obvious" (Uttal 2001,
2001, p. 248).
15. See
See also Kosslyn (1994), Szasz Szasz (1996), and Wilson (1998).
16. Danziger ((1990a)
1990a) provides a history ooff task design in different psycho­ psycho-
logical schools.
17. Raven's
Raven’s test is used by individual
individual psychologists as a measure ooff general
IQ.
IQ.
18. SeeSee Saha, MacIntyre,
MacIntyre, and Go 1992; Wolf 1981b). 19816). Gallium-68,
Gallium-68, bromine-
75, rubidium-82,
rubidium-82, and copper-62 can be produced produced without
without a cyclotron, using a
"generator.''
“ generator.” Other
Other articles list the half-life of oxygen-15 as 2.04 minutes (Welch (Welch
and Kilbourn
Kilbourn 1984).
19. For most PET researchers, the cyclotron cyclotron is currently
currently a black box: Its pro­ pro-
duction
duction process is standardized
standardized and automated,
automated, and the cyclotron
cyclotron is notnot some­
some-
thing that
that generates errors.
errors. In fact, at m most institutions, one should not
ost research institutions,
mess with
with the cyclotron.
20. Fluorine-18
Fluorine-18 can be and has been produced produced regionally and distributed
distributed to
hospitals,
hospitals, but this limits the kinds of imaging that that can be done with PET. PET.
21. There is no consensus over what what to actually call the labeled molecule.
The Positron
Positron Emission Panel of o f the Council of Scientific
Scientific Affairs ooff the American
Medical
M edical Association
Association prefers labeled tracer as the m most
ost accurate term (Council
on Scientific
Scientific Affairs Reports
Reports 1988). There has been a long debate over whether whether
radiopharmaceutical is proper
radiopharmaceutical proper in the case case of nuclear medicine. Some researchers
have argued
argued against this term because “"the quantities of chemicals (both radio­
the quantities radio-
active and nonradioactive)
nonradioactive) used in these agents are so minuscule that that they fall
below the level level of immunoresponsiveness"
immunoresponsiveness” and are therefore therefore not
not pharmaceuti­
pharmaceuti-

192
192
 NOTH
NOTES TO CHAPTER 3
TO CHAPTER

cals or "drugs" (Subramanian 1974). These definitional

“ drugs” (Subramanian definitional battles are not trivia~
trivial,
because pharmaceuticals
pharmaceuticals are regulated quite differently from radiodiagnostic
radiodiagnostic
agents, (International
(International Atomic Energy Agency 1971). This definition currently
seems to be moot,
m oot, however, because the Food and Drug Administration (FDA)
Administration (FDA)
continues
continues to exercise jurisdiction
jurisdiction over PET tracers in the United States (Levine(Levine
and Abel 1990; Siegel
Siegel 1981).
22. The story usually includes an anecdote about about von Hevesy using this ra- ra­
dioactive lead to prove that that his landlady reused leftover meat meat in the hash she
served later in the week (Brucer 1978).
23. From the chemist's
chemist’s perspective, choosing the rightright molecule to label is the
critical element of PET.PET. Edward H Hoffman
offm an said, “"YouYou know, the heart
heart ooff the
whole thing is chemistry. I always had the faith that that if the right application
application isn't
isn’t
here now, some young chemist is probably
probably going to learn to synthesize the right
probably with fluorine-18, and it will be very important.
thing, probably important. Well, we have
FDG, butbut not
not too many more things!"
things!”
The challenge for the chemist is to figure out how to convince a radioisotope
radioisotope
properly bind to the molecule, which involves making sure that
to properly that in the pro-
pro­
cess, the solution produced is relatively pure (free from other
solution produced other radiolabeled
radiolabeled sub-
sub­
stances) and retains high enough (radio)activity
(radio)activity so that
that the tracer
tracer will be detect-
detect­
able. OOff course, the solution
solution injected into the patient
patient is mostly nonradioactive;
nonradioactive;
the labeled molecule is only a tiny percentage of it, a trace amount. amount.
For some molecules, such as oxygen gas (O (0 22)) or carbon
carbon monoxide
monoxide (CO), the
production
production process is quite straightforward.
straightforward. For others,
others, like FDG, the process
involves a lot of precise, hands-on
hands-on work. Currently,
Currently, an entire branch
branch of PET
work
work concerns labeling new molecules, drugs in particular,particular, and is the subject of
many doctoral
doctoral dissertations.
dissertations. Unfortunately,
Unfortunately, this field is also extremely labor in­ in-
tensive without
without clear signs of rewards. Many M any years are often invested in these
attempts,
attempts, and often they are completely unsuccessful, as described by one re- re­
searcher:
have seen
I have seen researchers
researchers spend
spend years
years trying
trying to
to develop
develop aa specific
specific ligand
ligand [a[a
radiotracer] and do the modeling work,
radiotracer] work, and then the monkey work [i.e., [i.e.,
testing it on an animal], and everything, trying to get the ligand into hu­ hu-
mans. The upshot
upshot was that
that if they picked the wrong
wrong tracer, five
five years or
more of work basically goes to nothing
nothing because of something that couldn't
that couldn’t
have been foreseen.
The labeling process takes place in "hot labs" ("hot"
“ hot labs” (“ hot” for the radioactivity),
radioactivity),
where chemists work
work behind heavy shields and underunder hoods with prosthetic
with prosthetic
arms. One of their primary
primary concerns is radiation
radiation dose, which
which is measured via
badges or rings (rings because the isotope is often handled
handled by hand,
hand, exposing
the fingers more than
than the rest of the body). As the government
government has set strict
yearly and lifetime dose limits and exceeding these limits means having to stay
out
out ooff the lab for months
months at a time, the chemists have to balance carefully
exposure with experience.
Computers
Computers have also joined the team of chemists. SinceSince the late 1980s, some
researchers spend almost all of their time in front of
o f a monitor
monitor instead of in the
lab. Using high-speed graphics workstations,
workstations, they take the results of X-ray crys-
crys­

193
NOTES
n TO
o tes t o CHAPTER3
CHAPTER

tallography
tallography and model the physical structure structure ooff the molecule so as to measure
better and then predict which isotopes will successfully successfully bind and which will not.
Ideally,
Ideally, this process saves years of trial and error. One chemical modeler ex- ex­
plained that
that the cost of modeling was that that one had to more or less less give
give up the
lab. Like good lab hands, he explained, "you “you have to be constantly
constantly working
with the computer, programming,
programming, playing with it, getting to know its idio- idio­
order to get good results. If
syncrasies, in order If you are away too long, you forget.” forget."
24. MMaximum positron ranges: carbon-11
axim um positron carbon-11=4,1 nitrogen-13=5.1
= 4 ,1 mm; nitrogen-13 = 5.1 mm;
=
oxygen-15 = 7.3 mm; fluorine-18 ==2.4 2 .4 mm.
patient lies down on a movable table, and his or her head is held
25. The patient
Because the slightest head movement can result in a blurry scan,
firmly in place. Because
keeping the head steady is an importantimportant task. Head holders are often designed
specifically subject, In some institutions,
specifically for each subject. institutions, a special kind of o f thermoplastic
thermoplastic
mask
m ask is molded to subjects’
subjects' faces, and this is affixed to the bed and can be kept
aligned. (Kearfott et al. 1984). For information
information on other head holders and posi- posi­
tioning systems, see see Kingsley
Kingsley et al. (1980), Mazziotta
M azziotta et al. (1982), Vanier et al.
(1985).
For subjects who must remain immobile for 30 minutes to an hour, some
technicians have come up with innovative ways ooff keeping them comfortable,
intravenous fluids
such as placing an intravenous fluids bag, filled
filled with water, under their head or
playing music in the background.
background. Institutions
Institutions have reported
reported thatthat they often
manually examine images for signs signs of head movement: “"Any Any pair of PET studies
that generate characteristic
that characteristic crescent-shaped areas of positive or negative changes
without further
are discarded without further processing”
processing" (Mintun et al, al. 1989).
Some
Some of o f the technicians I talked with reported reported thatthat between 1980 and the
early 1990s, they were being slowly automated automated out of their jobs. Initially they
not only kept the subject comfortable,
comfortable, monitored
monitored the scanner, and withdrew
blood samples, but also performed
performed much of o f the image analysis on the data, data,
before sending it on to the researchers. Two trends trends intervened to make the tech­ tech-
nicians' jobs more boring. First, as computers became more powerful and af­
nicians’ af-
workstations fit onto desktops, researchers created teams
fordable and graphics workstations
programmers to process and reprocess the raw radioactive data themselves.
of programmers themselves.
Second, commercial programs appeared appeared thatthat black-boxed many of the process­ process-
algorithms, allowing researchers to buy their image-processing software off
ing algorithms,
shelf. Injection is thus also becoming more and more black-boxed.
the shelf.
26. Different kinds ooff scintillation crystals include sodium iodide (Nal), bis­ bis-
muth germanate
germanate (BGO),
(BGO), and cesium flouride (CsF). (CsF). Each of these crystals is
quite dense, and the tightly packed atoms are thus better able to stop the
gamma
gam ma rays than than the body is. is. Each gamma ray enters the crystal and begins to
run into atoms dislodging electrons while losing energy. energy. As each ekctron
electron returns
normal energy state, it releases
to its normal releases energy in the form of a photon photon of light.
scintillation, Crystals also have different resolution
This process is called scintillation. resolution times,
which refer to how discriminating the crystal is between two different gamma
rays in time. SomeSome crystals, such as CsF, CsF, for example, are so fast that that they can
distinguish not only coincidence windows but also the time between the arrival
of each of the two gamma rays. This allows the scanner to interpret interpret where the
positron was along the
positron the line between the two detectors. This is known known as time-

194
194
 CHAPTER 3
NOTES TO CHAPTER

of-flight information,
information, and time-of-flight PET scanners have been developed on
this principle (Yamamoto
{Yamamoto et al. 1983; Yamamoto et al. 1982; Zimmerman
1988).
27. In conventional
conventional nuclear medicine, radioisotope
radioisotope decay results in gamma
rays of
o f varying and usually lesser intensity, and these rays are random random in their
directions. To assess
assess their point of
o f origin, collimators
collimators were developed, which were
dense shields arranged such that that only gamma rays traveling in one direction could
get past them. Gamma rays traveling at angles would hit the collimators and be
absorbed
absorbed (see(see figure 3.5a). Collimators
Collimators thus made localization
localization possible at the cost
of sensitivity: "Though
“ Though you had a good idea of where the gamma rays were
coming from;
from, very few of them were ever counted.
counted. Thus, a higher dose ooff radioac­
radioac-
tivity would be needed to produce enough counts” counts" (Wilson
(Wilson 1988).
Because
Because the gamma rays from positron positron emitters come in pairs traveling in
opposite directions, it is possible to perform “electronic
"electronic collimation”
collimation" by assum­
assum-
ing that
that if two detectors register gamma ray hits at almost exactly the same same
time, then
then there most probably
probably was positron
positron decay along the line between the
two detectors
detectors (Phelps et et al. 1975).
In a PET scanner, then, detectors are arranged around the subject
arranged in a ring around subject-—
often more thanthan one ring (or hexagon). Each of these detectors is wired together
so that
that near-simultaneous
near-simultaneous hits (within, e.g., 20 nanoseconds) can be registered,
and the three-dimensional
three-dimensional line between them can be passed on to the next stage stage
of the imaging process.
The architecture
architecture of the PET scanner determines the sampling it is is able to
achieve. Sampling is the relative ability ooff the detectors to capture capture as much
information
information as possible within the field of view. view. M More
ore detectors and smaller
detectors contribute
contribute toto better sampling and also better resolution
resolution (the size
size of
each volume area being sampled). Both sampling and resolution resolution tend to vary
between the center and the edge of the field view.
field of view.
Although the principles remained
remained the same between 1974 and 1994, some
researchers have described PET scanners as fitting into three generations: The
first generation consisted of single-ring scanners and began with the PETT series series
at Washington University in the early 1970s. The second generation generation consisted of
multislice scanners and new types of crystal detectors and began in the early
1980s. The thirdthird generation of scanners became more complex and more practi­ practi-
cal for clinical use and began in the rnid-1980s.mid-1980s. SeeSee Koeppe and Hutchins
(1992) forfor aa complete
complete review
review of
of these
these generations,
generations.
28. It is possible to view the data temporally informa-
temporally to look for time-course informa­
tion. Usually,
Usually, however,
however the time-course data do not have enough counts (enough
radioactivity) per time segment to produce an accurate picture. Even in this
case, to get any picture at all, some time segment m must
ust be condensed into a
state.
29,
29. In an interview, HenryHenry Wagner described for me the meaning of func­ func-
tional in this case:
tional

A researcher named Shigekoto Kaihara is the one who coined the term
functional image. That
functional That then subsequently got translated
translated into what
what is called
called
parametric
parametric imaging, but that
that guy,
guy, actually in a paper that
that he published in

195
 TO CHAPTER
NOTES 10 CHAPTER 3

1968 here at Johns

Johns Hopkins,
Hopkins, when he w was
as a trainee, the whole paper
paper was
in the title. It said, "the
“the construction functional image from rate con­
construction of a functional con-
stants."
stants.” He
H e took
took rate constants, measurements, and instead of put­
constants, spatial measurements, put-
ting distribution
distribution in space, he displayed the distribution
distribution ooff the rate constant
constant
and called it a functional
functional image. SoSo that
that is the only way you can handle
that
that much quantitative
quantitative data.
data. Plus it has the additional
additional advantage
advantage of relat­
relat-
ing it to space, so it relates space and time. The essenceessence of physiology is is
time.
30. PET experiments
experiments are founded assumption that
founded on the assumption that the flow of these
molecules is different
different in different regions of the brain and that that this difference is is
related
related to the activity of that that part
part of the brain. Brain activations are fast bio­ bio-
chemical and biophysical
biophysical activity increases. The bulk of these fast changes occur
in the synaptic regions. The energy demands are therefore the highest in synap­ synap-
tic regions when the brain brain activates. The extra demands on glucose and oxygen
also result in increases of o f the regional
regional cerebral blood flow (Seitz(Seitz and Roland
1992).
Another
Another assumption
assumption of PET is that that the regions of the brain
brain that
that show these
differences are not necessarily the regions of the brain delineated by anatomists.
John Mazziotta,
M azziotta, neuroanatomist neurologist at the University of California,
neuroanatomist and neurologist
Los Angeles, declared this assumptionassumption in an editorial: “A "A basic premise that that
must be discarded is that that structural functional anatomy
structural and functional anatomy are equivalent”
equivalent"
(Mazziotta
(Mazziotta 1984). The concept concept of "function" that M
"function” that Mazziotta internal
azziotta invoked is internal
to the PET experiment:
experiment: A study that that shows a certain area of the brain “"lighting
lighting
up"
u p ” in response to a verb-generation
verb-generation task refers to the area corresponding
corresponding to the
"verb
“ verb generation"
generation” function,
function, regardless ooff whether
whether this area corresponds
corresponds to a
nicely delineated
delineated anatomical
anatomical structure
structure (Petersen et al. 1989). The PET image
may show a "circuit"
“ circuit” of areas that together comprise the “"function"
that together function” {Begley
(Begley
1991; Raichle 19946).
1994b).
related but different concept
A related concept of function refers back to Shigekoto Kaihara’s Kaihara's
article, "The Construction of a Functional
“ The Construction Functional Image from Spatially Localized Rate
Constants Obtained
Constants Obtained from Serial Camera and Rectilinear Scanner D Data."
ata.” This
concept
concept is also internal
internal to the imaging experiment. A A “"functional
functional image”
image" in
Kaihara's
Kaihara’s sense is one in which which each pixel corresponds
corresponds to the value of a mathe­ mathe-
matical function
function thatthat describes the rate of flow of the molecule in that that anatomi­
anatomi-
cal area. In some PET images, for example, red areas mean that that those areas ooff
the brain
brain had a flow rate twice that that of blue areas. “"In
In a sense, the scanning
image may be thought
thought of o f as a map of regional function”
function" (Kaihara et al, al. 1969).
31. His technical
technical discussion reveals the true difficulty faced in standardizing
standardizing
brains:
As we discussed above, SPM
SPM [uses
[uses the brains from the M N I for its temp­
MNI temp-
SPM99b
lates. SPM 99b uses the M MNI
N I average of 152 scans, and SPMSPM9696 uses the
scan data from the individual
individual brain that has been scanned many times.
brain that times ..... . .
This means that
that the Talairach atlas is not exactly accurate for interpreting
interpreting
coordinates
coordinates from SPM analyses, if (as (as is
is almost always the case)
case) the scans
have been spatially normalized
normalized (coregistered) to the SPMSPM 99 or SPMSPM 96
template.
template. This can be a problem,
problem, as, to my knowledge, there is is currently

196
 CHAPTER 3
NOTES TO CHAPTER

no published
published MNI M N I atlas, defining Brodmann's
Brodmann’s areas on the M MNI brain. In
N I brain.
contrast
contrast there
there is extensive information Brodmann's areas for the Tal-
information on Brodmann’s
airach atlas
atlas....., . . However, the SPM authors
authors have referred
referred to the coordi­
coordi-
nates from SPM96,99
SPM 96,99 analyses (matched(matched to the M MNIN I brain) as being “"in
in
Talairach
Talairach space"
space” .... . . . . By this they mean that
that the coordinates
coordinates are reported
reported
in terms of the system that that Talairach
Talairach developed, with coordinate
coordinate 0,0,0
being at the anterior
anterior commissure
commissure (AC), and with with the anterior/posterior
anterior/posterior
commissural
commissural line (ACIPC where z == 0. (In fact the
(AC/PC line) defining the plane where
AC is not exactly at 0,0,0 in the MNI brain, but about
M N I brain, about 4mm below—see
below-see
the 152 Tl
T1 average brain brain in the canonical directory). However, they do not
canonical directory).
mean by this that that the coordinates
coordinates match brain in the Talairach
match the brain Talairach atlas,
because this is not not precisely the case."
case. ”

providing some transformations

After providing transformations himself, he concludes:

Other
Other methods
methods that
that you can use to work your activation
work out where your activation is are:
(1) Use the SPM 99 and 96 overlay displays to show you the activations
activations on
M N I brain. If you know
the MNI know your
your anatomy
anatomy well, or can seesee the equivalent
equivalent
structures
structures in the Talairach
Talairach atlas, then
then you may knowknow where
where your activa­
activa-
tion
tion is. Unfortunately,
Unfortunately, outside the primary sensorimotor cortices, the rela­
primary sensorimotor rela-
tion
tion of functional
functional areas to sulcal anatomy
anatomy can be very variable; (2) (2) Use the
Talairach atlas, and try by eye to take into account
Talairach account the difference in brain
size (given that
that the differences are relatively
relatively small). Obviously this can be
inaccurate,
inaccurate, and it is very difficult to standardize
standardize across labs.
32. Automatically
Automatically or semiautomatically.
semiautomatically.
33. See
See Valentino
Valentino (1991) for a comprehensive
comprehensive review of mappingmapping and regis­
regis-
tering
tering strategies.
strategies. See
See also Mazziotta
Mazziotta and Koslow (1987) for a survey of different
institutional
institutional methods.
methods. Specific
Specific methods
methods include those explicated
explicated by Bajcsy
Bajcsy et al.
(1983), Fox et al. (1985), and Mazziotta
Mazziotta et al. (1991).
34. Tracer-kinetic
Tracer-kinetic modeling
modeling is both
both a unique
unique strength
strength of PET and its most
complicated
complicated weakness.
weakness. When
When done carefully, and assuming the assumptions assumptions
hqld, modeling
hqld, modeling allows PET to produce
produce truly
truly quantitative
quantitative information
information about
about the
precise amount
amount of the molecule in each region of the brain. brain. Without
Without modeling,
only relative differences and relative changes are possible to measure. Whether Whether
absolute
absolute quantitation
quantitation is necessary or even valuable
valuable has been the subject of de­ de-
bate
bate for decades (Strother et al. 1991). Again, this debate debate is one of paradigms
paradigms
with implication
with implication for the meaning
meaning of the data.
data. Does it matter, for instance, if if the
whole
whole brain
brain is less active in some subjects or during
during some activities, or do only
relative
relative differences between different regions matter?
To reduce the technical
technical complexity
complexity of this stage, I have moved a discussion of
biomathematics
biomathematics to this note. This step consists in turning turning the reconstructed
reconstructed m ma-
a­
trix of counts,
counts, the data
data set, into the actual physiological information.
actual physiological information. In 1981,
Barbara
Barbara Croft
Croft defined the difference between what she called “"direct
between what functional
direct functional
imaging, in which images of a particular radiopharmaceutical distribution
particular radiopharmaceutical distribution are
used by themselves,"
themselves,” and "indirect
“ indirect functional which the images are
functional imaging, in which
formed by mathematical
formed mathematical manipulation"
manipulation” (Croft
(Croft 1981). The reconstructed
reconstructed data
set represents
represents a direct functional
functional image at this point,
point, the amount
amount of radioactive
radioactive

197
197
 CHAPTER 3
NOTES TO CHAPTER

material
material that
that was
w as present in each area of the brain during the period of the scan.
scan:
Because
Because the relationship
relationship between the isotope and the brain action is quite com­
com-
plex, as noted earlier, the data require mathematical
mathematical manipulation.
manipulation. Croft called
called
these indirect functional
functional images "parametric."
“ param etric.”

In order to convert these data to meaningful information

information such as is implied
by the processes listed above or any other than can be studied by PET, PET, a
model that
that allows the determination particular process, e.g., glucose
determination of the particular glucose
metabolism, is required. This is the essence
essence of the PET method and sets sets it
apart
apart from methods whose primary
primary purpose isis imaging. (Wolf
(Wolf 1981a)
The kinds of o f parametric
parametric scans can be divided into two types: types: accumulation
and flow, with variances to be discussed later. Accumulation scans are like io­ io-
dine scans in the thyroid; a tracertracer is introduced
introduced that
that flows through
through the body and
is "trapped"
“ trapped” in particular
particular areas. Studies ooff cancer metastases work on this prin­ prin-
ciple. FDG, for example, travels like glucose glucose across the blood-brain
blood-brain barrier
barrier and
into cells,
cells, where, because it is not glucose,
glucose, it goes
goes through
through only some of the
reactions
reactions glucose does. It stops reacting before it gets kicked back out ooff the
cell. Therefore,
Therefore, the accumulation
accumulation of FDG in cells cells represents a percentage of the
glucose activity that that cell during the period ooff uptake. In quantitative
quantitative FDG
FDG
studies, blood samples are taken taken at 15 seconds, 30 seconds, 60 seconds, 2 min­ min-
utes, and so on, to measure the amount radioactivity in the blood at each
amount of radioactivity
time. This produces
produces a time-activity curve that that allows an estimate ooff the actual
amount
amount of FDG FD G glucose trapped
trapped in each area of the brain at each point in time.
Without
Without this blood sampling, only the relative amounts amounts of FD FDGG activity can be
measured (i.e., activity in frontal
frontal lobes relative to activity in the cerebellum).
Of
O f course, this trapping
trapping process of FD FDG cells is metabolically compli­
G in the cells compli-
cated. There are many variables to consider in using the data set of counts to
figure out
out how much activity was going on in each region of the brain. What What isis
ultimately measured is the average rate of accumulation
accumulation of FD FDGG over a period
of
o f time.
Flow studies are similar conceptually: During a 2-minute oxygen scan, for
instance, the radioactive
radioactive blood is circulating through
through the brain. Areas
Areas with
with more
activity are assumed to have increased flow. flow. Thus, more blood is present to be
counted. Again, there are models of the relation relation between flow and activity,
activity, but
the final result is a data set of the rate of flow. flow.
FDG and oxygen are the more simple kinds of studies. In neurotransmitter neurotransmitter
studies, notnot only must the amount
amount of the labeled tracer be estimated for each
area but the reactions by the brain to the tracer must also be estimated. See See
Kilbourn and Zalutsky
Zalutsky (1985) for an excellent technical overview ooff receptor
imaging with PET. PET. As a dopamine
dopamine agonist arrives and binds to dopamine recep­ recep-
tors, possible reactions include more or less less dopamine becoming available, more
receptors, increased receptivity of o f the receptors, and increased or decreased ac­ ac-
tivity in other
other neurotransmitters.
neurotransmitters. The actual design of models, testing, and esti­ esti-
mation
mation of o f parameters
parameters is a long and complicated process. One postdoctoral postdoctoral re­
re-
searcher described his experience with kinetic modeling:
To study certain topics, some of us are using models to calculate different
kinds of parameters,
parameters, like disassociation constants
constants and so on. These kinds

198
r
.

.
.

of things we have to do when we use a new ligand, just to define

ligand. For example, the ligand that
that I am working
NOTES TO CHAPTER
CHAPTER 3

define the
working [on] now is for opiate
receptors. First, I have to see how specific
specific the binding is:
is: Does the ligand
bind just to the opiate receptors I am interested in;
in, or does it also bind to
other kinds of receptors? The next step will
will be to define the compartmen-
tal model: the association and disassociation constants,
constants, the transport
transport wave
over the blood-brain
blood-brain barrier back and forth.

See
See Carson (1986) on parameter
parameter estimations and Huang H uang and Phelps (1986)
on the principles of tracer
tracer kinetic modeling.
35. This project involves securing a number number o off brains of deceased people,
freezing
freezing them in the skull, and then slicing them with a microcryotome,
microcryotome, produc-
produc­
ing high-resolution
high-resolution photographic
photographic images of micron-level detail. An entire
database
database of cells, neurons, and so forth can be built up in this process. Vari-
cells, neurons, Vari­
ability is accounted for by using many brains instead of just one.
36. Per Roland devotes the last chapterchapter (the final 10 of 600 pages) to poten- poten­
tial problems deriving from variability issues.issues. In addition
addition to to functional-anatomi-
functional-anatomi-
cal variability, tracer-related
tracer•related variability, data normalization
normalization and transformation
transformation
variability, and institutional
institutional variability are all significant concerns (Roland
1993). Ford et al. surveyed these concerns and offered this: “"Because Because of the
complexity of the data collected and the questions of o f interest, the extent
extent to
which these problems truly influence biological conclusions is difficult to assess. assess.
This uncertainty
uncertainty is in itself one of the major issues facing this area of research”research"
(Ford et al. 1991, p. A94).
See especially
37. See especially Pawlik (1988), and Pawlik (1991),
38. Kosslyn (1989) commented that that mmost
ost visual displays make poor use of
color. On color coding in PET, see especially Dr. Wagner’s
PET, see Wagner's “"Color Nuclear
Color in Nuclear
Medicine: Contribution
Contribution or Camouflage?"
Cam ouflage?” which argues in favor of the American
adoption
adoption of pseudo-color scales. He notes: “"The
pseudo-color scales. The colors we instruct
instruct the com-
com­
puter
puter to assign .... . . are arbitrary
arbitrary only in the sense thatthat not all of
o f us have as yet
agreed on what
what they mean. Once we agree on a color code and become prac- prac­
ticed in it, the issue
issue of arbitrariness
arbitrariness disappears and the result is shared experi- experi­
ence and a new language with which we can communicate communicate more effectively”
effectively"
(Wagner 1974).
See also Jardine (1992).
39. See
40. I am currently investigating the history of conventions
conventions by which extremes
are chosen for visual display and by which differences among types are empha- empha­
sized over variability within
within types -—the usefulness of typing in this way at all.
41. See
See Nelkin and Tancredi (1989) for a discussion of the problem of false- false-
positives in experimental research. See See also Ford (1983) and Rapoport
Rapoport (1991)
for discussions of the implications of o f type I and II errors.
another set of images on the facing page, the scans are labeled normals
42. In another normals
and schizophrenics
schizophrenics illustrating the difficulty of keeping these labels clear. clear. The
volunteers for this study are perhaps better better described as normal
normal subjects with no
history of psychiatric diagnosis (the normals) and normal normal subjects with no his- his­
tory ooff psychiatric diagnosis other
other than schizophrenia (the schizophrenics).
than schizophrenia
43. See
See Brodie et al. (1983), Delisi and Buchsbaum (1986), Ford et al. (1991),
Phelps and M Mazziotta
azziotta (1985), and Volkow and Wolf (1991).

199
 CHAPTER 4
NOTES TO CHAPTER
NOTES

44. The most sustained

sustained attack
attack on these anti-psychiatrists
anti-psychiatrists (including a fantasy
condemned by parents
trial in which they are condemned parents of those with mental
mental illness)
illness) was
by Torrey (1983).
45. See
See Faulstich and Sullivan (1991). Metz (1989) provides a conceptual
conceptual and
technical critique
critique of the psychiatric diagnosis with PET.PET.
46. Another
Another train reasoning is the “"modeling
train of reasoning modeling critique"
critique” defined by Charl­
Charl-
ton (1990) and based on Bernard's
Bernard’s critique of averages in physiology. The pro- pro­
duction
duction of explicatory
explicatory images risks producing
producing an "average
“ average schizophrenic"
schizophrenic” who
is "perhaps
“ perhaps more of a mythical
mythical beast than
than the so-called ‘classic
'classic cases’
cases' of other
branches of medicine"
branches medicine” (p. 4). Averages also condense into a steady state what what is
in fact a variable in time, a pulsatile phenomenon.
phenomenon.
47. Considei;
Consider, for example, the following statements
statements culled from contempo-
contempo­
rary neuroscience: "Today, there is hardly
“Today, of course, there respectable neuroscientist
hardly a respectable neuroscientist
alive who thinks
thinks the mind exists apart
apart from the functions of the physical brain
and body"
body” (Montgomery
(Montgomery 1989, p. 67). Gazzaniga (1989) commented commented on the
"organization
“ organization of the human
human brain"
brain” in Science: "An“An emerging view is that that the
brain is structurally
brain structurally and functionally
functionally organized into discrete units or 'modules'
‘modules’
and that
that these components
components interact
interact to produce mental
mental activities"
activities” (p. 947). Le-
Le-
Vay (1993) stated thatthat even though
though culture and environment
environment might be opposed
to genetics, all fall under biology: “"Thinking
Thinking about
about the mind in biological terms
not the same thing as believing that
is not that all mental
mental states are genetically deter-
deter­
mined, since even environmental
environmental and cultural
cultural influences on the mind operateoperate
through
through biological mechanisms.”
mechanisms."
.48. See
See especially Metz (1989), in which difficulties with PET are highlighted
and the author
author calls for focusing on PET-distinguished groups.

Chapter 4
Chapter

1.
1. The first CT scan of a patientpatient was performed
performed in 1971 by EMI. Kevles Kevles
discussedthe
(1997) discussed therapidity
rapidity with
with which
which CCT entered the
T entered the medical
medical and
andpopular
popular
imagination,
imagination, with fivefive contracts
contracts awarded
awarded during 1972. Nonetheless, Kevles also
Nonetheless, Kevles
notes that
that "the
“ the first CT images were a puzzle to the physicians and surgeons
who would
would be expected to use them (Vanoverschelde et al. 1993). Ledley [Amer­ [Amer-
ican inventor
inventor of a C CT T scanner] recalls that
that he felt obliged in 1976 to publish his
own atlas to teach radiologists
radiologists how to see the images his ACTAACTA produced"
produced” (p.(p.
162).
See, for example, Andreasen
2. See, Andreasen (1984) and Kuhar (1990).
3. Quoted
Quoted in Froehlich (1987, p. 17).
4. Other
Other researchers have commented
commented on the difficulties
difficulties of drawing
drawing conclu-
conclu­
sions from the newest machines with the best resolution.
resolution. Because there are ·nono
other
other devices capable of generating
generating comparable
comparable data, they have no way of
knowing
knowing what
what it is that
that they are seeing.
5. As mentioned
mentioned before, this demand
demand for programmatic
programmatic clarity is part
part of the
court
court system. It is also at the basis of U.S.
U.S. malpractice
malpractice claims resulting in defen­
defen-
sive medicine, wherein deviation standardized medical protocol
deviation from standardized protocol is avoided

200
 NOTES TO CHAPTER
CHAPTER 5

for fear of lawsuits. See See Konner (1993) for an analysis ooff this system and alter­ alter-
natives to it.
6. Shelton and Weinberger (1986) reviewed “"more more than 100 C CT in-
T studies in­
vestigating brain abnormalities schizophrenia ..... . . M
abnormalities in schizophrenia. ost ooff these studies
Most
(75%
(75%)) have reported
reported enlarged lateral ventricles even though though fewer than 10% of
the CT scans have been interpretedinterpreted as abnormal neuroradiologist
abnormal by a clinical neuroradiologist
(cited in
schizophrenia" (cited
,.... . this emphasizes the subtlety of the changes noted in schizophrenia”
Shenton et al. 1997, p. 299). Shenton et al. reviewed sixty-seven M MRI
RI studies asas
I well as the C
enlargement
CTT studies and discovered a variety of divergent findings.
enlargement in particular
particular was discussed as
Ventricle
findings. Ventricle
correlated with schizophrenia
as being correlated
in twenty-seven of thirty-seven studies that that looked aatt it, but some of those in­ in-
cluded significant enlargement
enlargement only in men (two studies) or only in women (two
studies). In addition,
addition, they began their discussion noting that that “"enlarged
enlarged lateral
ventricles are not, however, specific schizophrenia as
specific to schizophrenia as there are many other
disorders such as Alzheimer’s Huntington's chorea that
Alzheimer's disease and Huntington’s that can result in
ventricles" (p. 380).
enlarged lateral ventricles”
7. The decision in Daubert v. Merrell D Dow Pharmaceuticals, Inc. (113
ow Pharmaceuticals, Ct.
S. Ct.
(113 S,
2786 1993) and its ramifications go beyond the narrow narrow considerations discussed
considerations discussed
in this book. Daubert
Daubert changed the focus of admission of scientific scientific testimony
from a “"general
general acceptance”
acceptance" test, including peer review, to one in which the trial
judge evaluates expert scientific testimony
expert scientific outset, considering many issues
testimony at the outset, issues
such as validation,
validation, testability, falsifiability,
falsifiability, and peer review. Jasanoff
See Jasan
review. See off (1995)
for an excellent analysis of the changing legal and scientific scientific landscape in the
wake of Daubert.
8. Caught here is the sublime dilemma ooff brain brain imaging. The researcher finds finds
it almost impossible to argue that that the yellow blob or any other “"abnormality"
abnormality”
might mean that that the person is is “"completely
completely normnormal."
al,”
9. Paul M acLean has been quoted
Maclean quoted as saying, “"One One of the worst things in the
'discovered' by
world is to be ‘discovered’
world by the popular
popular m media"
edia” (Harrington 1992).
(Harrington 1992).
Michael (1994).
10. Michael
11. I have not figured out out why Hatfield reportedreported 12 men and 2 women
whereas
whereas BegleyBegley reported
reported 13 men and 4 women.
turn-of-the-nineteenth-century futur­
popular turn-of-the-nineteenth-century
illuminating look at popular
12. For an illuminating futur-
surrounding X-rays, see Knight (1986).
ism surrounding

Chapter
Chapter 5

1. Frame arrangement of images

Frame is used here to denote the whole arrangement cap-
images and cap­
tions, and its positioning Newsweek,
positioning in an article on mapping the brain, in Newsweek,
toward an educated audience. See,
oriented toward
oriented See, for example, Barthes (1968), Dumit
(1995a), H Hartouni (1992) on framing and audience.
araway (1991), and Hartouni
Haraway
Other influences include books, magazines, television, the advice of our
2. Other
reported experiences of our friends.
doctors, and reported
3. See,
See, for example, Huff (1954), which focuses primarily on the visual per­ per-
presentations.
suasiveness of certain kinds of graph presentations.
Goodman's elegant “"Seven
4. Nelson Goodman’s Seven Strictures on Similarity” con-
offers a con­
Similarity" offers

201
201
I

l
NOTU
NOTES TO
TO CHAPTH
CHAPTER 5

trary perspective in which "circumstances similarities" (Goodman 1992,

“ circumstances alter similarities”
p,
P. 21)
21)
5. She also describes the New
New Yorker magazine cartoons:
which in a few drawn
drawn lines capture Moreover., such im­
capture layers of nuance. Moreover, im-
ages often carry profound
profound cultural
cultural meaning or suggest storks
stories told with wit
through symbolism or metaphor. Paralleling the process of
and intelligence through
perception itself,
perception itself, such images reveal a contempt
contempt for indiscriminate atten­
atten-
tion and for superfluous detail; they eschew
eschew the irrelevant and reveal the
pattern that
pattern that emerges only from essential characteristics in in synchrony,
synchrony.
(Barry 1997, p. 77)
6. Being caught should not not be confused with believing. Anthropology
Anthropology has a
History (if
long history o f critiquing
critiquing the concept of belief,
belief, as if culture could be reduced to
false knowledge or reasonable mistakes about the world (Good 1994); see see also
also
Douglas 1966; Douglas and Hull 1992; and Levi-StraussLevi-Strauss 1966)
7. Functional
Functional magnetic resonance imaging (fMRI) (fMRI) is an adaptation
adaptation of the
software of MRIM RI technology that
that shows images of blood flow rates in the brain
PET. See,
similar to PET. See, for example, Kwong et al. (1992).
(1992).
8. Laypersons is from laity, meaning “those "those before the cleric.”
cleric." “It
"It is worth
noting that 'layman' now means 'not
that ‘layman’ scientist' as before [it meant]
‘not a scientist’ meant} ‘not
'not a
cleric,' which suggests the same faith in the one kind of knowledge worth hav­
cleric,’ hav-
ing" (Barzun 1964).
ing” 1964), See
See Ademuwagun (1979) for anthropological
anthropological discussions of
lay knowledge.
9. This can also be thought
thought of as an “"operational aesthetic" (Harris 1973), in
operational aesthetic”
which highbrow
highbrow science is appropriated
appropriated and played with by the masses. masses, See
See also
Dumit (2001).
(2001),
10,
10. Even if they are maintained
maintained unevenly (see(see Rapp 1999).
11. Delgado (1969) made similar pronouncements
pronouncements regarding brain waves and
stimulation via telemetry (see
electrical stimulation (see Dumit 1995a),
1995a).
12. M MEDLINE
ED LIN E breaks down violence into the categories Aggression, Crime, Crime,
Social Problems, Dangerous Behavior,
Social Behavior, and Domestic (though Domestic was
added after 1990).
1990),
13. For instance, in an article, "Positron
“ Positron Emission Tomography and in vivo
Brain Chemistry,"
Chemistry,” Wagner stated:
Perhaps it is not too far-fetched to believe
believe that
that information
information about
about the
chemistry of "toxic"
“ toxic” emotions
emotions such as aggression and violence, can help
control
control aggressive behavior, which seems
seems to be built into human
human genes, and
is encouraged by many humanhuman activities, from sports to watching televi­
televi-
sion.
sion, Such emotions
emotions are reflected in measurable changes in the chemistry of
the brain. Violence —- both personal
personal and cultural
cultural-—may not be uncontrolla­
uncontrolla-
ble or inevitable, and perhaps will be regarded as aberrant
perhaps one day will aberrant behav­
behav-
ior, a disease similar
ior simitar to illness." (Wagner 1989, p. 130)
to other mental illness.” 130)
14. Jeffery (1994) contended
contended that
that biological psychiatry and other biological
research into behavior, together
together with the failure of prisons, implies the need for
treatment
treatment of
o f criminals or offering them a choice between prison and treatment.
treatment.
Current
Current legal responses ignores the necessity treating mentally dysfunctional
necessity of treating

202
 NOTES TO
NOTES TO CHAPTER
CHAPTER5

individuals. See
See also Monahan
Monahan (1988), Sheard (1984), and Storr (1970) for eval­eval-
uations
uations of research on violence and aggression research. These reports urge a
cautious approach
approach especially
especially to the problem of predicting
predicting violence and offer
increasingly specific
specific breakdowns
breakdowns of types and causes of violence. Men/.ics
Menzies et al.
(1985) argued that
that violence is too complex to study (i.e., it has too many causes
causes
and the term refers to too many different kinds ooff activities).
activities).
15. '"Ecstasy'
“ ‘Ecstasy’ Damages the Brain and Impairs Memory in Hum Humans."
ans.”
Mathias, Robert. NIDA
M athias, Robert. N ID A Notes Research News,
News, vol. 14, no. 4, 1999. SeeSee http://
www.nida.nih.gov/NIDA-
www .nida.nih.gov/N IDA-N Notes/
otes/ NNVol 14N4/Ecstasy.html,
NNVoil4N accessed February
4/Ecstasy.htm l, accessed
25, 2003. The text
text reads, in part:
In the brain imaging study, researchers used positron
positron emission tomography
tomography
(PET)
(PET) to take brain scans of 14 MDMA
M D M A users who had not used any psy­ psy-
choactive drug, including MDMA,
M D M A , for at least 3 weeks. Brain images also
were taken of 15 people who had never used M MDMA.
D M A. Both groups were
similar in age and level
level of education
education and had comparable
comparable numbers of men
and women.
In people who had used MDMA, significant
M D M A , the PET images showed significant
reductions in the number
number of serotonin transporters, the sites
serotonin transporters, sites on neuron
surfaces that
that reabsorb
reabsorb serotonin
serotonin from the space between cellscells after it has
completed its work. The lasting reduction serotonin transporters
reduction of serotonin transporters oc­
oc-
curred throughout
throughout the brain, and people who had used M MDMA
D M A more of­of-
ten lost more serotonin
serotonin transporters than those who had used the drug
transporters than
less.
less.
16. Statement of the Director, National Institute on Drug Abuse, U.S.
National Institute U.S. Senate
Senate
Caucus on International
International Narcotics
Narcotics Control, See http://www.
Control, July 25, 2000. See
drugabuse.gov/Testimony/7-25-00Testimony.html,
drugabuse.gov/Testimony/7-25-00Testimony.html, accessed M March
arch 22, 2003.
The full caption
caption reads:
Figure 1 (right) shows the images of two human human brains. Through
Through the use
of positron
positron emission tomography
tomography (PET), we can actually see see that
that the brain
images on top belongs to an individual who has never used M MDMA.
DM A. The
bottom
bottom images show the brain of an individual who had used M MDMA
DMA
heavily for an extended period, but was
but w abstinent from drugs for at least
as abstinent
three weeks prior to the study. Clearly the brain
brain of the MMDMA
D M A user on the
bottom
bottom has been significantly altered. The specific
specific parameter
parameter being mea­
mea-
sured is the brain's
brain’s ability to bind the chemical neurotransmitter
neurotransmitter serotonin.
Serotonin is critical to normal
normal experiences of m mood, emotion, pain, and a
ood, emotion,
wide variety of other
other behaviors. On the figure, brighter
brighter colors reflect
reflect
greater serotonin
serotonin transporter
transporter binding; dull colors mean lessless binding capac­
capac-
ity.
ity, This figure shows a decrease in the M MDMA user's ability to remove this
D M A user’s
important
important neurotransmitter
neurotransmitter from the intercellular space, thereby amplify­
amplify-
ing its effects
effects within
within the brain. This decrease lasts at least three weeks after
the individual has stopped using MDMA.
M DM A.
17. It should be noted
noted that Rampage
that the book Ram page (Wood 1985), on which the
movie is based, does not mention PET scanning at all. It also has no pictures.
18. There is quite a lot of research on mental illness and violence. The legal
legal

203
NOTES
NOTES TO CHAPTER
CHAPTER 5

category in the United States is “"dangerousness"

dangerousness” (a danger to self or others can
be grounds involuntary commitment).
grounds for involuntary Mestrovic and Cook (1986) and
commitment). Mestrovic
Monahan
M onahan and Shah (1989) provide histories and evaluations evaluations of the dangerous-
dangerous­
ness standard.
standard. Many researchers
researchers have argued that that mental
mental illness is actually n-0tnot
predictive of violence (Mulvey and Lidz 1984; Pollock 1990).
19. M
Movies
ovies and other
other media are often the direct route for new sciences like
courtroom. Consider, for instance, the case ooff Barry Wayne
PET to enter the courtroom.
MMcNamara,
cN am ara, who on JanuaryJanuary 5, 1985, killed his parents,
parents, his sister,
sister, and his niece.
When this case was brought brought to trial,
trial, M
McNamara's
cN am ara’s attorney, Santa Barbara
Barbara Dep­
Dep-
uty Public Defender Michael McGrath McGrath thought
thought his client was not not sane and
sought proof
sought proof beyond psychiatrists
psychiatrists diagnosing schizophrenia:
schizophrenia: “We "We know there
was
w trend in the law which
as a trend which is hostile to psychiatrists
psychiatrists in the courtrooms.
courtrooms ..... . .
What we needed was objective evidence.”
What evidence." M McGrath
cGrath learned of PET scanning
through
through a PBS PBS television series, The Brain, and contacted contacted Monte
Monte Buchsbaum at
University at California,
California, Irvine's
Irvine’s Brain Imaging Center.Center, Buchsbaum reported that
reported that
McNamara
M cN am ara received a life sentence and not the death penalty penalty "partly,
“partly, perhaps,
perhaps,
because of the ameliorating
ameliorating circumstances
circumstances of a brain brain which was w as not entirely
normal"
norm (Black 1989).
al” (Black
Contrary to this tendency, however, many researchers
20. Contrary researchers are worried
worried that
that
successfully is more a triumph
the ability to image successfully triumph for science
science than
than for medicine.
“"We
We perceive victories for medicine because o off the way we define victories. That
more people are going to die of lung cancer this year than than last is less important,
important,
apparently, than
apparently, than thatthat we can see those cancers earlier with with C T ” (Ell
CT" (Ell 1988).
Selzer, commenting
Steven Selzer, commenting on this article, wondered wondered “"whether
whether the mindset
mindset of
medicine will shift, perhaps
perhaps from the problems of individuals to those of popu- popu­
lations"
lations” (Seltzer,
(Seltzer, 1988, p. 958). Robert Robert Proctor's
Proctor’s thesis on cancer as a social
disease, one of o f the few diseases we know we can prevent prevent by altering our daily
practices, is worth
worth reflecting on as such an alternate alternate approach
approach to medical inter-inter­
vention (Proctor 1991).
Merleau-Ponty (1964, p. 85), cited in Levin and Solomon (1990, p. 517),
21. Merleau-Ponty 517).
22. MMauss
auss (1985). See See also Carrithers
Carrithers et al,al. (1985), Geertz (1973), Schweder
and Bourne (1984), and Strathern Strathem (1992).
See, for example, Rhodes (1990) and Part III ooff Romanucci-Ross
23. See, Romanucci-Ross et al.
(1991).
24. See
See Carrithers
Carrithers et al. 1985.
25. See
See Farquhar
Farquhar (1992), Manning Manning and Fabrega (1973), Saunders (1989),
Taussig (1991), and Taussig (1993).
26. See
See the works
works of Canguilhem (1988), Foucault Foucault et al. (1988), and Gilman
(1988) especially;
especially; see seealso
also Terry
Terry (1989).
(1989).
27. See
See Csordas (1990): "The “ The body is not not the object of study but but the subject
culture." Culture
of culture.” Culture entails science for us; therefore, our bodies have to take
account science.
into account science.
factoid in the C
28. I use factoid CNN apparently nonscientific, even
N N sense of an apparently
pseudo-scientific claim. William Safire Safire (1993), described many current current defini­
defini-
factoid. H
tions of factoid. Hee eventually declared that that though
though he does not like it, C N N ’s
CNN's
constant use of the term means that
constant that CCNN's notion of it will in the end prevail.
N N ’s notion

204
204
 CHAPTER 5
NOTES TO CHAPTER

chapters 4, 5, and
29. In chapters and 6 of this book,
book, I am concerned
concerned with
with how
how facts are
put together
put together and and disseminated,
disseminated, how how authority
authority and qualifications
qualifications work
work together
together
or are at odds with with each other.
T.evi-Strauss (1963). See also Turkle (1984). “When
30. See Levi-Strauss "When one says in con­ con-
nection with
nection with totemism
totemism thatthat certain
certain animal
animal species are chosen not not because they
‘good to eat'
are 'good eat’ but
but because they
they are 'gocid
‘good to think’,
think', one is no doubt
doubt disclosing
important truth.
an important truth. But it must
must notnot lead one to neglect the questions that that then
follow: whywhy are some species 'better ‘better to think’
think' than
than others; why is one pair of
oppositions chosen
oppositions chosen over all the the other
other possible pairs offered by nature; nature; who
r thinks these pairs, when
thinks when and
and how?"
how?” (Castoriadis
(Castoriadis 1984, p. 19).
31. See pages 244-249244-249 of Listening
Listening to Prozac for Kramer’s
Kramer's discussion of this.
32. OnOn coming
coming to to identify
identify with
with a group
group of like sufferers see Edgerton
Edgerton (1993),
Rabinow (1992),
Rabinow (1992), and and Rapp
Rapp (1999). On On the
the NAMI
NAMI (National
(National Alliance for the
Mentally Ill),
Mentally 111), see Torrey (1983), among among others. On the Twelve-Step movement,
Makela et al. (1996).
see Makela
rewording of Lutz's
33. This is a rewording Lutz’s passage “We "We play withwith the
the terms of, but
but also
ultimately satisfy, Western
ultimately Western (cultural) common
common sense.”
sense."
especially, Browner and
34. See especially, and Press (1996), Rapp (1998), Shohat (1992),
and Treichler (1991).
and (1991), This is further
further developed
developed in DumitDumit (2000a).
35. Genes convey a future, future, a disposition
disposition for something
something to happen,
happen, andand are in
modality of speed (Fortun
the modality (Fortun 1998; Fortun
Fortun 2001;
2001; Sunder Raj'anRajan 2002). Brains
present, a self, and
convey the present, and are in the the modality
modality of infinite speed, the the future
now,
now.
36. See Taylor (1998, pp. 19-20) 19-20) on reassurance
reassurance and and bonding—psychologi­
bonding-psychologi-
provided by ultrasound
cal benefits provided ultrasound (in addition
addition to behavioral
behavioral benefits)
benefits)-—
through awareness
through awareness of the fetus. These benefits all are seen as medical side ef­ ef-
Other anthropologists
fects. Other anthropologists have studied
studied the varieties of experiencing the “real "real
baby” through
baby" through ultrasound
ultrasound (Mitchell and and Georges 1998; Rapp 1998).
research may also be used to reinforce
37. Brain research reinforce stereotypes of race and sex,
but in these situations,
but situations, social identification
identification is readily
readily apparent
apparent when
when brain-types
produced and
are produced and then
then affixed to the identification.
identification.
spiritualists argued
38. In Braude (1989), early spiritualists argued that
that they were able to func­ func-
tion as mediums
tion mediums precisely to the extent extent that
that they
they could
could render
render their
their mind
mind and
body passive, letting the spirits speak through through them. This is part part of how
how women
were able to turn
were turn the tables on assertions
assertions of their passivity: Men Men being active
were therefore
were therefore unsuited
unsuited to be mediums.
39. OnOn incorporations,
incorporations, see especially Crary Crary and Kwinter
Kwinter (1992) and Diprose
and Ferrell (1991).
and
psychiatrist in this instance
40. The psychiatrist instance is using the PET scan to “therapeutically
"therapeutically
emplot” the patient
emplot" patient as well. That
That is, by helping the patient patient to see mental
mental illness
illness
physiological phenomenon,
as a physiological phenomenon, physiological intervention
intervention is also facilitated. See See
Good et al. (1994) and
Good and Mattingly
Mattingly (1994).
One researcher
41. One researcher noted
noted during
during our our conversation
conversation thatthat he should
should list this
validation as a confounder
feeling of validation confounder in in future
future PET studies of depressed patients.
42. See Post and and Ballenger (1984),
(1984), as cited in Kramer (1993, (1993, pp. 110-118,
110-118,
334).

205
1.1

NOTES
NOTES TO CHAPTER
CHAPTER 6

Chapter
C h apter 6

historiographical inquiry
1. An excellent historiographical inquiry into
into the history
history of descriptive psy­
psy-
chopathology provided by Berrios (1985). The journals
chopathology is provided journals Psychological Medi­Medi-
cine, Philosophy
Philosophy of o f Medicine and Biology, and and Culture, Medicine and Psychia­ Psychia-
try provide forums
forums for discussions of these issues,
issues.
2. Heath
Heath and Crabb
Crabb (1993) surveyed research on depression in terms of a
history of mind-body
Western history mind-body dualism and and scientifically oriented
oriented biomedicine.
Starobinski (1990), for instance,
3. Starobinski instance, historically
historically investigated
investigated whether
whether emotions
are equated
equated with
with bodily
bodily sensation
sensation in being opposed
opposed to cognition,
cognition, or whether
whether
consciousness is unitary,
body consciousness unitary, incorporating
incorporating all of these “perceptions”
"perceptions" into one
process,
process.
cross-cultural investigations
4. For cross-cultural investigations into emotion,
emotion, see Kleinman and and Good
(1985), Levy (1984),
(1985), (1984), Lutz (1988), Rosaldo
Rosaldo (1980, 1984), and Schweder and
LeVine
Le Vine (1984). On On mental
mental abnormalities,
abnormalities, see Baer (1987), Johnson Johnson and and Sargent
and Romanucci-Ross
(1990), and Romanucci-Ross et al. (1991).
(1991),
5.
5, For example, Kramer, in Listening
Listening to Prozac, compared
compared length of grieving
time in Greece with with that
that in the United
United States (Kramer 1993, pp. 269-271). 269-271).
I: Fontanille (1993), see page 52 and the entire chapter. I do not
6. Greimas and Fontanille
!.
think that they
think that they succeeded in theirtheir characterization
characterization of the passions, but they
achieved the
the most
most comprehensive
comprehensive attempt
attempt to think
think through
through what
what is necessary to
study them.
study them. MEDLINE
MEDLINE breaksbreaks emotions
emotions down
down into affect, anger, anxiety,anxiety, be­
be-
reavement, boredom, frustration, guilt, happiness, hate, hostility,
boredom, euphoria, fear, frustration,
jealousy, laughter, andand love. Of these, from
from 1990 to 1994, only affect, fear, and
anxiety keywords in more
anxiety were listed as keywords more than
than 1,000 articles.
[1890]) and
7. See also James (1970 {1890]) and Solomon’s
Solomon's analysis of James’sJames's theory
theory of
emotions with
emotions with respect
respect to anthropology
anthropology (Solomon 1984).
Irigaray (1993) analyzed
8. lrigaray analyzed (Descartes's
(Descartes’s 1970) “Passions
"Passions of the Soul,”
SouV' to re­
re-
cover “wonder”
"wonder" as the the first of all passions.
9. This raises questions
questions of the limits of thinking,
thinking, because methodmethod acting in­in-
volves bodily
bodily memory
memory as muchmuch as cognitive skill.
10. OnOn philosophical
philosophical anthropology,
anthropology, see Blumenberg (1985), Buytendijk
(1974), and
(1974), and Kant (1978). Also see Eccles (1989), Kosslyn and Koenig (1992),
Luria (1973) and and other
other neuroscientists
neuroscientists on theorizing
theorizing consciousness. It is proba­proba-
though, because of the challenge of theorizing
ble, though, theorizing emotions,
emotions, thatthat Mayberg
Mayberg must
philosophical anthropologist
become a philosophical anthropologist earlier, and more more thoroughly,
thoroughly, at the be­be-
ginning of her
ginning her experiments,
experiments, rather
rather than
than in hindsight.
hindsight.
Clarke and
11. See Clarke and Dewhurst
Dewhurst (1972) for a history history of illustrations
illustrations of such
functional diagrams,
functional
12. Berrios (1985) confirmed
confirmed this: “The
"The work
work on brainbrain localization,
localization, for all its
great importance to the development
great importance development of neuropsychology, did not serve the
emotions well as it concentrated
emotions concentrated on speech, perception
perception and movement”
movement" (Meyer
Tizard 1959, p, 745).
1974; Tizard
with artificial intelligence.
13. To go with
extreme example of the computational
14. An extreme computational metaphor
metaphor of the mind mind is Mac-
.Mac"
Cormac’s thesis of coevolution.
Cormac's coevolution. In an article, he began by noting noting that
that computers
computers

206
206
 NOTES
NOTES TO CHAPTER
CHAPTER 6

are similar to minds in many respects: storing data, recalling and manipulating
manipulating
it, and recognizing patterns:
Although
Although computers are faster . •. ,. most of the differences between the two
remain
remain on the side of humans
humans who
who have emotions,
emotions, possess more creativity,
creativity,
and are intentional
intentional in many of their actions. ., .••. I presume the conceptual
metaphor propose the thesis that
metaphor and propose that visual and auditory
auditory perceptual im•
im­
ages serve as interactive devices'between
devices between culture and the mind/brain,
mind/brain, gener•
gener­
coevolutionary process (biologic and cultural
ating a coevolutiona:ry evolution).” (Mac-
cultural evolution)."
198 9)
Cormac 1989)
Emotions are explicitly excluded from this pointpoint on (even in considering art and
language).
language),
15. Pain and pleasure in neural network
network theory
theory (itself painfully caught up in
being the model for as well as modeled on the human human brain) is translated
translated into
reward and punishment. In other
reward other words, they are also always understandable,
understandable,
reasonable, and purposeful (rewards and punishment
punishment teach neural
neural nets how to
rationally behave). In fact, the medical anthropological
rationally anthropological work
work of Byron Good
and Jean Jackson on chronic pain explores the contradiction without
contradiction of pain of without
understandability (Good et al.
purpose or understandability al, 1992; Jackson 1994, 2000).
16. These questions are elaborated
elaborated in, for example, Fox (1994), Fox and As­ As-
Social Anthropologists
sociation of Social Anthropologists of the Commonwealth
Commonwealth (1975), Konner
(1982), and Kosslyn and Koenig (1992).
17. See
See Danziger (1990a), Kruger et al. (1987a), Kruger et al. (1987b), and
Porter (1995). Phenomenologists should be glad to to note
note that
that despite a long dry
spell, they are once again being read by cucting•edge
cutting-edge quantitative
quantitative psychiatric
and neurological researchers.
18. Heidegger (1962). Of Of course, Heidegger also privileged the mood (?) (?) of
caring, which is as much a social relation as a neurological
neurological state.
metaphors are elaborated
19. These metaphors Shannon and Weaver
elaborated in Ronell (1989), Shannon
(1962), Wiener (1948), and Wiener and Schade (1965). ·
Though why they are not
20. Though not considered
considered as important
important in cognitive psychol-
psychol­
ogy is a good question.
question. For a summary
summary critique
critique of neurotransmitters
neurotransmitters as being
ever more numerous therefore too complex to model, see Charlton
numerous and therefore Charlton
(1990),
21. PET studies of memory include those by Fazio et al. (1992) and Heiss et
al. (1992). Perani et al. (1992) argued that that PET demonstrates
demonstrates the clusters of
cerebral areas associated with with different memory function components,
memory function components, “in "in
agreement with
with ‘neural network* models of the neural basis of cognition, ac-
'neural network' ac­
cording to which complex functions are subserved by multiple interconnected
interconnected
structures” (p. 903).
cortical and subcortical structures"
related to regulation
22. An area related regulation is coordination.
coordination. How
How do all of these highly
specialized circuits work
work together? Kosslyn, in Wet Mind, posited (in the final
20 pages) a “decider” that weighs each decision, taking
"decider" circuit that taking into account
emotional weight. Other
emotional Other researchers use different metaphors:
metaphors:
[Steven
[Steven E.] Peterson favors "a localized region or a small number of lo•
lo­
regions,” where
calized regions," whete perceptions, memories and intentions inte­
intentions are inte-

207
 NOTES TO CHAPTER
CHAPTER 6

grated, Goldman-Rakic
grated. Goldman-Rakic is leaning toward
toward a nonhierarchical
nonhierarchical model in
which “separate but
which "separate but equal partners
partners are interconnected,
interconnected, communicating
communicating
with other.” (Horgan
with each other." (Horgan 1993)
23. I hesitate
hesitate to use this metaphor
metaphor as current,
current, because it implies that other
that other
metaphors are outdated.
metaphors outdated. This book
book has been trying
trying to show
show that
that there
there are many,
contradictory, metaphors
often contradictory, metaphors alive at the same time, distributed
distributed unevenly.
24. PET is marketed
marketed to the NIH,
NIH, for instance, rather
rather than
than health
health maintenance
maintenance
organizations -so
organizations —so far. On
On the congressional declaration of the 1990s as the De-
congressional declaration De­
cade of the Brain, see Ackerman
Ackerman (1992).
25. See,
See, for example,
example, Haraway Hartouni (1991), Martin
Haraway (1991), Hartouni Martin (1990),
Rapp (1998), and
Rapp and Triechler (1999).

,;
r:.
208
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