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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5553_Библиотеки_им_академика_М_И_Перельмана
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determining in what fashion and direction the single [staining and
fixation] solutions impact the tissue. But pathological anatomy cannot
wait until this difficult question is solved. In the meantime, it has to
deal with pictures of equivalence, that is to say, it has to compare the
pathological tissue with normal tissue that have both been subject to
the same chemicals in the same way” (Alzheimer n.d., 1; trans.
Keuck 2017, 26). That notion of pictures of equivalence really struck
me. It did so not only because of its epistemological underpinnings for
understanding the anatomy of mental disorders but also because it
shows how much the establishment of the “normal” and the
“pathological” was a materially guided, practical issue.
In your work, the relationship between the appeal of metaphors
and the practical issues surrounding materiality seems to play an
important role. Can you tell me more about your choice to work with
concrete blocks?
JVDB Materiality is central to all the projects that I do. My
overarching belief is to use materials we are intuitively familiar with,
clay and concrete for example, so that complex scientific advances
can be anchored physically. Perversely, the more durable the
material, the better the anchoring, as Daniel Miller (2005) has
observed.
I had completed an epidemiological art commission that looked into
blood cancers. In it I had used concrete and the metaphor of
concrete cancer, which is when concrete degrades due to water
ingress, rust, and structural failure, etc., as a way of depicting blood
cancers and people’s pathways. It dawned on me that concrete is
formed from aggregates: all sorts of different stones, sands, and
cements ranging in grading and scale, so that the interlocking matrix
acts as a human-engineered glued stone. When I had discussions
with Vendruscolo, he talked about misfolding proteins and the
aggregation of these misfolding proteins as being central to the
progression of Alzheimer’s. These discussions about aggregating
proteins triggered an idea that centered on building a language
around aggregates and using the aggregates in different ways to
intimate progression and decline. So that was the starting point for
the commission. It then fell to me to work out a visually coherent way
of describing this decline as a continuum. One of the ways I did this
was to start with a panel that represents a normal person’s spectrum
of health that then starts to visually age, if there is such a thing
as a standard model of aging or health decline.
FIG. 2 Matter in Grey panel detail from the middle of the natural aging spectrum.
Photo: Jacob van der Beugel
I then created the end panel with holes, gray in hue, empty.
Then I mixed increments of the normal panel with the Alzheimer’s
panel in order to get different gradations to that point, very much like
line blending in ceramic glaze practices. It brings to mind the
continuum fallacy or the Sorites paradox: When does one thing
become the other? This was an aesthetically pleasing way of
depicting a spectrum.
FIG . 2
FIG . 3
FIG . 4
FIG. 3 Matter in Grey panel detail from the end of the untreated Alzheimer’s
spectrum. Photo: Jacob van der Beugel
FIG. 4 Eleven-step line blend with red and blue for ceramic glazes (Au 2015)
The gradation is one of color, aggregates, and then also other
kinds of ceramics with holes in them that suggest a cellular decline.
So you go from the fleshy pink color, which we usually associate with
good health, to a gray endpoint, which has holes and is symbolic of
decline. I used the same material spectrum for the Alzheimer’s row,
but with the starting point already slightly grayer, and then ended with
more holes and a quicker deterioration of those ceramic cells or
ceramic neurons. Then I applied the same logic to the treated
spectrum and prevented spectrum. In the treated row there was an
element of degradation, but that decline was much, much slower. I
added self-healing concrete in the form of expanded clay particles
that contain bacteria that precipitate calcite under the right conditions.
As the condition becomes increasingly difficult to treat, the medication
(the self-healing particles) starts to overwhelm the concrete matrix.
I find the use of self-healing concrete metaphorically intriguing.
Part anthropomorphization, part physical process. This regenerative
metaphor is akin to the elixir of life, the holy grail of medicine. Yet, in
the context of this piece, it becomes another element that
overwhelms.
FIG. 5 Matter in Grey treatment panel detail. The small black particles represent
self-healing capsules. Photo: Jacob van der Beugel
In the prevented spectrum, I encased the cells of the neurons in a
protective clay. So each cell is surrounded by an impenetrable
barrier, suggesting that it is protected from the consequences of
aggregation.
FIG . 5
FIG . 6
FIG. 6 Detail of the first panel in the prevented spectrum of Matter in Grey. Photo:
Jacob van der Beugel
The process for casting the panels also became symbolic. I poured
the concrete, containing the correct proportions of aggregates, into a
mold about 50 centimeters long and about 40 millimeters thick. Once
it had cured, I sawed through the concrete along its thin side with an
enormous stone saw. This was done in a stonemason’s yard who
cuts funereal tombstones—quite apt really. It’s almost like an autopsy
of the brain. You slice it open, and you have a doubling of very fragile
panels.
LK Autopsy has played a vital role in diagnosing Alzheimer’s
disease. It really formed the diagnosis as an exploratory category. It
was the goal of Alois Alzheimer’s research program to show that
pathological anatomy could help to better the clinical diagnosis in
psychiatry. Patients whose clinical diagnosis had proven difficult were
tracked down, and after their deaths he had their brains sent to his
laboratory to fix, slice, stain, and examine them under the
microscope. He was convinced that the identification of characteristic
alterations in their brains could indicate how clinical cases could be
ordered into more fitting categories. Publications that would become
known as first descriptions of Alzheimer’s disease feature
descriptions of clinical courses alongside descriptions or drawings of
microscopic plaques and tangles in the deceased patients’ brains.
Drawings that indeed show striking similarities to your made-up
aggregates in the blocks of concrete.
3
FIG . 8
You were saying the more you learn, the more critical you get. I
would be interested in knowing more about how this learning process
is tied to your own artistic work, to your practices of translating
biomedical theories and metaphors into blocks of concrete. Would
you say that you take scientific ideas and techniques literally, or how
would you describe your own stance?
JVDB I usually recoil at the idea of thinking that I’m a kind of conduit
for a researcher’s perspective. Because ultimately that’s not why I’m
doing this. But for this commission . . . I think it’s one of the few
pieces—or the only piece—I’ve ever done where I didn’t have my own
ideological angle from the outset. Once I’d finished the piece, I didn’t
feel like I had added anything to the debate. And yet, it still endures
as an artwork. By the end I thought, “Is Alzheimer’s really
preventable or just, at best, treatable as a chronic condition? Isn’t
prevention illusory?” However, in retrospect, I created the spectrum
of prevention with cells that had these protective bands around it.
Initially the bands are thick, robust, and impervious. Moving across
the spectrum, the protection—or the encapsulations—become thinner
until they’re delicate to the point that they could break down entirely.
This was a way of introducing the idea of entropy—things are always
on a spectrum of decline. At the very last moment there is an
introduction of an aggressive black aggregate of red serpentine stone
(also highly symbolic) to suggest that there would always be
something else—the specter of unintended consequences. So
maybe I do myself a disservice in saying there wasn’t a conceptual
slant from my perspective!
FIG. 7 Detail of the last panel in the prevented spectrum of Matter in Grey. Photo:
Jacob van der Beugel
FIG . 7
FIG. 8 Hand-drawn microscopic image of a stained slice of the brain of a
deceased patient who had suffered from severe symptoms of dementia. P indicates
a plaque (Alzheimer 1911, table IV, fig. 1).
LK How did the researchers react to that?
JVDB Oh, I never told them. Artist’s prerogative!
2
The Artificiality of the Spectrum
LK When describing how you crafted a spectrum, you mentioned
the Sorites paradox, which is an ancient paradox about a heap of
sand. The question of the paradox is: How many grains of sand can
you take away before it is no longer a heap? One single grain of sand
doesn’t make a difference, but there are of course times when there
is a heap of sand and times where there is not enough sand to form a
heap.
In the original paradox, the grains of sand are seen as
interchangeable. In contrast, you are working with quite
heterogeneous materials and you show how complex your blocks of
concrete can be. To my mind, this makes them much more akin to
diseases that exhibit not only vagueness of degree (like in the Sorites
paradox) but also combinatorial vagueness, meaning that it is unclear
which features necessarily have to be assessed (in other words,
questioning whether there is a clear universal meaning of a heap).
What did your material choices add to the idea of a spectrum? How
did they help you visualize not only the problem of the tipping point of
vagueness of degree between health and disease but also, more
fundamentally, the combinatorial vagueness of what is at stake. What
did your practice teach you about the paradox? Put differently: What
did you need to do to create a convincing spectrum?
4
JVDB That’s the core of this discussion. I think about this an awful
lot, probably too much! Because everything I do seems to actually be
about creating a visual and textural spectrum. With this piece, I
needed to break down the installation into manageable parts. So
there are 58 panels in one row, but actually it’s a spectrum of 29
because it mirrors onto the other side; a result of cleaving open one
concrete block into two panels. I needed to, in essence, find a
convincing way of breaking the spectrum down into component parts.
And the question was how many component parts do I break it down
into in order to cover the space—the physical architecture of the
building? But if there are too many parts, which of course produces a
more visually convincing spectrum because each step becomes more
imperceptible, it becomes unmanageable as a piece. You would also
get very narrow panels that wouldn’t actually be visually attractive.
And where do you stop? That’s the continuum fallacy. So the goal
was to find a practical breakdown of the space into manageable
parts that were still able to depict a convincing visual textural
spectrum. And so, there was a balance between what I could
technically do whilst remaining appealing to the eye.
I found all sorts of interesting other things along the way, because
when I placed panels next to each other without a break, you could
very clearly see a difference in color and texture.
FIG. 9 Matter in Grey without bars makes the spectrum appear less convincing.
Photo: Jacob van der Beugel
FIG . 9
This felt unsatisfactory. But I realized that if you insert a border in
between them, the spectrum starts to look incredibly convincing
because there’s a visual break; the brain fills in the gaps. And
that was a fascinating lesson. Ironically, it sets up an amazing
analogy for disease progression and classification. Diagnosing or
situating the disease within a disease spectrum is categorizing on a
continuum.
FIG. 10 Matter in Grey with bars placed between the blocks of concrete creates a
more appealing spectrum by introducing visual breaks. Photo: Jacob van der
Beugel
LK So would you say that these artistic experiences undermine the
difference between a spectrum and categories? Or how would you
formulate the question that these insights pose to our thinking about
and acting with categorial or gradualist concepts of disease?
JVDB There is a question of the resolution: Are there specific
resolutions that make different disease states appear to be on a
spectrum and others that make it appear more categorial?
What is the aim of diagnosticians? Do they prefer rigid boundaries
to guide their actions or not? Do they imagine the disease to be on a
spectrum or categorial? Depending on their beliefs they will find
different resolutions more convincing or not.
LK From my historical and philosophical perspective, I would very
much agree. One important source of the vagueness is that the
definition of reference standards for setting looser or stricter
FIG . 10
boundaries is interest-relative. In modern medicine, negotiations
about the right granularity of grouping cases, and the reasons for
lumping or splitting categories, for advocating a spectrum or clear-cut
boundaries, are commonplace.
Your work can help a person reflect on the limitations of imagining
an ideal continuity. On the one hand, the idea and the aesthetics of a
spectrum have something that is instantly appealing; on the other
hand, this might disguise some of the dangers that come with that.
Because of course there are some implications when boundaries are
drawn but also if you imagine there to be a borderless continuity.
Classifications guide actions. If the continuity between severe,
eventually lethal, symptoms of disease and ever milder, potentially at-
risk but potentially also reversible states is stressed, then this claim
of continuity might help researchers get funding and expand markets
for diagnostics and therapeutics. It could, however, also cause
severe stress to not-yet-patients and the allocation of resources in
health systems.
Boundaries matter, but so does the lack of boundaries. There
might be something deeply unsettling about it. Your work
demonstrates that a spectrum can be just as artificial as categories.
You have shown me, for instance, your experiments with colored
ceramic blocks; if blocks of the same color are doubled up, the
spectrum becomes less convincing and the eye sees more
boundaries. Why is this insight so important to you?
5
6
FIG . 11 AND 12
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