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this doesn’t really happen with other materials. Concrete, by contrast,
struggles with this movement but excels in its metaphorical prowess.
The aggregates resonate with nature, locality, and cultural
associations, but also have a way of hiding, destroying, and
obfuscating them. It all depends on what you reveal as an artist. I feel
it is most resonant when its inertness is embraced. It isn’t alive
(although the self-healing component throws this into question). It is
an artificially engineered stone. And perhaps this is why using it for
Matter in Grey serves as a way of highlighting the artifice. The artifice
of a spectrum. Our concept of Alzheimer’s at this moment is also a
snapshot in time—a material construct.
There is also a considerable amount of editing and refining these
materials. With a pot, for example, you turn it and trim excess clay to
lighten it, to make it more functional and more visually appealing. This
also occurs with concrete. When I cleaved open the two panels there
was a roughness, an unsatisfactory quality. I put each panel through
a process of polishing, a very arduous and physical process. In
the end, the panels retained a sheen and glasslike texture. Here, I
like to think that I am making even more visible, what is already
present, giving more visual clarity but also imbuing the panels with
more luster and appeal. It is difficult to know whether I am
acquiescing to my innate desire to create beautiful objects or
suggesting the illusory sheen of spectrums. They both serve the
same ends!
FIG . 16
FIG. 16 Unpolished and polished concrete cores. Photo: Jacob van der Beugel
LK Again, I can’t help but see the similarities to scientific practices:
to create histological slides of the brains, you stain dead brain tissue
to display a pathological process; to understand and examine the
living. The corporeality has material properties that limit what can and
cannot become visible, but the way you treat it likewise allows for
different sorts of resistance to be perceivable or not.
JVDB It might be interesting at this point to discuss the constraints
of using spectrums and how this could relate to a wider practical
application. I would refer this question back to how I relate it to my
own art practice. There is no doubt that using spectrums or
gradations has had a massive impact on how I work. I see most
things in life and in my art as a process from one to the other, or as
being situated within a spectrum of choice or transition. On the
surface, this is quite a liberating perspective since it visualizes or
conceptualizes subjects with a degree of quiddity. It has an integrity
that I like. Conversely, I also regard it as a formal constraint. The
ideal way for me to portray something would be on multiple, perhaps
even infinite spectrums concurrently—I haven’t quite worked out how
to do this! Once you really acknowledge spectrums you also have to
resign yourself to not being able to depict them: perhaps only a
snapshot within one, amongst many. But how does this perspective
relate to action in art and diagnoses in disease pathology? In terms
of creativity in art, and maybe, Lara, you can elucidate if this chimes
with your academic experience, I have this strong sense that these
formal constraints act as creative pressure points that force you to
continually expand within these boundaries. And whilst these
frameworks may eventually crumble under the weight of novelty,
something positive happens for me when there are restrictions. It
might seem trite or random to think of traditional Japanese craft in
respect to this idea, but having been schooled in the pottery tradition,
it is a pertinent comparison. Given the rigid scope and aesthetic
practice of these crafts, some exceptional leaps have occurred that
seem to inhabit novelty and tradition all at once, pushing the craft
deeper into itself but to a new depth. In this respect, it is like
evolutionary biology: a pressure point seems to push an organism
onto a novel pathway, even with the aforementioned constraint intact.
The original form is still there in essence, but something feels new.
My understanding of spectrums is similar to these creative pressure
points. The formal structuring of these spectrums enables points of
arrival and departure. There is a truth to them but also the possibility
to go deeper into them or beyond. When turning to disease taxonomy
and other issues we have discussed I have a sense that there is a
synergy with this perspective. The spectrum allows for pressure
points to exist, which allow for entry into the disease, but also
emergency exits! Perhaps it creates a feeling of not quite getting the
diagnosis right and, that this is a tacit understanding of the illusory
nature of the constructed spectrum, allowing a small opening for
further research/practical actions.
LK I like the expression of pressure points and the productive nature
of uncertainty that you stress. But with regards to medicine, we also
need to ask: Who can bear the uncertainty? I am acutely aware that
it’s quite a privileged standpoint that I am taking when I praise—as
you do—the reflexive knowledge created by the feeling of doubt. In
practice, for patients or relatives waiting for a diagnosis, and also for
doctors, in particular young doctors who are not yet confident in their
knowledge and skills, doubt can be a very unpleasant, unsettling
feeling. For me, this is one of the major challenges when writing
about medicine and especially when teaching medical students: taking
this unpleasantness seriously while trying to show how it can lead to
reflexive knowledge, and how this again can be a resource for dealing
with and living through uncertainty. Do you encounter this dilemma in
your artistic practice or in the way people react to your artwork?
JVDB You are right to shift the focus to the perspective of doctors
and patients and, in my case, viewers. My instinct is telling me it is
slightly different. People can afford to test out uncertainties in the
arena that art superficially creates, perhaps softening the unsettling
transition to a more uncertain perspective. This is the magic of art:
the creation of a world that is experimental but at the same time still
firmly rooted in the real world. People are able to dip their toes into
new waters. Sometimes the temperature is more jarring, other times
it allows for a gradual acclimatization. In the situation you describe,
people are not afforded such a speculative luxury.
There is also another element to your question, which is people’s
relationship with uncertainty and doubt. I would love to know if we, as
a whole, are less capable of dealing with unpleasantness in general.
Again, this is just a gut instinct and perhaps I am blinkered by the
current polarization pandemic that eviscerates the middle ground:
gray, opaque, and uncertain. I have a sense that we are less well
adjusted to the gray and that we have inadvertently found ways to
reaffirm certainty and paper over the cracks of doubt. So that, when
it inevitably bursts through the dams we have created, it is all the
more unsettling.
5
Art as Mode of Inquiry
LK When I give lectures on history and philosophy of medicine, I
often face a dilemma of visualization. If I refer to scientific
representations and illustrations, I often get questions that seem to
me to address the scientific content itself rather than the reflection
upon this scientific content. If I don’t show pictures, however, many
people find it much more difficult to follow. I have tried to address this
problem in creating my own illustrations that focus on the meta-level
issue that I am addressing. For instance, I came up with a schematic
representation of historical reconfigurations in the classification of
Alzheimer’s disease. I noted that this worked particularly well
when communicating with scientists. Perhaps because my amateur
graphics resemble illustrations in scientific papers.
FIG . 17
FIG. 17 Graphical conceptual frameworks of classifying Alzheimer’s disease.
Adapted from Keuck (2020).
However, I always felt a bit uncomfortable when showing this
schematic to historians, who could easily see this as an overly
simplistic representation of a much more complex history. Recently, I
have also started to show artwork in my presentations, for instance,
in order to illustrate epistemic situations. I find this helpful and
inspiring. Yet I also have the feeling that I am to some degree
instrumentalizing artwork for my purposes, which might be
problematic in its own way. In the course of our conversation, I
sometimes had the same impression. On the one hand, your artwork
can be regarded as a mode of inquiry; I think it can be very nicely
used to illustrate some important elements of how scientific
knowledge is made and how it can be challenged. For instance, your
artistic representation of the scientific framing of the course of
Alzheimer’s disease makes the human activity in creating scientific
knowledge palpable. This, again, allows us to render the scientific
infrastructures, actors, and theories into objects of analysis, thereby
opening up the possibility that they are debatable, fallible, and
adjustable. What are decisions that have been made, how are they
shaping our understanding of health and disease, and what would
alternatives look like? Matter in Grey can, in this respect, be seen as
an entry point for opening up a metascape, in which such questions
about conditions, contingencies, assumptions, and alternatives can be
addressed. However, I am also aware—and you emphasized this
9
several times—that your main purpose is to create aesthetically
compelling artwork. How do you see the relationship of art and its
uses outside of art contexts?
JVDB Talk about saving the most difficult till the end! To answer this
partially I think beauty needs to be considered, just for a second. This
is often maligned in the art world, perhaps for good reason, and I
note you stated “aesthetically compelling” as a circumvention. It is
such a fragile and elusive quality, and there is a balance between
individual responses and more universal traits. I have always been
captivated by this property. I suspect it is a very normal thing to
engage with, nothing new here. What I can say is that the effects of
this quality, in my experience, do a couple of things. It can provide a
neutral arena to engage with subject matter in a nonthreatening way.
One is seduced into engaging with the subject matter that is depicted.
On reflection perhaps seduction isn’t so neutral after all, but the allure
enables a comfort or receptivity. Most interesting of all, is that for
something to be truly visually engaging or beautiful there needs to be
a small degree of disharmony within the harmony, something minute
that sows the seed of imbalance. There are countless examples from
art history of this; my favorite is Japanese Raku ware, where tea
bowls can be repaired with gold leaf, called kintsugi; the accidental
immortalized. Perhaps, the black serpentine stone aggregate that is
ever so slightly disruptive in the prevented row in Matter in Grey
is this disharmony. To conclude, the “visually appealing” is a fragile
balance of harmony, with some degree of dissonance. This is why I
mention beauty, because it specifically relates to spectrums but also
to wider applications.
FIG .
18
FIG. 18 Detail from Matter in Grey. The black serpentine stone disrupts the
preventative spectrum in the bottom row. Photo: Paul Riddle
To be able to comment on the relationship of art and external uses,
one needs to distill many different viewpoints into a homogeneous
whole—not something I am prepared or able to do. I do not position
myself as a disruptor with highly ideological narratives. If anything, I
feel like the artworks hold up a “material mirror,” in the words of
Daniel Miller (2005, 8), to a wider audience or to the researchers
who practice within the buildings. I do this in the hope that we can
take just a slow second to contemplate things, to create a fissure or
bardo where we can reassess what we thought we knew, through a
mirror that I have tried to artistically tinge as little as possible.
If you are asking whether art should be used for more illustrative
purposes, then this changes the nature of the debate. There are
countless examples of this being extremely fertile ground. I love
Waddington’s valley illustration (see Borck and Meunier in this volume,
figure 2B), and its subsequent contemporary reinventions. Obviously
not for its accuracy but for the fact that it cast new light and created
a new way of seeing. My answer would be that every artwork comes
with its own insights, idiosyncrasies, limitations, and suppositions,
which can serve research but also highlight its problems. I dare say
Matter in Grey will suffer the same fate. So use them at your own
peril!
LK What a literally beautiful reflection to end with. Thank you,
Jacob.
1 The text grew out of a recorded and transcribed conversation about ’s
work Matter in Grey and its resonances with ’s work on gradualist
approaches to disease generally, and specifically Alzheimer’s. After
presenting the project at the September 2023 authors’ workshop in Berlin, the
authors edited, cut, rearranged, and added text, structured it along the section
headings, and included photographs of ’s works. This draft was
presented at a second virtual authors’ workshop. Following helpful comments,
in particular by Gideon Manning, Alfred Freeborn, and Elizabeth Hughes, the
authors included some excerpts of ’s work, expanded sections, and
polished the draft. Footnotes were added but kept to a minimum; they are not
intended to represent the academic state of research in history and
philosophy of medicine or art history, but simply to provide references to work
that is mentioned in the dialogue or to former work of and to which
their statements implicitly refer.
2 See, for instance, these works from Vendruscolo’s lab: Freer et al. (2016)
and Rosie Freer et al. (2019). See also: http://www.vendruscolo.ch.cam.ac.uk/
research.html (Accessed: May 6, 2024).
3 For the argument that the initial classification of Alzheimer’s disease was
exploratory, see Keuck (2018).
4 On the application of theories of vagueness to gradualist approaches to
health and disease, see Keil, Keuck, and Hauswald (2016a).
5 On interest-relative vagueness in the context of disease classification, see
Hauswald and Keuck (2016).
6 On the critique regarding the expansion of contemporary psychiatric
classification, see Keuck and Frances (2016). On the expansion of the
definition of Alzheimer’s to include people without clinical symptoms, see
Keuck (2020) and Daly and Keuck (2024).
7 For a discussion of this point related to the value of vagueness in medicine
and psychiatry, see Keil, Keuck, and Hauswald (2016b).
8 Borrowed from the 2022 film of the same name.
9 On different understandings of health and disease that are reflected in
contemporary debates on Alzheimer’s disease, see Keuck and Freeborn
(2020) and Daly and Keuck (2024).
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