Is Seeing Believing?

Isn’t it interesting that some of us can look at a forest and miss the wind riffling through the leaves, while others see the moon as a ‘ghostly galleon tossed upon cloudy seas’? What determines what we see? Does it have to relate to something we’ve seen before -patterns that we recognize? Is our apprehension of reality an expectation? A sorting through the chaos and discarding what we don’t understand -the noise– until something more familiar emerges? Why do we not all see the same thing?

If patterns are what we are evolved to see, if they are what we use to make sense of the world, are there always patterns everywhere? These are things I wonder about, now that I have time to wonder. Now that I am retired, I suppose I can wade more thoughtfully into the turbulence I once found swirling about my days. Clarity is certainly not a common property of old age, but occasionally it descends as softly as a gossamer thread, and then as quickly drifts away leaving only traces of its presence. Doubts about its visit.

Are these mere hints of what the gifted see? Is peering beyond the horizon just a gift, or is it fleeting and unstable unless learned? There was an interesting essay in Aeon, an online offering that touched on the subject of insightful examination, by Gene Tracy, the founding director of the Center for the Liberal Arts at William and Mary in Williamsburg, Virginia: https://aeon.co/essays/seeing-is-not-simple-you-need-to-be-both-knowing-and-naive

‘When Galileo looked at the Moon through his new telescope in early 1610, he immediately grasped that the shifting patterns of light and dark were caused by the changing angle of the Sun’s rays on a rough surface. He described mountain ranges ‘ablaze with the splendour of his beams’, and deep craters in shadow as ‘the hollows of the Earth’. […] Six months before, the English astronomer Thomas Harriot had also turned the viewfinder of his telescope towards the Moon. But where Galileo saw a new world to explore, Harriot’s sketch from July 1609 suggests that he saw a dimpled cow pie.’ And so, the question must be asked, ‘Why was Galileo’s mind so receptive to what lay before his eyes, while Harriot’s vision deserves its mere footnote in history?’ But, as the author notes, ‘Learning to see is not an innate gift; it is an iterative process, always in flux and constituted by the culture in which we find ourselves and the tools we have to hand. […] the historian Samuel Y Edgerton has argued that Harriot’s initial (and literal) lack of vision had more to do with his ignorance of chiaroscuro – a technique from the visual arts first brought to full development by Italian artists in the late 15th century. By Galileo’s time, the Florentines were masters of perspective, using shapes and shadings on a two-dimensional canvas to evoke three-dimensional bodies in space. […] Harriot, on the other hand, lived in England, where general knowledge of these representational techniques hadn’t yet arrived. The first book on the mathematics of perspective in English – The Art of Shadows by John Wells – appeared only in 1635.’

But is it really as fortuitous as that? As temporally serendipitous? Tracy makes the point that, at least in the case of Science, observations are ‘often complex, contingent and distributed.’ And, ‘By exploring vision as a metaphor for scientific observation, and scientific observation as a kind of seeing, we might ask: how does prior knowledge about the world affect what we observe? If prior patterns are essential for making sense of things, how can we avoid falling into well-worn channels of perception? And most importantly, how can we learn to see in genuinely new ways?

‘Scientific objectivity is the achievement of a shared perspective. It requires what the historian of science Lorraine Daston and her colleagues call ‘idealisation’: the creation of some simplified essence or model of what is to be seen, such as the dendrite in neuroscience, the leaf of a species of plant in botany, or the tuning-fork diagram of galaxies in astronomy. Even today, scientific textbooks often use drawings rather than photographs to illustrate categories for students, because individual examples are almost always idiosyncratic; too large, or too small, or not of a typical colouration. The world is profligate in its variability, and the development of stable scientific categories requires much of that visual richness to be simplified and tamed. […] So, crucially, some understanding of the expected signal usually exists prior to its detection: to be able to see, we must know what it is we’re looking for, and predict its appearance, which in turn influences the visual experience itself.’

‘If the brain is a taxonomising engine, anxious to map the things and people we experience into familiar categories, then true learning must always be disorienting. […]Because of the complexity of both visual experience and scientific observation, it is clear that while seeing might be believing, it is also true that believing affects our understanding of what we see. The filter we bring to sensory experience is commonly known as cognitive bias, but in the context of a scientific observation it is called prior knowledge. […] If we make no prior assumptions, then we have no ground to stand on.’

In his opinion, there is a thrust and parry between learning to see, and seeing to learn. I have no trouble with that, but I have to say that Science is only one Magisterium in a world of several. Science is neither omniscient, nor omnispective.

I happened across a friend standing transfixed in the middle of a trail in the woods the other day. A gentle breeze was coaxing her hair across her face, but her eyes were closed and she was smiling as if she had just been awarded an epiphany.

At first I wondered if I should try to pass her unannounced, but I suppose she heard my approach and glanced at me before I had made up my mind. Her eyes fluttered briefly over my face for a moment, like birds investigating a place to perch, then landed as softly as a whisper on my cheek.

“I… I’m sorry, Mira,” I stammered, as surprised by her eyes as her expression. “You looked so peaceful, I didn’t want to disturb you…”

Her smile remained almost beatific, rapturous, but she recalled her eyes to brief them for a moment before returning them to me. “I was just listening to that bird,” she said and glanced into the thick green spaces between the trees to show me where, “when I felt the breeze…” I have to say, I hadn’t noticed anything -I hadn’t even heard the bird. “…And it touched my forehead like a kiss,” she said, and blushed for describing it like that. She closed her eyes and thought about it for a moment. “I can’t think of another word,” she added, and slowly walked away from me with a wink, onto a nearby path.

I don’t think that what she was saying was Science, or even meant to require a proof, and yet I felt far better knowing there are people like her in my world. I think I even felt a brief nuzzle by the wind as I watched her disappear into the waiting, excited fondle of the leaves.

 

 

 

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Hi, Heels!

I find it interesting that I can be so blind to something I see every day. How it can fade so completely into the Gestalt, that it is invisible. Not there.

Is it just me, or do we as a species, always attempt to accommodate to that which is constantly present –block it out like persistent odours- to make room in our heads for other sensations that may be more important for our survival? And yet, we don’t seem to be able to block all things out –patterns for example. We see patterns everywhere –we even invent patterns where there aren’t any- so it strikes me as odd that we can afford to ignore other things which might be even more malevolent. Is it just a matter of getting used to them, once we decide that they mean us no harm? Or, like taking off a pair of glasses, do we simply defocus them so they blur into the background with everything else?

It’s the unpredictability that bewilders me, I think. Why do some things persist, perhaps with only minor variations, while others seem to feel the need to change attire at the slightest whim -or even jump ship entirely? Disappear so thoroughly from sight that what once was common becomes laughable on review? Creepy –until, Phoenix-like , they rise again from their still-smoldering ashes, and mutton-chop sideburns, bell-bottom trousers, or even Afro haircuts are flaunted as if they were newly invented, and we get used to them all over again.

But do we ever get tired of beauty? Or does it have to dress itself up in constantly changing fashions to get our attention? So we don’t take it for granted? So we still regard it as having beauty? Is fashion just a trick to keep us on our toes? And, when is fashion no longer fashion? Is it just when we fail to notice anymore? Then what is it…? Invisible again? There’s something suspiciously circular in that. Suspiciously desperate. Meaningless.

Do I seem petulant about this –or at least leery of being clasped in fashion’s capricious arms? Perhaps it’s my age –although I seldom succumbed to the siren call even in my youth- but I remain genuinely puzzled at its grasp. Some things –like the styles of dresses or ties, as examples- seem sufficiently banal or entertaining to accept with little more than an inquiring glance and perhaps a shrug, while others… Others verge on the bizarre, the dangerous –all, no doubt well-intentioned, seemed-like-good-ideas-at-the-time inventions, and yet in the often unkind light of retrospect, unwise.

The Victoria era corset springs readily to mind. Worn by both sexes to slim the waist, it is better remembered as a device to mould women’s figures into some arbitrarily ideal hourglass shape. And in extreme cases, or with extended use, had deleterious effects on health by restricting the diaphragm, and unduly constricting the abdominal organs. Fortunately, in Western societies at least, they now seem to be confined to museum manikins labelled and planted behind glass like old photographs. Lesson learned…

And yet we may not have learned. There is another fashion as accepted as the corset in its time, and unless exaggerated, as invisible. As unremarked. I refer, of course, to heels –high heels. Once in the exclusive domain of men, they shifted into that of women, as I learned from a CBC article: http://www.cbc.ca/news/health/high-heels-health-and-popularity-1.4458020

‘[..] high heels have been popular for centuries, and were originally worn more by men than by women. “I dated the origin of the heel as far back as the 10th century in Persia,” said Elizabeth Semmelback, senior curator at the Bata Shoe Museum in Toronto. “They seemed to have been invented to keep the foot in the stirrup,” she said. “It allowed men on horseback to wield heavier weaponry, to be more successful at warfare, and so they really were a military tool.” From soldiers, the high heel eventually became the footwear of kings. But by the end of the 19th century, the style became fashionable for women only. Over the decades, high heels, and especially stilettos, became synonymous with sexuality […].’

There are those who might defend their use as a way to even out uncomfortable height discrepancies –my first date to a prom with an even shorter girl, for example- but by and large they are just a fashion statements. They are expected in certain circumstances, impractical in others.

But ‘Long-term wearing of high heels can have long-term medical effects for the entire body, said foot specialist Kevin Fraser, a pedorthist at Sunnybrook Health Sciences Centre in Toronto.  “Wearing high heels is going to force us to flex our ankles downward, a downward direction, straightening our knees as well as extending the back,” Fraser said. “That can create a whole host of complications within joint levels in the back all the way down to the feet.” People can experience problems ranging from bunions to osteoarthritis, he said.’

I suppose the reason I was even tempted to read an article on high heels stemmed from an incident on a bus –or, rather, off a bus- a few days ago. I was coming home from an evening meal at a downtown restaurant and it was raining quite heavily so people on the sidewalks were being careful about where they stepped. Sidewalks can be dangerous even at the best of times, especially for the elderly –there are cracks and uneven surfaces lurking in shadows cast from street lights at night, or under puddles in the rain.

My particular bus travelled past a seniors home in a posh neighbourhood, and that evening there must have been a concert that had lured several elderly ladies downtown in the evening despite the weather. The bus was noisy and unusually crowded for that time of night, so there were no seats available -the only place I could find to stand was in the aisle opposite the door.

There were two especially well-dressed women seated beside me, chattering excitedly about the music they’d heard, when one of them noticed they were near their stop. As they got up to leave, the bus was still moving, and I noticed one of the ladies wobbling as she stood. From her expression, I don’t think it was alcohol, so much as her unfamiliarity with the length of the heels she had chosen to wear. I suppose they were fashionable, but she seemed rather unstable in them, so I reached out to steady her as she exited the bus onto the curb. As soon as I let go, however, her ankle seemed to give out at an odd ankle and she fell, screaming into her friend.

Unfortunately the door to the bus closed at that point and the bus began to pull away, despite my efforts to notify the driver and keep it open. I was left watching through the window at her being picked up by her friend, unable to put any weight on her foot.

The point of the CBC article was to point out discriminatory dress codes in workplaces such as restaurants that require their female employees to wear high heels. They are considered a sign of being ‘dressed up’, and so prevalent that it is usually unquestioned. Like a tie on a man, the heels on a woman may be an expected accoutrement in some circumstances. Fair enough, I suppose, and yet I wonder if that poor woman on the bus might now have second thoughts about what should be deemed appropriate… I think I would.

Let Every Eye Negotiate for Itself

We are very attuned to patterns, aren’t we? We see them even when they aren’t there, filling in the lines, reading the shadows to complete the image. But does the face we see in the play of light on forest leaves, or the finger in the sinuous beckoning of the windblown grass really fool a mind that can do mathematics in its head? Or is it just a brief dalliance, a foray into a theatre for a moment or two? A titillating fantasy that fades when the eye moves on to other, more important, things?

A stereotype is a pattern too, but more deeply etched, and coloured so convincingly it is mistaken for the thing itself. Not recognized as a simulacrum, it is treated as archetypal, requiring few, if any, revisions –so self-evident it is almost a causa sui. And yet, hic sunt dracones, to continue the Latin –here be dragons- for stereotypes are, by default, fancifully-charted territories. Like incomplete maps filled in with imagined beasts, they are not reliable guides. They do not help.

And yet they are so prevalent, it is often difficult to recognize them, let alone extract them from the gestalt. So they persist, and like a Where’s Waldo face, only emerge from the background if we make a concerted effort to find them. But usually, there has to be a motivation to look –something that shakes us from our apathy. Our indifference.

It’s so easy to slip into somnolence, isn’t it? So easy to let things pass us by unexamined as long as they don’t threaten to disrupt our day. And yet, to escape the pastel hues in which our waking hours are often painted, it is sometimes an adventure to search for the chiaroscuro hiding in plain sight.

There was a delightful article I noticed a while back that managed to open my eyes again: http://www.bbc.com/news/world-latin-america-38132503

It recounts the story of a a 19-year-old woman from Guatemala who designs clothes for people with Down’s syndrome. The thing is, ‘Before she was an internationally-recognised designer, Isabella Springmuhl says she was rejected by two fashion schools in her native Guatemala because she has Down syndrome. “They said I would not be able to cope,” recalls the 19-year-old. But that rejection was exactly what Isabella needed to turn her life around […].’

So, instead, her mother took her to a sewing academy that would accept her. ‘While learning how to sew, Isabella was asked to design outfits for worry dolls – traditionally hand-made dolls originating from Guatemalan and Mexican folk traditions. The tiny dolls are usually put under children’s pillows in the hope that they will take away their sorrows while they sleep.

‘Isabella took a different approach.

‘”Isabella didn’t want to design clothes for… finger-sized dolls,” says Mrs Tejada [her mother]. “She created life-sized dolls and dressed them in the colourful embroidered jackets and ponchos that she’s now famous for.”

‘Isabella moved from designing for dolls to people, and soon enough produced a collection that gained the attention of the fashion world. Earlier this year, she became the first designer with Down’s syndrome to take part in London Fashion Week.’

But it didn’t stop there. Isabella points out that her main inspiration for designing arose after a struggle to find well-fitting clothing for her body type.

“It was difficult for me to get clothes,” Isabella says. “We have a different body constitution; we are shorter, wider, or very thin. My mother always had to fix the clothes she bought for me. So I decided to design clothes that fit people with Down’s syndrome, plus I really love Guatemalan textiles and the diversity of colours and textures they represent.”’

Wow! I get a shiver down my spine when I think of the odds that Isabella was willing to tackle. But, I wonder if she ever thought of them as odds, or merely as challenges that needed extra effort each time they arrived. Not only are there rivers to ford as a young person hoping to succeed in a highly competitive field, but the water sweeps all but the most determined, the most talented, downstream with barely a ripple.

But what am I? asks Tennyson, An infant crying in the night, An infant crying for the light, And with no language but a cry. I doubt that Isabella ever thought of herself like that. From time to time, there arise those exceptional people who do not understand the concept of failure. Who do not doubt or lose their way. Who are so confident in themselves, no matter the circumstance, that they press on and build on what they know they have, and are ingenious about what they don’t.

Stereotypes fail these individuals, as they do anything unique. How can you epitomize a Caesar, or cage a Churchill? How can you oversimplify a courageous person? How to paint the journey of a cloud? Tennyson, again from In Memoriam A.H.H:

The hills are shadows, and they flow

From form to form, and nothing stands;

They melt like mist, the solid lands,

Like clouds they shape themselves and go.

And so, how to stereotype a syndrome? In Down syndrome, or trisomy 21, there is an extra (part or whole) chromosome 21, which causes an assemblage of physical and intellectual features, including a characteristic, recognizable, but variable facial dysmorphia. It is the latter that may prejudice unthinking employers into feeling that they couldn’t cope, that the individual could never fit in, or perform like the rest of their employees –or other students, in Isabella’s case. But they were wrong.

Creativity knows no boundaries; we all fit somewhere on a spectrum –individuals with Down syndrome included. And imagination, like courage, does not stop at the edge of a chromosome.

Let every eye negotiate for itself, says Shakespeare’s Claudio in Much Ado About Nothing, And trust no agent, for beauty is a witch against whose charms faith melteth into blood.

I think Isabella is a beautiful person, don’t you…? And how do you stereotype that?

 

 

Prove it!

If there’s one thing that a long life has taught me, it is that most of us seldom stray far from the path. Once launched, our trajectory is largely predictable. I suppose this is necessary for co-existence –that there are societal norms is, after all, what binds us together as a group. Knowing what people want –what they are comfortable with- makes it possible to plan ahead with a reasonable expectation of success.

And yet, what if circumstances change? Even Science admits it runs on statistical probabilities. Nothing is forever the same, despite our expectations; despite the hopes of even the most enlightened that it will not deviate too much from that to which we have become accustomed. But progress depends on change, depends at least on altered perspective. That someone can look at the same data and interpret it differently –see different patterns in it, perhaps, or even apply it to something entirely different- is what we have come to expect of our modern world.

But there is often an inter regnum, that can be confusing -a time before the paradigm shift is complete; when wisdom, -no, expectations– demand that we judge the results of whatever investigations we have done, in the light of what the past, or experience, has taught us. And as a consequence, not only do we limit our inquiries to those things that seem to prop up those views, but we discard, or criticize data that fail to validate them. Same information, different eyes. It’s often called the Confirmation Bias and I’ve written about this in one form or another before: https://musingsonwomenshealth.com/2015/05/15/the-polarization-bias/

The problem is that it seems to be a Mobius strip, and the same data are used to prove opposite contentions. There are rules that can be applied, of course –methodologies that help to sort out interpretive biases:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126323/  but it’s all too easy to fall back on what seems natural to us: to assume that what has been found either substantiates what we believe it should, or to criticize it for its presumed deficiencies or mistakes if it does not.

There seems to be no end to the variations on that all too familiar theme. It’s certainly not unknown in Medicine, and a recent example springs to mind.

I remember Jerra -partly because of her unusual name, I suppose. When I saw it on the office day sheet, I assumed it was a typo and thought I would correct it as I introduced myself to her in the waiting room. She was the first patient booked for the day and none of the few other early-risers in the room looked anywhere near 62.

“Jerri,” I said with a smile, walking directly over to a thin, grey-haired woman sitting bolt upright in the only chair by the window. Her first reaction was to assess me from head to toe with hostile green eyes that, had they not been restrained, might have attacked me as I approached.

“It’s Jerra,” she said, ice congealing on the words as they approached my ears.

I blushed. “I’m sorry, Jerra,” I stammered, embarrassed at my rash decision to modify it.

“And it’s Mrs. Tandill…” she added haughtily, refusing –or perhaps not deigning– to shake my extended hand.

The waiting room went quiet, all eyes on us, as she followed me reluctantly across what now seemed a long hike over the floor and down the corridor to my office.

Once inside, she glanced quickly at the sculptures, and plants, and repositioned the chair further from my desk. She did not want to be here, and was letting me know in the bluntest possible way.

“You seem uncomfortable, Mrs. Tandill,” I said when she seemed settled in her seat. “I’m sorry we got off to a rather rough start…”

“So am I, doctor,” she said, still glancing around disapprovingly at the art work hanging on the walls. “I am only here at the behest of my GP, you understand.”

I smiled, hoping to diffuse the tension, but her face didn’t change. She was an attractive, if severe looking woman. Dressed in a loose black silk dress that brushed the tops of her shoes when she walked, tiny silver hoops in her ears, and a matching silver brocaded scarf that hid her neck, she carried herself like royalty. Even her short, greying hair sat regally on her head like a tight-fitting crown, not a curl out of place.

And me? I was still dressed in my OR scrubs –albeit freshly changed- after an unscheduled 8 AM Caesarian section that made me late for the office. The stark contrast with her apparel and the thwarted expectations of how a new specialist should present himself may have stoked her anxiety with the visit.

“My GP says I need a hysterectomy,” she said, suddenly glaring at me like a vexed mother with her child.

I checked the very thorough history her GP had sent with the consultation note. Jerra had presented to her with postmenopausal bleeding, years after her periods had finished. She had sent her for an ultrasound which had confirmed that there was a thickened lining in the uterine cavity, and had even done a biopsy of the tissue. The pathology report of the biopsy did not find cancer, but rather an overgrowth –hyperplasia- that can be a precursor to cancer.

Jerra was still staring at me when I looked up from the computer screen. “Dr. Hannah gave me a copy of the pathology report, doctor,” she said, sternly. “And I researched it further.”

“And what did you find, Mrs. Tandill?” I needed to know what she had read before I could put the results into some sort of context for her.

Her body seemed to relax at being given an opportunity to discuss it, but I could see her face was still wary. On guard. “First of all, that there are several types of hyperplasia” –she pronounced the word very carefully- “… and that some types are further along the spectrum towards cancer.”

I nodded slowly, not wanting to challenge her interpretations unless warranted.

“The type that seems most predictive of cancer, is the abnormal hyperplasia…”

Atypical,” I interjected, just so she’d know I was listening carefully, I suppose.

She managed a rigid, if fleeting smile. “Atypical. Thank you.” She referred to some notes she’d folded into her purse. “That word was not mentioned in the report, and I even showed it to a friend of mine -who is a nurse- and she agreed.” When I didn’t object, she lashed out at her GP. “I’ve been going to Dr. Hannah for several years now, and I usually trust her judgement, but I think she’s made a mistake here… I’ve never been on hormones,” she added as a kind of preemptive rebuttal of an accusation she expected to hear. “She says the biopsy may have missed a more… atypical area and so to be safe, I should have my uterus removed. You doctors always seem to want to remove things.” She settled back in her chair having made her case, and prepared to fend off the denial.

I took a deep breath while I decided how to approach the problem. I agreed with the concerns of her GP -at her age, there shouldn’t be much of a lining in the uterus at all, let alone one that was sufficiently thick to bleed. Something must have caused the hyperplasia. And yet, I could also understand Jerra’s anxiety. “I suppose our problem in cases like this is one of certainty, isn’t it? On the one hand, the pathology results as they stand could explain the bleeding and the ultrasound, but not with complete certainty. There could be some even more abnormal tissue hiding in a corner of the uterus that was not sampled with the endometrial biopsy…” I’m sure her GP had already gone over this with her, but it needed to be repeated. “And if that were the case, and we left the abnormal cells in place, we might all regret the decision later.”

She sat straight up in her chair shaking her head the whole time I was speaking. “Dr. Hannah kept saying the same things, doctor.” She sighed and stirred restlessly on the chair. I could see her clasping and unclasping her hands on her lap. “Let me be clear -as far as the pathology report is concerned, there is no cancer. I have…” she referred to a copy of the report in the bundle of papers again carefully folded in her purse. “… I have ‘simple hyperplasia’ –which, as I understand it, is far removed from the cancer end of the spectrum. I find it reassuring, and I fail to understand why you do not.” At this point she actually crossed her arms tightly across her chest and nailed me to my chair with an angry glare. “You’re looking at the same data as I am, and yet you are interpreting it totally differently,” she added, as if she were paraphrasing something she’d read online.

I smiled, again, but it did nothing to diffuse those eyes that searched for a permanent foothold on my face. “I suppose I’m just being careful, Mrs. Tandill. Experience teaches me that…”

Medical schools teach you, doctor!” she interrupted angrily. “Mentors that have been through the same system instruct you how to think about these things.”

I sighed, and I’m afraid I was not very successful at disguising it from her. “Have you had any more bleeding –since the biopsy, I mean?” She shook her head dismissively, and I sat back a little on my chair, all too aware I had also been revealing my discomfort at her anger. “Would you feel better if I did another biopsy…? To confirm the first one?” I added this in hopes of walking the middle road between her wishful thinking that the biopsy was indeed reassuring, and at least not denying the possibility that it may have missed something worse.

At that point she got to her feet, still scratching at my cheeks with her eyes. “No, I would not feel better! You would probably continue to recommend biopsies until you found the result you anticipate, doctor, and I will simply not play that game with you.”

And with an angry shake of her head she turned and walked out the door.

But maybe she was on the right track; maybe compromise -the middle ground- only re-routes the problem and detracts from whatever the data purport to demonstrate. No matter the number of repetitions, an interpretation of the results is still required. And if the data warrant it, a stand on one side or the other must be taken and we must live with the consequences. I think there comes a time when we must disagree with Macbeth when he says to MacDuff ‘Damned be him that first cries, “Hold, enough!”’