Embodiment and Experience
Sensing is first and foremost an embodied experience. It therefore seems surprising that culture and meaning – rather than experience – is the focus of so much sensory history, but cultural history provides us with valuable tools to reach individual or collective experiences. Only by understanding what sensory experiences mean to people, can we understand how they feel. However, there are also limits to a cultural approach – or at least to an overly broad one. There is a wide range of individual variation in sensory experience in any given time and place: in addition to the broad cultural context, age, gender, ethnicity, socio-economic background, health condition, sensory sensitivity, and individual life stories are just a few of the factors that feed into individual perceptions (and experiences) of the same sensescape. It is difficult to do justice to these differences, though not impossible. Some medical historians have addressed experience in relation to specific sensations (for example pain, breathlessness), and historians have successfully engaged with the ways in which specific factors (such as gender and ethnicity) affected embodiment in the past. Can we also engage with the diversity of individual experience if we look beyond a single sense, sensation or demographic category? It seems that the bigger the scope of a sensory history, the more likely these nuances are to fall by the wayside in favour of discussions of ‘culture’ at a macro level.
A cultural history approach is often the necessary consequence of source availability; historians do not have the same ‘live’ opportunities for research as anthropologists or phenomenologists. Considering how many people enter and leave hospitals, and the changing make-up of this population on a daily basis, it is almost impossible to find comprehensive surviving historic accounts. When records are closed, we do not know who was even in the hospital at a given time, irrespective of whether or not they kept a diary of their stay. We can draw upon work in embodiment theory, medical humanities and phenomenology to close some of these gaps, but we inevitably come back to culture in order to reach experience. In part, this approach also helps us to reach important historical questions. While there is certainly a case for understanding experience for its own sake, in general we are also seeking routes to ‘bigger’ questions: only by looking for social and cultural patterns or trends are we able to achieve this.
‘The’ patient could be almost every person in a population; we could look at this as an advantage, providing unlimited source material. However, accessing their experiences is easier said than done. Critically or terminally ill patients are often too unwell to record any accounts of their stay, while many others simply choose not to do so. The rise of pathography (illness narrative) in recent decades provides some fruitful source material, although tends to focus on specific types of illness such as cancer. Rising concern about hospital aesthetics and sensory experiences in the late twentieth century also resulted in a number of studies that provide useful qualitative and quantitative data on patient sensory experiences of hospital – particularly in relation to sound – but we lack the raw data for these. It might be possible to produce our own data by taking specific hospitals and populations as case studies for oral history projects (‘did you go to X hospital between X-X years?’). However, there are some obvious limits to this approach as well. People who have had life-changing or extremely traumatic experiences often remember them vividly, but those who visited A&E for a broken toe as a child might remember it little. This is not to say that we should not try, but such sources will need to be engaged with imaginatively.
It might be fruitful to divide patients along key social, cultural, demographic and health lines. Certain patient groups may have shared embodied sensory experiences (for example, cancer treatment affects taste, and the elderly are more likely to suffer sensory impairment). They might also have shared cultures around good/bad sensescapes that affect their perception of these experiences (such as when a sound becomes a noise). This kind of approach offers a route out of the danger of either (a) overgeneralising about ‘the’ patient experience, based on broad historical trends or (b) getting so engrossed in individual life stories that we do not see the wood for the trees. This is a fine balancing act, and there is no simple solution: many of the above lines along which we might divide patients also intersect, and embodied experience is inevitably always still highly individual. However, it is important to try our best to engage not only with changes over time in the nature of sensescapes, but also changes in the experience thereof. Did design changes actually result in any perceived shift in patient experience in hospitals? Was ‘patient-centred’ sensory design really ‘patient-centred’ for all? Did culture (both in terms of broad historical trends and individual background) shape individual experience of hospital sensescapes, and the meanings given to those experiences?
A final point in this discussion is an obvious but crucial one: patients are not the only people in hospitals. Much modern literature on improving hospital sensescapes focused on patients, but hospital staff and visitors are important and under-studied figures in the history of hospitals. Staff stress and wellbeing is intertwined with sensory experiences, as is their ability to communicate with colleagues and patients. Doctors and nurses are also not the only staff members in hospitals; existing oral histories give glimpses into the hidden histories of medical students, hospital porters, maintenance staff, receptionists and others. These individuals were a key part of hospital sensescapes, keeping them always dynamic by producing (and eliminating) sounds, smells, sights, food and touch. They also have a specific relationship with hospital sensescapes that are worthy of further study, such as with machines. Staff move through the hospital’s many and varied sensescapes, in a way that patients cannot. Each of these individuals is subject to the same caveats above, in relation to their specific embodiment of hospital sensescapes, but there are some historical trends and sensory experiences specific to staff that we should examine further. Visitors and relatives also have their own history, not least in terms of the growing relaxation around visiting rules and how this affected their experience of the hospital. Visitors’ rooms and spaces for ‘breaking bad news’ have their own design histories, with sensescapes that have often sought to address the emotional aspects of caring for an ill loved one.
It goes without saying that we cannot do justice to the sensory experiences of every single person who entered a modern British hospital. Nor should we, however, only seek to write broad histories of changing hospital sensescapes and their cultural meanings. We can use the multi- and inter-disciplinary tools available to us to draw out trends in – and within – patient, staff and visitor experiences. Understanding these experiences has value in its own right. It will also help us better to understand the relationship between culture and the body, and to fill in the gaps between ‘objective’ and ‘perceived’ sensory experiences.