February 19, 2013, by Warren Pearce

The opaqueness of seeing: expertise and guidance in clinical interventions

Rene Magritte: La Condition Humaine (Washington: National Gallery of Art)

One of the benefits and, perhaps, risks of calling our research programme ‘Making Science Public’ is that it lends itself to a great many interpretations, something which came out very strongly from our launch event last week. One of these ‘ways of seeing’ Making Science Public is through studying the role of expertise in translating scientific knowledge into the public sphere. In this guest post, Professor Alison Pilnick brings together these ideas, reflecting on how expert judgement affects and guides perceptions of success in a clinical setting and highlighting how the act of seeing is far from transparent…

We often talk about the ability to see something as though seeing is an entirely transparent activity. However, a quick run through of some commonly used expressions begins to hint at something a little more complex (“Do you see what I mean?”, “Can you see the problem?”). In fact, knowing whether participants to a joint activity have a shared or mutual understanding of what they are perceiving is a practical problem of considerable significance. How we detect when discrepancies in what we ‘see’ have arisen, and how we try to reconcile these, is critical for smooth day to day interaction. It’s also critical for safe and effective practice in a wide range of clinical settings.

With a colleague at Northumbria University, Deborah James, I have been examining some data from an interaction-based intervention aimed at improving communication between children with autism and hearing impairments, and their carers. The intervention is called VIG (Video Interaction Guidance) and it uses video recordings of the children as they go about their normal business in home and school settings. The idea is that the ‘guider’ identifies existing moments of success in these interactions with carers, which are played back to the carers and can then be built on in future interaction. However, for this to work, what counts as a ‘moment of success’ has to be agreed on by all the participants. And since what counts as success in this setting is often far removed from everyday ideas of good communication, that means guiders have to facilitate particular ‘ways of seeing’. Drawing on Charles Goodwin’s work on ‘professional vision’, we have been examining how carers’ perceptions of particular moments or events are shaped, so that they too come to perceive success. Essentially, for the success of the intervention, carers need to be able to see not only what is visible (in the sense of having access to the same materials as the intervention guider), but also to be able to see it in the same way as the guider.

Unpacking how this process works is important not just for this particular intervention, but for interaction-based interventions more generally. The integrity of an intervention depends on whether it can be reproduced in all important aspects across different settings, and without detailing the process this is not possible. But it is also a reminder that seeing in any context is a socially situated activity. Charles Goodwin illustrates how significant this point is by using the example of the trial of the white policemen accused of beating the black motorist Rodney King in the US in 1992. Despite the fact that a passer-by filmed the beating, the policemen were originally acquitted, sparking riots in LA. Goodwin shows that the acquittal was possible precisely because seeing was not treated as a straightforward activity. Rather than treating the events on the tape as speaking for themselves, the defence lawyers presented it as something that could be understood only by embedding the events visible on it within the work life of a profession, and by framing the ways in which these events should be so perceived; a reasonable police response towards a potentially dangerous man. Expert testimony on how the tape should be viewed ultimately overrode what the tape showed. Ultimately awareness of how different forms of expertise can shape the framing and management of happenings and issues might, ultimately, lead us to a less critical acceptance of proposed policy or social ‘problems’.

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