“Seeing is Being”

The possibility of reducing twins to a single fetus at the end of the first trimester is becoming part of the medical conversation, particularly during an IVF pregnancy.  For “Jenny” (below) who opted for the procedure, the thinking process behind an IVF twin reduction is markedly different from what she supposes would be a more visceral response to a “natural” twin pregnancy.

“Things would have been different if we were 15 years younger or if we hadn’t had children already or if we were more financially secure,” she said later. “If I had conceived these twins naturally, I wouldn’t have reduced this pregnancy, because you feel like if there’s a natural order, then you don’t want to disturb it. But we created this child in such an artificial manner — in a test tube, choosing an egg donor, having the embryo placed in me — and somehow, making a decision about how many to carry seemed to be just another choice. The pregnancy was all so consumerish to begin with, and this became yet another thing we could control.” (Padawer, New York Times Magazine, August 10, 2011).

For many people the new science of IVF – and the possibility of fetal reduction if all of the implanted embryos take – allows commonsense considerations of fitness cost (for the mother), financial investment, and quality of parent-child relationships to come into play. But the article presents twin reduction as a special moral case because a twin pregnancy (as opposed to carrying 4 or 8 fetuses) usually results in the birth of two healthy infants, aligning science and “nature.” Furthermore, fetal reductions, unlike abortion, are performed using ultrasound to guide the injection of potassium chloride into the fetus, “making it quite visually explicit.”

Jenny’s rationale in particular hit a nerve for many of the commentators, who began their responses with, “I am totally pro-choice, but….”

As the (near-sighted) mother of twins, I was just as in thrall to the gravelly turbulence of the ultrasound images as the next pregnant person who staggered into the examining room and hoisted her body onto the examining table.

Maps of average brain surface contraction rates and uncorrected p-maps of converters vs. non-converters comparison (Sun et al., 2008).

But a certain amount of reductionism when thinking about fetal reduction is at work. The sonograms present the illusion of (male/female) fetuses as autonomous entities – or perhaps more accurately little patients – in their own right rather than technological “phenomena” (Barad, 2007; cited in Lock, 2010, p. 94 ). Such a perspective excludes “the pregnant woman, her body parts vital to pregnancy, her emotions, and the social context in which the pregnancy has arisen” (Lock, 2010, p. 94).

A similar opacity to human experience occurs when we think about brain imaging of mental illness. (And “It has become an NIMH mantra,” as NIMH director Thomas Insel reminds us in his 8/12/11 blogpost, “to describe mental disorders as brain disorders.”) For example, in a longitudinal study following 35 individuals between the ages of 14 and 30 at ultra high risk for psychosis, investigators reported that fMRIs of converters showed significantly greater brain surface contraction, particularly in the frontal regions, than non-converters (Sun et al., 2008). For those of us living with (or living with persons living with) psychotic disorders, the ability to predict (and prevent) the illness by means of brain imaging would restore months or years of robust and attentive life.  But the brain images have a tendency to deflect important questions about culture, society, and physical environment (infection, stress, nutritional deficiencies, cannabis use, childhood trauma) in favor of an inexorable process involving “faulty wiring.” To paraphrase physicist/philosopher Karen Barad (2007, p. 23), we should be thinking about these other things, but it’s not yet clear how to think of them in relation to the imaging sciences, beyond mere acknowledgment.

The fetal reduction piece was a good reminder for me of an oft-repeated warning about the other kind of reductionism. Ironically, the ease with which we’ve internalized visual representations – the pregnancy sonogram, the psychiatric MRI – may in fact cloud our understanding.

References

Barad, K. (2007). Meeting the universe halfway: Quantum physics and the entanglement of matter and meaning. Durham, NC: Duke University Press.

Insel, T. (2011, August 12). Mental illness defined as disruption in neural circuits [Blogpost]. Retrieved from http://www.nimh.nih.gov/about/director/2011/mental-illness-defined-as-disruption-in-neural-circuits.shtml

Lock, M., & Nguyen, V.-K. (2010). An anthropology of biomedicine. Oxford, UK: Wiley-Blackwell.

Padawer, R. (2011, August 11). The two-minus-one pregnancy. New York Times Magazine. Retrieved from http://www.nytimes.com/2011/08/14/magazine/the-two-minus-one-pregnancy.html?_r=2&ref=magazine

Sun, D., et al. (2008). Progressive brain structural changes mapped as psychosis develops in ‘at risk’ individualsSchizophrenia Research, 108(1–3), 85–92.