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The exploration of how places are heard, ‘how they sound

and resound’ (Ree 1999:53), has been very largely neg-

lected in ethnographic enquiry. Academic literature on

place has been dominated by a pervasive visual bias, with

the result that a deaf ear has been turned to the acoustic

properties of environments. Stephen Feld (1996) questions

the sufficiency of visually-orientated enquiry into

emplacement. Like Stoller (1997) and Ingold (2000), he

suggests that the multi-sensory nature of perceptual expe-

rience should logically require the multi-sensory concep-

tualization of place. In his article ‘Waterfalls of song’ he

argues ‘the potential of acoustic knowing’ (1996: 97).

Sound, combined with an awareness of sonic presence, is

posited as a powerful force in shaping how people inter-

pret their experiences. Acoustemology, the ‘exploration of

sonic sensibilities’, brings the ethnographer closer tounderstanding the significance of sound to experiential

truth (ibid ).

This article is based on fieldwork carried out between

May and August 1999 at the Edinburgh Royal Infirmary in

Scotland. During this time I worked as a team member on

Red Dot Radio, also known as the Edinburgh Hospital

Broadcasting Service, which was housed in a small studio

within the compound of the Edinburgh Royal Infirmary.

My job was to talk to patients in all wards to find out what

they enjoyed listening to, and what they felt could be

improved about the radio service. However, it quickly

became apparent that Red Dot Radio was a very minor

concern, and patients were far more preoccupied by the

very busy and distinctive hospital soundscape which sur-rounded them. Surprised at the intensity of patient feeling

about this soundscape, I began an enquiry into the acoustic

existence of a distinctive hospital soundscape, created b

the activities and work of care, which has come to charac

terize the hospital environment. The sounds of medica

practices, equipment and technology punctuate and pe

vade hospital life, and have been endowed with particula

significance by many of the patients whose thoughts ar

present in these pages. They express an understanding tha

the soundscape is produced through the enactment of

code of medical practice (which anthropologists know a

biomedicine) which requires them to be the passive recip

ients of medical attention, the objects of medical tech

niques, and accepting of certain systems of control. Th

soundscape thus comes to be experienced as a symbol o

this construction of ‘patienthood’, meaning that sounds ar

central to the patients’ experience of themselves as ‘patien

selves’. The hospital environment thus gives rise to a sonically constituted sense of self.

Active soundscape

Early on in my fieldwork, a patient told me he had writte

a letter to the hospital administration suggesting tha

nurses should be required to wear shoes which make n

noise, as the constant sound of their footsteps up and dow

the corridor was irritating, disturbed his rest and woke him

early. ‘It’s all you can do to forget about it just to get t

sleep, but before you know it the noise has woken you u

again,’ he explained. He had numerous other complain

concerning intrusive sounds. He was bothered by the nois

of the television, which he could not see properly from hi

bed. Hushed voices and whispers, the rasping of bed cutains and the squeaks of hospital trolleys also becam

oppressive. Of course noise was muted in the interests o

SoundselvesAn acoustemology of sound and self in the Edinburgh Royal Infirmary

TOM RICE

Tom Rice became interested

in patients' experience of hospital soundscapes while

working as a volunteer at the

Edinburgh Royal Infirmary.

He wrote his BA dissertation

on the subject, and this article

engages with issues raised by

that study. He is currently

studying for a PhD in

anthropology at Goldsmiths

College, University of

London, looking at techniques

of medical listening,

conducting fieldwork among

patients and medical staff at

the Cardiology Unit of St

Thomas' Hospital in London.

His email address is:

[email protected]

Fig. 1. An elderly man at a

maternity clinic in Pakistan

performing azan, a call to prayer, a traditional way of

celebrating the birth of a

male child. Although the ears

are important channels for

religious communication, he

blocks them to exclude the

extraneous sounds of the

open hospital ward which

make it difficult to create a

sphere of privacy and

concentration.

I would like to thank the

members of the Edinburgh

Hospital Broadcasting

Service, in particular Tom

Cornell and Malcolm Kirby,

who created the opportunity

for me to study the sounds of

the hospital. These thanks are

extended to the many

patients I met who lent their thoughts and feelings to the

project. I am also very

grateful to my supervisor, Dr

Di i i T i jil i f hi


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hospital’s acoustic profile. Many had grown accustomed

to the noise in ‘the way the sound of a waterfall soon

becomes an unheard sound to those who live near it’

(Kesey 1962: 75). But this patient’s feelings were echoed

by others, and it became clear that the aural ‘scenery’was

a distinctive feature of the hospital environment. As

Priscilla, who referred to herself as ‘one of the bladder

ladies’, remarked: ‘With all the coughing and the noise and

buzzing, where else could I be but in hospital?’

In Western society, as Ree points out, hearing is cultur-

ally constructed as a kind of supine passivity (1999: 53).

But within the hospital, listening and hearing appear to be

an active means of orientating oneself in the world.

Patients come to know the hospital and understand its rou-

tines and events through their ears. Hugh, commenting on

the sounds in the male respiratory ward, told me: ‘You cantell what’s going on, you know. You can hear that they’re

getting dinner ready, or that the medicine trolley’s coming

round, and you can set your watch when you hear the

nurses changing shift.’ It is clear that for some, hearing

becomes an important means of gaining familiarity with

the hospital environment.

Recounting one of the most disturbing events of a 110-

day stay in hospital, Gordon, a man who had recently been

discharged after a liver transplant, described an experience

which had been based entirely in sound. In the middle of

the night a patient in his ward had suffered a heart attack.

Nursing staff had rushed in, and had pulled the curtains

around all the beds in the ward before attempting to resus-

citate the man. Gordon was unable to see what was hap- pening, he could only listen in his bed to the urgent

struggle to keep his ward neighbour alive. The medics

Gordon had the sounds of the occurrence re-echoing in hi

mind. ‘I was shattered for days by these horrible noises

he said. This violent eruption in the hospital soundscap

was a deeply disturbing experience for him.

The vividness with which Gordon experienced th

sound in this account is heightened by an absence of othe

available sensory information. Indeed, the sound took on

more affective quality because of the dearth of other sen

sory modalities. In her discussion of blind aesthetic

Constance Classen describes how, for a blind ma

standing in a park, the reality of his environment is createout of sound generated by the movements of other people

‘It is precisely when someone else enters the park – whe

the tread of footsteps is felt, the sound of a voice heard

that the world comes out of nothingness into being

(Classen 1998: 141). She draws on the work of the blin

writer John Hull, who explains that experience for him i

brought into being through a ‘dynamic sequence o

sounds’, the consequence of ‘world of happenings’ (Hu

1990, cited ibid .: 142). For Gordon, an alarming and sin

ister ‘world of happenings’ was manifested in a hauntin

sonic presence which was never affirmed or dispelled b

the proof of his other senses. His account is indicative o

what many patients felt to be a more general impoverish

ment of non-auditory stimuli within the hospital, aunusual atmosphere of sensory absences.

The environment created in the ward appears to be on

of stasis rather than the constant sensory flux one migh

experience outside the hospital. The ward forms a spac

characterized by a peculiar sensory monotony. Whe

walking through a hospital one might be struck by the di

ferences in smells between one ward and another, change

in the colour of the paint or the texture of the floor, but fo

patients who remain in the same ward for long periods o

time the environment becomes one which they experienc

as remarkably constant. An example of this stasis is foun

in the ‘olfactive silence’, or rather the uniform scent of dis

infectant which pervades the atmosphere (Howes 1988

94). Odours are suppressed, a fact which Classen links t

the symbolic odourlessness of sterility and scientific pre

cision in Western culture (1993). Patients commente

upon the remarkable fragrance which visitors would brin

in with them on their clothes and possessions, or th

amazing fresh scent which would be produced when the

opened packages brought from home. These new smel

were evocative and interesting in the olfactory blanke

which the disinfectant of the ward created. Patients wer

thus sensitive to the ‘deodorized’ environment of the hos

pital, which Bubandt (1998) suggests is crucial to the sym

bolic vocabulary of that institution.

The notion that the hospital ward creates particular area

of sensory ‘anaesthesia’ also applies to the visual dimension (Feldman 1994). Patients frequently expressed th

sentiment that the ward set-up was visually dull, unstimu

lating and even restrictive. Sitting in their beds, their eye

were inevitably directed inwards towards the centre of th

ward, forcing a kind of introspective gaze. Peter describe

how when he first came into hospital and realized he wa

bored of his surroundings, he would punctuate h

boredom by taking slow walks to the toilet, stopping to tal

to as many people as possible on his way. He gave up thes

walks when he realized he was spending most of his day i

the toilet. Televisions were sometimes provided, and news

papers and magazines were available. These diversion

though, were also introspective in terms of the ward layou

and there was little scope for looking out or gaining different perspectives on one’s surroundings. The beds wer

positioned in such a way that it was difficult to see out o

Fig. 2. ‘What makes your

ears so long!’Cartoon by

C.H. Bennett, published in1863 at the height of the

evolutionist/creationist

debate. Bennett sends up

Darwin's theory, using the

ears to plot an absurd

morphology across species.

However, eight years later, in

the Descent of Man , Darwin

compared the ears of men

and monkeys and found them

to be 'curiously alike' (2003:

150). He noticed small points

visible in 'the inwardly folded

margin, or helix' of the ears

of both species ( ibid.: 16),

which he believed to be

‘vestiges of the tips of

formerly erect and pointed

ears’( ibid. ), and asserted

that the points in question

‘are in some cases, both in

man and apes, vestiges of a

former condition’ ( ibid.: 16-

17).

T H E W E L L C O M E L I B R A R Y , L O N D O N


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In his analysis of Bentham’s ‘Panopticon’, Foucault

suggests that this lack of visual prospect is an essential ele-

ment of the architecture of institutions such as hospitals

(1975). In these institutions constant surveillance is used

as a means of control by the ‘supervisors’ (an idea I

explore in greater depth below). The patient/inmate/

schoolch ild is made conscious of his or her permanent

visibility. But while he ‘is seen… he does not see’ (ibid .:

200; my italics). The patient’s ‘axial visibility’, meaning

his or her being continually visible to the supervisors,

implies a ‘lateral invisibility’, that is, an inability to gain a

visual perspective on the system in which he or she is

caught up. Patients are necessarily prevented from gaining

an informed insight into the systems by which the hospital

operates. Access to staff areas is forbidden, as it is to therooms in which the preparation and organization of care

takes place. Patients are also prevented from seeking out

other patients for widespread interpersonal communica-

tion. Very strict regulations governed patients’ freedom to

move around the Infirmary and to enter different wards in

order to mix with other patients. As one man remarked,

‘You’re basically confined to the ward. The only people

you see are those that come to see you.’Thus, ‘[t]he crowd,

a compact mass, a locus of multiple exchanges, individu-

alities merging together, a collective effect, is abolished

and replaced by a collection of separated individualities…

that can be numbered and supervised’ (Foucault 1975:

201). The lack of visual opportunity, then, may be con-

strued as part of a mechanism for the control of patients,inbuilt in the hospital’s architectural and social structure. I

would suggest that the lack of opportunity for in sight is

of taste. It was a favourite pastime of patients to compet

for the most offensive terms in which to describe the

food, which became a symbol of the mundane, bland an

unappealing nature of the hospital routine. ‘The food sum

up just about everything to do with hospital. It’s really

really boring,’ I was told on one occasion. Many patien

were on strict diets because of their illnesses, meaning tha

the range of tastes available to them was severely curbed

While conscious that the restrictions might be beneficial t

their health, several patients found them highly frustrating

Joanie, an elderly woman in the cardiology unit, told mshe would happily kill for a cup of coffee if only she coul

‘get the strength up’. Furthermore, some treatment

patients were undergoing meant they did not really wan

and certainly did not enjoy their food. A small numbe

were on ‘nil-by-mouth’ order, so that their experience o

taste was negligible during parts of their stay in hospita

Some supplemented their diets with sweets and chocolat

brought from home, and supplies were replenished by vi

itors, but these were small gestures to change or counte

the mundane flavour of hospital life.

Many of my best informants were patients in the derma

tology unit. They, in particular, reported an impoverish

ment of their sense of touch. They wore ‘jammies’, pyjam

suits which covered their skin disorders and applied thnecessary medication. Several patients remarked that the

felt starved of contact because of these suits, and sensin

through the skin became an unfamiliar experience. ‘Yo

forget what things feel like sometimes, and then one tim

you pick up an apple or an orange without the bandage an

you think, “Wow”.’Patients ‘lost touch’with even the sim

plest forms of contact. Even the act of shaking hands wa

palpably different, altered by the barrier of cloth. Th

‘jammies’ became a second, thicker, less sensitive skin

Northoff et al. observe this sensory privation in the

analysis of the psychosomatics of atopic dermatitis: a wa

is formed, reducing contact between the ‘lived body’ an

the ‘lifeworld’(1992: 149).

The hospital environment, then, is one in which sensor

experience is ordered in ways which patients interpret a

being restrictive. Experience is delimited in such a wa

that particular areas of sensory anaesthesia are formed. Bu

concurrently with the creation of these areas, other areas o

sensitivity arise. For many patients, auditory informatio

took on an unusual prominence in the construction o

experience. Hearing came to be ‘privileged as a sensor

mode’ (Howes 1988: 84). It is not my intention here t

argue that the sense of hearing should be accorde

supremacy over the other senses; neither am I trying t

reinforce existing conceptual divisions between sensor

categories. What this study indicates is that even within

Western cultural milieu, sensory experience and intersensory emphasis is subject to variation. Within the partic

ular environment represented by the hospital, sound i

accorded a certain emphasis in the analysis of sensor

interplay. It is lent an immediacy which might habituall

be eclipsed by a visual bias in the ethnographic construc

tion of reality.

The presence of imposed sound was generally experi

enced in negative terms. Patients felt it to be an unwel

come intrusion which disrupted their privacy and mad

rest fitful and difficult. Some used their hospital radi

headphones to muffle or drown out the sounds aroun

them. Others, exasperated by the constant noise, woul

cover their heads with pillows. Michael Bull describe

how personal stereo users employ headphones to excludor escape the chaotic urban soundscape. The headphone

grant ‘users’ sanctuary from ‘the disenchanted and mun

T H E W E L L C O M E L I B R A R Y , L O N D O N

Fig. 3. Swiss theologian J. C.

Lavater (1741-1801)

popularized ‘physiognomy’,

which suggested that a

person’s character could be

read from their external

appearance. ‘I am fully

convinced that the ear... has

its determinate signification,

that it admits not of the

smallest disguise, and that it

has particular analogy to the

individual to which it

belongs… Examine this

part... and you will soon see

the distinctive differences

pertaining to each character’

(1789: 319).


4/8

in elaborating this contrast in experience: ‘Users describ

the “bright, detailed imagery of the flow of time” exper

enced through personal-stereo use, just as they describ

the fear of that “long, dark hallway of time” without i

(Bull 2000: 67, citing Adorno 1973). Here I deal with th

subtext of Bull’s work on a culture of resistance to a dom

inant soundscape. I explore how hospital patients confron

conceptualize and appropriate a soundscape which per

vades the environment in which they live, and which ou

lasts their attempts at escape; I examine the thoughts o

those who, in a very literal sense, are sitting in the ‘londark hallway’ of Adorno’s imagining. It is to this them

that I now turn.

Passive soundselves

In his article ‘Sound and senses’, Sullivan (1986) explore

sonic symbolism among the peoples of the highlands an

eastern mountain regions of the Andes. He describes how

the screeching of industrial machinery is imagined to b

the cries of a monstrous being named ‘Pishtaco

‘Pishtaco’ screams as he sucks out the body fat of Indian

in order to lubricate car and aeroplane engines, boa

motors and mining equipment. His scream is the sound o

the invading industrial society and its machinery, whic

displaces, enslaves and ultimately destroys indigenoucommunities. Sullivan’s analysis links the significance o

sound to its integrality with a wider social process, namel

the influx of modern industrial technology and its terribl

impact on those who are affected by it. Thus ‘the metalli

whining of technological societies prolongs the deat

agony of indigenous populations’ (1986: 15-16). The ho

pital soundscape does not represent a cultural metaphor o

the same power or directness as the harrowing exampl

described by Sullivan. However, here I briefly explor

how powerful cultural symbols may be disguised in th

background noises of a society. I suggest that the sounds o

the hospital have become symbols of patienthood and th

regime which patienthood entails for some within th

Royal Infirmary.

Residents of the hospital’s dermatology unit saw them

selves as being a generally active and alert group o

patients because, as James pointed out: ‘We’re not reall

ill, as such; we have skin conditions of course, but that

not the same, and our minds are pretty much OK.’A ver

interesting remark made by a woman on the same war

was that she wished she could just leave her body in th

hospital and get on with things, as she felt her mind wa

still active, and her spirits were high. These people, then

observe a clear-cut mind/body dualism. They conside

themselves to be in hospital because of a physical ma

function which does not affect them mentally. But th

activities of the hospital served to remind them of their ‘ilness’, and impose on them an awareness of their situatio

as patients. James expressed this in the following com

ment: ‘Sometimes when I’ve just woken up I lie there an

think “I’d like to go for a nice walk”, but hearing every

thing going on in the ward chases that idea away becaus

I realize “Oh no, of course I can’t, I’m sick aren’t I?”’Th

soundscape forced James to recognize his ‘patienthood

More specifically, it was influential in making him accep

and consequently live out one of the structures whic

underpins the workings of the biomedical model, namel

the distinct mind/body dualism implicit in the under

standing of illness as an organic reality, a consequence o

biochemical changes.

As Helman observes, biomedicine increasingly undestands the body as ‘an animated machine’ (1984: 104). Th

doctor’s project is to link observed symptoms to

Fig. 4. The ear is implicated

in punishment and control. In

1883, anthropologist

Alphonse Bertillion launched

a system for the identification

of persistent criminals based

on a series of body

measurements including the

'length of the right ear'. It

proved very successful, and

was adopted by police in

Britain and the United States,

some even going so far as to

suggest that all citizens should be physically

inspected for such signs of

delinquency. The ears thus

became integral to the

development of a projected

bio-panopticon (see

www.cmsu.edu/cj/

alphonse.htm and

www.oreilly.com/catalog/

dbnationtp/chapter/ch03.html).

Fig. 5. In traditional Chinese

medicine the ear is closely

connected with the meridians

(energy pathways) relating to supplementary vessels and

organs throughout the body.

It is both part of the body and

an organic representation of

the whole body.


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of machines and monitors were an ever-present feature of

the hospital soundscape, their sounds impassive and clin-

ical, representing what Sullivan describes as ‘phonetic dis-

memberment’, atonal electronic sound which is ‘parcelled

out one phoneme at a time’ (1986: 24). The soundscape

was characterized by signals and notifiers, conversation

was punctuated by their pulsing. These sounds generated

feelings of alienation in some patients. ‘When I lie there

and listen to those bleeps and blinks I feel as though I were

a lab rat, something in a laboratory, you know’ said Carrie

from the female cardiology unit. ‘It’s very strange when

even in the night all these machines are bleeping away,’remarked Brian, who was recovering from a stroke. ‘They

never stop, and you think to yourself “What kind of place

am I in?”’ The repetitive electronic noise served as a con-

stant reminder to patients of their own illness and that of

others around them. One man recalled a time when the

bleeping had merged strangely with the sobbing and

wailing of a woman in the bed opposite, creating a bizarre

contrast between the noise of a machine and that of human

suffering. The sound added a frightening drama to his sit-

uation, making him conscious of his vulnerability in the

presence of technology, his exposure in a domain of scien-

tific medical interest.

Tyler (1984) equates the scientific discourse with

Western visualism, an idea supported by Bronowski, who

states that the ‘world of science is dominated by the sense

of sight’ (1978: 11). The discussion of a soundscape,

then, must represent something of an anomaly in an envi-

ronment ordered according to the visual metaphors of a

scientific medical discourse. But when looking at, or

rather, listening to the scheme of optical control

employed within the hospital, this opposition apparently

collapses. Indeed, sound appears to reinforce and com-

plement the visual mechanism of authority rather than

undermine it.

In exploring the unlikely collusion of the sonic and the

visual I draw on the words of Anthony, a man of 32, who

had been given six weeks’ bed rest in order to allow asmashed elbow and a fractured pelvis to heal. This meant

he was unable to get off his bed, except to wheelchair

himself to the toilet and to his daily physiotherapy ses-

sions. He proudly informed me that he was known as the

ward troublemaker. He had twice been caught smoking

and once got drunk on vodka which one of his friends had

smuggled in disguised as mineral water. He took great

pleasure in recounting how he had succeeded in buying

hash from someone. Anthony expressed a willingness to

exchange information for pornographic magazines.

Three Fiestas and a couple of Knaves later he agreed to a

formal interview. His mischievous activities, he said, had

only been possible since his transfer from the main ward

to a small side ward. In the main ward he had been awareof being constantly watched by the nurses. ‘They were all

over the bloody place,’ he said. ‘Always saying “What do

reminded him that he was under observation, and durin

the day their voices and activity meant he was unable t

forget that authority was not far away. Rolling a cigarett

on the windowsill one day, he thought he heard a nurs

approaching; panicking slightly, he pushed his paper

and tobacco out of the window. It was a false alarm.

Earlier I considered Foucault’s analysis of Bentham’

Panopticon in relation to the visually restrictive environ

ment of the hospital. But the introspective organization o

ward space represents only one dimension of the panopti

system and its application to that particular institution. Thmainstay of the Panopticon is the principle of surveillance

Conscious of the possibility that his every move is bein

watched, the observed modifies his behaviour to conform

to the dictates of a particular system. Thus he begins t

watch himself, internalizing the disciplinary gaze. In th

hospital environment, Foucault suggests, surveillanc

ensures that patients observe the regulations.

The Panopticon’s efficiency lies in its preventative char

acter. The institution need never exercise its strength b

intervening. Power is exercised spontaneously, and inter

estingly, Foucault remarks, ‘without noise’ (1975: 206; m

italics). His implication is that control may be exercise

silently, stealthily and with precision. However, there is

definite inconsistency here, for while sound is understooto be indicative of disorder and imprecision, contrastin

sharply with silent optical control, the patient abov

clearly experiences sound as an auditory complement t

surveillance, reminding him of its omnipresence. Just a

the click of a camera asserts that a picture has been taken

or the whir of a closed-circuit TVcamera informs a perso

that his or her movements are being observed, the sound o

nurses moving suggests to patients that they are bein

watched. The soundscape reinforces the system of visua

surveillance. It implies the presence of panoptic contro

creating in patients like Anthony a sense of being a con

trolled, monitored patient self. Indeed, in Anthony’s cas

the sound of the nurse reached him at a point when he wa

deliberately concealing his actions from view. It pervade

a space which the gaze could not reach. Sound thu

extends the scope of panoptic possibility. We see th

emergence of a Panaudicon, an acoustics of power which

unlike the Orwellian notion of the ‘never-sleeping ear

(1949: 174), is not manifested in the possibility of bein

heard by a listening presence, but in hearing an authori

tarian presence. The Panaudicon operates actively throug

the subtle infiltration of sound into the patient’s awareness

The patient becomes the bearer of a receptive ear of powe

as well as the object of an active eye of power. The channe

of the ear thus becomes an important ‘channel of power

(Foucault 1975: 205).

I have tried to establish here that the hospital soundscape is not composed of meaningless scraps of sound

Rather, the acoustic elements which constitute the sound

scape are the products of particular medical practice

embedded in the discourse of biomedicine. Patients hav

endowed these sounds with complex meanings, such tha

the soundscape has become a symbol, a sonic articulatio

of the patients’position. In some patients, then, we see th

emergence of a sonically ordered sense of self, a ‘self

hood’shaped by the acoustic dimension.

Conclusion

Echoing Sullivan (1986) and Feld (1996), this stud

emphasizes the significance of sound in human experienc

in terms of both knowledge and imagination. In doing soit stresses the immediate relevance of sonic meaning t

ethnographic inquiry, and the need to nurture auditor

Fig. 7. Van Gogh may well

have experienced auditoryhallucinations during the

psychotic attack in which he

cut off the lower half of his

left ear. He noted that in the

sanatorium where he stayed

other patients heard strange

sounds and voices as he had,

and he speculated in one

case that this was probably

due to a disease of the nerves

in the ear. He may have cut

off his ear to silence the

disturbing sounds.

Bull, M. 2000. Sounding out

the city: Personal stereos

and the management of

everyday life. Oxford,

New York: Berg.

Bronowski, J. 1978. The

origins of knowledge and

imagination. New Haven:

Yale University Press.

Bubandt, N. 1998. The odour of things: Smell and the

cultural elaboration of

disgust in Eastern

Indonesia. Ethnos 63(1):

48-80.

Classen, C. 1990. Sweet

colours, fragrant songs.

American Ethnologist 17:

722-735.

Classen, C. 1993. Worlds of

sense: Exploring the

senses in history and

across cultures. London,

New York: Routledge.

Classen, C. 1998. The color

of angels: Cosmology,

gender and aesthetic

imagination. London,

New York: Routledge.

Darwin, C. 2003 [1871]. The

d t f d

Fig. 6. In his etchings,

Leonardo da Vinci ensured

that the features of the face

were in correct proportion by

matching them to the

dimensions of the ears, nose

or eyes. This image is of da

Vinci's framework of facial

proportions superimposed

onto a tracing of a sketch by

him.


6/8

endeavour, the discussion is focused more on how patients

experience sound in terms of the construction and ordering

of the self than on the manner in which the senses are

engaged in emplacement. It is through exploring the

acoustemology of the self that this study attempts to sound

out new ethnographic depths.

I have sought to demonstrate here how the acoustic

dimension of the hospital is heightened by a relative dep-

rivation of other sensory modalities. Thus, the sense of

hearing gains a particular sensitivity and force. Much is

heard while little is seen, smelled, touched or tasted. Butis not my intention to create new ‘sensory centrisms’

(Bubandt 1998: 73), nor to argue the case for an avenue of

auditory supremacy, subverting the primacy of visualism

in Western conceptual models through the construction of

an anti-visualism. My point is that for some patients,

experiencing the hospital creates a slightly different per-

ceptual emphasis, ‘a re-evaluation of the senses from the

standpoint of their interplay’ (Feld 1996: 96). I have dis-

cussed this re-evaluation of the senses, exploring the

meanings and associations patients accord to the sound-

scape. It is through experience of the sonic dynamics of

hospital that patients become familiar with and under-

stand the environment and practices in which they are

caught up.Sullivan makes the following observation concerning

the creative power of sound: ‘Sound achieves creation in

different ways. The presence of a new sound or song can

create a new form of existence’ (1986: 24). This creative

power is evident in the accounts of the patients to whom I

spoke. They suggest that the sonic structure of the hospita

plays an integral role in the creation of the reality of tha

place, and in the way they perceive themselves to exi

within it. Hearing and the interpretation of sounds are thu

understood to be vital to orientation in a social, as well a

a material and spatial sense. After all, patients have no

always been patients. It is partly through the hospita

soundscape that they are able to situate themselves withi

the biomedical discourse of which they have become

part. In a sense the soundscape may be construed as a coe

cive influence, imposing upon patients a role which themay consider disagreeable or inappropriate. Sound there

fore becomes implicated in the subtle articulation an

exercise of power.

Finally, I would support Classen’s assertion that ‘[m]or

than any other discipline, anthropology should seek t

counter our tendency to perceive other cultures throug

our own sensory model by attempting to understand them

through their cultural model’ (1990: 722). But the explo

ration of the hospital soundscape indicates a case in whic

our sensory model is not an entirely appropriate tool fo

understanding certain aspects of our own culture. If sen

sory interplay is to be analysed meaningfully, even withi

our own cultural milieu, changes are required in ethno

graphic representation. There is a need to amplify and harmonize aural idioms in ethnographic texts in order t

explore the complex interplay of senses in cultural prac

tice. The descriptive power and vocabulary of soun

studies must be developed in order to allow proper explo

ration of the depths of sonic knowledge. !

This drawing, of which a detail is reproduced on the front cover, is illustrator Miriam Navarro's response to the article 'Soundselves' by Tom Rice. The article explores the ways in which

hospital patients are affected by the sounds which surround them. Far from being simply irritating by-products of the activities taking place within the hospital, sounds carry important

meanings for those patients who are compelled to listen, and whose daily lives are therefore filled with noise. The exploration of soundscapes provides an interesting challenge for

th l i t i th hi hl i l t f th di i li ’ t l d th ti l i i ti Y t th l f th hi h d t d th f h i t b

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