10.54103/2036-461X/17748
Dominant narratives across Medical Humanities have been focused on the cultural construction of the notion of medicine as epistemic discourse and social practice, on the role of humanities in medical design of the disease as well as on the humanization of the clinical encounter in order to facilitate the anamnesis, the therapy and the care. Among the main declinations, a more complex point of view arises, suggesting the critical integration and exploitation of a variety of methodologies, previously used by art and humanities research, into a peculiar human-centered dispositive, both narrative and therapeutic, in which audiovisual practices and languages acquire new healing potential and activate bias for unprecedented processes of subjectivization for particular target of suffering human beings.
Based on the aforementioned premises, the essay aims at investigating the therapeutic set as performative and methodological model, consistent with art-therapy and narrative-based medical approaches, applicable in specific pathological conditions and health-care contexts. Within such reflexive and operational framework including documentary studies and visual anthropology, self-representational and amateur theories, the therapeutic set becomes a media environment where the formative encounter, both technical and pragmatic, finally ethical, between the self and the world, the action and the awareness takes place.
My purpose is to explore the theoretical pillars of the therapeutic set as transformative interplay between profaned cinematic dispositive and psychotherapy setting, dwelling on bodily involvement, audiovisual gestures and amateur self representation to which active participants, storytellers of their own illness and treatment, are called in the making of therapy and narrative.
The paper finally intends to illustrate selected interdisciplinary case studies in order to discuss the healing potential of creative participatory processes and self-representations, occurring thanks to the relocation and amateurization of the contemporary cinematic experience.
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Anna Chiara Sabatino
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Cinéma & Cie. Film and Media Studies Journal
Therapeutic filmmaking
Audiovisual Means to Therapeutic Ends. The Cinematic Dispositive within Medical Humanities
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Cinéma & Cie
Anna Chiara Sabatino
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Università degli Studi di Salerno
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Audiovisual Means to Therapeutic Ends. The Cinematic Dispositive within Medical Humanities
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                                                                                       Audiovisual Means to
                                                                                       Therapeutic Ends.
                                                                                       The Cinematic Dispositif within
                                                                                       Medical Humanities
                                                                                       Anna Chiara Sabatino, Università degli Studi di Salerno




                                                                                       Dominant narratives across Medical Humanities have been focused on the cultural con-                       Keywords
                                                                                       struction of the notion of medicine as epistemic discourse and social practice, on the              Cinematic device
                                                                                       role of humanities in medical design of the disease as well as on the humanization of
                                                                                                                                                                                        Medical Humanities
                                                                                       the clinical encounter in order to facilitate the anamnesis, the therapy and the care.
                                                                                       Among the main declinations, a more complex point of view arises, suggesting the criti-           Self-representation
                                                                                       cal integration and exploitation of a variety of methodologies, previously used by art and            Therapeutic set
                                                                                       humanities research, into a peculiar human-centered dispositive, both narrative and           Therapeutic filmmaking
                                                                                       therapeutic, in which audiovisual practices and languages acquire new healing potential                          DOI
                                                                                       and activate bias for unprecedented processes of subjectivization for particular target                https://doi.
This work is licensed under a Creative Commons Attribution 4.0 International License




                                                                                       of suffering human beings.                                                                     org/10.54103/2036-
                                                                                       Based on the aforementioned premises, the essay aims at investigating the therapeutic
                                                                                                                                                                                              461X/17748
                                                                                       set as performative and methodological model, consistent with art-therapy and narra-
                                                                                       tive-based medical approaches, applicable in specific pathological conditions and heal-
                                                                                       th-care contexts. Within such reflexive and operational framework including documen-
                                                                                       tary studies and visual anthropology, self-representational and amateur theories, the
                                                                                       therapeutic set becomes a media environment where the formative encounter, both
                                                                                       technical and pragmatic, finally ethical, between the self and the world, the action and
                                                                                       the awareness takes place.
                                                                                       My purpose is to explore the theoretical pillars of the therapeutic set as transformative
                                                                                       interplay between profaned cinematic dispositive and psychotherapy setting, dwelling
                                                                                       on bodily involvement, audiovisual gestures and amateur self-representation to which
                                                                                       active participants, storytellers of their own illness and treatment, are called in the
                                                                                       making of therapy and narrative.
                                                                                       The paper finally intends to illustrate selected interdisciplinary case studies in order to
                                                                                       discuss the healing potential of creative participatory processes and self-representa-
                                                                                       tions, occurring thanks to the relocation and amateurization of the contemporary cine-
                                                                                       matic experience.




                                                                                       INTRODUCTION
                                                                                         With the aim of dispelling terminological and definitional ambiguities, in
                                                                                       2014 the Consensus Conference organized by the Italian Istituto Superiore di
                                                                                       Sanità (ISS) established the guidelines for the application of Narrative Medicine
                                                                                       (henceforth NM), understood as ‘a clinical-assistance intervention methodology
                                                                                       based on a specific communicative competence’, which aims to ‘acquire,


                                                                                       Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                                              53
     understand and integrate the different points of view of those involved in the
     disease and in the treatment process’.1
       Exploring the different lines of actions outlined in the Consensus Conference,2
     the Medical-Narrative approach is characterized, on the one hand, by the adoption
     of narration as a medical anamnesis and a research tool that contributes to the
     collection of clinical and biographical data of the patients and, on the other — to
     an extremely limited extent — by a narrative therapeutic approach designed to
     improve the patient’s quality of life.
       The leading theory in this area is dedicated to the integration of narrative
     skills into clinical practice, in particular as a tool for implementing doctor-patient
     communication, hence facilitating diagnosis as well as the therapy itself.3 In fact,
     this concept of Narrative-Based Medicine (NBM), in opposition to a physiological,
     symptom-driven Evidence-Based Medicine (EBM), aims to construct a shared path
     of personalized care, which is methodologically grounded on the conversation
     between patient and doctor regarding the experience of an illness, but also on
     the social, cultural, and personal history of the individual. Here I do not refer,
     however, to psychological and psychotherapeutic approaches,4 which, although
     differentiated according to specific methodologies, can be broadly defined as
     specific forms of narration, within clinical definition of Narrative Therapy.
       In the following pages, I present performativity and agency as the key
     concepts of Narrative-Based Therapies, with the aim of framing Medical
     Narrative techniques and methods within a humanistic lens, and suggesting
     a fertile, interdisciplinary convergence. From this perspective, the purpose of
     the article is not only to map out the relationship between Medical Narratives
     and audiovisual tools, but also to investigate and propose the theoretical,
     methodological, and then applicative framework of Therapeutic Set as a
     peculiar double dispositif. Accordingly, in the following discussion I explore self-
     narrative forms that are agentive, in a way, and a therapeutic approach that
     uses narrative as the therapy itself.



     HOW VISUAL MEDICAL
     NARRATIVES (COULD) WORK
       In an attempt to take the stock of the theoretical, methodological, and pragmatic
     state of art,5 the contribution of NM to clinical practice would seem limited to the
     ability to acknowledge, interpret, and act on the stories and plights of others,
     under a label of a medicine practiced with narrative competence.6 A large
     portion of NM, therefore, deals with meta-clinical elements and paratherapeutic
     aspects, such as the compilation of medical records, medical training programs
     and improvements in the effectiveness of the healthcare team.7
       Within the Medical Narrative approach, the relevance of biographies reported
     by the patients themselves is also a valuable contribution to the disease’s
     clinical delineation. A narrative interaction conceived in this way enables a



54                                      Sabatino, Audiovisual Means to Therapeutic Ends
therapeutic dialogue where intersubjectivity arises from the fertile encounter
between the patient-narrator and the doctor-listener; the latter is facilitated in
investigating the multiple interweavings between physiological symptoms and
the patient’s verbal and non-verbal narration.8
  Unlike NM, Narrative Therapy (NT) can be erroneously considered as an
equivalent to the macro-category of psychotherapy. While the ‘narrative’
attribute can be confusing, since ‘all therapies are narrative therapies’,9 White
and Epston identify the therapy as the narrative process through which patients
shape their identities.10
  More specifically, while psychotherapy requires psychological treatment
involving ‘either removing, reducing, or modifying specific emotional, cognitive,
or behavioral problems, and/or promoting social adaptation, personality
development and/or personal growth’,11 NT is a peculiar psychotherapeutic
approach focusing on the exploration, examination and editing of the stories
people tell themselves about their life, in order to trigger ermeneutical and self-
storytelling shifts that therapeutically intervene on specific targeted issues.12
  While the aforementioned approaches elect the patient’s words as the
privileged narrative tool, Medical Humanities seems to have taken a visual
turn in 2018, when two key events take place: the roundtable Interdisciplinary
Entanglements: Towards a Visual Medical Humanities convened by Fiona
Johnstone and Natasha Ruiz-Gómez during the Association for Art History’s
2018 Annual Conference, and the drafting of a Visual Medical Humanities
manifesto, which proposed to focus on relevant issues and topics that had
previously been neglected:

         the value of the visual is not limited to the illustrative (for example,
         as a way of making existing academic research more ‘accessible’);
         nor to the purely instrumental (for example, as a way of producing
         more ‘empathetic’ doctors) […] A Visual Medical Humanities asks
         questions about our expectations of what certain types of visual
         artefact can do for us (recognizing that this ‘us’ is not a unified
         singular entity, but plural and diverse); it also notes that these
         expectations are contingent on context. […] for example, an artwork
         might commonly be asked to act as a marker for subjectivity, or as
         a way of articulating the ‘patient experience’.13

  Despite the theoretical and methodological efforts to establish a disciplinary
orientation that relies on visual and narrative-based strategies, these attempts
appear promising but remain partial. Indeed, a crucial reflection on the linguistic
specificity of one visual field or another appears to be lacking; a reflection that
has to be provided by scholars, professionals and experts in the field, and not
only by clinicians and psychologists. Nevertheless, the importance of reflecting
on ‘what certain types of visual artefact can do for us’14 — and, I would add, to us
— should certainly be acknowledged.
  In short, there would seem to be a lack of specific toolsets for visual-based
clinical interventions; this is particularly true of the audiovisual medium, since
numerous different approaches are often incorporated within the definition of


Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                      55
     Cinematherapy.
       Within Film Studies, the methodological and epistemological matrices of the
     therapeutic models that use cinematic language can be traced back to early
     cinema theories, which described the cinematic vision as a captivating and
     enthralling experience, that is potentially pathogenic and pedagogical in equal
     measures.15 The attraction exerted by the cinematic apparatus is justified by the
     technology’s specific ability on the one hand to capture attention and stimulate
     the viewer’s perceptual activity,16 and on the other to address, through technique
     and sensorial apparatus,17 therapeutic — prophylactic and curative — potential
     to the social body it invokes.18
       In identifying used and usable therapeutic narrative tools, one priority goal is
     not only ‘to frame the narrative approach in the context of empowerment and
     the transition from paternalistic medicine to the relationship model in which the
     patient is a partner and not just an object of care’,19 but also to cultivate its true
     innovative potential through the co-construction of ‘therapeutic emplotments’,20
     which pursue a continuous renegotiation of meanings between caregivers and
     patients.
       This raises an important question that merits our attention, regarding the
     possibility of building up a methodology which could include both therapeutic
     and narrative interventions.21 Within a setting that involves the adoption of a
     double rhetorical and linguistic register, visual narratives and psychotherapy
     in its narrative dimension can expand their effects in reciprocal agentivities. In
     this context, a double dispositif arises from the encounter between therapeutic
     interviews and audiovisual images, creating a symbolic, relational-pragmatic
     and narrative space which creates fertile opportunities for subjectivation
     processes.
       However, this double narrative — both therapeutic and cinematic — dispositif,
     in which both the spectator (or the ‘maker’, as we will see below) and the patient
     participate, might appear doubly binding, determining even more restrictive
     positions and roles for the patient involved. Far from Baudry’s apparatus
     theory22 and Foucault’s early, prescriptive conception of the dispositif,
     characterized by a dominant strategic function,23 I would imagine such double
     dispositif as a rhizomatic machine that forges links between heterogeneous
     entities.24 If, according to Deleuze, the dispositif already acts by creating a
     dynamic equilibrium that is analogous to a skein — a multilinear set composed
     of lines of a different nature25 — and therefore activates an autopoiesis — a
     process of subjectivity formation that is never given and always in the making
     — this is even more true within a bifid device such as a therapeutic visual
     medium, in which components interact by mutual interference through lines
     of subjectivation, becoming fluid and open enough to escaping attempts of
     totalising control. Consequently, the position and role of the user of this double
     dispositif changes according to different therapeutic approaches, following a
     dynamic configuration that oscillates between subjection and subjectivation.
       Within the outlined bifid and hybrid structure, but also the current debate
     on visual narrative therapies, a definitional framework appears increasingly



56                                      Sabatino, Audiovisual Means to Therapeutic Ends
necessary, regarding not only the therapeutic aim, but also the rhetoric,
language, and account that may characterize the specific narrative-based
approach.



THE THERAPEUTIC SET:
FROM CINEMATHERAPY
TO THERAPEUTIC FILMMAKING
   In reconstructing a brief history of psychotherapeutic approaches that
have made use of the cinematic language, as well as of audiovisual tools
and techniques, it is evident that the cinematic dispositif cannot be totally
reproduced and reconstructed in its original form within the peculiar setting
that the application of therapeutic functioning requires. Within clinical studies
and theoretical contributions on Cinematherapy and Filmtherapy,26 we can
find a common tendency to assimilate one another as a therapist-assisted film
visions, followed by comments and discussions of therapy-targeted contents.27
In a scenario where psychotherapy seems not to operate any theoretical,
procedural and methodological distinctions between techniques and their
therapeutic uses, great attention must be paid to the differences, that can
be substantial and relative to the position and role of the patient, between
Cinematherapy and Filmtherapy. Referring to ‘relocated cinema’,28 I propose
to distinguish between Cinematherapy and Filmtherapy in the light of their
setting and delivery operations.29 While the setting process coincides with the
reproduction of the viewing modes of the cinematic environment outside the
movie theatre, thereby provoking in the viewer a feeling of being almost like in
a cinema auditorium, the delivery process refers to the object of vision, to the
movie in itself, its content as the binding evidence of its specific visual language.
   From this point of view, Cinematherapy may be defined as a setting
process, through which the therapist recreates in the therapeutic setting the
environmental characteristics that make the patients feel as though they are in
a movie theatre, also possibly involved in a collective vision together with other
patient-spectators, and eventually using a movie theatre itself as a therapeutic
setting.
   In Cinematherapy, both the therapeutic setting and the movie theatre maintain
reciprocal relationships, being configured as enlargements of the patient-
spectator’s living space through an illusion of continuity: experiencing fictional
reality at a safe distance, within a ‘liberated embodied simulation’30 framework,
the patient-spectator faces the viewed fictional reality in which alternative
events are possible, and consequently achieves a different perception and
manages her/his own agency in relation to illness and treatment.
   Filmtherapy, on the other hand, is configured as a delivery process, in which
the therapist, using filmic content, tackles particular issues that are told
and treated in the movie. The movies, selected on the basis of the targeted


Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                       57
     therapy goals, are therefore seen, alone or together with other subjects, during
     psychotherapeutic sessions.
        In both Cinematherapy and Filmtherapy, the patient-spectator is the privileged
     recipient of the effects produced by the double dispositif I previously mentioned:
     the cinematic apparatus capable of affecting relationships between a seeing
     subject and the object of the vision, and the therapeutic setting — the latter
     constituted, in the case of Cinematherapy, by the modes and location of viewing,
     and in the case of Filmtherapy, by the choice of the film to see and then comment
     on.
        While Cinematherapy and Filmtherapy can be defined as circumscribed
     manifestations of the cinematic dispositif within the therapeutic setting, where
     the act of vision is limited to a series of exclusively spectatorial practices,
     Therapeutic Video Recording, frequently generically called Videotherapy,
     requires the patient not only to pay attention and listen actively, but also to
     participate through a creative presence.31
        Used in selected settings or supervision sessions, Therapeutic Video
     Recording offers an opportunity for cognitive and emotional distancing between
     one’s own mental image and the picture 32 of oneself acting on the screen, in
     order to activate a process of Self Video Confrontation.33 As the main character,
     and no longer just a spectator of someone else’s movie, but also participating
     in some creative choices — like, for instance, the camera movements during
     the session — the patient starts to resemble a spectator-performer, not only
     for the active attitude of creating her/his own experience of vision, but also for
     creatively engaging in amateur and performative grassroots practices. In the
     light of the used footage technique, I define this videotherapeutic approach as
     Documentary Videotherapy.34
        In this way, the therapeutic setting begins to include the movie set: it
     disciplines both the liminal and heterotopic experience to which they provide
     access, hybridising each other thanks to the relocation of procedures, dynamics
     and roles that shape a spectatorial experience, without stating a hierarchical
     and binary distinction between bodies and images, or between material reality
     and its representations.35
        On the Therapeutic Set the patient can be involved in an increasingly narrative-
     performative process through Therapeutic Filmmaking.36 In the Therapeutic
     Filmmaking methodology, the participatory mode and the bodily involvement
     that it carries with itself is crucial.37 The participatory documentary model
     has been therapeutically theorized by Jackie Shaw and Clive Robertson, who
     conceive Participatory Videotherapy as characterized by a strong focus on the
     production process, as well as on customized interventions based on the social
     and emotional needs of the participants. According to this kind of relational
     therapeutic model, self-representation reveals itself as the starting point of a
     transformative intervention to overcome trauma and treat ailments, as well as
     of the cultivation and realization of the potential of each individual.38
        Even before Shaw and Robertson’s therapeutic methodology, in the 1950s
     Fernand Deligny’s artistic and pedagogical project of, in the context of La



58                                     Sabatino, Audiovisual Means to Therapeutic Ends
Grande Cordée, used cinematic language as an educational tool for taking care
of children and adolescents with Autism Spectrum Disorder outside traditional
structures. In this way, he contributed significantly to the implementation of
therapeutic practices based on the participatory and interactive production
and fruition processes, as well as on subjectivation dynamics through an iconic
register.39
   In therapeutic viewing techniques, the presence of a multimodal spectatorship
was already evident, with cinema vision impacting not only the disembodied
psyche, but, also, on a kinesthetic subject that touches and is touched by the
representation taking place both on and off the screen.40 Recalling a therapeutic
participatory (and performative,41 as I am going to further explain later) model,
Therapeutic Filmmaking involves the patient’s creative and self-narrative
agency, not only as a social actor but also as the material maker of her/his
own stories of illness and therapy. In the framework of a substantial theoretical
modification of the spectatorship paradigm, the everyday media user is no longer
just prosumer, but also a serious amateur,42 who is increasingly audiovisually
literate and frequently aware and engaged in self-narrative processes, which
occurs first and foremost through a bodily act and an artisanal-technological
creation.
   In fact, as Maya Deren has argued, the advantage that the amateur can enjoy
over the professional consists in a freedom that is both artistic and physical:
‘the most important part of your equipment is you: your mobile body, your
imaginative mind and your freedom to use both’.43 Identically to the amateur
audiovisual producer, then, the patient-author is inextricably body-grounded
during the whole Therapeutic Filmmaking process, under clinical supervision
and creative facilitation, s/he is materially entangled in filmmaking process,
from screenwriting to the editing phase, that allows her/him to translate her/
his pathological history into audiovisual narratives, gaining technical and
creative, but, mostly, cognitive and emotional abilities to reinvent the trauma or
disorder and reshape it into a re-narrativized version of the Self.
   Within a medical-narrative treatment, enrolled in a holistic dynamic that is not
only psychic but also bodily and pragmatic, the patient can finally evolve from a
simple beneficiary to an active and co-creative participant within an exquisitely
narrative psychotherapy, which the cinematic approach helps to facilitate and
implement.



SELFREPRESENTATIONAL THERAPY:
A VIRTUOUS CIRCULAR AGENCY
  Within such an increasingly participatory and performative framework,
the Therapeutic Set that hosts the whole therapeutic process is a singular
audiovisual fieldwork: a ritualized set in which ‘social and ritual dynamics
intersect with scenic ones due to the presence of the movie camera’.44


Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                     59
        The procedural and material creation through which patients produce an
     audiovisual narrative on the Therapeutic Set confers a specific agency on
     their audiovisual artefacts, that is both therapeutic and iconic. As imagines
     agentes assuming a decisive role in shaping our experiences with relevant
     impact on life and experience,45 visual artefacts can exert agency through an
     embodied cognitive process that Alfred Gell has called the ‘abduction of agency‘
     by the means of Peircean material indexes.46 In this context, the productive
     and receptive events would be intentionally made by acting and producing
     entities, both of which are connected to the creators and to the recipients of
     these iconic products. If the model developed by Gell partially overcomes the
     cultural dichotomies between the subject and the object as social agents, the
     performative nature of selected iconic representations, their potentiality to act
     as ‘performing images’,47 inevitably requires a continuous de-constructive and
     reconstructive process that has to take into account the social, intersubjective,
     as well as evenemential dimensions,48 and this essentially happens through an
     experiential and participatory creation.49
        In my opinion, this theoretical and methodological premise constitutes a
     starting point for the reconsideration of an iconic, possibly therapeutic, agency,
     not to be found in the power of pictures in themselves, but in the experiential
     power of the process. In this perspective, I propose an interpretation of self-
     representations as paradigmatic intersections emerging from the constitutive
     relationship between the living medium (the body) of perception, projection,
     image acquisition, and technological medium. Material agency, which is
     conveyed by picture and image as essential to the emergence of an iconic
     power,50 can potentially shape a transformative process and a singular
     experiential effectiveness, both relying on bodily involvement and interactional
     living in its environment.
        The amateur patients-filmmakers51 in fact transfer their agency to amateur
     videos through their bodily and creative intervention, making them secondary
     agents, capable of bearing agency themselves. This kind of symbolic exchange
     does not work from agent to patient in their immutable roles,52 but indeed,
     ‘in any given transaction in which agency is manifested, there is a patient
     who or which is another potential agent, capable of acting as an agent or
     being a locus of agency’.53 Operating bidirectionally, agency can be therefore
     theoretically traced back to Merleau-Ponty’s chiasm and the reversibility of the
     living subjective body in the world of beings and things, as a mutual passion of
     the material.54 The therapeutic efficacy would also seem to be enhanced by a
     performative surplus55 which involves the participants as they tell their stories
     in front of a camera. If, still, patients are pigeonholed in a double dispositif,
     the opportunities for subjectification are very many, in particular due to the
     narrative and therapeutic parallax effect 56, that determines a repositioning
     of the participants’ point of view — since, previously, patients-subjects were
     exclusively ‘observed’ and passively treated.
        In this regard, the linguistic form of the selfie, as self-representational,
     democratized audiovisual form, is emblematic.57 Crystallizing the authorial



60                                    Sabatino, Audiovisual Means to Therapeutic Ends
trait in the material representation of the gestural production,58 the practice
of the selfie ‘constitutes a deictic movement of the body that draws attention
to the immediate context in which the observed image is inserted and towards
the observer’s activity’.59 The technical gesture of shooting, zooming and
selecting the frame contains a connective performance, which is not exclusively
characterized by its reference to the represented subject, but related to the
production of a trace of reality which concerns its own operator or agent. In
amateur and self-narrative audiovisual representations, such indexical and
productive circles materially bind the self-portrait to its creator, as well as
the subject to its objectual representation. The amateur video as gestural act
therefore constitutes an autographic artefact, whose identity can only depend
on the technical and experiential conditions of its production and on the material
immanence of its object, the bearer of an indexical trace of its creator and agent
as singular human being.
  By experiencing the triple role of main character, creator and spectator, the
amateur filmmaker-as-patient of a medical-narrative treatment is uniquely
entangled in a material, perceptual, emotional and self-reflexive relationship
between her/his own audiovisual self-representation, between the images
on the screen and their agency on the targeted pathological condition off the
screen. Conceived in a post-phenomenological perspective, within a procedural
art nexus, this technical and material processuality determines a complex
abduction of agency and a possibly beneficial reversibility between the subject
and its self-representation.
  In my theoretical and methodological proposal so far, the potentially
therapeutic agency of amateur audiovisual self-narratives is determined by the
activation of a suspension of the threshold60 and the consequent permeability
between the story on the screen and the reality off the screen, within an
agential, deictic, and representational circularity between subject and object, as
is particularly evident in amateur audiovisual self-narratives.



ICONIC PHARMAKON
   In 2007 the Cineteca and the ASP Giovanni XXIII in Bologna launched an
experimental clinical trial which aimed to use audiovisual language for the
treatment of dementia and Alzheimer’s disease. A team consisting of a doctor,
a licensed psychologist and a director created a customized, audiovisual short
movie, specifically edited for the patient, using a collage of clinical data, filmed
testimonies on the patient’s everyday life, and photographic material provided
by family and friends.
   The research group hypothesized that the periodical administration of
Memofilm — that is the name of the project — would positively impact the
patient’s memory, modifying not only the recovery of the past, but also the self-
perception of her/his agency in the present. And in fact, within a timeframe of
five years, seventeen Memofilms have proved to be effective in treating specific


Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                      61
     symptoms and pathological behaviours related to the targeted disorders.61 Not
     only did the Memofilm designate the patient as the main character, object and
     subject of the person-centered narrative treatment, but it was also plot-based
     on the unique life story specifically designed for that one patient as its single
     spectator.
       If, therefore, the Memofilm, as exemplification of Documentary Videotherapy,
     can activate a symbolic exchange between a pathological condition and its
     narratively reconstituted real life,62 the therapeutic art nexus that involves the
     patient — who is also the patient in the secondary agency enhanced by the
     Memofilm — has significant beneficial effects on the condition that the patient
     passively undergoes. Through an embodied vision and a cross-modal sensory
     viewing, the patient-spectator therefore experiences the Memofilm by placing
     him/herself simultaneously on the screen and outside it. Unlike fictional or
     documentary movies, where the action and interaction of characters act out
     a plot, in the Memofilm the viewing experience is about real life: this is the
     content of vision and the action of its singular and unique spectator. Indeed,
     the Memofilm is conceived to give the patient access to the screen in order to
     access her/his life’s story on which the plot — and the corresponding therapeutic
     strategy — is based. Furthermore, the clinical and creative intervention of the
     team, together with the participation of the patient as spectator and main
     character, are decisive for the configuration of Memofilmic Therapeutic Set
     which symbolically, pragmatically, and operationally intervenes on the targeted
     pathology.
       In the second research-intervention project I am going to describe, the
     Therapeutic Set requires an even more consistent attendance and participation
     by the spectator. The Video-Pharmakon project is designed to treat children
     and adolescents with Autism Spectrum Disorder (ASD) through a complex
     corpus of videotherapy techniques and methodologies.63 Like Memofilm,
     this methodology consists in the administration of customized audiovisual
     products edited by the videotherapeutic team, made up of a filmmaker, a child
     neuropsychiatrist, and a trained and licensed psychologist. Though the patient’s
     position and role as spectator is maintained during the initial therapeutic phase,
     the Video-Pharmakon protocol differs with regard to a set of crucial elements
     that serve the therapeutic goals. In fact, the role of the patient as spectator and
     main character of the final product constitutes only a marginal phase; rather the
     patient’s creative intervention as author and director, as filmmaker of her/his
     own self-portrayal and autobiographical narrative, prevails [Fig. 1].
       To be more efficient with regard to the behavioural difficulties typical of ASD,
     mainly related to the socio-communicative sphere,64 the protocol is designed
     with a methodological focus on the Therapeutic Filmmaking technique — at the
     expense of Cinematherapy and Documentary Videotherapy, which are used to
     a less substantial extent. During Therapeutic Filmmaking, young patients use
     cameras to tell their own fictional or autobiographical stories, transforming
     themselves from patients to agents, in an audiovisual field that is configured
     as a transitional, materially moldable, and narrative therapeutic context. Within



62                                     Sabatino, Audiovisual Means to Therapeutic Ends
                                                                                     Fig. 1
                                                                                     On the Therapeutic Set ©
                                                                                     Video-Pharmakon project




their role as facilitator on the Therapeutic Set, the professional filmmaker only
assists the participants in creating their audiovisual story, oscillating between
self-representational and inevitably participatory narratives. Simultaneously,
the psychologist works on targeted issues during every creative phase on the
Therapeutic Set, according the narrative therapy principles and framework.
  This processual mode leads to the realization of a Video-Pharmakon, which
can be understood as the material outcomes of a horizontal collaboration and
as a dynamic audiovisual object of which patients, clinicians and filmmakers are
simultaneously the authors, main characters and spectators. [Fig. 2]
  Created and then re-viewed by the participants themselves, the Video-
Pharmakon produces its therapeutic effect not only during the patient-
spectator’s re-vision, but also within the productive and creative process itself:
the relationship between authors and their audiovisual narratives, as well as
the intersection between the authorial and the same spectatorial self, make




                                                                                     Fig. 2
                                                                                     Directing patient © Video-
                                                                                     Pharmakon project



Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                                        63
                          the therapeutic process effective according to specific therapeutic behavioural
                          goals.
                            As an intermedia montage65 of the amateur patients’ footage with the
                          documentary video recordings collected by videotherapeutic team during each
                          production phase, Video-Pharmakon is a complex linguistic assemblage of
                          self-representational and documentary forms, able to help the participants to
                          recognize their own proactive role not only in the creative process but also,
                          transitively, in their own lives.




Fig. 3
At the movie theatre ©
Video-Pharmakon project



                             Thanks to the iconic and experiential agency derived from a deictic self-
                          representational process, the therapy is finally enabled by the re-visioning of
                          oneself in the act of reinventing the trauma or disease on the set of everyday
                          life, but also in all the procedural phases of anamnesis, conception, shooting
                          and editing, which are all delivered by the patients themselves.
                             The whole experience, embedded in the patients’ bodily involvement in
                          the material act of filmmaking, which therefore acquires the ability to affect
                          a pathological reality thanks to the spectauthorial role finally gained by the
                          participants.66 Such spectauthorship, characterized by a circular processuality
                          which involves the patient firstly as spectator, then as author, and finally as
                          spectauthor, finds its methodological roots in the self-representation and body
                          performativity of creative audiovisual acts, as discussed so far.



                          CONCLUSION
                            Within the current context of the Medical Humanities, therapeutic audiovisual
                          approaches still require field-specific reflections on definitional and application
                          possibilities. This discussion has provided attempt in this regard, in shaping a
                          participatory-ascending path regarding the roles of patient and spectator. By



64                                                          Sabatino, Audiovisual Means to Therapeutic Ends
enabling participant access in a double dispositif, that is both therapeutic and
narrative, and through their physical and gestural inscription within the self-
portrait form, the amateur, self-representational process has the pragmatic
potential to trigger, thanks to a material, perceptual, emotional and self-reflexive
entanglement, a potential reversibility between the movie on the screen and its
agency in everyday life. From a Medical-Narrative perspective, a specific, iconic
agency arises in the embodied relationship between the amateur audiovisual
creator and her/his own self-representation, in a deictic circle of subject and
object representation.
  In the methodological path outlined so far, within the context of visual
Narrative Therapy, Cinematherapy and Filmtherapy, on the one hand, consist in
a cinematic fruition with a high interpretation rate, that is nonetheless controlled
by the workings and the rules of the therapeutic setting; on the other hand,
Therapeutic Video Recording, Documentary Videotherapy, and Therapeutic
Filmmaking offer an increasingly interactive and performative relationship with
the filmic text.
  From this perspective, the audiovisual product distinguishes itself for its
counter-gifted nature, acting therapeutically as a self-reflexive, creative and
iconic subjectivation process. This ecological progression — consisting in an
amateur spectauthorial creation and a metanarrative Video-Pharmakon vision,
based on a kind of agency which can only be bodily, material and self-made —
contains the condition of possibility for beneficial effects of audiovisual therapy.




Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                      65
Notes
 1
      ISS-CNMR,‘Conferenza di Consenso. Linee di indirizzo per l’utilizzo della medicina narrativa in ambito
clinico-assistenziale per le malattie rare e cronico-degenerative’, I Quaderni di Medicina de il Sole 24 Ore
Sanità, 7.24 (2015), 3-24 (13) (my translation).
   2
      Ibidem. The ISS defines four different Narrative Medicine theoretical and methodological approaches,
13-15.
   3
     I am refering to the seminal work of dr. Rita Charon, Narrative Medicine: Honoring the Stories of Illness
(New York: Oxford University Press, 2006).
   4
     The Handbook of Narrative and Psychotherapy: Practice, theory and research, ed. by Lynne Angus and
John McLeod (Thousand Oaks, CA: Sage Publications, 2004).
   5
      In this regard, see at least Rita Charon and others, The principles and practice of Narrative Medicine
(New York: Oxford University Press, 2016); Maria Giulia Marini, Languages of Care in Narrative Medicine:
Words, Space and Time in the Healthcare Ecosystem (New York: Springer, 2018).
   6
      Not to be overlooked, in my opinion, is the related concept of subjunctive medicine. Cf. Doug Hardman
and Giulio Ongaro, ‘Subjunctive Medicine: A Manifesto’, Social Science & Medicine, 256 (2020), 113039.
   7
      See, at least, the seminal work of Trisha Greenhalgh, ‘Narrative Based Medicine in an Evidence Based
World’, BMJ, 318.7179 (1999), 323-25; Megan M. Milota, Ghislaine J.M.W. van Thiel and Johannes JM van
Delden, ‘Narrative Medicine as a Medical Education Tool: A Systematic Review’, Medical Teacher, 41.7 (2019),
802-810.
   8
      On this matter, Ann King and Ruth B. Hoppe, ‘Best Practice for Patient-centered Communication: A
Narrative Review, Journal of Graduate Medical Education, 5.3 (2013), 385-93; The Routledge International
Handbook of Embodied Perspectives in Psychotherapy: Approaches from Dance Movement and Body
Psychotherapies, ed. by Helen Payne, Sabine Koch and Jennifer Tantia (London, New York: Routledge, 2019).
   9
     John McLeod, Narrative and Therapy (London: Sage, 1997), X.
   10
       See Martin Payne, Narrative Therapy (London: Sage, 2006).
   11
        Philip Barker, ‘The Healing of the Mind: Meaning and Method’, in Talking Cures: A Guide to the
Psychotherapies for Health Care Professionals, ed. by Philip Barker (London: Nursing Times Books, 1999),
8.
   12
       See at least Michael White, Wijaya Made and David Epston, Narrative Means to Therapeutic Ends (New
York: WW Norton & Company, 1990).
   13
        Fiona Johnstone, ‘Manifesto for a Visual Medical Humanities’, BMJ Medical Humanities Journal, <
https://blogs.bmj.com/medical-humanities/2018/07/31/manifesto-for-a-visual-medical-humanities/?msc
lkid=9ce56c6cc4d911eca26a069a9b58d3f0>, [accessed 23 April 2022].
   14
       Ibidem.
   15
       Mireille Berton, Le corps nerveux des spectateurs: Cinéma et sciences du psychisme autour de 1900
(Lausanne: L’Age d’Homme, 2015); Moralizing Cinema: Film, Catholicism, and Power, ed. by Daniël Biltereyst
and Daniela Treveri Gennari (London, New York: Routledge, 2014).
   16
        Vittorio Gallese and Michele Guerra, ‘Embodying Movies: Embodied Simulation and Film Studies’,
Cinema: Journal of Philosophy and the Moving Image, 3, (2012), 183-210.
   17
       Christian Metz, The Imagery Signifier: Psychoanalysis and the Cinema (Bloomington: Indiana University
Press, 1982).
   18
       Walter Benjamin, The Work of Art in the Age of Mechanical Reproduction (Penguin UK: London, 2008).
   19
       ‘Conferenza di Consenso’, 19, my translation.
   20
       Cheryl Mattingly, ‘The Concept of Therapeutic Emplotment’, Social Science & Medicine, 38.6 (1994), 811-
822.
   21
       This mixed therapeutic methodology is not new to the field of Art-Therapy, on which I am, however, not
going to dwell in this discussion: in this regard, see Cathy Malchiodi, Art Therapy and Health Care (New
York: Guilford Press, 2013).
   22
       Jean-Louis Baudry and Alan Williams, ‘Ideological Effects of the Basic Cinematographic Apparatus’, Film
Quarterly, 28.2 (1974), 39-47.
   23
       Michel Foucault, Power/Knowledge. Selected Interviews and Other Writings 1972-1977, ed. by Colin
Gordon (New York: Pantheon Books, 1980), 194-195.



66                                                            Sabatino, Audiovisual Means to Therapeutic Ends
 24
      Gilles Deleuze and Félix Guattari, Rhizome. Introduction (Paris: Eds. de Minuit, 1976), 18-19.
 25
      Gilles Deleuze, ‘What is a dispositif?’, in Michel Foucault: Philosopher, ed. by Timothy Armstrong (London:
Harvester Wheatsheaf, 1992),159-166.
   26
      See, among others, Linda Berg-Cross, Pamela Jennings and Rhoda Baruch, ‘Cinematherapy: Theory and
Application’, Psychotherapy in Private Practice, 8.1 (1990), 135-56; Danny Wedding and Ryan M. Niemiec,
‘The Clinical Use of Films in Psychotherapy’, Journal of Clinical Psychology, 59.2 (2003), 207-215. Also
see the more recent Christie Eppler and Jen Hutchings, ‘The Use of Cinematherapy to Illustrate Systemic
Resilience’, Journal of Clinical Psychology, 76.8 (2020), 1463-1471, Sayyed Mohsen Fatemi, Film Therapy:
Practical Applications in a Psychotherapeutic Context (New York, Routledge, 2022).
   27
      Cinematherapy/Filmtherapy has frequently been considered a form of Art-Therapy, cf. Materials and
Media in Art Therapy, ed. by Catherine Hyland Moon (New York, Routledge, 2010). In this discussion, I
instead try to frame it within Film and Media Studies.
   28
      Francesco Casetti, The Lumière Galaxy: Seven Key Words for the Cinema to Come (New York: Columbia
University Press, 2015), 60-71.
   29
      Ibidem, 96-102.
   30
      Vittorio Gallese and Michele Guerra, The Empathic Screen. Cinema and Neuroscience (Oxford: Oxford
University Press, 2019 [2015]).
   31
       This therapeutic concept may be defined as a set of video recording techniques used during the
psychotherapeutic session, cf. Videotherapy in Mental Health, ed. by Jerry Fryrear and Bob Fleshman
(Springfield: Charles C. Tomas, 1981); Ira Heilveil, Video in Mental Health Practice: An Activities Handbook
(New York: Springer, 1983); Lou Furman, ‘Video Therapy: An Alternative for the Treatment of Adolescents’,
The Arts in Psychotherapy, 17.2 (1990), 165-169.
   32
      I am referring to the image/picture distinction proposed by John W. Mitchell, What do Pictures Want?
The Lives and Loves of Images (Chicago: University of Chicago Press, 2005).
   33
      In this regard, see at least the seminal study of Gérard Bléandonu, La vidéo en thérapie. Le choc de
l’image de soi dans les soins psychologiques (Paris: ESF, 1986).
   34
       I have described this approach to a higher level of detail in Anna Chiara Sabatino, Valeria Saladino,
Valeria Verrastro, Cinema terapeutico. Linguaggi audiovisivi e percorsi clinici (Rome: Carocci, 2021), 57-62.
   35
      In fact, ‘it is rather a question of discerning multiple and continually varying interactions among what
can be defined indifferently as bodies and as images’, cf. Steven Shaviro, The Cinematic Body (Minneapolis:
University of Minnesota Press, 1993), 256.
   36
      Cf. Video and Filmmaking as Psychotherapy, ed. by Joshua L. Cohen, Lauren Johnson and Penelope
P. Orr (New York: Taylor & Francis, 2015); Małgorzata Jakubowska and Monika Michałowska, ‘Filmmaking
as Therapy: between Art Therapy and Resilience Theory’, Panoptikum, 18 (2017), 227-236; Rivka Tuval-
Mashiach, Benjamin Patton, and Charles Drebing, ‘“When You Make a Movie, and You See Your Story There,
You Can Hold it”: Qualitative Exploration of Collaborative Filmmaking as a Therapeutic Tool for Veterans’,
Frontiers in Psychology, 9.1954 (2018), 1-11; Anna Chiara Sabatino and others, ‘Therapeutic Filmmaking,
Strategic Psychotherapy and Autism Spectrum Disorder: An Integrated Approach’, Journal of Psychological
& Educational Research, 29.2 (2021), 56-89.
   37
      Participatory video manifests itself in multiple forms: from collaborative video, developed in the 1960s
within the Fogo Process movement, in which the camera remains in the hands of the facilitators (see
Donald Snowden, ‘Eyes See; Ears Hear: Supplement to a Film Under the Same Title’, Memorial University,
1984, n.p.), to projects in which the participation is more consistent (for instance, the Video in the Villages
by Vincent Carelli in 1987 and Terence Turner’s Kayapo Video Project in 1990 Navajo Project); see Terence
Turner, ‘Representation, Politics, and Cultural Imagination in Indigenous Video: General Points and Kayapo
Examples’, in Media Words, ed. by Faye D. Ginsburg, Lila Abu-Lughod and Brian Larkin (Berkeley: California
University Press, 2002), 75-89 and also Sol Worth and John Adair, Through Navajo Eyes: An Exploration in
Film Communication and Anthropology (Bloomington: Indiana University Press, 1972).
   38
      Jackie Shaw and Clive Robertson, Participatory Video: A Practical Approach to Using Video Creatively
in Group Development Work (London, New York: Routledge, 2008 [1997]).
   39
      Fernand Deligny, ‘La caméra outil pédagogique’, Vers l’éducation nouvelle, 97 (1955).
   40
      This matter is extensively discussed by Vivian Sobchack, Carnal Thoughts: Embodiment and Moving
Image Culture (Berkeley: University of California Press, 2004).
   41
      I am here refering to performative documentary as defined by Stella Bruzzi, New Documentary (London,



Cinéma & Cie vol. 22 no. 39 2022 · ISSN 2036-461X                                                          67
New York, Routledge, 2006), 185-217.
  42
     David Buckingham, Maria Pini and Rebekah Willett, ‘“Take Back the Tube!”: The Discursive Construction
of Amateur Film-and Video-Making’, in Video Cultures, ed. by David Buckingham and Rebekah Willett
(London: Palgrave Macmillan, 2009), 51-70.
  43
     Maya Deren, ‘Amateur versus Professional’, Film Culture, 39.1 (1965), 45-46 (45).
  44
     Simone Moraldi, Questioni di campo. La relazione osservatore/osservato nella forma documentaria
(Rome: Bulzoni, 2015), 87, my translation.
  45
     In this regard, see, at least Horst Bredekamp, Image Acts (Berlin: De Gruyter, 2017).
  46
     Alfred Gell, Art and Agency: an Anthropological Theory (Oxford: Clarendon Press, 1998), 13.
  47
      Chiara Cappelletto, ‘Performing Image, or how the Visual Dimension is Enacted by Pictures’, in
TransVisuality. Dimensioning the Visual in a Visual Culture, ed. by Handers D. Christensen, Tore Kristensen
and Anders Michelsen (Liverpool: Liverpool University Press, 2013), 59-74.
  48
     I am refering to a performance concept as defined by Judith Butler, ‘Performative Agency’, Journal of
Cultural Economy, 3.2 (2010), 147-161.
  49
     I previously argued this elsewhere. Cf. Anna Chiara Sabatino, ‘Performance’, International Lexicon of
Aesthetics (Milan: Mimesis, 2021), 3.
  50
     In this regard, see at least David Freedberg, The Power of Images: Studies in the History and Theory of
Response (Chicago: University of Chicago Press, 2013 [1991]).
  51
     See, with respect to amateur filmmaking forms, Amateur Filmmaking: The Home Movie, the Archive,
the Web, ed. by Laura Rascaroli, Gwenda Young and Barry Monahan (USA: Bloomsbury Publishing, 2014).
  52
     This is how Gell defines the users of the agency: as ‘patients’, see Art and Agency, 21-23.
  53
     Ibidem, 22
  54
     Sobchack, Carnal Thoughts, 294.
  55
     Gauthier Guy, Le documentaire: un autre cinéma (Paris: Armand Colin, 2007).
  56
      Faye Ginsburg, ‘The Parallax Effect: The Impact of Aboriginal Media on Ethnographic Film’, Visual
Anthropology Review, 11.2 (1995), 64-76.
  57
      André Gunthert, ‘Viralité du selfie, déplacements du portrait’, L’Atelier des icônes, (2013)<http://
histoirevisuelle.fr/cv/icones/2895>, [accessed 20 April 2022].
  58
     Regarding the artistic trait, Jean-Luc Nancy, Le regard du portrait (Paris: Galilée, 2000 [1995]).
  59
     Paul Frosh, ‘The Gestural Image: The Selfie, photography theory, and kinesthetic sociability’, International
Journal of Communication, 9 (2015), 1607-1628 (1615).
  60
     What was discussed lies within an aesthetic of the performative context that redefines the very concept
of boundary, strongly emphasizing the experiential moment of trespassing and passage and configuring a
threshold as a space in which anything can happen: see Erika Fischer-Lichte, The Transformative Power of
Performance: A New Aesthetics (London, New York: Routledge, 2008).
  61
     Memofilm. Creatività contro l’Alzheimer, ed. by Luisa Grosso (Milan: Mimesis, 2013).
  62
     Memofilm does not propose a fictional, restorative version of the pathology, rather it attempts, through
documentary language, to positively convert the events in order to intervene on patient’s perception and
dysfunctional behaviours.
  63
     The Video-Pharmakon research-intervention project was born out of my doctoral research, and it has
involved me as on field as lead researcher and filmmaker in therapeutic team. The therapeutic protocol
was approved by by the Institutional Review Board of the University of Cassino and Southern Lazio (Italy)
and by the Ethics Committee of the University of Salerno (Italy). This is described with a higher level of
detail in Valeria Saladino and others, ‘Filmmaking and Video as Therapeutic Tools: Case Studies on Autism
Spectrum Disorder’, The Arts in Psychotherapy, 71 (2020), 101714.
  64
      Cf., among others, Konstantin Yenkoyan et al., ‘Advances in Understanding the Pathophysiology of
Autism Spectrum Disorders’, Behavioural Brain Research 331 (2017), 92-101.
  65
     In this regard, cf. Pietro Montani, L’immaginazione intermediale: perlustrare, rifigurare, testimoniare il
mondo visibile (Milan: Meltemi, 2022 [2010]).
  66
     This is extensively explained and described in Cinema terapeutico.




68                                                             Sabatino, Audiovisual Means to Therapeutic Ends
