Autophony: Listening to your eyes move
One doctor, seven medical students and an anthropologist crowd into the patient’s very small hospital room. The doctor places his briefcase next to the bed, introduces himself to the patient and turns to his students. Whose turn to do a respiratory examination? Mumbling, shuffling, staring at shoes but soon a volunteer. First inspection, palpation and then the tricky techniques of percussion and auscultation; that is, tapping out body sounds with one finger over another and listening to the patient’s breathing through a stethoscope. The student isn’t sure if he is finding a dull note when he percusses one part of the patient’s back, as she hunches awkwardly forward in her cotton gown. The other students are watching and sneaking a few taps on their own chests, practising their swing. How to tell if the note is dull? The doctor teaches the students a trick, while the patient looks on, listening in to the lesson too. The students should tap their own thighs, for that is a dull sound and a dull feel. You always have yourself as a gold standard, he tells them; use this! Excuse yourself to the toilet if you have to, tap away and remember that sensation.
I have observed many instances of self-percussion during my long-term fieldwork researching how doctors learn the sensory skills of diagnosis. In self-percussion, medical students sounded out their own bodies, practising the technique by feeling for ‘dullness’ or ‘resonance’. This knowledge was then to be applied during their examination of patients, where dullness or resonance in the ‘wrong’ place or in uneven distribution, may indicate disease. Tom Rice (2013) also observed similar acts of self-listening in a London hospital, in the form of auto-auscultation. Rice found that the first sounds a medical student listens to, when they buy their first stethoscope, are often their own. What does it mean to use your body as a case for others? Medical students (and indeed many other practitioners of the body) do this all the time. It is a common way of learning new bodily skills and bodily knowledge.
When students take their own body as a case, they are learning not from a pickled body part or cadaver, nor from written descriptions of symptoms and signs, but from their living, breathing body that creaks and pulses and moves. There is a sense of delight and discovery as students learn to listen to their heartbeats through stethoscopes, when they discover hollow and dull spaces in their abdomen and chests. There is fear and trepidation too, as students learn that there may be abnormalities among themselves, heart murmurs often being discovered at this moment, disrupting neat distinctions between pathology and normality, between the healers and the sick (see Nott and Harris (2023) for more on this). Through self-listening and other forms of self-sensing, students experiment with their bodies, learning through the sensations they experience and bring about with their own bodily practices.
Doctors and medical students are not the only ones listening to their own bodily sounds in medical settings. Patients do too, although this is regarded as a pathological rather than pedagogical event. In the medical literature, self-listening is referred to as autophony, a word that could also be used to describe what the medical students are doing. In the medical case, however, autophony is definitely an ‘abnormality’, described as a form of ‘hyper-perception’. For most people, sounds from inside the body are ‘screened out’, so as to make the outside world audible. For patients with medical conditions inducing the effect of autophony, such as having a small crack in the bone protecting the delicate semi-circular canals in the ear for example, the torrent of internal sounds, necessarily inaudible to most of us, can be heard and is dramatically amplified. That is, normal anatomical features which protect us from constantly hearing our internal workings, are fractured.
Patients may be able to hear their eyeballs moving from side to side, the pulsing of blood or the gurgles of digestion. I first heard of a patient suffering from autophony during my fieldwork from one of the nurses with whom I spent time. Curiosity led me to the medical literature, where I found the condition documented largely through case studies.
Take, for example, two case reports in the Journal of Neurology, Neurosurgery and Psychiatry which describe the ‘unusual but fascinating’ symptoms of autophony (Albuquerque and Bronstein, 2004). The first case is a fifty-three-year-old woman who presents with a tendency to stumble to the left side of her body. Questions about tinnitus reveal that the patient hears sounds of increasing pitch when she rolls her eyes upwards and decreasing pitch when she rolls then down. Case 1 is noted as saying she could play a tune with her eyes. Case 2 is a thirty-two-year-old man, also falling to the left, this time when he hears loud sounds such as a telephone ringing. He can hear his own heartbeats, bone taps and footsteps. Case 2 is reported to complain of ‘a soft low pitched sound in his left ear “rather like moving a hard-pressed finger across a clean, wet china dinner plate” when he move[s] his eyes’ (Albuquerque and Bronstein, 2004).
For these cases/patients, inner movements of tendons stretching and blood pumping are constantly heard. Their descriptions of these sounds are unusual, which make them such fascinating case studies for medical practitioners. In medical cases the intriguing is plucked from the mundane. Something is learned from the unusual. In ethnographic cases, it is often the other way around, and mundane acts such as tapping on your chest are made more intriguing and fascinating through description and situation within other stories.
Whether rare or mundane, the same question arises for both medical and ethnographic cases as it does for students tapping out their own bodies: how to move from one case to others?
Moving from one case study to others requires interpretation. For a case to become meaningful in other sites, similarities as well as differences are found and compared. A medical student compares sounds from their thigh with those tapped on a patient’s back. A clinician reading the medical journals compares case studies with patients in her clinic. An anthropologist compares their ethnographic findings with other accounts in the literature: Melbourne hospitals compared to London hospitals. These cases, like their brief and suit versions, travel. As Annemarie Mol has pointed out in the preceding chapter in this edited volume, though, cases do not always transport knowledge easily; interpretation takes work.
What might be taken from these cases of autophony in medicine, of students and patients listening to their bodily sounds, presented here side-by-side? They might teach us that through acts of self-listening bodily borders are crossed, blurring inside/outside, and in the process not only does one’s own vitality, amazingly, horrifyingly, emerge, but the possibility of others’ too. Patients suffering from autophony, like tinnitus, might try to pay less attention to these sounds. Both of these are in the end more pedagogical rather than pathological concerns, matters of learning how to listen and what this reveals.
The medical student is taught to be aware, to listen to their own body, a fleshy textbook they carry with them at all times, so as to listen better to the bodies of their patients. As Tom Rice has shown in his ethnography of listening practices in medicine, this can reify and isolate aspects of the body, turning patients’ bodies into objectified clinical cases – the beautiful murmur on the wards for example. Self-listening disrupts this too, by showing that medical students can also be one of those cases, when they find a murmur in their own heart or something else that stands out as ‘abnormal’.
The case of autophony, this being a more recognised clinical case, helps us to understand how self-sensing can be overwhelming, too. It cannot always be the basis for knowing others, as the roar of inner sounds may distract from noticing the world. For the patients, this inner sensing, more hearing than listening, is unwanted, always in the background. It differs from the medical students’ experience of seeking out these experiences and trying to learn to attend to them.
And the anthropologist? How do we listen in? And when we do, what does it do to our stories of the world when we use our own sensing, moving, living bodies as a case for others? As many anthropologists have invited us to do over the last decades, awakening the scholar’s own sensuous body has effects, and it may be that we listen or we hear, that we desire to learn through attentive and careful attention, or that we want to ignore the inner roar, so as to better help us notice other details in the worlds we inhabit. Scholars in other fields such as history have shown that attending to these different sensuous practices of knowing bodies is revealing if we look across time and medical frameworks. As anthropologists, we can attend, as this book encourages, to the different kinds of cases in our field sites, and to learn through comparison of their framings, to listen in, in whatever sensory and bodily ways makes sense to us, to how these cases may or may not resonate with each other.
This chapter has benefited from research conducted as part of a Dutch (NWO, Vici) funded research project entitled ‘Sonic Skills: Sound and Listening in the Development of Science, Technology, Medicine (1920–now)’, led by Karin Bijsterveld (grant agreement No. 277-45-003), and a project which received funding from the ERC under the European Union’s Horizon 2020 research and innovation programme (Starting Grant agreement No. 678390), called Making Clinical Sense. Anna would like to especially thank all interlocutors in the various medical schools for their generosity, Emily and Christine for their incredible editorial support, and Charlotte Bates, Susan Whyte and Christy Spackman for their excellent comments via open peer review.
Albuquerque, W., and A. Bronstein, ‘“Doctor, I Can Hear My Eyes”: Report of Two Cases with Different Mechanisms’, Journal of Neurology, Neurosurgery and Psychiatry, 75 (2004), 1363–364.
Nott, J., and A. Harris, ‘Teaching the Normal and the Pathological: Educational Technologies and the Material Reproduction of Medicine’, Science As Culture, 32(2) (2023), 214–239.
Rice, T., Hearing and the Hospital: Sound, Listening, Knowledge and Experience (Canon Pyon: Sean Kingston Publishing, 2013).