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ICONO-DIAGNOSIS, A MEDICAL-HUMANISTIC APPROACH, DETECTING CROUZON'S MALFORMATION IN COOK ISLANDS' PREHISTORIC ART ANNEUESE A. PONTIUS* Much of the significance of prehistoric art has remained a riddle. A new method, icono-diagnosis, uses pattern detection based on the known facts of patho-physiology of body functioning. This method has so far been found to be fruitful in detecting malfunction or malformation of the human body using specific deviations represented pictorially in hundreds of samples, perpetuated over hundreds of years, and characteristic of certain isolated cultural groups: Easter Islanders, Maori, preliterate enclaves of New Guinea and Indonesia, as previously described [1-7]. In this study, icono-diagnosis will also shed light on Cook Islands' art. What is the relevance of applying this new method of icono-diagnosis to prehistoric art? There are two sets of reasons to do so: a heuristicpractical one—providing a workable theory and specific directions for future research; and a heuristic-theoretical reason—helping to conceptualize factors that contribute to the emergence of the human capacity to create representational art beginning with depicting the human body in a puzzling variety of shapes. Heuristic-Practical Implications Application of the anatomical and physiological principles of clinical diagnosis to prehistoric representations of the human body revealed a surprising solution to the meaning of such art. It also opened access to a more directed kind of scientific inquiry with more specific working The author thanks Dr. Paul I. Yakovlev for his helpful advice. * Assistant clinical professor of psychiatry, Harvard Medical School. McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02178.© 1983 by The University of Chicago. AU rights reserved. 0031-5982/84/2701-0361$01.00 Perspectives in Biology andMedicine, 27, 1 · Autumn 1983 | 107 hypotheses than would be possible without recourse to clinical "diagnosis ," which is based on a vast number of known and testable physiological laws. As Foucault [8] emphasized, in medicine the meaning and organization of symptoms and signs into a specific pattern became possible only with the (physio-) logic attained through understanding the functions of the organ systems involved. By contrast, of little use had been the early ways of constructing a taxonomy (as used in botany) that was based on symptoms and signs unconnected by the still unknown laws of physiology . The very fact that the prehistoric artist represented a unique pattern of malformation, only now understandable by our knowledge ofthe underlying patho-physiology, argues strongly for the artist having actually witnessed the dysfunction which he depicted. Moreover, statistical laws speak very strongly against the chance assembly of a score of specifically interrelated signs, and no explanations have been offered by other fields so far [9, 10]. The icono-diagnostic approach presented here is a form ofpattern detection. The prehistoric cultures under study have left no enduring record other than that oftheir art. Body representation in these artifacts is characteristic ofentire cultural groups over centuries, and notjust of the fancy of an individual artist, as in some artifacts from South America and Mexico [11, 12]. Our mental representation of the body, the body schema, was defined by Head [13, p. 605] as "this combined standard, against which all subsequent changes of posture are measured before they enter consciousness ." This concept was further elaborated on by Schilder [14]. Studies of pictorial representation ofthe body by persons suffering from mental illness began with Prinzhorn [15] and have recently been done on a cross-cultural basis [16, 17]. There is, however, a puzzling silence regarding the art ofentire prehistoric populations who depict the body as deviating from its usual state of health. It is reasonable to assume that such states of deviation had actually been observed and had a traumatic impact on the prehistoric cultural group. Living in isolation, with no conception of natural disease, they were bound to project the cause of illness or malformation onto external powers, so that mastery [18] over those malevolent influences had to be attained. It is speculated here that in prehistoric groups such traumatic experiences as observing diseases or malformations without knowledge oftheir natural causes is one factor which triggered a creative leap toward the emergence of art depicting the human body, a kind of sublimation analogous to that occurring in...


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