Matter of Fact: Using Creative Film to Disseminate Sensitive Research in Medical Sociology

Abstract

Matter of Fact is a talking heads film based on extracts from qualitative interviews with a range of different health professionals. The film sought to co-productively and sensitively tell the story of baby loss and post-mortem from different healthcare perspectives. In the film, interview extracts are read by four actors from the applied theatre specialists Dead Earnest, who are each playing the roles of mortuary technician, pathologist, obstetrician, and midwife. The film was one of several installations in a project exhibition Remembering Baby, which used sound and visual art as well as acting to present and represent qualitative data. It had significant impact on parents, professionals, and public exhibition attendees and has subsequently been used as a bereavement support tool, and to run training events for health professionals. We use Matter of Fact in this article to show how a talking heads film can be used to directly but sensitively illuminate hidden and emotive aspects of healthcare, and in doing so provide a unique conceptual, substantive, and methodological contribution to sociology. We conclude by arguing that this film provides a novel example of what Bradby refers to as a progressive sociology of health and illness.

Introduction

Medical sociologists have critiqued various issues in health and medicine – from assessing medical power and dominance to problematising issues of medical surveillance (Armstrong, 1995; Foucault, 1979; Turner, 1987). Medical sociology has, however, often occupied a complex position within the discipline of sociology. As Williams et al. (1998) have shown, this relates to several issues, from its complex and often turbulent relationship to medicine to the location of its practitioners who can reside in sociology departments, medical schools, or other health service settings. Sub-disciplinary tensions have also emerged between a medical sociology which appears to operate for medicine to a more conceptually driven sociology of health and illness rooted in the foundations of the sociological imagination (Mills, 1959: cited in Williams et al., 1998). The challenge in the 21st century, according to Bradby (2016) is to create a progressive sociology of illness which can critique biomedicine while acknowledging its benefits along with those of other knowledge systems and moralities of healing.

Matter of Fact, we argue, provides an example of a progressive sociology of health and illness. This film was created initially to appear in the Remembering Baby exhibition, a travelling exhibition inspired by an ESRC-funded research project on baby loss and minimally invasive post-mortem. The original research had two aims, first to understand how parents/families who have experienced baby loss feel about, and experience, the (MRI) post-mortem process, and second to explore the impact of this technological application on professional practice and relationships between professionals from different fields. The project used go-along interviews with various professionals involved in the post-mortem process (from pathologists through to coroners and funeral directors), and creative qualitative interviews with parents using object elicitation. Ethical approval for the research project was received from the UK National Research Ethics Service.

The Matter of Fact film emerged and was co-produced through dialogue between members of the research team, artists, and applied theatre specialists. It sought to showcase the key findings from the research project emphasising the role of MRI in the post-mortem process; the importance of hidden care practices enacted by health professionals; and the centrality of memory-making for parents and professionals during post-mortem. In the following section, we describe how the film used a talking heads approach to illuminate latent and sensitive aspects of healthcare, and in doing so offers a unique contribution to the discipline of sociology.

Talking heads, sociological themes

‘Talking heads’ are a dominant feature of contemporary documentary cinema and a key element of film and television language. They can involve speaking subjects directly addressing the camera to the testimony of witnesses addressing an on-screen or off-screen interviewer (Baker, 2008). Developed in 1950s Western media, this technique was coupled with a growing fascination with public and collective forms of talk, which according to Baker (2008) was fostered largely by the post-war work of sociologists such as Paul Lazarsfeld and widespread recognition of the ‘focus group’. Matter of Fact uses the direct to camera talking heads approach, because we felt it enabled us to deal ‘head on’ with the difficult issue of baby loss and post-mortem in a way that was sympathetic.

Polyphonic voices are central to talking heads filmmaking. In Matter of Fact, this form of filmmaking enabled us to illuminate multiple perspectives and bridge clinical and sociological themes. Prior to filming, the research team selected transcripts from interviews with professionals who played a key role in the post-mortem process. As other parts of the exhibition were dedicated to conveying the experiences of parents, we decided to focus exclusively on the perspectives of professionals in the film. Extracts from the interview transcripts were used to outline clinical processes in an informative manner while showcasing the care demonstrated by health professionals administering this form of work. Actors were used to protect the anonymity of research participants as outlined as part of our ethical approval process. The relevant participants were approached for explicit consent to use their data in this way and they each agreed that an actor could represent them in the film. The actors worked collaboratively with the research team to bring the interview transcripts to ‘life’ in a way that was sensitive and appropriate. Decisions about what clothing to wear during filming were led by the actors and their choices reflected their own embodied sense of, and connection with, the interview data. The use of props was deliberately minimal to avoid clinical caricature and to ensure emphasis remained with the spoken words and any subtle inflections and emotions they conveyed.

The film provides service users, professionals, and members of the public with a comprehensive overview of post-mortem examination, but also offers original conceptual and substantive contributions to the discipline of sociology. For example, the issue of choice has long been a central concern in the sociology of health and illness (Nettleton, 2021; Reed, 2012). While choice is often viewed as a positive attribution of contemporary society, sociologists have sought to highlight how the decisions individuals make are often informed and constrained by wider social structures and relationships (Bauman, 2007; Nettleton, 2021). Matter of Fact problematises the issue of choice in the context of post-mortem, and in doing so extends sociological thinking about the concept beyond life and death decision-making.

The concept of care has a long history in sociology, social policy, and feminist literature (Fine, 2005). While sociologists have explored care in various settings (including palliative care), little is known about the care that takes place during sensitive forms of clinical work such as post-mortem. Matter of fact brings to light some of the concealed care that takes place in the hidden world of the mortuary – such as dressing and singing to babies. It provides a novel example of how care in this setting is both a feeling and an activity state (Thomas, 1993: 652), thus contributing new knowledge to sociological discussions of the concept of care as applied to healthcare. By shedding light on these lesser acknowledged aspects of medicine, the film highlights both the limitations and benefits of healthcare. In doing so, we argue, the film provides a creative example of a progressive sociology of health and illness. It also acts as a bridge between the sub-discipline of health and illness and the discipline of sociology more broadly.

The film also provides an innovative contribution to sociological debates on methodology and research impact. Social scientists have sought to understand key processes behind knowledge exchange and research impact (Olmos-Peñuela et al., 2014). The value of utilising particular approaches to filmmaking, such as co-production with research participants, is increasingly recognised (Cunnington et al., 2024). The role of research methods in this process has, however, often been overlooked. Films produced to disseminate qualitative health research generally involve the development of fictionalised or composite accounts of a participant’s experiences (e.g. Toye et al., 2015). Less often, they centre individual perspectives verbatim and without any additional narrative, auditory, or visual embellishment, as is the case with Matter of Fact. By using verbatim qualitative interviews with professionals to thoughtfully document the post-mortem journey, our talking heads film creates an intimacy between viewers and interview narratives which illuminates the power of qualitative sociology in knowledge exchange, thus contributing to wider debates on the use of methods in achieving research impact.

Film release and impact

The exhibition in which the film first appeared was interactive featuring visual images, film, physical objects, sound installation, and parent/sibling artwork (Reed et al., 2018). The exhibition aimed to examine the post-mortem process from different viewpoints. Matter of Fact focused on uncovering professional perspectives, but other exhibits focused on parent voice (e.g. parent artwork), or juxtaposed parent and professional experiences (e.g. memory boxes). The research team worked collaboratively with Hugh Turvey HonFRPS, who is artist in residence at the British Institute of Radiology to curate the exhibition, based on key themes emerging from the research. The Remembering Baby collection also featured sound art produced by Justin Wiggan, and graphics designed by Lee Simmons (Reed et al., 2018). We reflected continually on ethical issues as we created the exhibition to ensure confidentiality and anonymity were upheld for all research participants. We sought advice and input from baby loss charities at every stage to ensure the exhibition was curated with care and sensitivity. Remembering Baby toured four art galleries across the UK in 2017-2018.

Matter of Fact has been used to train UK health professionals and as a bereavement support tool by charities. It was translated into Spanish and featured in an international event on Stillbirth, SIDs, and Perinatal Post-mortem. Anonymised professional testimonials demonstrate the value of the film: Highly useful tool for families and healthcare professionals and parent accounts highlight its emotional impact: The word ‘post-mortem’ used to scare me, now it doesn’t, as now I know my baby was treated with love, care, dignity and respect. Thank you. The film and exhibition created significant non-academic impact, which led to the project winning the ESRC Outstanding Impact prize in 2019. The creative and sociological elements of the project continue to evolve through academic publications, including a research monograph which won the Foundation of Sociology of Health and Illness Prize 2024 (Reed et al., 2023). The Remembering Baby website, which hosts a shortened version of the film, also continues to develop and thrive.

Conclusion

This article has shown how the talking heads documentary style film can be used as a vehicle through which to embed medical sociology conceptually and substantively within the discipline of sociology. We have also sought to illuminate the ways in which film can be used as a novel form of dissemination for sensitive qualitative research, thus offering an original contribution to sociological debates on research methods and knowledge exchange. By using a talking heads approach which centres the words of participants as expressed verbatim in interview data, Matter of Fact creates an intimacy between interviewees and viewers and therefore a particular potential for affect and impact, which is distinctive when disseminating qualitative research. Using qualitative interview data more directly in filmmaking, we have argued, can provide a medium through which to bridge the gap between a sociology of health which operates in the service of medicine and one which seeks to advance the sociological imagination (Williams et al., 1998).

Changes in clinical practice may have occurred since the creation of this film. Matter of Fact is based on data collected between 2015 and 2018 prior to the onset of COVID-19. During the pandemic, as Abbott et al. (2023) have noted, face masks could facilitate, hamper, or judge social interaction. We know from our ongoing knowledge exchange and impact activities related to this project that mask wearing during the pandemic interrupted the nature of care work in this sensitive area of healthcare. Sympathetic facial expressions, for example, were partially distorted by masks and could affect staff interaction with families. Future research and filmmaking in the sociology of health and wider discipline would perhaps benefit from greater reflection on this.

This article has aimed to show how film can be used to develop a progressive sociology of health and illness. Such sociology should engage with core socio-theoretical frameworks and methodological innovations that remain at the heart of the discipline. It also means engaging with STEM subjects and healthcare carefully, not acting as window dressing for medicine, nor focusing solely on critique of it. By providing a critical but compassionate lens through which to examine medicine Matter of Fact provides a platform through which to develop and showcase a progressive sociology of health and illness. This mechanism, we argue, could be used in future to tackle other sensitive areas of health and healthcare and social life more broadly.