The reception of an American medical drama, ER, in Britain and in France

by Solange DAVIN

NOTE : [B] indicates British informant; [F] indicates French informant; Italics indicate verbatim quote

ABSTRACT

INTRODUCTION

Medical dramas (1) have been a staple of British networks since the late 1950s. Dark-haired Ben Casey, boyish James Kildare, holistic Marcus Welby, Dr. Quinn, Emergency Ward 10, St. Elsewhere, Angels, Nurses, General Hospital, University Hospital, American Hospital, The Doctors, The Practice, Peak Practice, Out of Hours, Medics, Black Forest Clinic, Bramwell, Chicago Hope, Where the Heart is, Cardiac Arrest, Psychos, ER and many others have had large followings over the years. This enthusiasm shows no sign of fading: Casualty, the longest running medical drama in Britain, now in its fourteenth year, still retains over eleven million devoted fans and its off-shoot, Holby City, nine million, according to BBC ratings.

In France fewer medical dramas have been aired: in the 1960s, Janique Aimée, the story of a nurse's emotional entanglements; in the 1970s, MASH and Médecins de nuit; in the 1980s, Petit docteur, a mixture of medicine and mystery, Black Forest Clinic and General Hospital; Dr. Quinn, Dr. Silvestre and University Hospital in the 1990s. But the response was lukewarm, the ratings average, and none of these programmes figured at the top of the popularity lists (2). Chicago Hope, shown around the same time as ER but on another channel, attracted only limited attention, possibly because of its schedule (on Saturday afternoon, when the risks of cancellation or delay are high and when many people are busy or out) and of its title, La vie à tout prix, which did not make its content explicit. Two post-ER shows, Une femme en blanc in 1997 and Les pédiatres in 1998 (a telefilm of four episodes), went almost unnoticed. But ER, well publicized by trailers and shown at evening peak time, was warmly greeted as an amazing, not-to-be-missed novelty, as illustrated by these informants’ quotes:

My first reaction was ‘this is revolutionary!’. I had never seen anything like it. It was so unexpected, the rhythm, the realism... I was so surprised! [F106].

It is a real phenomenon... wonderful, full of life, it makes you feel high [F18].

Perhaps this relative dearth of medical dramas in France is linked to the fact that the genre does not exist in French. The expression is not directly translatable. The French drame médical bears no relation to the media; it refers to a medical disaster, an unaccountable death following minor surgery, for example. Medical dramas in France are called série or feuilleton, words which in turn have no simple English equivalent since both encompass series, serials and soap operas (which are notorious by their absence from French networks (3)).

Such discordance between French and British audiences’ familiarity with and fascination for medical dramas suggests the possibility of differing interpretations. Discrepancies were certainly perceptible in the form of the replies: French viewers had a tendency to ‘philosophize’, to develop at length the themes of the broadcast and to relate them to their own vécu in a existentially-inclined fashion, and their answers were, on average, longer than their English counterparts’ (up to eight sides). Nevertheless, the expected variations between British and French readings per se never materialised: similar topics were evoked and commented upon in comparable fashion on both sides of the Channel. This echoes the findings of other projects which failed to unveil cross-cultural variations: Harindranath (1998) on Indian and British viewers; Silj at al (1988) on spectators in Denmark, France, Ireland and Italy; Bellemare, Caron-Bouchard and Gruau (1994) on Canadian, French and Swiss adolescent viewers; Ruddock (1998) on international Website users (4).

In this article, I first briefly summarize the cross-cultural discrepancies which appeared in the overall research. I then address the congruence of the readings: in both countries, the American-ness of ER was seen as an asset; viewers gathered medical, socio-medical and health promotion data from ER, which was routinely ‘re-genred’ as a documentary while remaining a captivating entertainment show enticing viewers by its rhythm and its continuous storylines; there was consensus about the realism of the show although informants were fully aware of the ‘manufactured’ status of ER and sometimes disagreeing as to whether a particular factor impaired or enhanced the impression of realism. In conclusion, I argue that broad, vague notions like ‘culture’ are not be fruitful analytical tools. Audiences and the interpretations they produce are too sophisticated to fit in such a priori, over-simplified, naturalized categories which may obscure other important subjectivities.

METHODOLOGY

Advertisements were inserted in four television magazines (two French and two British), asking viewers their reasons for watching the American medical drama ER. ER follows the (mis)adventures of medics and patients on the casualty ward of a Chicago hospital. It was conceived in the late 1970s by Michael (Jurassic Park) Crichton and was inspired by his medical training. Current scripts are written or supervised by physicians and based on true case studies reported by medical professionals.

One hundred and ninety-four replies were received, a third of which came from men. Informants’ ages ranged from twelve to eighty-four, their occupations from unemployed to clerks, teachers, doctors, engineers. The analysis followed the principles of Grounded Theory (Glaser and Strauss 1967).

DIFFERENCES

I) Letters

Had they been written in the same language, French and British replies would still have been easily recognisable. Many British letters were brief (one or two sides) and followed a routine pattern of short paragraphs, each referring to a specific topic approached in a descriptive fashion. French respondents gave fewer depictions and elaborated further on the drama storylines, disclosing intimate emotions and relating the narratives to their own experiences in a revealing fashion.

There are several (not mutually exclusive) possible explanations for this disparity: more episodes having been aired in the UK where the series started two years earlier, viewers were able to draw on more plots and characters; norms about letter-writing, assumptions about researchers' expectations, and how much of private circumstances and feelings it is acceptable to divulge in this situation may all have played a part. The latter can be connected to my relationships with informants: a number of French people actively sought to remain in contact with me by writing regularly, sharing sensitive problems (depression, abortion), sending press articles and video tapes, offering help (5) and inviting me to their homes. Many of these exchanges have developed into friendships which endure several years later, while, on the other hand, no such relation was initiated by British respondents.

II) From pleasure to labour

Another difference may offer a partial clue to the cross-cultural variations in writing patterns. As Stacey (1994: 81) and Hermes (1997: 21) found their informants enjoying participating in the research, many French viewers delighted in writing about ER:

I cannot refuse myself the pleasure of answering your advertisement [F70].

I can't wait to give my opinion on this topic [F19].

But British contributors emphasized the arduousness of the task:

It is always difficult to pinpoint why you watch a particular programme, but I'll try [B10].

I thought long and hard about my love of ER; it's taken me a couple of attempts to get it written down [B11].

This hurdle did not prevent many Britons from replying (although their motivations for so doing are a moot point) but French viewers, finding the task more congenial and rewarding, may have invested more time and effort in their replies and thus produced more extensive answers.

III) 'Philosophizing'

"We know that life is flawed and messy and imprecise and fabulous and it does us good when we see that reflected in the shows we watch" wrote Pourroy (1996: 17) in her book Behind the scenes at ER. As indicated in the introduction, many French informants displayed a taste for what I call ‘post-ER reflection’ - "philosophizing", in Tannen’s (1994) words. The drama inspired many to engage in discourses on issues of life and death:

I leave each episode more convinced than ever that life is an opportunity, a precarious equilibrium, and this makes it even more beautiful and precious; and that being a therapist (in the wider sense of the term) gives us a chance to get closer to essential issues and to ignore the trivial [F16].

Death revisited, fantasized... Other people’ s death, of course. What we see on the screen is nothing less than the little comedy of our lives given its proper dimension. If he were alive, Shakespeare himself would like to direct an episode! [F89].

That this disposition was not shared by British viewers may be due to the enduring emphasis in France on philosophy, which remains a compulsory baccalauréat subject and which may be seen as a hallmark of a ‘culture of suffering’, a world-view with deep existential roots common in Mediterranean countries, and where it is not merely acceptable but proper to see life as

"difficult, burdensome, and taxing. One’s day to day life is seen as a constant ‘struggle’ which periodically weighs one down. In France, it is deemed appropriate to have a view of life as tragic or sad. To view life otherwise is an indication of immaturity and a shallow personality" (Gaines 1992: 178).

Consequently, questioning the past, wondering about the future, meditating over the beauty, cruelty, meaning(-lessness), unfairness of life, are part and parcel of everyday life, of personhood, of being a social individual (6).

This mirrors the pattern found by Tannen (1994) in her study of Greek and American women speaking of films. The latter conceived of the research as a memory test, talked of film as film and were concerned with accuracy and details. For Greek women the exercise was an opportunity for conversation and story-telling. They related narratives without indicating that it was a film, ascribed feelings to characters and examined the emotions they experienced during the film.

Popular culture has long been a source of materials to reflect over matters of values, morals, relationships, to practise everyday philosophy. In 1941, Herzog wrote that "to many listeners [radio soaps] seem to have become a model of reality by which one is to be taught how to think and how to act". Since then, a wealth of studies have shown that television soaps and dramas are routinely used to allay ongoing worries, to help to make decisions, to evaluate and compare relations with friends and family, to comprehend and assess others people's conduct, "to think through their own problems vicariously and safely... to legitimate their experience... to have their problems put into perspective" (Livingstone 1988: 71).

SIMILARITIES

I) American-ness

National productions were often referred to by British and French respondents alike. The latter’s choice of medical dramas was perforce limited but they recalled having seen a number of them, Médecins de nuit in particular. Most British letters quoted at least one, many cited several, Casualty being by far the most prominent and Cardiac Arrest a distant second. Pre-ER dramas were often evaluated negatively:

I used to watch [Médecins de nuit] because my parents did but I am more selective now [F106].

Casualty is even slower now and its storylines are really poor [B30].

The comparisons made by viewers between British or French and US dramas revealed that the American-ness of ER was seen as a major asset in fostering a sense of excitement, of fascination, of anticipation which local channels seem unable to deliver:

British dramas cannot compare with ER. They are slower and don't keep you on the edge of your seat [B17].

French programmes are nowhere near as good. Medical series are anecdotal and they focus only on the doctors, who are more important than the patients [F104].

Another reason why fans welcomed this American-ness was that they assumed that censorship was lower in the US (7) and believed that ER raised issues which would not be dealt with, or would not be handled so openly, by programmes made in their respective countries (8):

Why is UK entertainment sanitized to the extent that it fails to grasp the imagination? [B44].

French programmes are so watered down, battered children or Aids are never mentioned [F61].

II) Docutainment

A) ER as documentary

As a result, ER is said to provide a non-PC portrayal of the US which counterbalances the images of the wealthy-healthy Beverly Hills-style America depicted in other US-made series like Dynasty or Dallas. Social concerns have long been a key feature in the popularity of television dramas (Dienstfrey 1976: 82) and ER is no exception. They were taken by the show’s blunt disclosure of the lack of welfare structures, the endemic poverty, the rampant violence, the fear - the American nightmare (9):

The main interest of the series - apart from entertainment and stress - is that through the emergencies we discover the social life in the US, the problems of insurance, of violence, of abuse [F33].

We keep seeing patients who need social workers, who cannot afford care, children with bodies full of gunshots, abused children [B8].

In addition, spectators from both countries seized the opportunity to gather socio-medical data on the American market-led health structures and to compare and contrast them with European health care organisation. The no-payment-no-treatment system was rejected as unacceptable; it was overwhelmingly considered inferior to British or French welfare provision which makes free care available to all citizens, rich or poor (at least in principle). Witnessing the inequalities resulting from lack of public funding and laissez faire private medicine induced in informants a sense of fear and of foreboding that a similar two-tier system might be implemented in their own countries (10).

Many informants believed that one of the production team’s objectives was to disseminate health promotion messages, to publicise risky behaviours and to raise public awareness of health hazards (11). This was achieved, viewers thought, without detracting from the continuity and tension of the storylines and these efforts to pass on health advice about Aids, smoking, drugs, allergies etc. were appreciated:

We learn all sorts of things, what damage a car crash can do, the consequences of drinking or of taking drugs [F53].

It does help with health promotion when it can, warning about glue sniffing, drug abuse, smoking [B8].

Medical data was memorized:

A cancer can cause a broken bone, I did not know that at all [F105].

I had no idea that you could do internal heart massages [B12].

Incidental findings from other studies confirm that viewers do learn medically-related information from fictional shows: in the soap All My Children, a woman heard of ovulation prediction kits, which helped her to get pregnant (Rogers 1995: 329); viewers learnt about amniocentesis from Dallas and from St. Elsewhere (Rapp 1988: 155-6) and about mental illness from Brookside (Philo 1996). Kingsley (1995: 159-161, 176) claims that not only have millions of followers assimilated medically-related and first-aid material from Casualty, but that the programme has helped to save lives (12). There is also growing evidence from Health Promotion research that soaps and dramas are a particularly efficient support for health-promoting and illness-prevention advice, perhaps more so than traditional advertising campaigns (see Singhal and Rogers 1999).

Viewers did more than merely extracting knowledge from an entertainment show which they conceived as a reliable educative tool. Their trust in ER led some to explicitly re-classify the drama, to ‘re-genre’ it as, literally, a documentary:

We find it a very realistic series, that is, in the sense of documentary, which is very rare and interesting [F24].

When I watch ER, it is more like watching a documentary [B33].

B) ER as entertainment

This is not to suggest that ER was not entertaining. On the contrary, in line with the current ‘infotainment’ trend, ER was described by French and by British informants as providing enjoyable recreation as well as useful information:

I watch ER for its entertainment value, and it gives 100%... I also enjoy it because I am interested in medicine and in patients' views and feelings [B44].

It is entertaining, amusing... You try to find out what the abbreviations mean. It is a puzzle. You learn more every time [F106].

This "entertaining-ness", to use Arlen's (1981: 283) word, stemmed firstly from the pace of ER, from its regular yet unpredictable cycle of fast/slow, action/reflection, success/failure, chaos/ order:

Each episode seems to take you on a roller-coaster ride, laughing one minute, crying the next... It shows life at both ends of the spectrum [B19].

It gives you an overview of life, beautiful, ugly, unfair, bruising, subtle, ridiculous. There are dramatic seconds and tender minutes [F16].

The second key appeal of ER was the weekly rendez-vous with regular characters which enabled viewers to familiarise themselves with their backgrounds, their personalities, their motivations, their idiosyncrasies. This generated a sense of gradually getting to understand and appreciate each person in all her/his complexity:

Bit by bit we discover Benton's obsession with work, Doug's depth and humanity, Carter's maturation. They evolve like portrays made with brushstrokes, not sudden reversals [F25].

The director knows how to make the characters evolve slowly, how to give them a subtle psychological depth [B38].

III) Realism

There was widespread consensus about realism. ER was repeatedly depicted as realistic, as true to life, so true-to-life that you feel that you are there, many wrote. In this discourse, the American-ness of ER, which was foregrounded at other times (as seen above when the focus was on social and healthcare problems), was now rendered invisible as bio-medicine, technology, hospital procedures and routines, doctors’ gestures and mistakes were taken as universal and the ward became an almost familiar, and thus realistic, space:

The universality of the images created by the script-writers transcends national characteristics [F89].

Everything seems true, universal. We are in America and the equipment is new but it is in all the ERs of the world [B15].

Viewers’ personal experiences and knowledge could act as a benchmark of reality; they recalled stays in or visits to hospitals and/or recounted encounters with physicians and drew private connections:

You can find yourself comparing medics you have met to characters with similar traits [B32].

Suzan reminds me of a doctor who examined me when I had an infectious disease [F104].

Many people, however, did not use first-hand, direct experience as a comparison point. Instead, other broadcasts were mentioned as a benchmark of reality. Sometimes viewers cited medical dramas, sometimes documentaries, and sometimes they simply remembered seeing related programmes without specifying (and probably without remembering) their titles (13):

It is realistic compared to what I know of the US. I have never been there but I know from watching other series [F122].

Before the Atlanta Olympic Games, there was a programme about a poor region in the US. It was very similar to ER. There were a great many gunshot wounds, as in ER [B32].

While convinced that ER was a realistic broadcast, respondents in both countries were also aware of and conversant with the artificial character of television programmes, and enumerated a host of factors enhancing or detracting from the impression of realism: the actors, whose outside commitments may impose implausible scripts; the needs to keep costs down, which may hinder the realistic depiction of events; the props, widely known to be genuine medical appliances; the make-up, changing potentially glamourous artists into sickly-looking patients and tired medics; the hand-held camera and its powerful vérité feel; the involvement of medical professionals in writing and/or supervising the scripts, an invaluable guarantee of reliability and of realism.

However, agreement was not always forthcoming as to which factors reinforced or diminished realism. The role of two elements in particular was disputed both in Britain and in France. For some, the ER physicians and nurses made it possible for patients - and thereby viewers - to grasp at least some of the medical jargon, and this undermined the realism of the series. But those for whom the jargon remained incomprehensible, it was a faithful reflection of life:

The jargon makes the situations more real. I mean, how many times have you been to the doctor's or to the hospital and you don't know what on earth they are talking about? [B42].

You can't tell if the terms are true. It is like in real life, you have to trust your doctor [F101].

Secondly, a similar divergence of opinion occurred about the break neck speed at which patients were brought in and assessed, which some viewers considered realistic and others artificial, unreal, the very element giving away the fictional status of ER (which is not to say that ER was consequently judged unrealistic (14)).

CONCLUDING REMARKS

Culture (15) did not generate differences in interpretations. Given that ER is an American programme, this result could be taken to be a manifestation of the ever-dreaded ‘Americanization of Europe’. But this would be too hasty a conclusion. Firstly, one well-known study (Liebes and Katz 1993) discovered cross-cultural differences in readings of Dallas. Secondly, even well-known American ‘cult’ broadcasts do not have universal appeal: Dallas failed in Japan (Liebes and Katz 1993: chap.9) in Peru and in Brazil (Silj et al 1988: 57); a Russian audience found the American talk-show Donahue not to their taste (Carbaugh 1996); in this research many scathing criticisms were made of other American series (particularly Dallas and Dynasty, but also Dr. Quinn, Chicago Hope, University Hospital). And, thirdly, that no difference could be systematically linked to ‘culture’ does not imply homogeneity, ‘globalism’, of readings, many of which contradicted each other and/or had idiosyncratic overtones (see note 23).

A priori grouping of informants is always a dangerous practice (whichever category the groups are based on - culture, gender, class etc.) as the chosen categories may be hyperinvested and act as straitjackets masking other components. For instance Hoijer (1999) suggests that alleged gender differences may sometimes be due to lifestyle. Carbaugh’s (1996) example of the negative reception given in Russia to a Donahue talk-show illuminates these problems; in this case, it is a broader element, self-consciousness, which is hidden and reduced to nationality (see also Carbaugh 1988). Carbaugh explains the Russian rejection thus:

"We find, on the one hand, a soulful collective conversing on the basis of morality, orienting to the possible virtues of societal life. On the other hand, we have mindful individuals conversing on the basis of factual information, disclosing their real personal experiences in response to societal problems and issues. The former might sense the latter, at times, as soulless (lacking morality commitment and loyalty to the common good), just as the latter may sense the former as mindless (lacking factual information and analytical abilities)" (Carbaugh 1996: 101).

These attributes - soulful vs mindful - are not characteristic of nationality per se: ‘soulful collective’ is not specifically Russian or ‘mindful individuals’ American. The link is rather to self-consciousness, a trans-cultural factor. The misunderstanding seems to stem from a clash between selves situated on the "sociocentric" side of a collective-individualistic continuum (which in this case happen to be Russian) and selves on the "egocentric" side rather than to actual national factors.(see Gaines 1992). Other groups positioned at equally contrasting points on the ‘collective-individualistic’ sequence may produce a similar disharmony in reception.

Furthermore, it is difficult to establish what ‘Russian’ and ‘American’ exactly mean, and this is the second reason why pre-set classification of informants is risky: it implies stable, homogeneous, necessary categories, "empirical illusions", to use Ang’s (1996: 118) expression (16). But ‘The Russian’, ‘The American’, ‘The French’ or ‘The British’ are by no means stable, homogeneous, necessary classifications. Indeed they have all the signs of empirical illusions; what does it mean to be ‘French’ or ‘British’ in the heart of the European Union, in an era of dissolving and (re-)forming nations, of weakening borders, of increasing migration, of intensifying balkanisation and globalisation? On what does (the perception of) national identity rest? Birth, blood, residence, language, passport, choice, wish? The historian Théodore Zeldin rejects the notion altogether because, he says, nations are not distinct entities but (in the words of Benedict Anderson (1991)) "imagined communities": "All our instincts tell us that there is something different between a German and an Italian but then all our instincts tell us that the earth is flat...", argues Zeldin (in Himmelfarb 1987: 123) (17). How much overlap, how much distance, is there between ‘the French’ and ‘the British’, both (like most nationalities) being complex mélanges of adopted and adapted multicultural elements with plentiful internal divisions (18)? Certainly the idea of ‘British-ness’, far from eliciting a unified response from ‘The British’, evokes a wide range of feelings going from pride and a sense of superiority through ambivalence to a rejection of all affiliation (Billig 1992, Condor 1996) (19).

In a post-modern climate of scepticism where most hitherto taken-for-granted concepts are suspect, approaches which suggest that a single naturalised factor could determine interpretations are obsolete. The focus is no longer on establishing the influence of French/British-ness but on examining what it means for an individual to adopt a particular identity and which elements shape it (Cruche 2001: 96) (20). As Morley concluded after his seminal (1980) Nationwide study in which the looked-for links failed to materialise between viewers’ socioeconomic level and dominant, negociated and oppositional interpretations (after Hall’s 1980 "encoding-decoding" model):

"one cannot conclude from a person's class, race, gender, sexual orientation and so on, how she or he will read a given text (though these factors do indicate what cultural codes she or he has access to). It is also a question of how she or he thinks and feels about living her/his social situation" (Morley 1991: 43).

Thus, continued Morley,

"The same man may be simultaneously a productive worker, a trade union member, a supporter of the Social Democratic Party, a consumer, a racist, a home owner, a wife-beater and a Christian" (Morley 1991: 42).

This multiplicity of identities is typical of post-modern viewers, the "chameleon generation", "screenagers" living in a world of "chaosophy", to use expressions from the Observatoire Foreseen (2000), who have flexible, volatile, protean, sometimes deliberately chosen (eg. Bishop 2000), subjectivities. Hartley’s (1992: 29) seven elements - self, gender, age, family, class, nation, ethnicity - or even Fiske’s (1994: 51) additions - education, religion, political allegiances, region - are at once too vague and too limiting. The many interlocking identity segments (in the case of medical narratives, health and illness beliefs and experiences may be worth exploring (21)) which form viewers’ ‘horizon of expectations’ are likely to guide the process of interpretation, as illustrated by Liebes’ (1997) reception study of the Israeli-Arab conflict on television in Israel:

"The status of Jerusalem... may change places dramatically when different identities come into play. In the context of ‘our historical right’, when the identity of Jew and Israeli is activated, it is the most cherished dream, whereas in the context of everyday life, when the identity of mother is activated, it is argued to be a dangerous, alienating place" (Liebes 1997: 85).

Such "nomadic viewers" (Grossberg 1997) are fleeting "communities of improvisation" (Machin and Carrithers 1996) rather than steady ‘ interpretive communities’, an "infinitely expanding myriad of dispersed practices and experiences which cannot be contained in one total system of knowledge" (Ang 1994: 369) (22). Their readings strategies and their interpretations are dynamic, unpredictable, inconsistent (23), depending on, to repeat Morley’s sentence, how viewers "think and feel about living [their] social situation" and the identities thereby generated. ‘British-ness’ or ‘French-ness’, even in their emic definitions, are only one of many keyings which colour spectators’ reception narratives (24). It should therefore come as no surprise that in this research, as in several other similar projects, neither culture, nor any other single element, was found to be determining and that no cross-cultural differences emerged.

NOTES

(1) Defining 'medical drama' is not as easy it as may seem. One only need to think of Bramwell, Dr. Quinn and ER to realise that the said genre, as many others, is a ragbag of barely related shows (see Davin forthcoming: chap.3).

(2) Although Boon et al (1990: 134) indicate that Janique Aimée was a popular feuilleton.

(3) France is almost alone in Europe in lacking soaps (O'Donnell 1999: 27-28, Bianchi 1990). Bianchi (1988: 134-139) reports that ‘The French’ complain that long-lasting serials are (here talking of Dallas and Chateauvallon, nicknamed ‘Dallas sur Loire’) "not interesting, superficial, banal, plodding" and essentially "always the same thing". No serial has gone past one hundred and eighty five episodes (Croft 1995) in stark contrast to the UK where soaps like Coronation Street have been around for decades.

(4) Harindranath (1998) found education a more important factor than national identity. Silj et al (1988) stated that: "the comments and observations emerging from interviews and group discussions in the four countries (Italy, France, Ireland and Denmark)... build up a fairly standardized picture of viewers’ readings, as well as coinciding with many of the reactions to Dallas in the Lealand survey in Great Britain. The variations among countries are matters of stress rather than content" (Silj et al 1988: 61) without further speculation. The aim of Bellemare, Caron-Bouchard and Gruau (1994) was to explore the role of television in adolescent identity formation, irrespective of country, and nationality was therefore not emphasized. Nor did Ruddock dwell on cross-cultural matters, merely noting that the geographical breadth of the informants exacerbated the problem of generalisation. Liebes and Katz (1993), who did find cross-cultural differences between their groups, are a notable exception.

(5) For instance, a teacher offered to give her students ER-related questionnaires.

(6) The adoption of such a world-view would not be socially acceptable in the UK.

(7) This is not always the case. Some topics, notably homosexuality, are heavily censured in the US.

(8) Others see French television as strongly emphasizing social issues (eg. Bianchi 1990: 96); as for ‘British television’, its reputation for ‘gritty kitchen-sink drama’ is well-known.

(9) The setting of ER in a public hospital acting as a refuge for many poor/homeless people allows the introduction of a variety of social as well as medical ills.

(10) The social problems also rang alarm bells across borders. Many worried that ER (perceived) sombre ambience might be a preview of their own dismal future when the social difficulties afflicting America would reach their shores.

(11) The ER producers, Warners Brothers, declined to reply to my letters, but, according to Pourroy (1996:18), while the team ensured that all medical data were accurate, they did not set out to give out health information .

(12) Casualty (and some other fiction shows) does aim at providing information or at least food for thought (see Kingsley 1993: 86 and Livingstone 1988: 56 respectively).

(13) Some informants mentioned the written press. The interaction between different programmes and between different media needs to be examined.

(14) These elements (eg. speed) were discounted in viewers’ assessment of ER realism because they were seen as deliberately introduced for suspense and drama. This demonstrates how form and content are interlinked in a sophisticated fashion. The concepts of realism emerging from the letters, far from being simple dichotomies, were complex in many ways (see Davin forthcoming: chap. 4).

(15) The word ‘culture’ is a minefield in itself with many definitions suggested but no consensus reached.

(16) Predetermined groups have collapsed at analysis (eg. Morley 1980, Dahlgren 1986, Schlesinger et al 1990). Vaughan’s (1986) example show how elusive the reasons for changing perceptions can be.

(17) A recent study of German viewers (Moran 2000: chap.10) confirmed the polysemy of the word ‘German’.

(18) How informants (would have) described themselves, or even whether they had ready-made, stable self-descriptions, remains unknown. Some might have disagreed with my classification which was based on which magazine the reply came from.

(19) See Crick 1991 on "The English and the British", Barley 1990 on "What does it take to be English?", Rogers 1991 and McDonald 1989, 1993 on French identities, Breakwell and Lyons' 1996 edited book on ‘European’ ones.

(20) Another moot point is how factors like nationality could affect viewers. For example, we saw above that ‘The French’ tend to dislike ongoing serials. But even without disputing this statement, how exactly could ‘French-ness’ be related to ‘early boredom’?

(21) There is incidental evidence that viewers’ ill-health identities influence their readings (see Philo 1996: chap.5 on mental illness; Cumberbatch and Negrine 1992: 123 on disability; Crowther 1998: 168-9 on plastic surgery). In this study, informants mentioned how experiences of sickness (often alongside other factors) affected decisions to watch (or not) ER. The impact of illness on interpretations was occasionally visible but the methodology, which lacked initial personal contact, was probably not best suited to collecting such sensitive data.

(22) The complexity of post-modern audiences and of their interpretations is illustrated by, amongst others, Just et al (1996), Brown and Schulze (1995), Hill (1999), Kitzinger (1998), Pasquier (1999).

(23) For example, viewers were prone to making their own genres, re-reading old medical dramas as comedies and ER as a quiz as well as a documentary. Some interpretations had idiosyncratic overtones: one person identified with ER surgeons because she used lancets in her art restoration training; the reply from another was replete with mechanical metaphors after his current hobby; a third depicted the ward as an ambiguous, liminal place, neither inside nor outside the hospital. Contradictions abounded (Benton was seen either as getting increasingly soft and nice or as getting more rigid, arrogant, annoying. In ER, sexuality is everywhere or it’s very soft, there’s very few sex scenes. Some can’t help wanting to go to Chicago to be treated while others must make sure we don’t do to the States to be treated. Some see the characters as caricatures, others see them as naturalistic etc.).

(24) This conclusion raises theoretical questions (a re-conceptualisation of ‘audiences’ and therefore of ‘text’ is clearly needed) as well as methodological problems (How can such volatile audiences be studied? How could the findings be generalised?) which are beyond the scope of this article.

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