Doing history in an age of visual medical humanities: a review of Suzannah Biernoff’s Portraits of Violence (2017)

Jason Bate reviews Suzannah Biernoff’s Portraits of Violence: War and the Aesthetics of Disfigurement (University of Michigan Press, 2017).

In Portraits of Violence: War and the Aesthetics of Disfigurement, Suzannah Biernoff presents a cultural history of medicine through the richness of its visual materials as it plays out during the First World War in the development of facial reconstructive surgery. A study of the politics of representation in medicine and popular culture that points to the importance of interrogating the dominant image of war disability, Biernoff’s narrative is not limited to an investigation of image content, surgical technique or the innovation of individual doctors that often define histories of medical photography. It is instead concerned with exploring an aesthetic culture of wartime facial disfigurement through an understanding of visual experience as perceptual, embodied and affective.

Biernoff’s methodological approach draws on scholarship in the history of emotions. While the personal affective dimensions of disfigurement are difficult to evaluate, due to a distinct absence of emotional language in medical records and official war propaganda, Biernoff’s approach allows for the uncovering of multiple complex layers of anxiety, shame, and disgust as responses to trauma; these provide a nuanced interpretation of subjective feelings. These emotional responses encompass not only the servicemen who experienced the primary traumatic event, but also the community who comes into contact with that individual and tries to cope with their repressed and revealed reactions to disfigurement.

The voices of facially disfigured veterans are challenging to retrieve, and Biernoff stops short of tracing the individual journeys of men back into their familial and social environments. I would have liked to have seen this book extend its focus on the social and cultural implications of facial disfigurement by uncovering personal stories of survival, of the pain and humiliation hidden underneath, and of veterans’ efforts to construct new selves after the war. Nevertheless, the attention paid to veterans’ reintegration into society following surgical intervention does offer us an account of the role of ‘the family as healer’, and shows how the onus was placed upon the individual and the family to seek medical solutions as a follow-up aftercare.Biernoff’s method foregrounds the affective nature of photography: I suggest that by paying attention not only to how photographs describe emotions, but also actively produce them, we can arrive at an expanded and richer account of the medical legacies of WW1 (1).

Trauma, censorship, and the limits of portraiture

Biernoff probes the conventions and limits of portraiture as a means of conveying the affective impact of facial injury. None of the images she focuses on could be described as typical portraits: instead, the social and psychological effects of war are signified by the destruction of the recognisably human portrait.The relationship between portraiture and trauma is elaborated through the work of artists and photographers, where image-making involves processes of social and aesthetic negotiation. The questions that Biernoff poses at the beginning of her book provide a conceptual foundation for the chapters that follow: What is a portrait? How does trauma alter or transform the genre of portraiture?

One of the defining characteristics of Biernoff’s narrative is the unofficial censorship of facially disfigured veterans in the British press (2). Turning to popular culture, Biernoff considers the visual contexts of stigma through the anxiety that facial mutilation evoked in the press, poems, memoirs and fiction. These sources show the social impact of the wounded servicemen’s recoveries and reveal how supportive local communities were. However, because of the politics of the two organisations that ran military hospitals, the RAMC and the British Red Cross Society, medical photographs became embedded in a contradictory story about the wounded soldiers’ rehabilitation that shifted between public and private spaces of healing.The RAMC and British Red Cross never showed these photographs to non-medical viewers, considering them to be unsuitable for the public because they exposed the hideous nature of facial injury and showed wounded servicemen in a weak and vulnerable state. As Biernoff contends, the medical photographs highlight a contrast between war propaganda’s romanticised view of the conflict versus its catastrophic bodily consequences.

F. C. Grayer, 1917-18, pastel drawing by Henry Tonks, 1917. From the Hunterian Museum of the Royal College of Surgeons of England, London.

Another example of censorship occurs in relation to images taken by the official home front photographer Horace Nicholls, documenting the making and fitting of prosthetic masks by British sculptors. Blurring the conventions between photojournalism, medical science, and official documentary, Nicholls’s photographs, under the strict control of the British government’s propaganda bureau, remained unseen by the public. As Biernoff argues, ‘it is hard to imagine the photographs featuring in a propaganda campaign. As much as the sculptor’s skill they evoke the loss of identity alluded to in written accounts.’(3)The photographs taken by Nicholls, supported by newspaper articles, reveal that although facial mutilations were abundantly photographed, they were organised for public consumption in a particular way. By censoring facial disfigurement to make them less shocking, heroic and patriotic meanings were being constructed around the patients and their rehabilitation to appeal emotionally to ideals of national and domestic value. The dissemination of these narratives among a public audience attempted, therefore, to convey a positive reading of facial mutilation, and presented a restoration of the social function of the face to calm political and social controversies.

Henry Tonks’ pastel drawings of servicemen before and after facial reconstructive surgery lie somewhere between medical illustrations and portraits, allowing Biernoff to make a point about the absence of the disfigured face from traditional portraiture, and the crossing of disciplinary boundaries from art to medical illustration, from the history of surgery to popular culture. Tonks’ pastels are used, along with Nicholls’ photographs, as evidence of the extent to which creating, preserving, or restoring humanity is as much a cultural and aesthetic matter as a biological or medical one.

Digital re-appropriation: disfigurement and BioShock

The book returns to the present by exploring the digital re-appropriation of a medical photograph taken from the case files of the Gillies Archive, and used in the computer game BioShock. This final chapter provides a critical framework for an ethics of viewing that consider the broader significance of historical representation and context in contemporary art and digital culture. She is troubled by this mediated appropriation, and by our cultural desensitisation to images of the body in pain: ‘If BioShock is unethical, it is because it violates a common feeling that photographs of suffering somehow contain or embody their subjects; and that they therefore carry a burden of care’ (4).

At the core of this cultural history of looking at disfigurement, Biernoff is concerned with the ethics of looking and the aesthetics of difference. The crux of her argument is that the possibility of seeing difference differently is not just a matter of representation. In the context of war, disabled and disfigured are burdened with meaning; they become symbols of nationhood and allegories of loss. This is one of the strengths of approaching disfigurement from as many perspectives as Biernoff does. It will leave the reader re-interpreting medical imagery of disfigurement, where seeing approaches a limit and is faced with its own negation, not only because it presents us with a history of aversion in which the act of looking is itself negated but because the representation of the disfigured face disrupts the conventions of Western art history, and with it a whole pictorial language of identity and empathy.

F. C. Grayer, 1917-18, photographs by Sidney Walbridge, 1917. Gillies Archive, in the Archive of the Royal College of Surgeons of England, London.

Biernoff concludes the book by providing a personal explanation for her research interest in a cultural history of disfigurement, a response that is intensely emotional, as for her ‘these cannot not be personal subjects’ (5). Originally, the medical photographs were made with a specific purpose in mind: portraying the processes of repairing facial injury. Although photographs can be exchanged and repurposed, they can never entirely shed the conditions of their making (6). Yet their reclaiming by historians gives them a redemptive second life, in an entirely different way than was originally intended. These photographs are of course perceived as challenging by virtue of their subject matter alone; the agendas they reveal, the political debates they feed into and stem from, the emotions that they engage and the lack of any sense of resolution to be found in their exploration or perhaps exploitation. Such histories make difference, personal struggle, impairment, privacy and human rights visible, and as such they ask uncomfortable questions about memory and forgetting. Yet Biernoff’s invitation to think critically about medical imagery as necessarily interdisciplinary offers much to the reader in the medical humanities. There is relatively little guidance from within the history of medicine on how to use visual sources. As a result, much historical writing continues to prioritise written sources over visual ones. Not only does photographic evidence offer another dimension to the medical humanities, but it complicates and challenges established historical narratives, and points to future directions for the history of medicine.

In writing these challenging histories more broadly, we see great anxiety about the use-value of emotion and subjectivity in relation to working with sensitive histories. Nevertheless, by reflecting on the limitations and potential of engaging visual artefacts in the medical humanities, including the possible disjuncture between what images show and what is written down or said, this book spotlights wider historical questions about the subjective reinterpretation of the past, its adaptability to multiple reviews and retellings, and the nature of memorialisation as transformative of its objects. This book asks what it is to ‘do history’ in the age of a visual medical humanities. But rather than addressing the philosophical aspects of this question, Biernoff engages the practices and apparatus of history itself—relationships with, for instance, ideas of time and distance, evidence, the constitution of an event, materiality, agency, and context.

Works Cited

1. Elspeth H. Brown and Thy Phu, eds. Feeling Photography (Durham and London: Duke University Press, 2014).

2. Biernoff, Portraits of Violence, 55-80.

3. Ibid.,20

4. Ibid., 163.

5. Ibid., 164.

6. Greg Mitman and Kelley Wilder, eds. Documenting the World: Film, Photography, and the Scientific Record (Chicago and London: University of Chicago Press, 2016), 15.

Jason Bate is a historian of photography, with particular interest in Edwardian histories of medicine, the First World War, visual culture and medical humanities. He lectures in the practices and histories of photography at Falmouth University. His research focuses on medical photographic archives and collections and he has published in the journals Visual Culture of Britain, History and Technology, contributed a chapter to Approaching Facial Difference: Past and Present (Bloomsbury Academic, 2018), and is currently working on a monograph for Bloomsbury Academic’s History series.  His latest article ‘Bonds of Kinship and Care: RAMC Photographic Albums and the Making of ‘‘Other’’ Domestic Lives’  has recently been published in Social History of Medicine.


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