(Not) Looking at Historical Medical Images

How do researchers respond to the politics, ethics and emotions raised by archival medical images? Michaela Clark reviews the workshop ‘Emotions and Ethics: the Use and Abuse of Historical Images’, organised by AboutFace, 17 June 2020.

Theorists of photography have long been at odds with the medium – questioning its ability to capture and convey evidence, its potential to make the mundane beautiful, as well as its capacity to bring the intimate, the painful, the vicious into public view. Most infamous in their critique of the photograph is Susan Sontag, who, within On Photography (1977), abolishes the photographic image for being too singular, too exposing, too violent:

to photograph people is to violate them, by seeing them as they never see themselves, by having knowledge of them they can never have; it turns people into objects that can be symbolically possessed. Just as the camera is a sublimation of the gun, to photograph someone is a sublimated murder – a soft murder, appropriate to a sad, frightened time (Sontag 2005, 10).

This condemnation of photography is coupled with a resentment for a society obsessed with spectacle at her time of writing: it is a critique of the pervasive craving for something novel and dramatic, a strike on a voracious public that cannot get enough of both beauty and suffering, pleasure and pain. It is in the climate of Andy Warhol, disco, the Vietnam War, the ‘golden age’ of pornography, and the rise of neo-liberalism in which Sontag sees photography thrive, fuelling a voyeuristic audience whose thirst for images seems impossible to quench.

Fast-forward 50 years and Sontag’s scathing remarks continue to permeate thought on photography, especially with regards to depictions of violence and suffering. The appetite for the spectacular endures as the consumption of more and more photographs and footage (in newspapers, 24-hour news channels, and social media) appear to create a public forever eager to see. Somewhere in this flurry of visual activity and online debate a conversation began – not in terms of explicitly violent imagery but rather with regards to historical representations of a medical kind. It was Jennifer Wallis’s tweet that brought awareness to the use of this genre of ‘difficult’ historical material to the fore on social media. But, beyond this, her post had the added effect of funnelling attention to the (then) upcoming workshop titled ‘Emotions and Ethics: the Use and Abuse of Historical Images’ to be hosted by AboutFace on 17 June 2020.

The Workshop

Held virtually (via Zoom), this intimate gathering was host to both established and emerging commentators on the broad topic of patient images, including visual representations of the symptomatic, the surgically treated, the stigmatised, and the deceased. To begin the proceedings, Dr Fay Bound Alberti – historian of medicine and emotions, and head of the AboutFace team – opened with a contextualising statement on the project: this workshop was to be first of many to deal with questions surrounding the politics, ethics, and emotions embedded in the human face (as an organ, as the seat of identity, and as a medicalised body part). Part of this project meant thinking through the responsibilities of the historian (as researcher) in relation to historical subjects (as research participants). And this is where the presenters came in.

While each speaker had only a brief 10-minute slot to fill, the provocations offered were evocative and revealing. Drawing largely on individual case studies and personal experiences (as researchers, as writers, as curious viewers, and as educators), presenters bared their thoughts and theories on what it means to both dive into the visual archives of medicine as well as disseminate their riches. Offering a striking example, Katherine Rawling demonstrated how a lack of concern for patient consent emerged on Twitter where a historical subject she knew from asylum casebooks was laid bare (in name, image, and action) via a historical news report. Questions around the discursive frame thus came to the fore: the same image seen and known differently tells a different story; what is the responsibility of the historian to contribute to this public telling of events?

Many utterances felt like confessions of individual uncertainty; statements were notably weighted by a sense of duty towards those depicted and the questions that emerged spoke to the dread of mis-stepping in an uncertain legal and ethical terrain. In a brutally honest reflection, Jennifer Wallis highlighted how her own research meant engaging post-mortem asylum photographs within the archive. Framing the encounter as a form of emotional labour, Wallis suggested that looking at troubling photographs requires significant work – it is hard to engage these images, and it is only getting harder.

Testifying to this difficulty was the noteworthy lack of images featured in the papers, with only one out of eight presenters choosing to include visual examples in their submissions. What re-emerged again and again throughout the workshop was thus the question: do we or don’t we show what is buried in the archive?

To think through this ‘looking/not looking’ dilemma (Möller 2009), presenters drew on ideas from a diverse set of disciplines (including art history, anthropology, philosophy, media studies, bioethics, history of psychiatry, and sociology to name but a few). My own contribution sought to grapple with what the medium of photography is in relation to the clinical context. Providing a rather theory-heavy approach, I sought to outline how the manner in which we make sense of the photograph (as a representational mode) as well as our relationship to the subject depicted (as patient, as person, as kin) ultimately influences our emotional investment therein.

Framing such researcher responsibility along lines of care, Harriet Palfreyman demonstrated how the context of the 19th century Lock Hospital infuses medical images with concerns of patient agency and professional exploitation. Rather than avoiding this material, however, Palfreyman suggested that an ‘ethics of care’ (Puig de la Bellacasa, 2017) allows even clinical illustrations to be reframed: focusing on personal details and human elements (such as delicately rendered facial features and individual attire) demonstrates the artists’ care while also prompting viewers to acknowledge personhood amidst pathology.

Similarly drawing on ideas of care, Beatriz Pichel touched on the question of social media in terms of the visceral discomfort felt when she and many others witness a historical subject exposed online. Suggesting that we err on the side of caution, Pichel emphasised that as historians we should consider ethics as an integral (rather than secondary) part of our research and writing practices – essentially asking us to ‘think with care’.

But what would care of this kind look like? Within the archive or the museum, it could mean treating medical photographs with custodial respect (ensuring they are properly cared for). Within our writing, it could mean paying careful attention to their content and context (paying due diligence in terms of our research). And when we publish, it could mean thinking through why, when, and how we introduce images of this kind to our audiences (caring about the consequences of public access).

Beyond the above scenarios, difficult images also circulate within the classroom and lecture hall. Grappling with this pedagogical terrain, Sarah Jones gave details on the various methods she has explored with her students in an effort to use images to teach the history of sexuality. Beyond the usual content warnings, students were encouraged to ‘disrupt’ the act of looking by making it a ‘conscious act’ within the classroom. Asking whether or not their peers wanted to look, placing images in and removing them from envelopes, as well as omitting human subjects entirely (leaving only the background context of an image) were all proposed as strategies for getting students to not only look but to think about and discuss looking itself.

Building on debates regarding the viewing experience, Juliet Roberts payed careful attention to her encounter with a facially wounded WWI veteran in both hand-illustrated and photographic form. Shifting gears from one representation (in pastel and ink) to another (in gelatine and sliver salts), Roberts engaged methodological overlaps between the act of visual as well as historical analysis and interpretation. Both subjective and contextually grounded, her discussion of these medical images demonstrated how they provide avenues for thinking through the historical moment of their making. However, while Roberts’ argument rested on an engagement with representations depicting a single person, the broader target of her paper – a collection of WWI-era photographs hosted online by BIU Santé – also poses ethical questions that have made workshops like this one so pressing.

It is precisely material of this kind that Jason Bate turned his attention to. In his paper, Bate highlighted the personal and, indeed, ancestral ties to similarly clinical military photographs in Britain. Having recently been deemed ‘national collections’ by their custodial institutions, these medical repositories are often made available to researchers while relatives might not even know visual records of their loved ones exist. In demonstrating the depth and richness of familial memory in his paper, however, Bate gently advocates for reconnecting disparate frames – that of the institution and that of the home.

Drawing the papers and discussions together, esteemed historian of visual culture, respected author, and now AboutFace advisor, Ludmilla Jordanova, highlighted the workshop’s overarching thread – that visual sources are deeply imbedded in the ethical context of historical research as a whole. What is it that makes images so different from case notes, diaries, and other forms of exposing and highly personal writings? What makes us feel the need to govern the entrance of medical images into the public domain? As Jordanova elaborated, it is impossible to control the flow of historical images; where and how they land is hard to regulate, while regulation in and of itself always speaks of power. And, while the bureaucratisation of ethics – via review boards and clearance policies – are a necessary component of our work as historians, the nuances, tensions, uncertainties, and even contradictions emerging from our papers confirmed that standardised forms and administrative procedures remain a clumsy and inapt solution. Ultimately, to decide who can and cannot look at what we find in the archives is to make a moral judgement that in itself requires care – care in the form of reflection and, perhaps, even critique.

Closing Thoughts

In her 30-year follow-up text to On Photography (1977) titled Regarding the Pain of Others (2003), Sontag is commonly recognised to have had a change of heart. While she continues to deem the photograph too singular to provide understanding of tragic events – preferring narrative (text, writing, storytelling) – she rejects the notion that images pacify viewers or render them inert. Instead, Sontag makes a claim that it is not the images themselves that are at issue but rather the way we encounter them: they require time, a space for contemplation, rather than the fleeting turn of the page or the flicker of a screen. What the workshop demonstrated is precisely this tension between the medical image, the act of looking, and the viewing public. It is not merely about what or who is depicted but howthe visual history of medicine is encountered in the present.

As evidentiary, institutional, and personal images, medical photographs and illustrations continue to puzzle regulatory norms. While a 100-year closure period (aligned with data protection laws) is often implemented by archives and other repositories, questions need to be asked about the usefulness of these guidelines that safeguard contemporary (rather than historical) subjects (Sappol 2017). With the passing of time, more and more archives of medicine are not only opening up to the public, they are being placed online as their time of closure recedes and the importance of access comes to the fore. How are we to think through this new influx of ‘difficult’ images?

As Roger Simon (2014) argues, images can shock, they may offend, and they could cause discomfort – but this is part of what makes them a powerful learning tool. They challenge viewers to face their assumptions and internalised attitudes head-on. Even Sontag (2003) ultimately believed it is better to be haunted by the past than to be ignorant its atrocities.

While the verdict is still out on how to grapple with the troublesome nature of medical images, clinical collections remain an integral part of our institutional and emotional record. And with greater numbers of clinical collections coming to light after decades in the dark, it has never been more pressing to consider the place of this material in society today.

*A note of thanks to both Sarah Hall and Victoria Hoyle for their seamless organisation and running of the workshop.

*****

Michaela Clark is a PhD candidate at the University of Manchester’s Centre for the History of Science, Technology and Medicine (CHSTM). Her ongoing research focuses on the history of medicine and the politics of (scientific) representation with a particular emphasis on 20th century clinical photography in South Africa.

AboutFace is an interdisciplinary research project exploring the emotional and cultural histories of facial difference, surgery and transplantation: https://aboutfaceyork.com

Bibliography:

Möller, F. 2009. “The Looking/Not Looking Dilemma.” Review of International Studies 35, no. 4 (October): 781-794.

Puig de la Bellacasa, M. 2017. Matters of Care: Speculative Ethics in More than Human Worlds. Minnesota: University of Minnesota Press.

Sappol, M. 2017. “Anatomy’s Photography: Objectivity, Showmanship and the Reinvention of the Anatomical Image 1960-1950.” REMEDIA [online].

Simon, Roger I. 2014. A Pedagogy of Witnessing: Curatorial Practice and the Pursuit of Social Justice. Albany: SUNY Press.

Sontag, S. 2003. Regarding the Pain of Others. New York: Picador.

Sontag, S. 2005[1977]. On Photography. Electronic ed. New York: RosettaBooks LLC.

2 thoughts on “(Not) Looking at Historical Medical Images”

  1. In the preface of Susie Linfield’s 2010 book ‘The Cruel Radiance’, she states that it “is written, in large part, against the photography criticism of Susan Sontag. This is not because Sontag was wrong about most things; on the contrary, many of her insights remain sharp and true. But it is Sontag, more than anyone else, who was responsible for establishing a tone of suspicion and distrust in photography criticism, and for teaching us that to be smart about photographs means to disparage them… I believe that we need to respond to and learn from photographs rather than simply disassemble them… I believe that we need to look at, and look into, what James Agee called “the cruel radiance of what is.” Photographs help us to do that; so would the kind of criticism that believed in their worth.”

    Linfield’s critique of the criticism of photography includes a very useful history of said, and while the kinds of photography she has in mind aren’t historical medical imagery of the sort discussed in this very interesting event review, it’s still relevant. I wonder how the doubts and questionings discussed at AboutFace can be resolved if the understanding of photography is limited to the (negative) positions of one person, i.e. Sontag.

    I also wonder in what way historical medical photographs might be more or less politically and ethically difficult objects (with regard to deciding for potential audiences for them whether they should be allowed to look at them or not) than items publicly displayed historical medical collections, such as Edinburgh University’s Anatomical Museum?

    1. Hi Lucy,

      Thank you so much for your comment! Linfield’s Cruel Radiance is one of my favourites – especially her section ‘Why Do Photography Critics Hate Photography’! As you say, Sontag remains an integral part of contemporary discussion re. photography theory. But coupled with her critique, more and more attention has and is being turned towards ideas of affect, empathy, and recognition. Much of this is drawn from another long-standing concept – that of Roland Barthes’ punctum. Judith Butler has addressed this in terms of grievability, Jill Bennett in terms of trauma, and many others in an attempt to re-read photography against ideas that the medium itself is exploitative, violating, and even ‘violent’ or ‘victimising’ (as Martha Rosler suggests).

      I think it is important for us to remember that theories are historical in and of themselves – they are formed and influenced by the contemporary moment. Sontag was largely drawing on the work of authors before her, including Walter Benjamin, who was also critical of the medium; but these critiques were informed by the context in which they were writing. Linfield does a super job of highlighting this, as does Kaya Silverman in her ‘Miracle of Analogy’. For me, what is important is not to discard established frames but to recognised when/why they emerged and to what end; is about asking ‘are these ideas still useful’ and thinking about in what context they can operate productively.

      Photographs are always imbedded with power-relations which means that objectification and subjugation must necessarily be considered. This is particularly accute when they are institutional images (products of the prison, the asylum, the hospital, the museum). My personal feel is that groups like AboutFace offer a safe space to look beyond the disciplinary and discursive frame of the medium, to break beyond the insights of singular individuals (like Sontag) without discarding their ideas. I guess as historians/theorists/authors/researchers the best we can do is present ideas that can help us make sense of (medical) photographs and other difficult images in accordance with the needs of the present.

      *Please note these thoughts are entirely my own. I do not represent the AboutFace team 🙂

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