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EDITORIAL |
Correspondence: Requests for reprints should be sent to Robert Sember, PhD, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032 (e-mail: res47{at}columbia.edu).
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INTRODUCTION |
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 TOP INTRODUCTION THE DESIRE TO SEE"HAVE A REAL GOOD...THE USE OF IMAGESReferences |
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Suppose that a man thinks he has done a wrong to another, the nobler he is the less able is he to feel indignant at any suffering. . . . But when he thinks that he is the sufferer of the wrong, then he boils and chafes, and is on the side of what he believes to be justice.Plato, The Republic, Book IV1p256
Close to 2 years ago the editors of the Journal took the bold step of including images in the content of the Journal. This decision was not without its detractors, who expressed concern that images would have a negative impact on the other content in the Journal. Some feel the status of the Journal has been compromised by the images, making it look more like a magazine than a scholarly publication. Others, and I am among them, assert that images have the potential to underscore and strengthen the other content while bringing a crucial tool to public health scholarship. These concerns and assertions are by no means resolved and should be the focus of ongoing discussion, not only in their own right but for the way in which they frame larger questions concerning the role of images, and the role of other forms of media or representation more generally, in public health.
Regular readers of the Journal are now familiar with the use of images on the cover and within each issue. There is even a department devoted to highlighting how images are used in public health. Each month these images capture a moment in the history of public health and illustrate a particular public health practice or intervention. In some cases, these images are also public health gestures in their own right, for in presenting experience and actions for us to look at they inspire and provide the opportunity for critical reflection on the project of public health. Historical images not only remind us that things change, they actually show us what was once there, how we once thought, felt, and acted. The power of images lies in their capacity both to convey information and to evoke reaction, often in the form of a feeling or an impulse. And if we know how to use and interpret them, images may also provide a critical space for thinking about the very enterprise of public health, for they capture the relationship between the development of public health and our contemporary assumptions and actions.
That there is a relationship between images and the health of the public is not a new idea by any means. The concern that certain images may inspire unhealthy, even deadly behavior has been and remains a constant anxiety, one that regularly consumes the highest governing bodies of the United States and other nations. The epidemic of violence in this country is often attributed to the fact that our media are saturated with images of violence, and the argument that pornography is unhealthy has an ancient history.
The use of images to advance public health is also not new. At any time we are likely to find public health images circulating in the media and on the streets of our cities and towns, competing in a marketplace of ideas where consumerism blends with the development of civil society. That these images register the fundamental, albeit contested, commitment of public health to the well-being of all members of society is also readily apparent. Just consider the protracted and painful debates that have circulated around health-related images that represent or attack the cultures, practices, beliefs, and rights of certain populations—I think of the bitter attacks on explicitly sexual images constructed to promote safer sex practices among youth and gay and bisexual men, or the use of shocking images of fetuses to attack the reproductive rights of women.
Given the centrality of images to public health philosophy, history, and practice, it strikes me as essential that we understand how images work and that we apply this knowledge to the science, art, and politics of public health. What I am suggesting is that images are a way of knowing, not in the narrow sense of containing information but in the more profound sense of making information meaningful, and among the experiences and institutions images make meaningful are those related to illness and suffering. That is, images have an epistemology and deserve our serious attention. Such a project will require, among other activities, sophisticated philosophical discussions concerning what we define as legitimate knowledge in the scholarship of public health, historical analyses of how the development of images and the development of public health are related, and investigations of how best to use images in public health interventions.
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THE DESIRE TO SEE |
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TOPINTRODUCTIONTHE DESIRE TO SEE"HAVE A REAL GOOD...THE USE OF IMAGESReferences |
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The tale serves to illustrate that we are seldom of one mind—instead, we are divided against ourselves, our rational thoughts at odds with our desires. Commenting on the implications of this struggle, Plato notes that they have consequences beyond our personal dramas and are "like the struggle between political factions," the desires of which threaten to prevail over the rational voices of the rulers—political, corporate, religious, and military leaders empowered to make decisions that affect us all.
Understanding how to manage the well-being of the populace through its relationship to the state is the conceit of The Republic, one shared by the project of public health, which asserts that the health and well-being of citizens should be placed firmly within the contract between a state and those it represents. Within this relationship, we see that state and citizen manifest the symptoms of each other’s well-being or distress—for if all is not well with the populace, then all cannot be well with the state. What the Leontius episode suggests, however, is that the success of this relationship of representation between citizen and state may also relate to what we see of citizens and the state, with the practices of representation, which have the power to disturb, the power to provoke unsettling desires. In other words, at the heart of both the self and the state is a struggle to be resolved by rational thought, which should, in its calming effect, control the desire "to see." Here lies the political force of the image, and we may well ask, What is it that the state desires overwhelmingly to see, yet believes it should not?
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"HAVE A REAL GOOD LOOK!" |
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TOPINTRODUCTIONTHE DESIRE TO SEE"HAVE A REAL GOOD...THE USE OF IMAGESReferences |
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Sontag’s bleakest realization is that a commitment to the alleviation of suffering is qualified by ambivalence, an observation underscored by her almost exclusive focus on war images, one of the least equivocal examples of how we may be implicated in the suffering and death of others. Her interest is in the tension between the capacity to identify with the other’s suffering—evident in the shock felt when first regarding an image of brutality—and the fact that war continues, that despite our shock we do not bring it to an end. While I am tempted to acknowledge this as a timely concern, such a rhetorical gesture would deny the reality that there is always conflict in the world and that the accomplishments (the very fact of an evidentiary trace, the act of witnessing) and failures (a numbing malaise, the distancing of experience, the reification of suffering) of images are always a timely concern. In a sense, we are always looking at horror. The challenge is not the looking but what we do with what we see. Thus, returning to the charnel grounds outside the ancient city walls, we should ask what Leontius sees when, succumbing to his desire, he opens his eyes and looks at the dead.
To answer that question, Sontag takes us, in the final pages of Regarding the Pain of Others, into a field of death, a photograph by the artist Jeff Wall titled Dead Troops Talk (A Vision After an Ambush of a Red Army Patrol near Moqor, Afghanistan, Winter 1986). She asks us to look. What meets our gaze is the not just the horror of the battle, she notes, but the fact that "the dead are supremely uninterested in the living: in those who took their lives; in witnesses—and in us."3(p125) Our horror lies not only in seeing the aftermath of violence, the field littered with remains, but in the fact that we are not seen, that we are alone in our looking. Our "we" is, in fact, defined by the limitations of our own experience. " ‘We’—this ‘we’ is everyone who has never experienced anything like what they went through. . . . We don’t get it. We truly can’t imagine what it was like."3(p125) Thus, while we may look, Sontag suggests, we fail ultimately to see.
Is it possible that this is the case with public health, that in trying to figure, to image(ine), the public, it constructs a nation that is quite unable to see outside itself? Or does public health imagine another relationship between those who are within and those who are without the city walls? The geography of Leontius’s journey home illustrates this beautifully. His status as citizen is demarcated by the city walls, and it is just outside those city walls, just outside the space of "the public," the "we" of the city, that he encounters those who have violated the harmony of the state and have been literally expelled. Their violation is marked by the ultimate punishment, which is more than death, the denial of a burial. If you need a literal example of how bodies are produced in order to build the walls that define who "we" are as a nation, witness the photographs taken in the US South only decades ago of African-American men hanging from trees, many of them circulated as postcards among White friends and family. It is in contradistinction to these corpses that the status of the citizen is defined.
Leontius’s struggle, our struggle, is about the turmoil involved in getting the categories right and ensuring that things are in their proper place—the citizen in the city, the noncitizen beyond the walls, preferably dead. One of the ways in which this is accomplished is through that startling encounter between the image outside us and the deep impulse within us to see. The state inscribes this geography of inside and outside, but in a manner that ensures that if we open our eyes, we shall confront what we are not. Thus Leontius, fearing that the sight of those who have been excluded will corrupt, covers his eyes but is overcome by a desire to see, to witness the very thing against which his citizenship is defined.
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THE USE OF IMAGES |
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TOPINTRODUCTIONTHE DESIRE TO SEE"HAVE A REAL GOOD...THE USE OF IMAGESReferences |
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The need for public health to acknowledge the power of images is made particularly incisively by Arthur and Joan Kleinman in the work they have done on the cultural appropriation of suffering, a gesture made by all of us in public health as we advocate for the needs of the populace.4 Like Sontag, Kleinman and Kleinman acknowledge that images of suffering have the power to mobilize resources and intervention, while also acknowledging that it is equally possible that these images will be used for sentimental effect, a form of privileged catharsis in which a swell of sympathy for those who are less fortunate than ourselves is an end in itself.
In trying to demarcate the one use from the other, Kleinman and Kleinman turn to the relationship between images and history. Images are vehicles of memory, they argue, and memory can be found in both the content and the nature, or ontology, of images, especially photographs. Photographs of the killing fields in Cambodia, for example, or images of American Indians on the Trail of Tears, record not only what happened but also the fact that something that was once there is there no longer. This subtle but critical point marks a crucial node in the power of the images, their capacity to open time to critical scrutiny by bringing a past moment into our present experience.
"Representation is the absence of presence,"4(pxii) observes Shapiro; it shows us something while underscoring that the moment in which it existed, as we see it in the image, is long since over. In this sense, the image is like desire itself, which imagines what it longs for, underscoring what it does not have. As we have learned from Plato, the desire to see has troubling possibilities; it takes us beyond the city walls, so to speak. Which is where Kleinman and Kleinman go when they argue that "the totalitarian state rules by collective forgetting, by denying the collective experience of suffering, and thus creates a culture of terror."5(p17) The suppression of images is one form of this denial, as it erases the record of social experiences of suffering. To force the state to see in this context is to assert the role of the witness, to forge a secret history and to engage in "an act of political resistance through keeping alive the memory of things denied."5(p17)
That public health has an investment in memory is, troublingly, not immediately apparent in the work we do. The silence of the totalitarian state is, at times, matched by a lack of interest on the part of the public health community in understanding what lies outside the narrow disciplinary walls of current public health practice. The corollary to that is the issue of who is included in the "public" of public health and under what conditions they are permitted to enter the walls of the institutions of public health. In addressing this point, Kleinman and Kleinman, having argued for the need to bring to witness the lives and deaths of those who are excluded from the state, turn their attention to the experience of the ones who succumb to desire and actually look. They write, "the transformation of epochs is as much about changes in social experience as shifts in social structures and cultural representations . . . subjectivity too transmutes."5(p19) This is the shuddering within, the shock felt in the face of the other’s suffering, the fact that change demands more than rational analysis. It also requires experience.
It is in this tension between rational thought and experience, between the actions of the state and the lives and deaths of the populace, that images reside. Western systems of scholarship have distinguished themselves by wrestling with the image, condemning it as a material distraction from the abstract truths of pure or scientific fact, as an invocation to desire and the pollution of the empirical "inside" with the "outside" of the imagination. Much of this condemnation is provoked by the troubled nature of the image, that it speaks of both now and then. In a sense, this relationship to absence, especially death (for the image is experienced as an unsuccessful substitute for what it represents), marks the absence of the thing, just as the corpses beyond the city walls gesture to that from which they have been excluded. It is this relationship to absence and death, and the politics they define, that argues for the importance of the image in discussions of social and individual health. The Journal has taken a crucial step in making these discussions possible.
Accepted for publication April 7, 2003.
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References |
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TOPINTRODUCTIONTHE DESIRE TO SEE"HAVE A REAL GOOD...THE USE OF IMAGESReferences |
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2. Plato. The Republic. Lee D, trans. New York, NY: Penguin Books; 1987.
3. Sontag S. Regarding the Pain of Others. New York, NY: Farrar, Straus & Giroux; 2003.
4. Shapiro MJ. The Politics of Representation: Writing Practices in Biography, Photography, and Policy Analysis. Madison: University of Wisconsin Press; 1988.
5. Kleinman A, Kleinman J. The appeal of experience; the dismay of images: cultural appropriations of suffering in our times. In: Kleinman A, Das V, Lock M, eds. Social Suffering. Berkeley: University of California Press; 1997.
This article has been cited by other articles:
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  M. E. Northridge, K. R. McLeroy, and M. L. Haviland Essential Tensions in the Journal Am J Public Health, January 1, 2004; 94(1): 11 - 13. [Full Text]
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