Academic Medicine:
doi: 10.1097/01.ACM.0000366951.34531.ec
Medicine and the Arts

Commentary

Williams, Arthur Robinson MBE

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Author Information

Mr. Williams is a medical student, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; arwilliams@gmail.com.

People often ask, “How did you find your participants?” I always begin with a clarification: They're not mine. At times I worry it sounds flippant, but possession is a dangerous realm beholden to imbalances of power and distortions of perspective.

Much like that of medicine, the legacy of photography is tainted when it comes to human rights, including notions of “normalcy.” Modern Western history exemplifies medicine at some of its worst moments. Despite the millions of clinicians who have devoted their careers to uplifting the human condition and embracing those most vulnerable among us, the residue of oppression remains. Especially for stigmatized patient populations, the oral histories of provider prejudice and scurrilous diagnostic categories (drapetomania, hysteria, homosexuality...) continue to resonate, undercutting even the most sincere and fluent efforts of delivering care.

Likewise, the camera's lens is tethered to misconduct as aged as silver emulsions. In her earlier writings on photography in the late 1970s, influential cultural critic Susan Sontag argued that photography objectifies, that it turns people and events into something that can be taken or possessed. Although I disagree with her central tenant, that people can be taken as such (a position which she herself further qualified upon reflection in subsequent writings), her suggestion that the photographer—like the doctor—wields great power, is instructive.

The ethics of making photographs and presenting cases are much the same. In either genre an overemphasis on pathology objectifies the person depicted, obfuscates the self in the interest of the body. Pathologizing those depicted is itself an act toward possession. Whereas photographers may use dramatic light or warped perspectives to render a subject sickly, physicians have other media at their disposal. Through the use of lab values, imaging data, and other pertinent positives, the image created may neglect the subjective (illness) experience of the patient in concern.

More significantly, the distinctions between normalcy and pathology can become obscured. Especially in realms of human behavior and self-identity, nosological classification is as much an exercise in the delineation of disease as it is the protection of personhood. That deemed pathological is resultantly no longer normal. Such depiction is especially problematic when it is the categorization of whole persons that is under review.

Hence, the power of the depicter. The authority to name and display is one of great magnitude. Medicine and the sciences have increasingly held sway over delineating the normal from the pathological, whether on the order of the individual or the collective. Photographers similarly work toward compiling a visual classification of persons and personhood. As technology advances, both fields gain in capaciousness and, thus, influence.

It is with this in mind that I make photographs. As a challenge to misplaced authority, I hope the images truly do arise from collaboration: my expertise bowing to that which the participants bring.

Of late, my work has been with transgender individuals. As always, my goal is to use photography as a venue for expression—theirs and mine. In each case, participants have written their own text to accompany the photographs. The work featured here shows Allie, a young lesbian transwoman and her former girlfriend. The entire project can be found online at www.MyRightSelf.org.

Transgender (or gender-variant) individuals as persons have historically been pathologized by the medical establishment (and photographers alike). “Gender Identity Disorder” still exists as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, and in my experience many clinicians maintain a circumspect gaze toward trans patients.

Through my photography, I hope that the individuals depicted can be seen more deeply than is usually allowed by the monolithic portraits included in most archives. Although gender identity is a fundamental component of a person's self, it is nonetheless a part of a much larger whole. Ideally, no part of an individual—whether deemed normal or pathological—would be used to objectify the person in question.

As the Civil Rights Movement of the 1960s, the feminism of the 1970s, and the Gay Rights Movement of the 1980s sediment into our nation's history, medicine is confronted with a new wave of urgent normalcy. “Gender identity,” like that of race, gender, and sexuality, has asked to be freed from the mantle of pathology, the realm of possession. Today, transgender advocates pose before our collective lens, suggesting that gender identity is not something to be taken, but to have.

© 2010 Association of American Medical Colleges

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