Received January 10 2022
Citation: Purcell, Sean ‘Dermographic Opacities’ Epoiesen http://dx.doi.org/10.22215/epoiesen/2022.1
Sean Purcell is a PhD student at Indiana University (firstname.lastname@example.org) ORCID:0000-0001-9062-1510.
☞A Preamble — Undoing Medical Knowledge
The following interactive photo essay challenges medicine’s past with anti-essentialist modes of knowledge production. I am responding to a problem in the history of medicine, whose reverberations can be felt in medicine today. This problem is simple: what is to be done with medical knowledge that relies on an exploited subject?
This abused figure repeats itself in the history of medicine—from the theft and centuries long exploitation of Saartjie ‘Sarah’ Bartmann’s remains in Paris (Mitchell, 2020); to the theft of Indigenous people’s bones in anthropology and medicine (Redman, 2016); to the exploitation of Jewish people’s bodies by Nazi medical experimentation; to the theft and continued use of Henrietta Lacks’ cancer cells (Skloot, 2010); to the infamous Tuskegee experiment—where Black citizens with syphilis were tracked for decades to study the effects of the disease, even after an effective cure had been developed. The issue that this list (which is by no means exhaustive) points to, is both epistemic and cultural: interwoven in the production of knowledge is a culture that rewards knowledge claims at the expense of marginalized demographics.
I use the term ‘epistemic’ in this essay so as to reference and revise Foucault’s ‘episteme’ (Foucault, 1994  & 1995 ). Dependent on established scientific, juridical, and social norms, Foucault’s ‘episteme’ signals to knowledge that is devised not by a positivist, external universe so much as the staging of that universe within a premade discourse. While empirically true (and reproducible in lab settings) epistemics, cannot be separated from the cultural contexts which undergird their production.1 For example, I could point to the successful and actionable developments in oncology to produce treatments for cancer patients, but I also would have to imbricate how these findings rely on the HeLa cell; this knowledge depends on the theft from and continued exploitation of the body of the late Henrietta Lacks (Skloot, 2010).
What follows are images marked with various residues—that of scientific practice, of medical knowledge production, of clinical norms, and of cultural biases. The last of these residues is the most obviously avoided in medical rhetoric during the turn of the twentieth century; after all, science’s claim to objectivity would discard any cultural interlocutor. The bodies photographed below would signify nothing so much as the proof of a kind of knowing—one linked to both discourses of medicine and the productive use of the photograph’s indexical qualities. Of course, as those thinkers associated with science and technology studies have made clear over the past forty years, science is embedded in and contingent on the culture that creates it (see Latour & Woolgar, 1986; Knorr Cetina, 1999).
The problem that arises, once culture is woven back into the fabric of these photographs, is that these images serve a double intention. They convey the physiognomy of disease for diagnosis and treatment, but they also produce an array of subjects who, when viewed in unison, display a generalized population who are labeled as diseased (see Sontag, 2003). These photographs take advantage of subjects unable to say ‘no’ to their doctors. It presumes that the law will protect the sitter, without understanding the subtle coercion at play; the underlying guise of medical science these images reify preconceptions about the sitter (see Hartman, 2019, 24-29). Certainly the clinical photograph’s ability to extend the clinical gaze—or the vision based practice to perceive disease through contrasts between the generalized “normal” body and the body of the patient—is clear, (Foucault, 1994 ; O’Connor, 1999); however, this practice is but one way of looking, and these images fortify assumptions concerning race, gender, sexuality, ability, and class. As medicine capitalizes the bodies of the poor to produce a succor for the rich (Rosenbloom, 2020, p. 46), the images below take a secondary tenor. These are clinical images, but also a collection of bodies of subjects willing (be it by their choice or through the coercion from their doctors) to sit and become a representation of a disease (see Lederer, 1995).
This exploitation in the production of scientific knowledge redoubles: for it is not just knowledge as an abstract quality, but also a rhetorical thrust to both make a knowledge claim, and through this claim, to support a scientific actor—the doctor, a lab, a university, or a hospital (Latour & Woolgar, 1986, p. 273-285). Biomedical claims do not just cannibalize the poor to forward truths about human health; they buttress the social, economic stature of those making the claims (see Richardson, 1987). The body, the corpse, the subject, becomes material to reify the profession and the discipline. Through this process, medicine justifies its social, economic character.
☞The Recursive Knot
Bound in this relationship between the culture, the scientific subject, and the biomedical system, is a recursive reliance on the same images I hope to critique. To make the product below I need to reuse the material: my rhetoric, just like the scientific rhetoric levied by researchers, depends on the solidity of the photograph. My goal, while driven by a reformatory zeal, is still self centered: to promote both myself and my discipline. I exhume my subject, knowing that if I were to omit them, their absence would remain the unseen center to which I must inescapably return (Moten, 2003, p. 4). As much as I hope that these stolen images are remediated in a call for justice (see Baron, 2020), they reify the academic systems that have so easily laid claim to the othered subject.
This knot of recursive problems, represents a desire to develop an ethical framework that supersedes the will to know. My hope is to produce epistemics that could divest the knowledge claimed from the bodies of the exploited, the othered, the forgotten. Scientific medicine relies on the subject’s undoing—or the productive arrays by which the subject in living, in dying, and in death are capitalized in the production of knowledge claims. I borrow ‘undoing’ from Jill Casid’s polemic on the Necroscene (see McBrian, 2016), because of how the author frames the capitalization of both life and death, and because her usage of the term ‘undoing’ figures not just a reductive destruction, but a potential mode of praxis through the metaphor of compost (Casid, 2018). Undoing, in this sense, affords a means of viewing the subject beyond their death, and it reforms the epistemic ground from which the exploited subject is made into knowledge.
I want to find ways to undo these images, to break the epistemic assumptions concerning what is known, what should be known, and how it can be known. Most simply, I follow Edouard Glissant’s “right to opacity” as a means to undermine the totalitarian epistemics in biomedical science (Glissant, 1997 ). I clamor for the right to be forgotten, the right to be unknown, and the right to be extricated from systems that would harvest data from me in perpetuity. However, as much as I wish for this, this ideal cannot be separated from the power of the present discourse, or of any discourse (Foucault, 1995 ), and so the intent of this project is not to form an antithesis to the problem, so much as consciously and actively warp primary material, until its epistemic grounding is laid bare, and its secondary violence is unraveled and undone.
☞Opacity and erasure
Above, I have traced an impossible project built on a recursive problem in knowledge practices. Below, in the interactive essay, I have leveraged practices of opacity and erasure to modify primary images. Building an opaque methodology, the images sampled are shown with varying levels of alteration. On their face, I have left the images unaltered (save for the act of digitization). Mousing over the images, viewers will be able to see a second version, one in which any extra, discursively insignificant material has been removed. This second image emphasizes the ways the subject is held in place (in many cases by the hands of the researcher) for their photograph. By clicking the image, viewers will see a third version: stripped of anything but the physiognomy of the disease. Each moment of erasure is meant to forward two implicit claims: that the body of the subject is necessary to figure the disease, and so is the intervention of the doctor. Through this arise three key figures—the subject, their ailment, and the researcher—who orbit one another; and the visual rhetoric of these photographs requires all three to represent disease.
I have sourced these images from primarily English language dermatological atlases published around the turn of the twentieth century. These are all examples of the clinical photograph, a remediation of the clinical gaze afforded by the photochemical apparatus (O’Connor, 1999). I have chosen dermatology because of its focus on the skin, a psychosomatic register that can signify difference as well as emotional and physical feeling (Lafrance, 2018; Anzieu, 1989). Emphasis on the skin, the dermis, the cutis, recontextualizes medical visual culture away from the idealization of the transparent body (see Van Djick, 2005; Waldby, 2000) and toward what is written upon the surface of the skin: ‘dermographia’. Borrowing how Sara Ahmed and Jackie Stacey use the term, dermographia stresses how surfaces write upon themselves and upon other surfaces: creating new readings and altering past ones. They write,
“[s]kin, like writing, can be ‘cut off’ and made to signify anew. It can acquire new meanings, new forms, new shapes. But this potential does not render irrelevant the contexts in which skin has already been marked or which skin has already marked. For, like writing, skin carries traces of those other contexts in the very living materiality of its forms, even if it cannot be reduced to them” (15).
This photo essay rewrites and reskins the surface of the clinical photograph. The intervention is obvious, as a means to work through the interwoven relationship between the larger culture and medical exploitation. This process helps me pinpoint how difference (in class, race, gender, sexuality and ability) characterizes medicine during the period. Primarily these images reverberate with the kinds of medical spectacle leveraged in medical libraries, operating theaters, and in world’s fairs (Alberti, 2011; Redman, 2016). These photographs, in part, draw me in with a mix of dread, disgust, and curiosity; their abjectivity is something that I cannot pin down nor completely understand. They rely on a spectacularization of the subject: a circuit that runs between a residual memento mori and the exploitative, circus-like, and deeply classed educational complex of the modern museum (Bennett, 1995). I share these images, not only because they forward my argument, but because I cannot wrap my head around them. My hope is that the reader may reflect on and respond to these photographs in ways that I cannot.
I have left the primary images and have a link to their sources, so as to better facilitate discussion. My interest is not, at present, in the erasure of these objects, but to develop practices that recenter their epistemic locus. I encourage viewers to consider the relationship between subject and researcher; between subject and the knowledge claimed through and upon their body; and between subject and the biomedical system. And in addition to all of this, I encourage viewers to consider in regard to these images my own placement (as a white, able-bodied, middle class, heterosexual, cis male) whose connection to and support of academic knowledge production is present in these dialogues.
☞Please Read the Visual Essay Now
At this point, I invite you to open this link in a new window to view the visual essay.
ed: content warning - images are graphic. Mobile and Touch browsing not currently supported.
What did you see when you moused over these images? What did you see when you clicked on them? What do these images claim to show, and what do they function to show?
In working on this project I found myself returning to Tara McPherson’s (2003) lenticular logic—a way of seeing two images that appear unrelated but which are bound to and dependent on the same structure. She writes, “[a]s critics, we can read these two images (and the connections between them) in a variety of ways, but the structural logic of the [lenticular postcard] itself makes joining the two images within one view difficult if not impossible, even as it conjoins them at a structural level” (26). What interests me, for this photo essay and for conceptions of medicine, is the way the benefits of health are necessarily tied to the reproduction and maintenance of particular modes of othering. On one hand, the will and desire to heal the ill patient (bound tightly to the Hippocratic ideal) portrays medicine as an essentially good process. On the other, the troves of bodies stolen, mutilated, experimented on, and discursively made to produce knowledge are a necessary lesion, which are seen as a messy but solved byproduct of a distant, immoral past (excluding, of course, HeLa cells, the Alder Hey scandal, and the Tuskegee study). I cannot see this past when I engage with medicine as an individual: when I visit my primary care physician, when I view websites for the most up to date Coronavirus information, and when I get my yearly flu shot. Even if it is not present in these moments, contemporary medicine and its horrific pasts are inextricably bound.
The problem is not in the positivistic quality of modern biomedicine, but in the structures around which that positivity is built. The social, classed character of the medical doctor, which supplanted the folk healers in the nineteenth century in America (Sappol, 2002), is bound tightly to both flows of capital (more sophisticated techniques, technologies, tools, and environments) and the promise of class fluidity provided by medical training associated in kind. These flows of capital (both in the literal and in the social sense) are dependent on the ideologies upon which capital emerged: upon the moralization of conquest and control (driven by racist ideologies) leading to the technologies of the colony and the plantation (Mbembe, 2019; McKittrick, 2006), and are expressed in the social character of these seemingly objective sciences.
After all, to the untrained eye (of which I am certainly a constituent), these images rely almost entirely on a ground for the figure to present itself. When I isolate the disease to the degree where the disease is wholly and totally itself (in the ideal of the objective sciences), its meaning becomes increasingly, impossibly abstract.
In borrowing Tara McPherson’s lenticular logic, I am also borrowing her worldview concerning a problematized history. In Reconstructing Dixie McPherson’s object—the American South—is lenticular by design. Like oil to water, certain ideals concerning race, gender, and class are supported in an imagined construction of the South, which rely on one another to maintain an entrenched, essentialist racism. In mixing imaginations of the past, in refusing solidity in history of the South, McPherson aspires for a way of thinking about the South as an object in flux and contested by the everyday (28-31). Central to her argument is a will to see the South not as a determined object, but one which is made by various interlocked actors.
In attempting to make opaque these dermatological photographs, I have sought to echo McPherson’s project. I have tried to imagine a medical image that both points to its epistemic reliance on the embodied, cultured subject, and have tried to emphasize how those ways of thinking maintain forms of othering, particularly concerning race, ability, and gender.
In the preamble to this photo essay, I made a call for an ethic of opacity: to offer these subjects a way of being viewed that does not reduce them to a disciplinary object. In the essay I failed (intentionally) because the physiognomy of the subjects forwarded my own claims concerning the racial, classed character of medical research (see Washington, 2006; Owens, 2017). My method sought to amplify frictions I saw in the material, and thus relied on the exploitative image itself to establish my claims—I reified the significance of these horrible images at the same time it tried to reject them.
In working through these images, what becomes most clear for me is a necessary plane of analysis in the context of the body. If I try to isolate the disease, I find myself over abstracting the object. Without its ground—the body—the disease loses its figural power. While visual overdetermination in the sciences was slipping during this period, certain disciplines such as physiology and neurology were still mediating their discourse through imaging technologies (Cartwright, 1995). Central to these discourses, of course, is not just the object in isolation, but in the context of the body and culture. In some cases, these images are utterly devoid of meaning without the body to inscribe onto or describe through, and in others, this is only made possible through a disciplining of the subject’s body to hold still long enough for proper exposure (see Curtis 2016, 44). The embodied subject, in all their various contortions and framings, is always the object: the disease that blooms in whatever fashion upon their skin gives the pretense to discipline them. The discourse that images them, imagines them: it writes upon and through their body. It inscribes who and what could be considered aberrant. And its absences (through omission, elision, or excision) reinforce and reify what is already known: the physiognomy of disease, and the authority of the medical class.
1 Foucault’s approach to knowledge, however, is overdetermined by social construction, and critiques of the sciences’ political power have classically undermined the scope of the unhuman world (Barad, 2007). While this conception forms a groundwork for the kinds of arguments levied by science and technology studies, overdetermining the social in context of health can too easily leave open attacks against the validity of the health sciences. Given the continued rhetoric against vaccines in the endless Covid-19 pandemic, and the massive loss of life caused by these arguments, socially determined critiques of medical epistemics needs to be reconceptualized so as to not undermine the ways positivist science can produce positive health outcomes. This problem, however, is beyond the scope of the present photo essay.
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Masthead Image Sherwell, Samuel, and James C. Johnston. 1901. “A Case of Xanthoma Diabeticorum.” In Transactions of the American Dermatological Association at Its Twenty-Fourth Annual Meeting, edited by Frank Hugh Montgomery, 165–72. Chicago: P. F. Pettibone & Co., Printers, p. 166
Cover Image Darier, J., 1920. A Text-Book of Dermatology. Lea & Febiger, Philadelphia & New York. p. 50.