Dissecting Images: Multimodal Medical Anthropology

When Foucault spiraled into the historical depths of the rise of the modern clinic and the double-edged sword of biopower, he foregrounded the primacy of the medical gaze (Foucault 1973). With each successive advance in the technologies of visual and auditory perception came dominance over and subjugation of the body and its diseases, the biopower complex began. First, advancing technologies of auscultation then visualization permitted an increased penetration into the body; feeling and hearing from without, then seeing organs, then cells, and then the tiniest of micro-processes that power the cells. Along with the increased capacity to perceive came the capacity to name, to classify, to manipulate, and ultimately to control and to cure. That process of striving to visualize, understand, and control continues.

Taking inspiration from this trajectory of Foucault’s conception of the gaze, the authors in this special issue dissect images, their content, the processes that created them, and their ability to display, distort, and preserve minute slices of our lived moments. Images, both moving and still, used in these articles bring with them insights into the multimodal environment where we live and work (Collins, Durrington, and Gill 2017). They show how we interact with other people and objects in our environment, they include information on the places and spaces where research took place, and they preserve metadata that demonstrate the timing of events and of the interactions of the researchers. We emphasize the trust, timing, and tempo of the processes that surround making meaning of the images both by participants and researchers. By engaging these images as data, as actors themselves, we can tweak our theoretical notions about how they play an expanded role in the work of medical anthropology.

Central to our theme of considering images (and more broadly multimodality) for use in medical anthropology is our recognition that images (and other modes) are representations of the world filtered by the positionalities of the makers themselves, influenced by unique experiences that brought them to that point in time. Their conscious effort to use a camera to capture something of interest reflects their intent, or motivation, to do more than simply document and describe for an audience. Images become an extension of a way of thinking, visually connecting maker with participant along lines of thought. In this special issue, we share six examples of how images inform and enhance our approaches to the body and its well-being, encouraging logophiles to consider making images in a multimodal sense for more than illustration in film or print production. Rather, we encourage people to include the dynamic process of the production of knowledge, in which researcher, participant, and audience are each present and contribute to the work.

Vision

There is increasing evidence for the extraordinarily rich interconnectedness and interactions of the sensory areas of the brain, and the difficulty, therefore, of saying that anything is purely visual or purely auditory, or purely anything. The world of the blind can be especially rich in such in-between states—the intersensory, the metamodal—states for which we have no common language. (Sacks 2011:237–238)

Medical moulages, as discussed by Cristiana Bastos in this issue, highlight the complex layers that go into creating our ideas about what an illness “looks like,” both physically and morally. Patients suffering from such disfiguring diseases as syphilis and leprosy were cajoled or perhaps forced into having their lesions immortalized. The purulent, smelly wound of the individual was cast in plaster and wax, and then transformed into a multi-colored body part that was transportable and holdable. This object was then photographed and made two-dimensional and very small to fit on the printed page, where ultimately, it was visually consumed by the aspiring medical students in their human anatomy classes. Moulages were relied on for their clear, iconic expressions of disfigurement and disease. Bastos’ unpacking of the use of moulages in teaching, in texts, and in religious reliquary reveals morality and gender issues as surely as it illustrates human pathology.

Nina Nissen considers modalities of gender, analyzing images created by Danish men who participated in her study on masculinity and everyday logics of self-care. Using photo-elicitation to guide the interview resulted in men’s narratives and conversations revolving around how they care for themselves and their families. She explores the images shot on men’s cell phones that elaborate and celebrate the mundane rituals and small pleasures that the men valued, their rebellions and their fears. Tacking back and forth between the visual and the textual, Nissen and her participants demonstrate how images enrich their discussions and reflections with precision that memory alone could not provide. Nissen’s use of images that are deeply embedded in the everyday lives of men expands Mol and colleagues (2010) concepts of the logic of care. We see how these Danish men perform gender as a “caring masculinity” that includes caring for both self and others. Photographs of the fleeting moments in the men’s lives testify to the importance of the quiet ways in which we live. There is a poignancy when we are confronted with what the men find most compelled to portray and share: a meal, a wall of family photos, an adult diaper. The importance of the mundane is given its due.

In search of ratings and sensationalism, the popular media has emphasized the violence, devastation, and human trauma brought about by the “drug war” raging on both sides of the US-Mexico border. While human suffering seems to be an all-to-common experience, hope has not disappeared amidst the chaos and structural violence residents endure daily. Jennifer L. Syvertsen and her colleagues use photo-elicitation and critical phenomenology to delve into the personal lives of six sex workers/drug users and their partners in Tijuana, as they sort out their lives and make ends meet, finding hope in the liminal space between their reality and an imagined future. The photos made by the project participants reflect that hope, challenging the normalized violence depicted by media and various levels of government complicity.

Tempo

The production of images is embedded in the rapidly changing technologies of communication, visualization, and miniaturization. With each successive generation of digital camera, if in a cell phone, a laparoscopic device, or basic handheld point-and-shoot, the resolution of the images and the amount of metadata retained increase significantly. In his article, Jerome W. Crowder reviews information embedded in a series of ethnographic photographs that he made 10 years ago, to document a healing event in Bolivia. Through an analysis of the metadata, his notes, and the images themselves, he reconstructs his movements as a photographer, a medical anthropologist, and a friend of the person in need. By reviewing the time stamps embedded in each photograph, Crowder develops a means for slowing down the ethnographic moment and questioning how and why the researcher engaged in either documenting the event or helped in providing first aid to his injured friend. In doing so, Crowder offers insight on the multiple types of data recorded by digital devices and a creative means of analyzing them to reconstruct positionality.

The types and quantities of metadata captured by our digital devices are vast. Operational metadata include time stamps, geographic coordinates, device settings, and even Wi-Fi or Internet connectivity; these data are recorded and embedded in each file we make (image, video, or audio). Researchers can also add their own descriptors, like codes, as metadata to digital files. Images and data are combined with the seemingly ubiquitous surveillance systems that document our every physical and virtual movement, giving birth to a panopticon of mammoth proportions. Faced with such structural encroachment, anthropologists must dissect these data to illuminate and analyze human behavior via the minute moments and in large-scale data troves. By reconsidering our theoretical positions vis-à-vis such evolving types of data, we acknowledge how embodied multimodalities have become in our daily lives. Escaping them is futile; embracing them is our best option for coexistence.

Chelsea Wentworth’s article on child feeding practices and food scarcity in Vanuatu investigates research time in a different manner, employing a methodology she terms the “visual-narrative elicitation process.” By carefully partitioning her research activities in a consecutive order, Wentworth indicates how each step in the process generates different information that cumulatively builds on what has already been collectively discovered. Her careful training of participants to use a camera, select images, and then work through their captioning leads to discussion and the use of pile sorting to identify themes regarding food use and vitality. She also highlights the process of building trust that allows for an increasingly authentic participation between researchers and participants (Cartwright and Schow 2016).

Following the theme of tempo, Cartwright offers a visual analysis of nonverbal, embodied communication by observing the timing of interactions between a toddler daughter and her father during their lunch together at home. After selecting a short segment of footage shot during their meal, the data were loaded into a computer program that allowed Cartwright to code behaviors as the sequence played. Coding for various nonverbal cues, such as touch, gaze, cooing, and facial expressions, so unpacking involuntary reactions between the two participants, allowed Cartwright to describe nonverbal cues that were being passed back and forth between the father and daughter. Cartwright’s codes are metadata she is inputting, which will work with the device’s embedded operational data so she can systematically analyze each frame. Unique to this article is an inset written by the father, Adam LaVar Clegg, about his perception of his interactions with his daughter, providing a subjective positionality which Cartwright could not code, although the context helped her translate his actions into thoughts. Cartwright argues that similar methods can be implemented to study persons whose disease leaves them unable to verbally communicate with the world around them (e.g., stroke, autism, and Lou Gehrig’s disease).

Transition

Historically, one of the reasons anthropologists have preferred textual data and written analysis to still images, film, and audio data is because they are easier to manipulate, theorize, and analyze. Because of this, visuals were relegated to the sidelines, often used for little more than illustrative purposes (Pink, Kürti, and Afonso 2004:212). Such a bias may also stem from the fact that analog technologies were expensive, conspicuous, bulky, and delicate, making them difficult to use in the field (Prins and Ruby 2001). Despite Mead’s plea for a greater use of photography in fieldwork and publication (1975), anthropologists have continually shied away from image making, most recently due to issues concerning power, representation, voice, objectivity, and reflexivity (Hammond 2004; Wolbert 2000). Today, ethnographic practice cannot escape the multimodality of life itself as cameras, microphones, and screens are installed in almost every handheld electronic device available around the globe; the increased use of these devices requires consideration of ethics and respect for positionalities at all levels. We developed this special issue to “nudge” our colleagues to recognize how multimodal types of data are inherently connected to our work, whether we want them to be or not. Multimodal Medical Anthropology embraces forms of data that resolve the webs of interconnection between humans and their biosocial and imagined environments. Further integration of the senses into our methods and theories enhances our understanding of what embodiment means in a lived manner (Streeck, Goodwin, and LeBaron 2011). Multimodal practices enable us to transition from verbal, linear narratives and interrogations to multilinear depictions and analysis, accounting for participants, researchers, and audience members through layers of information that are easily accessible, shareable, and manipulated.

Acknowledgments

Projects like this special issue always have several persons at their core, either as inspiration or for their dedication to the cause. We are lucky enough to have been influenced by some of the best colleagues there are, and for them we are very grateful. H. Russ Bernard encouraged and began prodding us to consider systematic visual analysis nearly 10 years ago; because of this initial impetus and ongoing support, we could work toward an issue like this one. Thank you, Russ, for your wisdom and advice; we never stop learning from you. Lenore Manderson and Karen Nakamura willingly served as discussants on our AAA 2015 SVA invited panel in Denver where their comments about the articles and enthusiasm for the ideas galvanized us to propose the panel as a special issue with MA. Thank you, Lenore, for your guidance and brilliant use of your scalpel-like pen; you are an editor’s editor! Victoria Team kept us all organized and on deadline, thank you! We also want to acknowledge members of the panel for accepting our call and working with us to produce this special issue. The peer reviewers who were tasked with these articles helped us craft them into stronger, more significant works; we appreciate your time, insight, and collegiality—the products of which lie herein.

Additional information

Notes on contributors

Elizabeth Cartwright

Elizabeth Cartwright, PhD, is Professor in the Department of Anthropology at Idaho State University and author/editor with Manderson and Hardon of The Routledge Handbook of Medical Anthropology (Routledge 2016). She has published widely on structural vulnerability and health among immigrant and ethnic populations. She has extensive experience in obstetrical nursing and publishes in the fields of anthropology, nursing, and women’s health.

Jerome W. Crowder

Jerome W. Crowder is Assistant Professor at the University of Texas Medical Branch, Institute for the Medical Humanities where he is a medical and visual anthropologist teaching in both the medical school and biomedical sciences graduate school program. He and Liz Cartwright have co-taught Systematic Visual Data Analysis for the National Science Foundation's Short Course on Research Methods program in 2008, 2009, and 2012.