Medical Illustration and the Ethics of Representation

84A little over a week ago I attended an conference on the ‘Promises of Monsters’, which explored various manifestations of monsters and the monstrous in contemporary culture. One of the plenary papers, delivered by Professor Margrit Shildrick, raised several key questions about the ethics of representing the monstrous visually. What, she asked, is at stake when we visualise something – or someone – in an academic discourse? Do we have the right to comment on ‘monstrous’ bodies by virtue of our scientific approach, or does this actually render our relationship to the monstrous even more problematic?

These questions reminded me of a 2014 Slate article by Rebecca Onion called ‘History, or Just Horror?’ Reviewing the Wellcome Library’s book The Sick Rose: Disease and the Art of Medical Illustration, Onion weighs the ethics of displaying vintage medical images of ‘monstrous’ bodies (none of which I’ve reproduced here) in the digital age:

As historical medical images go digital, scholars and archivists are being forced to weigh the benefits of disseminating the undoubtedly important and interesting record of the evolution of medical practice with concerns that the images will be misused and misunderstood. Making the images available will almost certainly lead to some tone-deaf uses, lacking empathy and regard at best – exploiting the shock value of a disfigured face or body at worst. On the other hand, digitization of the kinds of images that were once available only to researchers with the means to travel to archives can do a lot of good. Such visibility can raise awareness about past wrongs, facilitate connections between historians and the families of former patients, even provide us with a new way to think about our own mortality.

What is our responsibility to the people in these images? Onion discusses a particular case in which these archived photographs found another, less historically-minded function:

Some photographs from the Project Façade archive ended up used in the design of the genetic mutants (‘splicers’) that players of the videogame BioShock must battle. One of the patients in the photographs, Henry Lumley, a pilot trainee, was injured on the day of his graduation from flying school and lived with his injury for a year before being admitted to Gillies’ care. Lumley died of postoperative complications, at age 26. (Here’s his page on the Project Façade website. And here’s an image of the BioShock character in question.) Lumley and his fellow patients are now forced to wander about in virtual space, made into monsters for the entertainment of gamers.

14f36705d99c356a607fb3a89176e222Is this morally objectionable? Should we only use such images for educational purposes? In the rest of the article, Onion demonstrates how the situation is more complicated than that. In the end, she concludes that what we really need to cultivate in response to these images is reflection – something for which there is increasingly little time in our internet culture:

[A] vanitas requires space for contemplation – a space the Web seems ill prepared to offer. Susan Sontag’s final book, Regarding the Pain of Others (2003), was written as the Web was in the process of scattering photographs to the four winds. Sontag wrote that photographs of suffering could be a ‘memento mori’ and serve as a still point around which to contemplate mortality. But she wondered how this might work – or fail to work – in ‘a modern society,’ where ‘space reserved for being serious is hard to come by.’ If she thought that about art galleries, books, and television, one wonders what she might have made of Pinterest.

These types of responses are comparable to those Shildrick suggests we must cultivate as researchers of the monstrous. To come to terms with the monster, ethically speaking, we must continually question our own parameters of identity. Otherwise we risk mistakenly identifying ourselves in these figures, overwriting their identity in the process. Or worse – identifying them as alien, absolutely different, and impossible to live alongside. We shouldn’t turn away from images of the monstrous, but we must also be wary of becoming desensitised to these images, or sentimentalising them.


Onion’s final thoughts on the matter are similar. In the last paragraph of her article, she writes:

Perhaps the answer might be image or video files that contain within them a trigger that activates a program blocking the rest of the Web. Just for a minute, or two, you’d be forced to look, see, and feel, without distraction. Like a visitor sitting at a patient’s bedside, you’d bide a while with a fellow human, a witness to our collective frailty.

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