(Re)Framing and the (medical) anthropological lens

To photograph is to appropriate the thing photographed. It means putting oneself into a certain relation to the world that feels like knowledge – and, therefore like power.  – Susan Sontag, On Photography [note 1]

In her seminal essay on the subject of photography, Susan Sontag (4) suggests that while the written word can never pretend to be anything but an interpretation, photography provides the illusion of transparency and can trick us, concealing the photographer’s hand and the ways it is ‘haunted by tacit imperatives of taste and conscience’. In this editorial note, we reflect on the relationship between photographs and ethnographic accounts, photographers and ethnographers, and photographic and ethnographic subjects.

This issue of MAT brings together several ‘regular’ submissions with the nine offerings that make up our first Special Section, ‘Beyond “Trauma”’. Collectively, the editorials, essays, articles, and translations make use of the strategy of (re)framing, common to both photography and ethnography. This strategy is at once aesthetic, ethical, and political, permitting the artist/ethnographer to guide the viewer/reader toward particular understandings of the world.

The photographic metaphor came to us while viewing/reading the two photo essays in this collection, both of which mix the art of portraiture with the art of ethnography. The portrait is a unique form and, like ethnography, often focuses on individuals or small groups. Unlike ethnography, however, those individuals are usually invited to pose (or are posed) with the aim of capturing a particular version of reality through the conscious act of composition. The photographer and photographed subject work together, each with varying degrees of agency, to present the individual. The figure in a photographic portrait is able to ‘pose’ consciously in relation to an imagined audience. This is much more difficult for the subjects of ethnography, who may struggle to imagine the reading audience. Writing culture by definition entails an act of (re)framing both the individual and the particular to represent a collective imaginary of the other. But as this issue of MAT demonstrates, ethnography – especially when combined with photography, poetry, and other forms of media – also has the potential to provide a space for individuals, in collaboration with ethnographers, to (re)present their memories, traumas, wounds, and imaginaries in particular ways, which might just serve to create, incite, entice, and coalesce collectives of their choosing.

In a photo essay about contemporary imaginaries of fatherhood among men in Malawi, Fiona Parrott and her colleagues from the Karonga Prevention Study, Malawi, and the London School of Tropical Hygiene, make use of a series of portraits of men, most of whom are pictured in domestic settings with their families, in order to reframe public health development perspectives that have historically overlooked the positive roles men might and do play as fathers and spouses in rural Africa. What is exciting about the images is that when the men were given the opportunity to compose their own portraits, they elected to be photographed in ways that forced the team of ethnographers to recognize the multiple roles that men play in the domestic sphere, as well as the deep pride they feel as family men. Similarly, the portraits of young people with cystic fibrosis in Berlin, presented in the photo essay by Stefan Reinsch and Johannes Rascher, invite the viewer into medicalized domestic spaces, reframing boundaries between personal and medical space, health and illness. While the photographs illustrate the agency granted to the subjects by photographer Rascher, Reinsch’s ethnography produces an effect similar to double exposure, allowing the reader to imagine the ways people with cystic fibrosis transpose multiple realities.

In MAT’s second Found in Translation offering, Hansjörg Dilger and Bernhard Hadolt ruminate on the importance of context in examining medicine. This translation of the introduction to their edited volume Medicine in Context, now nearly ten years old, is valuable both as an introduction to medical anthropology and as a glimpse into the genealogically complex world of German-language medical anthropology, which incorporates practitioners from Switzerland and Austria, as well as Germany. Deciding the boundaries of ‘context’ is an ethnographic art, they remind us. Anthropologists rely on close-up portrayals to counter the top-down aerial views of health problems in a globalized world. The authors suggest that as the objects of our study (medicines, bodies, technologies) expand and become increasingly understood as hybrid, we must take multiple scales of context into account, or, like a photographer, learn to utilize a wide-angle lens to complement the close-up lenses to which we have grown accustomed.

Kirsten Bell’s unsettling Nightstand piece on academic journal standards invites us to reflect on the practice of photographic touch-ups. The comparison she offers between the Queen’s gardeners, who paint the white roses red to avoid getting their heads chopped off in Alice in Wonderland, and the ways that current academic metrics can result in distorted stories and partial perspectives, to say nothing of touched-up CVs, should encourage us all to revisit the ways such metrics might be reframed as ‘a trip down the rabbit hole’.

The Special Section ‘Beyond “Trauma”’, guest edited by Orkideh Behrouzan who organized the September 2014 workshop by the same name in London, undertakes an impressive effort to reframe multiple objects, including psychiatric diagnosis, the Middle East as a region, and interdisciplinarity. With excellent editorial introductions written by both Behrouzan and Michael Fischer, and the text of the keynote lecture given by Jennifer Leaning, we keep our comments brief here and invite our readers to explore the three original articles by Behrouzan, Omar Dewachi, and Zuzanna Olszewska, as well as two Think Pieces, one by Veena Das and another by Hanna Kienzler and Zeina Amro, on a topic that seems particularly relevant given current events in Syria and the Middle Eastern region today.

Behrouzan’s article on the psychological afterlife of the Iran-Iraq War examines the psychiatric self-medicalization of the generation of people who were children in the 1980s, arguing that both medical and cultural forms outlive wars. Her ethnography, which artfully weaves in the accounts of her interlocutors, ‘tells a story of how generations are built around shared experiences, how history is psychologically reconstructed, how social anomie is perceived in the collective mind, and how, above all, pathology becomes a cultural resource for demanding justice’ (Behrouzan, this volume).

Omar Dewachi attempts to provide a close-up of Iraqi refugees in Lebanon, but finds himself somewhat defeated by the persistent fuzziness of refugee stories. Expanding upon the metaphor of the wound, Dewachi explores the ways wounds are utilized in stories, particularly humanitarian ones. He shows, however, that too close a focus can also lead to disinterest and even social exclusion when doubt is cast on the stories. Sontag (15) states that ‘photographed images of suffering’ do ‘not necessarily strengthen conscience and the ability to be compassionate’, and further that our conscience and compassion may even be corrupted by living with such images. Focusing the same object (the wounds of war) reframed via different technologies – the ethnographer’s voice recorder, the humanitarian aid officer’s reporting forms, and most hauntingly, the neighbor’s mobile telephone – Dewachi demonstrates that although each attempts to frame the refugee, the portrait remains out of focus.

Continuing with the themes of displacement and the afterlife of war, Zuzanna Olszewska’s article on poetry among Afghan refugees living in Iran explores the relationship between suffering and aesthetic expression. According to Sontag (7), ‘people robbed of their past seem to make the most fervent picture takers, at home and abroad. Everyone … is obliged gradually to give up the past, but in certain countries … the break with the past has been particularly traumatic’. For Afghan refugees in Iran, poetry is an art form akin to photography, ‘a way of making a statement about collective suffering and speaking on behalf of others less able to raise their voices’, and a means through which poets are occasionally able to harness their depression ‘to “remake a world” and to feed creative responses that both articulate collective claims to social justice and offer individual healing’ (Olszewska, this volume).

In teaching us a new visual code, photographs alter and enlarge our notions of what is worth looking at and what we have a right to observe. They are a grammar and, even more importantly, an ethics of seeing. (Sontag, 1)

In attempting to grapple with an issue that is both historically and theoretically complex, the authors whose work appears in the Beyond ‘Trauma’ Special Section take an important step toward offering both a grammar and an ‘ethics of seeing’ how the lives of people from the Middle East have been shaped by war-related traumas, as well as by the political, humanitarian, legal, and psychiatric responses to those traumas over the past half century. By offering close-up portrayals of the afterlife of wars as lived by individuals and by seeking ways to frame social worlds that are in spatial and temporal flux, they collectively expose the limits of our ethnographic instruments and invite us to take interdisciplinarity seriously by engaging with history, gender studies, and medical humanities.

In closing, we would like to take this opportunity to formally welcome aboard our two new editorial assistants, Sarita Fae Jarmack and Kathleen O’Farrell, both of whom will be working out of our Amsterdam office for the coming years. We’d also like to welcome Josien de Klerk, who has taken the helm of our Found in Translation section with much enthusiasm, and Tanja Ahlin as the head of our communications team. Many of you will have noted our increased activity on Facebook and Twitter. Thanks to Tanja for her regular posts on contemporary issues relevant to medical anthropology. We are grateful for this growing editorial team, and we are already looking forward to our next issue, which will be published in April 2016. Special thanks go to Wendy Kuijn for teaching the new staff and interns our various systems and technologies, and making this transition smooth.

(For the full list of contents, please click here.)