Picturing Health and Illness: Images of Identity and Difference (review)

Abstract

Reviewed by: Picturing Health and Illness: Images of Identity and Difference Timothy F. Murphy (bio) Sander Gilman, Picturing Health and Illness: Images of Identity and Difference. Baltimore: Johns Hopkins University Press, 1995. 200 pp. Clothbound, $29.95. Gilman’s book is an exercise in the very project it proposes: a history of medicine that is rooted in the visual image. Against a tradition that would merely catalogue medical images or use them as props, Gilman is out to show that these images can be meaningfully mined for what they say about the interplay among concepts of health, disease, morality, and the rules of representation. He offers in this regard not definitive interpretations but “readings.” In so doing, he rejects the view that these images offer a static, veridical view of “the way things were.” Instead he proposes adoption of the heuristic that images are subject to rules of representation, which are revealing in their own right, and that, so understood, images offer multiple, simultaneous, and even contradictory meanings. Indeed, Gilman admits that his readings may not even be the best ones and that one might even “read” his book without adverting to the text. This richly illustrated volume with ninety-one plates was previously published in the United Kingdom as Health and Illness: Images of Difference. Working mostly with images from the late-nineteenth and twentieth centuries, Gilman discusses the pictorial representation of the mentally ill, norms of beauty, the contested meaning of the nose, Mark Twain’s views of the diseases of the Jews, the origins of cosmetic surgery, and public health posters for AIDS. His primary thesis is that there is a strong tendency in visual representations to equate health with beauty, truthfulness, and the erotic, and to associate illness with [End Page 270] ugliness, falsity, and the anti-erotic. Such equations undergird, for example, images of the insane as distorted in their appearance and in their romantic pursuits. Syphilitics are a paradigm case in the conflation of their moral and physical decrepitude. For all that, beauty can sometimes appear as a mask, as a lure to fatality, a fatality all-too-often constructed in gendered and racial categories. The rules of representation for images of health and disease embody cultural fantasies, techniques of moral distancing, and strategies by which to affirm the merit, identity, and distance of the viewer. A third of the book deals with images of AIDS, which is no small project given the contested nature of that epidemic and its emergence in a culture drowning in visual images. Specifically, Gilman considers a number of public health posters from around the world that involve representations of the body. In the discussion, Gilman must answer the question of why these posters for the most part avoid imaging people with AIDS (or with HIV infections) as visibly diseased. It turns out that the context of these images precludes this approach. Insofar as health education apes mass marketing, it must model its messages in a format congenial to mass audiences: using frank images of disease and death would undercut the ability of health education to sublimate its products into the higher goals of love and responsibility to self and nation that are the common currency of mass marketing. In addition, gay men have long and rightly resisted images of themselves as ill and fated to early death. The body with AIDS is, therefore, the body beautiful in order to piggyback onto prevailing marketing currents and to protect gay men. What Gilman could have also noted in posters involving gay men is that great pains are taken to normalize men’s erotic interest in one another. For this reason, most AIDS posters depict highly masculinized images of men. This strategy prevents the “taint” of effeminacy in order to ward off the claim that homoeroticism is inherently disordered. In the poster-boy fight against AIDS, no sissies need apply. It is indeed true that the history of medicine is open to a great deal of benefit from the kind of analysis Gilman works through here. For example, the same kind of reading might be done with portraiture of people with AIDS, considering the kinds of differences between the photographic work...