The Female Burden Visualized: Cinematic Representation of Women during Epidemics

Abstract

The images of a heavily pregnant woman treating patients in a hospital and of female medical workers visibly distressed as their heads are shaved in China during the COVID-19 outbreak have brought into the sharp focus the gendered dimensions of epidemic disease outbreaks. In many parts of the world during this pandemic, the majority of “front line” “key workers” in food sales, health and social care, and education and childcare are women. Both scholarly literature from disaster studies and development economics has supported the claims from charities and NGOs over the years that women and girls bear the harshest consequences of terrible disasters, such as floods, earthquakes, and droughts (Neumayer and Plümper). Recent literature focusing on epidemic disease outbreaks—particularly regarding Ebola in West Africa and Zika in Brazil—has suggested much the same (Smith; Davies and Bennett). Frequently, access to sexual and reproductive health resources have been severely compromised (Sochas et al.), something complicated further during quarantines and isolation when travel is needed (Wenham et al., “Gender Mainstreaming”). More than two-thirds of patients in the 2019 outbreak of Ebola in Congo were women, while during the same affliction in Sierra Leone from 2013 to 2016, more women died from obstetric complications than the disease itself. However, despite these obvious concerns, it has also been pointed out that we still lack a systematic approach to epidemic outbreaks down gender lines of analysis (Harman). In a survey of almost 5,000 articles published on Zika and Ebola found in the Scopus journal database from January 1, 2014, to May 15, 2016, less than 1 percent addressed gender (Criado Perez). This neglect of gendered impacts has continued with the most recent outbreak of COVID-19, according to a new article in The Lancet (Wenham et al., “COVID-19”), and in a recent piece in The Atlantic entitled “The Coronavirus is a Disaster for Feminism” (Lewis) numerous references are made to the difficult negotiations taking place at the household level about care responsibilities, women’s incomes, and the dangers of isolation—including heightened levels of domestic abuse. The lack of gendered analysis on how societies deal with epidemics is curious given that when we look to history—at least anecdotally—the experience of women and girls was also often very different to that of men and boys: from increased avenues for social control of sex workers (and sexual behavior) and regulation of female attendance at burials and funerals (Arnold; Curtis; Ross), to women taking on various kinds of epidemic-related roles as codifiers of bodies, caregivers, cleaners, fumigators, and leading organizers of community or collective welfare provision (Munkhoff; Curtis and Han). Just like with the “feminized” images and representations of famines going back into the past (Kelleher; Edgerton-Tarpley), female distress has also been foregrounded in early modern paintings depicting epidemics (van Asperen 7, 10–11; Barker). In this article, we try to fill a void in the lack of focused gendered analysis by exploring how cinema has depicted and represented the roles and experiences of women and girls during epidemic outbreaks using a wide range of illustrative film examples from a catalogue of almost 300 twentieth- and twenty-first-century epidemic-related or epidemic-focused films recently compiled in a metareview of social responses to epidemic diseases in cinema (Han and Curtis, “Social Responses”). This is especially important given that it has been noted that visual culture has a long historical tradition of offering deliberate gendered messages—for example, the early educational documentary films of the first half of the twentieth century that tried to emphasize how the battle against the microbe was something to be fought within the household—a domain presented as predominantly that of the woman (Ostherr, Cinematic Prophylaxis 4–11). Indeed, the healthy female body was placed at the center of the concept of nationhood—the state’s power linked at the roots to the family organization at the household level (Wald 85–86; also, on the family as a microcosm of the state see Han 22–27). Furthermore, approaching the issues of gender and epidemics through the lens of cinema is important for two reasons. First, although films are not reality, they can affect our thoughts, feelings, and values: Stories are how we make sense of the world around us and how we share that understanding with others. Even highly implausible situations—such as those seen in apocalyptic zombie movies—are said to have significant public health implications by telling us how to act and behave (Brown et al.; Nasiruddin et al.). When accompanied by emotive narratives and sympathetic relatable characters, films can become very effective mediums for delivering messages (Wald; Ostherr, Cinematic Prophylaxis, “Contagion”; Kendal; Han and Curtis, “Social Responses”; “Suspicious Minds”). This is especially the case for epidemics, where films can reflect upon the ordinary lives of citizens—especially the poor or marginalized who are most vulnerable to the various demands of a disease outbreak. Put simply, the experience of women and girls during epidemics seen in films either represents an entrenched view of the gendered impact of disease within societies—shining a light on what we see within society—or even more significantly, works to help further entrench those views and values. Second, it is clear that a major feature of epidemic-related films (and popular culture and media more broadly) has used fear over disease transmission and spread to create—in the words of Priscilla Wald—an “outbreak narrative” informed by othering. Literature has focused on these issues down a number of important lines, with the most important being sexuality (especially with regard to films concerning AIDS-HIV; Rees-Roberts 89–128), socioeconomic status (especially fear over migrants), and race—where, according to theories on Orientalization and othering, disease spread typically moves from “marginalized,” “deviant,” or “underdeveloped” groups to “native,” “mainstream,” or “developed” society (Wald; Kendal). “Traditional” communities are sometimes seen as “heroically” saved by the actions of well-meaning outsiders with expertise (Han and Curtis, “Social Responses” 390). Mirroring the lack of attention to specifically gendered experiences of epidemics in real life, however, epidemic-related films have yet to be systematically analyzed with regard to their presentation of the experiences and roles of women and girls (although these issues form significant components of chapters in Wald 68–113; Ostherr, Cinematic Prophylaxis). Over the course of this article, we show that women are often at the center of social responses to epidemics presented in films, consciously foregrounded by directors. However, the extent, nature, and direction of these female images are quite clearly demarcated. First, we show that in films women have often been portrayed as symbolic “carriers” or “spreaders” of disease—sometimes as a punishment—and this phenomenon is often connected to female characters seen deviating from the “expected” gender roles prescribed to them during epidemics. Frequently, this is tied to a moralizing view of female sexuality—termed by some as a “sexual epidemic” in reference to the outbreak’s capacity to provide authorities with unparalleled access to bodies and a series of codes for inscribing them, with a justifying discourse (Singer 117). Second, we show that in films one of these prescribed roles is for women to frequently take on heavy burdens during epidemic outbreaks—often by “selflessly” caring for others. In extreme cases, this even leads to women sacrificing themselves for the “greater good” of the wider community or to protect a male protagonist. Accordingly, both images can be seen as mutually reinforcing. Although, of course, changes in the nuancing of these two images occur over time with changes in societal values—aspects and components of them can still be observed in one form or another from the earliest films of the twentieth century to more recent productions post-2000 across a diversity of cultural contexts for filmmaking. It was once remarked that the “invisibility of contagion” is pinned to a “concreate embodiment of ‘otherness’” through other “potentially invisible aspects of identity, race and sexuality” (Ostherr, “Contagion” 1). It is down these lines that we can understand the first representation of women during epidemics: the female carrier or spreader. The use of an image of a woman to personify a particular disease, or make society more vulnerable to the outbreak of a disease, has a long history—for example, in the medieval imaginary, leprous blood was linked to menstruation, supposedly discharged by impure women and believed to be a carrier of the disease (Zimmerman). Miasma-informed rationale of disease transmission also informed decisions to ban women from funerals during early modern plague outbreaks—with warnings that female presence increased the danger of contaminated air rising from the graves (Noordegraaf and Valk 120, 134). In modern history, many related examples are strongly connected to stigmatization and prejudice. Arguably the most famous case was that of “Typhoid Mary”: an appellation bestowed upon Mary Mallon, an Irish cook working in New York in the early part of the twentieth century who unknowingly spread the disease in every household she worked. This term used by media and health authorities was morally coded: an unclean “fallen woman,” condemned for her sexual activity and unmarried status (Echeverría, “Women Who Killed”; Wald 108). Focus was put on her spending evenings with a “disreputable looking man” in a room full of “filth and disorder” (Wald 84). Indeed, films themselves have also reflected on the long historical connection between women and their perceived role as “carriers” or “spreaders”—in particular, the persecution and scapegoating of women as witches during plagues. As might be expected, films derived from the dramatization of original historical source material tend to avoid some of the worst problems of anachronism—for example, by correctly representing the connection between witch hunting and plague as an early modern phenomenon (sixteenth and seventeenth centuries, especially). This is seen in well-known films such as Dangerous Beauty (Marshall Herskovitz, 1998), based around the story of a sixteenth-century Venetian courtesan, who later becomes a target for a church-led inquisition when plague breaks out, and The Last Valley (James Clavell, 1971), set in the context of the political and religious struggles of the Thirty Years’ War (1618–48) in Central Europe, where conflict and epidemics go hand-in-hand with the accusation of rural women as witches. Similar scenes are also seen in lesser-known films, such as the Swedish Himlaspelet (Alf Sjöberg, 1942) in which two peasants are about to marry until a disease breaks out in their village, and the female protagonist, Marit, is burnt alive as the identified “spreader.” In Mariken van Nieumeghen (Jos Stelling, 1974)—a film highly revered and entered at Cannes Film Festival, and based on a play written in Middle Dutch in the early sixteenth century—a woman, Marieke, travels from Nijmegen to Antwerp, where she is ultimately blamed for an outbreak of plague because she had cohabited seven years with the devil. Other links frequently drawn between the Black Death of the mid-fourteenth century and the persecution of witches, however, are wholly anachronistic (Black 192), and yet the premise has formed a central part of the narratives in critically revered films, such as Ingmar Bergman’s The Seventh Seal (1957) and the acclaimed British comedy Monty Python and the Holy Grail (Terry Gilliam/Terry Jones, 1975), where the accused woman is found to weigh the same as a duck and therefore said to be made out of wood and hence a witch. Similar trends can be seen in contemporary film. For example, in the recent Season of the Witch (Dominic Sena, 2011), a woman (Claire Foy) is explicitly accused of causing the Black Death—in the process she is forcefully escorted to an isolated monastery by two knights as recompense (Nicolas Cage and Ron Perlman). Not only as a source of literal infection, in Black Death (Christopher Smith, 2010), the female protagonist, Langiva (Carice van Houten), as the village herbalist, is even portrayed as the causal catalyst for the male protagonist, Osmund (Eddie Redmayne), turning “evil” himself—seeing all women as potential witches in the process and misogynistically hunting them down and brutally torturing them. This trend is also found in lesser-known films, such as the Norwegian Trollsyn (Ola Solum, 1994) in which the initial stages of a Black Death outbreak are accompanied by a physically aggressive inquisition of a female peasant villager. It is unsurprising then that the representation of women at the center of potential epidemic activity has long roots in cinematic history. For example, it has been shown through the United Public Health Service's early documentary, How Disease is Spread (1924), that the morally inappropriate role taken by a middle-class white woman runs contrary to the prevailing view of the time that women were guardians of the private sphere—and thus the front line against public health crises (Ostherr, Cinematic Prophylactics 4–11). In particular, the film moralizes the actions of a woman who escapes the household to participate in commercialized leisure activity—in the process infecting a man with tuberculosis, an “innocent” youth, and most damningly, a naval serviceman. The narrative is militarized; the failure of the woman to protect others from the “germ invasion” means that men cannot protect the country’s physical borders. This was not a trope confined to the West either. In the Korean Life’s Enemy: Cholera [Insaeng ŭi ku: hoyŏlja] (Kim Sorang, 1920), cholera was used to create a narrative on two scales: A justification of “modernizing” practices connected to the colonial authority of Japan (diseases were associated with a feudal past), a feature shared with similar films shown in Taiwan during the cholera outbreak of 1919 (Lee 115–16), but also an emphasis that the battle against the microbe was something domestic, and largely female responsibility, by zooming in on the ordinary confines of two contrasting family homes (Chung, 2014). In the Japanese film Diseases Spread [Byodoku no denpa] (Sanae Yamamoto, 1926), one household scene suggests a woman’s “carelessness” first affects the family, then the city at large. Moving through time, similar themes were seen during later educational documentaries set during the World War II, such as Borne on Two Wings (UK War Office, 1945) in which where the malaria threat is linked to mosquitos symbolized as predatory and promiscuous women—“Noffie the Skita” and her daughter “Anophilina” (Peckham 308; Fedunkiw 1049–50). In one scene, the soldier is found kissing a woman when he himself gets stung by “Noffie,” provoking him to kill the female mosquito. The malarial parasites meanwhile are depicted as a group of corrupted men drinking and partying with a number of “temptress” women. A feature linking many of these documentary films is the focus on personal blame attributed to “deviant” sexual behavior—an aspect predictably present in early public health films on sexually transmitted diseases (Pernick 24; Parascandola). Indeed, the sexualized female image in Borne on Two Wings operates on three levels: the woman “tempting” the military man, the “predatory” female mosquito, and the “corrupting” female parasites. It should be noted that these associations were not found only in early educational documentaries but feature films too. Indeed, one of the major images of silent film, Die Pest in Florenz (Otto Rippert, 1919), was the Black Death conceptualized as a “beautiful seductress.” Furthermore, this moralizing view on female decision-making as a source of societal vulnerability to epidemic outbreaks was not confined to the period before World War II. In the British film 80,000 Suspects (Val Guest, 1963), the emergence and spread of a localized outbreak of smallpox in the small town of Bath is framed as a distinctly moral issue. Indeed, the pursuit of the final carrier of the disease ends up at the feet of a woman, Ruth Preston (Yolande Donlan), who had an affair with the central male protagonist in the film, Dr. Steven Monks (Richard Johnson). The condemnation of these actions is magnified when placed against other developments—the fact that Ruth’s husband is also a medic, but more importantly, the wife of Dr. Monks actually contracts and dies from smallpox. Elsewhere, in the US film The Crazies (George A. Romero, 1973), the highly contagious virus caused by contaminated water supplies—creating people with homicidal tendencies—was actually code named “Trixie”; a shortened form of the names Beatrix, Beatrice, or Patricia. Later in this film, an infected man, Artie (Richard Liberty), attempts to rape his daughter, Kathy (Lynn Lowry), only prevented by outside intervention. Nevertheless, the viewer is encouraged to pity the rapist—who hangs himself—whereas the daughter is “punished”: shot dead by soldiers the very next day (Williams 71–72). Significantly, however, similar scenes have even been seen in very recent cinema—in particular, during the widely renowned Contagion (Steven Soderbergh, 2011). Indeed, the “outbreak narrative” of spread from East to West is set within another narrative of a woman with “loose morals”—Beth Emhoff (Gwyneth Paltrow)—whose decision to have an extramarital affair ends up spreading the infection further (while “selfishly” already conscious of her symptoms). Supporting this trope are the initial scenes of the film set within a Macau casino, reminiscent of the cocktail lounges and nightclubs frequented by women of “dubious virtue” in Hollywood film noirs of the 1940s and 1950s (Peckham 308). Elsewhere, in the German film Der Medicus (Philipp Stölzl, 2013)—a historical drama about an English orphan, Rob (Tom Payne), who travels to Persia to learn medicine from the famous polymath Ibn Sina (Ben Kingsley)—the same issues appear. Overall, the film itself is full of historical anachronism: people die of the Black Death in the eleventh century, which is centuries after the end of the First Plague Pandemic and centuries before the start of the Second Plague Pandemic (even if the temporal dimensions of these pandemics are now beginning to be debated). Nevertheless, one of the female protagonists, Rebecca (Emma Rigby), becomes afflicted with this so-called plague and is abandoned by her husband. She is nursed back to health by Rob and upon recovery is impregnated by him. Rebecca subsequently is sentenced to death by stoning and has to rely on last-minute reprieve by “white knight” Rob from her impending execution. The female spreader image has furthermore been present within recent zombie-pandemic or “end of humanity” crossover movies. In the popular Korean film Train to Busan (Sang-ho Yeon, 2016), the epidemic takes root in the actions of a reckless young woman running onto a train unnoticed, infecting other passengers. In the British film 28 Days Later (Danny Boyle, 2002), the disease origins are found in the actions of a female animal rights activist—her infection presented as logical punishment for her rage. The urgency of patriarchal oppression can be seen in the male scientist immediately exclaiming, “We have to kill her!” (Adesola Mafe 20). The recurring fear of female sexuality also appears within this genre: in Rabid (David Cronenburg, 1977; remade Jen Soska and Sylvia Soska, 2019), a rabies epidemic is set off by a woman (Marilyn Chambers), who develops a form of phallic stinger. Most of her initial victims are male—with two particularly instructive scenes being the infection of a leering customer at a pornographic cinema, and the ending in which Rose’s corpse is literally tossed away into a garbage truck (Weinstock 63–64). Throughout cinematic history and even in films produced today, misogynistic and chauvinistic images of women are produced—pushing women into the background, limiting female agency, creating cliched or stereotypical female roles, or presenting women with a limited skill set compared to male protagonists. This is seen also in films creating images of women in scientific or public health roles (although with a large array of different archetypal characteristics) (Steinke, “Cultural Representations,” “Portrait,” “Women Scientists”; Flicker; Kasi Jackson; Hassel), and films depicting epidemic diseases have not been immune to that particular trend. For example, in the popular recent Korean film Flu (Kim Sung-su, 2013), an experienced and educated female medical doctor (Soo Ae) is effectively presented as entirely reliant on the efforts of the male protagonist, Ji-goo, an Emergency Response Team member (Jang Hyuk). The doctor is effectively rendered passive, as both herself and her young daughter are time and time again “saved” by Ji-goo’s “heroic” and decisive actions. In the Chinese box-office hit Wolf Warrior 2 (Wu Jing, 2017), centering around an outbreak of “Lamanla” (based loosely on Ebola) in an unnamed region of Africa (entrenching a view that “Africa” is all the same), a UN medic, Dr. Rachel Prescott Smith (Celina Jade), refuses to evacuate—asserting the desperate need of her specific medical knowledge—and yet is swept off her feet and tossed into a vehicle by the lead male protagonist (Wu Jing), who at the same time exclaims, “Don’t make any more trouble for me!” For these two examples, of course, we should recognize cultural context: The female doctor in East Asian contemporary cinema is often presented in such a way as to appease demand for “hyper masculinity” or valorize masculine protection (Louie). Nevertheless, related elements exist also in the most recent of mainstream Western cinematic traditions. For example, the epidemiologist, Susan (Eva Green), in Perfect Sense (David Mackenzie, 2011)—a film centered on a fictional disease attacking all five human senses—is an educated professional, yet the film presents her as divorced from her working context or laboratory, together with neurotic or unstable behavior patterns. Perhaps more than in other films, however, women in epidemic-related films are often visually present as active agents placed at the center of societal responses to outbreaks (Schweitzer). However, in line with the expectations of the broader medical humanities literature presented above, much of this “centering of women” is often shown by the epidemic providing an exceptional female burden. Frequently, this is seen down two lines: women forced into cliched roles that center around selflessly caring for others and women that have to go above and beyond the call of duty—in the process endangering their own lives, and sometimes even sacrificing themselves for the perceived “common good.” These images are certainly seen in earlier film history. In King Vidor’s The Citadel (1938), Dr. Andrew Manson’s (the Oscar-nominated Robert Donat) experience treating tuberculosis in a mining community in the South Wales valleys leaves him mentally scarred. On a downward spiral, he leaves behind his “medical principles” and becomes enticed by wealthy London patients presented as hypochondriacs. Although the death of his friend, Dr. Denny (Ralph Richardson), through the malpractice of an unprofessional surgeon plays a role, it should also be mentioned that Dr. Manson’s return towards his “original calling” is mainly stimulated by the attention, devotion, and advice of his wife, Christine (Rosalind Russell). This caregiving role, however, becomes sacrificial in the end: She is involved in a car accident that leaves her infertile. In the original A. J. Cronin novel, this was taken one step further—Christine experiences another accident and dies (shortly after resolving differences with her husband), though in King Vidor’s film, this was not included (McKibben). More usually, however, women who stay true to their prescribed gender roles during an epidemic tend to be rewarded with protection and salvation. In an Egyptian film set in 1947, The Sixth Day (Youssef Chahine, 1986), a laundry woman (Dalida) is depicted in the midst of a cholera outbreak mainly doing two things: taking care of her family and resisting the romantic advances of a younger man—despite her own clear aspirations and dreams. A similar story is told in the Italian film Storia di una capinera (Franco Zeffirelli, 1993), the third film adaptation from the original novel by Giovanni Verga (1871) set in the mid-nineteenth century in which the female protagonist and nun, Maria (Angela Bettis), has to leave the confines of her convent in Catania, Sicily, due to a cholera outbreak. Through the course of the film, Maria is tempted by life outside the convent—falling in love with a young man, Nino (Johnathon Schaech)—but in the end makes the decision to return to a life serving God and the church. It should be noted that in some cases this recurring theme is presented from a different angle. For example, in The Blonde Saint (Svende Gade, 1926) it is the selfless and caregiving efforts of the male protagonist that are foregrounded (Lewis Stone)—looking after a poor village community stricken by cholera (again in Sicily)—which allows him to secure the attention and love of an English woman, Anne Bellamy (Doris Kenyon), and fend off a potential rival (Malcolm Denny). In many recent films, prescribed gender roles are often hidden behind a veneer of female assertiveness. A clear example of this view is also seen in the film Blindness (Fernando Meirelles, 2008), an adaptation of a Portuguese novel of the same name (José Saramago, 1995). The wife (Julianne Moore) of the male ophthalmologist (Mark Ruffalo) is presented as one of the most central and active characters—a leader of the isolation facility—and yet still this is framed within typical caregiving, guidance, and support tasks. Indeed, through the course of the film, the wife first is presented as being entirely forgiving of her husband’s unfaithfulness, continues to tend to the immediate needs of her afflicted partner, and then works to ensure the safety and protection of others in her ward, and eventually even becomes the leading protagonist in the group escape from the institution—guiding followers to safety, despite the threat of violence from other men. Similarly, in World War Z (Marc Forster, 2013)—depicting a global struggle against a “zombie plague”—the female protagonist, Karin (Mireille Enos) starts the film as the apparent household “breadwinner,” while her husband Gerry (Brad Pitt) is found in the kitchen making pancakes for the small children. Yet as the pandemic takes hold, the roles reverse, and we see the familiar trope of a man saving women and children (Doyle). Karin spends most of the film waiting for a phone call from her husband—with one particularly revealing scene being Karin typing GERRY into her satellite phone, while Gerry simply types HOME (Rodriguez). In Children of Men (Alfonso Cuarón, 2006), based on a 1992 novel by P. D. James, the future success of society in a post-epidemic world even rides on basic female reproductive capacities. The story revolves around the one lone struggle of the only pregnant woman on earth (Clare-Hope Ashitey) who holds the key to human existence after a global flu pandemic that leads to widespread infertility (Echeverría, “Liquid Cinematography”). The film Contagion shows numerous images of women responding during an epidemic, risking their own lives for the perceived greater good. For example, Dr. Ally Hextall (Jennifer Ehle) works night and day in a secured lab to try and isolate the virus and develop a serum. In the end, she disregards regulations and risks her own life by testing the vaccine on herself. A similar situation can be seen with the WHO epidemiologist sent to Hong Kong to find the origins of the MEV-1 pathogen. Although effectively lied to and kidnapped by a Chinese official, Sun Feng (Chin Han), and used as leverage to obtain vaccines for his family’s village, Dr. Orantes (Marion Cotillard) not only is found caring for and educating the local children in one scene, but upon realizing that the village were given placebos instead of real vaccines, voluntarily returns to help. Other examples of women acting selflessly as “saviors” can be seen in the presentation of the CDC officials. Dr. Erin Mears (Kate Winslet), an Epidemic Intelligence Officer, begins investigating the situation in Minneapolis but in the process is infected herself. Despite warnings from a colleague, she continues to concern herself more with the welfare of others with whom she might have come into contact. In her final act, she selflessly passes a coat to another sick person for warmth before dying. A plane was intended to evacuate Dr. Mears while alive but instead diverts to pick up “important” political officials. This contrasts with her final scene in which she is promptly zipped into a body bag and thrown into a mass burial site—a cold and brutal scene that emphasizes her unacknowledged selfless efforts (Han and Curtis, “Suspicious Minds”). The woman’s role as prominent caregiver is often entrenched in these films centered around epidemic responses—even when we see a “transformation” in the attitudes, values, and role of the female character across the course of dealing with the disease. For example, in The Painted Veil (John Curran, 2006), based on a novel of the same name (W. Somerset Maugham, 1925), the female protagonist of the film, Kitty Fane (Naomi Watts), is initially negatively presented as a vain socialite more in