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

Sander Gilman has ably demonstrated the close relationship between visual images and cultural attitudes toward mental and somatic illness. In earlier works—The Face of Madness (1976), Seeing the Insane (1982), and Disease and Representation (1988)—he analyzed images from a variety of sources ranging from madness to sexually transmitted disease, and in this new study many of the same issues, and even some of the same images, again pass in review. One of his six chapters, for example, returns to images of madness, and the revisit elicits new glosses on several topics. He looks again at madhouse scenes because he has found an 1887 political caricature by Joseph Keppler based on one by Wilhelm Kaulbach. Discovering 1886 photographs of asylum inmates, he compares them to previously studied images stressing the contrast between the healthy/beautiful and the ill/ugly. Discussing a wanted poster for a mentally ill patient, he notes the importance of extensive captions for the posters intended audience. He compares two photographs of patients with Graves’ disease to point out how the patients’ physiognomy changed as the disease was better understood. In distinguishing between madness and sanity, Gilman emphasizes repeatedly that the ill are ugly and the healthy beautiful—melancholic patients, for example, had darker skin, and religious ecstasy was marked by bulging eyes. The duality of beautiful/healthy and ugly/ill has repercussions in several areas beyond the analysis of images of illness, not least in eugenics and the formation of racial stereotypes.

AIDS posters, reviewed in 1988, are also revisited, this time with a much larger sample. Gilman is surprised to find that poster images do not necessarily follow the dictum of illness/ugliness, health/beauty, and he tries nobly to find a compelling reason why. But because these posters are propaganda, designed to change behavior, they do not quite fit the general pattern of images of disease and illness represented in the fine arts. The artist creating the poster knows it will not be heeded if it shows the progress of the disease. There is little interest in truth or accuracy, only results, for the art of the poster has its own criteria.

For most historians of medicine, images are a relatively untouched source, and they have been used in different ways ranging from mere illustration to basic material for extensive analysis. In the simplest case there is no analysis or interpretation of illustrations that show medical progress, even though the selection of what is shown can be highly manipulative. Photographs, rather than engravings or lithographs, provide a second method of reinforcing meaning, but as is well known, photographs can also be framed to present a point of view and thus are not totally objective. Then again, as in studies such as those by Choulant on anatomical illustration, or by Holländer on medical caricature, images are considered as works of art rather than as representations of reality. Finally, images can be presented as evidence to be analyzed as a reflection of cultural fantasies about health and disease; often, what was not apparent even to the creator of the image is clarified through the work of the historian. Although all methods are valuable, Gilman stresses the need for an approach that combines elements of each, while stressing the analytical.

Ultimately, Gilman knows that his is not the only means of interpretation available, and he is disarming when he notes in his conclusion that “my readings make no claim to being exhaustive interpretations in any sense; I am not attempting to give the only (perhaps not even the best) examinations, but only my present take on each of these manifestations” (p. 173). His takes are often provocative, imaginative, and profitable nonetheless, and even though they may shift over time, they deserve to be considered by all who have an interest in the medical image.