When the Photograph Speaks: Photo-Analysis in Narrative Medicine

I am exhilarated and gratified that contemporary narrative pedagogy in medicine is making room for visual media as integral to our evolving understanding of the care of the sick. The pedagogical challenges of integrating visual and photographic theory with narrative medicine have lead to a deep questioning of the clinical and aesthetic complexities of narrative and image, creating new research questions and implications for practice. Leading the way, recent national and international research conferences have contributed to forging meaningful connections among photography studies, history of medicine, clinical practice, and visual art.¹ Participants in various forms of training in narrative medicine or humanities and medicine are more and more frequently invited not only to read and write but, as part of developing rigorous narrative competencies, to let images speak through acts of responsive attention. The powers of the image are fundamental to connections among our knowing (gnarus, a Latin root of narrative), telling (narro)², and desiring selves. They erupt at times with the velocity of sudden insight (“Aha! I see the connection now!”); at other moments, these powers emerge gradually, with the recognition that flights of thought benefit from the concretization and focus that visual artifacts and images provide.

Of course, photographic images do not speak in and of themselves, nor do they speak about an unqualified “real.” Looking is a way of thinking and narrating—and this itself is not news. Words give something to images when we contextualize them, make arguments about them, and treat them as “telling objects” by positioning them in larger storied worlds; reciprocally, images re-contextualize and give something back to words when we attend to photography’s visual codes as these overlap with narrative codes, such as frames, borders, focalization, and perspective.³

The project of re-conceptualizing empathy, as Maura Spiegel notes, implies “reckoning ourselves into the picture”⁴ of visual analysis and narrative analysis, paying continued reflexive attention to cognitive and emotional practices of “close seeing” as parallel processes to “close reading.” An understanding of viewing and reading as reciprocal practices further implies a multi-layered, multi-literate definition of narrative competence in medicine, one that requires, as Rita Charon asserts in Narrative Medicine, that we “dig deeply into the interior and aesthetic representation of seeing and representing visual images for others to see.”⁵ Taken to the fullest extent, such intertwining and overlapping connections between verbal and visual forms pursues narrative medicine to the very heart of representation and its capacity for cultural work.

Photography as a site for narrative inquiry is the thread I want to follow in this essay, considering some recently published (and a few not so recently published) photographic collections that address themes such as “re-conceptualizing empathy” and “witnessing” from the theory and practice of visual analysis. I want to propose ways that the flexible pairing of photographs with literary texts, a practice with deep roots in humanities traditions of teaching with ekphrastics,⁶ emphasizes the values of dialogue and expression in clinical practice and teaching. Along the way, I point to a few of the methodological challenges and opportunities of paying the same kind of rigorous attention to photographic texts that intentionally represent illness, suffering, and the medical encounter, that we conventionally give to literary texts.

I locate my interest in the visual world of narrative medicine in two related motives: first, in a desire to visually enrich a core medical humanities course I have developed in “Literature, Writing, and Worlds of Medicine”; second, in recognition of the need for “bridging” languages and concepts across disciplines, with the hope of achieving an authentic depth that exceeds the lip-service commonly paid to trans-disciplinarity, I work collaboratively with colleagues in bioethics, creative writing, history of medicine, and medical anthropology to design colloquia and curriculum in a public university program for students diversely situated in pre-professional humanities, health care, or pre-med tracks. In many ways, our work is just beginning. Our regional medical associations tell us they want medical students to be grounded in humanistic values and to bring a critical awareness of information literacy in their...