WEBVTT 00:00:01.730 --> 00:00:16.020 [Seeing Diseases: Visual Sources and the Meaning of History, Sander Gilman, Ph.D.] 00:00:16.560 --> 00:00:27.920 Dr. John Parascandola: Dr. Gilman, who took his Ph.D. in German from Tulane University, is currently Goldwin Smith Professor of Humane Studies at Cornell University. 00:00:27.920 --> 00:00:42.780 Now, he's also Professor of History of Psychiatry at the Cornell Medical College and at the same time he serves as Director of the Program of Jewish Studies and as Director of the Western Societies Program at Cornell University. 00:00:42.780 --> 00:01:04.130 Somehow, in spite of all that, he's managed to find the time to write and publish fourteen books, I don't mean edit, I mean write fourteen books with another one in press. He's also managed to publish sixteen volumes that he's edited, not to mention numerous scholarly articles. 00:01:04.130 --> 00:01:13.300 It's probably a relief for him to come to the library for the year and at least be able to give up some of those responsibilities and produce some more books. 00:01:13.300 --> 00:01:33.590 What he's doing with us this year at the library is a project for a book entitled "Freud: Race and Gender," in which he's looking at the development of psychoanalysis and the racial biology of the Jews as discussed in the medical literature of the late 19th and early 20th century. 00:01:33.590 --> 00:01:46.990 That's not what he's going to talk to us about today, though, he's going to talk to us about and interest he's had for a long time, which has to do with pictures or iconographic sources in history. 00:01:46.990 --> 00:02:09.960 He has written a number of books which you may be familiar with, for example, "Seeing the Insane: a Cultural History of Psychiatric Illustration," "Difference in Pathology: Stereotypes of Sexuality, Race, and Madness," and in 1988, "Disease and Representation: Images of Illness from Madness to AIDS." 00:02:09.960 --> 00:02:27.560 So he's had an interest for a long time in this question of images and their relationship to medicine. So it's my pleasure to introduce to you Dr. Sander Gilman. [Dr. Parascandola leaves the podium and Dr. Gilman approaches it.] 00:02:27.560 --> 00:02:43.210 Dr. Gilman: Thank you, ladies and gentlemen, for coming this afternoon. When John asked me to come and give a general talk at the National Library of Medicine, to sort of introduce myself to you all, and introduce you to my work, 00:02:43.210 --> 00:03:02.840 I thought that one of the questions which perhaps should be raised in the course of my stay here during this year is, in a sense: what is happening in the History of Medicine and its evolution, in terms of cultural history. 00:03:02.840 --> 00:03:19.210 My own role is indeed of someone who is very much peripheral to the mainstream of academic history, but someone whose work is becoming more and more important, and I don't flatter myself to say that it's because of my intelligence 00:03:19.210 --> 00:03:30.180 but only because of the fact that I tend to uncover sources that people normally don't look at, to fields ranging from anthropology through to the history of medicine. 00:03:30.180 --> 00:03:53.190 And my main interest, as John has pointed out, in the last fifteen to twenty years, has been visual sources. And today what I'm going to do is talk to you about how visual sources can be used in talking about medicine and medical experience as part of general culture. 00:03:53.190 --> 00:04:06.050 Now, the obvious question that one wants to as is: why bother using visual sources at all, aren't words more efficacious. And perhaps the answer is they are. 00:04:06.050 --> 00:04:28.890 But visual sources provide us with two things that verbal sources cannot. One, they provide us with an absolute set of culturally determined guidelines to the way that people have represented the world they've seen. 00:04:28.890 --> 00:04:41.850 It doesn't mean, of course, that the visual source mirrors the world. It represents the conventions by which the world is represented. Now why is that important? 00:04:41.850 --> 00:05:02.020 It's important because it's a vocabulary, a way of representing the world which is a shorthand, which is a specific historical set of icons or images tied to a place and a time. 00:05:02.020 --> 00:05:13.010 Is this the way the world really was? I can't answer that. Is it the way that people wanted to understand and see the world they were in? 00:05:13.010 --> 00:05:20.260 The answer is, of course, yes. Now what I want to do today with is you is, in a sense, work through a set problem. 00:05:20.260 --> 00:05:37.810 And I want to teach you, together with you, teach you how to see historically. Because you're doing it, and you're doing it every day, but because you're in the middle of history, you're not aware that you are doing it. 00:05:37.810 --> 00:05:50.890 And my example is, indeed, an example from the history of medical illustration. Medical illustration is part of the general history of illustration. 00:05:50.890 --> 00:06:13.820 And my problem is: how does culture and medicine as part of culture see and represent seeing people who are diseased, who are ill, and who, to use the broadest category, are understood as being different. 00:06:13.820 --> 00:06:33.710 My example, because it’s the field I know best, is taken from the history of psychiatric illustration. But I could, and will, based on the project I'm working on, do the same thing looking at patients suffering from somatic diseases. 00:06:33.710 --> 00:06:55.850 So don't take psychiatry as an anomaly, don't take psychological illnesses as atypical. Whoops, let's see... there we go. 00:06:55.850 --> 00:07:23.510 I want to begin in the 18th century with a work from general culture, and this is the last plate of William Hogarth's series of seven engravings, paintings and then engravings, on A Rake's Progress, first published in 1735. [Image of Hogarth's last in "A Rake's Progress" series, The Madhouse.] 00:07:23.510 --> 00:07:57.800 We find ourselves at the end of the story. William Rakewell has come from the country into the bad city, London, not Washington, and he's been exposed to all of the temptations that the city can give him, to gamblers and criminals to prostitutes, and he has fallen into that lowest of low states: madness. 00:07:57.800 --> 00:08:17.270 And what Hogarth is depicting here, looks, again, on the surface, because we're seeing it, for the moment, through 20th century eyes, as something which is arcane, which is antiquarian, and which, in a sense is nonrealistic. 00:08:17.270 --> 00:08:43.080 Now I want you to sort of step back and I want you to, with me, for a moment, think about this as a real image for the 18th century eye, but a real image not of the surface of Rakewell in Bedlam Asylum, but a real image of the entire society which leads people into the asylum. 00:08:43.080 --> 00:09:01.330 In other words, what Hogarth is giving us is a symbolic vocabulary by which to understand what creates madness, where madness is located, and how to identify madness. 00:09:01.330 --> 00:09:23.960 What do we see? We see a range of figures, and each single figure has meaning ascribed to it by its position, by the expression on its face, by the clothing it wears. [Image of Hogarth's The Madhouse.] 00:09:23.960 --> 00:09:44.690 Let's start, of course, with Rakewell. He's put in chains, without clothing, hand against his head, fingers clenched. Remember the hands, we'll come back to the hands. [Close-up of Rakewell's hands in The Madhouse.] 00:09:44.690 --> 00:10:08.670 Now that position, we would say it's torment, anguish, but one has to know, of course, is outside, on the portal of Bedlam Asylum, are two statues by Caius Cibber, and one of them, called Raving Madness, is precisely in this position. 00:10:08.670 --> 00:10:42.380 So outside the asylum, when you walk into the asylum, is indeed this image of raving madness. Rakewell is raving, he has been stripped of his senses and he is in a world in which everyone has been stripped of their senses, the religious maniac, my favorite, the mad professor, everybody has their favorites, scribbling his figures on the wall. 00:10:42.380 --> 00:11:07.300 And here, the individual love of mad. And again, mind the hands, look at the hands. Arms on knees in that position of melancholic madness. 00:11:07.300 --> 00:11:25.610 Each one of the figures means something, but you've also caught onto the fact that all of the figures represent aspects of that world outside the gates, and [?] Lichtenberg, 18th century German philosopher, 00:11:25.610 --> 00:11:46.270 who does a plate-by-plate explication of all of Hogarth's images, points out that, in point of fact, here in Rakewell's asylum scene we have the macro-bedlam, the world itself. 00:11:46.270 --> 00:12:01.210 Indeed, Lichtenberg says, "Not all the mad men are chained, and even the chains have their degrees." So the real image is the image of the world. 00:12:01.210 --> 00:12:17.490 The world in which every madness can be found and in which the asylum is simply an image, a mirroring of the whole world. Exaggerated but identifiable. 00:12:17.490 --> 00:12:35.460 Now, that idea of looking and seeing the symbolic implications exists within the medical or quasi-medical literature of the 18th century as well. 00:12:35.460 --> 00:13:06.710 In the 1870s, Johann Kaspar Lavater, a Swiss theologian, novelist, writer, publishes his physiognomy, and in his physiognomy, in the study of faces, he also presents, for our examination, plates of faces of people who are mentally ill. [Image of Lavater's plates with the faces of six older women.] 00:13:06.710 --> 00:13:31.270 Now, if Hogarth's argument is, the mentally ill are simply the normal exaggerated, for Lavater, his faces here of "six crazy old women," so the caption, Lavater wants to show us something quite different. 00:13:31.270 --> 00:14:02.710 He wants to argue that indeed there is a fixed physiognomy, a way to see that which, in a sense, is almost hidden under the skin. In terms of the form of the face, specifically in terms of the set facial features: the nose, the ears, the eyes. [Close-up of the each of the six faces.] 00:14:02.710 --> 00:14:14.850 This is a very different way of seeing the insane. If Hogarth argues we all are at risk, Lavater argues we know who is at risk. 00:14:14.850 --> 00:14:32.070 We can tell the distinction between the healthy and the ill because of the way it is written on their face. But you have to look, again, at the slide, and look hard. 00:14:32.070 --> 00:14:50.500 The obvious thing that we see is that, all of a sudden, that the world, the complex world of men and women which Hogarth gives us, is now, suddenly, a world which is very gender-specific. 00:14:50.500 --> 00:15:00.360 And indeed, if one counts up, and there are a number of plates like this, if one counts up in the physiognomy, who is represented as mad, they are overwhelmingly women. 00:15:00.360 --> 00:15:24.210 And it's a problem that we're going to have to face which is indeed, the old medieval equivalent of masculinity in rationality and femininity in irrationality, which comes here in a very specific context. 00:15:24.210 --> 00:15:44.930 The idea that there are set physiognomic forms. So we're, in a sense, almost adding on layer by layer. So we're going to see what the parts of the face mean, what gender means, but also there are things here which you see and, again, you don't see. 00:15:44.930 --> 00:16:01.990 This is very real for the 18th century; it represents a very real world. One of the things you're looking at is shading, a representation of color and skin texture. 00:16:01.990 --> 00:16:16.800 And one of the guidelines for the physiognomists in the interpretation that Lavater gives us is that, indeed, the melancholic is dark, is black. 00:16:16.800 --> 00:16:29.690 And it is indeed the blackness of the classical Greek humor of melancholia literally, here, written on the skin. 00:16:29.690 --> 00:16:54.730 Medicine looks at the externals, it looks at the signs and the symptoms written on the skin. So color of skin, gender, physiognomy all become ways of distinguishing between the healthy and the ill. 00:16:54.730 --> 00:17:06.150 Now, 18th century physicians had access to asylums, they don't always take advantage of it, but they have access to asylums. 00:17:06.150 --> 00:17:15.900 By the very end of the 18th and beginning of the 19th century, the number of physicians who have access to asylums begins to get more and more limited. 00:17:15.900 --> 00:17:31.400 And here we have a plate from one of the very first medical handbooks, and that's Vincenzo Chiarugi's handbook entitled "On Madness in General," which appeared in the 1790s. 00:17:31.400 --> 00:17:41.490 This is a plate which, again, is a very technical plate, it's a plate illustrating the use of one of the new, humane methods of restraint. 00:17:41.490 --> 00:17:59.810 Replacing those shackles that we saw in Hogarth's image, this is the English strait waistcoat. But look at the image, the image of the patient. [Image of person lying on a bed or padded table, restraints around wrists and ankles.] 00:17:59.810 --> 00:18:18.550 Isolated, look at the face, the use of shadows. Here we have the beginning, indeed, of a tradition which is medical, and not from the general culture. 00:18:18.550 --> 00:18:41.530 Which is technical, it is not used to teach moral lessons, as Hogarth, or indeed to make general points about the nature of the human being, as Lavater, this is a technical image, the sort of image we could well imagine seeing in contemporary textbooks. 00:18:41.530 --> 00:18:59.760 But it is also a set of images which represents isolation, control, which represents the patient, indeed, as the object of the physician's gaze, looking. 00:18:59.760 --> 00:19:15.310 We, because we are opening the medical textbook, share, with the physician, the ability to look at the patient. Now, this is a very technical image. 00:19:15.310 --> 00:19:32.870 Within the decade, Philippe Pinel publishes what is really the first textbook of psychiatry, 1801. And in that textbook, he provides us with a set of images. 00:19:32.870 --> 00:20:04.910 And I'm going to be interested, for the moment, in the two images here and here because it points, again, out the fact that this idea that there's a technical literature separate from the general culture is not only wrong but it leads us then to make general assumptions about the isolation of the way physicians see from the way the world wants them to see. [Drawings of people in profile from Pinel's textbook.] 00:20:04.910 --> 00:20:29.210 Pinel is interested in the fact that one can do a differential diagnosis between what he describes as "continuous madness," the figure on the bottom, the idiot, and what he views as "sporadic" or "periodic" madness, the maniac. 00:20:29.210 --> 00:21:10.500 And he explains it in the most fascinating way. What he does is to compare the size of the skull and also, implicitly, the physiognomy of the idiot to the body size and he comes to the following conclusion: that the maniac, in his proportion and in his physiognomy is, and I'm quoting, "closer to the ideal proportions of the Apollo Belvedere than is the idiot." 00:21:10.500 --> 00:21:28.750 So one of the things that is important, then, in distinguishing the healthy from the ill, the inherently pathological from only the sporadically pathological, is, in point of fact, beauty. 00:21:28.750 --> 00:21:47.800 And now we can go back and think about the images we've seen up until now. Illness is indeed ugly. It is ugly in terms of its physiognomy, and the ugliest of the ugly is the old woman. 00:21:47.800 --> 00:22:00.530 So we're setting up a whole set of grids in the way that we are learning to see, and see very much the way physicians were taught to see, and, by the way, they are still taught to see. 00:22:00.530 --> 00:22:18.970 There was an excellent study that was done about four or five years ago which evaluated mainly residents’ responses to what are "good patients," good patient meaning a patient that will obey the rules. 00:22:18.970 --> 00:22:27.660 And who, surprise, surprise, was at the top of the list? Young, attractive women. And who was at the bottom of the list? 00:22:27.660 --> 00:22:46.000 No surprise at all, older women, and men were in between. Beauty becomes a quality indeed of seeing, hence seeing health. 00:22:46.000 --> 00:23:00.850 The middle figure, by the way, just to mention in passing is Victor, the wild boy of Avignon, an example, indeed, of an almost intermediate stage. [Close-up of Victor's profile.] 00:23:00.850 --> 00:23:19.000 The experiment with this young boy attempted to turn him from being a wild boy into a member of society, unsuccessfully, but the idea was that he was, indeed, educatable. 00:23:19.000 --> 00:23:44.960 The beginning of the 19th century saw a tradition which, again, we've seen with Hogarth, maintained. Which is the idea that madness is associated with ugliness, but even more so here, we're going to simply continue this vocabulary, with "the beast within." 00:23:44.960 --> 00:24:05.960 This is an image from Sir Charles Bell, one of the great physiologists of the 19th century, an amateur artist of some competence. An illustration that he made for his essays on the anatomy of expression, published 1806. [Image of muscular, beastly-looking man with unruly hair and beard and a wild expression.] 00:24:05.960 --> 00:24:26.600 Bell's book is important for us, because it is a book written for artists, as, by the way, many anatomies were, and it's a book which explains to us why artists would want to represent madness. 00:24:26.600 --> 00:24:44.300 And he argues that when portrayed, the insane with a moral aim, to show the consequence of vice and the indulgence of passion, very much the same argument, indeed, of Hogarth and the Rake's Progress. 00:24:44.300 --> 00:25:22.730 But what are we looking at here? We're looking at the beast, brutal face, narrow, piercing eyes, bright red hair, from his description, his hands shackled, but also, again, remember I said to remember where the hands were and how they were held. Here it becomes very obvious that the position of the hands, which seems so incidental to us, has, indeed, meaning. [Image of muscular, beastly-looking man with unruly hair and beard and a wild expression.] 00:25:22.730 --> 00:25:38.330 The meaning, indeed, is a very old one, it goes back to the biblical image of those who refuse to work with their hands and who eat the bread of inequity. 00:25:38.330 --> 00:26:13.260 The insane as those unwilling or unable to take part in the world, unwilling, unable to work. So the hidden hands have a very specific significance. This is a British image, and the more I look at that image, and the more I read that description, it's very clear what the model is that Bell is giving us. 00:26:13.260 --> 00:26:35.660 It is the British fantasy of the early 19th century Irishman. All of these images reflect on the world in which these people find themselves, in ideas of difference which dominate the culture in which they are to be found. 00:26:35.660 --> 00:26:43.350 In the course of the 19th century, a number of different theories about madness and about seeing madness evolve. 00:26:43.350 --> 00:27:05.550 And certainly one of them that has great and important consequences is almost the counterpoint to Lavater's physiognomy, and that is the development of phrenology by Franz Joseph Gall at the beginning of the 19th century 00:27:05.550 --> 00:27:17.320 and applied to the study and treatment of the mentally ill by his collaborator, and the man who, by the way, coined the term "phrenology," Johann Gaspar Spurzheim. 00:27:17.320 --> 00:27:33.410 Spurzheim, like Gall, was driven out of Vienna. Spurzheim wound up in London, where he, in 1817 published a handbook on madness entitled "Observations on the Deranged Manifestations of the Mind." 00:27:33.410 --> 00:27:53.900 And for Spurzheim, as for Lavater, it was indeed the fixed structures of the body. Here, very much the shape of the skull which determined whether one was mad or not. [Images of children's profiles with enlarged skulls.] 00:27:53.900 --> 00:28:18.640 Now, here we're getting into an interesting area which is the absence of a distinction between mental retardation and mental illness. The cases, clearly, that Spurzheim are bringing are cases in which one might well assume that one is dealing with some form of hydrocephaly. 00:28:18.640 --> 00:28:48.690 Why is it that these are, in a sense, all put together? One of the reasons -- there are many reasons -- but one of the reasons is, in point of fact, that here you have a set of images in which there is indeed an absolute relationship between the form of the body, here size and structure of the skull, and a very specific form of describable mental illness, here mental retardation. 00:28:48.690 --> 00:29:25.160 This is true, by the way, equally true in the images of people suffering from various forms of [?]. These become keys to the way that mental illness is understood as a reflex of the body. And, as with Lavater, we are focusing very much here on the face, on the head, on the skull, on fixed structure, not on the fleeting moments of expression. 00:29:25.160 --> 00:29:47.210 High science of the early 19th century, high medical science, and phrenology is not high medical science, as much as people like Combs would like it to be, high medical science, such as the work of Esquirol in Paris, simply assume that we can see mental illness. 00:29:47.210 --> 00:30:02.430 And Esquirol does something that is phenomenal. He publishes a two-volume handbook and appends to it an atlas. An atlas, that's the word. Now what is an atlas? 00:30:02.430 --> 00:30:18.680 It's a collection of maps to show you how things are, where they're to be found...here, melancholia. Look at the hands, look at the shading on the face, look at the isolation. [[Image of woman looking down and to the side, arms folded, profile shaded darkly.] 00:30:18.680 --> 00:30:41.390 Except for two of the sixteen plates, all of his patients were women, and indeed the image of madness by the 1830s becomes the image of the melancholic female. 00:30:41.390 --> 00:30:55.850 The idea of an atlas, an atlas which captures both movable and fixed physiognomy is something which, today, we cannot even understand. 00:30:55.850 --> 00:31:09.910 Because mental illness is understood, today, as something separate from physiognomy, but certainly not for the early 19th century. 00:31:09.910 --> 00:31:49.780 The British psychiatrist, alienist Alexander Morison, publishes what is most probably the largest atlas in the 1850s. His physiognomy of mental illness has 98 plates and again focuses, as Esquirol's does, on both fixed and movable physiognomy. [Image of frowning, disturbed person, lips open and teeth clenched, face discolored, shoulder exposed.] 00:31:49.780 --> 00:32:12.670 This is a real image. It's real in a sense that the physician could learn to see his patient's anomalies, could distinguish between categories of mental illness and between mental illness and normal states by looking. 00:32:12.670 --> 00:32:34.510 There's virtually no text in Morison's case, it's not appended to a monograph. It is a series of images which virtually stand alone. Now, again, this is realistic. But it's realistic in early 19th century terms. 00:32:34.510 --> 00:32:43.580 But you and I know they're not real, they don't look real at all. They're schematic. 00:32:43.580 --> 00:32:49.640 How do we make them more real? One way we do it is we add color. 00:32:49.640 --> 00:33:02.600 Karl Heinrich Baumgartner in the 1840s present another handbook of images. It has these images hand-colored. 00:33:02.600 --> 00:33:13.520 So we look again at the face, but we can also look at what's not there. The hands have vanished, as they have in Morison's. [Head and shoulders image of woman with narrowed eyes and slightly hooked nose, lips pursed, looking sideways, wearing a bonnet with strings hanging down. Hands cannot be seen.] 00:33:13.520 --> 00:33:50.210 And the absence of the hands, the focus on the face, it has two meanings. Again, we are layering this. We are slowly but surely seeing a set of symbolic references, here monomania, everything from position of the head, focus of the eye, skin color, the realism given to us by color. 00:33:50.210 --> 00:34:09.000 But again, we say because we're used to MTV, this is not real. This is simply a colored lithograph. It's an image which, by its very nature, by its very structure, is unreal, is symbolic. 00:34:09.000 --> 00:34:24.760 Anybody can create an image in which the vocabulary has meaning if, in point of fact, they are doing it themselves. It's not representative of the real world. 00:34:24.760 --> 00:34:38.690 But, of course, by the 1850s, we have a technological breakthrough that gives us the real world... or does it? 00:34:38.690 --> 00:34:54.660 This is from a set of photographs by Hugh Welch Diamond. Diamond is the director of a women's asylum in Surrey. [Photograph of seated woman, hands in her lap, hair stringy, bonnet askew, eyes cast down.] 00:34:54.660 --> 00:35:18.480 He is also an amateur photogrpaher, the first generation of photographers, a friend of Lewis Carroll’s, and somebody who is extraordinarily interested, as many physicians were, in what photography, the real representation of the world, would mean for medicine. 00:35:18.480 --> 00:35:33.970 So Diamond begins to photograph his patients. By the middle of the 1850s he takes, well, I found about a hundred and ten, but there are probably many more, photographs and he's not alone. 00:35:33.970 --> 00:35:53.910 Many of the asylum directors are photographing their patients. But Diamond does something which is very unique in the 1850s, which is that he holds a paper at the Royal Society on why he's doing it, and he discusses three things. 00:35:53.910 --> 00:36:08.430 First of all, he discusses the fact that these photographs are useful in therapy. I find that very interesting, that for the first generation of people who had never seen a photograph, could never have seen a photograph, 00:36:08.430 --> 00:36:25.620 it was a sort of a shock effect, they saw themselves as crazy. Now that means they saw themselves as crazy, which means they understood the vocabulary of what it meant to look normal and look crazy, and they were cured. 00:36:25.620 --> 00:36:42.830 They looked at themselves and they were cured. And I, by the way, don't doubt that initial impact, if you read letters describing peoples' first reactions to a photograph, especially a photograph of themselves, it's extraordinary. 00:36:42.830 --> 00:36:49.660 No one had ever seen themselves before, remember that when you see yourself in the mirror it's always backwards. 00:36:49.660 --> 00:37:08.730 No one had ever seen themselves. The second thing that Diamond says is, "Hey look, all these people are wandering the countryside and always coming in and out of asylums, this is a great way of keeping records." 00:37:08.730 --> 00:37:11.440 Not wrong. 00:37:11.440 --> 00:37:30.810 And the third thing that he says, and here's where, again, the idea of a tradition of seeing becomes very important, he says, "From these images, we can learn the essence of madness. We will be able to see the real physiognomy." 00:37:30.810 --> 00:37:51.350 Now, this is quote-unquote real, but we know that it's posed, and has a very, very long exposure time, so the maniac, like Tom Rakewell, can't be photographed. 00:37:51.350 --> 00:38:03.420 The positions in which these patients are photographed are indeed the positions of the portrait and of the portrait photograph. 00:38:03.420 --> 00:38:25.560 They are meant to be highly stylized representations of patients. Patients suffering from very specific and recognizable syndromes. 00:38:25.560 --> 00:38:43.290 This is a very powerful argument, that, indeed, the insane represent themselves, through their physiognomy, in a way that is identifiable. Identifiable as what, though? 00:38:43.290 --> 00:39:13.480 And here we have, again, a fascination with difference, with images of difference. This is from the first periodical devoted solely to images, photographic images, mainly images of the mentally ill. 00:39:13.480 --> 00:39:35.290 It is called the "New Iconography of the Salpetriere,” the great hospital in Paris. It is a periodical which presents, over more than a decade, hundreds, indeed, thousands of photographic images. 00:39:35.290 --> 00:39:52.280 And that's what is so striking about the end of the 19th century. The end of the 19th century becomes an age in which mental illness is to be seen. 00:39:52.280 --> 00:40:12.540 If a portrait of the physician reveals the physician to be morally upright and intelligent, as, of course, all portraits of physicians will do, then a portrait of the patient will reveals the patient's illness. 00:40:12.540 --> 00:40:31.300 Jean-Martin Charcot, who was director of the hospital of Salpetriere in the 1860s on until his death in the 1890s, is so convinced of this that he employs, for the first time anywhere, a director of photography, a man name Albert Lund. 00:40:31.300 --> 00:41:03.000 And Lund spends his career photographing the patients in the Salpetriere and they learn to be photographed. They learn how to look so that Lund and Charcot can see, have images of precisely those aspects which prove their theories of mental illness. 00:41:03.000 --> 00:41:27.350 And here we come to an interesting problem, because up to now we've been saying, "hey look," when we look at Hogarth and we look at the sketches and engravings up to the end of the 19th century, we're looking at fantasies about mental illness. 00:41:27.350 --> 00:41:44.820 The photograph changes that. Because you have someone who's being photographed and who is responding to being photographed. It becomes part of the process of illness. 00:41:44.820 --> 00:42:11.910 And we have a change, then, by the end of the 19th century. A change in which the object seen is no longer passive, and that's not clear to people like Charcot, but rather takes part in the active generation of images. 00:42:11.910 --> 00:42:38.490 Now, that tension between the way the world is seen and the way the world represents itself as being seen is one which appears in an interesting way in one tradition which I want to trace with you in a series of images. 00:42:38.490 --> 00:43:03.130 And it's a tradition which we actually have been tracing all along, because we've been talking about the position of hands, and if you remember the Hogarth slide, and if you remember the sufferer from love madness, from melancholia, sitting on the stairs, you will recognize this next image. 00:43:03.130 --> 00:43:20.800 This is Vincent Van Gogh, end of the 19th century, it is, indeed, the image of old age and of despair in the classic position of melancholia. [Image of an older man with gray hair, partially bald, seated in a chair, bent over with his face in his hands, clothes frayed.] 00:43:20.800 --> 00:43:36.250 Durer’s Melancholia is perhaps the best known image, but I wanted to start at the end of the 19th century because one of the things that is important about body position and its symbolic significance is that it does change over time. 00:43:36.250 --> 00:43:55.940 Here, the old man, at the end of his life, who can no longer work, is represented in a tradition, which is a tradition of mental illness. 00:43:55.940 --> 00:44:38.120 And to point out that Van Gogh was quite aware of what he was doing, I'll give you a parallel image, and this is his image of sorrow, the pregnant prostitute, also cast out from society, having no function in society, in a position which we, because, indeed, we are attuned to this vocabulary of body position, we read as melancholia, depression, sadness. [A naked woman sits on a mattress on the floor, knees pulled up, arms crossed and resting on her knees, head bent and face hiddne, pregnant belly protruding and long dark, unkempt hair flowing down her back.] 00:44:38.120 --> 00:44:51.200 Now, I want to change the venue. I don't want to talk about mental states, I want to talk about somatic illness for the moment. 00:44:51.200 --> 00:45:21.540 And I want to take us back to the very, very beginning of the 16th century, one of the first broadsides to discuss the new disease, the new plague, the French disease, the German disease, the Portuguese disease, the Jewish disease, the disease which, about forty years after its presence in Europe, comes to be called syphilis. 00:45:21.540 --> 00:45:47.350 Here we have an image, a biblical image, the image of Job being tormented. The syphilitic as Job, the mournful, melancholic Job sitting, elbow-on-knee, in the classic position of melancholia. [Image of man seated on rock, elbow on knee, chin resting in hand, sores on his body.] 00:45:47.350 --> 00:46:01.370 Now wait a minute, syphilis isn't a mental illness. Why evoke state of mind in the 16th century if you're talking about the body? 00:46:01.370 --> 00:46:17.990 And the body here is clearly marked, clearly marked. What is the relationship between body and mind? 00:46:17.990 --> 00:46:42.140 This is a poster from the First World War. It is a warning to Belgian soldiers not to consort with women of easy virtue, because if they do, what will happen to them? [Poster with soldier's face above tombstone which is engraved with instructions to the soldiers, a skull at the bottom, a woman embracing a soldier on the left and on the right, a soldier sitting on a bench with his hands on his knees.] 00:46:42.140 --> 00:47:11.280 They will become ill, unable to fulfill their obligations to their country, in the position of illness, of somatic illness, of le syphilis, is again, the position of melancholia, of depression. 00:47:11.280 --> 00:47:31.660 This is a page from an article which appeared in September 1986, in the popular scientific Journal Discover. It's a peculiar article, a very peculiar article, because it tends to -- well, let me just quote its subtitle. 00:47:31.660 --> 00:47:57.350 In 1986, the subtitle of this article is, "Still No Reason For Hysteria," and it's an attempt to counter the fear in 1986 that some of us had that AIDS was already, in '86, becoming a danger to everyone, to heterosexuals as well as gay men. 00:47:57.350 --> 00:48:14.510 Now, this image, again, evokes the image of mental illness. The person suffering with AIDS becomes indeed the person despairing. [Close-up of page from article, with text in two columns and images between the columns, including a person seated with elbows on knees and head in hands.] 00:48:14.510 --> 00:48:28.150 Physical illness and mental illness become elided in this image, and it's a powerful image. It speaks to the association of two forms of stigma. 00:48:28.150 --> 00:49:05.860 But what is being evoked here, in this image, is, indeed, our heterosexual illusions about AIDS. And yet today, we can look back and see how powerful such an image was in generating an image of a person with AIDS as doubly stigmatized. 00:49:05.860 --> 00:49:19.290 A year later, in Newsday, there's a full-page article, which, again, I want to point out the tensions, is pointing out exactly the opposite. [Newspaper article with multiple photos.] 00:49:19.290 --> 00:49:41.710 Here, we have those categories of people who suffer from AIDS, this is 1987. We have the family exposed because of the contaminated blood supply, nurturing, holding, caring. [Image of man, woman, and two children on their laps.] 00:49:41.710 --> 00:49:51.580 We have the IV drug user, a little bit hard to see, but he's covered with Kaposi’s sarcoma. [Image of a man who appears ill, multiple bottles of medication on a table in front of him.] 00:49:51.580 --> 00:49:57.160 As in the image from the 16th century, the disease is literally written on his skin. 00:49:57.160 --> 00:50:05.410 And we have two gay men, we'll use that image, and blow it up a bit for you. 00:50:05.410 --> 00:50:32.800 It is indeed our image of a melancholic, confronting his illness but evoking that position. Now, Peter Gay, about 15 years ago, published an essay about the incidental iconography of the photograph. [Image of dark-haired man with glasses, mustache, and beard, seated with his elbows on thighs and hands clasped between knees.] 00:50:32.800 --> 00:50:43.280 I want to argue a bit against Gay and the problems of using this material in terms of a historical record. 00:50:43.280 --> 00:51:07.000 Assuming that one has a wide range of possible visual sources, and certainly picture editors in magazines and newspapers have wide ranges, what is it that the picture editor wants to evoke by selecting a specific image or set of images, we've had a number of them. 00:51:07.000 --> 00:51:19.950 There may, indeed, be a certain accident to how a photograph is composed, and I will not disagree with Gay on that. 00:51:19.950 --> 00:51:45.030 But the selection of photographs places those photographs within this vocabulary that I've been sketching. A vocabulary which is, indeed, one of attempting to represent difference, and attempting to represent disease. 00:51:45.030 --> 00:52:09.220 Now, I argued in the general history of representing mental illness with the photograph, one gets the individual being photographed responding, being part of the system, and I want to argue that this also happens with the iconography of AIDS. 00:52:09.220 --> 00:52:27.970 When, indeed, when we begin to look at the imagery generated by the gay artistic community, that one of the sets of images that gets incorporated is, indeed, this image of melancholia. 00:52:27.970 --> 00:52:36.780 I want to use a set of images because I think they're very powerful images by the West Berlin artist, Salome. 00:52:36.780 --> 00:52:57.120 These were all painted in 1989 and appeared in a show of AIDS art which was in West Berlin in that year. This is a very unusual set of images for Salome, his images are usually much more abstract. [Painting of four men, each wearing a different color shirt. One of them kneels, touching a nude prone figure. Three stand nearby. One looks down, hands hanging in front of him; one glances upward, hands almost in a praying position; the third gazes upward, fists clenched.] 00:52:57.120 --> 00:53:32.980 But they, indeed, evoke a gay response to the iconography, the blending, the melding of the iconography of melancholy, of depression, of mental illness. The positions are indeed the classical positions evoked by an artist who knows the classical positions. 00:53:32.980 --> 00:53:57.320 They are, however, within a context of caring, of support, and, indeed, provide a counter-valence to the images of isolation that we've seen up to now. 00:54:03.270 --> 00:54:19.160 I've made no distinction this afternoon, and do not want to make a distinction between the vocabulary of images evoked within the general culture and within the medical culture, which I believe is part of the general culture. 00:54:19.160 --> 00:54:38.570 These images move, without any problem, from one world to the other. They affect those who are represented and they affect those of us who are anxious about where we stand. 00:54:38.570 --> 00:55:06.980 Whether we are to be represented, or whether we are to gaze at the image, isolated from it and safe from it. The history of depicting disease can give us, then, a vocabulary, a historical vocabulary, of talking about how disease is understood, how disease is internalized. 00:55:06.980 --> 00:55:37.140 And maybe, now, when we look at images, those images which are generated in our world, we might be more aware of the vocabulary that we employ, and the vocabulary that we evoke when we both look at and generate images of illness and disease. 00:55:37.140 --> 00:55:43.680 I thank you. [Applause] 00:55:43.680 --> 00:55:56.910 [Produced by: The National Library of Medicine Bethesda, Maryland 20894, 1990]