Contested Images

The challenges of visualizing a pandemic

Traditionally, plagues were named by the marks they left on the body: smallpox, bubonic plague (after the inflamed lymph nodes known to the Greeks as “buboes”), yellow fever (after the jaundice which accompanied the fever). Before our understanding of microbes, the body was not just the site onto which the disease was inscribed; it was literally the only surface in which the disease could be read, and no plague was real until it demonstrated regular, visible signs on the body.

With modern epidemiology, we’ve gradually moved to naming diseases not for how they look but for what they do: Acquired Immunity Deficiency Syndrome, Sudden Acute Respiratory Syndrome. But even with AIDS, it took a visual reference, one that marked the body, to make the disease real to the general public. Kaposi’s sarcoma, an opportunistic cancer that had been all-but-unheard of before the emergence of AIDS, became its iconic signature. Not everyone who had AIDS developed Kaposi’s sarcoma (initially, only half of AIDS patients had KS, and within two years that number had fallen to 20 percent), but to have the disease signified that one had AIDS. When Benetton’s Colors magazine ran a satirical piece reporting Ronald Reagan’s death from AIDS, they illustrated it with a doctored picture of him bearing the telltale lesions.

No plague was real until it demonstrated regular, visible signs on the body. There is no single visual symptom that defines Covid-19

These physical markers are more than just symptoms; they are the means by which we conceptualize the disease into discursive space. Judith Butler, revising Foucault’s formulation that the body is a site on which meaning is generated, argues that the body “is not a site on which construction takes place; it is a destruction on the occasion of which a subject is formed.” Which is to say, the disease is brought to life through its visible destruction of the body.

But Covid-19, as its name implies, has neither a physical marker nor a defined etiology. Technically, it’s a variant of SARS, but is often neither “sudden” nor “acute,” which helps explain a name that’s far more generic, simply an abbreviation of “Coronavirus Disease discovered in 2019. Its symptoms are varied and still poorly understood, even in the medical community, creating an uncertainty that’s been magnified exponentially by misleading, contradictory and self-serving statements and directives from politicians. Perhaps most importantly, there is no single visual symptom that defines the disease. The closest thing to a specific symptom yet identified — a loss of the sense of smell or taste — has nothing to do with outwardly visible signs at all.

None of this is to say that the disease is not viscerally apparent to its sufferers or their loved ones, or to the healthcare workers on the front lines of fighting it. Nor is it to say that none of the potential symptoms are visibly apparent (the CDC lists, for example, “bluish lips or face” as an emergency warning sign). But none of these are unique, stigmatized and easily recognized signs of the disease. And in the absence of a visible stigmata like KS, the only visible marker is a wildly imperfect and misleading one: the mask.

In the absence of any physical markings on the body, the mask is the only visual hallmark we have that the disease exists. And while wearing a mask denotes a desire to slow the spread of the disease, and everyone is advised to wear one outside (not just those who’ve tested positive or have been exposed), they’ve become politically contentious, precisely because of the supposed stigma they convey. The right-wing protests against wearing masks are motivated by many things, but at least a part of it is a fear that to wear a mask is to have one’s body marked by the disease.

This would not be the first epidemic that complicated the visual record. Influenza doesn’t have the same striking visual markings on the body as other diseases, and flu outbreaks have often confounded our ability to correlate visual images with the illness. Writing in Art in America, Aubrey Knox describes how this problem played out in 1918, when cities initially struggled to depict this invisible killer. “Pictorial records of the Spanish flu,” she writes, “relatively scant by today’s standards, suggest a public vacillation between bravado and horror.” Public health officials posted announcements about the disease and urged people to wear masks, but the graphic effects of the disease on the body (most notably, cyanosis, in which a severe lack of oxygen turned the skin entirely blue) were kept from the public eye. Unfortunately, this strategy did little to slow the spread. In time, public health images were complemented by newspaper photographs of overflowing, freshly dug mass graves, and other evidence that the public health system had been overwhelmed. A full page spread from a Philadelphia newspaper at the time reads “Preparing to Bury City’s Dead” across the top, displaying a group of laborers digging trenches for mass burial, along with a photograph of embalmed corpses, and another captioned “Row after row of unburied dead.”

The Philadelphia photographs do not convey the effects of the flu on the physical body (the corpses in the photographs not explicitly visible); instead they illustrate both the scope and the speed of the virus through the rise of temporary infrastructure: the ad-hoc morgue and the mass grave. Other photographs from that time tend to be of similar, temporary structures: emergency wards and makeshift hospitals. A widely circulated collection of images from National Museum of Health and Medicine, Armed Forces Institute of Pathology show a series of emergency hospitals and converted barracks, from Camp Funston, Kansas to Aix-les-Bains, France, each with rows of cots, makeshift dividers between patients, and masked nurses.

The right-wing protests against wearing masks are motivated by many things, including a fear that to wear a mask is to have one’s body marked by the disease

In the absence of marks on the body itself, the Spanish flu photographs show the marks on the body politic. These images can only show the scope of the pandemic to the extent that it has overwhelmed existing infrastructure, and in as much as they document the Spanish influenza, they also document the public health and policy failures that exacerbated the crisis. (The need for mass graves in Philadelphia, after all, stemmed from that city’s notorious decision to go ahead with a Liberty Loans parade that spread the virus to thousands of spectators.) These images of temporary architecture provide a topographical representation of the disease — the lesion on the city itself.

As the Covid-19 crisis in New York City has spiraled out of control, the temporary field hospitals set up in Central Park, the refrigeration trucks as temporary holding spaces for bodies too numerous to be processed by funeral homes, and the medical ship USNS Comfort all seemed poised to occupy that visual space: striking and anomalous presences that give a material weight to the pandemic. As with Philadelphia’s mass graves, such interruptions were double-edged, making real both the disease’s seriousness and the failure of government to take it seriously. But even so, their impact was short-lived: the Comfort left New York after barely a month, treating only 182 patients, and the Central Park field hospital has also closed down. As the curve is flattened and we settle into the long duration of the crisis, it seems that we will not have these easy visual referents to point to as evidence of the pandemic.

The locus of the tragedy has returned to existing hospitals, their existing infrastructure no longer strained. And while this signals a short-term success, it also heralds a return to the invisibility of the virus. The real site of the Covid-19 crisis remains the interior of the hospital — a place that has largely been placed off-limits to photojournalists.

Much of this has to do with patients’ privacy rights and restricted access to hospitals, which are not public spaces. But as Lauren Walsh, director of the Lost Rolls America archive and author of Conversations on Conflict Photography, notes, historically, American media has tended to show more “visuals of faraway suffering rather than photos that display our own suffering, particularly when it comes to graphic images and pictures of the dying and dead.”  Despite prolific recent visual coverage of wars in the Middle East, victims of famine in Yemen, or sufferers of diseases like Ebola, she suggests, there’s a squeamishness with looking at pictures that “hit too close to home” — and this may be the case with Covid-19, too. When explicit images of Americans suffering do get circulated, online and in the media, they tend to be more often than not marginalized populations: Black victims of police violence, or gay men dying of AIDS.

Squeamishness aside, some have argued that a visual record may be ultimately vital for understanding the devastation that Covid-19 has wrought. Sarah Elizabeth Lewis, in an op-ed for the New York Times, lamented the lack of visualization of the current crisis, and in particular the lack of images from inside the hospitals that have become the de facto plague wards in America. It is a lack, she claims, that has hampered our ability to empathize or even understand fully what we’re facing. “Images force us to contend with the unspeakable,” she writes. “They help humanize clinical statistics, to make them comprehensible.”

Bureaucratic incompetence, politicized suppression of numbers, and failure of an overwhelmed medical infrastructure have left grieving families fighting for recognition

In their absence, a different kind of image has become the hallmark of Covid-19: the photograph of the empty street. First in a series of photo-essays out of northern Italy, this soon became the means of documenting the extent of the crisis: not by visibly marked bodies but by the absence of any bodies whatsoever. In a series by Marco Di Lauro for Getty Images, empty shopping malls and plazas predominate, and the few figures seen crossing the Piazza del Duomo are dwarfed by the gothic cathedral in the background.

The images convey a sense of desolation, but only to a point, and the accompanying captions are crucial to anyone not already familiar with these locations. One photo, of a city sidewalk with a few squat housing blocks in the background, and a solitary figure making his way down the street, is augmented by a line that explains: “Roads and squares in the Bicocca University neighborhood usually full of hundreds of university students are seen empty on February 26, 2020 in Milan, Italy.” Without the context, it could just be a remote suburb, or early enough on a weekend morning that everyone is still asleep.

The pox and the emergency ward, the two usual ways of visualizing a plague, have been replaced instead with the mask and the empty street. Both of these are images of absence: the absence of visible, marked skin behind the mask, and the absence of normal urban density. And as the presence of absence, they remain relatively unstable in their ability to convey meaning.

In the wake of social media and easily manipulated images, the ability for a single image to speak in a straightforward and uncomplicated manner has vastly diminished. The rise of Truthers who maintain that documentary images signify exactly the opposite of what they appear to show (be it the World Trade Center collapse or the Sandy Hook shootings), and the ability of hoaxers to spread viral images during catastrophes (sharks swimming in the New York Stock Exchange during Hurricane Sandy) has made it almost impossible for a photograph to convey a single, unequivocal message. Any simple correlation between an image and its truth is shattered (if it ever existed at all), and the image of the disaster no longer has any real capacity to shock a population into awareness, let alone empathy.

If the mask is the closest marker we have to an objective, undeniable presence of Covid-19, to refuse this unique identifier is to refuse the plague altogether

Covid-19, you could say, does not belong to the previous category of pandemics from the Black Death to AIDS, as much as to a more recent group of maladies: diseases like Chronic Fatigue Syndrome, Gulf War Related Illness, and Chronic Lyme Disease — sometimes classed as “Contested Illnesses,” ailments that are not immediately visible to the medical gaze but which are experienced as real by their sufferers nonetheless. They are diseases which, in Joseph Dumit’s words, “you have to fight to get,” those which require arguing with doctors until a positive diagnosis is achieved (or turning to alternative medical practices for treatment).

Invisible and at times elusive, Covid-19’s symptoms are varied and sometimes unrecognizable, and its reach is subject to constant political revision. For every documented death accompanied by a positive diagnosis, there are an unknown quantity of deaths at home, deaths of Covid-19 that did not include a positive diagnosis, deaths by opportunistic diseases complicated by undiagnosed Covid-19. This combination of bureaucratic incompetence, politicized suppression of numbers, and failure of an overwhelmed medical infrastructure, has resulted in grieving families left having to fight for recognition that their loved ones’ deaths were due to Covid-19. It is a disease marked as much by absence as presence: the absence of tests to detect pathogens in the body, the absence of medically recognized vectors or symptoms clusters, the absence of a positive diagnosis, the absence of insurance reimbursement for treatment.

In such a contested space, there is a newfound political power in denial. David Abrams, a clinical psychologist and professor of social and behavioral science at New York University’s School of Global Public Health, argues that people refusing to wear masks may be in part acting out of a refusal to admit that they’re frightened by this new, invisible enemy (“Putting on that mask is about as blatant as saying, ‘Hey, I’m a scaredy cat,’’ he told CNN), as well as an attempt to deny the reality of the moment: “If everybody started wearing masks, suddenly, the old way of life is gone. You’ve suddenly admitted that this is the new normal. But you don’t want to believe that.” The maskless face has become its own kind of terrible signifier, of a community bonded over their refusal to believe in the invisible menace all around them, forging a social bond in a time of uncertainty and anxiety. If the mask is the closest marker we have to an objective, undeniable presence of Covid-19, to refuse this unique identifier is to refuse the plague altogether.

We seem to be torn; on the one hand, there are those struggling to find some way to manifest the scope of the tragedy — the cover page of the Sunday, May 24, 2020 issue of the New York Times lists 1,000 victims of the Coronavirus in a sobering rollcall that takes up the entire front page and two more inside. Such strategies are, for now, at best provisional (the Times lists only one percent of the total, and thus can’t convey the staggering weight of the loss of life) and will require a constant reimagination and revision.

On the other is a segment of culture who seem to think that by refusing such visualizations, they can make the disease disappear altogether. This kind of magical thinking, of course, still leaves these individuals acutely vulnerable.

Colin Dickey is the author of, most recently, Ghostland: An American History in Haunted Places, and the forthcoming The Unidentified: Mythical Monsters, Alien Encounters, and Our Obsession with the Unexplained.