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Sociology of Health & Illness Vol. 24 No. 6 2002 ISSN 0141–9889, pp. 856–872
Barbara
Using
visual
Harrison
methodologies
in a sociology
health and illness
Blackwell
Oxford,
0141–9889
2002
0
1
24
Original
Sociology
SHIL
©
00
Blackwell
UK
Article
Science
ofPublishers
HealthLtd
& Illness
Ltd/Editorial
Board of
2001
Seeing health and illness worlds – using visual
methodologies in a sociology of health and
illness: a methodological review
Barbara Harrison
School of Social Sciences, University of East London
Abstract
This review starts from the premise that the visual has been, until
recently, a neglected dimension in our understanding of social life,
despite the role of vision in other disciplines, including medicine
itself. The potential for a visual approach will be analysed drawing
on a range of studies, broadly within the sociology of health and
illness, which have used visual approaches. I highlight the value
of visual methodology projects within qualitative approaches to
research more generally, and assess the difficulties as well as the
advantages. It is suggested that using visual methodologies does
not necessarily lead to greater reactivity in the research process
as has sometimes been proposed; and that visual worlds are
themselves unique topics of sociological study which may be
enhanced by using visual techniques rather than written and
spoken language. A combination of visual and traditional
methods can also be fruitful. Painting and drawing, video, film,
and still photography are included as examples which researchers
have used and can use.
Keywords: visual sociology, visual methods, photography, health and health
care
The visual dimension in social life and social research
Anyone with an interest in visual representation, visual documents and
visual techniques as part of social science methodology will find numerous
reminders of their marginality in a context where the primary means of
communication has been words. Fyfe and Law (1988: 1) have referred to the
‘invisibility of the visual’, and in her excellent overview of theoretical and
empirical approaches to the visual in sociology Chaplin (1994) notes that
‘sociologists behave as though they were sightless’. ‘The visual is repressed
by the verbal’ and Chaplin questions this privileging of the written word.
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Using visual methodologies in a sociology of health and illness
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Similarly the American visual sociologist Douglas Harper noted that ‘even
though most sociologists are sighted, and even though much sociology
depends upon observation, sociology has not derived from, nor has it
reflected, a visual record of the world’ (1996: 69). Visual methodologies are
not considered part of the mainstream repertoire of research approaches
available to social scientists as a trawl through methodology textbooks has
revealed1.
Such authors, including myself (Harrison 1996), have found this absence
surprising: not only because of the ubiquity of visual images encountered on
a day-to-day basis in a wide variety of social contexts; but also because we
use visual skills and visual resources as ‘taken-for-granted’ ways of being in
the world, even if such visual dimensions may be translated into words. In
addition, much of the routine work of social actors in many different contexts requires visualisation as a component of human thinking and problem
solving (as witnessed in the many accounts of ‘doing’ science for example).
There are indications of change however, especially in the numerous new
texts that focus either on the analysis of visual representations (such as
Hall 1997, Evans and Hall 1999, Rose 2000) and on visual methodology
(for example, Prosser 1998a, Bauer and Gaskell 2000, Emmison and Smith
2000, Banks 2001, Pink 2001). A number of factors have probably contributed to this. There has been an interest in the coincidence of certain
visual technologies alongside particular social and political developments,
including those of knowledge itself. There has been work taking a historical
perspective, many following Foucault’s (1977) theorisation of disciplinary
power, which has demonstrated the importance of photography in particular
to the capacity for ‘scientific observation’ – and thus to the power of scientific knowledge and its place within the developing health and welfare
institutions of the 19th century. A related tradition of analyses of visual
representation has demonstrated their role in scientific and medical work
(see, for example, Gilman 1982, Stoeckle and White 1985, Jordanova 1987,
Tagg 1988, Pasveer 1989, Harrison and Aranda 1999). There are new lines
of inquiry into surveillance in the present as the technologies of vision have
developed in medicine (Lister 1995), as well as in other social contexts, e.g.
the CCTV camera (Davies 1997, Ball 2000).
A second important influence has been that of critical theory and ‘cultural
studies’ on sociology, including post-modern concerns within these. Here
discourse and forms of representation are key areas of inquiry and, within
this, sociologists have sought to demonstrate the importance of images as
forms of communication which are culturally and socially contexted and
bounded and are mediated by ideology and subjectivity. Visual images thus
take historically specific forms linked to political, economic and social relations, which determine both their mode of production and their ability to
constitute the social world itself. The languages of visual presentation also
draw on wider cultural perceptions, categories and metaphors, and provide
us with views of how things are or should be. An important aspect of this
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work has been the critique of photography and of those assumptions that
led early sociologists to reject the use of photographs in their work: they are
neither reflections of ‘truth’ nor unproblematic portrayals of the human
condition and cultures2. Instead, the meanings of photographs are constructed, both by producers and by viewers. Equally, an emphasis on narratives as ways of ‘telling’, stressing the particular experiences, views and
situations of the subject/author, has expanded from language texts to
include imagery as well as music and performance. Visual images such as
photographs are now also analysed as texts, produced and interpreted
through human consciousness.
This review takes both the marginal status of a visual sociology in the
form of image-based research and the use of camera technologies and also
the potential of the recent changing emphasis, as a starting point for considering the contribution such a visual sociology might make to the sociology of
health and illness. A number of researchers within the health and illness
domain have been successful in utilising a variety of visual methodologies in
their work, but as Prosser (1998b) has noted of visual sociology, the practice
and practitioners have tended to be fragmented, especially in the UK3. This
review brings together some of this research and these approaches.
The visual as ‘topic’ and ‘resource’
Where the visual dimension has been of interest to the social scientist, translation into words has been a necessary element in separating the topic of
study from the forms of its analysis (Chaplin 1994). In attempting to break
down such separations and to make the visual more central to all aspects of
the research process, a useful distinction (with origins in ethnomethodological studies of language) can be drawn: the distinction between topic and
resource. In the former the visual itself is the subject of investigation. This
would include representations as well as depiction (the activity of visual
production4), where there are quite distinct theoretical interests and approaches, of which ethnomethodology is only one. Social scientific studies
of ‘art’, film and other media, photography as well as advertising, fall into
this category; as do studies concerned with the deconstruction of images or
of visual discourse, analyses of production and producers, visual literacy and
analyses of genre, and iconography and its constitutive role in specific contexts. There are numerous studies of representations within a sociology of
health and illness (such as Showalter 1987, Stoeckle and White 1985,
Jordanova 1987, Pryce 1989, 1996), and there is a long history of a relationship
between ‘art’ and ‘medicine’5.
The alternative approach is to use visual images and techniques as a
resource. Again such studies will vary in their theoretical orientation, but
here the visual is a means of accessing data about other topics of investigation.
Using already published research, the aim in this review is to demonstrate
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the utilisation of visual data and technologies in the study of a range of
topics of interest both to sociologists of health and illness and to health care
practitioners.
General considerations
Whether the researcher’s interest is in the visual as topic or as resource, s/he
must consider a number of issues which are important for decisions about
the appropriateness of visual methodologies in any study. First, there is the
relationship of visual data to the sociological questions or concepts being
addressed. Images are not just illustrations or documents. For example, to
take one medium, Harper (1998) insists that we have to ask whether the
sociological ideas we are exploring can be photographed? We may need to
ask whether the visual will provide data that are different to or unavailable
through words, since it is also possible to appreciate the visual dimension of
an idea or phenomenon without visual display.
Second, using visual data requires both a theoretical and an empirical
understanding of the visual itself. I would argue that one of the impediments
to the use of visual methodology as a resource has been the lack of sociological work on the visual as topic. To illustrate this point briefly let us
consider ‘everyday’ snapshot photography. Family albums or researchergenerated visual diaries potentially offer data about personal lives and
experiences, forms of subjective understanding and identity construction.
As Bourdieu (1990) has pointed out, everyday photography is a sociallydesignated and highly-regulated practice. This includes both the production
of imagery and its consumption (Harrison 1999). Using such imagery in
research will require an understanding of such everyday contexts and practices. Thus, Schwartz (1989: 120–121) has argued:
viewing [and I would add producing] photographic imagery is a patterned
social activity shaped by social contexts, cultural conventions and group
norms. In order to present photographs to informants for the purposes of
photo-elicitation, some fore-knowledge of the respondents’ groups use of
photographs is required (my words in parentheses).
The conventionality of photographic practice will mean that both existing
and elicited photographic records will encompass only selected social occasions, particular people and places, and that they will be framed or composed utilising some aesthetic principles. These areas require evaluation
within such data. If we wish to ask respondents to produce a visual diary
or journal of their illness career, for example, then we need to be aware
that illness is not a typical subject for everyday photography.
A third important consideration in evaluating visual data in social
research is the technologies of visual production. Technological developments
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have been a crucial determinant of the kinds of imagery produced, the
amount that becomes available at particular times, and the kinds of skills
required to use them. These technologies range from the most elementary
such as pen, paints and other drawing materials, through simple cameras, to
more complex systems of audio/video and film recording. It has been
assumed that such technologies are familiar and commonly used (increasingly so in the case of video) and so have cultural currency. This combined
with the simplicity of the technology, that ‘anyone can do it’, has led
researchers to opt for visual methodologies in their work. As Prosser and
Schwartz illustrate: ‘Because photography is a popular hobby and photographs pervade western industrial societies, our subjects are likely to be
familiar with both making and viewing images’ (1998: 121). These ideas
about the production of visual images have found favour with a number of
researchers who wish their research relationships to be collaborative and to
offer opportunities for subject empowerment. Developments in camera technology, and new possibilities for the storage (e.g. photographic archives on
the internet), analysis and presentation of images and text, are available.
CD-ROM technology and forms of multi-media software which provide such
opportunities will also open up further questions, in relation both to access
to resources and to the development of skills, for researchers and perhaps
participants too (see Henley 1998).
Finally, while the problematic nature of visual methodology has been
exaggerated, and many of the issues for the visual sociologist are no different
from those which any other qualitative researcher must consider, there
are some distinct epistemological and technical issues. As Cicourel (1964)
argued some time ago in relation to language-based methods, we cannot
assume that such materials or techniques do not also pose problems of
interpretation by the researcher. The research process and research relationships also often differ from those found in more conventional forms of field
research. There will be ethical issues also, since by its very nature visual
materials can make much more information (including identities) available to a public gaze (from either covert or overt investigation), raising
questions about anonymity, confidentiality and invasions of privacy.
Forms of visual inquiry
In this section, possible uses of visual materials and visual techniques in
the sociology of health and illness are examined, drawing mainly on studies
in the field. One might wish to examine specific techniques, e.g. photoelicitation or video observation here. In what follows, however, I link particular
techniques with the wider epistemological concerns of particular approaches
or research designs. Banks (1995: 1) makes a three-fold distinction between
visual records produced by the investigator, those produced by the researched,
and the study of ‘representations whether pre-existing or produced’; although
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as he rightly points out, ‘such distinctions have begun to collapse’. In
examining designs it will be evident that particular kinds of image-based
research do not belong exclusively to one or other of these three types.
Visual imagery and ethnography
Following anthropology’s early use of the camera for the classification of
human types, which ceased to be an important element in the 1920s (Green
1984), interest was mainly in using the camera to support traditional field
work. This was mainly in the form of ethnographic film making with photographs that were instigated and produced by investigators themselves, and
used as forms of documentary text. The main aim was to provide some kind
of visual map of material culture. It was only with Bateson and Mead’s (1942)
classic work on Balinese character that visual imagery became an integral
part of the overall analytical approach. This kind of approach has been used
in sociology as well, notably in Harper’s studies (1986, 1987) in which he
made photographs of the ‘subjects world’ as he went about his work. He
then entered into a dialogue with the research subject to make sense of this
visualised world, so that the images were a kind of field note that required
the collaboration of the participant to ‘translate’ its meaning. A second
approach, pioneered in the early 1970s, was to switch the image-making
from investigators to participants or members of the particular cultural
group (see Worth and Adair 1972 who called them ‘native’ filmmakers). The
assumption was that such image production would reveal what members of
a culture themselves viewed as most significant. This approach of ‘indigenous’ film-making or photography has also been used within collaborative
designs or projects, where the direction of image-making is viewed as a joint
effort. Collaborative projects, however, are not only ethnographic in design,
and may be autobiographical and/or experiential, evaluative, or orientated
to specific topics of sociological enquiry. I return to some examples of these
later.
Rich and Chalfen (1998) used the idea of an indigenous medium in a
study of children with asthma. In what they call Video Intervention Assessment (VIA), children and adolescents who shared the medical condition of
asthma were asked to create visual narratives using video cameras. I have
chosen to include this project here because, as with other ethnographic
studies, the emphasis was on all aspects of their social worlds and life
experiences. The participants were essentially asked to ‘teach us about your
asthma’. The study also drew on the tradition of personal narratives, the
telling of a story, a story in words and pictures, with words spoken into and
in front of the camera. As with autobiographical approaches, it utilised the
idea of video diaries. One notable difference in this study was the degree of
direction from the researchers. This included certain tasks required to fulfil
defined research objectives, such as ‘tours of their homes’, conducting
interviews with family members, and personal monologues. Participants
were also interviewed about the research process. The authors argue that life
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circumstances never captured before were revealed by this method, and that
for participants the sense of being more active, of having some control over
the research process, also gave them greater control over their illness.
Collaborative and participatory design
It seems appropriate in the light of my discussion of the last study to outline
an important theme emerging in a number of research studies which use
visual techniques or data. As mentioned above, this is the theme of doing
research in ways that reject traditional models of power and knowledge
production within the research relationship. In some cases researchers locate
their concerns in the development of critical consciousness, and in the
empowering possibilities that result from that development (e.g. Cohen
1989, Wang et al. 1996a,b). This approach to using cameras is sometimes
referred to as photo-voice. Wang and colleagues’ (1996a) use of photo-voice
was connected with a women’s health project in China where women were
given cameras to shoot aspects of their lives and then to use the photographic record to identify ‘needs’ from their own point of view. Considerable
effort was made to enable the photographers to maintain ownership of their
images, and then to join in dialogues, discussion and story telling using this
imagery with researchers, policy makers and planners. Such approaches
have been used in community research in the UK, where photographs by
residents provide the basis for focus-group discussions (Wood and Vamplew
1999). It is possible to think of numerous possibilities where such an
approach could be used to research health and illness worlds from participants’ own perspectives, with a number of different forms of visual and
written text emerging from these.
Film and video-observing and analysing interaction
The development of technologies capable of capturing more than the ‘single
instant’ would seem to offer considerable advantages to the social researcher
for some areas of investigation, although it is important not to overstate its
potential or to minimise the additional ethical and practical constraints
there may be. Exponents of the video camera as a research tool (Dowrick
and Biggs 1983, Heath 1997) have emphasised the opportunity it provides
for studying interactions in ‘natural’ settings, either by static deployment in
a specific locale, such as clinic, ward, or operating theatre, or by using a
hand-held camera, which permits greater movement of researcher/photographers around specific locales, and over a range of activities and events. The
value of a permanent verbatim record allowing for repeated observation at
the analysis stage, and the camera’s ability to record non-verbal behaviours,
are also stressed. Banks (1995) points to a number of formalistic analyses
that can be undertaken using this technology, including: proxemics (the
study of personal spatial behaviour); choreomatics and kinesics (the study
of body style and communication) and conversation analysis (CA). Christian Heath (1984, 1997) develops his analysis of the medical encounter
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using CA with extensive video footage. Examining naturally-occurring
medical consultations, he demonstrates the relationship between the verbal
(speech) and the non-verbal (body-movement) as aspects of doctors’ activities and work. Both are integral to interactional involvement and to getting
the consultation done. It is also important in that people orientate to objects
and to their physical environment. These aspects are not just a backdrop to the
action/interaction, but are constituted through it, and Heath (1997) argues
that this is demonstrated in a number of workplace studies where technology
is an important component of the workplace’s organisational features.
A further valuable addition to the debates about video recording as a
methdology is provided by a study within the CA tradition by Lomax and
Casey (1998: 2) exploring the ‘interactional accomplishment of midwifery
postnatal examinations and consultations’. Lomax and Casey reject two
traditional views of the validity of video data: that data are not influenced
or contaminated by the collection process; and that they intrude to alter and
distort the ‘reality’ under study. They claim that the way both researchers
and participants manage the research process itself provides valuable data
which can be analysed. That is, the video camera provides data for a
reflexive analysis of the process, which in turn gives further data about the
phenomena under study. One example of this was midwives’ attempts to
influence when a camera was on, which provided insights into both the
orientation and management of sexual taboos, and the ways in which they
differentiated between dimensions of their work. In the light of the video
camera’s capacity to record occasional activities, it therefore needs to be
recognised that the taking of video records is part of those activities.
A different set of concerns is exemplified in a study by Brooker (1993)
who used video to study ‘unplanned interactions’ between nurses and relatives in a renal ward, emphasising the camera’s value in studying non-verbal
communication. Using initial field work she ascertained where most
unplanned interaction occurred, and then positioned the cameras at the
renal ward office door and public corridor. These interactions were most
commonly about a minute in length. For nurses, patients and relatives the
study demonstrated the extent to which non-verbal skills in such interactions
had important therapeutic implications. It also demonstrated that not all
nurses could be described as ‘skilled’ in the interpersonal aspects of their
practice. Such research data could educate nurses as to what can and should
be done in such brief encounters.
In Brooker’s study discussed above, participants were aware of and consented to filming, but were not informed where the camera was located, and
its positioning was inconspicuous. Unlike Lomax and Casey (1998), Brooker
argues that if normal routines are able to continue, reactivity can be minimised. Debates about reactivity will no doubt continue amongst visual
methodologists. Already routine camera surveillance has become common
in our society, although equally their presence affects behaviour, as the
observation of driving behaviour in relation to speed cameras confirms. How
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researchers and their cameras influence the research process, and thereby
data collected, will require the kind of detailed analysis provided by Lomax
and Casey (1998). We need to be mindful that an emphasis on the value of
‘natural’ or candid images may neglect the value of analysing contrived
images. Evaluations of video methodology should also keep other issues
under constant review: ethics; the potential of cameras to disempower as
well as to empower; the relative merits of fixed versus variable camera positions; and the limits to what and how much one can film. Finally, there are
also decisions to be made about the role video imaging will play in producing the research account or text.
Studying lived experience and autobiographical approaches
The increasing popularity of qualitative methodologies in the study of
health, illness and health care has reflected an epistemological commitment
to the ways participants themselves interpret, give meaning to and make
sense of, their experiences. These might be ‘ordinary’ everyday experiences
and events, or those which disrupt and require new responses from both self
and others, including the construction of new identities. Interest focuses on
the mutuality of relations between self and society, which has been articulated within the developing field of auto/biographical studies in general.
Illness and other changes to the body provide one particular form of disruption that has been considered suited to these approaches. A number of
studies have focused on the impact of children’s chronic illness or death on
mothers and families (Bertoia 1993). Personal narrative approaches have
tended to dominate within this tradition, and it is here that the potential of
visual methods has been demonstrated, either alone or in conjunction with
verbal or written responses. There are a number of distinct approaches to be
discussed here.
Asking respondents to interpret images of themselves and/or others elicits
processes of ‘making sense’ of meanings assigned. It is not necessary for
images to be self-generated for visual materials to be read as texts. Our
interest in a painting, drawing or photograph is not about the producer’s
world of meaning, but about that of the audience. It is much more about
‘ways of seeing’, to borrow Berger’s (1972) phrase. Some authors, such as
Barthes (1981), argue that the symbolic form of photographs (or indeed
other imagery) invites ‘speaking about’ the experience of others. There are
theoretical and empirical questions here about how the worlds of self are
distinguishable from others in such interpretative work and, in my view,
the idea of ‘audience’ remains the most underdeveloped and problematic
area for the visual sociologist.
Asking what people see in pictures can also be used to study personal
orientations. Produced images can be used in conjunction with in-depth
interviews or ethnographic field work as eliciting techniques. This is referred
to in some texts as photo-elicitation. It is the reflexivity between image and
verbalisation which produces the data for the investigator. In some respects,
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the use of the visual is simply a technical means to an end: that is, the
generation of verbal data for analysis. In other studies it may become part
of the data and have a relationship to both verbal data and eventual text.
An example of the former is provided by Gillian Bendelow’s (1993) study of
people’s ideas of pain. Pain is a difficult concept to get people to verbalise,
and so here they were asked to talk about pain in relation to a series of
images, and only later to do so in relation to their own circumstances. A
complex array of ideas was revealed by this method, as well as the finding
that notions of pain varied by gender. It is perhaps not surprising that artists
have also used their work to give voice to pain and suffering – suggesting
that the visual can provide ‘ways of telling’.
Varieties of drawing, painting and photographic projects have explicit
aims to use self-generated imagery to symbolise and make visible aspects of
the self in social and physical environments. Ziller (1990), a pioneer of this
approach in psychology, describes this kind of work as photobiography.
Participants are encouraged to use the camera in order to address fundamental questions of identity – who am I? Users of such techniques further
argue that photographic journals reveal ‘unfamiliar and unknown aspects of
human health experience’ (Hagedorn 1994: 44). In what she describes as
a hermeneutic photographic study, Hagedorn (1994) asked eight families
to take photographs of their experience of caring for a child with chronic
illness. These, she argues, provide symbols of experience that represented
the meaning of that experience, and prompted ‘spontaneous story telling’
(Hagedorn 1994: 48). The photographs, however, did not stand alone as the
‘story’, but were used in relation to interviews where further reflection and
interpretation of the images occurred, as is common with other uses of
photo-elicitation. This approach may be the most practical one for researchers,
but it does raise issues about the presumed integrity of the generated images,
and again of the relation to them of personal and researcher interpretations.
A further example of the use of photography to study personal orientations and personal worlds also differs from the above in that it is argued that
‘visuality’ is itself a method by which one particular social group exists, or
is, in the social world. Thoutenhoofd’s (1998) study uses photographs to
explore Deaf 6 people’s worlds, in what he terms auto-photography. Here
visual modalities, and the resultant symbolism, lie at the core of forms of
conduct and strategies utilised for successful participation within Deaf
communities. The project used three kinds of photograph: those taken by
the researcher, those taken by a group of hearing and non-hearing A level
students, and images used in magazines aimed at the Deaf audience, producing photo stories and content or textual analysis. The gains are, he claims:
If we look sympathetically at the idea that the ‘Deaf way’ hinges on an
ability to literally see its phenomena, we should be willing to bracket (or
abandon altogether) verbally-based, or rather, literacy dependent research
methods in favour of other forms of inquiry (Thoutenhoof 1998: 7).
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Such an entreaty can also be seen as relevant to other kinds of visual
experience.
A final example of participant-produced images brings this group of
approaches to a conclusion. This is the ‘Draw and Write’ technique used
with children in a number of studies and geographical locations (Wetton
1992, Pridmore and Bendelow 1995, Wetton and McWhirter 1998) to
examine conceptions of health, death, drug-use and cancer. With a specific brief to look at implications for health and education, Wetton and
McWhirter (1998) argue that much of the imagery and materials aimed at
children does not start ‘where the children are’, especially because health
and safety are abstract concepts. In this case it was used to look at children’s
ideas and knowledge from their everyday worlds. Children were asked to
draw and then to write something at the side of the picture. In one case it
was ‘who has dropped a bag of drugs?’ and in another they drew themselves
doing the things that make them healthy. Such a method is viewed as quick
and cheap to administer, as a starting point for interviews, and as able to
yield quantitative as well as qualitative data.
A number of researchers have used visual methodologies with children. A
variety of rationales are given, from giving a voice to children, revealing
the wealth of children’s knowledge, and, in the case of photography, because
cameras are familiar and easy to use. Finally, there is considerable controversy
about the use of visual imagery with children in some contexts, particularly
child abuse investigations, on the grounds that suggestibility is developmental
and this requires consideration if visual materials are used in investigations
(see for example Wakefield and Underwager 1998). It is simplistic to consider
visual images only as a means of enabling children to tell a story in their
own words: images may also include fears, anxieties and fantasy. The ‘draw
and write’ technique has also been used with adult samples and should not
be considered solely as a method for children.
Images at work
In this section I briefly discuss the analytical traditions that focus on the
visual as ‘topic’, as forms of discourse. Visual representations do ‘social
work’ and so visual representations in health and medicine can be analysed
in this way. This encompasses a number of approaches. The interest may be
in the content of representations – that is what their manifest message purports to be about – or in the purpose to which representations are put, such
as education, recruiting staff, or selling products. There are also interests in
the visual in terms of its symbolism – the latent meaning of imagery – in a
similar vein to the art historian’s use of iconography, or the semioticians use
of sign (see for example Williamson 1980, Pryce 1996, Hall 1997). Whatever our interest in the representational text, it is necessary to consider
modes of representation as devices which produce particular types of
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accounts and/or theories, not simply as some kind of ‘reflection’: there is an
act of construction which involves the interpreter as much as the maker of
the representation. When visual imagery is used as a resource, similar activities are undertaken. Either participants or investigators are required to
decode representations, so an understanding of these processes is important
to the visual methodologist.
Sociologists of health and illness will have interests in varieties of
representations and discourses in both historical and contemporary contexts. This includes imagery produced or used within research and forms
of ‘publicity’, health education messages, photographs, paintings and
advertising. There are both correspondences and continuities of signs in
works of art and in advertising, just as there are particular ways in which
publicity works in a consumer society. The interest of some social investigators in advertising has been to demonstrate how advertising trades on
‘taken-for-granted’ or unconscious cultural codes, including those of gender
display (Goffman 1976, Williamson 1980), which ‘naturalise’ and reproduce
a reality already known–known, it is argued, through systems of ‘myths’,
evoked by the product, whether this be motor cars, cigarettes, or psychotropic drugs. Such a short review cannot consider these or other media
representations of health and illness in greater depth, but all representations can be shown to ‘work’ as forms of discourse, not forgetting the
potential to reconstitute issues in more radical and empowering directions
(Karpf 1988).
Conclusion
In some of the examples discussed above, research using visual imagery is
seen to have educational, clinical or therapeutic aims and benefits arising
either directly from participation or from the research findings. This was the
case with the use of the ‘draw and write’ technique as a basis for a health
education curriculum for children (Bendelow and Pridmore 1995, Wetton and
McWhirter 1998) and the use of videocam in the asthma research on young
people (Rich and Chalfen 1998). There are also many examples of images
made to explore personal experiences of illness or disability which were not
produced in a research context or for research purposes. These cannot be
discussed in detail here, but they might be used by the researcher, for example, as forms of representation (see Hevey’s 1992 work on disability imagery)
or as contributing to autobiographical enquiry as in the case of Jo Spence
(1986, 1991, 1995) and her work with Rosy Martin on ‘phototherapy’ (Martin
and Spence 1987, Spence and Martin 1988, Dennett 1997). Darbyshire
(1994) has proposed that viewing and interpreting the paintings of Frieda
Kahlo provides a basis for articulating personal views of suffering and
caring in a way similar to Barthes’ (1981) idea that symbolism invites us to
speak about others’ experience and so also to speak about our own.
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Barbara Harrison
The camera as a visual technology has been evaluated in two contradictory
ways. In the historical context there are attributions of ‘faithful’ depiction –
revealing things as they ‘actually are’, which although much criticised, is not
entirely absent from more contemporary uses of video, film and photographs,
especially where researchers lay claim to non-interference of camera use with
‘naturally occurring’ phenomena. The alternative evaluation lays great stress
on the reactivity of camera technologies in the research context, and the
elements of selection and contrivance in the production of data images. This
has been seen as one reason why visual methodologies have a problematic
status (Prosser 1998b) or as a reason why sociologists have tended not to
consider their use (Lomax and Casey 1998). This is similar to concerns
about the use of tape-recorders in interviews, yet the evidence is that participants allow such technical intrusions to assume something of a ‘natural’
quality in the setting. In fact in the case of video, where there is no human
observer, the camera may be less intrusive. On the other hand, whatever means
are used to collect data, researchers do influence research situations and the
production of data. In qualitative methodology this is recognised in the
requirement for reflexivity and ‘audit trails’ in judgements of credibility. In
visual methods, it may be that we have to think about a different kind of
‘reactivity’ rather than whether it is present or not. Finally, as we have seen
in some examples discussed here, it is the possibility of ‘reactivity’ itself,
whether to cameras, to the symbolic content of images, or to the production
of images, that a visual methodology can uniquely provide. This itself may
offer opportunities for new knowledge. There are, of course, challenging issues
that confront the visual methodologist at the different stages of the research
process. The ultimate value of such approaches will not only depend on how
well we meet those challenges, but will also require that we pay attention to the
visual not just as a resource for our studies, but also as a topic in social life.
Address for correspondence: Barbara Harrison, School of Social Sciences,
University of East London, Longbridge Road, Dagenham, Essex RM8 2AS
e-mail: [email protected]
Acknowledgements
The author would like to thank Douglas Harper and Merl Storr for comments on
an earlier draft of this paper.
Notes
1 Prosser (1998b) who conducted a systematic content analysis of ethnographic and
qualitative research texts, where most visual methodologies would be located,
found the majority contained less than one per cent of such content. Equally, they
tended to emphasise the problematic and complex nature of such approaches.
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2 Within the early history of sociology the status of visual was in the main as
‘illustrations’. Social scientists did not accept the assumption that the camera
provided a neutral and accurate recording – emphasising instead the unreliability
of the human recorder/observer to the positivist enterprise (see Stasz 1979).
3 There are two American–based organisations for visual sociology and visual
anthropology. The International Visual Sociology Association which published
the journal Visual Sociology (Visual Studies from 2002) and the Society for the
Anthropology of Visual Communication. In the UK during 2000–2001 there was
a very successful ESRC seminar series on Visual Evidence organised by the Pavis
Centre of the Open University, which brought North American, European and
UK scholars together.
4 Not all authors use depiction in this way. Rather it is sometimes used interchangeably with representation. Equally, representation itself can refer to action,
hence my preference for depiction as action, and representation as the product.
5 This was seen recently (2000) in the exhibition Spectacular Bodies at the London
Hayward Gallery.
6 I have used the capital D here as does the author, although he acknowledges the
political debates around its use (see pp. 4 – 5).
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