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Disfigured Faces, “Accursed Ugliness”, and Hollywood

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disfigured

Disfigured Faces, “Accursed Ugliness”, and Hollywood

The Author

Patrick Adamson

disfigured

The fourth and final blog in our Halloween series, written by Paddy Adamson, brings together the key themes of Hollywood and disfigured faces. As a researcher in film, and a member of Face Equality International’s Lived Experience Group, Paddy brings a unique perspective to the topic. Don’t miss the rest of the series, starting with Fay Bound Alberti’s introduction, Sara Wasson’s blog on Les yeux sans visage and Lauren Stephenson’s analysis of The Eye. Let us know what you think!

Disfigured Faces, “Accursed Ugliness”, and Hollywood

One of the best-known scenes in all of silent cinema unfolds about halfway through Rupert Julian’s The Phantom of the Opera (1925). Young soprano Christine Daaé (Mary Philbin) has been carried down into a suite prepared for her in the cellars under the Paris Opera House by the Phantom (Lon Chaney), a mysterious masked composer who haunts the venue. He promises her a great career, providing she can devote herself to following his orders.

But curiosity about what lies beneath her mentor’s disguise gets the better of her. Stealing up behind him as he plays “Don Juan Triumphant” at his organ, peering over his shoulder as he faces the camera, she snatches the Phantom’s mask away, revealing directly to the audience a cadaverous face of sunken cheeks, protruding teeth, and flared, elongated nostrils. When he turns to look at her, intrigue gives way to screams; the film cuts between the Phantom’s true face and the terror and disgust it inspires in hers.

Said to have led to screaming and even fainting among moviegoers of the day, the Phantom’s unmasking is a shocking spectacle of physical difference and an iconic moment in horror film history – the unveiling of a face that has continued to fascinate in the near-century since. Created by Chaney himself, an actor famed for his extreme transformations, the villain’s look was kept secret until release. Today, his elaborate make-up can be imitated for the price of a high-end Halloween mask.

“Feast your eyes”

Yet, for all that the Phantom’s command as he forcibly turns the cowering Christine’s face toward his – “Feast your eyes – – glut your soul on my accursed ugliness!” – could equally be directed at the film’s audience. There is more to the scene than the thrill of seeing Chaney’s make-up artistry paraded on screen. It provides a revelation vital to the story. Confirmed by the disclosure of his deformed face is the Phantom’s monstrous true nature. The corrupted body of this gruesome physical spectacle befits the corrupted soul of this dangerously deranged outcast from Devil’s Island, his disfigurement the outward expression of the ugliness within.

Film still from The Phantom of the Opera (1925)

For me, as a disfigured viewer, this is the most striking aspect of this iconic moment. Not only is it testament to the longevity and pervasiveness of an all too familiar tendency, unavoidable at this time of year – the imitation of appearance-altering conditions in the name of a “spooky” costume – but it is an uncomfortable reminder of what it means, in the codified world of Hollywood cinema at least, to be facially different.

Physical Appearance as Cinematic Shorthand

Filmmakers have long exploited the meaning-making potential of distinctive physical characteristics, using non-normative appearances as an expedient shorthand for character. The most notorious example of this physiognomic logic is the prevalence of facial scarring among movie villains. Examples range from the monstrous of horror cinema – the burn-scarred Freddy Kreuger foremost among them – to the crime lords and Sith Lords of the latest James Bond and Star Wars blockbusters. Visible evidence of a past gone awry, stated or otherwise, their scars offer a convenient rationale for the malevolent course they now follow.

At the same time, there can be little doubt that the appeal of figures from the Phantom to Kreuger owes also to a fascination with such bodies and the uncomfortable feelings they are supposed to excite. They are the frightful icons behind many a Halloween costume, after all, evidence of a pleasure found in the display or performance of physical difference that can be traced back through the history of film and the freak show. Chaney made something of a career of it, earning the nickname “The Man of a Thousand Faces” for the lengths he went to: strapping his lower legs to his thighs to play a double amputee in The Penalty (1920); labouring under a skin-tight rubber suit and seventy-pound hump as Quasimodo in The Hunchback of Notre Dame (1923); and apparently combining his famed make-up skills with painful wire hooks to create his iconic Phantom.

LOn Chaney

The Man Who Laughs

Paul Leni’s The Man Who Laughs (1928) typifies this marriage of exploitation and empathy, using the non-normative appearance of its protagonist to directly interrogate conventional ideas about the face and the role it plays in how we understand ourselves and others. Originally planned as a Chaney vehicle, this adaptation of Victor Hugo’s novel stars Conrad Veidt as Gwynplaine, a travelling show attraction famous for his wide frozen grin, carved into his face as a child by a Comprachico surgeon under orders from the King of England.

While his condition does not, in theory, preclude his entry into the spaces and pursuits enjoyed by the masses, Gwynplaine’s world is circumscribed by his facial difference. Most welcome on society’s edges, in carnivals and freak shows where difference is a valued commodity, he internalises the daily ridicule and the aesthetic and moral judgements of a callous, grotesquely prejudiced, yet superficially “normal” public; he fears he is unworthy of the woman he loves, Dea (again played by Philbin), for her blindness prevents her perceiving the real him.

To portray a man who can only laugh, Veidt’s wide grin was held in place using a bespoke, and apparently painful, appliance that deprived him of access to normative facial expressions, along with the social cues associated with them. Where the face is conventionally seen as inseparable from selfhood, the foremost means by which we recognise each other, Gwynplaine’s face not only fails to reflect his inner self but seems to contradict it, thanks to the fixity of its lower half; when not covering his mouth via a protective gesture of sorts, he is seen to grin his way through incidents to which such a reaction rarely seems appropriate. His character divorced from his appearance to jarring ends, the result invites audiences to search for an understanding of his agony in his eyes and comportment, and, in the process, perhaps reflect on their assumptions about how a face should react and look.

A Damaging Reliance on Disfigurement

And yet, for all the nuance, or at least ambivalence, that The Man Who Laughs brings to its handling of disfigurement – being, at once, indebted to and critical of the exploitation of facial difference – the film’s enduring place in the popular consciousness again owes overwhelmingly to the unusual look of its protagonist. In 1940, a photograph of Veidt in make-up as Gwynplaine was used by DC Comics artists as a model for a new villain: the Joker – flamboyant nemesis to the noble, honourable Batman.

A staple Halloween costume today, the Joker has gone through numerous incarnations in the intervening eight decades, with the extent and cause of his scarring and famous malevolent grin being repeatedly reimagined. The latest, in 2022’s The Batman, finds him with full-body scarring and a permanent smile attributed to a congenital condition. Director Matt Reeves explains, “…he’s had this very dark reaction to it, and he’s had to spend a life of people looking at him in a certain way…and this is his response.”

Nearly a century on from the unmasking of Chaney’s Phantom, and in a world where media images are routinely decried as a source of body dissatisfaction, Reeves’s comments illustrate the extent to which popular cinema’s damaging reliance on disfigurement as a visible expression of inner corruption or evil continues to go unexamined in many circles. Moreover, they speak to the unique challenges faced by the facial difference community and how these extend beyond the cosmetic and the medical, beyond even the more overt forms of discrimination and abuse to which many of us have grown up accustomed.

Everyday Prejudice

Yet, for all that characters with facial differences are disproportionately given (often lurid) backstories involving some kind of “dark reaction” to what is treated as an inevitable social stigma, the toll such everyday prejudice can have on the life experiences and mental health of those affected by it has rarely been addressed via bespoke legal protections or support. Recent years have, it should be highlighted, seen some more promising signs on this front: the British Film Institute’s 2018 commitment “to stop funding films in which negative characteristics are depicted through scars or facial difference”, and the ongoing efforts of Face Equality International, a global alliance of NGOs working around disfigurement, advocating the overdue recognition of facial difference as a human rights issue in its own right. These are significant steps and, in their being so, reminders of how much remains to be done.

Author Bio

Patrick Adamson is an editor and independent film researcher who lectured at the University of St Andrews from 2021 until 2022, having received his PhD from there in 2020. Specialising in silent Westerns, early popular historical filmmaking, and universalist discourses in 1920s Hollywood, he has been published in journals including Film History and received awards for his research from BAFTSS (British Association of Film, Television and Screen Studies) and SERCIA (Société pour l’Enseignement et la Recherche du Cinéma Anglophone).

He is a member of the Face Equality International Lived Experience Working Group.

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Diminishing their Voices: Face Transplants, Patients, and Social Media

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Diminishing their Voices: Face Transplants, Patients, and Social Media

The Author

Patrick Adamson

Public Engagement and Events Officer, Sarah Hall, writes about facetransplant patients and social media. In this blog, Sarah explores the familiar narratives that circulate in the media, and argues that the primary voice should be restored to the patients themselves, giving them control over their own narratives.

Diminishing their Voices: Face Transplants, Patients, and Social Media

A video showing a woman inside a spider monkey enclosure at El Paso Zoo, Texas, started circulating on social media in late May 2021. The woman allegedly broke into the enclosure to get a video of her feeding the monkeys Flamin’ Hot Cheetos. She did so for her social media channels. The video predictably gained a lot of attention, much of it negative. Commenters decried the woman’s reckless disregard for her own and the animals’ safety. These reactions are familiar to those of us on social media. Whether because of the relative anonymity that it affords, or because we are so strongly encouraged to share our opinions on any given issue, we are used to witnessing, feeling, any maybe even contributing to waves of collective outrage. But such moments are fleeting, and the outraged crowd will flock to a new issue before long. 

Social media is core to my work on AboutFace. The Institute of Historical Research’s History Labs+ recently invited me to speak about my work in this area. Namely, on how we present sensitive histories on our social media channels. Over the past six months I’ve come to realise that social media is capable of being far more than a tool for disseminating research. Additionally, it can be a space in which to conduct research. A valuable place to connect with trends, conversations, and public feeling. 

Drawing Parallels

It was while looking for recent tweets mentioning face transplants that I came across the video of the woman in the spider monkey enclosure, and the vitriol that followed it. I noticed that a number of angry responses mentioned Charla Nash. Nash (pictured) received a face transplant in 2016, after being brutally attacked by her friend’s pet chimp in 2009. Tweeters drew parallels between the real life attack and the potential for a repeat occurrence. However, few actually named Nash. Comments instead mentioned ‘the woman overseas who needed a face transplant’. One referenced what happened to Nash indirectly, writing ‘I see a face transplant in her future’.

Unusually, a number of replies came from British authors, who may have recently been reminded of, or learned about the event for the first time in a recently published Daily Star article. The article presented a graphic description of the attack, including audio of the 911 call made by Nash’s friend.

The news of Nash’s attack circulated widely in the US when it happened. And follow up coverage shared news of her face transplant. But coverage in the UK was limited to a few sensationalist pieces in the tabloids, while the broadsheets focused on surgical innovation. There is likely a link between the publication of the Daily Star article and the references to Nash’s attack in tweets from British authors. Tweets largely focused on the event, on the chimp, not on Nash herself, echoing the tone of the article. 

Familiar Narratives

Face transplants receive diverse treatment in social media. From flippant remarks to government conspiracies, fascination to condemnation and mockery of the aesthetic outcomes. Stories such as Nash’s circulate in public discourse according to familiar scripts. They are presented like films, featuring protagonists and antagonists, and readers treat them accordingly. Both social and news media present a fragmented view of reality, distancing audiences from the actual trauma of events. This process is exacerbated by the fact that most face transplant recipients are rarely the protagonists in their own stories. For Nash, people remember the chimp, Travis, before they remember her. They remember the attacker, not the attacked. If you Google ‘Charla Nash,’ the first result is the Wikipedia page for Travis, which remembers him both as perpetrator of the attack and tragic ‘child star.’ 

Contributing to this is the plurality of online discourse. Nash’s story, no longer simply her own, has been hi-jacked by multiple different parties. Just as some news outlets have used it to hail the victories of the surgeon leading her treatment, others have used it to mourn the tale of a wild animal raised in captivity. On social media, it circulates as a warning, a lesson against reckless contact with animals. Not long ago, it was employed to mock the people who had responded to a YouGov survey, claiming that they would beat a Chimpanzee in a fist fight. 17% of respondents answered that they would win. In these public spaces, Nash’s story is not her own, despite her efforts to present her own narrative. 

https://youtu.be/tOLaDP5UgRI

A fixed moment?

When the media, hospitals, and surgeons share news of completed face transplants, naming the patients, they catapult them onto the world stage, and directly into the public eye. Instantly, these patients’ stories are available to be picked up, claimed, shared, and transformed by others. Patients become supporting characters in other stories. I even find myself asking: were they were ever presented as something more? At AboutFace, we are concerned about this process. 

Face transplant patients are patients for the rest of their lives. There is no final ‘healed’ state, where they will no longer need medical care to monitor the donated tissue for signs of rejection. They may even have to undergo further surgeries to improve the function of their new face. But these are not the stories that are presented to the public. The people who continue to make passing, flippant remarks about face transplant, are presumably not aware of the ongoing challenges that transplant patients face. But there is no good reason that they should not be made aware. 

There is a sense, almost, that the moment the patient was presented to the media, their story became fixed in time. And it is that moment, that memory, that holds pride of place in the public consciousness. That is the moment that circulates periodically on social media, sitting below the surface until familiar details emerge in current events or conversations. Even then, it is sensationalised. These patients, who did not choose the spotlight, have been given it nonetheless.

Public Perception

It’s notable that the people referring to Nash’s story online rarely know more than the most basic details of her story, and even these details are not always accurate. As these narratives are picked up and reframed to suit the story being discussed, they take on new life. But what happened to the patient’s story in the process? 

With the distance afforded by the internet, social media users are removed from the reality of the people whose stories they co-opt. Face transplants can, in this space, continue to exist as both medical miracle and science fiction, and everything in between. The patient almost becomes irrelevant in the effort to prove a point, make a joke, or impress with a display of knowledge. But these narratives are still important to AboutFace, because they provide insight into public perceptions of face transplant. As an experimental procedure, where fewer than 50 have been performed worldwide, face transplants are still not common knowledge. We seek to understand what people know, what they want to know, and how we might contribute to more productive narratives. 

In this process, social media becomes an important research tool. We can quickly tap into the swift moving debates, opinions, and currents of public opinion. In few other spaces are people so willing to share their innermost thoughts. The anonymity afforded them provides a safety net. The nature of social media means that thoughts are shared instantaneously, without the pressure of, say, an online survey where people may seek to impress or please a reader, rather than honestly sharing their thoughts. Social media remains a performance, but it is a performance to which we have a front row seat.

Providing a Voice

When face transplant patients are not the protagonists in their own stories, something is wrong. They do not have control over the way that their narratives are told. It is time for that to change. At AboutFace, we believe that restoring the patient to the centre of the narrative is essential if we are to fully understand face transplantation and its outcomes. We speak to patients, as well as the medical teams who work with them. In doing so, we seek to place greater attention on patient reported outcomes. This means identifying ways in which medical teams can more effectively record what it means to live with a transplanted face, and what success looks like. In doing so, we will give a voice to the people who are actually at the centre of the story.

Author Bio

Sarah is Public Engagement and Events Officer on the AboutFace project. She is an experienced events manager with significant experience in the Higher Education sector, and is interested in engaging with creative methods for disseminating academic research to different audiences. She manages the social media profiles for the AboutFace project, and offers training in social media use for ECRs. Sarah is a passionate believer in the benefits of interdisciplinary research and collaboration. She is also interested in academic outreach, and is committed to making research widely accessible to non-specialist audiences. Using a combination of qualitative and quantitative methodologies, Sarah’s research is interdisciplinary and engages closely with digital humanities.

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Robert Chelsea and the First African American Face Transplant: Two Years On

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Robert Chelsea and the First African American Face Transplant: Two Years On

The Author

Fay Bound Alberti

On 27 July 2019, Robert Chelsea became the first African American to undergo a face transplant. The facial injuries that led to a transplant occurred six years earlier, when a drunk driver struck Robert’s car, causing an explosion and third-degree burns over 60 per cent of his face and body. Robert received multiple reconstructions over several years. Once they had done all they could, his surgeons suggested Robert spoke to Bohdan Pomahac and his team at Brigham and Women’s Hospital in Boston. 

Robert Chelsea and the First African American Face Transplant: Two Years On

Bohdan Pomahac and his team had performed the second partial face transplant in the USA on James Maki in 2009, and the first full face transplant in the USA on Dallas Wiens in 2011. By the time Robert was referred to the team, there had been fewer than 50 face transplants around the world, and none, as yet, on an African American patient. In his late 60s, he was also the oldest patient to date that had been considered for facial transplantation. Pomahac, meanwhile, had established himself as one of the world’s leading experts in the field. Would he and his team be able to provide the improvements in form and function that were sought by Robert: to enable him to eat and drink normally? To walk down the street without people staring, and insects falling into his mouth? To kiss the cheek of his daughter Ebony? 

The First African American Face Transplant Patient

The decision to undergo the procedure was relatively swift for Robert, though the wait for a donor took time. A devoutly religious man, Robert believed that God had paved the way for the face transplant, putting Pomahac and his team in his path. For Robert’s family and friends, the decision was less cut and dried. Ebony worried that her father had already undergone more surgery than anyone could be expected to endure – how could he voluntarily undergo more? Her mother talked her round. Her father was doing it for reasons of ‘health’; he needed to be as well as he could be, even if that meant undergoing such a radical and risky procedure. 

Robert’s transplant has been the subject of many media stories, focusing not only on the fact of his being the first African American to receive a face transplant, but also on his being the oldest such patient to date. There has been coverage, too, of the racial nuances involved; the fact that of course Robert needed a face that reflected the right skin tone for him. The hospital did not, until Robert’s operation, cover a wide range of skin tones when it came to matching donors and recipients; it took Robert’s procedure for them to rethink the implicit racism of the default White face transplant recipient. For his part, Robert has openly engaged with questions of racial inequalities in the system: the fact that for historical and social reasons there are fewer Black donors of all kinds than White. This gives Robert’s journey an additional sense of purpose: perhaps his media profile can pave the way for more public conversations about organ and tissue donation. 

Robert Chelsea. Image courtesy of Brigham and Women’s Hospital

The Hidden Costs

When I spoke to Robert and his daughter Ebony, and to Robert’s godson Ricky, as well as some of Robert’s friends in advance of the second anniversary of his transplant on 27 July 2021, I was struck by the thoughtful reflectiveness of everyone concerned, and by the love and support that surrounded him. I was also reminded that Robert’s journey towards health is an ongoing one. One of the core concerns of the AboutFace project is the largely neglected cost for patients: social, psychological, financial, and physical. Because while most media reports focus on such innovative procedures as surgical milestones, and the visual transformations that can take place, there has been far less attention given to the lived experience of patients and their loved ones. 

A face transplant is a highly visual shift from one form of appearance to another. Less visible, but equally important, are the behind-the-scenes challenges that patients must go through every day. At a physical level, there is a punishing regime of medications that include the immunosuppressants that prevent the rejection of donor tissue, and also come with a wide range of side effects besides the body’s weakened immunity to disease. In the first instance these include loss of appetite, nausea, vomiting, and trembling. Immunosuppressants can also cause other conditions, including diabetes and kidney disease. 

Alongside these physical challenges are the social costs, as a patient is generally unable to work, as even when feeling relatively well. Being a long-term patient is time-consuming, and individuals rely on a steady stream of caregivers, paid and unpaid. Financially, the costs of those caregivers, of the medications, of travel to and from the hospital and day to day living expenses can rise far beyond that which is covered by medical insurance. Indeed, insurers do not tend to accept face transplant patients because it remains experimental medicine; the majority of such operations in the US have been paid for by the military. 

Quality of Life for Patients

It is critical that we, as a society, and within medicine, start to acknowledge these hidden costs, that are not as transformative, dramatic, or immediately visible as the surgical procedure, but equally important to determining how far face transplants can be counted as successful. Quality of life for face transplant recipients must include not only some of the functional and psychosocial aspects of the procedure, in this case Robert’s ability to eat and drink normally, to kiss his daughter, and to avoid the stares of others, but also the implications for long-term health and care. Most face transplant recipients in the US (and potential recipients) need to fundraise to provide for this care, though its requirement can be seen as a side effect of the procedure itself. Quality of life must also consider the psychosocial implications of becoming a lifelong patient, with all the challenges to identity and meanings that this brings. 

The work that we are doing at AboutFace, in collaborating with surgical teams, patients and their families, ethicists, sociologists, psychologists and people with lived experience of visible facial difference, shows how critical stories like Robert’s are to the historical framing of face transplants. Medicine does not, and has never, taken place within a vacuum. Like all other aspects of society, it is influenced by beliefs about race, ethnicity and gender (whether in the question of skin tone or  presumptions about acceptable female appearance), and it is intensely emotional. Not only for patients, whose journeys towards health can be arduous and circuitous, in terms of outcomes as well as the emotional stamina needed to keep going, but also for surgical teams, who balance ‘risk’ and ‘need’ alongside their own personal and professional desires to progress the field. 

Measuring Success

Historically, the experience of patients has not been core to evaluating the success of a surgical procedure. Christiaan Barnard’s first successful heart transplant in 1967 was not so successful for the patient Louis Washkansky, who died after just 18 days. Of course, surgeons care about their patients, but the long-term effects on the lives of patients and their families tend not to be prioritised when evaluating the clinical outcomes of procedures that are innovative and path-breaking. 

In part this hierarchy reflects the fact that ‘quality of life’ measurements (like many categories associated with ‘mental health’) are inherently subjective, but it also reflects the ways medicine advances by implicitly prioritising the future needs of the many over the present few. Indeed, it is only within the last couple of years that surgical teams have begun collecting patient reported outcomes, and comparison between countries and institutions remains rare. We urgently need a more open and balanced discussion of human experience, and historical, comparative analyses of patient-reported outcomes alongside clinical findings, to evaluate the evolving role of face transplants. Listening to people like Robert Chelsea is a good place to start.

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History has Many Faces: researching histories of facial surgery

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History has Many Faces: researching histories of facial surgery

The Author

Emily Cock

For Face Equality Week 2021, Emily Cock writes about encountering facial difference in historical documents, and the associated emotional and ethical issues.

History has Many Faces: researching histories of facial surgery

This is a post about the conditions in which I am able to research facial difference in early modern history. It is a post about the ways in which book provenance and the building of research collections tie sixteenth-century facial surgery and medicine to the more recent past, and to contemporary ethical issues faced by libraries, archives, and the people who use them. Ultimately, it is a post about the historical research and book collection of physician Ernst Alfred Seckendorf, who was born in Nuremberg on 30 December 1892, and murdered in Auschwitz concentration camp on 11 February 1943.

Dr Seckendorf occupies a small note in a spreadsheet I constructed for my book on early modern rhinoplasty. I was recently reminded of this note while listening to one of the Folger Library’s brilliant 2020-2021 Critical Race Conversations talks. The conversation was a rich discussion between Urvashi Chakravarty and Brandi K. Adams on Race and the Archive. Please do check it out soon.

Adams and Chakravarty cover a lot of ground in the session, but I was particularly struck by their notes on the role of white supremacy in constructing and regulating access to archives. The presence of Seckendorf in my notes on sixteenth-century Italian facial surgery is an illustrative point that all research collections can prove this true, and that efforts to shed light on the stories of one discriminated-against minority can be contingent on the exploitation, subjugation, or even annihilation of another.

Seckendorf and sixteenth-century facial surgery

Seckendorf was a former owner of Chicago Northwestern University’s copy of a pirated edition of Gaspare Tagliacozzi’s De curtorum chirurgia per insitionem (1597; this edition was printed in Frankfurt in 1598 as Cheirurgia nova). As I began to research the provenance of copies of Tagliacozzi’s book during my PhD, I emailed libraries around the world for information on their holdings. I regret that Northwestern’s correspondence was lost with the end of my email account for that university, so I cannot name and thank the librarian who helped me at that institution (I have learned from this mistake in my practice, and now always try to acknowledge this labour!).

In this book, the Bolognese surgeon Tagliacozzi (1545–1599) detailed how a skinflap from the arm could be used to reconstruct a nose, lip or ear. Surgeons would continue to use this skinflap technology into the twentieth century: Sir Harold Delf Gillies (1882–1960), who led the immense developments in plastic surgery in WWI, conceded that the ‘There is hardly an operation – hardly a single flap – in use to-day that has not been suggested a hundred years ago.’ Tracing copies of Tagliacozzi’s and related books helped me to explore the circulation and reception of these ideas in the intervening centuries, and thus levels of access to facial surgery techniques for people with significant facial difference from injury, illness, or other causes.

According to the city’s Wiki, Seckendorf practiced in the Bavarian town of Fürth from 1921, specialising in skin, urinary and venereal diseases. He had an interest in medical history, which extended to translation of Latin texts: his German translation of Italian physician Girolamo Fracastoro’s (c. 1476/8-1553) Syphilis sive morbus gallicus (1530) was first published in 1960. This was the first text to use ‘syphilis’ for a disease that plagued early modern Europe, accruing many pejorative and often xenophobic names. I am grateful to Sara Belingheri at the closed Wellcome Library for providing an ad hoc scan of the book’s biographical notes on Seckendorf and Fracastoro by German dermatologist and medical historian Walther Schönfeld (1888–1977). 

How research collections are formed

Last year, AboutFace hosted a workshop and published a series of posts about the emotional and ethical dimensions of researching and publishing medical images of the face. The contributors raised important issues about the invasion of the photographed person’s privacy, acknowledging and negotiating the emotional effects of these images on the researcher, and using difficult images in teaching, among other topics. But my contribution today perhaps shares the most ground with Michaela Clark’s call to heed the tactile and material when thinking about the photographs and other sources that researchers use to understand historical experiences and ideas of facial difference. In the case of Seckendorf’s copy of Tagliacozzi in an American university library, what conditions have contributed to the construction of archives and public availability of research materials? 

Seckendorf tried to leave Germany in 1937 but was denied. He is still listed in a 1937 medical directory as a “Jewish specialist for skin and venereal diseases” (in Schönfeld, 19). He was arrested in January 1938, officially for performing abortions and for attempting to marry a non-Jewish German woman. Most online portraits of Seckendorf are the photographs used by the police after his arrest, and in the Nazi media when targeting him just prior (see the news clipping on the general German Wiki). It was therefore striking to see an alternative, personal photo used on the Fürth Wiki page. These photographs are, after all, a new archive through which the public understanding of Seckendorf is to be built up, and the choice of image a very deliberate and consequential move. 

There are provenance notes inside the copy of De curtorum chirurgia that can be used to trace some of its sale history. At one point, publisher J.F. Lehmann sold the book in Munich. Someone purchased the book from the still-extant Munich Karl & Faber auction house in 1932. One of these purchases, or possibly even the selling of the book, might have been by Seckendorf. I do not know the circumstances behind Northwestern University Library’s acquisition of this book. Perhaps the prominence of Seckendorf’s bookplate at least indicates a disinterest in denying or destroying the book’s provenance by whoever sold it to the library.

But millions of books were stolen from Jewish owners, including on Jewish topics, with restitution a slow process that receives less attention and funding than for more glamourous objects like priceless art. Schönfeld says that Seckendorf had an extensive (‘umfangreiche’) library of medical literature and history. Further research by people more skilled in twentieth-century German book history than myself will be required to establish the full circumstances of his collection’s dispersal. 

Provenance as ethical practice

I do not know enough about Seckendorf’s practice to explain the specific information he might have gleaned from De curtorum chirurgia, but it intersected with his specialisations in the skin and venereal diseases, since destruction of the nose was strongly associated with syphilis. He published a number of articles on medical history and on current practice. I argue in my book that some surgeons in controversial fields like plastic surgery used history and bibliography to defend their practice: operations to reshape the nose, for example, were not just products of ‘modern’ vanity, but had histories of development to help men injured in wars, duels, and other honourable, masculine pursuits. Perhaps Seckendorf saw similar value in contributing to the historical understanding of venereal and skin diseases.

Tracing books by previous owner is a difficult process: provenance information is often held in libraries’ private or less-searchable catalogue metadata, assuming that they have had any budget to research and catalogue this information to begin with. Nevertheless, I hope that it is only a matter of time before Seckendorf’s library can be reconstructed, if only as a digital catalogue, and his contributions to medical history better appreciated.

In the meantime, Seckendorf’s copy of De curtorum chirurgia, and Adams and Chakravarty’s discussion, remind us of the many historical figures, structures and processes entwined around the research materials that we can sometimes take for granted.

Author Bio

Emily Cock is a Lecturer in Early Modern History at Cardiff University, and author of Rhinoplasty and the nose in early modern British medicine and culture (Manchester University Press, 2019). Emily’s research explores early modern social and cultural histories of medicine, sexuality, and disability.

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When face transplants fail: Carmen Tarleton and the world’s second retransplant

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When face transplants fail: Carmen Tarleton and the world’s second retransplant

The Author

Fay Bound Alberti

What happens when face transplants fail? Project lead Fay Bound Alberti discusses Carmen Tarleton’s retransplant in this blog on donation, innovation, and patient voices.

When face transplants fail: Carmen Tarleton and the world’s second retransplant

In 2007, Carmen Tarleton was attacked in bed by her ex-husband, who broke into the home where she lived with her daughters. He hit her with a baseball bat, then covered her face and body in industrial lye. Carmen’s injuries were so terrible that her doctors at Brigham and Women’s Hospital put her into a medically induced coma for three months. 

Carmen underwent at least 55 separate surgeries before she was given a face transplant in 2013. She had also undergone multiple blood transfusions, and this exposure to other people’s blood made the rejection of her face transplant more likely. As a nurse for 20 years, Carmen was aware of the challenges of rejection, as she explained in an interview with the BBC. Her face transplant was widely reported, and she was interviewed for the BBC in 2015. 

Identities

Asked what created her identity, Carmen replied that she had been a ‘disfigured person’ and a ‘person who had a new face’, and that the process had been strange and unsettling, though the ‘core’ of her identity unchanged. When she started dreaming again, which she did some months after the procedure, she began to dream about herself with her new face, suggesting some deep psychological acceptance. 

In surgical terms, Carmen also made an exceptional recovery. CNN reported how she had ‘fulfilled her wish to kiss her boyfriend. She wrote a book, headlined an organ donor float in the Rose Parade, lectured about resilience, learned to play the banjo and became a hands-on grandmother’. Carmen Tarleton, speaking at the Congress of Future Medical Leaders in 2018 shared her secrets of resilience in an extraordinary and moving presentation.

https://youtu.be/8e41-ado7dE

No simple ‘before’ or ‘after’

There  was no simple ‘before’ or ‘after’, however, between the ‘old’ and ‘new’ lives and faces, and this is a running theme of the work of the AboutFace project. As a society we tend to focus on transformations (of houses, landscape, weight, faces), but the reality is far more complex. Any long-term patient will experience multiple, often conflicting, emotional responses. Surgically and emotionally there will be successes and failures, good days and bad days. Like any transplant patient, moreover, Carmen lives with the day-to-day possibility of rejection; that her body would start to reject the organ she had received.  

And rejection is something that all face transplant recipients will experience, albeit to different degrees. Unfortunately, for Carmen, this process became impossible to reverse. By 2019, parts of Carmen’s face began to die as its blood flow was restricted; she began to lose some of her transplanted hair and eyebrows, and part of her left nostril. Her surgeon Bohdan Pomahac and others at Brigham and Women’s Hospital in Boston believed that the only option was another transplant, an even more challenging prospect than usual given the Covid-19 pandemic. 

Second face transplant

Carmen’s second face transplant made international headlines, just like the first. Some of those reported, incorrectly, that this was another surgical first: that there had never before been a retransplant. NBC News’ Today programme ran with the headline: ‘Domestic abuse survivor becomes 1st person ever to receive 2nd transplant.’ 

This is not the case, though Carmen’s second transplant was a first for the USA. In 2010 the French surgeon Laurent Lantieri performed the first face transplant on Jerome Hamon in 2010 in Paris; the second in 2015, after Hamon was given drugs that interfered with his anti-rejection medication. 

Carmen’s second face transplant took place over two days, which is unusual; she needed to be stabilised in the ICU halfway through the surgery due to excessive bleeding, and so the face transplant was resumed the following day. Given the excessively long surgeries involved in face transplants, ranging from 20 to 30 hours, the fact that in this case the procedure was able to take place over two days put less pressure on the surgical team. This might even be a model for future face transplants, according to Dr Pomahac. 

Carmen has met the family of her second face transplant recipient, just as she met the first. Her surgeon has told her that the transplant might only last for seven years, like the first, but Carmen is unconcerned about the future ‘I believe this face is going to last me until I leave the Earth’, she said in an interview to People magazine. ‘It is my last face. I won’t have a third’. 

Progress

The success of Carmen’s second face transplant shows how far the procedure has come, in terms of managing immunosuppressants, surgical skills and expertise, and the preparedness of the public to conceive of face transplants as an acceptable form of transplantation. Carmen’s donor family was unsure, the second time round, whether donating their loved one’s face was something they could do. 36-year-old Casey Harrington had died of a drugs overdose, leaving behind a 15-year-old daughter. And the family was understandably grief-stricken. 

Although Casey’s organs saved five more people, it was the idea of donating a face that was difficult for them emotionally. At least in the beginning. Researching the procedure, learning about its life-changing nature for other people, is what swayed their decision. The family and Carmen have since met online, and, after the lockdowns caused by Covid-19, they intend to meet in the flesh. 

Public conversations

Raising the profile of face transplants in the media encourages people to donate the faces of their loved ones. But it also opens up a space for a public conversation about the challenges involved – physical, emotional and social – of the circumstances by which people end up as face transplant recipients or donors, and the multiple impacts of the surgery. The voices of patients like Carmen need to be heard if we want to understand the emotional and physical impacts of face transplants as a form of surgical innovation. This is why it is critical to move away from headlines that stress the competitive and revolutionary nature of face transplants (the drive to be ’the first’ having long dominated the history of medical innovation) towards a more patient- and person-centred understanding of face transplant.

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Portrait of an Angry Man – or not?

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Portrait of an Angry Man – or not?

The Author

Juliet Roberts

Part of our Emotions and Ethics series, ‘Portrait of an Angry Man’ is written by Juliet Roberts.

Portrait of an Angry Man – or not?

The focus of my presentation for the Webinar on 17 June 2020 was a portrait created in 1918 by the French illustrator, Raphaël Freida. The sitter is Albert V., a French soldier who was severely disfigured in action in Belgium 1915. He was a patient under the care of the orthodontist Albéric Pont, who had established a specialist maxillofacial unit at Lyon in 1914. The middle section of his face was shattered, and along with several fractures of his upper and lower maxillae his nose was torn away. He lost several teeth.

I found this particular image unsettling, since his gaze seems to fix on the viewer, and for some reason I interpret his emotional state as angry. Few of Freida’s portraits have corresponding images in alternative media. However, I was intrigued to find four photographs of Albert V. in Albéric Pont’s albums at the BIU Santé in Paris. This I hoped might resolve my idea that it was an ‘angry man’ in the portrait by Freida, or at least give broader scope to analyse the man and his injuries. With this in mind, I wanted to explore themes of objectivity and tensions between photographic or ‘scientific’ reproduction as opposed to artistic interpretations of clinical images. (Daston & Galison, 1992)

My other concern was that as historians, speculating on the emotional state of an individual may be an overly subjective approach to analysing an image as a primary source.  The following questions came to mind: Is it really possible to decipher the sitter’s emotional state from the images or, in the case of this portrait, are we simply staring at the artist’s own anger? Are the photographs of Albert V. examples of how a ‘mechanical image’ produces a more dispassionate picture of disfigurement and its resolution? Are the words ‘analysis’ and ‘interpretation’ in some way interchangeable? Does their own emotional reaction to and ‘reading into’ an image produce ethical problems for the historian?

Albert V

Using just five colours, Freida’s full-face portrait shapes Albert V.’s features and scarring using multiple, precise strokes, a technique which belies his pre-war profession as an illustrator. The sitter’s eyes and forehead have been spared injury, but the lower section of his face is a gnarled mess of disfigurement. A band of tissue covers the space where his nose was, and there is extensive scarring around his mouth. The viewer is left in no doubt as to how Albert V. received his injuries; he is wearing his military uniform.

Undated, the ‘before’ and ‘after’ photographs show Albert V. with and without a nasal prosthesis. They were part of an album of maxillofacial cases used by Albéric Pont, an orthodontist and prosthetist who established a facial surgery unit at Lyon in 1914. There is more extensive damage visible here, with a large, gaping hole where his nose should be. The corners of his mouth are turned upwards into what appears to be a smile, particularly with the nasal prosthesis in place, and there is a perceptible glint in his eyes (presumably due to light exposure). Somehow, the man in the photograph does not seem to be as troubled as he is in the portrait.

Approaching primary sources

Since subjectivity is such a personal concept, I wondered if any scientific methods had been deployed to measure emotional reactions to art. One study by Leder et al (2014) revealed that ‘challenging’ or controversial art produced more negative reactions from ‘lay’ viewers than ‘art experts’. However, I found this research unsatisfactory as it was based on anticipation of art being a pleasurable experience, or expectation of some kind of mood enhancement; obviously for those who research medical visual culture this is not always possible.

As historians, our approach to primary sources requires us to consider an object beyond its superficial impact. We have to consider how images are manipulated and audiences are targeted. The words ‘interpretation’ and ‘analysis’ produce similar explanations in the Chambers Dictionary (2008); to elucidate, unfold or resolve to arrive at the root cause of something. Consequently, exploring the context in which these images were created allows us to better understand our reactions to them. Certainly, the aim was more than simply recording the injuries for pedagogical purposes.

Portrait and viewer

Freida saw action during the Great War, and was subsequently deployed as an orderly at the military hospital in Lyon. He created a series of portraits of Albéric Pont’s patients and intended to publish a portfolio of these images entitled Les Misères de la Guerre after the war. In view of Freida’s war experience, it is essential to consider the possibility that he absolutely meant to provoke an emotional reaction from the viewer, hence his desire to publicise his portraits of these broken men. As for the photographs, it is clear that behind the recording of Albert V.’s injury and its attempted resolution lay Pont’s desire to promote his work, even if to a limited audience. Accordingly, the photographs were carefully chosen for the album (Mazaleigue-Labaste, 2015).

With regard to the ethical challenges posed by the provocation of emotions, it is reasonable to suggest that it is perfectly acceptable for the viewer, historian or not, to react to and interpret an image in terms of their personal feelings. Whether positive, negative, indifferent, these remain sentient reactions to an image. This portrait is an example of how an image forces the viewer to confront their own emotions, if not that of the sitter and the artist as well.  However, the methodological tools we have as historians allow us step back and take into consideration the broader context of these materials and hopefully reach a satisfactory, balanced conclusion to our inquiry.

Author Bio

Juliet Roberts is a second-year PhD candidate based at the Centre for Contemporary and Digital History at the University of Luxembourg. Her interest lies in artistic representation of facially-wounded soldiers from World War I. Following on from her Master’s research on the theme, her PhD project is entitled Altered Images: A Comparative Study of Medical Portraits by Henry Tonks and Raphaël Freida in the Great War.

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