[In the following review, Kleinman praises Regarding the Pain of Others for not only displaying human fascination with images of death and pain, but for urging readers to view such images with sympathy and compassion.]

Susan Sontag has been, since the 1970s, one of the leading public literary figures in the United States. In addition to six novels, two film scripts, and a play, she has written eight books of essays. Two of the latter are widely cited meditations on medically relevant topics. Illness as Metaphor and AIDS and Its Metaphors, books that are taught to medical students in courses in the medical humanities and social sciences, illustrate the power of meaning to shape experiences of pain and suffering, often in ways that create problems for patients and practitioners.

Sontag also wrote one of the earliest and most penetrating and influential interpretations of photography in modern society, On Photography. In the early 1990s, during the horrific civil war in Bosnia, Sontag traveled to Sarajevo, from where she penned powerful pieces on the brutal effects of the fighting and the social forces that fueled its explosions of inhuman political violence, pieces that also burned with passionate criticism of the seeming incapacity of Europe, the United States, and international agencies to intervene effectively to stop the bloodshed, psychological trauma, and societal destruction.

All of these themes come together in a powerful and disturbing way in her brilliant new book, Regarding the Pain of Others. Sontag focuses on photographs of pain and suffering that are caused by “hellish events,” especially war (p. 26). Photographs, she avers, unite opposites: objectivity and a special point of view. Sontag insists “to photograph is to frame, to frame is to exclude … it has always been possible for a photograph to misrepresent” (p. 46). Yet, in commonsense realism, “A photograph is supposed not to evoke but to show. That is why photographs, unlike handmade images, can count as evidence” (p. 47).

Sontag reminds us of Ernst Friedrich's Krieg dem Krieg! (War Against War!), a book of photographs from the First World War that was deemed unpublishable by German censors while the war was being fought because of the horror the photos portray, including close-ups of soldiers with difficult-to-look-at gaping facial wounds. The purpose of this picture book was to shock readers with graphic evidence of the immense destructiveness of the Great War, a war in which 1.7 million Germans died. Here photography not only acknowledges social suffering but also offers a protest. That this protesting image and the many others used by antiwar activists offered no serious resistance to the gathering storm of fascism and Nazism that only a generation later would create a second world war, with at least fifty million deaths, reminds us soberingly of the limits of images to prevent the very real dangers in human experience. To be sure, Sontag also reminds us that images of horror and gore can feed a prurient voyeurism that many of us are capable of experiencing.

Sontag joins earlier critics of the famous war photographer Robert Capa's iconic photograph of the Spanish Civil War depicting a Republican soldier at the very instant he is killed by enemy fire. Other evidence suggests that this universally recognized photo was almost certainly staged and may have recorded a training exercise. Many of the most memorable pictures from the Second World War were indeed staged, including that quintessential picture of American military bravery that conjures patriotic sentiments each Veteran's Day, the photo of American servicemen raising the Stars and Stripes over Iwo Jima in the winter of 1945. Live television broadcasts, such as those by “embedded” reporters in the Iraq War, may prevent staging; still, the ability to frame and interpret make point of view as crucial to photography now as in the past, as anyone comparing images from Iraq on American and Arab television can attest.

One widely cited picture of human suffering that Sontag does not discuss, but that makes many of her points, is a picture that won the South African photojournalist, Kevin Carter, a Pulitzer Prize.¹ It frames an isolated toddler bent over in a stubble field in southern Sudan during a famine. Near the dying child is a large black vulture poised, it seems, to move in for the kill. The message is stark and terrible: look at what a basket case Africa is. Africans can't even protect their own children from natural disaster. Leading international nongovernmental organizations featured the picture in their campaigns for funds to relieve the dire plight of famine victims. Almost everything the picture depicts is seriously misleading. It took Carter days of tramping through the brush to find a child separated from its family. The so-called natural disaster is in fact a political strategy in Sudan's decades-long civil war by which the government, dominated by northern Muslims, seeks to subdue the Christian Nilotic tribes of the south. The evil symbolized by the menacing vulture is actually situated in the political offices and military barracks in Khartoum. Although Leonardo da Vinci ordered artists who depict war to be “pitiless” and to appall, critics of Kevin Carter (who, shortly after receiving his prize, committed suicide) wanted to know how he could take such a picture while the vulture acutely threatened the child. How long did he wait before he intervened? Was he inhuman and unethical? Sontag's powerful essay includes at least one troubling ethical issue in every chapter.

It used to be thought, when the candid images were not common, that showing something that needed to be seen, bringing a painful reality closer, was bound to goad viewers to feel more. In a world in which photography is brilliantly at the service of consumerist manipulations, no effect of a photograph of a doleful scene can be taken for granted. As a consequence, morally alert photographers and ideologues of photography have become increasingly concerned with the issues of exploitation of sentiment (pity, compassion, indignation) in war photography and of rote ways of provoking feeling.

(Pp. 79-80)

Pictures, actually home photos, taken by whites watching the lynching of black men in the American South “tell us about human wickedness. About inhumanity” (p. 91). Sontag is attracted to the notion that “there exists an innate tropism toward the gruesome” (p. 97). Pain and suffering can be represented to beautify, to uglify, to steel the observer, to numb her, to “acknowledge the incorrigible,” to haunt, and to transform (p. 98). Just as pain transforms the sufferer, pictures of pain can transform the observer, making a bystander into a witness, a member of a lonely crowd into a social activist, a nonengaged observer into a healer.

In the essay's closing pages, and to her great credit, Sontag turns from “regarding the pain of others,” with its primary emphasis on representation and interpretation, to the reality of the suffering itself, the experience of injury and loss. Without explicitly saying so, Sontag is criticizing writers who so readily forget that images of pain are not only images, who may even seek to weaken the authority of the real world. Trauma and dying are lived. Danger is at the very core of the experience of most men and women. Sontag has been in the thick of battle; she knows what violence is about. She knows that to be there demands practical action:

To speak of reality becoming a spectacle is a breathtaking provincialism. It universalizes the viewing habits of a small, educated population living in the rich part of the world, where news has been converted into entertainment. … It assumes that everyone is a spectator. It suggests, perversely, unseriously, that there is no real suffering in the world. But it is absurd to identify the world with those zones in the well-off countries where people have the dubious privilege of being spectators, or of declining to be spectators, of other people's pain, just as it is absurd to generalize about the ability to respond to the sufferings of others on the basis of the mind-set of those consumers of news who know nothing at first hand about war and massive injustice and terror. There are hundreds of millions of television watchers who are far from inured to what they see on television. They do not have the luxury of patronizing reality.

(P. 110)

So much has been made of the moral duty to remember trauma through pictures that Sontag's admonition to forget, to allow pictures to lapse into amnesia in order to stop the cycles of killing, comes as a shock, as does her argument that there is no difference between watching suffering at a distance and up close. One wants to argue back, and that is a virtue of the great clarity of her writing and the compelling logic it conveys—a forceful position moves the reader to want to argue back.

Interpreting an art photo of dead Russian soldiers in Afghanistan, intended by its creator to haunt the everyday, Sontag concludes,

What would they have to say to us? “We”—this “we” is everyone who has never experienced anything like what they went through—don't understand. We don't get it. We truly can't imagine what it was like. We can't imagine how dreadful, how terrifying war is, and how normal it becomes. Can't understand, can't imagine. That's what every soldier, and every journalist and aid worker and independent observer who has put in time under fire, and had the luck to elude the death that struck down others nearby, stubbornly feels. And they are right.

(Pp. 125-6)

And this is also the issue for physicians involved in responses to war and other forms of political violence: Can we project to policy makers the actual horrors of war, so that the terrible burden of our experiences can bring the reality of social suffering to weigh on those who are responsible for waging war, to move them to prevent it?

Note

1. Arthur Kleinman and Joan Kleinman, “The Appeal of Experience; The Dismay of Images: Cultural Appropriations of Suffering in Our Times,” Daedalus 125, no. 1 (Winter 1996): 1-23.