Can I take your photograph?

This is the second blog in a series of four in which I document my research in Dhaka and the Sirajganj district of Bangladesh. You can read the first post here. My work was facilitated by Lepra, but all views expressed are my own.

The first time was an awkward neck-crick inducing in-flight selfie with a little girl who watched A Bug’s Life on repeat (cue uncontrollable sobbing each time the grasshoppers bring their greedy ruination of the bugs) and her mother. Both also in-transit through Dubai, by the time we’d landed we had bonded over our collective Frozen screening (compulsory watching should be introduced during political question times nationally. Walt Disney: infamous cohesive gelling agent) and a selfie was deemed warranted.

From that point forward every tourist snap I took in Bangladesh was matched by at least two less than subtle phone shutter snaps and camera flashes not to mention the many, many photos taken upon request. I’m not averse to ridiculous gurning shots for my social media profiles, but the sudden level of interest in me as subject was both as hilarious as it was unexpected and unnerving. So much so that I actually questioned it.

A shop opposite the TB/Leprosy clinic in Sadar, Sirajganj. Image Credit: A. Bow-Bertrand

A shop opposite the TB/Leprosy clinic in Sadar, Sirajganj. Image Credit: A. Bow-Bertrand

When based in Sirajganj, the requests increased which is perhaps understandable given that many locals had never met nor seen a fair-skinned individual in person. Indeed, my Bangla soon developed an armoury of vocabulary based on what might be termed shouts of surprise namely ‘white’, ‘lady’ and similar that would travel up the street bringing with it an audience before our rickshaw had so much as careered past the first roadside tea stall. There is something of the Instagram fever here – the desire to showcase something perceived as ‘other’ or different for appraisal.

Mobile phone usage is as pervasive as social media and without any judgement being passed, wishing to record the novel or atypical is perhaps an innately human desire to have and to hold something that might otherwise be fleeting or difficult to memorialize without physical evidence. After all, so much photography is about capturing snippets of narrative, or perhaps more importantly, in triggering one. Indeed, this must be the reasoning behind my presence in many distant selfie snaps from sneaky youth paparazzi. I can only apologise that these records will feature a generally sweaty me – not my best angle by all accounts.

But this is not a linear activity. During my fieldwork interviews, it was the norm for clinic staff to photograph patients to support written disability assessments, presumably as a visual point of reference. These images fill iPhone camera rolls and personal cameras – stills of entire people rather than dismembered or exposed bodily segments. These photographs are identifiable and identifying, something that would rarely be seen in our own National Health Service. But there is real value in these visuals in this context. The rural population from whom we drew persons with leprosy for interview has a wildly variant education level from illiteracy to higher secondary education (equivalent to A2 levels in England).

Image Credit: A. Bow-Bertrand

Image Credit: A. Bow-Bertrand

Visual used during FGD. Image Credit: A.Bow-Bertrand

Visual used during FGD. Image Credit: A.Bow-Bertrand

What is seen, and re-seen, is the single common denominator of information dissemination in Sirajganj supported by the spoken word (necessarily barring those persons with hearing or visual impairments). As such, the basis of my focus group discussion (FGD) was a series of visual aids or themed drawings inspired by lexical codes established from the semi-structured interview transcripts with these participants. But of course, perception and comprehensions derived from the visual are not fixed. The opening activity of the FGD was a word association exercise, which invited participants to express states or labels associated with the image they were witness to. For instance, a line drawing of a Singer sewing machine garnered reactions of ‘sewing machine’, ‘weaving’, ‘income’, ‘employment’, ‘asset’, ‘own home’, ‘independence’, ‘hard with clawed fingers’, ‘heavy’ and ‘job’.

Image Credit: A.Bow-Bertrand

Image Credit: A.Bow-Bertrand

VIsual aids used for FGD ordering activities. Image Credit: A.Bow-Bertrand

Visual aids used for FGD ordering activities. Image Credit: A.Bow-Bertrand

So too, the clinic staff’s photographs of the participants with leprosy do not tell a singular, nor comprehensive, narrative of the individual depicted. From the nascence of a research question, my focus has been on the experiences of psychological distress amongst this target populace, or rather the awareness of limitations or challenges to the mental health of the individual. For many of the participants we encountered, disability is measured according to the biomedical model of grading as approved by the World Health Organization (Grade I for anaesthesia to extremities, Grade II for shortening of limbs and fixed or mobile clawing) with diagnosis based on physical, external examination. There is a checkbox for ‘visual disability’.

However, mental health here, like mental health anywhere in the world, is rarely ‘visible’. This idea proved to be both difficult to explain to participants versed in this system of disability measurement and for whom understandings are mainly composed from received images rather than from internalized understandings of the self. They are more familiar with the disability gradation of a nose as ‘depressed’ than as a lexical term for a psychological state. The closest to participant self-awareness I discovered was a self-reflexivity in the name of their faith, largely Islam with some 90% of Bangladesh Muslim. The dedication to individual cleansing and improvement in accordance with Islamic doctrine and the affiliation with a deity who is figuratively invisible has useful and potentially productive parallels with investigating awareness of, and experiences of, psychological health.

In profile. Image Credit: A. Bow-Bertrand

In profile. Image Credit: A. Bow-Bertrand

I would be wary of directly inviting participants to parallel their faith-based introspection and worship with an understanding and prioritisation of mental health and self-care, but the two are not so wildly irreparable. What was apparent from my research is that while there is little resistance to mental health per se, this openness is partly owing to its nature as an intangible entity. Stigmatisation of persons with leprosy is almost always related to the visible deformities or physical handicaps associated with late diagnosis and challenged disease management. However, national provision for mental health care and awareness of it as a priority within a multisectoral health system is all but non-existent and resource-poor.

Perhaps the increasing use of interactive healthcare and research techniques such as PhotoVoice in which participants are encouraged to photograph scenarios or things in their everyday life that represent the research focus, could be applicable to mental health work. Just because mental health is difficult to see, does not mean that it cannot be helpfully considered manifest in the physical – an image of a bed perhaps representative of anxiety-induced insomnia, or as a vast white island of security for the depressed patient. I am more than happy for this understanding to be free from labels of the ‘mental’ or ‘psychological’, providing an understanding and prioritisation is established for each person in their own manner.

If this means starting with selfies and inviting a conversation around the resultant medium, then this is something I’ll willingly keep posing in the name of.

Image Credit: A.Bow-Bertrand

Image Credit: A.Bow-Bertrand

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