Introduction

Anthropologists are making more images now than ever before; digital technologies make it easier to capture, save, and share the visual documentation of our research. Medical anthropologists are no exception. Such regular use of digital images reflects comfort with image-making among researchers and subjects alike. This phenomenon marks our own time as notably unlike any other time in the history of anthropology, as in the past cameras were symbols of power, wealth, and prestige. Today, smartphones with cameras are ubiquitous and nearly everyone is comfortable with their use in public and private spaces (Horst and Miller 2020; Miller 2019).

Given this reality, we assume that readers are making images during their fieldwork and are subsequently looking for ways to use them that go beyond simple illustrations—perhaps even ways that expand the reach of their research to new audiences. The photo essay is an evolving form of digital media that has changed the way we create our theoretical and methodological arguments. We feel there are three basic elements every photo essay must consider that are informed by the theory and practice of visual anthropology. While a solid background in visual anthropology is not necessary to produce a successful photo essay, the common assumption that images only serve to illustrate ethnographic text ignores the power images bring to an academic argument and reasserts the primacy of text in the production of knowledge.

The process of successfully using images moves first from the selection of images (or even the conscious creation of the image during fieldwork) to, second, the writing of text , and, third, to the layout of image and text. These three elements may appear simple, but they are deeply informed by ethics, theory, and practice. Being mindful of these three elements in relation to your work will help you develop a photo essay that combines the best of what both media (i.e., images and text) offer your audience.

Taking a position on the photo essay

In response to the need for more considered approaches to the photo essay, in 2017 we urged our colleagues to recognise how images and other digital modalities could play central roles to the ethnographic work of medical anthropologists (Cartwright and Crowder 2017). Images can do the work that often words simply cannot. Images and visual representations can be used to make statements about the human condition that describe, evoke, and illustrate lived realities, tensions, and politics.

The uses and placement of an image in an academic publication must be considered as important to scholars as the written word. Images are not mere decoration. Similar to the manner in which a sentence is crafted, an image is a refined visual product that has undergone a process involving much thought and skill. The creation of the image requires an amount of expertise equal to that involved in crafting text.

In this Position Piece, we present guidelines for the creation of ethnographic photo essays related to medical anthropology that do not simply combine image(s) and text, but that create a balance that allows words to provide context for the image(s) and images to reinforce or challenge the text. We wish to stress that images take us deeper into the sensory knowledge of a subject through a visual portal. In the ethnographic photo essay, images and text must be complementary rather than supplementary to each other (also see Harper 1987; Pauwels 1993; Wagner 2002; Lovejoy and Steele 2004; Sutherland 2016, Marion and Crowder 2013).

The photo essay was born as a journalistic tool, and typically used one image to illustrate a story (Becker 1974; 1995). Over the years, the modality of the photo essay has allowed photojournalists to develop a story through a short series of images by providing detailed captions to establish context. Unlike artistic photography, ethnographic images usually require written context and explanation. In ethnographic research and publications, photos have primarily supplemented or illustrated text, with the notable exceptions of Bateson and Mead (1942), Collier and Collier (1986), Gardener and Heider (1968), and Boas (see Jacknis 1984). As medical anthropologists, we propose that the equal weighting of image and text is a way to make a unique argument, one that is notably different from those presented by illustrations and captions. Pushing beyond photojournalism then, the ethnographic photo essay is well-grounded in theory and is a thoughtful medium for expressing many of the central theoretical and topical concerns of medical anthropology.

We (Crowder and Cartwright) are both trained as medical anthropologists and photographers; we continue to use images (both moving and still) in our research on health and healthcare in the Americas. We use photography in a variety of ways, and many of our projects are not intended for publication or sharing beyond the research project itself. Images are very useful for helping one remember an event or person, or as an elicitation prompt during an interview or conversation (Harper 2002; Marion 2010). Images selected for photo essays then must speak to an audience beyond the scope of the research and offer the viewer a means of engaging with them. When we teach classes or workshops on the photo essay, we help our learners curate their images into small collections that tell stories that others can immediately relate to.

Theory and history of the visual in medical anthropology

In the past, social scientists defined photo essays as descriptive endeavours that did not take into account the positionality of the researcher. [1] With the flexibility of websites, social media, and online gallery applications where researchers can post images in real time, anthropologists now have many options for sharing their work in ways that are both non-linear and more participatory for multiple audiences.

Most recently, Sutherland’s discussion of the photo essay speaks to ethnographers about the photo essay’s journalistic roots, encouraging ethnographers to consider how photojournalists use images as a narrative tool and to understand the essential elements necessary to create their own (2016). Sutherland’s conflation of a narrative photo essay with a ‘form of collage, with images being read individually and also with a wider visual narrative’ (idem, 115) addresses the non-linear nature of websites, social media, and online galleries. Most importantly, he considers how the constituent images interact with each other, their sequencing, and their layout on the page. It is at this specific intersection—where descriptive image meets ethnographic context—that the photo essay resonates with visual medical anthropology. While our photo essays may be similar to those of journalists in their documentary aspects, we ground our work in theory to explore ideas about being human, providing images as data as we argue to make points beyond the empirical. Our ethnographic photo essays can be aesthetically pleasing, politically engaging, theoretically grounded, and ethnographically compelling.

From theory to practice: The praxis of the photo essay in medical anthropology

These are the three elements that make for a strong photo essay:

• Strong images that are aesthetically pleasing, theoretically interesting (meaning they are well composed), and technically strong, with good exposure, a focused subject, etc.
• Concise text that provides context for the images; it should share background or inside knowledge that helps the reader understand what is taking place in the image and why the image was taken.

• Balanced layout that allows the reader to access the content on the page, wall, or website.

We will more deeply describe these three elements in the remainder of this paper and provide some clear examples of photo essays that capture these three elements.

Strong images

There is no formula for making strong images; composition, like any form of expression, must be practised and critiqued. We suggest that researchers think about the aspects of their work that are visually interesting and consider which moments could be photographed in order to tell a story. This is called ‘previsioning’. Image composition, framing, or mise-en-scène includes several elements like lighting, depth of field, arrangement of the subject in the frame, etc. The ‘rule of thirds’ is a common rubric for a basic understanding of how the human eye reacts to subject placement within a frame. Imagine placing a noughts and crosses grid over an image (or over a viewfinder/digital screen) and evaluating where the subject falls within that grid. Theory suggests that the human eye hones in on objects placed near or around the intersections of those vertical and horizontal lines. It does not naturally move to the middle of the image, but to the side and above or below the line across the middle of the frame. Learning how to compose images that capture the eye takes practice. Experimenting with elements like lighting, focus, and subject placement significantly affect the image and the ways in which the viewer engages with the content (see Crowder 2013; Wright 2016).

To improve your composition skills, consider browsing websites, books, and magazines that contain images that appeal to you or that capture the same subject matter that you are addressing. Recognising how images are composed and exposed will help you when you conduct work in the field. There are many photo essays in MAT that are excellent starting points for this sort of exploration. Other publications that may prove useful include Visual Anthropology Review ( VAR ) and Visual Studies , among others.

It should be noted that there has been a resistance to, or hesitation regarding, the use of images in anthropology that is firmly rooted in discussions of power, authority, voice, and representation (Hammond et al. 2009; Wolbert 2000). Community-minded approaches to collaboration and research address these concerns (Liebenberg 2018; Mitchell and Sommer 2016; Wang et al. 1998) and have shown how images can enable empathy and ambiguity as well. Photo elicitation techniques like ‘shooting back’ or ‘photovoice’ are common examples of research methods that combine photographers with ethnographers, usually with the intent of developing a community perspective; such methods translate well into photo essays because of the collaboration involved in their production (Catalani and Minkler 2010; Ewald 2001; Mitchell 2011; Mitchell et al. 2017; Wang and Burris 1997). Often such images are accompanied by text written by the participants themselves; they are given space to provide context for their own images, revealing their own values and the meanings they bring to them.

Collaborations and compilations

As academics, we are taught to pay attention to how we compose our textual arguments. We are taught to edit and re-edit our work. But images too deserve this careful process of thought and refinement. Collaboration between ethnographers and photographers can be exciting and impactful (e.g., Bourgois and Schonberg 2009); collaborative photo essays that highlight the strengths of both professions can often address a topic more thoroughly and profoundly than single-author essays. We encourage researchers to work with photographers (either amateur or professional) and create photo essays that reflect a variety of approaches to the same topic.

Sometimes in reviewing our images we find two or three that work well together either because they complete a thought or moment or because their subject matter contrasts with the aesthetics of the image in an informative manner. Combining them into a diptych or triptych shows those relationships. A compiled image may only ‘count’ as one image in the larger scheme of the photo essay. However, the images must be smaller in order to be placed together in the one image’s worth of space. Compilations only work with images that are oriented in the same way (vertical or horizontal).

Concise text

Text developed for the photo essay should be accessible and concise. If necessary, theoretical premises and research methods should simply set the stage for the work itself, and the main body of text should provide context for the images in a complementary rather than supplementary fashion. Text should not describe the scene. Instead, text should support the image(s) by explaining who the subjects are, the anthropological importance of what is taking place, the ethnographic details that enhance the power of the image, and the (medical) anthropological argument that the piece is presenting.

Likewise, long paragraphs of text tend to detract from the images. Readers’ attention will inevitably jump between image and text throughout the photo essay; as such, while front-loading the photo essay with details may appear appropriate, it in fact often burdens readers/viewers with decontextualised information. Leaving text until the conclusion/finale works to prioritise the body of images but may ultimately overpower the viewer due to the bottom-heavy separation of information from subject matter. When preparing text for an image, approach it like writing an abstract: provide essential information not available through the image itself and some basic analysis based on ethnographic understandings of the story and its development.

While citations and quotations support our academic arguments, they should be used sparingly in a photo essay, as word limits are usually small (fewer than 2000 words). Use your own words, not someone else’s, unless a quotation comes directly from the research itself and either provides context or helps develop a character in the visual narrative. Anthropological theory helps frame your argument; cite the influential work, but refrain from quoting from it at length. Instead, write with confidence, concisely demonstrating how theory informs the work by paraphrasing it.

Audience

Equally important when developing the story is understanding the photo essay’s audience. Professional or novice, researchers should not discount their assumptions regarding their potential audience. Shots should be carefully selected, either during the research event of photographic interest or following it. While we encourage researchers to go into the event with the intent of making a series of images that can be used in a photo essay, many others may return to their collections of images to develop a story that was not relevant or obvious at the time the images were made (Crowder 2013).

The audience is also critical to consider when thinking about how images go together and how textual information should be worded. We cannot second-guess who our audience will be, but we can gain a general understanding by placing a photo essay in a professional journal rather than in a local newspaper or museum. By speculating about what our audience may already know about the subject matter, place, or people featured in our photo essay, we can make more informed image selections and write more precise contextual information. Colleagues will have a strong understanding of theory, whereas the general public may not; therefore, in a piece intended for the general public, referring to theorists may be inappropriate even in theory-driven research. Conversely, professional audiences may find ethnographic detail and theoretical nuance necessary to relate to a photo essay and the research it represents.

Balanced layout

Once the images have been selected and the text edited, the third element of the photo essay comes into play. It is through the layout of the text and the images that the message of the photo essay is clearly and effectively conveyed to the reader. It is essential that the layout is pleasing to the eye, whether the essay is digital or physical. In a balanced layout, the image is large enough to easily view and the text (box) does not distract from the image itself. Some journals have predefined layouts for their photo essays, reflecting an understanding of how images and text work together. Others may not, and may place the image along with the text in a double column; make sure you are familiar with previously published photo essays in the journal you are submitting to. Before submitting your photo essay, lay it out in publishing software or a word processor. Experiment with photo order, orientation, and text box placement. Print it out if you have the means to do so and see how it looks on the printed page. Doing so will help you recognise how well the piece flows and how it may be tweaked to improve balance. Never underestimate the editing process when it comes to crafting a balanced and accurate photo essay.

Here are some thoughts on what makes for a balanced layout:

Size your images consistently. In post-production, resize all of your images to the same dimensions (whether in inches, centimetres, or pixels). Too many different sizes can be distracting to the viewer. Make sure the images are large enough that all details can been clearly seen. The format of the images will also inform the way in which they may best be produced. Review how the journal you are planning to submit to lays out its images and follow their production guidelines. [2]

The orientation of your images (vertical or horizontal) determines how large they can be on the page; it also affects how many words effectively fit on the page. Keeping your text and images on the same page is paramount; readers do not want to flip between pages to continue reading text on the page following an image. Remember that compilations are useful for making mini visual statements, but that individual images must all have the same orientation in order for the diptych or triptych to work effectively.

Write roughly the same quantity of text for each image. You might try keeping a strict word limit for each image or developing as much context as you think necessary and then editing it down to five or six sentences per image. Either way, text-heavy pages look awkward and can discourage readers from completely reading the work.

Some thoughts on Photo Essays for MAT

The key to a strong MAT Photo Essay is the selection of images that fit together to make a visual argument (Barthes 1977, 93; Wright 2016, 143–44). There is no specific number of images you must include in a Photo Essay; however, bear in mind it is an inherently short form that offers the potential to bring the work of anthropologists to a broad audience. As in writing, good editing tightens up the message, easily moving the viewer through the material. As concise writing requires the consideration of each word, photos must be considered for their visual merit in the context of the argument of the essay. Analogue media traditionally required the photos in a Photo Essay be placed in a particular order (e.g., in a book, on a wall) but in the digital age viewers can access specific images immediately (e.g., through online galleries). In MAT , we publish images in a specific order (see Layout ) and feel the relationship between images must be considered when developing a Photo Essay. We take into account how well images work together or resonate with each other with regards to colour, content, and orientation. The order of images should tell a story, develop an idea, and create an atmosphere.

Authors should consider submitting a series of between five and 12 photos. These are not arbitrary figures; they are based on our history creating and publishing Photo Essays in MAT and our knowledge of what works best in our electronic format. We emphasise a selection process that begins with no more than 20 potential images, which are then whittled down by way of asking a series of questions:

1. How essential is this image for conveying the story?
2. Is it a strong/evocative/compelling image? Is it technically strong (focus, lighting, cropping, etc.)?
3. Is it redundant next to any other image?
4. Is there sufficient ethnographic information to help provide context for it?
5. Do I have permission to use this image in this way?

Often, we subconsciously select our favourite images to include without understanding what makes them special to us. In such cases, the logic we use to justify our affection may not translate to the viewer. The viewer then, through our text, will learn that the image reminds us of a moment, person, or event that is personally meaningful, but probably not important to the story at hand. (Or maybe we just like the image because it is pretty!) Instead, consider the images that satisfy the questions above and arrange them in a way to share with colleagues or participants. Keep in mind that the point of a Photo Essay is to advance a message and tell a story that produces new knowledge about the human condition. As the number of potential images are honed down, the message becomes tighter and better focused.

Conclusion

Medical anthropologists who take images during fieldwork and who have consent from their participants may want to consider the photo essay as an academic medium for expressing their ideas. The medium challenges the reader to ‘see’ through the eyes of the author and explores beyond conventional ethnographic authority. In the field of medical anthropology in particular, academic readers, having visually placed themselves in the photographed environment, may be prompted to see new relationships or tensions between healthcare, wellness, and disease that they had not considered before.

Acknowledgements

The authors would like to thank Terence Wright, Jonathan S. Marion, Stephanie Takaragawa, Andrea Heckman, Malcolm Collier, Mark Westmoreland, Brent Luvaas, and Richard Freeman, who have provided feedback, collaborated, co-taught, or brainstormed with us about the uses of the photo essay as an academic medium in anthropology. We are grateful for the suggestions and insight provided by our peer reviewers, which strengthened this piece immeasurably.

About the authors

Jerome W. Crowder is an associate professor in the Department of Social and Behavioral Sciences at the University of Houston, College of Medicine. Trained as a medical and visual anthropologist, Crowder’s applied work has appeared in journals, books, and museums throughout the Americas. He co-edited an issue of Medical Anthropology (2017) on the role of images in medical anthropology research and was photo editor for The Handbook of Medical Anthropology (Routledge, 2016). Crowder is the co-author of a book published by Bloomsbury Academic Press titled Visual Research: A Concise Introduction to Thinking Visually (2013) and is a co-editor of Anthropological Data in the Digital Age (Palgrave, 2020).

Elizabeth Cartwright is professor of anthropology at the Department of Anthropology, Idaho State University. She has focused much of her work on visual methods, employing filmmaking, photography, and a variety of multi-modal approaches in her applied medical anthropology projects. She co-edited, with Crowder, a special issue of the journal Medical Anthropology (2017) that wove together visual methods and medical anthropology theory in new and innovative ways. She and her students present the annual SpudDance Ethnographic Film Festival, which showcases regional stories from the Intermountain West, and she regularly teaches an online course in multi-modal ethnographic field methods. She is the current photo essay editor for MAT.

Footnotes

1. Grady states that a photo essay is ‘a statement about human affairs that purports to represent reality and is consciously and creatively crafted from non-fictional materials that are, at least in part, directly connected to the affairs this represented. The primary medium of expression for the statement is some variant of photographic imagery’ (Grady 1991, 27; also see Harper 1987; Pauwels 1993; Simoni 1996). Sarah Pink (2004) has discussed the photo essay as ‘appropriate for representing [the] certain types of ethnographic knowledge’ that appear predominantly as photographs in books, chapters, and articles alongside text, ‘each representing ethnographic knowledge in ways that the two media best lend themselves’ (177). ↩︎

2. MAT ’s submission guidelines can be found at http://www.medanthrotheory.org//ContributionTypes#PhotoEssays . ↩︎

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