SMSXXX10.1177/2056305116641343Social Media + SocietyTembeck 641343research-article2016

SI: Selfies

Social Media + Society January-March 2016: 1­–11 Selfies of Ill Health: Online © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav Autopathographic Photography and DOI: 10.1177/2056305116641343 the Dramaturgy of the Everyday sms.sagepub.com

Tamar Tembeck

Abstract This article offers a preliminary investigation into what I term “selfies of ill health” and traces the expansion of the autopathographic genre in visual media from professional art photography to the vernacular selfie in recent years. In this context, the word autopathography is used to describe self-representational practices that offer a first-person perspective on experiences of illness or hospitalization. I first situate the genre by identifying several typologies of selfies of ill health, including diagnostic selfies, cautionary selfies, and treatment impact selfies. I then focus on the forms of identity performance that selfies, and selfies of ill health in particular, deploy. I argue that the performative qualities of certain selfies of ill health overlap with salient characteristics of autopathographic practice in the arts. Using Karolyn Gehrig’s #HospitalGlam series as a case study, I examine how autopathographic selfies can also construct a politicized dramaturgy of the lived body, notably by enabling individuals like Gehrig to “come out” as being invisibly ill. I conclude that the dramaturgical thrust of such autopathographic imagery is to convey both the centrality of medical experiences in subjects’ lives and their specific desire to be publicly identified as persons living with illness. In light of this, although selfies of ill health may have opened up new avenues for autopathographic practice thanks to the affordances of social media, their communicative intents remain consistent with those of earlier forms of autopathographic photography.

Keywords selfie, illness, autopathography, self-representation, self-portrait, social media

Introduction Among many new trends of online self-imaging that have coming from literary studies, refers to a sub-genre of autobi- arisen thanks to the ubiquity of smart phones, the rapid ography in which the life narrative pivots around an experi- increase in data storage capacities, and the proliferation of ence of illness, an accident, or trauma, hence the replacement image-sharing platforms, representations of illness have of the root word bios with pathos. The term is adopted here gained an unprecedented public presence. These “selfies of to describe visual self-representational practices that offer a ill health,” as I dub them, are surprisingly wide-ranging in first-person perspective on experiences of illness or hospital- scope: broadly disseminated images include a number of ization. This article presents a preliminary investigation into celebrity hospital selfies (e.g., Yahoo Celebrity UK, 2013), a particular subset of selfies of ill health which, while an aspiring model’s bikini selfie showing two colostomy anchored in earlier forms of performative photography, pro- bags (Birch, 2014), a selfie-video of a stroke in progress vide new outlets and purposes for autopathographic practice (Ahmed, 2014), and the #NoMakeupSelfie trend purportedly thanks to the affordances, both technological and imagined used to help raise cancer awareness (Dockterman, 2014). (Nagy & Neff, 2015), of social media. Notwithstanding the widespread tendency to pathologize the very phenomenon of taking and sharing selfies (Senft & McGill University, Canada Baym, 2015), selfies of ill health constitute a significant incarnation of the autopathographic genre in contemporary Corresponding Author: Tamar Tembeck, Media@McGill, McGill University, 840 Dr Penfield, image-based practices, given the abundance and range of Room 231, Montreal, Quebec H3A 0G2, Canada. these images now in circulation. Autopathography, a term Email: [email protected]

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Situating Selfies of Ill Health: A Preliminary more about them, with the intent to perhaps try them out Overview of the Genre themselves (see De Choudhury, 2015; Schott & Langan, 2015; Seko, 2013). As such, while pro-ana or self-injury self- As Theresa M. Senft and Nancy K. Baym (2015) have noted ies may ultimately find their way to the eyes of the general in their pioneering review of this “global phenomenon,” the public, their intended target viewership is decidedly more selfie is not merely a “photographic object”; it is also “a restricted. practice—a gesture that can send (and is often intended to A third category of selfies of ill health serves to acknowl- send) different messages to different individuals, communi- edge the impact of illness or treatments on the subject. These ties, and audiences” (p. 1589; emphases in original). As such, autopathographic images are often circulated for the benefit even within the specific category of selfies of ill health, a of peer education, but in contrast to the two instances above, number of discrete sub-genres may be distinguished, both in their intended audience is not limited to communities with a terms of the subject matters the images address and in terms confirmed interest in a particular health condition. Images of their communicative intents. The following typologies of fitting within this category include what I term diagnostic selfies of ill health are grounded in my personal observations selfies: Stacey Yepes’ April 2014 selfie-video, taken as she of the genre’s emergence in social media and are nourished was experiencing numbness on the left side of her body by my ongoing research in the area of autopathographic pho- while in her car, first educated the medical community by tography (Tembeck, 2008, 2009, 2011, 2014). The examples aiding Yepes’ physicians to come to a conclusive diagnosis from which these typologies draw have been culled from of her transient ischemic attack or mini-stroke. Once the images that garnered widespread attention in social and mass video was shared online and then covered by the press, it media, as well as images retrieved through limited online served to help the general public recognize the signs of a searches, using keywords such as #hospital, #selfie, and stroke as well (e.g., “Stroke Diagnosis,” 2014). Other forms #me. The descriptors used to differentiate the categories of of popular education illness selfies include what I describe as selfies of ill health listed below are chosen in accordance cautionary selfies: photographs that are intentionally circu- with Carolyn R. Miller’s (1984) understanding that “a rhe- lated as a warning to the public. For instance, Tawny torically sound definition of genre must be centered not on Willoughby’s widely disseminated April 2015 posting of a the substance or the form of discourse but on the action it is photograph on Facebook shows her facial scabs resulting used to accomplish” (p. 151). As such, the categorizations from skin cancer. The image is accompanied by a comment that I propose to distinguish different types of selfies of ill in which Willoughby (2015) promotes the use of spray tan health depend not only on their variations in form or the- and sunscreen over tanning beds and sun exposure. Treatment matic content but also on their variations in communicative impact selfies such as Laura Price’s (2014) time-lapse video intent. composed of selfies taken daily, which document her chang- A first sub-grouping of selfies of ill health encompasses ing appearance over a period of 18 months after she had com- selfies whose appearances and purposes are essentially indis- pleted chemotherapy treatments, also fall under the broader tinct from those of selfies produced in any other context, category of illness impact selfies that are shared for the ben- except for the fact that these images may include indications efit of peer education. This characteristic is only reinforced of either a medical environment (e.g., medical furnishings) by the ways in which such images are received and framed or a health condition (e.g., a hospital gown). These selfies by popular media (e.g., Hodgekiss, 2014). reproduce the familiar poses and framings of selfies at large, The above categorizations offer but a preliminary glimpse but without any apparent modification attributable to the into the genre of selfies of ill health, and would merit further experience of illness or hospitalization. While such self- expansion through future research. My focus here is primar- images may indeed be tied to medical experiences, these ily on images that belong to the third category of selfies of ill experiences hardly appear to direct or even inform the health—autopathographic images that attest to the impact of image’s content. In other words, a selfie taken by a patient in illness or its treatments on the subject—however these still a health-care environment does not necessarily amount to an need to be understood in relation to broader practices of self- autopathographic selfie. ies at large, and against other categories of selfies of ill health A second grouping of selfies of ill health circulates among in particular. In an autopathographic selfie, the representa- online communities to promote or offer support for certain tion of an experience of illness not only constitutes an inte- behaviors that are generally deemed pathological: images gral part of the image’s subject matter but also serves to shared on Tumblr in the “pro-ana” and “pro-mia” move- publicly attest to the pictured subject’s identity as an indi- ments (supporting anorexia or bulimia), for instance, or self- vidual living with illness. While this form of self-imaging injury photographs circulating on Flickr (Seko, 2013). emerged alongside other related products of the Web 2.0 Setting aside the difficulties in addressing the subject matters generation, including the rise of e-patient movements and the of these images, it is of note that they are generally directed growth of online illness support groups, autopathographic toward like-minded online communities: people who already selfies can also be understood as the prolongations of earlier partake in similar behaviors, or who are curious to learn forms of performative self-representations that center on the Tembeck 3 experience of illness (Tembeck, 2009). In light of this, in the the instant connectivity of apps like Instagram to users’ article’s next section I will situate the expansion of the auto- Facebook or Twitter accounts), the selfie is also susceptible pathographic genre from professional photography and per- to appropriation and remediation (Baym & boyd, 2012).1 formance to the vernacular selfie in recent years. My aims Even when used in the somewhat more “fixed” form of an are to identify the primary characteristics of these emerging online avatar or profile picture, the selfie effectively becomes selfies of ill health and to investigate the extent to which they a technology of embodiment (Jones, 2002), a virtual social overlap with other forms of contemporary autopathographic (inter)face through which users engage with other actors— imagery in the arts and with broader social media practices. human or non-human—who are surfing the web. In the subsequent section, I will examine how a more politi- Given its widespread sociality, the selfie offers a privi- cized dramaturgy of the lived body can be discerned within leged means through which to continually explore possible the autopathographic selfie and identify specific representa- relationships between one’s personal sense of identity and tional codes called upon to that end in Karolyn Gehrig’s one’s public self-image. As Rob Cover (2013) has suggested, #HospitalGlam series. Gehrig’s production repurposes the rather than seeing social media users’ identities as “fixed, selfie medium in order to explore the relationships between static, and merely represented or expressed through online illness and representation in everyday life, shedding light on activities,” scholars ought the personal and political stakes of making ill health publicly visible online. While hers is not necessarily a dominant to consider the ways in which social networking sites operate as incarnation of the autopathographic selfie genre, it offers a a space for the continued, ongoing construction of subjectivity— particularly compelling case study through which to better neither as a site for identity play nor for static representation of understand selfie production as a form of identity perfor- the self, but as an ongoing reflexive performance and articulation mance that holds repercussions both on and offline. of selfhood. (p. 55) In this optic, activities undertaken in social media are not A Picture to Be Seen: Selfies and Identity merely reflective of the everyday presentations of self that Performance occur offline; rather, they count among the very spaces through which such explorations are effectively performed Current scholarship positions the practice of the selfie in the today. With its characteristic seriality due to frequent itera- aesthetic line of the self-portrait and in a technological lin- tions and its insertion into larger forms of online autobiogra- eage that descends from automated photographs enabled by phy or self-portraiture such as personal profile pages on devices such as Polaroid cameras or photo booths (Levin, social media accounts, the selfie is a particularly apt site for 2014; Rettberg, 2014; Tifentale & Manovich, 2015). While investigating longitudinal performances of the self. Their this aesthetic and historical positioning accounts in part for discrete incarnations become interwoven with other photo- the selfie’s characteristic subject matter (a picture of oneself) graphic traces of everyday activities, from meals eaten to and production format (rapid, automated image capture and people encountered, places visited, or events witnessed.2 treatment), it does not take into consideration the immediate What most distinguishes the selfie from earlier forms of and ubiquitous modes of dissemination that are proper to the self-portraiture is the fact that the publicly oriented function web. As Alise Tifentale and Lev Manovich (2015) observe, of the image is already embedded within the gesture of tak- these characteristics are so intimately bound with selfie pro- ing the photograph, given the immediacy and potential duction that they cannot be distinguished from its unique rai- breadth of its dissemination—hence my framing of this form son d’être: the instantaneous and prolific spread of the selfie of self-portraiture as a type of dramaturgy: the selfie crystal- across multiple social media and image-sharing platforms is lizes what Erving Goffman (1959) dubbed “front stage” integral to what constitutes its distinct identity within a behavior. However, certain forms of pre-digital autopatho- broader array of self-imaging practices. graphic imagery also conveyed a strong transitive intention, As a born-digital genre, the selfie is not just an automated suggesting—perhaps surprisingly so, given their ostensibly picture of oneself; the selfie is, per the Oxford English taboo subject matters—that these self-portraits were emphat- Dictionary’s (OED) definition, a self-image that affords ically meant to be seen by others. With the intent to show instantaneous sharing with myriad receivers, both known oneself in these autopathographic images, certain scripts and unknown to the pictured subject: “A photographic self- played out that helped to determine not only what exactly portrait; esp. one taken with a smartphone or webcam and was to be seen but also how it ought to be interpreted. shared via social media” (“Selfie, n.,” 2014). By this token, For instance, in autopathographic photographs and self- the selfie is very much a publicly oriented image of oneself, portraits produced by professional artists—ranging from specifically destined to circulate amidst the shifting ecolo- Albrecht Dürer’s self-portrait drawing as a sick man in the gies of social media environments and beyond the control of early 16th century, through to Frida Kahlo’s, Günter Brus’, the original emitter. The selfie is thus implicitly social, but and Hannah Wilke’s painted and photographic self-portraits in since it is often directly tied to social networks (e.g., through the 20th century—there is a recurrence of the subject shown in 4 Social Media + Society

a frontal pose with a gaze directed straight toward the viewer, consistent with the willful intent to show oneself as being ill or in treatment.3 Such a pose carries a demonstrative quality; it appears to say, “I present myself/my body in this way before you for you to observe.” Particularly in the context of breast cancer activism, being seen as sick (or as having been sick) was in part the very purpose of the self-portrait images pro- duced by Jo Spence in the United Kingdom (Figure 1) and Matuschka in the (Dykstra, 1995; Spence, 1988). Both photographers specifically sought to counter the illness’ lack of visibility outside of a medical context, and wanted to produce images that ill women might relate to dif- ferently than pictures of cancerous cells seen through the lens of a microscope, or of women wearing wigs and mammary prostheses, having effectively evacuated the disease from their sight (Cartwright, 1998). Autopathographic photographs such as these also carry a documentary function, attesting to personal experiences of illness or hospitalization. Since the disease itself often can- not be shown, its presence becomes legible only through the signs of its treatment or of the medical environment in which the picture is taken. In their respective autopathographic self- portraits, performance artists Günter Brus and Hannah Wilke may be read as being sick or in treatment due to the medical Figure 1. Jo Spence/Terry Dennett, Crash Helmet Portrait, 1983, paraphernalia that surrounds them, while Matuschka’s and © Spence’s scars on the breast become the visible indices of the The Cancer Project series. Jo Spence Memorial Archive. Courtesy of Terry Dennett. malignant tumors that were once present, now removed (Tembeck, 2009). But in addition to offering indirect visual evidence of present or past ailments, explicitly autopatho- beyond, on the other (boyd, 2011; Levin, 2014). Nowhere is graphic images—images that feature or announce illness as this duality clearer than in celebrity hospital selfies, which integral to their subject matter—operate as statements con- espouse the codes of these two seemingly incompatible firming that these experiences should be regarded as integral impulses: showing one’s ailing condition as well as one’s parts of the subject’s life, even when the image does not nec- exceedingly mastered appearance, as evidenced in hospital essarily give any indications as to how the health condition is selfies recently circulated by Miley Cyrus, Justin Bieber, experienced. This particular function of the autopathographic Kelly Osborne, , , and many others.4 image—the deliberate inclusion of illness in the photo- But in contrast to Matuschka’s production, which combined graphic account of oneself (Tembeck, 2009)—can also be the slick look of fashion photography with the sight of her found in selfies of ill health. What is common to the vernacu- mastectomy scar, the celebrity-type “sickbed selfie” (Yahoo lar selfies of ill health and to the autopathographic photo- Celebrity UK, 2013) all too often denies any specific value graphs produced by professionals is the communication of a to a particular health condition. A celebrity selfie by any decidedly willful display of the health condition on behalf of other name is simply yet another celebrity selfie: the context the author. In a visual culture where non-medical representa- changes, but the pose remains. The same applies to a vast tions of diseases such as breast cancer were long excluded breed of selfies of ill health produced by non-celebrities (Cartwright, 1998), the deliberate inclusion of signs of ill- who wish to emulate celebrity life—a desire that, after all, is ness in one’s public self-image has often been positioned as at the origin of selfie hype.5 an affirmative, if not activist, gesture (e.g., Dykstra, 1995; Like few vernacular media phenomena before it, selfie Spence, 1988, 1995). production combines the fantasy of ’ “jeder Nevertheless, the cool frontality and often impassive Mensch ein Künstler” (everyone is an artist) with Andy expressions found in the autopathographic self-portraits Warhol’s prediction that “in the future everyone will be produced by the artists listed above lie in sharp contrast to world famous for fifteen minutes” (Knowles, 2009). Warhol the highly affected duck-face poses that we are accustomed himself produced a hospital selfie avant la lettre while recov- to expect of selfies. This is perhaps due to the selfie’s dual ering from surgery in 1968, after having been shot by Valerie function as icon of the self, on one hand, and as object Solanas. Holding a 35-mm camera in one hand, Warhol cap- endowed with the capacity to confirm, deny, or negotiate tured his bare-chested reflection in a mirror with a flash, group membership within social media environments and inaugurating a hospital selfie pose that would unwittingly be Tembeck 5 repeated by countless others some 40-odd years later. recent accidents or injuries. This is especially the case with Warhol’s spontaneous self-portrait exposed a large scar on celebrity sickbed selfies (see, for instance, those featured in his abdomen. The image was processed and printed by Yahoo Celebrity UK, 2013). In contrast to such images, Royaltone photo service, which offered a bonus wallet-size chronic or acute health conditions appear to generate further- print (Zuromskis, 2013), as if in anticipation of the present- reaching reflections on the relationships between illness and day selfie’s propensity to be distributed.6 Astonishingly, the representation, and on the social and political stakes of pub- of the self that arises from the conjunction of licly identifying oneself as being sick or disabled as a conse- Beuys’ and Warhol’s declarations is remarkably stereotypi- quence of illness. For the final part of this article, I turn my cal: I am undoubtedly not the first to note the irony whereby attention to a series of selfies of ill health that are exceptional a type of image that is regarded as an icon of individuality (if in terms of their capacity to bring together the lighter sides of not self-absorption) should be reducible to a set repertoire of selfie culture with the more radical stances of performance familiar gestures. Selfie aesthetics, which are predicated practice. among other things by the technological affordances of 7 mobile devices and their apps, have been summed up in Rendering Illness as Spectacle: #HospitalGlam, recurrent patterns of arm’s-length shots and pouty poses, Theatricality, In/Visibility, and Activism captures of one’s mirrored reflection, as well as close-ups and other predictable positions within the picture frame, such Mise-en-scène and masquerade are well-established strate- as angles offering flattering views of the subject’s profile, gies in professional photographic self-portraiture (Bright, cheek bones, or arm musculature (Bruno, Gabriele, Tasso, & 2010; Kent, 2006). Such theatrical approaches to self-display Bertamini, 2014; Morrison, 2013; Tifentale & Manovich, have been the subject of queer and feminist readings of pho- 2015). Were it not for the addition of descriptive metadata to tographic works by Claude Cahun or , for these images, such as location hashtags (e.g., #hospital), or instance (Rice & Gumpert, 1999). Comparable aesthetic the interpretation of contextual visual information (such as strategies were employed in the photographic autopathogra- medical furnishings) indicating that these particular selfies phies of Jo Spence as well as Hannah Wilke, who staged her- are likely related to health conditions, many selfies of ill self with reference to historical artworks in addition to poses health would in fact show few distinctions from selfies of from the worlds of fashion and popular culture (Tembeck, (very) good health.8 2008). pushed the theatrical mise en abîme Were it possible to undertake a rigorous survey of existing somewhat further by staging himself as a sick patient within selfies of ill health in the manner that was attempted for a gallery setting. For the duration of his exhibition Visiting funeral selfies (Gibbs, Meese, Arnold, Nansen, & Carter, Hours, first presented at the Santa Monica Museum of Art in 2015), for instance, I suspect that the majority of images col- 1992, museum-goers were invited to visit Flanagan, who had lated might be described as politically innocuous.9 My par- Cystic Fibrosis, in a hospital room entirely reproduced within tial perusal of the web suggests that the hospital selfie the art space (Drier, 1996). The photographic work of equivalent (in volume, at least) to the duck-face pose is a Karolyn Gehrig, instigator of the #HospitalGlam social point of view shot showing an injured limb or body part, a media movement launched in 2014, can be situated within a hospital identification tag on the wrist, or an arm attached hybrid lineage that descends from such precedents. Owing to with an intravenous (IV) drip, a peripherally inserted central her professional training in the arts, Gehrig’s production catheter (PICC) line, or in the process of having blood drawn. bridges advocacy and aesthetics through the fulcrum of her Many of the images encountered using informal keyword performative selfie practice. searches (e.g., #hospital, #selfie, #me) hold a purely docu- On her Instagram profile, Gehrig identifies herself as a mentary function within the subject’s visual narrative of the “Queer Disabled Artist + Writer / Ehlers Danlos Syndrome / self, stating “I was here” (in the hospital, clinic, or ambu- #HospitalGlam” (Gehrig [karolynprg], n.d.). The subtitle on lance) or “this happened to me” (with “this” referring to an her Tumblr page reads, “Taking the shame out of being in ailment, accident, or medical procedure).10 Other groups of treatment one selfie at a time” (Gehrig [#HospitalGlam], selfie images pertaining to ill health, such as bedside selfies n.d.). Media accounts refer to Gehrig’s health condition as a in the hospital with loved ones, participate in the larger social disabling chronic illness and connect her selfie production narratives that are instantiated by the selfie genre at large: the with a desire to not feel invisible despite the invisible nature proclamation that the pictured “I” is not isolated and the of her diagnosis (Bahadur, 2015). A chronic connective tis- aspiration to conserve, or potentially elevate, one’s social sue disorder, Ehlers–Danlos Syndrome (EDS) can lead to a standing online as well as offline (Levin, 2014; Wendt, variety of other health conditions that require regular medi- 2014). The social currency warranted by this breed of selfie cal consultations. Visits to the hospital are thus an ordinary of ill health exists either precisely thanks to—or on the con- part of Gehrig’s current life experience. She began to docu- trary, notwithstanding—particular health-related circum- ment her frequent medical appointments by taking selfies stances. It is also of note that many hospital selfies are not in and planning special looks for these photographs, inserting a fact related to long-standing health conditions, but rather to touch of glamour into her medical regimen (Figure 2). 6 Social Media + Society

Figure 2. Karolyn Gehrig [#Hospitalglam]. Selection of auto-timer selfies posted on Tumblr as part of #HospitalGlam, 2014–2015 ©Karolyn Gehrig. All images courtesy of Karolyn Gehrig. Retrieved from http://hospitalglam.tumblr.com/post/113572883129/ last-summer-i-laughed-too-hard-and-landed-in-the; http://hospitalglam.tumblr.com/post/112153654344/karolynprg-ill-be-joining- letterstothrive; http://hospitalglam.tumblr.com/post/114025774989/hospitalglam-is-also-active-on-twitter

Gehrig’s presence is noticeably posed in these images. At digital self-representation is closely connected to the tradi- times she adopts the far-away gaze of fashion photography; tion of the diary” (p. 44), so in this vein, Gehrig’s Instagram in other instances, her direct stare into the camera lens is feed presents a loose analogue in visual form to a written more reminiscent of the seemingly unrehearsed selfie genre. diary or journal that documents and reflects upon illness. One such posting consists in a before and after shot, showing Seen from a cumulative, longitudinal perspective—not Gehrig with and without pink lip-gloss (Figure 3). A com- restricted to a singular image, but rather as a series of pic- ment accompanying the image on her Instagram page parrots tures produced within a given timeframe—Gehrig’s the instructional rhetoric of makeover blogs, repurposing it #HospitalGlam selfie production finds itself woven into for the benefit of patient empowerment. With a discernible other elements recorded from her everyday experiences on note of camp, Gehrig writes, “#HospitalGlam tips: Color her Instagram feed, ranging from dinner with friends to inter- makes an impact and draws attention to your features. If you actions with her dog. Her selfies of ill health punctuate the are advocating for yourself, drawing attention to your mouth thread of images that are unmarked by illness, effectively inserting her private and invisible condition into the public is not a bad thing. Go bold. You’ll like it” (Gehrig [karolyn- online picture of her everyday life. prg], 2015, March 25). Similarly, a number of Gehrig’s Setting aside the potentially reparative dimensions of her #HospitalGlam posts emulate spreads in fashion magazines. 11 selfie production, Gehrig’s self-stagings on her Instagram At the request of her followers, Gehrig’s comments often feed can also be read as acts of coming-out as being invisibly credit the designers whose clothing and jewelry are featured, ill or disabled, to use Ellen Samuels’ (2002) analogy. From or reveal the makeup application techniques she employed this perspective, Gehrig’s selfies constitute online political (e.g., Gehrig [karolynprg], 2015, March 25) (Figure 4). performances that have significant bearing upon her offline Just as autobiography scholar Laurie McNeill (2014) has experiences as well. Gehrig’s description of her process for read Six-Word Memoirs as auto/tweetographies and Aimee taking selfies in the doctor’s office helps to instantiate this Morrison (2014) positions selfie practice as a form of life- claim. She explains, writing (see also Fallon, 2014), Gehrig’s Instagram feed could be read as a visual autopathography. Jill Walker I find a place where I can set my phone down and look through Rettberg (2014) has noted that “the serial nature of most the viewfinder to see where the frame will be. Using Camera Tembeck 7

before the camera, interacting with the doctor, or both; how- ever, it appears that each benefits from her “centering” activ- ities. Like an actor warming up, Gehrig’s attention to her body and breathing allow her to be more present to her future selfie image, as well as to her immediate experience: one informs the other. “By photographing myself,” Gehrig adds,

I find some comfort in that space and reacquaint myself with my body. By the time the doctor enters, I’ve checked in enough that I feel confident enough to speak about my concerns and take a more active role in my treatment. (Gehrig [#Hospitalglam], 2015, February)

Gehrig’s performance before the camera enables her to be more at ease within the medical space. While the texts accompanying the images on her social media profiles frame #HospitalGlam as an outward-reaching political interven- tion—seeking to raise awareness, reduce stigma, and Figure 3. Karolyn Gehrig [karolynprg]. (2015, March 25). #HospitalGlam tips [Instagram post]. Retrieved from https:// heighten the visibility of EDS—Gehrig’s poses before the instagram.com/p/0o9npHh0UU ©Karolyn Gehrig. Courtesy of camera also serve her immediate personal needs, allowing Karolyn Gehrig. her to be more attentive to her body and, in so doing, to take charge of the situation at hand in the doctor’s office or wait- ing room.12 Like Spence, Wilke, and others before her, Gehrig’s autopathographic pose (Tembeck, 2009) constructs a particular dramaturgy: it is staged not only to be seen by others, but also to be read in specific ways that emphasize Gehrig’s sense of personal empowerment even as she pro- duces the selfie. The comments accompanying her photo- graphs serve as the stage directions that orient our gazes in receiving her self-images. One such comment, annotating a photograph that shows Gehrig (Figure 5) sitting in a waiting room wearing a dress whose pattern consists in magnified images of pills, affirms,

Having #ehlersdanlos means my #disability is often an #invisibleillness and maintaining a visible presence in my non- disability communities while doing #hospitalglam has been valuable. I care for myself and I have no shame attached to the health issues that make up my life. (Gehrig, 2015, January Figure 4. Karolyn Gehrig [karolynprg]. (2015, March 20). I have [2014, October 16]) had an exquisite night [Instagram post]. Retrieved from https:// instagram.com/p/0c_EzSB0bL/ ©Karolyn Gehrig. Courtesy of The mutual reinforcement between comment and image Karolyn Gehrig. is a characteristic of digital intermediality and confirms the specificity of Gehrig’s work as selfie production in contrast Genius, I set a timer to repeat at 10 second intervals and turn off to self-portraiture.13 As Martin Gibbs et al. (2015) have the sound. I step into the frame, si[t] or stand however feels noted, the capacity for users to tag images and thereby “insert comfortable, and focus on my breathing. I count out 10 seconds their photo[s] into a wider ‘hashtag conversation’” is central between shots, figuring that I’m probably off a little. To me, it is extremely calming and centering. I am focused on how my body to Instagram’s “platform vernacular” (i.e., its specific affor- feels in space. If the doctor enters and I am still doing it, I dances) (p. 258). The interplay between images and words— explain what I’m doing and that I’ve been posting the photos potentially generated by numerous authors but rejoined online to help reduce the stigma surrounding invisible illness. through the use of common hashtags—allows for a broader Then the camera stops and we have our appointment, like “discursive field” to be opened beyond the singular post, normal. When I get home, I filter and post the photos using [the since Gehrig’s selfies can be attached to “multiple hashtags, app] VSCO Cam. (Gehrig [#Hospitalglam], 2015, February) accompanying captions and comments from other people” (Gibbs et al., 2014, p. 260). While still anchored in a repre- Gehrig limbers up for the performance. From her account, sentation of the self, here the selfie becomes a point of entry it is unclear whether this performance consists in posing for discussion among individuals identifying with diverse 8 Social Media + Society

Figure 5. Karolyn Gehrig [#Hospitalglam]. (2015, ca. January Figure 6. Karolyn Gehrig [karolynprg]. (2014, June 2). Next up: [2014, October 16]). This Waiting Room [Tumblr post, reblogged Neurology [Instagram post]. Retrieved from https://instagram. from Hyper by Extension]. Retrieved from http://hospitalglam. com/p/owucMNh0V7/?taken-by=karolynprg ©Karolyn Gehrig. tumblr.com/post/105702098527/karolynprg-this-waiting-room- Courtesy of Karolyn Gehrig. hospitalglam ©Karolyn Gehrig. Courtesy of Karolyn Gehrig. communities, ranging from EDS patients and disability advocates to fellow fashion or jewelry aficionados. Both Gehrig and social media bloggers who have covered her production use the language of activism to refer to her self- ies: recurring words used to describe her practice include “empowerment,” “starting a movement,” countering “stigma,” and so on. Without a doubt, Gehrig’s project is informed by a politics of visibility: her #HospitalGlam selfies position her as a self-identified, chronically ill individual, effectively exacer- bating the public legibility of her private health condition. In going public with these selfies of ill health, Gehrig resists the possibility that she might pass as not disabled, both online and offline. The public medical setting for her selfie production gives her a pretext to instruct potential bystanders of her activ- ism in social media: in turn, her Twitter, Tumblr, and Instagram feeds accomplish a similar didactic function online, alerting her followers (and through their reblogs, their friends) to Gehrig’s experience of living with EDS. Figure 7. Karolyn Gehrig [karolynprg]. (2015, January 21). All While Gehrig’s selfies ostensibly place her health condi- hail the protective qualities of silver [Instagram post]. Retrieved from https://instagram.com/p/yIePKRB0bz/?taken-by=karolynprg tion in the foreground—if only by virtue of the medical loca- © tions in which they are shot and the hashtags that accompany Karolyn Gehrig. Courtesy of Karolyn Gehrig. them—they also play with the dubious visual legibility of her illness. On more than one occasion, Gehrig has blended medi- trimmings are the products of artifice or necessity: where do cal accoutrements with fashion accessories in such a way as the medical aids end and the fashion accessories begin? to cast doubt upon their mutual identifications: a black Gehrig’s production is certainly not representative of the webbed necklace recalls the curling of cords attached to majority of existing selfies of ill health, either in its sophisti- medical instruments in an examination room (Figure 6); sil- cated form or in its more radical intents. Nevertheless, while ver finger splints become unrecognizable amid an array of hers began as a singular voice, the call for participation jewelry worn on her hands (Figure 7); a net placed around her instigated by her #HospitalGlam movement has prompted head for an electroencephalograph test is assorted with an unsuspected avenues for creative self-expression by other outfit inspired by a recent Beyonce performance during which patients—primarily young women—as evidenced by the the singer sported similar headwear. In confounding their numerous re-posts on her Tumblr page (http://hospitalglam. appearances in this manner, one wonders whether Gehrig’s tumblr.com/). In opening up a space for the public visibility of Tembeck 9 her own health condition, Gehrig has managed to skirt certain Rota (The Broken Column), 1944, Museo Dolores Olmedo; aspects of the “conundrum of visibility” (boyd & Marwick, Hannah Wilke, Intra-Venus Series, 1992–1993, Ronald Feldman 2009, pp. 412-413) inherent to social media which, while Fine Arts, New York; Günter Brus, Kleine Narbenlehre, 1999, promising full exposure, are generally only consumed by the private collection, reproduced in Lammer (2007). few (Baym & boyd, 2012, p. 322; boyd, 2011, p. 48). Tying 4. See, for instance, the celebrity “sickbed selfies” assembled by Yahoo Celebrity UK (2013), which include the following: patient and disability advocacy to her non-health-related Miley Cyrus [mileycyrus] (2014, December 2) This gown interests in fashion, art, and jewelry, Gehrig’s selfies of ill is so hipster [Instagram post], available at https://instagram. health reach beyond a community of peers who already par- com/p/wiK_6dwzGu/; Lady Gaga [ladygaga] (2014, August take in her politics. Her images of illness function as patient- 7) Altitude sickness is no joke [Instagram post], available at centered counter-representations to the medical and diagnostic https://instagram.com/p/rYtKd-pFOs/; Lily Allen [lilyallen] pictures that also populate the web, such as those now circu- (2014, May 8) #SHEEzUS in #SHOSPITAL [Instagram post], lating through the Figure 1 app, which international news available at http://metro.co.uk/2014/05/08/lily-allen-rushed- media have dubbed “Instagram for doctors.” Such images to-hospital-after-poorly-chatty-man-performance-but-shes- reproduce conventions of medical textbook photography, kindly-documented-her-ordeal-in-pictures-for-you-4721287/ showing afflicted body parts in isolation, after having 5. See danah boyd (2011), who notes that “in networked publics, removed any identifying marks from the depicted individual. attention becomes a commodity,” adding that “in an environ- ment where following the content of one’s friends involves the Whereas the doctors’ images aim to protect patient confiden- same technologies as observing the follies of a celebrity, indi- tiality, Gehrig and other partakers in #HospitalGlam selfies viduals find themselves embedded in the attention economy, seek on the contrary to affirm their identities as subjects liv- as consumers and producers” (p. 53), and Theresa M. Senft ing with illness (“#HospitalGlam is about you, not the proce- (2008, 2013), who coined the term “microcelebrity” to refer to dure,” Gehrig affirms in her #HospitalGlam Frequently asked youth practices of self-branding on the Internet. For an exam- questions [FAQ] [2015]). Their public proclamations of ill ple of hospital selfies and the emulation of celebrity life, see health are achieved through the inclusion of recognizable Nate Scimio [nate_scimio]’s (2014) selfie posted on Instagram health-related content within the selfie image and through the with the caption “Chillin’ at Children’s” after a widely covered appendage of contextual information in hashtags, captions, stabbing in an American high school. metadata, and so on. In this respect, selfies of ill health draw 6. Andy Warhol, Self-Portrait (Andy Warhol at Columbus upon the specific affordances of social media in terms of their Hospital, New York, June 1968, recovering from bullet wounds inflicted by Valerie Solanas), 1968. The Royaltone dual print is production and dissemination; however, their communicative reproduced in Zuromskis (2013, p. 215). intents remain consistent with earlier forms of autopatho- 7. According to Gibbs, Meese, Arnold, Nansen, and Carter (2015), graphic self-representation, both in visual and narrative the capacity to “apply photographic filters” (p. 258) is central to forms. The dramaturgical thrust of such imagery is to convey Instagram’s platform vernacular, along with the capacity to share both the centrality of medical experiences in the subjects’ images across other social media platforms as well as to tag images. lives and their specific desire to be publicly identified as per- 8. For a discussion of the importance of metadata in determining sons living with illness. an image’s online circulation and meaning, see Rubinstein and Sluis (2013). Declaration of Conflicting Interests 9. Rather than conduct an analysis based on a bulk of images sam- pled through set criteria, which nonetheless render a partial picture The author(s) declared no potential conflicts of interest with respect of an online phenomenon, I have embraced the perspectives of my to the research, authorship, and/or publication of this article. disciplinary provenances—visual culture and art history—accord- ing to which an image’s significance may equally be determined by Funding its distinctive qualities as by its prevalence. As such, this research The author(s) received no financial support for the research, author- makes no pretense to account for the significance of certain types ship, and/or publication of this article. of selfies of ill health on the basis of their volume or frequency. 10. One of the particular difficulties in conducting research on Notes selfies of ill health is that the genre itself is seldom identi- fied or declared, so finding appropriate keywords to delineate 1. For examples of image appropriations and remediations in the a corpus of images proves difficult. Not wanting to restrict my context of selfies of ill health, see Crohn’s and Colitis UK’s searches to individual types of illnesses, my online queries (2015) GetYourBellyOut campaign on Facebook, calling for were instead primarily directed to the places that administer recreations of Bethany Townsend’s bikini selfie showing her health care (e.g., #hospital). colostomy bags. 11. While medical sociologists have made the contested assertion 2. Jill Walker Rettberg (2014) has noted “the cumulative, serial that illness constitutes a “biographical disruption,” interrupt- practice that underlies most digital self-representations” (p. 36) ing the life plan (Williams, 2003), scholars of autopathography and specifies that this “cumulative logic is built into the soft- affirm that literary production offers the means by which to ware and into our habits of reading and sharing online” (p. 35). integrate the experience of illness into the account of oneself 3. See, in particular, the following artworks or series of works: (Brody, 1987; Frank, 1995; Kleinman, 1988). A further dis- Albrecht Dürer, Selbstportrait, krank (a.k.a. The Sick Dürer), cussion of the potential reparative functions of photographic ca. 1509–1511, Kunsthalle Bremen; Frida Kahlo, La Columna autopathography is beyond the scope of this article. 10 Social Media + Society

12. Yukari Seko’s (2013) study of self-injury photographs uploaded http://time.com/40506/nomakeupselfie-brings-out-the-worst- on Flickr similarly concludes that the practice encompasses “a of-the-internet-for-a-good-cause/ paradoxical mix of personal catharsis and social performance.” Drier, D. (1996). Rack talk: Interview with Bob Flanagan and 13. Gehrig’s images appear on Instagram, Twitter, and Tumblr, as Sheree Rose. Artforum International, 34(8), 78–81. well as on her personal website (www.karolyngehrig.com), Duncan, A. (2014, May 4). Lily Allen rushed to hospital after which also features her multidisciplinary artistic production poorly Chatty Man performance (but she’s kindly documented (visual arts and writing). On her personal website, a selection her ordeal in pictures for you). Metro. Retrieved from http:// of Gehrig’s images is presented as self-portraits. 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