Copyright 1993 by Laura Hershey
[The following article has not been published before now.]
Every year, it seems, the Academy Awards provide new fodder for analyzing and critiquing America's cultural obsessions, especially about disability and illness. In particular, the Best Actor Oscar usually goes to a non-disabled performer who has portrayed, in epic, exaggerated terms, a man with some kind of impairment. These actors -- Tom Cruise, Daniel Day-Lewis, Tom Hanks, Geoffrey Rush, Dustin Hoffman, and so on -- do, in fact, possess substantial talent. But their success, their receipt of the highest award available to Hollywood entertainers, rests at least as much on their subject matter as on their acting abilities. Perhaps the Academy voters, along with many critics and viewers, cannot help finding something terribly fascinating in the image of a man -- that most powerful and invulnerable of creatures, a larger-than-life, virile, handsome white male -- compromised by some kind of physical or mental impairment or infirmity.
This year, my attention was drawn to another category of film, one supposedly dedicated to truth, rather than to the usual Hollywood myths. The Best Documentary Oscar went to Donna Dewey for "A Story of Healing." Dewey lives in Denver, and so received a lot of enthusiastic local news coverage after her appearance on the Academy Awards: Local girl makes good.
Dewey's film follows a group of American plastic surgeons, anesthesiologists, and nurses on a journey to An Giang, Vietnam, in January 1997. In this remote province in the Mekong Delta, the surgeons operate on over 100 children to correct various "facial deformities," including cleft palates, cleft lips, and tumors. The journey was organized by Interplast, a charity which sponsors fifty overseas trips annually, to provide plastic surgery to children in various developing countries.
Somewhat skeptical the subject matter, but intrigued by the universal rave reviews I was hearing, I had been looking for an opportunity to see "A Story of Healing." That opportunity came during a local Asian Film Festival, sponsored by the Denver Film Society.
Before I even get to my ethical concerns about "Healing," I have to say that I just didn't think it was a very good movie. It had a bland overall tone, more like a TV commercial or a propaganda film than an independent documentary film. It was shallow and uninformative, with no sense of conflict or ambiguity, and no real insights about the subjects or their work.
How, I wondered, could such a flat, unrevealing production win so much acclaim -- and the Academy Award? In retrospect, I think the answer lies -- just like with the Best Actor category -- in the subject matter. Dewey herself seemed to recognize this fact in her acceptance speech at the Academy Awards on March 23. "I would like to thank the Academy for recognizing the selfless efforts of the doctors and nurses of Interplast," she said. Indeed, that is exactly what the Academy was doing: They were not evaluating a film; they were applauding what they saw as a noble act. Faced with a group of "dedicated, heroic physicians" giving up their vacation time and paying their own way to travel to a "hopelessly backward country" to "restore normalcy" to a bunch of a "hideously deformed children," the Academy judges simply suspended all their critical faculties.
I do not mean the quotation marks around the phrases above to be misleading. I am not quoting directly the words of the film's interview subjects (although many of these terms were used liberally). But I believe I am conveying their sentiments quite accurately. The medical professionals were presented as travel-weary saints, serving children who in turn were presented as voiceless but manifestly grateful.
At the festival I attended the audience, like the Motion Picture Academy judges, seemed to swallow Dewey's version of events with uncritical acceptance. They gasped in all right places, in automatic response to a series of shots showing children with disfigurements. They sniffled in all the right places, as the children emerged from their surgeries looking groggy, swollen, but normal. They clapped loudly as the final credits rolled. And as the lights came on, most appeared properly misty-eyed.
Dewey appeared after this screening to answer questions about her film. I found some of her remarks more telling than anything in the movie. The origin of the project is a good place to start. An audience member asked what inspired her to make the film. She replied that she had been encouraged to do so by a foundation which had supported some of her previous works. This foundation, she said, is also a sponsor of Interplast. The result, naturally enough I suppose, is an effective fundraising tool, but not a solid documentary. The film asks no hard questions, paints no shades of gray. It is clearly designed to jerk tears, not provoke thought.
The film's attempt at emotional manipulation did not work with me. My reaction was very different from most of the audience's responses that night. As a woman with a physical disability, with more than my share of encounters with the medical profession -- some good, some bad, but all complex -- I found myself identifying much more strongly with the Vietnamese patients than with the American practitioners. And I felt angry that I was not allowed to hear from those patients. They do not talk in the film; they are talked about. This is not their story, though it purports to be. More than once, the surgical procedures which remove their facial anomalies are called "life-changing." But we are shown nothing about their lives, either before or after the surgery. Later, still troubled by the film's silencing of the patients' voices, I felt compelled to watch it again. So I checked out the video from my local library. I wanted to see if it was really as bad as it had first seemed to me. Viewing it several more times, I decided that it was worse than I had thought.
There's more at stake here than good taste and critical thinking. Dewey's choice of setting, focus, and technique have produced something more insidious than mere sentimental drivel. The film becomes, ultimately, an act of domination on two distinct levels: On a global or geopolitical level, "A Story of Healing" serves an imperialistic function, striving to erase all memory of U.S. intervention in Vietnam (which is not alluded to once), and to establish the superiority of American values, character, technology, and sensibilities. On another more intimate level, the movie posits a particular, mythic relationship between doctors and their patients and, by extension, between all people who serve and those whom they serve. This too is a kind of imperialism, for the patients in the film are mercilessly reduced to objects, never allowed to speak for themselves, not even in translation; and this is not just by virtue of the fact that most of them are children or teenagers. Both their foreignness, and their status as patients, are used to shrink them to minor characters in Dewey's fabricated drama.
Conversely, the American doctors and nurses loom large in the film's foreground. They comment extensively not only on their work, but on their patients' lives and on Vietnamese culture in general -- topics about which they obviously know very little. Dewey gives free rein to their articulate ignorance. For example, Dr. Larry Nichter, a reconstructive surgeon from Long Beach, California, who directed the medical team in An Giang, asserts, "You must realize that children with cleft lips are completely ostracized here. They often times do not come out of their homes, and are not accepted in common life."
Prejudices surrounding facial anomalies may, probably do, exist in Vietnam -- as they do in many societies, including the United States. But these American medical professionals are in no way qualified to explain the complex cultural beliefs of a country they are visiting for the first time. One of the doctors, in a rare show of humility, admits that when they first arrived at the An Giang clinic, he and his colleagues were unable to identify the roles of any of the dozens of Vietnamese people who greeted them. They simply could not read the visual cues to discern the differences among doctors, nurses, patients, family members, and onlookers.
But filmmaker Dewey fails to take into account the cultural ignorance of the visiting Americans. Instead she continues to insist on presenting the physicians and nurses as de facto experts on Vietnamese society. She allows them to spout ignorant, racist platitudes to which the Vietnamese have no opportunity to respond. For example, early in the film, Dr. Hank Duffy marvels to find that Vietnamese parents "love their children as much as we do!" And one of the U.S. nurses refers to her Vietnamese counterparts in insufferably patronizing terms. "The nurses here are just darling!", she says, chuckling as if speaking of a pet.
These statements, although spoken in affectionate tones, convey an overwhelming arrogance that is characteristic both of U.S. imperialism toward people of other cultures and races, and of the medical profession's imperialism toward people with illnesses and disabilities. In this film, the two forms of imperialism intersect again and again -- just as, increasingly, they do in the United States' global economic and health policies.
While the U.S. medical team presumes to speak both about and for the clinic patients, the Vietnamese people themselves are silenced throughout the film. Dewey must have made a conscious decision not to employ interpreters, not to interview any of the patients or their family members, not to offer us any of their perspectives. She thus joins a long tradition in literature, journalism and film, of mythologizing help and service. Examples abound, from movie saint Annie Sullivan taming wild child Helen Keller (whose own agency and radicalism was minimized by Hollywood), to the sentimental media portrayals of Mother Teresa.
One of the lesser-acknowledged rewards of "helping others" is the right to determine how that help will be documented, presented, and interpreted. Just as the winner of a war gets to write its history, while the loser's perspective goes unreported and is eventually lost, so also the provider of service gains control over the recording and telling of the story of service. The "client" or "patient" is rarely asked to contribute facts to the story, and even more rarely to interpret it from her or his own perspective.
The above war analogy might be more apt than it first appears. For the dynamic between helper and helpee might, in many cases, be described as adversarial, even when it is not openly antagonistic. The relationship is most often characterized by a significant power imbalance, in which one party has almost exclusive control over information, resources, and social sanction. With all this at his or her disposal, the helper is in a far better position to make decisions about identifying the problem, prescribing the solution, choosing approaches, setting priorities, and evaluating outcomes. This is certainly the case with the Interplast doctors profiled in "A Story of Healing."
The helper's control of the helpee's situation can be, and often is, misused. Some helpers behave arrogantly and cruelly, and inflict tangible physical, psychological, or economic harm on those they claim to serve. Examples can be found periodically in the daily newspaper: orderlies who beat, neglect, and steal from nursing home residents; foster parents who abuse their charges; doctors who molest their patients.
Such blatant atrocities are not rare, but they do constitute a minority of the interactions between more-powerful helpers and less-powerful helpees. Far more common, even routine, are the small, nondescript violations, the instances where people's choices and feelings are disregarded by accepted policies and procedures, where their self-respect is systematically undermined. In these situations, many of which are created and perpetrated by the U.S. medical system, cruelty is not a motive; rather, it is an unintended but accepted consequence of business as usual.
Despite the fact that helpers can, and often do, disempower and harm their clients or patients -- perhaps partly because of that fact -- the helper remains an object of cultural admiration. Highly-educated, professional helpers, such as doctors, garner even greater reverence. And as much as helpers are respected, those who receive their help are disrespected. The disparate relative social status of helpers and helpees has taken on a moral dimension: People in need are either pitied or scorned; while the people who fill their needs -- usually people who have abundant resources in terms of money, education, and/or leisure time -- are praised.
Our cultural wisdom on this subject is best summed up by the popular adage, "'Tis better to give than to receive." A variation goes "'Tis more blessed to give than to receive." Parents teach this saying to their children; ministers remind their congregations of it. From one viewpoint, it expresses a nice ethic of generosity and unselfishness. But looked at another way, the adage contains a harsher meaning: It says that people who give are better than, morally superior to, people who receive. Consider the implications of this judgment in a world where unequal distribution of wealth brings economic deprivation to some, abundance to others; and where violence, environmental degradation, hazardous working conditions, and lack of access to medical care creates chronic illness and disability, most prevalently in the global South and in lower income groups in the North; and where people who are ill or disabled incur social penalties such as ostracization, discrimination, unemployment, segregation, and/or institutionalization. In such a world, some people will have greater need; and others will have more to give. This fact itself results from unequitable social relations. To add to this imbalance the additional weight of moral judgment is to compound the unfairness of the situation.
In this way, American imperialism and helper oppression mirror and reinforce one another. In both cases, dependence is manufactured, but then perceived as natural and inevitable. For example, in "A Story of Healing," the visiting doctors express shock at the sparse, outdated conditions of the clinic. There is, of course, no discussion of the reasons for this, no reference to the devastation which American intervention wreaked on Vietnam's economy and infrastructure. These conditions are presented simply and unquestionably as evidence of the country's "backwardness." Similarly, the entire film emphasizes the patients' deep gratitude toward the American doctors for removing their "deformities." Never once does the film acknowledge (as Dewey, prompted by a question from the audience, casually mentioned in her post-screening remarks) the probability that many of these facial anomalies were caused by the Agent Orange with which the U.S. government poisoned the Vietnamese countryside during the intervention.
Imperialism, like helper oppression, offers charitable acts -- sometimes merely symbolic, sometimes providing real but limited relief -- as a substitute for a more just distribution of power and resources. In the U.S., disabled people may be offered Special Olympics and telethons in lieu of meaningful jobs and accessible housing. Internationally, our government doles out token foreign aid for poverty programs, while continuing to pursue foreign policies which exacerbate poverty worldwide.
There is something ironically appropriate about the service provided in "A Story of Healing." Plastic surgery, like advertising, has become such a growth industry in United States largely because of its, and our, focus on appearances. Our eagerness to export plastic surgery should not surprise anyone. Along with our export of movies, television, and music videos, the goals and techniques of plastic surgery reflect U.S. ideals, and promote a U.S. agenda. In the new world order, all residents of the planet are endowed by the Superpower with certain inalienable rights. Among these rights are consumer goods, choice of brand names, and the pursuit of physical perfection and beauty. The reality, of course, is that under the economic system which vaunts these "rights," financial success and physical health are equally unattainable for a majority of the world's people. Those on the lower rungs of the capitalist hierarchy might covet expensive homes, cars, and appliances; and might emulate the American pop icons who radiate health and fitness. But most will never be in a position to participate in this consumer economy themselves, in any meaningful way.
But in corporate-controlled media products such as "A Story of Healing," symbolism and surface appearance are more important than painful realities. Given the film's obvious agenda, it's certainly no coincidence that it focuses exclusively on plastic surgery. Doing so allows it to ignore such unavoidably political issues as malnutrition, war casualties, and illness related to industrial pollution and environmental degradation. Thus, the film implicitly advocates a Hollywood approach to global health policy -- as Billy Crystal's character used to say on Saturday Night Live, "It's not how you feel, it's how you look.... And you look mah-velous!"
Reconstructive surgery, it is true, does have some functional value for some individuals. Cleft lips and cleft palates can impair one's ability to eat and/or drink. Correcting these conditions can improve one's quality of life. But neither the doctors, nor the filmmakers, seem to have made any distinction between surgery to improve functioning, and surgery that is merely cosmetic. Indeed, the emphasis is on the patients' facial appearance. One of the most emotional scenes in the movie involves a teenaged boy on whom the doctors operate to correct a cleft lip. After the surgery, a nurse hands him a mirror, while a doctor tells him how "handsome" he looks. The point is made repeatedly that these surgeries will change the lives of the Vietnamese patients. The message is clear: Their lives change because their appearance changes.
Just as the doctors aim to erase the flaws in their patients' faces, so the filmmakers aim to erase history's blemishes. This handsome film, with its shallow appealing images and sentimental soundtrack, covers an ugly history of imperialist domination and violence. Dionne Warwick sings "What the World Needs Now is Love Sweet Love," while the doctors and nurses do their thing, and the viewer is supposed to agree with the premise that the superficial "love" of American do-gooders "is the only thing that there's just too little of."