Hektoen International

A Journal of Medical Humanities

“Looking at … Looking away”: A challenging and vital skill

Florence Gelo
Philadelphia, Pennsylvania, USA

Alice Neel's self portrait, used to teach guided looking
Alice Neel Self-Portrait. Alice Neel. 1980. Oil on canvas. National Portrait Gallery, Smithsonian Institution. © Estate of Alice Neel, 1980.

For nearly a decade, I have used images of paintings to teach students in health care professions how to cultivate the skills of looking while learning to recognize their own feelings and those of others. Most recently, I have been concerned with how emotions compel us to look away.

Inspired by Alice Neel’s self-portrait of her naked and wrinkled body, I have been using the image with medical students and residents to uncover the universal human tendency to look at the image and to notice when looking away.

Looking away is ubiquitous and permeates interactions both basic and complex. We may look away when our car is covered with pollen and must be washed or when we see a potato chip bag on the sidewalk and do not pick it up. In these cases, we refuse to notice because we do not want to see what is before us and what it may invite us to do.

Equally common is the tendency to look away when what is in front of us is accompanied by unwanted emotions. We might look away when we are angered by parents who shout as they hit their child for misbehaving in the grocery store. When approached by a person with a disability, we may cast our eyes downward in fear of that person coming toward us. We pretend that if we do not look at such persons, they will not see us.

Though these examples of engaging with an unwanted presence reside in the physical world, there are times, metaphorically speaking, that we encounter a “presence” arising within ourselves. Commonly we try to avoid unpleasant and undesirable thoughts or feelings to avoid engaging with them.

In a similar way, we may look away from what arises within us when we look away from what is visually unwanted in the physical world. We learn to shield ourselves from the experience of encountering either the person in the outer world or thoughts and feelings that reside within, and arise from, our inner world.

Medical students encounter various unwanted thoughts and feelings such as disappointments and frustrations in their preclinical studies, fear, discomfort, distress, curiosity when assigned to dissect a cadaver in their first year, and inadequacy or trepidation when first interacting with peers and teachers. They may also experience vulnerability, anxiety, and, later in clinical practice, apprehension when interacting with patients, and encountering illness, suffering, and death. Whenever humans avoid unwanted thoughts and feelings, deny, suppress, or make futile attempts to rid themselves of them, they risk causing harm to their bodies and psyches.

Health professionals and students preparing for such professions cannot afford to disregard these by-products of human encounters. The ability to look, see, and feel is vital to providing holistic medical care and avoiding stress and burnout. When looking and feeling becomes blocked or too painful, it becomes imperative to speak with friends, family, trusted faculty, or to seek counseling to ease distress and learn new ways to think about what is uncomfortable and to cope.

Teaching about “looking at” and “looking away” can be accomplished using visual images. Reaching beyond the boundaries of the rational mind and its influence, the visual arts are powerful tools to tap into the human capacity for responding to what has been seen. Guided looking prompts students to look carefully at a painting and see elements of art including line, color, shapes, design, and subject matter. Students are guided to examine the painting in detail and to experience the work of art and notice how looking at an image creates thoughts and feelings.

Students can then be guided to identify unwanted thoughts and feelings and manage their own and others’ emotions. Developing the skill to “look at” becomes the foundation to notice the impulse to “look away.”

I have explored how best to teach this skill through a series of medical humanities courses. The objectives for my first course, Training the Physician’s Eye: Enhancing Clinical Skills through Art Observation, were to teach close looking and to name, rather than interpret, what was seen. A second course, “Image as Lens: An Exploration of the Patient’s World of Illness and Suffering Through Visual Arts,” advanced the goals of the previous course and used art images to teach about meaning-making and human encounters with suffering. The next course moved further toward interiority: the task of recognizing, naming, and growing a capacity to identify and contain personal feelings and use that capacity to understand self and benefit others.

Self-portraits are intimate portrayals of the visible person and can point to what lies beneath the skin—a presence that can only be imagined and interpreted using one’s own emotional competencies. In a recent program during “Training the Physician’s Eye,” medical students viewed the self-portrait of Alice Neel. I chose this image to teach self-awareness of behaviors and thought patterns that contribute to “looking at” and “looking away.”

Neel’s self-portrait can be provocative. An old white-haired woman sits naked and vulnerable on an upholstered chair. The flesh of her arms, torso, and legs droop while her arthritic hand holds a paintbrush firmly. From a wrinkled face her sparkling blue eyes stare at the viewer both inviting and daring.

Student viewers responded to the image of aged female nudity with a variety of reactions, including hate, embarrassment, self-consciousness, discomfort, anxiety, pleasure, shock, and tension. Some perceived Alice Neel as “brave,” “vulnerable,” and were “confused” or “perplexed” by Neel’s daring to draw herself in the nude at the age of eighty, boldly staring at viewers daring them to “look at” and see her. These statements from students acknowledged the complexity of human identity where a multitude of emotions and attitudes coexist. Students also experienced themselves as intruders into the artist’s private world.

Group conversations among students deepened awareness of the presence of these feelings and revealed their attitudes, values, and biases. They discussed “looking at” and the urge to “look away” from this painting. At first, some students were drawn to this surprising portrait, Neel’s bold eyes staring, rosy cheeks, demanding to be seen. For a few, “looking at” included seeing and naming the blue-and-white striped upholstered chair, the rug, the paintbrush, the rosy cheeks. But not her body.

Elaine, a first-year medical student remarked, “At the very beginning I looked away from her breasts. Surprised by her nakedness, I felt that I was invading her privacy. Then I was drawn to her face, her flushed red cheeks staring at me. Then I was shocked to see that she was completely naked, so casual as if she is about to have some tea. Looking at her expression again, she shows no sense of surprise or embarrassment . . . [she is] looking at the viewer as if to say, ‘So what are you looking at?’ . . .  as if she is judging me for thinking that it is strange for her to be naked.”

Elaine also noted that “looking away” is at times a respectful behavior. “When we were practicing how to take a femoral pulse or performing an abdominal exam, we drape a patient with a cloth. Only the area we examine is exposed so that their modesty is maintained, which is a form of looking away.”

A second-year medical student, Dylan, commented, “Initially I did have an inclination to pause before fully examining the painting. Not necessarily to look away . . . but like I’ve been caught coming into a situation I wasn’t expecting and wanting to pause . . . [her] face isn’t surprise or fright. Instead . . . it is a look of curiosity, ‘why have you entered?’”

Both students experienced and discussed “looking at” and “looking away.” They felt they were being drawn into a relationship with the woman who was asking the questions and setting the limits.

Through her paintings, it is easy to surmise that Alice Neel communicated aspects of herself that were true to her life. She lived boldly and painted portraits that embraced the fullness of humanity. Her visual style challenged the art world of her day. Her portrait paintings embody the humanity and uniqueness of those often overlooked in our society, including an interracial family, children, a developmentally challenged infant, a frightened mother clinging to her infant, Neel’s African American, Haitian, and Puerto Rican Harlem neighbors.

Developing the ability to “look at” as a foundational skill to learn about one’s motivations to “look away” is essential to circumvent societal prejudice and prepare students for respectful, empathic encounters with those who are often defined by negative attitudes, stereotypes, and stigma.

Guided “looking at” and “looking away” based on Neel’s painting provided a vehicle for reflection and debriefing. Students were prompted to recognize their own capacity for insight, to deepen awareness of their own emotions, beliefs, values, and personal biases that contribute or inhibit personal and professional growth.

Supporting the process of examining one’s inner process and essential nature is one basic goal when teaching students using the visual arts. Recognizing and reflecting on thoughts and feelings that cause one to “look at” or “look away” is essential to join with a patient and to provide respectful and holistic healthcare.

FLORENCE GELO, D.Min, NCPsyA, is a medical humanities and behavioral science educator. She directed and produced “The HeART of Empathy: Using the Visual Arts in Medical Education,” and uses the visual arts as a teaching tool to enhance clinical skills. She has published articles about illness, death, and dying.

Highlighted in Frontispiece Volume 13, Issue 1 – Winter 2021

Fall 2020  |   Sections  |  Education

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