THE SCAR PROJECT: Visual Language for Telling the Story of Breast Cancer in Women | Lori Kelly


In 2005, fashion photographer David Jay began a photography project to honor his friend Paulina who at 29, underwent a mastectomy of her right breast following a diagnosis of breast cancer. In addition to honoring his friend, The SCAR Project as it came to be known also had a larger educational mission: to create awareness of breast cancer in a specific demographic, women of the ages of 18-35. The project, which produced portraits of 50 young women surviving cancer, received solid reviews in publications as diverse as Forbes, Le Post, Life, and Psychology Today. In addition to favorable coverage in the press, the exhibit was enthusiastically received by visitors to the galleries that hosted it across North America. In 2011, Jay produced a book that contained 50 portraits from the original installation of the project. Publication of the book led to a collaboration with the director Patricia Zagarella who in 2012 won an Emmy for the documentary film she directed about the project, Baring it All.  

Along the way, The SCAR Project ignited a public controversy on Facebook, which temporarily shut down the site because of concerns about the display of nipples on some of the project participants' healthy and/or reconstructed breasts. The raw untouched images of the project were and are powerful, and there is no doubt that they contributed to drawing much needed attention to the need for more vigilance about this deadly and disfiguring disease, particularly in the female demographic to whom it was directed. Nor is there doubt, especially as evidenced in the autobiographical commentaries that appear in the back of the volume or in blogs online, that The SCAR Project simultaneously empowered the women who participated in it as well as those who saw it online or in galleries. The SCAR Project was empowering because it brought into public view images of transformed bodies that until the time of the photo sessions with Jay in New York, had never been seen outside of doctors' offices and for some of the participants, rarely or never by lovers, husbands, or their own children. But by coining the acronym SCAR, which stands for Surviving Cancer Absolute Reality, Jay has opened himself up to criticism concerning the truth about breast cancer that he seeks to represent. In this paper I want to examine the extent to which Jay's powerful depiction of post mastectomy women supports his claim of it being "Absolute" and "Reality." I also want to examine the ways in which Jay's project carves out new cultural space within the conversations concerning breast cancer and the extent to which this project may enact its own hegemonic practice even as it attempts to dismantle another.

 In addition to an indent of a scar on the front cover of volume I of the portraits in The SCAR Project, a phrase is splayed across the back cover of each book: "Breast cancer is not a pink ribbon." The incorporation of these words into the title of his project functions as a discursive cue for how the images that follow are to be mediated. By referencing pink ribbons, Jay positions his project inside the most dominant of the cultural practices surrounding breast cancer, but at the same time, he also establishes an oppositional stance within it. Jay has been quoted as saying "In our society, breast cancer is hidden behind a little pink ribbon that (unintentionally) diminishes something that is terrifying, disfiguring, and deadly" (Ram). As this statement and its placement within The SCAR Project suggests, Jay's goal is to perform cultural work that is markedly different from that undertaken by the Komen Foundation. Instead of enhancing or extending the work of that organization, Jay's announced goal appears to be to dismantle it, to attack its credibility and utility in the ways that it represents breast cancer in women, and to replace it with something that he characterizes as more in tune with the reality of this disease, particularly as it affects younger women. 

It is this oppositional stance that drives the choice of images in The SCAR Project.  Unlike the Komen campaign, which constructs breast cancer as an abstract "problem" that can be "solved" by organizing large numbers of participants into a variety of collective efforts to raise money for research for a cure, Jay relies on a visual rhetoric of shock, embodied in a series of jarring images of women's post mastectomy bodies that are generally marginalized and hidden away from public view. Nearly all of the women in Jay's project are posed individually, without the support of family and friends that is a central construct in Komen events.  Each displays a jagged scar across her chest, the result of a mastectomy to treat her cancer. A particular source of the power of the portraits is Jay's positioning of each woman. With few exceptions, the portraits of the women face the viewer head on, and in doing so, in the parlance of contemporary photography, they "activate a demanding reciprocity of direct, face to face interaction with the viewer" (Harriman 40).  Unlike depictions in campaigns to eradicate polio as one example of an alternative depiction of medical embodiment, the women in these portraits are not posed in ways that suggest they are helpless--looking up at us as we look down at them. Nor are they, as a result, in apparent need of protection or succor from us, infantilized grateful recipients of the bounty of the spectator. Instead the portraits depict individuals who have entered public space, displaying confidently and not covering their marked bodies.

Indeed, portraits in The SCAR Project reify a different form of female embodiment, one that resists containment within conventional and exclusionary physical standards of female display. Jay's images consistently dislodge the privileged normative body that constitutes the cultural center of female body acceptability at the same time as they open up a discursive space for imagining a new way of being and a new female aesthetic. These are, as De Shazer has characterized them, acts of "somatic cultural resistance" and "somatic defiance in the face of disfiguring disease" (24), a theme reiterated in the autobiographical essays that accompany Jay's book where participants refer to themselves as "warrior[s]" (Toni), as "powerful" (Nikki), as "not ashamed or afraid" (Erin). The portraits are empowering to participants and viewer alike because they display women defining themselves in terms of their uniqueness--their changed post mastectomy bodies--dislodging and dismantling the confining norms that devalue their radically transformed bodies even as they operate within the parameters that constitute the borders of these categories.  Rather than resist or obscure these bodies, the cumulative effect of their display in The SCAR Project is to position corporeal otherness into a new and "coherent subjectivity" (Thomson, "Disabled" 257) that operates inside of existing categories of normative femininity.  As one participant characterized it, "Being a part of The Scar Project allowed me to speak out about something that has deeply affected who I am. . .  If my story helps one woman have the courage to be tested and be proactive about her health, it makes my experience purposeful . . . allow[s] me to feel back in control of my life and experience. . . helps me to feel as though what I've gone through actually has a purpose" (Sara). 

The way Jay poses participants for his portraits also contributes to the notion of SCAR being an alternative and empowering form of female embodiment. As Bartky reminds us, female faces as well as bodies are "trained to the expression of deference. Under male scrutiny women will avert their eyes or cast them downward; the female gaze is trained to abandon its claim to the sovereign status of seer" (135). Indeed, shame, represented by a bowed head, a body part hidden behind a piece of clothing or a carefully placed hand, is "a measure of the extent to which women have internalized patriarchal standards of bodily acceptability" (Bartky 145). But none of the images of post mastectomy bodies in The SCAR Project display these postures. In fact, the individuals in Jay's portraits generally adopt the posture of a stare, which as Rosemarie Garland Thomson reminds us can function as "a powerful rhetorical device that can be mobilized in the interest of persuasion" ("Seeing" 349). Individually and collectively, the portraits wrest control from the spectator who has, by entering into the cultural space of the gallery, the internet, or Jay's book, secured permission and opportunity to gaze as long as they wish on the image being represented and more particularly, to what it is the woman, in collaboration with Jay, wants the viewer to see.  The portraits on display in SCAR represent the aftermath of a fight with breast cancer and as the bodies show, the result, even following breast reconstruction, is never pretty.  Although Jay used the Komen site to solicit participants for his project, the images participants were invited to display--self portraits displaying the jagged scars on chests following mastectomy--were clearly different from the imagery of raucous and festive crowds associated with pink ribbon events. If Komen's pink campaign which some Komen critics have dubbed "pink culture" seems designed to hide the reality of breast cancer under a buoyant vibe of hope and team effort mobilized to work for a cure, Jay's seemed designed to capture the devastation of the disease with a vengeance. His project reifies breast cancer in women, brings into view a reality of the treatment of breast cancer that is generally off limits to the public, even in cancer campaigns. In place of the warmth and fuzziness associated around the color pink and the promise of a cure, something that Sarah King who has written a book on the Komen group dubs "the tyranny of cheerfulness" (103), Jay offers up a more somber portrait of survivors of breast cancer, puts on view something that physician Susan Love in the documentary Pink Ribbons, Inc. candidly describes as the accepted treatment method of "slash, burn, and poison." The fact that the images are all of young women under the age of 35 contributes to the rewriting of the cultural script not only of what breast cancer does to female bodies but also the groups it can impact.  

The replacement of one image--the pink ribbon--with another--the post mastectomy scar-- became the central thematic of The SCAR Project. Autobiographical statements in the back of Jay's book frequently incorporate the scar and the pink ribbon into their narratives of their experience with breast cancer, an indication, as practitioners of institutional ethnography characterize it, of the extent to which the dominant ideology of the discourse of Jay's project is reflected in the ways participants have come to view themselves and their disease (DeVault and McCoy 28). Although there have been other women who visually represented the ravages of breast cancer by baring their scars--the Russian artist and fashion model Matruschka on the cover of the New York Times Magazine in 1993 is probably the most famous example of this-- The SCAR Project dramatically expands that effort by incorporating the image across multiple bodies, securing buy in from post mastectomy women survivors of breast cancer from all over the world. Together, Jay and the participants in SCAR seize upon an opportunity for discursive resistance as they construct a new representation of what breast cancer does to women's bodies, one that specifically critiques the Komen Foundation's facile message of hope as symbolized in their pink ribbon campaigns. Jay's introduction of a white page with a single black square at the end of the series of portraits breaks with the images of triumphant women and introduces another powerful element into his narrative. The square represents 27 year old Jennifer Buffaloe who, after several appointments to pose for Jay, ultimately had to withdraw from the project when her breast cancer metastasized and took her life. Placement of this image at the end of the volume and the series of portraits acts as a somber addition to the visual rhetoric of the portraits. It acts as a cautionary reminder that triumphs over breast cancer are only temporary, something which is acknowledged but diluted in the hyped music and pageantry that is characteristic of pink culture events.   

Much of the impact of The SCAR Project is a function of the public display of post mastectomy bodies, in particular, a function of the cultural significance assigned to the excised body part, the female breast. This too is a marked departure from the way that pink culture shapes public perception of breast cancer in women. Each of the images in SCAR features a female chest with a scar marking the area from which the breast was removed, and like the faces of each participant in the project, every scar is different. Indeed, scars are the central thematic of the project, as central to Jay's campaign as the pink ribbon is to Komen's. But unlike the images associated with cancer survivors in the Komen campaign, the images in Jay's are intentionally jarring to viewers in part because of their placement within cultural understandings of female bodies. Because of the surgery that they have undergone, the women on display in The SCAR Project have lost what Mary De Shazer terms the "culturally inflected symbol of gender identity" (22) and as a result, they are out of conformity with the dominant cultural standards of female beauty.  In every one of his portraits Jay directs the viewer to view not the normative eroticized breast but a female chest from which the once "normal" breast has been amputated or reconstructed. In doing so, Jay challenges representational practices that make everyday erotic spectacles of women's bodies in general and of the breast in particular, replacing, as Rosemarie Garland Thomson has described it, the "spectacle of the eroticized breast which has been desensationalized by its endless circulation, with the medicalized image of the scarred breast, which has been concealed from public view" ("Integrating" 12). In place of an airbrushed image of material embodiment, Jay foregrounds the ravages of a disease, intentionally visualizing for viewers the body in attitudes that are otherwise difficult to see.  By insisting on displaying in his portraits of women what is NOT there, Jay situates himself inside a visual convention--the display of women's bodies-- at the same time as he radically positions himself outside of it. Since the female breast often functions as a sexualized object for male appropriation and pleasure, the female without a breast would seem, devoid of this marker of female embodiment, to be lacking erotic appeal. Yet even though these women are out of conformity with normative standards of beauty because of their surgeries, Jay's portraits function to dismantle the perception of them as defeminized and desexualized, in part because of his calculated manipulation of cultural conventions surrounding female display. The women in Jay's portraits frequently display jewelry--necklaces, pendants, earrings--on their bared chests. They are carefully made up by a stylist Jay hired for the project. Some even sport sexy lingerie or strike erotic poses, hands raised over head while reclining on a mattress or fingers nestled inside the waistband of low slung jeans. Elsewhere in the series, he positions post mastectomy women within conventional scripts of female embodiment. One example is the very visibly pregnant Emily, the 32 year old woman who carries the scars of a bilateral mastectomy. Indeed, it was Emily's image that was displayed on the posters used to advertize The SCAR Project when it premiered in New York in 2005. The marked bodies of the women in the project, the central feature of which is the scar which Jay displays in all of his portraits, makes the private and hidden public. Each portrait maps a specific and unique history of a journey. This is a marked difference from the generic pink ribbon that is central to Komen events. Because it is worn by both survivors and their advocates, the pink ribbon, unlike the scars on the bodies in Jay's portraits, does not differentiate among women who have had breast cancer, women who currently have it, and women who are there to support or commemorate these different groups of women.  SCAR, on the other hand, focuses on one group: young women under 35 who have undergone mastectomy.  Unlike Komen events, these bodies do not hesitate to reveal what is not often seen. Jay's portraits depict individuals who refuse to enter into complicity with oppressive standards of beauty that privilege any one part of their bodies or accede to ideologies that would marginalize them because of their surgery or their disease. Put more simply, the women, at odds with normative categories of female identity, appear to be shaping cultural and corporeal otherness into a unique and deeply personal coherent subjectivity. They claim physical difference as exceptional rather than inferior, embrace a new sense of self that is constructed in terms of its uniqueness rather than its conformity to conventional norms , and in doing so "move from a politics of sympathetic advocacy to a politics of affirmative identity" (Thomson, "Disabled" 242).

The extent to which Jay's project successfully challenges the hegemonic practices of the Kohler campaigns becomes very explicit in the autobiographical statements that appear at the back of The SCAR Project. What becomes apparent is the extent to which participation in Jay's undertaking gave participants a new way to articulate their experience. Before their experiences posing for SCAR, participants complain about the steep learning curve required "to speak breast cancer" (Trisha), of feeling "like my body did not belong to me," and of the struggle to wrest back control of "my body and all that it has been through" from the medical community (Julia Louise). The images in The SCAR Project, which as one participant described them are "in your face [saying] look at my scars DAMMIT" (Andrea), provided these women with an alternative language with which to "capture" and express what one of them described as their "feelings about survivorship in such a powerful and moving way" (Jill). It was, as Emily described it, " an opportunity for me to stand tall and strong with my scars and redefine my beauty for myself." Since, as Judith Butler reminds us, we cannot know anything except that which exists inside language, participation within Jay's project, in particular, representation of their experience within the images associated with the visual rhetoric of that project, assumed a constitutive function in helping participants in SCAR come to know and understand what had happened to them and to articulate that experience for others and for themselves. 

In addition to providing a new conceptual framework and an accompanying way of understanding and articulating their experience, SCAR also created new roles for participants, in particular, roles in which their post mastectomy bodies acquired real and valuable cultural capital. Darcie, for example, observes that "When I was first diagnosed, I could not find photographs of young women who had experienced surgery for breast cancer, either with or without reconstruction." Other participants speak of being "hungry for images of what my body might look like" (Trisha) and of finding it "very hard to find anything about young women who were in a similar situation. . . and of not knowing what to expect after the mastectomy physically and emotionally" (Katie). The SCAR Project, by "showing and not merely telling about their cancer experiences" (Tamara), helped women to "know what to expect" (Katie) and to "redef[ine] what it looks like to be young and to have cancer" (Trisha). In addition to supplying images of post mastectomy bodies of young women, SCAR also gave participants a chance to counter the dominant cultural representation of female bodies within the larger cultural imaginary by enlarging it to include images "of women looking strong and beautiful after surgery" (Amber), of showing the world that women are "not left looking terrible when it is done. . . that women can still feel beautiful, even after this surgery" (Liane).  Participation in SCAR allowed these women to reclaim a femininity that they felt had been lost when their breasts were removed. It offered a cultural alternative that equated breasts "[with] the organs that have come to define womanhood in our culture" (Cary). The portraits of empowered women showing and not hiding changed bodies provided an alternative to the cultural imaginary that surrounds equation of constructions of womanhood and femininity with breasts and to embrace the notion that, as Jill, one of the participants characterized it,  "A woman's beauty is about so much more than her breasts. My breasts did not define me as a woman, and without them, I am still curvaceous, sexy, confident." 

Although The SCAR Project did contribute to pushing the boundaries surrounding normative standards of beauty and female identity, it does not totally transcend them. Clearly, as evidenced by the terms in which they describe their bodies, internalization of conventional standards of female beauty went very deep for all of the participants in SCAR. Indeed, for some of them, struggles with self esteem around body issues went to a new level following their treatment for breast cancer. As one of them notes, "Losing my breast, developing thick red scars across my chest and the visible aftermath of chemo only made matters worse. I could not bear to look at myself in the mirror" (Gabriele). Tamara, another SCAR participant, speaks of her refusal to "let anyone . . . see me bald. My husband and doctors are . . . the only ones who have seen my post lumpectomy body." Katie speaks of being unable to "stand naked in front of the mirror and just see my face, not my mutilated chest."  Jody describes her scars as making her "feel ugly." Yet to a person, each of the women credit SCAR with helping them "embrace" their scars, and realize they are markers of "a fight I fought for my life" (Jolene). They describe SCAR as providing them with an opportunity to "reclaim. . . confidence and learn to see my new self--scars and all-- in an entirely different light" (Cary). In part this is because the images of post mastectomy women in The SCAR Project explicitly engage conventional imagery associated with female embodiment, a function of Jay's practice as a fashion photographer. In addition to the use of jewelry and stylists, some of the settings for the portraits, such as rooms featuring large beds which dominates the frame, reposition participants within a visual discourse which depicts them as sexual and confident about the desirability still inherent in their changed bodies. 

Although it offers a much-needed corrective to the ways in which the Komen Pink Culture has shaped public perception of breast cancer in women, The SCAR Project is not without flaws. For one thing, the overwhelming majority of the portraits are of white women. While the documentary on the project is more balanced--two of the four women featured are not white--the images that Jay displays in the galleries and in the published volume from the first show in New York puts an overwhelmingly white face on the disease. Given what one of the participants accurately described as the power of the project residing in its ability to show and not merely tell about breast cancer in young women, the project may actually perform a disservice to African American women and Hispanics in the 18-35 age demographic, the very age cohort that Jay identifies as the one he most wants to educate.  This claim of presenting breast cancer as an overwhelmingly white and middle class disease is one that is frequently leveled at the Komen Foundation as well. In the case of SCAR, the allegations are particularly troubling, in large part because African American and Hispanic women 18-35 are two of the groups that the CDC identifies as being at greater to equal risk for the disease than white women. In an article published in The Oncologist in 2005, Lisa Newman notes that in addition to a higher mortality rate in African American women diagnosed with the disease, another "notable feature regarding ethnicity-related variation in the epidemiology of breast cancer is that African American women face a greater risk for being diagnosed with early-onset disease" (1). In particular, she noted that:

"Although breast cancer risk clearly increases as a function of age, African American women under the age of 45 years have a greater incidence of breast cancer than Caucasian-American women in this young age range. . . . Although the absolute values of these population-based incidence rates may not appear very large in magnitude, this ethnicity-related variation in age distribution is far more striking in clinical practice where 20% of Caucasian-American breast cancer patients are younger than 50 years of age, compared with 30% of-40% of African-American breast cancer patients younger than 50 years of age (2)".

In attempting to provide an alternative depiction to the ravages of breast cancer in young populations, Jay's reliance on primarily white bodies to carry his message may unintentionally render a disservice to young African American and Hispanic women who experience a higher prevalence of the disease but who on viewing the images in SCAR might be led to believe that this is a disease that affects only young white women and not them. 

A second concern involves the parameters within which Jay constructs his cultural imaginary and the extent to which in manipulating and expanding the boundaries of female identity and beauty he ironically contributes to reifying the very categories that he purports to challenge.   In part this issue rises from Jay's practice of drawing on many of the same convention he uses as a fashion photographer. At no point in the autobiographical essays in SCAR do any of the women challenge these prevailing norms of female embodiment. In fact, in crediting Jay with making them feel--once again-- attractive and desirable, the women in SCAR ironically reproduce rather than contest the very component of an ideology that contributed to their oppression. In spite of Jay's insistence that cancer is "terrifying" and that the photos are "honest, raw, and unflinching," (Preface), the focus in SCAR is on an appearance that, with the enhanced lighting of an experienced photographer and the help of a stylist, contributes to reinforcing rather than dismantling normative standards of femininity and beauty.

A third limitation of The SCAR Project comes from Jay's decision to position his project in opposition to the pink ribbon events associated with the Komen Foundation. Although his focus is more narrow and specific--individual women under the age of 25--the autobiographical statements which appear at the end of the first volume of portraits share the universally positive vibe that is characteristic of Komen events. Or as Barbara Ehrenreich, a survivor of breast cancer has commented in her study of blogs of "survivors":

"No one among the bloggers and book writers seemed to share my sense of outrage over the disease and the available treatments. What causes it and why is it so common, especially in industrialized societies? Why don't we have treatments that distinguish between different forms of breast cancer, or between cancer cells and normal dividing cells? In the mainstream of breast cancer culture, there is very little anger, no mention of possible environmental causes, and few comments about the fact that, in all but the more advanced metastasized cases, it is the treatments, not the disease, that cause the immediate illness and pain (25-26)".

Yet even with these limitations, as an undertaking to reshape understandings around breast cancer, The SCAR Project makes some unique and valuable contributions. By deploying a visual rhetoric of shock, SCAR provides an opportunity for viewers to encounter what is generally available only to a limited and specific audience, thereby helping visitors to Jay's exhibits (and participants) enlarge their understanding of what a woman's post mastectomy body actually looks like and how women who have undergone this surgery can still be viewed as vital and attractive.  Rather than challenge cultural conventions of female desirability, Jay has chosen to provide women who undergo mastectomies with a visual vocabulary, one which not only facilitates their ability to reclaim their position within the very female imaginary that excluded them but one which also aids them in constructing their narratives of what it is to be both female and a breast cancer survivor. 



Works Cited


Bartky, Sandra Lee. "Foucault, Femininity, and the Modernization of Patriarchal Power." Writing on the    Body: Female Embodiment and Feminist Theory. Ed. Katie Conboy, Nadia Medina, and Sarah Stanbury. Columbia U P, 1997, pp.128-154.

De Shazer, Mary K. "Postmillennial Breast Cancer Photo-narratives: Technologized Terrain." Mammographies: The Cultural Discourses of Breast Cancer Narratives. U Michigan, 2013, pp. 17- 40.

DeVault, Marjorie and Lisa McCoy. "Institutional Ethnography: Using Interviews to Investigate Ruling Relations." Institutional Ethnography as Practice. Ed. Dorothy Smith. Rowman and Littlefield, 2006, pp.15-45.

Ehrenreich, Barbara. Bright-sided How Positive Thinking is Undermining America. Henry Holt and Co., 2009.

Harriman, Robert and John Louis Lucartes. "Public Identity and Collective Memory in U.S. Iconic Photography: The Image of 'Accidental Napalm'." Critical Studies in Media Communication, vol. 20, no.1, 2003, pp.35-66. 

Jay, David. The Scar Project Volume 1. New York: Meridian, 2011. King, Samantha. Pink Ribbons, Inc. Breast Cancer and the Politics of Philanthropy. U of Minnesota P, 2006.

Newman, Lisa. "Breast Cancer in African American Women." The Oncologist, vol. 10, no. 1, 2005, pp. 1-14. Accessed 18 Feb. 2017.   

Pink Ribbons, Inc. Lea Pool, director. National Film board of Canada, 2011. Ram, Sadho. "[PHOTOS] A Heartwrenching Glimpse into the Reality That Will Change the Way You View Scars," 3 Feb. 2014, Accessed 10 Feb. 2017.

Thomson, Rosemarie Garland. "Disabled Women as Powerful Women in Perry, Morrison, and Lorde:         Revising Black Female Subjectivity." The Body and Physical Difference. Ed. David T. Mitchell and Sharon Snyder. U Michigan P, 1997, pp. 240-267.

---"Integrating Disability, Transforming Feminist Theory." NWSA Journal 14.3 (2002): 1-32.                    Feminist_Theory. Accessed 12 Feb. 2017.

---"Seeing the Disabled: Visual Rhetorics of Disability in Popular Photography." The New Disability History: American Perspectives. Ed. Paul Longmore and Lauri Umansky. NYU P, 2001, pp. 335-374. 

Lori Duin Kelly was the founder and longtime chair of the Body and Physical Culture area of the Popular Culture Association. Now retired from full time teaching at Carroll University, Professor Kelly continues to publish work exploring the notion of how narratives become constructed around medical events and how and why the different voices within those conversations become subordinate or ascendant in constructing medical understandings. Her work has appeared recently in Sage Open and Journal of Medical Humanities.