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How to Handle an Unsettling Photo

By Andy Alexander

A number of readers were upset today by the photos that showed Connie Culp of Cleveland before and after she became the nation’s first recipient of a face transplant. The photos appeared in The Post’s A section and at the top of’s homepage before being swapped out late this morning. The readers who contacted me were all reacting to the online photos, which can still be found elsewhere on the site.

“It is an upsetting image, so much so I’ve switched my home page to after years of having it set to the Washington Post,” wrote reader Ray Cuadro. “Ignorance is bliss and I go out of my way to avoid such gruesome imagery.” He added that “greater discretion on your part would be appreciated.”

The “before” photo is unsettling to the squeamish. It shows Culp as she looked prior to a 22-hour operation last December, when doctors at the Cleveland Clinic replaced most of her face with skin, muscles, nerves, bone and blood vessels from a woman who had just died. Culp had been horribly disfigured in 2004 when her husband shot her in the face with a shotgun.

These are tough calls for editors who must weigh sensitivity with reality and the desire of readers to be informed. Editors often know in advance that an image will disturb some readers. But in this case, they also knew that many would want to see the dramatic difference in Culp's appearance.

Dee Swann, who plays a key role in photo selections at, said editors Tuesday night discussed the selection of images, including the “before” photo. She said they concluded that “the image was representative of the story -- it was the woman’s choice to come forward with her doctors to share the photos showing the success of her surgery,” and that the image, although graphic, "was not gory.” She said there was further discussion this morning about “moving the photo back in the home page rotation, so it was not the first photo a reader saw when they came to the home page.”

Swann said graphic photos are routinely discussed before they are posted. They’re considered on a “case by case basis, taking into consideration the story, how the photo relates to the story, how the subject is portrayed in the photo, our level of comfort in how the photo will be received by readers and where it will live on the site.” In some cases with potentially disturbing photos, she said, the decision may be made to “run it in a photo gallery behind a warning.”

My view: I think the photos were handled properly in the newspaper. They were small in size and were played on an inside page. The accompanying short wire story explained the extraordinary medical procedure. It would have been tempting to run only the “after” photo in the newspaper and then provide a Web address for the “before” photo. But that would be asking a lot of readers interested in the comparison. And many print readers do not go online.

I would have handled it differently online. The readers who contacted me all said the photo showing Culp’s pre-transplant disfigurement seemed to jump out at them on’s main page. Cuadro said when he saw the image, “I instantly put my hand up between my face and the monitor to obscure my vision.” An option would have been to feature only the “after” photo, while giving readers the opportunity to click on a link if they wished to view the “before” image.

Swann said other options could have included using only the "after" photo on the home page, but including both the "before" and "after" photos when a reader clicked to read the accompanying story. Or, she said, both photos could have been included in a "slideshow" accompanying the article, with the "after" image being first and the "before" image second.

Tell us how you would have handled it.

By Andy Alexander  | May 6, 2009; 4:00 PM ET
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I have been shocked today at how many news outlets published the "before" picture of Ms. Culp. One can only speculate that the photo editors wanted some shock value to illustrate an otherwise amazing news story.

My initial feeling was the photos breached some element of respect for privacy. However, if the pics were used with Ms. Culp's knowledge and consent, that leaves only the bad taste of those editors who cannot perceive a better use for news media than gratuitous photos of trauma victims.

Will WP start running accident photos and crimes scene gore, too? How about operating room blow-ups of heart operations to greet the morning reader.

Posted by: roboturkey | May 6, 2009 5:09 PM | Report abuse

The photos of Culp were disturbing and necessarily so. It pictured the reality of the violence reported in daily stories and never followed up the reality of war statistics and automobile accidents: it is clean and neat to hear about the death count but what about all the vegetables in our nursing homes that Pro-Lifers and Secularists alike keep alive in the name of the sanctity of life? How about an in-depth feature on this, with our without photos?

The right to life means nothing without the right to die!

The pictures of Culp were disturbing but not obscene. The publication of John Bolton's attack on the Obama administration this morning was obscene. And it was not at all connected to any social or political or foreign policy REALITY.

Posted by: walden1 | May 6, 2009 5:28 PM | Report abuse

Instead of being a pi$$er and moaner about the before pix, I was amazed at what these wonderful doctors did for this lady. You wouldn't get the full effect without seeing the before.

The before picture shows man's inhumanity to (wo)man. The after picture is one of hope and compassion. It took a lot of courage for the lady to go through with the transplant.

It's a good thing the whiners didn't see the lady on the street. Who knows what they would have said or done.

Posted by: waterfrontproperty | May 6, 2009 5:35 PM | Report abuse

i thought it was amazing. scary for kids maybe. props to the doctor's the donor and the recipient.

Posted by: jcck | May 6, 2009 6:44 PM | Report abuse

Oh, you poor delicate things, confronted with that awful picture! You must be terribly upset! But imagine what it was like being behind that face instead of in front of it.

Is this why The Post keeps an ombudsman on the payroll, to mollycoddle the hypersensitive? Doesn't he have any *important* issues to look into?

Posted by: donnolo | May 6, 2009 8:12 PM | Report abuse

"Oh, you poor delicate things, confronted with that awful picture! You must be terribly upset! But imagine what it was like being behind that face instead of in front of it."

That's great, but the truth is that the Post and the rest of the news media have been exploiting this story and its subject for shock value. The story has no news value whatsoever.

Entertainment Tonight ran the story tonight, showing the pictures over and over. The story has as much news value as it does entertainment value: none. It is just an opportunity for ghouls to boost numbers by showing shocking pictures to ghouls.

Posted by: bobmoses | May 6, 2009 9:31 PM | Report abuse

People were unsettled by the before picture?

Wow! Maybe they should consider what it is like to live with that face. What would you do if you encountered it in the grocery store? What would you tell your children? Afterall, she really shouldn't become a hermit, living behind closed blinds and never coming out.

So, I hope that picture made people think a bit about walking in someone else's shoes. This is a normal person, living a normal life until something happened to her. This could happen to you. Then you would have to look at this every morning when you looked in the mirror.

Posted by: elgoth | May 6, 2009 9:31 PM | Report abuse

I think the editors made the right call in running the photos online for two reasons:

(1) Many readers---I suspect many, many more than wrote in expressing their discontent---were fascinated, awed, and humbled by this story. I read about it as much as I could and looked at as many pictures as I could today. Ms. Culp's story is sad, inspiring, and happy all at once and I'm glad to have been privy to the whole story, pictures and all.

(2) Echoing elgoth---this is a real person who lived this life for the past few years. You saw that readers basically recoiled in horror at the sight of the *picture?* I ask these people to imagine what it would be like to live that picture every single day. Stories like this should make each of thankful for what we have.

Finally, the comments that this story has no news value is ignorant. This is the first full face transplant in the U.S.! Something that would have been unthinkable just a few years ago! Unless you have no interest in health and medical stories or don't consider them news, this has incredible value as a news story.

Posted by: arlingtonresident | May 6, 2009 10:09 PM | Report abuse

I'm still getting used to condom and tampex commercials, so this was a little over the top for me.

While I have kept in mind that this women wanted her story told, it's just seeing the images over and over amongst the news outlets that was a little to dramatic for me.

These pictures coupled with the chimp attack victim ... a little to gory for front page articles.

Posted by: playfair109 | May 6, 2009 11:46 PM | Report abuse

I think the photos should not be on the very front page, out of consideration especially of youngsters surfing alone, but available if clicking on the article headline.

The before photo is extreme since few suffering injuries like these survive them, but publication is justified for two reasons: One being to illustrate the story about the surgery itself, the other to show what domestic violence can be. So many women are abused, raped, tortured and killed by their spouses.

Posted by: asoders22 | May 7, 2009 5:11 AM | Report abuse

Ms. Culp must feel so much better, now that people can stand to look at her, or not shield their children's eyes from another unfortunate yet amazingly lucky human being.

I would hate to imagine if those who decided made such a stink over these pictures were to have the very same accident happen to them.

Perhaps they would have the chance to be told they are "not fit to be seen", or "its inappropriate for you to walk outside", or have people gasp, then start writing letters to everyone they know to remove you from their sight so they no longer have to acknowledge your existence in any way.

Its immensely sad and sickening at the same time. And I'm not talking about Ms. Culp.

Posted by: trident420 | May 7, 2009 8:53 AM | Report abuse

I agree with the later part of this article. The after photo should have been posted on the website cover and the before photo available for those who opened the lead for this article. It really seems amazing that this was not the decision taken by Ms. Dee Swann. After seeing the photo on the website cover, I shielded it with my hand. I never did read the article, although I am very happy for Ms. Culp getting the successful face transplant.

Posted by: henryhoople | May 7, 2009 2:24 PM | Report abuse

I thought that a real before picture would have been useful. I wanted to see the lady before the disfigurement. There are some real miracle workers in hospitals. Internal organ miracles can not be illustrated in a newspaper. This one represented them too.

Posted by: shlomiesdad | May 7, 2009 2:41 PM | Report abuse

"That's great, but the truth is that the Post and the rest of the news media have been exploiting this story and its subject for shock value. The story has no news value whatsoever."

I respectfully disagree. Face transplant surgery is new, and Ms. Culp was the first American face transplant patient. Since very few people have had this type of surgery, it is still quite newsworthy.

The Post could have used a bit more discretion in how they posted/published the before and after shots. The before shot was really not for the squeamish. On the other hand, posting the after shot was in my opinion necessary. It is her face, the very same face she has to live with and show in public. Censoring the after shot sort of implies that Ms. Culp should only go out in public with a face covering head scarf. Her basic right to show her face in public should be not be restricted to please a few overly sensitive people.

Posted by: GP04 | May 7, 2009 3:53 PM | Report abuse

Newspapers are supposed to be truthful reflections of the world we live in.

This is an amazing, newsworthy story. Only a handful of these transplants have been successfully undertaken. Ms. Culp is to be respected, not only for what she has experienced and endured, but for the brave way she has shared the importance of her story with us.

We should be grateful for the opportunity to read about what her doctors and medical teams have been able to accomplish. We should stand in awe of the amazing medical strides that have been made in our own lifetimes.

This is a new life for a wife betrayed and beaten by a husband.

As to those readers who have chosen such unfortunate turns of a phrase as "I'm still getting used to condom and tampex (sic) commercials, so this was a little over the top for me," I have to wonder, what is so difficult for you to see? Are these two photos of Ms. Culp to be lumped in with condoms and Tampax? I don't get the connection, except that perhaps you are seeking to avoid any "unpleasantness" that distracts from an antiseptic and unruffled environment.

Ms. Culp has the right to be here. What would you do if you saw(either as she was or as she is now) her in the mall, on the street, in an elevator? Please don't tell me you would avert your eyes and hurry away. I have no doubt you would peek and if you thought you were unobserved, you would stare.

Sometimes we stare out of natural curiosity, or because of a titillation with those things "freakish"; or we try to cast a glance of compassion and understanding, but in the end we all look.

So it is astonishing to hear writers proclaim that their sensitivities are such that they just cannot bear to even be aware that such tragedies happen or such miracles occur.

And as for the idea that children simply should not be exposed to such information: If your children are old enough to read the newspaper, either in print or by surfing the net, or see the pictures and ask questions, they aren't too young to know and discuss what goes on in the world - Socially, environmentally, medically.

It's your job to create a forum for intelligent discussions with honest answers.

And you last, but not least, should be grateful that your kids are surfing the newspaper instead of some inane shoot-'em-up video game...

Posted by: CityCommuter | May 7, 2009 10:10 PM | Report abuse

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