All the Beauty and the Bloodshed is Laura Poitras’ spiritual sequel to Citizenfour – an extraordinary documentary about the artist Nan Goldin and her activism around the opioid academic. Part of the film focuses on Goldin’s prolific career, and the ways in which she revolutionsed photography and media art in the 1980s and the 1990s. The other half revolves around her advocacy regarding the Sackler family, who are the main name in art philanthropy in the United States and abroad, with bequests that stretch from the Guggenheim to the Tate, the Met to the Louvre, but who also spearheaded the opioid crisis in the late 1990s. Laura Poitras interweaves these two areas of focus, presenting Goldin, or allowing Goldin to present herself, as an artist-activist who is always searching for new ways to be present and authentic.

The first part of All the Beauty and the Bloodshed describes how Goldin came of age as an artist. The “banality and deadening grip of suburbia,” the distance and detachment of her mother, and her sister’s suicide all propelled her out of home and into a series of queer subcultures where “the relationships that have mattered the most to me…are my friends.” Goldin started photographing these friendships, and these communities, as a “way to walk through fear,” and describes Polaroids as “the first language I spoke.” Goldin also attributes her sister Barbara’s suicide to her closeted lesbian orientation, and tells of how the moment she heard of her death, as an eleven year old, “it clicked: denial.” In response, she opted for ultra-candour in her photographs, as an antidote to depression, and examined her female friends, whether cis, trans or drag, as a way of giving voice to her sister after she had been silenced. These two tendencies, an inclination towards friendship, and a commitment to openness, led to the flowering of Goldin’s candid, confessional, compassionate photography.

Seen from the present, Goldin’s work feels like a new kind of image culture, a forerunner of modern media, and an inception point for the casual, curated and conspicuous photography that characterises our world today. It’s surreal to hear Goldin recount how artists would tell her that “this isn’t photography” and “nobody photographs their own life” since the photography she pioneered presages Instagram, the biggest and most globalised artistic platform in human history. Goldin started out working with disposable and fleeting images, photographs that were only meant to be seen in passing, from her earliest Polaroids to the photo buttons she made to support herself while living in a separatist lesbian community in Provincetown, one of which she sold to a young John Waters. Before ever exhibiting in galleries, she would orchestrate slideshows exclusively for those who were in her images – those who were “tagged” – and these often play like inchoate Instagram stories, especially since Goldin encouraged people to send in music for each staging. Many of these slideshows still feel open, susceptible to change, or else are “dated” to decades at a time, imbuing them with the “live” sensibility of social media, rather than the stasis of gallery hung photography.

While Goldin’s candour sometimes shocked audiences, it also anticipates a time when candour has become a banal part of the social media economy. Goldin’s naked photographs of herself, and others, foreshadows the constant stream of nudes that occurs over Instagram every day, as well as the way in which exchanging nudes might become an end in itself: “I have often used photography as a substitution for sex – it’s often better than sex.” She also documents more traumatically candid experiences, such as the aftermath of a mid-80s boyfriend who tried to blind her when she broke up with him. This photograph formed a network of domestic violence survivors before online platforms, causing many women, over the years, to tell Goldin that her image had given them the courage to come out about their own experiences. Likewise, Goldin herself became a beneficiary of the network she had created, returning regularly to the photo to ensure she never got back with the perpetrator.

Across all these photographs, Goldin evinces an uncanny ability to capture the exact right pose, the flash that makes her subjects who they are. Many of her photographs feel like distilled films, whole narratives whittled down to a single cinephilic moment. At times, Poitras’ own film feels like a later and more sober iteration of one of Goldin’s slideshows, narrated by Goldin herself, whose voice is utterly compelling, shot through with the same gift for storytelling that you see in her artistic work. It’s this voice, and this blending of Goldin’s and Poitras’ filmic visions, that fuse this account of an artist’s self-discovery with a later moment in Goldin’s life. Upon being prescribed Oxycontin for pain management after  routine surgery, she became addicted, and almost overdosed, and set out to draw attention to the opioid crisis, along with the role of the Sackler family in unleashing the epidemic on the public.

This situation is all the more urgent and pregnant for Goldin in that the Sacklers are virtually synonymous with the practice of art philanthropy, especially in the United States but also internationally. The Sackler name and capital is so powerful that it is effectively a claim on the history of art itself. By pointing out that the Sacklers established their ties to the art community at the same time they they were laying the platform for contemporary Big Pharma with the marketing of Valium, Poitras presents the institution of art philanthropy as a sedative, the exact opposite of the “flash” and “rush” of Goldin’s provocative outsider art. Paradoxically, however, Goldin’s outsider art has also been appropriated by most of the major galleries in the English-speaking world, providing her with a unique bargaining chip as she prepares to target only those institutions that have her work in their permanent collection.

Much of the film focuses on the way in which Goldin’s artistic practice evolves through this activism, and vice versa. We hear about how Goldin made an art of getting thrown out of foster homes, which she now reflects was good preparation for getting thrown out of galleries. Then, she learned the art of survival from the queer communities she inhabited throughout the 70s and 80s, and especially from her best friend and de facto life partner David Armstrong. They met stealing steaks, he named her Nan, she was the person to ask if he was gay, and so they “liberated each other” from the suburban worlds they had departed. Goldin also takes artistic inspiration from Barbara, whose decision to lie down on the train tracks near their home she sees as an act of defiance. Not only does Goldin return to these train tracks for some of her later work, but she tacitly presents Barbara’s actions as a distant ancestor of the lie-ins and die-ins she arranges as part of her campaign against the Sacklers.

More specifically, Goldin draws on two particular moments in the history of art, and her own participation in that history, to fuel her protest here. The first involves the great happenings of the 70s, the convergences of art and activism that sought to collapse the thresholds between gallery and world into collective ceremonies: “One of the first steps in making the private become public is ritual.” Drawing on the 70s love for acronyms, Goldin forms PAIN, the Prescription Addiction Intervention Network, and teams up with USU, the Urban Survivors Union, to construct a series of sublime site-specific works. The film starts with one of these, a die-in around the transplanted Temple of Dendur in the Sackler Wing of the Metropolitan Museum of Art. However, the most spectacular occurs in the Guggenheim, where PAIN and USU line the concentric balconies and drop down a flurry of prescription pads in response to a leaked Purdue Pharma document that anticipated a “prescription blizzard” that would be “deep, dense and white.” PAIN members and the public are clearly moved by the message of this happening, but also simply “in awe of the visual it created” in the iconic gallery space.

The second point of reference here is the ACT UP movement of the late 80s and 90s, and its footfalls in the New York art world. One of the key ideas of ACT UP was “no stigma, no shame,” and Goldin voices the same philosophy when she is called upon to testify at a hearing about the impacts of opioid addictions. Various Silence=Death accessories crop up during the PAIN happenings, while Poitras draws a lineage between Goldin’s current activism and a show that she curated in the late 80s called “Witness: Against Our Vanishing,” the first to focus exclusively on the experience of AIDS. At the time, the National Endowment for the Arts cancelled funding for the exhibition, but this only drew the participants, and their spokesperson David Wojnarowicz, closer together. The convergence of art and activism into a politics of visibility continues into the way that Goldin takes on the Sacklers in the present.

In both present and past, Goldin’s works thus become a vehicle for speaking back to the dominant image culture. The verite style of her photographs segues into a strategy for documenting the surveillance efforts of the Sacklers, as in one particularly eerie scene in which she uses her phone to record a car that appears to be following her. Compared to the collective warmth of the 70s and 80s, the contemporary moment can feel quite wintry and austere here, attuned to the coldness of the upscale gallery space that Goldin challenges. Her later photographs no longer contain people, and that sparseness continues into the mood of the film itself, meaning that when her parents emerge in the final scenes, they feel somewhat displaced, reminding me of Chantal Akerman’s depiction of her mother in No Home Movie. Yet the power of Goldin’s vision lies in her commitment to this collective spirit even in a world that seems to mitigate against it, and a New York far removed from the low-rent 70s and 80s.

It’s not just a matter of vision either, but pure dogged tenacity. Goldin puts her own legacy on the line by threatening to pull a retrospective of her work from the Tate if they don’t refuse to stop taking Sackler money. Amazingly, the gallery caves to her pressure, and the Louvre, Guggenheim and Met all do the same, followed by a wave of hedge funds (or as Goldin terms them, “bottom dwellers”), who also stop accepting Sackler money now that the PR cost is starting to outstrip the financial gain. This isn’t enough for Goldin, who then pressures these major galleries to remove the Sackler name from their various wings, bequests and collections. Finally, she plays a key role in having the Sacklers fined for six billion dollars, and forced to listen to a series of victim testimonies and 911 calls related to opioid overdoses. Lest this feel too idealistic, Goldin soberly reflects that the fine is a mere pittance compared to both the Sacklers’ fortune and the total cost of the opioid epidemic (over a trillion dollars) and that it provides them with “unprecedented civil immunity,” meaning that they benefit even from their punishment, so intractable is the pull of the ultra-wealthy in contemporary America. Likewise, Purdue Pharma is found guilty of federal crimes, but the Sacklers are never directly prosecuted. None of them engage much with the witness statements and calls either.

In the end, Goldin reflects, the only place that the Sacklers could be held accountable was within the art world they helped finance. The film ends with the Met becoming the first gallery to remove the Sackler name, but the lingering final image, for me, was a one-page ad that the Sacklers take out in major newspapers to counter Goldin’s claims. Everything about this ad is reasonable, sensitive and commonsensical – it reminded me of a scene in HBO Succession, when the Roy family deals with its enormous malfeasance by adopting a similar kind of corporate authenticity, with a one-page spread of their own that simply reads “We get it,”. Sackler’s response here is also an empty “we get it” statement, pure PR, and the same PR that led to the marketing of Oxy in the first place – and so different to Goldin’s brilliant bluntness.