February 11, 2019

Demystifying Illness: Rob Clough on the GRAPHIC MEDICINE: COMICS AS A MEDIUM FOR NARRATIVES OF ILLNESS show at the Louise Jones Brown Gallery

It's been interesting to track Graphic Medicine as a comics movement over the past decade. The term was coined by Welsh physician Ian Williams, who wrote comics under the nom de plume of Thom Ferrier until he chose to start using his real name. I'm not sure if it was just part of the zeitgeist, but the advent of Graphic Medicine came at a time when autobiographical comics switched from quotidian material to a more direct examination of experiences like illness, parenthood, and mental health. Williams' iconic "I Am A Shit Doctor" image is symbolic of the movement from the caregiver's perspective. It directly reflects Graphic Medicine's aim of humanizing medicine and creating a sense of empathy between doctor and patient. That's especially true in the UK, where thanks to the National Health Service, everyone is entitled to free healthcare. Being a doctor isn't a gateway to making a lot of money like it is in the US, and there is a corresponding decrease in prestige as a result. That said, the discipline is the same, as is the corresponding level of stress that accompanies it. 

Williams teamed up with an American nurse named M.K. Czerwiec, who works in hospice care and HIV/AIDS, to formalize the movement and give it an academic bent. There have been yearly conferences since 2010, and the comics have gone from self-published minis and webcomics to having major publishers. What's interesting is that all of this has gone on in parallel to both mainstream comics and alternative comics. When I mentioned it off-handedly to a comics publisher last year, her ears perked up because she had never heard of the term before. Graphic Medicine is partly an academic movement and partly a true mainstream movement. Part of its focus is to get both potential readers and artists to recognize comics as a legitimate art form. It should be noted that a central part of its mission is to empower health care professionals and patients alike so that they can tell their stories.

Medicine and cartooning complement each other well, in part, because it's easy to think of disease in narrative terms. It often has a beginning, middle, and end. It offers dramatic struggles, setbacks, and successes. It's open to a variety of visual approaches, from graphic naturalism to magical realism. Even mental illness, whose depiction is perhaps the backbone of Graphic Medicine, can be depicted in a variety of ways despite being an outwardly internalized struggle. The trick is to get potential artists thinking like cartoonists as opposed to illustrators. Not everyone can be taught to be a great draftsman, but anyone can be taught the fundamentals of cartooning. 
That certainly is true when one looks at the length and breadth of the books that fall within this category. Interestingly, the story that's considered to be the foundation of modern autobio is explicitly wrapped up with mental health: Justin Green's 1972 classic "Binky Brown Meets The Holy Virgin Mary". That story details Green's struggle with crippling OCD and how it got wrapped up in Catholic iconography. Harvey Pekar, Joyce Brabner, and Frank Stack's Our Cancer Year in 1994 was the first cancer narrative, and it's still the best. As oncology has evolved to provide better outcomes for patients, the social and emotional well-being of the patients has become increasingly important. This book illustrates why, as cancer has a powerfully disruptive effect on both patients and their familial caretakers. Other examples include David B's 1996 book Epileptic (which is not only about his epileptic older brother but also about the lifestyle changes his family his family adopted in an effort to help him) and Ellen Forney's Marbles (2012), which is one of many first-person accounts of bipolar disorder. 

While encouraging patients to tell their stories is a crucial aspect of Graphic Medicine, I'd argue that at its core, it's still more of an academic and vocational movement. It's giving voice to a particular expression of how one can combine medicine and the humanities, one that has a unique power. That power stems from the paradox of telling one's own story: the more particular and personal its details, the wider its overall appeal becomes. I believe this is true because of basic human empathy. When reading someone's story and realizing they're revealing something personal and vulnerable ("spilling some ink", as Rob Kirby and I like to put it), it's easier to empathize and thus identify with that story than a more generic story. Even if that experience comes from a completely different point of view, it doesn't matter. 
As comics has continued to become part and parcel of academic curriculums in the US, so too has Graphic Medicine expanded. At Duke University, recent grads Kelsey Graywill and Omar Khan recently unveiled a new show at the Louise Jones Brown Gallery titled "Graphic Medicine: Comics as a Medium for Narratives of Illness." That duo taught a house course on the subject in the spring of 2018, and Graywill, in particular, is an interesting talent. As an undergrad, she created her own major: "Creating Meaning: Empirical & Evolutionary Neuroaesthetics." Throughout her life, she's always focused on working in science & medicine, as well as being an artist, finding ways to integrate them and bring them to a wider audience. 

With Czerwiec as a mentor, she branched off into cartooning from a variety of perspectives. She's been an EMT, so she's seen its crises from that perspective. She's done stories about her own bipolar disorder. She's drawn comics about being a pre-med student observing a surgery and being told how a doctor must always think of their patient as a person rather than the latest set of body parts that relate to their technique. All of these comics were in the Louise Jones Brown Gallery show, and each one is in a different style. Her EMT comic is a single-panel gag strip, albeit one with a dark punchline. The story about observing a surgery is a typically formatted comic. Her strip about being bipolar is stripped down in terms of its imagery, with its blown-up panels instead focusing on different kinds of negative space in order to make an impact. 
Graywill told me that one of the most important parts of co-curating the show was giving the artists the confidence and freedom to be cartoonists instead of worrying about their draftsmanship. That showed in the innovative way they laid out a number of the strips. In the explanatory text for many of the pieces, the cartoonists drew self-caricatures, and the text was designed as a word balloon. Rather than simply slapping original art on the wall with no context, Graywill and Khan instead blew each piece up in size and made sure each told its own story. Some of them were single-panel strips, but there were a number of longer pieces as well. In Alina Walling's Something's Wrong, for example, the artist focuses on the experience of being in an emergency waiting room, knowing that something was deeply wrong with her despite being told otherwise by doctors who weren't listening to her. The use of spot reds against black and white art stood out in a clear manner as she went back and forth from being a red dot in a waiting room to a patient with a serious issue. Caroline Bay's strip about rehab showed past, harmful behavior on a top row of panels and current, healthy behavior on a bottom row; each panel was catty-corner to the other. 

Some offerings, like Ashley Manigo's "The Face of HIV", used color and text to complement each other in a single, striking image. Dr. Nathan Gray's single-panel gag strips wouldn't be out of place in the New Yorker, given his skill and trenchant wit. While most of the artists in the exhibit were either pre-med undergrads or medical students, Gray is a practicing physician at Duke. He specializes in palliative medicine, a discipline that calls for a great deal of empathy in its practice. "Bad News" focuses on this disconnect between medicine and empathy, especially at an institution like Duke that specializes in rare and unusual diseases. He uses a tight perspective in "Empathy Robot" to emphasize the cramped nature of an exam room, as the clearly uncomfortable doctor eschews even an attempt at empathy as he turns it over to a robot. 
Manigo, Gray, and Graywill were the standouts of the exhibition, and it's not surprising that each had multiple pieces in the show. Even the lesser pieces saw attempts at visual innovation, though some bordered on cliche'. There was a bit of repetition in terms of themes, especially regarding mental illness, without much variation in terms of style. Still, the show's execution of its intent was entirely effective. Aimed at a general audience but focusing particularly on students, the show could be navigated in less than a half hour, reading every piece. The language of the exhibit seemed particularly aimed at undergraduates majoring in STEM fields and medical students, encouraging them to incorporate the humanities into their studies and explore a new kind of self-expression. 

While some of the language around the exhibit is condescending ("Graphic Medicine...explores how we can use silly things to understand serious things, by combining comics with medicine"), its intent is subversive. By creating a narrative of empathy around stigmatized illnesses in particular (like HIV or mental illness), Graphic Medicine blunts the way that society has tended to isolate and silence suffering individuals. By creating a narrative of empathy between caregivers and patients, Graphic Medicine blunts the inequitable hierarchy between physician and patient. By creating powerful visual narratives that operate at clear visual and metaphorical levels, Graphic Medicine can demystify illnesses shrouded in mystery, jargon, and fear. While Graphic Medicine has been receiving international attention by way of the wave of books being published on the subject, its true impact is on the local level in shows like this.
Rob Clough has written about comics for Cicada, the Comics Journal, Sequential, tcj.com,
sequart.com, Savant, Foxing Quarterly, Studygroup Magazine, as well as for his own blog, High-Low (highlowcomics.blogspot.com).

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