The term of graphic medicine, intersection between comics and health, was coined in 2007 by the Welsh doctor Ian Williams. This same author, together with his collaborators, this year defined Graphic Medicine as “an interdisciplinary field of the medical humanities that encompasses the creation, use and study of comics in medicine and health.”
In 2010, Michael J. Green and Kimberly R. Myers, in a article focused on the use of comics In medical education and patient care, they coined the term graphic pathography and defined it as “the narrative of the disease in graphic form.” These works are the heart of Graphic Medicine and constitute an excellent form of doctor-patient communication.
Graphic pathographies existed long before anyone defined them and, in most cases, they were (and are) performed by patients. The first to appear in Europe was cult work Epileptic: the rise of a great evil by David B (1996). In this cartoon, with a claustrophobic design in black and white, the author tells how his brother’s illness marked his life and that of his family.
He tells us about the journey through the endless false therapies that his parents used, the frustration of each of them, the physical and psychological change of his brother, the pilgrimage through different medical appointments and the wall of impotence against which they constantly collided. . Epilepsy, an incurable disease, entered David B.’s life like an elephant in a china shop, marking his childhood and that of his brothers.
The epilepsy of the great evil
In the prologue that his sister wrote for the comic, there is a very significant phrase: “The only certainty of my life is Jean-Cristophe’s illness: the epilepsy of the great evil.” David B. uses a lot of black ink to convey that feeling. Anyone who has or has had a family certainty of similar magnitude will be identified in many of its fragments. At least that’s the idea.
The comic can perfectly convey this type of story because it uses resources capable of representing the invisible (hope, fear, anger, love, uncertainty, compassion, etc.).
In literature (and in ordinary discourse), the metaphor is a semantic device in which a real object is identified with an imaginary one. The first definition of metaphor comes from Aristotle: “Metaphor is naming one thing for another.”
Disease and its metaphors
For Susan Sontag, who has had cancer twice, he did not like metaphors who were used to talking about some diseases: “The concept of disease is never innocent, but when it comes to cancer it can be argued that genocide is implicit in its metaphors.” He said that the metaphors used to talk about tuberculosis, AIDS and cancer instigated an absolutely irrational fear of the disease.
In addition to other resources, graphic pathographies have many visual metaphors that, dare I say, would have been to Sontag’s liking.
At Blue pills (Frederik Peeters, 2001) the fear of diagnosis is represented as a huge rhinoceros with scared eyes sitting between the protagonists of the story, and in Alice in a real world (Isabel Franc and Susanna Martín, 2010) transforms the face of the protagonist into the face of The Scream por Edvard Munch.
Two different but unmistakable ways to convey the same feeling to the reader. Sometimes the opposite happens, the authors use the same visual metaphors. Thus, the effects of morphine are represented by calming spirals in The story of my breasts (Jennifer Hayden, 2015) and in Paul in Quebec (Michel Rabagliati, 2009).
But what do graphic pathologies bring to the patient?
There are many diseases that have a great social stigma: cancer, depression, schizophrenia, epilepsy, autism, bipolar disorder, Alzheimer’s, among others.
Graphic pathographies can provide the reader with information about a disease without abusing the technical language that permeates books and, sometimes, medical consultations.
Knowledge is the only way to mitigate the atavistic fear of some diseases. Furthermore, by naming negative fears and feelings, the patient feels the feeling of belonging to a community, of not being alone.
The realistic and unsweetened treatment of these works ends up instilling strength in the patients when they realize that others have already passed and lived to draw it. To the relief of patients, these jobs lack self-help messages such as: “You have to be positive” or “You have to fight.” These messages impose a totally unfair and disproportionate burden of responsibility on the patient.
The best thing about graphic pathographies is that they give the patient a voice, helping to further humanize medicine. The patient talks and the doctor listens. The idea is that the doctor acts appropriately to close the communication cycle.
For all these reasons, in recent years, medical schools around the world have been purchasing graphic pathographies for their libraries. It is a way of teaching medical students to understand and listen to the stories of the sick. When a patient draws how he feels and manages to convey that information, he is creating new knowledge that will be of use to future doctors and patients.
Also, not everything you want to tell in graphic history is explicitly written. Some parts of the story must be completed by the reader. Therefore, this tool can be used in the training of future doctors. In their professional practice, they will also need to infer information from incomplete stories told by patients.
Learning through comics in medical schools.
For graphic medicine to occupy a place in the training of future doctors, several obstacles must be overcome. One is the unfounded prejudice that comics are stories for children or young people. Another (and no less important) is to find a space for the comic in the saturated curricula of medical students.
They are working in this line in some medical schools around the world. Pennsylvania School of Medicine (USA) Has had a course taught by a physician since 2009 Michael J. Green. In it, students critically reflect on some comics and create their own stories about their experiences as medical students.
Similar seminars are also held at the Feinberg School of Medicine in Chicago, USA and Toronto, Canada. At Yale University (since 1998) and Harvard University there is a very curious initiative. They organize a course to improve the observation skills (and therefore the diagnosis) of medical students using works of art.
In Spain, as part of a teaching innovation project, the degree in Physiotherapy at the University of Almería made its students reflect on some aspects of their professional practice with the help of various comics. At the Faculty of Medicine of Albacete (Castilla-La Mancha university), in addition to acquiring graphic pathographies for the library, an exhibition and a series of lectures show students some aspects of Graphic Medicine. Little by little, in many universities around the world, in one way or another, seeds are being planted in the hope that they will germinate in our students.
Since its inception, Graphic Medicine has not stopped growing. Graphical pathologists are popping up from all over the world to explain (as Susan Sontag would say) the healthiest way to get sick.
This article was written in collaboration with Blanca Mayor Serrano, professor at Own Master in Comics and Education from the University of Valencia.