Graphic Medicine

Kuniyoshi at the RA

Went down to London yesterday to see the Kuniyoshi exhibition at the Royal Academy. It is closing in this weekend. It was well worth the trip. I love japanese woodblock prints (as well as japanese ceramics, calligraphy and garden design). Yes, as has been pointed out by many commentators, they look remarkably contemporary and the reason for this is at least partly to do with the similarity they bear to the clear line style of comics masters such as Herge. As Paul Gravett points out in an article in the Spring 2009 edition, No. 102, of the Royal Academy Magazine modern manga comics owe much to these classic prints. I love Paul Gravett's writing. Read the article on his site www.paulgravett.com/articles/articles.htm

Manga grew from a fusion of traditional japanese illustration and western comics style and animation. Post war japanese cartoonists supposedly appropriated the oversized eyes and large heads of disney characters and so developed the classic manga style of physiognomy.

We all know how western artists of the late nineteen and early twentieth century were influenced by woodblock prints from Japan. This exhibition shows how Japanese artists were also influenced by reproductions of western paintings- as evidenced by the european perspective used in "The Night Attack".

I was thrilled to see Kuniyoshi's animal cartoons, humorous and satirical depictions or anthropomorphic creatures that neatly sidestepped the rigorous censorship imposed by the ruling government which prevented depictions of many types of activity and of many famous people.

Glad I caught the last day of the exhibition

Going back to comics: The first graphic novel with a medical theme that I came across was Cancer Vixen, by Marissa Marchetto. See my review of it at www.graphicmedicine.org . I liked the autobiographical form of the book, and felt that it gave an awful lot of "non propositional" knowledge- information about what things feel like, the soft fuzzy stuff as opposed to "hard facts". There were things here that you wouldn't find in any medical textbook (such as how bad farts smell after chemotherapy!), and I suppose this book started me off on the search for other comics and graphic novels of a similar theme. I soon found Mom's Cancer by Brian Fies and Our Cancer Year by American Splendor author Harvey Pekar. These were the first of many varied works I found to be relevant, but these three, all being about cancer, were interesting to "compare and contrast". In fact, although the graphic and narrative styles vary, the three are remarkably similar in theme. They reflect the disorientating and frightening experience of receiving a diagnosis of cancer an embarking on a course of treatment under the American health "system" (which seems less of a system, more of a multifaceted consumer industry, through which the patient must pick his/her way without a map). We moan about the NHS, but if you read these books you might find yourself grateful too live in a country where healthcare is free. The British system also seems much more holistic than the fragmented, ultra-specialized American model.

Marissa Marchetto had let her health insurance lapse when she was diagnosed with breast cancer. Had not her wealthy fiance been able to add her to his policy, she would have faced bills for $200, 000 for treatment. As it was, she faced crippling uncertainty with well meaning friends undermining her confidence in her chosen specialist and suggesting their favourite doctors who proposed different, "better" treatments. She was even cold-called by oncologists, touting for business and offering her "lighter" chemotherapy. Poor communication on the part of health professionals is rife, a theme echoed even more strongly by Brian Fies and Harvey Pekar, whose works reflect a more prosaic experience than that of Marchetto. Fies describes the effect his mother's cancer had on his ordinary, middle class family and Pekar, the working class everyman recounts his experience of lymphoma in a script jointly written by his wife Joyce and illustrated by Frank Stack.

I've just got home from a weekend at the Hay Festival and feeling inspired to do some writing. With limited time before bed, I'm torn between adding a post here, or doing some drawing. The blog wins, but mainly through a sense of duty: I've only just started it and I feel I should add something regularly, but lets leave comics and medicine for tonight and let me tell you about Hay: if you don't know, its a literary festival, and has become so successful it is now being exported and copied all over the world. It is very well organized and terribly…civilised, in a well spoken, slightly left wing, intellectual kind of way.

I went to a talk by Jake and Dinos Chapman, chaired by Tim Marlowe. I admire their work because I tend to like things that are made to deliberately offend the common sensibility (providing, I guess, that it doesn't contain real violence or animal cruelty or whatever). They were, by turns, deliberately obnoxious, ascerbic, puerile, incisive and funny. Jake seemed to do most of the talking. I did quite like some of their ideas; I'm not that keen on fine art that has an obvious moral message, and positive insight can come out of occasionally exposing oneself to the gruesome or gothic. (although having the choice to do so, it should be remembered, is a privilege) In the end I decided that I preferred to look at their work than listen to them talk, and left feeling rather unsure as what to think: are they really as mean as they seem to make out?

I was sitting on the second row. In front of me sat a guy with long grey hair and a grey beard. At his feet was balanced a canvas bearing a painted portrait of the brothers. He seemed poised to make some sort of approach to the stage. I couldn't get a clear view of the portrait but it looked to me like it was rendered in a naive style. "Shit", I thought, "he's going to present them with the painting, this could be mortifying". In the end, he wanted them to sign it, making his move after the ending applause died down. I hung back slightly and waited to see if he'd get his wish or whether he'd be told to "Fuck Off". He got his wish: as I left I saw Jake, seeming to overcome a moment of puzzlement, signing his name across the forehead of his painted avotar. I later saw they grey haired man walking around carrying his canvas and wondered what he was going to do with it: was it simply a piece of fandom to proudly display to his friends or some sort of comment on authorship, or was he going to stick it on ebay?

So… I started to read loads of graphic novels and trawled comics sites and shops for anything that could conceivably be of medical relevance. I wanted to see whether reading these works gave some insight into the situations of experiences they described- or rather I assumed they would give some insight but I wanted to work out what made comics a good medium for portraying these experiences. Not that I was coming up with any great new theory here- there is plenty of "comics theory" out there, some of it if fairly highbrow. A good place to start, if you want to understand how the medium works is Scott McCloud's classic "Understanding Comics" (1993).

When selecting material I didn't want to "over medicalise" life: as a GP you are presented, day in day out, with everything from neighbour's squabbles over bin bags to life threatening illness, and there is a tendency nowadays to think that everything is in someways medical- smelly feet, or shyness, or "anger problems" or bereavement. This is partly caused by control freak medics appropriating everyday occurrences, partly the fault of "big pharma", inventing new conditions for their new expensive drugs to treat, and partly caused by those people who look for answers to all of life's problems in a pill.

I decided to include stories that dealt with situations or conditions that might reasonably present to a GP surgery, like cancer, epilepsy, mental illness etc. I wanted to construct an argument along the lines that comics would be a useful resource for health professionals, giving some understanding of what it is like to suffer a particular condition of care for somebody who has that condition. What the arts and literature give, that textbooks don't, is an insight into how it feels to experience something, and I think comics, with its combination of text and image is well set up to provide acres of detail.

You know when you are reading a comic strip and, in the corner of each panel there may be another sequential story going on, something in the background? Like a mouse engaged in some humorous activity outside his hole in the skirting board while a the family discuss something at the dining table? Or the artist includes a little arrow pointing at, say, a pile of letters with a little caption heading the arrow that says "love letters"? Well comics can provide loads of visual footnotes and subsidiary information in each panel alongside the main story.

You may think I'm stating the bleeding obvious here, but there is more to follow.

ref: McCloud, S. (1993) Understanding comics. New York: Harper Collins

So, I spent ages reading graphic novels and comics that I felt were relevant to medicine. My idea was that they might be of use as a resource for health professionals. We were all into comics as children, I'd read them through my teens-american underground commix, I was never into super-heroes, and, after hiatus of many years had started reading graphic novels and autobiographical art comics again some years back. Academics have been writing about graphic fiction for years; there is plenty of comics theory around, and I think I have read a good proportion of it, but no one in the anglophone countries had systematically studied medical narrative in comics, although certain scholars had reviewed selected graphic novels or looked at historic comics. In France Videlier and Piras had published La Sante dans les Bandes Dessinees in 1992 (sorry, francophones, I can't get this blog editor to show accents) but there is nothing equivalent in English that I know of.

It's late and I'm tired. Just wanted to get this blog off to a good start. Will add more shortly.

here is some more work of mine