Mirion Malle’s This Is How I Disappear (Drawn & Quarterly, translated from French by Aleshia Jensen and Bronwyn Haslam in 2021) features the first depiction of a panic attack I have seen in comics form. In this scene, the graphic novel removes the thick lacquer of comedy and caricature that, until recent years, was typically ingrained in media representations of mental health and illness. Malle, author of the award-winning The League of Super Feminists (2018), brings the reader deep into the panic attack experience, tracing the root cause of the episode with an intimate and vulnerable approach. As Clara, the novel’s main character, comforts the young woman, with whom she empathizes due to her own similar experiences, This Is How I Disappear demonstrates with revelatory power the role of community care in addressing mental health crises.
Yet illness and health as concepts are not new to graphic narratives. Cartoonists and comics enthusiasts credit Justin Green’s Binky Brown Meets the Holy Virgin Mary, issued in 1972 by counterculture publisher Last Gasp Eco Funnies, as the first autobiographical comic to illustrate a psychological disorder. In it, the protagonist Binky — a stand-in for Green — struggles to prevent phallic-shaped objects that transform into literal penises from desecrating the Virgin Mary with their filthy emissions — beams of light called “pecker rays.” Through his comic, Green explored his struggle with obsessive-compulsive disorder, undiagnosed and referred to at the time as a compulsive neurosis. Reading Green in a new context 50 years later, in conjunction with Malle’s work, offers a stylistically different but equally insightful contribution from both to graphic medicine, a growing genre in comics literature.
Physician and cartoonist Ian Williams originated the term graphic medicine in 2007 when he created a website by that name to spotlight the potential influence of comics in healthcare. On this site, Williams and his colleagues continue to generate conversations between comics and healthcare providers via book reviews, podcast episodes, videos, and other resources. Since its creation, Graphic Medicine has spawned sister sites that connect authors, comics fans, and academics to a growing international readership. The related term graphic pathographies later emerged from the work of Penn State professors Michael J. Green and Kimberly R. Myers. Writing for the British Medical Journal in 2010, they described graphic pathographies as “illness narratives in graphic form.” In graphic medicine and pathography, narratives such as comics, novels, and memoirs converge with discourse about healthcare and personal well-being.
There is currently no substantial empirical data on the impact of graphic narratives in medical settings. However, these narratives provide anecdotal but highly detailed accounts that could improve how medical professionals assess patients and administer care. When people, identifying as medical patients or not, are unable to thoroughly vocalize the extent of their illnesses, graphic-medicine narratives provide a medium for them to better recognize and communicate their symptoms and needs. These stories peel away layers of confusion separating the affected person from medical professionals and the community at large, creating a twofold revelation. For medical professionals, graphic medicine demonstrates the greater nuance necessary to complement information taught in healthcare education and training settings. For people who once believed that their troublesome experiences were normal, graphic medicine reveals difficult truths to the contrary.
Graphic medicine is also invaluable for everyday interactions as we constantly renegotiate how to socialize with one another and the spaces we inhabit. In an interview with Malle, I asked about her process for rendering a panic attack on the page. “I move my hands a lot” during an attack, she said, “and I cannot really speak. So, I took a little bit from that. And then I took a little bit from other people that I know. It’s kind of observation. It’s something that’s really in my day-to-day life.” By interweaving her and her friends’ panic-attack experiences with the “day-to-day” moments that led up to them, including recreating details such as personal mannerisms, Malle indirectly instructs readers on how to interact (or not interact) with someone experiencing a similar episode. Thus, This Is How I Disappear serves, in part, as a mental health manual. And this is just one scene from a graphic novel that delves into depression, trauma, and the pitfalls of therapy.
Graphic medicine and pathographies have come a long way since Binky Brown. They have now arrived at a critical point when discussions of invisible, or hidden, disabilities such as mental health disorders and chronic illnesses are at the forefront of our collective social consciousness. And since invisible disabilities are by their very nature unseen, they are often unrecognized and mischaracterized. Thankfully, graphic medicine provides clearer, more tangible descriptions of the anguish associated with these disabilities.
Debbie Tung’s new graphic memoir Everything Is OK (Andrews McMeel Publishing, 2022) illustrates the conflict between a person’s interiority and their outward appearance. Even though the protagonist version of Tung tells a friend that she’s “fine” and “doing great,” overwhelming anxious thoughts form a tangled, dark mass that hovers above her head. The mass follows her home and eventually grows until it weighs her down at her desk. Anxiety — represented by a creeping black aura — edges Tung’s gray-tinged days while she goes through the motions of working and living. Moments of self-love and personal revelation appear against a starry background in rainbow watercolors. “Sometimes, coping with difficult things is giving the problem some space in your life and not locked away inside,” Tung writes. The ups and downs (of which there are many) recur cyclically, but by drawing their repetition, Tung acknowledges the familiarity of this pattern while reassuring other sufferers that it’s possible to overcome it.
As graphic narratives have expanded, complex health experiences have become more common on the comics page. Last year, publishers offered graphic medicine in abundance. A tribute to its author’s grandmother, Kate Schneider’s Headland (Fantagraphics, 2022) illustrates an elderly woman’s declining cognitive function and the intricacies of personal autonomy following a stroke. In mostly dialogue-free panels, the woman meanders through a world in her own mind, with a tortoise for a companion, as she adapts to the new reality of her hospital bed and her dependence on others. Through the strained relationship between the woman and her adult daughter, as well as her emotional journey with the affable tortoise, Headland emphasizes the importance of focusing on a patient’s mind and emotions as well as their body.
Mental health also features prominently among the themes of Jess Ruliffson’s Invisible Wounds (Fantagraphics, 2022). An oral history marketed as “graphic journalism,” the book investigates how soldiers’ identities are impacted by the effects of war and military life, while also exposing the irreparable damage of inadequate support systems. In one account, Infantry Sergeant Paul David Mansfield tells Ruliffson how his emotions unraveled as he watched an older couple driving in a rainstorm at night. He wept for them, for the man struggling to drive and for his fearful wife “braced” beside him, until another driver began aggressively tailgating the couple. “Just like that, I went from despair to rage,” Mansfield confesses. His emotions and general awareness change with the metaphorical flick of a switch until Mansfield finds himself “incoherent,” lost, and in desperate need of help. Invisible Wounds reveals how post-traumatic stress disorder, anxiety, and other invisible — and often unstated — conditions create ongoing, paralyzing effects in the lives of American veterans.
But PTSD is not just for veterans. In Look Again (Street Noise Books, 2022), Elizabeth A. Trembley shares the emotionally jarring account of finding a dead body while walking in the woods. Through different variations of that fateful morning, Trembley shows how much psychological damage one incident can cause in a person’s life. In an increasingly digital world, social media’s impact on the psyche has also found a place in graphic medicine. Frankie Barnet’s Kim: A Novel Idea (Metatron Press, 2022) provides a pointedly introspective narrative that juxtaposes anxiety and depression with intimacy, parasocial relationships, and the experience of being “very online.”
Mental health narratives predominate in graphic medicine, but while chronic illness has yet to be equally represented, new narratives bring fresh perspectives. The phenomenal Ripple Effects (Fanbase Press, 2022), a five-issue series from creator Jordan Hart, author of Doppelgänger (2018), and artist Bruno Chiroleu, creator of El Borde (2022), foregrounds an unassuming superhero with type 1 diabetes. In each issue, George Gibson reckons with the age-old comics adage that “with great power comes great responsibility” as his glucose levels plummet, leaving him unable to function and jeopardizing his relationship dynamics. Each issue also features an essay penned by other writers and comics creators about living with disorders like thrombophilia, paranoid schizophrenia, and myalgic encephalomyelitis (chronic fatigue syndrome). It’s a standalone series that leaves a crater-sized impact in the discussion of unseen, physical illnesses in comics.
Canadian comics publisher Drawn & Quarterly continues to lead the pack, publishing a number of graphic-medicine narratives since the 2021 release of Malle’s This Is How I Disappear, including trans cartoonist Emma Grove’s graphic memoir The Third Person (2022), which chronicles living with dissociative identity disorder and seeking approval for hormone replacement therapy; Keiler Roberts’s autobiographical The Joy of Quitting (2022), which meshes humorous everyday moments with the challenges of living with bipolar disorder and multiple sclerosis; and Kate Beaton’s memoir Ducks: Two Years in the Oil Sands (2022), which covers the author’s time working in the Canadian oil sands and depicts the mental illnesses that arise in these isolated, harsh conditions, as well as the cumulative effects of enduring misogyny and sexual harassment.
Integral to graphic medicine are the conversations that these narratives generate about the difficulties of navigating healthcare systems and how often medical professionals can cause additional damage to patients or delay adequate treatment because of ignorance and stereotypes entrenched in medical education. (See Grove’s The Third Person, Malle’s This Is How I Disappear, and Lili Sohn’s 2022 Vagina Love: An Owner’s Manual from Street Noise Books, which addresses gynecological violence.) Showing how biases and stigmas can interfere with proper healthcare, graphic medicine breaks taboos at the intersections of ethnicity, gender, and religious belief.
The efforts to untangle the damages inflicted by miscommunication and bias are slow but mighty. The National Library of Medicine graciously hosts a digital collection of graphic-medicine works, accompanied by lesson plans for varying education levels that seek to make a substantial impact in the medical sphere. As Green and Myers write in their article, “Graphic pathographies also provide doctors with new insights into the personal experience of illness (especially regarding concerns patients might not mention in a clinical setting) and misconceptions about disease and treatment that could affect compliance and prognosis.”
Graphic medicine is subjective, of course, since one person’s experience will not necessarily reflect the experience of another; however, this subgenre provides a sense of relatability, adding crucial context where it was previously unavailable. Literature in this genre is steadily upending established ideas about health and medicine as it illuminates the full complexity of individuals through nuanced depictions of illnesses and health. The stories are not just about the illnesses themselves but also about how people live with them, work with them, manage them, and recover from them.
DW McKinney is a comics reviewer for Publishers Weekly who lives in Nevada.