“What is Graphic Medicine?”, keynote by Shelley Wall
Shelley Wall has been making, researching, and teaching graphic medicine for about ten years. Shelley is a board member of the Graphic Medicine International Collective, and organized the annual graphic medicine conference in Toronto in 2012. Shelley is also a certified medical illustrator and an associate professor in the Biomedical Communications program at the University of Toronto; this is a two-year professional MSc program that trains students to become medical illustrators and animators.
Editor’s Note: The following serves as a transcription of Shelley Wall’s keynote address for participants of the Comix From The Heart workshop session. The text has been edited slightly for the purposes of best presenting the material in this static modality, while also allowing the text to stand-alone, without the many visual references that were provided throughout the keynote.
What is Graphic Medicine? Rather than start with a definition, I want to give you an example. This is from a graphic memoir by Peter Dunlap-Shohl called My Degeneration. It’s about his diagnosis and life with young onset Parkinson’s disease. This is early in [My Degeneration], his diagnosis.
Editor’s Note: In the two panel sequence that Shelley shows, artist-author, Peter Dunlap-Shohl visits with his doctor. The artwork is rendered in a very loose, sketchy style. The doctor’s office has some posters and certificates on the wall; the doctor is wearing a white coat, and Peter is touching his fingers, nervously.
Panel 01:
Narration: My meteor hit when I was 43 years old.
Peter: So is it some ergonomic thing?
Doctor: Well, Pete, I’d like to refer you to a neurologist...
Panel 02:
Doctor: I believe it’s Parkinson’s Disease. Look here...
In this panel, the doctor is holding a heavy book.
Now, you can imagine this as just a textual script. There’s a whole dimension in that encounter that would not be there. We later see the literal impact of this diagnosis on the patient, as he is struck by a falling piano. We also see the impact on the healthcare worker who is blown back by this impact as well. So, it captures that interpersonal affective dimension of diagnosis in a way that mere words could not. We also see the quality of the drawing is embodying the discinesia of Parkinson’s. Dunlap-Shohl was an editorial cartoonist when he was diagnosed, and trained himself to draw in a new way to accommodate his disability.
He also uses the memoir as a teaching tool. To try and educate people about what Parkinson’s is like, and some of the effects that they might observe. So he talks about logorrhea by showing his words literally smearing across the floor, and him trying to clean up afterwards. In the second half of this page, he talks about bradykinesia, the slowness of Parkinson’s and he uses pacing and repetition, the layout, and the spacing of text to embody that bradykinesia.
Graphic medicine as a term was coined by the physician and comics artist, Ian Williams in the early 2000s. He was part of the team who published the graphic medicine manifesto in 2015. It’s a scholarly work in both comic and textual form that maps out the different domains of this emerging discipline. In the manifesto, they define graphic medicine as the intersection of the medium of comics and the discourse of healthcare. The people who are involved int he graphic medicine community are the most diverse group I’ve ever had the pleasure of being part of. They’re healthcare workers, patients, psychiatric survivors, educators, literary scholars, ethnographers, sociologists, health geographers, and artists.
The group also says that graphic medicine is a movement for change that challenges dominant methods of scholarship in healthcare. A lot of comics’ association with counterculture and subculture gives it a kind of grittiness and accessibility that really gives voice to those who are not normally heard in mainstream medical discourse.
Reading graphic medicine fosters empathy in medical trainees and professionals, but also in the general public by experiencing what it’s like to live with illness. Because it is not simply the ideology, pathophysiology, symptoms, treatment, of a disease, but it embodies all of that in the lived experience of people, and in the larger psycho/social/cultural/political/economic context in which illness is experienced, it fosters an awareness of that socio-cultural context. In depicting interactions between patients and families and healthcare providers, it can allow for social critique of the medical profession. These are points made by Michael Green and Kimberly Myers in this article that appeared in 2010 in BMJ. That was quite a significant thing, for a major medical journal to publish something about comics. A lot of progress has been made since then.
One aspect of graphic medicine is stories of illness and caregiving; graphic memoir. Non-fiction comics by people on all side of the gurney: patients, survivors, healthcare professionals… These can reflect, but also change the cultural perception of healthcare and medicine. They convey the lived experience of illness. Because comics are an entertaining and non-threatening medium, they can enable discussion of difficult subjects. There are a number of graphic memoirs that have been published about grief and loss, for example. They can help other patients and caregivers by allowing them to see their own stories reflected and contrasted in the stories of others. There has been an explosion of this kind of work.
Another aspect of graphic medicine is more instrumental, and that’s its use in patient education and public health outreach. They are really good for this because they’re an accessible medium, can help transcend or at least mitigate language and literacy barriers, they use the power of narrative to embody and dramatize specific situations, and as we saw in the Peter Dunlap-Shohl example, they can use visual metaphor to explain and enhance the understanding of complex processes. Comics are not always humorous, of course, but they can use humor to approach frightening or taboo subjects.
Comics artists have been really active during the pandemic. Comics were used to explain to people what is this disease, how it is transmitted, and what’s the rationale behind the strict public health measures being put into effect. Comics have also been used during the pandemic to capture the huge variety of experiences on individuals that this pandemic has caused.
Editor’s Note: At this point in the talk, Shelley shows us a strip from In/Vulnerable. She describes the project as “journalistic interviews with people from all walks of life, from across America.”
I’ve supervised major graduate research projects that were comics based. “My Palliative Care Journey: A Graphic Guidebook” was created by Mona Lee in collaboration with a palliative care unit at a major hospital in Toronto. It walks people who are new to the system through what is palliative care, what is it not, and tries to remove some misconceptions. It intersperses these didactic pieces with the story of an individual couple who are moving into and through the system.
Another student of mine, Patricia Nguyen, worked with the trauma therapy unit at Women’s College Hospital in Toronto to take a set of text based psycho-educational tools that they work through with their clients. Pat took those text-based models and translated them into these comics that are meant to be interactive prompts for discussion and activities that therapists use with their clients. This has since been paired with a short descriptive guide with one of the therapists explaining how to use the model, and how to use these comics with clients. This work, Looking at Trauma: A Toolkit for Clinicians”, is going to be published as a handbook for clinicians and people working in trauma-informed care.
A final example, “Patient-Informed Consent”, from the Annals of Internal Medicine in 2019 transforms a 16 page patient-informed consent document into a comic. This walks a patient through the entire process of cardiac catheterization and talks about what they will experience, feel… In the comic, we see anatomy being explained; the patient can see what the exam room will be like; where in their body they will be effected.
This comic was part of a randomized trial that was done where patients were presented with either the standard of care, which was the text-based official consent form and a conversation with a physician, and then the experimental group was given the comic, along with the same conversation. The comic had a significant impact on patient comprehension. The second group scored higher across all aspects of the procedure such as procedural details, what the risks were, and what the behavioral measures were that they would have to take after the procedure. The authors conclude that the use of pictures in close juxtaposition with written or spoken text has been reported to increase a patient’s ability to understand or recall health information, compared with text alone.
This is an example of the multi-modal theory of learning in action, where patients have access to text, but through a different channel are simultaneously processing visual information to supplement, enhance, and enrich the textual information.
Thank you so much for listening.
Editor’s Note: To further explore the vast array of resources shared during Shelley’s keynote talk, we recommend seeking out the following works:
My Degeneration by Peter Dunlap-Shohl (2015)
In/Vulnerable: Inequity in the Time of Pandemic: https://revealnews.org/invulnerable
Graphic Medicine Manifesto, by MK Czerwiec, Ian Williams, Susan Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T. Smith (2015)
Heart and Brain, by the Awkward Yeti: https://theawkwardyeti.com/chapter/heart-and-brain/
“My Palliative Care Journey: A Graphic Guidebook”, by Mona Lee
Looking at Trauma: A Toolkit for Clinicians”, by Patricia Nguyen
“Patient-Informed Consent”, from the Annals of Internal Medicine in 2019
