Comics, says literary scholar Hillary Chute (2011: 112), are “about bodies – about locating them in space and time.” Comics engage the body regardless of their theme, and this kind of engagement inspires the project that is Lissa: A Story about Medical Promise, Friendship, and Revolution. In the book’s Foreword, George Marcus positions Lissa as a work of public anthropology in that it adopts a popular narrative form to reach diverse audiences. Yes, this is a book that presents anthropological insights into medical dilemmas in an appealing, eye-opening way. But it is more than that. The book initiates discussion of how comics can invigorate our understandings of the relations among bodies, viewpoints, and contexts.
Recently, medical-themed comics have excited the interest of health professionals, medical educators, literary scholars, and others who have come together under the rubric of “graphic medicine” (Czierwic et al. 2015), designating a loose conglomeration of pursuits – from using comic books as tools for patient education or promoting reflexivity among medical students to reading graphic novels about illness for insight into the human condition. Graphic medicine is rapidly finding a place within traditional medical humanities, tucked comfortably into the notion that telling stories of illness will ultimately foster more person-centered, humane, and ethical health care. Eavesdropping on the upbeat conversations among graphic medicine enthusiasts, medical anthropologists can’t help but recall our own, much more vexed sense of the ways narrative understanding works in counterpoint to biomedical reasoning. Medical anthropology has asked, specifically, to what extent do narratives unsettle power relations in biomedicine? What happens when narrative approaches are embraced in clinical care? Anthropologists have a power-conscious version of what it means to tell stories about, within, or against medical realities. Even as Lissa uses the familiar form of a character-based plot whose action is driven by illness and crisis, it also introduces a more explicitly socio-political framework to graphic medicine.
In the graphic medicine canon, the most celebrated works are memoirs or diaries by artist-authors. Books like Miriam Engleberg’s Cancer Made Me a Shallower Person or Peter Dunlop-Shohl’s My Degeneration explore how a health crisis challenges identity, rearranges intimate relationships, opens up social dilemmas, or thrusts us into a previously invisible world of fellow sufferers. Centered on the struggles of persons coping with illness, these stories inevitably dramatize interactions with institutional medical systems from a patient’s perspective. Medical anthropologists can appreciate the insights astutely expressed in these works and yet long for something more. Most of the Anglophone works so far reflect white, middle-class experiences, often within the US health care system. These comics also represent biomedical knowledge and its routines as a taken-for-granted, if problematic, backdrop against which personal struggles unfold. They show important things about sickness and the quest for healing, but they don’t ask the sorts of questions anthropologists ask about cultural common sense and structuring assumptions, let alone see the production of medical knowledge as a story in its own right.
Lissa, in contrast, offers slices of contrasting Egyptian and American biomedicines and uses the characters’ dilemmas to pry open the contradictions within and between these medical systems. Anna, an American, has to come to terms with genetic knowledge that turns her into someone who is pre-diseased. Her dilemma dramatizes how the individualism of North American discourses about risk and patient choices sidelines both the emotional histories of families and collective discussions of carcinogenic environments. Layla, an Egyptian medical student, seeks to help her father, who is dying of kidney failure, but does so fully aware both of the class-stratified experiences of the medical system and the limitations of medical technology as a solution under existing structural conditions and of the ethical relations kin have to each other. Their contrasting situations foreground the contingencies of different medical worlds, subtly altering the routine staging of the figure-ground relationship in graphic medicine, where typically the character is the figure, presented against the ground of social relationships, situations, and places. Lissa can be read in reverse: the contexts are the characters and the people (Anna and Layla) are the ground.
Graphic narratives show contexts in which bodies, sick or well, exist; context-awareness is built into the medium itself. Drawings compel a descriptive specificity that ethnographic writing allows us to elide. At the same time, by forcing decisions about what to leave out of the picture, drawings concentrate perception. In comics, bodily placement, posture, and gesture convey information that propels the narrative. (Notice in Lissa the recurring panels with tight focus on body parts to indicate relationships or interactions.) The reader has to first apprehend what is suggested by the positioned elements depicted in a panel, and then, in looking at the next panel in the sequence and the rest of the page, fill in their own understanding of the story that must be there to link the images together. This active, inferential process is called “closure” by comics theorists, who argue that it is precisely the way the medium calls on the reader to insert meaning into the arrangement of a series of separate pictures that makes stories told through comics so impactful.
Chute (2011: 112) says, “Comics is, above all, a haptic form. It demands tactility, a physical intimacy with the readers in the acts of cognition and visual scrutiny.” Feelings, ideas, contradictions, memories, hopes, associations, motives, and judgements – these are rendered through bodies and their placement in relation to others and to the world. Comics art activates the senses (evoking experiences of sound, texture, lines of sight, motion, time, and speed). By calling up multisensory bodily experience, by coaxing readers to project themselves – emotionally, viscerally, socially – comics stage the experience of interpellation.
Empathy and identification are thus central, as Ian Williams, describes:
This understanding of empathy also undergirds broad (and unfounded) claims in graphic medicine that the stories we have are “great examples of our universal experience” (Green and Meyers 2010). However, in Lissa characters sometimes struggle to empathize with each other: “Why did he find out about his kidneys so late?” “Why would you mutilate your body if it is healthy?” “Why treat a disease you don’t have?” The many forms of caring become a repeated motif, making the story itself a meta-commentary on empathy. Overall, Lissa moves beyond simplistic notions of shared experience to create a story spun from the concept of “local biologies” (Lock 2001), injecting an attention to differences that matter. To read (or make) comics anthropologically, we need, with Juliet McMullin (2016: 153), to engage the question, “What is the imagery that is used to construct a social world wherein we relate to each other and suffering is viewed as universal?”
Comics offer a form of multimodal anthropology because they communicate not through propositional statements, but through display, including the pictures themselves, the gaps between what is said and what is shown, the sense of placement-in-space, and the sense of temporal rhythms. As Karasik notes in Lissa’s Afterword, artists use composition purposefully in comics to organize “what the reader feels about the information in ways that the reader might never notice” (p. 241). Narratives in the comics medium therefore require a less linear, more holistic kind of reading. For anthropologists, the comics medium also invites techniques of depiction that disrupt routine ideas about bodies-in-contexts by calling forth visceral understandings of contexts-in-bodies.
[Read the authors’ response here.]
Chute, H., 2011. Comics form and narrating lives. Profession, 2011(1), pp.107-117.
Czerwiec, M., Williams, I., Squier, S.M., Green, M.J., Myers, K.R. and Smith, S.T., 2015. Graphic medicine manifesto (Vol. 1). Penn State Press.
Dunlop-Shohl, P. 2015 My Degeneration: A Journey through Parkinson’s. Penn State University Press.
Engelberg, M. 2006. Cancer Made Me a Shallower Person: A Memoir in Comics. New York: Harpers Collins.
Green, M.J. and Myers, K.R., 2010. Graphic medicine: use of comics in medical education and patient care. BMJ: British Medical Journal (Online), 340.
Karasik, P. 2017 Afterword: Reading Lissa. In Lissa: A Story about Medical Promise, Friendship, and Revolution. University of Toronto Press.
Lock, M. and Kaufert, P., 2001. Menopause, local biologies, and cultures of aging. American Journal of Human Biology, 13(4), pp.494-504.
McMullin, J., 2016. Cancer and the Comics: Graphic Narratives and Biolegitimate Lives. Medical anthropology quarterly, 30(2), pp.149-167.
Stacy Leigh Pigg is Professor of Anthropology at Simon Frasier University.