Please introduce yourself briefly. What kind of work do you usually do?
I am a psychiatrist. I’m currently the head of the psycho-oncology department at the Aichi Cancer Center. I don’t read manga on a regular basis, and I don’t do medical education for a living, so I’m not in a position to introduce graphic medicine (GM), but for some reason, my colleagues and I translated a book, Graphic Medicine Manifesto. It’s always the patients who inspire me to try something new.
Have there been times when comics have come up in your interactions with patients?
I was inspired to translate Graphic Medicine Manifesto, but even before that, there were several situations in which manga appeared in clinical practice.
When I was a resident in pediatrics at Gifu University, the attending physician would occasionally admit asthmatic junior high school boys to the hospital and say (seriously or not), “It’s a case of ‘parentectomy'”and he would assign me, who was interested in psychosomatic disorders, to be in charge.
It was a heavy snowy morning, and the boy was still in the hospital room when he would normally be on his way to school from the hospital. Very exceptionally, he was on Professor’s round and he suddenly showed the professor a comic he had drawn on a piece of huge paper at his bedside. The picture was a scene of the professor’s rounds made into a procession of feudal lords. The reason this is not funny is because the daimyo (feudal lord) is wearing a kimono and a chonmage (and the professor’s head and white coat look similar). I thought it would be another eye-opener due to lack of supervision, but the professor just said, “That’s pretty good,” with a not-so-satisfied look on his face. This was, in a way, the first time I realized the power of manga, I think. A few years later, when I opened an outpatient clinic for psychosomatic kids, some of the children who were not attending school would bring me their manga success stories, which I called “drawing success stories” and used them for treatment.
Not only manga, but also family drawings and squiggle game were within the scope of my drawing therapy, and after I became a psychiatrist, I also started externalizing puppet shows for families of schizophrenics. I am proud to say that the skit “Mr. Schizo Complete Exclusive Interview,” featuring the anthropomorphic schizophrenic “Mr. Schizo,” was liked by my foreign collegue, Stefan Geyerhofer’s team in Vienna, and was developed into five very nice psychoeducational DVDs.
Please tell us about your first encounter with Graphic Medicine.
After I moved to the cancer center in 2006, I started cancer family psycho-education earlier than anywhere else. As I continued my cancer family classes, I looked for supplementary cancer education books and found Brian Fies’s overwhelming Mom’s Cancer. And when I was trying to write a commentary on that book at the time of publication, I discovered “graphic medicine.” At first I thought it was a joke, because I was quite into narrative medicine (NM), but I had to admit that I was surprised. It’s so serious. I’ve always thought it would be interesting to combine manga and medicine. The thing to keep in mind about this metaphor is that if either one of them is below par (or, to continue the metaphor, below 1), the result will be sad. This is different from addition, which of course GMers are well aware of.
I couldn’t believe my ears when narrative-based medicine (NBM) was first introduced with the propaganda that “narrative and evidence are the two wheels of medicine.” I myself think, to use a metaphor, that narrative is the whale and evidence is the dolphin. Both are cetaceans, and the only difference is size. Dolphins may be small and clever and adorable, but they are not as sacred as whales are in “Moby Dick” or “The Sea” by Jules Michelet. Aside from that, if we continue with the literary metaphor of the relationship between comics and medicine, I think the image of “opening up medicine in comics” (adverbially) is more appropriate than imagining GM (the noun) in practice. This is what fascinates me.
How do you practice GM in your clinical practice?
Let me introduce how I practice GM in the NM way, from the perspective of “reading,” “drawing,” and “sharing what we have drawn”.
In terms of reading, there is the “Cancer Survival in Manga” lecture using Mom’s Cancer. For example, when I show a slide of page 94 with mom’s crying face spread out in the foreground and explain why “total pain” should not be divided, I feel a response that I can never get anywhere else. I even wonder if it can be achieved in anything other than comics.
This panel is, in fact, very interesting. The hint is that this panel is page 94 out of 112 pages. In other words, the dialogue here is taking place at the end of chemotherapy (as indicated by the hair loss). Mom’s statement, “Five percent?” should normally be a question she asks herself immediately after being told the stage of her cancer at the time of diagnosis and after checking (or being told by someone) the five-year survival rate on her own. As for her eldest daughter who was told this, her response was, “That’s not going to happen now. I wondered how she could have worked so hard with such a lax understanding.” On the other hand, the patient herself may have forgotten (or was able to deny) that the probability was 5%, so she was able to continue her treatment up to this point (believing that the probability was much higher.) It’s a dialogue that makes it clear just how vague the hope for a cure is based on something. It also makes me think about what hope is in the first place. It’s amazing that such an intricate exchange can be expressed in just one panel. And how do we know that this is the heart of this panel? You can find out by describing this panel with 5W1H. It’s a narrative. The time notation goes in there, and that’s how this dialogue turns out to be strange, and how we can think about the depth of this thing called therapy. It is better to discard the noumenal idea that manga is easy to understand. Incidentally, this lecture has become a staple of the first lecture of the family class at the Aichi Cancer Center Palliative Care Center.
Incidentally, 99% of patients do not understand that stage classification is a “spatial classification” and not a “temporal classification.” Doctors do not explain it at all. Therefore, they think that stage classification is the division of the time from the formation of a single cancer cell until the patient’s death into four categories. If that is the case, stage IV is just one stage before death. Or, “I’m stage IV because I’ve had a recurrence and metastasis, so I’m out.” Stage classification is only used for the initial diagnosis. So, no matter how much it has spread spatially (even if surgery is not possible), if the medicine is effective, the cancer will disappear. It is not a miracle or anything. The pharmaceutical companies that have developed such drugs are wonderful.
The Aichi Cancer Center is planning a book report contest using Mom’s Cancer as the subject book. What kind of initiative is that?
It is a new approach to cancer education that started in 2019. Our aim is for young people to learn about cancer survivors through reading, and at the same time, to become an opportunity to learn about cancer autonomously.All you have to do is to choose one of your favorite pages of “Mom’s Cancer” and write what the author thinks about it, why you chose it, and what you found there on a single A4 page within 800 words.
Some patients say, “‘Mom’s Cancer‘ is my bible”. By comparing and referring to their own experiences, they are able to have a quiet dialogue at any time. It seems to be used as a bookmark for the journey of cancer survival.
The award-winning works so far are always available on the website. Please take a look.
The 1st “Summer Vacation Book Report Contest for Junior and Senior High School Students” result announcement page.
The 2nd “Summer Vacation Book Report Contest” result announcement page.
What are you doing in “drawing” and “sharing what you draw”?
I first tried a workshop on drawing manga at the Japanese Association for Family Therapy in August 2018. Shiro Dan, Eiko Adachi and I were the three instructors there. I asked them to draw a four-frame manga using page 94 of “Mom’s Cancer,” which I mentioned earlier, as the first frame. The only explanation I offered was, “This is where the cancer patient was informed about the five-year survival rate”. Let me introduce a representative work by Junko Okamoto (Department of Psychology, Faculty of Letters, Teikyo University).
When I told the authors, Brian Fies and MK Czerwiec, about the workshop and attached seven of the participants’ works, I immediately received the reply.
Brian wrote back, ” Yasu, You must be careful, you are in great danger! In 2010, my friend Ian Williams organized a one-day GM workshop in London, and now graphic medicine has taken over his entire life! Your event sounds wonderful. I imagine participants did not know what to expect when they came. I’m sure your enthusiasm won them over. Thank you so much for showing me your participants’ comics inspired by that page of “Mom’s Cancer.” Some ideas are much better than mine. The pictures tell the stories very well even though I can’t read the text. This is part of the great power of comics, to transcend even language and culture”.
And from MK, this comment arrived on the same day, “Yes! Yasu, I echo what Brian says here, I am just coming from our annual Graphic Medicine conference. It is our goal to expand our mission to non-English speaking countries. Our colleagues in Spanish-speaking countries have created a “sister site” to Graphic Medicine in Spanish https://medicinagrafica.com/ If I connected you with some interested Japanese colleagues and you gather ones you know, might this be something of interest? Unfortunately it’s not something that pays money though. It’s a labor of love for all of us at this point.”
And Okamoto-san, who shared this with me, replied with this: Thank you for sharing the reply from Brian and MK. The reply is full of wit, energy and warmth. It’s wonderful to have friends like them. I’ve been spending my days getting caught up in the mundane, but at the workshop, not only did I do some creative work that I haven’t done in a while, but I also received a lot of suggestions that made me feel a little new. This is one of the advantages of going to conferences.
You can imagine that this kind of dialogue is the atmosphere that was created on the day of the conference as we shared what we had drawn.
What would you like to say about the future activities of the Graphic Medicine Association?
I’ve never been to a GM conference, I only read about them on their website, but I’m sure it’s a very friendly and good gathering. I also feel that it is tremendously energetic. I’m curious to see how far it will grow. One thing I noticed when I started talking about manga at work was that there are surprisingly many people who draw manga.
So I think there is a lot of promise in Japan as well. However, I think the key to success or failure is how committed the medical humanities people will be. Just as NM may end up being a story about “listening to the patient”.