Graphic Medicine Manifesto – Book Review

by Kevin Wolf

Though Graphic Medicine Manifesto (Manifesto from hereon) by MK Czerwiec, Ian Williams, Susan Merrill Squier, Michael J. Green, Kimberly R. Myers, and Scott T. Smith[i] hasn’t been reviewed at www.graphicmedicine.org it has appeared many times at the website. It’s appearances include when it’s publication was first announced, a blurb about Manifesto, a podcast  with all the authors, a link to a review in the Journal of Graphic Novels and Comics, when it was nominated for an Eisner Award, and being part of the annotated bibliography of Essential Graphic Medicine. I’m somewhat embarrassed that it’s taken me this long to read Manifesto. To be honest, I’ve read a lot of medical related and comic academic papers, and I was expecting Manifesto to be filled with hard-to-understand jargon, boring discussion about the meaning of graphic medicine, and its self-importance. Now that I’ve finally read Manifesto, I found none of my misconceptions occurring. The Manifesto’s authors are among the founders of the subject of graphic medicine and their contribution in Manifesto are all interesting. They emphasize that graphic medicine should be an additional tool for medical providers, patients, caregivers, and those curious about healthcare to help navigate the world of caregiving, explain some healthcare options, support learning and empathy gaining in a readily understood, attention-grabbing and entertaining topics on medical issues, treatments, patients’ perspectives, and outcomes whether non-fiction or fiction. Manifesto was the first book in the Graphic Medicine Series from The Pennsylvania State University Press. Since I’ve covered it elsewhere[ii] in detail, I won’t give much of the history of graphic medicine, except to write the term, “Graphic Medicine,” began when Ian Williams in 2007 created the www.graphicmedicine.org website. The idea of “the intersection of the medium of comics and the discourse of healthcare [Manifesto, pg 1]” has been around for a long time, perhaps going back to the 1700s as single panel cartoons, and since the 2000s has grown tremendously in quality and quantity in the form of graphic novels (including internationally). Each chapter of Manifesto is created by one of the six authors, except the introduction and first page of the conclusion which are an entertaining comic of all six authors’ avatars providing background information. The rest of the conclusion is single panel comics of what graphic medicine means to 28 attendees at one of the early graphic medicine conferences, which began in 2010. I highly recommend Manifesto for its structure, friendly understandable language, and topics covered. It’s an excellent introduction with illustrations for everyone to learn about graphic medicine.

All chapters begin with how and when their author found the world of comics. Their comic starts varied from childhood finding comics for sale in their local drugstore (Smith) to finding this medium in adulthood (Myers). Their profession varies with one nurse and artist-in-residence (Czerwiec), two medical doctors (Green, Williams), and four university professors (Green, Squier, Myers, and Smith). Beyond Manifesto at this point, all of them have either published academic articles about graphic medicine, produced works of graphic medicine, or both. Graphic medicine works by Williams include Disrepute (2012, under pseudonym Thom Ferrier), The Bad Doctor (2014), and The Lady Doctor (2019), Czerwiec’s Taking Turns: Stories from HIV/AIDS Care Unit 371 (2017) and as editor of the Eisner-awards winning Menopause: a comic treatment (2020), Green’s Annals of Internal Medicine Graphic Medicine’s first entry in 2013 entitled “Missed It,” and Squier’s (and Shelley L. Wall) “Surgical Menopause—in Ten Postures (2020, in Menopause). I will discuss each chapter in turn.

“Who Gets to Speak? The Making of Comics Scholarship” is Smith’s contribution. It doesn’t discuss graphic medicine, per se, but covers how comics are analyzed in academic journals. As Smith explains, comic fans have been way ahead of university scholarship by discussing comics since they were first created; initially when fan friends circulated their own mimeograph articles, eventually creating critical review journals (e.g., The Comics Journal began in 1977, Squa Tront, a fanzine about EC Comics, began in 1967, among numerous others). The problem that I often have with academic articles about comics is that their language sucks the life out of what makes comics so fun: their illustrations, their typical fast pace, their direct language, absorbing topics, and inside jokes to the frequent reader. The negative aspects of comics—at least in the recent past—especially early superhero, war, crime and horror comics, were sometimes sexist and racist with white males dominating as characters and as creators. About current academia, Smith writes, “This current state of affairs [2015] indicates that comic studies is still very much occupied with announcing itself to the general public and defining (and justifying) itself as an academic field [28].” For the reader’s perusal—the only time Smith brings graphic medicine into his discussion—Smith includes four pages (37–40) from Nate Powell’s Swallow Me Whole (2008) as “… one example of a long-form comic that represents the variable experience of illness in several characters and raises questions over how standard medical discourse and diagnosis might be incomplete in response to those experiences. [36]”

Squier’s chapter, “The Uses of Graphic Medicine for Engaged Scholarship,” provides interesting mini-scholarly reviews of several graphic medicine works. Squier provides graphic medicine examples for each topic that she considered, including disability studies, women’s studies, science, technology and environmental studies. For disability studies, she used Kaisa Leka’s I Am Not These Feet (2003, also reviewed by Williams at GM.org). I Am Not These Feet is a memoir that provides distance to Leka’s disability by showing her and other characters anthropomorphically as mice. She was born with arthritic feet and later decided her best and least painful outcome was having her feet amputated and replaced with prostheses. Women studies’ works included two works. The first was Marjane Satrapi’s Embroideries which “… alludes to the medical procedure of vaginal suture, or hymenoplasty, that some Iranian women secretly undergo in order to satisfy their culture’s fetish of female virginity. [51]” The second was “Not Your Mother’s Meatloaf ­—… a sex-ed ‘zine pioneered by Liza Bley and Saiya Miller…­—[that] accepts submissions of autobiographical or biographical comics that narrate sexual experiences. [51]” For science, technology and environmental studies, Squier discusses Ken Dahl’s Monsters a funny memoir about his herpes transmission fears. Squier includes several pages (62–64) from Leka’s work.

“Graphic Storytelling and Medical Narrative: The Use of Comics in Medical Education” is Green’s chapter and includes an excerpt from Julia Wertz’s The Infinite Wait & Other Stories. Green is the founding editor of the Annals of Internal Medicine’s web stories of Graphic Medicine[iii]. These stories can come from credentialed health care providers, students working toward such credentials, and patients. Green created the first entry, entitled Missed It. Green explains his Manifesto contribution “… will describe how graphic narratives (or comics) can be (and have been) integrated into medical education, as well as a role they can serve in the curriculum … [and] since my experience is within a medical school, I will focus on the medical-student population. [67]” He provides a topic list of a course that he created, as well as a list of sample graphic medicine texts used in that course, such as Cancer Made Me a Shallower Person by Miriam Engelberg (2006), Stitches by David Small (2009), and Tangles: A Story about Alzheimer’s, My Mother, and Me by Sarah Leavitt. The course is meant [70],

• To teach students to read medically related comics critically, and
• To help students create an original comic based on a meaningful medical school experience.

Green has many classroom observations, including

• The importance of attending to the patient’s concerns;
• The importance of truth telling in medicine;
• The complexity of doctor-patient communication and the implications for informed decision making;
• Among other observations.

Green critiques his students’ graphic medicine works, The Taming of Tina by Taylor Olmstead, as well as several pages from Wertz’ work mentioned at the start of this paragraph.

Myers’ chapter, “Graphic Pathography in the Classroom and Clinic: A Case Study,” discusses breast cancer as presented in Cancer Vixen: A True Story (2006) by Marisa Acocella Marchetto and Myers’ own personal narrative that occurred during her class on this subject. Graphic medicine can be powerfully personal, showing vulnerability of the creator and laying bare what have often been taboos of telling everyone about one’s own illness, treatments, and outcome. Through Cancer Vixen, we see one patient’s experience with medical personnel with her metaphorical—almost (emotional) drowning and with the word “cancer” in her thoughts in even the most mundane situations—reaction to bad news. In addition to Marchetto’s revealing story, Myers’ puts the spotlight on herself when she gets similar news while teaching that graphic medicine class. This chapter is probably the most intense of all the chapters provided because of Myers’ showing her own vulnerability. Myers also provides another example with a ten-page story of “… a fourth-year medical student in Michael’s [Green’s] course, Graphic Medicine and Medical Narratives [104]” entitled “Vita Perseverat (Life Goes On)” about “the need to hide one’s emotions—especially fear—from team members, lest one be thought weak and unfit to practice medicine; the conflict between students’ individual needs and the needs of their team; a questionable self-image … freighted with self-doubt …; the chaos not only of physical space filled with cacophonous high-tech machines but also of a universe in which tragic outcomes occur at random; the despair of patients and family; and the isolation, physical and emotional, medical students often experience. [104]”

Williams provides his insights of how graphic medicine can benefit current medical practitioners in his chapter, “Comics and the Iconography of Illness.” Among other graphic medicine works used in earlier chapters, Williams also uses Ellen Forney’s Marbles: Mania, Depression, Michelangelo, and Me (2012), Justin Green’s Binky Brown Meets the Holy Virgin Mary (1972), and nine page “…from Glyn Dillon’s masterpiece The Nao of Brown …[132]” which is a fictional work about a woman who suffers from OCD (obsessive compulsive disorder). Williams empathizes by discussing his own OCD.  Williams concludes with “Comic artists who portray themselves autobiographically … might be said to belong to the radical, unofficial iconography of healthcare, of which the medium of comics is, as yet, an underused source. [133]”

Finally, Czerwiec’s “The Crayon Revolution” covers a five-part, five-week class she’s presented many times where she teaches medical students that they can draw, how crayons become an easy tool to bring back youthful fun with drawing, making a single panel can lead to a longer story, and applications of comics outside the classroom. For example, Czerwiec relates how she slowly found herself creating comics to cope with the life and death stresses of working on a specialized hospital ward during the early days of the HIV/AIDS pandemic. From that experience, she learned the benefit of creating comics as a form of catharsis and therapy which she could teach to others. And post-Manifesto she authored her own extended story (Taking Turns: Stories from HIV/AIDS Care Unit 371, 2017).

Manifesto includes a comics bibliography where one could find many other valuable graphic medicine books. Once again, I highly recommend Manifesto for any reader to learn about the wide world of graphic medicine. Other resources to learn more about graphic medicine include book reviews and podcasts among a lot of other information at www.graphicmeedicine.org, or check out a list of “essential graphic medicine,” Penn State University Press Graphic Medicine Series, and (hopefully) hundreds of graphic medicine works at your local library, bookstore, and comic book shop.

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[i] From their book jacket bios: MK Czerwiec is a nurse and comics artist. She is the artist-in-residence at Northwestern University’s Feinberg School of Medicine. Ian Williams is a visual artist and illustrator, a medical doctor, and an independent humanities scholar. His most recent book is The Bad Doctor: The Troubled Life and Times of Dr. Iwan James. Susan Merrill Squier is Brill Professor of Women’s Studies and English at Penn State. Michael J. Green is a medical doctor and Professor of Humanities and Medicine at the Penn State College of Medicine. Kimberly R. Myers is Associate Professor of Humanities at the Penn State College of Medicine. Scott T. Smith is Associate Professor of English at Penn State.

[ii] See my article in Visual Studies Volume 37, 2022, Issue 5, pages 420-439, entitled “Graphic medicine’s golden age?” for more history.

[iii] The Annals of Internal Medicine’s Graphic Medicine weblink is https://www.acpjournals.org/topic/web-exclusives/annals-graphicmedicine.