by Abbey L. Berg, PhD, CCC-A, FNAP: Pace University, Communication Sciences & Disorders Program and Keyra-Nicole Lecointe, BS: Pace University, Graduate Program in Communication Sciences & Disorders
Abstract: 22 speech-language pathology (SLP) graduate students read the graphic novel, El Deafo (Bell, 2014). Groups of 3-4 students produced a 4-frame comic of communication impairment. Five categories emerged from student responses to activity: 1) increased perspective-taking; 2) awareness of knowledge/beliefs; 3) academic/clinical training/practicum experiences tool; 4) advocacy/public health; and 5) intra- and inter-professional collaborations. In summary, incorporating graphic novels and comics in graduate education and training is valuable.
Background: Narratives fill a gap and are becoming more common in healthcare delivery as they provide a more complete, holistic perspective of a patient’s health condition. Narratives build empathy in practitioners’ care and increase understanding of the patient experience, trust, and health outcomes (Charon, 2001a; Greenhalgh & Hurwitz, 1998). The World Health Organization-International Classification for Functioning, Disability and Health (WHO-ICF, 2001) endorses a biopsychosocial perspective to address not only the structural and functional aspects of disease, disability, and illness, but also the personal, environmental, and social factors to increase activity level, participation, and intervention success. Graduate students and practicing audiologists and speech-language pathologists (SLPs), however, still often view the communication impairment as a disorder and/or disease with a primary focus on the anatomy and physiology of the auditory and/or speech mechanism, without considering the impact of the personal and environmental contexts on the individual, family members, and prognosis.
While comics are a type of narrative in that they tell a story, they include unique components; specifically, they are very visual and when combined with metaphors and character-driven stories are appealing, engaging, non-threatening, and accessible to a wide range of audiences (Farinella, 2018). Engaging in and producing comics can increase perspective-taking, and assist individuals, family members, significant others, as well as audiologists and SLPs to empathize, recognize, reframe, and reflect on the influence of the communication impairment on interactions and quality of life. In addition, they can be used in therapy to develop pragmatic skills, language sequencing skills (beginning, middle, and end of stories), and introduce and increase inference skills. Comics are also becoming more mainstream in healthcare delivery. For example, the Annals of Internal Medicine Graphic Medicine Series (February, 2019) publishes medically themed works. The American Medical Association Journal of Ethics (February, 2018) dedicated an entire issue to the role of comics in medicine. Penn State University Press, publishes a Graphic Medicine Series (n.d.). The National Library of Medicine (March, 2018)) launched an online and traveling collection of graphic medicine. Czerwiec (2018) wrote an opinion piece regarding the use and value of comics in healthcare. And finally, Graphic Medicine (n.d.) publishes a website that informs practitioners and the public on comics, podcasts, blogs, conferences, as well as book reviews related to health, disability, disease, and illness.
Thus, narratives, and in particular graphic novels and comics, have a role in communication sciences and disorders practices and graduate education. Individuals’ perception of their communication disability, as well as their response to it, is central to their perspective (Gregory, 2013).
Aim of Study: To expose students enrolled in a graduate program in communication sciences and disorders to comics as a means to explore their use as a reflective activity, potential in academic and clinical training, and clinical practicum experiences.
Participants: Participants were 22 first-year second semester graduate students in SLP enrolled in an audiologic rehabilitation course.
Procedure: Students read the graphic novel, El Deafo, by Cece Bell (2014) and then worked in groups of three and four to produce a 4-frame comic on a communication impairment of their choosing. The first student drew the first frame, with each successive students’ contribution related to the initial frame. Students were also provided with a 1-frame comic to create an individual work. The class discussed the uses of the comic genre, reflect on what they learned and gleaned from engaging in this graphic comic experience, and its potential value and place in the profession.
Results: Five categories emerged from student responses regarding their engagement in this activity: 1) an increase in perspective-taking (affective); 2) awareness of their knowledge (or lack of) and beliefs (reflective); 3) as a tool to use in therapy – e.g., individuals with specific language impairments, on the autism spectrum, hearing impairments, and especially with children and adolescents (academic/clinical training and practicum experiences); 4); as an educational tool to raise public awareness of communication disabilities and provide information in a non-threatening format (advocacy and public health); and 5) as a tool to engage in brainstorming ideas with colleagues both in communication sciences and disorders and other health and education professions (intra- and inter-professional educational and professional practice collaborations). All students reported they appreciated the opportunity to create, think outside the box, exchange ideas and collaborate with their colleagues, and had fun while learning.
Conclusions: Introducing and incorporating graphic novels and comics in graduate education and training is of value and warrants further study regarding their detailed use. For example, the role of fictional characters and the use of anthropomorphism in comics. Also, to determine the types of visual metaphors that increase patient/client understanding of abstract concepts in the therapeutic setting.
Annals of Internal Medicine Graphic Medicine Series. (2019). Accessed March 18, 2019 from https://annals.org/aim/channel?articleTypeIDs=14671&ft=Graphic%20Medicine&fl_HasAOE=false
American Medical Association (AMA) Journal of Ethics. Accessed March 10, 2019 from https://www.nlm.nih.gov/exhibition/graphicmedicine/index.html.
Bell, C. (2014). El Deafo. New York: Scholastic Books.
Charon, R. (2001a). Narrative medicine: Form, function, and ethics. Annals of Internal Medicine, 134(1), 83-87.
Czerwiec, M. K. (2018) Getting graphic in medicine: Using comics to tell health stories. Accessed March 18, 2019 from https://www.statnews.com/2018/04/26/using-comics-in-medicine/
Farinella, M. (2018). The potential of comics in science communication. Journal of Communication, 17(01), Y1-Y17. Accessed March 18, 2019 from https://doi.org/10.22323/2.17010401.
Graphic Medicine. Accessed March 10, 2019 from https://www.graphicmedicine.org.
Greenhalgh, T., & Hurwitz, B. (1998). Narrative based medicine. London, UK: BMJ Books.
Gregory. M. (2013). The Ida Institute Toolbox: Tools to enhance collaborative self-management of hearing problems. Perspectives on Aural Rehabilitation and Its Instrumentation, 20, 22-36. doi:10.1044/arii20.1.22
National Library of Medicine Graphic Medicine Ill-Conceived and Well Drawn. Accessed March 10, 2019 from https://www.nlm.nih.gov/exhibition/graphicmedicine/index.html.
Penn State University Graphic Medicine Series. Accessed March 10, 2019 from www.psupress.org/books/series/book_SeriesGM.html.
World Health Organization-International Classification of Functioning, Disability, and Health (WHO-ICF). (2001). Accessed on March 10, 2019 from http://psychiatr.ru/download/1313?view=name=CF_18.pdf.
More student-created comics: