guest post by Pin-chia Feng, Chair Professor in the Department of Foreign Languages and Literatures and Director at the Asian American Studies Research Center of National Chiao Tung University in Hsin-chu. Pin-chia is also a Research Fellow at the Institute of European and American Studies, Academia Sinica, Taiwan and Editor-in-Chief of the Review of English and American Literature.
There is a long history of Taiwanese medical professionals engaging in creative writing; the creation of graphic narratives, however, is a relatively unknown genre of creative writing among the island’s healthcare providers. While there were Taiwanese doctors and medical students creating comics as a way of releasing stress and educating people as early as 1960s, it was not until the publication of Crazy Hospital 1in 2013 that graphic narratives created by medical practitioners and devoted to training and the practices found in Taiwanese hospitals gained considerable popularity and publicity. In this article, I will present an overview of the development of graphic medicine in Taiwan.
The term ‘graphic medicine’ was coined by Ian Williams when he started this website “to denote the role that comics can play in the study and delivery of healthcare.” In the 2015 Graphic Medicine Manifesto, Williams claims, “Graphic medicine combines the principle of narrative medicine with an exploration of the visual system of comic art, integrating the representation of physical and emotional signs and symptoms within the medicine” (1). Williams, a general practitioner from Wales, is also a graphic artist. His Bad Doctor, was highly commended by the British Medical Association at the Medical Book Awards 2015. He is also the author of Sick Notes, weekly comic strips on the state of national health system in the Guardian.
In Taiwan, graphic medicine came to public attention around the same time. In February 2006, For a Better Life (康健雜誌), a Taiwanese magazine promoting healthy lifestyles and providing general medical knowledge, presented a special report on “medicine comics” (醫學漫畫) and introduced three doctors who had published comics regarding the practice of medicine in Taiwan. In the interviews, these early practitioners of graphic medicine in Taiwan stress the importance of comic art to record their personal stories in medical school and to create healthy and affective interactions between medical practitioners and their patients. For instance, as early as 1969, Mao-chang Shen (沈茂昌), a specialist in surgical oncology, pictured his first day as an intern in ER when there were no regular medical staff present in “An ER Intern’s Prayer.”
In 2002, urologist Hao-kia Jen (詹皓凱), published Medical Fantasiesin which Jen uses the combination of graphic and written texts to instruct the general public on how to lead a healthy and happy life.
Emergency medicine doctor, Kuo-hsing Wang (王國新), has contributed regularly to the monthly bulletin of Taipei Medical Association for more than two decades. His two volumes of HospitalComics can be regarded as the predecessor of Crazy Hospital.
The graphic styles of both Jen and Wang appear recognizably American. While both tend to use the format of single-paneled comics, Jen’s graphic representation aims to be humorous whereas Wang’s line sketches are, more often than not, direct and harsh. Wang’s work adopts a multiple-paneled format in the second volume of HospitalComics. Organized around thematic clusters, HospitalComics Iand IIoffer bitter medical and political satire reflective of the doctor’s own ethical and moral standards. The cover of the second volume, for instance, shows doctors prostrating before the god of National Health Insurance to highlight his point on the degeneration of the health system in Taiwan. Subtitled “the Collapse of the Health System, a Doctor Strikes Back,” Hospital Comics IIaims to directly challenge the National Health Insurance system, a systemthat threatens to destroy medical system for many medical practitioners.Hiscritique in theexposé comes very close to Williams’s Sick Notes.
These early locally-produced “hospital comics,”however, have relatively low visibility in Taiwan. The publication of the first volume of Crazy Hospital demarcates the beginning of a new trend in Taiwanese graphic medicine, being shortlisted for the Golden Comic Awards of the Ministry of Culture from 2013 to 2016, and finally winning the award in 2016.
The original creator of the series,Laya, or Dr. Tse-yao Lin(林子堯), is a psychiatrist, nicknamed “the Black Jack of Taiwan” after Osamu Tezuka’sinspiring manga character. Teaming up with graphic artist Liang Yuan (兩元Two Dollars), Laya, in his comic strips, offers wacky and sarcastic caricatures of hospital culture in Taiwan. Like Dr. Wang, Laya started his creation of graphic narratives by contributing to the bulletin of the medical school when he was a student.
Growing up, as Lin recalled on the website of Crazy Hospital, he learned how to tell stories with graphic art by reading local Taiwanese manga by Hung-ja Yeh (葉宏甲) and Xing-qin Liu (劉興欽).
Later Lin discovered works by the Japanese “God of Manga,” Osamu Tezuka (手塚治虫), and Fujimoto Hiroshi (藤子不二雄) and were greatly inspired by these manga masters.
Among the two Japanese artists, Tezuka is definitely the most influential figure in contemporary Taiwanese graphic medicine because of his medical background and the popularity of the memorable manga character, Black Jack, which he created.
Black Jack was serialized with weekly installments from November 1973 to 1983, and has had tremendous impact on comic fans and medical professionals alike. In 2003, for instance, cardiac surgeon Akihiro Nabuchi (南淵明宏) claimed that almost all Japanese doctors under 40 were influenced by Black Jack (qtd. in Chen 26).
I would like to argue that Japanese manga has had a lasting influence on the creation of graphic medicine is contemporary Taiwan. Most of the younger generation of medical professionals have grown up reading Japanese manga, and are very likely ignorant of the presence of local artists such as Yeh and Liu due to the enforcement of pre-publication screening system on comics from 1966 to 1988. Taiwanese comics industry virtually withered during the two decades of censorship and did not begin to gain enough energy for revival until the 1990s (Lee 37-41). Compounded with the fact that Taiwan was under Japanese colonial rule from 1895 to 1945, and that pirate editions of Japanese manga thrived during the two decades of Taiwanese censorship, it stands to reason that Taiwanese readers and creators of comics are strongly influenced by Japanese imports.
Graphic medicine works currently produced in Taiwan inspired by the success of Crazy Hospital come from medical practitioners choosing to express themselves through graphic art. These graphic authors tend to form their own Facebook fan groups to promote and publicize their works.
They also attend manga and/or cosplay festivals and some of the works, mainly self-published ones, are only available at these events.
In fact, the first two volumes of Crazy Hospital were also published by Dr. Lin himself. The current subjects of graphic medicine in Taiwan include stories about interns, nurses, emergency care, and general medical practices, as seen in Crazy Hospital. These graphic narratives focus mainly on daily happenings in hospitals, and tend to be episodic stories.
Among these texts, Dr. Chih-wei Wei’s (魏智偉) two volumes of The ER Ironmanin 2016 and 2017 featuring the daily challenges faced by Wei and his co-workers in the emergency room stand out.
In contrast to the black-and-white comic strips in four panels as in Crazy Hospital, The ER Ironman presents full-color illustrations in contemporary manga style presenting ER stories clustered around different themes and with several inserts of prose vignettes.
In addition to the Marvel superhero image alluded to in the title, Dr. Wei also invokes the image of the Chinese martial arts master in portraying his ER team. Such a fusionist practice, combining mainstream American comic tradition and Asian cultural elements, makes The ER Ironman stand out among other graphic medicine texts in Taiwan.
In terms of public and official recognition, however, Crazy Hospitalis still the most influential work of contemporary Taiwanese graphic medicine.
In an advertisement for Crazy Hospital, the creators of the series offer a mission statement explaining what they would like to achieve: offering glimpses of the hardships and humor found daily inside a hospital; promoting medical knowledge and concepts to the general public; providing a voice for the overworked medical staff; exposing social problems in Taiwan that are related to medical care, including issues regarding food safety, air pollution, and the impending danger of the total collapse of the medical care system.
The subtitle the first issue of Crazy Hospitalis “the Wacky and Fantastic Journey of a Doctor.” There are now eight volumes in the series, featuring the apprenticeship of Laya — the alter ego of the writer — and his fellow interns, as well as the daily happenings in Swordsoul Hospital.
Interestingly, the writer of the series also appears in the graphic stories as Dr. Lin, a psychiatrist masked with a paper shopping bag. This doubled representation apparently aims to portray life in a Taiwanese hospital from both the perspectives of interns and medical practitioners. Stylistically, Liang Yuan’s graphic rendition of the medical staff in Crazy Hospital clearly shows the influence of the Japanese master, Tezuka. Moreover, one of the medical students, Oro, wears a mask as in the Japanese animation series, Karmen Rider, created in 1971 by comic artist Ishinomori Shōtarō (石之森章太郎).
In addition to the graphic representations of the medical faculty, Crazy Hospital follows the traditional Japanese Yonkoma format in which a comic strip is presented in four panels of equal size. First produced in 1902 by the founding father of Japanese manga, Rakuten Kitazawa (北澤樂天), the Yonkoma format has a Euro-American origin, but the structure of the panels depicting the beginning, development, twist and (often surprising) conclusion of a specific storyline is definitely of Asian origin.
In comparison to the development of graphic medicine in Euro-American contexts, graphic medicine in Taiwan is still in the process of evolving. For example, at this stage, we are yet to see works by patients and their families. For now, the next step is the creation of full-length graphic narratives, such as The Bad Doctor.
There are, however, some short animations available online. The very first short animation, produced by the creators of Crazy Hospital, Crazy Hospital: ER Uniform, satirizes the violence suffered by medical staff that is now quite common in Taiwan. The Ironman outfit in the animation again alludes to the American superhero, as in Dr. Wei’s ER stories. The lack of respect for medical practitioners is but one of the social anomalies that creators of graphic medicine in Taiwan are trying to critique with their visual texts.
In conclusion, from the very beginning, the main purposes of Taiwanese graphic medicine are to instruct, to critique, and to entertain. Many of these narratives try to teach the general public some basic medical know-how, and can be categorized as knowledge-based comics.
Almost of the graphic texts criticize the degeneration of medical care under the tyrannical rule of National Health Insurance. At the same time, these graphic narratives try to attract readership by representing dark and the unsightly aspects of the medical profession in humorous and/or satirical ways. Finally, the graphic representations of Taiwan’s medical culture afford Taiwanese doctors an efficient and expressive means to share their lived experiences, comment on the decline of the healthcare system, and reclaim their profession.
Chen, Chun-wei(陳仲偉). OnBlack Jack: From the Perspectives of Medical Ethics and Comic Culture[怪醫黑傑克論：醫學倫理與漫畫文化的觀點]. Taipei: Taiwan Tohan, 2012.
Crazy Hospital: ER Uniform[醫院也瘋狂：急診新制服].Dir. DaBoSa. Woolito Studio. 2015. Web. 6 June 2017.
Jen, Hao-kia(詹皓凱). Medical Fantasies[醫想天開].Taipei: Linking, 2002.
Lee, I-yun(李衣雲). Reading Comics: Readers, Comic Artists, and Comic Industry[讀漫画：讀者、漫畫家和漫畫產業]. Taipei: Socio Publishing, 2012.
Lin, Tse-yao (林子堯) and Liang Te-huan(梁德垣). Crazy Hospital1[醫院也瘋狂1].Taichung: Lin Tse-yao, 2013.
Shen, Mao-chang(沈茂昌). Intern Diary[銀蛋見聞錄]. Kaohsiung: Kaohsiung Medical University, 2004.
Wang, Kuo-hsing(王國新). HospitalComics[醫林漫畫]. Taipei: Showwe, 2006.
—. HospitalComics II [醫林漫畫II：醫療環境崩壞中].Taipei: Showwe, 2015.
Chih-wei, Wei (魏智偉). The ER Ironman[急診室鋼鐵人Dr.魏的進擊]. Taipei: Suncolor, 2014.
—. The ER Ironman 2.0[急診室鋼鐵人2.0戰鬥吧！護理師]. Taipei: Suncolor, 2016.
Williams, Ian. Graphic Medicine Manifesto. Czerwiec, MK et al. University Park, Penn: Penn State UP, 2015.
Tezuka studied medicine at Osaka University and received a doctoral degree in medical science in 1961,yethenever practiced medicine during his lifetime. Deploying filmic techniques such as camera movement and starting the trend of “story manga,” Tezuka is the most influential graphic artist in post-war Japan.
The influence of Black Jackis not limited to the graphic aspect. In 2001, a number of Japanese doctors organized a conference reviewing what they termed “the B.J. Symptom” in which they examined the ways in which reading Black Jack affected their career choice (Chen 17).
Chen makes a claim that graphic medicine is an important subgenre of professional knowledges-based comics that can “reflect, represent, even reconstruct” professionalism and professional ethics. Furthermore, he believes that graphic medicine not only touches upon issues on professional ethics and career, it also touches upon how we face problems in life (22 my translation). According to Chen, knowledge-based comic art is different from educational or instructional comics in that the former aims to create a dialogue between a graphic narrative and the reader that can either be fun and/or emotionally charged (36).