When I mentioned to friends that I was attending the 2014 Comics & Medicine Conference in Baltimore, this is how they responded: “What? That’s so weird. Why would you put those two together?" To me, it never seemed weird. As a public health professional and a cartoonist, I always believed that comics had the potential to be an engaging and effective health communication tool. Because, let’s be honest: a lot of health education materials are boring.
I learned of the conference from Graphic Medicine, a website dedicated to exploring the “interaction between the medium of comics and the discourse of health care.” The site was founded in 2007 by Ian Williams, a doctor and artist from South Wales. Much of Williams’s scholarship focuses on the usefulness of medical narratives in graphic form for health care professionals, caregivers, and patients. In 2012, he was joined by MK Czerwiec, RN, MA, who is also known as the “Comics Nurse.” Czerwiec is an educator and cartoonist, often drawing from her experiences as a hospice and HIV/AIDS caregiver. Williams and Czerwiec are part of the small committee of scholars, health care professionals, and artists who have organized this international conference since 2009.
This year’s conference was held June 26-28 at Johns Hopkins University Medical Campus, and titled “Comics & Medicine: From Private Lives to Public Health”. It was the fifth year of the event, and featured keynote speakers Carol Tilley, Arthur Frank, James Sturm, and Ellen Forney.
Just as I was deciding whether or not to go, cartoonists Cathy Leamy and Kriota Willberg reached out to me. I had met both of them at the Massachusetts Independent Comics Expo a few years back when they presented on a health and comics panel. Cathy, a health communications grad student, works as a web applications developer at Massachusetts General Hospital in Boston, where she creates diabetes education comics for their site. She also produces minicomics on the side such as Mindful Drinking and Diabetes is After Your Dick! (which concerns diabetes and erectile dysfunction). Kriota Willberg works at Sloan Kettering Cancer Center as a massage therapist and has taught at the Center for Cartoon Studies, the Swedish Institute of Health Sciences, NYU, and the Society of Illustrators. Recent works include her minicomic (NO) PAIN! about injury prevention for cartoonists and her minicomic series Pathology Laffs.
And me? I completed my master's in Public Health with a focus on health education and mental health literacy. As a health educator, I have worked in a counseling center with college students on issues ranging from stress management to sexual health. I am also a cartoonist intrigued by the idea of making health education comics. I was not sure what to expect from this sort of conference, but decided that I might as well seize the chance to meet people with the same niche interest as mine and see what type of health comics were out there.
The conference started on Thursday afternoon with a brief reception. We then filed into the East Auditorium and the opening program “lightning talks” began. Lydia Gregg, the organizer of the Baltimore Conference, presented on Dorcas Hager Padget, an early 20th century neurological illustrator who had unwittingly created a sequential illustration of the first appropriately treated “spinal perimedullary arteriovenous fistula” in 1934. Gregg is an instructor and certified medical illustrator in the Division of Interventional Neuroradiology and the Department of Art as Applied to Medicine at Johns Hopkins University, where she creates illustrations and animations for health communication materials, including comics. She also noted that she has been a lifelong comic fan, having attended SPX for the past 10 years.
For the next hour we listened to presentations on everything from West Nile Virus to cancer. I was particularly impressed with the work of Meredith Li-Vollmer, Ph.D. Li-Vollmer, a risk communications specialist for Public Health-Seattle & King County, spoke about “Comics 4 Health Coverage”, an initiative to encourage young people to sign up for health coverage available through the Affordable Care Act. Aimed towards young adults or the “young invincibles” as she called them, the project solicited people to submit four-panel comics on why health insurance mattered to them. Among the participants was Eisner Award-winning cartoonist David Lasky, who was also working with Li-Vollmer on some other health comic projects which would be presented later.
That night at dinner, a small group of us discussed our backgrounds and initial thoughts on the conference. One medical professional was interested in developing health education comics for her clients. She planned on doing formative research before embarking on a project and wanted to know what “us cartoonists had to say.”
We debated the usefulness of creating a health comic that was targeted towards a specific population versus creating one with “universal” appeal. Would a comic book protagonist need to be ethnically and culturally ambiguous enough to translate to various groups “successfully?" I had never discussed comics in such a calculated way before.
“I have a question,” she asked. “How do you read comics? From left to right?”
I was taken aback. “Yeah… generally. Um, do you not read comics?”
“Not really, I just find them to be stressful.”
So why comics then? That night, something did not sit well with me. Was it possible to use comics if you were neither a consumer nor a producer? Was that co-opting a medium?
The next morning Benita Fernando, a blogger and communications consultant for Dharavi Biennale, an arts and health festival run by the Society for Nutrition Education and Health Action, spoke about the comics workshops the festival conducted with residents of Dharavi, a “slum” with an extremely high population density in Mumbai. Chaitanya Modak, a Mumbai-based comics creator, had worked with residents to create comics on common health issues facing the community, such as nutrition, injury, and suicide. These comics would be posted on the walls of the workspace and on the streets to raise public awareness.
The first keynote speaker was Carol Tilley, an assistant professor in the Graduate School of Library and Information Science at the University of Illinois Urbana-Champaign. She presented on the legacy of Fredric Wertham’s controversial 1954 publication Seduction of the Innocent. Wertham, a psychiatrist who treated children identified by social welfare and law enforcement agencies in the 1940s and 1950s, became an advocate against children reading comics, as he believed that they promoted unsavory behavior and ideation. For one well-known example, he suggested that Batman and Robin were in a homosexual relationship. Tilley discussed Wertham’s manipulation of his research data, doing a nice job of explaining the unprecedented readership of comics at that period in history.
Next, we had a choice of three concurrent sessions, so I decided to attend “Comics and Public Health Communication”. Melvin F. Baron, PharmD, MPA and his team from the University of Southern California had developed diabetes education “fotonovellas” for low-literate Latino populations in East Los Angeles. Although not comics in the traditional sense, they utilized the comic book format. The team’s pre- and post-testing indicated that community members’ knowledge of diabetes increased, even though the studies were not longitudinal.
It made me think about what makes a story memorable. If illness was the focal point of a story, was that enough? Or was creating an emotional response more important than the content in retaining knowledge and changing behavior?
Apparently there was a theory for this, as I learned shortly. In their respective presentations, Sarah Dobbins, MPH, CPH and May May Leung PhD, RD, spoke of their use of Narrative Transportation Theory (NTT). This theory postulates that a person could be “transported to a different world through narrative,” which would “lead to an emotional exchange” and subsequently a change in beliefs and attitudes.
Of course, testing was necessary to make sure that this “transportation” and “transformation” had indeed occurred. I understood objectively why testing the efficacy of a health comic was necessary. Research had to be done to secure funding, sure. But furthermore, if the purpose of these comics was for mass distribution, it would need to “speak” to a population as effectively as possible. Improved health was the objective here. Comics were the vehicle and not an end in and of itself.
Comics was never an equation for me, but I felt like it was becoming one more than ever here. Was it enough to pick a well-researched health topic and demographic, and insert the content into a conventional comic structure of panels and word balloons? Would that make me turn the page?
During lunch, I talked to James Sturm, cartoonist and co-founder of the Center for Cartoon Studies. Sturm was presenting on CCS’s collaboration with veterans in the Residential Recovery Center and Inpatient Psychiatry unit at the White River Junction, Vermont VA Medical Center. This was his first time at the Comics & Medicine Conference.
I was concerned. “Look, I’m not trying to be a negative Nancy, but something’s bothering me," I said. "What about the importance of artfulness? I feel like that’s a bit of a problem.”
Sturm did see this as a minor issue, but one that could be remedied by health comic creators better learning the language of comics. CCS was going to start offering a two-year MFA degree in Applied Cartooning. The curriculum would be geared towards those interested in creating comics for “fields outside of traditional publishing,” such as education and health care sectors.
“I see comics going down two tracks”, he said. "You know, I can’t compare my own projects to something that someone is doing for a public health campaign. That use is utilitarian. And that’s OK.”
After lunch I went to the concurrent session, “Cyborgs, Freaks, and Geeks: Overcoming Neuroses, Depression and Social Death in Graphic Novels, Comics & Web Comics”. These presentations turned out to be purely academic analyses of comics dealing with mental health and disability. I had been an academic person for most of my life, but at some point had soured to the idea of over-intellectualizing inappropriate subjects. On the other hand, I felt that some of the academic research on comics as presented did not seem very rigorous, and more closely resembled elaborate book reviews.
Kristen N. Gay’s MA, presentation “Breaking Up [at] Illness Narrative, or, is it Okay to Laugh About Depression?” was intended to “discuss ways in which the emerging psychological illness memoir-graphic novel genre defies totalization”, analyzing Ellen Forney’s Marbles and Allie Brosch’s Hyperbole and a Half. I asked her: “These are great memoirs on mental illness, but why do a PhD on graphic memoirs as opposed to regular ones?” Gay believed that the use of panels was a distinguishing factor. I suggested that she look into small-press titles as well, given the variety of comics dealing with chronic mental health conditions. Many of the presenters throughout the weekend cited and studied a relatively small group of comics and graphic novels. These narratives were no doubt popular for a reason, but I felt that expanding what they read was essential if they were doing research on the medium.
I went to the next panel “Comics as Applied to Medicine” to see Cathy Leamy speak on “Using Webcomics to Debunk Insulin Therapy Myths”. Leamy made a key point: just because you discuss a subject in comic form, that does not make it inherently interesting. She emphasized that health comics needed to be engaging to work. As Leamy mentioned to me before, “The people on the medical side come up with excellent ideas, but they need skilled creators to execute them.”
The last presentation of that round was from Nancy Silberkleit, co-CEO of Archie Comics. Silberkleit said she had not started reading comics until about five years ago, but discovered the potential usefulness of health education comics, especially for young readers. She spoke about Rise Above, a comic about bullying that was published in collaboration with Rise Above Social Issues Foundation. She delightedly shared that she had discovered that “kids plus comics equals reading.”
Afterward, I ran into Warren Bernard, the executive director of the Small Press Expo. SPX is one of the sponsors of this conference and this was his first time attending. He was pleasantly surprised that there was such an interest in health comics. He realized the potential the field had and was wondering how the greater comics community could support these efforts.
It was time for James Sturm’s presentation, which I had been eagerly awaiting. Sturm gave a brief history of CCS as well as his personal interests and motivations as a cartoonist, explaining that working with panels helped him organize his thoughts and experiences. Cartooning was therapeutic for him, and he hoped that he could offer that for vets at the VA. Sturm was not only speaking as a creator and activist, but as a “patient” himself.
The second day of the conference concluded and we went to the after event at Atomic Books, which was hosted by Laydeez Do Comics, a multi-chapter “graphic novel discussion” group co-founded by Nicola Streeten. I had assumed it would be a lighthearted meet-and-greet, but instead a few conference attendees presented on their comic projects, giving harrowing accounts of their cancer diagnoses and subsequent coming to terms with their new identities as patients. Alongside health promotion narratives, patient narratives dominated the conference. People came to this conference to discuss David B’s Epileptic, Brian Fies’s Mom’s Cancer, and of course Ellen Forney’s Marbles. Well-crafted patient narratives changed lives, humanizing people living with different medical conditions to the outside world. And in the least, they were therapeutic personal projects.
A few rounds of Skeeball and several drinks later, Kriota, Cathy, and I sat up into the early hours of the morning, discussing our feelings about the conference. We loved the idea, and were impressed by a lot of the work that was being done, but also saw some flaws and limitations.
“I just get frustrated because comics are an emotional experience for me, both as a reader and cartoonist,” I said. “Why do I like comics? What makes a good comic? It’s ineffable. It can’t be described by a theory and it can’t be created by a formula.”
They agreed. “Whit, we’re straddlers,” said Kriota. “We are cartoonists and health professionals. We speak both languages, so that reaction makes sense.”
We rolled into the conference the next morning, following a late breakfast, and unfortunately missed professor Arthur Frank’s well-received presentation “When Bodies Need Stories in Pictures”, which contrasted prose representations of illness experiences to graphic ones.
I sat in on the session “Communicating Medicine, Past and Present”. I was very impressed by the emergency preparedness comics that Meredith Li-Vollmer and David Lasky had worked on. They talked about their process for making a comic on flu pandemics, including their focus-group work and creative process. Lasky had mentioned that he had to make his artwork a bit more restrained when dealing with an anxiety-provoking topic like the flu. He even added with some humor that he had committed the sin of using Comic Sans, as it was the most versatile font when translating into 23 languages. Working in health comics was a new experience for Lasky, but he said he really enjoyed his partnership with Meredith and hoped to work on more.
At lunch, I briefly chatted with Ellen Forney. We had been trying to meet up throughout the conference, but she had been quite busy. Forney was very impressed and inspired by the conference. “It’s just more nerds, which is great, but they’re not like the traditional comics nerds," she said. "They’re analyzing comics in a way that I don’t see that often.”
All of my planned questions suddenly melted away and I returned to my five-minute conversation that I had with her right before the opening presentation on Thursday: “Hey Ellen, I’m a big fan of your work. I really relate. I’m a cartoonist and I also have a mood disorder.” Marbles had done a lot for me on a personal level that was hard to articulate. I didn’t want to ask her questions for a conference write-up. I just wanted to talk to her like a person. “Were you worried about telling the world you were bipolar and how people would treat you after?” I asked. “Because, you know, a lot of people think that it just means crazy or unstable.”
“Well, when it comes down to it, it’s really about self-acceptance.” Forney was living authentically and wouldn't allow others’ judgment of her illness to hurt her.
“You know, I’ve been public about my mental health too," I said, "and some people have been like, 'You’re so brave.' That bothers me for some reason.”
She smiled. “Yes, that word. Brave. Like it implies, that’s great, but I would never do it.”
It was reassuring to talk to a cartoonist with a nuanced understanding of mental health. Many of these attendees, aside from their professional gigs, were searching for just that. They wanted their illness experiences to be heard and validated. They wanted to feel that they were not alone.
Forney packed the auditorium for her keynote address, the last of the day. She briefly talked about the language of comics and addressed the issue that had been on my mind: the necessity of “closure” (as defined by Scott McCloud), both within a panel and between panels, for creating a compelling comic. She then “performed” the early parts of Marbles, detailing her coming to terms with her Bipolar I diagnosis. She mentioned that many of her graphic representations, such as her mood-spectrum-as-carousel-ride metaphor, helped readers conceptualize difficult concepts. Forney was now traveling all over presenting on this book. Although Marbles may have started out as a personal meditation, it was apparent that she had not anticipated the effect that it would have on teaching and comforting others about mental illness. Forney ended to a standing ovation, which she later mentioned to me had deeply moved her.
The last two hours of the conference was a marketplace for creators to sell their work. Lydia Gregg was pleased with the conference, noting that 235 people had attended, a significant increase from previous years. The presentation proposals she had received for the conference had also doubled from 2013. Greggs believed that conferences like this had the potential to “normalize” the illness experience.
So what was my takeaway? Would this always be a niche thing or did it have the potential to grow? Would the greater comics community ever invest in such a thing? And regardless, could these comics change lives? As I walked out of the building, a stack of Li-Vollmer and Lasky’s flu comics sat on an abandoned table that the custodian was clearing off. They had mentioned to me that they couldn’t bring them all back on the plane to Seattle.
I motioned to the custodian. “You can take one if you want," I told him. "They’re free. They’re about the flu.”
“The flu?” He picked the comic up incredulously.
“Yeah, there’s some helpful stuff in there.”
“I can have one? Thanks.”
He sat there, reading it with rapt attention.