Show Me Where It Hurts: Part 2

In this second part of my survey of the growing field of graphic medicine, I review four recent nonfiction books about health, illness, recovery and loss. These books vary in many respects—in their visual styles and narrative approaches, but especially in the ways in which the educational and the personal are engaged. However, what they share in common, like the books addressed in Part 1, is a dedication to demystifying and humanizing experiences that, due to institutional, ideological, and societal pressures, often leave us alone, groping in the dark for answers.

Leah Hayes’s Not Funny Ha-Ha is in one important respect an outlier among contemporary graphic medicine, in that it explicitly eschews the personal for the pragmatic, the autobiographical for the procedural. However, Hayes’s clinical approach is not so anomalous as it might at first appear, in that it makes appearances—however fleeting—in most of the books that fall under the umbrella of graphic medicine. In Marbles: Mania, Depression, Michelangelo, and Me, for example, Ellen Forney always has in mind a reader struggling with new meds or a new diagnosis of bipolar disorder; and so she blends practical advice and a veteran’s perspective with her very own personal journey to a place where she was finally able to look in the mirror and say, “I’m okay.”

While few works of graphic medicine are written exclusively for the reader suffering from, say, cancer or depression, such readers are always foremost in the cartoonist’s mind, an attentiveness that leads to frequent returns to a tradition of educational cartooning epitomized by Will Eisner’s “Joe Dope” preventative maintenance pamphlets during WWII.¹ With its association with government pamphlets and Cold War propaganda, this is not a tradition that many cartoonists embrace today. Hayes does so fully, however, as demonstrated by her carefully detailed explanation of what happens following the decision to have a medical or surgical abortion.

Using two fictional protagonists to walk the readers through the two procedures and their aftermath, Hayes demystifies an often terrifying and confusing process. There is a bravery to Hayes’s decision to eschew the autobiographical at a time when graphic memoir is “hot.” But more importantly, there’s a subversive energy in her use of a form often associated with government propaganda at a time when segments of government are working overtime to defund Planned Parenthood and state legislatures around the country have made it more difficult for women to exercise their rights to a legal abortion than at any time since Roe v. Wade.

In the end, what makes Not Funny Ha-Ha so effective is Hayes’s skill as a teacher and guide, one who both inspires and empowers her readers. Some of her explicit formal decisions underscore her pedagogy. For example, instead of the four-color comic book palette of historical educational comics, Hayes works within an even smaller range—black pen with spare apricot and lemon—against a warm goldenrod paper. The goal, as Hayes put it in an interview, is that the book will come off not as cold and preachy, but “homegrown … sketch-y.”² Even as Hayes is walking the reader through some detailed and often mundane steps—including making an appointment, filling out forms, waiting in one antiseptic space after another—one feels the physical presence of the cartoonist, assuring the reader that despite the challenges the process and its attendant emotions can pose, it really will be okay.

Hayes rejects traditional comics framing, instead inviting the reader to insert herself into the narratives being told, activating the intimate, collaborative relationship that resides (too often neglected) in the comics genome. Similarly, Hayes rejects computer fonts in favor of handwriting to create a sense of intimacy with the cartoonist and her own unique “voice.” She also explicitly avoids a formal beginning and ending. What it all “means” is explicitly left to individual readers to determine, and the book starts after the decision to have an abortion has been made. These formal choices ultimately mitigate the colder aspects of the traditional clinical approach, allowing the book to feel more like a living scrapbook than a medical pamphlet, offering information while simultaneously inviting the reader to personalize the book with their own story.

I begin with Not Funny Ha-Ha because it is unique among recent graphic medicine books in its refusal to place the cartoonist’s life experience at the center of the story. At the opposite far end of the spectrum is Jennifer Hayden’s The Story of My Tits, a book that is nominally about Hayden’s experience with breast cancer and a double mastectomy but is in truth a full-scale autobiography in which her own cancer is not addressed until more than 250 pages into the book. This is not to say that illness and medicine are not to be found everywhere, as cancer punctuates her story throughout. But in the end this really is her life story, or the story of her relationships with her parents, her friends, her husband and family, and of course her breasts.

The story starts off in familiar territory, a narrative many readers will recognize as their own: from her youthful shame in the “late” development of her breasts, to her mix of pride and confusion when their arrival transforms the way in which friends and strangers see her. We also learn of her mother’s breast cancer and her father’s affair and secret life outside the family. Hayden recounts her furious retreat from her childhood home into a relationship with the man who will eventually become her husband—a retreat that starts with a long-term stay in his childhood home. It is here that Hayden meets and ultimately falls madly for a new mother, her soon-to-be mother-in-law, who represents a strength and integrity she is not yet able to recognize in her own mother. Cancer, however, is never more than a few panels away, it seems, and her mother-in-law’s eventual diagnosis and death from breast cancer feels as inevitable as it is devastating for young Hayden.

Yet, even as cancer and death hover over much of The Story of My Tits, this is also a joyous and funny book, full of the alternating acid and deadpan humor that readers familiar with the webcomics collected in Underwire will immediately recognize. Here Hayden shares everything and spares no one—not her husband, not her parents, and most certainly not herself. Ultimately, however, this is a story about forgiveness and love, and every injury, every loss, every incision is allowed to heal—and the relationships (and our protagonist) are all the stronger in the end. Indeed, it is the losses and injuries of her younger years that give Hayden the strength to face her own breast cancer diagnosis in 2004.

For some readers—especially for one coming to the book looking for concrete advice about how to deal with a cancer diagnosis and the decisions that follow—this book might well be a disappointment. It is not a book deeply invested in the procedural or the clinical. Indeed, there are other graphic memoirs better suited for a reader in need of something closer to what Hayes offers in Not Funny, such as Marisa Acocella Marchetto’s Cancer Vixen (2006), a book that directly inspired Hayden, and
Brian Fies’s Mom’s Cancer (2006). But as a living, breathing monument to the ways in which illness doesn’t just rewrite your life but allows you, in some fundamental way, to begin seeing, writing, and rewriting the shape and pattern of your own story, The Story of My Tits belongs in a category of its own—perhaps ideally suited not for a patient newly diagnosed but for someone like the protagonist at the end of Not Funny heading off to “think about everything that her body had been through, and what it all meant to her …” The Story of My Tits is what it looks like when you have finished a medical journey and are ready to start sharing its meanings with others.

Peter Dunlap-Shohl’s My Degeneration: A Journey Through Parkinson’s is an early entry in the new Graphic Medicine series from Penn State University Press that I discussed in Part 1. It is in many ways what I would describe as the very model of a graphic medicine book: perfectly balancing the two extremes represented by Hayes and Hayden, the educational and the autobiographical, the clinical and the personal. As the first memoir in the series (following the excellent semi-autobiographical graphic novel The Bad Doctor, by the group’s co-founder, Ian Williams), it is a perfect foundation for this important new venture. It is also a rather remarkable achievement as a piece of graphic narrative, not least because Dunlap-Shohl is a veteran editorial cartoonist for the Anchorage Daily News with no background in long-form sequential comics. I can think of very few editorial cartoonists who have moved effectively into long-form comics—although I can imagine that more might be inspired to give it a try after seeing this impressive debut, especially as we witness the slow but inevitable extinction of newspaper editorial cartooning as a viable profession.

There is an immediacy and simplicity to Hart’s art that leaves even those readers who know better open and unguarded.

That extinction, in fact, plays an important supporting role in Dunlap-Shohl’s narrative. Struggling with his Parkinson’s symptoms and desperate to keep the job he loves, Dunlap-Shohl forces himself late in his career to master new digital tools for producing his comics. Once he makes his way through the grueling undertaking, to his surprise he finds himself infused with new creative energy, becoming more productive than ever and discovering outlets for his creativity he never imagined he could access. Of course, as his editor at the paper muses, it is those same digital platforms that are endangering newspaper jobs, making what comes next feels almost inevitable. In the compressed time of comics storytelling, his creative rebirth is followed almost immediately by the announcement that someone will need to be laid off. Knowing it is only a matter of time before his Parkinson’s makes him unable to keep up with the daily demands of newspaper publishing, he volunteers.

As with so many illness narratives, loss here brings an opportunity for reinvention. In Dunlap-Shohl’s case he devoted himself to working on behalf of the Alaska Parkinson’s community and to exploring new media cartooning on two blogs he established in 2008.³ These blogs—one more focused on the patient community and one on his own cartooning experiments and personal narrative—became outlets for exploring the two elements of the story that would eventually be My Degeneration. Cartooning quickly proved the perfect medium for describing the disease and his own personal experiences.

In Chapter 2, for example, Dunlap-Shohl teaches his reader “to speak Parkinson’s” by demonstrating what “festination” (also known as the Parkinsonian gait) looks like, through a sequence that meticulously and comically demonstrates what it looks like. He then goes on to describe other symptoms—such as “emotional incontinence,” logorrhea, and the complex and unpredictable effects of the medications that Parkinson’s patients rely on to extend their lives. In doing so he uses formal cartooning techniques that include typographical changes, symbolism, visual metaphors and puns, personification, and that most unique of comics’ affordances: the ability to represent two states of time simultaneously.

One particularly effective moment is when Dunlap-Shohl describes the “mask of Parkinson’s”—the lack of expressiveness that makes communicating so much more challenging after the onset of disease. Speaking with someone with Parkinson’s, as Dunlap-Shohl puts it, can be like communicating via text messaging without recourse to italics, emoticons, or punctuation to provide emotional context. The comics form allows Dunlap-Shohl to show simultaneously what the Parkinsonian believes he is conveying and the flatness of expression and affect actually being communicated. Cartooning becomes one place where Dunlap-Shohl is able to remain as expressive as ever—conveying a tonal range on paper that his disease no longer allows him to convey in person.

He also deploys a range of comedic devices, sometimes subtle and winking, sometimes broad and slapstick. But he does not back away from that other major symptom of the disease that no pun or pratfall can make funny: severe depression. The book opens with a meditation on suicide, and shortly after interviewing a personified Parkinson’s in Chapter 3, Dunlap-Shohl discusses the possibility of ending his life with his understandably resistant wife. She wins the argument, to be sure, but this only means they both have to figure out how to live with a disease that will make living harder with every passing year. This is a positive book, as befits a cartoonist who is also an engaged member of the Parkinson’s community. But it is a deeply honest book, too—one that, to borrow from Dunlap-Shohl’s self-professed motto on his cartooning blog—both lights a candle and curses the darkness.

Finally, and with some reluctance, I turn to the most recent among all these very contemporary books, Tom Hart’s Rosalie Lightning. My second review for Public Books was of Leela Corman’s magical Unterzakhn (2012), a book that remains one of my favorite graphic novels of the past decade.⁴ Corman was working on this book when her daughter with Hart was one year old. But by the time Unterzakhn was published, their daughter had died, suddenly, just a few weeks before her second birthday. I have never met Corman or Hart, but, with that strange and undeniable intimacy good comics inspire in their readers, I love them both, so much so that, when I first heard through a mutual friend the story of Rosalie’s death, I wept. I did so again, last year, when I read Corman’s graphic essay for Nautilus, “PTSD: The Wound That Never Heals: Coming Back to Life after Losing my First Child.”⁵

The book is a promise to all who will suffer unimaginable, constantly imagined losses that there is a “yes” that will finally, impossibly arrive once again.

So I approached Hart’s Rosalie Lightning with dread. Now that I have read it, twice, I feel only barely ready to write some words about it. I knew this would be an important book in this fast-growing library of graphic medicine. And it is. It is brave and fiercely articulate in the face of soul-shattering, mind-destroying grief. It is also a masterpiece of graphic storytelling, putting on display all of Hart’s sophisticated understanding of the comics form to take us places only comics, and only he, can. Hart works the most complicated and subtle comics magic through a visual style that might at first fool a reader new to the form into believing they are looking at the raw lines of an amateur cartoonist. There is an immediacy and simplicity to Hart’s art that leaves even those readers who know better open and unguarded.

The book celebrates life even as it narrates the desolation left by its passing. It pivots between life and loss with dreamscapes that often knit the two together, dreams that are sometimes savage nightmares and sometimes bright, vibrant memories of Rosalie. It is hard to know which is the more devastating of the two. In the end the book manages to share one of the loneliest, most isolating experiences imaginable, in part by telling the related stories of other losses and other survivors, including the other people who helped pulled Hart and Corman slowly to shore. These include Hart’s unintended collection of “children lost and not found,” but also the children who found him—touching his hand, kissing his face, playing with Rosalie’s toys. It includes the friends who brought them food and took them in, a man in New Mexico whose response to a seemingly impossible series of losses was to establish a refuge where others could explore their grief in safety with an experienced guide by their side, and two sets of strangers who push their borrowed, stalled cars out of the mud and ice on country roads. Finally, it is about Corman and Hart and their journey together: how they cried together, lay on the ground together, gave up and got up together. The book is a promise to all who will suffer unimaginable, constantly imagined losses—which is, inevitably, all of us—that there is a “yes” that will finally, impossibly arrive once again.

I could spend pages marveling at the formal magic of the book, and the next time I teach my graphic medicine seminar I will keep the students late one day pointing to yet another example of Hart’s powers as a cartoonist, or to the way he weaves comics history so beautifully and meaningfully into this most personal of meditations. But now, here, it feels too soon, and too late. For now, let me say that this most affecting and effective book on traumatic loss, PTSD, and impossible grief is one that will remain on the shelf by my desk for the rest of my life, close at hand for when loss and impossible grief comes for me, as inevitably it must. This is the book I can trust to get me from there to whatever comes next.