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AAP Bulletin Winter 2016

Comics and Psychiatric Pedagogy!

Craigan Usher, MD, 1/26/2017

In this year’s Association for Academic Psychiatry meeting plenary session, I explored with the audience ways in which comics can be useful in psychiatric pedagogy. For those unable to attend, I highlight some of the key points.

Comics, also referred to as sequential graphic art, is a medium particularly useful for psychiatrists as our field focuses on thoughts, feelings, and behavior. Comics distill the complexity of these registers of human experience through it’s own artistic language: thought bubbles, an array of symbols that convey feelings—such as beads of sweat emanating from one’s temples to convey nervousness, and behavior—including speech bubbles or actions—often shown through motion lines. Through only a few frames, it is easy for comics readers to discern  the biopsychosocial roots of these phenomenon as one can literally be drawn into the neural, social and psychological spheres of a character’s subjectivity (for a particularly vivid exploration of this, please see Nick Sousanis’s Unflattening).

At our institution we have found reading book length stories written in comics form, often referred to as graphic novels, useful in promoting a developmental understanding through the life cycle. Books written for middle reader audience’s such as Jeff Kinney’s Diary of a Wimpy Kid series, Rain Telgemeier’s Drama, or  Cece Bell’s El Deafo transports readers back in time, causing them to reflect on the major social pressures and psychological themes facing grade and middle schoolers. Meanwhile a comic series like Giant Days by John Allison and Whitney Cogar, or Craig Thompson’s Blankets capture collegiate life and some of the concerns of transitional age youth. Finally, students and residents may better imagine the lives of patients outside the office by reading graphic pathographies. For example, by reading Ellen Forney’s Marbles one might move from seeing a mere snapshot of what it is like to have bipolar disorder—say what one learns from individuals in an emergency department—to understanding the subjective, longitudinal experience of someone who has this illness. To better understand the lived experience of depression, passages from Allie Brosh’s Hyperbole and a Half may be helpful. For other ideas, please see Table 1. Also, a word of caution: for those of you who are child psychiatrists—some of the images in these books may not be appropriate for your younger patients; should you keep these comics your office, be mindful of bookshelf placement and preview everything before sharing!

Table 1:

So You Want Your Kids to Read More: Epic Adventures & Tremendous Fun for the Young Crowd:
·        Amulet (series) by Kazu Kibuishi
·        Bone (series) by Jeff Smith
·        Diary of a Wimpy Kid (series) by Jeff Kinney

Learning Alongside Our Grade School & Middle School Age Patients: Navigating the Psychosocial Waters
·        Awkward by Svetlana Chmakova
·        Drama by Raina Telgemeier
·        El Deafo by Cece Bell
·        Smile by Raina Telgemeier
·        Tomboy by Liz Prince

Coming of Age Graphic Novels: Learning About Development
·        Blankets by Craig Thompson
·        Ghost World by Daniel Clowes
·        French Milk by Lucy Knisley
·        This One Summer by Mariko Tamaki and Jillian Tamaki

Adult Reflections on Childhood
·        Are You My Mother? by Alison Bechdel
·        Fun Home by Alison Bechdel

Going to College: Quirky Fun
·        Giant Days by John Allison and Whitney Cogar

Growing Up Outside the US
·        The Arab of the Future: A Childhood in the Middle East, 1978-1984: A Graphic Memoir by Riad Sattouf
·        The Complete Persepolis by Marjane Satrapi

Learning More: LGBTQ
·        Snapshots of a Girl by Belden Sezen
·        Honor Girl by Maggie Thrash

Appreciating Comics:
Comics and Sequential Art by Will Eisner
Understanding Comics by Scott McLeod

Graphic Medicine
·        The Graphic Medicine Manifesto by MK Czerwiec and Ian Williams (eds)

Alzheimer’s Disease
·        Tangles: A Story About Alzheimer’s, My Mother, and Me by Sarah Leavitt

Bipolar Disorder
·        Marbles: Mania, Depression, Michelangelo, and Me: A Graphic Memoir by Ellen Forney

·        Cancer Vixen by Marissa Acocella Marchetto
·        Mom’s Cancer by Brian Fies
·        Our Cancer Year by Harvey Pekar and Joyce Brabner

Cystic Fibrosis
·        Ghosts by Raina Telgemeier

·        Hyperbole and a Half by Alie Brosch

Eating Disorders
·        Lighter Than My Shadow by Katie Green

·        Epileptic by David B

·        The Bad Doctor by Ian Williams

Parkinson’s Disease
·        My Degeneration: A Journey Through Parkinson’s by Peter Dunlap-Shohl

Psychosis & Perspective
·        Swallow Me Whole by Nate Powell

Trauma & Resilience
·        Maus I and Maus II by Art Spiegelman
·        Stitches by David Small

Creating comics may also be useful for solidifying learner’s understanding of various concepts.  For example, as an educator you might ask learners to demonstrate their understanding of an idea you just shared in lecture by showing opposed to telling you (via quiz or multiple choice question) what they learned. This will give you, the lecturer, immediate visual feedback on how students understood what you just taught. For example, I recently taught a lecture on psychosis and—mid lecture—asked medical students to draw a three panel comic on this. I asked students to use books like Microbiology Made Ridiculously Simple as their inspiration. Below is an example of positive symptom—an illusion—wherein, for a moment, someone sensed that the wood grain on their door had morphed into a monster.

Figure 1: The optical illusion of wood grain morphing into a monster.

Finally, creating comics that describe one’s own experience may be a valuable tool for connecting with fellow students, residents and attending physicians. By conveying the heartaches and triumphs of psychiatric practice and one’s subjective experience, we may enjoy more empathy for our patients, for one another, and “draw” from these comics a stronger sense of professional identity. One way that we can do this is through Comics Jams—wherein you divide into groups of four and give each person a blank four-panel comic. In the left upper corner of the first panel, provide a prompt. This can be anything upon which you’d like your students to reflect: “Rounds were going smoothly until…” “I imagine that patients in our clinic waiting area experience…” “The main obstacle to improving our healthcare system is…” “The electronic medical record…” Give each person 2-3 minutes, then have them pass their comic to the right. Once all of the panels are complete, have participants present the completed comics to one another and discuss.

To learn more about graphic medicine, a term coined by Dr. Ian Williams that refers to the interface between comics and medicine, with an emphasis on the role that sequential art “can play in the study and delivery of healthcare,” please consider the book The Graphic Medicine Manifesto, visiting the website or attending their yearly conference.

Craigan Usher is an Associate Professor of Psychiatry and Program Director for Child & Adolescent Psychiatry Training at Oregon Health & Science University. The author would like to thank Dr. Kimberly Myers and Dr. Michael Green of the Penn State College of Medicine Department of Humanities for their encouragement and expertise in graphic medicine.

AAP Bulletin – Winter 2016_17, Page 2 of 7