MEDICAL HUMANITIES

 Coined by George Sarton, the founder-editor of the ISIS journal in 1948.

 For Sarton, medical humanities was an endeavour that focused on

understanding science and medicine across various cultures and periods by
integrating literature and philosophy.

 In 1967, Penn State University became the first medical school to offer a
medical humanities course in the US.

 In the UK, The Centre of Philosophy and Health Care at the University of
Swansea in 1997 became the first medical unit to offer a course in medical
humanities.

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 WHY MEDICINE NEEDS LITERATURE?

 To Enhance Empathy

 To Improve the doctor-patient communication

 To supplement the objective knowledge of the professionals with

the help of subjective patient narrations.

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 The term medical humanities is now being replaced with the term

‘health humanities’ to include non-clinical members of medical

humanities, namely, social scientists, arts and humanities scholars.

 It goes beyond the clinical encounter alone, and involves the non-

medical problems like stigmatization and marginalization that the

illness occasions.

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 NARRATIVE MEDICINE

 Rita Charon’s narrative medicine movement opened new avenues

in medical humanities by bringing attention to illness narratives by
patients.

 While Medical Humanities is primarily a field, Narrative Medicine

is a form of practice.

 Bridges the gap between the medical professional and the patient.

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 Spearheaded by Rita Charon, narrative medicine emerged in the

1970s as a “clinical practice fortified by narrative competence—the

capacity to recognize, absorb, metabolize, interpret, and be moved
by stories of illness” (1265).

 Charon urges healthcare professionals to develop a culture of

listening.

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 GRAPHIC MEDICINE

 Ian Williams, a comic creator and physician coined the term “graphic
medicine” in the year 2010.

 Intersection of comics and illness narratives

 Graphic turn in narrative medicine

 Williams defines graphic medicine as a field, that “combines the principles

of narrative medicine with an exploration of the visual systems of comic

art, interrogating the representation of physical and emotional signs and
symptoms within the medium” (1).

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 “These powerful images illustrate the patient’s and family member’s

experience in a way that standard clinical reportage could never
achieve with such economy” (575).

 Includes fictional and non-fictional portrayals regarding challenges of

medical professionals, patient’s illness experiences or any other graphic

narratives related to health.

 Found its way into the curriculum of several medical schools and

humanities courses.

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 Susan Squier in her groundbreaking essay “Literature and medicine, Future

Tense: Making it Graphic” notes that “the future tense” of “literature and
medicine” lies in graphic narratives (13).

 Autobiographical comics serve as a remarkable area of study within the field

of graphic medicine.

 Williams notes that autobiographical “comics offer a window into the

subjective realities of other sufferers and provide companionship through
shared experience” (5) thereby bringing out the true potential of the medium.

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 Some notable examples: Justin Green’s Binky Brown Meets the

Holy Virgin Mary (1972), Alison Bechdel’s Fun Home (2006),

David B.’s Epileptic (2006), Tangles: A Story about Alzheimer's,
My Mother, and Me by Sarah Leavitt and My Degeneration
(2015) by Peter Dunlap-Shohl

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 COMICS AND AFFORDANCES: GRAPHIC
MEDICINE, A THEORETICAL FRAMEWORK

 Affordances in the context of comics refers to the general attributes of the

medium such as temporality, spatiality, gestures, handwriting,
photographs and visual expression.

 Pascal Lefevre calls the feature of bringing different temporalities on the

same visual scheme as “multi-temporality” (24)

 Lefevre observes that comics medium exhibits “temporal flexibility” (24).

 Temporal flexibility refers to the capacity of comic conventions to disrupt the

linear succession of events .

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 Comics “register temporality spatially” as “comics moves forward in

time through the space of the page” (Chute, 452).

 The comics medium invites the reader to participate in the meaning-making

process, with the help of gutters.

 Scott McCloud observes that gutters , “plays host to much of the magic and
mystery that are at the very heart of comics” (66).
 The fragmented medium becomes an appropriate means to convey the
narratives fragmented by trauma

 gestures, body and its movements and postures are seminal aspects of the
comics medium that helps embody human emotions
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 The author’s handwriting render’s immediacy to the author’s experience.

 Chute observes the handwriting to be “mark of its maker”, in the memoir

and that this subjective presence of the author, “bodily mark of
handwriting both provides a visual quality and texture and is also
extrasemantic” (pp.10, 11).

 Photographs are used to accentuate the personal experience of the

illness represented.

 Natalie Edwards observes that incorporating photographs into an

autobiography provides “evidence of the author’s lived reality beyond
the way that she or he may manipulate it in words; photographs
constitute a physical trace of a reality” .
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 Elaine Scarry contends thus, “physical pain does not simply resist language but actively
destroys it, bringing about an immediate reversion to a state anterior to language, to the
sounds and cries a human being makes before language is learned” (4).

 Graphic medicine translates the visceral(emotional) experience of pain, trauma and

otherwise untranslatable aspects of illness conditions, with the help of the affordances
unique to the medium.

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COMICS , WOMEN AND ILLNESS EXPERIENCE

 In the latter half of the 1960s and early 1970s, women artists started
publishing comics on taboo topics such as female sexuality, gender
equality, abortion etc.

 Wimmen’s Comix (1972), Abortion Eve (1973) by Joyce Sutton (now

Farmer) and Lynn Chevli are some early examples
 Some of the notable contemporary comic artists are Alison Bechdel, Lynda
Barry, Marjane Satrapi, Sophie Crumb, Ellen Forney

 Maria Tamboukou argues that women’s self-writing have given a voice to

women’s experiences which have been “long unattended and discredited”
(30).

 In the context of illness narratives, Courtney Donovan notes that “Memoir

and personal narrative are a key point of intervention for feminist scholars
interrogating the realms of health and medicine” .

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 Graphic illness memoirs by women provide a critical

interface between illness experience biomedicine and
address the body as a site through which health and medical
experiences occur.

 Graphic illness narratives depict the ill body and the

wounded self.

 Graphical illness narratives achieve an “eversion of the

interior” , where the ill body’s sufferings are effectively
foregrounded.

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 Chute argues that “The stories to which women’s graphic narrative

is today dedicated are often traumatic” as “the cross-discursive
form of comics is apt for expressing that difficult register” .

 Chute observes that graphic illness narratives by women provoke us

to look at “the female subject as both an object of looking and a
creator of looking and sight” .

 This shift from object to subjecthood, generating a newfound

agency.

 Graphic narratives about lived experiences of illnesses, therefore

depict the body and memory.

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THEMATIC MAP OF ILLNESS NARRATIVE OF COVID-19 SURVIVORS

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 CHRONIC ILLNESS: A DEFINITION

 Susan Wendell opines that it is difficult to

pin down chronic illnesses with a definition,
but explains them as illnesses with which the
patient continues to live, in most cases.

 Lupus, herpes, cancer, depression etc. are

some examples of chronic illnesses.

 Michael Bury argues that chronic illnesses

bring about a biographical disruption and
explains biographical disruption as an
instance “in which the relations between
body, mind and everyday life are threatened”.

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 He notes that a ‘biographical reconstruction’ can be brought

about with the help of personal narratives.

 The graphic mode of storytelling employs the convention of

gutters that disrupt the flow of the verbo-visual narrative.

 This narrative disjunction is suitable to narrate chronic illness

experiences.

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 AUTHORS AND WORKS CONSIDERED FOR STUDY

 Cancer Made Me A Shallower Person: A Memoir in Comics (2006) by

Miriam Engelberg

 Cancer Vixen: A True Story (2006) by Marisa Marchetto

 Marbles: Mania, Depression, Michelangelo and Me (2012) by Ellen

Forney

 Lighter Than My Shadow (2013) by Katie Green

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 Cancer Made Me A Shallower Person: A Memoir in Comics by Miriam

Engelberg

 Miriam Linda Engelberg was a graphic novelist and illustrator

 She also worked as a computer programmer in

the non-profit sector.

 Text
 Published in 2006
 The author employs humor to deconstruct the

myths around breast cancer and as a mode of critique.

 examines ways in which the breast cancer body

is silenced and ostracized within the medical

establishment and in the society.
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 The most widely circulated breast cancer narratives today have the structure of a
Bildungsroman.
 They market personal growth, overcoming, and self-improvement, and reflect a
strikingly neoliberal stance, even towards a potentially fatal illness as breast cancer.
 This is not the case with Miriam Engelberg’s graphic novel Cancer Made Me a
Shallower Person: A Memoir in Comics (2006), which resists this dominant
tendency.
 Engelberg’s book, does manifest some of the typical Bildungsroman traits (e. g.
introspective hero, need for belonging).
 Mostly, however, it is torn between opposing tendencies: Engelberg oscillates
between vulnerability and detachment, irony and expectation, the urge to withdraw
from a frightening situation and the desire to speak up against all the injustice and
bad practices she witnesses.

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 Engelberg never gives in to “the pressure to become someone different – someone
nobler and more courageous than (she) was” (Engelberg 2006: xiii), but mocks and
denounces all oppressive cultural attitudes.
 Instead of becoming “deeper” and more spiritual, in the socially prescribed ways,
she chooses “the path of shallowness” (xiii), and remains a witty and critical
outsider.
 These attributes, together with the episodic fragmentation of Engelberg’s book,
bring it closer to a picaresque, the protagonist of which, like her, occupies a
marginal position, moves from situation to situation, and makes the reader aware of
the social norms while she simultaneously challenges and destabilizes them
(Moenandar 2017: 5).
 The goal of comic book is to examine Engelberg’s memoir as a minoritarian, hybrid
form of writing between Bildungsroman and picaresque, pointing to alternatives
to the dominant stories of overcoming and neoliberal survivorship.

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 Computer trainer Miriam Engelberg had always been a voracious reader of comics,
from the popular satire of Mad Magazine to the more literary and autobiographical
comics written
 When Engelberg was diagnosed with breast cancer in the fall of 2001 at age 43, it
didn’t take long before she started to doodle.
 She created her first cartoon about cancer while waiting for the biopsy, before she
even knew she had a malignant tumor.
 As the disease progressed, drawing comics was a lifeline and way to resist the
pressure she felt “to become someone nobler and more courageous” than she was.

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 Cancer Made Me A Shallower Person: A
Memoir in Comics by Miriam Engelberg is a
collection of short comic strips that deal with
varied aspects of her cancer experience,
from the awkwardness of post-diagnosis
“social niceties” to the realities of nausea
and baldness, to existential questioning,
despair and isolation, to among other things
the mind-numbing effects of daytime TV.
 In “Waiting”, Miriam reveals where the mind
can go when anticipating test results. Thinking
about things on the bucket list yet undone;
imagining your children growing up without
you; replaying scenes from movies about
people facing scary diseases; being absorbed
in feelings of futility;
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“The test of my life is a story in my own words. It is about my toughest
days and how I managed to come out of it. It is about hope,
determination and courage to face challenges despite all odds. And
believe me, we all have the strength to do it. So keep it up and keep your
dreams alive and never give up. God Bless.” – Yuvraj Singh.

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 His success is mirrored into another story of
helplessness and loneliness as he struggled to
fight cancer.
 The book describes even his initial denial of
cancer’s presence within his body which later
turned into an emotional turmoil for him.
 His sessions through chemotherapy, the time spent
in Indianapolis for the treatment with his mother
and few friends leave the reader teary eyed and
yet, at the end of each phase he survives with the
hope for a better future, for a comeback in the
cricketing world.
 The book is a ray of hope for everyone struggling
with cancer, it gives strength to face those difficult
chemotherapy sessions with the hope of living a
normal disease free life and the simply told fact that
“this too shall pass”.
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AUTOPATHOGRAPHY AND HUMANE
MEDICINE
 Autopathographies are an expanding genre of books and articles that are a
potential resource for students interested in the medical humanities….
 Sickness had not been paid enough attention in the literature of the time.
 Woolf exhorted writers to pay attention to the “daily drama of the body”, and the
neglected wars fought “in the solitude of the bedroom against the assault of fever or
the oncome of melancholia”
 Although Woolf named “the poverty of the language” as one of “the drawbacks of
illness as matter for literature” (p. 34), at the beginning of the twentieth century,
artists and writers actually did make the ordinary experience of illness the subject of
their works in moderate ways.

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 The varied works and intermedial projects examined in the five articles can all be
broadly defined as “illness narratives”.
 As a general rule, illness narratives comprise an intersection between
(auto)biographical narratives about living with an illness and meditations on the
broader implications of the disease, treatment, relations with the medical entourage,
recovery and impacts on familial and other relationships (Bolaki 2016, p. 4).
 Such a definition also includes those varied narratives arising from carers and
medical staff.

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 These photo-textual interrelations and narratives also construct meaning about
illness by evoking and interweaving other forms of images and media.
 Illness narratives attempt articulation of the trauma of a specific illness from the
patient’s perspective. The term “Autopathography” was first introduced by G.
Causer in his text Recovering Bodies: Illness, Disability and Life Writing in order to
distinguish these narratives from pathographies, which are narrated by a care giver,
friend, family member of the ill person.

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 The term Autopathography is a blend of two words- “autobiography” and
“pathography”.
 . In this genre, the term “trauma” goes back to its understanding as a wound on the
physical body. These narrations talk about the trauma of the physical body and
weave that into the trauma of the psychological and emotional self.
 The traumatic event often registers in the psyche of the traumatized subject
“belatedly” much after the occurrence of the traumatic event. (qtd in Elissa Marder).
 Often these autopathographical narratives are written in the post traumatic phase.
The stem of psychological and emotional trauma in these narratives comes from
this wound on the body.

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IT IS THE PATIENT’S TALE.

 A person's changed perspective on life and the body post the traumatic event
manifests itself in autopathographical narrations.
 It is also a call for action against the societal marginalization of the ill.
 As the word itself suggests it is an autobiography, with the traumatized subject as the
narrator.
 They explore how illness disrupts the construction of the self by changing the course or
length of life.
 The change in the perspective of the traumatized subject or the recovered self,
manifests itself in these narrations.
 It articulates a change in their outlook towards life which is deeply affected and
integrated in their experience.
 These narratives call for an action against the stereotypical perceptions about the
patient and the illness. It articulates the disruption of the normal self. It bears witness
and stands as a testimony to the re-construction of the self.
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 Cancer Vixen: A True Story by Marisa Marchetto

She is also an American cartoonist who works
 for The New Yorker

Text
 Published in 2006, the text narrates the period

in Marisa Marchetto’s life when she battles her

breast cancer diagnosis and its treatment.
 The text draws from the author's traumatic

experience and functions as a self-help memoir

in addition to helping the author navigate her
shock and mental agony
 Critiques the increasing privatization and

commoditization of healthcare in the U.S

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 Marbles: Mania, Depression, Michelangelo and Me by Ellen Forney

 Ellen Forney is an American cartoonist and an educator. She teaches at the Cornish College of the Arts.

Text
 Published in 2012.
 The memoir traces the author’s search for balance and

stability after she is diagnosed with bipolar 1.

 Discusses her mental illness in a frank and personal

manner normalizing the existence and treatment of the

mental illness.
 Through self-portraits, sketches and journals in her

text, Forney generates a sense intimacy with the reader.

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 Lighter Than My Shadow by Katie Green
 Katie Green is a U.K.-based author and illustrator.

Text
 Published in 2013
 Intense visual narration of her struggle with
obsessive compulsive disorder (OCD)
 The text also explores the author’s distress caused by
eating disorder and PTSD (post traumatic stress disorder)
caused by sexual violence.
 Relies on drawing as a language of communication
and as a means of recovery.
 The author articulates the subjective realities of living

with mental disorders.

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 In her seminal work, Illness as Metaphor, Susan Sontag (1978) questions the use of
metaphorical language in biomedicine.
 Sontag analyses metaphors relating to tuberculosis and cancer to illustrate how
metaphors of illness are deeply entrenched in the social, cultural and biomedical milieu.
She notes that such a metaphorical thinking brings about a shift from attacking the
illness to attacking the patient resulting in stigmatization of the patient.

 Arthur Frank (1997) in his book, The Wounded Storyteller: Body, Illness, and Ethics
observes that illnesses challenge the representation potential of words as pain can never
fully be contained in or translated to language. He asserts that “bodies need voices” and
this need for stories or a voice arises when illness disrupts the old story or lived
experience. He classifies illness narratives into three namely: quest, chaos and restitution
narratives.

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 Susan M. Squier (2008) in her essay Literature and Medicine, Future Tense: Making it
Graphic, Squier asserts that graphic medicine is a hybrid genre that combines word and image,
narration and juxtaposition. She observes that “the imagetext or graphic narrative has the
capacity to articulate aspects of social experience that escape both the normal realms of medicine
and the comforts of canonical literature” (130). She opines that comics shows us details that
cannot be said and coveys a richer sense of different intensities at which a person experiences
illness, treatment or healing.

 Hillary L. Chute (2010) in the Introduction to Graphic Women: Life Narrative and
Contemporary Comics titled “Women, Comics, and the Risk of Representation” observes that
comics differs from other forms of writing because of its visual-verbal hybridity, which she calls
cross-discursivity. Chute contends that the authors “re-view” the events represented, thereby
pointing to the female subject as both an “object of looking” and a creator.

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 Elisabeth El Refaie (2012) in her book Autobiographical Comics: Life

Writing in Pictures, the author addresses the centrality of the body and
significance of embodiment in graphic memoirs. Refaie discusses how the
dominant cultural inscriptions of the sick body are challenged and
subverted in the graphic medium. Refaie introduces the term “pictorial
embodiment” to capture the process of drawing the author’s body to reflect
their state of mind.

 Writing Sickness, Writing Healing Narratives of Illness and Identity by

Neerja S (2013). In her doctoral dissertation, she examines narratives by
patients, doctors and medical documentaries in the Indian context, and
explores how the “disease is performed in narrative”. She argues that the
illness narrative accounts investigate self and identity of the patient altered
by illness and treatment.

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 In her essay “Cancer Comics: Narrating Cancer through Sequential Art

Martha Stoddard Holmes” (2013) contends that the comic medium helps the
author to represent in time and space, the invisible and illegible aspects of
illnesses. She notes that cancer comics perform the unspeakable, supplementing
and transforming the understanding of cancer dominated by biomedicine. She
investigates the aptness of the graphical medium to represent cancer
experience.

 Courtney Donovan (2014) in her essay “Representations of Health,

Embodiment, and Experience in Graphic Memoir”, examines the
importance of including graphic memoirs in the feminist scholarship of health.
She draws on Ellen Forney’s Marbles to demonstrate this point. She analyses
Forney’s representation of bipolar disorder, embodiment and illness experience.

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 Nancy K. Miller (2014) in her essay “The Trauma of Diagnosis: Picturing
Cancer in Graphic Memoir” discusses how graphic memoirs combat cancer’s
threat to minimize the self to “thinghood” through their visual representational
strategy. Miller notes that the form’s capacity to hold multiple temporalities and
“wordless assaults of mercurial emotional states”(208) makes it uniquely suited to
communicating the extreme mind/body challenges engendered by cancer.

 Emily Waplesin (2014) her essay “Avatars, Illness, and Authority: Embodied
Experience in Breast Cancer Autopathographics” studies the efficacy of the
graphic memoir genre to chart out embodied change caused by breast cancer
using Marisa Marchetto’s Cancer Vixen: A True Story and Miriam
Engelberg’s Cancer Made Me a Shallower Person: A Memoir in Comics. She
explores how these illness narratives depict the somatic disruption and
confusion occasioned by breast cancer.

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 Ian Williams (2015) in the Introduction to Graphic Medicine Manifesto

asserts that graphic medicine merges the principles of narrative medicine
with comic art. Williams states that graphic medicine disrupts the
completely objective medical study and explores the different ways in
which health and disease can be represented using the comic medium.

 Pramod K. Nayar (2015) in his essay “Communicable Diseases:

Graphic Medicine and the Extreme” examines graphic
autopathography’s emergence as a new genre. He remarks that graphic
representations of illnesses help draw attention to “the visibly suffering
body”. He calls the visceral representation of the suffering body the
“eversion of interiority”.

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 Sathyaraj Venkatesan, Anu Mary Peter (2018) in their essay “I Want to Live, I Want to Draw’:
The Poetics of Drawing and Graphic Medicine”, analyses Katie Green’s Lighter than My Shadow
to investigate the healing potentials of drawing. The paper explores how drawing helps to reclaim
the threatened self by creatively channelizing the trauma caused by the illness.

 Andrew Godfrey-Meers (2020) in his doctoral thesis titled Elements of Ritual, Myth, and
Subversion in works of Graphic Medicine, establishes a framework to understand the association
between comics, ritual and myth in the context of graphic medicine. The thesis explores how graphic
medicine examines and subverts the medical hegemony.

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 The literature review reveals that a considerable amount of work has been done on graphic narratives
discussing Holocaust, war trauma, racial , ethnic persecution and displacement. However, scholarship on
graphic narratives discussing health and illnesses, termed as graphic medicine is in the nascent stage.

 Attempts at understanding illness related representations and trauma are scanty in general. Studies
regarding the representation of the female body and bodily embodiment of ill subjects in graphical
narratives have been particularly less.

 The project, therefore, intends to fill the significant gap in the study of female illness representations in
graphic format by critically examining the primary and secondary texts.

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 a) Why is the graphic turn in medical humanities significant? How do

affordances of comics help to bring immediacy to the author’s lived illness

experience?

 b) What can autobiographical comics reveal about health and illness that would
be unique to the medium, as opposed to other forms of medical writing or
illness narratives?

 c) How do women writers verbally and visually represent their ill bodies,
wounded selves and traumatic memories?

 d) How do graphic illness narratives bring an alternative understanding of

chronic illnesses ?

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 OBJECTIVES

 a) To investigate how pictorial embodiment serves as a useful tool to

communicate pain and the visceral aspects of the illness experience.

 b) To critically analyze how graphic illness narratives gives voice to those

who are normally marginalized and denied a voice in medical discourse?

 c) To critically examine how these personal representations by women authors

become political iterations?

 d) To understand how graphic medicine utilizing the affordances of the

medium of comics produce an alternative knowledge system regarding the
female body and illness experience?

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 RELEVANCE OF THE STUDY

 Medical Humanities can improve empathy and communication between

healthcare professionals and patients.

 These public expressions of illness experience provide information and

reassurance to patients and caregivers going through similar turbulence and
function as enlightening resources to sympathetic readers.

 IIT Hyderabad is one of the first technical institutes to offer Medical Humanities
course for students of engineering and allied sciences. The purpose, according to
the institute, is to introduce students to humanities and perspectives about the
human body, health, and illness experience.

 The importance of graphic medicine lies in two different directions: consumption

and creation.

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 Graphic medicine through the comics medium conveys a unique perspective on health and illness conditions.

 Writing about the illness experience functions as a therapy

 the combination of visual and written information improves the efficacy of communication and helps the
reader understand the experience better.

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Thank You

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