For HIV-negative individuals, post-test counseling is a critical period in which to increase risk perceptions and decrease risk behaviors. In Latin America, where resources for testing are limited and the stigma surrounding HIV and risk behaviors is high, health providers and counselors may skip crucial risk behavioral screening (e.g., questions about unprotected anal sex) during post-test counseling. To address this issue, in 2014–2015 with funding by the U.S. Naval Health Research Center's Department of Defense HIV/AIDS Prevention Program, RTI International piloted the development of a self-administered post-test counseling interface for Voluntary Counseling and Testing centers in the armed forces of the Dominican Republic and Belize. The tablet-based interface aids in post-test communication about risk factors and behaviors associated with contracting HIV. Visuals were needed to help explain terminology and various aspects of HIV prevention, including risk behaviors and preventive measures (e.g., condom use). Often, the public health illustrations that typically are used to display images of sex may reinforce the stigma surrounding sex. Many members of the military population in the region are young and exposed to western media, so it was thought that casting characters in comic art would be more appealing. Two virtual comic characters, Bob and Britney, were created to guide users through two gender-specific risk assessments. A visual narrative was developed around the characters to assist with explaining survey questions, including demonstrations of risk behavior (e.g., unprotected sex), and to encourage safe behaviors. In preliminary tests of the interface, the visuals eliminated confusion about the survey questions (as there had been in the past). A 3-month pilot study of 128 military clients was conducted that measured the ability of the interface to enhance the impact of the behavior change messages provided. The positive response to the visuals led to updating the artwork in companion flipchart tools.
Ten Little Memories: Visual Theater for Adults with Mental Health Conditions - Steven FraserDo It Theatre create Private Plays – unique theatrical events for adults who live with mental health conditions. Our work centres on illustration, literature and animation to convey theatrical stories within settings that remove the stimuli from traditional theatre that some individuals may find uncomfortable. In Private Plays, dialogue is replaced with text, characters replaced with illustrations and the audience becomes immersed in an original form of performance. Private Plays are presented in a specific method. Individuals enter the theatre space and are given a ‘zine. Inside this ‘zine is a theatre script, illustrations and a comic all conveying a story. The audience then walks around a theatre set that presents props, found objects, illustrations, animated flip books and interactive puppets. Participants read the script in the ‘zine and follow the instructions. Here they experience a theatrical performance that requires the use of imagination to bring the story to life. We embrace DIY culture and exciting ways to perform engaging stories. In 2014 Do It Theatre won a New Emerging Company Award from New Diorama Theatre London. We have also received Creative Scotland Open Funding and a Tom McGrath Grant to develop our work. We have presented our stories at festivals and venues throughout the UK including Rich Mix London, All Change Festival at the Lyric Hammersmith and the Horror Souk Festival Sheffield. Our new Private Play, Ten Little Memories, is taking place at the BasicSpace Festival London (17-21 February 2016), with subsequent performances at Ignite Sparks Festival Dundee (14 May 2016) and Hidden Door Festival Edinburgh (27 May - 4 June 2016). We would like to present the findings from staging Ten Little Memories and discuss how successful the performance has been in using illustration, ‘zines and comics in presenting theatre to adults who live with mental health problems.
Few graphic narratives have made the connection between stage and page more explicit than Charlotte Salomon’s proto-comic and serial narrative Leben? Oder Theatre? (Life? or Theatre), which opens with a painting of a red curtain and divides the story into three acts, outlining a full cast of characters. Rather than simple graphic autobiography, we can call Life? or Theatre? an act of self-fashioning, centrally and consciously preoccupied with the performance of identity. Salomon inserts her artistic signature onto every page, through the linked C and S that is her constant insignia. Her multimodal artwork, complete with musical cues that channel the subtitle of Singspiel, or Song-Play, explores a family legacy of mental illness and suicide in the ouroboros of the text—the circular trauma that encompasses and swallows the narrative. The story begins with the suicide of her aunt and namesake, and ends with the suicide of her grandmother. In the interim, six other friends and family members take their own lives, including her own mother, who she is told died of the flu. This is the role that Salomon is herself expected to play—in the theatre of her life, suicide is the anticipated final act, and in the bildungsroman of the story, Salomon’s challenge is to find a different way to stage her future. Life? or Theatre? explores the problem of mental illness in a fraught and dangerous era. Charlotte Salomon came of age as an artist at a time when she was told that her art and her race were both an expression of mental illness and a vector for mental illness. Ultimately, as Salomon chooses not the escape of the window but the potential of the page, she rejects the inevitability of madness, and in doing so, rejects the Nazi alignment of Judaism, modernism and madness.
This panel will blend the theoretical and the personal in order to reflect on “illness as performance” in graphic narratives. Calling attention to both form and function, we will analyze how the genre shapes and is shaped by the experience of being ill, and how we might more critically engage with Graphic Medicine by making our own readings more performative. If comics are indeed stages upon which authors perform their illness, how might Graphic Medicine be used as a filter through which to view and respond to other people’s experiences, as well as our own? How might the subject “become” through drawing? And how might a better understanding of the performativity of patienthood help us breakdown obstacles to care? Each speaker will present his or her work, leaving ample time for Q&A. Lisa Diedrich will explore the way the representation of illness and identity is staged through the doubling of mirrors, photographs, and other imaging technologies in the graphic narratives of Lynda Barry, Alison Bechdel, and Brian Fies. Andrew Godfrey will draw on his own experiences with Cystic Fibrosis, as well as reader-response theory, to investigate reading as performance in Graphic Medicine, along with his own performances of being ill. Sarah Hildebrand will examine scenes depicting therapy within the graphic works of Alison Bechdel, Ellen Forney, and Marjane Satrapi, positing the therapist’s office as a stage upon which both patients and doctors are called to perform uncertain roles. Together, we will deconstruct the performative nature of illness, offering new perspectives on the strengths and limitations of graphic narratives in providing a stage for sharing these experiences.
Benjamin Bates: The Truth about Captain America: Partial challenges to the celebration of medical/military experimentation
In 2003, Physicians for Human Rights reported that US medical personnel were involved in researching more effective “enhanced interrogation” techniques; more commonly known as torture. In their report, and surrounding media discourse, these experiments were compared to other abuse allegations involving the US military and medical systems, in particular the Army “Medical Research Volunteer Program” and the Central Intelligence Agency’s “MKULTRA” mind control experiments. Later that year, Marvel comics released its Truth: Red, White & Black limited series. This series re-narrated the origins of superhero Captain America, an origin that usually celebrates medical/military experimentation. In the original story, the “Super Soldier Serum” transformed 98-pound weakling Steve Rogers into a “peak human” soldier. Truth may be, in part, a response to concerns about military/medical experimentation and explores the untold story of the development of the Serum. Making the “original” Captain America African-American also emphasizes the differential impact that US medical/military experimentation has had on communities of color. Truth re-narrates medical/military experimentation through two primary moves. First, the original narrative emphasizes Rogers’ active consent, Truth shows the 300 Black men experimented on to develop the Super Soldier Serum were denied both informed consent and autonomous choice. Second, agents who conducted the experiment are transformed. For example, the code-name “Doctor Reinstein” is moved from the original narrative’s Abraham Erskine, a kindly patriotic American, to Wilfred Nagel, a eugenicist Nazi affiliate. These moves echo contemporary standards of ethical research that respond to a shared history of medical/military experimentation. The Truth series also inadvertently reinforces narratives that justified US medical/military experimentation, particularly arguments that the subjects of experiments were less valuable members of society and that the results – in this case, the creation of Captain America – justify unethical means. Ethical/social implications of this retelling of the narrative are discussed for how we perform research.
Crystal Lie: Crip Time as Space: Putting Critical Disability Studies and Graphic Life Narrative in Conversation
This paper turns the lens of feminist disability studies (DS) onto graphic life writing narratives. These narratives have been mobilized in the service of healthcare-centered fields such as Narrative Medicine – a field that I contend has failed to interrogate unequal doctor-patient power relations and engage with disability as both a complexly material and socially constructed identity inseparable from political practices. While there is merit to training medical professionals in narrative competence to make them more empathetic and attentive to patient experience, this approach by-and-large has left the hegemonic medical model of disability unchallenged. Concomitantly, this approach reinforces the privileged status of diagnosis as “truth” and narrative expectations of what Sidonie Smith calls the “certitudes” of traditional (masculine) autobiography – i.e. chronological time and the fixedness of identity that can be definitively known by its reader (or doctor). I posit “cripping” the study of graphic life writing can help us explode these norms and illuminate new meanings, centering the marginalized perspectives of disabled people. I also argue the formal qualities of sequential art in particular contribute to conversations in DS surrounding chronic illness and crip time. Because comics stage time as space, examining graphic temporalities help expand our knowledge of how disability affects one’s orientation to time. Following Alison Kafer’s call to examine “disability in time,” I read chronic illness memoirs such as Julia Wertz’s The Infinite Wait (2012) – which centers on her diagnosis with Lupus – as opportunities to theorize how disability in comics forcefully articulates non-normative temporalities; plotlines beyond the curative; and defies expectations and conventions of (dis)closure. Such comics powerfully perform what it means to both be a patient and be patient with the ever-shifting experiences of illness and its social consequences. Comics orchestrate productive spaces of indeterminacy and open-ended histories of embodiment that need be witnessed, not merely diagnosed.Esther Bendit Saltzman: Performing Disability: Parts of a Hole Mainstream comics and disability
“Hello, villain. I have a performance for you,” threatens Echo as she smiles before attacking Daredevil. The “performance” exhibits her exceptional ability to mimic the movements of others, allowing her to learn new skills upon observing them. Thus, by studying Daredevil’s moves, she can anticipate them in combat. Since Daredevil is blind and Echo is deaf, they take advantage of each other’s disabilities in subsequent battles. Comics have been including disabled characters for some time. The field of disability studies examines the role of social construction in the way that society views the disabled. Since comic books can reflect societal attitudes and attempt to change them, we can look to the representation of the disabled in comic books as a tool to understand these attitudes. Echo’s declaration addresses the necessity of the individual to perform in certain ways to be accepted as “normal” in today’s society. In fact, the idea of performance is used as a trope throughout the Daredevil comic, Parts of a Hole. Daredevil’s performance is his music, which becomes a metaphor for aspects of the world that he cannot see. Similarly, Echo performs dance and martial arts, but in front of an actual audience. This paper examines the use of this performance trope to communicate issues in disability studies, and argues that the treatment of disability in comics is in need of further research.
Maria Stoian: Character Design for Real-Life Stories
Take it as a Compliment is a collective graphic memoir dealing with sexual violence, composed of 20 real-life stories submitted anonymously. I collected stories via e-mail, Tumblr, and carried out some interviews. I hoped it would challenge the expectations of who survivors and perpetrators are – that no one asks to be violated, and that rapists aren’t strangers hiding in bushes. They are all everyday people. Part of the thinking behind Take it as a Compliment involved considering how character design is interpreted. I composed an activity book to help me understand how character design, and particularly my illustrations, were understood. Among other activities, I asked participants to match personality traits to a series of (what I thought were) neutral faces, and to label them as heroes and villains. Some said the activity was difficult because the faces were “too neutral” to fit any description. Participants expressed, either verbally to me or in notes on the activity book, anxieties over the inability to “correctly” identify the traits. This need for the characters’ appearances to reflect their personalities is in my opinion the most important piece of information from this study. It is a product of years of exposure to generalizations about character in children’s and adult media. The idea that a character labelled with negative qualities must visually suit those qualities is something that I believe contributes to rape culture, and how we interact with the individuals perpetuating or experiencing abuse.
This presentation will examine the interface between potentially useful instances of Graphic Medicine and academic audiences, with a focus on higher education in the domains of psychotherapy and social care. Original data regarding comics and their academic use was gathered from the Tavistock and Portman NHS Foundation Trust, a specialist mentalhealth training and treatment centre in North London, United Kingdom. A survey and followup questionnaire were implemented during October and November 2014 to test attitudes toward comics and their utility with a sample of 108 students and staff. This was accompanied with semistructured interviews with four clinicians at the Trust to give further insights into how comics are perceived in this unique academic setting. Additional original data was gathered from the comics industry through semistructured interviews with 15 participants involved in creation and production to reveal attitudes to the origination and dissemination of mental healthrelated comics, as well as interactions with academia. Analysis of the combined data sets reveals that while limited use of comic strips is being made in the context of teaching and treatment at the Trust, challenges remain in getting this type of document accepted for use as a learning tool in the context of this academic population.
Marie-Jean Jacob: Bringing comics into the hospital
During this presentation I will discuss how I used comics as a tool, taking advantage of their accessibility, and bringing them into the hospital setting. Working as an artist with Waterford Healing Arts Trust at the University Hospital Waterford, my aim was to engage the patient population in meaningful, creative experiences by creating, reading, and interacting with comics. This work focused on inviting patients to take on a new role within the hospital environment, empowering them in a space where they may feel like have very little say over their lives. By shifting attention to the comics, the patients’ focus is transferred away from their illness or disability, if even for a little while. I worked alongside occupational therapists and speech and language therapists, from the Child and Adolescent Mental Health Unit (CAMHS), designing, co-ordinating and facilitating workshops that focused on particular patient and/or client needs. I also ran storytelling and comic creation workshops within the Department of Psychiatry and the neighbouring psychiatric hospital's ATU unit (St Otteran's Activation Therapy Unit). I found different ways in which to approach bringing comics into the hospital setting: The aforementioned workshops; Gift-bags (containing a handmade gift, information leaflets, selections of comic strips, activities, etc.), and life-size comic panels on the walls (with whiteboard speech bubbles inviting the staff visitors and patients to interact with them). Throughout this presentation I hope to share the challenges and rewards that come with bringing comics into the hospital; the stages of the creative process in the comics can be used in a positive way to brighten up daily life in the hospital.
Julie Anderson, Claire Watson and Lydia Wysocki: Making great comics and books with the Great North Children’s Hospital
We are creating the first in what we hope will become a suite of materials for use by young patients at the Great North Children’s Hospital in Newcastle-upon-Tyne to help them understand their treatments. This has developed from an idea by Radiology staff to involve colleagues from across the Hospital and Newcastle University, and this new project builds on two previous projects at Newcastle University (Newcastle Science Comic, and the Body Matters website). Our first output is currently a work in progress. It focuses on supporting children’s understanding of what it is like to have an MRI scan. This sets it apart from existing materials aimed at parents/carers, in use at other hospitals. We are working with children and young people through the Hospital’s Young People’s Advisory Group as part of our process in creating these outputs, so will also share our reflections on the early stages of this involvement. In this session we will share our plans and works-in-progress for possible comics, children’s books, colouring books, apps, and digital comics, acknowledging fuzzy boundaries between these formats. We would particularly appreciate feedback from comics and medicine practitioners on the practicalities of creating print-digital hybrid projects for use in a hospital environment
Dr Theresa Maatman and Dr Kathlyn Fletcher: For Coping and Giggles: Pilot Course on Use of Cartoons to Reflect in Medical School
Reflection is used to combat higher rates of depression, anxiety and burnout in medical students. Comics, by using humor, can be an effective way to promote reflection. The Medical College of Wisconsin offers fourth-year students a Humanities elective with sessions on topics including reading, writing, and art. In one session, on cartooning, students brainstormed ideas and drew a comic strip about something they found stressful in medical school. Students then shared their cartoons with the class and discussed them in a student-led format. Ten students evaluated the session. Sixty percent of students stated they enjoyed having time to write, draw and create, or viewed the session as a break. Twenty percent of students reported viewing their experience in a different light; another 20% reported that it reinforced their current opinions. Thirty percent of students thought there was a benefit in learning that their peers had similar experiences. Additionally, students reported finding value in the process of putting their thoughts into words and the use of humor in coping. Eleven comics were analyzed for emotional content revealing 82% expressed a scared emotion; 64% mad (angry), and 45% sad. Common settings of the comics included rounds, surgery, and the classroom. Perceived barriers of the session were limited time, difficulty brainstorming, and concerns about drawing capabilities. Students met the objective of reflection as demonstrated by their comments and the comics themselves. Even if the students did not change their perceptions, there was an evaluation of their current opinions. The most important parts of this curriculum were providing time for students to create and a setting where they can share. Small class size promoted conversation among students. Overall, this is a useful tool that can facilitate reflection on medical school stress.
