Graphic Medicine: Worth a Thousand Words

Art and science are two sides of the same creative coin− they sometimes even manage to be one and the same. Increasingly, in a whole range of mediums, tales from medicine are getting an artistic rendering, allowing practitioners and patients alike to share their stories with the public. Graphic medicine is one such genre, a small but growing body of work that blends medicine and comics or graphic novels. The result is a unique take on healthcare that illustrates (literally) the experience of the sick and those caring for them, while fostering understanding and empathy.

Comic genius

Comics often show more than tell a story. The artwork allows comics to clearly demonstrate emotionally complex situations, like the effects of a disease, or abstract concepts, like a vision or a dream, without getting bogged down in the laborious detail that would be required in text alone5. Because they don’t rely solely on words, comics can convey feelings and ideas that are difficult to articulate. And because the pictures don’t have to be literal, comics can present how a situation feels, instead of simply how it looks4.

Comics are a fundamentally flexible medium. They easily incorporate complex plot devices like magical realism, and allow for contradiction between what is written in the text and what is shown in the artwork. They can be meta, with the artist depicting themselves creating the comic that is being read (this narrative sleight of hand is called self reflexivity). Even the frame format of comics provides a tool for storytelling. Because the human brain seeks out a narrative, leaving gaps in the story between frames draws the reader in, forcing them to connect to the dots5. Comics have also developed a countercultural ethos in some quarters, and can be also delightfully anarchic. They can be explicit and rude, but they can also be deeply moving3,5.

graphic medicine
From One in a Million, by YZ Cohen and S Haber

Not all fun and games

Graphic medicine is a diverse genre. Although it does include humorous strips (see below for an example), the comics aren’t always funny (see above for an example). They can even be academic, blurring the boundary between textbooks, novel, and autobiography by including factual information like infographics. The malleability of medical comics allows it to give a voice to range of people in the healthcare system, from patients and their loved ones, to their caregivers4.

medical comics
From Doc Rat, by Jenner

The best medicine

Medical education seeks not only to impart knowledge about disease, but also understanding about the patient experience. Graphic medicine may provide a key tool in bridging that gap. Creating comics has been shown to increase confidence in skills like empathy, communication, and clinical reasoning and diagnosis in medical students5. Fortunately, it’s growing rapidly.

The genre has taken off in the last decade. Since 2010, there has been an annual graphic medicine conference, and there is at least one online repository of medical comics: Annals Graphic Medicine, a part of the Annals of Internal Medicine1. The website Graphic Medicine provides reviews and resources about medical comics, lists over 100 graphic novels (as well as comic books, manga, etc.) and has its own graphic medicine book series2.

Perhaps more than anything, the impact of graphic medicine highlights the fact that− when it comes to disease and healthcare− words aren’t enough.

References

  1. Annals of Graphic Medicine. Annals of Internal Medicine. Web. 22 May 2016.
  1. Graphic Medicine. Graphic Medicine. Web. 22 May 2016.
  1. Lawson, E. (2013). Graphic medicine: humanity in cartoon rats. British Journal of General Practice, Fall: 541.
  1. Squier, S. (2008) Literature and medicine, future tense: making it graphic. Literature and Medicine, 27:124-152.
  1. Williams, ICM. (2012). Graphic medicine: comics as medical narrative. Medical Humanities, 38:21-27.

Image credits: 1. Cohen, YZ, and S Haber. (2015). One in a million. Annals of Internal Medicine, 163:W129-W134. doi:10.7326/G14-0001 2. Doc Rat, by Jenner

 

Aphasia: When There Are No Words

Aliases: Aphasia

Language is tightly bound up with what it means to be a person and it is integral to how we function in the world. It can describe and enlighten, but it can also confuse and deceive. It’s just so… human. Although it feels innate, it’s actually a cultural legacy that we inherit from previous generations. It is the single greatest meme we’ve ever created (in your face, Grumpy Cat), yet we take it for granted. Language is so central to our lives that it doesn’t even occur to most of us that it can be taken away. But it can.

Aphasia is a language disorder that affects language processing. It is common in people who have experienced a stroke; 20% to 40% of acute stroke patients develop aphasia. Because stroke is so common (it is the third leading cause of death in industrialized countries1), that amounts to 40-60 people out of every 100,000 every year3.

There are several types of aphasia, and the condition can have a variety of symptoms, potentially affecting all areas of language. It can impact a person’s ability to both speak and understand the speech of others, as well as their ability to read and write3. Lots of factors influence recovery, including age, gender, environment, as well as the type of stroke3. Unfortunately, total recovery is rare. Most patients are left with some impairment. The experience of aphasia patients illustrates the downside of our dependence on language, and it is a stark reminder of the importance of language. Studies have found that aphasia reduces the chances of a patient returning to work and social activities, and (likely because of this) also significantly reduces their quality of life3.

But it’s not all bad news. Patients usually experience some gradual spontaneous recovery from aphasia, with the greatest amount occurring within the first 3 months. This type of recovery generally plateaus around a year after the stroke1. Recovery depends on the return of normal blood flow to the parts of the brain impacted by the stroke. After that, the neural circuitry responsible for language must be rebuilt. Because the brain is plastic, neural connections can be formed and reformed throughout our lives (to a certain extent, anyway). The brain can literally heal itself, allowing us to survive adversity by giving us a nearly infinite capacity for change.

What could be more human?

Aphasia highlights the brain's ability to repair itself.
Plastic makes perfect.

Cause: Aphasia most commonly results from a stroke3. Stroke is caused by depleted blood flow to the brain from either blood loss (through a burst or leaky blood vessel) or the blockage of a blood vessel by a blood clot. With decreased blood flow comes a reduction in oxygen, which leads to brain cell death and can impact brain function2.

Consequence: Aphasia affects all aspects of language processing, including speech comprehension and expression, and reading and writing ability. Adding another layer of complexity, the severity of these symptoms also varies3.

Cure: There is no cure for aphasia. Aphasia is predominately treated with speech therapies, and the type, time started, duration, and intensity of therapy may significantly affect recovery3. Although some medications have been suggested to treat aphasia, their use is still controversial1.

References

  1. Berthier, ML. (2005). Poststroke aphasia: epidemiology, pathology and treatment. Drugs & Aging, 22: 163-182.
  1. National Stroke Association. What is a stroke? Web. 28 April 2016.
  1. Watila, MM, and SA Balarabe. (2015). Factors predicting post-stroke aphasia recovery. Journal of Neurological Sciences, 352: 12-18.

Image credit: Creative Commons, https://www.youtube.com/watch?v=HgmQe-HXP9w