GRAPHIC MEDICINE: THE ART OF STORYTELLING WITH COMICS MICHAEL - - PowerPoint PPT Presentation

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GRAPHIC MEDICINE: THE ART OF STORYTELLING WITH COMICS MICHAEL - - PowerPoint PPT Presentation

Nov 24, 2022 43 likes •547 views

GRAPHIC MEDICINE: THE ART OF STORYTELLING WITH COMICS MICHAEL GREEN, MD, MS PENN STATE COLLEGE OF MEDICINE mjg15@psu.edu What to Call These Things? In the context of Graphic Medicine, the vocabulary is imperfect Comics, graphic

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MICHAEL GREEN, MD, MS

PENN STATE COLLEGE OF MEDICINE mjg15@psu.edu

GRAPHIC MEDICINE: THE ART OF STORYTELLING WITH COMICS

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What to Call These Things?

  • In the context of Graphic

Medicine, the vocabulary is imperfect

– Comics, graphic memoir, graphica, graphic narrative, illness narrative, graphic pathography, comic memoir

  • For every definition, there

are counter examples and arguments

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“What to call these things is one of the most nettlesome questions in the field. “Graphic” conjures for many the idea of sexually explicit; “novel” is usually a reference to fiction; ‘‘comic” suggests to some that these are supposed to be funny, or that they occupy the same terrain as “Batman.” Any of which could be true, but are not generally descriptive of the scope or ambition of these works.”

Peter Dunlap-Shohl, 2018

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Important Features of Comics

  • A form of literature that includes….

– Pictures – Words – In sequence – To tell a story – Words complement and enhance pictures to produce greater meaning than either alone

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Graphic Medicine

  • Coined by Dr. Ian Williams
  • Speaks to interconnection between the medium of

comics and the field of medicine

  • Not one thing; includes:

– Stories by patients about illness experience – Stories by clinicians about being a health care provider – Materials to educate patients or clinicians – Tools aimed at changing health behavior – Scholarship about comics – It’s also about community

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Storytelling

  • At it’s core, Graphic

Medicine is about stories

  • The power of comics to

show us something about health, illness and the medical context

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Storytelling

  • In particular, stories that give voice to

perspectives that are not often told

  • Comics have a long history of being a

subversive medium

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  • R. Crumb

Underground Comics

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Taboo Topics

  • Suicide
  • Mental illness
  • AIDS
  • Sex
  • Abortion
  • Death and Dying
  • Herpes
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12

Monsters, by Ken Dahl

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Giving Voice to Those at the Margins

  • Transgender
  • Cancer patients
  • People with eating

disorders

  • Those with chronic

illness

  • People with

disabilities

  • Mutism
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14

Dumb, by Georgia Webber

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Offering Uncommon Perspectives

  • The inner thoughts of a

doctor

  • The experience of

being a front line nurse during the AIDS crisis

  • Being a family member
  • f patient with cancer
  • Life as a medical

student

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Challenging the Status Quo

  • Myths about pregnancy

Slightly Plural, by Marnie Galloway

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Challenging the Status Quo

  • Doctors don’t bring personal feelings to work

Tom Ferrier, Disrepute

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20

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Creation of “Missed It”

  • Began as a narrative essay about a mistake I made during

my internal medicine residency

  • Written as part of “Physician’s Writers Group”
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Evolved into a short and intense work of flash fiction

Routine ER page. He says it’s a COPDer. This will be easy -- nebs, steroids, 02. Home in a day. “What about the murmur?” I ask, “No worries, it’s innocent.” Just what I wanted to hear. Admit to floor; return to bed. 3 a.m. nurse is calling. Looks worse. “I can’t breathe.” Smell of fear. Lunge for my arm. Dead. Autopsy: pinpoint aortic stenosis. Fixable.

Creation of “Missed It”

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  • Wanted to tell this story visually
  • Collaborated with Ray Reich, a talented illustrator
  • How to “show” rather than “tell” this story

Creation of “Missed It”

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JAMA 2015. Vol. 314, No. 22: 2345-2346

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Zombie Themes

  • Fear of dehumanization
  • Isolation and loneliness
  • Mindless consumption
  • Being led by ruthless authority figures
  • Devaluing human beings
  • Erosion of empathy
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Zombies serve as powerful metaphors for our deepest fears and preoccupations

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Not About Zombies

  • Backdrops for stories about

– Survivors – Relationships

  • Emerge in response to

challenging times

George Romero

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Zombie Questions

  • How do people react to danger?

– Band together, or is everyone out for self? – Help the least advantaged, or survival of the fittest?

  • How do survivors cope with stress?

– Calmly or panicked?

  • How are power relationships negotiated?

– Smartest and most egalitarian as leaders, or rule by strong & ruthless?

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A Mixed-Methods Study Using “My Degeneration”

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Study Team

  • Daniel George, M.S., Ph.D.
  • Mike Goldenberg, M.A., MSIII
  • Michael Green, M.D.
  • Erik Lehman, M.S.
  • Kimberly R. Myers, M.A., Ph.D.
  • Xuemei Huang, M.D., Ph.D.
  • L.J. Van Scoy, M.D.
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Study Questions

  • Does reading My Degeneration help health care

providers (HCPs) better understand the lived experience of patients with Parkinson’s Disease?

  • Specifically, does it:

– ↑ confidence in understanding patients’ experience? – Change attitudes?

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Mixed Methods Approach

  • Participants:
  • 12 health care providers who treat patients

with Parkinson’s Disease

§ Mean age = 42 years § 83% female

  • All participants provided copy of the book
  • Pre/post intervention surveys
  • Qualitative assessment of small group discussion
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Mean Self-Efficacy (n=12)

scale 0-100; 0=low confidence, 100=high confidence

72 83 10 20 30 40 50 60 70 80 90 100 Self-Efficacy

Pre Post

P=0.001

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Smart Interesting Innovative Complex Active Mature Valuable Good Bad Worthless Juvenile Passive Simple Unimaginative Dull Stupid Pre Post

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Semantic Differential Scale

Comics Are . . .

Mean score 4.8 à 5.3 (p=0.029)

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Net Promoter Score

  • 100 = would not recommend book to family or friends

+100 = would highly recommend book

  • 50

38 77

  • 50
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  • 10

10 30 50 70 90

Before Reading Book After Reading Book After Discussion

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No Change in Knowledge or Attitudes About PD

Measure Pre Mean Post Mean P value Knowledge About PD (0-100) 85 86 0.56 Attitudes about Parkinson’s * 52 54 0.166

*scale 15-60; 60 = patients worry a great deal

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Qualitative Results

  • 1. “My Degeneration” provided a meaningful way for

healthcare providers to learn about the lived experience of patients with PD

  • 2. The comic form engaged the healthcare providers in

ways that were different from other other mediums

  • 3. The benefits of the book may extend past the

healthcare team

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Graphic Medicine is a dynamic new field with many potential applications:

  • For teaching
  • For research
  • For patient care
  • For public health
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MICHAEL GREEN mjg15@psu.edu