Oh, the Humanities (OTH) recently conducted a Q and A session with Dr. Kimberly Myers. Dr. Kimberly R. Myers. Dr. Meyers is Professor of Humanities and Medicine and Distinguished Educator at Penn State College of Medicine, where she designed and co-directs Observation & Interpretation, a required course in art museum-based education for first-year medical students, and where she founded and hosts the Penn State Health Physician Writers Group, the group being a way for doctors to pursue creative writing for publication in medical journals. Dr. Myers also created with photographer Wendy Palmer the 2015 exhibition Edges of Light: Images of Breast Transformation with photographer Wendy Palmer which has toured the U.S. Her publications include the books Breast Cancer Inside Out: Bodies, Biographies & Beliefs (Peter Lang, 2021); Graphic Medicine Manifesto (Penn State University Press, 2015, co-authored with MK Czerwiec, Ian Williams, Susan Merrill Squier, Michael J. Green and Scott T. Smith), Clinical Ethics: A Graphic Medicine Casebook (Penn State University Press, 2022, co-authored with Molly Osborne, Charlotte Wu, and illustrated by Zoe Schein), and Illness in the Academy (Purdue University Press, 2007).
Clare (OTH): Dr. Myers, I had the pleasure of attending a recent talk that you gave at Trinity College, Dublin on graphic medicine. Your presentation’s theme was, briefly, that the medium of comics can enhance the training and practice of healthcare providers and can be an important source of information and support for patients and caregivers contending with illness. There was some very cogent feedback from the audience. What was the most unexpected question or response from the session — or something else that stood out to you about the event?
Dr. Myers: Thanks, Clare, for reaching out with these questions. What stood out most for me was that we had such a lively discussion from both sides of the Atlantic—even though here in the U.S., where we’re five to eight hours behind you in Ireland, we began before breakfast! Our meeting was a fine example of the ways graphic medicine—that is, issues of health, illness, and wellbeing conveyed in the form of comics—can so easily open up discussion among people from all walks of life. Comics is a great ice-breaker. One reason for its effectiveness is likely subconscious—that is, comics aren’t threatening because they are associated with childhood. People who view a comic typically assume they’ll “get it.” There’s no pressure to sound erudite when commenting on it and there’s no test to follow, so they feel free to offer their thoughts about what’s going on in the panels. Further, comics is a democratic medium in that it has the capacity to engage people no matter their understanding of a particular language or their cultural contexts. Pictures and words work together to create understanding and/or questions, and it usually feels natural to invite other people to share our responses when we talk about comics. When we gathered at Trinity, it was interesting to see the plentiful comments in chat that continued throughout our entire spoken discussion.
OTH: In your essay in Graphic Medicine Manifesto (2015) you talk about coming to appreciate comics later than some of your co-contributors—as a child who was a voracious reader you preferred biography and “proper” fiction. Have you encountered a prejudice against adults reading comics amongst doctors and other members of the medical community?
Dr. Myers: As learned professionals, whatever our professions, we probably all initially carry some unconscious bias against comics as a “serious” medium. There’s actually a debate within the graphic medicine community whether we should call what we do “graphic medicine” or “comics.” For some GM folk, the former term lends legitimacy to our work that might otherwise be dismissed as juvenile. Inasmuch comics could seem lightweight to some, it’s wonderful to engage in discussion of a medically-themed comic and witness that skepticism evolve, somewhat magically, into surprise and then conviction that we’re onto something with this comics thing. That’s one of the pleasures of working in this field: it’s just plain fun to experience how comics work as an art form in its own right and also as a catalyst for social engagement.
To be sure, though, creating comics and readings comics are also very demanding work, as we have to attend to multiple dimensions simultaneously. Just to give you brief insight into the complexity of this process, here’s an overview of how our team created each of the eight comics that comprise Clinical Ethics: A Graphic Medicine Casebook. We created the narrative arc, the essence of what would happen within the story. This includes the kind of characters we wanted (e.g., gender, race, socio-economic status, etc.) and the fine points of the ethical dilemma we were featuring. We consulted with ethics experts to double-check our own training and practice, with patients and caregivers, and with lay readers, including students (our targeted audience) to gauge how effectively we were conveying information and inspiring questions that would lead to invested discussion. The drawing of the comics themselves included a story board, pencil sketches, basic ink drawings, edits, and final inking . . . and there were multiple revisions between each stage of this process. In the verbal sphere, we had to make language concise enough for comics while also ensuring adequate detail and precision to convey the complexity of any situation requiring deliberation multiple stakeholders in the medical-ethics situation we were depicting. It took several months to move each 6- to 8-page comic from idea to publishable art.
OTH: Some academic librarians have had success using unconventional methods in reaching “nontraditional” learners—for instance, Central Methodist University in Missouri has used Pinterest as a library marketing and information literacy tool. Library staff created boards from images of books and videos and found that this form of social media “lends itself very well to sharing information to visual leaners and traditionalists alike.” Are medical comics also suitable for visual learners, and what are some other cohorts who might also find them helpful?
Dr. Myers: Yes, medical-themed comics are quite useful for visual learners as well as non-native speakers, low-literacy patients and younger people. It’s important, however, to distinguish between graphic medicine and illustrated guides, for instance pictures showing how to use an inhaler for asthma. Graphic medicine is also different from medical illustrations like those one would find in an anatomy textbook and from visual depictions of bioscientific processes like diagrams of neural pathways. Graphic medicine is more expansive and complex than these other genres, not in terms of the knowledge and talent needed to create or understand them, but in terms of their scope. Graphic medicine artifacts attend simultaneously to structural, biological, psychological, and social dimensions (to name a few) of an illness experience.
OTH: Let’s talk about another visual medium. When talking about the 2015 exhibition Edges of Light that you created using photos of you by Wendy Palmer and reflective text by yourself, you say that after receiving a diagnosis of breast cancer, the decision to meet with a photographer and document your pre-surgery body was taken very early on. Why choose photography as a medium and not, for instance, a comics-style illustration?
Dr. Myers: The short answer, Clare, is that the original motivation for the exhibit was purely personal. Like many women, I wondered how my body would look after mastectomy, and I wondered if, at some point in the future, I might want to remember what my body looked like “before.” I had only a week between diagnosis and my first surgery (lumpectomy), and I acted on that impulse very quickly because I didn’t have time to deliberate. It was only later, after chemotherapy, mastectomy, and surgical reconstruction, that I revisited the photographs that Wendy had taken. We were struck by how many different emotions she had captured, and we thought that other women might find some community—even solace—in seeing someone else’s journey of physical transformation. That’s when we narrowed the 400+ unposed photos to the 30+ photos that constitute the actual exhibit (part of which is reproduced in Breast Cancer Inside Out). After we chose the photos, I wrote the brief verbal reflections, recalling what I was feeling in that moment. I could do this easily because of the remarkable nuance Wendy had captured on film.
OTH: In your book Breast Cancer Inside Out, you bring together essays from patients, practitioners involved in breast cancer treatment, and academics from the health humanities field.
The aim of the project, as you say in the introduction, is to move towards an inclusive health humanities account of breast cancer, one which gives voice to those with lived experience. As an educator, do you feel that the stories of breast cancer patients have particular resonance for the field of medical humanities? And as someone with her own experience of this disease, do you hope that patients who are living with or have lived with breast cancer will read this book?
Dr. Myers: I’ll tackle your second question first. I do hope that people living with breast cancer—the patients and also the family, friends, and healthcare professionals who care for them—find the book meaningful and helpful. I created this particular book because it was what I needed and wanted when I was diagnosed but couldn’t find all in one place: various components of diagnosis and treatment; insights from people who shared my illness; personal perspectives from doctors, nurses, therapists, and other professionals who care for those with breast cancer; wider contexts of scientific, historical, cultural, academic, and artistic significance. Nobel laureate Toni Morrison once said, “If there’s a book that you want to read but it hasn’t been written yet, then you must write it.” Breast Cancer Inside Out is the book I wish I’d had.
I think stories about all illness experiences are valuable, integral in fact, to medical humanities because we’re meaning-making creatures and we make meaning through the stories we tell and those we hear. One thing I discovered with my first book, Illness in the Academy, is that people who have experienced breast cancer have a need and a desire to write and otherwise tell their stories. If I were a medical anthropologist, I would conduct a study on why breast cancer pathographies are so popular and seemingly much more plentiful than first-person accounts of other illness experiences. My conjecture is that it has to do with the fact that the disease affects mostly women. I’m not an essentialist with regard to gender, but I do think women tend to form communities around deeply personal struggles perhaps more often than men do. Sharing stories about breast cancer can certainly be a bonding experience, one that women might imagine men could not as fully, if at all, understand. Whether the impulse grows out of a community or serves to create a community, I believe many people have a desire to help others who are faced with the trauma of a potentially life-threatening illness. Stories in the form of first-person reflections, photographs, comics, visual and other artifacts can create virtual support groups.
OTH, thanks very much for providing an opportunity to think about what I do from different angles.