This was basically a 2.5 hour introduction to graphic medicine with a focus on supporting critical medical librarianship. Given as a 2 credit CE at the NCNMLG/MLGSCA Joint Meeting 2019, held at USF in San Francisco, CA.

1. Comics to Promote Equity,
Communication, Health and
Wellbeing*
Kathryn Houk, MLIS, CHIS, AHIP
2019 MLGSCA/NCNMLG Joint Conference
Wednesday, June 12, 2019
1* All references listed by slide number at end of presentation.

2. Objectives
● Explain Graphic Medicine and how
comics can be used for health education
and wellness; particularly regarding
marginalized communities
● Create a relevant Graphic Medicine
collection and discover new titles for
specific audiences
● Brainstorm and explore opportunities to
use comics in clinical and health
education settings to provide more
empathetic and equity-minded care
● Design an active learning session for a
stakeholder audience about Graphic
Medicine as a health education tool
By the end of this CE session,
attendees will be able to:
2

3. Agenda
● Visual Literacy
● Comic Anatomy
● Activity
● Break
● Critical Comics
● Introduction to Graphic Medicine
● Resources for building collections & programming
● Activity
● Discussion with Q&A
3

4. Let’s Draw!
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5. Don’t be scared, it’s easy! See:
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6. It’s Your Turn!
● Use a blank sheet of paper and any writing/drawing
instrument at your table to draw:
○ A subject (can be a human, animal, personified
inanimate object)
○ A verb (give your subject an action – it can be simple)
○ A setting (where is your individual doing their action?)
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7. Share @ Tables
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8. 8

9. 9

10. 10

11. Visual Literacy
Visual literacy is a “set of abilities
that enables an individual to
effectively find, interpret, evaluate,
use, and create images and visual
media.”
11

12. Visual Literacy’s Importance
● Modern college students will both use and need to evaluate images for
assignments, as well as create visual works to communicate their
scholarship and research
○ Comics can help us move beyond the traditional graphs, and even beyond
infographics
● “Visual media is ubiquitous in contemporary society, and increased access
to digital technology means increased access to images. But visual literacy
does not arise from sheer exposure to visual content.”
○ It can be taught, though!
12

13. Image Evaluation Vocabulary
● Line - the continuous movement of a point along a surface. The edges of
shapes and forms also create lines
● Shape - an area enclosed by line. It is two-dimensional and can be
geometric or organic
● Form - occupies space. The attributes of form are mass and volume
● Size - the relationship of the area occupied by one shape to that of another
● Color - is used to create illusion of depth, provide connotative
meaning/feeling
● Value - the lightness or darkness of a color
13

14. Image Evaluation Vocabulary
● Contrast - the juxtaposition of opposing elements
● Balance - the distribution of the visual weight of objects, colors, texture, and
the space
● Emphasis - the point of focus in a picture of area that draws the viewer’s
attention
● Variety - different elements are combined to create visual interest: notably
use of contrast, emphasis, difference in size and color
● Harmony - the quality of wholeness or oneness that is achieved through the
effective use of the elements and principles of art
14

15. What Makes Comics Special?
Comics do, and are, the following:
● Combine explicit expression
(narrative) with abstract
expression (art)
● Approachability to information
● Emotional connection and
impact
● Rooted in underground
movements and the need to
express alternative viewpoints
from the perceived norm
15

16. Comics & Graphic Novels: Serious Business
● Popularity
○ Resurgence of comics and graphic
novels
○ Movies of comic book characters
○ Comic Conventions in almost every
major U.S. city
● Comics in classrooms & libraries
○ Popular choice for reluctant readers
○ Aid critical analysis
○ Teach visual literacy
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17. Critical Visual Analysis Practice
17

18. Fill in the Blank
Instructions:
● Use a piece of blank paper to write your own text for the word bubbles and
narrative box for the comic on the next slide
● Share what you wrote and how the images informed your content at your
tables
● Table representative will share out themes, observations etc. with the large
group
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19. 19

20. Comics Through a Critical Lens
● Caveat: I’m not a comics scholar (& there’s a LOT of scholarship out there)
● Brief United States Comic History:
○ 1950’s: Comics Code Authority banned anything subversive in popularly published comics
○ 1960’s-70’s: Underground comix movement in reaction:
■ Age of Focoult and Friere, who challenged conventional thought & histories
■ A call to marginalized groups to examine and push back against standard narratives
■ Underground magazines, zines and comics depicting life of marginalized and “othered”
■ Women, people of color, LGBTQ still marginalized publicly, but empowered to create
○ 1980’s-present: Independent and alternative comics, graphic novels
■ Comix culture became less underground with self-publishing and independent
publishing options
■ Will Eisner, Art Spiegelman, Alison Bechdel, and broader representation from POC and
different abilities
20

21. Before Their Time
● Maus (1991) by Art Spiegelman considered one of the first graphic novels
and earned critical acclaim
● Binky Brown Meets the Holy Virgin Mary (1972) by Brian Green considered
one of the first graphic medicine comics; explores OCD
○ Graphic pathology
21

22. More Representation, Less Stigma
● Comix and Indie Comics value the ability of comics to represent without
fear
○ “You” can be represented however the artist wishes
○ “They” can be represented however the artist wishes
○ Stigma, recognition & repercussion reduction
22

23. Break
23

24. Graphic Medicine
a definition.
“The intersection of the medium of
comics and the discourse of
healthcare.”
- Graphic Medicine Manifesto
24

25. Graphic Medicine for the Masses
● Approachability to information
○ Can be child-friendly
○ Less-intimidating than an “official” flyer or brochure
○ Emotional connection and impact
● Provide a companion/guide for those experiencing a similar health issue
● Narrative/Stories: better for connection, retention and understanding
● Low Literacy Friendly
○ Combination of pictures and words easier to understand than words alone
○ Fewer words to read on the page
25

26. “Authors of graphic memoirs of illness, by depicting
their conditions and experiences, create valuable
new knowledge, which informs the iconography of
illness.”
-Ian Williams
Graphic Medicine Manifesto
26

27. Reframing Illness
● Ways of Showing Pathology
○ Manifest
■ Signs and scars of illness are visible on the body
○ Concealed
■ Health conditions that occur intermittently, or cannot be noticed by the casual
observer
○ Invisible
■ Health conditions that cannot be observed, only experienced by the individual
■ Mental health and chronic/invisible diseases (and cancer) are a large percentage of
current graphic medicine titles; due to the ability to make the invisible visible
● Artists choose how to present their pathology; influencing how the reader
interprets and perceives the illness & its impact.
○ “Iconography of illness”
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28. 28

29. GM, huh? What is it good for?
● Knowledge Creation
○ Stigma reduction
■ Humanising illness: presenting health information in educational comics
○ Patient-provider relationships
○ “Iconography of illness”
29

30. GM, huh? What is it good for?
● Health Literacy
○ The potential of educational comics as a health information medium
○ Informed consent
■ Medical graphic narratives to improve patient comprehension and periprocedural anxiety before coronary
angiography and percutaneous coronary intervention: a randomized trial
○ Booster Shot Media: Iggy and the Inhalers
■ “Iggy and The Inhalers has been the subject of a research study published in the Journal of School
Nursing. In this public-school study, asthma knowledge increased significantly after educational
intervention (p < .001) and this increase was retained at the one-month follow-up (p < .001).”
○ Cultural sensitivity
○ Engagement
■ Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An
Action Research Approach
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31. Read, Relate,
Reason
● Each table has copies of a narrative and a
comic
● For the first 5 minutes:
○ Read the story and then answer the
questions on the given sheet
● For the second 5 minutes:
○ Read the comic and answer the given
questions
● Discuss with your table for about 5-10
minutes
○ Questions are provided if you need
some guidance
● We will discuss with the whole room for
~5 minutes
Instructions
31

32. Graphic Medicine & Healthcare Providers
Benefits of creating and reading comics:
● Communication & Medical Practice
● Empathy & Ethics
● Personal well-being & Reflection
32

33. Communication & Practice
● Act of reading a comic is similar to art of
diagnosis
○ Must piece together a story from incomplete
information and inference
● Informed Consent
● Discharge instructions & at-home care
● Low-literacy in English
● Graphic Pathographies and the Ethical
Practice of Person-Centered Medicine
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34. Empathy & Ethics
● “...assign and discuss graphic pathographies that give insights into different
aspects of the illness experience.”
○ Preclinical years: remind students that the knowledge they are trying to master will help
real people
○ Clinical and Residency years: reinforce that healing is more than treating a body
● Difficult Doctors, Difficult Patients: Building Empathy
● Hospice Comics: Representations of Patient and Family Experience of Illness and
Death in Graphic Novels
● "There's no billing code for empathy" - Animated comics remind medical students
of empathy: a qualitative study
34

35. 35

36. Personal Well-Being & Reflection
● Catharsis & Meaning-making
○ Bad Doctor - Ian Williams
○ My Degeneration - Peter Dunlap-Shohl
○ Taking Turns - M.K. Czerwiec
○ Bittermensch - online comic by Alex & Jason
○ Comics and medicine: peering into the process of professional identity formation
○ “The Crayon Revolution,” in Graphic Medicine Manifesto - MK Czerwiec
36

37. “I felt sad and anxious and ashamed that morning as
I sat before a blank white piece of paper, trying to
help myself look at this tangle of feelings.”
-MK Cerwiec
Graphic Medicine Manifesto
37

38. 38

39. 39

40. Let’s Draw, Again!
Each table has several sheets of paper with 4 blank panels.
Draw a 4-panel comic based off of one of the following prompts:
● The first moments you or a family member got an unexpected diagnosis
● What bugs you MOST about healthcare visits or insurance/access issues
● The most stressful time/event you can remember
● When you got a physical or emotional scar, or had an epiphany about yourself or a
situation
These are YOUR comics/drawings. They can be as symbolic or literal as you feel
comfortable.
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41. Building Collections
Graphic medicine specific resources:
● Penn State University Press Graphic Medicine Collection
● Graphicmedicine.com
○ Reviews
○ Facebook Group
● Carnegie-Whitney Grant (2018)
○ Essential Graphic Medicine: An Annotated Bibliography
○ Matthew Noe and Alice Jaggers
● Alicejaggers.wordpress.com
● LibGuides & public catalogs
○ Harvard, Kansas, UNLV, Tufts, U of Florida, Penn State, more
● MLANET MedHum Facebook Group
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42. Building Collections
General comics and graphic novels resources:
● ALA Graphic Novels & Comics Round Table
○ Facebook Group
● Conventions
○ Zines, small publishers, etc.
● Library Review Journal, Forward Reviews, Graphic Novel Reporter, New
York Times and Washington Post!, and others
● Brodart, Ingram, Baker & Taylor, YBP and Amazon all sell Graphic Novels
● Be prepared!
○ Convincing may be required
○ Collect based on the needs & strengths of your institution
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43. Examples of GM Projects and Libraries
● HIV/AIDS information promotion at the library: creative campaigns for young
adults
● NNLM - Graphic Medicine Book Club Kits
● NER Graphic Medicine Initiative Education and Programming materials
● Difficult Doctors, Difficult Patients: Building Empathy
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44. Questions/Discussion
44

45. References
Slide 6
Green, M. [Michael Green’s Graphic Medicine Channel]. (2017, July 14). Brunetti Style [Video file]. Retrieved from:
https://www.youtube.com/watch?time_continue=3&v=jIlNtjsOKRo
Slides 9 & 10
Abel, J. (2012, October 12). "What Is a Graphic Novel?" PDF downloads. Retrieved June 7, 2019, from http://dw-wp.com/2010/10/what-is-a-gn-pdf/
Slide 11
Anonymous. (n.d.). Comics Terminology. Retrieved June 7, 2019, from http://www.teachingcomics.org/copy.php
Slides 12 & 13
Visual Literacy Standards Task Force. (2018, March 09). ACRL Visual Literacy Competency Standards for Higher Education. Retrieved June 10, 2019,
from http://www.ala.org/acrl/standards/visualliteracy
Slides 14 & 15
Dufour, J. (2019, January 7). Visual Literacy: Visual Grammar. Retrieved June 10, 2019, from
https://guides.lib.uci.edu/visual_literacy/visual_literacy_visualgrammar
45

46. References
Slide 16
National Library of Medicine. (2018, November 16). Graphic Medicine: Ill-Conceived & Well-Drawn. Retrieved June 10, 2019, from
https://www.nlm.nih.gov/exhibition/graphicmedicine/index.html
AND
Fies, B. (2015, July 09). Mom's Cancer for July 09, 2015. Retrieved June 10, 2019, from https://www.gocomics.com/moms-cancer/2015/07/09
Slide 18
Forney, E. (2013). Marbles: Mania, depression, Michelangelo, & me. London, UK.
Slide 20
Marchetto, M. A. (2009). Cancer vixen: A true story. New York, NY.
Slide 23:
Images from: http://sirrealcomix.mrainey.com/page/b/cvr_BinkyBrown-1.htm and https://images-na.ssl-images-
amazon.com/images/I/5197%2BrKH4WL._SX342_BO1,204,203,200_.jpg
Slide 24
Jason. (2018, June 10). Il Residente. Retrieved June 10, 2019, from http://www.bittermensch.com/2018/07/il-residente.html
46

47. References
Slide 25
Czerwiec, M.K., Williams, I., Squier, S.M., Green, M.J, Myers, K.R., Smith, S.T. (2015). Introduction. In S.M. Squier and I. Williams (Eds.), Graphic Medicine
Manifesto (pp. 1-20). University Park, PA.
Slides 27 & 28
Williams, I. (2015). Comics and the Iconography of Illness. In S.M. Squier and I. Williams (Eds.), Graphic Medicine Manifesto (pp. 115-142).
University Park, PA.
Slide 29
Green, K. M. (2017). Lighter than my shadow. St. Louis, MO.
Slide 30
McNicol, S. (2014). Humanising illness: Presenting health information in educational comics. Medical Humanities, 40(1), 49-55.
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48. References
Slide 31:
McNicol, S. (2017). The potential of educational comics as a health information medium. Health Information and Libraries Journal, 34(1), 20-31.
AND
Brand A., Gao L., Hamann A., Crayen C., Brand H., Squier S., Stangl K., Kendel F., Stangl V. (2019). Medical graphic narratives to improve patient
comprehension and periprocedural anxiety before coronary angiography and percutaneous coronary intervention: a randomized trial
(epub
ahead of print). Annals of Internal Medicine. doi: 10.7326/M18-2976.
AND
Booster Shot Media. (2018, January). Comic Books for Patient Education. Retrieved June 10, 2019, from
http://www.boostershotmedia.com/comic-books
AND
Lee, T., Sheu, S., Chang, H., Hung, Y., Tseng, L., Chou, S., . . . Sun, J. (2019). Developing a Web-Based Comic for Newly Diagnosed Women With Breast
Cancer: An Action Research Approach. Journal of Medical Internet Research,21(2), E10716. doi:10.2196/10716
Slide 33
Jason. (2016, February 25). Delivery Chivalry. Retrieved June 10, 2019, from http://www.bittermensch.com/2016/02/delivery-chivalry.html
Myers KR, Goldenberg MDF (2018). Graphic pathographies and the ethical practice of person-centered medicine. AMA Journal of Ethics, 20(1), 158-166.
doi:10.1001/journalofethics.2018.20.2.medu2-1802
48

49. References
Slide 34
Dwyer, J., & Torres, T. (2018). Diabetes Superhero Comic Book. Retrieved June 10, 2019, from
https://www.healthdesignby.us/diabetes-superhero-comic-book/
Slide 35
Green M.J., Myers K.R. (2010) Graphic medicine: use of comics in medical education and patient care. BMJ, 340 :c863. doi:
https://doi.org/10.1136/bmj.c863
AND
Anderson, P. F., Wescom, E., & Carlos, R. C. (2016). Difficult Doctors, Difficult Patients: Building Empathy. Journal of the American College of
Radiology,13(12), 1590-1598. doi:10.1016/j.jacr.2016.09.015
AND
Czerwiec, M. K., & Huang, M. N. (2014). Hospice Comics: Representations of Patient and Family Experience of Illness and Death in Graphic Novels.
Journal of Medical Humanities,38(2), 95-113. doi:10.1007/s10912-014-9303-7
AND
Tsao, P., & Yu, C. H. (2016). “There’s no billing code for empathy” - Animated comics remind medical students of empathy: A qualitative study. BMC
Medical Education,16(1). doi:10.1186/s12909-016-0724-z
Slide 36
Anderson, P. F., Wescom, E., & Carlos, R. C. (2016). Difficult Doctors, Difficult Patients: Building Empathy. Journal of the American College of
Radiology,13(12), 1590-1598. doi:10.1016/j.jacr.2016.09.015
49

50. References
Slide 37
Williams, I. (2017). The bad doctor. Oxford, GB.
AND
Dunlap-Shohl, P. (2016). My degeneration: A journey through Parkinson's. University Park, PA.
AND
Czerwiec, M. K. (2017). Taking turns: Stories from HIV/AIDS care Unit 371. University Park, PA.
AND
Green, M. J. (2015). Comics and Medicine:peering into the process of professional identity formation. Academic Medicine,90(6), 774-779.
doi:10.1097/acm.0000000000000703
AND
Czerwiec, M.K. (2015). The Crayon Revolution. In S.M. Squier and I. Williams (Eds.), Graphic Medicine Manifesto (pp. 143-163). University Park, PA.
Slide 38
Williams, I. (2015). Comics and the Iconography of Illness. In S.M. Squier and I. Williams (Eds.), Graphic Medicine Manifesto (pp. 115-142).
University Park, PA.
50

51. References
Slide 39
Pistorio, A.L. (2015). Vita perseverat. Collection of Graphic Narratives. Retrieved June 10, 2019, from
http://www2.med.psu.edu/humanities/files/2015/08/Ashley-Pistorio.pdf
Slide 40
Dunlap-Shohl, P. (2016). My degeneration: A journey through Parkinson's. University Park, PA.
Slide 44
Norton, H. F., Ansell, M. E., Pomputius, A., Edwards, M. E., Daley, M., & Harnett, S. (2019). HIV/AIDS information promotion at the library: Creative
campaigns for young adults. Journal of the Medical Library Association,107(2). doi:10.5195/jmla.2019.588
AND
NER NNLM. (2019). NER Graphic Medicine Initiative. Retrieved June 10, 2019, from https://nnlm.gov/ner/graphic-medicine
AND
Anderson, P. F., Wescom, E., & Carlos, R. C. (2016). Difficult Doctors, Difficult Patients: Building Empathy. Journal of the American College of
Radiology,13(12), 1590-1598. doi:10.1016/j.jacr.2016.09.015
51