Motherhood and apple pie

Some great graphic novels and comics have come into the library recently on the themes of pregnancy, childbirth and motherhood.

Kate Brown’s graphic novel Fish+Chocolate provides three short stories around the theme of motherhood. The third of these, Matryoshka is the most powerful. With beautiful, intense and at times brutal imagery, it is the heart-rending account of a woman struggling to cope with the aftermath of miscarriage. It’s in no way a medical account, but the moving depictions of an alienating encounter with a well-meaning workmate, devastating recollections and hallucinations of loss and grief go some way towards helping an outsider (health professional or otherwise) empathise with the woman’s experience. Here's a stunning example of how graphic art might contribute to narrative medicine. You can see samples of the artwork in a review of all three of the stories at Forbidden Planet.

Entirely different in tone is Francesca Cassavetti’s The Most Natural Thing in the World, a deceptively light-hearted and charming take on a young couple’s journey from deciding to have a baby, trying to get pregnant, pregnancy, child-birth, through to coping with the new baby. It’s deceptive because, despite the comic (pun intended) tone, it doesn’t shy away from the emotional roller-coaster (for both parents) of pregnancy and childbirth, yet still manages not to be so worthy that it alienates non-parents or so scary as to terrify prospective new parents. Even without the great drawing, that’s quite an achievement.


Offering the male perspective on childbirth is the comic Miracleman (issue No. 9), with an episode entitled “Scenes from the nativity”. Miracleman (known as Marvelman in the UK version) is a superhero who was created by a scientist as a result of secret experiments with alien DNA. In this episode Miracleman rescues his heavily pregnant wife from an attack and flies her to an isolated location where he delivers their baby.

During the birth it is the father’s comments and thoughts that are to the fore as he delivers the baby and tries to reassure the mother: “yes… I can see the fontanelle and it doesn’t feel as if the cord’s tangled. Just keep breathing.” As the baby is delivered, he thinks about the scientist who created him in a laboratory: “Did it feel like this when you took the first cell scrapings? Did it feel like this as you watched it divide and replicate as you hauled me dripping from the tank?”. He concludes that for all the trauma, the natural birth of his own child is an act of redemption: “For here is blood. Here is violence… redeemed by love, by this pure act of creation.”

It has been suggested that the poignant quality of the scenes was a result of the writer Alan Moore’s experience of the birth of his own child. This issue of the comic gained some notoriety for the very explicit nature of the birth scenes, which, along with the use of some clinical language certainly suggest an eye witness account of childbirth. The significance of the Nativity is that the baby goes on to become the first naturally born superhero.

From the sublime to the seemingly ridiculous in four easy steps. My final offering is Al’s Baby, which was first published as a comic in serial form in 2000AD with Judge Dredd, but is now available as a graphic novel of the complete story. This is another very male view of pregnancy and motherhood, but with a twist. The violent gangster Al Bestardi, known as Al the Beast, is a hitman for mafia boss Don Luigi, and also married to his daughter, Velma. Al tells Velma that The Don has issued him with an ultimatum: either provide him with a grandson or “he’s gonna fit me up wit’ a pair a’ concrete overshoes!” Unfortunately for Al, Velma’s not willing to comply, she points to a newspaper headline that reads “Florida man gives birth” and suggests that Al could do it himself. At his wit’s end, Al goes for a consultation, where the doctor (held at gunpoint) unsurprisingly agrees to ‘remove a section of your intestine’ to make room for the pregnancy.
Once pregnant, Al goes through all the things involved in pregnancy, he gives up smoking his ‘gangster’ cigars, endures morning sickness, and goes for a scan: “nobody puts the grease on me Lady” he warns the nurse giving the scan. He is advised throughout his pregnancy, not by a recent mother, but by his henchman who reassures him that he has delivered three of his own. None of this stops him going about his hitman duties for Don Luigi. He practises changing diapers, feeding and bathing as a form of humiliation on one of his victims.

The birth itself couldn’t be more different from the naturalistic ‘nativity’ in Miracleman. In a modern operating theatre surrounded by a full medical team, he prepares for a caesarean section. Unfortunately the operation is interrupted by a deranged enemy who cries “Here comes your caesarean” as he hurls an axe and various surgical instruments at the prone figure of Al. In a whirlwind of sharp objects, blood and violence, the attacker is finally brought down by Velma, Al’s wife, and the caesarean proceeds as planned, culminating in the birth of their son. The issue ends with a charming family portrait of Al the Beast, Velma, and Don Luigi and his new grandson, festooned with the words “He’s one mean mother!”

Stories of illness: biographies, pathographies and narratives

Back in June 2011 I attended a seminar on the role of biography in the history of psychology and psychiatry. This interesting and informative day raised a lot of questions about the relationship between biography and history. Modern academic historians often have an uneasy relationship with biography, perhaps because of the emphasis on the ‘Lives of the Great and the Good’ in traditional histories, perhaps because of the temptation to subjectivity, so dryly observed by Oscar Wilde:

“Every great man has disciples, and it is always Judas who writes the biography”

One of the consequences of the rise of psychology in the Nineteenth century was that biographers were no longer concerned merely with recording the events in a person’s life. As noted biographer Robert Gittings put it:

“Modern biography aims to take account of every aspect of a man or woman’s life, conscious or unconscious, psychic or physical, public or private, physical states, especially long-term or deeply-laid, must be important to the biographer”

There is no doubt that developments in medicine in the past 200 years have contributed to the evidence available to biographers, not least the death certificate, attesting to the cause of death. You have only to recall how eagerly the media report coroner’s reports on the death of celebrities to see how much medical evidence has become integral to the account of a person’s life. Indeed, there is even a sub-genre of biography that focuses on the medical evidence for the physical and mental state of its subject: the pathography, defined by the Oxford English Dictionary as:

“The study of the life of an individual or the history of a community with regard to the influence of a particular disease or disorder; (as a count noun) a study or biography of this kind.”

Musicians (and composers), genius and power seem to be the most popular subjects for celebrity pathographies. For understandable reasons books such as The Pathology of Leadership raise concerns about the effects of illness and medical disorders on the decision making faculties of great leaders. At the Library, a whole section of the Biographies Collection is dedicated to famous patients (shelf locations BZPX and BZPXA). Here you can find out how a lock of Beethoven’s hair revealed that the likely cause of his many ailments and painful death was lead poisoning (syphilis, another candidate was ruled out because of the absence of mercury - the most common treatment for syphilis in the seventeenth century - in the lock of hair). An absence of traces of opiates suggested that he had not received pain relief during his illness and this may have been the reason why he was able to compose right up to the time of his death.

The latter half of the twentieth century saw the emergence of personal memoirs and autobiographical accounts of illness by ordinary people, as opposed to biographies about celebrity patients. These were usually less concerned with the physical and mental effects of illness and treatment than with the subjective experience of being ill: “the attempts of individuals to orient themselves in the world of sickness….”. as Anne Hawkins put it.

Early patient pathographies such as Anatomy of an Illness helped to address this issue, often expressing frustration with the health system as much as their experience of illness. Under the more general description of patient narratives, they are now relatively commonplace, and to be found in a variety of formats, including biographies, autobiographies, memoirs and graphic novels, and may recount the experience of the carer or family, as well as the patient.

In Reconstructing Illness, Anne Hawkins suggests that one factor in the rise of patient narratives has been the focus of modern medicine on the biophysical aspects of disease at the expense of the patient’s experience of illness. While there have been popular medical accounts about patients, often based on case studies, such as Oliver Sacks’ books, in general, the patient’s voice was missing. It appears the medical establishment are seeking to address this issue, in the relatively recent field of Narrative Medicine :

“A scientifically competent medicine alone cannot help a patient grapple with the loss of health and find meaning in illness and dying. Along with their growing scientific expertise, doctors need the expertise to listen to their patients, to understand as best they can the ordeals of illness, to honor the meanings of their patients’ narratives of illness and to be moved by what they behold so that they can act on their patients’ behalf.”

Medical education programmes have begun to make use of Graphic arts and other patient narratives to train doctors and health professionals in patient relations. And there is another, perhaps just as important function of the patient narrative. Some evidence suggests that writing about their illness may be beneficial to a patient’s well-being.

The proliferation of a more recent form of patient narrative – the online blog - may also testify to the beneficial effects of writing about illness. As one account of blogging during terminal care notes, it can also be a beneficial experience for the community of carers, friends and family around the patient.

Along with published patient narratives, blogs on illness offer a valuable insight into our contemporary cultural and personal experiences of illness and treatment, which will be of interest to historians in the future. It is relatively simple to preserve published materials, but less straightforward for transitory websites. The Library is doing its bit to preserve this material by electronically archiving selected examples of patient blogs, such as My personal journey through depression, and making them available in the Library catalogue.

Images:
A cholera patient experimenting with remedies. Coloured etching by R.I. Cruikshank, [1832?]. V0011135
Girl aged 12 in bed in a private ward of a hospital. N0012623

Graphic Medicine

I’m not a great aficionado of comics or graphic novels. I know who Alan Moore and Stan Lee are; various (male) friends and family have raised my awareness of Marvel and DC Comics; I’ve read the odd issue of Swamp Thing, but the term graphic medicine was new to me. I came across it when a list of recommendations for the Library’s Medicine & Society Collection landed on my desk. They all came from the Graphic Medicine website created by Dr Ian Williams. This excellent website identifies and reviews graphic novels relating to all aspects of health and medical culture. Since the Medicine & Society Collection is all about exploring key medical and health themes in contemporary society, graphic medicine seemed like a perfect fit.

Definitions
A quick aside here: The distinction between graphic novels and comic books is imprecise, but graphic novels tend to come in bound book format and are usually a single continuous narrative, they can be fiction, biography or non-fiction. The term ‘comic books’ is generally used for single unbound pamphlets that serialise a story in weekly issues traditionally bought from newsagents. The Wellcome Library also has a selection of comic books, most of which are public health information pamphlets.

Variety
Having had a chance to examine some of the graphic novels in more detail, I’ve been impressed by the range of topics covered and by the diversity of authors working in this relatively small field:

There are patient accounts of illness and treatment, such as Cancer made me a shallower person by Miriam Engelberg and Spiral Cage, Al Davison’s autobiographical account of living with spina bifida.




There are views from inside the health care system such as Psychiatric Tales by Darryl Cunningham who worked as a health care assistant in an acute psychiatric ward, and Couch Fiction, an account of a therapy session from the points of view of both the patient and the therapist.



Perhaps surprisingly, there were quite a few accounts of carers and family members’ experiences of living with a sick person, such as Epileptic, a memoir of growing up with a brother who has epilepsy, and Blue Pills, a love story about a man’s relationship with a woman and her son, both of whom have HIV.



There are also more traditional comic formats such as the manga style Monster, a thriller about a hospital doctor tracking down a serial killer. The manga novels offer an extra challenge to readers in English because, although they are translated from the original Japanese, they still read from right to left, which can take some getting used to.



The authors are a mix of ages and sexes, and come from Japan, the United States, France and the UK, and there are almost as many different and styles and techniques as there are authors.

Medical education
Along with the development of medical humanities, literature and arts are proving to be useful tools in medical education and patient care. Patient narratives can give health care professionals a valuable insight into the patient’s point of view, but a recent BMJ article on graphic medicine suggested that by using techniques such manipulation of scale, text and image, graphic novels have “the ability to convey visceral understanding in ways that conventional texts cannot” [i]. Their ‘unreal’ quality can also make it easier for trainee health practitioners to discuss difficult or complex issues of ethics or interpersonal communication. In the increasingly global field of public health, they can be particularly useful for reaching young people or non-native speakers.

Pay attention here’s the library bit...
All the titles can be found at the same location in the Library, a specially created classification for graphic novels in the Medicine & Society Collection: HHLC. This allows readers to see the variety of themes amongst the graphic novels and directly compare their different styles. Library catalogue users can also search by genre for ‘graphic novels’ to see what is available across the collections.

As an emerging genre, graphic medicine offers a vivid representation of how illness, disability and health issues can touch people in so many different ways: personally, professionally, directly and indirectly. They are an exciting addition to the Library collections, and one that I look forward to expanding in the future.

[i] Green, Michael J. and Myers, Kimberly R.; Graphic medicine: use of comics in medical education and patient care in BMJ Vol. 340 Iss. 7746, 13 March 2010

Author: Lalita Kaplish

Item of the month - March 2009

In the wake of the ‘Frankenstein science’ fears stirred up by last year’s Human Fertilisation and Embryology Bill, startling evidence has come to light of a strange hybrid organism genetically engineered in the USA.

A newly-catalogued file in Francis Crick’s archive reveals the existence of Kameelman, a chameleon-human clone created by the ‘evil fertility specialist’ Dr Gor Menchin. Kameelman’s chameleon DNA gives him the power to ‘metamorph bodily characteristics to resemble a different person’. But don’t panic! Kameelman is not a megalomaniac hellbent on destruction but a teenager ‘on a mission to fight social injustice through peer-to-peer mentoring’.

Crick received issues 1-3 of the comic book Kameelman in 2003 along with a request to write the foreword for a book version. On the face if it an unlikely publication to turn up in an eminent scientist’s papers, Kameelman is just one in a bewildering torrent of unusual requests sent to Crick over his career.

Back in 1994, for example, he was offered literary immortality by the science fiction writer Jack McDevitt, who sought Crick’s permission to write him a cameo role in Ancient Shores, his novel about a stargate in North Dakota.

Despite his extrovert personality, Crick was publicity shy and fiercely protective of his own personal ‘brand’ - unlike, in his view, James Watson, his co-discoverer of the structure of DNA. He was also no fan of science fiction. It is no surprise then that he refused McDevitt’s invitation – nor that he slyly suggested instead ‘Why not ask Jim Watson?’.

Kameelman clearly draws on a long science fiction lineage of human/animal hybrids, but the comic also taps into contemporary fears about assisted fertility, genetic research and violence between young people. As for the merits of its graphics and storylines, connoisseurs of the genre have plenty to say – see, for example, TheFourthRail on Kameelman’s ‘help-line altruism meets super-heroics’.

In the end Kameelman fails to tempt Crick into the world of graphic novels. But the very request reflects the power of Crick’s public persona. 50 years after his and Watson’s ground-breaking discovery in 1953, supplicants still came to him in the hope that some of his greatness would rub off on them.

For more information on the Crick archive please see the Archives and Manuscripts catalogue.