Brian Callender is an internal medicine physician from the University of Chicago interested in the health humanities, with a focus on the theory and practice of “graphic medicine” to understand and improve our understanding of health, illness and the delivery of healthcare. Exploring representations of breathlessness in comics, he writes…
For most, breathing is an effortless act. But for those who suffer from pathologic breathlessness, the experience is distressing and becomes central to their illness narrative. As the Life of Breath project attests, the experience of breathlessness is multifaceted and challenging to express and articulate. As with all illnesses, pathologic breathlessness is often experienced as physical and psychological phenomena, unfolding within the time and space of the world in which we live. These multiple dimensions of breathlessness, sometimes in conflict, make it difficult to truly convey the nuances, variation, and complexities of breathlessness.
Graphic Medicine is an emerging field that utilizes the medium of comics to convey the many facets of the experience of health and illness. Graphic medicine is broadly defined as the “intersection between the medium of comics and the discourse of healthcare” and captures a broad range of works and practices exploring the use of comics to depict, analyze, and understand health, illness, and the practice of medicine. As comics scholar Hillary Chute notes, “stories about illness and disability use the show-and-tell aspect of comics so basic to its hybrid form to reveal hard-to-convey truths about sickness or ability” (from p.240 of her book Why Comics? 2017). The interplay between image and text inherent to comics provides a diagrammatic and simultaneous way to express both the bold and subtle features of an experience, including emotions, sensations, and thoughts, within the broader context in which the experience occurs, including relationships to the physical environment and other people. Physical, cognitive, and emotional aspects of health and illness can be expressed and rendered, through text and image, in creative ways to make their relationships and imperceptible features more apparent to the reader. Graphic medicine allows illness narratives to reach their full effect by not only taking advantage of the medium’s capacity to simultaneously depict multiple internal and external narratives but also to manipulate space and time to amplify narrative impact.
For these reasons, the creation and reading of graphic illness narratives aligns more closely to the realities of the illness experience and provide useful insight for educational, therapeutic, historical, and recreational purposes.
When it comes to the intersection of breathlessness and graphic medicine, the graphic memoir Things To Do in a Retirement Home Trailer Park… When You’re 29 and Unemployed by Aneurin Wright is an exemplar of how comics can capture the experience of living with a respiratory condition. The work portrays the relationship of a son and his father (Neil), who suffers from end-stage COPD and is enrolled into hospice. The deterioration of Neil’s condition and death is deftly captured by the interplay between images and text as the story unfolds. Additionally, Wright utilizes the plasticity of the comics form to anthropomorphize the main characters. For reasons that reveal themselves later in the book, Wright depicts himself as a Minotaur and his father as a rhinoceros to layer additional meaning into the narrative. The images that follow are notable examples of Mr. Wright’s ability to convey the experience of illness through comics…
The experience of illness is often marked by spatial restrictions and dependency on technology. In this image, Neil is confined to his easy chair, tethered to his oxygen supply. Despite the wide-open space that the image promises, the limits of Neil’s ability to move about are starkly defined by his need for supplemental oxygen and the length of oxygen tubing.
One of the unique aspects of graphic medicine is its ability to convey complex ideas through didactic diagrams. Mirroring educational diagrams often used in healthcare, this image captures the anatomic and pathologic features of COPD. When compared to other images of Neil’s breathlessness, the medicalized or objective details of Neil’s disease contextualize, yet contrast with his subjective experience of that disease.
A unique feature of comics is the ability to manipulate time and space to highlight aspects of an experience. In this series of images, two different chronologies simultaneously express the day-to-day tedium and repetition of living with a chronic disease within the broader passage of time as expressed by the changing of the seasons. For many living with chronic disease, time is defined by repetitive disease-related activities, including taking medications, escalation of needs (going from nasal cannula to face mask) due to exacerbations, visits with clinicians, and assistance with basic activities of basic living.
In this series of images depicting the interaction between clinician and patient, simultaneous narratives unfold much as they do in a clinical encounter. Diagnostic, therapeutic, and prognostic narratives, supported by objective data (heart rate, oxygen level), are presented by the physician and parallel the narrative of Neil’s lived experience, including physical limitations of one’s body and its relation to the environment, responses to medications, and the loss of hope. The sense of breathlessness is heightened by Neil’s inability to speak without the repeated interruptions of “heff, huff” the textual representations of labored breathing.
These images capture the all-consuming nature of Neil’s breathlessness and illness, as all the depicted daily activities of his life are accompanied by the textual “hef, hef, hef” and “pant, pant” and his physical capacity is debilitated to the point of needing assistance. While these images represent the impending end-stage of Neil’s illness, the progression of his disease to this point is more broadly conveyed throughout the book as the text in Neil’s speech bubbles become increasingly populated with textual representations of breathlessness, as his speech is increasingly shortened.
The symbolic power of a lone image to convey multiple meanings is inherent to comics and well-used within the field of graphic medicine to portray the broad spectrum of feelings that accompany the experience of illness. In this image, both loss and freedom are conveyed. This image also highlights how technology can come to define an individual who relies on medical devices.
As these images illustrate, the experience of illness can be powerfully portrayed through the medium of comics. The field of graphic medicine is expanding, with an increasing number of works representing a broader range of medical conditions, and collectively is an important contribution to our understanding of health, the experience of illness, and the practice of medicine.
All images are courtesy of the author (Aneurin Wright) and publisher (Myriad). Things To Do in a Retirement Home Trailer Park… When You’re 29 and Unemployed is available on Amazon (link)
For additional information about the field of graphic medicine, visit: https://www.graphicmedicine.org/ or contact Brian via email (below).
Brian Callender, MD
Brian is an assistant professor of medicine at the University of Chicago and a core faculty member of the Institute on the Formation of Knowledge.