Juliet McMullin

Department of Anthropology
University of California, Riverside ([email protected])

Cancer and the Comics: Graphic Narratives

and Biolegitimate Lives
Cancer graphic narratives, I argue, are part of a medical imaginary that includes
representations of difference and biomedical technology that engage Fassin’s (2009)
concept of biolegitimacy. Framed in three parts, the argument first draws on dis-
courses about cancer graphic narratives from graphic medicine scholars and authors
to demonstrate a construction of universal suffering. Second, I examine tropes of
hope and difference as a biotechnical embrace. Finally, I consider biosociality within
the context of this imaginary and the construction of a meaningful life. Autobio-
graphical graphic narrative as a creative genre that seeks to give voice to individual
illness experiences in the context of biomedicine raises anthropological questions
about the interplay between the ordinary and biolegitmate. Cancer graphic nar-
ratives deconstruct the big events to demonstrate the ordinary ways that a life
constructed as different becomes valued through access to medical technologies.
[graphic narratives, cancer, health inequalities, biolegitimacy, medical imaginary]

From institutions of scientific research such as the National Cancer Institute and the
American Cancer Society to TV shows, movies, novels, comics, and the stories that
our neighbors and friends tell us, cancer is embedded in a wide array of discourses
and lived experiences. Cancer messaging (risk factors, diagnosis, and treatments) to
quit smoking, obtain regular breast and prostate examinations, and support pro-
grams for individuals and families going through a cancer diagnosis are ubiquitous.
The popular IMDb movie, television, and celebrity database, which boasts over
100 million patrons, has created a list specifically for movies about cancer (IMDb
2013), while Wikipedia devoted a page to cancer movies. In 2010 and 2011, two
cancer biographies, Mukerjee’s (2011) The Emperor of All Maladies: A Biography
of Cancer and Skloot’s (2010) The Immortal Life of Henrietta Lacks, quickly made
their way to the best-seller lists in the United States and abroad. Literature, theater,
and art, fictional and non-fictional stories all contribute significantly to cancer’s
multiple discourses.
Narratives of cancer, illness, and suffering in general are widespread in anthro-
pological and medical scholarship.1 One medium that has received less attention in
these literatures is comics and the field of graphic medicine. Graphic medicine is a

MEDICAL ANTHROPOLOGY QUARTERLY, Vol. 30, Issue 2, pp. 149–167, ISSN 0745-
5194, online ISSN 1548-1387. 
C 2016 by the American Anthropological Association. All rights

reserved. DOI: 10.1111/maq.12172

149
150 Medical Anthropology Quarterly

term coined by physician, cartoonist, and medical humanities scholar Ian Williams
and is defined as “the role that comics can play in the study and delivery of health-
care” (Williams 2007). Williams launched the graphic medicine website in 2007 to
recognize the increasing number of illness graphic narratives (Williams 2007, 2012).
Graphic narratives are “book length works composed in the medium of comics”
(Chute 2010:3). Graphic narratives of medical experiences include stories of mental
illness, sexually transmitted diseases, obsessive compulsive disorders, and epilepsy.
Among the many narratives dealing with illness and medicine, the majority are
concerned with cancer and depression. As the second-leading cause of death in the
world (WHO 2005), the prevalence of cancer as a death sentence and the definition
of the disease by biomedicine create a site of struggle for life, where the power
relations of biomedical technologies and access often define the individual during
and after diagnosis. These relations are the source for many cancer narratives.
While there are numerous fictional and nonfictional comics on cancer that focus on
education, fundraising, and self-help, I will only focus on memoirs and biographical
comics.
Given the ubiquity of cancer education and stories, what can we learn about
the social relations of cancer and health care delivery through the field of graphic
medicine and graphic narratives of cancer? What can the image and the words in
graphic narratives add to our expectations of cancer, given the history of stigmatiza-
tion (Chavez et al. 2001; Sontag 1978) and cancer’s discourse of hope (DelVecchio
Good 1990; Erwin 1987; Patterson 1987)? More specifically, what can graphic nar-
ratives of cancer add to our understanding of categories of difference (between self
and other, healthy and ill) or social, economic, and political inequality (differences
that come to matter in the unequal treatment of individuals and groups)?
I argue that graphic narratives about cancer are part of a medical imaginary
(DelVecchio Good 2007) in the era of biomedicalization (Clarke et al. 2010). Clarke
et al. (p. 5) state that biomedicalization began approximately in 1985, is part of an
increasing reliance on technology to resolve health issues, and is coproduced with
neoliberalism. Biomedicalization attends to technological enhancements that can,
as an indicator of neoliberal practices, emphasize individual responsibility, promote
self-governance, and/or empower individuals and groups to innovate, creating new
social paths and forms. For example, the graphic narratives examined in this article
are examples of individuals rendering the narrative as their own. Offering a critical
questioning of medicine, they depict moments when human communication failed
and biomedical technology was prioritized. Biomedicalization also emphasizes a
political economy of health care, where treatments for cancer are among the most
expensive (see AHRQ 2012 for costs in the United States) and highly dependent on
biotechnology (chemotherapy, bone marrow transplants, and the continual search
for new drugs). Cutting-edge biotechnologies drive both a hope for a cure and
prolonged life, producing a biotechnical embrace (DelVecchio Good 2007). To
continue living with cancer demands an acknowledgment that biomedicine will be
part of that definition of life.
In considering the entanglement of graphic narratives in cancer’s imaginary, I ex-
amine how the combined effects of the dependency on technology for the treatment
of cancer create a framework of “biolegitimacy” (Fassin 2009). Moving within and
beyond Foucault’s concept of biopower as the “art of governing,” Fassin (2009)
 Cancer and the Comics 151

argues that foundations of biolegitimacy, “the sacredness of life as such,” outweigh

the politics of how we let people die. Fassin is not as concerned with the technologies
that constrain life, but with the attachment to treating its present physical condition.
In this way, the politics that brought a life into a condition of suffering, such as the
political refugees he describes, can be ignored in favor of the “present suffering and
its physical evidence” (2009:51). It is not relevant how people come to suffer, rather
the importance lies in how we alleviate its immediate physical manifestations.
Biolegitimacy is a study of meanings and values and ultimately a study of inequal-
ity because of the preference toward favoring intervention for some, or, following
Foucault, how we “make live and let die.” For this article, the preference is de-
pendent on a body that has a malignant cancer or is in remission, caught between
waning life and immediate death. How do graphic narratives of cancer provide an
insight into the creation of valued lives, the use of technologies to make live, and
for whom might those narratives be meaningful? Povinelli’s (2011) call to attend to
the “ordinary, chronic, and cruddy” is useful for thinking about graphic narratives.
The illness experience is bound in the ordinary relations between objects (biomedical
technologies) and people in the chronicity of interacting with health professionals,
oncologists, and institutions who preserve life, and the cruddy experience of cancer
treatment. These relations become the illustrated aspect of the medical imaginary
generating assemblages of meaning and value.
Graphic narratives illustrate the ordinary. They are an ideal medium that visually
situates people and things in relation to one another as objects that matter in
sustaining life. These relations are integral to the narrative; they are subjective
and structural moments of potential. Potentials that, on the one hand, produce
affiliations of cancer and biosocial identities and communities (Klawiter 2008; Rose
2006), and, on the other hand, bring into view attachments to life and a form
of biolegitimacy. As the numbers of biographies of and related to cancer grow,
they provide a material source for deciphering the nuances of illness experiences
acknowledging differences created by illness and embodiments of biolegitimacy and
inequality.
The analysis of cancer graphic narratives that follows is framed in three
parts. First, drawing on comments from graphic medicine scholars, authors, and
commentators, I argue that the framing of these stories as “universal” builds a
structure for expressing how cancer can or should be experienced. As a global
epidemic embedded with a “biotechnical embrace” (DelVecchio Good 2007) where
high-tech treatments foster a discourse of hope (DelVecchio Good 1990), the
relations of cancer presuppose treatment trajectories and experiences (Livingston
2012; McMullin and Weiner 2009). Second, despite the expectation of shared
experiences, a diagnosis of cancer makes one different in ways that matter from
the cellular level to relations with others (Sontag 1978). I examine how cancer
graphic narratives engage tropes of difference and horror as part of the biotechnical
embrace to create a narrative that begins to define the biolegitimate “life as such”
(Fassin 2009). Finally, I consider the roles of biosociality and communitas within
the context of this imaginary. With the creation of communities around cancer,
graphic narratives are marshaled into sources of self-governance and sometimes
critiques for social change. The sense of difference created for people diagnosed
with cancer is profound, yet graphic narratives also visualize how health inequalities
152 Medical Anthropology Quarterly

can be obscured as a category of difference that matters in a disease that, to its

core, is defined by difference (Heurtin-Roberts 2009; McMullin and Weiner 2009).

Cancer and Graphic Narratives in the Medical Imaginary

In many cancer discourses, people have been given an opportunity to rethink their
lives and relationships, engage biomedicine, be called on to participate, fight car-
cinogens in our environment, give money for research, and to walk, run, and eat.
It can all be so exhausting. The overproduction of cancer products (i.e., clothing,
cars, foods labeled with pink ribbons) has been critiqued by numerous authors
such as Ehrenreich (2001) and Jain (2007a), and the constraints of how a person is
supposed to live through cancer (with “appropriate” attitudes and prosthetics for
example) has similarly been examined (see Jain 2007b; Lorde 1997; Stacey 1997;
Stoller 2004). These authors ask important questions stemming from cancer dis-
courses that evoke a battle against the disease and a hope of overcoming, beating,
or surviving the battle. It is a survival that is all too often biomedically defined
(Stacey 1997) with a host of excess meaning (Sontag 1978).
Graphic narratives are an under-studied medium and allow for an examination of
multiple meanings of cancer. The use of memoir and biographical graphic narratives
is not only about the act of retelling an illness story—the graphic form designs a
space for visual metaphors of the authors’ thoughts and experiences that are not
as easily said in textual form (McCloud 1993). There is creative license within
these stories, especially when employing imagery (Williams 2012). This creative
license facilitates the medical imaginary through the objects chosen to appear in the
panels and directs our attention to imagining potential opportunities for change.
Biographical graphic novels are also a more recent endeavor, with many graphic
novelists pointing to Justin Green’s (1972) Binky Brown Meets the Holy Virgin
Mary or Art Spiegelman’s Maus (1986) as inspiration for their work. As Wolk
(2011:44) has argued, “Art Spiegelman’s interpretation of his father’s experiences
as a Jew during the Holocaust used comics as a set of idioms to communicate
what words alone couldn’t, not as a set of conventions to subvert.” This is true
for graphic narratives of cancer. Details not captured in other forms of storytelling
allow authors to connect the pain, suffering, alienation, and community created
within the cancer experience (and other illness experiences).
Cancer graphic narratives are based in lived experiences and caught up in the
flows of medical knowledge, technologies, and ideologies. The imagery is embedded
in an assemblage of the individual, taken-for-granted, and structurally determined
(Clarke et al. 2010; Foucault 2003). These comics literally show us the relations
between things, people, tropes, and subjective experience. Moving Wolk’s comment
even further, it is in the illustration of those moments of the ordinary, of demon-
strating “life as such,” that biographical and memoir comics have the potential of
allowing us to see relations and the absence of relations that are open for subversion,
and allow for a critique of medical hegemony or inequalities.
Comics provide a context that has been distilled into important, yet simplified,
versions of lived experience (McCloud 1993). As an anthropologist, examining
only memoir and biographical comics feels more closely aligned to the conduct of a
conversation with an interlocutor; it analyzes what someone is saying in relation to
 Cancer and the Comics 153

their context and the objects around them. The cancer graphic narratives I examine
are published between 1994 and 2013. One early publication of a cancer graphic
narrative is Pekar and Brabner’s Our Cancer Year (1994). Between 1994 and 2003,
I was unable to locate any cancer graphic narratives. Beginning in 2004, there has
been a rapid increase in this genre, with 12 graphic narratives published to date.2
Our Cancer Year (1994), Mom’s Cancer (Fies 2006), Cancer Made Me a Shallower
Person (Engelberg 2006), and Cancer Vixen (Marchetto 2006) are among the most
well-known narratives. A thematic content analysis was used to examine the graphic
narratives. I analyzed the images for recurring representations of difference. For
example, repeated use of objects such as the chemotherapy chair were read as
moments that differentiate healthy from sick, people who need medical treatment
or not, and power relations in the conflation of technology and life. Images of the
body were similarly read for representations of difference, or effects of cancer and
treatment. Commentators writing on the narratives, informal conversations with
some authors/artists, and field notes from my ongoing ethnography of the graphic
medicine community supplemented the analysis of graphic narratives.

Universality of the Story

Illness narratives in anthropology often reveal individual subjectivities and suffering
as well as the attendant social suffering produced by inequality (Kleinman 1989;
Mattingly and Garro 2000). As illness narratives, comics are expected to do the
work of stories—to help us connect to others and to construct social worlds
(Mattingly 1998). Considering graphic narratives with the same analytical lens as
illness narratives raises questions about how the story is used to connect to others.
What is the imagery that is used to construct a social world wherein we relate to
each other and suffering is viewed as universal?
Physician Michael Green, who developed the first comics and medicine course in
the United States, notes that “these [graphic narrative] stories are such great exam-
ples of our universal experience” (Green and Meyers 2010). For Green, the stories
enhance the medical encounter. Green states: “It’s helpful not only for physicians to
understand patients better, but a chance for a doctor to say, ‘Read this story. You’re
not alone’” (Penn State College of Medicine 2011). His coauthored article (Green
and Meyers 2010) on graphic medicine, describes the valuqqe of graphic narratives,
or what he terms “graphic pathographies,” in medical education and patient care.
Using two graphic novels on cancer, Cancer Vixen (Marchetto 2006) and Mom’s
Cancer (Fies 2006), Green and Meyers (2010), following the work of comics artist
and scholar Scott McCloud (1993), demonstrate how comics provide insight into
the anxieties and anguish that patients feel when trying to obtain medical care.
Using Mom’s Cancer, Green and Meyers show a panel of Fies’s mother’s face when
she realizes that only 5% of people who have her type of cancer “make it.” The
bald image of Mom crying “conveys the universal experience of anguish” (Green
and Meyers 2010).
What I want to highlight here is not how to read the iconography of the comic,
but rather, because these graphic narratives are about cancer, how the biotechnical
embrace comes to structure the interactions with medical personnel. High-tech
medical procedures are the foundation of the treatment plans. They give rise to
154 Medical Anthropology Quarterly

anxieties about the disease: how to pay for the treatment, the potential efficacy
of the treatment, and, ultimately, the probabilities of prolonging life. All of these
moments are imaged in cancer graphic narratives and can be transformed into
moments of medical intervention—enhancements in doctor/patient communication
and in high-tech treatments. As potentials for medical intervention increase, the
biotechnical embrace gives rise to hope and the statistics of survival. Jain (2010)
refers to this as the “mortality effect,” a “ghosting of lives” through cancer trials and
mortality statistics, where “deaths maintain an everywhere and nowhere quality”
(2010:90). The anguish on Mom’s face is not only universal anguish, but made
possible through the realization of the statistic—while she is alive, she can also
be statistically dead. Statistics and anguish in these narratives become part of the
assemblage of the biotechnical embrace as they are constructed as universal.
The expectation that people will connect through universal tropes, come to better
understand each other, and not feel alone is referenced in the introductions of many
cancer graphic narratives. Cancer Made Me a Shallower Person (Engelberg 2006),
Cancer Vixen (Marchetto 2006), Everything’s Okay (Shute 2009), and even Alicia
en un Mundo Real (Franc and Martı́n 2010), a graphic narrative from Spain, all
mention the desire to connect to others experiencing cancer, or to connect caretakers
of people diagnosed with cancer. There is a desire to represent what the authors
have experienced so that others will know that they are part of something that has
touched many lives. Charles Kochman’s introduction to Brian Fies’s Mom’s Cancer
(2006:iii) expresses this sentiment well: “All stories, if they are honest are universal.
Sadly, few things in life are more universal than illness. Each year, approximately
1.5 million people in the United States and Canada are diagnosed with cancer. This
is one family’s story. In many ways, it is also all of our stories.”
In the experience of illness and the work of stories, commentators of graphic
narratives express a basic assumption of universal suffering: We all get sick and we
all struggle. The author’s story is not necessarily unique, except in that it is his or
her story. The suffering experienced is both physical and social. Universal suffering
is simultaneously an experience of difference. Once in the village of the sick (Sontag
1978), these stories can help them know that they are not alone. That someone, the
author, has reached out to make a human connection, an object (the book and the
narrative) merge into the global flows of the imaginary that define cancer’s culture.
Green and Meyers (2010) point out that graphic narratives also give physicians
insight into what patients and the people who care for them are feeling. Embedded
within the reemerging emphasis on narrative medicine (see Charon 2008), the qual-
ity of the biomedical encounter can be enhanced by reading and creating graphic
narratives. The universality of physical suffering is matched by the universality of
biomedical interactions. All of the cancer graphic narratives depend on interactions
with physicians and biomedical technologies to structure the arc of their story. Di-
agnosis, treatment, post-treatment, remission, the cancer continuum is guided by
biomedical knowledge—its triumphs, miscommunications, and heartbreaking end-
ings. There are multiple levels of hope in the claim of the universality of physical
suffering. The commentators and authors hope to show their patients that they are
not alone and to make a connection to their own lived experience and those of
others. There is also a hope in biomedicine that the technologies, while frightening,
 Cancer and the Comics 155

can wage war with cancer, and a hope that the care received by patients and their
families would be greatly improved by the world opened up in the story.
In the era of biomedicalization, cancer graphic narratives illustrate the biotech-
nical embrace by normalizing and universalizing illness experiences while simul-
taneously empowering individuals to tell their own story as a way to transform
and enhance their lives. If physical suffering and medical encounters are universal
(assumptions of universal bodies and treatments), then whose discourse is served?
As the field of graphic medicine works to bring the value of these stories to the
fore, an anthropological position asks for a consideration of medical hegemony:
Are the “pathographies”—defining individual stories by their disease3 —used only
to support biomedicalization (Squier 2007)? How does universalizing a story create
a differing in valued lives and practices?

Treatment and Technology

The general structure of cancer narratives is chronological, following the cancer
continuum starting with diagnosis, through treatment, post-treatment, remission,
and/or death. Sometimes the narrative will begin with the symptom, as in Harvey
Pekar and Joyce Brabner’s Our Cancer Year (1994). Harvey notices a lump near
his groin. After avoiding having it checked for a year, the lump grows and Joyce
insists that he seek care. In this narrative, we are placed into the context of Joyce
and Harvey’s life,4 daily obligations, big events, and Harvey’s fears that are based
on a previous lump removal experience, which turned out to be a fiasco. More often
than not, a cancer graphic narrative begins with diagnosis, a routine trip to the
doctor, or if first a symptom is mentioned, the reader is transported to an encounter
with biomedicine within the beginning two pages. Physician/patient/caretaker in-
teractions and the technologies used to treat cancer structure the remainder of the
stories. The movement in and out of interactions with biomedical technologies is
a necessity of cancer diagnosis and treatment and the production of hope. These
interactions with biomedical technologies draw attention to cancer’s creation of dif-
ference. The move into the village of the sick, however, is not taken as a movement
across a clear border in which technology comes to define a life. Rather, the authors
of the cancer narratives demonstrate their encounter with cancer and its technolo-
gies as a recurring dialog, a shock at their emergence into the morality effect, and
then a returning to the memories and practices of life unaffected by cancer.
Miriam Enelberg’s Cancer Made Me a Shallower Person (2006) is a personal and
very witty telling of her experiences when diagnosed with metastatic breast cancer.
Unable to find an artist to collaborate on her story, someone who could adequately
imagine her ideas, Engelberg decided to draw her own narrative. Engelberg often
comments on her interactions with the host of medical personnel, the good and bad,
who scan, read, cut, and irradiate her body. In a set of panels titled “A Potpourri of
Scans,” Engelberg’s description of her MRI shows the struggle to maintain a sense
of self, despite the redefining of her life through biomedical technologies. During
her MRI, Engelberg suspects the efficacy of the device: “I never quite trust that
MRIs are an actual medical procedure. I picture the Monty Python team out in the
control room making sound effects.” The skepticism of the technology is brought
to bear when her cancer is diagnosed as metastatic, having gone to her brain. With
156 Medical Anthropology Quarterly

this news, the panels show a world that was once divided as those with cancer
and those without into a world where a smaller group of people had metastatic
cancer and an even smaller group with “brain mets” (cancer metastasized to the
brain). In this moment, she returns to a questioning of the technology. Images of
Monty Python’s instruments make the appropriate clacking and plinking sounds of
an MRI while a thought balloon reads, “At least I still have the hope that I didn’t
really have brain mets.” Then in a speech balloon, she states: “That MRI was no
real medical procedure! You can’t fool me!”
Radiation and chemotherapy are icons of cancer treatment. All of the cancer
graphic narratives I reviewed have either an image of the author or their loved one
receiving radiation and/or chemotherapy treatment. The drawing of the chemother-
apy chair or the radiation table creates a space to include other objects or relation-
ships that acknowledge the particularities of the individual. Marchetto’s opening
page of Cancer Vixen (2006) shows her in the chair applying lip gloss. On the
table in front of her is a tape recorder, a lunch bag, and a drawing pad with other
notes, and the header “Chemo #1.” The panel is titled “CHEMO #1. August 12,
2004. I applied Viva Glam Lipglass by M.A.C.” In contrast, Pekar and Brabner’s
Our Cancer Year (1994) shows Harvey getting into the chemo chair, his face con-
cerned. His fellow chemotherapy recipient reassures Harvey by acknowledging his
own fear during his first chemo treatment. With the poison that makes one live as
the standardized treatment, by including personal objects and expressed emotions
these representations maintain a sense of individuality and social connections to a
pre-diagnosis experience.
Fies’s Mom’s Cancer (2006) reveals a poignant encounter with technology’s
defining of the self. A panel (Figure 1) titled “Arrangement in Grey and Black”
shows Fies’s mother sleeping while receiving chemotherapy. The image shows not
only the treatment “Chemotherapy: Taxol on Tap, Carboplatin on deck” dutifully
pointed to by an arrow, but also a “strawberry shake: Jack in the box (large),” a
“Manzanita walking stick found in Oregon, whittled while camping in Alaska,”
and an assortment of other medical and personal artifacts. In a public presentation,
Fies (2013) says that this was one of the first images he drew of his mother’s cancer
experience. Recognizing the relation (the assemblage) of the medical context and his
mother’s life and experience, the story became recognizable—something that could
be shared because “I knew we weren’t alone.” This sentiment is expressed on page
103 of Mom’s Cancer, where Fies draws himself at his work table drawing a picture
of his family.
The technology used to diagnose and treat cancer are pivotal in redefining “life as
such.” Marking a movement from healthy to sick, the inclusion of medical devices
in the panels recognizes the technologies in the construction of difference in the
storyteller’s lived experience. The technology and the drawing are also material
artifacts that point to a possible shared experience for people with cancer. And
yet, the construction of difference through technology is not so simple, not as
hegemonic. The insistence on individual knowledge and experience through the
inclusion of personal objects, such as the Manzanita walking stick, or the relation
between the drawing of technology with the words (Monty Python’s Instruments)
relaying skepticism that undercut the efficacy of the technology, remind us of the
ordinary and the cruddy. The continued biomedicalization of the cancer experience
 Cancer and the Comics 157

Figure 1. “Arrangement in Grey and Black.” Courtesy of Brian Fies.

enables both a construction of biolegitimate lives and a moment of critique—a

possibility where individual life is valued and technology becomes a companion of
sorts (Haraway 1996), a prosthetic in the life-giving force. Continuing to follow
Haraway, we must not only see the enhancement of life in the technologies, but
how these lives are situated, how they can negate a wholehearted acceptance of an
hegemonic biomedicine through the insistence of their experience. In attending to
the ordinary objects in the panels, we ask how they represent differences in access
to care, quality of care, and pre-diagnosis lifestyle.

The Horror of the Body

The horror of cancer arrives in levels: First, cancer cells are often described as
growing differently from other cells: “uncontrollable,” “mad,” and “crazy.” Then
the realization that cancer is not foreign to your body—it is made of your own
out-of-control cells that existed before you are ever diagnosed. And yet, discourses
of cancer refers to the disease as outside of the body, not truly belonging to the
sufferer, parts to be cut out. Thus, cancer is transformed into a thing to be fought
and battled against (Erwin 1987). Its former status as a death sentence highlights the
inevitability of death. We are made fully aware of the implicit understanding that we
are all mortal. As Jain (2010) has noted, receiving the prognosis of cancer becomes
the “truth” of a patient’s life, while simultaneously pointing to the universality of
death. In this confrontation with death, cancer patients are often alienated from
158 Medical Anthropology Quarterly

Figure 2. Isabel Franc and Susanna Martı́n. Alicia en un mundo real, p. 72.
Courtesy of Isabel Franc.

others and at times even from themselves. Cancer breaks down the meaning of the
body, the boundaries of self and other, and of life and death. Horror is evoked in
response to the abject, the loss of boundaries (Kristeva 1982). Within cancer graphic
narratives, the tension between the life-giving treatment and knowledge of cancer
as uncontrollable develop into a host of images that represent the naturalness of
death within bodies that are, despite a cancer diagnosis, still alive.
The use of the living dead, as an abject body, is familiar in cancer narratives.
Isabel Franc draws an image (Figure 2) of her character, Alicia (who is based on
Franc’s experience with breast cancer), standing partially nude in front of a mirror.
Compared to earlier and later drawings in her cancer narrative, Alicia’s body is
thin (lines drawn to show the chest bone and rib cage that do not appear in later
images of her body), one breast is gone, only a few stubbles remain of what used
to be a full head of hair; she looks tired and sad, noting that her body has become
“a great unknown.” Near death but still alive, she pushes forward, learning how
to live with her changed body. It is not the suffering body that is being evoked,
but rather the abject body, one that is not immediately recognizable as the self she
cared for prior to cancer. There is an exhaustion and blurring of boundaries that
the reader is invited to reflect on, with Alicia. The biomedical becomes ordinary in
the mirror and endured with the new habits, new creams, and new routines.
The abject body is also shown in Engelberg’s (2006) work, where she com-
ments on acquaintances’ reaction to her still being alive after her treatment. The
acquaintance, on meeting her, says: “Oh my God, you’re still alive!” Admittedly,
Engelberg notes that those weren’t his exact words, but the horror on his face
evoked that sentiment. For Engelberg, the acquaintance’s reaction spoke volumes:
“When suddenly I became THE UNDEAD,” stated in a thought balloon next to
the drawing of her as a zombie.
 Cancer and the Comics 159

Figure 3. Reprinted from Stitches: A Memoir by David Small. Copyright 

C 2009

by David Small. With permission of the publisher, W. W. Norton & Company,

Inc. All rights reserved.

Similarly, Fies (2006) draws his mother undergoing radiation treatment with the
classic Frankenstein imagery. Mom is strapped to a table with electrodes hooked
on to her and a mad doctor raises his hand into the air. The thought balloons state,
“The problem: a beam of radiation strong enough to kill a tumor . . . also destroys
any healthy brain tissue in its path.” “*Artist’s conception. Your terror may vary.”
Finally, David Small’s (2009) book Stiches has grey-shaded panels showing his
throat cancer, symptoms of which began at the age of 12, as a growing fetus in
the side of his neck (Figure 3). This imagery comes from his memory of seeing
jars of human fetuses kept in formaldehyde in the basement floors of the hospital
where his father worked. This image evokes a literal dead Other occupying the
space of a young boy’s body. David Small’s work, unlike many of the other cancer
narratives, has very few words, relying primarily on the image to represent the
life/death imbroglio.
In cancer narratives, bodily difference is simultaneously created internally and
externally by the reactions of other people and physicians who treat the patient.
160 Medical Anthropology Quarterly

Reactions of others and technological treatments demonstrate that the cancer pa-
tient is no longer a citizen of a healthy community. Meanwhile, cancer evokes an
imagery of impending death that has always existed internally and is now made
real. The images illustrate the lived experience of the cancer patient, the details of
treatment, changing bodies, and startling statements made by friends and strangers
alike. Figured as part of life, the images direct us to the contradiction of death in life.
Moreover, despite the horror response to the abjection, a self/other difference, the
images also convey a biolegitimate life. Within the cancer experience, the diagnosed
are alive, enduring, commenting on, and possibly critiquing the interactions that re-
inforce the self/other and healthy/sick differences. And yet, there is no commentary
on how they come to be abject bodies. There is only the relation to biomedicine and
its technologies that maintain/value life.

Political and Personal Communities

Despite the persistence of a narrative of difference at the cellular and social level,
the imaginary of cancer, through the discourse of hope, is deeply enmeshed in the
process of community building. This community building is part of what makes
the cancer experience a universal story that moves between an understanding of
shared biology as evidenced by diagnosis and the psychological trauma of the
diagnosis and treatment. Anthropological writing about cancer communities has
demonstrated that the discovery of “cancer genes” such as BRCA1 or BRCA2 has
led to the creation of a biosociality around cancer; biological identities that are en-
twined in the politics of managing life (Gibbon 2007; Rose 2006). Cancer patients
and their family members become a part of the many efforts surrounding cancer
activism and finding a cure (see, e.g., Gibbon 2007) or activism engagement on
policy and environmental issues (see, e.g., Jain 2007a; Klawiter 2008).
Within cancer narratives, explicit links to larger institutional cancer communities
come in the form of referencing cancer information or support groups. Not all, but
a few of the narratives as in Fies’s and Engelberg’s, provide links to resources for
individuals who may need more support or cancer information. Sources include the
American Cancer Society, the Komen Foundation, sites for clinical trials, and even
a site for alternative therapies. Marchetto’s Cancer Vixen is a testament to pink.
Marchetto draws a panel devoted to Evelyn H. Lauder, the creator of the Pink Rib-
bon campaign and founder of the Breast Cancer Research Foundation (Marchetto
2006:133). Marchetto’s awe of the infrastructure of cancer research, plus the hope
for a cure is matched by her “vixen” agency. Her power to say no draws her into
a biosocial identity, in which she introduces “the cancer card” (p. 107). With this
card, Marchetto touts the benefits of getting out of things she doesn’t want to
do, “dinners, lunches, breakfasts . . . family function(s).” In the “Introducing the
Cancer Card” panel, Marchetto states that as a member you are part of a “universal
survivor network—now that you’re a member, hotline other survivors who can
assist you on physicians, medication and more!” The cancer card is pink, covered in
pink ribbons, with the membership date beginning with diagnosis. These represen-
tations of belonging to a “cancer group” while pointing out their newly acquired
status link the larger structures of the biotechnical embrace with a biological state
of being. New subjectivities are formed that simultaneously empower and further
 Cancer and the Comics 161

enmesh individuals in cancer’s medical imaginary that define the biolegitimate

life.
With approximately one of every three people receiving a cancer diagnosis in
their lifetime and the plethora of popular culture drawing on cancer as an object or
a driving force in the narrative plot, it is common to know of cancer at some social
level. In the narratives analyzed above, cancer as a social relationship is brought to
the fore through panels that draw out moments of (re)discovering friends, relatives,
acquaintances, or movie stars who are part of the cancer group. While the politics
of cancer have become a large part of the cancer discourse, the medical imaginary
in which graphic narratives are entangled are for other scholars more similar to
the concept of communitas (Turner 1969). Stoller (2013) has noted that “rites of
passage, after all, work like a good narrative, for every such rite had a beginning, a
liminal middle, and an end, which marked a reintegration into society.” Although
recognizing the complications of liminality for cancer patients who are always in
remission, Stoller draws on the work of Edith Turner (2012) to consider commu-
nitas as “the sense felt by a group of people when their life together takes on full
meaning.”
The larger evocations of life taking on fuller meaning are brought out in the
ordinary details. Mom’s Cancer (Fies 2006:66–67), has a series of panels titled
“Puzzlement,” where we see the whole family sitting in the oncologist’s waiting
room when Fies notices a puzzle. He ponders the observation of a puzzle in the
oncologist’s office when no other physician’s office he has been in has had a puz-
zle. Every day someone works on the puzzle, adding new pieces; each week during
the follow-up appointment, the patients and families can see that others have con-
tributed to the puzzle’s completion. Fies interprets this as a way to show progress.
A cancer patient returns to the office so frequently that through the puzzle they can
see they are both part of a larger community and that they are making progress.
In the last panel, Fies reveals that the image they were putting back together is his
mother. Thus, as a caretaker, Fies demonstrates that everyone is involved in the
difference that cancer creates and in the effort to put a life back together.
Returning to panels in Cancer Made Me a Shallower Person that represent the
way in which the world has been divided, those with cancer and those with brain
mets, those with cancer and those without. As someone diagnosed with cancer,
Engelberg (2006) shows how the realization that one is now a member of the cancer
group takes hold of daily interactions with a series of panels titled “Luck,” showing
her purchasing groceries and thinking “I have cancer, she (the checker) doesn’t”;
at the movie theater, “I have cancer, they (the theater audience) don’t.” Unlike
Marchetto, Engelberg with brain mets does not have the luxury of being a mem-
ber of a “universal survivor network.” Despite the manner through which cancer’s
imaginary is diffused through society as structured by biomedical technologies and
the treatment continuum, Engelberg reminds us that the experience is not the same.5
Ubiquity does not manifest as similarity. The imagery of the world divided, paired
with its manifestation in the minutia of life demonstrate the layers of differentia-
tion between life and death—to be simultaneously experiencing the mortality effect
and yet to be alive to tell your story brings about communitas in cancer graphic
narratives. As Engelberg states in her introduction:
162 Medical Anthropology Quarterly

But most of the time, drawing comics has been my lifeline through this
cancer experience (that—and wanting to stay alive as long as possible for my
husband and son, of course). We all have issues that follow us through life,
no matter how much therapy we’ve had. The big one for me is about feeling
different and alone—isolated in a state of Miriam-ness that no one else
experiences. That’s what drew me to read autobiographical comics, and
that’s why I hope my comics can be of comfort to other readers who might
be struggling with issues similar to mine. (2006:xiii)

Animating Difference and Inequality

Cancer marks our notions of difference in physical, social, and structural worlds.
The authors of the graphic narratives demonstrate this difference in the visual
telling of their encounters with assemblage of people and objects that contribute
to cancer’s culture. One might argue that the themes addressed in the narratives,
the internal suffering of dealing with a diagnosis and subsequent treatment, doc-
tor/patient communication, and engagements with hope are frequently addressed
in textual literature. Comics, however, are particularly skilled at visualizing simul-
taneity of thoughts, actions, and interactions with objects. They show the everyday
minutia of life before cancer and the creative path to struggle against the category of
difference into which one is drawn through the disease and biomedical technology.
A chronicling of everyday experience in text may seem irrelevant, too mundane to
convey. The juxtaposition of images and text show the nuances of the story, the ease
by which biomedical knowledge and technologies come to define and enhance life,
and how cancer patients and their caretakers come to endure the experience. Sharing
their stories gives voice and relevance to the individual and their experiences.
Graphic narratives demonstrate the relation between technology and the expe-
rience of cancer as difference, a necessary connection in the flow of this medical
imaginary. Its importance is not only in the binary of healthy and sick, but in
the constellation of relationships between shared suffering, the ghosting of the self
through the horror of being statistically dead with proliferating cells that bring
death, the building of meaning and community around the pathology, and people
affected by cancer. Within the era of biomedicalization, narratives, imagery, sto-
rytellers, and readers are bound together through the biotechnical embrace and a
desiring of biomedical technology to provide treatment and hopefully a cure. But
narratives also maintain the sacredness of being the individual storyteller’s story, an
expression of their right to life, and their right to give voice to and a visualization
of that story.
In the process of creating universal stories of how individual lives can work,
the narrative also develops definitions of lives deeply marked by the difference of
cancer. It is a kind of difference, however, that we can live with and potentially
live through because of biomedical technologies. What we are left with, then, is the
framework for biolegitimacy; the linking of the “biological and the biographical,
the matter of the living and the sense of life” (Fassin 2009:49). The narratives show
us the relationship between the experience and the objects as what matters in the
lives of the authors affected by cancer. Yet the hope of cancer’s culture is not for
everyone, and the stories are not universal. As Fassin suggests, biolegitimacy and
 Cancer and the Comics 163

bio-inequality go hand in hand, the narratives of life as such, a life of difference,

and prolonged liminality obscure the differences that come to matter in accessing
health care resources, the technology, and the histories that produce inequality in
the first place. Graphic narratives show us how to perceive difference in cancer,
difference between healthy and sick. What is less often apparent are questions of
social inequality.
Marchetto’s (2006) narrative is among the few comics that mention issues of
economic inequality. One panel with a background of $100 bills has a pink textbox
in the middle stating “Fact: Women without insurance have a 49% greater risk of
dying from breast cancer. And when it’s needed the most, that’s when it’s the hard-
est to get” (2006:94). As a freelance cartoonist, Marchetto’s cancer experience is
fraught with questions about how to pay her skyrocketing bills. Yet, her biograph-
ical narrative, wherein she marries her wealthy boyfriend and obtains insurance,
undercuts the “fact” that lack of insurance affects mortality. The contradictory na-
ture of the mortality statistics and how her life becomes valued demonstrates the
ease with which the politics and bio-inequalities of health care access can be erased
when a life is biolegitimate.
My goal is not to critique the stories of the graphic novels for not explicitly
addressing social inequality; indeed, there is much about social inequality that can
be gleaned, as noted, in the variations of the chemotherapy chairs. The graphic
narratives are the authors’ own stories and reflect their own experience, and not
an anthropological analysis. How the particular medical experiences of the stories
become part of a universalizing discourse, however, is a moment, a query. As the field
of graphic medicine grows, there is much anthropology has to offer in engaging the
critical moments of individual narratives. Our analysis is not solely in considering
how the narratives might be used in the service of medicine, but how a singular focus
on biomedicine can take us to interpretations that reinforce a medical hegemony
and the erasure of differences that matter in health inequalities.
There is much for anthropologists to consider when engaging graphic medicine.
We might follow Hamdy’s (2014) questioning of what a pairing of graphic nar-
ratives, and ethnographies such as Mom’s Cancer (Fies 2006) and Improvising
Medicine (Livingston 2012) can tell us about structural violence or biosociality. Ad-
ditionally, the majority of the graphic narratives analyzed in this article are from the
United States or Europe. An integration of diverse cultural contexts could enhance
questions about biomedicalization and the presumed universalizing that occurs with
biomedicine. Analyses should also attend to the ordinary, chronic, and cruddy dis-
tilled in graphic narratives to enhance anthropological methods and to consider how
the graphics can collaborate with ethnographic interviews to tease out the objects
and relations in contexts of inequality.
Graphic narratives of cancer deconstruct the big events to demonstrate the seem-
ingly mundane ways that a life constructed as different becomes valued through
access to medical technologies. Importantly, they also provide insights as to where
to explore the bio-inequalities that occur outside the panels. Graphic narratives
push us beyond the ethnographic interview and into the social relations of words
and objects as an assemblage of the medical imaginary. The connections they create
remind us of processes of enduring and that those are precisely the same relations
that are intensified toward differences that matter in creating and addressing health
164 Medical Anthropology Quarterly

inequalities. The field of graphic medicine is a reminder to medical anthropology

that comics are not only for children, educational tools for public health, stories
that can enhance physicians’ empathy, or stories that might support the medical
complex. It is vital that medical anthropology collaborate on the potential of these
works and other graphic narratives to recognize how they represent the subjective
and structural nuances of difference and inequality, and, importantly, to ask whose
voice is not visualized and why.

Notes
1. Examining illness narratives has a long history in anthropology with Arthur
Kleinman’s Illness Narratives (1989) spearheading much of the conversation
between medicine, culture, and narrative. The Department of Social Medicine at
Harvard University, originally founded by Arthur Kleinman and joined by Byron
Good and Mary-Jo DelVecchio Good, has trained and collaborated with a number
of anthropologists working in the area of medicine and narrative, including Cheryl
Mattingly (1998) and Linda Garro (Garro and Mattingly 2000).
2. See mednarratives.com/bibliographies (2013) for a listing of cancer graphic
narratives analyzed. This count of published cancer narratives does not include
the rapidly increasing number of web comics such as The Conoclast by Matlida
Tristram (2011).
3. Dana Walrath (personal communication) insightfully noted that the term
“pathography” is embedded in the biomedical model and reduces an individual’s
identity to their sickness.
4. Squier (2007) similarly argues that Our Cancer Year gives a broader contex-
tualization of cancer as embedded in politics of suffering.
5. See Jain (2013) for another anthropological use of Engelberg’s comic.

References Cited
Agency for Healthcare Research and Quality (AHRQ)
2012 Total Expenses and Percent Distribution for Selected Conditions by Type
of Service: United States. http://meps.ahrq.gov/data_stats/tables_compendia_hh_
interactive.jsp?_SERVICE=MEPSSocket0&_PROGRAM=MEPSPGM.TC.SAS&
File=HCFY2012&Table=HCFY2012_CNDXP_C&_Debug= (accessed November
9, 2014).
Charon, R.
2008 Narrative Medicine: Honoring the Stories of Illness. Oxford: Oxford University
Press.
Chavez, L. R., J. M. McMullin, and F. A. Hubbell
2001 Beliefs Matter: Cultural Beliefs and the Use of Cervical Cancer Screening Tests.
American Anthropologist 103:1–16.
Chute, H.
2010 Graphic Women: Life Narrative & Contemporary Comics. New York: Columbia
University Press.
Clarke, A. E., L. Mamo, J. R. Fosket, J. R. Fishman, and J. K. Shim, eds.
2010 Biomedicalization: Technoscience, Health, and Illness in the U.S. Durham: Duke
University Press.
 Cancer and the Comics 165

DelVecchio Good, M.-J.

1990 American Oncology and the Discourse of Hope. Culture, Medicine and Psychiatry
14:59–79.
2007 The Medical Imaginary and the Biotechnical Embrace: Subjective Experiences of
Clinical Scientists and Patients. In Subjectivity: Ethnographic Investigations. J. Biehl,
B. Good, and A. Kleinman, eds. Pp. 362–380. Berkeley: University of California
Press.
Ehrenreich, B.
2001 Welcome to Cancerland. Harpers Magazine, November, pp. 43–53.
Engelberg, M.
2006 Cancer Made Me a Shallower Person: A Memoir in Comics. New York: Harper
Collins.
Erwin, D. O.
1987 The Militarization of Cancer Treatment in American Society. In Encounters with
Biomedicine: Case Studies in Medical Anthropology. H. Baer, ed. Pp. 201–228.
New York: Gordon and Breach Science Publishers.
Fassin, D.
2009 Another Politics of Life Is Possible. Theory, Culture, Society 26:44–60.
Fies, B.
2006 Mom’s Cancer. New York: Image.
2013 Mom’s Cancer. Presented at the Medical Examinations: Art, Story, Theory. Med-
ical Narratives Conference at the University of California, Riverside, April.
Foucault, M.
2003 Society Must Be Defended. Lectures at the Collège de France 1975–1976.
New York: Picador.
Franc, I., and S. Martı́n
2010 Alicia en un Mundo Real. Barcelona: Norma Editorial.
Garro, L., and C. Mattingly
2000 Narrative and the Cultural Construction of Illness and Healing. Berkeley: Univer-
sity of California Press.
Gibbon, S.
2007 Breast Cancer Genes and the Gendering of Knowledge: Science and Citizenship in
the Cultural Context of the “New” Genetics. New York: Palgrave Macmillan.
Green, J.
1972 Binky Brown Meets the Holy Virgin Mary. San Francisco: Last Gasp.
Green, M. J., and K. R. Meyers
2010 Graphic Medicine: Use of Comics in Medical Education and Patient Care. British
Medical Journal 340:c863.
Hamdy, S.
2014 Top of the Heap. Somatosphere http://somatosphere.net/2014/03/top-of-the-heap-
sherine-hamdy.html (accessed March 27, 2014).
Haraway, D.
1996 A Cyborg Manifesto: Science, Technology, and Socialist–Feminism in the Late
Twentieth Century. In Simians, Cyborgs, and Women: The Reinvention of Nature.
Pp. 127–148. New York: Routledge.
Heurtin-Roberts, S.
2009 Self and Other in Cancer Health Disparities: Negotiating Power and Boundaries
in U.S. Society. In Confronting Cancer: Metaphors, Anthropology and Advocacy.
J. McMullin and D. Weiner, eds. Pp. 187–206. Santa Fe: School for Advanced
Research.
166 Medical Anthropology Quarterly

IMDb
2013 Movies about Cancer by Celinegoslinga. http://www.imdb.com/list/2LFdxc0zOhw/
(accessed July 30, 2013).
Jain, S. L.
2007a Cancer Butch. Cultural Anthropology 22:501–538.
2007b Living in Prognosis: Toward an Elegiac Politics. Representations 98:77–92.
2010 The Mortality Effect: Counting the Dead in the Cancer Trial. Public Culture
22:89–117.
2013 Malignant: How Cancer Becomes Us. Berkeley: University of California Press.
Klawiter, M.
2008 The Biopolitics of Breast Cancer: Changing Cultures of Disease and Activism.
Minnesota: University of Minnesota Press.
Kleinman, A.
1989 The Illness Narratives: Suffering, Healing, and the Human Condition. New York:
Basic Books.
Kristeva, J.
1982 Powers of Horror: Essays on Abjection. New York: Columbia University Press.
Livingston, J.
2012 Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epi-
demic. Durham: Duke University Press.
Lorde, A.
1997 Cancer Journals. 2nd ed. San Francisco: Aunt Lute Books.
Marchetto, M. A.
2006 Cancer Vixen: A True Story. New York: Pantheon Books.
Mattingly, C.
1998 Healing Dramas and Clinical Plots: The Narrative Structure of Experience.
Cambridge: Cambridge University Press.
Mattingly, C., and L. Garro
2000 Narrative and the Cultural Construction of Illness and Healing. Berkeley: Univer-
sity of California Press.
McCloud, S.
1993 Understanding Comics: The Invisible Art. New York: HarperCollins.
McMullin, J., and D. Weiner
2009 Confronting Cancer: Metaphors, Anthropology and Advocacy. Santa Fe: School
for Advanced Research.
Mednarratives.com
2013 Cancer Graphic Narratives. http://mednarratives.com/research/bibliographies/
cancer-graphic-narratives/ (accessed July 18, 2014).
Mukherjee, S.
2011 The Emperor of All Maladies: A Biography of Cancer. New York: Scribner.
Patterson, J.
1987 The Dread Disease: Cancer and Modern American Culture. Cambridge, MA:
Harvard University Press.
Pekar, H., and J. Brabner. Art by F. Stack
1994 Our Cancer Year. Philadelphia: Running Press.
Penn State College of Medicine Alumni Update
2011 Beyond Superheros: Comics as a New Genre for Medical Storytelling.
http://www.pennstatehershey.org/web/alumni/beyond-superheros (accessed June 15,
2012).
Povinelli, E
2011 Economies of Abandonment: Social Belonging and Endurance in Late Liberalism.
Durham: Duke University Press.
 Cancer and the Comics 167

Rose, N.
2006 The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-first
Century. Princeton: Princeton University Press.
Shute, A. E.
2009 Everything’s Okay. Mundelein, IL: Escalation Press.
Skloot, R.
2010 The Immortal Life of Henrietta Lacks. New York: Crown Publishers.
Small, D.
2009 Stitches. New York: W.W. Norton & Company.
Sontag, S.
1978 Illness as Metaphor. New York: Farrar, Straus & Giroux.
Spiegelman, A.
1986 Maus I: My Father Bleeds History. New York: Pantheon Books.
Squier, S. M.
2007 Beyond Nescience: The Intersectional Insights of Health Humanities. Perspectives
in Biology and Medicine 50:334–347.
Stacey, J.
1997 Teratologies: A Cultural Study of Cancer. New York: Routledge
Stoller, P.
2004 Stranger in the Village of the Sick: A Memoir of Cancer, Sorcery, and Healing.
Boston: Beacon Press.
2013 Cancer Rights and the Remission Society. Harvard Divinty Bul-
letin 41. http://bulletin.hds.harvard.edu/articles/winterspring2013/cancer-rites-and-
remission-society (accessed November 10, 2014).
Tristam, M.
2011 Probably Nothing: A Diary of Not-your-average Nine Months. http://www.
mmaattiillddaa.com/probably-nothing/intro/ (accessed July 20, 2013).
Turner, E.
2012 Communitas: The Anthropology of Collective Joy. New York: Palgrave Macmillan
Press.
Turner, V.
1969 The Ritual Process. Ithaca: Cornell University Press.
Williams, I.
2007 Why Graphic Medicine. www.GraphicMedicine.org (accessed August 10, 2010).
2012 Graphic Medicine: Comics as Medical Narrative. Medical Humanities 38:21–27.
Wolk, D.
2011 1986: The Year Comics Grew Up. Comic-Con International 2011 Annual Review.
San Diego: Comic-Con International. Pp. 44–48.
World Health Organization (WHO)
2005 Preventing Chronic Disease: A Vital Investment. WHO Global Report. Geneva:
World Health Organization Press.