Visual Metaphor and Embodiment in Graphic Illness Narratives 0190678178, 9780190678173

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Visual Metaphor and Embodiment in Graphic Illness Narratives

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Visual Metaphor and Embodiment in Graphic Illness Narratives ELISABETH EL REFAIE

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3 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Oxford University Press 2019 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-​in-​Publication Data Names: El Refaie, Elisabeth, author. Title: Visual metaphor and embodiment in graphic illness narratives / Elisabeth El Refaie. Description: New York, NY : Oxford University Press, 2019. | Includes bibliographical references and index. Identifiers: LCCN 2018016168 (print) | LCCN 2018031400 (ebook) | ISBN 9780190678180 (updf) | ISBN 9780190678197 (epub) | ISBN 9780190678203 (online content) | ISBN 9780190678173 (cloth : alk. paper) Subjects: LCSH: Autobiographical comic books, strips, etc.—History and criticism. | Narrative art—Themes, motives. | Metaphor in literature. | Diseases in literature. | Sick in literature. | Diseases in art. | Sick in art. | Graphic novels—History and criticism. Classification: LCC PN6714 (ebook) | LCC PN6714 .E43 2018 (print) | DDC 741.5/35–dc23 LC record available at https://lccn.loc.gov/2018016168 9 8 7 6 5 4 3 2 1 Printed by Sheridan Books, Inc., United States of America

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Contents

Acknowledgments Introduction I.1. Toward a Notion of Dynamic Embodiment in Conceptual Metaphor Theory  4 I.2. An Example  7 I.3. Data and Methods of Analysis  11 I.4. Outline of Chapters  14 1. Reanimating the Body in Conceptual Metaphor Theory 1.1. The Discovery, Neglect, and Rediscovery of the Lived Body in Conceptual Metaphor Theory  21 1.2. Experimental Evidence of Flexible Embodied Conceptualizations  27 1.3. “Dys-​appearance” and Empathic Projection  31 1.4. Embodiment and the Affordances of Modes and Media  36 1.4.1. Modes and Embodied Metaphor  36 1.4.2. Media and Embodied Metaphor  42

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2. Dynamic Embodiment and the Graphic Illness Narrative Genre 47 2.1. Genre, Multimodality, and Embodiment  50 2.2. Origins and Evolution of the Graphic Illness Narrative Genre  54 2.3. The Body and Metaphor in Graphic Illness Narratives  56 2.4. Metaphor and the Characteristic Formal Features of Graphic Illness Narratives  60 2.4.1. Words and Images  61 2.4.2. Sequence and Space  72 2.4.3. Style and Materiality  75

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3. A Tripartite Taxonomy of Visual Metaphor in Graphic Illness Narratives 3.1. Pictorial Metaphor  86 3.2. Spatial Metaphor  102 3.3. Stylistic Metaphor  109 4. Unseeing Eyes: Metaphor in Graphic Illness Narratives about Cancer 4.1. The Epistemology of Vision  123 4.2. The Medical Gaze  126 4.3. Cancer Metaphors in Graphic Pathographies  128 4.3.1. Visualizing Invasions, Journeys, Thieves, and Parasites  128 4.3.2. Visualizing Outer and Inner Selves  138 4.3.3. Like Pictures from Outer Space  145 5. Trapped in Spacetime: Metaphor in Graphic Illness Narratives about Depression 5.1. Time and Depression  159 5.2. Time, Space, and the Comics Medium  161 5.3. Depression Metaphors in Graphic Pathographies  165 5.3.1. Descent, Darkness, and Time  166 5.3.2. Fractured/​Split Selves and Time  173 5.3.3. Temporal Entrapment  179

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Conclusion

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Notes

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Graphic Illness Narratives

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References

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Index

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Acknowledgments

have contributed, either directly or indirectly, to the creation of this book that I am unable to mention everyone by name, but a few individuals deserve my special thanks. It would have been difficult for me to complete this book without the benefit of a six-​month period of research leave in 2016–​2017. Indeed, my colleagues at the School of English, Communication and Philosophy at Cardiff University have been unfailingly supportive; in particular, I would like to thank Michael Handford for his invaluable advice and encouragement throughout the process. I am also grateful to the friendly community of metaphor scholars, especially Charles Forceville, Elena Semino, Ray Gibbs, Jonathan Charteris-​ Black, Jeannette Littlemore, and David Ritchie, whose work has inspired me and who have been generous in sharing their thoughts and knowledge whenever our paths have crossed. Both Zoltán Kövecses and the second, anonymous reviewer for Oxford University Press have offered highly perceptive and constructive criticism, and Hallie Stebbins has done a superb job as my editor. Several other people also have commented on various sections and versions of the manuscript, including Ann Heilmann, Tom Bartlett, Clari Searle, Irene Velentzas, Sheila Spielhofer, Maria O’Riordan, Ian Masters, and Amr El Refaie. There is no doubt at all in my mind that all these individuals have played an important role in shaping the ideas expressed in this book, although of course any errors are entirely my own. SO MANY PEOPLE

Elisabeth El Refaie Cardiff, February 2018

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Introduction

What is its purpose? What shape does it take, and why? How does it relate to our fundamental experiences as human beings? These and similar questions have exercised writers, artists, scientists, linguists, and philosophers for many centuries, yet until quite recently the focus has always been on particularly creative verbal metaphors in literature, poetry, and politics. The emphasis shifted when, in the late 1970s, cognitive linguists turned their attention to the vast number of unremarkable metaphorical expressions that we use constantly in everyday discourses. According to what has since come to be known as Conceptual Metaphor Theory (CMT) (Johnson 1987; Lakoff 1993; Lakoff and Johnson 1980, 1999), many of these conventional metaphors relate to abstract areas of our experience, such as mental states, emotions, and social relations, that are hard for us to grasp and convey to others without recourse to our “embodiment,” that is, the concrete reality of our own body and its interactions with the environment. Seen from this perspective, metaphor is not a special use of language, but rather a fundamental way of thinking that is based on parallels between our sensorimotor experiences and more intangible areas of our lives. These patterns of thinking become entrenched in our conceptual system, generating clusters of conventional nonliteral expressions and influencing our thoughts and actions throughout life, albeit at a mostly automatic and subconscious level. For example, we experience a link between the ability to see things clearly and our success in obtaining important information; hence we acquire a tendency to think and talk about knowledge and understanding in visual terms (e.g., “I see what you mean,” “His motivations are totally transparent”) (Johnson 2007: 165–​166). Similarly, the spatial dimension of up and down becomes correlated from infancy onward with W H AT I S M E TA P H O R ?

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the experience of being upright and able to move about freely, or forced to succumb to gravity, which encourages us to talk about our state of happiness in terms of being “up(beat)” or “down(cast),” for instance (Gibbs 1994: 414). Indeed, even the most celebrated literary metaphors are, according to CMT, often just unusual extensions or combinations of the same conceptual metaphors that underlie our ordinary, everyday thinking (Lakoff and Turner 1989). Although the notion of “embodiment” has thus been central to CMT since its inception, many scholars in this tradition still operate with a rather static and one-​dimensional view of the human body. At least until recently, the focus has been on identifying sets of universal (“primary”) conceptual metaphors generated by the actions and perceptions of an ordinary, healthy body going about its everyday business:  “If you are a normal human being, you inevitably acquire an enormous range of primary metaphors just by going about the world constantly moving and perceiving” (Lakoff and Johnson 1999: 57). The very notion of “normalcy” in relation to our embodied existence is problematic, however. First, it disregards the experiences of disabled people (Vidali 2010). A person who is born blind, for example, will not experience a connection between seeing and knowing, while the conceptual system of an individual who has never been able to move her limbs is unlikely to be influenced by motor actions to the same extent as she would be if she were able-​bodied. Second, the qualities, states, abilities, and actions of our bodies that we perceive and understand to be “normal” are largely determined by the values and assumptions that our culture imposes on us, including those relating to class, gender, sexuality, race, ethnicity, age, health, and beauty. Third, and most important for the purposes of the present study, nobody—​however “normal” he or she may appear to be—​experiences physicality in a way that is straightforward and stable throughout life. Even a temporary illness may, for example, profoundly affect and disrupt our ordinary, taken-​for-​ granted ways of interacting with the world around us. The relationship with our own bodies is also shaped by our moment-​to-​moment activities, including our acts of communication. CMT’s claim that metaphor is conceptual rather than just linguistic has inspired several scholars to search for examples of the phenomenon in a range of different semiotic modes, media, and genres, such as advertising (Forceville 1996; Jeong 2008), political cartoons (El Refaie 2003, 2009), film (Coëgnarts and Kravanja 2012; Rohdin 2009; Winter 2014), animation (Forceville 2013; Popa 2013), co-​speech gesture (Cienki and Müller 2008),

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corporate branding (Ng and Koller 2013), art (Parsons 2010; Serig 2008), experimental literature (Gibbons 2012, 2013), and comics (El Refaie 2012a, 2012b; Forceville 2016; Kukkonen 2008; Potsch and Williams 2012). In each of these contexts, metaphor takes diverse forms and fulfills many different functions. Yet the majority of the literature on nonverbal metaphor has remained firmly within the confines of CMT and has not presented any fundamental challenges to a theory that was originally developed on the basis of linguistic data. The current book has a more radical agenda in this regard: I will argue that the modes and media we use to communicate foreground or background particular aspects of our embodied experience, a process that in turn has a profound influence on the metaphors we create. Artists working in the visual medium of comics, for example, are compelled to engage with the nature and limitations of human vision, making it more likely that they will use metaphors that draw on the experience of seeing or not seeing things clearly, regardless of whether this is an explicit theme in their stories. The present study uses the systematic analysis of (verbo)-​ visual metaphors in a corpus of graphic illness narratives—​book-​length comics about physical and/​or mental illness—​in order to propose a new conceptualization of embodiment that is more representative of the range of experiences of different people and of each individual as she goes through life. I argue that the human experience of our own bodies is forever adjusting to changes in our sociocultural beliefs and practices, our individual bodily dispositions and dysfunctions, and the activities we are engaged in at any given moment, including the modes and media we are using to communicate. This leads to a more fluid and creative relationship between our physicality and metaphor use than many CMT scholars assume. In developing this notion of what will be termed “dynamic” embodiment, I shall build on some of my own previous work (El Refaie 2014a, 2014c, 2017) and other emerging ideas in metaphor theory, while also drawing on valuable concepts and findings from other disciplines, including experimental psychology, phenomenology, anthropology, social semiotics, and media theory. The purpose of this project is thus (a) to encourage metaphor scholars to adopt a more nuanced conceptualization of embodiment as something that is constantly shifting and changing in response to physical or mental illness, and as a result of different ways of communicating; (b)  to provide the first comprehensive account of metaphor in the emergent graphic illness narrative genre, which is increasingly being recognized for its

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ability to reveal aspects of the illness experience that may be concealed by other, less creative ways of communicating about disease; and (c) to raise awareness among health professionals of the powerful role of both verbal and visual metaphors in shaping attitudes and sometimes even health outcomes, while also inspiring them to be more imaginative in their own use of metaphor.

I.1. Toward a Notion of Dynamic Embodiment in Conceptual Metaphor Theory One of the inspirations for the arguments expounded in this study was the emergent Dynamic Systems perspective in CMT (Cameron et al. 2009; Deignan and Cameron 2013; Gibbs 2011a, 2013), which is challenging the long-​held belief that conceptual metaphors are selected from a limited set of pre-​stored mental mappings. According to this approach, metaphors should instead be seen as arising from the continuous interplay of social and cultural constraints, neural processing, and the unfolding of in-​the-​moment sensorimotor experience. There also has been some important research on cross-​cultural differences in people’s use of embodied experiences to understand abstract domains of life, particularly the emotions. These studies have revealed not only how cultural models may act as a filter for our physical experience, but also how physical experience is itself shaped by specific sociocultural norms, values, and practices (Barcelona 2000; Kövecses 2005, 2015; Maalej 2004; Maalej and Yu 2011; Sharifian et al. 2008; Yu 1995, 2008). Recent experimental work in psychology also has contributed useful insights into how individual differences in our embodied experience may generate distinct patterns of nonliteral thought. Whereas the values and emotions associated with the spatial orientation of up and down appear to be universal, for example, people’s mental representations of left and right are more varied. Thus, right-​handers are significantly more likely to value things more highly if they are presented to them on their right side, while left-​handers prefer those on the left (Casasanto 2009; Casasanto and Henetz 2012). Other experiments have revealed that, in cultures with a left-​to-​right script direction, the past is mentally represented preferentially on the left, whereas the future is subconsciously placed to the right; in societies with right-​to-​left writing systems, the converse is true (Cooperrider and Núñez 2009; Maass et  al. 2009; Maass, Suitner, and

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Nadhmi 2013; Santiago et al. 2007). This suggests that both the particular bodies we have from the outset and the routine actions we perform with them play a role in how we mentally represent abstract concepts. Indeed, it seems that even the short-​term manipulation of people’s embodied experience—​for example, by making them wear a bulky ski glove on their dominant hand or by giving them a mirror-​reversed text to read—​can cause a temporary reversal of their usual associations between left-​right orientation and the more abstract concepts of good–​evil or past–​future (Casasanto and Bottini 2014; Casasanto and Chrysikou 2011). In sum, recent research in CMT and experimental psychology suggests that our bodily perceptions and experiences are molded by our sociocultural values and practices, our individual bodily dispositions, and our ongoing actions and perceptions. My notion of dynamic embodiment extends this work by developing the following three original ideas. First, the experience of disease fundamentally unsettles our usual relationship with our bodies and in doing so changes our thought patterns. According to the French phenomenologist Maurice Merleau-​Ponty (1962), our attitude toward our body is ordinarily characterized by “disappearance,” in the sense that our conscious attention is directed outward, away from the body and toward the world it reveals to us. Only in certain situations, such as when we are experiencing illness or a sudden disability, our physicality forces itself into our consciousness, although now it is experienced as something strange, troubling, and fragmented; in Leder’s (1990:  91) terms, it has “dys-​appeared.” In such situations, I suggest, the direction of the transfer of metaphorical meaning from embodied to more abstract experience is often reversed, as the need arises to understand the body’s malaise. Metaphors have, indeed, been found to be pervasive in the way people talk and write about a whole range of diseases, including cancer (Demmen et  al. 2015; Reisfield and Wilson 2004; Semino, Heywood, and Short 2004; Williams Camus 2009), depression (Charteris-​Black 2012; Demjén 2014; Fullagar and O’Brien 2012; Pritzker 2007), dementia (George and Whitehouse 2014; Lane, McLachlan, and Philip 2013), and HIV/​AIDS (Jansen et al. 2010). While some metaphors, such as journeys and military combat, occur frequently across many of these different discourses (Gibbs and Franks 2002; Gwyn 1999), others appear to be unique to a particular physical or mental illness. I argue that such differences in metaphor use result from the distinctive ways in which each disease disrupts the harmony of the “mind-​body-​world continuum” (Bullington 2009: 108), as

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well as from divergent social, cultural, and medical attitudes toward them. Cancer, for example, draws attention to the secret, inexplicable, and life-​ threatening processes going on beneath the body’s visible surface, particularly now that microscopic and digital-​imaging technologies play such a central role in the diagnosis and treatment of the disease. By contrast, depression typically results in the adoption of certain body postures and behaviors that give prominence to the effort required to resist the effects of gravity on the human body, as well as severely disrupting sufferers’ ordinary sense of time. As I shall demonstrate, these disease-​specific forms of “dys-​appearance” make the use of particular metaphors more or less likely. Many of the metaphors identified in the graphic illness narratives under consideration also seem to have been inspired by the fact that their authors were required to represent their thoughts and emotions through the multimodal comics medium. Accordingly, the second key claim of the current study is that the modes and media through which we communicate have a major impact on how we experience and exploit our bodies for the creation of metaphorical meaning. Drawing on Gibson’s (1979) notion of “affordances,” which refers to opportunities provided to us by the material properties of objects in our environment, I  will show how each semiotic mode and each medium emphasizes or de-​emphasizes particular aspects of our sensorimotor experience, which in turn shapes the metaphors we create. For instance, when we are communicating through the visual mode, any emotion, abstract concept, or nonvisual sense perception must necessarily be represented nonliterally, as they do not possess a concrete, imageable form. Another case in point is the way in which each medium of communication engages our temporal and spatial awareness in unique ways: since comics have a spatial but no temporal dimension, for instance, artists are forced to utilize the layout of the various elements on the page to convey chronological sequence and duration. Moreover, the human sensorium is itself deeply imbued with social and cultural meanings (Howes 2005: 3). In the European tradition, vision has a long history of being associated with male rationality and scientific inquiry, while women have been deemed to be intrinsically more suited to exercising the “lower” senses of touch, smell, and taste (Classen 2005a). The unique properties of the various modes and media, together with the cultural meanings linked to each of the human senses, are bound to affect the way we perceive the world and thus also how we use metaphors to represent these perceptions.

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The third main argument developed in this study is that we need to broaden our definition of visual metaphor. The majority of the existing literature on the phenomenon focuses on what Forceville (1996) has termed “pictorial metaphors,” which use images of concrete things to stand for something else. An example of a pictorial metaphor is the depiction of the tuberculosis pathogen as a giant monster in some health information comics for children (El Refaie 2015a). However, as I will demonstrate, there are also other types of visual metaphor that are more directly inspired by our physical experience. The arrangement of visual elements on a page is able to convey metaphorical meanings by drawing on the experience of our bodies in space, for instance, while stylistic features of both drawings and words may, via synesthetic transfer, conjure up nonvisual sensory perceptions such as smells, sounds, pressure, pain, and temperature. Thus, a character’s vulnerability might be represented by showing her from a high angle and a great distance, while words written in large letters and with thick brushstrokes may indicate loudness. These forms of what shall be termed “spatial” and “stylistic” visual metaphor play a crucial role in the representation of the illness experience in the books analyzed in my study.

I.2. An Example The following extract from My Degeneration, Peter Dunlap-​Shohl’s (2015) graphic memoir about his experience of Parkinson’s disease, will serve to illustrate my key arguments (Figure I.1). It shows a conversation between the author and his wife about the pain he is experiencing as a result of his illness, which is severely affecting his ability to pursue his career as a newspaper cartoonist. The verbal narration contained in the text box uses a story from Peter’s past to provide evidence for his essential stoicism, recounting how, when he was hit by a truck, he still tried to go to work, despite having fractured several ribs and having ruptured his spleen. The discomfort he felt then is compared to the intense pain experienced currently as a result of Parkinson’s disease. His body, which he has hitherto always taken for granted as a vehicle for acting in and toward the world, suddenly occupies all his conscious awareness; in other words, it has “dys-​appeared” (Leder 1990). The pain he is experiencing is described verbally as “incapacitating,” which is a literal reference to the fact that it takes away his capacity to draw.

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Figure I.1.  Dunlap-​Shohl, P. (2015) My Degeneration (p. 40). © 2015 Pennsylvania State University.

Visually, it is represented through the image of a demon stabbing Peter’s shoulder with a pitchfork. Thus, the common direction of conceptual projection from the body onto more abstract concepts has been reversed, as his intensely physical experience of pain becomes the target of a striking pictorial metaphor. The image of a malicious creature that is entirely separate from Peter’s own body is also a particularly apt metaphor for the loss

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of motor control that is one of the main symptoms of Parkinson’s disease (Mazzoni, Shabbott, and Cortés 2012). Spatial affordances of the comics medium such as left–​right orientation, relative size, and inside–​outside relations are fully exploited by the artist to enhance the meaning of his visual metaphor. In the first two panels, Peter is on the left-​hand side, facing his wife on the right, which, as Western comics are traditionally read from left to right, facilitates the reading of their conversation in the speech balloons in the correct temporal sequence. In the large panel at the bottom, he has turned back toward his drawing board and is now facing toward the left, which tends to be associated with the past and, in some contexts, with an inability to move on with one’s life. The demon is also perched on Peter’s left shoulder, as is traditional in folk representations of demons or devils trying to cause mischief by leading a person astray (Hall 2008: 42, 61). The final panel is much larger than the other two, conveying a greater sense of significance to the feeling of incapacitation. Moreover, Peter’s pen, the demon, and the speech balloon containing the exclamation “Ow!” all transgress the panel borders, suggesting a sensation that is so overwhelming it cannot be contained within the boundaries of normal, everyday experience. Every decision that Dunlap-​Shohl had to make about where to place each element within the panel and on the page was thus informed (albeit probably at a subconscious level) by the experience of his own body in space and the metaphorical correlates this experience is able to evoke. The comics medium also enables the artist to express metaphorical meanings through aspects of his drawing style, such as color contrast, brightness/​darkness, and quality of line. In this example, the excruciating nature of Peter’s pain is evoked through the demon’s dark red appearance against the bright yellow background. The irregular, jagged lines used to draw the demon, the stars emanating from Peter’s shoulder, the sharp contours and content of the speech balloon with the word “Ow!” and the chaotic black squiggles underlying it further emphasize the pain sensation. These conventions signal pain to the reader by referencing, through synesthesia (i.e., the transfer of meaning across different sensory modalities), the damage sharp objects are liable to cause, particularly when they are wielded by the jolting hand that must have produced these lines. The background also contains visual signs of the type that Potsch and Williams (2012: 27) call “impact flashes”: lines that, by metaphorical association with the sparks of light caused by a forceful collision, may

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represent sudden bursts of energy in any sensory modality. The specific quality, thickness, length, and direction of these lines give the reader a sense of the quality and quantity of the impact of the pitchfork and the resulting pain sensation. Another significant aspect of Dunlap-​Shohl’s style of drawing is that he has chosen to portray himself wearing spectacles that completely cover and obscure his eyes. This visual conceit is maintained throughout the whole book; there are only a small number of significant moments in the story when Peter removes his glasses and we are able to see his eyes clearly, which encourages a metaphorical reading. On pages 70–​71, for instance, he is represented as a survivor of a shipwreck, “cast up on the shore of the Island of the caring and competent” (70; emphasis in the original). The first panel on the following page shows Peter in his normal surroundings, his glasses firmly in place again, reflecting on the fact that “[t]‌he island is a weird country to a budding misanthrope” (71). In the next panel he has removed his glasses and is cleaning them, while staring into the distance with a bemused look on his face. “I don’t get it . . .,” the text in the accompanying speech balloon reads, “The islanders seem to be working to make a better present and future. And even succeeding to a surprising degree.” In an ironic twist to the conventional conceptual metaphor knowing/​understanding is seeing,1 this scene thus suggests that Peter can actually “see” the suffering of others more clearly when he is perceiving the world not through the eyes of a cynical American cartoonist, but rather from the more empathetic perspective of a patient. In fact, the very notion of vision as the culturally privileged way of accessing the “truth” is revealed to be deceptive. A few pages later (75–​78), the metaphorical link between the glasses, or selective perspective, and Peter’s mental self-​defenses is reinforced. As he is preparing for brain surgery to address some of the symptoms of Parkinson’s disease, Peter muses: “What could be more symbolic of vulnerability and hope than taking off everyday clothes and donning the uniform of a patient?” (75). At this point he is still wearing his glasses, but in the next panel his question is answered visually as we see him in the operation theater, a close-​up of his “naked” face revealing his eyes, which stay uncovered throughout the surgery and the immediate recovery period, too. It is doubtful that this particular verbo-​visual metaphor, which emphasizes the need to acknowledge our own vulnerabilities and limited perspective if we really want to understand other people’s suffering, could have been expressed as effectively—​if at all—​in any other medium.

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Indeed, I would argue that it is precisely the fact that Dunlop-​Shohl was working in this profoundly visual medium that motivated him to convey his thoughts and emotions in this particular way. My final observation about this example concerns the way Peter’s pen is represented. In the first two panels, he is holding it up and pointing it toward his wife, while talking about his fears for his future career as a cartoonist. The pen thus represents, literally, the main tool of his trade. In the final panel, however, the pen has taken on additional metaphorical meanings by being visually associated with the demon’s pitchfork. The preexisting similarities between the two objects in terms of their shape are underscored through the way they are depicted in the same size, at more or less the same angle, and with the different parts (handle and sharp end) being roughly aligned, indicating how the very act of putting pen to paper is causing the artist such intense suffering. On a more abstract level, this visual metaphor may also suggest that the cartoonist’s pen, like the pitchfork, is able to cause damage by hurting the feelings and destroying the reputation of the people it portrays. It is illustrative of the way in which perfectly literal objects in the “storyworld” (Herman 2011) of a graphic illness narrative may reappear in another context where they act as visual metaphors for more intangible experiences, or vice versa.

I.3. Data and Methods of Analysis My data set consists of 35 graphic illness narratives (or “graphic pathographies”) by North American and European authors on a range of physical and mental diseases. The majority deal with either cancer or mood disorders, but there are also stories that deal with eating disorders, epilepsy, Parkinson’s and Huntington’s disease, dementia, infertility, schizophrenia, herpes, HIV, obsessive-​compulsive disorder, and a fictional sexually transmitted disease that causes those who are infected to grow horns, tails, and additional mouths. The books were selected on the basis that they focus on social and/​or emotional aspects of the illness experience and use at least some nonliteral visual forms to express these. Most of the works are by established comics artists, while other creators come from a background of fine arts, graphic design, book illustration, or creative writing. Consequently, the style of the artwork and the relative weighting of verbal and visual meaning vary across the body of works I  discuss. The books may also be distinguished with regard to whether they are explicitly autobiographical or (semi-​)fictional, and, in the case of

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the former, whether they deal with the author’s own illness or that of a family member. As outlined earlier, the main purpose of the current study is to review key theories and concepts from a range of scholarly disciplines in order to develop the concept of dynamic embodiment in CMT, by using the systematic analysis of metaphor in graphic illness narratives as a case study. Although works of this type are enjoying increasing popularity and influence, they have not yet been subjected to any sustained examination by metaphor analysts. I aim to show how the illness experience, and the use of the visual mode and the comics medium to convey this experience, may change the way artists relate to their physical selves and thus influence the metaphors they use. In the case of real or fictional stories about another person’s suffering, I will assume that the embodied experience of “dys-​appearance,” triggered by a particular disease, is based on empathetic projection (Keen 2006) and embodied simulation (Barsalou 2008; Bergen 2012; Gibbs 2006; Semino 2010), cognitive processes that in turn are thought to be rooted in mirror systems, neural networks that display similar patterns of activity when we perceive or imagine an action as when we carry it out ourselves (Feldman 2006: 215). Rather than offering close readings of individual texts, I will search for patterns of metaphor across a number of different works and try to relate these to the creative processes of authors/​artists as they are faced with the task of representing disease in a primarily visual format. I will start by describing the specific meaning-​making resources that are available to artists working in the comics medium to convey metaphorical meanings; such meaning-​making resources include pictures of both real and imaginary objects or creatures, the layout of the page, the spatial arrangement of characters and other visual elements relative to each other and to the reader, and the specific visual style of the drawings and written words (Chapter 2). In a second step, I will submit my entire data set to a systematic analysis in order to identify common patterns in the use of (verbo-​) visual metaphors, grouping these together according to which of the previously discussed meaning-​ making resources they exploit, the formal features they have in common, and the degree to which they appear to be motivated and shaped by embodied experience (Chapter  3). Finally, two smaller subsets of the entire body of works, consisting of graphic illness narratives about cancer and depression, respectively, will be analyzed on a more granular level to take into account potential differences between

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individual works, depending on the kind of disease in question, the factual or fictional nature of the stories they convey, and the specific nature of the artwork used (Chapters 4 and 5). Visual representations in graphic illness narratives defy traditional distinctions between metaphors that promote understanding of abstract concepts through the use of more concrete ones and those that aim to unsettle established thought patterns by encouraging us to look at a particular phenomenon with new eyes (Grady 1999; Punter 2007). Individual cases of metaphor, I argue, do not necessarily fulfill just one or other of these two contrasting functions; rather, they exist in a relationship of constant creative tension. In the extract reprinted in Figure I.1, for example, the artist has used a striking, novel image of an evil demon with a pitchfork, but the evocation of pain through the metaphor of a sharp object penetrating the skin is extremely common in everyday language, too (e.g., “a stabbing/​piercing pain”; Scarry 1985: 15), which suggests that it has an entrenched conceptual basis. Moreover, the way the scene is represented visually evokes additional metaphorical meanings based on spatial orientation and quality of line. This extract also demonstrates that an object (in this case, a pen) may first be introduced as a perfectly literal part of the storyworld and then assume metaphorical meanings later in the story, and vice versa. “Reorientations” of this kind, which have been identified by Biebuyck and Martens (2011: 64) as a characteristic feature of prose literature, also are particularly common in those graphic illness narratives that deal with cognitive or mental disorders; they allow artists to show how the boundaries between a person’s external and internal reality may shift and dissolve as a consequence of illness or under the influence of neurochemical drugs. If we accept that the notion of the metaphorical is a fundamentally unstable category, the judgment as to whether or not to consider something to be a metaphor for analytical purposes becomes difficult. In CMT, an important distinction is made between metaphorical expressions and the conceptual metaphors that are believed to motivate them. The Metaphor Identification Procedure (MIP) was developed by the Pragglejaz Group (2007) in order to provide a set of criteria that experts could use to detect metaphorically used words in verbal discourses; once all metaphorical expressions have been identified in a particular corpus, scholars would then typically attempt to group them together according to their underlying conceptual metaphors. A lot of effort also has gone into pinpointing the specific formal qualities that might allow us to recognize instances

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of visual metaphors, including, for example, the fusion or symmetric alignment of objects belonging to disparate conceptual domains, and the replacement of an anticipated element with an incongruous one (e.g., Forceville 1996; Forceville and Urios-​Aparisi 2009; Gkiouzepas and Hogg 2011; Schilperoord, Maes, and Ferdinandusse 2009). Again, these are taken by CMT scholars to be the surface realizations (i.e., visual metaphorical “expressions”) of more fundamental conceptual mappings, which, at least in theory, can be articulated in any semiotic mode or medium. As Gibbs and Colston (2012:  55) point out, however, metaphors are similar to colds “in the sense that they have symptomatic, but not defining features.” It certainly seems that the ability of images to evoke a metaphorical interpretation is not dependent upon the presence of one of a limited number of formal cues, and, conversely, that not every image containing one or more of these cues is necessarily intended to be understood metaphorically in context. I thus propose that any aspect of visual representation should be regarded as a potential visual metaphor if it invites us to consider one kind of thing, concept, or experience in terms of another, regardless of whether this underlying thought process represents a conventional conceptual metaphor or an entirely novel mental mapping (see also El Refaie 2017). Indeed, as the analysis of the preceding example revealed, even the apparently straightforward distinction made by many scholars between verbal and visual metaphors is not adequate, first, because the “visual” encompasses too many different kinds of image-​ making resources to be a useful category of analysis, and second, because written language also has an important visual dimension that can be exploited for metaphorical purposes. Instead of using the term “visual metaphor” as a catch-​all label, I will thus propose a three-​way distinction between pictorial, spatial, and stylistic metaphors, which are then divided into more specific subcategories.

I.4. Outline of Chapters The first chapter introduces my central theoretical concerns and arguments regarding the relationship between embodiment and metaphor. I start by outlining the traditional approach in CMT toward embodiment, which, I suggest, is characterized by a somewhat narrow and static view of the way the human body shapes our thinking. I then review three emergent strands of research that are re-​animating the body in metaphor theory, including a perspective that emphasizes the dynamic, context-​sensitive

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nature of metaphor production and reception (e.g., Cameron et al. 2009; Gibbs 2011a, 2013; Kövecses 2015), cross-​cultural linguistic studies (e.g., Kövecses 2005; Maalej 2004; Yu 2008), and research in experimental psychology (e.g., Casasanto and Bottini 2014; Casasanto and Chrysikou 2011). Probing aspects of this work and confronting it with key theories from phenomenology, ecological psychology, social semiotics, and media theory, I develop the notion of dynamic embodiment. Accordingly, the degree to which we draw on our own bodies when producing metaphors depends not only on our cultural practices and the specific actions we are engaged in at any given moment, but also on the degree to which we are consciously aware of our physicality, as well as the affordances of the modes and media we are using to communicate. Metaphors, I  suggest, are particularly good at capturing experiences that are ambiguous and paradoxical in nature, such as the sense of our body as something that is both part of our self and separate from it, “a thing in the world, like other things” (McGilchrist 2009: 67). In Chapter  2 these ideas are applied to the graphic illness narrative genre. I suggest that some genres are more centrally concerned with the human body than others, and that each genre exploits the affordances of its modes and media in unique ways. Thus, graphic pathographies are characterized not only by their focus on the physical, social, and emotional impacts of disease, but also by their innovative and often self-​reflexive use of the tools and materials of the comics medium, for example, by combining words and images in new ways and taking advantage of inherent tensions between the content of sequential images and their layout on the page (e.g., Hatfield 2005). These characteristics of graphic illness narratives, I argue, impose certain constraints and offer unique opportunities to artists, influencing their choice of metaphors and the shape these metaphors are likely to take. For example, in many of these works the expected direction of metaphorical transfer from sensorimotor experience to more abstract concepts is reversed, as the diseased body and/​or the nature of our various sense perceptions are foregrounded in the artist’s consciousness. Moreover, the emphatically pictorial nature of written words in comics enables artists to exploit the synesthetic connections in the brain that all human beings are thought to share at least to some extent (Ingold 2000; Merleau-​Ponty 1962; Ramachandran 2011; van Campen 2010). Chapter 3 uses the systematic analysis of my complete data set to catalogue the different forms that visual metaphor may take in graphic illness

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narratives. I  propose a novel tripartite classification system, based on a distinction between pictorial, spatial, and stylistic metaphors. Building on and extending the work of Charles Forceville (1996, 2002, 2009), I  will use the term “pictorial metaphor” to refer to images of concrete, recognizable objects, scenes, and people that are used to stand for something else. I introduce the notion of “spatial metaphor” to describe how the position of and distance between elements in the story, and their relative size, arrangement, and orientation on the page, may be exploited to convey thoughts, emotions, or social relationships. In the case of stylistic metaphors, finally, visual features such as color, form, level of detail, quality of line, and/​or visible traces of the means of production are used to indicate an abstract concept or a nonvisual sense perception. As I will demonstrate, these main categories can be further subdivided, and in many instances two or more different types of visual metaphor are used in combination. In Chapters  4 and 5, I  present case studies of visual metaphor in graphic illness narratives about cancer and depression, respectively. Each of these illnesses, I argue, has unique consequences for the way patients engage with their embodied being and thus entails distinct patterns of metaphorical meaning-​making. In the case of cancer, the illness takes its course inside the body and is completely beyond the conscious control of the patient. Even when there are external, visible symptoms of the disease, we nevertheless require imaging technologies to see and understand what is occurring beneath the surface of the skin. However, the images produced by these technologies are utterly baffling and unfathomable to the untrained eye, which unsettles entrenched metaphorical connections between human vision and knowledge. Issues of visibility and invisibility are, inevitably, always at the forefront of the comics artist’s mind when he or she is creating a piece of work in this medium. Taken together, these factors motivate the prevalence in comics about cancer of metaphors that reflect people’s anxieties about their lack of control over internal physical processes, while also often functioning as a form of resistance against the all-​seeing and all-​powerful “medical gaze” (Ostherr 2013), a gaze that is traditionally associated with male mastery over the unruly “animal sensuality” of the female body (Classen 2005a: 71). Depression also represents a form of suffering with invisible causes, yet it engages embodied experience in different ways and so generates distinct metaphorical themes. It typically involves a range of both mental/​

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cognitive and physical symptoms, including low mood, feelings of guilt or worthlessness, changes in appetite and sleeping patterns, psychomotor disturbances, and altered perceptions of the flow of time (Bartczak and Bokus 2015; Flynn 2010; Fuchs 2005, 2013; Ratcliffe 2012). These symptoms lead to an inability to engage actively in the world and a tendency to spend many hours in bed or in a prostrate position on the sofa or floor. Correspondingly, in graphic illness narratives, depressed characters are frequently drawn lying down and at the bottom of panels and pages, which reflects the close links between feelings of hopelessness and the effects of gravity on the body (sad is down), for example. Many metaphors of depression in these works also show an intense engagement with a sense of what shall be termed “temporal entrapment.” This, I  argue, is due to the unique process of translating time into space in the comics medium, which foregrounds temporal aspects of the depression experience in the mind of artists when they are communicating through the graphic pathography genre. In the conclusion, I show how the notion of dynamic embodiment may challenge some of the fundamental assumptions of CMT. In particular, I aim to encourage metaphor scholars to give more attention and weight to the broad range of embodied experiences of individual people as they go through life. My focus on visual metaphor in graphic illness narratives will also, I hope, foster new interest in how the specific modes and media we use to communicate shape our embodied experiences, and how these in turn influence metaphor use. The findings of this study have the potential to change people’s attitudes and practices beyond academia, too, specifically in the sphere of cancer care, where the crucial role of metaphor in shaping the attitudes and behaviors of both patients and health professionals has long been recognized (Casarett et al. 2010; Harrington 2012). There is also a growing interest on the part of many medical professionals in the use of graphic illness narratives in public health education, patient care, and the training of future doctors (Green and Myers 2010; Williams 2012), due to the ability of this genre to convey the illness experience in a way that is highly personal but has a broad appeal. The current study seeks to raise awareness of the many creative metaphors that tend to occur in these materials, which may help professionals to use them more effectively and appropriately, while encouraging patients to discover new metaphors—​or create their own—​to facilitate a better understanding and sharing of the illness experience.

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Reanimating the Body in Conceptual Metaphor Theory

in metaphor has focused mainly on novel, creative metaphorical expressions in literature and poetry, with the central question being how our minds are able to deal with this supposedly special use of language. There were suggestions, for example, that people must first identify and reject the literal sense of a metaphor before they can access its nonliteral meaning, and that interpreting metaphors involves a complex process of picking out relevant similarities between the two objects that are being compared (see Gibbs and Colston 2012: 58–​ 127). Whatever the exact details of these different models of figurative language comprehension were, they all shared a view of metaphor as a purely mental process that does not involve the body in any significant way. The notion of the human mind as an immaterial thinking substance, governed by entirely separate laws from those that rule the material body, has had an enormous influence on Western thought for many centuries. It is often attributed to René Descartes (2000 [1641]), although in fact his theories just confirmed much older ideas that were expressed, for example, by the ancient Greeks (Lindblum and Ziemke 2007:  133–​144). Mind–​ body dualism has since been challenged repeatedly by several schools of philosophy, but perhaps most coherently and influentially by the French phenomenologist Maurice Merleau-​Ponty (1962), who maintained that it is via our physical sensations and actions that the world comes into being and reveals itself to us in a meaningful way. He insisted that both consciousness and subjectivity should be regarded as inseparable from the lived body, the body that perceives, acts, reasons, and interacts with others:  “One’s own body is in the world just as the heart is in the T R A D I T I O N A L LY, S C H O L A R LY I N T E R E S T

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organism: it continuously breathes life into the visible spectacle, animates it and nourishes it from within, and forms a system with it” (1962: 209). This shift from a Cartesian mind–​body split to a view of the two as one integrated system can also be traced in cognitive science. From its inception, cognitive science was dominated by the metaphor of the brain as a machine, or more specifically, a computer. Cognition was defined narrowly as “mathematical and logical computation with intrinsically meaningless internal symbols that can supposedly be placed in relation to aspects of the external world” (Johnson and Rohrer 2007:  20), while the human body was relegated to a minor supporting role. Under the influence of embodiment theory, however, people’s physical, social, and cultural interactions with their environment moved center stage and came to be regarded as essential in shaping the way we think and express ourselves. Accordingly, cognition is recognized to be utterly dependent upon “the kinds of experience that come from having a body with various sensorimotor capacities,” which “are themselves embedded in a more encompassing biological, psychological, and cultural context” (Varela, Thompson, and Rosch 1991: 173). Embodiment theory was taken up with enthusiasm by cognitive linguistics, too, particularly those with an interest in metaphor. The central claim of Conceptual Metaphor Theory (CMT) is that we draw on the concrete experience of our bodily perceptions and actions (“source domains”) in order to help us grasp theoretical notions, mental states, and emotions (“target domains”), based on correlations in our experience (Lakoff and Johnson 1980, 1999). A  frequently quoted example is the conceptual metaphor love is a journey, which encourages people to consider their intimate relationships in terms of a typical journey, by systematically “mapping” elements from the latter onto corresponding elements in the former: The lovers are travelers on a journey together, with their common life goals seen as destinations to be reached. The relationship is their vehicle, and it allows them to pursue those common goals together [ . . . ]. The journey isn’t easy. There are impediments, and there are places (crossroads) where a decision has to be made about which direction to go in and whether to keep traveling together. (Lakoff 1993: 206) Whenever English speakers think and talk about relationships, CMT claims, they are likely to use any of the numerous conventional verbal

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expressions that are based on this metaphor (e.g., “We’ve reached a crossroads”; “My marriage is stuck in a rut”), which, in turn, activates the underlying system of mappings in both speakers’ and listeners’ minds, albeit at a mostly automatic and unconscious level. In this sense, it is often the most mundane, conventional metaphorical expressions—​ which metaphor scholars in other traditions would typically regard as “dead”—​that have the greatest influence on our life; as the title of Lakoff and Johnson’s (1980) popular introduction to CMT suggests, they are the “metaphors we live by.” The proponents of CMT never tired of emphasizing the crucial role of our sensorimotor experience in shaping the conceptual metaphors that supposedly underlie our thinking, and yet the living, breathing, acting body as it was conceptualized by Merleau-​Ponty is often remarkably absent from the way these scholars tend to describe, in a rather mechanistic way, the mapping of structure, knowledge, and logical entailments from one conceptual domain onto another every time a metaphor is used. Although more recently theorists in this tradition have begun to develop a more nuanced understanding of embodiment, there is still a lingering sense in CMT that once the body has “done its job” in terms of revealing correspondences between embodied experience and more abstract notions, it is no longer seen to play a significant role in the way metaphors are generated in our everyday life and creative endeavors.1 The purpose of the present chapter is to find ways of reanimating the body in metaphor theory, by reassessing some of the recent developments in CMT in the light of theories and discoveries from a range of other disciplines, including experimental psychology, phenomenology, media theory, and social semiotics. My main argument is that nobody experiences their physicality in a way that is straightforward and consistent throughout life. Instead, I propose that embodiment must be conceptualized as a complex, ever-​shifting process of lived experience, which is shaped not only by our sociocultural background and the specific situations in which we find ourselves, but also by the extent to which we are consciously aware of our bodies at any given moment. Illness, pain, or injury, for example, may heighten our body awareness, albeit in a negative way, by making us perceive our bodies as alien and threatening. The modes and media we use to communicate are also likely to draw our attention to different aspects of our sensorimotor perceptions. This dynamic relationship with our bodies, in turn, inspires and guides us as we select the metaphors we use.

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1.1. The Discovery, Neglect, and Rediscovery of the Lived Body in Conceptual Metaphor Theory CMT was founded on the central notion that the body and its concrete experiences shape our thoughts, language, and behavior at different levels of complexity. At the most basic level, scholars have identified so-​ called image schemas (Johnson 1987), minimal recurrent patterns that all human beings encounter in their everyday embodied interactions with the physical world, such as part–​whole, containment, balance, support, center–​periphery, source–​path–​goal, and up–​down. The up–​down image schema, for example, is linked to our fundamental experience of gravity, including the way it requires constant effort and energy to accommodate and resist its effect on our bodies as we endeavor to stay upright and mobile. “Simple” or “primary” metaphors are rooted in the way the world is perceived from infancy onward (Grady 1997). Correlations in experience between the ability to see things clearly and to obtain relevant information, for example, encourage us to think about knowledge in terms of vision (Johnson 2007:  165–​166). Some primary metaphors are also based directly on image schemas. For instance, we acquire the meaning of up first in the pleasurable context of being lifted up by a caregiver, and later, as we gradually learn to maintain an upright posture and walk, we connect up with a greatly enhanced sense of independence. We also tend to stand upright when feeling well and in a positive mood, and to adopt a more slouched posture and spend more time lying down when ill, depressed, or exhausted. In a physical fight, the victor typically ends up being on top. CMT scholars maintain that these concrete embodied experiences of being upright and able to move about in the world, or of being forced to succumb to gravity, are transferred onto the sphere of emotions and social relations, thereby forming the basis of more specific conceptual metaphors such as good is up, happiness is up, control is up, health is up, status is up, and their respective opposites (Gibbs 1994: 414; Lakoff and Johnson 2003: 15–​17). Such cross-​domain correlations typically generate clusters of related linguistic expressions (“feeling up”; “being high”; “feeling downtrodden”), which are frequently used in everyday discourse. From a neural perspective, primary metaphors are thought to be based on circuitry linking the rich, detailed brain networks for sensorimotor processes to those dealing with more abstract concepts. This circuitry is formed as a normal consequence of associative learning, in the sense that

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“neurons that fire together, wire together” (Feldman 2006: 201; see also Lakoff 2008). One or more image schemas and primary metaphors, combined with specific cultural values and beliefs, form “complex” or “secondary” metaphors, which involve the transfer of attributes, relational structure, and logical entailments from a concrete source domain to a more abstract target domain (Grady 1997). They also often draw on metonymic meanings, defined in CMT as conceptual projections “whereby one experiential domain (the target) is partially understood in terms of another experiential domain (the source) included in the same common experiential domain” (Barcelona 2000: 4). For example, one of the most conventional complex metaphors for anger in English is anger is hot fluid in a container, which motivates expressions such as “boiling with anger,” “letting someone stew,” and “to flip one’s lid” (Kövecses 2002: 48). It appears to be based on a combination of the inside–​outside image schema, physiological metonyms—​such as redness in the face and neck, and an increased pulse rate and body temperature (Ungerer 2000)—​and metaphorical notions of the body as a particular type of machine. The hot fluid is mapped onto the anger, the degree of fluid heat onto the intensity of the emotion, the physical container onto the angry person’s body, the top of the container onto his or her self-​control, and so on. Metaphorical entailments include the idea that intense anger produces increasing pressure on the container, which the person can try to keep inside for a while but which will typically erupt in the end (Kövecses 2002:  95–​98; 2005: 39–​43). Similar pressurized container metaphors for anger have also been identified in a range of other European and non-​European languages, leading Kövecses (2015: 92) to conclude that “a large and important part of emotional conceptualization, because of universal physiology, appears to be universal.” Despite the emphasis placed on embodiment in CMT, there is a sense that, once conceptual mappings have become entrenched in our conceptual system, the lived body is no longer considered to play a particularly important role in our day-​to-​day use of metaphors. This assumption on the part of some scholars has been encouraged, in my view, by the increasing influence of Conceptual Blending Theory (Fauconnier and Turner 2002). According to this theory, we are able to generate and understand metaphors by creating two or more conceptual “input spaces,” which share the “generic space” of common structural features but are unique in certain other respects. The final step in this complex mental

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operation involves integrating all this information into an ad hoc “blended space” that is made up of a combination of shared and distinctive characteristics. A  much-​cited example is when a surgeon is referred to as a butcher, which invites us to combine elements from the shared generic space of a person who uses sharp instruments to perform a procedure on another being, with “emergent” features resulting from the juxtaposition of the unique goals, tools, and workspaces of surgeons and butchers, respectively (e.g., Grady, Oakley, and Coulson 1999). Conceptual Blending Theory extends CMT by allowing multiple domains and mappings in both directions; it is also more dynamic in that it operates with ephemeral, pragmatic mental spaces, rather than more or less stable conceptual domains and entrenched mappings. Consequently, it seems to be particularly well suited to the analysis of novel, creative metaphors, including those of a nonverbal or multimodal nature, although it is hard to see how its central claims could ever be empirically tested (Gibbons 2012: 105–​106; Gibbs and Colston 2012: 109–​113; Müller 2008:  163). More important in the context of the argument I  am developing in this chapter, the notion of input spaces and mental operations downgrades the role of the body to that of a mere container of our thought processes. Indeed, it is strikingly reminiscent of the old “mind as computer” analogy that used to dominate traditional cognitive science. More recently, however, the pendulum has started to swing back again, as scholars within the conceptual metaphor paradigm have begun to rediscover the crucial role of the body not just in the way conceptual metaphors are formed initially, but also in how they are generated by individuals in specific contexts. It is possible to identify two relevant strands of this emerging scholarship. The first of these emphasizes the role of culture in how we exploit our physical experiences for metaphor. Lakoff and Johnson (1980:  57) have always insisted that embodiment is “never merely a matter of having a body of a certain sort,” since all experience takes place against a background of cultural values and assumptions and is thus “cultural through and through.” Yet much of the research into cross-​cultural differences in the use of metaphors has focused on the cultural variability of complex metaphors, while the bodily experience underlying primary metaphors is often regarded as in some way “pre-​cultural.” A  case in point is Yu’s (2008) study of metaphorical expressions based on the human face in English and Chinese. According to Yu, the body provides a universal source domain for metaphorical mappings, because all humans share the

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same basic physical structures and functions. These bodily experiences, he argues, must pass through “the filter of the culture” (2008: 253), and it is this process that governs which of the many potential metaphorical mappings are selected, how they are combined, and the degree to which they are manifested and conventionalized in the language. So, although in both Chinese and English the face is used as a source domain for notions of dignity and prestige, the former has far more expressions for saving face than the latter, because the notion of a “social face” carries so much cultural weight in China. Similarly, the fact that happiness is conceptualized as flowers in the heart in Chinese, and as being off the ground in English (but not vice versa), reflects the more private and introverted Chinese character (Yu 1995). Pritzker (2007) adopts a more flexible notion of culture, seeing it as a rich resource that individuals utilize in order to understand and share their experiences. People in China suffering from depression, for example, appear to draw on both Western folk models and traditional Chinese medical philosophy when generating metaphors of the heart and the brain—​or a combination of both—​to describe their feelings. Cultural models also change over time; thus, the universal physical symptoms associated with anger were apparently interpreted and metaphorized differently by the Victorians than they are by contemporary British people, because the norms and values that govern the expression of anger have shifted (Kövecses 2000:  191–​192; see also Kövecses 2015:  79). Moreover, variations in metaphor use are found within what is commonly defined as the same culture, depending, for instance, on people’s social class, ethnicity, religion, or political affiliations (Kövecses 2005: 88–​113). These differences in terms of our individual experiences as human beings lead to what Kövecses (2005) has termed “differential experiential focus”; in other words, the tendency to be attuned to, downplay, or ignore particular aspects of our bodily functioning in relation to the conceptualization of a particular target domain, in accordance with our own values and expectations (2005: 246). The notion of “differential experiential focus” chimes with Barcelona’s (2000) argument that the distinction between a metaphor and a metonymy depends on what our culture considers to be a natural physical correlate of a particular emotion. For example, the association between down and sadness in English speakers is generally regarded as a primary metaphor, whereas the one between heat and anger is described by most

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CMT scholars as a metonym, even though both could be said to be included in the same experiential domain, in the sense that sad people often adopt a drooping posture, and angry people typically feel hot. However, Barcelona suggests that verticality is only subconsciously associated with sadness, whereas body heat is a common element of the conventional folk models of the physiological and behavioral effects of anger, at least in most Western cultures: “Therefore when we say that metaphor is a mapping across two separate domains, we mean that they must be consciously regarded as separate” (2000: 9). A more radical proposition put forward by Maalej (2004) is that bodily experience is itself shaped by a person’s cultural background. He discovered that many of the common expressions for anger in Tunisian Arabic refer to body parts, such as bones and testicles, that do not show any noticeable physiological changes when a person is angry. Instead, they have become associated with the emotion through specific cultural rituals, which suggests that, even at this most basic level of the bodily expression of emotion, culture influences our every perception. Another possible example of what Maalej calls “cultural embodiment” can be found in the different ways people draw on their bodies in order to conceptualize spatial relations. Thus, in some cultures, the human body itself is used as the reference point (e.g., the head for up, and either the buttocks, legs, or feet for down), whereas in others, it is the human body in its natural or its built environment (e.g., the sky/​clouds or the roof for up, and the earth for down) that is used for this purpose (Kövecses 2005: 79–​82). A second strand in contemporary CMT scholarship that is rediscovering the role of the lived body in our everyday use of metaphor is the Dynamic Systems perspective (Cameron et  al. 2009; Deignan and Cameron 2013; Gibbs 2011a, 2013). This developed out of the crucial insight that the way the body is exploited for metaphorical mappings is shaped not just by lifelong correlations in experience, but also by the immediate situation in which people find themselves. Although our notion of containment, for instance, is most likely based on a universal image schema, it must be regarded as “not just a sensorimotor act, but an event full of anticipation, sometimes surprise, sometimes fear, sometimes joy, each of which is shaped by the presence of other objects and people that we interact with” (Gibbs 2006:  37). The dynamic account of metaphor generation thus regards it as a complex process that

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is affected by a range of different forces, including the wider cultural conditions, the specific social context, people’s own bodily states and motivations, interactions with others, neural processes, and the immediate linguistic processing, all operating at different timescales:  “One does not experience image schemas or conceptual metaphors by ‘selecting’ one as opposed to another from a stored list. Image schemas and primary metaphors are ‘soft assembled’ spontaneously given the present state of the system, the wider context, and the task at hand” (Gibbs 2013: 30). This theory predicts that, while it is possible to discern certain temporary patterns of stability in the way we use metaphors, there will never be a single, overarching theory of metaphor use that applies to all circumstances. In her reappraisal of the traditional dead–​alive distinction, Müller (2008) draws on Dynamic Systems Theory to demonstrate that the degree of activation of a metaphor is not a stable property; rather, it depends on the degree to which the metaphoricity of an expression is activated in the minds of individuals in specific contexts. This, in turn, can be assessed by analyzing “empirically observable cues” in real-​world texts or interactions, such as the repetition or elaboration of a metaphor at the verbal level, or the visual representation of a source domain through a picture or hand gesture (2008: 217). She gives the example of a woman who, when talking about her relationship with a depressed boyfriend, makes a marked downward hand/​arm gesture. This, Müller argues, shows that the primary conceptual metaphor sad is down is shaping the woman’s understanding at this moment, even though she does not employ any verbal metaphorical expressions that would indicate such activation (2008: 78–​79). Despite using slightly different terminology, Kövecses’s (2015) contextualist theory of metaphor is also essentially concerned with the dynamic nature of metaphor production, which he regards as being motivated and/​or constrained by four main types of context: situational, linguistic, conceptual-​cognitive, and bodily factors. His argument that “the body—​ especially those aspects of it that are activated in the ongoing situation—​ can influence the choice of metaphors” (2015: 184) is particularly relevant to the current study. He suggests, for example, that Emily Dickinson’s optical illness may have influenced the choice of metaphors in her poetry, both at the conceptual level and the level of the specific linguistic expressions she uses (2015: 120–​122).

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1.2. Experimental Evidence of Flexible Embodied Conceptualizations As mentioned earlier, CMT considers the up–​down orientation to be one of the most basic and productive of image schemas, which also engenders primary metaphors such as good is up, healthy is up, and control is up. Psychological experiments involving a range of different tasks have demonstrated that there are, indeed, systematic links between where an element is placed on the vertical dimension and how it is processed and evaluated. In a study by Meier and Robinson (2004) based on measuring reaction times, positive words like “happy,” “champion,” or “witty” were evaluated faster and more accurately when presented in the top half of a computer screen, whereas for negatively valenced words like “sad,” “cancer,” and “liar” the fastest and most accurate results were achieved when they appeared at the bottom. Results consistent with the good is up mapping were also observed by Marmolejo-​Ramos et al. (2013), who invited participants to allocate words conveying positive and negative personality traits to fictional characters and to arrange them in a squared grid divided into four boxes of equal area. Again they found that positively valenced words were statistically more likely to be allocated to the upper areas, while negatively valenced words were placed in the lower ones. Another study, by Crawford et  al. (2006), used spatial memory experiments involving emotionally evocative images and yearbook photos about which participants had positive or negative feelings. The authors revealed a clear influence of valence on remembered location of stimuli on a screen, so that positive images were shifted upward in memory, relative to negative items. Finally, Casasanto and Dijkstra (2010) found that participants who moved marbles from a lower to a higher position were better able to retrieve positive memoires than participants who moved the marbles down. As experimental studies show such consistent good is up congruency effects, many psychologists believe this conceptual mapping to be universal in character (e.g., Damjanovic and Santiago 2016). The metaphorical meaning potential of left and right is hardly ever mentioned by traditional CMT scholars, perhaps because, at least in English, it is not reflected in systematic clusters of metaphorical linguistic expressions to the same extent as the up–​down opposition (exceptions include idioms such as “right-​hand man” and “two left feet”). However, just as

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for the vertical dimension, there are powerful and enduring associations between left and right that strongly suggest an embodied basis: Wherever one looks, on any continent, in any historical period or in any culture, right and left have their symbolic associations and always it is right that is good and left that is bad. If we were not totally immersed within such a symbolic system we would yell out in incredulity and demand some explanation for this astonishing fact. (McManus 2003: 39) Our ability to distinguish between left and right is linked to handedness, which, in turn, is connected to the fundamental asymmetry of the human brain. There is little doubt that the universal predominance of right-​handers, who make up around 90% of the population, has led to the right being the “unmarked” and the left the “marked” concept in every known human language, culture, and religion (McManus 2003: 70–​71). Left–​right symbolism also has always played a central role in Western art, with religious paintings up until the Renaissance showing a clear association between the right side (from the point of view of the depicted people) and the godly, virtuous, manly, and spiritual, whereas the left was used to represent the sinister, feminine, and worldly, for example (Hall 2008). However, it appears that, at least on an implicit, unconscious level, cultural values have far less of an impact on people’s conceptual mappings than individual physical predispositions. Thus, a series of value judgment tasks set by Casasanto (2009) provided evidence that right-​handers are significantly more likely to prefer things that are presented to them on their right side, whereas left-​handers prefer those of the left. The same tendency was demonstrated in children as young as five years (Casasanto and Henetz 2012). A study of the hand gestures used in the televised US presidential debates in 2004 and 2008 showed that positive content was associated with right-​hand gestures and vice versa in the two right-​handed candidates, George W.  Bush and John Kerry, while the opposite relationship pertained in the left-​handers John McCain and Barack Obama (Casasanto and Jasmin 2010). Surprisingly, in all three of these studies, the unconscious good is left association was in fact stronger than the good is right association, even though the former contradicted the prevailing cultural value system. The preference for things relating to the side of the dominant hand also seems to be independent of the strength of the symbolic associations

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with the two sides in any given culture. Thus, a comparative study of right-​handed Spaniards and Moroccans revealed a big difference in the strength of the good is right mapping when they were asked to make explicit, conscious value judgments, consistent with the much stronger taboos against the use of the left hand in Moroccan culture, but there was no such difference when the participants were asked to perform a value judgment task that assessed their unconscious preferences (Fuente et al. 2015). Finally, Casasanto and Chrysikou (2011) were able to demonstrate that people’s associations between space and emotional valence can be reversed through changes in motor fluency, for example as a result of brain damage due to a unilateral stroke. Even handicapping people’s dominant hand in the laboratory, by asking them to perform a delicate manual task while wearing a bulky ski glove on their dominant hand, was able to change right-​handers’ associations between left–​right and emotional valence, causing a temporary reversal of their usual judgments. When both the vertical and the horizontal plane are involved in the experimental design, there appears to be a salience of the former over the latter at the concept level, in the sense that the association of value judgments with up–​down was found to be stronger than with left–​right (Marmolejo-​ Ramos et  al. 2013). Indeed, in two experiments the expected tendency for right-​handers to associate the right with positivity and the left with negativity disappeared completely when the vertical and horizontal dimensions were in competition (Crawford et  al. 2006; Damjanovic and Santiago 2016). One possible explanation for this difference in the strength of the conceptual congruency effects, Crawford et al. (2006: 1166) suggest, is that “[w]‌hereas verticality is absolutely grounded in the common, embodied experience of gravity, left and right are body-​ centred directions which depend on the changing perspectives of mobile individuals.” It is also worth remembering that handedness is not binary in the same way as up and down is; many people only show a slight preference for one hand over the other, and then only when performing some tasks. Moreover, children take a long time to acquire the necessary skills involved in distinguishing left and right, which, apart from the ability to identify their own left and right side, also requires them to be capable of “carrying out a mental rotation, and seeing the world from a different perspective” (McManus 2003: 76). Even adults typically have more problems identifying left or right than up or down (77). The greater variability and flexibility in the way we experience the horizontal axis compared to the vertical axis may also help to explain why

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some of our unconscious associations with left and right appear to be determined not by handedness, but by arbitrary cultural practices. For example, a robust and pervasive finding from empirical studies involving both linguistic and nonlinguistic tasks is the tendency to imagine specific events, and time in general, as evolving in the same direction as reading and writing in one’s own culture, which, according to McManus (2003: 258–​267), is based entirely on the coincidental convergence of various historical, economical, and religious factors. So, in cultures with a left-​to-​right script direction, the agent of an action and the past are mentally represented preferentially on the left, whereas the recipient of an action and the future are placed to the right (Casasanto and Jasmin 2012; Cooperrider and Núñez 2009; Maass et  al. 2009; Maass, Suitner, and Nadhmi 2013; Santiago et al. 2007). In cultures with the opposite writing direction, these unconscious associations are reversed (de la Fuente et al. 2015; Fuhrman and Boroditsky 2010). Another intriguing finding is that the usual conceptual mapping direction based on the experience of reading and writing can be manipulated simply by presenting the instructions and stimuli of an experiment involving space-​time congruity tasks in either standard, mirror-​reversed, or rotated orthography (Casasanto and Bottini 2014). For each temporal expression appearing on a computer screen, participants were asked to press a key to indicate whether it referred to an earlier or later time. When the instructions and phrases were written in standard orthography, people were faster to judge the temporal reference of the phrases when required to press the left button for earlier times and the right button for later times, compared with the opposite arrangement of the two keys. By contrast, when mirror-​reversed or rotated orthography was used, the preference for the arrangement of the two keys changed accordingly, which suggests that they had temporarily adjusted their mental timeline to fit the reading direction they were being forced to adopt. While a general association between time and space is likely to be universal (based on the shared experience that time passing corresponds to a change in position along a linear pathway), the specific direction of this association is, Casasanto and Bottini (2014: 478) conclude, “remarkably flexible.” This, they argue, suggests that children acquire a culturally preferred direction for their mental space-​time mapping when they first learn to read and write, but that all the other possible mappings are preserved in people’s long-​term memory, ever ready to be re-​awakened if circumstances in the physical world contradict people’s usual expectations.

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Taken together, the results of empirical psychological research thus support, first, the “body-​specificity hypothesis,” which claims that “people with different kinds of bodies think differently” (Casasanto and Henetz 2012: 360). For instance, people have an inherent preference for things they find easy to perceive and interact with, which means that they will tend to prefer objects and people placed on the same side as their more skillful hand. Second, the findings also suggest that habitual cultural practices may specify some conceptual mappings in particular ways, so that the traditional script direction in a particular culture leads people to imagine time moving either from left to right or from right to left. Third, even very short-​term motor actions that conflict with people’s habitual embodied experience—​for example, having their more dexterous hand deliberately handicapped or being forced to read in a direction to which they are unaccustomed—​is able to cause temporary adjustments to the more conventional mappings in their heads.

1.3. “Dys-​appearance” and Empathic Projection As mentioned earlier, in traditional CMT the focus has tended to be on identifying universal patterns in the way normally functioning human beings experience the world, but the research discussed so far demonstrates that our bodily perceptions and experiences are molded by social and cultural values and practices, as well as by our moment-​to-​moment actions in our environment. Besides, as I will argue in the following discussion, our bodily self-​awareness is constantly shifting and changing over time as we move from childhood through adolescence to maturity and old age, learning new skills and forgetting some of them, falling ill and recovering, gaining and losing weight, and experiencing the physical changes associated with puberty, pregnancy, and aging, for example. Merleau-​Ponty’s (1962) theory of embodiment is central to my argument. According to him, our being in the world is entirely dependent upon having a body that is actively and intentionally engaged in seeing, touching, feeling, and moving about in the world. All perception and sensation should be regarded as a form of “coexistence or communion” (1962: 221) with one’s environment: “I offer my ear or my gaze with the anticipation of a sensation, and suddenly the sensible catches my ear or my gaze; I deliver over a part of my body, or even my entire body, to this manner of vibrating and of filling space named ‘blue’ or ‘red’ ” (219). We are normally not aware of our eyes seeing, ears hearing, nose smelling,

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or hand touching, because our conscious attention is directed outward toward the images, sounds, smells, and touch sensations these organs are revealing to us in the form of a unified experience of our entire being. Similarly, once we have learned particular skills, such as dancing or riding a bicycle, we engage in these activities without having to think about the detailed physical movements involved (see also Fuchs 2012; Johnson 2007: 4–​7). While Merleau-​Ponty was most concerned with the way our body tends to “disappear” from the perceptual field it discloses, later phenomenological theory has turned its attention to situations where this mind-​body-​ world relationship is disrupted in some way (see also Morris 2012: 124ff). One important idea to emerge from this scholarship is that, when our habitual ways of engaging with our environment are challenged through pain, illness, or injury, our body captures our attention and forces itself into our conscious awareness. We are now attentive to our body, but it is experienced as a “dys-​appearance” (Leder 1990: 91), something that is “wrong,” “bad,” or “alien” and that threatens the desired state of affairs. In some cases, dys-​appearance can also be triggered when we internalize the attitudes of people who regard us not as autonomous subjects but as objectified “others,” on the basis of cultural prejudices against our body shape, skin color, or gender, for instance. On the other hand, in the case of physical exercise, sexual pleasure, and wanted pregnancies, for example, the body is often experienced, either pre-​reflectively or reflectively, as something good, easy, or well—​experiences that Zeiler (2010) refers to collectively as “eu-​appearance.” A similar point is made by Michalak, Burg, and Heidenreich (2012: 404), who suggest that the kind of awareness of one’s body that is involved in the practice of mindfulness may, in fact, “reduce tendencies to disembodiment and existential feeling of encapsulation often found in psychological disorders,” by encouraging the mind to connect with the body and its environment in the present moment.2 Dys-​appearance is likely to cause a more enduring and certainly more disruptive shift in our engagement with the world around us than most forms of “eu-​appearance.” During both physical and mental illness, our habitual relationship to the world is severely unsettled, as everyday objects become obstacles to be avoided or circumvented, and space and time are restricted to the here and now. Chronic pain, for instance, “transforms the world” by forcing us to pay attention to our everyday bodily functions in a way that we are unused to and that we thus experience as unnatural:

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The harmony of the mind-​body-​world is disrupted. To pay constant attention to aches and pains brings about a new articulation of the world. The stairs are no longer something I effortlessly take myself up in order to get to my apartment, but rather become a technical problem to be negotiated. The background becomes foreground, to use a notion from Gestalt psychology. (Bullington 2009: 105) Similarly, when someone enters the medical system, the body becomes a biological object to be examined, explained, and treated, while remaining essentially inaccessible and incomprehensible to the patient. The ensuing sense of alienation is reflected in the commonly observed tendency for patients to talk, for instance, about the liver, or the heart (instead of my liver, my heart) when discussing body parts that are affected by their disease (Toombs 1988). Pain and illness thus disturb our sense of the world and of our own role within it, and rehabilitation must, according to Bullington (2009:  107), aim not just at healing the body, but also at reinstating a mind-​body-​world continuum “into the fluid harmony of everyday life,” in the sense that the patient is freed from his or her enforced focus on the body and enabled to turn toward the world again. The prevalence of metaphor in discourses about all kinds of diseases, including cancer, depression, HIV/​AIDS, and dementia (e.g., Demmen et al. 2015; Fullagar and O’Brien 2012; Jansen et al. 2010; Lane, McLachlan, and Philip 2013), suggests that nonliteral thought patterns play a central role in helping the affected people themselves, their families, and their wider communities to fashion meaning out of the illness experience. However, even in the case of autobiographical accounts, the sense of dys-​appearance that typically accompanies a disease, or at least its most acute phase, may well be a distant memory by the time someone decides to talk or write about it. In all these cases of non-​immediate experience, I suggest, we must rely on our human capacity for empathy, the “vicarious, spontaneous sharing of affect” (Keen 2006: 208), as well as our innate ability to simulate in our minds the actions or perceptual features of things that are being described to us, or that we are remembering or imagining (Barsalou 2008; Bergen 2012; Gibbs 2006; Gibbs and Colston 2012; Ritchie 2013; Semino 2010). As Bergen (2012:  14) explains, simulation “is the creation of mental experiences of perception and action in the absence of their external manifestation,” using “the same parts of the brain that are dedicated to directly interacting with the world”; in other words, “simulation creates echoes in our brains of previous experiences,

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attenuated resonances of brain patterns that were active during previous perceptual and motor experiences” (2012: 15). Both empathetic projection and embodied simulation are thought to be based on the automatic and involuntary activation of mirror neurons in the brain, which generate remarkably similar patterns of activation when we are witnessing the actions, sensations, or emotions of another person as when we are performing these actions or experiencing the sensations and emotions ourselves (Feldman 2006: 215). Consequently, it seems perfectly possible for people to experience the dys-​appearance that is triggered by illness through empathic projection rather than on the basis of their own bodily sensations, and to be guided by this when choosing metaphors (or creating new ones) to describe a particular disease. If the metaphors used by family members, journalists, or health professionals diverge considerably from those used by the patients themselves, this may thus be a sign of a lack of empathy or imagination on the part of the former. By contrast, the author of a story about other people’s real or fictional suffering is likely to make a concerted effort to simulate in vivid detail what they must be going through in physical terms and what their emotional responses might be. Psychiatrist and philosopher McGilchrist’s (2009) seminal book about the divided brain provides further evidence for the intimate relationship between empathy, imagination, and metaphor. Based on a vast body of interdisciplinary research, his book develops the argument that the bi-​ hemispheric structure of the human brain has always been crucial to our survival as a species, as it enables us to attend to the world in two complementary ways: Whereas the right hemisphere supports a broad, flexible view of things as whole, unified gestalts in their wider context, the left hemisphere permits us to focus attention on decontextualized objects that are first broken up into parts and then reassembled.3 As a result of these different forms of attention, the right and the left hemispheres deliver experiences of the world and of our own role within it that are poles apart: In the one, we experience—​the live, complex, embodied, world of individual, always unique beings, forever in flux, a net of interdependencies, forming and reforming wholes, a world with which we are deeply connected. In the other we “experience” our experience in a special way: a “re-​presented” version of it, containing now static, separable, bounded, but essentially fragmented entities, grouped into classes, on which predictions can be based. This kind

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of attention isolates, fixes and makes each thing explicit by bringing it under the spotlight of attention. In doing so it renders things inert, mechanical, lifeless. But it also enables us for the first time to know, and consequently to learn and to make things. This gives us power. (McGilchrist 2009: 31) The main thrust of McGilchrist’s argument is that, although we need both hemispheres, in Western civilization the left hemisphere has gradually become so dominant that we are in danger of losing sight of the very things that make us human, including our ability to empathize with others and appreciate fully the interdependent nature of our existence within the natural world. What makes McGilchrist’s work particularly pertinent to the present study is that, according to him, the two hemispheres also attend to the body in distinctive ways:  The right hemisphere is responsible for “our sense of the body as something we ‘live,’ ” something that forms part of our identity and connects us to the rest of the world, whereas the left hemisphere delivers a focus on body parts and a view of the body as something from which we are relatively detached, a thing in the world, like other things [ . . . ], devitalised, a ‘corpse’ ” (2009: 67). Metaphor, which relies heavily on right hemisphere understanding (McGilchrist 2009:  115–​118; see also Ojha 2015:  159–​164), is able to embody our thoughts and place them in a living context. Unlike literal descriptions, which tend to force unique experience into explicitness, thereby irrevocably destroying its “fruitful ambiguity” (McGilchrist 2009:  180), metaphors bring together the whole of one thing with the whole of another on the basis of “a single concrete, kinaesthetic experience more fundamental than either, and from which they in turn are derived,” thereby opening up meanings that are “extralingual, unconscious, and therefore potentially new and alive” (McGilchrist 2009: 117). The relevance of these ideas to my own arguments is evident: If dys-​ appearance often leads to the kind of alienation from our bodies that is typical of a left hemisphere understanding of the world, then metaphors may provide a unique opportunity to re-​engage the kind of open-​minded attention that the right brain hemisphere specializes in, allowing us to breathe life back into our devitalized, corpse-​like bodies and opening us up again to the world around us. Because they are based on our shared embodied experiences, metaphors may also facilitate a more compassionate and imaginative attitude toward one another.

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1.4. Embodiment and the Affordances of Modes and Media So far, my key argument has been that our sensorimotor and affective experiences of the world are shaped by the cultural context and the specific situations in which we find ourselves at any given moment, as well as individual bodily dispositions and patterns of attention. This final section establishes meaning-​making and communication as the most fundamental social practices we human beings engage in. I suggest that the affordances of the modes and media we use to represent our experiences have a profound effect upon the way we attend to and experience our embodied selves, which in turn shapes the metaphors we create. When we are writing about our illness experience in prose, for example, we are likely to use different metaphors than if we are trying to convey the same thoughts and feelings by means of a painting or a comic strip. The notion of affordances is drawn from Gibson’s (1979) Ecological Psychology, according to which perception is not the computational activity of a mind in a body, but rather the exploratory actions of a complete mind–​body organism in its environment. All the things we come into contact with in our environment take on meaning (they “afford”) by virtue of being incorporated into our day-​to-​day activities and enabling us to use them in the pursuit of specific practical goals; for example, the air allows us to breathe, the ground to stand on, and certain tools to throw, hit, scrape, or leave marks. I use the notion of “affordances” to include both Gibson’s (1979) original definition and what social semioticians refer to as “meaning potential,” which is concerned mainly with the way meaning-​making resources have been used in the past and are still being used today in specific cultures and contexts (van Leeuwen 2005a: 4–​5).

1.4.1. Modes and Embodied Metaphor We human beings use all kinds of physical actions and a variety of both naturally occurring and created materials in order to express our experiences, values, thoughts, and feelings, and to share these with other people. As Lemke (1990:  187) puts it, we “speak meaningfully, draw meaningfully, compose and choreograph meaningfully, dress and move meaningfully, build and play meaningfully by deploying the resources our community gives us (words, lines, notes, steps, moves), according to patterns that make sense to others in our community.” In social semiotics, any such resource

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that is developed and organized by a particular culture or social group into a coherent meaning-​making system is considered a separate “mode”: “A mode is what a community takes to be a mode and demonstrates that in its practices” (Kress 2009: 58–​59; see also Kress and van Leeuwen 2001). The criterion of being a coherent meaning-​making system is met if a resource is able to fulfill the same three “metafunctions” as language does: to represent states and events (ideational or representational function); to convey a sense of the relationships between sign producers and their audiences (interpersonal function); and to create a recognizable kind of text out of individual parts (textual or compositional function). One way of categorizing modes is to start with the senses involved in the perception of different meaning-​making resources, which enables us to distinguish between five distinct modes:  the visual, aural, gustatory, olfactory, and somatosensory, which is taken to include the perception not just of touch and pressure, but also of pain and temperature.4 Each of these senses provides different kinds of information about our environment. Hague (2014: 124), for example, argues that sight and hearing are “powerful but insubstantial means for experiencing the world,” while touch “connects us to the reality of the world’s substance very directly,” and smell and taste “sit somewhere in the middle.” On the other hand, there is mounting evidence that many links exist between the senses during such processing, even in people who are not considered “proper” synesthetes (Ramachandran and Hubbard 2005; see also Chapter 2 in this volume). Moreover, many different ways of making meaning depend on the same sense. Visual perception, for example, is centrally involved in producing and/​or interpreting still and moving images, sculpture, written language, gesture, facial expression, and dance, among others. Forceville (2009:  23) suggests that we can distinguish, at the very least, between the following nine separate modes:  pictures, written words, spoken words, gestures, sounds, music, smells, tastes, and touch. However, this preliminary list also raises as many questions as it answers. While it is incontrovertibly true, for example, that hand gestures are an important meaning-​making resource for all able-​bodied human beings, only some social groups have organized such gestures into a more structured system of communication (e.g., for use in auctions), while for the Deaf community, signing, in combination with facial expression and gaze, head and shoulder movement, and mouth patterns, has developed into a full-​fledged language (Sachs 1989; Sutton-​Spence and Woll 1999). On the other hand, if ordinary co-​speech gestures are considered a separate

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mode, should not facial expression and body language be given the same status? More pertinent for the purposes of the present study is the distinction between written words and pictures. These two forms of communication involve the use of distinct types of signs. In Peirce’s (1960) terms, words are symbols, which are based on an arbitrary, conventional connection between signs and their meaning; people are only able to communicate verbally if they have learned a common code. Images, by contrast, are icons, which convey their meaning through the close physical resemblance between signs and the objects to which they refer. Moreover, language “is built from a limited set of discrete minimal units,” whereas visual meaning cannot be broken down into individual meaningful elements, since it is “continuous and infinitely graded” (Miodrag 2013:  8; see also Bateman 2014:  5–​29). Visual meaning is also even more context-​dependent than language. A single straight line, for instance, can represent an object, an edge, a crack, or a texture, depending on how it is used and what other marks are surrounding it (Massironi 2002: 106–​112). There are also important differences in the way the two modes are organized: Text almost always follows a sequential order, whereas images are generally perceived more holistically. Because of these different affordances, language seems to be particularly well suited to the representation of events, actions, and causality, while the spatial organization of an image may “lend itself with greater facility to the representation of elements and their relation to each other” (Kress 2000: 147). According to Paivio’s (1986: 53–​95) “dual coding theory,” language and nonverbal objects and events are also handled by two separate cognitive subsystems that are both structurally and functionally distinct. Building on this theory, scholars have since amassed plenty of empirical evidence for differences in the way visual and verbal information is processed, including, for example, the finding that producing verbal descriptions of visual images (e.g., faces) can impair visual memory and subsequent recognition (the so-​called verbal overshadowing effect) (Reed 2010: 54). It is important to recognize, however, that visual meaning-​making is by no means limited to the use of iconic pictures; it also includes nonrepresentational aspects of visual design, such as style, layout, color, and typography.5 Once we accept that the term “visual” is more than just a synonym for pictures, even the apparently straightforward division between the verbal and the visual mode turns out to be rather blurred. Many early writing systems are thought to have developed from pictograms,

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highly conventionalized, simplified pictures of concrete objects, and ideograms, which use basic picture-​like forms to stand for something conceptual and invisible (Yule 2003:  21). Even in a purely phonetic writing system, the size, color, weight, and shape of type often convey a vast amount of connotative meanings, which interact with the meanings of the words themselves. Experiments dating from as far back as the 1930s have provided clear evidence for the so-​called Stroop effect, which refers to the finding that, when color words are printed in different colors, or when the names for typefaces are printed in a range of distinct typefaces, people find it much harder to name the color or typeface when there is a conflict between the meaning of the word and its formal features. Summarizing this research, Feldman (2006: 85) concludes that “the brain does not separate words into form and meaning.” It is therefore simply not possible to draw up a conclusive, finite list of all the different modes available, because new modes are constantly being created, existing modes are transformed by their users in response to specific communication needs, and the boundaries between modes shift and change over time and across different cultures and communities of practice. For the purposes of scientific analysis, the decision as to whether something should be considered a separate mode or not will thus depend upon the specific conventions of the genre that is being examined and the kinds of research questions a particular study is trying to answer. In the case of the present study, we are dealing with graphic illness narratives, which, as I  will show in Chapter  2, are characterized by a very close but complex semantic and stylistic relationship between the drawings and the words, a comprehensive exploitation of the meaning potentials offered by the spatial composition of the page, and a particularly explicit and often self-​reflexive engagement with the material properties of the book, including its size, shape, weight, and color, and the surface and texture of the pages. Accordingly, in this study I will maintain a broad distinction between the verbal and the visual mode, the latter being taken to include figurative pictures, spatial composition, and the visual style of both the drawings and the written words. “Materiality” will be considered as a separate mode, although it also often overlaps with the visual mode (for instance, when the style of a picture indicates whether it was produced by hand or digitally). The different affordances of the verbal and visual mode have a profound impact upon the areas of experience that are likely to become either the sources or the targets of metaphorical mappings. For example,

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even the most abstract and physically inaccessible concept, can, at least in theory, be referred to through the use of a literal linguistic label. By contrast, strange, new shapes and sights are extremely hard to describe verbally without comparing them to something more familiar. In the visual mode the constraints are different: Some entities that are abstract in the sense that they are not accessible to the naked eye (e.g., viruses, planets, internal bodily processes) can be made visible through the aid of technology and thus can be represented literally in pictures. Most of us also are able to form a clear mental image—​and thus to depict—​entities that do not exist in the real world, including angels, demons, fairies, superheroes, and hybrid objects and creatures of all kinds. On the other hand, abstract concepts such as love, life, the passage of time, death, truth, and mental processes and emotions, cannot be visualized at all without recourse to metaphor, metonymy, or symbol. Similarly, concrete entities that are perceived by sensory organs other than the eye, such as smells, sounds, tastes, or only indirectly through their effects on our bodies or objects in the world, including forces such as gravity, wind, and tides, always and inevitably require some form of nonliteral representation, including synesthetic visual metaphor. However, as CMT scholars have shown, in practice metaphorical forms of expression are common in the verbal mode, too, as soon as we move beyond a very simple labeling of abstract concepts, emotions, and sense perceptions, regardless of whether or not they could, in principle, be expressed literally. Take the experience of physical pain: Scarry (1985: 4) points out that pain “does not simply resist language but actively destroys it, bringing about an immediate reversion to a state anterior to language, to the sounds and cries a human being makes before language is learned.” The lack of an adequate vocabulary for physical pain with no obvious external cause means that people typically describe their experience in terms of bodily damage caused by dangerous objects touching or penetrating the skin (e.g., “burning”; “scolding”; “pinching”; “stabbing”; or “stinging”) (Scarry 1985:  15; see also Semino 2010). This metaphor externalizes pain and makes it sharable, but it conceals the fact that pain often exists without either agency or external damage. While some visual images of physical pain seem to draw on the same source domains—​for example, representing it as a sharp object piercing the skin, or as rays emanating from what appears to be red, burning skin—​it is also possible to use quality of line or aspects of composition to convey the experience through synesthetic transfer (see my discussion of Figure I.1 in the Introduction).

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The representation of anger is another case in point. The conceptual metaphor anger is a hot fluid in a container, which has generated a host of linguistic expressions in English (see section 1.1), may have also inspired many of the conventional visual signs used to represent anger in cartoon drawings, such as a red face, bulging eyes, a wide open mouth, and spirals surrounding a character’s head, since both the verbal and visual representations of anger express similar notions of pressure being contained, with effort, inside a character’s body, or escaping from it suddenly and with explosive effect (Forceville 2005). However, as Forceville argues, the visual mode reveals aspects of this dominant anger metaphor that are less evident or absent in its linguistic manifestations, including the loudness of the verbal expression of anger, and the marked facial expressions and gestures that are associated with it. The human tendency to understand and talk about time in spatial terms also finds distinct expression in the verbal and visual modes. The English language reflects two main conceptual metaphors underlying expressions for time (Lakoff 1993):  the ego-​moving and the time-​moving metaphor. Although both share an orientation along the sagittal (back–​front) axis, with the observer facing toward the future, in the former he or she is imagined as moving though time (“I’ve almost reached the end of term”), while in the other, time itself is moving toward and past the static observer (“Christmas is fast approaching”). In nonverbal modes, space is exploited somewhat differently to represent time:  In spontaneous and elicited gestures and in sign language, for example, it is common for people to conceptualize time either along the sagittal or the lateral axis (Casasanto and Jasmin 2012), or else through a combination of both:  for example, by using their right hand to gesture behind their left shoulder to indicate the past, or a diagonal, forward-​right gesture for the future (Walker and Cooperrider 2015). As we will see in some of the following chapters, in visual images circular representations of time are also common, perhaps because they are particularly apt ways of expressing cyclical patterns in the way we experience day and night, the phases of the moon, and the changing seasons. At least in English, there are no linguistic expressions at all that reflect lateral conceptualizations of time (we would not say that “Sunday is to the left of Monday,” for instance), and only a small number that suggest its cyclical nature (e.g., “We’re going around and around in circles”; “Christmas is coming around again”), which, moreover, might just be considered elaborations of the more general ego-​moving or time-​ moving metaphors.

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Differences in the verbal and visual metaphors for the same target domain have also been identified in relation to wine promotion discourses. In her study of a large international corpus of wine-​tasting notes and print advertisements, Caballero (2009) discovered that the verbalization of the sensations provoked by wine in the taster’s mouth and nose invariably involves either metaphors or similes, the sources of which are most commonly drawn from the conceptual domains of textiles (e.g., “the fabric of the wine”), geometrical entities (e.g., “angular”; “deep”; “round”), buildings (e.g., “a wine that is constructed/​buttressed/​fortified by its ingredients”), human anatomy (e.g., “full-​bodied”; “flabby”; “masculine”) or abstract qualities of character (e.g., “aggressive”; “civilized”; “demure”). Caballero found very few attempts to convey the organoleptic experiences of wine tasting visually, because, she surmises, this poses virtually insurmountable challenges. In one rare example of a visual metaphor in a Spanish magazine advertisement for a rosé wine (Caballero 2009: 86–​87), the picture shows a well-​known ballet dancer with a long, pink dress pirouetting inside a giant wine glass, which helps to convey both the swirling motion of the glass required to assess the wine’s “nose” and the light, smooth, soft texture people may expect in their mouths when they taste it. As Caballero points out, this synesthetic metaphor draws on the tactile experience of skin touching a diaphanous, silky fabric to suggest an equivalent sensation inside the mouth. It thus creatively combines several of the conceptual metaphors underlying linguistic metaphor (textiles, human anatomy, qualities of character), while also adding the suggestion of movement to the mix. Although many metaphorical meanings can, in principle, be represented in any semiotic mode, the examples discussed in the preceding show that the chosen mode of representation not only shapes the way such meanings are expressed, but also determines which concepts become the target and source domains of metaphors in the first place, and which of these conceptual domains relate to our embodied experience. This demonstrates that metaphors are categorically not “modality independent,” as Müller (2008: 32) claims.

1.4.2. Media and Embodied Metaphor The same intimate link between our means of communication and the metaphors we use can be seen at the level of medium, too. Even within the scholarly field of media studies, it is surprisingly hard to find a

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straightforward definition of a “medium” (see Williams 2003:  3–​ 7). O’Sullivan et al. (1994: 176), for instance, describe it as an “intermediate agency that enables communication to take place.” However, this definition on its own is not specific enough to allow a distinction between media and the type of meaning resources I discussed earlier under the label of “modes.” One way to differentiate between a mode and a medium might be to regard the latter as a superordinate category of the former, in the sense that a medium typically (though not necessarily) involves a combination of two or more modes that interact with each other in a specific, structured way; for example, the cinema necessarily involves moving images, which are often accompanied by sounds, spoken language, and music. Media also often (though, again, not always) implicate some form of technology in the production, transmission, and reception of meaningful content. A valuable contribution to the discussion is offered by Ryan (2004), who argues that “mediality” or “mediumhood” is a relational property that depends on the purpose of investigation. From her point of view as a narrative scholar, for example, the defining criterion of a medium must be that it “truly makes a difference about what stories can be evoked or told, how they are presented, why they are communicated, and how they are experienced” (2004: 18). The purpose of the current investigation is to understand how the forms of communication we use shape the way we relate to our embodied experience, and how this, in turn, may impact on the metaphors we choose and what meanings they are able to convey. So, from this vantage point, “mediumhood” needs to be determined with reference to theories of how ways of organizing and communicating meaning limit, extend, or transform our physical, sensual, or affective experiences of the world. In this context it is worth considering McLuhan’s (1962, 1964) claim, made famous through the adage “the medium is the message,” that the content of media is largely irrelevant in terms of their influence on society; instead, it is the specific nature of the technologies used and how they change the balance between the senses that influence human thought processes and, in turn, transform cultural attitudes, norms, and behaviors. He argues that the media should be considered as prosthetic extensions or amputations of our embodied selves, which change the scale, pace, or pattern of our sensations and actions, as well as biasing social life in favor of either time or space (McLuhan 1964: 7–​8). For example, print privileges vision and encourages linear, sequential, logical, analytical

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forms of thinking and a separation of thought from feeling, while the electronic media, television in particular, involve multiple senses and enable people in vastly remote places to feel connected as part of a “global village” (McLuhan 1962). One of the most well-​known distinctions McLuhan (1964: 24) draws is between “hot” media, such as print, photography, film, and radio, which extend “one single sense in ‘high definition’ ” and do not invite much empathy or participation, and “cool” media, including cartoons, comics, and (perhaps more controversially) television, which provide limited information about the specific time and place of each object, and which thus demand the active participation of the audience “in completing and interpreting the few hints provided by the bounding lines” (1964:  174). Although McLuhan has since come under attack from some quarters of the scientific community for his political naïveté and belief in technological determinism (see Williams 2003: 67), his theories have nevertheless remained highly influential in media and cultural studies, where they have been taken up, for instance, by scholars studying the transformative effects of cyberculture and the network society on notions of truth and authenticity and the way we relate to our own bodies, time and space (e.g., Hayles 1999; Shaviro 2003). For the purposes of this study, I  will put aside McLuhan’s problematic claims about the power of communication technologies to shape human history, and focus instead on his valuable notion of the media as extensions of our embodied selves. Combining his insights with Ryan’s relativist notion of mediumhood, I will thus consider a medium as a form or technology of communication that makes a significant difference to the scale, pace, or pattern of our embodied sensations and actions, including the emphasis it places on time and/​or space, and the degree to which it encourages active audience participation. As mentioned earlier, McLuhan regarded television and film as entirely different media because of the way the technologies involved extend or limit our senses, even though they appear to be closely related in terms of how they combine moving images and other modes to tell a story. Similarly, despite their both being visual art forms, photographs and drawings engage producers and audiences in distinct ways. The former relies on mechanical means of production that appear to involve a straightforward causal mechanism. Even after decades of discussions surrounding the problematic relationship between photographs and truthfulness, which intensified further when digital technologies made it possible

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to “reach into the guts of a photograph and manipulate any aspect of it” (Ritchin 1990:  29), an inherent belief in the photograph’s superior capacity to transcribe reality in an objective and reliable way persists at some level of people’s consciousness (Adams 2000). Drawings, by contrast, are created through a deliberate process of translation and interpretation by the individual artist’s hand. They thus offer complete freedom to the artist to visualize any object, creature, or scene—​however “unreal” and fantastical it may be—​and to represent these visualizations in a range of different styles and at different levels of abstraction. Each of the two media also presupposes a distinctive view of time: A photograph is evidence of an encounter between event and photographer. A drawing slowly questions an event’s appearance and in doing so reminds us that appearances are always a construction with a history.  .  .  . [A]‌drawing or painting forces us to stop and enter its time. A  photograph is static because it has stopped time. A drawing or painting is static because it encompasses time. (Berger 2007: 70) Comics are primarily a drawn medium, although many contemporary works also use photographs, paintings, collage, or computer-​generated images. In such cases, some of the affordances of these other media will also need to be considered, because they have an impact on the kind of meanings that are expressible through metaphor and on how such meanings are represented. For example, the traces left by the artist’s pen, pencil, or brush on a material surface are able to convey haptic perception in a way that would not be possible in photographs, collage, or even the most sophisticated computer-​generated image. Another good example of the impact of mediumhood on embodiment is the use of space. Space is basic to all human narratives, since “the human mind cannot conceive of anything from a totally extraspatial viewpoint. Simply put, that which exists, exists somewhere” (Donahue 1993: 77). Yet the radio, for instance, does not have any spatial resources at its disposal (except through the analogous affordances of stereo sound, for instance), and the space of the conventional book is flat and strictly linear. By contrast, the theatrical text “is defined and perceived above all in spatial terms” (Elam 1980: 56). In the traditional proscenium theater, where the stage is imagined as a room with one wall removed, the stage is conventionally split into zones—​upstage,

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center, and downstage; stage left and right; and above and below stage—​ that carry specific meaning potentials. The placement of stage sets and objects, and of the actors relative to these objects and to each other, is also always significant. “The theatrical text,” Ubersfeld (1999:  94) concludes, “is the only literary text that absolutely cannot be read according to a diachronic succession of a reading, and that opens itself to understanding only through layers of synchronic signs tiered in space, spatialized signs.” In fact, Ubersfeld’s claim that the theater is unique with regard to the central importance it places on spatial meaning is incorrect:  Comics represent another example of a medium in which space performs an essential role in telling stories, although, as I shall demonstrate, the affordances of the spatial dimension in comics differ in important ways from those of space in the theater. This chapter has critically reviewed the dynamic systems approach to metaphor analysis, cross-​cultural studies of metaphorical language, and experimental work on unconscious associations between spatial orientation and abstract concepts or values. One of the most striking common findings to emerge from this body of work is that the relationship between embodied experience and metaphor use is more fluid and unpredictable than previously assumed in CMT. I then introduced Leder’s (1990) notion of bodily “dys-​appearance,” suggesting that illness and disability may also profoundly affect our embodiment and, in turn, the metaphors we create. Similarly, the modes and media we use to communicate all tend to emphasize or de-​emphasize distinct aspects of our sensorimotor experience, drawing more or less attention to the different senses, and to temporal or spatial relations, for example. My concept of “dynamic embodiment” pulls all these threads together: Accordingly, the way we draw on our physical experience when producing metaphors depends not only on individual predispositions (e.g., whether we are right-​or left-​handed) and cultural values and practices (e.g., beliefs about socially acceptable manifestations of anger; writing direction), but also on the degree to which we are consciously aware of particular aspects of our bodies, either due to illness or disability, or because of the means of communication we are using. The following chapter applies this key notion to the genre of graphic illness narratives.

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Dynamic Embodiment and the Graphic Illness Narrative Genre

chapter I gathered together theoretical arguments and empirical evidence from several scholarly disciplines in order to propose the notion of dynamic embodiment in Conceptual Metaphor Theory (CMT). Accordingly, embodiment should be regarded as something that is constantly shifting and changing in accordance with our cultural models, individual bodily dispositions, and the practices we are engaged in at any given moment, including the modes and media used to convey our experiences. These numerous and diverse factors that shape dynamic embodiment make it hard to predict which metaphors people will choose in specific instances of communication. In the present chapter I  argue that the concept of genre provides an effective means of addressing this challenge. There is already a lot of evidence that the quantity and quality of metaphors are influenced by the particular genre in which they occur, with those found in literary texts typically showing a more complex conceptual structure than those employed in journalism, for example (Deignan, Littlemore, and Semino 2013; Goatly 1997; Kövecses 2015; Ritchie 2013; Semino 2008, 2011; Steen 1994). Such correlations have usually been explained with reference to the way genres shape the expectations of both communicators and their audiences regarding the metaphors that are likely to be used, including their density, what functions they fulfill, and how creative they are likely to be. The problem with this apparently straightforward explanation is that it misses the role IN THE PREVIOUS

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of embodiment in mediating between genre conventions and metaphor use. As I argue in this chapter, some genres are more centrally concerned with human physicality than others, which is likely to influence both the type and direction of any metaphorical mappings. In multimodal genres, in particular, the unique affordances of each mode and medium, and the distinctive ways these engage the human sensorium, must also be taken into account. In the case of the graphic illness narrative (or “graphic pathography”), the body and its (mal)functions inevitably play a central, if not a pivotal, role, and the unique multimodal features of the comics medium encourage the use of particular types and forms of metaphor, as the following extract (Figure 2.1) demonstrates. It is drawn from Sarah Leavitt’s (2012) graphic memoir about her mother, Midge, who developed Alzheimer’s disease when she was only in her early fifties. The autobiographical verbal narrator describes how, as Midge’s sense of smell gradually decreases, she develops an uncharacteristic longing for the taste of sugar. Sarah, who used to eat sweet things secretly for fear of attracting her mother’s disapproval, now hides her stash of candy to prevent her mother from eating it all. Visually,

Figure  2.1.  Leavitt, S. (2012) Tangles: A Story about Alzheimer’s, My Mother and Me (p. 59, detail). © 2012 Sarah Leavitt.

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Midge’s sense of separation from the world and the people she loves is conveyed through the image of her body trapped inside black boxes. Although these black rectangular shapes are formally similar to the comics panels within which they are located, they have a different narrative function. Whereas each panel in a comic typically represents a portion of time of differing length (Hatfield 2005: 58), the black boxes in Figure 2.1 act as visual container metaphors, with an explicit inside and outside structure. The drawing in the fourth panel, for instance, shows Midge struggling to escape the box in order to sniff the enticing aromas of ripe fruits, which are represented visually through swirly lines and dots. In panels 7–​9, her attempt to connect with the world through the taste of sweet things is suggested by the fact that her tongue and arm are now protruding from the box, although they are still not quite able to reach what she is longing for. In the final two panels, the autobiographical narrator explains that “Mom forgot more and more of herself. She didn’t know that she thought sugar was evil. She only knew it tasted good.” In the accompanying images, Midge’s head and body have become disconnected and are trapped in separate boxes, which, in the final panel, have shrunk in size and seem to be disappearing into the distance. The verbal narration thus provides the general context, but it is through the combination of words and drawings that we get the most powerful sense of Midge’s suffering and Sarah’s feelings of acute loss. While the latter is clearly based on Sarah’s own embodied experience, the artist’s skill in representing her mother’s perspective shows her capacity for empathic projection (see Chapter  1, section 1.3). The picture of Midge’s head and body in two separate black boxes also provides a poignant visual metaphor for the intimate links between the body, brain, and mind, including how the malfunctioning of one will inevitably affect the others. This extract illustrates perfectly what will be described as the prototypical communicative goals and formal features of the graphic illness narrative genre: (a) a focus on not only the physical, but also the social, emotional, and existential implications of disease, both for sufferers themselves and their loved ones; (b)  the complex interplay of the verbal and visual mode to convey concrete objects and sense perceptions, as well as more abstract experiences; (c) the significance of spatial orientation, relative size, and composition in the way such meanings are represented; and (d) a (metanarrative) foregrounding of the formal and material properties of the comics medium.

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These generic qualities of graphic illness narratives have a bearing on which themes are likely to become the targets of metaphors in individual works, what shape these metaphors will typically take, and the degree to which they draw on concrete physical experience. Thus, in many of the metaphors in my data set, the ordinary direction of the mappings from sensorimotor experience to more abstract concepts is reversed, as the experience of disease renders the body and its perceptions strange and hard to grasp. The affordances of the verbal and visual modes, and the specific features and materiality of the comic book, allow artists to appeal to shared embodied experiences, while also conveying their unique thoughts and emotions, and demonstrating their creativity. Even when quite conventional conceptual metaphors, such as isolation is containment, or mental disorder is disintegration of the body, are employed by the creators of graphic pathographies, they are often elaborated, specified, combined, or expressed in ways that have no obvious verbal correlates. The characteristic features of graphic illness narratives listed under (a–​ d) in the preceding will form the focus of chapter sections 2.3 and 2.4. First, however, I will critically review different theoretical conceptualizations of “genre,” demonstrating how these may be enriched by paying more detailed attention to the modes, media, and concrete artifactual nature of particular text types. I will then briefly trace the origins and evolution of the graphic pathography, arguing that it should be considered not simply as a subgenre of the illness narrative more generally, but as a separate genre in its own right, which engages our sensorimotor experience in unique ways and thus tends to encourage the use of specific forms of metaphor.

2.1. Genre, Multimodality, and Embodiment The notion of “genre” appears frequently in both linguistics and literary theory, yet it is defined in a number of different ways. There are three broad approaches to genre in linguistics, although they are increasingly converging (see Hyon 1997; Swales 2010). Writing from a background in English for specific purposes, Swales’s (1990) seminal account of genre defines it as a class of communicative events that have a set of communicative purposes in common, which, in turn, impose certain constraints on their schematic structure, content, style, and intended audience. In order to be considered a communicative event for the purposes of genre

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analysis, it must be a reasonably frequent or otherwise prominent event within a particular “discourse community,” and language must play an indispensable role within it. Academic journal articles, for instance, fulfill the primary purpose of communicating scientific advances to the discourse community of experts in a particular scholarly field. Another important perspective on genre comes from Australian Systemic Functional Linguistics (Martin and Rose 2003), which describes it as a series of identifiable steps or “stages” that speakers or writers must go through in order to achieve their goals, and which are each characterized by specific linguistic features. The third main strand of genre analysis in linguistics is associated with the New Rhetoric School (Bazerman 1994; Miller 1984). It regards genres as social and rhetorical actions, which often form systematic relationships within particular social settings and which are subject to historical change, hybridization, and creative adaptation. The definition of genre as purposeful communication that is common to all three strands is less applicable to literary and poetic works, as they often defy any ascription of specific objectives beyond the general desire to tell a story and create something of aesthetic value (Sinding 2010). Perhaps this explains why the focus of literary approaches to genre analysis has, instead, always been on the expectations regarding themes, settings, plot, structure, and style that both writers and readers bring to certain types of works, based on their knowledge and previous experiences of the relevant conventions. According to the influential institutional perspective, genres should be seen as “social contracts between a writer and a specific public, whose function is to specify the proper use of a particular cultural artifact” (Jameson 1981: 106; see also Culler 1975: 147). This specific public includes not only the readers, but also the academics, reviewers, publishers, and booksellers who have a professional stake in identifying distinct genres and deciding where to draw the boundaries between them. Although the notion of genres as institutions might evoke connotations of stability and conformity to inflexible rules, they are, in fact, subject to the same imperative of constant change and adaptation as any other form of complex sociocultural organization (Fishelov 1993: 88). Indeed, given the high value placed on creativity in the arts and the constant drive for innovation dictated by the market economy, literary genres may be particularly fluid and ephemeral categories. In spite of the apparent differences between linguistic and literary approaches to genre, there are in fact several commonalities between

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them, including an acknowledgment of “the interactive nature of textual meaning, the rhetorical triangulation of writer/​reader/​text, and the embeddedness of those relationships within context or culture” (Devitt 2000:  699). One important development that has encouraged genre scholars to look beyond the boundaries of their respective discipline is the increasingly important role played by nonverbal modes and media of communication in both nonliterary and literary genres. All the approaches discussed so far have focused on verbal text types, yet many contemporary communicative events, such as service encounters, for example, require customers to actively engage with computer screens, where words, pictures, and layout all contribute to the fulfillment of particular communicative purposes (van Leeuwen 2005a: 131). Similarly, photography is now ubiquitous in texts that are subsumed under the label of “life writing” (Adams 2000), and much contemporary experimental literature uses images of all kinds, unconventional layout, and novel formats (Gibbons 2012, 2013, 2016). As a consequence, some genre scholars have turned their attention to the affordances of the different modes and media, and the unique constraints imposed by each of these on the schematic structure, content, and style of a communicative event or artifact. The actual materiality of particular text types can also no longer be ignored: “Whereas traditional accounts of genre would have little to say about whether their objects of interest are being published in books or in looseleaf binders or as posters, the move to multimodal genres places the artefactual nature of genres very much in the limelight” (Bateman 2008: 10–​11). Prototype theory has proved to be a fruitful basis from which to address some of these emerging issues (Gibbons 2016; Sinding 2010; Steen 1999). According to this theory, each category has its own internal structure, with probability rates assigned to particular features (Rosch 1975). For example, in the United States tables and chairs are considered the most prototypical items of furniture, apples and plums are seen as the most central members of the category of fruit, and the robin is regarded as “birdier” than, say, a penguin or an ostrich. Categories are themselves organized into related systems, with a basic level of categories like “chair” or “apple” being recognized, remembered, and learned more readily than more specific, lower-​level categories such as “barstool” and “Granny Smith,” or higher-​level categories like “furniture” and “fruit.” Basic-​level categories are the highest level at which we have a concrete mental image of concepts and specific sensorimotor

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programs for interacting with them (e.g., chairs are easy to visualize/​draw and have the affordance of providing something to sit on), which suggests that they develop out of our concrete bodily experience (Lakoff 1987). Genres can thus be regarded as cognitive categories with central and more peripheral examples. Whereas communicative function is generally considered the privileged property of genre for the purposes of categorization (e.g., Swales 1990: 49–​52), other properties, such as content, structure, or style, may be used to determine which particular exemplar is prototypical. Genre categories can also be organized into levels of greater or lesser specificity. Steen (1999:  112), for instance, describes press and Internet advertisements, and radio and television commercials, as “subordinates of the genre of the advertisement,” which are “mainly distinguished by one feature: their medium.” These ideas are highly relevant to the present study. Prototypically, graphic illness narratives are autobiographical accounts in the comics medium about either the author’s own or a family member’s physical or mental illness, although some (semi-​)fictional stories and some primarily verbal accounts with visual illustrations often are included in the category as more peripheral members. Literary critics such as Steen (1999) and Sinding (2010) would probably regard graphic illness narratives as belonging to a lower-​level category, or subgenre, of autobiography (or pathography), whereas many comics scholars might describe them as a particular subtype of graphic narratives. However, as I will argue in the following section, there are two important reasons why I believe that the graphic illness narrative deserves to be given the status of a separate, basic-​level genre category. First, genre categorizations are culturally specific and historically variable constructs, and there are clear indications that comics about the illness experience are being conceptualized and discussed by their “discourse community” (Swales 1990)—​that is, the publishing industry, academics, creators, and, increasingly, the comics readership—​as a distinctive genre. Second, the multimodal, artifactual nature of graphic pathographies is not an incidental property; rather, it engenders a unique set of communicative conventions and constraints, and invites a specific form of sensorimotor engagement that makes it a central defining feature of such works. Thus, we should expect metaphors in graphic illness narratives to be unique to this genre and to differ from those found in other types of comics or in purely verbal pathographies, for example.

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2.2. Origins and Evolution of the Graphic Illness Narrative Genre Graphic illness narratives are closely related to both oral and written accounts of people’s own experiences of disease, yet each of these formats invites different forms of expression on the part of speakers/​ writers, and different ways of engaging with the material presented by listeners/​readers. Frank (1995) was one of the first scholars to describe and classify oral illness narratives. He identified three main types of such accounts, all of which provide a way for people to make sense of their suffering. The “chaos” narrative is born of a complete lack of hope, which leads to the absence of any sense of coherent sequence and causality. The “restitution” narrative is based on the deep-​seated human desire to recover from disease and return to a previous state of health and normality. It is the culturally preferred narrative in contemporary Western societies, since it places great trust in medicine and offers people a way of denying the inevitability of death. In “quest” narratives, finally, illness is seen as the occasion for setting out on a journey toward greater acceptance or personal improvement: “What is quested for may never be wholly clear, but the quest is defined by the ill person’s belief that something is to be gained through the experience” (Frank 1995: 115). Frank suggests that illness narratives are always fundamentally embodied in the sense that they are triggered by the disruption of established ways of remembering the past and imagining the future:  “The body sets in motion the need for new stories when its disease disrupts the old stories. The body, whether still diseased or recovered, is simultaneously cause, topic, and instrument of whatever new stories are told” (1995: 2). The second half of the twentieth century witnessed the appearance in ever greater numbers of written accounts of the illness experience; for example, by the mid-​1990s there were at least 60 works in print about breast cancer alone (Hawkins 1999: 127). This led to literary critics inventing new labels for the phenomenon (“pathographies” or “autopathographies”), and dedicating scholarly books and journal articles to the specific communicative purposes and prototypical forms, structures, and stylistic features of this emerging class of texts (e.g., Bevan 1993b; Couser 1997). Hawkins explicitly contrasts such autobiographical stories about disease with a patient’s medical records:

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Case reports are generally about a biomedical condition and its treatment; pathographies, on the other hand, concern illness and treatment as it is understood by the ill person. They differ in subject and in composition. The medical report is usually made up of impersonal statements by medical caregivers about symptoms, test results, and response to treatment. A pathography is an extended single-​author narrative, situating illness and treatment within the author’s life and linking them with the meaning of that life. (Hawkins 1999: 128) Pathographies give a voice to the kind of subjective emotional experiences that modern medicine, with its focus on bodily symptoms and cures, is often ill-​equipped to describe. Hawkins distinguishes between “didactic,” “angry,” and “alternative” pathographies, depending on whether the authors’ aim is primarily to share their knowledge and experience with other patients, to attack a medical system they perceive to have let them down, or to promote alternative therapies. A fourth subgenre, which she terms “ecopathography,” “links a personal experience of illness with larger environmental, political, or cultural problems” (1999: 129). Personal stories about the illness experience are thus always deeply social, in the sense both that they imply a listener or reader, and that they are inevitably shaped by dominant cultural attitudes toward illness and health. By moving such narratives from oral storytelling or the traditional book format to the multimodal comics medium, graphic illness narratives have created a new set of expectations, constraints, and conventions (Donovan 2014; Miller 2014; Waples 2014). These emphasize distinctive aspects of our sensorimotor experience and thus also invite new forms of metaphorical conceptualization. The origins of the graphic illness narrative genre can be traced back to 1972, when Justin Green published a semi-​autobiographical comic about the torments of his alter ego, the adolescent Binky Brown, who suffers from an obsessive-​compulsive fixation on his genitals and other vaguely penis-​ shaped body parts. His strict Catholic upbringing leads him to construe his obsessions in religious terms, imaging “pecker rays” emanating from his body that threaten to desecrate everything they touch. The publication of this book occurred in the context of the underground “comix” movement in the United States, so named to emphasize the deliberately “x-​rated,” taboo-​breaking content of the titles produced under its banner, although the artists behind comix were also inspired by a new political awareness

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on issues such as civil rights, the environment, feminism, and the anti-​ war movement (Skinn 2004). The movement only lasted from about 1968 to 1974, yet it completely revolutionized the comics art world and paved the way for a surge in the production of comics for adults across North America and Western Europe from the 1970s and especially the 1980s onward, with subject matters ranging from fantasy and science fiction, to history, journalism, biography, and autobiography (see El Refaie 2012a: 31–​34). Our Cancer Year (1994), by Joyce Brabner and Harvey Pekar, which chron­ icles Harvey’s diagnosis, treatment, and eventual recovery from cancer, was a second pivotal moment in the development of the graphic illness narrative, though it took another decade for the genre to really take off. In 2007, the British physician and comics artist Ian Williams created a website, graphicmedicine.org, which has provided a forum for comics practitioners, scholars, and medical professionals to exchange ideas and, from 2010 onward, has led to annual international conferences on the interstices between comics and medicine. According to Williams (2015: 116), these initiatives were prompted by his realization that “there were many authors who were putting their experience of healthcare and illness into comics form and that the comics memoir of illness—​‘graphic pathography’—​constituted an important genre within comics.” He is also one of the authors of Graphic Medicine Manifesto (Czerwiec et al. 2015), the inaugural volume for a new book series by Pennsylvania State University Press, which publishes both scholarly works and original comics on this new alliance between comics creators and healthcare professionals. There are also numerous book chapters, journal articles, and special issues that focus specifically on comics about physical or mental disease, often under the banner of the “Medical Humanities” (e.g., O’Brien 2013; Squier and Marks 2014; Williams 2011, 2012, 2014). The grouping together of individual comics into a recognized genre category thus occurred partly as a result of the frequency with which such works were beginning to appear, and partly because scholars, artists, publishers, and medical practitioners (in other words, the relevant discourse community) began to notice and describe common patterns in these artworks.

2.3. The Body and Metaphor in Graphic Illness Narratives As discussed in Chapter 1, phenomenologists believe that it is only when our ordinary ways of engaging with the world are unsettled in some way that our body captures our attention and “dys-​appears” (Leder 1990: 91).

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Because of their heavy reliance on visual storytelling, the tendency in all illness narratives to engage explicitly with the body is further amplified in the case of graphic pathographies, since the act of “inscribing of sickness into story” (Bevan 1993a: 4) through drawing multiple (self-​)portraits itself entails a form of “dys-​appearance,” in the sense that the body can no longer be taken for granted as an unconscious presence (El Refaie 2012a:  62). Thus, all comics artists are obliged to engage with the role of the body in constructing and maintaining a person’s identity, but this link between appearance and identity is even more in the foreground in stories about disease, particularly if there are visible physical changes (Donovan 2014). When we experience our bodies as problematic, we tend to search for metaphors that can help us understand and express aspects of our physical self. As a consequence, a characteristic feature of the graphic illness narrative genre is that the usual direction of mappings from embodied perceptions to more abstract experience is frequently reversed, with the body acting not just as the source but also the target of many metaphors. The following extract (Figure 2.2) from The Facts of Life, an autobiographical comic by Paula Knight about struggling with infertility and myalgic encephalomyelitis (ME)/​chronic fatigue syndrome (CFS), may serve as an example. On this page, the autobiographical narrator, Polly, is describing the debilitating physical symptoms she has been experiencing for several years, so far without having obtained a conclusive medical diagnosis. Her sense of constant exhaustion is represented through the image of a tortoise dragging a cast-​iron weight up a hill, and the metaphor of a toad with an inflated vocal sack is used to convey the discomfort caused by her swollen glands. What Polly describes as “toothache in my bones” and her severe muscle pains are represented through the pictures of a bear’s claws digging into her arms and an elephant squashing her body. Taken together, these striking verbal and visual metaphors allow the reader to understand what the various symptoms feel like. The three panels running down the middle of the page contain details of the medical tests she undergoes, ending with the statement “I was ‘diagnosed’ with ME/​CFS and referred to the ME service and pain management clinic.” The fact that the word “diagnosed” is placed in quotation marks, and the accompanying drawing of another tortoise dragging a weight behind it in the direction pointed out by a giant hand, underline the dearth of well-​founded clinical knowledge about this condition and the paucity of treatment options available to sufferers. The way the individual visual elements are arranged

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Figure 2.2.  Knight, P. (2017) The Facts of Life (p. 141). © 2017 Paula Knight. Permissions granted.

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on the page suggest the general shape of a woman’s body, with the elephant forming the head and the row of rectangular panels between the two arms, her torso. This creates another, overarching metaphor, in which Polly’s sense of bewilderment and uncertainty about the symptoms of her disease is represented through the spatially discontinuous, fractured, and incomplete image of her body. Some CMT scholars like to draw a distinction between those conventional, everyday “correlation” metaphors that allow us to understand abstract areas of life in terms of embodied experiences, and “resemblance” metaphors, which draw attention to the similarity between two fundamentally different things and which are typically more creative and unusual (Grady 1999), as in the case of the animal metaphors in Figure 2.2, for example. Embodiment and similarity are regarded as imposing fundamentally “different kinds of constraints on the creation of metaphor” (Kövecses 2005: 267), since the former is firmly anchored in our bodies, whereas the latter is limited only by the power of human imagination, which, at least potentially, “is boundless in its capacity to impose resemblance on disparate objects” (Grady 1999:  96). Which of these two main types of metaphor predominate in any given text or visual image will depend to a large extent on its overarching communicative function. In some genres, the primary purpose of metaphor is to make an abstract concept easier to grasp, while in others the aim is to defamiliarize something ordinary for poetic or persuasive effect. Thus, correlation metaphors are likely to be more common in educational texts and many everyday discourses, whereas resemblance metaphors abound in literature and advertising, for example. In the case of graphic illness narratives, the authors typically want to share their experience of a particular disease with others in a way that can be readily understood, while also being motivated by the desire to create an original work that bears witness to their own, unique experience and/​or vision of the world. The first purpose may encourage authors to use conceptual metaphors that have become conventionalized ways of understanding certain diseases, and the second is likely to inspire more imaginative, ad hoc resemblance metaphors. These two types of metaphor are not mutually exclusive, however. Indeed, Lakoff and Turner (1989: 72) assert that even the most celebrated literary metaphors are typically constructed upon the same conventional correlation metaphors that underlie our ordinary, everyday thinking, although authors are often able to find novel extensions, elaborations, or combinations of these metaphors, thereby guiding us beyond their

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“automatic and unconscious everyday use.” In comics, the simple act of rendering a conventional verbal metaphor in a striking visual manner may draw our attention to the underlying thought patterns. In the extract from The Facts of Life (Figure 2.2), for example, the relatively conventional notion of illness as the disintegration of the body (reflected, for example, in common ways of talking about physical or mental suffering in terms of “falling apart,” “collapsing,” or “going to pieces”) is rendered through a unique visual design, where individual animal metaphors are arranged on the page in a manner that evokes the general shape of a woman’s body, albeit in a way that prevents the different parts from cohering fully into a unified whole. This demonstrates that it is possible for the body to act as both the target and the source of metaphors in graphic illness narratives, sometimes even on the same page. Because of these competing forces at work in the graphic illness narrative, the relationship between embodiment and metaphor can be described as one of dynamic tension rather than unidirectional causation. If we respond emotionally and intellectually to the metaphors in such works, it is precisely because they feel “true” to our shared bodily experience, while also surprising and delighting us by unsettling established thought patterns and encouraging us to look at a particular phenomenon with new eyes.

2.4. Metaphor and the Characteristic Formal Features of Graphic Illness Narratives Another defining feature of the graphic pathography genre is that stories are told through the comics medium. When scholars have tried to determine what unites the many different cultural objects that have historically been labeled comics, they almost invariably describe one or both of the following distinctive features (see El Refaie 2012a: 19–​36): first, a particularly intimate but complex relationship between the verbal and visual elements, and second, a unique way of combining sequential storytelling with the atemporal logic of spatial composition. Graphic pathographies also form part of a higher-​level category of comics that are sometimes referred to as “graphic novels” or “alternative comics” (Hatfield 2005; Kukkonen 2013; Tinker 2007; Wolk 2007). These book-​length works are characterized by their literary ambitions, while still being indebted to the playful, irreverent, satirical traditions of more conventional, “low-​brow” comics genres. There is also often an explicit, self-​referential focus on

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the formal features and material properties of the comic book itself, including its shape, weight, printing, and binding, the surface and texture of the paper, and the processes, materials, and tools used to create the artwork. I will now consider each of the key characteristics of graphic illness narratives in turn, focusing on how they are likely to foreground or background specific sensory-​motor experiences of the people producing works in this genre, and how this, in turn, impacts upon the prototypical forms and functions of the metaphors they use.

2.4.1. Words and Images Although some comics are designated as “wordless,” it is actually hard to find examples of the medium where language does not play any role at all (Beronä 2001). Alphanumeric signs may occur not only in the form of titles or subtitles, verbal narration in text boxes, and speech and thought balloons, but also as part of the landscape of the storyworld, or as a way of indicating diegetic sounds. Accordingly, one of the defining characteristics of the graphic pathography genre is that it is characterized by the use of both semiotic modes, even though the relative contribution of each varies considerably across individual works. The blurb on Dark Early, Hannah Bradshaw’s (2015; see also Chapter 5, Figure 5.3) visual account of depression, for instance, describes the work as “A story without words. A picture of everyday survival,” yet the title itself has an influence on how we are likely to interpret the images, as the notion of darkness is strongly associated with undesirable emotions, particularly when it is prefaced with the qualifier “early.” Moreover, a few pages contain word fragments (“Hou . . .,” “Mon.-​” “Sat.-​,” “. . . lence”) on the door and above a shop, as well as European digits on a bank note, which function as symbolic signs that “anchor” the story in the real world, even if this link is rather vague and tenuous. The term “anchorage” was coined by Roland Barthes (1977), who used it to describe the way that language is often employed to fix the meaning of images, which by their very nature are able to carry a range of both straightforwardly referential meanings (“denotations”), and more implicit and culturally inflected associative meanings (“connotations”). In the case of sequential narrative media such as comics and film, by contrast, images and text often stand in a complementary relationship, which Barthes termed “relay.” However, this simple distinction between anchorage and relay is unable to account for the many different relationships that

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can pertain between the verbal and the visual mode in comics. McCloud (1994:  153ff; 2006:  130ff) specifies seven different word-​image relations in this medium, ranging from “word specific” or “image specific,” where one mode carries the crucial information and the other merely adds non-​ essential detail, to “interdependent,” where both modes together produce meanings that neither could convey alone. Additionally, comics scholars have identified “disjunctive” and “ironic” word-​image relations, defining these, respectively, as a situation “where the word and image seem to follow a similar course yet in fact express opposing alternatives” (Cioffi 2001: 98), and where pictures “belie” words (Varnum and Gibbons 2001: xiv). In fact, in comics the verbal and visual modes are often so closely intertwined that the word/​ image dichotomy collapses completely. As Hatfield (2005:  37) points out, “visible language has the potential to be quite elaborate in appearance, forcing recognition of pictorial and material qualities that can be freighted with meaning,” while, conversely, “images can be simplified and codified to function as a language.” The following extract from It’s a Bird (2004) provides a particularly good illustration of Hatfield’s claims. This book was created by Steven T. Seagle and Teddy Kristiansen, both of whom have a broad portfolio of work, including superhero comics. Seagle tells the semi-​autobiographical story of comics writer Steve, who is offered the chance of a lifetime to come up with some new Superman adventures, while struggling to confront a grim family secret:  The inherited gene that causes Huntington’s disease and that killed his grandmother has just reappeared in the next generation. Steve reluctantly invents a series of new stories about Superman related to the real-​life concerns and vulnerabilities of ordinary human beings, each of which is drawn or painted in a different style by Kristiansen. The page reprinted in Figure 2.3 appears in the context of a visit by Steve and his brother to a care home, where their aunt is in the final stages of what the men correctly surmise to be Huntington’s disease. Steve remembers the ominous whispered conversations he witnessed as a little boy when his grandmother was diagnosed with the illness, as well as the medical report he glimpsed, in which the “s” at the end of the word “Huntington’s” struck him as somehow “out of place . . . like it was added later” (2). In the extract in Figure 2.3, the artist offers a multimodal reflection on the letter “s,” using both its shape and its linguistic uses as a marker of possession and the plural form to explore different aspects of Huntington’s disease and how it affect its victims.

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Figure 2.3.  Seagle, S. T., and T. Kristiansen. (2004) It’s a Bird (p. 104). © 2004 DC Comics.

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While some elements of the page, such as the picture of the protagonist’s own father and of “Father Time,” function as visual icons of real or imagined characters, and the words in the text boxes are more or less “pure” written language, all the other words and drawings on the page mix iconic and symbolic meaning resources (in Peirce’s terms), albeit in different proportions. The snake, whip, and clock face are mainly pictorial signs, although they also happen to spell out the letter “s.” In contrast, the word “victims” functions primarily as a linguistic sign, but the way it is written multiple times, in different sizes and shades of red, all crammed together and partially overlapping each other, emphasizes its visual qualities. The Superman “logo” can perhaps be described as approximately equally weighted in terms of its textual and visual meaning components. As this example shows, the different affordances of the verbal and visual mode have an impact on the kind of meanings that are represented metaphorically, and on the specific forms such metaphors may take. Words such as “victims,” “pandemic,” and “time,” as well as those indicating specific family relationships (“brother,” “father”), for instance, refer to intangible, invisible concepts that could not be represented literally through pictures at all. Similarly, the sense of terror generated by the threat of Huntington’s disease cannot be expressed visually without recourse to some form of symbolism, metonymy or metaphor. By contrast, what Arnheim (1969: 208ff) calls “pure shapes,” that is, shapes that do not refer to specific things in the real world, often elude straightforward, literal verbal description. In order to draw attention to the shape of the letter “s” (Figure 2.3), for example, the artist has used his visual imagination to create pictures of concrete objects, including a snake and a whip. Striking differences also emerge with respect to the way the abstract notion of time is represented in the verbal and the visual mode. For instance, the narrator credits the letter “s” with the ability to “literally steal time,” which, in reality, is of course anything but literal. Instead, it is a slightly unusual elaboration of a deeply entrenched view in Western consumer cultures of time as a valuable commodity (Lakoff and Johnson 1980: 7–​ 8), which is more commonly reflected in conventional verbal expressions such as “you’re wasting my time,” “he’s invested a lot of time in this,” “I don’t have time to spare,” and “she’s living on borrowed time.” The notion of time as a valuable commodity that can be stolen is difficult to represent visually. In the accompanying image, the artist has instead drawn a clock face with curved hands that echo the shape of the scythe carried by “Father Time”; this is likely to trigger the rather different metaphorical notion of

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time as an agent that deliberately and maliciously cuts down all living things. The extract in Figure  2.4 from graphicmedicine.org founder Ian William’s semi-​autobiographical comic The Bad Doctor, which shows the main character Iwan’s exaggerated fears of death due to his worsening obsessive-​compulsive disorder (OCD), is a another good example of how the verbal and visual modes, as well as literal images, visual metaphor, and symbolism, may interact in graphic illness narratives. When the protagonist, Iwan, feels obliged by his superstitious beliefs to throw the beans he is cooking into the bin and go out to buy fish and chips instead, his irrational chain of thoughts is indicated through a combination of words and images. The written nouns (“crow,” “psychopomp”) and noun phrases (“omen of ill fortune,” “harbinger of death”) act as verbal anchors for the sequence of thoughts conveyed primarily through picture fragments of increasing size, arranged in an arc away from Ian’s forehead down to the saucepan. Due to our embodied knowledge of the effects of gravity on projected objects, Iwan’s twisted logic (the crow causes bad luck, which in turn poisons the beans) seems to make intuitive sense. The pentagonal frames carry additional connotations, which draw both on their conventional use as symbols of the occult and the way they have been used repeatedly in this same context throughout the book. The part-​iconic, part-​symbolic nature of a lot of written language in comics is most obvious in the case of words that form part of the world in which the story takes place, including signs, letters, documents, and inscriptions on packaging and clothes. In the example in Figure 2.4, the words on a poster and on a shop sign in the final two panels are part of the cityscape inhabited by Iwan. The tarot card featuring a drawing of a skeleton with a scythe and the word “death” performs a more complex role: As a figment of Iwan’s imagination, it is not part of the “real” world in which the story is taking place, yet it clearly seems real enough to Iwan to persuade him to act in a particular way. Thus, it could perhaps be described as belonging to the character’s internal storyworld. Other words in comics are written in a visual style that supports the illusion of a particular sound quality. Our ability to “hear” written language in comics depends on the human propensity for synesthetic perception, “a condition in which stimulation in one sensory modality also gives rise to an experience in a different modality” (Sagiv 2005: 3). “Real” synesthetes make up only a tiny proportion of the general population, although among creative people the incidence is thought to be much higher. Ramachandran

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Figure 2.4.  Williams, I. (2014) The Bad Doctor (p. 127). © 2014 Ian Williams.

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and Hubbard (2005: 169) hypothesize that synesthesia and an increased aptitude to create novel metaphors may be linked through the “deep architecture” of people’s brains: “[J]‌ust as synesthesia involves making arbitrary links between seemingly unrelated perceptual entities like colors and numbers, metaphor involves making links between seemingly unrelated conceptual realms.” However, all human beings can be described as synesthetes in the broader sense of the term, because we all tend to map properties from distinct sensory modalities in a non-​arbitrary manner onto each other. The famous “bouba/​kiki” experiments, for example, in which participants are asked to attribute one of these two invented words to either a softly rounded or a sharp-​edged shape, have yielded remarkably similar results across many different languages and writing systems. The “gentle curves and undulations of contour on the amoeba-​like figure,” Ramachandran (2011: 108–​109) explains, “mimic the gentle undulations of the sound bouba, as represented in the hearing centers in the brain and in the smooth rounding and relaxing of the lips for producing the curved booo-​baaa sound,” whereas “the sharp wave forms of the sound kee-​kee and the sharp inflection of the tongue on the palate mimic the sudden changes in the jagged visual shape.” According to Merleau-​Ponty (1962: 244), synesthetic perception is, in fact, the rule, not the exception, since our body is a “ready-​made system of equivalences and of inter-​sensory transpositions,” in which “visual and auditory experience, for example, are pregnant with each other.” The conscious experience of each sense in isolation only occurs in those rare moments when, rather than abandoning one’s whole body to the world, we turn toward the act of perception itself and consider what it is we are perceiving (1962: 235). Ingold (2000: 268) is also convinced that our sensory organs form one single unity within our body as it responds to its environment: “So if I hear the flight of birds it is because, following their course across the sky, the movement of my own body—​of my eyes, of my hand, indeed of my entire posture—​resonates with theirs.” Similarly, when we listen to live music while watching the movements of the musicians, we are engaged in a form of active listening that involves “hearing” with our eyes and “seeing” with our ears (Ingold 2000: 277). One theory is that we all experience our sense perceptions as a “primordial sensory soup” (Campen 2010: 160) when we are babies, but that these innate connections in the brain are gradually pruned back in most people as we are socialized into accepting whatever our culture defines as the norm and directing our attention accordingly:

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Most people are only familiar with a small number of provinces of the empire of the senses. It is as though your conscious perception were limited to a little garden in the middle of a jungle. You taste the five types of vegetables that you grow in the garden and overlook the exotic fruits in the surrounding jungle. (van Campen 2010: 157)1 However, the seeing we do with our ears and the hearing we do with our eyes may differ in kind from our more immediate sense perceptions. Mental images—​at least those generated when we are awake and not suffering from hallucinations—​are typically less distinct and detailed than actual visual perceptions, enabling us to distinguish between what we are actually seeing from our memories and fantasies (Breitmeyer 2010: 141). Similarly, as Ihde (1970, 2003) points out, “perceived” and “imagined” auditory experience are not identical: While perceived sound either floats “lazily” around us or intrudes on our consciousness, imagined sound tends to be more focused and under our active control. Thus, unlike the actual sound made by a crow smashing into the kitchen window, the sound evoked through the onomatopoeic word “BANG!” written diagonally over the head of the bird in large, bold, capital letters in Figure 2.4 is probably imagined by most readers as just a short, sharp thud that is isolated from any other ambient sound. In the case of speech balloons, the size, shape, color, and placement of the balloon itself may give additional paralinguistic information about the volume, pitch, intonation quality, or emotional timbre of the spoken words (Barker 1989: 11; Khordoc 2001). As Forceville, Veale, and Feyaerts (2010) point out, our ability to derive such abstract meanings from concrete visual qualities depends heavily on embodied experience. For example, sharp, spiky balloons, tails, and graphemes tend to connote anger and aggression, because we associate sharp, angular objects with potentially injury, while an imbalance of form may suggest, via analogy with our bodies in space, an imbalance in a character’s physical or mental state. Indeed, the authors suggest that the very notion of speech and thought balloons as visual containers for meaning may be based on what Reddy (1979) calls the “conduit metaphor,” according to which meanings are imagined as residing in “containers,” such as words and sentences, that move along channels from a sender to an audience when we communicate. In comics, the conduit metaphor is sometimes literalized for humorous/​rhetorical

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effect, for example, when speech or thought balloons press down on a character, cover other elements (including other characters’ balloons), are filled to the bursting point with repeated words, or break the frame of a panel. A particularly creative example of the use of balloons can be found in another extract from the Facts of Life by Paula Knight (Figure 2.5). When Polly complains to her husband that nobody seems to want to talk about her recent miscarriage, this is illustrated through the picture of several disembodied heads with no mouths, each of which is connected to an empty speech balloon. The following two panels show Polly first with a hugely inflated torso, filled with the thoughts and feelings that she is unable to share with others, and then puffing them all out into one giant speech balloon. The words are presented as a continuous block of text in a fluid, joined-​up handwritten style, which fills every available space right up to the edge of the balloon, without any gaps or punctuation. In this case, readers are encouraged to “hear” Polly’s inner voice and to imagine what it feels like to have so many jumbled-​up thoughts and emotions. The speech balloon is then transformed into a hot air balloon, in which Polly is shown floating over the Clifton Suspension Bridge, the scene of Europe’s largest annual meeting of hot air balloons. Two passersby decide to ignore it, dismissing it as being “common round here,” and so it drifts off into the sky, the words becoming ever fainter as Polly and her balloon are enveloped in the clouds. The third and fifth panels in this extract also contain instances of “pictorial runes” (Forceville 2011), a term that refers to any lines indicating movement, impact, emotion, or nonvisible perceptual qualities such as smells and temperature. Pictorial runes are another example of the close relationship between words and images in comics, since they are partly symbolic and partly iconic signs. They are symbolic in the sense that they rely heavily on readers’ familiarity with sociocultural conventions: In Japanese manga, for instance, the squiggles around body parts that indicate emotions are not identical to the ones used in Western comics (Abbott and Forceville 2011). They are also highly context-​dependent, with the same lines able to suggest either painful throbbing (e.g., Polly’s aching arms and wrists in Figure 2.2) or the sharp jolt and thud caused by a sudden impact (e.g., the crow smashing against the window in Figure 2.4), depending on the pictorial and narrative contexts in which they occur (see

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Figure 2.5.  Knight, P. (2017) The Facts of Life (p. 115). © 2017 Paula Knight. Permissions granted.

also Miodrag 2013: 183). However, the meaning of pictorial runes is not completely arbitrary, since they typically draw on parallelisms of attributes within our visual perception or across different sense perceptions. In the extract from The Bad Doctor (Figure 2.4), for example, the wavy lines above the saucepan represent heat, which is most likely motivated by our

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perception of steam rising from hot liquids, and the swirly shapes and lines indicating Iwan’s distress in the middle panel are reminiscent of the erratic, fluttering flight path of bats. In the extract in Figure 2.1, swirls and dots create a powerful sense of smell, by drawing on our experience of aromas wafting toward us in waves, or being carried on tiny particles of pollen in the air. When pictorial runes are used to represent emotions, the transfer of meaning typically involves more complex combinations of metonymy and metaphor. For instance, when anger is translated into jagged lines or spirals around a character’s head, this is probably based on a synesthetic metaphor that translates the experience of heat into particular visual shapes, which itself is based on the common conceptual metaphor anger is hot fluid in a container. Similarly, the tiny beads of sweat above the tortoise’s head in Figure 2.2 are able to suggest physical or mental effort, because we know from experience that our body temperature rises when we exert ourselves, which, in turn, may lead to sweat pouring off our foreheads. In relation to pictorial runes indicating motion, Potsch and Williams (2012) propose a useful distinction between “ribbon paths,” which suggest movement from one point to another from an outside observer’s perspective, and “motion lines,” where the movement of a character in the story toward or away from the viewer is implied. They believe that our interpretation of the ribbon behind an object or person in motion in terms of the path already traversed draws on the source-​path-​goal image schema (2012: 23), whereas the thin lines radiating outward from a central point that is the source or goal of movement simulate the effect of “optic flow,” “the expansion or contraction of the visual scene as the observer moves toward or away from the focal centre” (2012: 24; see also Kukkonen 2013: 20). Pictorial runes indicating speed and motion are less common in graphic illness narratives than in action and superhero comics, though they do sometimes occur. Figure 2.5, for instance, contains two instances of ribbon paths, although in the first case, we are dealing with a change in shape rather than in location: the multiple short, almost straight lines surrounding Paula’s hands and body in the third panel suggest the gradual expansion of her abdomen as it is filled with her unspoken words, while the three longer, parallel lines behind the hot air balloon in the fifth panel conjure up a smooth, swift movement from left to right and on an upward curve. A particular sense of motion, pace, and time can also be evoked in comics through the judicious use of sequence and spatial layout, as will be discussed in the following section.

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2.4.2. Sequence and Space The comics medium is also characterized by a relationship of tension between temporal sequence and space, resulting from the fact that unfolding events are broken down into individual images arranged in a sequence on the surface of the page or double page spread. Consequently, each single image in comics represents both “a ‘moment’ in an imagined sequence of events” and “a graphic element in an atemporal design” (Hatfield 2009: 139), inviting both a “successive or diachronic reading” and “a kind of global or synchronic look” (Genette 1980: 34). As I will show with reference to the following extract from David B.’s Epileptic (Figure 2.6), this unique medium-​specific affordance enables comics artists to translate the embodied experience of space into the arrangement of visual elements both within individual panels and on the whole page, which, in turn, may convey a range of subjective experiences of time and emotion, for example. The story revolves around the increasingly desperate attempts by the author’s parents to find a cure for his elder brother’s severe epileptic seizures.2 When the brother, Jean-​Christophe, reaches adolescence, he feels increasingly encumbered by the limitations his illness and the resulting disabilities impose on his daily life. In an attempt to assert his independence, he starts hanging out in the nearby town and visiting the local supermarket, often without telling anyone where he is going. The top panel in Figure 2.6 recounts one of these occasions. Discovering Jean-​Christophe’s absence, his mother sets off to try to find him, but he is already on his way home, and, suffering a seizure, falls by the roadside, where he is not visible to her as she drives past in the opposite direction. As I have argued elsewhere (El Refaie 2010a), this panel bears a striking resemblance to the subsection of an altarpiece by the mid-​fifteenth-​century Siennese painter Sassetta, The Meeting of St. Anthony and St. Paul. Art historian Steiner (2004) uses this painting as a prime example of a continuous narrative, in which the repeated representation of the same figure or figures against a unified background is used to convey a sequence of related events. In the painting, St. Anthony is shown in the top left-​hand corner, as he is setting out on a quest to find his fellow hermit, St. Paul. He reappears twice more at different points along a winding path, first in the middle of the painting, engaged in a conversation with a centaur, and then again in the bottom right-​hand corner, where he is depicted embracing St. Paul.

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Figure 2.6.  David B. (2005) Epileptic (p. 127). © 2005 L’Association.

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Although the drawing in Figure 2.6 is similar to Sassetta’s altarpiece with respect to its overall visual design, the story it tells is more complex. First, there are two separate chains of events, which, as we can infer from the text in the four textboxes, are actually moving in opposite directions. The depictions of Jean-​Christophe and his mother overlap at the bottom of the panel, but the figures are drawn in strikingly different dimensions, and they are facing in different directions, which makes it clear that their paths only intersect in the spatial but not the temporal dimension. Second, the road has taken on the features of a monster that holds Jean-​Christophe in its grip as he succumbs to the epileptic fit. This is a good example of the “reorientation” of metaphors (Biebuyck and Martens 2011: 64) that is common to graphic illness narratives, whereby what first looks like a literal reference or a metonym can later turn out to be a metaphor, or vice versa. Thus, what on the previous page (Epileptic, 126) was still just a literal road has now turned out to be the tail of a monster/​road hybrid, only to resume its literal signification as an ordinary road in the lower panels of this page. This snake-​like monster with a dragon’s head is by far the most common of several recurring metaphors used to represent Jean-​ Christophe’s disease throughout the book. Third, the boy is facing toward the left-​hand side, which, in the Western tradition, tends to be associated with the past (see Chapter 1, section 1.2). This sense of “moving backward in time” is also implied by the fact that, in order for the verbal narration to make sense, the text boxes must be read in a counterclockwise direction. Finally, unlike Sassetta’s painting, the image from Epileptic forms part of a sequence of panels, in which each one follows on from and leads on to the next. As Peeters (1991: 16–​21) points out, the sense that each comics panel is incomplete and represents an instant in a continuity is one of the crucial features of the comics medium that distinguishes it from the stand-​alone narrative painting, which, by contrast, forms its own, isolated time capsule. On the page in Figure 2.6, the three panels along the bottom of the page show Jean-​Christoph cycling into town and trying to make friends with much younger boys, who do not pay any attention to him, despite what he tells his family at dinner that evening. He is drawn from an angle that emphasizes his distance from the other children, and the left-​to-​right orientation and its association with goal-​directed action of the first panel in the bottom row is contradicted and canceled out by the opposite orientation of the following one, suggesting, once again, that Jean-​Christophe’s illness prevents him from truly connecting with other people and moving

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on with his life. The whole page also forms a cohesive overall design, with echoes of the black road/​monster hybrid from the top panel appearing in the bottom row of panels, initially as sections of the road or pavement and then, in the final panel, in the shape of the wood paneling along the wall of the dining room. Taken together, all these verbal and visual signs, the way they are arranged in each panel and on the whole page, and how they connect with similar visual themes throughout the book, convey very effectively the sense of Jean-​Christophe’s being trapped in an endless cycle of frustrated aspirations and despair.

2.4.3. Style and Materiality While in conventional comics the reader’s conscious attention is typically focused on the storyworld, many alternative comics are described as “metacomics” (Stevens 2009) in the sense that they deliberately draw attention to the material and sensual qualities of the book itself. This provides additional opportunities for the creation of embodied metaphors in this genre, as Figure 2.7, an extract from Ken Dahl’s Monsters, demonstrates. Monsters is the autobiographical account of the overwhelming sense of guilt and depression triggered by the protagonist’s realization that he carries the herpes virus and has infected at least one of his girlfriends. Having done his best to avoid even thinking about the problem for several miserable years, he decides to confront his fears and find out about the disease. This decision to finally take the plunge and get to the bottom of the disease is literalized by showing him diving headfirst into a fetid pool made up of giant blob shapes that represent the viruses; the bubbles formed as he swims toward the bottom of the lake function as a special form of ribbon path, suggesting the source, path, and goal of his literal and metaphorical journey. The verbal text (“Herpes:  A brief and confusing introduction”) visually echoes Ken’s downward motion through the way each word is arranged on a separate sloping line, with the emboldened capital letters of the word “Herpes” being followed by words of diminishing size, written in lower case glyphs. The black background of this page thus represents both water in the storyworld and a physical sheet of paper in a book, and metaphorical associations of up and down may be triggered in the reader not just by seeing Ken diving down into the lake in the unfolding events of the storyworld, but also by taking in the evident vertical orientation of the physical canvas space of the page.

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Figure 2.7.  Dahl, K. (2009) Monsters (p. 110). © 2009 Ken Dahl.

The double perception of the “virtual surface” and the “picture surface” applies to all types of visual representation (Gibson 1979: 283), yet it seems to be particularly foregrounded in the graphic pathography genre, for several reasons:  First, unlike sculptures or art installations, for example, the space of the comics page does not afford actual depth, although artists are able to evoke depth through stylistic means, including linear perspective, and the smaller size and occlusion of characters and objects in the background. This means that there is always a degree of tension between the two-​dimensional comics page and the three-​dimensional storyworld. Second, most comics are drawn, not painted. When we look at any type of pictures of concrete objects in the world, we tend to react “to the representation in ways that are analogous to reactions to the represented objects,” and to focus on their “aboutness” at the expense

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of their style (Massironi 2002: 77). However, unlike some forms of realistic paintings, which “compete with nature” by closely imitating the visible, drawings always retain their status as “only notes on paper” to some degree: The paper lends itself between the lines to becoming tree, stone, grass, water, masonry, limestone mountain, cloud. Yet it can never for an instant be confused with the substance of any of these things, for evidently and emphatically it remains a sheet of paper with fine lines drawn upon it. (Berger 2007: 50) The drawing style adopted by most alternative comics creators is not primarily about achieving an accurate representation of the visible outside world. Instead, these artists tend to lean toward a more cartoonish drawing style, which is characterized by a reduction in detail and complexity and the exaggeration of certain key features. Although, paradoxically, this style is often able to achieve a greater sense of likeness than a more realistic representation ever could, by avoiding “the illusoriness, the blinding, which likeness produces” (Scott 1999:  236), the resulting pictures are thus unlikely to be confused with the things they represent. Third, in autobiographical comics, in particular, the artwork represents a way for artists to make invisible aspects of their subjectivity visible (El Refaie 2010b; Etter 2017). Ingold (2013) makes a distinction between drawing styles that are mainly “propositional,” in the sense that their main purpose is to be about the things they depict (such as architectural drawings or instruction manuals for the assembly of furniture), and those that are “gestural” in nature (that is, they are intended to express the very gesture that created them). The latter, he argues, do not simply project a thought from our mind onto the page; rather, “both hand and head are together complicit throughout in the work’s unceasing generation” (2013: 127). The lines we see are the traces left by the hand of the artist that moves over the page at a particular tempo and rhythm, while applying more or less pressure: “These lines are both inspired by, and carry forth, our affective lives” (140). Handwriting is produced by the same gestures, which means that there is no need to “do two things simultaneously—​ look and read” when, as in most comics, we are confronted with a mix of drawn objects and handwritten words: “We need to do only one thing—​ follow the hand-​drawn line—​and if that line is a letter-​line of writing, then the words will ‘fall out’ from it” (130).

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Fourth, even if the visual style adopted in a particular comic is unusually “painterly,” realistic, and propositional, the multiple images, the addition of text boxes and speech balloons, and the gaps between panels inevitably foregrounds the materiality of the comics page to some extent. Indeed, one of the defining characteristics of alternative comics is that they typically include at least some self-​reflexive engagement with the tools, materials, and processes of their own creation, which inevitably draws further attention to the picture surface. As a consequence, the creators of graphic illness narratives are able to exploit the metaphorical meaning potentials of both the diegetic space and of the physical space of the page/​book. It is illuminating in this context to compare the hand-​rendered pictures and words in Figure 2.7, which are intensely evocative of the nature and intensity of the emotions the artist was experiencing as he was drawing this page, with the artwork in German artist Reto Gloor’s (2015) graphic memoir about the impact of multiple sclerosis (MS) on his life (Figure 2.8). As the symptoms of this progressive neurological disorder worsen, Reto loses his ability to draw, which, the narrator explains, “shook the foundations of my very existence” [“was meine Existenz in ihrer Grundlage erschütterte”]. These verbal reflections are accompanied by a series of self-​portraits, which were created digitally through the image-​editing software he eventually learns to use as an alternative to hand-​drawing. In the first, we see a simple head-​and-​shoulder view of Reto against a white background; his eyes are wide open and he is staring into the distance. In the second and third image his eyes are shut, and the pictures seem to be fading more and more into the gray background. The final panel shows just a faint outline of his head and shoulders in white against a uniform black background. Reto’s loss of his fine-​motor control and, on a more abstract level, of a central aspect of his self-​identity, is thus represented through the explicit visual metaphor of him shutting his eyes, followed by the gradual dissolution and disappearance of his bodily presence. Additionally, the visual style itself functions as a metaphor for Reto’s inability to express his unique experience, since the computer-​generated text and images are clearly an inadequate substitute for what Gibson (1979: 275) calls the “fundamental graphic act,” “the making of traces on a surface that constitute a progressive record of movement.” In some cases, the creators of graphic illness narratives also insert other media, such as medical reports, or images produced by microscopic

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Figure 2.8.  Gloor, R. (2015) Das Karma-​Problem (p. 63, detail). © 2015 Verlag bbb Edition Moderne AG.

and digital-​imaging technologies, into their texts. This technique, which often involves playing these inserted documents and images off against the comics medium in a way that highlights their distinct affordances, is sometimes described as “hybridity” or “intermediality” (Rippl and Etter 2013; Vandermeersche and Soetaert 2011), although I  prefer the term “heterosemiosis,” which I  have defined elsewhere as “the explicit mixing of different meaning resources for rhetorical purposes” (El Refaie 2014b: 21). In her memoir about her treatment for breast cancer, Cancer Vixen, for example, Marisa Marchetto (2006: 1) includes a sonogram of the tumor (see Chapter 4, Figure 4.1) on the first page of her book. It is placed at an angle and underlain with a shadow effect, which creates the impression that it has just been placed on top of the surface of the page, from where it could be picked up and handled as a separate, tangible object. Later in the book, the artist sets up an explicit three-​way analogy between opening a door, turning a page, and repeating an experience. On the page preceding her detailed portrayal of the mind-​numbing routines and procedures involved in radiation therapy, she has drawn a large gray

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door with a sign saying, “Danger:  Radiation” and an arrow with the instruction to the reader to “[t]‌urn page to open door and do it 33 times” (2006: 195). Although readers are, of course, not really expected to follow these instructions, Marchetto has very skillfully drawn attention to the materiality of the comic book and the embodied processes involved both in creating and reading works like this. Every individual work in my corpus is unique in some respects, depending, for instance, on the specific nature of the illness that is being described, the particular circumstances of the artist’s illness experience, and his or her individual drawing style. And yet, as I have shown in this chapter, the specific thematic focus in these books on the body, and the way they all exploit the affordances of the comics medium, means that they must be considered to constitute a separate, basic-​level genre, which engages our sensorimotor experience in distinctive ways. As a consequence, metaphorical concepts are likely to be represented in at least fairly predictable ways across all the works under consideration. The following chapter is dedicated to identifying and categorizing the prototypical forms and functions that visual metaphors have in graphic pathographies.

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that the genre conventions of the graphic illness narrative generate a particular form of engagement with the body, which in turn shapes the metaphors that authors/​artists use in their work. Building on these ideas, the current chapter develops a novel tripartite taxonomy of visual metaphors in the graphic pathography genre, based on the systematic search for patterns of use across the works in my data set. This raises an important issue:  As was discussed in Chapter  1, the creation and appreciation of novel metaphors, in particular, appears to be heavily dependent upon the kind of flexible, intuitive attention to things in their wider context that is characteristic of the right brain hemisphere (McGilchrist 2009). By contrast, when the aim is to try to pin down, label, and categorize metaphors, we must rely on the left hemisphere, which is specialized in “wresting things from their context” through the process of abstraction (McGilchrist 2009: 50). For this reason, the close attention to individual examples always runs the risk of destroying the very phenomenon we are seeking to capture, by reducing the unique coming together of two entirely different experiences that “are felt in our embodied selves as sharing a common nature” (McGilchrist 2009: 117) to something that is unambiguous and already familiar: IN CHAPTER  2, I  ARGUED

Many things that are important to us simply cannot withstand being too closely attended to, since their nature is to be indirect or implicit. Forcing them into explicitness changes their nature

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completely, so that in such cases what we come to think we know “certainly” is in fact not truly known at all. (McGilchrist 2009: 180) On the other hand, there is value in trying to find regular patterns in the phenomena we encounter; without this process of abstraction, we are not able to generalize and thus to advance human knowledge. There is a wealth of empirical data to suggest that, in our normal, everyday experience, whatever is new is typically presented first to the right brain hemisphere for processing, before being processed further in the left hemisphere and finally returning to the right for the purposes of (re-​)integration into the whole context. This “hierarchy of attention” suggests that the right hemisphere performs both an initially grounding role and an ultimately integrating role, “with whatever the left hemisphere does at the detailed level needing to be founded on, and then returned to, the picture generated by the right” (McGilchrist 2009: 46). In my view, this right → left → right progression provides an effective model for the analytical process: By starting with the complete work and allowing metaphorical meanings to rise unimpeded to the surface of the narrative, and then, after examining individual examples in detail and grouping them together according to abstract criteria, reintegrating them into their original contexts, I hope to evade the danger of ruining whatever it is that makes metaphors so alive and compelling in the first place. Thus, although the present chapter focuses on describing the analytical, left hemisphere part of the process, I will always endeavor to take into account the role of individual metaphors in the overall narrative, and make sure to acknowledge ambiguity instead of trying to force “betweenness” (McGilchrist 2009: 31) into being one thing or another. The extract in Figure 3.1 from Swallow Me Whole, by Nate Powell (2008), will serve to illustrate the many different forms that metaphor may take in graphic illness narratives. It tells the story of Ruth and her twin brother, who are growing up with a form of mental illness that causes them both to have terrifying hallucinations. The page in Figure 3.1 is taken from the final pages of the book. Ruth is obsessed with insects, but the substantial collection of specimens she has assembled in her bedroom has just been removed surreptitiously by her parents while she was out. Her fragile mental equilibrium is disrupted by this intrusion, and she suffers a severe mental breakdown. The drawings show her sitting on her bedroom floor, to all appearances relaxed and unperturbed, while a swarm of insects and several frogs are

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Figure 3.1.  Powell, N. (2008) Swallow Me Whole (n.p.). © 2008 Nate Powell.

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forcing their way through the bedroom window and an air vent in the ceiling, with the frogs adopting distinctly anthropomorphic behaviors as they push open the window frame. The room—​and, by implication, Ruth’s head—​is filled with the screeching and buzzing of millions of tiny creatures. On the following pages, the insects start piling up around her, gradually engulfing her whole body, until only the top of her head and her eyes are visible in the mass of tiny insect corpses. Out of this quagmire, the Amazon Queen Bullfrog, which Ruth recently stole from the natural history museum and which has now grown to a monstrous size, emerges and swallows her up. While for her these hallucinations are a distressingly real and “literal” part of her life, for the reader they are a powerful metaphor for what is going on inside her mind. The question addressed in this chapter is how such metaphorical meanings are conveyed to readers in the graphic illness narrative genre. By far the most comprehensive and influential taxonomy of visual metaphors was developed by Charles Forceville (1996, 2002, 2007, 2009). It has since been applied to a range of different visual genres, but most frequently to advertising.1 He has identified several different types of what he terms “pictorial” metaphor, which all involve establishing relationships of equivalence between two or more distinct concrete entities through specific formal cues, such as fusing the two things together (“hybrid metaphor”), presenting them side by side in a way that draws attention to their likeness (“pictorial simile”), or placing one of the things in a context where we would normally expect the other to be (“contextual metaphor”). Examples of all these forms of pictorial metaphor can be found in my corpus. However, their precise forms and communicative functions often diverge in significant ways from the examples discussed by Forceville. The insects and anthropomorphized amphibians in Figure 3.1, for instance, could be described as a type of contextual metaphor, as they are clearly incongruous in the context of the otherwise realistic storyworld set up by the narrative, yet they do not involve the mapping of meaning from one concrete entity to another, as mental illness is not something that can be visualized literally at all. There are also some pictorial metaphors in graphic illness narratives that do not fit into any of Forceville’s categories, including instances of what I  shall call “body modification,” in which (parts of) the human body are represented in an altered or distorted shape in order to evoke metaphorical meaning. Moreover, pictorial metaphors are not the only—​ nor indeed necessarily the most common—​ forms of visual metaphor in the works

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under consideration. For example, Ruth’s sense of terror and confusion is conveyed not just through the concrete image of frogs and insects invading her bedroom, but also through the way the buzzing sound is evoked by means of a ribbon of onomatopoeic words that gradually grows in size and thickness as it snakes its way from the air vent at the top of the page, diagonally across the two rows of panels, and down to the bottom right-​hand corner. In addition, the way these words transgress the panel borders implies an experience that is so overpowering that it cannot be controlled or contained. In two of the panels, Ruth is facing toward the left-​ hand side, which in our left-​to-​right script culture is subconsciously associated with the past. In the third panel, she is shown from a close distance, turned toward the reader. This, according to social semioticians (Feng and O’Halloran 2013; Kress and van Leeuwen 2006), encourages us to feel a sense of closeness and involvement with the depicted person, based on our real-​life experience of the use of space in interpersonal relationships. However, her face is blank and her eyes are firmly shut, which invites the reader to try to enter her mind and imagine what is going on there. Finally, the artist has used the two-​dimensional space of the page layout to represent both the three-​dimensional setting of the action in the storyworld (in this case, Ruth’s bedroom, which is being invaded by the outside world) and the invisible, multidimensional universe of Ruth’s thoughts, feelings, and sensations. As the reader’s attention is drawn from the surface of the page into the bedroom, from the bedroom into Ruth’s mind, and then back again, these three spaces become inextricably linked. Such metaphorical meanings, I  will argue, are based on the experience of our own bodies in space and in relation to other people, creatures, and objects, which is why they will be referred to as “spatial” metaphors. Although other scholars from various disciplines have noticed instances of this form of visual metaphor in a variety of visual and multimodal genres, including artworks (Parsons 2010), newspaper layout (Huxford 2001), and the cinema (Coëgnarts and Kravanja 2012; Ortiz 2011; Winter 2014), their discussions of the phenomenon tend to be quite narrowly focused and unsystematic. The present study addresses gaps in the existing literature by detailing several relevant aspects of embodied spatial experience and drawing a distinction between spatial metaphors in the layout of the page, in the storyworld, and in the relationships between the depicted characters and the reader. Spatial metaphors also need to be distinguished from what I shall call “stylistic” metaphors, which use formal features such as brightness, color,

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form, level of detail, and quality of line, as well as actual or implied material qualities of the page or the whole book, to indicate an abstract concept or a nonvisual sense perception. Instances of stylistic metaphor can be identified in both images and written words. For example, in Figure 3.1 the black background draws on universal associations with darkness, while the increasing size and spiky, overlapping, irregular shapes of the written words emphasize the excruciating nature of the buzzing sound in Ruth’s head, referencing, through synesthetic analogy, the damage that large, sharp objects are liable to cause. In the following discussion, I consider pictorial, spatial, and stylistic metaphors in turn. As I  will show, the intricate blending of different types of visual metaphor that has been identified in the extract from Swallow Me Whole is commonplace in many graphic pathographies.

3.1. Pictorial Metaphor Forceville’s taxonomy (1996, 2002, 2007, 2009), which was developed mainly with reference to advertisements, distinguishes between “hybrid metaphor,” “pictorial simile,” “integrated metaphor,” “contextual metaphor,” and “verbo-​pictorial” metaphor (see also El Refaie 2017). In the case of hybrid metaphors, two entities are fused into one overall figure, whereas in pictorial similes they are depicted separately, but in a way that strongly suggests their equivalence. For example, the equivalence between a car and a panther may be implied through the creation of a hybrid car-​panther form, or by depicting the two side by side in the same size and from an angle that accentuates preexisting similarities of color and shape. The term “integrated metaphor” is used to describe instances where an object is represented in a way that strongly suggests a different entity, whereas in contextual metaphors only the source or the target is depicted in a setting where we would normally expect something else. An example of an integrated metaphor is the depiction of a tie in such a way that viewers are reminded of a snake slithering down a man’s chest. Alternatively, in a contextual metaphor an advertisement might show a male torso adorned with a shoe in place of a tie, which invites the viewer “to perceive the phenomenon SHOE not in its usual, ‘literal’ sense, but in terms of the very different phenomenon TIE” (Forceville 1996:  109). Verbo-​ pictorial metaphors, finally, require language for metaphorical meaning to emerge: a picture of a naked body with insects crawling all over it, for instance, is transformed into a metaphor through the addition

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of a verbal caption that compares the represented predicament to the discomfort suffered by people with skin disease. Before readers are able to realize that a picture of a concrete thing has a meaning beyond what it literally denotes, they must thus be alerted to the metaphorical reading by some kind of cue. Such cues can be very explicit and hard to miss, or rather subtle and implicit; and they may be verbal, pictorial, or a combination of both. Pictorial metaphors are the visual equivalents of instances in verbal language that have been termed “resemblance” metaphors by Grady (1999) (e.g., “My bicycle is a horse”). They are less constrained by embodied experience and often are more creative and idiosyncratic than the type of embodied “correlation” metaphors that have always been the focus of CMT (Grady 1999). In advertising, the prototypical purpose of a pictorial metaphor is to render a familiar product—​such as a loaf of bread, a car, a watch, or a bank account—​strange and wonderful by linking it with an object, creature, or situation that carries powerful, positive cultural connotations and which we would not normally associate with whatever is being promoted. As was demonstrated in Chapter 2, some metaphors in graphic illness narratives are similarly designed to make the apparently ordinary appear extraordinary, but others (also) fulfill a different function, namely to help readers understand the emotional, social, and cultural impact of illness on sufferers and their families, by appealing to our shared embodiment. Moreover, when pictorial metaphors are used to represent the protagonist’s “conceptual universe” (Freeman 2000: 267), it can become virtually impossible to distinguish between the literal and the metaphorical. This narrative technique is particularly common in works about certain forms of mental illness and dementia, which tend to disrupt sufferers’ ability to distinguish clearly between their hallucinations and reality (as in Swallow Me Whole, for example). Finally, in graphic illness narratives, metaphors always occur in the context of a complete story, where they may form patterns or clusters, interact with other rhetorical tropes, and shift, expand, or contract in terms of the range of meanings they are able to convey. So, although examples of all the types of pictorial metaphor identified by Forceville can be found in my data set, they often convey more diverse and complex meanings than their equivalents in advertising. Hybrid metaphors were, in fact, first described not in advertising but in political cartoons and the cinema. Art historian E. H. Gombrich (1971:  134) remarked that in many portrait caricatures the face of a

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particular politician is visually amalgamated with the body of an animal, which encourages viewers to attribute stereotypical characteristics of the animal to the politician. Similarly, Carroll (1994:  214) identified instances in the cinema where a shot of one entity gradually dissolves into an image of a different kind of entity, so that for a moment the two are blended together in a form of “superimposition,” or “fusion,” of “physically noncompossible elements” from two separate areas of reality into a unified whole. In Fritz Lang’s classic film Metropolis, for example, a shot of a gigantic machine is blended with the image of a monster devouring the workers: “The machine, or at least parts of it, have been transformed into parts of a monster, Moloch. Nevertheless, the machine is still recognizable as a machine. The monster elements and the machine elements are co-​present—​or homospatial—​in the same figure” (Carroll 1996:  810). This, Carroll argues, invites us to regard factory machines as man-​eating monsters and, more broadly, to consider the plight of factory workers. Although it is possible to find instances of hybrid metaphors in graphic illness narratives, the transfer of meaning from one object to another that they invite is typically subtler and more multifaceted than the majority of the examples identified in advertising, cartooning, and film. The following extract from Aliceheimer’s: Alzheimer’s Through the Looking Glass, by Dana Walrath (Figure 3.2), shows the author’s mother, Alice, who is in the advanced stages of Alzheimer’s, with some of the physical features that are conventionally attributed to the devil. However, as the verbal commentary makes clear, this metaphor is not intended to suggest that Alice is in any way devilish; in fact, Dana has very tender feelings toward her mother, and the whole book is a testament to how the illness may sometimes help to reveal positive aspects of a person’s character that were previously hidden by complicated family dynamics. Instead, the depiction of Alice with devil’s horns and hooves is meant to convey the way she feels about herself. The accompanying text explains that Alice called on her daughter to comfort her, because she was convinced that she had grown hooves and horns. When Dana asks if she is feeling bad about herself, her mother worries that “I wasn’t very nice. I wish I had done better” (33). On this particular occasion, Alice’s bad conscience has been triggered by memories of her difficult relationship with her sister. Like hybrid metaphors, pictorial similes do occur in graphic illness narratives, but their function is often more multilayered than it is in other

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Figure 3.2.  Walrath, D. (2016) Aliceheimer’s (p. 32). © 2016 Dana Walrath.

genres. Pictorial similes, which are sometimes discussed under the alternative labels of “symmetric image [object] alignment” (Ortiz 2010; Schilperoord, Maes, and Ferdinandusse 2009; Teng and Sun 2002)  or “juxtaposition” (Gkiouzepas and Hogg 2011), are metaphors in which both the source and target are depicted in their entirety as two separate entities, albeit in a way that highlights their similarity. As Schilperood, Maes, and Ferdinandusse (2009:  158) point out, the resemblance can either be inherent in the two objects or created through the manner in which they are presented. The authors distinguish between the entities’ “object-​ constitutive attributes,” including size, shape, color, and texture, and their “object-​depictment attributes,” which relate to their manner or representation, such as the background, lighting, spatial alignment, and distance from the viewer. These latter attributes are derived from the Gestalt principles of similarity and proximity, which are thought to guide the way we group perceptual elements in our environment together based on how similar they look or how close they are to each other (Kimball and Hawkins 2007; Zakia 2002).2 Other relevant Gestalt laws are symmetry, continuity,

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and common region, according to which items tend to be regarded as belonging together if they are presented in a symmetrical order, continue a pattern or direction, or share a common background or bounded area (see El Refaie 2015b). A case in point is the way the artist’s pen and the demon’s pitchfork are represented in the extract from Peter Dunlap-​Shohl’s (2015: 40) graphic memoir about his struggle with Parkinson’s disease, My Degeneration, which was discussed in the Introduction to the present book (see Figure I.1). In this example, the preexisting correspondences in terms of their object-​constitutive attributes (i.e., both have a handle on one side and one or more sharp edges on the other) are highlighted through their object-​ depictment attributes, including their parallel orientation and similar size, as well as the fact that they are both contained within the same panel. The following page from Dad’s Not All There Any More, Alex Demetris’s (2016) account of his father Pete’s gradual decline as a result of a combination of Parkinson’s disease and dementia, also contains what looks at first glance like a straightforward case of a pictorial simile (Figure 3.3). In this extract about Pete’s increasingly frequent hallucinations, father and son are looking through the window at the same scene. The second panel shows the closed sun-​umbrella on a flat roof opposite as seen by John, the author’s autobiographical alter ego, while on the right-​hand side the artist has drawn—​in the characteristic pale pink hue that he uses throughout the book for this purpose—​the father’s perception of the same object as the Virgin Mary.

Figure 3.3.  Demetris, A. (2016) Dad’s Not All There Any More (n.p.). © 2016 Alex Demetris.

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In this case, the author clearly does not intend the visual similarity between the two entities to be taken as an invitation to search for other characteristics they may have in common. Instead, its main purpose is to give readers an insight into the world as John imagines it might be perceived by his father. In this context, it is precisely the fact that the folded sun umbrella and the Virgin Mary do not have anything obvious in common that reveals the strange, frightening, but also darkly humorous nature of Pete’s hallucinations; this intended meaning is emphasized by the ironic labels (“JohnVisionTM” and “PeteVisionTM”) that are attached to the panel halves. John’s comment to his father (“I see your point, though”) reflects our firm cultural belief in the links between seeing and knowing. By not only imagining but also visually depicting the father’s view of the world, the artist is thus trying to empathize with him and to foster among his readers a greater understanding of people who are suffering from similar conditions. Because of the sequential nature of comics, artists also have the option of evoking metaphorical meaning by showing the gradual transformation of one concrete object into another, rather than just presenting the two side by side. Examples of this particular form of what might be termed “transformational” metaphors may be found in Ken Dahl’s (2009) Monsters, about his overwhelming feelings of shame at carrying the herpes virus (see also Chapter  2, Figure  2.7). The autobiographical protagonist becomes so obsessed with the idea of his body as a container full of polluting matter that he begins to see virus-​shaped blobs everywhere. On page 22 of Monsters, Ken is shown kneading dough in the pizza shop where he works, when he receives a phone call from his girlfriend to tell him that she has herpes. In four panels on the following page, he is standing immobile with the receiver in his hand, stunned by the realization that he must have infected her. Meanwhile, the dough gradually breaks up into smaller balls, which take on more and more of the visual features of what he imagines the herpes virus to look like, before rising up and covering him. In another multi-​page sequence (60–​64), the sun morphs bit by bit into a round virus-​shaped blob that descends from the sky to loom over and envelop first Ken’s head and then his whole body. Again, we are not really being encouraged to see pizza dough or the sun as anything like the herpes virus; rather, these transformational metaphors are meant to show Ken’s obsessive thoughts and fears. It is also possible to find a few instances in graphic illness narratives of what Forceville calls “integrated” metaphors, where “[a]‌phenomenon that is experienced as a unified object or gestalt is represented in its entirety in

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such a manner that it resembles another object or gestalt even without contextual cues” (2007: 18). In advertising, the direction of meaning transfer from a source to a target is generally very clear, but this is not necessarily the case in other genres. I prefer to use the term “ambiguous” to refer to such metaphors, because they call to mind the figures invented by Gestalt psychologists in the first half of the twentieth century, such as the Necker cube and the duck-​rabbit, which can be seen in two separate, incompatible ways, but only in one version at a time (see also Müller 2008: 24). An example of an ambiguous pictorial metaphor can be found in Black Hole, a dystopian tale by Charles Burns (2005) about a group of American teenagers who are beginning to explore their sexuality under the shadow of a mysterious sexually transmitted disease, which causes a range of disturbing symptoms, such as sprouting horns, tails, warts, webbed hands, molting skin, and additional mouths. Right from the start of the story, human bodies and vegetation are linked together. The first intimation of this association occurs in the second chapter of the book, where the male protagonist and his friends have retreated to some woodland in order to smoke cannabis and to discuss sex and the first rumors of sickness among their classmates. At one point, the group of friends is seen from a distance, framed by two tree trunks leaning apart in a V-​shape (n.p.). By the time we encounter a similar image again, some 80 pages later, the trees and the bush beneath them have assumed more explicit sexual connotations. At the bottom of each of the three narrow vertical panels we see Keith smoking a joint with some friends and drug dealers. In his mind, however, he is back in the woods, where he chanced upon Chris, a girl he has been admiring from afar. In the third panel, Chris’s naked torso has appeared between the two angled tree trunks, which now strongly recall the thighs of a woman. Another 16 pages later, this ambiguous image is repeated in a scene in which the protagonist is in bed with a girl called Eliza, while still fantasizing about Chris (Figure 3.4). As is the convention throughout the book, the wavy panel outlines in the top two-​thirds of the page indicate that we are being shown a character’s thoughts, dreams, or memories. The page is again split into three long, vertical panels. In the upper part of the first panel Chris’s naked torso is depicted lying on the ground. As we zoom out from this scene and into the second panel, we see her from a greater distance through what might still conceivably be interpreted as a gap between two trees, but this time the resemblance to a woman’s parted legs and pubic hair is unmistakable. In the final vertical panel, we have moved in even closer and are introduced

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Figure 3.4.  Burns, C. (2005) Black Hole (n.p.). © 2005 Charles Burns.

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to a different ambiguity. Our first assumption might be that it is a male hand reaching out to touch the female sexual organs. However, the image of the couple at the bottom suggests that Eliza is the active partner, whose left hand has disappeared from view in the final panel. Moreover, the long, tapering shape hanging down from the top of the second panel, which initially appears to be designed to draw in metaphorical associations with a penis, turns out on the following page to be Eliza’s tail, which she has grown as a result of her infection with the mysterious virus. As we observe this unsettling image, the mind keeps flipping between the expected and the unexpected, male and female, active and passive, the healthy and the sick. This shows that ambiguous pictorial metaphors in graphic illness narratives tend to fulfill a more complex role than in advertising, for example, where the communicative purpose is generally much more straightforward. The same is often true of contextual metaphors, too. In Forceville’s taxonomy, this type of metaphor is characterized by the source or the target being depicted in a context in which we would normally expect something different; the replacement of the anticipated element with an incongruous one encourages viewers to interpret one thing in terms of another. Two reasonably straightforward instances of this can be found in Matt Friedman’s (2014: n.p.) graphic journal about his grueling experience of suffering from cancer of the tongue. On the 29th day of his treatment, his whole mouth feels so sore that he visualizes his tongue as “a wounded squirrel hiding from dogs behind a tree,” and as “St Sebastian shot full of arrows.” The accompanying sketches show his open mouth with a squirrel or St. Sebastian where his tongue should be. Although in these cases the metaphor is expressed both verbally and visually, the verbal explanations are in fact superfluous, as the substitution of something unexpected for the tongue is sufficient to invite a metaphorical interpretation. A contextual metaphor involving a mouth also features in Katie Green’s (2013) autobiographical work about her eating disorder, Lighter Than My Shadow, albeit here the mouth represents the source rather than the target of the metaphor. Having suffered from anorexia for most of her teenage years, Katie finds herself succumbing in young adulthood to bouts of uncontrolled binge eating. In the extract reprinted in Figure 3.5, the artist has depicted herself twice on the same page. At the bottom, her tiny, emaciated body is shown standing in front of a kitchen counter covered in open packets of biscuits and other snacks; a small hole in the area of her stomach indicates her insatiable hunger. Hovering above her head and enveloped by a cloud of black squiggly lines, which are used throughout the book to

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Figure 3.5.  Green, K. (2013) Lighter Than My Shadow (p. 350). © 2013 Katie Green.

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represent Katie’s negative emotions, is a second self-​portrait. Here, the young woman’s abdomen has been replaced by a giant, gaping, bottomless pit of a mouth, into which she is tipping whole packets of food. This visual metaphor conveys effectively the toxic mixture of longing, self-​disgust, and powerlessness that many people suffering from bulimia experience. This example fits Forceville’s definition of a contextual metaphor, in the sense that it is based on the replacement of an expected element (Katie’s abdomen) with an unexpected one (the giant mouth).3 However, as I mentioned earlier with reference to the swarm of insects in Swallow Me Whole (Figure 3.1), it is quite common in graphic illness narratives for an object or creature to invite a metaphorical interpretation by appearing in some way out of place or incongruous in its context, but without it necessarily replacing a more expected, concrete item. The swarm of insects and giant frogs are an expression of Ruth’s intangible and invisible fears, for instance; they do not replace something else that would have been more congruous in this context. Indeed, even the notion of congruity as a marker of metaphoricity is not as straightforward as it may seem at first glance. Forceville (1996: 143) suggests that, of all the different types of pictorial metaphor, visual hybrids are signaled most clearly, since the fantastical figures they create contradict our expectations of what the world is like and thus leave the viewer no choice but to understand one thing in terms of another. Pictorial similes, in contrast, merely “invite” a metaphorical interpretation, particularly if there is also a plausible literal explanation for the combination of the two entities. Pursuing a similar line of argumentation, Gkiouzepas and Hogg (2011: 105–​106) propose that the juxtaposition of two different things may be more or less explicitly metaphorical, depending on “the extent to which the relation between the two objects complies or fits with real-​life visual experience”: In cases of “realistic symbiosis,” there is a perfectly plausible real-​life scenario that is able to account for the combination of two objects, whereas “replacement” refers to cases in which one visual element intrudes on a scene where it is not expected, and “artificial symbiosis” is based on an entirely unrealistic concurrence of objects. However, in many stories told through the comics medium, the distinction between what is and is not “expected” or “realistic” is less clear-​cut than in advertising. As Busselle and Bilandzic (2008:  273) point out, “within the confines of a clearly unrealistic genre or story world” we are generally perfectly willing to accept even the most improbable objects and characters as congruous, provided the storyworld is internally coherent and logical. Conventional

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children’s comics, for example, have a long tradition of telling stories involving monsters, superheroes, and talking animals of all kinds, none of which is necessarily intended to be read as a metaphor. In the graphic illness narrative genre, by contrast, artists typically use fantastical elements much more sparingly and almost invariably in a context that invites a nonliteral interpretation of some kind. A  scene from Frederik Peeters’s (2008) Blue Pills, an autobiographical comic about the author’s love for an HIV-​positive woman, Cati, may serve as an example. The couple has gone to see their doctor, as they are worried that Frederik may have been infected when the condom he was using tore during intercourse. On page 119 we see the doctor examining Frederik and reassuring him that, provided he has no lesions on his genitals, he has “as much chance of catching AIDS as you have of running into a white rhinoceros on your way out.” On the following page (Figure 3.6), a huge white rhinoceros has appeared behind Frederik and Cati in the consultation room; both the couple and the animal are staring at the doctor with a look of alarm on their faces. Frederik seeks reassurance that “[t]‌he circus isn’t in town . . . right?” and, in the final panel, the creature seems to be rising up into the air behind the couple’s backs, suggesting perhaps that they are “letting go” of some of their most pressing concerns. Later in the story, it reappears in two scenes and is shown as following Frederik around town (Peeters 2008:  123, 146). Even without the verbal anchorage provided on the page preceding the rhinos’ first appearance, readers would most likely realize that it is meant to be interpreted as a representation of Frederik’s anxieties, rather than as a literal fact, since it clashes with the otherwise realistic nature of the story world set up by the author of Blue Pills. The artist has thus found a striking visual way to convey the fear of infection that is constantly on the couple’s mind, and, more broadly, to show how doctors’ and patients’ perceptions of risk may diverge considerably. Particularly when a scenario is not in itself overtly incongruous or unrealistic, aspects of style and page composition may also play an important role in suggesting whether or not something is intended to be understood literally or nonliterally. Ng and Koller (2013) argue that a metaphorical interpretation is encouraged when images are designed in a way that downplays their literal, denotative meanings and foregrounds their more abstract connotations. This may be achieved, for instance, by blurring or removing background detail, or by manipulating the colors. In those visual media that use multiple,

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Figure 3.6.  Peeters, F. (2008) Blue Pills: A Positive Love Story (p. 120). © 2008 Frederik Peeters; English translation © Anjali Singh.

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sequential images, such as the cinema or comics, the repetition of related images may also highlight their potential for metaphor. Occasionally, an unrealistic scenario or mini-​narrative is extended over several panels or even pages of a graphic pathography, often in the context of a dream, fantasy, or hallucination; in such cases, the overarching narrative context will suggest whether the inserted scenario is meant to be interpreted metaphorically or not. Several examples of this technique can be found in Rachael Ball’s (2015) fictional graphic novel The Inflatable Woman, about a young zookeeper, Iris, who develops breast cancer (see also Chapter  4, Figure  4.8). The story is highly fantastical in many respects—​penguins are able to speak, sing, dress up, and play instruments, for example—​yet these antics form a normal part of the way things are in this particular storyworld. By contrast, several of Iris’s dreams, paranoid hallucinations, and daytime fantasies are clearly intended to be interpreted metaphorically in the context of the overall plot of the story. For example, the book starts with a dream sequence (2015: 8–​15) in which Iris is on top of a hill, taking her clothes from the washing line because a storm is brewing. A horde of stick figures rushes past her in a panic, warning her that “it’s coming” and urging her to run away with them. Iris insists on gathering in her clothes first, but, before she can finish, a giant, spherical rock rolls on top of her and squashes her flat. The final image shows the rock balanced on top of the hillock, which has the word “ring” written in large, capital letters across it; we then see a picture of an alarm clock ringing loudly. Given that this is the morning on which Iris is to discover a lump in her breast, the dream scenario of being hit by a giant rock takes on metaphorical associations, particularly as the final image of the hill faintly resembles a breast and nipple. Drawing on Crisp’s (2008: 292) definition of an allegory as a special kind of extended verbal metaphor in which all language “refers to or characterizes a fictional situation that itself then functions as the allegory’s metaphorical source,” I will use the term “pictorial allegory” to label extended visual metaphor scenarios such as the one described in the preceding. In other cases, the pictures are completely reliant on verbal text for their metaphorical potential; thus they fall into the category that Forceville has termed “verbo-​pictorial” metaphors. The image of a cat and dog fighting in Dana Walrath’s drawing of her mother (Figure 3.2), for example, would probably be regarded by most readers as an entirely literal representation of family pets, were it not for the verbal explanation that “Alice and her sister sublimated their sibling rivalry into their respective preferences for

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cats + dogs,” which invites us to see the depicted scene of fighting animals as representing the squabbling sisters. In this instance, only the source of the metaphor (the fighting cat and dog) is conveyed visually, while an understanding of the target (the sisters’ antagonistic relationship) depends upon the verbal cue. In some cases, written text—​individual letters, words, or whole text lines or blocks—​may itself take on explicitly pictorial features, in the sense that they are made to look like a recognizable creature or object, which in turn may add metaphorical meanings to an image. Building on Stöckl’s (2005:  207) notion of “typopictoriality,” which he uses to refer to any “graphic qualities” of type that have “pictorial dimensions,” I will use the term “typo-​pictorial” metaphor to describe any instances in which handwritten or printed words, and/​or the balloons that contain them, assume a concrete form in the storyworld. We have already encountered one example in Chapter 2 (Figure 2.5), where, in Paula Knight’s (2017: 115) The Facts of Life, the autobiographical protagonist’s unspoken thoughts and worries about her fertility problems form the shape of a speech balloon, which then morphs into a hot air balloon that carries her off into the distance. Another striking example of a typo-​pictorial metaphor can be found in Miriam Engelberg’s (2006: n.p.) graphic memoir about breast cancer, Cancer Made Me a Shallower Person. The night after she has received the diagnosis, Miriam is lying in bed desperately trying, and failing, to fall asleep. In an ironic twist to the conventional “counting sheep” method of trying to get to sleep, the artist has drawn an elongated thought balloon floating above Miriam’s prostrate body. In it, the word “cancer” is written multiple times in a way that suggests the words are taking turns to jump over a gatepost in a field of grass. Finally, there is one further subtype of pictorial metaphor in my data, which, since it involves the conspicuous alteration or distortion of (parts of) the human body, I have termed the “body modification” metaphor. To my knowledge, it has not been identified previously in any other visual or multimodal genre, which suggests that it may be particularly well suited to the visual representation of meanings relating to the illness experience. In Phoebe Potts’s (2010: 25) graphic memoir about her fertility problems, Good Eggs, for example, Phoebe desperately wants to talk to her mother after experiencing a miscarriage. When the phone finally rings, she rushes to pick up the receiver (Figure 3.7). The artist has drawn herself four times in the same image: In the first self-​portrait, she is her usual adult self, sitting at the dinner table with her

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Figure 3.7.  Potts, P. (2010) Good Eggs (p. 25, detail). © 2010 Phoebe Potts.

husband and friends, but then, as she is running to the phone, she takes the form first of herself as a young woman with a ponytail and in dungarees, and then as a small child. By the time she has reached the phone, she has reverted to toddlerhood, and we see her swaddled in nothing but nappies as she bleats “Ma ma” into the receiver. Her multiple self-​portraits thus represent a striking visual metaphor for her vulnerability and desperate need for her mother’s attention. Katie Green’s (2013) book about her eating disorder (see also Figure 3.5) contains several depictions of her own body as being grotesquely distended and bloated, representing not what she actually looks like, but rather how she feels about herself and her own physicality (e.g., 2013: 101, 151, 172, 196, 420, 442). Similarly, after she has been sexually abused by her therapist, the resulting catastrophic effect on her self-​confidence is conveyed through a series of panels showing strips of flesh being peeled off her naked body and revealing more and more of her bones and inner organs, before cracking and breaking up into many pieces

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(376–​378). Another example of a body modification metaphor is the way the protagonist’s eyes are almost always obscured by his spectacles in Peter Dunlap-​Shohl’s (2015) My Degeneration, which was discussed in the Introduction (figure I.1).

3.2. Spatial Metaphor Unlike pictorial metaphors, which involve images of one or more concrete things, spatial metaphors work by exploiting correlations between the experience of our bodies in space and more abstract mental states, emotions, and social relations. Although scholars from various disciplines have also observed the nonliteral meaning potentials of spatial orientation and layout, they have tended to concentrate on just one or two specific aspects of the phenomenon in a particular medium and/​or genre. Art historian Parsons (2010:  233), for instance, describes verticality as a key expressive feature of a large number of visual artworks and suggests that its association with possessing “grandeur of character” originates in our experience of standing upright when we are feeling positive and self-​ assured. Media scholar Huxford (2001) notes that the placement of two or more newspaper images in close physical proximity often implies emotional closeness, while being in the middle can, depending on context, signify either keeping two entities or people apart, or mediating between them. This type of metaphor has been described in relation to the cinema, too: Spatial closeness or distance between characters is commonly used to indicate how they feel about each other, for example, and changing the perceived size of characters relative to each other and their surroundings exploits the conceptual metaphor importance is size to convey tacit messages about their respective significance (Coëgnarts and Kravanja 2012). In horror movies, in particular, the correlation metaphor evil is down is ubiquitous (Winter 2014). Both the notion of verticality as an expression of an “upright” character and that of downward orientation as an expression of evil are likely to draw on the universal need to expend effort and energy on maintaining an upright posture and resisting gravity, while the associations between physical and emotional closeness, and between relative size and importance, are probably derived from the embodied experience of interacting with other people, animals, and objects in space. Other spatial metaphors that are relevant to graphic illness narratives are those pertaining to left–​right and inside–​outside relations, for example.

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As discussed in Chapter  2, it is possible to distinguish between two levels of space in the comics medium, each of which may be exploited for their metaphorical meaning potentials:  the space of the storyworld, where human or human-​like characters are shown moving around and interacting with each other, and the space of the page or double-​page spread, on which panels, images, and words are arranged in a particular order. I will use the term “diegetic” to refer to spatial metaphors that relate to the former, and “compositional” to label instances of the latter, although in practice the two are often closely intertwined. The term “compositional” is drawn from the work of social semioticians (Kress and Van Leeuwen 2006; Van Leeuwen 2005a), who use it to describe the (often highly ideological) meaning potentials of layout, which, they argue, have developed over time through their repeated use in specific sociocultural contexts. For example, they suggest that in the visual culture of contemporary Western consumer societies, compositions with a clear up–​down contrast typically use the upper half of the picture space or the page to present the “Ideal,” and the lower half to present the “Real”: For something to be ideal means that it is presented as the idealized or generalized essence of the information, hence also as its, ostensibly, most salient part. The Real is then opposed to this in that it presents more specific information (e.g. details), more “down-​ to-​earth” information (e.g. photographs as documentary evidence, or maps or charts), or more practical information (e.g. practical consequences, directions for action). (Kress and Van Leeuwen 2006: 186–​187) Re-​ examining social semiotics through the lens of CMT, Feng and O’Halloran (2013: 331) argue that this notion of the “Ideal” is closely linked both to the well-​established conceptual metaphor good is up and to the related mapping unrealistic is up, which, they argue, stems from the universal experience of difficult or unrealistic things being too high up to be reached. For example, in magazine advertisements a desired yet rather unrealistic scenario is often represented at the top, while the product details are typically given in the bottom half of the page. In graphic illness narratives, up is also frequently associated with mental processes, dreams, fantasies, and illusions, which, when they are represented visually, are almost invariably positioned above the characters’ heads (see, for example, Figures 3.1, 3.2, 3.4 and 3.5). While this may well be partially

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inspired by a symbolic opposition between down-​to-​earth facts and up-​ in-​the-​clouds fantasy, as Kress and van Leeuwen claim, it is also probably connected to the simple fact that our brains are located at the top of our bodies. Another relevant feature of visual composition that may carry metaphorical associations is based on the experience of having a body that acts as a container with an inside and outside, which can be exploited to convey meanings relating to control or a sense of belonging together. In document design, for instance, the principle of “framing” (Kress and van Leeuwen 2006: 203–​204) or “enclosure” refers to the use of “lines, borders, and shadings” as a means to “show separation and to group complex objects” (Kimball and Hawkins 2007: 35). As the example from Nadia Shivack’s graphic memoir Inside Out in Figure 3.8) demonstrates, explicit container metaphors are particularly common in comics about eating disorders. In this extract, the artist has drawn herself as an overweight, shapeless figure with a much smaller self-​portrait situated inside her belly, struggling to get out. This second, smaller self has a grotesquely oversized head in relation to the rest of the body, which makes it appear more abstract and cartoon-​like than the more realistically proportioned container-​self. While these nested self-​portraits could thus be seen as constituting a body modification-​type pictorial metaphor, their expressive potential also draws on the diegetic spatial metaphor of the container-​contained relationship. Further spatial metaphorical meanings are evoked in this drawing by the fact that the smaller self-​ portrait, despite ostensibly clamoring to be let out, is facing toward the left, which, as we have seen in section 1.2 (Chapter 1), and section 2.4.2 (Chapter 2), tends to be associated with a sense of stagnation, or even the desire to return to the past. Whereas such meaningful spatial orientations of the characters in the storyworld belong to the subcategory of diegetic spatial metaphors, the ways in which the visual elements are arranged on the page and in relation to any verbal text need to be analyzed as potential instances of compositional metaphor. We are more likely to attribute the words “PLEASE Help!!! Get me out of here!” to the smaller figure inside than to the larger container figure, even though both are drawn with their mouths open and the words are actually closer to the latter than the former. This is because its spatial location chimes with our experience that a shouted plea for help is projected above and beyond our own bodies (a mumbled apology, by contrast, might be expected to “fit” better at the speaker’s chest level, for example). Moreover, the text and the smaller figure are both contained

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Figure 3.8.  Shivack, N. (2007) Inside Out (n.p., detail). © 2007 Nadia Shivack.

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within the same “frame” of the larger self-​portrait. The narrative voice in the black text box (“I felt huge”), by contrast, is more closely associated with the larger figure, because it is located just below her chin and at the height of her mouth. The more general information about the particular pressure on athletes to remain thin is placed at the bottom of the page, right by the container-​self’s feet, where it forms a kind of objective “footnote” to—​or concrete, factual “pedestal” for—​the more subjective experience represented above the informational text. Metaphorical meanings may also be evoked through the way the depicted people are positioned not in relation to each other, but rather relatively to the viewer. Drawing once again on social semiotics, the term “interactive” metaphor will be used to refer to those aspects of the way characters are represented in an image that encourage the viewer to adopt a particular stance toward them, by exploiting equivalent spatial relationships in the real world. In developing their notion of interactive meaning potentials, Kress and van Leeuwen (2006: 114–​153) were themselves inspired by what Hall (1966) calls “proxemics” (i.e., the culturally specific uses of interpersonal spaces). Accordingly, they claim that the implied distance between the viewer and a depicted person is associated with the quality of a relationship:  a close-​up and a medium shot suggest an intimate or social relationship, respectively, while a long shot may indicate a partial or complete sense of detachment, depending on how far away the depicted person appears to be. Where the depicted person is shown from a fully frontal angle, and particularly if he or she is looking toward the viewer, there is a sense of interaction between them, whereas a profile view typically suggests a measure of detachment; a view from behind may either create disengagement or else encourage a sense of identification with the depicted individual (Messaris 1997). The fact that in the third panel in Figure 3.1, Ruth’s face is depicted in close-​up and from a fully frontal angle, for instance, may encourage the reader to empathize with her feelings, even though her blank expression and closed eyes make this task more difficult. Nadia Shivack’s self-​ portraits in Figure 3.8, by contrast, are both shown from a distance that focuses our attention on the whole body rather than the face, and they are also both looking away from us, which invites a slightly detached, scrutinizing perspective. The vertical angle of images, finally, is seen by social semioticians as encoding power relationships:  regarding people from above awards the

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viewer symbolic power over them, an eye-​level view implies an equal relationship, and a low angle makes the depicted person appear more powerful. As Feng and O’Halloran (2013: 330) point out, the latter is based on “the structural features of real-​life situations in which we ‘look up’ to powerful people and ‘look down’ upon weak people,” as, for example, when children interact with adults. Walrath’s (2016) portrayal of her mother lying on the couch (Figure 3.2) is a good example of how a high angle may suggest the latter’s vulnerability and lack of control over her life as she progressively loses her grip on reality. Spatial metaphorical meanings may also occur independently from any specific pictorial metaphors, as the extract in Figure 3.9 shows. It is taken from Joyce Brabner and Harvey Pekar’s (1994) autobiographical comic about the latter’s battle with lymphoma, with artwork by Frank Stack. Harvey has returned to his job as a hospital porter, even though he is still undergoing chemotherapy and is suffering severe side effects. Panels 4–​6 show him finding a quiet place to rest for a while. He is deeply humiliated by his own frailty, wondering whether people will think that he’s “some pitiful jerk staggerin’ around like this  .  .  .  ,” and lamenting that he feels like a stranger, despite having worked in the same place for 26 years. In the images, various forms of spatial metaphor are used to accentuate his feelings. In panel 4, we see a close-​up, fully frontal view of just the upper part of his head; although he is looking toward us, there is a sense that he is focusing not on what is in front of him, but on what is going on inside his own head. Both this image and the following two, which are also placed at the bottom of the page, contain a clear emphasis on the lower half of the panel, thereby invoking associations with the effects of gravity on the human body (bad is down), and, especially in combination with Harvey’s hunched posture, with ill-​health and unhappiness. The fact that, in the final two panels, he is facing toward the right-​hand side, and thus, by implication, toward the future, might be seen to add a note of optimism, although the vertical line splitting the final panel in two just in front of Harvey’s bowed head creates a spatial metaphor for his sense of hopelessness and separation from the world and the people around him. This extract shows how diegetic, interactive, and compositional spatial metaphors are often closely interwoven in graphic illness narratives. Further metaphorical meanings may emerge from the style in which a particular work is drawn.

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Figure 3.9.  Brabner, J., and H. Pekar. (1994) Our Cancer Year (n.p.). © 1994 Joyce Brabner and Harvey Pekar.

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3.3. Stylistic Metaphor Some comics scholars believe that the idiosyncratic gesture that produced a particular work offers readers “a constant visual reminder of the hand of the illustration artist, much more so than the writer’s traces” (Carney 2008: 195), in the sense that drawing style is an expression of an artist’s unique personality and perspective, as well as indicating the nature and level of her artistic training and experience. Other scholars have noted how visual style can be used to enable us to see the world through one of the character’s eyes and/​or to emphasize key themes. Chaney (2013) suggests that the drawing style in Epileptic, David B’s work about his brother’s suffering and how it affected the entire family (see also Chapter 2, Figure  2.6), represents both physical illness and psychic agony:  Many panels overwhelm readers with a “disorienting surplus” of detail, thereby positioning us “as epileptics by forcing us to see chaotically, frenetically, wildly” (Chaney 2013: 59). Miodrag (2013: 205) makes a similar point about Charles Burns’s Black Hole (see also Figure 3.4), noting how the panels depicting scenes in the woods, in particular, appear to be “teeming with tiny white blades and leaves, like so many multiplying microbes writhing across the page.” She also observes that the thematic link in the text between various kinds of rips, tears, fissures, and bodily openings (mouths, vagina) are highlighted through the way they are all drawn using similar “fluidly curling forms” (2013: 211). Indeed, Wolk (2007: 21) goes so far as to claim that the style and materiality of any comic may be regarded as “inescapably, a metaphor for the subjectivity of perception.” While Wolk’s insight is doubtlessly true in a general sense, it is too broad and vague to be useful as the basis for defining stylistic metaphor. Instead, I  propose a more rigorous and systematic approach that starts by identifying the different aspects of visual style in alternative comics and then focuses on instances where conventions have been highlighted, exaggerated, or ostensibly flouted in some respect in order to exploit their metaphorical potential. Consequently, recognizing stylistic metaphors requires an awareness of the conventions not only of the comics medium in general, and graphic illness narratives in particular, but also of the specific style used by an artist in each individual work. Moreover, any meaningful stylistic choices will only be considered to be metaphorical if they can be shown to be linked to embodied experience. In this study, I  use the term “style” in a broad sense to refer to the pictures, handwritten or typed words, and more abstract visual elements,

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including speech or thought balloons, panel frames, pictorial runes and other nonrepresentational lines and patterns, as well as to the materiality of the book itself, including such factors as its format, weight, printing, and binding, and the quality, thickness, and surface of the paper. As I will demonstrate in the following discussion, there are two different aspects or levels of style in alternative comics that may be exploited by artists in order to produce metaphorical meanings: In the case of “isomorphic” stylistic metaphors, basic visual attributes such as shape, color, brightness, quality of line, and texture are used to suggest nonvisual sense perceptions (i.e., qualities of sound, taste, touch, or smell) or more abstract meanings, such as social relations and emotions, by drawing on our embodied experience. For example, thin, irregular, spiky shapes may suggest, by synesthetic association with the damage that sharp objects are able to cause, a grating sound, physical pain, or mental anguish. “Indexical” stylistic metaphors, by contrast, bring into play higher-​order features of style that give us clues as to the creative process and the mode of production involved, “bearing traces of hand, gesture, mechanical and photographic means, or digital techniques” (Drucker 2008: 50). The level of detail and regularity, and the degree of realism or abstraction, of an image may indicate whether it was drawn or painted by hand, for instance, or produced using some form of printing, collage, or photographic or digital techniques, which in turn may convey a particular mood, attitude, or value.4 The two forms of stylistic metaphor are closely interrelated in many instances. Take the isomorphic and indexical stylistic qualities of words in comics, for example: As the extracts discussed in this chapter demonstrate, the majority of comics artists hand-​letter their work, which not only increases the sense of coherence between the drawings and the words, but also enables the artist to convey the unique properties of the individual human voice. Even those artists who use a digitally produced typeface typically choose one that has some of the qualities of handwriting, such as slope and (fake) irregularities. Commercially produced typefaces also have a range of connotations derived from their historical provenance and conventional uses (Garfield 2010; Jury 2004), but these meanings are culturally variable, highly dependent on an individual’s levels of professional knowledge, and thus not directly based on embodied experience. By contrast, when the size, shape, weight, expansion, curvature, slope, quality of line, and regularity or irregularity of individual letters, whole words, and lines or blocks of text are used to indicate pitch, volume, intonation, and the emotional timbre of speech, these meanings depend on parallels

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between visual and auditory perceptions, or between visual properties and our embodied experience of equivalent solid objects (Stöckl 2004, 2005; van Leeuwen 2005b, 2006). The different lettering used by Nadia Shivack in Inside Out for the various textual elements in Figure 3.8, for example, indicates distinct kinds of “voices.” The writing inside the main figure (“PLEASE Help!!! get me out of here!”) can only have been produced by hand. It consists of a mixture of capital and lowercase letters, each of which is unique in terms of its exact shape, size, and thickness. The spaces between the individual characters, words, and lines are also irregular. By drawing on our shared experience of not being fully in control of our movements and gestures when we are upset, and of larger things typically producing more noise than smaller ones, this irregularity suggests a highly emotional, wavering voice pleading for help. The words “I felt huge,” by contrast, are those of the autobiographical narrator looking back on her former self. Again the words have clearly been written by hand, but in this case they are all in capital letters, and they are also reasonably regular and “measured” in terms of their shape and spacing. Both blocks of texts thus index handwriting, thereby encouraging readers to “hear” them with their eyes (Barker 1989: 11), yet their precise visual properties convey different sound qualities and emotions. By contrast, the writing along the bottom of the page, which gives factual information about the social dimensions of eating disorders and thus represents a more objective, impersonal voice, is printed in an entirely regular, angular font, which could only have been produced by mechanical or digital means. We are thus invited to respond to this in the way we normally do to printed texts. If we “hear” this voice at all, it is likely to have the clear, authoritative, detached intonation and neutral, unemotional quality of a public speaker or news reporter. It is also worth noting the deep black background color of the textbox containing the words “I felt huge” compared to the dark yellow of the textbox at the bottom. Many of the connotations of individual hues are symbolic rather than metaphorical, in the sense that they depend on a group of people sharing specific knowledge about the relevant conventions (Gage 1993, 2000; Kress and van Leeuwen 2002). Pink, for instance, is now so intimately linked with femininity in Western consumer cultures that it is easy to forget that, until the 1920s, it used to be the color of choice for little boys rather than girls, since it represented a less intense version of red, which in turn stood for male energy and aggression (Koller 2008). Similarly, black has quite antithetical connotations in different cultures

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and social contexts, ranging from sobriety, elegance, and sophistication, to sin and dishonesty, authority and aggression, and death and misadventure. Each of these meanings can be traced back to one or more specific cultural contexts where this color was used in a particular way and for a specific purpose. For example, in early Protestantism both men and women were encouraged to wear black as a sign of their commitment to the serious matter of their spiritual salvation, whereas black uniforms have been used throughout modern history to signal authority and militarism. As van Leeuwen (2011: 2) points out, “there is always a reason for why a given colour becomes associated with given feelings or ideas, but that does not mean there is an inescapable cause-​and-​effect relation between the idea that is being expressed and the idea that expresses it.” If black is used by a comics artist to suggest sophistication or sobriety, for example, it is only likely to be interpreted as intended by readers who are aware of the relevant cultural conventions involved; accordingly, it should be considered primarily a symbolic rather than metaphorical use of color. On the other hand, there is a firm belief among many theorists and practitioners in psychology, marketing, art, and design that at least some of our responses to color are deeply embodied. Since the late 1940s, some psychologists have used people’s color preferences for measuring their psychophysical state and character traits. Interior designers routinely refer to the ability of certain colors to excite, calm, or inspire when recommending suitable color schemes for particular rooms in the house, and new foodstuffs and drinks are also created with the direct effects of color on our responses in mind (Garber and Hyatt 2003). Such supposedly universal, instinctual responses to different hues are sometimes explained by means of their distinct optical properties; for instance, red has the longest wavelength and lowest frequency, making it stay on photoreceptors of the eye for longer and thus perhaps motivating its association with danger. An object’s color also provides vital information about its physical composition, which, over the course of human evolution, has perhaps led us to respond to them automatically in a way that enhances our chance of survival; in the case of fruit, for instance, its color indicates whether it is ripe or unripe, whether it might be poisonous, or if it has gone bad. Some instinctual responses to a particular hue are also likely to be motivated by its most common or most significant occurrence in nature. Accordingly, our reaction to green may be based on the fact that it is the color of most of the vegetation around us, while red is the color of blood and thus of violence, excitement, and sexuality. Black and white, as well as the brightness

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or “value” of a particular hue, are liable to evoke meanings connected to shared human experiences of day and night, including the inability to see approaching dangers clearly when it is dark, although each culture has constructed its own value systems upon this universal basis (Kress and van Leeuwen 2002: 355–​356). For example, Toni Morrison (1992) delivers a compelling critique of how supposedly universal meanings associated with “whiteness” and “blackness” have become inextricably intertwined with notions of racial superiority and cultural hegemony in the American imagination. Some form of association of light and dark, and white and black, with good and evil, respectively, certainly seems to be prevalent across many different cultures, finding its expression, for example, in horror films (Ortiz 2011; Winter 2014). Indeed, experimental evidence suggests that these metaphorical links are unconscious, automatic, and remarkably independent of the specific context in which they occur. In a series of linked studies (Meier, Robinson, and Clore 2004), participants were asked to categorize words, printed in a white or black font, as either positive or negative. They showed faster reaction times and greater accuracy when categorizing positive words presented in a white font rather than in a black font, and vice versa for negative words. A related series of experiments (Meier et al. 2007) revealed that, when people were asked to evaluate positive and negative words that were written in fonts of variable brightness and then perform a brightness-​matching task, their perceptual judgments were consistently biased toward the brighter end of the spectrum following positive evaluations, and the other way around. The fact that Nadia’s plaintive confession to feeling “huge” (Figure 3.8) is printed in thin, white letters against a uniform black background is thus likely to heighten the reader’s awareness of the character’s misery. Similarly, in the extract from Our Cancer Year reprinted in Figure 3.9, the use of white and black is associated explicitly with light and shadow, which in turn acts as an isomorphic stylistic metaphor for abstract thoughts and emotions. In panel 3, we see Harvey’s shadow projected against the wall behind him, whereas in panel 4 most of the background is black, with just a small white area in the shape of a door, suggesting that he has literally entered a dark room or corner of the hospital building, and, metaphorically, that his thoughts are becoming increasingly gloomy. The next image depicts him as a small figure in front of a white circle, which picks him out in the manner of a stage spotlight and thereby emphasizes his feelings of self-​consciousness. In the final panel, Harvey’s hunched, black figure

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is silhouetted against a bright background, which again seems to chime with the utterly bleak thoughts and feelings he is experiencing. The pictorial runes in the form of wavy lines and droplet-​shapes above and around Harvey’s head further emphasize his mental and physical anguish.5 As mentioned earlier, indexical stylistic metaphors work by drawing attention to the creative processes involved in the production of a particular visual image. A good example of this type of stylistic metaphor can be found in Aliceheimer’s (Figure 3.2), in which Dana Walrath tells the story of her mother’s gradual decline as a result of Alzheimer’s disease. Throughout the book Alice is depicted in her dressing gown, which is formed through a collage of text fragments from Lewis Carroll’s famous children’s book, Alice’s Adventures in Wonderland (1953). The ploy used by the artist of cutting out these shapes and effectively “dressing” her mother in them reminds readers of the labor of love involved in creating this book, while also emphasizing the role reversal that has taken place in the two women’s relationship, with Dana now having assumed the responsibility of caring for her mother’s most intimate needs. The text fragments in the shape of a dressing gown also function as a unique combination of a verbo-​pictorial and typo-​pictorial metaphor, which sets up an extended analogy between Carroll’s story of a little girl who is lost in a world where all the normal rules of life no longer apply, and the strange, and by turns enchanting and terrifying, perspective of a person with dementia. My final example of how both isomorphic and indexical stylistic metaphors may be combined with pictorial metaphors to convey a person’s mental disarray is taken from The Nao of Brown, by Glyn Dillon (2012) (Figure 3.10). It tells the fictional story of a young woman who suffers from a form of obsessive-​compulsive disorder (OCD) which causes her to have terrifying fantasies about harming other people. In this scene, Nao’s boyfriend has just been delivered into hospital with a suspected stroke. The night before, they had a big argument, and Nao, convinced that she has caused this medical emergency, becomes more and more agitated. When she is left alone with her boyfriend, she feels completely overwhelmed. In the final panel we see what looks like an X-​ray image of her hand reaching inside her pocket for her pen. The sudden break in the visual style of this final panel as compared with the other drawings in the book is likely to encourage a metaphorical reading. In particular, the X-​ray-​like image may remind readers of the imaging technologies that are routinely used in hospitals in order to allow doctors to see what is inaccessible to the naked eye (see also

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Figure 3.10.  Dillon, G. (2012) The Nao of Brown (p. 182, detail). © 2012 Glyn Dillon.

Chapter 4). Accordingly, it suggests Nao’s terror at the thought of what would happen if her destructive fantasies, which are ordinarily hidden from view, were revealed to the world through her actions. The depiction of her skeletal hand could also be described as a form of body modification metaphor, which evokes associations with the grim reaper, and the black background acts as an isomorphic stylistic metaphor for evil intentions and death. The pen, too, has taken on an ambiguous appearance, perhaps calling to mind a syringe. The first panel on the following page (183) continues Nao’s fantasy, by showing her viciously stabbing her helpless boyfriend with the pen. This panel also deviates from the baseline style of the book by using different shades of red and black only, instead of the full palette of colors, a convention that is used regularly

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throughout the book to show what is going on inside Nao’s head and to distinguish such hallucinations from what is actually happening in the storyworld. In this chapter I  have identified the different kinds of visual metaphor that occur in the graphic pathography genre, drawing a distinction between pictorial, spatial, and stylistic metaphors, and their respective subcategories. These are summarized in Table 3.1. This original taxonomy fills three gaps in the existing literature on the phenomenon of visual metaphor, by (a)  providing a systematic way of identifying and analyzing various aspects of visual semiotics that are able to convey metaphorical meanings, including spatial composition and elements of visual style; (b) revealing significant differences in the communicative functions performed by certain types of pictorial metaphor across distinct visual/​multimodal genres (e.g., what Forceville [2007: 18] refers to as “integrated” metaphors and what I have termed “ambiguous” metaphors, which diverge considerably with respect to the extent to which the direction of mapping is typically fixed [in advertising], or more flexible [in graphic illness narratives]); and (c) identifying forms of visual metaphor that seem to be, if not unique to the graphic pathography genre, then at least particularly prevalent in it (e.g., “body modification” metaphors and “indexical” stylistic metaphors). The following two chapters will apply these findings to the analysis of graphic illness narratives about cancer and depression, respectively. I will show how the different natures of these diseases impact on the forms of metaphors we may expect to find, and the communicative and narrative functions they fulfill.

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Table 3.1  Types of Visual Metaphor in Graphic Illness Narratives Visual Metaphor Type

Prototypical Features

Pictorial metaphor

Metaphorical meanings emerging from specific ways of depicting one or more concrete entities The fusion of two different concrete entities The depiction of two or more separate entities in a way that highlights their similarity The gradual transformation of one concrete entity into something different The depiction of a concrete entity in such a manner that it can be interpreted in two different ways The depiction of a concrete entity in a context where it appears in some way incongruous The use of an extended visual scenario that functions in its entirety as a metaphor The combination of a picture of a concrete element and a verbal message that together create metaphorical meanings Individual letters, words, or text blocks with explicit pictorial dimensions, which in turn evoke metaphorical meanings The ostentatious alteration or distortion of (parts of) the human body for metaphorical effect Metaphorical meanings emerging from correlations between the experience of our bodies in space and more abstract concepts Spatial relations in the storyworld that evoke metaphorical meanings Spatial relations of verbal or visual elements on the page or double-​page spread that evoke metaphorical meanings Social relations between depicted characters and the reader that are implied by association with equivalent spatial relationships in the real world Metaphorical meanings emerging from the style of pictures, words, abstract visual elements (e.g., pictorial runes), and/​or the materiality of the book Basic visual attributes (shape, color, brightness, quality of line, texture) that suggest nonvisual sense perceptions or abstract meanings Higher-​order features of style that point to the creative process and/​or the modes of production involved, which in turn evokes metaphorical meanings

Hybrid Pictorial simile Transformational Ambiguous Contextual Pictorial allegory Verbo-​pictorial

Typo-​pictorial

Body modification Spatial metaphor

Diegetic Compositional

Interactive

Stylistic metaphor

Isomorphic

Indexical

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Unseeing Eyes Metaphor in Graphic Illness Narratives about Cancer

notion of dynamic embodiment and its relationship with metaphor has been discussed in general theoretical terms (Chapter 1), with reference specifically to the graphic illness narrative genre (Chapter 2), and as a basis for the creation of a new taxonomy for the different forms that visual metaphor may take in this genre (Chapter 3). The current chapter and Chapter 5 will provide detailed examinations of the role of metaphor in works about cancer and depression, respectively. I  will demonstrate that the specific embodied experiences prompted by these two diseases, in combination with the prototypical features of the graphic illness narrative genre, make the use of particular metaphorical themes more likely. Ten of the books in my corpus deal with cancer. Eight works are autobiographical (Brabner and Pekar 1994; Engelberg 2006; Fies 2006; Freedman 2014; Hayden 2015; Mackintosh 2011; Marchetto 2006; Small 2009), although in two of these cases it is not the author himself but a parent who is ill (Fies 2006; Mackintosh 2011), and another book was born out of the collaborative work of cancer sufferer Harvey Pekar, his wife Joyce Brabner, and comics artist Frank Stack (Brabner and Pekar 1994); the two remaining books are fictional stories (Ball 2015; Vanistendael 2012). Four books are by male creators, five by women, and one by a mixed-​gender team. Apart from one Belgian and two British creators, all the other authors/​artists are American. The artwork also differs considerably across the works, which is hardly surprising given that some of the creators are established comics artists or book illustrators, while others have just a general background in the arts, or no formal training at all. S O FA R , T H E

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Despite these differences, there are some striking commonalities in the way visual metaphors are used across these works to represent cancer. As I will show, the most prevalent metaphors in all 10 books share a central concern with the troubling and paradoxical relationship between human vision and knowledge/​understanding. To the best of my knowl­ edge, this particular conceptual metaphor has not been observed in any verbal cancer discourses. Cancer is a faulty and unregulated cell proliferation that disrupts bodily structures, functions, and processes at the original site and sometimes, through local spread or metastases, in other parts of the body. It is a terrifying disease, not only because “it is disorderly, unpredictable, and resists our attempts to impose order on its progression” (Teucher 2003: 5), but also because it challenges any notion of a clear-​cut boundary between the self and the non-​self: The malignant cell of the cancer tumour is not an invader, an outsider, like a virus or a bacterium; rather, it is produced by the body, it is of the body, and yet it is a threat to the body. Neither self nor other, it is both the same as and different from its host. It is misrecognised as one of the body’s normal cells, but it is a deviant cell in innocent disguise. (Stacey 1997: 77) In other words, cancer is a classic case of a system breaking down and seemingly turning against itself. Partly for this reason, many forms of cancer are difficult to treat effectively. People suffering from cancer also often experience a fundamental challenge to their sense of identity, as the disease changes the way they relate to their own bodies and its ordinary ways of being in the world. Perhaps it is thus not surprising that cancer discourses are especially replete with metaphors, which “rush to the rescue of the subject whose terror is otherwise uncontainable” (Stacey 1997: 63). Some of the most dominant metaphors that have been identified in various types of verbal discourses represent the disease as an obstacle on life’s path, a military invasion, a human or animal intruder, and a parasite (e.g., Gibbs and Franks 2002; Harrington 2012; Reisfield and Wilson 2004; Semino et al. 2015; Teucher 2003; Williams Camus 2009). Several of these metaphors betray a measure of anxiety about the borders between the manifest outside and hidden inside of the body, yet none of them appears to have human vision as its primary target.

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The apparent difference in terms of the main metaphors used in verbal and visual discourses about cancer can be explained, I argue, by the fact that artists working in the graphic illness narrative genre are compelled to attend to visual aspects of the experience, whereas people who are speaking or writing about cancer may disregard this particular dimension. Given the “immense but often unacknowledged power of visualizations” (Ostherr 2013:  7) in all areas of modern medicine, but especially in the diagnosis and treatment of cancer, this finding suggests that graphic illness narratives are able to reveal important aspects of the cancer experience that may otherwise be backgrounded or even completely hidden. It also supports my claim that the relationship between embodiment and metaphor use is dynamic, shifting, and changing constantly as we try to communicate our illness experiences through a range of semiotic modes and media. In his discussion of what he calls the “iconography of illness” in comics, Williams (2015: 121) cites cancer as a prime example of a “manifest” disease, since its symptoms and/​or the effects of treatment typically lead to a visible transformation of the body, which artists can then choose to depict with a greater or lesser degree of realism. Williams distinguishes manifest diseases from “concealed” conditions that are only partially or temporarily visible to the careful, trained observer, and “invisible” forms of human suffering that are primarily psychological. However, at least in some forms of cancer there are no visible signs of the disease on the surface of the body at all, and, even in cancers that involve manifest lumps, ulcers, or lesions, the cellular processes in the body that are causing the illness are nevertheless taking place invisibly, below the perceptible range of the human eye and under the surface of the skin. Moreover, though it is of course true that the patient’s visible appearance is often radically changed through the effects of treatment and surgery, a large part of his or her suffering is likely to be emotional.1 For this reason, the categorization of cancer as a straightforwardly manifest disease is too simplistic. As the first page from Marisa Acocella Marchetto’s Cancer Vixen (2006) (Figure 4.1) demonstrates, many of the metaphors used in graphic illness narratives about cancer reflect an awareness of the complex nature of human vision and its limitations with respect to recognizing and understanding cancer. Marisa Acocella is a socialite and cartoonist for the New  Yorker, who is obsessed with her physical appearance and glamorous consumer lifestyle, as well as with her upcoming marriage to a wealthy Italian restaurateur. The discovery of a lump in her breast is doubly devastating for

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Figure 4.1.  Acocella Marchetto, M. (2006) Cancer Vixen (p. 1). © 2006 Marisa Acocella Marchetto.

her, as it profoundly challenges her self-​image as a fit, healthy, and attractive woman. In this extract, the rising intensity of Marisa’s emotions is suggested through the way the text, handwritten in capital letters of increasing size, covers most of the page, ending in an exclamation mark bracketed by two question marks. The long, narrow panel along the bottom of the page shows her swimming in a public pool, when she suddenly notices “something fishy” going on in one of her arms, which is hurting her. This reference to aquatic life forms draws attention to the fact that most of Marisa’s body is submerged in the water, so that whatever it is that is causing the troubling sensation is located beneath its surface, and, by metaphorical extension, under the visible surface of her skin. The expression also evokes, via the common idiomatic extension of something smelling fishy, an olfactory sense impression, suggesting that there are some aspects of knowledge and understanding that “cannot be forced into visibility” (Classen 2005a: 82) and that may only be brought to our attention via our more neglected senses.

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Just above this panel the artist has inserted a sonogram of her breast, complete with her name and patient number, in which a dark, elliptical shape has been marked up with small crosses. According to the taxonomy introduced in Chapter 3, the sonogram can be described as an indexical stylistic metaphor, which is deliberately not integrated into the design of the rest of the page, in order to suggest its alien, puzzling nature (see Chapter 2, section 2.4.3). Marchetto has also added a large, yellow, arrow-​ shaped text box pointing to the shadow on the sonogram and containing the words “Here is the tumor. It looks like a black hole.” The reference to a black hole might initially be interpreted literally, in the sense that, to the untrained eye, the tumor does, in fact, visually resemble a dark hole on a lighter surface. However, a few pages later (8–​9), the notion of a black hole is picked up again, and this time it is used explicitly in its astronomical sense, as a region in space with such a strong gravitational pull that even light cannot escape from inside it. Upon receiving the cancer diagnosis, Marisa is shown being sucked up head first by “the Electrolux of the Universe” into a “black hole,” where she finds herself, completely alone, stuck in the pitch dark of “nothingness” for eternity (9). The metaphor of a black hole thus links Marisa’s terror at the incomprehensible notion of the universe to the equally unfathomable processes occurring inside her body. Moreover, neither the universe nor our internal bodily functions are visible to the naked eye, which means that we must rely on the images produced by modern imaging technologies to try to understand them. As I  will argue in this chapter, the central conceptualization underlying the representation of cancer, both in this extract and in many others taken from my data set, represents a reversal of the conventional metaphor knowing/​understanding is seeing (Johnson 2007:  165–​166), in the sense that it is vision, rather than understanding, that is the focus of attention and the target of metaphorical mappings; in its most basic form, it might be verbalized as seeing is (not) knowing/​ understanding/​ believing. In relation to graphic cancer pathographies, this conceptual metaphor typically takes two distinct but interrelated forms. One of its elaborations pertains to the contrast between our visible appearance and what is going on invisibly beneath the surface of our skin. As Arnheim (1969: 88) points out, under ordinary circumstance we typically focus exclusively on the visible outside of objects and people; the perceptual inside is only called up if it is relevant to the observer. When people are diagnosed with cancer, their inner organs and processes suddenly become pertinent, and the surface of the skin is revealed to be a barrier that vision cannot

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penetrate without the aid of technology. In this situation, the other human senses, including taste, smell, touch/​pain, and what might be described as our “sixth sense” (Howes 2009), may suddenly assume greater significance and pose a challenge to that most privileged of our senses, vision. The second common form that the seeing is (not) knowing/​understanding/​believing metaphor assumes in graphic illness narratives about cancer is one that problematizes the images produced through X-​ rays, scans, and other imaging technologies. Although such technologies provide some access to the secret inner realms of our bodies, the resulting images are only truly meaningful to the trained, experienced eye. This is troubling, not only because it accords enormous power to the “medical gaze” (Ostherr 2013) of the professionals, but also because it reveals that vision does not always provide straightforward access to knowledge and understanding. Before I  consider these two modulations of the central vision metaphor in graphic narratives about cancer, I will first discuss the complex relationship between seeing and knowing in Western cultures in general and in contemporary medicine in particular. I will then show that many of the most common verbal cancer metaphors, such as journey and war metaphors, also occur in my corpus of comics, although here they are often combined with and/​or complicated by explicit references to human vision and the (in)visibility of cancer in the body.

4.1. The Epistemology of Vision The human senses are never accorded equal status; in each culture or social context, one of the senses is given more prestige and credibility than the others, and such “sensory rankings are always allied with social rankings and employed to order society” (Howes 2005: 10). For example, in some indigenous cultures of Latin America, thermal symbolism is the dominant frame by which people make sense of their social relationships and material environments, whereas the Ongee people in the Bay of Bengal consider smell to be the cosmic principle that orders space and time, life and death, health and illness, and individual and social identity (Classen 2005b). In Western societies, by contrast, vision has, from the seventeenth and eighteenth centuries onward, assumed top place in the hierarchy of the senses, in parallel with the ascendancy of the scientific worldview.2 In accordance with traditional gender roles, vision was from the start closely associated with male rationality, while women were

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considered to be intrinsically incapable of showing clearsightedness and more suited to exercising the “lower” senses of touch, smell, and taste (Classen 2005a). Vision does, indeed, appear to be entirely efficient, straightforward, and firmly within our deliberate and conscious control. We seem to be capable of simply pointing our eyes at whatever it is we want to see, and all is revealed to us. Consequently, there is a strong tendency in many cultures to project the experience of being able to see things clearly onto our sense of knowing and understanding them well. The resulting metaphorical concept knowing/​understanding is seeing (Johnson 2007:  165–​166; Lakoff and Johnson 1980:  48) is manifested, for instance, in the way English speakers habitually talk “of seeing as a way of discovering; of illumination as understanding attained; of view and perspective as conceptual stances taken toward an object; of a perceptive or perspicacious remark, a myopic or blinkered understanding, or a grand and lofty vision as a capacious and comprehensive understanding of a field of knowledge or action” (Breitmeyer 2010: 157–​158). Evidence for similar mappings from vision to mental activity has been found across several Indo-​European, Austronesian, and Afroasiatic languages (Allan 2008:  58–​61; Sweetser 1990), too, which suggests that this conceptual metaphor has an embodied, experiential basis. However, a corpus study of English metaphorical expressions relating to vision in naturally occurring verbal data found that the conceptual link between vision and knowledge is not as straightforward as some CMT scholars have previously assumed (Deignan and Cameron 2013). Thus, in many cases, metaphorical expressions relating to vision are used to express not a straightforward state of objective understanding, but rather a lack of—​or change in a person’s state of—​knowing or understanding, as well as an awareness of the possibility of many different perspectives or interpretations (e.g., “Just as he couldn’t see what was going on under his nose . . .” [Deignan and Cameron 2013: 232]; “In those cultures where women are seen as “naturally” weak or vulnerable . . .” [233]). This finding may reflect an intuitive sense that our eyes cannot always be trusted. Indeed, research into visual perception and culture has uncovered much evidence to show that visual perception is not a simple recording of stimulus material, but a hugely complex process of active selection and construction by the visual system. At the most basic level, the vast amount of information that is constantly streaming in via the approximately one hundred million light-​sensitive cells on the retina must

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be bundled together into particular combinations of light patterns so that it can be conveyed to the brain via the mere one million fibers that lead there (Feldman 2006: 96). Once this “raw” visual data has reached the brain, it is subjected to another radical selection and problem-​solving process, which in turn is heavily reliant upon the activation of stored visual concepts and memory images: “The upshot is that our visual cognitions are much more than what is given to our sense of sight via the light rays transmitted to our eyes. We visually ‘know’ much more than we ‘see’ ” (Breitmeyer 2010: 185; see also Hoffman 2000). To give just one example, our visual perception of objects always includes aspects of our knowledge and experience of the actions we habitually perform with or in relation to them. Thus, a hammer is seen as something to be picked up and swung, and eyeglasses as an object that fits on the bridge of our nose and helps us to read if we are far-​sighted. This is more than just an association; rather, it is “the direct perceptual completion of an object that looks incomplete as long as it is unemployed” (Arnheim 1969: 90). For this reason, spectacles take on the appearance of “a spidery, blind-​eyed ghost” when they are detached from their ordinary context of use and placed on a plinth in a museum, for instance (Arnheim 1969: 90). There are also many feedback loops between these higher and lower processes of visual perception, with the result that our previous experience, knowledge, prejudices, interests, and both conscious and unconscious desires can lead us to see things that are not visible to others, or to be “blind” to the things we do not want to see. According to Elkins (1996), there is a particularly close connection between sight and sexual desire, which is most apparent in the voyeuristic gaze but which in fact underlies all acts of vision, making human sight unpredictable and hard to control, as well as giving the perceived objects enormous power over us: Seeing is irrational, inconsistent, and undependable. It is immensely troubled, cousin to blindness and sexuality, and caught up in the threads of the unconscious. Our eyes are not ours to command; they roam where they will and then tell us they have only been where we have sent them. No matter how hard we look, we see very little of what we look at. [ . . . ] Seeing is like hunting and like dreaming, and even like falling in love. It is entangled in the passions—​jealousy, violence, possessiveness; and it is soaked in affect—​in pleasure and displeasure, and in pain. Ultimately, seeing

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alters the thing that is seen and transforms the seer. Seeing is metamorphosis not mechanism. (Elkins 1996: 11) For the same reasons, we also tend to have intense and complex relationships with images, which have the ability “both to give us pleasure and to allow us to articulate our desires through looking” (Sturken and Cartwright 2001: 72–​73; see also Horstkotte and Leonhard 2007). When we—​or those close to us—​fall ill, however, seeing may become more closely aligned with fears of death and decay than to pleasure. The appeal of the body’s surface appearance is replaced by the disconcerting awareness of what may be lurking, unseen, beneath.

4.2. The Medical Gaze There is an important cultural dimension to the relationship between the diseased body and vision, too. In the premodern West, healing mostly revolved around practices such as touching, smelling, and administering syrups and aromatic herbs—​practices that were not far removed from traditional housewifely duties, and which were thus seen to fall within the feminine realm (Classen 2005a). Some of these ideas have survived or have been resurrected in contemporary Western society through alternative medical practices such as acupuncture, which is based on principles of heat and damp, and aromatherapy, for example. However, conventional medicine has followed the route of the other natural sciences, gradually distancing itself from the domestic sphere of women and being transformed into a primarily visual epistemology, practiced mostly by men and ruled by the principles of rationality and objectivity. As Foucault (2003) argues, the introduction of pathological anatomy at the end of the eighteenth century accelerated this trend, by opening up to the physicians’ gaze what had previously been invisible and hidden away. Before the invention of imaging technologies, vision was limited in terms of what it could reveal when the patient was alive, so touch and hearing still played a role in diagnosis, but only as “a way of anticipating the triumph of the gaze that is represented by the autopsy” (2003: 203). The physician’s hand and ear were thus “merely temporary, substitute organs until such time as death brings to truth the luminous presence of the visible; it is a question of a mapping in life, that is, in night, in order to indicate how things would be in the white brightness of death” (Foucault 2003:  203;

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emphasis in the original). Hence, Foucault claims, the perceptual and epistemological principle underlying clinical anatomy, and the entirety of Western medicine that derives from it, can be described as one of “invisible visibility,” in the sense that the truth, even when it is still hidden under the surface of the skin, is nevertheless in essence potentially visual (2003: 204). The ever-​increasing centrality of vision in medicine has also forged a new alliance between the visible, the knowable, and the expressible, “enabling one to see and to say” (2003: xiii). When the camera was invented in the mid-​nineteenth century, the medical profession was quick to seize upon the opportunities offered by this technology, using photographs of medical specimens and patients both as tools of scientific inquiry and as prized collectable items. By seemingly providing an entirely objective and reliable way of capturing empirically measurable and verifiable scientific facts, in the manner of “something directly stenciled off the real, like a footprint or a death mask” (Sontag 2005: 120), the camera also led to new forms of social power and control. Photographic documentation was regularly employed in the surveillance and classification of institutionalized patients, for example, with a focus on certain kinds of mental illness attributed to women, such as hysteria (Foucault 1977; Kember 1995). Despite decades of questions surrounding the slippery relationship between photographs and the truth, which were posed with renewed urgency with the digital revolution from the 1980s onward, a stubborn cultural faith in the photograph’s objectivity seems to persist undiminished. Paradoxically, we both believe and disbelieve the old myth that photographs never lie. A good example of this attitude can be found in the self-​reflective account of academic and cancer survivor Stacey (1997: 139) about the cultural meanings of cancer in Western capitalist societies. Looking at holiday snapshots of herself when she had cancer but looked and felt perfectly healthy, and, later, when she was cancer-​free but bore all the outward signs of illness, such as baldness, she concludes that neither “shows me what I  am looking for:  the visible signs of the disease. For despite myself, I still want to equate seeing and knowing: the promise of certainty is sought in the visual evidence.” In this quotation, the “visible signs of the disease” that Stacey is looking for in the photographs refer to things that affect the exterior of the body. The development, toward the end of the nineteenth century, of X-​rays, photomicrography, and endoscopy, and, later, of increasingly powerful digital-​imaging technologies, have also made it possible for

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the workings of internal organs and processes at the cellular and even the subcellular level to be made visible and represented through various types of (virtual) images. However, the information conveyed by means of these technologies is not immediately accessible to the untrained eye and requires the mediation of the medical gaze, which “is authorized to look at our private, hidden parts, to examine our vulnerable qualities and quantities, and declare them ‘normal’ or ‘pathological’ ” (Ostherr 2013: 3). The result is a significant disparity of knowledge and power between the doctor and the patient, a disparity that is further exacerbated when it is entangled with unequal gender relationships (Stacey 1997: 152–​157).

4.3. Cancer Metaphors in Graphic Pathographies Although vision is central to the way cancer is conceptualized in contemporary Western medicine, this aspect of the illness experience is not often thematized explicitly in verbal cancer metaphors, which tend to focus instead on the idea of something harmful entering inside and traveling around the body. As I will show in the following discussion, many of these dominant verbal cancer metaphors can also be found in my corpus of graphic illness narratives about the disease, but their translation into a (verbo-​)visual format typically entails a degree of irony or self-​reflexivity, with the result that the nature of human vision is often implicitly or explicitly interrogated, too. Other common metaphors in this genre are centrally concerned with the relationship between seeing and understanding, knowing or believing, directing attention to the imaging technologies which reveal aspects of our inner organs that are normally concealed, but which remain fundamentally mysterious and unfathomable to most patients.

4.3.1. Visualizing Invasions, Journeys, Thieves, and Parasites When Susan Sontag was diagnosed with breast cancer, she famously remarked that “it is hardly possible to take up one’s residence in the kingdom of the ill unprejudiced by the lurid metaphors with which it has been landscaped” (1978: 3–​4). She was particularly troubled by the plethora of military expressions she encountered, which encourage patients to “fight” the symptoms of a disease over which they have, in fact, little or no control. Sometimes such war metaphors are applied to the entire illness

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experience, including the patients’ decisions, attitudes, and emotions in relation to the diagnosis and treatment of cancer, whereas in other contexts, it is the disease in the individual body that is conceptualized as the enemy that must be conquered: After the cancer’s invasion of the body, the immune system launches an offensive to beat the disease. The army of killer T cells and stealth viruses fight the tumour cells. However, this is not enough to wipe out or eradicate the invader completely, especially if it has spread throughout the body becoming lethal. Thus, a bigger arsenal of weapons, consisting of magic bullets and blunt instruments, target the enemy. If the cancer is still resistant to the cancer-​fighting tools, other weapons are injected to attack the disease or to boost the body’s own defences. This attack may eventually lead to defeating the disease although it also involves serious side-​effects as healthy cells are also destroyed by the weapons. (Williams Camus 2009: 475; emphasis in the original) Depending on individual circumstances and the specific level at which war and other violence metaphors are applied, they can have more or less positive effects on patients, caregivers, and health professionals (Demmen et al. 2015; Penson et al. 2004). For instance, they may create a sense of camaraderie and common purpose between patients and doctors, and serve as a helpful counterpoint “to the powerlessness and passivity often associated with serious illness” (Reisfield and Wilson 2004: 4025). Yet they are also inherently aggressive and paternalistic, and they tend to emphasize the biomedical parameters of disease to the detriment of the more social and affective aspects of the experience. For people who are suffering from an incurable form of cancer, or who no longer have any effective treatment options available to them, having their illness experience framed in terms of victories and defeats is likely to be deeply demoralizing. Finally, the war metaphor suffers from conceptual limitations: “There are no actual enemy invaders; the enemy is self. In this ultimate war of attrition, the weapons indiscriminately destroy the enemy (cancer cells) and the defenders (the immune system). And the battlefield is the patient’s very body” (Reisfield and Wilson 2004: 4025). Another common metaphor that operates at the levels of both the cancer patients’ life experience and the cellular processes inside their bodies is that of a journey. In the case of the former, the disease is conceptualized

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as part of a person’s journey of life, as an obstacle in his or her journey, or as a way of offering a new outlook by clearing life’s path (Gibbs and Franks 2002). These conceptualizations seem to arise from “the same metaphorical constructions of life that people ordinarily live by” (Gibbs and Franks 2002: 144), including the primary mappings between a purposeful life and a journey, and between seeing and understanding. If the journey experience is applied instead to the development of the disease in the body, by contrast, “the cancer is mapped onto the moving entity/​ traveler, the body onto a set of locations, speed of growth onto speed of movement, periods of remission onto pauses in the journey, and so on” (Semino, Heywood, and Short 2004: 1279). As the authors point out, the notion of cells traveling through the body might be described as only partially metaphorical, since in contemporary English the word “travel,” while it is most commonly used to describe the intentional movement of an animate agent, can also refer to the directional movement of inanimate entities. In his analysis of British newspaper reports, Williams Camus (2009) identified a range of other, less dominant metaphors, including cancer is human, cancer cells are animals, and cancer is the enigma in a detective story. A  study of the metaphors most commonly used by physicians in their consultations with cancer patients also found some agricultural themes (e.g., stem cells as seeds), sports metaphors (e.g., a treatment regime as a marathon), and mechanical metaphors (e.g., a cell receptor as the “on” switch) (Casaret et al. 2010). Healthy Canadian teenagers frequently talked about cancer as the sick patient or as death itself (Woodgate and Busolo 2017), whereas research into the language used by cancer patients in Canada and Germany to describe their illness experience revealed clusters of metaphors around the notions of obstacles on a path, dark surroundings, a thief or intruder, and of being eaten from the inside by a parasitic growth (Teucher 2003: 6). The final two metaphor clusters both express anxieties about the boundaries between the outside and inside of the body, albeit with a slightly different focus:  “Thieves begin outside and then enter, whereas a ‘growing being inside the body’ or ‘death growing inside’ confuses the boundary between self and non-​self” (Teucher 2003:  6–​7). The literary cancer autobiographies that Teucher examined appeared to draw on the same limited pool of metaphorical mappings, although these tended to be couched in more poetic and dramatic language, and there were also marked shifts and changes in the authors’ use of metaphors as the illness evolved.

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The mode and medium of communication also appear to affect the metaphors that are generated and that are considered most helpful and apt. Thus, when people are encouraged to visualize cancer, rather than simply talking or writing about it, a different set of metaphors emerges. In a large-​scale project that invited children and youngsters in Britain to draw their knowledge and beliefs about cancer (Oakley et  al. 1995), common visual representations included fires in the body (often in association with smoking as a cause), clusters of cells, and repulsive faces or monsters. A  study of the mental images of 15 women who had completed treatment for breast cancer (Harrow et al. 2008: 343) found that most of these images fell into two broad categories: Some women imagined their cancer to be a living creature such as a parasite or a jellyfish, whereas for others it was “substance-​like,” resembling “a bit of old concrete that had fallen off,” for example. These mental images reflected their interpretations of the verbal metaphors used by health professionals, as well as the scan images they had seen. A patient who visualized the tumor in her breast as a piece of concrete, for instance, was apparently influenced by its gray appearance in a mammogram. Many of the (verbo-​)visual cancer metaphors in my corpus of graphic illness narratives also seem to be prompted by the experience of seeing scan images, as well as by dominant verbal metaphors, although these are typically employed in a highly self-​conscious and/​or ironic manner. In the blurb on the back cover of Our Cancer Year, by Joyce Brabner and Harvey Pekar (1994), for example, the story is described as “a true and unflinching account of two people battling cancer.” Harvey, it says, “had a better-​than-​ average chance to beat cancer and he took it—​kicking, screaming and complaining all the way” (1994:  n.p.). Although this seems to suggest an endorsement of the war metaphor in relation to cancer, the notion of Harvey as a “kicking, screaming and complaining” patient does not really imply heroism and is clearly meant to be ironic, particularly as the story repeatedly focuses on the disastrous consequences of his stubborn determination to complete his course of chemotherapy in the shortest possible time and his refusal to take any sick leave. The visual representations of Harvey also undercut his belligerent posturing, by emphasizing his increasing frailty and suffering (see, e.g., Chapter 3, Figure 3.9). Moreover, the story of Harvey’s cancer treatment is interwoven and juxtaposed with Joyce’s account of her peace activism and attempts to support friends living in war zones. In the very first panel of the book, the verbal narrator sets up an explicit analogy between the mistaken belief that the most aggressive

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cancer treatments are necessarily the most effective and the equally misguided conviction that violence can solve geopolitical problems: “This is a story about a year when someone was sick, about a time when it seemed that the rest of the world was sick, too. It’s a story about feeling powerless, and trying to do too much . . .” (n.p.). These verbal and visual devices together thus serve to undermine the common view of cancer survival as a military victory over enemy forces (see also El Refaie 2012: 89–​90). The fact that graphic illness narratives tend to adopt a critical stance vis-​à-​vis some of the most culturally dominant metaphors is in itself hardly surprising, as other literary art forms have also been found to encourage a reassessment of established ways of thinking by extending, elaborating, and/​or combining conventional metaphors in fresh, idiosyncratic ways, or by explicitly questioning them (Lakoff and Turner 1989). What is remarkable, however, is how often visual perception and/​or imagination are critically reassessed by comics artists through their innovative adaptations of established metaphorical ways of conceptualizing cancer. A particularly clear example of this can be found in Miriam Engelberg’s (2006) autobiographical account of her breast cancer diagnosis and treatment. The book is organized into short thematic chapters of between one and five pages each. These generally start with a real-​life experience or conversation she has had, which is then used to make a more general point about life as a cancer patient. Two of the chapters deal explicitly with visualization techniques, which are commonly used in alternative approaches to cancer. Inspired partly by motivational psychology, such techniques are believed to enhance the body’s capacity for self-​healing through the transmission of supportive messages to the immune system while in a receptive, relaxed state. Sometimes patients are encouraged to imagine in vivid detail the cancer cells being destroyed, sucked up, dissolved, or brought under control, whereas at other times the focus is on finding ways of facing painful treatments and the fear of dying (Stacey 1997: 169–​176). “Paul’s Visualization” tells the story of how Miriam tries and fails to follow the therapist’s instructions to create a mental image of herself “walking up a winding gravel mountain path,” meeting her ancestors inside a giant boulder, and receiving a gift from them (Figure 4.2). Even the most conventional part of the visualization, involving a journey metaphor, proves to be less than satisfactory for Miriam, who imagines herself getting hot and bothered as she struggles up a gravel path. In the drawing, the scene is represented inside a thought balloon

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Figure 4.2.  Engelberg, M. (2006) Cancer Made Me a Shallower Person: A Memoir in Comics (n.p.). © 2006 Miriam Engelberg.

emanating from Miriam’s head; the end of the path is obscured by a speech balloon, suggesting either that the path is leading nowhere, or that its goal is beyond her power of imagination. The task of coming up with a meaningful gift from her ancestors leaves Miriam completely stumped. The artist has once again drawn two self-​portraits within the same panel: Miriam 1 is sitting in a chair with her eyes closed, a thought balloon leading from her head; inside the balloon, we see a drawing of Miriam 2, who is haranguing the first Miriam to “come up with something profound and symbolic” quickly. On the following page, we learn

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that her friend Paul, who had accompanied Miriam to the session to show support, was able to imagine a detailed scenario, which makes her feel even more inadequate. The artist thus uses a humorous anecdote to show that even metaphors that are generally considered to be helpful for patients can have the opposite effect if they are not chosen freely by the individual sufferer. The extract also draws attention to the enormous variation that apparently exists between individuals’ ability to visualize things in vivid detail; indeed, about 3% of the population apparently do not generate any visual imagery at all, at least on the level of conscious awareness (Bergen 2012: 152). There are also documented differences in the degree to which people are object or spatial visualizers (Bergen 2012: 172), with some relying more on the “what pathway,” which is responsible for processing the detailed visual properties of things, and others on the “where pathway,” which deals with information about motion and the arrangements of objects in relation to each other (51–​53). Breitmeyer (2010: 145) is convinced that there is a close link between our ability to visualize things and the possibility of depicting them accurately. Whether because of an inborn talent, or years of paying close attention to colors and shapes, artists seem to be able to call upon a greater number of precise mental images than the average person, which they are then able to use to guide their visual representations: “Some of us might also be able to generate such imagery, but lack the skill to render them in any medium as art. Most of us, I must admit, simply do not have the mind’s eye of a good artist” (145). What is striking about Engelberg’s book is that, in contrast to most of the other graphic illness narratives in my corpus, the verbal text tends to be the dominant mode of communication, with the drawings adding elements of mood, perspective, and humor. The artwork is also very simple and cartoonish in style, with no attempt made to create a convincing illusion of depth, for instance. On one level, this is a straightforward reflection of Engelberg’s lack of artistic training and experience. However, the very spontaneity of her drawings also acts as an indexical stylistic metaphor for the artist’s unique personality and sense of humor, giving the story an aura of authenticity than may be lacking in the work of more accomplished comics artists (El Refaie 2010b). The anecdote recounted in the extract in Figure 4.2, for instance, could, in theory, have been conveyed perfectly adequately through the words alone, but the drawings inside the thought balloons of Miriam dragging herself up a steep mountain path and berating herself for failing to come up with an inventive visualization,

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together with the added “soundtrack” (“crunch, crunch”; “gong”), bring out unexpected, absurd details of her experience and thereby perhaps increase the reader’s perception of her candor. References to both journey and war metaphors can also be found in Relatively Indolent but Relentless, by Matt Freedman (2014), about his experience of treatment for adenoid cystic carcinoma, a rare form of cancer that, by the time it was discovered, had spread from Matt’s tongue to his neck and lungs. The book is like Engelberg’s in that it, too, consists of apparently spontaneous diary entries, although in Freedman’s case they take the form of verbal text with accompanying drawings, rather than being contained in traditional comics panels. Moreover, despite their sketchiness, the quality of the drawings clearly betrays Freedman’s professional art training. The harrowing details of his radiation and chemotherapy, and the debilitating effects these have on his physical and mental health, are presented both verbally and visually in terms of several different kinds of journeys, including climbing up and down a mountain (Nov. 2, n.p.), descending steps to where a large fire is burning (Nov. 6), and crossing an abyss on a tightrope (Nov. 17). In another entry (Nov. 8), Freedman has described and drawn himself as a wind-​up toy that runs along just fine in the morning but keels over in the evening. In Lakoff and Turner’s (1989) terms, the artist can be said to have elaborated the conventional metaphor of medical treatment as a journey by specifying particular kinds of journeys and then combining these with other metaphorical images, such as fire, an abyss, and a wind-​up toy, each of which adds further connotative and narrative meanings. Despite the aggressive nature of Matt’s treatment regimens, the war metaphor is referenced far less frequently. One rare example can be found in his diary entry for November 11, where he has illustrated the notion of “nasty tumors in the lungs . . . waiting, biding their time, prepared to strike at a moment’s notice,” through the drawing of a gigantic Trojan horse inside a cut-​away image of his upper torso. It represents an extension of the conventional war metaphor through the inclusion of elements that are not ordinarily involved in the mapping, by alluding to the mythological horse that the Greeks used to gain entry to the fortress city of Troy.3 This contextual pictorial metaphor thus draws on the reader’s knowledge of the original story in order to evoke a sense of cancer as a clandestine intrusion by apparently “harmless” but devious tumors. The metaphor also emphasizes the risk inherent in accepting things as they appear from the outside and neglecting their potentially traitorous interior spaces.

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At first glance, the cover illustration on Marchetto’s (2006) Cancer Vixen of Marisa administering a lethal martial-​arts-​style kick to an invisible enemy might be regarded as one of the most straightforward instantiations of the cancer is war metaphor in my corpus. However, the impractically short skirt and high-​heeled sandals she is wearing, and her exaggeratedly aggressive facial expression and body posture, introduce an element of parody, which is also evident in other parts of the book. As a professional comics artist, Marchetto is likely to be well-​versed in the visual vocabulary of conventional North American comics genres, and this image is clearly intended as an ironic reference to the antics of superheroines such as Wonder Woman, Supergirl, Miss Marvel, and the Invisible Woman. Other aspects of her style also draw on contemporary popular culture. For example, the cancer cells are depicted as belligerent-​looking green emoji. They make their first appearance after Marisa’s doctor has taken a sample of her breast tissue in the region of the tumor and informs her that it will be sent to the lab for analysis: “We need to see if the cells are angry. . . . We can’t know if there’s an abnormality until we look at them under the microscope. . . . What that means is, there’s a chance it could be cancerous” (2006: 4, emphasis in the original). Accompanying the doctor’s words is an image in large circular panel, labeled “possible cancer cells, an artist’s rendition . . . magnified 3 gazillion times” and showing a horde of emoji of different sizes sticking their tongue out and showing the middle finger. The image thus represents an ironic commentary on the doctor’s choice of metaphor, while also highlighting the gap between Marisa’s own understanding of aspects of her body that are hidden from view and the kind of knowledge obtained through the technologically enhanced gaze of the experts. The war metaphor is referenced again on page 156, when Marisa has started chemotherapy and has been told by her doctor to take it easy and allow her white blood cells to regenerate. Her decision to follow his advice and “support my troops” is represented through the image of yellow emoji lying asleep in a row of army-​style beds, helmets at their side. Again, this military image is subverted by the cartoonish appearance of “troops” and by the self-​portrait in the previous panel, which shows a close-​up of Marisa’s face with breasts in place of her eyes. She has a deadline for a work assignment, but, as a thought balloon reveals, she is unable to see/​ think of anything but her illness (see also El Refaie 2014a: 118–​119). A particularly creative combination of an agricultural metaphor and the conceptual metaphor cancer is human can be found in British artist

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Ross Mackintosh’s (2011:  54) graphic illness narrative Seeds, about his father’s gradual decline and eventual death from the effects of prostate cancer and secondary lung cancer. In the extract reprinted in Figure 4.3, the doctors have discovered that the “seeds” of the cancer have now spread to this throat, where they are affecting his ability to speak. The narrator laments the fact that “not only was the cancer taking his body away  .  .  .  it was now strangling his voice.” The first of the accompanying images shows a cross-​section of the father’s torso in white against a black background; the lungs are filled with tiny specks, which

Figure 4.3.  Mackintosh, R. (2011) Seeds (p. 54). © 2011 Ross Mackintosh.

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are also spreading upward into the neck. In the third panel, these dots have reassembled into the shape of two hands emerging out of the lungs, encircling the neck and strangling the vocal cords. Both the verbal narration and the visual images thus attribute malevolent human intentions and actions to the cancer, while also picking up on medical metaphors of “seeds” traveling through the body and creating new “growths.” Like the image used by Freedman of a Trojan horse lurking inside his lungs, the drawings in Seeds reveal a high level of alertness vis-​à-​vis the body’s ordinarily invisible internal spaces, although in this case it is a parent’s body, rather than the artist’s own, that is the focus of attention. The drawing of the lungs and trachea is reasonably anatomically correct, which suggests that Mackintosh is able to draw on detailed visual memories to guide his artwork. Significantly, Ross first realizes the seriousness of his father’s condition when a hospital doctor beckons him into his office to show him an X-​ray of the lungs, pointing out “this clouding” that needs to be checked out (2011: 7). This is followed by several panels (7–​8) that show Ross staring blankly at a screen, clearly trying but failing to take in what he is seeing. When he rejoins his parents in the waiting room (10), he imagines a giant grim reaper lurking behind them. The computer screen with the X-​ray image is still visible through the door in the background, the curve of the father’s ribs in the X-​ray subtly echoing the shape and direction of the grim reaper’s scythe. By combining two contextual metaphors with a pictorial simile, the artist has thus created an effective visual representation of the paradoxical relationship between seeing and knowing/​understanding/​believing. As I will show in the following two sections, this is only one of many instances in the works under consideration where vision reveals itself to be problematic and becomes the target of metaphorical mappings.

4.3.2. Visualizing Outer and Inner Selves The visible, outer body and how it appears to oneself and others is closely linked to our sense of selfhood and identity. Likewise, the ideas we have of each other are primarily visual in nature:  “When asked to think of someone, we picture the person and picture particularly his or her face” (Cole 1998: 13). Berger (1972: 9) emphasizes the “reciprocal” nature of vision, pointing out that to see someone normally means to be seen by them, too: “The eye of the other combines with our own eye to make it fully credible that we are part of the visible world.” Therefore, seeing others and

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in turn being seen by them is fundamental to our sense of existence as individuals and as bona fide members of a particular society. Social scientists and cultural/​feminist theorists suggest that we actively “perform” who we are or would like to be through our physical appearance, movements, postures, gestures, and facial expressions (Conboy, Medina, and Stanbury 1997). According to this view, the human body is more than just a material reality; it is “an enormous vessel of meaning of utmost significance to both personhood and society” (Waskul and Vannini 2006: 3), which is constantly being constructed and reconstructed based on cultural beliefs and practices relating to gender, class, age, ethnicity, health, and beauty. These in turn are reflected in, and influenced by, the actual bodies and body images we encounter in our everyday lives. As a result, the relationship between our body and sense of self is inevitably fluid and unstable: Put simply, there is no such thing as “the” body or even “the” body image. Instead, whenever we are referring to an individual’s body, that body is always responded to in a particularized fashion, that is, as a woman’s body, a Latina’s body, a mother’s body, a daughter’s body, a friend’s body, an attractive body, an aging body, a Jewish body. Moreover, these images of the body are not discrete but form a series of overlapping identities whereby one or more aspects of that body appear to be especially salient at any given point in time. (Weiss 1999: 1) Weiss believes that this multiplicity of body images allows us to adapt in productive ways to the many different situations and challenges we encounter in our lives. However, some people are afforded more freedom than others to determine how their bodies are viewed by others. Whereas privileged white men can define themselves in ways that are relatively unencumbered by their appearance, those whose bodies are constructed by the powerful majority as “other,” such as women and the socially, culturally, or racially marginalized, tend to be much more closely associated with one particular aspect of their physicality. Similarly, people with a visible illness or disability often feel compelled to adopt an identity that is inseparable from their “abject” (Kristeva 1982)  bodies, which can lead to distressing gaps and tensions between their own understanding of themselves and the meanings that are projected onto them (Charmaz and Rosenfeld 2006: 47).

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In contemporary Western consumer culture, physical appearance has also become ever more closely enmeshed with notions of personal value or worthiness. All individuals, women in particular, are encouraged to compare themselves to unattainable ideals of beauty, to monitor themselves constantly for signs of imperfections, and to treat their bodies as “a carefully crafted work in progress, open to change, always on the lookout for the most recent trends, and attuned to the demands of the image-​ makers who set the standards” (Edgley 2006: 235). Notions of (ill) health have become morally inflected, such that a healthy body is taken as a sign of a person’s self-​control, prudence, and general good character, while symptoms of illness are associated with moral shortcomings (Couser 1997; Featherstone 1991). Our bodies are thus both deeply personal, because our sense of selfhood and value depends on the way we appear to ourselves and others, and political, because the embodied performance of identity is closely linked to economic interests and social power structures. The complex relationship between our bodies and selfhood is exemplified by Jennifer Hayden’s autobiographical comic, The Story of My Tits. In this book, the artist traces all the different meanings that her breasts have held both for herself and other people throughout the course of her life, using a cartoonish drawing style to add humor to what would otherwise be a very distressing story. Even as a little girl, the pictures Jennifer spies in her father’s Playboy make her realize that “the world was going to expect big things of my body” (2015: 1), and her late development causes her acute embarrassment and shame. When she finally grows a pair of (rather small) breasts, other people’s reactions to her change accordingly: “Funny,” she notes, “now that I had tits, I found out that boys liked personality” (29). Her eventual progression to a size 38C makes her feel that she has, at last, fulfilled her “biological destiny” (42), and her breasts also take on specific significances for her husband and her two children. All this is radically called into question, however, when she is diagnosed with a carcinoma in one of her breasts and decides to have a bilateral mastectomy. The panel in Figure 4.4 follows on from a preoperative examination, which is observed by “a room full” of male students (274). Jennifer reimagines the scene with herself in the role of the star performer in a striptease club and the students as admiring spectators, but finds she cannot enjoy the experience as much as she had anticipated. “Maybe the problem was:  I know it was for the last time,” she muses, before concluding, “Or maybe it was that my tits had changed overnight from sexy flesh mountains to poisonous deposits of fat” (275).

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Figure 4.4.  Hayden, J. (2015) The Story of My Tits (p. 275, detail). © 2015 Jennifer Hayden.

The verbal narration is accompanied by an ambiguous pictorial metaphor that can be interpreted either as two adjoining lakes at the foot of adjacent mountains or as a cross-​section of a pair of breasts filled with a poisonous liquid substance. Jennifer is lurking in the background, a worried expression on her face and her hands gingerly fingering the mountains/​tits, which are completely disconnected from her own body. While the verbal metaphor is able to convey the idea of a sudden transformation from one perception of her breasts to another, only the visual image allows us to fully appreciate the paradoxical truth that Jennifer’s body is, simultaneously, both a visible sign of her (traditionally defined) feminine sexuality and a material, biological entity that may keep her alive or turn against her. The other notable feature of this image is that it draws attention to the body’s hidden interior spaces in a way that we tend to avoid in everyday life. Under ordinary circumstances, the body is understood and talked about as a container or residence for our authentic thoughts, feelings, and identity. This “inner self” metaphor, which carries echoes of the Cartesian notion of a disembodied mind, is also implicit in the scholarly notion of

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“interiority,” the psychic space or inner life of the subject. In their analysis of subjectivity in graphic memoirs, for instance, Horstkotte and Pedri (2017: 89) discuss the ability of such works to dismantle “distinctions between the protagonist’s interior and exterior realities.” The creators of graphic illness narratives also often implicitly invoke this dichotomy between a person’s inner and outer life, as can be seen in Nadia Shivack’s memoir about her eating disorder, Inside Out, which includes a drawing of her “true,” slim self being trapped inside a monstrously engorged outer self (see Chapter  3, Figure  3.8). As will be discussed in Chapter  5, the mental anguish associated with depression is also sometimes imagined as being located inside the sufferer’s body. The notion of a spiritual inner self is only possible if we imagine the human body to be a hollow container, even though, at least at some level, we are of course fully aware of the flesh and bones beneath the surface of the skin. Using a metaphor that recalls Hayden’s drawing of her breasts as mountains, Scarry (1985: 3) writes that the body’s internal spaces and processes “seem to have the remote character of some deep subterranean fact, belonging to an invisible geography that, however portentous, has no reality because it has not yet manifested itself on the visible surface of the earth.” In other words, the material reality of the body’s interior spaces is so hard to imagine that it is only called up if it is relevant to the observer. Arnheim (1969: 87) believes the same to be true of the perceptual inside of any material object. For example, if we know the contents of a closed box, these contents form part of what we see when we look at it, based on our visual memory of peering inside. Similarly, a man might see his lover as a body covered by clothes, whereas his mother is likely to be perceived by him as an entirely dressed shape. The surface of the human body itself constitutes a more substantial obstacle to our visual freedom, in the sense that it is only medical professionals and morticians who are likely to have clear, detailed visual memories of its interior spaces; the rest of the population is reliant on pictures to fill in the gaps in their knowl­ edge. Moreover, there are few situations where it is useful or necessary for us to imagine the perceptual insides of our fellow human beings. It is only under exceptional circumstances, for instance, that the head of a person will appear to us “as the surface cover of a skull, which in turn encloses the kind of brain known from the butcher shop or anatomy book” (Arnheim 1969: 88). One of those rare circumstances where the body’s interior spaces force themselves into our consciousness is when someone is diagnosed with

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cancer. This is illustrated in Belgian comics artist Judith Vanistendael’s (2012) fictional story about David, who has cancer of the larynx, which rapidly spreads to other parts of the body. For a long time, he keeps his diagnosis secret from his wife and two daughters, but when they notice his increasing physical frailty, he is finally forced to come clean. In the extract in Figure 4.5 we see David in his bookshop after having undergone a course of chemo-​and radiotherapy. His grownup daughter, Miriam, is deeply worried about his state of health and, when he turns away to find a book she has ordered, he appears to her as a skeleton (a body modification metaphor). Doubting the reliability of her vision, Miriam rubs her eyes and then opens them wide again, but the strange apparition persists for another eight panels (2012:  69–​70), until it finally morphs back into the figure she recognizes as her father. Miriam’s hallucinations are likely to be inspired by generic pictures of the human skeleton, as well as by the X-​ ray images of her father’s body that she may have seen previously. Such medical images play an important role throughout the book. The story starts with an over-​the-​shoulder view of David’s doctor (and close friend) drawing a cross-​section of his patient’s head and neck, in order to explain to him exactly where the tumor is located on the larynx (8). Later in the story (138), the same doctor is standing with David’s wife, Paula, in front of a large lightbox with multiple X-​rays showing the metastases that have spread all over his body. Paula is hurt by David’s silence and apparent unwillingness to share his suffering with her. A few pages later (161–​162), we see her crouched on the floor in a pitch-​black room; the walls are covered from floor to ceiling with the X-​rays, a pale green glow emanating from where the metastases are located. In another sequence (188–​191), Paula cuts the X-​rays up to form bone-​like shapes that she reassembles into a life-​size skeleton figure; then she curls up beside it in a fetal position. This indexical stylistic metaphor shows how cold, empty, and meaningless the X-​ray images appear when they are abstracted from David’s unique lived experience. By remodeling the images into a human shape, Paula is trying to make sense of the “subterranean geography” (Scarry 1985:  3) of her husband’s body, while also reconnecting it with the unique human being she loves. The following two pages are entirely black (192–​193), indicating, by way of an isomorphic stylistic metaphor, her unbearable grief and sense of loss. The fictional nature of When David Lost His Voice accords the artist maximum freedom in deciding how to represent complex, abstract notions as

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Figure 4.5.  Vanistendael, J. (2012) When David Lost His Voice (p. 68). © 2012 Éditions du Lombard, Judith Vanistendael; English translation © 2012 SelfMadeHero.

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effectively as possible, without being bound in any way by factual details. By combining several different forms of visual metaphor, the artist is able to challenge the notion that seeing inevitably leads to greater knowledge and understanding, since there are so many aspects of human experience, including our fears and emotions, that cannot be forced into visibility and that require other forms of sensory engagement. The following section will home in on the role played by medical images in the production and reproduction of knowledge about cancer—​images which, by their very nature, are liable to erase important aspects of the human experience of suffering.

4.3.3. Like Pictures from Outer Space Although it is now common practice, at least in Western medicine, for patients and their families to be shown visual evidence of cancerous tumors, the question remains what it is they actually see, since such visualizations are likely to be utterly unfamiliar and thus not fully comprehensible, even if a medical professional is on hand to provide advice. Ihde (2015:  21–​22) draws an explicit comparison between ways of imaging a brain tumor in medical radiology and a nebula in astronomy, pointing out that in both cases we must rely on computer processes that transform any kind of data—​or combinations of different data sets—​ into images, and back again. For example, since nebulae are made of gas and dust particles of different wavelengths, many of which the human eye is incapable of perceiving, astrophotography uses colors to make them visible. Similarly, in computer tomography, X-​ray information is converted into numbers and then into a visual display, whereby unwanted “noise” is eliminated and different types of tissue are represented through distinct levels of gray, or color variants. It is also possible for all the slices taken of a particular area of the body to be digitally reassembled into a three-​dimensional simulation on screen. The digital forms of representation that are now central to cancer diagnosis are thus able to supersede anything “that the human eye/​scalpel is capable of” (Kember 1995: 101). However, to the untrained eye, these images of “the most remote new surfaces of the body’s interior” appear “like pictures from outer space. A tumor can look like a nebula, and a cancer cell can look like a star” (Kember 1995:  100). Indeed, the similarity between these two types of images is not coincidental, given that advancements in medical imagining have historically always

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been closely bound up with the development of astro-​military imaging technologies (103). As was mentioned in the introduction to this chapter, Marchetto (2006) uses the metaphor of a black hole in outer space to convey her experience of seeing her breast tumor in an ultrasound image for the first time. The connection between medical and astronomical imagery has not escaped the notice of comics artist Brian Fies, either. In Mom’s Cancer (2006), a graphic memoir about his mother’s metastatic lung cancer, which, by the time it is discovered, has spread to her brain, the autobiographical narrator repeatedly draws parallels between our understanding of the universe and of the equally mysterious processes occurring inside our bodies. This theme is first introduced on page 52; Brian’s mother is telling him about her much-​loved grandfather, who died of tuberculosis. On his deathbed, he makes a pronouncement that, as the narrator remarks, “shaped his family’s future in ways I wouldn’t understand for decades.” The final panel of this page shows his hand gesturing toward the starry night sky, with the words: “fifty-​ year-​old echoes  .  .  .” in the text box above. The page opposite (Figure

Figure 4.6.  Fies, B. (2006) Mom’s Cancer (p. 53). © 2006 Brian Fies.

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4.6), entitled “Mom in Mathemagic Land,” starts with a brief illustrated explanation for why a substantial decrease in volume can easily be misjudged when a three-​dimensional object is represented through a two-​dimensional  image. The right half of the page shows how this notion can help nonprofessionals evaluate medical images of lung tumors pre-​and post-​ treatment. What looks like just a tiny reduction in size is, in fact, a clear indicator that the treatment is working and the cancerous tumor is significantly smaller. In the image in Figure 4.6, we see the doctor, Brian’s mother, and his two sisters from behind, silhouetted against a giant screen with white elliptical shapes on a black background. Due to their use of similar white shapes on black, the panel showing the starry night sky on the page opposite (52) and the screen image together form a pictorial simile, which invites us to draw comparisons between the sense of awe and confusion we may experience when gazing at the stars and when looking at images of the insides of the human body. The parallel is reinforced by the allusion to science fiction comics and films, where over-​the-​shoulder shots of the spaceship crew staring at giant screens are commonplace. The story of Brian’s great-​grandfather is picked up again some 20 pages later. His deathbed pronouncement, which made a deep impression on his daughter (Brian’s grandmother) at the time, was that “not your children, but your children’s children” would witness “great things coming out of the sky,” that would “come in peace to teach and guide us” (Fies 2006: 74; emphasis in the original). On the next page, we see Brian as a little boy, sitting in front of a television showing the first manned lunar mission in 1969. The screen has been replaced with an actual photograph of the launch of Apollo 11, which thus acts as an indexical stylistic metaphor for the paradoxical truth value of images produced by technological means. As the innumerable conspiracy theories that still surround the moon landing demonstrate, we simultaneously long to believe and yet instinctively mistrust photographic evidence of things we are unable to see with our own eyes and that we can never fully comprehend. Brian’s grandmother is convinced that her late father’s prophecy has come true, and she fosters in her grandchildren a lifelong fascination with space exploration and the stars. This, the adult narrator realizes, was instrumental in preparing him for the experience of his mother’s illness, which he glosses as the moment “when the aliens land” (77). The culmination of this extended analogy is reached on page 79, which shows an astro-​photographic image of M57, “a nebula in the constellation Lyra”:

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It’s a bubble of gas blown into space by a dying star. . . . Gas that will someday form a new star with new planets . . . a new chance for life. It’s also almost identical to an M.R.I. scan of a dying brain tumor. The intersecting beams of radiation worked. The tumor’s hollow now, rotting from the inside out. It’s funny how death giving way to life can look so similar. (Fies 2006: 79; emphasis in the original) This example shows how complex, new sights are sometimes impossible to understand and describe satisfactorily without comparing them to something that is at least a little more familiar. It also suggests that the tendency for graphic artists to use astronomical metaphors to convey their experience of looking at medical images is based on an actual perceptual likeness and parallels in the kind of knowledge they produce. David Small’s (2009) graphic memoir Stitches, about a traumatic childhood and adolescence in 1950s Detroit that was further marred by his cancer, is less concerned with the precise nature of medical images themselves, and more with how they are used by the medical establishment to perpetuate iniquitous power relationships. Throughout the book, David’s emotionally repressed parents are always drawn with glasses that mask their eyes and make their affective states impossible to fathom (see also El Refaie 2012b). In the case of his father, the glasses are explicitly associated with his profession as a radiologist. As children, David and his brother are often taken to visit the hospital where their father works. The narrator describes David’s olfactory perceptions, noting that “each time it smelled the same:  Carbolic acid, meatloaf or chicken, and bleach.” His father, by contrast, is fully engaged in the rational act of looking; “in a warren of small offices and in a cloud of smoke,” they find him “poring over X-​rays with the other radiologists” (Small 2009:  26). All three radiologists are depicted as middle-​aged, white men, wearing spectacles that completely obscure their eyes. In the final panel on this page, we see their heads and shoulders from a high, fully frontal angle, as they turn their bespectacled gaze toward the reader and, by implication, the X-​ray images they are analyzing—​suggesting, by means of an interactive spatial metaphor, their position of power. Their invisible gaze calls to mind what Foucault (1977) describes as the major purpose and effect of the “Panopticon,” namely to exercise control over the inmates of prisons, hospitals, and other institutions, by making them feel permanently watched by observers who themselves remain anonymous and invisible. This interpretation is reinforced on the following page,

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where we see rows and rows of similarly attired doctors, marching under the drawing of an X-​ray tube and the banner “piercing the unknown.” “To me,” the narrator observes, “Dad and his colleagues seemed like the heroic men featured in the ads in Life magazine, marching bravely into the bright and shining future. They were soldiers of science, and their weapon was the X-​ray” (Small 2009: 27). In the 1950s the X-​ray was regarded as a wondrous new technology with the ability to cure all manners of disease. As a fervent believer in its powers, David’s father regularly subjects his son to X-​ray treatment for his sinus problems (Small 2009: 21). Tragically, as is revealed later in the story, this was very likely the cause of the tumor David develops on his neck as a teenager. It takes several years for his parents to be sufficiently concerned about his health to have it investigated by an ear, nose, and throat (ENT) surgeon, who is also a family friend. The page reprinted in Figure 4.7 shows the surgeon holding up an X-​ ray image of David’s neck, the tumor clearly visible in the center. “Good news, sport!,” the doctor reassures him: “Looks like it’s only a cebaceous cyst.” In Mitchell’s (2008) terms, the top panel is a “metapicture,” “a picture in which the image of another picture appears, a kind of ‘nesting’ of one image inside another,” (18), and which is typically “employed as a device to reflect on the nature of pictures” (19). In this case, the reader is invited to study the X-​ray, which is drawn in a much more detailed and photorealist style than the rest of the page, and to try to understand what exactly it is showing us. Like David, most readers will have no way of judging the accuracy of the doctor’s interpretation of it, as a cebaceous cyst looks much like a cancerous tumor to the untrained eye. The doctor’s right eye is cut off by the panel frame, and his left eye is covered by his spectacles, which acts as an effective visual metaphor for the absolute power of the medical gaze, as well as making it impossible to tell whether his broad grin is an authentic expression of optimism or just a mask-​like grimace. In the second panel, the perspective has shifted, and we now see David from the doctor’s perspective, his thin, naked torso exposed and the lump on his neck clearly discernable. Part of his face is obscured by the X-​ray image, and a dark, ominous shadow is cast over the right side of his head and shoulders, including the area where the tumor is located, implying, by means of an isomorphic stylistic metaphor, that the doctor’s diagnosis may not be accurate. David is staring up at the image, a concentrated but baffled look on his face. In the background, his mother is sitting silently in a shadowy corner, her expression inscrutable.

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Figure 4.7.  Small, D. (2009) Stitches (p. 132). © 2009 David Small.

As mentioned earlier, the depiction of David’s parents with expressionless faces is maintained throughout most of the book. There are only one or two significant moments in the story when their masks slip a little. Toward the end of the story, after David has undergone two operations to remove what has turned out, after all, to be a cancerous tumor, his father unexpectedly invites him out to dinner (Small 2009: 278–​293). Following an awkward, perfectly silent meal, they go for a walk by the river, at which point the father admits that he probably inadvertently caused his son’s cancer. His eyes are, for once, clearly visible behind his glasses, and we see him giving his son a look of grief and remorse. The visibility or invisibility

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of a character’s eyes behind their spectacles is thus used by Small as a body modification metaphor, signaling both the parents’ (un)willingness to reveal their emotions, and the extraordinary power of the medical gaze. In their accounts of being treated for breast cancer in the United States, Marchetto (2006), Hayden (2015), and Engelberg (2006) all describe being seen mainly or exclusively by male cancer specialists and surgeons. Engelberg, for example, includes a short story called “The Disposition of Doctors” (n.p.), which shows two male doctors interpreting the same set of her breast scans in consecutive consultations, with one of them judging the tumor to be “about 2 centimeters . . . but it could be larger—​it’s hard to tell,” and the other pronouncing that it “looks about 2 centimeters . . . but it could be smaller—​it’s hard to tell.” The patient herself is not even looking at the images; instead, she is staring at the doctors, trying to work out whose judgment to trust. This kind of situation reinforces traditional gendered patterns of the gaze, in which the spectator is generally assumed to be male and the object of his gaze the female body (Berger 1972). Rachel Ball’s (2015) The Inflatable Woman, a fantastical fictional story that was nevertheless informed by its British author’s own breast cancer experiences (2015: Acknowledgments, 543), is notable for the fact that the doctor who diagnoses the cancer is a woman. The page reprinted in Figure 4.8 shows the protagonist, Iris, having a mammography done to verify whether the lumps in her breast are benign or cancerous. Several (compositional and diegetic) spatial and (isomorphic) stylistic metaphors work together to convey the character’s utter terror and confusion. All the pages in the book consist of one or more panels against a black background, yet the layout of this one (and of others in the same sequence) is unusual in that its frame is severely distorted to follow the shape of the eyebrow in the top left-​hand corner. The fact that the scanner is tilting downward and to the left further emphasizes Iris’s emotional unbalance. She appears small and vulnerable in relation to the strange-​looking scanner looming over her, and, though the nurse is most likely uttering reassuring words, these are written in illegible characters, suggesting that Iris is so terrified that she is unable to take in what she is saying. The giant eye hovering above the whole scene is later identified as that of the female doctor who, at the end of this sequence (2015:  53), bursts into tears as she informs Iris that she has breast cancer. Indeed, she is so distraught that she is unable to speak and delegates the task of explaining

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Figure 4.8.  Ball, R. (2015) The Inflatable Woman (p. 46). © 2015 Rachael Ball.

the diagnosis and treatment options to a tiny, spiteful nurse, who has both male and female characteristics. The verse written in large letters next to the eye are part of the poem “The Sick Child,” by Robert Louis Stevenson (1920), in which a mother is lamenting her dying child. Significantly, the lexical item “God” is positioned immediately adjacent to the eye, creating a close association between the omniscient Lord and the all-​seeing medical gaze. However, the artist has chosen to defy conventions and represent the medical gaze as female, motherly, and emotional, rather than male, rational, and dispassionate. This represents both a departure from and a confirmation of traditional gender stereotypes in the medical field, in

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the sense that, although the doctor is female, she is portrayed as too sensitive to perform her professional duties without being overwhelmed by her emotions. The analysis of examples in this chapter has demonstrated that many of the visual metaphors in graphic illness narratives about cancer unsettle the connections between seeing and knowing that are so deeply entrenched in Western culture in general and in contemporary Western medicine in particular. Although a corpus study of verbal expressions that are based on the underlying understanding is seeing metaphor similarly revealed a more complex relationship between the two conceptual domains than was previously presupposed by CMT scholars (Deignan and Cameron 2013), the current study is the first of its kind to demonstrate the fluid and potentially bidirectional nature of this conceptual metaphor on the basis of visual data. This finding is significant because this particular metaphor is often given as one of the most compelling and clear-​cut examples of the fundamentally metaphorical nature of all human cognition (e.g., Johnson 2007:  165–​166), which in turn is thought to emerge from relatively stable correlations between our embodied experience and more abstract concepts. As this chapter has shown, however, human vision is itself characterized by multiple ambiguities, gaps, and contradictions, which become much more apparent when people are confronted with a (partially) hidden disease such as cancer, as well as with the baffling digital images of internal bodily spaces that form such an important part of the diagnosis and treatment of the disease in Western medicine. In the following, final chapter I  will turn my attention to the works in my corpus that deal with depression; here, too, the affordances of the graphic illness narrative genre will be shown to shape the metaphors that the artists most commonly use to represent this form of disease, thus further substantiating my original claim that both embodiment itself, and the relationship between embodied experience and metaphor creation, are dynamic in nature.

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Trapped in Spacetime Metaphor in Graphic Illness Narratives about Depression

chapter, I  have shown that metaphors in cancer pathographies, when they are created in the comics medium, typically show an intense engagement with human vision and the tenuous links between seeing and knowing/​ understanding/​ believing. This chapter focuses on an entirely different kind of disease:  depression. Eight of the books in my corpus deal, either exclusively or among other topics, with depression (Bradshaw 2015; Brick 2010; Brosh 2013; Cunningham 2010; Leto 2015; Mademoiselle Caroline 2013; Swados 2005; White 2010), while another is about bipolar disorder (Forney 2012). One of the works is by a French artist, three are by British creators, and the remainder by US artists; six of the creators are women and three are men. The level of their drawing skills and artistic training varies greatly, as does the degree to which the works can be described as prototypical comics. Swados (2005), for example, eschews conventional comics panels, using a few handwritten lines and just one or two very simple, sketchy, and unframed drawings per page instead. All of the stories are explicitly autobiographical and are written from the perspective of someone who is recovering or in remission. This is surely no coincidence, as full-​blown depression would most likely dampen the creative impulse and diminish the self-​discipline required to produce a graphic narrative. Depression is a mood disorder that involves a range of related symptoms, lasting for a minimum of two weeks and including several or all of the following: low mood; loss of interest in previously enjoyable things; changes in appetite and/​or weight; sleep disturbances and fatigue; IN THE PREVIOUS

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feelings of guilt or worthlessness; psychomotor disturbances; recurrent thoughts of death or suicide; a decrease in emotional and perceptual reactivity; and disturbances in cognitive functioning, characterized, for example, by attention deficits, dichotomous thinking, and excessive generalizations (Bartczak and Bokus 2015; Flynn 2010; Harvey 2013: 184). Depression has also been shown to be linked to altered perceptions of the flow of time, specifically a sense that time is passing more slowly (Gil and Droit-​Volet 2009; Thönes and Oberfeld 2015). The enormous variations in the way the “conglomeration of signs and symptoms” (Flynn 2010:  37) that we now call depression has been defined, explained, and treated throughout history attest to the significance of the changing sociocultural contexts in which our understandings and practices of mental illness are based. The word “depression” comes from the Latin stem of deprimere, “to press down.” In the late seventeenth century it replaced the earlier concept of “melancholia” (from the Greek melaina chole, “black bile”), which was thought to be caused by an excess of black bile and which, at least in its less severe forms, was associated with exceptionally intelligent, sensitive men, such as scholars, artists, and noblemen (McMullen and Conway 2002: 168). However, over time, depressed feelings gradually lost any positive connotations and became more closely linked with women, whose bodies were believed to predispose them to mental disorders. The twentieth century saw the rise of psychoanalytic and cognitive-​behavioral theories, which sought to explain depression as a consequence of certain personality traits, family constellations, and early childhood trauma. Supported by brain-​imaging technologies and new drugs, the focus shifted again in the 1970s to a view of depression as a neurophysiological disease that is caused by a chemical imbalance in the brain. Today it is generally accepted that both biological and environmental factors are involved in depression, but the relative contribution of each is still hotly contested. For example, depression seems to be much more common among women than among men, yet feminist scholars believe that this reveals more about gender roles and expectations than it does about any significant biological differences (McMullen 2008; Metzl 2003; Schiesari 1992). While some professionals and patients place all their trust in the biomedical model, those who advocate a more holistic approach are convinced that, at least over the longer term, depression can only be addressed effectively by psychosocial therapies (Deacon 2013). Indeed, some scholars argue that the very notion of “mental illness” is itself a

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metaphor, since it is only one of several potential ways of thinking about disorders of the mind (Pickering 2006). What is clear is that depression is a deeply personal and often devastating experience that cannot be communicated easily without recourse to metaphor. The most common conceptual metaphors that people use when talking or writing about the disorder—​descent, darkness, bearing a heavy burden, being trapped, and disintegration of the self (Charteris-​ Black 2012; Demjén 2011, 2014; Fullagar and O’Brien 2012; Keefer et al. 2014; Levitt, Korman, and Angus 2000; McMullen 1999; McMullen and Conway 2002)—​are also prevalent in the works in my data set. However, in graphic narratives they often take on highly creative and unusual forms, which can convey nuances of meaning that would be hard to capture through either a single image or the verbal mode alone. As a result of the multimodal affordances of this medium, the possible meanings of each sign are “multiplied,” rather than simply added together (Lemke 1998:  92), making it possible for a comics artist to represent several aspects of the depression experience through just one page design, for instance. The main, original claim developed in this chapter is that many of the metaphors in the works under consideration are centered on time perception. Although changes in temporal processing seem to be a very common symptom of depression, they are apparently not (or at least not overtly) reflected in the metaphors that are used most frequently by sufferers in verbal discourses. As I will argue, creating comics involves a unique process of translating time into space, which is capable of conveying highly subjective, idiosyncratic experiences of time, and which differs in important ways from linguistic expressions of the time is space metaphor. Consequently, temporal aspects of the depression experience are likely to be especially foregrounded in the mind of comics artists when they are communicating their story through the graphic pathography genre. The extract in Figure 5.1 will serve to illustrate my arguments. It is taken from Tracy White’s (2010) account of her eating disorders and severe bouts of depression as a teenager, How I Made It to Eighteen. Tracy has just been admitted to a psychiatric hospital for young people after smashing her fist through a window pane for no apparent reason. Most of the page is taken up with a uniformly black background, the darkness of which is further emphasized by the contrasting white border. In the bottom right-​ hand corner of the page, we see, from a rather distant, high angle, half of

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Figure 5.1.  White, T. (2010) How I Made It To Eighteen (p. 9). © 2010 Tracy White.

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a hospital bed, with Tracy curled up on top of the bedclothes, hugging her pillow to herself, her eyes closed and a look of anguish on her face. The preceding page (8) contains an identically framed black space, entirely empty but for the words “I miss my life” printed in tiny, white letters in the middle. The same capital letters, font size, and color are also used for the three text blocks on the page in Figure 5.1. These are arranged in a diagonal line that leads the eye from the top left-​hand corner down to just above Tracy’s bed. The metaphor depression is down/​descent is thus conveyed through several interrelated spatial metaphors:  the fact that, in the storyworld, Stacy is lying down (diegetic); the way the viewer is positioned so that he or she seems to be looking down at her from above, making her appear vulnerable and powerless (interactive); and the placement of the text blocks and the bed, which together suggest a reading path with an emphatic downward orientation (compositional). Depression is also conveyed as unambiguously dark/​black, unlike the remembered sequence leading up to Tracy smashing the window pane (2010: 11–​13), for instance, which is drawn in varying shades of gray. Tracy’s thoughts indicate that her sense of self is distorted and fractured as a result of the depressive symptoms (“I just don’t know who ‘me’ is anymore”). This is emphasized visually through the way the drawing of Tracy on the bed in Figure 5.1 seems to be sliding out of the storyworld into what Lefèvre (2006: 10) calls the “extradiegetic” space of comics narratives, which includes both “the material space that surrounds the individual panels,” and “the real space in which the reader is located.” The ambiguity concerning the precise “location” of Tracy’s body thus becomes a visual metaphor for her perceived loss of an integrated “me” as a result of the onset of depression. Moreover, the huge, blank spaces of the black backgrounds on pages 8 and 9, interrupted only by the four spread-​out blocks of text representing Tracy’s fleeting thoughts, convey a sense of amorphous time, in which day-​and nighttime merge together and empty hours seem to drag on endlessly, devoid of any real meaning. Whereas speech balloons tend to convey their own sense of sequence and duration, by calling to mind “that which can only exist in time—​sound” (McCloud 1994: 95), thoughts are not linked clearly to a specific duration. The content of Tracy’s thoughts also points to alterations in her temporal experience, including the subjective perception of time slowing down (“It seems so long ago that everything was normal”), while her internal bodily functions feel as if they are operating at a frenetic pace (“When will my stomach stop going 1,000 miles per hour?”).

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Drawing on the work of Fuchs (2005, 2013)  and Ratcliffe (2012), I  will begin this chapter by suggesting that depression often leads to a sense of being disengaged from projects and out of sync with other people, which in turn causes the ordinary, “implicit” orientation toward time that comes with absorbed engagement to be suddenly rendered painfully “explicit.” Section 5.2 discusses the growing body of empirical evidence that points to such intimate connections between spatial and temporal processing that, according to Stocker (2014), they may, in fact, form one single domain of “spacetime” in our cognitive system. These connections are very obvious in comics, where, as McCloud (1994: 100) puts it, “time and space are one and the same.” Hence, comics may be particularly well suited to the task of representing subtle shifts in people’s experience of time as a result of depression. In section 5.3 I analyze several examples of the kinds of metaphors that occur most frequently across the nine graphic pathographies in my corpus, including metaphors of descent and darkness, metaphors of fractured/​ split selves, and metaphors that express a sense of what I  shall call “temporal entrapment.” Although only the latter cluster of metaphors have the experience of time as their explicit target, many of the others also carry more implicit, secondary meanings relating to the altered sense of temporality associated with depression.

5.1. Time and Depression Time can be measured objectively through timekeeping instruments of various kinds, yet the way it is subjectively understood and interpreted is influenced not only by shared cultural norms and practices (Hall 1973) but also by the unique situations in which we find ourselves. Accordingly, the human perception of time is often described as comprising two distinct notions: measurable, regular, linear “clock” time; and more complex, subjective, intuitive “lived” time, which “changes with the significance of our experience” (Kerby 1991: 17). If we are sad, bored and restless, for example, time will take on a different shape and significance for us than if we are excited or panic-​stricken. Since verbal language is essentially a system of abstract signs, the French philosopher Henri Bergson (1889) suggested, it is more suited to the task of classifying objects into distinct categories than capturing what is unique about actual lived experience. As a consequence, we find it easier to talk about clock time than to convey our

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subjective experience of what he calls “psychic” time, which requires more poetic forms of expression (see also Currie 2007). Writing from the perspective of phenomenology, Fuchs (2005, 2013)  makes a useful distinction between “implicit” and “explicit” time. Implicit time “is retrieved every time that we are absorbed in what we are doing,” and it reaches its apex in the sense of being completely absorbed “in unimpeded, fluent performance,”1 while explicit time refers to those situations in which time “is experienced as a ‘not yet’ or ‘no more,’ often with a component of displeasure or suffering” (Fuchs 2005: 195). In other words, implicit time becomes explicit when either our future plans are thwarted or we long for something that is irretrievably lost in the past, leading to the temporality of “awaiting, striving, or longing for” in the first case, and the temporality of “missing or mourning” in the second (Fuchs 2005: 195). The background–​foreground structure of temporality is similar to the way the body is experienced either as our tacit means of engaging with the world in habitual ways, or as the object of our conscious attention.2 Indeed, the two are often closely connected:  “For example, when falling ill, we experience our body no more as a tacit medium but rather as an object or obstacle, while we notice the slowing down of time and may even feel excluded from the movement of life” (Fuchs 2005: 196). Explicit time is also typically characterized by intersubjective “desynchronization,” the acceleration or retardation of an individual’s temporal experience in relation to his or her social environment. In the case of depression, Fuchs (2005: 170) argues, time is severely retarded with respect to others: “explicit time establishes a merciless rule; its passing by is noticed painfully, and the future of lived time seems closed forever.” The characteristic loss in people suffering from depression of interest, appetite, and libido manifests itself in “a reduction of the conative–​ affective dynamics of implicit temporality” (Fuchs 2013: 96, emphasis in the original), in the sense that the ordinary purposeful pursuit of actions in order to achieve desired future goals is disrupted. This, in turn, is closely associated with “an increasing rigidity of the lived body whose materiality, under the normal circumstances of life, is suspended, but now makes itself felt in depressive disturbances of vitality such as heaviness, exhaustion, oppression, anxiety and general restriction” (Fuchs 2013: 96). While agreeing with many of Fuchs’s conclusions, Ratcliff (2012) points out that depression may affect an individual’s perception of time in a range of subtly different ways, including with respect to how the past, present, and future are experienced. Thus, for some individuals it is not just

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the conative drive that is missing; rather, the very notion that there might be significant practical possibilities to strive toward is lost. This complete absence of any sense of real significance may explain the paradoxical experience of time moving both more slowly and more quickly, as expressed, for example, in Lott’s (1996) autobiographical description of depression as being “stuck in a time-​locked place” (cited in Ratcliffe 2012: 121), while simultaneously hurtling headlong toward death: “Nothing of consequence stands between one’s current state and the realization of that threat, given that the future promises only more of the same. Hence it seems imminent, an experience that is often conceptualized more specifically in terms of approaching death” (Ratcliffe 2012: 128). The subjective perception that everything has lost significance may also lead to an erosion of the boundaries between the past, present, and future; since all events appear equally inconsequential, different moments in time seem to warp and blend together. The extract reprinted in Figure 5.1 bears out Ratcliffe’s intuitions. Although Tracy perceives the past to be far removed and time to be progressing at an agonizingly slow pace, her internal bodily functions are speeded up, as though she were anticipating a future catastrophe to befall her. The empty black spaces that take up the majority of pages 8 and 9, and the absence of implied actions or speech, remove the scene from any clear sense of temporal sequence and duration, thereby blurring the boundaries between the past, present, and future. A reduction in the speed of the subjective flow of time in individuals suffering from depression is also confirmed by a meta-​analysis of relevant empirical studies (Thönes and Oberfeld 2015). This subjective impression of time passing more slowly does not significantly impair the practical ability of depressive subjects to judge the duration of time intervals, however, with the possible exception of production tasks involving longer intervals (see Sévigny, Everett, and Grondin 2003). In other words, it is mainly the perception of “lived” time, not “clock” time, that is affected by depression. In the following section I will consider the central role of spatial metaphors in allowing us to understand and communicate our complex and multifaceted experiences of time.

5.2. Time, Space, and the Comics Medium In CMT, time is often cited as a prime example of a highly abstract notion that cannot be understood properly without drawing on concepts that

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are derived from more concrete, embodied experience. Hence, in English, time is regularly personified as a thief, a reaper, a pursuer, or a destroyer, or else it is conceptualized as a valuable commodity (Kövecses 2002: 49–​50; Lakoff and Johnson 1980: 7–​9). The most common way of understanding and talking about time, however, is through spatial metaphors (Lakoff 1993). Indeed, Stocker (2014) believes that spatial cognition and temporal cognition are so closely intertwined that they should be discussed as two subcategories of the single domain of “spacetime”: “object spacetime” and “event spacetime.” There is also growing evidence from (psycho-​)linguistic and psychophysical studies that time is universally conceived in systematic spatial terms, although some cultural differences have emerged with regard to whether time is imagined as stationary or moving; horizontal or vertical; and oriented from left-​to-​right, right-​to-​left, front-​to-​back, or back-​to-​ front, for example (Bonato, Zorzi, and Umiltà 2012; Boroditsky, Fuhrman, and McCormick 2011; Casasanto, Fotakopoulou, and Boroditsky 2010; Casasanto and Jasmin 2012; Cooperrider and Núñez 2009; Fuhrman et al. 2011; Moore 2014; Nuñez, Motz, and Teuscher 2006; Núñez and Sweetser 2006; Santiago et al. 2007; see also Chapter 1, section 1.4.1). When English speakers consider time from their own perspective, they typically draw on either the ego-​moving metaphor, in which the observer progresses along a sagittal timeline through a landscape toward the future, or the time-​moving metaphor, where time is imagined as moving toward the static observer (Lakoff 1993). These two distinct ways of talking about time are not just a superficial feature of language; rather, they appear to be closely linked to our concrete sensorimotor perceptions, our current feelings, and our attitudes toward future events (Boroditsky 2000; Boroditsky and Ramscar 2002; McGlone and Harding 1998). A series of experiments by Richmond, Wilson, and Zinken (2012), for example, revealed a positive correlation between feeling happy or looking forward to an event and adopting an ego-​moving representation of time, whereas feelings of anxiety and depression were more likely to lead to a time-​moving conceptualization. Conversely, when people were given a task in which they had to use the ego-​moving metaphor, they reported significantly higher scores of happiness than those who completed a time-​moving scheduling task (see also Lee and Ji 2014). The ego-​and time-​moving metaphors, and the attitudes associated with them, can also be projected onto other people. Ruscher (2011) demonstrated that the two different subjective perspectives on time, primed through the depiction of

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objects moving in space, generated dramatically different projections as to how long the grieving process could be expected to last in the case of bereavement. Thus, participants who were primed to imagine the bereaved person moving through time anticipated a much shorter period of grief than those who were primed to focus on time, rather than the person, being in motion. Taken together, these results suggest that the ego-​moving metaphor is associated with positive feelings and a sense of agentive control, whereas the time-​moving perspective on time is connected subconsciously with sadness, anxiety, and passivity. Another way of imagining time is what Casasanto and Jasmin (2012) have termed the “moving attention perspective,” which involves the experiencer’s attention moving over sequential events on a static lateral line. It is apparently based on the embodied experience of reading and writing, and, accordingly, the association between the left or right side and the past or future is culturally variable (Cooperrider and Núñez 2009; de la Fuente et al. 2015; Fuhrman and Boroditsky 2010). According to the theory of “spatial agency bias,” there is also a tendency in left-​to-​right writing cultures for people to imagine and represent more active participant(s) on the left, and more passive participants on the right, whereas the opposite is true in cultures where people traditionally read and write from right to left (Maass et al. 2009; Maass, Suitner, and Nadhmi 2013). Furthermore, a study of elicited and spontaneous gestures discovered that, in their everyday practice, “people combine sagittal (past-​behind, future-​in-​front) and lateral (past-​to-​left, future-​to-​right) metaphors for time in their hands” (Walker and Cooperrider 2015:  12). This result led the authors to propose the “continuity of metaphor” hypothesis, which assumes that, in cases where there is more than one common source domain for a particular target, people do not necessarily choose only one or the other; instead, both sources may be activated more or less simultaneously (2015: 13). As the authors point out, verbal language is, by virtue of its sequential nature, limited in its ability to express two metaphors at the same time,3 so the study of gestures enabled them to reveal something new about how metaphors structure our thinking about time. This argument is highly relevant to the current discussion, as comics, like gestures, also have both sequential and spatial affordances that enable artists working in this medium to represent their experience of time through several different metaphors at once. In the comics medium, unfolding time is translated into the spatial arrangement of verbal and visual elements on the page; individually, these elements represent both

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moments in a sequence of events and abstract components of a spatial design (see Chapter 2, section 2.4.2). Consequently, both the imagined space of the characters and events in the storyworld, and the extradiegetic space of the page, the book, and the world beyond can be exploited for their metaphorical potential to convey aspects of lived time. At the level of diegesis, the perception of time passing in a sequence of images is based on “a trade-​off between permanence and variation” (Massironi 2002: 187). Providing there is a sufficient level of persistence in order for something to be seen as transformation and not as a new object, “the amount of change between two successive images is interpreted as information about the temporal distance between the depicted scenes” (2002: 199–​200). Accordingly, if a minor transformation is represented through a large number of successive images, time seems to be passing more slowly than if there is a big change from one image or panel to another. The depiction of implied movement also creates a powerful sense of temporal progression: “Motion and time are conceptually linked: whenever we conceive of motion, we conceive of time passing” (Potsch and Williams 2012: 29). Thus, when a character in the story assumes a static pose (e.g., lying on a bed), or when she is represented in a way that suggests energetic forward motion, this may evoke associations with the time-​moving or ego-​moving metaphor, respectively. If she is depicted on the left or right side of another character, the spatial agency bias may also take effect, making the character appear purposeful and active, or helpless and passive. In addition to such metaphorical meanings arising from the diegetic space, the extradiegetic space of the page composition is also significant. In page designs that invite the conventional “z”-​shaped reading path, time is conceptualized in a way that might be described as equivalent to the moving attention perspective, although here a simple left-​to-​right timeline is replaced by one that also involves the vertical and diagonal dimensions. Indeed, in many alternative comics, the spatial arrangement of elements on the page and the potential reading patterns are even more complex and ambiguous (see Miodrag 2013:  142–​165).4 As a consequence, up–​down, diagonals, and center–​margin orientations, as well as the number, size, placement, colors/​shading, and shape of individual panels, the visual properties of their frames, and the spaces and overlaps between them may also evoke temporal meanings (see also El Refaie 2012a: 125–​130). In the following discussion, I will use the analysis of a range of examples from my corpus to argue that the complex way of translating time into space

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(and back again) in this genre draws attention to temporal aspects of depression, as well as giving comics artists the tools to convey both regular, measurable clock time and more subjective, idiosyncratic experiences of lived time.

5.3. Depression Metaphors in Graphic Pathographies Verbal metaphors of depression have been examined primarily through the analysis of qualitative interviews with depressed individuals (Bjørkløf et  al. 2015; Charteris-​Black 2012), and audio-​recorded counseling or psychotherapy sessions (Fullagar and O’Brien 2012; Levitt, Korman, and Angus 2000; McMullen 1999; McMullen and Conway 2002); metaphors of descent, darkness, bearing a heavy burden, and being trapped or “stuck” are widespread across the different countries and age groups that have been studied by these methods. Literary accounts of depression, including the memoir Darkness Visible, by William Styron (1990; see Clark 2008; Schoeneman, Schoeneman, and Stallings 2004), Undercurrents, by Martha Manning (1995; see Dyer 2008:  47), and Sylvia Plath’s journals (see Demjén 2011, 2014), have been found to employ a similar range of underlying conceptual metaphors, though these are typically expressed in more creative ways. As Semino (2008: 54) rightly points out, metaphor creativity “needs to be considered both in terms of the novelty or otherwise of underlying conceptual mappings, and in terms of the salience and originality of individual metaphorical choices and patterns.” Furthermore, there is one conceptual metaphor that has been identified in several literary works but which does not appear to play a central role in everyday verbal accounts of depression; this metaphor describes a disintegration or loss of the self, or a splitting into “two selves, one well and the other ill” (Flynn 2010: 36; see also Dyer 2008: 47; Demjén 2014: 45). All these common conceptual metaphors for depression are prevalent in the graphic illness narratives under consideration, too. As in the more literary accounts of depression, these metaphors are typically combined, extended, elaborated, and expressed in novel ways, and they frequently convey additional meanings relating to a distorted perception of time. There are also several instances of metaphor in my data that explicitly address the temporal dimension of the depression experience.

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5.3.1. Descent, Darkness, and Time When depressive subjects talk or write about their experience, by far the most common metaphors they choose describe it in terms of descent, or being weighed down by a heavy physical burden (McMullen 1999; McMullen and Conway 2002). In both, the bad, troublesome feelings are associated with being “down” or moving downward, although in one the force being exerted on the body is gravity, whereas in the other it is the weight of another object. Female suffers of depression in Australia, for instance, frequently described “falling, going downhill, crashing, or descending into a state of depression” (Fullagar and O’Brien 2012: 1066). Another very frequent metaphor is one that describes depression as a state of darkness. This is probably based in the universal sense of gloom evoked by the lack of light at nighttime and in the winter, or during spells of bad weather, although it may also carry echoes of the formerly widespread assumption that melancholia was due to an excess of black bile (McMullen 1999). The prevalence of metaphors of descent and darkness for negative affect across a number of different cultures and languages suggests that these associations are grounded in direct correlations between mood and specific sensorimotor experiences (Kövecses 2005; Meier and Robinson 2005). Yet these mappings have now become so entrenched in our conceptual system that they bias our more abstract moral evaluations and perceptual judgments at an automatic and subconscious level, irrespective of the specific situation in which we find ourselves (Crawford et al. 2006; Meier and Robinson 2004; Meier, Robinson, and Clore 2004; Meier et al. 2007; Marmolejo-​Ramos et al. 2013; see also Chapter 1, section 1.2, and Chapter 3, section 3.3). In the case of depressed individuals, the sadness is down conceptual metaphor is apparently so dominant that it even shapes their patterns of perceptual attention. Thus, in a study by Meier and Robinson (2006:  460), depressive symptoms were shown to be correlated with a visual attention that is directed toward regions lower down in physical space, suggesting that, quite literally, “ ‘feeling down’ means seeing down.” Metaphors that are used over and over again in a particular context are also indicative of contemporary social and cultural attitudes, because they tend to be the ones that are “satisfying instantiations of a ‘conventional’ or culturally shared model” (Quinn 1991: 79). For example, as the related linguistic expressions indicate (“an upstanding or upright citizen”; “standing up for oneself”; “down in the dumps”; “put down”; “cast down”; “cut down”; “downtrodden”), downward movement is often attributed to some outside source,

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which means that the subject is passive, whereas upward motion tends to be active and goal-​oriented (Burford 1998). In Western capitalist societies, where competitive individuality and power are particularly highly valued and encouraged, this lends further cultural relevance to the vertical spatial dimension. Moreover, the ground is often associated with dirt, feces, and death, and, at least in some Christian denominations, Heaven is imagined as being high up and bright, whereas sinners go down to the dark pits of Hell. McMullen and Conway (2002:  179) worry that framing depression in terms of “uncontrollable descent to and effortful ascent from a low place” might in fact compound feelings of failure and loss of control, and thus “serve to keep a person in this place.” There is evidence from psychotherapy sessions, however, that at least some clients use both the conceptual metaphors of descent and darkness in a positive, constructive way to describe their changing sense of self as they started to feel better: “These metaphors of recovery stood in stark contrast to the death-​like stasis of depression: sun shining or climbing, or moving out of the blackness, hole, or pit” (Fullagar and O’Brien 2012: 1068; see also Levitt, Korman, and Angus 2000). In graphic illness narratives about depression, metaphors of descent and darkness are often combined into one striking image, as the extract in Figure 5.2 shows. It is taken from Mademoiselle Caroline’s graphic memoir about her long struggle with low mood, Chute Libre, and it refers to the moment after she has received a diagnosis of depression for the first time. In the middle of the preceding page (28), the word dépression is written in fine, white, elongated capital letters against a uniformly black background. The word is repeated in the top panel in Figure 5.2, although now the letters are much thicker and even more elongated, giving the impression of having been squeezed inside the panel frame. This typo-​pictorial metaphor plays on the original, literal meaning of the word dépression, by depicting Caroline as a small figure, doubled over under the weight of the letters “R” and “E.” As the autobiographical narrator explains, she is initially utterly stunned by the diagnosis, but her feelings shift as she begins to realize that the terrible malaise she has been experiencing has a name and thus might be curable. This shift is represented through three consecutive panels that show Caroline gradually uncurling herself and sitting up straight. The background color changes from a dark olive green to pale green, and the self-​ portraits also contain increasing amounts of color. In the second panel, her bright, open eye suggests a sudden thought, and in the third panel her self-​ portrait has reassumed the trademark features of a white face, yellow hair, and red nail polish, conveying the notion that she is feeling more like her

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Figure 5.2.  Mademoiselle Caroline. (2013) Chute Libre (p. 29). © 2013 Éditions Delcourt.

“normal” self again. The left–​right orientation of the drawings is also significant in conveying her fluctuating sense of time: In the top panel, Caroline is facing toward the left-​hand side, which, as we have seen, is associated with the past and with being the (passive) recipient of an action, whereas the other three panels show her looking toward the future. However, given that this page comes toward the beginning of a 149-​page story, the reader is likely to intuit that her hope for a rapid cure may be overly optimistic. The multimodal affordances of the comics medium—​including, in this case, an emphasis on the “materiality” of written language, the variable brightness of the background and foreground colors, and the spatial

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layout of elements in the storyworld, on the page, and in the book—​have enabled the artist to combine several conventional correlation metaphors (depression is a heavy burden, depression is darkness, and understanding is seeing) and to transform these into something more nuanced and original. By repeating a similar image three times, while introducing tiny but significant changes, she has also given the experience a temporal dimension that would have been difficult to convey through verbal language alone or through just a single image. As the title of the book suggests, the metaphor of darkness is also pivotal in Hannah Bradshaw’s (2015) short visual story about her experience of depression, Dark Early. Using no verbal narration, speech, or “sounds” at all, the work consists of around 40 fairly realistic, black-​and-​white, full-​page drawings on only the right-​hand pages, whereas the left-​hand pages are left blank, except in the case of a small number of double-​page spreads. Ostensibly, it is a very simple story about 24 hours in Hannah’s life. We see her at college, stopping off at a shop on her way home, entering her house, sitting in front of the open fridge, kneeling with her eyes closed and her forehead on the floor, staring at a laptop screen, taking a shower, lying in bed, and getting up again. The story ends with Hannah taking a pair of scissors out of her bathroom cabinet, holding the blades against her wrist as if she were contemplating wounding herself, but then cutting her hair instead. Finally, after turning to make “eye contact” with the reader and giving a hesitant smile, she leaves the house. The brightness levels of each page are broadly consistent with the implied time of day in the storyworld: the first pages have a white background; as she is walking home in the rain, the pages gradually take on a pale gray shading; the scenes at home are either drawn with a darker gray or an entirely black background, depending on the time of day and/​or whether the lights are supposedly on or not; and when she is leaving the house at the end the background has turned bright again. However, the time frame is deliberately left vague, and there is a sense that we may, in fact, be dealing with a much longer period, during which the days and hours blur and blend into each other. This interpretation is encouraged through the judicious inclusion of timepieces in three of the drawings:  A clock at school shows 3:30, and we also see Hannah checking her watch at what appears to be 1:20 (see Figure 5.3), and then again just before she leaves the house at the end, when a close-​up of her watch seems to be showing a time of 3:55. Normally, showing the time in images would provide a straightforward way of anchoring a story in precise clock time, but, as can be seen in

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Figure 5.3.  Bradshaw, H. (2015) Dark Early (n.p.). © 2015 Hannah Bradshaw.

Figure 5.3, in this graphic memoir the faces of the analogue timepieces do not feature any numerals or dividing lines, and Hannah’s watch is depicted from an angle that makes it hard to read. Consequently, we cannot be sure what time it is showing exactly, or whether it is the middle of the night or the afternoon. The fact that Hannah is wearing the same hooded jacket throughout the whole story further unsettles the boundaries between day and nighttime. Although on one level, shades of brightness or darkness are straightforward, literal indicators of time passing in the storyworld, the titular

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notion of it being “dark early” thus invites at least two additional metaphorical interpretations:  First, throughout the story, lightness/​ darkness levels are associated with body postures and behaviors that suggest Hannah’s fluctuating moods. Second, they are also used to evoke a time frame in which day and night seem to blend seamlessly into each other. This sense of amorphous time is further emphasized by the depiction of just a single scene per page, which, as in Figure 5.3, sometimes looks as if it is “bleeding” into the empty, crepuscular background and beyond into what McCloud (1994: 103) calls the extradiegetic “timeless space” of the reader. The whole story can thus be read as a pictorial allegory for the disrupted time perception that is characteristic of depression. My final example of a graphic illness narrative that uses images of descent and darkness is taken from Depresso (2010), by the British comics artist Brick, which centers on his rejection of the dominant biomedical model and his long-​ lasting struggle to access appropriate psychological support (see also El Refaie 2014c). The book is drawn in a style that often combines detailed, semi-​realistic background drawings with more exaggerated, cartoonish characters in the foreground. It also uses many references to popular culture, and a riotous jumble of words and pictures. The scene shown in Figure 5.4 may serve as an example of how even the highly conventional metaphors of darkness and descent are transformed by Brick’s vivid imagery. It occurs at the end of a prolonged sojourn in China, during which time the symptoms of his disease have gradually subsided, leaving him feeling “invigorated, purposeful, determined to get my life in the U.K. back on track” (2010: 81). However, as he is walking toward passport control at London airport, he feels as if every step is dropping him “deeper down the black hole of despondency” (82). This verbal expression is accompanied by a series of eight tall, narrow panels against a common background that gradually fades from white, to gray, to black. The panels show Tom’s lower body and legs in a step-​by-​step sequence; only the first panel is in an upright position, while the others are tilting back more and more precariously, with the final one ending up in a horizontal position. On the subsequent page (Figure 5.4), the themes of descent and darkness are combined with the metaphor of entrapment, as the narrator describes his sense of “falling, lurching as if in a lift held by failing cables, snapping, unraveling strand by strand” (83; emphasis in the original). The image in first panel depicts Tom from an extreme bird’s-​eye perspective, trapped in an elevator that is crashing down the shaft. The top of

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Figure 5.4.  Brick (2010) Depresso (p. 83). © 2010 John Stuart Clark.

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the elevator is covered by a metal grid and bars, which further emphasizes its trap-​like nature. Following a panel that shows people lining up at passport control, the theme of descent is continued through three overlapping freeze-​frame pictures in the center of the page of Tom plummeting toward a dark region. Along the bottom of the page, six high, narrow frames show alternating views of Tom’s face in an extreme close-​up and of the luggage conveyor belt, which is moving from right to left in front of his eyes. Seated among the suitcases, a giant white lizard (which is used throughout the story to represent Tom’s depression) appears, welcoming Tom home with the sarcastic greeting, “Hello sunshine.” The page design is an excellent example of how the inherent tension in the comics medium between the sequence of images and their layout may be exploited by artists to convey both an impression of chronological events in clock time (proceeding to passport control, picking up his luggage) and the more subjective and temporally discontinuous experience of sinking deeper and deeper into hopelessness and despair.

5.3.2. Fractured/​Split Selves and Time Another common metaphor in the graphic illness narratives under consideration in this chapter is one that conceptualizes the depressed self as fractured or split. A good case in point is Daryl Cunningham’s (2010) Psychiatric Tales, about his work as a psychiatric nurse and his own mental illness (see also El Refaie 2014c). One of the recurring themes in the book is that of the mind and/​or the self as a brittle object that may snap, crack or fragment when placed under too much pressure. Page  90, for example, contains a description of himself as being “too easily broken,” accompanied by a drawing that literalizes this relatively conventional metaphorical expression by showing a chain snapping in half. Since a chain is not a prototypically fragile object, and the notion of a breaking chain would ordinarily have positive rather than negative connotations, the choice of this particular image to illustrate the notion of the mind as a brittle object is somewhat unexpected. In this context, the chain might represent the willpower that allowed Daryl to control his destructive emotions and remain tethered to the world around him, whereas the notion of a breaking chain suggests a pressure that is so extreme that even the most resilient character would have fractured under its influence. The metaphor of his mental state as a brittle object is reintroduced on page 97 (figure 5.5), both verbally (“This is when I broke”) and visually.

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Figure 5.5.  Cunningham, D. (2010) Psychiatric Tales (p. 97). © 2010 Darryl Cunningham.

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The first panel in figure 5.5 contains another picture of a breaking chain, although this time the two segments are slightly further apart, which hints at the escalation of the artist’s mental crisis. Panels two and four show a shattered window pane and a pencil snapping in half. Both objects may have featured in the artist’s real life; it is reasonable to assume, for instance, that the author broke a pencil in exasperation at the way his illness was affecting his creative work (“I was unable to make any­ thing of myself as an illustrator”). Yet the repeated association between broken objects and negative emotions in the book means that they are more likely to be read as contextual metaphors for Cunningham’s mental illness than as straightforward literal references, particularly as they are also represented in a way that emphasizes their abstract connotations: the chain, the window pane, and the pencil all take up the space of a whole panel and are depicted without any background or pictorial context, which gives them a sense of being “set apart” from the ongoing story. In comics, every panel has potential links not just with other images on the page but with every other panel in the book as well, forming complex strands of correspondences through the repetition of particular objects, shapes, colors, or patterns. Psychiatric Tales is full of such instances of what Groensteen calls “braiding” (2007:  146; 2016). Apart from the repeated image of various shattering objects, the scene in Daryl’s living room in the fourth panel of Figure 5.5 represents an exact replica of a drawing on page 90, though the content of the speech balloon has changed. The image of Daryl with an empty hole in place of his heart in the final panel in Figure 5.5 is also reiterated several times (on pages 93 and 98).5 These repetitions produce an underlying impression of circularity and stasis, encouraging a sense of empathy with the protagonist’s disrupted time perception. For some people who are suffering from depression, the self appears as completely divided. Drawing on the work of Barnden (1997) and Emmott (2002), Demjén (2011:  17–​20) identifies at least three different ways in which the self can be experienced as split:  between an old and a new self; between two irreconcilable parts of the self; and between the mind and the body (or two different body parts). These distinct forms of splitting can also be combined in various ways; for instance, in several of the works under consideration, the mind is perceived as split, and one of the parts is then conceptualized as a distinct person or other animate being. Since autobiographical comics artists are obliged to produce multiple self-​portraits, this process is likely to foreground conceptualizations

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of the self as something that is constantly shifting and changing, which in turn may account for the preponderance of metaphors of a split self in graphic pathographies about depression. Hyperbole and a Half, Ally Brosh’s (2013) humorous comics blog that was later published in book format, contains two chapters that deal with her bouts of severe depression. Ally describes her experience in terms of having two distinct selves, one “normal,” healthy and rational, the other so despondent and lacking in energy and drive that she cannot even bring herself to get up from the floor or sofa for hours on end. The “normal” self assumes a critical parental role, blaming, scolding, and mocking her depressed self, although this only seems to make matters worse. In the excerpt in Figure 5.6, three identically shaped panels, each split into two parts, are stacked one on top of the other. In the much smaller left-​hand section of the panels, we see Ally’s depressed alter ego huddled on the floor, a deeply mournful expression on her face. She is being berated and accused of self-​pity by Ally’s “normal,” healthy self. Although the two versions of Ally closely resemble each other and are clearly meant to represent the “same” person, her “normal” self is larger, her facial expression and body language are more assertive, and there is greater distance between her body and the panel frames, which acts as a compositional spatial metaphor for the broader range of opportunities and potential for action in Ally’s life when she is well than when she is depressed. The only differences between the contents of the three panels is that the shape of “normal” Ally’s mouth changes slightly as she unleashes salvo upon salvo of vitriol on her depressed alter ego. This visual continuity, together with the fact that the expected “spatial agency bias” is flouted in this instance (since the more active Ally is on the right of her passive, depressed alter ego) and that both figures are turned toward the left-​hand side of the page, creates a powerful sense of temporal stasis, implying that Ally’s strategy for trying to talk herself out of her depression is not going to be successful any time soon. Another example of split selves in a graphic illness narrative can be found in Brick’s (2010) Depresso, where, as mentioned earlier, Tom’s mood disorder is represented throughout the book as a giant white lizard (see Figure 5.4). This image was probably inspired by the name “lizard brain,” which is sometimes given to the limbic cortex, phylogenetically the oldest and most primitive part of the brain that is responsible for survival instincts such as fear, aggression, and sexual drive. In the story, the

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Figure 5.6.  Brosh, A. (2013) Hyperbole and a Half (n.p.). © 2013 Alexandra Brosh.

lizard represents Tom’s depressed self, including his hitherto unexamined family background and harrowing childhood experiences, which, as he gradually recognizes, were largely responsible for his mental breakdown. The lizard appears suddenly out of nowhere (on page 35), and, once Tom has got used to its almost constant presence, he seems to find its company reassuring, occasionally even referring to it, with only a hint of irony, as his “friend” or “guardian angel” (40). At other times, the lizard takes on a more menacing quality, mutating into a fire-​breathing dragon because of neglecting to take its “meds” (101), and trying to goad Tom into committing suicide by jumping off the edge of a cliff (132). By representing the lizard

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as a separate embodied character, the artist is thus able to show how his depressive illness is both an integral part of his self-​identity and disconnected from it. Like Brick, Steven Leto, who wrote Negative Self-​Image:  Depression Comix as part of his ongoing cognitive behavioral therapy, is convinced that his recurrent depressive episodes are due to suppressed traumatic memories of growing up in a dysfunctional and violent family. The comic combines (digitally modified) photographic images, drawings, and a first-​person narration in the text boxes, as well as in speech and thought balloons, which addresses the reader directly, anticipating and responding to his or her imagined reactions: “Okay reader, I know what you’re thinking: ‘So you had a tough childhood! Boo-​Hoo! Grow up!’ [ . . . ] Why am I focusing on all this negative stuff? Because I need to see why I decided that everything I do and am is not good enough. [ . . . ] I need to see it clearly . . . and let it go’ (n.p.; see Figure 5.7). The conventional conceptual mappings between seeing and understanding (see also Chapter 4) are given a concrete form in Leto’s creative work, which allows him to visualize how his hitherto unacknowledged childhood trauma led to his current lack of self-​confidence and low mood. The fact that he uses and manipulates photographic images in his work may be regarded as an indexical stylistic metaphor for the close yet troubled relationship between photographs, memory, and the truth. A central pictorial metaphor, used both on the page reprinted in Figure 5.7 and on the cover of the book, is that of Steven’s childhood self as a tiny, crouched character trapped inside the adult author’s head, suggesting that his horrific experiences in childhood are still shaping his thoughts, feelings, and self-​image in adult life, albeit at a mostly unconscious level. In fact, in panel 3 the self is split into three parts: the childhood self, the adult self, and the self represented by the hand that is drawing the picture. On one level, this third self might be described as the autobiographical narrator—​or “monstrator,” as Groensteen (2013: 86) terms the “instance responsible for the rendering into drawn form of the story”—​yet on a more abstract level it can also be interpreted as a metaphor for the “learned, embodied, and arduous work” (McBean 2013: 106) involved in developing a critical, truthful vision of oneself and the wider world, and of translating that vision into a work of art. This, in turn, fulfills an essential role in Leto’s attempt to understand the origins of his damaged self-​esteem and low mood. The notion of a past self that is trapped inside the present self also evokes a sense of being stuck in terms of temporal progression. This

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Figure 5.7.  Leto, S. (2015) Negative Self-​Image: Depression Comix (n.p.). © 2015 Steven Leto.

theme of what I shall call “temporal entrapment” will be explored in more detail in the following section.

5.3.3. Temporal Entrapment Several studies of the verbal discourses of depressed individuals have identified metaphors that cluster around the notion of being contained, stuck, or trapped in “a three-​dimensional space such as a ‘pit,’ ‘hole,’ or ‘bubble’ ”(Charteris-​Black 2012: 207; see also Bjørkløf et al. 2015; McMullen and Conway 2002). Similarly, in Sylvia Plath’s journals, there are several expressions that equate her troubled mental state with a lack of motion, unproductive motion, movement away from something unpleasant, or being trapped inside a container of some sort (Demjén 2014: 14–​17). Underlying

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them all, Demjén argues, is the conventional life is a journey metaphor and its associated sub-​mappings changes are movement and purposes are destinations. Accordingly, depression is seen either as causing an impediment/​blockage in the journey of life, preventing movement through a form of physical paralysis, or taking away the very purpose/​reason for movement. Although the notion of inhibited motion strongly suggests a temporal dimension, too, none of these metaphor scholars has raised the possibility that the individuals who are talking about feeling trapped by depression may also be trying, via the conceptual metaphor time is space, to express their experience of temporality. When examining my corpus of graphic illness narratives about depression, however, I  have discovered such a close link between the notions of spatial and temporal containment that I  propose considering the experience that is being conveyed as a form of entrapment in spacetime. The most explicit example is a page from My Depression:  A Picture Book, by the American musician, playwright, and author Elizabeth Swados (Figure 5.8). It shows a desolate-​looking Elizabeth trapped behind the bars of a prison that forms the center of a larger-​than-​life wall clock. Underneath the sketchy drawing, the author has scrawled the words: “Each moment feels like it lasts forever.” This hybrid pictorial metaphor, which combines elements of a clock with those of a jail, provides an apt visual illustration of what Fuchs (2005:  170) calls the “merciless rule” of “explicit” time, which is experienced as progressing at a painfully slow pace and which seems to offer no chance of reprieve. As outlined in section 5.1, in the case of depression this warped sense of time is also often accompanied by “an increasing rigidity of the lived body” (Fuchs 2005: 96), characterized by a dulling of the senses and a heaviness, restriction, or paralysis of the limbs. The rough, sketchy lines used by Swados in both her drawing of the clock-​prison and the handwritten text further emphasize this rigidity, by referencing, via an indexical stylistic metaphor, the listless hand movements that must have produced these lines. A subtler way of conveying the distorted sense of time associated with depression is exemplified by the page design reprinted in Figure 5.9. It is taken from Marbles, Ellen Forney’s (2012) graphic memoir about her bipolar disorder. In the sections that represent Ellen’s manic episodes, the artist typically employs loose brush strokes, densely packing the pages of her book with lots of detailed drawings, handwritten words,

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Figure  5.8.  Swados, E. (2005) My Depression: A Picture Book. New York: Seven Stories Press (n.p.). © 2005 Elizabeth Swados.

and pictorial runes, such as whirls, spikes, and stars. In contrast, her states of depression are typically portrayed through very simple, sparse drawings, and few, if any, words (see also El Refaie 2017). In Figure 5.9 the near-​identical image of Ellen’s small figure on the bed is repeated six times in the first two rows, with her head and shoulders appearing and then disappearing again under the duvet as she struggles to muster all her willpower to get up and leave the room (in row three), before returning to sitting and then lying on the living room sofa in the final two rows. The outline of her body lying under her duvet on the bed or sofa calls to mind a lidded container, or even a type of casket, thereby acting as an ambiguous pictorial metaphor. Moreover, the artist has drawn herself from a great distance, so her facial expressions are invisible to readers. This functions as an interactive spatial metaphor, encouraging readers to experience the same sense of detachment that Ellen clearly feels toward her emotions and from the rest of the world during her

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Figure 5.9.  Forney, E. (2012) Marbles (p. 77). © 2012 Ellen Forney.

periods of depression. The arrangement of the pictures in a regular pattern with lots of empty space on the page between them, and the minor transformations from one to the next, convey a sense of time passing more slowly than if the drawings were all packed together, with lots of variation between them. Indeed, the close visual resemblance between the very first and the last image on the page of Ellen hiding under her duvet encourages a circular reading path, which in turn implies that there is no meaningful progression at all. Finally, the absence of panels disrupts the sense of regular, linear temporal progression that is typical of a more conventional comics page, while the lack of any speech

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balloons or verbal narration creates a powerful sense of what Carney (2008: 198) calls “the silence of time passing.” In spite of the obvious differences between them, the excerpts in Figures  5.8 and 5.9 thus both use a combination of pictorial, compositional, and stylistic metaphors to invite underlying thought patterns that might be verbalized as depression is entrapment in spacetime. It is important to note, however, that many of these visual features are only able to cue a metaphorical reading because they reinforce each other, and because they deviate sufficiently from the expected norms associated with the graphic illness narrative genre in general, and with the individual artist’s characteristic style in particular. Both the previous chapter and this one have revealed that graphic illness narratives about specific diseases show patterns of metaphor use that appear to be unique to works in this genre. These findings support the two central arguments developed throughout the current book, namely, that the foregrounding of aspects of lived experience that are normally backgrounded may trigger a reversal of the ordinary direction of metaphorical mappings, and that metaphors are partially motivated by the affordances of the modes and media through which they are being conveyed. Consequently, graphic illness narratives may expose aspects of the illness experience that are obscured by other ways of communicating about disease. In graphic pathographies about cancer, for example, the crucial role played by microscopic and digital-​imaging technologies in both revealing and concealing the reality of our inner bodies is emphasized, whereas comics about depression are (arguably more effectively than any other medium/​genre) able to convey the sense of temporal stasis and entrapment that seems to be very common among sufferers of the disease.

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underpinning the notion of “dynamic embodiment” developed in this book is that changes in the way we experience our physicality as a result of illness affect how we think and, consequently, the metaphors we use. However, it is not only when we are ill or in pain that our ordinary ways of relating to our bodies are altered; each specific context and the practices we engage in, including the different modes and media we use to communicate, may also affect our embodied experience, by foregrounding or backgrounding particular aspects of our sensorimotor perceptions. Whereas under normal circumstances we tend to conceptualize the abstract notions of understanding and knowing in terms of seeing, for example, being diagnosed with cancer and having to confront the reality of the many invisible aspects of our bodies may reverse the customary direction of mapping, so that vision itself becomes the target of metaphorical representations. This pattern, I have argued, is particularly pronounced in the genre of graphic illness narratives, where the focus of attention is inevitably on what is and is not accessible to human vision. Similarly, since comics artists are required to translate time into space, they are more likely to focus on the distorted sense of time that is associated with depression. This study makes a contribution to current debates in Conceptual Metaphor Theory (CMT) concerning the nature of embodied cognition and how it varies, not just across cultures and social contexts, but also from one individual to another. Specifically, my aim is to encourage a more nuanced view of embodiment as something that is constantly shifting and changing as we progress through life, learning new skills and losing some of them again, falling ill and sometimes recovering, growing older and becoming increasingly aware of our physical limitations, and employing a range of different modes and media of communication. Because of the type of material I have chosen to analyze, the focus of this book has been THE KEY IDEA

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on how dysfunctions of the body and mind may affect the way we relate to our physicality, causing what usually remains in the background of our consciousness as we engage with the world around us to force itself into our awareness as something unsettling and alien. On the other hand, there are other situations in which the body is conceptualized as something good, easy, or well, such as when we are dancing, meditating, engaging in sports, or making love. There is thus much scope for further research into how such cases of what Zeiler (2010) calls “eu-​appearance” may shape patterns of thinking and the metaphors we create. As I have demonstrated, in some cases the ordinary sense we have of our bodies as an invisible, taken-​for-​granted presence may be so severely disrupted that the normal direction of mapping from embodied experience to more abstract concepts is reversed, with the affected body part or sense perception acting as the metaphorical target rather than as its source. I also discussed several examples of metaphors in my data where the directionality of the mapping is much more ambiguous than would be predicted by the principle of “unidirectionality” in CMT (Kövecses 2002:  15–​16). Forceville (2002:  7), for example, regards nonreversibility as one of the defining features of metaphor, suggesting that “prototypical metaphors of all kinds and occurring in all media have clearly distinguishable target and source domains, which in a given context cannot be reversed.” While this observation may well be valid for some genres—​in advertising, for instance, it is almost always the product or service being promoted that is the target of a metaphor—​several instances of bidirectionality or source-​ target reversals have been observed, particularly in more literary or poetic verbal genres (Gleason 2009; Kövecses 2002: 25), in the cinema, and in surrealist art (Carroll 1994; 1996). My study thus adds weight to this growing body of evidence indicating that the unidirectionality principle of metaphors is not equally applicable to all genres. Another important finding of my study is that metaphors are, by their very nature, richly indistinct and paradoxical, which makes it not just difficult but even counterproductive to try to pin them down too forcefully. Many of the instances of visual fantasies, delusions, and hallucinations that are common in graphic pathographies about mental illness or dementia, for example, cannot be described as unambiguously literal or metaphorical, since they represent the world “as it is” in the eyes of the afflicted person. Similarly, although it is sometimes helpful, for heuristic purposes, to draw broad distinctions between verbal and nonverbal metaphors, and between different categories and subcategories of visual

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forms of metaphor, in fact any such boundaries are inevitably fluid and permeable, particularly when all the different layers of meaning contained within a literary work such as a graphic illness narrative are taken into account. By challenging the principle of unidirectionality, and refuting any notion of a clear boundary between the literal and the metaphorical, and between different types of metaphor, the theoretical arguments developed in my book might also serve to encourage a closer collaboration between the different traditions of metaphor study. Until recently, the tendency for exponents of CMT to concentrate on the search for universal patterns of embodied understanding and to underplay the creative potential of metaphor has alienated many scholars from other disciplines. Although there is now some tentative movement toward the integration of CMT and literary theories of metaphor, for example (e.g., Fludernik 2011), valuable insights into the nature of metaphor developed in disciplines such as anthropology, art history, and the psychology of perception have so far been largely ignored by both cognitivist and poetic traditions. The fundamentally interdisciplinary approach adopted in the present study may help future scholars to bridge some of these gaps and thereby advance our knowledge and understanding of a phenomenon that is at the heart of almost every aspect of human creative endeavor, as well as shaping our everyday thoughts, interactions, and behavior. The new tripartite taxonomy for analyzing visual metaphors proposed in Chapter 3 will also, I hope, encourage metaphor scholars to look more carefully at all the different aspects of visual meaning that invite metaphorical interpretations, including spatial composition and the stylistic features of both pictorial representations and written words. This taxonomy was developed specifically to describe the examples I discovered in graphic illness narratives, but it should also be applicable to other visual and multimodal genres, especially if it is used as intended, namely as a flexible heuristic tool that can be adapted freely to suit the analyst’s specific research questions and data. It is highly likely that other types of pictorial, spatial, and stylistic metaphors will emerge from the detailed analysis of multimodal websites, or moving images in animation and feature films, for example. My book presents the first comprehensive account of metaphor in graphic illness narratives. This gap in the literature is all the more surprising as recent years have seen an explosive growth in the number of people who choose to convey the experience of either their own illness or

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that of a family member in the comics format. Such works, which, as we have seen, are replete with (verbo-​)visual metaphors, are starting to attract a great deal of attention in the scholarly community and, increasingly, the general public, who recognize the ability of this genre to convey both uniquely personal and universal aspects of the illness experience. There is also a growing interest on the part of many medical professionals in the use of comics in public health education, patient care, and the training of future doctors (Green and Myers 2010; Williams 2012). The current study offers a detailed examination of cancer and depression metaphors, but it would be important to analyze the portrayal of other kinds of physical and mental disease in graphic pathographies, as they, too, are all likely to engender unique patterns of metaphor use. Moreover, alternative comics are being produced throughout the world, with distinctive styles developing in Japan, Africa, the Middle East, and South America, for instance. A comparative study of graphic illness narratives about a particular dis­ ease across these different cultures would deliver useful insights into how attitudes toward health and sickness may shape the metaphors that comics artists use to represent their experience. Throughout the present study, the focus of analysis has always been firmly on the metaphors themselves; it was never my aim to speculate about the individual authors’ intentions in creating these metaphors, nor the likely responses of readers. Consequently, I am unable to make any substantial contribution to the ongoing debate around Steen’s (2008) notion of “deliberate” metaphors and the degree to which these require a conscious act of creation, with the intention of effecting a change in the perspective of the addressees, although I intuitively agree with Gibbs (2011b) that at least some of the processes involved are likely to take place at an unconscious level. One fruitful way of addressing this issue might be to interview comics artists about their general working practices, or else to use a think aloud task (van Someren et al. 1994) in which they would verbalize their thoughts as they draw visual representations of their experiences. Likewise, my study was not able to address the responses of individual readers, since these can only be investigated properly through the use of audience research methods such as experiments, surveys, interviews, think aloud protocols, and focus groups (for an overview, see El Refaie 2017; Sorm and Steen 2013). Future research might use some of the visual metaphors contained in graphic illness narratives to investigate Gibbs and Colston’s (2012: 231) claim that the interpretation of creative, literary metaphors involves

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“the sensations of being ‘moved,’ which are neither purely mental or physiological but some interaction of the two that is fundamental to emotional reactions,” for instance. The findings of my study also have the potential for impact beyond academia, particularly in the sphere of health communication. It is now widely acknowledged that the specific metaphors we use to think and talk about a particular disease influence how it is diagnosed and treated by doctors, as well as shaping the attitudes and sometimes even the health outcomes of patients (Bleakley 2017; Kirklin 2007). For example, there are indications that using the “wrong” metaphor in consultations with depressed individuals may diminish the client’s trust in a particular treatment. A study that asked participants to judge how effective a (fictitious) new medication against depression was likely to be demonstrated that a match between the name of the drug (“Illuminix” or “Liftix”) and the way depression was described metaphorically, as either darkness or being down, increased the expectation that it would be effective, whereas a mismatch had the opposite effect (Keefer et al. 2014). The authors conclude that “there are clearly both costs and benefits” to the use of metaphors in health communication: Metaphors for therapeutic (e.g., counseling, medication) or non-​ therapeutic behaviors (e.g., exercise, diet, relationships) that fit a patient's metaphoric understanding of a health problem can increase perceived treatment effectiveness and perhaps result in better outcomes for patients. [ . . . ] On the other hand, metaphoric misfit may drive people away from behaviors that may in fact benefit them or toward unhelpful solutions. (Keefer et al. 2014: 18) The potential pitfalls of metaphor use have been discussed most widely in relation to cancer treatment (e.g., Demmen et  al. 2015; Penson et  al. 2004; Reisfield and Wilson 2004; Stibbe 1997), and these debates now seem to have filtered through to health professionals, many of whom are clearly becoming more aware of the issues involved. For example, some of the contemporary literature that is handed out to patients in Austrian clinics after they have been diagnosed with cancer encourages them to conceptualize their illness as an uninvited guest, rather than as an enemy. Sometimes sports metaphors are used to replace military metaphors, because they are better at suggesting positive aspects of the experience, such as “the richness, the gifts, and the beauty of living more in the moment,

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taking time to enjoy life, and continuing to be productive and involved in our lives and the lives of those we touch” (Campbell 2011: 349). Moreover, every medical innovation tends to generate new metaphors, some of which will inevitably be more helpful than others. In particular, the increased use of digital-​imaging technologies in the diagnosis of an entire range of diseases is likely to shape the way both medical professionals and patients think and talk about the experience of illness. A case in point is the experience of an elderly acquaintance of mine, who had suffered a minor stroke. In an attempt to explain how this had affected her brain, the doctor pointed to an area of her brain scan, which he described as “grainy” in appearance. Unfortunately, she took this to mean that her brain contained granules, causing her to conclude that these might be dislodged if she moved her head too suddenly or vigorously. Another example of how medical images can shape patients’ understanding of their illness was mentioned in Chapter 4, section 4.3.1. Harrow et al. (2008) discovered that the mental images formed by women recovering from breast cancer were inspired both by the verbal metaphors used by medics and the visual appearance of the tumor in the scan images they had seen, with one patient noting its gray appearance in a mammogram and concluding that it was “concrete-​like,” for example. Similarly, when, in Cancer Vixen (2006: 4), Marisa’s doctor describes the breast tumor he has detected in a sonogram as “about 1.3  cm  .  .  .  the size of a large pearl,” she immediately adopts this imagery in her own visualization of the tumor. Since both concrete and pearls are hard and brittle, these metaphors might encourage the women to favor surgical treatment options over those that aim to shrink or dissolve the tumors, for example. Graphic illness narratives can thus serve to raise awareness among health professionals of the need to avoid the use of confusing or inappropriate metaphors, or at least to draw the patient’s attention to their inherent limitations. As Teucher (2003: 13) rightly points out, however, it is impossible to find metaphors that will appeal to everyone, since “metaphors can have different meanings for different people, or even different meanings for the same person at different times.” My final recommendation is therefore that patients be given the opportunity to create their own metaphors, using a range of different modes and creative media. The importance of helping people to discover metaphors that are uniquely meaningful to them in their own personal and cultural contexts has long been recognized by counselors and (art) therapists (Atwood and Dobkin 1992; Burford 1998; Dwairy 2009; Lemmens et al. 2004). My

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own study has demonstrated that visual metaphors are often able to reveal aspects of the illness experience that would otherwise remain hidden, especially when complex, paradoxical thoughts and feelings are involved. Moreover, as Arnheim (1969:  129) suggests, drawings may “serve not simply to translate finished thoughts into visible models but are also an aid in the process of working out solutions of problems.” If they are used judiciously in healthcare settings, metaphor-​ based drawing workshops could thus enable people to transform dominant ways of framing a disease as something that must be battled and overcome at all costs into something that is, in spite of everything, part of their own lived body, a body that is also fully integrated into the wider world. I will end by quoting the anthropologist David Howes (2005: 7): “If we hold [ . . . ] that the mind is necessarily embodied and the senses mindful,” he writes, “then a focus on perceptual life is not a matter of losing our minds but of coming to our senses.” The main purpose of the current book was to show that, whether we are conscious of it or not, the body is always profoundly implicated in all our thoughts, emotions, relationships, and acts of communication, and that metaphor is one of the prime means by which the embodied mind and the mindful senses are manifested. Thus, I sincerely hope that I have made a small contribution to Howes’s project of encouraging us all to come to our senses, both as scholars and as members of the human race.

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In t roduc t ion 1. Following standard conventions in CMT, small caps are used to refer to abstract conceptual domains and conceptual metaphors.

C h a p t er   1 1. Rakova (2002) identifies other weaknesses in the theory of embodiment in CMT, describing it as “philosophically inconsistent” and arguing that some of its claims are contradicted by empirical evidence. In the same journal issue, Lakoff and Johnson (2002) mount an impassioned defense of their theory. For an overview of empirical findings in psycholinguistics that challenge or support the main tenets of CMT, see Gibbs and Colston (2012: 129–​156). 2. The intuitions of these scholars are confirmed by the results of an empirical study by Pollio, Henley, and Thompson (1997: 74–​92), which found that people are most aware of their bodies when they are engaged in a highly physical activity; when they are experiencing pain, disease, pleasure, or strong emotions; when they become aware of bodily changes over time; or when their physicality is foregrounded in interactions with other people. 3. In the overwhelming majority of the population, the left brain hemisphere is primarily responsible for the explicit manipulation of verbal language, including syntax, and for complex sequences of motor actions, whereas the right hemisphere plays the dominant role in making sense of both language and sensory perceptions in their wider context. Only around 5% of the population are known to have a different brain organization: In some, the two brain hemispheres are simply inversed, but there is also a small group of people, including a subset of left-​handers and some people with conditions such as autism, schizophrenia, and dyslexia, who have a more unusual brain organization (“cerebral variability”) (McGilchrist 2009: 11–​13).

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4. Throughout history, people have searched and found evidence for many more senses, including some of a more “spiritual” or “psychic” nature (Howes 2009). 5. Indeed, Kress and van Leeuwen (2002) believe that color should be considered a semiotic mode in its own right, because, at least in some contexts and communities of practice, it is able to fulfill all three communicative metafunctions.

C h a p t er   2 1. This notion of the close interconnectedness of the different sensory areas of the brain is backed up by a growing body of evidence from neuroscience, as well as by studies of deaf or blind individuals, many of whom develop extraordinary abilities to compensate for the missing sensory input from their ears or eyes by their enhanced sensitivity to signals from other brain areas (Sacks 1989, 2005). 2. In his analysis of Epileptic, Miers (2018: 315–​319) argues that the visual metaphors David B. uses to convey epileptic seizures are broadly consistent with those most commonly employed by patients themselves, which suggests the artist’s ability and willingness to empathize with his brother’s embodied experience.

C h a p t er   3 1. Similar taxonomies by Phillips and McQuarrie (2004) and Gkiouzepas and Hogg (2011), for example, were heavily influenced by Forceville’s work. 2. Experimental evidence (Indurkhya and Ojha 2013; Ojha 2015: 149–​152) suggests that the perceptual similarity of two images (determined through computer algorithms) does, indeed, encourage a metaphorical interpretation in certain circumstances. 3. Alternatively, it might be described as a hybrid metaphor, which combines elements of Katie’s body with a giant mouth. This is a good example of the inherently fuzzy boundaries between the different categories in the proposed taxonomy. 4. In both indexical and isomorphic stylistic metaphors, the metaphorical transfer of meaning often interacts with a cause for effect metonym. Thus, indexical stylistic metaphors typically rely on our ability to recognize the process or technique (e.g., a crayon drawing) that resulted in a particular visual appearance (e.g., thick, uneven lines), which then allows us to exploit this knowledge as a source of metaphorical meaning (e.g., childhood innocence). Many isomorphic stylistic metaphors that are based on synesthesia, on the other hand, invite us first to map particular visual features (e.g., spiky shapes) onto equivalent properties of solid objects (e.g., sharpness) and then to consider what effect something with these properties would have on our somatosensory system (e.g., pain). I am grateful to Zoltán Kövecses for drawing my attention to this.

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5. Some comics artists use panels, or even whole pages, that are entirely gray or black, either to signal a character’s loss of consciousness or sight, or to indicate an overwhelming sense of shock, emptiness, or sadness (El Refaie 2012: 114–​115).

C h a p t er   4 1. There is also the issue of the greater or lesser “visibility” of certain types of cancer at the level of public awareness, which is reflected in the variable amounts of funds invested in the search for treatments. In the United States, research into breast cancer, prostate cancer, and leukemia receive a disproportionally large amount of financial investment, for instance, whereas cancers of the bladder, esophagus, liver, mouth, pancreas, stomach, and uterus are under-​researched (Carter and Nguyen 2012). 2. As Howes (2005: 5–​6) remarks, today “scientific visualism” seems so natural and self-​evident that we no longer even pause to wonder what something like DNA, for example, might feel or taste like. The etymology of words such as “sapient,” which used to mean both flavorsome and wise, shows that the neglect of the other senses as legitimate ways of knowing is a relatively new development in Western cultures. 3. According to the myth, the Greeks hid a small number of warriors within the wooden structure and tricked the Trojans into dragging it inside the walls of their city as an offering to Athena. Under the cover of night, the men clambered out of the horse, and the city was taken (Howatson 2011: online).

C h a p t er   5 1. The notion of being so absorbed in an activity that time passes by unnoticed is also similar to Csikszentmihalyi’s (2008 [1990]) concept of “flow.” 2. There are obvious parallels here with Leder’s (1990) notion of the disappearance and “dys-​appearance” of the body (see Chapter  1, section 1.3), although Fuchs does not cite this source. 3. Even in the case of so-​called mixed metaphors, the respective source domains are necessarily introduced one after the other, and often they occur in separate clauses (Goatly 1997: 269–​271; Kimmel 2010). 4. The notion of a “reading path” is itself metaphorical, since it compares the moving focus of the eyes over the page to actual physical motion along a path. Genette (1980: 34) makes this explicit when he writes that “the written narrative exists in space and as space, and the time needed for ‘consuming’ it is the time needed for crossing or traversing it, like a road or a field.” 5. Metaphors that refer to some form of emptiness of a space or container that would normally be expected to be filled (such as a womb or head) occur in some verbal accounts of depression, too (Demjén 2014: 45).

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Index

Adams, Timothy Dow, 45, 52 advertisements composition of, 42, 92, 94, 96, 103 examples of metaphor in, 2, 59 genre categories in, 53, 185 taxonomy of pictorial metaphors in, 84, 86–​88, 116 (see also Forceville, Charles) affordances comparison of verbal and visual, 38–​39, 50, 64 definition of, 6, 36 of graphic illness narratives, 15, 72, 76, 79–​80, 153 of multimodal texts, 48, 52–​53, 156, 168, 183 of space, 9, 45–​46, 163 See also meaning potential agricultural metaphors for cancer, 130, 136 Alice’s Adventures in Wonderland, 114 Aliceheimer’s, 88–​89, 99–​100, 107, 114. See also Alzheimer’s disease allegory, 99 alternative comics. See graphic novels Alzheimer’s Disease, 48, 88–​89, 114 and container metaphors, 48–​49 anchorage, 61–​62, 97

anger cultural differences in meaning of, 25, 46 historical differences in meaning of, 24 visual representations of, 68, 71 anger metaphors as hot fluid in a container, 22, 41, 71 Angus, Lynne, 156, 165, 167 animal metaphors, 97, 99–​100 for cancer, 58, 60, 119, 130 animation, 2, 186 anorexia. See eating disorders anthropomorphism,  82–​84 Arnheim, Rudolf, 64, 122, 125, 142, 190 auditory experience, 67–​68 autopathography. See graphic illness narratives awareness of body, 7, 15, 20, 31–​32, 46, 120, 126, 185, 191n1.2 of space, 6 of time, 6 B, David. See Epileptic backgrounding-​foregrounding of colors in graphic illness narratives, 75, 86, 97–​99, 111, 113–​115, 137, 147, 156, 167–​169

0 2

220

Index

backgrounding-​foregrounding (cont.) of lived experiences in graphic illness narratives, 3, 15, 32–​33, 57, 61, 175–​176, 183–​184 of space in graphic illness narratives,  76–​78 of temporality in graphic illness narratives, 17, 156–​160 Bad Doctor, The, 65–​66, 70–​71. See also obsessive-​compulsive disorder Ball, Rachael. See Inflatable Woman, The Barcelona, Antonio, 4, 22, 24–​25 Barker, Martin, 68, 111 Barsalou, Lawrence W., 12, 33 Bartczak, Marlena, 17, 155 Barthes, Roland, 61 Bateman, John, 38, 52 Bergen, Benjamin K., 12, 33, 134 Berger, John, 45, 77, 138, 151 Bergson, Henri, 159 betweenness, 82 Bevan, David, 54, 57 Biebuyck, Benjamin, 13, 74 bipolar disorder, 154, 180–​183 Black Hole, 92–​94, 109. See also sexually transmitted diseases black hole metaphors for cancer, 122, 146–​147 for depression, 171 Bleakley, Alan, 188 Blue Pills, 97–​98. See also sexually transmitted diseases body, 18–​26, 31–​33, 67, 119–​120, 160 and the female, 16, 59–​60, 101, 104, 141, 151 and illness, 6, 9, 15–​16, 20, 33, 56–​57,  185 images of, 49–​50, 129–​130, 138, 142, 158 moral inflection of, 140 visualization of, 138–​139 See also breasts; brain; disappearance; dys-​appearance; embodiment; eyes

body-​specificity hypothesis, 31 Bokus, Barbara, 17, 155 Boroditsky, Lera, 30, 162–​163 Bottini, Roberto, 5, 15, 30 bouba/​kiki experiments, 67 Brabner, Joyce. See Our Cancer Year Bradshaw, Hannah. See Dark Early braiding, 175 brain circuitry of, 21–​22 differences between left-​right hemispheres of, 28–​29, 33–​35, 81–​82, 191n1.3 hierarchy of attention of, 82 lizard, 176–​177 as a machine/​computer, 19, 23 mirror systems of, 12, 34, 125 breasts metaphorical representations of, 99, 131, 136, 140–​142 Breitmeyer, Bruno, 68, 124–​125, 134 Brick. See Depresso brittle object metaphors for depression, 173–​174 Brosh, Ally. See Hyperbole and a Half bulimia. See eating disorders Bullington, Jennifer, 5, 33 burden metaphors for depression, 156–​157, 165–​166, 169 Burford, Elizabeth, 167, 189 Burns, Charles. See Black Hole Caballero, Rosario, 42 Cameron, Lynne, 4, 15, 25, 124, 153 cancer, 5–​6, 16, 33, 54, 118–​153 definition of, 119 symptoms of, 120, 122 treatment for, 120–​121, 131–​132, 135, 143, 147, 179–​180, 188 visualizations of, 79–​80, 94, 122–​123, 131–​132, 145–​151, 183, 189 See also cancer metaphors

221

Index Cancer Made Me a Shallower Person, 100, 118, 132–​135, 151. See also cancer cancer metaphors as agriculture, 130, 136 as animal, 58, 60, 119, 130 as black hole, 122, 146–​147 as emoji, 136 as enigma, 130 as grim reaper, 115, 138 as human, 119, 130, 136–​137 as intruder, 119, 130 as journey, 5, 54, 123, 129–​130, 132, 135 as military invasion, 5, 119, 128–​129, 132, 136, 188 as obstacle, 129–​130 as parasite, 119, 130–​131 as sport, 130, 188–​189 as Trojan horse, 135, 138 as war, 123, 128–​129, 131–​132, 135–​136 Cancer Vixen, 79–​80, 118, 120–​122, 136, 146–​147, 151, 189. See also cancer Carney, Sean, 109, 183 Carroll, Lewis. See Alice’s Adventures in Wonderland Carroll, Noel, 88, 185 Casasanto, Daniel, 4, 5, 15, 27–​31, 41, 162–​163 Chaney, Michael A, 109 Charteris-​Black, Jonathan, 5, 156, 165, 179 Chrysikou, Evangelia G., 5, 15, 29 Chute Libre, 154, 167–​168. See also depression cinema, 85, 99, 102 bidirectionality of metaphors in, 185 hybrid metaphors in, 87–​88 as a medium, 43 Classen, Constance, 6, 16, 121, 123–​124,  126 classification system. See taxonomy of visual metaphors Clore, Gerald L., 113, 166 CMT. See Conceptual Metaphor Theory

221

Coëgnarts, Maarten, 2, 85, 102 cognition, 125, 159 embodied, 19, 184 of space, 162 of time, 162 color, 16–​17, 39, 68, 85, 89, 110, 145, 168 historical meanings of, 112–​113 meanings of black and white, 75, 86, 94–​96, 111–​114, 143, 156–​157, 193n3.5 metaphorical connotations of, 9, 97 and psychophysical state, 112 universal and distinctive responses to, 86, 112–​113 Colston, Herbert L., 14, 18, 23, 33, 187, 191n1.1 comics, 45, 53, 55–​56, 75–​78 and metaphor, 3, 9, 16, 60, 154 and multimodality, 48, 50, 65–​67, 69–​70, 168–​169 and reading path, 164–​165, 182–​183 and space, 9, 46, 72, 76, 103–​107, 158, 175 and time, 6, 17, 49, 74, 156, 158–​159, 163–​164,  184 wordless, 61 See also graphic illness narratives comix,  55–​56 Conceptual Blending Theory, 22–​23 Conceptual Metaphor Theory, 1–​5, 12, 21–​22, 27–​28, 31, 40, 87, 107, 153, 162–​163, 184–​186 distinction between metaphorical expressions and conceptual metaphors, 13–​14, 59 Dynamic Systems perspective of, 4, 25–​26,  46 formal qualities of conceptual metaphors, 14 image schema, 21–​22, 25–​27 and the lived body, 3, 22–​23 simple/​primary and complex/​ secondary metaphors, 21 source domains and target domains, 19–​20, 22, 24, 42, 60, 92

2

222

Index

conceptualization of cancer, 128–​138 of depression, 161, 165–​176 of time, 41, 162, 164 conduit metaphors, 68–​69 connotation,  61–​62 container metaphors, 21, 25–​26, 50,  68–​69 for Alzheimer’s disease, 48–​49 for depression, 179–​182, 193n5.5 for eating disorders, 104–​106 continuous narrative, 38, 69, 72. See also repetition Conway, J.B., 155–​156, 165–​167, 179 Cooperrider, Kensy, 4, 30, 41, 162–​163 correlation metaphors, 21–​22, 59–​60, 87, 102, 169 Couser, G. Thomas, 54, 140 Crawford, L. Elizabeth, 27, 29, 166 Cunningham, Darryl. See Psychiatric Tales Currie, Mark, 160 Czerwiec, M.K. See Graphic Medicine Manifesto Dad’s Not All There Any More, 90–​91. See also Parkinson’s disease Dahl, Ken. See Monsters Damjanovic, Ljubica, 27, 29 Dark Early, 61, 154, 169–​171. See also depression darkness metaphors for depression, 61, 156, 159, 165–​173,  188 Darkness Visible, 165 Das Karma-​Problem, 78, 79. See also multiple sclerosis data set, 11–​12, 50, 87, 123–​124, 156, 165 Deacon, Brett J., 155 dead metaphors, 20 Deignan, Alice, 4, 25, 47, 124, 153 de la Fuente, Juanma, 30, 163

deliberate metaphors, 187–​188 dementia, 5, 11, 37, 87, 90, 114, 185 Demetris, Alex. See Dad’s Not All There Any More Demjén, Zsofia, 5, 156, 165, 175, 179–​ 180, 193n5.5 Demmen, Jane, 5, 33, 129, 188 denotation, 61 depression, 5–​6, 16–​17, 33, 154–​183 definition of, 154–​155 etymology of, 155 factors of, 155 symptoms of, 154–​155 therapies for, 155–​156 and time, 156, 159–​164, 180, 183–​185 depression metaphors as black hole, 171 as a brittle object, 173–​174 as a burden, 156–​157, 165–​166, 169 as a container, 179–​182, 193n5.5 as darkness, 61, 156, 159, 165–​173, 188 as descent, 156, 158–​159, 165–​167, 171–​173 as disintegration of self, 50, 60, 156, 165 as entrapment, 171–​172, 179–​183 as fractured/​split self, 59, 158–​159, 165, 173–​179 Depresso, 154, 171–​173, 176–​178. See also depression Descartes, René, 18, 19, 141 descent metaphors for depression, 156, 158–​159, 165–​167, 171–​173 destroyer metaphors for time, 162 differential experiential focus, 24–​25 digital-​imaging technologies in astronomy, 122, 145–146, ​148 in comics, 39, 78–79, 110–111, 178 in medicine, 6, 127–​128, 145, 153, 183 in photography, 44, 127

23

Index Dillon, Glyn. See Nao of Brown, The disappearance, 5, 78, 193n5.2. See also dys-​appearance; eu-​appearance discourse community, 51, 53, 56 disintegration of self metaphors for depression, 50, 60, 156, 165 doctor. See medical professionals Donovan, Courtney, 55, 57 drawings coherence between words and, 39–​40, 49, 110–​111, 134 engagement with producers/​ audiences,  44–​45 function of, 77, 190 drawing style of alternative comics creators, 77, 109–​110 definition of, 109–​110 metaphorical aspects of, 9–​10, 109 propositional and gestural, 77 dual coding theory, 38 Dunlap-​Shohl, Peter. See My Degeneration Dyer, Brenda, 165 dynamic embodiment, 12, 15, 46–​47, 184 definition of, 5 Dynamic Systems, 4, 25–​26, 46 dys-​appearance, 5–​7, 12, 32–​35, 46, 56–​57, 193n5.2. See also disappearance; eu-​appearance eating disorders, 11, 111, 156–​157 and container metaphors, 104–​106 and representation of the body, 94–​ 96, 101, 104, 142 ecological psychology, 15, 36. See also affordances ego-​moving metaphors for time, 41, 162–​164 Elkins, James, 125–​126 El Refaie, Elisabeth, 2–​3, 7, 14, 56–​57, 72, 77, 79, 86, 90, 132, 134, 136, 148, 164, 171, 173, 181, 187, 193n3.5

223

embodiment, 20, 22, 47–​48, 120, 153, 184 cross-​cultural differences in, 23 cultural definitions of, 25 definition of, 1 and embodied simulation, 12 and interiority, 142–​143 and normalcy, 2 origins of embodiment theory, 2,  19–​20 short-​term manipulation of, 5 See also dynamic embodiment; Merleau-​Ponty, Maurice emoji metaphors for cancer, 136 empathetic projection, 12, 34 Engelberg, Miriam. See Cancer Made Me a Shallower Person enigma metaphors for cancer, 130 entrapment metaphors for depression, 171–​172, 179–​183 epilepsy, 11, 109, 192n2.2 and monster metaphors, 72–​75 Epileptic, 72–​75, 109, 192n2.2. See also epilepsy eu-​appearance, 32–​33, 185. See also disappearance; dys-​appearance eyes, 124–​126, 138–​139, 145 absence/​presence of glasses in graphic illness narratives, 10, 102, 148–​152 metaphorical representations of, 78, 84–​85, 106, 133, 151–​152, 158, 168 See also vision Facts of Life, The, 57–​60, 69–​71, 100. See also infertility; myalgic encephalomyelitis Fauconnier, Gilles, 22 Feldman, Jerome A., 12, 22, 34, 39, 125 Feng, Dezheng, 85, 103, 107

4 2

224

Index

Ferdinandusse, Heleen, 14, 89 Fies, Brian. See Mom’s Cancer figurative language. See metaphors Fludernik, Monika, 186 Flynn, Deborah, 17, 155, 165 Forceville, Charles, 2–​3, 7, 14, 16, 37, 41, 69, 84, 86–​87, 91, 94, 96, 99, 116, 185, 192n3.1 format. See medium Forney, Ellen. See Marbles Foucault, Michel, 126–​127, 148 fractured/​split self metaphors for depression, 59, 158–​159, 165, 173–​179 Frank, Arthur W., 54 Franks, Heather, 5, 119, 130 Freedman, Matt. See Relatively Indolent but Relentless Fuchs, Thomas, 17, 32, 159, 160, 180, 193n5.2 Fuhrman, Orly, 30, 162–​163 Fullagar, Simone, 5, 33, 156, 165–​167 Gage, John, 111 gaze. See social semiotics gender stereotypes, 152–​153 Genette, Gerard, 72, 193n5.4 genre, 15, 39, 47–​48, 53, 56, 80 constraints of graphic illness narratives, 15, 49, 52 conventions, 48, 61, 76, 82 definitions of, 50–​51 expectations, 47, 51, 55 fluidity of boundaries, 46, 51, 185–​186 and prototype theory, 52–​53 Gestalt theory, 33, 89–​92 Gibbons, Alison, 3, 23, 52, 62 Gibbs, Raymond W., 2, 4–​5, 12, 14–​15, 18, 21, 23, 25–​26, 33, 119, 130, 187, 191n1.1 Gibson, James J., 6, 36, 76, 78 Gkiouzepas, Lampros, 14, 89, 96, 192n3.1

Gloor, Reto. See Das Karma-​Problem Goatly, Andrew, 47, 193n5.3 Gombrich, Ernst H, 87 Good Eggs, 100–​101. See also infertility Grady, Joseph, 13, 21–​23, 59, 87 graphic illness narratives characteristic features of, 13, 15, 39, 48–​50, 57, 61, 72, 78, 120 definition of, 3, 53 origins and evolution of, 54–​56 picture and virtual surfaces in, 76–​77 as a source of self-​reflection, 15, 39, 78, 128 types of, 55 Graphic Medicine Manifesto, 56 graphic novels. See comics; graphic illness narratives graphic pathography. See graphic illness narratives Green, Justin, 55 Green, Katie. See Lighter Than My Shadow Green, Michael J., 17, 187 grim reaper metaphors for cancer, 115, 138 Groensteen, Thierry, 175, 178 Gwyn, Richard, 5 Hague, Ian, 37 Hall, Edward T., 106, 159 Hall, James, 9, 128 hallucinations, 68, 87 and disruption of reality, 99, 185–​186 and mental illness, 82–​84, 90–​91, 116, 143 handedness. See left-​right happiness metaphors, 2, 21, 24 Harrington, Kristine, 17, 119 Harrow, Alison, 131, 189 Hatfield, Charles, 15, 49, 60, 62, 72 Hawkins, Ann R., 89, 104 Hawkins, Anne H., 54–​55

25

Index Hayden, Jennifer. See Story of my Tits, The Henetz, Tania, 4, 28, 31 Herman, David, 11 herpes. See sexually transmitted diseases heterosemiosis, 79 Heywood, John, 5, 130 HIV/​AIDS. See sexually transmitted diseases Hoffman, Donald, 125 Hogg, Margaret K., 14, 89, 96, 192n3.1 Horstkotte, Silke, 126, 142 hot fluid in a container metaphor for anger, 22, 41, 71 How I Made It to Eighteen, 156–​158. See also depression; eating disorders Howes, David, 6, 123, 190, 192n1.4, 193n4.2 Hubbard, E.M., 37, 67 human metaphors for cancer, 119, 130, 136–​137 human sensorium, See senses humor, 68–​69, 91, 134, 140 Huntington’s disease, 11, 62–​64 Huxford, John, 85, 102 hybridity. See heterosemiosis Hyperbole and a Half, 154, 176–​177. See also depression icon, 38–​39, 64–​65, 69 iconography of illness, 120 identity and appearance, 57, 121, 138–​142 and illness, 78, 96, 101, 104, 119, 130, 141, 158, 165, 167, 167, 173–​179 and performance, 140 ideogram, 39 idiom. See metaphors Ihde, Don, 68, 145 impact flash, 9–​10 Indurkhya, Bipin, 192n3.2

225

infertility, 11, 57–​59 Inflatable Woman, The, 99, 151–​152. See also cancer Ingold, Tim, 15, 67, 77 Inside Out, 104–​106, 111–​112, 142. See also eating disorders intermediality. See heterosemiosis intruder metaphors for cancer, 119, 130 irony, 128, 277 It’s a Bird, 62–​64. See also Huntington’s disease Jameson, Fredric, 51 Jansen, Carel, 5, 33 Jasmin, Kyle, 28, 30, 41, 162–​163 Johnson, Mark, 1–​2, 19–​21, 23, 32, 64, 122, 124, 153, 162, 191n1.1 journey metaphors for cancer, 5, 54, 123, 129–​130, 132, 135 for life, 180 for love, 19–​30 Keefer, Lucas A., 156, 188 Keen, Suzanne, 12, 33 Kember, Sarah, 127, 145 Kerby, Anthony Paul, 159 Kimball, Miles A., 89, 104 Knight, Paula. See Facts of Life, The knowledge and understanding metaphors for vision, 1, 119, 122, 124, 128, 130, 145, 153–​154, 169, 178 Koller, Veronika, 3, 97, 111 Korman, Yifaht, 156, 165, 167 Kövecses, Zoltán, 4, 15, 22, 24–​26, 47, 59, 162, 166, 185, 192n3.4 Kravanja, Peter, 2, 85, 102 Kress, Gunther, 37–​38, 85, 103–​104, 106, 111, 133, 192n1.5 Kristeva, Julia, 139 Kristiansen, Teddy. See It’s a Bird Kukkonen, Karin, 3, 60, 71

6 2

226

Index

Lakoff, George, 1–​2, 19–​23, 41, 53, 59, 64, 124, 132, 135, 162, 191n1.1 Lane, Heather Patricia, 5, 33 Lang, Fritz. See Metropolis layout. See social semiotics Leavitt, Sarah. See Tangles Leder, Drew, 5, 7, 32, 46, 56, 193n5.2. See also dys-​appearance Lefèvre, Pascal, 158 left-​right and asymmetry of the brain, 29, 34–​35,  81–​82 good-​bad associations of, 9, 27–​28, 30 influence of handedness, 27–​30, 46, 191n1.3, 194 and influence of script direction, 4–​5, 9, 30 mental representations of, 4–​5, 29 metaphors,  27–​28 past-​future associations of, 4–​5, 85, 104, 163 and time perception, 31, 41, 168 Lemke, Jay L., 36, 156 Leto, Steven. See Negative Self-​Image Levitt, Heidi, 156, 165, 167 Lighter Than My Shadow, 94–​96. See also eating disorders Littlemore, Jeannette, 47 Lott, Tim. See Scent of Dried Roses, The lymphoma. See cancer Maalej, Zouhair A., 4, 15, 25 Maass, Anne, 4, 30, 163 Mackintosh, Ross. See Seeds Mademoiselle Caroline. See Chute Libre Maes, A., 14, 89 Manning, Martha. See Undercurrents Marbles, 154, 180–​183. See also bipolar disorder Marchetto, Marisa Acocella. See Cancer Vixen Marmolejo-​Ramos, Fernando, 27, 29, 166

Martens, Gunther, 13, 74 Massironi, Manfredo, 38, 77, 164 materiality, 39, 50, 52, 78, 109–​110, 168 McCloud, Scott, 68, 158–​159, 171 McGilchrist, Iain, 15, 35, 81–​82, 191n1.3 McLachlan, Sue Anne, 5, 33 McLuhan, Marshall, 43–​44 McManus, Chris, 28–​30 McMullen, Linda M., 155–​156, 165–​167,  179 meaning-​making resources for comic book artists, 12, 38–​39 and meaning potential, 36 and mode categorization, 37–​38 meaning potential, 27, 46, 99 definition of, 36 of space and layout, 39, 78, 102–​106, 109, 164 See also affordances mediality,  43–​45 medical gaze, 16, 123, 126–​128, 149–​152 medical humanities, 56 medical imaging, 16, 122 and generation of new metaphors, 189 sonography, 79, 122, 189 X-ray, 114, 123, 127, 138, 143, 145, 148–149 See also digital-imaging technologies medical professionals disparity of power between patient and, 97, 128–​129, 189 and interest in graphic illness narratives, 17, 129, 187–​189 and use of digital-​imaging technology, 114–​115 medium definition of, 42–​44 difference between mode and, 43 differences between print and electronic,  43–​44 hot and cool, 44 is the message, 43 mediumhood. See mediality

2 7

Index Meeting of St. Anthony and St. Paul, The, 72 Meier, Brian P., 27, 113, 166 Merleau-​Ponty, Maurice, 5, 15, 18–​20, 31, 33, 67. See also embodiment metacomic, 75 Metaphor Identification Procedure,  13–​14 metaphors ambiguity of, 15, 82, 92–​94, 115, 141, 153, 158, 164, 181, 185 congruity/​incongruity as a marker of, 14, 29, 84, 94, 96 contextualist theory of, 26 continuity of, 163 costs and benefits in health setting of, 188–​189 creation of, 6, 59, 75, 81, 153 creativity of, 17, 23, 47, 59, 87, 156, 165, 187 cross-​cultural similarities and differences in, 4, 15, 23–​24, 46 differences between verbal and nonverbal, 41–​42, 185–​186 differential experiential focus, 24–​25 experimental evidence of, 27–​31, 46, 113 formal cues for, 14, 26, 84, 87, 92, 100, 183 importance of meaningful, 189–​190 influence of cultural background on, 3, 20 interpretation of, 14, 18, 24, 61, 71, 92, 96–​97, 99, 112, 122, 124, 131, 141, 169, 171, 178, 182–​188 limitations of, 120, 129, 189 non-​reversibility of, 185 reorientation of, 13, 74 unidirectionality vs. bidirectionality of, 60, 153, 185–​186 use of speech and thought balloons as, 9–​10, 68–​69, 100, 133–​134, 158, 182–​183

227

metapicture, 149 metonym for anger, 22 definition of, 22 distinction between metaphor and, 24–​25, 74 Metropolis, 88 Metzl, Jonathan, 155 Miers, John W., 192n2.2 military invasion metaphors for cancer, 5, 119, 128–​129, 132, 136, 188 mind-​body dualism,  18–​19 mind-​body-​world continuum disruption of, 2, 5, 32–​33 Miodrag, Hannah, 39, 70, 109, 164 Mitchell, W.J.T., 149 mode categorization of, 37–​40 definition of, 37 difference between medium and, 43 Mom’s Cancer, 118, 146–​148. See also cancer Monsters, 75–​76, 91. See also sexually transmitted diseases monstrator, 178 Morrison, Toni, 113 motion line, 71 moving attention perspective, 163–​164 Müller, Cornelia, 2, 23, 26, 42, 92 multimodality. See social semiotics multiple sclerosis, 78–​80 myalgic encephalomyelitis, 57–​59 My Degeneration, 7–​11, 90, 102. See also Parkinson’s disease My Depression, 154, 180–​181. See also depression Myers, Kimberly, R., 17, 187 Nadhmi, Faris, 5, 30, 163 Nao of Brown, The, 114–​116. See also obsessive-​compulsive disorder Negative Self-​Image, 154, 178–​179. See also depression

8 2

228

Index

newspapers cancer metaphors in, 130 proximity of images in, 102 visual metaphors in, 85 Ng, Carl Jon, 3, 97 not knowing or understanding metaphors for vision, 10, 122–​123, 138, 153, 184 Núñez, Rafael E., 4, 30, 162–​163 nurse. See medical professionals O’Brien, Wendy, 5, 33, 156, 165–​167 O’Halloran, Kay, 85, 103, 107 Oakley, Todd, 23, 131 Oberfeld, Daniel, 155, 161 object-​constitutive attributes,  89–​90 object-​depictment attributes, 89–​90. See also Gestalt theory obsessive-​compulsive disorder, 11, 55–​56, 65, 114–​116 obstacle metaphors for cancer, 129–​130 Ojha, Amitash, 35, 192n3.2 onomatopoeia, 68, 85 oral illness narratives types of, 54 Ortiz, María J., 85, 89, 113 Ostherr, Kirsten, 16, 120, 123, 128 Our Cancer Year, 56, 107–​108, 113–​114, 118, 131–​132. See also cancer pain metaphors as a sharp object, 9–​10, 13, 40–​41, 68, 110 Paivio, Allan, 38 Panopticon, 148 parasite metaphors for cancer, 119, 130–​131 Parkinson’s disease and metaphor, 7–​11, 90–​91 symptoms of, 9 Parsons, Michael, 3, 85, 102 part-​whole metaphors, 21

pathography. See graphic illness narratives Peeters, Benoît, 74 Peeters, Frederick. See Blue Pills Peirce, Charles S., 38, 64 Pekar, Harvey. See Our Cancer Year Penson, Richard T., 129, 188 phenomenology, 3, 20 and bodily perceptions, 5, 15, 18–​19,  56–​57 and disruption of mind-​body-​world continuum, 32 and time, 160–​161 Philip, Jennifer, 5, 33 Phillips, Barbara J., 192n3.1 photography and time, 44–​45 and truth, 44–​45, 103, 127–​128, 147, 178 physicality, 3, 15, 20, 48 and illness, 2, 5, 101, 184–​185, 191n1.2 and otherness, 139 Pickering, Neil, 156 pictogram,  38–​39 pictorial metaphors, 8, 84, 86–​87, 96, 116–​117,  178 ambiguous/​integrated, 86, 91–​92, 94, 116, 117, 141, 181 body modification, 84, 100, 102, 104, 115–​117, 143, 151 contextual, 84, 86, 94, 96, 117, 138, 175 definition of, 7, 16 difference between spatial metaphors and, 102 hybrid, 84, 86–​88, 96, 117, 180, 192n3.3 pictorial allegory, 99, 117, 171 pictorial simile, 84, 86, 88–​90, 96, 117, 138, 147 transformational, 92, 117 typo-​pictorial, 100, 114, 117, 167 verbo-​pictorial, 86–​87, 99, 114, 117

9 2

Index pictorial runes, 109–​110, 114, 180–​181 definition of, 69 and motion, 71 and non-​arbitrary meanings, 70–​71 Plath, Sylvia, 165, 179 political cartoons, 2 and hybrid metaphors, 87, 88 Potsch, Elisabeth, 3, 9, 71, 164 Potts, Phoebe. See Good Eggs Powell, Nate. See Swallow Me Whole power and angle in images, 106–​107, 148, 158 (see also social semiotics) and the camera, 127 and identity, 139–​140, 167 and illness, 96, 129, 132, 138 and patient-​doctor relationships, 97, 123, 128–​129, 148, 149, 151, 189 Pragglejaz Group. See Metaphor Identification Procedure Pritzker, Sonya, 5, 24 prototype theory, 54, 117 basic-​level categories, 53 and genre, 52–​53 proxemics, 106 Psychiatric Tales, 173–​175. See also depression pure shapes, 64 pursuer metaphors for time, 162 Quinn, Naomi, 166 Rakova, Marina, 191n1.1 Ramachandran, V.S., 15, 37, 65, 67 Ratcliffe, Matthew, 17, 159, 161 reading path, 193n5.4 and ambiguity in comics, 158, 182 and metaphor, 182 and time conceptualization, 164 reaper metaphors for time, 162 Reed, Stephen K., 38

229

Reisfield, Gary M., 5, 119, 129, 188 Relatively Indolent but Relentless, 118, 135, 138. See also cancer relay,  61–​62 repetition, 69, 72 and time metaphors, 26, 99, 175 resemblance metaphors, 59–​60, 87 rhetoric, 52, 68, 87 and genre, 51 and heterosemiosis, 79 ribbon path, 71, 75 Ritchie, L. David, 33, 47 Robinson, Michael D., 27, 113, 166 Rosch, Eleanor, 19, 52 Ryan, Marie Laure, 43–​44 Sacks, Oliver, 192n2.1 sadness metaphors, 24–​25, 166 salience. See backgrounding-​ foregrounding Santiago, Julio, 5, 27, 29–​30, 162 Sassetta. See Meeting of St. Anthony and St. Paul, The Scarry, Elaine, 13, 40, 142–​143 Scent of Dried Roses, The, 161 Schiesari, Juliana, 155 Schilperoord, Joost, 14, 89 schizophrenia, 11, 191n1.3 Seagle, Steven T. See It’s a Bird Seeds, 137–​138. See also cancer self. See identity Semino, Elena, 5, 12, 33, 40, 47, 121, 130, 165 senses hearing, 31–​32, 37, 40, 43, 61, 65, 67–​68, 110–​111,  136 rankings of, 123–​124 sight (see vision) sixth sense, 123 smell, 6, 7, 31–​32, 37, 40–​41, 69, 71, 110, 123–​124 taste, 6, 7, 37, 40, 48–​49, 110, 123–​124 touch, 6, 7, 31–​32, 37, 42, 110, 123–​124,  126

0 32

230

Index

sensorimotor experiences, 1, 4, 6, 15, 19–​21, 25, 36, 46, 50, 52–​53, 55, 80, 162, 166 sexually transmitted diseases, 5, 11 and metaphor, 33, 75–​76, 91–​2–​94,  97 sharp object metaphors for pain, 9–​10, 13, 40–​41, 68, 110 Shivack, Nadia. See Inside Out Short, Mick, 5, 130 Sick Child, The, 152 Sinding, Michael, 51–​53 Small, David. See Stitches social semiotics, 3, 15, 20, 36–​37, 106, 116 distance, 7, 16, 49, 85, 89, 92, 102, 106–​107,  176 facial expressions, 38, 41, 136, 139, 176, 181 framing, 65, 69, 104, 151, 158, 164, 173 gaze, 148, 151–​153 gesture, 37–​38, 41, 139, 163 horizontal angle, 29–​30, 162, 171 metafunction, 37, 192n1.5 posture, 6, 21, 25, 102, 107, 136, 139, 171 sequence, 6, 9, 54, 72–​74, 158, 161, 164, 173 spatial arrangement and orientation, 4–​7, 9, 12–​13, 15–​16, 41, 46, 49, 52, 71–​72, 74–​75, 85, 90, 102–​104, 120, 128, 134, 151, 158, 163–​164, 165, 168–​169, 173, 182 vertical angle, 7, 29–​30, 75, 106–​107, 162, 164 Sontag, Susan, 127–​128 sound quality. See synesthesia source-​path-​goal metaphors, 21, 71, 74–​75,  167 space and changes in motor fluency, 29 and comics, 9, 46, 72, 76, 103–​107, 158, 175

diegetic, 78, 103–​104 extradiegetic, 158, 164, 171 physical, 78, 103, 166 and radio, 45 and theatre, 45–​46 and time relationship in comics, 17, 30, 32, 41, 72–​80, 156, 184 space metaphors for time, 156, 180 spacetime, 159, 162, 180–​183 spatial agency bias, 163–​164, 176. See also left-​right spatial metaphors, 16, 86, 102, 107, 117, 158, 162 compositional, 103–​104, 117, 148, 151, 158 diegetic, 103–​104, 117, 151, 158 interactive, 106, 117, 148, 158, 181 sport metaphors for cancer, 130, 188–​189 Stacey, Jackie, 119, 127–​128, 132 Steen, Gerard, 47, 52–​53, 187 Stevenson, Robert Louis. See Sick Child, The Stitches, 148–​151. See also cancer Stocker, Kurt, 159, 162 Stöckl, Hartmut, 100, 111 Story of my Tits, The, 118, 140–​142, 151. See also cancer storyworld, 11, 13, 61, 65, 75–​76, 84, 99–​100,  116 metaphorical use of space in, 85, 103–​104, 158, 164, 169 representations of time in, 169, 171 stroke, 114, 189 Stroop effect, 39 style. See drawing style stylistic metaphors, 16, 86, 109–​110, 117, 151, 183, 192n3.4 indexical, 110, 114, 116–​117, 122, 134, 143, 148, 151, 178, 180, 183 isomorphic, 110, 113–​115, 117, 143, 149, 151, 183

231

Index Styron, William. See Darkness Visible Suitner, Caterina, 4, 30, 163 Sun, Sewen, 89 Superman,  62–​64 surgeon. See medical professionals Swados, Elizabeth. See My Depression Swales, John, 50, 53 Swallow Me Whole, 82–​84, 86–​87, 96. See also hallucinations Sweetser, Eve, 124, 162 synesthesia, 15, 37, 40 definition of, 9 and metaphor, 7, 42, 71, 86, 110 and perception, 65–​67 Tangles, 48–​49. See also Alzheimer’s disease taxonomy of visual metaphors El Refaie, Elisabeth, 16, 102–​117, 186 Forceville, Charles, 84–​102 temporal entrapment, 17, 159, 179–​183 Teng, Norman Y., 89 Teucher, Ulrich, 119, 130, 189 texture and metaphor, 38–​39, 42, 61, 89, 110 thief metaphors for time, 162 time amorphous, 158, 171 circular representations of, 41, 175, 182 clock vs. lived, 160–​161, 164–​165, 169–​170, 173, 180 desynchronization of time, 160 flow of, 17, 155, 161, 193n5.1 implicit and explicit, 160–​161 linearity of, 30, 159, 182 moving attention perspective of, 163–​164 perception of, 17, 155–​156, 158–​161, 164–​165, 171, 175 permanence and variation of, 164 psychic, 159–​160

231

sagittal vs. lateral axes of, 41, 162–​163 time metaphors as destroyer, 162 as ego-​moving, 41, 162–​164 as pursuer, 162 as reaper, 162 as space, 156, 180 as thief, 162 as time-​moving, 41, 162–​164 as valuable commodity, 64–​65, 162 time-​moving metaphors for time, 41, 162–​164 Tinker, Emma, 60 Trojan horse metaphors for cancer, 135, 138 tuberculosis, 7, 146 Turner, Mark, 2, 22, 59, 132, 135 typography and metaphor, 38–​39, 110–​111 typopictoriality, 100 Ubersfeld, Anne, 46 Undercurrents, 165 Underwoods. See Sick Child, The valuable commodity metaphors for time, 64–​65, 162 van Campen, Cretien, 15, 68 van Leeuwen, Theo, 36, 37, 52, 85, 103–​104, 106, 111–​113, 192n1.5 Vanistendael, Judith. See When David Lost His Voice verbal overshadowing effect, 28 verticality and associations with good/​bad, 102, 107 and associations with happiness/​ sadness, 17, 21, 25, 27 and effects of gravity, 2, 6, 29, 102, 166 and up-​down metaphors, 2, 17, 21, 27, 107

23

232

Index

vision and perception, 37, 68, 70, 124–​125,  132 and rationality, 6, 123–​126 relationship between medicine and, 120, 126–​128, 145, 153 and sexual desire, 125 visibility-​invisibility in comics, 16, 121–​123, 127, 145, 150–​151, 193n4.1 and what/​where pathways, 134 vision metaphors as knowledge and understanding, 1, 119, 122, 124, 128, 130, 145, 153–​154, 169, 178 as not knowing or understanding, 10, 122–​123, 138, 153, 184 visual metaphors. See also pictorial metaphor; spatial metaphor; stylistic metaphor; taxonomy of visual metaphors definition of, 7, 14

war metaphors for cancer, 123, 128–​129, 131–​132, 135–​136 Weiss, Gail, 139 When David Lost His Voice, 118, 143–​145. See also cancer White, Tracy. See How I Made It to Eighteen Williams Camus, Julia T., 5, 119, 129–​130 Williams, Ian. See Bad Doctor, The Williams, Kevin, 43–​44 Williams, Robert F., 3, 9, 71, 163 Wilson, George, 5, 119, 129, 188 wine promotion discourse and metaphor, 42 Winter, Bodo, 2, 85, 102, 113 Wolk, Douglas, 60, 109 word-​image relations types of (in comics), 62

Walker, Esther, 41, 163 Walrath, Dana. See Aliceheimer’s

Zakia, Richard D., 89 Zeiler, Kristin, 185

Yu, Ning, 4, 15, 23–​24