Enlarge / Martinique-born psychiatrist Franz Fanon explored the bioethics of studying and treating trauma in his 1961 book, The Wretched of the Earth. An academic paper written in comic form examines one case study in particular from a modern perspective.

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Is it possible to ethically treat someone with post-traumatic stress disorder (PTSD) developed as a result of inflicting torture on others? That's the question posed in a paper published last summer in AJOB Neuroscience, but there's a twist. The paper is written and illustrated as a comic book by Lehigh University artist and neuroscientist Ann E. Fink.

Fink is part of a growing movement called "graphic medicine," a term coined back in 2007 by physician and comics artist Ian Williams to describe the use of comics to enhance both professional and general public discourse on healthcare issues. Comics may be a form of visual rhetoric ideal for medical education and patient care, and proponents include M.K. Czerwiec, aka "Comic Nurse," who worked in an HIV hospice at the height of the AIDS epidemic. When the clinic closed in 2000, she struggled to find an outlet to express the bittersweet emotions she was feeling, but she found the comic format was perfect.

"I realized that the combination of image and text in sequential fashion really helped me organize my thoughts," Czerwiec told the University of Chicago News last year. "It just worked." Now an artist in residence at Northwestern University's Feinberg School of Medicine, she published a graphic nonfiction memoir/oral history, Taking Turns: Stories from HIV/AIDS Care Unit 371, in 2017. Czerwiec and Williams, along with Penn State University's Michael Green, were among the first attendees in 2010 of what is now an annual international graphic medicine conference. They published The Graphic Medicine Manifesto, a collection of scholarly essays with visual narratives, in 2015.

Like many in the graphic medicine community, Fink has a longstanding interest in comics, although her early training was in psychology and neuroscience, with an emphasis on the larger social and ethical questions surrounding learning, memory, and mental health. During a fellowship at the University of Wisconsin-Madison, she met comic art legend Lynda Barry and a group called the Applied Comics Kitchen. That's when Fink started using comics to teach topics in biology and health. "A lot of this is really about centering the personal narrative, the experience of the patient, the experience of the provider," she told Ars. But the AJOB Neuroscience paper is her first academic essay in comic form.

In the paper, Fink revisits in comic form a bioethical dilemma described by psychiatrist and political philosopher Franz Fanon in his seminal 1961 book, The Wretched of the Earth. Born on the Caribbean island of Martinique (then a French colony) and educated in France, Fanon described the dehumanizing effects of colonialism on the colonized people in his book, offering numerous case studies he'd encountered in the final chapter.

The most well-known is the tale of a white male police inspector in Algeria whose job involved torturing prisoners of the colonial government for many hours each day. He would likely have been diagnosed with PTSD today, since the stress of his day job led to the man regularly beating his wife and children at homeincluding a 20-month-old infant. He sought treatment, Fanon wrote, to deal with the stress and guilt he felt over torturing human beings so that he could continue torturing people at work with "total peace of mind"and thereby curb the impulse to inflict physical abuse on his own family.

The police inspector's bioethics dilemma and decision tree

Ann E. Fink

Should he help this man suffering from PTSD be a better torturer?

Ann E. Fink

Outlining the basics of PTSD

Ann E. Fink

Useful lessons for the torturers of today?

Ann E. Fink

On a lighter note: a dissertation on Icelandic sagas in comic form

Yoav Tirosh

This posed an ethical dilemma for Fanon. The police inspector is both victim and perpetrator: he inflicts abuse on Algerian prisoners and his family, but he himself is also a pawn and a victim of the larger sociopolitical pressures and mental trauma incurred on the job. So should Fanon treat the man and make him a better torturer, thereby sparing his wife and children while Algerian citizens continue to suffer? Or, should he refuse to treat him and let the family continue to suffer? And was it even possible to treat the man in any meaningful sense, if he continued to work in the context of an inherently violent colonial regime?

Fink's interest in learning and memoryparticularly her early experiments on the plasticity of individual neurons in the amygdala region of the brainled to an interest in PTSD. "I always wanted to put it in a broader context," she said. When she read Fanon's police inspector case study in The Wretched of the Earth, the psychiatrist's ethical dilemma struck a chord. "How do you think about PTSD as a reducible biological phenomenon in the context of a society that's sick, violent, and inhumane?" she said.

"How do you think about PTSD as a reducible biological phenomenon in the context of a society that's sick, violent, andinhumane?"

For Fink, the case is a useful starting point to explore the larger ethical issues surrounding the social dimensions of traumatic stress. She developed a "decision tree" to help clarify the complex ethical issues involved. "You can think of PTSD as a biological entity, or something socially contextualized," said Fink. "And you can think of it as a personal narrative issue."

But there are no easy solutions to the dilemma. "I don't have an answer, and that is kind of the point," Fink told Ars. "It wouldn't be a good ethical dilemma if it had a pat answer. The narrative shows us what the problems are." Fanon's own solution wasn't a solution at all. He quit his job at the hospital and joined the Algerian resistance. "This situation wasn't tenable for him in the long run," she said. "HIs ultimate conclusion is that you can't treat PTSD. There's no healing you can do in this inhuman context."

The comic trend might be spreading beyond the health and medicine arena. Last fall, a PhD candidate at the University of Iceland produced a comic version of the abstractfor his doctoral dissertation on a famous 13th century Icelandic saga. TheLjsvetninga saga has multiple versions, and scholarship has typically focused on dating the various versions to determine which might be the earliest. But Yoav Tirosh chose to explore how the saga's construction has constantly changed. His comic abstract is in the form of a dialogue, in which a fictional version of Tirosh meets the ghost of one of the saga's central figures (Gumundr inn rki, a goi, aka a priest or chieftain) in the restroom of a hotel inReykjavk.

I liked the challenge of trying to interpret visually something that is very text-based like a PhD thesis, and initially even intended it to be incorporated into the thesis itself, he told Medievalists.net. This, however, would have delayed my submission in at least a month and time was pressing, so I decided to do it during my post-submission 'vacation.'" It also served as preparation for a bigger goal: Tirosh hopes to produce an introduction to Old Norse literature in comic form one day.

DOI: AJOB Neuroscience, 2019. 10.1080/21507740.2019.1632970 (About DOIs).

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Academic paper in comic form explores ethics of treating torturer with PTSD - Ars Technica