By Edcel Javier Cintron-Gonzalez
Saji, Sweetha, and Sathyaraj Venkatesan. Metaphors of Mental Illness in Graphic Medicine. Routledge, 2022.
Scholarship in children’s and young adult (CYA) literature has increasingly engaged with questions of mental health, reflecting broader interdisciplinary conversations in the health humanities. Works such as Keywords for Health Humanities (2023) highlight how health is shaped by social, cultural, and political forces, a perspective resonating with ongoing discussions in graphic medicine, where visual storytelling represents the lived experiences of mental illness. Sweetha Saji and Sathyaraj Venkatesan’s Metaphors of Mental Illness in Graphic Medicine (2022) contributes to this interdisciplinary dialogue by analyzing the role of visual metaphors in graphic medicine. Through a theoretical framework rooted in Conceptual Metaphor Theory (CMT) and multimodal analysis, the book examines how graphic narratives depict mental illness in ways that challenge dominant biomedical and cultural discourses. By closely analyzing seven graphic narratives such as Swallow Me Whole (2008), Depresso (2010), and Marbles (2012), Saji and Venkatesan offer a compelling study of how comics serve as a counter-discourse to pathologizing and stigmatizing representations of mental illness. Their work expands the scope of comics studies, medical humanities, and visual rhetoric, offering new insights into how the affordances of the comics medium contribute to our understanding of mental health.
The book is divided into an introduction, six chapters, and a conclusion, each focusing on a different comic text, and using Conceptual Metaphor Theory (CMT) as a tool to analyze the visual and verbal-visual representation of mental illness. Drawing from George Lakoff and Mark Johnson’s Metaphors We Live By (1980), the authors argue that metaphor is not merely a linguistic device but a fundamental cognitive mechanism through which individuals structure and make sense of abstract experiences, including illness. In the context of graphic medicine, metaphors function as multimodal heuristics, bridging the gap between subjective mental states and the external world through image-text interplay.
The first chapter titled “Drawing Illness: History, Theory, and the Development of Graphic Medicine,” explains the correlation between graphic medicine and its engagement with healthcare. Saji and Venkatesan draw from Scott McCloud’s Understanding Comics (1993) to explain how graphic medicine opens the space for readers to experience the accuracy of others’ suffering through mental illness, treatment, and the journey to recovery. While McCloud notes that a comic image’s focus on “the face itself” blurs the boundary between the visible and invisible worlds, and that a loss of visual context moves such an image into the symbolic realm (130), Saji and Venkatesan add how by “blending verbal and visual semiotic codes, comics allow the author to express an idiosyncratic and intricately embodied experience in a universal way, thereby inviting the readers to the author’s visceral and immediate experience” (16). Together, these insights underscore how graphic medicine harnesses the potency of both image and text to convey the subjective, lived dimensions of illness. By rendering experiences in a simultaneously personal and universally accessible way, graphic narratives invite heightened empathy, challenge clinical distance, and reframe the discourse around mental health. Although this chapter offers a clear account of the field’s development, the historical genealogy of graphic medicine could be expanded, as the authors gesture only briefly to recent disability studies scholarship that also interrogates visual representations of illness.
The discussion in Chapter 2, “Function of Metaphors in Illness Narratives,” does more than trace the evolution of metaphor theory; it links these theoretical shifts to the narrative and expressive demands of depicting illness, particularly in graphic pathographies. After establishing the historical movement from Aristotle’s comparison-based and ornamental conceptions of metaphor to contemporary cognitive frameworks, Saji and Venkatesan underscore why these developments matter for autobiographical accounts of illness. The chapter argues that conceptual and multimodal metaphors are indispensable tools for rendering experiences, pain, depression, fragmentation of self, that resist direct representation. In its latter sections, the chapter explicitly connects metaphor theory to illness narratives by examining how visual and verbo-visual metaphors allow artists to externalize internal states, translate subjective symptoms into legible forms, and bridge the experiential gap between patients and readers. This connection is especially evident in their discussion of multimodal metaphors in graphic memoirs, where the fusion of word and image conveys psychic turmoil, bodily disruption, and the altered temporality of illness. Although the chapter prioritizes cognitive models such as CMT, it also gestures toward critiques that emphasize embodiment, cultural context, and the socio-rhetorical stakes of illness metaphor, which are areas that might have benefitted from fuller engagement.
Drawing on theorists such as W. J. T. Mitchell, Andrew Edgar, Peter Sedgwick, and Ella Shohat, Saji and Venkatesan emphasize that representations are embedded in cultural, ideological, and power relations. They continue this conversation in Chapter 3, “Mental Illness and the Politics of Representation,” where they treat representation not as a static image or object but as a dynamic process that constructs and mediates knowledge. Rather than being neutral depictions, representations simultaneously create, fragment, and obstruct knowledge, thereby shaping how identities and social realities are constructed. Their discussion moves from media portrayals of AIDS and colonial‐era images of slavery to mental-illness discourse, showing how popular culture and mainstream psychiatry draw on the same repertoire of metaphors and visual stereotypes; DSM categories, medical illustrations, and news images function as a kind of “popular” visual culture that organizes lay and professional understandings of madness. This move implicitly suggests that graphic medicine, as another popular form, could be mobilized to complicate and sophisticate these reductive medical narratives by recentering lived experience rather than pathologizing images. At times, however, this productive insight remains more implied than fully theorized, and the chapter might have been strengthened by more explicitly framing biomedical discourse itself as a popular genre that graphic narratives can critically rework.
In “Nobody Memoirs as Counter-Discourse: Bipolar Disorder and Its Metaphors,” the authors turn to two already influential graphic memoirs, Ellen Forney’s Marbles: Mania, Depression, Michelangelo, and Me (2012) and Rachel Lindsay’s Rx: A Graphic Memoir (2018), to ask what precisely these texts do as illness narratives in comics form. The contribution of these works lies in showing how Marbles and Rx function not just as compelling personal stories but as what Margaret Price calls counter-diagnostic sites where verbo-visual metaphors actively “write back” to biomedical logics and popular stereotypes of bipolar disorder. Forney’s much-discussed DSM scene, for example, becomes for Saji and Venkatesan a paradigmatic counter-diagnostic page: the neat, box-like panels that reproduce the “criteria for manic episodes” are slowly crowded out by scalloped, overflowing balloon-panels in which Forney’s racing thoughts are rendered as “spinning wheels burning rubber” that literally become her hair (qtd. In Saji and Venkatesan 76-77). Similarly, the carousel that charts her movement from hypomania to depression, and the later panel in which her head becomes “a cage of frantic rats” (qtd. in Saji and Venkatesan 81), are read not simply as expressive images but as alternative iconographies of bipolarity that displace the rigid, symptom-based authority of the DSM. By tracing how such metaphors intervene in the spatial, formal, and rhetorical organization of the comics page, the chapter shows how these well-known memoirs construct a counter-discourse that contests both sensationalist media depictions and the pseudo-clinical imagery of mainstream comics and film.
Chapter 4’s second major intervention is to situate Forney and Lindsay within Thomas Couser’s paradigm of “nobody memoirs,” and to demonstrate how the comics medium amplifies the democratic and political potential of that category. For Saji and Venkatesan, Marbles and Rx are “nobody memoirs” not only because their authors are known primarily through their illness narratives, but because their verbo-visual strategies reconfigure what counts as expertise about mental illness and who is authorized to speak about it (73). Lindsay’s recurring wolf avatar, for instance, is unpacked as a layered metaphor that visualizes both internalized stigma and the social construction of the “dangerous” mentally ill subject. In one panel, Lindsay appears as a wolf with blank eyes against a background patterned with capsules and tablets, a composition that simultaneously figures her self-stigma, the pressure to remain medicated to be “sane,” and the way society consigns her to the status of a banished predator. Later, when Lindsay depicts herself as a wolf in sheep’s clothing at her corporate job, and in the splash page where she tap-dances under a spotlight while psychiatrists in the audience coolly take notes beneath the caption “sanity is a performance,” Saji and Venkatesan connect these images to Foucauldian notions of disciplinary power and Butler’s theory of performativity (86-87). The wolf and performance metaphors do more than signal “otherness,” that is, they expose sanity/insanity as a socially enforced script and illustrate how Lindsay “owns” her diagnosis by revealing the theatrical, policed nature of normalcy itself. Saji and Venkatesan show how these now-canonical graphic memoirs leverage the multimodal affordances of comics to pluralize illness identities, unsettle the sanity/insanity binary, and claim representational agency from within the very diagnostic systems that seek to contain them.
Chapter 5, “Visual Metaphors of OCD and Schizophrenia,” underscores Saji and Venkatesan’s central claim that ethical representation is not merely a matter of accuracy, but of affirming the dignity, agency, and communicative potential of individuals whose mental health experiences are frequently stigmatized or misunderstood. Their analysis of Nate Powell’s Swallow Me Whole (2008) and Glyn Dillon’s The Nao of Brown (2012) foregrounds the narrative and visual challenges inherent in depicting disorders like OCD and schizophrenia–conditions that reshape a person’s perceptual world and resist straightforward translation into images. As they note, artists must navigate the delicate boundary between representing internal experiences and avoiding reductive or sensationalized portrayals, particularly in cases where hallucinations are experienced as reality, not as distortions the patient recognizes as false. Saji and Venkatesan draw on Osamu Kitayama to argue that patients generate “new metaphors” as alternative epistemic tools through which their experiences may be communicated, and it is precisely here that the chapter invites broader consideration of how graphic medicine can enact a more expansive ethics of care. This emphasis on metaphor as a relational and communicative bridge provides a natural point of connection to Daniel C. Batson’s framework in “These Things Called Empathy: Eight Related but Distinct Phenomena,” where he argues that empathy involves an imaginative entry into another’s perspective, one that can motivate “action by one person that effectively addresses the need of another” (4). Batson’s insights illuminate what Saji and Venkatesan identify visually and narratively: Powell and Dillon’s strategic layering of textual narration with expressive visual metaphors, such as fragmented panels, shifting line textures, or perspectival distortions, invites readers to inhabit the protagonists’ perceptual worlds rather than merely observe them. Through this immersive aesthetic, readers move from passive spectatorship to a form of empathetic, participatory witnessing, sharing in the emotional textures of OCD and schizophrenia in ways that foster understanding rather than voyeurism.
Lastly, Chapter 6: “Visualising the Fragmented Selves: Conventional and Creative Metaphors of Depression,” discusses how the genre of graphic memoirs “facilitates multilayered connections to the patient’s narrative which provides depth beyond the raw medical discourse, and thereby reconfigures the extant perceptions surrounding mental illness” (110). Ian Williams in his contribution to Graphic Medicine Manifesto (2015) explains how graphic novels are a practical medium to portray the emotion and feeling of characters with struggling mental health, and increased understanding of mental illness made possible by the metaphorical devices explicated and analyzed by Saji and Venkatesan allows for nuanced perspectives that recognize varying degrees of affliction and envision the possibility of improvement.
In short, Saji and Venkatesan’s Metaphors of Mental Illness in Graphic Medicine stands as an essential contribution to comics studies, children’s and YA literature, medical humanities, and visual rhetoric, as the authors’ integration of conceptual metaphor theory with detailed analyses of graphic narratives yields a richly interdisciplinary account that pushes against dominant discourses of mental illness. Their work reinforces the unique affordances of comics as a medium, one that gives voice to marginalized experiences, subverts biomedical norms, and fosters empathetic engagement with the complexities of mental health. For scholars of graphic medicine, visual rhetoric, and disability studies, this book offers a theoretically rich and methodologically rigorous model for analyzing the interplay between comics and mental health discourse. It will undoubtedly serve as a foundational text for future studies in how comics shape our understanding of illness and identity.
Works Cited
Batson, C. Daniel. “These Things Called Empathy: Eight Related but Distinct Phenomena.” The Social Neuroscience of Empathy, edited by Jean Decety and William Ickes, The MIT Press, 2011.
McCloud, Scott. Understanding Comics: Writing and Art. Harper Perennial, 1993.
Murison, Justine S. “Anxiety.” Keywords for Health Humanities, edited by Sari Altschuler, Jonathan M. Metzl, and Priscilla Wald, New York University Press, 2023.
Williams, Ian. “Comics and the Iconography of Illness.” Graphic Medicine Manifesto, Penn State University Press, 2015, pp. 115–142. https://doi.org/10.1515/9780271079264-006
