ImageTexT: Interdisciplinary Comics Studies

ISSN: 1549-6732
Volume 7, Issue 2 (2013).
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Breaking Quarantine: Image, Text, and Disease in Black Hole, Epileptic, and Our Cancer Year

By Bruce Dadey

In his seminal work The Body and Society, Bryan Turner proposes that a sociological understanding of disease must "combine the notions that (1) disease is a language, (2) the body is a representation, and (3) medicine is a political practice" (177). Turner's aim is to problematize the social construction of disease in modern medicine, but the discursive, representational, and political aspects of disease have been foregrounded for millennia in the Western literary tradition. In ancient works such as the book of Exodus and Oedipus Rex and in more contemporary texts such as Albert Camus's The Plague and José Saramago's Blindness, disease has served as an incarnation of divine wrath, as a metaphoric representation of political turmoil, or as a means of depicting the state of human existence in an indifferent universe. More recently, it has embodied the uncertain condition of subjecthood in a postmodern age where identity itself seems merely a site for the production and reproduction of the viral memes of mass culture. Given the ubiquity of disease as a literary motif, it is not surprising that it has often appeared in comics as well, from the images of the diseased earth in 1960s underground comics, to the depictions of mental illness in the earlier cartoons of Art Spiegelman and Chester Brown, to the ambiguous plague that provides the off-stage social context for Daniel Clowes's David Boring.

But the role of disease in comics goes beyond mere literary precedent: indeed, the very characteristics of the comics medium give the motif a self-reflexive significance that transcends the metaphoric or allegorical functions it serves in written text or even film. In three graphic novels that examine the experience of disease—Our Cancer Year by Harvey Pekar, Joyce Brabner, and Frank Stack, Epileptic by David B., and Black Hole by Charles Burns—the motif of disease serves, as it does in literature or film, to embody particular themes. But, more significantly, the various forms of isolation and quarantine associated with institutional responses to disease are also enacted within the very form of the works. While the nature of the disease and the agents responding to it vary from book to book, in all these works societal forces attempt to contain the multivalent visual symptoms of disease by framing not only the symptoms of a disease but also those suffering from it within an objectifying medical or pseudo-medical discourse. This process of containing the disease and its sufferers constitutes an imposition of text on image, and the struggle between the constraining societal forces and those who seek to escape the constraints is reflected in the shifting ways that pictures and words interact within the works.

In The Birth of the Clinic, Michel Foucault suggests that changing conceptions of the nature and treatment of disease at the end of the eighteenth century were linked to a larger shift in the relationship between the textual and the visual. In literature, religion, and the popular imagination, disease had traditionally been the visual embodiment of a previously hidden social text: it etched onto the body the symptoms that made visible theological and ideological disruptions that were previously invisible. But the progress of medicine in the late eighteenth century was predicated on the re-conversion of the visual symptom into the textual sign through a new, objective medical discourse:

Between sign and symptom there is a decisive difference that assumes value only against the background of an essential identity; the sign is the symptom itself, but in its original truth. At last there emerges on the horizon of clinical experience the possibility of an exhaustive, clear, and complete reading…all pathological manifestations would speak a clear, ordered, language…. It is no longer a question of giving that by which the disease can be recognized, but of restoring, at the level of words, a history that covers its total being. To the exhaustive presence of the disease in its symptoms corresponds the unobstructed transparency of the pathological being with the syntax of a descriptive language: a fundamental isomorphism of the structure of the disease and of the verbal form that circumscribes it. The descriptive act is, by right, a 'seizure of being'…and, inversely, being does not appear in symptomatic and therefore essential manifestations without offering itself to the mastery of a language that is the very speech of things. (94-96)

Symptoms possess a multiplicity of potential meanings—pathological, social, theological, political—that medical discourse seeks to constrain, primarily through asserting interpretive authority over the visual. As Foucault points out, the development of a controlling medical discourse is based on the formation of an objectifying medical gaze. The control of things by words is inextricably linked to the mastery of the visual by the textual. In Discipline and Punish Foucault further links this mastery of the visual by the textual (or of things by words) within medicine to a broader process of social control: "Against the plague, which is a mixture, discipline brings into play its power, which is one of analysis….there was also a political dream of the plague….the assignment to each individual of his 'true' name, his 'true' place, his 'true' body, his 'true' disease. The plague as a form, at once real and imaginary, of disorder had as its medical and political correlative discipline" (197-98). Institutional discourses curb and contain the ambiguities associated with the visual and physical, constructing essential subject identities that can be used to rationalize processes of quarantine for those who are sick or socially marginal, and intensive self-surveillance for those who are not.

Yet it must be emphasized that this opposition of word and image is not inherent but is effected by this particular sort of discourse. Words, of course, have their own ambiguity and richness, not only because of the unstable relationship between signs and referents, and even signifiers and signifieds, but also often precisely because they are semantically associated with the visual. The rhetorical term "figure" in itself suggests the relationship between textual multivalence and the visual, as, for that matter, does the word "sign." If therapeutic discourse is an attempt to contain the symptom within the sign, it is also an attempt to contain the ambiguities inherent in the sign itself, to quarantine it from the visual. In all three books under discussion here there is a re-orientation of the verbal to the visual. At first therapeutic discourses attempt to quarantine images using words, to keep the complexities of the physical world in check through the use of an objectifying or essentializing discourse. But in all three works this quarantine is broken: the subject whose essence is defined by his or her illness assumes a richer identity, and the visual elements whose meanings were delimited by text re-assume their complexity, a process which also restores the richness of words. Obviously comics, a medium that combines the visual and textual more intimately than any other, is particularly suited to exploring and representing these issues.

In both Our Cancer Year, which depicts Pekar and Brabner's struggle with Pekar's testicular cancer, and Epileptic, which chronicles how David B. and his family cope with his brother's epilepsy, the critique of an objectifying medical discourse is overt. When Pekar's surgeon, Dr. Cantor, announces Harvey's lymphoma, the doctor's abrupt, depersonalized monologues are purely clinical, failing to take into account the human impact of Harvey's cancer. The disjunction between patient and doctor, and between the traumatic complexity of Harvey's condition and the reductive medical characterization of it, is especially conveyed through two panels in which the textual elements are filtered through Joyce's consciousness. In the first, Cantor is depicted speaking to a shocked Joyce immediately after he baldly announces that Harvey has a tumor, but in place of his actual words there is only a narrative summary stating that "Cantor is talking way too fast for her" (80.2).[1]

The alienating medical discourse Cantor speaks is incomprehensible to Joyce in part because of its jargon, but even where Cantor speaks colloquially, announcing that he had "simply scooped [the tumor] out and sewed [Harvey] back up" (80.1), his words are equivalent to silence for her because they do not speak to the emotional impact of the news of Harvey's cancer. And Cantor's medical discourse is not only a form of silence, but a means of silencing, since Joyce must push her fist in her mouth to stop herself from crying—in order to situate herself within his discourse, she must forcibly repress the more personal terms in which she would express what Harvey's diagnosis means to her. Foucault comments on the ways in which medical discourse both reveals and hides those who are subject to it: "Western man could constitute himself in his own eyes as an object of science, he grasped himself within his language, and gave himself…a discursive existence, only in the opening created by his own elimination" (The Birth of the Clinic 197). Cantor's discursive imposition reinforces his own power and disempowers Joyce: his higher positioning in this panel further emphasizes his superiority and Joyce's muteness and infantilization, and his placement in shadow identifies him with the looming shadow immediately behind Joyce—he is a source of encroaching darkness rather than light. In the second panel (82.2), Cantor's words are visible, but only as scattered fragments, with the most emotionally salient words written more largely, vaguely joined by ellipses and other connecting phrases. Joyce and Harvey are once more reduced to a disempowered muteness as they vainly attempt to weave the fragments they can comprehend into a cohesive fabric. But, as he often is, Cantor is here portrayed within a hermetic circular frame, isolated from the people he speaks to, at the far right of the panel, distant from other figures and ready to follow the reader's sightline out of the scene.

A similar depersonalization takes place in the chemotherapy room when Harvey, whose emotional condition makes him a difficult patient to treat, is ejected because of his low white blood cell count. His treatment is a reflection not of his complex physical or psychological needs, but of his status as a number; later, under Dr. Rhodes, he will be given a saline solution even when he cannot receive his chemotherapy in order to maintain his sense that his treatment is progressing, but at this point the hospital is not treating a patient, but a condition. The nurse's comment, "I've got other patients coming in…. This one's toxic…get rid of him!" (135), employs a term that is both medical, in the sense that it identifies the poison present within Harvey's body, and evaluative and controlling, in the sense that it rationalizes his exclusion by identifying him with his disease. Though Harvey is in no way contagious, he is treated as if he were (Joyce comments, "OK, Babe, looks like you're a leper" [135]) because he refuses to passively follow the routines set by his medical caregivers. He and Joyce "are making a little more noise than one normally hears in this part of the clinic" (133), violating the patient silence that is the integral counterpart of a hegemonic medical discourse.

Nonetheless, after Harvey is diagnosed, he also begins to see himself in the terms that medical discourse provides: as a host for cancer rather than as a complex human being. As he looks at himself in the mirror after noticing that his hair is falling out, the shift in his self-perception is conveyed through a modification in Stack's drawing style (115; figure 1).

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The first panel shows a realistic, detailed portrait of Harvey, but in the second, Harvey views himself as if through the mist that has accumulated on the mirror after his shower, and the density of the lines increases to the point where Harvey's features are shadowed and obscured, reflecting his increasing alienation from himself and his sense that who he is will be increasingly determined by the illness he has. Stack also often visually encodes the dehumanizing effect of medical discourse though variations in the iconicity or abstraction of various figures. For instance, Dr. Cantor (80.3) and Dr. Fisher (157; figure 2), who signs Harvey out of the hospital in spite of Harvey's psychotic reaction to his pain medication, are both drawn with greater solidity and detail than Harvey or Joyce, emphasizing their relative power within the hospital environment.

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If, as McCloud argues, increasing iconicity implies a shift away from photorealistic representation and toward the abstraction of language (46-47), then the difference in representation here reflects the degree to which characters are either the autonomous producers of medical discourse or the subjectified products of it. Further, at key moments when the impact of cancer is particularly acute, such as when Harvey and Joyce return home after first learning of his cancer (83), when Harvey explodes in anger at his diagnosis (88), or when Joyce strikes Harvey in frustration (175), the loss of control is depicted through drawings which are particularly cartoonish or drained of detail. In these scenes, words are largely absent, but the effect of the reductive discourse has infected the very drawings themselves. It could also be argued, following McCloud (36-37), that the increased iconicity of Stack's drawings allows readers to identify with the characters more easily and therefore empathize more thoroughly with them, but in any event the dearth of detail makes us perceive the protagonists less as autonomous characters and more as projections of someone else, whether that is the reader or the medical establishment. The disease and its attendant medical discourse rob both Harvey and Joyce, as she becomes more identified with his condition, of their complex subjectivity, reducing them to sketches of themselves.

But there are alternative discourses within the book, and these are accompanied by different relationships between the book's visual elements. Dr. Rhodes, Harvey's oncologist, takes a holistic view of her patients, engaging in a dialogue with Harvey and Joyce over treatment options and accommodating Harvey's emotional needs by giving him explicit permission to take time off work and giving him a placebo treatment when he cannot withstand chemotherapy, so that he still believes that his treatment is progressing. Rhodes's more dialogic approach to treatment is in turn reflected in a more consistent level of abstraction in the drawings of physician and patient, suggesting that, while Rhodes possesses the expertise Harvey requires, Joyce and Harvey are not interpellated by her discourse, but are rather empowered by it (see, for example, their consultation with Rhodes on pages 102-04; figure 3).

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The way in which discourse constructs and controls subjects in the field of medicine is further critiqued through Joyce's own professional practices as a journalist. Throughout the book, the story of Harvey's cancer is explicitly paralleled by the commencement of the first Iraq war, and by the story of Joyce's relationship with the foreign students she meets through her peace activism: "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" (3). By interweaving the two stories, Pekar and Brabner suggest that war itself is a form of illness, and they also demonstrate how both the war and Harvey's cancer are physical realities framed through different forms of discourse. The lack of media coverage of anti-war demonstrations and sentiment parallels Harvey's own initial denial of his disease in spite of his growing lump (71-72), and the contrasting discourses of Dr. Cantar and Dr. Rhodes, one hegemonic and the other dialogic, are reflected in the two discourses used to frame the war: the official discourse that frames the conflict in unambiguously positive terms, and Joyce's own professional discourse, which presents a more complex picture.

The official discourse associated with the war is presented most directly as Joyce and her sister wander the mall just before Christmas. As they listen to piped announcements that assert "We're proud to support our troops, who are part of Operation Desert Shield" and encourage shoppers to "roll up our sleeves and show our troops we're proud of them" (112), Joyce's sister suggests that Joyce join a cancer support group. Joyce, in turn, says that the students she's met through her peace activities are her support group. On the one hand, the controversy and suffering associated with the war are elided by framing the conflict explicitly in terms of the generic humanitarianism of the Christmas holiday and implicitly with the privileges of American consumerism; on the other, Harvey's cancer is framed in terms of Joyce's peace activism, linking the war with Harvey's disease. But whereas the piped announcement is monologic and sentimentalizes the war, Joyce, as a "comic book journalist" (4), brings out its complex human realities through dialogue. For instance, when Dana and Zamir debate the role of Saddam Hussein in the war, both sides are presented in an extended manner without drawing the reader to a particular conclusion (50-53).

Like Dr. Cantor, Joyce relates to her subjects through her own professional discourse, but rather than using it to frame her subjects in terms that fit her own agenda, she uses it, like Dr. Rhodes, to empower her subjects. When she finds that Zamir, a Palestinian student she met at a peace conference, has made up stories about his imprisonment by Israeli Defense Forces, she examines how her own role at the conference and her own professional discourse may have led to the lies: "The more horrific his story, the more attention he got…. I'm one of the cameras Zamir was playing to. I was there for a 'good' story" (34). Rather than confront Zamir, she tutors him in journalistic practices and conventions so that he can tell his own story in a way that reinforces his credibility (54). Joyce's desire to allow the students to create their own narratives and her openness to forming personal friendships with them results in a discourse that, unlike those accompanying the war or Harvey's medical treatment, allows for a multiplicity of voices and meanings.

The parallel sub-plots, both set in the rising tensions that accompanied the first Gulf War, are not meant to depict Harvey's experience of cancer as a heroic battle; like Susan Sontag, who insists that "We are not being invaded. The body is not a battlefield" (183), Harvey refuses to adopt the military metaphor, telling himself that "You don't have to be a hero to get through, you just gotta keep breathing" (186). Rather, Harvey's own suffering relates synecdochically to the broader human suffering associated with war. As Harvey's condition worsens, graphic and textual parallels link Dana's anxieties over a chemical attack in Israel to the damage that Harvey's own chemotherapy inflicts on his body, so that the diffused impact of the larger international conflict is made concrete and visible through the depiction of Harvey's individual pain: Joyce gets up to give Harvey a drink of baking soda and water, and Dana is preparing baking soda to soak handkerchiefs in case of a gas attack; Joyce surveys the fridge to see what Harvey might eat, and Dana surveys the emergency food stores in her brother's closet; and, finally, Harvey is shown covered in blisters from the shingles he has contracted, drawn as if he were a victim of a chemical attack (126-27). Over the next few pages, the panels showing Harvey's suffering have little to no background detail; instead, all that is shown is his agonized figure. The detailed depiction of his figure emphasizes the individuality of his suffering, but the lack of background universalizes it, reinforcing the implied connections between Harvey's disease and the first Iraq war. By associating the war with a vivid depiction of Harvey's psychological and physical suffering, Pekar and Brabner undermine both the reductionist official discourse that conceals the human costs of war and the objectifying medical discourse that sees the patient only in terms of his disease.

Pekar and Brabner also suggest that a disruption of such discourses and an acknowledgment of the complex ambiguities associated with war and illness are key to healing. Two factors—the hiring of a home care aide, Dolores, and the visiting of Joyce's students—are associated with Harvey's psychological healing. While Dolores does provide practical support for Harvey, it is his personal involvement with her that allows him to re-imagine himself not as the subject of a controlling discourse, but as the creator of a narrative. In fact, in this section of the work, the subject of the story shifts from Harvey to Dolores, who is being domestically abused by her boyfriend, and Harvey even assumes the work of overt narration, speaking directly to the reader for the first time since the beginning of the book (195). It is as if by telling the story of another, Harvey is finally able to gain control of his own. This, of course, parallels what Joyce has been doing all along with the students she met at the peace conference, and the hiring of Dolores and the arrival of the students for a visit is accompanied by a shift in the register of Stack's drawings. While Stack still uses variations in detail to establish focal points within panels, the drawings of Harvey gradually become more detailed. Even while Harvey is still in pain and reluctant to have the young people visit, he takes on more substance both visually and attitudinally (213).

In the end, it is Harvey's willingness to situate his own suffering within a larger context, to place himself within the relational discourse that Joyce's activism invokes, that allows him to move beyond his self-identification as a patient or victim. The final page of the book (220), portraying Harvey and Ju's visit to the waterfall where Harvey and Joyce decided to get married, returns to a degree of visual detail that echoes its first page, although unlike the first page, the last has no narration. And while the images on the final page imply a variety of sounds—people talking, the roar of the falls—the only dialogue is a small series of expletive symbols coming from a man who has stepped in something, perhaps some feces left behind by a dog another couple is walking. The lack of words in the final episode of Our Cancer Year is not a sign of the poverty of language, but of a willingness to let the visual manifest itself in all its complexity without its being given a particular meaning through text. Stack's drawings on this page convey a reality that encompasses both the sublime and mundane, free from textual predetermination, but broadly open to textual interpretation. Superimposed over the rushing falls (an image of protean transience and fluidity) and just below the image of Harvey accompanying Ju is the image of Harvey's face in a circular frame, an image that speaks to a holistic restoration of his own complex subjectivity, an identity that may be imperfectly reflected in words but can never be captured by them.

Like Our Cancer Year, David B.'s Epileptic portrays an individual suffering from both a disease and the discourses used to frame it. In a Comics Journal interview, David B. states, "When my brother would speak or when he'd have a seizure, there was something to read in that." But Jean-Christophe's epilepsy is a text the family cannot read; his seizures are visible signs without any determinable significance. The perpetual journey of David's family from one doctor, guru, or cult to another is, in part, a search for a cure, but it is also a search for a discourse that would allow them to make sense of Jean-Christophe's condition and what it has done to them, to render his indefinable visual symptoms comprehensible by containing them within a therapeutic discourse. But, with the exception of Master N., all the therapeutic discourses that the family encounters not only fail to cure Jean-Christophe, but complicate their reading of his condition by framing it, and him, within alienating, often bewildering conceptual systems, from the machinations of the neurosurgeons (10), to the strictures of the macrobiotics (216), to the metaphysics of the spiritualists (280). While the esotericists construct Jean-Christophe in ways that differ from those of the physicians, all of these discourses impose regimes whose physical restrictions embody particular subject positions. Indeed, David's relationship to his brother's epilepsy, like Joyce's relationship to Harvey's cancer, shows that while disease as a set of physical symptoms may be contained within a single body, disease as a set of discursive signs can envelop all those who are associated with the sufferer. After Harvey is ejected from the chemotherapy room, Joyce thinks, "The bad patients are the noisy troublemakers, like us. Wait a minute…when did this become our cancer?" (136), and David, desperate to escape the burden of his brother's disease and the stress of attempting to understand it in artistic terms, says, "I am an epileptic…If I push myself I'm sure I could trigger more serious seizures…I could let myself fall" (286). If, as Foucault suggests, medical discourse operates in part by creating a subject position that identifies the sufferer with his or her disease, then insofar as those close to the sufferer are characterized by the discourse as adjuncts or contributors to the disease, they too will be constructed by the discourse and, like the sufferer, may define themselves in its terms. David B., analyzing his family dynamic, says, "We're all on Jean-Christophe's side. We're sick with his illness" (191).

The therapeutic alternatives explored by David's family all purport to have "the answer" to Jean-Christophe's condition. Each offers a different way of reading his epilepsy, but in the act of reading, David and his family are themselves interpellated by the texts. Narratologists suggest that every text contains an image of its implied reader, a role which the reader must occupy in order to read with the text rather than against it: "It is only as I read that I become the self whose beliefs must coincide with the author's…he makes his reader, as he makes his second self, and the most successful reading is one in which the created selves, author and reader, can find complete agreement" (Booth 138). In the case of David and his family, the power of this prescribed role is reinforced by the fact that they themselves are the characters described by the therapeutic texts. The family soon realizes that the solutions offered by the neurosurgeon are radically reductive and rob both Jean-Christophe and the family of their humanity: "Jean Christophe is 'the case.' He will allow Professor T. to perform a brilliant operation" (43). But in their search for a more holistic way of framing Jean-Christophe's illness, they continue to encounter manipulative therapeutic discourses. In the macrobiotic communes, the strict diet becomes a means of controlling the behavior of its members: "Soon the entire commune is running entirely on guilt. The society we left behind has recreated itself. We have a macrobiotic cook, macrobiotic judges, macrobiotic cops" (106). Similarly, the various esoteric doctrines they explore fail to improve Jean-Christophe's condition and further identify the members of the family with his condition. One psychic says of the family that "there is a Karmic link between us. It's no coincidence that we've found ourselves reincarnated together in our current life" (151.1), framing the epilepsy as an inescapable consequence of acts performed by all the family members in past lives. In these discourses the disease is given meaning by assigning direct or indirect responsibility to the practices of the family, and so the family assumes responsibility for the epilepsy, seeing themselves as secondary victims of the disease and as contributors to it. It is this guilt that compels Jean-Christophe's mother to continue her search for a cure—she feels there must be a cause and meaning to his condition, and the discourses suggest that she still plays a role in it.

But David's way of reading his brother's illness, and of eventually escaping his own shadow-illness, is through his art: "I perform magic to acquire strength and valor. I forge the weapons that will allow me to be more than a sick man's brother. They're unique, and only I can wield them" (319). Two artistic practices in particular allow David to escape the restricted identities imposed by the various therapeutic discourses on the family, and both subvert the power of the defining word by blurring the line between text and image. First, in order to depict those therapeutic discourses, David appropriates the emblematic art tradition, in which moral, theological, and natural truths are conveyed through complex, often enigmatic, allegorical diagrams that are especially common in alchemical or esoteric art. Whether describing macrobiotics (47), the hermetic system of Raymond Abelio (136), or the Rosicrucians (203; figure 4), David uses a combination of narration and emblematic representation that disrupts the authority of the discourses by historicizing them and foregrounding their origin in a specific time or person, and by using the conventions associated with medieval and renaissance allegorical art to emphasize their mystical and archaic nature.

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Even Jean-Christophe's neurologists do not escape a similar treatment (40.4, 43.2), suggesting that, in spite of the callous arrogance exhibited by the doctors, their surgical efforts are as esoteric and, ultimately, as futile as those of the spiritualists.

Emblems, which "stand somewhere between the painted sign and the written word" (Freeman 17), usually contain both text (often a motto, proverb, or illustrative poem) and image, each of which is intended to reflect or reinforce the other. However, the visual elements of an emblem can often destabilize or complicate its textual elements even as they purport to reinforce them—one thinks of the classic depiction of vanitas, a naked woman whose obsessive mirror gazing provides a rationale for the prurient male gaze, allowing for both condemnation and enjoyment of the depicted sinner. Even as David's text describes without evaluation the various therapeutic systems and the doctrines underlying them, his illustrations undermine the systems by associating them visually with alchemy and other debunked hermetic traditions. By telling the personal history of Raymond Abelio (134-35), for example, David shows that his complex esoteric philosophy is the product of a specific individual with a sometimes questionable background that includes participation in both the French resistance and far-right parties. The demystifying text contrasts with the symbolist illustrations that convey the grandeur of Abelio's system, and this contrast is further reinforced by the placement of Abelio as a stooped, diminutive figure next to a large schematic figure which represents the "absolute structure" that governs the universe (136.1).

The implicit critique continues with the image of Abelio and David's mother conversing under a tree whose foliage is an inward-spiraling pinwheel of creatures eating one another's tails (137.4), representing the intertwining mystical topics of their conversation. But, at the base of this grandiose tree, Abelio makes a crude proposition to David's mother, saying "Of course, you can't really share these subjects with a woman until you've made love to her" (137). While the conversation may be elevated, the suggestion is that Abelio's motives are not, and the grand tree of esotericism becomes another tawdry version of the Edenic myth, with Abelio as the wily serpent.

But David's illustrations do more than simply assist his text in demystifying or critiquing the various esoteric traditions. Presented through David's art, the esoteric doctrines lose their authority as representations of the hidden spiritual reality behind the physical world or as physical cures for Jean-Christophe's epilepsy and instead become compelling, indirect representations of the repressed, unconscious drives that underlie the family's perpetual search for a meaning for his condition. After David drops out of art school and finds himself artistically sterile (a sterility reflected in his inability to have a baby with Helene, his girlfriend), he is nearly driven to suicide. But when he begins to draw his dreams, he finds himself free to tell the stories he has repressed: "I am reborn. All the ideas for stories I wasn't getting anywhere with become possible. I see a breach in the wall, I take a deep breath, and I charge ahead. In my slumber the light of dreams shines as daylight" (328.5-6). This artistic breakthrough toward the end of Epileptic has retroactively determined the artistic presentation of the various therapeutic discourses throughout the entire story. Indeed, David B.'s presentation of the discourses in visual form reverses the work they perform: whereas the discourses attempt through text to frame the visual in a way that assigns it a fixed meaning, David's visual presentation restores to the discourses themselves the complex ambiguity of their own textual signs. For example, when David recounts his father's interest in Armand Barbault's spagyric alchemy, the chemical receptacles that his father molds for his experiments are presented as anthropomorphized figures and his father's head is transformed into a retort flask, suggesting that the pseudo-scientific practice is in fact a distillation of his father's desire to assign meaning to Jean-Christophe's condition (208.2).

Similarly, the illustrations accompanying the description of Rudolph Steiner's Goetheanum are not architectural, but symbolic: various allegorical figures form a body which represents Steiner's building, and the illustration of its destruction is an allusion to the tarot card entitled "The Tower" (241-42). The various esoteric doctrines attempt to reify their mystical ideas through scientific methods or architectural design, but even as David's text objectively recounts these efforts, his illustrations re-frame them as projections of complex internal drives and desires. Once David recognizes that the power of the therapeutic doctrines lies in their ability to embody his own desires, he is able to evade the static subject positions they impose on him and to use them in his art as a means of examining the anxiety and guilt he feels around his brother's illness. They become, like his dreams, a means of self-awareness and a foundation for artistic expression.

In an interview with Matthias Wivel, David B. identifies the distinct roles that text and image play in Epileptic: "I wanted to create a very 'transparent' text, a very 'transparent' kind of writing. There's no pathos in it—I was showing all the pain, all the emotions, the whole symbolic aspect of it, in the drawings." Though text and image play very different roles in Epileptic, it is their interaction that allows David to appropriate the various therapeutic discourses for his own ends. In The Interpretation of Dreams, Freud posited that it is this interaction of text and image in dreams that allows for the indirect expression of desires that would otherwise have remained repressed in the unconscious. The dream is like a rebus: "dream-content…is expressed as it were in a pictographic script, the characters of which have to be transposed individually into the language of the dream-thoughts" (312). Lacan, adapting Roman Jakobson's work, suggests that the multivalence of any given sign (its various possible metaphoric associations along the vertical, paradigmatic axis) is restricted by its metonymic placement alongside other signs on the horizontal, syntagmatic axis ("The Agency of the Letter" 1299-1300). Though David B. defines very different roles for text and image in Epileptic, his emblematic comic art lives at the crossing of these axes, where the metonymically-repressed signs of the therapeutic discourses are filtered through the destabilizing, paradigmatic medium of David's drawings, creating new, complex meanings that manifest to David his unconscious fears and desires, and those of his family.

The relationship between text and image in Epileptic is almost always one of mutual dependence and destabilization, not just of the respective content conveyed through each medium, but of the very image/text dichotomy. David B.'s emblematic art, like Jean-Christophe's seizures, must be not merely viewed, but read. However, the images cannot be read as pure allegory, in which a secondary, textual level anchors a stable interpretation of the primary, visual level, but as metaphors, in which the interaction of tenor and vehicle invokes a field of meaning that encompasses but extends beyond both elements. When, for example, David's mother uses a Ouija board to contact her dead father, the letters of the board are composed of the spirits that she projects: she seeks the authority of an autonomous text to help her guide her lost father through the afterlife (or to guide her through her unresolved grieving), but the drawing makes clear that the very substance of the text she seeks is a result of her own projection, and that, as David states, "It is my mother who is lost" (147-48; figure 5).

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Significantly, while the skeletal figures of the spirits are at first contained in the two-dimensional plane of the printed board, they begin to rise out of the board into the vertical, or paradigmatic plane, and David's mother becomes unable to constrain her father within the text she unconsciously attempts to create. As the dead figures slowly rise around David's grandfather, submerging him in a babble of voices, he says, "It's getting harder to talk to you. I'm not alone here, everyone wants to talk" (148.2-5), and the spirits projecting from the board mock the family as "idiots" and "morons" (149). The harder that David's mother tries to constrain her father within language, the further she gets from grasping her own feelings about him. This reality is expressed in an image of the family viewing themselves as corpses, each speaking in a series of fragmented phonemes that collectively form the statement "I hurt" (153; figure 6)—the simple, visceral reality that language does not reveal, but rather displaces.

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Lacan states, "I think where I am not, therefore I am where I do not think…. The ring of meaning flees from our grasp along the verbal thread" ("The Agency of the Letter" 1302), and David also sees this paradox: "We created the questions and the answers…. But we were unable to answer our own questions." This is natural enough, since the questions, like Freud's dream images divorced from their underlying dream-language, were meant to conceal rather than reveal answers. Neither text alone nor image alone can reveal what is hidden. But David grasps what is truly at stake: "The only true mystery is that of our unconscious ability to move the board" (153). Accompanying this statement is an image that embodies both text and image: out of the Ouija board's pointer, which is parallel with the board's horizontal surface, rises a ghost (153; figure 7). Where the visual ghost and the textual pointer intersect, the unconscious is expressed.

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One of the key moments in the relationship between text and image in Epileptic is the family's refusal to cooperate with a homeopathic psychiatrist. In the face of the psychiatrist's questions, and of David's mother's insistence that, "You must speak to him about your feelings. We've got to work through this therapy together" (196), the rest of the family remains silent. Significantly, the portrait of the silent family includes the three fantastic characters from Jean Ray's "The Last Canterbury Tales" (death, a magical cat named Murr who represents creation, and the devil) whom David has identified as his true confidants, the artistic projections that allow him to most fully express the pain and terror arising from Jean-Christophe's epilepsy (196.5-6). For everyone but David's mother, psychiatric therapy, with its normative interpretive paradigms, offers the opportunity not for self-revelation, but for self-displacement, since words alone, even if they themselves provide them, cannot capture the complexity of their situation. David's statement, "We're on the side of monsters. We have nothing to say to that guy" (196) affirms that he values the authenticity of his monstrous representations, whose complex visuality embodies more completely his situation, over any discursive construction of normalcy. He is now more interested in understanding his situation than in escaping it, an understanding that will require him, through his artistic production, to occupy that position at the crossroads where image and text, the metaphoric and the metonymic, the revealed and the repressed, all meet.

In Charles Burns's Black Hole, one is struck not by the presence but by the absence of institutionalized medical discourse. Teenagers in the story suffer from an often-deforming sexually transmitted disease ("the bug") in total isolation from the adult world, sometimes to the point of quarantining themselves in isolated camps. Of course, Black Hole is not, like Our Cancer Year or Epileptic, based on actual incidents (though the motif of sexually transmitted disease and the fact that the story is set in the 1970s inescapably evoke the AIDS epidemic), but one might expect in a narrative so centered on the concept of disease a reciprocal medical discourse. However, as we come to understand the nature of the disease and its relationship to the adolescent society in which it is acquired, it soon becomes evident that an external source of objectifying medical discourse would be redundant. Bryan Turner suggests that modern medicine in some respects serves as a surrogate for what were formerly religious or moral prohibitions: "While the sacral conscience collective withers away, medicine provides, as it were, a second-order moral framework—a framework which is, however, masked by the language of disease" (181). Though adults are almost entirely absent from the world of Black Hole, teenagers have internalized the moral prohibitions of the adult world so thoroughly that adolescence itself—the inevitable bodily changes and sexual awakening that accompany maturity—is perceived by them as a disease. So, while the physical symptoms of the bug are its most overt manifestation, it is the discursive power of the disease, the fact that the teens frame desire and their developing awareness of it in terms of infection, that is the bug's most pervasive effect. The teens do not need doctors to diagnose their condition—because disease is the social language that allows them to interpret who they are in the light of adult prohibitions, they self-diagnose based on the values they have assimilated.

In Our Cancer Year and Epileptic, the physical symptoms of the diseases precede the imposition of controlling discourses onto the sufferers and their families, but in Black Hole the bug is an external manifestation of the already-existing psychological dynamics that accompany sexual maturation, and the bug is, therefore, primarily a psychological phenomenon, in spite of its horrifying deformations. Only some show symptoms, but all are already infected. (One cannot help but recall Sigmund Freud's remark to Carl Jung just prior to their first landing in North America in 1909: "Little do they know we are bringing them the plague." Of course, North America was already sick, but it was about to be burdened with the consciousness of its condition.[2]) As with Pekar's cancer and Jean-Christophe's epilepsy, the discourse imposed on the teens' sexuality involves a mastering of the visual by the textual, although in Burns's obsessively Freudian work that mastery is best framed in Lacanian terms, and is most primally manifested in the book's central motif, the black hole. The signifier "black hole" is paradoxical, in that it seems to evoke an image, but in fact refers to an absence that acquires presence only when it is manifested as text. The image of the hole, the necessary absence which gives text the illusion of presence, is embodied throughout Black Hole primarily in sexual terms, and plays out a patriarchal dynamic in which woman, as image, is defined as lack in order to give the male phallus, as text, the illusion of an autonomous presence. Laura Mulvey, in her essay on visual pleasure in the cinema, states that "Woman…stands in patriarchal culture as a signifier for the male other, bound by a symbolic order in which man can live out his fantasies and obsessions through linguistic command by imposing them on the silent image of woman still tied to her place as bearer of meaning, not maker of meaning" (2182).

As Lacan points out, the fact that the phallus's apparent autonomy is in fact relational, requiring the creation of an absent Other, is paralleled linguistically by the signifier's apparent self-referentiality, which is in fact predicated on its repression of the signified in the course of its relation to other signifiers (see "The Signification of the Phallus" [1306] and "The Agency of the Letter in the Unconscious" [1300]). The ambiguous status of the phallus and the signifier makes the repressed Other (the woman, the signified, or, in the case of text, the image) that gives the illusion of autonomous presence a source not only of power but of anxiety. As Keith looks down at the slit he has made in the frog specimen he shares with Chris in his biology class, he says, "I was looking at a hole…A black hole and as I looked, the hole opened up…and I could feel myself falling forward, tumbling down into nothingness" (5-7). A series of vulval images, all of them echoing the shape of the slit in the frog and anticipating other episodes in Black Hole, flashes through his mind before he faints (6-7), suggesting a fear of being consumed or castrated, of being made identical with the absence that is the object of his desire. At first Keith deals with his fear by forming an idealized attachment to Chris even though she is sexually unavailable. This allows him to sublimate his sexual desire by translating it into discourse, and to avoid relating to Chris as an object of sexual attraction by translating his attraction into a chivalrous determination to save her from herself, first expressed when he extracts a piece of glass from her cut foot (86-87)—another vulval image repeated throughout the text—and later when he allows her to stay at the house he is taking care of. Keith's sublimation of desire into discourse here is part of his general pattern of substituting words for action; caught within language, he is in continual motion with no sense of progress, futilely pursuing meaning as it escapes perpetually down an unending chain of interdependent signifiers. As he thinks, "Wherever I was, I always wanted to be somewhere else….but it was always impossible. I was stuck. I was never going anywhere" (98-99), Keith's mind zooms in on an image of Chris lying naked on the grass, suggesting that, unconsciously in any case, he knows that his fascination with Chris is a form of immobility. It is not a coincidence that when Keith first sees Eliza's drawings, he most identifies with the picture of the bound, gagged man suspended between two trees with his hands tied in front of his genitals (112.1-4).

The two main characters of the book, Keith and Chris, each catch the bug, but the people from whom they contract it are also the means by which they escape the constraining subjectivities imposed on them by the discourse of disease, and thereby come to terms with their own maturity and sexuality. Eliza infects Keith with the bug, but in doing so she also becomes the catalyst for a re-imagining of his own identity in a way that frees him from the prison house of language. Eliza is the character in the book most comfortable with her sexuality, and unlike the other characters, she refuses to define her physical alteration, the growth of a tail, in terms of a disease. Indeed, her tail regularly serves as a phallic symbol in the book; in the series of panels during which she seduces Keith, Eliza's phallic tail in the top of the panel slowly approaches another image of her spread legs, as if she is hermaphroditic, sexually self-contained (114-15; figure 8).[3]

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During his first experience of sex, Keith actually breaks off a piece of Eliza's tail, an act that represents his reclaiming of his own sexuality. At first her tail is poking him and interfering with his lovemaking, but after she tells him to grab it, "it felt good…it was strong and alive in my hand…something to hold on to," and when he accidentally breaks it off as he climaxes, she comforts him, saying "it'll grow back" (219-220), a statement that indirectly allays his former castration anxiety and allows him to define sex and desire in ways that transcend the discourse of threat and disease. Eliza's tail in fact serves as a reassertion of the image against the disempowering text. Like the phrase "black hole," the word "tail," in its vulgar sense, refers to the female genitalia, and metaphorically to women themselves when they are reductively considered only as a source of male sexual satisfaction. But when the colloquial sexual term is manifested as an image, Eliza's tail becomes a sign of her sexual power and discursive autonomy, qualities that she passes on to Keith.

Eliza is also connected with the visual through her art, which in its content and style resembles Burns's own illustrations; in fact, during the sequence in which Keith looks at Eliza's work for the first time, Eliza's art is initially contained within Burn's own drawings but gradually becomes the independent content of the panel, a process that speaks to Eliza's ability to determine the discourses within which she is framed (109-12). Through works of art that she can proudly claim as her own, Eliza is able to face and assimilate the complex and disturbing feelings associated with her sexuality—in Mulvey's terms, she is not a bearer of meaning, but a maker of meanings that evade the strictures imposed by patriarchal or medical discourses. It is no surprise then that when she is drugged and sexually assaulted at the house she shares with a number of drug dealers, the men involved deface with words first her drawings and then her body (312-13; figure 9), seeking by sexually assaulting her to reduce both her and her art to text, re-imposing her role as a bearer of the symbolic order.

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Ultimately, however, Eliza refuses to play the role of the empty signifier; Burns's self-reflexive use of her art means that she is both the drawn subject and the drawing creator, neither hollow nor omnipotent, evading any fixed signification that other characters try to impose on her.

Like Keith, Chris is both infected and liberated by her sexual partner, and like him she comes to accept her own sexuality by eventually accepting the image of it impressed by the bug on the Other. Her initial sexual experience with Rob (49) begins as an act of freedom and defiance, but becomes a source of shame and alienation after she notices with horror the second mouth on Rob's neck, a classic vagina dentata that thrusts upon her a vision of her own sexuality as consuming and destructive, and forces her to suddenly reframe her sexuality through the discourse of disease (50.1-2). Immediately after seeing the mouth, she begins to view her own body as an absence which only assumes presence through the phallus: "He pulled out…where he had been inside of me felt cold…like a ghost…like some dead thing had crept into me" (51). Chris's definition of her vagina in terms of the phallus, as "where he had been inside of me," reduces her to a ghost of herself, fracturing her identity. She is unaware of the bug's effect on her until, in a chapter entitled "Seeing Double," she uses a hand mirror to view the splitting skin of her back in the wall mirror of her friend's bathroom (136; figure 10).

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The result is a mise en abyme that shows both the identification of Chris with her disease (when she looks in the mirror, it is the symptom of her infection that she sees), and the fragmentation of her identity (she views an infinite series of reflections that represents her perpetual desire and inability to unify the person she wants to be with the subject that is constructed through the discourse of disease). She has become a fractured sign, a hollowed-out signifier lacking a signified.

Chris's lack of autonomy is further shown through the skin shedding that the bug imposes on her: the shedding, linked visually by Burns with other vulval images in the book (6), concretely manifests the new instability associated with her identity after her sexual experience. Her healing begins when she reconciles with Rob, a reconciliation linked to a realization of the instability of textual signs. After talking with Rob, she realizes that when she said "I know" prior to having sex him, it had completely different meanings for the two of them, he thinking that it implied knowledge of his infection. Knowing that Rob had not intentionally deceived her, and realizing that even the signifier which is supposed to convey certainty contains ambiguities, Chris is freed from the constrictions of the disease-centered discourse that had alienated her from herself and finds herself able to accept Rob and her desire for him. She kisses his second mouth, which is a visual metonym for her own sexuality; her affirmation that "nothing about you is gross" signals self-acceptance (144). This is not to say that Chris escapes her condition—now that she has passed the threshold of maturity she will be shedding her skin, in both the physical and figurative senses, for the remainder of her life. But, as is shown by her eventual ability to move on after Rob's death, she no longer considers that shedding repulsive. Moving beyond the framework of illness, she learns to view the instability associated with her identity in terms of potential rather than lack. In the book's final scene, Chris swims out into the ocean and looks up at the star-filled evening sky; the subsequent pages zoom in to the blackness of the night and the stars eventually resolve themselves into a spiral galaxy, as if affirming that a black hole is not merely a passive emptiness waiting to be filled, but a source of attraction that has the power to create its own patterns and objects.

As with Our Cancer Year and Epileptic, the protagonists in Black Hole don't necessarily escape the physical realities of their illness. However, by challenging the discourses that attempt to fix the meaning of their conditions, the characters transform the ways in which their lives are framed and re-assert the complexity of their own identities. They do not reject text in favor of image, but rather undermine the seeming autonomy of medical discourse in favor of a dynamic interaction between the visual symptom and the textual sign that encompasses a wider range of potential meanings. The fear of contamination portrayed in all three of these texts and the accompanying desire to contain the visual by means of controlling discourses are a local form of what W. J. T. Mitchell characterized in Picture Theory as a contemporary anxiety over "the way modern thought has re-oriented itself around visual paradigms that seem to threaten and overwhelm any possibility of discursive mastery" (9). But as graphic narratives, these books, at the levels of both content and form, undermine the discourses of quarantine and mastery by allowing the visual and the textual to semiotically infect one another, a mutual contamination that leads away from ideologies of purity and into a state of dynamic indeterminacy that blurs distinctions between the healthy self and the diseased Other, and the word and the image.

Notes

[1] Our Cancer Year and Black Hole are not paginated, but for the purposes of this paper, page one immediately follows the copyright page of each work.

[2] Jung told this story to Jacques Lacan in 1954 (Rabaté xxiv).

[3] Vanessa Raney suggests that the spread legs in this sequence are, metaphorically, Keith's, and in the sense that a contemplation of Eliza's sexual autonomy eventually assists Keith to come to terms with his own sexuality, that is a possible reading of the sequence. The image of the proscriptive hand covering genitals, however (114.3), is repeatedly associated by Keith with Eliza (6.5, 102.6), and so the increasing proximity of Eliza's tail and her spread legs suggests that Keith's primary realization at this point is about Eliza. It is only later that he follows through on his own attraction to her.

Works Cited

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McCloud, Scott. Understanding Comics: The Invisible Art. New York: HarperCollins, 1994.

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Rabaté, Jean-Michel. "Chronology of Lacan's Life." The Cambridge Companion to Lacan. Ed. Jean-Michel Rabaté. Cambridge: Cambridge UP, 2003. xix-xxviii.

Raney, Vanessa. "Review of: Charles Burns' Black Hole." ImageText 2.1 (2005). 22 June 2009 <http://www.english.ufl.edu/imagetext/archives/v2_1/reviews/raney.shtml>.

Sontag, Susan. "AIDS and Its Metaphors." Illness as Metaphor and AIDS and Its Metaphors. New York: Picador, 1989. 87-183.

Turner, Bryan S. The Body and Society: Explorations in Social Theory. Oxford: Blackwell, 1984.

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