J Med Humanit

DOI 10.1007/s10912-017-9442-8

Drawing Invisible Wounds: War Comics

and the Treatment of Trauma

Joshua M. Leone 1

# Springer Science+Business Media New York 2017

Abstract Since the Vietnam War, graphic novels about war have shifted from simply
representing it to portraying avenues for survivors to establish psychological wellness in their
lives following traumatic events. While modern diagnostic medicine often looks to science,
technology, and medications to treat the psychosomatic damage produced by trauma, my
article examines the therapeutic potential of the comics medium with close attention to war
comics. Graphic novels draw trauma in a different light: because of the medium’s particular
combination of words and images in sequence, war comics represent that which is typically
unrepresentable, and these books serve as useful tools to promote healing among the psycho-
logically wounded. Graphic narratives, both fictional and non-fictional, illuminate the ways
that the unseen wounds of traumatic experience affect public health by compromising the
ability of communities, individuals, and survivors to create and maintain meaningful relation-
ships with others.

Keywords Trauma . Posttraumatic Stress Disorder (PTSD) . Comics . Graphic medicine .

Graphic narrative . Vietnam War . Iraq War . Afghanistan War

In the The Wounded Storyteller: Body, Illness, and Ethics, Arthur Frank observes that Bserious
illness is a loss of the ‘destination and map’ that had previously guided the ill person’s life: ill
people have to learn ‘to think differently’^ (2013, 1). The bewilderment Frank describes can be
characterized as a disruption of narrative identity. Narrative identity describes an individual’s
internalized and evolving life story that includes a coherent past and an imagined future as well
as providing a level of unity, purpose, and meaning (McAdams and McLean 2013). Like
illnesses, injuries also cause disorientation, and the wounds sustained during war are no
exception. Some war-related injuries involve physical injuries while many more wounds entail
psychological trauma that directly challenges narrative identity. This article explores war

* Joshua M. Leone
Joshua.Leone@usma.edu; joshleone@hotmail.com; Joshua.m.leone.mil@mail.mil

1
Department of English and Philosophy, ATTN: MADN-DEP, United States Military Academy,
Building 607 Cullum Road, Room 323 West Point, New York 10996, USA
 J Med Humanit

comics to better understand the medium’s potential for promoting healing and restoring
narrative identity for survivors who suffer from psychological injuries of war. I use the phrases
Bunseen wounds of traumatic experience^ and Bpsychological injury or wounding^ because
they are preferred by some practitioners over the American Psychiatric Society’s phrase
BPosttraumatic Stress Disorder,^ as less stigmatizing and more faithful to the phenomenon
(Shay, Casualties 2011). Contemporary treatments of the subject increasingly look to include
many non-scientific and nontraditional medical approaches and therapies. My analysis builds
on the discourse in the medical humanities about the non-psychopharmacological approaches
to recovery by asking two questions: first, why are war comics aimed at representing the reality
of lived experience a relevant topic in the study of the treatment of psychological trauma; and
second, how might war comics serve as useful tools for promoting healing among the
psychologically wounded? Graphic narratives draw trauma—a phenomenon characterized
by its unspeakability, invisibility, and silence—out onto the open spaces of the comics page.
Furthermore, graphic narrative represents unseen wounds in a readable form of visuality:
combinations of words and pictures linked graphically in sequence provide an alternative
means of depicting trauma’s ineffable and disorienting nature (Chute 2010, 3).
Although the unseen wounds of traumatic experience disrupt a survivor’s ability to
maintain a personal narrative identity and, consequently, relationships with others, war comics
can promote healing by informing patients and practitioners about the psychosomatic effects of
trauma, foster communalization of the trauma or the safe retelling of a story to an attentive and
trustworthy listener, and protect survivors’ narrative identity from outside forces (Shay 1994,
4). In their capacity for rebuilding and preserving narrative identity, war comics represent an
underexplored connection between graphic representation and therapeutic practice. The after-
math of serious illness, injury, and especially psychological wounding requires an individual to
learn to think differently about his past, his new normal, and his future. War comics can help
patients and practitioners better understand trauma’s serious disruption of life’s charted path
and provide an opportunity for restoring a clear tempo and sense of direction for living.
Time, which usually heals wounds, does little to relieve the suffering of psychological
wounds that return again and again even after combat in war ends. Jonathan Shay, a well-
known psychologist and medical doctor who worked with Vietnam veterans for many years in
a Boston Veterans Affairs hospital, notes that Bpersonal narrative—the idea that an event takes
place in a temporal context—is built into the very structure of the family of languages to which
English belongs,^ and when veterans continue to experience the invasive symptoms of
psychological wounds, Btheir experience [becomes] ineffable in a language that insists on
‘was’ and ‘will be.’ The trauma world knows only is^ (1994, 190–191). Within the human
mind, the repetitive action experienced by survivors destabilizes narrative temporality: trauma
clouds the happiness of past memories and shrouds hope for a better future. Past wounds
continually return the survivor to the moment of the trauma and confuse the difference
between past tense and future tense, effectively creating an a-temporal trauma-time-loop that
traps the survivor in the present. Veterans returning from war may recover from physical
injuries, and yet they may remain unable to maintain a coherent narrative identity and
meaningful relationships with others because of how psychological injuries upset time for
them and continuously haunt their tales.
A fragmented sensation of time—a fundamental characteristic of psychological
wounding—disrupts narrative identity. Intrusive thoughts, the signature symptom of traumatic
experience and the most basic threat to narrative identity, skew a survivor’s sense of tempo-
rality. The synchronic and synesthetic effects of experiencing bodily shock and distress,
J Med Humanit

especially an unexpected one, or witnessing others undergo physical suffering overwhelms an

individual’s sensorium. Cathy Caruth points out that this overload subsequently creates a
Bbreach in the mind’s experience of time, self, and the world^ (1996, 4). Unlike bodily
wounds, however, psychological wounds remain B[un]available to consciousness until [they]
impose [themselves] again, repeatedly, in the nightmares and repetitive actions of the survivor^
(4). The rupture of the mind’s experience of time causes moments of reality to repeat over and
over again, while the survivor remains unable to consciously access the nature of the trouble.
The continual return of the trauma, which can take the form of behavioral, emotional,
cognitive, and physical paroxysms, eventually begins to unravel an individual’s narrative
identity by fragmenting his sense of linear time.
Comics present a unique avenue for stimulating health by transforming invisible wounds
into iterable and representable graphics. Like Caruth and Shay, Shoshana Felman writes about
the fragmentary form of traumatic storytelling. B‘Composed of bits and pieces of a memory
that has been overwhelmed by occurrences that have not settled into understanding or
remembrance, [narrative] … cannot be constructed as knowledge nor assimilated into full
cognition’^ (Frank 2013, 138). Comics can restore narrative. On the one hand, overwhelming
events shatter an individual’s narrative by turning coherent memory into disassembled and
chaotic pieces. On the other hand, the structure of cartoons requires a continual interaction
between the reader and the page to construct meaning out of fragmented words, pictures, and
graphic sequences.
Scott McCloud’s explanation of breakdown and closure in comics reveals the medium’s
connection to the unseen injuries of traumatic experience. Comics capture and order time
through the seriality of panels and gutters, and McCloud explains that in each panel this unique
construction requires that the narrative be disassembled through the process of breakdown and
put back together again and reconnected with other panels through the process of closure
(1999, 67). The practice of closure (the act of reading through images and inferring connec-
tions between them) while reading comics rehearses the same mode of cognition essential for
reassembling what trauma has disjointed. Comics have the ability to create a sense of temporal
ambiguity on the page through their content but simultaneously create coherence by ordering
events and memories on the page. Breakdown and closure creates more comprehensible
connections between seemingly unconnected panels across the space of a graphic narrative’s
pages. This attribute gives the medium an important and unique ability to represent trauma’s
damage to narrative identity.
Other mediums have some aspects that can be valuable for revealing the damage created by
traumatic experience and for promoting psychological health for survivors as well; neverthe-
less, the characteristics of breakdown and closure and the way that the eye moves across the
gutters and panels of the comics page make the medium exceptionally suitable for
reconstructing an event and situating it in time. Charles Hatfield points out that Bcomics …
are not mere visual displays that encourage inert spectatorship but rather texts that require a
reader’s active engagement and collaboration in making meaning^ (2005, 33). Though print
media also requires a reader to construct meaning from words, print media generally does not
provide the same kinds of quickly digestible images and icons that comics deliver. Fine art,
conversely, can produce images for the eye to read. However, comics use an array of images
ordered sequentially to convey narrative. Film also differs from, and perhaps falls short of, the
comics medium in the representations of traumatic experience. BIn comics, as in film, television
and ‘real life’ it is always now…but unlike other media,^ McCloud explains, Bin comics, the
past is more than just memories for the audience and the future is more than just possibilities…
 J Med Humanit

wherever your eyes are focused, that’s now. But at the same time your eyes take in the
surrounding landscape of past and future!^ (1999, 104). In other words, whether reading
comics or watching film, one’s eyes actively engage with the page or screen. Since film passes
by quickly, previous images only exist in the viewer’s mind. Viewers cannot reconstruct scenes
or images across a surface because different frames continuously come and go on the screen.
Comics advantageously allow the reader’s eyes to quickly move back and forth across the page
to reread the past and progress into the future at the person’s own pace. Reading graphic
sequences helps readers manage narrative time. This interpretative method has application in
therapeutic practice because readers can restructure fragmented time, memory, and narrative
across splintered elements that exist simultaneously next to one another on the same page.
McCloud demonstrates the medium’s usefulness for representing temporal disorder, and the
genre of war stories—whether created by veterans or nonveterans—provides a relevant kind of
comic for better understanding war’s mark on the mind and body. Authorial authenticity does
not have an effect on a particular war comic’s usefulness for reconstructing what war
deconstructs. For Tim O’Brien, a writer of the Vietnam War, the important issues is not
authorship. Instead, he suggests another heuristic. O’Brien writes, Ba true war story is never
moral. It does not instruct, nor encourage virtue, nor suggest proper models of human
behavior, nor restrain men from doing the things men have always done. If a story seems
moral, do not believe it^ (BHow to Tell a True War Story^ n.d.). A truthful war story, according
to O’Brien, affects the body and refuses moral and narratological resolution. These tales resist
satisfying moral or structural closure by insisting on amorality (Samet 2007, 39). Simply put,
prose war stories like O’Brien’s The Things They Carried, Robert Olen Butler’s A Good Scent
from a Strange Mountain, and others like them become literary representations of the physical,
moral, and narratological disorder caused by war. Comic war stories not only reflect the same
types of disorder found in literary representations of war and trauma, but comics also foster a
unique form of reconstruction for the reader.
While Vietnam war stories like O’Brien’s and Butler’s provide conventional textual
accounts of war, Will Eisner’s Last Day in Vietnam: A Memory (2000) and Doug Murray’s
The ‘Nam (1986) instead provide graphic representations. These comics, unlike many super-
hero comics from the same time period, represent lived experience by providing visible
depictions of invisible trauma. Short comics about the Vietnam War, drawn by Eisner while
traveling through combat zones researching for the Army’s P.S. Magazine, make up Last Day
in Vietnam. Murray’s comics, unlike Eisner’s sketches, began a serialized comic run with
Marvel comics in 1986 with the intention of depicting a group of soldiers’ experiences in the
Vietnam War. The comic ended in 1993. Though Eisner’s and Murray’s Vietnam War comics
contain dissimilar publications and styles, they do share similar content and these comics
demonstrate sequential art’s capacity for illustrating the temporal and moral disorder created by
the unseen wounds of traumatic injuries pictorially (Fig. 1).
Eisner’s BThe Casualty^ and Murray’s BThree Day Pass^ (both episodes within the larger
comics) share similar themes and content which illustrate the psychic damage wrought by
trauma through graphic representation. BThe Casualty^’s wordless representation of an Amer-
ican soldier’s contact with a woman occurs entirely within the character’s thought bubbles.
Bandages cover the man’s face and his left arm rests in a sling (Eisner 2000, 47–52). Eisner’s
style is blurry, drawn in black and white without any hard lines or detailed inking, and the
graphics appear slightly more cartoonish than realistic. The comic’s thought bubbles show the
soldier’s encounter with a woman with long, dark hair who appears in a white blouse and a
black, tightly- fitting skirt. In the sequence that follows, the two have sexual intercourse, the
J Med Humanit

Fig. 1 BThe Casualty.^ Eisner, W.

(2000). In Last Day in Vietnam: A
Memory. Milwaukie: Dark Horse
Comics: 45

soldier falls asleep, and the woman then casually slides a hand grenade under the slumbering
man’s bed as she leaves the room. The subsequent thought balloon shows an explosion as the
hand grenade detonates. Below the thought balloon of the explosion, the soldier’s sneering
expression renders his face almost unrecognizable revealing his anger at having been caught
off guard by the woman (Fig. 2).
Importantly, the entire course of the narrative in BThe Casualty^ takes place in the soldier’s
mind as Eisner’s thought balloons pull the reader into a flashback and reveal the site of psychic
wounds. The traumatic narrative completely subsumes the soldier’s waking attention in BThe
Casualty^ as the past and present blend together on the comic page to distort narrative time.
The entire dramatic narrative development taking place within the short comic’s thought
bubbles overshadows the soldier’s solitude in the narrative present as the soldier spends almost
the whole chapter drinking and smoking alone at a bar. The soldier’s traumatic thought bubble
storyline (or the sequence of pictures displaying his painful experience), however, takes over
the story, arrests the soldier’s waking thoughts, and fixes the reader’s attention on the soldier’s
flashback. Eisner’s comic renders the temporal disruption of narrative identity observable
through its pictorial sequences.
The stylistic dissimilarities between Eisner’s BThe Casualty^ and Murray’s BThree
Day Pass^ valuably illustrate how trauma simultaneously exists on a universal as well as a
personal level. Eisner’s blurred lines, black and white coloring, absence of definable panels
and gutters, and a more cartoonish-sketchy feel creates an iconic and dreamy quality that
universalizes the narrative. In contrast, Murray’s comic recreates lived experience through
colorful pages and sharply detailed faces and physical bodies. The ‘Nam’s panels appear in a
variety of shapes and sizes, and Murray’s style of comics structure refuses to allow the panels
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Fig. 2 BThe Casualty.^ Eisner, W.

(2000). In Last Day in Vietnam: A
Memory. Milwaukie: Dark Horse
Comics: 48

to bleed into one another in stark contrast to Eisner’s absence of definable panels and gutters.
Murray’s more restricted structure creates a more narrow type of storytelling. One could locate
Eisner’s comic almost anywhere, but Murray’s style firmly locates the graphic narrative in
Saigon during the Vietnam War. When juxtaposed with one another, the two graphic narra-
tives’ styles picture traumatic experience in two different but related ways. Eisner’s indistin-
guishable characters reveal how trauma affects people while Murray’s detailed cartoons show
how trauma impacts a person. Accordingly, these comics capture the ways that trauma occurs
both universally as well as individually.
Murray’s comic thematically parallels Eisner’s comic but in addition to the portrayal of
trauma’s seizure of the conscious mind in BThe Casualty,^ BThree Day Pass^ depicts the
occupation of the unconscious mind. In the third issue of Murray’s comic, three soldiers
embark on a pass to Saigon after bribing their crooked first sergeant to get out of their jungle
base of operation. Upon arrival in the South Vietnamese capitol, the three men visit a movie
theater which is almost immediately bombed. The men escape the violence unscathed and
decide to get away to a bar. There, two Vietnamese women, both wearing tightly-fitting and
revealing clothes, begin flirting with the soldiers. A third woman wearing a brightly drawn red
dress appears and gestures toward the reader. The detailed line work of her figure portrays an
idealized thin waist and large breasts in a distinctly male gaze as the scene not only includes
overtly misogynistic language but also shows the soldiers objectifying the Vietnamese women.
One of the more seasoned soldiers tells Ed Marks (the first timer and center of the plot) to be
wary of the women (Murray 1987, 66). Marks, nevertheless, eventually follows the woman out
of the bar, but the woman’s enticement turns out to be a trap. Fortunately for Marks, the other
J Med Humanit

two soldiers show up before the attack turns deadly. Two pages later, as Marks sleeps in a
Saigon hotel, the Vietnamese woman in the red dress returns in a graphic splash panel to
inhabit the young soldier’s unconscious dreams. The splash panel synchronically depicts the
woman approaching, a village of Vietnamese people, a U.S. M-60 machine gun firing, and the
muzzle of an AK-47 pointed straight at the viewer. Additionally, the splash panel shows a
black skull in the Vietnamese woman’s left eye as the panel transforms the sexually attractive
woman from the bar into the embodiment of enemy violence. The circular lines on Marks’s
face reflect the traumatic dream understood to be seizing his unconscious. Two panels later a
saboteur detonates a bomb that destroys the hotel. Murray’s comic represents the war’s
violence synchronously inhabiting Marks’s dreams and his waking reality (Fig. 3 and 4).
While Eisner and Murray’s comics portray individual psychological wounding, these
graphic novels also picture the destabilization of other social forces that trauma causes during
and after combat. Both of these comics share an alluring yet dangerous Vietnamese woman
who is initially depicted as the object of the men’s gaze but then becomes dangerous to the
soldier’s physical wellbeing. Because of the prominence of the male gaze in these comics, the
men misrecognize the potential danger of the situation. These women, far from being sexually
compliant, in fact represent a wartime threat to the soldiers. The violence in these episodes

Fig. 3 BThree Day Pass.^ Murray,

D. (1987). In The 'Nam (Vol. 1).
New York: Marvel Enterprises: 65
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Fig. 4 BThree Day Pass.^ Murray,

D. (1987). In The 'Nam (Vol. 1, pp.
55–76). New York: Marvel
Enterprises

takes place in a closed off bedroom which usually represents a traditional site of physical
intimacy. The violence wrought by wartime trauma, much like the violence inflicted by the
Vietnamese women, once thought to be confined to the battlefield becomes an asymmetric
threat in that it exists beyond geographic and temporal boundaries. The violence to the men’s
bodies, like the effects of trauma after war, moves beyond the usual boundaries of space (a
bedroom) and time (combat) to affect these survivors. Additionally, these comic panels reflect
the wide ranging racial tensions between Asian and non-Asian bodies during the period. In
short, Eisner’s and Murray’s episodes unsettle the period’s traditional understanding of gender
hierarchy, race, and nationalism which might be understood as a social trauma for these
cartoon survivors.
While Eisner’s and Murray’s comics picture social trauma, Jason Lutes’s Berlin: City of
Stones draws attention to the impacts that individual psychological wounds have on relation-
ships with others and the surrounding community (2001). Berlin’s stories, focusing on the
interwar years of the Weimar Republic, trace a web of individual and shared narratives from
September 1928 through May 1929. Though not primarily a war comic, Lutes’s graphic novel
includes episodes of traumatic experience, and one particular chapter highlights the impacts of
psychological wounding on a community. Texts that reflect shared traumatic experiences
J Med Humanit

engage the central problem of listening, of knowing, and of representing the invisible injuries
that emerge from the experiences of a crisis (Caruth 1996, 5). Lutes’s graphic novel sketches
this problem of communicating shared trauma and illustrates the phenomenon’s effect on a
population. His style, in some ways more like Eisner’s than Murray’s, distorts the distinction
between the different Berliners creating a sense of shared history among the city’s collection of
characters, and the book’s black and white style makes it very difficult to tell the characters
apart. Martha and Kurt, Otto and Gundrun, two of the couples that the book follows, are at
times hard to distinguish from the graphic novel’s secondary characters.
Berlin illustrates the web of traumatic experience and how communities form around
phenomenon through an innovative illustration of World War One trauma. About half way
through the novel, the traumatic nightmare of a Great War veteran takes over the narrative. The
book’s panels shift from focusing on one of Lutes’s more prominent characters to a homeless
unnamed uniformed man huddled in a doorway. Over a series of three panels the book’s gaze
closes in on the man’s face, and then the war begins. The succeeding three pages depict the
man’s traumatizing experience of trench warfare as well as the death of one of his comrades. As
in Eisner’s and Murray’s comics, the veteran’s trauma in Lutes’s story inhabits the character’s
consciousness by first occupying the man’s thought bubbles and then overwhelming the entire
comics page. The war sequence itself uses many well established techniques for depicting the
sights and sounds of battle. Splash panels depict the sounds of combat by turning letters like
BKRK,^ BBRKT,^ and BCHRM^ into graphics of deafening artillery fire and the book’s images
portray the decimated landscape of no-man’s-land (Lutes 2001, 96). The innovation in Lutes’s
comic, however, is how the veteran’s flashback ends. The last panel of the battle ends on one
page, and the next page shows Martha awakening. Her heavily inked brow indicates that she
has experienced the trauma of the dream that began with the unnamed veteran several pages
before. These unrelated characters are understood to have experienced the same traumatic
dream, and the depiction of the war-related shared trauma in Berlin shows the mesh of unseen
wounds shared by a community. By using the comics medium to graphically depict the same
dream shared by two different individuals, Lutes’s narrative renders the connection between
trauma, individuals, and the community graphically recognizable (Fig. 5).
Although Eisner’s, Murray’s, and Lutes’s graphic war stories exemplify the ways in which
comics can draw invisible trauma, a variety of more recent graphic stories employ the
medium’s unique representational characteristics for therapeutic use, revealing a shift in the
functions for war comics attempting to illustrate lived experience. This distinct sub-genre of
comics attempts to represent war related trauma’s effects on the mind and body—using many
of the same features as the previously examined cartoons—in order to relieve the symptoms of
invisible injuries for survivors.1 Garry Trudeau’s The War Within: One More Step at a Time
(2006) and RTI International’s The Docs (2010) commissioned by the Naval Health Research
Center both focus on the Iraq War (2003–2011) in an attempt to help veterans recognize their
own individual symptoms and to restore their narrative identity by providing a picture of the
healing process. Though these two comics seem to make an odd pairing—a book from a
satirical cartoonist best known for criticizing government executives alongside an official
government publication— studied together these graphic novels reveal an important change.
They dramatize an explicitly therapeutic program whereas Eisner’s, Murray’s, and Lutes’s
books do not. Instead of merely chronicling or reimaging the Vietnam and European
conflicts, the BForward^ to The War Within articulates the aim of B[helping] soldiers … find
their way to the help they need and deserve,^ (Trudeau 2006, 4–6) and the Naval Health
Research Center’s The Docs communicates the intention to reverse B[t]he social stigma
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Fig. 5 BShared War Trauma Dream.^ Lutes, J. (2001). In Berlin: City of Stones. Montreal: Drawn and Quarterly:
94, 96, 98

attached to psychological problems^ by B[developing] a new health communication tool for

the military (BGraphic Novels: A New Tool^ 2012). These comics, and an increasing number
of others like them, share the innovative goal of providing treatment and promoting healing for
psychological injuries through graphic narrative.
J Med Humanit

Garry Trudeau’s The War Within, the second book in a trilogy about the Iraq War (2003–
2011), seems like an unlikely text from an unlikely author for treating psychological wounds.
Trudeau’s weekly comic strip Doonesbury, which has been running in syndication since the
early 1970s, is more renowned for its political satire—its lampooning of political and cultural
figures ranging from the Bush family to Frank Sinatra—than for its contributions to healing.
Nevertheless, the graphic narrative that appears in this second book does a different kind of
work than previous war comics and previous Doonesbury comics. The War Within recounts
B.D. and his family’s struggle to regain their lives after a rocket propelled grenade attack
leaves the former football hero physically and psychologically wounded. Trudeau’s use of
graphics is less elaborate than other cartoonists, favoring a more iconic style. However, the
characters’ heavy-lidded eyes create a sense of hard won world-weariness familiar to many
Iraq War veterans, especially in B.D., and in the Vietnam War veteran turned social worker
Elias, who ultimately guides B.D. back to a more stable life (Soper 2008, 133). Even the
parentheses-and-dot eyes of B.D.’s wife, Boopsie, create a sense of immediacy and realness
while still maintaining a universalized feel. Trudeau’s comic characters provide a vivid account
of the symptoms of psychological wounds after war rather than during the conflict like Eisner
and Murray. B.D., a college football star and one of Trudeau’s original characters, spent the
early years of the comic always wearing his helmet, even after graduating from university and
living in the real world. Now a middle-aged baby boomer, B.D. has long since matured out of
his college football glory days, but since surviving an ambush in Iraq that resulted in the loss of
his left leg, B.D. appears plagued by the symptoms of his unseen injuries.
In The War Within, B.D.’s road to dealing more effectively with the symptoms of psycho-
logical wounds takes him to both a military psychologist and to Elias at the local veteran’s
center. The two characters act as graphic representations of the medical narrative and the non-
medical narrative. The Army psychologist relates to B.D.’s stories and trauma and even does a
good job listening, but all that comes out of B.D.’s appointments are two somewhat unhelpful
results. First, the psychologist applies the medical narrative by diagnosing B.D. with PTSD.
Instead of addressing the psychological injuries and their symptoms, the doctor attributes
B.D.’s nightmares, anxiety, hyper-vigilance, and paranoia to PTSD but does nothing to help
him deal with the arresting effects of his fractured memory of the traumatic event. This does
little for B.D. who later in the narrative refuses to leave his own car out of fear that a vehicle
borne IED may explode at any moment. In another scene revealing the veteran’s symptoms,
his daughter, Sam, reveals that B.D. has hit Boopsie during a night terror. To make matters
worse, B.D.’s alcohol consumption complicates the other problems as his drinking spirals out
of control. Second, the Army psychologist transfers B.D. on to the U.S. Veteran’s Adminis-
tration’s medical system and tells him that Bwe can’t do much more for you here. You have to
get on with your life^ (Trudeau 2006, 24). Instead of attempting to provide B.D. with a readily
available community for dealing with his symptoms, the psychologist simply moves him along
the chain of care. These scenes with the psychologist show how inadequate treatment can
worsen the effects of psychological wounds. Instead of improving after leaving the Army’s
care, the effects of psychological wounds continue plaguing B.D., but these early episodes set
the stage for B.D.’s recovery (Fig. 6).
Trudeau’s ending of The War Within provides a framework for B.D.’s recovery and an
example of therapeutic practice for the larger audience of veteran survivors. As the comic
unfolds, the counselor Elias helps B.D. gain some control over the fragments of his traumatic
experience to reestablish a more coherent narrative identity. Eventually the straight-faced
Vietnam veteran from the local Vet center connects with the Iraq veteran. Elias, also an
 J Med Humanit

Fig. 6 BB.D. and Army Psychologist.^ Trudeau, G. (2006). In The War Within: One More Step at a Time.
Kansas City: Andrews McMeel Publishing: 22–23

amputee, gradually gains B.D.’s trust through a combination of persistent caring, listening, and
wit. Importantly, the comic recaptures B.D.’s shattered narrative of the injury in Iraq through
pictorial storytelling, and the sequence of panels also shows the two ascribing new meaning to
B.D.’s experience as Elias counsels B.D. to replace his feelings of guilt with the belief that his
actions fulfilled a higher sense of duty and responsibility. The establishment of a supportive
community defines the therapeutic message of Trudeau’s comics. Though the nature of
trauma’s effects on survivors distances individuals from others, communities provide oppor-
tunities for learning ways of coping with the reoccurring symptoms of the unseen wounds of
traumatic experience, and The War Within shows B.D. healing through his relationship with
Elias (Fig. 7).
Like Trudeau’s Doonesbury, The Docs, is fictionalized yet aims to be representative of real
experiences. Commissioned by The U.S. Naval Health Research Center in San Diego and
written, drawn, and produced by a collective of researches, writers, and artists at RTI
International (a non-profit research institute), this comic specifically aims to educate and
provide a means of therapy for veterans. The book centers on four Navy corpsmen who
accompany Marine units to combat operations in Iraq. RTI’s cartoonists, in contrast to
Trudeau’s more iconic style, draw the characters and events with a much more realistic feel.
The comic presents the characters in color and include more detailed faces and settings in
almost photographic depictions of reality. The Navy directed RTI to create the graphic novel
with life-like characteristics so that veteran sailors would more closely identify with the
characters and circumstances depicted (Peeler 2014).2
The four main characters in the graphic novel represent the Navy’s diverse population of
service men and women and experiences. One of the book’s main characters, a twenty-two
year old enlisted woman named Erica Mendez, suffers both from past physical and psycho-
logical wounds and experiences new ones during a subsequent deployment to the war zone.
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Fig. 7 BAscribing New Meaning.^ Trudeau, G. (2006). The War Within: One More Step at a Time. Kansas City:
Andrews McMeel Publishing: 108–109

Mendez’s narrative begins at her home station where some of her old memories resurface. In
one graphic sequence that spills over the boarder of several other panels capturing the
intrusiveness of traumatic psychosomatic symptoms, Mendez simultaneously rubs her aching
shoulder while a thought bubble reveals her past injury. The thought balloon shows Mendez
prostrate on the ground in a helmet and body armor with a bloody wound to her shoulder, the
same shoulder that she massages in the story’s narrative present outside of the balloon (Kraft
et al. 2010, 21). This panel reveals the nature of her past traumatic experience. Later in the
novel, Mendez recalls the death of a fellow corpsman, who bleeds to death in her arms, as well
as a number of other traumatic events in which she witnesses other sailors, marines, and
civilians wounded and killed by war (Fig. 8).
Mendez’s presence in the graphic novel reveals a changing role for women in the U.S.
military during the Iraq War (2003–2011) which the comic pictures. In stark contrast to the
objectified women in Eisner’s and Murray’s comics, and far from the Bdamsel in distress^
narrative which characterized Jessica Lynch’s ordeal early in the recent Iraq war, Mendez
requires no dramatic rescue from Special Operations forces and is herself the subject of the
story rather than the object. The Navy sailor problematizes neatly defined stereotypes of
masculine and feminine roles, and she undermines assumptions about biology and respect-
ability within the military culture (Enloe 2007, 64–65).3 It is Mendez who, in several scenes,
rescues wounded Marines and braves enemy danger to treat wounded comrades. Mendez also
remains susceptible to the effects of undergoing physical wounding and witnessing others
suffer trauma and death (Fig. 9).
Though Mendez and the other characters experience physical and psychic wounding
throughout the graphic novel, the last and final chapter titled, BPart 7: Returning Home,^
contains the book’s most striking examples of therapeutic design, and Mendez’s story serves as
the prime example. In the closing moments of the book, Mendez visits the grave site of a dead
corpsman who appeared earlier in the novel. The scene inhabits an entire page and shows
 J Med Humanit

Fig. 8 BMendez’s Past Trauma.^

Kraft, H., Peeler, R., Larson, J.,
Lambert, S., Wiggins, D., Nguyen,
D.,. . Jessup, A. E. (2010). The
Docs: A Graphic Novel. San
Diego: The Naval Health Research
Center: 21

Mendez, in her Navy combat uniform, kneeling in front of the deceased sailor’s grave. B‘Live
for others so others may live,’^ exclaims Mendez through a speech bubble, BGood work, Doc.
Rest in Peace^ (Kraft et al. 2010, 197). This episode pictures the ascription of meaning to
trauma for the reader in a unique way. In an effort to demonstrate a path toward healing, the
graphic narrative shows the reader how to think differently about past traumatic events by
giving them new meaning. Death and wounding become sacrifice in the service of a higher
meaning for Mendez. The corpsmen’s death, as understood by Mendez, fulfills the honorable
code shared among Navy BDocs.^ This new assignment of meaning to the traumatic event
shows Mendez reconciling her past suffering with her current belief system. This resolution
between the past and the present restores a coherent narrative and reorders her narrative
identity (McAdams and McLean 2013).4 The ascription of meaning to traumatic experience
revealed in The Doc as well as the establishment of a community of support as illustrated in
The War Within represent the systems that these comics employ to promote healing for
sufferers of the unseen wounds of traumatic experience (Fig. 10).
Recent graphic novels with therapeutic aims not only include practices that promote healing
for survivors but also act as vehicles for the prevention of iatrogenic damage caused by the
J Med Humanit

Fig. 9 BMendez in Combat.^ Kraft, H., Peeler, R., Larson, J., Lambert, S., Wiggins, D., Nguyen, D.,. . Jessup,
A. E. (2010). The Docs: A Graphic Novel. San Diego: The Naval Health Research Center: 71–72, 76

subordination of individual narratives by the medical narrative. Medical narratives overwhelm

personal narratives when a person no longer controls the story of illness or injury but allows
physicians and modern medical science to become the spokespersons for the disease or
wounding (Frank 2013, 6). The translation of traumatic experience into medical chart data
problematizes recovery and can cause a secondary wounding that occurs with the best of
intentions for survivors. The very act of interpreting a traumatizing experience into facts and
figures, digital records, and unfamiliar terminology confuses survivors; this damage constitutes
iatrogenic harm. One report on the U.S. Veterans Affairs website calls for clinicians to reduce
mental health jargon and to avoid pathologizing common stress responses, yet to claim
insurance compensation through the Veterans Affairs system in the United States survivors
must still translate their experience into the medical terminology of their official medical
records. These official medical records, unlike the graphic narratives in war comics, contain
the medical practitioner’s translation of the wounded person’s physical injuries into scientific
data such as heart rate, blood pressure, and anatomical descriptions of surgical procedures.
This translation renders the individual’s story far less recognizable to non-medical
 J Med Humanit

Fig. 10 BMendez Ascribes

Meaning to Death.^ Kraft, H.,
Peeler, R., Larson, J., Lambert, S.,
Wiggins, D., Nguyen, D.,. . Jessup,
A. E. (2010). The Docs: A Graphic
Novel. San Diego: The Naval
Health Research Center: 197

professionals. In the insurance example, the individual’s assemblage of tables, numbers, and
jargon compiled for the necessity of gaining indemnity benefits does little or nothing to help
the survivor establish community or ascribe meaning to their suffering. Instead, the story told
by the physicians becomes the normative one against which others are ultimately judged true
or false, valuable or not. On one hand, medical narratives describe injuries and illnesses to the
physical body and serve a useful purpose in modern diagnostic medicine. Even so, these tales
fall short of treating the individual holistically. Ian Williams, Michael Green (both medical
doctors), Kimberly Myers, and Anne Hunsaker Hawkins (professors in the humanities) caution
against an overestimation of medical science and technology and insist on more complete
approaches to patient health. These critics point out how modern medicine dehumanizes and
objectifies patients in order to treat their diseases or injuries. The process of reducing an
individual to a body and then further reducing the body to its biophysical components may
indeed help to narrow the list of appropriate treatments, but according to Hawkins, the patient’s
B[m]ental attitude, nutrition, exercise, response to stress, even personal and societal goals and
values … [should be] judged at least as important as the narrow biochemical focus of orthodox
medicine^ (1999, 9). On the other hand, war comics, though they lack medical specificity or a
J Med Humanit

specific medical program, maintain the ability to heal the unseen wounds of traumatic
experience by illustrating therapeutic practices as well as inviting survivors to participate in
a reconstructive reading process.

Conclusion

Arthur Frank’s call to think differently about oneself after a serious illness or injury
begins, for trauma survivors, by regaining control over the fragmentation caused by
invisible injuries. The development and sustainment of a health-giving narrative iden-
tity rests on one’s ability to share stories in accordance with particular cultural
parameters within particular groups. These groups include families, peers, and other
formal and informal social contexts (McAdams and McLean 2013). War comics like
Eisner’s Last Day in Vietnam, Murray’s The ‘Nam, and Lutes’s Berlin provide illus-
trations of the psychological disruption that occurs after trauma to individuals and
communities. These cartoons translate invisible mental health phenomena into visible,
readable occurrences that can facilitate relationships among survivors and the people
who support them. Recent comics attempt to put these formal characteristics to
therapeutic use: Trudeau’s The War Within sketches the avenue for communalization
of trauma, and the Naval Health Research Institute’s The Docs outlines the ascription
of meaning to suffering for survivors. These recent graphic novels provide systems of
recovery that promote the reestablishment and maintenance of a healthy narrative
identity.
Not merely limited to war comics and the trauma associated with wartime experi-
ence, graphic representations of psychological phenomena speak for other types of
mental health issues as well. Ian Williams articulates the medium’s therapeutic poten-
tial: BComics and graphic novels can effectively relate the patient experience and,
indeed, the experience of the caregiver or healthcare provider, and that [they] might
have a particular role to play in the discussion of difficult, complex or ambiguous
subject matter^ (2012, 21). Indeed, David Small’s Stitches, Darryl Cunningham’s
Psychiatric Tales, Sarah Leavitt’s Tangles, Ellen Forney’s Marbles, and others graph-
ically portray a wide variety of mental illnesses and diseases including depression and
Alzheimer, as well as the perspectives of practitioners, patients, and family members.
This growing body of graphic novels about mental health issues seems representative
of a growing awareness among physicians, mental health practitioners, social workers,
patients, journalists, self-help experts, governmental officials, and religious organiza-
tions that the comics medium can do much more than simply represent lived expe-
rience through words, images, and sequences of pictures (Cvetkovich 2012, 91).
Indeed, comics are providing trauma survivors, and people with other mental illnesses
and disease, the chance to reconceptionalize their recovery beyond traditional lan-
guages of therapy. People often think in pictures, and these types of graphic narratives
are helping people to picture mental health and wellness differently.

Acknowledgments Thank you to John Said for introducing me to the concepts discussed in this paper and to
Professor Susan Merrill Squier for her Graphic Medicine class at Penn State which taught me a great deal about
comics and their therapeutic value. Thank you to Professor Kit Hume, Dr. Sarah Salter and Michelle Huang for
reading the draft. Most importantly, I want to thank my wife Michelle for carrying me along.
 J Med Humanit

Endnotes
1
Kimberly Myers and Michael Green define graphic pathographies as graphic narratives that center on illness,
injury, or wounding. The comics I examine fit this description, but I am focusing on a specific set of fictional
graphic pathographics aimed at recreating lived experience with the purpose of providing therapy for suffers of
psychological wounds. See BGraphic Medicine: Use of Comics in Medical Education and Patient Care^ (Green
and Myers 2010) for a more detailed analysis.
2
I had the opportunity to speak with one of The Docs’ authors, Russ Peeler, at the conference, Comics &
Medicine: From Private Lives to Public Health, in Baltimore, Maryland June 2014. There he mentioned that the
military liaisons from the Navy believed that the more authentically real the graphic novel appeared, the more it
would resonate with servicemen and women. For more information about the conference see www.
graphicmedicine.org.
3
In Globalization & Militarism: Feminists Make the Link, Cynthia Enloe compares recent women soldiers to the
BNew Woman^ of the early twentieth century. In her book, she points out how both groups of women raised
discomforting questions within their societies about the roles and privileges of men and women.
4
Psychologists McAdams and McLean articulate that there are two steps for healing from the unseen wounds of
traumatic experience. In the first step, one meditates on the past traumatic experience’s role in the person’s overall
life story. In the second step, the person expresses and commits the self to a positive resolution of the event.
Simply put, the person replaces the meaninglessness of the traumatic event with a more meaningful narrative.

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