Chronic illness—that grand umbrella—is the postmodern condition that seemingly moves into the spaces vacated by all the diseases modern medicine has vanquished in the past century. Today remarkably few of us will die of infectious diseases. One recent study in London found rates of community-acquired infection requiring hospitalization to be only 6.4/100,000. In the 14th century when the plagues leveled Europe no one everyone forgot they were dying, ever. The very adjective healthy did not even exist in the English language until the second half of the sixteenth century because it was as unimaginable a condition as futurity, a word that does not arise in English until around the same time.

Today despite the ongoing scourge of cancer and AIDS, the 20th century’s final plague, we have an expectation that medicine will make the pain go away, or at the very least give us a name and a narrative for all that is happening to our bodies. I am an educated guy who should know better, but nonetheless I wake up some days full of anger at medicine for not fixing me. It’s the fault of my individual doctors for not trying hard enough. Or the American medical system for forcing my poor doctors to take on ever more patients such that they can never give me the time needed – just two more minutes and I’d be saved! Or it is Big Pharma, which sees no profit in chronic illness and prefers to bombard patients into steroid psychosis to keep them from organizing for a cure. Or Big Chemical, which has been force-feeding me toxins and fudging the public data. Anything but the alternative, the one my employer/doctor/insurer has been passively pushing for years—that the reason I am sick is because I did not follow the program when I had a chance.

Of course, all of this is kind of true: Big Pharma does put profits first; Industry has dumped all kinds of new chemicals into our air and water that were not there a century ago; doctors have too little time and are drawn to cases where modern medicine can most reliably result in happy endings. And I did not work the program as hard as I could have—there was that martini period in my early 40s, dramatic weight gain in my 30s, smoking in grad school … . But despite all these plausible villains, internal and external, the reality is that the main reason for the extraordinary rise of “invisible illnesses” is that those of us who are genetically and/or environmentally immune-compromised in one way or another are no longer inevitably dying in infancy, or being swept away in any of the once-endless stream of infectious diseases. We are living to ripe old middle-age and well beyond, long enough for our neuromuscular, autoimmune, hormonal, and other dysfunctional destinies to reveal themselves. Before modern medicine we would have been Little Nell and Little Eva. Today we get to fulfill a different destiny.

The problem of course is how to tell this story. In some sense we were wired to be tragic casualties in someone else’s novel like Nell and Eva, and without either an early death or an ultimate victory we don’t have a wide range of narrative tropes into which to fit our stories. (“Next is Chapter 3, in which I describe how I had some halfway decent days followed by one of the worst days I have had in many months. Also: a fall and some public incontinence ... Oh, wait: was that Chapter 2? Or 6?") Finally we get to be the heroes in our own novels, stars of our own films, only to discover that our stories suck—with no overcoming, no last minute rescues, and not even a touching deathbed scene we are as non-novelistic, anti-cinematic as it gets (and that’s leaving out the prednisone bloat, the frantic bathroom breaks, the surprise vomit). No wonder our doctors run the hell away from us: we are literally narrative poison. And they have their own stories to tell.

And then we come back to the problem of metaphors. Because our diseases are often “invisible,” we search for new metaphors to tell our stories. Rejecting the military metaphors that work well for modern medicine’s assault on acute disease, we turn to… cutlery? Not even the cool cutlery like knives and forks: no, we go for spoons. We don’t fight wars, we manage. We don’t run marathons, we slog through the deserts. We are very fond of desert metaphors. And rocks. We really like rocks. I am not here to call for better metaphors. In the end, they could not tell our story any more than the novel we cannot write (because who on earth would possibly read it). What we need are not ways to make our stories fit into conventional media or literary figures. What we need is a form that does not rely on metaphor and is not industrially programmed to tell its stories in 3 act structures. If only there was a form that could communicate our stories without feeling compelled to find marketable metaphors, cinematic imagery, or novelistic structure. If only there was a form that had been working with stories that go precisely nowhere, stories of repetition, and the insights and recurring tragedies of the everyday. …

Of course, comics have been telling these kinds of stories long before many of these conditions had names. Bodies under stress, bodies in pain; chronic, repetitive, inescapable—this is the stuff of comics as they took shape in the newspaper supplements at the turn of the last century. For example Outcault’s Yellow Kid, commonly credited as the first recurring comic strip character, is marked by his chronic encounter with head lice—the scourge of the tenements and a parasite that remains remarkably resistant to modern medicine even today. Our protagonist’s head is shaved as a prophylactic against the louse, in the 1890s believed to spread many of the infectious diseases not yet corralled by modern medicine such as yellow fever, typhoid, tuberculosis. There is also evidence to suggest that the Kid’s unique facial features were derived from illustrations of deficiency diseases endemic to the tenements and just then beginning to be studied systematically. And the figure of the Kid became linked with disease in the very phrase “yellow journalism,” which makes its first appearance in print in a critique of hysteria being worked up by the Hearst and Pulitzer papers in 1897 about the plague in India making its way to America: “After an attack of yellow-kid journalism New Yorkers are not going to worry about the Bombay plague,” he wrote, shortening it to “yellow journalism” one day later in describing the infectious nature of this brand of journalism itself. “The Yellow Journalism finds a parallel in the bubonic plague,” one paper quipped a few weeks later. But as fascinating as these connections to the acute and infectious diseases of the era are for the history of comics and medicine, I have always been particularly fascinated by one minor character who appears in many installments Outcault’s comics. I love this kid—Slippy Dempsey is name—and have long celebrated him in the privacy of my own very geeky mind as comics’ first superhero—capable of falling off tall buildings each week and returning the next to do it again. He is the direct heir of some of the very earliest sequential comics in the illustrated magazines of the previous decade, especially those by F. M. Howarth, who was fascinated with tall buildings and people falling out of them. But unlike the unfortunates in Howarth’s comics, Outcault’s Slippy is not killed or maimed, but bounces back each week. Instead of being thrown out of windows by angry neighbors or malicious thieves or the sheer force of the urban crowd, he seemingly falls of his own volition—or least does not mind the journey.

As I argued in Projections, the early comic was a response to the modern city—itself identified as the source of a wide range of new illnesses, physical and mental. On the front pages of the newspapers readers would learn about the victims of the city in graphic accounts of streetcar accidents, grisly murders, or the neurasthenia and hysteria that thinkers as different as Weir Mitchell and Georg Simmel believed were psychological diseases endemic to modern, metropolitan life. In the comics supplements, however, the assaults of modern life are miraculously absorbed, and while nothing is ever defeated or overcome—indeed, nothing is ever changed in the world of the early comic—our protagonists returns each week to try and try again.

This was the formula adopted by Frederick Burr Opper when he created in 1900 the first comic strip to have all the grammatical elements we today associate with the form: recurring characters, dialogue balloons, sequential panels. Like the Yellow Kid, Opper’s Happy Hooligan is an impoverished Irish immigrant. Each week Happy sets out to try and do right by the American Dream, seeking to find gainful employment, help a citizen in need, and prove that he is not in fact the hooligan his name marks him out to be. And each week, his actions are misjudged by his fellow citizens and especially by the police, who routinely bash his head in before hauling him off to jail. And of course each week he returns, ready to resume his doomed attempt to do right.

Happy is for me the next great superhero of American comics—for 34 years he suffers the weekly indignities of police beatings, mob violence, even the betrayals of his cousin Gloomy Gus without ever once a crack appearing in his overwhelmingly generous outlook on life and humanity. His cartoon career is the No to Simmel’s prediction that the city and its anonymous violence would destroy the fundamental humanity in us all. He is the chronic sufferer who super-heroicly maintains his humanity despite constant suffering over the course of decades. Nothing changes: and that is precisely the story, precisely the miracle. If Opper brought together the grammatical elements of modern sequential comics, it was Winsor McCay who first envisioned the possibilities of comics to capture experiences and worlds unrepresentable with the indexical technologies of cinema. Even as Edwin S. Porter was filming little Eva’s death bed scene for the 1903 Uncle Tom’s Cabin, McCay was creating Little Sammy Sneeze, about a boy with chronic allergies who forever turned the world upside down through the force of his mighty sternutation—even to the point of shattering the fourth wall and the very grammar Opper had helped erect. Sammy’s act of blowing apart the rigid grid of the comics panel opened up new possibilities for McCay and for comics—and in his next strip he turned from chronic allergies to that scourge of the early 20th century, welch rarebit addiction in his remarkable Dream of a Rarebit Fiend. Here insomnia and addiction (with rarebit is standing in for one of the other wares found in the late night oyster bars of the city) opened up magical and often terrifying dreamworlds, where time and space bent in ways entirely—let’s say relative, to borrow the term of Einstein’s special theory which would be published the following year (as I discussed at last year's conference).

Of course, McCay’s most famous and enduring creation is Little Nemo, born in 1905 and opening up entirely new fantastical places for exploration for a young man who is forever physically rooted in the same place—plagued by troubled sleep and insomnia and gifted with a remarkable inner life.