The history of the comics form’s evolution is hard-wired to the non-novelistic narrative of chronic illness, mental and physical, genetic and environmental. Krazy Kat is as good example as one could hope to find: for over thirty years George Herriman told the story of a mouse who was compelled to throw bricks at a kat, a kat who translated the pain of those blows into love letters—a sado-masochistic relationship made more overwrought by the addition of Offica Pup, whose love made him wish to protect Krazy from the very bricks Krazy most desired—as well as a menagerie of other citizens of the magical southwestern landscape of Coconino County each driven by their own demons in ways that warp and woof together create something akin to a comics version of a beautiful Navajo rug.

Or we might take the first successful daily strip, Bud Fisher’s A. Mutt (soon to be Mutt & Jeff), which told the story of a gambling addict determined each day that his next bet would be his big score—a strip that turned San Francisco into a city of daily comic strip junkies by basing each of Mutt’s bets on actual horse races whose outcomes—almost always horrible—would be revealed in the following day’s paper.

From this breezy tour through early comics history we might notice a few common features. On one hand, we see repetitive injury, compulsion, and the complete lack of forward movement—and in fact an entirely new open-ended seriality that did not exist before. Krazy Kat or Happy Hooligan at the end of their 30+ years are still engaged in the same patterns as they were at the beginning. This is not what we would necessarily call the easy shortcut to comedy success—it is precisely not a shortcut to anything. It is humor that works deliberately against the grain of its often bleak subject matter—the imprisoning structure of pain and compulsion that locks in our characters to seemingly inescapable patterns and unnarratable stories.

But of course, on that other hand, we have the strange alchemy of these comic strips by which the repetitive and often crushing weight of daily pain is transformed into beauty, love and magic. These are not stories of triumph over pain or escape from its prisonhouse. These are not narratives to be mapped out via novelistic or three-act screenplay structure. They are stories that take a lifetime to read, measured out in weekly and daily installments in which on one level nothing ever changes while at the same time everything is made wholly new precisely because of the combination of time, serial repetition, and the active collaboration of readers intrinsic to the comic form—and vital to the sharing of illness narratives. Born in the later 19th century alongside modern medicine, comics emerged as the narrative form of the chronic as opposed to acute illness, a form we now need more than ever as chronic illness now impacts the lives of upwards of half of the adult population in this country.

There were rare moments in early comics history when acute illness was the story, most famously in the infamous 1929 continuity in Sidney Smith’s The Gumps in which over the course of many daily installments the beloved character Mary Gold wasted away on her sickbed from an unnamed illness while Smith’s legion of fans wrote in begging him to spare her life. And they had every reason to believe he would listen: after all, he had so many times in the past. In May 1929, however, death came to the comics for the first time striking down a major character and sending millions of comics fans into the paroxysms of despair.

But such encounters with acute illness and death were the exceptions, and the Gumps' 42-year run, while punctuated with moments of high melodrama, was primarily dedicated to the repetitious struggles of everyday domestic life. Still it was an exception that would increasingly become more familiar heading into the 1930s, as newspaper comics began to aspire to more cinematic storytelling, visually as well as narratively. By the end of the 1930s, of course, a new comics medium would emerge from these experiments with adventure and science fiction comics—the comic book where in 1938 the modern superhero would be born. Superman was famously the creation of two children of immigrants who surely took great pleasure in the fantasy of an immigrant whose ancestors, like their own, had Hebraic names, but who, unlike themselves, could put the world’s bullies in their place, leap tall buildings, and of course laugh off the doctor’s feeble hypodermic.

But in so many ways Superman was and remains an exception among superheroes. Beginning with Batman the following year, we see what would later become the more familiar pattern, of a superhero finding his or her power in disability and chronic illness. For Batman of course it is the trauma of witnessing his parents’ murder, an event which would replay in his mind and in the pages of his comic books for decades to come. But at the time it was the Superman model that was dominant, and less than a decade after first being introduced, the superhero boom was over—well and truly so by 1947, when a range of new genres exploded on the newsstands: romance, crime and horror among the most popular and ultimately the most controversial as the relationship between readers and their comic books continued to grow more intense, intimate. For many cultural gatekeepers and midcentury paranoids, these comics were a new agent of disease—and only in part because of their content. What really freaked out the most attentive of those sounding the alarm about the dangers of comics was their seemingly unaccountable addictive nature. Young readers collected, saved, and reread their comics, losing themselves between the panels and in the third meanings that emerge from the tension between word and image. To those of us who study comics, these practices make perfect sense: it is how comics work, summoning the reader to active engagement and collaboration. But as Carol Tilley discussed last year, for Dr. Wertham and many others, it was terrifying—something to be monitored—better yet, censored.

And so it was, with the Comics Code of 1954 (the same year the polio vaccine was introduced). But we here have very good reasons to be grateful for this misguided act of quarantine. For one thing, the banning of horror and crime comics lead to the rebirth of superhero comics, most famously at Marvel in the early 1960s, where disability and chronic illness became foundational to not only the origin stories of superheroes but their ongoing narratives, as Jose Alaniz describes in detail in his recent Death, Disability and the Superhero. As a sickly kid in the 60s and 70s I used to hang out on the streets of Brooklyn hoping to get run over by a truck loaded down with radioactive material (which comics told me were pretty much ubiquitous). I was far from alone in such fantasies: these superheroes made our duck-and-cover drills less terrifying, true, but they also made us think differently about the chronic illnesses that were for many kids like myself a part of daily life in the inner-city in the early 70s—especially asthma, only recently recognized at the time as an inflammatory disease and not a psychosomatic condition. Heck the X-Men and Iron Man even made genetic defects and the iron lung look sexy.

Meanwhile, in San Francisco, a particularly virulent strain was emerging from underground—dedicated to exposing the chronic miseries of normative life and exploring the possibilities of opened up by dropping out and dropping acid. By the early 70s, however, this particular assault on Normal was looking less radical than it first appeared, especially to cartoonists who found themselves excluded from the white male comix jam sessions and increasingly weary of seeing female and African American bodies used as props for white male fantasies. Out of this frustration, both Tits & Clits (co-founded by Joyce Farmer, who is with us this weekend) and the Wimmen’s Comix collective were born in 1972, shifting the focus from acid trips and rape fantasies to women’s lives, bodies and health issues. It was here at Aline Kominsky would publish her earliest autobiographical Goldie stories in 1972, and it was here that our own Carol Tyler would publish some of her own early autobiographical comics in the 1980s. Others had grown weary of the dominant world-view of underground comix as well. Justin Green famously stands at the headwaters of the autobiographical comics tradition the river in which we graphic medicine folks do most of our fishing, and in 1972 he turned his personal struggle with obsessive compulsive disorder into Binky Brown Meets the Holy Virgin Mary, a story not about conquest or cure, but about testimony and perseverance. As Green’s trussed-up narrator puts it in the opening page:

Many others are slaves to their neuroses. Maybe if they read about one neurotic’s dilemma in easy-to-understand comic-book format these tormented folks will no longer see themselves as mere food-tubes living in isolation. If all we neurotics were tied together we would entwine the globe many times over in a vast chain of common suffering.

The first American long-form autobiographical comic is a work graphic medicine, and specifically about a chronic condition, in which happy endings and cures are not at hand and triumph is found in the act of sharing and entwining with others, and in the magical translations only comics can perform.

We are gathered here to celebrate and learn from the tradition that was inspired from Justin Green’s pioneering work, but it is a tradition that has its origins, as I hope I have shown, deep in the genome of American comics—a strange symbiotic connection between sequential graphic narrative and the decidedly non-Hollywood stories of the modern illnesses that have emerged front and center as modern medicine has corralled so many of the plagues and epidemics that long notched the tree of human history. And it makes good historical sense in terms of the understanding of chronic illness as simultaneously a profoundly individuated story and one requiring, as Green put it in 1972, the entwinements of shared stories, that graphic autobiography has emerged as such a crucial tool in conveying these stories.

What follows is too numerous, to thick to recount in detail. Shortly after he first saw Green’s pages for Binky Brown, Art Spiegelman began working in autobiographical comics and on Maus—a story of depression and the multi-generational impact of both the global historical trauma of the Holocaust and the deeply personal trauma of a mother’s suicide. In the late 80s, Al Davison began publishing his story of growing up with spina bifida in his graphic memoir The Spiral Cage, while the 1990s brought us Harvey Pekar and Joyce Brabner’s Our Cancer Year. And by the turn of the 21st century, it was as if a cork had come off the bottle: graphic medicine memoirs were suddenly everywhere, a great many of them addressing chronic illnesses and disabilities, ranging from depression, bipolar disorder, OCD to herpes, Crohn’s, lupus and anorexia. And we are just getting started.

Beth Hewitt will be talking on Saturday about a couple of recent graphic narratives about chronic illness, Julia Wertz’s Infinite Wait and Jeffrey Brown’s Funny Misshapen Body, so I will leave those gems to her. I want to end by turning briefly to a recently self-published narrative about living with IBS, or irritable bowel syndrome, one of a number of chronic illnesses that add insult to injury in their acts of naming—as if the primary condition of IBS was irritability or the overwhelming concern of CFS was fatigue. These names, like the metaphors Sontag decries, impact the way in which diseases are perceived and treated—not to mention gendered. And a narrative like Joy Spencer’s brave and uncompromising Chronically Me is a bold refusal of such attempts to write off her decades of pain, suffering and shame as “irritability.”

Like the comic strips of a century earlier, Spencer’s Chronically Me is not about triumphing over adversity—and all attempts to defeat IBS over the course of decades prove as futile as Happy Hooligan’s attempts to do the right thing. Following in the spirit of Miriam Engelberg’s Cancer Made Me a Shallower Person, Spencer ultimately rejects the promise of deeper meaning and cosmic structure. But where Engelberg’s book ultimately ended when the course of her cancer made it so that it could not go any further, Spencer’s story continues—and almost 30 years since the onset of her disease, despite countless interventions from modern and alternative medicine, precisely nothing has changed at book’s end. She offers no promise of release or relief, only the promise that is graphic memoir—that in telling your story, even a story that goes nowhere, there is fellowship, entwining. As Spencer puts it here, the book serves for her as a connection to “other sufferers” so they “will know they are not alone.”

This is the balance of graphic illness testimony: the balance of reaching out with our stories not so that someone else sees their story told by another. Chronic illness, after all, is like a really painful, sucky snowflake: each one is profoundly unique—which is but one of the reasons of why it confounds evidence-based modern medicine. No, we reach out through this form so that we can hear another’s story and fill in our own as comics invariably commands us to do—so that we don’t isolate in our own “feedtube,” as Green put it in 1972, but lock arm in arm, cane in chair, and entwine the globe in our stories so that we can find finally the balance to move forward into the 21st century together.