When she discovered she had breast cancer, Miriam Engelberg moved quickly -- toward the remote control.

"I did what I always do when faced with something difficult," she wrote over an illustration of herself perched on a chair. "I turned on the TV."

Fortunately, Engelberg didn't stop there. She kept drawing, and in 2006 Harper released a paperback version of her moving, hilarious 126-page graphic memoir, Cancer Made Me a Shallower Person.

Breast cancer isn't usually a laughing matter -- Engelberg herself died from complications from cancer on Oct. 17, 2006. But increasingly, serious health issues have invaded comic books. In addition to Cancer Made Me a Shallower Person, 2006 also saw the publication of Mom's Cancer, a comic art memoir released by Abrams Image and Cancer Vixen, an illustrated account of the author's battle with breast cancer, from Alfred A. Knopf.

With the wide appeal of movies like Ghost World and American Splendor, which were based on graphic novels by cartoon heavyweights Daniel Clowes and Harvey Pekar, literary comic books based on serious, real-life concerns are long overdue, according to graphic novel experts.

"Comics have been relegated [to] a junk medium for so long. It's taken a while for society at large to accept that comics should be taken seriously," says Michael Kobre, a professor in the English department at the Queens University of Charlotte in Charlotte, North Carolina. Kobre teaches a course in graphic novels and pop culture at the university.

In recent years, however, graphic novels have gained literary respectability. It's been more than a decade since Maus, Art Spiegelman's graphic account of a Holocaust survivor, won a Pulitzer Prize in 1992. In 2003 Marjane Satrapi's Persepolis, a cartoon memoir about life in Iran during the Islamic revolution, drew widespread acclaim. In 2006, a graphic novel about growing up in two worlds by Asian American cartoonist Gene Yang was nominated for a National Book Award.

What's different about the new crop of graphic memoirs is that they come illustrated with cartoons that explore health issues like brain tumors, lung cancer, emotional abuse, epilepsy, and depression. They range from Our Cancer Year, by Harvey Pekar and his wife Joyce Brabner, to Pedro and Me, in which Judd Winick chronicles his friend Pedro Zamora's battle with HIV on MTV's The Real World.

In 2006 the industry grew 12 percent to $330 million, according to book publishers and booksellers who attended a February 2007 conference on graphic novels in New York. One reason for the past five years of double-digit growth in graphic novels, participants said, was an increase in female readership for illustrated nonfiction and memoirs like Cancer Vixen and Mom's Cancer.

"It's been kind of a boy's club for the last 30 or 40 years," says Milton Griepp, the CEO of ICv2, which sponsors the graphic novel conference. Griepp, who watches trends in pop culture, said the new readers of graphic novels are women who want characters like themselves.

"Cancer Vixen and Mom's Cancer both have females as primary characters," he said. "They're not superheroes. And superheroes tend to be a male genre."

Anticipating an upcoming boom in graphic novels, mainstream publishing houses have established divisions devoted exclusively to producing high-quality graphic literature. Among them is Hill and Wang, Farrar Straus and Giroux's imprint, which in 2006 published The 9/11 Report: A Graphic Adaptation. Even the New York Times has come on board, describing French cartoonist David B.'s memoir Epileptic, for example, as "graceful," "moving," and "magnificent."

Another reason for the appeal of graphic novels is that they can convey certain aspects of a disease better than prose, particularly when a book is printed only in black and white. Cartoonists can diagram body parts, exaggerate and distort facial expressions, and write dialog boxes that often convey psychological and emotional states better than prose. "It's an easy way to convey information," Kobre says.

When Rosalind B. Penfold told her story of love and emotional abuse in her graphic memoir Dragonslippers (Grove Press, 2005), she used a simple black-and-white style. Penfold said her self-portraits represent the way she envisioned herself at the time.

In one series depicting a visit to a doctor's office, Penfold, looking like a child, sits on a table awaiting an abortion. In the next frame, she appears to be slightly older, but still a teenager. In the third panel, after she's received an abortion, she depicts herself as an adult.

"All of this was unconscious," she writes later in the book.

Enter Cancer Vixen. With striking artwork and four-color cartoons on each page, it chronicles a love story interrupted by a cancer diagnosis. The memoir, by cartoonist Marisa Acocella Marchetto, is entertaining, irreverent, and sometimes tragic. Marchetto's journalistic approach sets her memoir apart: To ensure accuracy, she copied her medical charts, took dozens of photos, and recorded every conversation she had with her doctors, nurses, surgeon, and oncologist. The result is a cancer memoir as educational as it is engaging.

Breast cancer cells appear as unhappy green blobs, some sticking their tongues out in anger, and others giving the finger. In other frames Marchetto creates the Cancer Guessing Game, a twisted kind of Monopoly board on which, no matter where you go, there's no way to win. Each space a player can land on involves moving backward rather than forward. One space on the board shows a lighted cigarette with the words "I smoked and now I have breast cancer… coincidence? Move back 7 spaces." Another space says, "My mother had breast cancer. Do I have the gene?" Move back 6 spaces."

The author delivers a real sense of what her life was life was like "B.C." -- before cancer: Hanging out with her fiancé, a celebrity restaurateur who owns DaSilvano, drawing cartoons for The New Yorker, and getting assignments on such things as how much money it takes to be an "It" girl. Until the day she discovers she has cancer, Marchetto admits, her life was "caught up in superficial, stupid stuff." Indeed, some readers may not want to know all about this "It" girl's shoe rack (unless you come from Milan you may not be up-to-date on the latest Guiseppe Zanotti slingbacks), what she eats at each delectable meal, or what kind of wig or extensions she should use to disguise hair loss after chemotherapy.

Unfortunately, Marchetto's penchant for the superficial may put off readers who might otherwise benefit from her remarkable journey. The artist shines when she chronicles what happens to her "after cancer" in cartoons, from her difficulties undergoing chemotherapy to the trials of working while afflicted with "chemo brain" and her fear that a younger, healthier woman will steal her boyfriend. And many women may identify with her determination to keep some glamour in her life "A.C." -- such as buying new shoes to distract herself from the horrors of chemotherapy.

"I didn't want to focus on the IV in my hand, so I'd look down at my feet and give myself a little shoe therapy. My thought was, yeah, this needle sucks, but what a pretty pair of shoes," she said in one interview.

Marchetto wasn't the only one having a good year in 2006. Brian Fies' graphic memoir Mom's Cancer was nominated for a Quill Book Award, sponsored by the parent company of Publisher's Weekly. The year before, his online series about his mother's cancer, which preceded the book, won an Eisner Award for Best Digital Comic.

In 2004, Brian Fies had begun drawing Mom's Cancer as a serial on the Internet, at first detailing his mother's treatment for a brain tumor and then for lung cancer. As his drawings progressed, he realized he might have the material for a book. He also changed his mind about what kind of style to use.

"My first inclination was to draw a dark graphic -- every page dripping with a foreboding feeling. Then I realized that wasn't our life," he says. "We had a tremendous sense of humor about this. Sometimes we'd be in the doctor's office and laughing so loud that we'd be disturbing the other patients."

Fies says he intentionally drew his family in a simple style so that readers would identify with what his family experienced. None of his family members even have names. They're identified only as Kid Sis, Nurse Sis, and Mom.

Before the book was published, thousands of readers followed his mother's progress in a blog she wrote on her son's Web site. In an epilogue to the book, Fies finally identified his mother as "Barbara" and talked about her death in October 2005.

"Mom always sought purpose in her life and, in her last months, her suffering. She shared in the production of Mom's Cancer: the drafts, proofs, correspondence with my publisher and the public," he wrote only a few days after she died. "Nothing made Mom more proud or happy than hearing from people who said they'd quit smoking because of her or that her story had given them hope. Hope is never in vain. She told me she thought she'd found her purpose after all."

This kind of sentiment is hard won. Many readers will be gratified to see that graphic novels explore the messy and all-too-human fallout from a cancer diagnosis -- including its impact on families -- that is missing from glossy pages of a hospital handout.

In one chapter of Mom's Cancer, for example, Fies assumes a comic-book style and draws himself and his sisters as superheroes locked in battle, sporting tights and shooting beams from their fists like lasers. These scenes were an attempt to capture the many clashes that erupted around his mother's medical treatments, Fies said.

Graphic novels about health issues won't replace medical books and hospital brochures. They won't help readers decide on a course of cancer treatment or whether to seek psychotherapy. But they may offer invaluable support and solace for readers who want a breather from the grueling ordeal of treatment.

"One might no longer feel as though on an island of despair after reading this comic-format book," a North Carolina reader writes on Amazon's web site after reading Engelberg's memoir. "It is a charming and witty and yet soberingly realistic look at life with cancer. And it also [is] a wonderful comic-relief from some of the (often times quite frightening) issues and concerns of having cancer. It helps one realize that many others in the same boat are having the same feelings."

Of course, graphic memoirs aren't for everyone, Fies says. "There's some subsection of the public that won't read comics," he says. "They don't get it. There's nothing I can do. "

But others feel that comic art can say it more poignantly than words, Fies says. Since the publication of Mom's Cancer, Fies has heard from many grateful readers: A doctor told him it helped him provide end-of-life care for terminal patients. A professor at a nursing school in Australia mailed it to student nurses in the outback to help them deal with families of people who have cancer. And many others have written to share how much they identified with his family's ordeal with cancer treatment.

"That's the power of cartooning," he says.

-- Psyche Pascual is a former staff writer for the Los Angeles Times. She serves as executive editor at Consumer Health Interactive.

References

First published March 12, 2007
Copyright © 2007 Consumer Health Interactive