(Full version of academic acticle for CIMVHR 2017, related web-article here.)

From Villains to Superheroes:
The use of graphic novels in promoting resiliency
​and supporting recovery from military traumatic exposure.
​
Belinda M. Seagram, Ph.D., Seagram & Associates
Martin R. Crawford, Fuel Graphics, Artistic Director

Introduction
A decade of conflict in Afghanistan and Iraq has caused a substantial mental health burden for veterans and their families, with post-deployment rates of PTSD averaging 10-20% (Hoge, 2011).  The Stranger Returns comic book series is a specialized tool, intended to provide support and education for service members, veterans and their families who are coping with the effects of Operational Stress Injuries.  Therapists and treatment centres may also use this series as a resource, to help reinforce and consolidate core therapeutic principles.
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Memory challenges faced by those experiencing PTSD

• Memory dysfunction is both a pre-existing risk factor for the development of PTSD as well as a consequence of the disorder (Samuelson, 2011).
• Individuals diagnosed with PTSD are thought to have developed memories that come back as emotional and sensory states with little verbal representation (van der Kolk, 1996).
• Fear and exposure avoidance also serve to impact access to and recall of traumatic events.  Thus, development of an understanding of events, sequencing, meaning and interpretation are all important stops in the recovery process (Zoellner & Bittenger, 2004).
• Therapeutic resources and support materials should take into account neuropsychological deficits related to PTSD (Samuelson, 2011).

Why Choose Graphic Novels as an Aid in the Recovery from PTSD?
Use of a comic book style format is intended to create a user-friendly interface for dissemination of key educational and therapeutic materials. Paper and animated digitized versions will be available, offering a wide array of formats to increase the likelihood of comfort of fit for injured members veterans and their families. An engaged reader will re-read comic books or review digital animations, assisting with the goal of memory consolidation of content materials.  

Graphic Novels: An Adaptive Strategy for Responding to Learning Differences and Individual Needs

• Despite individual learning style differences, traditional psychotherapy tends to be talk-based.
• Education research demonstrates that visual learners remember best what they see: diagrams, sketches, flow charts or other visual representations of material being presented; whereas verbal learners benefit more from written and spoken explanations (Felder & Soloman, 2007).
• Graphic novels are increasingly being integrated into educational curriculums. They reinforce left-to-right sequencing, and for weak language learners or those struggling with memory or verbal comprehension issues, concise text paired with detailed images helps readers to decode and interpret text.  The pairing of words and images gives learning a boost by creating new memory pathways and associations (Jaffe, as cited by Alverson, 2014).  
• For visual learners, graphic novels provide an alternative and complementary method of information delivery, removing barriers that might otherwise be present in accessing information.
• Aesthetically pleasing, high quality graphics and an engaging storyline are designed to mitigate avoidance tendencies, providing an effective alternative to traditional therapeutic modes of communication.  
• The addition of sound effects and movement in the digitized version, and presentation of materials in a non-verbal format  is intended to promote right brain processing of deeply embedded, often fragmented, heavily emotionally-laden material.

Comic Books as a Powerful Medium for Education and Social Change

• Comic books have historically played powerful roles in promoting resilience, reinforcing social values, and mitigating the effects of trauma.  
• They allow the reader not only to enjoy the experience, but also to learn or be inspired.
• The use of “heroic moments”(Russell & Leslie, 2012) is a tool employed to define the character of the protagonist, instigating change and embodying empowerment, usually in the name of social justice.
• During WWII Captain America emerged during this time as a “Golden Boy” figure who embodied traditional American values.  
• After the atomic bombings in Japan in 1945, comic book heroes emerged with radiation-gained powers
• The September 11, 2001 terrorist attacks had a profound effect on the comic book industry, with stories focusing more on “American” values and images of American patriotism (Ibid).  
• An opportunity exists to remove the stigma of operational stress injuries, bringing PTSD into the forefront of public awareness and increasing general support for those struggling with this condition.

The Reluctant Hero

• Batman, Wolverine and The Shadow serve as examples of comic book characters that play the role of the reluctant hero.  Their dark histories, tragic backgrounds and tortured internal lives contain elements of darkness, exemplifying the loneliness and social exclusion that often accompanies the hero role.
• Many military members suffering the effects of PTSD feel shameful about their condition. A dark internal life can create feelings of isolation, alienation and despair.  Many do not know what is happening to them, or how to get help. In many ways, they may feel as though they have “lost their power”.

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The Making of a Hero:
In the comic book literature, superheroes typically possess a number of traits:

• Extraordinary powers or abilities, exceptional skills and/or advanced equipment
• Strong moral code, including a willingness to risk one’s own safety in the service of good without an expectation of reward.  Such a strong code often includes a refusal or strong reluctance to kill or wield lethal weapons
• Motivation, such as a sense of responsibility, a formal calling, a personal vendetta against criminals, or a strong belief in justice and humanitarian service.
• A secret identity that protects the superheroes friends and family from becoming the targets of his or her enemies
• A distinctive costume, often used to conceal the secret identity
• A supporting cast of recurring characters who may not know the superheroes secret identity: thus the existence of a dual life.
• Independent wealth or an occupation that allows for minimal supervision
• A secure base of operations
• A backstory that explains the circumstances by which the character acquires his or her ability and motivation for becoming a superhero (Wikipedia, 2017).

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Real Life Heroes and Injury

• Equipped with specialized training and equipment, military members are deployed on missions hopeful that they might make a significant contribution or be a part of meaningful social change.  
• They possess a willingness to risk their own safety in the service of other’s, and are guided by values of honor, leadership, loyalty, integrity and commitment.
• Trauma, for many, often takes the form of profound disillusionment as many service members experience a sense of powerlessness, futility or hopelessness as they are exposed to conflict zones or situations in which the values and norms witnessed exemplify the basest form of human behaviour.
• Trained to act, a significant internal crisis can occur when these service members are prevented or unable to act or make meaningful contributions when required.  In the worst case scenario, they are asked or forced to do things that conflict with strongly held internal values.  As a result, the internalized dreams of hero disintegrate and a darker self-concept emerges.
• On returning home, many injured members are hesitant to discuss or share the nature of their internal injuries.  
• A secret identity may develop that is kept hidden from family and friends.
• This “enemy within” is not consistent with the person the military member set out to be.
• Friends and family might complain that a “stranger” returned home from deployment.  
• Released from the military due to injury, a structured and highly regulated life is replaced with minimal supervision or peer interaction
• Emotional, spiritual, philosophical and existential harm may serve to create a divide between the injured member and those they are closest to.  
• This comic book series is written with the explicit goal of assisting those suffering the effects of Operational Stress Injuries in recovering from these more invisible wounds.

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The Reluctant Hero’s Journey:

• This PTSD comic book series entitled “Stranger Returns” starts with book one “The Enemy Within.”  
• In this first installment, the reader is introduced to Jay, a format combat veteran who has lost his sense of meaning, power and purpose, following deployment to Afghanistan.  
• On the encouragement of his wife Lindsey, Jay ventures out from his basement sanctuary, only to be reminded of the extent of his injuries, and the vulnerability associated with his condition.
• A chance encounter with a helpful stranger, Dave, who is also a veteran, helps Jay emerge from his predicament with his battered ego relatively intact. Like a hero who has lost his powers, Jay has little sense of his bearings.  The reader walks with Jay, experiencing the world through his eyes, as Jay begins the journey of recovery.
• Family members and friends of Jay also have a first person perspective of the impact of PTSD on their loved one.  

Embedded within an engaging story, the first comic book of the Stranger Returns series “The Enemy Within” conveys the following information:

• Recognizing symptoms of PTSD
• Reducing sense of isolation
• Providing hope that recovery is possible
• Staring to lay the groundwork for recovery

The second book “From Hero to Zero,” the reader learns more of Jay’s backstory, better understanding the internal demons he faces.  This book covers the following core therapeutic principles:

• Understanding that avoidance prolongs injury
• Window of tolerance and Central Nervous System activation
• Introduction to the concept of pacing
• Understanding the causes of PTSD, and first steps necessary in order to move forward.

There are an intended six installments to this series, with subsequent editions focussing specifically on the following topics: steps to recovery; the unique experiences of female military members; families of members; and Vietnam veterans.

Summary
This book is the first of a series of graphic comics aimed at addressing the isolation, alienation, and confusion experienced by those suffering the effects of PTSD.  The goal is to meet the veterans where they are at, capitalizing on a user-friendly interface to convey useful information critical to recovery.  This adaptive approach has been designed to mitigate avoidance tendencies, ease comprehension, and allow for an enjoyable and engaging experience. Presentation of materials in a non-verbal, sequential format is intended to aid in the development of an understanding of the events, sequencing, meaning and interpretation of the factors that contributed to the injury.  These are all critical steps in the recovery process. The first release of this series is in paper format.  An interactive, digitized animated version will be released within the year.
References:

Alverson, B. (2014), Teaching With Graphic Novels, School Library Journal, September 8, 2014.  Retrieved on August 6, 2017 from http://www.slj.com/2014/09/books-media/the-graphic-advantage-teaching-with-graphic-novels/

Felder, R. M , & Soloman, B. A. (2007). Learning styles and strategies. Retrieved on August 6, 2017, from
http://www4.ncsu.edu/unity/lockers/users/f/felder/public/ILSdir/styles.htm

Hoge, C. (2011), Interventions for war-related Posttraumatic Stress Disorder: Meeting veterans Where they are at, JAMA, 306(5) 549-551.

Magnussen, Anne, and Hans-Christian Christiansen. Comics & Culture: Analytical and Theoretical Approaches to Comics. Museum Tusculanum Press. 2000 Google Scholar. Web.

Russell, C. and Leslie. P. (2012), Heroic Moments: A study of comic book superheroes in real-world society.  Honours Seniors Thesis.  Explorations, Social Science, pp. 121-131.
http://uncw.edu/csurf/Explorations/documents/russell.pdf

Samuelson, K.W., Post-traumatic stress disorder and declarative memory functioning: A review, PMC Free Article, PubMed.

Van der Kolk,B.(19xx), The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

Wikipedia, Superhero, https://en.wikipedia.org/wiki/Superhero

Wild, J. Gur, R.C. (2008), Verbal memory and treatment response in post-traumatic stress disorder. Br J Psychiatry. 2008 Sep;193(3):254-5.

Zoellner, L. A., & Bittinger, J. (2004). On the uniqueness of trauma memories in PTSD. In G. Rosen (ed.), Posttraumatic stress disorder: Issues and controversies. NY: John Wiley, Inc. 


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