National Institutes of Health

Graphic Medicine & Mental Health

7-10
Health Education
Three 45-minute class periods

Description: Students explore the graphic novel format used for personal stories of illnesses, known as graphic medicine.

In class 1, students review the online exhibition, Graphic Medicine: Ill-Conceived & Well-Drawn! and excerpts from a graphic memoir by Ellen Forney, Marbles: Mania, Depression, Michelangelo, and Me. With a guided visual analysis activity, students examine the complex interplay between subjective experiences of mental illness and clinical descriptions of a disorder. In class 2, students work in pairs to learn about the causes, symptoms, and treatments for depression and bipolar disorder. They also create a graphic to communicate their findings. In class 3, students assess how effective textual and graphic formats are for sharing information about and destigmatizing mental illnesses like depression and bipolar disorder.


At the end of this lesson plan, students will be able to:

  • Define graphic medicine.
  • Describe at least two symptoms of and treatments for depression and bipolar disorder.
  • Use reliable health information websites to research and produce accurate written and visual statements about depression and bipolar disorder.
  • Form their own perspectives on the strengths and weaknesses of visual and textual formats in communicating emotional and research-based information.
  • Identify language or iconography that stigmatizes bipolar disorder and/or mental illness.

Graphic Medicine: Ill-Conceived & Well-Drawn! presents artwork at the intersection of comics and health care. This online exhibition features several works that demonstrate how artists working in the field of graphic medicine create complex, emotional stories about injury, illness, and caregiving by employing words, images, and symbols—i.e., in comic format. Teachers are encouraged to preview the exhibition website and become familiar with the following online resources that support this lesson’s class activities:

Special Considerations: Teachers should prepare students for discussing sensitive topics such as depression and bipolar disorder. The class can review existing school guidelines on talking about sensitive topics; or may establish shared expectations for discussing and treating mental health issues respectfully, empathetically, confidentially—i.e., what is shared in the classroom stays in the classroom, how and why we need to avoid stigmatizing mental illness, as well as use of person-first language that first puts the person then the condition—for example, a “person with bipolar disorder,” and not a “bipolar person.” For specifically addressing the importance of avoiding stigmatizing language and examples, teachers may ask students read and discuss the online article, “Mental Health: Overcoming the Stigma of Mental Illness.”

Classroom conversations about mental illness can touch on sensitive, troubling, or confidential aspects of a student’s life. Teachers may want to have information about mental health services available for students in need.

The following words may be introduced/incorporated into the lessons. If additional guidance and current definitions are needed for the terms listed below, teachers may find them in the websites included in this lesson plan.

  • Mood disorder, bipolar disorder, bipolar I, bipolar II, manic depression, depression, mania, cyclothymia, unipolar depression, dysthymia, mental health, chronic, acute
  • Psychiatrist, psychologist, mental health therapist, social worker, psychotherapy
  • Medication/“meds,” lithium, self-medicating, self-care, pharmaceuticals, prescriptions, side-effects
  • Graphic novel, comic strip, panel, frame, infographic, memoir
  • Stigma

Handouts:

  • “What is a ‘Mood Disorder’ anyway?” (PDF), p. 59 excerpt from Marbles: Mania, Depression, Michelangelo, and Me
  • Four Excerpts (PDF), from Marbles: Mania, Depression, Michelangelo, and Me
  • See, Think, Feel, Wonder (PDF, Word); Teacher’s See, Think, Feel, Wonder (PDF)
  • Two Ways of Showing (PDF, Word)

Other Materials and Set-Ups:

Preparation: Post “Mental Health” and “Graphic Novel/Comics” labels on two separate display boards or walls. List under each label its corresponding questions listed below, providing space by each question for placing several sticky notes.

Mental Health
  • What do you think it means to say someone has a mental illness?
  • What does depression mean to you?
  • How do you define mental health?
Graphic Novel/Comics
  • What was the last comic book, comic strip, or graphic novel you read?
  • What do you like most about graphic novels?
  • When you read a graphic novel, do you pay more attention to the words or the drawings?
  1. Begin with an entry ticket exercise to gauge students’ base level understanding of mental illness and graphic novel. As students enter class, provide them with sticky notes and ask them to write a short response to one of the posted questions.
  2. Have students post responses (sticky notes) by their corresponding questions. Read aloud and review students’ responses as a class. During this short discussion, correct and extend student responses to ensure accurate understanding.
  3. Display Graphic Medicine: Ill-Conceived & Well-Drawn! and explain that there is a comic genre called graphic medicine. Read aloud from the display: “Graphic medicine is the use of comics to tell personal stories of illness and health.” Tell students that graphic medicine can inform readers about what it is like to live with and manage an illness.
  4. Show students “Marbles: Mania, Depression, Michelangelo, and Me” in the exhibition website then introduce its author and artist, Ellen Forney, by reading aloud the narrative. Tell students that Forney describes her experiences as a person with bipolar disorder using words and images in her graphic medicine memoir.
  5. Distribute copies of “What is a ‘Mood Disorder’ Anyway?” Ask students to turn to a neighbor and work together to understand the five types of mood disorder (by the stars) based on what they can read and see on the page.
  6. While students are working in pairs, write the five mood disorder types on the board. When they are done discussing, ask students to provide their understanding of each term. Follow up with questions like:
    • How did you come to that?
    • What in the writing or drawing brought you to that conclusion?
    • Why did the writing/drawing lead you to that conclusion?
  7. Tell students that Forney describes her experiences of living with her bipolar disorder in Marbles. Explain that studying selected images from her book will offer them insights into what it is like to live with and treat dipolar disorder and/or depression.
  8. Group 3 to 5 students together and assign each group one excerpted image from the Four Excerpts handout from Marbles. Distribute copies of the See, Think, Feel, Wonder worksheet to all students. Review the worksheet as a class and clarify any questions before groups start their See, Think, Feel, Wonder activity.
  9. Project the images from Four Excerpts and call together the class. Viewing each, ask groups to share observations on their assigned images—i.e., We saw…, We thought…, We felt…, We wondered…
  10. Record groups‘ “We wonder…” statements as questions on the board then collect the See, Think, Feel, Wonder worksheets for evaluation. Tell students that the listed “wonder” questions will guide their research in the next class.
  11. Class 1 Evaluation: Students‘ entry tickets are used to assess their existing knowledge or assumptions to inform teachers about appropriate remediation activities as needed. Teachers also use the See, Think, Feel, Wonder worksheet to evaluate students’ visual and health information literacy, as well as to address any misconceptions or stigmatizing of people with mental illness.

Preparation: Prior to the class session, review students’ “wonder” questions from Class 1 and list 3–6 of them that are appropriate topics for students to research during this class. For example, a wonder statement, “we wonder if she gets back to the dock?” can be reframed as a research question, “we wonder how people with bipolar disorder are treated. Do they ever recover?” Sample research-focused questions may include:

  • What causes depression? Bipolar disorder?
  • What are the symptoms of depression and those of bipolar disorder?
  • How are depression and bipolar disorder diagnosed?
  • What kinds of treatments are available for depression and bipolar disorder?)
  1. Return students’ See, Think, Feel, Wonder worksheets and summarize some of the most common or most relevant questions.
  2. List 3 to 6 questions from the “wonder” statements. Tell students they will work in pairs to find research-based answers to those questions—e.g., causes, symptoms, and treatments. Explain that they are to report on their findings in two different forms—text and drawing. Display and introduce to students MedlinePlus websites and online PDFs from the National Institute of Mental Health on depression and bipolar disorder below: If needed, use these websites to model how to evaluate whether a website offers reliable, evidence-based health information.
  3. Distribute a Two Ways of Showing worksheet to each student, and review it as a class. Clarify any questions students may have, and explain that each student needs to complete the worksheet although they are working as a pair of researchers.
  4. While students work in pairs, observe how students locate and process information on the websites and provide guidance as needed. Afterwards, call the class together and ask some students to volunteer their findings.
  5. Collect students’ worksheets and let students know that they will present their findings to the class in the next session and will have time to prepare for that at the start of class.
  6. Class 2 Evaluation: Teachers can use observations of students’ pair-research work and the completed Two Ways of Showing worksheets for assessing how students identify and summarized the information that address specific questions.

  1. Return to students their completed Two Ways of Showing worksheets with corrections or notes.
  2. Use the “jigsaw” method to form pairs where each member worked on a different research topic. Students should take a few minutes to explain their findings to each other and answer any questions from their new partner.
  3. Allow students to update or edit their worksheets, then post them on class walls or display boards. Have students walk around and look at other students’ worksheets.
  4. Call the class together and ask students to reflect on what they viewed. Have students volunteer to complete the following prompts:
    • One thing I learned from others’ work is…
    • Graphic medicine uses both text and drawing. Text works well for… and artwork works well for…
  5. Display 5 images—i.e., “What is a ‘Mood Disorder’ anyway?” and Four Excerpts—from Marbles: Mania, Depression, Michelangelo, and Me. Ask students how these images communicate both personal—i.e., Ellen Forney—experiences and facts of living with and treating bipolar disorder. Record students’ reflections and summarize how Graphic Medicine offers different ways to share and understand multiple aspects of dealing with an illness.
  6. Show students the “Exhibition Collection” web page in Graphic Medicine: Ill-Conceived & Well-Drawn! Tell students that there are many graphic medicine titles that share and inform patients, caregivers, and health professionals about experiences with health and illness.
  7. Assign students homework to review the Graphic Medicine’s “Exhibition Collection” then write a brief article about the online exhibition for a school newsletter, or create a short comic that explains what graphic medicine is to other students.
  8. End the class with an exit ticket where students complete these prompts: I used to think…; But now, I think… Collect students’ exit tickets.
  9. Class 3 evaluation: Teachers can assess students’ pair discussions, presentations, and class discussions to assess their progress in understanding how the comic format can reveal personal experiences of illnesses and health care. Also, teachers can continue to address any misunderstandings or use of stigmatizing language. The exit ticket gives students the opportunity to reflect on the whole lesson, and the instructor a sense of the big take-aways for each student. The homework assignment provides the instructor with evidence that students reviewed the exhibition and can explain the concept of graphic medicine to a peer.

  1. Students create short, graphic biographies of prominent people with depression or bipolar disorder. In this extension activity, students apply insights into the strengths of graphic medicine to reduce the stigma around mental illness by learning about people who successfully manage their illness. To identify possible subjects, students may want to review the NIH MedlinePlus Magazine article “Depression Strikes…Anyone.” Students may hand-draw their comics or use any number of online comic book creation tools.
  2. Students read an entire, age-appropriate graphic medicine book and create a book review in comic format. Some possible titles are:
    • El Deafo, Cece Bell, 2014
    • Wonder, R. J. Palacio, 2012
    • Stitches: A Memoir, David Small, 2010
    • Epileptic, David B., 2005
    Teachers are strongly encouraged to review materials to ensure appropriateness for their students, school, and community.

History/Social Studies
  • CCSS.ELA-LITERACY.RH.6-8.5: Describe how a text presents information (e.g., sequentially, comparatively, causally).
  • CCSS.ELA-LITERACY.RH.6-8.6: Identify aspects of a text that reveal an author’s point of view or purpose (e.g., loaded language, inclusion or avoidance of particular facts).
  • CCSS.ELA-LITERACY.RH.6-8.7: Integrate visual information (e.g., in charts, graphs, photographs, videos, or maps) with other information in print and digital texts.
Speaking & Listening: Comprehension & Collaboration
  • CCSS.ELA-Literacy.CCRA.SL.6-8.1: Prepare for and participate effectively in a range of conversations and collaborations with diverse partners, building on others’ ideas and expressing their own clearly and persuasively.
  • CCSS.ELA-Literacy.CCRA.SL.6-8.2: Integrate and evaluate information presented in diverse media and formats, including visually, quantitatively, and orally.
Science & Technical Subjects
  • CCSS.ELA-LITERACY.RST.6-8.5: Analyze the structure an author uses to organize a text, including how the major sections contribute to the whole and to an understanding of the topic.
  • CCSS.ELA-LITERACY.RST.6-8.7: Integrate quantitative or technical information expressed in words in a text with a version of that information expressed visually (e.g., in a flowchart, diagram, model, graph, or table).
  • CCSS.ELA-LITERACY.RST.6-8.8: Distinguish among facts, reasoned judgment based on research findings, and speculation in a text.

  • 3.8.1: Analyze the validity of health information, products, and services.
  • 3.8.4: Describe situations that may require professional health services.
  • 8.8.4: Identify ways in which health messages and communication techniques can be altered for different audiences.
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