Javier A Suarez will complete a movement disorders fellowship at the University of Minnesota in summer 2025. He received an MD degree from Feinberg School of Medicine and completed neurology residency at Mass General Brigham. His clinical interests include the management of movement disorders with deep brain stimulation. Suarez, who is an avid reader of comics and graphic novels, has presented work on the neurology of comics at the American Academy of Neurology Annual Meeting.
Parkinson’s disease (PD) is a progressive neurodegenerative condition clinically identified by the hallmark features of shaking, stiffness and slowness. PD is also marked by a multitude of non-motor symptoms like constipation, cognitive changes and sleep disorders. Any number of symptoms and intensities can exist in each patient, leading to a remarkably heterogenous patient population. While effective symptomatic treatments exist, the only known means of quantitatively slowing progression to date is exercise, specifically cardiovascular exercise that increases heart rate (1).
Simply counseling patients to exercise more, however, often falls flat in the face of the overwhelming weight of the very term “exercise.” For patients who are accustomed to being active, the slowing induced by PD can feel like a screeching halt, and they are often disheartened by the change in their abilities. Those who are not used to regular exercise can feel bewildered and intimidated by the thought of taking on a new endeavor on top of the way their lives have been upended by the disease. Neurologists often partner with physical and occupational therapists to help with prescribed exercises for gait and strength, but these rarely engender excited motivation.
Enter Lisbeth Frølunde, Maria Bee Christensen-Strynø, and Louise Phillips, a group of researchers from Roskilde University in Denmark who set out to investigate dancing as a therapeutic intervention for Parkinson’s disease. They worked with a multidisciplinary team at Roskilde University, Tivoli Ballet School and the Parkinson’s Association in Denmark on a project called “Dancing with Parkinson’s” that took place from 2019 to 2022. The stated aims of the project were “to create research-based knowledge about, and further develop, dance as a form of collaborative, person-centered treatment of Parkinson’s and other diseases” and “to provide research-based knowledge about, and further develop, collaborative, participatory research in which people outside the university and university researchers co-produce knowledge.” They explored these aims by creating a series of dance classes designed to meld the physical, emotional and spiritual benefits of creative expression through movement, and then taking a narrative approach to exploring patient experiences.
They then took their many encounters and transformed them into an anthology titled Moving Along: A Co-Produced Graphic Novel about Parkinson’s Dance (Medical Humanities: Criticism and Creativity Book 2. Peter Lang Ltd, International Academic Publishers, 2022). The book is structured as a series of narrative vignettes highlighting single patients and/or their partners. It describes, in written form, details of the research project and their findings along with an exploration of themes found within patient narratives.
Read the book if you are interested in learning more about the technical aspects of the study. This review, however, reviews and highlights the comic portion of the book with special attention to how the comic medium in general and the style of illustrators Clara Jetsmark and Thomas Vium in particular accentuate the impact of Parkinson’s dance in patients’ lives.
One of the first style choices that stands out for me as an avid reader of comics and graphic novels is the coloring used. The entire book uses shades of blue and orange, with white and black serving primarily as outline, highlight and texture. The motivation for this color scheme is not explicit, but one can speculate. Blue and orange are complementary on the classic color wheel, with red/green and purple/yellow being the other pairings. These pairings create strong contrast and work to clearly demarcate objects and separate foreground from background. However, one can imagine seeing red/green and purple/yellow as the sole colors in a book becoming harsh and less appealing to the eye over time, even with the softening and slight graying of the hues used by Jetsmark and Vium.
In addition, the balance of blue and orange in a given scene can evoke warmth or cool, and are naturally occurring in the sun and sky. These feats are not so easily achieved with other complementary color pairings. Jetsmark and Vium manage to imbue a richness and immediate readability to every scene, enhanced by their style’s relative simplicity. One of the character vignettes sees a man named Hugo with PD in a team rowing race. His symptoms interfere with proper technique, and orange is used to accentuate the intensity of Hugo’s struggle with the water. The amount of orange in the background increases along with Hugo’s effort in successive panels. Scenes do not suffer for having colors that do not match reality; instead emotion and themes are brought to the forefront and made all the more recognizable.
Likewise, the simplified coloring works with the highly iconic style chosen by Jetsmark and Vium. Characters and objects are uncomplicated in their construction with enough unique linework to easily distinguish each character from the others. The use of lines in the extra-personal space to depict movement is similarly excellent, leaving readers with a keen sense of directionality and intensity of movements, even subtle ones. Depicting movement in a comic about Parkinson’s dance is nothing less than paramount to a proper exploration of these patients’ experiences, and the illustrators do so triumphantly. As Hugo struggles to keep up with his rowing team, there exist wavy lines of tremor and smooth curved lines of rowing motions, with another set of smooth lines depicting the boat turning amidst the asymmetric paddles.
Beyond the depiction of movement, there are numerous details that highlight a keen understanding of the PD patient experience. For example, one patient vignette includes a 4-wheel seated walker near a patient named Helene while she is sitting on a couch, and later shows her using the seat portion while helping their partner Anne-Marie cook; this is exactly how this might be navigated in life. In a different vignette, a series of panels depicts a couple, Paul and Lone, entering their car after a dance class. With Lone’s symptoms leading to some disability, Paul must take on the role of ensuring they and their belongings enter the car safely. Jetsmark and Vium dilate time by using multiple panels to depict many small actions, forcing the reader to perceive additional events that may otherwise have been inferred. PD is a disease that forces patients to be purposeful. Where previously simple tasks occurred automatically and smoothly, now getting into a car is a distinctly active process. There is a relative contraction of the patient with PD and a concomitant expansion of the caregiver, exemplified here by how many more panels feature Paul compared to Lone.
Comics are a static visual medium, so artists must be creative to represent other senses. Onomatopoeia is a common tactic for illustrating audition, often with tonally consistent lettering (e.g. “Wham! Boom! Pow!” in a superhero comic). Jetsmark and Vium instead use their iconic style to show Parkinson’s dance as a visual, auditory and tactile experience; with simple lines and colors, they show patients feeling the music as they move. The sound emanates from speakers as a substance that envelops dancers as they move. No music notes are used; instead a gushing fluid captures a flow state, evoking an ethereal sense of synesthesia and connection to the body despite illness. This palpability , which is used as a motif for music, is as emotionally charged as it is visually stunning throughout the book.
The Moving Along creative team have crafted a special work overflowing with movement and personality. They capture the sadness, fear and loneliness that comes with a PD diagnosis and show how it can be married with hope, triumph and genuine joy. They deftly maneuver the comics medium to reflect the impact of Parkinson’s dance on patients’ lives via excellent use of an iconic style, attractive color scheme, effective motion cues, clever panel structure and recurrent synesthesia. The dialogue can feel a bit stilted, but this is almost certainly a byproduct of translation and does not detract from the overall quality of the book. For clinicians who see PD patients and for those who are a PD patient, or know a PD patient or have even a passing interest in graphic medicine, Moving Along is a worthwhile read and a valuable way of understanding the experience of Parkinson’s disease.—Javier Suarez Olivers
References
1. Tsukita, Kazuto, et al. “Long-Term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease.” Neurology, vol. 98, no. 8, 2022, pp. e859–71, https://doi.org/10.1212/WNL.0000000000013218.
2. Frølunde, Lisbeth; Phillips, Louise; Christensen-Strynø, Maria Bee. Moving along: A co-produced graphic novel about Parkinson’s dance (Medical Humanities: Criticism and Creativity Book 2). Peter Lang Ltd, International Academic Publishers, 2022, ISBN: 9781800799356.
About the book authors Lisbeth Frølunde is Associate Professor in Visual Communication in the Department of Communication and Arts at Roskilde University, Denmark. Her research concerns existential and dialogic perspectives on the arts and illness, especially in the field of graphic medicine. She develops co-creative arts-based research methods for telling experiences of caregiving and living with disabilities. Louise Phillips is Professor of Communication and coordinator of the Dialogic Communication Research Group in the Department of Communication and Arts at Roskilde University, Denmark. Her research concentrates on collaborative, dialogic, and participatory approaches to communication and knowledge production, including in the field of participatory health research. Maria Bee Christensen-Strynø is Assistant Professor of Visual Culture and co-leader of the research cluster Art and Health in the Department of Arts and Cultural Studies at the University of Copenhagen, Denmark. Her research traverses the fields of critical and cultural disability studies, visual culture, media studies, and dialogic communication.
Javier A Suarez will complete a movement disorders fellowship at the University of Minnesota in summer 2025. He received an MD degree from Feinberg School of Medicine and completed neurology residency at Mass General Brigham. His clinical interests include the management of movement disorders with deep brain stimulation. Suarez has worked on improving healthy equity education in neurology residency as well as improving accessibility to neurology educational materials generally through open-access videos. He is committed to increasing exposure and attention to neurology among local youth whose demographics are traditionally underrepresented in medicine via mentorship and partnerships with local schools. Suarez, who is an avid reader of comics and graphic novels, has presented work on the neurology of comics at the American Academy of Neurology Annual Meeting.