English & Med Humanities SG2

Bildungsroman

Coming of age story

Künstlerroman

Coming of age story for an artist

How is Stitches an artist’s story and a medical story combined?

It’s both and künstlerroman and a medical narrative

• The book follows David Small’s childhood illness, misdiagnosis, cancer treatment, and loss of his voice, showing how medicine and family trauma shape his identity. At the same time, it traces his development as an artist. Drawing becomes his way to escape pain, process trauma, and eventually reclaim his voice. In this way, art and medicine intersect—his illness shapes his artistic perspective, and art becomes part of his healing.

Visual literacy

Is the ability to understand and interpret meaning from images, symbols, layout, and visual storytelling

Visual literacy in Stitches

Meaning comes not just from words but also from facial expressions, shading, page layout, and imagery. Readers must analyze visual cues—such as darkness, doors, swirling chaos, and silent panels—to understand the emotional and psychological story

How can a paper text be cinematic in approach?

By using:

• Close-ups (focusing on faces or eyes)

• Zooming or panning across scenes

• Sequential frames that mimic motion

• Changes in perspective or angle

Theme in Stitches: silence and voice

• David grows up in a household where communication is indirect or absent

• Eventually he literally loses his voice after surgery

• The story explores finding another voice through art

Theme in Stitches: trauma and generational trauma

• Family trauma passes through generations, including mental illness and emotional neglect

• David’s great-grandfather loses his voice after drinking drain cleaner

• His mother carries unresolved trauma from her own upbringing

Theme in Stitches: illness and medical authority

• Doctors and science appear powerful but also impersonal

• Radiation treatment intended to help David ultimately causes cancer

Theme in Stitches: isolation

• David often feels invisible within his family

• His illness and artistic personality separate him further from others

Theme in Stitches: art as survival and healing

Drawing helps him process fear, pain, and confusion

What did the text show about trauma and generational trauma?

The novel suggests trauma can pass through generations within families. Examples include:

• David’s great-grandfather losing his voice

• His mother being rejected by her family for marrying outside their approval

• Patterns of silence and emotional distance repeating

However, the book ultimately suggests trauma is not destiny. David breaks the cycle by leaving home and creating a life through art.

Themes overlapping with between Stitches and The Shaking Woman

• The relationship between mind and body

• Illness connected to psychological trauma

• Storytelling and art as healing

How does art figure in Stitches and The Shaking Woman as a healing device?

In The Shaking Woman, writing and storytelling help Siri Hustvedt understand her neurological symptoms. In Stitches, drawing and visual storytelling allow David Small to process trauma and reclaim identity.

In both works, art becomes a therapeutic process.

Literary references used in Stitches: Lolita

• David reads the novel as he matures intellectually

• His mother throws it away because she believes it is inappropriate

• After his surgery, she gives it back

This moment shows his transition from childhood to adulthood and highlights tensions between curiosity, knowledge, and control within the family

Literary references used in Stitches: Alice in Wonderland

• In Alice in Wonderland, the White Rabbit leads Alice into a strange and confusing world

• In Stitches, the therapist (the White Rabbit) guides David through his psychological journey and self-discovery

• Squeezing

• David’s dreams often connect to Alice in Wonderland

This reference emphasizes David’s descent into the confusing world of memory, trauma, and the subconscious, similar to Alice’s journey

Elements of form used in Stitches

• Minimal dialogue

• Silent panels

• Symbolic imagery

• Dark shading

• Recurring visual motifs

Page layout observations in Stitches

Often reflects emotional states:

• Large empty spaces emphasize isolation

• Dark shading suggests fear or danger

• Tight close-ups focus on emotional reactions

• Flowing panel movement mimics memory or dreams

Ex: Chaotic swirling patterns visually represent David’s fear and confusion

How form and content work together in Stitches

The form of the graphic novel enhances the medical and psychological themes

Examples:

• Darkness and shadows represent trauma

• Broken buildings symbolize David’s damaged inner self

• The umbrella imagery represents unreliable protection from his mother

Because the story is visual, readers experience David’s emotions rather than simply being told about them

Language and Communication in Stitches

Different characters communicate through different “languages”:

• Mother: slamming doors

• Father: punching a boxing bag

• Brother: drumming

• David: illness (art?)

These forms of expression show how the family avoids direct emotional communication

Artist as a boy in Stitches

David escapes into imagination and drawing

Examples:

• His drawings seem to come alive (pg. 48–49)

• He uses art as a place of safety

• His creativity is misunderstood by others

• His art is his “underground” person

This shows how art becomes his emotional survival tool, which is important in medical humanities because creative expression can help patients process illness and trauma

Illness, family, and society in Stitches

David’s family often ignores or minimizes his needs.

When outsiders (Man on boat & Mrs. Dilion) mention concerns about his growth or health, the family dismisses it, claiming they cannot afford to care for his issues (even though they can). This leaves David feeling unimportant and neglected.

David’s therapist demonstrates the three aspects of narrative medicine

Attention

• He listens carefully to David’s story

Representation

• He helps David articulate and understand his experiences

Affiliation

• He forms a trusting relationship with David

How the ending represents healing in Stitches

• David leaves home

• His mother sweeps a path, but he chooses not to follow it

This symbolizes him breaking free from generational trauma and creating his own identity

David Small – Identity Crisis (Stitches)

• David discovers his parents hid the truth that radiation treatments caused his cancer, which creates a deep betrayal and identity crisis

• Losing his voice after surgery makes him feel invisible and disconnected from himself, forcing him to rebuild his identity through art

Comparison of identity crises

• Ivan Ilyich: Illness makes him realize he lived a shallow life and forces him to confront his true self

• Paul Kalanithi: Cancer shifts his identity from doctor to patient and leads him to rethink life’s meaning

• Mrs. Bates: Gains awareness that illness involves the patient’s emotional and personal experience, not just medical treatment

Key idea: In all cases, illness leads to a moment of self-realization and a reevaluation of identity

Who are we? (Identity)

Stitches shows identity is shaped by:

• Family history

• Trauma

• Illness

• Creativity

David ultimately discovers his identity through art and self-expression, even after losing his literal voice

How can art and literature help healing?

Art provides a way to:

• Process trauma

• Express emotions when words fail

• Reclaim identity

For David, drawing becomes both therapy and a lifelong vocation

What does Stitches offer medical humanities students?

• Illness is deeply connected to emotional and family contexts

• Patients’ stories matter

• Art and storytelling can be powerful tools for understanding trauma and healing

The novel encourages future medical professionals to see patients as whole people rather than just medical cases

What objects was David projecting on?

• Christ on cross - relates his grandma to this

• Man in jar - first scary then peaceful

Who all loose their voice in Stitches?

• David (vortex represents this visually)

• Grandpa (drank dranio)

• Mom (on her deathbed because she was hooked up to a bunch of machines)

Remote control car represents what in Stitches?

It’s a proxy that David sends out so that he can come out of himself to go fix it once it crashes

Why do they tell us David’s moms’ backstory?

So we have empathy for her and to see where her actions and feelings come from

Why would Stitches be used in medical schools?

To teach empathy, communication, and the patient experience

How does Stitches and The Shaking Woman represent psychoanalysis (talking)?

• Stitches: White rabbit therapist (actually a man)

• The Shaking Woman: Brother Eric (he’s not real)

What does Hustvedt connect her shaking to?

• Trauma (father’s death)

• Speaking publicly (trigger)

• Anxiety / stage fright

• Migraines / neurological issues

• Repressed emotions

• Possible seizures

• Smoking/caffeine

• Hysteria

What is Hustvedt’s main philosophical question?

• What is the relationship between mind and brain?

• Are thoughts just brain activity, or something more?

What is dualism?

• Mind and body are separate

• Hustvedt challenges this as too simple

What is reductionism?

• All thoughts/emotions = brain activity (neurons)

• Hustvedt resists reducing human experience to biology alone

Why does Hustvedt reject both dualism and reductionism?

• They oversimplify → experience is both biological + lived

• Mind and body are deeply interconnected

What is the “psyche/soma trap”?

• The false divide between mental (psyche) and physical (soma) illness

• Real symptoms don’t fit neatly into one category

What is the self?

• Not fixed → multiple, shifting, layered

• Includes conscious + unconscious parts

Narrating self vs experiencing self

• Narrating self: tells the story

• Experiencing self: feels/undergoes events

• These are not always the same

What is a “self of selves”?

Identity is made of multiple selves, not just one unified “I”

Attempted Therapies: Neurological testing

• MRIs/tests → no clear diagnosis

• Shows limits of medical imaging

Attempted Therapies: Psychiatry (behaviorism)

• Focus on symptoms, not meaning

• Misses deeper psychological causes

Attempted Therapies: Psychoanalysis (“talking cure”)

• Explores trauma, memory, repression

• Slow but helps with understanding

Attempted Therapies: Narrative reconstruction

• Builds her own case history

• Storytelling becomes a form of healing

Attempted Therapies: “I remember” writing

• Daily handwritten memories

• Helps recover identity and process trauma

Attempted Therapies: Automatic writing

• Writing without conscious control

• Shows split self / unconscious processes

Attempted Therapies: Medication (Lorazepam)

• Reduces shaking

• Treats symptoms, not root cause

Attempted Therapies: Biofeedback

• Controls bodily responses

• Helps with pain and headaches

Attempted Therapies: Distraction

• Shifts attention away from pain

• Shows pain is perception-based

Attempted Therapies: Meditation / attention

• Similar to biofeedback

• Mind can influence body symptoms

Attempted Therapies: Observing patterns

• Tracks triggers (stress, memory, activity)

• Helps understand condition

Psychoanalysis

Therapy focusing on unconscious, trauma, repression

DSM

• Manual used to classify mental disorders

• Changes over time → diagnoses are not fixed

Galen

• Ancient physician

• Linked hysteria to female biology (uterus)

Conversion disorder

Psychological distress → physical symptoms

Somatoform

Physical symptoms with no clear medical cause

Dissociation

Split memory, identity, or awareness

Aphasia

Loss or impairment of language ability

Repression

Pushing painful thoughts into the unconscious

Freud

• Developed psychoanalysis

• Linked symptoms to unconscious conflict

Jacques Lacan

• Focus on mirror stage and identity formation

• Self develops through others

La belle indifférence

• Lack of concern about illness

• Suggests hidden/unconscious trauma

Anosognosia

Lack of awareness of one’s own illness/disability

Behaviorism

Focuses on observable behavior

Phenomenology

Focuses on lived experience

Corpus callosum

Connects the brain’s two hemispheres

Literate alien hand syndrome

Hand acts independently, may even write on its own

Psychogenic symptoms

Symptoms caused by psychological factors

Synesthesia / mirror-touch synesthesia

• Senses overlap (ex: feel what others feel)

• Linked to empathy and perception

Transitivism

Projecting feelings/symptoms onto another (a double)

Progress is not always linear

Healing/knowledge move forward and backward

Importance of naming

• Naming illness gives meaning

• But can also create stigma (ex: hysteria)

Tolstoy (Caius vs Vanya)

• People understand illness abstractly (Caius)

• But deny it personally (Vanya)

Places have power

• Memory is tied to location

• Places trigger recall

The Shaking Woman and Stitches connections

• Trauma + body connection

• Voice/silence

• Art as healing

• Illness shapes identity

What happens in reading?

Reading lets us experience another mind

Fiction vs nonfiction

• Fiction: deeper emotional/embodied experience

• Nonfiction: more informational

“Body electric” (Whitman)

• Describes nervous system sensations

• Body feels alive/charged

Febrile convulsions

• Seizures linked to fever

• Show neurological vulnerability

Migraine

• Includes auras, visuals, sensitivity

• Blurs line between neurological + psychological

“God spot”

• Brain area linked to religious experience

• Doesn’t mean faith is “just biology”

Oceanic feeling

• Sense of oneness or unity

• Linked to spirituality (Freud)

Genetic predisposition

Inherited tendencies (migraines, voices, etc.)

Living with ambiguity

• Not all illnesses have clear diagnoses

• Medicine has limits

“Health makes room for illness”

• Being healthy includes vulnerability

• Illness is part of being human

Themes in The Shaking Woman: memory and place

• Memory is tied to location (places have power)

• Places help store and trigger experiences

Themes in The Shaking Woman: splitting and doubles

• The self can divide into multiple parts

• Ex: narrating self vs “shaking woman”

• Doubles help process trauma

Themes in The Shaking Woman: trauma in the present

• Trauma is not just past → it reappears in the present

• Felt through body (shaking, fear)

Themes in The Shaking Woman: trauma and dissociation

• Trauma can be split off from awareness

• Returns through physical symptoms or memory fragments

Themes in The Shaking Woman: doctor’s expectations

• Doctors often rely on pre-set ideas

• May miss patient’s full story/history

Themes in The Shaking Woman: history of illness

• Many doctors focus only on current symptoms

• Hustvedt shows importance of full case history

Themes in The Shaking Woman: the self

• Is the self one or many?

• Includes conscious + unconscious parts

Themes in The Shaking Woman: free will and identity

• Who controls the self?

• Are we shaped by biology, trauma, or choice?

3 kinds of memories

• Semantic: informational stuff or facts about the world

• Procedural: remembering how to do something such as write or ride a bike

• Episodic: recollection - owned by the self