Lissa: An EthnoGraphic Experiment

The paper analyzes a recent experiment in the collaborative production of ethnographic knowledge and the use of the graphic novel form as an alternative to the conventional academic monograph. Lissa: A Story about Medical Promise, Friendship, and Revolution (2017) is discussed here as a useful tool in the age of globalization for building recognition of the need to protect the lives of people other than our immediate kin, tribe, race, or nation. The paper argues that both the collaborative research behind the story and the formal experimentation stem from the authors’ sense of accountability to their informants. By telling a story about distant others who are given names and faces, Lissa’s authors encourage readers to develop empathy across borders.

Scholars of art and literature tend to think of experimentation as an avant-garde practice that may be cognizant of politics but not usually politically engaged, that tends to be antiutilitarian, and that involves suspending conventions to broaden the sphere of artistic freedom, allow for greater complexity, or render the hitherto unrepresentable. We assume that when visual artists and writers experiment, they forsake or tamper with established genres and styles, rules of decorum, grammar, and prosody, risking the possibility that their work will not be understood by many -at least until the broader public's aesthetic expectations adjust in response to challenges posed by the innovations. But that is not necessarily the case. This paper discusses an artistic experiment in translating research that would only be read by a handful of social scientists into a graphic language accessible to anyone with basic English reading skills, without sacrificing complexity. The ingenuity of this project lies in its synthesis of expert and grass-roots knowledges through collaborative research, writing, and drawing. Socially engaged and utilitarian, the experimental graphic novel Lissa: A Story about Medical Promise, Friendship, and Revolution (2017) was conceived as a consciousness-raising book about the etiology and management of two serious illnesses: kidney failure and genetically transmitted breast cancer. To complicate matters further, the authors made one of the protagonists Egyptian and the other American to bring out the dependencies between the Global South and the Global North, between the individual body and the body politic, between health and wealth. Despite the somber subject matter, they managed to write an engaging story. This paper discusses the potential uses of multimodality for those anthropologists whose goal is not just to generate knowledge for Western academia but to make it available to non-academics and people outside the West. The paper also suggests that both collaborative research and formal experimentation may be related to the authors' sense of accountability to their informants, and that by giving fictional names, faces, and complex lives to distant others the authors hoped to foster interest in, and empathy towards, them.
Work on the graphic novel Lissa began as two independent studies within the field of medical anthropology at Brown University. Sherine Hamdy investigated Egyptians' attitudes towards kidney transplants while Coleman Nye interviewed American women on their attitudes towards mastectomy as a preventive or therapeutic measure. After drafting a plot that allowed Hamdy and Nye to merge their two stories into one, they recruited two Rhode Island School of Design art students, Sarula Bao and Caroline Brewer, to create the graphics. The four women negotiated the complex plot and the visual aesthetics of the story. Mindful of the history of Western anthropologists representing others "behind their backs," they traveled with a filmmaker to Egypt to fine-tune the story and gather visual material for the illustrations.
The question arises: Why did Hamdy and Nye feel compelled to experiment in this way? One possible answer is that their project evolved in response to the postcolonial critique of anthropology. Cultural anthropology, which became an academic discipline towards the end of the nineteenth century, on the one hand, benefitted from the expansion of western colonial empires and, on the other, embraced a mission of preserving premodern cultural diversity from the homogenizing force of modernity. Assuming homogenization to be inevitable, Western anthropologists documented what they saw as authentic indigenous cultures primarily for an academic readership. By the 1970s, however, decolonization forced ethnographers to rethink their role in relation to the people they studied. 1 This involved, among others, justifying the usefulness of doing ethnographic research to its potential subjects, doing applied rather than strictly academic work, engaging in collaborative projects co-designed and co-authored by people from the investigated communities, as well as developing new, less objectifying forms of ethnographic writing. Lissa responds to all the above demands. Its radical experiment lies in the co-production of knowledge by an international team of scholars, graphic artists, physicians, students, and activists. Moreover, it was intended to be equally informative for people in Egypt and the United States. The fact that images are steadily replacing text in contemporary communication may be another way to explain the choice of the comic genre. At first glance, comics seem an unlikely vehicle for conveying complex ideas about such issues as illness and revolution. And yet, ever since Art Spiegelman drew the Holocaust in Maus and Marjane Satrapi represented Iran's Islamic Revolution in Persepolis, comic books have participated in current historical, social, philosophical, and political debates. Responding to the changing role of comics, the University of Toronto Press approached Hamdy and Nye, proposing a graphic novel project, and used the publication of Lissa to launch a new series titled ethnoGRAPHY.
A third reason for resorting to the comic form is its power to engage readers emotionally through visual storytelling techniques that foster identification with the characters. Such engagement is necessary if the novel is to evoke in readers what Hamdy and Nye (2018b) refer to as a sense of response-ability. "Donna Haraway," they explain, "describes response-ability as an active practice of attention, care, and openness to the complex and unresolved relations within which we live and work". Globalization has made human lives interdependent, but we have not yet developed an ethics of response-ability towards people other than our own kin, tribe, race, and nation (Butler, 2004(Butler, , 2009Fraser, 2010). Lissa depicts a turbulent friendship between an Egyptian and an American woman because it wants to make us understand and care about those who are culturally different from us. The incongruous title Lissa: A Story about Medical Promise, Friendship, and Revolution floats on the cover against a blue-and-pink sky above the smiling faces of two girls. A decoy, the cover does not prepare the reader for the subsequent images of a country under a military dictatorship, a mother's death of cancer, protesters blinded by rubber bullets, and the interior of a morgue after a massacre. Can any story successfully combine such disparate and unappealing phenomena as the failure of medicine and revolution to deliver on their "promises" to heal and to redeem? Can friendship bear such a double burden? In taking on these unpromising subjects, Lissa provides an apt illustration of Butler's (2004) observation that the body implies mortality, vulnerability, agency: the skin and the flesh expose us to the gaze of others, but also to touch, and to violence, and bodies put us at risk of becoming the agency and instrument of all these as well. Although we struggle for rights over our own bodies, the very bodies for which we struggle are not quite ever our own. […] Constituted as a social phenomenon in the public sphere, the body is and is not mine (p. 26).
Lissa's characters exercise (a limited) agency over their own and their loved ones' bodies, and over their social environment. Although the text points to an analogy between resistance to bodily and political disorders, and although it encourages resistance as such, it makes no promises of a successful outcome.
The study of vulnerability grew out of the 1980s feminist research on dependency and ethics of care. Precarity is another name under which vulnerability has been studied. Butler (2004), whose book Precarious Life: The Powers of Mourning and Violence gave this term resonance, continued to investigate the ethics of corporeal vulnerability in Frames of War: When Is Life Grievable? (Butler, 2009). Along similar lines, Fraser (2010) has been asking for over a decade: (how) can our sense of responsibility for vulnerable others be extended to people living beyond the borders of our own nation-state? Fraser has rightly pointed out that although the Global North benefits from the human and non-human resources of other parts of the world, we tend to only recognize the vulnerability of fellow citizens. Some of us willingly, some more reluctantly, pay taxes for their benefit. Responding to the inequities caused by globalization, Fraser (2010) has argued for a transnational ethics of recognition, redistribution, and care. In Scales of Justice: Reimagining Political Space in a Globalizing World, which gives the fullest expression of her ideas to date, she points out that in the twentieth century, when justice was imagined on a national scale, citizens were encouraged to care about the welfare of fellow-citizens. Due to globalization, we can no longer draw sharp distinctions between national and international space. Neither can we use the vision of territoriality as the sole basis of assigning obligations of justice, given patently trans-territorial problems, such as global warming or genetically modified agriculture, which prompt many to think in terms of functionally defined 'communities of risk' that expand the boundaries of justice to everyone potentially affected (p. 5).
Changing the way people around the globe conceptualize their obligation towards human beings other than their own kin, tribe, race, or nation is clearly a long process. Non-fellow-citizens, Butler (2009) argues, are generally not seen as grievable because we do not recognize them as living beings in the same way that we do fellow-citizens. "Why is it that we are not given the names of all the war dead, including those the US has killed, of whom we will never have the image, the name, the story, never a testimonial shard of their life, something to see, to touch, to know?" she asks. Compassion for war victims is not encouraged, she writes, because it might lead to outrage, which "has enormous political potential" (p. 39). If she is right, then names, faces, and stories -which appeal to our emotions -might be an effective way to foster the recognition of all human lives as equally deserving protection, and of every death as grievable 2 .
Although graphic fiction does not have the power of a photograph or witness testimony, it can move readers by revealing characters' thoughts and emotions. It encourages identification with (imaginary) distant others, because, unlike real distant humans, cartoon characters have expressive faces that can be shown in close-up. Graphic artist Scott McCloud argues that readers identify more readily with characters drawn in a few quick lines than with those drawn in detail or photographed (McCloud, 1994, pp. 28-30). If so, then Hamdy and Nye's (…) 2 This claim is not uncontroversial. In her introduction to Compassion: The Culture and Politics of an Emotion, Berlant (2004) suspects that compassion might be little more than a feelgood emotion, allowing us to empathize with those who struggle and fail, without having to work towards a more equitable system (p. 10). choice of the comic medium is justified. Admittedly, caring for imaginary others costs us nothing: we need not pay higher taxes for their benefit, take to the streets on their behalf, nurse the wounded, or bury the dead. But reading carefully researched stories like Lissa, readers become aware of lives that would not otherwise count as lives. Films can perform similar work, but because they are far more expensive to produce, they must appeal to 19 much larger audiences.
In short, Lissa is about a transnational girlhood friendship which extends into adulthood and barely survives conflict over values and politics. The story opens in Cairo, where two pre-teen girls, Layla (Egyptian) and Anna (American), become friends. In the middle section of the novel, Anna returns to the United States but she returns to Egypt twice to visit Layla while the two are college students. When the Arab Spring 3 spreads from Tunisia to Egypt, the two women become involved in anti-government demonstrations. They witness atrocities as well as minor victories. The revolution creeps on without bringing the expected change, while quarrels over cultural values and Egyptian nationalism cause a rift in their friendship. But the protagonists are eventually reconciled and learn to support each other at critical moments.
Each protagonist faces a different combination of problems. Layla is a janitor's daughter and her family lives precariously. Environmental factors precipitate her father's kidney failure. Layla is able to arrange for dialysis, but as his health continues to decline the family needs to decide whether he should get a kidney transplant, and if so, should one of his children be the donor. Meanwhile, Anna, the daughter of an American oil company executive, is financially secure, but in the opening pages of the novel she loses her mother to breast cancer caused by the BRCA genetic mutation. Worried that she may have inherited the mutation, Anna must negotiate with her father, who disapproves of preventive mastectomy, because she cannot afford the expensive genetic test, monopolized by a single pharmaceutical company. Diagnosed with BRCA, she deliberates whether to undergo surgery or wait until cancer develops.
Unlike in traditional comics, the artwork in Lissa is not uniform. Whereas in some sections (in which the protagonists are friends and spend much of their time together) Bao and Brewer worked on the same panels, in other sections (where Anna and Layla live apart or are not on speaking terms), Bao and Brewer worked in their distinctive styles, each drawing the experiences of one protagonist so as to emphasize her individuality and cultural identity. To slow down the tempo of the 3 The Arab Spring was a series of pro-democracy uprisings that took place in several predominantly Muslim countries, including Tunisia, Morocco, Syria, Libya, and Egypt, in the early 2010s. Initiated in Tunisia in December 2010, by a street vendor's act of self-immolation, these popular uprisings had a major political and social impact, although in some cases they resulted in political instability or the reassertion of authoritarian rule, rather than increasing democracy and cultural freedom. narration and encourage readers to contemplate the theme of vulnerability, they drew close-ups of hands, feet, and other parts of living and dead bodies. In the case of Anna's busy father, Bao and Brewer inserted his figure into several panels but left his head outside the frame to signal his inattentiveness towards Anna. Only when the father starts listening to Anna do the readers finally get to see his face. These are just a few examples of formal innovations developed in response to the novel's central themes.
What is new from an anthropological perspective is the adopted process of knowledge production and representation. As Hamdy and Nye explain in the film The Making of Lissa (Dragone, 2018b), they first worked from the "fine-grained details" of their Egyptian and American informants' lives "to develop a bigger story about medicine, culture, and bioethics." Then they "worked backwards." Taking "the abstractions that [they] wanted to teach through this book," they immersed themselves in the street life of Cairo, together with the graphic artists, observing and taking photographs whenever possible in a city that was heavily policed due to the unrest.  (Dragone, 2018b) They also consulted local experts -medical doctors, artists and political activists who had been involved in the 2011 demonstrations, as well as workingclass people who resembled some of the novel's protagonists -to develop credible and historically accurate scenes. In the documentary, Nye admits that although she had initially believed the trip to Egypt might be "useful" but not "crucial", afterwards she could not "imagine having done the script without having come here" (Dragone, 2018a).
Lissa intertwines academic knowledge and storytelling, Egypt and the United States, as well as the private sphere in which individuals/families make medical decisions and the public sphere in which health care systems operate, governments govern (or fail to do so), and citizens rebel against governments. Lissa's characters are composites "each based on scores of interviews and research" (Hamdy & Nye, 2017a). The outcome, as academic and non-academic reviewers unanimously attest, is a highly informative yet readable and engrossing book. Both groups appreciate the fact that Lissa addresses their disparate interests and expectations. It has been praised by anthropologist Julie Livingston (cf. Hamdy & Nye, 2018a) for exploring experimental modes of doing ethnography, by people seeking information on how to cope with genetic susceptibility to breast cancer and kidney failure, and most notably by Egyptians seeking international recognition for their political struggle. As we learn from the documentary The Making of Lissa, in which several medical doctors and activists engaged in the Tahrir Square demonstrations appear, Lissa was interesting to them as an unconventional vehicle for conveying their dramatic experience to members of the international community.
Multimodality 4 allows this novel to address various audiences. Non-academics probably start reading the novel on page 15, where the cartoon panels begin. But anthropologists are unlikely to skip the foreword by Marcus (2017, pp. 13-17), who endorses the project and positions it in the context of experimental ethnography, which he helped to pioneer in the 1980s. For more inquisitive readers, the book has 60 pages of appendices, including study questions and an afterword by graphic artist Paul Karasik, which highlights the formal innovations introduced by Sarula Bao and Caroline Brewer. Another indispensable teaching tool is "Timeline of the 2011 Egyptian Revolution," with cross-references to Anna and Layla's story. Nineteen pages of interviews offer a fascinating back story. The project also branches out into other media. The book's homepage http://lissagraphicnovel.com/ includes more interviews, a link to the above-mentioned documentary, and links to related websites, such as the Egyptian Women and Memory Forum. Readers interested in health can follow the links to various medical humanities websites and find a list of graphic memoirs of illness.
Although cultural attitudes are shown to play a major role in the management of both kidney failure and genetically transmitted cancer, Lissa does not stop at 4 There is a growing body of research on multimodality, well represented in the Routledge Series on Multimodality, which includes Gibbons's (2012) groundbreaking Multimodality, Cognition, and Experimental Literature. exploring cultural difference. The characters' material status and geopolitics are shown to be no less important in their decision making. Traditional ethnographies 5 cannot offer such a complex view of life in a globalizing world because they tend to focus on small communities, portray them in a synchronic mode, and focus on shared beliefs and practices. Meanwhile, the novel's action is not limited to one location or a single historical moment. By choosing the graphic novel genre, Hamdy and Nye were able to cover a period of about seven years, and to show two societies in contact. They were additionally able to zoom in on individual characters' bodies and facial expressions, showing them at their most vulnerable, and then zoom out to show panoramic views of thousands of Egyptian characters gathered in Tahrir Square, risking their lives in an attempt to topple a corrupt government. By traditional ethnographies I mean texts by Malinowski (1922), Mead (1928), Chagnon (1968), and others who embraced the modernist approach. Among the earliest scholars to counter this mode of doing ethnography were feminist anthropologists, including Shostak (1981), Lawless (1988) and Behar (1993), in whose collaborative studies the native informant co-authored the final narrative. The three latter works can be viewed as antecedents of Lissa.  While the various forms of vulnerability and risk are not equated in the novel, the authors suggest analogies between them that may lead While the various forms of vulnerability and risk are not equated in the novel, the authors suggest analogies between them that may lead to a better understanding of their causes, and, potentially, stronger identification on the part of the readers.
Unlike sociologists, who tend to focus on social problems that government agencies should address, anthropologists have traditionally shown communities' adaptability and resilience. Interestingly, Lissa does not advocate resilience, for in an unbearable situation resilience may inadvertently preserve it, as Chandler and Reid (2016) point out in The Neoliberal Subject: Resilience, Adaptation, and Vulnerability: Politics requires a subject capable of conceiving the transformation of its world and the power relations it finds itself subject to. In contrast, the neoliberal subject is a subject that must permanently struggle to accommodate itself to the world. Not a subject that can conceive of changing the world, its structure and conditions of possibility (p. 4).
Admittedly, Layla's parents do embody stoicism, but the novel offsets it with examples of resistance. Even as a child, Layla does not passively absorb class prejudice: she plays pranks on the Egyptian neighbor who snubs her family. When news of the Tunisian uprising reaches Cairo, Layla develops a strong political identity. The more passive and self-absorbed Anna learns from Layla's example and supports the protesters by carrying medical supplies and helping to identify the dead. She then applies the principle of resistance in her private life and decides to undergo a preventive mastectomy (Hamdy & Nye, 2017b, pp. 118, 147). Not every sick or wounded body in the novel can be saved. Many of the protesters in Tahrir Square die, as does Layla's father, having refused a transplant so as not to endanger the life of a child or burden his family financially by lifelong immunotherapy. The uprising is suppressed by the police and one pernicious government is replaced by another. But the novel asserts in a double spread at the end that "there is still time" (Hamdy & Nye, 2017b, p. 235) to bring about real change. The spirit of dissent is still there in the image of the chanting woman; the short-haired girl in western dress seems to be striding confidently into the future. Lissa: Still Time was, in fact, an earlier version of the novel's title, one whose multiple meanings ("there is still time," "not yet," "it is still the case") Hamdy and Nye discussed with Dr. Amr Shebaita in the documentary The Making of Lissa (Dragone, 2018a). On one level, the subtitle expressed the hope for change shared by the authors and the Egyptian activists. On another level, the phrase "still time" invoked for them the power of the hand-drawn and photographic image to still or stop the passage of time, to preserve and contemplate moments. Anna's mother is a photographer who develops her own negatives. Mother and daughter are shown bonding in the darkroom. Photographs of the mother are all that Anna is left with after scattering her ashes. Later Anna takes up photography to better grasp the overwhelming events in Egypt. She takes snapshots of the faces of the dead in the morgue, which she then compares with photographs brought by people looking for their loved ones after a massacre.
The hand-drawn photographs fuse the two modes of representation and add a spatial-temporal dimension to the text, allowing the past to intrude in the narrative present. The foregrounding of the relation between time and image in the novel's early title suggests that Hamdy and Nye took seriously both the artistic and documentary aspect of their project.
To return to the question whether experimentation inevitably means the pursuit of aesthetic freedom at the expense of intelligibility, one could argue that Hamdy and Nye explore unconventional modes of storytelling in order to do the reverse -make sophisticated, synthesized knowledge intelligible to a broad readership. In this sense their work can be compared to that of David Simon and Ed Burns, creators of the HBO series The Wire (2002-2008)touted as an important experiment in realist filmmaking. What Simon (who spent 12 years doing investigative journalism for the Baltimore Sun) and Burns (a local public school teacher) attempted to do was to translate their immensely complex diagnosis of Baltimore's late-capitalist urban blight and the failure of public institutions into the language of a television series accessible to millions. In order to do so, they turned the police procedural genre inside out and merged it with several others, submitting the screenplay and settings to a standard of realism not hitherto required of television shows. For this documentary strain, fueled by a utopian desire for social transformation, the series was praised by Jameson (2010). As Flight (2019) explains in a podcast about the making of the series, Simon and Burns, "had an extreme level of commitment to realistically portraying Baltimore.
[…] When they came up against a subject they didn't know inside out, they conducted extensive research," interviewing stevedores, immigration officials, port personnel, customs inspectors, steamship agents, and drug sellers. Methodical research and reliance on grass-roots consultants is something the creators of The Wire share with the Lissa team. In both works, the leading characters are composites based on informants and historical figures. Simon and Burns went so far as to hire retired policemen and former drug dealers as actors and extras, to draw on their insider knowledge. According to Flight (2019), the watchfulness of the non-professional actors, "helped to keep the show from straying into the realm of fantasy". Similarly, the Lissa team adjusted story details and characterization on the advice of their Egyptian informants, several of whom appear as cartoon characters under their own names (The Making of Lissa).
Far from being pedantically or naïvely attached to "the real", The Wire filmmakers adopted a stance of accountability for their representations of real people living in troubled places -people left behind by the global economy, caught up in alternative economies based on drugs or human trafficking, and shortchanged by public institutions.  (Hamdy & Nye, 2017b, pp. 134-135). In several interviews Hamdy and Nye mention that panels like the above synthesize knowledge that took thirty or more pages of academic writing to explain.
Likewise, the Lissa writers and artists made it clear in interviews that they felt accountable to their informants in both Egypt and the United States. Although the graphic novel is a much more compact work than the 60-hour television series, it, too, offers a multilayered socioeconomic diagnosis. Layla's brother Ahmed, for instance, makes a connection between the Egyptian government's dealings with American oil companies and the scarcity of jobs in Egypt, which forces him to migrate for work. Ahmed also connects the imported fertilizers and pesticides his father once used with water quality and his subsequent kidney failure. The novel includes several large panels that synthesize the information in graphic form.
Lissa could have been told as three separate narratives: Story 1: an American woman's experience of breast cancer prevention; Story 2: an Egyptian man's difficulties with accessing basic medical care for kidney failure and his family's dilemma concerning a potential kidney transplant; Story 3: The Arab Spring. But the three stories merge into one because in real life vulnerable human bodies function at the intersection of the local and the global and are influenced as much by cultural as by economic and political factors. By telling a story with relatable fictional characters, Hamdy and Nye attempted to make their academic research accessible to the largest possible audience, including their informants. Underlying this project is the assumption that readers' capacity for emotional involvement in fictional lives will encourage reflection on how their own bodies relate to other bodies beyond their immediate family, tribe, and nation. There is of course no guarantee that readers' identification with Anna and Layla will translate into a commitment to improving the living conditions of people like them. In fact, literary critic Felski warns us against making unwarranted assumptions about what it means to be moved by literature: "Caught up in the suspenseful drama of Goldfinger, I feel a surge of delight as Bond outwits the dastardly schemes of SMERSH, even though as I go about my daily life I have no interest in saving the free world from Soviet conspiracies" (Felski, 2018, p. 157). But if Butler (2009) is right in arguing that we cannot recognize distant others as worth protecting unless they have faces and names (p. 39), then even if Lissa does not guarantee such recognition, it brings us closer to this goal.