Graphic Neuroethics: A Comics-Making Curriculum (Part II of II)

By Ann E. Fink

In Session

Figure 4: Three attendance cards by the author.
Description: In the first attendance card, a person hugs a cactus.
In the second, a decaying pumpkin smiles, wearing a scarf.
In the third, a person floats in space 

In my undergraduate classroom, I have a variety of students. Some will become health professionals, some will be scientific researchers, and some will move on to businesses or professions outside of science. All students can benefit from the ethical analyses that we conduct through comics. How does the process of Graphic Neuroethics unfold? My syllabus informs students that they will:

“explore... important historical and current topics in neuroethics through weekly case studies... creative means of exploring and communicating neuroethics concepts... close reading and critical analysis of journal articles, integration of biological concepts with moral reasoning, effective written communication... peer review, oral presentations and group discussions.”

Although this is a writing-intensive class, credit is distributed across a number of areas. Attendance is important, and we draw attendance notecards each day to start off the session (another Lynda Barry innovation^2,3). My cards throughout a semester look something like Figure 4.

Each week, students write a reflection on the reading assignments, and somebody leads the week’s discussion. In doing so students become familiar with the terminology underlying neuroethics, build fundamental neuroscience knowledge and learn to critically reason through the clinical and technological applications of contemporary research. Through close reading of articles and reflection on scientific concepts, rhetoric, argumentation and writing style, students gain insight into how language shapes scientific thinking. At mid-semester, students craft a creative project that communicates a neuroethics topic in a way that is comprehensible to members of the lay public. The course culminates in a multi-stage final essay that addresses a neuroethics problem of the student’s choice.

Comics are not an explicitly assigned or graded component of this particular course. Instead, comics-making fosters reflection, insight and discussion in the classroom. Students may use these exercises as stepping-stones toward their written analyses. Together, engagement in written and visual narrative allow students to consider how neuroscience can be used or misused in real-world situations.

The class builds up to more involved comics as the weeks pass, in the following sequence (note that this is an abbreviated list of assigned reading). In Week 1, the course opens with the language of ethics, logic and argumentation (with excerpts from Talbot’s 2012 Bioethics: an introduction⁴) and introduces foundational questions in neuroethics.⁶ In Week 2 (global neuroethics), students consider cultural context in neuroethics dilemmas.⁷ In Week 3, students dive into challenging reading on definitions of mental health and illness. We consider the perils of essentialism⁸ and ask how biological explanations may interact with a person’s self-narrative.⁹ In Week 4, we explore the ethics of neurotechnologies, including the murky territory of brain organoids¹⁰ and the ethics of wearable technologies.¹¹

In Week 5, we consider how neuroethics informs ideas about youth, mental health and education.^12-14 Questioning how young people are shaped by neuroscience stories can provide a welcome opportunity for students to reflect on their past and present educational experience. In Week 6, we explore neuroethics perspectives on brain injury, consciousness and brain death,¹⁵ including important conversations about safety and ethics in college athletics.¹⁶ In Week 7, students compare four pieces from AJOB Neuroscience’s 2017 Issue dedicated to the issue of head transplantation. Utilizing the skills that they have built over the first half of the course, students describe the distinct voices of different writers, weigh various arguments in the language of neuroethics, and ultimately produce a reasoned conclusion about the issue based on the evidence and the arguments from the four articles.^17-20 In-class comics made during this week help to kick-start this process of analysis.

Figure 5. Two panels from a comic illustrating different pieces on head transplantation
Description: On the left, two people share a large thought bubble containing a globe, a plane, a person with a detached head, with spinal cord and nerves, a brain, the Chinese and Japanese character for spirit / soul, with a cat and some fish peeking into the frame. On the right, an illustration of a head being detached from a body, which is then depicted as complete with a new head. Word bubbles say: “I’m healthier than ever! I love my new body”

In Week 8, we consider the neuroethics of cognitive enhancement,^21-22 and in Week 9 the class shifts to addiction neuroethics.^23-24 This week’s class takes two directions. It considers the neurobiological underpinnings of addiction as we know it, and then evaluates the “brain disease” model of addiction. Students prompt each other with key words and then use hand-written cases and drawings to collaboratively piece together a story of addiction neurobiology (Figure 6):

Figure 6. A collection of 10 note cards illustrating different aspects of addiction neuroethics.
Description: Together the illustration of cards includes a hypothetical case, some illustrations of brains, drugs and neurotransmitters, and many circuit diagrams and illustrations of synapses that relate different brain regions and neurotransmitters to models of addiction.

In Week 10, we address the ethics of deep brain stimulation.^25-26 Then, in Week 11, students consider the ethical implications of human interactions with their natural and social environments.^27-28 Throughout the course, students have been learning to articulate the importance of social context in neuroscience research and at this point they are thinking about the neuroethics of health and illness in a much more expansive way. Students are able to draw more specific connections between people’s environments and their health and well-being, and they achieve this in part through drawing comics.

On the left of Figure 7 is a representation of a safe environment that meets a person’s physical and psychological needs. Following that are two narratives that links a person’s social, emotional and physical environment to a life trajectory. In class, we would discuss these images and narratives to more clearly define what people perceive to be necessary for a human being’s safety, health and well-being, and how neuroscience knowledge can play a role in defining these needs across the life course.

Figure 7. Three full-page comics depicting how an environment that does or does not meet a person’s needs can be linked to health and illness. Description: On the left is a full-page comic depicting a cat character sitting in a chair. There is a bowl of food on a table, a rug, a lamp, a ceiling fan overhead, and a door and window in the background. Nearby, other animals talk and laugh. In the center panel there is a picture of a person in a cave, looking down, with a visible brain and an “I heart NY” T-shirt. A small creature stands nearby. The written narrative tells a story of material privilege and emotional detachment. On the right, a busy page including, among other things, a brain, multiple organs in disease states, mountains, pollution, and a log cabin. The narrative tells a story of environmental degradation, isolation, poverty and poor health.

Having laid this groundwork, in Week 12 we discuss what happens when people experience gross deprivation or deliberate harm in situations of confinement, conflict and displacement.^29-31 Students articulate the specific moral problems raised in these situations and also discuss how neuroscience may help to define and ameliorate these conditions.

In Week 13, after students have spent an entire semester creating and discussing together, the class tackles a complex and often personal topic: gender/sex, sexuality and love.^32-34 Together, we explore the complexity and nuance of defining these terms and discuss ethical quandaries arising from potential neurotechnological interventions. When asked what worried them most about interventions into gender/sex, sexuality and love, students produced the following evocative pieces (Figure 8):

Figure 8. Two full-page comics in response to “What worries you most about neurotechnological interventions into gender/sex, sexuality and love?” Description: The comic on the left depicts a large angry character with “Neuroscience / Drug interventions“ written on its head. As it says “CHOOSE!!”, it pushes small, frightened people into two categories: A, a stick figure, and B, a stick figure with long hair and a dress. The comic on the right simply depicts a full color spectrum being reduced to black and white.

And finally, students answered the following questions, on two sides of a page, similar to a zine:

1. “What is love?” and 2. “Is love an illness?” Some examples of their work, in Figure 9, demonstrate the humor, thoughtfulness, and adventurousness with which they approached this conundrum.

Figure 9. Series of seven comics from different students answering the questions: 1. “What is love?” and 2. “Is love an illness?” Description: Overall, the comics wrestle with these definitions. Most answers to the first question (left side of page) show two beings / entities in connection with each other, although one carries a “Rejected” stamp, and another shows a figure awash with thought bubbles. Most comic responses to the second question (right side of page) show scenarios with outcomes related to love, from realistic scenes of connection to a comedic representation of a “love epidemic.”

Final thoughts on comics in the neuroethics classroom

To intentionally draw and color on a page is a meditative act. Drawing provides a space to step away from everyday stresses; this space is where reflection takes place. Students then have an opportunity to see a question differently, from multiple perspectives. They may cohere as a group and find insight through collaboration. I am continually struck by the capacity of drawing to calm and focus the classroom.

To share a creative work is also to show a piece of oneself. By sharing this sense of vulnerability, instructors and students open avenues of discussion that may not otherwise be available. Students also assume more control and more responsibility in such a classroom: for each class session, for reading, for asking questions, and for moving their understanding forward. Classes can be less predictable, including unplanned moments of silence. The silence is also important.

Figure 10. A page drawn by students at the end of the course 
depicting the many neuroethics topics covered together.
Description: A free-form, colorful sheet with a collection
of course topics written and colored in, accompanied by 
small illustrations and characters.

Lynda Barry, in Making Comics (p 44-48), discusses the importance of passing attendance notecards around the room and, elsewhere, the importance of laughter. It creates a certain kind of space; without this space and movement, the intellectual possibilities can also grow stagnant. The shared space and the laughter are both risk and opportunity, the gamble that leads to transformative forms of learning.

Finally, a note on accessibility. Some students may not be able to draw because of a disability. Any comics-based activity can be modified: what is important is that each student engages in an imaginative narrative process. When working with students who are blind, I have asked them to compose a narrative that describes detailed aspects of a scene: who is present, how they are feeling and acting, and details of the sensory context. They would then discuss their stories with classmates.

A comics curriculum is a process of narrative and symbol that can provide rare moments of connection and intellectual discovery. In an educational and political landscape where students and instructors are rushed and distracted, where perspective-taking is devalued, complexity is steamrolled and tolerance for ambiguity is scarce, the act of creatively teaching and learning ethics is a gift. 

I would like to acknowledge the work and insight of my Neuroethics (and other) students, past and present. All works shown here represent a combination of student and instructor creations, and most are collaborative.

References

1. Caulfield T, Rachul C & Zarzeczny A. (2010) “Neurohype” and the Name Game: Who's to Blame?, AJOB Neuroscience 1(2): 13-15.
2. Barry, Lynda. Syllabus. (2014). [Published in the USA by Drawn & Quarterly]. 
3. Barry, Lynda. Making Comics. (2019). [Published in the USA by Drawn & Quarterly]. 
4. Czerwiec, M., Williams, I., Squier, S.M., Green, M.J., Myers, K.R., & Smith, S.T. (2015). Graphic Medicine Manifesto. University Park: Penn State University Press. muse.jhu.edu/book/58781.
5. Talbot, M. (2012). Bioethics: an introduction. New York, NY: Cambridge University Press. pp 32 – 71.
6. Farah M. J. (2015). An Ethics Toolbox for Neurotechnology. Neuron 86: 34 – 37.
7. Global Neuroethics Summit Delegates, Rommelfanger K. S., Jeong S. J., et al. (2018) Neuroethics questions to guide ethical research in the international brain initiatives. Neuron 100:19–36. 
8. Haslam N. & Whelan J. (2008). Human Natures: Psychological Essentialism in Thinking about Differences between People. Social and Personality Psychology Compass 2(3): 1297-1312.
9. Postan, E. (2016). Defining Ourselves: Personal Bioinformation as a Tool of Narrative Self-Conception. Bioethical Inquiry 13: 133.
10. Bredenoord, A. L., et al. (2017). "Human tissues in a dish: The research and ethical implications of organoid technology." Science 355(6322).
11. Kreitmair K. V., & Cho M. K. (2017) “Chapter 5: The neuroethical future of wearable and mobile health technology”. In: Illes, ed. Neuroethics. Oxford, UK: Oxford University Press. pp 80 – 107.
12. Stein et al. (2011). “Ch 47: Ethical Issues in Educational Neuroscience: Raising Children in a Brave New World.” In: Illes and Sahakian, Eds. Oxford Handbook of Neuroethics. New York, NY: Oxford University Press.
13. Karnik, N. S. (2017). “Chapter 4: Vulnerability, youth, and homelessness: Ethical considerations on the roles of technology in the lives of adolescents and young adults.” In: Illes, ed. Neuroethics. Oxford, UK: Oxford University Press. pp 123 – 143.
14. Panofsky, A. (2015) “What Does Behavioral Genetics Offer for Improving Education?” The Genetics of Intelligence: Ethics and the Conduct of Trustworthy Research, special report, Hastings Center Report 45 (5): S43-S49.
15. Fins, J. J. (2016). "Giving Voice to Consciousness." Camb Q Healthc Ethics 25(4): 583-599.
16. Partridge B., Hall W. (2017) “Chapter 26: Concussion, neuroethics and sport: Policies of the past do not suffice for the future”.  In: Illes, ed. Neuroethics. Oxford, UK: Oxford University Press. pp 123 – 143.
17. Rommelfanger, K. S. and P. F. Boshears (2017). "The Rubicon Already Crossed." AJOB Neuroscience 8(4): 197-199.
18. Ren, X. and S. Canavero (2017). "HEAVEN in the Making: Between the Rock (the Academe) and a Hard Case (a Head Transplant)." AJOB Neuroscience 8(4): 200-205.
19. Illes, J. and P. J. McDonald (2017). "Head Transplants: Ghoulish Takes on New Definition." AJOB Neuroscience 8(4): 211-212.
20. Wolpe, P. R. (2017). "Ahead of Our Time: Why Head Transplantation Is Ethically Unsupportable." AJOB Neuroscience 8(4): 206-210.
21. Mohamed, A. D. and B. J. Sahakian (2012). "The ethics of elective psychopharmacology." International Journal of Neuropsychopharmacology 15(4): 559-571.
22. Maslen, H., et al. (2014). "Pharmacological cognitive enhancement—how neuroscientific research could advance ethical debate." Frontiers in Systems Neuroscience 8(107).
23. Duncan, J. R. and Lawrence, A. J. (2012). “Chapter 2: Molecular Neuroscience and Genetics”. In: Carter, A., Hall, W., Illes, J., Eds. Addiction Neuroethics. San Diego: Academic Press. pp 27 – 54.
24. Hammer, R., et al. (2013). "Addiction: Current Criticism of the Brain Disease Paradigm." AJOB Neuroscience 4(3): 27-32.
25. Mayberg, H. S., Lozano, A. M., Voon, V., et al. (2005). Deep brain stimulation for treatment-resistant depression. Neuron 45: 651-660.
26. Kubu, C. S. and P. J. Ford (2017). "Clinical Ethics in the Context of Deep Brain Stimulation for Movement Disorders." Archives of Clinical Neuropsychology 32(7): 829-839.
27. Hackman, D. A. et al. (2010) Socioeconomic Status and the brain: mechanistic insights from human and animal research. Nat Rev Neurosci 11: 651 – 659.
28. Tesluk J, Illes J, & Matthews, R. (2017). “Chapter 23: First nations and environmental neuroethics: perspectives on brain health from a world of change”. In: Illes, ed. Neuroethics. Oxford, UK: Oxford University Press. pp 455 - 476 
29. Boulware, JN. (2018). Not Our Problem? The Neuroethical Implications of Youth Detainment. 2018 INS Essay Contest Winner. Retrieved from:  http://www.dana.org/INS/essay-2018-scicomm/
30. Teicher, M. H. (2018). "Childhood trauma and the enduring consequences of forcibly separating children from parents at the United States border." BMC Medicine 16(1): 146-148. 
31. Lobel, J. and H. Akil (2018). "Law & Neuroscience: The Case of Solitary Confinement." Daedalus 147(4): 61-75.
32. Fine, C. (2012). Explaining, or Sustaining, the Status Quo? The Potentially Self-fulfilling Effects of ‘Hardwired’ Accounts of Sex Differences. Neuroethics 5: 285-294.
33. Earp et al. (2013). If I could just stop loving you: Anti-love biotechnology and the ethics of a chemical breakup. AJOB 13(11): 3-17.
34. Gupta, K. (2012). "Protecting Sexual Diversity: Rethinking the Use of Neurotechnological Interventions to Alter Sexuality." AJOB Neuroscience 3(3): 24-28.

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Ann Fink, Ph.D.,is a neuroscientist, educator and artist. She received her doctorate in Neuroscience from UCLA, and her publications on the neurobiological basis of memory, emotion and mental health have appeared in the Journal of Neuroscience, Journal of Neurophysiology, PNAS, AJOB Neuroscience, and other journals. Ann’s interdisciplinary work addresses the ethics of neuroscience in relation to topics surrounding identity, mental health, and social justice. She was a prior Wittig Fellow in Feminist Biology at the University of Wisconsin-Madison and is currently a Professor of Practice in the Department of Biological Sciences at Lehigh University.

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Fink, A. (2020). Graphic Neuroethics: A Comics-Making Curriculum (Part II of II). The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2020/04/graphic-neuroethics-comics-making_14.html