Making Parables of Care Available in Open Access Repositories

We have been working hard making Parables of Care available to the public.

The PDF of the publication can now be freely downloaded, under a Creative Commons Attribution-NonCommercial 4.0 International License, from the following locations:

City Research Online, City, University of London: http://openaccess.city.ac.uk/18245/
ChesterRep, University of Chester: http://chesterrep.openrepository.com/cdr/handle/10034/620684
DOOR, Douglas College: http://dc.arcabc.ca/islandora/object/dc:18369?lrstc=1LBWB
CORE, Humanities Commons: http://dx.doi.org/10.17613/M6FN7C

Depositing your work with a repository ensures that it is archived, preserved and citeable, making it quickly and widely available to others.

These are open access repositories which means that it is not necessary to have a subscription or academic credentials to access the material.

Depositing an output is, of course, only a point of departure. In today’s highly competitive attention economy, only active, ongoing and direct efforts in disseminating content by engaging audiences can lead to better prospects of public ‘impact’.

We also continue shipping printed copies within the UK. If you live in the UK you can request printed copies at no cost here.

Parables of Care: A Q&A with Dympna O’Sullivan

By Ernesto Priego.

Dr Dympna O’Sullivan, Senior Lecturer in Health Informatics at the Centre for Human-Computer Interaction Design, City, University of London.

Dr Dympna O’Sullivan is a Senior Lecturer in Health Informatics at the Centre for Human-Computer Interaction Design. Dympna’s research is in the area of health informatics, clinical decision support systems and evidence-based medicine. She is interested in managing the large volumes of data generated by today’s digital healthcare environments and in developing intelligent software systems to bridge the gaps between clinician’s information needs and the computational resources available to meet them.

Dympna participated in the Parables of Care workshops held at City in the spring. I asked Dympna some questions related to Parables of Care.

An important part of your work focuses on finding solutions to developing sustainable healthcare. In your view, what is the role that ‘graphic medicine’ (the role that comics can play in the study and delivery of healthcare) could play in finding these solutions?

Dympna O’Sullivan: A hugely challenging aspect of developing sustainable healthcare models is finding ways to engage patients and service users in health and social care. An important aspect of patient engagement is looking for new ways to communicate with patients and service users and new ways of providing meaningful and actionable information to then. I believe graphic medicine can play an important role in getting this kind of health information to patients and service providers in a new way.

Further, the modality has the potential to address issues of low levels of patient education and health literacy which are commonly observed in patients lacking engagement. Persons with low health literacy are also often at high risk for poor health.

Health and healthcare are complex constructs and the graphic medicine medium has the potential to decompose complicated information. By using characters, graphic medicine can also add humanity to information by lending a human face to health information. Graphic medicine could be particularly pertinent for public health messaging as it may be combined with existing media like pamphlets and booklets. This also has the potential to engage new audiences, for example younger patients, in health.

We employed User Centred Design activities in the development of Parables of Care. Why is user-centred or person-centred healthcare important?

DOS: User-centred healthcare design brings together patients, healthcare staff, families and communities to explore and understand the real-life experiences of healthcare. These experiences can be very different, thus requiring diverse functionality, services and even systems for each group of end users. Healthcare is a complex web of organizational, environmental and ergonomic factors all of which influence the use of computer technology in a healthcare setting. From a clinical perspective, involvement of users assures developed systems will be fit for purpose and operationally optimized for the environment in which they will be used. From a patient perspective, personalizing medicine using user centred approaches to develop technology, has been shown to engage patients in their healthcare more effectively and to improve outcomes.

Dr Dympna O’Sullivan and Dr Simon Grennan at a Parables of Care workshop at City, 8 March 2017

Parables of Care adapted cases from Care’N’Share. How difficult is it to get the public interested in evidence-based healthcare?

DOS: Public access to evidence based health is generally facilitated by public health bodies such as Public Health England. Although methods for communicating evidence based health have developed and expanded rapidly due to new technologies, the scope of public health messaging remains rather narrow generally focusing on changing individual behaviours such as smoking, alcohol, exercise and eating habits.

While there are undoubtedly some issues concerning a lack of public interest in evidence based healthcare, a greater issue is the lack of knowledge on the part of the public, that other types of health evidence apart from those typically made available by Public Health England exists. Very few initiatives have had the focus of Parables of Care to make data from an existing health dataset available to the public and particularly in such an accessible format.

What were your thoughts on Parables of Care as a publication?

DOS: Parables of Care is an exceptional publication, thoughtful and simple, yet grounded in established academic practices for communicating information. It works on many levels, making good practice information available to clinicians, formal and informal carers as well as patients themselves. It is accessible for wide ranges of literacy and health literacy, an important consideration in the care industry. Finally it specifically focuses one of the grand health challenges of our time, dementia, which despite its huge burden is chronically underfunded and thus any attention on the condition is welcome.

Health Informatics and comics: what’s next?

DOS: I return to my original points on patient engagement which is one of my active research areas. I believe there is huge potential for graphic medicine is this space. Patient engagement was recently described by Forbes Magazine as “The Blockbuster Drug of the Century”!

Patient engagement is composed of a number of dimensions all of which can be facilitated very effectively by the graphic medicine format. First by providing an understanding of the importance of taking an active role in one’s health; Second by imparting knowledge, teaching skills and providing confidence to manage health conditions; And thirdly by providing guidance on how to perform specific health-promoting behaviours. All while offering a human face to the information, something that is generally not present in the many apps being developed in this space.

I believe this is an exciting interdisciplinary research area where health informatics, comic artists and behavioural scientists can provide some much needed solutions.

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Parables of Care can be downloaded as a PDF file, under a Creative Commons Attribution-NonCommercial 4.0 International License, from City Research Online: http://openaccess.city.ac.uk/18245/.

If you live in the UK you can request printed copies at no cost here.

HCID Research Seminar: Making Parables of Care – Presenting creative responses to dementia care in comic book form

By Ernesto Priego.

HCID Research Seminar: Making Parables of Care – Presenting creative responses to dementia care in comic book form

Friday 17 November 2017, 1:00-1:50 PM, A214

If you are not a member of the University and would like to join us for this seminar, please contact Katerina.Bourazeri@city.ac.uk for further details.

Simon Grennan Dispossession

Speaker: Dr Simon Grennan, University of Chester
Series: HCID Research Seminars

Abstract

This seminar will discuss the practical rationale, theorisation and production of Parables of Care, a new 16-page colour comic book, which presents creative responses to dementia care, as told by carers, derived from a group of existing case studies available at http://carenshare.city.ac.uk.

Parables of Care is an impact project of the Centre for HCID, City, University of London, the University of Chester and Douglas College, Canada. Distributed as free hard copies and a free download to carers and those engaged in debates about dementia care, the book investigates the ways in which specific habits of reading comics can be activated in order to engage readers emotionally, as well as informatively, concerning the challenges of caring for people with dementia.

About the speaker:

Dr Simon Grennan is a scholar of visual narrative and graphic novellist. He is author of “A Theory of Narrative Drawing”(Palgrave Macmillan 2017) and “Dispossession” (one of The Guardian Books of the Year 2015), a graphic adaptation of a novel by Anthony Trollope (Jonathan Cape and Les Impressions Nouvelles 2015). He is co-author, with Roger Sabin and Julian Waite, of “Marie Duval” (Myriad 2018) and “The Marie Duval Archive” (www.marieduval.org) and co-editor, with Laurence Grove, of “Transforming Anthony Trollope: ‘Dispossession’, Victorianism and 19th century word and image” (Leuven University Press 2015), among others.

Since 1990, he has been half of international artists team Grennan & Sperandio, producer of over forty comics and books. Dr Grennan is Research Fellow in Fine Art at the University of Chester and Principal Investigator for the two-year research project “Marie Duval presents Ally Sloper: the female cartoonist and popular theatre in London 1869-85”, funded by an AHRC Research Grant: Early Career (2014).

For more information visit www.simongrennan.com

https://www.city.ac.uk/events/2017/november/hcid-research-seminar-making-parables-of-care-presenting-creative-responses-to-dementia-care-in-comic-book-form

If you are not a member of the University and would like to join us for this seminar, please contact Katerina.Bourazeri@city.ac.uk for further details.

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Parables of Care can be downloaded as a PDF file, under a Creative Commons Attribution-NonCommercial 4.0 International License, from City Research Online: http://openaccess.city.ac.uk/18245/.

If you live in the UK you can request printed copies at no cost here.

Parables of Care Canada Moving Along

By Ernesto Priego.

Parables of Care is a project of the Centre for Human Comuter Interaction Design, City, University of London, The University of Chester, UK, and Douglas College, Vancouver, Canada.

What follows is a brief update by Dr Peter Wilkins on the Canadian component of the project.

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The Douglas College component of the Parables of Care project has been moving along nicely.

We have hired two Student Research Assistants. Kindra Van-Nettey has a degree in Sociology and is working on a second degree in Nursing. She wants to go into elder care and work specifically with dementia patients. Nicole Cox is in the Marketing program; she has good experience working with focus groups.

Student Research Assistants Kindra Van-Nettey and Nicole Cox, Douglas College, Canada

Melissa Martins is our artist. Her background is in game design but she is keen to get into comics. Melissa has been attending sessions on creating comics given by Miriam Libicki (jobnik!, Toward a Hot Jew) at the Vancouver Public Library. The latest one was on interview comics, which will be helpful for our project.

Artist Melissa Martins

We have been meeting every two weeks to set up the focus group sessions that will provide the raw material for our comic. Our plan is to do one before Christmas and the rest in Winter term.

Finally, the Douglas College Print Shop did a bang up job of printing out Parables of Care. They went above and beyond the call of duty to produce an “A5” paper size, even though that is not a standard North American size.

The Douglas College Print Shop version of Parables of Care, meant for North American distribution.

The Canadian printed edition of Parables of Care.

Watch this space for more updates!

Words and photos by Dr Peter Wilkins.

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Parables of Care can be downloaded as a PDF file, under a Creative Commons Attribution-NonCommercial 4.0 International License, from City Research Online: http://openaccess.city.ac.uk/18245/.

If you live in the UK you can request printed copies at no cost here.

Parables of Care: A Q&A with Neil Maiden

By Ernesto Priego.

Neil Maiden, Professor of Digital Creativity in the Faculty of Management at the Cass Business Business and co-founder of the Centre for Creativity in Professional Practice at City, University of London.

Neil Maiden is Professor of Digital Creativity in the Faculty of Management at the Cass Business Business and co-founder of the Centre for Creativity in Professional Practice at City, University of London.

Neil directed research that led to the innovative Care’N’Share application, which is available publicly to support creative and collaborative care of older people with dementia.

I asked Neil some questions related to Parables of Care.

The Care’N’Share website provides users with access to good care practices in residential, live-in, domiciliary, acute, day service and family care. What was the personal and/or professional motivation for developing Care’N’Share, and what got you interested in dementia care?

Neil Maiden: The original motivation was professional. One of our projects was seeking a domain and partners to explore digital support for creativity and reflective learning in the health sector. Due to various last-minute machinations in the consortium, we began to work with a residential care organisation, and our team was exposed, for the first time, to the needs and challenges of older person social care.

The response of the research team was interesting, and overwhelmingly positive. Team members could seek the immediate and personal benefits of their technology work on care.

Of course, over time, many of us have relatives who have become older, and the motivations for the development of our tools have become more personal.

You also worked on CarePlus, ‘an interactive digital solution for collecting care quality information for residential homes’ (2016). How did that project relate to Share ‘N’ Care?

NM: There are no direct connections between the CarePulse and Care’N’Share tools, apart from the word ‘care’. However, the research work that led to tools such as Care’N’Share established our team as researchers and designers in the older person care sector. That experience and reputation established the links that led to the CarePulse tool.

You and your team found indication of usability issues in the care sector. How can User-Centred Design activities help contributing for better usability?

NM: Delivering digital technologies into the care sector is challenging, and usability is a major source of challenges. The challenges associated with developing tools that older people with conditions such as dementia can use are obvious, however designing for care professionals with little time or motivation to use technologies has also proven to be difficult. So user-centred design can help, as long as it recognises the priorities of stakeholders and the scarcity of resources available to participate in these design processes.

Parables of Care is an attempt to communicate health care information employing comics, a visual medium related to scenarios and storyboards, which are UCD activities. What were your thoughts on Parables of Care as a publication?

NM: I think that Parables of Care is fantastic. First, it exploits and makes available good care practice stories – stories that were hard-won from care practitioners, and makes them available to others. Second, it renders the stories simple to access. Third, the comic format engages different types of readers – including kids and teenagers – who might not be otherwise interested in care.

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Parables of Care can be downloaded as a PDF file, under a Creative Commons Attribution-NonCommercial 4.0 International License, from City Research Online: http://openaccess.city.ac.uk/18245/.

If you live in the UK you can request printed copies at no cost here.

Parables of Care: A Q&A with Ernesto Priego

By Abi Roper.

Dr Ernesto Priego, City, University of London

Ernesto Priego is a lecturer at the Centre for Human-Computer Interaction Design at City, University of London and the Editor of The Comics Grid: Journal of Comics Scholarship.

Ernesto worked in partnership with Dr Simon Grennan of the University of Chester, Dr Peter Wilkins of Douglas College, Vancouver, Canada, an NHS Trust, and colleages from HCID, leading the team to produce Parables of Care.

I asked Ernesto some questions about working on Parables of Care.

As a speech and language therapist researcher, I work with people who have aphasia and may have difficulty in reading large amounts of written text. People with dementia can experience similar challenges. What do you think the comics format offers that other mediums might not?

Ernesto Priego: My view is that comics are a unique medium because they often rely on a unique, complementary combination of writing, still graphic images and other components of visual communication. There are, of course, comics that are very wordy—they employ a lot (and I mean a lot) of written text. And there are, of course, comics that include almost no text at all (titles, indicia, series names are also written text). Unlike animation, video, TV or cinema, most comics, particularly printed ones, allow users / readers to linger on the comics page. Comics are therefore, in their own way, a very ‘mindful’ medium, as they often rely on a type of hyper awareness of concrete and abstract constraints, of context.

In most comics, time passes through different vehicles so to speak: through the time of the written text, the time represented through layout (panel size and arrangement and the placement of characters, backgrounds, props, narrative components), the time represented through panels in sequence and the gap between them, and the time it takes each reader to read or navigate the comic itself. So comics are a very complex medium indeed, but at the same time they give users a freedom to linger and to interpret information in a way that synchronic media such as music, video, TV or film do not allow them to.

Rather than just a question of comics being able to present ideas without the need for many words, in this case we think of comics as a medium that can actually evoke the kind of de-structured and re-structured experience of time that is akin to dementia but also to illness, ageing and caring in general (Paco Roca’s Wrinkles does this very well).

Illustration from Wrinkles, a graphic novel by Paco Roca. © Knockabout Comics, 2015

In many cases, people with dementia, as well as their carers, experience a time which is ‘out of joint’ (Hamlet, that tragic hero…). The fragmentary yet sequential structure of the comics in Parables of Care seeks to communicate and empathise with this experience, and in this way it attempts to share a way of experiencing the world.

I’m more familiar with comics being used to tell stories of superheroes. How are Care’N’Share stories similar and/or different to these more traditional comics narratives?

EP: That’s a very good question. For many people the term ‘comics’ means ‘superheroes’. Comics are much more than superheroes but in the case of the Care’N’Share stories the analogy achieves the status of poetic justice. Peter said in the previous Q&A that the Care’N’Share caregiver-storytellers are poets. This is true. Your question makes me think that they are similar to Romantic poets, and in this sense to heroes. Caregiving is heroic because it is a journey, and the hero’s journey is both motivated and defined by a sense of ethics, a thirst for justice and order, and fate or destiny. I also think people with dementia are poets: they see the world in a way that forces the carer and other people to realign their way of seeing things. Like the poet, they often see things that others don’t. The carer is a poet-hero because they need to learn to interpret that poetry and engage in creative endeavour themselves.

The best superhero comics, in my mind, are not about invincible heroes but about vulnerable folk that are somewhat different: their ‘superpowers’ lie in their difference and in their ability to find solutions to problems for the betterment of their communities. (Think of Peter Parker, for example). There is a lot of doubt, anxiety and pain in the hero’s journey.

Peter Parker takes care of his aunt May after she suffers a heart attack. In Stan Lee (w), Steve Ditko (p), Sam Rosen (l), The Amazing Spider-Man, Vol 1, No. 17, October 1964.

Peter Parker cares for his aunt May after she suffers a heart attack. In Stan Lee (writer), Steve Ditko (artist), Sam Rosen (letterer), The Amazing Spider-Man, Vol 1, No. 17, October 1964. © Marvel Comics

John Keats, by Joseph Severn, 1821-1823 – NPG 58 – © National Portrait Gallery, London

The caregiver-storytellers of Care’N’Share however do not see themselves as heroes, but what they do is heroic, it requires a sacrifice and a determination that is only possible when our deepest fears are defeated and our inner super powers come to the fore. I have the uttermost respect for dementia carers/caregivers. The stories they share are lessons to us all on our duty to our fellow human beings on how to empathise with what is often completely incomprehensible and find solutions that are respectful, loving and fair.

So it’s important to say that to me the beauty of ‘Graphic Medicine’ is that it’s not about idealisation or about fitting into generic narrative structures and archetypes. It’s about the personal journey, the vulnerabilities that make us human, and discovering the ways in which we can overcome serious challenges.

What have you learnt about dementia through your experience in creating Parables of Care?

EP: I am still learning a lot. The statistics alone provide sufficient evidence that dementia is one of the key public health and social challenges of today, not just in the UK but around the world. Working in this project required having an open mind about what we could achieve and be willing to accept that our contribution would be relativelly small but potentially impactful on some level.

To come back to my previous answer I think all of us working in the project learnt that a lot is achievable in terms of health care of incurable conditions if there is tolerance, empathy, creativity and imagination. In general working in adapting the stories forced us to attempt walking in the carers’ shoes. Susan Sontag wrote a beautiful book discussing the im-possibility of experiencing the pain of others through photography. I hope Parables of Care can contribute to share the experience of dementia care in a respectful and sensitive way.

Where else might comics be applied in healthcare? Where do you want to go next?

EP: Ah, that is the question! Short answer: almost everywhere. We believe that comics can be brilliant health information resources. And I think that Health Informatics and Graphic Medicine are a match made in heaven. We are already working on that next step. I am definitely interested in developing more work that explicitly connects the dots between graphic narrative and User-Centred Design and Interaction Design. I won’t say more for the time being. Watch this space!

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Dr Abi Roper is a Research Fellow at City, University of London. She is a speech and language therapist and researcher passionate about technology use within atypical speech & language populations.

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Parables of Care can be downloaded as a PDF file, under a Creative Commons Attribution-NonCommercial 4.0 International License, from City Research Online: http://openaccess.city.ac.uk/18245/.

If you live in the UK you can request printed copies at no cost here.

Parables of Care: A Q&A with Peter Wilkins

By Ernesto Priego.

Dr Peter Wilkins, Douglas College

Dr Peter Wilkins is the Research and Innovation Coordinator at Douglas College (Canada), and he manages programs for at-risk youth for the Douglas College Training Group. Peter is a founding editor (with David N. Wright) of Graphixia and the Deputy Editor of The Comics Grid: Journal of Comics Scholarship.

Peter worked in partnership with Dr Simon Grennan of the University of Chester, Dr Ernesto Priego of City, University of London, and an NHS Trust, to produce Parables of Care.

We asked Peter some questions about working on Parables of Care.

What is it that most interested you about Care’N’Share as a resource?

Peter Wilkins: Care‘N’Share gives a startling insight into the caregivers’ relationship to the dementia situation and their patients. I think we were all struck by the power of the stories even though they often occur in the most mundane settings. If we looked at it from a literary or narrative point of view, the stories often begin in realist mode and then suddenly shift into a surrealist or absurdist one.

The caregiver is like a character who passes through the wardrobe into a Narnia painted by Salvador Dali. Or like Marlowe going into the Congo in Heart of Darkness. They bring back something that gives us a glimpse into an alternative reality that shocks and frightens us. The uncanniness of the stories made me think of an untapped potential in using art, not as therapy, but as a means of accounting for dementia in a way that medical discourse doesn’t allow us to do.

Some stories in Parables of Care appear to be more or less difficult to ‘get’. What was the thinking behind it?

PW: Well, dementia is difficult to ‘get.’ Indeed, it is what philosophers would call sublime, unpresentable. This is where the idea of parable as a form or genre comes from and why we were so interested in the stories in the app. They are stories of practical reason, of enigmatic utility, of not knowing what to do in a difficult situation. This quality of the stories lends to the caregivers a kind of poetic heroism: they are faced with demands from the other side of rationality, dementia world, that they have to respond to in creative ways. So our conclusion was that caregivers are poets. To present the comics as easy solutions to the difficult problems of caring for people with dementia would not do justice to the caregivers.

On a related note, we were not interested in using the comics medium as a way of making things appear simple, in an “instrumental” use of comics. We don’t care for the idea of comics as simplistic communication; we care for the idea of comics as provocative works of art that will make their audience think and think again. It was great to work with Simon because he understands this through and through, and his drawings work really well at managing the audience’s response.

Peter Wilkins and members of the Douglas College Psychiatric Nursing team participate remotely at a Parables of Care workshop at City, 22 March 2017

Dr Peter Wilkins and members of the Douglas College Nursing team participate remotely with City Publishing & Creative Industries and HCID participants at a Parables of Care workshop, 22 March 2017, City, University of London

You are based in Vancouver, Canada. Can you tell us more about Douglas College‘s involvement in Parables of Care?

PW: We want to produce a companion volume to Parables that depicts the attitudes towards, and knowledge about, dementia from faculty and students across our Health Sciences faculty. We are working with focus groups from a range of programs, from Nursing through Dental Assisting, to generate material for the comic. The enthusiasm for the project here is tremendous, so we are very excited.

We are involving students in the work, which is important to us. They are running the focus groups and collecting the data. We have a young artist who has more experience in video game design than comics, but she is very committed and enthusiastic. It will be interesting to see how her work plays off of Simon [Grennan]’s. Sarah Leavitt, whose Tangles: A Story of Alzheimer’s, My Mother and Me is a groundbreaking graphic memoir on the subject, is consulting on the project, working with the artist.

Cover of Tangles, by Sarah Leavitt (Broadview Press, 2010)

A number of people from the faculty have told me about how they are professional caregivers, but when one of their family members has been struck by dementia they have been incapable of dealing with it. I’m interested in capturing those stories.

In any event, I see Parables of Care as the beginning of a much larger project that explores and documents dementia in comic book form.

Did you identify differences in how Canada and the UK approach dementia care?

PW: I can’t answer this question yet, but I hope to have some clues as we compare the data we collect with that from the Care‘N’Share app. I suspect that there will be differences and that they will be meaningful because even within Canada the different caregiving disciplines that engage with dementia don’t seem to communicate with each other that much. There are all kinds of gaps in the responses. I hope that the project allows people who work with dementia sufferers and their families to connect some dots and work towards a more holistic and universal approach to care.

There’s more than a hundred cases in Care’N’Share. As an editor, how did you approach the collection?

Our approach was to identify cases that represented particular strands of the dementia situation. While each case is unique, the stories do fall into categories: broken analogies, misrecognition, confinement and a desire for freedom and so on. What is important is that there are lots of satisfying though enigmatic eureka moments, where the undoubtable horror of dementia is relieved temporarily by the caregiver’s sympathy and genius.

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Parables of Care can be downloaded as a PDF file, under a Creative Commons Attribution-NonCommercial 4.0 International License, from City Research Online: http://openaccess.city.ac.uk/18245/.

If you live in the UK you can request printed copies at no cost here.

Parables of Care: A Q&A with Simon Grennan

By Ernesto Priego.

Dr Simon Grennan, University of Chester

Dr Simon Grennan, is a Post-Doctoral Research Fellow in Art and Design at the Department of Art and Design, University of Chester. He is an internationally acclaimed contemporary artist, comics scholar and author of over 40 comics and artists’ books.

Simon worked in partnership with Dr Ernesto Priego of City, University of London, Dr Peter Wilkins of Douglas College, Vancouver, Canada and an NHS Trust, to produce Parables of Care.

We asked Simon some questions about working on Parables of Care.

What was your first impression of the Care’N’Share stories?

Simon Grennan: I was immediately fascinated by the combination of descriptions of emotional/physical challenges and the extreme brevity of the case studies. The stories told by carers already conformed to a rather strict pattern derived from a proforma, designed to enable speedy access to the information that each story provides, for readers. This might have denuded the case studies of their affective aspects, but in fact, it focused and intensified them. That was immediately striking and interesting.

What was the most challenging for you in the drawing process?

SG: The editorial task for Peter, Ernesto and I involved considering how this combination of emotional impact, information and brevity could be visualised. The concept of the parable offered an accurate description of the stories as told by carers: the original stories already had the effect of parables.

We lighted upon a key aspect of the parable – its function of representing big effects (issues, truths, significant ideas) by small means. This ‘big in small’ characteristic was actually quite easy to visualise, because there is a great range of visual models, particularly in the history and traditions of the comic strip: visual gags, for example.

We immediately thought of the four panel Japanese ‘yonkoma‘ joke strips, which follow a set pattern for divisions of action. The form both produces and disperses ambiguity. That’s the way in which it works as a visual joke. Although the Care’N’Share stories aren’t jokes, by any means, part of their ‘parable’ character articulates exactly this manipulation of clarity and ambiguity. This seemed like a form particularly suited to these particular stories about dementia care, in which initial challenges to capacity, comprehension and communications are overcome by creative means.

In each story, there is a challenging scenario resulting from a specific experience of dementia, which is then reflected/acted up and finally resolved. For me, the task was then to visually articulate this balance of ambiguity and clarity in the narrative drawing, first creating a level of affective unclarity in the reader that I then develop and finally resolve.

As with visual jokes, creating the right affective balance between ambiguity and clarity is the main task. Too much ambiguity and the reader doesn’t know what’s happening. To much clarity and the reader has no emotional stake in the story. In both of these scenarios, the joke (or in this case, affect) disappears and the story fails.

I hope that I’ve managed to get the balance right! If so, each story should function as a parable, packing a lot of emotional punch (and taking the reader from ambiguity to clarity) with very few means.

Dr Simon Grennan during one of the Parables of Care workshops, 22 March 2017, City, University of London

‘A Theory of Narrative Drawing’: what theoretical principles did you apply in Parables of Care?

That’s an interesting question. My new book A Theory of Narrative Drawing seeks to explain experiences of drawn stories, but it’s not quite a handbook for drawing stories! However, one of the interesting things about Parables of Care is its self-announcing, overt reliance upon the reader to articulate the visual story and the story world. Of course, the reader always undertakes this articulation, in every story.

However, in Parables of Care, this is entirely due to the creation of ambiguity in each story. These are stories where a reader feels that they can or are making mistaken readings or, if the stories don’t clarify themselves for some readers, they think that the stories are simply incoherent or/and badly told. It is only when a reader realises that ‘making mistakes’ is an affective substitute for aspects of the experiences of dementia that are told about in each story, for example, that the sensation of ambiguity is transformed, located and resolved. This is entirely the type of affective reading that A Theory of Narrative Drawing explains.

What are you hoping Parables of Care can achieve?

SG: I hope that Parables of Care will focus attention on the emotional aspects of dementia care. We have worked hard to introduce readers to the (largely non-clinical) experience of dementia care by providing them with affective sensations of ambiguity, including a sense of inexplicable altered capacity, frustration and maybe a sense of powerlessness. These sensations are turned around and articulated in each story, retaining the emotional intelligence and creativity of the resolutions to challenging situations. The reader goes throught this process too, and reaches a similar clarity and resolve.

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Parables of Care can be downloaded as a PDF file, under a Creative Commons Attribution-NonCommercial 4.0 International License, from City Research Online: http://openaccess.city.ac.uk/18245/.

If you live in the UK you can request printed copies at no cost here.