Swallow Me Whole is one of the year’s most powerful graphic meditations on both adolesence and mental disorder. Author Nate Powell walks a tightrope between imagination and hallucination for the duration of the book, effectively generating as many questions as he attempts to answer, a method that is frustrating, to be sure, but also imbues the book with a sense of fascination that commands repeat readings.
In this second part of our interview with Powell, we delve deeper into this heady topic of childhood schizophrenia, and hit on some equally troubling questions about the role that gender politics play in the diagnosis of mental disorders.
How large of a role does misdiagnosis play in the book?
It definitely plays a big role. In fact, I have a lot more words in this book than I did in my early days, mostly because I didn’t know how to write at all.
There mere existence of words in this one is a marked difference from some of your past books.
That’s true. The words help. But here are a couple of things that I did want to keep open-ended. There are a couple of things that I think became more powerful by being open-ended. But one thing that I know in my brain for the story, which I kept open-ended is that—and I don’t know if this was successfully communicated or not—that basically both kids, when they’re 11 or 12, or whatever, coincidentally get a degree of hallucinations—mild delusions. A lot of of stuff I was trying to communicate was the stigma of behavior for children of different genders.
Exactly. When you have Perry and let’s say he’s 16, and he has this delusion with this little wizard that basically has these grand plans that Perry has to draw, so that they can complete their big mission together. The fact here is that he’s compulsively creating art, and I assume he’s pretty good at it. But we basically have a teenage male who’s an artist, who’s doing something that’s creative and constructive. It’s not someone who is cutting themselves or doing something destructive, where I find—this is not from personal experience—to be very easy to pass off, even something like a hallucination, as being the product of someone not getting enough attention and having an overactive mind, but being a part of the creativity itself, and maybe not even being appreciated or pushed enough, so they’re pushing themselves.
On the other hand, you have a teenage female with almost the same issues. Even though I personally feel that might be constructive with Ruth, who’s actually creating an armada out of these bugs and amphibians. She has a particular rank and file system to them. She’s exercising her creative and constructive capacities, as well. Constructing an imaginery army out of insects is not always considered art, or whatever, but she’s actually female and she’s crossing a line of introversion/extroversion, as it relates to gender in our society. She also has delusions to mild hallucinations, but they’re more readily perceived as a problem, much more than if a male had these same issues. So that’s kind of an under-current that I thought was important.
That’s interesting—there seems to be two issues at play here. There’s the gender issues, which you mentioned, and then there’s the ways in which their psychoses manifest themselves. Do you think that, were the roles switched, and he were collecting bugs in jars and she were drawing, that the reaction would still be the same?
I don’t think that they’d be the same. Interestingly, I think it’s more of the presumed gender norm that males are more physically interactive with their world, especially when you have bugs and frogs and related things. That would fall more under the category—once again, I think that females who grow up having a very strong interest in math or science generally are considered at least slightly more aberrant in their interest than a male having the same passion. So I would say, then, that it would not be the exact same, but I think it would open up some entirely new doors of stigma. In fact, it might be a little more intense. I think it plays on the same thing, but probably to different degrees.
The gender of one isn’t totally clear from the art, but it seems that the boy goes to a male doctor and the girl goes to a female doctor.
Do you think the gender of the person making the diagnosis plays a factor in the diagnosis itself?
I do think that the male doctor’s does. The male doctor formerly has some kind of a relationship with the family, as general practitioner. He was a pediatrician for the family. He knows their history. It was just Perry and dad, Brady Bunch-style. He has a previous relationship with them. So there are these theoretical concerns which you’re picking up on, which are absolutely correct. At the same time, it’s only—I would credit the doctor by saying that he knows enough about the way that a child would interact and express their problems. And also, he knows the dad enough to know that something else is going on to know why he is there for treatment, to know what’s behind the injuries.
And, as far as the psychiatrist is concerned, interestingly, I will say that I don’t necessarily think that her gender plays a role in her diagnosis. As a side note, that doctor is actually based physically and somewhat behaviorally on a friend of mine who is female, but who kind of skirts the line, as far as being transgendered sometimes and being a female other times. That was actually an intentional choice, and she’s got a couple of things on her plate, mentally. Part of it was sort of an empowerment exercise, by casting this dear friend of mine in the position of psychiatrist, basically making sense of someone else’s problems. So there’s a personal reason for that, and actually, gender did play a role, in a different way. I didn’t want things—gender was the whole reason that they went to these different doctors, and there was a point in their diagnoses that I didn’t want it to be just that binary.
It seems like something of a double-edged sword. On one hand you’re saying, once these diagnoses are made—and if they are, in fact, accurate—especially in the South, there’s a tendency to ignore them and write them off, but at the same time, in terms of the diagnoses themselves, you seem to be siding with the male doctor’s decision not to diagnose Perry as schizophrenic. Without giving too much of the subtext away, where do you side, as far as the difference in terms of diagnosis between childhood creativity and schizophrenia?
That’s an excellent, excellent point, within your question there. First off, I should reveal that for the last nine-and-a-half years or so, I’ve worked basically inside the mental health field and human services field. I’m a direct care worker for people with mental health and developmental disabilities. I work a lot with people with mental impairment issues as well as developmental disabilities. From a professional perspective as well as a personal perspective, I do side with the male doctor in his decision not to recommend Perry to a psychiatrist or a psychologist, but I’m not freeing him from basically playing a part in a gender stigma of boys being boys and encouraging basically the existence of this order because it’s creative.
One of my biggest frustrations and fears, however, and this goes beyond talking about my brother, as far as the kind of stigma that happens whether it’s someone with developmental disabilities or a mental disorder has any kind of encounter, no matter how minor, with law enforcement, something gets set in motion that can never be erased, and I’ve seen people’s lives really go down the shitter, just by getting a little out of control or out of hand, one time, or doing something inappropriate at the exact wrong spot. There’s really no way to get back from there.
For people who actually have schizophrenia, it’s very frustrating, because perhaps the most important thing is that you get diagnosed and you find something that works for you. If that’s medication, you find the kind of medication that works, and then you make sure you keep taking it, and then you make changes in your life around this important role of getting diagnosed and finding something that works for you. And schizophrenia is a neurological disorder, and its roots are medical. That’s what makes it different. That’s what makes chronic depression different from intense sadness. The roots are neurological, they’re not just 100-percent how fucked up the world is, making you depressed. So, basically, I do side with the male doctor, but I’m not letting him off the hook.
For people with schizophrenia, diagnosis and treatment are incredibly important. But at the same time, I do want to say that, even if there is this gender diagnosis stigma going on with Ruth as well, from a narrative perspective—the fact that we’re dealing with comic books here—there is a gray area, where the fantasies that we see in our heads, especially when we’re young, whether it’s emotional extremities, or whether it’s actual creative energy happening—our imaginations at work—from a strictly visual standpoint, it really isn’t fully resolved whether these are actual schizophrenic hallucinations. I will tell you that they are actually the result of schizophrenia in the book, however.
It being a comic book, the reader never really knows whether the fantasies themselves are real.