Trigger warning: Discussion of chronic and post-partum depression.
The second part of Rachel Masilamani’s NON-PARTUM, a series of comics about her journey with fertility, “The Subject,” is about access to care. The first part, “Plan B-2o0,” which I reviewed here, is about choice, fertility, and above all, perspective. This one digs into equally thorny territory: physical and mental health, the priorities and politics of the medical system, and who gets and who deserves care.
Where “Plan B-200” juxtaposed teen Masilamani with a Masilamani just starting fertility treatments, “The Subject” focuses on her time in graduate school. Here, Rachel is struggling to stay afloat and participating in every paying study around, so many that a tax form is issued for her study income and her identity is pushed and pulled into “The Subject.” Not that Rachel’s identity is subsumed—it certainly isn’t, thanks to Masilamani’s strong voice and expressive cartooning—but simply, that being an intensive research subject does things to you, to your self. It’s a “teachable moment” about your self and about the American medical system.
What do I mean by that? I’ll show you.
This is a great page. Masilimani doesn’t dwell on the experience of grad school too much or on the actual going to and from the studies and what space it occupied in her life at that time. She’s got other things on her mind as far as the major themes go, but here we can see it quite clearly. How do you find this work? Constant vigilance: reading fliers and ads in every spare moment, while somehow keeping up with classes and life and self care (Self care? Who has time for that?). What is it like to be a research subject or “The Subject?” You are kept close and tight in an apparatus—physical and institutional—and are made to perform actions rendered nonsensical, sometimes even farcical, by your lack of knowledge about the experiment. This is how you get paid. This is how you get to eat.
Throughout “The Subject,” Rachel is kept in ignorance, and not just by researchers. Her stint as a research subject—performing, unknowing, ineffectively reassured by those who do know—is neatly mirrored by her experiences as a patient.
About midway through “The Subject,” and I think nearing the end of her time as a research subject, Rachel, participating in a major study on post-partum depression, receives a letter from the study director. She is in the control group: not a mother, but a woman who has suffered depression. The experience is harrowing and silly. It’s a multi-stage study that requires exhaustive questioning, weird exercises, and a stint in an MRA while playing a light-based game. But she gets paid, which is good, and she gets the letter. The Letter, as much as Rachel, is The Subject. The study finds that Rachel has “elevated thyroid antibodies in the context of normal thyroid function.” This could mean nothing, or it could mean that she has a serious thyroid problem. The page above details Rachel’s attempts to discuss a possible thyroid problem with her doctors. Over and over.
Later in the comic, after she’s received the letter, she goes back to her doctors. Here we go again:
The page structures aren’t perfect mirror images of each other, but the connection is clear, and the deviation from that four panel structure is useful too. In that wide panel, we move from entreaty and rebuttal to entreaty and dismissal. Rachel’s posture is hunched with worry, holding out the hair that’s always falling out; the doctor’s filling out a chart with no more worry than a furrowed brow. Let us know. Let us know. Let us know. Now Rachel is angry, not just frustrated—when does letting them know translate into actual care?
Sometimes I feel sorry for doctors. Always following dictates set by predecessors. Those good students. The experts on what’s been done. Unable to admit that doing well on multiple choice tests is not the same as knowing the answers.
When will people take your worries about thyroid problems seriously? When you want to have a baby, Rachel discovers.
“The Subject” continues the structure established in “Plan B-200.” It is more a thematic memoir than a strict retelling, with Masilamani using contrasting colour schemes to denote changes in time and mood. And, as with “Plan B-200,” these visual/tonal shifts aren’t heavy-handed or obvious; instead they are just right. When Rachel is at a doctor’s appointment, the tone is generally cool. When she’s participating in a study, the tone is much warmer. This suggests that the experience of being a patient, an ignored patient, was more damaging than the experience of being a research subject. And that’s true, given what we learn in “The Subject” about the neglectful care she received. But Masilimani cleverly undercuts the warmth of those research sequences with alienating closeups as in page two (above) and with oppositional postures as in the page below. Neither experience is a good one, but somehow, being a patient is even worse than being a research subject.
This is my favourite page in the comic. That posture, split between fuck you and worry. That barrage of questions with clear recognition when Rachel feels like this study, it knows me. And with Rachel pictured alone, but for those voices, those unseen questioners. The page serves as a self-portrait of Rachel as The Subject. Here is Rachel’s identity, fully intact, expressed through her posture, her clothing, her face, and her answers, but here too is the experience distilled: whatever self-knowledge she finds through the study, whatever use she gets from the experience, good or bad, the study continues on. She’s just another subject. Just another patient.
The question at the heart of “The Subject” is this: why does “I want to have a baby” get you VIP access to attentive medical care while “I don’t think it’s just depression” gets you dismissals? Or put differently, why is access to care so unequal? Masilamani hints at it when she calls doctors “[t]hose good students. The experts on what’s been done,” but it goes deeper than habit. During the post-partum study, other participants are taken aback by discovering that she’s “just” part of the control group; “just” depressed, not post-partum depressed. Post-partum depression is no easier to deal with than other forms, but there’s something in having your illness defined—there’s a reason the other participant’s are depressed. For Rachel, she’s “just depressed.” The reason is unknown. Is this the key to good medical care? Some solid, quantifiable lead for doctors to pursue?
Also, there’s something in how Rachel finally figures out what’s going on with her (Hashimoto’s Thyroidosis, which can cause severe depression, weight gain, and changes to your skin and hair), not through diligent investigation, but by accident, while she’s participating in research studies just to live. As a student, Rachel might have been insured by her student union, but that’s nothing like a proper, paying customer, is it? And don’t forget, “College sure is hard, isn’t it sweetie?”
This hits home for me. I first started feeling depressed and angry in middle school. Teen angst, a bad school environment—who cares what the exact trigger was at this point? I didn’t tell anyone I was feeling bad; I just skipped school. In university, things got worse—chronic and acute insomnia worse—and I finally started to talk. But what does talking about depression, insomnia, and anger get you on a university or college campus? “School sure is hard. Try these pills.” These days I’m doing much better, through lifestyle choices, but I’m still waiting for my correct diagnosis. When Rachel gets hers—first the letter, and then finally, a doctor who takes it seriously and confirms her suspicions—well, that’s everything isn’t it? Doors opening, so much anxiety and self-doubt put to bed. Finally someone listened.
“The Subject” is part two of Rachel Masilamani’s NON PARTUM, published by Mutha Magazine. Please join me again for my review of part three, coming soon!