Graphic Novels: A New Stress Mitigation Tool for Military Training, Developing Content for Hard-to-Reach Audiences

Theoretical Background and research questions/hypothesis: The social stigma attached to psychological problems is the greatest obstacle to psychological health in the military.  Members of all Services have reported a reluctance to seek help for stress or mental health problems for fear of being branded as weak by their peers and superiors (NTTP 1-15M, MCRP 6-11C, Combat and Operational Stress Control, December 2010). As a result, Service members may be disinterested in combat stress information delivered through conventional training programs.  New innovative methods are needed for delivering information to help psychologically prepare Service members for the stress of active combat and to ultimately reduce the stigma associated with seeking assistance for mental health problems (Naval Health Research Center Quarterly Update, First Quarter, Winter 2009-2010). The graphic novel format was selected because of its anticipated appeal to the targeted age group of enlisted 18- to 34-year-olds and for its non-threatening value in providing thought-provoking content about combat stress scenarios for discussion in training sessions.

Methods: RTI International collaborated with the Naval Health Research Center to develop a new health communication tool for the military, The Docs, a 200-page graphic novel published in 2010 that is used to prepare Navy Corpsmen for the stresses of combat deployments.  Currently, RTI is developing a follow-on novel specifically for Marines. The graphic novel format is a different type of stress mitigation tool for the military. Visualization of traumatic events allows for subtleties that are not easily interpreted through reading a description. For example, there are situations where characters look and say they are fine but are actually upset. These situations teach service members the "buddy system" to check on the mental health of each other. For the new USMC novel, RTI collected qualitative data for storyline and visuals using 8 focus group interviews of approximately 80 active duty Marines and their spouses.  RTI conducted visual research interviews of weapons and equipment specialists on a Marine Corps base and attended demos and tours. 

Results: Common stressors were identified based on the insight gained through the focus groups and interviews.  A compelling story and realistic characters were developed. Combat Operational Stress Control (COSC) elements were embedded into scenes.  The storyboard and sequential art were designed to meet health communication objectives through visual interpretation of stress scenarios and psychological effects.

Conclusions: RTI identified and utilized these approaches for development of content:  Base storyline on real-life Service members and the current situations they face in combat and their personal lives. Partner with COSC experts to embed teaching points. Ensure technical accuracy through research and target audience reviews of the storyboard and artwork.  Develop characters that are representative of the target audience with varied jobs, ages, backgrounds, and professional concerns. Design artwork in a manner sensitive to training objectives and the physiological effects on readers.

Implications for research and/or practice: Because technical accuracy, realism, and sensitivity were noted as essential components of an effective graphic novel tool, focus group research and review of author drafts by the target audience are recommended.