“Amplification through Simplification”: Why I created cartoon-images for therapy
Forty years ago, Art Spiegelman published his groundbreaking novel, Maus, the story of his father’s nightmare journey through the Holocaust. Although there had been other novels about the Holocaust, Spiegelman did something unique. He used cartoon images to tell his story. He portrayed Jews as mice, Nazis as cats, and Poles as pigs. This symbolism gave his novel a strange, yet compelling, quality. Spiegelman had elevated comics – in the form of the graphic novel – to a serious art form, eventually earning a Pulitzer Prize. I read Maus when I was 23 years old, shortly after it came out. The emotional power of its narrative, enhanced by cartoon-imagery, blew me away.
What explains the power of Spiegelman’s novel? Part of the answer lies in the cartoon-images themselves. According to the cartoonist and comics theorist, Scott McCloud, cartoons operate on the principle of “amplification through simplification”. By taking an image and simplifying it, stripping away its excess “baggage,” an artist can amplify its meaning. This principle seems to explain the explosion of cartoon-images, such as emoticons and memes, in our visual, internet-based culture. Cartoon-images are an efficient and powerful means of conveying information, a kind of visual shorthand that speaks to us in ways that go beyond “mere words.”
McCloud’s analysis of the power of cartoon-images has had influence in diverse fields such as design, marketing, and education. We can also use amplification through simplification to make therapy more effective, a process that I call “Icon Enhanced Therapy (IET).” This is the idea behind the Bernstein iModes, cards that enhance therapy through cartoon-images.
I did not know about McCloud’s ideas when I began to work on the iModes, a set of 25 cards depicting common emotional states. However, I had an intuition that cartoon-images would facilitate patients’ ability to recognize these states. Some of the iModes images involve emotional pain, such as loss, fear, shame, and loneliness. Others involve difficulties with anger and impulsivity. Some involve self-criticism and excessive internal standards. Yet others represent dysfunctional forms of coping, such as emotional avoidance, aggression, compulsions, self-aggrandizement, over-control, and subjugation.
In Schema Therapy, we call these states “modes.” Schema Therapy is an evidence-based treatment for personality disorders that I have practiced and researched for much of my career. We all have various emotional states. However, modes go to extremes, producing the self-defeating and destructive behaviors seen in personality disorders. Using the iModes cards, patients and mental health professionals can quickly recognize these states, enhancing the ability to work with them.
You do not need Schema Therapy training to use the iModes. They are highly intuitive to use, and can be combined with any form of therapy. However, to assist therapists of all backgrounds, I have also published a practical guide showing the diverse uses of the iModes as a medium for assessment, psychoeducation, and therapy. The manual includes many clinical illustrations of how to use the cards.
In developing the iModes, I was lucky to collaborate with the well-known Dutch comic-artist, “Vick” (Patrick van den Berg). I had met him years earlier when he taught the cartooning course that my son, Max, took in school. We spent about three years developing the iModes, going through the painstaking but enjoyable creative process of making images that match emotional states that might otherwise seem abstract. Sometimes we went through as many as seven or eight drafts of a single iModes image. In doing so, we managed to boil down each of the images to its essential meaning, the process of amplification through simplification described by McCloud. When I finally discovered McCloud’s work, during the time that Vick and I worked on the iModes together, it all made sense.
Eventually, we created a complete first version in pen- and ink-form. I tested these draft images with fellow therapists who worked with diverse patient populations in various settings (e.g., private practice, hospital, forensic, youth, addiction). I also used them in trainings and supervision sessions that I gave. The reaction was encouraging. My colleagues reported that their patients could easily recognize the meaning behind the images, and apply them to themselves. Equally important, many of the patients loved working with them. When I told Vick about the initial results, he said, “Wait until they see the colored versions!”
Recent research supports McCloud’s theory, demonstrating that cartoon-images are powerful and efficient. For example, in a 2016 study, Kendall and colleagues found that cartoon faces conveyed more emotional information than actual faces. The more a face became simplified — morphing from an actual face to a simplified, cartoon-image of the same face — the more accurately participants identified its emotion. In fact, cartoon faces were 60% more accurately recognized than real faces. Moreover, when viewing the simplified faces, participants showed lower levels of brain activation in an area (P1) that reflects an early stage of perceptual processing. In essence, the brains of the participants needed to work less hard to perceive the facial images, when they saw them in cartoon-form.
This research seems to explain the “Ah-ha!” moment that patients (and professionals) experience when they view the iModes for the first time. They just get it.
Since creating the iModes, I have developed two additional kinds of cards with Vick: cards depicting basic emotional needs (e.g., attachment, autonomy, limits), and ones showing positive qualities of a healthy adult (strengths such as self-reflection, resiliency, and empathy). My colleagues and I have already used the iModes in two published treatment studies. We are also preparing our first validation study of the iModes, showing positive results, for publication.