Californian Author Uses Black Humor and Bear to Highlight Health System Flaws

Mother-to-be Kathleen Founds booked a scheduled appointment with her doctor to discuss the risks of taking antidepressants during pregnancy. After the visit, Founds, who relies on medication to quell the manic highs and despondency of his bipolar disorder, learned the doctor was off the grid.

She unexpectedly received a $650 bill that landed her in a maze of claim forms and hours of phone calls redirected from one office to another to dispute expenses—the insurance red tape that many Americans have experienced. Ten years later, Founds chronicled her experience in the graphic novel Bipolar Bear and the Terrible, Terrible, No Good, Very Bad Health Insurance, a richly illustrated, darkly funny adult story about the country’s dysfunctional healthcare system.

The book, published in November, follows Theodore, a smart but anxiety-ridden bear who is trying to cure his own manic-depressive illness. But first he must navigate the demands of WeCare, a shady company run by cigar-smoking cats who, among other things, profit unfairly from a lopsided economy and a corrupt justice system. Among his fellow outcasts are characters such as an over-educated owl drowning in student debt and a bomb-sniffing puppy suffering from post-traumatic stress disorder.

America is known worldwide for high quality care for those who can afford it. A new Gallup poll shows a record high proportion of Americans — 38% — have put off getting medical care due to high costs in 2022. Federal and state laws enacted in the past few years have been designed to protect consumers from unexpected medical bills. But they don’t prevent costs like high deductibles or fees hidden in the fine print on their insurance policies.

Bipolar Bear joins other recent works to shed light on health inequities, part of the emerging genre of graphic medicine. It includes seminal illness stories such as “Mom’s Cancer” by Brian Fiese and “Take It In Line: Stories from HIV/AIDS Care Ward 371” by Nurse M.C. Cervik, as well as “Rx”, a memoir by Rachel Lindsey about how she got a job at a pharmaceutical company. Get insurance to cover the costs of treatment for bipolar disorder.

Originating from the underground comics of the 1960s, graphic medicine has evolved into a new area of ​​research into the role of the medium in learning and delivering medical care, said Ian Williams, the Welsh physician who coined the term back in 2007. “It’s perfect. for exploring topics related to human life and well-being in an ironic and funny way,” he said.

According to Founds, humor is a powerful weapon against despair.

The 40-year-old mother of two teaches English at Santa Cruz County Community College on California’s Central Coast. She never took art classes and had no intention of writing a graphic novel. The book began with scribbles in the margin of her notebook while she was studying for a master’s degree in fiction at Syracuse University in New York. Her 2014 novel in the stories “When Mystical Creatures Attack” is about a teacher who suffers a nervous breakdown and interacts with her students from a psychiatric hospital.

KHN correspondent Rachel Shyer told the Founds about how to bring Theodore back to life. The interview has been edited for length and clarity.

Q: How did you come to write a book about a bear with bipolar disorder?

I made children’s books for my little brother. They were all about anxiety-ridden animals: a lonely giant squid, an opossum with social anxiety disorder who falls asleep whenever he finds himself in an awkward situation, a donkey who wants to be a unicorn. My goal was to write a novel. But whenever I was too depressed to relate a sentence, I drew bears. Then I realized that anyone dealing with a mental health issue in this country would have to deal with the health insurance maze. And I thought it would be funny to depict it as a real labyrinth with hatches and cannibal flowers. Once I’ve gone in that direction, it’s no longer a children’s book.

Q: Was the book based on your own experience of mental illness?

Yes. At the end of high school, I had my first major depressive episode, but I didn’t seek professional help. I’m just kind of confused about this. Then, when I was a sophomore at Stanford, I had my first manic episode. I had a series of realizations about the nature of the universe, I hardly slept or ate. Then, in graduate school, I went to the clinic because I was depressed and the psychiatrist would ask me questions like, “Was there ever a time when you had a lot of energy and didn’t feel the need for sleep?” And I said, “Oh, sure, but it was a spiritual awakening.” So after that I had to rethink my life story a bit.

Q: But does religion still play a role in your life?

I am a Quaker. This is what I came to because of my interest in non-violent social change. When I am in a deep depression, it seems to me that life has no meaning. So, following a code that says that life has meaning, that we are all connected by the power of love that sustains the universe, is something that has helped me a lot.

Q: Why animals?

People are hard to draw! Cartoon animals are much easier. I wasn’t interested in art in school – actually when I started painting it was during that first manic episode. I don’t recommend writing a 200-page graphic novel without artistic preparation. I mean, it took 13 years, but I finished.

Q: Why so long?

I worked on it from time to time while writing essays and working on the beginning of several other novels. When I finally finished it, I was so excited. I was ready to see it on the bookshelves within a year. I sent it to my agent and she wrote me a very nice email saying “I love this. It’s very creative. But I can’t sell it.” Most adult graphic novels are memoirs—there was no clear genre. Then another agent I approached said, “I can’t take it upon myself, but you should try Graphic Mundi, which has published several novels in the field of graphic medicine.”

Q: What inspired you to write about health insurance?

Our system actually kills people. We have a high suicide rate in our country and people don’t have access to mental health care. And then when they get help, it’s not necessarily the psychiatrist who decides the course of treatment; it’s an insurance company. If you walk into a room with 10 Americans, five might tell you a nightmare story about health insurance.

But I also wanted to explore what it means to live a healthy lifestyle and grow a strong community, to go through all the growth and healing that a bipolar bear goes through in history, only to have the depression come back again. What is the point of my journey if I end up back where I was before? Ultimately, there is no answer to this question, but the right decision is to seek help. We are all saved by each other.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Foundation.