Efectos secundarios: Book Review

Katie Salmon reviews Efectos Secundarios: 19 Historietas del COVID (2021), copublished by Astiberri and la Fundación Cultura en Vena.


Various authors, Efectos secundarios, Astiberri, 2021

Efectos secundarios (Side Effects) (2021) comprises nineteen graphic narratives from 2020 about the COVID-19 pandemic. These were conceived as part of the ‘ambulatory art’ program run by the Spanish Fundación Cultura en vena (Culture in the vein foundation), which investigates the impact of artistic practice on health and wellbeing. The program ‘injects culture in places it doesn’t usually reach’, taking art and music to hospitals and rural regions at risk of depopulation. The decision to accompany the roaming exhibition with a print anthology ensured that the artists were supported during this precarious time for the arts sector. The collection, published in partnership with Astiberri, brings together notable Spanish and Latin American illustrators, including previous winners of the National Comics Prize. Side Effects encompasses a broad range of voices, perspectives, styles and themes: from Antonia Santolaya’s isolated, expressionist seniors, who retreat into their memories, to Alfonso Zapico’s endearing cartoons capturing his pandemic teaching experiences.

The side effects of graphic medicine

From the outset, Side Effects stresses the social, meditative and transformative potentialities of comics in and beyond the healthcare sphere. The inside cover humorously emulates the side effects labels on medications. ‘Read carefully before taking this graphic medicine’, it instructs, as there may be ‘traces of social criticism’ and ‘side-effects’ like ‘increased reflection’ or ‘social empathy’. The term ‘graphic medicine’ was coined in 2007 by British physician and comics artist Ian Williams to denote ‘the intersection between the medium of comics and the discourse of healthcare’. It now delineates this field of study and practice. The graphic medicine movement, which is coordinated for Spain and Latin America by Mónica Lalanda, champions the fundamental role that comics may play in informing clinical pedagogies and practice.

The movement further emphasises comics’ value for articulating lived experiences of physical illness and psychological distress where words alone prove cumbersome or inadequate. As Hillary Chute notes, the comic has an ‘immediacy and diagrammatic ability to display otherwise hard-to-express realities and sensations’ (2017, 241). In the pandemic context such capacity comes into its own because ‘invisibility is an important aspect of contagion’; the immateriality of the viral pathogen and its transmission routes creates ‘a mix of fear and doubt about the pandemic experience that can play out in our personal behaviours, politics, and dissemination of disinformation and misinformation’ (Callender et al., 2020, 1062). The visual documentation of the pandemic ‘demystifies’ contagion. It creates personal narratives about the virus from which solidarity and public health education is gleaned.

Various authors, Efectos secundarios, Astiberri, 2021

Indeed, Side Effects yields cultural dialogues that might practically or therapeutically aid healthcare professionals, patients, families and individuals. Cristina Durán’s and Miguel Ángel Giner Bou’s narrative offers comfort to parents of clinically vulnerable children. It evokes their experiences of the pandemic as parents of a daughter with cerebral palsy. In their characteristically angular style, they show a little girl being rushed to hospital with respiratory problems amid the weekly ‘clap for carers’. The sequence conveys the parents’ gratitude for the selflessness of the healthcare staff, but also their profound fear of catching COVID. In another four-tiered frame, Meritxell Bosch tells the heartrending story of a couple who lose their child when the mother catches COVID. Bosch’s use of colour captures the couple’s emotional journey: from the pink tones that mark the joy of expecting, to the final green backdrop (the Spanish colour of hope), as they tearfully embrace and resolve to try to conceive again.

Several narratives employ anthropomorphism: a recurrent therapeutic device in visual documentations of the pandemic (Saji et al. 2021). Martín López Lam, for example, creates a devilish, winged creature with a virus particle for a head. The ascription of human or animal attributes to the virus combats its invisibility, making it more tangible for the artist and reader alike. Anthropomorphism increases at times of uncertainty, high cognitive load and social isolation: ‘People anthropomorphize to satisfy effectance motivation —the basic and chronic motivation to attain mastery of one’s environment’ (Waytz et al. 2010, 410). This process harnesses the unpredictability of nonhuman agents since the neural correlates involved mimic those engaged when envisaging other humans.

Overload and inactivity  

The anthology also tackles existential and ethical questions raised by the virus. Núria Tamarit’s ‘personification of nature’ character addresses the impending environmental crisis caused by the neoliberal growth model. They fly around the world, pointing out the deforestation, carbon emissions and loss of biodiversity that have caused climate change and increased humans’ vulnerability to pandemics. The comic further reveals discrepancies between the state and media neoliberal reporting of the pandemic, based on ‘the science’ and statistics, and people’s lived experiences. Nowhere is this more apparent than in Carla Berrocal’s contribution. Powerful, real testimonies give voice and visibility to the emotive experiences of medics, cleaners and psychologists. The title – What is not mentioned – emphasizes how such experiences are concealed by the macro-level focus on death rates, GDP decline or disinformation.

In What is not mentioned, medic Mónica López describes her increasing mental weariness. She expresses a sense of fighting a losing battle due to the inaction of global authorities and individuals’ self-interest. Mónica Mateo, a cleaner, talks of the ‘Dantean’ scenes when she began working at a hospital in April 2020. A close-up of binbags invites the reader to share her indignation that these were used as PPE, because healthcare workers took the scant resources available. While highlighting such inequities, Berrocal’s accounts share an overriding jadedness and fatigue. This is reflected in her speakers’ eyes which are missing or obscured by crosshatching.

The stories of overwork in the anthology, like Berrocal’s, contrast with those of inactivity. These encourage reflection on capitalism’s overvaluing of activity and productivity. María Herreros contemplates the psychological entrenchment of such expectations in the narrative They are rushing yet going nowhere. Brooding self-portraits are framed by a thorny vine with virus particles for roses. Herreros’ images flesh out an accompanying verse which articulates first the guilt, then relief, that she felt at not doing or producing anything during the pandemic. ‘Capitalism pushes us towards productivity’, Herreros affirms (cited in Soto 2021). ‘When we had to stop, we felt strange, as if we were missing something’. Her vine represents the vicious productivity cycle in which we are entangled and in which we will remain stuck by continuing to prioritise capital.

Byung Chul Han  shares Herreros’ sentiments: a ‘purely hectic rush produces nothing new. It reproduces and accelerates what is already available’ (2015, 13). Contemporary hyperactivity means that we are denied (or deny ourselves) contemplative time. In negating the fundamental role that idleness plays in de-cluttering the brain, we stifle the creativity and innovation that might fuel counterhegemonic imaginaries. We must recuperate the lost ‘art of lingering’ for life to gain ‘in time and space, in duration and vastness’ (Han 2015, 86). For Herreros, this is the message we must take from the pandemic. In slowing down ‘we discovered that we could do other things and now the question is whether we will apply what we have learnt at societal level’ (cited in Soto 2021). Two years on, this message risks getting lost as governments clamour to return to ‘business as usual’. The media talk of a ‘great resignation’ but with COVID induced redundancies and price hikes that follow a decade of austerity, inactivity will only be preserved for a privileged few. In Spain, at least, the Ministry of Social Security reported a reduction in voluntary redundancies since the pandemic, compared with the marked increase in countries like the UK.

Open stages and lonely windows

Side Effects prompts consideration of the simultaneous shrinking and expanding of our world(s) since the pandemic. In his foreword, Álvaro Pons suggests that our lives now resemble small windows akin to the frames of the comic. There is the television that bombards us daily with alarming figures, the videoconferences that fulfil our need to socialize and that have altered our way of work, and the windows of our homes in which we have been confined. Pons also refers to our neighbours’ windows as ‘small theatrical stages that allow access to lives that never interested us before’. Sole Otero evokes these ‘stages’ in her illustration of an apartment building where multiple everyday ‘performances’ are taking place (a father cajoles his children into bed, an old woman receives groceries).

Pons’ likening of our pandemic lives to windows and Otero’s apartment, made me recall Olivia Laing’s The Lonely City (2016), which I applied to a previous analysis of pre-pandemic urban loneliness in Chilean comic Diario de un solo (2014). Laing equates loneliness in the city to being trapped behind glass: sitting alone in an apartment watching the world go by through the window, but also sensing multiple pairs of eyes looking back from the surrounding buildings. For Laing, visual art, like that of Edward Hopper, communicates, illuminates or destigmatises such feeling. Lockdown has evidently extended this lonely experience beyond the metropolis, making the role that visual art plays in understanding loneliness even more pertinent. As one pandemic tweet read: ‘We are all Edward Hopper paintings now’. Amaia Arrazola’s narrative features a solitary Hopper-esque figure, who sits in the same spot as forty days pass by. Colourful imagery and visual metaphor evoke their changing perception of the outside world. Crimson flames and a menacing dragon make it appear threatening on some days, while verdant leaves and vibrant flowers capture its beauty on others. The images also allude to the creative imagination stimulated by solitary reflection.

Various authors, Efectos secundarios, Astiberri, 2021

Visual insight into loneliness is crucial because it is a diffuse emotion that is notoriously ineffable. Fay Bound Alberti calls loneliness an ‘emotion cluster’ of disparate, conflicting or transient states (2019, 5-6). It involves the individual’s desires and expectations, as well as cultural and environmental factors. Loneliness is not the physical state of being alone, but ‘a conscious, cognitive feeling of estrangement or social separation from meaningful others’ (Bound Alberti 2019, 5-6). There is no one facial or bodily expression easily associated with loneliness. It is often devoid of movement and expression, as captured in Arrazola’s story. Affect theorists have therefore interpreted loneliness as derivative of other emotions, like shame, which have conclusive, biological reactions (Tomkins 1963). Neuroscientists understand loneliness as a primal ‘flight or fight’ response triggered by the survivalist need to belong to an intimate group. It is a warning that we are failing to satisfy this need, prompting us to strengthen existing connections or forge new alliances (Cacioppo & Patrick 2008). In the anthology, Ana Galvañ’s constructivist image of people pulling together on the virus particles suggests that such communal survival instinct has been triggered by enforced isolation.

The virus has brought new forms of loneliness to decipher. A terminology of detachment (social distancing, self-isolation, shielding) now permeates the everyday. Many individuals, families and caregivers have faced the deepest of human fears: dying lonely and alone. Those left behind have felt unable to adequately honour loved ones and attain closure due to limits on the number of people allowed at funerals. Ana Oncina’s poignant narrative, The Hug, pays tribute to a young friend who died during the pandemic. It depicts her solitary visit to the mortuary where prominent social distancing signs underscore the estranging scenario. The story suggests, once again, that isolation and tragedy have reinforced connection and friendship. The final frame captures the protagonist and her friends interlinked from behind. A pink figure stands out from the otherwise monochromatically shaded group. The caption underneath reads ‘for Lía’. Oncina thus emphasises the fragility of life that the pandemic has brought into stark focus.

Various authors, Efectos secundarios, Astiberri, 2021


The overall contribution of the anthology is hard to assess when the scenarios and emotions it depicts are still so raw. Ultimately, however, the stories will allow us to ‘remember what was happening when the world stopped’, as philosopher Marina Garcés expresses in Berrocal’s final testimony. When we are back to ‘normality’, they will remind us that it was normality that caused the virus: that the virus was a warning about the social, ecological and psychological unsustainability of continuing ‘business as usual’. More optimistically, the comics will remind us of the alternative communal, contemplative and creative possibilities the pandemic germinated.


Katie Salmon is a postdoctoral researcher in Iberian and Latin American Studies and Medical Humanities. She completed her PhD at Newcastle University in 2021. Her thesis examined societal crises and youth mental health in Chilean and Spanish culture. Katie has since held an NNMHR ECR Fellowship. Her particular research interests include affect theory, visual and literary culture, (crises of) neoliberalism and bio/psycho-politics.



Bound Alberti, F. 2019. A Biography of Loneliness: The History of an Emotion. Oxford: Oxford University Press.

Cacioppo, J & Patrick, W. 2008. Loneliness: Human Nature and the Need for Social Connection. New York: W W Norton & Co.

Callender, B., Obuobi, S., Czerwiec, M. K., & Williams, I. 2020. COVID-19, comics, and the visual culture of contagion. Lancet, 396(10257), 1061–1063. https://doi.org/10.1016/S0140-6736(20)32084-5

Chute, H. 2017. Why Comics? From Underground to Everywhere. New York: Harper Collins.

Han, B. 2015. The Burnout Society. London: Verso.

Laing, O. 2016. The Lonely City: Adventures in the Art of Being Alone. Edinburgh: Canongate Books.

Saji, S., Venkatesan, S., & Callender, B. 2021. Comics in the Time of a Pan(dem)ic: COVID-19, Graphic Medicine, and Metaphors. Perspectives in biology and medicine, 64(1), 136–154. https://doi.org/10.1353/pbm.2021.0010

Soto, A. 2021. Una dosis de comic contra la covid. Las provincias. Available at: https://www.lasprovincias.es/culturas/libros/dosis-comic-covid-20210919205956-ntrc.html

Tomkins, S. 1963. Affect Imagery Consciousness: Volume II: The Negative Affects. Springer: New York.

Waytz, A., Morewedge, C. K., Epley, N., Monteleone, G., Gao, J. H., & Cacioppo, J. T. 2010. Making sense by making sentient: effectance motivation increases anthropomorphism. Journal of personality and social psychology, 99(3), 410–435. https://doi.org/10.1037/a0020240

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