Do children have a right to know about what is going on in their own bodies? Should parents tell a sick child just how sick he or she is or should they shield their children from such information? And if parents do hide the truth, what consequences can that deception have for a child frightened by the mysteries of the medical establishment, by the changes she sees happening to her body, and by the recognition that her parents are keeping something important from her? These questions structure both the story and the art in David Small's illuminating graphic narrative memoir, Stitches. Largely told through the eyes of a thirteen year old suburban Detroit boy facing throat cancer and the near total loss of his voice, the book is a black and white exploration of the consequences that may befall some people with physical impairments when information about their bodies is withheld from them. As Small's memoir reveals, such withholding marks one important way in which culture can disable some people with illnesses by turning them into voiceless, infantilized objects of medical knowledge that cannot be trusted to be informed subjects.

Small's memoir charts the author's early life to the age of sixteen, growing up in a frightening and emotionally distant family. His father is an aloof, career-driven radiologist so committed to his work that he even subjects his young son to excessive radiological treatments — later theorized as the "cause" of David's cancer — in the basement of the family's suburban home. The treatment, consisting of "the many x-rays that were supposed to cure my sinus problems," are carried out in a basement rendered as a cross between a prison hospital and an abattoir (21). Small's mother is cold and withdrawn: virtually uncommunicative, "Mama had her little cough … Once or twice, some quiet sobbing, out of sight … Or the slamming of kitchen cupboard drawers. That was her language" (15).

Within this emotionally troubled environment, the young protagonist develops cancer in the throat at fourteen and, without his consent, has a vocal cord removed, which severely hinders his ability to speak. This silencing serves to physically literalize the silence that engulfs the family and that characterizes David's relationship with his parents; his metaphoric silence becomes a physical inability to speak. This treatment of disability as metaphor without embodied consequence is of course potentially troubling, as many disability critics have pointed out (see Mitchell and Snyder). Although Small might be accused of such an approach, he does also explore the materiality of that metaphor. Disability operates for him metaphorically even as it is, at the same time, a lived bodily experience. In other words, Small shows how disability can operate both symbolically and physically at once, thereby resisting the critical impulse to show that reading disability as metaphor is always only a damaging reading.

The conspiracy of silence between Small's parents is not surprising but is still unsettling given what we know of them. And the curious author's attempts to find out what exactly is going on with him, which include snooping through drawers and papers, are stymied at every turn. The parents' secrecy makes them into villains akin to those we might expect to find in a nineteenth century gothic novel or even a fairy tale. Small frequently depicts them as grotesques — his mother's face is often scary and distorted in scream, while his father, at times a mad scientist, is also drawn as one of "the soldiers of science" (27). The book's title, then, signifies that this is an account not just of a surgery but of the deeper, more disabling wound of the parents' abuse, a wound stitched together that may never fully heal. This is suggested in one particularly memorable sequence in which young David examines his stitches in the mirror only to have them open up as his wound speaks back to him: "Surely, this is not me./No, friend, it surely is" (191).

Small's impressionistic illustrations do an excellent job of expressing the sadness, anger, frustration, and confusion that he — and we — experience as a result of his parents' actions. And though he generally relies on a fairly conventional panel layout and organization (the familiar boxes and squares that make up many traditional graphic narratives like comic strips and comic books), he also makes frequent use of full bleeds, in which the art extends the full page without any borders, to portray moments of fantasy, hallucination, abstraction, or quiet reflection. Such bleeds abandon the panel structure of conventional "realistic" graphic narrative and allow more abstract or philosophical representation. The art is able to expand to the full page into less "realistic" but nonetheless valuable directions. This technique, accompanied by a relative scarcity of dialogue (of course, David has trouble speaking), creates a slow, meditative pace that compliments the ominous story.

Beyond being a personal account of his life, Small's book raises a powerful, implicit objection to those who would advocate keeping young people with illnesses in the dark. As James Charlton points out, when it comes to people with disabilities, culture "often must transform its subjects into children or people with childlike qualities" (53). And in this case, the narrator actually is an adolescent. Yet the infantilizing impulse that Charlton describes is no less objectionable in this case. For by insisting on treating him as a child who cannot "handle" the truth, Small's parents objectify him in such a way as to further disable him. Cancer, surgery, and vocal impairment are one thing, a fact of nature. But the voicelessness and the dehumanization that Small experiences are the sort of cultural effect that much of disability studies works so hard to contest.

The book also extends an admittedly superficial but welcome meditation on the relationship between physical impairment and the medium of graphic narrative. Small wisely avoids the all too simplistic equation between his physical impairment and his art. A story like this one is highly susceptible to the impulse to interpret the growth of one skill set — drawing/writing "comics" — at the expense of a complimentary physical deficit — the author's loss of speech. In other words, of course he can draw; he has to because he can't talk! Small, however, resists such magical thinking. He acknowledges, "Art became my home. Not only did it give me back my voice, but art has given me everything I have wanted or needed since" (302). That is to say, Small seems to have been drawn to art as a way to communicate, but he is not the sort of "abnormally" empowered figure we are familiar with from more traditional comic characters like the X-Men or Daredevil.

However, Stitches would benefit from a more rigorous reflection on the relation between disability and the medium of graphic narrative itself. In Disability Aesthetics, Tobin Siebers points out "the aesthetic prejudice against the image and in favor of words as the product of the image's symbolic association with disability" (4). Small's memoir is well-positioned to intervene on this front but does not seem especially interested in pushing on the prejudice Siebers describes. What does it mean to write a disability memoir mostly in pictures when images have such symbolic association with disability? And how is the meaning of such images affected when they are created by a writer/artist who has difficulty speaking words aloud? Stitches raises these questions but does not provide definitive responses. Small leaves it to his audience to meditate on these relationships.

Stitches also problematically resists delving into the importance of gender or sexuality. Does it matter, for instance, that David is a boy and not a girl? And how is sexuality related to keeping David an ignorant child? He is, after all, pointedly reading Lolita throughout the memoir, a fact to which his tyrannical mother strenuously objects. Small peppers the story with hints that gender and sexuality are important, even going so far as to include later sessions with his psychoanalyst — drawn as a rabbit straight out of Alice in Wonderland — yet the significance of those larger issues remains opaque. Most surprisingly, Small has almost nothing to say about the same-sex affairs that his mother engages in. He closes the memoir with a coda explaining that if "this had been her story, not mine, her secret life as a lesbian would certainly have been examined more closely" (327). Such a statement strikes a curiously evasive note for such an open storyteller. Another recently acclaimed graphic novel, Alison Bechdel's Fun Home, is far more attuned to gender, sexuality, and disability, particularly depression and suicide. Those interested in questions of gender and sexuality therefore might find Stitches frustrating in its refusal to confront these topics.

But for those interested in an exploration of childhood illness and the disabling shroud of ignorance that parents may often project onto their children, Stitches is a beautiful piece of art, and at times a welcome political statement in the form of graphic autobiography. Too often, "comics" flirt with disability topics without substantive meditation on how disability matters. That isn't the case here. Though it may disappoint in its reluctance to make more of an argument about the relationship between its form and disability, this book is a refreshing and entertaining contribution to disability studies from the world of graphic narrative. I hope its willingness to take the first steps in thinking about how disability matters to "comic books" will mark a new, more prevalent trend.