This paper argues that the graphic adaptation of Dennis Lehane’s Shutter Island utilizes the medium to evoke an affective participation and investment from the reader. It explores the ways the graphic novel overcomes problematic representations of mental illness in the popular film version. Drawing on graphic fiction theory, I contend that readers’ engagement in and construction of the story between panels, in the “gutters,” allows them to participate in the protagonist’s persecutory delusion. Additionally, I draw on Foucault’s conceptualizations of the (...) medical gaze and historical figurations of madness connected to water in order to demonstrate the mechanism by which the reader is placed in a dual subject position, becoming both observer and observed. In this capacity, I suggest that graphic fiction provides a unique experience to engender empathy for psychiatric illness. (shrink)