Reached at his home in Menden, in the southwest corner of the state, David Small says, “It’s a gray day in Michigan.” Gray seems appropriate for the conversation; somehow, discussing Stitches, Small’s grim, deeply affecting graphic memoir, in bright sunshine would feel wrong.

The book describes Small’s gothic-horror childhood, his weird, remote parents and deranged grandmother and the catastrophe that shaped his young life. As a boy, Small had sinus problems; his father, a radiologist, treated him with X-rays, state of the art at the time. When David developed a lump on his neck, no one seemed worried. A doctor friend diagnosed him with a cyst at age 11. At age 14, his parents finally took him to get the cyst removed. He underwent not one but two surgeries and woke up missing half his vocal cords, unable to speak. No one told him he had cancer— no one told him anything.

An acclaimed illustrator of children’s books, Small says his early attempts to write his memoir as prose got him nowhere. He’d been having bad dreams and knew he had to write something, but he couldn’t dredge up the memories.

“When I started making it a graphic [memoir], it started coming back,” he says. He worked “by identifying one object in the room and then, in my mind’s eye, making the camera pan around the room.” The first image that came back to him in this way is also the scariest scene in the book: six-year-old David wanders through hospital corridors at night, waiting for his father to finish work. He stumbles into the pathology department where, on an eye-level shelf, he sees a tiny, shriveled human form preserved in a jar, little hands cradling its enormous head. It looks furious and sad, just like him. Then it looks at him, and he flees, but the creature haunts him. “I think I identified with him somehow,” Small says, “that angry little face.”

Despite the difficulty of the material, he says, the memoir process was rewarding: “I feel like a new man, like a cinderblock’s been lifted off my neck.”

One thing he didn’t have to worry about was how his parents might react. “My mother and father are dead, so I don’t know what they would’ve thought,” he says. “I can only guess. My editor asked me, ‘What would your mother have thought about this book?’ And I said, well, she probably would never have spoken to me again. And there was a pause. And then he and I spoke at the same time and said, oh well, that wouldn’t have been anything new!”

About a year ago, he says, his editor called him in a panic. “Have you seen the New York Times today?” he asked. “Go online and read the front page and then call me back.” Small did, and immediately saw a story about Margaret Seltzer, whose sister had just denounced her gangland memoir as a fabrication. His editor said, “David, I know this has nothing to do with you, but is there anybody left who might remember these events and contradict what you’re saying?”

“I don’t think so,” Small replied. “I do have this brother . . . I don’t talk to him much.”

“You have to send him the book,” said the editor.

“I can’t, it’s not even done!” Small protested, but in the end he sent his brother the book. After a few days, he says, “I called him up with much heart-pounding and said, what did you think of the book?”

There was a long pause. “And then, in his sepulchral tones—he sounds like Richard Nixon—he said, ‘David, your book blew me away. It was like a snapshot of my youth.’ He asked me if he could show it to his therapist. It was just amazing.”

After that, his brother visited. “We laughed and cried and drank and talked and reminisced,” Small said. “After 30 years, I have my brother back. If nothing else happens with this book, it’ll be worth it just for that.”

Small’s drawing in Stitches is both roomy and precise, with lots of open space in and around the panels but an intensity of focus—especially on facial expressions—that feels almost claustrophobic. Often, panels zoom in on an angry frown, a narrowed eye, a kitchen cupboard slammed shut. One two-page spread shows a close-up of David seeing his stitches for the first time, opposite three dizzyingly abstract details of the gash. Turn the page and the cut is even more abstract, just a series of lines over shadow.

It’s also a loud book. David’s brother is constantly banging on drums, his mother bashes around in the kitchen, his father peels out in the car. (Meanwhile, of course, David is silent, first by choice and later against his will.) Small is deft with angle, as in the scenes drawn from a hospital-bed’s-eye-view that force the reader into David’s position, helpless and vulnerable. Small describes his drawing style as cinematic.

“I’m sort of glad I didn’t know anything about comics to begin with,” he says. “I took my own approach, which came straight out of cinema.”

In the acknowledgements, Small thanks “Dr. Harold Davidson for pulling me to my feet and placing me on the road to the examined life.” Davidson appears midway through the book as a therapist who looks like a rabbit with a pocketwatch, part Donnie Darko, part Alice in Wonderland.

“He was an unusual analyst,” Small says. “He let me stay at his family’s house, for example. I’d called him at 2:00 in the morning just terrified that my mother was going to come into my room and shoot my head off. So he let me spend the night on the couch in his home office.”

“I had no conception of how to be in the world,” Small continues. “It was like being raised by alcoholics. He really cared for me and took extra care with me.” Davidson’s philosophy was that “in order to really effect anything close to a cure you have to really love your patients,”

Small says. “If you’ve been raised by an unloving mother it leaves a hole in your heart, and you just learn to live with it. I can’t imagine what would’ve happened to me. . . . I’m so thankful to him. I feel really lucky. I’ve kept in touch with him all these years.”

Small illustrates children’s books written by his wife, Sarah Stewart, but they work in separate phases. “We like each other too much to collaborate,” he says. “We come at the world from two points of view. She’s a much more optimistic person than I am. My poetry is the poetry of slagheaps and ironworks.”

Small says if there are hints of his troubled childhood in the children’s books he has written and illustrated (Imogene’s Antlers, Hoover’s Bride, Paper John), they only appear in subtext. “It’s all very hidden,” he says. “When you’re working for children, you’ve got to put some restraints on. Doing the graphic memoir was a big relief, to just be able to say and draw whatever I wanted.”

Small is currently working on more children’s picture books. “I don’t know what the next graphic will be,” he says. “I hope there will be one. It was such a great experience— I guess it will take another story as compelling to me.”

Becky Ohlsen writes from Portland, Oregon.

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