Halfway through the second season of Breaking Bad and Walter White has left a distorting dent in the towel dispenser of a hospital bathroom with his fist. The reflective surface of the dispenser distorts his own face as he distorts it. Walt is coming to terms with the horrifying fact that he may live.
Yet, in the very same episode, Walt has come out of an ordeal in the desert in which he fought for survival (and won). This gap between his triumphant survival and his ambivalence about surviving cancer, perhaps, is located in his own agency as a patient and as a man. The narrative that he has built around his illness enables the agency that he enacts as a man-with-nothing-to-lose. This moment could be more simply interpreted as the moment at which, because he will live, Walt now has consequences to contend with for his crimes.
But I think it is more than that. What does his illness give him, in terms of identity and a narrative about end-of-life? His (specific) mortality gives him license to live. There’s lots more to be said about the masculinism of this license to live, but for now I won’t go there. In Intoxicated By My Illness, Anatole Broyard discusses the way that diagnosis changed his sense of self. giving him a grandiosity that is similar to Heisenberg’s (as opposed to Walt’s meek pre-diagnosis emasculation). He talks of the need “to make illnesses metaphorical, to make them our own, and how we need always to be ill, and to die, with style”.
In becoming sick, people “must become story-tellers” (Broyard, Intoxicated By My Illness). This is because “in emergencies we invent narratives. We describe what is happening, as if to confine the catastrophe”. Walt’s narrative about providing for his family in the last weeks of his life is one that he clings to and is one that is breached by the remission of his illness.
A critical illness is like a great permission, an authorization or absolving. It’s all right for a threatened man to be romantic, even crazy, if he feels like it. All your life you think you have to hold back your craziness, but when you’re sick you can let it out in all its garish colors.
This position, with all its grandiosity and masculinism is mirrored in the conversation that Walt has with a post-traumatised Hank in the previous episode. Walt offers a listening ear to Hank, and Hank responds dismissively.
HANK: “The things I deal with. You and me don’t have much of what you might call an experiental overlap.”
WALT: “What if I told you we do? I have spent my whole life scared, frightened of things that could happen. Might happen, might not happen. Fifty years I spent like that. Finding myself awake at 3 in the morning. But you know what, ever since my diagnosis, I sleep just fine. What I came to realise is that fear, that’s the worst of it, that’s the real enemy. So get up, get out in the real world, and you kick that bastard as hard as you can right in the teeth.”
Throughout my pregnancy, I have been casually reading a few memoirs about pregnancy, birth, and motherhood, including the ubiquitous Up the Duff, Welcome to Your New Life by Anna Goldsworthy, and What I Didn’t Expect (When I Was Expecting) by Monica Dux (although I didn’t finish this last one).
The thing that immediately strikes me about this genre is the use of ironic distance particularly in the sections on pregnancy and birth, in which the authors express a profound ambivalence about the messages they receive about birth. This is totes fine, but it does get a bit boring when there is seemingly no way out of this deadlock, which contrasts to the more earnest conventions in the genre of the positive birth story, scores of which can be found online. But I have yet to see a published pregnancy/birth/motherhood memoir that doesn’t take a stance of ironic distance.
What is going on here? Anna Goldsworthy doesn’t strike me as the ironic distance type - I’ve read her stuff in literary journals before - and the second half of her book on birth and motherhood (i.e. after birth has taken place) is a much more serious and poignant work. Likewise, Dux has (co-)written relatively serious trade books before (The Great Feminist Denial) and yet lapses into almost a facsimile of the wry deprecating style of Up the Duff in her own pregnancy memoir. Likewise, writing about pregnancy and birth in the media, when it’s not preachy stuff about why homebirths are bad, mmkay, also has this ironic “aren’t bodily fluids hilarious?”, and/or “aren’t we all ridiculous for thinking we can control this?” style.
What is being covered up by this distance? As Rita Charon says in Narrative Medicine, “irony confers distance on the author, who often selects it when nearing a truth that is too painful to say. […] [S]omething so hot, so provocative, so potentially destructive that it had to be done in reverse.”
So is it trauma, then? But surely birth trauma is not so universal as to crowd out any other possible writing style for talking about birth?
Ask me again in a month, I guess.
This isn’t an entry about social movements, although it talks a bit about social contagion. Instead it’s about movement disorders and neurology. A bit of it draws on my own experience of movement symptoms, but mostly it’s some general thoughts about the assumptions of neurology (the practice/science, not necessarily the practitioners, who can be individually fantastic), particularly of its framing of patients (more so than other medical practice, barring perhaps obstetrics) as subjects who cannot know.
I watched a documentary recently called “The Town that Caught Tourettes” which was about some girls (some, though not all, in the same town) who developed a movement disorder or tic disorder (never actually ever diagnosed as Tourettes, but described repeatedly as ‘Tourettes-like’). The documentary was kind of standard TV doco fare, awkwardly structured and often sensationalised.
The neurologists’ diagnosis? “Conversion disorder”, then when more than one person got it “Mass psychogenic illness”. Not “mass hysteria” though, because “that’s an outdated term that we no longer use”. Of course this is a terminological distinction, not a philosophical one, but more on that soon.
Conversion disorder is defined (on the Medline Plus website, a service of the US national library of medicine) as “a mental health condition in which a person has blindness, paralysis, or other nervous system (neurologic) symptoms that cannot be explained by medical evaluation.”
"The physical symptoms are thought to be an attempt to resolve the conflict the person feels inside. For example, a woman who believes it is not acceptable to have violent feelings may suddenly feel numbness in her arms after becoming so angry that she wanted to hit someone. Instead of allowing herself to have violent thoughts about hitting someone, she experiences the physical symptom of numbness in her arms."
Later in the documentary (and if you follow up on some of the girls’ stories, such as Lori Brownell who has since been diagnosed with Lyme disease) you find out that other neurologists/doctors gave some of the young women alternative diagnoses to explain their illness, but the documentary focuses mainly on the idea of conversion disorder and the illness as a social contagion.
It seems that many neurologists have trouble providing a physical explanation for involuntary movements (regardless of whether they also have a known organic cause). Hence, conversion disorder. A person’s phenomenological experience of stress or anxiety is never taken into account in these explanations. I am an anxious person, but intensifications of my movement disorder often occur at times in my life when I am calm. For example three weeks in February 2013 during which I had periods of violent involuntary movements (I’ve been told I can’t use the word fit or seizure to describe these episodes because I don’t have epilepsy, though visually they were indistinguishable from most people’s idea of a motor seizure). The neurologist’s explanation was my thesis due date in March 2013. Never mind that this was also one of the calmest and stress-free periods in my life. I felt in control, and I had also cut all other commitments in my life in order to finish on time.
“I was just wondering what was going on with me. There was something wrong and I couldn’t stop it” – Lori Brownell
Likewise, the young women’s awareness that their illness wasn’t caused by stress was never taken into account. The girls’ claims that they were happy before they developed the symptoms were ignored or mistrusted, including by a New York Times journalist who ‘uncovered’ trauma in several of the girls’ lives. The girls’ reaction to being diagnosed with conversion disorder is one of anger and despair. But they are considered unreliable subjects, because the idea of conversion disorder itself assumes a split between the self-aware mind, the subconscious, and the physical brain. The existence of the movements themselves makes the young women always-already untrustworthy. They do not know their own minds, and the movements are evidence of this. The movements rob the girls (and they are always framed as girls) of their status as agents in their own lives, as people who (can) know, as people who can tell a story about their lives and what has happened to them. The diagnosis of conversion disorder itself performs this function. The diagnosis of movement disorder at all performs this function. How can you be a subject with agency if you cannot control your body? How can you be a subject with agency if your subconscious converts your neuroses into physical symptoms without your knowledge?
“The electrical shock feeling that I get in my spine is there 24/7, it never goes away, and what it does, I feel like it pushes the tics out. Like, when it goes through my body, I can feel it go through my spine into my arms, into my legs. I can feel it go through my entire back. And then the tics just happen as it pushes itself out. And it’s just a cycle that keeps going on and on” – Lori Brownell
One of the women in the film describes the sensations she feels in the course of her movement disorder. She feels these sensations in her body, and they are metaphors that enable her to understand or make sense of her illness. They may also be entirely accurate. Certainly this description matches my own experience of the physicality of my (involuntary) movements.
The assumption of the split between the self-aware mind, the subconscious, and the physical brain, I think, belies these experiences of involuntary movements. There’s often a sense of premonition before a movement. I can often tell how long the movements will last and what their intensity is likely to be, although if I’m not tuned in they can still take me by surprise. They are involuntary, and unintentional, and yes, I “can’t stop it”, but at the same time they are my movements, insofar as I can feel the premonitory pulse of them, which “pushes them out”. My movements are not called tics, because they have an organic cause and are therefore called ‘myoclonus’, but I suspect they are almost identical to what some of these young women experience. The removal of the self from movement, even involuntary ones, I think is false. You feel it happen, you feel it fire. Your body moves in response, and it’s still your body moving, although you may not have chosen its movements
Regardless of the existence or non-existence of conversion disorder (I personally believe it is a bullshit illness, but if anyone ever has felt that the diagnosis adequately answered their questions about what was going on in their body then great), the philosophical underpinnings of it (it is derived from the concept of hysteria) make it hugely problematic in practice, and I think colour the entire neurological profession with some really problematic understandings of self, mind, and brain/nervous system. And also women. Conversion disorder is more common in women (or more accurately, more commonly diagnosed in women), a fact uncritically reproduced on its Wikipedia entry. I think this is part of the sense in which women are already considered to be lacking capacity to understand their own experience, and as people who do not and cannot know themselves. Doctors know (what is) best for and about women, particularly adolescent girls, who are already framed as problems. In the film, the lingering shots over their prom dresses and cheerleader pasts give the documentary a Heathers flavour. The contagious suicide “problem” in that film mirrors the concern trolling that goes on around these young women in this documentary.