On the Craving for Diagnosis: Part III

I: Exposition.“What do you want me to tell you?”

II: Development. “You don’t want to know.”

III: Recapitulation: “Created sick, commanded to be sound”

My own confluence of contradictions, my peculiar blend of craving for and aversion to diagnosis, expresses itself in avoidance of doctors. I perk up every time public health bodies come out against a screening test for causing too many false positives and saving too few lives. Thanks to fortunate genetics, still more fortunate life circumstances, and a Brute Squad-grade immune system, I never worry about health. I am not speaking hyperbolically, still less prescriptively – it’s merely how I am. “This seems minor, but what if it’s a sign of something much worse?” simply never crosses my mind.

This means, however, that I do not seek diagnosis except when I also seek relief. This is a setup for agitation and disappointment. I am averse to diagnostic testing, not because of what I fear it will show, but because of what it won’t. Negative test results do not improve my peace of mind. They only mean “your trouble cannot and need not be fixed.”

These observations were primarily developed within the horrifying underworld of female complaints – poorly studied, still more poorly understood, and, it seems, generally disregarded unless encountered within the context of fertility. But what complaints aren’t disregarded, unless they affect how long the sufferer lives or whether the sufferer can reproduce? I heard a doctor discussing a study on IBS out of Japan which noted that negative diagnoses failed to reassure the sufferers – that, far from being pleased at being told they did not have the disorder, they would look for another doctor who would tell them they did. I wonder if anyone on earth is surprised by that.

Month by month, symptom by symptom, my google searches map a precise, even methodical attempt to find out whether this suffering is normal and should be accepted, or abnormal and should be addressed. But if there was one thing I learned in my reading, it is the appalling range of things that are considered normal in the female reproductive system. Will this kill you? Will this sterilize you? If not, then what do you have to worry about?

The stories piled up. These women missed work, they lost consciousness, they crawled and vomited and were sent to the emergency room, then were sent home again. There is nothing about you that needs to be fixed. Diagnosis: human.

If this is health, then what, good God, is sickness?

Perhaps, like the distinction between the individual and society, the distinction between sickness and health is not nearly so clear as we would like to believe it is. But whether there are options available to address the sickness-that-is-not-sickness seems to depend largely on the goals.

“Follow up with them,” my friend told me, (a friend to whom I voiced my complaints in far more detail than to any doctor; perhaps that should tell me something about what I was really looking for.) “This is persistent and worsening. This is interfering with your life.”

It was hard to know what exactly to follow up on. If I were trying to reproduce, I could demand knowledge or at least the quest for it. But otherwise? What was I asking the doctor for? Relief? Certainty? The opposite of certainty, which is hope?

“Yeah, that seems consistent,” said the doctor when I told her that I suspected endometriosis, that ghastly parody of the old notion of wandering womb, where the type of tissue that lines the uterus escapes the confines of the womb, growing over and into organs and flesh. I didn’t get as far as “that ghastly parody” before she went on. “It would take surgery to know for sure, and the treatment’s the same anyway, so.”

It’s not like I have any reason to be discontented with “Yeah, that seems consistent” in lieu of knowledge, when knowledge wouldn’t actually change anything I do. And yet I feel discontent. I left that appointment as I have left others, thinking “I need to find a good quack. Someone who can persuade me I have something wrong with me, and then persuade me that it has been cured.”


On the Craving for Diagnosis: Part II

II: Development. “You
don’t want to know.”

The other side of the craving for diagnosis is the aversion
to diagnosis. I have seen this aversion more frequently in the environmental
than in the medical context, but it’s in both. Indeed, it is everywhere that a
name may be given to a problem, or withheld from it. It’s in the rattling car
that we dread bringing to the garage, in the mouthful of rotting teeth that we
refuse to open to the dentist, in the water we won’t test and the reports we
won’t read. This is fine. Everything’s

Part of this aversion is denial, the oldest and simplest of
superstitions. If we refuse to name the problem, there will be no problem. If
we don’t say its name, it will take no notice of us. Terrible things may
happen, sure, terrible things happen all the time, but if we can only keep from
recognizing this particular terrible thing, then we can keep from suffering its

Unfortunately, consequences don’t work that way.

But there’s something more complex as well. Naming the
problem means assuming moral responsibility for it. Refuse to act on the
complaints of a few whiny citizens and you’re simply unhelpful. Refuse to
address lead over the federal limits, and you’re a criminal. Have the doctor
turn around so he can have deniability. Don’t ask questions you don’t want the
answer to.  If you refuse to name the
problem, it will not be your problem.
And when the consequences come – and they will come – at least they will not be
your fault.

Unfortunately, innocence doesn’t work that way either.

In some ways, the worse things are, the easier they are to
ignore. The cognitive adjustment required to admit to a problem of this
appalling scope is too great; cognitive dissonance is comparatively simple.
Interestingly, the aversion to diagnosis involves resisting pattern recognition, which until now I would have said
was a drive far too strong to resist. But no: a pattern risks a meaning, which
risks a name. This is just a bad day. (Like all the other bad days.) This is
just a sick child. (Like all the other sick children.) This was just a bad

The craving for and aversion to diagnosis are driven by two concurrent
and coeval urges: the drive to pathologize and the drive to normalize,
respectively. The former is louder, but the latter is stronger. The former
dances up and down in the front of the mind, it buzzes and chirrs. The latter
is silent and invisible and strong as the tide that carries you out of reach of
the land before you’ve even noticed it has you. The former leads us to believe
absurdities; the latter to ignore atrocities. (The former is checked by
specificity, the latter by sensitivity…I could go on)

I have refused, even to myself, to put names to problems. I
have talked around them, identified them even to myself with an illegible symbol
rather than risk crystallizing knowledge into admission by writing them down.
There are times when uncertainty is easier than certainty; when suffering seems
preferable to the unfathomable effort of recovery or to the crushing knowledge
that recovery will not come. When one bad day is preferable to all of the bad

On the Craving for Diagnosis: A Semi-Personal Fugue

Now that I think about it, I should have approached the
medical system the way I approach clothes shopping : I should have gone in knowing
exactly what I wanted to get out of it. Knowledge? Peace of mind? Relief from

Instead, dissatisfied, I shift the pieces around in my mind.
Bills for medical tests. A wall-high poster for gluten-free beer. Lead in
school drinking water. Recommendations against breast self-exams. Under-diagnosed,
over-diagnosed, self-diagnosed, my
(as if a diagnosis were something you could possess, rather than
a descriptor applied to you!) They all seem to bear one pattern, but what is
the picture there?

What is this need to name what ails us? And how do we decide
what counts as knowledge?

I: Exposition.“What
do you want me to tell you?”

The obvious answer is we’re looking for something to help. Something
that will alleviate our suffering. But that can’t possibly be the whole of the answer.
We crave diagnosis even when that diagnosis promises no cure. Even when that
diagnosis is no more than a restatement of symptoms, our own complaint echoed
back to us in a doctor’s voice.

Is that what we’re looking for? Validation? Perhaps we
suspect our own suffering.  (Rightly so; we
lie to ourselves, consciously and unconsciously, all the time.) And so we
desire to have someone official speak our own suffering back to us, so that we
can in turn present it to the world. Look.
There is a word for me; someone else has a word for me.

What a peculiar need. Unless they have the power to
materially affect it, what does other people’s opinion of our suffering matter?
It’s loneliness, probably.  It’s hard to
believe how something which rises up to consume our world, which colors every
perception, molds the shape of our lives, can be so colossally irrelevant to
anyone else. Only the experience of love, I think, approaches that of pain in the
rigor of its isolation. It is a language that everyone understands and no one
can use to communicate.

It’s certainly not deference to authority that drives the
craving for diagnosis – or why are we so dissatisfied when the official
assessment disagrees with our own? Part of it, to be sure, is seeking a cure – tell me what this is so we can do something
about it
– but as before, even if there is no cure, we still want a name
that will account for our experience.  

There’s a faith, I think, that such a name is out there. Half
in towering arrogance, half in meekest humility, we believe that there must be
a word for our suffering that will transmute it from the chaos of interiority
to the order and light of true, communicable knowledge. The doctors may not owe
us a cure, but surely they owe us knowledge, at least! What do we pay them for,
if not knowledge?

The trouble is, of course,
that knowledge is not fixed and immutable like the stars. Where are the diagnoses
of yesteryear? Where is the excess of humors, where is wandering womb? In some
cases, diagnosis is no more than a constellation: imaginary lines are drawn
between symptoms and the resulting picture given a name. And yet, aren’t
constellations useful for navigation? For looking into the night sky and seeing
comprehensible patterns instead of pinpricks of wheeling light?

There. A piece clicks into place. A diagnosis doesn’t have
to point toward a cure for it to be useful.  Instead, it gives us a map by which we
understand and navigate our experiences. The craving for diagnosis is the
desire to present a complete narrative. The craving for diagnosis an expression
of the need for meaning, which (pace Maslow) is the mightiest of human needs.
Offer a man meaning and he won’t just kill for it or die for it, he’ll see his
children die as well. Anything, anything, is preferable to causeless suffering.
A world without love is preferable to a world without meaning.

Second Fifth

It’s the second fifth of Spring that’s the problem. When the
astonished joy of knowing that winter will end gives way to the sodden messy
business of winter actually ending; when the matter at hand is not the first
green spikes nudging their way through the soil, but the tangle and clutter of
dead bits of things all over everything; when the snow melts and the ice
recedes and leaves all the foulness that had been frozen within it scattered
about. When all the work that was put off over winter becomes feasible again,
and because feasible obligatory. You can,
says the second fifth of Spring, therefore
you must.
But the air, though not outright murderous, is still cold. The days,
though longer, still have no particular light to speak of. Mud is everywhere. Before
the springing plants have yielded flower,  while the branches are still unbudded, we must
still carry on as though the world had something to offer us. In the second fifth
of spring we have exhausted our winter stockpiles of excuses, and the new ones
have not yet come to harvest.

Whose Cheese Is This?

“Nacho Cheese,”  the
poster read, over a picture of happy, toned, sweating woman.  “Another reason Y.” Now, the penitential model
of exercise is widespread; you have doubtless encountered and probably used the
language of “working off” or “burning off” something indulgent and
energy-dense.  This personal calculus – this good thing will balance out or
neutralize that bad thing – is a
particular quirk of human psychology currently allowed free play in the culture
as a whole. It’s hardly surprising it should be applied to food. I am
interested, though, to see it picked up outside the sordid confines of the
individual mind and given solemn cachet by the giants of industry.  Consider the way that Coke is presenting
itself these days
: its logo curling across athletic wear, an ill-fated attempt
to sponsor a research group promoting exercise
as that which would allow the
sugar to continue to flow.  

The American war on weight fascinates me. It fascinates me
in its deep entanglement with the great drivers, hidden and otherwise, of our
culture. Our thwarted asceticism, our tedious, all-purpose class prejudice, our
deep confusion about the distinction between the individual and the collective.
But above all, it fascinates me in its ineffectiveness.  (I heard an interview with a public health
official lamenting what a hard time they were having getting results from
weight loss initiatives, no matter what they tried. Public health official, have you met anyone trying to lose weight?)

We try dozens of approaches – economic, moral, behavioral –
to shed the encumbrance of the flesh. But every so often, quite by accident,
things like this ad manage to articulate the truth we all know but cannot speak:
the knowledge that we are fighting a losing battle with our own abundance.  Is nacho cheese really the culprit behind the
weight that laps us in its squashy embrace? It doesn’t matter. For our purposes, we believe it
is, and we know that we cannot beat it. We celebrate our commitment to fight the losing battle, not in some grim I-am-off-to-diet-with-Odin display of doomed heroism, but as the gambler returns to the table, saying, if not believing, that there is still a chance.

Villanelle on a theme of Cash

I keep a close watch on this heart of mine
My thoughts the guards, my will the armed patrol
 I keep my eyes wide open all the time

Since I retain what I cannot resign,
I must restrain what I cannot control.
I keep a close watch on this heart of mine,

It grins at me as one who dreams on crime,
(Given the chance, my heart would kill my soul)
I keep my eyes wide open all the time.

I dare not dream of what it may design
I cannot guess at what may be its goal
I keep a close watch on this heart of mine

Scanning the heights to which my heart may climb,
Prodding the corners where before it stole,
I keep my eyes wide open all the time.

Could but self-knowledge and self-will align
My sundered state might be at one and whole!
I keep a close watch on this heart of mine,
I keep my eyes wide open all the time. 

Above My Station

The phone in my hotel room rang – a harsh tone, alarming and
alarmed – and I froze. “Welp, it had to happen sometime,” I thought, “they’ve
had complaints about the midafternoon Leonard Cohen karaoke.” For surely if I
could hear the details of my neighbors having themselves a good time, they
could hear me relieving my own existential sorrows by croaking out “I can’t
forget, but I don’t remember what.”

I paused the music. I saved my work file.  I picked up the phone. I hate picking up phones
but it’s the only way to make that noise shut up.

“Good afternoon, this is [my name], can I help you?” I said.

“Good afternoon! We just wanted to thank you for being a
Gold level member of [Hotel Loyalty Program] Is there anything I can get for

I panicked. This is why I hate telephone calls! They put one
on the spot, asking questions that cannot easily be answered. Well, I thought, what can you get for me? Do
you have a menu or something? And how much would it cost? What do people…
have done for them?

“Anything we can do to make your stay with us more pleasant,”
she clarified.

Well, the only thing I

I thought. You interrupted me singing my
heart out in appreciation of sex, God, and clinical depression, is that any way
to treat a Gold Level Member of [Hotel Loyalty Program]?

“Er, no,” I said, “I can’t think of anything. Thank you.”

“All right, well, if you do, let us know, we’re available
24/7!” said the voice on the phone.

You know I make less
than you do, right?
I wanted to say. I’m
actually the sort of person that it’s an insult for your sort of person to
offer service to.
But it would hardly be a gracious to admit that. I would
have to pretend I am the sort of person one does things for.  

I have now travelled extensively enough that I have
qualified for various programs for frequent travelers, and have found it
advantageous to use travel-targeted credit cards. This has gained me admission
to a polished, sordid world, the world of the cheap luxury, the world of the just-slightly-better-than,
the world of airport lounges, seat upgrades, what-can-I-do-for-you phone calls.
I don’t know what to do here. I don’t belong. When I first walked into an
airport lounge, which had plants growing out of the walls and people who looked
better than me clearing my glasses, I kept expecting to be shown the tradesman’s

This is me. I bite
my nails. I sing in public. I bumble through the world with my roly-poly
physique and my coat belt perpetually unbuckled, my scarf wrapped around my
ears like a babushka, googling cocktails on my phone so I know what to order at
the bar.

It’s not that I am oblivious to the nuances of social behavior,
still less that I am somehow miraculously free of the trappings of my context.
Rather, I have a very strong behavioural accent, like someone who learned a
language late in life. Like someone who, while he has no trouble with understanding
highly complex or technical speech, or in expressing detailed concepts, will always
have an accent fit to curdle milk and make transcriptionists tear out their
hair. I can see what other people are doing, I even have a tolerably good
notion of what it means, I just find myself incapable (and, in truth,
insufficiently motivated) to mimic it in my own mannerisms. (I suspect this
strong behavioral accent is also behind my perennial inability to assume the
trappings of femininity on any consistent basis. Every so often I tell myself I’m
going to learn how to, say, wear makeup, a resolution which lasts exactly as
long as it takes to open the bathroom cabinet.)

It was that social awareness, in the end, that let me know
that no one here was, at heart, classier than me. This cheap luxury is not for
actual rich people, of course. Take the LaGuardia airport lounge. Actual rich
people don’t fly out of LaGuardia at all. It’s for people who would like to
think of themselves as one-percenters. Don’t get me wrong, it’s nice! But it’s
nice in a way that only born-and-bred-bourgeois like me can appreciate. It’s
cheap, being rich! I haven’t paid for a coffee or sad airport salad or
ball-o-carbs since gaining access to the lounges, and the Gold Level
Midafternoon Phone Call Program came with free breakfast! But I look around: like every one of you isn’t contemplating
stuffing his pockets with the free pastries. Hypocrite voyageurs – mes semblables
– me freres.

But what, in truth, are the luxuries of the airport lounge?
Peace. Quiet. Food and drink. Outlets. If anything, it shows up in nauseating
detail just how unnecessarily unpleasant the airport experience is. Indeed, the
business of artificial distinction is nowhere on display more blatantly than in

If lounges are a cynical reminder of the engineered
difficulty of the travel experience, airport class distinctions are so crude as
to make one feel as if one is a kindergartener, or perhaps the subject of a
social experiment designed by a particularly dull undergraduate. Yes, you are
all about to be stuffed into a small metal tube, but you, you special ones, you
may tread upon a 5×2 square of carpet before you do so. Yes, you are all about
to hurtled through the upper airs at speeds passing comprehension, but you, you
chosen ones, you have a small separation curtain and 8.5 oz of water. Oh yes,
and the seats are wide enough so that you and your neighbor need not negotiate
your hip-spring, and equipped with a cupholder, or more accurately a cupsplat,
a flat smooth area from which the 8.5 oz bottle of brand-name water tumbled at
every opportunity.

What truly extraordinary lengths we will go to in order to
obscure the fact that we are, as Dickens said, fellow passengers to the grave!
Yet where is that more apparent then when we are all sharing an airplane ride (so small against the stars, so large against
the sky?)
I was sitting in my poached first class, indeed typing the first
draft of this essay, when we hit turbulence. People clapped hands over glasses
and over mouths, raising their free liquors in the involuntary toasts of the
rich and helpless, as forces beyond our control (and certainly beyond our
everyday experience) lifted us up, pressed us back down, shook us, sloshed the
liquids in our glasses and in our stomachs.

Gasps and soft cries, like the sounds of pleasure, echoed
around the plane, sounded even beyond the separation curtain. The flight
attendant crouched in her jump seat at the corner of our vision, gray-faced and

“I don’t want to die working,” muttered a voice behind me. I didn’t want to spill wine all over
this laptop, the first I have owned for years with the kind of battery life to
stand up to a cross-country flight. The plane lurched and danced. Wine sloshed
against my palm. Even in first class, there are barf bags. Coach peanuts or
first class TV dinners, it all looks the same coming up. And in that moment,
surely we knew, even if we could not possibly afford to admit, that we all look
the same coming down.

“Well, folks, we’ve descended to 25,000 feet,” said the
voice on the intercom. “Didn’t see that coming.”

Nervous laughter. Requests for more liquor. (That’s another
thing about cheap luxury: you are allowed, encouraged, to drug yourself). “Nothing
like a little turbulence to let you know you’re alive!” said my invisible
companion behind me.

Christmas Song Rant: Santa Baby

I make not the slightest pretense to address the psychosexual issues of the 1950s; they are far beyond my poor power. That said…

Santa baby… you compromised too, don’t pretend you didn’t. You claim to be a giver of gifts, but you know and I know that gift does not exist. There is only exchange. Yes, there will be gifts beneath the tree, but not for all, for the good. For the good…

Let’s see exactly what you mean by gifts. Santa baby, a ’54 convertible too…

Is that extravagant, for a gift? Am I asking too much? Why then there is a scale, even though you won’t admit to it. Are you sure it’s too much, Santa baby? There are other men, you know, who would give such gifts. For certain sorts of goodness.

I’ve been an awful
good girl.

You know what you have at your disposal, Santa baby. You know the power that gives you. What do I have to do? How good, Santa baby, is good enough?

Yes of course hurry down the chimney is a euphemism. Don’t look at me like that; if you make me explain it, it’s not sexy.

What? Santa baby, I know my price. Every girl past puberty knows her price. Do you know that that’s like, I wonder, to know exactly how much you are worth, to silently size up everyone you meet: he can afford me, he cannot, if he can things will have gone ill with me. Everyone’s a commodity, but some of us are more honest about it than others.

Stop looking at me like that.

You traffic in playthings, Santa baby. Do you wonder that I appeal to you? Think of all the fellas I haven’t kissed. I retain my worth, you seasonal saint, but for how long?
Perhaps I will wither before you will. I watch the market with an investor’s eye. I have skin in the game, Santa baby, I have nothing but skin in the game. Will you trade me security for my skin, Santa? If not, do you know someone who will?

Santa baby, forgot to mention one little thing.

A ring.

They say, you know, of Nicholas of Myra, that when there were three young girls who could not afford to marry (every girl knows her price, Santa), that he put a sable under the tree put three bags of gold down the chimney, so their father could sell them without loss.

So you know too, Santa baby, how much a young girl costs.

Holy Nicholas, pray for us.

Santa baby – mon semblable – mon frere! Hurry down the chimney tonight.

Christmas Song Rant: Jingle Bell Rock

I realized that the last couple of rants have been unusually
positive, so let’s get back to the roots of the rants with a proper two-minute
hate for what might be one of the worst Christmas songs on record: Jingle Bell

This song hates you just as much as you hate it. Can’t you
hear the contempt oozing through the lyrics? “Yes,” it says, smiling at you with
hooded eyes, “I did just stick the words “jingle bell” in front of every noun
and verb in this piece. And you’re going to sing it. And you’re going to play

Slowly, deliberately, it drops the laziest pop-culture
references, the most vapid word-pairs. Around
the clock. One-horse sleigh. Mix and mingle.
Dance and prance. The jingling is everywhere, repeated and repeated
until the word swells and twists and grows unrecognizable, so familiar it has
become strange.

“Jingle bell square? Jingle hop? Jingle horse?” you spit. “That doesn’t mean anything, what is a jingle
horse, what is it doing, why is it in the square where we’re dancing-“ But the
song is laughing at your increasingly desperate attempts to find meaning in it.

You realize, with a surge of something like terror, that you
are in the hands of a nihilist. It must see the revulsion in your eyes, because
it turns on you savagely as it rocks the night away.

“I was written by an ad man and a PR man,” it snaps, showing
its teeth – its jingle teeth, you
nearly thought, retching at the realization. “What do you expect?!”

“But you can’t – you don’t – since when can you snow up bushels of fun?” you demand,
fighting to hold on to your sanity, clinging to a world you can now barely
remember, a world where words had meanings.

“Giddy-up, jingle horse,” it says quietly, and turns the
volume up.

Christmas Song Rant: The Coventry Carol

am not squeamish in my musical tastes. Traditional ballads are one of my
favorite musical genres, and they are just wall-to-wall murder, rape, murder,
dismemberment, murder, incest, murder, executions, curses, adultery, and
murder. There’s a joke here to be made about looking at human experience from
all ‘cides (homicide, fratricide, infanticide…) That said, I have one
question for anyone who includes this carol in their compilation of Christmas

What is wrong with

to adequately explain what’s going on in this song, let’s try an analogy. Are
you familiar with the Yuletide fanfic exchange? You pick a rare/obscure fandom
and ask someone to write you a story from it, in turn you write a fic for
someone else’s obscure request. (What’s an obscure fandom? For example, this
year people have requested stories for the fandoms 13th Century
Russia, Christina Rossetti’s Goblin Market, and the Thrilling Adventure Hour
podcast, to name a few). Anyway, the Coventry Carol reads (sings?) like someone
received the following prompt:

New Testament. CHARACTERS: Any. I’d like a Christmas fic, but not something
featuring the Nativity – maybe you could explore some of the lesser-known
events or background characters? I’d also like something a little edgier than
the usual sweetness and light we get for this season. Bonus points if it’s in
the form of a song.”

writer gets this prompt, thinks about it for a few weeks, and then turns out a
short masterpiece of grimdark New Testament fanfic* – a sweet melancholy song
that initially sounds like a fairly standard lullaby of the “rock-a-bye baby,
death is inevitable” variety, but is made ten thousand times more horrifying by
the fact that it’s sung by a group of mothers to a shortly-to-be-massacred

 * * *

is something to be said for facing the appalling facts of life. There’s
something to be said for a song that puts you, the singer, in the position of a
mother who can do nothing to protect her child from violent death, who can only
sing him to sleep so perhaps he won’t see the sword fall. There’s even, perhaps,
something profoundly Christian about that sort of empathy, something
incarnational, something Christmaslike. Not rising to the heavens in glory, but
sinking straight into human nature at its most helpless, powerless and bleeding
and bereft.

SAID, we have already run ourselves down to the last few drops of light in the
year. Isn’t it dark enough?

*look I know that the pageant of the Shearmen and the Tailors IS basically New Testament fanfic; significant portions of medieval European culture are New Testament fanfic!