Head troubles
Lately, I keep having this recurring disembodied vision where I am floating in a large calm body of water, Ophelia style. It is both soothing and ominous. I am floating, I am drowning. It is not as dramatic as it sounds. The reason for this vision is that, lately, I keep having migraines that come on abruptly and that linger, like a bad hangover, overshadowing days and days. Headaches submerge you, fill your skull with pain. My brain burns while I am in it, feels like soggy paper afterwards. I experience nausea, cramps in my stomach and chest and hips, phantom pains in different limbs, relentless fatigue and sleeplessness, overwhelming crushing despair.
This rash of symptoms may be primarily psychological or physiological, it is hard to know. The last time I had terrible chronic headaches was in 2017, after my grandmother died. I lived with her when I was a young child, and I was devastated when she died. My grief seemed manic to me later, hallucinatory, inconsolable. This time around, no one has died.
My only way to explain this experience is linguistic, a kind of metaphysical reconstruction of where my spirit allegedly intercepts my body. The psychological does not live anywhere supposedly, except in the transient electrical impulses of your brain, but it can make you quite literally sick to your stomach. It can break your heart. In extreme cases, it can kill you. Although this is spiritual or intangible in nature, it is transmitted quite concretely through nerve pathways and through the parts of your brain that regulate hormones, that form long term memories, that govern sleep. Like all forms of pain, they are subjective, impossible to locate, and on the border between the mind and the body. But because migraines dwell in your head and produce a dizzyingly wide and complex range of physical symptoms, they typify the mind-body problem even more than other kinds of chronic pain.
Migraines have often been associated with weakness, with femininity, with nervous or hysterical personalities. In her 2019 social history of the condition, Migraine: A History, Katherine Foxhall quotes an influential neurologist’s book on the topic written in 1948, which details the personality type of a migrainous woman as sexually dysfunctional, “perfectionist, driving,” sickened by her “essential psychobiologic rigidity.” Similarly, in a 1952 book, physician Walter Alvarez describes migraine sufferers as nearly all women who are, “tense, perfectionist, hypersensitive, easily fatigued, and often depressed or disconnected.” He claims that although they are often sexually attractive, they invariably think coldly and dispassionately like a man. As recently as 2014, Sadie Stein claimed in a Paris Review essay that migraines are the “most glamorous” of headaches, boasting benign but sexy symptoms.
I have wondered at times, cocooned in my private suffering, if this pop typology, with its distinct flavor of 19th century medical misogyny, has some truth to it. If I am working too hard, if I am too sensitive to the freefalling world around me, if my womb is wandering, if I crave my biological destiny of a softer life. The onset of this season of headaches coincided with changing circumstances in my life, some of which have been stressful. When the first one came on, I was at work. I went to the pharmacy and got an Excedrin and went back to work. The headache did not recede.
Literature is full of headaches. Joan Didion suffered from migraines, which she called “a shameful secret, evidence not merely of some chemical inferiority but of all my bad attitudes, unpleasant tempers, wrongthink.” (“In Bed,” 1968). Hilary Mantel describes seeing “floating lacunae in the world, each shaped rather like a doughnut with a dazzle of light where the hole should be.” (So Much More Than a Headache). Sexual or physical abuse, especially during childhood, can increase the likelihood of migraine, a link that is poorly understood. Alice Munro’s daughter, Andrea, who was sexually abused by her stepfather in childhood, suffered weekly migraines as an adult, which she eventually linked to her abuse according to The New Yorker. “It wasn’t until she had read Gerry’s letter that described her headache on the morning he first abused her that she connected the onset of the condition to what he’d done. Now she understood migraines as a “way to experience the intensity of my pain without inflicting it on anyone.” Hildegard Von Bingen’s shattering visions err close to a description of migraine symptoms. The line between the sublime and the devastating is too thin to be threaded. “All pain is simple,” writes Lisa Olstein at the opening of Pain Studies. “And all pain is complex. You’re in it and you want to get out. How can the ocean not be beautiful? The ocean is not beautiful today.”
Up to 50% of migraine sufferers are not diagnosed as such according to another migraine history by Esther Lardreau (La Migraine: Biographie d'une Maladie). Either because they do not acknowledge their own condition or because they have slipped through the porous cracks of the medical establishment. For this reason, theorists of migraines such as Katherine Foxhall and Esther Lardreau refer to migraines as a socially contingent illness, the provenance of a self-selecting group. Migraines were historically considered more of an existential or social complaint than a distinct illness as such. The Greeks treated them with herbs applied to the temples, the Victorians with leeches. In a Ming dynasty novel set a thousand years earlier, a famous physician called Hua Tao proposes cutting open an army commander’s skull with a cleaver to relieve the trapped air and fluid from a humor imbalance. He is imprisoned for his troubles. Migraines are often associated with imbalanced humors, with a bad personality type, with intellectuals, with women, with readers. Only in modern medical texts do migraines become an object of study in their own right, a form of chronic illness, something physically located in nerve pathways.
These days, western medicine tends to understand physical symptoms as biomedical, which is to say, purely located in the body. To suggest that my headaches are caused by stress or other psychological symptoms seems to remove them from the realm of medical reality. The first time I had chronic headaches in 2017, the doctor I went to see offered me Xanax for stress. The second time, my doctor suggested not skipping meals, sleeping well, exercising. So I did all of that, I stopped drinking, I stopped going out, I cut back on caffeine, I tried to work less, I tried to look at my phone less, I tried to stretch more, I tried to predict which foods or situations would incur the bouts of dizziness and nausea that presage the storms of my headaches. None of it worked.
A 2007 article in the American Migraine Society’s official journal, Headache: The Journal of Head and Face Pain, argues for a “biopsychosocial” model of headache, one that spans the gulf between psychological and physiological inquiry. The legacy of Cartesian dualism, the traditional mind-body separation of Western thought, has left not only doctors, but also migraine sufferers themselves unable to understand the locus of their pain. In other words, in disassociating the mind so completely from the body, we have also disassociated ourselves from our own corporeal experience.
This problem has given rise to ideas of somatic primacy such as Bessel Van Der Kolk’s The Body Keeps the Score, which Danielle Carr calls “traumatic literalism” because it totally rejects mind-body separation. Trauma and other psychiatric conditions thus are literally brain disorders that can be functionally mapped, diagnosed, and eventually, treated using neuroimaging techniques. Above all, Carr suggests, this framing offers a neat solution to a sociopolitical problem. It provides a concrete, visual proof of injury for suffering, something that is otherwise invisible. It also offers medical legitimacy. If your pain can be seen and described, it can be documented and covered by profit-driven medical systems and insurance companies. The problem with traumatic literalism is that it imposes blunt categories on things that are complex and delicate. It insists that things that are subjective and personal and impossible to impart, like pain and grief and the long shadow of their memories, must be real in the legal sense, which is to say, describable in a graph or a chart or a scan or a scale.
It is tempting to imagine ourselves as the only reliable narrators of our own bodies, especially faced with the indifference, cruelty, and discrimination of the medical industry. But understanding your own somatic experience is different than being able to accurately convey it. Eula Biss describes seeking a diagnosis for her chronic pain in “The Pain Scale” and agonizing over how to rate her pain. Is this compared to the worst pain she personally has ever felt? Is it compared to the potential suffering of anyone anywhere in the world at any given time? Children, she notes, often look at the series of smiling and frowning faces on child-friendly pain scales and mistake fear with pain or conflate feeling with pain.
I have often heard that menstrual cramps are as painful as a heart attack, and have often thought, in the midst of my own agony, that that was probably true, but I have never thought of my cramps as an emergency. I know that I will not die of them. They will come and they will go. This perspective may be partially the result of medical sexism (the point of the comparison), but regardless, that framework influences my entire worldview and my own relationship to my body. It is not only doctors who might look at you and underestimate or misunderstand your pain. Many of us also wildly misunderstand our own physical experience in different ways because of how we have been trained to exist in the world. This is partly due to the way that many able-bodied people imagine their relationship to health. It is mystifying to imagine that your body may not be able to function the way it has generally functioned. Sickness is inconceivable when you are healthy and yet, almost everyone, at some point in their life, will get sick and watch parts of their body start to fail.
“I wanted to write about exhaustion the way I used to write about love,” writes Anne Boyer in her cancer memoir, The Undying. “Like love, exhaustion both requires language and baffles it, and like love, it is not as if exhaustion will kill you, no matter how many times you might declare that you are dying of it.” Boyer, who was treated for a rare and aggressive form of breast cancer in her 40s, was forced to continue working throughout her illness because she was poor, precariously employed, and a single parent. She describes being evicted from the hospital a few hours after a double mastectomy, which is now considered an “outpatient procedure” and teaching with surgical drainage bags sewed to her chest a few days later. At the end of her treatment, while she is being evaluated for chemotherapy-induced heart failure, she stages an elaborate masquerade, putting on makeup and propping herself up in a chair, to convince a doctor to let her leave and go to work. “If exhaustion as a subject has become newly popular,” writes Boyer, “it is because a once-proletarian feeling has now become a feeling of the proletarianized all.”
Under these conditions, acceding to fatigue, illness, and pain is a symptom of defeat. In times like these, it is increasingly easy to transmute clear physical symptoms into imagined mental symptoms that can be overcome by the sheer power of clean eating, manifestation, prayer, a vitamin regime, good habits, or other kinds of “biohacking.” When I scroll through TikTok, a series of impossibly beautiful young women promise cures for bloating, fatigue, depression, stress, back pain, acne, and other such ailments that include going off birth control, eating red meat, eating chia seeds, drinking gallons of water, not drinking water, walking for hours a day, doing pilates exercises, and getting B12 shots. Sometimes, the symptoms spill over into other kinds of complaints. “Cortisol belly”, a faddish term describing abdominal bloating, can allegedly be cured by cleanses that are functionally indistinguishable from disordered eating weight loss advice.
In one recent trend, young women contrast sloppy pictures of themselves from past relationships, wearing sweatpants and eating junk food with their boyfriends, with post-breakup pictures, where they are invariably slimmer, more dressed up, hair done, makeup done. This convergence of pop feminism and pseudo-health advice advertises appearances above all else. Would you rather be a thin, popular influencer, devoting all your energy to your followers and fans and to raking in money, or be in a relationship and get ugly? After scrolling through too many of these, I started to wonder if I had the wrong priorities. I looked back at photos of myself from a few years ago, when I was heartbroken, in so much pain I thought I had a stomach ulcer, and subsisting on a diet of black coffee, gin, and late-night pizza slices. I look gaunt and beautiful in the pictures. It was then that my online writing career had really taken off.
I have an argument with my boyfriend at a restaurant over something stupid and petty. Afterwards, I experience sudden stomach cramps so severe I think I am dying. I weep on the street in SoHo, clutching my stomach. A drunk young woman comes up to me and asks me to take her photo before she sees my tears and shifts to concern. I tell her I can take her photo if she wants and she explains that her friends had all declined to do the requested photoshoot, which would be in the middle of Crosby Street between red lights because she lives in the neighborhood, and because it is fundamentally a cringey activity. I do not take her photo, but the encounter cheers me up enough that I drag myself and my painful belly home.
Later, in bed I scroll through articles on my phone about Crohn’s Disease, which several members of my extended family have, and then about IBS and gastritis and gluten allergies, and remember a time when I was 20 and living in Eastern Europe and had gastric symptoms so severe I could barely keep food down for almost a month. At the clinic I went to, the doctor, who spoke no English, diagnosed me on sight with “gastroenteritis” and dismissed me. I lost nearly 20 pounds over the course of that period and everyone I saw after told me how good I looked. I wonder if I can trick my body into repeating the experience. The cramps linger for days. I cannot tell what is responsible, my mind, my body, my diet, my faulty ideas about things.
In Greek mythology, the god Zeus swallows his pregnant wife Metis, after hearing a prophecy about how she will have a son who will kill him. She gestates in his head, and he later endures a splitting headache that drives him mad with pain. When he finally convinces one of the other gods to break open his head with an axe, Athena emerges fully formed from his mind, carrying her spear and shield. Birthed in brain fluid, she will become the goddess of wisdom.
I imagine that inside each of my headaches there is a revelation waiting to be born, a tiny goddess of wisdom ready to spring forth. I secretly think that if I can write about headaches, if I can untangle the complex tangle of stress, sadness, lifestyle factors, the cluster of physical and psychological symptoms surrounding them, that I will be able to solve them. I secretly think my headaches, my stomach aches, my extreme fatigue, my joint pain are a symptom of laziness, of discontent, of a refusal to participate in this world with its spectacular violence and abandonment. It feels cheap, as Eula Biss worries, to try to measure your own pain against the pain of people living in war zones, undergoing the worst deprivations imaginable. It feels frivolous to wallow in the diffuse pain in my body, to be too tired to get up. It demands an impossible metric of proof. “We can’t measure spirit,” writes Anne Boyer. “This because it isn’t real, or at least because it is not material, but it feels real when we become acutely aware of our own aridity. But no matter how potentially unalive or indistinct an exhausted person feels inside of herself, her body will look like a body, discreet, alive and animate, and capable of trying more, of trying harder, of improving or remedying or aspiring or producing.”
Yet the notion that you can cure your physical ailments, however superfluous they may be, with the power of positive thinking has long been an American credo. It is costly, even deadly, to peer inside yourself and figure out what’s wrong. Americans cumulatively owe $220 billion in medical debt alone. The uninsured are routinely turned away from hospitals. Even the insured rack up bills and unpaid leave that can easily spiral into a life-ruining crisis. It seems easier to just ignore it and hope it goes away. I can’t tell if my ability to continue functioning during my migraine crises is a sign they’re not really that serious or a sign that I am inured to working through different kinds of suffering. I used to go to work sick all the time, until I would be told, Devil Wears Prada style, to go home. At a previous job, when I told my employer my mother had been diagnosed with cancer, she first suggested I quit sooner rather than later and then lashed me verbally for slacking off. Nearly everyone I know has kept working through some kind of personal or health crisis, be it psychological or physical, because there simply is no other option.
What frightens me the most about fatigue and pain and depression is how indifferent it makes you, how absorbed in your own internal suffering, how it alienates you from the world and from everyone around you. This is difficult to articulate, but Hanif Abdurraqib said it very beautifully in a recent essay about despair and suicidal ideation for The New Yorker, where he writes, “I am no longer wired to catalogue and sift through only my own internal horrors, and so, by the mercy of simply looking up and looking around, I can see that there are people willing to love me, and that I am willing to love them.”
In this sense, love is and is not like exhaustion. It is true that love can feel like it will kill you, but love can also feel like it will save your life. It makes you beholden to other people and to the world. Like pain, it is almost impossible to remember what it feels like when you are not inside it, but the trace of it lingers in your muscle memory long after it is gone. “Love is action,” writes Marie Howe in her poem After the Movie. “[…] Simone Weil says that when you really love you are able to look at / someone you want to eat and not eat them. / Janis Joplin says, take another little piece of my heart now baby.”