Home, Sick

In my mid-twenties I was often unwell. Not with serious illness—the kind that I think about all the time now, fifteen years later, as my parents age and my friends get screened for and diagnosed with and sometimes die from cancers of every goddam type. But the kind of illness that casts a shadow over the everyday, that makes simple things, like getting up before noon or going an evening without an anaesthetizing drink, feel impossible. The kind of illness about which doctors have little to say apart from the suggestion, made repeatedly over many years by my dogged GP, that I quit grad school and give up on philosophy. Luckily my symptoms had few consequences beyond themselves, save the endangerment of my own distant, highly notional future. My friends and I called this mysterious illness my “malaise,” my “hysteria,” my “neurasthenia”: nineteenth-century diagnoses that implied something hovering between reality and illusion. It was all in my mind, which didn’t mean it wasn’t also in my body, making my limbs drag, my head throb, my throat rasp.

I was explaining all this one day to a friend visiting me in Oxford, when she asked me about my experiences of being ill as a child. I told her I had been sick a lot—multiple cases of strep throat, treated by so many rounds of amoxicillin that I alone could be responsible for the crisis of antibiotic resistance. Staying home sick from school was a source of secret and great pleasure. My mother on her break would take the subway from Manhattan, where she worked, to our apartment in Brooklyn, picking up lunch from a greengrocer on the way.

We would sit together, my body gathered in hers, in a large armchair, inside our apartment that was now gloriously emptied of my sister and father. This left just us, the precious dyad. In that moment I felt simply loved, in a way that had nothing to do with being the most dutiful daughter, or best student, or indeed anything other than what I was in those moments: an ill child, perfectly lovable in my complete vulnerability. I said all this, and then remembered my friend. I looked at her, astonished by what she had prompted me to recall. Briefly we were silent. Then we burst out laughing.

Who wouldn’t want to flee into illness, if that is the place where one is most completely loved, without demand or expectation?

2.

I could have told my friend other stories about my childhood and illness. There’s a story my mother often told to me, since I was too young to remember it myself. Just six weeks after my parents had taken me home from the hospital, I started projectile vomiting. Within twenty-four hours I had lost much of my body weight. The diagnosis was pyloric stenosis—a thickening of the pylorus muscle, which controls the travel of food from the stomach to the small intestine. It was one of the worst cases the hospital had seen; the video footage of the surgery would later be used to teach students. The doctors wheeled all eight pounds of me into the operating theater on an adult-sized gurney. My maternal grandmother in India fasted, vowing that no food would touch her lips until I started eating again. My parents kept vigil for hours by my hospital cot, tapping the IV that was pumping into my arm. They had been told by the nurses that if an air bubble entered my infant veins I could die.

Another story: I am maybe six or seven, in bed with a sudden raging fever. My whole body is shaking; my teeth chatter noisily in my skull. Somehow my parents, both of them, know this—did I cry out?—and burst into my bedroom, together. They pull layers of clothes onto me, and pile the bed high with extra blankets. My mother puts a sock onto one foot; my father puts a sock onto the other. It is a rare memory of my parents doing something together, in happy concert.

Who wouldn’t want to flee into illness, if that is the place where everyone gets along?

3.

These stories are stories of origins, of what medical practitioners for centuries, including the great doctor of the mind Sigmund Freud, called “etiology”: the causal genesis and history of disease. By asking me about my childhood experience with illness, my friend prompted me to uncover something I did not know, though it was in a sense always there, ready for me to know. Since childhood, illness has offered me temporary escape from the dominant logic of my life, whose axiom is that love is something earned through achievement and lost through failure. 

This is not an axiom I consciously avow— on the contrary, if you asked me I would insist that love is something which we give without reason. But what I consciously avow is precisely what is unimportant here. What matters, for understanding my periodic illnesses that had no apparent somatic cause, is the stories my mind tells despite itself. The stories that reveal the wants and wishes that are buried deep, and are all the more powerful for that. These stories say: I fly into illness because I want to be loved.

4.

(Though an analyst would rightly ask: Is this auto-diagnosis not itself a performance of a kind? Yet another request for love on the terms I claim to dispute?)

5.

“Etiology” doesn’t just have to apply to illnesses, physical or mental. Anything at all can be analyzed as a symptom: your beliefs, your politics, your language, your taste in music, the way you raise your kids, the gods you worship, the car you drive, the kind of sex you do or don’t want to have. Behind each of the things you hold dearest about yourself lies a story, indeed multiple stories, that promise to explain these things not as the result of consciously held reasons, but underlying and a-rational causes. You vote the way you do because that’s the way your dad voted, or because you are in the grip of ruling-class ideology, or because the campaign fired up your amygdala, or because the candidate makes you somehow feel more securely like the woman or man you, deep down, fear that you are not.

What holds all these explanatory stories together—whether they operate in the vocabularies given to us by Nietzsche (will to power), Darwin (natural selection), Marx (class), Freud (the unconscious), Bourdieu (habitus), neuroscience (synaptic firings), or identity politics (whiteness, cishet-ness, able-bodied-ness, neurotypical-ness)—is that they situate their explananda in what philosophers like to call “the space of causes.” The space of causes is to be contrasted with “the space of reasons.” To treat someone as situated in the space of reasons is to ask what considerations they themselves would offer that speak in favor of living and thinking as they do. It is, in other words, to suppose that they are rational creatures, who behave as they do because they have good reasons. By contrast, reductive modes of explanation search out the deep causes that are “really” doing the work: work of which subjects themselves are generally unaware.

The human drama is that we live, at once, in both the space of reasons and the space of causes. (The metaphysical drama is that—somehow—these two spaces must be equally real parts of the world, must be indeed just one space.) We can be treated as sole inhabitants of the space of reasons, as when others presume us to be rational persons who believe and behave as we do because we have considered the evidence and arguments. (“I voted for him because he will bolster the economy”; “I support the war because we face an existential threat.”) Or we can be treated instead, or also, as inhabitants of the space of causes, radically shaped by subterranean forces of which we are unaware and that are at odds with our self-conceptions. (“You voted for him because you long for order”; “you support the war because you fear your own death.”)

6.

As a rule, treating someone reductively—at least outside the therapeutic setting, and sometimes even there—is considered an assault on their personhood. Freud called the patient’s defensive response to the therapeutic enterprise “resistance,” and said it was an ineluctable part of psychoanalysis. The patient does not want to know the truth about herself, does not want to accept the interpretation of her symptoms to which all her memories and dreams and associations and slips-of-tongue increasingly point. The patient wants to hold onto an image of herself as healthy, rational, and (ironically) not in need of the analyst whose help she has sought. The patient, Freud thought, wants to remain ill.

Psychoanalysis—the least reductive of all the reductive discourses—has wrangled ambivalently with its practice of reading the patient’s unconscious back to them. Freud himself grew increasingly pessimistic about the possibility of cure, given the inevitability of the patient’s resistance to the analyst’s interpretations. Many post-Freudians have distanced themselves from the idea that diagnosis is central to their practice. Rather than seeking to unearth hidden causes and concealed meanings, psychoanalysis has increasingly become focused on the transformative power of the therapeutic interaction itself: as a practice that generates not just self-understanding and release from repression, but newly possible selves.

Outside the therapeutic setting, where there is little scope for the mutuality of analyst and analysand, resistance to interpretation can thicken into naked hostility. The Zionist is enraged by the idea that her assault on Palestinian life is the result of unprocessed historical trauma. The trans-exclusionary feminist is incensed by the proposal that she is in the grip of an anxiety about male violence that has overflowed its rational bounds into something excessive. The Trump voter is sick to the back teeth of being told that his politics is at root an expression of his racist and patriarchal fantasies. 

In the political sphere, it is not at all obvious that treating people symptomatically—as inhabitants of the space of causes—gets us anywhere, at least as tools of interpersonal persuasion. It may get us to the truth of what is “really” going on. But if that truth is met with resistance—a resistance that, unlike in the therapeutic setting, has little hope of being worked through—of what practical use is it?

7.

And yet, being treated reductively can inspire something other than hostility. To be on the receiving end of a reductive explanation of oneself can sometimes be a source of welcome—and transformative—revelation. Indeed it can be a source of secret and great pleasure. I am thinking of a pleasure like that I used to feel as a sick child, and still sometimes feel as a sick adult: the pleasure, precisely, of being treated not as a person, but as something “less”—a helpless child, a howling animal, a feverish body. Treated this way by my mother, I was released from all the expectations of personhood: the expectations of responsibility, duty, achievement, of rationality itself. Reduction was my entry into a form of love that otherwise eluded me.

At the moment in which my friend asked me about my childhood experiences of illness, she effected in me that same great pleasure. That is why we laughed. Not only because of the intellectually satisfying perfection of the diagnosis—textbook!—but because of our shared pleasure in my reduction.

8.

To be reduced to the Other, Simone de Beauvoir said in The Second Sex, was the essence of women’s oppression. Men have made women into the Other, so that they could be Subject. But this did not mean that women’s situation was without pleasure or happiness. On the contrary, to be treated as Other was to be granted very real pleasures—the pleaures, indeed, of the child, who is subject to the authority of the adult world, and so unfree. Women, like children, are compensated for their unfreedom with protection and care, and—above all—relief from the burdens of ethical responsibility. The woman who allowed herself to be othered by patriarchy not only mitigated, Beauvoir writes, the “economic risk” of material independence, but avoided “the metaphysical risk of . . . freedom.” She goes on:

[B]eside every individual’s claim to assert oneself as subject—an ethical claim—lies the temptation to flee freedom and to make oneself into a thing: it is a pernicious path because the individual, passive, alienated, and lost, is prey to a foreign will, cut off from his transcendence, robbed of all worth. But it is an easy path: the anguish and stress of authentically assumed existence are thus avoided.

To live inauthentically—in “bad faith”—as a mere thing was the path of least resistance.

For this reason, Beauvoir insisted, men would find in the women they wanted to dominate “a deep complicity”: It is because the woman “often derives satisfaction from her role as Other” that she “makes no claim for herself as subject.” In order to achieve liberation, women had to reject the alluring pleasures of objecthood, and take responsibility for themselves as subjects capable of autonomous choice. 

And yet, unlike her intellectual and romantic partner Jean-Paul Sartre, Beauvoir did not entertain fantasies of total subjecthood—or, put otherwise, the fantasy of final exit from the space of causes. Truly authentic existence was, Beauvoir said, an ambiguous existence. It involved being at once Subject and Other, free and determined, transcendent and immanent, will and body. Beauvoir identified a flash of this ambiguity in the erotic encounter: “The erotic experience is one that most poignantly reveals to human beings their ambiguous condition; they experience it as flesh and as spirit, as the other and as subject.” In sex, humans could experience themselves as denizens of both the space of causes and the space of reasons.

9.

There may seem something too rosy in Beauvoir’s description of sex as the sphere of human authenticity. It can be that, yes. But so too can it be, as generations of feminists have insisted, a sphere of unambiguous unfreedom, domination, coercion, subjection: a distillation of the feminine situation of Otherness, rather than a prefigurative reprieve from it. In fact Beauvoir was well aware of this: The young woman who is initiated into the world of heterosexual sex, she says, is “dominated, subjugated, conquered.” (Beauvoir does not stop here: The first act of penile penetration, she says, “always constitutes a kind of rape.”) It is only in the rare condition of “reciprocal recognition of the self and the other”—in which the man “covets her in her flesh while recognizing her freedom”—that a woman can be at once subject and object. Only here can woman remain “free in the submission to which she consents.”

Beauvoir invokes the idea of “consent,” but notice how little weight she puts on it. For Beauvoir, it is not the woman’s consent that renders sex (to borrow a phrase from the revolutionary psychiatrist Frantz Fanon) “an encounter between two freedoms.” Consent may matter, but it is not for Beauvoir the essence of the sort of sex to which we should aspire. Rather, the woman “remains free in the submission to which she consents” only when there exists a “reciprocal recognition of the self and the other”: when woman and man (for it is heterosexual sex that troubles Beauvoir) see each other as a locus of transcendent freedom, and address each other with a “generosity of body and soul.” 

Beauvoir calls into question the idea, one which has become increasingly central to our modern sexual ethics, that consent is the hallmark of ethically permissible sex. Consent is a permission to have done to you what no one has the right to do; it is the waiving of a right, as philosophers like to say. The giving of consent can transform what would be an assault into something ethically unworrying (“just sex”). But consensual sex can still fall far short of the sort of sex we should want for ourselves and others. We can and do say “yes” to sex that isn’t really wanted, in order to pacify, conform, or perform, or in order to secure those basic necessities which, in a materially rich society, should be guaranteed.

Like sex, reduction and interpretation can be exercised as an assault on another person. But it can also be exercised as an act of intimacy: between therapist and patient, between friends, between lovers. Where here is the line between assault and intimacy? 

10.

One of Freud’s early patients, a young woman of eighteen whom Freud pseudonymized as “Dora,” was “a mature young woman of very independent judgement, who had grown accustomed to laugh at the efforts of doctors, and in the end to renounce their help entirely.” According to Freud, she came to see him only because of her “father’s authority.” Did Dora consent to undergo psychoanalysis? It is not entirely clear, but we do know that Dora actively participated in the therapeutic endeavor for over two months. Then, much to Freud’s frustration and surprise, Dora abruptly quit: “She said good-bye to me very warmly, with the heartiest wishes for the New Year, and—came no more.” 

We know too that over the course of her analysis, Freud subjected Dora to a relentless interpretive assault, insisting that she was really in love with, and sexually desirous of, the man—her father’s friend, “Herr K”—who had repeatedly sexually aggressed her as a child. Many have noted the disturbing parallel between Dora’s treatment by Herr K and her treatment by Freud—between sexual assault and a dogmatic form of psychoanalysis. But the thread that connects them is not obviously the absence of Dora’s consent. 

Dora had undeniably rejected Herr K’s advances, to the point of slapping him on the face. Here there was no consent. But the case with Freud is more complex. It is true that Dora replied with a fervent and repeated “no” to Freud’s diagnosis of her, which Freud (maddeningly) interpreted as a secret “yes,” just as Herr K had done. But Dora did not withdraw from the therapy, showing up again and again to see Freud and hear his account of her, until she did not. (Perhaps being listened to, even if it meant being misunderstood, was a relief after the dismissive treatment Dora had received from the adults in her life.) Dora’s “no” represented a rejection of Freud’s particular interpretation of her, but perhaps not to being interpreted as such.

If so, then Freud’s gross mishandling of Dora’s therapy was not, at its heart, a failure to secure his patient’s consent. It was not even necessarily a failure of interpretation: Perhaps Dora was in some way excited by Herr K’s attentions, even as she was also evidently repulsed and upset by them. Freud’s failure was instead what the Hungarian psychoanalyst Sándor Ferenczi called the absence of “tact,” that sensibility that tempers and restrains the analyst’s constitutive keenness to interpret. In insisting on his interpretation of her, Freud was at best reading only a part of Dora, missing that part of her that was resistant, unready, pained. 

11.

The law of consent is an attempt, always failed, to capture the idea that ethical engagement—whether of the sexual or psychoanalytic or some other kind—requires the attunement of one person to another. “Attunement” does not presuppose love or even acquaintance, though knowing the other can often make it easier to attune ourselves to them. (At the same time, interpersonal intimacy can lead to some of the cruelest refusals of attunement, in both sex and diagnosis.) What is required—and what consent can never quite stand in for—is that our actions respond to the fullest possible reading of the other.

In sex, failures of attunement are often systematically produced, most obviously by the patriarchal eroticization of male domination and female submission—by an ideological system that aims to make boys and men want whatever it is that girls and women don’t want to give, precisely because they don’t want to give it. These dynamics can and do carry over to non-straight sex.

In diagnosis, it’s less clear that failures of attunement have a sexed character. Of course, one’s ability and willingness to impose an interpretation is inflected, like all social powers, by gender as well as class, race, and other structures of domination. But most of us, regardless of social position, know something of the pleasures of diagnosis. To interpret the other is a form of power whose thrill we all know, and which we are all tempted to abuse. In this sense, we are all Dora, and all Freud.

12.

Consent may not be the whole of ethical sex, but it does appear to be a necessary condition of it. Can the same be said of diagnosis? 

Should we at least refrain from diagnosing and reducing the other absent their consent? Should diagnosis be reserved to the therapeutic setting, where it is likelier to have a degree of mutuality: where the analysand actively contributes to the interpretation through the provision of dreams, memories, words, and silences?

It’s a tempting thought. But it will not do. Fanon did not seek the consent of French colonists in Algeria before arguing that their racism was a mutilating madness. Nor did Marx secure the consent of the bourgeoisie before reading them through the lens of class ideology. Feminists have long diagnosed men with various pathological fantasies that they would vehemently deny: of pure subjecthood, invulnerability, non-dependence. Should immigrants not speculate about the libidinal investments of white supremacists without first securing their consent? Should Palestinians refrain from psychoanalyzing their génocidaires?

It is right to say that sex should never be wielded as a weapon. But we should be cautious about saying the same of interpretation, so long as it remains a vital tool of the dominated.

13.

There is also the fact that nonconsensual diagnosis is sometimes the most precious kind: not a weapon but an act of generosity, of extraordinary intimacy. When my friend led me to see myself as a sick child, hungry for a form of love that came without strings or conditions, she did not ask for my consent first. She guessed at what I did not see, and then showed me how to see it myself. 

She read me, and I allowed myself to be read, and in so doing I was permitted, once again, the pleasures that are found only in the space of causes, which can also be a space of love.