“IT DOESN’T TAKE ME LONG TO REALIZE that no one wants to read this pathemata,” writes Maggie Nelson in her new book, Pathemata. Nelson is not speaking of the book itself, but rather about a document that provides much of its source material: a record she has made of her jaw pain, for the benefit of doctors––its genesis, medical imaging, and history of unsuccessful treatment.
Pathemata, Or, The Story of My Mouth is a companion piece to Nelson’s Bluets (2009), which was formed, after Wittgenstein’s Tractatus, as a series of numbered propositions. Bluets inspected Nelson’s own heartache alongside the suffering of her friend Christina Crosby, who had been left paralyzed by an accident that broke her spine in two places and spared her “very little face.” Subverting the form of its philosophical precursor, Bluets refused to mount to any logical conclusions, mirroring Crosby’s own rejection of efforts to redeem or resolve the problem of physical pain. Bluets irradiated like few other texts pain’s frustrating illogic––the pointlessness of trying to diagnose it (merely a restatement of the problem), the need to go limp in the face of it while also making the effort to live livably in its midst. To the clinical eye, Nelson observed, even a pain reflex as innocent as crying could signal a dysfunction. “Well then,” she wrote, “it is as you please. This is the dysfunction talking.”
Much has changed in sixteen years. There was a pandemic, Crosby died—her eyes, Nelson writes, “cobalt rock where there once had been sky blue.” By that time, Nelson’s pain had long since relocated from her heart to her jaw. In Bluets, Nelson was on a quest to reawaken her experience of life by channeling a thwarted romantic obsession into studies of the color blue. In Pathemata, the quest has devolved into an all-too-recognizable search for a health care provider who might numb her. Nelson marvels at her own inability to sort the wheat from the quacks, “how the intensity of my desire to get out of pain,” as she puts it, “vies with my intelligence.”
Various aspects of the pandemic, let’s face it, made us stupid. Some conjugation of fear and desperation, perhaps, retrained the most critical minds on the promise of one neat medical fix, not just for the spread of the virus, but for every problem––social, political, intimate, psychic, artistic, whatever––that the virus had merely worsened. In the early days of COVID vaccination, Nelson would like to be a “supermom going to vaccinate my child after all this time to protect him and make everything ok.” She would also like the constant ache in her facial joint to be solved by a five-thousand-dollar dental appliance, antibiotics from a Lyme doctor thought to have treated Amy Tan, “unthinkably subtle touching” from a bodyworker, or clairvoyant reckoning by the bodyworker’s guru. Nelson feels occasional shame at her own half-credulous exploits, at her diligent catalogue of pain made to interest professionals whose interest is only in her money.
Fortunately, we do not have to read the medical record to which the book’s title refers. The book itself is not, as its subtitle tells, a history but a story, built—like Nelson’s 2015 memoir, The Argonauts––around anecdotal fragments. Scenes of early-morning “bite-check” rituals and trips to various dentists accumulate among snippets from Nelsons’s marriage, from the pandemic, and from the end of her time with Crosby. Rather than showing us her mouth for diagnosis, Nelson lets us play analyst with her free associations around it. The book’s accounting of pain is sprinkled with Nelson’s recapitulations of her dreams. If that sounds potentially worse than reading someone’s medical record, Nelson sees that it is all in the telling. It’s not the dream that matters, she insists, crediting Freud, but the words you choose to externalize your mind. Like her formal influence Hervé Guibert, whose The Mausoleum of Lovers remakes the “journal” as a merger of waking life and nocturnal fantasy, Nelson gives us an imaginative hinterland through which we might begin to get to know her mouth and its discomfort.
This gets us far from mere diagnosis, which demands that we reduce the events of waking life to possible causal “factors.” In her diligent medical document, for example, Nelson has listed, in flat, universalized forms, those life events she thinks “might prove key” to her pain: “perimenopause, domestic stressors, the literal and symbolic role of the mouth in the life of a writer.” As though to atone for this linguistic betrayal of life’s infinite depth and variety, Pathemata gets creatively digressive. We may be stupid in life but in our making of dreams, Freud thought, we are each a kind of genius.
To know about Nelson’s mouth, the book proposes, we must know about her memories of childhood orthodontics, designed to correct her “tongue thrust,” identified by adults who felt the girl spoke to excess. We must know about her dreams of phosphorescent teeth as punishment for keeping dark secrets. We must know about her fantasies of having her tongue rip free to produce such extraordinary speech that only “like-tongued people” might hear her echolocate. Perhaps we must even know about seemingly unrelated bogeymen in Nelson’s sleeping mind: a Victorian Kewpie doll wearing a mustard-colored dress, a “stringy mound” of pubic hair visible through its fabric.
Then there are the wells of interpretative context that exist beyond the bounds of Nelson’s mind and mouth. There is the mouth of the other––here Crosby’s again––metal bars across its roof. Did she never complain of pain in this zone, Nelson wonders, because it didn’t actually hurt there, or because she simply had more pain everywhere else? There is the fact of a COVID winter—a somewhat collective pain “caked in griminess and fear and death.”
The sheer breadth of matter that Nelson takes to constitute the “story of her mouth” is fitting for a book that claims the philosopher Gilles Deleuze as a conceptual guide. For if artists are symptomatologists, as Deleuze claimed they were, this is not to say they are experts in their own clinical cases, nor indeed with any specific ailment; rather, as he put it, “they are clinicians of civilization,” placing pain in new imaginative and meaningful contexts. The artist’s genius, thought Deleuze, was to take ordinary events, like “eating, shitting, loving, speaking, or dying” (very Nelson themes), and to extract from their mere physicality some metaphysical truth.
Nelson occasionally falters as a clinician of civilization. This is not simply a matter of her avowed disinterest in diagnosing crises or prescribing political solutions. This, as she put it in her 2021 book On Freedom, is “not [her] style.” Her style, she said, was to “bear down on felt complexities,” to encourage a “greater tolerance for indeterminacy.” The problem is in how the commitment to “indeterminacy”––about social norms, politics, and morals––tends throughout Nelson’s oeuvre to obliviate, rather than nuance, any understanding of power. In On Freedom, Nelson’s commitment to the “indeterminacy” of art’s moral status saw her scold the belligerent “left” for protesting works of art. In the process, she mounted an inadvertent case for rich and powerful artists’ moral unassailability. At the opening of Pathemata, Nelson’s—arguably worthier—target is a set of “ex-prosecutors,” whose thoughts and dogs and vagaries she tracks each morning on Twitter. She “marvel[s] at their ease with moral language––this, after years of putting people in cages.” In other words, she comes for moral language even as she rightly deploys her own. Presumably, Nelson does not wish to imply that caging is morally complex. Meanwhile, little complexity is granted to the “febrile seeming assholes” she encounters in a suburban medical clinic––“assholes reading their phones with their masks hanging below their chins.”
It was only in reading Pathemata that I came to understand this recurrent hitch in the work as a matter of style as much as logic. Nelson’s writing, after all, is endemically, perhaps even quintessentially, humorless. This is not me being a dick; the author points it out herself. In a rare post-5 am doze, Nelson dreams she has written “a book with the word Pensées on the cover in cursive pastels.” “I wake up delighted,” she tells us––“I finally wrote something funny.” (Even then, did she?)
Why should humor matter to how we minister to civilization? Because it is one of very few means through which our partial claims––cloaked in indeterminacy or otherwise––can have their effect on others tested. To write with humor is to expose your big theories to ridicule as well as recognition. And recognition, when it latches onto humour, is affirmation earned. There is, granted, a fundamental comedy in Nelson’s portrait of a woman seeking answers, a woman who won’t let her own mistrustful feelings or self-described “formidable” mind get in the way of a good farce; and yet at every point of imminent humor, Nelson hits us with a righteous defence. It feels reckless, she admits, to fly to San Francisco to see a man about a disease she does not believe she has. “It feels reckless,” she writes, “but the pain keeps demanding an answer.” When she tells us it is only in “the good script” that she, the vaccinating supermom, is going to “make everything ok,” we might expect “the bad script” to offer a reflexive alternative to this delusion. Instead, when it comes, it is merely an extension of “good script”: supermom plus baddies. Disorganized medical clinics getting in the way, febrile-seeming assholes personifying the threat.
Still, I read on, as I would not have done with most other humorless writers, undeterred, even delighted. For if there is also value in the intractable, the dogged, truly this author knows how to seize it when it comes to the question of feeling—perhaps not civilization itself, as it were, but its scars on the individual psyche. “I think to myself, I never feel well. I am never well. / Something is systemically wrong with me, maybe I’m systemically sick.” Nelson knows that the problem is not strictly with herself—why else would she write such a book?—but still sheis unafraid to dramatize the throbbing psychic damage of discourse. Nelson’s articulations of pain, of loneliness, of love may be borderline thespian at times, yet it is only through her unchecked commitment, not to the bit, but to the hyper-sincere, that we come into a rare kind of contact with that truth Deleuze described. After Crosby dies, Nelson tells us:
I can’t stop hearing C’s voice saying,
“Maggie, my dear Maggie.”No one will ever say my name like that
again––no lover, no parent, no husband,
no friend.
The way C knew me died with her; from now
on I will be less loved, less known.
How unreconstructedly self-focused. How horribly, frighteningly true.
The significance of our scars––threads of pain in the gum––are, as Nelson shows, infinitely ripe for exploration. She is brutal in displaying the extent to which pain most often exceeds human action. We can go about sharing our meanings, attempting to understand, if never quite the pain, at least each other. Then we lose each other, too, watch our fathers carried away under tarps, our marriages cracked, our friends reduced to a labored rattle of breath. In Guibert’s The Mausoleum of Lovers, the writer describes, at the grocery store, a loquacious old woman . . .
who proclaims suffering, who enumerates all the places, and all the circumstances, on which roads she has inflicted herself: Nazi Germany, Cambodia, etc., and she leaves whispering: “All that suffering!” and follows, very amicably, with a “good-bye ladies and gentlemen.”
Perhaps we should be grateful that Nelson is not so wry with herself as Guibert cannot help but be with this woman, that she is unprepared to slice her own pain in half with humor. For Nelson, like the loquacious woman, sees no need for moderation with respect to the facts as they are lived. It may well be true, she understands, and as a dentist declares, that after three years of torture, nothing physical, observable, or measurable has actually taken place in her mouth. Still, she has lived with the sense that this mouth “has been rearranging itself daily, catastrophically.” She is undiscouraged from styling this catastrophe at full Nelsonian pelt. Each morning, she insists, “it is as if my mouth has survived a war––it has protested, it has hidden, it has suffered.” Civilization might have us believe that pain, in order to be real, should be biologically traceable. But the artist, says Deleuze, is not just civilization’s doctor, nor its patient; she is also its pervert.
Amber Husain is the author of Replace Me (Peninsula Press, 2021) and Meat Love (Mack, 2023). Her forthcoming book, Tell Me How You Eat, is due out from Atria Books in 2026.