#36: On diagnosis
#36: On diagnosis
& the most invigorating live performance on YouTube
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Hello!
Welcome to my first Maybe Baby of 2021. At the end of last year I took a month off from writing and about six weeks off social media and am obliged to report I learned very little, almost nothing. But I was happy to be welcomed back to the internet by the bean dad discourse. It’s like I never left!
Maybe it’s unfair to say I learned nothing. I read a lot and took a lot of notes. I learned the puzzling definition of cupiosexual and read the seven-year-old Reddit AMA of double-dick dude (double-dick-dude?). I learned the definition of the word inchoate and then, humiliatingly, proceeded to see it everywhere. I even made three new spreadsheets, my favorite form of palliative productivity. But I can say with confidence that I expected to learn more—something tantamount to the Era of Enlightenment (1685-1815)—and consequently spent most of December wondering why I was coming up short. By the end though, like a good fable, my failures provided their own kind of answer, which will be the topic of this week’s newsletter.
My only caveat is I wrote this before MAGA rioters stormed the capitol, so you’ll have to forgive me for writing as if the new year was the most interesting recent turn of events. (Was it ever though?)
Assessment
When Covid numbers hit record lows in New York last fall, I booked a haircut with a hairdresser I’d never been to before. A few days later, I sat in her empty salon in the East Village, the door held open by a white t-shirt tied to a pipe.
Naturally, I was there to be transformed into a person I didn’t recognize physically nor emotionally. But from behind my mask, I wondered how she would unlock all my wasted potential via haircut if she couldn’t actually see me—my modest mouth, my bulbous nose, my gentle asymmetry. “Is it hard to cut hair without seeing your clients’ faces?” I laughed nervously. She assured me she was just happy to be back—a fair enough dodge—then asked to see a photo of me instead. For lack of a better idea, I pulled up a selfie from my Instagram that probably looked nothing like me. “Okay,” she said, as if patting me on the head.
In the end she was incredibly sweet, and I left with the best worst haircut of my life. Which is to say: an excellent haircut that is exactly what I asked for (a subtle shag) and which I incorrectly assumed I would love. I’m not one to waste too much energy on a bad haircut, but what’s unusual about a good bad haircut is its resistance to acceptance. How can something look great—exactly as it should, even—and yet also so wrong? For the first time in my life, my messy waves fell in bouncy ringlets. I looked like Farrah Fawcett if she lived in Bushwick. Lucky for me, I live in BedStuy and no longer socialize. I tipped big.
Of course, the haircut solved none of my problems. Instead, “lack of shag haircut” became merely another bullet point on my 2020 list of incorrect diagnoses—another feature of my life I was certain needed addressing. I blamed my depression on so many things last year it’s impossible to recount them all, but among them are my teeth, my left knee, going freelance, sugar, social media, Zoom, the space between the end of my bed and the wall—less than a foot!—Man Repeller, Mitch McConnell, Mark Zuckerberg, my failure to journal, my personality, my apartment, the DNC, decaf coffee, cops, my hair color, corporate activism, my credenza, the fact that I don’t own these specific Nikes. Obviously the pandemic reigned supreme and remains the rot at the foundation of my mental health, but when I break that down into its component parts—quarantine, masks, isolation, corruption, turmoil, death, closures, stasis, nothing being fun anymore—each had their moment of letting up and nevertheless I persisted (in feeling bad).
It’s fair enough to say I was depressed last year. Maybe you were, too. But the term never feels specific enough, does it? I felt a profound lack of selfness. A tedious volatility. An ambient sense that something beyond the obvious was very wrong, ever-present in my periphery and yet impossible to examine directly; my emotional nose. Despite this being one of the more benign consequences of the pandemic (the luckiest people were merely bummed), sadness has a gravity to it—it’s hard to ignore. I imagine this is a function of being alive. Unless we think it’s hot or making us hotter, humans tend to avoid pain. But there’s something distinctly current about the impulse to feel good all the time, too. Like WebMD but applied to everything, modern life under capitalism invites us to diagnose our problems and treat them as efficiently as possible. It suggests our unhappiness is necessarily solvable on an individual and ever-comprehensible level. And it’s mediated perfectly through the internet, where there are infinite suggestions on what we’re doing wrong, how we could be better, or who we might be if we were. It’s worth noting I saw the perfect shag haircut on Instagram.
And so, even if I understood—understand—the general thrust of my depression and that it’s currently unsolvable (pandemic), I struggle to stop trying. “It’s perfectly acceptable to feel low-grade misery right now,” my friend recently texted me, and yet that kind of acceptance feels anathema to everything I know about coping. It later occurred to me that perhaps my approach to addressing my problems had itself become the problem. And not in the Buddhist way, whereby you’re meant to embrace problems as a fact of life (although perhaps a little bit that), or in the altruistic way, whereby you address your problems by extending yourself to others, although that’s important too. I mean, instead, in a diagnostic sense. As if by becoming so hyper-focused on diagnosing the sadness, I’d failed to ask whether such a diagnosis was necessary, possible, or helpful.
Diagnosis
According to ethicist and philosopher of medicine CJ Blunt, the three primary purposes of diagnosis are as follows: 1. to understand what’s gone wrong and why (explanatory), 2. to predict what will happen (prognostic), and 3. to treat the problem (therapeutic). These make perfect sense to me, especially if thought of as consecutive steps. But Blunt points out there are many complications to diagnosis, making it just as much art as science. Some common pitfalls include deciding which symptoms are relevant; determining cause versus effect; and understanding the consequences of an incorrect diagnosis or treatment, i.e. properly vigilance might prevent you from prescribing Advil to treat arm pain, since the patient could be experiencing a heart attack and Advil can worsen heart conditions despite being an otherwise harmless pain-reliever. Does that make sense? I pulled that example out of my ass and it may or may not be medically sound.
In the emotional realm, I rarely consider such diagnostic risks. For example, I never considered that my chosen solution for a recent bout of anxiety (to quit social media) might deepen one of the conditions that caused it (isolation). Nor did it occur to me that examining my every dissatisfaction for clues to the source of my depression might serve as a multiplier rather than solution to it. As both doctor and patient, I unpack everything ailing me and attempt to treat it with anything that seems reasonably useful. I diagnose like I breathe. Much of my personal and cultural writing is likewise concerned with tracking symptoms to a source. We do X because we feel Y—I’m doing it right now! There’s something addicting to the semblance of control the format grants. A “maybe,” meanwhile, is just as frustrating coming from myself as from a doctor (this newsletter being my transparent attempt to feel otherwise). Obviously I’m more comforted by the clear-cut answer, the solution I—we—can act on immediately. Unfortunately, this doesn’t square with what I know about insight, which is that I’m most effective at cultivating it in hindsight, or over time as things change. This leaves me with the exigent question of what I’m meant to do when I have neither. Like say, now—going on ten months.
I asked my friend Jules (who is a doctor) what her first course of action is when a patient is experiencing symptoms and it’s too early for her to make a diagnosis. She said it depends on the stakes of treating, waiting, or guessing. She offered some examples: “If a patient has symptoms of a UTI, but the culture is not back and I want to make sure that I’m treating the right bacteria with the right antibiotic, I wait until I have a diagnosis and don’t treat the symptoms,” she told me. “If someone is suffering from chronic low back pain and I can’t find an organic cause, like a herniated disc or nerve impingement, then I just treat the symptoms. If someone has recurring dizzy spells that make them pass out and vomit, then I keep looking and testing until I understand what is causing these dangerous episodes.”
The strange quality of the pandemic is that its symptoms, i.e. consequences, have been both visible and invisible in the extreme. The number of articles I’ve now read that detail the effects of this crisis in very literal ways is just as high as the number I’ve read about how incomprehensible and unknowable it remains. “At no point in recent memory has grief been so widespread and yet so deliberately invisible,” writes Jess Bergman. We understand and yet we don’t. We miss everything we can think of and also things we can’t. We require things we cannot currently access and others we won’t realize we needed until we get them back. That last one I’ve been thinking about more and more—the sense that none of this will really make sense until months later. We have a collective UTI without the culture back, mysterious lower back pain, and dizzy spells making us pass out and vomit. By which I mean we understand the treatment for some of what’s ailing us (but can’t get it), can treat a few of our symptoms superficially (but not at the source, nor equitably), and can’t do a thing about the rest but sit around and vomit all over the internet.
Gestation
Fittingly, I came to similar conclusions back in May. “I think most of us understand, on a cellular level, that this time is and will continue to be one of endurance,” I wrote. What I meant to imply, I think, is that rushing to resolution mid-pandemic would be a fool’s errand. I just didn’t realize how hard it would be to resist. So I find myself here again, begging myself to just accept things for a while. To cease my attempts at self-preservation so that I might pursue a different form of it. One that looks less like diagnosis and more like observation. Waiting, even. It’s part-punishment, part-consolation, to return to the same lesson again and again. But at least I know I’m on to something, however indirectly.
What’s changed since May is back then I thought I understood what I needed and simply couldn’t get it. I didn’t really. If anything, last year taught me that, aside from my basic means of survival, I have a far looser grasp on what I need or want than I thought. Or at the very least, that the contours of it are far more abstract than I imagined them to be. There is an alchemy to non-pandemic life that makes me who I am, life what it is, us who we are, and it’s not as easy to define as hugs or coworkers or coffee shops. Obviously I feel this is particularly true of New York, but I’m sure you feel that’s true wherever you are, if not here. Maybe one day I’ll be able to put my hands around what it is. But right now it’s time to incubate, and trust that it’s possible to wait for something without knowing exactly what that thing is, or forcefully willing it closer.
A reader recently sent me a story by Lydia Davis called “What I Feel.”* In it, Davis—or the character she inhabited to write it—imagines what it might be like to discount her emotional state. “These days I try to tell myself that what I feel is not very important. I’ve read this in several books now: what I feel is important but not the center of everything. Maybe I do see this, but I do not believe it deeply enough to act on it. I would like to believe it more deeply.” It’s much easier to know something intellectually than believe it—like that you’ll be okay, or that it’s not your fault, or that answers will come. I imagine more religious people would call it faith. I don’t know if I have that, but I do trust the process, if I can just learn to better endure it, however unstable it makes me feel.
“What a relief that would be,” she goes on. “I wouldn’t have to think about what I felt all the time, and try to control it, with all its complications and all its consequences. I wouldn’t have to try to feel better all the time. In fact, if I didn’t believe what I felt was so important, I probably wouldn’t even feel so bad, and it wouldn’t be so hard to feel better.” And so my attitude going into 2021 is not as doctor or patient, but as curious onlooker. A long-distance runner with a blindfold on. A pregnant pause with a weird haircut. Or, in the words of Gail Walden on Twitter, whoever that is, “My new year's resolution is to see what happens.”
*You can read Davis’ full (short) piece here via this random Tumblr. I confirmed it was accurate in my copy of Davis’ collected stories.
Today’s Small Good Thing is this 10-second video by Cole Escola that is somehow the height of comedic genius to me.
“Far Out, Man,” a staggeringly beautiful essay by Sam Adler-Bell for SSENSE about doing mushrooms and experiencing oblivion.
The downright iconíque 2004 rainy performance of “Iris” by the Goo Goo Dolls:
(Please DM if you were there.)
“What Was Fun?” an essay I loved so much by Rachel Sugar for Vox about how the pandemic killed fun. It’s rare that a piece is deeply funny, gripping, and insightful at the same time. I was a little envious reading it.
The perfect Bollywood film Kabhi Khushi Kabhie Gham, i.e. K3G, which I watch with Avi every Christmas as per his family’s perfect tradition.
The core-shaking news that you can group your tabs in Chrome.
“The Last Children of Down Syndrome,” by Sarah Zhang for The Atlantic, about the collective effect of many individuals choosing to abort fetuses with Down Syndrome. I’m so glad I took the time to read this one—it was moving and illuminating.
The peek of artistic expression known as Bridgerton. I keep laughing about this tweet and the show’s penchant for covering pop songs via string quartet.
“The Downward Spiral: 2020,” Dean Kissicks stream-of-conscious art column for Spike Art Magazine, in which his lucid, unselfconscious writing never disappoints me.
The Sound of Metal, a movie starring Riz Ahmed that apparently came out in 2019 (?), which I profoundly loved. It’s been a long time since I loved a movie!
“Quarantine Brain,” in which E. Alex Jung attempts to describe the tenor of the internet in 2020 for Vulture, an impossible task he somehow made possible, like he always does.
The perfect gift from my brother: a candle made in Bug’s likeness by Janie Korn, which I’d die before I burned.
“Going Postal,” a brilliant piece by Max Read for BookForum about Twitter, Instagram, and their associated death drive. This is one of my favorite pieces about social media I’ve ever read (next to Dayna Tortorici’s “My Instagram”). Also loved Stella Bugbee’s “Our Shared Unsharing” for The Cut.
A torrent of welcome slander care of asking pudding.cool to judge my Spotify activity.
“David Fincher’s Impossible Eye,” a NYT profile I might have skipped until Jeremy Gordon named it one of his favorite pieces of the year. Jonah Weiner weaves together years of notes and interviews and the end result is completely immersive. I even rewatched Citizen Kane afterward, which I honestly believed I’d never do.
Five books I couldn’t put down:
Unspeakable by Meghan Daum
The Situation and the Story by Vivian Gornick
The Collected Schizophrenias by Esmé Wang
On Immunity by Eula Biss
Klara and the Sun by Kazuo Ishiguro“Is Substack the Media Future We Want?” a piece by Anna Wiener for the New Yorker in which I’m heavily featured. This is my first piece of big press, and while my inclusion has begun to register increasingly like a backhanded compliment as I think about it, I’m still flattered!
And finally….the perfect throw pillows, by SUAY.
Thanks so much for reading. If you’re a paying subscriber, Avi and I will be diving deeper on some of the above (fun, social media, tripping) in Tuesday’s podcast. If not, I’ll see you next week!
Haley
This month a portion of subscriber proceeds will be redistributed to Food Bank for NYC, the city’s largest organization focused on ending food poverty in the five boroughs.
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