Jane Hartshorn explores the poetics of gender, illness and complex constructions of subjectivity beyond medical definition in Alanna McArdle ‘Voice’, published in Brief Encounters Journal, March 2020.
> In her essay ‘Voices in the Air’ Adrienne Rich describes waking after knee surgery, writing, ‘I was in the depression of spirits that follows anaesthesia, unable to sleep or to discover in myself any thread that might lead me back to a place I used to recognize as "I."’
> The experience of losing one’s sense of self within the medical encounter is one that Alanna McArdle explores in her poem ‘Voice’. However, the self that McArdle is attempting to recover in ‘Voice’ is not a cohesive one. Her ‘I’ is multiple, polyphonic, fragmented. Here, the ‘I’ is not a solid place of self-knowledge one can return to, but a shifting landscape of interwoven threads that interrogate the notion of selfhood itself.
> Elaine Scarry writes that pain can be ‘self-modifying and, when most successful, self-eliminating.’ Although she is referring to physical pain, I believe this extends to the experience of psychological pain – all pain is felt. Self-elimination in the face of illness is one that McArdle grapples with throughout the poem:
Imagine your body as a cloud whole entity made from vapour and vapour made of shards always collapsing and rebuilding itself shredding your fabric.
The processes of ‘collapsing’ and ‘rebuilding’ the self are inherent to long-term illness. Rather than existing on a linear continuum, the self is trapped in a never-ending cycle of improvement and deterioration, of re-birth and decay.
> The narrator refers to themselves as a ‘collage’, writing ‘I am not a whole person, I cry, I / am just bits and pieces’. Illness is a disruptive force that makes it very difficult to hold onto a concept of the self as whole, as a container. It becomes a permeable construct, a fragile membrane that is subject to external forces. Illness decentres the self; the self moves in relation to what can sometimes feel like an external ‘other’.
> This fragmentation of the self is only compounded by the medical encounter. When a person becomes sick, they are expected to give themselves over to the care of a health practitioner. Arthur Frank calls this a ‘narrative surrender’, writing ‘the ill person not only agrees to follow physical regimens that are prescribed; she also agrees […] to tell her story in medical terms.’ The doctor becomes a medium between the patient and their body, interpreting symptoms as symbols for diagnosis.
> Medical language also alienates the patient from their body. It is a specialised discourse that excludes the patient. The patient’s lived experience of their illness does not always appear in their medical notes. In fact, there is often an absence of person. The patient is reduced to their body, to a collection of symptoms.
> McArdle attempts to articulate her own lived experience of illness, reinstating her agency as a subject. However, this is not always a simple process: ‘And what do I mean / when I write it down like this spill into existence / or out of it’. Perhaps the very act of writing about one’s experiences can be considered as an act of othering itself, of drawing a line of separation between self and illness. In a kind of mirror-image of dissection, perhaps it, too, can be regarded as an objectification of the subject.
> The struggle between medical authority and selfhood is evident throughout the poem. Lines such as, ‘Here is the failure of language / Who is describing me this time and what do they mean’ are indicative of the narrator’s inability to self-define. This search for meaning is woven throughout the poem; the narrator’s selfhood evades definition, slipping between meanings, demonstrating the futility of trying to control a body with language.
> And what happens when the body resists the medical professional’s attempts to diagnose? What if there is no visible evidence of the patient’s pain? Patients, particularly female patients, are often treated as unreliable narrators. ‘What can I say, maybe I’m a liar / for many, mentally ill is a synonym for untrustworthy’ reveals how difficult it is to speak on behalf of a body that hides its secrets, as well as illustrating the disbelief and scepticism that many people with invisible illnesses face.
> The narrator as unreliable permeates the patient-doctor relationship. Within a patriarchal medical establishment, women have often been labelled as hysterical, or of exaggerating their pain. McArdle acknowledges this implicit gendering, writing, ‘big box of Man-Size Kleenex for my / girl-sized tears / (good , good girl)’. The ‘girl-sized tears’ emphasise the false perception that women are more prone to emotional outbursts, and is related to the role of the ‘good patient’. ‘Good girl’, the doctor tells her, praising her for keeping her emotions under control. This infantilization is seen elsewhere in the poem, for example ‘I sit on a squeaky pink chair in a room pasted with children’s drawings’. The good patient is passive and compliant, and does what she’s told.
> In some instances, the patient can be subjected to what feels like a kind of medical gaslighting, where their concerns are consistently undermined or brushed aside. This doubt infiltrates the narrator’s own attempt to self-define: ‘I thought my memory was faulty.’ In a reversal of roles, McArdle subjects the medical professional to the same kind of scrutiny. ‘I can’t relax / I don’t believe them’, she writes, and, elsewhere, ‘Sister, / sister, / I’m scared to tell you / how I feel’. This breakdown in trust characterises a medical establishment that does not always listen to its patients. The bond of trust between patient and doctor is a fragile one.
> Confessional poetry is often similarly gendered, and described as an emotional outpouring. Jennifer Ashworth writes, ‘confessional writing is a way of spilling your blood on the ground and, like a public disembowelling, it certainly risks disgusting your reader.’ Often described as memoir, or diary-esque, it can be considered self-indulgent and less cerebral than other genres of poetry. Messy, and summoning the stickiness of bodily fluids.
> However, the confessional is more complicated than it’s given credit for, and ‘Voice’ plays with the ‘I’ of the poem, presenting its shifting perspectives, for example, ‘Do you try to deplete something / in yourself / the therapist asks’ is quickly followed by, ‘But really she doesn’t she / never asks anything so relevant’. The ‘I’ of the poem is polyvocal, speaking as both the patient and the medical professionals who seek to help her.
> Judith Harris writes that ‘confessionalism seeks to break the silences that encode, censure, and censor private and public truths.’ This is particularly important in cases where the ‘I’ has been oppressed due to patriarchal structures, such as the medical establishment. In order to resist marginalisation, it is important to give voice to the experience of the patient, even if that voice is self-questioning and contradictory.
> In ‘Voice’, McArdle challenges the authority of the medical voice. She manages to move seamlessly between voices – her own voice, the voices of medical professionals and therapists, and the voices of friends and family. She does not speak from one perspective, but many, thus complicating the very concept of the ‘I’ as a fixed place. The poem ends with the lines, ‘I’m not quite / feeling like myself today / I’m not quite feeling today’, encapsulating this place of uncertainty, of existing between-states that illness can incite. Although the self in ‘Voice’ is destabilised both by illness and the medical encounter, perhaps the idea of selfhood that McArdle describes – as fluid, porous, and multi-faceted – can be used as a model for understanding the complexities of identity. In the same way that health and illness are inextricably woven together, perhaps identity too exists not as a place one can return to, but as ever-evolving, temporary and fragmented states of being.
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Text: Jane Hartshorn
Published: 21/8/20