68. Slipping the Trap

The dimension of embodiment is often overlooked in the doctor's office unless it is visible, but the ontology of fibromyalgia is one of perpetual becoming through unpredicted, cunningly anticipated, or accidentally or intentionally inflicted corporeal disruption. The management of continuous corporeal disruption speaks to our preconscious capacities for posture and movement, as demonstrated by Steve Paxton's "small dance," the body's incessant and creative "adjustment of orientation, alignments, contractions, relaxations, and balancing" (Dumit & O'Connor, 2016, p. 35). The kaleidoscopic constellation of cunning I've assembled here provides a framework for understanding how the fibromyalgic subject plays with (or stills) the small dance to comply with biomedical expectations and the middle-class revulsion to pain. Deft, cunning use of the small dance can earn treatment while necessitating alternate modes of assessment and reorganizing the sensory hierarchy, thereby challenging the massified practices of chronic pain treatment.

Siebers (2004) reflects on how public claims to disability must be supported by visual evidence, like mobility aids, disfigurement, or obvious physical impairment. He acknowledges that disability passing, or concealing disability to look like a normate subject, effectively points to the stigmatized disability identity as one that no one would voluntarily want to assume. It preserves social hierarchies by presuming that disability is lower-class and that disabled individuals desire to rise to the top of the social hierarchy. At the same time, Siebers offers a tricky "third thing," a strategic, fluid position that defies easy categorization: the disability masquerade, "an alternative method of managing social stigma through disguise, one relying not on the imitation of a dominant social role but on the assumption of an identity marked as stigmatized, marginal, or inferior" (p. 5). Disability masquerade uses private and public space for political ends, exposing false presumptions or making strategic use of them, tinkering with the social meaning of a particular disability and disability as a category (pp. 9-13). Unlike passing, disability masquerade makes disability "overvisible," performing or exaggerating stigmatizing difference to expose and resist social prejudices, such as a misapplied or absent prosthetic or an exaggerated limp (p. 19).

Misability takes a cue from disability masquerade, as both rely (albeit to different degrees) on others' misinterpretations and biases to legitimize accommodation and treatment.

Non-apparent except during flare-ups, fibromyalgia already passes, and fibromyalgic disability masquerade merely looks like the expression of acute pain. Fibromyalgic fascial cunning must visibly evince different experiences of pain in different locations, from trigger points to the meridians of referred pain, to confuse the biomedical and social norms defining pain long enough to reveal those definitions as arbitrary. It must balance an expression of pain intense enough to signal bodily crisis with bourgeois taste and decency. Fibromyalgia masquerade must be "overvisible" and "civilized" to keep the physician engaged in the quest for personalized treatment. It is a composite performance intended to appear contradictory and surprising to create the conditions for kairotic transformation, such as costuming to appear nondisabled while expressing pain in fascial position-states and vocalization; or using a cane but breaking out into an exaggeratedly hobbling run to cross the street; or coming from work but dropping the head, hunching the shoulders, rounding the back, tensing the hips, to look small, forlorn, and immobilized by my own fascia.

When the stethoscope is deployed, I breathe extra deeply to exaggerate the gurgling noise my abdomen makes when my diaphragm expands, to surprise my doctors into admitting that I'm viththiyaasam — an anomalous body whose anomalies don't always bear pathological significance.

Disability masquerade calls attention to the disabled organ. Fibromyalgic masquerade must take the whole body as the disabled organ and enact it in a way that insists that the entire body is afflicted. As such, fibromyalgia masquerade centralizes fascia, the lubricating and supporting membrane that envelopes and interpenetrates the whole body, an "active, intelligent, communicative, and sensory organ; sometimes three, sometimes many and sometimes one, liquid, solid, and mucus" (Dumit & O'Connor, 2016, p. 36). Fascia is the only whole-body organ and may be critical to managing fibromyalgia, but it's invisible to biomedicine. The mechanical techniques in Gray's Anatomy captured fascia as a prominent organ, but modern-day clinical textbooks and pedagogy present fascia as an irritation — an organ to be cut through, a barrier between the surgeon and the treatable body, not a treatable organ in its own right.

These descriptions of fascia echo descriptions of cunning: a polumetis, poikilometis, kairotic, empathetic, irritated and irritating somatic intelligence, as invisible as the invisible illness to which it belongs.

Its absence in modern anatomy texts is a particularly significant exclusion that has inhered in social and cultural norms. Until recently, fascia was considered the scraps of cadavers and the provenance of alternative therapeutic practices like myofascial massage, rolfing, and movement training. These therapies foreground touch to transform the fascia at the cellular level and recuperate its potentials. They challenge the Western anatomical vision of reality as musculoskeletal, a concept that emerged after dissection revealed muscularity as the agent of structure and function and was documented as such by Galen and Vesalius (Inanici & Yunus, 2004). Fibromyalgia is considered a rheumatological disorder, a musculoskeletal disease, but evidence suggests that fibromyalgia is fascial in origin. Unlike joints and muscle, fascia possesses continuity, nervous system investments, and vascular relationships throughout the body. It also heavily influences functional unity and is impacted by processes such as habitual sitting posture, stress, trauma, and surgical intervention (Myers, 2009; Schultz and Feitis, 1996; Schleip et al., 2014).

If fibromyalgia is a disease of fascia, which can only be encountered through touch, it must be assessed not with the eyes, but by how the body feels.

Merleau-Ponty (1945/2012) recognizes that touch is extremely difficult to deceive, as contact conveys both form and content of reality around which other sensory meanings can occur, and that we should celebrate the function of the invisible. He notes that "the body is the vehicle of being in the world, and having a body is, for a living creature, to be involved in a definite environment" (p. 94), which includes ambivalent presences like phantom pain as part of the body's commitment "to a certain physical and inter-human world, who continues to tend towards his world despite handicaps and amputations and who, to this extent, does not recognise them de jure" (p. 94). In other words, the embodied world sets the conditions for our existence, and we experience the world as embodied subjects, largely through fascia that habituates our emotional and physical reactions and projects our future bodily responses. As such, fascia may be conceived as an "organ of form," changing to accommodate and memorize our habitual movements to reduce our expenditure of effort when we assume our usual postures, but also potentially trapping us in them (Rolf, 1989, p. 37). The postures encouraged by disciplinary power and neoliberal productivity imperatives, particularly wreak havoc.

Fibromyalgia causes a heightened interoception, or awareness of internal bodily processes like sliding, sticking, or pain in the fascia, leading to disordered pain processing. This can be read as a cunning tactile art that channels an awareness of postural "fishnets" and how our bodies become trapped in them, how the innumerable crises of modernity contribute to that entrapment. A reliance on peripheral sensing and high interoceptive sensitivity, characteristic of chronic pain sufferers, has been correlated with an increased ability to affectively and cognitively empathize with others (Grynberg & Pollatos, 2015). Empathy, a feminine quality of metis, can be thought of as the ability to "feel into" another. Fibromyalgic cunning urges empathy from its witnesses, compelling them to see and sense the body differently and, potentially, to retrain their own mode of being.

Weig (2020) reminds us that fascial slide is more integral to movement than muscle power, echoing trickster myths that pit slippery, oblique cunning against pure brawn. Healthy fascia is cunningly "intelligent": plastic, responsive, adaptive, with "indeterminate, generative qualities [that] encourage remaining open and attentive to the unexpected" (p. 96), a site of bodily intuition with a complex power to cunningly afflict, relieve, transform, disguise, and navigate. Fibromyalgia necessitates a close, intentional relationship with this organ that is both/and: liquid and solid, tissue and fiber, sliding and stuck, separated and interconnected. By familiarizing herself with the small dance of my fascia, Sara is able to locate my stuck places by touch. In 2014, her fingers and mine are able to intimately track the full shape of the hard, immobile, mass in my abdomen, well before a CT scan and ultrasound discover widespread inflammation. Thinking through the skin, paying attention to the "small dance," affords new ways of sensing to guide and complement the imaging procedure and to broaden techniques of therapeutic management (Dumit & O'Connor, 2016).

As a richly sensory organ that interfaces with the visceral body, the skin, and the external environment, fascia is the organ best equipped to deal with contingency and being in a threatening, unpredictable world made more unpredictable and threatening by fibromyalgia. Dumit & O'Connor (2016) suggest fascia models a "thinking in our edges," a peripheral, tactile intelligence that mimics the aspects of a feminine cunning invested in not only deception, antagonism, and evasion, but also in prudence, empathy, and (self-)care (p. 40). ?Fibromyalgic fascial cunning aims to reveal to the medical gaze how our bodies are physically random and mechanically disordered, as we unconsciously modify, solidify, or liquefy our fascia and preserve our postures and postures-in-action until forces alter them for us (Myers, 2009). This suggests that fibromyalgic assessment must be hands-on and tailored to the patient's individualized small dance. Made visible through masquerade, fibromyalgic cunning is a lived, embodied, ceaseless effort to "strip the civilized disguises from pain" (Morris, 1991, p. 118). To compile an evolving repertoire of ways in a pain-repressing world to feel and express both pain and numbness and dissolve binaries like stoic/weak, masculine/feminine, caring/apathetic.

As Fortunati (2015) observes, metis is more culturally instinctive for women, so women are more likely to possess phronesis when it comes to communication strategies and social masquerade to "make their message really incisive" (para. 15). Managing affects and emotions already inheres in the feminine labor of care, bestowing on women a cunning intuition about others' emotional well-being in the sphere of social reproduction. Women already understand that "emotions work like multipliers of energy" (para. 16); the fibromyalgic woman grasps without much struggle that emotions place costly demands on energy and can intuit how to coax energy investments out of others around them. As de Certeau (1980/1984) suggests, a minimum of effort for the maximal result. A scream on palpation, whether the patient would ordinarily scream or not, is pain cunningly made visible, offering physicians yet another clue in the puzzle of a so-called wastebasket diagnosis and attempting to further the disorder's acceptance and legitimacy. Fibromyalgic cunning further acts on language and secondary expressions of pain, awaiting the opportune moment to strategically express pain in ways popularly presumed authentic without extending it so long it becomes alienating under the humanitarian sensibility or the biomedical impetus to rehabilitate. This creates a generative connection between bodies, opening new avenues for communication, irascibility, and empathy, potentially affecting the form and space of all bodies involved and qualitatively altering their relations (Manning, 2007).

Attending to chronic pain is the phronetic practice of constantly attending to nerves, arteries, bones, muscles, the fascia whose slides and restrictions are imposed or undone by bodily habits and training, all acting in concert so that I may type this sitting upright, a posture that is more lively, dynamic, and intelligent than we think (Dumit & O'Connor, 2016; Hensley Owens & van Ittersum, 2013). Fibromyalgia is incurable, and fascia training doesn't try to cure it. It serves as a system of management that replaces the biomedical model of pain with a biocultural one that recognizes that both body and mind are implicated in sensory processes. This requires managing instinct, intuition, cognition, and close attention to the body to distinguish pains that signify from those that don't. Like metis, zhi, and thanthiram, this can't be taught; it must be learned as bodily knowledge, habituated like the fascia it seeks to make the visible locus of this form of chronic pain. But like upaya-kausalya, components of this disposition are pedagogical in nature and can be pedagogically transmitted.

Fibromyalgic fascial cunning, replete with Trickster's mimicry, accidents, and failures, resists biomedical categorization by intuiting and visibilizing pain vectors that lead the assessor to focus on multiple implicated organ systems, particularly the fascia. This action seeks to disturb the sensory hierarchy and the physician's phronesis that informs his assessment. Once the web of signification is divested of its allure, its terms become contingent and revisable, repudiating the fixed end to meanings that are vital to techniques of quantification and massification in favor of stochastic knowledge (Hyde, 2010; Sullivan, 1992). ↩