37. Karma, Vali, Shakti

Fibromyalgia has no known etiology in Western medicine, but Tamil-Hindu belief configures an implicit etiology of imbalances, impurities, and the erratic incursions of deities and ghosts. For most of my childhood, we didn't live near temples and weren't practicing Hindus, but Appa and Amma observed their faith in Batticaloa and in New York, where temples were nearby. Amma's grandmother fire-walked at Kali Kovil; her sister experienced pey pidichittu, being caught by the goddess, and had to stay at the temple for two weeks. Both my parents believed. We designated a sacred space for a saamiyarai, a home shrine, at which we worshiped deities like Pillaiyar, St. Anthony (a reminder, perhaps, of my parents' having attended schools in Batticaloa founded by missionaries in the 1800s), and Sathya Sai Baba (who called himself the man who was god), thus maintaining a cultural-religious identity as Tamil-Hindu while assimilating into U.S. society.

In all our houses, our saamiyarai was in Appa's home office, where I'd do my homework on the computer. The gods themselves occupied the top shelf of a wooden bookcase. It seems not uncommon in the Eelam Tamil diaspora for the shrine to be kept near a desk or bookshelf, to remind second-generation children of cultural and religious values while studying (Ratnam, 2020, p. 127). I existed "in-between" American and Tamil identities, negotiating language (Tamil spoken to me, while I responded in English), dress (Western, though we wore pottus as children and I, an unmarried woman, pierced my left nostril in college, unintentionally in keeping with the Ayurvedic association with female reproduction), diet (mostly Eelam Tamil cuisine), and worship (Pillaiyar, Murugan, Gopala-Krishna).

I say all this to note that, while I consider myself agnostic, I assimilated the values of my parents' religion and can't easily separate my interpretive frames from it. While my Eelam Tamil Hindu parents instilled in me acceptance, stoicism, and "an aesthetics of smooth surfaces" (Desjarlais, 1992, p. 77), I acquired American dispositions and aspirations that challenged these frameworks. For a time, a socially inculcated apathy towards white privilege in society, white skin bias in medicine, and the destructive legacy of colonization, coupled with antagonism towards Tamil-Hindu values coded by Americans in Orientalist terms, as oppressive, primitive, exotic. A loss of connection to land and language. Self-assertiveness in professional and clinical encounters. A willingness to take "shameful" disclosures public. Skepticism towards those in power. Overt sexual expression. Edges in place of softness. Entropy in place of equilibrium.

Isolated from Tamil diasporic community as we were, it was easy to conflate my parents' insistence on the preeminence of my Tamil-Hindu identity with overbearing parental authority, not cultural identity, and make this the central grievance in my cliched teenage rebellion. In the college towns where we lived, we didn't have the local Tamil Sangams — organizations promoting the culture, arts, and literature of ethnic Tamils — that cities like Toronto, London, or Oslo have, rendering my parents the sole arbiters of my culture.

In the Hindu tradition, chronic pain is the debt of karma incurred by previous mental, verbal, or physical acts committed in previous incarnations. I grew up knowing this in our home shrine every day and find it again in Whitman's (2007) research on Hinduism and pain management. Hinduism does not view chronic pain as punishment or random affliction, but as a just consequence. As in The Bhagavad Gita, pain does not affect the embodied self, though I don't always agree; more in the veins of Malabou's (2012) ontology of the accident, chronic pain is an eternal self-destruction, an eternal becoming, an eternal return to a no longer recognizable room. An eternal gaslighting. A never-ending game of murder in the dark. The fruit of one's karma.

Western medicine focuses on control: decreasing problematic — that is, non-normative — sensations, thoughts, experiences, feelings, in order for the patient's condition to improve. It insists on results. Hinduism takes an acceptance-based approach. This does not mean passivity so much as understanding, like Arjuna had to while bracing to kill his relatives and friends in war, that the Self is indestructible and eternal and, ultimately, impervious to pain, which is a temporary feature of the world of suffering. Recognizing this encourages an even disposition in the face of happiness, misery, pleasure, and agony (Whitman, 2007, p. 609). Then, for the Tamil Hindu chronic pain patient, physicians should actively manage pain but remain detached from outcomes. Accept it as a state of being. Accept palliative care with an open heart. Attend to the present instead of being consumed by the future or by past karmic debts. Let moments of failure — frustration, passivity, fatalism, self-pity — become opportunities to study the self. Lessen the desire to cure chronic pain. Instead, listen to it without judgment, without going mad, without going to war with its behavioral changes. Above all, do your best.

Some of this is suggested by interviews with pain management specialists on News7, but none of my physicians, or my parents' physicians after immigrating, have been Tamil Hindu. Most of mine were white. Those who came closest to an acceptance-based approach include: Dr. Birnbaum, Jewish American and haunted by her parents' memories of surviving the Holocaust; Dr. Jiang, Chinese American; Dr. Zagara, of Middle Eastern descent. In the ER in 2014, Dr. Sattva was South Asian, invested in my survival and attendant to my narrative. At the other extreme, Dr. Tamas, a South Asian woman, seemed to expect silent, stoic endurance — detached acceptance when problematically taken to extremes.

Obviously, as Whitman (2007) also acknowledges, this way of being doesn't apply to everyone. But even in non-religious pain literature, acceptance has been found to be the superior coping mechanism (Hayes et al., 1999; McCracken & Eccleston, 2003). Control-based approaches seek to cure pain, by reducing problematic thoughts, experiences, or feelings about states of pain, but the core concept — that the pain will pass — is incongruous with the chronic pain experience (Morris, 1991, 1998, 2000). We still imagine fibromyalgia as a pain that will get better, if we could only get a picture, and validate it, and curb its contagion, because in our limited constructions of pain as an acute biochemical phenomenon, to live in eternal pain is unthinkable. But acceptance-based strategies attempt "to teach clients to feel emotions and bodily sensations more fully and without avoidance, and to notice fully the presence of thoughts without following, resisting, believing, or disbelieving them" (Whitman, 2007, p. 611).

In Hinduism, everything that will happen is already determined. There is a prevailing Tamil belief in destiny, and the proverbial belief in thalaiyeluththu, the script written on our heads when we are born, recording in detail the course our lives will take (Daniel, 1984, p. 4). It is a history predetermined by the actions of a former state of existence.

The moment I repudiated allopathic medicine's control-based approach in favor of Hinduist acceptance, I could be at home in my skin once again. As Dolphin-Krute (2017) puts it, the chronically ill body "holds out hope for a being better" (p. 72) instead of a getting better, a return to the pre-illness self. Like Shiva with Halahala in his throat, there is no going back, and it isn't the end of the world; in fact, it is literally balance-renewing.

Tamil myths are like this, always doubly signifying, full of figures in the carpet. To speak specifically of pain, the Tamil word vali/வலி means "pain" or "ache," but this word is also the root of another (valimai/வலிமை) that means "power," "force," "strength." Even if the specific word was rarely referenced at home, the notion that strength is derived from pain — not in the Western sense of suffering breeds character, but because pain and power coexist as intermingled — was an infectious one. In her ethnography of childbirth in Tamil Nadu, Van Hollen (2003) examines the biomedicalization of reproduction through the lens of vali, finding that, in contrast to Western trends in medicalized childbirth, where women routinely use analgesics like epidurals, in Tamil Nadu analgesics are an unaffordable luxury and are also culturally questionable. One of her female respondents says, baffled, "When you are grinding, it is only if you go on grinding and grinding that you will get a good paste. Like that, without pain how will you deliver a baby?" (p. 119).

The cultural forms and aesthetic values evoked in this statement seem to be the Samudra Manthana, a millennium of churning for divine knowledge and immortality, and the story it contains about Halahala and shakti.

Tamil Nadu is not the same as Sri Lanka, but they share cultural overlap, so Van Hollen's (2003) analysis of why women in rural Tamil Nadu demand to be induced — increasing the intensity of their contractions — without attendant pain relief is significant. Biomedicalization in Tamil Nadu hasn't eliminated discourses of vali or shakti, but the two have absorbed each other, creating contradictory discourses of pain, womanhood/motherhood, and power. Linguistically, vali refers both to a sensory experience of pain and its function, with no distinction made between these two aspects. Piracava vali, which translates to labor pain, then, means both the pain of delivery and the contractions that lead to birth; thus, stopping the pain is like stopping the birth.

To be a (re/productive) Tamil woman is to possess shakti, the activating principle of the universe. Shakti, creative power and endless change, a uniquely female regenerative power, is located primarily in women's reproductive capacities (Van Hollen, 2003, p. 119). As with the most powerful sages, self-denial produces tapas, proportional to the duration and intensity of the suffering. Tapas is a currency expendable only in sacrifice, another form of self-denial. Van Hollen (2003) sums it up as, "the bodily experience of internal heat from self-inflicted suffering as well as the power derived from that heat. This power can sometimes be visionary and bring the sufferer into contact with a divine world" (p. 119). In childbirth, tapas is accrued through oxytocin-induced contractions without analgesics; enduring this pain increases shakti and improves the likelihood of a strong child. This may even be perceived as necessary, because "one result of the degrading effects of modernity on women's bodies, so these arguments go, is that women's threshold for tolerating the pain of childbirth has diminished" (p. 122). These arguments parallel those made in Europe and America during the 18th and 19th centuries, equating a high tolerance for pain with "savage man" and increased sensitivity with the "civilized races" and upper class (Bourke, 2014).

Van Hollen (2003) concludes that many rural Tamil women perceive epidurals as necessary now because "modern" women's bodies have become fundamentally different: more used to leisure and technological intervention, no longer working hard until the moment of labor, today's women can no longer tolerate the pain of childbirth without anesthesia. "These discourses among women in Tamil Nadu reflected a kind of class critique and a critique of 'Western' modernity, their implication [being] that because of modernity women of all socioeconomic classes no longer had as much sakti as they once did" (p. 124). The concept of shakti facilitates the discursive construction of Tamil women as powerful, noble, and valiant — even as paavam, which signals the power of martyrdom and a pitiable creature in need of comfort — but these constructions often perpetuate their subordination (p. 121). Women become restricted to reproductive roles, housework, and emotional labor, and misogyny is endemic in South Asia. Furthermore, in Tamil Nadu at least, even though labor pains are represented as noble, women in labor wards may be derided or even struck when they scream in pain, encouraging conformity with an "aesthetics of smooth surfaces" (Desjarlais, 1992), which in Tamil we might call asingam, meaning impure, polluted, or unseemly (Van Hollen, 2003, p. 132).

This too looks like stoicism, but the rationale for this self-control stems from the fear of disturbing social equilibrium (Van Hollen, 2003, pp. 129-130). Perceptions and outward expressions of pain may act to limit tissue damage and the possibility of damage to reputation or social relationships (Singh, 2018). However, whether laboring women are screaming or silent, their shakti is never in doubt, for the experience is known to be a painful one. The Tamil woman body is irrevocably linked to postcolonial, biopolitical state interests, such as population control in Tamil Nadu, and Tamil-Hindu discourse around maternal suffering can perpetuate women's subordination. However, the biomedicalizing of shakti offers women control over the administration or withholding of drugs that produce or reduce pain, ascribing more or less shakti to them, along with more or less social power (Van Hollen, 2003, pp. 22).

In the Hindu tradition, pain is not redemptive, and corporeal self-denial or self-flagellation does not yield a state of grace. Though it may be divinely inflicted, pain is often constructed as undeserved; curses are spat too strongly and then mitigated, as they cannot be repealed. Sufferers are given the chance to atone but reap the rewards in their earthly life. After all, for us, there is no afterlife, just life upon life and the quest to attain moksha and be liberated from samsara.

Where Euro-Western biocultural approaches are employed, the cultural and religious referents are Euro-Western, given that I'm a U.S. citizen and English is my first language, discounting the ways in which second-generation immigrants are raised in households that balance assimilation with maintaining a cultural-religious identity. In many ways, this project attempts to address this balance, by articulating the aesthetic experience and understandings of pain that emerge from encounters with the (Eelam Tamil) home culture and the received (American) culture, not as two separate frames of reference, but as a hybrid culture that blends and exceeds both. Culture comprises dispositions, collective memory, aspirations, and aesthetic experience and is negotiated among members of an in-group — my nuclear family alone, in this case — and in relation to outsiders. We construct borderlines based on perceived differences and similarities in worldview, redrawing these borders as called for by particular social circumstance (Bourdieu, 1977/2013).

Having a Tamil Hindu upbringing my suffering differently, as suffering that is and isn't suffering, that is world-shattering for self and yet carries the potential to shake the heavens. It's invisible, but with regards to shakti, does it matter if others know it or not? In New York clinics in the 1980s, Amma gave birth to my nondisabled younger sister without an epidural, but she had one for me because I was induced. A framework of aesthetic experience might suggest, rather neatly, that when my sister was born, Amma generated tapas by enduring piracava vali, thus increasing her shakti and the likelihood of having a strong child. During my birth, oxytocin alone might have guaranteed Amma's shakti and my strength, but the epidural meant she yielded to the depletion of modernity (though one might contend that modernity's "degradation" of womanhood is what necessitates an epidural to begin with).

But can it be said that I am born weak as a result? If unmitigated vali increases shakti, then did Amma make the right biomedical choices with me, for me to have been born with fibromyalgia in my thalaiyeluththu? Sensitized to pain as I am, what do I inherit from having this story narrativized to me?

It's problematic to pose modernity as diametric to tradition, to say science and technology are modern/foreign and the ritualized, mythic, and organic are Indigenous/native. Like Bhabha's (1994) third space, a hybridized cultural discourse emerges. Van Hollen (2003) asks, "if women were previously constructed as powerful because of the long drawn-out pain they experience in childbirth, what happens to that power when the pain is short-lived and no longer naturally produced?" (pp. 139-140). Moreover, what happens to that power if pain itself diminishes her reproductive potential, if she is childfree by choice?

Represented as both benign Parvati and destructive Mahakali, the regenerative power of shakti is predominantly associated with motherhood but is the unchecked, chaotic, pure energy of the cosmos. If a woman exists in a volatile state of chronic, incessant pain, destructive and generative, emerging naturally and resisting control, how powerful can she become? At what point — like a Mahakali, or a Vishwamitra or Ravana — does she become so terrifying that the gods themselves become afraid and must trick her into wasting her potential?

Knowing this about my birth empowers me to look for patterns. To reconfigure this connection not as purely reproductive or as the compensation disability myth, in which the disabled individual transcends their limitations through a special talent (Dolmage, 2014), but as forms of cunning resistance, in ways that enable me to accept my way of being.

If women are considered the prime embodiment of shakti, and shakti is the activating principle of the cosmos, and shakti is tightly coupled to willingly, willfully endured pain, then pain is divine energy; pain (re)makes the world. ↩