40. Nadaippinam (நடைப்பிணம்)

I wonder if it matters that I write this on November 27, 2019, the first Maaveerar Naal1 (மாவீரர் நாள்) since Gotabaya Rajapaksa was elected president on November 16. He's a war criminal, often referred to as white van chief for all the white van abductions he ordered. On November 10th, in a Colombo press conference, a white van driver admits to torturing the disappeared, eviscerating them, and feeding the bodies to crocodiles.

That's it. That's the story.

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"Nohuthu," Amma gasps at the stove. "Udambu nohuthu." It's a daily refrain, preceded by air sucked sharply through the teeth and followed by a drawn-out ai aiyo, a catch-all word used in Sri Lanka for outrage, frustration, disgust, indescribable grief. Vali is normal in our household, and the ability to withstand it is socially constructed as a must. Tamil discourses of female pain hold that the languid lifestyles of modernity have increased women's sensitivity to pain, weakening their bodies and reducing their shakti to the point where inducing childbirth with oxytocin is necessary to increase vali, and by extension, shakti (Van Hollen, 2003). In my home, it's never as explicit a relationship as this, but it's perhaps due to this mindset that we never owned analgesics. Amma bemoans her body aches but does nothing for them. After knee surgery, Appa gasps aiyo and nohuthu and doesn't take his Vicodin. I pop my knee out and back during marching band rehearsal in 11th grade, endure the rest of practice, and limp to the nurse's office, where I'm called a trooper for my precise descriptions and lack of tears and refusal of Advil. My wrists and back have always hurt, but that was the first major pain event in my life. Neither the nurses nor my physical therapist consider the cultural dimensions of pain, gently mocking me for shrugging off NSAIDs, chastising me for putting weight on a limb that hurts. I'm sure they're baffled, but I am too. I'm implicitly taught, locally in my house and collectively as a people, that we withstand pain. I'm weak if I take them. Eelam Tamils know pain far worse than this.

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Halbwachs (1941/1992) describes collective memory as socially constructed by individuals in a collective that is enlivened by its integrated, shared memories (p. 22). It is the intertwining of individual memories and identity expressions integrated into the group that creates the foundation for collective memory and for culture. Collective identity is crafted through a careful process of sharing, comparison, negotiation, and construction. Hirsch (2012) suggests that postmemory, or the relationship of the "generation after" to the personal and collective trauma of the previous generation, is mediated by memory, projection, and creation: that is, we "remember" through stories, behaviors, and artifacts that are so profoundly felt that they feel like memories (p. 31-35). By directly linking memory and imagination, Ricoeur (2000/2004) argues that our memories may claim faithfulness to the past and a desire to shape self-identity in the present and future, but because imagination and memory are so closely linked, our memories are susceptible to distortion or to dodging recollection. Thus, we need an "other" to authorize the act of remembering. In this sense, memory — and the voices of the past it contains — shapes our identity as collective (p. 21).

"It was the universality of the body and of physical pain, first mapped in surgical theaters and in experiments on animals in physiology laboratories, that provided science and medicine with its authority to talk about traumatic suffering of the mind" (Young, 1996, p. 246). Embodied traumatic history appears towards the end of the 19th century, the result of Ribot's, Charcot's, and Freud's clinical studies of somnambulism, hysteria, and the "pathogenic secret," the memory so disturbing the patient suppresses it, though it continues to affect her behavior. The traumatic event appears in Western literature with accounts of railway spine, nervous shock, surgical shock, wound shock (Young, 1996; Geroulanos and Meyers, 2018). Violent injuries and violent emotions were thought to have the power to disperse the effect of violence on one part of the body to all parts. Fear, anticipation of repeating or reliving the event, the consequent life lived poised in uncertainty, "is simply an assault, comparable in its action to a physical blow or injury" (Young, 1996, pp. 248-249).

In her work on the commemoration of victims and survivors of atrocities in Sri Lanka, Orjuela (2019) notes that the memory of war and genocide is a physical, place-based fear and pain; the experience of suffering is materially grounded. My parents meant to return home but are thwarted by increasing ethnic tensions and war. So I am born, months after Black July, in New York instead of Batticaloa, into the Eelam Tamil diaspora, a collective that captures a sense of being displaced from one's homeland, left to long for it and worry about it and the people who live there. Diasporic existence is driven by postmemory, the link between past and present, the mode by which people maintain a sense of belonging to their homeland and their dispersed community. When the dispersal is compulsory and violent, this memorial glue emerges as a collective, intergenerational trauma around which a diasporic identity coalesces and is mobilized (Orjuela, 2019, pp. 1-3; Hirsch, 2012).

A few of my psychologists have explained to me that immersion in such a history, regardless of geographical displacement, can create secondary PTSD even in someone who never directly experienced violence, especially when the storying begins in childhood. Seoighe (2021) identifies two genres of this kind of storying in communities in or from Sri Lanka: the conflict memory script promoted by the state, mobilized to deflect accountability and deny genocidal violence; and the Tamil counter-narrative, linked to social justice movements regarding families of the disappeared, land dispossession, and the reintegration of ex-LTTE cadres and detainees who suffer violence, stigma, and surveillance (p. 170). My parents did not proffer their counter-narratives until I was an adolescent, but like many kids, I dabbled in espionage: eavesdropping on their grainy phone calls to Batticaloa, hiding behind the couch while they spoke in Tamil about the war. I had a Webster's Dictionary and context clues to sort out the meaning of Tigers, shelling, burning, white vans. I must have been considered old enough as a preteen, which is when they began casually weaving stories about state-sanctioned murders into otherwise mundane conversation. I understood that they needed someone to tell, and isolated from the diaspora as we were, that there was no one else to listen.

I am not alone in this experience, where my parents unpredictably divulged traumatic stories, often in the course of an argument in the car, in ways that expend and exert pain, an affective dumping (Jeyasundaram, 2020, p. 418). Like many of the respondents in Jeyasundaram et al.'s (2020) study, I couldn't control the flow of or detail in these conversations, and so I turned to media sources "but found that the excessive communication on violence and destruction often led to feelings of pain, guilt, shame, secondary traumatization and depression" (p. 418). Looking up Tamil people in the early 2000s took me to a photograph of a suicide bomber's leg on Rotten.com, the first violent image I ever saw, and I knew I wasn't supposed to look, so I told no one, and looked anyway, and became a storehouse of atrocity with the doors dutifully locked. Maybe it comes as no surprise that an acquaintance once asked me, while we were belting out Radiohead's "Just" — you do it to yourself, you do, and that's what really hurts — if I thought I had.

My parents' personal memories might fit into these broader "emblematic" memory narratives, which shape collective memory, but the Tamil diaspora is heterogeneous, ideologically diverse, and comprises distinct lived experiences (Grønseth, 2011; Tyyskä, 2015; Jeyasundaram et al., 2020; Seoighe, 2021). My parents left Sri Lanka willingly, not as persecuted refugees, but their move was meant to be temporary. The unexpected experience of permanent resettlement stripped them of kin, Hindu temples, local Eelam Tamil community, the familiar social and religious contexts that imparted meaning to their routine social activities and relations back home. Grønseth (2011) calls this a loss of "Tamil wholeness" (p. 321), to which she attributes inexplicable aches, pains, and fatigue. She notes that the Tamil refugees she interviewed in Arctic Harbor withdrew from local Norwegian social arenas to the Tamil social arena in Oslo, as the governing Norwegian biomedical framework failed to grasp how they linked recuperation to being with kin, going to kovil, eating purifying diets, and meditating (p. 327). We had no Tamil social arenas to withdraw to. Cultural anxiety and ethnic essentialism are linked. Rather than engaging in cultural exchange, my parents resisted pluralistic integration, avoiding neighbors, distrusting white people, and forbidding me from dating, attending senior prom, hanging out after school, or visiting American friends' houses.

Tyyskä (2015) observes that core cultural values are a source of intergenerational conflict in Eelam Tamil families in the diaspora in Canada, the primary disagreements being about clothing, personal freedoms, romance and sexuality, and other "Western ways" that challenge Tamil customs (p. 55). According to her, "many Tamil youth do not feel they fit in either Sri Lankan or Canadian culture, and so they create hybrid cultures, mixtures of the two. The resultant cultural conflict manifests frequently in communication gaps between parents and children" (p. 50). She also notes that the work of cultural transmission falls on women, who are expected to become mothers. Additionally, Jeyasundaram et al. (2020) find that the Tamil children of refugees grow up with the messaging that outsiders cannot be trusted, impacting their social development; they internalize a fear of failure, leading to risk-averse, fear-based decisions; they struggle with accepting "Western" identities and engaging in occupations that do not represent Tamil cultural values, like depression, queer sexualities, or creative professions (pp. 417-418). In her study of Tamil refugees in Norway, Grønseth (2011) suggests that this fractured Tamil wholeness, combined with the receiving country's insistence on erasure through assimilation, heavily impacts the Tamil self in its phenomenological capacity of "being-in-the-world," and that consequently, "Tamils embodied ongoing social processes by developing vague and lasting pain and fatigue" (p. 321). In the absence of local Tamil community, as the oldest daughter and expected future cultural transmitter, I was designated the first recipient of my parents' stories, and it made me the middle-schooler who feared cutthroat gestures and struck matches, the high-school self-injurer, the suicidal college sophomore who parted her flesh over feelings of non-belonging and guilt over surviving a conflict she never saw.

In Ayurvedic medicine, the mind is seated in the heart, and the physical manifestations of psychological disorders are not construed as psychosomatic but somatopsychic, except for anxiety, grief, and psychological shock, which are thought to increase bodily heat and shrink emotional and cognitive functioning (Affleck et al., 2021, pp. 10-11). Although physician after physician dismissively dubbed my symptoms psychosomatic, the same emotional and cognitive dysregulation that attend fibromyalgia might be somatopsychic in a Tamil framework. According to Affleck et al. (2021), Eelam Tamil refugees in Toronto who directly experienced detainment, torture, rape, and/or other forms of sexual violence during or after the war use expressions and idioms of distress like nalintha, weak, or nadaippinam, walking corpse. Trauma is considered a possible etiological factor for fibromyalgia, but not secondary traumatic stress. According to the white physicians I see in New York, apart from Dr. Birnbaum, stories can't compare to the real thing.

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Many syndromes are culture-bound. Dr. Birnbaum, the rheumatologist who diagnosed me, is the daughter of Holocaust survivors and the first medical expert to ask me not only "Where does it hurt?," but also "Where are you from?" in an attempt to complete the clinical picture. Chandradasa et al. (2020) note that in Sri Lanka, psychiatric disorders have presented in culturally specific ways: autism reported as evidence of samsara and the impact of amalgamated past lives; depression described as a fire throughout the body; or Cotard syndrome referenced as pey (p. 1). "Idioms of distress," or the ways that members of a sociocultural group represent their suffering, correspond to culturally specific syndromes or associations, like attributing somatic complaints to familial disputes or describing secondary PTSD in terms of malaise (Affleck et al., 2021, p. 1). These idioms can facilitate a therapeutic relationship between the patient and physician, particularly "non-Western patients [in Western clinics, who] often consider the idiom of distress to be their most salient problem; if the clinician does not ask about this complaint and does not specially address this idiom, the patient can feel misunderstood. This, in turn, can fracture the therapeutic alliance, and with it, the efficacy of the intervention" (Affleck et al., 2021, p. 2).

It helps that Dr. Birnbaum has stories and pain too. There is a lot in her that reminds me of Amma. We are women implicitly taught to harbor pain in secret, because displaying weakness in our parents' respective genocides so often proved fatal. It makes it easier to confess that my cranial nerve issues and consequent visual snow manifest as visual hallucinations of a woman being burned alive and tactile hallucinations of being necklaced. Given that this is the expression, we wonder if the emotional weight of the ethnic conflict and familial strife has finally settled too far into the places that hurt me most, a lifelong series of affect transmissions deepening the biological aspects of chronic pain.

Little is known about the intergenerational transmission of trauma experiences in the Eelam Tamil diaspora after the war, let alone when the transmitters are not refugees (Sanmuhanathan, 2020, p. 185). My parents did not flee genocidal violence, but they grew up in a Sinhala-Buddhist nationalist country with a history of anti-Tamil pogromist violence and they had stories of close family members experiencing violence. Proximity as well as direct exposure can lead to post-traumatic stress. Appa collected and saved newspapers about the war, and both of my parents received stories about near-misses, rapes, disappearances, and deaths from relatives in Batticaloa. According to Sanmuhanathan (2020), a history of trauma can impact parenting practices, such as the capacity to attune to their child's emotions or to communicate in age-appropriate ways, contributing to trauma symptoms in the child (p. 120). Much like refugee parents, Appa and Amma were distrustful of outsiders, overprotective and cautious, and reproachful when I expressed dissatisfaction with my life or with core Tamil cultural values.

Before Dr. Birnbaum, doctors suggested genetic determinants for my pain and fatigue, but epigenetic history too describes a type of heredity, a specific mode of intergenerational transmission of information, with phylogenetic consequences. Transcription through RNA modifies genes without altering the DNA sequence, and it is a key mechanism in epigenetic history. The "epigenetic turn" in science and biomedicine recasts DNA as no longer solely responsible for evolutionary and hereditary differences and understands that epigenetic modifications are heritable from one generation of organism to the next. Our environments and lived experiences become potential but fluid points of genealogical origin. Two forms of epigenetic modification are called methylation, which chemically modifies DNA, and histone acetylation, which remodels chromatin, opening DNA to transcription processes. In other words, methylation silences gene expression while histone acetylation activates gene expression, enabling "epigenetic memory" (Jaarsma, 2020, pp. 117-118). Epigenetic transmission, then, may occur in two ways. After conception, the child may be exposed to the parental trauma in utero and post-natally, potentially changing function in the DNA. Preconception, the parental trauma may remain in the cells and affect the child's development (Sanmuhanathan, 2020, p. 119).

The field of epigenetics is controversial, often considered an insufficiently developed framework, easily misappropriated and overgeneralized to pathologize specific social, cultural, and/or ethnic identities as biologically damaged and inferior. Its strong curative philosophy might also make it complicit with genocidal violence, undercutting the singularity of trauma with a differently violent erasure. And yet, epigenetic understandings of embodiment, collective memory, and intergenerational trauma permit us to conceive of organisms as intersubjective and relationally co-constituted by their environments. Recent studies connect the higher incidence of chronic pain syndromes in nonwhite people to epigenetic mechanisms like racial discrimination, economic hardship, environmental stress, and depression, in addition to biological factors. Race, for instance, impacts lived experience; in the U.S., darker skin leads to more stressful lived experiences. Stress catalyzes adaptive processes that activate multiple systems, such as the autonomic, endocrine, and immune systems. This is meant to modulate stress, but overactivation results in a maladaptive response, chronic stress, and changes to the neuroendocrine and immune systems. Women with fibromyalgia pain often have different DNA methylation patterns in genes involved in neural development (Aroke et al., 2019, paras. 11-15).

Dr. Birnbaum subscribes to the gut theory of fibromyalgia, and I am a novice to the world of chronic pain. She addresses me like a protégé or a niece, disrupting the power dynamic typical to the doctor-patient encounter, but perhaps replacing it with the skewed communication formats of the secondarily traumatized. She's the one who includes trauma in the list of fibromyalgia's etiological factors. At the same time, she is a white Jewish woman in New York who does not share my experiences of discrimination in the U.S.; secondary PTSD is only a possible factor for fibromyalgia, not the sole cause; and epigenetics is marginal to Western biomedicine. Still, in the exam rooms and offices of her private practice, I can speak of Sri Lanka without fear of scorn.

I can't think of another member of my medical team who I could have told this to, who would not have immediately labeled me schizophrenic and told me the pain is all in my head.

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Amitav Ghosh (2003), who spent most of his childhood in Sri Lanka, calls it "a species of pain": the jagged lines of flight of refugees crisscrossing Europe, Australia, North America, and elsewhere; these unpredictable movements of dispersal and exile caused by the gash of partition and refugees' realization that they have been severed by the state; all the conditions that make the fugitive bodies of diaspora. "The memory of dispersal is haunted always by the essential inexplicability of what has come to pass; by the knowledge that there was nothing inevitable, nothing predestined about what has happened" (para. 10). It's an ontological dislocation that finds its twin in chronic pain, similarly inexplicable and haunted, a haunting itself, a body imperceptibly and always on the run.

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In The Collected Schizophrenias, Esmé Weijun Wang (2019) writes about an experience of Cotard syndrome, also known as walking corpse syndrome, a delusion of negation wherein a patient denies the existence of body parts, organs, or blood, or believes they are already dead, putrefying, or never existed to begin with. She is in there, somewhere, wandering through an unreality or afterlife. She negotiates this seemingly arhetorical experience through the rhetorical act of writing while gripped by the delusions. Her therapist tells her that ritual might help "but it was not the solution; there was no solution" (p. 147).

In Tamil, this is nadaippinam, to be alive but deprived of life or soul. Three times in my life have I been such a nadaippinam that others saw it in me: in May 2009, during the Mullivaikkal Massacre; in September 2014, during my ruptured appendix's slow bleed; and in November 2019, when the white van driver confesses, when Gotabaya is elected, when Tamils are attacked in Kegalle, when police crack down on Maaveerar Naal commemorations and confiscate the only photos of dead cadres from mourning parents, when the abductions begin again.

Extending Aroke et al.'s (2019) findings, living in prolonged fight-flight-freeze alters the body's response to the ordinary functioning of daily life. In some ways, by saying this, I leave myself vulnerable to the accusation, by laypeople and clinicians who doubt the disease's validity, that I did this to myself. In some ways, the vicarious secondary PTSD-induced hypervigilance I never felt entitled to was good training for the experience of fibromyalgia. There was no solution. Complementing Eelam Tamil pain, I'm used to the torture of uncertainty.

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The "sick/disabled role" was considered an honorable way for an LTTE cadre to exit combat, as the LTTE otherwise strictly punished those who wanted to leave (Somasundaram, 1998, p. 196). War overwrites the stigma of pain or disability, bestowing on the pained and disabled a patriotic and moral character (Scarry, 1985).

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In Kafka's (1925) The Trial, a man is arrested and sentenced to death, never learns the name of his crime nor sees the faces of his judges. And this is where the fear lies, in a landscape so contingent and unpredictable that "direction has no meaning and being lost is every direction" (Gunesekera, 2019). It's an apt metaphor for the Eelam Tamil identity. It's the one I subconsciously cultivated, growing up in U.S. towns physically isolated from Tamil communities: to never know what was true, which news to trust, who to fear most. The infra-ordinary and innocuous become not objects of theoretical marvel on close examination, but threats. A discarded piece of rebar signals bodily havoc, inside and out. Electrical cords are for whipping. When I question my teaspoons, I see how an eyeball is easily removed with a utensil and a will, and I'm not sure this is what Perec (1974/2008) meant. My infra-ordinary is, in the mostly white middle-class American clinical and academic environments through which I move, registered by others as extraordinary.

A general search for information on Eelam Tamil pain yields results that are all about war and displacement. It's the thing that seems often overlooked in Scarry's (1985) germinal work on pain, phenomenology, and languaging, that her focus is largely torture and war. She reminds us of the links between pain and knowledge, like the ancient yaksha cults that sacrificed travelers who failed to correctly answer a series of riddles (p. 28), and the transformation into a more modern iteration like torture, when an interrogator asks a question as though the answer matters, when both torturer and prisoner know better. It's a false motive. The point is converting the (Tamil) Other's pain into (Sinhalese) Power (p. 59).

I describe fibromyalgia often as a life lived by navigating a world made threat, where every touch or object is unpredictably and potentially painful, and the parallels are easy to see.

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For a generation born and raised outside the homeland, who know it through brief visits and the storying of violence, diasporic identity can be memory more than place. Nora (1989) understands lieux de mémoire, or sites of memory, as the exclusion of the event, as memory attaches to sites and history to events (p. 8). These sites of memory exist as the original intention and the capacity for return, metamorphosis, and the recycling of meaning and implications. They are material, symbolic, and functional, created by an interaction between memory and history that results in their mutual overdetermination. The intention to remember — the archival impulse — is essential to distinguishing between sites of memory and sites of history, which lack this impulse. That said, without the intervention of history, the objects of memory would be a static catalogue (p. 12). Modern memory is essentially archival, and lieux de mémoire originate from the impetus to archive, the sense that there is no longer any spontaneous memory and that archives must be deliberately created. We are preoccupied with the individual rather than the social psychology of remembering, from repetition and "living" memory to the rememoration of the archive, resulting in a new economy of the identity of the self, the mechanisms of memory, our relationship to the past.

Lieux de mémoire impel a will to remember alongside the understanding that "without commemorative vigilance, history would soon sweep [the traces of memory] away" (Nora, 1989, p. 12). Angle this theorizing towards Sri Lanka, towards the Sri Lankan government's active repression of rememoration of the archive during Maaveerar Naal, towards the diaspora's scattered commemorations, and we might see the Eelam Tamil body as the only possible archive, and one taught to live by anticipating abduction or execution.

What happens to the body that grows up believing that, even an ocean away, this is the most likely outcome? Or, to extend Nora's (1989) observation that "when memory is no longer everywhere, it will not be anywhere unless one takes the responsibility to recapture it through individual means" (p. 16), what happens in the process of recapturing memory when memory and cultural heritage are systematically being erased by the state, and all that's left is the pain of relatives' stories, survivor narratives, intergenerational affective transmissions from those who weren't killed or disappeared but inevitably knew many who were? Does such a haunted memory-individual risk becoming nadaippinam, the "memory-individual" of Tamil Eelam, fibromyalgia partially a somatic idiom for all this pain with nowhere else to go?

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Asked differently, what is the grammar of the body born into intergenerational trauma and affective diasporic hauntings? Affect studies theorists like Tompkins (1991), Damasio (2000), Massumi (2002), and others differentiate between feeling and affect. We might think of feeling as biographical, cross-checked against personal experience; emotion as social, apparent expressions of feeling that might be authentic or feigned; and affect as pre-personal, a non-conscious experience of intensity, bodily grammar that resists verbal articulation (Massumi, 2002). In her study of affect transmission, Brennan (2004) suggests that affects are transmitted between bodies, which are more permeable than Western rationality would have us believe. Affect transmission is social in origin but physiological and biological in effect (p. 3). Affects have "an energetic dimension," capable of enhancing or depleting; in her estimation, outwardly projecting affects, relieving you of them, is energizing while introjecting them is enervating. Brennan suggests that trauma is directly linked to the transmission of affect and notes that in many cases of fibromyalgia, the contours of muscular and nervous debilitation are molded by psychological or emotional precursors, more so than frequently comorbid disorders like rheumatoid arthritis. She describes trauma as "a piercing of the psychical shield as well as a dumping" (p. 47) that resists fading with time and distance, instead incorporating itself into the psyche, reverberating through the musculature. It creates a disequilibrium the subject must constantly seek to rectify, until the quest for equilibrium becomes more normal than equilibrium itself: an internal theater of war, of perpetual precarity.

In their articulation of wound shock, Geroulanos and Meyers (2018) use a surprisingly similar phrasing, saying, "Normally, the body would attempt to compensate for the injury, but the equilibrium of even minor injuries was inhibited by the disordered cardiovascular system. The very attempt to bring forth equilibrium became deeply pathological. . . . In counteracting the injury, the body was harming itself" (p. 58). Wartime research in the early 1900s records that soldiers at rest remained in acute physical exertion, suggesting they deployed as civilians but returned as something else, preconditioned for chronic syndromes, a new normal. In a sense, the rise in cases of wound shock in the early 1900s necessitated unique treatments, as each patient came with a singular clinical presentation, such that patients became increasingly individualized as whole-body syndromes became increasingly common (p. 60).

Wound shock was considered fundamentally internal, caused by the body's response to intrusion and not the intrusion itself. Shell shock, where physical intrusions were non-apparent, was theorized as percussive. Both have been historicized under the aegis of Cartesian mind-body dualism, but in reality, physicians tended to lump them together as issues of functionality, where the whole body's reaction to stimuli determined psychological effects and vice-versa (Geroulanos and Meyers, 2018, pp. 71-72). These were bodymind disorders that begged the question, "what kind of wound applied to the kind of violence that seemed to leave no physical trace behind" (p. 71). In wound shock, the initial injury was long healed; in shell shock, it was invisible to begin with.

In both disorders, war itself is the wound.

Not so with me. Growing up in the Tamil diaspora in the U.S., I only grow up with stories of war, of oppression, violence, disappearances. I understand shells as artillery before I grasp the reference to marine mollusks. I'm warned against writing about the conflict, both playfully and seriously, because I'd endanger myself and my family. I'm forbidden from owning a comforter patterned with jungle and tigers, as though symbolic LTTE affiliation, even an ocean away, is a risk. I turn two on the day of a Batticaloa massacre. Sex ed coincides with the rape of Krishanthi Kumaraswamy by Sri Lanka Army soldiers. Sexual penetration connotes the female Black Tiger practice of vaginally containing grenades. Universities are tinged with the specter of disappearance and murder, by the Army and the LTTE. Somasundaram (2014) observes, "So strong is the collective experience of trauma that it affects those the community comes into contact with as well as the Tamil diaspora itself [emphasis mine]. The Tamil community and its fate is constantly held in mind by the community [abroad] and in that sense, the pain and fear generated by the traumatic events at home are shared by the diaspora" (p. 284).

Given that the Tamil diaspora is characterized by cultural hybridity, its chief source of group coherence is projection into a shared imaginary of spatial rupture, war trauma, and historical resilience. As Seoighe (2021) points out, remembrance in Tamil diasporic spaces is complex. Memory and trauma are shared by those with firsthand memories of the Tamil genocide as well as those who can only recognize and imagine it. Without diasporic community, remembrance is a complex affair. Familial narratives of historical Tamil resilience and resistance give rise to a mythic comprehension of the past, homeland, community. I "held in mind" the traumas of the Eelam Tamil community, connected to it by a common grievance and general sense of loss and alienation, but I could only conjure these mythologized events from my parents' memories and online news in my Dartmouth dorm room, my apartment in New York. Speaking about a thing suggests a mastery of it, and storytelling, and the risk of telling stories, binds the diaspora. Trauma is bequeathed like an ancestral legacy, even when the actuality of violence is mediated through the memory of others. The mythic, traumatic, and painful all collapse time.

Shock, like fibromyalgia, is seen by some as a pathological dumping ground. Is this affective dumping enough to generate a whole-body syndrome akin to shock, with invisible causes, few if any quantifiable markers, a disordered body whose quest for equilibrium is pathological and self-injuring? The shocked body that doesn't die in war or the surgical theater goes on to be nadaippinam.

But outside of the context of the direct experience of war in Western biomedicine, it seems the holistic and personalized approaches developed in relation to wound/shell shock or exhaustion don't apply, and checking off the racial category of Asian American on the intake questionnaire doesn't leave room for Eelam Tamil particulars. So I almost never mention Tamil or trauma to my physicians, many of whom are all too eager to label my pain purely psychiatric. The only ones who thought to ask were Dr. Birnbaum, bearer of intergenerational trauma herself, and Dr. Sattva, who performed my appendectomy, himself South Asian.

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Here are some facts.

  • PTSD emerges as a diagnostic category after the Vietnam War, and secondary traumatic stress disorder, a.k.a. vicarious trauma, is identified in 1995, both as psychosomatic conditions (Geroulanos & Meyers, 2018).
  • In the U.S., I ran the gamut from self-harm to ideation to attempts, often while staring down leaked images of the conflict like a compulsion, trying to understand what my parents, and therefore I, had escaped.
  • Whole-body shock syndromes, attended by symptoms such as constipation, glassy eyes, and clenched jaws, were "synonymous with a self that attempts to protect itself by closing its orifices, letting nothing go, hoarding its vulnerabilities, entrenching itself against a world in shards, shards that threaten to tear it apart" (Geroulanos & Meyers, 2018, p. 38). Nothing enters, nothing exits.
  • Fibromyalgia has been informally described to me in similar terms by rheumatologists and bodyworkers, who identify my habitual clenching of the jaw, shoulders, neck. Psychotherapists and physical therapists alike have insisted, baffled, Why can't you let go?
  • Barker (2005) mentions a study in which nearly 60 percent of FMS patients exhibited clinically significant levels of PTSD symptoms, a rate much higher than in the general population; another study found that a high percentage of PTSD patients possessed undiagnosed FMS. However, no clear causal link has been established, and there isn't always overlap (p. 36).
  • People forget that the Eelam Tamil diaspora did not form in a vacuum, or as a happy exodus. It was exile, Ghosh's (2003) species of pain, as intentional as escaping with smugglers on fishing trawlers that often sank, as unexpected as my parents realizing war prevented them from returning home as planned.
  • I belong to a generation that has "had to learn that to have made it out, despite all the trauma it brings, was a privilege" (Nathan, 2019). To have sidestepped it, to have been born to those who did, is my privilege. Suddenly forced to live permanently in the U.S., Appa chased tenure, our family fell into debt, but I grew up with the trappings of the middle-class, if also a sense that there was never enough money, that home represented not safety but a thing so easily taken.
  • The first time I heard of masquerade, I was a child illicitly attending to my parents' conversations about how government-incited Sinhalese mobs would stop buses, ask each passenger a question in Sinhala, and passengers who didn't understand or whose tongues couldn't shape a fluent Sinhala reply were dragged off the bus and executed. They didn't intend this news for me, so it was unfiltered and uncontextualized. I think of this every time I consciously perform disability masquerade.
  • Sophocles writes his play Philoctetes such that Odysseus specifically frames Philoctetes, isolated and in agony from his incurable wound, as socially dead: "A man without friends, without city, a corpse among the living [emphasis mine]" (Vernant & Vidal-Naquet, 1990, p. 166); he is "a victim consecrated to the god of the dead" and "a corpse, the shadow of a wisp of smoke, a vain phantom" (p. 168). The ancient Greek word is atimos, a man civically dead. Pain makes Philoctetes nadaippinam, living an agony he will always survive.
  • My only firsthand experience was in 2004, when a soldier in Polonnaruwa pointed his gun at me. The other soldier with him was appraising my body, so I appealed to him with my eyes, and, grinning like I was cute, he calmed his sterner comrade down. When I play girl games in the clinic (Greenhalgh, 2001), this is what I remember.
  • Kleinman and Kleinman (1985) view chronic pain as "a coping style, a form of social communication, a cultural symbol and its interpretation" (p. 472). Perhaps the diasporic interpretive schema for making sense of the history of genocide I grew up with reorganized my body schema to match.

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While I'm growing up, Amma insists that mental illness is a Western phenomenon, nonexistent in Sri Lanka, that only (straight, cisgender, white, heterosexual, middle-class) Americans have the luxury of indulging mental illness. It wouldn't surprise me if Appa and Amma struggled with their mental health. For a long time, they are baffled by the idea that pain is a disorder, by my incessant complaints about pain. If not the byproducts of injury, Tamil aches and pains embody social experiences, such as aloneness or disharmony in the home-world (Grønseth, 2007, p. 29). Everyone hurts, living hurts, to be Eelam Tamil is to be molded from pain and ever absorb more, what makes my pain worthy of pathologization? To them, complaining of a pain that needs treatment and yet can't be cured creates disharmony in the Tamil home-world and my American social and medical life-worlds. Tamils are a collectivist society, but my pain expressions disturb an aesthetics of smooth surfaces, of equilibrium, reminding everyone: you can't help me.

Grønseth (2007) finds that Tamil people suffer "when they are unable to live in accordance with habituated expectations and practices" (p. 34), when the society they live in imperils their sense of belonging, identity, and self. Existing in the borderlands between life-worlds meant suffering acculturative stress and racial discrimination. "When we consider that the knowledge and meaning of suffering is attained and embodied by living in an everyday world on the edge and with borders," Grønseth (2007) says, "a complex Tamil agency appears. Through their pains and illnesses, the Tamils gain a new knowledge and make new meaning of their surroundings. It was not only their intellect but also their intentional body, with its passions and pains, which enabled them to create new social and religious practices and relations, as well as mend torn shreds of the same" (p. 35). The only (culturally) sensible response to my parents, on the border between Tamil and American life-worlds, is for us to accept and endure pain as a socially produced ache in our bodies. Resilience, the kind synonymous with stoicism, is our currency, no matter the forms in which it is passed down — as hope; political resistance; advocacy; memory work mobilized to open up public discussions about alternative or marginalized interpretations of genocide; and pain endurance (Seoighe, 2021, p. 184).

My parents can understand the social as chronic, so fibromyalgia is less baffling to them than trauma. In his research into the psychological impact of chronic ethnic conflict on Tamils in Sri Lanka, Somasundaram (1998) observes that most non-Western patients don't complain of (or, like Appa and Amma, believe in) PTSD, a Western concept, despite significant trauma experience (p. 169). In the 1990s, before the war reached its climax, he writes, "By all appearances, violence, brutalisation and disrespect for human life and basic rights of the individual, are fast becoming part and parcel of Tamil society, and a way of life for the next few generations to come" (p. 217). Everything from "noise shells," percussive but not destructive, such that the whistle of artillery stokes terror but signals nothing definitively, to mass arrests, to white van abductions, to symbolic or overt violence being institutionalized into law, all of this designed "to keep a whole community in a state of fearful apprehension" (pp. 262-263). Residents who didn't recognize the war as a psychological antecedent of their conditions "'somatised' the stress of being displaced through bodily symptoms" (p. 180).

There is an everydayness to this sort of trauma, and the Western biomedical complex examines it through Western assumptions of personhood, memory, morality, temporality, and well-being. Chronic arousal and continual autonomic nervous system stress and discharge are linked to the widespread musculoskeletal aches survivors often complain of in post-traumatic states (Somasundaram, 1998, p. 169). The white vans and crocodiles, Amma's family hiding from the Sinhala-Buddhist mob in a neighbor's house, the endless stream of state-sponsored anti-Tamil riots, the lack of justice and accountability and the resignation it breeds, maybe it's a kind of affective shell shock, a reverberation of intergenerational trauma through my bodymind. A history of collective trauma can serve as a strong glue of affiliation for diasporic identity (Orjuela, 2017, p. 2). As Nora (1989) reminds us, "as traditional memory disappears, we feel obliged assiduously to collect remains, testimonies, documents, images, speeches, any visible signs of what has been, as if this burgeoning dossier were to be called upon to furnish some proof to who knows what tribunal of history" (pp. 13-14). This dossier is proof of being Tamil, but in a sense, it is also proof that we remembered to remember (Nora, p. 1989, p. 16). In compiling it, we become our own historians; we also archive the numbness of survivors and witnesses, relatives, writers, and make it our own. Though its somatization may vary across the diaspora, remembering stories of violence exerts violence on the rememberer.

Kleinman and Kleinman (1985), in describing the social genesis and biocultural construal of chronic pain in China, suggest there is a relationship between political and social stress and a somatic idiom for various threats to the integrity of the self, from violence and loss to communal non-belonging (p. 470). In many non-Western societies, somatization is the primary expression of mental illness, including trauma, as indicated by studies done in the Middle East, West Africa, the Philippines, East Asia, and India. While somatic complaints are culturally unique, the through-line seems to be that in many non-Western cultures, physical illness — something comprehensible, visible, potentially curable — is preferable to the social and moral stigma of mental illness, which influences the high prevalence of somatization in these societies (pp. 433-434).

Where the children of refugees in Sweden who succumb to resignation syndrome do so in the face of the tangible, immediate threat of deportation, I self-paralyze from pain, from embodying and possessing the lieux de mémoire of Tamil Eelam, the objects, gestures, reflexes, and traces gained through cultural and affective transmissions from relatives' stories, news articles, war photographs. They comprise a specific time and place where, once, stray dogs ate the dead because families feared the repercussions of claiming them, hospitals were carpeted in bodies, and universities were spaces of massacres and disappearances. They evoke culturally specific gestures and symbols, the seri-seri head waggle, karthigai poo, jackfruit and mango. The "fearful apprehension" (Somasundaram, 1998, p. 263) I inherited and internalized is ordinary for me but not for most of the Americans I've known, and it stymies the creation of a common American experience, complicating social and personal relations, intruding on public feeling (Stewart, 2007). The silence after I talk about the Tamil genocide is consistently staggering. Somasundaram (1998) writes, "Narrow medical models are quite inadequate to express the full extent of the mental agony and reactions to war" (p. 169), and Western medicine has never made space for this part of my patient narrative. It's the fear of being medically blacklisted and academically and socially isolated, nadaippinam, or atimos, that prevents me from owning up to, let alone expressing, this fearful apprehension, this species of pain.

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"In the final analysis," Somasundaram (1998) suggests, the somatic idiom of Eelam Tamil survivors "is a testimony to the suffering caused by war" (p. 169). Of course, fibromyalgia is not solely an Eelam Tamil phenomenon, nor is it always linked to trauma, vicarious or otherwise. Not everyone in the Tamil diaspora shares this diagnosis or its constellation of symptoms. Even if they did, Brennan's (2004) formulation of fibromyalgia as primarily affective in origin through the impact of trauma on the ego and musculature makes me deeply uncomfortable, the kind of theory that sounds good on paper, but in the doctor's office, gets you labeled hypochondriac or (only) mentally ill.

Still, if we treat fibromyalgia as a disorder as individualized as the whole-body shock syndromes of the 20th century, these geopolitically specific affective hauntings are significant. The ghost stories of the Tamil diaspora end up writ large on the bodies of second-generation listeners like me, traumatic knowledge as an affective haunting, informing the subject's biographical experience and subsequent categorization of pre-personal affect as personalized feeling. We are conductive systems, all of us. Each storyteller a lightning rod without grounding wire, each story telegraphing intensities from pole to pole, amplified through resonance and reaction. My first-generation parents tell stories that forcibly conjure imaginaries of pain; and I am compelled to reconcile their telling with my own experience and prefabricated biogenetic traces of trauma in my fascia, vertebrae, gut; and my body reflects my particular version of it back: in effect, they did this to me, too.

Being haunted, being the ghostbody of Dolphin-Krute's (2017) formulation, is embodying "a particular kind of time [and] a particular kind of feeling in time" (p. 16), which manifests as the affective experience of the non-apparently fibromyalgic body making itself known and inciting in onlookers a momentary shock and inability to comprehend the spectacle of pain. Once apparent, this haunted body is made "not scary by its official designation as ghost and complete removal from the land of the living" (p. 16); however, it is also a contaminant, signaling the slow creep of illness and trauma without termination, bleeding into spaces and people (Dolphin-Krute, 2017, p. 19; Halttunen, 1995, pp. 310-311).

I endanger others when I bring my embodied hauntings into the spaces where I move, the incomprehensible ai aiyo, udambu nohuthu of FMS and the even less comprehensible vicarious trauma — Appa's, Amma's, Anji's, and mine — of memories of Black July, Mullivaikkal, white vans, crocodiles, storied into existence for us by newspapers and relatives overseas. But also, perhaps I've acclimated to the expectation of being endangered by their indifference or discomfiture. It's not just pain I bring into these spaces but Tamil pain, genocide pain, individualized and incomprehensible despite being more shareable than chronic pain. In my day-to-day existence in the academy and in the clinic, I am faced with nondisabled audiences to whom "atrocities that were known remained abstract and remote . . . Because the savagery of genocide so defies our everyday experience, many of us failed to wrap our minds around it. . . . Bystanders were thus able to retreat to the 'twilight between knowing and not knowing'" (Power, 2003, p. 505).

How to describe my painervation, when faced with able-bodyminded audiences whose histories are clean, or with academic audiences who prefer I soldier on? Everyone asks how are you, but that twilight is dangerous, and it is rare that anyone wants to forge ahead into the realm of knowing.

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Examining ethnic identity in Sri Lanka and the diaspora, Thurairajah (2019) observes, "For a large population of Sri Lankan Tamils, the war was all they knew, as they were born and raised during this time of conflict. As a result, when the conflict ended in 2009 with the Sri Lanka Army declaring defeat over the Tamil Tigers, it forced an entire population of Sri Lankan Tamils to consider for the first time in over 30 years: 'Who are we without the war?'" (p. 7).

"The ghostbody is only the memory of the body" (Dolphin-Krute, 2017, p. 26), but the nadaippinam is the memory of other bodies as well as your own. The sick ones. The amputees in the homeland where the same military responsible for their lost limbs makes a show of handing them prosthetics, journalists are detained, and white van fear endures. In the wake of a civil servant escaping to Switzerland, a white van abduction occurs. A Sri Lankan employee of the Swiss embassy is held for several hours and forced to unlock her cell phone, according to diplomatic officials, "her phone contained information about Sri Lankans who have recently sought asylum in Switzerland, and the names of Sri Lankans who aided them as they fled the country because they feared for their safety after Gotabaya Rajapaksa won the presidency" (Abi-Habib & Yasir, 2019). They threatened to kill her if she told anyone. Clearly she told. She's a nadaippinam too. Infectious in the act of telling to anyone who hears.

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Taylor (1997), in describing Argentina's Dirty War, coins percepticide, which "blinds, maims, and kills through the senses" (p. 124), a pact of forgetting, a compulsory and collective production and performance of denial. Witnessing is brutal. You dare not be caught in an act of unauthorized seeing. The clinical question for Eelam Tamil chronic pain is not "Where does it hurt?" but "What happens when you shut your eyes against/to avoid a bloodletting?" In striving to be insensate, the senses become heightened.

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"Pain provides a certain knowledge and voice to culture as it transgresses culturally constructed diagnoses" (Grønseth, 2007, p. 33). I write this a decade after the Mullivaikkal Massacre and the war's end, after the election of Gotabaya, and a father is shot in Mannar, parents of the disappeared have died, and journalists are detained. The aiyo exclaimed over all my childhood injuries will always be the same aiyo stammered over the rotten bodies in Mullivaikkal, by an elderly shell-shocked man, nadaippinam, staggering by. This is not a solution. There is no solution.

1 Literally "Great Heroes' Day," the remembrance day observed by Eelam Tamils to commemorate the LTTE cadres who died during the war. November 27 is the anniversary of the death of Lt. Shankar, the first LTTE cadre to die in combat. Originally transpiring in Sri Lanka only, commemorations eventually spread through the Eelam Tamil diaspora. After May 2009, the Sri Lankan government banned Maaveerar Naal commemorations, despite criticism that this essentially denies Tamil people the right to mourn their dead. There are no restrictions on this day in the Tamil diaspora, and so large public gatherings are held every year in cities like London, Toronto, Oslo, as close to me as New Jersey and Queens. I myself have never been. ↩

(–15. The Author Is in Pain)