The Myth of Normal 79

more we understand about disease, the less clear it becomes when you have it and when you don’t.” Within the myth of normal, of course, this kind of nuance is barely comprehensible: you’re either “sick” or you’re “well,” and it should be obvious which camp you’re in. But really, there are no clear dividing lines between illness and health. Nobody all of a sudden “gets” an autoimmune disease, or “gets” cancer—though it may, perhaps, make itself known suddenly and with tremendous impact. A few years ago, the New Yorker featured an article titled “What’s Wrong with Me?,” a poignant first-person account of yet another “idiopathic” autoimmune condition.[10] The piece was also a perfect depiction of disease as a long-term process rather than a distinct entity. “I got sick,” the author writes with a pained humor, “the way Hemingway says you go broke: ‘gradually and then suddenly.’ One way to tell the story is to say that I was ill for a long time—at least half a dozen years—before any doctor I saw believed I had a disease. Another is to say that it took hold in 2009, the stressful year after my mother died, when a debilitating fatigue overcame me, my lymph nodes ached for months, and a test suggested that I had recently had Epstein-Barr virus.” The telltale hallmarks of the disease process are there: the prolonged course; the professional befuddlement at the lack of specific markers on physical examination, blood tests, or imaging studies; and the sudden interpersonal stress that finally brings on the full-blown manifestations of illness. Toward the end of the article the writer reports a revealing clue as to the source of her devitalizing malady, one that should have been a signal to her treating physicians: “In May, my endocrinologist speculated, after various M.R.I.s, that I had an ‘idiopathic’ disorder in the hypothalamus which is probably untreatable.” The clue? We’ve seen it already: the hypothalamus is the hub of the body’s and brain’s stress apparatus, a key modulator of immune activity, and the apex of the autonomic nervous system. It is the transducer into physiological data of our emotional functioning and, therefore, of our interpersonal relationships and of our relationship to ourselves. It translates fear, loss, grief, and stress into responses in our bloodstream, organs, cells,