At my advisor’s suggestion, I presented at this art and aesthetics conference, developing material I’d written for my dissertation. More art analysis here than in the diss, which I think expanded my thinking about it: myth, art, pain, anomalous embodiment.
Access copy of the talk below.
Peyththai and Image-Making: Cripping Chronic Pain the Tamil Way
Vyshali Manivannan, Pace University – Pleasantville
Universities Art Association of Canada Conference (UAAC), Toronto, CA
November 4, 2022
Hello, my name is Vyshali Manivannan, and I’m an Eelam Tamil American woman with fibromyalgia (or FMS) and myalgic encephalomyelitis (or ME). I’ll be presenting an autoethnographic account of the use of body modifications to introduce a Tamil aesthetics of experience into the clinical encounter, enhancing communication about and assessment of pain.
In this presentation, I’ll examine a few visual representations of mythological Tamil figures, which informed my perception of pain and fatigue. I will then examine how the meanings made around my nonwhite woman FMS/ME bodymind in U.S. clinics can be qualified via body modifications I commissioned that directly or obliquely reference those myths and my conditions while painting me as able to stoically endure. I hope to illustrate that the corporeal codes of cultural images and body modifications support the notion that pain is an intersubjective, biocultural phenomenon in clinical settings where this fact is often disbelieved, ideally leading to a collaborative, dialogic process in which the clinician better understands how the nonwhite, non-Western patient understands her pain.
Fibromyalgia is a chronic pain syndrome of unknown etiology, characterized by widespread nomadic pain in the muscles and the soft tissues surrounding the joints. Myalgic encephalomyelitis is a syndrome characterized by overwhelming chronic fatigue and post-exertional malaise that isn’t improved by rest. My symptoms became unignorable in 2006. I was diagnosed in 2007. That year, and the year 2014—when I endured a ruptured appendix for 9 months because I didn’t look like I was in pain—were characterized by medical gaslighting and a rejection of my Eelam Tamil “aesthetics of experience” as a distraction from empirical medicine that stereotyped me as non-scientific and irrational.
According to Desjarlais (1992), “aesthetics of experience” refers to “the tacit cultural forms, values, and sensibilities—local ways of being and doing—that lend specific styles, configurations, and felt qualities to local experiences” (p. 65). Cultural practices and forms are inscribed on bodies and pattern how people affectively transmit, receive, and interpret the forms of everyday life, like pain and suffering and the emotional responses they occasion. Desjarlais observes that “pain, if it is to bear meaning, must be situated within a system of aesthetic value, a system that shapes the moral and emotional dimensions of the experience” (p. 68). The body and its visible, tactile, and affective expressions become compositions crafted and interpreted through a specific cultural schema of value. Culturally significant “corporeal codes” crystallize in everyday forms and local experiences, like mythology, movement, and how we assess sensation and interaction. In short, I seek treatment in New York clinics governed by Euro-Western biomedicine, but the aesthetics of experience that determines how I interpret and represent my pain is Eelam Tamil.
In Euro-Western biomedicine, fibromyalgia is a medicalized disorder visibilized through impersonal body diagrams, like this white female body diagram displaying the 18 fibromyalgia trigger points on labeled bones and muscles. As an experience, pain is a universal quality of the human condition despite its varied manifestations, expressions, and meanings. Scarry (1985) observes that physical pain is a personal, private, inarticulate interior state that lacks referential content, easily grasped by the sufferer but inaccessible to sensory confirmation by spectators. However, this glosses over its fundamentally intersubjective nature. Phenomenologists like Merleau-Ponty (1945) have argued that sensation is determined by the way we organize stimuli and not the stimuli themselves, itself determined by cultural schemas of value, or aesthetics of experience. Furthermore, pain is historically contingent and can’t be divorced from the meanings it accumulates in specific social contexts. As Morris (2000) concludes, pain is not only biochemical but also biocultural, shaped by forces like gender, race, sexual orientation, and emotional well-being.
For most of my doctors, pain is understood through empirical observation and measurement. For me, pain is understood through a biocultural framework, an Eelam Tamil aesthetics of experience that encompasses a history of collective violence; a sensorium that privileges hearing and touch; linguistic and gestural obliqueness; a need for resilience; and the belief that bodily anomaly is ordinary.
In the modern Euro-Western medical and visual tradition, disability is undesirable. Regarding art and architecture, Siebers (2010) defines “disability aesthetics” as a critical concept that “seeks to emphasize the presence of disability in the tradition of aesthetic representation. Disability aesthetics refuses to recognize the representation of the healthy body—and its definition of harmony, integrity, and beauty—as the sole determination of the aesthetic. It is not a matter of representing the exclusion of disability from aesthetic history, since such an exclusion has not taken place, but of making the influence of disability obvious” (p. 64).
As Das (2009) explains, the Indian aesthetic tradition revolves around rasa, the philosophy that beauty is linked to an act of intrinsic perception and intrinsic experience and the subsequent realization of harmony between the individual soul and the cosmos. The phenomenal world is illusory, and art intuitively expresses the true nature of beings and things under its surface through symbolic, archetypal characteristics, like third eyes, multiple limbs, or exaggerated proportions. Such bodily anomalies are commonplace in South Asian art, with the understanding that anomaly represents a facet of experience, perception, or morality. Das points to the negative valences around these representations, but rasa excludes the Eelam Tamil perspective, which attributes moral ambivalence or tragic anti-heroism to many of these anomalously bodied figures.
These visual representations acquired additional significance for me when I became disabled and realized that they helped me make sense of my symptoms but had no place in U.S. clinics. Lakhani and Lakhani (2015) observe that “descriptions and pictures of art forms in literature, sculpture and performance often help the student navigate the complex maze of medical learning.” This isn’t part of the standard Euro-Western medical curriculum, whose foundational academic medical texts rarely even represent darker skin tones. My visual referents, which included figures like Karna, Ravana, Kabandha, and Kumbhakarna, helped me understand and accept my anomalous embodiment, enabling me to prioritize care over cure. This position, and any non-empirical literary and aesthetic tradition that enables it, is at odds with the violent curative logics of Euro-Western biomedicine. I had to engineer occasions to tell these stories to my doctors to demonstrate how I made sense of pain and fatigue, and this was unexpectedly facilitated by my body modifications.
For instance, this 20th century painting depicts Karna, famously unaware of his heritage until his high pain tolerance exposes him to a sage who recognizes his warrior status. He is born with anomalous skin, described as golden armor and earrings that render him invincible. In this painting, he is dressed in white, handing the flayed gold “skin” of his arms to Indra disguised as a beggar seeking alms, with blood on the ground, a woman in a red and gold saree behind him, and Indra’s elephant visible in the clouds above. Kalra et al. (2016) suggest that Karna’s “skin”—both remarkable and ordinary—is a mythic substitution for ichthyosis vulgaris, a disorder where skin cells accumulate in thick, dry scales on the epidermis, depicted here in photographs of lined, pitted brown arms, hands, and feet. Karna is a Puranic antagonist, but Tamil representations often position him as a tragic anti-hero cheated by biased gods. For Eelam Tamils in particular, his stoicism in the face of oppression may signify our own resilience. I learned I’m thick-skinned myself when I commissioned thigh scarifications of a motherboard and ham radio schematic, here shown as pale healed scars against brown skin under the hem of a raised burgundy saree skirt. The first time they were exposed in the clinical exam, I perceived an opportunity to innocently ramble about my desire to endure experiences of pain I can control, about my thick skin, Karna’s skin, the fatal trap of impassivity, here made legible and tactile.
Or, take ten-headed, twenty-armed Ravana, rakshasa king of Lanka. In some tellings, his heads and limbs aren’t congenital but acquired through intense spiritual discipline, suggesting anomaly is not only ordinary but desirable. This 19th century watercolor painting depicts Ravana, heads and limbs visible, seated on a decorated plinth under an umbrella on a terrace under a blue sky, holding various tools, weapons, and ritual instruments. As Das notes, representations of Ravana use multiple heads and arms to symbolize his intelligence and strength. Ravana is also a Puranic antagonist, and he too becomes a tragic anti-hero for Tamils. His corporeal codes similarly gesture at the unremarkable nature of bodily anomaly, allowing me to understand myself in similar terms. As for my way into this story, I have a magnetic implant, pictured here as a faint dark spot in my fingertip, only a single blue stitch indicating anything anomalous. The extended sensory perception it grants me gestures at Ravana’s extended sensorium, immediately evoking wonder or repulsion in clinicians; regardless, I can recount the story to explain my interpretation of and approaches to my sensory dysfunction.
Or, take Kabandha, a celestial being cursed to exist as a demonic torso with an insatiable appetite. In this 16th century painting on a temple ceiling in Tamil Nadu, Kabandha is depicted as a blue-skinned torso in a yellow sarong with a gaping mouth and long, upraised arms against a yellow background; Rama and Lakshmana sit on his arms with their swords drawn. The corporeal codes of Kabandha here signal a reduced sensory perception, an all-consuming hunger. His is a “monstrous deformity,” but the fact that he’s cursed is offset by his divinely blue skin and his presence in a temple. Viewed as medical art, this representation suggests gastrointestinal disorders like hyperphagia or malabsorption. When my appendix ruptured and doctors reassured me it was an FMS flare-up for 9 months, pain made me averse to eating. I force-fed myself, and this grim pursuit of food to nourish a body that didn’t feel like mine recalled Kabandha for me. Lacking radiological expertise, I see him when I view my post-surgery CT scans: all torso, guts shaped like the gaping maw, pelvic bones two long arms. This black ink trash polka tattoo spanning my ribs and area of post-appendectomy complications, depicting a snail crawling on a razor, connotes the nightmare of surviving. Its placement allows me to describe these meanings and my altered relationship to appetite, which in turn admits the story of Kabandha, illustrating for clinicians the ways that abdominal pain reduces my sense of selfhood to my torso.
Or take the rakshasa Kumbhakarna, a younger brother of Ravana, who is granted a boon. However, because the gods fear his strength, he is tricked into misspeaking, so instead of asking for Indra’s throne, he requests to sleep like the dead. This 17th century painting depicts Kumbhakarna, sleeping supine while Ravana’s army attempts to prematurely wake him by raising his head, making noise, and beating and trampling him. The rakshasa’s corporeal codes indicate not only the intensity of chronic fatigue, but also the relationship between fatigue and pain. Lakhani and Lakhani (2015) relate representations of Kumbhakarna to hypothalamic obesity or Klein-Levin syndrome, while other medical publications suggest his curse is a mythic substitution for hypothyroidism, or diabetes. Padfield (2011) suggests that patient-produced images offer opportunities to collaboratively interpret pain and introduce biocultural frameworks, like this photograph of myself in constructive rest at a Pilates session, taken by my bodyworker. In black sweatpants and a blue T-shirt, I lie on a massage table, bound by straps and TheraBands with my head propped up and my legs raised over purple bolster pillows. The fact that my eye discerns similarities in the composition of the images is enough of a basis to mention the myth and my identification with Kumbhakarna’s exhaustion and failures to process painful stimuli.
From a Euro-Western perspective, these characteristics support standard symbolic readings of disability as unaesthetic and deficient: bodily deformity, asymmetry, disproportion, subversions of bodily integrity and perfection. However, ancient Tamil culture embraced anomalous embodiment. The word “disability” isn’t part of common Tamil vocabulary; as Canagarajah (2022) notes, anomalous conditions are referred to as viththiyaasam, a non-pejorative word for difference or anomaly that holds that bodily deviation is the norm. Moreover, a Tamil aesthetics of experience realigns many of these “disabled” anomalous bodies, like Karna and Ravana, with virtuousness, nobility, and/or symbols for resistance to oppression.
Ultimately, the clinical conversations I had about chronic pain prompted in these ways yielded assessments and treatment that better aligned with my goals for care. In visually reassociating its avatars and by drawing on aesthetic codes that already center difference, my body modifications permit occasions for storytelling and dialogically forming new meanings. This method happened to work for me, but it isn’t universally applicable, nor should it have to be. Permitting patients to reference or imagine different visual lineages of pain and fatigue is essential to facilitating a low-risk, openly biocultural, collaborative interpretive approach, which is theoretically and materially important for nonwhite patients seeking palliative care.
Works Cited
Canagarajah, S. (2023). A decolonial crip linguistics. Applied Linguistics, 1-22.
Das, S. (2009). Rasa theory and the varieties of rasa according to Natyashastra. IJRTI, 9(1).
Desjarlais, R. (1992). Body and emotion: The aesthetics of illness and healing in the Nepal Himalayas. University of Pennsylvania Press.
Kalra, B., Baruah, M. P., & Kalra, S. (2016). The Mahabharata and reproductive endocrinology. Indian Journal of Endocrinology and Metabolism, 20(3), 404-407.
Merleau-Ponty, M. (2012). Phenomenology of perception (D. Landes, Trans.). Routledge. (Original work published 1945)
Morris, D. (2000). Illness and culture in the postmodern age. University of California Press.
Lakhani, O. and Lakhani, J. (2015). Kumbhakarna: Did he suffer from the disorder of the hypothalamus? Indian Journal of Endocrinology and Metabolism, 19(3), 433-434.
Padfield, D. (2011). “Representing” the pain of others. Health, 15(3), 241-257.
Scarry, E. (1985). The body in pain: The making and unmaking of the world. Oxford University Press.
