From Plague to Palate

B. K. Fischer reviews Maggie Nelson’s “Pathemata, or The Story of My Mouth.”

By B. K. FischerApril 27, 2025

• Poetry

• Memoir & Essay

IF PAIN CAN TEACH us anything, we might have to wait for the ache to subside, or at least change, before the lesson becomes clear. Maggie Nelson arrives at this conclusion in her new book Pathemata, Or, The Story of My Mouth, an account of chronic pain and a pandemic diary. Fans of Bluets (2009) and The Argonauts (2015) will be thrilled to find Nelson returning to the erotics of the everyday, applying again the whiplash intelligence that exposes the entanglements of nurture, work, and memory with the substrata of dreams. Her title comes from a Greek phrase attributed to Pythagoras, “pathemata mathemata,” or “learning through suffering,” and Nelson gleans what she can from a period that is excruciating on both individual and collective scales. Navigating the conditions of living with pain and seeking measures to alleviate it, she finds the agnosis in diagnosis—the doubt, the deepening disbelief that a cause or cure will ever be found.

Finding herself in the role, familiar to many, of being a patient with an intractable problem—“a pain puzzle”—Nelson seeks treatment for chronic jaw pain and finds even the most well-intentioned practitioners limited by their blind spots and biases. Imaging, appliances, and surgical options lead to dead ends. Dental solutions peddled by quacks and earnest healers of all stripes turn out to be based in zealotry, or overapplication of a single theory, or outright hoax. In desperation, she dispatches a Polaroid to a guru in Minneapolis and, unnervingly, never receives a response, prompting an intensified dread of mortality that colors a year. She encounters the surprising honesty of one surgeon who says he thinks a much-touted procedure won’t help her and sends her away. After each consultation, each interview and exam, she is left alone with the solitary experience of the inscrutable body.

Returning to the mind, Nelson puts the gnosis back in diagnosis—the mystery and confusion, the reverberations that pain sends through human relationships and through perception itself. The second half of the book’s title, “The Story of My Mouth,” invokes her vocation as a writer and the condition of being a woman with a lot to say. The story begins in childhood when, as a child who talked so fast she was sent to speech therapy, an orthodontist treated—or rather, punished—her apparently problematic tongue thrust with a spike affixed behind the front teeth. Recalling this early attempt to discipline her fluent and copious verbal expression, Nelson draws on Gilles Deleuze’s idea of the artist as symptomologist to gather evidence of the sequelae of this constraint. Because the mouth, the organ that produces speech, is an important symbol for a writer, the mouth as locus of pain is especially fraught—and connected, diffusely but permanently, with the nerve that stung when the child overheard an adult ask, “Does her mouth come with an off switch?”

Nelson finds a formal model in Hervé Guibert’s The Mausoleum of Lovers: Journals 1976–1991 (2001) and mirrors the riveting intimacy of Guibert’s style—a book inviting such close attention that it feels almost prurient to read it, like overhearing pillow talk. But Guibert’s posthumous volume is 10 times longer; gathering her daily notes, Nelson wields a facility for radical distillation, paring down the yearslong struggle to 62 pages that read as a single essay—the tip of the pain iceberg. What looms below the surface is the distant past, labyrinths of devotion, and the subconscious: “a sentence I disinter from beneath my mouth, from the undermaw.”

Braided through the diagnostic narrative are chronicles of dreams presented with uncanny realism. Unmarked as dreams, the passages begin as episodes that might be real, then swerve unexpectedly into the surreal. Has a car actually pulled over to save a turtle? Does a humiliating scene in the middle school gymnasium really happen, or is this anecdote, including the sister’s response, also a dream? (I think it really happened.) This seamless weaving demonstrates the indeterminacy of the divide—if there is a difference of relevance or importance between the dream’s urgency and the reality’s perplexity, we might not know it. In one scene, Nelson’s husband assures her that “bad dreams are mental detritus signifying nothing, forget about it, go back to sleep. This dismissal, which I know he intends as a comfort, enrages me.” Her anger prompts her to write the dreams down, and to argue that “it’s not the dream that matters, it’s the telling of the dream—the words you choose, the risks you take in externalizing your mind.” Those risks are particularly explicit in dreams that involve exposure and shame, such as finding oneself in public in “a robe that won’t close in the front.” Narrating them, Nelson shows that dreams, far from random, are “like an invagination—a chamber to hold the pastiche of lacerations”: they are a palimpsestic record of the countless marks and cuts, whether scarred over or still raw, that the mind holds.

Public exposure, at the time of this telling, entails heightened risk. Nelson documents the weirdness and alienation of the pandemic years—frantic searches for vaccines, trolls in the chat, social pods, remote schooling—as the collective backdrop that necessitates her own “solitary pain management.” In the first line of the book, Nelson notes, “I get up first to be alone,” and the word “first” resonates ambiguously, identifying the earliest riser in the household and the primary reason for the early rising. As isolation deepens, the self spirals: “I am talking to myself, a fractal interiority.” Yet bonds with others continue to drag the self outside of its immediate perceptions and afflictions. A beloved friend and mentor, herself chronically in pain for years, declines rapidly and dies, her final hours conveyed over texted pictures, Nelson’s final words to her spoken through a phone held up to her ear.

The direness and unraveling connections of this period compel a drawing-down into source material: where has the self experienced these difficult conditions before, and how can recognition, solace, or even distraction be found? Pandemic fears summon the deadly specter of AIDS in the 1990s, the protracted anxiety about contagion that waiting six months from exposure for an HIV test entailed. Meanwhile, the book, like memory, jump-cuts from the tragic to the ridiculous—public health as extolled by Mr. Goodbody, social mayhem as explicated in The Brady Bunch, which Nelson watches with her son. Noting that she now identifies with the caretaker (Alice) rather than the kid (Jan), Nelson observes that each episode’s plot “depends upon a secret or lie or omission”; miscommunication is necessary to the narrative momentum. Disconnect makes the comedy, and comedy makes the disconnect tolerable.

Pathemata conveys the reader from plague to palate to parenting with searing images of lived details—no one else does it like Nelson. She brings us into the despondency of being alone in the bedroom, overhearing a partner’s nighttime activities: “popcorn popping, the clatter of violence on Netflix.” She sees what we have seen and never articulated, the chaotic life force that appears “like mold growing under the lid of a marinara jar.” (The opening half of this comparison is Britney Spears’s “humping spirit,” which is admired.) Nelson’s pen is fast enough to catch the moment in the dream of being abducted and looking down to see “someone else’s beat-up Chelsea boots.” And she has the rueful clarity to recognize the concept of heaven as “a marble rolled in from someone else’s game.”

Like many stories of chronic pain, and perhaps like most suffering in most lives, Pathemata ends with the affliction unresolved but managed. Nelson returns to a dentist she had seen before the pandemic, and resumes his “no-frills approach of naproxen, compresses, stretches, and soft-food diet.” The reader exhales, but not all the way—what has emerged in the process of working through the pain puzzle has tapped lodes of deep loss and hit the bedrock of parent-child bonds. Nelson recalls her father, who died when she was young, and writes, at a psychotherapist’s suggestion, a letter to herself in his voice. And she recalls the pathemata mathemata inculcated during labor with her son: “[M]y birth coach kept encouraging me to notice the space between contractions […] so that I could use it as a reprieve, to gear up for the next contraction, to stay strong. I remember thinking, there is a life lesson here, but this isn’t the moment for it.”

The insight—that the pause between waves of pain offers an opportunity for respite, however fleeting—is one that reverberates after Nelson’s final pages. We trust the wry self-awareness of someone “trying to act nonchalant, and not like someone who keeps a 10,000-word pain history on her desktop,” because our collective pain history runs to infinite pages. Concluding a book grounded in the experience of the COVID-19 pandemic, Nelson avows, “the moment for the lesson is now,” and her “now” lands with startling prescience in our “now” of excruciating uncertainty and ongoing dismay. These hard-won lessons of resilience and stamina offer, if not consolation, then indispensable counsel.