Women in Knots: A Conversation with Sarah Rose Etter

Kate Durbin speaks to Sarah Rose Etter about her debut novel, “The Book of X.”

Women in Knots: A Conversation with Sarah Rose Etter

SARAH ROSE ETTER’S The Book of X is a difficult book to categorize. It is entirely itself, although it shares affinities with absurdism, the new weird, and the lineage of feminist coming-of-age novels. Etter’s novel brings to mind idiosyncratic masterpieces like Joy Williams’s The Changeling, a book that, as Karen Russell writes in The New Yorker, “generates its own autonomous magic.” 

The book is about Cassie, a girl born with her stomach in a knot — literally. Melding the speculative and the mundane, from her father’s job at a meat quarry to her desk job in the city, Etter’s book is formally inventive, while also being easily digestible. I found myself reading it quickly, its images lingering in my mind, filling my dreams. Etter answered my questions about The Book of X through email.


KATE DURBIN: You begin The Book of X with a Carol Rama epigraph: “Are you living in hell? Well, try to make the most of it.” Rama’s grotesquely beautiful paintings seem like a perfect reference point for Cassie’s body and experience. I am thinking, too, of how Carol Rama’s inspiration for her early paintings was her mother’s time in a psychiatric hospital. Can you talk to me about the book’s relationship to Rama?

SARAH ROSE ETTER: I found Rama’s work by accident, really. I was in New York for work, and I randomly went to The New Museum and ended up wandering into Antibodies, her first full retrospective in America. I’d known nothing about her, and I was completely blown away. Every room was a little bit different, and it traced her work from these early drawings of mental institutions and the female body through her exploration of eyeballs and rubber on canvas and fox carcasses painted gold. I became really obsessed with her life and work — and not just her paintings. Throughout the exhibit, there were blown-up paragraphs she had written that were so stark and gorgeous. The whole exhibit, I was taking notes and quoting her:

Black is the color that will help me to die. I’d like to paint everything black, it’s a kind of incineration, of wonderful agony.

I seek to improve the body, and give joy and meaning also to those that are deformed. In debased, diseased bodies I was looking for a spark, a flash of vitality, a desire, even obscene, to exist. 

Delirium and fear have always been my strength. If a person enters the labyrinth of his obsession, the obsession becomes more and more maniacal. 

I think that deflecting one’s manias, one’s obsessions, is dangerous: you have to try and group them together, make them more and more microscopic. It isn’t an easy job, but it’s the job the artist has to do.

Some of those are a bit paraphrased or cribbed, but ultimately, I found her stance on life and her own work so visceral and poetic.

She was self-taught, and every piece felt so heavy with the suffering of life and death. She responded directly to her lived experience and society — visiting her mother in mental institutions, her own mental illness, the suicide of her father, portrayals of the nude and suffering female body, the twisted black insides and intestines of the body. She went into that darkness and returned with work. In many cases, she’s portraying suffering women in institutions and adding these beautiful crowns to their heads — almost this implication that they were both human and regal, sainted in their state of agony.

There is an element of the grotesque to her work, but it’s also so honest — the female body writhing, the human body dissected, the darkness brought to light. I thought of her as a great way to forward this book, which touches on so much that we’re still hiding about the female body: miscarriage, scars, trauma.

In our social media age, it’s difficult to stumble upon anything by accident, and there’s nothing better than discovering an artist that way. I see a kinship between Rama’s work and yours, where the body reveals its truth through its form. The Book of X opens: “I was born a knot like my mother and her mother before her. Picture three women with their torsos twisted like thick pieces of rope with a single hitch in the center.” Why did you choose to draw Cassie this way?

The first line of the book came to me while I was thinking about my own family. I think I had been on the phone with my mother, and we realized we both had a similar type of anxiety about work. My grandmother has been dead for some time, but it kicked off this thought process of whether the anxiety had been handed down, generation by generation, until it got to me. The body is fascinating because so much of what we inherit is physical, chemical, even emotional. I felt very knotted that day, as if I were twisted up about something bad that was just waiting to happen. And that’s how the first line came to me.

It took me a long time to let myself interpret that first line as a literal concept, not just a fragment I could use in a poem or a short story. I had to give myself permission to be weird and build a world around it. But in some ways, it became easy; once I realized who Cassie was and what she looked like, it opened the floodgates to just experiment. While I was writing it, her body became the focal point because it felt so true — to be in high school and be obsessed with your imperfections and stare at yourself in the mirror. But here, because of her physical condition, it wasn’t as simple as getting her braces taken off or growing into her lanky limbs. Here, it became a source of obsession and terror and depression. I think the body can do that to anyone — knotted or not.

Absolutely. And as someone who also lives with anxiety, I can relate to the feeling of my stomach twisting into knots. In The Book of X, you capture the feeling of being constantly looked at, that hypervisibility that begins in adolescence and is a horrible initiation into womanhood and being constantly objectified. I won’t give away what happens to Cassie in the second half of the novel, but the entitlement others feel toward her body, the constant threat she is under, feels true. What was it like working through these intense feelings for the book? 

A few weeks ago, I saw Miriam Toews read from Women Talking, and I asked her a similar question: how did you write such a painful, wrenching story without going crazy? Her response was really beautiful. She mentioned that her writing the story was nothing compared to what the women she was writing about had gone through. But she acknowledged she had a small ritual — she would light a candle and had a small piece of jade near her whenever she wrote. I thought that was very gorgeous, a way of holding space for these women who suffered while she told that story.

I went into a very dark space when I wrote this book. I was alone in Iceland while I drafted it, and looking back, it was sort of trance-like. I was reading Robert Olen Butler’s From Where You Dream, and he suggests waking up every morning and going straight into writing. I did that for this book, which did remove a lot of the over-thinking that can stop us from just going anywhere. The initial drafts were also much darker than what is here now — there were no facts woven throughout the book, there was a lot less breathing room, there was more trauma. The final product is sort of the lighter version, and I say that only to give an idea what a burden it felt like to be in that headspace. I started calling this book “my tumor” whenever I discussed it with friends. I meant it affectionately, but it’s true — that’s what it felt like to me, a malformation of disparate parts that might hopefully be beautiful as a whole. I did go pretty crazy for a few months while writing it — deep bouts of depression, obsession over getting the editing right, fear of publishing it because it is so raw and weird.

You’re right to note that things don’t ever get better for Cassie. That part was a conscious choice — I wanted to push back against this very American idea of the novel as a redemption tale. There are so many people in America who are never redeemed. In a way, too, this is also a book about class and gender as much as it is a book about the body. Cassie is a character who doesn’t go to college, isn’t encouraged to explore her interest in manual labor, and then is thrust into a world where how she looks is prioritized above all else. It’s an outsider story too — she doesn’t look like anyone else so she can’t last long in our world. 

Not only do you undermine the trajectory of the redemption novel, you also play with form in original ways. I thought of the different vignettes almost like knots themselves. How did you come up with the form for the novel?

I’ve always been a fan of books that are doing something completely different. There’s a book called Why the Child Is Cooking in the Polenta by Aglaja Veteranyi, translated by Vincent Kling, that really resonated with me. It’s a Swiss novel about a young girl who grows up in a family of traveling circus performers, and every night her mother hangs from the big top by her hair. It’s told in short, sparse sentences, and there are pages that are just snippets of text in all caps that are really effective.

I can also think of a few other books that were on my mind while I was writing this — A Bestiary by Lily Hoang, anything by Maggie Nelson, anything by Anne Carson. Carson, especially, was so great and liberating to read; she’s constantly coming to the page in a new way.

Due in part to my love of visual art, I wanted to create a book that felt like a movie, full of heart and horror and visuals and facts. Part of that is to give the reader a break from the horrors of Cassie’s life. Then I added the facts at the very end and carried them through the book. Another part of that was wanting to create a book that would keep the audience’s attention in a world where we can barely look away from our phones for five seconds.

It’s amazing how Carson reinvents form for every book and often multiple times in a single book, like in Decreation. You also do this in The Book of X. Since you mentioned films, are there any that influenced The Book of X? Are you a horror fan? I see possible connections between your work and David Cronenberg’s films, especially The Brood, which also deals with pregnancy and trauma. I can also see parallels to Karyn Kusama’s Jennifer’s Body and Luca Guadagnino’s Suspiria, which I consider coming-of-age body horror films. And the Meat Quarry in the book feels like it could come out of a Quay Brothers film. 

Ha! You know, I never thought of that. I tend not to watch a lot of horror. I think my imagination is probably bad enough as it is. I watched the remake of Suspiria because I’m obsessed with Tilda Swinton, and I loved that. I tend more toward the weird in movies — I was insane about rewatching The Lobster and The Favourite. I think both of those heavily influenced this book. I also watched a lot of Planet Earth and Blue Planet, which is where I think the facts probably came in; I was struck frequently by how poetic the facts about nature were. It’s so funny that you don’t realize what influenced you until you sit down to talk about it. What’s that Charles de Gaulle quote? “A lion is made up of the lamb’s he’s digested.” That always felt true to me — it’s really a subconscious hodgepodge of Louise Bourgeois, Carol Rama, The Favourite, Aglaja Veteranyi, Anne Carson, and Planet Earth. Those are the lambs I’ve been eating.


Kate Durbin is a Los Angeles–based artist and writer whose work focuses on popular culture and digital media. Her fiction and poetry books include E! Entertainment, The Ravenous Audience, and the collaboration ABRA. ABRA is also a free interactive iOS app that is “a living text,” which won the 2017 Turn On Literature Prize for electronic literature and an NEA grant. In 2015, she was the Arts Queensland Poet-in-Residence in Brisbane, Australia. Her work has been featured in The New York Times, Art Forum, Art in America, The American Poetry Review, and elsewhere.

LARB Contributor

Kate Durbin is a Los Angeles–based artist and writer whose books of poetry include Hoarders (Wave Books, 2021), E! Entertainment (Wonder, 2011), and The Ravenous Audience (Akashic, 2009). Her digital poetry app, ABRA, won the Turn on Literature Prize for Electronic Literature in Europe. In 2017, and again in 2020, she was the Arts Queensland Poet-in-Residence. Kate’s artwork has been shown nationally and internationally, and has been featured in The New York Times, Art in America, Artforum, and elsewhere.


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