Jon Venn reviews So Much More Than a Headache: Understanding Migraine through Literature (The Kent State University Press, 2020) by Kathleen O’Shea.
The migraine is a sealed phenomenon and leaves those who suffer from it alone in their experience of pain. It is to puncture this sense of isolation that Kathleen J. O’Shea (herself a migraineur) has compilated So Much More Than a Headache: Understanding Migraine Through Literature. The collection brings together articles, extracts from fiction and non-fiction, poetry, and a play, to explore different attributes of the migraine as an experience.
Outside of the extracts acting as bookends to the collection (In Bed by Joan Didion and Half-Skull Days by Anna Leahy) the volume is divided into five sections outlining different qualities and considerations of the migraine. In Part I of the anthology, titled ‘What It Feels Like’, the process and visceral experience of the migraine is explored, migraine as a phenomenological sensation. Part I is divided into subsections: ‘The Warning Signs’, followed by ‘The Headache’ itself, and finally the aftermath Postdrome Phase termed colloquially as ‘The Hangover’. The ordering seems designed to evoke that sense of flow, providing a sense of the narrative arc of the migraine, rather than conceiving the migraine as an instantaneous phenomenon . The notion of the migraine aura (an ordinarily visual disturbance that precedes the migraine itself), despite only present in a fifth of migraineurs, is taken up as a phenomenon in ‘The Warning Signs’. It excites description, as Oliver Sacks details in his visions of ‘tiny branching lines, like twigs, or geometrical structures covering the entire visual field: lattices, checkerboards, cobwebs, and honeycombs’ (11), or as in Jean Hanson’s stark image of the ‘lightning in my eyes’ (31). The section on ‘The Headache’, in its concern with the visceral, immediate, totality of pain, shifts away from prose description. It is primarily composed of poetry, from figures such as Marilyn Hacker and Robert Herrick. O’Hara notes of the selections that they possess, ‘warlike, violent imagery and fragmented lines and line breaks, capturing the utter chaos sufferers feel in their brains and body’ (4). The section of ‘The Hangover’ is brief, comprised of two poems by William Dunbar and Michael Morse.
In ‘What People Don’t See: The Invisibility of the Migraine’, Part II of the anthology, the emphasis shifts from the experience of the migraine to its misunderstanding by non-migraineurs and the medical establishment. The section explores ‘invisible’ pain and the sense of isolation that accompanies the visceral pain of the migraine. As a section, it speaks most to the collection’s stated aims of situating literature as a means to address isolation and straddle the gulf between migraineurs and those without experience of it. Moreover, across the selection, at points a suggestion arises that the migraineur is also susceptible to invisibilities, that in the midst of the pain its cessation becomes unconceivable.
Part III, ‘It’s Just a Headache?’, continues this concern with invisible pain. It details how the perception of the migraine as proximate to the headache leads to the damaging presumption of understanding. Loneliness is drawn out again as a consequence of the ignorant equivalence made variously by family, friends, colleagues, and medical professionals. The sense of presumed understanding as a form of harm is potent, even extending to the aetiology of the migraine as Lisa Gluskin-Stonestreet outlines the various supposed causes of the phenomenon in Six Explanations for Migraine.
Part IV – ‘It’s a Lifetime Job’ – shifts the concern, from the empathetic gulfs of the non-migraineur to the question of longevity of the phenomenon, something that is reckoned with over a lifetime. The sense, not of migraine as an individuated phenomenon, but as something that scores itself across a longer and wider temporality, is richly explored. As Kathleen J. O’Shea outlines, ‘it’s like holding down an additional full-time job—one without guaranteed vacations and sick days’ (142). The section seems to offer questions of the porous boundaries between the phenomenon and identity, as Andrew Levy suggests in A Brain Wider Than the Sky, that ‘The migraine is my companion now, and I simply can’t live without it. It has become my geography, my compass’ (150).
Finally, in Part V, ‘When It’s Gone’ refers to the lapses and respites that exist between the migraine, despite the knowledge that, as O’Shea states, ’we know there will be another’ (180). As with Part IV, this section explores the more complicated temporality and legacy of the migraine, its experience, and its management. The fraught sense of negotiating the vacillations of a long-term condition is ably presented, between a sense of relief and trepidation, as Michael Cunningham narrates in The Hours, ‘her periods of freedom, however long, always feel provisional’ (185).
The structure of the collection is coherent and well-judged. Each section is ably introduced by O’Shea, outlining the ratiocination for the part, drawing out potential connections and themes elicited from the selection. As with all compilations, resonances and connections expand beyond the stated ‘themes’ of each section. I was drawn to the negotiations and struggles migraineurs necessarily make with medical services and how the bureaucratic components effect the sense of the phenomenon (as expressed in the extracts from Maia Sepp’s The Migraine Mafia). Likewise, especially in autobiographical work, I noted the attention to the different accounts of the struggle and act of writing to the migraineur.
O’Shea clearly outlines the intended audiences and purposes for this volume. She claims the collection is ‘directed, first of all, but not solely to, those who suffer migraine’ (xi). At its strongest, this volume offers a substantial contribution to pierce the isolation of the experience. The extracts themselves often attest to literature’s ability to foster a sense of recognition against the solitude of pain, as they refer to and cite one another. In the final selection of the anthology, Half-Skull Days by Anna Leahy, the comfort of such citationality is pronounced, where the work of Didion, Levy, and Sacks fosters an imagined communitas. At its best, for instance in Part I’s section on ‘The Headache’, the collection manages to combine this sense of connection with breadth of context, including poets such as Evelyn Lau and Iman Mersal. However, if this work’s purpose is (in part) to provide solace and connection to the wide range of those who suffer from the migraine, the breadth of selection could have been furthered, given the dominance of white British and American writers across the compilation.
Outside of being directed to migraineurs themselves, O’Shea also states that the ‘anthology will afford medical students and their professors a substantive tool to teach empathy and compassion’ (xv). The compilation seems orientated by a conviction that, ‘through the discovery of literature we develop empathy’ (xiv). Whilst the sentiment that medical students and practice should be informed by the accounts of migraineurs is one with which many would sympathize, this account of ‘empathy’ seemed slightly undertheorized. Whilst the compilation’s comparative lack of space to elaborate is an understandable challenge, to suggest the selected literature can elicit empathy ushers in critical questions of what constitutes empathy, how it is cultivated, and to what extent it can be understood as an uncontested ‘good’, as memorably challenged and unpacked in Anne Whitehead’s Medicine and Empathy in Contemporary British Fiction.
This compilation, nevertheless, represents an essential intervention and contribution into a phenomenon. The choices (both of selection and of their organization) give a profound sense of the complexity and depth of the ‘migraine’ as a phenomenon, one that is not simply limited to more generalized questions of pain, gently stretching from the sense of the migraine as phenomenon, to the violence of its invisibility, to the sense of it as a phenomenon that abates and returns over the course of decades.
Dr Jon Venn is Teaching Fellow in Drama at the University of Birmingham. He specializes in mental health and suicide in contemporary British and Irish theatre. His research has appeared in publications such as the Interdisicplinary Journal of Voice Studies, Performing Ethos, and the Cambridge Companion to Theatre and Science. His monograph, Madness in Contemporary British Theatre: Representations and Resistances was published this year by Palgrave Macmillan. Follow Jon on Twitter @jonvenn.