They describe us, … That’s all. They have the power of description, and we succumb to the pictures they construct. — Salman Rushdie, The Satanic Verses
I saw through the words to what seemed to me beyond them and not dependent on them, even though I could get there no other way than by reading those words. — J. Hillis Miller, On Literature
There’s a glib reenactment of Thomas Mann’s Berghof sanatorium midway through The Satanic Verses: a treatment facility for a respiratory ailment becomes more fantastical by the moment until we are no longer so sure if our protagonist has ever been sick — but now they are and obviously need to be hospitalized. Nigerian businessmen sprout horns, Senegalese asylum seekers grow fangs, our Chamcha becomes a manticore, and our Castorp just another Fritz. They are transformed into diagnoses of our national conditions. What may have been no more than a fiction, a line on a page, is made up into the real. Signifying nothing, then signifying something.
Diagnosis resides on the border between making-up and making-real. In “knowing between (γιγνώσχειν + διά),” diagnosis is a line that is drawn and then redrawn in the sand. Susan Sontag describes sickness as the nation of the Other; how fitting, then, that the diagnosis is its border, conferring a privileged reality to one side of its wall over the other. Symptomatic diagnosis of sickness simultaneously settles and legitimizes what it means to be well, to be not-sick, to be one of us: the forced union of the symptomatic into the systematic. In Kenneth Calhoun’s “Bad Actor” we meet a vigilante who goes by “We the People” to administer justice onto a traitor. The diagnostic act confers national legitimacy onto his (or rather, our) act of violence. Indeed, we think of diagnosis as a favor. We are healthy, they are sick; diagnosis lays bare what words we think have authority all on their own.
Take the biblical leper colony, or any variation on the diseased nation stereotype: Leila Jackson ’26 declares that “a country is a country because I say so.” Diagnoses rooted in the body can moor imagined communities, but anthropologists like Arthur Kleinman have long shown that even the body is not a stable sign under the pressure of diagnosis. What to a Chinese body may be called “neurasthenia” has given way in the West to current diagnoses of depression, chronic fatigue syndrome, myalgic encephalomyelitis, and the like. Yet instability is what grants diagnosis its power: the campaign to remove homosexuality from the DSM was powerful precisely because we acknowledge that it is mutable. Shifting diagnostic borders are not flukes or mistakes, but territorial moves in a language-game of human experience.
What to make of the diagnostic act when turned inwards? The deprivileging of diagnosis from the reins of a professional class — “therapy speak” — is a critique of contemporary language repeated ad nauseum: I am depressed, she has OCD, we all need safe spaces, how boring. Yet diagnosis bequeaths us language to build epistemologies of experience that open to others. An inflamed wound creates an opening for the poetry of McGowin Grinstead ’26, “itching the heart” for us. Indeed, self-diagnosis can reappropriate language as counterpoint to institutional encroachment and epistemic incarceration. Carmen Winant’s Body/Index presents a collage of images that suggest the possibility of co-existing reinventions. Her bodies exist in multiplicity through the varying anatomical snapshots, not precluding each other despite co-opting many of the same parts and gestures. Diagnoses maketh man.
In elementary school I had to recite the works of the Chinese author Lu Xun. His works bracingly touched on aspects of “feudal” society --- including academic recitation --- that were in variously successful processes of remaking in the turbulent first half of the last century. In Lu’s Diary of a Madman, the protagonist increasingly experiences psychosis, coming to believe that his village is trying to eat him, as they (and maybe he) have already done to his sister. The madman is ultimately cured of his madness and assimilates back into village life.
Fredric Jameson describes Diary as the “supreme example” of his (somewhat maligned) definition of Third World Literature as “national allegory,” but more essentially Madman is characterized by its double diagnostic structure. The protagonist is diagnosed with “persecution complex” and views the world with suspicion, but it also awakens him the strange state of things around him. Neighbors eye each other, silent, stagnant, and hungry, while the village teeters on the brink of collapse. Thus, what the madman actually sees is a metaphor for the oppressive Chinese feudal society at-large, ensnared by tradition and involuted into itself. The diagnosed patient comes out of the clinic with a new ontological orientation: a re-understood past and re-ordered future. The Sick Man requires an author.
To diagnose is to see what others cannot and transcribe it into action. Diagnosis gives an actionable fiction — scrawled onto a page, or notebook, or electronic healthcare system — the potential to heal. Lu originally studied medicine overseas in Japan, but quit to focus on writing, to heal the spiritual, not physical, pangs of my nation. Perhaps one form of diagnostic training informs another. Franz Fanon, Anton Chekov, Friedrich Schiller, John Keats, William Carlos Williams: all diagnosticians.
In Daniel Frears’s “Boy Found on Speedwell with Mouthful of Dirt,” the words of a newspaper are inextricable from reality. The newspaper is prophetic at times, seemingly dictating the boy’s various inelegancies, but sways during others, following along. The World and the Text write each other — or, at least that’s where the Critic falls in. Yet a diagnostic Trinity seems further and further from reality: have not enough think pieces and crisis histories diagnosed the crimes of our times? Do we really not know the ills that keep us up at night? For a more literal example: how many around the world are knowingly dying of conditions we have long diagnosed — starvation, infection, poverty; when does a diagnosis become a death sentence, a certificate for our crimes?
Our ills are not goblins named Rumpelstiltskin, let us be clear. Naming is not a solution but the beginning of a diagnostician’s political and practical orientation towards healing.
Diagnoses heavy and light fill the pages of this Advocate issue. Rodrick Howard titles a painting Paranoia; The Drift’s editors are easily susceptible to boredom. I cannot tell you whether these diagnoses are apt, and I encourage you to inspect their bodies, digest their words, and diagnose for yourself. Perhaps I can tell you one thing about Paranoia, that to call violence a figment of the imagination is a dangerous thing indeed. Yet again, diagnosis itself is the call of real violence — radiate diseased cells, quarantine diseased nations — originating from a crossed line, imagined in the sand. Sawyer Connally ’28 diagnoses a severe case of disembarkment syndrome onboard a boat (the USS Carter Hall) — in that case, I hope some lines are crossed. There is no such thing as a neutral exercise of power over the body’s access to care, social position, and even identity.
Lisa Mendelman tells Annika Inampudi ’25 a personal story of loss from errors in the hospital: “The report doesn’t get read correctly, like it’s riddled with human error, not necessarily out of any kind of malevolence on the part of these people, right? Just because we’re all human and we make those kinds of mistakes.” True diagnosis is no faultless altar or hardbound book, but a human addressing another human at her most vulnerable, in rooms big and small around the world at every moment. Diagnosis demands leaps of faith despite being a fallible art. For it to overcome the efficacies or neutralities we inevitably lose in the cracks of human discourse, I can only make another leap of faith: diagnosis as a form of care.
We are immensely happy to publish the work of four physicians in the Diagnosis Issue. Their joint essay argues for the urgency of diagnosis from technological, social, and decolonial perspectives. The brevity of the title, “On Diagnostic Equity,” reflects the countless factors that must work together for global equity in care. Diagnoses are time sensitive, and never more so than now. Mendelman discusses revising the language of her grant application for studying the history and literature of psychiatric diagnoses in the context of race, gender, and sexuality. Kiara Barrow ‘16 and Rebecca Panovka ’16, on the other hand, talk about their mission to refine leftist cultural diagnoses beyond “this is bad,” from their time leading the Advocate to The Drift.
In Drape (transfusion) the Fermaux-Valdezes transform a simple blood transfusion into the Pietà. The nurse is heroic; the naked patient is monumental. In Igor Shcherbakov’s Dream of the Earth, a girl in fetal position is a nymph. “Today’s event is / royal or political just as grace and water are,” Ewen Glass writes.
This is all to say, that diagnosis starts and ends with the body. Like grace and water: the body is our indisputable, holy, and grounding truth. Diagnostic borders shift, pathologies go in and out of fashion, but the body stays, and with it, our duty to care.
Frank Y.C. Liu
President
2025