At midday on most days, I’m felled by the fatigue of an illness that puts spots before my eyes and pulls at my limbs. This tiredness forms a blinking, mindless need to lie down. As my body’s longing for the surface of the sofa takes over, I throw the cat off my spot – whoosh – and drop down. With the immediacy of the need to be horizontal satisfied, I feel the frisson of a blood rush. My legs vibrate as the blood moves up and down inside them. When I sense the blood reach my fingertips, I sigh. The cat climbs onto my stomach to sleep knowing I won’t be moving for a while.  

I inhabit the land of fatigue for about two hours each day.  I watch, immobilized on the sofa, as mind and body blur, melt into each other. In the territory of advanced fatigue, bodily feeling blossoms into thought.  With my body clinging to the sofa and my blood relocating itself, my “to do” list becomes academic.  I ponder that I don’t actually need to own the professional clothes that I’d been planning to get to the dry cleaners because I can’t do anything.  I can’t work.  And I’ll never work again.  I can’t move and I will never move again.  My mind rolls over to other tasks and I remember we’re having people over for dinner.  I feel a fuzzy, faded form of anxiety, a muffled version that seems to come from a distance: I must cancel before people leave home.  I can’t have people over for dinner because I can’t cook because I can’t stand up.

The deep fatigue that has turned me into a personal experiment in mind-body states, I’m told, is physical, not psychological.  It has a medical diagnosis --  orthostatic intolerance – and afflicted me a few years ago when my then sixty-two-year-old body lost its ability to adjust my blood pressure to its fluctuating needs. Neurologists do not know what causes the autonomic nervous system to malfunction in this way though, in my case, they posit that a virus I had, which followed a bacterial infection and preceded a case of c. difficile, was the instigator.  

Fatiguing illnesses carry the stigma of psychosomatic conditions and arouse fear and anger in those who suffer. Laura Hillenbrand, the author of Seabiscuit and Unbroken who suffers with severe chronic fatigue syndrome, described her relief, after a year of doctors’ visits, at hearing the head of infectious disease at Johns Hopkins say to her, “You have a real disease.”  Real diseases, colloquially, are those that have an epidemiological case definition and can be identified as a known entity, experienced by many, and thus not simply imagined.  Medical affirmation of a diagnosis removes the onus of symptoms with no clear organic cause and allows the sufferer to escape the dreaded realm of psychogenic disorders.  

With a medical diagnosis to tout, I escape the stigma, and I’m free of the blame that lies at the heart of our understanding of psychosomatic conditions. I’m innocent.  I’ve been exonerated by internal medicine, cardiology, neurology and psychiatry.  But if my symptoms didn’t add up to an identifiable condition recognized by contemporary medicine, where would the blame lie?  Of what, exactly, would I be guilty?  

For most of the hours of the day, I’m a normal person.  I experience my mind as we commonly understand it, as the conscious, choosing mind that Locke and Rousseau assumed as the basis for the social contract: the rational mind on which we confidently rest our belief in the rightness of governments based on the consent of the governed.  It’s the self-directed and willful mind that accepts responsibility for the illegal left-hand turn I made onto Main Street and pays its fine with a suitable sense of guilt.

In fatigue, I drift, I’m helpless, bodily pinned to the sofa and mentally finding myself incompetent, disabled.  On the sofa I stumble across a picture of myself in a department store, trying on a cobalt blue coat dress and getting lost in the store, without my shoes, being told by a salesperson that my credit card is not good even though I had just bought a pair of silver earrings with lapis stones using that card a minute ago.  Queen Elizabeth shows her disapproval at my husband’s tweed jacket which he’s worn to a formal occasion at Westminster Cathedral to which we’ve been invited.
 
Lucid dreaming morphs into deeper dreams.  At some point, I wake up with a clear mind.  The dry cleaning can wait until tomorrow.  Queen Elizabeth recedes back onto my internet news feed.  The cat jumps off the sofa as I stir. As mind and body resume their distinct shapes, I wonder whether, when fatigue strikes again at midday tomorrow, I’ll be better able to distinguish the contents of my fatigued mind from the thoughts generated by my supposedly better self.  Maybe.  For now, it’s time to start making dinner.  

“Body as Mind” describes my experience with a medical condition -- orthostatic intolerance -- whose symptoms are often seen as psychosomatic. With fatigue as its primary manifestation, this condition has turned me into a personal experiment in the blurriness of the boundary between mind and body. This essay reflects my own experience with this condition as well as thinking garnered from my own research in mental health and my past work administering services to adults with serious mental illness. 

Barbara Felton is a farmer and writer in Warwick, New York who began writing creative nonfiction in 2014 following careers in psychology (NYU; Department of Psychology) and mental health administration.  Her publications, in addition to her academic work, include personal essays published in Psychiatric Services, Dirt, skirt! and Tupelo Quarterly. She writes about livestock farming and the world of psychiatric illness.