Belly Alchemy : Gastritis

Life is a fountain of delight: but all wells are poisoned for him out of whom an upset stomach, the father of affliction, speaks.

Friedrich Nietzsche, Thus Spake Zarathustra (1883)

In the 8th century, when Jabir ibn Hayyan was in the process of turning alchemy into chemistry, he had his hopes set higher than than isolating citric acid. Sure, he invented the alembic, introduced the experimental method, formalized crystallization and distillation, etcetera, but his main project was takwin, a wildly ambitious goal that entailed an absolute understanding of biology.

In my quest for treating persistent stomach pain (GERD, gastritis, IBS), I was surprised at how distant takwin still seems to be after 1200 years. I’ve had plenty of times where OTC meds sufficed, or I made simple lifestyle modifications that made the problem go away. But after a particularly brutal virus, my body wasn’t kidding around, and I’ve found online communities where I’m clearly one of very many. I’ve read many stories written in a shocked and sometimes suicidal panic, where a sufferer’s prescribed drugs only help superficially, create vicious dependence cycles, do nothing, or make things worse with painful side effects. In a way, this makes sense, since it’s unlikely that human culture in this particular moment will have an complete understanding of the trillions of moving parts involved in human wellness. So how did people handle this kind of pain in the generations before mine?

For most of human history, millennia would pass with sparse innovation. Baking soda (sodium bicarbonate), the central home remedy for calming down excess stomach acid, had been stumbled upon by ancient Mesopotamians five thousand years ago, and Pliny’s culture had figured out Tums two thousand years ago by grinding up corals which contained calcium carbonate. It took until the late 18th century to move on to an alternative treatment involving bismuth, which got its modern form in the early 1900s as bismuth subsalicylate (Pepto Bismol). These tools make up the bulk of what the average person in the third millennium A.D. would resort to when they have an upset stomach, and all three are crude interventions. For the fancier stuff, humans had to wait until the 20th century, where belly science really took off.

In the textbooks of the 1920’s, it was already established that histamines put the brakes on stomach acid, but the usual histamine medicines didn’t seem to do anything, so they figured there must be a different receptor in the same category, hypothesized as H2. It took them twelve years of research to come up with a solution, although given their technique of trying hundreds of random chemical combinations, one gets the impression that there isn’t much scientific insight. After a bunch of useless toxic compounds, they came up with a marketable result and their success was nothing less than monumental. The first H2 blocker, cimetidine, pulled in $4.6 billion in a single year, becoming the best-selling prescription drug in history and earning one of their chemists a Nobel prize in medicine.

Why isn’t this blockbuster drug on the (Canadian) shelves? I don’t know why, although a gastroenterologist refused to prescribe cimetidine since she said it causes impotence in men. Worse things have surfaced, like the carcinogenic compound recently found in ranitidine (Zantac), a later generation of H2 blocker. The only survivor of the H2 crew is famotidine, commonly known as Pepcid, which we might reasonably suspect has its own undiscovered bête noire (nizatidine remains obscure). In any case, all these drugs had a big problem since the very beginning, which is that everyone who was treated for ulcers would relapse within a year, requiring a lifelong administration of the drug. For pills that cost $100 a month, the drug companies were hardly frowning.

Ulcer? Hardly Knew Her

Peptic ulcers are excruciating, and not only did medical experts often blame the victim for poor stress management, but it could lead to a slow, painful death. For a long time, ulcers required brutal surgery that only helped half the patients and crippled a quarter of them, a common occurrence well into the 20th century.

Some light broke with the discovery of Vitamin U, when juice extracted from raw cabbages showed great potential in healing ulcers, possibly due to the presence of s-methylmethionine sulfonium chloride. A small study published 1949 showed that drinking at least a liter of fresh cabbage juice every day for a couple of weeks wiped out ulcers, but even though the results were replicated twice, it never picked up, and Vitamin U remains an obscure and unstudied element. Might have something to do with the fact that profit margins of cabbage are tiny, and no one’s going to invest money to research it. Or maybe it’s because cabbage juice is disgusting, and nobody has the time to press fresh juice from two kilos of cabbage every day.

It would take way more suffering, effort and time to shed more light on these nasty little stomach craters. The fog began to clear in the 1970’s, when a couple of maverick Australians (are there any other kind?) made the discovery that killing a little bug named Helicobacter Pylori could mean reversing a death sentence for many ulcer sufferers. This was like finding out that a short course of antibiotics could cure diabetes; mammamia! Although the story about the discovery often features Barry Marshall taking a bold risk and drinking H. Pylori broth to prove his hypothesis, he had already successfully treated a patient before he tried it out on himself. Still though, it was a gutsy move and he rules for doing it. After dosing himself and experiencing the classic symptoms, he cured himself with readily available antibiotics. You’d think this would be front-page news, but most experts were deeply skeptical, and it took another decade before it caught on.

And really, a decade isn’t that bad when it comes to medical breakthroughs. If science is conservative, medicine is straight-up North Korean in its inertia: it takes about 17 years for new findings to reach clinical practice. This is probably owing to the way medicine was originally a priestly caste in elite universities geared around theology and absolute truths established in a book, rather than an open, iterative understanding of the world. Nothing new under the sun; the guy who told doctors to wash their hands when delivering babies after examining corpses got fired and eventually committed to a mental hospital where he died a slow and painful death. Life’s tough!

Marshall has spoken out about how crummy medical training was for becoming a general practitioner:

I realized that at least 50 percent of patients were undiagnosable. In medical school it’s quite possible to get taught that you can diagnose everybody and treat everything. But then you get out in the real world and find that for most patients walking through your door, you have no idea what’s causing their symptoms. You could slice up that person into a trillion molecules and study every one and they’d all be completely normal. I was never satisfied with saying that by ruling out all these diseases, a person must have a fake disease, so I accepted the fact that lots of times I couldn’t reach a fundamental diagnosis, and I kept an open mind.

This open mindedness earned Barry Marshall & Robin Warren a Nobel prize, and rightly so, but their discovery is bittersweet. Their finding, along with the eradication therapy, is now just as entrenched as the dogma they fought hard to overthrow, which is unfortunate since H. Pylori turns out not to be the whole story. A lot of people with the bacteria feel fine, and plenty of people without the bug still manage to get debilitating ulcers. Not only that, but if you’ve ever seen the frightening box of antibiotics that nuke your gut, you’ll likely want to try some alternatives, maybe nigella sativa seeds or Brussels sprouts, although research on these kinds of alternatives are still in their infancy until the market’s changed by antibiotic resistance.

The Little Pump That Could

Along with antibiotics for H. Pylori, the golden standard for modern stomach woes is the proton pump inhibitor, discovered even more accidentally than H2 blockers. It was stumbled upon by chemists trying to develop an antiviral drug when they noticed that one of the compounds was great at shutting off certain acid pumps in the stomach, although they got stuck for a while figuring out how to get it to survive the acidic environment of the stomach. Once they nailed that, omeprazole was born, and although they earned some $37 billion its first 13 years, it took a while to catch on, in part because of the cancer scares that surfaced in the trials. Nonetheless, four years after its release in 1989, the PPI managed to outcompete H2 blockers.

AstraZeneca, the makers of omeprazole, fought bitterly to extend the patent as much as possible, although they eventually gave up whining in court about not having enough diamonds to bathe in, and wound up just making a tiny tweak to omeprazole and releasing it as an all-new drug. Ridiculously lazy and bound to fail, right? Well, esomeprazole (aka Nexium) has earned them a healthy $72 billion to date, and managed to reach coveted OTC status.

There are over 100 million prescriptions for proton pump inhibitors in North America every year, and the world spends $23 billion on them every year, although it doesn’t hurt that drug companies give bundles of cash to doctors along with samples to distribute. These drugs are prescribed liberally since they’re reliably powerful, although their mechanism has the elegance of a beagle playing piano. The official pamphlets warn against any treatment beyond eight weeks, but this is a deceptive legal formality which doesn’t reflect the fact that many people are stuck on the drug for years. Even in healthy controls, stopping a PPI will result in the rebound effect, where the body freaks out thinking it’s been asleep at the wheel and overproduces massive quantities of acid to compensate. This can take months to resolve.

When I first tried pantoprazole, a later generation of PPI with better bioavailability, it felt like the pumps in my stomach shut off. My guts began to cramp, food wouldn’t digest, I got dizzy, my heartbeat was erratic, and my abdomen was zapped with thunderbolts of pain. It alleviated the burning at the cost of messing everything else up, like using a rocket launcher to deal with bedbugs.

I went into the alternative route for a few months, but it looked like those options were only going to start working in another lifetime. A few months in, I had a night with such overwhelming pain that I caved and tried another PPI, the latest generation of the drug. Dexilant, or dexlansoprazole, has Dual Delayed Release™ w/ Extra Racing Stripes™ and UnicornMagic™ , meaning that you don’t have to take it before a meal like the other PPIs. It wiped out the burning and reflux, along with a cascade of nasty side effects where it felt like my insides were imploding. I figured my version of toughing it out would involve taking it every other day, and since the drug was so strong, I would have a little burning & reflux on the off days, and have time for the side effects to subside. After a month of trying this out, the nausea was driving me nuts. I decided I’d rather have my insides be on fire than to feel like I’m just about to throw up for hours on end, with a swollen throat and tongue to boot.

After weaning myself off, the rebound had me on the ropes. My old symptoms came back with a host of new ones, and even a simple, small, alkaline meal burned my chest like the fire of my hatred for corporeality. The throat and chest tightness became a daily reality, making any food difficult to swallow and having it constantly stuck just behind my Adam’s apple. I tried using Gaviscon to wean myself off, which made my tongue swell and burn from a bunch of delicious, nutritious foods that hadn’t been an issue before; avocados, bananas, mackerel, almond milk, peanut butter, spinach, and hemp seeds.

The answer? Take a PPI, of course! I tried to power through the pain and just accept my old problems, but after a month of no improvement, I returned to my abusive lover. Or rather, a slightly different version; I wasn’t going to let dexlansoprazole slap me around anymore, so I tried omeprazole, esomaprazole and rabeprazole. All three gave me awful chest pain, but I settled on the latter because it metabolized a little differently than all the rest. It worked for a little bit, but after a couple of weeks, it started to wear off, and after a month, I got a lung infection. Since PPIs are linked to pneumonia, I can’t help but think this is another one of their many gifts.

So what else is there?

Eastern Wisdom

Mucosta (or rebamipide) was developed in Japan at the tail-end of the Belly Alchemy Boom of the ’70s and ’80s, and currently rakes in billions of dollars. It’s a gastroprotective drug as opposed to an antacid, and provides stiff competition to H2 blockers and PPIs. While it’s a popular drug in Asia, it’s virtually unknown in North America, so I had to resort to eBay to get some. The ancedotal reviews are mixed, with some people claiming miraculous results and others horrified at the new levels of pain brought on by the drug. The legitimate medical publications seem to think it’s great.

Rebamipide works in a more intelligent way than PPIs since it boosts the ability of the stomach to heal itself. It increases mucus production and blood flow, protects from chemical damage, and prevents ulcers. It also increases something called prostaglandin E2 (PGE2) via prostaglandin EP4 receptor gene expression, which neutralizes the acid in the duodenum (the first part of the small intestine) and provides various protective effects. Sounds great, but my first rebamipide dosage was like getting punched in the head, I felt disoriented, in pain, and ready to cry. I looked up the link between PGE2 and headaches, with the first result showing it can clearly induce migraines, so I stoically accepted a broken head with the hope of healing my broken stomach.

The PGE2 connection to migraines made me realize that I’ve been abusing and neglecting my PGE2 since I was a kid. At one point I collapsed on the playground from one of my horrible migraines and had my parents take me to the ER, where I passed out and recovered enough to go back home to sleep it off. This was indicative of the need to rest and take gentle care of myself, but I wanted a quick fix. After a migraine attack during a visit to some family friends, I was offered some ibuprofen (Advil), and was finally old enough to take some. My parents were understandably apprehensive, but the effects were nothing short of miraculous, relieving my symptoms in 20 minutes. I relied on the drug for many years, and it only started to catch up to me when I was 17, manifesting as nasty heartburn. I regret my decision to rely on this drug, but I understand my desire for normalcy, since as anyone with a migraine knows, it can shut your life down. I’ve had migraine attacks where even thoughts going through my mind felt like sandpaper scraping a wound. But regularly lying alone in the dark wasn’t compatible with a normal life.

As you might have already guessed, ibuprofen shuts down PGE2 by messing with cyclooxygenase, killing both the quality of the stomach lining’s protective mucus as well as its quantity, increasing the risk of ulcers. Switching to acetaminophen (Tylenol) eventually healed some of the damage and provided years of relief, although it came with plenty of side effects, eventually scaring me off with its increased risk of kidney cancer. They claim it’s stomach friendly and that it only lowers PGE2 outside the gut, but that’s not been my experience, probably because I needed such high doses for it to have any effect. I eventually settled on CBD, which seemed like the best headache relief since it’s gentler than ibuprofen or acetaminophen and requires tiny doses, ranging from 10mg for mild headaches and 30mg for strong ones. I was dismayed to find that CBD also tinkers with PGE2, and that THC ruins gut motility, which leads me to conclude, as others have, that chronic pain is currently an impossible problem, something I’ll expand on shortly.

After a month on rebamipide my symptoms showed no improvement, and my chest pain got slightly worse, so I decided to give up on it. There’s some evidence that PGE2 can be naturally increased by increasing the intake of linoleic acid, which brings me to the thorniest subject of all: diet.

Food of the Gods

The irony is that my diet was the best it’s ever been before my digestive tract took a nosedive, since I was cooking all my meals at home and avoiding all processed foods, sugar, coffee, and alcohol, choosing instead to eat fruits, veggies and lean meat. Such is the caprice of viral infections. But I needed to up the ante on my dietary knowledge, and after spending hundreds of hours researching nutrition and thereby plunging into the Dunning-Kruger valley, the majority of dietary advice looks painfully facile. Companies spend many years and billions of dollars to figure out the effects of a drug, usually just a single molecule, while any common fruit at the supermarket has thousands of different molecules.

You’d think that there would be precision to something as basic as caloric energy, but even that’s a rough estimate. The caloric content of any natural product varies even if it’s from the same crop with the same storage conditions. Calories will change depending on the eater’s genetics and gut bacteria, as well as simple mechanical alterations like if food is blended or heated. You can forget accuracy if there are subtle but debilitating microscopic defects in the gut like villus atrophy, GTPase Rab11a & Rab8a dysfunction, increased cytoplasmic vacuolization, intercellular edema, enterocyte apoptosis, and reduction in tight junction protein expression.

One study did find that most ulcer patients benefit from a high-protein diet, but also that forty percent of ulcer patients will get better no matter what you feed them. Some people in a 1914 study ate lots & lots of cream, and they got better just as long as they stuck with it. You would also think that restrictions like alcohol are common sense, but even that is up for debate.

I found this conclusion from a 1957 study bracingly honest, summarizing the “failure of diet to significantly influence the course of the ulcer patient”:

The natural history of the disease, rather than the long-term medical treatment was responsible for the clinical course. The natural history of peptic ulcer, however, is of little help in dealing with the individual patient. Each patient must be studied and treated as an individual. The factors responsible for his ulcer must be determined if possible. This is frequently very difficult, and as a result we are prone to speak of patients as “ulcer-bearing” individuals or having the “ulcer diathesis.” The ulcer diathesis appears to be a very important part of the ulcer patient.

The author goes on to quote an excerpt from a 1943 BMJ article:

To separate the ulcer patient from his diathesis is like severing the fisherman from his soul, and until we can learn some new secret of Nature, we must be content to try to teach the patient how best to live at peace with his ulcer and to do this he must probably learn how to live at peace with himself.

Some new secrets of Nature did drip out in the form of H. Pylori, but there are many more to come. Philosophical discussion of suffering and death in a medical context would be refreshing if it wasn’t a glib mask for ignorance and impotence, amounting to “just deal with it, bruh”. But if my diagnosis and treatment wasn’t a question mark, it’s still the most important question: how can I learn to be at peace with suffering?

Will to Chill Pill

One shortcut to peace is chemistry: myself and many others with intractable stomach pain are prescribed low doses of antidepressants. I’m not at all against the idea of using chemicals to improve my consciousness, I think it’s safe & necessary in many cases, but if PPIs are inelegant piano beagles, SSRIs are trinket ratdogs with that struggle to reach the keys.

Even the iron-willed Friedrich Nietzsche, who remains the popular advocate for sublimating pain, depended on drugs as his illness progressed. He had terrible congenital migraines and contracted severe gastrointestinal infections while he was a nurse in the Franco-Prussian war, which made his adult life an uphill battle. He eventually quit his job because of his failing health, living off of a pension that University of Basel graciously paid him indefinitely. The year after he quit, he wrote of his symptoms:

…for many hours of the day, [I have] a sensation closely akin to seasickness, a semi-paralysis that makes it difficult to speak, alternating with furious attacks (the last one made me vomit for three days and three nights, I longed for death!). I can’t read, rarely write, visit no one, can’t listen to music! I keep to myself and take walks in the rarefied air, a diet of eggs and milk. No pain-relieving remedies work. The cold is harmful to me.

When Paul Lanzky met him, he noted that the bulk of Nietzsche’s everyday pain consisted in his broken digestion, which Lanzky cruelly blamed on minor lifestyle choices like high protein intake. If only he’d chewed his food more thoroughly or ate more veggies he’d be cured, Lanzky figured. This oversimplification of human biology is especially deplorable given the fact that 150 years later, and there is still no cure or treatment for the after-effects of dysentery or other severe infections.

To cope with this hellishness, Nietzsche used chloral hydrate (a sort of 19th century Xanax) to help him fall asleep, which would come with hallucinatory side effects like visions of “an abundance of fantastic flowers, winding and intertwining, constantly growing and changing forms and colors in exotic luxuriance, sprouting one out of the other.” Along with mysterious Javanese tinctures, he relied on opium, something he argued was much better than alcohol, which he dubbed “the European poison”. There’s something to this, as there’s a steady flow of online posts from people whose stomachs are completely ruined after a tryst with alcohol. Unfortunately for Nietzsche, his various chemical interventions were ineffective and if anything, only hastened his painful demise.

Bro, That’s Sick!

If drugs won’t work, we might need to use philosophy. There have been moments this past year where my little tummy hurt so much & for so long that I had fantasies cutting open my guts and ripping everything out, despite the utter stupidity of this revenge. During these levels of pain, talk of finding peace is a cruel joke, but there’s gotta be some truth to it. One way to start finding this truth is through pendulating which I’ve written about here, but on a broader level, I’ve found it useful to look at the way that pain is constitutive of life. To start with, in order to have had anything resembling civilization, we’ve tortured each-other into compliance for countless ages:

Only a body amenable to suffering is amenable to the kind of socialization that is characteristic of human life. Pain is the price of culture… [which], in its origins, is the unconscious cultivation and use of pain in order to facilitate the formation of norms that regulate behaviour and thereby ensure communal survival.

Peter Sedgwick, Nietzsche, Illness and the Body

Splitting apart the human soul into instinct and civility means a permanent state of inner conflict, which is why Nietzsche calls human beings “the sick animal”. Children are a clear example of cultural tyranny at work, since they need to have every aspect of their instincts, beliefs and actions corrected. They are notoriously stupid with their dietary choices, since their bodies are wired to crave the junkiest of junk foods, which in turn are ingeniously designed to be hyperpalatable. Healthy veggies are an awful chore to eat, probably since their beneficial effects are from the small amounts of poison that stimulate our immune systems. With this in mind, it’s easy to understand why food takes on such a dark and torturous dimension when the stomach is in pain. So many of the palate’s deepest instincts ravage the GI system, and a large variety of cultural norms revolve around hyperpalatability. That is, it sometimes seems the highest goal of online support groups is just to be able to eat harsh junk food again, with people dreaming of returning to a child’s tolerance for pizza and ice cream, eventually working their way up to the point where their stomach can handle the twin elixirs of Western adults: caffeine & alcohol. Using mouth pleasure as a means of determining the quality of food may work for every other species and provides them both joy and nutrition, but it’s a broken travesty for the Promethean human being. We need to lean on chromatographic partition coefficients to measure invisible life-giving molecules and depend on state governments to add in missing essentials like Vitamin E, which in some cases is mandatory.

Behind the wish to return to innocent satisfaction is the restitution narrative, a concept introduced by Arthur Frank which is intuitively familiar to all of us in cold medicine ads. Someone has their social obligations ruined by an illness, but with the purchase of a medical product, the sufferer is restored to normalcy. Visits to the doctor are generally framed in this way, with the expectation that the patient will resume their social roles in due course after they are given the restitutive product, usually in the form of prescribed medicine, but also with restitutive periods of time. Talcott Parsons, a sociologist of medicine, describes the doctor as an agent of social control, whose goal is to return patients to their regular social roles in work and family, rather than to fully engage with their suffering. Reading about this was a personal epiphany, since it explained the maddening experience of having doctors ignore my detailed descriptions of intense pain and focusing entirely on numerical data that needed to be restored to a defined range, like my weight.

This “broken car model” divides the suffering body into a series of parts which have their malfunction addressed, thereby dodging mortality. When a patient isn’t being helped by treatment and lab tests give inconclusive or contradictory results, a natural response would be to feel hopeless. But in the medical view of things, this is classified as depression, a pathological hiccup to be fixed through drugs and licensed authorities. In a sense, this is reasonable, since entertaining the vulnerability, futility and impotence underlying medical treatment is to invite chaos.

Chaos narratives are somewhat of an oxymoron, since the experience of chaos is too painful and overwhelming to narrated coherently. Days in-between writing this essay, my thoughts were a jumble of reactive pain, anger and hopelessness, a classically incoherent chaos narrative. But when there’s reflective distance, the sufferer can create a quest narrative, which assumes that there is value to be gained from the illness that can be shared. This is in contrast to the restitution narrative which centers around the restitutive product or treatment. The quest loosely follows the hero’s journey as described by Joseph Campbell. There’s departure; a break with normal bodily function, initiation; extensive engagement with the medical gaze, and finally return; the sufferer integrates the dark side of life after being its witness.

The book of Job is the most famous quest narrative that addresses suffering, blending restitution and chaos into poetry. After having his wealth taken away, his family wiped out, and his body destroyed, he begins to lament ever being born. Job’s friends take turns interpreting his suffering as having a logical structure: Eliphaz says that all suffering is deserved and natural, God’s way of disciplining Job. Bildad agrees, saying there’s no smoke without fire, and Zophar concludes that there’s hope for Job if only he’ll let go of his delusional innocence. After a lot of back and forth and a weird interruption from some rando named Elihu, God finally shows up and claps back with rhetorical questions that are meant to put Job in his place, reminding him that the universe is far more complex than any human could ever begin to understand. At the end of this nightmarish confrontation with the mysterious chaos underlying life, Job’s life is restored just as quickly as it was ruined. Slavoj Žižek reads the story as a warning against the pressure of meaning, as Job’s friends are inveterate ideologues who think they have everything figured out. He was inspired by G.K. Chesterton’s reading, where the key of the story lies in God’s description of life and the sense of wonder it evokes. Put another way, as soon as we think we’ve come close to takwin, we’ve stultified our curiosity and are doomed to suffer with concepts of how things should be or should have been.

I think that focusing on God’s solution at the end of the text is to miss the tragic beauty of Job’s poetry in the debates that prefigure the text’s conclusion. It’s clear the author(s) went through some terrible dark moments and spent a great deal of time arguing with themselves and others about its meaning. As Job’s adversaries make clear, the contemporary culture believed something along the lines of what’s in Proverbs; that there’s a harmonious economy of righteous reward and just punishment. The offensive stupidity of this idea is laid out in the majority of the book, where life’s chaos and incomprehensibility is liberally criticized, without strawmanning opposing views, all the while demonstrating the alchemical transformation of suffering, confusion and conflict into poetic art. It reliably gives me goosebumps. My guess is that the Disney happy-ever-after ending is for people looking for an easily verbalized solution, rather than rich, dense, complicated pessimistic poetry. This applies to me, since I was desperate for answers to the meaning of suffering and only begrudgingly engaged in a close read. Even the introduction to the story in the New Oxford Annotated Bible hints that the dense bit in the middle is incidental to its meaning. This issue crops up in Ecclesiastes as well, which ends abruptly with platitudinous conventional wisdom after some beautiful and devastating critiques of all human endeavor. These additions are like the final touches on omeprazole to ensure its ability to be metabolized, as without them, the texts might be too acidic.

In the midst of his suffering, Job echoes Silenus and Schopenhauer by saying that human life must be some sort of mistake, arriving at the conclusion that peace can only be found in death, and that the greatest luck of all is to never have been born. In the midst of sedative hazes, terrifying withdrawals, sleepless nights, nausea, vomiting, constant headaches, we might reasonably expect Nietzsche to agree and yet, he absolutely refused such an attitude:

I tense every fiber of my self-overcoming—but I have lived in solitude too long, living off my “own fat,” so that now, more than anyone else, I am being broken on the wheel of my own feelings. If only I could sleep! But the strongest doses of my opiates help me no more than my six-to-eight-hour marches. If I do not discover the alchemists’ trick of turning even this filth into gold, I am lost. Thus I have the most beautiful opportunity to prove that for me all experiences are useful, all days holy, and all human beings divine!

The night after I first read the quote above I had a dream where I was trying to offer someone the Bible as a source of guidance, wisdom and peace, but they would accept this offer only on the condition that I summarize three key life-affirming components. My mind immediately went blank, since it’s such a complicated book with a plurality of perspectives, so I just went to Nietzsche instead: everything that happens can have meaning, everyone’s life matters, and every day is worth experiencing. Along with these three points, we also need to add dance and laughter as key components of a great life:

Lift up your hearts, my brothers, high, higher! And do not forget your legs! Lift up your legs, too, you fine dancers! Even better, stand on your heads!This crown of the laughing one, this rosary-crown: I myself set this crown on my head, I myself have sanctified my laughter. I could find no one else today strong enough to do so.

This crown of the laughing one, this rosary crown; to you, my brothers, I throw this crown! I have sanctified laughter; you higher men, learn to laugh, I beseech you!

I’ve yet to find more essential substances for the mysterious alchemy of transforming sickness and suffering into gold. I like that it avoids the insipid notion of being at peace with suffering, as if calmness was the summit of the human spirit. This transformation might be idiosyncratic and ambiguous in its particularities; it doesn’t guarantee the absence of teary-eyed public breakdowns as I’ve had on the subway, or as Freddie did on the streets of Turin at the close of the 19th century. Our perseverance has limits. As Freddie wrote in a letter, his existence had been such a burden to him that he would have killed himself long ago if he wasn’t determined to experiment with suffering and see what sort of implications it had on his philosophy. To paraphrase Satan’s query to God in the Book of Job: what value is our affirmation of life if it crumbles in the face of adversity?

Leave a Reply

Your email address will not be published. Required fields are marked *