My temporomandibular joints are extremely inflamed. In conversation I refer to this condition as “TMJ,” like everyone else does, but my father, a chiropractor, corrects me. “You have tee-em-DEE, Temporomandibular Joint Disorder. Everyone has tee-em-jays.” But sometimes it’s better to be understood than to be right. I clench my teeth.
Temporomandibular disorders comprise a collection of medical conditions affecting one or both jaw joints and/or their associated muscles and other tissues. They are the most complex joints in the body, richly endowed with nerves and muscles that allow coordinated movements in three dimensions.¹
These burly joints frame my face, stretching from the space in front of my ears that’s not-yet-cheek to the vacant lots behind my earlobes. They connect the mandible bones of my jaw to the temporal bones of my skull, my mouth to my brain.
When I’m feeling anxious, peevish, or generally disagreeable, I clench, and my mandibles mash my molars together. The muscles under my jaw protrude like gills on a fish. Sockets pop. The bandy strips of joint tissue stiffen, get stronger, and thicken.
But why? Like doctors and psychologists before me, I call on the process of discovery— of prodding, unearthing, diagnosing— with small and gradual questions. So here I start: Why do I clench? How does such a condition develop? What causes my TMJ?
Not all causes are known. Research has shown that TMJ patients are hypersensitive to pain, which may explain why they may also have other chronic pain conditions.
I start to notice my TMJ symptoms when I am a sophomore in high school. I’ve been rattled each morning by terrible headaches, so I’m taken to the optometrist. “You read so much,” my mother says. “You’re probably straining your eyes.”
Dr. Rose dilates my pupils and peers in. “You’re fine,” he says. “Twenty-twenty. But if you’re going to be an English major, you might want a pair of reading glasses. You’ll ruin yourself.” So I get some reading glasses, and then I have headaches and reading glasses.
One morning, while at a creperie in Boston with my mother, I notice that my teeth hurt. I am fourteen. I’m skipping school that day because I have an appointment with Dr. Fawaz, a pediatric gastrologist. My stomach has been roiling—I have acid reflux, esophagitis, gerd. Probably an ulcer soon. Extremely inflamed everything. I have the stomach of a middle-aged man on a strict diet of steak, Bloody Marys, unfiltered cigarettes, and thumbtacks. But I’m a teenage girl, a sober vegetarian who perhaps swallowed too much stress too soon.
How did I become such a, well— what word would my mother use— a stressbucket?
At age nine, I am quietly diagnosed with an anxiety disorder and depression. I am hypersensitive, overly empathetic, and I read too much. I am particularly obsessed with the Chicken Soup for the Soul anthologies, comprised of heartrending testimonies by everyday folks— about heartbreak, betrayal, loss, cancer, rape, divorce. That summer I lie in my stepfather’s bed, in the hottest room in the house, and I let myself crumble under the weight of other people’s tragedy, rise with the triumph of their redemption stories. I feel it all— guilt for everything I’ve ever done, or never done, what others have done, what I might do and what might be done to me— and it pins me to the bed. I stare at the ceiling fan blades and try to parse these folks’ memories from my own. But I can’t stop myself from conflating it all. I know too much. The rush of emotions, of knowledge, is both dizzying and paralyzing.
I can’t sleep at night. My pediatrician, Dr. Boulanger, tells my mother to give me Benadryl each night. At the same time, my father, who left home six years earlier to study chiropractics and sleep with college girls and listen to underground grunge music, decides that modern medicine is evil. “You can’t just medicate her,” he says to my mother while draining warm Heinekens he brought in from his car. “It’s unnatural. She needs to talk to someone.”
So my mother keeps slipping me Benadryl and my parents each choose a separate therapist for me, unable to decide on just one. My mother sends me to my school’s counselor, Mrs. Gratton, who pulls me out of my fourth grade classroom each Wednesday; the whole class watches as she knocks on the door and waves, smiling. “Why do you get to skip class? What do you do with her?” a classmate asks. “We just talk, I guess.” I wonder why none of the other students need to just talk to someone. But Mrs. Gratton is kind and I like being around her, even if she has hair in her armpits and surely on her legs under her long, hand-dyed skirts. She asks me about my parent’s divorce and the poetry I’ve started writing. I answer her truthfully, but I don’t understand how telling her stuff I already know is supposed to help. Why does it matter if two people know how I feel, or just one, or everyone in the fourth grade? I’d rather be in class, with a book and everyone else.
My father’s therapist, Bashia, has a cream-colored office, cream-colored linen suits, and impeccable hair. My father takes me to see her on Thursdays, his “visit days,” before taking me out to Dandelion’s for chicken fingers and ice cream. Bashia speaks privately with my father before each of my sessions, after handing me crayons and construction paper.
“Draw whatever you’d like,” she says, smiling.
When it’s my turn to meet with her, she asks to see my drawings.
“Is this a man?” she asks.
“Yes,” I say.
“Who is he?”
“My dad.” Isn’t it obvious?
“Why did you draw him?”
“Because he’s here now.”
She’s more insistent, more annoying than Mrs. Gratton. She asks me questions that I don’t know the answer to, and they’re usually about my father.
“Why are you upset with your father?”
“I don’t know,” I answer. It’s mostly true.
“What does he do that you don’t like?”
“Aren’t you going to tell him what I say?”
“Well, he drinks a lot of beers.”
“And, he yells at my mom. He is usually at college but when he comes to pick me up I hide in my room. I put my toy box in front of my door so I can’t hear them fighting and crying and so Dad can’t get me when he’s mad.”
“Has your father ever hurt you?”
“He twists my arm sometimes, and yells. Mom doesn’t yell. One time, when he was cooking chicken legs, he picked up a big knife and held it over my arm because I was talking too much. He said it was a joke. He didn’t cut me but I still cried. And then he wouldn’t let Mom come pick me up from his house because he had custody that weekend.”
“Do you like visiting him?”
“Sometimes. His license got taken away by the police so we go on walks to the park and make newspaper boats to race in the pond. Sometimes before I visit him I feel sick to my stomach. When Mom calls to tell him I’m sick he gets angry, but he usually gives in and lets me stay home with her anyway.”
“So you’d rather be with your mom?”
“Do you feel more comfortable around women than men?”
“Has your father ever touched you?”
“Has he ever touched you inappropriately?”
I don’t know why she asks this. But because I’ve read so many stories about fathers and daughters and incidents and repression in the Chicken Soup anthologies, my mind starts flooding with scenes. Are these other people’s stories or are they my own? Are they real? It’s all inseparable, intractable. Why is she asking this? I can’t stop thinking about the possibilities and I feel ashamed for myself and for all those families I’ve read about.
“I don’t know,” I say. Even the thought of it makes me sick to my stomach.
Bashia tells me to quiet myself. Breathe deeply. She gives me a cassette tape to listen to before bed as a homeopathic alternative to the clear liquid magic masquerading as allergy medicine.
Imagine a beach, the tape coos in an impossibly calm female voice, and write your troubles in the sand with a stick (breathe in)... then imagine waves slowly rolling onto the shore (breath out)... and imagine these waves rushing over the words in the sand (breathe in)... erasing all your fears and worries (breath out)... until you are calm (breathe in, count to ten)... and you are so, so sleepy...
Each time the tape ends I rewind it to the beginning and start again, wide-eyed as the shoreline fills with words I’ve dredged up and the sea is drained of its waters. The words stay put as if I’d etched them into quick-drying concrete. When I do sleep, I dream of tsunamis.
I catapult into adulthood with a cassette tape, two tablespoons of Benadryl, a roiling stomach, and a dull sense of shame.
Fast forward to that morning at the creperie, when I am fourteen: Before my doctor’s appointment, I close my SAT book and tell my mother that, yes, something else is bothering me: my teeth hurt. Then something miraculous happens. When I jut out my chin to show her that yellowing picket fence in my mouth, my jaw clicks audibly.
“Oh!” I say.
“Ah-ha,” she responds, already dialing the orthodontist’s office.
“They’re the size of golf balls!” Dr. Hrinda exclaims while probing the joints under my oily cheeks. He paces his office. “What’s on your mind, kiddo?”
I rub my jaw and shrug and stare blankly at photographs of his family smiling at the beach on the wall in front of me. He hands me a soft disk of rubbery plastic, fitted to the roof of my mouth, to bite down on while I sleep. After nine years of orthodonture, this monstrosity. I wear it every night.
...Think you may have TMJ disorders? First, try eating soft foods, using ice packs, and avoiding extreme jaw movements, like wide yawning and gum chewing.
As I chew peanut brittle, peppermints, and ice cubes, the joints strain and grow. The sharp pain is somehow soothing. Chewing gum becomes unbearable around the time I discover the joys of making out in the backseat of my boyfriend’s powder-blue Oldsmobile. I feel self-conscious each time I turn down a stick of Doublemint, hoping he doesn’t judge me for my pizza breath.
Symptoms include pain and difficulties in making normal jaw movements, such as those used in speaking, chewing, swallowing, or forming facial expressions.
By the time I’m eighteen, my jaw clicks and pops each time I open my mouth. Even boredom hurts; yawning is the worst. Smiling rarely feels worth the strain. The first time a boy unzips his pants and pushes my head between his legs, I think about how much it would hurt to open my jaw so wide for so long. I tell him I’m just not that kind of girl, even though I’m not sure.
Currently, diagnosis of TMJ disorders is based on patient's description of symptoms, history, and examination of the head, neck, face, and jaw.
I examine my history, my head—how does such a thing start? Not in one instant, of course, but over time. I trace my way back through the moments myself, without a therapist.
I am seven. During my ballet recital, my dad ambles into the school auditorium, twenty-three minutes late. He is six-foot-five, near-sighted, and bumbles over a dozen knees to get to a seat in the front row. After I bow, after an almost perfect performance except for that one chene turn, my father throws pinks roses at me, tries to lift me onto his shoulders. My tutu rips. Later, en route to the pizza parlor, I hear water sloshing and ice rattling against aluminum cans in a cooler in the trunk. But I don’t say anything; I just clench my teeth as he rounds corners.
I am ten. I see a woman smack her son in the cereal aisle of the grocery store. She catches me looking and scowls. I want to scoop the boy up into in my arms and tell him that he is a good boy, I promise. I want to hit the woman back. But I just clench.
I am fifteen. In the backseat of that Oldsmobile again, a boy is sliding his hand down my stomach. I close my eyes and think about Jessica, my closest friend in middle school, and her red thong stretching across her hip bones, peeking out over her uniform skirt. I think about her bird calls: cardinal, canary, chickadee. I think about the word some boys yelled out when the two of us walked arm-in-arm across the four-square courts (who would want to be one of those, when everyone spat the word with such disdain?) I think about the weekend we spent together in my parent’s motor home, parked in my backyard. We didn’t have to whisper as we lay side by side on the scratchy mattress, parallel bodies only inches apart, wearing boxer shorts and wifebeaters without bras. When we both stood in front of the mirror to dress, I looked at her instead of myself— she scoured her own body intently, sucking in her stomach, scowling, swiping glitter over her eyelids. And then I see in my mind those red, red lines covering her pale arms, like swollen larvae, that she covered and called cat scratches. And then I open my eyes again and I’m in a car with some boy, and I see the red scar on my left palm like stigmata, which I pierced while slicing green peppers in her kitchen on the last day I saw her. I clench.
I am sixteen. My boyfriend’s little brother, Spencer, is sitting on his front porch, sniffling. His artfully applied eyeliner runs down his face as he starts to take off his high-heeled sandals. He looks beautiful, but I spy fresh red scars between his knuckles, on his shoulder blades. Our Catholic high school won’t let him attend the homecoming dance with his boyfriend—two boys can’t buy tickets together, and neither can two girls. And earlier that day he got a detention for threading rainbow shoelaces through his uniform shoes. I clench.
I am eighteen, home from college for Christmas break. After five months without a single conversation, my father picks me up on New Year’s Eve for dinner. He asks if I have a boyfriend, if I know what kind of job a liberal arts degree will get me. I decide not to answer and eventually he succumbs to the silence, orders another beer. On the drive home, he yells at me, then cries. I clench. “Happy New Year,” I say. I slam the jeep door.
I am twenty. A tattoo gun flirts with my anklebone, which is more delicate than I’d like to believe. I close my eyes and picture myself on that imagined shoreline from the cassette tape, and I write words in the sand (pain, vanity, weakness.) I envision the tattoo artist etching his own troubles into my skin.
I am twenty-one. For three whole years, I’ve ignored each and every one of my father’s voicemails and emails and text messages and greeting cards. When he mails me modest checks, I send them back without a letter. When a hulking repo-man hunts me down at my college campus, scouring New England for my father’s jeep, I tell him I know nothing. The way I growl the words between teeth convinces him.
Over time, it becomes clear to me that clenching my teeth is a means of coping, of silencing myself. Of squelching that paralyzing feeling I had while reading on my stepfather’s bed, while my therapists asked me questions I couldn’t answer— consciousness of everything that is confusing and unpresentable and indecent inside me, inside others. The shame.
Silencing myself becomes mechanical and routine. I learn to speak even less than I did before. The sound of my voice begins to surprise me when I manage to use it. It squeaks and I’m all static. I’m compared to a transistor radio, a pubescent boy. I shut up.
My neck, shoulders, and back tense up too. My posture worsens; I become an inch and a half shorter, because I constrict. I quietly collapse in on myself. The retainer buffers the pain and allows me to sleep once my mind has shut down, but it doesn’t stop me from stirring and clenching. It only eases the symptoms.
...As I grow older, as my jaw clamps tighter, I stop seeing therapists. And I stop seeing my father. They rile me up too much; they ask too much. I develop an almost symbiotic relationship with my mother in the wake. But after a while, my adolescence creates an inevitable rift even between us, and I learn to silence myself around even her more often. I feel like I can’t answer all her questions truthfully — Why don’t you want to come to church with me? Why don’t you talk about boys? Can’t you be alone? Why won’t you show me your writing?
Once I’m in high school I don’t want anyone to badger me with questions. I want to ask them questions, I want to question myself and everything around me because I am a teenager in the suburbs and I am defiant and I feel different and repressed. Once I leave home, I have my biggest aha! moment—
I am seventeen. I have just arrived at a small liberal arts college, said goodbye to Catholic school forever, and I sit down cross-legged, under the dark shade of a willow tree, in a circle of students. Across from me is a pair of hairy legs, also crossed, peeking out from a flowered skirt. I look up at this person’s face, and suddenly my skin prickles hot and my veins trickle cold and my face is a tomato. It’s dizzying. The girl belonging to the legs has boyish, curly hair, smudged glasses, and a huge schnoz. When she sees me staring at her with my jaw open (not too wide), she lets out a sonorous laugh—a honk, really—that can only be described as the sound a seagull might make if someone stepped on her throat. I am absolutely enamored, enthralled. And silent.
The two of us spend a few days together, traipsing through Vermont to do community service, and I learn that she is brilliant and a great cook and gay. She talks to me about punk music and Swedish films and homeopathic remedies, and I can’t grasp onto any of the allusions she makes; I nod silently and Google them when I’m alone, ashamed at my ignorance.
Each night I find myself sleeping next to her, parallel bodies inches apart on top of sleeping bags, like silverware laid out onto napkins. The edges of our separate sleeping bags overlap. Whenever I hear a swish of nylon as she turns in her sleep, I’m a hot and cold tomato again. I write her name with a stick in the sand of that distant shoreline, breathing in and out, but waves can’t wash it away. I decide not to wear my retainers on those nights, embarrassed by them and my neurosis; I wake up restless with rattling headaches.
A few weeks go by and I turn eighteen and she turns twenty-one. On the Friday night after I visit home and break up with my high school sweetheart at the homecoming game, I find myself dancing next to her at a party. At proms I always had to “leave room for the Holy Spirit,” dance two feet away from a boy with rigid, outstretched arms, but here on this dance floor I am free to do whatever I want and I am terrified. There are no rules here, no rulers in the hands of chaperones to pry us apart, no commandments set in stone. I can get as close to this girl as I want and no one will mind. Do I want to?
I ask if she wants to step outside. She wants to. I find a blue mug in the kitchen and fill it with water from the tap, we pass it back and forth. Her breath is sweet with Bombay Sapphire and pomegranate juice. She takes my hand— her hands are so small, and soft— and leads me back to the dance floor. Her hands move to my hips and the bass croons low and she sings in my ear and I’m dizzy. At the end of the night she walks me home. I don’t lead her up the stairwell to my room but she kisses me on the cheek. Her lips are so small, and soft.
As I walk home from her apartment a few weeks later, after she has made me an omelet and the two of us have read the newspaper across the table from each other like adults, with sun pouring in through the windows, I stop at a crosswalk. I have a choice to make. I pull my cellphone out of my skirt pocket and type in my mother’s number. I flip the phone shut and cross the street. A train whistles in the distance. I walk a few feet and open my phone again. I clench.
My feelings are harder to compress as time goes by. I have to clench harder to hold them in. They are more solid, more fully-formed, and they have fists. They thunder against the walls of my mouth. Headaches vex me.
With a scarlet face and my heart pounding in my ears, I just can’t take it anymore—my mandible needs to MOVE. And mightily, I release words from my mouth like hawks from a cage.
I call my mother. “I’m walking home from R’s apartment,” I say nonchalantly. “Have I told you about her? She just made me breakfast. Yeah, it was great. Hey, Mom? We’re kind of, uh, seeing each other, okay?”
“Okay,” she says. “It’s okay.” I breathe out.
A few days later, my mother makes my stepfather a steak. She sits him down at the dining room table and hands him a beer in a frosted glass. She says, “I have something to tell you about our daughter.” He chokes a little.
...I enjoy the openness of my relationship with R— Who holds the door? Who’s the big spoon? Where do I put my hands when I dance? Nothing is prescribed or routine. What happens between us is mutually decided upon or instinctual, unassigned. She always asks, “Is this okay?”
But eventually this enthralling girl breaks up with me. “You’re too young,” she says. “Maybe when you’re a sophomore?”
And then I start dating a boy. He’s pretty enthralling too. I had three boyfriends before that girl, and now one after her, and even though she haunts me, I know that I miss her for the person that she is, not because she is the first girl I kissed. I prove this to myself when she changes her name and starts taking testosterone pills and flattening her breasts under flannel shirts with Ace bandages and I still think I love this person.
How could I hold onto to all these feelings at once?
College students are attracted to anything with a pulse. Young people love to experiment. Girls fool around with girls because they don’t want to get pregnant. This is what most people tells me. My stepfather, responding to a Lady GaGa interview on the news, slurs, “People who say they’re bisexual are just gay and lying.” I stare down at my dinner. What’s worth fighting for? That night I write it down in the sand.
Naming myself bisexual or gay or straight or curious or bi-curious feels as uncomfortable as silence. The labels all fit wrong and the relief of coming out is short-lived for me. I still feel a little ashamed, dishonest. I still clench.
Around Christmastime that year, I’m in a gag gift store with my friend Jon and I tell him about R and then about my new boyfriend.
“But what do you like better?” he asks, while gingerly inspecting a penis-shaped water bottle.
“Don’t most bisexuals or whatever have, like, a preference? Men or women?”
“Oh.” I pause. “Women, I guess.” I leave it at that because it’s the most convenient answer for the occasion; I know that Jon loves me and I don’t love him back. Lying can be a louder form of silence.
...Furtively browsing the “Gay & Lesbian” section at a bookstore one day, while my mother pores over Danielle Steel novels, I discover a name for my tendency towards fluidity, my seemingly indiscriminate attraction. I am pansexual: attracted to women and men, to anyone in-between or outside the gender spectrum. Eureka! The relief of finding the right word, of legitimizing the feeling, echoes diagnosis— ah, this is what makes me tick.
Pansexuality (also referred to as omnisexuality or polisexuality) is a popular term referring to the feeling that one has the potential for sexual attraction, sexual desire, or romantic love, towards people of all gender identities and biological sexes. Some self-identified pansexuals refer to themselves as gender-blind— that gender and sex are insignificant or irrelevant in determining whether they will be sexually attracted to others.²
The potential for affection and sexual feelings towards any person, regardless of sex or gender. Not towards all things— I’m not attracted to my dog, my sister, or my lawn mower, for instance— but towards any person for reasons other than the typical formula (I am a man or woman, you are a man or woman, and hence, there might be some chemistry between us.) It rejects the binary of bisexual. It’s freeing. It’s fitting.
And I think to myself: I don’t have to be silent anymore because I know what to say. Right? At first I want to tell everyone in the store— the book-browsers, the baristas, the cashiers. But then I can’t even bring myself to tell my mother on the drive home. The complexity of it frightens me. She has accepted my girlfriends, my boyfriends. Shouldn’t this be enough? Can partial acceptance offset the full truth?
Here’s the complication: Hardly anyone else understands or believes in the word pansexual. It’s like, say, the word petrichor. Petrichor is the precise word for a very common phenomenon— a pleasant, distinctive smell frequently accompanying the first rain after a long period of warm, dry weather in certain regions³— but if I were to say to my mother, “Ah, there’s nothing like petrichor on a hot summer day,” she would not understand what I mean. Instead, I’d say, “How about that rain smell?” It’s like saying “TMJ” when I really mean “TMJ Disorder.” Sometimes it’s better to be understood than to be right. My identity, it seems, depends on whom I’m with. To my closest friends and queer friends, I’m pansexual. To reasonably progressive acquaintances, I’m bisexual. The kids in my hometown that I’ve fallen out of touch with decide that I’m just “gay now,” and when I start dating a boy, “it was just a phase.” To beautiful strangers buying me gin and tonics, I’m open-minded. My mother and I only talk about it when we have to (mostly, before I bring someone home for dinner.) My father probably thinks I’m still seeing my high school sweetheart. And in my mother’s church, when the special intention for Mass is the sanctity of marriage, I’m still silent. As I sit in the pews and shake hands with members of my congregation as a sign of peace, I clench. My mouth is a wire-trap cage.
...Most people with TMJ problems have relatively mild or periodic symptoms. Some TMJ problems improve on their own, without treatment, within weeks or months with simple home therapy. For others, symptoms worsen over time and develop into long-term, persistent and debilitating pain.
Now that I can name these symptoms, diagnose my pain, I can work on the treatment. Luckily, during years of almost monastic silence and reflection, I have learned to listen, to write. I find the words and I find my voice.
Final prognosis: a deep sense of shame and uncertainty causes me to silence myself, silencing myself causes me to clench, teeth-clenching causes headaches, — but maybe what I’m ashamed of isn’t so shameful after all.
At first, my newfound words— released like hawks from a cage— merely circle the air, inexpert. They’re happy to be free. They stretch their wings, learn their limits. They sometimes knock against each other ungracefully. But as I release them into the wild more frequently, they start to fly straight, wavering little. People understand them, relate to them. I think back to when I was nine and listening to those cassette tapes, and I realize that Bashia had it all wrong. Once you name what stirs you awake, you shouldn’t wish it washed away. Quite the opposite. Have it written in stone and carry it proudly. The right words mean very little if you don’t use them. Share them, because shame and silence only lead to a tightening of the self, to limitation, paralysis.
When I drop my stick onto the sand and let it slither away, when I talk to other people tracing their troubles into the shoreline, when I turn it into a narrative, I start to open up. I feel less anxious, less peevish, even agreeable. My temporomandibular joints slacken, move with ease and, occasionally, poise. My jaw doesn’t pop as often, and sometimes I can make it through the night without a piece of plastic between my teeth. I find myself loosening.
1 All italicized text excerpts, unless otherwise specified, are borrowed from the TMJ Association’s website, tmj.org.
2 Text borrowed from Wikipedia.
3 Definition of “petrichor” from the Oxford English Dictionary website, oed.com.