I’d classify a lot of personal writing about extreme hardship as either “trauma porn”—stories meant to titillate readers with gory details—or Hero’s Journeys from survival to thriving. Both stories serve an important purpose—the first to shock comfortable people out of complacency, the second to provide the suffering with hope—but I started writing the collection this essay is from to explore what other types of stories I might tell about myself.

—PLW

I lay my body on a cold stone slab and pick up my clipboard and pen to take notes.

Start with my hands. They’re small, contained, but brimming with information. First, note that the nails all have vertical ridges, common as people age, but these have been present since childhood. Most likely a sign of iron deficiency anemia. They’re short but uneven—chewed. Anxiety. The cuticles are picked to bloody on three fingers of the right hand, two on the left. (Also present on toes.) Excoriation disorder, also called skin-picking disorder or dermatillomania, is a form of body-focused repetitive behavior (BFRB) that is not well understood. It affects approximately 1% of American adults, most often women. Usually first diagnosed in infancy through adolescence and co-morbid with rocking, head-banging, and other self-injurious behaviors. It has been implicated as a self-soothing behavior associated with severely dissociated states, including dissociative identity disorder (DID), formerly known as multiple personality disorder, which is most often caused by child abuse, incest, and neglect.

The left hand also bears a hypertrophic scar, present since infancy, in the shape of a crescent moon. The moon is a symbol of wisdom, intuition. It’s also the exact shape of a grown woman’s fingernail.

Moving on to the head and face. The presence of some silver in the hair suggests age in the thirties. Discolorations on the cheek and neck consistent with scab picking and incomplete healing. Eyebrow and facial hair tweezing—usually indicative of feminine identification (which, in this case, aligns with the presence of pronounced breasts and biologically female genitalia). Teeth indicate some history of orthodontia, but all wisdom teeth are present, two partially impacted, and a chipped premolar on the upper left side. Though there are signs of strong personal dental hygiene, plaque buildup at the base is consistent with limited professional dental care. Possible indication of poverty in early adulthood and ongoing? A deep crease by the inside of the right eyebrow could indicate either a challenging career or prolonged suffering. The forehead furrows are often associated with anxiety. Co-morbidities include frequent headaches and neck pain.

Muscle stiffness throughout the body could be caused by generalized anxiety disorder, as well. The body is also significantly overweight. In women, this is sometimes but not always associated with trauma, most often childhood sexual abuse. The lack of hair removal from the legs and mons pubis, along with feminine presentation, could, given the other evidence, indicate a lack of interest in physical intimacy.

Notable absences: tattoos, body piercings, or any indication of recreational drug use or other high-risk behaviors. Theorize there may be a frightened-avoidant, self-injurious mode of coping that is starkly different from the external risk-taking coping mechanisms more often discussed.

What can we conclude?