FIBROMYALGIA IS A DIAGNOSIS OF EXCLUSION

Written by Sumitra Singam

Widespread Pain Index (WPI) ≥ 7 and Symptom Severity Score (SSS) ≥ 5, or WPI 3-
6 and SSS ≥ 9

Take a woman. No. Take a girl. Show her how to minimise herself. Teach her to
curve into her shoulders. That mountainous stance takes up too much space. She
must learn to make way for her betters. It is for her own safety. There must be pain
now. It is a barter for the other kind of pain. The one that her pride, if unchecked, will
invite. Teach her that she does not know her own shameful power.


The SSS is the sum of the severity of the following 3 symptoms: fatigue, waking
unrefreshed, cognitive symptoms; plus the sum of the number of the following
symptoms occurring in the previous 6 months: headache, pain or cramps in the
lower abdomen, depression


Teach her early that if she isn’t bowed with pain and fatigue, then she isn’t working
hard enough. Teach her that her worth is tied to movement. That she must strive.
There is nothing inside her that will salvage her. Teach her that rest is for the wicked.
Teach her to cinch herself tight around the emptiness inside, lest she fall into it. Give
her a little nudge from time to time, to check the bind is secure.

Fibromyalgia may only be diagnosed in the setting that no other organic disorder
sufficiently explains the patient’s symptoms.


Ensure that the hollowed-out girl binds herself together with the abiding glue of
shame. Teach her never to reveal the filthy secret she holds. Her eggshell brittle
emptiness is her own fault after all. Keep her from knowing even herself. When you
see that she tries every trick to stop herself crying, you know you are making
progress. You know then that she will have learnt the dual trick of ignoring her pain,
and knowing that she deserves it. Teach her all this, and she will be a system unto
herself. She will provide her own exclusion.

.

Sumitra Singam is a Malaysian-Indian-Australian coconut who writes in Naarm/Melbourne. She travelled through many spaces, both beautiful and traumatic to get there and writes to make sense of her experiences. Her work has been published widely, nominated for a number of Best Of anthologies, and was selected for Best Microfictions 2024. She works as a psychiatrist and trauma therapist and runs workshops on how to write trauma safely. She’ll be the one in the kitchen making chai (where’s your cardamom?). You can find her and her other publication credits on twitter: @pleomorphic2