The Two Kinds of Decay

"In her second year of college, the poet Sarah Manguso developed a neurological disease so uncommon it doesn’t even have a real name. The autoimmune condition, a rarer form of the already rare Guillain-Barré syndrome, is known as chronic idiopathic demyelinating polyradiculoneuropathy, and it took more than four years to run its course. For several of them, Manguso had to undergo periodic treatments in which her plasma was completely removed and replaced. The treatments worked, but sometimes only for a few days. Later, she moved to steroid treatments, which restored a degree of physical well-being but created complicated side effects. In her sharp, affecting new memoir, The Two Kinds of Decay, Manguso writes from the far side of a long period of remission. 'For seven years I tried not to remember much because there was too much to remember,' she writes. From an original welter of experience, she has carefully culled details that remain vivid. Filtered through memory, events during her illness seem like 'heavenly bodies' that 'fly until they change into new forms, simpler forms, with ever fewer qualities and increasingly beautiful names.' Manguso is acutely interested in these processes of renaming and remembering, the way time changes what we say about the past. Her book is not only about illness but also about the ways we use language to describe it and cope with it. The author of two books of poetry, Manguso brings the virtues of that form to the task of writing memoir. Her book is divided mostly into one- and two-page chapters titled like poems. She mixes high and low language, the crass and the scientific, with a lyric poet’s sure-handedness. The chapters themselves—among them 'The Hematologist,' 'The Forgetful Nurse,' 'Corroboration'—resemble her own poetry, broken into aphoristic, discrete sections on the page. This disjointedness gives the prose a rhythm that mirrors the confusion and fragmentation of illness. It also clears space for one of the book’s most remarkable aspects: its dark humor. What makes this account both bearable and moving is Manguso’s keen sense of the absurdities that accompany severe illness. Often these come from its odd proximity to ordinary life . . . Manguso was already a writer when she became ill, and her obsession with words, their capacities and limitations, permeates her book. The world of hospitals and doctors has its own language, which she translates for the uninitiated reader. Her plasma replacement treatment is called 'apheresis,' which she notes is 'from the Greek aphairein, to take away.' She is amused that hematologist-oncologists abbreviate their titles to '"hem-oncs" (pronounced almost like he-monks).' But her interest is more than literary curiosity. When she has a line implanted directly into her chest so her plasma can be replaced more easily, she parses her reaction: “I had read Freud in school. He distinguishes fear, a state of worrying anticipation . . . from fright, the momentary response of our mind to a danger that has caught us by surprise but is already over.' For hours, she writes, 'I lay there, weeping in fright. Not fear. Fright.' Manguso’s desire for precision is urgent, even if it cannot always be fulfilled. 'I need to describe that feeling,' she says of the deep cold induced by apheresis. 'Make a reader stop reading for a moment and think, Now I understand how cold it felt. But I’m just going to say it felt like liquid, 30 degrees colder than my body, being infused slowly but directly into my heart, for four hours.' As much as anything, this book is a search for adequate descriptions of things heretofore unnamed and unknown. Manguso concludes her account with questions—and an exhortation to the reader to pay attention. Through her own attentiveness, Manguso has produced a remarkable, cleareyed account that turns horror into something humane and beautiful."—Emily Mitchell, The New York Times Book Review

"Sarah Manguso, a poet, and the author of The Two Kinds of Decay, says that her memoir ‘is a usual book about illness’ . . . Manguso vividly describes the morning she awoke at home with numb feet and tingling in her hands; how during the next few days at college she began to walk stiffed-legged and then to stagger; how finally, after she fell down in the courtyard, she was taken to the hospital by her parents, and promptly admitted to the intensive care unit."—Diane Johnson and John F. Murray, The New York Review of Books

"When she was 21, Sarah Manguso developed a rare form of Guillain-Barre syndrome, in which the body's immune system attacks the nervous system; with Manguso, the condition began as a numbness in her feet. To survive, she required long hospitalization; endless sessions of apheresis (the separation of blood into components); frightening and invasive medical tests; and a Hickman line in her chest because human veins can tolerate only so much piercing. Hers is not a day-by-day description of this grueling time, but an impressionistic text filled with bright, poetic flashes . . . Many sick people learn to live in the moment, but the power of Manguso's writing makes that truism revelatory. Her book is filled of generous-hearted descriptions of those who helped her: the nurse who always remembered to bring mints; the engineer who designed a new apheresis machine; and a boyfriend, Victor, who continued to sleep with her and to whose tender intervention she credits her recovery. Victor himself subsequently died of an aneurism."—Juliet Wittman, The Washington Post Book World


"The novelist Richard Yates, discussing his masterpiece Revolutionary Road, once told an interviewer that the success of his writing depended upon his 'avoiding the terrible traps that lie in the path' of autobiographical writing—'self-pity and self-aggrandizement.' In trying to to decide what makes a poet and short story writer Sarah Manguso's debut memoir, Two Kinds of Decay, feel so successful, so brazen in its emotional clarity, it would be easy to chalk it up to language—to the crystalline quality of perception and sheer accuracy of observation evinced in each of her going on in this beautiful book, something tied to avoiding those traps Yates cautioned against . . . Manguso's talents as a poet are evident throughout this book, in its concision and precision, but so is a kind of empathy she's able to establish . . . We're led by the parade of empathetically drawn characters that accompany our narrator through her ordeal—the parents, nurses, doctors, lovers and friends we meet only briefly, who come to inform us in a way that lets us in so fully to the experience of the wraith of illness, we gain just what we want from a memoir: Not self-pity. Not self-aggrandizement. Only what we need—the reality, the truth, told with all the efficiency and honesty possible."—Daniel Torday, The Kenyon Review

"The story of [Manguso's] diagnosis with [CIDP] and the ensuing years of illness, recovery, and relapse, Manguso's memoir is structured as a string of short, titled chapters that together read more like a series of related lyrical essays than sections of a traditional narrative.  The book is distinctive also for its decidedly unsensational quality . . . she recounts her story as a meditation on her experience, on illness as metaphor, as metaphysical crisis, as spiritual awakening.  The book explores questions about who we are to ourselves—how we reckon with our weaknesses and with the relentlessness of an unknown future—and to one another—how our seemingly minor day-to-day social transactions are really the roots of our humanity . . . Because Manguso's primary aim in her memoir was clarity, the writing is spare, the language economical . . . [she decided] to write about anything that had to do with the experience of growing up, being sick, and getting better."—Mary Gannon, Poets and Writers

"Few writers are memoirists by profession, and it’s hard to imagine what the qualifications might be. A compelling and even awful life history helps (Mary Karr), but it’s not really necessary or a guarantee. Exceptional success in some other field (Barack Obama) also creates basic narrative interest, but a talent for politics, for example, doesn’t always translate into a talent for meaningful reflection. What does seem to distinguish many great memoirists, though, is an almost supernatural intuition with language: the ability to take recollections that have personal resonance and make them echo for readers in written sentences (Joan Didion, Jamaica Kincaid, and Elie Wiesel). In comparison with this gift, experience seems almost beside the point. It’s no surprise, then, that poets so often write memoirs, and that they take to the prose form so naturally. Karr is the blockbuster example of a contemporary poet-memoirist, but other young poets who have written in the form in recent years include Nick Flynn (Another Bullshit Night in Suck City) and Paisley Rekdal (The Night My Mother Met Bruce Lee). Most recently, both Sarah Manguso and Lavinia Greenlaw have written memoirs that press on the boundary between poetry and prose and affectingly describe, in intentional fits and starts, the poets’ tumultuous girlhoods. Sarah Manguso was 20 when she was diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP), an obscure neurological disorder. At first, before she endured four years in and out of the hospital and five more of sickness and recovery, she took solace in the rareness of her problem. For a young woman who already was in some respects an artist, the uncommon diagnosis was 'proof that my death, the end of my disease, whenever and in whatever form it came, was going to be remarkable.' By the end of the 12 years Manguso recalls in her memoir, The Two Kinds of Decay, this perspective is what has changed the most. Manguso, who became sick and then well over so many years, now believes that 'the most important things' happen incrementally. Manguso describes what happened to her in about 80 discrete sections, each focused on one character or moment and none longer than two or three pages. The paragraphs, or perhaps stanzas, tend to be short and are separated by one-line breaks that function like intakes of breath. Manguso’s writing is similar to Rekdal’s in that, as one reviewer wrote of Rekdal’s memoir, the writing is poetic 'not in its dictions but in its elisions.' Like Rekdal, Manguso tends to let the most significant moments in the text fall in the line breaks between thoughts . . . Memoirs of sickness are common; what is remarkable about Manguso’s is that it conveys more subtle developments. The years she describes as nothing were, as she slowly explains, not entirely empty."—Carla Blumenkranz, The Poetry Foundation