Book Review: American Sentencing (Jen Karetnick)

Reviewed by Shane Neilson

American Sentencing, Jen Karetnick's sophomore book of poems from Winter Goose Publishing, tackles the contemporary experience of chronic disability due to mental and physical illness. One of the things that can be lost when a reviewer like me (critic with lived experience of mental illness and institutionalization) considers a book like this (about illness and dedicated to "those who suffer from chronic, invisible illnesses/ For their physicians and caretakers / And for my brother") in a publication lik e Wordgathering (devoted to covering work by/for disabled people) is an appreciation of beauty and poetics, sacrificed in favour of an appreciation of politics. To avoid this pitfall, I begin by presenting a few bona fides of the book's thematics in order to situate a specific political problem facing the "invisibly" ill as it is developed in Karentick's work. I conclude with commentary on the beauty of the text.

The first poem, "Adult Congregate Living Facility," is about a group home for, among others, a "screamer" and a "barker." The second, "Mental Hygeine," is a satire of the eponymous concept. "Aphasia," the third poem, plays with the material of language to simulate a damaged brain's attempt to construct experience. The Fourth poem, "Because You Can't Win Emotional Bingo," biomedically metaphorizes emotion as a "diagnosis of exclusion." In addition to the mental illness thematics, there is also substantial content devoted to physical illnesses that are also "invisible" – including lupus, migraine, thyroiditis, and celiac disease. In short, this book starts, proceeds, and ends with disability thematics, but it also includes a substantial number of poems about family that act to root, richen, and complicate the more overtly critical pieces.

Yet the project is less about the alternative and novel subjectivity of the mad, for it does not attempt a mad voicing. Nor does it try to present an alternative embodiment for the speakers suffering both verifiable and unverifiable chronic medical illnesses. Instead, the book is about the paradox inherent to the term "invisible disability." Although mental illness is not represented on the body as scar or absence, it is nevertheless bodily, manifesting in facial expression, intonation, speech content, gesture, and posture. Moreover, those suffering from the physical illnesses in the text experience fatigue and pain, both of which are recognizable symptoms to doctors and laypeople. Thus the "invisible" terminology, to me, has always suggested a kind of ableist wishful thinking with destructive end effects. The unstated hope inherent in the term is that sufferers of mental illness be, in actuality, invisible; that their greatest suffering and distress is somehow invisible in fact.

Poems are a way to resist such thinking. To repurpose a William Styron title from the disability canon, Karetnick makes darkness visible: throughout the collection, the discourse of medicine (doctors, laboratory tests, and medical vocabulary) is deployed in order to make illness experience more manifest, as if the language around such illness experiences and interpersonal interactions, by the fact of its being, are visible markers. Sometimes, the uninvisibilizing argument is made on behalf of both mental and physical illness: "Routine for the Invisibly Ill" begins with the mundane act of taking medication (and, being an action, is hardly "invisible") but proceeds to make the process surreal, personifying and serially metaphorizing the pharmaceuticals ("I drive my kinds to soccer camp so they can kick / into nets and heads the bloated pills"). The argument becomes concrete in poems like "Amniocentesis," which articulates the need for a tissue sample of a fetus because there is no "visible image" of a possible genetic mutation, creating an irony – the needle is guided by ultrasound (the invisible made visible) but even so, that picture is not enough for the task. Medicine needs more to make its proofs, for there is always another step to take on the path to certainty. But illness experience is as certain to the sufferer, and perhaps possessing a greater specificity, than is medicine's gold standard investigations.

Another way uninvisibilization occurs is through deliberate formal construction. As critic Lesley Contreras Schwartz has said,

The poems in Jen Karetnick's American Sentencing, use elements of formalism—such as the structure of the ghazal, the villanelle, or the pantoum—to reveal painful patterns of illness, to reenact the experience of the body at risk of failing. Through the rigidity and repetition subscribed by these forms, Karetnick finds a way to illuminate the limitations of the diseased body; she shows us the cell's obsessions, their hidden language that imprisons us. (


I add to this list sonnets, a double recursive sonnet, prose poems, and a cento. Such forms confront the reader with their deliberateness, their conscious presence as constructed, crafted things. In the same sense, the inclusion of poems not about disability per se – ie. the presence of poems about love for husband and dog ("Husband and Dachshund, Snoring") – act as the integument in which the invisibly ill speakers visibly perform "normal" functions, begging the question: isn't it the norm that is supposed to be invisible? What sinister function is served by relegating ill persons to a terminology of invisibility? Or does this circumstance constitute an opportunity for the invisibly ill to resist relegation in unique ways?

In the title poem, which, curiously, is written in columnar free verse, Karetnick throws down the gauntlet: "Between you and me, there is no /doubt in your mind." As if sharing a secret in which, to invert a phrase of Elaine Scarry's about pain (which, paraphrased, is: to have pain yourself is to have certainty, but to see someone else in pain is to have doubt), to be ill is to be certain of medicine's skepticism and to be a physician is to be certain of the patient's unverifiability and malingering. Karetnick provides more sad certainty in the immediately following lines, "I have been here before /and will be again." The poem comments on what the book feels is a peculiarly American (although, in truth, white Western) phenomenon in which the chronically unwell – including those with mental illness, who in the main are categorized according to symptom and sign, the future of blood-based diagnosis still far off, if at all possible – suffer in the absence of pathophysiological proof. But the suffering is, nevertheless, real, and Karetnick chips away at the very philosophical foundations of "invisibility" here.

Look down my throat. Peer
in my ears. Allow your instruments to dictate
the truth as you have learned it—

With such lines, the process of medicine – taking of a history, performing a physical exam, ordering laboratory tests, and integrating those into diagnosis – is beautifully questioned, as it should be. Like Karetnick maintains in this wonderful poem, "intuition" is a "tissue," the imagination is "fatty" and, as she puns, "the instinct of the gut" is "flexible and in no way demonstrable." The poem powerfully renders the medical encounter between doctor and patient not as an informatics-based one, but rather a provisional one. The speaker surpasses the nullity of negative lab results and instead praises the poetry of uncertainty. In consequence, what will be certain after reading this collection is that the coded value judgement (and lie) inherent in "invisible illness" has rarely met such an able challenge.

Title: American Sentencing
Author: Jen Karetnick
Publisher: Winter Goose Publishing
Publication Date: 2016



Shane Neilson is a Canadian poet, physician, and critic from New Brunswick who is completing his PhD in English at McMaster. He published Dysphoria, the final volume in his affect trilogy, with PQL in 2017 and won the Walrus Poetry Prize in the same year.