The medical term for an indigestible lump in the stomach is a bezoar. People swallow foreign bodies, like hair (a hairball is a cat bezoar), or quantities of fibrous food, like unripe persimmons, which collect into a ball that stomach acid cannot penetrate. Often these are people who have a delayed gastric emptying time, a mental disorder, or both. The stomach sequesters what it cannot break down. Some people with bezoars have no symptoms, or only a sensation of fullness and mild nausea. If the bezoar is very large, it may obstruct the passage of food into the intestine, leading to vomiting and abdominal pain.
Knowledge can also be tough to digest, especially for children. The mind balks at the concept of slavery, the growing realization that people dismiss you, a black girl, as doubly less. Swallowed words and facts land in the stomach, and provoke a reaction inside, invisible. Slights and insults accumulate over the years, the “hush” in public tinged with fear. Nausea rises. Your parents tell you that there is nothing to be done. You are lucky to walk freely on the street, not to be bound and beaten. It is best not to talk about feelings. Maybe you are imagining the discomfort. For years, no one speaks of anger.
James Baldwin named it. “To be black and conscious in America is to be in a constant state of rage.” During my first week at the clinic as an internist, I overheard a neurologist gloating, “I got that black bitch now.” He had reported a medical assistant for tardiness; she was out of earshot, but I was not. I never spoke of it. What was the point? Trouble caused in the first week would follow me forever; it was not my business. In the nine years I worked there, I never heard another comment like that, but I was vigilant. Some people bring their authentic selves to work, others develop indigestion.
Oddly, the Persian word “bezoar” means antidote. Ruminants, especially goats, grew stone-like bezoars of calcium and hair, which people used as an antidote to poison from the eleventh to the eighteenth centuries in Persia and Europe. They were embedded in drinking glasses or swallowed. Modern-day scientists confirm that the bezoars reacted chemically to neutralize the toxic compounds in arsenic, which was the most common poison. Perhaps anger is also chemically active, transforming bitter fruit into rock-hard determination. We’ve had hundreds of years to evolve a physiological response to racism and scorn.
There should be a different word for the complex emotion that lives inside people at the bottom of the hierarchy—anger mixed with sorrow. Unlike cinematic anger, loud and violently expressed, stomach anger is hidden and resistant, passed from generation to generation like the microbiome. The unfairness of life, economic inequality, and discrimination are realities which defeat traditional talk therapy and anger management. Indigestible, unacceptable. Anger provoked and stored in the stomach is also a reliable energy source. Some say that depression is internalized anger. Depression does not fuel action and ambition the way anger does.
Gastroenterologists can remove smaller bezoars through an endoscope, or break them into pieces so they will pass through the gut. Large symptomatic bezoars may require surgery. Sometimes the entire stomach is full of foreign material: long ago, in a journal, I saw an x-ray of a human stomach distended by Barbie doll heads. A rare visible manifestation of mental distress. Photographs of the old animal bezoars show smooth stones, an inch or so in diameter, mounted like gems in ornate settings. That’s how I imagine anger in the stomach: a reaction to lived experience that hardens over time, polished by tears.
Each generation hopes that the world will change enough, or that we will be strong enough, to clear the debris we swallow as it comes along. Not yet. Parents face the work of explaining hate to children. We pass along the truth, to protect them insofar as we can. My father-in-law made us laugh about his friend in the army, a man so naive he expected white people would honor the printed ticket he received for a sleeping car on the train. “I told that fool that they ain’t going to give no Negro a sleeping car in Texas, or let him in the dining car, not when they got those German prisoners of war eating. And they didn’t,” he said, smiling. He coated the message with syrup to make it go down easy, but ultimately it was as indigestible for his grandchildren as it was for him.
Toni Martin is physician and writer who lives in Berkeley.
