Cavar’s sophomore poetry collection, Differential Diagnosis (Northwestern University Press, 2026) is a visceral dissection of postmodern anxieties through the lens of trans* and Mad experiences. Reminiscent of Joanna Klink and Lyn Hejinian’s surreal work and, more broadly, a long lineage of Mad literature, the collection also uses quotes and footnotes to engage in conversation with writers like Michel Foucault, Jos Charles, Kim Hyesoon, T. S. Eliot, and Evelyn Berry. The body of the work both structurally and thematically expresses the gravity of grief, lamenting lost time and the limitations of language. The speaker uses sullen puns to play with language despite resignation and fatigue after enduring years of obscurity. The voice of this collection is a prolonged exhalation of exile woven through a variety of loose forms and unconventional syntax, the solemnity inextricable from the structure. In other words, the form augments the content, a harmony that consistent and effective collections aspire to accomplish.
The primary arc of Differential Diagnosis, as alluded to by its title and eponymous series of poems, involves postmodern and metapoetic anxieties about language. In “Substitution Poem,” the speaker is distanced from the self, a dissociated caricature or “stick figure… in crisis” (Cavar 29). They tend to be assertive but not authoritative, with an unspoken hope that the reader will respect and affirm declarations of a self that has been chronically undermined and underestimated. This “stick figure” frequently slips into compulsive disclaimers and self-sabotage as self-defense, only rarely snapping under pressure with exclamations like, “I am sick / to fuck of being sensible!” (10). In “Envy Narrative,” they briefly admit, “I have myself to blame. She can’t / Be trusted” then turn to the reader for support, asking, “Do you understand?” as if anticipating revulsion or rejection (42).
Similar self-deprecation appears in “My First Crime” with the lamentation, “I am have never been cage-free. Always compensating for something” (40). Under relentless external and internal scrutiny, the speaker eventually crumples into humility—“What exactly is required of me, I can’t / do it… Am I worth all I am capable of doing. This cruel / Knowledge” (Cavar 58). This is a striking example of the quintessential metapoetic voice, both self-referential and confessional, resigning to the shortcomings of the self. This collection’s place in postmodern poetry, especially trans* and Mad lineages, is evident in the confessional nature of these self-portrait poems.
The urgent insecurities of Differential Diagnosis orbit around the act of naming. From a trans* and Mad perspective, gender and sexuality markers and medical diagnoses can be both a constructive and inadequate constraint. Even selecting a new name for oneself is a fraught journey of grappling with language and the self, its own microcosm of metapoetics. In a rare moment of conviction, the speaker expresses early on, “I believe I have / No name but rather perhaps dent or event… This thing / sends me into dark places / where the nameless live” (8). To be nameless is undesirable and disorienting, associated with trauma (“dent or event”). Who holds the power of naming—the self or the other? Is naming an internal or external process?
These questions and more guide us through the central conflict. One possible resolution is, “Name goes to its grave a secret. / Name is anecdotal / evidence” (49). A name can be a subject, a proper noun, a pronoun, a narrative. It can be fleeting. It can be dismissed. The eighth poem in the titular “Differential Diagnosis” sequence narrates, “You spot my wrong a while / away. You may / Get even to name it, for good / or ill” (31). The act of articulating and labeling is a coveted privilege. The speaker goes as far as to say, “I am helpless in the face / Of my own legitimacy,” identifying their own powerlessness to externally imposed labels. However, as many disabled and Mad folks know, a diagnosis can also provide clarity in suffering and even a redemptive relief that one’s experiences are not imagined but recognized. In other words, “my name is the sick of my illness. i am good / and named” (45).
In correspondence with the omnipresent dread and desire surrounding the act of naming, the collection delays assigning any specific terminology to its speaker. The word “autism” does not appear until halfway through the book, compared to “a backward / flower,” both natural and unnatural (37). The term “anorexia nervosa” is explicitly absent for even longer, and begrudgingly personified as something that “struggles / to name itselves” followed by a footnote innuendo calling it “That big / bad word” (50-51). Having pursued and yet postponed these diagnoses, the speaker clarifies, “I am not sure I believe in all the things wrong with me” (32). Presumably, possessing the terminology to name their experiences did not provide the desired clarity, instead lending them to experience further neglect and shame: “Being disordered is a manner / of being out of order, that is, insequential, that is, inconsequential” (59).
The idea of wrongness and disorder expands from the specificity of diagnosis until it begins to degrade the definitions by which we understand reality. In yet another installment of introspection, the speaker tells us, “I don’t know / about you, but I was born in the wrong / episteme.” (18). This collection and its narrator dwell outside the realm of accepted knowledge, condemned to feel defective and dysfunctional compared to an unknown other. Structurally, the poem uses enjambment and spacing to emphasize a crucial confession: “I don’t know.” In another piece, a doctor tells the speaker, “‘No theory will protect you here. / Redemarcate the boundaries / of your knowing’” (60). The poem frames this sage wisdom as professional advice, both relevant within the context of diagnosis and the broader, metapoetic contemplations about redefining knowledge.
Another aspect of naming to consider is gender identity and the queering of language. At one point, the speaker self-identifies as “a victim of the / pronouns” (34). The consistent voice of the collection establishes a new grammar of gender, playing with visual text through homonyms, capitalization, abbreviation, and even font size. Which elements are interchangeable and fluid? Which are rigid and therefore brittle? Readers must parse through unconventional syntax as if they are hearing English for the first time, daring them to participate in meaning-making. The audience is invited to suspend their disbelief and become a co-conspirator in the speaker’s testimony: “Can you help me pass into a new mythology?” (6). This intimate dynamic later becomes a demand: “Get my name and fuck me / with it. / I delight with delicious / Literacy” (31). In the world of Differential Diagnosis, the act of description is inherently sensual.
This sensuality is facilitated by both the anatomical and metaphorical body, with a recurring motif of “holes” representing anything from emptiness, orifices, wounds, and gaps, but also etymologically connected to themes of “holiness” and “wholeness.” Is the speaker being literal or figurative in saying, “I have… many / unofficial holes” (18)? Does this refer to trans* corporeality that defies conventional labels, or something more metaphysical? One poem is titled “You are holy, your [Name*] is holy, etc.” and another says, “i am wholly the wait of the name” (54). This play on words creates a paradox of presence and absence, “weight” and “wait,” what is included in a name and what is left out, what language can do and what it fails to do. One humorous yet rueful scene finds the speaker “trying to fill a basket. / But there’s / You guessed it / A hole” (66). The physical and metaphysical are reunited when one poem reckons with “The backbreaking / Labor of being born, nay, / Of being known,” a state of intimacy that comes at great cost to the ego (25).
The ambient caution regarding labels and “being known” is not unwarranted. One poem hypothesizes, “Let’s say I’m a monster. Say poetry made me this way. Let’s say words / are monsters trying to become sentences. Let’s say it’s pathological” (21). This passage sheds light on the pathologized pathos of trans* and disabled bodies. The motifs of monsters and marginalization appear throughout the text. “The Ways of the Monster” is declarative and abrupt: “We are in the gutter. / Someone narrows the aperture” (17). The window of inclusion is closing, and the oppressor is nameless and therefore blameless. The ambiguity and anonymity of “we” and “someone” nevertheless establish a dichotomy. Who is included and who is excluded?
Despite grappling with an ostracized existence, the speaker expresses a profound longing for life, imploring the universe to “send me to that great sad / struggling world of things” (15). The collection contemplates the cost versus capacity of language in a postmodern world, with the apostrophic prayer, “Name don’t kill me just bring me someplace / I can live” (49). The speaker comes to terms with the “many unknowns… and even more / diversions” that “made me everything but dead and in / that way twice as killable,” acknowledging that being open and available to a full life renders one vulnerable to exploitation and harm (19). The collection even goes as far as to declare, “Being born wrong is a gift” (48). This bittersweet philosophy manages to reconcile the speaker’s pain from a life in the margins of madness and queerness with everything their identity has illuminated. They resolve “to stick to horrors within my / comprehension” and accept their physical and spiritual limitations, “because to end the bad’s / to end the whole thing” (63). The ideas of “wrongness” and “wholeness” become one.
Reading this collection as a trans* and Mad poet with many of the same thematic obsessions, I found Differential Diagnosis to be a highly cohesive and effective deconstruction of how we attempt and sometimes fail to relate to one another as humans of intersectional experiences. These poems simultaneously wrestle with, transcend, and concede to the boundaries of the written word. They “invent a value / -system as consistent / as nonsensical” (25). Just like its author, this work is a paradox incarnate that resists labeling, a bittersweet celebration of complexity and the human condition (25).
Differential Diagnosis is available for purchase from Northwestern University Press
Zoe Korte is a queer and mad poet whose work has appeared in Roi Fainéant, Maudlin House, new words {press}, Foglifter, Room Magazine, Eunoia Review, and elsewhere. They have earned degrees in English, Spanish, and Ancient Greek from the University of Missouri. They live with their partner in St. Louis, where they work for Sundress Publications and the Missouri History Museum. You can find them on Instagram @zoekpoetry or Bluesky @mostlymosspoetry.
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