The Tiger and the Cage

The Tiger and the Cage
A Memoir of a Body in Crisis

by Emma Bolden

Soft Skull Press, 2022

Reviewed by Kathleen Kirk,
EIL Poetry Editor

Wow, what a great memoir. Beautifully written, gripping from the start, and I learned so much: about precipitation and the water cycle, Catholic school, what it’s like to have a body in crisis, endometriosis, and the history of and, alas, current medical practices that don’t take women seriously when they talk about pain or their own bodies. I’ve encountered shocking and fascinating things before in the history of medicine and psychiatry, especially as applied to women, but I keep wishing things were better today. Sometimes they are, but The Tiger and the Cage reminds us how often medical research and medical practice still favors men and does not adequately address women and their needs.

The central metaphor comes from a nurse’s explanation of Bolden’s dysautonomia, a condition that causes her to faint or become dizzy. The nurse asks her to imagine herself as a tiger in a cage. “Now imagine that tiger gets spooked and feels threatened.” Young Bolden does, she has a great imagination. The nurse goes on: “Your body is the cage. Your autonomic nervous system is the tiger. You could be just sitting there on the couch, perfectly still, and your autonomic nervous system will act like that, like a tiger who gets scared.” In addition to her great imagination, this young woman has logic and plenty of rational questions. She wants to know why. No one can tell her why the tiger gets scared.

Dysautonomia is a general term for many symptoms and can be a condition in itself or a condition secondary to other diseases or disorders. In The Tiger and the Cage, Bolden has “passed out faster than any patient they’d seen” when she takes a major test on a tilt table. It barely moves, and she’s out. And yet this is surpassed by another tilt table test that mattered more to the expert doctor at hand. “The miracle was this: they had discovered and diagnosed a case of dysautonomia in a boy.” That made it real. In girls and women, you guessed it, it was all in their heads.

It’s not only this disequilibrium, dizziness, and fainting that Bolden suffers, but also the terrible, relentless pain and bleeding of endometriosis, where endometrial tissue grows outside of the uterus and can invade other organs and stick things together inside the body. The surgery required can be very delicate and complicated, and often must be delayed or compromised by the assumption that every/any woman wants to try to have a baby first, and get a hysterectomy after that. And what if the surgeon is not delicate and careful? The relentless pain and bleeding continue. And what if a woman does not want to live her life dedicated to having children? Why can’t she be treated compassionately and rationally, taking into account her own view of what’s important in her life, not a view that always privileges reproduction above other concerns?

This is a kind of horror story, beautifully and honestly told. We watch Bolden grow up, face and deny her fears, speak her fears, accept herself in radical ways, make hard choices, and thrillingly survive as a writer. I first knew through her poems, some published here at Escape Into Life, and I am awed by all she has gone through. This book was important for me to read, to see a woman come into her own identity and power, with the loving support of her parents, and will surely be especially important to women with difficult medical conditions, including endometriosis and dysautonomia. But I do hope anyone and everyone will read it, including those doctors who treated her. They might learn something.

Emma Bolden’s Website

Endometriosis at the World Health Organization

Emma Bolden’s The Tiger and the Cage at Soft Skull Press:

The Tiger and the Cage

Emma Bolden at EIL:

Emma Bolden

The Dysautonomia Project:


Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.