Belief in the unity of mind and body among poor working class women in metropolitan Cairo is exemplified by the "state of being upset." The Egyptian women of this study use physical symptoms that they believe derive from emotional causes to negotiate and give meaning to relationships with neighbors, friends, and relatives; to jockey for power; to fill emotional needs; to manage presentation of self; and to weave the political fabric of interpersonal life. A detailed case study of Um Ramadan, a woman whose misuse by her husband made her nerfiza, illustrates the relationship between emotional upset and physical illness and the use of psychosomatic illness to gain sympathy and exact revenge. The expression of Um Ramadan's symptoms is further analyzed in terms of the underlying cultural constraints placed on Muslim women and the tensions inherent in local gender role relations.