Poetry and psychiatry: a trainee’s perspective

I.
"And I was alive in the blizzard of the blossoming pear,
Myself I stood in the storm of the bird cherry tree.
It was all leaflife and starshower, unerring, self-shattering power,
And it was all aimed at me.

This poem rings through my head, a haunted hopeful lullaby. Haunted, because it was written by a man hounded to his death in a Siberian gulag. It may well be the last poem he ever wrote. Lullaby, because the right lyric can feel like a chord, played on your instrument brain. And hopeful, because I too was alive in the blizzard of that blossoming pear. And through this poem, I am vouchsafed to know it.

**

For the past six months, trainees in St James’ Hospital have had the opportunity to consider (and compose) poetry, prose and song as part of a narrative medicine group run by a kindly consultant. It’s been a good time, and a worthy exercise in considering an idea often expressed but rarely explored: that the practice of medicine is art as much as science; that there is meaning to be mined in what we do; that it is helpful to be articulate about this.

The year that never happened: tackling the Covid era through poetry

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Colm Tóibín sells Thomas Mann back to the Germans. Not everyone’s buying

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Fintan Drury: Brian Cowen put country first, party second

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Let me try to say what I mean: each one of us at all times carries ourselves coiled up in story. And it should never cease to amaze that as doctors, we but ask and oh! we receive. We knock, and stories of selves come unspooling through doors like a red, broken carpet. Like the storm of the bird cherry tree.

What to do with these stories?

We are asked to consider shame. The stories contributed to the Mother & Baby home commission were destroyed, we now know. How, I wonder? Were they buried? Burned? Were there ashes? Should we have been compelled to wear them on our foreheads? Should we not sprinkle these stories into our water supply, fertilise our crops with them, so that we can recognize the taste of who we surely, truly are?

II.

What is this dire delight flowering fleeing always earth?
What is being? What is truth?
What, indeed, is this?

Questions that cannot be answered really ask but one thing: can you face them, or do you turn away? We approach our interviews with multiaxial inventories and diagnostic criteria and think we control the narrative; but the stories we unspool often ask such unanswerable questions of us:

“What’s wrong with me?”

“How do you know?”

“Why won’t you help me?”

At a teaching session recently, another kindly consultant passed this parcel on to a roomful of trainees: “You are not responsible for the existence of the patients you meet.”

We unpacked this in appreciative silence. It felt like an acknowledgement of something that both was and wasn’t true. (“What is truth?”) It was as if to alleviate its burden, he renamed the weight of this work we do as gravity: an awesome force for which we bear no personal responsibility, but to which we cannot but be responsive.

**

Osip Mandelstam, the poet whose poem I have been tracking in this piece once wrote: “To exist is the artist’s greatest pride. He desires no other paradise than existence.” (The Morning of Acmeism)

If we work, as I believe we do, at the frontline of inner landscapes, then poetry is an art form uniquely positioned to help us navigate the trenches of existence, to cultivate artistic pride in the gravity of our undertaking.

At the heart of poetry lies a lyrical exchange, an alchemical transference from poet to reader through poem. As Edward Hirsch writes in How To Read a Poem: And Fall in Love with Poetry, “we stumble upon poems, but it feels as if they have come searching for us.” This mysterious, soulful interrelationship requires engagement and openness from the reader. It essentially asks of us that we be what we are: vulnerable. When we soften our resistance to unanswerable questions, we strengthen our purchase on reality. And the point of this essay is that attention to a good poem can model this for us.

Let me try to show you what I mean: return to the paragraph above and perform the following substitutions:

Poetry – Psychiatry.

Poet – Patient.

Reader – Doctor.

Poem – Story.

The patient – story – doctor dynamic, then, is mirrored in the poet – poem – reader exchange. Both burrow inward just as they bridge outward. Both connect us more deeply with ourselves just as they connect us more intimately with another. Both, ultimately, rely on words to enchant life back into being.

III.

Blossoms rupture and rapture the air,
All hover and hammer,
Time intensified and time intolerable, sweetness raveling rot.
It is now. It is not."
(And I Was Alive, from Stolen Air: Selected Poems of Osip Mandelstam. Trans. Christian Wiman)

What interests me most, in life as in work as in poetry, are what Virginia Woolf rather perfectly described in Mrs Dolloway as “moments of being”: those “little daily miracles, illuminations, matches struck unexpectedly in the dark.”

I am, I believe, a psychiatrist because of how this profession privileges me to participate communally in such moments of being. I do not mean to suggest that in this field transcendence is on tap and shame on you if you’re not lapping it up. But it does have its moments: often sublime and rarely anticipated, when the sense of connection comes close to Mandelstam’s rupture and rapture. I have been changed by my patients, and I am weary of what I perceive to be a contemporary reticence to name and to honour such experiences for what they are: holy (tr. other, set apart.) And there is little doubt, if the mystics, poets, and scientists are to be believed, that existence is nothing if not communal: thou art that, as the saying goes.

We are asked to consider shame, the great rejection of our shared vulnerable state.

Consider this: Osip Mandelstam was a genius and was tortured psychotic because of a poem he wrote. And yet, he rejected nothing. He was last seen, emaciated and in tattered clothes, rummaging through garbage. And yet, possibly the last poem he ever wrote ends with blossoms rupturing and rapturing the air. In short, he was alive. So too, he sings, are you.

Narrative medicine trains close attention. It is the least this world deserves.
Dr Matthew M Shipsey is a foundation year trainee working on the ACCES team. Here are five poems he likes: My own heart let me more have pity on by Gerard Manley Hopkins; The White Lilies by Louise Gluck; Hamlen Brook by Richard Wilbur; Clearances by Seamus Heaney; Filling Station by Elizabeth Bishop.