Robert Pinsky and the Poetry of Psychiatry

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    Academic Psychiatry, 25:3, Fall 2001 173

    Robert Pinsky and the Poetry of Psychiatry

    Neil Scheurich, M.D.

    Dr. Scheurich is at the University of Kentucky College ofMedicine, Lexington, Kentucky.. Address reprint requests to Dr.Scheurich, Dept. of Psychiatry, University of Kentucky Collegeof Medicine, 3470 Blazer Pkwy., Lexington, KY 40509-1810.

    Copyright 2001 Academic Psychiatry.

    Images of psychiatrists have abounded in televisionand cinema, albeit largely in the form of variouscrude stereotypes (1). However, although madness,suicide, and innumerable other gradations ofpsychological misery have obviously been prominentsubjects for literature since its beginning, intelligentexplorations of psychiatrists per se, in their modernmanifestation as professional therapists and medicaldoctors, have been harder to come by in seriousction.

    In contrast, other kinds of physicians have beendepicted powerfully and often sympathetically insuch major works as Sinclair Lewiss Arrowsmith, Al-bert Camuss The Plague, and Aleksandr Solzheni-tsyns Cancer Ward. It is difcult to think of anyworksof comparable stature having a psychiatrist as a sig-nicant character. Although Dick Diver in F. ScottFitzgeralds Tender Is the Night is a psychiatrist (whorather obliviously falls in love with and marries hispatient), it can be argued that the novel is essentiallya tragic love story that happens to contain vague no-tions about 1920s psychiatry (2). The psychiatrist inKen Keseys One Flew Over the Cuckoos Nest is a ci-pher. The view of psychiatrists in Sylvia Plaths TheBell Jar is mostly resentful, but does allow for someambiguity. One must advance to Pat Barkers recenttrilogy Regeneration, The Eye in the Door, and The GhostRoad, based on the work of World War I (de facto)psychiatrist W.H. Rivers, for a sophisticated and gen-erally sympathetic treatment of its subject.

    Interest in the medical bildungsromana tale ofthe development and maturation of a physicianhasbeen a signicant part of the burgeoning interest inmedicine and literature. It has been recognized thatmedical students, residents, and physicians mayidentify powerfully with ctional doctors (3). Fictionhas ethical implications that are inseparable from itsaesthetic impact (4). In this sense, it is regrettable thatthere are so few complex and credible role models,

    either positive or negative, of psychiatrists in seriousliterature. Samuel Shem (5) has lamented the paucityof psychiatrists as both authors of and characters inction and has speculated that realistic psychiatricpractice offers insufcient dramatic possibilities. Healso noted that psychiatrists have themselves veryrarely produced signicant literature (a point towhich I will return).

    In contrast to prose works, the poetry most com-monly associated with psychiatry has been confes-sional, written by sufferers of mental illness. Most in-famously, American poets John Berryman, SylviaPlath, and Anne Sexton, among others, wrote vividand powerful evocations of depression before ulti-mately succumbing to suicide. However, psychiatryand mental illness have been relatively rare topics forpoets lacking rsthand experience with them. A no-table exception is Robert Pinskys long expositorypoem Essay on Psychiatrists, which comprises aself-proclaimed outsiders reections about psychia-trists and their patients. This poem stimulates dis-cussion of psychiatric issues that are of particular in-terest to medical students and residents. What doesit mean to be a psychiatrist, and what are the publicperceptions of psychiatry?What is the nature of men-tal illness, and what is the relationship of psychiatryto other domains of knowledge and wisdom aboutwhat it means to be human?

    Pinsky, a prominent contemporary poet and re-cent Poet Laureate of the United States, publishedEssay on Psychiatrists in his 1975 collection Sadnessand Happiness, and it was recently reissued in The Fig-ured Wheel: New and Collected Poems 19661996 (6).Surprisingly, the work has, to my knowledge, gone


    174 Academic Psychiatry, 25:3, Fall 2001

    largely unnoticed in the psychiatric literature. Thepoem contains 464 lines of free verse, divided into 21titled sections of various lengths. Wewill focus on thepoems content, which comprises a constellation ofincidents, reections, and observations related to psy-chiatry. Pinskys themes include, rst, a broad consid-eration of the psychiatric project, and, specically, thevalues embodied in psychiatrists, patients, and thework they do together; and, second, a comparison ofpsychiatry and poetry as means of understandingand approaching life.

    I will argue that this poem, although not narra-tive in the conventional sense, does function as a po-etic bildungsroman of sorts. Instead of exploring a slowdevelopment of identity (as George Eliot famouslydid for a young physician in Middlemarch), Pinskygenerates a multifarious collection of images and po-tential identities of psychiatrists drawn from the me-dia, from the culture-at-large, from literature, andfrom his imagination. These images collide and strug-gle with one another throughout the poem, to cul-minate in a nal, yet tentative, literary judgmentabout psychiatry and its practitioners.

    What follows will necessarily be a limited ex-amination of the poem, given that I am specicallyinterested in the poems implications about the con-tested values of psychiatry. Although I will touch onthe contribution of Pinskys language to the poemsimpact, I will focus less upon poetic devices thanupon the theme of the work. There are, doubtless,many other possible ways to approach the poem,which, much like Alexander Popes more famousEssays, may be approached on distinct aesthetic ortheoretical grounds.

    Literature has lent itself to a number of uses inpsychiatry, chief of which, in terms of volume andsignicance, has been psychoanalytic literary criti-cism; that is, the application of psychoanalytic prin-ciples to authors, as well as ctional characters. Anexample of this is Norman Hollands analysis of apoem by Emily Dickinson (7). In contrast, the litera-ture of general medicine has more often been used toinstill empathy for the experience of illness, as wellas to facilitate a broad examination of what it meansto be a physician (8). The latter is my objective here;that is, to use this poem not to illustrate specic psy-chiatric theories, nor to demonstrate stark ethical di-lemmas, but rather, as an instrument of profession-alism, to catalyze an inquiry into what it means to be

    a psychiatrist. Because the piece represents a kind ofliterary critique of psychiatry, I wish to respond to iton its own terms, not to beg the question by subject-ing it to a psychiatric critique of literature.

    Pinskys ambivalence about psychiatry is plainthroughout the poem (for simplicitys sake, I will re-fer to the narrator as Pinsky, since no other identityis suggested, although this identication obviouslymay not be valid). Notable at the outset is his alacrityin declaring, of psychiatrists, that he has never (eventhis is difcult to say / Plainly, without foolishnessor irony) / Consulted one for professional help (p265). The statement, which implies that what followsshould be considered untainted by diagnosis or med-ication, reects the contested authority and interpre-tation associated with psychiatry.

    In discourse about psychiatry, uniquely amongmedical specialties, ones perspective and judgmentare inevitably called into question; it is necessary todeclare where one stands in the diagnostic situation.Pinsky does acknowledge that many of his friendshave consulted psychiatrists, a fact that appears toprompt his interest; however, he does not mentionever having known a psychiatrist personally or so-cially. Evidently, psychiatry is quite foreign to him,and he speaks of psychiatrists distantly: it seems ur-gent to try to speak / Sensibly about them, about thepsychiatrists (p 265).

    The poem teems with psychiatrys stereotypes,some challenged and some seemingly accepted. Therst lines seem to recognize and protest the preva-lence of cliches:

    Its crazy to think one could describe themCalling on reason, fantasy, memory, eyes and earsAs though they were all alike, any moreThan sweeps, opticians, poets or masseurs

    (p 265).

    Pinsky casts about for metaphors for what it isthat psychiatrists do. Do they clear the mind of debris(like sweeps), enable discernment (like opticians), orsoothe and stimulate (like masseurs)? As we will see,Pinsky seems to decide that psychiatrists most resem-ble poets, and it is in that sense that his ambivalencewill crest.

    Apparently, some stereotypes aremore easily dis-pelled than others. Pinsky rejects notions of theshrink, the religious analogy, and the Viennese


    Academic Psychiatry, 25:3, Fall 2001 175

    accents and beards, which, he says, hardly applyto the good-looking woman / In boots and a knitdress. . . (p 265) But, later, he writes, As far as onecan generalize, only a few / Are not Jewish. Many, Ihave heard, grew up / As an only child (p 274). Andhe relates an incident in which a woman he knew sawa stranger from afarwho was Pink and a bit soft-bodied (p 266)and correctly surmised that he wasa psychiatrist. Encountering such ethnic and demo-graphic caricatures, one senses that Pinsky knowsbetter and perhaps is being ironic, but it is signicantthat he does not bother to repudiate them.

    Prominent in the poem (and perhaps redolentmore of the decade in which it was written than ofthe current era) is the alleged conspicuous prosperityof psychiatrists. At various times, psychiatrists are as-sociated with expensive running shoes (p 265), ajazzy / Middle-class bathing suit (p 266), and el-egant machines and luxuries, with caroling / Andkisses, with soft rich cloth and polished / Substances,with cash, tennis and ne electronics, / Liberty oflush and reverend places (p 280). Pinsky seems re-pulsed by the thought of individuals making moneyfrom others misery, and he implicitly objects to acommodication of experience that may be a lurk-ing peril in psychiatry, a tendency to view happinessand relationships as things to be bought and sold. Helikens some of psychiatrys cash matters to thosethings that ought not to be sold: Seder / Services athotels; skill at games from paid lessons; / Fast di-vorce; the winning side in a war seen / On TV (p274).

    In addition to the problematic relationship ofprot and suffering, there is a wider concern aboutthe values embodied in psychiatric transactions. Inthe important third section, titled Proposition, Pin-sky writes

    These are the rst citizens of contingency.Far from the doctrinaire past of the old ones,They think in their prudent meditationsNot about ecstasy (the soul leaving the body)Nor enthusiasm (the god entering ones person)Nor even about sanity (which meansHealth, an impossible perfection)But ponder instead relative truth and the warmDusk of amelioration. The cautiousYoung augurs with their family-life, good booksAnd records and foreign cars believeIn ameliorationin that, and in suffering

    (p 266).

    This passage powerfully captures the view ofpsychiatrists as soulless and relativistic technicians,committed to no goal or belief system beyond theirpatients satisfaction and their own well-being. In re-cent years, the role of values in psychiatry has be-come widely considered (911). The pretense ofvalue-neutrality in an endeavor such as psychiatry,so closely tied to notions such as empathy, hope,guilt, and responsibility, may carry the risk of moralvacuity. Salient in psychiatry is the inquiry into howit is that one should live, a project that may supersedethe purview of clinical parameters as well as formalethical principles.

    Pinsky conjures up a kind of moral wasteland inhis likening of some psychiatric patients to thosewhoconsult Ann Landers. He writes that beyond a certainthreshold of consumer goods, such individuals ndthat their capacity / For mere hedonism lls up, oneseems to need / To perfect more complex ideas ofdesire, / To overcome altruism in the technical sense(p 275). He refers to this as a standard of cui bono,which, although seemingly opposite to more Spar-tan or Christian codes, is, nonetheless, rigorous inits own way:

    It suggests a kind of league of men and womendedicated

    To their separate, inward duties, holding incommon

    Only the most general standard, or no standardOther than valuing a sense of the conictAmong standards, a league recalling in its mutualConict and comfort the well-known fact that

    psychiatrists,Too, are the patients of other psychiatrists,Working dutifullycui bonoat the inward

    standards (p 276).

    This is an ugly vision of well-to-do solipsistic pa-tients and their therapists, absorbed in navel-gazingand justicationof themostgeneral standard,thatis, self-interest.

    Interestingly, in his references to psychiatric pa-tients, Pinsky reects another notorious cliche, thesharp distinction between neurosis and psychosis. Inthis poem, one encounters the Ann Landers clients,suffering from wealth and ennui, but then there arethe mad: Other patients are ill otherwise, and do /Scream and pace and kill or worse. Pinsky concedesthat nothing Helps me to think of the mad otherwise/ Than in cliches too broad, the maenads / Andwild-


    176 Academic Psychiatry, 25:3, Fall 2001

    eyed killers of the movies... (p 276). For him, thereseem to be no intermediate steps between problemsof living and raving psychosis.

    Pinsky also irts with the assertion of a certainphilistinism of psychiatrists, who appear not onlymaterialistic, but also bourgeois. He maintains thatGreek tragedy of course is the sort of thing / Theylike and like the idea of (p 270; my italics). He com-pares a psychiatrist to the mask-like comic char-acter Rex Morgan, M.D. and produces a bit of vapid,wooden dialogue between the latter and a youngwoman whom he takes to a concert (p 271). Else-where, psychiatrists are depicted, somewhat conde-scendingly, as engaged in activities like recyclingtheir garbage, / Voting, attending town-meetings (p273). Psychiatrists have good sense, and are solidcitizens, albeit dull and unimaginative ones. Thecharge of philistinism is put most bluntly in the fol-lowing:

    But after allwhat cultural life and whatFurniture, what set of the face, would seem

    adequateFor those who supply medicine for misery?

    (p 271).

    In this passage, one of only two references to so-matic therapy in the poem, psychiatrists are locatedsquarely on the scientic side of the two cultures,and are made to seem quite oblivious to humanisticand cultural subtleties.

    The implicit charges of moral relativism andpurblind philistinism dovetail in an arresting com-parison of psychiatrists to cowboys. Pinsky writesthat psychiatrists are stock characters like cow-boys. . .Like a cowboy, the only child roams / Thelonely ranges and secret mesas of his genre (p 275).The simile seems based on a common presumptionof lawlessness: in the popular conception,...


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