Robert Pinsky and the Poetry of Psychiatry
Post on 23-Dec-2016
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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
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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
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
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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
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-
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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?
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, psychia-trists and cowboys play by their own rules, far fromcivilizations standards, and are beholden to no one.Both are cool and utterly in control, yet uncouth anduncultured, roaming their respective barren wilder-nesses, one, of the landscape and one, of the mind.
Perhaps, for Pinsky, the notion of psychiatrist asmoral and cultural cowboy follows from the nec-essary detachment of therapeutic work. In consider-ing the seriousness of psychiatrists, he reects thatthey are serious only in the way that airline pilots,
radiologists, and master mechanics are. Their work,like that of all technicians, suffers from over-involve-ment. He contrasts psychiatrists with painters, schol-ars, and (interestingly) surgeons, who presumablymay benet or even attain greatness from giving theirlives over to their work, and he fashions an amusingmetaphor of the Terrifying idea / That a pilotcould over-extend, perhaps try to y / Too well, orsuffer from Pilots Block (p 267).
Similarly, in order to do their work (and perhapsto model for their patients), psychiatristsmust exhibitrestraint and balance, must carefully preserve theirown lives apart from their work. However, the poemimplies that detachment may come only at the priceof a certain gray neutrality. That is, psychiatristsmusteschew obsession, overcommitment, and conviction,inasmuch as these may impede therapy. As in thepsychoanalytic caricature, psychiatrists must becomefeatureless and even vacuouscontainers for theirpatients transferences. The poem implies that such aneed may give rise to psychiatrists venal and mid-dle-brow lives, combining the worst features of anethical relativism and a social and cultural conser-vatism.
In the heart of the poem, Pinsky uses the story ofDionysius and Pentheus from Euripides The Bacchaeto further explore the shadowy gure of the psychi-atrist. In the play, Pentheus is hostile to the attemptof his divine cousin Dionysius to bring the lattersself-worshipping religious cult to Thebes. In retalia-tion, Dionysius inames with madness the women ofThebes, who ascend Mount Cithaeron to engage inthe cults frenzied rites. When Pentheus goes to in-vestigate, the mad women, including his motherAgave, tear him limb from limb. Pinsky wonderswhether Pentheus or Dionysius best exemplies thepsychiatrist.
With his reasonable questions, Pentheus triesTo throw light on the old customs of savagery.Like a brave doctor, he asks about it all. . .
In this trope of the psychiatrist as somewhat be-fuddled do-gooder, Pentheus is the sober rationalistwho, unfortunately in this case, is wholly ineffectualand overwhelmed by chthonic powers quite beyondhis ken. On the other hand:
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In a more hostile view, the psychiatristsAre like Bacchusthe knowing smirk of his mask,His patients, his condent guidance of passion. . .
This is the view of arrogant psychiatrists who donot treat, but actually foster and fabricate illness andits classications. This is a primitive dread that is theother half of a striking dichotomy: if psychiatrists arenot like Pentheus, that is, if they are not helpless foolsand can signicantly alter behavior and experience,then perhaps they are to be feared. Patients and theirpsychiatrists therefore attract complementary stereo-types. Patients are either just like normal people (thatis, they just have problems of living and choose toengage in therapy about them) or they are TheMad, and purely Other. Similarly, psychiatrists areeither just like normal people (that is, despite theirclaims they are just as clueless about human behavioras the rest of us) or they are powerfully manipulativeto a sinister degree. According to these stereotypes,mentally ill patients and those who treat them maybe either dismissed or demonized: no middle groundof engagement is possible.
So far, it may seem that Pinskys view is a whollynegative one of coldly mercenary psychiatrists. Butthis is not the case, for, notwithstanding their allegedcool rationality, they are viewed in the poem as artistsof a kind, with whom Pinsky appears to feel, there-fore, some kinship:
They are not gods or heroes, nor even priests chosenApart from their own powers, but like artists are
mereExperts dependent on their own wisdom, their
own arts. . . (p 272).
And Pinsky sees psychiatrists specically as po-ets of a kind. Near the beginning, he asserts, Shrinkis a misnomer, and, a few lines later, writes that nosmall part of the psychiatrists / Role is just that: topoint out misnomers (p 265). So psychiatristslikePinskyare fundamentally engaged in using lan-guage to dene experience. Both psychiatry and po-etry are interpretive and hermeneutic endeavors,arts / Of knowing and naming. . . (p 273). Theterms of psychiatry are likened to Water thinnerthan blood or under bridges; bridges / Crossed in thefuture or burnt in the past (p 273). Naturally thisviewof psychiatric concepts that come and go, like
all words and languagesmay impugn psychiatrysscientic aspirations.
Of course, this comparison is meant only in thebroadest sense, and the poem seems to imply thatpsychiatry and poetry may, in fact, offer rival, andnot complementary, conceptions of experience. Theystem from different premises and utilize very differ-ent dialects. Considering psychiatric terms such asneurotic, anal, and paranoid, Pinsky seems to have hisdoubts about the capacity of psychiatrys clumsy ter-minology to capture experience in the way that po-etry does. He writes that it is Easier to cut thin airinto planks with a saw / And then drive nails intothose planks of air (p 273). (one wonders if this is aswipe at psychiatric diagnosis) than to evade what hecalls the terms of myth, such as Justice, Fortune,and Love (p 273). In fact, he writes that charactersin a poem by Walter Savage Landor are
In a sense, my own psychiatrists, shrinkingThe sense of contingency and confusionItself to a few terms I can quote, ponderOr type: the idea of wisdom, itself, shrinks
Pinsky is open about his allegiance to ideals ofpoetry, wisdom, and acceptance of suffering, andseems puzzled that so many of his friends, many ofthem artists like himself, have felt the need to resortto psychiatrists. He intuitively feels that art, beauty,and knowledge ought to sufce for us, and that psy-chiatry is, in fact, an inferior poetry.
At the end of the poem, Pinsky is at his mostgracious toward psychiatrists, writing, I nd I havefailed / To discover what essential statement couldbe made / About psychiatrists that would not apply/ To all human beings (p 279). Human beings, aswell as psychiatrists try tentatively / To understand,to nd healing speech (p 280). Finally, he speculatesthat we are all psychiatrists, / All fumbling at somany millions of miles / Per minute and so manydollars per hour. . .saying what we can (p 280).
With this conclusion, Pinsky decisively repudi-ates the stereotypes and attempts to accept psychia-trists back into the fold of humanity, as it were. Ofcourse, one could say that this dismissal of invidiousdistinctions may also amount to a back-handed com-pliment. After all, to say that we are all psychia-trists may be tantamount to saying that psychiatrists
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do not have any separate area of expertise. Fewwould say that we are all neurosurgeons or that weare all gastroenterologists. But I think that Pinskywould acknowledge that we are all psychiatrists onlyin the sense that we are also all poets, or all politi-cians, or philosophers, for that matter. All of thesedraw upon rhetorical arts, having as their bailiwickthe commonality of human experience; and althoughtechnique and expertise are real, any endeavor soclosely tied to humanity must acknowledge a certaingeneral wisdom that has gone before and cannot layclaim to a hermetic and superior understandingwith-out risking estrangement and self-isolation. So Pinskyvoices his hope that psychiatrists Will respect themeans, however pathetic, / That precede them; thatthey respect the patients / Own previous efforts,strategies, civilizations. . .(p 274).
Essay on Psychiatrists represents a poets sus-tained attempt to come to grips with an alien en-deavor, and the author seems to posit as a commonground the rhetorical and interpretive faculties of po-etry and psychiatry. For him, both practices are at-tempts to use language to make sense of the bewil-dering ux of experience. The fact that the point ofview of the poem is a limited onethe author evi-dently had no personal acquaintance with the prac-titioners or the patients of psychiatry, and he wroteat a time when much of the science of the disciplinewas less mature than it is nowdoes not negate theinterest of the questions it raises.
Perhaps because words constitute his domain, hehas little to say about the science or technology ofpsychiatry; these seem to be as wholly Other as theprofoundly insane. Or perhaps he deeply distrustssuch a direct application of technology to the prob-lems of human life, which, for so much of history,have been the province of poems and other stories.Arguably, he comes to see psychiatrists as would-bepoets of a kind (or, in his more hostile moments, asfailed poets), who forsake wisdom and beauty intheir desire for a degree of authority, not to mentionlucre, that exceeds what mere writers may expect.
The poems technique and form also contributeto the theme of the uneasy similarity of psychiatricand literary modes. It seems to me that what makesthe work poetically signicant (and of interest to theaverage reader and not just to the psychiatrist) is theexhilarating profusion of vivid images and meta-phors. As we have seen, at various points in the
poem, psychiatrists are likened to sweeps, opticians,poets, masseurs, pilots, radiologists, master mechan-ics, Pentheus, Dionysius, Rex Morgan, M.D., mereexperts, pilgrims, journeymen, bourgeois savants,gallant seekers, persistent sons, and cowboys, tomen-tion only a few. The poems wild profusion of meta-phor serves to celebrate the capacity of language toopen up new points of view and even new worlds ofexperience; implicitly this project honors psychother-apys hope of altering subjective, and eventually ob-jective, reality through the mere exchange ofwords. However, it is signicant that the poet seemsto wriggle free from each metaphor just as he is onthe verge of yielding to it; that is, his technique im-plies a recognition that language and metaphor canentrap as well as liberate. His ambivalence toward histerms is analogous to that of the good psychothera-pist.
The poems form mimics psychotherapy in otherways, as well. It is literally an essay, inasmuch asvarious identications of psychiatrists are tried onfor size, as it were, then discarded, as needed. Thispractice parallels the tradition of psychotherapy, inwhich the self is viewed not as some unchanging es-sence to be discovered, but rather as a eld of possi-bilities to be created by imagination and contingency(12). By the end, Pinsky seems to have given up onnding a metaphor that will precisely illustrate whata psychiatrist really is. Also, the construction of mul-tifarious identities for the psychiatrist bears somesimilarity to transference, although in this case it islargely cultural transference, inasmuch as media-derived images are profoundly inuential.
Essay on Psychiatrists yields a number of usesfor psychiatry and its ethics. Judging from the persis-tent lack of enthusiasm of medical students for psy-chiatry (13), the eld still suffers from the relative dis-dain and mistrust of other areas of medicine, and itis incumbent upon its practitioners to examine and toquestion the cultural stereotypes, as well as the socialrealities, that underlie views of psychiatrists as dull,ineffectual, or parochial.
Essay on Psychiatrists provides a sophisticatedand stimulating context in which medical students,residents, and their mentors can discuss ethical is-sues. What does it mean to prot from the illness ofothers? What standard of living should be adequatefor physicians? How much of psychiatry is science,and how much is rhetoric? Notwithstanding the
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vaunted Decade of the Brain, psychiatric diagnosisremains embattled, particularly, but, by no means,only, in the popular press (1416). What are the dif-fering implications, if any, of medication vs. psycho-therapy as treatments for mental illness? How doessymbolic understanding of patients experiences co-exist with categorical and manualized diagnosis?
What is the role of values in psychotherapy?What is the effect upon ones personality of becominga psychiatrist? How does one preserve ones identityamid the swirling storms of patients lives? It seemsto me that, as advancing psychopharmacology andstandardized diagnosis aspire to make psychiatrymore mainstream, too little attention is being paid tothe phenomenological and sociological strangenessof what it is that psychiatrists do. Becoming a psy-chiatrist is still fundamentally different from becom-ing a surgeon, a cardiologist, or a pediatrician; it en-tails the assumption of a highly ambiguous roleembroiled in stereotypes and contested value sys-tems.
Finally, this poem illustrates the sometimes tensecoexistence of what one might call the narrative andthe clinical views of experience. In recent years, nu-merous arguments have been made for the impor-tance in literature of instilling empathy and under-standing of the illness experience (1719). Othershave countered that the realms of literature and ofethics are not congruent, based, as they are, on dif-ferent methods and goals (20).
In this work, Pinsky accentuates the more subtle,but no less real, differing implications of the speech ofpoetry and psychiatry. What, for instance, are the di-vergent connotations of love and the more clinicalnotion of attachment?What very different semanticuniverses unfold behind such contrasting notions asevil and antisocial personality disorder?What, inpoetry, corresponds to the notion of global assess-ment of functioning? Conversely, what, in psychia-try, captures the concept of wisdom? Emotional in-telligence?
Certainly, much is often gained in examining lifefrom a clinical point of view: attention to diagnosisand neurochemistry has alleviated much suffering.But other, much older traditions have viewed bothjoy and suffering as experiences to be understood andexplored, rather than necessarily manipulated. In therush toward empiricism, can psychiatry honor itsdebt to, and ultimate dependence on, the great faiths
and wisdoms that have preceded it? A poem like thisconfronts us with this question and urges us to ex-amine our own identities; our beliefs about illness,health, and treatment; and the power of language toshape our experience.
In conclusion, I wish to distinguish my own par-ticular interest in this poem from the wider educa-tional uses to which it may be put. As regards theformer, I have found that the piece is a powerful re-ection of the sometimes tense coexistence of litera-ture and psychiatry. From the time that Freud usedpsychoanalytic tools to interpret fairy tales and theworks of Shakespeare, artistic endeavor has remaineda dark continent, of sorts, that psychiatry hasstriven mightily to subjugate.
Psychoanalysis is the only subculture of psychi-atry that has engaged in any signicant collaborationwith literature, and psychoanalytic criticism is to lit-erary criticism as a whole as psychoanalysis is to gen-eral psychiatry; that is, a crucial and yet not uncon-tested component. The often- bewildering diversityof psychiatry makes any discussion of the disciplineas a monolithic entity difcult, and psychiatrys re-lationship to literature is ambiguous and multifac-eted.
Inasmuch as the tools of psychiatric thought areapplied to texts, they constitute the tools of the criticof literature, but inasmuch as they are applied to life,that is, general concepts, such as wisdom, suffering,and values, they may amount to a rivalry with liter-ature. Because literature and psychiatry often usevery different means to the shared end of illuminat-ing human experience (both arguably aim to makepeople not only more content but also more aware,morally and otherwise), they sometimes step on oneanothers toes and settle for an ambivalent coexis-tence. Many artists have harbored a mistrust of psy-chiatry that they have not had reason to hold towardmedicine as a whole. Perhaps it is therefore no acci-dent that (pace Shem ) no psychiatrist has yet pro-duced major literature (of the stature, say, of theworks of general physicians Anton Chekhov or Wil-liam Carlos Williams).
As I have implied, however, the poem is educa-tionally interesting for various other reasons. Of thepsychiatry residents with whom I have discussed thepoem (so far I have utilized it only for optional jour-nal club gatherings), few have taken particular noteof the psychiatry-vs.-literature opposition noted
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above. Rather, many have been struck by the moregeneral notion of psychiatrists as purveyors of valuesin general; the religious images in the poemhave gen-erated discussions of the similarities and differencesbetween psychiatry and religion. Some residentshave felt strongly that psychiatry has become muchmore necessary in modern times as previously as-sumed value systems have given way to skepticism.Related to this, some have wished to discuss the de-gree to which their own beliefs or faiths should bedisclosed in therapeutic relationships; that is, the ex-tent to which a psychiatrist ought to be genuine.
Other residents I have supervised have beenmore interested in the many psychiatric stereotypesand, in particular, the various media images (of theraving mad, of the bland psychiatrist) conveyed inthe poem. This has led to discussions of culturaltransference in general, not only of patients towardpsychiatrists, but also of the latter toward their pro-fession. To a degree that is probably unmatched byother medical specialties, individuals come to psy-chiatry with a tremendous number of culturally in-duced assumptions. For instance, notwithstandingmarked changes in therapeutic techniques in recentdecades, many beginning trainees continue to as-sume that a psychotherapist ought to maintain a re-lentlessly impassive and taciturn demeanor, presum-
ably because this remains the prevailing stereotype.Also, for a few residents, the poet has evoked the no-tion of the dreaded patient (often nudged into treat-ment by a spouse or other family member) whodoesnt believe in psychiatry. The poets generalappraisal of the discipline as depending much moreupon rhetoric than upon science or proven efcacycan give rise to discussions of what it is likein anexperience all too familiar to psychiatriststo workwith patients or even colleagues whomay not respectthem.
Finally, I have found residents to be intensely in-terested in contested areas of psychiatric diagnosis.Early clinical contacts often generate questions as tothe extent to which complex human experiencesgrief, religious enthusiasm, and vicious behavior, forinstancecan or ought to be captured by diagnosis.Essay on Psychiatrists helps to stimulate such dis-cussions. Apart from what I consider to be its mostoriginal themethe agon between psychiatry and lit-eraturethe work also serves as an excellent teachingtool insofar as it is not only poetically interesting, butalso because it fosters varied discussions of what itcan mean to become that strange personage, a psy-chiatrist.
The author thanks Debra Katz, M.D., for her sugges-tions regarding an early draft of this article.
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