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Ron Charach : Down in the Dark: Poetry in Psychiatry

Feature Essay in Poetry Canada, (Summer 1990), pp. 6-7

There is, and perhaps always will be, a healthy amount of suspicion, even competition, between poets and psychological healers. After all, the two professions both strive to understand the psyche, and achieve an expertise in the full range of human emotions. As a poet who happens to be a psychiatrist, I often find myself in the role of trying to demystify the beliefs and practices of one of these two groups to the other. It's not usually an easy task.

For example, after I sent in the first draft of this article to Poetry Canada, I got back this reply from then editor Maggie Helwig:

Your article is interesting, but I don't think I can use it in its present form... First of all, it bogs down too much in psych-jargon, to which I have a great aversion. It is probably the main thing that turns people against therapists —that they speak in this disempowering language that only other therapists really understand. You should also keep in mind that most writers are fully aware of the destabilizing and destructive aspects of their profession and quite willing to choose to pay the cost, even if it means a few brilliant poems and suicide. That very often is a conscious decision and should be respected as such, even if one believes that it is ultimately, in some way, wrong. You must go down into the dark, and sometimes nothing — not therapy, not religion, can bring you out the other side . . .

I found Helwig's suggestion that I rework the article somewhat chastening; after all, I thought I'd managed to set out my views in acceptably plain English (though on re-reading my article I came to see her point). Her reply, concise and eloquent as it is, helped me to crystallize my own thinking, in that it neatly summarized the kind of arguments one often hears from writers when the subject of creative writing and mental illness is broached.

In the first version of this essay I put forth some reasons why the writing of modern poetry can in itself be stressful. How, for example, poetry has become, over the past thirty years or so, more and more confessional in nature, and more and more fragmented (the recent movement back to formalism notwithstanding). It is easy to speculate that the intensely personal material which, say, confessional poets were working with might well have served to intensify their moodswings, or increased their sensitivity to their poems being rejected — as if they themselves, or parts of themselves, were being rejected. And that such dynamics might have contributed to the high rates of suicide and madness among poets like Sylvia Plath, Robert Lowell, Ann Sexton, Randall Jarrell, John Berryman, and Theodore Roethke. Nor could the balancing act these poets had to perform, between self-disclosure and bad taste, have been made any easier by the fact that the art form they chose paid so poorly in both money and reputation, and was read by a relatively small percentage of the reading public.

But even as I presented such material about what one might call "the perils of writing modern poetry," I hastened to add that it may not be such "occupational hazards" per se that bring the modern poet to a premature death, so much as the poet's behavioral responses to those stresses. And I wondered aloud how long the casualty list would have been, even among American confessionals, had the variable of alcohol abuse been factored out.

More and more, as a practising psychiatrist who sees a lot of creative young people, I'm coming to believe that it's not so much that any one type of creative activity is uniquely stressful, but that there is a self-selected group of people who are attracted to the activity in question; and that perhaps a profession like the writing of poems attracts more than its share of inherently moody people.

Some recent research findings are beginning to point in this direction. For example, the University of Iowa's renowned psychiatric researcher Nancy Andreasen (who has a background in English literature as well as psychiatry) has been studying a group of 30 American writers on faculty at the prestigious University of Iowa's Writers Workshop over a 15 year period. She has been finding that an unusually high percentage of the writers — some 80% of them — were treated for some sort of mood-related disorder. This has been in marked contrast to her comparison group — which was also made up of high achievers, and matched for age, education, social status, and the like, of whom "only" 30% showed similar psychopathology. (Her comparison group was also a rather "driven" group of very high achievers, which may account for their surplus of, say, manic-depressive illness, a condition in which high levels of pathology and high levels of ability and achievement often coexist.)

Of Andreasen's creative writers, 43% were thought to have some degree of manic-depressive illness. This is all the more likely to be a valid finding, insofar as it was not something Andreasen and her group had predicted in advance. Rather, they had expected to find an increased level of schizophrenia in the creative group, and not manic-depressive illness. Alcoholism, a condition now thought to be closely associated with manic-depressive illness, afflicted a whopping 30% of the writers, compared to 7% of the control group (and probably 4 to 5% of the general population). Most compellingly, 2 out of the 30 creative writers have already committed suicide, during the course of the study. Though the small sample size makes this figure not statistically significant, it certainly points to just how dangerous these conditions of disordered mood tend to be.

Andreasen has also looked for evidence of both psychopathology and creativity in the families of creative individuals. She has found an increase in both factors in the family members, with several of the same individual relatives—especially siblings of creative people—having both clinical psychopathology and high levels of creativity. Andreasen's findings lend added weight to findings of a I983 investigation conducted by British psychologist Kay Jamison. She surveyed 47 of the top British artists and writers, and found that 38% of them had sought treatment for mood disorder, a rate about 10 times that of the general population. Intriguingly, poets topped the list, some 50% of them reporting psychiatric intervention. Equally intriguingly, the rate for biographers—those writers whose work is perhaps furthest removed from "creative fire" — was lowest, though still about 20%. By further contrast, the rate for visual artists was about 13% — again, compared to 4 or 5% of the general population.

Coming at things from the very specialized base of an investigator in mood disorders, the University of Tennessee's Dr. Hagop Akiskal looked over his records of 750 patients — a much larger sample size — who were diagnosed as suffering from depression, manic-depression, or schizophrenia, to see if any subgroup of these patients showed differing levels of creativity compared to normative samples. Interestingly, he found that those with severe manic-depression had high rates of being arrested for antisocial behaviors, but did not show a marked increase in creative achievements. But, among those with moderate versions of the illness (which Akiskal views as a kind of forme fruste, or partial expression of the condition), fully 10% were artists and creative writers.

It is impossible in an essay of limited scope to do justice to what these findings might mean. To me as a poet, I'm not surprised that conditions characterized by extremely powerful feelings tend to occur often in people who write poetry, since poetry, perhaps more than most forms of writing, tends to get "written with the nerves"; in fact, it is hard to imagine someone writing an effective poem about anything he or she didn't have very strong feelings about. In that light, perhaps we ought to be more surprised that while 43% of Andreasen's sample were treated for mood-related disorders, more than half the writers needed no such treatment.

I'm certainly not surprised, as a psychiatrist, to hear (in Akiskal's work) that severe forms of manic-depression — those forms in which the individual is prone to losing touch with reality — are not very compatible with high levels of creative achievement. To me it's always been a wonder that a man as rocked by emotional disorder as Robert Lowell was — a man who had to be repeatedly hospitalized, who was prone to violent, assaultive rages, who at times lost complete sense of his own identity and imagined himself to be a figure from the past — that such a man nevertheless managed to leave behind a sizable body of great work, teeming with the most lucid truths. Surely such accomplishment is a testimony to the ability of manic-depressive disorders to remit, and to allow the sufferer complete returns to his premorbid state — a luxury that schizophrenia rarely allows its victims. (In the psychiatric profession there are examples of men who suffered from devastating bouts of manic-depressive illness, but who pulled together, and, while in more lucid states, pressed for reforms in the ways that psychiatry and society treat mental patients. Such men included the American Clifford Beers, founder of the then progressive Mental Hygiene Movement, and author of The Mind That Found Itself, and Toronto's influential C.M. Hincks, after whom a major treatment centre for adolescents is named.)

Anyone who reads books like Ronald Feive's Moodswing or Anthony Storr's Solitude will come upon example after example of individuals with some variant of moodswings severe enough to be regarded as manic-depressive, who made major contributions to the world, and especially, to the literary world. Truly, manic-depressive illness, especially in its milder forms, or when it is counter-balanced by unusual bravery and determination to function on the part of the sufferer, can be a blessing to society as a whole, as much as it can be a curse to the individuals who suffer from it.

But to come back to a point made earlier. It's not simply having a biologically inherited mood disorder that determines whether you rise to the top of a given field, or sink to the bottom of humanity — any more than inheriting certain creative abilities can by itself decide tiffs. Rather, it's the individual's responses to her or his emotionality, responses that are based on such things as how well their personality has developed, how able they are to be intimate with others, or at least to have close acquaintances, the extent to which they are able to forgive their own imperfections, and the extent to which they have developed a conscience — these are the kinds of differences that so often tip the balance towards living a creative life, versus "going along with" the forces of illness, and choosing the fast lane to an early death.

Too many poets who suffered from powerful mood swings chose to self-medicate with alcohol while many around them kept silent about their obvious self-destructiveness; or accepted these out-of-control behaviors as a necessary accompaniment to the creative process itself, part of what Helwig refers to as "going down into the dark."

Perhaps some people are condemned to inevitably go under, at a tragically early age. But it would be pessimistic of us, even cynical, to fail to reach out to help those who can very much be helped, instead of excusing, joking about, or even glorifying their self-destructiveness. Manic-depressive or depressive illness, for example, and alcoholism, are, for the most part, treatable or at least mitigatable conditions. But they all take a lot of united effort on the part of those who know the sufferer; it is better to warmly but firmly confront people who are heading for suicide, than it is to over-attribute intentionality and "conscious" decision-making powers to them, since they are usually truly desperate.

I dearly wish that Sylvia Plath's family doctor would have succeeded in having her temporarily hospitalized before she completed her suicide—not just for the sake of her young children, but for the sake of all the unwritten poems she still had in her. Regaining her psychic equilibrium would have allowed her to add much more to the literary canon, poems that might have been of the quality of the ones she wrote before the fateful winter of 1963, during which her work deteriorated into fragmented raging. To those who would say, "Well, then, we would have missed out on those winter poems," I can only say that Plath would have written them from her hospital room, just the way that she wrote the poem "Tulips" a year earlier.

Not that I think that getting professional help is the only route for someone with a mood disorder to take. As a reader of literary biography, I am constantly impressed by how resourceful some literary figures have been at finding ways of soothing their tormented souls, and staving off self-destructive impulses which might have done in others with less resourcefulness. Contentious and extremely anxious individuals like T.S. Eliot or Robert Frost were able, time and time again, to rise above their nervous temperaments, and find support and soothing in institutions ranging from stable marriages (a first unstable marriage was almost Eliot's undoing), idealized mentor figures (such as the lifelong support and encouragement Eliot received from Pound), the Catholic Church, or the world of nature (one thinks of Frost again, his efforts as a farmer, and his tendency to anchor himself to the world views of other older, more successful Yankee farmers, from whom he borrowed many of his best sayings).

But again, Eliot and Frost were essentially non-drinkers. When, in the reading of literary biographies of poets, one finds a lack of stabilizing institutions, and a turn instead towards destabilizing soothers like alcohol or drugs, the result for the individuals and their families is almost always tragic. Now and then one reads about poets whose inherited emotional syndromes were too severe for them to even think of going without professional medical help, the latter providing them with varying degrees of temporary relief from their torment; one thinks again of Plath, and Sexton, whose therapists did much to encourage their writing efforts; or of Robert Lowell, for whom the newly invented mood-stabilizing medication lithium was only available during the last three years of his life.

Finally, I am well aware that some poets fear that professional treatment of their emotional torment might in some way compromise their creativity — that the cure might be worse than the disease. In my experience, by the time the poet decides, or her or his family decides, that she or he is in urgent need of professional help, the point has already been reached when their symptoms already have compromised or retarded their creative output. By that point the person is too slowed down or speeded up to really concentrate on their work; they are usually aware of having crossed over the line of addiction to some substance or other, or they have incurred enough senseless financial or emotional debts as to have caused their families and loved ones to move gradually away from them. They are often isolated, feeling helpless, even while refusing help, and contemplating suicide.

It goes without saying that it is far easier to try and help such a person before this point is reached — perhaps at a time when their family and friends see the warning signs, even if the poet himself is still rationalizing his self-destructiveness under such bad-faith labels as "the tormented poet." To me such a label is more objectionable than a psychiatric one, because it never seems to be linked to a plan of positive action.

Ron Charach's works copyright © to the author.

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