Are poetry and psychotherapy too ‘wet’ for serious psychiatrists?

Not long ago I met for the first time a psychiatrist colleague whose articles I had enjoyed reading. I introduced myself, saying how impressed I was by his account of introducing cognitive—behavioural approaches in a tough inner-city general psychiatry setting. He responded graciously, saying ‘Oh, but you're the psychotherapist fellow who writes those nice articles about poetry in the Bulletin’ (Holmes, 1996). Feeling slightly put down by this male banter, implying that there was something vaguely ‘wet’ and irrelevant about both poetry and psychotherapy, and keen as always to establish psychotherapy as a vigorous equal player with social and psychical treatment approaches, I was reminded of how easy it is to see psychotherapy as a frivolous luxury when compared with the rock face of general adult psychiatry — and how to view it as ‘poetic’ might merely reinforce that view. But poetry can be extremely tough — Kipling, Graves and Hughes would be obvious 20th century examples — as can psychotherapy, which often outmatches other psychiatric disciplines in the rigour of its research methods (Roth & Fonagy, 1996) and strictness of its boundaries.

Nevertheless, in considering links between poetry and psychotherapy I run the risk of confirming my new friend's prejudices. In order to confound the idea that psychotherapy and poetry are essentially ‘wet’ (to use a favourite word from my public school past) I have deliberately chosen to consider a poem by one of these rather ‘masculine’ poets, Simon Armitage (1992), who spent many years working in a related field to ours, the probation service. See Box 1 for the poem in full.

Box 1. The Catch

The Catch
Forget the long, smouldering afternoon. It is
this moment when the ball scoots off the edge
of the bat; upwards, backwards, falling seemingly
beyond him yet he reaches and picks it
out of its loop like
an apple from a branch, the first of the season.

It is hard to describe why I find this seemingly simple poem so moving. It is essentially an action replay of a tiny yet significant moment in a cricket match. Like an action replay it plays with time, slowing it down to a freeze-frame where the powerful feelings aroused by a batsman's dismissal can be examined and absorbed. The event described takes place in a fraction of a second, yet the tone of the poem is languorous and sleepy — a typical afternoon in early summer, evoking nostalgic memories of childhood, boring or forgettable perhaps, but punctuated by a single moment of beauty and brilliance where ball meets hand. Just as the affiliated sounds — full rhymes, half rhymes, internal and external to the line, assonances — reach out across the spaces between them — scoots/loop, falling/ball, reaches/branch — so the arm finds itself in the right place at the right time — a miracle of skill.

Then suddenly the poem turns on the reader with a striking simile that sends a shimmer back through the poem right up to its title. The hand that grasps the ball is the same hand that picks the apple — the forbidden fruit, the ‘catch’ that has caught mankind, the irresistible desire for knowledge, our undoing, and what makes us human. Not just the batsman but the catcher is ‘out’ too — out of the Garden of Eden, out in the cold. Now we feel that the reflex action of the man in the slips is not so much brilliant as driven by unconscious forces over which he has no control — he cannot not catch the ball, even though to do so may be his undoing.

What is poetry doing here that we can learn from, and what is its relevance to psychotherapy? First, like psychotherapy, poetry has the capacity to home in on tiny moments of experience, to amplify them, put them under the microscope and so make them accessible to conscious awareness. Psychotherapy supervision, like this poem, may take a particular moment in a session, either in self-report or audio- or videotape, and subject it to detailed discussion. The minutiae of interpersonal phenomena, the quicksilver of the unconscious that makes us get it ‘right’ or ‘wrong’ time and time again, move as fast as a cricket ball and with equally devastating or ecstatic results. As psychiatrists we are constantly making interpretations, deciding and acting in ways that deserve this kind of close scrutiny — or being blindly driven by our transference and countertransference. Poetry and psychotherapy can help us slow down and cultivate reflective function, in order to practise our art more truly, safely and deeply.

Second, like psychotherapy, poetry is based on words, but words used in a very special way. For Lacan, the word is the paternal oedipal sword, categorising and separating, and disrupting the primary narcissistic fusion of subject and object, of mother and child. So here's a paradox: poetry uses words to re-establish that lost pre-verbal unity. Poetry's means to make those connections are rhyme, rhythm, metre, repetition and above all simile and metaphor, which, in different ways, reach out across the divide between the words, re-establishing connectedness and attachment. This happens at the level of meaning, but also physiologically. Rhyme and rhythm link bodies across the spaces that separate them, evoke the soothing sounds of parents with their infants, and the ‘Mmms…’, ‘Lllet's sees…’ and metaphors of psychotherapists with their patients. Right brain speaks to right brain in a secure-base inducing attunement where mother/infant, poet/reader and psychotherapist/patient use similar fundamental psychoneurobiological mechanisms (c.f. Holmes, 2001). Armitage's poem starts at the Oval and ends up beyond Eden: the moment when the pre-verbal oneness of mother and infant comes to an end, the expulsion from the garden; but its sleepy rhythms and half rhymes remind us how things were before we were ensnared by our desires — to win the game, to cause an opponent's downfall, to revel narcissistically in our skill.

Third, in both poetry and psychotherapy (and cricket) there is a dialectic between form and content — the firm boundaries of the former allow for infinite variety of the latter. Like the all-important psychotherapy ‘setting’ — consistency of place, time, person and technique — poetry creates a structure, a container, a set of rules and parameters that allow feelings to arise spontaneously. The importance of these simple technical devices should not be underestimated. Just as the invention of the stave system of notation ushered in a new era in music, so Freud's invention of the rules of therapy in the consulting room made it possible to put relationships and emotions under the microscope in ways that were impossible before.

Poetry, like dynamic therapy, is a device for generating ‘emergent meanings’. ‘Difficulty’ seems to be inherent in this process. Unlike prose, where meaning is usually manifest and transparent, we have to struggle to understand a poem with its concentrated latent implications and reverberations. Despite its apparent simplicity, The Catch resists total explication; what exactly, for example, is the function of the word ‘forget…’ at the start of the poem? How often do we finish a session with a patient and say to ourselves ‘I really didn't understand what was going on there’? We have to be able to tolerate the poem's obscurity, and the consequent feelings of splitting and falling apart of meanings, secure in the knowledge that a resolution will emerge, given time and attentiveness and faith. Similarly, with patients we have to attune ourselves to their and our own feelings, without knowing in advance what they ‘mean’, or how they fit into a predetermined schema. Poetry, like psychotherapy, and healthy psychological functioning enables us to reflect on the flux of life (faster than the flight of a cricket ball), penetrate its mysteries and learn from experience.

Fourth, a poem, arising apparently from ‘nowhere’ and out of ‘nothing’, becomes an object in its own right with which the poet, and later the reader, has a relationship. The poet/reader speaks to the poem, and the poem speaks back to the poet/reader. A poem is an artefact, but once the first words are down on the paper, it has a life of its own to which the writer/reader can relate. A dialogue emerges where previously there was silence, emptiness and loneliness. Similarly a psychotherapeutic relationship is both ‘real’ and an artefact; and liking poetry can, like undergoing psychotherapy, be seen as ‘narcissistic’, self-indulgent even, but both use narcissism to overcome narcissism — as Jung said, we have to first find our Self before we can lose it. With the help of the therapist, the psychotherapy patient begins to learn how to talk to and listen to him-/herself. Where previously there was just a ‘blob’ — as many patients describe themselves and their misery — a subject and object emerge.

Finally we can ask what kind of a thing, or ‘object’, is a poem or a psychotherapeutic relationship — compared, say, to a magnetic resonance image scan or a DSM diagnosis? Neither is entirely ‘out there’ on the page or the consulting room, nor wholly ‘in here’ in the mind of the therapist/patient or poet/reader. This ambiguity can be described as a ‘selfobject’ (Kohut, 1977), a ‘transitional object’ (Winnicott, 1971) or a ‘poetic third’ (Ogden, 1994) arising out of the intersubjectivity of poet and reader, patient and therapist.

This intersubjectivity is both subject and object in the science of psychotherapy and the art of poetry. Without an intersubjective perspective people suffering mental pain are stuck — trapped within their narcissism or nihilism (which is only a negative form of narcissism). Psychotherapy and poetry help us escape from this cul-de-sac. Both put us in touch — physiologically, emotionally, cognitively — with creativity and with the living reality of the other. Psychiatry needs psychotherapy — and perhaps even poetry — if it is to go beyond a reductionism that excludes the mind and cannot theorise relationships. Just as psychotherapy needs to expose itself to the pain and difficulty of coalface psychiatry, so my bantering new friend needs to open himself to the poetry of his discipline. Without it he is in danger of being caught out.