On therapy - extra

I worked in medicine for many years before I was drawn to psychiatry. My encounters with patients with physical ailments prefigured those encounters I would have as a psychiatrist. The cognition of pain. The search for meaning. The elicitation of a story. The laying of hands on where it hurts. The re-cognition of pain. Sometimes I would cut it out. Sometimes I would cover it up. Sometimes I could do neither. In these instances, I am reminded of Mural by the Palestinian poet of exile, Darwish. I find it quite a haunting piece, lingering in the back of my mind before, during, between sessions with patients. A patient knocks at the door of therapy. Therapy: ‘the dialogue of dreamers’ where the patient ‘shuns body and self… to finish that first journey towards meaning, which burnt me, and disappeared.’ Disappeared into absence and no space, where ‘nothing hurts at the door of doom’. In no space, and no time, that insistent voice says ‘one day I shall become…’. And they come, knocking at the door of therapy. Therapy is a space-time, an en-closure where dis-closure unfolds through language/thoughts (‘one day I shall become a thought’), that threatens to ‘split [the patient's nascent sense of being like] a burgeoning blade of grass’. A battle-field, between ‘neither being nor nothingness’. Therapy, language, the act of re-telling one's story seems to me like a sword ‘wresting being from non-being’, that promises an ‘epiphany’. That epiphany that comes on the wings of the words: ‘This is your name’. Darwish's ‘epiphany’ reminds me of Heidegger's Da-sein and the ecstasy of temporality. Being which temporalises itself yet unites past, present and future ‘selves’. I believe Darwish wishes to leave this activity of being open: ‘I know this epiphany, and know I'm on my way towards what I don't know’.

Ramy Daoud is specialty registrar in general adult psychiatry, East Cornwall Community Mental Health Team.