Poetic Reflections of a Psychiatrist

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AFTER nearly forty years' work as a Consultant Psychiatrist predominantly in the National Health Service, I have acknowledged that there is wide scope and perhaps deep need for reflection. Eclectic in psychological orientation, I always found that no consideration of biochemical mechanisms, of unravelled genetic principles, of environmental moulding, nor the study of statistical cohorts did anything to tarnish or blur a clinical picture. That is what one remembers.

A particular concatenation of symptoms may occur frequently enough to merit the term 'syndrome' but the inevitable, albeit minor, variation ensures the unique individuality of each. So often did its presentation seem in some degree poetic that to record a syndrome in poetic form seemed entirely right, and to make the attempt was compelling. Across the whole spectrum of run-of-the-mill psychiatry each poem had to portray its syndrome with clinical accuracy and nowhere could this priority be sacrificed to poetic licence. The most tidily complete syndrome may have been uniquely different simply because it was seasoned with the patient's peculiar sense of humour, or disdain, criticism, or frank ridicule. Such were often enough broadly based on unfortunate experience and were in no way blunted by the continuing need and request for help. Often enough too they were salutary in prompting a fresh look at oneself, at colleagues elect and less elect, and at the system in which we wrestled to find peace of mind. To the retrospective gaze there are inevitably some presentations which stand out with enduring clarity, and the material or texture of each poem comprises the exact symptoms of a patient or in some poems several patients who, over the years, presented classical or textbook examples of a particular syndrome. It seemed appropriate, and indeed important, to include here and there a state of mind which was not unhealthy where this could indicate the mental mechanism towards or away from a pathological state.

The poem about rehabilitation is based on letters to me from Malcolm Lowry who was my patient. He described with evident delight the …