Poetic Reflections of a Psychiatrist

Article excerpt

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 Rip van Winkle like re-discovery of independence and of simple mundane aspects of life. To write this poem and to re-read the letters on which it is based has had a special import for it has been to recollect what, perhaps because of the circumstances of his untimely death, may have been overlooked or underestimated hitherto by his biographers. He had recovered his balance, was enjoying life, and was writing again. This achievement re-states his inner resources, and makes nonsense of any suggestion that alcohol had produced the permanent disability of dementia.

Malcolm Lowry, author of one of the great novels of the century, was born in New Brighton in 1909 and died unexpectedly and mysteriously in 1957 at Ripe in Sussex. After leaving Cambridge he lived abroad until 1954 when he returned to England for medical treatment. The first draft of his masterpiece Under the Volcano was written in Mexico in 1938, the year when his first marriage broke down. The following year he married Marjorie (Bonner) on whom he eventually became so dependent. Alcohol seems to have been one of his problems since his student days. Settled for a while in British Columbia after his second marriage, he re-wrote Under the Volcano and it was first published in 1947.

'The Return' is based on a letter to the author from Malcolm Lowry. When Lowry was admitted to hospital, he had become completely dependent on his wife, Marjorie. 'I am the child Marjorie never had', he once remarked. 'A cross between a brothel and a monastery' was how he once, somewhat enigmatically, described the hospital atmosphere. He recalled seeing the initials R.I.P. on the briefcase of a man he met on a tramcar.

THE RETURN

When to your brothel-monastery I came I could not dress myself or open my own mail And might as well have chased the holy grail As independence; efforts to defy My mother keeper were of no avail. …