Practical Poetry: Essays From Clinical Work

Practical Poetry

Essays from Clinical Work

by

David W. Mann, M.D .

Practical Poetry: Essays from Clinical Work

ISBN 978-1-312-48807-6

Copyright 2022 by David W. Mann, M.D.

Some of the material herein has previously appeared elsewhere, as noted.

PRACTICAL POETRY

Essays From Clinical Work

Table of Contents

1.  Introduction

2.  Covid Psychosis

3.  Practical Poetry

4.  Three Forms of Transference

5.  On Primary and Secondary Feelings

6.  The Mirror Crack'd: Dissociation and Reflexivity in Self and Group Phenomena

7.  The World Book

8.  A Pragmatic Convergence in the Programs of Psychoanalysis and Alcoholics Anonymous

9.  Lay Analysis

10.  The Repetition Compulsion

11.  Victims From a Sense of Shame

12. Theories of the Self: A Review

13. The Virtues in Psychiatric Practice

14.  A Mathematical Model of the Self

15.  Psychiatric Pain and Deliberate Suffering

16.  Ownership: A Pathography of the Self

17.  Some Philosophical Directions Toward a Simple Theory of the Self

18. Review of Roustang's The quadrille of Gender

19.  Crowding, or The Complexity of Group Relationships

20.  Reunion and War Within

21.  The Question of Medical Psychotherapy

22.  Six Months in the Treatment of Two Young Paranoid Schizophrenics

23. This Proposition is False

PRACTICAL POETRY

Essays From Clinical Work

INTRODUCTION

No one asked for this sheaf of old musings, and no one is likely to miss them if they never reappear. My motives in assembling them are personal and mixed. Most of them I wrote two to three  decades ago, and published in professional journals aimed at readerships in psychiatry, psychology, philosophy and psychoanalysis. Most of them seemed to draw little notice when they first appeared, and still very well may interest none but a fringe of readers who prefer the peculiar angle and the eccentric style to the standard offerings in these fields. This I accept. I never expected otherwise. I never wrote to join a crowd.

So why bother revisiting these tracts, and why now?  The urge came to me in the midst of a pandemic, under the alarm of quarantine and unable to muster the will to undertake anything new. Cleaning house seemed much the more urgent task. If I was to live in a bunker, let it at least be an orderly one. Consolidating the useful and discarding the inessential felt imperative. Dozens of boxes of books hit the sidewalk. New clothes that I had never worn slithered down the bins of charities. In the wake of all this jetsam, though, a core of material things remained that I felt unable to discard. I knew that I must part with them all eventually, but they felt so much a part of me that I continued to feel  responsible for them. Chief among these were certain gifts that I had received and objects that I had made myself – photographs, furniture,  a sculpture assembled from the remains of other projects, yards of notebooks and journals that I am unlikely ever to open again, and so on-- including these orphaned essays. Despite their vintage-- or maybe because of it-- I felt as if losing these relics would somehow dangerously diminish me.  Now, Buddha taught, and I have found it to be true, that to identify with things, to cling to the material forms of meaning, is to chase illusions that yield above all unnecessary suffering. The appropriate response, he taught, would be to let all these old things go. So comes freedom. Compounding all the foregoing concerns, there has been much talk of retirement in the air. People are leaving their life's work behind in search of new and safer ground. Some, in excellent health and younger than I, have contracted Covid. Some have died. The handwriting is on the wall. The future, where over the years I have stationed so many promising ambitions to await my attention, suddenly seems a mirage. The urge to consolidate, magnified by a kind of nostalgia for family in a time of general plague, has bred in me a yearning to gather my far-flung brain children  for a final  farewell. This is it. Fly, little book.

Most of the essays collected here discuss theoretical and practical notions condensed from clinical work. These I have arranged roughly in the order that they appeared in print, last-to-first. Final in this sequence, the two earliest pieces, while not clinical in origin, show some of the roots of my later clinical thinking-- e.g., the problematics of addiction, and the motif of paradox as the shadow of a higher-dimensioned unity. The most recent piece, a paroxysmal reaction to the current pandemic, was never previously published, but hints at the turbulent state of mind that led me to undertake this project. 

All the foolishness, mistakes and misunderstandings reproduced in these efforts are mine. Despite  their shortcomings I offer them here with the hope that they may prove interesting, or even useful, to at least  someone.

With gratitude,

David Mann, Cambridge, MA

March 9, 2022

COVID PSYCHOSIS:

An involuntary meditation

1

We hear a lot in common talk of how a mind can fail.  Traumatized,  overwhelmed by emotion, intoxicated or crumbling from flaws within, it becomes moody, illogical,  distracted,  fixated, hallucinated, delirious... and so on, ad asylum. A normal mind, by contrast, has no positive definition of its own, but is known by its failure to demonstrate, to any noteworthy degree, any of those familiar disturbances. The readily-recognized abnormal implies a quietly taken-for-granted, background normal. You do not smell the air. You smell the odor. Such a normal mind is not an objective phenomenon, but a socially constructed one.

And so it is from within each mind. We orient ourselves through connections to a world that we seem to share, where we conduct ourselves according to the conventions and treaties that we've absorbed implicitly through experience. Our minds have maps and rule-books, that is to say, compliant with the physical and social worlds that we inhabit. These are relatively stable and therefore reliable enough to help us cobble through. They are also pliant. We can play with them. We can operate offline from reality. We can ponder and plan. We can conjecture, hypothesize and rehearse. We can suspend orientation and enter a narrative other than our own, elsewhere, elsewhen, elsewhom. Through empathy, in witnessing we can become-- dance with the dancer, weep with the bereaved. We can even furlough all the rules and take a daydream or a night's safari.

These ways of playing with reality and tuning in or out of it, most would agree,  fall within the mind's normal range of functioning. They are part of thinking and most of us can engage in them at will. When they happen unbidden, though, something unmistakably abnormal is afoot. The inner world loses its correspondence to the outer, and the sense of control or choice in this state of affairs breaks down. The clinical term psychosis refers to "...an abnormal condition of the mind that results in difficulties determining what is real and what is not "(Wikipedia).  As Carl Jung purportedly told James Joyce about the resemblance of his schizophrenic daughter's speech to the author's own prose,  She falls. You dive.  Psychosis is not chosen. It happens, beyond our conscious control.

Psychosis is also relative-- relative to others' experience and to one's own. Decades ago I had the occasion to present to the patients in a long-term psychiatric hospital a series of lectures concerning  medical views of their illnesses. After my talk on psychosis, one waif-like but very self-assured young man raised his hand and asked, Doctor, do you never hear voices when no one is there?  When I answered, No, he responded,  "Doctor, what is wrong with you?"  Just as reality is defined consensually, islands of irreality, to their denizens, define the real.

Psychosis, as I said, is relative to oneself, as well. If the world suddenly changes, I may mirror it rightly yet doubt the reality of my own experience because it presents such a departure from what I have come to expect.  Am I dreaming? Have I lost my mind? When the world that meets my senses ceases to resemble the world that I have known, my map fails, my own rules don't apply. When my usual means of recalibrating myself grow faint, when my expectations of the future dissolve and there is no identifiable horizon, my basic feelings of reality go dim. In  crazy times, a normal mind can feel psychotic.

Walking around Fresh Pond  not long ago, I noticed a tree leaning into the water on the support of one thick limb. Idly I tried to imagine how natural selection might have resulted in a species of shore-dwelling osiers that tend to fall in just this way and thus outlive their clumsier neighbors. This line of thought amused me, but felt a bit off-kilter. Why was I trying to normalize one odd tree-- in particular, one that had by mere accident saved itself from drowning-- using the the logic of evolution?  Suddenly, in the way that one suddenly understands a dream, I remembered the news reports of Covid19 sweeping towards us. A previously unconscious tsunami of terror struck, I felt the dam of my understanding suddenly break and the sheer,  incomprehensible enormity of evolutionary time sweep over me. I saw in my mind the corona virus hurtling toward earth like a submicronic asteroid to wipe out the human race. What hath evolution wrought?  I had succumbed to Covid Psychosis.

I call this experience psychotic mostly in an ironic sense. It did manifest in a sudden and otherworldly way, and brought with it for a moment the eerie overtones  of madness. However, the prophetic picture that had come to me was not (I like to think) the hallucination of a diseased mind, but  normal mental imagery for a diseased time, an eidetic  grasp of a cataclysmic break in our reality. It was my way of suddenly getting it – everything has changed and human life as we know it is facing a challenge of evolutionary impact. (And by what fluke can I ever survive?)

Yes, Covid19  and its aftershocks could ravage humanity as thoroughly as any plague that human beings have endured, but this in itself seems to me unlikely to threaten the survival of  our species. However, the spiritual enfeeblement  with which a frightened and fragmented humanity could respond to it seems to me greatly to threaten our chances of surviving well-- by nudging us further along the paths of self-destruction that we have already blundered through. 

This unliving proteinaceous key that happens to unlock in some of our cells the machinery of its own replication, is an accident that arrived no more thinkingly, and no less momentously, than the Chicxulub collision that rearranged life on Earth and led to the extinction of dinosaurs (and much, much more) almost 66 million years ago. We did not choose the pandemic of Covid19. It happened. It came over us suddenly and changed our reality in ways that we flail to accommodate and that baffle our every effort to predict. It disconnects us each from the other, like a jealous god rending the Babylonians. It frightens us, fragments us, foments mistrust and paranoia, confuses and demoralizes us. It leaves us prey to  charlatans and demagogues, who will not hesitate to take our money, our votes, our spirits and any hope for a long-term future that we may yet cling to.

Not if, but when Covid Psychosis takes hold of you-- maybe waking from a dream into the grey, ambiguous light and feeling the sense of unreality persist, perhaps finding thoughts of death vaguely exciting-- how will you respond? 

2

Covid madness in many ways resembles the madness of active addiction.  Fear of contamination and disease co-opts our minds just as obsessive craving overtakes the addict. Avoiding the object of these fears isolates us, just as pursuing the object of addiction (or struggling to manage it) isolates the addict. Our inability to control the virus feels much like addicts' powerlessness over their own compulsions. And as we lose control and focus and social connection, like the addict we may lose hope and purpose and confidence in our own mental functioning. Fear may trap us  in a sliver of time that we feel we cannot endure, and we may despair for distractions. Pursuing these, as the addict pursues their sequence of unsatisfying substitutions-- until no satisfaction can hold, and even the thought of pleasure short-circuits to dread-- may postpone the cataclysm of  the soul, but cannot eliminate it. And when finally the fear returns, like the addict we risk losing all perspective and embracing it, leaping like Empedocles into the volcano.

From this purgatory, a fortunate few addicts find a way up and out.  That way entails surrendering every  maddening effort to control what they cannot control,  joining forces with others to control what they can, building a new faith based on their true resources, cleaning house spiritually and  keeping themselves and their relationships with others as honest and pure as possible. Might we apply these same remedies to the madness of Covid19 ?  I am going to try.

Cambridge, Massachusetts,

5/12/2020, 6/3/2020

PRACTICAL POETRY

I am going to utter a tree, Nobody

shall stop me—e.e. cummings

I. INTRODUCTION

  In the beginning was the Word, says an ancient text.¹ The beginning of what? Surely not the world at large, which had conceived us long before we conceived it in words. Not even the world as I know it, which had strummed my senses for millions of years before I began to resonate in speech (see Tomasello, 1999, and Wade, 2006). What began with the Word was nothing less than a whole new world—not the world that made us, but the world that we make, the world of sharable human experience.

Sharable is bearable. Together we can manage what, alone, we never could. The god of that ancient text linked all things within a single consciousness. Human language, linking individuals’ consciousness, seems to offer us powers of potentially competing scope. In that same text the story of the Tower of Babel relates how a common language enabled His children to rival God Himself in deeds. And the Lord said, Behold, the people is one, and they have all one language; and this they begin to do; and now nothing will be restrained from them, which they have imagined to do (Gen. 11, emphasis added). For reasons that the story does not make clear (but that it suggests might amount to His own jealousy), God foiled the creators of that competing universe. He did this not by destroying them but by destroying the means of their creativity: their ability to communicate. As is often true of tales that have stood the win-nowing of so much time, the morals of this story are at once many and obscure. A flurry of warnings come to mind: Power corrupts. Beware of pride, which cometh before a fall. Likewise its relatives, jealousy and envy. Do not trust human communication, which routinely breaks down, with the most grievous results. Like the humankind that rely upon it, human language cannot bear very much reality … (Burnt Norton I, Eliot, 1943), and so on.

Language links our minds, enabling us to transcend person, space, and time, even the limits of the possible. e.e. cummings utters a tree, and no one can stop him. Because it is so powerful, we must take care with language. The minds it links are human, so by its means we lie, betray, malign, and pollute our souls with drivel as readily as we build magnificent towers of fact and fancy.

Language links our minds imperfectly. It interferes with the process that it enables, becoming, in a sense, a meddlesome third party to every communication that it helps to broker. Except when the exchange breaks down, we tend to accept these intrusions because we feel, for the most part, as if language were not something that we create or even use, so much as something that happens to us as a result of the company that we keep. So Ernst Cassirer (1946) could speak of a language which does our thinking for us (p. 16).

We can take language in hand, however, and forge it to our purposes. We can fashion a language for engineering that is clear, precise, and outwardly descriptive; a language for diplomacy, tooled for persuasion; a language for wine that evokes autumnal aromas of burnt sugar and undergrowth. (Keefe, 2007, p. 113).

The language of psychoanalysis famously reflects the medical past and scientific ambitions of its originator, who intended with it to enunciate a scientific psychology. The resulting jargon has come so thoroughly to emblematize psychological work that popular representations of psychoanalysts and other therapists often depict them blathering earnestly at their patients in its pseudomedical, jargon-filled tones. Anyone who genuinely practices psychological work knows that nothing useful ever could transpire that way. The actual language through which patient and therapist meet, engage, and transform each other bears no resemblance whatsoever to the psychosurgical metaphors of Freud. In my experience, the language of clinical encounter sounds and feels much more like poetry—so much so, that I have come to regard clinical work all-in-all as a form of poetic action, of practical poetry.

With this essay I explore this idea by discussing two questions that strike me as its preliminaries: (1) What is poetry? and (2) Can poetry be practical? Considering these questions, I hope, will clarify how it is that the best moments of psychological work feel like practical poetry.

II. WHAT IS POETRY?

As a child I felt drawn more to nature than to nurture. A tree to climb, a stream to wade, a lizard to tame, all excited me far more than what anyone around me had to say. Of the artifacts of thought, only science and mathematics held much interest for me because, more than most of the people I knew, these seemed to speak truthfully of how the world worked and thoughts cohered. Whatever literature I encountered in childhood must have struck me as, at best, a means for telling stories, for I remember the gist of some of those tales but practically none of their language. Only one poem managed to penetrate the fortress of rationality that was my latency: Little Boy Blue, by Eugene Field, first published around 1889 and anthologized ever afterwards in grade-school English texts, where I encountered it at about age ten. Here it is:

The little toy dog is covered with dust,

But sturdy and stanch he stands;

And the little toy soldier is red with rust,

And his musket moulds in his hands.

Time was when the little toy dog was new,

And the soldier was passing fair;

And that was the time when our Little Boy Blue

Kissed them and put them there.

Now, don’t you go till I come, he said,

And don’t you make any noise!

So, toddling off to his trundle-bed,

He dreamt of the pretty toys;

And, as he was dreaming, an angel song

Awakened our Little Boy Blue—Oh! the years are many, the years are long,

But the little toy friends are true!

Ay, faithful to Little Boy Blue they stand,

Each in the same old place—

Awaiting the touch of a little hand,

The smile of a little face;

And they wonder, as waiting the long years through

In the dust of that little chair,

What has become of our Little Boy Blue,

Since he kissed them and put them there.

Today I see this verse as a saccharine dirge to lost childhood, which at the time must have owed its impact to my own presentiments of puberty and lost innocence. Back then, though, it simply meant that Little Boy Blue had died in his sleep, and—I had no idea why—this completely unhinged me. I remember lying in bed at night, daring myself to allow the poem’s images to appear. So long as I kept them just behind the wings, rustling at the verge of consciousness, I could enjoy my own awe of the power they held over me, as one might enjoy wild tigers in a cage. But when my discipline faltered (or I let it go just right), and there edged into view that little toy dog … covered with dust, I was gone, utterly dissolved in grief. For me, encountering this verse was a loss of innocence in itself. A poem had touched me where I had never been touched before, loosening tigers of emotion that, before, I had not known I caged. How did it do this?

A poem is a thing of words, like but also different from other things of words. Its outward structure, first of all, distinguishes it from other word-made things. When spoken aloud it is set apart from the more ordinary speech that surrounds it. When written, it sits differently upon the page. The very term poem originated in the Greek poíéma, meaning something made. Like a castle in the sand, a poem’s structure draws attention to its made-ness, heightening the intentionality of its message. The structure says, Now, Hear This! Our empathy is on alert. We read or listen with special care.

A poem’s way with words, too, sets it apart from everyday speech. It may use ordinary vocabulary, but with special economy and emphasis. Each word holds its place, in both form and meaning, as no other could. A poem’s language tends to flow like music, with rhythm and melody as well as form. It is composed. It conveys lucidity and depth. Linguists (e.g., Lévi-Strauss, de Saussure, Jakobson) have held that language is made up of both sound and sense, the physical medium and the metaphysical meaning. Poetry tends to fill both these dimensions to their fullest capacity, exciting both body and mind, conjuring images more vividly than do other forms of utterance, communicating not just information but feeling. I. A. Richards (1926) wrote that poetry gives words their full imagined sound and body, and in doing so helps to restore the reader to a fuller state of being. The poem’s formal announcement that it intends to do something, its precision and music, its stirring of spirit and flesh, all have the effect simultaneously of focusing our attention upon the particular images that it elicits, and of rumbling the mind’s great store of associated imagery. Our imaginations light up with another’s vision. We see ourselves in it, and it in us. We feel surprise, and more. We remember. We connect. Allen Grossman (1993) says, poetry strives to overcome the death and separation of individuals by bringing us into contact with our ultimately shared experience (p. 5).

Poetry is different from ordinary speech, but it is so direct, fresh, and full of feeling that it is in many ways the most authentic form of speech. Poetry is the mother tongue of humanity, said J. Hamann (quoted in Cassirer, 1946, p. 34–35). Northrop Frye (1964) asserted,

Poetry is the most direct and simple means of expressing oneself in words: the most primitive nations have poetry, but only quite well developed civilizations can produce good prose. So don’t think of poetry as a perverse and unnatural way of distorting ordinary prose statements: prose is a much less natural way of speaking than poetry is. If you listen to small children, and to the amount of chanting and singsong in their speech, you’ll see what I mean. (p. 121)

Thought itself, when spontaneous and undisguised, is the same as poetry, according to Heidegger (1975, p. 74f.). Finally, William Butler Yeats held that poetry springs spontaneously from common people, offering as an example this anonymous lament:

It is late last night the dog was speaking

of you; the snipe was speaking of you in

her deep marsh. It is you are the lonely

bird throughout the woods; and that you

may be without a mate until you find me.

You promised me and you said a lie to me,

that you would be before me where the sheep

are flocked. I gave a whistle and three

hundred cries to you; and I found nothing

there but a bleating lamb.

You promised me a thing that was hard for

you, a ship of gold under a silver mast;

twelve towns and a market in all of them,

and a fine white court by the side of the

sea.

You promised me a thing which is not possible;

that you would give me gloves of the

skin of a fish; that you would give me shoes

of the skin of a bird, and a suit of the

dearest silk in Ireland.

My mother said to me not to be talking

with you, today or tomorrow or on Sunday.

It was a bad time she took for telling

me that, it was shutting the door after

the house was robbed.

You have taken the east from me, you have

taken the west from me, you have taken

what is before me and what is behind me;

you have taken the moon, you have taken

the sun from me, and my fear is great you

have taken God from me. (quoted in Yeats, 1912)

Poetry is primal language, then; truthful speech about things that matter. Using music, imagery, and form, it re-creates an author’s experience in the mind of an audience, in the process evoking powerful networks of meaning and emotion. It may be hard-wrought through discipline, but also arises spontaneously in the play of thought and passion. When it works it links us through universal experience, at once exalting the spirit and humbling the self.

CAN POETRY BE PRACTICAL?

About practicality and art Tom Stoppard (1972) once quipped, Skill without imagination is craftsmanship and gives us many useful things, such as wicker picnic baskets. Imagination without skill gives us modern art (p. 19). At its best, poetry surely epitomizes both verbal skill and imagination, but is it, can it ever be, in any sense, practical? Practical things, by definition, do something useful. What, if anything, can poetry do? And can that ever be useful?

Poetry presents the experience of one for the consideration of others. The experience may be of actual events, or entirely fantastical. It may take the form of a story, or consist of seemingly contextless images. A poem should not mean/ But be, Archibald MacLeish (1985) admonished us (p. 106–107). Nonetheless, a poem’s very presence in the world of words suggests that it means something, at least to its author. We take it up and look it over as we might a peculiar object on the beach: What is this thing? Where did it come from? What is it for? What, if anything, a poem means to its reader depends upon the prior experience that the reader brings to the reading, as well as upon the robustness and universality of the poem’s own verbal substance. Like music, of which it partially consists, poetry plays the senses of its reader, evoking image, sensation, and emotion-rich feeling. More than most everyday speech it leaves us joyful, sad, frightened, angry, surprised. More than everyday conversation, it connects us to a sense of the universal. [Poetry] is not about what has happened, said Aristotle (ca. 350 b.c.e.), but about what can happen (Part IX).

Like science, poetry presents a way of seeing the world. Both seek with clarity and precision to express the universal. When either succeeds, we speak of beauty. Beyond this, neither science nor poetry, in themselves, literally do anything. They are practical inasmuch as they clear the way for us to act knowingly. Science is practical because it makes technology possible. What might poetry make possible? Terrence DesPres (1988) noted,

The self that cannot speak, as the man or woman being tortured cannot, or the self that cannot find words to make its own, has not the power to join or withdraw from the world. Poetry won’t change the nuclear order. But … a poem can make something happen. It allows me to know what I fear, to understand (by standing under) the burden of my humanness. It also makes possible the essential decency of compassion, of suffering with—a symbolic action, to be sure, but one without which the spirit withers, the self shuts down. (p. 230)

Antonin Artaud said of van Gogh, "No one has ever