Wild Unrest

I have found a kind of solace in poetry that I cannot find elsewhere. Perhaps it is because poetry so astutely conjures moods; moods, in turn, have determined so much of my life. I have had manic-depressive illness since I was seventeen; others in my family, many of my friends and colleagues, and most of my patients, have suffered from mood disorders as well. Not surprisingly, much of my scientific and clinical writing has focused on trying to understand the psychology of normal and pathological moods—especially mania, depression, and “mixed states” (psychiatric conditions characterized by the simultaneous presence of both manic and depressive symptoms)—as well as attempting to elucidate the role of temperament and intense moods in artistic and scientific creativity. 

At a personal level, I have turned time and again to poetry for comfort and understanding. As a clinician and teacher, I have used poetry to provide young doctors and graduate students with a deeper sense of the subjective experience of extreme mood states such as depression and mania. Both psychotherapists and psychopharmacologists need a more profound understanding of mood disorders than that which is presented, in staggeringly desiccated prose, in The Diagnostic and Statistical Manual of Mental Disorders, also known as the DSM, which is the foundation of clinical diagnosis in psychiatry and psychology.

It is essential that diagnosis be based on objective and rigorously researched criteria, of course. No patient is well served by subjectivity alone; empathy, while critical, will not in itself heal. Incorrect medication given on the basis of incorrect diagnosis is at best ineffective, and at worst dangerous. But a deeper understanding of psychological suffering must come from the experiences of those who have been there. Clearly, the most important sources for such knowledge are the words and clinical presentation of the patients themselves. But because patients may be too ill, disjointed, mute, or inarticulate to put into words experiences that are, under the best of circumstances, exceptionally difficult to describe, poetry can be an additional and powerful way to teach doctors (and, ultimately, the patients themselves) about disorders of mood.

Madness, and the agitation associated with madness, is nearly impossible to describe to those who have not experienced it. But poets do it remarkably well. I know of no better description of mania, for example, than Robert Lowell’s pithy phrase that, when manic, one is “tireless, madly sanguine, menaced, and menacing.” Likewise, Byron’s description of madness as “a whirling gulf of phantasy and flame” rings painfully true for anyone who has lost access to reason. The violent perturbance usually present in mixed states and mania is brilliantly conveyed by poets who have known it firsthand. Thus, Poe wrote of a “fearful agitation” which, left unchecked, would drive him “hopelessly mad,” and Plath described in herself a violence as “hot as death-blood.” Byron, who knew psychological and physical restlessness well, spoke of “the mind’s canker in its savage mood,” and Tennyson, in the wake of great grief, wrote brilliantly of “the wild unrest that lives in woe.”

Depression, which is bloodlessly, if accurately, described by the DSM as, “depressed mood or the loss of interest or pleasure in nearly all activities,” is more humanly conveyed by William Cowper, in lines he wrote after a suicide attempt:

encompass’d with a thousand dangers,
Weary, faint, trembling with a thousand terrors,
...........................................................................
I, fed with judgment, in a fleshy tomb am
Buried above ground.

Cowper catches the horror of depression, not just its symptoms. So too does Tennyson when he writes: “When the blood creeps, and the nerves prick / And tingle; and the heart is sick, / And all the wheels of Being slow.” His portrayal of the melancholy of mourning is as clinically accurate as it is unforgettable.

Exaltation and expansiveness are hallmarks of the early stages of mania, but, as with depression, clinical texts find these psychological states difficult to convey. The great ecstatic poems of Delmore Schwartz and George Herbert, however, and those of Gerard Manley Hopkins, Dylan Thomas, and Walt Whitman, pulse with grandiosity and vitality. It may not be actual mania when Whitman writes,

O the joy of my spirit—it is uncaged—it darts like lightning!
It is not enough to have this globe or a certain time,
I will have thousands of globes and all time.

But his poetry breathes what mania is all about.

Poets who themselves have been touched by despair or madness bring wisdom from the edge, not only to healers who would otherwise be untouched and uninformed, but to their patients who would otherwise be bereft of solace. I, like so many others who have been sick in mind, owe an inexpressible debt to poetry.