A poet and psychiatrist on the two fields’ surprising similarities

Who’s on the couch here? The psychiatrist or the poet? The poem or the practice of psychiatry?

As a poet and a psychiatrist/therapist, I exist in both practices, and the worlds of each enrich the other. Each speaks with abandon, and each interrogates the other, and there are many ways in which each discipline supports the other, some obvious, some not so obvious.

The most obvious connection is that words are the medium of a poem just as words are equally the medium of exchange between therapist and patient. I’m reminded of my friend Richard Berlin, another psychiatrist/poet, who has a series with the Psychiatric Times called “Any Good Poem.” He begins each installment with a quote from the poet Dorianne Laux, “Any good poem is asking you simply to slow down.” That’s what poetry does and that’s what psychotherapy does. It asks you to slow down and consider the words. 

Through words an individual explains themself. Through words they reveal themself. And through words, understanding is shared. Listening to a patient and listening to a poem have much in common. Both poem and patient are paced in their telling as they pause, wait, and emphasize. Being attuned to the written line breaks, or stanza breaks, the caesuras, the enjambments, a narrative will often lay out as a poem. And poems, certainly in the past century, often seek to capture the cadences and variations of speech. William Carlos Williams, a poet-physician of the 20^th century, helped bring the speech of the everyday into poetry, often jotting lines in his patient notes. When people speak from the heart, their language is always fresh and novel. They use words in a combination of choice, stress, and cadence that I’ve never heard before. This is exactly what I look for in reading poetry and writing my own. While I never use my patients’ words in my writing, I listen for a genuine diction, and it’s a genuine diction that I strive for in my communications to my patients and that I work toward in my poetry.

A second obvious connection is that both quest for meaning. A poem, if nothing else, touches by creating a fresh experience in itself and implies, suggests, or embodies a meaning of that experience. That meaning is co-created by both poet and reader. Wallace Stevens in “The House Was Quiet and the World Was Calm,” writes, “The reader became the book; and the summer night/ Was like the conscious being of the book.” More than a co-created meaning, it is meaning that is transformative. What is the “summer night”?  At that moment it represents a changed world view. Much the same happens between therapist and patient — and here I’m addressing not overt, biological depression or anxiety, for example, but the realm of what a person feels is wrong with their life once the diagnoses have been “fixed.” While patients initially want to be given “insight,” and younger practitioners at first often feel it’s their role to impart understanding, both, in time, come to see that it’s the life’s narrative that gives and reflects meaning, and this can only emerge jointly. As a psychiatrist and as a poet, I am reminded to trust my reader and trust my patient, and to allow for the space for this kind of interaction. 

There is another less obvious but equally important connection to the practice of psychiatry/therapy  and the practice of poetry that involves a particular mode of listening. Freud advised listening with an “evenly hovering attention,” meaning paying attention to what he called id, ego, and superego contents. “Active listening,” another approach, has had many meanings, but in the therapeutic space has been described as the capacity to listen for overt as well as hidden contents (similar to Freud), but also involves the listener taking in what the patient says in a very personal way, that is, allowing their fantasies, images, and emotions to emerge freely — and silently — until the meaning becomes clear. Before meaning can emerge, objective and subjective inputs are received. This, indeed, is similar to how a poem is listened to or read. In reading, one suspends judgment about form or confusing syntax or an unlikely pairing of images so that the reader/listener can also respond with personal associations and feelings. When stumped by an intriguing poem, I sometimes enter the poem with an admonition, what if a patient were speaking these lines? Confounded by a confusing expression or dream from a patient, I might seemingly shift gears and ask myself, what if this were a poem? This shifting between mind sets that are not all that dissimilar allows me a fresh “listen.”

I teach narrative medicine to medical students at Columbia University and to trainees in child and adolescent psychiatry at the Albert Einstein College of Medicine. My goal is to teach through poetry and literature how to listen (as physician “listening time” continues to decrease with electronic medical records) and to understand that meaning is always co-created — how to listen, what to listen for, how to both ask questions and allow space for the unquestioned to emerge, all part of the goals of this training. Poetry is often an ideal approach to teach “active listening.”

Finally, there is another less obvious similarity between the domains of therapy and the writing of poetry that I’ve understood through the writing of Wilfred Bion. Bion, a mid-20th century British psychoanalyst, evolved a number of important ideas that have influenced both practices for me. Describing an aspect of the therapeutic relationship, he proposed the idea of the “container” and the “contained.” For him, the therapeutic “space” of the therapeutic relationship often serves as a container for the thoughts and emotions that can’t be contained within a patient’s psyche. Unwanted thoughts, extremes of emotion — where do they go? As trust develops in patients, they become more willing to let out what is otherwise bursting to get out. Explosions of anger, paroxysms of grief, terror of becoming the person one fears, all come to be expressed in sometimes extreme, often disavowed, ways that defy the understanding of the individual and may well challenge understanding by the therapist. A second concept, going hand in hand with this, is the therapist’s capacity to tolerate “not knowing” and reside intimately with the unknown. When the therapist is comfortable containing what then is unknown, comfortable and convinced that the role of containing is central to the process, the patient feels contained in much the same way that the presence of a calming mother can soothe a child distraught for reasons neither at that minute know.

So, too, does the poem become the therapeutic container for the poet, and the process described above also applies to the writing process. Robert Frost famously said, “No tears in the writer, no tears in the reader. No surprise in the writer, no surprise in the reader.” How the writer brings this domain of the unknown into the writing perhaps remains mysterious, but the process is recognizable. The “container” of the poem is rarely known in advance, and yet it serves this function. And where an individual poem may serve as this container for the experience of a moment, or an hour, an entire book may serve this containing function for larger chapters of a writer’s life. 

In the writing of two of my books of poetry, I have acutely felt the book as a whole as a container. It first occurred in the writing of “best man.” This book is a sequence of 23 poems, an elegy to a brother who had died at the age of 23 some 25 years earlier. I had wanted to write about him, his tragic overdose, the toll it took on him, on me, and on our family, but never found the right voice, the right container. The right container needed to contain my anger and to allow me to move past the anger to grief and reconciliation. Once the process began, the book was written in less than three months. I had a feeling of giving myself up to it. I had also begun to wonder, before the writing took off, how I could introduce him and this part of my life to my new fiancée. In the writing I came to envision him, this brother who had caused such heartache to himself and to his family, as a “best man” at my wedding, sitting on my shoulder. He joined my children who walked me down the aisle.

I again experienced the writing of an entire book of poetry as a containing therapist in the wake of the Oct. 7 massacre and throughout that next year. “A Prayer of Six Wings”  was written over that year, and in many ways, the writing of it contained me, saved me, and allowed me a modicum of balance. The enormity of the massacre, its scope and brutality, sent many, but especially Jews, reeling. As someone who grew up with stories of the Shoah, it was happening again. As someone who had worked his way out of the insularity of his community to embrace world citizenship, it was humiliating. As someone whose daughter, son-in-law, and two grandchildren live in Israel, it was terrifying. And as someone who lives a block from 79^th and Broadway in New York, where nightly marauders viciously ripped down posters of the hostages (only to have them put up again the next day), and as someone who teaches at Columbia University where pro-Palestinian protesters proclaimed “Send the Jews Back to Poland,” I felt disoriented to both time and place. Was this Weimar, 1942? Was this Baghdad, 1951? 

All these emotions and fears and thoughts found daily release in the emerging container which became the book. Had I not been engaged in the writing, I am quite sure I would not have had optimal focus and availability to my patients, many of whom had similar preoccupations. Was I able to contain their fears and anxieties? Only because this evolving book of poetry contained mine.

Who’s on the couch? Even as he analyzes, even as he writes, this poet-psychiatrist-therapist certainly was and is, to the betterment of the poems, the patients, and last but not least, himself. 

Owen Lewis is a professor of psychiatry in Columbia University’s department of medical humanities and ethics and the author of the poetry collection “A Prayer of Six Wings.”