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Why Psychiatric Clinicians Need the Humanities

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I don’t meet many fellow psychiatric clinicians with English degrees. This doesn’t surprise me; the contrast between psychiatric training and my undergraduate English classes are comical to the point of absurdity, down to the way the classrooms smell. Imagine the set of "Masterpiece Theatre": old leather, the smug satisfaction of understanding Oxford comma use, time to meander through sonnets. Now, enter a psychiatric hospital: shatterproof windows, the acrid smell of disinfectant, time to grab a Coke before the next crisis arises.

Psychiatric training is about teaching a future clinician to impose calm and structure to environments where instability is the norm. Psychiatric units are heavily-charged environments, collections of vulnerable people wading through the sticky sludge of overwhelming experiences. In the midst of an emergency, the skills required to restore homeostasis do not include the ability to read Chaucer in Middle English.  

Psychiatry is my second career. In a previous life, I used my English degree—sort of. Upon college graduation, I moved to New York City with the goal of working at the New Yorker. Instead, I spent the next 15 years writing and editing at a string of national women’s magazines, most of which were destined to fold with the advent of the internet. When I left to become a psychiatric nurse practitioner, it felt like fleeing a quaint, lavishly decorated iceberg. It was an ambivalent departure, but I never questioned my choice. The humanities and I had consciously uncoupled. A liberal arts degree was a vestigial appendage, the wings on flightless birds, interesting, but useless--or so I thought.

After five years of serving high acuity clients in public clinics, I joined a private psychiatry and psychotherapy practice. Sitting in a cushy office across from a sober, actively participating client is the harder job. Dealing with a floridly psychotic client is straightforward—you’re there to restore stability. There’s no point in pondering the Oedipal underpinnings of a client’s marriage when the person in question is a man who believes he is pregnant with twins.

Healing a wounded psyche is a complex task. Medications help, but to effectively interweave them with therapy, a therapist must wade through the murky treachery of a client’s pain without succumbing to its depths. To paraphrase psychiatrist Leston Havens, we are encouraged to swing into a client’s psychic interior, to foster therapeutic empathy that blurs the boundary between a client’s experience and our own.   

Simultaneously, we’re trained to recognize countertransference: the conscious and unconscious meaning of how our clients make us feel. I think of it as a thread through maze, a safety mechanism that allows me to explore a client’s interior without shattering necessary boundaries.

But sometimes, a client’s pain is so penetrating, the thread slips my grasp. Sometimes, these feelings fasten themselves to my emotions like a virus, a sticky, spiky ball that replicates again and again. I knew I needed a method that could act as a distraction and possibly, an alternate lens through which to view a client’s problems.  The method in question stemmed directly from my days as an English student. I unearthed a bunch of old poetry chapbooks and began reading short poems during my lunch hour. At their very least, they provide a diversion. At their best, when my translating abilities fail me, they are an emotional “Rosetta Stone” that at times, slips the thread back into my palm.

The first poem I read was “How Distant” by Philip Larkin. It took minutes to read, but in five short stanzas, I felt Larkin’s ambivalence about getting older, his curiosity about the experiences of new generations, his regret at missed opportunities. I remembered why I’d spent four years studying such texts, and why people write and read poetry: to give voice to feelings and emotions in previously unheard ways, to make them understood when plain language and conversation fail.  I realized that this echoes the relationship of client and therapist—the client provides the text; the therapist is the interpreter and translator.

Recently, I began seeing an intelligent young man hell-bent on drowning his potential in drugs and alcohol.  After a particularly fraught session, I turned to W.H. Auden’s “Musee des Beaux Arts.” Auden contemplates Brueghel’s painting of the Icarus myth, in which a boy, despite his father’s warnings, attaches homemade wings, flies too close to the sun, and perishes in the sea. Auden describes the boy’s legs disappearing into the sea as a nearby ploughman makes his way to market and an elegant ship sails silently on. He contemplates the bystanders’ states of mind. Were they so entrenched in their own interests that they could watch a boy fall from the sky without pause?  Then, chillingly, he posits that perhaps they never saw him fall.

Maybe my client is the boy and I am the ship, replete with resources and education, but missing vital cues that could hoist him out of his misery. Or, the client is the ploughman, turning blindly away from disasters that lie ahead.  Perhaps I’m Icarus, drowning in my own helplessness, unable to help my client. Did this exercise lead to a breakthrough in therapy? I don’t know. But I do know that examining the session through a novel framework provided me with some perspective on this case. It reinforces the idea that my client and I serve different purposes to each other at any given time, that no individual characteristic trumps the others. We are both Icarus, the ploughman, the sailing ship.

I haven’t replaced my DSM-5 with The Norton Anthology of Poetry, but I’ve realized that I use my humanities degree with every client.  My formal psychiatry training taught me how to use scientific evidence to approach psychopathology; my English degree trained me to recognize the abstract ways that human beings express feelings. To paraphrase Walt Whitman, human beings are vast; they contain multitudes. To eschew the humanities is to discard a vital set of tools with which to understand and heal the human psyche.

Isadora Fox is a psychiatric nurse practitioner who manages medications and engages in psychotherapy in Austin, Texas. She is also a doctoral student at the University of Texas at Austin School of Nursing. She believes strongly in the biopsychosocial model and encourages all of her clients to engage in self-care, but never takes her own advice.

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