Poet, editor and physician Shane Neilson follows in the long tradition of doctor-writers: someone who works closely amongst the drama of life; who sees the personal, difficult, often hidden aspects of living and is compelled to express this in literature. His latest poetry collection, Dysphoria, examines metal illness from a personal perspective, by placing the reader inside of a patient being treated, as well as the historical perspective, by adopting the voice of 18th century physician and forerunner of psychiatry, Benjamin Rush. Though factually based and formal in its approach, Neilson’s poetry is deeply empathetic in its observations while still maintaining a playful dream-logic towards language.
I'd like to start by asking about Dysphoria's long, title-poem. It presents the reader with a stream of conscious voice of a man whose mind quickly wanders from one subject to the next, all under an anxious light. This poem stands out from the rest of the collection, in terms of both the narrative and language. What brought you to write this poem and what is Dysphoria in the context of this book?
The title poem is an anthem for the unwell, while it itself is unwell. It sings out difference while occurring within a carceral institution. My idea was use personal experience of involuntary admission to psychiatric institutions as the frame for the poem. The man in this poem is, quite literally, getting an intramuscular injection of haloperidol and lorazepam in his buttock. He's quite "unwell" - and I mean in a real, medical sense. I do not go so far as some mad studies brethren to contest the construction of psychosis as aberrant, undesirable, even pathological, because, in my personal and clinical experience, psychosis is quite destructive to relationships (to say the least).
Yet the man is also unknown to the ones who are restraining him. He is sad and desperate. He wants to be loved. He did love, once upon a time. His life features core experiences that recur throughout the collection (ie., the water tower) but these core experiences are presented as he sees them in real time, as they are meaningful to him and as they connect with the other narrated experiences he cannot regulate or control. For him, metaphor and image are indistinguishable from memory and time. I wonder if this is what "psychosis" really is - experience and being, disrupted along with the tools we use to construct our sense of self and world.
This frame allows the poem to range very far. It is not meant to be a didactic, signposted experience, yet there is enough repetition - enough deliberate sense - for an interested reader to follow along. Percy Sledge appears to sing parts of "When A Man Loves A Woman" because one of the man's greatest difficulties is a turbulent love affair. He also lost a child - run over by police as they were engaged in a chase. Traumatic things happened to this man, and he's stating what they are - but it takes a process to realize what they are. It would, naturally, take actually talking to him and relating to him in order to make the buried narrative realized. This doesn't happen in the poem. He gets drugged - and legitimately so, for his own safety - but such is the bind we are all in. The ill and society are less in opposition with one another than they are tragically misaligned. The man needed the treatment but he needed to be understood, too. And sometimes circumstances make that impossible. Thus the work is not one in the antipsychiatry tradition, but rather one of mutual witness. I truly believe we are all in this together.
I imagine that a doctor encountering this man would have to listen to him for quite some time, and have a certain interpretative capacity and sensitivity, before they could make sense out of him. What they would immediately apprehend, however, would be the mixed-ness of his presentation: anger, sadness, a preternatural energy.
A sensitive reader of this poem, though, would understand much more than that. They would understand how this man, at the end of a needle - experiencing all the things in the poem/speaking the things in the poem/thinking the things in the poem - cares much more for them than he does for himself. His thoughts and feelings are for all ill persons, the predicament of mental illness that is made more perilous by stigma, irregular and poor medical treatment, poverty, and a culture of increasingly technologized relationships that hinder connection.
If I boiled it down to a metaphor, I'd say the poem is a live wire, but at both ends. The reader is on one end, and the poor man is on the other. The wire is the relationship between them.
"Dysphoria" (the poem) is the skill-testing question, the deliberate provocation, a call-out to digestible, Twitter-esque technologized aspiritual single-page prizewinning poems. I recognize their place and beauty, but it crowds out my experience of long-form disorder and disruption. The poem despises such containment due to the narrative provenance of its ostensible subject - a poor man at the end of a regulatory needle & poor people existing at one end of the live wire - but also is written as a serial long poem with careful embedded perfect rhyme as a metaphor of technique. I mean for rhyme to represent a failed or only partially successful straightjacketing. The form of this poem is, in that way, a resistance to regulation. "Dysphoria" goes on a long time, takes a long time to apprehend, is difficult and beautiful. It wishes to be free.
Dysphoria (the experience) is the word I find that best describes the peculiarly destructive energy of mixed mania. Rather than euphoria, in which the mood is elevated as overlay on excess energy, dysphoria is a black face expending the same inexhaustible energy supply.
I started my book with a huge obstacle - a beautiful, aphoristic monolith that employs many of the same nonlinear splice strategies that post-Dodds Canadian poets use, but for a purpose. I wanted to challenge people because the poor man's life is hard - as are the lives lived like his. As is mine. I wanted to make a poem that only I could write, that had never been done before. I wanted to demonstrate, in language, what it feels like to be in a mixed manic state - but also write out beauty. I wanted it to be beautiful more than statement, meaning, and cause. But those things are interdependent, of course.
How are these things interdependent? I’m curious how poets see the relationship between the meaning, statement, cause and the more beautiful or ethereal qualities of the poem.
Here, I’m afraid, I evoke a great borrowing. Margaret Laurence spoke of “the multiplicity of everything.” Look carefully: in that phrase is a container capacious enough to contain everything. Paranoid 60s counterculture freaks said “It’s all connected, man.” Semiotics presents/represents life as a system of symbols and signs, and since these symbols and signs exist in a system - ergo connection. (Teleology and syllogism are poetry’s jam.) Traditions of faith, too: for example, in monotheism, everything is attributable to the maker and therefore is connected. But what about physics? All objects possess a gravitational force that is in relation to others. To bring evolution and mathematics to bear on beauty requires a Laurence-sized capacious container, and this paragraph response isn’t that. I could enfold all the previous metaphoric evidences as offspring of the Enlightenment. More pointedly, though, there is a tension between statement or message and beauty in poetry. When message takes precedence, when message proselytizes, there can be trouble. I note two kinds: the poet either places too much weight upon message and it dominates their text, or the poet simply is overwhelmed by the message itself and their talent is unable to match the message’s importance. Either way, the beautiful sinks into didacticism’s pit. One other comment: quite often, there is poetry that does not concern itself with cause or meaning. This need not be taxonomized, though lyric poetry is usually meaning’s handmaiden, and anecdotal/narrative poetry is especially prone to messaging. Poetry that is less politically active nevertheless espouses a politics, but I fear I’ll go too far on this tangent - and my train of thought is enacting a skipping, gleefully obscure connectedness, so perhaps I’ll just stop by saying: beauty should be built in to the connections between every word in a poem because beauty is already baked into the words themselves. (Look up any word in the OED to see what I mean - for me, it’s a monumental archive of beauty.) So don’t screw it up is what I sometimes tell myself when starting a poem. And when I’ve written one, I say: you had such riches! How did you screw it up?
The second section of Dysphoria takes on the voice of American founding father and forerunner of psychiatry, Benjamin Rush. He was a fascinating intellectual of his day, contributing to the American Revolution, Abolitionism, public health and anti-capital punishment. But what was you attraction to him and why did you decide to write in his voice?
There are several attractive qualities. The first, and perhaps most obvious, is the fact that Rush authored the first psychiatric text in North America, Inquiries and Observations Upon Diseases of the Mind, in 1812. Partly as a result, he is nicknamed the “father of American psychiatry.” Because I am also a physician, because I suffer an illness that Rush would have encountered as bread and butter, and because of my keen interest in medical history, I saw many points of connection with Rush. The prospect of converting his antiquated psychiatric textbook into a dramatization of his daily practice and medical philosophy was irresistible.
I was discussing an important point with the poet-physician Conor McDonnell the other day: one of the ways into a historical subject is one’s own imaginative life within that subject. In other words, I am not writing poems in Rush’s voice, or even in my own voice so much. I am encountering Rush as he encounters me encountering him, I am feeling his impressions of me when I’ve been unwell. But also his impressions of me as a physician - I understand Rush’s work, notwithstanding period difference, I know what it is like to witness madness. I recognize how heartbreaking it is, how difficult. I grieve for those in his care, in my care. And celebrate them too.
Because of this portal, I access the emotional power inherent to witness. Writing Rush (but not writing as him) hurts to do because it often hurts to be me, it hurts to be vulnerable amidst other suffering persons. Such is my recommendation to any young poet who wishes to cover a historical subject. Basic advice, I suppose: find your own place within the subject, your own strong affinity: and sing from there. One of the advantages of being a physician in this situation is a familiarity with method and discourse. I have read a not-inconsiderable share of medically-inflected Canadian poetry collections, and it is easy to determine when words are used as sonic wallpaper as opposed to being properly deployed. There is a veracity inherent to using words in the right way - it keeps poetry from becoming merely decorative. In the same way, dialogue needs to be convincing in fiction and film. Dialogue should be something that people actually would say - otherwise it’s flat, boring, annoying, unwatchable and unreadable. I feel the same principle applies in poetry. This sets a high bar for the non-professional. Membership has to have its privileges sometime?
Because this answer is going on rather long, I’ll restrict myself to just two quick additional reasons for “choosing” Rush: (1) his writing reflects an unusually compassionate disposition towards mental illness for his day, and (2) the writing is often quite beautiful. Though to think similarly, one has to enjoy non-contemporary modes of expression, of course.
All this said, Rush was a man of his times and entertained views and attitudes that would not be endearing today. Yet for my people, the mentally ill, he seemed to care. And I cannot emphasize this enough to any ill person: find a doctor like that, who cares. This is also simple advice. But it is not so easy to do.
Before concluding, I have to ask about, “There is a veracity inherent to using words in the right way - it keeps poetry from becoming merely decorative.” This interests me especially in relation to medical text and especially in relation to something you wrote about Sylvia Legris’ The Hideous Hidden in a recent issue of POETRY: “Legris isn’t interested in solving the ‘riddle of meat,’ preferring instead a jangling, sound-dense poetry that ruminates on the substance of the human body (while chewing the language used to render that body).” For you, what is the difference between ruminating, sound-dense poetry and merely decorative poetry when appropriating texts and language (like the language of medicine for example)? Or, is there a way to be respectful to the the words and their origin while also using them for one’s own purposes?
Yes, after writing that, I thought: I’m going to get into trouble for saying so. One risks challenge when one creates categories or somehow elevated conditions - as my favourite critic has said (M. Travis Lane) when challenged by b p Nichol about her organized approach to literature, “I think you’re quite right. Categories exist to be broken and qualified and changed.” My instance is made more perilous by invoking a special privilege - albeit one earned through work and experience. To be specific in my answer and touch upon Legris, I would claim that Legris doesn’t use medical discourse inappropriately. Her engagement with that material - as I said in the piece - is substantial and far in excess of casual. She might not be an anatomical pathologist, but she is certainly someone who has processed centuries of medical discourse. I suppose I am objecting to the casual deployment of, for example, the terminology inherent to hematopoesis in poetry. When one takes up words that have a functional life in an intellectual and scientific tradition that is ancient, the onus is on the poet to not use the words in a way that’s incorrect. (Decorative use is not necessarily incorrect because it’s not meaningful in the narrative sense.) As a doctor, I sometimes catch poets playing doctor in their poetry and I can tell it’s false, just as I watch medical shows and groan at the implausibility and error on display. Yet, and here’s the thing, I object moreso to the clear lie of it all - the way the language is used has no viability, no connection to a greater and sustaining context. Thus I’m less snorting at the television for its bogus medical information than for the utterly ridiculous way medicine is sometimes presented as working. Same goes for poetry redolent of the medical. Often, it’s less that terminology is used incorrectly used and moreso that the relationships between the terms and the other concepts or people in the poems are discordant. I’ve been a doctor for almost twenty years and this profession keeps me from pretending, I don’t have to. (Although I’m sure I’d be guilty of the same thing if I tried to write poems about plastic surgery. We always give ourselves away, right? My specialist colleagues would be able to rest assured of their superior knowledge. And they do, they do.) In truth, my poet friends can rest easy, too. It is the rare physician who can write. But for the ones who can, they know a special language intimately. Ghetto, tomahto, goldmine, tomato. I’ll close with a retelling of an anecdote by one of my favourite Canadian poets, Al Moritz. Al visits his doctor regularly for check-ups. At the end of his visits, as farewell, the doctor says to Al, “You keep doing the important work.” Of course there need be no hierarchy here, and indeed there isn’t one - the doctor and the poet need one another. But they need one another for different reasons, and I think Al’s doctor is offering respect. Let’s conclude on that note!
The views expressed by Open Book columnists are those held by the authors and do not necessarily reflect the views of Open Book.
James Lindsay has been a bookseller for more than a decade. He is also co-owner of Pleasence Records in Toronto, a record label specializing in post-punk, odd-pop and avant-garde sound pieces.