Theater, film, literature and poetry are forms of expression that allow artists and their audiences to explore the compelling issues of their lives. By understanding which pieces "speak" to patients and physicians, the dialogue and therapy may be enhanced.
Theater, film, literature and poetry are forms of expression that allow artists and their audiences to explore the compelling issues of their lives. On a very basic level, the various forms of art are windows into the emotions and impulses that populate the human unconscious. Furthermore, art, both in its creation and its enjoyment, can be as healing for the psyche as psychotherapy. The themes explored in literature allow us to understand, from a different perspective, the difficult issues with which our patients grapple in therapy. Of all of the medical specialties, psychiatry may have the greatest affinity for the humanities. Psychiatry is inherently about the human psyche, a topic addressed by all of the arts in one way or another. Thus, psychotherapy and art are merely different approaches to the understanding of the human experience.
Drama and literature play an important role in both the professional and personal lives of psychiatrists. Art reflects our own emotional issues and provides a glimpse into our unconscious. The films, poems and plays that we find most gripping or poignant tell us something about our own unconscious world and help us reach a greater degree of self-understanding. In creating our own poetry or performing in theater, we are revealing part of ourselves to others that is important for us to share. Our reasons for creating art and our personal reactions to art tell us about who we are and what is most important to us. The decision to create is revealing in itself, but what we decide to create can be equally informative. Writing poetry and performing on stage are very different forms of expression that reflect the personality of the artist. These insights can be invaluable to psychiatrists in identifying and dealing with countertransference in psychotherapy.
The role of art in the lives of our patients is equally important. Our patients' reactions to art can be utilized in therapy. Understanding how to examine these issues can be very useful to the psychiatrist. As I said earlier, the pieces of art that we find the most compelling, the ones that we come back to over and over again, the phrases that we always remember, tell us about ourselves. These experiences can be used in psychotherapy by psychiatrists when patients describe films, poems or books that they find moving. Even if the psychiatrist hasn't read the book or seen the film, the discussion of the piece and why it was important to the patient can provide powerful insight into that individual's psyche. To illustrate my meaning, I will reflect on several pieces of particular importance to me.
One notable example is Macbeth. The initially noble Macbeth, ultimately destroyed by ambition, serves as a powerful warning. In an early scene, Macbeth argues with himself about whether to murder the king and seize the throne (Act 1, Scene 7):
He's here in double trust: First, as I am his kinsman and his subject, Strong both against the deed; then, as his host, Who should against his murderer shut the door, Not bear the knife myself.
Macbeth recognized that--as kinsman, subject and host--loyalty and honor dictated that he should not murder his virtuous king. Nonetheless, stoked by Lady Macbeth's goading, his ambition carried the day, setting him on a path to destruction. Images of notable historical figures who, like Macbeth, destroyed themselves through their ambition, come to mind. The importance of leaders balancing ambition with integrity resonates strongly today.
In a second scene from Macbeth, Lady Macbeth walks about the castle in a trance-like state, muttering psychotically. Her doctor observes (Act 5, Scene 1):
Foul whisperings are abroad: unnatural deeds Do breed unnatural troubles: infected minds To their deaf pillows will discharge their secrets: More needs she the divine than the physician.
Macbeth becomes less hesitant and more tyrannical as the play progresses. His noble traits disappear as his murderous behavior escalates. In contrast, the initially vital Lady Macbeth regresses into psychosis induced by guilt over her crimes. It is reassuring to observe that realizing one's ambition by sacrificing one's morals does not bring a satisfying outcome. In psychotherapy, my patients and I frequently note that those who live their lives according to their values are often the happiest.
Let us consider next Shakespeare's Julius Caesar. When Mark Antony comes upon Caesar's dead body, he moans (Act 3, Scene 1):
O mighty Caesar! Dost thou lie so low? Are all thy conquests glories, triumphs, spoils, Shrunk to this little measure?
This passage prompts me to contemplate the ephemeral nature of success. It seems to warn that life can change in a minute and that we should endeavor to achieve fulfillment in both love and work. Career accolades will be of little comfort if we reach the end of life lonely and empty.
In one last scene from Macbeth, Macbeth discusses his wife's psychotic illness with her doctor (Act 5, Scene 3).
Macbeth: How does your patient, doctor?
Doctor: Not so sick my lord, As she is troubled with thick-coming fancies, that keep her from her rest.
Macbeth: Cure her of that. Canst thou not minister to a mind diseased; Pluck from the memory a rooted sorrow; Raze out the written troubles of the brain; And with some sweet oblivious antidote Cleanse the stuff'd bosom of that perilous stuff Which weighs upon the heart?
Doctor: Therein the patient Must minister to himself.
In 16th century Britain, centuries ahead of Sigmund Freud, Shakespeare recognized that diseases of the psyche exist and hinted at the healing powers of psychotherapy.
Moving on to another of Shakespeare's plays, Othello reprimanded his lieutenant Cassio following a drunken brawl. Cassio later laments (Act 2, Scene 3):
O God, that men should put an enemy in their mouths to steal away their brains! That we should, with joy, pleasance, revel and applause, transform ourselves into beasts! ... It hath pleased the devil drunkenness to give place to the devil wrath: one unperfectness shows me another, to make me frankly despise myself.
With this scene, I am reminded that patients can sabotage themselves and are frequently their own worst enemy. As with Cassio, patients often loathe themselves for their flaws. Much of therapy is intended to help patients gain insight into self-destructive behavior and develop the capacity for self-forgiveness.
Let us look next at Shakespeare's Hamlet, in which Hamlet utters his famous lines (Act 3, Scene 1):
To be, or not to be: that is the question: Whether 'tis nobler in the mind to suffer The slings and arrows of outrageous fortune, Or to take up arms against a sea of troubles, And by opposing end them?
While this soliloquy is subject to many interpretations, these opening lines speak to me about the difficulty in deciding how and when to choose one's battles. Our society idolizes courage and taking a stand. However, many of us have learned that the better part of valor is often to leave well enough alone in order to live to fight another day. In therapy, psychiatrists encourage some patients to advocate more strongly for themselves and work with others to learn to be less aggressive.
Moving past Shakespeare, I remember vividly other poems and passages, even though I read them years ago. The first is "The Road Not Taken" by Robert Frost. The closing lines of this poem are:
Two roads diverged in a wood, and I--I took the one less traveled by, And that has made all of the difference.
This speaks to my need to believe in the power of choice, and that, if I make healthy choices for myself, I will live successfully. The enduring popularity of this poem suggests its message resonates similarly with others.
On a more whimsical note, A.A. Milne opens Winnie-the-Pooh with:
Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it. And then he feels that perhaps there isn't.
This passage provides an eloquent metaphor for the work of psychotherapy. Our patients struggle to find a better way to cope with life's problems, sometimes hopefully and other times with resignation.
Stephen White wrote in the opening page of his novel Critical Conditions (1998; Delacorte Press):
I hold the hands of people I never touch. I provide comfort to people I never embrace. I watch people walk into brick walls, the same ones over and over again and I coax them to turn around and try to walk in a different direction.
White has artfully incorporated psychotherapy into his murder mysteries, using a clinical psychologist as his central character. In the previous passage, he deftly describes the art of psychotherapy and the difficult role we as healers have in the lives of our patients.
As a military psychiatrist, I find myself quoting Lord Alfred Tennyson's "The Charge of the Light Brigade" dozens of times a year:
Their's not to make reply, Their's not to reason why, Their's but to do and die: Into the valley of Death Rode the six hundred.
In Lord Tennyson's era and today, military culture demands obedience and discipline. Indeed, many of us--in the military or not--do not have control over our future. Fate and circumstances often conspire to change the direction of our lives for better or worse. I find Lord Tennyson's poem to be of comfort in dealing with those moments when I lack of control of my life.
In discussing psychiatry and the arts, I cannot resist indulging my interest in psychiatry and film. In The Prince of Tides, Tom Wingo goes to New York City in the aftermath of his sister's suicide attempt to help her psychiatrist. The psychiatrist, Susan Lowenstein, asks Tom, "You don't like psychiatrists very much, do you?" Tom responds, loudly and angrily:
Why should I? What good do you people do? You ask a lot of questions. I am sick of this whole routine. I am sick of my sister's attraction to razor blades. I am sick of shrinks who can't do a thing to help her.
This single brief passage describes vividly the public perception of impotence that plagues our profession, as well as the severe difficulties for families and patients dealing with chronic psychiatric illness. Despite my passion for psychiatry and the many patients whom I have helped, there are days when I feel just like Tom. I have patients who I despair will never improve. This scene echoed those sentiments beautifully.
Both psychotherapy and art deal directly with the emotions of their participants. In psychotherapy, psychiatrists and patients sift through human emotions to help deal with life's problems. In art, artists seek to inspire, to create beauty and to grapple with difficult issues through various mediums. In both instances, the challenges facing the human condition are central. By examining the literature we find most moving, we can better understand ourselves. Equally important, the discussion of art, film and literature can provide an invaluable glimpse into the unconscious world of our patients. The themes of integrity, ambition and choice emerged in my exploration of this topic, capturing part of the essence of who I am as a person. While a similar study with another person would yield a different picture, the connection between art and the unconscious is undeniable.