The Rise of Autobiographical Medical Poetry and the Medical Humanities

Assisted by a grant from the Mental Health Foundation of New Zealand, the collection Walking to Africa by Jessica Le Bas was the best-selling New Zealand “book of fiction”8 a week after its launch on October 9, 2009. The series of poems, told from the point of view of a mother whose daughter is being treated for depression, looks at the provision for mental healthcare for adolescents in our country.

Other medically-themed poetry collections published in New Zealand thus far in the 2000s include Anne Kennedy’s Sing-song (2003), hospital doctor Angela Andrews’s Echolocation (2007), past poet laureate Jenny Bornholdt’s Mrs Winter’s Jump (2007) and The Rocky Shore (2009), the late Sarah Broom’s Tigers at Awhitu (2010), and Ingrid Horrocks’s Mapping the Distance (2010). Many of these collections have an autobiographical basis—indeed, a number of the works under discussion evolved from authors’ journal entries that were later developed into poetic sequences or whole collections. For example, the subject matter of C.K. Stead’s poem “Ischaemia”, written especially for the Hippocrates Prize, is directly related to the stroke he suffered in 2005. The poem is narrated, in dictated-letter form, by Catullus, Stead’s poetic alter-ego, but the experience is Stead’s own, down to the details documented in the poet’s other writings and interviews—the transient dyslexia, the distortions of vision that persisted even months after the ischaemic attack (Stead 2006, 76–77). Stead’s first post-stroke collection The Black River (2007) features a number of poems that grew from a notebook kept at his bedside while he recovered (Stead 2006, 80).

In addition to these books, other notable collections have been published between 2003 and the present date. Paula Green’s (2010) Slipstream is a series of poems about the poet’s diagnosis of and treatment for breast cancer. Throughout the book, cross-word clues and song titles are woven into the story, reminding the reader of the patient’s everyday life and interests while she goes through surgery and radiotherapy, humanising and giving character to the nameless “she” persona, caught in the slipstream of illness and recovery.

Leigh Davis’s posthumously published Stunning Debut of the Repairing of a Life (2010) follows the author’s struggle to write again after brain surgery. This book won the Kathleen Grattan Award. The first half of the collection is the facsimile of a handwritten notebook. The second is a month’s worth of printed poems informed by The Odyssey. Davis’s poetry is transcendent, personal; it looks at illness, faith and death from the position of an unflinching “I”. Another posthumous collection is Gleam by Sarah Broom, which was published in 2013. This second volume of the poet’s work focused on terminal illness and the family and was linked to her premature death from secondary lung cancer.

2013 also saw Selina Tusitala Marsh’s Dark Sparring published. The second section of the collection deals with the poet’s mother’s diagnosis of breast cancer, and then her treatment for the disease. Using Wallace Stevens’s poetry as a springboard, Marsh explores a family’s way of coping with the matriarch’s illness and death.

In 2014, Zarah Butcher-McGunnigle’s Autobiography of a Marguerite was published. Told by an “I”, suffering from an undisclosed autoimmune disease and enmeshed with her mother/carer, the book explores the themes of identity and language from the inside of illness. The first section of the collection is a series of connected prose poems, linking daughter, mother and grandmother. The second section features poems punctuated by footnotes taken from books by Marguerite Duras and Marguerite Yourcenar. The last section uses photographs as well as prose poems to return to the story of the mother, daughter and grandmother, and the effects of illness on family and identity.

Cloudboy by Siobhan Harvey was also published in 2014. Told in the third person, but very much from the viewpoint of “Cloudmother” (35–36) to the eponymous autistic and gifted child, it is searing in its criticism of the educational, psychological and paediatric healthcare provisions for children on the autism spectrum.

These collections provide a rich range of narrative positions taken by the poets, and the ideas they express about identity and family life in the face of illness and medical treatment vary in terms of how the speakers view the familial relations they present, as well as life in the context of a clinic or hospital. Yet, they have in common a sustained narrative engagement with their topic, a real-life tie to the occasion of the series or collection and a polemical intent behind the poetry—one which very often reveals itself via the interplay of medical and personal language, and which is in keeping with contemporary sociological findings regarding doctor-patient relationships.

Critical Perspectives

The writing of doctor-poets in the UK and the USA has, generally, been received very well by critics, the democratic and revelatory aspects of the doctors’ writing pin-pointed for especial praise. For example, Joseph Cohen (1983) observes of Dannie Abse’s poetry that “The poems deriving from Abse’s experience as a practising physician are increasingly powerful […] and Abse’s medical practice is to his poetry […] what trench warfare was to Wilfred Owen’s poetry” (33).

In a similar vein, reviewer Heather A. Burns (2008) writes of Rafael Campo’s multi-voiced poems, which often feature both the first-person doctor’s point-of-view and his patients’ voices: “we come to see that for him, writing a poem is an act of humility and service, just as healing is. Both practices rely on the power of narrative itself; no poem or story is owned by one person” (437).

Critics and reviewers admire the perceived honesty of the doctors’ accounts of their workdays; the ways in which they share the ordinary and the extraordinary, not forgetting the ever-present air of the mystical about their role. Burns explains with reference to Campo in his fifth collection, The Enemy (2007): He has awe for the mysterious and a familiarity with despair, and he catches frequent hints of God’s presence. In this book, there are tiresome days in the clinic and patients who are near death but who will not die (Burns 2008, 438).

It is interesting, though, that Abse, a way-shaper for many future doctor-poets, who had experience in the medical humanities during its nascence (both in terms of his understanding of it, and in terms of his own involvement in teaching on American programmes that involved its precepts and those of narrative medicine) did receive a few reviews of the early medical poems which suggested that his craft was not commensurate to the potent emotionality of their subject matter: “the emotion here is impeccable, but the poetry does not quite rise to become its equal,” says Bruce Whiteman (n.d., par. 10). Similarly, in a review of Way Out in the Centre, the poet Douglas Dunn (1981) was critical of Abse’s “tendency to over-relax; while his easy manner contributes to a distinctly readable verse, it detracts from a complete seriousness” (par. 6). Dunn, himself, published a book of personal medical poems in the same year (1981) called Elegies, about the loss of his wife to cancer. His style in this book was described as being “accessible and direct” (Lyon 1990, 47).

Dunn’s remarks regarding the “relaxed” or “easy manner” of Abse’s writing about personal medical experience typify those usually aimed at poets who are not also doctors. These poets are usually “lay poets” doing what Dunn chose to do: to write poems about relatives who were experiencing illness. Just a cursory search of reviews for poets who have written recent medical poems will turn up a few such reviews and critiques. For example, British poet Hugo Williams’s I Knew the Bride (2014) featuring a series called “From the Dialysis Ward”, about the poet’s experience of kidney failure and its treatment, received reviews that questioned its ratio of craft to emotive confession: “while many of the individual dialysis poems are unflinching and unforgettably harrowing, the bleak subject matter narrows rather than widens Williams’s stylistic options” (Kelly 2014, par. 23).

Williams’s long history of using (and reusing) material that is autobiographical as the catalyst and basis for his poetry may be one reason for Robert Potts’s famous complaint that he is a “one-club golfer […] a charming and stylish prose writer [whose) poems don’t think hard [nor] encourage anyone else to” (quoted in Kelly 2014, par. 13). Also interesting here is the notion of less formalist poetry being questionable poetry; poetry that has prose-like elements being inferior to that which adheres to a distinctly taut aesthetic (as did Williams’s first collection Symptoms of Loss (1965), which was very much in the style of his idol Thom Gunn).

It is apt to say that Williams’s books are personal. It is not something the poet denies. Writing Home (1985), for example, is a homage to Williams’s father, an accomplished actor, as well as being an account of Williams’s boarding-school days; Billy’s Rain (1999) is about an extra-marital affair to which Williams has admitted. Dear Room (2006) charts the end of the affair. Regarding I Knew the Bride, therefore, one reviewer feels justified in asking, “The last 16 poems in the collection are dispatches From The Dialysis Ward. Is this God’s perverse way of keeping the poet supplied with fresh material?” (Taylor 2014, par. 6).

The general rule appears to be that unless a writer of self-referential medical poetry is without a history of confessionalism in his or her previous work, and he or she makes it particularly clear in interviews that “I’m not an autobiographical poet in that sense; I’m not someone chasing her own ambulance” (Jo Shapcott quoted in Crown 2010, par. 6), charges of emotionality weighing heavily against stylistic concerns can fairly be found in a number of reviews and critiques.

Peripherally, it is also noteworthy that Jo Shapcott’s Of Mutability (2010) received much praise from reviewer Kate Kellaway (2010) of The Observer for its very obliqueness—its avoidance of the medical realities. For Shapcott had been diagnosed with breast cancer in 2003, and she underwent surgery followed by both chemotherapy and radiotherapy. All of these facts appear as elements of Of Mutability. However:

Cancer is not mentioned—never dignified with a name. It is characteristic of Shapcott to avoid the banality of straight autobiography. Instead, her illness exists as an anarchic rabble of cells in the body of her texts: “Too many of the best cells in my body/are itching, feeling jagged, turning raw/in this spring chill… (Kellaway 2010, par. 4)

Sarah Crown (2010), the Guardian reviewer, agrees. She interprets the title of the collection as extremely telling with regard to the poet’s general perspective throughout the book:

Of Mutability, which was shortlisted this week for the Forward prize, is her first book in almost a decade, and while the title is no less plangent than those that preceded it, an audible tonal shift has occurred; the preposition “of” creates a gap between poet and poem, introducing a new note of reticence. (par. 2)

Kellaway’s and Crown’s are interesting readings of lines of the eponymous poem and the title of the book, respectively, but they are easily countered by focussing on the way in which, in the lines quoted from the poem, the “cells” are made more familiar and less threatening by the language used both to personify them and to bring them into a known, lifeworld context. They are a “rabble”, causing trouble, up to no good. The “I” (the patient) cannot possibly understand the process at work inside her body, the relentless cell division of the tumour, nor its would-be metastases, and so she turns the mutant cells into things that one associates with minor injuries; things that itch or feel rough to the touch, as if chapped. Through this familiar language, she subdues the terror of the unchecked cell growth, the cancer whose name she avoids and from which she disassociates herself. Similarly, the title “Of Mutability” (poem and book title) is in homage to the artist Helen Chadwick, whose solo exhibition held at the Institute of Contemporary Arts in 1986 aimed to evoke images of transience, death and rebirth. Clearly, also, “Of Mutability” alludes to the last line of Shelley’s “Mutability”: “Nought may endure but Mutability” ([1885] 2017, line 16). Everything about the collection speaks of ephemerality and change, something that the author had been contemplating because of her illness experience, perhaps9, but also because she is a person who has written for years about transformations, particularly those which occur in the classical world—Ovid’s Metamorphoses,10 for example.

Moving on to personal medical poetry’s reception in New Zealand, author of The Luminaries, Eleanor Catton, described the country as having “no reviewing culture at all” in a Guardian article of September 7, 2013. While this is an exaggeration to make a point, it is perhaps true to say that conducting a balanced and far-reaching survey of academic reviews is challenging in New Zealand. It is not a large or populous country; its reviews are often few, short, and written by other poets within a small literary scene. However, there is enough material in the form of reviews from The New Zealand Poetry Society, The Lumiere Reader, and magazines such as the New Zealand Listener, New Zealand Books, regional newspapers and longstanding literary publications such as Landfall and the Journal of New Zealand Literature, to make and illustrate some substantive remarks regarding differing critical receptions of doctor-poets’ and patient-poets’ works. The critical reception of the work by doctor-poets and patient-poets was in some ways schismatic. The former was most often viewed as brave and heroic in its revelations, the latter as solipsistic. Furthermore, it was evident that when parents made their sick children the subjects of their poems, some reviewers would interpret their narrative position as exploitative or sermonising.

To expand a little, Colquhoun’s Playing God has been called “revealing” by reviewers (Bieder 2003, par. 2); the content, largely autobiographical, insofar as it discusses his work with patients and his own family’s experience of illness, has been said to reflect Colquhoun’s “intense, almost fragile self-awareness,” a quality that makes his poetry “heartbreaking and beautiful” (Bieder 2003, par. 3). Southland Times reviewer Margaret Hunter (2004) similarly praises the work’s “personal appeal and the sense that the author is near you and talking to you” (35), a comment that aligns with Colquhoun’s recent classification as one of three New Zealand “poets of the people” (Green, in Green and Ricketts 2010, 398), alongside Hone Tuwhare and Sam Hunt.

As the title Playing God suggests, Colquhoun’s doctor-speaker’s perspective in many different poems apprehends the doctor’s place as authority figure and object of faith and trust. However, it also articulates the difficulties and pressures associated with such perceptions, the poems voicing what Colquhoun calls “a long conversation with my doubt” (Playing God Introduction 8).

Angela Andrews is another doctor-poet, whose collection Echolocation (2007) takes as its subject her personal and professional concerns. In an interview with Linley Boniface for an article in the New Zealand Listener, Andrews explains the emotional catalyst to her writing:

The hardest thing to deal with as a doctor […] is not the drugs or the mechanics of illness but the human stuff—birth, death and suffering. Poetry helps you to acknowledge what you’re going through, and to accept the uncertainty of it all. (par. 9)

In keeping with this tone of the doctor-poet’s inner conflict, as in Playing God, Echolocation has poems which explore the topic of familial illness, and reviewers have admired Andrews’s ability to present a speaker in whom “the concerned eyes of a loving granddaughter combine with the precise observation of a doctor” (Liang 2008, par. 4).

Similarly, in Simon Sweetman’s 2007 review of Tributary, haematologist Rae Varcoe is commended for her “honest” approach as she unflinchingly describes her work on the hospital ward: “her written word/world is very much the real world according to her, a world she is moving through” (par. 6). Sweetman is taken with the fact that “[s]he stops off to offer advice from time to time (“A Wish List for Melissa at 21”) but mostly (“Signs”) she assures us that she’s no surer than anyone else” (par. 6)

What the reviewers have in common is their praise for the apparent honesty of the work and the appearance of a dichotomous biomedical/personal self on show in the writing. That the doctor-poets are writing about their own experience is understood, and it is seen by these critics to enhance their poetry.

By contrast to the almost unanimous admiration of reviewers for the doctor-poets’ collections, poems written from the point of view of patient-poets have met with some less favourable appraisals in keeping with those usually levelled at poetry labelled “confessional” or autobiographical, for as Jo Gill and Melanie Waters report (2009), to “identify autobiographical sources or voices is tantamount to denying [a work’s] creative or aesthetic value”, and particularly for women poets (3). Accordingly, various reviewers have perceived the patient poets in particular as resorting to “the gut-spilling impulse of the ‘confessional’ mode” as USA-based reviewer Hugh Roberts said in a review of Stead’s poetry 2007, par. 6). Or, as poet and critic Joanne Preston (2009a) suggested in her review of Jenny Bornholdt’s The Rocky Shore, “Why pretend these are poems? There is a genre that they fit into much better—the memoir” (par. 6).

These negative comments regarding poetry-as-memoir or poetry-as-confession raise a pertinent issue. Despite the fact that contemporary medical poetry collections have proved popular with the reading public and have sold widely, and despite the fact that the point of attraction for many readers seems to be the very closeness of the material to the medical life experience of the poets, be they doctors or patients, there is a notable division between reviews of the work of the doctor-poets and the work of the patient-poets.

Perhaps it is the case that, as Marilyn Chandler McEntyre (2012) proposes in Patient Poets; Illness from Inside Out, despite our society’s increased awareness of disability and illness, and our purported acceptance of sufferers whom once we might have feared or scorned through ignorance, “some conditions are still spoken of only behind closed doors, or with an edge of unease and an eye on the privacy clause” (40). She makes the point that approaching and engaging with autobiographical work that involves mental health or sexual health, for example, “remains emotionally, politically, or theologically complicated” (40). Is the critical divide with regard to these poets, then, the line between the clean, healthful doctors giving us an insight into their lives on the wards versus the struggling patients and parents of sick children, revealing more than we wish to see of potentially taboo-raising, embarrassing or fear-inspiring illnesses? McEntyre sees it thus: “Poets who set themselves the task of writing past that tacit social barrier know their words may give offense. Their disclosures are a kind of “coming out” that locates them in a geography of controversy” (40).

In a similar vein, in her recent doctoral thesis (now a published book) How Does it Hurt (2014), New Zealand poet and chronic pelvic pain sufferer Stephanie de Montalk “acknowledges the possibility that for reasons of self-protection […] we are conditioned or ‘hard-wired’ not to accept the pain of others” (Abstract, 6). She sees our non-acceptance as a self-protection mechanism. The pain of other people is not to be admitted, lest it infiltrate our own armoury.

But if social discomfort could explain part of the reaction to these patient-poems and parent-poems, aesthetic concerns also play a role. For Hugh Roberts (2007), the autobiographical basis of Stead’s post-stroke poems is not only unpalatably “gut-spilling” (par. 6), it also contradicts the octogenarian author’s career-long adherence to modernist impersonality. Roberts sees The Black River’s new mode as an unsuccessful stylistic experiment:

It might seem a paradox that the writer who nailed his colours so definitively to the mast of Pound and Eliot’s “impersonal” modernism in The New Poetic back in 1964 should have produced a literary oeuvre that so obsessively mines his own autobiography. (2007, par.4)

For Roberts and some other critics, the stylistics of the patient-poems is tied to, and perhaps inextricable from, their theme and their content: that is, the poems’ nascence in the authors’ recent medical experience is associated with a raw, diaristic quality to the writing that precludes sophistication and craft. As Roberts remarks with regard to Stead’s stroke-related poems, they are “most remarkable for being unremarkable” (2007, par.10).

In another review, this time of Sarah Broom’s Tigers at Awhitu (2010), Roberts goes so far as to suggest that medical confessional collections are in fact part of a current trend in New Zealand poetry: “a new genre that could be described as exercises in Higher Blogging: free-verse ruminations on Stuff That Has Happened to Me Lately” (2010, par. 1). Broom’s first collection, concurrently published by Auckland University Press and Faber, features many poems on the subject of her diagnosis of lung cancer and her subsequent treatment. Roberts concedes that the subject matter of some of Broom’s poems is “riveting” (2010, par. 14), the implication being that interest in this collection would rely on schadenfreude or voyeurism, the content being more compelling than the craft. Roberts suggests that the poems themselves are not masterfully or completely rendered; they are overshadowed by the very emotion of the experience they are trying to express. He explains that “there is in these works what Wordsworth called an ‘overflow of powerful feelings’ but not quite, yet, that transformation by reflective ‘tranquillity’ that would sublimate these feelings into a fully realised work of art” (2010b, par.14).