Measuring Poetic and Inner Landscapes of Illness and Pain
Over recent decades the medical community has come to realise how increasingly they must rely on the voice of the patient, not just in clinical consultation, but in creative articulations.
In the medical encounter, whether an appointment with a GP or an emergency situation, time is of the essence. The voice of the patient, while vital, is given little opportunity to speak, mostly limited due to time restrictions. As a patient, we tend to hierarchise the problems, and may even leave the appointment never having mentioned something that was bothering us. So much of our time and effort is put into trying to explain and describe, as accurately as possible; before the appointment we instinctively prepare explanations of the problems, symptoms, concerns. We must measure what we say, and how we say it.
Yet, this measuring is not a purely negative thing, as restriction is not always limiting; in fact it can be freeing and illuminating. Shaping how and what we have to say enables the creation of a narrative, which uncovers things not yet realised. For example, we might realise how one sensation is a direct result of a sensation elsewhere on the body, or how some problems only emerge at certain times of the day. The art of narrative and creative construction can emphasise, subordinate and organise these symptoms and sensations, helping make sense of pain and illness.
The same could be said for poetry, where “restriction” or “limitation” in its construction can be freeing. In crafting poetry, word choice is measured, sometimes designed into a specific poetic form, or breaking convention outright. Writing poetry, like explaining symptoms, is a negotiation with and navigation through language. The poetry of illness can and does contribute to the language and articulation of pain, and consequently the recognition and understanding of illness and pain.
In experiencing illness, there is a need to express and explain one’s sensations, but the language of pain and illness is often elusive or fails us. In sharing one’s sensations, whether with medical practitioners, or friends and family, we require our language to bring them with us; to give them access and insight into what we are experiencing, and how it feels. We try to give them the directions to follow us on the journey. However, as Arthur Frank in The Wounded Storyteller remarks: ‘Serious illness is a loss of the “destination and map” that had previously guided the ill person’s life’ (Frank, 1). Thus, we are left to redraw the map, and create a new route and pathway which might aid the expression of pain and communication to others.
I wish to explore such a struggle with expressing the inner landscape of pain through Marguerite Bouvard’s poem ‘Landscape’:
The dimensions are dizzying; peaks
unraveling the sky, light sheer
as rock unbroken by leaves or shrubs
or the humble shadows of passersby.
In this wilderness, I must invent
my own markers, a way of describing
distances only my body knows.
I’m like the first settlers who tried to stake out
a plot in rampant space: nights,
the frail structure of belief crumbles.
And yet you look at me and see a woman
like any other; you don’t see
the landscape of illness, the cliffs
within myself I scale each day.
Bouvard describes the internal landscape of mental illness as if it were the natural environment. Immediately we can see the overwhelming nature of the illness she is experiencing where the ‘dimensions are dizzying’. While it is ‘unraveling the sky’, it unravels her world, and the knowledge of her body. The poem specifically concerns mental illness, which explicitly suffers from invisibility, compounded by the struggle to share the symptoms and pain. The illness is isolating and confusing, made worse when she cannot explain the extent and details that make up the symptoms and effects of the illness.
It is at night when the vulnerability and isolation especially (re-)emerges for her, when ‘the frail structure of belief crumbles’. She questions the belief in everything, from the validity of the sensations, to the accuracy of the body and the mind in identifying these ruptures. Crumbling belief leads to doubting one’s ability to not only articulate and convey, but also survive. This ‘frail structure of belief’ might also be the system of language, which has never seemed so frail before. It is often only in times of crisis, emotional or somatic, that we realise the futility and failings of language as a tool to express what is going on inside. Finding ‘a way of describing’ becomes an urgent personal and social need. At the same time perhaps her failing ‘belief’ is in medicine itself; a system and institution which seems to fail her.
These anxieties are intensified by the heavy descriptions of a natural landscape, ones which are infused with sublimity. The poem is made up of images of sublime natural features: ‘peaks’, ‘wilderness’, ‘rampant space’ and ‘cliffs’. These are natural features which are awe-inspiring, but which put the individual on a brink between pleasure and terror – the effect being both breath taking and triggering breathlessness. The final image of poem, ‘the cliffs/ within myself which I scale each day’, is reminiscent of Gerard Manley Hopkins. In his sonnet ‘No worst, there is none. Pitched past pitch of grief’ are the lines: ‘O the mind, mind has mountains; cliffs of fall/ Frightful, sheer, no-man-fathomed’. Both poems focus on the cliff as the image for the mind, but more specifically of a mind undergoing crisis. For Bouvard this is the daily struggle; it is the cliffs which she must ‘scale each day’; ‘scale’ in the both the sense of climbing and of measuring. She must climb and conquer these cliffs in order to function, but she must also measure and take note of changes from day to day, recognising the good and the bad days. The cliff images from both poets poignantly convey the struggle and the fear which is a large part of mental illness, melancholy or grief.
At the heart of these sublime images however is the overwhelming sense of being lost; lost not just in any expanse, but ‘this wilderness’; ‘this’ cementing the personal, first-hand nature of the experience. The ‘dizzying’ sense is reinforced by the inclusion of: ‘I’m like the first settlers who tried to stake out/ a plot in rampant space’. Such a detail makes us ask, where do we begin? A huge expanse lies open to us, instilling fear and anxiety. A number of things are taking place. On the one hand the ‘dizzying’ feeling infers that she is the first to feel the pain and symptoms of the illness, as a ‘first settler’ she must scope out and ‘stake out’ the topography of the landscape, so that she can provide a “mappable” list of symptoms.
On the other hand, her body is an undiscovered country, which must be territorialised by modern medicine. Arthur Frank explains that ‘Just as political and economic colonialism took over geographic areas, modernist medicine claimed the body of its patient as its territory, at least for the duration of the treatment’ (10). Medical treatment must begin with the initial medical encounter, of which she is both the object and the subject. She must speak as an ambassador for her own body, to communicate the inner landscape.
Of course, Bouvard is not alone in adopting the physical landscape to represent the interior state, but it is significant that she places cartographic images alongside permeable and amorphous aspects of nature. She presents images of unchanging and stable marking: ‘distances’, ‘dimensions’, ‘markers’, ‘structure’, ‘scale’, which suggest a solid framework around which to articulate the mutable experience of subjective illness. Yet, we might argue that these frameworks are not entirely solid, but rather subjective and adjustable. In fact they are movable markers, lacking specificity, for example exact units of measurement. The landscape of one’s own body is something that is familiar so surely we know what to expect of it, but to convey this becomes increasingly difficult. Perhaps Bouvard’s use of such, seemingly, stable features of measurement is an attempt at providing some lynchpin foundational concepts around which to construct a language and expression.
The overpowering loss of control is protracted by the perceived inability to articulate and therefore communicate the illness. She must find an individual language of pain and illness: ‘I must invent my own markers’, through a personal reading of her own body. The invention of these ‘markers’ demonstrates her awareness for the need to be responsible for demonstrating one’s pain, as well as solidifying the instinctual, human necessity to find ‘a way of describing’. Specifically, ‘markers’ suggests a physical sign. While mental illness is less likely to produce a physical ‘marker’, the demands of the body require a physical or material output. Bouvard adopts ‘marker’ as an externalisation of her inner landscape. This poem is the ‘marker’ she has invented for herself.
The fact that she ‘must invent’ such ‘markers’ is due in part to the failings and disappointments of medical encounters, which is especially evoked at the volta of the poem. The overall poem fits the traditional 14 line structure of the sonnet, including a volta, or turn, where the tone and message slightly changes key. It places significance with ‘And yet you…’, engaging directly with the disenchantment and frustration of expressing pain, and of making someone else see the pain. This is the only second person address in the poem, extending the content of both the poem and the illness experience outwards. The ‘you’ implicates us in the disillusion of invisible suffering. We ‘see a woman/like any other’, and ‘don’t see/ the landscape of illness’, because the pain, and the nature of mental illness is invisible. The symptoms are emblazoned on the inner landscape so cannot be witnessed. Crucially there are different levels of disenchantment; not just the medical institution, but with the frustration at conveying pain. It is not an outright criticism of the medical system, but a subtle critique of something far more pervasive: the ineffectiveness of language for pain, twinned with the problem of listening and understanding another’s pain.
The language of measurement, distances and sizes, etc. infuses the poem with images of quantification. In this poem Bouvard subtly employs the quantifying language of the physical world as a replacement for the non-existent language of bodily quantities. When we attempt to describe our symptoms, we measure our words carefully.
We must measure our words carefully; measuring in every sense of the word. We literally measure the amount of what we say. We must measure and quantify the level of pain, on a scale or comparison which can be communicable to others; medics, friends and family. Poetry, and any creativity through art and literature, allows for a reification of the unknown, abstract and unquantifiable symptoms of the inner, mental landscape. Art opens up a space for experimenting with the articulation of illness; of redrawing a map on the sufferers own terms, and of showing to others the inner landscape of illness and pain.
Marie Allitt is a second year PhD Candidate in English Literature at the University of York. Her thesis explores spatial representations in first-hand medical accounts and narratives in the First World War, from the perspectives of caregivers. This draws upon interdisciplinary ideas from Human Geography, History, Medical Humanities, as well as Literature.
She holds an MSc by Research from the University of Edinburgh, entitled ‘The Traumatised Body in Combat Narratives of the First World War’ (2014), and an MA(Hons) from the University of Glasgow, in English Literature (2013).
Marguerite Bouvard, ‘Landscape’, Articulations: The Body and Illness in Poetry ed. Jon Mukand (Iowa City: University of Iowa Press, 1994) 273
Arthur Frank, The Wounded Storyteller (Chicago: University of Chicago Press, 1995)
Gerard Manley Hopkins, ‘No worst, there is none. Pitched past pitch of grief’