Delusions as to silver

Nuala Watt

Handwritten sources make it hard to pry.
Asylum records swivel: shit to silver.

Here’s when you were admitted, some of why:
The patient has delusions as to silver.

I liked the page illegible so I
could say I worked without disturbing silver.

Bodily health indifferent. Mind awry.
Certain that your hand was spurting silver.

Although my notes are pulped, my sessions by,
still, I also had a phase of silver.

I saw my notes and blanched. I would be shy
if all the future saw of me was silver.

No privacy in archives. Once you die
no protocol can ever staunch the silver.

Does poetry excuse me as a spy
if all it ever shows of you is silver?

Commentary

I am responding to the medical record of James Clydesdale, who was admitted to Glasgow Lunatic Asylum (now Gartnavel Royal) in 1883. I am finding this commission very challenging. I am troubled by the ethics of using others’ psychiatric records for creative projects. Do concerns about privacy apply to the dead, who cannot give consent? Once archived, are medical notes irredeemably public, though they may be about private matters? If the notes are handwritten, and therefore difficult to read, is it wrong to give them to a third party to decipher? Is reading such material prying? Is it better to remember and acknowledge these people and their experiences, difficult as they were? And is my reticence and confusion, which comes partly from my own psychiatric experience, linked to societal reticence about mental health? These concerns shaped the formal choices I made in my response.

It’s important to say that my psychiatric experience was very different from James Clydesdale’s. I was an outpatient in receipt of NHS psychotherapy for four years. The psychotherapy was for depression and PTSD. I am deeply grateful to the psychiatrist who provided it. James Clydesdale’s notes say that he ‘could give no account of himself’. My treatment was predicated on my giving a detailed account of aspects of my life. The psychiatrist facilitated my doing this. Respect for my narrative was central to the lengthy, difficult, circuitous process. I was approximately the same age as James Clydesdale, but otherwise my experience was almost completely different. This is especially true in terms of what happened to our respective notes.

It is not clear who wrote the notes I was given, but it seems to be a medical professional. We get a description of James Clydesdale’s behaviour and an assessment of his mental state but no first-hand account. I know that my psychotherapy helped me to move to the next stages of my life, but we do not know what happened to James Clydesdale. It is not clear whether he ever saw his own notes or had any input into what they contained.

In 2013, after we had been meeting for several years, my psychiatrist wrote a furious – and very useful – letter in response to an erroneous benefit assessment. Recognising that the material was sensitive – and that the benefit assessor had already misrepresented me – the doctor called me in to read her letter. I approved it, although I blanched when the secretary typed it up. I am sure that the secretary routinely typed up much more interesting material, but my history felt private. When it had to become public the doctor treated it and me with care and respect.

By contrast I was given the notes of somebody who could not approve what I did with them. Admittedly he will never know, but I blanched when a professional typed up my notes for a medically valid reason. How would he have responded to a random individual writing a poem about his?

Initially I had a digitised copy of handwritten notes. I needed help with reading this because the handwriting was difficult. My husband helped. I felt this was ethically awkward, because my husband was not formally involved in the project, but on the other hand, without his help I was stuck. We passed the computer between us and gave up halfway down the page. I asked for a typescript and could no longer dodge the content. I decided to focus on James Clydesdale’s belief that there was silver coming out of a small wound in his hand.

At first I thought I would write a sparse free verse poem that said as little as possible to reflect concerns around privacy. Then I realised that if I was ever going to respond I would need a poem with some formal constraints to set me going. The first lines I thought of were in rhyming iambic tetrameter. They sounded far too jaunty for the subject matter. So that would not do. Then I tried a poem with ghazal features.

A ghazal was originally an Arabic form that became prevalent in Persian poetry. It consists of between five and fifteen couplets. Each couplet is syntactically autonomous, which is helpful when you come to edit the poem. Each couplet ends on a repeating word, which is preceded by a rhyming word. In my case the rhyme trigger was ‘pry’ and the repeating word ‘silver’. In English the metre is often, but not always, iambic pentameter. Traditionally, the last couplet contains a name, often the poet’s. I have not included James Clydesdale’s or my own. Doing so would sit ill with my worries about privacy.

Equally, placing the patient’s ‘delusions as to silver’ front and centre is problematic. The silver is, for me, the most interesting feature of the notes. But it is only one episode in his life. It’s true that I had PTSD and it’s true that the experience that triggered that happened, but to focus on this exclusively distorts the narrative of my life. Choosing a form that emphasises a particular word draws attention to the power of poetry to shape and sometimes distort narrative by choosing some elements over others. I hope that this will raise questions about the ethics of using psychiatric notes for creative projects. Perhaps it is better to commemorate and acknowledge these difficult experiences. But I would be deeply unhappy if all that was known about me was my psychiatric treatment in my 20s, vital as that was. When I was agonising about this a friend quoted a Polish archaeologist who said that ‘the dead wish to be acknowledged’. But how, and how do we acknowledge the deeply unequal power relations that acknowledgement involves?

[Patient record for James Clydesdale, HB13/5/63]