Poetry for PTSD and Preventing Suicide

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Q&A

June is Posttraumatic Stress Disorder (PTSD) Awareness Month. One psychiatrist is dedicating a portion of the proceeds from his new book, Poetry Rx, to the David Lynch Foundation (DLF)—specifically the Resilient Warrior program—in the hopes of curbing US military veteran suicides.

In this Q&A, we speak with author of Poetry Rx, Norman E. Rosenthal, MD. Dr Rosenthal is a world-renowned psychiatrist and researcher, most widely known for defining seasonal affective disorder (SAD) and pioneering the use of light therapy as treatment.

Psychiatric Times (PT): Tell us about your book Poetry Rx and what inspired you to address PTSD in veterans in this way.

Rosenthal: Over my years as a psychiatrist and long-time poetry lover, it has become increasingly clear to me that poems can heal, inspire, and bring joy to our lives. Some time ago it occurred to me that this is our goal as psychotherapists, doctors, and healers. Over time I accumulated many poems that have this potential. Finally, I felt I had a way of organizing these poems so that they could deliver on the therapeutic promise of poetry.

PT: Your book features a poem by Russian poet Anna Akhmatova. Why did you choose this particular piece? How does is speak to the overall meaning of your work? Is there a particular poem that stands out to you as the most important?

Rosenthal: I first encountered this poem in the web-based Favorite Poem Project, a brainchild of former poet laureate Robert Pinsky. “The Sentence” by Anna Akhmatova was chosen by Georgia Tech professor of cognitive science, Nancy Nersessian, PhD, in memory of her brother, who was a Vietnam veteran traumatized by his wartime experiences. The second stanza of Akhmatova’s poem goes as follows:

“Today I have so much to do;

I must kill memory once and for all,

I must turn my soul to stone,

I must learn to live again—”

Dr Nersessian, whom I interviewed for the book, wondered whether it would have been helpful to her brother to kill the memories of the war that haunted him. In Akhmatova’s poem, we see that this was not a helpful strategy for her. As I discuss after presenting the poem, the intrusive memories of PTSD are often treated by encouraging those who suffer to actively think about their traumatic memories in ways that decondition their painful responses.

In “The Sentence” we also see an excellent depiction of dissociation, which is valuable for individuals suffering from PTSD to understand. It is easier for clinicians to focus on the dramatic symptoms of PTSD like nightmares and flashbacks and to overlook the emotional costs of shutting down one’s emotional dealings with others, which can severely impoverish the life of the individual with PTSD.

Another poem in the book also highlights the problem of PTSD: “We real cool” by Gwendolyn Brooks, in which the poet describes 7 young men in a pool hall. Brooks describes them as lurking late and thinning gin, amongst other behaviors that suggest young men looking for trouble. The last line of this short verse packs a powerful punch: “We die soon.” That poem was brought to my attention by John, a young man in Boston, who was suffering from PTSD after hearing about a violent attack on a close relative. To numb the painful symptoms of PTSD, John started drinking too much, taking substances, and filling his hours with fantasies of revenge. An English teacher saw he was having problems and suggested he try reading and writing poetry. John came across “We real cool” and was impressed by how it described the rapid cascade by which young men can fall into trouble and end up dead. He is now in recovery and credits poetry in general, and “We real cool” in particular, with saving his life.

PT: What impact do you believe poetry has on mental health?

Rosenthal: Mental health involves having the skills to navigate all phases of life. Poetry Rx is organized into categories that engage different challenges that we encounter along life’s hopefully long journey. From loving and losing (the first section), to aging and dying (the fifth and last section), the book provides poems that offer specific comfort and advice at all stages. In between these 2 bookends are 3 other sections: 1. Responses to nature; 2. Aspects of the human experience; and 3. A design for living and the search for meaning. After each poem I provide a short essay, which basically discusses what the poem is all about, followed by several specific take-away lessons, ending with a short bio sketch of the poet that illustrates the connection between poet and poem. Individually, the poems offer specific guidelines on specific issues. Collectively, the anthology provides a guide to living a good life and enjoying poetry along the way.

PT: Is creative writing an outlet for you? How has it personally helped your mental health?

Rosenthal: Creative writing has been terribly important to me. There is great joy in being able to say things in exactly the way you want to and have it come out as beautifully as possible. An even greater joy is to touch the reader in a meaningful way by offering descriptions, ideas, and insights that stimulate, comfort, enlighten, delight, or all of the above. I get pleasure and fulfillment in writing and in the response of my readers. During the pandemic when there was so much isolation and deprivation, not to mention fear and loss, the poems themselves and writing about them were a great boon. Here is how I describe the effects they had on me in the closing remarks of my book:

As I think about the poems in this book, what I have learned from them, and how they might help people, certain images come to mind. At times the poems have seemed to me like precious stones, refracting the ambient light and filling the room with color. At other times, they have been like lamps, illuminating the dark caverns of the mind, revealing new ways to understand old mysteries. Beyond these images of delight, however, the poems have felt like medicine or balm, and their poets like healers, speaking to us across the ages. It has been an honor to interpret these great works through the lens of one who has spent my career trying to understand and heal the troubled mind, and help people reach the outer bounds of their potential. I believe that these poems have the power to heal, transform and enliven. Perhaps some of them have done so to you. If not, I hope they have at least offered a brief reprieve from an all-too-often troubled world.

PT: A percentage of proceeds of your book go to the David Lynch Foundation’s Resilient Warrior program. Can you tell us about the program and what it means to you?

Rosenthal: The David Lynch Foundation is devoted to teaching Transcendental Meditation (TM) to groups of individuals who cannot afford to pay for their own tuition. One such target group consists of veterans with PTSD, of whom an estimated 21 commit suicide every day. Even those who do not meet such a tragic end nevertheless suffer badly.

At one point in my career, when I was CEO of a clinical trials organization, I used a small grant to do a pilot study on the effects of TM on veterans with PTSD and was impressed at the powerful benefits they experienced. Later, I collaborated on a large (210 subject) controlled study of veterans at the San Diego VA, which found that TM was as effective as a standard therapeutic treatment and superior to an active control. These experiences have led me to believe that providing free TM tuition to veterans with PTSD is an excellent way for me to allocate the funds I set aside for charitable donations.

PT: You’re known for your work on the development of light therapy for seasonal affective disorder (SAD). Do you consider yourself more research-oriented or creative-minded?

That seems to me like a misleading dichotomy. I think that a good researcher must be creative-minded, has to put together unexpected pieces of data, chase up hypotheses that seem most likely to yield fruit, assemble a team creatively, and analyze the data creatively. In other words, the best research involves a great deal of creativity at multiple levels. But not all creativity uses the scientific method. Literature, music, and art are creative without using formal scientific methods, such as controlled studies. I always remind myself that our research on SAD began with 1 patient who reported seasonal variations in depression that he hypothesized were driven by changes in environmental light. That led me to think of my own winter lows after immigrating to North America, which I had never suffered in South Africa, my sun-filled native country. We did not leave matters at the anecdotal level, however, and went on to do the scientific work necessary to defining the syndrome of SAD and exploring the beneficial effects of light therapy in its treatment. We collected a large number of individuals who complained of winter depressions, defined the syndrome of SAD, and designed controlled light therapy and other studies exploring which aspects of light therapy were important and how bright light affected the psychobiology of our patients.

My current project, Poetry Rx, describes a hypothesis that is still at the anecdotal level, based on the subjective experiences of individuals both in sickness and in health. Once again—as with seasonal changes—I have experienced these beneficial effects myself and seen them in my patients, with various poems having specific effects. These observations do not readily lend themselves to the scientific method, so I thought that before such methods are developed, I will share them at the anecdotal level in the hope that they will prove helpful and enjoyable to readers. At this stage, you might consider it more creative-minded than research-oriented.

To answer your question, I enjoy moving fluidly between these different ways of thinking.

PT: What recommendations do you have for doctors who are treating veterans with PTSD?

Rosenthal: There are many established treatments for PTSD. Some involve exposure to the traumatic triggers, either directly (as in Prolonged Exposure), or in the context of a cognitive approach (Cognitive Processing Therapy), or eye movement desensitization and reprocessing. Other approaches do not employ exposure-based techniques, such as interpersonal psychotherapy or TM. I would like to think that someday poetry will also be employed to help patients with PTSD as an ancillary treatment.

PT: June is PTSD awareness month. In your experience, what’s the most important thing for practicing clinicians to know about veterans with PTSD?

Rosenthal: Please be aware how much they suffer. Many of these veterans are not used to talking about their feelings. They feel ashamed about their symptoms, which they often perceive as weakness. They need encouragement and support. It is useful for PTSD patients to associate with other veterans with PTSD, who have undergone therapy for the condition and experienced the rewards. 

PT: Besides the Resilient Warrior Program, are there any other veteran resources you’d recommend?

Rosenthal: Here are some important resources:

-Military One Source. www.militaryonesource.com. 1-800-342-9647

-National Center for Post Traumatic Stress Disorder. https://www.ptsd.va.gov/

-PTSD United. www.ptsdunited.org

-Suicide Prevention Action Network. www.spanusa.org and www.suicidepreventionlifeline.org

-National Alliance on Mental Illness (NAMI) www.nami.org/veterans