When he was taking lithium, Lowell was rarely overtly manic but on occasion mildly to moderately so. During those periods his mind was a simmering, mixed state of moods and thoughts, one that threw out more ideas and generated more poetry. Esther Brooks described his mood during this period as often being one of “muted euphoria,” which is consistent with what is known about elated mood states driving productivity and creativity, as we shall see later. It is possible that the lithium capped his mania well enough to allow him to write with some of the productive advantage of mild mania.
“He had a massive drive to write,” Helen Vendler observed. “Perhaps one of the consequences of having his extreme ups and downs was his interesting pendulum-swings between counted and free-verse, in both of which he could be masterful. I think one unfortunate result of his initially exhilarating freedom from hospitalization after he was put on lithium was the unrelenting drive—once he had started on his blank-verse sonnets in Notebook 1967–68—to continue in that form.” Ian Hamilton suggested that Lowell’s post-lithium writing was “different from the more pointed articulation of the earlier books; his poetic intelligence is on the rampage, swooping into all kinds of biblical, classical, and historical sources for analogies and omens, and deliberately shunning the old, orchestral melodiousness.”
There is not much known about lithium’s specific impact on productivity and creativity. Two small studies during the 1970s found that three-quarters of artists and writers reported an increase in productivity, or no change, while on lithium. A study of the impact of short-term lithium use on creativity in normal individuals found no effect. Other studies of patients with bipolar illness, however, found that measures of creativity increased as the level of lithium decreased. All of these investigations have been problematic; they studied only a small number of individuals, the patients had different durations and severities of illness, and they varied in their blood levels of lithium. None of the studies looked at the effects of altering dose or discontinuing lithium in writers or artists.
Lithium gave Lowell a relative mental stability that led to greater productivity; this may or may not have come at the expense of originality. Although many, but by no means all, critics believe that Lowell’s work declined during the last decade of his life, which was when he was being treated with lithium, it is as likely that his progressing illness would have taken a far greater toll on his work had he not been taking the drug. Lithium’s well-established efficacy in preventing the recurrence of illness resulted in Lowell spending less time in the hospital, less time ill with mania and depression. The accumulating evidence that lithium has neuroprotective and neurogenerative effects on the brain suggests that lithium may have decreased some of Lowell’s vulnerability to an otherwise progressive, neurodamaging disease.
In May 1975, during a trip to New York, Lowell suffered from lithium toxicity and had to be hospitalized. During lunch with his editor, Robert Giroux, Lowell’s head fell forward onto the table and he appeared heavily sedated. Robert Silvers, a friend and the editor of the New York Review of Books, described what happened some time later that evening: “We’d all been to the opera, and at the restaurant afterwards Cal seemed in terrible shape—exhausted, excited, incoherent. He slumped at the table drinking glass after glass of orange juice.” The next day in the hospital, “he talked in a wandering way about Alexander the Great—how Philip of Macedon had been a canny politician but Alexander had been able to cut through Asia.” Lowell was treated for lithium intoxication and possible delirium at Mount Sinai Hospital; the experience left him and his friends shaken.
Some of Lowell’s medical difficulties stemmed from his being treated by different doctors in different cities, including Boston, New York, and London. Dr. Curtis Prout, one of Lowell’s Boston doctors, wrote to him on May 13, 1975. “A week ago, you called me because you were feeling lethargic and sleepy. You felt unwell and thought, perhaps, you needed to take more Lithium to prevent a manic attack.” Lowell, he said, appeared to have increased his lithium from five tablets a day to eight and his lithium blood level was 1.5 milliequivalents per liter (mEq/L), which is in the toxic range. Dr. Prout continued, “Because I was overly concerned with the overdose, I overestimated the time it would take to reduce the Lithium in your blood.” This, he explained, had resulted in too low a blood level, 0.2 mEq/L, well below the therapeutic level. The toxicity and the lowering of his lithium level almost certainly played a role in Lowell’s subsequent unstable psychiatric course. If lithium is sharply decreased or stopped, it can be difficult to restabilize the illness and recapture the previous effectiveness of the drug. Mania often comes back quickly after lithium has been discontinued, and the risk of suicide increases. These things are better understood now than they were forty years ago.
From the time Lowell started taking lithium in early 1967 until his lithium toxicity in May 1975, he was hospitalized for mania only once, briefly, in 1970. After 1975 his moods were unstable and, by many accounts, he was fitful in taking his lithium. His manic attacks returned with a vengeance and he had to be admitted to the hospital several times in 1975 and 1976. In January 1976 Hardwick wrote to Mary McCarthy, “I suppose it is back to the lithium. It is a lifeline, but somehow we are all depressed about it.” He was taking lithium at the time he was hospitalized for heart failure at Massachusetts General Hospital in January 1977.
Lowell died in September 1977; it is not clear what would have happened to his manic illness had he lived. What we do know is that lithium worked well for him, if problematically, for nearly ten years. He gained hope and relative stability from it. “Of all our conversations,” Robert Giroux wrote after Lowell died, “I remember most vividly Cal’s words about the new drug, lithium carbonate, which had such good results and gave him reason to believe he was cured: ‘It’s terrible, Bob, to think that all I’ve suffered, and all the suffering I’ve caused, might have arisen from the lack of a little salt in my brain.’ ”
Lowell had the advantage of good doctors, a good salt, and caring friends and family. But it was to his writing he turned for healing. Writing could restring the beads, mend the rent. It would require and provide the discipline and excitement of creating poetry, and it would give some solace, albeit limited, once the madness returned.
I am at the end of something. Up till now I’ve felt I was all blue spots and blotches inside, more than I could bear really, if I looked at myself, and of course I wanted to do nothing else. So day after day, I wrote….I look back on the last months with disgust and gratitude. Disgust because they seem so monstrous, gratitude, because I have lived through the unintelligible, have written against collapse and come out more or less healed.
—LETTER TO ELIZABETH BISHOP, 1963
“I have a formidable new doctor,” Lowell wrote to Bishop in 1965. “Maybe I’ll get well, this doctor is the first I’ve had who is really much like an artist, though it took several days for us to speak a language intelligible to the other.” The doctor, Kurt Eissler, a psychoanalyst who emigrated from Vienna to the United States in 1938 to escape Hitler, was the author of twelve books and the director of the Sigmund Freud Archives. In his two-volume study of Goethe, Eissler concluded his examination of the relationship between psychosis and artistic creativity by quoting Heinrich Heine:
Sickness, methinks, has been the final cause
Of the whole urge to create;
By creating was I able to recover
By creating I became well.
Lowell agreed with Heine, to a point. He wrote because he was a poet, not because he was ill. But, like other writers, Lowell described the solace he found in his work and the meaning it gave to him when he was depressed. Writing could keep black moods at bay; it could allow escape from pain, give purpose. It could heal. “Sometimes nothing is so solid to me as writing,” Lowell wrote to Elizabeth Bishop when he was thirty-one years old. “I suppose that’s what vocation means—at times a torment, a bad conscience, but all in all, purpose and direction.” “
If I don’t write I am a blank,” he told Hannah Arendt twenty years later. This is a view reminiscent of Virginia Woolf. “Directly I am not working, or see the end in sight,” she wrote in her diary, “nothingness begins.” She kept afloat by writing: “Directly I stop working I feel that I am sinking down, down.”
Repeated attacks of mania left deep scars on both Lowell and Woolf. Time helped them to heal, but work helped more. “For the last four months I have been writing every day,” Lowell wrote to his cousin shortly after being released from a hospital. “It seemed the best way to live through the slump that usually follows my attacks….Now that I begin to look back, I feel as though I had been wrestling with some giant, and I say to myself, ‘you’ve somehow survived.’ ” Many writers have expressed their indebtedness to writing. “I fight depression by work,” wrote the Orkney poet George Mackay Brown. After countering darkness with new poems, he said, “I inflicted 2 bright wounds on the dragon by writing.” Isak Dinesen, the author of Out of Africa and someone subject to debilitating depressions, said that art could bind the wounds of the mind: “All sorrows can be borne if you put them into a story or tell a story about them.”
The Antarctic explorer Apsley Cherry-Garrard, a writer subject to paralyzing and, on occasion, psychotic depression, observed, “To go through a terrible time of mental and physical stress and to write it down as honestly as possible is a good way of getting some of it off your nerves. I write from personal experience.” His friend, T. E. Lawrence, likewise subject to depression, had written his masterpiece Seven Pillars of Wisdom in the midst of “morbid self-introspection and distortions and weaknesses and fears.” The fights he had with himself “were worse than anything he had with the Turks abroad, or the Foreign Office at home.” He won relief to his “tortured mind” through writing, self-discipline, and self-forgetfulness, maintained Cherry-Garrard. Writing, as Lowell would put it, takes the ache away.
Writing imposes order and demands discipline. To draw down pain through meter and discipline is to tame grief, wrote John Donne:
Then as th’earth’s inward narrow crooked lanes
Do purge sea water’s fretful salt away,
I thought, if I could draw my pains
Through rhyme’s vexation, I should them allay.
Grief brought to numbers cannot be so fierce,
For, he tames it, that fetters it in verse.
Writing also compels mental concentration. “Dejection of spirits,” wrote the poet William Cowper in 1795, “which, I suppose, may have prevented many a man from becoming an author, made me one. I find constant employment necessary….Manual occupations do not engage the mind sufficiently, as I know by experience, having tried many. But composition, especially of verse, absorbs it wholly.”
Lowell expressed a similar view a century later. “Writing,” he said, had been his “indissoluble bride for forty years”:
Working, I sit groping,
monomaniacal,
jealous of even a shadow’s intrusion,
a nettle
impossible to divert, deflect.
“Writing fell to me like a life-preserver,” Lowell told his psychiatrist. It gave him a place to channel his excitable blood, to exert control, mount a defense against the world without, and the world within. “At last I could dominate, despise, say nothing mattered except the great works of art. I think I really cared for these, but I enjoyed using them as a battering-ram against everything and everybody who puzzled me or seemed indifferent or critical.” Writing was two edged, cutting even as it gave life:
The onionskin typing paper I bought by mistake
in Bucksport Maine last August? The last sheet
creasing cuts my finger and seems to scream
as if Fortuna bled in the white wood
and felt the bloody gash that brought me life.
Tennyson argued that the exercise and discipline of poetry offered relief from despair. “But, for the unquiet heart and brain,” he wrote in In Memoriam, “A use in measured language lies; / The sad mechanic exercise, / Like dull narcotics, numbing pain.” Structure and purpose are required for art, but it is the gift of art to provide structure, purpose, and escape. “No one has ever written, painted, sculpted, modeled, built, or invented except literally to get out of hell,” declared the French playwright and poet Antonin Artaud. The novelist Graham Greene concurred: “Sometimes I wonder how all those who do not write, compose, or paint can manage to escape the madness, the melancholia, the panic fear which is inherent in the human situation.” In Lowell’s 1973 appointment book, which is filled with fragments and sketches of poems, there is a single line written for February 19: “The cheer of writing that cures no physical hurt.”
Transformation can heal and art can transform. There is a connection, Lowell believed, between how the world is and what the imagination comes to rest upon, what it works to transform. “What it usually lights on now is some grueling murk or release at all costs. Well, why not? It has always been so. Nothing could be more terrible than Lear and the Oresteia, both of which I have been reading. And there is no more harmless way for the elemental and black to come out than in words, paint and notes, where nothing ever can be hurt.”
Excerpt from 1973 notebook
“The cheer of writing that cures no physical hurt.” Credit 25
Lowell wrote, “I think I am escaping my destiny by writing, much, much too much my habit and even now inescapable,” he observed to a friend. “At least it was absorbing. Often three or four hours would go by before I looked up, and saw low tide changed to high.” Ten years later, not long before he died, he wrote in like vein to another friend. Writing salves, he said. The ambition of art gives glory, exhausts, and frays. It saves. He offered the consolation of writing, and the reality of its limits, to the poet Frank Bidart:
I gather from your phone calls the summer has had some very hard moments for you. It’s miraculous, as you told me about yourself, how often writing takes the ache away, takes time away. You start in the morning, and look up to see the windows darkening. I’m sure anything done steadily, obsessively, eyes closed to everything besides the page, the spot of garden…makes returning a jolt. The world you’ve been saved from grasps you roughly. Even sleep and dreams do this. I have no answer. I think the ambition of art, the feeding on one’s soul, memory, mind etc. gives a mixture of glory and exhaustion. I think in the end, there is no end, the thread frays rather than is cut, or if it is cut suddenly, it usually hurtingly frays before being cut. No perfected end, but a lot of meat and drink along the way.
Hydrotherapy room, Payne Whitney Clinic
“Why don’t I die, die?” Credit 26
In a poem published a few months later, Lowell put forward the question at the heart of it all: the ambition of art, the tending of the soul, the healing of the mind. “Is getting well ever an art,” he asked, “or art a way to get well?”
In September 1954, after a four-month hospital stay in the Payne Whitney Clinic, Robert Lowell went home to Boston. Within weeks he began work on an autobiography, in part at the suggestion of his psychiatrist, Dr. Vernon Williams, who believed that writing down his early memories would help him piece together and make sense of his childhood. There were other reasons. Lowell was finding it difficult to write poetry, and both he and Hardwick had come to believe, as had his mother ten years earlier, that writing prose was less likely than writing poetry to set off the kind of excited state, the enthusiasm, that led to mania. (The relationship between writing and mania was more complicated than this. Lowell was also more likely to write poetry when he started to become manic.) The border between enthusiasm and mania was permeable for Lowell; he crossed it with abandon. The words “enthusiasm” and “pathological enthusiasm” held heavier meaning for Lowell than for most; they were words he often used to describe his manic attacks.
Lowell dredged his memory in the belief that it would lead him somewhere he wanted to go. It did, but not without frustration. Prose was more difficul
t than he had imagined. “I’ve just started messing around with my autobiographical monster,” he wrote to John Berryman in October 1954. “Prose is hell. I want to change every two words, but while I toy with revisions, the subject stinks like a dead whale and lies in the mud of the mind’s bottom.” He found it difficult to keep from veering into “intolerable poetic darknesses.” To Flannery O’Connor, whom he regarded as a master of prose, he lamented, “I find it hard to be neither sugary nor acid; and Oh the effort to keep one’s eyes open and see what one describes!” His struggle between poetic and prose expression did not go away. He wrote to Elizabeth Bishop years later, “How different prose is; sometimes the two mediums refuse to say the same things.” Without verse, he said, and without philosophy, “I found it hard, I was naked without my line-ends.”
Lowell’s criticism of his prose was misplaced; “91 Revere Street,” “New England and Further,” and “Near the Unbalanced Aquarium” are remarkable works. If they were fitfully created—drafted, redrafted, and revised yet again—then so too was his poetry. His writing came first from the creating, then from revising, chiseling; from reworking shards that he set together, ripped apart, rearranged, reimagined, and changed, at times beyond recognition.
“Near the Unbalanced Aquarium,” an account of Lowell’s 1954 stay in Payne Whitney, is an unmatched portrayal of madness and life on a psychiatric ward. Threaded through his recollections of mania are memories of his childhood and descriptions of his parents, many of which he took later into the poems and prose of Life Studies. Even the title of his essay was unsettled: in the first six drafts the title object was a “balanced” aquarium; by the final version, published after his death and considerably altered in content and style from the drafts, it had shifted to “unbalanced.” Lowell liked the aquarium metaphor. Five years earlier, during his first stay in Payne Whitney, he had likened psychotherapy to “stirring up the bottom of an aquarium.” The ward’s aquarium, Lowell wrote, was “a huge affair with snails, sanitary plants, little fish with seven tails, midget sunfish and midget silver tarpon.” The day nurse complained that none of the other nurses “understood ‘balance’ but were always casting breadcrumbs and dead flies on the waters, so that the fish and snails didn’t know whether they were coming or going. I made my worn-out joke about the aquarium being a sanitarium within a sanitarium, ‘only I’m not on display.’ ”
Robert Lowell, Setting the River on Fire: A Study of Genius, Mania, and Character Page 22