In 1848, a tamping iron flew through the head of a railroad worker named Phineas Gage and changed the way his brain works. Described post accident by doctors and family as “no longer Gage,” he became a medical case study, used to show how damage to a specific area of the brain can affect personality traits. He also became an oddity, touring medical centers and museums, all the while experiencing mood shifts, headaches, and seizures. Still, he kept the tamping iron that altered him close, calling it his “constant companion.” In Shira Erlichman’s poem “Thirteen Ways of Looking at Phineas Gage,” from her debut collection Odes to Lithium, the speaker imagines Gage with the rod still in his head, reflecting her own experience with mental illness:
We’re old friends. Kissed once to test the waters, but found we liked talking and fighting better. Still, we lie in bed. It’s time to flip the record. In the static he drags a slow thumb across my forehead, “you’ve got your own pole,” he says like a fortuneteller, “two of them. High and low. Get it?” I don’t like clever men, but his hand lingers on my forehead, blessing.
The workings of the brain and the work of fixing it are through lines in Odes to Lithium, a twisted love letter to the drug that treats her bipolar disorder. As Erlichman chronicles life with her condition, interspersed with drawings and childhood photographs, she also explores the difficulties of representing her disorder to anyone outside of her brain. It might be easier if her mental state was a literal rod like the one that hit Gage, jutting out for all to witness. But then she’d also never be able to hide or pretend, as in “Thirteen Ways of Looking at Phineas Gage,” when the speaker’s mother looks at Phineas, the “silver saber impossibilizing itself through his head.” Her reaction is fear, seeing only the rod and not the person carrying it:
On the phone a week later she says to me, “You were always such a serious child. At ten, you couldn’t sleep. Then with everything that happened to you I suppose I always knew something like him would come.” I want to correct her, “someone like him,” but I don’t.
The difficulty of externalizing mental illness to family, friends, and doctors haunts Erlichman, and her poems, even as she examines her disorder up close. When doctors do appear, they are sometimes helpful, sometimes mistrusting of her ability to understand her condition. In “Snakes in Your Arms,” the collection’s opening poem, the speaker is told her physical tests came back normal, though she still feels little zaps under her skin. Rather than identify this as a symptom of mental illness, the doctor doubts her ability to understand reality. Of course she’s aware the zaps aren’t physically there, but she still feels them.
The sharpness of bipolar disorder appears again and again, cutting like knives and razors, an undeniable electricity under the skin. This destructiveness runs counter to the peace lithium promises—but even that peace has its side effects. In “Side Effects II,” the speaker lists memory loss, tremor, increased thirst, vertigo, and coma between functional moments at the movies or eating breakfast in the morning. The drug provides stability for her brain, but other parts of her body, and mind, will likely suffer. At the end of a laundry list of side effects, some of them permanent and life altering, the speaker affirms the future like a mantra, “I make a plan for tomorrow, I make a plan / for tomorrow, I make a plan for tomorrow.”
Planning for tomorrow, drawing a clear line from no disorder to disorder, is messy and unpredictable. For Erlichman, life before and after lithium is not easy to pinpoint. Instead, she creates a disordered sense of time in the collection. Moments of clarity on medication are followed by moments where her condition takes over, as in “Conversation with K.”, where the speaker goes from advising a mentally ill friend about treatment to experiencing a breakdown.
any of us / know / me especially / me / just weeks later / side of the tracks /
at a freight train / in the sharpened air / mindmouth / unable to
stop weeping / inconceivable speeds / no sleep / pushed a ghost
back with my palm / told it to get the fuck / away / the train screaming
back / I should have told her / this is how it happens: how it shouldn’t
Lithium, like her illness, is an ever present “you,” a pill that acts as a necessary friend, a constant companion who can’t be ignored or weaned off of. It pumps salt into Erlichman’s blood and steadies her mind, but it also makes her a lightweight at parties. It makes her feel cared for and enacts a sense of control, but at the price of life-altering side effects. In her odes to the drug, Erlichman’s speaker oscillates between gratitude for this “you” and discomfort around how much she depends on this “you” to function. “There Were Others” lists all the other drugs the speaker had taken before lithium and asks forgiveness for loyalty to those which helped and then stopped working. In “The Watchman,” lithium equals sanity but remains mysterious and omnipotent, leaving her asking, “who do you speak to in my body that listens.”
Often in these poems, the drug seems more alive and engaged than family members. The speaker’s mother and father are portrayed distant and unable to engage, loving but unequipped to provide like lithium does. The mother’s inability to communicate is articulated in “On This End,” scraps of letters between mother and daughter, formal and stilted, broken across the page. “Beatrice” conjures the speaker’s grandmother, watching her take a dose of medication. She links her mental illness with her grandmother’s undiagnosed condition, a possible lineage to her disorder.
I twist the see-through
orange bottle open, lay
the dose on the counter.
It is the day of rest.
But she has traveled
all these miles
to watch me swallow,
to pull a flower
from her skull &
weave it into mine.
Unlike Gage, Erlichman did not experience a freak accident that damaged a portion of her brain, and the causality of her illness ripples throughout the collection. This preoccupation with causality extends to what lithium does and continues to do, enacting sanity in exchange for control. The drug is essential, yes, but it also feeds on her to make her better. Maybe this is why it’s so important for Erlichman to remember “the brain broke itself,” rather than, “I broke the brain.” Like the self-immolating monk described in the closing poem, she knows her options are limited and seems to accept the drug might burn her up, in exchange for a kind of bliss.
There is something incredibly biting and honest about Erlichman’s portrayal of mental illness, where the pain of her disorder also reveals the beautiful mechanics of the brain. In “Portrait of a Release,” the speaker spends four days in a mental hospital, locked in with boredom and isolation, her family’s apologetic phone calls, her collisions with other patients that are and are not like her. It’s fall and the leaves are turning. For practice and to kill time, the speaker describes a cognitive behavioral exercise where you notice colors to try to reroute your brain from the emotional to the logical.
Red: leaves, stoplight,
jacket on a woman down the path,
red fleck of paint on my brown boots.
Orange is how headlights look when they’re turned off midday;
where are these cars going? To work? To family?
Orange is a tree shaking its arms like a bad dancer.
Orange is the sign advertising a new TV show,
one lost orange glove near the bus stop bench.
Yellow, slutty tree,
oh cerebellum, oh lithium, do your job.
In these moments, we are there with her, to witness the work of staying sane.