Bibliotherapy in a Patients' Library

Bibliotherapy in a Patients' Library*BY DAVID J. MCDOWELL, Patients' Librarian

McLean HospitalBelmont, Massachusetts

ABSTRACTThis paper describes the involvement of patients

in the Patients' Library at McLean Hospital, andthe relationship between them and the librarian inlibrary activities. The publication of a patients'magazine is discussed, with case histories of per-sons who had taken part in its production. ThePatients' Librarian has a personal role in patienttherapy, and accounts are given of various activitiessuch as play-reading, poetry-reading, and the dis-cussion of poems by established writers, with thera-peutic aims in view. Actual clinical experiences aregiven.

FIRST, I want to share with you some waysthe library and librarian can make a therapeuticcontribution to a mental hospital. Then, morenarrowly, I shall discuss bibliotherapy theoreti-cally. poetry therapy as I have approached it,and outline formats using other genres that Ihave found useful in a psychiatric milieu.

Let me expose my background and prej-udices. I hold a B.A. in Religion, but studiedcreative writing for four semesters and wrote anovel for my thesis. I studied more literaturethan religion, more religion than psychology,and no library science. For a year and a halfbefore becoming Patient Librarian at McLeanHospital, I taught physical education in gradesone. two, and three; religion in six, seven, andeleven: and English in ten and twelve.

That background implies much about howthe patient librarian is expected to function atMcLean. Obviously, a professional librarianwas not sought. Rather, something already akinto a bibliotherapist was in the minds of thoseresponsible for my hiring, though the terms"bibliotherapy" and "bibliotherapist" werenever used in description of my role. Signifi-cantlv, my predecessor had held an M.A. inEnglish but had no library training.McLean practices milieu treatment, in which* Presented at a meeting of the New England

Library Association on October 8, 1970.

the whole range of a patient's hospital experi-ence, from ward life to work programs to in-formal and recreational activities, is seen as ad-junctive therapy. That philosophy, the li-brarian's position in the Activity Therapies De-partment, and my qualifications point to an im-portant preconception to which I will return:that the therapeutic use of a patients' librarywas not seen to be dependent on the profes-sional training of the librarian.

In my application to the hospital, I quotedRollo May:

Many of us made the odd discovery inthose college days that we learned a gooddeal more about psychology-that is, manand his experience-from our literaturecourses than we did from our psychology it-self. The reason, of course, was that literaturecould not avoid dealing with symbols andmyths as the quintessential forms of man's ex-pression and interpretation of himself and hisexperience. (1)

That statement still reflects my attitude towardthe use of literature with psychiatric patients.But let us turn first to a variety of other func-tions best suited to the patient librarian.The McLean Patient Library employs eight

to twelve patients through the rehabilitationwork program. Employees work three to fifteenhours a week, staffing the library from nine tofive weekdays and twelve to four on weekends.I meet with patient librarians individually asneeded but at least once a month, and lead aweekly Library Group of all patient employees.That group deals with two concerns: first, li-brary policy and procedure; second, issues aris-ing from the job. The group decides what sub-scriptions and books the library will order,determines the fines for overdue books (thoughno fines system is in operation now), and is thearbiter for all operational issues. Its responsibil-ity is real and direct. At least as important, how-

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ever, are the group's discussions of work-relatedissues and problems. While individual pathologydiffers, certain issues arise regularly in variousforms as the group's membership changes. Ego-strength, self-image, authority relations, em-ployment expectations, socialization ability, andattitudes toward responsibility are important re-current themes.

Patient workers shoulder as much real re-sponsibility as possible without debilitatinganxiety, and perform according to the sort ofexpectations that might reasonably obtain in acommunity library. During their hours of duty,librarians must maintain the area neatly, checkin returned books and place them in the stacks,check out books, assist patrons in finding thematerial they seek, send overdue notices, billpatrons for lost books, maintain the periodicalrack and check in new issues, and respond totelephone inquiries from patients restricted totheir wards. In addition, patient librarians mayundertake long-term projects, such as mainten-ance of the card catalog, inventories, orreading current reviews in subject fields of theirinterest with a view toward recommending titlesfor purchase to the Library Group. Employeesare supervised and evaluated by me in consulta-tion with one of four rehabilitation counselors(who are the source of referrals for employ-ment), and followed closely by the psychiatricstaff. Communication among members of thetreatment team occurs in several ways: first, Iwrite monthly evaluations for each patient withspecial reference to our relationship, his per-ception of himself in the work situation, perti-nent pathology or functional blocks, and overallperformance. Second, I attend biweekly meet-ings between members of my department andeach ward's staff, at which questions about spe-cific patients are raised and discussed. Finally,I attend treatment reviews for those patientsworking in the library. In whatever form, com-munication is essential to the concept of milieutreatment, and is a cardinal responsibility of thelibrarian.

Clearly, the librarian's role is fluid regardingthe rehabilitation work program. He is super-visor, advisor, group leader, interpreter, moni-tor of individual and group progress, and mem-ber of a specialized psychiatric team. The ob-vious and crucial observation that must be re-membered throughout these remarks is that his

relations to persons and groups, and the easeand sincerity with which he can not only ex-press concern but translate that concern to help-ful insight, anxiety reduction, realistic expecta-tion, development of competence, and trust, arethe criteria for therapeutic success.

I promised to refer again to my qualificationsbecause my greatest difficulty in the Patients'Library has been teaching library procedure topatients. On the other hand, my dearth of pro-fessional training is an incalculable asset inpreventing me from devoting my energies toclerical and routine work. Margaret Hannigansuggests that adequate performance as a biblio-therapist "may demand streamlining or evenabandoning some routines presently performedby the librarian. It certainly requires shiftingmore duties to volunteers until additional staffcan be added" (2). Although patients executemost library duties, I have lacked confidence inmy ability to teach clearly and transmit realisticexpectations. The problem will be met in one oftwo ways. The first might be the acquisition of atrained librarian as a volunteer consultant,spending five to ten hours a week in the libraryas a teacher and generator of work projects. I(or the bibliotherapist) would continue to super-vise patients' employment but would delegateteaching and work organization to a person withlibrary training. More difficult to establish butmore rewarding in other ways would be a pro-gram established with nearby graduate schoolsin which the patients' library would serve as apracticum in therapeutic applications of libraryscience for students seeking to relate their pro-fessional training to the psychiatric field. Mc-Lean has long been a teaching hospital; thereseems considerable value both for the hospitaland for the future of bibliotherapy in a pro-gram, perhaps for credit, whereby library sci-ence students would spend several hours a weekworking with patients under the bibliotherapist'ssupervision.

Another responsibility of the librarian is asadvisor to the Mirror, the patient-written and-edited magazine. When I arrived at McLeanthe magazine had been dormant for nearly amonth for two related reasons. The previous li-brarian had left the hospital weeks before Iarrived, leaving a vacuum easily personalized toabandonment. Moreover, even before my prede-cessor's loss, the Mirror had endured largely

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because of the efforts of a very small group ofpatients, sometimes only one or two. I felt theregular production of the magazine demanded alarger group of invested patients, and postulatedan added therapeutic effect if the group couldbecome relatively self-sufficient and integratedaround a task-orientation. Again, sensitivitiesand skills in groups would be important for thelibrarian.The Mirror has functioned now for half a

year with an editorial board of six to ten pa-tients, a population, like that of the LibraryGroup, always in flux due to admissions and dis-charges. The editors perpetually seek new formsand expressions, though the magazine remainsprimarily literary and poetic in content. A typi-cal issue might be twenty-four pages long, in-clude five to ten poems, a bridge column, a con-tinuing novel in installments, perhaps a moviereview or other article of current interest, oneor two short stories, three to six illustrations in-cluding cover and endpiece, and a statement ofeditorial policy soliciting new material, pro-voking controversy, or thanking those whohelped produce the previous issue. The editorialboard meets once a week for an hour and a half,but frequently schedules another meetingwhen the volume of submission warrants. Dur-ing production weeks each member will devotebetween five and ten hours typing stencils,mimeographing, and collating. The magazine ispublished approximately every three weeks.My role in the group's task orientation is

explicitly that of advisor, though in times ofcrisis or transition I am frequently cast as leaderor therapist by the group. Because of our con-text, a certain ambiguity surrounds our raisond'etre. "Are we a task group or a therapygroup?" is a frequent question, direct or other-wise, and its being asked is always a hint that ifwe aren't we should be the latter. Two examplesmay illustrate situations in which therapeuticconcerns supersede magazine business.Some months ago when three new editors had

joined the board, the discharge plans of theeditor-in-chief provoked several levels of con-flict. His leaving was unsettling to us all becausehe had exercised a pleasant, nonauthoritative,consensual leadership from the board's incep-tion. When it became clear that I would not ac-cept designation as task leader or intervene sub-stantially in the selection of a new one, anxietyrose as another experienced editor, a young

woman of considerable intelligence and erudi-tion, gradually asserted herself. This patient wasa hysteric with feelings of ambivalence towardothers and a system of intellectual defenses torepel the closeness with others she desired butfeared. Her fragility and imposing intellectualitywere seen by the other patients as reasons sheshould not be the editor-in-chief, a sentimentshe took as an attack and interpreted as a totalrejection of her as a person. Clearly magazineproduction was secondary to dealing with theinterpersonal crisis. That was accomplished in aseries of four meetings over the next two weeks,in which the group gradually perceived theyoung woman's affect as her expression of agenuine terror of others, an understanding facili-tated by the remaining presence of the oldereditor-in-chief. The young woman learned dur-ing this period that she was safe with the group,that others could care genuinely for her, andthat her own approach to others was often thereason for their distaste. She is now functioningas task-leader without a ruffled feather, clearlybeing the logical choice for editor-in-chief.

Another time, a new editor related to thegroup exclusively by controlling discussionsthrough submitting a plethora of his own ratheraccomplished fiction and poetry. It became evi-dent that the next three or more issues couldeasily be devoted entirely to, and that our dis-cussions were effectively dominated by, hiswork. His pathology included a narcissisticcharacter, developed in answer to feelings ofworthlessness generated by rigid parental ex-pectations and punishment. Issues of inde-pendence were thus most important to him, andhe expressed his needs for a satisfactory self-image by controlling the group through hiswriting, the one thing he felt he did well andfor himself. His behavior was confronted firstby the group's setting limits on the percentageof an issue his material could form. This re-sponse provoked both hurt and thanks, anatmosphere in which it was then possible to dis-cuss over several meetings the causes for hisuse of the group and his potential for convertinghis needs and assets into a more realistic andfulfilling mode. In both these situations, thenecessary response of the patient librarian wasto act as the sort of catalytic, supportive, andinterpretive agent consistent with the grouptherapy model.The Mirror as an example of a patient ac-

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tivity wholly executed by patients highlightsthe need for a structural orientation to reality.While the hospital setting demands an abilityto convert task-orientation to therapy wheninter- or intra-personal issues arise or pathologyblocks normal functioning, the persistent real-ness of the task at hand holds peculiar therapeu-tic advantages. First, of course, reality-testingis incorporated into the group's style of neces-sity. The ego-gratification and subsequently ap-preciated self-image from accomplishing a realtask in concert with others is an importantelement of rehabilitation. Learning to share re-sponsibility without excessive anxiety or author-ity structure is often a crucial lesson for pa-tients with poor ego boundaries. And identifyingwith a successfully planned and finished projectabout which positive feedback is available fromstaff and patients not connected with the Mirroris an important experience for poorly cathectedegos.As with other potentially therapeutic rela-

tions, transference is an important factor forthe bibliotherapist in groups as well as in in-dividual relations. My own neuroses are suchthat I am most often misperceived as a paternalfigure, though other transferences have oc-curred. The bibliotherapist, like other psychi-atric workers, must be sufficiently aware of hisown patterns, problems, and resolutions to un-derstand why he is the object of a particulartransference. Conversely, his own personalitymust be sufficiently integrated so that he canperceive in himself the inevitable counter-transference of the normal neurotic.

Another area of responsibility for the pa-tient librarian is in individual meetings with pa-tients. While such meetings cannot be frequentand can rarely be regular due to limitations oftime, it is also unrealistic for the librarian notto step out of his role to offer advice, interpre-tation, insight, or support. Within limits, suchcontacts should be encouraged, for they repre-sent the paradigm of any help: a human re-lationship. Because mutual interests or experi-ence and complementary abilities or needsusually promote a relationship, patients withinterests in literature and writing will be drawnto the librarian. And this is the point at which,in addition to describing another responsibilityof the patient librarian, I intend my commentsas that second response I mentioned, concerning

some kinds of bibliotherapy and my approachto them.A group of five to eight patients meets weekly

in the library, with myself and a volunteer, toread and discuss short stories. Stories are chosenby the group at the end of each session for thenext meeting. Selections reflect patients' prefer-ences, although I have suggested titles at times.We choose stories that can be read aloud withinforty-five minutes, leaving half our time fordiscussion. Each member of the group readsabout a page in turn, after which we discuss thework with initial reference to similarities be-tween the story and our own feelings.The play-reading group works in much the

same way. The group of four to eight patientsselects short plays each week for the next ses-sion, parts are assigned at the beginning of themeeting, and patients read the play withoutpreparation.The poetry reading groups, which I conduct

on the wards rather than in the library, attractfrom three to ten patients, last between an hourand an hour and a half, but differ from theother groups in that I select, mimeograph, anddistribute poems at the beginning of the session.While soliciting suggestions for authors andparticular poems, I take more responsibility inthese groups for selection of material. Dis-cussion proceeds organically from concordancesbetween the poem and feelings or experiencesof the patients. The reasons for this approachwill be discussed directly.The fourth group using literature was called

a Writers' Group, whose format included dis-cussion of poems by established writers butemphasized patients' own work. The group'sname speaks to the problems I encountered: Ifound very high resistance to using patients'poems as a projective device as in the othergroups. Edgar and Hazley, in Poetry Therapy,suggest why. They write, "An individual withan idealized image feeding upon his competenceas poet or writer may not be a suitable candi-date for [bibliotherapy] inasmuch as the sessionsmay enhance the image at the expense of thealready deflated real self" (3). I would put thisslightly differently by saying that writing as anavenue of self-expression is frequently sostrongly cathected by the writer's ego that ex-treme externalization and objectification of hiswork are necessary foT him to come to grips

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with it at all. Such reification obviates theprojective possibilities for therapy.

Writers in general find their relation to theirwork problematic. Thomas Mann's remarkableessay The Making of The Magic Mountain ex-plores his relation to his Nobel Prize novel. Heconfides that he finds it easier to discuss hiswork in English rather than his native German,and thus reminds himself of the novel's hero,who likewise reverts to a second language whendiscussing things close to his heart. Mann says:

It eases his embarrassment and helps himto say things he could never have dared to sayin his own language.... In short, it helpshim over his inhibitions-and an author whofeels embarrassed at having to talk about hisown works is in the same way relieved atbeing able to talk about them in anotherlanguage. (4)

Mann describes how his book grew from plansfor a humorous short story into a two-volumenovel, and because his expression outgrew hiscontrols, he writes:

I consider it a mistake to think that theauthor himself is the best judge of his work.He may be that while he is still at work on itand living in it. But once done, it tends to besomething he has got rid of, somethingforeign to him; others, as time goes on, willknow more and better about it than he. Theycan often remind him of things in it he hasforgotten or indeed never quite knew. Onealways needs to be reminded; one is by nomeans always in possession of one's wholeself. Our consciousness is feeble; only in mo-ments of unusual clarity do we really knowabout ourselves. As for me, I am glad to beinstructed by critics about myself, to learnfrom them about my past works and go backto them in my mind. My regular formula ofthanks for such refreshment of my con-sciousness is: "I am most grateful to you forhaving so kindly recalled me to myself." (5)

Mann's words need translation to a psychologi-cal vocabulary to be appreciated in their rele-vance and promise. I suggest, however, that thevery richness and mystery surrounding a writerand his work and yet separating them are otherreasons, in addition to that suggested by Edgarand Hazley, that writing in a group for therapyis untenable for persons whose writing is impor-tant to them. Yet Mann's comments also antici-pate my positive experience in working individ-

ually with patients who write: this is perhapsthe single most enjoyable aspect of my work.The ability of the poetic form to distill feelingand communicate it experientially is its uniquepower in therapy.

There are, however, two cautionary principlesin this relation to patients. The first is that thebibliotherapist is not a psychotherapist, andthe second is that patients' poetry must beevaluated as communication, not art. There areseveral reasons always to revert to the frame-work of the patient's writing, rather than his be-havior or current feelings, when discussing hiswork. Edgar, Hazley, and Levit argue that"since the poem appears to be objective, (it) ...may circumvent repressive barriers and breakthrough resistance ... it can be dissected andused for the acquisition of insight more readilythan personal symptoms or behavior" (6). More-over, psychotherapy must always involve a con-tract between patient and therapist which mustbe respected. To attempt deep insight therapymay confuse a patient, frighten him, or implya degree and kind of commitment for which thebibliotherapist is unprepared. While I alwaysinterpret patients' work and explore with themits relation to their lives, I also loop the threadof our discussion back to the poem or story it-self for closure. The other principle runs moreagainst my grain. It seems unfortunate to treatattempts at art not as art, but I have discoveredthat an assessment of patients' writing accord-ing to aesthetic principles is inevitably perceivedas a judgment of self. And a judgmental at-titude is probably the most damaging stance onecould adopt.

There is a reason patients perceive aestheticjudgment as ego judgment, and it has to do withwhat I think of as the core of bibliotherapytheory. Writers, suggests Thomas Mann, maynot be aware of their own work fully becausethey may have put more of themselves into itthan they intend or recognize. The name forthis capacity is projection-one can projectboth conscious and unconscious material. It isthis ability to express what one does not hold inconsciousness that makes the projected object-the poem or story-a potential vehicle forhealth. Suzanne Langer develops the conceptof projection in her chapter "The Projectionof Feeling in Art" in volume 1 of Mind: AnEssay on Human Feeling. "Art," she says, "isthe objectification of feeling and the subjectifi-

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cation of nature" (7). Compare Edgar, Hazley,and Levit's comment on the poem's semblanceof objectivity. I think it is the projective processthat makes sense of Dr. Leedy's isoprinciple,whereby a poem corresponding to the patient'smood seems most therapeutic (8). I have reser-vations, however, about the isoprinciple, be-cause poems or stories not clearly related tothe patient's mood often produce unpredictableinsights in discussion. Evalene P. Jackson's arti-cle "Bibliotherapy and Reading Guidance: ATentative Approach to Theory" (9) discusses theplace of projection in the use of literature intherapy, although she regrets the Freudianmodel. For my part, I am able to hold Freudand poetry quite easily together. Miss Langerends her discussion of projection by saying:

Feeling is projected in art as quality...There is a kind of quality that differentcolors, or even a tonal form and a visualone, may have in common; even events mayhave the same quality, say of mystery, ofportentousness, of breeziness; and a word like"breeziness" bespeaks the qualitative similar-ity of some moods and some weathers. Homerrefers to "the wine-dark sea," althoughGreek wine is red, and the Mediterranean isas blue as any other sea water. But the trans-lucent blue in the curve of a wave and theglowing red in a cup of wine have a commonquality.

It is quality, above all, that prevades awork of art, and is the resultant of all itsvirtual tensions and resolutions, its motion orstillness, its format, its palette, or in music,its pace, and every other created element.This quality is the projected feeling; artistsrefer to it as the "feeling" of the work asoften as they call it "quality." The image offeeling is inseparable from its import; there-fore, in contemplating how the image is con-structed, we should gain at least a first in-sight into the life of feeling it projects (10).

That life of feeling, whether projected by authoror reader, is what literature allows one to dis-cover, understand, and integrate.

But how, you may ask, can the patient-writer misapprehend comments directed at hiswork as directed at himself? Doesn't the processof projection permit a distance from one's crea-tion that separates self from object? Dr. DavidForrest says "Poetic thought resembles that ofchildren, of dreamers, and of patients, espe-

cially schizophrenics, in that it proceeds byparalogic (11). Poets share with schizophrenicpatients (among others) a reliance upon para-logic to establish the links that fancifully satisfytheir whims in the world of words" (12).Whereas normal consciousness permits whatColeridge called the "willing suspension of dis-belief" to enter the poem's paralogical world, adisturbed consciousness may substitute the para-logic of primary process for the rational abilitiesof abstraction and differentiation known assecondary process. That is, schizophrenics andother patients may reason poetically and figura-tively, so that what we recognize as metaphor,synecdoche, or metonymy may be seen by themas legitimate ways of referring to and acting inthe world. Thus, "the schizophrenic does not al-ways realize ... that what he does with thewords for things is not thereby done to thethings themselves" (13). Not only can uncon-scious feelings be projected in art, but the wholenotion of projection as a linking process may bemissing, thereby making of a patient's writingsomething far different from what we think ofas art.

Let me summarize before sharing some clini-cal experiences with you. I see the author ofimaginative literature, particularly poetry butalso fiction and drama, as infusing affect intohis work which then assumes the form of ob-jective quality. Because of the rich unconsciousnature of projection, especially in disturbed orcreative individuals, I think a patient's writ-ing is best explored individually. The dangersof this practice involve the potential for ex-cessive transference. In addition, the biblio-therapist must be careful to place patient art inthe therapeutic context and leave aesthetic orcritical questions for another setting. But theprocess of projection allows another relation toliterature, a receptive rather than originatingposition. That is, objective qualities in the workof art can be translated back into feelings forthe reader. That is the theoretical frameworkfor group bibliotherapy using poems, shortstories, or plays. The facilitation of such pro-jection, whereby the reader can identify someaspects of self with objective qualities in litera-ture while realizing that such identification isvirtual and not real, is the task of the biblio-therapist.The use of groups in this sort of therapy is

advantageous insofar as they permit a broader

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source of feedback for the individual strugglingto know hbimself. In the poetry groups we haveread from a broad selection of authors: Shake-speare, Berryman, Stevens, Yeats, Aiken, Au-den, Jarrell, Cummings, Rukeyser, Simpson,Plath, Merton, Williams, Frost, and others.These are mostly modem poets, both becausethat is my strength and because these poetsseem most likely to speak clearly to and for to-day's person. Let me give an example of onemeeting.On this day four patients and I met to dis-

cuss a short poem by Wallace Stevens. This isthe poem.

GUBBINALThat strange flower, the sun,Is just what you say.Have it your way.

The world is ugly,And the people are sad.

That tuft of jungle feathers,That animal eye,Is just what you say.

That savage of fire,That seed,Have it your way.

The world is ugly,And the people are sad.

The ensuing discussion touched on severalpoints: the tone and real meaning of the carpingphrases "have it your way" and "is just whatyou say"; the speaker's intention; the probableaudience and its relation to the poet. Finally,the issue was cast as a question of belief: doesthe writer really believe "The world is ugly,/And the people are sad"? Does he want to be-lieve it? Is he lying or ironic for ulterior pur-poses, such as silencing his listener? At thispoint I considered the essential quality of thepoem to be clear. That quality is a terrible am-bivalence between enjoying the world (as repre-sented in the startling images "strange flower,""tuft of jungle feathers," "animal eye," and"seed"), yet feeling that "The world is ugly,/And the people are sad." This deep ambiva-lence, and the resulting anxiety manifested bythe patients, was soon our focus. The oldestmember of the group, a middle-aged wife andmother with a history of loss and abandonment,spoke disjointedly and at length about the

poem, not so much explaining her feelings aboutit as conducting a discussion in monologue.Another member of the group, noting my un-subtle surprise at the woman's behavior, con-fronted her with it. She stopped in mid-sentence,hesitated, and began to cry, explaining that shefelt like the poem: attracted to life yet afraidof it, and suddenly realized that her talking wasa way of isolating and protecting herself byexcluding others, just as the speaker in thepoem did. Her speech habits were at once herbest defense and most obvious behavioral symp-tom of her ambivalence between longing for andfearing others. She tried to fill her need bytalking because talk is communication, but hertalk was controlling and isolating. Thus hermethod of expressing her need also expressedher fear of the consequences of satisfying it.With this insight, the other patients helped setlimits for her when monologue threatenedagain, and she was able to take their remindersas help, not criticism.

Stevens' theme in "Gubbinal" is consistentwith the quality that haunts the poem and itsauditors. In one case, that quality spoke directlyto a problem that had brought a patient to thehospital. Ideally, that is how I make the clinicalconnection between "biblio-" and "-therapy."The technique and style of the short story

group is similar. We have read stories by Joyce,Kafka, Hemingway, Salinger, Porter, Updike,and Anderson; and sections from novels byDostoevsky, Gide, Camus, and others. We readthe first chapter of Camus' The Stranger, inwhich the protagonist describes his mother's fu-neral. The overwhelming quality of this chapteris its emptiness, its muted affect, the exclusion ofall feeling except physical sensation from thenarrative. It was this emptiness that promptedand underlay the group's consideration of theirown responses to the deaths of parents and otherloved ones. In the course of the discussionseveral patients confronted poignant losses oftheir own, the guilt they felt, and the parallelsbetween Mersault's reaction and their own ap-parent lack of emotion in dealing with loss. Iclosed the discussion feeling that most of usknew more about ourselves than before thereading.

In the play-reading group, a slightly differentformat is employed. The patients' relation toand feelings about their roles are explored forthe insight they may shed on their own prob-

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lems. The group is most helpful diagnosticallysince much can be inferred from the tone andstyle of reading particular parts. This sort oftherapy may increase resistances because ofanxiety aroused in the course of acting likesomeone else, but can also be a satisfying andsafe way to express what self prohibits. Patientswith unclear ego boundaries risk the greatestanxiety but also have the best chance throughplays of recognizing their problems. Safetyand structure are most important in this group.My method has been to assign parts wholly atrandom so that everyone is certain that only achance relation exists between personality andpersona.The theory and practice of bibliotherapy has

progressed far since the publication in 1931 ofThe Poetry Cure by R. H. Schauffier, who dedi-cated his book "to the noble army of creativelibrarians, practitioners all-consciously or un-consciously-of the poetry cure." Schauffier'stable of contents includes the following pre-scriptive headings: "Magic-Carpet Poems-Hasheesh for a Torpid Imagination"; "Poemsof Courage-Stimulants for a Faint Heart";"Soothers and Soporifics-Poppy Juice for In-somia"; and "Poems of High Voltage-Ac-celerators for Sluggish Blood" (14). Despite thecontemporary humor of his subject headingsand the anachronistic methodology, his dedi-cation speaks to librarians as the first biblio-therapists and the group from which a promiseof better bibliotherapy might rise.

Finally, let me leave you with a poem by JohnBerryman, a poem describing better than anyprose how a poem is therapeutic, how it is born,grows in the world for its reader's lives, and howit calls to us with our own wisdom.

Turning it over, considering, like a madmanHenry put forth a book.No harm resulted from this.

Neither the menstruating stars (nor man) wasmoved at once.Bare dogs drew closer for a second look

and performed their friendly operations there.Refreshed, the bark rejoiced.Season went and came.Leaves fell, but only a few.Something remarkable about thisunshedding bulky bole-proud blue-green moist

thing made by savage & thoughtfulsurviving Henrybegan to strike the passers from despairso that sore on their shoulders old men hoistedsix-foot sons and polished women calledsmall girls to dream awhile toward the flashing &

bursting tree. (15)

REFERENCES

1. MAY, ROLLO. The significance of symbols. In:MAY, ROLLO, ed. Symbolism in Religion andLiterature. New York: Braziller, 1960. p. 13.

2. HANNIGAN, MARGARET. The librarian in biblio-therapy: pharmacist or bibliotherapist? Libr.Trends 11: 188-9, Oct. 1962.

3. EDGAR, K. F., AND HALEY, R. Validation ofpoetry therapy as a group therapy technique.In: LEEDY, J. J. Poetry Therapy. Philadel-phia: Lippincott, 1969. p. 122.

4. MANN, THOMAS. The making of The MagicMountain. In his The Magic Mountain. tr.H. T. Lowe-Porter. New York: Vintage,1969. p. 717.

5. Ibid., p. 725.6. EDGAR, K. F.; HALEY, R.; AND LEVIT, H. L.

Poetry therapy with hospitalized schizo-phrenics. In: LEEDY, J. J. op. cit. p. 31.

7. LANGER, SUZANNE. Mind: An Essay on HumanFeeling. Baltimore: John Hopkins Press,1967. v. 1, p. 87.

8. LEEDY, J. J. Principles of poetry therapy. In:LEEDY, J. J. op. cit. p. 67.

9. JACKSON, EVALENE P. Bibliotherapy and read-ing guidance: a tentative approach to theory.Libr. Trends 11: 118-122, Oct. 1962.

10. LANGER, SUZANNE. op. cit. p. 106.11. FORREST, DAVID V. The patient's sense of the

poem: affinities and ambiguities. In: LEEDY,J. J. op. cit. p. 234.

12. Ibid. p. 235.13. Ibid. p. 239.14. SCHAUFFLER, R. H. The Poetry Cure. New

York: Dodd, Mead, and Co., 1932.15. BERRYMAN, JoHN. 77 Dream Songs. New York:

Farrar, Straus, and Giroux, 1967, p. 82.

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