Minds, Medicine, and the Mad: An Interview with sam sax

From the green room in Alphabet City, as he prepared for his reading, sam sax was kind enough to speak to Sampsonia Way about the precarious nature of language and the power and history of madness. sax was in Pittsburgh to read from his most recent book bury it and his first published book madness, the latter of which is a collection of poems inspired by an early version of the Diagnostic and Statistical Manual of Mental Disorders published in 1952. The collection explores history, medicine, and sax’s own journey with illness and was selected by Terrance Hayes as the winner of the National Poetry Series. bury it , is a recent recipient of the James Laughlin Award and sax has also been awarded the American Literary Award, the Gulf Coast Prize and the Iowa Review Award. Currently he works as the poetry editor of BOAAT Press and is a Wallace Stegner Fellow at Stanford University.

I. Reasons for Admission

What made you decide on the subject matter for madness?

I wrote much of that book in a residency up in the Adirondacks, called “Blue Mountain Center.” There wasn’t really Wi-Fi or cell service there. The Blue Mountain Center does month-long summer residencies for artists and activists. So I went for a month with a bunch of other writers and painters and union organizers and journalists. And I just spent that month writing that book.

So my entry point into it was actually this list that I found online of all of these antiquated reasons for admission to a so-called mental asylum in the 1800s — it was like, “kicked in the head by a horse” or “tobacco chewing” or “masturbation”  or “novel reading” — and these were all reasons for admission. And so the initial project I had was going to be called “Reasons for Admission,” and I was going to take each title and make a poem out of it.

But when I got to the residency I was like, “This feels like too constricting of a project.” So I started to think more about my own experience as a mental health patient and my family’s experience as mental health patients and practitioners. I brought along a copy of the DSM-1, which is one of the pages that opens the book, and then is erased throughout. I was sort of seeing how all of these antiquated medical diagnoses still inform how we think through the body and pleasure and how we move through the world in general. And how homosexuality was in the DSM-1, until it was removed in the 80s.

You mentioned a lot of your family has history in the medical field. Specifically, I know you talk about your grandfather in the book, who was a psychoanalyst.

Yeah, he was trained in the 50s, which has this really innovative and fucked-up masculinist history of thinking about the mind and pathologizing the mind. So a lot of my research was just talking to him and hearing wild stories he had — hearing about his experience being trained as an analyst in New York in the 50s.

And other people in my family have other histories of depression and anxiety and bipolar stuff. So I think all of that made its way into how I was thinking about how these sort of diagnoses can be useful and the ways in which they can marginalize or pathologize the ways we think about ourselves.

In your book, there’s a conversation between your identity as a gay man and mental illness. Do you think there’s any connection there? Not in the backwards-thinking ways of the 50s when homosexuality was classified as a mental disorder — but today, in more modern terms. Do you think there is any connection between people who are gay and rates of mental disorders?

I think so, but that probably also has to do with societal heterosexism. All this research I’ve read about trans suicide has a lot to do with the world refusing to use peoples’ names. And the rate of suicide and depression dropped dramatically when folks decided to honor kids’ chosen names. I think that sort of negative societal impact informs how we think about ourselves and informs our mental health and stability. It’s an interrelated thing.

On that same note, I remember another entry point for me to think about this project was when I got diagnosed with an anxiety disorder and depression and how before that, I was just like, “Oh this is just how my mind works.” And then afterwards, I had a diagnosis — which sort of changed how I thought about my own brain and then changed how my thinking worked. So these external factors — that inform how the body works, or how the mind works, or how we think — absolutely change how we are in the world.

II. Medicine and Histories

There is a contrast between the sections where you mention your therapist and the sections where you talk about conversion therapy and other really brutal practices. Because there’s a difference between people who are trying to use psychotherapy techniques to “cure” homosexuality and people going into therapy willingly to treat the mental disorders that they actually have.

Absolutely. And that’s really important to me. I’m pro therapy. Therapy saved me in a lot of ways. And it also, like any institution, has its particular history. In order to think through the ways that it can be useful is also to fully hold it accountable for its history. And a history of medicine or a history of science or a history of psychoanalysis is always, for me, a more compelling way into a material than the science itself. Because I just don’t have a mind for it.  

In looking at the section titled “Men,” there were a lot of references to prayer and religion. And I was surprised because there were references to religions that were more specific towards Catholicism, rather than Judaism, even though you yourself are Jewish. So I was curious about why you chose to have these references in your book.

I think there’s a way that the church in particular has informed how we think about the brain, or religious freedom, or strictures and violence. And all of this is important to discuss when thinking about mental health. Or when thinking about constriction. Or restriction. And it’s tough. It’s impossible in a lot of ways, in America or in English literature, to divorce oneself from judeo-christian rhetoric, symbolism, and language. And so I think all of my attempts to do it in this book are to interrogate those linkages.

I know there’s a section on transubstantiation in the “On Mass-Hysteria” poem. And that’s sort of looking at collective moments of mass hysteria and religious organizing. I think my second book has a bit more of the oral dysphoric Jewish folktelling stuff afoot. And the third book will probably be even more chock-full of it.

Do you know why you are so interested in history?

It seems to be everything. I don’t know. I think it offers context for a world that doesn’t make sense. I think looking at the antecedent of a thing can help to put a problem you’re struggling with into context. Etymology is a particular area of interest for me. I’m interested in the history of words and how a word moves across borders and through time and across languages to get to us. And I think how we speak, even in our most common language, is so rooted in the history of those words and is always alive even when we talk.

So history is everywhere and in everything. When we deign to look at it or to acknowledge it, I think for me, it offers so much. I’m always trying to write from where the body meets the world. And when I’m stuck in something, that sort of internal, emotive, and experiential body butts up against a world with its history and its violence and its structures. And I think, in that moment, history helps offer a little clarity into what’s going on in that exchange.

III. Madness and Asylum

You talk a lot about loss throughout the book and you have certain spots where you’ve blocked out text in an intentional act of omission. I thought that was interesting in a book that focused so much on loss in the body and in other ways.

There are a couple of moments with the hard parenthetical brackets where the sections are redacted. I think that has a lot to do with loss, with permission, and with what I feel like I’m able to say. And if I can’t, if I feel like I’m not permitted to say the thing, I offer it in a blank shape. To write the text and erase it feels like a powerful gesture — to be both present and gone at once.

I like thinking about these lost fragments. And I guess that also points to the Sapphic-like fragment, which is one of the building blocks to poetry. These lost or recovered texts that are written in the fragment as honored. And the blank spaces honored. So I think that’s a little bit what I’m pointing to.

Was there any thought when you were writing this book, after naming it madness and talking about these historical diagnoses of madness? Was your intention in any way to try to humanize the mad?

The original title was going to be Reasons for Admission. And then the second title was Asylum but then that’s actually a great Quan Barry book that came out in the last six years. So madness was its third title. I’m a little wary of the term “to humanize.” I think it was less about humanizing anyone and more so about pointing out structures that dehumanize. It was more about seeing what are the historical precedents that lead to a type of dehumanizing practice or practices or theory.

So you mentioned earlier the influence of your grandfather and psychoanalysis, and it made me curious. How much of your your scientific background comes from your family and how much of it comes from your readings, and your listenings?

When I was making this book, I had Madness and Civilization and a bunch of early Freud. I did a lot of reading and then specified writing exercises based on the book I was reading. And I think being in a place of such isolation without Wi-Fi really helped me to focus and really synthesize these books and think about how they impact and think through my life. I was reading Totem and Taboo and Beyond the Pleasure Principle. My Grandpa’s a Freudian. He’s a Freudian analyst, so I think that’s also part of it.   

IV. Raw and Honest

One of the larger themes you have in your book is about substance abuse and your history with that. There is a way in which your book has a rawness to it. And I know some reviewers describe your book in a very positive way as vulgar. Was your goal with your rawness and with this almost filthy sense of imagery to help normalize that this is something that happens and to paint a bigger picture of honesty?

Well I think there are a couple things to talk about. First of all I wrote this book when I was sober. I was sober for like three and a half years after a drug overdose. And a partner of mine, an ex, had overdosed in that same time. And so I was writing a lot about addiction: how we think through addiction and how we think through addiction as an external diagnosis versus an embodied thing you live with — or as a word or as a word you live inside. And I think that informs how I was thinking mostly about the distance between addiction and the mind.

As far as vulgarity, my first love was dirty books. All of the first books I loved were the sort of shared eroticisms that can happen in the page — how it’s an immediate transference of the brain enacting pleasure inside the body. Or desire. Or disgust. And I think anything that elicits physical response in writing, as long as it’s not rearticulation of trauma, I think is sort of what I’m going towards. I think my interest in vulgarity quote unquote, or eroticism, is to normalize it. But it’s also to participate in a lineage of queer literary explorations of the body.

So, have you gotten any kind of pushback for the content you’ve been trying to write?

Oh yeah. I mean, I think less now. I’ve gotten some mean reviews that are basically just heterosexist or reviews that sort of flatten any queer writing into a subject instead of a lens for exploring the world. Which I think is an important distinction. To be like, “Oh that’s just a gay poem” doesn’t acknowledge the breadth of a human homosexual as like a person who also eats apples.

But early on I had way more pushback in performance. I had a bottle thrown at me once. I got yelled off the stage. So I think the sort of criticism that has come now, which is pretty infrequent, thank goodness, sort of pales in comparison to some of the physical threats that were there in some of my early performance life. That was part of a really intense educational experience that showed me how poetry can both transform people’s lives and also physically reorganize community. And that’s sort of when I fell in love with it, when all of these negative things were happening. It was also part of a blooming moment of exploration and discovery for me.