Duty of Care Laid Bare: Shane Neilson’s Dysphoria

Dysphoria’s first part, “The Grand High Medium Abominable,” comprises the long title poem, “Dysphoria,” which exemplifies an extreme disorientation whereby a patient on the sharp end of forced medication tumbles through religion, technology, Jim Jones, Moby Dick, Percy Sledge, Mad Max, and more. Across 18 pages of sometimes cryptic couplets, I occasionally felt disoriented – which may have been Neilson’s intent – yet lines like “all is null in this hell of unrest, / though you’ve heard that you are blessed” and “Here Be Police / who eat explorers that touch too much,” served as welcome buoys to direct me through waves of image and colliding allusions. The poem is emotionally and intellectually challenging; as a reader I struggled to ascertain who exactly the “we” is to which there are multiple references throughout. At times I felt excluded; however, on allowing that I am lucky enough to have never experienced the symptoms and mistreatments described, I was able to view this diction of “we,” “our,” and “us” through a more compassionate lens – a much more rewarding experience. Elsewhere in the poem, recurring mentions of sensors – suggesting physiology, pharmacology, pain, detection, and protection – hint at the homophone ‘censor’ and at booted troops that execute oppressive orders. Indeed, the poem is at its most incisive when addressing Sammy Yatim’s public death: “…needed the depot shot but the cop’s / gun gave him lead poisoning instead.”

The second section focusses on the suffering that misguided – on occasion, malevolent – physicians have caused, particularly in the past. Neilson highlights both past failings of asylums and incarceration and current community-care shortcomings. This section contains my favorite poem in Dysphoria, “Great care should be taken,” where Neilson writes:

Because delusion is
a line connected
between two dear
points, do not break
the line. Instead,
redraw it by first
marvelling at the
line’s elegance.

As a physician, these verses offer a devastating and rare insight for me into what might truly comfort the sick. In a collection crammed with harrowing images and howling perspectives, this seemingly-simple voice excited and frightened me the most.

I am personally less horrified by Neilson’s descriptions of blood-letting and leeching than I am by reminders that present-day treatments may well be laughably misguided in the eyes of better-informed future generations. Dysphoria is a powerful example of narrative medicine, and Neilson’s poems hope that we might all strive to deliver better care guided by compassion, understanding, and definitive deduction: any other path points toward despair. Apathy, callousness, cruelty, and distance: these attitudes and approaches have no place in healthcare, and it is these practices, rather than archaic ones, that Dysphoria takes to task.


Conor Mc Donnell is a physician and writer. His first chapbook, The Book of Retaliations, was published by Anstruther Press in 2016. His acceptance : rejection ratio is still alarmingly low but slowly improving with time. More details can be found at conormcdonnell.ca.


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