Book Review: The Patient Admits (Avery M. Guess)

Reviewed by Andrea Nicki

Avery M. Guess' chapbook The Patient Admits is a taut, finely-crafted collection of seventeen poems which explores her family life experience of child abuse and chronic incest rape and subsequent institutionalization in a psychiatric facility. Literary scholars and the general public have typically medicalized and marginalized ideologically and aesthetically diverse narrative writings about chronic incest rape, regarding these as courageous, inspirational "trauma narratives" which provide healing for the authors.i Guess' book, in its original, accomplished handling of the subject matter, serves as a strong challenge to this reductionist view.

Incest rape is not a rare occurrence. Based on reports of Child Protective Services in the United States for the period of 2009-2013, 1 in 9 girls and 1 in 53 boys under the age of 18 are sexually abused by an adult, and the perpetrator is most often the father ( However, because of societal denial over the high prevalence of incest, survivors are often subject to disbelief and hostility from health care professionals and others who perceive them as having "borderline personality disorder" or as overly sexual individuals who seduced their attackers.ii Importantly, Guess' thoughtful, precisely-chiselled poems promote more understanding and compassion toward survivors.

For example, in her poem The Patient Admits Guess presents an agonizing experience of waiting for her father to make his regular trip to her bed every night and her decision one night to actively seek him out. The reader's compassion is prompted by her poignant reference to a "Peanuts sheet" that she sometimes held "as tight/as [she] could for protection" (3) and by her moving comparison of the waiting to "knowing the exact moment an accident/will kill your children or being told the day/but not the month, not the year you will die,/and you are helpless to stop it. Or avoid it." The reader is then persuaded to view her "trudge" (3) to her father's room and her whisper "Dad" (3, emphasis in original) as being the reasonable response of a sexually innocent, intelligent girl with a strong grasp of her impossible situation, not the invitation of a "young temptress." In the last line of the poem, Guess anticipates readers' criticism of her action and adopts the persona of a nervous girl before adult judges, stressing that she whispered to her father only once: "I …saw my father asleep/and snoring…and (just once,/just once, I swear, just once) whispered, Dad" (3, emphasis in the original).

Guess also brilliantly keeps the reader's focus on the girl's innocence in her poem "The Patient's Aversion to Bananas Begins" which describes a meeting between her father, her therapist and herself, in which her father said, "When she was two or three,/she saw me naked on the bed. She asked what my penis was. I said it was a banana. Then I asked her if she wanted to lick it." She emphasizes in italicized font: "The average height of a father is seventy inches…The average height of a toddler is thirty-six inches…The average length of a small banana is six inches" (10). The reader is thus directed to visualize the great difference in height between the narrator as a toddler and her father, with an adult-sized penis, and so cannot deny the fact of her father's grossly inappropriate behaviour.

Further, the poem "In Therapy, the Patient Is Asked to Define: Alimony" adds to Guess' argument of the girl's innocence in its insightful comparison of money that her father gives to her as an adult, which she uses for therapy, to alimony: "a bribe given by a parent to the child they pretended was their/spouse for continued silence and complicity" 12). Indeed, when a mother does not act to protect her daughter, as in the narrator's case, the girl becomes "the other woman" or like a second wife; this poem stresses the gross unfairness of such a situation, which is on a par with a girl being forced into a child marriage. At the end of this poem Guess presents a prompt for writing an acrostic poem: "Write a poem using each letter [of the word alimony] as the first letter of each line" (12, emphasis in original). She then writes/presents a poem about her incest experience with her father. While writing an acrostic poem is a common exercise in poetry workshops, when facilitators get participants to take part in such an exercise, they typically do not expect or welcome the taboo topic of chronic incest rape, (unless the workshop is geared toward exploring women's issues or issues related to family dysfunction)iii. Guess also uses this exercise frame in other poems in the chapbook, thus pushing a marginalized experience to central stage and showing the great impact of chronic incest rape on a survivor's everyday life and activities.

Guess' poem "The Patient Attempts to Describe her Experience with Depakote" further demystifies the experience of chronic incest rape, while presenting a powerful critique of the view that psychiatric medication treats a chemical imbalance. Guess details some dysfunctional interactions in her home and in the last stanza writes: "Imagine your head filled with…a house…Picture everything that happened there/in that house portrayed on endless loop/at full volume on the projection screen/of your mind. The daughter. Her father./Her mother. A constant stream. A TV playing/every channel at same time at full volume./Or ten TVs. A hundred. Now, pull the plug" (13). The unexpected twist ending jolts the reader into a strong understanding of her psychological burden and of the severe limitations of a mind-numbing drug like Depakote, which can only offer stillness and silence. The drug can provide no guidance for her life, for what to do with her horrible memories and feelings--how to be a "pilot [and] not [a] passenger" (1) in life. As she claims in her poem "The Patient Decides She Wants to Live," the narrator hasn't been taught how to live: "But no one explains what to expect. How to court life" (14).

I highly recommend this engrossing chapbook, which I read in one sitting, and look forward to reading the author's first full-length collection (title TBD) due out in April 2019 with Black Lawrence Press. The accessibility of the writing would make the poems good additions to reading lists for college and university courses in medical humanities, social work, family studies, psychology, disability studies, and mad studies. The poems would also be useful ones to include in reading lists for general courses in English Literature on the theme of family so that students can receive a better representation of diverse family life.


Title: The Patient Admits
Author: Avery M. Guess
Publisher: Dancing Girl Press Press
Publication Date: 2017


i. See, for example, Rachel Spear 2013. Spear stresses the healing potential of "trauma narratives," and references many researchers who support this view. See also Elly Danica's book Beyond Don't: Dreaming Past the Dark (1995). Her book of prose poems Don't: A Woman Word (1989) details her experience of child abuse and chronic incest rape. In Beyond Don't, Danica discusses how the public treated her as a courageous, inspirational person who had healed herself through her writing and had the power to help heal others. She emphasizes, though, that writing and publishing her book was of limited healing value; the public attention that the book received did not improve her emotional well-being, better her life conditions, or help her writing career.

ii. See Andrea Nicki 2016.

iii. See Nicki 2016. My poem "Pink Balloons" is about my experience in a poetry workshop of being censored and rejected by the facilitator for writing about chronic incest rape in response to a poetry exercise on the theme of loss and vulnerability.



Danica, Elly. (1989). Don't: A Woman's Word. Charlottetown: Gynergy Books.

Danica, Elly. (1996). Beyond Don't: Dreaming Past the Dark. Charlottetown: Gynergy Books.

Nicki, Andrea. (2016). Borderline Personality Disorder, Discrimination, and Survivors of Chronic Childhood Trauma. International Journal of Feminist Bioethics 8 (1): 218-245.

Nicki, Andrea. (2016). "Pink Balloons." I Am Not a Silent Poet.

Spear, Rachel. (2013). "Let Me Tell You a Story: on Teaching Trauma Narratives, Writing, and Healing." Pedagogy: Critical Approaches to Teaching Literature, Language, Composition, and Culture 14 (1): 53-79.


Andrea Nicki has two collections of poems published: Welcoming (Inanna Press, 2009) and Noble Orphan (Demeter Press, 2012). A third collection is forthcoming with Mago Books. Nicki has a Ph.D. in philosophy with a specialization in applied ethics and narrative medicine. Her poems and articles have appeared in North American journals and anthologies. She teaches graduates courses on professional ethics and private writing classes to youth and adults. See more of her work at