Hektoen International

A Journal of Medical Humanities

Under the lime tree: medicine, poetry, and the education of the senses

Alan Bleakley
Sennen, West Cornwall, United Kingdom


Portrait of Samuel Taylor Coleridge
Portrait of Samuel Taylor Coleridge (1772-1834), by Peter Vandyke, 1795. Edited by Sue Bleakley.

When in the summer of 1797 Samuel Taylor Coleridge’s wife Sara accidentally spilled hot milk over his foot, causing serious burns such that Coleridge could not walk, he sat in the garden of his friend Thomas Poole’s house under a lime tree, immobilized. A party of friends, meanwhile, had set off on a walk. He mockingly called the lime tree bower his “prison.” But Coleridge was ready to get out of gaol and poetry would be his ticket. Coleridge and Sara were staying in a small cottage on the grounds of Poole’s house—the marriage was falling apart and Sara had recently suffered a miscarriage. But the emotional agitation seemed to stir something in Coleridge’s imagination. Under the lime tree, he wrote his finest poem before “The Rime of the Ancient Mariner” (1798) and “Kubla Khan” (1797).

(Excerpts from “This Lime-tree Bower my Prison”1):

Well, they are gone, and here must I remain,
This lime-tree bower my prison!
. . .
They, meanwhile,
Friends, whom I never more may meet again,
On springy heath, along the hill-top edge,
Wander in gladness, . . .
Now, my friends emerge
. . .
and I am glad
As I myself were there!
. . . Pale beneath the blaze
Hung the transparent foliage; and I watch’d
Some broad and sunny leaf, and lov’d to see
The shadow of the leaf and stem above
Dappling its sunshine! And that walnut-tree
Was richly ting’d, and a deep radiance lay
Full on the ancient ivy, which usurps
Those fronting elms, and now, with blackest mass
Makes their dark branches gleam a lighter hue
Through the late twilight: and though now the bat
Wheels silent by, and not a swallow twitters,
Yet still the solitary humble-bee
Sings in the bean-flower!
. . . No sound is dissonant which tells of Life.


The poem is a conversational piece that places the reader into the landscape through which the poet’s friends are walking and to which Coleridge was so deeply wedded. Wordsworth and Coleridge were both attempting a new kind of democratized, reader-friendly poetry—drawing on everyday conversational style that they picked up from local working-class folk met on their near-daily walks.2 We can compare this with the doctor who has mastered technical, clinical, biomedical lingo conversing in a lay manner with patients in consultations. Paradoxically, in such translation, the metaphor count of the conversation is likely to increase as the literalism of the biomedical tongue is countered by conversational or dialogical intent.

Coleridge’s account is not a collection of flimsy, recollected, passing images—a tree here, a bird there—but an unfolding, in-the-present, filmic sequence of deeply embodied (sensory and emotional) connections with the landscape. It is less a narrative and more a lyrical, poetic series of spatial (and melancholic) close observations of nature. Coleridge, subject to extreme mood changes, might be seen to be describing a treatment for such affliction that we now call a “green gym prescription”—outdoor exercise alongside antidepressants (the poet’s choice was laudanum). Such exposure to nature has been shown to increase cortisol levels that in turn reduce stress, while the benefits of exercise and social interaction such as walking with others are self-evident.

On Coleridge’s imaginary walk, shadowing what he knows intimately in reality, a walnut tree is “richly ting’d,” the “blackest mass” of a grove of elms makes “dark branches gleam a lighter hue,” while in the absence of bird song “the solitary humble bee / Sings in the bean flower!”; and then, at dusk, “the last rook . . . / Flew creeking” above the walkers’ heads, their tired limbs creaking too. Coleridge’s technique involves not only sensing of detail (the richly tinged walnut tree, the solitary bee’s song, the overhead creaking of the rook), but also foregrounding a striking contrast: a positive image drawn out of a negative background. This frontstage/backstage metaphor also describes the productive conversation between consciousness and tacit knowing, the basis to all clinical reasoning. Coleridge described this as the conscious Will (Intelligence, Reason) making sense of the deep well of unconscious images and memory (for the doctor, the fruits of a medical education as biomedical knowledge).

Because of their black mass, the elm tree grove forms a background for the emergence of the foregrounded branches’ lighter hue, indeed “gleaming”—yet, paradoxically, still dark against dark. While the first photograph taken by a camera would not be seen until thirty years later, around 1800 Coleridge’s benefactor Thomas Wedgwood and the chemist Humphry Davy (whom Coleridge would befriend in Bristol in 1799), produced relatively substantial shadow images on chemically-coated paper and chamois leather. Coleridge’s mind was already light sensitive, photographic. His reasoning was radically future-focused, his poetry prescient.

Coleridge highlights two practices common to poetry and medical work: close noticing and witnessing. The first, an intense use of the senses in close or focused attention; the second, a free-floating paradoxical attention like an antenna that picks up on atmospheres, on the unspoken, and provides in medicine a mirror for the patient and in poetry a route into the unspoken and unspeakable. Both practices are shared with narrative medicine, but what non-narrative lyrical poetry does is spatial rather than temporal, and radically collapsed into bundles of metaphor.

The effect on the reader of Coleridge’s lime tree poem is, again, to occupy the bodies of the walkers and not just their minds as the poet sympathetically tracks their movements through the landscape, the group led by his friend Charles Lamb. So the doctor must inhabit the landscape of the patient. Again, it is as if Coleridge is mixing and applying the chemicals that produce a photosensitive surface from which the rich images of the walkers and their surroundings emerge, but as film rather than stills. This sensitivity can be described as an “embodied hermeneutics”3—a state of being that engages in an interpretative manner with the bodily being of another, just as the patient walks into the landscape of the clinic, under the gaze of the doctor.

Strangely, Coleridge’s iconic poem has often been read purely as a meditation on his forced immobility, taking the “prison” part of the title literally. The poem, however, is surely a warning against the immobility of a blunt (and not active) imagination or insensibility, that is also the doctor’s major block to diagnostic acumen. Active imagination is grounded in the senses and affect. Doctors complain of patients with “flat affect” who give away nothing, but nothing is worse than flat affect in the doctor, the consultation deadened by biomedical literalism and lack of enlivening metaphor. Diagnosis begins with the sensation of close noticing, but this must be accompanied by appreciation, a combination of respect for the patient and wonder at the expressions of body and mind. There is nothing abstract about Coleridge’s observations. They are precise and grounded in natural events and forms.

Coleridge’s closest friend and co-writer William Wordsworth, with whom Coleridge had often taken the walk described in the lime tree poem, says in his preface to the third (1802) edition of Lyrical Ballads (co-written with Coleridge and first published in 1798): “I wish to keep my Reader in the company of flesh and blood.” The doctor as diagnostician must be a reader of patients’ flesh and blood as text, but her sensibility should be lyrical and not just technical or instrumental. Coleridge himself was both a close observer of, and a prisoner in, his own body. He suffered from a number of afflictions that melded the physical and the emotional: “neuralgias, mysterious swellings of the scrotum and the eye, nightmares, elaborate bowel complaints.”4

To draw on the word that Coleridge himself coined in the mid-1790s, the lime tree poem itself is quintessentially “psychosomatic,” advertising an embodied imagination. The doctor walks with the patient through the physical examination, perhaps already satisfied with a pattern-recognition of the familiar, or in more complex cases juggling a differential diagnosis and sifting through alternatives. In memory recall Coleridge narrows the possible scene down to a number of key images. So the diagnostician samples previous cases, sets of clinical scripts, or oppositional semantic qualifiers (chronic or acute onset, a reactive or episodic depression). The rook flies overhead, casting a shadow whose perimeter delimits the possibilities of diagnosis. This back-and-forth between tacit knowledge and explicit reasoning is again common to both the medical mind and the poetic imagination. It is about the quiet work of words as they gain wings in metaphor, the poet and doctor both “silent with swimming sense.”2



  1. Samuel Taylor Coleridge. This Lime-tree Bower my Prison. Available at: https://www.poetryfoundation.org/poems/43992/this-lime-tree-bower-my-prison.
  2. Adam Nicolson. 2019. The Making of Poetry: Coleridge, the Wordsworths and Their Years of Marvels. Glasgow: William Collins.
  3. Richard Kearney and Brian Traynor, eds. 2015. Carnal Hermeneutics. New York: Fordham University Press.
  4. Susan Eilenberg. A Moral Idiocy. The London Review of Books, Vol. 19, No. 12. 19 June 1997.



ALAN BLEAKLEY, DPhil, educated in zoology, psychology, and psychotherapy, and working both in academia and clinically as a psychotherapist, is internationally renowned in medical education and medical humanities. He has written 20 books, including five volumes of poetry. He was past President of the Association for Medical Humanities and helped to set up the Canadian Association for Health Humanities. Alan implemented the first extensive core, compulsory, and assessed medical humanities program at a UK medical school (Peninsula) in 2002. He has been a keynote speaker at many international conferences.


Summer 2021  |  Sections  |  Literary Essays

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