This article examines the psychological connotations of Joseph Brodsky's “art of estrangement” in light of the psychiatric evaluations the poet underwent in 1963 and 1964 and his depiction of madness in the poem “Gorbunov and Gorchakov” (1965–68). Several years before the punitive uses of Soviet psychiatry came to the attention of samizdat readers, Brodsky was forced to weigh the dangers and benefits of psychiatric diagnosis in his dealings with the state. The balance that he struck is mirrored in “Gorbunov and Gorchakov,” in which the state's claim that “being determines consciousness” and Brodsky's claim that the “estranged” consciousness determines being are personified and placed in dialogue. The poem, which is set in a psychiatric hospital, indicates that the “art of estrangement” can lead to madness if consciousness strikes out too far on its own. By engaging with being in life and work, Brodsky kept consciousness grounded for the sake of sanity and self-definition.