A Psychiatrist Writes Thrillers?

My work as a psychiatrist is geared toward calming anxiety and tension, so why would I want to put people on edge with a thriller? I don’t typically recommend thrillers or violent crime novels to my patients. I’m more likely to suggest humorous books, entertaining mysteries, or self-help manuals that could lighten the mood or build skills in managing symptoms. But the stories my patients tell me about their lives can be full of danger, even terror. I’ve listened to thousands of these accounts and seen the reach of human behavior.

After decades of writing textbooks, scientific articles, and self-help books as part of my job as a professor of psychiatry, I was ready for a change. I’d gotten past the “publish or perish” stage of establishing my career as a teaching physician, and my academic books were doing well. Why not write something I’d enjoy more? Create mysteries and puzzles for readers to unravel? Write stories that excite and thrill? I couldn’t say that any of my medical books did those things. I envisioned clinicians and students slogging through the medical treatises because they were trying to improve their therapeutic skills, not for the joy of reading.

I wanted to write the type of fiction that appeals to me. Although my tastes in reading are diverse, I especially like books that grab my attention and make me turn the pages with eager anticipation or, in some instances, with foreboding. If there is an underlying message or insight—something to learn or to chew on—the book is even better. Alex Michaelides’s The Silent Patient, Sarah Pearse’s The Sanatorium, and Dennis Lehane’s Shutter Island meet those standards. Suspense, terror, and psychological themes abound.

What business does a psychiatrist with little background in writing fiction have penning a thriller? Not much, some would say. Go to grad school to get an MFA before you try. However, I thought I might have some pluses on my side. I’d spent many years honing my discipline to stick with writing projects. I’d developed a thick hide when scientific articles and grants were rejected, and I knew that breaking into publishing novels wouldn’t be easy. I’d decided to recruit a team of experts—a bestselling author and a seasoned editor—to help me.

The biggest plus from my perspective as a psychiatrist-novelist is my knowledge of the human mind. Paranoia and bone-chilling fear are common fare in my clinical practice, and I’ve studied and written professionally about the twists and turns the mind can take. I worked as a forensic psychiatrist early in my career and have consulted on fascinating and horror-ridden cases since then. I’ve assessed criminals who have committed unspeakable offenses, and I’ve helped legions of victims. My research on depression and anxiety has led to development of new treatments that give hope. Over and over, I’ve seen people who are terrified or trapped find solutions. I know how to locate a vein of resilience and nurture it. And the borderland between paranoia and reality is like a second language—one I can speak with those who are riddled with fear.

My most recent novel, Dance in a Madhouse, takes readers into this borderland. When Owen Townsend, a young doctor, contracts typhoid fever, his world splinters. Facing death from the infection, he’s given massive doses of a drug that may have made him psychotic. Released too soon from the typhoid ward, Owen has a relapse and commits a psychosis-fueled act of violence. He soon finds that his father, who is running for the governorship of New York, has locked him away at Fairmont Lodge, a mental asylum in Philadelphia. It is 1905, a time when entry to an asylum can be a one-way ticket.

Owen believes that his psychosis has disappeared and there is no reason for him to be held against his will. But is he sane? On his first night at Fairmont Lodge, an arsonist sets a fire that kills one of the doctors and wreaks havoc among the patients. Owen becomes the prime suspect. Is he an innocent victim of misdiagnosis and mistreatment for typhoid fever? Or is he a dangerous and cunning paranoid? When he meets with his psychiatrist, questions about sanity get murkier. Owen is having flashbacks to his typhoid-induced delirium. Yet his psychiatrist is doing strange things. Treatment goes astray. Owen senses that someone wants him silenced forever. He is attacked. There are more fires at Fairmont Lodge.

The title of the book is taken from Dance in a Madhouse, a lithograph by George Bellows in the collection of the Metropolitan Museum of Art. I chose the title because it speaks of the egregious stigma about mental illness that existed in the early part of the 20th century and, to some extent, continues now. Bellows depicted a “lunatic ball” where the patients danced in front of townspeople who gawked at them. Margot Taft Stever, a poet who told me a true story that inspired me to write Dance in a Madhouse, captured the abasement in one of her poems. “Behind a glass wall, well-dressed spectators, riveted, sit amused. Looking at them looking, the patients know they are through.” (From "The Lunatic Ball," Cracked Piano, Poems by Margo Taft Stever, Cavankerry Press, 2019.)

Although my novel is a thriller meant to entertain, it touches on deeper questions. What is sanity? Do we still marginalize and fail to understand people with mental illnesses? Can paranoia have benefits? Do our biases make us do harmful things? What is good and bad psychiatric treatment? How far have we come since 1905? The psychiatrist in me couldn’t neglect my long-standing commitment to improved treatment in writing this book.

Why do I, a psychiatrist by training and temperament, write thrillers? The answer is that the writing can be stimulating and fun, particularly when the words flow. I love being inside a puzzle and working to figure it out. I can dig into the characters’ psyches. I can raise questions on psychiatric and social issues that concern me. And the writing transports me to a realm where I can control what happens—a different place than the messy and often confounding nature of psychiatric practice. Another part of the answer is finding a good story, like the one Margo Taft Stever told me about her great-grandfather, that begs to be told.

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