Jacob Appel is a physician, attorney, and bioethicist in New York City, where he teaches at the Mount Sinai School of Medicine. His story collection The Amazing Mr. Morality will be published by WVU Press in February.
One of my favorite jokes relates the story of an impious rabbi who goes golfing on a Jewish Holy Day and is punished by God with a perfect score. In the punchline, God asks the angels, “But who can he tell?” My job, as an emergency room psychiatrist and hospital-based bioethicist, raises similar challenges: I hear the most amazing, unlikely, compelling stories all day long—but the magic often lurks in the details, and both canons of medical ethics and federal law prevent me from sharing these stories with others. (For fifty years beyond the death of the patient, at least; check back with me at the turn of the next century.) So if I cannot write about my professional experiences, even in the most oblique or veiled manner, how does being a psychiatrist or ethicist influence my writing?
Medicine teaches three skills of high value to a writer: skepticism, intrusiveness and iconoclasm. Among the significant responsibilities of an emergency room headshrinker is rooting out malingers—individuals who fake mental illness for nefarious purposes (such as to avoid a court date or a drug deal gone wrong). I have found a similar technique helps shape my stories: My characters may make claims, but as a writer, I find myself wondering whether their claims are actually true—and sometimes I even challenge or undermine them in the story. For example, in “Tracking Harold Lloyd,” an old woman launches a search for her missing dog . . . and then I start to question whether there is a dog to be found. This technique works well up to a point in life: It’s helpful to count your change in a convenience store, less so to ask your elderly father to undergo a paternity test. Similarly, as a writer, you want to raise questions about the veracity and insight of your characters, but if they are always lying or mistaken, readers will feel betrayed.
Intrusiveness is the core skill of the clinical psychiatrist: Asking people about their sex lives and their murder fantasies and why precisely they stopped wearing clothing on the bus. Similarly, posing unwelcome questions to one’s characters is crucial to making readers connect with them. In my story, “Right of Way,” for instance, about a fatal conflict over the renaming of a suburban street, my goal was to expose the complex psychological and social stakes behind a seemingly innocuous controversy. Again, this approach can prove a double-edged sword in real life: Great if you are a Supreme Court litigator, less appealing on a first date.
Yet the most distinctive feature of my own fiction, I have found, derives from iconoclasm—that blend of contrariness and irreverence that helps one see the world through the wrong end of the kaleidoscope. In both bioethics and psychiatry, it is essential to take patients on their own terms and to rethink accepted norms. Much of my fiction, including the stories in The Amazing Mr. Morality, are designed to force audiences to envision normative standards very different from their own. So, for instance, “The Children’s Lottery” asks readers to imagine a world in which “harm reduction” theory is applied to pedophilia and thus pedophiles are treated with sympathy and tolerance. Needless to say, there are limits to this approach in everyday life as well: It’s one thing to acknowledge that nobody would want to be born a pedophile (any more than they would want to be born an alcoholic or a schizophrenic), so we should treat pedophiles as mentally ill . . . but quite another to invite them over to babysit one’s kids.
And of course there is the obvious way in which being a psychiatrist helps me to be a better writer: I never have to worry about keeping a roof over my head, because the planet’s supply of crazy folks seems bottomless. At least, here in downtown New York City. So I suppose the moral of this blog post is that if your kids or grandkids dream of becoming writers, the best advice is to send them to medical school.