From 1982 to 2001 I was a community mental health psychiatrist. Although I’d been an avid reader prior to medicine, I seldom had time or energy for nonprofessional books during my years at Blue Ridge Center. The writing I did may have been less dreary than the medical average but it was all clinically related. Telling other sorts of stories didn’t become a passion until after developments in the mental health field had convinced me it was time to do something else.
The form of psychiatry I trained in—think Freud—could have been responsible for my fascination with language, but it wasn’t. I’d caught the word bug earlier, from a startling expression. “It had him sweating like a whore in church” knocked a hole in my grade school concept of what words can do. The speaker might have settled for, “He was nervous.” But, I suddenly realized, nervous is only a term. I felt that whore sweat in her pew. Wow! I committed myself to inventing potent phrases. Much later, when reading Virginia Woolf’s masterpiece, The Waves, I resonated with Bernard, the maker of phrases. Bernard meant his to capture and contain his world. I’m too claustrophobic for that. A well-honed turn of phrase delights me more by challenging something I’ve accepted as truth. Is it still okay to allow this something to contain my thinking?
Mental jailbreaks keep me from going crazy. During orientation week at med school they gave us a battery of psych tests. I intended to become a family practitioner and scoffed at the report predicting a psychiatric career. But family practice was a drier game than anticipated. Too often the objective of treatment was coercing a set of naughty numbers to behave. Patients were vessels who carried the miscreants from place to place. Psychiatry, back then, gauged success by how patients felt and what they started or stopped doing. I jumped the family practice ship.
Specialty training taught me that psychiatric ills can be approached from above or below—mind or brain—or both. The art lay in discovering the optimal combination for a specific situation. The brain approach was and is the technically simpler avenue. I wrote beaucoup prescriptions at Blue Ridge. But the challenge of the mental approach—fewer side effects and less pill dependence—intrigued me. To make psychotherapy effective, it helps to develop a sense for how Mr. A experiences his rut of illness and what prevents him from escaping it. Blue Ridge therapists and I spent a lot of time finding out.
Step one was suspending the idea that everyone in his or her right mind sees the world as I do. This normal assumption has limitations. Feed a hundred computers in good working order the same problem and they’ll arrive at the same conclusion. But how they get there depends on operating system and software. A skilled computer tech doesn’t suggest that the owner of a Windows machine minimize all windows by pressing Option-Command-M. Multiply such inconsistencies by a humongous factor when dealing with minds. But the tech principle remains the same. It’s usually best to work within a client’s operating system, software and relevant environment—such as family—even when that’s foreign territory. At Blue Ridge we tried to get far enough inside our patients’ heads to help them apply their own rules in a rut-busting capacity.
The lesson of the whore in church stuck with me, too. Presenting the familiar in a surprising light can be liberating. As a tactic, it had obvious psychotherapeutic applications. I wasn’t the first to realize that, not by a long shot, but Blue Ridge therapists and I studied the techniques of its pioneers. A woman complaining of headaches doesn’t necessarily have to admit to herself that she’s pissed at her lay-about husband for expecting dinner when she returns from work. Since he cooks when she has a headache, might she fake one if she comes home really tired? Turns out she can. Problem solved.
After leaving medicine I became interested in rut-busting processes that don’t require professional assistance. We all have unconscious habits that outlive their usefulness. How do they get broken? Dislocations: births, deaths, and job losses will do it. So can art. At a pragmatic level, art pays its cultural keep not only by crystallizing understandings but also by enticing us to question what we think we know. Art suggests the possibility of alternatives.
Whether I’m producing fiction or nonfiction, the potential for shaking things up in a constructive manner still informs my wording decisions. The guy who made the comment about the sweating whore couldn’t have anticipated its effect on me. But his choice not to settle for “nervous” gave me the space to notice an unexpected doorway. Would I have discovered it otherwise? Maybe.
Such doorways appear whenever a person or character behaves in an unanticipated manner. I have to rethink my assumptions about them. In the novel I’m working on now, none of the point of view characters are quite the people I first imagined. Xan, the young man, is less up front with his dark side than the Jack White-type musician I assumed him to be. As he unfolds his experience, I begin to understand why. His girlfriend, Caitlin, is surprisingly impulsive. Her buttoned-down dad, the third POV voice, harbors a latent wildness as well. Developing a better understanding of their psyches tells me how they’re likely to do what they do. The narrative becomes more theirs, less mine.
I used the same approach for the short stories in MacTiernan’s Bottle. Readers have been surprised at the range of protagonists. There’s a nineteenth century Ukrainian peasant girl, a bitter Korean War vet, an elderly couple, a bereaved New York City attorney, a disapproving daughter, etc. As their stories presented themselves I was aware of desiring the variety. Only after publication did I stop to ask myself how these characters are able to come across as themselves. To the extent that they do, it’s because I got inside their heads.