2022/Oct/05 Why I write, a reflection by Nassir Ghaemi

Dr Nassir Ghaemi

Dr. Nassir Ghaemi, MD, MPH is a psychiatrist and researcher specializing in depression and bipolar illness. After his medical training, he obtained an MA in philosophy from Tufts University in 2001, and a MPH from the Harvard School of Public Health in 2004. He is the author of A First-Rate Madness, among other books. His clinical work and research has focused on depression and manic-depressive illness. In this work, he has published over 200 scientific articles, over 50 scientific book chapters, and he has written or edited over half a dozen books. He is an Associate Editor of Acta Psychiatrica Scandinavica, and is a Distinguished Fellow of the American Psychiatric Association. He is Professor of Psychiatry at Tufts Medical Center in Boston and also Lecturer on Psychiatry at Harvard Medical School.

Why I Write

Every writer has a story about why he or she writes. Every doctor-writer has an even more complex story. Mine begins with an ambivalence about becoming a doctor. In college, I majored in history, making sure I completed only the minimum pre-medical requirements to apply to medical school, as my doctor-father wished, while studying humanities for the rest of my education. I even wrote a fictional short story, “Eagle Forgotten,” about what it must have felt like to be among the last free Indians in the American West, just before they were captured and put on reservations at last. I still have it; it’s still the only fiction I ever wrote. I used to go into the basement of the college computer laboratory, and type away on a huge word processor. That’s commitment.

In medical school, I remained ambivalent. I would go around and ask my dormmates why they decided to become doctors. In that first year of school, many of them, now doctors of long standing, were regretful. The best answer I got was from an apathetic middle-of-the-class guy whose name was Joe (seriously): he said couldn’t think of anything else to do. I used to go to the medical library and browse the shelves of the old books. I looked for biographies of doctors who did great things, and I found that many of them, like me, had been reluctant to become doctors, or had wanted to do other things almost as much, like writing or art. I looked up books on every writer or otherwise non-medical public figure I could find who had been a doctor. The list turned out to be long:

Arthur Conan Doyle, Chekhov, William James, Oliver Wendell Holmes, William Carlos Williams, Walker Percy, Michael Crichton, W. Somerset Maugham, Pio Baroja, Georges Clemenceau, Salvador Allende, Che Guevara (of course), Karl Jaspers.

I came to the conclusion that becoming a doctor was good preparation for writing, among other things.

A few years later, when I was a psychiatry resident, I attended the annual meeting of the American Psychiatric Association where they had a special session for residents called “Meet the Experts.” I arrived late, my Middle Eastern habit, and the tables were already taken for the experts in various diagnoses: schizophrenia, bipolar, depression, PTSD, psychotherapy—all taken. One of the few tables with an open chair had a sign on it: “Writing.” I went over there; our expert was Peter Kramer, who recently had published his hugely best-selling “Listening to Prozac.” It felt like most of the experts were lecturing to the seated residents; Peter was asking everyone questions. Tell me something about yourself, he would ask. Why do you want to write? When he got to me, I described my short story in college, preceded by my first published article in high school, when I had sent a little piece on the biology of pain to a science magazine. And I described how extensively I read, and my humanities degree. “Sounds like the background of a writer,” he said matter-of-factly, or something to that effect. He went on. He described his writing schedule. He would see private patients in the morning and write in the afternoons. I remember reading something like that about Conan Doyle’s early writing career. It seemed doable. In later years, Peter and I became, and are, friends, and he once told me that being a doctor and a writer made sense to him because almost all writers have to have another job. It’s very difficult to making a living as a pure writer. Most are journalists, and, early in their careers, many work menial jobs. Being a doctor is much better than being a waiter, Peter said; you make more income for less time, which gives you more time to write. Very rational.

But it was that little matter-of-fact comment that had the most impact on me. Sounds like the background of a writer. Maybe I already was a writer! I was a writer. He said I was a writer. After that event, I felt more confident that I would be a writer; I would publish books someday. I would make it happen.

There’s more to it. But that’s the genesis of my dual identity as doctor and writer.

We could fast forward two decades to my most successful book, A First-Rate Madness. It got me recognition, best-selling status, media attention. By then I was married and had two kids in the middle of their childhoods. My 8 year-old son had seen me write intensely in our third floor attic in the final year of preparing that book, and he saw the attention I received afterwards. And he had seen me in the hospital and the clinic and traveling to and from conferences. One day he smiled and said, “Baba (Dad), you’re either a doctor or a writer; in between, you’re crazy!” But that’s what my book was about – about how being crazy was actually a good thing in many ways.

You can be a doctor and a writer, but it works best if you really are both, which usually means you were a writer from the start, and later became a doctor. Then you would find that the two roles complement each other and synergize in a way that most people can’t imagine.

I continue to write. In the last two decades, the rise of blogs and the internet has created a totally new space for writing. I keep writing now, and in that setting, especially with blog posts, I mostly write out of a need to write, as well as in response to questions. People often ask me, what do you think about this article or that? What do you think about this issue or that? Instead of writing long emails, I write blog posts and circulate them on social media. Sometimes people don’t ask me anything, but I feel a need to write. I have an urge to say something. Instead of haranguing my wife and kids or colleagues with my unsolicited opinions, I write a blog post and harangue the rest of the world. It’s much better for one’s marriage. I’m not sure it’s better for the world, but it is better for me. Once I’ve had my say, I feel lighter and can go about my daily business.

It’s a cliché to say writing is therapy; it’s not therapy, but it can simulate some of the benefits of therapy, especially catharsis. People don’t want to hear you talk much; people get tired of listening. But a writer just talks, in print, and people have to listen, if they read what he writes. They don’t have to read it, obviously, but the writer doesn’t know that. He or she still gets the benefit of having written, the benefit of the catharsis.

So for me, writing blog posts and opinion pieces isn’t a chore; it’s a relief. But at the same time, a serious writer has to fight this trait too. Because it’s too easy to write little pieces about all kinds of things, instead of finishing that long memoir. Long writing is hard writing and it’s the most important. I read somewhere that Arthur Schlesinger, the great Harvard historian and advisor to President Kennedy, regretted in later life writing too many articles and too few books. That was before the internet.

My advice to doctor-writers is to write when you feel the need to write. Talk less, write more. But also, always have a long-term project going, and keep at it. That longer, harder writing will be your main legacy.

~Nassir Ghaemi.

For more on Dr Ghaemi, check out his website: https://www.nassirghaemi.com/about and follow him on Twitter @nassirghaemi