The Psychiatrist as Novelist: A Discussion with Keith Ablow

At a glance it might appear that for first-time novelist Keith R. Ablow, M.D., success came easy. The ink wasn't yet dry on the pages of Denial: a Novel, released in late June, when Ablow was negotiating with his publisher, Pantheon, about a sequel. Plans are being laid for yet a third book that will, like the first two, center on the character of Frank Klevenger, forensic psychiatrist. St. Martin's Press won paperback rights to the dark whodunit, competing successfully against Bantam Books.

Ablow, however, himself a forensic psychiatrist, wouldn't call it easy.

"In this business of writing fiction," Ablow said, "and I bet it's true in every other line of endeavor as I know it's true of medicine, it's all about the work. It's really about learning the structure of the novel, learning how to put your thoughts into that structure so that they can be more powerful, and then respecting the structure of the business itself, so that you can be published."

No doubt it also helps that before he was a psychiatrist, the 35-year-old Ablow was a writer. He edited a newspaper in high school and later at Brown University, where he was a neurosciences major. Then, during his first year at the Johns Hopkins School of Medicine, he went to the dean's office with a problem. They knew he was a writer, he said, and yet he had no time to write. "I asked for their help, and they gave it to me by letting me write some feature stories for the [Johns] Hopkins Medical News, giving me credit for some rotations at Lifetime Medical Television, where I learned a bit about production... [They supported] me in my application for a fellowship at Newsweek, which I got, which was a summer fellowship as a reporter after the first year of medical school.

"So both writing and practicing medicine have been evolving at the same time. The writing has been a lifelong passion. As a boy I wrote for pleasure; in the earliest grades in school my hobby was writing outside of class. It's been with me a long, long time."

Since then, his essays have appeared on Mental Health InfoSource on the World Wide Web, in USA Today, U.S. News and World Report, the Baltimore Sun and other print media. He wrote a column for the Washington Post's health section and continues to write for the Post occasionally. An article is planned for this fall in Discover magazine as well as the Boston Herald. Taken collectively with his works in the medical literature, this is not an unimpressive platform from which to make the leap into fiction writing. In Denial, however, it is his particular experience in his chosen field that supports and gives authenticity to his characters and delivers to readers some harsh and poignant truths about humanity.

He spoke about Denial's central character, the coke-snorting Klevenger, a man whose work and love combine to assign him a dreadful mission: he must learn the identity of a killer regardless of who that person may be.

"I think...Frank is a likable person who is trying to be courageous in facing his personal pain, even while he is doing things that could be perceived as self-destructive," he said. "He's a womanizer, a cocaine addict and a compulsive gambler. But he's also a psychiatrist, and he's a very empathic and skilled psychiatrist. And I think people are intrigued by the fact that you could be both things-that you could be broken and therefore resonate with other people's pain.

"I think most people need to help open that long black bag that they drag behind them, and inspect its contents and become integrated as people by facing the darkest part of themselves. Klevenger is trying to do that; he's fumbling and stumbling along the way, but ultimately he has the courage to own his own pain. I think that's why people are attracted to him."

The media have indeed responded to Klevenger, whose creator has been on a spate of television talk shows and newsmagazines. "What the media want to talk to me about is Frank Klevenger's heartfelt belief, and mine also, that we're going down the wrong path in society by building bigger prisons to hold more and more people with smaller and smaller cells. Psychiatry has been remiss in not claiming sociopaths and people in jails as our own. I think we know that those who lack empathy for others are ill, but we haven't been willing to say it very loudly and insist that people who inflict violence on others are sick in a very real way and they need help."

Asked whether Denial's publication is a turning point in his life, Ablow said he is not about to give up psychiatry and only write.

"I'd miss [psychiatry]," he said. "It keeps me connected with people's pain and with the truth. The skills I learned as a psychiatrist were my real guides to better psychological health. And I honor the profession not only because of its vast power, but because it's helped me. I wouldn't want to lose touch with it entirely."

What advice would he share with his colleagues who might want to pursue fiction writing?

"My best advice is that whatever you're going to branch out into, it's like Abraham Lincoln said: 'If I had nine hours to chop down a tree, I'd spend eight sharpening my axe.' If you really want to write a novel and use your psychiatric expertise to do that, first really dedicate yourself to learning the structure of a novel. Even if it's something as simple as buying a series of tapes, taking a class or buying a book. Do that before you put pen to paper. And then, actually do the work.

"A lot of this is about dedication. It means if you have to get up at 5 a.m. and work until 7:30, then that's what it takes. Having discipline and doing it every day makes it a reality.

"Another thing," he continued, "is that if people have the suspicion that they're writers, they probably are. Maybe that's the most helpful thing I can say. It's not a fantasy; if you think you have a story and you'd like to tell it, that's very good evidence that you're a storyteller and could probably do it. It's just about collecting the skills.

"The more psychiatrists writing, the better. I think we have a unique view of the world, and we should be sharing as much as we can."