The Art of Medicine with Dr. Andrew Wilner
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The Art of Medicine with Dr. Andrew Wilner
"Dance in a Madhouse" with author and psychiatrist Jess Wright
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Many thanks to Jess Wright, psychiatrist and author of “Dance in a Madhouse.” Jess is a Professor of Psychiatry at the University of Louisville, where he sees patients, teaches, and does research.
Jess joins several other psychiatrists featured on “The Art of Medicine:” Jesse Gold (Episode #130), Richard Berlin (Episode #99), Awais Aftab (Episode #85), Steve Moffic (Episode #78), and Ronald Pies (Episode #63). Now working part-time, Jess has more time for fiction writing. As a psychiatrist with decades of experience, he incorporates some of his patient experiences into his creative writing.
During our 30-minute discussion, we discussed why Jess writes, how he writes, and his upcoming novels and memoir. We also addressed how the practice of psychiatry has changed since 1905, when his novel “Dance in a Madhouse” takes place.
Jess truly enjoys the intellectual challenge of creative writing and believes it may be a strategy to stave off the intellectual stagnation that can come with retirement and aging! Y
ou can pre-order “Dance in a Madhouse” on Amazon here: https://amzn.to/4vZY7oV
Or learn more about Jess at his website: https://jesswrightmd.com/
#psychiatry #mentalillness #madness #madhouse #depression #bipolar
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Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Wilner. I've planned a great program for today, but first a word from our sponsor, LocumStory.com. Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. Locumstory answers your questions on their website, podcast, webinars, videos, and they even have a Locums 101 crash course. Learn about Locums and get insights from real life physicians, PAs, and NPs at LocumStory.com. And now to my guest.
Speaker 1Today, I would like to welcome psychiatrist and author Jess Wright. Jess is a professor of psychiatry at the University of Louisville, where he sees patients, teaches, and does research. Jess is also the author of the psychological thriller Dance in a Madhouse, due to be released any day now. Welcome, Dr. Jess Wright.
Speaker 2Thank you, Andrew. It's a real pleasure to be here with you.
Speaker 1You know, in uh preparation for our discussion, I reviewed uh some prior programs and I discovered that I've interviewed five other psychiatrist writers.
Speaker 2My goodness, I didn't know there were that many. Jesse Gold. There are, because you've done it.
Speaker 1Ronald Pye, Steve Moffik, Oyais Aftab, and Richard Berlin. And at least one of those writes exclusively poetry. And um Jesse Gold has a recent kind of autobiographical story about um uh COVID and the stresses, and she actually works here at uh my institution uh here in Memphis, Tennessee. You're in Louisville University. That's not Louisville, Louisville, Kentucky?
Speaker 2Louisville, Kentucky. It's the University of Louisville.
Speaker 1Okay. Which which I guess that's in Louisville, right? Um but that's quite a ways from Memphis, isn't it, driving-wise?
Speaker 2Well, I've never driven to Memphis, but I suspect it would take you a few hours to get there.
Speaker 1Yeah, not on my uh radar. But you've been there for a while, right?
Speaker 2That's correct. I spent my entire career as an academic position at the University of Louisville.
Speaker 1Where you still are, but in a slightly more part-time.
Speaker 2Yeah, so I've uh I've been fortunate to be able to step back a bit from some of my responsibilities. I still see patients. In fact, this afternoon I'll be in the clinic uh seeing patients and I teach. Uh I started a new course this afternoon, also, and um I do some research. So for many years I was full-time and wrote uh a fair amount of medical works, uh several textbooks, self-help books, lots of scientific articles, grants. Uh so I had some experience as a writer, but not really in fiction, so that was a bit of a transition for me.
Speaker 1So now that you have a tiny bit of extra free time from all of your other responsibilities, you've decided to use it to write.
Speaker 2That's correct. And I'm having a good time with it, get a real kick out of it, and I think I'm learning some things along the way. And as an older physician, I'm I extol my patients that uh physical exercise and mental exercise are really good for longevity. So this is a bit of Dr. Heel myself, and so I'm I'm doing something new with my brain of learning these uh skills of of writing fiction, plotting, um, keeping suspense going, and so forth, which uh I never really did that. I read a lot of the books, but not uh not not didn't try to write it until much later in my life.
Speaker 1All right, so you've touched on a lot of things there. I've done a few programs on uh retirement, and uh I did one recently on Matt Harmady, and uh who's an ER doctor recently retired, and he retired to become an advocate for kidney donation. Um and uh he himself donated a kidney to a perfect stranger. His dad had had renal disease, and he just felt, you know, you can uh a lot of people dying and waiting for kidneys, and there are all these uh people with two kidneys that only need one. You know, let's fix that. So that became his uh mission that retiring to something, as uh you're I guess at retirement age, whatever that is these days, right? Yes, yes.
Speaker 2I could retire if I decided to do so.
Speaker 1You know, but um then uh but the advice that I see is that, well, you know, you want to retire from your work, uh, but you have to retire to something. So if you retire to the challenge of sitting at your desk um concocting these uh plots, right?
Speaker 2Right. I'm doing puzzles every day. I sit down to write because I have to not only figure out uh a large puzzle to try to present to potential readers, uh, because these are mysteries, thrillers, uh some excitement in them. But also each day there's a puzzle in how I'm gonna figure a way out of this that somehow I've put my characters into and myself into, and trying to solve these uh problems of being an author. So I think it might help grow a few brain cells, I'm not sure, but it's probably better than um just sitting watching TV all day long, which I wouldn't recommend.
Speaker 1So I think you're answering my uh question number three here. Why do you write? And uh you write because it's fun, right?
Speaker 2Yeah, sometimes it's a lot of fun. And I I didn't know this when I wrote just my medical things. And uh in fiction writing, sometimes I get into this sort of a flow state where I have an outline and I you know I know where I'm going, I think. Uh, but the outline serves as uh like a structure that allows some things that begin to happen that I never really experienced that much before in my so-called creative life. So there's to me, there's a bit more creativity than anything I've ever done before.
Speaker 1Um Yeah, I've written a bunch of medical papers, and I can't say that they were fun. There was satisfaction, right? Uh feeling of uh particularly when it was done. But uh the process was very uh spelled out for you, right? You've got to fill in the fill in the blanks.
Speaker 2Um I agree with you. Uh extensive literature reviews, lots of citations, uh making sure you have every little fact just straight. But in fiction writing, you have a lot more license to just let it go where your muse wants to take you.
Speaker 1So what about support? You know, writers, uh people, if you're not a writer, people don't understand what writers do. And um, you know, oh, you're at home all day, right? You can do this, you can do that, you can answer the door, get the UPS package. And it's like, no, I'm writing. Uh and at home, do you have support for your um writing?
Speaker 2That's uh really an excellent question. I'm glad you asked it. Uh, I think you need support, obviously, at home. I mean, the people that you live with have to be on board, at least in part. Um sometimes my wife uh wonders if I could give her a bit more time because I might parcel out uh a whole morning or a whole afternoon, which is the way I do it, by the way. I I have a schedule I pretty much stick to as far as my writing time. Uh, but she's been very supportive. I'm working on a memoir now, which is something that she wanted me to wanted me to do for many years, and I resisted it because I said, well, how can a psychiatrist write a true memoir? Because you're supposed to be honest and tell what's really happened. And and I need to tell somewhat about what I'd done as a psychiatrist and how can I protect confidentiality. But I did read a book, uh Do No Harm, uh, by a British neurosurgeon that uh really inspired me, and he was able to fully mask his patients.
Speaker 1So I'm at the-is that the guy he's got the big glasses, um uh British neurosurgeon. I think he just passed away.
Speaker 2Oh, did he? Yeah.
Speaker 1He's written a couple of books.
Speaker 2Um beautiful writer, yeah. But my wife is really on board for that, so she uh likes to read each chapter and give me some suggestions because she's been along for the entire ride. We've been married now for a long time. Uh, but I wanted also talk about support that you might need, or at least I've needed, from other people, from experts. So sure.
Speaker 1So at home, uh you've gotten good support from your wife. Uh, she acknowledges that you need protected time so you can be creative and get something done. And is there any other support that you find is uh helpful?
Speaker 2Yeah, very important. Um, particularly when I wanted to make this transition to fiction writing. Uh I had a support team of colleagues that I wrote with, you know, write books with, chapters with, and so forth. But uh in writing fiction, it was a whole new ball game, if you will. And I was real fortunate to find uh New York Times bestselling author, Will Lavender, who's been my writing coach. So Will is a big part of my support team. And then I also have a copy editor who really does a lot more than look for commas and punctuation and things like that, but she gives me great advice on how things are spinning out and what I'm writing. And each chapter that I write, I send off to them and get some feedback. And I sit down with Will. Uh in the beginning it was once every couple weeks. Now it's less frequent, and they're very helpful. And I have friends that read and others that uh help me out with along the way. So it's really important to have that because writing can be a pretty lonely affair if you don't have any connections. So I've I've been I've been uh real happy to have some people behind me.
Speaker 1Now I always thought writing is something you really don't want to share until it's done. You know, no, no, don't look, it's not done. But you're finding that along the way it's useful to have uh input.
Speaker 2I'm sure there are many different styles of writers, some that would like to keep it all to themselves and then have somebody take a look at it. But for me, it's been helpful to have feedback along the way. So I make adjustments and get ideas and it's enriched the writing, I think. So that's that's just the way it's it's worked out for me.
Speaker 1That's very interesting. Now you're kind of in a unique position to write a thriller, um Dance in a Madhouse, right? That that focuses on uh site, the world of uh, I guess, psychiatry pre uh medication, right? Pre-medication.
Speaker 2Yes, we're going way back to the beginning of the 20th century.
Speaker 1Right, which isn't really that long ago, right? I mean, we don't, you know, I mean, there was a pre-antibiotic era, right? Before World War II. You know.
Speaker 2This is a time when uh psychiatrists like Freud and Jung and Pierre Janet and Adolph Meyer in the United States were just beginning to put some science into trying to understand the mind and its maladies. Uh, but it's a period very rich in history, and it was very intriguing to me. I got the idea for this particular novel from a friend of mine who's a poet. Her name is Margot Taft Stever. And Margot's uh great-grandfather was uh named Peter Taft, and he was the brother of William Howard Taft, the president. It's a very interesting story that had never come to light. And uh Margot found some letters of his that were written from inside a mental asylum back in the early part of the 20th century. And uh Peter, who was uh number one in his class at Yale, uh had contracted typhoid fever and was treated for and apparently became psychotic, at least briefly. And it was enough of an embarrassment to the president and the other people of the family that he deep-sixed him in this mental asylum. And he was in there for a very long time and his life really fell apart. And uh his letters, which are very lucid and beautifully written, uh, are pleading to be released. And the poor fellow, by the time he was released, he had TB that I think he probably contracted in the asylum and he died. So it's a pretty sad story. Uh Margot asked me to write it uh an introduction to her book because she suspected that Peter actually was toxic on mercury chloride because he was treated with calomel. I don't know if you remember that name from your medical training, but calomel was used to treat typhoid before there were antibiotics, and calomel is essentially pure mercury. Um, so it was an interesting tale. And I thought, well, writing exactly about Peter would not interest too many people that's because we didn't know too much about the story, so I concocted a fictional story of a young doctor who gets typhoid and uh is also from an important family and gets put away, and then he's stuck in this place where some really bad things happen, and he's he's in quite a great deal of jeopardy even for his life, and has to use his wits and his connection to other patients to be able to somehow figure out a way to save his reputation, save his life and get out of this place. And there are lots of adventures that happen along the way. So I was able to infuse it with some of some of my psychiatric experiences, like uh cases of postpartum psychosis and uh catatonia. Um, you may have heard of catatonic excitement, where uh someone who changes from almost a stupor to a sudden severe agitation. So I was able to bring some of my experience for many years of doing inpatient psychiatry into writing this book. So you might say, could Dr. Wright have fun doing this? Well, in a way, yeah, because I'm trying to share these experiences and put them together in a way that holds people's interest, uh, makes it a mystery that they would might like to try to figure out themselves, and also says something about stigma and some of the social issues, not only of those times, but social issues today. So that's a bit about that book.
Speaker 1Right. So Mercury, wasn't that there was this expression mad as a hatter? Didn't have something to do with mercury poisoning. That's it, yeah.
Speaker 2And uh that's that comes from Lewis Carroll and uh Alice in Wonderland. And uh realized that yeah, the uh rabbit uh was a hatter. Uh and hatters treated their, I guess beaver fur was with mercury, and that's why it was a it was an occupational asset. Of course, we don't use mercury in medical treatment for typhoid fever today, but uh it was used extensively back then.
Speaker 1You know, you are in a unique position to write something like this. You have 40 plus years of seeing patients with psychiatric uh illness or disorders. And of course, I'm a neurologist, and so very often I'll see patients and who have altered uh mental status in one way or another, and it's a question: is this psychiatric or is this neurologic? You know, and sometimes it's kind of uh the wrong question, right? Because psychiatry and neurology are there's no dividing line as far as I can tell. Um you know, all has to do with the the brain. Um and we saw a patient just the other day who uh a lot of uh bodily complaints, but uh seemed to be to me more psychiatrically uh generated. But uh it's a challenge to treat patients uh like that. Um but you know, you have uh now uh a historical kind of uh view. Um had what what would you say are the biggest changes you've seen in how we treat people that have psychiatric problems?
Speaker 2Well, if we contrast today with uh 1905 when my novel takes place, it's been a you know huge sea change. Even in my career, I started my career in the 70s, and um we had lithium and we had sedatives, barbiturates, and uh, but this was really the dawn of psychopharmacology. Uh chlorpromosine had just been introduced in the 50s. Uh the Prozac didn't come out until the 90s, and we didn't have anything like transcranial magnetic stimulation or ketamine. Uh there was uh not a single randomized controlled trial that showed it that talk therapy worked, and now there are thousands that show that uh talk therapy, particularly things like cognitive behavior therapy, are highly effective, which is extremely interesting. And we also know that if psychotherapy like cognitive behavior therapy changes tracks in the brain, as a neurologist, here you might be quite interested in this, that it actually has uh an effect on neuroplasticity and uh changes the way connections are made and the way the brain functions, which you'd expect. I mean, if it's if a psychotherapy is going to work, it's got to work through the brain somehow or another. Uh but some of the drug treatments and biological treatments and the psychological treatments may have a final common pathway. So that's all that's what fascinated me. So I think you're quite correct that the there's no real firm border between neurology and psychiatry, and uh all of them have daily puzzles for us as clinicians that are just fascinating and uh make us think and uh make our days interesting and uh fascinating and sometimes full of uh happiness and joy when we can figure out a solution on those occasions when it actually occurs.
Speaker 1I know back in the day, so in the pre-antibiotic, pre-pharmacologic treatment for psychiatric illness, the treatment was to put these people away in a quote, madhouse, right? Or an asylum. They had asylums for tuberculosis, they had asylums for people, I'm an epileptologist, for people with epilepsy. So they find some farm somewhere, and everybody with epilepsy just go live there, you know, get away from the regular population.
Speaker 2That was the treatment, and it it uh created huge problems. Um in psychiatry, patients with psychiatric illnesses were essentially segregated away from mainstream medicine. Uh, there was a big movement in the 30s and 40s to move psychiatry back into the general hospital, of psychiatry units that were smaller that were embedded along with the other medical treatments, which was a uh much needed move. But prior to then, it was mostly state hospitals or private hospitals. People just go and stay, sometimes for a lifetime. Um, and they became so-called institutionalized. They stayed there for so long that they lost their social skills, their ability to do things like even like um manage uh grocery shopping or getting on a bus or whatever because they've been taken care of. So there's it was a huge move away from that institutionalization. Some of us think that it may have been the pendulum swung too far, and now we have few options for people that have persistent, really severe psychotic illnesses or other conditions where they may need some kind of a long-term treatment. So it's pretty hard to get that in in today's world.
Speaker 1Right. And we have many of the people who are homeless are not homeless, you know, because they they can't afford an apartment. They're homeless because they can't.
Speaker 2Exactly. The rates of mental illness and substance abuse are huge and in the homeless are in house population.
Speaker 1Yeah, I'm thinking of the movie as a reference, a rain man, where uh the patient lived, it was a very nice estate, but where he was totally dependent on his caregivers for for everything. You know, when to get up, when to go to sleep, when to eat, where to go. And that's not the way to bring somebody to make them functional in society. Um you have to develop those skills, not uh sort of uh over over protect. I mean, it did protect the patients, I would say that was the purpose, really, right? To protect people from violence, because some psychiatric patients are violent, although that's a minority, I would say. Would you agree with that?
Speaker 2Yeah, in fact, psychiatric patients are more likely to be victims of violence than perpetrators of violence. Uh so I've you know I've had a long career. I've of course I've seen patients that have become aggressive and and um have even had them attack me, which has been very disturbing. Uh, but the vast majority, 99 plus percent, find people uh suffering illnesses and need our understanding and support and help. To go back uh just uh for a moment to 1905 when this novel of mine takes place, uh I found the title for this book, which is an unusual title, from a lithograph done by George Bellows, who is uh, I think pretty well known as an American painter. And the the uh lithograph is in the Metropolitan Museum of Art and the National Gallery of Art, and it's titled Dance in a Madhouse. And the uh the practice at that time was to have so called lunatic balls, which is a terribly stigmatizing term, and the patients that were held in the hospitals would be asked to have dances and the public would be invited to come in and essentially gawk at them. And it was like sport for the public. And to me that was a an egregious example of the stigma or mental illness that existed in you know quite extreme form back then and still does to uh to a large extent uh even among physicians by the way. So physicians that may be suffering from depression or um substance abuse or other problems are pretty reticent to get help because they have fear that they're gonna be it's gonna they're gonna have lots of repercussions. The term suffering in silence is is in use to talk about physicians that have depression.
Speaker 1Right you know I I I talk at the resonance you know to try and visualize stigma it's like let's suppose uh you know it's three in the afternoon and I tell my residents hey I have to leave early I got to go see my cardiologist right that would be they to go okay no problem yeah right but if I say oh I have to leave early it's just like I got to go see my psych psychiatrist that would that would raise some eyebrows right it does yeah and it's it at least from my perspective as a psychiatrist we shouldn't do that.
Speaker 2We should be seeing any illness as needing our understanding and you know giving people an opportunity to get the treatment they need. But it's still rampant. It's seen often but it's a weakness somehow there you should have enough willpower to put this away and uh willpower doesn't do much good against doesn't do much good against bipolar disorder or severe depression or or anorexia nervosa or you name it. You need uh good help. People who know what they're doing to try to help you out of it.
Speaker 1I I think there is progress certainly in epilepsy where there's also been a stigma in the last four years there's less you know people uh before if you had epilepsy you wouldn't tell anybody you wouldn't the people they would keep the children in the house not let them go out it was uh shameful to have epilepsy I think that's phased out for the most part people will come for treatment and admit they have seizures not happy about it but um there is less stigma now um but I wouldn't say there's none right well I think we've tried to get across the message that psychiatric treatment for the most part is effective.
Speaker 2It it really helps people it works. Uh so we need to see it for what it is. And psychiatry's changed a great deal moving from those days of Freud and Jung and so forth to uh a lot of understanding of neurobiology so we now have these treatments that are based um on uh like changing circuits in the brain through transcranial magnetic stimulation which uh it's really nice to have those treatments for people that need them.
Speaker 1Right I'm gonna venture that one of the reasons that you have not completely retired is that psychiatry is getting pretty exciting now in terms of how you can help people.
Speaker 2Correct it's uh it's it is in a very exciting time for psychiatry. By the way we have uh huge competition for residency spots in psychiatry which wasn't the true wasn't true uh number of years ago when I first went into it when I chose psychiatry I I think my family a lot of people I knew thought I was making a terrible mistake it was like I was throwing away my career here I'd gone to medical school and you know took a lot of money and effort and everything to get there and now you're gonna be a psychiatrist you know what why should you do that? But to me it was uh like a frontier um and uh something I thought would be extremely fascinating and interesting throughout a very long career and it's proven to be that and you were work every day I I'm I'm looking forward to it I don't want to retire. That's uh that's I still get a real kick out of it. So I'm mixing this writing and uh and uh working essentially about halftime as a as a psychiatrist and teacher.
Speaker 1All right so back to the book. Is it out yet? Is it on it?
Speaker 2Actually the formal publication date is September 29th but I think it's probably going to be available uh sooner than that you can order on Amazon now or other uh online retailers uh so it'll be out and uh about a year after that's a the second in a series of mysteries uh medical mysteries that are based on this character Owen Townsend who is the fellow that ends up in this mental institution and dance in a madhouse so the next novel is called Dance on the Edge and it uh also has a medical background and instead of doing so much with psychiatry I get into the very early dawn of human transplantation and um I think it's a it's a pretty good tale that's gonna be very interesting for people and uh so that'll be coming out in about another year.
Speaker 1That's great by the way I did an episode on this program uh on human uh transplantation uh a couple of them uh so uh there's some background info picking back and talking a year or so about yes yes well I'll make a note to have you good back uh we are recording today August 4 and uh your episode is gonna come out probably right around September 15th so that it's perfect timing. Perfect perfect timing yes launch of the book well I I wish you the best of luck that your book is uh appreciated.
Speaker 2Well thank you uh you know you you hope that a few people will read something when you spend a lot of time on it so uh I I thank you for helping get the word out Dr.
Speaker 1Jess Wright thanks for joining me on the Art of Medicine.
SpeakerAnd now a final thanks to our sponsor locumstory.com Locumstory.com is a free unbiased educational resource about locum tenens it's not an agency Locumstory exists to answer your questions about the how-tos of locums on their website podcasts webinars and videos they even have a Locums 101 crash course at Locumstory.com you can discover if locum tenens make sense for you and your career goals. What makes Locumstory.com unique is that it's a peer-to-peer platform with real physicians sharing their experiences and stories both the good and bad about working locum tenens hence the name Locum Story Locumstory.com is a self-service tool that you can explore at your own pace with no pressure or obligation it's completely free thanks again to locumstory.com for sponsoring this episode of the Art of Medicine I'm Dr. Andrew Wilner see you next time this program is hosted edited and produced by Andrew Wilner MD F-A-C-P-F-A-A-N guests receive no financial compensation for their appearance on the art of medicine Andrew Wilner MD is a professor of neurology at the University of Tennessee Health Science Center in Memphis Tennessee views thoughts and opinions expressed on this program belong solely to Dr. Wilner and his guests and not necessarily to their employers, organizations, other group or individual while this program intends to be informative it is meant for entertainment purposes only the Art of Medicine does not offer professional, financial legal or medical advice. Dr. Wilner and his guests assume no responsibility or liability for any damages financial or otherwise that arise in connection with consuming this program's content.com