There’s Not Always a Pill for That: In Defense of Conflict

February 18, 2016 | 28 6 min read

If you talk to literature professors, you may have heard them wonder aloud at the tendency of their students to diagnose characters. Anna Karenina clearly has borderline personality disorder, Holden Caulfield seems to have been abused as a child, Raymond Carver’s characters wouldn’t have these problems if they’d just go to AA. Perhaps it’s an obvious direction for students to take, given the information society provides them. Yet it’s pointless to reflect that Mrs. Dalloway could have benefited from Prozac. It wasn’t available to her.

The stakes are raised, though, when you consider work being produced by those same students in creative writing workshops, whose characters (period pieces excluded) have access to a range of drugs and treatments for mental illness. In the rush for realism, students are quick to say a character struggle wouldn’t happen because, “she’d be on Lithium by now.” This class climate presents a challenge for the fiction teacher. When there’s a pill-for-that at every turn, what happens to conflict in narrative?

I recently returned to school to pursue my MFA. During student-teaching of a fiction workshop I was surprised at the difference from the workshops I’d attended in undergraduate classes 20 years before.

The students, I noticed right away, have a more gentle demeanor than those who’d been my peers in undergrad during the early-90s. They seem more mindful of the tender feelings connected to the works-in-progress. They give constructive criticism and demonstrate little joy in pointing out weaknesses in their peers’ stories. But they are relentless on medical details that are likely to vary from person to person. Like how the body responds to Oxycontin. How people with Alzheimer’s behave. How depression manifests itself. How sleeplessness is not usually a symptom of psychosis (Really? I’m not sure about that. How do I correct this student? I didn’t receive this particular training!)

A friend with whom I’ve workshopped fiction for years, Maggie Leffler, is also a doctor, so I thought she might have an interesting perspective, that she might at least be shocked at all these laymen so quick to make diagnoses they’re not trained to make. People aren’t shy on that front, she tells me. In a workshop with her own peers, one reader said her character should just get on Lexapro. “But her mother had just died,” Leffler remembers thinking.

“Pretty much any character’s idiosyncrasies could be interpreted as symptoms of a mental illness,” Leffler says. “But we want to read stories about the human condition, not necessarily a medical case study.”

Still, why should it bother me? Why not just redirect and move on? After all, doctors are using writing to improve their approach with patients, why shouldn’t writers use the medical knowledge they’ve accumulated? I asked Jason Lewis, who runs a series of writing classes for physicians through his work as the director of the writing and humanities program at the University of Iowa Carver College of Medicine, and who is also the editor of its journal, The Examined Life, which features the creative works of physicians.

The doctors-in-training who take his course love it because it represents a departure from their typically humanities-free curriculum. “They tell me the writing helps them remain present as individuals for their patients. When things get difficult they may be less likely to shut themselves down.” Free from the hunt for a final and correct answer, their thought processes have room for a fresh kind of discovery.

Lewis believes that the reverse, however—letting a creative writing discussion get hung-up on the finer points of a medical or psychiatric condition—is a form of narrowing, of letting the science take over in a realm where the human condition (not the medical condition) must remain sovereign. He has also taught young people who want to be writers, and he thinks the medicalization trend is a symptom of a desire to sanitize, to avoid anything uncomfortable. Their characters tend to act wild only if they’re drunk (so he forbids his first-year students from including excessive drinking in their works), conflict rarely reaches a breaking point, characters get on anti-depressants, and the story ends abruptly. “How can you blame them: they live in the era of micro-aggressions and trigger warnings. Their characters, their very thoughts, must seem dangerous.”

Author and psychiatrist Doris Iarovici adds a wider lens to Lewis’s observation, pointing out that the students might be right to worry about what thoughts they put on the page. “In medicine, we once thought of fantasy as something the patient was unlikely to act on, but now, in these times of mass shootings, spurious lawsuits, and limited time to evaluate patients, if a patient divulges a fantasy with certain disturbing elements, in some cases we are required by law to take it very seriously, even to report it.”

Our imaginations may not be considered sufficiently separate from real life anymore. So the fiction writer, at work conjuring conflict (a form of Munchausen by proxy, maybe?), becomes a sort of psychopath, a war-monger of human emotions, when we should be giving peace a chance.

Where does this leave a fiction student exploring characters of all types, asking peers to look at the work and offer suggestions to improve it? If these peers don’t say the psychotic protagonist needs psychiatric help right now, are they themselves guilty by inaction? If they don’t scold the sexist behavior of a character, are they somehow complicit?

Conflict has long been considered a cornerstone of fiction: Man against man. Man against nature. Man against himself. Sharon Dilworth, professor of creative writing at Carnegie Mellon, thinks the discomfort with inner turmoil may be the reason so many students are turning to science fiction. They can handle man-against-nature or man-against-evil, but they come up dry on conflicts against another good person, or against self. “We’ll workshop a story about a planet without water, so I’ll ask them, ‘but what’s the problem?’ and of course I mean interpersonal but they say, ‘well, there’s no water.’” Or a student will turn in a story in which the roommate who at first seemed distant is revealed to be paranormally evil, so the “good” main character has no choice but to kill her. “There’s no conflict for a whole story and suddenly they’re blowing up the world or killing the roommate.”

If main characters are always good, if protagonists always squeaky clean, what is revealed about our inner selves? Have we decided there is no value in exploring the darker side of real human existence?

Literacy advocates argue that putting conflict on the page is a good way to help people process it in their imaginations so that real life is more manageable—Lewis’s medical students use fiction to build bedside manner, for example, and (scientific!) studies show that reading literature builds empathy. For great moments in literature to play out, conflict must play out, and often characters must behave in ways that aren’t pretty. By resisting conflict on the page, we may risk being resistant to empathy.

It’s a phenomenon wrapped up with the likability theme that recurs in writing discussions. Writers worry in workshop about the moment a character does something evil or wrong. Perhaps the action needs to be explained, perhaps there’s a psychological problem that has seized an otherwise likable person. They squirm at the idea that a character might be evil or wrong in a way that is untreatable, unsolvable. To be evil or wrong, even just once, may be culturally untenable. And the phenomenon reaches beyond the workshop, awaiting writers who may one day face agents and publishers who are equally influenced by trends that demand likable characters who only do the right thing—or who do the wrong thing for a very good reason.

Iarovici remembers a discussion she had with a high school student preparing an essay for college. Iarovici asked the young woman to describe something in her life that went poorly or she regretted, a reflection on strengths and weaknesses. The student became flustered and couldn’t answer the question. “I guess I should come up with a weakness that’s really a strength, huh?” she finally said. Iarovici reflects: “It’s like it’s unacceptable to make mistakes or have anything dark in your past.”

We’re a culture of problem-solvers. The very format of the workshop—to read the work of peers, find “problems” with the work and suggest solutions—is often at odds with the human complexity that fiction so effectively celebrates.

But a workshop instructor has good reason to wrest the discussion away from the quick fix, to inspire these fledgling authors to get their hands dirty, go into the darkest recesses of the imagination. The future of narrative (at least the interesting kind) may depend on it.

Here are a few suggested re-directs for a medically-derailed workshop discussion:

1. Applaud the attention to detail and accuracy, but question whether too much detail about the psychological disorder will be meaningful to the story.

2. Remind the students that they’re the same ones who are resisting the confines of gendered pronouns. Why are they okay with boxing characters into diagnoses?

3. Remind the students that discussion time is short. A medical point can only be made quickly and then back to the conflict.

4. Suggest that, for purposes of narrative, the malady the author has included could go unnamed, thereby preventing the reader from comparing symptoms in the story to a WebMD page when (we hope) the story is about much more.

5. Ask to explore reasons that the character might avoid the “obvious” solution. Have them brainstorm ways to preserve conflict. Remind them that maybe it’s better to have a story than a diagnosis or case study.

Image Credit: Pexels/Pixabay.

is the author of short story collection Inventing Victor, Carnegie Mellon University Press, 2003. Her publications include work in ACM, Kenyon Review online, Passages North, Chicago Quarterly Review, and the Autumn House Press fiction anthology, Keeping the Wolves at Bay. She finished her MFA at the University of Pittsburgh in 2014 and is at work on a novel, Welcome to Kindness.