Source: New York Times
By Wyatt Mason
Late this spring, off a nondescript hallway in the Psychiatry and Behavioral Sciences building at Stanford University, inside a small, windowless office — standing desk; sitting desk; bookcase; chair — the 42-year-old physician Daniel Mason revealed some unease about what we were doing. “I come from a tradition,” Mason said, in his swift, reassuring cadence, “in which some people go into the room without a ring on. So this kind of disclosure is deeply foreign to the kind of work that I do.”
The tradition Mason was referring to is psychiatry; the room in question was the one in which a clinician would encounter distressed patients (in Mason’s case, the inpatient psychiatric unit of Stanford Hospital, where he works as a psychiatrist); the ring was a wedding band; and the kind of disclosure Mason had in mind was his having agreed to answer my questions — the third day of them; the 17th hour of them, by then — questions about his life.
“Some people of an earlier generation would reveal absolutely nothing,” Mason continued, one leg of his long, lean frame crossed loosely over the other. “And I think that, generally, what we’re taught is that if a person asks a personal question, the important thing to ask is why they want to know and what they think.”
So why, exactly, would a married doctor enter a room without a ring?
“The theory behind the ring,” Mason said, his own wedding band visible on the hand resting on his knee, “is if a psychiatrist goes into a room without it, that’s going to change what the patient’s going to share. Much more information is going to come when a patient meets a doctor who’s not wearing a ring and, according to people who believe this very strongly, the patient asks: ‘Are you married?’ That’s a moment when a psychiatrist responds: ‘We could talk about that. But maybe more important right now is what you were feeling when you asked that.’ And then, this door opens — hopefully: We’re always looking for a door that might open — and a patient might say, ‘Well, I imagine that you are married because I imagine that everybody is happily married except for me.’ That’s Answer A. Answer B is: ‘I don’t think you’re married because you’re attracted to me.’ Answer C is: ‘I have no idea. I don’t feel like I can read anybody now. I don’t understand anybody. I didn’t understand my wife, apparently. I don’t understand you.’ Each one of those leads the psychiatrist down these totally different paths. That’s really helpful information.”
Mason wears his ring while seeing patients, as do many of his colleagues. But despite that measure of clinical transparency, he was clear during our conversations that it was essential to his ability to practice medicine that certain details of his personal life beyond the most basic published facts — he is married to the novelist Sara Houghteling — remain unavailable to his patients. He acknowledged the awkwardness of this preference — I was there, wasn’t I, to profile him? — but it couldn’t be helped, given that he has been, as he says, “negotiating two worlds” throughout his professional life. In one, he serves on a team of clinicians that includes psychologists, social workers, nurses, occupational and physical therapists, residents and medical students, treating people admitted for acute mental illnesses or crises. And in another, he is a fiction writer who, nearly two decades ago, published, at 26, while still in medical school, his first novel, “The Piano Tuner,” which describes the journey of a man sent by the British War Office to the Burmese interior in 1886 to repair a piano. It became an international best seller, was translated into 28 languages and adapted as an opera. His third novel, “The Winter Soldier,” which took 14 years to complete — his first about a doctor and, in part, a coming-of-age story about what that profession can demand and return — arrives this month and with it, for Mason, no little inner negotiation: It will be his first book to appear since he began practicing psychiatry, a vocation which maintains that the practitioner’s face is best kept blank.
In part, Mason has displaced this concern by locating the novel in history. Mason’s original idea, a decade and a half ago, the story of an early psychiatrist practicing in Freud’s Vienna, involved the relationships that form between a female patient, who is an artist, her doctor and the patient’s husband. But during the course of his research for the book, Mason (to whom, I should say, I am not related) made a discovery. “I was researching his back story,” Mason told me, “and I came across this moment in history where the Austro-Hungarian Army finds itself so ill-equipped for the war that they don’t have enough doctors. So they invest in medical students with no clinical training and send them off to hospitals. I came across this at a time when I had just finished medical school, was deeply aware all of a sudden of this whole new range of human experience that I hadn’t known existed before. Suffering mostly. Physical and metaphysical, but one is most impressed by physical suffering. Most medical students, up until that moment in their lives, haven’t suffered an illness as severe as the illnesses they will encounter in their patients. And it sounds so unbelievably naïve, but I don’t think I’m the only one whose world is shaken by the duration and the depth of suffering that people go through.”
Though it would take him a decade, Mason would jettison the part of the novel — many hundreds of pages — about the psychiatrist and instead explore his education: that of a medical student out of his depth who must try to help wounded men who are beyond helping.
That urge, that fear — to help the afflicted; to avoid harming those who suffer — is at the center of Mason’s practice, both as a writer and as a doctor. That afternoon, Mason discussed, in broad strokes, the challenges of trying to help real people in crises. “It’s so bewitching to feel like you’re curing somebody,” Mason said. “The first time I saw someone who had catatonia respond to treatment with Ativan, it was like, my God, I’m witnessing a miracle. The hard part is the next time around, when it doesn’t work.
“It is very hard to learn to go home when a patient is not getting better,” Mason continued, “or to stop searching for an explanation.” With all the unknowns involved in the treatment of mental illnesses, Mason said he takes comfort, as a clinician, in Freud’s definition of the goal of treatment: “Much will be gained if we succeed in transforming your hysterical misery into common unhappiness.” As a fiction writer, Mason’s path to comfort — comfort with the form; comfort with the sense that what he is producing is meaningful — has had to come from practice, from a long process of figuring out what, for him, fiction can do: what it can reveal, and what it can offer, to a writer and his readers.
The information we reveal to others about ourselves isn’t, of course, the exclusive province of psychiatrists; it’s the regular texture of human interaction. How much or how little we let the door of the self open can be a matter of intractable temperament or malleable habit or, at certain moments, life and death. What I’ve found most remarkable about Mason’s fiction is the quality of his revelations, his ability to unveil temperaments, habits, natures. His stories are mysteries, albeit not in the genre sense: When you come to the end of a Mason story, an explanation or solution to the puzzle of a person doesn’t punctually arrive. The unknown remains unknown; the unexplainable remains unexplained. There is, instead, an intense quality of revelation — a mystical intensity — of the sort described by the Austrian philosopher Ludwig Wittgenstein in his “Tractatus Logico-Philosophicus”: “There are, indeed, things that cannot be put into words. They make themselves manifest. They are what is mystical.”
The first Mason fiction I read was “Death of the Pugilist or, the Famous Battle of Jacob Burke & Blindman McGraw.” It is, in thumbnail outline, spectacularly unpromising: a 7,000-word narrative of a boxing match. And not just a boxing match, but a fight between a scrappy young outsider and a seasoned champion. The form of the story seems no less enervating: like a long piece of reporting, with headlines, 17 of them — “Who was Burke? His Beginnings”; “Who is Blindman?” “The day approaches”; “The fight begins” — prefacing each section. As you read them, however, something funny happens. Mason turns the familiar theater of two men at brutal odds into a state of original fascination. Part of what makes the story so remarkable is Mason’s sense of what language can do, his functional belief that words, as Guy Davenport wrote, “are animals, alive and with a will of their own.” Here, the challenger, Burke, watches the arrival of the champion, Blindman McGraw: “Burke hears the murmurs thrumming through the crowds, then shouts going up, the hillside parting for a dark figure to come through. … Six foot six at least, but the illusion of height is increased by the size of his chest and belly, which set his head back like some faraway peak.” We have seen this scene before, the arrival of the gladiator, and yet we have not, not this way, not through this elemental seizing of time and space, of hillsides parting and peaks looming, far away. We are not in a boxing match; we are in nature, and the struggle will be for survival, hand to hand, word to word.
My favorite of Mason’s stories to date, “The Ecstasy of Alfred Russel Wallace,” involves a more explicit investigation of our species. Wallace was a naturalist, explorer and biologist who, independently through his fieldwork, developed the theory of evolution through natural selection before Darwin published “The Origin of Species.” Mason situates us at Wallace’s elbow and occasionally in his head as he gathers the specimens and accumulates the ideas that, he is coming to understand, will, for all time, change the way we see our world:
Wracked by malaria, thin, exhausted, he could barely remain upright for the entirety of his meals, and yet, in the field, he moved with the same alacrity as he had during his childhood days collecting in Wales: powered not by physical strength but by a momentum of mind, of wonder and joy, movement driven by movement itself, by the sun and heat and cold on his neck, the astonishment of the natural world unfolding. From life at sea, he had acquired the habit of rising early; from the rivers and countless portages, the conviction that one does not own what one cannot carry. In moments of reverie, he imagined his body light of all but the clothes on his back and the exquisite catalog of his mind. He was thirty-four. To his mother he wrote, I am running out of time.
Mason makes the urgency of a thought, and the energy of its pursuit, palpable, as Wallace, in total isolation, deep in the Malay Archipelago, in a state of total separation from the developed world, develops inside him an appreciation of the world new to human thinking. As the story builds to Wallace’s expression of that understanding, Mason manages to capture a state I haven’t felt so powerfully before in fiction: solitude, the space in which a thought can grow as organically as a cell, in which the real loneliness and boredom of intellectual work are eclipsed by the ecstasy such work can yield. Moreover, Mason shows how solitude is a kind of suffering that the human animal, if it is to achieve what only our species sometimes can, must — and will — endure.
During the long gestation and production of his new novel, Mason accumulated half a dozen short stories, among them “Pugilist” and “Wallace,” five appearing in Harper’s and a sixth in Zoetrope. They vary in form — one is a letter; one is written as if by Herodotus; another is in the first person; three in the third — but they are united by their reliance on history for some spark, whether factual or textual. “Pugilist,” though its combatants are products of Mason’s imagination, was in part inspired by Mason’s reading of 19th-century magazine accounts of boxing matches, and “Wallace” by Mason’s reading of Wallace’s “Malay Archipelago.” In all of the stories, you can see Mason figuring out new strategies to get closer to the people he is writing about. Each is a portrait, each a deep dive into an individual’s nature, each rooted in history.
I wondered why Mason’s fiction insisted on, and drew from, historical subjects.
“I feel it’s a better skeleton on which to hang other questions,” Mason said. “I feel astounded by the natural world. I could write an essay about how I’m astounded by the natural world. But there’s a man who spent most of his life traveling alone, and with such astonishment for the natural world, that he’s willing to endure everything so he can see one more plant and capture one more animal and sit cooked by fevers in the archipelago — because he wants to see more.”
Mason himself traveled down the Amazon in 2004 after graduating from medical school. He says it remains one of the most extraordinary experiences of his life: “There was something that happened to the perception of time during the long days traveling on the river, which gave me a sense of a fundamentally different way of experiencing the world.” But though this journey inspired the Wallace story, it wasn’t enough to be a story in itself. “I would say my personal history is not particularly interesting,” Mason said, with a small smile that predicted his questioner’s disbelief. “I do believe that. Now, the psychiatrist sitting with me would say: ‘When you say that your personal history is not interesting, it means you probably think that your personal history is actually painful or difficult, and so this is a way of deflecting that.’ I don’t know if that’s the case. I actually do think I grew up without the trials of most people.”
Mason recalls a childhood spent outdoors, in pre-dot-com Palo Alto. He and his younger sister grew up with a mother who taught art in an elementary school and a father who was a radiologist.
“It’s one of the most technical professions in medicine,” Mason said. “But I think that the way I grew up around it, because of my father practicing it, radiology had a kind of mythical quality — the idea that my father was somebody who could see inside other people was a mystical thing.”
Mason was an obsessive reader, a kid who took bikes apart and put bikes back together, who read magazines about bikes and how to take them apart and put them back together. There were baseball cards and stamps. There were math competitions. There was the seasonal youth-sports cycle — soccer, baseball, basketball. There were posters on his wall: “Whales of the World,” a Lamborghini. He played clarinet because he had to. He excelled because he enjoyed school, and he went east to college at Harvard, because he sensed that there was something different about it from where he grew up.
When he arrived, he labored under a sense of insecurity. “It wasn’t an easy place. I felt very lost at the beginning. I felt that friends on the East Coast had access to an intellectual tradition and a historical tradition that engaged with a history that went even farther back into Europe, and I was some kind of rough.”
He was lonely there, homesick. Early in his junior year, he thought of transferring back to California to be closer to home. His adviser, perhaps sensing this lack of direction, introduced him to the young mathematician Ellis McKenzie, then a graduate student working on applying mathematical models to malaria infections. “Not only was Ellis kind and generous with his time for a clueless undergraduate,” Mason explained, “but also there was something about him that was familiar. He had gone to college in Santa Cruz, spent a lot of time on the same beaches and redwoods, wore flip-flops in winter. He also introduced me to a way of thinking across disciplines, which I hadn’t encountered in my classes. The project was to apply population models to the changing levels of malaria parasites in human blood, and Ellis introduced me to thinking of the body as a kind of ecosystem, rather than just a ‘them’ and ‘us.’ In this way, he anticipated the current interest in the microbiome. But even more than mixing disciplines like population biology and medicine, he had this respect for older literature and had discovered this remarkable old data set of blood-parasite levels from back in the early 1900s when people were infected with malaria to treat their neurosyphilis.” (The high fever of malaria was thought to kill the organism that causes syphilis.) “In some ways,” Mason continued, “my current interests in psychiatry come from this notion that he embodied, that biomedicine has enormous debts to other fields of biology, to the humanities.”
Mason graduated with a degree in biology in 1998, writing his thesis on the population dynamics of mixed-species malaria infections. Building on that work, he spent the following year in Thailand on a Luce Scholarship — malaria research in Bangkok and at field sites on the southern Thai-Burmese border, preparation for what he supposed would be his specialization in medical school when he returned: infectious diseases.
Though Mason began medical school at the University of California, San Francisco, in 1999, he did not practice medicine until 2011. During his first year, gross anatomy underway and tissue samples in the microscopes, in a state he describes as complete disinhibition, Mason began writing a novel prompted by his time in Burma — needed to, in fact. “I returned home amazed by this new world. I felt like there was this huge part of me that was there, and I wanted to capture it, somehow. Preserve the experience. Otherwise it was going to be lost.”
“I didn’t think about publishing it,” Mason said. “And then at a certain point I thought: If I’m going to share it with friends and family, could Kinko’s do a nicer job of printing this than just binding it on one of those spiral things?” Kinko’s was spared the challenge: By the time he was beginning clinical rotations in 2001, Mason had managed to complete, and sell, a draft. Published in 2002, it was “The Piano Tuner.”
By the time Mason graduated in 2004, after taking a year off to write and travel, especially in Brazil, he had begun conceiving two more novels — the writing of one and the researching of another — as well as the first of the suite of stories. Though he had intended to continue directly into his medical residency, the unexpected success of the first novel gave Mason time to try being a full-time fiction writer.
It didn’t go well. The ease with which he wrote the first book — the pure, unselfish freedom of writing only for himself, which Mason now calls “a kind of lost youth” — was replaced by difficulty. “If I characterize the trouble I hit with the second book, it felt very inhibited. I wondered, Why am I doing this? If you start asking that, you’re in trouble.” “A Far Country” took five years in all and was by design a very different book than its predecessor. “I began to feel when I finished ‘The Piano Tuner,’ perhaps because of the attention, and a lot focused on the historical and musical apparatus in the book, I thought, Maybe I didn’t capture anything, other than put into a nice fictional form some pretty cool stuff.”
Mainly, Mason sensed that he had failed to get close enough to his protagonist. So he sought a new direction. “I had gone to Brazil to research this other story — two convicts on a ship of Pedro Cabral’s, mentioned in the record of his voyage as having been left on shore to learn the native language and weeping as the caravels sailed off. And I thought: Great premise, and so I went from town to town finding cool things, but I began to feel like: All I’m doing is taking this history and arranging it into a more palatable form.” Wishing to avoid that pitfall, Mason abandoned the Cabral story and scrubbed “A Far Country” clean of history and place, writing it from the point of view of a 13-year-old girl from the most rural part of an unnamed “far country.”
“Honestly, my intent was not to try to write about the experience of a 13-year-old girl. My intent was to write about somebody torn up from the roots they come from. I think I would have felt less restraint in retrospect and would have suffered less in writing the book had I picked a gold-rush migrant. Certainly, when I was writing it, that thought came across my mind: Do I have a right to be writing this person’s story? And then there was this resistant thought that said, ‘It’s a work of fiction, and it’s a work of the imagination, and I’m here.’ ”
The novel received a more muted reception than his first, by which time Mason was also three years into a third novel that would become “The Winter Soldier,” and which, like the second, wasn’t going as planned. It was vast, it was a story of the Great War, it was a novel of history that was also trying to be a novel of consciousness, it was about a psychiatrist, and it wasn’t working. By 2010, “it had become this huge appendage that I was constantly trying to beat into shape.” Mason didn’t know what to do about it and was dispirited.
“When I hadn’t decided to go back to medicine, there was this existential pressure on the book to be worth existence. If this book is not expressing everything, what am I doing with my life? And if what I was attempting to do was trying to do something in the book to make life meaningful, it’s a pretty tall order. And if I’m going to have to survive on this financially, it had to feel meaningful to me.”
Fate intervened. Mason, who had passed his first two medical board exams, would have to complete the third by 2011. “Between 2004 and 2010, there were months I deeply wanted to return to medicine,” Mason said, “and months when I felt like I could keep writing forever. But I missed medicine more than I didn’t.” Mason decided at last to begin residency. And then, busier than ever, Mason returned to the stalled novel and, once he began practicing psychiatry, completed it, 14 years after he began.
It is not unusual to lead a divided professional life. Many doctors, say, split their work, as Mason himself does, between practicing medicine and teaching it, not to say pursuing research or public policy. Many doctors, too, have written fiction, quite a long and interesting list, among them Rabelais, Chekhov, Bulgakov, Céline and William Carlos Williams, all practicing physicians who were also writing. And many if not most writers have second jobs: Vladimir Nabokov worked as a lepidopterist and a college professor; Wallace Stevens as an insurance executive; Arundhati Roy as an activist who was trained as an architect. If this kind of bifurcation isn’t uncommon, the psychiatrist who has written a novel is also not unheard-of. Peter D. Kramer, famous for “Listening to Prozac,” has written short stories and a novel, “Spectacular Happiness,” and the prolific Portuguese writer António Lobo Antunes, who long maintained a clinical practice, has been mentioned as a potential laureate for the Nobel Prize for Literature (should the Swedish Academy manage to give one again).
Even so, Mason’s “The Winter Soldier” is a risky book, at least within contemporary letters. So much writing currently in critical favor — that of Rachel Cusk, Karl Ove Knausgaard, Ben Lerner — exploits the tension between the world on the page and the world that variously inspires those pages to reorient fiction on the author. Whereas Mason takes a resolutely old-fashioned approach by believing in historical fiction — a genre which trusts that the world and history may be seized unselfconsciously, without the author’s formal uneasiness elbowing in. “The Winter Soldier” is about the varieties of human suffering, which, you could say, is risky, because that’s what the long literary tradition from Homer forward has always sought to illuminate: the ways in which we bring pain to others and to ourselves, even and especially as we try to show compassion. At the heart of Mason’s attempt to add to that tradition is a young medical student named Lucius, son of a prominent Polish family. Mason gives us glimpses of the brutality involved in medical training and the brutality that needs to be noticed and then, by the student, negotiated:
Sometimes he was called forth as Praktikant. In Neurology, he stood next to the day’s patient, a seventy-two-year-old locksmith from the Italian Tyrol, with such severe aphasia that he could only mutter “Da.” His daughter translated the doctor’s questions into Italian. As the man tried to answer, his mouth opened and closed like a baby bird. “Da. Da!” he said, face red with frustration, as murmurs of fascination and approval filled the hall. Driven on by the lecturer’s aggressive questioning, Lucius diagnosed a tumor of the temporal lobe, trying to keep his thoughts on the science and away from how miserable he was making the old man’s daughter. She had begun to cry, and she kept reaching for her father’s hand. “You will stop that!” his professor shouted at her, slapping her fingers. “You will disturb the learning!” Lucius’s face was burning. He hated the doctor for asking such questions before the daughter, and he hated himself for answering. But he also did not like feeling that he was on the side of the patient, who was inarticulate and weak. So he answered forcefully, with no compassion. His diagnosis of early brainstem herniation and the relentless destruction of the breathing centers and death, was met by rising, even thunderous, applause.
Seeking experience, Lucius enlists when doctors are needed at the front, the pages devoted to his route there placing the reader deep into a very different world of expectations:
The forest thinned. They passed empty fields, now scarred by war. Bomb craters, abandoned bulwarks, trenches. From a tree, something was hanging: a body, now encased almost entirely in ice. At the far end of the field lay a dark pile of what seemed like boulders, but as he drew closer, Lucius saw that they were frozen horses. There were perhaps fifty, half-covered in snow. Garish, dark-red flowers bloomed from their heads. In the shadows of the forest, he thought he saw others.
What Lucius finds, once arrived at the deserted “hospital” in the Carpathians, that hospital a bombed-out church, is a whole new medical education at the hands of the one nurse in the doctorless outpost. Margarete, a young nun, has been treating the scores of grievously wounded, undertaking amputations and triage and palliative care on her own, and Lucius will learn, or not, what caring for people in pain entails. Margarete is the heart of the book, a gloriously real creation, a mystery that Lucius wants to know, solve, save. Failures accumulate as the war wears on. A patient is brought in, one who, amid all the varieties of suffering sprawled on the floor of the church, stands out: speechless, motionless, in some kind of shock. Lucius and Margarete will try, in their very different ways, to cure him. What unfolds is a kind of parable of what it means to sit with suffering, to charm it, to bear it, the novel performing the limits of a doctor’s cure. It marks an evolution in Mason’s idea of a novel. Gone is information for its own sake; gone is a pure investigation of a consciousness. Kept is Mason’s committedness to history, in his way.
“I know the book will fit under the Library of Congress designation for ‘historical fiction,’ but if you want to learn about the First World War, I think there are many better things to read than my book. So the question is: What am I bringing to it?
“I couldn’t write honestly about psychiatry because I would risk betraying confidences. What’s interesting for a novel is all the complex feelings that a doctor has. The mistakes that he makes. The bad medicine that he practices. The guilt that he feels. And I felt an additional anxiety would flow back into my life, which is taking care of people who would then be reading this novel in which there’s this protopsychiatrist who feels he’s doing a bad job and who needs to make mistakes to move the book.”
We shouldn’t mistake Mason’s decision for an evasion so much as a decision about the kind of doctor he insists on trying to be and the kind of metaphysic he hopes his work will embody. Although “The Winter Soldier” contains some of the most brutal moments of suffering I’ve encountered in fiction, they’re never there just to move the story along. They allow the reader to sit very close to someone in great pain and to listen to him. They feel entirely of a piece with the story Mason is telling, both about history and about one man’s imagined personal history, a story that, for this imagined doctor, involves a great, signal failure.
“His failing is that he failed to protect someone from harm, violating his oath, which is both simple and so profound in all of its implications. This idea of doing no harm.”
What if, I wondered, there were an oath for novelists?
“It’s hard for me to be cruel in writing,” Mason said, with feeling. “I know there is a horrible scene in this book. But it’s redeemed. I don’t think I could have written it if I weren’t looking for moments of lightness. Maybe what I’m trying to do in the end is to create the possibility for kindness or,” Mason said, after a pause, “for relief.”