Writing Psychologically-Realistic Characters in Fiction

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Good novelists create characters who are complex. unique, and have relatable human needs and feelings. Joyce Carol Oates is one of our best contemporary novelists, and has created a host of memorable characters. including a hippie, an imagined Marilyn Monroe, and a teenage boy. When she and I met and exchanged novels, she said: “You’re a psychiatrist and a novelist. What a great combination!”

There certainly are superb novelists who are also psychiatrists. Dr. Daniel Mason, for example, is both an inpatient psychiatrist and one of our finest contemporary writers of fiction. However, non-psychiatric physicians have also written psychologically rich characters. Dr. Abraham Verghese, for example, specializes in internal medicine. And many of the greatest novelists of all time who created complex characters: Dickens, Tolstoy, and Dostoevsky were neither psychiatrists nor physicians.

So how, then, are psychiatrist novelists “a great combination"?

The advantages of being a psychiatrist-novelist

Humans are fascinated by other people and their behaviors. From earliest childhood, we listen to and read stories to show how people face challenging situations. We psychiatrists have an added advantage. In our clinical work, we are privileged to hear the most private thoughts and feelings of many people: their fears, the different ways they have tried to protect themselves in difficult and often traumatizing relationships and situations. We also see how they change and grow. When creating fictional characters, we have access to this well of knowledge to write imaginary but psychologically realistic people.

The challenges

When it comes down to the writing, though, physicians have a disadvantage. We're trained to write clinical case histories in a rigid format: presenting problem, history of present illness, past medical history, family history, and so on. This is totally unlike the process fiction authors must master to write characters that come alive on the page. We physicians must put aside that ingrained pattern of straightforward reporting if we are to write good fiction.

One psychiatrist-novelist’s process of writing

Is our process of writing fiction different from that of other novelists? What follows is my own method. I tend to think it is not; readers here may hazard their own guess.

Finding a topic gripping to the novelist

A novelist will spend countless hours in his/her imagination, even more writing sentences, paragraphs, and chapters, then even more rewriting. Because of this heavy expenditure of energy and time, we must find a topic that fascinates us so much we are willing (or needing) to invest the months and years necessary to write about it.

In my case, the idea for my novel of psychological suspense, The End of Miracles, came directly from my clinical work as a psychiatrist. Over a period of a few months, I was asked to see three women, each with an extended false pregnancy, a condition technically named pseudocyesis.

In addition to my clinical interest in evaluating and treating them, and my scientific interest in studying their hormone levels, I also thought: wouldn’t it be fascinating to write a novel in which, at some point, the main character develops pseudocyesis?

Why was this topic so appealing? Only during the course of writing did the realization of the likely roots of my fascination become apparent.

Having an overarching goal

I'd long harbored a creative need to write a novel. I also wanted to add an engrossing book to the world of literature in return for the pleasure I’ve received from reading fiction since my childhood. As a psychiatrist, I set myself additional goals. I wanted to show psychiatrists as they really are, not as the devious or incompetent stereotypes so often portrayed in books or films. I wanted to show that people who develop a serious mental illness are not that different from the rest of us.

Creating the characters

One method I used was to become an actor. I'd pretend to be a particular character and then "listen to" their inner monologue and dialogue. Probably the easiest chapters to write were about the psychiatrist in the novel. I simply imagined myself in my own office, sitting across from the main character, Margo, and having a therapeutic session with her.

Writing the psychological roots of behaviors

It was very important to me to make Margo’s thoughts and actions grow out of her psychology. Once I'd written enough to know her feelings and behaviors in the present, I added to prior chapters instances of thoughts and experiences that were roots of the current ones.

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In the process of writing this way, I discovered a possible clue as to why I was so attracted to the theme of a false pregnancy. A memory came to mind: 5-year-old me seeing my mother very pregnant, seeing babies in fancy carriages, seeing women nursing their babies. Likely I wanted a baby then, too—yet never got to have one. But these women who’d developed false pregnancies with distended abdomens had found a solution to that problem! Why hadn’t I thought of that? Well, now I had.

Writing suspensefully

I’ve read many thrillers, and now used the techniques I’d observed in them to create tension and a page-turning experience for my own readers. In the most suspenseful sections, I kept chapter lengths short and hinted in their last sentences that something crucial was about to happen,

Sending the book out into the world

Publication was a joy mixed with an unexpected momentary sense of loss. In a way, it resembled what it’s like when a baby is born: for many months, you’ve had a private, intimate relationship, and then it ends. Similarly, when my novel was published, there was a brief sadness about sending it out into the world to make new relationships with its readers.

The audiobook re-creation

When we read a book, we're not actually reading the same book as its other readers. We filter what we see on the page through our own experiences and understanding of the world. With an audiobook, the narrator voices the story and the characters through their own response to the text.

For The End of Miracle's Audible audiobook, I listened to many of their narrators read aloud sections of other books and of my own before choosing the one whose voice resonated best with the story. I would be entrusting this person to be a kind of co-creator with me. It’s been gratifying to read comments of those who’ve both read and listened, writing they very much liked the print version and loved the audiobook. Then, I am reassured that I made the right choice.

The effect on one listener, though, was unexpected and humorous. My teenage grandson wrote on his Facebook page: “After reading the novel I listened to the audiobook and it was a relief to hear the phrase ‘egg showered in sperm’ in someone else’s voice instead of my grandmother’s.”