Writer's Block — Ruling Out Medical Factors
If the block is biologically-driven, fix that first!
Barbara: Just to pick up the thread … we’ve been talking about a variety of topics surrounding the issue of writer’s block. Today we’ve decided to dig into a somewhat different but related and significant topic: medical conditions that can lead to what looks like writer’s block.
In these situations the medical condition (and I include mental disorders since they are brain disturbances) isn’t obvious; it might begin very gradually and not have clear physical signs. But it can still erode or completely obstruct the usual writing process and lead writers to falsely assume they have writer’s block. It’s crucially important to recognize this possibility.
Elizabeth: Well, if there are no obvious signs, how would you know?
Barbara: For a writer or other creative individual, the first clue that something is amiss could be that their process isn’t going well…or isn’t going at all.
Here’s what William Styron said about his writing at the onset of his unrecognized depression:
I could no longer concentrate during those afternoon hours, which for years had been my working time, and the act of writing itself, becoming more and more difficult and exhausting, stalled, then finally ceased. (from his book, Darkness Visible: a Memoir of Madness)
Elizabeth: What other kinds of conditions besides depression are we talking about?
Barbara: There are so many. Anxiety disorders and sleep disorders are common conditions that can develop gradually, “sneak in” and affect how well your brain functions. The slowing or speeding up of your thyroid gland in the production of thyroid hormone can have a huge impact. Many medications can impact brain function as an unwanted side-effect. And then there’s drug and alcohol use and abuse. Maybe that should go to the top of the list!
Elizabeth: Perhaps the best reason to find out if your writing impasse could be caused by one of these conditions is that there are treatment approaches for them. There may be a fix!
Barbara: One way to think about this whole topic — to give it some order and to clarify how all of these wildly different medical conditions could each affect writing — is to think about the brain processes that writing depends upon. Any medical condition that impedes a brain function that a writer has always relied on has the potential to create problems.
The main underlying brain function affected by the disorders we want to focus on is attention. But there’s also processing speed, motivation, and a slew of high-level processes called executive control functions — the CEO of the brain.
Elizabeth: Okay, since depression is such a common problem, let’s use that as an example. Tell me how the functions you’ve listed are affected by depression.
Barbara: Before we get to symptoms, let me just say that depression may be a relatively straightforward mental disturbance, but it can also be caused by something else, like hypothyroidism, an emerging Parkinson’s disease, or multiple sclerosis. And it can also be a medication side-effect; for example, high blood-pressure medication or birth-control pills can cause depression.
Actually, I was motivated to write my two books because I wanted to be sure that healthcare professionals who were seeing patients with what appeared to be diagnosable mental conditions, such as bipolar depression or panic disorder, didn’t miss an underlying medical diagnosis. It’s tragic to miss a treatable condition, and without an accurate diagnosis that is what happens. In any case, back to depression.
Whatever the root cause, however, even mild depression can affect writing. Depression is considered a mood disorder, and feeling “down” is certainly one of the presenting symptoms. Depression changes the content of thought along a spectrum, with more severe depression being associated with dark, self-condemning ruminations and obliteration of any sense of a future. Motivation can be undermined … as in, “What’s the point?”
But depression also affects cognition, slowing thinking and the ability to process new information or to generate ideas.
At the risk of being boring, I think it might be helpful to go into some detail about attention and executive control functions, as depression also has a big impact on these. What do you think?
Elizabeth: Sure. Go for it.
Barbara: Let’s start with attention. Everyone has a notion of what attention is. What is generally not appreciated is that attention is a very, very narrow “spotlight,” to use a common metaphor for it.
So, let’s say you set out to write a chapter; that’s your goal. But, if you think about it, in the process of writing, your attention shifts very rapidly from a focus on one task to another along the way — for example, from revisiting a personal memory to … trying to find the right word to … thinking about how a reader would experience your story to … realizing that you just used the same word twice in one paragraph to … and so on. In addition, your attention also might be captured by a noise outside the window or by feeling famished and wanting to take a break.
Elizabeth: I get it. And all this can happen in a few seconds. It’s kind of beautiful, actually.
Barbara: It is! This effective shifting of attention — which is not only fast but also effortless — is orchestrated by the executive control functions of the brain. Ordinarily, we don’t think about how the various components of brain function work together to make what we do happen. There’s a complex orchestration/coordination going on, outside of our awareness.
Think of the executive control functions as the director who decides where to shine the spotlight, shifting it from moment to moment. The director initiates, starts the action, in this case, writing. The director continuously monitors progress toward the ultimate goal of writing the chapter, sets smaller tasks that are necessary to reach that goal, and makes course corrections as needed. The director sets priorities depending on the circumstances at that very moment. At some point, eating or running to the bathroom becomes the priority! And … if the noise outside the window was a car accident, the writing is abandoned.
With depression, the director cannot perform effectively or efficiently. Depending on how impaired the director is, the writer will experience varying degrees of difficulty.
Elizabeth: I’m aware of feeling something like what you’ve described when I’m over-tired. In those instances I can’t think clearly, let alone write. I stare at the screen and feel like I’m mentally slogging through deep mud. Given the complex coordination you’ve described, it’s not surprising.
Barbara: Trying to write while exhausted is a lot like trying to write while depressed, since the same underlying brain functions are affected — only for you it’s a short-term problem and one with obvious causes and solutions.
When you’re depressed, it’s difficult to even get yourself to sit down at the computer. Your ability to think is slowed. You have trouble sticking to the task. You wonder whether it’s worth it to keep plugging away. And, you don’t know why you’re having so much trouble, when writing used to be easier.
Anxiety, thyroid disturbance, medication side-effects can all impact the brain in similar ways. And a lot of other, less common medical conditions that I haven’t mentioned can do the same.
Elizabeth: Being able to write is everything to a writer. Wouldn’t experiencing an impasse, with all the inherent frustration and sense of hopelessness, be enough to cause depression?
Barbara: Well, interestingly, in a 2015 interview, Styron’s youngest daughter, Alexandra, said that she initially thought her father’s depression came about because he couldn’t write. But Styron’s editor was sure that it was the other way around — that Styron couldn’t write because he was depressed. In the biography of her father, Alexandra says she explores this “chicken and egg” question and concludes that there was a multiplicity of factors.
I would suggest that any writer who finds that they aren’t able to work the way they used to…anyone who is experiencing new and sustained difficulties with their mental clarity or focus … ought to consider the possibility that they have an underlying medical condition. Get a diagnosis! And get treatment!
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