When Iโm asked about my career and my latest novel, Costaโs War, one question comes up again and again: How did I make the transition from practicing psychiatry to writing fiction, particularly suspense thrillers? The answer, I have come to realize, is that the journey was not nearly as dramatic as it might appear. Although the settings and disciplines are different, the fundamental questions that interested me as a psychiatrist continue to inform and inspire me as a novelist.
My specialty was forensic psychiatry, which involved the intersection of psychiatry and the law. Over the years, I interviewed, examined, and treated individuals who had endured some of the most catastrophic experiences imaginable. My patients included Holocaust survivors, survivors of the September 11 attacks, and people who had sustained devastating injuries in fires, explosions, airplane crashes, and motor vehicle accidents involving death or the loss of limbs. Others had been victims of rape, muggings, and other violent or traumatic events. Many had confronted their own mortality under circumstances that were far beyond the realm of ordinary human experience.
These individuals often suffered from post-traumatic stress disorder (PTSD), depression, and other psychiatric conditions. Their experiences left an indelible impression on me. I was continually reminded of the fragility of human life and the unsettling reality that catastrophe can strike anyone, anywhere, and at any moment. The seemingly predictable routines of everyday existence can be shattered in an instant, leaving individuals struggling to comprehend what has happened and how they are going to survive its consequences.
One observation, in particular, stayed with me throughout my years of practice. I might see fifty patients carrying the same diagnosis of PTSD, yet each patient had an entirely different story to tell. There was a common clinical destination, but no two journeys were alike. Each person had experienced a unique convergence of circumstances, vulnerabilities, relationships, and personal reactions. The diagnosis might provide a framework for understanding the psychological consequences of trauma, but it could never fully capture the individual human experience behind it.
As a psychiatrist, I was fundamentally a listener. My patients entrusted me with their stories, often recounting experiences of extraordinary suffering, fear, loss, and survival. I learned that understanding human behavior requires looking beyond symptoms and diagnoses to examine the personal history, emotional conflicts, motivations, and circumstances that shape an individualโs response to adversity. Two people can encounter remarkably similar threats and respond in profoundly different ways.
When I began writing fiction, I discovered that I had carried these observations with me. In writing suspense thrillers, I found myself exploring many of the same psychological questions, albeit through fictional characters and circumstances. The thriller genre offers a particularly compelling setting for this exploration. Its protagonists are frequently thrust into extraordinary situations, confronted with mortal danger, forced to make consequential decisions, and given precious little time to determine their fate. The ticking clock, an essential element of suspense, becomes a metaphor for the urgency of survival itself.
I came to understand that the psychological dilemmas that had captured my attention in clinical practice were equally compelling as the foundations of fiction. Fear, resilience, vulnerability, courage, desperation, and the instinct for self-preservation are not merely psychiatric concepts; they are universal elements of the human condition. What happens when ordinary people are confronted with extraordinary circumstances? How do they react when their lives, relationships, and most fundamental beliefs are threatened? What inner resources do they discover, or fail to discover, when survival becomes the overriding imperative?
In that sense, my transition from psychiatry to fiction was less a departure than an evolution. My patients told me stories about real catastrophes and their psychological aftermath. My fictional characters inhabit imagined catastrophes, but their emotional struggles are rooted in the same human realities.
Ultimately, Costaโs War and my other fiction explore the enduring questions that first drew me to psychiatry: What makes us who we are, how do we respond when life takes an unforeseen and devastating turn, and what are we capable of when our survival is at stake? I may have exchanged the psychiatristโs consulting room for the novelistโs imagination, but I am still exploring the same fascinating subject: the human condition.
Mark Rubinstein is an award-winning novelist, former forensic psychiatrist, and U.S. Army veteran. He served as a field medic with the 82nd Airborne Division before earning his medical degree and practicing forensic psychiatry. He later served as an attending psychiatrist at New York-Presbyterian Hospital and a clinical assistant professor of psychiatry at Cornell. The author and co-author of 26 books, Rubinstein draws on his experience exploring human behavior to write psychologically rich fiction. His latest novel, Costaโs War, follows a young soldier in Vietnam confronting the moral consequences of an unlawful order. Learn more about Mark at https://markrubinstein-author.com/
