Q&A With Physician-Author Dr. Richard Friedman

Dr. Richard Friedman is a professor of clinical psychiatry and a psychopharmacology clinic director at Weill Cornell Medical College, where he focuses on mood and anxiety disorders. In addition to his research, Dr. Friedman has interests in mental health policy and psychiatric practice, and is a classical pianist and long-distance swimmer. He graduated from Duke University in 1978 with a degree in physics before graduating from Robert Wood Johnson Medical School – University of Medicine and Dentistry of New Jersey in 1982. He has written for The New York Times science section since 2002, and recently became a contributing opinion writer in 2015. He has also written for The New England Journal of MedicineThe American Journal of Psychiatry, and The Journal of the American Medical Association. Dr. Friedman graciously agreed to talk with me over the phone. This interview has been edited and condensed.
Thanks for sitting down with me to talk about your career as a physician-writer. I just wanted to give you a chance to give a quick overview of your background and your training. 
I went to Duke and graduated in – oh, yikes – ’78, then went to Rutgers…Took off a year – I’m a pianist, I was playing chamber music. Then went and did a residency, a year of medicine and then psychiatry at Mount Sinai. Left Sinai, came to Cornell in ’87, where I’ve been ever since.
And what did you study at Duke?
Physics.
You have a lot of interesting paths that you took to get to psychiatry.
At some point, I must have decided somewhere along the line that the mind was more interesting than the universe… I read Freud and I read some basic neuroscience…I remember reading Oliver Sacks and thinking that the brain is incredibly interesting.
I mean, the thing about physics and chemistry that I really liked was that you don’t really need to know a lot of stuff. And since I like puzzles, it just seems like a big game. There’s not a whole lot to remember. You just start to manipulate things and you solve problems, and it’s fun and interesting and tells you about the world. I still…love mathematical puzzles. But I’m an intensely social guy, and the idea of being in a field of basic science really wouldn’t have appealed and did not have the ideas that really excited me.
I was wondering if you could [tell us about] what sparked your interest in the written word. 
I’ve always enjoyed writing. I mean, I like language…and essentially love the pleasure of, you know, putting thoughts to words. Most people think that you write when you have an idea, but for me, I discover what I think by writing. And that’s the most fun part of writing, which is kind of like an exploration when you sit down. You have to have a bit of a general idea of a topic or something about an issue or an argument that you’d like to make. And then you discover really what you think by writing it and constructing it. So, for me, it’s a way of learning about how I think about a particular topic, and then the pleasure of the discovery.
Sometimes you try to construct an argument, you write about something, and you decide that, you know, well, it’s not at all what I thought to begin with and maybe I’m not going to even publish this. But it’s the process of discovery of what one actually thinks about something. You can have a very clear idea…about what you want to write from the beginning and that’s one type of writing. And I do that too, which is more like public service, where you are telling the public about something.
The more fun things to write are, you know, areas where you’re not exactly sure what you think, but you’re interested, you’re intrigued by it. Something’s caught your attention and it won’t go away.
So when and how did you decide to make writing a part of your career?
Actually, it all began with a dog. You know, I had dogs my whole life, but I had one in particular that was a very special animal, highly intelligent, even musical. This dog when he was dying of cancer, it was around the time that scientists had cloned the first cat. My father asked whether I’d consider cloning him at lunch one day. That would probably be a very bad idea for all kinds of reasons. So I wrote an op-ed piece about it which I just sent blindly to The New York Times. And it was essentially sort of a spontaneous piece about, you know, why you wouldn’t want to clone a dog or any other creature that you had had a relationship with. That piece…I think it touched a nerve because people have a very strong attachment to their pets. It was very popular.
Then the paper started calling me and asking me to write about other things. Although I liked to write before this, and I wrote all kinds of things but never really sort of public, that was the start. I wasn’t looking to write for the paper either way. And then one thing led to another…There was a coincidence that sort of turned into a nice accident. Then I started writing a column for the science section.
And that was in 2002, right?
Yeah. Then I discovered that the things that were most interesting to me were the broad implications of time. You know, not just about what the piece said literally, but what it might mean if it were replicated, and say, extended. You know, what’s beneath it, what’s the deep structure underneath it and the broader implications.
I’m a highly opinionated person so I naturally gravitated towards the op-ed page, started writing pieces for them. And then, you know, it was clear that that was more to my liking. And then I started writing, you know, regularly for the op-ed page.
It’s a little like the process of going down a river in an inner tube. You catch an eddy, you stop at one point. You go down, and you keep going until you find another place. And eventually you find some place where you just suddenly feel, “Aha!” and you want to spend a lot of time. That to me feels like where I am now.
Psychiatry does share many similarities with writing. Has writing changed how you practice psychiatry, or even vice versa? 
Not so much. I mean, it makes you more observant in some ways…I’m a very curious person and I like to know a lot of things. But for me, they’re both symptoms of the same thing. I write for mostly the same reason that I do psychiatry – I’m fascinated by people, their behavior and what makes people tick and what’s underneath things. And I have to know about lots of things. So for me, it’s just another expression of the same process, the same habit of mind that is underneath psychiatric practice.
You know, it’s made me sharper as an observer in many, many ways. You have too many ideas to write about. There’s so many things in the world that are interesting, and you can’t pick every flower that you see. You know, there are many, many things along the way that are absolutely curious and fascinating – especially the things that are unanticipated…that surprise you and that don’t just confirm what you believe about the world. That’s what’s most interesting.
And you do have a lot on your plate. I mean, you’re a clinician, an educator, writer and also a mood disorder researcher. What’s the greatest challenge and what was the most helpful in becoming a physician-writer? 
I would say the most helpful thing is the feedback that you get from your colleagues and…your readers. It’s sort of a dialogue, a living thing that happens. Realizing that you’re engaged with a group of people who are out there, you know, it’s just the tip of the iceberg. You realize you’re having an impact. People are actually thinking about this. And so it increases your motivation.
You get emails from people saying, “you know, you’ve really changed how I think about this” or “you’ve changed something in my life to make it better.” Of course, you also get the opposite – people who are enraged and furious. You’ve either ignored something they think is important or you were critical of something they believe strongly. And that’s to be expected.
So that and also writer colleagues and editors have been very important to my ability to think critically, to edit and be a better writer. I happen to be a very energetic person and I think it helps to not need a whole lot of sleep if you want to do many things.
I like that you talked about the dialogue between yourself, other writers, and your readers. Taking on such a public role as a psychiatrist-writer carries a lot of responsibility and can subject someone to a lot of criticism. I mean, your recent New York Times piece, “How Changeable is Gender?” stirred quite a bit of controversy. And I was wondering how you deal with criticism of your writing. 
I take it seriously, I look at it. I think reasonable minds can differ. I expect people not to agree, especially about highly controversial areas. But my feeling is when you’re talking about areas that are controversial, they’re usually controversial because either there’s a disagreement about the nature of something, there’s variability in data…and people can interpret things in one way or another just depending upon their personal value system or their bias.
And so, you know, if I make a mistake, meaning a factual error, I would feel very bad. If I say something that upsets people because it’s critical or it’s just not consistent with what they believe or would like to believe, I’m not so upset. In fact, my feeling is that if you have an argument to make and you have data and you have logical merit to your argument, then make it. But if you’re railing and screaming and upset because I said something that overturns the way you’d like things to be, I can live with that. I have rather thick skin at this point. I expect some people not to be happy. That’s okay with me so long as I really haven’t made an error, a factual error.
That piece on gender really did stir up a lot of controversy among people both in outraged letters, emails, and all kinds of things. People were demanding retractions and things like this…And I said, well, just send one line back to everybody who says this to you: “Point out one factual error and we’ll correct it.” To which there was no response.
So, you know, if you wade into controversy, should you expect that? But I think that as long as you’re open-minded and fair, you’re going to get very strong responses. That’s okay. I mean, that’s okay with me. Not everyone will like it.
And I mean, that’s a responsibility. It’s a responsibility not to be a flamethrower, and certainly to not say something that’s unnecessarily inflammatory. But if you feel there’s a topic or an issue where the thinking is, let’s say, affected or controlled by people who have a particular agenda and it either goes against what you think or makes sense scientifically, or it’s narrow-minded and people need to be exposed to other ways of thinking about it, then it’s perfectly fine to wade in.
I would just say that [psychiatry is a] field that people are particularly curious about what we do. And I think that if we don’t talk about ourselves and what it is that we do, other people will do it for us, and usually not as well.
Along those lines, if you had one piece of indispensable advice you’d give to physician trainees – either, you know, students, residents, or fellows – who are interested in writing, what would that piece of advice be? 
That’s easy. Write what intrigues you. Write something because you can’t not write it, because it haunts you, because this idea won’t go away. Don’t write something because it’s “important” or because you think it should be said. Write something because you personally have a stake in it and it matters to you and it’s intriguing to you. And if you are excited by it, chances are other people will find it intriguing.
Do you have any last thoughts at all?
Aside from what I said, writing should be fun. We’re in sort of a unique position because we’re in a field that’s intrinsically interesting to people because people want to understand themselves and behavior. So, you know, you have so many advantages as a physician-writer who is a psychiatrist because you’re writing about the most interesting thing in the world – humans. In some ways, it’s easy. It should be fun and exciting. And unlike people who have to write full-time for a living…you have the security of, as much as one has, of a profession that’s by itself fascinating and constantly giving you ideas for stories…to write about. So we’re in a unique position even in the physician world.
Christy Duan is an award-winning writer, editor of in-House magazine, fourth-year medical student at Albert Einstein College of Medicine, and incoming psychiatry resident at Northwell Health.