Welcome to Lightspeed Magazine! Your story “Empathetic Psychosis” sweeps readers up into a whirlwind that leaves us doubting everything by the end, especially our narrator’s grasp on reality. How did this story take shape for you?

There’s still a lot of stigma around mental illness. Even the profession that treats it isn’t immune. There would most definitely be the pressure for a psychiatrist with a psychotic disorder to hide their diagnosis from colleagues and patients. So, already, the ‘what if?’ was ripe in my head. I’ve always found the brain, consciousness, and human perception fascinating. It’s what’s drawn me both to being a speculative fiction author and a psychiatrist. Exploring the topic of psychosis from a profession at the position of power in the field allowed me to balance a delicate illness with my own experience.

Once the stage was set, I could explore what I know about treating patients who struggle with their mental health. What are the principles of being a good provider? What insights might I find valuable? Many patients lament that their provider “could never understand.” What if they could, no matter the experience?

Thanks for the consultation, Dr. Key. Writer Justin took it from them.

Dr. Holloway’s “unorthodox methods” of treatment end up blurring the boundaries between himself and others, but he believes that it allows him to more accurately understand and treat his patients. Is there any value to his methods? Are the connections he feels with his patients real?

The simple answer is: It’s all about balance. We’re taught early on in our medical training—and then learn more and more through experience—about the importance of boundaries. Getting too close to a patient can have undesirable consequences. Loss of objectivity. Conflict of interest. Susceptibility to burnout. And, in some cases, it can lead to safety issues. At the same time, though, a physician (especially a psychiatrist) will inevitably miss out on important connections if the wall they raise is too impenetrable. Dr. Holloway has the ability to experience what his patients are experiencing. Turning it all the way off would be like taking away one of his senses. Letting it overwhelm and control, however, can interfere with his ability to make sound clinical decisions.

As for if they are real . . . in the context of the story, it’s a mix. Similar to our perception of the world we perceive being “real,” Dr. Holloway’s brain is taking in real data but interpreting it. The same way that the color “red” each of us sees is our own interpretation of that specific wavelength hitting our retinas. He is taking in information from his patients—from their speech cadence to body language to eye contact to spoken experience—and his brain is creating a story that it then overlays over his own perception.

“Empathetic schizophrenia” is such an intriguing concept and the way it’s woven into the narrator’s perspective makes the experience of reading the story very engaging, especially on a second read-through. Do you have any advice on writing from the perspective of an unreliable narrator?

The clues have to be there. What was so great about The Sixth Sense was that once the “twist” was revealed, the subsequent watch-throughs were rich with exposed nuance. From a narrative craft perspective, it’s okay (and encouraged) to work backwards with the details. Elements that I figured out later in the story I went back and seeded them in. It can in some ways be easier to insert inconspicuous clues in already finished scenes. Starting a scene, on the other hand, with that clue in mind may inadvertently draw more attention to its existence.

It also helps to have only one or two specific things be unreliable. Using again The Sixth Sense as an example, there’s one aspect of reality that’s changed and it affects all of the main character’s interpersonal interactions throughout the movie. My goal wasn’t for the reader to think, “Dang, was anything real?” While one could certainly raise that question, I didn’t want to undercut Dr. Holloway’s expertise as a psychiatrist. He still knows his stuff.

Despite the chaotic and shifting nature of the story, Dr. Holloway fits well into his professional role at the hospital. What made you interested in exploring this depiction of treatment centers? How do you feel about the ending?

I work as an outpatient psychiatrist in a clinic where people come to see me from once a week to four times a year. I would be considered the lowest level of care. On the other end, inpatient, locked hospital facilities are the highest levels of care where people go if they are a danger to themselves or others or can no longer care for themselves due to a mental illness. Intensive Outpatient Programs like Margins are in the middle. Not sick enough to be in the hospital but needing more than what I, for example, could provide. And psychiatry encompasses a broad range of disorders and experiences. Some patients will be in and out while others will be there for months. And there are various aspects of treatment, from one-on-one therapy, group therapy, medication management, to social work. So there are a lot of professionals working with (or, at times, against) each other. This all makes for a ripe clinical environment when you add an eccentric “I do things my way” provider to the group.

The ending is more of a critique on the system and those in power than on Dr. Holloway. Dr. Holloway thinks he’s doing the right things, thinks he’s gotten his care under control. And even if he does, in a way, Dr. Lynch chooses to ignore what could very well be a danger to patients to support her bottom line. She’s afraid of something threatening what she’s built, this brand that she’s worked so hard on. She’s so removed from patient care that success is about the rise to the top. Dr. Holloway, for now at least, is her golden ticket. Even if things work out well for him and for the patients, it’s in spite of Dr. Lynch (the broken system), not because of.

Do you have any upcoming projects you’d like to mention?

Yes! I have a short story and a companion essay coming out in Blacklandia’s forthcoming 88 Unashamed Black Mental Health Stories. Besides that, by the time this goes live I should be awaiting impressions from beta readers on what I hope to be my next novel, a body horror/SF mash-up. Stay tuned!