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Bridging Medicine and Literature – Interview with Åsa Nilsonne

Senior professor at Karolinska Institutet, psychiatrist, psychotherapist and author. She has published several books, including crime novels and non-fiction literature.

by Iskra Pollak Dorocic and Irina Pader / Photos by Martin Kjellberg

 

Medicor talked with Dr. Nilsonne about her career, her motivations for writing and her newest book “H”.

Åsa Nilsonne has always been fascinated by human behaviour, and this interest is what ultimately drew her to medical school. “Konrad Lorenz had won the Nobel Prize for research into behaviour, and he was a doctor, so I thought this is a wonderful way to become a researcher”, explains Dr. Nilsonne.

Now in her 60s, Nilsonne has retired from medical work, instead focusing on the writing career she started while working as a doctor. Despite her soft-spoken voice, she comes off as confident and passionate, with a bright red streak in her short edgy haircut.

On her quest to explore human behaviour, Nilsonne quickly realized that the path is not as straightforward as she had imagined. Instead of immediately throwing herself into research after medical school, Nilsonne spent most of her days seeing patients. Psychiatry was an obvious choice. Despite short stints in orthopedics and gynecology, ultimately her initial interest prevailed, and led her to treat psychiatric disorders.

Nilsonne quickly realized that the path is not as straightforward as she had imagined

 

Nilsonne followed a ‘conventional’ medical and academic route, specializing in psychiatry, completing a research-heavy PhD and ultimately becoming a professor. But looking at the fine-print, her career was far from conventional. “I decided early on that I didn’t want to do psychopharmacology, because I didn’t trust the drugs that were given to psychiatric patients”, she says. Instead, Dr. Nilsonne pursued psychotherapy training and started using it as a treatment tool. “My colleagues said this is ridiculous, you can’t be a psychiatrist and not prescribe drugs. And I couldn’t see why not. And it worked out perfectly well, I’ve been able to find employment and do well without ever prescribing anything.”

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Continuing on her own path, Nilsonne once again took an unusual step. She completely stopped seeing male patients in psychotherapy sessions. While treating one particular patient, suddenly realizing she was completely bored, Nilsonne came to the realization that she just could not relate to her patient. “He had some sort of hierarchical problem with his boss and it just bored me to tears. And at that moment I realized that I was in exactly the same situation as many male doctors have been sitting with female patients and not understanding the problem and being very bored. And so I thought what I was doing was unethical. I stopped seeing men completely.” From there on she worked in an eating disorder clinic and following that, with women who are suicidal and emotionally unstable.

The transition from medicine to literature was a fairly smooth one. “Everybody thinks that doing artistic things is different from doing other things, for me it hasn’t been”, says Nilsonne. Her first endeavour into writing novels did not veer too far from the familiar setting of the clinic, in fact it was set in a psychiatric unit and featured a gruesome death of a patient.

The transition from medicine to literature was a fairly smooth one

 

Early on in her writing career, while contemplating the structure of a good story, Nilsonne realized that the crime novel has a very familiar and straight-forward organization, not unlike the course of a medical diagnosis. “You have something that happened, then you have the question of who did it, then you have sorting things out, and then you have an end. Which is very much what happens every time a patient visits a doctor. There’s a problem, you try to find out what kind of problem it is, you do it by investigating the symptoms, and then figuring out the diagnosis.” Not so different from the typical ‘whodunit?’ detective story.

IMG_3804Writing crime novels came easy. However, the genre did not come with the ultimate fulfillment. “In Sweden, crime novels are not considered serious. And anybody who writes crime novels is not considered serious”, laments Nilsonne. She wanted to discuss actual issues in her writing, and soon gave up on the genre to pursue topics she considered more meaningful, and often more personal in nature.

More recently, Dr. Nilsonne has begun writing novels that are based on real-world cutting-edge scientific research. “My last two books have predicted the Nobel Prizes”, explains Nilsonne with a smile. In the novel En passande död [A fitting death], the story is based around the scientific breakthrough of creating pluripotent stem cells from adult cells, the discovery which was awarded the Nobel Prize in Physiology and Medicine in 2012, the same year the novel was finished.

Coincidentally, her current novel H features a main protagonist who is a neuroscientists studying the place cells in the hippocampus, which happens to be the discovery that the most current Nobel Prize recognized. “I just try to pick up what I think is interesting”, explains Nilsonne, who still follows the latest developments in the scientific world and aims to keep her literature scientifically accurate.

This is one way of bringing science to people who don’t normally bother about science

 

A big motivation for writing about these topics is to introduce the general public to science. “This is one way of bringing science to people who don’t normally bother about science, who don’t understand that science is interesting and who don’t understand that science is relevant.” Nilsonne finds it surprising that so many people, including members of the media, know so little about science. The Nobel Prizes are supposed to be the big showcase for science every year, but when her first novel about induced pluripotent stems cells came out it was described as science fiction in the newspapers. “The journalists had no idea that this type of research actually goes on [today]”, she adds with disbelief.

Part of the effort is demystifying human behaviour and the brain. “If you want to be serious about understanding human behaviour you can’t just say the brain belongs to natural sciences, and is not interesting and that the brain doesn’t concern me”, explains Nilsonne. Her most current book, H, features a main protagonist, but we do not learn much about him beside the first initial of his name. Instead, different parts of his brain are the main characters – the amygdala, the prefrontal cortex, and most centrally the hippocampus. Each area has its own personality, and tries to convince the protagonist to follow its advice while he is in the process of falling in love (or not) – depending on which part of the brain he chooses to listen to.

“You can’t just say the brain belongs to natural sciences”

 

Again, inspiration came from medical experience. During psychotherapy sessions with patients, Dr. Nilsonne introduced the different regions of the brain based on their functions and used their ‘personalities’ as a treatment tool. The amygdala, for example, is involved in emotional processing and is fast to react to stressful situations, while the prefrontal cortex is involved in rational thinking. Nilsonne would ask her patient, “What does your amygdala say?”, and then “What does your cortex say?” and contrast the two approaches in a given situation. “Conceptualizing the parts of the brains as motivational systems with their own agenda and with their own voice was very, very helpful.”

 Now that she is retired, Nilsonne spends most of her time on writing, and also with her dogs – she loves training them and entering competitions. The next book will also be a blend of science and literature, with alcohol as its central theme. As for advice for doctors and researchers who are interested in writing, Dr. Nilsonne enthusiastically says: “Just go for it!” – and not to believe that a journalist is better at writing than a scientist.

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