Daniel Mason

Author, physician and NEA Lit Fellow
Headshot of a man.
Photo by Sara Houghteling

Music Credit: “NY” written and performed by Kosta T from the cd Soul Sand. Used courtesy of free Music Archive.

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Daniel Mason: …the concerns that a psychiatrist has in treating a patient are, in some ways, the concerns that a novelist would have in constructing a character; that's this kind of deep curiosity about where the person comes from and what it is in their life that could have created the person who they’ve become both their strength of the things that they’re suffering from.

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Jo Reed: That’s psychiatrist and author Daniel Mason and this is Art Works, the weekly podcast produced at the national endowment for the Arts. I’m Josephine reed.

In some ways, I think Daniel Mason fell into writing accidentally. He had studied biology at Harvard and spent a year in the jungle at the Thai/Myanmar border, researching malaria. He returned to the United States and went to medical school where he began writing his novel The Piano Tuner…a novel set in the Burmese interior in 1886. The Piano Tuner was published while Mason was still in medical school—it became an international best-seller, was translated into 28 languages and was adapted for both theatre and opera. Not bad for a 26 year old. He continued these dual careers—delaying his residency to finish in second novel A Far Place, which was also very well received. But two demanding careers can be tricky and Daniel Mason’s third novel was 14 years in the making. But it is absolutely worth the wait.

The Winter Soldier is the story of a doctor’s coming age. It begins in 1915 with Lucius a 22 year-old medical student—he lives in Vienna with his wealthy aristocratic family—a bit of an outcast, until he finds medicine. Although the family sees it as a profession beneath them, Lucius has the aptitude, the passion, and the curiosity to excel as a doctor. When the first World War begins, the Austrian Hungarian empire facing a shortage of doctors allows medical students to staff field hospitals—anxious for this practical experience, Lucius joins up and finds himself in a tiny village in the Carpathian mountains. Lucius was expecting a well-staffed hospital run by experienced doctors who can mentor him. What he finds instead is a semi-demolished church that has been turned into a field hospital. The hospital staff have died of Typhus—the only remaining staff person is a nurse—Sister Margarete. And with Margarete as his teacher Lucius quickly learns the difference between medical books and medical practice and, somewhat more slowly, opens himself to humility and empathy.

It’s a strong portrait of a young man learning the human cost of modern warfare and the horrific damage it can do on the human body, as well as the burden of wounds that can’t be seen.

Daniel Mason spoke to me from the studio in Stanford University where he’s a clinical assistant professor of Psychiatry.

Jo Reed: Daniel, I'm curious about the origin story for the book. How did the book come about?

Daniel Mason: So this is a long story. I'll make a shorter version of this long story, because the book-- from the beginning to end it took me I think 14 years of sort of thinking and working on these characters in some form or another. It began as a different story. It began as a story about a doctor in 1920s, psychiatrist working in an asylum, and I knew at the time-- I'm a psychiatrist, so I was interested in this particular period of psychiatric history, and I knew that any doctor in the 1920s of course if I was going to write a backstory for them needed to have some sort of history during the war, some sort of service in the war, and so as I began to read about medical service in World War I, I came across these stories, which I hadn't known before, of the sorts of responsibilities that medical students were forced to assume without any preparation whatsoever. I had completed medical school and was thinking about what it'd be like to be starting residency, this would've been back around 2006, 2007, and imagining what it was like for these students in a similar kind of training that I have to all of a sudden have these kinds of responsibility was an idea that really gripped me, and so all of a sudden this story, which was meant to have somewhat simple backstory, really became the heart of the book, and it became just a story of a person sort of coming of age in medicine.

Jo Reed: As you mentioned, he comes from an aristocrat family who thought becoming a doctor was a definite step down.

Daniel Mason: Right, right. His father's side, they're very old aristocrats. They trace their roots back in Poland for millennia and are sort of sleepy traditionalists. His father was in the cavalry, was injured in a early war with a-- has a musket ball in his hip and essentially retired then and spent the rest of his life in his garrison singing cavalry songs and studying military history. His mother's a bit different. She's also of the aristocracy, but she's a much more modern person, a kind of proto-capitalist, very aggressive, who recognizes that Lucius's father owns these estates, and the states control mines and that she can make an awful lot of money by ramping-up production, especially once the war starts.

Jo Reed: His mother, y’know, she’s not in the book a lot, but, boy, she casts a shadow on this book. What a superbly cold creation she is.

Daniel Mason: Hmm, hmm, thanks. She was a lot of fun to write.

Jo Reed: I bet she was.

Daniel Mason: She was one of my favorite characters to write...

Jo Reed: That line she had when she's trying to get Lucius married and she's, she'll find the proper girl, i.e. rich girl, for him, and it's like "I will provide the menu. You may choose the dish." Ohh.

Daniel Mason: Right, right. Right, right. And I think that, right, she refers even at one point to the marriage market as one in which the supply of men because of the war is nothing compared to the demand because of the number of men who have died, so she even sees the marriage as a kind of marketplace.

Jo Reed: She’s quite amazing. What a character.

Daniel Mason: Oh, thank you.

Jo Reed: And World War I, I’d really like you to talk about the research you did for this, because World War I casts its shadow on the 20th century, and it's just this absurd, horrific war that swept away three different dynasties and is fought with both 19th and 20th century attitudes and weapons. It's so incongruous every step of the way.

Daniel Mason: That incongruity is one of the aspects of the war that really drew me to writing about it. I didn't go into it, like I mentioned, thinking that I want to write a war novel. One thing that drew me to the war, though, and made me want to write more about the war as I was writing, wanting it to play a stronger role in the book was exactly this transition that it offers between more traditional forms of warfare and more modern mechanized warfare. And as I'm writing and as my attention is primarily on this character and this character's development I began to feel that in thinking of the war I was also seeing a kind of representation of who he was, because he in many ways is composed of these two different worlds. He's grown up reading the kinds of stories that a little boy in the early 20th century would've read, stories about knights on horseback and lancers and cavalry charges, and he's heard a lot of these stories from his father. That's what war is in his imagination, and yet the war that he enters is this horrific, industrialized, brute, modern war, and so within him this kind of incongruity plays itself out, just like it's playing itself out on the battlefield, so at one point in the book he stumbles into a battle in which Cossack horsemen are racing with their sabers into machine-gun fire, which would be not an uncommon sort of conflict, and I just loved the idea that this could be occurring on the battlefield in front of him, but at the same time this is occurring internally as his imagination of what war's like is becoming replaced by his realization of what it's become.

Jo Reed: His romantic notion about medicine is also replaced by what in fact it is and what he practices in a field hospital.

Daniel Mason: Right, right. He has entirely book learning when he heads out to the front, and, I mean, this is one of the universals with medicine. As different as his education was then and the kinds of circumstances that he was serving in were like then, it is still the same in many ways today, that one learns in the books, and one of the great sort of adaptation one makes as one begins to practice is the realization that the kinds of illnesses that people experience are very different from those that are described in the textbooks, and it's necessary to learn about the ones in the textbook, but life's far messier, and of course he has to learn this in a very, very dramatic sense. The moment that he arrives, like the night that he arrives at the hospital there's a group of soldiers who are brought in by ambulance from the snow injured, and almost instantly he realizes how the kind of book learning that he had is not going to serve him.

Jo Reed: His view of medicine is both romantic but also kind of detached in a way, and it's Margarete, the field nurse and the only other medical staff at the hospital, who actually teaches him not just about medicine and how to practice in the real world but also empathy.

Daniel Mason: Mm-hmm.

Jo Reed: But she's also not sentimental at all.

Daniel Mason: Right, right, so she doesn't have space to be sentimental. One of the mysteries of the book is who she is and where she comes from, and I don't want to give it away, she's probably grown up in a pretty rough place where the circumstances of life and death are apparent from a very early age and that kind of sentimentality is not available, is not possible. But at the same time her way of interacting with the men is very different than his way, and early on when he's a medical student he's, I would say, a reasonably shallow person. I don't mean that to put him down. I think it's probably developmentally normal for a young man of about 20 who's very scientifically minded, who's interested in the anatomy and in the biology of disease to not really think about the people who have the disease, and so in the beginning there's a line in the book about how certain people say to him that it's kind that he would go into this profession, but I write that kindness doesn't interest him. Disease interests him. And so part of what he learns from her is that kind of kindness.

Jo Reed: You're also really, really clear about the conditions in the hospitals there with rats and lice and maggots and the stink. I'm curious about the research you did, about the war, the hospitals and medicine, and the medicine that you learned has to be different from the medicine they practiced.

Daniel Mason: Right. And that was very hard. I think that writing about the medicine at the time was one of the harder parts of the book, because there's always this question of "How would a person have, first, been practicing?" That was maybe a little bit more straightforward. What kind of medicines were available? But even more than that, how would they understand disease? What would they expect? How would they approach mortality? I mean, it's very different now. Medicine's so effective now that in many ways in not every situation of course medicine recognizes that certain times a person can't be saved, but in many forms of modern medicine there's almost no tolerance for illness, no tolerance for death, whereas medicine at that time-- that was a understood outcome, and people talk about how the doctor at the time did a great job of describing what was going on but was terrible at treating it, and so trying to think of somebody who lives and thinks and is from that environment was hard. It was even harder than trying to learn what kind of diseases they had or what kind of medicines they would use to treat them. I relied mostly on medical manuals at the time, and so both sides of the war issued books to doctors on the frontline and medics telling them what they were going to encounter on the front and how they were going to cure the problems that they encountered, and so that provided me with material to work with and to imagine, and the books also really suggested what doctors could and couldn't do. So one of the I think fascinating but horrifying aspects of reading them is that one would find long, long chapters about how to get rid of lice from clothing, but then you'd get to the part of the manual in which they would talk about, for example, abdominal surgery. I actually put this in the book because it was so striking, and there would be these terse comments that for the most part people feel that abdominal surgery shouldn't be done because the mortality rates were so high.

Jo Reed: I wonder where Margarete came from, because she is really a great character. I was so taken with her and her strength, self-sufficiency and bossiness, and she just seemed incredibly real to me.

Daniel Mason: Well, that's great. I mean, I think, like Lucius's mother, she was also a lot of fun to write. When there were moments that I knew I'd be able to write some scenes with her I was always happier. In part I loved the language that she uses. She's very forceful. I did not expect her to be a big character in the book, so when I first imagined this book I imagined Lucius showing up at this hospital and meeting this nurse, and he was going to listen to her for a little while, and then he was going to go back to Vienna, but then this relationship develops, and so she began to take on a greater and greater role.

Jo Reed: Was it challenging to put the research down and actually begin to write the fiction? Because it's so easy to just get trapped in research, and I don't mean that in a bad way, but it's so interesting.

Daniel Mason: No, no, absolutely, and I think that it certainly was challenging, and I found that I think especially over the course of the book my strategy changed. This is my third book, and so I still haven't quite figured out how to do this, and I certainly had different approaches to writing a novel back when I began this than I did later, and so I would do a lot of reading, and then I'd start writing something, and then I'd learned that maybe that was not the kind of path that I wanted to go down, and so I'd chuck that research out, and eventually I reached a kind of equilibrium, although there would always be this tension between how much more reading should I be doing, how much more research should I be doing versus how much of the story should I be telling.

Jo Reed: Central to the book, also, is the psychological damage of the war. And back then they called it shellshock. And I wonder how new a phenomenon was this? Was this something that really came out of World War I?

Daniel Mason: Very much so. So for time immemorial people have recognized that people experience psychological distress after calamities and after either having something terrible happened to them or almost having something terrible happen to them. And there's some medical literature on this during the Civil War and afterwards, particularly, around industrial accidents or transportation accidents. But really this particular syndrome which would eventually become known as shellshock was unheard of and in this form. And when I say shellshock I should add that the typical shellshock patient actually looks surprisingly different from the typical patient who would be diagnosed with posttraumatic stress disorder today. The words are sometimes used interchangeably, but the common symptoms of shellshock as it was used in World War I, would be, for instance, unexplained paralysis, trembling, headaches, stutters, amnesia. And then, also, symptoms that we would more associate psychological illness today, depression, anxiety, hallucination. Now, at the time, there was a group of patients who did experience this mix of psychological and neurological symptoms but it was a very different group of people. They were primarily women who were diagnosed with what was then called hysteria or grand hysteria, different kinds of hysteria and we use the word more broadly today. But there’s this medical entity at the end of the 19th century that was highly studied but really studied among women. And so it was, in fact, when people, proposed that men could actually, also, have hysteria this idea was thought to be absurd. And then all of a sudden World War I comes about and, all of a sudden, there occurred this epidemic among men all of a sudden exhibiting these symptoms that had previously had been recognize in women. So it completely took medical authorities by surprise. Both sides sent to medical expeditions to frontline hospitals at the very early start of the war. That's when the word shellshock comes about. The first cases are identified right at the beginning of the war and there was a lot of debate as to whether or not these symptoms were due to physical traumatic injury caused by these new kinds of bomb blasts the soldiers were experiencing. Or whether it was due to a particular kind of psychological trauma.

Jo Reed: How was it typically treated?

Daniel Mason: As you can imagine, for these armies that might have 10, 20 percent, sometimes higher rates of shellshock after a confrontation, trying to fix it was a very urgent problem for them. But, like today, treating psychologically takes a long time. And so all sorts of experimental techniques were employed. I think, at first they seemed sort of well-intentioned, so kinds of physical therapy, getting people to reuse limbs that had become paralyzed, psychologically paralyzed so that they could be taught to reuse them, again. But then, as one feels from reading this literature, a kind of impatience growing among the medical establishment, as well as in the army who really want to get these men out the front, a lot of these forms of treatment began to cross over into coercion. This wasn’t the only form of treatment, by any means. So people were experimenting with hypnosis which was reasonably effective, I think, at the time. And then, also, forms of psychotherapy and psychoanalysis. The challenge always being that there weren't enough practitioners to take care of so many victims.

Jo Reed: I'm curious, remind me where you were in your professional career when you started this book? It's your third book, so I sort of know where you were in terms of your literary career, your medical career?

Daniel Mason: I had started thinking about it right at the end of medical school around back in 2004 which is when I graduated. And then I began it and then didn't feel like the idea was fully ready to write about. So then I went back to the second novel that I had started which is a book called “A Far Country”, because I was sort of so engaged in writing that I ended up taking time off from medicine. So I had finished medical school but I hadn't started residency yet. I finished the second book then and then began his third one. Each year I'd say, this is going to be the year I’m going to return to medicine. This is the year going I’m going to apply to a residency. And I kept on putting it off until it was 2011 when I went to residency in psychiatry and kept on working on the book, although, it was harder then, of course. So it took, I guess, since the book came out in 2018, it took another six, seven years, after that for it to be completed.

Jo Reed: Even when you were working as a resident in psychiatry, did you continue to try to work on the book every day? Residency is hard.

Daniel Mason: Residency is hard. During residency I really didn’t write very much at all. There were periods of time where I felt that I might have an idea that would come or a possible solution to a problem I felt I had encountered. And so I would really try then to write over the weekends or write over vacations but it was difficult which is why it took so long. So I certainly didn't write every day.

Jo Reed: I would’ve thought medical school would keep you too busy to write.

Daniel Mason: I think in medical school when I began I was able to write much more regularly but it’s very different because as a medical student one is trying to learn but ultimately at the end of the day there are other people who are making the decisions. In residency it felt very, very different. It felt like that the writing was competing with reading for the patients I was taken care of. And so it was a much more difficult thing to find time to do.

Jo Reed: I'm wondering what drew you both to literature and to medicine? And what you get from one that you don't get from the other?

Daniel Mason: Now, I found that they complement each other in wonderful ways. It's certainly there have been times when I feel like the two careers have run in parallel but a lot of times it's been a little bit more serial. I’d write for some time and then I did training for some time, and then I went back to writing. I think now I'm at a point where I'm not changing my career much. I’m done with my training. And so this sort of equilibrium has developed. There are ways in which they interfere with each other, but I find them to be very complementary. First of all, I'm a psychiatrist and so I think that psychiatry and all medical professions are going to be attentive, should be attentive to the social and familial and the environmental world that a patient comes from. But for psychiatry it’s central. And so the concerns that a psychiatrist has in treating a patient are, in some ways, the concerns that a novelist would have in constructing a character; that's this kind of deep curiosity about where the person comes from and what it is in their life that could have created the person who they’ve become, both their strength of the things that they’re suffering from. And so I think that there's a process of deep inquiry that feels very similar between the two fields.

Jo Reed: I'm sorry, I don't mean to interrupt but its making sense of somebody's story.

Daniel Mason: Right. It's making sense of somebody's story to different ends. So, and this is where I feel like sometimes they're not quite as complementary as they seem on the surface. And that ultimately as a psychiatrist there is a point in which I'm trying to kind of wrap up an explanation or I'm trying to tie things together or I’m trying to create something cohesive or help somebody create a kind of coherent narrative about their lives. Whereas, I think, in fiction explaining how a person has come to be doesn't make for good fiction. The mystery has to be preserved. I think that's a tension that sometimes I grapple with.

Jo Reed: Yeah. I mean I know what I get from books as a reader of them. And I'm just curious about what you get from books as a writer of them, and I'm talking about the books that you write.

Daniel Mason: I feel like that's a question I still ask myself like why do this? And I don't have a great answer to it. I think that there are manifest reasons to do it. There's a joy in storytelling, and there are times that I feel like it's important, and there's a joy in playing with language and discovering and imagining people. I think that those are all there. I think that there's also something else that is a little bit of a mystery but, maybe like I mentioned before, maybe the kind of mystery I don't necessarily want to explain.

Jo Reed: Oh, I get that.

Daniel Mason: But for some reason I do this. And why this is something that I want to do, why I want to spend so much time by myself, why I want to spend so much time writing something that I'm then going to tear up is strange to me. But it's there. And at this point it seems to be a part of me that's almost like this other part of me that I haven't quite figured out.

Jo Reed: Fourteen years is a long time. How did you keep going? I understand there were times you took off for your residency but that's still a long time to live with a book in process.

Daniel Mason: It was a long time. And there were certainly periods during that time where I was doing other things so I was writing short stories. I have a collection of short stories that is going to come out this spring, so most of them were written during this period of time. But most the time that I spent writing this book was spent writing something and throwing it away. I made a lot of mistakes. And I think in retrospect, had I known it was going to take so long, I'm not totally certain I would've done it. I think that I’m happy with the book. I liked being with these characters but it did take up a lot of time and it's quite painful to get rid of so much of something that I’ve written. I think on the bright side, or this is what I sort of tell myself, and that is that it was a period of a lot of learning. And so each one of those drafts, at least I tell myself, hopefully, wasn't for nothing. That there was something learned. And that now, as I begin to write something new, I do feel like some of the lessons from this book hopefully I’ve learned from.

Jo Reed: You also received an NEA lit fellowship in 2014. Did you use the grant for The Winter Soldier or another project?

Daniel Mason: Right. So that was actually during a period of time when I put the book aside and the NEA fellowship was for the book of short stories which is going to come out in May of next year. There are nine stories now. I think there was probably four or five of them at that point. I remain deeply appreciative for the fellowship. That was particularly at that time when I was in a way sort of recalibrating what I was going to work on. And I think probably when I got it-- it was right around then that I had a sense of maybe a way to fix the novel. I had kind of run into this one gigantic roadblock. But there was this period of time when I was just working on the collection of short fiction.

Jo Reed: Was it helpful doing both?

Daniel Mason: Yes. So, I think without the short stories I think I probably would have despaired because part of the process-- there are moments of joy in the process and there are difficult moments. And for me some of the moments of joy come in beginning something new and finding a particular way of saying something and completing something and sharing it. I think one of the wonderful parts about a short story is that a short story offers that much more immediately - that I could think of a person, sort of meet them, get to know them, find the language and then share it. And it gave me this kind of - these sort of bursts of encouragement while I was also on this long road towards the novel. And, actually, I think now what I'm working on is I’ve begun a novel and I recognize that it’s sort of this long slow process. But at the same time over the last couple of months I've been writing short stories. They complement each other. That short fiction offers some something that the longer novel doesn't, and then longer novel offers something that a short story also doesn't provide.

Jo Reed: Has you reading for pleasure changed?

Daniel Mason: It has. There have been periods of time where I thought that in some ways writing has, I don’t want to say ruined but, changed forever the way that I read. And, in part, I think it has because I'm a notetaker. And it's hard, as I’m reading, not to come across a good sentence and suddenly feel like I need to study this. I need to recognize why it was good. I have to learn from this. And so the text then becomes constantly interrupted by these kinds of observations. But there are books, many, many times I'll be reading and it's so good that I say to myself, “let it go and just enjoy this and carry it on you can come back and look at it again.” But there's always this question of “how did they do that?” And the wonderful thing about writing is it’s there on the page. It's not like studying to be a painter where you can’t quite figure out what paints they mixed to create this color. Like how they did that, it's on the page and how they came up with that’s a totally different story, maybe. But how a particular affect was created, how kind of narrative rhythm was accomplished, how a form of dialogue sort of became so lively, like it's possible to go back and study it. But I'm constantly asking that question but it also makes it fun.

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Jo Reed: That’s author and physician Daniel Mason—we were talking about his book The Winter Soldier which is out in paperback.

You've been listening to Art Works, produced at the National Endowment for the Arts. You can subscribe to Art Works wherever you get your podcasts, so please do. And leave us a rating on Apple because it helps people to find us. For the National Endowment for the Arts, I'm Josephine Reed. Thanks for listening.

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Author, physician, and National Endowment for the Arts Creative Writing Fellow Daniel Mason wrote and published his first novel while he was still in medical school. The Piano Tuner received international acclaim, was translated into 28 languages, and adapted for theater and opera. Mason took time off after medical school to complete his second novel, A Far Place, which was short-listed for several literary prizes. Mason then finished his medical training and began his clinical practice and--since he’s not super-human after all--his third novel was 14 years in the making. Again,he struck gold wowing critics and readers alike with The Winter Soldier. The Winter Soldier tells the story of Lucius who leaves medical school in Vienna at the outbreak of World War I to serve in the Army. The Austrian-Hungarian empire, facing a shortage of doctors, allows medical students to staff field hospitals. Anxious for this practical experience, Lucius joins up and finds himself in a tiny village in the Carpathian mountains. He is expecting a well-staffed hospital run by experienced doctors who can mentor him. Instead, he finds himself the sole doctor in a bombed-out church doubling as a hospital whose single remaining medical personnel is a field nurse, Sister Margarete. The story that unfolds is Lucius’s medical and emotional coming of age. But the novel is also about the mad incongruity of World War I, the fleeting connections forged by war, and the growing awareness of the pervasiveness of a new condition affecting the armies—shell shock. Mason speaks thoughtfully about writing and psychiatry (his medical practice) and how his two careers are complementary and how they are not. We also talk about the joys and pitfalls of research and the attitudinal changes in medicine in the past 100 years.