Style of Sciction: Prologue

While writing this book, I was faced with a dilemma. How do I convey important scientific information on psychiatry, neurology, social issues and medications in a vivid and readable fashion? Science, at times, is too detailed and dry; and case histories plus factual information do not easily fit the fabric of a novel.

The solution was sciction -- science through literature (or based on its name but less precisely because sciction is classified as non-fiction, science through fiction).

Sciction (pronounced "skikshun") reflects the literary vehicle for the voyage of exploration that is this book: I apply the methods of medical diagnosis and treatment to the cases, but the patients they represent are fictitious amalgams. I have melded concepts with composite patients to portray my approach to helping another's suffering. The object is an education far more diverse than the management of the actual patient. The end is greater understanding of numerous different psychiatric and pharmacological areas; the means is the composite illustrative patient.

Sciction allows for a special style-a play embedded in prose-to facilitate comprehension and enjoyment. The teaching model of doctor and student is woven into the dialogue of the book, just as the treating model of doctor and patient is. These interactions represent a well-established interactional teaching style. However, the added prose amplifies, links, clarifies and narrates compassionate care.

Sciction necessitates three diverse didactic leaps: Firstly, providing helpful information sometimes necessitates actually detailing doses; this may compromise the literary flow, but helps to remind us that specific dosing is critical for success. Secondly, the medical student, Andrew, through his questions and especially through the responses of the Doctor, becomes a particularly convenient educational device to convey relevant information; but of course, in reality, almost all these interactions with patients are performed in the confidentiality of the doctor-patient relationship, and not with a student present. Thirdly, a large letter beginning a paragraph separates significant theme changes. This commonly reflects time-shifts or changes in the discussion. Signifying these separations creates more intelligible portions for the reader to digest; it also allows for targeting significant interest areas more easily. This balance of detailed complex pharmacology and intelligible simplification is a delicate one: Particularly complex themes or pharmacological detail are, in addition, punctuated by an explanatory footnote linked with the large letter beginning and ending the section. This way, the reader is alerted to what can be skimmed over. These techniques allow more comfortable reading: Appropriate comfort level is a priority for education and fascination.

Stylistically, maximizing education without sacrificing clarity proved a challenge solved by a series of global structural changes aimed at greater ease of reading: The dialogue style of italics for questions and regular print for answers enables you to more easily scan for specific interest areas. I have found the "em dash" (written "--") a valuable way to define medical phrases succinctly. Other techniques are also aimed at easier comprehension: Every chapter begins with a "Key Chapter Themes" summary. Furthermore, I encourage you to make use of a series of reference glossaries at the back of the book. These clarify concepts and terms. They include a brief brain diagram, drug categories, lists of neurotransmitters, definitions of medical terms, specifics on the pier and bathtub analogies in the book, medical abbreviations, generic and trade names, indexes and endnotes. By these means, difficult concepts become more comprehensible to the curious layperson.

Sciction produces its own dilemmas. As a scientist, I wanted to document every comment with a reference. I fought off that temptation to make this book more readable to the lay person. I have generally found it inappropriate to cite the text, as the cases themselves are scictitious-scientific fictional composites. I have restricted citation to a minimum, in endnotes at the back of the book, identifying only the essentials of the concept under discussion or sources for amplification. Sometimes these endnotes reference my work in order to share the personal and professional voyage of discovery that is the overall thrust of this book. This allows you to resonate a little with the historical perspective. Such citations are not meant to diminish the important contributions of uncited colleagues.

The sciction style of this book allows for two interwoven elements: The unique case histories in this book fascinate, the themes in the chapters educate. However, the factual areas dealt with may reflect exceptions, not the rule. Simplification may compromise extremely complex subjects and there is a danger of loss of perspective if specific patient experiences are too easily generalized. Most patients do not require extreme measures to improve; most physician consults yield beneficial results; and critiques of particular drugs do not imply the medications are deficient, just unsuitable for the portrayed scictitious patient. Individual bad reactions do not make medications globally inappropriate. Pharmacological interventions generally involve the subtle balance of beneficial effects far outweighing side effects; and profound adverse reactions are relatively rare in practice. "When you hear the hoof beats you should think of horses not zebras." Cry the Beloved Mind portrays the exotic mysteries of zebras, even as it teaches the general principles of horses.

-Vernon Neppe

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