A few years ago, writer Jasper DeWitt posted a horror story called “The Patient Who Nearly Drove Me Out Of Medicine” on the reddit subreddit NoSleep. But as he reveals in the following email interview, when it came time to translate that posting into the novel The Patient (hardcover, Kindle), DeWitt didn’t just cut and paste his original.
To begin, what is The Patient about, and when and where is it set?
The Patient is a series of forum posts written in 2008 but describing incidents that took place in 2004-2005 in a small mental hospital in Connecticut called the Connecticut State Asylum. It follows Dr. Parker H—- as he first learns of, and then attempts to cure, the supposedly incurable patient known only as Joe, who has been in the hospital since he was 6 and yet has not even been diagnosed in the decades since. Everyone who has tried has either killed themselves or gone mad, but Parker is convinced his elite medical school education and capacity for empathy will enable him to reach Joe where others couldn’t. He tries. It doesn’t go well.
Where did you get the idea for The Patient and how did that original idea evolve as you wrote this story?
Every story I’ve written, and there were others before The Patient, begins with the antagonist. So naturally, answering this requires me to get into spoilers. I actually wrote The Patient as a metaphor for what self-loathing can do to a person: showing what would happen if a person not only internalized negative feedback, but actually completely transformed into whatever negative thing was said about them.
It became very clear to me as I considered this idea, however, that a person who did this would not so much be a human being as something supernatural and deadly dangerous, and that even if it could look like a person, people would think that person was dangerously mad. From there, the idea of the bogeyman getting tired of scaring kids in the closet and becoming curious about what the species he feeds on is actually like evolved, as did the idea that he would learn about humanity by observing other mental patients. From there, the obvious conclusion was that, in order for the story to have any dramatic tension, I had to show this process from the point of view a mystified observer who nevertheless wanted to figure out what was going on with this inscrutable apparent human being.
It sounds like The Patient is supposed to be scary. Do you think of this as a horror story or a psychological thriller or something else entirely?
I think The Patient is very much meant to be frightening, and I think it has elements of both horror and psychological thriller. The first line of the book very clearly indicates that Parker might have just lost his shit, and I did set out to write the story such that you could question how much of this is real, and how much is him losing his mind. A lot of the supposedly supernatural occurrences have only him as a witness, for example, and electronic records conspicuously fail to pick up what he believes he’s seen / heard. That could be supernatural, or it could be a traumatized man snapping in response to workplace stress, gaslighting by a genuine psychopath, and obsessiveness born of past pain. I personally think that what Parker goes through in the books is real, but the reader is entitled to make up their own mind.
The Patient was originally published on the reddit subreddit NoSleep under the name “The Patient Who Nearly Drove Me Out Of Medicine.” Is The Patient the same as “The Patient Who Nearly Drove Me Out Of Medicine,” or did you make any changes, save for spelling errors?
I would say the two are very close cousins, but no, it’s not the same book. For one thing, Parker’s reason for caring so much about abandoned people has been heightened a lot. I won’t spoil it, but let’s just say the difference between the traumatic memory that inspired him on reddit and the traumatic memory that inspired him in the book is vast, and the book is much darker and much more tragic. I wanted people to be in no doubt as to why this man wouldn’t just give up. Also, in the original version, you really get no sense of the hospital itself, so Parker comes off as a very arrogant kid because we have no frame of reference for why he thinks he’s so good compared with everyone else. I added the character of Dr. Bruce P—– to give Parker someone to rebel against, and to embody how things are usually done in this admittedly very low quality hospital. I also took out a section at the end that kind of tipped my hand on the “is this real” question, largely because while it worked on an interactive medium like reddit, it didn’t work in a book, and I wanted the reader to keep guessing. I wanted to also give Parker’s fiancée Jocelyn more depth as a character, too, but anything I added sort of made the plot grind to a halt, so I’ll leave developing her up to the people turning this into a movie.
And we’ll get to the movie in a moment, but first, I wanted to ask: Is there a reason why everyone’s last name is just a letter and some dashes? Because I’ve seen people do this before, but only in really old books.
Simple: I wanted to nod to those “really old books,” many of which inspired the writing style of The Patient. In particular, I was nodding to the M.R. James short story “Two Doctors,” which, while it has little in common with The Patient‘s plot, had a very appropriate title, and was therefore an easy way to acknowledge James’ influence on me as a writer.
The Patient is set up as a series of online posts. Was the decision to do because it was written for reddit or was that not a factor?
So the “online posts” thing was actually added for the book. On reddit, people just read it as a contemporaneous account. And I wanted to add that extra layer of mystery where these posts only appeared on a website that no longer exists.
In a similar vein, why did you decide it would be a series of online posts as opposed to entries in someone’s journal or diary or something similar?
So one of the most important things about this story is that it is not just one man trying to make sense of what happened to him. It is a warning from Parker to us. He says that in the beginning: “For me, this is a matter of responsibility to humanity.” I toyed with the idea of having this be a manuscript Parker sent to a supernatural magazine or paranormal journal, but ultimately, using the internet to get the warning across seemed like the most effective and most topical means of doing it.
Did using this format inspire any aspects of the story that you think you wouldn’t have come up with if you’d written this as a first-person prose novel?
I think it improved it in a very specific way. NoSleep requires every individual chapter to have a horror beat, which demanded that I keep the story as concise and propulsive as possible. I couldn’t waste time on long chapters where nothing happens or go off on tangents. That definitely improved my discipline as a writer when coming up with this.
Once you decided to use this format, did you look at any similarly structured novels of someone else’s to see what to do, and what not to do?
So The Patient was less influenced by books and more by short stories. For example, the design of the monster in Joe’s wall is an homage to stories like “Negotiam Perambulans” and “Caterpillars” by E.F. Benson. The idea of a mental patient whose identity conceals a dark secret was very much an idea that was in my head from reading H.P. Lovecraft — specifically “The Case Of Charles Dexter Ward” and “The Thing On The Doorstep.” The monster’s coming from Joe’s wall took some inspiration from Michael Whitehouse’s iconic ghost story creepypasta “Bedtime.”
But as far as books, Silence Of The Lambs by Thomas Harris very much contributed to the “alone with the psycho” element of Parker’s interactions with Joe, and Psychopath by Keith Ablow heavily influenced my decision to use psychotherapy as a dramatic device and to make a psychologist my hero.
Along with the people you may have just mentioned, are there any other writers whose work has a big influence on The Patient, but not on anything else you’ve written?
Ken Kesey. You can’t write about the banal cruelties of an overstretched mental institution without invoking One Flew Over The Cuckoo’s Nest on some level. Not to mention, the unreliable narrator element obviously takes something from him.
What about non-literary influences, such as movies, TV shows, or video games? Did any of them have a particularly big impact on The Patient?
Martin Scorsese’s Shutter Island had a big impact on how I structured the story, and probably on how I wrote Parker, as well. Also, the character of Dr. Thomas A—— takes a lot of inspiration from Ben Kingsley’s character in that film.
Speaking of movies, Ryan Reynolds is producing a movie version of The Patient. If it was up to you, would Ryan play Joe and give the part of Parker to Hugh Jackman, or should Jackman play Joe and Ryan play Parker?
I’d say Jackman is too old for both. Parker’s a kid in his late 20s and Joe’s in his late 30s / early 40s. If I had to give Jackman a role I’d make him one of the older doctors.
Ryan to me makes a lot of sense as Joe, though: I think the comedic sociopathy he brings to Deadpool is just a hair off from being a horror performance anyway, and one thing I like about Ryan (besides that he plucked me from obscurity) is that he can make anything likable, and always seems like the guy who knows more than anyone else. We have to sort of root for Joe for part of the story, and Ryan could really make that happen. The man can make Pikachu seem like the smartest guy in the room. If he can do that, he can convince us a universally feared man is misunderstood and sane.
Finally, if someone enjoys The Patient, what similarly constructed novel or novella of someone else’s would you suggest they read and why that one?
I actually said most of them above. If that person hasn’t read Lovecraft, they obviously need to start, and “The Case Of Charles Dexter Ward” is probably the best jumping off point if they like The Patient. Keith Ablow is criminally underrated as a thriller author, and Psychopath is his best, for my money. But also, obviously, there’s The Silent Patient by Alex Michaelides, and The Outsider by Stephen King, both of which play with a lot of the same ideas. There are probably tons of other books that involve evil lurking at the bottom of a twisting mystery, but I can’t think of them at the moment.