Writer's Block

After writing nearly 70 Perspectives, it was bound to happen; it seems I have hit “writer's block.” This is the first time I sat down to write my monthly essay in over 8 months and I decided to use the occasion to familiarize myself with this condition (and try to liberate myself from it). Writer's block varies in intensity from extreme (abandoning one's career as an author—think Harper Lee and Ralph Ellison) to trivial and temporary (which I hope mine is). Why worry? Most writers have it at one time or another. The most common causes cited for writer's block are lack of inspiration, illness, depression, financial pressure, and a sense of failure. None of these apply to me. In my case, maybe it is just good old academic pressure. With increasing frequency, I hear that the only part of AJNR that our subscribers read is my Perspectives, to which I say: What about the rest of the Journal? That is where most of my energy and time are spent! And, if our readers are paying that much attention to my short essays, should each one be better than the last? Writer's block sounds like the ideal excuse to avoid thinking about what to write (just look at the title of my first reference: “Writer's Block as an Instrument for Remaining in Paradise”).¹

Writer's block is a modern notion, and the term was coined in 1947 by Dr Edmund Bergler, a famous Austrian psychiatrist living in New York City.² Today, it is well accepted that the notion of writer's block arose in conjunction with the sudden prestige of psychiatry in the United States after World War II. Dr Bergler, a follower of Freud, blamed writer's block on oral masochism and a milk-denying mother (that gives me something to think about because I know that I was bottle-fed!), in addition to other “phallic and anal” explanations along Freudian lines. Stress leads to panic, and some scientists believe that the reticular activating system in the brain stem will shift higher functions associated with writing from the cortex to the limbic system under duress.³ Others disagree and think that the creative writing process starts at the level of the limbic system, whereas more technical writing is initially fueled by the frontal cortex. If both were true, all writing would stop as functions shift from one location to the other. However, writer's block can be selective, as it is in my case. That is, I continue to write other articles, chapters, and books, but writing this specific series of essays is my problem. Writer's block is commonly seen in college and university students who consistently fail to turn in their written assignments. In them, procrastination (a behavior specifically called “academic trait procrastination”) is a major component of writer's block. Procrastination is learned, so education specialists claim that it can be unlearned.¹ Perfectionism is also blamed for the block; it seems to motivate some procrastination, and together these both promote writer's block.¹ In academia, the notion of writer's block is disdained by younger members but seems to gain respect at higher levels where it occurs more commonly.⁴

Writer's block is better termed “creative inhibition” or “creative block.”⁵ It is becoming more prominent: it was little known by the early Romantic writers, became more prominent during the epoch of the French Symbolists, and last, was rampant (and became a recognized entity) during the period of the great American novel. Today, in a manner similar to attention-deficit disorder, writer's block is a nearly unique American affliction (though it occasionally happens in other countries, vide infra).⁶

Agraphia is the ultimate writer's block because it refers to the physiologic inability to write, but, in this case, lesions in the brain, such as those induced by trauma or stroke, are present and explain it. Agraphia results from damage to the Wernicke area and is nearly always accompanied by other language disabilities. In some cases, the inability to write may be physical, such as so-called “writer's cramp.” This is a muscle dystonia, and DTI has shown fractional anisotropy changes in the fibers connecting the primary sensorimotor areas with subcortical structures in individuals who suffer from it.⁷ In such individuals, fMRI has also shown abnormally low activation of the sensorimotor cortex and supplementary motor areas.⁸ The findings of these studies imply that both inhibitory and excitatory mechanisms play a role in writer's cramp and that the pain it causes prevents writing by hand. Writer's cramp can also develop during typing and other activities such as using a screwdriver. Compared with men, women are thought to be better writers; however fMRI does not show significant differences in brain activation for either sex while writing.⁹ The same study found significant differences between good and poor writers while handwriting, mostly in brain regions involved with planning for serial finger movements.

The opposite of writer's block is also known to occur, and it can be temporary or affect an individual all of his or her life. Balzac, Hugo, and Dickens probably had “graphorrhea.” The problem with calling the obsession to write “graphorrhea” is that this term is also used for manic patients who compose long lists, many times containing only meaningless words, which is not the same as writing many great novels. As psychiatry evolved from an analytic discipline to a chemical science, writer's block came to be blamed on abnormal brain chemistry. More seriously, writer's block can be a manifestation of a dangerous underlying psychiatric disease such as schizophrenia, obsessive compulsive disorder, or substance abuse (think Scott Fitzgerald).

Writer's block has been assessed in individuals who speak languages other than English. Two studies addressed it in Chinese and Spanish native speakers and found that it occurs in those languages as it does in English.^10–12 In other languages, as in English, writer's block appears to be related to premature editing and to a lack of strategies for dealing with complex writing tasks. Developing a strategy before the actual writing helps some individuals. Princeton Professor and author John McPhee tells a related story in his essay “Structure.”¹³ For 2 weeks he lay down on a picnic table under the trees looking at them and wondering how to start a piece on pines. After 8 months of work, he was finally able to turn it in. He suggests that having a preplanned structure eases the stress of writing and results in a better organized and flowing article. The ease of cutting and pasting makes attaining the desired structure easier today than in the past.

The use of a computer with word-processing capabilities reduces writer's block for second-language writers but not for native-language writers.¹⁴ Spelling is also intimately related to the ability to write. In one study, disabled spellers showed significantly more activation in clusters of neural networks associated with working memory and executive functions.¹⁵ Computer programs that automatically correct spelling may help these individuals overcome writer's block.

Because writing is intimately related to reading, recognition of the written word is needed for both activities. Alexia is a condition in which patients lose their ability to read and is associated with lesions in the left parietal and occipital lobes.¹⁶ Alexia has been “folklorized” in several accounts by the famous and popular author and neurologist Oliver Sacks. His patients who had this condition were said to have lesions affecting the VWFA (visual word recognition area), which is presumably located in the left midfusiform gyrus (running from temporal to occipital lobe under the parahippocampal gyrus). Because this area is also involved in the recognition of auditory, phonologic, and visual impulses, patients with lesions there have more symptoms than alexia only. Pure alexia caused by a lesion in the VWFA has not been reported. More importantly, a meta-analysis of the literature, including fMRI studies, states that this brain region does not participate in visual word processing, and thus its concept is erroneous.¹⁷ Alexia without agraphia occurs with lesions involving the left-sided splenium of the corpus callosum.

Strategies for coping with (and curing) writer's block include group discussions, brainstorming (I wrote an essay against this), list-making (I have a long list of topics that I have considered, but none seem very attractive now), and engaging with the text (I have no idea what this means). Recalcitrant blockage must be treated with extensive “therapy.”¹⁵ Other cures include “automatic writing” in which texts are produced from the subconscious without conscious awareness.¹⁸ Instead of coming directly from the writer's mind, Arthur Conan Doyle believed that automatic writing came from external spirits. Channeling writing from a spirit is called “psychography.” Both phenomena may be explained as “ideomotor effects” meaning just an activity of which we are partially or completely unaware. Of course, all of this is nonsense, and fMRI has proved (many times) that ideomotor effects originate in the brain and not outside of it.¹⁹

At this point, I must say that having finished this Perspectives, I feel somewhat liberated. Whether that feeling will be short-lived or last and allow me to write next month's piece, you, kind reader, must wait and see.