The Things Not Named

Joshua Doležal
  • 0.0 (0)
  • EDUCATION

Conversations about literary craft and the things not named that bring high quality to fiction, memoir, and poetry. Hosted by Joshua Doležal, creator of THE RECOVERING ACADEMIC. joshuadolezal.substack.com

  1. Why This Doctor Reads Detective Fiction

    5 HRS AGO

    Why This Doctor Reads Detective Fiction

    “What we now consider modern diagnosis, and the literary genre of detective fiction, arose around the same time and mutually influenced each other. We cannot understand the way we do diagnosis today without tracing this prehistory.” — Dr. Lakshmi Krishnan Today, on “The Things Not Named,” I speak with Dr. Lakshmi Krishnan, physician, scholar, and director of medical humanities at Georgetown University, on why diagnosis and detective fiction grew up together, and what doctors and patients lose when humanities is stripped from medical education. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Doležal: Welcome back to The Things Not Named. I’m Joshua Doležal, and my series this year is based on a famous phrase from Willa Cather, who said that it’s the presence of the thing not named that gives high quality to literature. So this year I’m asking that question of medicine. How might we all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side? My guest today is Dr. Lakshmi Krishnan, and she’s the first in the series to talk about teaching, so that’s going to be a real treat. Lakshmi is an assistant professor of medicine and director of medical humanities at Georgetown University. Her work spans history of medicine, literary studies, and clinical research. She writes about how doctors know, how they think they know, and what impact those stories have on patients’ diagnosis and research. Her scholarship appears in journals such as JAMA, The Lancet, and BMJ Medical Humanities. She’s also been featured in STAT News, The History Channel, and Voice of America. She publishes The Workup with Dr. Lakshmi Krishnan, a Substack on medicine and culture, and is writing a book for Johns Hopkins University Press, which we’ll definitely talk about, titled The Doctor and the Detective: A Cultural History of Diagnosis. Lakshmi was born in Bombay, India, and is a proud immigrant. Her childhood was spent in England and most of her young adulthood in the southern United States, quite a few different regions there, and she adores all things theater, swimming, curating playlists, and weekly trips to the DC Public Library. So welcome, Lakshmi. Lakshmi Krishnan: Thanks so much for having me. This is great. Joshua Doležal: I can’t wait to dig into all of this. I’m fascinated by all of your personal interests, but I wanted to start with your origin story. So fascinating. I grew up in Montana, went to college in Tennessee in the South, did my graduate work in the Midwest, in Nebraska. I spent some time in South America. I’ve also been to Prague a few times. So I don’t know that I’ve been shaped by all those places quite the same way as you, because these were formative years for you. But I’d like to know more about your story. You’re from Mumbai originally, but you grew up in the UK and the southern US. So how have each of those places contributed to who you are now and how you think today? Lakshmi Krishnan: I think it’s interesting, because at first glance, these are places that don’t necessarily have much in common. So yes, I was born in Bombay, now Mumbai, but I still have the pre-90s, very colonial name in my head. But that was really formative. I was born there and was raised for a good chunk of my young childhood, and then actually went back to part of elementary school there in a joint family. So there’s a lot of storytelling. There’s a lot of trading health stories. That’s very much in our culture. I think the things that you observe when you’re a small child and are embedded in are at work often subconsciously. But I still have very strong memories of our family doctor who paid house calls and would come over with this beaten-up leather bag, and lived down the way in this particular neighborhood in Bombay. He was very much a local character, very much a pillar of that neighborhood. He’d come over and do all the checkups, like the young kids — it was a joint family, so cousins, aunts and uncles, parents, then the grandparents. The grandparent visits usually took longer because they had more things going on in terms of health conditions, and he would get plied with cups of tea. I just remember the storytelling that was such a big part of that. And then we moved to the UK and lived in four or five different places in the span of about four years. So even within the UK, broad regional variation, like London to Salford, which is just outside of Manchester, in the north, and then back down to Nottingham, which is in the south of the country, or kind of the Midlands, I suppose. And when you’re the kid who’s always new in school, who’s always finding their footing, I think that part of my experience was very lonely in a lot of ways. I was an only child at the time. My sister was born later, so I’m no longer an only child. But books were a huge — they were a constant and an anchor. And so I think that kind of reading habit, and reading as a source of solace and comfort, and knowing that I wasn’t the only person who had been an outsider in different places, was really big. And then we moved to the US, and we moved to East Tennessee, actually, which was new again. So I guess, as such retrospective narratives go, if I have to assign some coherence to this — my interest was always in connecting across these experiences, even if on a surface level they seemed, southern England to the southern United States to a huge, densely populated city in India. Finding points of connection and commonality was, I think, very important for my internal coherence as a person. And I guess that translated in some way to the work that I do, or to the paths that I followed. Things that seem on the surface disconnected might not be, and you might actually find really surprising connections. So yeah. I could go on, but I’ll stop there. Joshua Doležal: I went to college in Tennessee, in East Tennessee actually. So I’m curious — I was in Bristol, the birthplace of country music. In fact, not Nashville, but Bristol. And so I had a crash course in barbecue and NASCAR and all kinds of things there. But where were you? Lakshmi Krishnan: Johnson City. Joshua Doležal: Johnson City. Wow. Pretty close. What years? Lakshmi Krishnan: We were there from 1995 to — my folks moved to North Carolina in 2021, so a significant — I mean, I went to middle school and high school in Johnson City. Then I left. I went to North Carolina for college. But that was, and is still, home in a lot of ways. Joshua Doležal: How interesting. I’m sure much older than you. I was in college there at that time. I started college in ‘94 and graduated in ‘97, so we overlapped, very close proximity, for two years without knowing. So interesting. I don’t know if you believe in coincidences, or plans, but that’s pretty remarkable. Lakshmi Krishnan: So interesting. The Tri-Cities. Joshua Doležal: Yeah. I played baseball there, and in those days funding for athletics was a different thing, especially at a small school. So we did fundraisers like go clean the NASCAR raceway after the Bristol 500. Lots of character-building experiences like that. So, Lakshmi, you have an MD and a PhD in English, which is kind of an unusual combination. So I want to talk about those two degrees. I’m sure you had lots of people telling you not to get the PhD in English. Maybe I’m wrong about that. But one of them is the degree that everyone pushes for down the STEM path, right? Go be a doctor. The PhD in English is the one that everybody’s like, well, what can you do with that? It’s not practical. So when did you know you wanted both? And what was the through line that connected them for you? And am I right or wrong that people questioned the second one? Lakshmi Krishnan: You’re absolutely right that people questioned the second one. I’ll answer the first question first. So it was kind of an odd and winding road. In undergrad, I was an English major and I was pre-med. I went to Wake Forest for college, and it was a very liberal-arts-heavy curriculum, which was wonderful. We had divisional requirements — you had to take philosophy, some kind of theology, you had to take a couple of lit classes. That kind of didn’t matter to me, because I was interested in those courses anyway and would have taken them anyway, but it was nice to have it as part of the structure. But at that time, majoring in a humanities field and being pre-med was very atypical. I think then, as now, there have been critical mentors or teachers or professors who’ve been supportive and who’ve believed in this nontraditional curriculum, this nontraditional path for me. And that was the case at Wake. I had a few English professors who either were very interested in STEM or were medical humanists, and I didn’t even have the language to articulate that at the time. They were sort of like, you can do both of these things. If you’re interested in them, you might have to take extra — you might be on an overload a couple of semesters because of organic chemistry lab or things like that. But generally, I felt like I was well supported. It was really post-undergraduate that I got more pushback. So the plan had been to go to medical school. I didn’t really know how to make sense of a PhD in English plus medical school. But really, it came down to funding, which is the frank and blunt answer. I got a scholarship to go to England to get a master’s. And at that time I was like, I could get a master’s in a STEM field, but I’m going to be doing that in medical school. I’m going to be doing the science thing. I love literature. When will I again have this opportunity? So for me it was — maybe my scarcity mindset was helpful, because I was like, I’ll never again get the chance to be funded to do this work. So I did the master’s, and

    55 min

  2. APR 28

    What's Named And What's Withheld

    “That's what a storyteller's job is. What do you relay and what do you withhold? And frankly, that's the chronic illness storyteller's mode as well. What am I going to tell this doctor in front of me and what am I going to withhold?” Dr. Michael Stein, author of “A Living: Working-Class Americans Talk to Their Doctor” Michael Stein is a physician, a health policy researcher, and author of 15 books — six novels and nine books of nonfiction. He’s currently Chair and Professor of health law, policy, and management at the Boston University School of Public Health and has also taught at Brown University. Michael is a frequent contributor to The Washington Post, The Boston Globe, and the New York Times. He’s also been featured on NPR’s Fresh Air and in O Magazine. In his spare time, he is Executive Editor of the Public Health Post. Below is an edited transcript of our conversation on Substack Live. Transcript: Joshua Dolezal: Welcome back to The Things Not Named. I’m Joshua Dolezal, and my guest today is Dr. Michael Stein. Willa Cather famously said that it’s the presence of the thing not named that gives high quality to fiction, drama, and poetry. So this year I’m asking that question of medicine. How might we all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side? Michael’s recent book addresses that question because he’s giving voice to a lot of people who normally don’t get to tell their story in popular culture or in medicine, so that’ll be a treat today. Michael is a physician, a health policy researcher, and author of 15 books — six novels and nine books of nonfiction. He’s currently Chair and Professor of health law, policy, and management at the Boston University School of Public Health and has also taught at Brown University. Michael is a frequent contributor to The Washington Post, The Boston Globe, and the New York Times. And he’s also been featured on NPR’s Fresh Air and in O Magazine. In his spare time, he’s also the executive editor of the Public Health Post. Welcome, Michael. Thanks for joining me today. Michael Stein: Josh, thanks for having me. This is great. Joshua Dolezal: I want to get to your latest book, A Living, which you’ve modeled after Studs Terkel’s classic, Working. But first, I’ve talked with almost everyone on this series about craft and how they think of themselves as a writer. And I’d kind of like to start with when you first started thinking of yourself as a writer, what some of your formative influences were, any significant mentors you had that shaped you as a writer. What’s your origin story? Michael Stein: Right, great. Thanks again for having me. So my origin story is — I think the first book that influenced me as a quasi-adult was in my 20s when I read a biography of Robert Lowell. And I thought that was just a fascinating life. And he was obviously a poet primarily, and I was writing poems at that point. And I spent many years doing poetry, which I published all over the place, and came into contact with the famous editor Gordon Lish, who had reached out to me and asked me to send things to his magazine. So I started to send some things to a journal that he was running called The Quarterly. And so I wrote a lot of poems early on. At the same time, around then I had done some work as a journalist, which was not creative writing but an important kind of writing. I had done that in college and I thought of doing a career — I sort of reached the fork of do I do medicine or do I do journalism? And so, of course, being who I am, I chose both. I ended up going to medical school and was still sort of writing journalism pretty much through medical school. I paid for medical school working as a journalist for Nature magazine and went to occasional medical school classes. And I was writing a lot of poetry. Then years passed and I had children, and I started one night — when I was up feeding children in the middle of the night — to write fiction. I wrote six novels, published six novels over the next number of years. And then along the way, I just decided to come and try to start writing about medicine directly. So I went back to writing nonfiction about medicine. My writings have gone all over the place since then. As you said, I’ve written a lot of books — six novels, eight books of nonfiction — and they range from my recent book, A Living, to more straightforward essays, to public health arguments. I wrote a book called Me Versus Us, which explains to people the difference between public health and practicing medicine, because I now work in a public health school. So I’ve flittered. Joshua Dolezal: Well, so coming back to nonfiction is actually coming back to your roots. And I think I had it wrong — I thought you’d started as a fiction writer and then sort of came to nonfiction later. But it sounds like the essay form, personal form, and your journalistic training was really the foundation. Michael Stein: Yes, I think so. But very different, obviously, from journalism. I’ve always taken my nonfiction to be — having gotten to it really through fiction — a more creative form than I ever considered journalism, which I considered a public service as opposed to my personal writing. So a little different. Joshua Dolezal: Here’s an unfair question, and it probably differs because I know you’ve published 400 scholarly articles too, and all these modes are very different. But when you’re thinking more in the literary sense in nonfiction, or perhaps even in fiction, how do you know good writing when you see it? When you hear about craft, what does that mean to you when you’re making decisions in your writing process? Michael Stein: Well, I would have to say it’s a great question, and I probably see what you’re calling good writing differently at different times in my life. I think what I’ve considered good or enjoyable or meaningful to me — I’ve read different things at different times where, when I went back to reread, they didn’t appeal to me in the ways that they had the first time, which is telling me that I probably have a bit of a shifting view. Having written novels, I became much less interested, for instance, in writing — and therefore stopped writing — naturalistic literary fiction. It just wasn’t so interesting to me as a form anymore. It’s not to say that I don’t like stories, but for the moment, I’ve probably read over the past 10 years, when I pretty much stopped writing fiction, fewer novels than I read in the first 20 years when I was writing fiction. It would take a lot unless the fiction I was reading had something experimental or interesting to me. So technical format changes interest me. But I think what’s a satisfying read — which is sort of what you’re asking me at the moment — depends on my goal of what I’m reading it for. Is it just pleasure or is it something that I’m interested in because it’s a subject I’m thinking of writing about and I want to see the lay of the land? But in general, I think like everybody else, I’m interested in tension. I’m interested in pathos. I’m interested in some investment in a character or in solving a mystery. I’m interested in the theme, which is probably what’s going to draw me to something in the first place. And I’m interested in variation. And as I said, usually these days I’ve been interested in technical questions. So all of my books, as you’ve read, have slightly different forms. I try to ask myself different technical questions, which I think I did when I was writing fiction as well. Can I write a mystery and can I write it from backward to forward? I would ask myself these things and then try to set out to do them. So I think I’ve bounced around both in what I consider satisfying and therefore what I consider good. I don’t know that there is a single “good” for me. Joshua Dolezal: Well, I guess we’re all hopefully evolving — we’re not stuck in our sensibility. But so the book we’re talking about today, A Living: Working Class Americans Talk to Their Doctor, is really kind of unique stylistically for your books. I had my suspicions as I was reading it and then discovered in your closing that you did, in fact, intentionally style it after Studs Terkel’s classic oral history, Working, which I think was published in 1974 — people talk about what they do all day. And so in this kind of form, you’re not doing the typical thing that a nonfiction writer does, which is act as a friend to the reader, as Henry James said, as a guide that frames things, contextualizes things, analyzes things. You do that a little bit around the edges. But really, this is a book where your patients tell their own stories in their own voices, much more like a curated or edited oral history form. So I’m curious why you chose that style. What about Terkel’s project felt necessary for you now to revive? And why is your voice so absent from this book compared to all the others? Michael Stein: So let’s put the Terkel comparison and the absence aside for a second and just give you my context for this book. A Living came out in 2025. Four years ago, I wrote a related book with a related structure called Broke. And Broke was similarly about talking to patients about money. So I’m a primary care doctor. I work in an inner city and I see people who are broke. That’s the primary focus of my work. The patient group I’m best known for is taking care of people with HIV or people with addictions. So I’ve naturally grown to populations that are vulnerable and generally poor. And people were just talking to me all the time about money. It was just a constant part of our conversations. And I just thought, nobody writes about how money influences the lives of people. And so here enters two things with Broke. One is I’

    53 min
  3. The Things Not Named — With Kimberly Warner

    MAR 31

    The Things Not Named — With Kimberly Warner

    “Some things can’t be healed. They just need to be held. Narrative medicine does a great job with this — sometimes the healing is in the holding.” Kimberly Warner, author of “Unfixed” Thank you to Mr. Troy Ford, Annette Laing, , Jill Swenson, and many others who tuned into my live interview with Kimberly Warner last week. Kimberly Warner Bio: Kimberly Warner is a filmmaker, author, and patient advocate whose work explores what it means to live fully in a body that doesn’t always cooperate. After studying pre-med and biology at Colorado College and pursuing graduate training in naturopathic and classical Chinese medicine, she left a clinical path for a creative one. In 2015, a rare neurological condition upended her sense of balance. That experience became the seed of Unfixed Media, a multimedia platform for chronic illness storytelling that has been recognized by PBS, Harvard Medical School, and the Invisible Disabilities Association. Her debut memoir, Unfixed, was serialized on Substack, picked up by Empress Editions, and earned a Publishers Weekly Editor’s Pick and a Kirkus review calling it “genre-defying.” Kimerly is a member of the Global Advocacy Alliance, the PPAA (Patient and Physician Advocacy Alliance,) and a visiting faculty member with Global Genes. She also serves on the editorial board of the Journal of Health Design and is an ambassador for the Vestibular Disorders Association). The full transcript of our conversation is available below. Transcript: Joshua Doležal: Welcome back to The Things Not Named. I’m Joshua Doležal, and my series this year is titled for a phrase from Willa Cather. Cather famously said that it’s the presence of the thing not named that gives high quality to fiction, drama, and poetry. So this year I’m asking that question of medicine: How might we all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side? My guest today is Kimberly Warner. Welcome, Kimberly! Kimberly Warner: So great to be here. I love that you are exploring the white space, the unnamed, and that you’re putting that into the realm of clinical care this year. That’s fascinating to me. Joshua Doležal: It seems appropriate for illness and especially for your story. So, lots of mouthfuls there in your bio. You’ve been really active, it seems, in medical communities as a patient advocate and also as a storyteller. Kimberly Warner: Yeah, it was not intended. I certainly didn’t set out to go that direction. Although I do remember even in high school when I told my parents I’m going to medical school. And my parents said — well, my father was a physician and they said, do you really want to work with patients all day? And what’s the reality of that? And I said, no, I want to be a high school health teacher. And they’re like, how are you going to pay off your school loans? And I’m like, I don’t know, I’ll figure that out. But it’s interesting to look, you know, 35 or 40 years later and see how education has become a really big part of the way that I work with healing. And a lot of that has come through my own personal struggles and personal insights through living with a body that doesn’t always feel great. Joshua Doležal: I mean, it’s great that you’re using storytelling as a form of advocacy because I think it’s underutilized. And we were talking before we went live about narrative medicine and how it began at Columbia University. But there’s a long tradition of doctors writing about medical practice and really giving voice to things that can’t be said in the examining room or in the operating room. And I first came to this in graduate school. I was learning about deconstruction theory and this idea that all reality is constructed by language. And I kept wondering, well, what about the body? You know, the body has a kind of grammar. The body has a way of making sense of things and finding balance. So it’s not all relative, as Derrida and others would say. So I got into medical history and wrote a dissertation on the medical humanities and taught for many years courses like illness and health and literature, where I would have loved to have featured your book. It’s nice to be sharing that with folks on Substack this year. But I want to get back to your memoir, which is the first in this year’s series of illness narratives. I’ve been mostly interviewing doctors who are either in the process of writing a memoir or have written memoirs. My conversation last week with Damon Tweedy centered on his second book about mental illness and integrating mental health care into general medicine. So you’re the first author of an illness narrative. And before we dive into that, could you just give us a brief synopsis of your book for anyone who hasn’t heard of Unfixed or doesn’t know anything about it? Kimberly Warner: Yeah, I’d be happy to. I’ve got the little dust jacket summary here, and I can read that to you. But I’ll preface it with — it’s not your classic illness narrative in the sense that it’s a weaving of two different types of narratives, though they are both about identity, because anybody that’s lived with chronic illness knows that that really can crush our identities. There is — it’s not — true in the sense that I have a stack of favorite illness narratives here, and a lot of them are just like, this was the diagnosis, and this is the journey with that, and this is the resolution. And mine is much more complicated, let’s say. But here’s the dust jacket summary for those that don’t know. Unfixed: A Memoir of Family Mystery and the Currents That Carry You Home, is a haunting exploration of identity, loss, and the unsteady ground of becoming. When a midlife DNA test reveals that the man who raised her isn’t her biological father, Kimberly Warner is drawn into two parallel mysteries — one excavating the silence surrounding her beloved father’s death, the other tracing the absence of a stranger whose blood shapes her very being. As she unravels the secrets hidden beneath her family’s story, another rupture emerges, this time in her body. A mysterious illness takes hold, leaving her adrift in dizziness and a growing awareness that her body knows truths language cannot hold. Joshua Doležal: Nice. And I’ve got my copy here, so I’ll put a link in the show notes for anyone who wants to order it. So you are braiding two stories. Why did you not tell them separately? Kimberly Warner: Because they were completely linked, to the point where I think that the DNA revelation when I turned 40 was very much a catalyst for the disassembly that was happening in my neurology at the same time. And I think many — anyone listening that knows about vestibular disorders, especially ones that are neurologically related instead of within the ears, can often be heightened or triggered by extreme states of panic. And I was definitely going through a protracted panic attack and a real disorientation to who I was and who I had known myself to be for 40 years. So while I don’t think it was a direct link, I think there are a lot of factors that were happening. It was definitely a piece that pulled the rug out from underneath me and quite literally created the sensation of living on water, which is what this Mal de Débarquement that I have — that is the actual symptom. The experience of it is living on water. So you can’t really disentangle the illness from your life circumstances and it’s all part of the same fabric. Absolutely. And I don’t know if that’s always the case. I’m not going to say that everyone gets an illness because something psychological shifts in their life story. But for me, it did play a huge role. And I think, unfortunately, because of that, I also wasn’t diagnosed for five, five and a half years. And a lot of that was because of the multifactorial events that were happening. Based on which doctor I saw to try to figure out why I was so dizzy, they were either looking at the psychological issues and doing trauma work and brain spotting and everything under the sun, or concussions on the other end of the spectrum. So it made it very difficult to diagnose what was going on. Joshua Doležal: All of the people I’ve interviewed so far are doctors, and in a doctor memoir, doctors write about patients. The patients don’t always have the chance to write back. Your book is coming from the other side of that. When you’re going through your diagnostic journey — years of dizziness with no explanation and so on — I’m wondering if you really struggled with other people’s stories being projected onto you. I know with neurological conditions, it kind of literally is in your head, right? And there’s a kind of condescending form that that takes. So did writing Unfixed feel like you were reclaiming the narrative for yourself instead of being a character in someone else’s story? Kimberly Warner: Yes. And I’ll say that when I started writing this, it was 2018. So this was still pre-diagnosis, but it was also right on this precipice of me being so tired of pursuing cures. So I was resting in this place of trying to, like you said, reclaim all of what had just happened to me — including the DNA discovery and the dizziness and all the subsequent things that happened because of that. The loss of job, the loss of friends, nearly the loss of my relationship. And I was trying to just piece it all back together for myself. This was not intended to be something to be read by the world. It was very much just, let’s get this down on paper as much as I possibly can so I can remember the details. So as you know, when you read this, there’s certainly trauma in this, but there was also so much magic and love that was happening throughout this. And that was a really important part that I didn’t want to forget. And so i

    50 min
  4. The Things Not Named — with Damon Tweedy

    MAR 24

    The Things Not Named — with Damon Tweedy

    Thank you Kae, Lori, Michelle Ray, and many others for tuning into my live video with Damon Tweedy! Damon Tweedy Bio: Dr. Damon Tweedy, is a psychiatrist, author, and leading voice on race, medicine, and mental health. He’s a professor of psychiatry at Duke University School of Medicine and a staff psychiatrist with the Durham Veterans Affairs Health System, where he co-leads an integrated primary care mental health team. A graduate of Duke School of Medicine, he also earned a law degree from Yale Law School, focusing on health policy and medical ethics before returning to Duke to complete his psychiatric training. Dr. Tweedy is the bestselling author of Black Man in a White Coat, which takes a hard look at racism and American medicine. The book was a New York Times bestseller and was named a top nonfiction book of the year by Time Magazine. His latest book, Facing the Unseen, explores the struggle to center mental health within medicine and was recognized by Nature as one of the best science books of 2024. The full transcript is available below. Transcript: Joshua Dolezal: Welcome back to The Things Not Named. I’m Joshua Dolezal, and my series this year is based on one of Willa Cather’s famous passages. She said that it’s the presence of the thing not named that gives high quality to fiction, drama, and poetry. And so for my series this year on the medical humanities, I’m applying that principle to how we might all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side. My guest today is Dr. Damon Tweedy, psychiatrist, author, and leading voice on race, medicine, and mental health. He’s a professor of psychiatry at Duke University School of Medicine and a staff psychiatrist with the Durham Veterans Affairs Health System, where he co-leads an integrated primary care mental health team. A graduate of Duke School of Medicine, he also earned a law degree from Yale Law School, focusing on health policy and medical ethics before returning to Duke to complete his psychiatric training. Dr. Tweedy is the bestselling author of Black Man in a White Coat, which takes a hard look at racism and American medicine. The book was a New York Times bestseller and was named a top nonfiction book of the year by Time Magazine. His latest book, Facing the Unseen, explores the struggle to center mental health within medicine and was recognized by Nature as one of the best science books of 2024. So thanks for joining me, Dr. Tweedy. Damon Tweedy: Yeah, it’s a pleasure. Joshua Dolezal: So Damon, maybe we can start with your family origins. If I’m not mistaken, you and I are both first-gen college students. So it was kind of a long road that you took from where you were born and raised to Duke and then also to Yale. Damon Tweedy: Yeah, so, you know, growing up, it didn’t feel that way. But now, looking back — I’m 51, almost 52 — it does feel like, yeah, you know, it was quite a journey. So I grew up in a two-parent home, mom and dad, both of whom traced their families back to America’s origins, right? Back through segregation, even back to slavery — because I have an 1860 census my dad showed me of some of his relatives. And so they grew up from Southern Virginia, grew up during the time of segregation. My parents are still living, they’re elderly now, and literally, you know, the things that we read about in textbooks were their lived experience. The Civil Rights Movement came to them when they were in their early 20s. So their whole first 20 years were in that space. And so that undoubtedly impacted how they experienced the world, see the world. And so for me, I grew up — so my dad worked in a grocery store, a food store. Mom worked in a sort of government, kind of administrative secretarial type work. And I had an older brother and we were in a community that was all Black, literally 100% Black, a very working-class sort of Black community outside of Washington, D.C. Back in those days, busing was still around. And so we were bused to a neighboring district that was all white. And so those are probably my first earliest kind of signs of, okay, you’re different. And what do people make of you by being different? And so for me, that difference was that, you know, I was kind of really into math and numbers — I was sort of an odd kid in that way, really into that. So I excelled in math, but I was also one of the Black kids bused to a school that was all white. And there were a lot of perceptions among teachers there about the Black students not being capable or being somehow, you know, a problem — things that we sort of all hear about. And so for me, I was finding myself in a space where, at the same time, I was a top student. And so people didn’t know what to make of me — the teachers and sometimes my classmates — because there were all these perceptions about what it meant to be a Black person, you know, largely negative, right? And so I experienced that sort of duality at a very early age. When I got to high school, my middle school was a local Black neighborhood school, but then I tested into a magnet program in high school. Little did I know at the time how powerful a school it was in terms of some of the people who went there and what they achieved. But it was a magnet school that was pretty much all white and Asian within a school that was otherwise Black. And so I was in these magnet classes with white and Asian students, but the rest of the school was mostly Black. And there was always this sort of tension between — where do I fit in in these two worlds? And so that was sort of a common theme, and it played out in a lot of really kind of crazy ways. One story I can tell real quick that will encapsulate this. In high school, in 10th grade, I was in a chemistry class — literally the only Black student in a class of 30 students. And one day, our school was a school of excellence, and so they brought in several leading politicians to sort of talk about our tech program and how great it was. And so at that time — given my age — this was Governor Bill Clinton before he was president, and several people across both parties. And they sort of took them around our school to the tech programs. So here I am, the only Black student in that class. And before they get to our particular classroom, there’s suddenly four or five other Black kids in the class who are just sort of there, positioned. And then you see where I’m going with this? And then suddenly, as soon as these political people leave, those kids are just kind of told to leave. And so I’m back here as the only Black student in the class. And I’m looking around like, what the hell just happened? And no one had any reaction. It was like no one else seemed to get what had just taken place. And that sort of in some ways encapsulated my perspective of being different, you know, and having to navigate two worlds. So my first book sort of starts with me being a medical student, but that’s sort of the backdrop to that. And so when you get to medical school at a place like Duke, that’s just accentuated — that whole idea of two worlds. The world of the doctors, you know, mostly white and Asian. Then there’s the world of patients and the community that you’re around, which is largely Black. And how do you navigate those two worlds? And so that was sort of the tension that I experienced at a young age, but it just really was accelerated in a medical setting. Because for me, you know, part of what attracted me to medicine was the idea that it was objective, that it was concrete. It was data-driven. You know, it doesn’t matter what you look like on the outside. A bone is a bone. A blood vessel is a blood vessel. And so that’s part of what appealed to me. It’s like I could contribute to society, but in a very concrete way. And so it was really kind of a shock to the system to get into medicine and realize that it was sort of in some ways the same old thing in terms of those problems that I’d experienced as a young person. Joshua Dolezal: Yeah. One of the philosophers that I used in my dissertation was Helen Longino, whose iconic book is called Science as Social Knowledge, kind of questioning this idea that science is just objective because it always takes place in a context that is social, and that certain questions get privileged and certain research gets funded and all of that. We’re the same age. So I remember Clinton when I was in high school and all of that. Two questions came up as you were telling a little bit of that story. One — you said that you tested into this program. I know that recently there’s been some debate about whether standardized tests are actually exclusionary, whether they set arbitrary barriers for diversity in college. And I know during COVID, a lot of those standards were just taken away. And yet I’ve heard other writers talk about this — Thomas Chatterton Williams is another one who felt like standardized testing was the only way that he got noticed at all, that he would have been lost in the cracks if it hadn’t been for some kind of merit-based way of breaking through. So I’m curious what your thoughts are on that, whether standardized testing is actually a way of bringing more diverse voices into medicine or whether it’s been kind of exclusionary. Damon Tweedy: I think it’s a mixed picture. I think it depends on how you use it. I think that if it’s used — like, a number in and of itself — it has to be — it’s going to sound crazy to some people, but a number has to almost be contextualized. Like, if you take, let’s say, an SAT score — let’s just say 1,200, right? Now, 1,200, depending on what your background is leading up to that place, that could be a not-so-good score, that could be an exceptional score, depending on what your background is and what you sort of had to over

    53 min
  5. The Things Not Named — With Istiaq Mian

    FEB 24

    The Things Not Named — With Istiaq Mian

    Thank you Natalie Lago, Michelle Ray, and many others for tuning into my live video with Istiaq Mian, MD yesterday. Istiaq Mian Bio: Dr. Istiaq Mian is a hospitalist (an internal medicine physician who works exclusively in the hospital) in Madison, Wisconsin. His Substack, The Substaq of Istiaq, explores narrative medicine through memoir and essays about what it means to care for people at the most vulnerable moments of their lives. His essays have also appeared in the New York Times. Before medical school, Istiaq spent a year as an AmeriCorps volunteer at Joseph’s House, a hospice in Washington D.C. for homeless men and women dying of HIV/AIDS. That experience shaped everything that came after, and it’s the subject of a memoir he’s been writing for years. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

    54 min
  6. The Things Not Named — With Holly Starley

    2025-12-09

    The Things Not Named — With Holly Starley

    Welcome back to The Things Not Named. I’m Joshua Doležal. This year I’ve been asking writers how they know high-quality writing when they see it and how their own sensibilities have been forged. My guest today is Holly Starley. Holly is the author of “Holly Starley’s Rolling Desk,” which she writes from her DIY van, AKA Vivian. She’s got solar panels on the roof, steadily changing views out the window, and community wherever she lands.  But before Holly was roaming the countryside she was an award-winning journalist in West Virginia and the managing editor of a cycling magazine. She’s founded a radio station, taught courses in person and online, and rebuilt a van with her own two hands.  Holly has also been a freelance editor for twenty years. When she’s not chronicling her van life, Holly works one-on-one with authors as a “self-editing coach.” She is a co-founder of the Caravan Writers Collective, where you can find on-demand courses, write-ins, and many other resources for your writing practice.   This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit joshuadolezal.substack.com/subscribe

    52 min

  7. 2025-10-14

    The Things Not Named — With Sam Kahn

    Joshua Doležal: Welcome back to The Things Not Named. I’m Joshua Doležal. This year I’ve been asking writers how they know high-quality writing when they see it and how their own sensibilities have been forged. My guest today is Sam Kahn. Sam Kahn writes literary-minded essays, short stories, reviews, and political commentary at Castalia and is an editor at Persuasion. He is also Founder and Editor of The Republic of Letters. Sam has worked as a documentary producer at Netflix, Paramount+, and other studios. I should mention that when Sam and I spoke, he was in a café in southern Kyrgyzstan, where he is helping to establish a new college. So you’ll hear some of that background noise as we go, but I hope it adds a note of authenticity, which is one thing I’ve come to associate with Sam’s writing. I hope you enjoy our conversation. On Literacy, The Soul, And The New Intensity Joshua Doležal: It’s funny, Sam, you’re so prolific. And yet you’re kind of an enigma online. I tried to do a little bit of research on you, and it’s like you’re a spy or something. Sam Kahn: So the throughline is basically that I get paid for the stuff that I care the least about. There’s an almost perfectly inverse proportional relationship between the thing that I put time and effort and love into, and the things that get monetarily rewarded. If that makes sense, everything else kind of follows from there. So I’ve had one life, which is just basically trying to earn a living. And essentially I’ve been going through a career change the last few years. So for about 10 years I was working in documentaries first as an associate and then as a producer. There were some things I liked about it, but at the end of the day it wasn’t really for me. And then I was doing kind of a career transition to trying to figure out something to do with print media that could actually make money. And what ended up happening was that I worked for Persuasion, which is based on Substack. So I’m an editor there. It’s been really a nice job to have. And then in the middle of that, I moved out of nowhere to Kyrgyzstan to teach at a university, which somebody I knew offered me a job for. And actually right now I’m involved in setting up a college in Southern Kyrgyzstan, which is wild and is a very exciting thing to be doing. But my real life story is basically just trying to be a writer and trying to get better at it, to be a quality writer. And then secondarily trying to get things out there. And that’s mostly been long, endless frustration of just having lots of things in my laptop, no real outlet, a little bit of outlet for the stuff I care less about, which is journalism and criticism. But very little outlet for the stuff I care a great deal about, which is plays, which is fiction, both novels and short stories. Substack for me has just been a godsend. It’s been an unalloyed good in terms of taking all this material that was just sitting in the black hole of my laptop and sending it out into the gray hole of internet space. That’s really why I’ve been so evangelical about Substack and where you and I differ a little bit, is that for me it took this hole in my soul that I’d had for about 10 or 15 years, and then flipped that into a productive outlet. Joshua Doležal: It seems like the thing that you really care about is the thing that you get the least engagement on. So what you are known for by most people on Substack and in your freelance writing is this electric and really just shockingly creative take on history, on criticism. The way that you write a review, you’re not really a journalist, but the way that you write that kind of think piece is really unlike anyone else. And so that’s how you’ve made your name on Substack. Sam Kahn: I’ve been serializing something the last few months, which has much less engagement than hot takes on other stuff, and that’s just the way it is. I mean, that’s just a fact of the internet age and probably something about the human psyche in the 21st century. But thank you for what you’re saying about the criticism. I guess the philosophy on this is a few things. One is that I feel very strongly that writing is basically closer to speech and to thought than a lot of people tend to think. So if we’re talking about craft, I always have this idea in MFA land and these kinds of things, I tend to feel that everybody’s talking about creating a wicker chair, creating this immaculate product. And to me, that’s not really what it’s about. What it’s really about is just connecting to your thoughts and your instincts at a given moment in time. If you’re accessing that honestly, then it’s always interesting and it’s always valuable, and so I get frustrated with most social interaction. I don’t really like talking to people that much. Because there’s just so many layers and so many filters barring you from what anybody really wants to say. And in writing you just don’t have that problem. If you have the guts to say what you want to say, then to me that’s automatically interesting and true and of value. I partly train myself to do this through some complicated inner journey, but I think I also believe in this more than a lot of other people do. That it’s okay to just put a lot of stuff out there. You don’t need to have a brand. You don’t need to be that structured in it. If it’s true to you, it’s worth saying. And then it’s other people’s problem if they want to read it or not. So that’s my worldview. Joshua Doležal: I don’t mean this to be as glib as it might sound, but in some ways you’re kind of like Susan Sontag, right? Who had this vision of who she really was as a writer or wanted to be, and then became known for all these essays that she kind of wrote in her mind with her left hand, but that was her legacy, Illness As Metaphor. I don’t know of any of her novels that I’ve read that I think of as more influential than that. Sam Kahn: I think if I kind of strip down to who I am, I have a pretty analytical cast of mind. I’m not a super creative person. Sometimes you’ll meet these people and they become writers or artists, and you ask them what their lives were like as children, and they had these imaginary friends in complicated worlds. My inner life as a child was baseball lists, I mean, over and over again. But I really loved reading. I loved writing. I knew I wanted to be a writer, and I kind of knew from fairly early on what I was lacking in, which was really imagination and a certain degree of social nuance, social understanding. And I feel like I went through a whole journey to basically develop that in myself. And so I think being able to write plays opened up for me when I was in my mid or late twenties. Being able to write a short story opened up when I was towards my mid-thirties, and I think novels really opened up for me a few years ago. I mean, there’s still this thing that drives me crazy, which is that this novel that I’m very fond of, that I’m posting, if I post a chapter of it, it’ll get about seven likes. If I post something on the Israeli conflict or something about Trump, which fundamentally I know nothing about, I’ve never met Trump, I know it’s going to get about 70 likes, something like that. And it’s just the way it is. It’s not really something I can fight. I mean, there are these limitations to Substack about it being maybe at its heart a social media. But to me it’s close to being a miracle because everything in the culture was going towards shorter and shorter form b******t for a long time. And I mean, that’s just what it seemed like with Facebook and Twitter. And the fact that people’s attention spans are getting longer again is amazing. And then that creates the possibility for something else to happen for a renaissance and people really appreciating fiction and really appreciating deep stuff. And that’s what I’m here for. I want a flourishing literary culture where people have pride in their inner lives and in essentially their souls and in the stuff that matters. Joshua Doležal: This is always happens when I read your work and then when we talk, I feel like we’re kindred spirits. But then I hear these, for me, irreconcilable tensions in some of what you’re saying. So all of my life, when I became a serious writer, the writing itself took place out of sight. And the only way that you had engagement was when you worked through this laborious process of revision and you had this longform piece or poem that you’d really crafted as carefully and beautifully as you could. And then you shared it and then you would amass a body of work and then publish a book and you didn’t really show much mess behind the scenes. I don’t write longform as much as I used to because I think there’s something fundamentally antithetical to the real-time engagement and the work that it takes to produce longform writing. Longform writing happens over sustained solitude. It’s not something that is improved by commentary. The soul of my creative life that I followed for 20 years with the literary journal scene...it’s not gone, but it’s antithetical to everything you’re saying about Substack, the hot take, the shorter post. All those things are what get engagement and you sink more time into the longform work, you sink more of your soul into it, and that’s not what moves the needle. To me Substack is really the opponent of that kind of creative work. Sam Kahn: This might be close to I think where the pivot of our usual disagreement is. I’ve had a turn in the last few years where I’ve really become kind of a McLuhanite in terms of really believing that the technology shapes the communication and that that’s kind of the way it is. And that basically in the collective memory of all of us, everything has been done a certain way for a couple of hundred years. We have this ver

    35 min

  8. 2025-09-09

    The Things Not Named — With River Selby

    Most of my content in 2025 is free, but I appreciate the support of readers who make my interviews possible. Upgrading your subscription unlocks my monthly essays from a memoir-in-progress, as well as the entire archive. I’m also proud to be a Give Back Stack. 5% of my earnings in Q3 will go to the State College Food Bank. See my accountability page, with receipts for Q1 and Q2, here. The Things Not Named — With River Selby Joshua Doležal: Welcome back to The Things Not Named. I’m Joshua Doležal. This year I’ve been asking writers how they know high-quality writing when they see it and how their own sensibilities have been forged. My guest today is River Selby (they/them). River is the author of Hotshot: A Life on Fire, their first book. River worked as a wildland firefighter for seven years, stationed out of California, Oregon, Colorado, and Alaska. They are currently a Kingsbury and Legacy Fellow at Florida State University, where they are pursuing their PhD in Nonfiction with an emphasis in postcolonial histories, North American colonization, and postmodern literature and culture. River has spent nearly a decade researching the history of fire suppression in the United States, Indigenous fire and land-tending practices, climate change impacts, and ecological adaptations across North American landscapes. River holds an MFA in fiction from Syracuse University and a BA in English and Textual Studies from the same institution, where they served as a Remembrance Scholar. Visit their website at www.riverselby.com and find them on Instagram @riverselby. As you might know, I was a wildland firefighter for many years, so I was delighted to see this new release. I hope you enjoy our conversation. Joshua Doležal: It sounds like you grew up reading a lot and you describe in your book about firefighting a kind of journaling habit that you were chronicling your life as it was happening more or less. But it doesn't sound like you started writing seriously until near the end of your firefighting career. So when you look back to some of those early influences, before you even started consciously trying to write what were you reading? Or what were some of those early guideposts for craft, when you responded to literature powerfully and you knew that what you're reading was high quality? River Selby: I had an unusual upbringing. I was born into Scientology. My mom left when I was two and she was very into new age things, and she read a lot. She had dropped out of high school. But she was very smart and her bookshelf was filled with new age books of the eighties persuasion and also a lot of true crime. And then some Pearl S. Buck and Rachel Carson and Aldo Leopold, who she got from my grandmother, who I also lived with for a while when I was younger. My grandmother had left her wealthy family in Texas to marry my grandpa, who was a Marine. In World War II she was a nurse and they met during the war. And my grandma's bookshelf was also filled with true crime and all kinds of pulp, fiction and nonfiction, but also all of the Shakespeare and Emily Dickinson. She loved poetry, loved renaissance poetry. Read to me a lot, encouraged me to read beyond my grade. I talked really early. I read really early. I was very verbal when I was a child. And too verbal according to many of my teachers. And we also moved a lot. And so reading was my way of connecting with the world because I didn't connect with my peers very well. I was also autistic and didn't get diagnosed until a few years ago. And so I kind of read all of the stuff they give to kids like Laura Ingalls Wilder. But I also would go to the library and go to the bookstore. I started out reading beyond my age with Stephen King, Dean Koontz, stuff like that because I really loved the genre of fiction and horror. And then started reading more nature writing. When I was a teenager, I read Mary Karr’s, The Liars’ Club and really became a fan of memoir because it was a way that I could imagine myself out of my life in a way, because memoirs are almost always writing from a place in the future narratively. Joshua Doležal: When you started to think about writing your own memoir, I was curious about who some of your influences were, but it sounds like you discovered the literary memoir pretty early. So there was kind of a period there where it was very much a scene that was emerging as you were a teenager. What spoke to you about Mary Carr's book and how she made literature out of her life? River Selby: It's interesting for me to reflect back on my reading life when I was a teenager because I ran away for the first time when I was 12 and was homeless on and off throughout my teens. Sometimes I was encountering books and sometimes I just wasn't because I wasn't living in a home. And I think that when I was encountering books, they were almost like, I almost just picture someone climbing up a cliff and they were the handholds for me. And Mary Karr’s The Liars’ Club. Yeah, my childhood was really unstable and my mom had mental health issues and was an alcoholic and she had this kind of cycle of boyfriends coming through who also were not very stable and then married an alcoholic when I was 13. And so her book felt like being seen because so much of what I had read felt very constructed and far away from me, whether it was fiction or nonfiction. But because of her voice in that book she really inhabits her younger self. And I think that because that voice was so strong and there wasn't really a narrator that was placed outside of the time of the book, that made me feel like I had a companion almost in my own experiences, so it was really special to me. And I don't think at that time I was thinking, I want to be a writer. That thought was so far away, but I do think that subconsciously it was planting a seed of, oh, well this person lived this life and now she has this book and she's a writer, and so maybe that's a path that I could take. Joshua Doležal: For a lot of years, I'd associated memoir with autobiography. Ben Franklin's autobiography is very chronological. There's not a lot of layering that happens with it…sort of this happened and that happened. But literary memoir, as I understand it has more fictional elements to it. And also some layering of what we call the voice of innocence and the voice of experience. The younger self immersed in moments that that self can't see or understand, blinded by impulse or just naivete and the voice of experience that can make meaning of it or see a bigger picture—read against the grain of some of what the younger self saw. So I liked the texture of that and it really fit my own life story because I'd grown up in an evangelical home and I'd left that faith tradition. So there was a lot of before and after distance for me to use. And I think that's true for you as well, because in your memoir, Hotshot, you use she because your name was Anna then. And so you've since rediscovered or evolved in your identity. The voice of experience is quite different, in a very literal sense, from the voice of innocence in that book. Is that fair to say? River Selby: I needed to have a certain level of authority narratively embedded into the prose. That was a huge process personally, psychologically, because so much of memoir for me, and I think for some others as well, in that reflection for me, I had to go back and re-experience those things and essentially not re-traumatize myself, but I had to be in that space and it was not a comfortable space. I would write from that space, and my authority wouldn't be there yet because it was so still in the past. And so part of the revision process was having to work through so many things personally and kind of parse through things so that I could write about my past self in a way that was not judgmental, that was not scared. That was where I could really bring myself forward in all of my flaws, while also bringing forward a lot of the cultural issues I was trying to engage with. And also pulling out things. As far as my non-binary identity, I look back at myself then and I see myself trying to inhabit an identity that didn't fit me. Joshua Doležal: So last week I pulled out one tool from your book because I really admired how you'd used it. And it was signposting, which I really first understood in radio form, where you would get a teaser clip and then it's almost flipped from academic writing. In academic writing, you always identify the speaker ahead of time. I spent a lot of time working with students on signal phrases and seamless integration of quotations and things like that. And in radio it's completely the opposite. You want to let an audio artifact build suspense or intrigue and then identify it almost immediately after. So it’s an intuitive thing where you anticipate a point of need for the listener, and then address it at that point of need. In your book, I thought it was especially evident because firefighting is such a subculture with its own arcane language. And that's a real barrier for readers coming into firefighting, not knowing what a trunkline is or what a Mark 3 pump is, those kinds of things. You could have done it very tediously. But instead you just told the story in an immersive way. You set the scene and then would name the thing. Piss pump, for instance, was one of the examples I used. And in the very next sentence, you would then describe either the tool or you would just show how it was used or you would address what surely was confusion for the uninitiated reader. And I don't know how conscious you were of that, if that came through the editing process as you're working with your commercial publisher or if that was something that you learned along the way in your coursework. River Selby: So thank you. I really appreciate that because like I said, I teach writing, but usually when I teach it, we are looking at something and taking it apart. And it's also an intuitive

    30 min
See All (38)

About

Conversations about literary craft and the things not named that bring high quality to fiction, memoir, and poetry. Hosted by Joshua Doležal, creator of THE RECOVERING ACADEMIC. joshuadolezal.substack.com

Information

  • Creator
    Joshua Doležal
  • Years Active
    2025 - 2026
  • Episodes
    38
  • Rating
    Clean
  • Copyright
    © Joshua Doležal
  • Show Website
    The Things Not Named