Author Robin Cook Writes Psychology into Suspense

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Robin Cook is the pioneer that created a new category of fiction: a medical thriller, with his first novel Coma. Since then he has written 35 more.

When our books landed on a "10 best" list of novels featuring a doctor as a character (Charlatans for him, The End of Miracles for me), Robin Cook and I started an email conversation. During those early exchanges, he made this intriguing comment: "If I hadn't been bitten by the love of the immediacy of surgery, I would have studied psychiatry. After all, what is more interesting than the human mind?"

What, indeed, is ?

Robin Cook's novels are filled with characters who have specific diagnoses: PTSD, Narcissistic Personality, and Borderline Personality Disorder, for example. What's more, he includes the symptoms of these conditions and lets us see how they describe the people in the story, their motivations, and their capacity to do what they do.

He sprinkles psychological understanding throughout, such as showing the vulnerability felt by patients in the hospital for medical treatment because of their total loss of control. With humor, he teases about the personality characteristics of doctors choosing different medical specialties. He also draws attention to the psychologically negative effects of social trends, such as the heavy use of watching screens on electronic devices of all sorts. He does all this with such skill that it doesn’t distract at all from the constant tension running through his suspenseful plots.

Robin Cook's interest in the human mind benefits his readers greatly. Generously, he now shares with us how he weaves psychology and psychiatry into his thrillers. To show us specifically how he does this, he describes the writing process he used in his recent novel: Genesis.

How Robin Cook creates a medical thriller

His writing process in general

• Selecting the medical issue. He starts each book by selecting a medical issue he wants to highlight. His goal is to bring attention to an aspect of healthcare and medicine that has the potential to affect us all, for both good and ill.
• The plot. The broad elements of the plot usually emerge first in his thinking about any new story.
• The characters. Next, the personalities of the main characters are established. The characters are created so that their personality and motivations will move the plot along. Sometimes, they even create new directions in the plot.
• Diagnostic accuracy. When a character will have a certain diagnostic label, Robin Cook describes that character accurately. He studies that diagnosis thoroughly, so the character's behavior is consistent with the diagnosis—he is ably assisted by a research assistant: his wife, Jean, a social worker.
• The mix. "So it starts with the plot, but after that the creation of the story goes back and forth between elements of plot and formation of characters, with each one and forming the other", Robin Cook says. "Sometimes, the characters themselves create aspects of the plot."

The specific steps in the creation of the novel: Genesis

• The idea. "The idea for the novel began with my fascination with genetics, and how a murder case can be solved utilizing genetic information,” says Robin Cook. "I thought it was very interesting that it is possible to find a person by starting with only half of his or her DNA as determined by having the DNA of a son or daughter."
• Plot. "So the plot then began to emerge: An apparent overdose death that would be much more than it appeared on the surface."
• Character Development. A character needed to be created who would be suspicious about this apparent overdose death when others were not suspicious. The character would need a personal reason to be very motivated to investigate and find the true cause of death. With this in mind, Robin Cook introduced a character named Aria. She will be a physician who rotates through the medical examiner's office as part of her training to become a pathologist. She will perform the autopsy that sets the plot in motion. But why would Aria care about a pregnant young woman who died of an apparent overdose? And what in her personality and background would enable her to investigate the death in the manner necessary for the plot to unfold?
• Diagnostic Accuracy. To explain this, key aspects of her background were created. Aria herself had been abandoned while in college by a boyfriend after becoming pregnant. On top of that, her childhood was filled with incidents in which she had been abused and mistreated, which led to sociopathic personality characteristics. She's manipulative, lacks empathy, is angry, mistrustful, and disrespectful of authority figures. These traits enabled her to investigate in the manner she did by breaking rules, pushing boundaries, and offending people.
• The Mix. Through her personality, more elements of the plot were determined and these, in turn, further illuminated her personality. "It was a back and forth process, where plot informs character, and character informs plot," Robin Cook says.

For a doctor trained as a surgeon and the novelist who invented the medical thriller genre, Robin Cook's attention to the psychological is both surprising and welcome. Many thrillers of all sorts are simply plot-driven and thus much less rich.

There are few novels written by physicians, and even fewer written by psychiatrists, that can bring their psychological insights into fiction that is also entertaining. Robin Cook’s writing best-selling thrillers infused with psychological thinking is a service to the reading public.

And thanks are also due to him for helping shape our culture in another important way: at a time when only a very small percent of medical students were women, his 1977 ground-breaking and wildly popular novel Coma has a woman as a heroine—a young physician in training. His gender choice was deliberate, Robin Cooks says, with the hope of encouraging more young women to choose medicine as a career.