Brain Damage
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Freida McFadden on Brain Damage
In her own words: quotes and insights from the author.Why she wrote it
A diary mined for fictionMost authors struggle to reconstruct what set a book in motion. She has been candid that this problem is nearly universal, and that the question itself puts writers on the spot in a way that rarely produces honest answers.
Every author I have talked to agrees that our least favorite question to be asked is, ‘What inspired you to write Book X?’ First of all, it is a question we are asked constantly, so we are basically answering it over and over and over. Also, with any book, the motivation can come from many different places, and sometimes we can’t even remember what it was.
What she can say about Brain Damage is unusually specific: the raw material was already written down. Before the novel existed, she had kept notes on what she was seeing every day in her work as a brain injury rehabilitation physician, and those notes became the story’s spine.
I used to keep like a little diary sort of like of my experiences when I was working. So I like mined it for like things I could use in the Brain Damage book. Like things that happened to me or things that happened to people I knew. So much of the Brain Damage stories in that book were actually things that had happened to patients of mine or patients of friends of mine. So that one, that was definitely one of my more authentic books in that, like, so much of it just came straight from my life. [paraphrased from audio]
She self-published Brain Damage in 2016 while still working full-time in medicine, which means the diary and the job were running in parallel. The book did not follow the career; it grew out of it.
How she wrote it
The twist before the first wordShe did not approach Brain Damage as a research project. Her specialty is brain injury rehabilitation, the exact ward the novel inhabits, and she had spent years working alongside the occupational therapists, speech pathologists, and nursing staff who populate the book. That experience had a hard boundary, though, and she has been precise about where it stops.
If I do write about a doctor or something medical, I don’t need to research it because I’ve lived it. But it doesn’t mean I know everything medical — I only know my own field very well.
Once the source material was settled, her structural method took over. For every book she writes, the ending determines whether the project can start at all. She describes her husband, a mathematician, as the first stress-test for any plot: he looks for holes, and she won’t begin drafting until he approves. After that approval comes a process she treats almost like a sprint.
I come up with an idea including a twist in advance. I plan it out only in my head for a couple of months, then I spend a couple of weeks banging out a first draft. I don’t stop, just write. If it seems bad or I feel stuck, I just write. I keep telling myself that I’ll fix it later.
The twist-first discipline comes from a specific conviction about what makes a reveal land. Surprise alone is not enough: the person revealed must also matter. She has put the standard bluntly, describing a bar that most thrillers fail to clear.
I think it’s not enough for the killer to be the person you’d least suspect. It has to be someone that didn’t even cross your mind for a millisecond. And yet, at the same time, it also has to be someone that is meaningful.
The personal thread
Reading her diary without knowing itThe gap between a physician’s daily work and a reader’s experience of fiction is usually wide. She has described Brain Damage as a book that closes that gap almost entirely, because the ward she wrote about is the one she was still showing up to every day. The intimacy that readers feel is, in her account, not craft alone.
These books come from inside my brain. These are my personal thoughts. And it’s almost like when people are reading it. It’s like they’re reading my diary. [paraphrased from audio]
That closeness to her own experience also shaped Brain Damage‘s tone. A brain injury rehabilitation ward is heavy material, full of loss and slow recovery. She found humor in that setting anyway, and has described comedy not as a relief valve added in revision but as something she cannot write without.
Despite the dark subjects in my books, humour is so important to me. I love to laugh. I don’t like to take myself too seriously, and that translates into my books. I hope people get a laugh from them, even though they are actually thrillers, so humour is more like the side plot.
What she wants us to sit with
Good people doing bad thingsA rehabilitation ward is built around recovery, around the idea that patients are getting better and staff are helping them do it. She has written into that setting a more uncomfortable question: whether the people we trust with the most vulnerable patients are themselves as legible as they appear. Her answer, across all her fiction, is that moral clarity is the wrong thing to go looking for.
I’m intrigued by the idea that a person can be good deep down but still do bad things. Or a person can be mostly ‘evil’ yet still have sympathetic qualities. Someone who does nothing but good things is not interesting to read about, in my opinion.