Ward D
Ward D
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Freida McFadden on Ward D
In her own words: quotes and insights from the author.Why she wrote it
A short story that needed more roomThe book began smaller than its premise. Before there was a novel, there was a contained piece of short fiction called ‘The Psyching,’ and the expansion from that form to a full novel is the closest McFadden has come to explaining the book’s genesis in any public record.
The Psyching was a short story that I expanded into Ward D.
The psychiatric ward at the center of Ward D was not a setting McFadden reached for through research. Her father’s specialty meant the world of the book was already familiar before she ever sat down to write it.
My mom is a podiatrist and my dad is a psychiatrist.
That upbringing, combined with her own years working as a hospital physician, made the locked unit less an exotic location than a world she already understood from the inside.
Before Ward D, McFadden’s pull toward the hospital as a setting had already shaped earlier work. The intensity she was drawn to write about was autobiographical before it was fictional.
I’ve always wanted to write a book about my medical internship as it was such a… let’s just say, intense experience.
How she wrote it
Months in her head, weeks on the pageMcFadden’s drafting speed is a product of the work that happens before she opens a document. The planning phase is long and entirely interior, and by the time she begins typing she already knows where she is going.
I spend a lot of time planning the book in my head and the physical writing is quick. I’ll think about a book for months and then I like to blow through the first draft really fast because once I’m writing, it’s all I can think about.
That immersion doesn’t respect office hours. Once a draft is underway, the story colonizes the rest of her life, including the hours before dawn.
My agent wanted me to take a break from something I was writing but I said, I can’t, because I can’t sleep until I finish it. If I’m in the middle of a story and I wake up at 3am, I can’t get back to sleep because I’ll start thinking about the story.
The twist in any McFadden novel is not a late discovery she writes her way toward. It is a condition of starting, engineered into the plan before a single scene exists.
My process is that 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.
Knowing the twist in advance is only half the problem. The harder craft question is whether the reveal will feel both surprising and earned, and McFadden has a precise standard for what separates a twist that lands from one that merely shocks.
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 fast first draft is not the end of the labor. The weeks of writing are followed by what she describes as an open-ended editing process that could consume a year if she let it.
After that first draft, which usually takes a few weeks. I’ll just spend forever editing. I could spend another year editing.
What she wants us to sit with
Sympathy for the dangerous, laughter in the darkA psychiatric ward is a space where the line between dangerous and simply unwell is rarely clean. McFadden’s deliberate interest in characters who don’t resolve into simple moral categories makes it exactly the kind of setting she is drawn to populate.
I love writing morally grey characters. 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.
Dark material and humor are not opposites in McFadden’s thinking. She treats comedy as structural, not decorative, a quality of mind that runs through even her most unsettling books.
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.
Asked at the TIME100 Gala in April 2026 whether she feels any guilt for the ‘diabolical twists’ she subjects readers to, McFadden’s answer was immediate and reciprocal.
No, I love it. I love it when authors do it to me and I give it right back to you.
Her own website lists Ward D among the books readers may want to consider ‘for your mental health’ before opening, which suggests that reciprocity was fully intentional.