Writing and Medicine, Creativity and Career: My Journey, My Story
by Lawrence D. Mass
Statement for World AIDS Day, Dec 1, 2022, presented under the auspices of Elsevier Science Inc, New York City and Amsterdam, hosted by Thomas Collins
If I was serious in my attraction to the drama and adventure of medicine and the challenge of being a physician, writer and activist on the margins of society, I was being guided in this trajectory by something more inchoate: the need to tell my own story.
However prized art and creativity may seem to be in society at large, they are only rarely rewarded financially with even sustenance wages. Hence the stereotype of the writer or artist living hand to mouth.
There have been great writers who earned fortunes. Shakespeare and Hemingway come to mind. For most of us lesser mortals, however, while writing may always have been a deeply felt imperative, it could only come alive in the interstices of what are irreverently referred to as day jobs.
How easy is that? Well, as I perceived it, it was the cause of my hospitalization for Major Depressive Disorder in 1983, 2 years into the AIDS epidemic.
My writing career, which never became a professional career, had begun with unpaid pieces for small community presses on an array of subjects of interest to me in medicine, health, the arts and culture. As STD rates skyrocketed in the gay community, I found myself on the cusp of one of history’s greatest pandemics.
Writing on what we called gay health was rare even in the newly emerging gay press. Most of it was on mental health, in the wake of the declassification of homosexuality as a mental disorder by the American Psychiatric Association in 1973–74. That’s the matrix in which my own gay activism and journalism had begun, as a watchdog for reactionary movement within psychiatry to rescind the APA declassification.
STD’s culminating in AIDS were my trial-by-fire initiation into new realms of medical journalism and community medicine. Though there were a few other physicians doing notable work with the gay community in their practices, I was alone at that time as a physician in my self-designated mission of health reportage in the gay press, most of it for the fledgling newspaper, The New York Native. On May 18, 1981, the Native ran what became the first published report, by me, on the epidemic that would later become known as AIDS.
In the first year of this writing, I was trying as well to straddle a fledgling career in medicine, first as an anesthesiologist, then with work in addiction.
Addiction medicine had yet to come together as a medical specialty. 2 decades later, I would be among the first physicians to become a diplomate of the American Board of Addiction Medicine.
Prior to that time, scattershot addiction treatment clinics offered a minimally compensated alternative for physicians like me who were interested in community medicine and finding ways to work part time.
In outreach to LGBTQ subcultures, injection drug users and the chemically dependent, I was joined by a ragtag consortium of physicians such as Drs. Joyce Wallace and Joseph Sonnabend and other health care professionals doing overlapping work with street prostitutes, immigrants, the incarcerated and the homeless, often including LGBTQ’s rejected by their families. These were undesignated public health enclaves with little or no legal or medical recognition, protections or services.
After several years of earning less than subsistence wages with part-time work in Methadone Maintenance while trying to do my writing and activism on the side, I tanked.
I was drowning in a brine of personal frustration and despair, marinating in alcohol, marijuana and sex. The atmosphere was toxic with gay self-hatred, public apathy and homophobia. It was a miasma that’s well-captured in the current series American Horror Story NYC.
Doubtless there are writers whose writing is not initially invested with their deepest selves, their souls. And there’s writing on assignment. No shame in that. Hemingway did it. And within the confines of his commissions, he managed to express himself with his soul as a writer. In this, however, he was oblivious to the elephant in the living room of that soul, the big game stalking him — his alcoholism.
Whether under assignment or not, for many of us the commitment of writing is a calling that begins with the same practice with which one must begin recovery from alcoholism or any other addiction: acceptance.
But acceptance as well of the other realities of one’s life, such as paying the rent. I remember how in that early period of the Native, later AIDS journalist David France held a fundraiser for his own writing, to which I contributed $25, money I scarcely had for myself.
If I was serious in my attraction to the drama and adventure of medicine and the challenge of being a physician, writer and activist on the margins of society, I was being guided in this trajectory by something even deeper but more inchoate: the need to tell my own story.
On the locked ward at the old St. Vincent’s Hospital in Greenwich Village, now luxury condos, where I came within moments of getting shock treatments, I had to accept my specific reality. I would have to reconfigure my priorities around earning my living as a physician with those of finding the time and energy to do the writing and activism that seemed of such life-and-death importance to me personally and for the world, especially around the ever-worsening global crisis of AIDS.
As I recall conceptualizing it then, the image I had of my future was of someone having to spend the rest of his life with a ball and chain around his ankle.
What I consciously yearned for was something that was never to be — a life of independent means that would allow me to pursue my writing unfettered by day-job responsibilities.
Ideally, I would have the freedom to write that my friend and mentor Larry Kramer had. Larry’s brother Arthur, a corporate attorney, had so successfully invested Larry’s earnings from early Hollywood film work that Larry was set for life.
The much tougher prospect before me was doable, I could see, but I had neither the will nor the resolve, especially while still under the influence — a legal phrase still in use for alcoholism — to live a life of such Sisyphean hardship.
It would take another year following my hospitalization and treatment for depression for the progression of my alcoholism and cannabis use to reach bottom, the breaking point necessary for my recovery to begin in earnest.
Acceptance of the realities of my life as an outlier in medicine and writing without other means of support was the first step in this journey of unknown duration and destination.
Subsequent steps were painstaking. Around me were examples of writers who were physicians, and who seemed to have success in being both, including a number who were also immersed in arts and culture. Maimonides, Chekov, Schiller, Schnitzler, Maugham, Keats, Jonathan Miller, William Carlos Williams. One of my neighbors is Siddhartha Mukherjee.
Another reality I had to face early on is that I wanted to write what I felt impelled to write, rather than on assignment or commercially.
Though I had majored in English at my alma mater, the University of California at Berkeley in its late 1960’s heyday, and had done some personal writing and arts criticism there, I had no background in journalism. My only publications prior to 1979 were both medical. The first, during my residency in anesthesiology at Mass General Hospital and Harvard Medical School, was a report of a case of vocal cord paralysis following intubation and anesthesia. The second was a forerunner of the more personal journalism that would characterize much of my future writing. This piece, “Inpatient Impatient: Notes of a Hospitalized House Officer” was about my experience of being the victim rather than the perpetrator of comedy-of-errors hospital care by overworked, disgruntled residents like me. Apart from these early forays, the writing I was doing for the Native was otherwise come-as-you-are, on-the-job training.
From the earliest of these efforts, it was the subject matter and stream-of-consciousness flow that drew me to writing, rather than ambition for a literary career. I had no dreams of becoming a professor or literary celebrity.
What I did seem to want more than anything else was to find ways of telling my own story within the writing I was doing on medicine, health, the arts and culture.
Past that earliest period of my AIDS coverage, which later, albeit rarely and often grudgingly, became recognized as pioneering, I did try to find ways to make my life work with greater foundation and direction.
And so I inquired with mainstream publications about employment possibilities.
Between the lines of curt, cool exchanges with editors at the New York Times, it seemed clear that I would have to start out as a bottom-rung “stringer” — a term still used in journalism — doing assigned reporting on subjects I might not be inspired to write about.
I knew several NYT staff writers who worked like galley slaves on bloodless assignments. Their passion for writing had been discernibly eviscerated. This was not what I wanted.
Years later, the NYT would engage one of its fiercest critics, Larry Kramer, to write a piece for them on the pharmaceutical industry. What resulted was so lifeless and absent Larry’s passionate voice as to seem almost parodistic, a comedy skit from SNL: Larry Kramer as edited by the NYT.
Meanwhile, it was Larry Kramer who first encouraged me to honor my own idiosyncratic, discursive voice and vision as a writer. It was an encouragement that remained singular.
Absent any more discernible interest in me and my work on AIDS and gay health at a time when the NYT was, under editors Abe Rosenthal and Arthur Gelb, still flagrantly, homophobically neglectful and insensitive, I withdrew from further inquiry with them.
But what about a physician and writer who did seem to make it there — Lawrence K. Altman, author of that first NYT report, “Rare Cancer Identified in 41 Homosexuals in NYC” (7/3/81)? Wasn’t he a role model?
Altman was not gay, at least not that anyone knew. But isn’t not knowing who the writer really is in the best interests of objectivity, and isn’t such objectivity the highest standard of journalism? As a gay liberationist committed to telling the whole truth in a time of relentless suppression of gay truth, that’s not journalism I was ever going to do.
In Altman’s article, there’s of course nothing autobiographical or personal, and the word gay does not appear. Nor were any gay spokespersons quoted or consulted. Meanwhile, in a follow-up article for the NYT months later (5/11/82), Altman does use the term “GRID” — for “Gay Related Immune Deficiency” — but without quotes, thereby passively condoning this early pejorative nomenclature. In that article I’m quoted as saying “gay people whose life style consists of anonymous sexual encounters are going to have to do some serious rethinking.”
When I confronted Altman at the first international AIDS conference in Atlanta in 1985 and asked why he and the NYT were doing such a poor job of covering AIDS, his response was trigger-ready: “We’re not an advocacy journal,” he said, peremptorily ending the seconds of his time I was granted.
I also inquired about work with several medical publishers, including Elsevier. But there, too, it was made clear that the priority was not to hear my ideas but how I might best fit with the needs of the publication.
Had I been even less self-confident and more willing to play by the rules for newbies, I might be able to ascend along a traditional corporate career trajectory. Probing and encouraging whoever I really was and whatever it was I might really have to say and be capable of did not seem priorities.
Publishers and publications do, of course, have legitimate needs for organization and accountability. For writers, the challenge is to discern when, where and with which such enterprises they can feel supported. For me, such a fit proved elusive.
However challenging for finding the time and energy to juggle career with creativity, what earning a living as a physician afforded me was the ability to continue writing on subjects that were of interest to me and chosen by me.
If I couldn’t maintain that deeply personal, primary commitment to my writing, I felt certain two things would happen: the world would come to an end and I would die.
In the wake of 9/11, which did seem a kind of end-of-the-world cataclysm, I was offered full-time work in addiction with Beth Israel (now part of Mount Sinai), known for its outreach to the underserved. In this honorable if also demanding work, not only did I not die. With the help of recovery, with its precept of “To Thine Own Self Be True,” I somehow found the self-possession, motivation and stamina to continue my writing.
Occasionally I would be commissioned to do something I felt in sync with, like making today’s statement for World AIDS Day, because it also gives me the opportunity to place AIDS in the context of my own life. Always, even on clinical subjects, my writing has veered into the autobiographical, personal and subjective, even as scientific objectivity and accuracy retained priority.
It was during this period that I began writing about a gay subculture I myself had become involved with — the bears. For several years I wrote a column called “Bears and Health” for American Bear Magazine that covered topics of pertinence and interest to its readership of mostly overweight, middle-aged men like me: obesity, diabetes, bariatric surgery, alcoholism, addiction, depression, sexual compulsivity, AIDS and other STD’s.
Another piece I can recall being asked to write was a feature on the 30th anniversary of AIDS on a subject that kept slipping through the cracks of mainstream and most other AIDS coverage and activism. That piece was originally called “Genocide by Sloth.” It was about the backstory and players of the single biggest catastrophe in the history of AIDS: the AIDS denialism loss of a third of a million people in South Africa in the early 2000’s.
The only media venue to give this hugely pertinent subject — what I called “the great unwritten chapter on AIDS” — its due was the PBS Frontline special, The Age of AIDS, in 2006. But even that remarkable 2-part, 4-hour event, focused on AIDS in Africa, eschewed the origins of AIDS denialsm in the early history of AIDS in the gay community.
I remember meeting Mike Wallace at a NLGJA cocktail party hosted by Jonathan Capehart. I went to the party and schmoozed with Capehart and Wallace, waiting for an opportune moment to make the pitch I’d been planning around the urgent need for mainstream coverage of another emerging public health crisis. Hepatitis C had already begun decimating populations of drug addicts and was becoming the newest STD to contend with.
That nobody was covering hep C, eerily replaying the recent experience of AIDS, is one reason it became known as “the stealth epidemic.” The other reason is that this disease did its chronic, often fatal damage silently over decades. It would have been a perfect topic for 60 minutes. I did succeed in getting my few one-on-one moments with Wallace, notably homophobic in the past, but he brushed me aside with his characteristic alacrity.
I continued to persevere on this front, meeting and eventually working with Maer Roshan at New York Magazine. The result was a feature called “C Sick” that contributed to the opening up with the broader public of this major world health challenge. In a breathtakingly short two decades, hep C became pharmaceutically curable, but with the catch 22 of prohibitive cost for the greater world of the poor it mostly affects.
Paramount among the mega-topics in medicine and culture still in dire need of moral perspective, media coverage and health care activism is the malfeasance of the pharmaceutical industry that Larry Kramer was so intent on indicting. A generation later, groundbreaking photographer Nan Goldin would lead activists in protests against Purdue Pharma and its owners the Sackler family for their stoking of the opioid crisis that has left hundreds of thousands of preventable deaths in its wake. More than ever, in the magnitude of its global profiteering, sacrifice of medicine’s Hippocratic Oath and the mass casualties in its wake, Big Pharma invites comparison to the industrialization of slavery.
Meanwhile, I continued my autobiographical, cultural and creative writing. Looking back over time, I can feel some pride in being able to have had both medical and literary lives of fulfillment.
It has been a life crammed with responsibility and always under the gun of time. I recall my answer to people who, especially in the wake of my hospitalization for and recovery from depression, would ask me how things were going. I would always say something like: My life is very full now. I no longer have time for such luxuries as being depressed, having writer’s block or being unhappy.
Almost all of my writing has been done in the early morning from 4–7 am, before work, on weekends and the occasional day off.
At the heart of my commitments and responsibilities were decades of caretaking for my life-partner, legendary and beloved gay activist Arnie Kantrowitz. Arnie suffered heroically from all the advanced complications of diabetes, including heightened vulnerability to COVID, from which he died earlier this year. He was 81.
COVID was a politically fractious, vehemently science-denying epilogue to AIDS that vividly demonstrates how, given the opportunity, most of the world will continue to commit the mistakes, sins and crimes of even the recent past without hesitation or misgivings.
More recently and however tardily, monkeypox outreach and care did modestly demonstrate our ability to learn from the past.
But “Never Again”? Don’t bank on it.
Over our 4 decades together, Arnie underwent 52 hospitalizations. Surely, my greatest learning experience in the art and practice of medicine has been caring for him.
Meanwhile, the price for my independence as a writer has been high. Not only in recognition but for the writing itself, much of which continued to be unremunerated and for small community, academic or otherwise marginal publications.
For many years, I had the advantage of living with another writer, Arnie, who was also a college professor of English literature and a writer himself on subjects of mutual interest. He was also a great teacher and excellent editor. But as he became increasingly incapacitated by age and illness, I no longer had that advantage of relying on his feedback.
Ever-greater amounts of my subsequent writing had to proceed with myself as my principal and often only editor. As most writers will attest, we need editors and it’s at our own risk to proceed without one, as I’ve done for this presentation today. One of the greatest lessons I had to learn is that if you have no editor and are committed to your writing, you must accept that challenge and become your own editor, whatever the risks.
If you have an editor, but one you sense is working more against than with you, who is not really honoring your voice, you must persevere. This was notably the case for me with Richard Schneider at Gay and Lesbian Review, though that situation did improve somewhat over time. It’s Richard who commissioned that 30th anniversary piece on “AIDS Denialism and African Genocide” (changed from my original title, “Genocide by Sloth”). My ability to work with the fantabulous Tom Steele at Christopher Street, who became my good buddy in codependence, was a much better fit. Until the period when it became dishonorable to write under the auspices of AIDS denialist editor-in-chief Chuck Ortleb.
How far afield I was instinctively from mainstream journalism is evinced in how I did interviews. I’ve done many, some of which were published in a two-volume collection called Dialogues of The Sexual Revolution.
A priority for me was to allow those I interviewed to approve and edit their quotations. In medicine and science, as well as in history and as I’ve come increasingly to appreciate them, Gotcha confrontation and sound bytes tend to be troubled. This was something I felt acutely in my interview with Noel King on NPR on the 40th anniversary of AIDS. In what seemed her determination to frame me as an early apologist for gay promiscuity, replete with the bleeping out of my use of the word “fist-fucking,” the effort seemed to be to entrap rather than consider what I had to say.*
As I saw it, if I were asking questions that could be as complicated and personal as the answers I sought to elicit, respect and care for accuracy and context should be mutual and trustworthy.
Meanwhile, the screenplay-option lure of Gotcha, sound bytes, dramatization and semi-fictionalization has saddled the 3 forefront AIDS chronicles of our time with mounting questions of selectivity, distortion, inaccuracy and sensationalism.
Randy Shilts’s And The Band Played On, held in such high esteem by King (one of the greatest books she’d ever read, she said), who admitted she had never seen or read The Normal Heart, did break ground in chronicling the early unfolding of AIDS, however skewed to San Francisco. And it was the only history of and primer on AIDS geared broadly to the general public. Alas, the book’s angry title that broadly and rightly indicted everybody, but which invoked “Boys in the Band” stereotypes of gay licentiousness, proved a forewarning of the “Patient Zero” scandal to come.
Larry Kramer’s The Normal Heart may have been heartfelt, trenchant and on-target in key indictments. And the play may have been a life-and-death urgent sounding of the alarm for everybody. But it was also problematic in its stoking of the self-righteous anger, however otherwise and legendarily galvanizing, that led Shilts astray. More troubling were its semi-fictional proximations of individuals, relationships and events, undermining its author’s declamations of historical accuracy.
And what of David France’s How To Survive a Plague, the most recent and expansive of these docu-dramatizations in covering the epidemic from the early period of the first reports, however glossed over, through the identification of HIV and the epochal activism of ACT UP and treatment development over the ensuing two decades? Alas, this ostensibly comprehensive history never delineates the phenomenon of AIDS denialism, a phrase that does not appear in Plague, that so clogged early AIDS discourses and prefigured the later and likewise unmentioned mass-death catastrophe in South Africa. Quite a sleight-of-hand for a book that otherwise has more listings for the original standardbearer and Svengali of the early immune overload theory and multifactorialism that set the stage for AIDS denialism, Dr. Joseph Sonnabend, than any other personage.
In their reliance on selectivity and dramatization, each of these narratives can seem more akin to American Horror Story NYC than authoritative history.
Amidst my own Age of AIDS journey, as touched on here, has been my muse — that inchoate motivation to tell my own story. It’s the story of a gay Jewish man who came of age via gay subcultures and the world of opera against backdrops of AIDS, addiction and resurgent antisemitism.
Not so unlike the story of Fire Shut Up In My Bones, the memoir turned opera by Charles Blow and Terence Blanchard, it’s not a disquisition on ethnicity, discrimination or identity politics but rather the more deeply personal story of my coming of age and into my own. Whatever its worthiness and whatever its byways, it’s the story I’ve most needed to tell.
It took 40 years and is in two volumes. The first is my memoir, Confessions of a Jewish Wagnerite: Being Gay and Jewish in America. Its sequel, which continues the memoir and is as well a collection of my pieces on AIDS, medicine, art and culture, is called On The Future of Wagnerism: Art, Intoxication, Addiction, Codependence and Recovery. Together, they comprise what I call my “Jewish Wagnerism Series.”
I’m now 76 and retired. I’m proud to have recently received GMHC’s Founders Activism Award.
Apart from medium.com, I’m not active on social media, but information on these and my other books, including my anthology, We Must Love One Another Or Die: The Life and Legacies of Larry Kramer, can be found on my website: Lawrencedmass.com.
I worked for years on collections that were never completed:
Synchronicities: Chronicles of the Violaceous Death was a proposed anthology of my early pieces on AIDS, medicine, health and culture that met with indifference from agents and publishers. It would have been the first book on AIDS.
Musical Closets: LGBTQ Themes, Persons and Issues in Music and Opera. These essays, interviews and reviews on the frontiers of homosexuality and music were likewise met with resistance, especially around still-sensitive issues of outing.
Bears and Health was geared to the emerging gay subculture of the bears.
So, yes, it does seem regrettable that work of historical interest was never collected.
Most of this writing, however, is with my papers, along with Arnie’s, in the LGBTQ collections of the New York Public Library:
So there you have it. My journey, my story. I’m very pleased to have had this opportunity to express myself regarding what I would still have to say has been for me, as his writing was for Larry Kramer, the most important challenge, task, mission and fulfillment of my life: my writing.
Lawrence D. Mass, M.D.
World AIDS Day, December 1, 2022
New York City
*The NPR piece from May 18, 2021, “The Denialism That Shaped The AIDS Epidemic” by Noel King, opened with transcribed excerpts from my interview with her that concluded with input from Michael Specter, who is thereby given credibility for the AIDS denialism perspective I had so painstakingly endeavored to lay out.
The interview transcript was followed a week later by a more extensive feature by NPR producer Ryan Benk that presented the subject of denialism and my role in early AIDS coverage in greater detail.
I remain grateful to both King and Benk for their efforts to honor and illuminate this early period of AIDS coverage.