A Deeply Human Act

I did not come to writing easily. My teacher in infant school regularly humiliated me in front of the class because I struggled with handwriting and spelling; a casually cruel woman whose words lingered far longer than she could ever have imagined. Even today, I hesitate when asked to distinguish a noun from a verb or an adjective. Perhaps that is why writing has always felt so intensely personal. It may also explain why I have always found it difficult to watch someone else edit my work, despite knowing it is an essential part of becoming a professional writer. We pour something of ourselves onto the page, only to invite others to dismantle it with a red pen. That lesson was perhaps even harder for me because I arrived at writing relatively late, after spending 12 years as a postdoctoral scientist. I had learned how to think like a scientist before I ever learned how to think like a writer.

It has been said that writing is one the defining human activities: a deliberate act through which thought, emotion, memory, and imagination are shaped into language. For centuries, the difficulty of writing, the cognitive effort it demanded, the discipline it required, and the vulnerability it exposed, was inseparable from its value. Medical writing might be considered the next level up as it requires not only mastery of language but also mastery of the science you are writing about – no mean feat. In recent years, however, the world of medical writing has been profoundly shaken by the widespread availability of large language models (LLMs). Over the last 18 months I have mused extensively on how these systems can generate fluent, coherent, and stylistically convincing text in seconds, challenging long-held assumptions about authorship, creativity, and effort [1][2][3].

The emergence of LLMs introduces a fundamental tension. On one hand, reliance on automated text generation risks completely destroys the experiential core of writing. When language is produced with minimal cognitive or emotional investment, the process of struggle, reflection, and discovery that has traditionally defined writing may be reduced or bypassed altogether. This is why it can be hurtful when others suggest you are relying on LLMs or that LLMs will replace you. Writing, when mediated by LLMs, can become less an act of creation and more an act of selection, curation, or prompting. This shift raises concerns that the lived, psychologically transformative aspects of writing are diminished.

On the other hand, LLMs are radically egalitarian. They lower barriers related to literacy, education, disability, language proficiency, and confidence. Individuals who previously lacked the technical or linguistic means to express themselves in writing now have access to powerful scaffolding. This democratisation of writing prompts a deeper cultural question: will increased access produce more literary masterpieces, or simply more ‘slop’, what is effectively a proliferation of competent but soulless text? The oft-quoted claim that everyone has a book inside them becomes newly relevant. However, we might also want to consider the source and context of the quote. Christopher Hitchens, an American journalist, is quoted as saying this during a conversation with colleagues. Hitchens was known for his sardonic wit. The whole quote (or something similar) goes “Everyone has a book inside them, which is exactly where it should, I think, in most cases, remain.” Cynical but…

Against this backdrop, it is timely to re-examine writing not merely as text production, but as a psychological, emotional, and cognitive activity.

A Deeply Human Cognitive and Creative Act

As I already suggested, writing is among the most cognitively demanding activities humans perform. It requires the coordination of language systems, executive control, working memory, emotional processing, and imagination. Neurocognitive research has shown that writing engages distributed brain networks involving the prefrontal cortex, temporal language regions, limbic structures, and the default mode network, reflecting its integrative nature [4][5].

Unlike spoken language, writing is deliberate and sustained (or at least it is for me). It demands planning, revision, and self-monitoring, forcing the writer to confront ambiguity, contradiction, and uncertainty. For me it is best described as a problem-solving activity in which ideas must be generated, organised, evaluated, and translated into language in real time [6]. This effortful process is central to writing’s psychological significance.

Writing is also inherently relational. Even private writing presupposes an imagined reader, situating the writer within a social and cultural frame. This implicit dialogue contributes to writing’s capacity to shape identity, values, and meaning. Medical writing brings an additional social contract, defining not only the scientific correctness but also pitching it at the right ‘level’ for its audience.

Flow, Meaning, and Self-Expression

For many us, writing can be a source of joy. One well-studied mechanism underlying this experience is the state of flow, characterised by deep immersion, loss of self-consciousness, and intrinsic reward [7]. Writing lends itself to flow because it balances challenge and skill while providing immediate feedback. For the master craftsman (who we all aim to be), repeated practice transforms effort into intrinsic reward, as decades of deliberate refinement strengthen the neural circuits linking skill, prediction, and mastery, making the act of creation itself a source of profound satisfaction.

Beyond pleasure, writing offers meaning. It enables individuals to articulate emotions and understandings that are often difficult to express verbally, transforming diffuse internal states into structured narratives. This process can be profoundly satisfying, as it creates coherence where there was once confusion.

Empirical studies demonstrate that expressive writing improves mood, reduces stress, and enhances psychological well-being [8]. These benefits are not dependent on literary quality but on engagement with emotionally salient material and perhaps this isn’t immediately relevant for professional writers, but then perhaps it is. Telling a story is critical to communication and writing allows us to integrate experience into autobiographical memory, supporting narrative identity and psychological continuity [9][10].

Emotional Regulation and Psychological Healing

Writing has long been recognised as a therapeutic tool. Personal writing is where curiosity is indulged, ideas are tested, and our own voice is allowed to breathe without the constraints of a brief or a budget. It is often the place where we rediscover why we became writers in the first place.

I have always been amazed by the number of professional writers who tell me they have no desire to write for themselves. To me, that is like hearing a concert pianist say they never play unless someone is paying them. Surely every writer is, to some degree, a frustrated author. The urge to explore an idea, shape an argument, or simply create something because it matters to us is not a distraction from professional writing I believe that it is the very thing that keeps it authentic, rewarding, and alive.

Expressive writing facilitates emotional regulation by encouraging individuals to label, organise, and reframe emotional experiences. Neurobiological models suggest that this process enhances top-down regulation of limbic responses, reducing physiological stress and emotional reactivity [11].

In psychotherapy, writing is used across modalities, including cognitive–behavioural, narrative, and trauma-focused approaches. Writing allows for psychological distance, enabling individuals to examine thoughts and beliefs with greater clarity. It can also foster agency, as individuals actively construct meaning rather than passively experiencing distress [12]. Importantly, the therapeutic value of writing lies in the process, not the product. When writing is outsourced to LLMs, the emotional labour of articulation may be reduced, potentially weakening its regulatory and integrative effects.

Passion, Perfectionism, and Obsession

Despite its benefits, writing is not without psychological risk. The same intensity that enables creative immersion can slide into maladaptive patterns (particularly in the face of cruel critics). Passion for writing may evolve into perfectionism, compulsive revision, or excessive self-criticism, particularly in individuals with obsessive–compulsive traits.

Perfectionism in writing often shifts focus from expression to control. Writers may become preoccupied with correctness or originality, eroding joy and increasing anxiety. In my case, I found that resulted in my never finishing articles that I started. Repeated re-edits and procrastination leads to your articles going past their ‘sell by dates’. Cognitive models of obsessive–compulsive disorder describe similar dynamics, where compulsive behaviours temporarily reduce distress but ultimately reinforce it [13].

Writing can also serve as a form of escapism. While imaginative retreat is not inherently pathological, chronic withdrawal into writing at the expense of social engagement can exacerbate isolation and distress. The psychological impact of writing thus depends on context, motivation, and balance.

Rare but Significant Intersections

In rare cases, writing intersects directly with psychopathology. One notable phenomenon is hypergraphia, an intense and often uncontrollable urge to write, associated with temporal lobe epilepsy, bipolar mania, and certain neuropsychiatric conditions [14].

In psychotic disorders, disturbances of thought and language often manifest in writing. Disorganised syntax, loose associations, and idiosyncratic meanings reflect underlying disruptions in semantic processing and executive control [15]. It has been observed that in these circumstances writing may become infused with delusional themes, such as beliefs in special authorship or hidden cosmic significance.

The relationship between literary genius and mental illness is fascinating but often romanticised. Modern psychology suggests that while some eminent writers likely experienced mental health conditions, their creativity cannot be reduced to those conditions. Their talent arose from intellect, discipline, imagination, and relentless practice, with mental instability sometimes influencing the themes or intensity of their work rather than creating it. Some notable examples include:

• William Blake: Blake reported vivid visions throughout his life, claiming to see angels, prophets, and even converse with biblical figures. Today, these experiences have been variously interpreted as spiritual experiences, psychosis, or simply an extraordinarily vivid imagination. His poetry and artwork, particularly Songs of Innocence and of Experience and The Marriage of Heaven and Hell, blur the boundaries between reality, mythology, and vision.
• Samuel Taylor Coleridge: Coleridge suffered from chronic pain, depression, anxiety, and a well-documented dependence on opium. Poems such as Kubla Khan and The Rime of the Ancient Mariner reflect dream-like imagery, altered states of consciousness, guilt, and psychological torment.
• Virginia Woolf: Woolf experienced recurrent episodes of severe depression and periods that many scholars believe were consistent with bipolar disorder. Her stream-of-consciousness novels, including Mrs Dalloway and The Waves, explore perception, memory, identity, and fragile mental states.
• Edgar Allan Poe: Poe struggled with alcoholism, grief, and likely recurrent depression. His stories and poems delve into obsession, paranoia, death, and psychological disintegration, although they also demonstrate remarkable technical control.
• Ernest Hemingway: Hemingway experienced repeated trauma, alcoholism, and depression. Evidence suggests he may have had bipolar disorder, although this remains retrospective speculation. His later writing increasingly reflected themes of mortality, resilience, and despair.

It is essential to emphasise that intense or prolific writing is not, in itself, pathological. Rather, writing can serve as a medium through which cognitive disturbances become visible.

Writing and Mental Health

Writing occupies a dual role in mental health: it can reflect psychological distress and serve as a means of recovery. During mania, writing may be rapid and grandiose; during depression, it may centre on hopelessness and self-reproach. Yet in each case, writing also offers clinicians insight into subjective experience. I have myself found writing as a means of aiding recovery [16].

Therapeutically, writing can help individuals with psychosis organise experience, enhance insight, and regain narrative agency. Phenomenological approaches emphasise respecting such writing as meaningful attempts to articulate lived experience rather than dismissing it as mere symptomatology [17].

Ethical care is required to avoid reinforcing delusional frameworks while still validating emotional expression.

Writing, AI, and Creative Value

The rise of LLMs forces a re-evaluation of what writing is for. If writing is reduced to text output, then automation more than suffices. If, however, writing is understood as a psychologically formative act, one that shapes cognition, emotion, and identity, then outsourcing it may come at a cost to both writer and reader.

LLMs undoubtedly expand access, enabling more people to participate in written culture. This may lead to a dramatic increase in volume, but not necessarily in depth. The concern is not that machines will write badly, but that humans may write less themselves.

Whether this new era produces more masterpieces or more mediocrity remains uncertain. The same can be said about understanding. LLMs do not ‘read the room’ [18], they simply provide a statistical answer to what can be a human problem. The challenge is to ensure that writing remains an act of engagement rather than mere generation.

Conclusion

I believe that writing is a deeply human activity that integrates intellect, emotion, and imagination. It offers joy, meaning, and healing, while also carrying psychological complexities. In rare cases, it intersects with psychopathology; more commonly, it reflects the tensions inherent in creative self-expression.

It is also impossible to disconnect writing from reading. The arrival of large language models has transformed the landscape of writing, making it more accessible while potentially diminishing its experiential depth. Understanding writing as a human, psychological process rather than a textual outcome is crucial if its transformative power is to be preserved.

Whether or not everyone has a book inside them, writing remains most valuable when it is an act of genuine engagement with thought and feeling. In an age of effortless text, the challenge is not to write more, but to write more humanly.

References

1. Hardman TC (2026). AI and Plagiarism: Rethinking Scientific Writing Ethics.
2. Hardman TC (2026). AI Does Not Solve Writer’s Block. It Just Moves the Problem Somewhere Else
3. Hardman TC (2026). What Every Good Medical Writer Knows.
4. Lotze M, et al. Neural correlates of verbal creativity: differences in resting-state functional connectivity associated with expertise in creative writing. Front Hum Neurosci. 2014 Jul 15;8:516.
5. Beaty RE, Benedek M, Silvia PJ, Schacter DL. Creative Cognition and Brain Network Dynamics. Trends Cogn Sci. 2016 Feb;20(2):87-95.
6. Kellogg RT.The Psychology of Writing. New York: Oxford University Press; 1994.
7. Csikszentmihalyi M.Flow: The Psychology of Optimal Experience. New York: Harper & Row; 1990.
8. Niles AN, et al. Randomized controlled trial of expressive writing for psychological and physical health: the moderating role of emotional expressivity. Anxiety Stress Coping. 2014 Jan;27(1):1-17.
9. Pennebaker JW, Seagal JD. Forming a story: the health benefits of narrative. J Clin Psychol. 1999 Oct;55(10):1243-54.
10. McAdams DP. The psychology of life stories. Rev Gen Psychol. 2001;5(2):100–22.
11. Perlman SB, Pelphrey KA. Regulatory brain development: balancing emotion and cognition. Soc Neurosci. 2010;5(5-6):533-42.
12. Haddock G, Bentall RP.Cognitive Behaviour Therapy for Psychosis. London: Routledge; 2009.
13. Frost RO, Marten P, Lahart C, Rosenblate R. The dimensions of perfectionism. Cognit Ther Res. 1990;14(5):449–68.
14. Waxman SG, Geschwind N. Hypergraphia in temporal lobe epilepsy. Neurology. 1974;24(7):629–36.
15. Andreasen NC, Grove WM. Thought, language, and communication in schizophrenia: diagnosis and prognosis. Schizophr Bull. 1986;12(3):348-59.
16. Hardman TC.(2018). Ikigai – Find your purpose.
17. Stanghellini G, Lysaker PH. The psychotherapy of schizophrenia through the lens of phenomenology: intersubjectivity and the search for the recovery of first- and second-person awareness. Am J Psychother. 2007;61(2):163-79.
18. Hogan M. (2026). Can AI Read the Room? Psychology Today.