Goldberg and others have written about something known as "Executive Functions", complex mental functions that are controlled by the pre-frontal cortex, also known as the frontal lobes. Executive functions are those higher-level thought processes that enable us to plan, sequence, prioritize, organize, initiate, inhibit, pace, self-monitor, and sustain behaviors -- despite distractions -- in pursuit of our defined goals. Executive functions allow us to make adjustments and refine strategies along the way, so that if the roof caves in while you're writing Chapter Four, you can take a break and return to the project after arranging for roofers.

In a chapter called "Prefrontal Cortex, Time, and Consciousness" from The New Cognitive Neurosciences, Robert T. Knight and Marcia Grabowecky propose that our mental ability to think beyond the moment, to remember the past or muse about the future, is a function of the frontal lobes. "A central feature of consciousness is the ability to control the fourth dimension, time. Humans can effortlessly move their internal mental set from the present moment to a past remembrance and just as easily project themselves into a future event."

The process of storytelling -- envisioning a present or a past and working to create continuity to some imagined story future -- requires the same mental set shifting.

"Executive Dysfunction" is the term used when these processes are interrupted. Neuropsychologist Russell Barkley describes executive dysfunction as an inability to inhibit present behavior in deference to demands of the future, i.e. you want to write a novel, but you spend all your writing time checking email.

Executive dysfunction has been linked to disorders such as Attention Deficit Disorder (ADD, with or without hyperactivity) and Obsessive Compulsive Disorder (OCD). People with ADD report difficulties controlling executive functions, notably focus, impulse inhibition, and the ability to prioritize. People with OCD frequently find themselves stuck doing repetitive behaviors (perseveration) that prevent them from completing other tasks. Writers with writer's block report a failure in many areas of executive function. We can't initiate projects, we're easily distracted, we cannot pace ourselves or efficiently prioritize our tasks. In short, we just can't write.

While self-help books promoting cures for writer's block remain popular, medical and psychological research about block has been limited, and scientific studies are rarely cited by the lay press. An article titled "A Reticulo-frontal Disconnection Syndrome" can be challenging reading, but I believe it's worth the effort, as adopting a medical model could be the key to better understanding writer's block and why some "cures" work for some and not all writers.

Unlike diabetes, arthritis, or pregnancy, there isn't a lab test to confirm clinical symptoms, so blocked writers diagnose themselves based on subjective experience. Writers report similarities in their symptoms (often the inability to start or finish projects) but there can be great variance in the duration and severity of block.

In numerous interviews and informal discussions with writers, I've noticed a tendency to generalize based on personal experience. A writer who was able to "snap out of it" may believe another writer capable of doing the same. Writers who struggle for one afternoon to transfer their thoughts to paper earn little sympathy from writers who go for years without writing a word. Not everyone accepts the current trend of giving a medical diagnosis to perceived failures of personality, but evidence exists that personality may be as genetically determined as eye color.

Writers with block report decreased motivation. They simply cannot will themselves to work. As Elkhonon Goldberg says, "Drive has a biological basis. The frontal lobes are central to the maintenance of drive." He suggests that outside forces may be required to initiate action in cases of executive dysfunction. Outside forces may also be needed to help guide or terminate unhelpful behaviors. Robert Boice, in his article "Combining Writing Block Treatments: Theory and Research" speculates that one reason an exercise like "free writing" works to stimulate creativity is that it interrupts the inhibited processes and provides a new direction. Many cures for writer's block follow this example, redirecting the stalled writer and allowing him to initiate a new task.

Adding to the confusion, there's plenty of wiggle room in the definition of what, exactly, constitutes writer's block. A medical condition called agraphia refers to the physiologic inability to write and is sometimes a result of traumatic brain injuries, or stroke. The etiology of writer's block is more difficult to ascertain, and unlike agraphia, blocked writers are physically capable of typing, keyboarding or handwriting.

So what is writer's block and how do you know if you have it? I'll go with Kate Wilhelm's succinct definition: "Writer's Block is when you want to write but can't."

Causes of Writer's Block -- The Writer's Perspective

"There once was a time when I didn't know what writer's block was. I'm still not sure I know. Is this it? I somehow imagined it must involve not having an idea of what to write, and that sure isn't my problem. But not writing much of anything for 3 years sounds like writer's block, doesn't it? Guess I'd better admit it so I can get over it." -- Molly Gloss

"... There are two main categories of blocks: the block of the artistic poseur who earns sympathy for the struggle without needing to take the risks. For someone like that, the advice to write even if you're blocked is good advice ... The second kind of block is when other things in life interfere with the desire to be writing right now ... Something else needs your attention more than your manuscript, like your marriage." -- Bruce Holland Rogers.

"Writer's block is far more commonly found in the presence of too much, not too little will." -- Victoria Nelson

"I think writer's block is really burnout, just like one can get burnout in any other field, but by calling it writer's block we turn it into something bigger and badder -- and perhaps give it more power. Not that burnout itself doesn't feel wretched, of course." -- Janni Lee Simner

"Sometimes writer's block is simply not knowing where to go next and this is where the rapidwrite (From Henriette Klauser's book "Writing on Both Sides of the Brain") helps. Sometimes, it is deeper, I think, connected to fear and lack of confidence -- the feeling that any combination of words you put on the page will be stupid or flat -- and this is harder to shake. The writer can get a distorted image of her writing -- like an anorexic's distorted body image -- and can't gain enough confidence to keep writing." -- Susan Kroupa

"Lying fallow is part of the process." -- Jean Knudsen Hoffman

Other writers had this to say about writer's block:

• Writer's Block happens when you try to do everything at once.
  
  
• Writer's Block happens when you don't know enough to begin.
  
  Writer's Block happens when you've exhausted all the good or original ideas and feel your creativity flagging.
  
  
• Writer's Block happens due to physical stress, lack of sleep, depression, and bad health.
  
  
• Writer's Block happens due to mental blocks: fear of failure, fear of success, overbearing inner critic.
  
  
• Writer's Block happens due to psychological disturbances ranging from neurosis to something scary

Severity and Duration

If you suffered from a throbbing headache one Tuesday afternoon in March, it's probable you would treat yourself, either by resting or by taking two aspirin and going to bed. If that headache continued for a few weeks, it's likely you'd seek diagnosis and treatment, if only to reassure yourself that you weren't ignoring a brain tumor or another life-threatening problem. But let's say you experienced writer's block lasting for a year. If you made an appointment with your doctor and asked for treatment for writer's block, would the physician have a clue about what to prescribe?

Patricia Huston, MD, MPH, describes writer's block as a "distinctly uncomfortable inability to write," and categorizes the severity of as mild, moderate, and recalcitrant. Mild blockage, Huston believes, is easily resolved by revising expectations, breaking big projects into small ones, and giving oneself positive feedback, among other things. Moderate blockage can be addressed by practicing creative exercises, talking about your work with another supportive writer, or taking a break. In her experience, recalcitrant blockage can often be resolved with medical intervention or cognitive restructuring, i.e. therapy.

Examining block strictly in terms of duration, temporary, resolvable block lasting one hour to six months could be called "Acute Writer's Block", and resistant blocks that continue beyond six months from initial symptoms could be termed "Chronic Writer's Block".

People who experience acute block frequently report their symptoms resolve after self-treatment. I've heard scores of testimonials from writers suffering an acute block who say they've been able to work through their block after encountering books such as "The Artist's Way" or "Writing Past Dark." At the same time, people whose block has become chronic aren't always so easily treated. Ralph Ellison, whose first book, "The Invisible Man" was published in 1952, complained of intermittent writer's block that prevented him from completing his second book, "Juneteenth", before his death in 1994.

Breaking the Block: Writers Share Their Tips

There are hundreds of suggested treatments for writer's block, and while some writers swear by one tried and true method, other writers sample the smorgasbord of cures to find one or more that works. Here are just a few tips from writers interviewed for this article:

"The most familiar trick for ensuring a continuing hold on your material is to end work each day just short of what is in your mind to write, to leave for the next day a significant development, a scene you have quite clearly in mind. Many writers do this, so that they are eager to get started on the next stint, without the anxiety that may come if they are not sure of their direction or wonder which step to take first." -- Hallie & Whit Burnett

"McHugh's rule of writer's block: Writer's block is not the inability to write, it is the feeling as you are writing, that what you are writing is shit. The only way through it is to give yourself permission to write shit. (You may replace 'shit' with colorful euphemisms like 'cow dung' or even boring ones like 'crap.')" -- Maureen McHugh

"I rarely get writer's block, but when I do it's because I'm taking the story in the wrong direction. I may be following the outline that I've worked hard on and that I've already sold to an editor, but I've learned that when I can't seem to write, it's because my subconscious is telling me that I'm making a big mistake. So I have to spend a little quiet time listening to what my subconscious is telling me, and then I can make the changes and get on with the work. It helps that editors never remember the outline that you sold them anyway." -- Walter Jon Williams

"Don't beat yourself up. It's a waste of energy. Just enjoy the time off. Maybe your brain is telling you to do other things, gather material." -- Nina Kiriki Hoffman

"Writer's block is like a bad cold, annoying but surmountable." -- Julie Torchia

"That's easy for her to say." -- Leslie What

The array of suggestions for curing writer's block is confusing. Gary Glasser, MD, FACP, says a truism in medicine is that "The more treatments there are for any one condition, the less effective is any particular treatment." Another generally understood truth in medicine. Glasser adds, is "All cures for the common cold are equally effective," meaning that when a condition is self-limiting, it gets better no matter what you do. Why do some writers quickly recover from block while others struggle without relief? Glasser says, "The natural history of any condition has multiple outcomes. Some people are cured, some minimally impaired, and some are severely impaired despite attempts to cure them."

Miracle Cures? Try These!

• Don't try to be good, i.e., dare to be bad.
  
  
• Write about someone you hate and send it to a confession magazine.
  
  
• Do the Elmore Leonard thing and only write the interesting stuff.
  
  
• Join a writing group to give yourself a deadline.
  
  
• Call it writing time when you mail queries, revise, file, make backups.
  
  
• Make a date to write at a coffee shop with another writer.
  
  
• Switch from computer to pen or pencil.
  
  
• Borrow a laptop and write in the backyard.
  
  
• Take a walk around the block and use the time to let your subconscious mind work while your conscious mind relaxes.
  
  
• Try a free-writing brainstorm.
  
  
• Listen to music.
  
  
• Try exercise or yoga.
  
  
• Write in a journal knowing you are not trying to write for others.
  
  
• Look into Feng Shui and full-spectrum lighting.
  
  
• Break large writing goals into more manageable tasks.
  
  
• Write under another name to reduce expectations you have for yourself.

When Self-Help Isn't Enough

But what can one do when self-help isn't enough? Don't despair! There is ongoing research into cognitive rehabilitation and cognitive exercises to strengthen or regain lost executive functions. Researchers hope to develop frontal lobe cognotropic pharmacology that will specifically target executive functions.

J. Rawlins in The Writer's Way suggests that blocked writers shouldn't become fixated on trying to determine what is blocking them. "Sidestep" the block, he says. Create a good environment for work without stress and interruption.

Robert Boice suggests a five-step treatment program. The first is scheduled free writing, as taught by P. Elbow in his 1973 book and later popularized by Natalie Goldberg and others. Free writing, or brainstorming as it is sometimes called, can help a stalled writer gain momentum. The second: contingency planning, which involves setting up schedules and contingencies that force a writer to write at pre-arranged times. Third is to consciously abstain from "maladaptive self-talk," such as telling yourself something will be rejected, while replacing negative statements more positive ones, such as telling yourself how much you enjoy writing. Fourth is establishing a social support group, such as a writing group, that focuses on writing and support. Fifth is to periodically reorder the above to keep these treatments from become habits.

Some writers report a decrease in their symptoms after receiving treatments for physical or psychological maladies that are either a result of writer's block, or a contributing cause. If not writing makes you anxious or depressed, or if depression doesn't allow you to write, pharmacological treatment may prove useful. Writers report they've been helped by alternative health treatments, such as herbal therapies, Sam-E, light therapy, and acupuncture.

Gary Glasser says, "Sometimes, the symptoms are all that matters and you can treat something without ever understanding the underlying cause."

It's clear that at the moment, we don't really know the cause of writer's block, and there isn't a one-cure-fits-all approach. The trick that works for one writer may fail another. That doesn't mean you shouldn't try another trick. And another trick after that. Just keep trying, and please let me know when you discover something new that works for you.

"I see writer's block and artist's block as being very different. When I have artist's block, the solution is often to keep working through it... However, writer's block seems different to me... If I don't have that idea, or if I'm stuck on a section of a story, I find it really difficult to progress. So I guess my way of dealing with writer's block is more of a 'take a breather, go for a walk, put it out of your head for a while' kind of approach." -- Michael Dashow

"Here is the concept: first, anyone can write one page a day, so that is my minimum. I write a page of fiction every day no matter what. The kicker is that no one can write just one page, so I usually end up writing more... (One day) I cheated in that I typed in and did some small rewrites on what I'd done in a workshop. I decided that the rule must be firm. No cheating! One page a day no matter what! And it's been working ever since." -- Ray Vukcevich

"I used to be blocked routinely somewhere after the middle of every novel, but it occurred to me just now that it hasn't happened since I began working on a computer. I don't think that's the reason, though. What I think it is is that I began following my wife's example and gave up trying to write the novel in sequence. My hunch is that if you can't write the next scene, and you can't write any other scene till you write that scene, that's a block." -- Damon Knight

"As long as a book would write itself, I was a faithful and interested amanuensis and my industry did not flag; but the minute the book tried to shift to my head the labor of contriving its situations, inventing its adventures, and conducting its conversations I put it away and dropped it out of my mind. The reason was very simple... my tank had run dry; the story...could not be wrought out of nothing." -- Mark Twain

"When I was a young guy just starting out, I'd find I couldn't finish a story. Then I figured out the story wasn't ready so, I waited until it was ready and then I wrote it." -- Howard Waldrop

"The word block suggests that you are constipated or stuck, when in truth you're empty. You feel the writing gods gave you just so many good days, maybe even enough of them to write one good book, and then part of another. But now you are having some days or weeks of emptiness, as if suddenly the writing gods are saying, "Enough! Don't bother me! I have given to you until it hurts! Please. I've got problems of my own. " -- Anne Lamott

Boice, Robert, Combining Writing Block Treatments: Theory and Research, Behavior Res. Therapy, Volume 30, No. 2, 1992

Elbow, P., Writing Without Teachers, Oxford University Press 1973

Flaherty, Alice Weaver, The Midnight Disease : The Drive to Write, Writer's Block, and the Creative Brain, Houghton Mifflin Co, 2004

Gazzaniga, Michael S., Editor-in-Chief, The New Cognitive Neurosciences, Second Edition, MIT Press, 2000

Goldberg, Elkhonon,The Executive Brain, Frontal Lobes and the Civilized Mind, Oxford University Press 2001

Green, Erica L., MA, QMHP, "Cognitive Occupational Hazards and Psychopathology of the Artist", Occupational Medicine: State of the Art Reviews, Vol. 16, No. 4, October-December 2001

Huston, Patricia, MD, MPH, "Resolving Writer's Block", Canadian Family Physician, Vol 44, January 1998

Kaplan, Donald M, "The Unfinished Manuscript in the Drawer: Observations on the Analysis of a Type of Symptom", Int. J. Psycho-Analysis 1995

Persinger, M. A., and Makarec, Katherine, "The Feeling of a Presence and Verbal Meaningfulness in Context of Temporal Lobe Function: Factor Analytic Verification of the Muses?" Brain and Cognition 20, 1992

Rawlins, J., The Writer's Way, Houghton Mifflin; 1992

Find Out More...

• Facing Down Life Block, by Donnell King
  
  
• Fighting Writer's Block, Part I: Causes and Cures, by David Taylor
  
  
• Fighting Writer's Block, Part 2: Block Writing and Speed Writing, by David Taylor
  
  
• How to Beat Writer's Block - and Hone Your Skills! by Dawn Copeman
  
  
• Nine Anti-Muses and How to Placate Them, by Victoria Grossack
  
  
• When the Writing's Going Well: Ten Remedies to Demolish an Unexpected Block, by Noelle Sterne