Reasons to Remember Will Strunk’s “An Approach to Style”

So I read Psych Practice Blogger’s review of Dr. Jeffrey Lieberman’s new book, and thought of Will Strunk’s book The Elements of Style and chapter 5 therein, “An Approach to Style.” I’m unlikely to buy Lieberman’s book. One reason other than those already discussed in the review is that, as a general rule, I try to read what I think writers have carefully written and edited. I’m also a little suspicious of how the cover is presented. I know you shouldn’t necessarily judge a book by its cover, but the difference between the covers pointed out by Psych Practice Blogger in a previous post about his book begs the question–why the difference?



Why is co-author Ogi Ogas not shown in one image and shown in another? It leaves too much room for speculation. Before we leave the question of whether or not to judge a book by its cover, I also wondered about Allen Frances’ book.

Essentials of Psychiatric Dx by Allen Frances MD

high res image essentials of psychiatric dx allen frances

Why does the title on the left, which includes the arguably provocative “Responding to the Challenge of DSM-5,” differ from the one on the right, which doesn’t? Incidentally, I like his book, regardless of the subtitle.

There’s a lot of published material that makes me wonder what the writer was thinking about. So I think this JAMA editorial from the May 12, 2015 Vol 313 No 18 issue is an example of bad writing, in my opinion.

So you may not agree, but whether you’re edified or stupified by this piece depends on whether you mind the writers’ jargon. The tone is pretty dry but tone is partly what would drive me away from Lieberman’s book, if I’m to judge the rest of the book by the excerpts in the review. Getting back to the JAMA issue article by Madara and Burkhart, I have a hunch they’re complaining about Maintenance of Certification (MOC)–but they never mention it directly. Why not?

On the other hand, Drs. Paul Teirstein and Eric Topol wrote a pretty straightforward paper on MOC which doesn’t beat around the bush and uses plain language.

Now take a look at two other articles in the same issue, one written by the President and CEO of the American Board of Medicine (ABMS), Dr. Lois Nora, MD, JD, MBA;  the other written by the President and CEO of the American Board of Internal Medicine (ABIM), Dr. Rich Baron–excuse me, I mean Dr. Richard Baron, MD. See what I did there?

As an insider I get the feeling the proponents of MOC are trying their best to be politically careful by not making JAMA another battleground about the controversial regulatory program. But I also don’t trust them because their tone and language sound overly-complicated, apologetic, and full of jargon.

How about this one, a recently published study comparing Mindfulness Based Cognitive Therapy (MBCT) and maintenance antidepressant for patients with depression.

Now really, I came away from this article’s abstract with a negative feel about MBCT, mainly because of the negative sentence “We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence.” If you read the entire article, you’d be correct to come away cheering for mindfulness–yet another victory for a non-pharmacologic means by which to gain and maintain wellness without pills which can cause side effects for patients with depression.

Delirium in Critical CareOK, here’s one about which I’ve harped before. I really think the book “Delirium in Critical Care” by Valerie Page and E. Wesley Ely is a stunning achievement and a giant step forward for assessment and management of delirium in intensive care. I enthusiastically endorse it. But I’ve also thoroughly enjoyed poking fun at the short section on the psychiatrist’s role in delirium which takes up a space about the width of my hand in Chapter 9. Honestly, I read this to many medical students and residents during their rotation through the consult service. Everybody gets a big kick out of the way I clown my way through it.

The Elements of Style Will StrunkAnd then there’s the “little book,” by William Strunk, Jr. and E.B. White. I’m a big fan of the concept of the “little book”, made famous by Will Strunk in the writing of “The Elements of Style”. I even mentioned that in the preface to the book my colleague, Dr. Robert G. Robinson, and I co-edited, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry”: “And we informally gave it the name ‘The Little book of Psychosomatic Psychiatry.’ The name comes from Will Strunk’s book ‘The Elements of Style,’ in which Strunk, in the words of E.B. White, ‘…attempted to cut the vast tangle of English rhetoric down to size and write its rules and principles on the head of a pin. He hung the title ‘little’ on his book and referred to it sardonically and with secret pride as ‘the little book,’ always giving the word ‘little’ a special twist, as though he were putting a spin on a ball’.”

Most of the time I’m no better than average at crafting the brevity and clarity Strunk and White exemplified in their writing in my own (and sometimes much worse!). I doubt Strunk would have approved of blogging. The point is I appreciate this essential and apparently optional skill. It’s getting harder to maintain in the age of electronic health records, full of checklists and “smartphrases” many times lacking a succinct and descriptive story about the patient which would help us be more humanistic doctors. I should re-read Chapter 5, “An Approach to Style.”

Style takes its final shape more from attitudes of mind than from principles of composition, for, as an elderly practitioner once remarked, “Writing is an act of faith, not a trick of grammar.” This moral observation would have no place in a rule book were it not that style is the writer, and therefore what you are, rather than what you know, will at last determine your style. If you write, you must believe–in the truth and worth of your scrawl, in the ability of the reader to receive and decode the message. No one can write decently who is distrustful of the reader’s intelligence, or whose attitude is patronizing.–William Strunk, Jr and E.B. White: The Elements of Style.

2 thoughts on “Reasons to Remember Will Strunk’s “An Approach to Style”

  1. I read the first paragraph of the JAMA editorial. I read several sentences multiple times. I have no idea what the author was trying to say. I couldn’t read any more of it.


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