Mary Desch, writing under the pen name MM Desch, brings years of psychiatric expertise to her debut psychological thriller, Tangled Darkness. The novel follows Dr. Leslie Schoen, a psychiatrist who becomes a suspect when a clinical assistant is found dead amid missing opioid allegations. She becomes ensnared in a deadly scheme of clinic conspiracies and her own troubled past. With her career under threat and her pregnant wife in danger, Leslie must confront buried secrets and unmask a ruthless killer before she becomes the next target. But in a maze of lies, no one’s motives are what they seem.
After Desch finished her psychiatric training in Minnesota and practiced in the Twin Cities, she moved to Phoenix and established a private practice clinic. There she met her wife, Liz, and they relocated to the Pacific Northwest in 2015.
As an addiction therapist and a fellow Portland author of About the Carleton Sisters and Forever Blackbirds, I was eager to discuss her transition from psychiatry to fiction writing and how her professional background shapes her storytelling. Here’s our conversation:
Dian Greenwood: Mary, you and I have devoted our careers to working in the addiction field in varied settings—private practice as well as clinics and hospitals. You worked in medical mental health settings and as a consultant while my work as a marriage and child therapist focused on inter-relationships. In Tangled Darkness, your protagonist is a psychiatrist. How much of your professional experience did you draw on when creating Dr. Leslie Schoen?
MM Desch: A sizable portion. As a queer psychiatrist, these personal elements provided authentic grounding for Leslie’s character. The opportunity I had serving on Arizona’s Medical Board committee for impaired physicians, paired with my years of practicing psychiatry, informed Leslie’s backstory as a recovering alcoholic previously monitored by her licensing board. The professional environment—from group practice dynamics to on-call responsibilities—reflects realities I’ve lived. But I can’t claim the same investigative instincts and willingness to confront dangerous situations as Leslie shows!
Greenwood: What motivated you to explore prescription drug diversion in your debut novel?
Desch: This topic became a natural focal point. As an addiction psychiatrist, I witnessed firsthand how the healthcare system could be exploited. What makes prescription drug diversion compelling for a thriller is the inherent tension created when medications prescribed to help patients can destroy lives when misused or diverted into criminal networks. This contradiction offers rich dramatic territory where the healing profession intersects with the shadowy world of illegal drug distribution.
Greenwood: Your protagonist is in a same-sex marriage, and the couple is expecting a baby. Why was it important for you to include LGBTQ+ representation?
Desch: Living in Portland with Liz has shown me what privilege feels like in one of America’s most queer-friendly communities. After years as an avid thriller reader, I’m still amazed by how few medical thrillers feature LGBTQ+ characters. In Portland, we’re just another married couple—our relationship isn’t treated as exotic. I wanted to capture that normality by portraying Leslie and Izzy’s relationship as integral but unremarkable. Their largest challenges stem from external threats and personal choices, not so much from their sexual orientation.
Greenwood: How did you balance portraying psychiatric conditions authentically while avoiding stigmatizing those with mental illness?
Desch: Developing a psychotic character presented the most difficult challenge. Writing from this perspective required balancing clinical accuracy with narrative clarity. Rather than simply labeling her as “out of touch with reality,” I needed to show the progression of her condition—the early warning signs, the internal logic of her delusions, and how past experiences shaped her present reality.
Greenwood: What was the most challenging aspect of transitioning from psychiatric practice to writing fiction?
Desch: The transition was less about retiring and more about “rewiring,” as a fellow writer aptly suggested. Fiction writing demands an entirely different skill set from medical documentation. I needed to master fundamentals: story structure; writing scenes that show rather than tell; developing character arcs; understanding pacing and tension. In medicine, I used to bring together subjective and objective elements, come to conclusions or possibilities, then lay out a plan. Fiction requires revealing character through action and dialogue while maintaining narrative momentum.
To bridge this gap, I enrolled in writing workshops, joined critique groups, and dedicated myself to learning the craft. Workshops on structure, editing, and pitching proved transformative, as were local writing groups here in Portland. I read craft books and studied thrillers I admired, analyzing their structure and pacing. Learning to write concisely is an ongoing challenge. I’ve discovered that my understanding of human psychology lends itself well to character development, even as the technical aspects of storytelling require entirely new skills.
Greenwood: Your novel features several complex female characters. Was this diversity of female representation a conscious choice?
Desch: Absolutely. After reading thrillers for years where women often appeared as victims or one-dimensional supporting characters, I wanted to populate my novel with women who reflected the complexity I’ve lived and observed throughout my life. Leslie developed over time into a flawed but, I hope, compelling protagonist. Pearl evolved during the writing process from an outside mentor figure into a key ally within the office. Most challenged, Michelle had the least opportunity. She’s a survivor who shows up every day despite her struggles, yet she remains so defended and isolated that she can’t reach out for help when she most needs it.
Greenwood: How did your work inform your approach to addiction storylines in the novel?
Desch: One patient’s story particularly influenced me—a woman who, at two years sober, confessed she once chose spending her last $10 on drugs over feeding her toddler. This starkly showed how addiction warps a person’s sense of priorities. I wanted to show that addiction doesn’t end when substance use stops. Leslie’s recovery journey demonstrates how distorted thinking patterns persist—evident in her inability to be honest with Izzy. The ripple effects on relationships were equally important to portray. Izzy’s frustration and fear demonstrate how secrecy and trust issues can impact loved ones even years into recovery.
Greenwood: Portland serves as the setting for Tangled Darkness. How has living there influenced your writing?
Desch: When Liz and I first visited Portland, we each experienced the unmistakable sensation that we had come home. It’s the most authentic place I’ve ever lived, offering a compelling blend of urban grit and genuine community warmth.
The novel elements developed on repeated dog walks in the neighborhood, as we passed the house that became the model location for Damon’s basement apartment. Portland emerged as the natural setting.
Greenwood: What research did you need to do beyond your medical expertise to create an authentic police procedural element?
Desch: My most valuable resource for police procedure was a friend Marty, a retired commander with thirty years of law enforcement experience. I also joined Sisters in Crime, a crime-writers’ organization, and enrolled in their week-long intensive workshop on police procedures run by a law enforcement veteran, with a focus on crime scenes. This training helped me understand the methodical, often unglamorous reality of detective work. For the forensic aspects, I talked with my brilliant and generous sister Julie, a pathologist, who answered numerous questions about autopsies and medical examiner protocols.
Greenwood: After spending decades helping real people through psychiatric practice, what do you hope readers take away from Tangled Darkness?
Desch: First and foremost, I hope readers are entertained. I understand the vital importance of escape and mental respite. Beyond entertainment, I hope the novel lingers in readers’ minds. I believe fiction can create empathy by giving readers a window into experiences they might never otherwise understand. If readers finish the story with greater understanding about addiction and mental illness—how they affect not just individuals but entire circles of family, friends, and community—that would be deeply satisfying.
Desch will launch her debut at Annie Bloom’s Books, 7834 S.W. Capitol Highway, in Portland’s historic Multnomah Village on July 24, 2025, at 7 p.m. She’ll be in conversation with local thriller author Kathleen Rhodes. Readers can pre-order through this link — Annie Bloom’s. They’re releasing it two weeks early on July 1st! You can pick up the paperback in the store or have it mailed.
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Tangled Darkness officially publishes July 15, 2025, and will be available at Annie Bloom’s Books and other independent bookstores (Retailers).
