Novel medicine: How doctors use books to help treat insomnia, depression and more
Posted June 5, 2016
Vancouver-based marketing rep Jason Moore had everything going for him in 2013 — at 31, he had a master’s degree in business and was working his way up the ladder at several Canadian companies in marketing, a job he loved. He’d been in a stable relationship with his girlfriend, Stefani, since grad school and the two were expecting a child together.
Then, out of nowhere, the panic attacks started.
“We’d known (about the baby) for maybe a couple of weeks,” Moore recalled. “And one night, I was walking through the parking garage to my car and all the sudden it was a race to get into the car before I started bawling.”
Moore wanted kids and a family of his own, so his “breakdown,” as he called it, came as a surprise to him each time his day was interrupted by sudden trembling, struggling to breathe and the overwhelming urge to weep.
“I was scared to tell anybody about it because my whole life it was like, ‘I want (a family),’” he said. “I felt angry, like such a failure, because I should have been excited.”
Looking back now, Moore says he shouldn’t have been surprised at his reaction — as a small child, he’d navigated the foster system on his own while his parents slipped in and out of rehab for alcohol abuse. Some foster homes were great, he remembers. Others he still struggles to talk about, his only elaboration, “I still have dreams about it.”
His experience led him to a conclusion at a young age: When he had kids, they would never have to go through what he’d endured as a boy.
“I had it in my head that no matter what, I was going to be a good dad,” Moore said. “But I’d never really gotten over my own feelings of abandonment and it threw me. I didn’t know if I knew how to be a father.”
To help process his past, Moore sought help in the form of therapists and some medication. But nothing, he said, helped him like Harry Potter.
“It sounds stupid, I know,” he said. “But it makes sense because he was kind of in a crappy foster home, he lost his parents and he always felt out of control. I identified with him.”
Moore stumbled on J.K. Rowling’s famous series when someone gave it to the soon-to-be parents as a baby shower gift. He started thumbing through “Harry Potter and the Sorcerer’s Stone” while cleaning up and was immediately hooked.
“I was sort of embarrassed about it because I thought it was for kids. I took it to my therapists’ office and she saw it and we started talking about it,” Moore said. “And she explained to me that this is a whole thing.”
That “whole thing” is called bibliotherapy — the therapeutic use of books and poetry to help treat anything from the ups and downs of life to diagnosable conditions like depression.
It’s an approach that’s become popular overseas — British libraries offer full bibliotherapy services, including recommendations and exhaustive reading lists based on condition, to anyone, at every library in the U.K., at no cost.
This year, London-based charity The Reading Agency and the Society of Chief Librarians banded together to form Reading Well for Young People, an extension of its regular adult program that uses bibliotherapy to help teens and children find their way through problems like mental illness, bullying, exam pressure and eating disorders.
It’s paid off for the nearly half a million people who have used the service since its inception in January 2015, the Reading Agency reports — 90 percent of people who borrowed “prescribed” books based on their conditions said they helped and 85 percent said the books helped their symptoms feel manageable.
“It’s a testament to the power of reading, which we all believe in here,” Reading Agency spokeswoman Sue Wilkinson said. “It’s helpful because no matter what you’re going through or where you are, you can go and get a book without having to make any statement about yourself.”
Experts say books featuring characters or people that share a patient’s struggles can be an incredibly important piece of a larger treatment plan designed to give patients something a pill can’t always offer: Hope.
“It’s a little like a shortcut. Bibliotherapy and poetry therapy gets people farther faster because a great poem or story stirs up people’s emotions,” said Linda Barnes, president of the Colorado-based International Federation of Biblio and Poetry Therapy. “It’s not about looking for the one, right answer. It’s about inviting people to see their own lives in literature to heal.”
The idea of books being used for therapy has been around since the dawn of history.
Diodorus Siculus, an ancient Greek historian, reported in his first century B.C. historical tome, the "Bibliotheca Historica," that Egyptian ruler Ramses II considered his massive library in Thebes a place of healing, inscribing “Healing place for the soul” over its herculean doors.
The ancient Greeks and Romans reportedly held the written word in high regard as a form of healing as well as a sign of civilized culture.
“It’s not a coincidence that Apollo was the god of poetry as well as the god of medicine,” Barnes said.
Bibliotherapy likely first came to the U.S. from Britain after World War I, English bibliotherapist Ella Berthoud said, when it was found that Jane Austen novels helped calm soldiers afflicted with PTSD (then called “shellshock”). Then, as now, the main premise of bibliotherapy is pretty simple: Personal transformation through reading.
“It’s a much more long-lasting treatment because it takes you a bit to read it and that book will sink into your psyche and last forever,” Berthoud said. "It's not the same with drugs or other alternative therapies like aromatherapy, which can be very profound while you're there, but doesn't necessarily last long afterward."
How and why bibliotherapy works is less clear. Some research suggests that the brain gleans information about fictional characters in the same way it does from real people. Other research from 2013 suggests that reading literary fiction coincides with a heightened sense of empathy in adults and children.
In other words, people potentially stand to learn and be emotionally affected as much by a fictional person or situation as by, say, a testimonial at an AA meeting or through one-on-one therapy. But it's hard to talk about the value of bibliotherapy without considering the magical quality of fiction to transport the reader away from their own troubles, if only temporarily.
That's its true, undefinable joy and comfort, as Berthoud and her colleague, Cambridge University classmate Susan Elderkin, write in “The Novel Cure,” a book of therapeutic reading recommendations for more than 700 ailments.
"Sometimes it's the story that charms; other times it's the rhythm of the prose that works on the psyche, stilling or stimulating," Berthoud and Elderkin wrote in the book's introduction. "When you're engrossed in a novel … you are seeing what a character sees, touching what a character touches, learning what a character learns. You may think you're sitting on the sofa in your living room, but the important parts of you — your thoughts, your senses, your spirit — are somewhere else entirely."
It’s not a substitute for other forms of therapy in serious cases, Berthoud says, but its outcome can be significant.
Take the life’s work of pioneering librarian and bibliotherapist Sadie Peterson Delaney, who prescribed books to recovering African-American veterans at the U.S. Veterans Administration Hospital in 1920s Tuskegee, Alabama. She started small, using fairy tales to help bed-ridden, traumatized veterans make sense of their own emotional struggles and then began a public appeal for book donations for and about black Americans to help her patients, as she put it, “fit themselves for life.”
Reading about what she called “a higher type of Negro life,” through positive depictions of black Americans like W.E.B. Du Bois’ “Dark Princess” gave her patients purpose and hope to take with them when they were released back into segregated America.
“Books about the Negro cannot be written fast enough to satisfy the insatiate desire of these veterans,” wrote Delaney, who saw such books as “aiding him in his upward struggle to lay aside prejudice, all sense of defeat, and to take in that which is helpful and inspiring by the means of books.”
Today, Berthoud and others like her continue to adapt bibliotherapy for the modern world.
At its most basic, Barnes says a poem or a passage can act as a Rorschach test, where the patient’s interpretation dictates the course of therapy — which can be incredibly freeing for both therapists and patients.
“I can hold up a poem and ask you what you see,” Barnes said. “Our job is not to analyze poetry, we just ask, 'what does this poem say to you?' It’s very open-ended.”
Berthoud and Elderkin take a more traditional approach with “The Novel Cure."
Nursing a broken heart? A dose of Charlotte Bronte’s “Jane Eyre” is in order. Maybe a divorce or a death has left you a single parent; look no farther than “To Kill A Mockingbird” and emulate Atticus Finch.
Berthoud suggests Kazuo Ishiguro’s “The Remains of the Day” for chronic procrastinators. Or for those grappling with racism, Berthoud and Elderkin prescribe Ralph Ellison’s “Invisible Man.”
The book itself is a fun, light-hearted meditation on how good literature makes readers discover insights about themselves, but Berthoud’s methods are very grounded in therapeutic practices.
Each patient is given a lengthy questionnaire and talk sessions (often via Skype) before being presented with a reading list of six books tailored to their individual needs.
The individual nature of this process, Berthoud said, is crucial to avoid making matters worse.
“For some people, ‘The Unbearable Lightness of Being’ is brilliant because they can relate to it,” Berthoud said. “For others, that book might push them deeper into depression. So you really have to know what’s happening with that particular person.”
But bibliotherapy doesn’t always have to be specific to be a balm, as Seattle University associate counseling professor and bibliotherapist Mary Graham can attest.
Working as a school counselor, Graham likes to use children’s books to connect with both kids and adults about anything from stress to bullying. Her go-to author is Dr. Seuss because his work, she says, is universal, but can be tailored to fit nearly any situation.
“It’s not like you can just pull any book off the shelf and say, ‘Yo, let’s read this,’” Graham said. “Ideally, you get this lightbulb moment in the session and you help them process it. It makes it theirs, which makes them more likely to follow through with therapy.”
Graham uses children’s books even with adults, she says, because they’re less intimidating to patients who might not be thrilled to be given a reading assignment between sessions and the themes are endlessly rich.
“Bibliotherapy is a really safe venue for people to connect through characters dealing with a similar situation. If I’m in a session and my therapist is tying to get at my inadequacies, that’s a big leap to talk about all that right off the bat,” Graham said. “It’s isolating. Dealing with these things makes us feel alone, so it helps to be able to point to someone else and say, ‘I get that.’”
Best of all, unlike some other kinds of therapy, Barnes says that bibliotherapy changes with its patients.
“Every time I go back to (Pulitzer Prize-winning poet) Mary Oliver, I find something new or different, because I’m different, but it’s familiar — it’s like seeing an old friend,” Barnes said. “It’s something you can give yourself — no appointment necessary.”