Hektoen International

A Journal of Medical Humanities

The anatomy of bibliotherapy: How fiction heals, part I

Dustin Grinnell 
Boston, Massachusetts, United States


Man Reading Book showing cityscape, suggesting an Open Doorway.
From iStock.

Words are, of course, the most powerful drug used by mankind.
—Rudyard Kipling


Literature is medicine for the soul

In the 1980s, the mother of Northrop Frye, a Canadian literary scholar, was in the hospital, ill and delirious. Seeking to ease her suffering, her father gave her the twenty-five books of the Waverley Novels by Sir Walter Scott. Frye’s mother read them all, and by the end she was healed. “What impressed me about that was her own conviction that the Scott novels were in fact the curative agent,” Frye wrote in his essay “Literature as Therapy.”

Most of us have experienced the therapeutic power of literature. A good novel can stay with us for years, even for our entire lives. Like psychotherapy, literature can help resolve conflicts, navigate traumatic experiences, integrate disowned aspects of ourselves, and perhaps even achieve inner wholeness or self-actualization. Books and the experience of reading can promote psychological change, heal trauma, and offer spiritual fulfillment. Fictional narratives indeed are medicine for the soul.


The prescription of fiction for life’s ailments

The notion of reading for therapeutic effect is known as bibliotherapy, the Greek meaning of which is “book healing.” Bibliotherapy dates back to the Ancient Greeks. Over the entrance of the library in Thebes, they inscribed a phrase that means “healing place for the soul.” Grecian libraries were seen as sacred places with curative powers. In the early 1800s, reading became one of the most commonly used therapeutic interventions, second only to physical exercise.

Since 2008, Ella Berthoud and Susan Elderkin have run a bibliotherapy service out of The School of Life in London, prescribing books for their therapeutic effects. They call their book The Novel Cure: From Abandonment to Zestlessness: 751 Books to Cure What Ails You. In this they prescribe books for everything, for a broken heart or leg, for the loss of a loved one, single parenthood, and fear of commitment. According to The New Yorker writer Ceridwen Dovey, who received her own bibliotherapy session from The School of Life, Berthoud says that the common ailments people bring to them are “life-juncture transitions” such as “being stuck in a rut in your career, feeling depressed in your relationship, or suffering bereavement.”


What literature “heals”

But what exactly does literature “heal”? It would be foolish to assume a book can shrink a tumor or heal an open wound. Nor would a novel resolve a panic attack or reverse a psychotic break from reality. Literature is perhaps best used to “treat” deep emotional strain or despondency defined as “in low spirits from loss of hope or courage.” Another word for this is melancholy, which Robert Burton called a “disease of the soul” in his seventeenth century masterpiece, The Anatomy of Melancholy.

In his treatise, Burton surveys the causes and cures of melancholy. The book is an in-depth exploration of depression, and some have called Burton a “spiritual physician.” Burton wrote his book as a kind of autotherapy because he was melancholic himself. “Aren’t we all, at some point in our lives, touched by melancholy?” he asked. “And so I write this to heal myself. To heal you.”

After 1800, the concept of melancholy became accepted as boredom or ennui, writes Charles Rosen in The New York Review of Books (“The Anatomy Lesson”). Rosen reminds the reader of Pascal’s axiom: “All man’s unhappiness came from one thing, that is not to know how to remain quietly in a room.” He elaborates on this boredom: “When society has lost all human significance and all actions are mechanical and predictable, and when personal identity ceases to have any meaning.” He evokes Mme du Deffand’s expression of ennui: “We are fully alive, and we experience the void.” Rosen writes that after the nineteenth century, melancholy and ennui fractured into various mental diseases, such as neurosis, manic depression, and bipolar disorder.

Jerome Frank, professor of psychiatry at Johns Hopkins Hospital, referred to this disease of the soul as “demoralization” in his book Persuasion and Healing: A Comparative Study of Psychotherapy. He considers a demoralized person as deprived of spirit or courage, disheartened, or bewildered, confused or in a state of disorder.

In the third edition of Persuasion and Healing, published in 1991 and coauthored with his daughter Julia Frank, the two argue that demoralization is the common feature of many mental illnesses such as alcoholism, anxiety, and clinical depression. They suggest that most people seek help from a professional because they are struggling to control their symptoms and their lives. They tackle a complex question: in any therapeutic situation—in psychotherapy, religious healing ceremonies, primitive healing and miracle cures, experimental studies of persuasion, or even the prescription of a placebo—what is happening when a troubled person gets better?

The book contends that “common factors” are present in all forms of healing therapies: they enhance hope and a sense of mastery and promote emotional expression and learning. They “enhance a person’s feeling of wellbeing” and “help demoralized people gain traction over their lives.” In short, they boost morale. It can be argued that these are the mechanisms by which literature “cures.”


How stories heal

We do not know what Northrop Frye’s mother was suffering from, but we can use her illness and her use of books to recover as a model for studying the healing effects of literature.

Imagine a patient who is being prescribed books. What devices and techniques would such “healing books” employ? By which mechanisms can a therapeutic book get into our subconscious and change our minds? How do fictional narratives work on a reader’s body, mind, and spirit? How can they remedy melancholy or demoralization? How do they work as medicine for the soul?

Clearly a single book cannot cure melancholy, ennui, or demoralization. Emotional and psychological problems are not always pathological; they can result from larger societal forces such as economics or politics.

Consider instead literary therapy as one leg in medicine’s “three-legged stool,” the first leg consisting of drugs or medications, the second surgery and procedures, the third leg self-care and stress-relief techniques such as rest and meditation, nutrition, sleep, hygiene, and exercise. Bibliotherapy falls in the third leg.


The look and feel of books

For many, the physical act of reading is a pleasurable tactile experience. The weight, shape, and size of a book in one’s hands. The smell of the pages. “[Books] feel so good—their friendly heft. The sweet reluctance of their pages when you turn them with your sensitive fingertip,” said Kurt Vonnegut. “Many people, myself among them, feel better at the mere sight of a book,” wrote Jane Smiley in 13 Ways of Looking at the Novel.

Avid readers also take pleasure in building a library, stuffing bookcases with titles and stacking books near their beds, on desks, and on coffee tables. Looking at a novel often feels like an invitation to an adventure, a journey to unknown places with unfamiliar characters. Open a book and you are off on a new beginning, with a fresh voice and thought-provoking ideas. Exposing oneself to knowledge and wisdom can calm the mind and provide a rush of excitement.


The calming sounds of prose

In an interview with NPR, Susan Elderkin, coauthor of The Novel Cure, said that the rhythm of some books’ prose can have healing effects (“To Cure What Ails You, Bibliotherapists Prescribe Literature”), and that the way words are arranged and presented can calm a reader’s restless mind. “Ernest Hemingway’s The Old Man and the Sea . . . totally stills me in some really beautiful fundamental way.”

In The Year of Reading Dangerously, Andy Miller did not just love Douglas Adams’s The Hitchhiker’s Guide to the Galaxy for its ideas about science or philosophy, as appealing as they were, but rather for its words: “The humorous inflection, the rhythm and flow of his sentences, the glorious linguistic precision of his phrasing.” Miller shares examples: “‘mostly harmless’; ‘total perspective vortex’; ‘and me with this terrible pain in all the diodes down my left side’; ‘a liquid that was almost, but not quite, entirely unlike tea.’” He felt that Adams played with words like Louis Armstrong, bending the lyrics and the melody to express the joy of playing itself.

A wide body of research shows that prose can lull our brains into a trancelike state and cause our bodies to relax. The health benefits are like deep relaxation, writes Ceridwen Dovey in the article “Can Reading Make You Happier?” “Regular readers sleep better, have lower stress levels, higher self-esteem, and lower rates of depression than non-readers.”

Of course, the way a text impacts a reader is highly subjective. Readers of genre fiction may prefer the rollercoaster ride of an action-packed thriller, while readers of literary fiction may have a taste for quieter narratives that are more internal and concerned with exploring the psyche and the human condition. Michael Crichton’s Jurassic Park may not engage readers with the rhythm of its prose but rather with its ideas, action, and plot. The books we call “beach reads” are engrossing and hard to put down; they have short chapters with cliffhangers. The therapeutic value of such high-concept works may be their ability to absorb and distract. After all, the Waverley novels were commercial fiction.


The nourishing experience of reading

Spending time with a book allows you to be still and contemplative. It gives you permission to stop, slow down, and spend time with the thoughts and ideas of another person. Sometimes it does not matter what you are reading; just reading something can calm you down.

When you are engaged with a story, it is hard to ruminate on the past or anticipate the future. This is what people mean when they say they “lose” themselves in an activity. Some reading experiences even provide a sense of “hitting the zone.” Author and psychologist Mihaly Csikszentmihalyi argues in his TED Talk that flow is the secret to happiness, that the more time people spend in a “flow state,” the happier they are. The hypothesis is that such activity saturates our working memory, so the ego, or “self,” disappears. Reading thus provides a respite not only from life but from our own minds and, as Csikszentmihalyi argues, may produce feelings of happiness.

Turning the pages of a book also gives a sense of movement and forward progress, as well as the satisfaction of completing it. Finishing a novel is an achievement that can provide a rush of accomplishment and make us feel proud.


Distraction from everyday pressures

Anyone who has lost track of time while reading knows that books can serve as a distraction from reality. A good book removes us from the endless chatter of our minds and allows us to step outside ourselves and our egos. For some, playing cards, board games, or sports can provide the same benefit.

In “Literature as Therapy,” Northrop Frye suggests that the Waverley Novels helped his mother recover by concentrating and intensifying her mind, therefore distracting her from her pain. Frye suggests that fictional texts produce a controlled hallucination, or a “counter-delirium” that dislocated his mother from her illness.

When Andy Miller was in his midthirties, an existential angst began to creep into his life. He was thirty-seven years old, had one child, and was starting to become more aware that at some point his life would end and he would never do all the things he wanted to do. He fell into a slump. One could say he was melancholic, or demoralized.

At that point, Miller had written two books, and his job as a book editor at a London publishing house was causing him anguish. His days were filled with deciding, from among many manuscripts, which books should be published. And while editing and publishing books was his job, he was not reading much for pleasure. He had excelled at reading as a child; it had been a natural talent, but he had fallen out of love with books.

Miller then turned to books and, as he writes in The Year of Reading Dangerously, decided to read all the books he was most ashamed of not reading. Over the course of about a year, he read through a list of fifty great books (and two not-so-great books), which became known as “The List of Betterment.”

For Miller reading became a welcomed distraction from the daily grind, particularly during his commutes into London. “By the time I arrived at my office, two hours and fifty or more pages further on, I was energized, fortified, fit to deal with the multiplying piles of paper.”

For Miller, the healing effects of books came only from literature, not through what he called escapist fiction, such as The Da Vinci Code. He initially chose Dan Brown’s bestseller because he wanted something “lightweight and undemanding.” He soon found himself despising the book for what he thought was terrible writing—ugly sentences and exposition shoehorned into dialogue. He read the “forgettable” book in twelve hours. On the other hand, Moby Dick by Herman Melville was “long, grueling and convoluted,” so immersive that it “wormed into his subconscious,” causing him to dream about it.

After reading Middlemarch by George Eliot, Miller wrote, “I felt the unmistakable certainty that I had been in the presence of great art, and that my heart had opened in reply.” He then read Post Office by Charles Bukowski and Anna Karenina by Leo Tolstoy. What about these “works of art” healed him? “When we find a painting or a novel or a musical we love, we are briefly connected to the best that human beings are capable of and are reminded that our paths through the world must intersect with others. Whether we like it or not, we are not alone.”


Fiction takes us on a journey and transports us to other worlds

According to Jonny Cooper’s article in The Telegraph, bibliotherapist Susan Elderkin says that in order for a book to cure it has to sweep up the reader and transport him. “There are studies that suggest when one is transported, one is more suggestible and open to learning experiences. It seems that the more you relate to the character in a story and the more you are taken up by the story, the more likely you are to have your behavior changed in the immediate aftermath.”

In The Year of Reading Dangerously, Andy Miller wrote that Moby Dick “took him on a voyage, fleeing the ‘thousands of mortal men . . . tied to counters, nailed to benches, clinched to desks.’” After reading The Master and Margarita by Mikhail Bulgakov, he wrote: “Words are transport, our flight and our homecoming in one.”

A 2011 study published in the Annual Review of Psychology, based on an analysis of MRI brain scans shows that when people read about an experience, they display stimulation within the same neurological regions as when they go through that experience themselves. “Psychologists and neuroscientists are increasingly coming to the conclusion that when we read a story and really understand it, we create a mental simulation of the events described by the story.”

This imaginary experience is the work of what are called “mirror neurons,” brain cells that allow us to feel what others are experiencing as if it were happening to us. When we see someone cry, our mirror neurons for crying fire. Likewise when we witness anger or joy in another person. It has been hypothesized that mirror neurons evolved to help us better infer what others know in order to explain their desires and intentions.

“We don’t just mirror other people. We mirror fictional characters too,” writes Lisa Cron in Wired for Story. “In fact, when people are undergoing an MRI while reading a short story, the areas of the brain that lit up when they read about an activity were identical to those that lit up when they actually experienced it.”

The 2011 study shows that readers mentally simulate each new situation encountered in a narrative. Details about actions and sensation are captured from the text and integrated with personal knowledge from past experiences. These data are then run through mental simulations using brain regions that closely mirror those involved when people perform, imagine, or observe similar real-world activities.


Reality simulation that saves time

By mentally traveling to a fictional place, we can explore an unknown, making it less frightening and more familiar. “Fiction acts as a flight simulator by giving readers examples of how to act and not to act with others,” write Raymond Mar and Keith Oatley.

Alain de Botton calls literature the ultimate time-saver. In The School of Life’s video “What is Literature For?”, de Botton says that literature “gives us access to a range of emotions and events that it would take you years, decades, millennia to try to experience directly. Literature is the greatest reality simulator—a machine that puts you through infinitely more situations than you can ever directly witness.”

And why is this important? Neil Gaiman believes that “once you’ve visited other worlds . . . you can never be entirely content with the world that you grew up in. Discontent is a good thing: discontented people can modify and improve their worlds, leave them better, leave them different.”


Read Part II of this three part series here.

Explore the concept of healing books.




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DUSTIN GRINNELL is a writer based in Boston, MA, with interests in storytelling and medicine. His narrative nonfiction and journalism has appeared in The LA Review of Books, The Boston Globe, New Scientist, VICE, Salon, and Writer’s Digest, among others. He is also the author of The Genius Dilemma and Without Limits. He holds a BA in psychobiology from Wheaton College (MA), an MS in physiology from Penn State, and is currently pursuing an MFA in fiction from the Solstice program in Chestnut Hill, MA. He works as a staff writer for a hospital in Boston.


Summer 2019  |  Sections  |  Books & Reviews

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