Hektoen International

A Journal of Medical Humanities

The anatomy of bibliotherapy: How fiction heals, part III

Dustin Grinnell 
Boston, Massachusetts, United States


Portrait of Friedrich Nietzsche. Photo by Gustav Schultze. 1882.
Taken from Nietzsche by Walter Kaufmann, Fourth Edition. Public Domain.

A cure for loneliness

In the video “What is Literature For?” produced by The School of Life, author Alain de Botton claims that books are a cure for loneliness. Since we cannot always say what we are really thinking in civilized conversations, literature often describes who we genuinely are more honestly than what ordinary conversation allows.

“In the best books, it’s as if the writer knows us better than we know ourselves—they find the words to describe the fragile, weird, special experiences of our inner lives. . . . Writers open our hearts and minds, and give us maps to our own selves, so that we can travel in them more reliably and with less of a feeling of paranoia or persecution.”

In Leo Tolstoy’s novella The Death of Ivan Ilyich, a forty-five-year-old successful lawyer and magistrate named Ivan Ilyich is hanging curtains when he falls, grows ill, and realizes that he is dying. During the course of his illness, family and visitors act falsely toward him, ignoring that he is in his final days. “This falsity around him and within him did more than anything else to poison him in his last days.”

Unlike his wife and colleagues, who act inauthentically toward Ivan, his servant, Gerasim, treats him with sincerity. Gerasim cares for Ivan, looks after him, and listens. His attention and companionship is healing. Ivan is no longer alone with his illness. And we, as readers, are no longer alone with our struggles.

According to Marcel Proust, reading also offers us company without discrimination. In his 1905 essay “On Reading,” Proust writes that we can stop and start books at our leisure and enter fictional worlds on our own time, without all the messiness that accompanies human relationships. “We read not only because we cannot know enough people,” writes Harold Bloom in How to Read and Why, “but because friendship is so vulnerable, so likely to diminish or disappear, overcome by space, time, imperfect sympathies and all the sorrows of familial and passional life.”


Laughter: the best medicine

Some books are just fun to read. They make us smile and laugh, and we feel better because of it. A great deal of research has shown that humor is good for our health. Researchers have proven that people with certain types of humor have higher self-esteem, greater self-competence, more positive affect, more control over anxiety, and perform better in social situations.

For readers who may be struggling, Northrop Frye writes that literature can combat melancholy by providing amusement and lighthearted pleasure. He recommends literature that employs the “deliberate creation of hope and other positive emotions, particularly laughter, subscribing to the principle that ‘a merry heart doeth good like a medicine.’”

In The Anatomy of Melancholy, Robert Burton writes that mirth is the chief weapon with which to “batter the walls” of melancholy, allowing people to “distract their minds from fear and sorrow, and such things on which they are so fixed and intent.” For the melancholic, Burton prescribes “sports, music, a cup of good drink, [and] pleasing company,” including plays and merry tales.

In The Year of Reading Dangerously, Andy Miller says he could never truly love a book that was not at least a little funny. “This may be a feeling on my part, but if the writer offers no palliative, nothing to manage the pain, ironically I find it hard to take their work seriously.”

What is it, in books, that makes us laugh? “Nothing is funnier than the sudden escape of the exact truth of any situation,” writes Frye. He cites Milan Kundera who said, “The great comic geniuses are those who have discovered or uncovered for their audiences the comic aspects of what those audiences have not previously thought of as comic.”

Why does laughter have a healing effect? Frye notes that a comic character can uncover a funny aspect of life and restore balance in those for whom that aspect has been repressed. He cites Aristotle’s catharsis. A joke—in this case, “a sick joke”—“expresses forms of pity and fear which achieve something of a purgation of those emotions.”

But perhaps the healing effects are the result of the distraction that levity produces? As explained in Anatomy of an Illness as Perceived by the Patient, Norman Cousins laughed his way to a cure for his autoimmune disease by watching funny movies. Cousins explained that funny movies distracted him, so his body’s own internal healing mechanisms could do their work. “The art of medicine,” wrote Voltaire, “consists of amusing the patient while nature cures the disease.”


The splendor of the ordinary

Literature can expose us to images of beauty and help us appreciate the little things we so often overlook. “Beauty alone is a sovereign remedy against fear, grief and melancholy fits,” Robert Burton writes in The Anatomy of Melancholy.

In How Proust Can Change Your Life, de Botton says that Proust thought much dissatisfaction was the result of failing to see the beauty in the ordinary. Proust argued that fiction could open our eyes and make us notice the beauty that is all around us. For Proust, such appreciation could spark a spiritual transformation.

Proust once wrote an essay “in which he set out to restore a smile to the face of a gloomy, envious and dissatisfied young man.” The essay urged this imaginary young man to appreciate the work of Jean-Baptiste-Siméon Chardin, who painted mundane depictions of fruits, jugs, and loaves of bread. “Yet, in spite of the ordinary nature of their subjects, Chardin’s paintings succeeded in being extraordinarily beguiling and evocative.”

According to Proust, such an opulent depiction of mediocrity would dazzle this man and, if he took this encounter with art seriously, make him happy. Indeed, sometimes our unhappiness is not a lack of material things but an improper appreciation for what is already around us. Exposure to art may be especially important in the case of illness, as sickness can hijack our focus and detract from our appreciation of our surroundings.


Literary incitements

In the article “Books Should Send Us into Therapy: On the Paradox of Bibliotherapy,” James McWilliams argues that literature can help us heal by shaking us out of complacency. “Ever have a novel sneak upon you and kick you in the gut, leaving you staring into space, dazed by an epiphany? Yes. Novels do this.” In his own group therapy, McWilliams gives members books not to solve problems, as bibliotherapy is intended to do, but to create problems. He argues that certain books can present problems we did not think we needed and that overcoming these problems elicits catharsis.

It was Proust who thought of books not as “conclusions” but as “incitements.” In How Proust Can Change Your Life, de Botton writes that readers often want authors to provide answers. But authors can really only provide readers with the desire to look inward and better understand themselves by figuring out what they think and feel.

Franz Kafka said we should read books that “wound and stab us,” that “wake us up with a blow on the head,” “that affect us like a disaster . . . like being banished into forests far from everyone, like a suicide. A book must be the axe for the frozen sea inside us. That is my belief.”

Perhaps no author is more capable of inciting the reader than Friedrich Nietzsche, the German philosopher who gave us famous aphorisms, such as “fortune favors the bold,” and who thought man’s greatest enjoyment was to “live dangerously.” Nietzsche’s writing is potent and full of zest. It is the ultimate kick in the pants. A potential cure for ennui.

In Thus Spoke Zarathustra, Nietzsche’s only work of fiction, the protagonist Zarathustra became a mouthpiece for Nietzsche’s philosophy. Zarathustra comes down from the mountains as a prophet to report that “God is dead” and that the moral values by which most people conduct their lives should be rethought. He introduces the Übermensch—the over man, or “superman.”

An Übermensch is a symbol of man’s potential, according to Nietzsche. He is self-reliant and self-determined. He lives according to values he has set for himself. He strives toward authentic goals he has set for himself. A Superman drives humanity forward. He aims to raise the consciousness of people. Nietzsche thought that Goethe was the closest to what he thought of as a Superman. Maybe Voltaire and Julius Caesar too.

In Thus Spoke Zarathustra, no one listens to Zarathustra. Instead, they laugh and mock the prophet, and he is considered an enemy of the people. But many listened to Nietzsche. The philosophical novel had a powerful influence on twentieth century writers such as George Bernard Shaw, Thomas Mann, and Albert Camus.

A particularly soul-stirring concept in Nietzsche’s novel is the idea of “eternal return.” It is a thought experiment that urges the reader to think about living one’s life repeatedly, the same joys and pains, in the same order. How does that feel?

“If the prospect fills you with horror,” writes Nietzsche, “you’ve not yet become reconciled to what is unalterable about yourself, you’ve not yet become who you are—you have not yet managed to say, ‘Yes’ to the world as it is, to the point of wishing for its absolute recurrence and eternity: which would mean a new idea of philosophy and sensibility.”

Nietzsche also thought that literature provided a fictional training ground for the reader to ask “forbidden questions,” difficult-to-answer or even taboo questions that we might ask in the quiet moments of our lives. For example, “Is life worth living?”

Albert Camus posed one of the twentieth century’s best-known existentialist questions in his novel The Myth of Sisyphus. “There is only one really serious philosophical question, and that is suicide.” Camus’s provocative question encourages us to search for meaning in our lives so we might perhaps avoid the fate of his tragic character, Sisyphus, who endlessly pushes a boulder up a mountain, only to see it roll back down each time he gains the top.


Examination of values in the face of death

While discussing suicide and death may seem like a grim activity, thinking about the shortness of life can help us live more fully by encouraging us to focus on how we use our time. Blaise Pascal once said that life is like a prison from which fellow prisoners are taken away every day to be executed. We live; we die. “The problem is that we need to figure out how to make that all be all right,” says poet Jane Hirshfield in the documentary The Buddha.

If there is an existential fear of death, Tolstoy’s The Death of Ivan Ilyich may help us manage it. By all accounts, it seems Ivan has lived “the good life”: an enviable career with a great reputation. But as his health declines, he wonders: “What if my whole life had been wrong?” In light of his impending death, Ivan’s “successes” seem shallow. He realizes that perhaps he married too quickly; he was often preoccupied with money and professional advancement. “His professional duties and the whole arrangement of his life and his family and all his social and official interests might have been false. He tried to defend those things to himself and suddenly felt the weakness of what he was defending. There was nothing to defend.”

In The Road to Character, David Brooks writes that the story invites readers to examine their own lives. How would we feel if we were dying right now? Did we live true to ourselves? Have we ever thought like Ilyich: “Maybe I did not live as I ought to have done”?

We all want external success, however we define it, but Tolstoy’s short work of fiction urges us to monitor ourselves, to make sure that our drive for success does not result in spiritual poverty. “It’s probably necessary to have one foot in the world of achievement but another foot in a counterculture that is in tension with the achievement ethos,” writes Brooks.

Tolstoy thought fiction was more than entertainment; he thought of it as a tool for psychological education and reform. The Death of Ivan Ilyich encourages readers to examine their lives and choices and, at best, might lead to a change of what the reader is consciously aware of.

The novella also reminds us of our own mortality. The story encourages us to live like we are dying, which, of course, we are. Ivan dies with pity and forgiveness for everyone around him. De Botton writes, “In writing about Ivan, Tolstoy wanted us to see his life as representative of all human potential, if only we could wake up to it before it is too late.”


Literature as food for the soul

For psychological struggle, restlessness, and existential angst, the authors of The Novel Cure prescribe Hermann Hesse’s Siddhartha. In his article “Siddhartha,” Paul W. Morris writes, “Siddhartha served . . . to wake millions from their delusions, to inspire, challenge, and remind, as Hesse’s dream-voice has done, that ‘suffering is nothing, suffering is illusion.’”

In the novel, Siddhartha has it all. The young Brahmin is destined for greatness as he receives training from the finest teachers. Yet he is dissatisfied. He is restless and consumed by questions: “Who was he really? What did he want? Was this way of living all there was?” Unhappy, Siddhartha leaves the safety of his home to live with ascetics who have renounced material pleasures. The young man’s goal is to become empty of thirst, of dreams, and of joy and sorrow. Siddhartha wanders the country for years, peeling back the layers of himself.

He eventually returns to the city and works for a merchant, but his heart is not in it. The city life allows him to reflect, though. “He saw mankind going through life in a childlike or animal like manner, which he loved and also despised at the same time.” Siddhartha lives in the city for years, living “the good life,” but a voice inside him whispers that he is living a peculiar existence. He feels like all his dealings are just a game, that his real life is passing him by. A man of the world, he has a trade, money, a house with servants, and beautiful clothes. He disdains his fellow city-dwellers, but also envies them—for the importance they give to their lives, the passion they have in their dealings. Slowly, he assumes the features he so often found and disliked in rich people. It takes years, but after all the gambling, greed, lust and desire, and self-loathing, he realizes he must leave the city for good.

A city-dwelling reader of Siddhartha may witness Siddhartha’s struggles—his constant searching, his leaving the city to become a pilgrim—and experience catharsis. We might turn pages and look up in anguish while riding a packed subway train. We might also find ourselves disgusted with the city life. We might realize that we too have numbed ourselves with mindless activity, anesthetizing ourselves with our televisions and phones and seeking out the pleasures of sex or the oblivion of substances.

Like Siddhartha, we might also confess that we too are lost. This is what great books do: they hold up mirrors for the reader. They stir us. They change us. They wake us up, just as Siddhartha’s attempt to drown himself in the river after he leaves the city finally wakes his “dormant spirit.”

The authors of The Novel Cure write about the river. “Here he [Siddhartha] finds revelations to last a lifetime—including the true cycle of life and death, and what it is to be part of a timeless unity. And from that day on he radiates transcendent understanding, self-knowledge, and enlightenment. From all over the world, people come to him to seek wisdom and peace. People like you.”


Writing as therapy

Many authors build worlds for readers to inhabit and learn from, but oftentimes the writing itself confers a benefit to the author. Robert Burton exhaustively explored the causes and cures of melancholy in order to combat his own depressive bouts. Andy Miller read fifty books in a year to manage a midlife existential crisis. Nietzsche transmuted his suffering into philosophical fiction. Tolstoy had not written a word of fiction after the publication of Anna Karenina and then wrote The Death of Ivan Ilyich after a spiritual crisis. Hermann Hesse wrote Siddhartha while desperately searching for spiritual fulfillment in his own life.

In fact, the second half of Siddhartha took Hesse years to write because he “had not experienced that transcendental state of unity to which Siddhartha aspires,” writes Paul W. Morris. “In an attempt to do so, Hesse lived as a virtual semi-recluse and became totally immersed in the sacred teachings of both Hindu and Buddhist scriptures. His intention was to attain that ‘completeness’ which, in the novel, is the Buddha’s badge of distinction.”

In an increasingly complex and bewildering world, Hesse and these other authors were writing as a form of therapy, seeking to create fictional works that gave meaning to their lives and helped vaccinate themselves against future troubles. “And so I write this to heal myself. To heal you,” Burton wrote in The Anatomy of Melancholy.

As we have seen, fictional narratives offer more than just distraction, entertainment, or a temporary relief from our lives. Books are counselors, teachers, elixirs for the mind and spirit. “Literature has the function of delighting and instructing us, but also, and above all, save our souls and heal the state,” said George Stuart Gordon.

Even if a book does not provide a complete remedy for what ails us, as it did for Northrop Frye’s mother, at the very least literature might fulfill the role of the physician as defined by John Berger and Jean Mohr in their classic book, A Fortunate Man: The Story of a Country Doctor: “To cure sometimes, to relieve often, and to comfort always.”


Read Part I of this three part series here.




  1. Armetta, Flora. “The Therapeutic Novel.” The New Yorker. February 16, 2011. https://www.newyorker.com/books/page-turner/the-therapeutic-novel.
  2. Ayto, John. Dictionary of Word Origins: Histories of More than 8,000 English-Language Words. Arcade, 1990.
  3. Begley, Sarah. “Read a Novel: It’s Just What the Doctor Ordered.” Time. October 27, 2016. http://time.com/4547332/reading-benefits.
  4. Berg, Sara. “In Battle against Doctor Burnout, Reading—for Fun—Is Fundamental.” American Medical Association. January 18, 2019. https://www.ama-assn.org/practice-management/physician-health/battle-against-doctor-burnout-reading-fun-fundamental.
  5. Berger, John, and Jean Mohr. A Fortunate Man: The Story of a Country Doctor. Vintage, 1967.
  6. Berthoud, Ella, and Susan Elderkin. The Novel Cure: From Abandonment to Zestlessness: 751 Books to Cure What Ails You. Penguin, 2013.
  7. Bloom, Harold. How to Read and Why. Scribner, 2001.
  8. Brooks, David. The Road to Character. Random House, 2016.
  9. Camus, Albert. The Myth of Sisyphus. Hamish Hamilton, 1955.
  10. Chekhov, Anton. “Misery.” Peterburgskaya Gazeta, no. 26 (April 26, 1886).
  11. Fadiman, Clifton. How to Use the Power of the Printed Word. Anchor, 1985.
  12. Cooney, Elizabeth. “The Healing Power of Story.” Harvard Medical School (May 15, 2015). https://hms.harvard.edu/news/healing-power-story.
  13. Cooper, Jonny. “Meet the Bibliotherapists Who Can Cure Your Children . . . with Books.” The Telegraph. November 1, 2016. https://www.telegraph.co.uk/family/parenting/meet-the-bibliotherapists-who-can-cure-your-children–with-books.
  14. Cousins, Norman. Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration. W. W. Norton & Company, 2005.
  15. De Botton, Alain. How Proust Can Change Your Life. Vintage, 1998.
  16. ———. “Leo Tolstoy.” The Book of Life. Accessed [February 14, 2019]. https://www.theschooloflife.com/thebookoflife/leo-tolstoy.
  17. ———. “Nietzsche On: The Superman” (video). The School of Life, November 9, 2016, 2015. https://www.youtube.com/watch?v=bxiKqA-u8y4.
  18. ———. Religion for Atheists: A Non-Believer’s Guide to the Uses of Religion. Vintage, 2013.
  19. ———. “What is Literature For?” The School of Life, September 18, 2014. https://www.youtube.com/watch?v=4RCFLobfqcw&feature=youtu.be&list=PLwxNMb28XmpdJpJzF2YRBnfmOva0HE0ZI.
  20. Dovey, Ceridwen. “Can Reading Make You Happier?” The New Yorker (June 9, 2015). https://www.newyorker.com/culture/cultural-comment/can-reading-make-you-happier.
  21. Erofeyev, Victor. “The Secrets of Leo Tolstoy.” The New York Times (November 19, 2010). https://www.nytimes.com/2010/11/20/opinion/20iht-ederofeyev.html.
  22. “Faculty Spotlight: Sneha Mantri, MD.” Duke University School of Medicine. January 28, 2019. https://neurology.duke.edu/about/news/faculty-spotlight-sneha-mantri-md
  23. Frank, Jerome D. Persuasion and Healing: A Comparative Study of Psychotherapy. Johns Hopkins University Press, 1961.
  24. Frye, Northrop. “Literature as Therapy.” In The Eternal Act of Creation: Essays, 1979–1990, 21–36. Bloomington: Indiana University Press, 1992.
  25. Gaiman, Neil. “Neil Gaiman: Why Our Future Depends on Libraries, Reading and Daydreaming.” The Guardian. October 15, 2013.  https://www.theguardian.com/books/2013/oct/15/neil-gaiman-future-libraries-reading-daydreaming.
  26. Grubin, David, filmmaker. The Buddha. 2013. Television documentary.
  27. Hesse, Hermann. Siddhartha: A Novel. Bantam, 1981.
  28. Hughes, Bettany, host. Genius of the Modern World. 2016. Television documentary.
  29. Kafka, Alexander C. “Why Storytelling Matters in Fields Beyond the Humanities” (An Interview with Rita Charon). The Chronicle of Higher Education. October 4, 2018.  https://www.chronicle.com/article/Why-Storytelling-Matters-in/244729.
  30. Krznaric, Roman. How Should We Live?: Great Ideas from the Past for Everyday Life. 2nd ed. BlueBridge, 2015.
  31. Lindahl, Carl. Dream Some More: Storytelling as Therapy. Folklore. October 1, 2018.
  32. Martin, Rachel, host. “To Cure What Ails You, Bibliotherapists Prescribe Literature.” NPR. September 4, 2015. https://www.npr.org/2015/09/04/437597031/to-cure-what-ails-you-bibliotherapists-prescribe-literature.
  33. McKee, Robert, and Thomas Gerace. Storynomics: Story-Driven Marketing in the Post-Advertising World. Twelve, 2018.
  34. McMillen, P. S., and D. Pehrsson. “Bibliotherapy for Hospital Patients.” University Libraries (2004). https://core.ac.uk/download/pdf/62872843.pdf
  35. McWilliams, James. “Books Should Send Us into Therapy: On the Paradox of Bibliotherapy.” The Millions. November 2, 2016. https://themillions.com/2016/11/books-should-send-us-into-therapy-on-the-paradox-of-bibliotherapy.html
  36. Miller, James. Examined Lives: From Socrates to Nietzsche. Farrar, Straus and Giroux, 2011.
  37. Nietzsche, Friedrich. Thus Spoke Zarathustra. Dover, 1999.
  38. Oatley, Keith. “A Feeling for Fiction.” Greater Good Magazine. September 1, 2005. https://greatergood.berkeley.edu/article/item/a_feeling_for_fiction.
  39. Online Dictionary for Library and Information Science (ODLIS). s.v. “bibliotherapy.” Accessed [date]. https://www.abc-clio.com/ODLIS/odlis_b.aspx#bibliotherapy.
  40. Proust, Marcel. On Reading. Hesperus Press. August 24, 2011.
  41. Rosen, Charles. “The Anatomy Lesson”. The New York Review of Books. June 9, 2005. https://www.nybooks.com/articles/2005/06/09/the-anatomy-lesson.
  42. Schwalbe, Will. Books for Living. Knopf, 2016.
  43. Tolstoy, Leo. The Death of Ivan Ilyich. Penguin Classics edition. May 27, 2008.



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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