How the written word helps refresh body, mind and soul.

Ursula Sautter | October 2010 issue

Whenever the stabbing pain in her knee becomes unbearable, 17-year-old Mackenzie Bearup picks up a book and starts to read. Usually, it’s a teen novel or a mystery. But Bearup will read “anything that takes my mind away from the agony, that allows me to think of other things.”
Since Bearup, from Alpharetta, Georgia, is in pain almost all the time, she reads a lot. For the past six years, she has suffered from reflex sympathetic dystrophy (RSD), an incurable chronic disease that affects the nerves and blood vessels, causing severe swelling and discomfort in areas of the body that have been the site of injuries. “Especially when my leg lays me up in bed for days on end, I read constantly to escape from my aching knee, from my room, from the real world,” she says. While previous treatments—painkillers, physiotherapy, acupuncture, hyperbaric oxygen therapy—have failed, the self-prescribed reading cure works. “So far, books have been my only medicine,” Bearup says.
Reading and healing have an age-old association. In ancient Egypt, libraries were known as psyches iatreion, “sanatoriums of the soul.” During the Renaissance, the poetry of the Psalms was thought to “banish vexations of both the soul and the body,” according to Italian humanist philosopher Marsilio Ficino. And, as far back as the beginning of the 19th century, the American psychiatric community was discussing reading as a therapeutic technique.
Now, science is starting to prove what readers and writers have long known: Words can help us repair and revitalize our bodies as well as our minds. As a result, bibliotherapy—reading specific texts in response to particular situations or conditions—is becoming more and more popular among psychologists, physicians, librarians and teachers. “Whether the problem be physical discomfort or disability, emotional conflict or suffering, or problems arising from social situations in the family, work or community, reading can change and improve how we feel and behave,” according to Joseph Gold, a former professor of English at the University of Waterloo, Ontario, and author of The Story Species: Our Life-Literature Connection.
Bibliotherapy takes many forms. Doctors or therapists write prescriptions in the context of a practice setting, or individuals explore what works for them at home. The therapy involves either reading or writing, or both, while the texts are drawn from fiction (Shakespeare, Proust or Rilke, for example) or non-fiction (self-help books). Patients include the young and old, men and women, academics and non-academics. An increasing number of non-medical bibliotherapists, people who make reading suggestions based on individual situations, are setting up shop in Europe and America and looking to improve their clients’ quality of life if not alleviate specific symptoms.
The conditions for which bibliotherapy is prescribed are just as diverse as its forms. In Canada, nurses who care for the elderly in their homes successfully use American psychologist Peter Lewinsohn’s classic Control Your Depression to assist clients in dealing with their conditions. In the U.S., research has shown that patients suffering from borderline personality disorder engage in significantly less frequent and severe deliberate self-harm when their therapy involves reading a booklet on coping strategies. Adults with asthma and rheumatoid arthritis found that their symptoms lessened in severity after they started keeping journals about their most stressful experiences. Obese adolescent girls who read an age-appropriate novel about a teenager who discovers “improved health and self-efficacy” lost weight more easily than those who didn’t read that novel.
What makes the written word so effective? Michael Duda, a psychologist in private practice in Dortmund, Germany, and the author of several works in German on the healing power of books, believes success lies in a combination of the reading process and the content of what we read. When we immerse ourselves in a text, according to Duda, the words stimulate the production of mental images. We imagine what characters look and sound like; we visualize the places they live and work; we act out the words on the page in our minds.
“The reader is the creator of his or her inner tableau,” Duda says. The imagery is “individual and subjective but authentic as well, since reading always happens against the backdrop of existential experiences.” This is in sharp contrast to visual media, Duda points out; in that framework, the imagery is already provided, so requires less creative assembly by the viewer. Thus, in some respects, readers have to work harder—and that hard work can have psychological and physical benefits.
Brain imaging studies provide a glimpse of what happens when we get lost in a book. Using scanning technology, a team of scientists led by Nicole K. Speer at the Dynamic Cognition Laboratory at the University of Washington in St. Louis, Missouri, found that some of the brain regions active during reading a story “mirror those involved when people perform, imagine or observe similar real-world activities.” When reading, our brains simulate what happens in the story, using the same circuits we’d use if the same things happened to us. On a neurological level, we become part of the action.
The brain straddles fact and fiction when we read, which is why Dortmund psychotherapist Duda believes books are so powerful and why they “act like a key that opens the door to a person’s inner world.” Simulating the feelings and experiences of literary figures “allows readers to perceive and express their own emotions,” he says. That’s why it’s crucial to recommend the right reading material.

Duda keeps folders and filing boxes full of texts and excerpts for therapeutic reading. Individual prescriptions are based on “intuition and knowledge of human nature,” he says. If the selected text is a longer work, such as Antoine de Saint-Exupéry’s The Little Prince, clients read it at home. Duda reads shorter pieces, like fairy tales, aloud at the end of a session. He encourages clients not to analyze or interpret the stories, but to express the emotional responses or personal recollections triggered by them. In this way, fiction can serve as a “bridge”—between the client and therapist as well as between the client and his or her (often buried) memories and feelings.
For one client, a 36-year-old continuing education teacher in the midst of a relationship crisis, Duda prescribed the Brothers Grimm. Plagued by the feeling that she “couldn’t be herself” either at work or in her private life, the woman said she felt used by her partner. Afraid of his reaction and a possible breakup, however, she never discussed this with him.
Duda asked her to read “Clever Else,” a Grimm tale about a girl who prevaricates for so long about the things she wants to do that she never gets around to doing them. After reading it, the client called Duda that same evening, saying she had been moved by the story since “she had found herself in it.” At her next session, she told Duda about a vivid dream that convinced her she had to make a stand in her relationship. And after some more counseling, she did.
Bibliotherapy appears to have physiological advantages, too. A 2007 study involving 112 smelter workers in New Brunswick, Canada, for instance, found that workers who read a lot had greater protection against some of the effects of lead poisoning. Both readers and non-readers suffered equally from lead-caused motor impairment, but the non-readers had higher levels of intellectual impairment due to the brain damage the heavy metal can cause.
Reading alone can’t cure diseases, of course, but the researchers concluded that reading contributes to “cognitive reserve” (CR), the brain’s ability to protect itself and adapt to physical damage. CR has been “extensively studied in other neurological disorders—Alzheimer’s, stroke, other dementias, sleep apnea, traumatic brain injury,” says Margit Bleecker of the Center for Occupational and Environmental Neurology in Baltimore, Maryland, who co-authored the study. In all cases, “individuals with more CR are able to withstand injury to the brain.”
Pim Cuijpers of the Department of Clinical Psychology at the VU University in Amsterdam has conducted several studies into the successful use of self-administered bibliotherapy for depression, especially for those “who cannot be reached with traditional forms of therapy.” Most depressed people don’t seek professional help, Cuijpers says, because they’re unable (or unwilling) to see a therapist. For these people, bibliotherapy “is a non-stigmatizing and easy-to-use treatment method,” according to Cuijpers.
Cuijpers and colleagues from the Netherlands, China and Sweden examined the effects of guided self-help therapy on people suffering from depression, phobias and other anxiety disorders. Participants read standardized material on their respective conditions containing “step-by-step instructions on how to apply a generally accepted psychological treatment procedure to themselves,” Cuijpers explains. Clients accessed the information in book form, on the Internet and via video and audio. While minimal phone, e-mail or personal contact with a professional therapist or coach was provided, the patients generally worked independently at home.
The result: The guided self-help interventions had comparable effects to traditional face-to-face psychotherapy sessions. “There is no reason not to consider using [guided self-help interventions] as a complement in clinical practice,” Cuijpers concluded. Indeed, he expects the two forms of therapy to “blend in with each other increasingly in the near future.”
That could offer financial as well as mental health benefits, since bibliotherapy isn’t only effective but relatively cheap—which is why cash-strapped health systems are starting to set up “reading pharmacies.” In the U.K., the National Health Service gives physicians the option of prescribing self-help manuals to those seeking medical attention for mood disorders. The “books on prescription” program reaches tens of thousands of people each year, and has become so popular that more than half of English library authorities are using this or a similar form of bibliotherapy intervention, according to a 2007 survey.
Bibliotherapy has its limits, though, especially where psychological illness is concerned. “There are problems, such as severe depression or obsessive-compulsive disorder, that we can’t overcome with the help of a book alone,” says Doris Wolf, a psychologist in Mannheim, Germany, who has been working with bibliotherapy for more than 30 years. “In such cases, a book can’t replace a therapist.”
Reading an inappropriate or unhelpful text—whether it was chosen by your doctor, your librarian, your therapist or you—can also make things worse. After all, not all stories have happy endings, just as not all of life’s problems are happily resolved. “Experiences with the morals of stories may not always represent what we would consider self-improvement,” ­cautions Raymond Mar, an assistant professor of psychology at York University in Toronto. “Readers may choose to model morally murkier aspects of narratives as well.” Self-help manuals can also do more harm than good, if they’re administered without proper instruction or guidance.
If you’d like to get your recommended reading from someone other than a physician or psychologist, you’ll find plenty of bibliotherapists out there. In Milan, Italy, Stefania Moro takes her clients “on a journey to their memories, failures, hopes and dreams,” she says, by reading passages from carefully selected texts. Some of Moro’s regular recommendations include Dutch novelist Tessa de Loo’s The Twins (the fictional story of two sisters separated by World War II who meet again 40 years later) and American author J.R. Moehringer’s memoir Tender Bar (in which he recounts his childhood experiences with the quirky patrons of a New York pub, who become substitutes for his absent father). Works like these, Moro thinks, are ideal to help people “become travelers into themselves.”

A print and TV journalist for 15 years, Moro, who has a master’s degree in social psychology and a Ph.D. in philosophy, avoids “clinical or intellectual settings” in her meetings with clients, whom she prefers to call “searchers.” Instead, sessions often take place at her home over a glass of wine. Such welcoming, warm settings make it easier for searchers to find what they’re looking for, Moro says.
Both with individuals and groups, Moro reads aloud from the books she chooses and then discusses them with clients. While she’s quick to point out she’s not a psychologist and can’t provide “a solution for a happy life,” Moro is convinced these close encounters with fictional characters bring readers closer to themselves.
Laura, a 39-year-old video reporter from Milan who has attended Moro’s events for the past three years, agrees. “Stefania’s way of digging deep into the pages, her voice, all of her body and soul express a magical, mystical, but very humble and direct bond with the written word.” During the sessions, Laura says, she has been given “a key to open up to some sentiments, recollections, visions I could have never found on my own.”
At The School of Life in London, bibliotherapist Ella Berthoud first asks her client to fill out a questionnaire about his or her reading history, habits and personal circumstances. Then “after mulling the matter over for a few days,” she compiles a list of eight fiction titles she believes will provide the client with inspiration. Like a semi-humorous version of a doctor’s prescription, the list is accompanied by a brief diagnosis (“Patient suffers from job-related depression,” for example) and instructions on use and dosage (“Use for half an hour every day” or “To be read aloud once a week together with your partner”).
While many prefer to take their literary medicine alone, more and more people are opting to read and discuss books in the company of others, as evidenced by the increasing popularity of book clubs. In Dublin, there are 130 readers’ groups run by libraries and many more run privately. Some are hosted at library branches, hospices or prisons; others convene in restaurants, pubs or members’ homes. Some are for specific target groups, such as students in literacy classes or people for whom English is a second language; others welcome a general audience. Some specialize in particular literary genres; others plow through the bestseller lists.
All of the book clubs, however, share one rather simple thing: the pure joy of the written word. “Some people may augur the death of books,” says Jane Alger, divisional librarian at Dublin City Libraries, who has witnessed the local resurgence of readers’ meetings. “From what we are ­seeing here, that’s not true. It’s amazing what people will read. There doesn’t seem to be a limit.”
Some book aficionados are even reverting to the age-old rite of communal voiced reading. Since 2001, the Get Into Reading (GIR) project, set up by the U.K. non-profit The Reader Organisation, has been offering weekly group meetings for greedy readers in doctors’ practices, care homes and libraries across the country. “Our ­hypothesis is that reading literature aloud with others offers something uniquely valuable,” says Jane Davis, The Reader Organisation’s founding director. It “facilitates the creation of a series of powerful interplays: between the written text and the aural experience; between hearing the text from outside and processing it within; between one’s own experience and that of the author and characters; between the privacy of personal consciousness and the public experience of group discussion.”
When his wife, a dementia sufferer, was admitted to a nursing home in the Northern English city of Durham, retired businessman James Freeley decided that a GIR group would be a good thing for both her and the other residents. So in 2008, he trained to become a qualified reading instructor and, together with the care staff, has been running bi-weekly poetry sessions ever since.

“We pick poems with themes, like the seasons or starting school when term begins,” Freeley explains. “Often, while we are reading, someone will pipe up with a recollection from their past and that leads others to chip in with their own memories.” This helps the elderly participants “have a much better sense of being recognized as individuals,” Freeley says, and improves their speech development and concentration. According to staff, participants’ general sense of well-being, personal confidence and community increase, too.
The same effect can be observed in young people. Since 2009, the ­teenage members of a writing group run by the Clayport Library in Durham have regularly joined the poetry meetings, reading aloud both from the works of Wordsworth and Yeats as well as their own verses.
Young people may eventually be more comfortable with e-readers than with dog-eared paperbacks, but that’s unlikely to detract from the benefits of the ­reading experience. Dublin librarian Alger considers “electronic books and talking books as complementary to the traditional medium”—and for some, such as the blind and partially sighted, they’re essential. One of the Dublin reading clubs equips its members with audio books, without any apparent ill effects on discussions.
The way we read does matter, though. Proponents of Slow Reading believe we should linger over literature, not just speed as quickly as possible through 140-character tweets. Following the tradition of Slow Food, Slow Travel and other Slow movements, Slow Reading advocates like Canadian author John Miedema are convinced leisurely reading promotes both comprehension and enjoyment. Those who go slow “might only read a page or two at a time, reading and re-reading,” Miedema admits, but that leads them to better “apprehend the experience or meaning represented in the text.”
It’s not just reading that has salutary effects; putting pen to paper can be good for you, too. The Tumor Biology Center in Freiburg, Germany, carried out a three-year study in which cancer sufferers recovering from chemotherapy or surgery took part in poetry therapy. Their assignment: Write about the emotions triggered by their disease. The researchers concluded that patients’ well-being improved after they wrote about their feelings. Almost all of the cancer patients showed an “improvement in the psycho-social field,” says Susanne Seuthe-Witz, a sociologist who has conducted poetry sessions at the clinic since 1995.
At the start of a session, Seuthe-Witz reads either a short story, the first few paragraphs of a novel or a poem. The texts, such as German poet and essayist Marie-Luise Kaschnitz’ fairy tale, “The Old Garden,” are meant to encourage reflection and help patients face the future in a positive fashion. Seuthe-Witz asks participants to spend a few minutes jotting down whatever images, feelings or thoughts enter their heads. Then they have to write something—a sonnet, for instance, a haiku or a new ending to a familiar narrative. Seuthe-Witz believes brief forms like this are most suitable for expressing stressful emotions like fear because their brevity “protects against such emotions getting out of hand.” At the end of the session, the texts are read aloud and discussed. This exchange of ideas within a small group facing the same life-threatening disease intensifies the coping process started by the writing process.
“It’s possible that important feelings receive positive expression in this fashion and that patients no longer feel like victims but creators,” says Seuthe-Witz. “The words are like a part of themselves the patients can work with. In this way, they are no longer ruled by their fear but rather rule the fear themselves.” (For more on the health benefits of writing, see “Words that heal” on page 36.)
Writing exercises like this have application to spiritual as well as medical crises. Rev. Christine Fry, an adjunct faculty member at Starr King School for the Ministry in Berkeley, California, organizes “Write for Health” courses at her home three times a week. Participants “come from a variety of faith traditions or no tradition at all,” Fry says. “Writing helps us connect with something larger, deeper than ourselves—with God or whatever we call holy.”
Fry first presents participants with a handout of the day’s Bible readings and quotes. She then asks them to write for about 20 minutes on themes like surprise, gratitude, openness or beauty. This time of quiet reflection and release, Fry believes, helps people “notice, feel and ponder who they are and how they love and live.” Fry is convinced it strengthens their link to the divine, not least because it’s much “easier to feel the presence of the holy in the midst of a group,” she says. (For more on writing as a spiritual practice, see “Standing barefoot before God” right next to this.)
Mackenzie Bearup, the teenager with reflex sympathetic dystrophy (RSD), wants to share the healing power she’s found in books. When she heard that there were no books at the Murphy-Harpst Center for Severely Abused Children in Cedartown, 65 miles from her home, she started collecting them to donate to the facility. “Books have helped me so much,” she says. “I thought any kid that’s in really bad pain could use them, too.”
Bearup quickly amassed thousands of tomes, enough not only to stock the shelves of the Murphy-Harpst Center but those of numerous other children’s homes, treatment centers and homeless and domestic violence shelters in the area. She has since set up her own non-profit organization, Sheltering Books, and has so far distributed more than 38,000 books to some 30 different facilities.
Bearup’s experience, and that of others who have benefited from bibliotherapy, suggest it might be time to add a new twist to an old proverb: Reader, heal thyself.
Ursula Sautter, who has read a couple thousand books, thinks another couple thousand should probably keep her sane until old age.