Bibliotherapy

[nickh]

I have only just seen this article which appeared in The Guardian on 5th January. It is lengthy but very interesting. Plaudits to whoever is supporting the Merseyside scheme. I have to post in three chunks due to size restrictions


Saturday January 5, 2008
The Guardian

At a reading group in Birkenhead, nine women and two men are looking
at Act 1 scene 2 of The Winter's Tale, in which Leontes and his wife
Hermione urge their guest, Polixenes, not to rush off back to
Bohemia. Some of the language is difficult to grasp: what's meant by
"He's beat from his best ward"? or "We'll thwack him hence with
distaffs"? But thanks to the promptings of the group leader, Jane
Davis (from the Reader Centre at the University of Liverpool),
Shakespeare's meanings are slowly unlocked, and discussion ranges
widely over the various issues the passage raises: jealous men,
flirtatious women, royal decorum and what to do with guests who
outstay their welcome.

The rise of book groups is one of the most heartening phenomena of
our time, but this is an unusual one, including as it does Val and
Chris from a homeless hostel, Stephen who suffers from agoraphobia
and panic attacks and hasn't worked for 15 years, Brenda who's
bipolar, Jean who's recovering from the death of her husband, and
Louise who has Asperger's syndrome. Most of the group are avid
readers but for one or two it's their first experience of Shakespeare
since school.

Under the umbrella of Jane Davis's "Get into Reading" scheme, there
are now around 50 groups like this across Merseyside: groups in care
homes, day centres, neurological rehab units, acute psychiatric
wards, cottage hospitals, sheltered accommodation and libraries;
groups for people with learning disabilities,
Alzheimers, motor- neurone disease, mental health
problems; groups for prisoners,
excluded teenagers, looked-after children, recovering drug-addicts,
nurses and carers; groups that are small - no more than 10 - so
there's a sense of intimacy.

The educational backgrounds vary widely but there's no dumbing down
in the choice of texts - The Mayor of Casterbridge, Uncle Tom's
Cabin, Rebecca, Great Expectations, Adam Bede, Jane Eyre, Of Mice and
Men, Kes, even Robert Pirsig's The Art of Motorcycle Maintenance
among them. The usual pattern is for a complete book to be read
aloud, cover to cover, at weekly sessions, which for a group spending
an hour a week on a Dickens novel can mean six months devoted to a
single work. Nobody is pressured to read aloud, but if and when they
do the boost to their confidence can be striking.

These reading groups aren't just about helping people feel less
isolated or building their self-esteem. Nor are they merely a
pretext, in an area of high unemployment, for giving the experience
of working as a unit. More ambitiously, they're an experiment in
healing, or, to put it less grandiosely, an attempt to see whether
reading can alleviate pain or mental distress. For Kate, who has
suffered from severe rheumatoid arthritis for 30 years, the answer is
clear: "Reading pushes the pain away into a place where it no longer
seems important. No matter how ill you are, there's a world inside
books which you can enter and explore, and where you focus on
something other than your own problems. You get to talk about things
that people usually skate over, like ageing or death, and that kind
of conversation - with everyone chipping in, so you feel part of
something - can be enormously helpful." Others say the same: "I've
stopped seeing the doctor since I came here and cut down on my
medication"; "being in a group with other women who have what I had,
breast cancer, didn't help me, but talking about books has made a
huge difference."

Medical staff tell stories of the remarkable successes they've seen:
the neurological patient who sat in a group saying nothing for
months, then after a reading of George Herbert's poem "The
Flower" ("Who would have thought my shrivelled heart/Could have
recovered greenness?") launched into a 10-minute monologue at the end
of which he announced "I feel great"; the brain-damaged young man
whose vocabulary significantly increased after he joined a book
group; the husband caring for his disabled wife whose exposure to
poetry has proved not just a respite but a liberation. To outsiders,
the outcomes might seem small, but to the staff and patients
concerned they're huge breakthroughs.

Crochet or bridge might serve equally well if it were merely a matter
of being in a group. But as Judith Mawer of the Mersey Care Mental
Health Trust explained, focusing on a book is the decisive factor:
"People who don't respond to conventional therapy, or don't have
access to it, can externalise their feelings by engaging with a
fictional character, or be stimulated by the rhythms of poetry."

One particularly successful initiative has been reading poetry to and
with dementia patients, some of whom have lost all sense of who and
where they are but can recite the words of a poem learned at school
70 years ago. As Get into Reading worker Katie Peters describes it:
"One lady was shouting and swearing at anyone who approached, and
when I mentioned poetry told me in no uncertain terms to go away. But
as I sat and read poem after poem, she visibly relaxed, her mood
changed completely and she happily chatted about the poems to other
residents.

"Nurses tell me that patients seem less agitated after our sessions.
There is something about poetry, not just the rhythms and rhyme but
the way it provides an opportunity to hold a thought together through
time, that really helps, even with people who are not natural
readers." Katie's experiences echo those of Oliver Sacks with
patients suffering from severe Parkinson's disease, who found that
"people who could not take a step could dance" and "people who
couldn't utter a syllable could sing".

"One sheds one's sicknesses in books," DH Lawrence once wrote, and
the people I met on Merseyside agree with him that books - good
books, anyway - are a form of therapy. "Prose not Prozac" is the
prescription. Literature not lithium. A talking cure in the presence
of Keats, Dickens or Shakespeare rather than a physician or
psychiatrist.

Bibliotherapy, as it's called, is a fast-growing profession. A recent
survey suggests that "over half of English library authorities are
operating some form of bibliotherapy
intervention, based on the books- on-prescription
model". That's to say, an increasing number of people
are being referred by their GPs to the local library, where they'll
find shelves or "reading pharmacies" set aside for literature deemed
relevant to their condition. Lapidus, an organisation established in
1996 "to promote the use of literary arts in personal development",
has played a key role in bringing together writers and health
professionals; as has the current editor of the Poetry Society's
magazine, the poet Fiona Sampson.


End of part one

Nick.

 

[nickh]

Bibliotherapy Part 2

continued....

Bibliotherapy might be a brave new word but the idea that books can
make us better has been around for a very long time. Matthew Arnold
and FR Leavis temporarily hijacked it when they argued that great
literature - "the best that has been thought and said in all the
world" - can make us morally better, by kindling "our own best self".
That idea disappeared with the Holocaust, when immensely civilised
and well-read men brought up on Schiller and Goethe proved capable of
the most barbarous acts. But the idea that books can make us
emotionally, psychologically and even physically better goes back to
the ancient world.

Plato said that the muses gave us the arts not for "mindless
pleasure" but "as an aid to bringing our soul-circuit, when it has
got out of tune, into order and harmony with itself". It's no
coincidence that Apollo is the god of both poetry and healing; nor
that hospitals or health sanctuaries in ancient Greece were
invariably situated next to theatres, most famously at Epidaurus,
where dramatic performances were considered part of the cure. When
Odysseus is wounded by a boar, his companions use incantations to
stop the bleeding. And the Bible has the story of David calming Saul:
"And it came to pass, when the evil spirit from God was upon Saul,
David took a harp, and played with his hand: so Saul was refreshed,
and was well, and the evil spirit departed from him."

By the Renaissance, the idea that poetry and song could "banish
vexations of soul and body" was well-entrenched - to the point where
Thomas Puttenham argued, in The Art of English Poesie, that the poet
must "play also the physician and not only by applying a medicine to
the ordinary sickness of mankind, but by making the very grief itself
(in part) cure of the disease". What Puttenham meant was that the
writer should use "one dolour to expel another", the sad cadence in a
line of poetry allaying the burden of pain or depression in the
reader, "one short sorrowing a remedy of a long and grievous sorrow".

The image has a hint of homeopathy about it - like curing like - and
just as homeopathy is regarded with suspicion in conventional
medicine, so bibliotherapy is bound to strike sceptics as a form of
quack medicine. But considerable research has been carried out over
the past 20 years which seeks to prove the healing capacity of the
arts in general and literature in particular. A study in Alabama
demonstrated how depressives treated via bibliotherapy had less
chance of relapse than those given medication. At Kings College,
London, Gillie Bolton has explored the use of writing with a range of
palliative care patients and teenage cancer sufferers. Other studies
have explored the links between involvement in the arts and
longevity; between "verbally revealing it all" and fighting off
infections; between the generally calming effect of books -
relatively few of which are so bad that we want to hurl them across
the room and - and lower levels of cardio- vascular disease. An Arts
Council report of 2004 cited 385 references from medical research on
the positive effect of the arts and humanities in healthcare, among
them "inducing positive physiological and psychological changes in
clinical outcomes, reducing drug consumption, shortening length of
stay in hospital ... and developing health practitioners' empathy".

The scientific evidence is far from conclusive, nevertheless. Raymond
Tallis, author and emeritus professor of geriatric medicine at
University of Manchester, has been enormously impressed by Jane
Davis's work, but notes that most of the published research "consists
of equivocal findings in fourth-rank journals", adding: "I have been
a medic too long to be easily persuaded of the wider role of
literature in healing. No one sends out for a poet when they are
seriously ill." However, even he concedes that "my last boss before I
became a consultant was hugely helped in his last weeks by reading
War and Peace, when he was attached to a diamorphine pump." Tallis
also acknowledges that reading might be therapeutic in a variety of
ways, not least in easing depression: "the pleasure of escape into a
parallel world; the sense of control one has as a reader; and the
ability to distance one's self from one's own circumstances by seeing
them from without, suffered by someone else and gathered up into a
nicely worked-out plot - somewhere around here is the notion of the
Aristotelian purgation and Sartre's idea of 'the purifying reflection'."

Perhaps the most convincing argument for the effectiveness of
bibliotherapy comes from writers themselves. There's the case of
George Eliot, for example, who recovered from the grief of losing her
husband George Henry Lewes by reading Dante with a young friend, John
Cross, who subsequently married her. "Her sympathetic delight in
stimulating my newly awakened enthusiasm for Dante did something to
distract her mind from sorrowful memories," Cross later wrote. "The
divine poet took us to a new world. It was a renovation of life."

John Stuart Mill enjoyed a similar renovation after the "crisis in my
mental history" which he describes in his Autobiography, a crisis
that began in the autumn of 1826 when "the whole foundation on which
my life was constructed fell down [and] I seemed to have nothing left
to live for". Then one day "a small ray of light broke in upon my
gloom. I was reading, accidentally, Marmontel's Mémoires, and came to
the passage which relates his father's death ... A vivid conception
of the scene and its feelings came over me, and I was moved to tears.
From this moment my being grew lighter. The oppression of the
thought that all feeling was dead within me was gone. I was no longer
hopeless: I was not a stock or a stone."

What cured Mill was an account of death; what eased Eliot's mourning
of her husband was a journey through Dante's Inferno. If books are to
be therapeutic, it seems, it's because they take us to dark places
rather than bright ones. As Thomas Hardy recognised, "If a way to the
better there be it exacts a full look at the worst." Hence Davis's
preference for classic texts which address existential concerns, not
anodyne pep-ups. Medical staff attached to her scheme have
occasionally worried that such and such a poem or passage might "make
things worse". But what does "worse" mean when you're talking about
people on a psychiatric ward? One elderly patient became distressed
during a reading of Burns's "My love is like a red, red rose", but
insisted on staying there, through the tears, and professed herself
"much better for it" afterwards.

Hardy's famous quote comes from a sequence of three poems, "In
Tenebris", which he wrote in 1896-97, when his spirits were brought
low by the excessive optimism of his peers. To Hardy, hell was other
people being cheery - "the blot seems straightway in me alone .../one
born out of due time, who has no calling here". And yet he derives
consolation from the very pessimism or "unhope" that weighs him down:

Wintertime nighs;
But my bereavement-pain
It cannot bring again:
Twice no one dies.

Each of Hardy's "In Tenebris" poems has an epigraph from the Psalms.
And far from being a simple glorification of God, the Psalms are
often engulfed by despair: "my heart is smitten, and withered like
grass"; "attend unto my cry; for I am brought very low". Yet reading
the Psalms or Hardy or Gerard Manley Hopkins's "terrible sonnets" can
be cathartic. By attending to the cry of another, we articulate our
own cries, frame them, contain them, and feel less stranded. "I wake
and feel the fell of dark, not day," Hopkins writes, in his anguish:

What hours, O what black hours we have spent
This night! What sights you, heart, saw, ways you went!
And more must in yet longer light's delay ...

Though Hopkins plumbs the depths, he writes so searingly of his
torment that the poetry becomes a cauterising iron to burn away his
pain and ours, and to "leave comfort root-room" in which to grow.

Hopkins knew that not everyone will have experienced the "cliffs of
fall,/Frightful, sheer, no-man-fathomed" which he describes: "Hold
them cheap/May who ne'er hung there". But even those of a sunny
disposition will find his sonnets illuminating, an insight into the
mind of a fellow creature, and an expansion of their own empathic
powers.

This is surely the other great therapeutic power of literature - it
doesn't just echo our own experience, recognise, vindicate and
validate it - it takes us places we hadn't imagined but which, once
seen, we never forget. When literature is working - the right words
in the right place - it offers an orderliness which can shore up
readers against the disorder, or lack of control, that afflicts them.
Most misery memoirs fail in this respect - they invite readers to be
prurient rather than to identify, exaggerate where no exaggeration is
necessary, and are too clamorous to grant the space to contemplate
and withdraw.

In The Prelude Wordsworth speaks of certain memories or "spots of
time" - "scattered everywhere" - which have a special place in the
life of each man and woman, and which it is our task to recover: not
as an act of nostalgia but because they help repair and (the word
John Cross used) renovate us if we find them.

There are in our existence spots of time
That with a distinct pre-eminence retain
A renovating virtue, when, depressed
By false opinions and contentious thought,
Or aught of heavier and more deadly weight,
In trivial occupations, and the round
Of ordinary intercourse, our minds
Are nourished and invisibly repaired;
A virtue by which pleasure is enhanced,
That penetrates, enables us to mount,
When high, more high, and lifts us up when fallen ...

continued....

 

[nickh]

Bibliotherapy Part 3 (last)

continued (to end)....

The most consciously renovating or therapeutic writer I know is Ted
Hughes - surprisingly, perhaps, since in his lifetime he seemed to
friends, and accused himself of being, a man in denial. But he not
only considered individual works of his medicinal - "It is a story
intended to cure the mentally sick," he said of his children's book
The Iron Man - but defined poetry as "nothing more than a facility
for expressing that complicated process in which we locate, and
attempt to heal, affliction - whether our own or that of others whose
feeling we can share. The inmost spirit of poetry, in other words, is
at bottom, in every recorded case, the voice of pain - and the
physical body, so to speak, of poetry, is the treatment by which the
poet tries to reconcile that pain with the world."

When Hughes describes poetry as consisting of "things we don't
actually want to say" but "desperately need to share", he is talking
as a writer, not a reader. But the inseparability of reading and
writing is something which Proust acknowledges when he defines the
book as a "sort of optical instrument which the writer offers to the
reader to enable the latter to discover in himself what he would not
have found but for the aid of the book". It's often said that books
"take us out of ourselves", but in reality the best literature is
surreptitiously taking us inside ourselves, deeper than we might have
expected or chosen to go.

The self can get help from a book, then. But the best kind of help
doesn't necessarily come by way of self-help books. Nor are the books
which make us feel good usually feelgood books. That's the problem
with most of the bibliotherapy schemes that have been set up in the
UK so far. It's commendable that Kirklees, Calderdale, Neath and
Ayrshire - to name just four such initiatives - should have thrown
their weight behind bibliotherapy. But too often the prescribed
"literature" in local libraries consists only of leaflets, or
references to useful websites, or books written by "eminent
therapists or former service-users" which are
worthy, practical- minded and dull. There's no
recognition that people in trouble need
more than the right labels. As one of the reading group in Birkenhead
explained: "I would never have gone into a library and asked for a
self-help book on depression. I was feeling bad enough as it was, and
that would have made me feel worse. It's being in a group and talking
that helps." And, of course, using imaginative literature - poetry
and fiction, not self-medicating pamphlets.

Jane Davis would like the scheme she's created on a Merseyside to be
adopted throughout the country. With 2008 designated the Year of
Reading, and Liverpool the 2008 European Capital of Culture, it's an
opportune moment. If she's evangelical in the cause (she also runs
the excellent quarterly magazine the Reader), that's because of the
almost religious role which books have played in her own life -
notably, Doris Lessing's novel Shikasta, reading which, as a young
woman, pushed her "into something like a nervous breakdown. I felt so
disturbed by it that I wrote to Doris, care of her publisher, blaming
her and asking for help. She wrote back telling me to read more and
offering money for books if I needed it. 'I am not your teacher but
you need to read,' she said. I was a single mother living on social
security but in the end I decided what I needed wasn't Doris's money
but a public library. And, for me, the clue of Shikasta - that life
is serious and you have to do something with it - was a life-saver."

Books don't always save lives: writing about the Holocaust didn't
prevent Primo Levi from ultimately committing suicide; and the
reading - or perverse misreading - of The Satanic Verses led to the
deaths of innocent people. But literature's power to heal and console
outweighs its power to do damage. Hector, in Alan Bennett's The
History Boys, puts it beautifully when he describes how, in the
presence of great literature, it's as if a hand has reached out and
taken our own. That's the hand which Davis is trying to extend.

· www.getintoreading.org, www.thereader.co.uk

· This article was amended on Friday January 11 2008. Fiona Sampson
was mistakenly described as chair of the Poetry Society. She is
editor of the society's magazine, Poetry Review, and the chair is
Anne-Marie Fyfe. This has been corrected.

Nick

 

[dunglen]

bibliotherapy

I have dyslexia so long passages of text scare me as I find that I have to start and stop frequently and most of the stuff i have read just didn't make any sense. so i apologise in advance for only skim reading your posting and would like to add that the people in the group were the main focus of the therapy and that those who go out and read to others are offering a world that i would love to be involved in.
I find reading very time consuming, frustrating and avoid it most of the time.
BUT i enjoy being involved in discussion groups with people who can read, comprehend and discuss the things they have read as a willing participant. Many places do not cater for those of us that are textually disabled and as such any service that offers discussion group focus has to be encouraged and hopefully reach out to people like me who feel left out of the 'book loving' culture that at the moment is seeing a hugge revival.

ps i am able to read and write but shy away from engaging with blocks of text such as the one I have just created above.

Anne

 

[Dollit]

Thanks for posting this Nick. I'm going to try and find the article because I knew a few people (medics) who would be very interested in this work. Anne - even if you couldn't do the reading you could certainly make an important contribution to discussion. "Reading" should be more accessible to those who, for one reason or another, don't.

 

[nickh]

Thanks Anne and Dollit. The point you make is excellent Anne and one I hadn't thought of at all - which shows again how forums like this and discussing our issues help broaden our minds and make us more aware of other people .

I should have said I have no personal knowledge or connection with the scheme discussed. In Birmingham (where I live) there is a so-called 'Bibliotherapy' scheme but it is quite different - it operates on the basis that GP's can give patients a 'Book Presecription' - a recommendation of a certain book which they can take along to their local library. The library service have ordered lots of copies of these books. But the books are all self-help books and all on a CBT (Cognitive Behaviour Therapy) priniciple. This is fine as far as it goes but not for people (I am one) for whom CBT does not work. It is not really bibliotherapy in the sense in which it is being used in Liverpool (which I had never heard of till I read this article).