Guest Post on Mental Illness Memoirs

Serife Tekin, a postdoc at Dalhousie, writes in with a guest post on mental illness memoirs.  She can be reached here.  Here's the post:

A query into Mental illness memoirs: Does writing help psychiatric patients?

            One in every four adults in North America suffers from a diagnosable mental disorder in a given year.[1] Treatment options consist of pharmacological intervention and psychotherapy. Given the limited health care resources offered to psychiatric patients, and the limited time each patient is allotted for face to face psychotherapeutic treatment (see for instance Gardiner Harris’s[2] recent New York Times article, “Talk Doesn’t Pay, so Psychiatry Turns Instead to Drug Therapy”) should we perhaps consider memoir-writing – patients’ own expression of their experiences with mental disorders – an additional treatment venue available to patients?

            This question is motivated by the observation of the psychiatric landscape. In the last few decades we witnessed an increase in both the number of people who are diagnosed with mental disorders, and an increase in the number of patients who publish memoirs of their illness. Such illness narratives range from online blog entries to published manuscripts, representing a unique subset of patients –educated, with access to publishing industry. Patient memoirs offer accounts of a wide variety of mental disorders, and they tell individualized stories of treatment and coping. Patients present their stories of coping by appealing to various psychiatric discourses, e.g., psychoanalysis, DSM-driven psychiatry, biological psychiatry, the survivors’ movement, etc.

            Some of these patient-authors suggest that writing about their experiences helped them to acknowledge and accept their illness, and to remedy some of the repercussions of mental disorder challenges on interpersonal relationships. Being able to connect and situate the symptoms of their illness and to their specific life experiences, and retrospectively analyzing what they encountered, through writing, they experienced a stronger sense of agency.[3] Others, who focus on the negative influence of ruminating about one’s mental disorder, suggest that memoir writing, as an individually engaged therapeutic venue, may perpetuate one’s feeling of paralysis in the face of illness.[4] Based on these accounts it is hard to make a conclusive statement about the value of memoir writing in psychiatric patients’ ability to respond to challenges with mental disorders.

     There is relevant empirical research in trauma that could help us further judge the benefits of memoir writing. James Pennebaker’s empirical work on the value of writing about traumatic experiences on the subject’s well-being demonstrates that when individuals write about traumatic experiences by deeply engaging with the associated emotional difficulties in their lives, significant physical and mental health follows.[5] This is called the disclosure phenomenon. In these studies, writing about the deepest feelings related to traumatic experiences was associated with a significant drop in physician visits and with a beneficial influence on immunity. Further, writing about trauma was shown to yield comparably higher biological, mood, and cognitive effects than writing about superficial subjects. While some of the positive outcomes of the disclosure phenomenon are due to a reduction in inhibition, researchers argue that basic cognitive and linguistic processes during writing are a more significant factor in the positive outcomes. Support comes from the observed connection between language used and health outcomes. More thoughtful writing, which draws causal and insightful connections between the events and emotions, as well as the use of positive emotion words in expressing trauma lead to better health outcomes.

      

      Similar benefits might follow vis-à-vis a patient’s writing about her mental disorder. If, through memoir writing, the patient engages with the personal manifestations of the symptoms in her life, establishes causal and insightful relationships between her symptoms and other components of her life she might enjoy similar benefits to those individuals in Pennebaker’s studies who wrote about their traumatic experiences. While patients’ responses to writing seem to vary, it might be worthwhile to further investigate this topic empirically.

---

[1] Kessler, RC; Chiu, WT; Demler, O; Walters; EE.2005. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry;62(6):617-27.

[2] Harris, Gardiner. 2011.New York Times. Retrieved on March 15, http://www.nytimes.com/2011/03/06/health/policy/06doctors.html

[3] e.g., Saks, E. 2007.  The centre cannot hold: My journey through madness. New York: Hyperion.

[4] e.g., Thompson, J. 2010. Leaving the boy in the room. Philosophy, Psychiatry, & Psychology 17, no. 3:247–250.

[5] Pennebaker, J. W. 1997. Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), 162-166.

Comments

[Jackie Sullivan]

Kudos to Serife for raising this interesting and important question. If we are truly concerned with promoting the health of patients suffering from mental disorders, we certainly ought to explore viable alternatives and/or complements to pharmacological and psychotherapeutic interventions. It is very unfortunate that so little research to date has been done to investigate the therapeutic efficacy of engaging psychiatric patients in narrative writing, and cheers to Serife for initiating a dialogue in an effort to instigate future research efforts in this direction.

Also, I just want to point out a correction. Serife may be found at the following website: http://www.serifetekin.com/

[Adam Kolber]

I've updated the web link. Thanks, Jackie.

[Alice Carney]

Thanks, Jackie, for the insight and weblink. There are other populations who also benefit from being encouraged to write. I have see a definite improvement in mood and attitude in my brother who is asphasic after the removal of a large benign brain tumor and whose speech therapist is encouraging him to write and (most important) reading his writing and responding to it.
Alice Carney