Essay Writing and healing

The famous opening sentence of Leo Tolstoy’s novel Anna Karenina, “All happy families are alike; every unhappy family is unhappy in its own way”, implies that unhappiness is more artistically interesting than happiness. Tolstoy’s assertion, although arguable, conveys a profound human truth. Unhappiness and suff ering do seem to stimulate creativity and have evoked some of the greatest literature, art, and music in western culture—works such as Dylan Thomas’s “Do Not Go Gentle Into That Good Night”, Picasso’s Guernica, Shostakovich’s symphony 13 (Babi Yar), and, more recently, John Adams’s On the Transmigration of Souls. Similarly, it is more often illness than health that compels people to fi nd creative ways to express their experiences. Indeed, the German writer Thomas Mann believed there was a special affi nity between susceptibility to an illness like tuberculosis and heightened artistic sensitivity; he explored this affi nity in his stories and novels—“Tristan”, “Tonio Kroger”, Buddenbrooks, and The Magic Mountain, for example. Ironically, Mann himself was healthy enough to live to the age of 80. Not only great artists, however, have been inspired by illness. In recent decades, especially in the USA, illnessinspired writing has resulted in hundreds of autobiographical accounts of patients’ experiences with illnesses from AIDS, Alzheimer’s disease, autism, bipolar disorder, bulimia, cancer, through heart disease and lupus, to schizophrenia and stroke. A subgenre of autobiography, these accounts have spawned a critical and theoretical discourse of their own. In her book Reconstructing Illness: Studies in Pathography, Anne Hunsaker Hawkins off ers a taxonomy of such works, classifying them according to the prevailing myths, whether archetypal or ideological, that authors use to confront or accept their illnesses. Not surprisingly, she fi nds that most people choose the archetypal myths of battle, journey, and death and rebirth in writing their pathographies. In narrative reconstructions of their illnesses, these patients seek to answer the questions of why they became ill, what their illnesses mean in the context of their lives, and how they can reshape their lives to accommodate the signifi cant changes that illness brings. From her reading of hundreds of pathographies, Hawkins believes that writing their illness stories is the fi nal stage in healing for many of the authors. That writing about physical disease or psychic trauma off ers a powerful means of healing may seem selfevident not only to people who regularly read pathographies but also to those who use writing as a therapeutic intervention with patients and trauma victims. Yet fi nding a way to demonstrate the healing eff ects of such writing to a sceptical biomedical audience has presented quite a challenge. Things changed substantially in 1999, however, with the publication of a JAMA article by Joseph M Smyth and colleagues, who had completed a randomised controlled trial of diff erent writing interventions for patients with chronic illnesses— asthma or rheumatoid arthritis. The researchers concluded that writing about stressful life experiences, as opposed to writing about “emotionally neutral topics”, did indeed improve patients’ health, as measured with standard clinical tests and assessments. Although the research design and results were immediately called into question by sceptics, the article’s greatest contribution was the impetus it gave other researchers to investigate and report on similar writing interventions. Finding measurable outcomes that can demonstrate the benefi cial eff ects of patients’ writing about their illnesses is essential if this low-cost, low-risk therapy is going to be made readily available to more patients and their families. We will need many more practitioners trained to follow the paths of trailblazers such as James Pennebaker, Marian MacCurdy, Charles Anderson, and Gillie Bolton. In The Wounded Storyteller: Body, Illness, and Ethics, published in 1995, just a few years after his account of his own illness experiences, the sociologist Arthur W Frank ups the ante. In his theory of postmodern illness and medicine, patients’ fi rst-person narratives of illness are essential for those who cannot quickly be restored to the degree of health they enjoyed before illness struck. Of the three narrative types Frank thinks are available to patients—restitution, chaos, and quest—only in the quest narrative can the distinctive voices of the ill be expressed and heard. The quest narrative requires patients to accept illness as a journey that can lead to new insight, meaning, and purpose for their lives. Epiphany and transformation are the paradoxical gifts of illness, the boon conferred by the quest. Frank believes that it is incumbent on those who have returned from their illness quest to tell their stories, not only for themselves but also to others. He calls for these wounded storytellers to share their wisdom with people who are still well and may not want to hear. Correspondingly, he argues that there is an ethical obligation for the healthy to listen to the stories of the ill and thereby witness the human suff ering they have endured. Telling and listening to such stories are moral acts that we owe each other as fellow human beings. Presumably Frank intends for the ill to off er their insights and wisdom so that others can learn from them and heal their lives without Lancet 2006; 368: S3–S4