October 29th, 2010
06:21 PM ET
Writing has always been a prominent part of medicine. Doctors write “histories” of their patients all the time—brief for ordinary office visits, extensive for admissions to the hospital. Some medical schools use creative writing to help students gain empathy and insight.
There are doctors who write more publicly—from Anton Chekhov and William Carlos Willams to Oliver Sacks and Jerome Groopman—bringing medicine beyond the clinic walls.
Patients, too, have been writers. William Styron’s "Darkness Visible" could be seen as one of the most important “textbooks” on depression that exists.
Increasingly, though, there has been interest in writing for ordinary patients (ie, those not planning novels for the New York Times bestseller list.) The fledgling field of expressive writing, or writing therapy, has been gaining traction as a viable addition to the medical armamentarium.
In one of the earliest studies from 1996, patients with asthma and rheumatoid arthritis exhibited a decrease in symptoms after writing about the most stressful even of their lives.
A more recent, though preliminary, study using writing for patients with irritable bowel syndrome (IBS) also suggested positive benefit. A group of 82 patients did four 30-minute sessions, writing about their “deepest thoughts, emotions, and beliefs regarding the disease and their perception of its effects.” Compared with 21 patients who did not participate in writing, the writing group showed a significant improvement in symptoms. Interestingly, this improvement was still present three months later.
IBS—though biological in origin—is potently affected by psychological factors. Patients commonly report that stress worsens their symptoms. The mere act of writing might have reduced stress. Or perhaps the writing exercises helped patients work through some of the practical or emotional challenges of life with a chronic illness.
Many other diseases are felt to be less influenced by psychological factors, but the truth is that every patient—to some degree—has reactions to adjusting to an illness, even a broken leg resulting from tripping on the stairs.
Could writing be used more widely with patients? There seems to be little down side, except the investment of time. Compared with the side effects of medications that we routinely prescribe to patients—stomach upset, dizziness, weight gain, sexual dysfunction—writing seems fairly benign. And no one needs to call an insurance company for prior approval.
The only caution I might see is with patients who might write about severe traumas in their lives, stirring up painful memories. For these patients, doctors need to be prepared for powerful emotions, and must be able to provide timely referral to a psychologist or psychiatrist if needed.
With the exception of writer’s cramp—and perhaps writer’s block—writing therapy seems like a promising adjunct therapy for certain patients. I think I might start stocking extra pads and pencils in my clinic.
Danielle Ofri is associate professor of medicine at New York University School of Medicine and editor-in-chief of the Bellevue Literary Review. Her most recent book, “Medicine in Translation: Journeys with My Patients,” is about the care of immigrants and Americans in the U.S. health care system.
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