By Jane Turner Goldsmith MAPS, a psychologist and author who discovered some therapeutic benefits from the writing of a novel

The research into the healing power of expressive writing dates back to the mid-1980s. In the original, now classic experiment, James Pennebaker asked college students to write about ‘the most upsetting event’ of their entire life for 15 or 20 minutes a day, over four consecutive days. At follow up, the experimental group showed a boosted immune system and reduced visits to the doctor compared to a control group who wrote about trivial matters (Pennebaker & Beall, 1986). The study has been replicated many times, demonstrating a range of physical health benefits and reduction of illness symptoms (Sexton & Pennebaker, 2009). Benefits to emotional health, such as reduced post-traumatic symptoms and improved mood and psychological wellbeing, have also been shown (Baikie & Wilhelm, 2005). The author of the original and many subsequent studies concludes that “when people put their emotional upheaval into words, their physical and mental health improves markedly” (Pennebaker & Seagal, 1999, p. 1244).

This was certainly my experience. Fifteen years after the road accident that claimed my husband’s life in 1991, I felt ready to write about it. It seems that the process I engaged in is one commonly experienced by people recovering from significant trauma. “The act of constructing stories is a natural process that helps individuals to understand their experiences and themselves” (Pennebaker & Seagal, 1999, p. 1243). The idea that people might be able to feel better by reducing the strain caused by bottling up painful memories is intuitively appealing, yet the mechanisms have been shown to be more complex than simple catharsis.

In my reading of the literature and in my work as a psychologist, I have been interested to understand more about these mechanisms.

Trauma, written disclosure and healing

Smyth, True and Souto (2001) suggest that if people remain distressed about a traumatic event, memory does not integrate into their personal narrative, instead remaining as “disorganised sensory perceptions, obsessional ruminations or behavioural enactments” (p. 162).

Analysis of the content of study participants’ written accounts of distressing events has demonstrated that the recounts of people who benefit more from written disclosure contain higher frequencies of positive emotion words and moderate frequencies of negative emotion words (Pennebaker & Seagal, 1999). Increasing rates of insight words (‘understand’, ‘realise’) and causal words (‘because’, ‘reason’) over time are also associated with improvement (Pennebaker, Mayne & Francis, 1997). Thus it appears that both thoughts and feelings need to be expressed for improvement to occur and those participants who write about their problems and emotions in depth, and who later express insight and resolution, improve the most (Pennebaker & Francis, 1996).

These studies contribute to the theories of how people gradually come to terms with their traumatic experiences through writing. But just as we must exercise caution before entering into discussions about trauma with clients, neither should all traumas be re-lived through expressive writing interventions. We know from the trauma literature that if people do not want to talk about their trauma, pressing for disclosure may well be harmful. Interestingly, while written disclosure study participants are reported to experience an increase in distress immediately following a writing intervention, it usually dissipates quickly and may actually be necessary for later improvement (Pennebaker & Seagal, 1999). Note that these study participants – and clients in psychotherapy – are usually willing participants, satisfying the ‘ready’ condition, which seems to be important for beneficial growth.

The importance of narrative

In the study by Smyth and colleagues (2001), the instructions to participants were manipulated. In the ‘fragmented’ condition, participants were asked to write about their trauma by listing feelings, thoughts and sensations. In the ‘narrative’ condition, participants were explicitly instructed to ‘try to form a narrative about the experience’; that is, to have a beginning, a middle and an end; to include the circumstances leading up to the event, what happened, the consequences, how they thought and felt, how they dealt with the events and how it resolved. Participants in the narrative condition showed improved health indicators and reduced rumination about the trauma. The researchers concluded that the mere expression of thoughts and feelings was not sufficient for a therapeutic benefit to occur, and that telling a well-structured story is more beneficial.

Other studies have also demonstrated that the development of a coherent, forward moving narrative, complete with satisfying resolution, is important for participants to gain any benefit. As a reader (as well as a writer) I can say that this is usually what I want from a story – to see growth and development of the main character and to have loose ends neatly tied up in the denouement. It appears also to be critical to the writer’s mental health. Studies have shown that novelists who use this formula tend to be more robust psychologically, for example, than poets who use free form and an open-ended expressive structure in their writing (Kaufman & Sexton, 2006).

Voice and point of view

In the studies mentioned so far, participants were writing about actual events, and not fictionalising the narrative in any way. In my own case, I recall quite consciously not wanting to write a memoir, opting for the safety and distance of a work of fiction. Later I uncovered some interesting findings that fitted with my experience in this regard.

One study found that writers who use the third person (that is, who tell the story through a main protagonist’s point of view – ‘she’ or ‘he’ rather than ‘I’) are less vulnerable psychologically than their counterparts who write in the first person. As Sexton & Pennebaker (2009) summarise: “People who use the first person singular tend to be more depressed and less healthy” (p. 270). Third person voice is more commonly employed in a work of fiction (not always, of course), with memoirs classically being first person accounts.

Many poets also use the first person voice. In a rather harrowing study, Stirman and  Pennebaker (2001) found that the writing of suicidal poets contained more ‘individual self’ focussed words, and fewer ‘collective’ words than did the writing of non-suicidal poets . A study that analysed the writing of Kurt Cobain, John Cheever and Cole Porter showed that as their fame increased, their writing shifted towards the use of the first person (Schaller, 1997, cited in Kaufman & Sexton, 2006). But so, too, did their self-destructive behaviours – excessive drinking and eventual suicide (in the case of Cobain). The authors concluded that linguistic markers of suicide can be predicted through text analysis.

Readers may be interested to learn that there are entire fields of research dedicated to the analysis of the mental health of Shakespeare!

The above findings would appear to confirm something we as psychologists know – that very intense or prolonged introspection may be harmful. And that mastery over trauma might occur, in writing, with the distancing created via the use of the third person voice. It’s as if people are able, this way, to edge in gradually on their traumatic memories.

Narrative therapy

The reader may see similarities with the tenets of narrative therapy, in which the mechanism of externalisation allows the individual some relief from a “problem experienced as oppressive”(White, 1989, p. 97). Furthermore, in narrative therapy, ignored or ‘thin’ aspects of experience can be drawn out and made more salient and transformative for the individual experiencing pain. “Richer, combined narratives…emerge from disparate descriptions of experience” (Payne, 2006, p. 7). Though not exactly the same, some parallels to the process of fictionalising traumatic events can be drawn here. In a scene from my novel, one of the characters learns of the death of her mother in an accident. While difficult to write, the fictional creation – as if it had happened to someone else – afforded, for me, some necessary distance from the too-close pain of the real.

‘Flow’ in creative writing

Perhaps the therapeutic benefit I gained from writing may be explained by the experience of immersing myself in the creativity and freedom of fiction. Such a state of positive wellbeing, known as ‘flow’, has been studied in writers, artists and musicians (but which exists across science, aesthetic experience and sport, and is manifest in the absorption of anyone doing something they love). The Czech psychologist Csikszentmihalyi (pronounced cheeks-sent-me-high!), studying creativity in the 1960s, first described this phenomenon of ‘flow’. He was struck by the fact that when an artist’s painting was going well, he or she would disregard hunger, fatigue and discomfort while working.

Being absorbed in ‘flow’ is perhaps one of the most truly intrinsically rewarding states of being that one can imagine, with the features being intense and focussed concentration, a merging of action and awareness, loss of reflective self-consciousness, temporal distortion and having a sense of control over action (Csikszentmihalyi, 1997).

For flow to be beneficial, certain conditions must be met, such as receiving timely and accurate feedback. The individual has to work at a level that is just beyond their level of competence. There must be a level of ‘stretch’, such that the activity is just at the optimum level of difficulty with respect to the person’s skill. Too high the challenge or too low the skill set will result in anxiety and discomfort – classic conditions for writers’ block. In my case, I was fortunate to be mentored by an eminent Australian author who provided feedback and challenge in just the right measures.

Readers may be interested to read more about flow as it pertains to writing in Susan Perry’s essay (see Kaufman & Kaufman, 2009) which reports on her work based on interviews with 76 published writers.

 

The end (and the beginning) of the story

At the launch of my completed, published novel, the ‘big moment’ for me was not only that I had realised a valued personal goal, but that, by the end of the process I had reached a place of resolution and coherence. In writing the novel, I had managed to gather together all the flotsam and jetsam of my experience: love and death and everything in between.

It was like finding order from chaos, and a kind of healing, through story.

The author can be contacted at turngold60@bigpond.com

References

  • Baikie, K. A. & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11, 338-346.
  • Csikszentmihalyi, M. (1997) Finding Flow, New York: Basic Books.
  • Kaufman, J. C. & Sexton, J. D. (2006). Why Doesn’t the Writing Cure Help Poets? Review of General Psychology, 10 (3), 268–282.
  • Payne, M. (2006). Narrative Therapy. US: Sage Publications Inc.
  • Pennebaker, J. W. & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274-281.
  • Pennebaker, J. W. & Seagal, J. D. (1999). Forming a story: The Health Benefits of Narrative. Journal of Clinical Psychology, 55(10), 1243-1254.
  • Pennebaker, J. W. & Francis, M. E. (1996). Cognitive, emotional and language processes in disclosure. Cognition and Emotion, 10, 601-626.
  • Pennebaker, J. W., Mayne, T. J., &  Francis, M. E. (1997). Linguistic predictors of adaptive bereavement. Journal of Personality and Social Psychology, 72, 863-871.
  • Perry, S. K. (2009). Writing in Flow. In S. B. Kaufman & J. C Kaufman (eds), The Psychology of Creative Writing (pp. 213 – 224). Cambridge: Cambridge University Press.
  • Sexton, J. D. & Pennebaker, J. W. (2009). The healing powers of expressive writing. In S. B. Kaufman & J. C. Kaufman (eds), The Psychology of Creative Writing (pp. 264-273). Cambridge: Cambridge University Press.
  • Smyth, J. True, N. & Souto, J. (2001). Effects of writing about traumatic experiences: the necessity for narrative structuring. Journal of Social and Clinical Psychology, 20(2), 161-172.
  • Stirman, S.W. & Pennebaker, J. W. (2001). Word Use in the Poetry of Suicidal and Nonsuicidal Poets. Psychosomatic Medicine, 63, 517–522.
  • White, M. (1995). Re-authoring Lives: Interviews and Essays. Adelaide: Dulwich Centre Publications.

InPsych June 2015