Late in life, my father sometimes reminisced about his orthopedic surgery practice. Surprisingly, the patients he seemed to remember with the most satisfaction were not the ones whose complicated fractures he had set or those whom he had restored to full function with a hip or knee replacement. Rather, he felt he had been most helpful to those patients who arrived at his office clutching papers on which they had written long lists of their symptoms. My father believed that even when the symptoms werenÂ’t within an orthopedistÂ’s expertise to treat, there was something about the patients simply writing them down, and then sharing the writing with him, that made them feel better.
Dad may have been on to something.
In the past few years there has been growing recognition of the health benefits of writing. The leading proponent of writing for health has been Dr. James Pennebaker, a psychologist at the University of Texas at Austin. At the core of PennebakerÂ’s work is an assignment in which patients write continuously (ideally without lifting pen from paper or fingers from keyboard) for 15-30 minutes on three or four consecutive days about their most painful or traumatic experiences. Pennebaker has found that this simple exercise can reduce pain and decrease frequency of visits to doctors. He postulates that the reason journaling is helpful is that it turns a difficult experience into a narrative or Â‘storyÂ’ that feels less overwhelming.
One group of researchers used PennebakerÂ’s exercise to study the effect of journal writing on over 100 people with rheumatoid arthritis or asthma. The patients wrote about their painful and traumatic experiences for 20 minutes each day for three days and were then compared with patients who were instructed to simply jot down their plans each day. Even four months after the writing exercise, the patients who wrote about intense feelings had an overall 28% improvement in the severity of disease (by physician assessment of rheumatoid arthritis) or pulmonary function tests (for the asthmatics) compared with those who wrote about less emotionally charged matters.
A study of people with cancer showed that writing about thoughts and feelings can improve patientsÂ’ sense of well being regardless of the course of their illness.
PennebakerÂ’s writing exercise has also been used to accentuate the effects of positive experiences. In one study, college students were asked to write intensely for 20 minutes on three days about a very happy or satisfying experience. When they were surveyed three months later, the students who participated in the writing exercise reported fewer visits to the university health center and an overall better mood than those who had written about a neutral topic.
Writing benefits doctors as well as patients. Â“Narrative Medicine,Â” a new discipline founded by physician and literary scholar Rita Charon at Columbia University, uses writing and storytelling to sharpen cliniciansÂ’ diagnostic skills and increase their capacity for empathy. One technique Charon uses is Â“the parallel chartÂ” in which medical students are encouraged to write down feelings and thoughts about their encounters with patients in a private journal in addition to writing the traditional notes in the patientÂ’s hospital chart. She finds that this journaling improves both the studentsÂ’ and the patientsÂ’ satisfaction with their interactions and increases the studentsÂ’ capacity to listen closely to their patients and understand and empathize with their concerns.
The author Joan Didion observes: Â“I write entirely to find out what IÂ’m thinking, what IÂ’m looking at, what I see, and what it means. What I want and what I fear.Â” Her point is that writing is not merely the transcribing of thoughts you already have, but the creation of new thoughts and even new feelings. For patients Â— and for doctors as well Â— this can be a radically healing activity.
Give PennebakerÂ’s exercise a try. Write about something painful or traumatic for 15 minutes or so each day for 3 days. DonÂ’t worry about grammar, spelling, or penmanship. DonÂ’t censor yourself at all Â— this is just for you. Do you feel differently?
Dr. Suzanne Koven practices internal medicine with a special interest in weight issues at Massachusetts General Hospital in Boston, and teaches at Harvard Medical School.
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