Full transcript: Bibliotherapy: A novel take on mental health

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This is a full transcript of Bibliotherapy: A novel take on mental health as first broadcast on 18 May and presented by Niamh Hughes with Beth Rose and guests Harriet Allner and Dr Paula Byrne.

NIAMH - When it comes to managing our mental health there are countless ways we try to help ourselves through the day. Some of us will go for a run or take up a hobby to channel our energy into something positive, and even meet new people. But hitting the gym or attending an evening class isn't for everyone, especially if you are struggling with your mental health.

Some of us need to take smaller steps to combat our demons. And mental health management doesn't even require you to leave the comfort of your own bed. For plenty of us, reading is something we'd like to do more often. It's a chance to escape to Narnia, Westeros, times and places we could only dream of, but did you know that reading has long term benefits for your mental health? And those benefits are far more nuanced than you may think.

So, in honour of Mental Health Awareness Week we're going to look at the ways reading can not only help relieve stress and give you a good night's sleep, but act as a form of therapy. Bibliotherapy.

My name's Niamh Hughes, and with me is Ouch's very own Beth Rose. And joining us in the studio is writer, blogger, and mental health advocate, Harriet Allner. We're also joined by Dr Paula Byrne. She is the co-creator of an online course called Literature and Mental Health: Reading for Wellbeing. It's a course with FutureLearn in association with the University of Warwick.

Now Harriet, I wanted to start with you. Were you always a big reader growing up?

HARRIET- Absolutely. My dad just instilled… Actually, both my parents to be fair, they really instilled a love of books in me from a very young age. It was one of those things where growing up I had all sorts of things like 'Swallows and Amazons' and 'Moonfleet' and 'Kidnapped' and all these adventure stories, and it was very much a you can become anything you want to be. You can travel. You can do all these things. You can be a pirate or an adventurer or whatever. I just fell in love with that way of learning about the world and experiencing new things and travelling to new places, and it never left.

NIAMH - Yes, and did you find that it really helped you sort of develop as a person?

HARRIET- There's so much to be said about books in terms of being able to see what other people are experiencing and seeing them from their shoes. And actually, you know, there are certain things that I haven't experienced in my personal life, but I feel like I've learned about them and can understand them because of books.

And I think it's also one of those things that, you know, you get books today, so for example, 'Reasons to Stay Alive' by Matt Haig is one of those ones where people who I know who have been struggling with mental health have given it to friends and family and said, "Look, try and understand me," and actually that's been really helpful. And I think that goes for a lot of novels as well, and fiction as well as non-fiction. So yeah, definitely, empathy is a huge part of what comes out of reading.

NIAMH - When did you first start to struggle with your mental health?

HARRIET- So obviously everyone has mental health, and I've had ups and downs with mine. There have been times particularly where I've been stressed, where I've been anxious, those are my two kind of main things, where I've been lonely. I've written about that before. And I think that these are all things that kind of have peaked at different times in my life, my teens, early 20s. It's mostly under control these days. I think there's kind of a low level anxiety that most of us live with in London.

But it's one of those things where, in general, I think mental health is something that I've kind of learnt to live with and have learnt to understand and sort of notice that, oh, this is going to set me off in a certain way. Sometimes I need to centre myself, and reading's really helped me with that. And a lot of people probably don't know how to identify what's setting them off and when. That's something which I've definitely learnt to recognise in myself, it's personal for everyone.

NIAMH - How did your mental health, your anxiety etc, how did it kind of manifest itself?

HARRIET- The thing about anxiety is that it makes me very much like an over thinker. So when I've been particularly low I'll be just recycling thoughts when it will come back and back and back. And when it comes to those low points and then I was kind of just going, I don't know what I'm doing with myself, a sort of existential anxiety, combined with I'm not sure if I want to leave the house today.

It's weird, because actually I think for a lot of my life I didn't recognise what it was, and then once I hit 25 I suddenly had terms for it, because people started talking about it. People started saying, "Oh, this is what anxiety is. This is what depression is," publicly, and that really gave me an understanding of me.

NIAMH - And how did you initially start to address it? Obviously people say, you know, "Get a good night's sleep, go for a run," which don't always seem very attainable at tough times. Was there anything that you tried initially to try and get you back on that even keel?

HARRIET- I've always found writing has been my catharsis. It's really always centred me and brought me back. Reading has always done that as well, and I didn't even recognise that's what it was doing for a very long time. I've tried running. I love running. I've done also like the small things, having a bath with a bath bomb, you know, self-care things.

NIAMH - So what was it about books? And at which point did you suddenly think, oh okay, actually this is doing me some good, this is making a difference …?

HARRIET- I think it's something that I can now recognise, in the sense of I can see that holidays during exam periods or whatever, going and having a day where I would actually read something completely different was very important. That was stress, that was sort of a management tool.

But then actually when I did the FutureLearn course on Reading for Wellbeing it was such an eye opener because I was like, oh my gosh, this is what I've been doing forever. You know, I was suddenly surrounded by people and communicating with people who were or had experienced exactly the same thing with books, or potentially were learning how to use books in that particular way. That course was probably the pivotal moment where I went, reading is an essential part of my self-care routine, and it's always going to be from now on.

NIAMH - Speaking of your FutureLearn course, before we talk to you about your experiences with the course we actually have one of the course founders on the line. Paula, tell us a little bit about FutureLearn. What was the catalyst behind it, and what made you want to create this course?

PAULA - My husband had done a FutureLearn, open learn course, on Shakespeare, and really loved doing it. And when I was given the opportunity I said, "I'll only do it if I can do this with mental health and literature." And what I wanted for that course was really to open up the conversation, I wanted to make sure that when we were teaching a course it was done in a way that was just a conversation. I wanted our learners just to feel they were almost just listening in to a social conversation. And that was sort of the premise, and that's how it all began.

And my personal story was that my daughter when she was five lost her kidneys very unexpectedly, and we spent a lot of time in hospital. And over the years while she had… she was on dialysis and she had a transplant, and it really struck me as a writer, as a reader, the dearth of good reading material in hospitals. And I remember saying to my husband, "If only there was a sort of Gideon Bible of poetry and literature by the bedside, that would really fill you with hope or comfort." So the idea kind of sprang from that dearth, that sort of lack of reading material and it began from there.

BETH - What do you actually do on the course? What's it about?

PAULA - So how we designed the course was, it was a six week course, and we very much wanted a theme each week. So one particular week might be looking at Alzheimer's, another week might be heartbreak, another week might be stress. So we themed each week, and within that theme of that week we would have various conversations with healthcare practitioners like GPs who would just explain to our learners what is happening when you're stressed, what does it mean physiologically?

Because I wanted to get that understanding of we all sort of feel like this, but what is really going on in terms of our bodies? And then we'd move into talking more about the mental health angle, and then we also did speak to people like Stephen Fry, Melvyn Bragg, because they are people who have struggled with mental illness and have gone vocal and gone public. And I think it's really comforting for lots of learners to know that they're not alone, and that other people who may seem to have it all, also have their own struggles.

BETH - We're not talking about self-help books either here which is interesting, we're talking about poetry, novels, of any genre. So can you give an example of a book that might help someone, or someone has really told you that really changed the way they felt about their mental health?

PAULA - Children's literature's very helpful I think for me, but the classics really is where I come from, because they're tried and tested, they've lasted over the course of so many years, and many people find Wordsworth sonnets are very comforting. I think there's something about the sonnet form, it's very constrained and controlled and they have these wonderful rhythms and that seemed to help people.

And this is something that lots and lots of people have identified with, and somehow they feel comforted that that poem was written so many years ago and yet the feelings are the same. And another favourite poet is Katherine Philips who was writing in the 1600s, who I think is one of the great underrated poets, but she writes about the loss of children, miscarriage. I had a miscarriage and I always turned to Katherine Philips because I felt she really understood me.

And it's a wonderful feeling, as I say, to feel that there is no barrier to this, these are feelings that people have had for many, many years. And that in itself can make one feel better.

NIAMH - It's about connecting with other people, whether it's through somebody else's writing or through somebody you can physically talk to, or even online that you can talk to, to discuss these feelings. And it's almost like using literature as a buffer to talking about your mental health, it's quite a constructive way to talk about your mental health. So you're able to cultivate a community. Was that something that you were quite conscious of, Paula?

PAULA - But of course we did want people to share their stories, and one of the lovely things about the course when it came to an end was that some of the learners got a forum together, a Facebook forum, where they could carry on sharing poems and tips and, "Oh, why don't you read this, if you're feeling like…?" You talked about that word 'community', and I think many of us do feel isolated, you know, despite social media; it can make us feel more isolated.

But one of the benefits of social media and the digital world is this sense of, you are not alone, we're a part of this community. And that is a huge comfort when you're struggling with your mental health.

NIAMH - What sort of mental health conditions did some of your learners have, and did they tell you about their own experiences and how they might have learnt to get some comfort from reading?

PAULA - Yeah, some people were experiencing stress as a result of being a carer of somebody say with Alzheimer's, and so they would share the helplessness and the fear. And somebody would talk about how poetry can connect you with your loved one, even if they're not fully there and present in their mind, or they're suffering from some sort of dementia. So it was sort of the carers, but also people who were struggling with anxiety and felt that the sitting down and reading aloud of the poem, the rhythms of the poem, could really calm their breathing down or could slow you down.

Read a poem twice, read a haiku twice, and there's just something, it lowers the blood pressure. It just gives you that focus, it's sort of concentrated language in concentrated form, and it demands a kind of concentration that can be helpful, because it blocks out all the noise in your head.

BETH - There was a study a while ago I think, the University of Sussex did a study which said that reading a book can reduce stress by 68%, and actually it fares better than listing to music, taking a walk or drinking a cup of tea. And it helps the whole brain and body to relax.

Do you think with this….? So I mean, I'm a big reader, so I read a lot every day, so this is going to be playing devil's advocate a bit, but is bibliotherapy, is it about the books or is it about the fact that if you've got time to read a book, it probably means you've done all your chores, your homework's out of the way, you've got time to yourself so you choose to read? Where do you think that falls, Paula?

PAULA - Well I think you make a very good point, but I think you have to make time in your day because we're all so busy. So it's not so easy as to say when all your chores are done. I'm also struck by the fact that bibliotherapy is not new, it goes back to the Greek times. Aesculus said, "Words are the medicine of a mind diseased," you know, it's really not a new idea, and often the old ideas are the best, the sort of simple ideas, but you still have to make the time.

And Harriet used the words 'self-care', which I thought was just a brilliant phrase, that we all have to employ self-care to protect our mental health. And I think one of the best ways to do that is to sit down and read. Now, sometimes when we're stressed we can't face a huge book like 'Middlemarch', you know, we might just want a short poem. And I think poetry's so accessible it's sort of bite sized. And I think you can sit down and not feel too intimidated. Even if you don't understand what the poet's saying, I say don't worry about that, get the feeling. What is the emotion? You know, what's the emotion doing? What is the rhythm doing? So I think it's something really accessible but I still think you do have to carve out that time for yourself.

NIAMH - And are there any particular books, Harriet, that you would turn to if you're having a bad day?

HARRIET- This is the hardest question for a bookworm isn't it? It really depends on what I'm dealing with I think, because sometimes I'm going to a book because I want to escape and I want to take six minutes to three hours to whatever it is for me, and I want to go somewhere else and I want to go and just explore something completely different to what I'm experiencing.

So I might go for sci-fi novels, I might go for 'Ready Player One' or Leigh Bardugo's 'Six of Crows' or one of these fantastic books which kind of compounds loads of adventures and all sorts. Other times, I might be trying to address something or understand something better. I have books that I consider my comfort food, but then I also have the books which I think of as helping me to understand a scenario or an emotion better.

So Haruki Murakami's, 'Kafka on the Shore' is one of the books I turn to again and again because it explores loneliness and identity in a really interesting way. Likewise, Patrick Ness, 'The Rest of Us Just Live Here', that is a wonderful book, it talks about anxiety, it talks about OCD and eating disorders, but it does so in a really like practical and caring way. It's not the whole story, this is a part of who they are, but it's not the whole of who they are. And I think that's a really important nuance that is often missing from books which are specifically about mental health. But those sort of novels I think are really useful and I definitely use them as a sort of starting point to understand myself and others better.

BETH - Does it give you a different perspective? Maybe it sort of opens up the issue that you're trying to contend with?

HARRIET- Absolutely. I think with these books, sometimes it's because I want to relate identically, I want to know that I'm not alone, other times I'm still trying to process what I'm experiencing or what somebody else is experiencing, and I actually want to try and see it from another side, another experience.

NIAMH - Do you reread those books?

HARRIET- I reread things all the time. I reread so much from my childhood. 'Harry Potter' obviously, the 'Gateway' book, for so many people I think. Actually, childhood literature, AA Milne has this book called, 'When We Were Very Young' and I can recite tons of the poems from that book. And it's because I've reread them, my dad read them to me, I've read them to godchildren and such. It's one of those books that it gives me so much comfort and it taps into nostalgia, it taps into a happier, more calm time of my life I imagine. It's definitely one of those ones which I recommend to people as well, just because the poetry itself is so sort of relaxing and fun and joyful.

NIAMH - And do you consider it a safer space, sort of returning to a more innocent time?

HARRIET- I think with that one, yes.

NIAMH- Could you argue in some sense that rereading and returning to the same books over and over again isn't really addressing a problem?

PAULA - I mean I would disagree, I would say that rereading, going back to the books that we loved, perhaps as a child, is incredibly therapeutic and I would say helpful. 'Winnie-the-Pooh' for instance, AA Milne was such a wonderful wise writer, and he writes for children, but it's only as an adult that you really see how brilliant he is, because he's writing for both adults and children.

So you're not the same person reading, you're a person that's evolved and grown. And so with 'Winnie-the-Pooh' you just suddenly realise how funny it is, or 'Wind in the Willows'. And I don't think you always get that as a child, you just get what you sort of read on face value, but you come as an adult with your experience of life and you come from different places. And yes, you're reading the same things, but you see things in a very different light, or you see things that you just hadn't seen before.

HARRIET- I think if you don't know where to start with reading for wellbeing sometimes it can be good to go back, be with what's familiar and find out how that helped you. Maybe you won't be sitting there like me going, "What would Hermione do?" but one of the things that I found really eye opening was I read a book by Samantha Ellis called 'How to Be a Heroine', and in that she goes back and she looks at all the heroines that have sort of shaped her life. So that goes from 'Anne of Green Gables' all the way through to like 'Jane Eyre' and these sort of people.

And I went through a process of doing the same thing with my heroines, and I thought about 'Matilda' and I thought about the heroines that are there. I also came up with things like Sylvia Plath's 'Winter Trees' as one of my favourite collections of poetry. It's a very sad collection of poetry, it's also a very joyful collection of poetry at times, but I found it very interesting to see who I really liked when I was a child, who I really relate to now, and how far I've come.

So there are times when I was a very anxious, angsty teen, and actually I've grown out of that in so many ways, or I've grown up from that rather, I still have anxiety, but there's all those kinds of aspects I think which are really interesting.

BETH - And we're not just talking about happy ending books either here, which is interesting because you might think if you're having a tough time and you hear vaguely… you listen to this podcast and you think oh okay, reading will help me but I must find something that all ties up at the end, is all very happy.

It's interesting that more serious stuff can actually really resonate. I know you mentioned there was the poet that you turned to, Paula, are there any other books that you've used?

PAULA - Yes, absolutely. I absolutely loved Harriet's choices. I think the AA Milne is inspired because it does return us back to those rhythms as well of childhood that are very comforting as a child. I mean, my absolute go to is 'Mansfield Park', Jane Austen, it's my comfort blanket, it's like wrapping yourself in a big warm duvet when you feel miserable. And I think when Harriet talks about rereading that really resonated with me because I'm such a big fan of rereading, so 'Mansfield Park'.

I mean when I'm very low I love PG Wodehouse, when I'm ill I love PG Wodehouse, because I just love to laugh, and laugher's such a fantastic, joyful corrective when you're feeling awful. I think just laughing out loud, Barbara Pym makes me laugh out loud, and I think that instantly just puts you in a different headspace when you laugh.

I love E Nesbit, I love children's literature, I love Frances Hodgson Burnett, they're my sort of… They're almost like a sort of safety blanket really, and I think when I'm really struggling with mental health they're the ones I do turn to, sort of the tried and tested ones that really do comfort. And it's like going to visit an old friend and having a sort of glass of sherry.

BETH - Does it help with targets as well if someone's having a really tough time, maybe they're finding it really, really hard to get out of bed, just having that idea that you might get to the end of a page, a chapter, a book? Does that also give some structure to someone?

PAULA - Yes I think it does, and again it depends what you read, and I don't think there's one book for one symptom if you see what I mean. I mean it really just depends, it's very individual. But I guess if you're reading a book and you don't know the end it's a wonderful thing, I've got to get to the end of the story, what happens? The kind of what happens next can be very important in getting people out of bed and thinking, I've got to finish that book. And we know that does happen, but it really just does depend on the individual.

And we're lucky because there's so much out there, there's so much, but sometimes there's too much out there, you know, so it's sort of giving guidance to people, because sometimes navigating that sea can be quite tricky when there's so much out there.

BETH - Are there any tips you can give? Because I read loads but I feel like chatting to Niamh about this and listening to the both of you I feel like I just read them, they're delicious, I like them, and I don't think maybe beyond that. Are there any tips that you can give me and many other people about how I could perhaps get more from my reading to help my wellbeing?

PAULA - Try some poetry because as I say, there are wonderful anthologies out there, and our anthology is called 'Stressed Unstressed' and it's a sort of hundred best loved poems, old and new. And it gives guidance on how one might approach a poem and, you know, find a quiet place if you can, sit down, breathe slowly, relax, try and take a moment to be calm, try to empty your mind of your worries. So I would say try some poetry because it never lets you down and it does become like an old friend and it gives you a community of people. And you'll find such richness in poetry, there's something very manageable and accessible.

Read a poem a day I always say and particularly if you're feeling a bit low, maybe not try to take on George Eliot that day, but maybe just a nice short sonnet or a poem by the Liverpool poet, Brian Patten who's funny. There are all sorts of wonderful anthologies out there, so I would say that my tip would be just take it slowly, look at a poem, really think about what the poem's doing for you, and take it from there.

HARRIET- I also think that what's wonderful is that audio books, Kindles, paperbacks, whatever it is, whatever your choice is, it's so accessible in terms of you can just download it or you can buy it online if you can't get out today. If you're feeling anxious and you don't want to leave your bed you can go on Amazon and do that. Start small.

NIAMH - A huge thank you to Harriet Allner and to Dr Paula Byrne for joining us in the studio for a really fascinating chat on mental health management and reading. But we want to hear from you. Has any of this conversation resonated with you? Do you use reading as a form of therapy, or do you have other ways to manage your mental health? We want to hear from you, so get in touch via Twitter, we're @bbcouch. On Facebook, you can search for BBC Ouch, and we're on Instagram, BBC_Ouch_Disability. My name's Niamh Hughes, and I'll speak to you soon.