“Bibliotherapy” has been soaring in popularity as a means of improving people’s wellbeing. But getting it right depends on the book, and the person.
In the UK and elsewhere, bibliotherapy – which also includes recommendations for non-fiction and self-help literature – has been soaring in popularity as a means of improving people’s wellbeing, help navigate tough life decisions, and even to treat specific mental health conditions.
While the benefits of self-help literature are well documented, advocates of fiction-based or “creative bibliotherapy” claim similar advantages. They argue that immersing oneself in rich, simulated worlds – often reflective of real-life experiences – can help readers process emotions, discover coping strategies, or simply provide momentary escape from their everyday woes.
As two researchers wrote in a 2016 paper in The Lancet, immersion in great literature can “help relieve, restore, and reinvigorate the troubled mind – and can play a part in relieving stress and anxiety, as well as other troubled states of mind”. Considering the shortage of affordable mental health services in many countries, the idea that fiction can offer support is appealing.
As anyone who has ever read and loved a work of drama, poetry or fiction can attest, stories have powerful effects on our minds and emotions. But that doesn’t mean that any kind of fiction boosts mental health for everyone. Several experts interviewed for this article worry about what they see as an overhyped promise of creative bibliotherapy in treating specific mental health conditions, where they say the scientific evidence is still rather thin. In fact, research suggests that certain books can even be harmful.
Rather, the existing research paints a more nuanced picture, suggesting that fiction can help boost general wellbeing, but it depends a lot on the person, the book and how they engage with it, says James Carney, a computational cognitive scientist at the London Interdisciplinary School.
Some trace the origins of bibliotherapy to World War One, when fiction and non-fiction books were used to ease soldiers’ suffering and trauma. But the idea made a return in the 1990s, Carney says. Today it takes many forms – from bibliotherapists like Berthoud who offer tailored recommendations for £100 ($130) per session, to some GPs who point some of their patients to fiction, like Andrew Schuman. He’s an NHS physician who advises the bibliotherapy charity ReLit and co-wrote the 2016 Lancet paper about the benefits of bibliotherapy. (BBC)
While fiction bibliotherapy isn’t a substitute for other treatments, “in conjunction with other therapies, it can be a massively powerful, boosting therapy”, Schuman says. A benefit compared with other therapy types, Russell adds, is that people can do it on their own time, approaching their books when they feel emotionally ready and putting them down if they’re overwhelmed.
Since 2013, the UK non-profit The Reading Agency’s Reading Well programme has been curating book lists for people with conditions like dementia or depression. These lists are hand-picked and reviewed by experts and people with lived experiences of those conditions, says Gemma Jolly, the organisation’s head of health and wellbeing.
Yet the evidence that reading helps mental health is complicated. Scientists have observed that, compared with non-readers, people who read regularly for pleasure tend to be less stressed, depressed and lonely, more socially connected and confident, and perhaps even live longer, as the psychological scientist Giulia Poerio of the University of Sussex in the UK summarised in a 2020 article. But, Poerio asks, “is it actually that reading fiction is improving wellbeing, or is it just the case that people with better wellbeing tend to be people who read fiction?”
For many self-help books – which some experts describe as essentially self-guided therapy – the benefits are clear, Poerio says. One 2004 study, for instance, found that self-help books can help people with anxiety and depression, while a 2006 study on patients with eating disorders found that self-help was similarly effective as other psychological therapies in reducing binging, purging and symptoms of depression.
But the benefits of fiction are more complicated. Studies suggest that reading boosts empathy, make people less likely to stigmatise marginalized groups, behave kindlier to others and boost self-confidence. For children, it modestly improves behaviour, including reducing aggressive behaviours in boys. It has been found to help children with certain health and developmental conditions to express themselves.
But the evidence is shaky when it comes to treating specific mental health conditions. Some experts have theorised that reading about characters with our own lived experiences allows us to identify with them and experience a cathartic moment when the characters overcome challenges, which we can then emulate in our own lives, explains Emily Troscianko, a literary scientist at the University of Oxford.