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Home  >  Narrative and Healing  >  Perspectives
Writing as an Adjunct to Medical Therapy
By Michael Jones, M.D.


It is well known that the body can affect the mind. It has been found, for example, that physical exercise can be as effective as antidepressant medications in ameliorating mild depression. Conversely, more and more medical studies have accumulated to document what many people have long felt to be true: that the mind can affect physical health.

An extensive literature on the health effects of stress has evolved in the last several decades. We know that acute and chronic stress can suppress the function of the immune system. We know, too, that good social integration and adequate psychosocial support appear to be able to accelerate recovery from physical illness and to delay or prevent adverse health outcomes. Probably as important in this regard is one's ability to deal with one's emotions: Studies support the notion that the ability to express negative emotions enhances one's resilience in the face of stress.

Michael Jones, M.D.

Writing About Stressful Experiences

In the April 14, 1999, issue of the Journal of the American Medical Association, Smyth et al. published the results of a study titled "Effects of Writing About Stressful Experiences on Symptom Reduction in Patients with Asthma or Rheumatoid Arthritis." The authors of the study suggest that writing about stressful experiences can have a positive impact on diseases caused by disturbances of the immune system and resulting inflammation. In the study, individuals with asthma or rheumatoid arthritis were divided into "case" and "control" groups, and each group was involving in a writing exercise for 20 minutes daily on three consecutive days. Case subjects were asked to write about the most stressful event of their lives. Control subjects were asked to write about emotionally neutral topics (for example, their schedule for the day).

Over the ensuing four months, the study participants were evaluated medically to determine whether there was any change in their physical signs and symptoms of disease. Perhaps surprisingly, the group of case subjects showed objective, significant improvement; control subjects, on the other hand, experienced no significant change. This kind of "journaling" of traumatic events has been shown by other investigators to improve the function of the immune system. How it might do so is not clear, although a number of plausible explanations have been proposed.

The study described above is the first to demonstrate that writing about stressful experiences can benefit people with diseases mediated by the immune system. However, it is not a perfect study. The improvement in the health of the case subjects might have occurred by chance alone, or they might -- unknown to the investigators -- have been treated by their physicians with an effective therapy that was not offered to control subjects, or other unidentified influences might have accounted for the difference. As with any other medical study, these results will have to be replicated by other investigators before they gain general credence and acceptance.

Use of Writing as an Adjunct to Medical Therapy

It is too early for physicians to routinely recommend expressive writing as a therapeutic tool to individuals with asthma and rheumatoid arthritis. The absence of an established causal connection between the intervention (writing) and the effect (objective improvement in disease) will, to many, be a disincentive to promoting writing as a medical modality. Further studies will clarify its usefulness. But the intervention has no cost and is free of side effects, and its potential benefits certainly outweigh its risks. These reasons alone could serve to justify the use of writing -- in alleviating mental and physical stress -- as an adjunct to medical therapy. As David Spiegel, M.D. stated in an editorial accompanying the above paper, "[i'n this and a growing number of studies, it is not simply mind over matter, but it is clear that mind matters."

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The Patient's Story. The Doctor's Machine
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Stories and Healing: Observations on the Progress of My Thoughts
Introduction to Narrative and Healing
Narrative Medicine

About the Author: Michael Jones is a Board Certified Internist and a member of the staff of the Anchorage Medical and Surgical Clinic.

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