Clinical neurologist Donald Weaver, seen here in his Toronto lab in June, says although he doesn't believe every patient would be receptive to it, bibliotherapy can be an alternative to medication that is comforting to those dealing with difficult diagnoses.JENNIFER ROBERTS/The Globe and Mail
Clinical neurologist Donald Weaver often writes prescriptions for his patients with dementia. Occasionally, the Toronto doctor writes them poetry.
His compositions aren’t brilliant works of literature, he admits. But they do provide consolation to certain patients as they deal with a devastating diagnosis.
“The goal here is not to say, ‘Jeez, look how clever I am because I can write clever poetry,’” said Dr. Weaver. “The goal here is to communicate a message to patients who are suffering, and who just need to know that their physician cares and that they’re not alone.”
In his own informal way, Dr. Weaver doles out bibliotherapy, the use of literature for therapeutic effect. As emerging research in this field suggests, poetry and fiction can help reduce stress, provide solace and illuminate new ways of facing problems. And in recent years, experimental uses of bibliotherapy have been applied to an expanding range of medical issues, from depression and anxiety to phobias and sexual dysfunction.
Early bibliotherapy was championed by librarians, particularly in the U.S., during the First World War for sick, injured and traumatized soldiers. But more recently, many have turned to literature for comfort and escape, particularly through the pandemic, said Allan Peterkin, director of the Narrative-Based Medicine Lab at the University of Toronto’s Temerty Faculty of Medicine.
Dr. Peterkin explains there are two categories of bibliotherapy. There’s the informal kind, where one might pick up a memoir written by an author who’s survived a similar illness or a text on a particular theme. And there’s the formal kind, for clinical uses, which is often done in groups, led by a trained facilitator. In Britain, for instance, he said, some family doctors lead evening reading groups, where patients gather to discuss a given text.
There is still limited evidence to demonstrate the efficacy of bibliotherapy, Dr. Peterkin said, and studies have yet to compare how informal bibliotherapy stacks up against the formal kind. But in a systematic review, published in 2018 in the International Journal of Person-Centered Medicine, Dr. Peterkin found the use of poetry and fiction may have a positive impact on patients who have symptoms of anxiety or depression, or who experience difficulty coping with a cancer diagnosis.
Reading itself can be considered a form of self-care, allowing readers to exercise their imagination and ability to concentrate, he said. When you take time for yourself to engage with a text, your muscles are less tense, and your heart rate and breathing rate go down. It also offers a healthy escape from your immediate concerns and pressures. And literary fiction, in particular, has been shown to increase empathy and improve theory of mind – that is, the ability to infer the thoughts, feelings and desires of others, he said.
Dr. Weaver has no training in bibliotherapy. Yet he has seen the therapeutic power literature has on his patients. The first time he wrote a poem for a patient was in 1981 when he was straight out of medical school. He was called in to hospital one night to see a First World War veteran, who was reliving a traumatic experience from the war during an episode of confusion.
After the episode, the patient confided in Dr. Weaver that a poem, titled Suicide in the Trenches by British poet Siegfried Sassoon, had helped him cope during the aftermath of the war. What he needed now, he told his young doctor, was another poem.
Unable to help his patient medically, Dr. Weaver looked up the poem that night and memorized it. Then, as he put it: “I did my damnedest and I wrote another poem.”
Echoing Mr. Sassoon’s first lines, “I knew a simple soldier boy/Who grinned at life in empty joy,” Dr. Weaver’s also begins with pre-war innocence: “Ten fingers strong, 10 newborn toes/A healthy birth, our perfect son …”
The patient was so touched by his effort, his wife informed Dr. Weaver that her husband, who died shortly after, read it multiple times a day and would be moved to tears. It made the doctor realize his poem had a greater impact than any medication he could have given him.
Dr. Weaver, who is also a senior scientist at Toronto’s Krembil Brain Institute, sees art and science as two sides of the same coin when it comes to understanding human suffering. Yet too often, he said, the way medicine is practised and taught now focuses almost exclusively on biomedical training. “Medicine has to also appreciate a person’s cultural, social and psychological health,” he said.
For him, part of the art of medicine also involves recognizing which patients would benefit from and be receptive to receiving a poem.
“I don’t do this often. I’m careful about it,” he said, noting a lot of patients might balk at the idea. (For this reason, Dr. Peterkin prefers to encourage patients to do their own writing, or have patients choose a text themselves rather than prescribing a reading for them.) But Dr. Weaver’s dementia patients who do receive his poetry tend to find comfort in knowing their neurologist recognizes the exceptional nature of their disease, that it takes away their memories, thoughts and the very essence of who they are.
“Knowing that someone understands it, and it’s not just, ‘here’s a pill that hopefully will help,’ is helpful to them,” he said.
In Syracuse, N.Y., pediatrician Jaclyn Sisskind uses literature to connect with and build trust among the youngest of patients. She often asks them if they’ve read any good books lately, and even has a faux prescription pad, on which she’ll write recommendations for their next trip to the library. She also suggests books on her website, Readiatrician.com.
Sometimes, they’re books children and parents can read together to spark conversations about difficult topics, like divorce or puberty. Others are about characters going through similar experiences, which can help her patients, especially adolescents, feel less alone.
But reading about characters who have very different experiences can be beneficial, too, Dr. Sisskind said, since it gives readers a safe way to venture beyond their comfort zone.
“When you see yourself in a book, you learn to value yourself,” she said. “But when you see other experiences in the book that are outside of your bubble, you learn to value everyone.”
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