You may be familiar with Margaret Atwood’s phrase, “a word after a word after a word is power,” but did you know that many therapists believe in this power so strongly that they use books to aid in patient improvement? This practice, called bibliotherapy, holds fast to the idea that stories can heal, showing us time and time again how “a word after a word” truly is powerful.

With National Self-Improvement Month upon us, it’s time to commemorate the practice of using the healing power of books to better ourselves. Let’s take a brief dive into the history of bibliotherapy.

What is Bibliotherapy?

The definition of bibliotherapy has changed throughout history, but the term generally captures the concept of using books or stories as a form of therapy for individuals with mental illness, addiction, or emotional distress.

Samuel McChord Crothers coined the term, “bibliotherapy,” in the 20th century, but the practice of prescribing books has been around since the Middle Ages. The word comes for the ancient Greek for book (βιβλίον) and healing (θεραπεία).

Bibliotherapy is utilized for all age groups and often supplements other therapy types, such as cognitive behavioral therapy. It can take place in both individualized and group therapy settings.

Ancient Origins

Bibliotherapy stems from library science and management. In fact, the oldest known library motto, ψυχῆς ἰατρείον (which translates to “house of healing for the soul”) mirrors the basic tenets of bibliotherapy.

A number of ancient hospitals maintained libraries within their walls for both staff and patients. For example, a 1272 Cairo hospital used to prescribe Koran readings to its patients for medical treatment. Similarly, Galen of Pergamon kept his personal library at Sanctuary Ascelpion, an ancient Roman therapeutic spa. The practice of keeping hospital libraries and library services for long-term patients has continued throughout the years and into modern day.

20^th-Century Surge

In the late 19th century, Freud began utilizing literature in his psychoanalysis practice. This, in addition to Benjamin Rush and Minson Galt II’s push for libraries to be used as an intervention technique, helped normalize psychiatric institution libraries going into the 20th century.

By 1916, Crothers coined the term bibliotherapy and it slowly entered the medical lexicon. Dorland’s 1941 Illustrated Medical Dictionary recognized bibliotherapy as an official mental health treatment.

Meanwhile, during World War I, the Library War Service helped develop the science of bibliotherapy as they distributed books to patients in military hospitals.

The idea of “reading therapy” grew in popularity and, by the 1920s, the United States began hosting training programs for bibliotherapy at universities. As the concept made its way into academia, the term started popping up in medical journals.

Carolyn Shrodes pushed the field of bibliotherapy to new heights by offering a theoretical model based on the idea that story characters can influence readers directly, which provided an explanation for why bibliotherapy might be effective and suggested constructive approaches to implementing the therapy.

By 1966, the American Library Association adopted an official definition of bibliotherapy and soon after the Association of Poetry Therapy formed as a specific type of bibliotherapy.

Towards the end of the 20th century, librarian Rhea Rubin helped establish clear directions for bibliotherapy by constructing two categories: developmental bibliotherapy (for the classroom) and therapeutic bibliotherapy (for mental health treatment).

Modern Expansion Across Fields

Today, bibliotherapy is still used by some librarians and psychologists, but it has also expanded into several fields including social work, healthcare, education, counseling, and parenting. While originally referring to books alone, bibliotherapy casts a much wider net nowadays, including not only literature, but also poetry writing, self-help books, movies, comic books, art, songs, journaling, dance, and storytelling.

There is some debate about whether or not bibliotherapy should take place at home, or if we should limit it to clinical settings. Generally, people embrace the idea that art and stories provide an effective way to talk about life situations from a creative third-person perspective. This perspective is meant to offer a productive and less intimidating conversational space for difficult topics.

Psychologists today theorize that bibliotherapy succeeds because stories offer patients an effective means to process through identification, catharsis, and insight. By following this process, the patient and therapist can interpret the book against the patient’s situation, empathize with the fictional character, and productively face mental illness, emotional distress, and addiction.

Beyond Clinical Settings

While many therapists work alongside the patient throughout bibliotherapy (in addition to using traditional, clinical mental health therapies), some bibliotherapists are less involved in the active work of therapy. These remote bibliotherapists act similarly to a bookseller, chatting about your reading preferences and the worries you’re encountering at that moment in time. These conversations help the bibliotherapists provide a “book list prescription” for their clients.

Although bibliotherapy is not recommended in place of more conventional mental health therapies, some cultures utilize bibliotherapy while patients wait to receive conventional therapy. For example, in the United Kingdom—where some patients may wait up to six months for professional treatment—individuals often utilize bibliotherapy during this waiting period, making it a sort of “first step” in mental health treatment.

Other modern examples of bibliotherapy include literature courses aimed at reducing recidivism for prison inmates, the U.S. National Storytelling Network’s Healing Story Alliance branch, and the use of therapeutic storytelling for elders with dementia.

Although bibliotherapy looks very different today than it did back in the Middle Ages, it’s clear that we still believe that words and art have the power to heal people and improve our society.

Scientific Inquiry and Future Research

Bibliotherapy has been ingrained in cultures across the world for years, but it’s worth mentioning that many of the ideas it supports are only hypotheses; bibliotherapy has been used widely but without strong scientific evidence of its success.

That being said, researchers are beginning to take an interest in the idea that books impact our minds. In the last couple decades, scientists have begun utilizing randomized controlled trials to track the effects of this therapy form. Thus far, research finds positive effects of clinical bibliotherapy in those with certain mental illnesses and substance abuse issues. Studies also discovered promising results amongst older patients struggling with depression.

Further, a 2011 study that analyzes fMRI brain scans suggests that our brains use the same brain networks when reading about an experience as when we experience the scenario ourselves. Other studies revealed that fiction readers, in particular readers of literary fiction, tend to score higher on empathy and social perception tests. These findings seem to align with the theoretical model of identification, catharsis, and insight.

Although randomized controlled trials and the neuroscience of empathy offers some insight into bibliotherapy, the truth is, we need more research to answer the many questions about bibliotherapy and its effectiveness. What we do know, though, is that the practice of bibliotherapy is a testament to our love for books and the belief that they hold real power in our lives.

Sources:

“Bibliotherapy.” Good Therapy, 9 May 2016, www.goodtherapy.org/learn-about-therapy/types/bibliotherapy. Accessed 11 July 2020.

Dovey, Ceridwen. “Can Reading Make You Happier?” The New Yorker, 9 June 2019. www.newyorker.com/culture/cultural-comment/can-reading-make-you-happier. Accessed 11 July 2020.

Fanner, D. and C. Urquhart. “Bibliotherapy for mental health service users Part 1: a systematic review.” Health Information & Libraries Journal, vol. 25, no. 4, 18 Nov. 2008, pp. 237–252. Wiley Online Library, doi:10.1111/j.1471-1842.2008.00821.x. Accessed 11 July 2020.

Lutz, Cora E. “The Oldest Library Motto: Ψγxhσ Ἰατρεῖον.” The Library Quarterly, vol. 48, no. 1, University of Chicago Press, Jan. 1978, pp. 36–39, doi:10.1086/629993. Accessed 11 July 2020.

Mckenna, Grainne, et al. “Patients’ and Providers’ Perspectives on Bibliotherapy in Primary Care.” Clinical Psychology & Psychotherapy, vol. 17, no. 6, John Wiley & Sons, Ltd., Nov. 2010, pp. 497–509, doi:10.1002/cpp.679. Accessed 11 July 2020.

Rubin, Rhea Joyce. Using Bibliotherapy: a Guide to Theory and Practice. Oryx Press, 1978.

Schutt, Russell K., et al. “Using Bibliotherapy to Enhance Probation and Reduce Recidivism.” Journal of Offender Rehabilitation, vol. 52, no. 3, Taylor & Francis Group, Apr. 2013, pp. 181–97, doi:10.1080/10509674.2012.751952. Accessed 11 July 2020.