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Rapid Responses: Rapid Responses published:
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Scurrilous comments untherapeutic
- L Reinecke (1 August 1999)
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Literature as therapy
- Juan C Ansin (5 August 1999)
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Therapeutic Writing-follow this guide
- Jay Ilangaratne (6 August 1999)
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Subjects unrelated to the disease?
- George Jelinek (9 August 1999)
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Writing as therapy - get it right!
- Joyce M Carter (13 August 1999)
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Writing and Visualisation.
- Lewis Walker (27 August 1999)
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Response
- Tim Hall (2 November 1999)
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L Reinecke, Radiation Oncologist Rand Clinic
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The Editor, Trisha Greenhalgh's article is helpful and instructive and of great value to those who know how important "writing as therapy" is(1). It seems a pity that a great man like Billy Graham's name should be used in a derogatory way. This same Billy Graham was asked by Winston Churchill for an interview - and from all accounts was a great help to Mr. Churchill. Mr. Churchill did not have the same negative attitude to him. Putting back an appointment with the Duke of Windsor specially to speak to the great evangelist. It is always unecessary to spoil a good article by a scurrilous comment. Perhaps a quotation from his autobiography demonstrating Sir Winston's remarkable wit would help the author to have a different perspective on Billy Graham. "Well, first." he said, in the marvelous voice I had heard so many times on the radio and the newsreels, "I want to congratulate you for these huge crowds you've been drawing." "Oh, well, it's God's doing, believe me," I said. "That may be," he replied, squinting at me, "but I daresay that if I brought Marilyn Monroe over here, and she and I together went to Wembley; we couldn't fill it." (2) 1. Greenhalgh T. "Writing as therapy" BMJ. 1999:319:270-271 2. Graham Billy. "Just as I am" 1997:235-237. |
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Juan C Ansin, Republic of Panama Centro MÚdico Paitilla
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Stress is a mayor CHD risk factor, even no recognized from AHA. As cardiologist, also I can not run away from it. My therapy is write every day from 12 pm to 2 pm. In 1997 my short stories were awarded by special mention in National Literary Award Ricardo Miró. Since then, I recommended my patients to think and if possible, write under any stressfull circumstances. In the waiting room, in front of a red light or even when I am performing an Echocardiogram. Now a day we have a Literatherapy Club an all participants,including myself, fell much better... and HUMAN. Juan C. Ansin MD Note: "Den hop tavas yu den tyr" Proverb from Cornwall. |
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Jay Ilangaratne, Doctor
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Writing can be helpful,gratifying and even therapeutic if at least some of the following can be met: 1.If one can get the written expression published. 2.If the writer gets paid for what is written. 3.If the the writer is not subjected to cruel censorship. 4.If the writer is not added to a blacklist by a publisher. 5.If the writer is not subjected to unlawful discrimination as a result of his/her written expression. Others may add to this,hitherto unpublished list of essential criteria,for the purposes of diagnosing therapeutic writing. 01.08.99 |
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George Jelinek, Professor of Emergency Medicine University of Western Australia
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Dr Greenhalgh cannot be serious. Subjects unrelated to the disease? This cynical editorial should really make us angry if we have any understanding of patients and their diseases. The subjects about which these patients were writing in Smyth's study were not unrelated to their diseases, they were central to their diseases; they were writing about themselves. In our rush to find cures and magic bullets, have we forgotten the role of patients in healing. Diseases aren't separate from patients, they are part of them. Not only do patients have an effect on what diseases they get, but on how or whether they recover from them. This was well known to doctors of the past, but we seem to have forgotten it. That Smyth's paper could have been seen as something new or surprising is surprising in itself. That it could provoke such a thoughtless editorial is remarkable. What if Dr Greenhalgh's theories are correct and the patients did somehow guess what they were "supposed to" do as a result of writing? What caused the difference then? Dr Greenhalgh would do well to read some of Bernie Siegel's work. Let's give some credit to our patients for healing themselves. |
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Joyce M Carter
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If Greenhalgh`s editorial (1) had been published on 1 April I might have thought it was a spoof, but as it wasn`t, I read the main paper to which she referred (2) and could not understand why she questioned the plausibility of its findings! I have lived with rheumatoid arthritis for many years, and I had juvenile chronic arthritis in childhood. I was therefore surprised that Greenhalgh thought that the subject of `the most stressful experience that (subjects) had ever had` was unrelated to the disease. In my experience nothing is unrelated to having rheumatoid arthritis because we live in a society that does not take into account that some people have impairments. The greatest problem would be deciding which stressful event to write about! Would it be discovering after I had locked a toilet door that the designers of the lock had not taken into account that many people have impairments of manual dexterity and grip strength (it took an hour for someone to get me out!)? Or being on a job interview panel and arriving at the venue to find that although the organisers had made sure that four flights of steep stairs would not stop any of the candidates reaching the room where the interviews were to be held, they had not checked whether or not this was a barrier for any of the panel? Or finding out that baths are designed on the assumption that everyone can raise themselves up from a lying position by use of their arms and legs alone, which meant that I faced the prospect of a very long soak! Or arriving by train at an airport and realising that the platform was completely deserted, even though I had requested assistance to get myself and my luggage to the plane. I could go on! My main critcism of writing therapy as described in the paper (2) is that it does not acknowledge that for some people writing by hand is not an option, eg it can be too painful. If researchers ignore this, writing therapy, if proved to be of benefit, will not be accessible to everyone. There are ways of overcoming this barrier so that everyone can be included, eg my job involves a lot of writing, but I don`t need to write by hand or even use a keyboard because I have voice recognition software in my computer. Dr Joyce M Carter References 1. Greenhalgh T. Writing as therapy. BMJ 1999;319:270-271 (31 July 1999) 2. Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA 1999;281:1304-1309 |
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Lewis Walker, GP Ardach Health Centre, Buckie, Scotland
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Editor, As a General Practitioner I am fully aware of the extent of the part played by beliefs and emotions in psychological and physical illness. I have used Pennebaker's ideas of therapeutic writing over the past year with many patients. Whilst my experience is purely anecdotal I have been impressed with this technique, although with several caveats. Writing in the first person voice and present tense language is often accompanied by a re-experiencing of the original trauma. Whilst therapeutic and releasing for some, for others it can lead to a "stuck state". I have therefore experimented by getting them to write in third person and past tense language, as an observer of the situation. For some this seems to let the incident recede from their thoughts more effectively processed. I have also combined the writing with visualisation techniques with good effect. As they are writing patients are instructed to make a black and white movie of the past event projected in their mind at a comfortable distance. This uses both verbal and imagery modalities in a way that seems to enhance both. I see patients in 10 min appointments and they do the above as homework for no more than 15 mins per day. Beliefs values and emotions play a huge part in our day to day experience of illness. The above exercises seem to have an effect at a process level rather than merely content. I believe that rigorous trails as suggested by Greenhalgh are required in this potentially fascinating area of mind-body medicine. Sincerely Lewis Walker, FRCP(Glas). |
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Tim Hall
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Editor Everyone knows that 'a problem shared is a problem halved.' Life is an undulating journey. When we are up, we see things in perspective. When we are down, we may need something to lift us out of the valleys to get a glimpse of the world again. Sometimes all that is needed to move us from the doldrums is a walk in the park or along the beach, or an evening with friends. I am not surprised if 'writing therapy' benefits patients with immune related disease.[1] Good experiences can 'move mountains' in our mood. If the brain is a neurochemical compartment it is no great stretch of imagination to be convinced that experiences 'move molecules'. We don't have to understand why the things we do in life enhance or attentuate our molecular mechanisms (although the questions are fascinating). The real issue is whether or not the benefits of writing are any more valid than any other enhancer of 'well being' in the complex psycho social-physical interaction of disease. I am not sure we should read much into 'writing therapy'. Writing, as a means of 'getting it off the chest', organising ones thoughts or merely as a distraction is a surrogate form of talking to friends or walking along the beach. Perhaps writing as therapy is less a reflection of any focused immune response and more a reflection of modern society where people feel alienated amidst information overload. Not enough time for other people - too much to do, too many problems, too many solutions, too many choices ... and too much reading into things! Tim Hall 1 Greenhalgh T. Writing as therapy. BMJ 1999; 319: 270-271 |
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