How do your reading habits shape your health — and vice versa?

We read words everyday — whether it’s an article, a book, or just a text message. Some of these words are subtly helping people with eating disorders, and others are making things worse.

Dr Emily Troscianko is currently working with the eating disorders charity Beat, and is developing a metholodogy for empirically investigating both how reading might have an impact on mental health. Here, she explains how your reading habits can shape your health, and how the sciences and the humanities have a lot to learn from each other through the cooperative investigation of how minds and texts interact.

Dr Emily Troscianko is a Research Associate at The Oxford Research Centre in the Humanities (TORCH). Her monograph ‘Kafka’s Cognitive Realism’ (2014) explores the strange experiences we call ‘Kafkaesque’, and the third edition of the textbook Consciousness: An Introduction, coauthored with Dr Susan Blackmore, comes out in April. You can find her blog ‘A Hunger Artist’ here.
“There are many reasons to hope that literature might be part of an effective treatment or prevention for illness, from the appeal of the healing power of art to how much cheaper a book is than a drug or a hospital bed or a therapist. But is there really any reason beyond wishful thinking to expect literature (novels, stories, poems…) to have therapeutic effects?”

Eating disorders make an interesting case study for asking this question, for a range of reasons. First, they’re poised right on the boundary between physical and mental illness: they are about changes in behaviours and physical states as much as about alterations in mood and thought patterns. Although the salience of the physical component might make literature seem less relevant, it may do the opposite: finding the motivation to simply act differently (eat more, eat more regularly, stop making oneself vomit after eating) is often the very greatest hurdle to recovery and the most effective driver of it. So any experience that brings a shift in perspective sufficient to make possible a practical embrace of new habits can kickstart all the direct and rapid changes entailed by stabilising one’s physical state.

Related to this is the sociocultural angle. All our multimedia prompts to treat your body as an object to be aesthetically perfected through instrumentalised eating and exercise obviously encourage disordered eating habits — and make recovering from them, especially if that recovery involves regaining weight, desperately difficult. One needn’t espouse an idealistically narrow notion of ‘literature’ to ask whether media with less nakedly capitalist agendas might offer prompts to different kinds of engagement with our bodies, ourselves, our desires for our lives.

And then there’s the cognitive question: what mechanisms link minds, bodies, and texts. These can be gathered under the broad heading of interpretation. Interpretation is a basic function of the human mind, right across the spectrum from smelling the milk to see whether it’s off, to looking up at the sky to decide what to wear, to working out what the hell Finnegans Wake is about. And eating disorders, like all illnesses with a psychological component, are in part about interpretation going wrong. In eating disorders this manifests in both directions: both over-attributing meaning to some things (like the numerical stand-ins for nutritional intake or body size and shape) and downplaying the significance of other things (like the experience of hunger or physical weakness or social isolation). This means we might expect complex linguistic cues capable of eliciting new interpretive patterns to intervene in interesting ways in those disordered dynamics.

“So, those are some of the reasons to do the research. Another couple are that theories of ‘creative bibliotherapy’ have been around for a while but are based on very slender evidence, and that many of us are clearly already using literature (whether as part of a therapeutic process or just in everyday life) to achieve health-relevant effects: relaxing, escaping from pressing problems, cheering ourselves up.”

In a first attempt to map out the terrain, I carried out an online survey in collaboration with the UK’s leading eating-disorders charity Beat, investigating people’s perceptions of the links between their reading habits and their mental health. We attracted nearly 900 respondents, nearly 90% of whom reported personal experience of an eating disorder. And our respondents made clear that these motivations and effects can cut both ways: if reading is a powerful tool for distraction, for instance, you can use it to distract you either from the hunger telling you to nourish your body back to health or from the discomfort of eating the food which will do just that. For me one of the most striking accidental findings to arise from the survey responses was the phenomenon of what one might call ‘deliberate self-triggering’: how many people spontaneously reported seeking out particular kinds of books knowing they’ll make you more obsessed, more competitive, more ill, and wanting that. This links back to the cultural realm and the glamour which can attach itself to an eating disorder.

Many respondents’ testimony also made clear that interpretive distortions which characterise eating disorders are manifested directly within the processes and experiences of textual engagement. Many described how the interpretive filter which the eating disorder applies to the text can overpower the qualities of the text itself: however much description there is of pain and suffering, you might well take from it only the feeling of success, control, power. And that way danger lies, because the more the disorder finds confirmation of itself in everything you come into contact with, the easier it is to find yourself in a vicious circle of mind-body deterioration: for example, reading a book that makes you want to lose weight, losing weight, feeling emotionally down, trying to lose more weight to feel better about yourself… This kind of unstable feedback loop arose in many of the responses, but likewise the opposite: the power of reading to intervene in the instability by improving mood, distracting from body-directed thoughts, opening up spheres of possibility beyond the here and now, and many other forms of imaginatively prompted liberation.

Meanwhile, our central finding was that there is a strong contrast between the perceived effects of reading fiction specifically about eating disorders (e.g. featuring a main character who has one) and reading one’s preferred other type of fiction. Existing theories of bibliotherapy predict that the more similar the character’s situation is to the reader’s, the greater the potential for identification, which will generate insight into the nature of the problem — perhaps accompanied by some kind of profound emotional catharsis — followed by a problem-solving stage guided by the solutions found by the character. Our findings made clear, by contrast, that on all four dimensions we investigated — mood, self-esteem, feelings about your body, and diet and exercise habits — eating-disorder fiction had negative effects, while on all four other fiction was neutral or (especially in the case of mood) positive.

This suggests that something quite different may be going on from a simple sequence starting with feeling the same as a textual character and ending in enacting the same happy ending as the character. This idea that the mechanisms of change may be somewhat more indirect fits with the high levels of insight often already present in chronic eating disorders: what is needed may often not be yet more insight into one’s illness, but a new capacity to act on that insight. And reading about someone maximally similar to yourself may not be the way to achieve that capacity: maybe only reading about someone strikingly different is required to generate the elusive but galvanising realisation that your life really could be otherwise.

Our findings will be available soon in a paper forthcoming in the Journal of Eating Disorders. An article on the theory and practice of creative bibliotherapy for eating disorders is also coming out soon in Medical Humanities. Meanwhile you can read more about feedback loops in reading and eating disorders here: Feedback in Reading and Disordered Eating and about experiences of immersion in fiction, here: How should we talk about reading experiences?. Both discussions draw on our survey findings together with cognitive-literary methods and theory.


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Want to read more? Try our articles on: From literary studies to an anorexia recovery app, Our Oxford Community: University Mental Health Day 2018, and How is your lifestyle affecting your brain?