Grief, fear, heartbreak, depression — book therapy promises to treat it all.

Eight months ago, when his father died suddenly of a stroke, the last thing on James Mitchell’s mind was literature.

There were, of course, far more pressing matters to consider, far more natural instincts to confront than the strange impulse to seek refuge in a novel. The dimensions of grief are always unimaginable, and a desire to see reading, of all things, as the logical solution to its unique violence is hardly to be expected from anyone — least of all a board-certified medical doctor who administers literal anesthetics for a living.

But here was Mitchell, 40, sitting at his computer at his home in Holland Park — a tree-lined, photogenic neighbourhood in central London — consulting a webpage on “book prescriptions” and “literary remedies” for life’s random, debilitating occasions.

“I wouldn’t ordinarily be an early advocate for something like book therapy,” he told HuffPost Canada over the phone, laughing. Historically, he says, he’s always preferred nights with Netflix over nights with Nietzche.

“But the books I read throughout this process really changed my whole perspective,” he says.

What is bibliotherapy?
This change in perspective is, in fact, the point. Book therapy (BT), sometimes called bibliotherapy, refers to the ancient practice of reading or “prescribing” reading — as one might prescribe medicine — for therapeutic effect, and can include both fictional and nonfictional materials.

No matter the genre, the therapeutic approach is all predicated on a simple, if romantic, idea: that books contain secrets which can transform the way we live our lives, and help us to overcome some of its most unwieldy obstacles.

“When I first heard about it, it was through word of mouth,” says Mitchell. One of his friends who’d tried it out before had described a moving experience. “It seemed sort of farfetched,” he adds.

“I’ve never, ever felt that books could change you in that way.”

People who read regularly, for example, sleep better, are less stressed, are better empaths, have higher levels of self-esteem, and, according to Yale University’s School of Public Health, also live longer.

And while many of the evidence supporting the virtues of formal bibliotherapy tends to be anecdotal, there’s also plenty of research that illustrates its positive effects — particularly its general enhancement of mental health and well-being.

“I’ve never, ever felt that books could change you in that way,” Mitchell says. “But it was definitely a process whereby I could feel the change happening as I was reading.”

He pauses: “It was cathartic.”

Though bibliotherapy has a storied medical history across the globe — it’s been used both in mental hospitals, to treat mental patients, and in American military libraries, to treat soldiers after World War I — it’s only just beginning to find its legs in Canada, despite its longstanding support in the United Kingdom.

Social Bibliotherapy
Most of BT’s practitioners are divided into two streams, though both more or less share the same overarching philosophy.

Over the last 10 years or so, Dr. Natalia Tukhareli, director of library and information services at the Canadian Memorial Chiropractic College, has become the de facto lodestar of one of those streams, through her tireless work to make BT practices more available to people in North America.

Tukhareli, who is based in Toronto, is one of Canada’s foremost research scholars in social bibliotherapy: a creative approach to BT — often practiced by librarians and educators in prisons, retirement homes, and community centres — that isn’t intended as a substitute for professional help.

“Bibliotherapy originated in a clinical or medical setting,” Tukhareli told HuffPost Canada. “But through my reading programs, the ultimate goal is to build resilience, improve general well-being, and just help people to move through the adversity in their lives.”

Tukhareli’s practice draws from a popular reading intervention model used by several groups in London, including The Reader Organization, a national charity that wants to catalyze a “reading revolution” through a principal technique called shared reading.

Shared reading is a read-aloud group session, during which a leader reads a passage from a story or poem and group members are encouraged to respond by sharing thoughts, feelings and memories that may have been stirred up. It’s practiced in a number of forums, including public libraries, hospitals, rehabilitation centres, shelters, and retirement homes.

“We’re trying to expand it into non-clinical settings. This is the future,” Tukhareli says.

Over the last few years, Tukhareli created original reading packages based on core existential themes, like loneliness, adversity, forgiveness and bereavement. These packages have been included in a new one-year pilot project, for which seven bibliotherapy groups have opened in the Durham, Ont. region, all based on her approach. (The groups, she notes, are geared toward young parents, low-literacy learners, brain injury clients, seniors, and mental health clients.)

Not only did she help to develop the program, but she also trained the facilitators on how to use her thematic reading packages. “It’s the first time a bibliotherapy program here, in Canada, has received government funding,” she adds.

While this stream of BT isn’t intended to cover mental health issues specifically, it has been proven to engage with health and wellbeing in a profound and physiological way.

Studies on social bibliotherapy have linked the practice with reductions in the severity of dementia symptoms, alleviation of chronic pain, and, in one extended three-year study, lasting improvement in symptoms of depression

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Yet it has not managed to get much traction in Canada. Many of the country’s book therapists belonged to the Canadian Applied Literature Association (CALA) — an academic group that, until it ceased activity last year, explored the “therapeutic applications of literature and story” — but there is not, for example, an accreditation body that can certify people for the practice.

Courses and educational resources on bibliotherapy in Canada are rare, if almost nonexistent (even the aforementioned CALA is now defunct) and Tukhareli says the lack of institutional structure is partially responsible for why many librarians and other educators are deterred from getting involved: they often fear they’re overstepping their boundaries by entering a profession without being certified.

“But there are two different types of this, and only one needs certification” Tukhareli says. “There’s just a low awareness, nationally, when it comes to both.”

Clinical Bibliotherapy
The process behind clinical BT often cleaves to a template not unlike the completion of a medical questionnaire, or a dating profile for literature: you fill out a survey about your reading habits, confess what’s been eating at you, and in return, you receive a personalized reading list of “prescriptions” that will, hopefully, do something for your spirit.

Angry? Read Hemingway. Heartbroken? Read Brontë.

At least, this is one way it can be practiced. Clinical BT is exclusively undertaken by medically-trained doctors, such as psychiatrists and other mental health professionals, who tend to combine the treatment with more conventional forms of talk therapy.

 

“For the most part, it isn’t a kind of therapy that you do on its own,” says Dr. Hoi Cheu, a humanities professor at Laurentian University in Sudbury, Ont. Cheu is formally trained in marriage and family therapy, and says one of the reasons for this is that BT tends not to be taken seriously as a legitimate form of treatment.

“It’s a lot less obvious, physiologically,” Cheu tells HuffPost Canada. Most rational people wouldn’t reach for a book as a cure for a broken arm, but that’s not to say that no one has made a case for something like reading as an activity that could have a clear and identifiable effect on the body.

“Our brain is a network — it connects everything,” Cheu says. Some psychiatrists who also practice bibliotherapy, he says, prefer (in some cases) to prescribe books over medication. “If you know how, you can overcome a lot of pain by Buddhist meditation, for example. Books can do similar things … but mostly for the mind.”

How does it work?
The path Mitchell took toward healing was the clinical kind, and his prescribed reading list was filled with tough reads — “searching, drastic, stinging, relentless novels.”

There was the Austrian psychiatrist Viktor Frankl’s Man’s Search For Meaning, a psychological account of the author’s imprisonment in a Nazi concentration camp. There was Sheryl Sandberg’s Option B, a memoir about the aftermath of her husband’s sudden death, and how it disfigured her ability to experience joy. And there was Mitch Albom’s For One More Day, a philosophical exploration of how people might use the opportunity to spend more time with a lost relative.

The effects these books had on Mitchell were not at all abstract. They were concrete and definitive, apparent even to the people around him. “I think my friends and my loved ones could attest to the changes they made in how I was acting and feeling throughout the whole process,” he says.

Sandberg’s Option B, for example, taught him about resilience, and brought him strength in the midst of losing one of the most important people in his life. Albom’s For One More Day moved him to cherish and cling to those family members he still had around.

Frankl’s book, too, had an especially profound effect. “My interpretation was that it’s a story about how, through suffering, you can find purpose,” Mitchell says. “I mean, this is someone who has experienced one of the worst things a human being has ever been through, and comes out the other side with purpose.” Death and grief often force the wicked hand of nihilism, but Mitchell, through insights pulled from Frankl, found ways to locate meaning in his father’s passing.

That meaning was, in some ways, about legacy. For three or four years, Mitchell’s father was an aide to Mind, a U.K.-based charity that campaigns for increased services and resources for people with mental health problems.

After reading Frankl, Mitchell had an idea. “I went to my local charity, the same one [my father] worked at, and I started doing the same thing he did,” he says. Reading Man’s Search For Meaning led Mitchell on a path to retracing his father’s steps, and he now mirrors them almost identically, both as a means of bringing himself closer, spiritually, to his dad and also to confront his father’s passing “in a much healthier way than I would have otherwise.”

“The whole volunteering thing … it gives me a sense of meaning, a sense of purpose.”

Mitchell says people might be inclined to discount bibliotherapy because they don’t feel they need it, or can’t imagine reading as a plausible solution to anything other than boredom. (Even then, the average American reads just four books in a year, so perhaps boredom is less inspiring than one might think.) There’s also the matter of general awareness — most people don’t know anything about bibliotherapy.

Still, he argues that no one needs an “instigate event” to engage with bibliotherapy. Mitchell doesn’t think your heart needs to break for you to read something, or that you need to have some disastrous emotional experience in order to be tricked into reading. He wants to make book therapy a regular part of his children’s lives, so they can prematurely glean some of the insights he’s only arrived at now, in his 40s.

“This has changed my life in a beautiful way,” Mitchell says. “I think it would be a good gift for them, too.”