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Writing for therapy helps erase effects of trauma


March 16, 2000
Web posted at: 11:38 AM EST (1638 GMT)

(WebMD) -- Six years ago, Vietnam veteran John Mulligan was a homeless "shopping cart soldier" in San Francisco's North Beach, a man wracked with flashbacks and numbed by post-traumatic stress disorder. But his life took a turn during a veteran's writing workshop conducted by noted author Maxine Hong Kingston.

At the first workshop, Mulligan wrote about a horrific scene from the war: his buddies turning their weapons on a water buffalo for fun, sport, and misplaced revenge. The blood, the noise, the sense of loss and waste were all there.

Mulligan, now a 49-year-old novelist, left the workshop so elated he was "whistling and skipping." In the following years, he repeatedly discovered that putting past horrors into words helped clear his mind and lift his spirits. "I had to face my demons," he says. "I was an empty shell walking around the street, and writing made me feel like I had a soul."

Souls may be beyond the reach of science, but many researchers echo Mulligan's conclusion: Writing about stressful events can be powerfully therapeutic for body and mind.

Confronting dark memories

Dozens of studies have found that most people, from grade-schoolers to nursing-home residents, med students to prisoners, feel happier and healthier after writing about deeply traumatic memories, says James Pennebaker, Ph.D., a professor of psychology at the University of Texas and leader or co-leader of many of the studies.

Pennebaker's interest in the potential of writing therapy was sparked by conversations with government polygraph operators. A criminal's heart rate and breathing, he learned, is much slower immediately after a confession than before. Since then, he's spent much of his career proving that we can all feel better after confronting the past through writing.

Mulligan says writing helped him find his soul again  

The effect isn't just emotional, Pennebaker says. One of his studies, published in the "Journal of Consulting and Clinical Psychology" in April 1988, found that college students had more active T-lymphocyte cells, an indication of immune system stimulation, six weeks after writing about stressful events. Other studies have found that people tend to take fewer trips to the doctor, function better in day-to-day tasks, and score higher on tests of psychological well being after such writing exercises, he says.

Writing off asthma and arthritis

A new study, published in the April 14, 1999, issue of the "Journal of the American Medical Association," shows that expressive writing can even ease the symptoms of asthma and rheumatoid arthritis.

Joshua Smyth, Ph.D., an assistant professor of psychology at North Dakota State University, and colleagues asked 70 people with either asthma or rheumatoid arthritis to write about the most stressful event in their lives. The study participants wrote about their emotional pain for 20 minutes straight on three consecutive days. Another group of 37 patients wrote about their plans for the day.

Four months later, 47 percent of the group that wrote about past traumas showed significant improvement -- less pain and greater range of motion for the arthritis patients, increased lung capacity for the asthmatics -- while only 24 percent of the group that wrote about their daily activities showed such progress.

Pain from the past

Researchers don't know exactly why writing about painful events can improve health, but the answer probably lies somewhere in the still-mysterious connections between stress and disease, Pennebaker says.

Numerous studies have found that prolonged emotional stress can weaken the immune system, promote heart disease, and worsen the course of arthritis, asthma, and many other diseases. In one particularly startling example, a study published in the December 16, 1998 issue of the "Journal of the National Cancer Institute" found that elderly people who were depressed had nearly double the risk of developing cancer.

Hong Kingston
Maxine Hong Kingston, celebrated author of several novels including "The Woman Warrior: Memoirs of a Girlhood Among Ghosts," led the writing workshop where Mulligan first found his calling.  

Putting traumatic memories into words can help ease turmoil and defuse the danger, Smyth says. "Writing gives you a sense of control and a sense of understanding," he says. "To write about a stressful event, you have to break it down into little pieces, and suddenly it seems more manageable."

If writing can help ease the symptoms of arthritis and asthma, other stress-related conditions are bound to follow, Pennebaker says. He and his colleagues are now studying writing as an infertility treatment, and they're also looking to see if such therapy can prolong the lives of heart disease and breast cancer patients.

For his part, Smyth is studying veterans and victims of sexual abuse who suffer from post-traumatic stress disorder, or PTSD. Despite success stories like Mulligan's, there's little scientific evidence that writing can help treat such a severe psychiatric disorder, he says.

A home remedy?

It takes a concerted effort -- and a tolerance for intense emotional pain -- to write about dark memories, Smyth says. The process is always distressing; the PTSD patients in his study carry beepers for 24-hour access to counselors. "I have serious reservations about anyone trying this sort of writing at home," he says.

Yet John Mulligan never had a beeper, a counselor, or even a home when he started confronting his past. He would sit at cafeteria tables and park benches filling his notebook with horrific images, often pausing to take a break when the memories grew too upsetting. For Mulligan, writing was always a struggle, but it was also a matter of survival.

"Writing gives me a reprieve from the darkness of life," says the author, whose first novel, "Shopping Cart Soldiers," was published in 1997.

Pennebaker believes people can try writing therapy on their own, as long as they follow one rule: "If you can't handle it, quit."

In his book "Opening Up," Pennebaker suggests writing about life's current stresses -- not necessarily events from the past -- whenever spirits sag. Without regard to sentence structure or grammar, people should try to describe their traumas and explain their feelings, he says.

Like Mulligan, they will have faced their demons -- beasts that always seem tamer on paper than in the mind.

© 2000 Healtheon/WebMD. All rights reserved.

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