I can vividly recall my first contact with a dying patient. It happened in September, 1975, during my psychiatry rotation in my second year of medical school at Duke University. I was asked to interview a depressed woman who had terminal malignant melanoma.
She was only a few years older than me. Yet her body more closely resembled that of an elderly woman than a woman in her twenties. Her depression was palpable and filled the room. She knew she didn't have a lot of time remaining. The thought of leaving behind her young children and husband was understandably unbearable. I was overwhelmed.
Afterwards, I left the hospital to sit for a few moments in the beautiful garden located behind it. Amidst the flowers, I let go of my sadness for her seemingly unavoidable death. A half an hour or so later, while reporting my interview to a supervising resident, I asked, "Do you think her depression will hasten her death?" I'll never forget his reply. "No. According to research, there are only seven existing psychosomatic diseases where emotions play a role."
My response was complete and instinctive disagreement. I remember thinking, "You’re wrong. That’s utter hogwash." I knew, disregarding my limited experience, that emotions played an important role in the development, course and reversal of disease--and the creation of health.
The Psychological Dimensions of Disease
Medical science now acknowledges the impact that thoughts, feelings, and moods can have not only on the development of certain diseases, but also on the course of many and on the management of probably all. Our health status is strongly influenced by mood, coping skills, and social support.
Unfortunately, the primary medical approach to treating disease is drug- and surgery-based. We ignore the psychological needs and dimensions of disease.
This crucial mismatch between the psychosocial health needs of patients and the usual medical response leads to frustration, ineffectiveness, and wasted health care resources. By helping patients manage not just their disease, but also common underlying needs for support, health outcomes can be significantly improved in an efficient and cost-saving manner.
Keeping a journal is one such solution. During my early adolescence, I started to keep a diary. There was something very magical in placing my feelings about the events in my life in a book. The process has continued to be part of my life since that time.
About twenty years ago, I discovered in fact there is a scientific basis for expressive writing, also known as "journaling." While attending a health conference, I heard Dr. James Pennebaker, at the time a research psychologist at Southern Methodist University, talk about the events that led him to begin research in a new area: the psychology of expressive emotion.
Dr. Pennebaker had heard an interview with a man who had recently confessed to a murder that he'd kept secret for several months. In spite of the fact that this man was facing spending the rest of his life in prison, he expressed relief. He wondered if the emotional relief translated into physiological changes. He conducted research to determine the extent to which it is healthy to express suppressed, "stored," unprocessed and unresolved emotions through the medium of cathartic writing.
His research projects consisted of having subjects write for 15 to 20 minutes a day, for four consecutive days, about emotionally challenging topics and experiences. At the completion of the study he discovered that his subjects demonstrated significant physiological changes that correlated with mean increased immune system functioning. These positive changes remained for up to six weeks after the end of the four-day writing experiment. The participants reported fewer visits to health clinics and medical doctors for stress-related illnesses, even months later.
Writing About Trivia vs. Trauma
According to Dr. Pennebaker, "Active inhibition means that people must consciously restrain, hold back, or in some way exert effort to not think, feel or behave." This is a challenging and difficult physiological state.
Dr. Pennebaker compared a group of college students who wrote about trauma with a group who wrote about trivial things (i.e., a description of their dormitory). Before the study, the 46 students visited the campus health clinic at similar rates. But after the exercise, the trauma writers' visits were cut in half relative to the others. In another study, published in 1998, researchers found direct physiological evidence that writing increased the level of disease-fighting lymphocytes circulating in the blood stream. And preliminary research shows that writing can cause modest declines in blood pressure.
He and his associates investigated the impact of expressive writing among worksite wellness program participants. He found a 28.6% reduction in absentee rates from work relative to the eight month period before, compared to a 48.5% increase in the absentee rate of participants who wrote about trivial events.
Dr. Pennebaker wrote, "The degree to which writing or talking about basic thoughts and feelings can produce profound physical or physiological changes is nothing short of amazing.
"People who write about their deepest thoughts and feelings surrounding upsetting events have stronger immunity and visit doctors half as often as those who only write about trivial events. Writing about emotional upheavals has been found to improve the physical and mental health of grade school children, medical students, new mothers, nursing home residents, and victims of crime.
Source: Pennebaker, James W. Telling Stories: The Health Benefits of Narrative, Literature and Medicine - Volume 19, Number 1, Spring 2000, pp. 3-18