A Therapeutic Writing article written by Manu Rodríguez
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Brain, mind, behaviour and the written word.
The human brain, with its thousands of millions of neural connections, about 1011 neurons, seems to be the most extraordinarily complex organ that evolution has brought to life. Thus, our mind (feeling, emotional and creative) gives us a unique richness and unique abilities. Scientists say there is not a single human brain like any other, which means, therefore, that there is no mind like any other. It seems obvious that brain and mind, with their interrelated physical and psychological respective functions, make us precisely what we are. This doesn’t mean that brain and mind are unmovable entities, on the contrary, their capabilities of change and adaptation, their plasticity (‘neural plasticity’, a characteristic introduced by the psychologist and philosopher William James (1842-1910)), is a fact.
Our body is the medium that in contact with our environment receives and sends information to our brain, and it is this which, through complex neural activity, creates the information our mind processes and makes very personal and exclusive to us as individuals.
Although this statement could be more than obvious, I will explain this further, so as to be better understood and come to the right conclusions, and I hope to show clearly the influence of language and the healing power that writing can have.
It is through our body that we see, hear, taste, smell and touch (using our eyes, ears, nose, mouth and body). Our brain receives all this information, and it is then that our mind processes it on that very personal and particular way, influenced by our education, personal experience, culture etc., so then we behave as we do and take certain actions in our environment. Antonio Damasio, Professor of Neuroscience and Director of the Brain and Creativity Institute at the University of Southern California, explains in a brilliant and concise way this relationship of brain-mind-behavior: ‘The body and the surrounding environment interact with each other, and the changes caused in the body by that interaction are mapped in the brain. It is certainly true that the mind learns of the outside world via the brain, but it is equally true that the brain can be informed only via the body. The second special consequence of the brain’s body aboutness is no less notable: by mapping its body in an integrated manner, the brain manages to create the critical component of what will become the self.’ Antonio Damasio. (2010) Self comes to mind: constructing the concious brain. New York: Pantheon Books.
Having said that, to my modest understanding it is quite clear that we are in many ways what our brain and mind ’want’ us to be, and it is our responsibility to use these their/our abilities the best we can, as much for our own good as for our environment and common wellbeing. We have already mentioned the plasticity of the brain. A healthy brain, with no damages, can affect the workings and determinations of a mind, and vice versa. Brain takes actions and generates a mind, but mind also acts and can transform a brain. Brain, mind and body are in a very intimate relationship, and they make a way of feeling, thinking, understanding life, and then behaving. ‘Your character is your destiny’, I read once I don’t remember exactly where. I really believe this. Of course our genetic, physical conditions, and social and cultural background and surroundings can limit and condition us, but we also have our will and intelligence, or what psychologists Peter Salovey, from Yale University, and John Mayer, New Hampshire University, came to call ‘emotional intelligence’, a concept that the psychologist and journalist David Goleman made popular (D. Goleman, 1995), and that we could synthesise like the ability to identify, control and modify emotions of oneself and others.
But, how could we better organise all the information our mind process so we can have a healthy life, without causing dysfunctions within ourselves? How could we better understand what our senses receive, and our feelings and emotions as a result of our mind’s processes, to feel better in the present, understand past traumas and plan a better future? To me, the answer stays clear: the reflection and organisation of thoughts through language, and, in this case, through Creative Writing.
I’ve been writing since I was an adolescent, first songs and poems, then short stories, novels and articles. By doing this, I have tried to understand problems and traumas that have affected me. I really believe that without my writing I wouldn’t be the same person I am today. It wouldn’t be possible to understand where I’m coming from, organise my ideas to find explanations for what has happened to me and what happens around me in my everyday life, to plan in a positive way where I want to go… And I would have become a sick madman, desperate to find explanations and some way to talk to myself, talk to others and to heal.
‘Mind and behaviour are the moment-to-moment results of the operation of galaxies of nuclei and cortical parcels articulated by convergent and divergent neural projections. If the galaxies are well organized and work harmoniously, the owner makes poetry. If not, madness ensues’. Antonio Damasio. (2010) Self comes to mind: constructing the conscious mind. New York: Pantheon Books.
Having already introduced the role that brain and mind play in our character and behaviour, I think it is convenient to talk, also very briefly, about: firstly the strength and influence language has in our mental processes, and secondly what the written word can do for the regulation of feelings and emotions. I will then conclude and observe how Creative Writing can help to improve health, physical and psychological.
It was the scientist Roger Wolcott Sperry, Nobel Prize of Medicine in 1981, who discovered the different functions of the brain’s hemispheres and who stated the importance language and creativity have for the integration of those functions. According to his research, the left hemisphere is specialised in verbal and analytic functions while the right hemisphere specialises in non-verbal and global perception functions. The left hemisphere is rational and analytic while the right one is intuitive and imaginative. Language, involving the rules that organise rational thought, is a function of the left hemisphere, while imagination and creativity are functions of the right. ‘The main theme to emerge from the following is that there appear to be two modes of thinking, verbal and nonverbal, represented rather separately in left and right hemispheres, respectively, and that our educational system, as well as science in general, tends to neglect the nonverbal form of intellect.’ Roger W. Sperry. (1973) Lateral Specialization of Cerebral Function in the Surgically Separated Hemispheres. The psychophysiology of thinking. Studies of covert processes. Department of Psychology Hollins College. Roanoke, Virginia. 208-229
Twenty four years later, in 2007, Mathew D. Lieberman, professor of the Department of Psychology of the University of California, Los Angeles, conducted neuroimaging (fMRI) research which demonstrated that putting into words negative emotions (‘affect labeling’) reduces the limbic system activity in general and amygdala in particular (which are in charge of the emotional brain responses). This definitely demonstrates that the written word can alleviate the negative effects of negative experiences.
‘These findings begin to shed light on how putting negative feelings into words can help regulate negative experience, a process that may ultimately contribute to better mental and physical health.’ Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labelling disrupts amygdala activity to affective stimuli. Psychological Science, 18, 421-428
Therefore, it is evident to me that through the Creative Writing process there is an integration of the verbal/rational and non verbal/creative functions of both hemispheres of the brain. Left and right work together. What occurs then is as much an integration of both hemispheres as a regulation of the limbic system and the consequent emotional balance.
Writing cures: how, what, when… and other questions.
At the end of the XIX century, Josef Brauer, colleague of Sigmund Freud, discovered the healing potential of allowing clients to talk without inhibitions (cathartic method). Treating his client Anna O., who suffered from hysteria (today called ‘dissociative disorder’ by the DSM V), severe cough, paralysis, disturbances of vision, hearing, speech, hallucination and loss of consciousness, he observed how inducing her to a state of hypnosis and allowing her to talk, seemed to improve her state of health. Brauer called this method talking cure. It was later that Freud adopted the method developed by his colleague to develop his theory and techniques of psychoanalysis (Brauer & Freud, 1895-1966).
But since the development of the talking cure more than a century has passed, and as writing has been recognised as an important issue since the time of the Sumerians, it is not long ago, relatively speaking, that we are starting to talk about writing cure, expressive writing, written emotional expression or therapeutic writing.
In 1983, James W. Pennebaker started to study the healing power of writing, conducting a pioneering study in which it was demonstrated that writing about traumatic events, connecting people with their deepest feelings, improves physical and psychological health. Pennebaker’s paradigm and research, in which students who wrote about their feelings, and the facts surrounding their traumas, demonstrated a short term increase in physiological arousal and long term decreases in health problems (Pennebaker and Beall 1986). This caused an impact in the scientific community and was the trigger for the study of Creative Writing for Therapeutic Purposes. ‘The original theory that motivated the first studies on writing was based on the assumption that not talking about important psychological phenomena is a form of inhibition. Drawing on the animal and psychophysiological literatures, we posited that active inhibition is a form of physiological work. This inhibitory work, which is reflected in autonomic and central nervous system activity, could be viewed as a long-term low-level stressor (cf. Selye, 1976). Such stress, then, could cause or exacerbate psychosomatic processes, thereby increasing the risk of illness and other stress related disturbances.’ James W. Pennebaker (1997) Writing about emotional experiences as a therapeutic process, Psychological Science, American Psicological Society. Vol 8, No 3. p164.
So, how does ‘expressive writing’ work? What does it have to offer in comparison to other therapies? Which writing exercises and techniques are the most adequate? Which physical and psychological pathologies are more beneficial and in which cases are they not beneficial? Which cognitive and neuropsychological activity occurs in mind and brain?…
For some of these questions, answers have been found and are being found, but others remain open in a field of study still very young. Not thirty years has passed since Pennebaker and Beall’s first experiment.
The book Writing Cure (2002) looked at much of the research until the day of its publication. Stephen J. Lepore and Joshua M. Smyth, on the introduction of the book, attribute the interest of expressive writing to three main factors:
-Firstly, to the research and discoveries made by Pennebaker, that demonstrate that his paradigm of expressive writing ‘confer a wide array of benefits, including improved lung functioning in asthma patients and reduce symptoms in rheumatoid arthritis patients (Smyth, Stone, Hurewitz & Kaell, 1999), reduction in emotional and physical health complaints (Greenberg and Stone, 1992; Lepore, 1997; Pennebaker, Colder and Sharp, 1990), and enhanced social relationships and role functioning (Lepore and Greenberg, in press; Spera, Buhrfeind, & Pennebaker, 1994)’.
-‘Second, it may provide the sort of low-cost treatment that many clinicians and health care are seeking in today’s environment of health management and strict core controls. Despite accumulating evidence on the effectiveness of behavioral medicine interventions, barriers to the integration of behavioral and biomedical treatments remain (Friedman, Sobel, Myers, Caudill, & Benson, 1995)’.
-And third, as much to the difficulty of certain individuals to access counseling or psychotherapy treatments as to those that don’t feel safe talking to a therapist about their deepest feelings, emotions and private life. ‘Social constrains, problems in mobility, lack of access to adequate services or personal inhibitions may greatly reduce the likelihood that a person discusses stressful or traumatic experiences with others (Lepore, Silver, Wortman, & Wayment, 1996; Pennebaker & Harber, 1993)’.
Stephen J. Lepore and Joshua M. Smyth (2002) Writing Cure. How Expressive Writing Promotes Health and Emotional Well-Being. Washington: American Psychological Association.
Personally, in the therapeutic writing workshop I run, in applying the paradigm of Pennebaker and trying to find a response from attendees about how they felt after writing for fifteen minutes and dealing with traumatic events that have marked their lives, some of them expressed their ‘anger’ at me for wanting them to recall their deepest traumas and explore the resulting emotions they thought they had forgotten. At this, my immediate response was first to let them know that I am not the one to blame for their negative emotions, and second that to live in denial of traumatic experiences doesn’t help them to achieve physical and psychological wellbeing, and could lead them to, among other things, fall into the same or similar mistakes and resulting emotional pain.
ACT (Acceptance and Commitment Therapy), calls the process of wanting to avoid remembering and talking about problems and traumatic experiences from the past ‘experiential avoidance’. This is a process that, besides the involved inhibitory work and health deterioration, brings with it different attitudes and behaviours that may range from alcohol and drug abuse, as an immediate attempt to reduce anxiety and emotional pain, even to suicide.
While it has been shown that Pennebaker’s paradigm brings health benefits, mentally and physically (‘These studies are repeatedly demonstrating that writing about emotional events can influence people’s lives’ (Pennebaker 2002, p285), to my very modest understanding and experience we cannot use Pennebaker paradigm for every client in the first instance. Not everyone is ready for that very emotional exercise. We, therapeutic writing professionals and facilitators, have to be very cautious when using this exercise. However, I have found there are other exercises I have proposed first, by way of preparation for Pennebaker’s approach, that have brought the confidence, enthusiasm and positive attitude from students preparing them to later be more willing to deal with their deepest traumas and emotions.
In the first session, I asked them to write in their notebooks and answer as honestly as possible the following three questions: ‘Who am I? What do I need to live? What do I want to be?’ I have also said to them that the answers are just for them, that they don’t have to share them with anyone, and that they are there on paper so they can reread them, reflect calmly, write and rewrite as much as they want, and make their answers totally coherent and honest till they are completely satisfied. In general, these three basic and initial questions have been useful for them to start opening up and trigger their problems, traumas and personal needs in an indirect way. ‘We have discovered that the greatest thing about writing is that it belongs just to you’, they told me in a sharing time.
Next session I asked them again about those three questions, about how they were feeling about their personal writing and reflections, and whether they had reread and rewritten them during the week. Then I proposed another exercise to them. I asked them to shift into a third person perspective, but to ask themselves the same questions as if they were looking at themselves from outside themselves: he/she is… He/she needs…. He/she wants to be… ‘By writing about our problems and traumatic experiences in the third person, we have found that this permits us to express ourselves with greater freedom of writing, and to distance ourselves from an egocentric point of view. After this exercise, you can feel better, as it is not your problem anymore! It’s someone else’s problem! This can lend more objectivity and we can see that our problems and traumatic experiences can be shared and felt by others also.’
Then on the third week I used Pennebaker’s exercise/paradigm, which I assume was more successful than if I had proposed it immediately as part of the first week/session (my workshop is one session per week). At this point students/clients are more familiar with the expressive writing process. Even so, as I said, this has not prevented some of them from being discontented.
Once they have confronted their emotional traumas, in the fourth week I introduced a positive thinking approach. I proposed an exercise which usually brings smiles and joy to people’s faces. I asked them to reread what they had written about their trauma and the associated emotions, and to write two columns of words they had used: one for the negatives and one for the positives. Then I asked them to reflect for a moment on those words and try to rewrite the traumatic event using only the words from the positive column.
‘By doing this we could extract the positive parts of the story and rewrite it just with the positive words, avoiding the negative ones (…) What I mean is by making an imaginary new positive story you can keep turning the subject around, automatically you feel better about it after reading., I tell you, and the rest of us can bear it out.’
I have called this method of coming from a deep reflexive and expressive writing to a positive thinking and creative writing exercise: reflective-positive post-catharsis.
Antonio Damasio. (2010) Self comes to mind: constructing the conscious mind. New York: Pantheon Books.
Roger W. Sperry. (1973) Lateral Specialization of Cerebral Function in the Surgically Separated Hemispheres. The psychophysiology of thinking. Studies of covert processes. Department of Psychology Hollins College. Roanoke, Virginia. 208-229.
Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words: Affect labelling disrupts amygdala activity to affective stimuli. Psychological Science, 18, 421-428.
Pennebaker and Beall 1986. Confronting a Traumatic Event: Toward an Understanding of Inhibition and Disease. Journal of Abnormal Psychology, Vol. 95, No 3, 274-281.
James W. Pennebaker (1997) Writing about emotional experiences as a therapeutic process, Psychological Science, American Psicological Society. Vol 8, No 3. p164.
Stephen J. Lepore and Joshua M. Smyth (2002) Writing Cure. How Expressive Writing Promotes Health and Emotional Well-Being. Washington: American Psychological Association.
Gillie Bolton (2010) Reflective Practice. London: Sage.