An Open Book

In his book Opening Up: The Healing Power of Expressing Emotions, Dr. James Pennebaker describes in detail his research on the health benefits of writing. By walking the reader through the various studies that have influenced both his personal thoughts and the direction of his research, Dr. Pennebaker exposes both the strengths and limitations of writing as a coping method. Active inhibition appears to have negative effects on the immune system. Those who experience some sort of trauma but never disclose the event to others commonly experience this phenomenon. However, simply by writing about the event, these individuals can reduce their active inhibition and thereby increase their immune functioning.

Although self-disclosure can result in demonstrable increases in immune functioning, simply the act of writing itself cannot produce these changes. Writing that reflects low-level thinking, such as writing about superficial topics, has no health benefit for the writer. In order for one’s health to benefit, one must engage in critical self-reflection about the topic and the emotions that thinking about the topic raises. In particular, the people who experienced the most health benefits were those who could construct coherent stories when discussing their traumas. What benefits these people experienced were not permanent (physician visits would be reduced for approximately four months and no longer) and were further constrained by the personality and coping styles of the individuals.  Those who already had a “roll-with-the-punches” coping style evidenced no added benefit from writing and those who were low disclosers (i.e., people who become highly physiologically aroused when asked to disclose) experienced more health problems and illnesses in the months after being asked to disclose.

Additionally, the people whose health did benefit from writing in the months after the experiment actually became more depressed and sickly in the first few days/weeks after writing. This is not to say that writing should not be utilized as a therapeutic method. As compared to other self-expressive therapies such as art and expressive movement, writing produces gains in both immune function and the cognitive understanding the patient forms of their trauma. The act of translating events or traumas into language appears to have health benefits beyond simple self-expression, because writing requires the individual to reflect on their emotions as opposed to simply experiencing them.

Out of the diverse selection of books I could have chosen from to write this blog, I picked Opening Up specifically because I had previously read one of Dr. Pennebaker’s scientific articles on the subject. As a professor of Psychology at University of Texas at Austin, Dr. Pennebaker is indisputably both an expert in health psychology, and the leading researcher in the therapeutic effects of writing. His book is especially credible and scholarly in that it is a chronicle of the largest scientific findings he has made in this area of research. I believe that it was a good choice of book for me, if for no other reason than my personal interest/investment in the practice of health psychology. In fact, I believe the best audience for this book would specifically be health psychology students, whether they are at the undergraduate or graduate level. Although this book could be potentially useful for anyone who has ever experienced trauma or illness, the focus of the book is so narrow and Dr. Pennebaker’s writing style so academic that I cannot imagine this book holding laypersons’ attentions for very long.  In fact, many psychology students with no interest in health could easily become bored with this book as well, despite its obvious scientific and practical value. There is very little overlap between this text and our social psychology course (there is some discussion of ironic mental processes in avoiding traumatic thoughts and belief in a just world as both protective and damaging when searching for meaning in events), and this book could be an interesting source of information for anyone interested in learning about some of the different ways social psychology can be implemented in other fields.

Unfortunately (or fortunately), because of my personal health problems I found this book especially applicable to my everyday life. Where I grew up, I was always surrounded by the traumas of others. Whether I was hiding out a friend at my house because a biker gang was threatening to shoot up her house, listening to yet another girl disclose to me how her stepfather had molested her, or helping pick out clothes to send to drug dealers who were trying to turn their lives around with my mom’s help, there was always something. And whatever that something was, it always took its physical toll on me.  I was born premature and have been prone to sickness my whole life, but my immune system became especially poor after my first depressive episode. So, at twelve some part of me intuitively understood that to stay well physically and emotionally I would have to write. Writing became my only emotional release in a town where I knew my problems were nothing compared to…well, the problems of every other person I encountered.  As long as I had a roof over my head, three meals a day and a family who loved me, I had no right to complain. I was experiencing the social cost of my friends’ disclosures about their lives to me. As I was always the listener, I experienced the physiological arousal that the discloser was relieved of when they lowered their inhibitions to confide. To continue as a confidante, I had to find a way to lower my own inhibition or I risked becoming burnt out and losing friendships. Writing provided a safe, emotional release for me so that I could act as more than just a repository of others’ traumas.

Years later, in the early stages of my Lyme disease, writing became my only means of understanding the changes that were happening in my body. I had notebooks full of my rage at the doctors who dismissed my pain, full of self-loathing and feelings of worthlessness, and full of the fire that was burning me alive with every synapse. My immune system stayed intact until the words eventually stopped flowing. The cognitive fog had finally claimed the only method I had to understand the world I was slipping into. Once the words stopped coming, the constant infections crept back. Upon choosing to read this book, I decided to fight back again. Those of you who have read some of my other blog posts will have noticed they can be brutally honest. I decided to use these blog posts as a means of forcing myself to shed my inhibitions in hopes I could change what has been one of the worst periods of immune functioning in my life. I can’t attest to any change in my immune functioning (except perhaps in a negative direction) but I can attest to the emotional benefits of disclosure after experiencing the initial pain of writing. Perhaps I am a low-discloser and this project has actually harmed my immune system. I can’t be sure. I can be sure, however, that constructing my life experiences into stories has helped me put those experiences into perspective. I tend to think of myself as weak, but realizing that I have seen and been through more at 21 than many people will experience in a lifetime helps me understand what I’m truly capable of. My story is a painful one, but maybe it will be worth listening to someday.

What I enjoyed most about Opening Up, was the very practical guidelines that Dr. Pennebaker set forth so that the reader could potentially try to implement the findings of his research in their everyday lives. However, the largest strength of the book in my opinion was that although he set forward these guidelines, he made it perfectly clear that writing is not some cure-all, magic bandaid. There are obvious limitations to who benefits from writing and the extent to which they will benefit. Writing is not a substitute for counseling or medicine; it is primarily a preventative practice to help protect the immune system from the cumulative effects of stress or trauma.

Personally, I found his discussion of the social cost of disclosure to be the most useful. When you disclose intimate problems to love ones, often they reach a point at which they can no longer bear the stress of listening to your problems. The result is that when you most need support, your social support system often rejects you out of discomfort. Reading about this issue made me realize that my friends here haven’t abandoned me because I’m inherently worthless or unlovable. They’ve done it because they’re a bunch of fucking assholes who just don’t know what to say to me anymore. They want to be around someone who will make them feel at ease instead of someone who is in pain and wants to form a real human connection with them. So, fuck ‘em. I realize that this section of the book was probably meant to make people undergoing hard times realize that this is a normal human reaction and that they should empathize with the people who can’t relate to them. I don’t like that interpretation. The interpretation that my friends are dicks because that can’t overcome a simple cognitive aversion so that they could help a person in need is a much more useful interpretation for me. Just reiterate: fuck those fucking assholes.

Someone who is not as angry or petty as I am would most likely find Dr. Pennebaker’s discussion of the fundamental human drive to find meaning most useful. Although most of us would most likely consider a drive towards meaning an overwhelmingly positive endeavor, Dr. Pennebaker does a fantastic job of pointing out how that drive can lead us to erroneous thinking, such as victim blaming. Trying to find a simple cause and effect relationship where there is none can cause irrevocable damage, which is why we should learn to accept the limitations of our understanding.

The one thing I disliked about the book and found to be its largest shortcoming was the very complicated and confusing relationship that emerged from Dr. Pennebaker’s use of the words trauma and illness. At times, the two words almost become interchangeable. This tendency is present in my discussion of his work as well. I will fully admit that in trying to discuss this topic, it becomes nearly impossible to disentangle the two terms. The problem most likely stems from the divide between the actual topics of Dr. Pennebaker’s research (i.e., asking people to write about trauma) and the applications of his research (i.e., potential benefits for the chronically ill and disabled.) Although living with illness can have the same emotional impact of certain traumas on certain people, it is problematic to assume that illness itself is a trauma. Traditionally, traumas refer to specific, discrete events with long-lasting emotional impact. Illness is not an event in itself. Illness is a part of your body and a part of you, right down to the microcellular level. How can my body be a trauma? Unfortunately, I have no way of conceptualizing a response to this question. From personal experience I know that living with illness can feel like a trauma, but if doctors begin to consider the body as a trauma, how might this affect the self-concepts of the chronically ill?

Finally, the one thing I would consider the “take home message” of this book is that you should always listen to your body. Never take for granted that an infection is just an infection. There can be very complicated psychological factors in play that you are not fully appreciating. Always think to yourself, “Have I been under any particular stress that might have impaired my immune system, leaving me susceptible to catching this infection?” Don’t take any changes in your body for granted.

(n = 1,975)

References

Pennebaker, J. W. (1990). Opening up: The healing power of expressing emotions.

New York, NY: The Guilford Press.