Power of the Page: Writing as Therapy

Channeling our reflections and emotions through a pen (or keyboard) provides remarkable mental health benefits for bipolar, especially for stress, anxiety, and guilt.

Writing & Healing

Writing poems about painful memories has helped Andrea of Victoria, British Columbia, let them go.

“I call it ‘poetry therapy,’” says Andrea, who blogs as the Bipolar Babe, keeps a journal, and is writing a book. “Writing itself is healing, but poetry itself is absolutely blissful. It just really moves me.”

For Bill of Webster, New York, typing his journal on his laptop computer while listening to classical music provides catharsis, healing, and perspective. When the 48-year-old wrote about his divorce or about fighting to get time with his son, he gained insight into how his family was affected, too.

“It gave me some empathy,” says Bill, who was diagnosed with bipolar II when he was 35.

Whether on paper or electronically, documenting what’s happened in your life and your perceptions and feelings—an emotional exploration known as journaling or expressive writing—has great potential as a coping tool to manage bipolar disorder.

While research specifically on writing and bipolar is hard to come by, a growing body of literature has demonstrated that purposeful writing benefits physical and emotional health.

James Pennebaker, PhD, now a professor and chairman of the psychology department at the University of Texas at Austin, led the first study on writing and healing back in 1986. His team found that college students asked to confidentially write their deepest thoughts and feelings about traumatic events for just 15 minutes, four days in a row, were healthier over the next four months than students who wrote about superficial topics.

In his book Writing to Heal, Pennebaker argues that expressive writing can make people less anxious or depressed. Physical responses include lower blood pressure, less pain, slower heart rate, and better organ and immune system function.

Writing can be private or shared. It can take the form of journaling or keeping a diary, crafting poetry, blogging, answering specific questions from a book or therapist, or writing a memoir or life narrative.

According to Pennebaker’s research, people revisiting a traumatic experience may feel sadder just after putting down the pen or leaving the keyboard. But that tends to lift in about an hour and people then feel better than before they wrote. In the weeks afterward, people who’d written expressively behaved differently, such as being more social and performing better in school or on job interviews. By contrast, studies suggest that keeping upsetting experiences and emotions secret tends to increase physical and emotional stress.

Feeling Safe—Writing in Group Therapy & Hospitalization

Barbara, a licensed registered poetry therapist who has worked with mental health inpatients and outpatients in New York City, sees multiple ways that writing can help. “The page can contain the emotion. It doesn’t fall apart,” she says. “It’s a safe place to explore their feelings.”

The goal is to help people make sense of their thoughts and feelings—in their own words. At times, Barbara will act as a scribe, writing down what a client is saying. Seeing the spoken words on paper can have a powerful effect, she says.

In addition, the creative arts offer some freedom for those who are anxious, self-critical, or insecure. “There’s no right or wrong in art,” she explains.

Writing suits many people with bipolar disorder because they tend to have a strong inclination for creative output, according to Erin Michalak, PhD, associate professor in the psychiatry department at the University of British Columbia. Painting, sculpting, and making music can also satisfy that need—but writing is cheap and accessible, since no special tools or talents are required.

The writing doesn’t even have to be in paragraphs.

“If you’re at that stage where you can’t even put a sentence together—and I’ve been there—just write a list of words,” says Elizabeth Maynard Schaefer, PhD, author of Writing Through the Darkness: Easing Your Depression with Paper and Pen. “It may help put a name on some of the feelings you’re having.”

Schaefer, who lives in Northern California, is a former science journalist with a doctorate in biology. She took herself as a subject when she was hospitalized for depression—later diagnosed as bipolar disorder—over 20 years ago. She started taking writing workshops and now teaches creative writing to other people with mood disorders. She wrote her book as a guide for anyone who wants to try it on their own.

“I don’t think people need to be in a group or class to benefit from it,” she says.

Writing can’t replace needed psychiatric interventions. Schaefer, 49, notes that medication and other treatments were key to her recovery. But along the way, she says, “the writing provided me a thread that kept me going.”

Expressive Writing & Narrative Therapy

Michalak points out that the kind of writing that’s helpful varies from person to person. As team leader of CREST.BD (formally the Collaborative RESearch Team to study psychosocial issues in Bipolar Disorder), she helps assess strategies that help people live well with bipolar. In interviews and focus groups, individuals with bipolar have cited reflective and meditative practices—including journaling—as a useful coping technique. But, Michalak says, “There was no ‘one size fits all.’”

Some people found expressive writing a cathartic way to let go of traumatic, stigmatizing, anxious, or frustrating experiences. Or as Michalak puts it: “They used writing to externalize internalized turmoil or difficulties.”

Others liked the routine of writing in a journal, often at the same time each day. Creating structure is important for people with bipolar disorder, says Michalak. Then there are people who share their life stories in order to help reduce misconceptions and stigma.

Andrea, the poetry fan, has felt driven to share her story since suffering hallucinations and delusions at age 26, when she was diagnosed with bipolar disorder. She sees her blog and the book she’s writing as ways to educate others, which complements her outreach work with the Stigma-Free Society, formerly the Bipolar Disorder Society of British Columbia.

Writing can even change writers’ own judgments of themselves.

Narrative therapy, developed in the 1980s, helps people retell their life story from a more positive perspective, dismantling negative self-concepts that interfere with personal growth. A group-based intervention known as NECT (Narrative Enhancement and Cognitive Therapy) derives from research showing that reframing one’s personal narrative helps patients with schizophrenia reduce self-stigma and build hope.

Rosalind Irving, a family therapist on the CREST.BD team, has been studying the use of recovery narratives specifically for people with bipolar. She notes that looking back at the arc of symptomatic behavior, life events, and recovery helps people organize the information and gain an understanding about what happened. In addition, the process can help people confront their grief and regrets about the past, and discover and strengthen their “voice,” or sense of self-identity.

“There was a time I couldn’t look in the mirror without feeling worthless,” says Andrea. “Now it’s so beautiful to be free of what I call the ‘internal stigma.’”

Alarm Bells: Writing in Times of Crisis

There can be times, however, when writing is difficult or not helpful. Psychosis doesn’t lend itself to writing cohesively, notes Schaefer. (On the other hand, a piece of writing that reflects accelerated and disjointed thought patterns can be a warning sign for mania.)

In the lethargy of depression, it may be hard to find the motivation to write. If you know writing helps you, you could try checking in with a buddy by phone or email to encourage and hold each other accountable for writing a certain number of times a week, suggests Michalak.

Brooding over dark thoughts in a journal won’t be very productive, however. When life feels utterly bleak, writing might be safer and more useful in a supportive setting, such as a counseling session or with some peer support, Michalak adds.

Barbara, a past president of the National Association for Poetry Therapy, says professionals are trained to not take people beyond where they’re ready to go, and to use readings and exercises that build hope.

Bill found writing impossible when he was severely depressed several years ago. Now that he’s more stable, writing helps him avoid getting to that extreme low point.

“It’s one of my coping tools so I don’t spiral down further,” the former attorney says. Like his volunteer work for a mental health organization, writing gives him a fulfilling sense of purpose, he says.

Occasionally, though, while writing about something painful, he finds himself stuck in obsessive, negative thoughts. Then Bill steps away. He’ll turn to other coping tools, such as reminding himself that he’s been through tough times before and can do so again. Or he might reach out and try to help someone else, such as another recovering alcoholic or a relative who has bipolar disorder.

By contrast, Jonna of Rochester, New York, finds her poetry comes out better when she’s depressed. Then the words feel calming and rhythmic. If she’s happy, the 28-year-old college student says, she’s too impatient to write.

Whatever the case, it’s a good idea to think twice before putting your work out there for anyone to see. Michalak advises a 24- to 48-hour waiting period. Get some sleep, then run your words by a close friend. Otherwise, you may regret oversharing your unfiltered thoughts.

Benefits of Writing & Therapeutic Approaches

Writing exercises can be an essential tool in dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT), both of which teach skills to help people identify and change negative thought and behavior patterns.

Jonna found that structured writing in therapy—reviewing events that troubled her and how she reacted to them—helped her identify facts versus emotions and retrained her thinking. Jonna says she now can better tell the difference between things happening outside of her, which she has no control over, and her physical and emotional responses, which she can influence.

Robert M. Post, MD, head of the Bipolar Collaborative Network in Bethesda, Maryland, says writing work with a therapist can have other benefits. Individuals can record strategies and mantras during a counseling session, for example, and reread them during low moods.

Dana of Winnipeg, Manitoba, 38, says some of her poems serve the same purpose. When she’s feeling down or stuck, she can look back at poems written at happier moments and remind herself that she’ll feel good again. For example, a poem she wrote about feeling renewed by the cool, fresh air when she was shoveling snow can be helpful when she needs motivation to get out of her apartment.

And when she composes poems about how she’d like her life to be, that helps her envision a better future.

Dana started writing poetry in high school to express her confusing feelings. When she was hospitalized for her bipolar disorder, she found it helpful to look back to those high school outpourings and see what her moods had once been like and how things had progressed.

Writing to Cope with Guilt, Stress, & Anxiety

Now that she’s gotten back in the poetry habit, she says, the writing helps her recognize and release guilt, strengthens her inner voice, and increases her confidence. The mother of three often feels inadequate and thinks she can’t get things done, but her poems represent accomplishments. And posting some of her poetry on Facebook to positive feedback has been “empowering,” she says.

A study that appeared online in December 2011, in advance of publication in the journal Psychological Services, backs Dana up. Israeli teens with social anxiety or distress were divided into groups to blog, keep a private diary, or do nothing. After 10 weeks, the bloggers who wrote about their social difficulties showed greater improvement in self-esteem, social anxiety, emotional distress, and positive social behaviors—and the teens who opened their blogs to comments, which were overwhelmingly supportive, showed the most improvement of all.

Andrea, too, finds sharing her writing fulfilling. She hopes that her words inspire others even as they help her cope. She sees writing as one element in her “security net,” which also includes medication and mental health professionals, good nutrition, and balancing her job as a policy analyst for the provincial government with fun and relaxation.

“I feel like poetry brings light,” she says. “I feel like every time I write something, I grow emotionally.”

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Writing Tips: How to Get Started

Writing isn’t useful for everybody, so seek other outlets if this approach doesn’t bring benefits. If you are ruminating or being critical of yourself in your writing, or if a topic becomes emotionally overwhelming, do something different.

• If writing helps you, prioritize this tool. Schedule it into your day or week.

• Set aside 20 minutes to write continuously. Don’t edit as you write. Your words don’t have to be neat, organized, or well-crafted. Likewise, don’t apologize or be self-critical about your thoughts or your past.

• Start by writing about turmoil that’s on your mind now. Write what happened, when and where, the consequences, and your emotions. Look for both negative and positive feelings.

• Write like you’re talking to a friend.

• Experiment with different types of writing. Try poetry, fiction, and memoir. Experiment with a mind map, a type of diagram where you let words or phrases flow out of a central idea in the middle of a piece of paper.

• During manic and depressed periods, be cautious about sharing what you’ve written because you might regret it later. During dark times especially, it can help to stay in touch with a buddy writer or a counselor about your writing.

• A writing group, teacher, or therapist can provide helpful guidance. Self-help books also can get you started and offer ideas of things to write about. Among the guides by authors who have bipolar disorder: Re-Write Your Life: A Transformational Guide to Writing and Healing the Stories of Our Lives, by June D. Swadron, and Writing Through the Darkness: Easing Your Depression with Paper and Pen, by Elizabeth Maynard Schaefer, PhD.

Printed as “The Power of the Page,” Spring 2012