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Literature and mental health

Jonathan Bate and Paula Byrne
Jonathan Bate and Paula Byrne

On Monday, a new free online course is starting, exploring the mental health benefits of literature (you can sign up here). It’s made by the author Paula Byrne and her husband, literary academic Jonathan Bate, and features interviews with Ian McKellen, Stephen Fry, Melveyn Bragg and others, about how poetry has helped them through difficult times. Paula and Jonathan have also launched a new book, Stressed, Unstressed: Classic Poems To Ease the Mind, and a bibliotherapy charity, Re:Lit. I headed to my alma mater, Worcester College at Oxford, where Jonathan is provost, to ask Paula about the project.

JE: What inspired you to do this?

PB: Our daughter sadly and unexpectedly lost her kidneys when she was five. She was rushed to hospital, and we had this awful conversation – ‘your daughter’s probably not going to survive the night’. What do you read when your world is completely and unexpectedly tilted. I was conscious that there was nothing to read when you’re on your own in such a terrible night. In fact, I had a poem in my bag, coincidentally. I read it and felt it very much got me and her through the night. I’d been fermenting the idea of what one reads in hospitals – having spent a lot of time in them, I don’t want to read Hello magazine, particularly not a back-dated one from two years ago. What is there to read when you’re worried, anxious, waiting for an operation, and feeling the dearth of nutritious literature.

What was the poem?

It was actually a prayer by Julian of Norwich – ‘all shall be well and all shall be well and all manner of things shall be well’. I just kept saying it as a sort of mantra. I felt there was something very important about holding on to words when there are no words, and someone else gives you the words you can’t find.

Is your daughter OK now?

Yes she pulled through, bless her. She then went on to have a transplant and she’s six foot now. Touch wood she’s doing very well. But we’ve obviously spent a lot of time in waiting rooms where there hasn’t been any literature, and it’s just been frazzled parents and frazzled children. Your stress levels go through the roof. The other thing that made me think of this project was that I had very bad stress, because of my daughter’s illness but also overwork, and it manifested itself as pain in my hands. Having ignored it for so long, I finally went along to my GP and said I have this terrible pain in my hands, I think it’s something horrible. He just said, it’s stress. I said, but it hurts. He said yeah, stress really can hurt. I said, so what do I do? He said, I’m going to give you a prescription. I’m going to prescribe you a book. And he prescribed me some haikus. The pain completely went away. And I thought, there’s something in this, and if more GPs and medical professionals had a creative approach to stress, maybe poetry could be something in the tool-kit that helps some people. I did research into bibliotherapy, and realized poetry has been used in eastern and western cultures for thousands of years – Aeschylus said ‘words are the physicians of a mind diseased’. So I decided to start a bibliotherapy charity.

How is poetry therapeutic?

How it works for me is a form of curious alchemy. I think it’s repetition, it’s very soothing, there’s something reassuring about repetition and rhyme. Coleridge said poetry is the best spoken words in the best order. Sometimes when you feel stressed you can’t find the words yourself, and you feel very alone. In all the research I’ve been doing for this online course, the refrain over and over again is ‘I thought it was just me, and then I read this poem, and felt oh, that’s exactly it’.’

Let me give you a specific example. As you know, we’re launching a poetry and mental health course on February 1st, we have 11,000 people signed up already. And each week we’re taking a different theme – heartbreak, trauma, and so on. I wanted to move trauma away from military-related PTSD, and include things like female trauma from miscarriages. I had a miscarriage with my first baby, and the only thing that made me feel better was a poem by Katherine Philips from the 1500s. This was a woman who lost 14 children, as you did in Tudor times. She finally gave birth to a beautiful boy, who died after two weeks. And she wrote a beautiful poem to her son Hector. And it’s so modern, resonant and contemporary, you feel she could have written in yesterday.

Twice forty months in wedlock I did stay,
Then had my vows crowned with a lovely boy.
And yet in forty days he dropped away;
O swift vicissitude of human joy!

I did but see him, and he disappeared,
I did but touch the rosebud, and it fell;
A sorrow unforeseen and scarcely feared,
So ill can mortals their afflictions spell.

And now (sweet babe) what can my trembling heart
Suggest to right my doleful fate or thee?
Tears are my muse, and sorrow all my art,
So piercing groans must be thy elegy.

Thus whilst no eye is witness of my moan,
I grieve thy loss (ah, boy too dear to live!)
And let the unconcerned world alone,
Who neither will, nor can refreshment give.

An offering too for thy sad tomb I have,
Too just a tribute to thy early hearse;
Receive these gasping numbers to thy grave,
The last of thy unhappy mother’s verse.

I really like that. Woman to woman it spoke to me about what it feels like to lose a baby. And the power of words, the catharsis, making sense of it. It also shows there’s nothing really new under the sun. With all the advance of medicine, I still know how she feels. It’s not just me, but I couldn’t say it that well.

And I guess we’re a post-religious society, not everyone wants to turn to the Bible, but poems are sort of substitute for prayer-books, the Bible, rosaries etc?

I think that’s right. So often at funerals people recite poems. It seems there’s something about that art form.

Do you think poetry can do that more than prose?

I love prose too, but I do think there’s something about that particular art form, the concentrated language. It demands concentration in the way prose doesn’t always. You may not understand it, it doesn’t matter, you can just feel the rhythm and sense the symbols.

And it’s close to song, isn’t it, so it has an incantatory quality.

That’s right, and the rhythm can be like a heartbeat.

Do you usually read to yourself or out loud?

Usually to myself but I love hearing it being read out loud. We have Ian McKellen reading a Wordsworth sonnet in the course, and he has such a beautiful voice, hearing him read it took me to a completely different place, a different space.

Do you think academic literary studies tends to be a bit blind to the possible therapeutic benefits of literature?

I do. One journalist was quite critical of the project – he said poetry is high art, it’s not therapy. I thought, what a snobbish attitude. Bibliotherapy is a very ancient idea. In Chinese and Japanese culture, there was a tradition of getting away from the court, going to the country, and using poetry to get into a different headspace.

That’s interesting, the idea of poetry as an inner retreat – it can help one find a restorative depth, even in a hospital.

I really believe that. You could be in a high-rise flat, but feel like you’re in a garden, if you’re reading Wordsworth or Marvell. It enriches your inner life. Poems on the Underground was a really brilliant idea – on a busy tube, you read a poem and it transports you. You’re in a different space.

Harold Bloom talks about the importance of memorizing poetry, making it a part of your inner speech as it were.

Yes, my generation was taught to learn poems by heart. There’s all sorts of interesting studies, particularly with dementia, that people who learn poetry by rote can still remember them when they have dementia. I interviewed Melvyn Bragg for the course – his mother got dementia, and when nothing reached her, she’d still respond to Wordsworth’s Daffodils. One of the problems with dementia is that people are very frightened. Anything that stops people feeling so frightened is beneficial.I do. It’s an interesting expression – by heart. It goes in your heart. Then you can remember it in times when you don’t have a book to hand, and be comforted.

So you have launched a poetry for therapy book, a bibliotherapy charity, and this forthcoming FurtureLearn course on poetry and mental health. What is the long-term goal?

Definitely we want to raise awareness. We’re working with prisons and schools, using poetry for relaxation and well-being. My long-term plan is to get the anthology into hospitals and surgeries when they’re in stressful situations. It could be helpful for people to have access to nutritious literature. It’s food for the soul as opposed to fast food. Words have a particular power. They can give hope too.

I’m interested in the FutureLearn course and how one sets one up.

11,500 thousand have signed up for our course already. It’s the first time a mental health course has been launched, I think they’re quite staggered by the sign up rate. Around 2000 are already chatting to each other on the forum, sharing what poems they love. There’s some really interesting anecdotal evidence of people saying ‘this poem really helped’.

How is it structured?

It’s a six week course, with six themes and six videos. Most of the videos are 10 minutes long but some of them were so good – Stephen Fry was so good talking about Keats for an hour, we couldn’t cut it. We have a medical expert talking about each theme, like heartbreak, for example. We get the medical angle. And then we might look at Sense & Sensibility, and how the two sisters deal with heartbreak in different ways. Each week, we look at two or three ppems, and passages from novels. We also give lots of recommendations for extra reading. Then people can also discuss the poems or any other questions on the forum. Jonathan and I are giving feedback each week. We’re very much supporting the learners.

Is this the first online course you’ve done?

Jonathan has done a Shakespeare course which did very well, so he has thousands of MOOC [Massive Open Online Course] followers. It’s very global – people right across the world have done the course.

How easy is it to make a MOOC?

I’m a creative fellow at Warwick. They’re very forward thinking, they realize MOOCs are the way forward. The main platform is FutureLearn, which is part of the Open University. Each university signs up via the FutureLearn platform. Warwick is very professional, very good at filming and editing. I think they’re really at the forefront, and it’s very good for their impact and outreach.

Mindfulness, therapy and the Church

2012124132breath_1I sent out a tweet last week asking to interview someone who’d found mindfulness useful for coping with depression. Mary got in touch and told me her story, which was fascinating. I thought I’d share it for this week’s newsletter.

Mary is a 25-year-old ordinand-vicar, who uses mindfulness to cope with the Post-Traumatic-Stress-Disorder that developed after a car crash last year.

She tells me she had a sense of a vocation to be a vicar from the age of 19. ‘But I really didn’t want to do it. It wasn’t on my agenda.’ Instead, she studied physics at St Andrews and then trained to be a teacher at Cambridge. The priest of her college insisted she think about her vocation, and gave her a book by Michael Ramsey, The Christian Priest Today. ‘There wasn’t any mention of women priests in it.’

Finally, after three years of wrestling with her soul, she decided to give her life to God. ‘I was scared of doing it. I was giving up a good job and decent salary. My parents are still getting used to it. They think I’m a bit mad. It’s making a big statement. It’s not what most people do. It’s hard these days to be and do what you believe in – there’s always someone to knock you and mock you. Is it acceptable to be a Christian these days, to give your life to God?’

She went through the ‘discernment process’ by which the Church of England decides if you’re suitable to be a priest. This involved a 48-hour ‘residential interview’ (‘a bit like the Big Brother house’) in which you are interviewed by three different people, observed as you interact with your fellow wannabe-priests, and asked to fill in a ‘personal inventory’ with questions like ‘what would you have on your headstone?’

She passed the process, and won a place at a seminary college at Oxford for her priest-training. One week before she was due to begin the training, the car crash happened.

Angry at God

She was driving down an A-road into Harrowgate, when she had a head-on collision with another car. Her car was then hit again, and spent spinning across the A-road. She was rushed to hospital for surgery.

She says: ‘I thought I was going to die. And I wasn’t scared, I was annoyed. I was annoyed at all I had been through to commit myself to God, and now it was all going to be over before I had even begun.’

She was operated on for a perforated bowel and intestine. She spent the first two weeks of her ordination course recovering in hospital. ‘I wanted to be dead for quite a long time, in a way I felt rejected by God because He clearly didn’t want me in Heaven with Him!  It felt like I was being tested, in fact the whole year feels a bit like a test, a bit like Job.’

She says: ‘When I was in hospital I went to chapel, which was empty, and I shouted at Him and questioned what on earth was going on.  I then broke down in tears and could feel His presence and I knew I had to stay close, because He was all I had to get through the next phase. Initially, and I suppose for a few months I could not really engage with worship services, which was awful, because they and the Eucharist were what had sustained me through previous difficulties.  God felt rather far away, so I had to stay close and wait, regardless of how I felt.’

Then, in her first term, the symptoms of Post-Traumatic Stress Disorder emerged, like a bruise swelling. ‘I’d get flashbacks of the impact. I was very anxious, nervous a lot of the time. Any loud noise, I got palpitations. It led to me having very low self-esteem. I couldn’t really see beyond each day. My short-term memory was damaged – people would tell me their name and I’d forget it straight away. I felt hugely guilty, but couldn’t talk to anyone about it. I thought it would take less time to get better. My self-talk was like ‘come on, pull yourself together, you shouldn’t feel like this.’ It was like I had a noisy devil on one shoulder and a very quiet angel on the other. It seemed like an on-going torture.’

Mindfulness for depression

In January this year, she went to see a university counsellor, Dr Ruth Collins, who prescribed her anti-depressants, and also suggested she try mindfulness-CBT. She gave her a copy of The Mindful Way Through Depression, co-written by Mark Williams, the founder of the Oxford Mindfulness Centre.

0Williams, a psychiatrist and Anglican priest, is one of the developers of mindfulness-CBT, and has done more than anyone to bring mindfulness into the mainstream of British society – another of his books, Mindfulness, has been in the top 20 of Amazon for the last three years, selling thousands of copies a week.

His Oxford Mindfulness Centre has brought mindfulness into the heart of psychotherapy and healthcare, and also into public policy (there’s now an All-Party Parliamentary Group on Mindfulness), business, schools and higher education – in fact, Ruth Collins spoke at a conference on mindfulness in HE this week, arguing that university students should be offered free introductory courses.

Oxford already provides such free courses, and Mary went along to one earlier this year. ‘I was the only person there who said they had depression, so I wondered if it would work. But I found it interesting. We started with a counting exercise – you sit and count to ten breaths. Some could only get to 2 or 3 and they’d get distracted, but I could go further.’

She developed a daily practice, meditating for 10-30 minutes each day, sometimes counting the breath, sometimes doing a ‘body-scan’. She says: ‘It’s been very helpful with the depression. For one thing, I realized how important the body is to the mind. I realized how much tenseness was inside me, and I try to breathe through it. I’m now more aware of the signals from the body to the head. When things get stressful and I feel like I’m teetering on the edge of feeling bad, I try to go back into myself and keep saying ‘breathe, here and now’, and accept what I’m feeling, and try to deal with it or just support myself.’

She thinks this will ultimately make her a better priest: ‘I’m very good at looking after others, not so good at looking after myself. I now try to be kind to myself and say that it’s OK to be where I am. Mindfulness is something in the tool-box to support myself when I stop taking the anti-depressants in a few weeks.’

Mindfulness and the Christian way

How does she reconcile a Buddhist practice with her Christian vocation? ‘I’m quite flexible, I believe in using and learning from other traditions. I enjoy reading the Tao Te Ching, for example. I don’t see any conflict between mindfulness and Christianity – it also has the idea of the connection between the soul and breath [they’re the same word in Greek – pneuma].’

‘And of course there is a long contemplative tradition in Christianity – Jesus did go off to the mountains on his own, then the Desert Fathers developed forms of meditation, and St Ignatius and the Jesuits created a strong contemplative practice.’

19 DORE JESUS VISITS MARTHA AND MARY DETAILThere’s also the story of the two sisters, Mary and Martha, in the Gospel of Luke. Jesus visits their house, and Martha busies herself with the preparations, while complaining that her sister sits at Jesus’ feet, absorbed in adoration. Jesus replies: ‘You are worried and upset about many things, but few things are needed—or indeed only one. Mary has chosen what is better, and it will not be taken away from her.’ This verse has been taken by Christian contemplatives as a justification for the contemplative life versus the active life of ‘good works’. Still, it’s only one verse – not much of a foundation for a contemplative tradition.

Jesus has many more mystical sayings in the Gospel of St Thomas but, alas, that was excluded from the New Testament canon. Since then, the idea of bringing your mind and heart into union with God was often seen as heretically Gnostic or Platonic – and still is by some Christians.

I put it to Mary that contemplatives, monks and mystics always seem on the periphery of Christianity, suspected, cast out, and sometimes killed – much like the Sufis in Islam. There’s more of a mainstream contemplative tradition in the Orthodox Church, but even there it’s been controversial – witness the bitter fight in the 14th-century Byzantine church over whether the ‘hesychast prayer’ technique was heretical or not.  And the Protestant church seems particularly lacking in contemplative traditions and practices, beyond poets like George Herbert, William Blake and Emily Dickinson, forging their lonely furrow.

‘Yes, perhaps it’s not mainstream. The Church of Scotland is more Protestant than the C of E, and I’ve never witnessed any sort of meditation there. But perhaps it’s becoming more mainstream. Lucy Winkett [vicar of St James Piccadilly] is a big one for contemplative prayer, for example – she did a month-long Jesuit silent retreat. Even the Queen spoke of contemplative prayer in her Christmas message this year.’

Would Mary go on a mindfulness retreat? ‘I’d love to – there’s one in Snowdonia I want to go to.’ Would she say a prayer to the Buddha? ‘Well, no, I’d say a prayer to God. Like St Paul said, it’s what’s in your heart that counts, not the outer rituals.’

In two years, she finishes the ordination and becomes a curate in a church in her diocese. She says: ‘What am I most looking forward to about being a priest? Being able to try and reach out to people, to live the Gospel through my actions and allow God to work through me in ways I won’t understand. Also, being there for people at some of their most difficult times, and the most joyous.  I would hope to promote a greater sense of the need for spirituality of some sort (preferably Christian…!) What am I dreading?  Paper work, red tape and bureaucracy!  They will be the things that will prevent me from my ministry I fear…so I will just have to work hard to limit the impact.’

Good luck Mary! We think you will be a brilliant priest.