Monday, 11 February 2013

Bibliotherapy: Mood-Boosting and Gloomy Books For Depression

Bibliotherapy for depression - Penguin deckchairs
Bibliotherapy for low mood (at the seaside). Image from
For depression it's always best to contact your GP and discuss the possibility of therapy and/or medication.

There's been a lot in the media lately about using books to assist good mental health, largely because of the NHS decision to start "prescribing" self-help material for mental health issues.

As part of the "Books on Prescription" scheme, patients could be recommended one of 30 medical volumes dealing with specific conditions by their GP. These will be available to borrow from libraries, and not restricted to those "prescribed" them. Alternatively, the "Mood-boosting Books" scheme is a national promotion of uplifting novels, non-fiction and poetry selected by readers, which includes writers such as Jo Brand, Bill Bryson and Terry Jones. Ms McKearney, director of The Reading Agency, has said: “It will encourage people to use the other reading aspects from libraries to help them feel better: novels, poetry and reading groups.” Here's the link to the 2012 list of mood-boosting books by The Reading Agency. 

As I began my blog with the intention of blogging about books that have helped, or are helping, my own mental health, this is really exciting news. I believe that the "Books on Prescription" scheme could provide useful complimentary support, whilst the "Mood-boosting Books" project can work to sustain good mental health, particular after therapy and courses of medication.

Recent news articles have also ascertained that the encouraged books do not have to be of the uplifting, funny and summery variety. One such piece by The Telegraph is entitled "Depressing books could be just what the doctor ordered". I don't think that the miserable alternative approach would work best for me; I had to have several breaks from McCarthy's The Road because it was making me feel so low. I'm lucky enough not to have suffered low mood recently, however. A few years ago I had some really unhappy patches, but in hindsight they must have been highly related to undiagnosed PTSD. Nowadays, having things to look forward to, being positive, and, of course, reading good books helps.

Below are two lists of suggested reading material for if you're in need of a boost. One is for those in search of comfort and a laugh, whilst the other is for readers who want reminding that they could have it so much worse. I'm more of an advocate of the first list for when I'm feeling low, but the latter contains so many great pieces of literature regardless.

Uplifting books (most of the time) for low mood:

More gloomy books that you may (or may not) relate to:

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Lit. Hitchhiker said...

I'm happy you posted this. I feel that this sort of personal recommendation could actually be a good way for people who want to find literature that could help them with depression to choose what to read. Not because "hey, all sad books are good for this!" or "hey, all cheerful books are good for this!", but because someone whose opinions and personality they have a way of assessing (like someone who has a blog) gives a list of stuff they find suitable or that helped them - even better if they discussed some of those books. It's somewhat easier to judge what effect a book will have on you if you know that someone with a personality similar to yours experienced it in a specific way.

Elena said...

I loved "When Will There be Good News" by Kate Atkinson because it has a character, Joanna Mason, who overcame tragedy not only once but twice. She is so, so inspiring! Also, Jenny Cooper from "The Coroner": a divorced, middle-aged mom and coroner dealing with personal issues. Both very recommendable to women.

tolstoytherapy said...

Thank you for the comment! I love characters like those. "When Will There Be Good News" sounds like a book I'd really enjoy, especially after skim-reading your post on it. I'll have to designate some time to properly reading up on Atkinson on your blog tomorrow!

All the best.

Violet said...

When I read about the books on prescription thing I thought it was a joke, and when I realised it wasn't a joke, I felt really angry. If you have a broken leg or an infected wound you get the appropriate treatment, but if you have depression and/or anxiety you're told to go away and read a book? I feel insulted that my illness is trivialised in such a manner, and sad for all the people who won't go to the Dr and ask for help because they think they'll be discounted and told they should read a book and feel better. I'm tired of people trivialising what is a serious illness and adding to the stigma of having depression. A person with a broken leg isn't expected to heal him or herself, so why is a person with depression or anxiety expected to do so? The whole notion is bizarre and ridiculous and it makes me feel very sad that people will suffer needlessly because of other people's ignorance. Medication literally saved my life, and I'll probably need to use medication for the rest of my life. I'm glad you can manage your symptoms by other means. I'm glad you're feeling well and happy now. However, please don't trivialise depression and advocate for books instead of medication. People with depression already feel bad enough about having the illness without being told that taking medication to manage their symptoms is somehow bad. Would you say a diabetic should read books instead of using insulin? I think not. You're way smarter than that, Lucy, I know you are.

tolstoytherapy said...

(After not sleeping great this message may not be entirely coherent, and I may edit it later in the day.)

Hi Violet, a lot of my family members have been helped by SSRIs etc in the past for serious issues. Yet not all people who go to a doctor want medication. Many people I know associate prescribed medication with the doctor just wanting you out of his/her office, and meds occasionally turn people like me into depressed, insomniac wrecks.

The NHS would receive serious stick if it trivialised mental illness with a "here, just have a book" attitude. For patients in urgent need of medication, I'm sure that they'd get medication fast. Doctors with experience should know when it is appropriate. Yet doctors here generally don't like to prescribe medication without referring you to mental health services as well/first. Whilst waiting for NHS therapy - which, trust me, takes some time - the self-help books on offer could be really useful for many.

I understand that for many cases of depression being given a book seems laughable. But there are also the temporary, fleeting phases of low mood that people are sometimes unnecessarily prescribed for. My housemate was saying last week how every time she goes to her GP she declines receiving anti-depressants for problems that she feels are unrelated. If you're not at risk, according to various means of assessment, then I don't see the harm in working on a healthy lifestyle and using self-help books/fiction first to see if there's a change. If the depression stays around, then by all means medication should be tried.

But, personally, I do not believe that medication for depression is the same as insulin for diabetics, unless there are imbalances involved that will clearly benefit from medication. For many of the people I know, admitting that you're taking medication is often harder than saying you have depression/anxiety.

Everything is personal, and hopefully the NHS will learn to make the most appropriate decision for their patients. I do not think that depression sufferers taking medication to manage their symptoms is bad, I just don't think that it's for everyone.

Lit. Hitchhiker said...

I can see where you're coming from, but there are two separate issues here.

One is what the NHS recently said (and doctors are likely to follow). And what they said is that they had scientific studies showing that people *on* medication did better when they read self help books. I know that self help books are often ridiculed (some of them for good reason), but these are not the ridiculously-titled, easy-to-mock ones. They are cognitive-behavioral self help books, written by legit therapists/psychiatrists and basically designed to teach some of the strategies you might otherwise learn in therapy. There are some problematic studies regarding medication too out there, but what the NHS recommended was not books instead of medication, but self help books on top of medication. I think this might be a way to provide some of the benefits of a therapy we know works (studies etc.) to people who might not have access to a therapist/to a therapist trained in it.

The other issue is the "Books on Prescription" initiative (started by a charity, see link below) which aims to offer a "depression kit" in public libraries. They have a core list of self help books, plus an additional list of "mood-boosting" books recommended by reading groups/people across the country. The way I read their announcement on their site, doctors would only be able to prescribe books from the core list, i.e. the self help books. It might be questionable whether literature should be included here at all, but in any case none of it is intended to replace medication, just to offer some additional support to people (and in the case of literature, only to those who want it). Which is what I read this post as trying to do, as well.

tolstoytherapy said...

Thank you :) I'm glad that you gained something from this post. I similarly find it useful to read what books had an impact on other bloggers; it often indicates whether I'd enjoy it too.

All the best.

tolstoytherapy said...

Hi Claudia (I'm pretty sure you manage your blog Twitter account!)

Thank you for the clarifications. The media seem to have complicated the process slightly, but The Reading Agency website you've mentioned makes it a lot simpler.

I agree that the encouraged reading material cannot replace medication, but instead provide extra help or an alternative for those who would prefer it.

tolstoytherapy said...

Lovely readers - I've changed some parts of this post to avoid implying that books replace other mental health support. Books do not replace medication, but neither should medication replace talk therapy (I believe). Personally, as someone who has experienced medication, CBT and EMDR in the past, literature has been a really useful tool to maintain my wellbeing.

Brian Joseph said...

I think that your point and meaning is good Lucy. I did not read the original post but your clarifying comments make sense.

I second the nominantion concerning "To Kill a Mocking Bird". I would add Hermann Hesse's Siddhartha to the list.

tolstoytherapy said...

Thank you Brian :)

I'll add it to the list!

Violet said...

I could probably find studies which concluded that self-help books are of no use whatever to peole who have a mental illness. Statistics are easily manipulated.

Many people do not have the requisite literacy skills to read, comprehend, and implement the directives written in a book.

The NHS is strapped for cash. Prescribing self-help books instead of referring a patient for appropriate therapy is a cash-saving incentive.

I would argue that CBT works because of the relationship built between the therapist and client. Interaction with the therapist that is a vital component of CBT.

Mentally ill people need validation and reassurance. You can't get that from a book.

My professional qualifications are in counselling. I leave you to draw your own conclusions about how that fact may influence my opinion on the matter.

Violet said...

The tenor of your revised post has changed somewhat, so my comment is now largely superfluous. I did not think that you believed psychotropic medication was "bad", but your original post was certainly more ambiguous than the current version. Anyway, I think we both know where we stand now, and I'm happy to agree to disagree on the therapeutic value of books when dealing with mental illness.

Perhaps my personal experience has skewed my view on the matter. I was practising Mindfulness Meditation and reading Jon Kabat Zinn's books and listening to one of his guided meditation tapes when I had my complete psychological meltdown in 2008. I am totally convinced that during the body scan relaxation technique he advocates, the lid flew off the psychological box where I kept all the bad stuff tightly locked away, and my brain and body were flooded with memories and feelings I had no way to deal with. It was as if the genie had been let out of the bottle and I knew of no way to get it back in again. I went through a very tough time, and medication was the only thing that helped me. The therapist I saw made matters worse by trying to blame everything on my husband and telling me I needed to think about my options for moving. So, having had that experience, I am naturally going to feel wary of self-help books and of therapists. Years prior to my meltdown I tried an antidepressant and had a horrible physical reaction and swore I would never use medication again, so I understand where you're coming from. However, there are no certainties in life and I found myself in the position of having no choice but to use medication in order to stay alive.

Personal experience clouds everyone's view of everything. I'm sorry if I came down a bit hard on you in my comment. I guess I am on a bit of a mission to have mental illness taken seriously, to stop the discrimination and the stigma that goes along with being labelled as "mentally ill", and I honestly feel that the books on prescription thing is a very silly idea which only serves to trivialise mental illness as somehow not being a "real" illness that needs proper treatment. I acknowledge and respect the fact that your opinion differs from mine and as I said previously, I am happy to agree to disagree. xx

Lee-Anne Penny said...

I think this is terrific!

When things get out of control for me I always turn to books for advice, often before I even talk to people. I like the idea of a starting place to find those books that might help. As much as I value the help and guidance of librarians there are certain topics on which I would not feel comfortable asking for assistance, nor would I expect them to have this kind of specific knowledge. As one tool in the treatment toolbox this is something I will use because it simplifies what I already do, and expediates me finding the book that will help when I most need it.

I applaud this effort and your blog for raising awareness about mental illness. It comes in many forms and demands many responses.

tolstoytherapy said...

Lee-Anne, thank you so much for your comment. I greatly enjoy writing this blog - it's very cathartic in itself!

The scheme certainly simplifies what I already do as well. Lately I haven't been attending my library as much as I should, but now I'm motivated to pay it a visit. Hopefully it will encourage others to do the same, even if just out of curiosity.

I hope that the project will provide guidance to those who otherwise wouldn't want to ask for help (I'm certainly guilty of this). Personally, I find that both of the schemes are raising positive awareness of mental illness, and showing that it is a lot more prominent than most expect. If people are successfully encouraged to pay attention to their mood and take action, even if just by loaning a CBT self-help book, I think it is a big step forward.

All the best :)

tolstoytherapy said...

I'm glad that you feel I've cleared up some ambiguities. I'm sorry to hear about your experience of self-help; I know it isn't for everyone. Also, I too have seen some very unhelpful therapists, resulting in worsened mental health and lengthy complaint emails!

I hope you're currently feeling well, and all the best x