How reading can affect eating disorders – for better or for worse

Why do you read? Maybe you read to relax after a long day, to learn about unfamiliar people or places, to make you laugh or to let you dream. Maybe you never really ask yourself why, but turn to books out of some vague instinct that they’re what you want or need.

The question of why humans invest such a lot of time and other resources in reading is an interesting one for researchers of both minds and texts, especially when it comes to fiction and poetry, where the answer doesn’t seem as obviously pragmatic as just learning useful facts. Whatever the answer is, it promises to tell us as much about human nature as it does about literature.

For decades now, researchers in cognitive literary studies have been suggesting reasons for why we read fiction. The dominant thinking is some variant on the idea that reading (especially reading narratives, often fictional) is pleasurable because it serves some evolutionarily adaptive purpose, in particular by giving us the chance to hone cognitive skills of one kind or another, free of real world risks. One strand of the general idea that narrative reading may increase our “fitness” is that it may quite literally help us be healthier.

Self-help books are an obvious place to start. There’s a growing body of research on “self-help bibliotherapy” (reading a self-help book, with or without some kind of formal guidance) which indicates that self-help books can sometimes be effective alternatives or supplements to other kinds of therapy.

But very little is known about whether readers respond in clinically relevant ways to poetry, fiction, or other narrative genres, such as memoir. The lack of evidence has not prevented a range of claims and theories from being proposed, and small-scale clinical uses of fiction and poetry by psychiatrists and psychotherapists seem to be fairly widespread.

So is the belief in art’s healing power just wishful thinking, or is there something to it?

Identification and insight

The focus of my work is eating disorders. To find out more about the effects of fiction reading in this context, I set up a partnership with the leading UK eating disorder charity, Beat. We designed a detailed online questionnaire to ask respondents about the links they perceive between their reading habits and their mental health (with a focus on eating disorders). The survey attracted 885 responses (773 from people with personal experience of an eating disorder).

We found that 69 per cent of those with personal experience reported seeking out both fiction and nonfiction to help with their eating disorder, and that 36 per cent had found the fiction or nonfiction they tried helpful. We asked people to rate the helpfulness and harmfulness of different types of text in relation to their eating disorder, and 15 per cent rated fiction about subjects other than eating disorders as more helpful than any other text type. At the same time, memoirs featuring an eating disorder were rated the most harmful text type, with fiction about eating disorders in second place. This suggests a complex set of effects.

How reading helps

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But how does reading fiction actually affect health, positively or negatively? The dominant theoretical view holds that therapeutic effects arise out of a process involving identification (with the character or situation in the text) followed by insight (into the nature of one’s condition). This is perhaps accompanied by some kind of strong cathartic emotional response, followed by a problem-solving stage in which the insights are converted into intentions for personal change. This type of model usually requires that texts should portray situations as similar as possible to the reader’s own, and that they should provide happy but realistic endings.

There are many reasons to question this model. If reading about someone the same as yourself is meant to be therapeutic, what makes it different from, say, rereading your own diary entries? Does the concept of similarity become self-limiting at a certain point, and if so, at what point? And on what dimensions (nature of illness, age, sex, socioeconomic status) is similarity most relevant?

There are also reasons to wonder whether insight is necessarily the main driving force for therapeutic change. In the case of chronic eating disorders, extremely high levels of insight are often coupled with a paralysed inability to act on that insight. So at least among long term sufferers, there may be a more important role for reading experiences that increase motivation or self belief for recovery, rather than providing yet more confirmation of the awfulness of the illness.

Mean impact on diet and exercise habits by fiction type and presence or absence of eating disorder experience

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Help and harm

The survey findings also direct our attention forcefully to the power of reading to do harm as well as good: one 18-year-old female respondent in recovery from multiple eating disorders described harmful reading matter as “reminding me of why I wanted to starve myself and reinforcing my irrational thoughts”. The testimony on the effects of fiction about eating disorders was overwhelmingly negative; 18 respondents also spontaneously mentioned deliberately “self-triggering”, or choosing to read books they knew would exacerbate their disorder.

Many respondents reported that their eating disorder encourages them to read in such a highly selective way that anything and everything can end up supporting the disordered mindset. Self-perpetuating feedback loops also seem to play a powerful role. If you’re feeling trapped by some aspect of an eating disorder (like low self-esteem), you might be more likely to read a certain type of text, or to read in a particular way (like zooming in on every association of thinness with something positive). This then makes you feel worse (maybe feeling instantly fatter or more determined to lose weight), which in turn encourages more unhealthy reading patterns. These vicious circles can be hard to break.

How reading harms

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But fiction reading seems to be one of the things that can break them. Fiction about something entirely unrelated to disordered eating can be stabilising and therapeutic in numerous ways. This can be pragmatic and embodied (allowing regular eating to happen, for example) or broadly existential: exploring alternative worlds, or reminding yourself that your life really could be different. A 27-year-old male in recovery from anorexia said: ”After reading sci-fi my mood is raised and I tend to feel more at peace with the universe, cognitively and imaginatively stimulated and inspired.”

So, next time you pick up a book, reflect for a while on your reasons for doing so. And think about whether, when you’re tired or stressed out or indeed more seriously unwell, you find forms of solace, healing, or inspiration in the apparently simple black marks on a white background.

Emily Troscianko is a knowledge exchange fellow at The Oxford Research Centre in the Humanities (TORCH), University of Oxford. This article first appeared on The Conversation (theconversation.com)