is U. S. health care, writing is free. You only need pen / pencil and paper, or a computer. No judgment. No driving. No barriers other than time. We can write every day or sporadically, resuming with no cancellation fees. But consistency lets us harness writing’ s linear dose-response relationship.
Keystone habit
Aristotle explained virtue( aretē) as a character trait developed through practice; one must consistently choose virtuous actions until they become natural. He considered courage the highest virtue, as it enables that choice to be made consistently over time. Courage lets you face the inevitable obstacles to developing the other virtues. You need courage to buck the system. You need courage to become what Pilar Gerosimo calls, in a book of the same name, a“ healthy deviant.”
In the same way that courage enables other virtues, writing is a healthy behavior that begets other healthy behaviors, a so-called“ keystone habit.” Writing exposes motivations unknown to our conscious minds. It places a spotlight on how we spend our time. It allows us to reflect on the current state of our lives, how we got to this point and where we want to be in the future. Other lifestyle changes do not do this.
Much of the benefit of writing comes from remodeling one’ s interpretation of the past. In our offices, exam rooms and even ORs, we bear witness to patients’ unfiltered personal stories. Sometimes we ask for them, sometimes we don’ t. We hear narratives of hope, despair, tragedy and comedy. We encounter patients with life struggles that don’ t resolve with pills and procedures. We need better tools.
Decades of research, building on the work of James Pennebaker, PhD, demonstrate improvements in psychological and physical health through expressive writing. Pennebaker noticed something when conducting lie detector tests for court cases. Defendants looked distraught during exams as polygraph needle bounced wildly on the paper. When Pennebaker later interacted with those same people, many sentenced to prison time, they looked completely at ease. No longer holding in secrets, they felt relieved, even in the face of looming punishment. Maya Angelou captured this“ lie detector phenomenon” succinctly:“ There is no greater agony than bearing an untold story inside you.” Hemingway knew how to let it out:“ There is nothing to writing. All you do is sit down at a typewriter and bleed.”
Stories
I ended The Phoenix Club( a book of addiction redemption stories) with a chapter on how to“ Change Your Story.” You can read it at the Substack link in the references. It covers the highly replicated science behind expressive writing. Writing moves trauma from the mind-body onto a page. You have seen the weight lifted off patients when they disclose. By calming the nervous system, disclosure leads to health benefits: improved mood, fewer visits to the doctor, less workdays missed and better immune function.
Writing improves self-regulation, insight, meaning and gratitude. College students who participate in writing exercises get better grades. Unemployed subjects who write are more likely to obtain jobs. Writing benefits people who struggle with anxiety, PTSD, stress, asthma, chronic pain, cancer, HIV, cystic fibrosis and sleep disorders. Writing frees up processing space in the brain, like cleaning a computer hard drive. Slowing down our thoughts facilitates problem solving by widening attention, letting us search for solutions with a flexible mindset.
The more clearly we envision a future self, the more likely we are to become that person. In experiments, subjects who write about their future health exercise more. When they write about a financially secure future, they save more money. Imagining a happy future self makes you happier.
AI Digression
A recent YouTube video discusses a ChatGPT-created review of a Martin Amis novel. The host,“ Jake,” rants against“ AI slop,” the generic, homogenized output from large language models( LLMs) that sounds fancy but says nothing. AI writing creates a feedback loop that erodes originality, voice and meaningful thought. Writing is a desirable difficulty, but we cheat ourselves when we outsource that hard work. Despite how impressively LLMs can wordsmith, Jake professes hope for the future of real, gritty human writing. He asks his audience,“ Who is it [ AI slop ] for?”
I want to extend that questions to,“ Who is writing for?” I think writing is mostly not for the audience. Some people never show anyone their writing. Even successful authors write mostly for themselves. Novelist Neal Stephenson admits that“ Writing fiction every day seems to be an essential component in my sustaining good mental health. If I get blocked from writing fiction, I rapidly become depressed, and extremely unpleasant to be around.” Over 900 PubMed studies on expressive writing prove that Stephenson has stumbled upon a mental health effect that we must teach our patients.
Action
Here is the hard part. Patients don’ t want to write. Nor do they want to exercise, eat clean, meditate, prioritize sleep or take mental breaks, at first. But if we convince them of the benefits, and they build momen-
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