Journal of Mental Health

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“Reading maketh a full man”

Martin Guha & Lucy Seale

To cite this article: Martin Guha & Lucy Seale (2015) “Reading maketh a full man”, Journal of
Mental Health, 24:5, 257-260, DOI: 10.3109/09638237.2015.1078886

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ISSN: 0963-8237 (print), 1360-0567 (electronic)
J Ment Health, 2015; 24(5): 257–260
! 2015 Taylor & Francis, LLC. DOI: 10.3109/09638237.2015.1078886
EDITORIAL
‘‘Reading maketh a full man’’
Martin Guha1 and Lucy Seale2
1
Kings College London, Institute of Psychiatry, London, UK and 2Falmouth Exeter Plus, Falmouth, UK
The full quotation is ‘‘Reading maketh a full man; conference
a ready man; and writing an exact man.’’ If Bacon was right,
then a prescription for mental balance would be a judicious
combination of individual reading, group discussion and
accurate reporting. Perhaps reading a book about psychother-
apy, attending a Journal of Mental Health editorial board
meeting and then going home to write a book review would be
the Baconian recipe for sanity.
Group discussion has long been an established part of
psychotherapy, fully incorporated into a wide variety of
treatments. Autobiographical writing as a way of giving
meaning to mental illness has achieved some acceptance
(Mayes, 2011; Schon, 2009). Mental health professionals
have, however, been wary of self-help in general, appreciating
its benefits on the one hand, as ‘‘an approach where
individual strength is valued . . .; a belief which explicitly
promotes individual self-efficacy’’ but, on the other hand,
seeing it as merely an economic solution to volume and
demand: ‘‘a way to circumvent the professional skill short-
ages in psychological treatment.’’ (Richards, 2004). A meta-
analysis in Psychological Medicine asking why self-help is a
neglected field (den Boer et al., 2004) found that ‘‘self-help
strategies, both bibliotherapy and self-help groups alike, are
effective for various less serious complaints’’, but are still
very much under-utilised.
Even within the general field of self-help, the act of
reading seems to occupy a curiously low position. When this
journal published a special issue focussing on self-help –
Journal of Mental Health 20(6) 2011, virtually all of the
papers seemed more concerned with applications of infor-
mation technology (e-health), with the obvious exception of
the book review. Part of the problem is that self-help texts
vary very widely in quality. Bergsma (2008), for example,
found some that ‘‘effectively popularised insights from
psychological science’’, while others ‘‘could raise false
hopes or even do harm.’’ Similarly, Guha (2011) found some
books that provided ‘‘guidance that would help readers of
this journal in the difficult task of transforming themselves
from being providers of services to people in a state of
dependence into being supporters and advisers for people
who are trying to help themselves,’’ but others where ‘‘the
Correspondence: Martin Guha, Kings College London, Institute of
Psychiatry, Library, P018, De Crespigny Park, London SE5 8AF, UK.
E-mail: martinguha@phonecoop.coop
end result is rather a muddle,’’ and Redding et al. (2008),
analysing the top 50 best-selling self-help books, similarly
found huge variations in the overall quality: those books
which are rated most highly on their measures tended
to have a cognitive behavioural perspective, to be written
by mental health professionals holding a doctoral degree,
and to focus on specific problems. At the end of Redding
et al.’s measures were books which offered ‘‘potentially
harmful advice.’’ There is nothing to stop anyone from
writing a self-help book, and numerous people do. A search
on Amazon in April 2015 for ‘‘self-help’’ at http://
www.amazon.co.uk/s/ref¼nb_sb_noss_1?url¼search-alias%
3Dstripbooks&field-keywords¼self-help brought up a list of
75 pages of books, ranging from How To Love Yourself to
The Mindfulness Colouring Book (currently a non-fiction
best-seller) to Be Nice and Grow Famous. A considerable
proportion of the authors have ‘‘PhD’’ after their names or
‘‘Professor’’ before them, possibly indicating some level of
expertise, but some remarkably prolific self-help authors
either have no professional qualifications or do not feel the
need to parade them in front of potential purchasers. An
expert analysis of the therapeutic value of all the self-help
books on Amazon’s list might be an interesting research
project. Clearly, people are buying and reading these books.
There is therefore a substantial case for all therapists to
consider the self-help literature in their field, so as to have
book recommendations ready for inquiring clients, as well as
suggestions of useful web-sites, etc.
The value of reading, both as a means of absorbing
information about mental health and as a way of soothing the
troubled mind has, in fact, long been recognised. It is
interesting to note, for example, that the Journal of Poetry
Therapy (http://link.springer.com/journal/10938) has actually
been running successfully for longer than the Journal of
Mental Health. As far back as 1966 the Association of Hospital
& Institution Libraries, as the responsible division of the
American Library Association (ALA) adopted the definition:
Bibliotherapy: the use of selected reading materials as
therapeutic adjuvants in medicine and psychiatry; also
guidance in the solution of personal problems through
directed reading
which definition is still enshrined in the ALA’s website
(www.ala.org/tools/bibliotherapy). This has been followed up
258 M. Guha & L. Seale
by an array of professional publications, mainly of an
anecdotal or exhortatory nature.
Of these two separate strands of reading – reading as a way
of absorbing information about mental disorder and reading as
a way of soothing oneself – the former obviously predomin-
ates in professional eyes. A search for ‘‘bibliotherapy’’ in the
Psychinfo database (as at March 2015) brought up 471 hits, a
tiny number in comparison with most other forms of therapy.
Of these, 48 seemed to be connected with fiction in one form
or another, and 37 concerned poetry – a large proportion of
them from the Journal of Poetry Therapy, and most of them
more concerned with the therapeutic effects of writing it than
of reading it. (Much of modern poetry is what computer
professionals would probably refer to as WOM – Write-Only
Memory – no one else is likely to read it.) The other 386 hits
appeared to refer primarily to reading for factual self-help
information. Of the 48 that were concerned with fiction, it
was noticeable that the vast majority related to children and
young adolescents. It seems reasonable to assume that most
therapists occasionally read non-professional literature to help
them relax and to take their minds off their troubles. Reading
quite clearly can be a way of relieving emotional difficulties
in adults (Martensson & Andersson, 2015; Wang et al., 2013),
but therapists obviously do not think this a subject worthy of
study in anyone much over the age of 15. Even the American
Bibliotherapy Education Project (http://bibliotherapy.ehs.
cmich.edu/about.php) restricts itself to evaluating material
for work with children and adolescents.
There are innumerable published guides to fiction, both
on-line, for example, Who Else Writes Like (LISU, 2015) and
in print, such as The 100 Must-Read American Novels
(Rennison & Wood, 2010), but very few that take a
therapeutic approach. One of those that do, The Novel Cure
(Berthoud & Elderkin, 2013), was noted by our reviewer as
‘‘not an entirely serious volume (the entry for traffic warden,
being a refers you to nobody likes you which refers you to
unpopular, being which refers you back to traffic warden,
being a)’’ (Seale, 2014).
Literacy obviously makes self-help easier. There are
various studies linking both learning disability at one extreme,
and giftedness at the other, with increased emotional distress.
Harrison & Van Haneghan (2011), for example, found higher
levels of fear of the unknown, death anxiety and insomnia in a
sample of gifted adolescents than in a control group, and
included bibliotherapy in their suggested treatments, but there
is, as far as we are aware, no known correlation between
reading skills and the incidence of mental disorder. Non-book
media may play a role similar to books in self-help, ranging
from film (Dale et al., 2014; Sharp et al., 2002) to hip-hop
(Levy, 2012). One review even classified cinematherapy,
bibliotherapy and retail therapy together as recreational
therapies (Holmes-Layman, 2014).
Group discussions form an important strand in therapy.
Reading groups are popular cultural activities. Volpe et al.
(2015) found, however, that the evidence for reading groups,
specifically for patients with mental disorders was extremely
scarce, though their study showed that such groups could act
as valid rehabilitation tools.
The number of papers related to bibliotherapy has shown
an increase in recent years. This does seem to be part of a
J Ment Health, 2015; 24(5): 257–260
general trend: research by NESTA, the British innovation
charity, suggests that clinicians in general are becoming
increasingly keen on the ‘‘more than medicine’’ approach of
social prescribing (Langford, 2013), and more aware of the
value of self-help.
Library and information professionals have been running
bibliotherapy schemes in libraries for decades. These have
predominately been in public library settings, but there have
been some in hospital and academic libraries. The coverage of
these schemes in the academic and professional library
literature has been extensive, especially schemes in the United
States. A search of LISA (Library and Information Science
Abstracts) covering from 1969 to April 2015 returned just
under 600 results. A number of recent articles discussing
bibliotherapy projects, both within schools and in the wider
community, aimed at helping children and young people deal
with a range of issues, including bullying, lesbian, gay, and
transgender issues and natural disasters. Books are not seen as
a substitute for therapy but used ‘‘within the right context,
they can serve as valuable touchstones, conversation starters
and companions’’ (Moulton, 2014). A recent American study
examines how school and public librarians can select suitable
books to help combat bullying and improve the mental health
of teenagers as well as how they can make their libraries a
safe and welcoming space for children experiencing the
effects of bullying (Becnel, 2013).
McKnight (2014) conducted a comprehensive international
review of English-language publications on information
prescription programmes between 1930 and 2013. She
concluded that most of the literature is anecdotal, concerning
small pilot projects. Studies, in general, seemed to investigate
physician, patient and librarian satisfaction, but did not
usually measure changes in a patient’s knowledge of their
condition or changes in their behaviour.
Bibliotherapy schemes are becoming more popular in the
United Kingdom. Brewster et al. (2013) note that ‘‘biblio-
therapy is a cost-effective, non-medical resource that fulfils
current UK government agendas of improving well-being and
the importance of information provision and a life course
approach to dealing with mental health problems.’’
The current most widespread scheme in use in England,
Wales and Scotland is ‘‘Books on Prescription’’, which forms
part of the Reading Agency’s ‘‘Reading Well’’ scheme.
Approved by health professionals, this scheme is designed to
help individuals manage their mental health by reading
cognitive behavioural therapy based self-help books. Books
can be recommended by GPs and borrowed from public
libraries. This scheme is based on strong evidence from the
National Institute of Clinical Excellence (NICE) that self-help
reading can help people with common mental health condi-
tions such as depression and anxiety. (Reading Agency, 2013).
The research by Brewster et al. (2013) highlighted the
experiences of the users of this scheme: interviews with
participants showed that difficulties in reading and concen-
trating when depressed, for example, made books on how to
manage mental health difficult to read: escapist literature was
greatly preferable. Their exploration of the service-user
perspective lead them to conclude that there is a need to
create more service-user led models of bibliotherapy to
provide guidance on how to improve current schemes.
DOI: 10.3109/09638237.2015.1078886
Brewster et al. (2013) also note that in the current
challenging financial environment, it is important that
the role public libraries play in these schemes is recognised,
costed and valued. Indeed, it should be noted that the
public libraries are currently struggling in the face of local
government cuts. A 2014 report highlighted the fact that 324
public libraries have closed in the UK since 2011 and that
services in others have been drastically reduced (Clark, 2014).
Many public libraries now have no professionally-trained
staff in attendance, let alone staff with any training in the use
of therapeutic information sources. Similarly, in America
a number of authorities have closed libraries or have
reduced professional services (http://www.ala.org/search/
site/library%2520closure) and other countries are
facing similar problems. The answer to the question raised
by Brewster et al. (2013) ‘‘Do librarians understand ser-
vice-user perspectives on bibliotherapy’’ too often has to
be ‘‘No.’’
Macdonald et al. (2013) reported on the evaluation of a
scheme delivered via a Scottish local library with a
bibliotherapist on the staff, in conjunction with General
Practices, local social welfare agencies and through self-
referral. The Read Yourself Well (RYW) scheme was based
on the principles established from other similar schemes, as a
way of delivering support for adults experiencing mild to
moderate mental health problems for whom clinical treat-
ments are not appropriate. The intervention consisted of
initial referral and evaluation by the scheme bibliotherapist, a
one-hour session at the beginning and end of the intervention
where a purpose-designed questionnaire and two mental
health assessments were carried out (the General Health
Questionnaire and the Clinical Outcomes in Routine
Evaluation Questionnaire). Contact and support from the
bibliotherapist was provided during the intervention period.
One hundred and fifty-seven participants were recruited to the
evaluation, of whom 114 provided full data. Statistical
analyses of the mental health scores showed significant
improvements post treatment, for both male and female
participants, for all three referral routes, both for participants
who were previously library users and for those who joined
the library service in order to participate in the scheme. The
results of this large sample evaluation support the suggestion
that library-based bibliotherapy can be effective in the
treatment of mental health problems, with suitable profes-
sional support: librarians are there to give access to informa-
tion sources, not to advice on using them.
The growth of bibliotherapy schemes was reflected in the
recent International Bibliotherapy Conference in
Huddersfield: the ‘‘Well into Words: Using Bibliotherapy to
Enhance Wellbeing’’ conference was attended by over 70
delegates from different countries, aimed at anyone working
in health, social care or library services. Speakers and
workshop leaders included bibliotherapists, public health
directors, librarians and mental health professionals. The
conference tried to examine what bibliotherapy is, how it
applies to the health and wellbeing agendas of the organisa-
tions in a number of sectors and to explore the possibilities of
partnerships with others who are already running or are
planning to run a bibliotherapy scheme (Kirklees Council,
2014).
Reading maketh a full man 259
The forthcoming (July 2015) annual conference of the
UK’s Chartered Institute of Library and Information
Professionals will feature a paper by one of the organisers
of the Huddersfield conference, entitled ‘‘The value of
bibliotherapy in libraries’’. Julie Walker’s presentation will
‘‘demonstrate the impact of bibliotherapy in libraries in
particular, the impact it can have on its beneficiaries, the
value of this work in terms of an aid to recovery and
redressing the inequalities and stigma associated with mental
health issues in particular.’’ (Chartered Institute of Library
and Information Professionals, 2015).
The whole field of self-help is changing rapidly with the
spread of new technologies. e-Health has clearly become a
generally accepted part of therapy (Schmidt & Wykes, 2012).
It is worth noting that one Australian study found no
significant differences between the effectiveness of biblio-
therapy and of internet-administered cognitive behaviour
therapy (Wootton et al., 2013). Wicks (2012) has suggested
that the e-medium has reached maturity. This is quite clearly
not true: there are still substantial numbers of people who are
unable or unwilling to make use of such services (Ennis et al.,
2012), and the technology is changing so rapidly that detailed
description of information services such as Harrison &
Goozee (2014) can be obsolete within a year or so of
publication. Learning how to update your learning skills is
becoming an increasingly important skill in itself
(Lipczynska, 2014). It is arguable that people suffering
from depression or low self-esteem are less likely to acquire
this skill, along with elderly and learning-disabled people.
There is some alarmist literature on the deleterious effects
of the social media (Cammack & Kerry, 2013; Krishna et al.,
2013; Weigle, 2014a), as well as literature on social media as
possible aids to diagnosis (Park et al., 2013) and as
therapeutic tools (Musiat et al., 2012; Schmidt & Wykes,
2012).
Therapists is only beginning to adapt to technological
change. (It must be born in mind that, well within the
professional lifetimes of older therapists, anyone who wan-
dered around having a loud conversation with a piece of wire
hung round her neck, or who pulled a random object from his
pocket and gazed at it for hours while tapping on it
obsessively, would have been regarded as being in need of
treatment.) In an important study, Kanai et al. (2012) found
unequivocal evidence that using more of social media reflects
in changes in human brain structure. This is undoubtedly
leads to changes in mental processes, bringing new challenges
for therapists (Weigle, 2014b).
Anecdotal evidence suggests that readers feel very differ-
ently about physical books and book on e-readers. As far as
we are aware, however, there is, as yet, no evidence to suggest
that e-books are more or less effective as therapeutic tools.
Some research might be useful. In the meantime, as
encouraging self-help is gaining increasing professional
recognition, bibliotherapy – the art of guiding readers to
books which might help inform them about diseases and
disorders, books which might have a therapeutic value and
books which may comfort and sustain, seems likely to grow in
importance. Even in the face of the growth of social media,
many of us seem likely to continue to seek information,
comfort and solace by curling up in a nook with a book.
260 M. Guha & L. Seale
Declaration of interest
The authors report no conflicts of interest. The authors
alone are responsible for the content and writing of this
article.
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