I didn’t need to become a psychology student to understand something I’d learned as a writer and reader, and as a colonial. Words can make truth, can let it pass or obstruct it. They can smother truth, too, which is very nearly the same thing as unmaking it. But as I delved into psychological science, I found that others shared my hunch. Perhaps a secret could make you sick.
Stress – the necessary kind, known as eustress – is vital to safety and growth. Eustress empowers the nervous system into useful reactions to life’s demands and it can, as they say, be ‘completed’. When stress hormone tapers off, our nervous system, returning to homeostasis, signals to our limbic system that the source of stress is over. After sighting a snake or giving a poetry reading, we can reinforce this signalling in conscious ways – a bit of exercise, laughter or dancing, a stiff drink that relaxes vigilance.
At the pointier end of the stress continuum are distressing and traumatic experiences. In our social worlds, these are often experiences we associate with shame and stigma. Over the long term, the cognitive and physiological efforts of inhibition and avoidance of disclosure are significant forms of stress. This chronic stress includes symptoms like immune suppression and raised blood pressure, which are some of the many risk factors for Alzheimer’s Disease, among other things. It’s long been known, however, that disclosure of distress, in any form, is healing. What about writing?
Throughout the 1980s and 1990s, social psychologist James W. Pennebaker’s experimental research with expressive writing introduced new evidence that psychology couldn’t ignore – and hasn’t yet fully explored. Pennebaker had been looking into how environmental or situational factors influenced physical symptoms, when he found that the research participants who suffered from symptoms most were those who kept trauma secret. He developed a hunch that any form of chronic inhibitory effort is stressful and could produce immune and physical symptoms.
At that time, most studies of disclosure had been done using writing, so Pennebaker built on these, measuring markers of general health in individuals before and after short stints of written disclosure. Randomly assigned groups of participants were instructed to write on prescribed topics over 3-5 consecutive days for short periods up to half an hour. The experimental group was told to write on one or more topics that related to upsetting emotional experiences from their lives. The control group wrote under the same conditions on superficial topics. All deposited their writings into a sealed box and were told the contents would remain confidential. Prior to the experiments, many of Pennebaker’s participants showed signs of what he called secretive stress, including elevated heart rates and suppressed antibody levels. He found that those in the experimental group who wrote about distress or trauma for 15 minutes over 4 days showed reduced health centre visits and improved immune markers over subsequent months. Pennebaker also found that those who showed the greatest physical improvements were the ones whose writing had developed, from poorly organised thoughts to statements of causality and insight, over the period of the study. While Pennebaker never proved his inhibitory stress theory, and he later critiqued the validity of those initial studies, what his experiments revealed was a cognitive model of expressive writing that has since become well developed and evidenced as a therapeutic treatment.
Putting thoughts and feelings about distressing and traumatic experience into writing takes different clinical forms. Pennebaker’s expressive writing model is distinct from journalling used in cognitive-behavioural therapy, where the goal is to log and connect unwanted thoughts to emotions and behaviours. In expressive writing, the aim is for the writer to openly acknowledge and accept their emotions and memories, to give voice to avoided feelings, and to construct a meaningful story of their experiences. Expressive writing is also distinct from autobiographical therapy, which uses guided narrative structures and the full life story. In Pennebaker’s model, the frequency and timing of writing is limited and measured. The writing may or may not be read by the therapist. While the technique is often combined with talk therapy, only slightly better outcomes have been found to result from the combination in comparison to expressive writing used on its own.
In expressive writing, the cognitive process of putting thoughts and feelings into language is key. Not everyone can or will talk about emotionally intense experiences. The contained and procedural approach of written disclosure, for example, seems to be very helpful to those for whom emotional articulation doesn’t come easily (a condition psychologists call alexithymia). The effects of written expression have been found to be comparable to oral expression, but it hasn’t yet been proven whether the degree of privacy afforded by expressive writing makes a difference to the therapeutic outcome. Perhaps imagining a sympathetic reader, a witness, is enough to deflate shame and fear of stigma. So far, it’s been found that men raised in Western cultural contexts of masculine stoicism and hostility are the greatest beneficiaries of expressive writing.