Prescribed Print: Bibliotherapy after Web 2.0

When the organizers of this cluster asked us "how have paraliterary genres reframed 'the literary,'" it was hard not to hear echoes of other paras: paramilitaries, -medics, -legals. That the literary-critical profession depends on its shadowy "para" every bit as much as do governments or health systems or law firms is one of the takeways of Merve Emre's eponymous 2017 polemic Paraliterary: The Making of Bad Readers in Postwar America. As an English professor sick of reading Shakespeare sonnets at friends' weddings, I learned from Emre to listen to the "bad" readers who lurk just outside every classroom — and, perhaps, even for the bad reader who lurks inside every off-duty literary critic.

Bibliotherapists, in contrast, enlist non-literary professionals to act on the premise that books are good for you — a premise proclaimed with special authority by academics outside of English departments. Around the turn of this millennium, as scientific journals migrated online, their index entries on "reading" ballooned. Cognitive scientists, neurobiologists, epidemiologists, and statisticians vied to compare print-reading with screen-reading, book-reading with magazine-reading, fiction-reading with non-fiction-reading, literature-reading with the reading of whatever genres they identified as antonyms to the literary.

Thus literary fiction garnered testimonials from an unlikely quarter: science.1 Or more precisely, Science. In 2013, that journal published a study concluding that reading about fictional characters correlates with a more sophisticated theory of mind across tested subjects. More specifically, reading about characters in formally ambitious fiction did. The authors discovered experimental subjects to be better at identifying the emotions expressed on faces or at understanding others' false beliefs when they had just read prizewinning short stories than when they had just read less aesthetically ambitious popular stories.2 This latest version of the centuries-old attempt to distinguish trashy escapism from intellectually challenging and therefore morally respectable narrative was widely reported by journalists with their own investment in reading.

Neuroscientists drilled down, wedging readers inside fMRI scanners to measure novels' effect on "brain function and structure."3 Social scientists scaled up: psychologist Steven Pinker's 2011 book The Better Angels of Our Nature correlated a centuries-long decline in violence with an increase in fiction reading. Some studies measured effects on health; others on wealth; yet others on civic virtue. Back in 2004, data aggregated by the National Endowment for the Humanities suggested that Americans who read outside of work and school were likeliest to vote and volunteer. Four years later, a meta-analysis connected the frequency with which Canadians read books to the rate at which they donated and helped their neighbors.4 Also in 2008, a British study correlated pleasure reading inversely with divorce.5 Madame Bovary would have been surprised.

The questionnaires behind these studies asked about wanting to read and about acting on that desire. Their subject, therefore, was the choice of reading more than the act of reading itself. Whereas the Science study concerned identification with fictional characters, these social-scientific studies concerned identification as a reader. Conversely, even those lab interventions that pinpoint the neural mechanisms attending reading pleasure have little to say about pleasure reading. A letter announcing a lottery win wouldn't count as "pleasure reading" by the NEH's definition, which makes enjoyment mutually exclusive with grades or pay. The corollary seemed to be that a novel assigned in a course or the notetaking performed by the teacher who assigns it constituted reading for pain.

Beyond the classroom and the office, longform reading has become the domain of very young and very old Americans, replacing the middle-class women whose time was once of equally little value. In the lab, though, college students paid by the hour to act as research subjects read for work and school at the same time. Ergonomically, too, these 18-25-year-olds are anomalies, cramped flat in an apparatus rather than curled up with the proverbial book or goosenecked over a smartphone.

As the scene of reading shifts from library to lab, advice about what to read and why emanates from a new set of disciplines. Whereas once literary criticism aspired to fashion its own methods into a science, it's now likelier to outsource rigor. Invoking cognitive scientists' findings about the literary texts that form our object of study risks reducing us to curators of bibliotherapists' raw materials. Those therapists challenge the binary distinction between professional and amateur reading elsewhere critiqued by Melanie Micir and Aarthi Vadde in that they are neither professional literary critics nor amateur literature-lovers.6 Rather, they're professionals whose invocations of literariness enables activities adjacent or even antagonistic to literary analysis.

The Theory of Mind study focuses on genre. Other research shows more interest in delivery device. A lab intervention measuring melatonin levels, for example, found offline e-ink reading (as on an earlier-generation Kindle) to have more in common with print than with the use of blue-lit phones. Still other researchers consider the medium alongside the message. A study comparing three groups of teenaged girls — those assigned a book about healthful eating, those given a book on another topic, and those not asked to read at all — found not just that the first group ended up with a healthier body-mass index than the second, but also that the second fared better than the third.

Whether you read has consequences for your body and the body politic, these studies suggest — but so does what you read about, in what linguistic register, on what device, at what length. In 2016 a team of epidemiologists correlated reading with longevity. This held even after correcting for the fact that readers skew rich, white, and female — and more specifically that in the US as in other high-income countries, digital media have done nothing to change the several-centuries-old fact that men read less overall but read a higher proportion of short-form news than do women.7 Plotted against life expectancy — after correcting for gender — news-reading turned out to fall somewhere between reading books and not reading at all. Like Tess McNulty's argument that content can't be disentangled from medium or platform, these studies suggest that the relation between the what and the how of reading is changing before our eyes.

As striking as what the researchers considered is what they didn't. These weren't books about characters living to a ripe old age, or even gory depictions of smokers' lungs. Nor did the blue-light study distinguish Goodnight Moon from Gone Girl. When a study of teenagers finds that "major depressive disorder is positively associated with popular music exposure and negatively associated with reading print media such as books," (my emphasis)8 or when readers' heart rates and muscle tension are measured to prove books "68% better at reducing stress levels than listening to music,"9 the researchers don't ask about the words contained in either.

In that sense, neuroscientific studies of reading are a branch of what Jessica Pressman calls "bookishness."10 A formalist interest in medium (whether the bookish or the printed) at the expense of message sets those research studies apart from the largest effort to translate research on reading into policy. That effort goes by the name of book prescription.

In 2005, a Cardiff psychiatrist named Neil Frude saw his patients waiting months to be prescribed antidepressants, and years to receive talk therapy. He noticed, as well, that they were filling those days and months of waiting with furtive forays to the self-help section of the bookstore, or, in the privacy of their local library, with what was then coming to be known as Googling. Of the more than 100,000 books on sale that offered psychiatric advice in layman's language, at least some seemed to help. If randomized trials could identify which books those were, Frude realized, doctors without specialized psychiatric training would be able to recommend them.

Soon, "recommend" ratcheted up to "prescribe." In NHS Wales's Book Prescription program, any primary-care physician who diagnoses "mild to moderate" depression can scribble a title on a prescription pad. The patient takes the torn-off sheet not to the pharmacy but to her local library, where it gets exchanged for a copy of Overcoming Depression, The Feeling Good Handbook, or Mind Over Mood.

By 2011, doctors in Wales were issuing 30,000 book prescriptions a year. Whether or not those books were ever opened, many of them at least got as far as the circulation desk. By 2013, a third of libraries' top ten most borrowed titles were self-help books.11 A public library system suffering even more drastic budget cuts than the health service were in no position to turn away the foot traffic, funding, and legitimacy that Book Prescription supplied. No wonder that in 2013, Books on Prescription began to spread beyond Wales. England's Reading Well initiative was launched by a nonprofit rather than its own health service, but the doctors who participated were paid by the NHS. Within three months, English libraries had lent over 100,000 copies of the prescribed titles — 20,000 more than Fifty Shades of Grey.12 Book Prescription finds its trickle-up equivalent in private bibliotherapy. At London's archly-named School of Life, two self-proclaimed bibliotherapists named Susan Elderkin and Ella Berthoud scribble faux prescription pads with recommendations ranging from the allopathic (racing through a nail-biter like The Postman Always Rings Twice heals apathy) to the analogic (short stories treat diarrhea). More simply, patients can identify with similarly suffering characters. You get toothaches; so does Count Vronsky.

While self-help books provide a cheaper alternative to face-to-face treatment, "biblioconcierges" (the 2014 coinage of an American imitator) emerged on the contrary as an upmarket alternative to what librarians have long done for free. And then there are the hidden costs. "Buy The Enchanted April," Elderkin and Berthoux's bibliotherapy manual commands,"then book a villa in Tuscany and read it on the way out." If making your own reservation proves too onerous, its authors will chaperone you and your airport novels to a 1600-pound oceanfront "bibliotherapy retreat." This kind of bibliotherapist sounds more like a sommelier than like a doctor — "therapy" as in "aromatherapy," not as in "chemo."

Bibliotherapy can be top-down — prescriptive in the most literary sense. It can also be consumerist — the librarian as public servant replaced by the private sector catering to the worried well-off. A more horizontal model, though, might cast book talk as a form of group therapy. Proofreading and uploading classic texts (Project Gutenberg), logging the location of book giveaways (Book Crossing), posting smartphone snapshots of bedside book piles (Bookstagram), participatory online projects bind readers together with the help of printed books.

Bibliotherapists often quote Kafka's ambition to make his books an axe to break the frozen sea within readers. A more accurate metaphor for their uses of literature might be an icepack. Carried captive by comfort: instead of inciting readers to rage (as a critic might done have a generation ago) against the patriarchal logic of the sonnet, a bibliotherapy course at University of Warwick instead uses poems to "calm" and "reassure" readers.13 What's therapeutic here is the reading of literature — but not literary reading.

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Leah Price teaches English at Rutgers. Her books include What We Talk About When We Talk About Books (Basic Books, 2019), How to Do Things with Books in Victorian Britain (2012), and The Anthology and the Rise of the Novel (2000).

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Keywords: bibliotherapy; literariness; medium

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