Josie Billington, Is Literature Healthy? (Oxford: Oxford University Press 2016) 145pp. £14.99 Pb. ISBN: 9780198724698
In the concluding pages of Is Literature Healthy? Josie Billington states that ‘literature and literary reading are possibly the best forms of thinking that humans in need or trouble will ever have’ (134), and certainly the book offers a very thorough and convincing account that persuades us that this is, even if only minimally, the case. The title is slightly misleading in its implication that literature itself may be classified as either healthy or unhealthy, and that the discussion will focus on such a debate. In fact, Billington’s views on this are made clear in the introduction: ‘the chief contention of this book is not just that literature is too often what is missing from medical syllabuses and from theoretical approaches to the arts. It is missing most worryingly from life, from our normal ways of thinking’ (10); it is, therefore, for Billington, a decidedly salubrious entity. The author goes on to state that her concern is with the ‘usefulness’ (10) of literature, and the text proceeds to examine the pragmatic functions of literature in relation to health, but, importantly, without thereby reducing its scope, mystique or aesthetic appeal.
The introduction cashes out Billington’s suggestion that literature ‘is missing […] from life’ in a number of ways. She discounts the rationalist suggestion that literature ‘can appear a merely soft and weak thing, with no relation, or contribution to make, to “robust” knowledge’ (5), and turns to Johanna Shapiro’s theories on the importance of literature to the ever-growing field of medical humanities. For Shapiro, poetry engages with that affect which cannot be expressed in explicit terms, and, in this way, works beyond the bounds of clear-cut post-Enlightenment logic. Subsequently, she argues, such an approach can help to provide a range of angles, beyond the merely rational, for apprehending and engaging with questions and issues that arise in the world of medicine, for example the doctor-patient relationship. Billington frames the introduction specifically in terms of how literature might serve those suffering from depression, and, has good reason to do so, as she cites the World Health Organisation’s statistics that predict that ‘[o]ver the next two decades, depression is set to overtake every other major health problem, including heart disease and cancer.’ (1) Whilst there is no questioning the worthiness of pushing the question of depression to the forefront, parts of the book tend to veer off this specific focus without always explaining this change in direction. Moreover, assumptions such as the claims that depression is ‘common to us all’ (2) and that it is ‘[t]he medicalization and over-diagnosis of normal human nature’ (2) unfortunately do not consider the deeply disputed status of the ‘“disease entity”’ of “depression”.1 At times, Billington therefore presupposes a rigid conception of illness that does not hold enough weight. But, in spite of this, the introduction is generally very lucid and succinct in establishing the vital questions of how literature might serve a pragmatic function in relation to health.
The first chapter of the book is entitled 'Healthy and Unhealthy Thoughts', and in it Billington argues that if we accept that ‘“depression” ’ conceptualised as an illness is actually ‘on the normal spectrum of human unhappiness’, then we can also consider that there may be ‘a “disability” hidden behind depression which is possibly the secret cause of its felt want of a sense of meaning.’ (13) This is subsequently explained in terms of the psychoanalyst Wilfred Bion’s distinction between “thoughts” and “thinking”, where thinking is a specifically reflective process, whereas thoughts ‘happen prior to thinking’. (14) For Bion, ‘[i]n the unhealthy [or depressed] psyche, thoughts are evaded, ejected, or stored as inert, undigested facts and symptoms’ (15). In this way, suggests Bion, we are engaging in forms of ‘“not thinking”’ (13); we suppress our reflective capacity. As the chapter progresses, Billington contends that conventional varieties of thinking, such as ‘“positive thinking”', are, counter-intuitively, in fact ways of ‘not thinking’ (17). She proceeds to claim that Bion’s theory here may help us to ‘unlock how literature might aid the difficult task of real thinking.’ (17) Again, while Billington’s key contentions are intricate, clearly delineated, and indeed very original, there is again a slightly uncomfortable encounter with terms like ‘real thinking’, which appear as somewhat too axiomatic to fully convince. It is possible that such terms are intended to specifically relate to Bion’s theory, but this is not always clear. The rest of the chapter employs close reading techniques to elucidate how literature might stimulate ‘real thinking’. Perhaps the most interesting example of these is Billington’s discussion of ‘literature’s power to hold thoughts which humans feel it would almost kill them to contain in themselves.’ (31) On this model, literature becomes a proxy for Bion’s 'thinking' that allows humans to engage in the thinking that would otherwise be suppressed: ‘literature can “think” reality when ordinary human thought falls short’ (44).
‘Telling a New Story’ is the second chapter and it has at its heart the concept of 'narrative-based medicine'. Billington carefully sketches out the history of this movement, considering the significance of its veritable founder: the GP and psychotherapist Michael Balint. Balint studied the doctor-patient interaction and patients’ modes of explaining their ailments and problems to their doctor. He concluded that, and subsequent proponents of narrative medicine argue that, ‘without the inclusion of the patient’s subjective dimension, the reliance on objective explanation alone is unscientific.’ (57) A particularly incisive element of this chapter is the alignment of the figure of the doctor with that of the novelist. Indeed, Billington suggests that, by repositioning the importance of the patient’s subjective narrative, doctors ‘in the narrative medicine movement’ are ‘novelists of practical life – inhabiting the same intractable areas and using what is sometimes over-narrowly thought of as literary thinking in non-literary settings.’ (62) This chapter goes from strength to strength in the subsequent section, which is sub-titled: ‘Against Narrative?’ Here the author is rigorous in her examination of narrative medicine’s elevation of the concept of subjective narrative, and she is meticulous in her debunking of assumptions that narrative is a straightforward concept and tool. Invoking important philosophical evaluations of narrative, such as Galen Strawson’s 'Against Narrativity', Billington draws our attention to the risk of the reliability of patient narratives and their conception of their stories. Furthermore, she pinpoints a significant nuance in Balint’s theory: ‘Balint’s key instruments for finding the patient’s personal reality – “listening” and, especially “atmosphere” have become aligned with the concept of narrative; as such, ‘an impoverished and over-simplified definition of narrative comes to stand for all.’ (69-70) The author goes on to cite the technique of free indirect discourse and the genre of poetry as examples of how literature can serve a palliative function without having narrative certainty, and it is worth noting that her close analysis of the poetry and letters of Elizabeth Barrett Browning is excellent in illustrating the curative power of a literature that abandons any definitive concept of an over-arching personal narrative.
The third and fourth chapters of the book: ‘Reading in Practice’ and ‘Reading for Life’ have a more practical emphasis. Chapter Three discusses the role of reading groups set up by Billington’s research centre CRILS (the Centre for Research into Reading, Literature and Society), and there is a particular exploration of how reading aloud helps those suffering from illness. Billington provides the example of one man suffering from depression for whom ‘[t]he language of support groups was of little use.’ (91) Instead, Billington states, he required ‘a language to describe subjective experience’ (91), which Billington aligns with the language of certain literature. Her reasoning for this is that ‘[l]iterature is the one area of our inherited culture which does seriously explore the inner life.’ (91) Crucially, Billington argues that, unlike therapy such as CBT, reading literature can produce ‘the activation of good moments […] because neither the book nor the reader has set aims or outcomes in mind.’ (105) In this way, Billington positions literature as providing relief for pain in a more organic way than conventional therapy groups. This is a particularly original and acute line of argumentation, only slightly weakened by the recurrent reference to ‘the inner life’, which recalls dichotomies of body and mind, and which could account more for the importance of recent theoretical accounts of the embodied mind. The final chapter, ‘Reading for Life’, turns towards the practical implications of the usefulness of the discipline of medical humanities for university English departments. ‘Existing between arts and science, and between the academy and the world, medical humanities is uniquely positioned to re-humanize literature by getting out of its stuckness within a discipline and by renewing its original purposes as a help for people in trouble.’ (115) This normative recommendation for the function of literature is reiterated throughout the chapter, and Billington suggests that literature within the academy is too focused on theoretical concerns, which relegates ‘the powerful emotional place […] summoned by the literary work’ (134) to the back of the queue of scholarly relevance. Billington then makes the stronger claim that ‘English Literature departments […] sometimes can be, the places where literature has become most alienated from its human origins’ (134). She concludes the chapter by justifying the impetus for more reading to take place beyond universities, but, judiciously, cautions against the ‘packag[ing] [of serious reading] as [simply] a cure [or] “bibliotherapy”.’ (136)
Overall, Is Literature Healthy? contributes a highly original, succinct and probing analysis of how literature might be reconceptualised as an aid to turn to in times of human struggle and difficulty. In spite of occasional tendencies to generalise or lean on dichotomies of inner and outer worlds, this relatively short book covers a great deal of ground, making reference to key theorists within the field of medical humanities, as well contributing numerous original and rigorous arguments to the critical discussion of whether literature possesses a palliative function. Billington’s close analysis of primary texts is impressively detailed, precise and thoughtful, and yet is also crucially accessible to those who may approach this book from a non-academic background. In her introduction Billington states that ‘[t]he key concern for this present book is not knowing where to place reading in the modern world’ (7); this thorough overview of literature’s (often untapped) potential in promoting better health does an excellent job of setting down at least some of these unknown coordinates.
Emily Chester, University of Bristol
1 Lennard Davis, Obsession (London: University of Chicago Press, 2009), p 211