Literary genres used in medicine are multiple and versatile, there are also various methods of using literature.

Genres:

• Autobiographies and memoirs by patients, carers, family and physicians
• Self-help books
• Poetry
• Fiction
• Research works about applications and effectiveness of literature in medicine

Methods

• Books sought out autonomously
• Through physician’s recommendation, coupled with reflective discussions (McCullis, 2012)
• Literature electives incorporated into medical curriculum
• Reading groups and workshops (Longden et al, 2015) (Ratcliffe, 2016)
• Apart from reading literature, people also use creative writing to illuminate the patient experience (Aronson, 2000). This does not exclude writing about other forms of art (O’Neill, 2010) (Harris, 2002-2004)
• Literature obtained through search engines and reading lists

Benefits

• For patients: Can be autonomous in managing their problems. (McCullis, 2012) (HSE, 2017)
• For doctors: Act as a tool for reflective practice and clinical empathy-contemplate role and implications of medicine, understand the social interactions between doctors and society. (Oyebode, 2010) (Charon, 2001)
• All readers: personal development and wellbeing. (McCullis, 2012)
• Gain insight into the experiences of others, the stress of the physician, the frustrations of the patient, the isolation of carers and families etc…(Oyebode, 2010) (Billington, 2016)

As we all know, many authors have described the use of literature in reflection about self, the practice of medicine, the patient experience and the therapeutic use of literature. Many efforts were put into identifying useful texts for busy clinicians. There are several genres of literature used in medicine.  One approach may be the use of self-help books which are either recommended by doctors or independently sought out by patients. Other approaches may include autobiographies of the illness experience, which help readers, physicians and patients alike, to gain insight into subjective nature of the illness experience. Apart from reading literature, people also use creative writing and literature to illuminate the patient experience; the list about applications of literature can go on and on…There is also research around the effectiveness and different applications of literature in medicine.

Narrative medicine was introduced as a humane model for medical practice which requires narrative competence: “the ability to acknowledge, absorb, interpret, and act on stories and plights of others”. One of the methods to achieve narrative competence is through close reading of literature. This form of practice seeks to build a more empathic engagement between patient and physician, hence achieving a more productive therapeutic interaction (Charon, 2001). Not only that, reading literature can spur critical and creative thinking about the role medicine can play in contemporary culture (Oyebode, 2010)

Reading autobiographical accounts of the illness experience reminds physician readers about the unique individuality of the patient amidst the waves of objective biomedical reports (Oyebode, 2001)(Aronson, 2017). Reading these autobiographies allows readers to gain insight into the experience from the author’s point of view; in other words, to gain experiences without living through them. Consequently, this knowledge allows readers to have a greater capacity for empathy towards the people involved, patients and doctors alike, as well as being informed about how to behave appropriately around them. Apart from autobiographies, fiction also plays a role in reflective practice. It gives readers the unique opportunity to contemplate unconventional ideas, explore unusual scenarios and implications in medicine (McFarlane, 2017).

Close reading of literature can be done individually and autonomously by both patient and physician readers. In addition, patients who are prescribed bibliotherapy are encouraged to discuss about the reading experience with the physician.

In conclusion, literature has an invaluable capacity to enrich medical education, clinical practice, and personal wellbeing. The field of using literature in health is a diverse area and as a clinician it can be hard to know where to start.

As starting points, participants in the project identified some of the text below about how people use literature

• Josie Billington, Is Literature Healthy? -the first book of the Literary Agenda series. The author provides an introduction of the medical humanities, explores the definitions of illness from various perspectives, and then contemplates models of literary reading.

• Borys Surawicz, Beverly Jacobson, Doctors in Fiction: Lessons from Literature -This book is a compilation of reflective notes by multiple physicians from reading specific literature, contemplating how people view the medical profession

• Femi Oyebode, Mindreadings: Literature and Psychiatry -This book explains what literature can do for medical education and practice, with a focus on psychiatry.

• Art and Images of Psychiatry -A webpage featuring a compilation of essays written by a Professor of Psychiatry and published in JAMA Psychiatry between 2002 and 2014. The author refers to specific visual arts pieces in each of his essays where he explores the role of creative art in representing health issues.

• Desmond O’Neill, All That Jazz (2010) -a review article about the musical drama film: All That Jazz, on how it provides insight into the experience of illness and suffering.

• Sophie Ratcliffe, The Poetry of Medicine (2016) -an original article about the literature workshops the author ran for NHS professionals.
  

• Rita Charon, Narrative Medicine: A Model for Empathy, Reflection, Profession and Trust (2001) -In this article, the author introduces a model for more humane medical practice and explains its benefits. 

• Charon, R., Banks, J., Connelly, J., Hawkins, A., Hunter, K., Jones, A., Montello, M. and Shapiro, P., Literature and medicine: contributions to clinical practice (1995) -a review about incorporating literary studies in medical education

• Seamus O'Mahony, Against Narrative Medicine  (2013) “This essay aims to provoke debate on how and what the medical humanities should teach. It argues that the field has been dominated (to its detriment) by two misguided movements, postmodernism and narrative medicine, and that it should be redirected from utilitarian aims towards the goal of exposing medical students to a climate of thought and reflection.”-abstract 

• Susan Arjmand, Using Narrative in Medical Education (2012) -this original article describes a course which aims to develop skills of narrative competence through literary texts and reflective writing. 

• Femi Oyebode, The Medical Humanities: literature and medicine (2010) -this article talks about using literature to emphasize the subjective experience of patients, thus enriching medical education.  

• Jeffrey K Aronson, Autopathography: the patient's tale. (2000) -a review article about patient autobiographies, termed ‘autopathographies’

• Anne Hudson Jones, Literature and Medicine: Narratives of Mental Illness (1997) -this article is about the expression of mental illness in literature 

• Deshpande, S. (2012). A Writer′s Look at Literature, Fiction and Mental Health. Indian Journal of Psychiatry, 54(4), p.381.

• Richmond, K. (2014). Using Literature to Confront the Stigma of Mental Illness, Teach Empathy, and Break Stereotypes. Language Arts Journal of Michigan, 30(1).

Burnout

• Ahola, K., Hakanen, J., Perhoniemi, R. and Mutanen, P. (2014). Relationship Between Burnout and Depressive Symptoms: A study using the person-centred approach. Burnout Research, 1(1), pp.29-37.

• Dyrbye, L., West, C., Satele, D., Boone, S., Tan, L., Sloan, J. and Shanafelt, T. (2014). Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population. Academic Medicine, 89(3), pp.443-451.

• Epstein, R. and Privitera, M. (2016). Doing Something About Physician Burnout. The Lancet, 388(10057), pp.2216-2217. 

• Lemaire, J. and Wallace, J. (2017). Burnout Among Doctors. BMJ, p.j3360.

• Schrijver, I. (2016). Pathology in the Medical Profession?: Taking the Pulse of Physician Wellness and Burnout. Archives of Pathology & Laboratory Medicine, 140(9), pp.976-982.

• Wren, B. (2017). As a psychologist for NHS staff I saw how hospital work takes its toll. The Guardian.

Schwartz Rounds

• Chadwick, R., Muncer, S., Hannon, B., Goodrich, J. and Cornwell, J. (2016). Support for Compassionate Care: Quantitative and qualitative evaluation of Schwartz Center Rounds in an acute general hospital. JRSM Open, 7(7), p.205427041664804.

• Health Management and Policy Alert. (2018). A realist informed mixed methods evaluation of Schwartz Center Rounds in England.

Inter-Professional Education

• Reeves, S., Pelone, F., Harrison, R., Goldman, J. and Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews.

• Ramai, D. and Goldin, S. (2013). Humanities in medicine: preparing for practice. Perspectives on Medical Education, 2(5-6), pp.332-334.

• Miller, E., Balmer, D., Hermann, N., Graham, G. and Charon, R. (2014). Sounding Narrative Medicine. Academic Medicine, 89(2), pp.335-342.

• Green, M. (2013). Teaching with Comics: A Course for Fourth-Year Medical Students. Journal of Medical Humanities, 34(4), pp.471-476.

• Bachmann, C., Barzel, A., Roschlaub, S., Ehrhardt, M. and Scherer, M. (2013). Can a brief two-hour interdisciplinary communication skills training be successful in undergraduate medical education?. Patient Education and Counseling, 93(2), pp.298-305.

The Royal College of Psychiatrists and other helpful websites identify useful resources for mental wellbeing. Several user and advocacy group also identify these. Below we have listed some of the supportive literature (books, poems and essays) identified by our conference participants.

Death and Grief

• Thomas Lynch, The Undertaking: Life Studies from the Dismal Trade -Work memoir of a funeral director

•  Seamus O’Mahony, The Way We Die Now -Doctor’s take on death and dying

Anger

• Warwick Pudney and Éliane Whitehouse, Volcano in my Tummy -Children’s book: a guide for children and adult carers to understand and manage children’s anger –age 6-13

Sadness 

• John Keats, Ode to Melancholy -a poem about the poet’s perception of melancholy, with references to ancient Grecian characters and ideals

Depression

• Jim Lucey, In My room (alcohol dependence, OCD, PTSD) -a psychiatrist’s reflective account of his patients’ journeys to recovery

•  Matt Haig, 12 Reasons to Stay Alive -Patient’s memoir and written guide for readers

•  Lee Brosan and Brenda Hogan, An Introduction to Coping with Depression -self-help book written by GPs

•  Christopher Williams, Roch Cantwell and Karen Robertson, Overcoming Postnatal Depression: A Five Areas Approach -CBT based self-help book co-written by mental healthcare professionals

•  Anne Sexton, Live or Die -a collection of poems depicting the author’s struggles with post partum depression and suicidal thoughts (individual poems available online)

•  Lloyd Tone, The Princess and the Fog -Children’s picture book about depression –age5-7

•  Shaun Tan, The Red Tree -children’s picture book about dealing with, and overcoming depression –age 7+

•  Roddy Doyle, Brilliant – children’s book: provides a child accessible explanation of depression and how to overcome it. –age 9+

Stress

• Jonathan Bate, Paula Byrne, Sophie Ratcliffe and Andrew Schuman, Stressed, Unstressed -an anthology composed by ReLit, a selection of classical poems for casual reading or stress relief

Panic

• Áine Tubridy, When Panic Attacks -a self-help guide written by a specialist doctor in psychotherapy.

•  Charles Young, An Introduction to Coping with Panic (2007) -a self-help book written by a practitioner

Mental Health

• Aquilina, J. and Vincent, K. (2011). Mindfields. Port Adelaide, SA: Ginninderra Press.

• Sederer, L. (2015). The Family Guide to Mental Health Care. W. W. Norton & Company.

• Letran, J. (2016). I Would, but my Damn Mind Won't Let Me. A Healed Mind, LLC.

• Lemaire, J. and Wallace, J. (2017). Burnout Among Doctors. BMJ, p.j3360. Available at: https://www.ncbi.nlm.nih.gov/pubmed/28710272.

Anxiety

• Gillian Butler, Overcoming Social Anxiety and Shyness (2009) -CBT self-help book for patients and carers written by a clinical psychologist

•  Ronald M. Rapee and Lisa Lampe, I Think they Think: Overcoming Social Phobia (2006) -a DVD-ROM type, self-help CBT guide developed by doctors

•  Virginia Ironside, The Huge Bag of Worries -Children’s book depicting the main character’s anxieties and how she faces them. –age 5+

•  Anthony Browne, Willy and the Cloud -children’s book about worry and anxiety –age 3+

• Bourne, E. (2011). The anxiety & phobia workbook. New Harbinger Publications.

Mental Illnesses

• Cunningham, D. (2011). Psychiatric Tales. 1st ed. Bloomsbury USA

Burnout

• Procter, A. and Procter, E. (2013). The Essential Guide to Burnout. 1st ed. First Edition 2013.

• Maslach, C. (2015). Burnout. Los ALtos, CA: Malor Books.

• Scott, S. (2017). How to Prevent Burnout. 1st ed. Filament Publishing Ltd.

• Book list about burnout https://www.inc.com/madeleine-dore/5-books-to-help-you-beat-burnout.html

• Quesada, D. (2011). Buddha in the Classroom. New York: Skyhorse Publishing, Inc.

Bipolar Disorder

• Kay Redfield Jamison, An Unquiet Mind -a clinical psychologists’ memoir about her firsthand experience of bipolar disorder

Cancer

• Ruth Picardie, Before I Say Goodbye: Recollections and Observations from One Woman's Final Year - a collection of narratives about the author’s experience with breast cancer. The book includes the authors published memoirs in a magazine, correspondence by friends and family, as well as reflections from the author’s sister and husband.

•  Arthur Frank, At the Will of the Body: Reflections on Illness –Author’s (medical sociologist) memoir about the transformation from person to patient through firsthand encounters with serious illness, heart attack and cancer.

•  Christopher Hitchens, Mortality - Based on the author’s columns in Vanity Fair that chronicled his year-and-a-half battle with esophageal cancer

•  Anatole Broyard, Intoxicated by my Illness - a collection of irreverent, humorous essays concerning the ordeals of life and death, many of which were written during the battle with cancer that led to his death in 1990.

•  John Diamond, C: Because Cowards Get Cancer Too-a journalist patients’ cancer memoir

•  John Diamond, Snake Oil and Other Preoccupations -a cancer patient’s "uncomplimentary look at the world of complementary medicine", the second half of the book features a selection of the author’s previous written works. 

Dyslexia

• Philip Schultz, My Dyslexia – the prize-winning poet author details the lifelong struggle involved.

Stroke

• Robert McCrum,  My Year Off – Author’s memoir about his recovery after a stroke

ALS

• Roni Rabin, Six Parts Love - a biography written by the author and his daughter about himself and their whole family from the time he discovered he had ALS (Lou Gehrig's disease)

• D. Rabin, P.L. Rabin and R. Rabin, ‘Occasional notes. Compounding the ordeal of ALS: Isolation from my fellow physicians’, N Engl J Med, 307.8 (19 August 1982): 506-9.-Reflections on the physician’s experience as a patient.

Schizophrenia

• Olivier Martini and Clem Martini, Bitter Medicine -a graphic memoir about a family’s experience of schizophrenia

• Verteuil-Holliday, C. (2016). Paradise plums and cocoa beans. 1st ed. Heddon Publishing.

Dementia

• Rachel Hadas, Strange Relation: A Memoir of Marriage, Dementia and Poetry -a poet author’s memoir of her husband’s descent into dementia, how it affected the family, and how she used literature to help her get through it.

Stigma

• Alan Bennett, Untold Stories –an autobiography of a performer and writer-there was much discussion of the silence and the untold stories that accumulate around mental illness, and how this feeds into stigma.

•  Susan Sontag, Illness as a Metaphor - a “work of critical theory in which she (the author) challenges the victim-blaming in the language often used to describe diseases and those who suffer from them” (Wikipedia)

Health Literacy

• Eric Topol, The Patient Will See You Now: The Future of Medicine is in Your Hands (2015). -A physician’s guide to patient empowerment in healthcare interactions.

Behaving with the Ill

• Julia Darling, How to Behave with the Ill -a poem by a cancer patient for carers, family and friends

• Agnes Higgins and Alan West, Narratives of Recovery from Mental Illness: The Role of Peer Support -this books features personal recovery journeys of 26 GROW members, highlighting the importance of social interactions, peer and community support.

Hospitalization

• Elizabeth Jennings, A Mental Hospital Sitting Room -the poets’ experience as a psychiatric patient

•  Elizabeth Jennings, The Hospital -the poets’ experience as a psychiatric patient

Resources for Children 

• Warwick Pudney and Éliane Whitehouse, Volcano in my Tummy -Children’s book: a guide for children and adult carers to understand and manage children’s anger –age 6-13

• Virginia Ironside, The Huge Bag of Worries -Children’s book depicting the main character’s anxieties and how she faces them. –age 5+ 

• Anthony Browne, Willy and the Cloud -children’s book about worry and anxiety –age 3+

• Shaun Tan, The Red Tree -children’s picture book about dealing with, and overcoming depression –age 7+

• Lloyd Tone, The Princess and the Fog -Children’s picture book about depression –age5-7

• Roddy Doyle, Brilliant – children’s book: provides a child accessible explanation of depression and how to overcome it. –age 9+

• Holloway, A. (2006). The Bipolar Bear Family. Bloomington, IN: AuthorHouse.

• Book list for children to help with understanding mental illnesses

Bibliotherapy is the recommendation of books by doctors to patients in their care. Some evidence has shown the efficacy of prescribing books (HSE, 2017) (NHS wales 2017). Libraries also have a critical role in this, as patients will often seek information online and in local libraries about a range of illnesses. Where prescribing schemes exist, libraries may provide patients with the prescribed books.

Many bibliotherapy schemes provide reading lists for different life stages and major problems of emotional distress, such as anger and self-esteem. There are various bibliotherapy schemes developed by health organizations and libraries. These bibliotherapy schemes are supported by the organisations that published them, who have selected with a team of professionals from healthcare and community service recommended books they feel will be helpful.

Several authors recognise that bibliotherapy has its own set of benefits and limitations. It is a non-intrusive intervention and is therapeutically effective for mild to moderate mental illnesses (McCullis, 2012) (Jack and Ronan, 2008). Bibliotherapy is only useful for patients who have a good standard of literacy and are interested in the use of literature in this way. Also, self-help books have a myriad of quality standards, and prescribed books need to be of high quality to be effective (HSE, 2017) 

For more details, see the Professional’s Guide to Bibliotherapy on the HSE website. 

1. Power of Words Booklist (2009)- joint effort between Library Council of Ireland, Health Service Executive and Irish College of General Practitioners. For details see: http://www.dublincity.ie/main-menu-services-recreation-culture-dublin-city-public-libraries-and-archive-library-services 
2. Living with Mental Illness: Books, Stories and Memoirs- bibliotherapy section in AACAP (American Academy of Child and Adolescent) website.
3. Read Your Mind book project: a self-help and mental health initiative by Offaly county libraries
4. Reading Well- a nationwide scheme for self-help reading in the UK
5. Overcoming- this website provides a list of CBT self-help books
6. Children’s Books Ireland reading guide 
7. NHS wales bibliotherapy and book prescription scheme 
8. Dlr LexIcon: library in Rathdown, Dublin
   • Dlr LexIcon Healthy Reading List-child and family
   • Dlr LexIcon Healthy Reading List-adult 
9. Jigsaw: a support service for young people in Dublin
10.  “Your Good Self” scheme- a joint initiative between the HSE and Cork County Library and Cork City Libraries.It provides book recommendations and other resources for emotional wellbeing
    • Resource list for children and families
    • Resource list for adults

Evaluations of Bibliotherapy:

• G. McKenna, D. Hevey and E. Martin, Patients’ and Providers’ Perspectives on Bibliotherapy in Primary Care (2010) 
• Emma Hutchinson, Bibliotherapy Programmes in Dublin Public Libraries (2014)
• Brown, M., (2013, January 31) GPs to prescribe self-help books for mental health problems, the Guardian -a newspaper article about bibliotherapy
• McCulliss, D. 2012, "Bibliotherapy: Historical and research perspectives", Journal of Poetry Therapy, vol. 25, no. 1, pp. 23-38 -review article on its history, practice, research and education 

Websites and Apps

• NHS Choices website “Behind the Headlines” -Patient-focused website for health literacy
• Royal College of Surgeons of Ireland, MyHealth App (2015) -Mobile app to help patients easily access credible healthcare information.
• “Your Good Self” scheme - a joint initiative between the HSE and Cork County Library and Cork City Libraries. It provides book recommendations and other resources for emotional wellbeing 
• College of Psychiatrists of Ireland website - the public information section provides accessible information about psychiatry and mental health
• Healthtalk  – a social platform for people to share illness experience and find reliable information on health issues 
• Health Advice - a mental health information page in the Royal College of Psychiatrists website
• Royal College of Psychiatrists online homepage
  
• GROW –a mental health organization. Its website is social platform for people to share experiences and access helpful resources
• Re-Lit-a group dedicated to research and practice of bibliotherapy. Their webpage provides links to various resources such as online courses and literary reflection toolkit
• Dublin City Library services -this bibliotherapy page has links to other mental health resources for adults, youths and families
• The Schwartz Centre

Organisations and Services 

• Medical and Health Humanities Initiative by Trinity College Dublin
• King’s College London Centre for Humanities and Health
• TORCH- The Oxford Research Centre in the Humanities
• Children’s Books Ireland 
• Book Clinics 
• Dlr LexIcon- public library in Rathdown, Dublin
• HEAL project- a joint initiative for health literacy by public libraries in Dublin
• Offaly county library services- has a self-help and mental health initiative
• Jigsaw- a support service for young people in Dublin 
• Walk in My Shoes-mental health service in Dublin
• Mental Health Ireland
• Aware: Support System
• Your Mental Health
• Shine
• Making Connections