Wonderful insights into nature do not materialise from nowhere and they are never the final word. They are milestones in long and often disjointed stories that are populated with normal people who display all that is spectacular and dismaying about human behaviour in any walk of life.
Ian Sample: Science writer’s block

If you don’t link to primary sources, you are dead to me […]

[…] I do not trust you. There is a high risk that you chose not to link it, because you’re hiding something:

  1. that you didn’t read the primary source, and are reporting what it said second hand;
  2. that you’re misrepresenting the primary source, either because you didn’t read it or because you intend to deceive;
  3. in the case of newspaper articles copied and pasted from press releases, you’re hiding the fact that you plagiarised commercial promotional content.

by Ben Goldacre

Writing, trauma, and health.

This post isn’t about a recent research at all, in fact the article I’m going to discuss is from 1988, but I write about it because this research has given life to an entire line of studies of which you we can find traces even today.
Pennebaker, Kielcolt-Glaser e Glaser, had conducted a research  (‘Disclosure of Traumas and Immune Function: Implication for Psychotherapy’, 1988) placed in the long tradition of psychosomatics and in the more recent health psychology.
The authors wondered whether psychotherapy could be effective in reducing health problems. At the time of the research there had been several studies that had identified, for example, that in individuals who underwent a psychotherapy the medical utilization decreased relative to non-psychotherapy control group, but wasn’t clear why.
Moreover, it was observed that psychological conflicts, anxiety and stress can cause physical symptoms, and had been consistently suggested that a reduction of conflict or stress would also reduce the disease.
The way in which individuals face a traumatic experience is predictive of the appearance or absence of disease, for example, individuals who have suffered a great upheaval such as the death of a spouse, are more vulnerable to a variety of illnesses. At the same time, the negative effect of stress may be buffered by social support.
A common theme in psychotherapy, since from the beginning, is that people can better deal with trauma if they can understand and assimilate it.
On this line, Pennebaker and Beall (1986) conducted an experiment in which they asked healthy college students to write about a traumatic experiences or trivial topics for four consecutive days. Within one month of the experiment, subjects who had written about a traumatic experience, visited the student health center significantly less often than the others.
Psychoneuroimmunology research indicated also that the central nervous system can directly influence the immune system.

The research of the 1988 examined the effect of the writing about a traumatic experience on immune function.

Fifty healthy college students were randomly assigned to write about: either a personal traumatic experience or trivial topics for 20 minutes every day for four consecutive days.
To measure the immune response it was examined the response of lymphocytes to stimulation by substances foreign to the body (mitogens). The measurement of the proliferationof lumphocytes in response to the stimulus was considered a good in vitro model of the body’s response to pathogens such as bacteria and viruses.
In the research blood samples were taken on the day before the writing, the last day of the writing and six weeks after the writing. Other measures of health / disease such as visits to the clinic doctor, self-reported symptoms, and more, were also assessed.
The day before the writing session the subjects in group completed a battery of questionnaires, and, after having made them relax for 10 minutes,  their blood pressure levels, heart rates and skin conductance levels were measured. After that the the first blood sample was drawn.

Over the next four days, the subjects participated to the writing sessions. Subjects in the trauma condition were informed as follows:

During each of four days I want you to write about the more traumatic and upsetting experiences of your entire life. You can write on different topics each day or on the same topic for all four days.The important thing is that you write about your deepest thoughts and feelings. Ideally, whatever you write about should deal with an event or experience that you have never talked with others in detail.

Instead, subjects in the no-trauma condition were asked to describe specific objects or events in detail without discussing their emotions or thoughts.
At the end of the fourth writing sessions, blood pressure, heart rate and skin conductance were measured again, then a second sample of blood was draw. After six weeks the subjects returned to undergo the same checks.

At the conclusion of the study the Health center provided data on the number of visits each student had made for illness for the five months before the study and for the 6 weeks of the study. Three months after the end of the writing a follow-up survey about stress and their daily habits (smoking, exercise), the same topics addressed by the questionnaire prior to the writing, was sent to the subjects.

Results were surprising, indicating that writing about a traumatic experience had a positive effect on the mitogen response, on automic levels, on subjective distress, and also evidenced a drop in visit to the Health center. The effect was more pronounced in those who had never discussed before with others they had written.
These effects were not observed in the control group.

The authors hypothesized that there is a stress that arises when you are not able to cope with trauma, in particular, to inhibit, the active gold back, thoughts, feelings and behavior is associated with a “fatigue” that in the long run may occur in illnesses. In this sense it seems that there is a positive effect on health resulting from a liberation of the traumatic content, which should no longer be actively kept away from consciousness.

But later, with new of studies on this subject, Pennebakers and other psychologists have proposed the idea that the mechanism that causes positive change is the reorganization of mental event, the production of a narrative, sometimes even a first narrative, other times a new, around the event.
Indeed in the 1988 research, the authors note for example that many of those who had written about the trauma changed gradually, through the sessions, their perspectives. They report, for example, the case of a woman, molested at age 9 by a boy three years older.

[…] Initially emphasized her feelings of embarassment and guilt. By the third day of writing she expressed anger at the boy who had victimized her. By the last day, she had begun to put it in perspective. On the follow-up survey 6 weeks after the experiment, she reported, “Before, when I thought about it, I’d lie to myself.. Now, I don’t feel like I even have to think about it because I got if off my chest. I finally admitted that it happende…I really know the truth and won’t have to lie to myself anymore”

Pennebaker and Francis (‘Cognitive, emotional, and language processes in disclosure’, 1996) have summarized what happens when you write down an experience: you assemble a coherent, sequential, narrative; causal connections are recognized; you consider other points of view, even in the perspective that there is a potential reader; you reflect on and you define, emotions and thoughts.

This research is especially important because underlines the positive effect of this process of narrative reorganization of experiences.

As I said, this research, together with the original by Pennebaker and Beall, has stimulated a whole line of research on the writing technique. From Pennebaker’s personal page, you can download a lot of articles about research he has conducted, and many other psychologists have carried out similar projects, not only in the United States, but also in Europe.

[Italian translation of thi article]