🎧You Write Your Way to Healing | Chapter 25

Sarah Fay

Nov 16, 2023

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Outside my window, the trees have started to bloom though I can’t see them from my apartment. My view is of a brick wall.

I’m reading Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness. One evening, I sit at my desk and slowly turn the pages, not wanting to read what comes next. It scares me to think that so many people do, in fact, recover, even from bipolar disorder, my most recent diagnosis. It’s scary because although I may have already recovered, it’s still so foreign. Really? Recovery? For others too?

Whitaker cites studies showing stirring rates of recovery. Though many mistakenly believe that depression is biological, chronic, and lifelong, at least a century-and-a-half of studies have shown otherwise, citing recovery rates from 49 to 76 percent. In a meta-analysis, Samuel Guze and Eli Robins at Washington University Medical School, who actually inspired the biomedical model, found that 50 percent of people hospitalized for depression had no recurrence and only one in ten people were chronically ill. In the 1960s and 1970s, before the Prozac-biomedical-model era, the official line from the National Institute of Mental Health (NIMH) was that depression tended to resolve itself. One NIMH official wrote, “Depression is, on the whole, one of the psychiatric conditions with the best prognosis for eventual recovery with or without treatment. Most depressions are self-limited.” But with the biomedical model that took hold in the 1980s and 1990s, the NIMH spread the misinformation that depression was common and should be commonly treated with antidepressants.

He traces similar evidence of recovery from schizophrenia, a diagnosis often treated as deteriorating and hopeless. One NIMH study saw 73 percent of patients discharged after just one year and remaining in the community three years after discharge. Another study found that 85 percent of patients discharged within five years successfully lived in the community more than six years later. An additional study determined that of nearly half of the patients discharged in 1950, more than half never relapsed over the next four years. Overall, Whitaker found that these studies indicated that during this pre-pharma era, only 20 percent of patients with schizophrenia needed to be continuously hospitalized.

How—how—can clinicians not offer patients and their families these recovery rates? How can physicians and therapists and social workers not grant us this optimism and confidence?

It’s not that having recovered, I don’t experience depression and anxiety and panic and very mild mania anymore. Today, my body aches. It’s the kind of bone-ache that comes with depression, along with hollowness and irritability.

No, I say. No. Bracing against it makes it worse.

Sarah, I say to myself, you’ve got this. Nothing has gone wrong. You’re okay. Speaking to it doesn’t make it disappear, but it lessens and, most importantly, makes me feel less alone. I’m with me.

Five years from now I’ll discover this skill’s name: self-talk. It’s what it sounds like: positive statements we intentionally say to ourselves, often amidst a sea of irrational, negative unintentional thoughts.

Negative self-talk is automatic. Also known as our internal narrator, our inner monologue, or internal speech, it may arise when we’re under pressure. It’s a coping strategy to deal with tension, stress, and mental and emotional pain, but it acts like an inner enemy. As the former Nightline anchor turned bestselling author and award-winning podcaster Dan Harris put it: “The voice inside my head is an asshole.”

Supposedly, most negative self-talk stems from a single, universal fear: not being good enough. It occurs in the first person: I’m bipolar and will never be well. My self-insults are of the kind only a really mean fifth-grade girl might dish out: I’m so fat (an oldie but goodie from my teenage years), I’m a loser (sad, but it does come), I’m a failure, etc.

The machinations of our inner bully are something of a mystery. The subvocalization results from a phonological loop in the brain, including the inner ear. The research psychologist Russell Hurlburt, who has been studying auditory inner experiences since the 1970s, found that not everyone has an inner voice; some people think purely in images. Of those who do experience internal speech, many don’t know what it’s saying. Most people perceive their inner voice as sounding like their own.

For two decades, sports psychology has been studying positive self-talk and its effect on athletes’ performance. Positive self-talk is in the second or third person: You’re okay or Sarah is okay. Researchers found that the key to self-talk is the use of the second person: You’ve got this. Focus. Using your own name can also help: Sarah, focus. The second-person voice (you’ve got this) is like having a personal therapist on call.

It isn’t just for athletes. A 2020 study showed that those who used positive self-talk had less anxiety and OCD symptoms during the pandemic. Students who participated in a 2019 study experienced less performance anxiety if they recited affirming statements before a performance.

Reducing my negative self-talk and creating positive self-talk slowly becomes the core of my recovery. It’s not toxic positivity. You can’t bullshit yourself. Just no more vicious critic (I suck), only coach (you can do this). I invent a supportive voice (you) I’ve never heard before, one that will become essential to my recovery and staying well.

Another thought-management skill I learn comes in the form of writing. Writing down your thoughts to create distance from them isn’t exactly revelatory, but I hadn’t tried it with an understanding of our evolutionary predisposition. Cognitive Behavioral Therapy and other therapeutic techniques rely on writing to regulate thoughts and emotions.

I sit at my desk, take a pad of paper and a pen, and do it. I write down my thoughts in a list. They’re random, occasionally mean, and uniformly negative: This is awful, I’m going to get sick again, I’m so stupid, I hate this, I’m in trouble, I’m not doing this right, and on and on to the bottom of the page. The list reeks of self-pity but also self-hatred.

When I go back through the list with evolutionary psychiatry in mind, I see most of them differently. This is awful, I’m going to get sick again, I’m in trouble, and I’m not doing this right are alarms sent by a brain—my brain—on the lookout for danger. Just knowing this makes my chest loosen and the pit in my stomach lessen. These thoughts are just my primitive instincts gone awry. I crumple the page and throw it away.

Within a week, every morning, I write down my thoughts and try to see them from a frightened brain’s point of view. Soon I’m doing it at breakfast, lunch, and dinner.

Later, I’ll discover there’s science to back up this practice. One study found that people who wrote down their thoughts and threw away the piece of paper cast off the thoughts themselves. Those who wrote down their thoughts and carried them around had the opposite effect. Essentially, we “tag [our] thoughts—as trash or as worthy of protection.” Researchers found that we can’t just imagine doing this; we have to actually write them down, crumple the paper, and discard the thoughts that might otherwise stay with us, influencing our decisions and actions or inaction.

The writing-health connection started to be explored in the 1970s and 1980s and is most often associated with the psychologist James Pennebaker. He wanted to see how keeping a traumatic secret rather than writing about it affected both physical and mental health. Expressive writing, as it was called, seemed to benefit participants in myriad ways.

Many studies have shown the health benefits of writing down troubling thoughts or experiences. These studies have looked at the effects across diverse populations. The results are compelling. Writing about your difficulties can result in better grades, fewer missed days of work, and a better chance of getting a job after being laid off. For some, it means improved immune and hormonal dysfunction, less stress, and fewer physician visits.

Two studies examined how the process can improve mental health. A 2011 study published in Science found that writing down worries before an exam alleviated anxiety and improved performance. Researchers asked students to write down their thoughts before an important test. It’s every parent’s dream: not only did the students feel less anxious, but their scores also improved.

A 2006 study showed that writing down thoughts can stop you from brooding and ease depression. The study involved undergraduate students experiencing depression or with a history of it. One group was tasked with writing about difficult events for twenty minutes a day, three consecutive days a week. The control group wrote about time management. Students who expressed their thoughts in writing reported less rumination and depression.

It’s counterintuitive. Shouldn’t writing down our negative thoughts give them greater weight? Shouldn’t we ignore these thoughts in the hope that they’ll go away or “mindfully” let them pass like a leaf on a stream? Maybe but that never worked for me. I’ve tried to run from my thoughts, shut them up, see them as clouds, everything, but doing so only strengthened them and made them more unruly.

Mindfulness practices are forms of metacognition, a way of seeing your thoughts as thoughts, not reality. But I’ve never liked going down the reality-isn’t-real rabbit hole—not with my mental health history.

Writing down my thoughts—one sentence for each, in a list—gives me distance from them. It’s a way for me not to believe every negative and self-defeating idea as truth.

Writing down my thoughts slows me down and helps me see them for what they are: mechanisms of a primitive brain. Thoughts aren’t evil. They aren’t from some dark place, as Sigmund Freud wanted us to believe. They’re just the brain’s overly vigilant way of trying to keep us alive in an environment where such extreme vigilance typically isn’t required.