Why not enjoy a book over the Christmas period.
Photo: Sturlason
'I am actually a dancer, but I don't dance anymore', sings Kari Bremnes (1) . That is how I feel about fiction: I am actually a reader, but I no longer read. At least, not in the same way or to the same extent as before.
I am not alone in this. It has been a long time since reading a book from cover to cover was the norm (2) . Instead, we read, listen and search here and there, endless fragments of text across multiple platforms (2) . We also comment and share, while our minds are hijacked by powerful capitalist forces that increasingly shape our daily lives and perceptions of reality (2) .
Good-quality fiction can act as a 'life simulator', helping us to better understand others and ourselves. Consequently, literature has long had a place in medicine
In the process, we lose more than our ability to concentrate. Good-quality fiction can act as a 'life simulator', helping us to better understand others and ourselves (3, 4) . Consequently, literature has long had a place in medicine (3) . The term 'bibliotherapy' was introduced in 1916. During World War I, libraries in psychiatric hospitals served as 'intellectual and emotional pharmacies' (3) . Unable to serve in the war due to ill health, a professor at the University of Oxford was given the task of creating a 'fever chart', ranking books according to their therapeutic benefit for wounded soldiers (Jane Austen topped the list) (3) .
More recently, literature has been connected to the psychological concept of mentalisation (4, 5) . This concept is broader than empathy and encompasses both self-reflection and understanding of others: 'seeing others from the inside, and oneself from the outside' (5) . Reading groups designed to support mental health were established in England in the mid-1990s and have since spread to other countries, including Norway (3, 4, 6) . In these groups, patients with a range of conditions read a given text, using it as a catalyst for conversation and reflection.
Exposure to fiction alone is unlikely to have a major effect. Achieving meaningful outcomes appears to require reflection and discussion, much like what occurs in reading groups
Does it work? That has proven somewhat difficult to determine, but some researchers have tried. A 2023 meta-analysis, including 69 studies, found that reading fiction has a small but statistically significant positive effect on social cognition, including empathy and mentalisation (7) . The effect was notably greater for fiction than for non-fiction and was consistent across studies. However, it was not large enough to be considered clinically significant (7) .
Evidence regarding fiction's impact on mental disorders and psychological distress remains limited. In a 2022 article, the authors conducted five studies examining a range of interventions, including discussing previously read books, having books prescribed and comparing bestsellers with award-winning literature (8) . Their conclusion was that exposure to fiction alone is unlikely to have a major effect (8) . Achieving meaningful outcomes appears to require reflection and discussion, much like what occurs in reading groups.
Identifying the effects of literature through structured interviews and psychometry can be difficult, and it is uncertain whether research data will ever provide definitive answers (3) . Perhaps we must continue to rely on the stories themselves, as illustrated by the author Jeanette Winterson. In her memoir Why Be Happy When You Could Be Normal , she recounts how literature helped her through traumatic childhood experiences (the title refers to her mother's response to her desire to live as a queer person): 'That is what literature offers – a language powerful enough to say how it is. It isn't a hiding place. It is a finding place' (4, 9. 40) . Similarly, the literature professor and author Tore Rem describes in an essay in the Journal of the Norwegian Medical Association how literature supported him through a period of serious illness (10) .
Richard Smith, former editor-in-chief of the BMJ, prescribes literature as follows (11) : one and a half hours of uninterrupted reading each morning: 45 minutes of fiction, followed by 30 minutes of non-fiction, and finishing with 15 minutes of poetry. I have opted for a slightly lower 'dose' myself – for now. One of my most memorable reading experiences this autumn has been Knut Hamsun's Growth of the Soil , alongside NRK's Reading Club, which is a low-threshold, public reading group with no affiliation to the health service.
I want to become a reader again. Otherwise, I fear losing the ability to concentrate for extended periods, and to experience how simple black-and-white symbols can be transformed into colours, shapes and emotions, while being drawn into another world. That, ultimately, is the wonder that occurs if we simply take the time.