Poor Historians: Some Notes on the Medical Memoir

I’m not superstitious, but when I go for my mammogram every year, I perform a private ritual. As I wait in the dark for the tech to return and tell me that the radiologist has said all is well, I force myself to imagine that all is not well. I imagine the request for additional images, the biopsy, the consultation with the oncologist and the surgeon, the sessions in the reclining chemotherapy chair, my head bald. I try on various cancer personalities: brave and dignified versus whining and cowardly. In my mind I wear jaunty baseball caps and Hermès scarves. I feel the plastic lump of the catheter in my upper chest. I believe that the more clearly I imagine these things, the less real they are likely to become. I believe, against all reason and everything I know as a physician, that misfortune always surprises, and that I can prevent cancer simply by expecting it.

For many years, my ritual worked. Then, one year, a glitch. The tech returned and said “additional images.” She said there was an area of concern in my right breast and that the radiologist wanted to get a better look. Barely had she uttered these phrases when they italicized in my mind, angling deep into the fear center of my brain. Then the tech took another round of pictures and excused herself, leaving me in the cool, dimly lit room, half naked, the shadow of my doom glowing on a computer screen.

Imagining the worst as I stood and waited did nothing to assuage my fear. But imagining how I might write about imagining the worst did. I began composing an essay—or the first chapter of a memoir, I decided, if things turned out really badly. With each sentence I grew less anxious. A couple of hours later, when a needle aspiration proved the “area of concern” to be a benign cyst, I was already quite calm.

Writing makes people feel better. This may sound strange to anyone who’s struggled with a class assignment, or to many professional writers. But research begun in the 1970s, much of it done by James W. Pennebaker, a psychologist at the University of Texas at Austin, has shown that writing as little as thirty minutes a day for four days in a row can ease anxiety and depression and help people recover from illness and trauma. In one study of what Pennebaker named “expressive writing,” participants who wrote about stressful experiences were less likely to require urgent medical care than students who wrote about more mundane subjects, like their dorm rooms or their shoes. In another study, people with asthma or rheumatoid arthritis who wrote about the most traumatic events of their lives had fewer flare-ups of their diseases. Writing can boost immunity, relieve pain, improve liver and lung function, and lower blood pressure.

No one is really sure how this works, but it may be similar to how psychotherapy does. In ways which elude our full understanding, putting emotions into words changes brain chemistry and brain architecture, which, in turn, affects the rest of the body. Writing rather than speaking or thinking those words seems to have a particularly profound influence on the brain. If I’d had a way to jot down my thoughts in the mammography room that day, I might have felt even calmer. And there’s some evidence that putting pen or pencil to paper is even more helpful than typing.

In explaining his findings, Pennebaker emphasizes the toxicity of keeping secrets. One of his early studies showed that people who wrote about their traumas were less likely to have physical symptoms than those who didn’t articulate them, a validation and amplification of Freud’s work on conversion disorders and hysteria a century earlier. In thinking about my medical practice and my own experiences as a patient, I’ve wondered if writing restores, even if briefly, a sense of control. To be ill or injured is to lack control, and the humiliations of...