Review of Reading Literature and Chronic Pain by Josie Billington (Bloomsbury, 2025)

Laura Seymour, Swansea University

Reading Literature and Chronic Pain is an important book for our project because it validates and explores one of the key strands of our research: the ways in which reading can support wellbeing. Writing about the multidisciplinary study behind the book, Billington, a literary expert in the topic of literature and health, explains,

We had demonstrated with scientific robustness that the combination of reading literary works, fiction and poetry, and the group experience had alleviated symptoms of depression to a “statistically significant” degree (p. ix).

This study compared the practice of shared reading—reading a short piece of fiction or a poem with a group leader—with CBT as interventions for chronic pain. Billington reports that reading group members had lower pain ratings after shared reading compared to after CBT; moreover (unlike CBT) these lower pain ratings persisted beyond the immediate duration of the reading group (p. 77).

A combination of history and primary evidence

Though primary evidence (including a couple of free-floating quotations whose speaker was unclear, which I found disconcerting) is ‘the heart of this book’ (p. 75), Billington also provides a theoretical background to the idea of chronic pain as a pervasive experience, and one that involves a person’s mental health and emotional life. Key coordinates in the history Billington traces of theorising about what we now call chronic pain include the anthropologist Jean Jackson, alongside Sigmund Freud and Elaine Scarry. The shadow of the Sacklers and their addictive so-called ‘Empire of Pain’ lengthens across the pages at various points. Bolstering this discussion, Billington delineates some medical understandings of chronic pain which I am not qualified to assess for their veracity but which indicate several thought-provoking connections, such as links between chronic pain in adulthood and childhood sexual abuse.

The texts the reading groups shared were British, North American, and Irish writing from the nineteenth to the twenty first centuries (the earliest authors discussed were Charles Dickens and Christina Rossetti). This type of reading material is reflective of a lot of bibliotherapy training, and does not necessarily warrant a value judgement per se. Our research project here at Swansea will be exploring the bibliotherapeutic potentials of another specific group: early modern European literatures. In my bibliotherapy practice, however, I have found that bibliotherapy can be effective the more diverse it is: including zines, song lyrics, and literatures from across much wider time periods and cultures can help us to be as responsive as possible to reader-clients. I was glad to see Billington point towards the centuries-long history of knowledges about the uses of books and reading to explore, understand, and relieve pain, as she refers to research on the effects of hymn singing and scripture-reading in the nineteenth century for the Methodist Joseph Townend (pp. 34-6). I believe it is vital to continue to look into the past for what we might nowadays call disability and neurodiversity theory, skill, and knowledge (from the religious singing and reading Billington examines, to the notions of reading and writing as the cause/cure of melancholy in Robert Burton’s The Anatomy of Melancholy to the curative masque depicted in John Ford’s The Lover’s Melancholy). This helps to counteract reductive rhetorics in academia and the media that describe disability studies and neurodiversity studies as only recently-emerging and/or as passing fads. The more visible past theories are in all their complexity the more we can honour them as part of our own field today, even if people used different labels and concepts.

With rather cautious phrasing, Billington refers in the preface to finding only ‘partial evidence’ for the ways literary reading provides ‘something more complicated than, and perhaps as needful as, a simple remedy’ (p. x). However, I found her conclusions much more compelling than this caution prepares us for, with implications for pain relief, literature, and narrative medicine. Reading Literature and Chronic Pain demonstrates ‘the power of literature to shift, challenge or indeed find personal narrative’ (p. 110). A further, perhaps more implicit, conclusion is that this shift is particularly powerful when reading is conducted in groups. Billington notes throughout the book that literary reading can be a useful and supportive tool in a variety of contexts, including talk therapy and narrative medicine. I saw, further, its uses in everyday interpersonal relationships: for example, sharing a poem with a friend-group on an issue they are all experiencing. Of one reading group member, Susan, Billington writes,

Susan did not want to “tell her story” in a conventional sense and would have resisted any call to do so, not least because her experience did not permit of simple of straightforward telling…But she emphatically does not resist – quite the contrary – the power of the poem to discover and express her deep inner trouble without diminishment of its reality (p. 142)

One of the key reasons for reading’s positive impact on chronic pain, Billington suggests, is that it enables people to name their emotions on a more granular level. She reports that this has been associated with a raft of benefits, including less frequent hospitalisations and less dependence on medication (p. 192). It can also enable pain-sufferers to reframe their experiences, ‘open to a rewired vision or perspective, catalysed by the poem’s own’ (p. 192). I have found similar effects in my practice and in my own research (e.g. into reading Hamlet with lived experience of neurodivergence and suicidal ideation, though Billington’s book addresses the issue of reading and wellbeing in a more overarching and sustained way). Towards the end of the book, Billington centres intersubjectivity in the reading groups, analysing group members’ micro-expressions (the groups were video recorded) to observe how they reacted to the text and each other. This analysis, and quotations from members suggested that the groups felt safe and close-knit, like family.

Conclusion: the disruption of the personal

Throughout the case-studies presented in this book, reading group members extensively related the texts to their personal life experiences: ‘“You’re not asked to respond personally”, said one member of the chronic pain reading group, “you just do”’ (p. 187). Is this immediate personal response to literature an impulse that traditional literary criticism – as it is taught and practiced in schools and universities – interrupts? Billington’s work provoked me to think: what if our exam rubrics included questions like, ‘what did this book teach you about life?’, ‘how did it support your wellbeing?’, ‘describe the impact of engaging with this text on your emotions’, linking to assessment criteria focused on learners’ wellbeing and self-understanding. Do you think this is sappy? But why would you?

It is vital for investigations into literary reading, and literary criticism’s, impacts on wellbeing not to be siloed off from each other. Connecting this new book from Billington with recent work by scholars like Stephanie Aspin will help us to appreciate that such studies are not one-offs but part of a patient and sustained network of scholarship and practice. This can be our foundation for integrating an appreciation of wellbeing ever more into the teaching and practice of literary criticism.   

Whether or not you agree that this imagined educational and literary-critical world of mine would be a good thing, I hope you can see why I found Billington’s conclusion so compelling. Precisely because a ‘book…has no agenda in relation to the reader, nor any knowledge of or interest in their pain’, she explains, ‘at once uniquely disinterested and uniquely engaged, literature is that rare thing in our culture: a specialist discourse that is open to everyone, and always there, anywhere, anytime, whenever you need it’ (p. 200)

Reading Literature and Chronic Pain: : Josie Billington: Bloomsbury Academic - Bloomsbury

Laura Seymour is the principal investigator of AMEND.