Dr Shyam Bhat is a pioneer of integrative medicine and holistic psychiatry in India. He is also a published writer and a trustee of the Live Love Laugh Foundation set up by the leading Bollywood actor Deepika Padukone. He spoke to Scroll.in on the psychological aspects of reading in the context of a protracted crisis like the Covid-19 pandemic. Excerpts from the interview:

What kind of impact can a prolonged global health crisis like the Covid-19 pandemic have on people’s minds?
The human brain is engineered for survival. In this respect, we are like every mammalian species, our brain always subconsciously scanning the environment for signs of threat. Consider that you are walking down the road, perfectly relaxed, when suddenly a raging dog attacks you. Without a moment’s hesitation, without even thinking about it, you react. Threat-signalling in the brain creates a state of “hypervigilance”, a state of acute alertness and sensitivity to other possible threats.

Just above your kidneys are the adrenal glands, which release stress hormones in response to a threat, including adrenaline. Your brain and body are now in survival mode, in what is popularly called the fight or flight response. Your heart beats faster, your muscles tighten, your joints are poised, your pupils dilate, your sweat glands are hyperactive, while inside your body, your organs are responding equally vigorously to the impending attack. Your liver releases glucose and protein into the bloodstream to allow your blood to clot more easily in case you sustain injury.
Human beings dominate the planet because of our unique neurology – our brain has the ability to think about the future, to predict, forecast, prepare and plan. But this great power is also our greatest burden – for not only can we sense imminent threat, we also suffer pain due to a future threat.

This tendency to think of negative outcomes is worsened in times of uncertainty and ambiguity. Without enough information to guide its predictive mechanisms, your brain signals threat, and this is experienced as anxiety and stress. Research shows that the brain actually signals less threat in situations where there is certainty of pain, compared to a situation where there is uncertainty about the outcome. In other words, we are less troubled by the certainty of a bad outcome, compared to not being sure.

Our brains right now cannot see a certain future: what will happen, when will the pandemic end, what does it mean for our lives?

When the threat is continuous, slow-burning and subtle, as it is with this pandemic, these ancient neural systems no longer serve a purpose. Fight and flight are compounded by the “freeze “ response – something that an animal resorts to when there is no escape from the threat. This chronic state of alarm is what people call stress, a word so commonly thrown around that it has lost its potency to remind us that it is a debilitating life-sapping condition.

Over time, a person may begin to experience several “symptoms” of stress, but often remain oblivious to them. Persons who are under stress commonly feel impatient, irritable, prone to anger, body aches and pains, fatigue, insomnia, worrying and overthinking, inability to focus and concentrate and on edge.
Internally, the condition affects metabolic functioning, increases blood sugars and the risk for diabetes, elevates blood pressure and the risk for heart disease and weakens the immune system, making us more vulnerable to viral infections.
Unchecked, stress can lead to clinical depression and anxiety disorders, amongst other mental illnesses.

Is there an established link between reading and mental illness? Does a regular reading habit help lessen mental health issues like anxiety and depression?
Reading is one of those everyday activities that we take for granted, but if you pause to consider what is happening when you read words on a page, you will realise that this simple act is actually very complex, even magical. When you read, you look at shapes on a page, variations of a small number of letters, and it evokes in your mind visions and thoughts, transporting you to a different world.
Unlike visual entertainment like TV, reading requires engagement and work by the consumer’s brain. It is a complex act, with several brain regions working together to create a world inside the head that can be as, if not more, rich in emotional texture than lived experiences.

With the visual cortex receiving the images, the temporal lobes translating them into verbal information, the frontal cortex interpreting and predicting the unfolding narrative, the memory centres of the brain evoking autobiographical memory, the autonomic nervous system altering itself in response to the emotions being evoked, reading is a virtual reality experience that no technology has yet replicated.

Reading is a workout for the brain. And just as physical exercise decreases the risk of diabetes and heart disease, regular reading decreases the risk of conditions such as dementia, and improves memory, concentration, and mood. This is especially relevant in these times of Covid.

In one research study, people who read long fiction (not short fiction) had better tolerance of ambiguity and uncertainty, and an improved ability to think creatively. In an uncertain time like this, reading can help cope with the stress and also help think of creative solutions to life challenges. Reading also helps deal with isolation, by making the reader feel connected with other worlds.

The practice of prescribing books for mental health is probably as old as books themselves. In many ancient wisdom traditions, stories were used to impart deep insights about the world. Zen stories, Sufi Stories, the Panchatantra tales, fables from all over the world were powerful vehicles for the dissemination of morals, life lessons, and wisdom, and, centuries later, books continue to be relevant.

Although books by themselves cannot treat clinical depression, they help as catalysts in therapy, improving the insights one can derive from the therapeutic process.

Has reading ever been formally incorporated in your therapy? If so, how?
In what is called “bibliotherapy”, a therapist prescribes books selected for a number of reasons: narratives of people who have suffered similarly, novels that help a person understand the subtle contexts of their problem, and self-help books that might explore topics that have come up in therapy and so on.

The prescription is highly individual and variable, more an art than a science. The therapist has to have read widely and must understand the client’s inner world in order to recommend the right book. Following the reading, the therapist will gauge the client’s reactions to the book which will help reveal the themes of their underlying psychological conflict. Some questions I would ask include: What was your reaction to the theme of the novel? What did you like or not like about the protagonist? Which characters did you identify with and why?

Do you think the pandemic has made people start reading again? That is, has it become a choice that has often won over say Netflix or Amazon Prime?
It depends on the emotional state and temperament of the person. Those struggling with anxiety and stress will find it difficult to read, because anxiety interferes with the brain’s ability to focus and concentrate. The desire to distract themselves from stress will impel such people to consume media passively, by watching a show or scrolling absently through social media.

Just like sugar is easier to digest than whole grains, although it is unhealthier, visual and social media is easier to digest for the brain than most books. Unfortunately, this sugar candy for the brain makes it even harder to focus, creating a vicious cycle that results in people turning away from books and spending more time with a screen.

What kinds of books do you see people turning to during and after the pandemic and why?
Pop science, books on catastrophes, and fiction of various kinds.

Long-form work full of complex ideas will be avoided by many people during the pandemic. However, there will be significant exceptions to this: for instance, a work of nonfiction that offers relevant information about an issue that people are facing today will find resonance, such as accounts of previous pandemics, narratives of challenging times such as wars and economic uncertainty. Popular science books exploring virology, the immune system or infections, and books about dealing with the emotional reactions to uncertainty and stress would also appeal to readers.

Readers may also turn to fiction for respite from the incessant stress of Covid, or to process the fears and anxieties evoked by the pandemic. Themes that resonate particularly with the reader during this time include dealing with isolation and loneliness, global catastrophes, and fantasy fiction with a completely different, self-contained universe into which the reader can escape.

Others may seek a thrilling or fearful narrative to help them process their own fears. From a psychological perspective, movies and books that are scary or thrilling offer a safe space which people can work through and let go of fears, sort of like a ride on a roller-coaster which is scary but at the same time exhilarating.

A subgenre that will likely appeal to readers is post-apocalyptic fiction: stories set in worlds affected by major global catastrophe. These stories recreate, in a heightened fashion, the atmosphere of our times: the feeling that the world has changed irrevocably and that something surreal is happening, but they also serve as a reminder of the ability of humans to rebound, adapt and thrive in difficult situations.

What role does the visual appeal of a book, be it cover design or colour schemes, play in times like these? Do you think readers are likely to pay greater attention to it?
People tend to judge a book by its cover, and not just in these times. Research shows that the more emotional we are, the more impulsive we become. Covid-induced stress will result in people wanting to make quicker decisions, and therefore the impact of the cover and title may be more relevant than in other times.

How is the impact of reading different from that of the screen experience?
The theorist Marshall McLuhan famously said, “The medium is the message”. What he meant was, whenever a new medium is devised, it is not the content that shapes the mind, but the medium itself. To consume something on a screen through images and sound is not the same as consuming it through the written word.

Watching a show on a screen is a much more passive experience compared with reading, which requires personal engagement. While reading, the brain transforms the words on the paper into imagery, which engage senses like vision, touch, and sound, cognitive abilities like logical thinking, memory, and interpretation, as well as what we call the theory of mind, which is the ability to understand other people’s thoughts and feelings

The visual medium does this without the brain having to do any of the heavy lifting, so the experience is far more passive.

Do you feel that more people are taking to writing rather than reading in order to overcome their anxieties?
Writing can improve one’s mental health, particularly a form of writing called “expressive writing” where one writes whatever is on one’s mind without inhibiting or censoring oneself, so that one’s true feelings and emotions are put out there rather than suppressed within. Research shows that this form of writing reduces stress and even improves some markers of physical health, such as blood pressure and the immune system.

The pandemic with its consequent lockdowns and social isolation is creating a situation that might make people feel very lonely, but it’s also an opportunity for them to introspect and embark on creative projects. During the 1665 plague, Isaac Newton famously retreated to his family home for a year and emerged with his world-changing insights on gravity.

So there is historical precedent – we can use all our alone time for creative endeavours such as writing. Of course, the amount of time that a person can get depends on their life situation. It is a privilege that many will be denied due to economic hardship and stress.

Has there been a shift in your own reading habits owing to the pandemic? What have you been reading during the lockdown?
My reading habits haven’t changed significantly. I continue to read both fiction and non-fiction. However, one book I read, clearly influenced by the pandemic, was a historical account of the world during the Spanish Flu, Pale Rider: The Spanish Flu of 1918 and How It Changed the World.

Can books on mental health and wellness have the same efficacy as consulting a mental health professional?
For many life issues, a well-written and insightful book can have a powerful impact. The right words at the right time can create epiphanies that have the capacity to transform a person. Books can help people better understand themselves and others, and develop insights on how to handle difficult feelings and relationships. However, for people suffering from clinical issues, a book cannot replace a mental health professional.

What is your honest opinion of books on mental health and well-being written, edited and published locally? Do you have any suggestions for editors acquiring in this genre?
I am happy to see the number and quality of the books in this space in India. I would recommend that editors seek narratives of people who have personally experienced mental turmoil, along with writing that blends insights from western therapy and psychology/psychiatry with ancient Indian writing, including literature from yoga psychology and Vedanta.

This series of articles on the impact of the coronavirus pandemic on publishing is curated by Kanishka Gupta.