Former counsellor Elaine Bousfield is the founder of Kooth, a nationwide platform that has demonstrated significant success supporting children’s mental health and emotional wellbeing. Her new venture is ZunTold, which showcases fiction as therapy for young people. The first publication features a protagonist who writes 'to' his eating disorder. It was informed by some of the author's own experiences with anorexia.

I am very interested in the role that fiction has to play in mental health and recovery. Not just reading fiction but the writing of it and the use of it as a therapeutic process in its own right. There has been some research in this field but more is needed. Organisations such as The Reading Agency, who select and offer books on prescription, have evidenced that reading reduces depression and anxiety. Chung Yu Sun and Kwon Jung-Hye in their research on Bibliotherapy, demonstrated that reading non-fiction books with feedback was more effective in the treatment of social phobias than just reading alone, and that reading alone was more effective than being left on a waiting list.

"Fiction allows readers to see themselves, or versions they could be"

We know ‘self-help’ books are popular and that guided self-help is increasingly used as a low-level intensity intervention in IAPT services. But how can fiction as therapy work?

Well, we are exploring this at ZunTold Publishing. Our first Fiction as Therapy publication is Samuel Pollen’s The Year I Didn’t Eat, and in it the author explores the inner world of Max, a fourteen-year-old boy who has anorexia. Interestingly, Max writes to his eating disorder, whom he calls Ana, thus externalising the negative, self-destructive messages ‘she’ delivers to Max on a daily basis. It is a parallel process for the reader. Through fiction we are able to witness somebody else’s struggle whilst asking those eternal questions; who am I in relation to this story? How am I like this character and what does this story say about my own life?  Fiction allows readers to see themselves, or versions of who they could be.

The author Sam, now a recovered adult, agrees that Fiction as Therapy works for him on two levels:

"Fiction can give us stories that are nuanced and complicated. Stories that don’t boil mental health problems down to the most titillating details and about people with complex lives beyond their disease. And because those stories are fictional and don’t belong to any one person, they are all the more relatable.

"My eating disorder occurred when I was 12-years-old. Diagnoses of eating disorders among boys is on the rose. Recently we’ve realised that mental illness doesn’t look like any one thing, but our impression of eating disorders is still dominated by a powerful stereotype – of a teenage girl, usually privately educated, who is under great pressure to perform and desperately searching for a way to assert control. However, women between the ages of 11 and 35 – a far broader group – account for only about a fifth of those 1.25 million. The truth is, eating disorders are as varied as people themselves.

"When I had anorexia, rationally, I knew this, and I knew that many others had been through the same thing, but to me, they were just numbers on the factsheet the hospital gave me. Teenage girls always featured in the few stories I could find – along with photos of emaciated bodies in hospital gowns, detailed descriptions of how little a human being could survive on, or not survive on. Rather than making me feel less alone, they terrified me.

"For this reason, I think that fiction is a powerful and underused tool for dealing with mental health problems. Books help us all feel less alone and more understood.

"The Year I Didn’t Eat isn’t my story, but it’s a story I really wish I’d had when I was 12 – a story that might have made me feel less isolated, and might have helped the people around me understand this illness I was going through. I wrote it because eating disorders are more complicated than we make them out to be, and happen to a lot of people who don’t fit the stereotype. I wrote it because the thing I needed more than anything else back then was a sense that I wasn’t completely alone.

"Even writing it was cathartic. I looked beyond my own experience, and imagined what it was like for someone else - the thing that seemed so hard two decades ago. That’s the idea at the root of all fiction, of course – whether you’re writing it or reading it. Books help us see the world from someone else’s point of view."

Safe space

My ambition is to shine a light on books that can be used as part of the recovery journey, that we hope counsellors and therapists, teachers and young people will find insightful and helpful. Therapeutic fiction can provide a place where readers can engage with therapists, using it as a safe doorway to exploring the shadows and aspirations they see in their own lives.