Richard Smith: Reading for a long life

richard_smith_2014At 63 I’m preparing for my capacities and faculties to fall away, and I think about what I hope to preserve. Taking being with those I love as a given, the most important things to me are in order: reading, writing, listening to music, walking, and looking at art. I also love theatre, food, wine, travel, and whisky (all the paraphernalia of a privileged, middle class, highly educated life), but these are of the second rank. So I hope that reading will be the last to go, and recently I’ve learnt (through reading) two new things: firstly, that my reading may prolong my life; and secondly, what makes a regular reader.

The evidence that reading prolongs life comes from the Jerusalem Longitudinal Study of cognitively intact 70 year olds living in the community. Some 337 people (148 women, 189 men) were followed over eight years, and 93 (83%) of the 112 men who read a book every day were still alive eight years later compared with 47 (61%) of those who didn’t, a highly significant difference. There was no difference among the women, raising a question about the plausibility of a causal link. Reading books is, of course, associated with higher socioeconomic status and with all the goodies it brings, but after adjusting for socioeconomic status, smoking, physical activity, and several other possible confounders the men who read books still outlived those who didn’t read.

Looking at the Kaplan-Meier survival curve I do wonder about the men who don’t read. They begin to fall away quickly, and I imagine them to be a sour, exhausted group for whom death holds great attractions. Perhaps the link with reading is an artefact.

One of the weaknesses of the study is that it didn’t ask what people were reading. With my literary snobbish tendencies, I like to think that those who are reading Henry James, George Eliot, Tolstoy, and Flaubert are living longer than those reading modern potboilers, and I especially like to think that those reading Homer, Dante, and Shakespeare will live the longest of all.

Of course, I don’t really care. I’m certainly not reading to prolong my life, and I put quality of life way ahead of quantity. But so long as I can keep reading, I feel it will be enough. Even, I like to think, if deaf, immobile, incontinent, and in pain, reading will be a reason to keep going. This does mean that dementia, following my mother and grandmother, will be particularly awful, although I hope I won’t know (or will have bumped myself off first).

I read in an essay, My Father’s Brain, by Jonathan Franzen how dementia is “a prism that refracts death into a spectrum of its otherwise tightly conjoined parts—death of autonomy, death of memory, death of self-consciousness, death of personality, death of body.” (Franzen in his turn read that in David Shenk’s book The Forgetting.) My reading could survive death of autonomy, but not death of memory.

My second learning of the morning is about what makes a person a committed, lifelong reader of “substantive works of fiction.” My learning comes from Franzen’s famous “Harper’s Essay,” in which, he described later tongue in cheek, how he considered it “apocalyptically worrisome that Americans watch a lot of TV and don’t read much Henry James.”

Franzen learnt about the two things that make a committed lifelong reader of substantive fiction from Shirley Brice Heath, an American linguistic anthropologist. Firstly, such reading must have been “heavily modelled” when the person was very young. That applies to me and my two brothers: our mother read constantly, to herself and to us. “Thank you, mother. That was a great gift, equal even to the gift of love.” Secondly, the child needs somebody with whom he or she can share the passion. I can’t remember such a person, unless it was my mother or my brother.

These findings bothered Franzen as neither of his parents read, but Heath explains that there’s a second type of reader—“the social isolate—the child who from an early age felt very different from everyone around him.” These readers move into an imaginary world, but can’t share the world because it is imaginary. So their relationship is with the authors not others, and these kinds of readers are much more likely than the others to become writers.

This fits Franzen exactly. “You are,” said Heath, “a socially isolated individual who desperately wants to communicate with a substantive imaginary world.” Franzen is exhilarated by this description: suddenly he knows why he wants to write. And it’s nothing to do with living longer.

Richard Smith was the editor of The BMJ until 2004. He is now chair of the board of trustees of icddr,b [formerly International Centre for Diarrhoeal Disease Research, Bangladesh], and chair of the board of Patients Know Best. He is also a trustee of C3 Collaborating for Health.