I first met Betsan Corkhill in September 2008.  Stephanie Pearl-McFee (aka The Yarn Harlot) gave a talk at I Knit Day, a knitting event in London.  I bought tickets for the whole family.   Emma and Leah were 15 and 13 at the time, and joined me (and most of the audience) in knitting while we listened to the lecture.  After the talk, we wandered around the booths and exhibits while waiting for the crowds around Stephanie to diminish.  I lost Doug, but eventually found him at a booth labelled Stitchlinks, having an animated discussion about neurons, beta waves, brain plasticity, serotonin uptake, and chronic pain.  This was my introduction to Betsan, the most passionate and articulate advocate for the therapeutic benefits of knitting I know.

Betsan is the author of Knit for Health and Wellness.  She trained as a physiotherapist and continues to work closely with clinicians and academics.  You can find her online at Stitchlinks.com.  We have met Betsan on and off over the years; we went to a conference she organised in Bath on knitting and therapy for chronic pain, and she came and brainstormed with researchers at our neuroscience centre about how to study the link between knitting and brain plasticity.  Last week we met up again at a symposium on the perception and regulation of pain.

Betsan Corkhill and me

I asked Betsan if I could interview her for the blog, and she very kindly agreed.  I sent her a list of questions and she answered them very thoughtfully.  I warn you that this is a long post.  Grab yourself a cup of coffee and get comfortable.  Betsan has some fascinating insights, and I am sure you will find this discussion interesting and enlightening.

KELLY:  How did you first become interested in knitting as therapy?

BETSAN:  I had given up physiotherapy and started work as a freelance Production Editor with a large magazine publisher. When I found myself looking after the letters pages of the craft magazines I realised that I’d stumbled on something potentially very important. The vast majority of letters spoke about the therapeutic benefit of craft, particularly knitting. The striking thing was that there were large numbers of people from a range of different backgrounds and cultures saying the same things.

They spoke of the rhythm of the movements inducing a meditative-like state; the creative process enhancing their lives; of enjoying a state of flow; stress relief; of getting together with others to knit making new friends, as well as knitting enabling them to give gifts and knit for charitable causes.

I began to look at how these benefits could be enhanced to deliberately improve wellbeing, thinking it could be an accessible, relatively low cost way of helping a large number of people of all ages. Knitting’s portability means knitters can use it anytime, anywhere, from an armchair, wheelchair, bed, public transport, in the middle of the night. It was an exciting light bulb moment for me.

KELLY: I know that you have often struggled to get healthcare professionals on board.  In your book, you say: “To get my foot in the door with scientists, academics and clinicians I began calling knitting a ‘bilateral, rhythmic, psychosocial intervention’”  I love this!  Can you explain why this is important?

BETSAN: My first meeting with a GP to talk about the potential benefits of knitting didn’t go as I’d hoped. I had printed out several 100 stories from knitters and placed a large pile on his desk. He took one look and said “People are always telling me about weird and wonderful things that they’ve found beneficial. I’m not interested in stories. I’m only interested in hard-evidence.”  Just a mention of the word knitting was enough to send many into peals of laughter and ask “Are you serious?” One group of GPs called me that ‘mad knitting lady’.  The irony of that label was I didn’t regard myself as a knitter at the time. My mother had taught me at about 7 but I hadn’t done much since. I had to brush up my skills to do this work because I believe in practicing what I preach. I was treated like some sort of evangelist trying to spread the word of knitting, whereas I was coming at it purely from a health perspective.

I decided I needed to argue my case from a scientific perspective, from their viewpoint if I was to get anywhere at all. The first step was to call knitting something different so I could get my foot in the door before anyone realised I really was talking about knitting. Using the term ‘bilateral rhythmic psychosocial intervention’ helped people to overcome their preconceptions and to see knitting from a different viewpoint. It opened their minds.

KELLY:  One of the things I like about your book is that you emphasise the therapeutic effects of social knitting and also of “quiet knitting”.  The former can help with isolation (among other things) and the latter promotes “the enjoyment of solitude”.  Both of these speak to me.  Can you elaborate?

BETSAN:  The benefits of knitting alone and in a group are different. Long-term loneliness is harmful to health. Solitude on the other hand is beneficial to health and wellbeing. We can teach people to manage feelings of loneliness by enabling them to learn to enjoy moments of solitude through the absorbing, rhythmic process of knitting.

Online forums can provide a means of getting to know other knitters around the world whereas face-to-face groups offer a means of rich, safe social contact. Rich in that it provides a means of meeting a wide range of people from different backgrounds, cultures and ages. People we wouldn’t normally socialise with.  Enjoying fun, play, laughter and easy banter with friends is an important element of living well. The emotional and social support we get from others is vital for living well.

Those who attend knitting groups say they start to look forward to the next meeting in anticipation of showing off their knitting progress. They start to feel excitement, a sense of self-worth and increased confidence. Attending a group regularly can help to break into negative thought cycles in those times between group meetings and therefore begin to change thoughts in the home environment.

KELLY:  How can knitting be used to impact on chronic pain?

BETSAN:  We can explain how knitting works for pain from the biological perspective of pain. When I’m teaching people about long-term pain I describe it as emerging from a complex conversation between everything going on within you, around you, your environment, past, present moment and culture. I think it is important that people ‘get’ the complexity of pain because we can make the complexity work for us – it gives us lots of avenues in to change pain. For example, stress and pain are closely linked – we can use knitting to reduce stress. Lonely people feel more pain – knitting groups are a great way of meeting people in a safe environment. Knitting is an effective distractant, the rhythmic nature is relaxing, it can be used to improve sleep, to raise mood. It gives meaning and purpose.

Being creative can widen your experience base so your brain has more information to draw on when it makes important decisions. It helps to raise self-esteem, confidence and self-worth. You can enter different mind-states depending on the projects you choose – ranging from one of focused attention to one of daydreaming or you can choose to knit mindfully.

The feeling of being successful at something is really important. It releases powerful pain relieving, mood enhancing, motivating chemicals. Knitting provides a means of ‘being successful’ of achieving from an arm chair and this can help to motivate people to try new, different things. It can act as a springboard to other activities.

All these issues can bias that complex conversation towards not making pain. We can work on making small changes over a range of these issues. Nudging things forward one small step at a time.

Pain, ill health, health, wellbeing all need to be viewed from a whole-person perspective. Nothing in life is linear. Everything we do, everyone we meet, our environment and culture affects all these issues, so making changes in all these areas can help.

KELLY:  Since we last met, your career has moved in an interesting direction.  What are you up to now, Betsan?

BETSAN:  I’m developing my work as a Wellbeing Coach. When I was a physiotherapist I worked with people with long-term health conditions, so have 40 years of experience of working with people who are living with health issues – that makes me feel rather old!  I often come away from conferences with a feeling that there is a big gap between what happens in the world of research and the clinic – the coal face. Findings often don’t filter down to inform actual changes in treatments – the tools we have to offer people trying to live their day-to-day lives in the real, rather messy world.

Poor communication throughout the health service compounds the problems. Their treatment is often disjointed involving a number of departments who don’t talk to each other. If they do, letters often take weeks, sometimes months to travel between departments even in the same hospital … on the same corridor. For example, someone may be under the care of a Pain Clinic for hip pain whilst also seeing an orthopaedic surgeon who has put them on the waiting list for a hip replacement. Very often neither department is aware of what the other is doing or that they are even attending other clinics in the first place. The same happens in other conditions. Communication is so important, not simply from a clinical perspective in that more a accurate diagnose can be made, or a diagnosis of a complex condition with multiple symptoms can be made more quickly but also from the perspective of saving the NHS money and the person involved a lot of stress and time.

I’ve often thought that patients need the equivalent of a PA to help them navigate to get the best out of system and facilitate communication between various clinical departments. I also think our health system would do better focusing on health rather than symptoms, educating people about their conditions and enabling them to improve their wellbeing, so I took a coaching certificate and set myself up as a Wellbeing Coach.

It’s important to look at health from a whole-person perspective – the person in their environment and culture. Knowing a person’s whole story can mean the difference between effective care, and what is often, at best, an expensive waste of time. Past experiences, social issues, housing, education all need to go into the mix. I think Wellbeing Coaches can be a key to helping individuals as well as taking some strain off our health service.

Incidentally, when I ran a knitting group linked to a pain clinic, spending time knitting with the participants enabled me to hear their individual stories in a relaxed, safe space. I think this is so important because treatment plans should be taking these stories into account. Not only would they be more effective for the patient but would save the health service a lot of money from wasted approaches. This is particularly important in the case of individuals who have experienced adverse childhood experiences or abuse in any form. It’s important to have an understanding of how these issues affect people, how they affect their reactions to others in order to be able to optimise treatment and create an environment in which they feel safe to recover and heal.

Right now I’m focusing on running a ‘Wellbeing for People with Pain’ programme. It takes a different perspective from the traditional pain management programmes focusing on health, and improving wellbeing. I’m also writing another book based on this programme and looking at ways I can share this with others with an online version and perhaps a teaching programme to train others to run it. Feedback from participants has been wonderful, many of whom have previously been on traditional pain management programmes and ‘through the system’ a few times.

I’ve also been working with a colleague who is a film and video maker in the US to develop the Institution of Therapeutic Craft and Creativity. She is passionate about the hand/brain link and the importance of making, being creative with the hands. One of my workshops on knitting to improve wellbeing is available in video format on the site and we are working with other creative people and therapists who are developing a range of courses based on creative activities involving the hands.

KELLY:  Earlier you showed that people react differently to the word “knitting” than they do to the descriptor “bilateral, rhythmic, psychosocial intervention”.  Words often have powerful and unintended consequences. As a former professor of linguistics, I am always fascinated with language.  I know that you are now very interested in changing the language of pain.  What does this mean and how do you go about it?

BETSAN:  I first started looking at language in a lot more detail two years ago when I was asked to run my own pain management programme. My first thought was that if I had long-term pain I wouldn’t want to simply ‘manage’ it. I would want to learn to live as full a life as I could, so the wellbeing for people with pain programme was born.

The language that clinicians use sets our expectations about the condition and also about what our future of living with that condition holds. Words can set people on a path of fear, limitation and restriction or one of recovery and healing so it is really important for clinicians to consider the words they use wisely because those words can change outcomes.

As a society we often use warmongering language when dealing with disease. We talk about fighting, beating, winning the battle. It seems strange to me that we use words centred around killing and destroying when we are actually trying to achieve the opposite – to save lives, to enable people to recover and heal. It shouldn’t be about using medicine to win a battle against disease or death. If it was we’d all be losers because we all die eventually of something. Just thinking about fighting raises our stress levels to fight, fly, freeze or flop. When stress levels are high the body’s natural healing processes are tuned down, so it doesn’t make sense on many levels.

Advertisers have known how to use language and its presentation to influence behaviour and outcomes for years. It’s not just a case of not using harmful or factually incorrect language, I think we can take it further to deliberately use language and presentation to purposely improve wellbeing and outcomes.

It won’t be an easy task to change language. To do so means challenging long-held beliefs in medicine, society and individuals. Not to mention the pharmaceutical companies who thrive on promoting drugs as weapons.

KELLY:  Since I first met you, you have been battling against ingrained and often unsupportive behaviours and assumptions from healthcare professionals, scientists, and the industry in general.  What keeps you battling on, Betsan?

BETSAN:  The reality is that GPs still have very little other than drugs to offer those living with long-term health problems, particularly pain. Referral to a specialist unit can take months, treatment sessions are limited to a set maximum quota no matter how complex the issues. Care for those with mental health problems has been in crisis for some time. So when I stumbled across the therapeutic potential of knitting I knew I had to persevere because here was something that appeared to help people that was not only easily accessible to everyone but also had low cost implications for health systems.

Lorimer Moseley who is now Professor of Neuroscience at the University of South Australia and one of the world’s leading pain scientists was one of the first people to encourage me to persevere back in 2006. His support gave me confidence to ride those first, often derisive, comments about knitting. I was hugely proud and excited when he agreed to write the foreword of my book ‘Knit for Health and Wellnesss. How to knit a flexible mind and more…’

My initial theories back in 2006 have been supported by large numbers of ‘stories’ from around the world and increasingly by a number of studies of knitting in areas as wide-ranging as anorexia to preventing nurse burnout in palliative care. I’m also asked on a weekly basis to give assistance to students who are writing dissertations on the benefits of knitting. It’s great to see it developing, albeit still slowly. I can also talk about the benefits of knitting in most audiences now and people listen, so I guess we’ve made quite a bit of progress!

I’m also pretty stubborn and that has carried me through too. I have of course doubted the wisdom of continuing on this path on a number of occasions but then an email will pop into my inbox with yet another inspiring story of how knitting has worked its wonders for yet another person often when everything else has failed.