Letters might help loved ones more than another online meet-up

Jamie Friedlander

THE WASHINGTON POST – Supporting friends and family who are going through a hard time used to involve meaningful chats at the local coffee shop, venting over a cup of tea on the couch or warm embraces followed by words of encouragement.

Now, because of the coronavirus pandemic, those traditions are on hold.

But we can take another approach – sending handwritten letters. The old-fashioned gesture could be particularly beneficial now: The pandemic is adversely affecting Americans’ mental health, and research suggests that being contacted by letter can lower the risk of suicide.

Besides, after months of remote work and virtual communication, many people might welcome a tangible alternative to yet another Zoom call.

If you know someone who is troubled, that person is not alone. According to data from the Centers for Disease Control and Prevention (CDC), there has been a stark increase in emotional distress among Americans since the pandemic began.

In June, nearly 31 per cent of United States (US) adults reported symptoms of anxiety or depression, while almost 11 per cent said that they had seriously considered suicide.

The prevalence of anxiety symptoms alone was about triple that of the same time period in 2019.

One contributing factor to the national mental health struggle during the pandemic has been the ongoing social isolation plaguing millions of Americans.

It’s the greatest concern of Clinical Associate Professor of Psychiatry Amanda Spray at New York University’s Grossman School of Medicine. “Social isolation is a symptom of depression,” she said, “and it leads to worsening of depression.”

“(Letters) help provide social support, even if you can’t be there with your friend or family member, holding their hand and being by their side,” said Spray, who is also the Director of the Steven A Cohen Military Family Center at NYU Langone Health.

Research indicates that such support can have a significant impact on recipients’ mental health.

One study, conducted at Stanford University in the early 1970s, followed more than 800 people after they had been discharged from the hospital for depression or suicidal tendencies.

One group of patients received handwritten letters from a health-care provider they knew in the five years following discharge, while the other group received no letters. Patients in the letter-receiving group had lower rates of suicide over the five-year period.

A more recent study looked at a new treatment for those who recently attempted suicide.

The treatment involved three therapy sessions followed by two years of receiving personalised letters. There was an approximately 80 per cent reduced risk of a repeat suicide attempt in the group who received letters.

Psychiatrist Jena Lee, Medical Director of Paediatric Emergency Psychiatry at UCLA Mattel Children’s Hospital, said that when patients are at a crisis point – meaning they’ve attempted suicide or are seriously considering it – they often can’t name one person they trust or who they know cares about them. Letters can counter that feeling.

“If I had a superpower and could change one thing for everyone that would make the biggest impact for all mental illness, it would be that everyone had one person who cares for them,” Lee said.

The medium is as important as the message.

People consider letters meaningful, because so much effort goes into sending them.

It takes time to find the right stationery, think about what to write, buy postage stamps, look up the person’s address and find a postbox. “It requires a kind of deliberation that is so lacking in our time of fast-paced messaging and media,” Lee said. “When you receive a handwritten letter, you reflexively start imagining the author sitting down and reflecting, thinking about you. That’s why it’s so very effective at showing someone does care about you.”

Early in the pandemic, Good Juju Ink, a stationery brand headquartered in San Francisco, launched 18 Million Thanks, an initiative designed to support front-line workers through handwritten cards. Head of Operations Ryan Kissick at Good Juju Ink said one registered nurse in Alaska got in touch with them after receiving a letter.

“She said, ‘This is not a fun time to be a nurse. I got a thank-you note from a patient’s spouse, and I sobbed. It does matter. We are making a difference. We are all in this together’,” Kissick said.

To support a lonely or isolated friend with a handwritten letter, keep these tips in mind:


Emily McDowell is the writer and illustrator behind Emily McDowell & Friends, a stationery brand known for its clever, colourfully designed empathy cards. The cards were born of her experience having cancer at 24.

“The hardest thing about having cancer was not losing my hair or those other things you hear about,” she said.

“It was the loneliness I felt when friends and family didn’t know what to say and ended up disappearing as a result.”

Lee emphasises the importance of being as sincere and personal as possible, instead of focussing on writing the perfect message. “Sometimes, we get so distracted trying to find the right things to say, we don’t even realise that we sacrifice being absolutely genuine,” she said.

Picture the recipient before you begin writing. Instead of thinking about yourself and what to say, envision the other person. What do you like about them? Why are you grateful to have them in your life? Have you ever learned anything meaningful from them?

“If there’s anything you can think of that you learned from that person, either directly or indirectly, that’s very helpful,” Lee said.

“When we feel someone has benefitted from us, I think that boosts our self-esteem, even if we don’t realise it.”


We all love the feeling of knowing that someone picked out a notecard just for us. Select a relevant, pandemic-specific card that your recipient will always remember.

“When you’re in a tender moment, you’re not going to be sitting on the floor sifting through 10,000 text messages on the cloud to find the one that was meaningful,” said founder and Chief Executive of Thoughtful Human Ali O’Grady, one of the stationery brands participating in 18 Million Thanks. “You’re sitting on the floor going through your box of treasures.”


If possible, share your hopes for something you wish to do or experience with the other person once the pandemic has ended.

“That lens in the letter helps that person – and yourself – be a little bit more future-oriented,” Lee said. “It exudes some hope.”


Not only are older family members less likely to be tech-savvy enough for a video chat, but they’re also more prone to loneliness, Lee said.

“I think they’re especially vulnerable throughout this pandemic for so many reasons,” Lee said.

“Letters could really impact their sense of loneliness and social connection in a powerful way.”