The opening of the new Walter Reed National Military Medical Center (WRNMMC) in September 2011 marked a new era of holistic medicine in the U.S. military health system. An inspiring example of the “hospital of the future,” its whole-person approach to patient-care and state-of-the art facilities were informed by the Epidaurus Project, an initiative spearheaded by Institute Scholar Fred Foote, MD, to create a model healing environment for Wounded Warriors of the Iraq War as well as other service members.
Launched in 2001, the Epidaurus project brought together civilian and military thought leaders to identify the core principles of patient-centered care and define the physical environment that would facilitate it.
A barrier to the widespread adoption of holistic or integrative medicine has been the lack of metrics to directly measure the whole-body effects of such interventions. As the Epidaurus principles were coming to life through the construction of WRNMMC, Dr. Foote turned his attention to evaluating the impact of the innovative care that Wounded Warriors and veterans would receive there.
With support from the Nova Institute (then The Institute for Integrative Health), in 2010, he convened a group of experts, including Scholar Dr. David Lary, to develop a set of scientific metrics for this purpose. Drawing on genomics, systems biology, and complex systems science, the working group developed five metrics, which Dr. Foote describes in an article published in Global Advances in Health and Medicine:
The Green Road Project is using three of the Epidaurus metrics to evaluate the healing effects of spending time in nature—specifically, on a woodland path traveled by Wounded Warriors and their families at Naval Support Activity Bethesda, home of WRNMMC. This wheelchair accessible route allows people to cross campus through a tranquil sylvan area rather than on busy roads.
The project team hopes to scientifically demonstrate the positive impact of encounters with nature on human health. Objective evidence will advance the case for increasing community green space and making exposure to nature a therapeutic mainstay.
Article: Holistic Care in the US Military I – The Epidaurus Project: An Initiative in Holistic Medicine for the Military Health System, 2001-2012. Frederick O. Foote, MD; Roger J. Bulger, MD; Susan B. Frampton; PhD, and Edmund D. Pellegrino, MD. Global Advances in Health and Medicine. May 2012.
Article (abstract): The Epidaurus Project: Holism in Department of Defense Health Facilities. Frederick O. Foote, MD. Military Medicine. January 2012.
Healing is facilitated through safety, persistence, and trust.
Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”
“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad.
When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.)
“When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”
Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.”
Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. “…they gradually found relief from suffering and began to exhibit emergent characteristics: a sense of hope, self-acceptance, and a desire to help others—the immediate precursors to healing.”
In varying degrees, “they were able to transcend their suffering and in some sense to flourish.”
Suffering is the ongoing pain from wounding.
There is debate about whether or not one actually needs to experience suffering on the path to healing.
Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors.
“The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”
Characteristics: How predisposed someone may be to wounding/how many tools and resources someone may have to deal with trauma/illness.
Lifestages: Developmental timing plays an important role in the impact of trauma — young children often do not have the same resources as older adults.
Relationships: Relationships can provide solace and support for those suffering, while lack of healthy relationships can prolong suffering.