Maryland Matters – Opinion: The Military Believed Nature Could Heal. It’s Time for Others to Follow

Read commentary by Nova Scholar Fred Foote, who argues that health treatments for veterans and all Americans ought to include proven, non-medical interventions such as nature and art. A peaceful trail on the grounds of the Walter Reed National Military Medical Center in Bethesda serves as a reminder, he writes, of how the outdoors has provided a balm to our mental wounds during the era of COVID-19. 

By Dr. Frederick O. Foote

The writer is a retired U.S. Navy captain and Navy physician and a Scholar at the Nova Institute for Health in Baltimore. He leads the Epidaurus Project, which aims to integrate whole-person care in hospitals and clinics throughout the U.S. military health system. A practicing neurologist for 20 years, he served in Operation Iraqi Freedom as a staff neurologist and assistant medical department head on the USNS Comfort. He is the author of “Medic Against Bomb: A Doctor’s Poetry of War.”   

This Veterans Day, I’d like the health care community, including policymakers and advocates, to consider better ways to care for veterans and all Americans using proven, non-medical interventions such as nature and art.

Twenty years ago, we realized we needed a better way to care for American troops — 30% of whom were coming home from Iraq and Afghanistan with traumatic brain injuries and post-traumatic stress disorder. Conventional medicine alone wasn’t working. Our wounded warriors needed more than just medical care.

So we assembled a team of military service members, architects, engineers, landscape architects, research scholars and health care professionals who designed whole-body treatments for service members. Our goal was to treat the mind, body and spirit — not just one organ. Fortunately, the military was willing to take a chance on our ideas.

The new system of holistic care at the Naval Support Activity Bethesda — the home of Walter Reed National Military Medical Center — includes 12 programs that, in combination with traditional interventions such as medication and psychiatry, are helping veterans. Practices that include healing buildings, family-centered care, wellness initiatives, and healing through art, nature and spirituality are now used at Bethesda and throughout the military system.

One of these programs is the “Green Road,” which comprises 8 acres of a woodland ravine that follows Stoney Creek, a tributary of Rock Creek, and is the nation’s largest wild-type healing garden. Located between the main patient residence and the hospital rehabilitation facilities on the military medical base, its size allows for total immersion in nature, so visitors can experience a separate, unspoiled world as they undergo treatment.

Anyone who enters also sees a way out with “clear sight lines,” which enhances the observation of nature and supports the visitor’s sense of safety.

In contrast to many other spaces created to support health and healing, the Green Road remains largely rustic and undisturbed. War is a wild thing, its damage is a wild thing, so we thought it should be healed by something wild.

The Green Road provides wounded service members several places to connect, reflecting the communal nature of military life. It also provides a place to de-stress. Evidence-based studies show that exposure to nature reduces levels of perceived stress, anxiety and depression while boosting self-esteem and a sense of well-being. There’s no psychiatry involved in the Green Road — nature unprogrammed will heal.

One of our key partners is Nature Sacred, a foundation based on the philosophy that nature heals, restores and unifies us. As evidenced at the Green Road, it can also serve as a sanctuary to encourage reflection and honor those we’ve lost.

Since its opening, the Green Road has provided more than 12,000 servicemembers and their families with a way to find respite, sustenance and an encounter with nature. It also supports health care workers, who must manage their own trauma while they care for others.

What we have observed at the Green Road so far are statistically measurable increases in privacy, respite, relaxation, openness and mindfulness. Our team continues to study the physiological, biological and psychological responses to spending time on the Green Road. Using a new set of metrics designed to measure whole-body healing, future studies will look at biomarkers of stress, analyze participants’ journals and stories, and examine changes in gene expression.

We know that in conjunction with organ-system care, whole body medicine — that includes a connection to nature — is safe, effective, affordable, popular with patients, measurable and feasible for implementation in conjunction with conventional care.

It doesn’t have to be one or the other. But we also need to further develop ways to measure the effects of whole-body interventions, which are essential to the future of health, well-being and medicine. Measuring the impact will allow us to replicate this work elsewhere, based on the evidence.

Over the past nearly two years as our country has struggled with COVID-19, we’ve heard many reports about how the outdoors has provided a balm to our mental wounds. This is an opportune time for others to follow what the military did at Walter Reed and across the country, and perhaps even to take our work one step further to benefit both veterans and civilians.

 

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

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.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“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.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

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. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

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

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.”