Sara L. Warber, MD

headshot of sara warber

Home Institution: University of Michigan School of Medicine

Field: Integrative Family Medicine & Women’s Health

Current Positions:

My Driving Question

What is the lived wisdom of women’s relationship with nature that could inform how we create health for all (human, animal, plant, etc.) within the context of environmental change?

Scholar Project 

Dreams of Nature, Health, and a Balanced Life: An Exploration of Women’s Art, Writing, and Living Experience

The health of humans and the health of nature are inextricably intertwined. Yet we are not necessarily motivated to act in accordance with this fundamental truth. Recent news has highlighted concerns about climate change in the wake of the IPCC Special Report on Global Warming of 1.5°C, released by the UN. Debra Roberts, Co-Chair of Working Group II, commented, “The decisions we make today are critical in ensuring a safe and sustainable world for everyone, both now and in the future. The next few years are probably the most important in our history.” In the United States, the 2018 National Climate Assessment emphasized both the economic and health consequences of climate change.

Thomas Berry writing in The Great Work: Our Way into the Future in 1999, and summarized in the Great Teaching Work of Thomas Berry (Schenck, 2015) suggests that:

We need new means of cultivating ourselves if we are to live differently on the Earth. Developing and telling the new story is one component of establishing such cultivation. … [This new story is found in] myth, ritual, and dream; liturgy, poetry, and music; in wisdom literature and renewed philosophies and theologies; in the plastic arts of all kinds – painting, sculpture, architecture.

The wisdom of women was identified by Berry as essential to the way forward in reshaping our relationship with the Earth. Women have a particular interest in health, often being the decision makers within families about how and when health care is accessed. In addition, women have often been identified with the nurturing aspect of nature, i.e., Mother Nature. And in some Native American cultures, women have a role in the protection of nature, especially water. Berry notes that “…women seem to be more prominent in active doing, especially in the immediate work of preserving a viable planet for future generations.”

As a Nova Institute Scholar, Sara L. Warber, MD is undertaking powerful work to inspire others to imagine anew our human ways of living, such that we have a template for transformative action to support an expanded view of health that includes both humans and the environment. To examine these challenges, Dr. Warber and a women’s collaborative of academics, arts professionals and forest therapists will undertake a mixed methods study of women’s textual data, visual art and lived experiences in nature. The study will include overlapping phases, with iterative integration and dissemination occurring throughout the project, culminating in an art exhibit coordinated with provocative community engagements.

The initial phase will explore and synthesize written expression of women’s perceptions of nature and health. Women artists, organizations, and groups working at the intersection of art, nature, and health will be identified.  The next phase will move the exploration of this intersection into museums with rich repositories of women’s art.

The lived experience phase will engage diverse groups of women on excursions into nature utilizing two innovative ways of connecting people and nature. Forest therapy is an intervention to promote human health through brief sensory experiences in nature. Music of Plants uses biofeedback and electronic music technology to translate plant electrochemical changes into sound. Documentation and evaluation will include in-depth interviews, expressive art, brief self-report scales on spiritual wellbeing and nature engagement, as well as photography and videography.

Themes identified through the first three phases will be used to create a curatorial vision for an art installation/exhibit with companion experiential and socially provocative community art events. The goal of the exhibit and events is to inspire and support ordinary women and men to become people ready to speak and act for the health of both humans and nature. Imagery has power to touch emotions – beyond our mind – and we need to engage more than our minds in order to act in the world.

Biography 

Sara L. Warber, MD, is nationally and internationally recognized as a leader, researcher, educator and clinician in integrative healthcare. She is currently an emeritus professor of Family Medicine at the University of Michigan (U-M) Medical School.

Dr. Warber has contributed to the national and global advancement of integrative medicine through:

  • co-founding the International Society of Complementary Medicine Research, a professional, multidisciplinary, non-profit scientific organization that is devoted to fostering complementary and integrative medicine research;
  • service to the Consortium of Academic Health Centers for Integrative Medicine (now Academic Consortium of Integrative Medicine and Health) as the first treasurer and a six-year member of the executive committee; and
  • current work with the World Health Organization (2017-present) on their Expert Task Force to study “The Integration of Traditional &Complementary Medicine into health systems, in particular primary health care services.”

Dr. Warber is the co-founder and former co-director of the U-M Integrative Medicine program which included research and education, funded through a five million-dollar NIH center grant. Additional NIH funding awarded to Dr. Warber supported creating and evaluating an Integrative Medicine curriculum in U-M medical school, other U-M health professions schools, and a faculty scholars program that spread integrative health to courses throughout the U-M campus. Health Resources and Services Administration (HRSA) funding allowed her to expand integrative medicine education into the Preventive Medicine Residency at University of Michigan School of Public Health.

In 2000, Dr. Warber became a founding diplomat of the American Board of Holistic Medicine. She subsequently developed the University of Michigan Integrative Family Medicine clinic where she provided holistic primary care, pre-natal to elderhood, and integrative medicine consultations in women’s health and the use of herbal medicine within the environment of a high-level research-oriented institution.

In 2013, Dr. Warber won a Fulbright Scholarship to study “Nature-Deficit Disorder” and focus deeply on research into the salutogenic effects of nature on health and wellbeing, as well as other aspects of the healing response. Through the Fulbright award, she established a second academic home at the European Centre of Environment and Human Health, University of Exeter Medical School, Truro, UK. Subsequent appointment as honorary professor at the University of Exeter Medical School has facilitated numerous international research collaborations.

Dr. Warber is the co-author of Natural Products from Plants, 2nd Edition and over fifty peer-reviewed journal articles on use and measurement of integrative therapies, the phenomenon of healing, nature and health, and the effects of complex interventions on human well-being.

Education and Training
  • Robert Wood Johnson Clinical Scholars Fellowship, University of Michigan, Ann Arbor, Michigan (1997-99)
  • Family Medicine Residency, Department of Family Medicine, University of Michigan, Ann Arbor, Michigan (1993-97)
  • MD, Michigan State University, East Lansing, Michigan (1987-93)
  • Pre-Med, Eastern Michigan University, Ypsilanti Michigan (1983-86)
  • BFA, Illinois Wesleyan University, Bloomington, Illinois (1970-73)
Selected Honors
  • Core Faculty, Qualitative Methods, National Clinical Scholars Program, University of Michigan, 2016-2019
  • Executive Committee, Michigan Mixed Methods Research and Scholarship Program, University of Michigan, 2016-2018
  • Fulbright Scholar, US-UK Fulbright Commission; University of Exeter, European Centre for Environment and Human Health, Truro, UK, 2013-2014
Selected Publications

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.”