Nature Prescription – Biophilia

Feeling stressed?  Immerse yourself in nature. Visit the restorative Emerson Resort & Spa.

Recall the last time you felt overwhelmed, stressed, frustrated, or unhappy.  Imagine if in that moment, you could magically transport yourself anywhere in the world.  Where would you go?  Close you eyes for a moment and visualize this place.

Was your restorative place inside or outside?

At CAMA, we often ask our clients to describe places that offer them respite and relief from the daily pressures of life, places that rejuvenate their spirits.  The vast majority of people gravitate to places in nature such as beaches, parks, and hiking trails.  Spending time in nature feels good.  Scientists have measured many psychological and physiological health benefits associated with spending time in nature, confirming what we have intuitively known for so long.  Ironically, this evidence is emerging at a time when we are more disconnected from nature than ever before.

Consider how much of your day is spent driving, working, and sitting in front of a computer screen.  Americans spend over 90% of their time indoors.[1]  We actually spend more time in our cars than we do in nature.[2]  We continue to log long hours at work with the average work week increasing by 9% since 1979; however, more time at the office does not necessarily translate into increased productivity.[3]  We spend on average over 11 hours a day staring at digital devices.[4]  Unsurprisingly, we end up sitting a lot.  In fact, today we spend more time sitting than we do sleeping.[5]

This lifestyle is literally killing us.  Today, half of Americans live with a chronic disease and a quarter of us live with at least two of them.[6]  Treating people for heart disease, stroke, cancer, diabetes, obesity, and arthritis places a tremendous financial burden on our health system, accounting for a whopping 86% of all healthcare spending.[7]  While the most deadly and costly of all diseases, chronic illnesses are paradoxically the most preventable, having more to do with an unhealthy lifestyle than genetics.

How does spending time in nature affect our brain, body, and overall health and wellbeing?  How might rekindling our connection with nature help reverse these negative health trends?

Justin Bogardus, founder of Nature Rx, believes that nature has a marketing problem, and he has created a series of humorous videos to remind us that we are part of nature, not separate from it.  In his first video, a bearded man crouches by the edge of a wooded lake, looks directly into the camera and asks, “Are you feeling tired, irritable, stressed out?”  He raises his hands to gesture at his surroundings and says, “Well you might consider (dramatic pause) Nature.”  At this point, a logo for prescription strength Nature gradually appears.  A spoof on prescription drug commercials, Nature Rx even has a list of side effects that include “spontaneous euphoria, taking yourself less seriously, and being in a good mood for no apparent reason.”  The video concludes by suggesting that you “ask your doctor if Nature is right for you.”[8]

Part of what makes Nature Rx both funny and a bit unsettling is the underlying truth it reveals about modern culture.  As living creatures, we are genetically wired to respond positively to “life and life-like processes” a phenomenon American biologist E.O. Wilson describes as biophilia.[9]  By satisfying this urge to engage with the great outdoors, we reap numerous health benefits that include reducing stress, improving sleep, sparking creative thinking, and improving our sense of self.  Unfortunately, as we spend more time indoors, we are more likely to swallow a cocktail of pills for what ails us, than lace up our shoes and go for a walk in the woods.  A small cadre of physicians want to change this, initiating a movement in nature therapy.

Dr. Robert Zarr, a pediatrician at Unity Health, is the “physician champion” of DC Park Rx, an innovative park prescription program that encourages patients to visit parks throughout Washington, D.C.  Zarr, along with public health students from George Washington University, created a database cataloging over 350 parks and green spaces throughout the city and linked this information to Unity’s electronic health record.[10],[11]  The database allows Zarr to make concrete recommendations to his patients about accessing nature within a five-mile radius of their homes, and he literally scribbles instructions about where, when, and for how long on a prescription pad with the heading “Rx for Outdoor Activity.” [12]   Zarr hopes to gather data about the program’s effectiveness and his research has already shown that children with park prescriptions participate in 22 more minutes of physical activity each week. [13]  This program has gained national attention and has inspired the inception of at least 150 similar programs across the country.[14]

On the opposite coast, Dr. Nooshin Rzanai of UCSF Benioff Children’s Hospital in Oakland, CA trains pediatricians to write park prescriptions for their patients and families. The design of the outpatient clinic reinforces this new approach with maps and images of nature integrated throughout the interiors.  In an article for National Geographic, Rzanai explains, “we have transformed the clinical space so nature is everywhere. There are maps on the wall, so it’s easy to talk about where to go, and pictures of local wilderness, which are healing to look at for both the doctor and patient.”[15]

For some conditions, park prescriptions may be more effective and faster acting than prescription drugs.  For example, studies have found that light treatment reduces feelings of depression after less than 2 weeks, as compared to the 4–6 weeks typical for the effective onset of antidepressant drugs.[16]  Happiness researcher, Lisa Nisbet of Trent University, keenly observes, “People underestimate the happiness effect of being outdoors.  We don’t think of it as a way to increase happiness…We evolved in nature. It’s strange we’d be so disconnected.”[17]

Sunshine not only improves our mood, but also improves our sleep by influencing circadian rhythm, the body’s internal 24-hour clock.  According to the Centers for Disease Control, 50–70 million Americans suffer from sleep disorders or deprivation.[18]  Spending more time outside may reduce the need for prescription sleeping pills. Mariana Figueiro, Light and Health Program Director at the Lighting Research Center, contends that our body clocks are confused due to a lack of sunlight exposure during the day and an abundance of blue light emitted by digital devices at night.  She also argues that the prevalence of attention-deficit/hyperactivity disorder (ADHD) which effects more than one in ten children in America[19] may be a result of children not spending enough time outside and thus sleeping poorly at night.  Indeed, studies with children have shown that spending more time in nature reduces the symptoms of ADHD.[20]

If you find yourself in a sour mood, sleep deprived, and your kids are driving you crazy, maybe a camping trip is just want the doctor ordered.

Researchers from the University of Colorado have found that sleep patterns shift after a week of camping with only sunlight during the day and campfires at night.  In the absence of artificial light, people go to bed at least an hour earlier and rise an hour earlier in the morning, as their internal clocks recalibrate with the natural light and dark cycles of the day. [21]  New research has revealed that nearly every organ in our body has its own clock, not just our brains, and when these clocks are out of synch, our health suffers, exacerbating conditions such as diabetes and depression.[22]

Other studies have shown that spending three days immersed in nature helps our brain rest and restore its capacity for tasks that require focused, directed attention.  For the National Geographic article, “This is Your Brain on Nature,” Florence Williams shadows cognitive psychologist, David Strayer and a group of psychology students from the University of Utah, on a camping trip to experience first-hand what Strayer describes as the “three-day effect.”  According to Strayer,

“our brains…are easily fatigued. When we slow down, stop the busywork, and take in beautiful natural surroundings, not only do we feel restored, but our mental performance improves too…The three-day effect is a kind of cleaning of the mental windshield that occurs when we’ve been immersed in nature long enough.”[23]

Strayer has demonstrated this effect in previous studies with backpackers on Outward Bound expeditions.  In these studies, backpackers were not only immersed in nature but also completely unplugged from all forms of media and technology.  After three days, they improved on a creative, problem-solving task by a remarkable 50%.[24]  It is unclear how much of this increase can be attributed to engaging with nature versus disengaging with technology.  Nature writer, David Gessner, explains how technology is a constant distraction in our lives and source of stress, slowly turning us into “fast twitch animals.”  He explains, “It’s like an alarm clock going off every 30 seconds.  It is zapping our ability to concentrate for a long time and…our ability to appreciate the natural world.”[25]

It’s probably hard to imagine turning off your cell phone for three days, and while three-day nature retreats sound appealing, such excursions require planning and vacation time, but even small doses of nature can provide significant health benefits.  Japanese researchers have found that a 15-minute stroll through the woods, as compared to a walk through a city center, decreases stress, blood pressure, and heart rate.[26]  Even more intriguing, walking in the woods may increase our body’s ability to fight cancer.  Some trees, like Cyprus, emit chemical compounds called phytoncides, which our bodies absorb and respond to with an increase of natural killer cells, the cells responsible for killing tumors in our bodies.[27]  “We can experience a 40% increase in our natural killer cells from just walking in the woods.”[28],[29]

What does this mean for city-dwellers, where a walk through a dense forest is hardly a daily occurrence?  Today over half of the world’s population lives in a city and this number is expected to grow rapidly.  According to projections from the United Nations, by 2030, the world will have 41 cities each with 10 million inhabitants or more. [30]

How will megacity living impact our health and wellbeing?

New York City hit megacity status in 1950, but almost 100 years earlier civic leaders had recognized the need for green space, ultimately setting aside 750 acres of land in central Manhattan for what would become the first landscaped public park in the United States, Central Park.[31]  Its landscape designer and architect, Frederick Law Olmsted, understood the link between public parks and public health, famously saying, “The occasional contemplation of natural scenes of an impressive character…is favorable to the health and vigor of men.”[32]  Today Central Park is the most frequently visited urban park in the United States, receiving 42 million visits each year.[33]

More recently, New York City’s conversion of an abandoned, elevated railway into a landscaped pedestrian path known as the High Line has soared in popularity becoming “one of the top visitor attractions in New York, more popular even than the Statue of Liberty.”[34]  In 2000, the dilapidated railway stretching 1.5 miles from the Meatpacking District to the Hudson Rail Yards in Manhattan had become an eyesore.  Teetering on the brink of demolition, a group of community activists fought for its preservation.  Striking photographs by Joel Sternfeld captured the rails overgrown with wildflowers and grasses.  Set against a backdrop of brick, steel, concrete, and views of the city skyline, images of this green swath of “wildscape” surprised and delighted the public and played a major role in the movement to save the High Line and inspired the final design.  The resulting public promenade designed by landscape architect James Corner Field Operations and architects Diller Scofidio + Renfro utilizes shifting planks to demarcate an irregular pathway.  Plantings seem to creep between planks suggesting an overgrown trail, celebrating Nature’s ability to thrive even in the most unexpected places.

In Singapore, signs of nature are never too far from view, sprouting up in the form of lush rooftop gardens, tree-lined streets, and spectacular parks.  Former prime minister, Lee Kuan Yew recognized the unnatural and potentially harmful effect of urban living, once saying “A concrete jungle destroys the human spirit.”[35]  Yew set out to transform Singapore into a “garden city” by softening the hard edge of urban development with the integration of landscaping.  In the 1960s, he introduced an intensive tree-planting campaign, which was followed by the creation of parks and nature reserves.[36]  Today, Singapore continues to realize this vision with ambitious projects such as the Gardens by the Bay, a park equal in size to “177 football fields and home to 80 percent of the world’s plant species.”[37]  One of the park’s main attractions is a grove of solar-powered Supertrees.  These towering structures with branch-like canopies support the growth of an exotic collection of ferns and vines while simultaneously generating power, collecting rainwater, and acting as air vents for nearby attractions.

But even ordinary trees have superpowers when it comes to influencing our health.  An interesting study set out to isolate the health potential embodied in a single tree asking, “how much could a tree in the street or a nearby neighborhood park improve our health?[38]  Turns out, quite a lot.  Researchers “overlaid health questionnaire responses from more than 31,000 Toronto residents onto a map of the city, block by block. Those living on blocks with more trees showed a boost in heart and metabolic health equivalent to what one would experience from a $20,000 gain in income.”[39], [40]   Other studies have found that living in close proximity to parks and green space positively influences our health, even when we don’t use them.[41]  Maybe simply having more trees within view is good for us, and this may be especially true during times of illness.

Throughout history there are many examples of cultures harnessing the restorative properties of nature.  In Ancient Greece, the chronically and terminally ill sought medical care at temples located on hilltops with sweeping views of the Mediterranean Sea, and yet, it was not until 1984, that scientific data finally confirmed that views of nature promote healing.  The landmark study, “View through a Window May Influence Recovery from Surgery” published in Science magazine in 1984 was the first study to prove that patients heal more rapidly when exposed to views of nature.  Environmental psychologist, Roger Ulrich, reviewed the medical records of patients recovering from gallbladder surgery at a suburban Pennsylvania hospital.  Patient rooms either overlooked a grove of trees or a brick wall.  Those patients with tree views recovered almost a full day faster and required fewer doses of pain medication than those patients who viewed the brick wall.[42]  Even simulated views of nature have been found to have positive health effects.  In subsequent research, Ulrich and colleagues measured the impact of different visual stimuli including nature art, abstract art, and a control condition with no art on patients recovering from heart surgery.  Those patients exposed to a sunny, spatially open view of trees and water experienced the least anxiety and pain as compared to the other conditions.[43]

How does the interior design of the places we live, learn, work, play, and heal impact our health and wellbeing?  How can we design a healthier Life Indoors where people can thrive and flourish?

“Schools Out” is a delightful documentary of the outdoor adventures of 4-7 year olds enrolled in a forest kindergarten in Langnau am Albis, Switzerland.  Rain, snow, or shine these children spend their days climbing trees, crafting toys and tools out of found objects, clambering on slippery rocks, building forts, and digging in the mud.  They play, explore, and learn by engaging with nature on their terms.  The school’s emphasis on unstructured play in nature stands in stark contrast with American public education standards whose rigid schedules barely leave time for recess.  The children seem so at home and happy moving and playing freely in the woods, and it is a joy to watch their reactions to unexpected events and curious discoveries.   Watching this movie may have you longing for the simpler days of your childhood, when you would play outside until called for dinner.  Unfortunately, today American children on average “spend as few as 30 minutes engaged in unstructured outdoor play each day, and more than seven hours each day staring at electronic screens.”[44]  In his book “Last Child in the Woods” Richard Louv coined the phrase “nature deficit disorder” to describe the behavioral problems that result from spending too much time indoors.

Not only do we spend too much time indoors, but also the design of buildings themselves often further disconnects us from nature.  Judith Heerwagen is a leader in the biophilic design movement and advocates for a more humane approach to how we design buildings.  As a graduate student in psychology, Heerwagen had studied the dysfunctional behavior of animals in captivity.  Since then, zoo design has evolved dramatically, abandoning exhibit cages for immersive environments that simulate an animal’s natural habitat.  This new approach moves beyond merely trying to keep animals alive and attempts to improve their wellbeing with elaborate settings that encourage animals to behave as they normally would in the wild.   Heerwagen’s experience observing animal behavior within natural and unnatural environments gives her a unique perspective and causes her to question the fundamental needs that must be addressed in the built environment in order for people to thrive and flourish.  Creating opportunities to connect with nature becomes one of the most basic principles.  In the article “Biophilia, Health, and Well-being” she writes,

“If there is an evolutionary basis for biophilia…then contact with nature is a basic human need: not a cultural amenity, not an individual preference, but a universal primary need. Just as we need healthy food and regular exercise to flourish, we need ongoing connections with the natural world.”[45]



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