Last Child in the Woods: Saving Our Children From Nature-Deficit Disorder

by Louv, Richard

  As he points out, the American Psychiatric Association lists more than three hundred mental diseases in its Diagnostic and Statistical Manual, a large number of them associated with sexual dysfunction. “Psychotherapists have exhaustively analyzed every form of dysfunctional family and social relations, but ‘dysfunctional environmental relations’ does not exist even as a concept,” he says. The Diagnostic and Statistical Manual “defines ‘separation anxiety disorder’ as ‘excessive anxiety concerning separation from home and from those to whom the individual is attached.’ But no separation is more pervasive in this Age of Anxiety than our disconnection from the natural world.” It’s time, he says, “for an environmentally based definition of mental health.”

  Ecopsychology and all of its budding branches, reinforcing Wilson’s biophilia hypothesis, have fueled a new surge of research into the impact of nature on human physical and emotional health. Professor Chawla, the international expert on urban children and nature, is skeptical about some of the claims made in the name of biophilia, but she also argues that one does not have to adopt unreservedly the entire thesis to believe that Edward O. Wilson and the ecopsychology movement are on to something. She calls for a common-sense approach, one that recognizes “the positive effects of involvement with nature on health, concentration, creative play, and a developing bond with the natural world that can form a foundation for environmental stewardship.”

  The idea that natural landscapes, or at least gardens, can be therapeutic and restorative is, in fact, an ancient one that has filtered down through the ages. Over two thousand years ago, Chinese Taoists created gardens and greenhouses they believed to be beneficial for health. By 1699, the book English Gardener advised the reader to spend “spare time in the garden, either digging, setting out, or weeding; there is no better way to preserve your health.”

  In America, mental-health pioneer Dr. Benjamin Rush (a signer of the American Declaration of Independence) declared, “digging in the soil has a curative effect on the mentally ill.” Beginning in the 1870s, the Quakers’ Friends Hospital in Pennsylvania used acres of natural landscape and a greenhouse as part of its treatment of mental illness. During World War II, psychiatry pioneer Carl Menninger led a horticulture therapy movement in the Veterans Administration Hospital System. In the 1950s, a wider movement emerged, one that recognized the therapeutic benefits of gardening for people with chronic illnesses. In 1955, Michigan State University awarded the first graduate degree in horticultural/occupational therapy. And in 1971, Kansas State University established the first horticultural therapy degree curriculum.

  Today, pet therapy has joined horticultural therapy as an accepted health-care approach, particularly for the elderly and children. For example, research has shown that subjects experienced significant decreases in blood pressure simply by watching fish in an aquarium. Other reports link pet ownership to a lowering of high blood pressure and improved survival after heart attacks. The mortality rate of heart-disease patients with pets was found to be one-third that of patients without pets. Aaron Katcher, a psychiatrist on the faculty of the University of Pennsylvania’s Schools of Medicine, Dentistry, and Veterinary Medicine, has spent over a decade investigating how social relationships between human beings and other animals influence human health and behavior. Katcher and Gregory Wilkins, an expert on animal-facilitated therapy in residential treatment centers, tell of an autistic child who spent several sessions with passive dogs before encountering Buster, a hyperactive adolescent dog brought from a local animal shelter. At first the autistic child ignored the dogs—but at a later session, “without any other change in regimen, the patient eagerly ran into the therapy room and within minutes said his first new words in six months: ‘Buster Sit!’” The child learned to play ball with Buster and give him food rewards—and also learned to seek out Buster for comfort.

  The evidence of the therapeutic value of gardens and pets is persuasive. What do we know, though, about the next step—the influence of unstructured natural landscapes and experiences in nature on human development and health? Poets and shamans have recognized that link for millennia, but science began to explore it relatively recently.

  Most of the new evidence connecting nature to well-being and restoration focuses on adults. In the American Journal of Preventive Medicine, Howard Frumkin, M.D., chairman of the Department of Environmental and Occupational Health at Emory University’s School of Public Health, wrote that he considered this a mostly overlooked field in modern medicine, even though many studies credit exposure to plants or nature with speeding up recovery time from injury. Frumkin pointed to a ten-year study of gallbladder surgery patients, comparing those who recovered in rooms facing a grove of trees to those in rooms with a view of a brick wall; the patients with the view of trees went home sooner. Perhaps not unexpectedly, research revealed Michigan prison inmates whose cells faced a prison courtyard had 24 percent more illnesses than those whose cells had a view of farmland. In a similar vein, Roger Ulrich, a Texas A&M researcher, has shown that people who watch images of natural landscape after a stressful experience calm markedly in only five minutes: their muscle tension, pulse, and skin-conductance readings plummet.

  Gordon Orians, professor emeritus of zoology at the University of Washington, says such research suggests that our visual environment profoundly affects our physical and mental well-being, and that modern humans need to understand the importance of what he calls “ghosts,” the evolutionary remnants of past experience hard-wired into a species’ nervous system.

  The childhood link between outdoor activity and physical health seems clear, but the relationship is complex. The Centers for Disease Control (CDC) reports that the number of overweight adult Americans increased over 60 percent between 1991 and 2000. According to CDC data, the U.S. population of overweight children between ages two and five increased by almost 36 percent from 1989 to 1999. At that time, two out of ten of America’s children were clinically obese—four times the percentage of childhood obesity reported in the late 1960s. Approximately 60 percent of obese children ages five to ten have at least one cardiovascular disease risk factor, while the Journal of the American Medical Association reported an upward trend in high blood pressure in children ages eight to eighteen.

  Because of this fundamental concern, pediatricians now warn that today’s children may be the first generation of Americans since World War II to die at an earlier age than their parents. While children in many parts of the world endure hunger and famine, the World Health Organization warns that the sedentary lifestyle is also a global public health problem; inactivity is seen as a major risk factor in noncommunicable diseases, which cause 60 percent of global deaths and 47 percent of the burden of disease.

  In addition to possible links between child obesity and various genetic complexities, a common virus, and even sleep deprivation, the current debate circles two obvious contributors: First, television and junk food are linked to child obesity. The CDC found that the amount of TV that children watch directly correlates with measures of their body fat. In the United States, children ages six to eleven spend about thirty hours a week looking at a TV or computer monitor. Medical researchers in Seattle found that by three months, about 40 percent of children regularly watched TV, DVDs, or other videos. The second factor: More exercise would help.

  But what kind of exercise, and where? Parents are told to turn off the TV and restrict video game time, but we hear little about what the kids should do physically during their non-electronic time. The usual suggestion is organized sports. But consider this: The obesity epidemic coincides with the greatest increase in organized children’s sports in history. Experts on child obesity now concede that current approaches don’t seem to be working. What are kids missing that organized sports, including soccer and Little League, cannot provide?

  Oddly, the word “nature” has seldom shown up in the literature of child obesity, though that may be changing. Generalized, hour-to-hour physical activity is the abse
nt ingredient in this discussion. The physical exercise and emotional stretching that children enjoy in unorganized play is more varied and less time-bound than is found in organized sports. Playtime—especially unstructured, imaginative, exploratory play—is increasingly recognized as an essential component of wholesome child development. Research findings on outdoor play often mingle types of activities, such as bicycle riding in the neighborhood, with findings more specific to the nature experience. Additional rigorous, controlled studies are needed to sort out correlation, cause and effect. However, when recent studies are considered together, they do lead to strong hypotheses.

  “Play in natural settings seems to offer special benefits. For one, children are more physically active when they are outside—a boon at a time of sedentary lifestyles and epidemic overweight,” according to Howard Frumkin, M.D., now director of the CDC’s National Center for Environmental Health.

  Recent studies describe tantalizing evidence that links time spent outdoors to other health benefits, beyond weight control, that may be specific to the actual experience of nature. In Norway and Sweden, studies of preschool children show specific gains from playing in natural settings. The studies compared preschool children who played every day on typically flat playgrounds to children who played for the same amount of time among the trees, rocks, and uneven ground of natural play areas. Over a year’s time, the children who played in natural areas tested better for motor fitness, especially in balance and agility.

  Adults, too, seem to benefit from “recess” in natural settings. Researchers in England and Sweden have found that joggers who exercise in a natural green setting with trees, foliage, and landscape views feel more restored, and less anxious, angry, and depressed than people who burn the same amount of calories in gyms or other built settings. Research is continuing into what is called “green exercise.” These studies are focused mainly on adults.

  But what about children’s emotional health? Although heart disease and other negative effects of their physical inactivity usually take decades to develop, another result of the sedentary life is more readily documented: kids get depressed.

  Biophilia and Emotional Health

  Nature is often overlooked as a healing balm for the emotional hardships in a child’s life. You’ll likely never see a slick commercial for nature therapy, as you do for the latest antidepressant pharmaceuticals. But parents, educators, and health workers need to know what a useful antidote to emotional and physical stress nature can be. Especially now.

  A 2003 survey, published in the journal Psychiatric Services, found the rate at which American children are prescribed antidepressants almost doubled in five years; the steepest increase—66 percent—was among preschool children. “A number of factors acting together or independently may have led to escalated use of antidepressants among children and adolescents,” said Tom Delate, director of research at Express Scripts, the pharmacy benefits group that conducted the survey. “These factors include increasing rates of depression in successive age groups, a growing awareness of and screening for depression by pediatricians and assumptions that the effectiveness experienced by adults using antidepressant medications will translate to children and adolescents.” The growth in such prescriptions written for children occurred even though antidepressants were never approved for children younger than eighteen—with the exception of Prozac, which was approved as a treatment for children in 2001, after the rise in juvenile prescriptions began. The findings were announced a month after the Food and Drug Administration asked pharmaceutical companies to add explicit product labeling warnings about alleged links between antidepressants and suicidal behavior and thoughts, especially among children. In 2004, data analysis by Medco Health Solutions, the nation’s largest prescription benefit manager, found that between 2000 and 2003 there was a 49 percent increase in the use of psychotropic drugs—antipsychotics, benzodiazepines, and antidepressants. For the first time, spending on such drugs, if medications for attention disorders are included, surpassed spending on antibiotics and asthma medications for children.

  Although countless children who suffer from mental illness and attention disorders do benefit from medication, the use of nature as an alternative, additional, or preventive therapy is being overlooked. In fact, new evidence suggests that the need for such medications is intensified by children’s disconnection from nature. Although exposure to nature may have no impact on the most severe depressions, we do know that nature experiences can relieve some of the everyday pressures that may lead to childhood depression. I’ve mentioned the Ulrich study and a few others that focused on adults; in The Human Relationship with Nature, Peter Kahn points to the findings of over one hundred studies that confirm that one of the main benefits of spending time in nature is stress reduction.

  Cornell University environmental psychologists reported in 2003 that a room with a view of nature can help protect children against stress, and that nature in or around the home appears to be a significant factor in protecting the psychological well-being of children in rural areas. “Our study finds that life’s stressful events appear not to cause as much psychological distress in children who live in high-nature conditions compared with children who live in low-nature conditions,” according to Nancy Wells, assistant professor of design and environmental analysis in the New York State College of Human Ecology at Cornell. “And the protective impact of nearby nature is strongest for the most vulnerable children—those experiencing the highest levels of stressful life events.”

  Wells and colleague Gary Evans assessed the degree of nature in and around the homes of rural children in grades three through five. They found that children with more nature near their homes received lower ratings than peers with less nature near their homes on measures of behavioral conduct disorders, anxiety, and depression. Children with more nature near their homes also rated themselves higher than their corresponding peers on a global measure of self-worth. “Even in a rural setting with a relative abundance of green landscape, more [nature] appears to be better when it comes to bolstering children’s resilience against stress or adversity,” Wells and Evans reported.

  One reason for the emotional benefits of nature may be that green space fosters social interaction and thereby promotes social support. For instance, a Swedish study shows that children and parents who live in places that allow for outdoor access have twice as many friends as those who have restricted outdoor access due to traffic. Of course, no one would argue that nature’s solace is entirely dependent on the social interaction that nature may encourage.

  Nature also offers nurturing solitude. A study of Finnish teenagers showed that they often went into natural settings after upsetting events; there, they could clear their minds and gain perspective and relax. After a classroom discussion I conducted at the University of San Diego about nature and childhood, Lauren Haring, a twenty-year-old student, described the importance of nature to her emotional health:

  Growing up [in Santa Barbara, California], I lived in a house that had a fairly big back yard and a creek across the street. It was when I was by myself that the environment meant the most to me. Nature was the one place where, when everything in my life was going bad, I could go and not have to deal with anyone else.

  My dad died of brain cancer when I was nine. It was one of the most difficult times for my family and myself. Going out into nature was one outlet that I had, which truly allowed me to calm down and not think or worry.

  I really believe that there is something about nature—that when you are in it, it makes you realize that there are far larger things at work than yourself. This helps to put problems in perspective. And it is the only place where the issues facing me do not need immediate attention or resolution. Being in nature can be a way to escape without fully leaving the world.

  Richard Herrmann, a nature photographer, also understands the healing qualities of nature, which helped him through a tragic time. He told me:

  My first memories of bein
g affected by the natural world were from my youth growing up at Pacific Grove, not far from the burned-out cannery of Cannery Row. I remember being four years old, and looking into a tide pool, and being mesmerized by the tiny fishes swimming through the shimmering water, and the anemones and crabs scurrying about. I was transfixed; I could have looked at the same pool for days. To me, the tide pool represented perfection, and calmness. I also remember my father returning from fishing in the bay with sacks of colorful rock cod . . . I found them beautiful. They represented special treasures from the sea.

  I was a kid who could not sit still for more than a few minutes, so school was painful for me. But nature always gave me this incredible calmness and joy. I could literally sit and fish, or crab, for hours without getting bored, even if I wasn’t catching anything.

  Later, I needed this calmness again when my father was killed in a car accident when I was fourteen. I was lost, and the temptations and distractions were many in the late sixties. Drugs were everywhere. I remember being absolutely in pain and stress most days, but I would find solace by walking by myself to an area of coast oak woodland—just walking, looking at the undercover of poison oak . . . seeing salamanders, colorful mushrooms, and lichens. It all made sense to me. I experienced great calmness there that I could not find anywhere else.