A patient who regularly goes out walking along Shetland’s coastline specifically to improve his mental health recently described an encounter with nature. He slipped and fell in the mud on a cliff top. Lying on his back, thankfully unhurt, but cursing his bad luck, he noticed the cloud patterns in the sky, and spent a high quality quarter of an hour watching what went by directly above him. It is what you make of it.
Chances are, being connected to the natural world around us makes us healthier and happier. Quite apart from how much more physically active we might be while doing this, there appear to be benefits to health and well-being specifically from connecting with the natural world.
In Sweden, they call unwinding in the outdoors Friluftsliv, and consider it a national treasure. If you read about it, you’ll find people trying to carefully define what counts as this deep connection with nature and what doesn’t. Defining it is important, because, apart from there being some competition with Norway over ownership of the notion, there is a recognition that it probably plays a part in what makes their society function the way it does. As a rule of thumb, if it makes you feel better it’s probably working. But if a nation values this kind of behaviour, and government resources used to promote it, then it is easier to get a consensus if you can prove its worth.
Proving its worth is fiendishly difficult. In these days of evidence-based medicine, we feel more comfortable directing public resources to an intervention if there are research trials proving that it works. Comparing outcomes between people who engage with nature and those who don’t is loaded with confounding variables.
That said, the research that has been done suggests that seeking a positive interaction with the natural world can improve outcomes for conditions like anxiety and hypertension, and it probably gives people who are well a better experience of life.
In Shetland, there’s a lot of nature with which to engage, and RSPB Scotland have made available to us some materials for encouraging people to do it. As GPs, we have leaflets for patients who we feel might be helped by finding a connection with nature. I have a pile of them on my desk, and am pleased to be handing them out.
We are encouraged to go out, pay attention to what is living and growing, watch the landscape and light, and notice what the weather does to it, or a change in season, or a different time of day or height of the tide. The leaflets have some suggestions as to how people might successfully connect with their surroundings in a beneficial way.
Frequently, the resolution of some distracting difficulty has come to me whilst outside thinking about something else. We’re lucky here, as nature is outside our front doors. It howls around the eaves of our houses – the natural world in Shetland doesn’t sit and wait for you to go out looking for it. And there’s room for a lot more people out there. Every time I’ve been out running on the beach after dark, watching a violent sea in moonlight, I’ve had a mile of sand to myself.
Of course, going outdoors doesn’t invariably result in a positive experience. The kind of connection with nature you’re looking for can’t be guaranteed. To some extent you need to leave yourself behind, and go out and look, and be open to what any of your senses might give you. There’s a place for stewing over your problems while out walking, but you’re less likely to see the owl flying low at dusk, or the pattern of lichen on a stone, if you’re preoccupied with some conflict or distress. You can make a successful encounter with nature more likely by being in the right place, at the right time, in the right frame of mind, but you don’t know what will happen until you get there. “Noticing the simplest transactions of the natural world” is good place to start, to quote the author Robert Macfarlane in the 2017 film Mountain.
Some of the research also notes a recruitment bias towards people who felt inclined to do this for themselves anyway. Put someone without enthusiasm for nature outside in adverse weather, and they might well feel cold, wet and bored (Though you might imagine that if this were a national pastime, as it appears to be for the Swedes, there might be a greater participation). You might need some help in making it a positive experience, and this is where RSPB Scotland have stepped in to help.
The prescription for nature isn’t intended to replace anything we’re already doing. The evidence for improved outcomes in specific conditions isn’t strong enough to replace existing treatments. However, we are regularly asked by patients for advice about what kind changes in lifestyle might help their situation – general practitioners often have discussions with patients actively seeking help in unpicking what it is about their experience of life that is making them feel bad. Whether you feel calm or anxious, distressed or fulfilled depends on a lot of things, probably more to do with how we interact with each other than with nature. However, a dose of Friluftsliv probably helps us get on better with the people around us.
Getting out and seeing what nature is doing is a strategy I use myself regularly, but haven’t much been in the habit of recommending to patients. Having the RSPB Scotland leaflets to hand is a great help. As for my patient who fell in the mud, I gave him a Prescription for Nature leaflet, though I think he was already ahead of me on this one.
Dr Mark Maudsley is a Shetland GP. If you are affected by any of the issues mentioned in this article, you can find more help and support at Mind, the mental health charity, or by calling the Samaritans on 116 123.