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SocialPrescriptionwithintheNaturalEnvironment This talk is dedicated to Jane Lorimer, who died March 1 2022. Jane was a powerful voice promoting good diet as the foundation of robust health, and my greatest supporter. RIP Health Warning: I have no medical training other than a Wilderness First Aid certificate and a kind heart. Note: the below offers a broad perspective of preventive medicine from my perspective as running a business offering “green” health interventions. In my talk, I will only be covering a small part of this fascinating arena, summarised in Appendix 6 below. Good Evening My name is Rory MacPhee. I am 65 years old. My trade is Forestry and Timber Design. I own a Forest in Fife, which is being repurposed as a “Curative Forest” (2) A Curative Forest is simply where folk go to do absolutely NOTHING, turning off their weapons of mass distraction (cell phones) and turning up on their sensory perceptions. Talking of which...have any of you experienced a guided meditation (6) sat on a moss covered rock by a bubbling burn or river? Or have any of you sat with others, sipping tea made from pine needles, quietly sharing the experience of touching a tree? Yes? No? You should try it sometime, and consider how it might affect your cortisol levels. We hear much about the necessity to spend more time in the natural (as opposed to the built) environment. This is by no means a contemporary insight. Hippocrates said, after all, “walking is manʼs best medicine”. CarlJung, our great inspiration and teacher, published a book in 1949 titled “The Earth has Soul” . He wrote on the frontispiece “Our task is not to return to Nature in the manner of Rousseau, but to find the natural self again” . Over the past forty years or so, a subset of psychology has been under development, very much based on thinking in the USA. This is called“ecopsychology” and offers an approach to “ecotherapy”. The tenet can best be summed up as offering a structure that confronts and mitigates “Nature Deficit Disorder” . Please note that this is NOT generally accepted as a valid category within psychology. Ecotherapists are self-proclaimed, there is no Institute with agreed statutes that moderates practitioners. As a trained Forest Guide, my practice is based on opening up our sensory perception. We have many different senses - our five main ones, but also others. Can you think what these senses are...? (1) Some say we have fifty three different senses. Fifty three! These senses are designed to enable us to survive and thrive. As our sensory perception narrows, so do our neurological capacities. This is, surely, self-sabotage writ large? Incidentally, my own view is that our sixth sense is the IMMUNE SYSTEM. At the risk of losing youse all here, this is a concept rooted in psychoneuroimmunology (PNI) which avers that the communication system between our nervous and immune systems enables hunting and elimination of pathogens, tumours and allergens. So my question to you is, what techniques to you know of that seek to optimise our PNI? Or would this put you all out of work? The point is, that encouragement to interventions to support our sixth sense are all rooted in nature, and embrace Aristotleʼs description of the SOUL in his book De Anima. I urge you to research the word ANIMA and its root ANE- . (Clue: ane in the Ancient Greek means breathe.) By opening up awareness through, say breathing exercises, we find we become more present. Our chattering mind begins a process of taming. Magic happens, squirrels appear, tiny woodland flowers become apparent. We connect with the soil, which is our soul, our original semen. Over three hours or more, we engage with our own authentic self through peace in nature. And then...we drink it in community with others during a Tea Ceremony. This process is firmly rooted in the concept of preventive - as opposed to curative - medicine. Moreover, it is founded on the idea of INVITATION. I will say...”you are invited to dig a hole and inhale the soil, the so. I do not PRESCRIBE, believing this to be a word rooted in patriarchy and bureaucracy. Before looking in detail at Social/Lifestyle Invitation/Prescription, letʼs do some theology! It is clear to most of us that we have been fairly poor stewards of this Earth - which is 70% water by surface area in point of fact. We attempt to describe ourcurrent predicament in terms of “sustainability”, a word perhaps over-used. It simply means that we gather what we need whilst allowing regrowth for the benefit of our children. Thatʼs cool for us plants people, but a pretty redundant concept for miners of metals or drillers of oil. But, who cares anyway? God, according to Abrahamic religions (Judaism, Islam, Christianity, Druze and others), gave man DOMINION over the all things. Read Genesis 1▯26. The double-bind of this notion of dominion/mastery is that theologians have, over the centuries, developed the concept of Dualism - namely that there is sinful Earth where man is born evil, and there is the Kingdom of Heaven. Our role is to get to Heaven as efficiently as possible. What happens to the Earth is of secondary importance. Health warning: I have just summarised many millions of words of theological dialogue and writing. In point of fact, there is some scholarly argument about the Biblical translation from Hebrew to Greek to English. Hebrew is a language of poetry, insight and intuition. Itʼs fascinating, but, for, now, embrace the possibility that the ancient scribes ACTUALLY wrote something like “And God blessed them, and God said unto them, Be fruitful, and multiply, and replenish the earth, and subdue it: and have RESPECT FOR the fish of the sea, and FOR the fowl of the air, and FOR every living thing that moveth upon the earth.” Youʼll be wondering when Iʼm going to talk about the actual subject, eh!? The point is, language...emotionally mature language, really does matter. Iʼve suggested before that we frame lifestyle interventions as Social INVITATIONS. By the same token, how are we to refer to the PATIENT? What, really, does the word patient mean to you? Serene? Cowed? Obedient? Devoid of freedom of thought? The etymology suggests the root as being patientem from the Latin...meaning suffering, enduring. Do we really want your future “patients” to ENDURE your ministrations? Or do we we want those patients to be full and enthusiastic participants in their own healing (making whole) and their own treatment? So, your challenge tonight...come up with another word for PATIENT. Humour is allowed, so we can knock IMPATIENT off for starters as a possibility.Some history in a minute, but first letʼs clarify what we mean by INTERVENTION We have, at the last count, eleven categories...you heard it here first! ▯. Community Orders under the Criminal Justice Act 2003 (eg drug treatment) in England and Wales ▯. Self-medication that is generally bad but can be useful - Buckie and heroin ▯. Self-medication that is generally good but can be dangerous, if not idiotic - Foraging for eg psilocybin mushrooms or dandelions ▯. Medical treatment by the Blue Light services - Paramedics ▯. Medical treatment by General Practitioners ▯. Medical treatment by hospitals, some of which are teaching hospitals ▯. Curated self-identified lifestyle intervention - Pilates or Forest Bathing ▯. Non-curated lifestyle intervention - walk or joining a choir ▯. Doctor Google ▯▯. Doctor Main-Stream-Media ▯▯. Self-referral to fellowship groups eg AA and NA How could we score-card these interventions for efficacy? Which is the most cost-effective? Which ones could be characterised as PREVENTIVE? Which ones do the Health Agencies not finance? Which ones are criminalised? Now, when we discuss “Social Prescription” we are only referring to an extension of number five above, and possibly 11. Thus, in an ideal world the “impatient” presents at the Surgery; she is allocated her eight minutes. As an alternative to prescription drugs she is offered consultation with a Link Worker who will then advise on lifestyle options, eg a better diet, more exercise. Occasionally the GP herself will advise on dietary choices for diabetes 2. Any additional funding goes to finance the link worker, though I would argue that GPʼs should be able to give the impatient a voucher for, say, £25 that can be redeemed through non-clinical intervention - ie seven and eight above. As for the “classical” definitions, this is from the Royal Australian College ofGeneral Practitioners: Several different definitions of ‘social prescribingʼ exist, but as yet there is no universally agreed definition. In the United Kingdom, under the National Health Service (NHS) model, ‘social prescribing enables all local agencies to refer people to a link workerʼ. 2 A link worker is someone who can ‘give people time and focus on what matters to the person as identified through shared decision making or personalised care and support planning. They connect people to community groups and agencies for practical and emotional supportʼ.2 The NHS views social prescribing as a key component of its broader Universal Personalised Care agenda. In Canada, the Alliance for Healthier Communities is implementing a pilot of social prescribing. Under that model, ‘social prescribing refers to a deliberate and structured way of referring clients from clinical practice to non-clinical supports when appropriate, with the goals of improving their overall health and wellbeing and decreasing the use of the healthcare system for non-clinical needsʼ. Given that estimates suggest that around 20% of patients consult their GP for what are primarily social problems, more generally, social prescribing can be described as an opportunity to implement a sustained structural change to how a person moves between professional sectors and their community (3) For a full review of the subject, you should read and consider the Royal Society of Edinburghʼs recent publication (4). Letʼs do a little bit of history from a British perspective. First, we have the 1920 Dawson Report on the Future Provision of Medical and Allied Services. For those of you who are avid absorbers of TV drama, this is the Peaky Blinders era. The Report makes the startling observation that the maintenance of health “and curing disease should be made available to all citizens”! The Report makes a clear distinction between preventive and curative medicine, which “cannot be separated by any sound principle” and “must be brought within the sphere of the general practitioner, whose duties should embrace thework of communal as well as individual medicine”. And thus, public health was formally recognised. It is a fascinating read. Next, Iʼd like to introduce you to the Peckham Experiment, which is worthy of deep study by those interested in public health. This project started in 1926 and concluded in 1948, when the NHS was born. How do we begin to describe the Peckham Experiment? Far sighted, yet it had its shadow side. The essence was self-care, curated within a beautiful building that might now pass as a health spa. The generic was preventive social medicine. Nine hundred and fifty local families were recruited, each family paying the equivalent of £5 a week. They were offered physical exercise, games, swimming and workshops. The outcomes were enumerated as: ● Health is a process that has to be cultivated if it is to thrive ● If people are given information about themselves and their families they will attempt to make decisions that are in the best interests of their families ● When people are given resources in a community to enable them to grow they will thrive in their community for the benefit of that community The shadow-side is expressed by writer Emily Sargent: The experiment focused on encouraging health, rather than fighting disease, as well as empowering the people to actively participate in the pursuit and preservation of their health. Later I came across this statement: “While concentrating on disease in the unfit, we have been ignoring the development of health in the fit. We have been blindly and diligently working to reverse the law of Nature by procuring the survival of the unfit.” It makes unsettling reading – and demonstrates why the (Experiment) has attracted accusations of exercising ‘positive eugenicsʼ. This, some of you might think, is part of the dialogue we have been having since SARS-Covid arrived. My own conditional view is that the epidemic has targeted those, amongst others, with metabolic syndrome. go, the NHS needs to address the question of both preventing and mitigating metabolic syndrome. This will require funding and creativity. Politically, we should avoid the concept of self-care being framed within a culture of blame.So what are we to conclude about preventive medicine? Are we, as a society, prepared for massive up-front costs to reduce curative costs decades down the line? Do we have the necessary societal infrastructure (school playing fields and changing rooms, for example)? Can we design a system that embraces the socially marginalised and vulnerable? Do we even agree on the root causes of disease? Gabor Mate, my hero, states that emotional stress is a major cause of physical illness. Today, we who have suffered childhood trauma mitigate through addictive activity. How, I ask, does the medical professional treat childhood trauma when presented by an adult addict? The answer is often that the medic is replaced by the criminal justice system. Iʼm proposing this to you: Social Prescription is not really about employing a link worker within a surgery. Itʼs about actually PREVENTING disease with radical societal change, investment, focus. Iʼll give you an example. In South Korea the then Minister of Health travelled to Japan to further his understanding of a process known as Shinrin Yoku, which we translate as Forest Bathing. In Japan there are well organised forests with wooden walkways, platforms, medical staff and immersion facilitators. This is an initiative from the Ministry of Health. Funded. The research base is growing, and the results are positive. Anyway, the Koreans adopted this (there was some opposition due to cost) and the phrase “sanlimyok” . They now have a National Forest Plan whose goal “is to realise a green welfare state, where the entire nation enjoys well-being”. And guess what...the Forests are profitable due to merchandising! Iʼd like to finish with a thought from my old pal Satish Kumar The planet Earth is our common home Nature is our Nationality Love is our Religion I now INVITE you to sit quietly with hands folded, a straight back, shoulders strong with pride, and breathe very deeply through your nose three times. When you get home, try doing this with a sprig of rosemary - or any aromatic herb - close to your nose. Below is my text for tonightʼs INVITATION TO FIND OURNATURAL SELVES (6) Thank you for your attention. I imagine youse will all be planning to set up wee groups to do early morning sensory awareness sessions...yes??!! Appendices: 1 https://www.sensorytrust.org.uk/blog/how-many-senses-do-we-have 2 https://www.heilwald-heringsdorf.de/en/Forest-and-knowledge/What-is-a- curative-forest 3 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/ attachment_data/file/426676/Supporting_CO_Treatment_Reqs.pdf https://www.gov.scot/publications/rights-respect-recovery/pages/8/ 4 https://www.allianceon.org/sites/default/files/documents/CHF- RACGP_SPRoundtableNov2019_Stimulus_Paper_web.pdf 5 https://www.rsecovidcommission.org.uk/wp-content/uploads/2021/04/A-Desk- Review-of-Social-Prescribing-from-origins-to-opportunities.pdf 6 The Essence of Green Therapy, my script for March 9 2020 1900 hrs “Good Evening EveryoneMy name is Rory MacPhee, and I am a Forest Guide By Forest, I mean both tree forests and seaweed or kelp forests My calling is to welcome folk to my land and INVITE them to relinquish their cares, their anxieties, and revive their sensory perceptions. We have many senses designed for survival and joy, which together regulate our autonomic nervous systems so that we return to our parasympathetic state at regular intervals, indicated by cortisol reduction Yet we often forget to polish up our senses, often relying on sight to see us through the day. Thus the suggestion to reduce our use of weapons of mass distraction, namely cell phones! Whilst my Forest is my primary location, it is by no means essential that you are deep in nature. We can be in the home, the office, school, community centre, , hospital, hospice, prison As Jung almost said, our task is not necessarily to return to nature, but to find our NATURAL SELF. Iʼd like to invite you now to take hold of a sprig of rosemary, clove of garlic or bottle of essential oil and close you eyes. Breathe deeply several times through your nose. Weʼll now spend five minutes experiencing a guided meditation This is now YOUR time. The greatest gift you can give yourself is time wrapped up in beautiful paper, with a wee card saying, “I love and accept myself” . So, if you can, whisper quietly “I gift myself TIME, I gift myself the joy of NOW and I love and accept myself” . Now, breathe some more through your nose. Bringing your attention slowly to your body, try a toes to nose check-up. Focus on parts of your body, your toes, soles of feet, ankles....and ask how they are doing? As you get to your nose, give yourself a wee shake, a little shiver. And now, if you feel able, put your arms around yourself and give the YOU a big hug. Go on, squeeze tight! Now, breathe some more through your nose. As you do this, imagine a place, a special place, in nature. Perhaps your safe place when you were a child, or somewhere you went on holiday. Some sea, a lake, a tree, a garden, a mountaintop. How does that feel? If you find any pleasure in your recollection, open yourself more to thar pleasure. Do you notice any reaction to that feeling of pleasure, can you embrace the potential of pleasure? Now, start to smell, sniff your bit of nature in your hand. Open your lungs to the pleasure of that smell. Twitch your nose, wrinkle your nose, breathe. Try to focus back on your recollection of nature, your safe space. Now, having brought your attention through memory to a safe place, and having activated your precious, life-saving sense of smell...conjure up an image of yourself as a child. Maybe thereʼs a photograph of yourself as a toddler, with a happy smiling face. This is the precious YOU, a representation of your true essence, before you were reprogrammed into the harsh adult world. Put that image of your child-self at the front of your attention, imagine you now cuddling yourself then. Imagine your child-self climbing a tree, balancing on one leg, smelling baked pies in the oven, tasting ice cream and jelly, hearing a parent read bed time stories or hearing the sound of waves on a beach, touching a warm towel after bath time, waking up on the first day of school holidays...this child-self is the true you. So go on, if youʼre able, say to that beautiful child...”I love and accept you” . Now breathe some more, deeply, and now slowly open your eyes whilst exercising your facial mussels so that you find the biggest smile of the week...and finally bring your shoulders back, push out your chest and imagine what the word PROUD feels like! Well done, youʼve all started a reconnection with your true essence, your child- self! Finally, think how tomorrow you can celebrate your underused playful child- self...perhaps hopscotch, perhaps but an ice cream, perhaps footie in the park. Leave your adult-self behind for a moment and go out and play! Iʼd now like to give you a short explanation of the components of a Forest Immersion as practiced by myself and a very few others. Please note that this can be easily accomplished in an urban park or garden. ● Welcome and safety/housekeeping ● Handwash ● Threshold Ceremony ● Tea Welcome ● Breathing and Somatic Exercise ● Guided Meditation ● Invitation to Silent Walk engaging with peripheral vision ● Sharing Circle ● Singing Bowl meditation whilst inhaling pine resin ● Invitation to Sit - possibly to write a Haiku poem ● Tea Ceremony ● Sharing Circle This would normally take three hours. In cold weather this can be reduced with more somatic work and a focus on active walking. FAQʼs: ● What are the implications to our community goal of reaching net-zero by 2050? ● Are there any functional aspects of locating in a forest or sensory garden? ● What is the current state of research? (A) ● Is there any research directly linking “green therapy” to addiction recovery? ● Which countries focus on Forest Therapy as a health intervention? ● What is meant by “sensory awareness” ● How many categories of health intervention are there? ● What is the current uptake of green therapy by the Health Agencies ● Are there any authors whose work is worth reading? ● How does emotionally available language help? Iʼd like to conclude with one thought and one prayer: Thought: in my practice there are four essential ingredients. If you have all of them, then youʼll be living a balanced life and able to manage any addictive or destructive patterns. A sense of PLACE, a PURPOSE, a PLAYFUL aspect and a community of PEOPLE. And, for many, a companion PET. The FOUR Pʼs! Prayer, from my old pal Satish Kumar:The planet Earth is our common home Nature is our Nationality Love is our Religion Finally: Hippocrates said that, rather than asking what disease the person has, we should ask “what person does the disease have?” Thus the core of HUMANISING MEDICINE! “ A https://link.springer.com/article/10.1007/s11469-020-00363-4 https://www.researchgate.net/profile/Yasuhiro-Kotera/publication/ 342882589_Commentary_Suggesting_Shinrin- Yoku_Forest_Bathing_for_Treating_Addiction/links/ 5f0b582c92851c52d62d8439/Commentary-Suggesting-Shinrin-Yoku-Forest- Bathing-for-Treating-Addiction.pdf?origin=publication_detail