This blog often focuses upon the problems faced by those who venture into the mountains. So much so, that you might expect them to have a government health warning! However there are many positives to enjoy too. Not least the psychological benefits that can be gained from spending time in the outdoors. In 2022 we are hoping to run a one day face-to-face event "Hill Walking and Mental Health" that takes a closer look at how one of the country's most popular pastimes can have a positive impact upon mental health. If you'd like to get involved please get in touch. In this post Dr Tony Page gets the ball rolling by reviewing Jake Tyler's extraordinary new book, "A Walk From The Wild Edge" and makes a strong case for nature based mental health interventions...
Perhaps it is too soon to claim that nature-based mental health interventions are becoming mainstream but at least we can assume that the establishment is now taking notice - earlier this year there was an editorial entitled Green Care in Psychiatry published in the British Journal of Psychiatry. The editorial references no fewer than three comprehensive reviews but notes that many questions still remain unanswered. Green Care (also known as Green Space) interventions are often complex, studies tend to be small and of short duration and are often qualitative rather than quantitative. Which therapy works best for which condition? Does green care work as well for severe mental illness as with milder mental illness? If you are interested in how this might work there's a useful review by Dr Wendy Masterton and her colleagues from the University of Stirling. In it they provide a checklist for what's needed for a successful "Green Care" intervention...
Feeling of "escape" from day-to-day life
Opportunity to reflect
Physical activity in a safe and comfortable environment
Learning and mastery of new skills
Clear sense of purpose
Open and supportive relationship with a facilitator
Shared experience with others
I suspect, though, that most people reading this blog will prefer another route into thinking about "Green Care". Many of you will be aware of what has been called ‘the new nature writing’ and were perhaps, like me, introduced to the genre by reading Robert Macfarlane’s "Mountains of the Mind: A History of a Fascination". You may also have noticed, over the last decade and a half, the emergence of a ‘nature as a cure’ sub-genre. One of the first to write on this subject was Richard Mabey. In "Nature Cure" the author described the aftermath of a severe depressive illness following the publication of his prize-winning book on British flora. Despite the title, he makes no claims that the natural world provided a complete cure - rather this seems to have been a combination of conventional psychiatric treatment including inpatient admission and medication, and then being looked after by a series of friends before making a decision to move away from the area where he’d grown up and lived all his life. However having moved, he was able to re-establish and describe an incredibly rewarding connection with the natural world in a new landscape.
On crossing the Simplon Pass in Switzerland, Robert MacFarlane wrote that there is something, "that inspires the mind with great thoughts and passions … as all things have that are too big for our comprehension, they fill and overbear the mind with their excess, and cast it into a pleasing kind of stupor and imagination”
Other writers have followed Mabey’s lead. Recent examples include Helen Macdonald with "H is for Hawk" (2014), an account of how training a goshawk helped her deal with her grief following the death of her father. Amy Liptrot’s "The Outrun" (2016) is about her battle with alcohol dependence and how a return to her native Orkney and a combination of walks, swimming in the sea and watching wildlife (including a paid job monitoring corncrakes for the RSPB) helped maintain her sobriety. Lucy Jones’ "Losing Eden: Why Our Minds Need the Wild" (2020), is an account both of her personal struggle with drugs and alcohol and a selective review of some of the science behind Green Care. For Jones, psychiatric and medical care, psychotherapy, support of friends, family and fellow addicts were important but so was reconnecting with the natural world.
After being threatened and racially abused near her home in the north of England, Anita Sethi decided to walk the Pennine Way. In her memoir, "I Belong Here..." she wrote, "Gazing out over the valley from on high, I look back over my life and at other times when I had experienced abuse and either did not speak out or reported it but was not taken seriously. I realise how hatred can become internalised, become self loathing. As I walk, I feel those emotions shift and lift. I feel my mind open out as I look forward to walking through the forest of Bowland, rising up through the Yorkshire Dales, and the north Pennines..."
The latest addition to this list is Jake Tyler’s "A Walk from the Wild Edge" (2021). The book is an account of his descent into suicidal depression and the steps he took to recover. He was offered, but declined, antidepressants, had a short course of cognitive behaviour therapy which helped to some extent, but the most crucial early steps seemed to be resigning from his job as manager of a hipster pub in east London, returning to live with his mother and being encouraged to take her dog for regular walks. It was on one of these short walks that he had the idea to do a much longer walk that he describes as "a lap of Britain". Unfit and with no previous experience of long-distance walking, the rest of the book is a brave, interesting and entertaining story of his journey. He did the walk in support of the charity the Mental Health Foundation, interrupted by training for the London marathon and participating in the two-part BBC documentary Mind Over Marathon along with nine others. Linking national parks and long-distance trails, Jake walked and ran about 3000 miles, taking in Pen y Fan, Snowdon, Blencathra, Ben Lomond and Ben Nevis. His story includes losing a boot in the sea very early on, having his tent stolen in Pembroke, starting a 100 km trail running event 13 hours late yet not being the last to finish, and relates his encounters with a variety of often unconventional characters along the way. He camped, occasionally stayed in hostels and B&Bs, and used posts on social media to secure overnight stays in people’s houses, relying on the kindness of strangers - indeed his mobile phone seemed as important a piece of kit as his tent and sleeping bag, maybe more so!
Jake Tyler - "I loved waking up and realising I was just in some field somewhere, I loved unzipping my tent door and listening to the birds; I loved always catching the first star in the sky at night; I loved how no matter how many miles I walked and how tired I got, I never regretted it..."
It will be clear that I enjoyed the book on its own terms as a work of autobiographical outdoor adventure (with a message), but I think that with a medical eye it can also be viewed as a case study, as can the other books mentioned above. Out of fashion in high-impact journals, case studies can make concrete statistical and epidemiological abstractions and anchor us in the lived world of our patients, helping us focus on what is important for them. For instance, Jake concludes that he has learned that he needs to keep talking to people, as this has deepened his relationships. He needs to be open to both receiving and giving support. He also needs nature. He writes, "it makes me feel connected to the world in a way I can’t achieve in any other way and, sometimes, when I feel like a prisoner to depression, nature sets me free and makes me smile..."
In, "A Walk From The Wild Edge" Jake Tyler quotes from a blog written by his Mum, "When you look at all the elements of this momentous walk - the exercise, the openness to others, a new appreciation of the small, simple things, the sense of achievement and purpose, the fresh air, the deep restorative sleep that comes with all this - its a manual to mental health that has been written about and endorsed by mental health professionals for years..."
Potentially, though, case studies can be valuable in other ways. For example, they can be used as a check on the validity of a conceptual framework. From my reading, Jake’s successful experience ticks six out of the seven factors proposed by the review I cited earlier. The only one left out being ‘relationship with a facilitator’- but of course, as Jake organised his walk himself, there was no external facilitator!
So, "A Walk From The Wild Edge" is an interesting book that is likely to appeal to readers of this blog. At the same time it also goes some way to supporting the validity of a conceptual framework. The editorial in the British Journal of Psychiatry argues that the present evidence, "suggests the potential for Green Care as an additional therapeutic tool in the psychiatric arsenal" and I would add that there is also a strong case for more rigorous investigation of different Green Care interventions. Over to you, researchers!
Thanks Tony! Links to Tony's previous posts can be found here.
As mentioned earlier, we are hoping to run a one day face-to-face event in the Peak District on the 13th June 2022. Through talks, workshops and a walk in the hills we'll explore the power of hill walking in treating a range of mental health issues. All are welcome! More details to follow in the coming months.
Why not book a place on a BMMS UCLan Mountain Medicine Winter Webinar? All are welcome! Details can be found here.
If you would like to find out more about mountain medicine why not join the British Mountain Medicine Society? See this link for details.