The Natural Health Service

Isabel Hardman

Published by Atlantic Books 23 April 2020

336pp, hardback, £16.99

Reviewed by Elizabeth Hilliard Selka

Click here to buy this book


Could a book ever have been more timely? Just as the UK was put on lockdown to fight the COVID-19 coronavirus, and we were told not to leave home except in specific circumstances in order to ‘stay safe, protect the NHS and save lives’, Isabel Hardman’s The Natural Health Service landed on my desk for review. From the start, one of the essential reasons permitted for escaping lockdown was an hour’s exercise (better than some other countries like Spain, where outdoors was entirely forbidden unless you were walking the dog). To most of us, especially during the COVID crisis, the thesis of this book is a no-brainer: that at its simplest, fresh air and exercise is a life-enhancing, boredom-busting pleasure that encourages good mental health, being at the same time both relaxing and energizing, and able to reach parts that other activities cannot reach. And recently, it seems, the medical establishment has been taking the great outdoors very seriously indeed not only as an aid to mental health but also in treatments for mental illness.

Hardman writes bravely from a position of authority on mental illness having herself been diagnosed in 2016 with Post Traumatic Stress Disorder (PTSD) following an unspecified life event. There has been some discussion in the press about why she would withhold information about the source of her trauma. But surely this is her prerogative; in defence of her refusal to satisfy the curious, she has explained on Twitter that: ‘I didn’t write my book as therapy for myself. In fact, there were times when working on it made things harder for my own mental health but I knew it would help others.’ Instead, she offers us a critical analysis of the potential and limitations of the healing power of nature channelled through a wide range of outdoor activities.

She begins by describing how outdoor occupation helped alleviate the symptoms of her own collapse and aided not only the beginnings of her recovery but also the ongoing management of her condition which is not one of which one is suddenly ‘cured’. She needed to ‘distract myself from the torture chamber in my mind’, so her first step was to hunt rare and shy orchids near her home in Cumbria. This was the start of the natural world helping her ‘want to keep living, and [it] made living much more bearable.’

Other activities which helped Hardman include observant woodland walks, running, riding, cycling and wild swimming, and she examines the evidence both academic and gleaned on the medical front line for the benefits not only of these but also gardening, walking with dogs, exercising gratitude for neuroplasticity, ‘forest bathing’ (no water involved), animal therapy including keeping hens, outdoor mindfulness and birdwatching.

Also cold-water wild and sea swimming; the Finnish Institute of Occupational Health’s researcher reveals that immersion in icy water provokes a ‘hormone storm of mood-boosting endorphins, serotonin and oxytocin.’ This particular enterprise should however be approached with care, building up from warmer months in order not to shock the body with potentially dangerous consequences. And all the activities necessarily need monitoring in order to establish just how beneficial they really are, to the individual and more widely.

Doctors in Ireland have a programme called ‘Woodlands for Health’ whose results included mood and sleep improvements and a decline in suicidal thoughts amongst the evaluated group. In the UK meanwhile, GPs now apparently issue ‘social prescriptions’ as well as the usual sort for medication to address physical as well as mental conditions. Hardman describes how in 2018 NHS Shetland GPs began giving ‘nature prescriptions’ including ‘really look at a lichen’ and ‘step outside—be still for three minutes and listen’. The latter is a real challenge for anyone—three minutes can feel a very long time in which to do nothing but concentrate on listening without distraction.

Biophilia is an important word in this context. Coined originally by the philosopher and social psychologist Erich Fromm in 1964 in his book The Heart of Man, the idea of ‘biophilia’, that humans are innately drawn to living things because we are ourselves part of the natural world, was later widely promulgated by the biologist Edward O. Wilson. Hardman explains that shutting ourselves away from nature and ‘festering mentally’ is therefore asking for trouble, as many who have suffered isolation in COVID lockdown will attest, whereas engaging with appropriate physical exertion outdoors is healthy in every way. The Nordic concept of friluftsliv, meaning ‘open air living’ to feed our physical and spiritual wellbeing, is a given in Scandinavian countries where it was originally popularised by Henrik Ibsen in the 1850s.

Natural Health Service principles could and should not only be usefully introduced into homes and workplaces but also be integral to the planning of all environments where it is intended that humans will live and thrive, says Isabel Hardman. She researches results that seem common sense—that you will recover more quickly from an operation if you can see greenery through a window rather than a brick wall, and also perhaps not surprisingly the fact that ‘prisoners whose cells had a natural view were less stressed and were less likely to need medical attention’. This is not just wishful thinking; throughout the book these claims are annotated and the scholarly sources given.

She doesn’t hold back from difficult issues like what makes good therapy, the distinction between therapy and therapeutic activities, and the placebo effect. And she is critical of poor regulation of the entire field—this in a world which allowed The Jeremy Kyle Show to run on ITV until a guest actually committed suicide in 2019. Hardman describes the programme as ‘a modern form of Bedlam in which people with complex social problems and often mental illnesses were exploited for public entertainment’.

The converse of this is the pathologization of symptoms which we all feel in response to the inevitable ups and downs of our lives, and the medication of these symptoms when other solutions might be more effective and boost the robustness of our responses to the complexities of contemporary everyday existence.

Mental health and the de-stigmatization of mental illness has been the issue de nos jours, yet there is and never will be a simple solution because ‘mental illness’ is an umbrella term for countless different conditions and lacks the sort of research and funding from which cancer, for example, has benefited. It is, as Hardman has experienced, ‘messy, inconvenient, humiliating and life-limiting, and to pretend otherwise does a great disservice to the people trying to deal with a serious diagnosis… We have reached a stage where mental illness is considered acceptable in the abstract, but less so when it comes to the messy reality.’ A fully-functioning Natural Health Service would, she argues, save money in the long run because some people ‘wouldn’t need the acute interventions and medications that doctors find themselves with no choice but to offer’. And it would save lives. No-brainer indeed.

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