On Mental Health: How a psychiatrist included nature in his child and adolescent practice

U.S. Fish and Wildlife Service Children and Nature Workshop – June 27, 2007
By Claude Arnett, M.D.

On Mental Health: How a psychiatrist included nature in his child and adolescent practice

My practice is with Vaya Mental Health Resources, an intensive out-patient treatment program for adolescents and young adults with serious mental and addictive disorders. Vaya is the Hindu god of the winds -- he is said to represent the healing breath of change. Emotional injuries in childhood, particularly significant disruptions of attachment, are at the root of the problems of most of these youth. Reading Richard Louv’s book (Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder) about a year ago has deepened my understanding of the youth I work with and stimulated me to develop more nature-based interventions that have been helpful.

John Bowlby, one of our earliest investigators of attachment, defines attachment as “the enduring bond between caregiver and child that establishes a safe base from which the infant can explore and grow.” Dan Siegel, author of The Developing Mind, says attachment is an inside-to-inside bond of affection accomplished through the senses. When attachment goes well, a child feels loved, enjoyed, respected, supported and guided. Attachment relationships are regulating relationships. Siegel says, “It takes other minds to develop a child’s mind.” The resources of the caregiver become regulating resources for the child. By regulating, I mean as parents we help our children to manage their perceptions, their emotions, their thoughts and behaviors, even their physiologic processes. If our children are bored and listless, we might say, “Look at this. Taste this. Let’s go do something.” We engage them in stimulating their senses, their emotions, their minds and their bodies. If our children are over-excited and agitated, we help them to calm down. We say, “You need to rest. You need something to eat. Listen to some music, read a book, go for a walk. Let’s talk about what is on your mind.” Over the course of childhood, these kinds of interactions with family and others happen repeatedly.

These interactions are essential to the development and maturity of critical nervous-system structures that regulate emotional energy. Ninety percent of human brain growth occurs in the first six years of life. So early attachment to primary caregivers and the regulating experiences within the family are the experiences that strongly influence a child’s brain development. The nervous-system structures and pathways that are built through these early experiences form the basis of a child’s capacity to become “self-regulating.” Self-regulation is the ability to regulate one’s own perceptions, emotions, thoughts and behaviors in the absence of an attachment figure being immediately present. In turn, self-regulation forms the basis of a child’s emotional, social, intellectual and occupational functioning throughout their lives. A simpler way to say this is, “What we do for our children, they learn to do for themselves.” If we love and guide them and teach them to explore, they will love and enjoy themselves and they will seek others to love and enjoy them -- and they will explore and they will find others in their lives that support them in exploring.

Many of the youth I work with have attachment disorders – meaning, the process of establishing safe, loving bonds with a caretaker was disrupted. This happens for many reasons. Sometimes a youth was adopted late after spending early years in temporary foster homes. In some cases there is the death of an essential caregiver. More often, relationships are disrupted by mental illness or substance abuse in the caregiver, which often leads to abuse and neglect. In a growing number of youth, the problems are not so readily apparent. Youth from middle- and upper-class homes, who seem to have all of their material needs met, still can feel empty and lack confidence. These youth are poor amidst riches. Their lives are ordered, scheduled, and chaperoned toward achievement, but they suffer from what psychologist Jon Allen calls “emotional neglect.” They do not feel emotionally engaged and attended to. They do not feel loved, enjoyed, admired, respected for who they are, as opposed to what they can achieve.

When attachment relationships are disrupted, whether it be from abuse or loss of a caregiver or emotional neglect, then youth do not have regulating relationships that they trust, and they lose (or never develop) the capacity to regulate themselves. Their emotions, perceptions, thinking, and behavior are dysregulated. They don’t trust others and have difficulty trusting themselves. They vacillate between immobilizing fear and self-destructive fearlessness. These youth have many psychiatric diagnoses: depression, panic, bipolar, attention-deficit, post-traumatic stress, obsessive-compulsive, and addictive disorders. But consistent to all of them is disrupted early attachment and extreme difficulty forming trusting, regulating relationships. They are disconnected from others and themselves. And without a network of supportive relationships they are terribly lonely and alienated. Attachment disorder is a painful state of disconnection and represents horrendous suffering.

Youth I work with are disconnected from family and friends. They are often disconnected from productive, enjoyable activities. They sleep all day and are up at night. They watch television, play video games, and instant message on the computer to shocking excess. They are often addicted to alcohol or marijuana or other drugs like cocaine or Vicodin. As well, they are often addicted to technology. Technology offers a refuge from relationships or serves as a comfortable mediator -- so they prefer text messaging or instant messaging to face-to-face interactions. Often the youth I work with are exceptionally gifted. Some have special gifts with art, music, or mechanics. Many have been identified with superior to very superior intelligence. A couple have extreme sensitivity to nature and like to collect and compare rocks and feathers and leaves, as with the naturalist intelligence described by educational psychologist Howard Gardner. But these youth are disconnected from their gifts. They have difficulty sustaining their motivation and commitment. Without capacity to regulate their emotions and behavior, they lack discipline and the ability to be productive. This is a painful loss for them and their families, but the unfulfilled promise of their gifts is a loss for our communities and our culture as well.

As you might imagine, this is a difficult group of young people to help. Often they have failed many treatment approaches before they are referred to me. Trust that is broken so early is difficult to rebuild 10 or 15 years later. My approach is a creative blend of services. Youth are involved in traditional mental-health services such as individual, group, and family counseling. Most are on psychoactive medications. Clients participate in expressive therapies, including art, music, dance, and writing. They also participate in alternative health practices, such as yoga, massage, and meditation. They are deeply disconnected, so I’ll try whatever makes sense and is reasonably safe to help them get reconnected. I have been generally successful with this difficult group of youth.

Though I have had success, after reading Last Child in the Woods I realized I was missing something -- their disconnection from nature and their need for more nature-based experiences. Youth I work with often have 15 to 20 hours of services per week -- but they are still moving from one box, their homes, to another box, an office. They are still stuck in demanding and constricting time schedules. The book helped me realize that they needed to get out into open, natural spaces with blue sky, wind, water, plants and animals, and these experiences needed to be as timeless as possible.

So I began taking my clients on walks behind my office, on the American River Parkway, one of Sacramento’s natural treasures. We see birds and squirrels and rabbits. On occasion we have seen deer, even coyotes. We peer into the water to see fish and turtles. Once we saw a whole family of otters diving for crayfish and coming to the surface with their catch. I started recommending pets -- to love and train and care for. I encouraged family outings to hike or camp in the mountains, or to go to the beach. I asked my coaches (support staff who provide transportation and assist with daily living skills) to help the youth to get out to eat lunch at the park, to swim in the river on a hot day, to go on a day trip to Stinson Beach.

I also started a job-skills training program with a local organic farm, Soil Born Farms. These urban farmers grow vegetables, fruits, herbs, and flowers on small parcels of land within the city of Sacramento. They use no pesticides and no petroleum-based products. Almost everything on the farm is done by hand. For almost a year now, several clients have been tilling soil, planting seedlings, weeding, harvesting, composting, and they have enjoyed it immensely. The farm is interesting, engaging, and soothing. They see the results of their efforts, seedlings that grow into mature plants, a weeded bed, and the taste of a crisp, sweet carrot. And they have developed job skills -- to stay focused on completing a task, to work with others, to manage frustrations or other challenges. A couple of youth have started their own gardens and grow vegetables, fruits, and herbs that they are proud of and can enjoy sharing with others.

I have found that these walks, pets, outings, and the farm have greatly benefited the youth I work with. Being out more, active and connected to nature, relaxes them, helps them feel more grounded, more confident and resilient, more open to their senses and their bodies and minds. Then they are often more able to make use of their time in counseling to explore their thoughts and feelings or work on their relationships with their families. As well, they are more appreciative of yoga and massage to stretch and relax tired, sore muscles, or meditation to restore a tired or over-active mind.

Mahatma Ghandi said, “Be the change you wish to see in the world.” I grew up in Louisiana, playing in the woods and creeks behind my neighborhood; hunting, fishing, boating, and horseback riding in the Atchafalaya River basin. To my horror, I came to realize that my own children have become disconnected from nature. With school, soccer, swim team, piano, play dates, cable television, instant messaging, and cell phones—my 11- and 13-year-old daughters have been over-scheduled and over-supervised and over-technologized, and have become fearful of going outdoors and to explore on their own. They wouldn’t walk the dogs or ride their bikes to the ice cream store in the neighborhood. We used to have a vegetable garden where we grew tomatoes and zucchini and fresh basil, but shade from a tree cut the sunlight and several years ago we let it go.

I pushed my girls to get out in the neighborhood. For Father’s Day last year we took a day hike to a waterfall and swimming hole in the foothills. For spring break I agreed to go to Disneyland if they would go to the Joshua Tree National Park. They liked the desert better. The Joshua trees were in bloom, the best that had been seen in over 10 years. We climbed rocks and explored the desert flora and fauna. We went on a rafting trip recently and enjoy recalling the mishaps and perils we all survived. My kids are more likely to walk the dogs to the nearby schoolyard now. They will ride their bikes to the ice cream store or the donut shop. They will walk to a friend’s home several blocks away. We have cleaned out space for a new garden and are anticipating planting.

Adapted from a speech presented by Dr. Claude Arnett at the Children and Nature Workshop on June 27, 2007 at Tehama Golf Club in Carmel, Calif. Dr. Arnett is a child and adolescent psychiatrist with Vaya Mental Health Resources in Sacramento. The event was organized by Steve Thompson, Regional Director for U.S. Fish and Wildlife Service, and hosted by actor and director Clint Eastwood.