Note: Another old college paper (farts in repeating loops.) There were some pics in the post, may include later.
“How Gardens Compliment Healing for Individuals Suffering with PTSD”
Those who are suffering from PTSD or Post Traumatic Stress Disorder may require special treatment in order to heal properly. There are various methods available ranging from physical rehabilitation, psychotherapy, and medications. Another method that is regaining popularity is the use of healing gardens to help expedite recovery. In the following research paper, an overview of what is PTSD. There will be a discussion on how the physical and emotional needs are currently addressed. Lastly, how horticulture therapy may help and assist this traumatic condition.
PTSD occurs during a tragic event and can be recurring; an example is physical and sexual abuse. Some causes that trigger PTSD, include combat zones, natural disasters and serious bodily injury. During the event, the victim feels a loss of control due to their lives being faced with consistent danger. Most people face stress related reactions from these horrific events, but not everyone suffers PTSD. If the reaction doesn’t go away, and like other forms of serious mental illness, PTSD is developed. About less than half of people may seek help.
Symptoms of PTSD include “Emotional numbness, restlessness, anxiety, uncharacteristic irritability or even violent behavior, problems focusing or concentrating, and flashbacks (Sherin and Nemeroff).” While the person is experiencing PTSD, emotional detachment from the environment occurs and losing a sense of reality. This may effect functioning with daily life if the episodes are recurrent. Symptoms may surface a few months after the incidence, sometimes it can take many years. Experience may fluctuate for the victim and may have severe chronic symptoms. Early intervention after a traumatic event may prevent PTSD. Utilizing support groups, psychological consoling, and certain medications are optional methods. Use of prayer, rituals or healing ceremonies, may be helpful in alleviating the stresses of the trauma.
What would happen if this condition is left untreated? In 2012, “349 service members in all branches of the US Military committed suicide in 2012, up 15 percent from 301 suicides in the military in 2011 (VA).” A notable aspect of PTSD is the family members who deal with it on a daily basis. When a person who is suffering from PTSD may not realize their behaviors are causing emotional trauma to their families. These actions are usually unintentional while and the person may have limited or no control over their actions. Children with PTSD may develop learning disabilities, and are a higher risk for self-injury. The condition of PTSD should be taken seriously, as it may lead to emotional and physical harm, including death.
Currently, there are no “One size fits all,” for PTSD. Various methods are used in combination of support groups, therapy, medications, and time. Physical therapy may include yoga, aromatherapy, acupuncture, and meditation. Cognitive-behavior therapy is one method by helping the victim change the way they think about and react to their thoughts surrounding the trauma. Another method of therapy is called, “Exposure Therapy,” involving a licensed counselor to repeatedly relive the trauma in a “safe” environment in order to work through the violent experience. Antidepressants are the usual drug of choice for medications, popular commercial brands such as Prozac, Zoloft, Paxil and a few others. However, dependency on any medications may cause addictions and adverse reactions, such as overdosing. Let’s not forget good nutrition and supplements aid in the recovery. That includes limiting or eliminating nicotine, caffeine, narcotics, and light exercise throughout the week help, too.
The last section of the paper will discuss how horticulture therapy may complement recovery for those suffering from PTSD. A recommended read is “An Exploration of the Potential Benefits of Healing Gardens on Veterans with PTSD,” written by Brock Anderson. Mr. Anderson described how healing gardens may be implemented not just for people with PTSD but others with mental conditions. The paper outlines the use of healing gardens and how victims of PTSD help towards a speedier recovery.
So, what is a “healing garden” exactly? The definition of a healing garden is “A garden in a healing setting designed to make people feel better (Eckerling, 1999).” Any garden can be a garden. The design of the garden is to provide less stress, a place to relax in within a safe environment. Roger Ulrich, a professor of architecture at Texas A & M University describes healing gardens as “Viewing natural scenes or elements foster stress recovery by evoking positive feelings, reducing negative emotions, and blocking or reducing stressful thoughts (Ulrich).”
The question is how can horticulture therapy help those who are going through PTSD? History is an excellent indicator that gardens are a way to connect within oneself. Healing gardens have existed throughout time originating from the Eastern to the Western Continents. Louis XIV built a hospital in Paris for veterans that included numerous courtyards planted rows of trees (Anderson). The Royal Naval Hospital at Stonehouse in England incorporated gardens and sunlight into its design. Patient rooms had one wall lined with a row of windows that allowed for light and ventilation (Anderson). Military incidents like the Battle of Waterloo and the Crimean War increased the connection between nature and healing in the medical world. Physicians and nurses who observed soldiers that were treated following these conflicts noted that those who were put up in barns and tents had higher mortality rates than those confined to conventional hospitals. These are one of the many examples of how designing and implementing a healing garden was used in the past.
Japanese Zen Gardens are designed where it focuses on healing the whole person – mind, body, and spirit (UMN). Various monasteries throughout the European Middle Ages incorporated healings gardens for food, medicine, and the insane. The monasteries provide a way for weary travelers and pilgrims to rest after a long day journeys. The gardens around the Temple Ambler Campus provide a place to relax and study between classes. Even my humble garden amongst the Philadelphia row houses provides minor relief from daily life. From observations, gardens are a way a direct way to connect to nature and an inseparable connection to the “outside” world.
It wasn’t until the 1950’s that hospitals in the U.S. started replicating the structures of the corporate world. This means the rise of the uniformed dress codes, mannerisms, cubicles, time clocks, and the loss of connection to the world outside. At this time, long hours inside a building were the norm and relaxing amongst a natural setting become lost in American life. “Hospitals began to look more like corporate office buildings and natural ventilation was replaced by air conditioning. “…outdoor terraces and balconies disappeared; nature succumbed to cars and parking lots; and indoor settings designed for efficiency were often institutional and stressful for patients, visitors, and staff (Anderson).” This is true if anyone ever worked in a corporate environment where productivity and efficiency reigns and health of employee takes a back seat. What replaced the gardens are the rise of specialized hospital equipment, multi-billion dollar pharmaceutical industry and specializations.
Would a person going through PTSD regain accelerated health benefits through horticulture therapy? Observing human nature, a person residing in a room extensively and placed into an unknown location, stress levels are elevated. For example, a patient in a hospital room surrounded by artificial surrounding without access to natural surroundings, lives in sensory monotony. Humans like ancestors from days of yore, seek to experience life and find places where the mind, body and soul can seek refuge.
It wasn’t until the 1980’s and 1990’s that extensive research was done on the positive effects of nature and its health effects. The studies show that people respond well in natural settings when stressed or upset. Regarding the physical environment in the healthcare setting, the most commonly shared preference among these former patients was access to nature. This included gardens, views of nature, pictures of nature, and balconies (Marcus 2005, 2).” Thanks to the “The Patient Centered Care” movement, emphasis on the less time receiving healthcare, the greater the cost savings. Healthcare facilities are now promoting more comfortable and welcoming interior settings. It was only by removing a natural setting outside of hospital environments during 1950’s that the trend is regaining popularity.
Designing a garden that compliments the myriad conditions that PTSD requires various considerations. It may depend on the level of psychological trauma, the level of physical and mental damage, and other pre-existing health conditions. Since PTSD can last for days or even years, the use of natural settings compliments other therapies can be helpful. According to Brock Anderson’s thesis, an observation he made, “More research and focus be placed on the possibility of integrating this alternative therapy for the treatment of veterans suffering from PTSD (Anderson 36).” This quote applies to people who are not military personnel and a study may be beneficial for future garden designs and applications.
Is there any evidence that patients benefit from a natural settings? Yes, one study examined the effect patients who were able to view nature from a hospital window versus another building. The study demonstrated patients who were placed with a view of nature showed, “less frequent requests for pain medications, shorter post-operative stay, and there were even fewer negative comments noted from healthcare staff (Anderson 36).” There was another study done that compared participants who were exposed to rural settings and those of urban settings. The results were that those who were exposed to a rural setting had lower blood pressure than those of the urban setting.
There are various gardens that were introduced into healthcare. Such gardens include contemplative, restorative, healing, enabling gardens and therapeutic gardens. The following figures below are examples of each garden type. Some examples were photograph around campus, places I visit, and others were found on the Internet. I apologize in advance if some of the photographs are not perfectly aligned.
Figure 1 A Contemplative Garden – W. Watershed.
“Contemplative Gardens are generally meant to calm the mind and mend the Spirit (Koschnitzki 4.)” Of course there are much better examples. This type of garden offers privacy and to be with one owns thought. These are perfect places to meditate and calmly ease the mind from the daily grind of life. A person going PTSD would benefit as their attention are focused towards on the natural scenery and sounds of Mother Nature.
Figure 2. A Restorative Garden – A. Campus.
“For the sick of body or troubled in spirit, the Restorative Garden relaxes, soothes and thereby encourages the body and the mind to restore themselves (Koschnitzki 4).” A place for healthy people and patients, these place offer solidarity or conversations amongst other people. PTSD patients would benefit most from visitors such as family members, loved ones, or seeking a place for quiet conversations.
Figure 3 – Healing Garden – A. Campus.
“A healing garden refers to a variety of garden features that have in common a consistent tendency to foster restoration from stress and have other positive influences on patients, visitors and staff or caregivers” (Koschnitzki 4). This has some similarities that to a Zen Garden, minimal design and the maze offer contemplations and movement.
Figure 4 – Enabling Garden (Photograph courtesy of (http://volumeone.org/news/1/posts/2011/06/16/2539_Raising_the_community_garden)
“An enabling garden allows people of all ages as well as abilities to be able to enjoy,
work and interact with the garden despite their limitations. It is especially geared toward the elderly and handicapped (Koschnitzki 4).” These types of garden invite the patient towards activities, having these in an outdoor or a greenhouse encourages the mind to focus and promotes face to face interactions.
Figure 5 – A Therapeutic Gardens (Photograph courtesy of http://www.worldhealthdesign.com/Patient-specific-Healing-Gardens.aspx)
“Therapeutic implies an assessment and an understanding of a medical condition, its usual course and prognosis. Therefore, a therapeutic garden attempts to improve the medical environment in pursuit of the treatment of a medical condition (Koschnitzki 4).” These gardens are designed in close collaboration between the landscape architect and the healthcare professional. Questions are raised when designing, such as “Will having these gardens encourages better health for the patient?”
Patients with PTSD may favor different gardens, depending on the severity of the condition. A person with a physical ailment may find the restorative and therapeutic garden more favorable. Another patient who is more abled may choose to work in the Enabling Garden as a promotion of physical activity. The healing gardens are excellent when the patient needs a place that offers limited stimulation and a light physical movement. The contemplative gardens are favored for the patients who require minimal oversight and perhaps need time to be with their own thoughts.
In conclusion, there is no singular treatment for PTSD. Treatment may involve psychological, physical therapy and medications. The advantages of having gardens design around hospitals offers a much easier access to nature. Mother Nature offers her type of therapeutic healing for PTSD patients. Another benefit of having a garden is each type of garden can be used in conjunction to suite the patients need. I feel that more gardens built around hospitals are wonderful, for PTSD patients, employees and visitors alike.
Brock, Anderson. 2011. Brock Andersons Master Thesis, “An Exploration of the Potential Benefits of Healing Gardens on Veterans with PTSD” 21, 24, 36
Eckerling, Mara. 1996. Guidelines for Designing Healing Gardens. Journal of Therapeutic Horticulture, 8,21-25.
Jonathan E. Sherin, MD, PhD; Charles B. Nemeroff, MD, PhD. 2011. State of the Art. “Post-traumatic stress disorder: the neurobiological impact of psychological trauma” 264
Koschnitzki, Ken. Date Unknown. Eco Art, Landscape Architecture. “Healing Gardens” 4
Marcus, Clare Cooper. 2005. “Healing Gardens in Hospitals.”Interdisciplinary Design & Research E – Publication 1:1.
University of Minnesota. (Date Unknown). Healing Gardens http://www.sustland.umn.edu/design/healinggardens.html
Veteran Affairs Administration. 2007. “What is PTSD?” http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp
Veteran Affairs Administration. 2009. “How Common is Suicide?” http://www.ptsd.va.gov/professional/pages/ptsd-suicide.asp