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252 NATURE THERAPY
A dramatic therapeutic moment came for Pipher when, after encountering political obstacles, weary and imagining feeling like a wild
turkey running in circles when caught in the middle of a busy highway,
she happened to glance up and see a half-moon seemingly caught in the
branches of an ancient oak tree. Her breathing changed, and she felt intensely and perfectly present, with a sense of bliss and wonder.
As her example illustrates, a personal moral imagination can arise to
complement professional ethics. That can take people beyond empathy
and Buber’s (1971) I-it and I-thou relationships to sense that all relationships to people, animals, and plants can be sacred.
One group that joined the Nebraska cause was refugees from Nigeria, Africa, where protesters of an oil company risked their lives. Indeed, as seen in such examples, becoming significantly involved in
activism often carries great personal risk and stress.
In psychiatry specifically, the emergence of nature activism started
slowly. An early coalition was the informal Psychiatrists for Environmental Action and Knowledge, which later morphed into the formal
Climate Psychiatry Alliance (Moffic 2021). The alliance has written and
presented extensively, with increasing numbers of psychiatrists joining
it and the related Climate Caucus and the new Committee on Climate
Change and Mental Health of the American Psychiatric Association.
Increasing appreciation of the psychosocial harm being done has led
to advances in addressing psychological problems related to nature. A
recommendation to add ecology and have a biopsychosocial-ecology
model has been suggested (Moffic 2019).
At least two community-wide psychiatric movements have emerged
to address the adverse repercussions of natural disasters and disruptions. One is called transformational resilience, which consists of developing programs to proactively build mental health systems to prepare for
upcoming challenges and to build resilience (Doppelt 2016). In particular, and once again, poor communities with fewer resources need such
planning to avoid severe mental health adverse consequences. Goals of
such transformational resilience initiatives included empowering adults
and youths to
• Practice healthy behavior in both good and poor conditions.
• React to adversity with meaning, direction, and hope to achieve
more resilience and posttraumatic growth.
• Be active in addressing adverse environmental nature changes.
• Collaborate at various community levels.
• Consult with mental health experts to prevent and reduce psycho-
logical problems.
Nature Activism 253
Resilience building can have drawbacks, however. It can lead to ignoring the prevention of future traumas or, as in the case of burnout,
plowing ahead and ignoring that the mental health provider or the organization is burning out (LoboPrabhu et al. 2019).
Integrative community therapy is a related endeavor for poor neighborhoods that was created by Brazilian psychiatrist and anthropologist
Alberto Barreto. Its essence is community building led by small trained
groups to
• Promote a sense of “shared suffering.”
• Provide an atmosphere of inclusiveness and diversity.
• Promote healthy coping strategies.
• Enhance social support networks.
Tens of thousands of community therapists are said to have been
trained in Brazil and elsewhere. Although little has been published in
English, preliminary research has been promising. Integrative community therapy is being brought to the United States to help workingclass Americans with inadequate formal and traditional mental health
services (Silva 2019). The Visible Hands Collaborative (2024) is a Pittsburgh, Pennsylvania, based nonprofit organization that offers free integrative community therapy facilitator training and hosts weekly
integrative community therapy sessions open to the public via Zoom.
Many more nature intervention models could be mentioned, but
there is also a need for a more structured approach. To begin that process,
as reported in a special issue of Sports devoted to health and well-being
in an outdoor and adventure sports context, Shanahan et al. (2019) conducted a Delphi expert elicitation process with 19 experts from 7 countries to identify the common forms that such interventions could take, the
potential health outcomes, and the target beneficiaries. They identified
27 nature-based health and mental health interventions, which could be
broadly categorized into those that try to change the environment and
those that try to change behavior (Figure 11–6). Caution was expressed
about the socioeconomic variation that can influence outcomes.
The specific and general programs discussed reflect increasing psychiatric attention to social injustice and mental health (Shim 2021). The
American Journal of Psychiatry recently published an unprecedented issue focusing on structural racism in psychiatry and psychiatric illnesses
(Kalin 2021). Even so, such social injustice has rarely been applied to nature and ecology.
The adverse influence of racism and nature therapy even extends to
a more experimental process. As the psychedelic drugs are being re-
254 NATURE THERAPY
Figure 11–6. We need a change.
A battered house begins to topple within the chaos of destructive natural and social
forces. A bird lies lifeless at the window. Two great blue herons stand together in solidarity with a human protester who holds a ripped sign demanding change.
searched more carefully and extensively, there are indications that they
could jump-start increased attention to—and connection with—nature.
With the right setting, psychedelics can inspire a sense of deep connection with nature (Kettner et al. 2019). Yet if this becomes better verified
and available, Black people tend to have a strong distrust of such research, given that they were used as guinea pigs for the early Central Intelligence Agency research on whether lysergic acid diethylamide
could be a valuable truth serum (Strauss et al. 2021).
Within community mental health systems, therapists have the challenge to recognize and appropriately treat nature-related psychological
problems. As a new concept and consideration for the public and patients, it often puts the onus on clinicians to recognize the nature-related
problems, conscious or otherwise, of relevance for the patient while
Nature Activism 255
avoiding countertransference and reductionism. In addition, this global
problem implies that psychiatrists who are nature activists can be considered therapists for the Earth. Thus, Earth’s condition can be called
ecocide or ecosuicidal, as compared with an individual’s suicide risk.
To do all that well necessitates some soul searching on the part of the nature therapy activist. Despite the apparent ethical goodness of the work,
one can be motivated by other issues that need their own attention via
collegial discussion, the input of loved ones, and personal therapy.
Without that, the activist may be more prone to frustration and singlemindedness. As Pipher found, it also helps to keep a sense of humor
and have some fun in the face of life-and-death challenges.
Although being a nature activist has psychological risks, it also has
psychological benefits. Taking any steps today to address climate challenges can be satisfying (Eichacker 2021), as can reducing any conscious
or unconscious guilt about having contributed in the first place over
many years of fossil fuel energy use (Weintrobe 2012).
Clinical Translation: Case Example
Although the range of nature climate activism can be so wide, thereby
making an average example impossible, consider psychiatrist Mark A.
Haven.
Although he had long been concerned with the underserved in psychiatry, he had not been much concerned with nature and the environment. In fact, he was personally pretty wasteful. Then, a granddaughter
was born a few years back. On a visit to his home, Mark was asked to go
to the store to buy a few things. At the counter, he was asked, as usual,
“Paper or plastic?” But this time he froze and could not answer, so he
just grabbed the few items in his hands and left. Driving home, he had
the epiphany that his anxiety came from what those choices meant for
the future of his granddaughter. He investigated the options and found
out that the correct answer was neither, but to bring your own bag so as
not to pollute nature with substances that are hard to break down.
Afterward, he found some other psychiatrists interested in climate
change and the environment, and he started to become an activist by
speaking and writing about the apparent challenges for our future
health and mental health. When he was frustrated, he found that going
out into nature was relaxing and restorative. That was no surprise to
him, for when he was younger, he loved to play sports outdoors. But
was that enough to explain his later love of trees? His answer came
when his best friend from childhood recalled their nature forays. He
reminded Mark that they used to ride their bikes to what they called
“Bicycle Paradise,” which was a wooded area behind one of the early
McDonald’s restaurants. They went to golf courses, not to play golf but
to lie against trees lining the course. Near his friend’s house was a small
undeveloped area that the friend called “The Woods,” which became a
256 NATURE THERAPY
refuge for their friends to play. But one day, his friend’s father said that
it would be paved over with an asphalt parking lot. The friend was dismayed, but his father recommended that they rescue one tree, and they
planted it in the backyard of their house. The friend protected it as only
a child would imagine he could. Sixty years later, they visited, and that
oak tree had grown to fill the backyard and had become a sacred tree to
the young Indian American boy of the house (Marcus 2021). These
childhood experiences must have been part of the basis for Mark’s activist concerns. Although he had forgotten them, his best friend recalled
all, speaking as if this were a therapeutic exploration. This insight inspired him to try to protect any and all trees.
However, as time went on and the crisis did not abate, there seemed
to be more and more to do: sign petitions, read more articles, listen to
presentations, attend meetings, and so on. Finally, he realized that he
needed to pull back and try to find what in particular the expertise of
being a psychiatrist could add to the struggle and to let go of activities
that just added names and numbers to the general cause. His role model
was psychiatrist Robert Jay Lifton (2011), who not only was an incarcerated activist during the Vietnam War era but also is a climate activist
more than 50 years later.
Now Mark is trying to determine what psychiatric interventions
might work and ensuring that he will not burn out along the way. Mark
wondered about climate reparations (Moffic 2021). Climate and environmental disruptions are producing climate refugees, who tend to have
trauma as a result of their losses and situation. Does their psychological
suffering call for reparations from the countries with the greatest responsibility? Clearly, however, his long-term interest in the underserved
could be transferred here because, as in so many other matters, in regard
to nature and the environment, the underserved are being underserved.
CONCLUSION
At first glance, the task of activism for nature therapy appears simple
and straightforward: just do what is possible to increase therapeutic opportunities in nature for all (Figure 11–7). However, it is much more
complex and challenging than that.
Clearly, nature influences the mental well-being of humans, and hu-
man behavior influences the processes of nature. Myths tell us that. History tells us that. Psychiatric ethics tell us that. Science tells us that. In
either direction, there can be benefits and risks. Climate change and
other environmental changes in nature are associated with threats to
mental health such as PTSD, undue anxiety, grief, and depression. Conversely, nature is a therapeutic resource for mental changes such as poor
focus and anxiety. In other words, nature can be both a source of and a
solution for mental distress. Moreover, people and communities differ
Nature Activism 257
Figure 11–7. In my solitude.
There is nothing as refreshing as a walk in nature. It is a chance for reflection and repose,
a way to restore harmony within the chaos of modern life.
in their exposure to nature benefits and risks. Poorer communities and
people with limitations or those subject to discrimination need special
social justice attention in order to increase opportunities to experience
the therapeutic aspects of nature. These interactions necessitate pairing
our professional ethics with corresponding nature ethics, such as psychiatric ethics with biocentrism. Biocentrism extends our activist concerns not only to the mental well-being of people but also to the needs
of other living things. Some would add a spiritual or religious component to the ethics and morality.
258 NATURE THERAPY
At their worst, these interactions can result in a vicious psychologi-
cal circle. As nature and the environment are harmed by people, their
mental health tends to worsen. We need more nature therapy, but the
opportunities to incorporate this therapy may be lessening, especially
for certain cultural groups. If our collective mental health worsens, then
we are less likely to be successful activists. Perhaps the psychedelics being researched once again can help some break through the obstacles to
identifying with nature.
Psychiatric professionals can contribute at various levels. As an in-
dividual, clinicians should become involved in nature for their own
mental health, obtaining at least brief exposure daily. They should fill
their office and home with plants. In turn, clinicians must recognize the
importance of nature in their patients, especially those of lower socioeconomic status who may have become accustomed to their circumstances. Individual modeling of the importance of nature can have
social contagion spreading and rippling out to others just by talking
about it. Becoming a nature activist can be rewarding but also dangerous to one’s mental health and well-being. Activists can be working
against very powerful corporate and political forces and must watch out
for one another. Psychiatric help must be available when needed. A
cadre of readily available psychotherapists expert in this area is of the essence. We probably will need subspecialty training in nature psychiatry.
On another level, psychiatric professionals should join a small group
of like-minded colleagues. Whether famous cultural anthropologist Margaret Mead actually said this or not, there seems to be historical truth in
this quote: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”
Perhaps such a small group example would include the original
group called Psychiatrists for Environmental Action and Knowledge,
because that has morphed into much larger groups of climate-concerned
psychiatrists and a recommendation to add ecology to the traditional
biopsychosocial model.
The larger groups concerned with nature and nature therapy also
have been slowly evolving. Such groups may include mental health
professionals, general health professionals, politicians, and the public
(Pipher 2013). Especially complementary could be those who work in
environmental biology, artists, and Indigenous people. Education about
nature and nature therapy must become much more widespread. Press
releases can become potent nature prescriptions. More mass organizing
to combat organized financial support of fossil fuels may be necessary.
We need to address and pay attention to many things in nature, but
as one example, growing more trees is an attainable goal for all levels of
Nature Activism 259
intervention: individual, small group, and larger populations. Trees can
lower air temperatures in neighborhoods, which is so crucial in the hotter neighborhoods in poor communities. Taking care of them and exposing oneself to them, daily if possible, may help prevent the burnout
that is so common in activism of any sort. Trees will save energy costs.
Advocating for reforestation is a matter of professional ethics and environmental justice. Research indicates that green is good for mental
health (Barton and Rogerson 2017). Planting trees and using ultrawhite
paint seem to temper dangerous heat islands. Some cities are deploying
millions of trees to fight against climate change. If any city could be at
risk for being a “concrete jungle” (Figure 11–8), it is New York, and they
recently planted a million more trees (Rogers 2019) to supplement those
already in Central Park and other parks. A study in Toronto, Ontario,
found that adding just 10 trees to a city block had a major effect on people’s perceptions of their health and well-being. Perhaps this urban tree
planting is a complement to the forest bathing therapeutic opportunities. We also need to plant more trees to help make up for those consumed by the increasing climate-fueled wildfires. As trees grow, they
pull more and more carbon out of the atmosphere, but if the trees burn,
they release massive amounts of that carbon into the atmosphere.
Well-known mythologist Joseph Campbell’s advice was “follow
your bliss” for a fulfilling life (Campbell and Moyers 1991, p. 113). For
a mentally healthy life, I would add only one word to that: follow your
nature bliss. A nature activist might add one more word: follow your
nature activist bliss (trees or whatever that may be), as long as it is ethical. What is your bliss?
KEY POINTS
• Individuals should find an aspect of nature that they
love, such as trees, and use it for their own mental wellbeing.
• Various cu ltural gro ups have mo re limited access to the
benefits of nature therapy.
• Activism has multiple psychiatric ethical roots.
• Psychiatric professionals should find models of psychiatric activism and join a small group of like-minded colleagues.
• Nature therapists should learn and incorporate the
knowledge of nature of the Indigenous people.
260 NATURE THERAPY
Figure 11–8. A natural dream.
A child sits facing an urban landscape devoid of natural light. It is marked by bricks and
barred windows, bare of trees and other signs of nature. The child is not looking at the
walled barrier. He is looking inside himself, imaginatively transforming the world into a
living landscape.
QUESTIONS
1. Activism in nature therapy is best characterized as
A. A psychologically safe activity.
B. Producing better contact with nature.
Nature Activism 261
C. Applicable only in direct patient care.
D. A professional ethical principle.
E. Applicable mainly to certain cultural groups.
Correct answer: D. A professional ethical principle.
Although all the answers have some truth to them, the most
comprehensive answer is that activism in nature therapy is best
characterized as a professional psychiatric ethical principle (D).
Although activism in nature therapy is a psychologically safe activity (A) for the most part, there are also risks of activism burnout, facing criticism and depressing information, and frustration,
which worsen over time. Producing better contact with nature
(B) is an outcome of activism in nature therapy but does not describe the term itself. A large part of activism in nature therapy
happens outside of direct patient care (C), including community
organizing, peer interactions, and governmental lobbying efforts. Participation in nature therapy activism is nondiscriminatory with respect to cultural identity (E).
2. Psychiatrists can best become nature activists by
A. Joining activist groups.
B. Signing petitions.
C. Applying the unique expertise of psychiatry.
D. Bringing up nature therapy with all patients.
E. Ignoring personal motivation to be an activist.
Correct answer: C. Applying the unique expertise of psychiatry.
Clearly, psychiatrists and other mental health professionals have
the most potential to contribute to nature therapy by using the
biopsychosocial-ecology model of understanding and care, which
points to applying the unique expertise of psychiatry (C). Joining
activist groups (A) and signing petitions (B) are both forms of nature activism available to the layperson that are not as specifically
targeted as actions guided by professional expertise. Not every
patient is a candidate for nature therapy, so bringing up nature
therapy with all patients (D) would not be appropriate. Ignoring
personal motivation to be an activist (E) is the opposite action of
best becoming a nature activist.
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