Enchantment, Nurturing, and Wholeness

The science behind the Taproot Healing approach

This week I struggled to find the right topic to write about. I have at least ten half-baked ideas in my head, and I know how much readers of The Nettle Witch, MD have been longing for a think piece tying songs from Taylor Swift’s new album The Tortured Poets Department to heartbreak in medicine (I have 8 and 5 year old daughters/Swifties, what can you do?). However, I’m excited about a new business venture I’m pursuing, so I decided to take the practical route and organize the science that supports my approach. 

I’m tentatively calling this venture Taproot Healing. Taproots go deep into the soil to pull up nourishment from the soil, and leave that nutrition they have pulled up on the surface after the plant dies. They also break up compacted soil that is too packed down for anything to grow. This is what I am trying to do with Taproot Healing, to pull nourishment from deep within ourselves and the earth, in places that we haven’t thought to look and create new space to grow and thrive. I plan, at least initially, to focus on working with healthcare workers. I definitely hope to expand to providing rituals for closure regarding COVID for the general public as well. I hope to nurture their/our emotional and spiritual lives to help people feel less numb, more enchanted, more connected, and more whole. 

I want to create group gatherings and retreats that involve nature connection, making art (writing, dance, or visual art), sharing our stories and emotions with radically present listening and witnessing, creating communities of care, and likely much more. There’s so much science to back up the importance of these approaches. In some ways, knowing the science behind it almost weakens the power of these acts because, as anyone who has done these activities knows, you just feel better after you do them and you don’t need a randomized controlled trial to tell you that. They also put the rational mind back in the driver’s seat, when we are trying to give the heart, gut, soul, uterus, or skin, a turn at the wheel for a while. However, I think this information could be useful for convincing skeptics in your lives and will definitely be useful for convincing skeptical doctors and healthcare administrators as I try to take this show on the road. 

Nature

There is so much data to support the health benefits of time in the outdoors and attention paid to the natural world that, honestly, I’m sort of surprised it is still being researched. Exposure to natural environments has been shown to:

• Reduce cortisol (stress hormone) levels and stress levels

• Increase positive emotions and decreased negative emotions

• Increase social interactions and engagement

• Increase sense of meaning and purpose in life

• Improve manageability of life tasks

• Improve school performance

• Improve imagination and creativity

• Improve sleep  

• Decrease anxiety, rumination and depressed mood

• Improve attention and executive functioning (the set of skills that help you get things done like planning, organization, and time management)

• Increase activity in the prefrontal cortex (the part of the brain that plans and coordinates activities and provides impulse control)

• Decrease blood pressure

• Improve immune function

• Accelerate post-operative recovery 

Specific practices like forest bathing and gardening have similar effects. Practices such as shinrin-yoku (forest bathing), have repeatedly been found to improve stress, blood pressure, immune system function, heart rate, and nervous system activity. A meta-analysis (a statistical analysis that combines the results of multiple studies to assess the overall trends) found that gardening improved life satisfaction, quality of life, and sense of community, while decreasing depression, anxiety, and body mass index. In fact, just the act of putting your hands in the dirt or breathing the microbes outdoors have beneficial health effects. When we’re out in nature, “we’re breathing in a tremendous amount of microbial diversity” according to Christopher Lowry, professor of integrative physiology at University of Colorado-Boulder. Bacteria in the dirt have many positive health impacts. People who grow up on farms are less likely to have Crohn’s disease, asthma, and allergies. There is even bacteria in the soil called Mycobacterium vaccae that lowers stress and improves our immune response to stress. 

It’s not just that nature can cause benefits or did in just one study. In one systematic review (a search for and analysis of all studies on a given topic), 98% of the studies performed found mental health benefits to nature exposure. This is a pretty unheard of success rate. 83% of studies found physical health benefits and 86% found cognitive benefits.  

Can you imagine a medication or surgery that could do all this? We would pay thousands of dollars for it (at least)!  

Ritual

Ritual is “a religious or solemn ceremony consisting of a series of actions performed according to a prescribed order.” People use rituals for protective, restorative, and goal-directed purposes throughout the world. According to Cristine Legare, et al, in their study of how traditional medical rituals and the rituals of the biomedical model are integrating together in rural India, “During times of uncertainty, stress, or danger people turn to rituals to cope with anxiety and exert some measure of control.” Rituals performed after experiencing losses alleviate grief. Rituals performed before high-pressure tasks like singing in public or sporting events, relieve anxiety. Interestingly, rituals benefit even those who do not believe that rituals work. 

As I have mentioned before, rituals feel vital to healthcare workers to provide closure after COVID and to confront the many griefs and angers that are ever-present in a dysfunctional system. The fact that you don’t have to believe in it for it to work is especially fascinating given all of the jaded and cynical doctors that I have worked with. 

Psychologists have found that rituals cause changes in people’s thoughts, feelings and behaviors. Rituals can also strengthen relationships within a group, reinforce membership in a group, and reduce individual-level conflict in a group, which helps build cooperation. Additionally, the complexity and specificity of a ritual can impact a person’s view of its efficacy. In Brazil, a study of rituals used for things like quitting smoking, curing asthma, and warding off bad luck, found that people perceived rituals with more steps, repetition of procedures, and set times for performing rituals, to be most effective. 

Interestingly, the effects of more extreme rituals sometimes have more benefit. Anthropologists studied a ritual involving “bodily mutilation” according to the authors (unfortunately only the abstract was outside the paywall, so I couldn’t see exactly what was meant by this) and prolonged suffering. They found that those who participated in this ritual experienced no objective negative physical consequences to participating, and in fact, experienced a subjective health improvement that was increased in those who participated in more intense aspects of the ritual. 

Since this newsletter is about science, my daughter wanted to share a chocolate lab working in a lab with you.

Council/Talking Circles

Talking circles are known by quite a few different names, but come from traditional practices of people indigenous to North America (First Nations and Native Americans). At its simplest, the practice involves members sitting in a circle with a problem or a question. The circle starts with a prayer that is led by the person convening the circle or an elder. The person convening the circle brings a meaningful or sacred object and when they have finished speaking, they pass the object to the left. Only the person holding the object speaks. The key is that there is no giving advice (I’m sure you have experienced unsolicited advice that felt like criticism) or even providing comfort. No effort is made to change what a person is feeling. 

Talking circles are one way of expressing emotion in a healthy way. Repressed emotions, particularly fear, sadness, anger, and shame, can decrease mental energy and lead to health problems such as high blood pressure, heart disease, digestive diseases, and infection. Suppressing emotions is correlated with increasing rates of all-cause mortality by 30% and increases mortality due to cancer and heart disease by 70%.

In a study of the impact of talking circles, they found there was a significant decrease in symptom severity from issues including musculoskeletal pain, family problems, headaches, stress, depression, anxiety, and work/financial worries. They also found a significant increase in overall wellbeing. In this study, the effect size was measured and found to be 0.75-1.19. In layman’s terms, effect size measures the amount of difference between the experimental group and the control group.  As a frame of reference, a 0.8 effect size is large, 1.3 is very large. 

Tending to the emotions of healthcare workers has an impact beyond their individual wellbeing. In training and practice, we are often told there is no place for our emotionality in the hospital. However, when we can’t express our emotions at work, then many of us leave work and can’t or don’t want to share the emotion of the day at home. We gradually lose our ability to recognize what we are feeling. When we can’t feel the bad stuff, we can’t feel the good stuff: enchantment, joy, wonder, passion. If we find ways to nurture the emotional lives of healthcare workers, they can feel more. Unfortunately, in the current state of the healthcare system that is not adaptive for most. However, for those who do feel a deep sense of meaning about their work,  if their emotions are nurtured they have the ability to engage emotionally in their work, which is important both for their satisfaction in their job and their ability to provide care well. When a patient feels their physician has empathized with them their symptoms are shorter and less severe. 

Storytelling

When we are listening to a story our brains connect storyteller to story listener. Mirror neurons in our brains allow a listener to connect on an emotional level with the characters of the story. Connecting with the characters in a story causes our brains to release oxytocin. Oxytocin makes people more trustworthy, generous, charitable, and compassionate. In hospitalized children, listening to stories increased oxytocin, but also decreased pain and decreased stress hormones. In the above study, the impact of storytelling was twice as large as the impact of riddles, which were the comparison group in this study. As far as I can tell, the business impact of storytelling has been studied a lot more than the physiologic impact of storytelling, but from what little there is, it seems that storytelling is vital for building connection and understanding, something that many of us are longing for. 

Writing

Writing or talking about emotional experiences has been studied extensively and has been shown to have multiple physical and mental health benefits including: 

• Fewer stress-related visits to the doctor

• Improved immune system functioning

• Reduced blood pressure

• Improved lung function

• Improved liver function

• Fewer days in hospital

• Improved mood/affect

• Feeling of greater psychological well-being

• Reduced depressive symptoms before examinations

• Fewer post-traumatic intrusion and avoidance symptoms

• Reduced absenteeism from work

• Quicker re-employment after job loss

• Improved working memory

• Improved sports performance

• Higher students’ grade point average

Medical conditions that may benefit from expressive writing programs:

• Lung functioning in asthma

• Disease severity in rheumatoid arthritis

• Pain and physical health in cancer

• Immune response in HIV infection

• Hospitalisations for cystic fibrosis

• Pain intensity in women with chronic pelvic pain

• Healing after surgery

In patients with HIV, their viral loads dropped and CD4 cells (immune cells impacted by HIV) increased after participating in expressive writing. Similarly, expressive writing decreases the negative impact cancer has on a person’s mental health. Expressive writing had a much larger impact on resilience in people with PTSD than medication treatment. Effect size of medications was on average 0.72 versus effect size of 4.62 with expressive writing. 35% of the people who were clinically depressed at the start of the study were not clinically depressed at the end. 

Researchers have found a certain way of writing that is most beneficial for healing: 

1. It must contain concrete, authentic, explicit detail 

2. The writer must link feelings to events

3. The story must have a beginning, middle, and end. 

This results in a complete, complex, coherent story. 

Visual art

Creating art allows people to engage the body, mind, and soul in ways that verbal expression often can’t. As humans we’ve been making art for thousands of years. In fact, a new series of cave drawings was recently found that is over 50,000 years old. Beyond basic needs, there are few things that humans have done for so long. I suspect it means there is some essential nourishment we receive from the activity. Making or even just looking at art changes our bodies and our minds. Here are some of its impacts:

• Increases serotonin (chemical we are trying to increase with most depression medications)

• Increases blood flow to areas of the brain associated with pleasure

• Encourages new ways of thinking

• Helps us imagine a more hopeful future

• Decreases stress hormone levels

• Improves depression and anxiety symptoms

• Improves cognitive skills like inventive thinking, work planning and execution

• Builds a sense of self-sufficiency and satisfaction in one’s work. 

• Helps heal emotional traumas

• Improves self-awareness and awareness of others

• Enhances the ability for self-reflection

• Changes behaviors and ways of thinking. 

• Helps makers connect to new aspects of themselves, frees them from constraints, and allows them to access a flow state. 

Art can be helpful for PTSD and burnout, both of which are very common in healthcare. 

Women with cancer found that making art helped them focus on positive life experiences, strengthened their self-worth and identity, maintain an identity separate from “person with cancer”, and allowed them to express their feelings symbolically. Another study of women with cancer found that those who made art had decreased levels of physical and emotional distress and increased relaxation during cancer treatment. After just one hour of art therapy, cancer patients had a decrease in 8 out of 9 of the symptoms they were tracking, including the global distress score and measures of anxiety. Hospitalized patients who received music and art therapy had better treatment outcomes, better vital signs, less objective signals of stress (cortisol levels), and less need for sleep medication. 

Caregivers for patients with cancer found that making art significantly reduced stress, decreased anxiety, and increased positive emotions. They also had an increase in positive communication with their loved one and the healthcare team. The impact of art on caregivers is likely to have a similar impact on caregivers in the healthcare realm. 

“Art therapy has been hypothesized to bring order to traumatic experiences by creating links to nonverbal memories so that dissociated memories may be organized and processed in a meaningful way” Art therapy also involves the use of both the right and left hemispheres of the brain. As I understand it, therapies like EMDR are helpful because of similar engagement of both sides of the brain. 

Dance

Dance and creative movement release feel-good hormones like dopamine, relieve stress and anxiety, improves body image, and enhances quality of life, including better enjoyment of the here and now. Creative movement helps women in midlife as they explore and better understand their relationships to self, others, and spirit. Dancing twice a week decreased daytime fatigue and improved the quality of sleep. In adolescents with mental health concerns, dance improved physical symptoms associated with mental health, obsessive-compulsive symptoms, depression, anxiety, hostility, paranoia, and decreased emotional distress. Dance can help people with psychological trauma improve body awareness and mind-body connection. It also improves the ability to recognize emotions, focus on emotions, and release emotions. These are particularly important for people who work in healthcare, who are frequently exposed to traumatic events and exist in a culture that is especially disconnected from bodily needs. 

Singing/Music

Music engages movement, sensation, thinking, emotional and social parts of the brain. It also helps to regulate the autonomic nervous system (the automatic part that does fight or flight/rest and digest). Listening to or performing music changes the amounts of serotonin, epinephrine (adrenaline), cortisol, oxytocin, prolactin, and dopamine, which makes it one of the most pleasurable activities in many people’s lives. 

In order to sing, one must take slow, regular deep breaths, which soothes the body and lowers blood pressure. It also decreases heart rate. Singing increases levels of immunoglobulin A, thus stimulating part of the immune system. In one study, researchers asked choir members to complete questionnaires that assessed measures of well-being before and after choir practice. Even after one practice, there was significant improvement in mood, personal growth, and vitality. Choir members report increased self-worth and self-confidence. Music decreases anxiety and pain and may improve immune system function. For caregivers, participating in a choir significantly decreased anxiety and improved wellbeing. The study was performed on people who were caregiving for loved ones with cancer. However, it seems reasonable that much of the result could be expected to apply to caregivers in the healthcare industry as well. 

According to neurologist Oliver Sacks, ““Music, uniquely among the arts, is both completely abstract, and profoundly emotional. It has no power to represent anything particular or external, but it has a unique power to express inner states or feelings. Music can pierce the heart directly.”

Conclusion

As children, we were often told of the need to get our “head out of the clouds”, to focus on more serious things than watching ant hills, looking for magic, or creating art. However, the evidence doesn’t bear that out. Time in nature and time creating art through writing, visual art, music, dance, or storytelling are vital to our physical, mental and emotional health and change how we think and behave. Within our culture, a similar thing has happened with regard to ritual and God, often dismissed as superstition, gullibility, or just irrelevant to the modern world. However, these activities have real power in our lives and have the ability to bring enchantment and wonder, nurturing and nourishment, healing and wholeness back into our lives. Come join me!