Gardens that Heal

Elizabeth R. Messer Diehl

 

Landscape architect, journalist, and horticultural therapist Elizabeth Messer Diehl reports on the growing amount of research that confirms the healthful benefits of going outside and working in the garden—or simply being present in its soothing yet stimulating milieu. Beyond exercise, the benefits of horticultural therapy extend healing into the psyche, culture, and spirit, working in ways that are both concrete and symbolic.

 

 

Almost from the beginning of time, where there have been humans, so too have there been gardens. Gardens are a fun damental component of human life, and their design and use can tell us a great deal about the people who created them. Gardens have been used to grow food, provide shelter, display symbolism, reveal beauty, reflect beliefs, and offer refuge. Recently, interest in gardens as places of refuge and healing has dramatically increased, perhaps as evidence of our desire to reconnect with nature and the earth. For many of us, gardens have always provided sanctuary and facilitated our personal relationship to nature. So it’s no surprise that research has shown strong links between exposure to gardens and healing and emotional well-being.

This healing can come from active participation in the garden, including planting flowers, tending the soil, or pulling weeds. The physical labor of these endeavors can be therapeutic because it works our muscles while offering our mind beneficial and stress-free distraction. Because gardening involves so many activities, we can choose the one that best suits our physical ability and needs.

Perhaps equally important is the multitude of tactile and sensory opportunities that present themselves as we work the garden. Feeling the warm, moist soil in our hands, breathing in its earthy, rich scent, and anticipating its power to produce life—these are powerful experiences that have a positive impact on the body, mind, and spirit. Passive garden activities, also triggered by nature’s sensory qualities, can provide a source of healing as well. The act of sitting quietly in a garden and breathing in its fragrance and beauty while listening to the sounds of nature can reduce stress and calm one’s mind, leading to long-term restoration and rejuvenation.

Roots

Many historians believe that gardens first appear as a healing component of Western health care in monasteries during the Middle Ages. Most monasteries featured a cloister, an enclosed courtyard surrounded by an ambulatory: a covered open-air walkway. In addition to providing access to the monks’ cubicles, the ambulatory was a place for walking and contemplation. Although the layout of the cloister varied among monasteries, it was always enclosed by walls and open to the sky, and usually included a water feature in the center. This setting provided an ideal location for meditation and allowed for a pleasant variety of sun, shade, warmth, and shelter for the monastery’s residents and patients. St. Bernard (1090–1153) described the benefits of such a garden in Clairvaux, France, by referring to the therapeutic aspects of privacy, green plants, birdsong, and fragrance.¹

Although the Middle Ages may mark the earliest recognized use of a restorative garden in a Western healthcare setting, we can find its inspiration at least 10,000 years ago in Mesopotamia. After the last ice age, Mesopotamia consisted of lush savannah and was inhabited by animals and Paleolithic humans. As the glaciers retreated and the heat moved northward, many creatures were pushed out by the increasingly hot and dry climate. It was rather like a physical enactment of the banishment of Adam and Eve from the Garden of Eden. This is where the concept of the paradise garden came into being, and its origins are found in Old Testament history: “and the Lord planted a garden eastward of Eden . . . and a river went out of Eden to water the garden.” The passage goes on to link the paradise garden with heaven.² From about 2500 BC onward, visual inspiration for these earthly paradise gardens came from the lush agricultural plots that thrived in the Euphrates River valley, which was surrounded by an otherwise dead landscape. As a result, the shape and proportions of the early gardens reflected those of the agricultural fields.

In the hot, arid environment of Mesopotamia, the paradise garden was an oasis in the desert: a lush refuge from the harsh, dry surroundings. Fruit and nut trees provided shade, cooler temperatures, and nourishment for the body and soul. Water brought into the garden in narrow channels provided refreshment and music, watered the plants, and connected the garden to heaven by symbolizing the four rivers of heaven described in the Bible. In these very early gardens the concept of physical refuge was the primary purpose, but it is important to recognize that they offered emotional and spiritual refuge as well. In one of the earliest documented examples, King Nebuchadnezzar built the Hanging Gardens of Babylon (between 604 and 526 BC) for his bride in an attempt to alleviate her homesickness for her mountainous homeland of Persia.

Gardens and Healing

The significance of gardens in traditional healthcare settings has varied throughout history depending on era, culture, and medical technology.³ Today, gardens are again beginning to be recognized as important in complementary and integrative medicine. Traditional hospitals are starting to incorporate gardens into and around their buildings, both to take advantage of the garden’s healing powers for patients, visitors, and staff and to create a more appealing setting for the potential hospital customer. As the need for certain kinds of healthcare settings grows, specifically designed healing gardens are becoming more common. This is especially true in hospices and facilities for people with Alzheimer’s disease, where the focus is on care as opposed to cure. For facilities that try to provide homelike comfort, familiarity, and spiritual well-being, gardens create opportunities for activity, stress relief, privacy, and time in the outdoors.

A healing garden in a healthcare setting is a place to relax, connect with nature, reduce and relieve stress, and escape from an institutional atmosphere. Leaving the confining walls of the hospital for the natural beauty of a garden, even if only for a short time, can improve one’s mood rather quickly; whether providing privacy for meditation or encouraging conversation, the garden brightens one’s outlook. A healing garden may also play a role in the facility’s therapeutic programs, including horticultural therapy, occupational therapy, physical therapy, and recreational therapy.

In doing all of these things, the garden enhances the individual’s recuperative powers. Access to gardens and natural views throughout all phases of hospitalization and recovery has been shown to enhance healing, recovery, and recuperation.⁴ If recovery is not possible, the garden can offer calming conditions through its connection to life cycles and other natural processes. The healing effects can be felt throughout the healthcare facility, not just by patients but also by doctors, nurses, administrators, other staff, and visitors.

What is it about gardens that helps patients recuperate? The plants themselves offer a wide range of physiological and psychic benefits. Exposure to plants, mostly likely in tandem with other factors, stimulates cognitive and physical functioning, improves disposition, alleviates depression and loneliness, increases self-esteem, and helps disease recovery. ⁵ The multitudes of fragrances, colors, textures, tastes, and sounds of plants awaken the senses. Our sense organs are designed to detect changes in stimulation, not to monitor constant input. For example, changes in air movement around us reveal sensations and odors that go undetected in closed, static spaces. Sensory stimulation helps us connect with nature by engaging us physically, cognitively, and emotionally. Such positive stimulation occurs frequently in the garden, and a successful therapeutic garden will make these sensory opportunities accessible.⁶ When our senses are aroused in the garden, our relationship with nature gains experiential complexity, allowing us to experience a stronger connection to the landscape and, therefore, its healing qualities.

Numerous research studies have looked at the role that gardens and other outdoor settings play in healing. One such study found that patients recovering from gallbladder surgery whose hospital windows looked out over a natural setting recovered faster, required less pain medication, and made fewer demands on nursing staff than those whose windows looked out on a brick wall. Further research led to the theory that viewing natural landscapes reduces stress and promotes a sense of well-being that contributes to health and recovery. Another study comparing rates of delirium in intensive care units found that patients without windows showed a higher rate of delirium than those in units with windows.⁷

It has also been demonstrated that certain scents stimulate bodily organs to release neurochemicals that help eliminate pain, induce sleep, and create a sense of well-being. Researchers at Kansas State University found that female college students who were exposed to a combination of a cut flower arrangement and a lavender fragrance infusion experienced significantly lowered beta brainwave and electrodermal activity, suggesting increased relaxation and decreased physiological arousal. In addition, the olfactory effect of the lavender resulted in less sadness and less anger or aggression in the female subjects. Research has also shown a link between the smell-sensitive hypothalamus and the immune system, drawing a connection between scent and the body’s ability to fend off disease.⁸

One pilot study found that older adults participating in an activity in a garden had significantly lower cortisol levels (indicating lower levels of stress) than adults performing the same activity indoors. Finally, a 2006 pilot study revealed a connection between gardening and increased self-efficacy in homeless women.⁹ Certainly more research is needed, but a clear and strong relationship between access to nature and human healing has already been established.

Another example of this phenomenon is fascination theory, which describes how a garden setting can help us recover from mental fatigue. The directed attention required for most work-related tasks (such as working at a computer or studying a text) leads to irritability, impatience, mistakes, risk taking, and exhaustion when maintained for too long; in contrast, fascination involves focused attention without effort.¹⁰ For example, we might be fascinated with a butterfly in the garden and become fully absorbed in watching it float through the air from flower to flower. This kind of attention does not contribute to mental fatigue. It can, in fact, provide time to recover by permitting reflection and thought despite our absorption. In a restorative setting, fascination can help an individual explore difficult thoughts and emotions in a calm and less painful way.

A Blossoming Wellness Practice

While passive interaction with nature can create calming and healing effects, active participation in the garden can allow us to more fully tap into its restorative benefits. The physical work of digging in the soil to plant a new garden can provide appropriate outlets for aggressive energy, alleviate stress, and improve strength and dexterity. Tending a perennial garden can offer opportunities for nurturing and growth, stimulate feelings of self-worth, and rouse good thoughts about caring for living things and fostering beauty. The study of these types of people-plant interactions has increased dramatically over the past twenty years, providing both scientific and anecdotal evidence of its benefits.

The American Horticultural Therapy Association (AHTA) was founded in 1973 to promote and develop the horticultural therapy profession as a therapeutic and rehabilitative medium for people who are disabled or disadvantaged. This involves improving the physical, psychological, social, and educational aspects of individuals’ lives, thus nurturing their body, mind, and spirit as well. As an organized effort, horticultural therapy was first used in veterans’ hospitals following World War II. Great numbers of volunteers were mobilized by garden clubs around the country to bring horticultural activities to veterans struggling with psychological and physical disabilities.

Horticultural therapy was originally seen as a form of occupational therapy, and recognition of its many benefits grew in this context. Today, however, it is known for the great variety of human populations it benefits, including people with physical or developmental disabilities, mental illness, or other social disadvantages; older adults as well as children; victims of abuse; addicts; and public offenders. Although the basic premises of horticultural therapy remain the same, the techniques and treatment goals vary with the needs of the individual.

Countless horticulture-based therapeutic activity programs throughout the world are reporting success stories. Good examples can be found in Milan, Italy, where urban children are encountering nature and its study through school gardens and in Ontario, Canada, where patients with eating disorders are discovering the connection between health and nurturing through working with plants, while also learning a new leisure activity. In a therapeutic horticulture program in Massachusetts, bereaved family members have the opportunity to share grief and mutual understanding, which helps counter the isolating nature of grief.¹¹

A therapeutic horticulture program in California provides homeless and abused children with a vital and stabilizing link to the land, allowing them to recognize specific and concrete evidence of their abilities. Institutionalized adults with Alzheimer’s disease and other dementias participating in a horticultural therapy program in Wisconsin are demonstrating increases in self-esteem, social interaction with peers, confidence, interest in the future, awareness of the environment, and participation in other activities.¹²

Research published in 2005 examined the difference between Texas probationers who were randomly assigned, through a community service program, to either horticulture activities (including greenhouse work, plant propagation, landscaping, and vegetable gardening) or nonhorticulture activities. After studying 383 probationers over the course of the three-year program, researchers found that the probationers in the gardening group showed significant increases in self-esteem and higher environmental awareness than the nonhorticulture group. Perhaps most important, individuals in the horticulture group were also less likely to repeat crime: 74 percent of the probationers in the horticulture group did not repeat crime during the study period, whereas only 51 percent of the nonhorticulture group did not reoffend.¹³

These are just a few examples of the many populations that can benefit from interaction with nature. As healthcare providers and facilities face increasing pressure to become more consumer-oriented, the number of healing gardens and horticulture-based programs should only increase.

Americans are showing more interest in alternative medicines and healing techniques. This increased interest is at least in part due to widespread dissatisfaction with conventional medical treatments, many of which are increasingly unaffordable. With gardening being one of the most popular hobbies in the United States today, it is no surprise that our interest in the healing aspects of plants and gardens has grown. Since the 1990s, we’ve also seen an increase in people’s interest in their own health; at the same time many have recognized the calming effect that nature can have on feelings of stress. Even the Joint Commission on Accreditation of Healthcare Organizations requires that long-term care and pediatric patients be given access to the outdoors on or adjacent to hospital grounds.¹⁴

Fostering relaxation, recuperation, stress relief, invigoration, recovery, and general well-being, a well-planned healing garden allows for both passive and active interaction with nature. Fortunately, this phenomenon is getting increased attention, and healthcare facilities are responding. Further research into garden design will only enhance our ability to better fulfill the needs of patients, staff, and visitors alike. But it is also important to keep in mind that the powers of a healing garden are not limited to those who are ill or rehabilitating; almost anyone can benefit from the opportunity gardens create to invigorate the senses and rejuvenate the soul.