A Radically-Simple Approach to Getting Well | Julia Hotz

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Episode Transcript:

Julia Hotz: [00:00:00] It’s harkening us back to the things we need to be healthy. We need to count on other people. We need to have people we can call at 3 a.m. in a crisis, and we like to do that in return for others. And so these social prescriptions that enable us to hold other people accountable and be held accountable are, I think, just some of the most beautiful expressions of humanity. This is what we do. We try to make it through together. We count on each other. We notice when we’re not there and we celebrate when we are.

Jonathan Fields: [00:00:32] So you know how so many of us go to the doctor and leave with a prescription for whatever ails us, usually in the form of a pill or a capsule or a shot or a serum. But what if your health care provider looked you in the eye, then wrote you a prescription for dancing or nature, or making art often with others? You’d probably look at them like they lost their minds. And yet some physicians are starting to do just that. It’s called social prescribing, and the results have been astonishing. My guest today is Julia Hotz, and she offers a powerful prescription for what ails us and robs us of truly living a good life. And her groundbreaking book, The Connection Cure the prescriptive power of movement, nature, Art, service and Belonging, she introduces this radical concept of what she calls social prescribing, addressing our deep human needs through powerful antidotes like community gatherings, art classes, nature immersion, volunteer service, and physical activity now being prescribed by doctors. Julia is a solutions-focused journalist based in New York. Her stories have appeared in New York Times, wired, Scientific American, and more. She helps reporters bring new ideas to light at the Solutions Journalism Network and with The Connection Cure as her first book, she is at the forefront of an emerging health revolution that could transform how we really view wellness and living a good life. So if you’ve been yearning to experience more meaning and joy and belonging those essential ingredients for a life well lived, Lean into this conversation. Julia’s insights into the prescriptive power of reconnecting through movement, nature, art, service, and community, and how that’s actually starting to be prescribed literally in the medical profession, may just start to provide the antidote that your soul has been craving. So excited to share this conversation with you. I’m Jonathan Fields and this is Good Life Project.

Jonathan Fields: [00:02:33] You know, what’s interesting is we have this conversation. The world is in such an interesting state, and we as human beings, as individuals are in another quote, capital-i interesting state. And there’s a lot that ails us on any given day psychologically, physically, emotionally. It seems like so often when we’re feeling something, some kind of discomfort in our lives, we reach for the the quick fix. If we go to traditional medicine, we’re often prescribed, you know, some version of like what is the easiest, fastest way for this to go away? What is the pill? The thing I can take, the instant thing I can do. And not to say that that isn’t appropriate in a number of different situations. Thankfully that exists for a lot of different things. But you introduced this sort of like alternative approach to exploring our condition that I think is really fascinating that you describe as social prescribing. Take me into this. When we’re talking about social prescribing, what are we actually talking about?

Julia Hotz: [00:03:32] Sure. Thanks so much Jonathan, great question. We hear social prescribing and we hear the social. So we must think okay social prescribing is about prescribing friendship. Actually, the name social prescribing comes from the fact that a good portion of our health, some studies suggest 80% of it is determined by social factors in our environments. That includes things like do we have food to eat? Do we have safe housing? But it also includes things like do we have people we can call at 3 a.m. in a crisis? Do we have outlets to cope with the sadness and the loneliness of being human? Do we have a sense of meaning that wakes us up in the morning? These are all our social determinants of health. Social prescribing is about addressing those. It’s a way for doctors to prescribe us activities and resources in our environments, the same way they prescribe pills and therapies. So it could include everything from fresh food, housing assistance to an art class or a cycling group, or even a sort of community potluck. Anything that gives us a sense of joy, meaning and belonging.

Jonathan Fields: [00:04:52] I’m curious also because this is an I think a lot of us, when we hear about just the notion of, oh, if I get involved in this, that or the other thing, I’ll probably feel better. But when you wrap that in this word prescription, I think it gets really interesting. Where does this come from originally? You know? Right. Because it seems like in the research that you’ve done, this is maybe a newer concept for us, but maybe not so much for a lot of other places.

Julia Hotz: [00:05:18] That’s right. I mean, let’s be honest, social prescribing, this idea of addressing our social determinants of health, this is a very old idea. My introduction talks about how some of these ideas are present in writing from the Buddha or Hippocrates or Rhazes of Persia study, you know, texts going back thousands of years. It’s also very present in community health care, which has existed in the United States and elsewhere for a long time. It’s present in art therapy and nature therapy. I think the discipline of social prescribing is about combining these ideas and practices under one roof and making it mainstream in healthcare. Most of us, when we go to the doctor, we aren’t asked about what matters to us, and we aren’t given options to be prescribed things and resources activities in our community. But increasingly that’s changing. And the origin story this started off in the UK in the 1980s actually came from a very sad fact the fact that 1 in 5 people in the UK were going to their doctor for purely social reasons. And you think about it in a place like the UK where health care is nationalized, it’s public. Everybody buys in, everybody gets out. There’s a real incentive to reduce pressure on the health care system and make sure that the people seeking social care can get it, so that those seeking clinical care don’t have to wait on a waitlist or struggle to find a hospital bed. Um, so I would say that the pressure points to actually make this mainstream are coming from both the pressures in health care, but also the fact that the medicine, that movement, nature, art, service and belonging can deliver us has effects on par with traditional forms of medication.

Jonathan Fields: [00:07:24] I want to make sure I understand this too. So you were saying 1 in 5 folks in the UK were going to their doctor’s office? I mean, through some combination of loneliness or like basically it was more about the social interaction than the sort of like the need for true clinical care.

Julia Hotz: [00:07:43] That’s right. And usually it’s a combination of things. When I say social, I mean, sure, in part it’s social interaction. You know, my book tells the story of a man who would go to the emergency room every Friday night because the thought of being alone on the weekend was just unbearable. So it’s certainly that. But it’s also social, as in social determinants, like people were going to the doctors because they needed fresh food, or they were so stressed that they couldn’t put they couldn’t make their rent. So it’s a combination of all those things. And I think when we go to the doctor, most of us are earliest healthcare experiences are we go to the doctor for something like strep throat and that’s a clear bacteria. We get prescribed an antibiotic. Boom. We’re treated, it’s done. But as we get older, our health becomes much more complicated by these social determinants, by being disconnected from these basic needs for from basic needs, but also psychological needs for joy, meaning and relationships. And so social prescribing is about addressing all of that. It’s about being able for being able to be prescribed food and an art class in the same visit.

Jonathan Fields: [00:08:58] Yeah. I mean, it’s so interesting, right? Because I think anyone who’s been around long enough knows that, you know, the booboo you had in your kid where a Band-Aid took care of it, or like the strep throat, where like you got your bill and a couple of days later, you’re good, right? You know, you get further into life. And there’s a lot that tends to to drop into our lives that we struggle with. Yeah. And so often, you know, it falls into this category of quote, nonspecific, you know, where a physician kind of or it falls under the category of a, quote, syndrome. It’s kind of like largely medical speak for we can identify your symptoms, but we’re really not entirely sure what the cause is. So it’s a syndrome because it’s a collection of symptoms, but it’s not super helpful. And oftentimes those are the things that are most prevalent in our lives. Right. But also the hardest to treat through traditional clinical means. So it’s so fascinating that you’re sort of coming back to this notion of what else might be going on here that doesn’t necessarily require a procedure or a pill or something like that. Where else have you seen this? I mean, the UK is a really interesting example, and it also strikes me that in that that example, there is a kind of a business use case for this also because if 20% of the people who are showing up for this, you’re taking up 20% of their time in a publicly medical system, that’s an issue.

Julia Hotz: [00:10:22] Yeah, that’s definitely an issue. I think you’re absolutely right. You know, one of my favorite catchphrases of social prescribing comes from this professor of health equity, Michael Marmot, who says, why treat people and send them back to the conditions that made them sick? Otherwise? You know, we’re just keeping people on this like factory, almost. If we want to treat a person, we need to treat the whole person and the environment in which they live. So you’re right, this started in the UK. It’s had the most institutional investment in the UK. But for our American listeners, you might be wondering, well, of course it works there because they have national health care or they’re a smaller country. Whatever the reason might be, believe it or not, this is also happening in the United States increasingly, and it’s happening mostly on a state-by-state level through the power of, you know, local pilots and models. But to your point about it being a business case, I think the same holds here. Sure, we might not have a national healthcare system, but there’s a deep need for more preventative healthcare in this country.

Julia Hotz: [00:11:33] And we even see that some insurance companies are starting to get on board with this. This is why, for example, some insurance companies have started to invest in gym memberships. The logic being that if a person can use their gym workout on their own, maybe that will lead them to be healthier down the line, require less medication, require less therapy, and expensive care. Increasingly, the same logic is being applied to social prescribing, believe it or not, in our former shared neighbor here, new Jersey, they’ve created a pilot in which one of the private insurers, Horizon Blue Cross Blue Shield, has partnered with the new Jersey Performing Arts Center to prescribe their members six months of art prescriptions in the community. So concerts, glass-making workshop. The idea being that maybe if we invest in these things the same way we invest in a gym membership, this will lead them to make those life-sustaining connections find sources of joy, get them out of the house, and rely less on medical care.

Jonathan Fields: [00:12:41] It just makes so much sense when you think about it and it’s so much more enjoyable. Also, it’s like bringing things back into our lives that I think so many of us have walked away as we strive for sort of like this modern conception of, quote, success, you know, it’s like it means, you know, we move further away from people, we work longer hours. We do all these things in the name of what we’re told is supposed to be success. And then we wonder why we’re not feeling the way we want to feel. And it’s kind of like a return to, as you’re describing. It’s like, oh, so basically you’re saying being a kid again.

Julia Hotz: [00:13:14] Yes, yes.

Jonathan Fields: [00:13:15] Because it’s a lot of what it is. It’s like, all right. So everything we knew when we were six pretty much is the right way then, which is kind of fascinating.

Julia Hotz: [00:13:22] Gosh, you totally get it. That was I did a reading last night and that was exactly the reaction of everyone. I had people write down what they might like to prescribe themselves, asking variation of these social prescribing question, which is what matters to you. So I asked them questions like when was the last time you experienced? Or the feeling of, you know, just being totally transcended by an experience? Or what was the last time you experienced a glimmer, something that sparked your joy and your calm. And so I had them write this down on like a little prescription pad. And people said things like playing Frisbee in the park, learning a really hard board game, going to a concert and dancing with the crowd. Things that are just so intuitive for kids to do, right? We think about these things movement, nature, art, service, belonging. That’s pretty much a kid’s life. It’s pretty amazing that through social prescribing, we rediscover that in adulthood. That’s the common refrain I’ve heard from people I’ve interviewed in Japan to Portugal, to Canada, all the 30 countries where this is happening. It’s about returning to our childlike state of wonder and joy and search for meaning and relationships.

Jonathan Fields: [00:14:42] Yeah, it’s so fascinating. It’s like we we leave it behind at a certain point, once we buy into the sort of social expectation of what it means to be, you know, be a responsible grown-up, and then we spend the rest of our lives trying to effectively buy our way back to that state that we left behind. And we work harder and harder and harder, often in the name of, so we can get back there faster, not realizing that we’re also deepening into the damage.

Julia Hotz: [00:15:08] So true.

Jonathan Fields: [00:15:09] Yeah, it’s yeah, we’re weird. Just if there’s one thing I’ve learned, like in a lot of it, Good Life Project. is a dozen years old now. It’s like universally we are strange. Um, but, um, I think we’re all just trying to make sense. You know, I want to deepen into some of the different areas with you, you know, because you brought up these these different areas. Movement, nature, art, and a couple of others will drop into. And I also want to tease out a distinction here, which is the distinction of saying yes to certain types of activities and doing them in solitude versus doing them in community. So I want to deepen into what you actually mean with the word social here, because I think and this was what I said when we started our conversation, I was like, oh, so it means like socialization. That’s not really what you’re talking about. If I’m understanding properly.

Julia Hotz: [00:16:00] It’s a good question because it’s a little bit confusing. Socialization is a social determinant of health, but not all social prescriptions have to involve these sort of group experiences. Many of them do. But for people who are introverts, for example, for people who might really thrive off of one close connection in a very controlled environment, we don’t want to discount them either. I think introverts will especially find a home in arts prescribing, you know, creating and consuming art. It’s an intensely individual experience versus the movement prescriptions for things like cycling groups and sea swimming classes or community potluck dinners. So it’s a range. And like we’ve said, you’ve had Doctor Robert Waldinger on here, tremendous researcher who’s demonstrated that your relationships are one of the most powerful predictors of your health and happiness in the long term. That is one pillar of these social determinants in our environment, but it’s also sources of joy and sources of meaning. I think when we have social prescribing and there are other people present, or even that it’s not even so much about other people, but that it’s at a time, a place. There’s an expectation that you’ll show up that sort of holds us accountable more than, say, a doctor saying you should try to get 75 minutes of exercise a week, or you should really go try to make some friends. Like this is giving people a vehicle to do that, but on the terms that make the most sense to them.

Julia Hotz: [00:17:43] So just as one example, one of the case studies in my book is this man named Jonas. Jonas grew up back to that child-like wonder as this amazing explorer of other worlds. He loved fantasy novels, he loved computer games. And as he got older, he had some experiences in the real world. He was bullied a lot, where he withdrew from his environment and developed severe anxiety disorder, generalized anxiety disorder, agoraphobia. He would get panic attacks when he would think about socializing. So you could imagine how for Jonas, a doctor saying, hey Jonas, you need to go and meet friends. Maybe that’ll help with your, uh, your social anxiety. That wasn’t going to be the way in for him. Instead, his health worker really got to know what he liked as a kid and prescribes him what are called culture vitamins. And these are group activities, but they’re pretty individual experiences. They’re structured so a culture vitamin included a shared reading session at the library where people could just come and listen. They didn’t necessarily have to participate, or joining a concert or going to a film night or going to a museum, right. I think that the range of socialization really depends, but I think what’s powerful about social prescribing is that it is an official thing in the community, as opposed to just a recommendation that kicks the, you know, burden of figuring out where and how to do that. Back to the patient.

Jonathan Fields: [00:19:22] Yeah. Thanks for teasing that out. It’s helpful for me because my default was to just keep going back to like, oh, this is a thing that happens or you do with other people, but, you know, it’s more broad, it’s more this is a thing that we engage in that is sort of like nontraditional medical prescription that brings us closer to joy, to meaning to all these these child like experiences to wonder, to awe, and probably the level of actual social interaction that that you’re bringing to it. It’s going to depend on your social orientation. What feels nourishing to you? For some people, it may be a giant crowd in a club. You know, for other people it may be, you know, being in an art class where you actually never talk to another person, but you’re all kind of in there. You feel they’re beings, but you’re each doing your same thing, which again brings it back to kids like toddlers go through this phase. Any parent knows that it’s called parallel play, where you’ve got like, you know, two itty bitty kids sitting next to each other playing, but they’re not actually playing with each other, but they’re enjoying the presence of each other like they feel it, they sense it, and there’s a certain joy that comes from that. Did I get that right?

Julia Hotz: [00:20:27] Oh, I love that. I’m gonna have to look into that. Yes, absolutely. For someone who is not seeking social connection necessarily, that’s a beautiful way to put it, because it’s still connecting them to the play element of it. It’s about changing their environment so that they can change their perspective, which can then translate to some real changes in symptoms as well. So that’s exactly it.

Jonathan Fields: [00:20:52] Yeah, I love that. It’s funny as you’re describing that also. So I’m a writer and I have learned that over the years. I actually like to write in public spaces. I like to write in cafes, but I don’t want to talk to people. So I’ll be. And this, you know, when I was in New York City, too, you know, like I’m in a cafe and everyone’s elbow to elbow in there, I’ve got a tiny little piece of a table in a corner, and I would have noise canceling headphones on listening to something, so. But I wanted to hear enough of the noise around me, and I wanted to be around people. Yeah, um, but I didn’t necessarily want to be. There was something about just the energy of being around them that allowed me to drop into a really generative, creative space much more quickly and deeply than if I’m sitting at home in my own completely controlled environment. And and I’m an introvert also, you know, so it’s interesting the way you’re sort of like teeing this up and the way that we can step into social context without actually being social. And that’s still being something that we yearn for. Definitely.

Julia Hotz: [00:21:55] Wow. You’ve just between that and the parallel play, I think that’s a beautiful example and and illustration of it, you’re totally right. And I think a lot of that has to do with the way we evolved. You know, we evolved to live in groups. And that doesn’t necessarily mean we’re always chatting with the group about the weather and how their day was, but we just evolved to exist in community. And I think you’re tapping into something very primal and real there, that we are the most human when we exist alongside other people doing their own human thing.

Jonathan Fields: [00:22:31] And we’ll be right back after a word from our sponsors. Let’s drop into some of the specific prescriptions. You’ve referenced a couple, but one of them that you have early on is, is movement. And we’ve all heard, you know, like quote, you know, exercise is good for you. It’s important. We’ve all seen the data, all the signs, signs, signs, signs, signs. You take a more interesting kind of holistic approach to this, for sure.

Julia Hotz: [00:22:55] I mean, as I’m going through all the studies suggesting that movement is one of the best preventative health things you can do. We should get 150 minutes of activity a week. I’m imagining the reader saying, yeah, yeah, yeah, yeah, I know this, I know this. We’ve been told this from when we were kids, right? It’s why we took those like gym tests in school. But my book also talks about how the joy has kind of been sucked out of movements. Like if we think even back to those gym class tests at my school, we had to do push-ups and sprints and run back and forth to this beeper that is coming from a strong sort of capitalistic push to move in order to be fit for the military. We’ve also seen how movement has become very commoditized, like, you know, gym memberships cost money. Joining a sports team often costs money. And there’s some real data showing that there is a huge access gap between people who can have free spaces to move. It’s very much determined by what you can afford. So what I love about social prescribing to movement is, number one, those logistics are covered. Like I talk about a cycling group prescription where everybody who’s prescribed this gets a free bike coach. And two, you’re coming back to the joy of it. So the man Frank, who’s prescribed this cycling group, his doctor literally asks him, what’s something that you loved to do when you were a kid but haven’t had a chance to do since? And he says, ah, I loved riding a bike, but I haven’t done that in 50 years.

Julia Hotz: [00:24:30] So his doctor Ollie says, I’ve got just the group for you. They teach a cycling confidence course. It’s for people like you who are over 50 and are maybe a little scared to ride a bike. So what social prescriptions for movement do is anticipate those barriers also of maybe being insecure about your body or your ability level. And it’s been found that, of course, movement is great for our physical health, our cardiovascular health. All that’s true. But what I loved and was surprised to learn is also incredibly effective for our mental health. Some studies suggest that running movement something that gets your heart rate up, any kind of activity like that, releases serotonin in the same way that SSRIs or antidepressants do. It’s why movement is increasingly being prescribed as an additional therapy to an antidepressant because of these very real effects. So that that one came through a sea swimming prescription. Again, 50-year-old woman hasn’t been swimming since she was a kid and let alone in the cold, open sea in the winter time. But this group actually trains people. Some basics of sea safety meets early morning and gets them moving their bodies together. So those are just two. But I’m sure your listeners could think of lots of other movement prescriptions as well.

Jonathan Fields: [00:25:57] Yeah. What I love that you brought up also. And again, I think this is part of where we move beyond just saying go exercise. To say like, no, this is a social prescription for movement is you’re anticipating the potential barriers to doing this thing and saying, okay, so how can I think about what are the most common barriers? And then how can we actually set somebody up for success along the way? And that’s unique in this in this scenario?

Julia Hotz: [00:26:25] Yeah, absolutely. Because I think it harkens us back to the whole purpose of social prescribing. It’s about really understanding someone’s environment, shifting from what’s the matter with them to what matters to them, and within the elements of what matters. That also includes a person’s introversion, extroversion, what they can afford, what they have access to, what insecurities they have. Social prescribing is really a vehicle for that more holistic form of care that sees us as people with flaws and fears and limitations, but also build their strengths and assets and interests?

Jonathan Fields: [00:27:05] Yeah, that makes so much sense to me. I have a background in the fitness industry and then the yoga world, and I remember always going deep into the data because I wanted to understand one of the consistent data points was always something like 85% of adults in the US at least know that they should be exercising. They want to be exercising, but they will never join or stay a member of a sort of traditional commercial health club. And it was always like, what’s going on there? And then you start getting deeper into the research and you realize people are terrified by so much of the environment. I’ve had a number of conversations you probably have. Also, I’m curious whether this came up at all in some of the research you were doing where people would say some version of the phrase, I want to go to the gym, but first I need to get a little bit fitter. I need to lose a little bit more weight. I need to like, check this box so that when I first show up in this place where I’m supposed to actually like, feel better and get healthier, I need to be able to show up in a certain way because I’m terrified I’ll be judged if I don’t. And there are so many barriers rather than just facilities. And I think there’s like a newer wave of solutions in the industry that are anticipating that. I think doing a better job of inviting people in and saying, it doesn’t matter where you are, like, we will take you as you are, like, show up, we’ve got you. We’ll take you by the hand, we’ll introduce you around. This is for you. But I think that’s still the outlier in this space.

Julia Hotz: [00:28:26] Absolutely. I’m so glad you said that. The book talks a lot about this phenomenon of gym intimidation. It’s this catch-22 where working out would make people healthier, but because they’re already so ashamed of their body image, they won’t go and work out. So I love it because social prescribing is about addressing that. The cycling group I mentioned has a firm rule nobody’s allowed to wear Lycra, you know, like and that’s just a silly thing, expressing their very real commitment to all sizes, all abilities. It’s not about going fast, it’s about cycling together. And the second thing where I think this distinguishes social prescribing a little bit from, for example, recommending somebody go to a gym, even if it is an inclusive gym, which is great. But is this bit of accountability for Frank, who took this cycling course? They had a meeting time every Tuesday, 10 a.m. if it’s 1005, Frank’s getting a text. Where are you, Frank? So some people in the group said to me, I showed up, they compared it to getting a dog. They’re like, just as you know, you can’t let the dog down. You can’t let your fellow cyclists down. They’re counting on you to be there. And that’s where the socialization bit comes into it. Turns out this cycling group realized they actually had a lot in common. They’d meet up at the weekends for tea and holiday parties, and that also made it more fun and inviting. More exciting to be moving your body. Not just this thing that you know, we’re told we should do. Or once I had a bad experience with in the eighth grade gym class.

Jonathan Fields: [00:30:04] Yeah, I love that. I think cycling is such an interesting example too, because there are built-in windows for not being social within the actual activity. So like no matter who how social you are, how, you know, introverted, extrovert, ambivert you feel you have like the activity itself built into it is the opportunity to kind of like choose the social context you want. And when you’re on the road, when you’re cycling with people, sometimes you’re in a group, sometimes you’re one in front of the other, and there are windows where built into the activity. There’s quiet, you know, there’s a certain amount of solitude even though you’re surrounded by people. So it’s a it’s such an interesting example. And the notion of accountability, I think is really fascinating too, but not accountability. Like somebody who’s like going to shame you or be like, you committed to this or you paid money for this. It’s like there are people who are counting on you, right? You know, like you need them and they need you, and you kind of want to honor that commitment because these are people that, you know, you feel like you want to be good in their eyes, and you want them to be good in your eyes.

Julia Hotz: [00:31:01] Absolutely. That’s exactly it. You know, it’s harkening us back to the things we need to be healthy. We need to count on other people. We need to have people we can call at 3 a.m. in a crisis, and we like to do that in return for others. And so these social prescriptions that enable us to hold other people accountable and be held accountable are, I think, just some of the most beautiful expressions of humanity. This is what we do. We try to make it through together. We count on each other. We notice when we’re not there and we celebrate when we are.

Jonathan Fields: [00:31:39] Mmm. I love that you also talk about the social prescription for nature, which to me is fascinating. You know, I spent 30 years of my life in New York City three and a half years ago, moved out to Boulder, Colorado, where now I walk out my front door and I’m surrounded by the most breathtaking nature. And I’m in nature all day, every day. And I’ve always said my entire life, like, this is in me. This is this has to be a part of my life. Yet for the 30 years or so I was in New York City, I was kind of like, I’ll get to it. You know, I’d sneak into Central Park or I’d go for a walk along the Hudson. And then that helped. But it’s different. So take me a little bit into the notion of nature as a social prescription. Totally.

Julia Hotz: [00:32:18] Well, as a fellow New Yorker, I can relate. I’m a little jealous. Um, so nature is kind of like movement, a pretty intuitive one. Like, we know that we should move our bodies, and we know that we evolve to be in nature. We evolve to specifically pay attention to nature. If we knew, you know, which fish were in the river or which bird were in the trees, that was very advantageous for our survival. So there’s a deep, primal part of us that has evolved to be in nature. And these amazing researchers in the 1980s came up with a theory to encompass this. They called it the attention restoration theory. And this is the 1980s. So they were working from a context of, you know, constant distraction video games, movies, neon signs. You know, all these things were capturing our attention and leading to something they called directed attention, fatigue being so overstimulated by our environment that we can’t pay attention to anything. But then building on the work of E.O. Wilson and others who’ve long talked about indigenous traditions as well, long talked about the incredibly healing power of nature. They hypothesized that there’s something about nature that enables us to pay attention to it, and it doesn’t give us that directed attention fatigue. It actually restores our attention the same way that a good night of sleep restores our energy.

Julia Hotz: [00:33:48] And they said this is because we evolved to pay attention to nature, and it invites something called soft fascination, where intrigued by it. And when we come away from it, not only do we feel less stressed. You know, I know you’ve had Robert Sapolsky on here, less stressed, more calm, but you also feel better at judging the stressors that you came in with. And this has been shown that doses of nature are incredibly effective for kids struggling with ADHD. Some studies have found that walking in nature versus a walk in a busy cityscape, there’s less activity. There’s less neural activity after the walk in nature, in the part of our brain, the subgenual prefrontal cortex, that’s associated with rumination. In other words, I’m picturing you out in your beautiful mountain scape and you’re experiencing or the opposite state of rumination that’s very real, down to the neurochemical level. So that’s a bit about nature in my book talks about people who are prescribed nature for stress and the symptoms of stress, chest pains, insomnia, and a man who’s prescribed a fishing group for his ADHD. And I don’t want to spoil it, but based on, you know what I’ve just told you about the science, I’ll tell you that this was incredibly effective for both of them.

Jonathan Fields: [00:35:15] Yeah, I can imagine. It’s just a transformative experience for me. I hike 3 or 4 days a week now, which is just a stunning blessing. And it’s funny because and it’s built into my calendar, you know, my team looks at my schedule, they’ll say like, hike 90 minutes. And I love that. That’s generally in the middle of the day. Um, and for a while I was framing that as, you know, oh, I’m like, I’m not working. What I realized was that this 90 minutes was so essential to yes, to my wellbeing, to my physical and emotional wellbeing. It got me moving, got me exercising, I didn’t care, I didn’t know I was like working really hard, but and it really helped reset my mental health. You know, if I was spinning, if I was stressed out, I would go on the trail somehow. Everything was so much better when I got back. But I also realised that I would come back and I would sit down and whatever problem I had been focusing on, whatever creative task or thing that I was working on, or maybe I was stuck. I would come back with new ideas and feeling less stuck. So there was a business use case for this saying like, this actually should be in my calendar on a regular basis. I’m not slacking off. I’m not stepping away. It’s not just about honoring my commitment to mental and physical health. It is, but it actually really let me show up differently in a contribution context as well.

Julia Hotz: [00:36:38] You are so spot on with that. I’m so glad you said that, because people hear about nature prescribing for stress and they think, what? I don’t have time for that. This is why I’m stressed. I don’t have time for nature. But you’re exactly right that investing in that attention through nature is actually a really wise investment. Because you will come back better focused, better at concentrating calmer, right? A lot of studies show that, you know, we reduce our cortisol production. And just a really quick anecdote about one of the first places to really systemically embrace nature prescribing this was in Japan in the 1970s. You know, their economy post World War Two grew so quickly. People were so productive. People were pouring into cities. And yet you ask a doctor who was alive at that time and you saw increasing rates of heart disease, increasing rates of mental illness, increasing reports of stress, so much so that there was a new term coined around this time karoshi, meaning death by overwork or even more tragic, kajitsu, which is suicide by overwork. So the government realized we have a real crisis on our hand. Yes, people are working harder, smarter, faster, or they’re working harder and faster, but they’re not working smarter.

Julia Hotz: [00:38:03] And our nation’s health is is really faltering because of it. So what did they do? They invested in this government campaign for forest bathing forests have been something revered in Japan’s ancient Shinto and Buddhist traditions. But because people were leaving the cities or leaving the country to pour into the city, a lot of them abandoned that essential part of their culture. And so this was a big campaign. It was called shinrin yoku forest bathing to actually send people back out into the forest, immerse with their full five senses into it, and then see, does this actually have a medicinal effect on stress? And sure enough, I interviewed Doctor Ching Li. He’s one of the leading forest bathing researchers in the world. This helps with so many things. It increases our NK cell natural killer cell activity, which helps boost our immune system. It lowers our cortisol and adrenaline production. It lowers our heart rate, it lowers our blood pressure. And it just goes to show that to exactly your point. You know, how could it be that these totally busy Japanese businessmen would get on board with something like forest bathing? Well, because it was an investment in their health and attention in the long term.

Jonathan Fields: [00:39:24] Yeah. It just makes so much sense to me. I read a lot of that research. Also, I’m sure you’re more up-to-date on it than I am, but when I was reading it and this was many years ago now, I was working on a book actually, and at that point the research was showing, yes, we can identify all these benefits, but they were struggling to identify the mechanism. Like, we can’t tell you exactly why this happens, but we know when people go into the woods, it happens. Have you seen more updated research that that in some way can identify the actual mechanisms at all, or is that still a bit of a mystery?

Julia Hotz: [00:39:53] Yeah, I mean, I think all of this stuff is like all of our mental health is a little bit of a mystery. I think. On the other hand, a lot of it is very primal. We evolve to be in nature, but I think a lot of it comes back to that attention restoration theory, the research in the 80s. It’s really interesting that all forest bathing, attention, restoration theory, biophilia from E.O. Wilson, all of this came out around the same time. And I think the mechanism is this idea of soft fascination, restoring our attention without taxing it. And certainly in the 40 years since then, there have been many, many, many, many empirical studies showing that time in nature is so good for the traditional biomarkers of stress, but also of attention. Like another one of my favorite studies, a little bit after the 80s came out where they compared patients gallbladder surgery, recovery patients who hospital rooms were overlooking a brick wall versus those who were overlooking a naturescape. And sure enough, they found that the patients who were overlooking the nature scape recovered faster, had a better mood. The health care staff reported that they were, you know, easier to work with, less cranky. So I think to your question, it’s a little bit of a mystery. It’s a little bit intuitive, and it’s a little bit down to this science of nature being incredibly powerful for restoring our attention.

Jonathan Fields: [00:41:29] Yeah, I totally agree. And we’ll be right back after a word from our sponsors. One of my fascinations around this also, I’m so curious what your take is on this is there will be times in people’s lives where they literally cannot get into nature. Maybe they can bring a little bit of nature in, they can put plants in, and there’s some interesting research around that. But there’ll be times where there will be just folks who really you can’t get there. Or maybe you’re struggling with your ill, your injured, your bedbound, or your room bound. Right? I’m so curious now with the advent of not just I, but are. Can we actually have somebody put on a pair of goggles that will allow them in a small fixed space to have the tactile and the visual experience of navigating nature. And would that have the same effect on them, or do you actually really have to be there, you know? I haven’t seen anybody exploring that yet, but I think it’s a fascinating question in my mind.

Julia Hotz: [00:42:28] That is such a fascinating question. I would love to see that research. Two things I can say is that let’s go back to forest bathing, for example. This is about engaging all five senses in the forest. Doctor Ching Li, before I left Japan, he gave me this, like, block of wood. I still have it. It’s in my kitchen and it releases the scent of the hinoki trees on which, you know, it really common in Japan because it’s been found that this scent alone triggers in our mind. Oh, okay. We’re in a forest. Where? Around nature. That’s good. We can calm down. Um, that’s very true and real. I don’t think it’s as rigorous. I don’t think it’s been as rigorously studied as actually being in nature. But that’s one point. But another. I think you make a really important point about those of us who might not have such easy access to nature, and that’s very real. And that is why doctors, I’ll shout out one Nooshin Razani in San Francisco again, anticipating all the barriers that could come up about why wouldn’t kids and adults be able to access nature. She’s organized programs that actually bus kids out to a nature experience from the inner city for the weekends, because I think a true social prescription, you know, takes into account all of a patient’s social determinants and that access barrier, even if you have a car, if you live nearby, is very real.

Jonathan Fields: [00:43:54] It’s so fun learning about all these different things where people are like, how can we solve not just for part of the problem, but for like a much fuller part of the experience? You talk about art also as an interesting social prescription, which I’m like always fascinates me as somebody who’s both, you know, at various points in my life, has been an artist and with different media and different domains, but also who has found myself in tears standing in front of a painting at the Guggenheim. So it feels like this is this is one of those prescriptions also where somebody may immediately like the hair on the back of their neck say, I’m not an artist. Like, this isn’t going to work for me. But it’s bigger than that. It’s more about the it sounds like the way you’re teeing it up, it’s more about just the experience of what art can do around and with us.

Julia Hotz: [00:44:38] Absolutely. You’re not alone. I’m definitely with you. I almost teared when I heard your voice today because you’re. Your podcasts have moved me so much, and there’s something very real about that. But yeah, I think a person is absolutely right to have a little bit of hesitation saying, I don’t want an art prescription. I’m not an artist. I think there’s two kinds of art prescriptions. One of them is about creating art. My book focuses on the story of a woman named Kuhn who had always loved art. She’s an aspiring novelist but grew up in a really harsh environment, developed PTSD, developed anxiety, developed depression, and had always had this voice in her head that she wasn’t good enough. You know, she hears her mother’s voice telling her all the time, you’re not good enough. You’re not good enough. So she was really scared to try this art prescription that she was given. And the facilitators of this, Caitlin Marshall and Lizzy Rose, they run a great program called Creative First Aid in Australia. We’re very intentional about making sure that nobody was forced to do the art here. Again, you’re anticipating all the barriers, all the reasons why a person might not want to participate. But just like exposure therapy does in clinical settings, right? Exposure therapy, this idea that exposing us a little bit to the thing we’re afraid of, to the thing that’s giving us anxiety, is actually really medicinal for treating that anxiety. I think art prescribing gets into that. Kuhn’s story is one of you know, she again, didn’t want to really go to this. Told herself she wasn’t good enough, ends up becoming this extraordinarily prolific artist, and ends up filling her home with plants, which she considers a form of art, even though she grew up having a really negative association with plants, her mother always criticizing her for when they weren’t doing well.

Julia Hotz: [00:46:35] So that’s one form, is when we create the art and that’s we know for any art therapists listening, incredibly effective for our trauma, because it invites us to create sort of a new story about our trauma and access it without verbally accessing it. Another one has to do with consuming art, and maybe this will resonate with you. You know, when you’re listening to that song that brings you to tears. Art, just like movement in nature, is something that we evolved to do. We evolved to share stories with one another because this is a way we cope with all the emotions that come with being human. And for some methods of consuming art, one way is bibliotherapy being read a story in which the character maybe reminds us of our own struggles. That’s incredibly effective for treating anxiety, because it allows us, again, to just sort of softly identify with the story without having to fully expose ourselves to that story. In other words, it’s a way for us to explore our emotions without having to fully reveal them to a therapist, for example. And so for someone like Jonas, who was prescribed culture vitamins, literally, that’s what it’s called for his severe anxiety. You know, those shared reading sessions where he could read about other people who dealt with anxiety was incredibly powerful for him. And yeah, I think that art just gets into art, by the way, comes from the etymology of the imitation of nature. So I think when we create and consume art, we are on some level being the most human we can be.

Jonathan Fields: [00:48:24] Yeah. Also, just to tease it out a little bit more, when when you talk about art, I think a lot of people immediately like, oh, they’re like, they think visual art, right? You’re talking more expansively writing music, like all these different aesthetic experiences that in some way evoke something in you. Right?

Julia Hotz: [00:48:40] Absolutely. I’m talking about anything that could be a method of telling a story, whether we are the creators of that story through words or paint brushes or cartoons, whatever it might be. These are just some of the social art prescriptions that I investigated, or we are the consumers of that story. We’re going to a concert. We’re going to the library to be read to. We’re going to a museum to learn sort of the art of the civilizations that have come before us. All of this, anything that immerses us in a story is what I would consider art, but that could be a whole book. I mean, what is art? Right?

Jonathan Fields: [00:49:22] Exactly the other thing that occurs to me about art is that I’ve been thinking about this recently and curious what your take is, is it’s one of the experiences that allows me to time travel. You know, if I hear Pink Floyd’s Dark Side of the moon, I can tell you exactly where I was when I was a kid lying on the floor of my basement with headphones on, listening to that just completely gone, transported somewhere else. And when I hear that song now, I’m back there again. And I would imagine if you were measuring all of these physiological indicators in my body, that you would see a really meaningful shift in them. And for me, music tends to be the thing that really allows me to time travel, but also visual art as well. I wonder if that’s something you’ve thought about or explored at all.

Julia Hotz: [00:50:07] Definitely can definitely relate both to the to the artist and the experience. I think a couple of things are happening there. Number one, in your story, you know, you are being transported to a time in your life that you associated with a lot of joy and meaning. And not only does that, like kind of just feel good physiologically, but I think subliminally it’s also a reminder that of how good things can be. You know, if we turn to art when we’re feeling really low, especially I think Susan Cain talks a lot about this when we’re listening to sad music, we are just reminded of the depths of being human. And if we’re feeling some of that sadness or anger, we find comfort in the fact that, wow, this artist is expressing that. I can feel that. I think that’s exactly it. You know, it is connecting us to our most deeply human states. And here’s the spoiler alert with social prescribing, whether it’s movement, nature, art, these are just gateway drugs for us to shift our perspective on things, whether that’s telling ourselves that it’s going to be okay, this thing you’re feeling right now, it’s going to be okay, this stress that you’re experiencing, we’re going to make it through this exhaustion and lethargy and sadness that feels so unbearable. We’re going to get to the other side of that. And social prescriptions, I think, can help us get there faster, especially art. I have a soft spot for art.

Jonathan Fields: [00:51:41] Yeah, you and me both. Um, and there’s something about it. You know, you also write about service and you write about belonging as one thing. Um, but if you zoom the lens out, you know, in all five of these different categories, you know, like service, belonging, art, nature and movement, there is this opportunity to step into all of them in a way that makes you feel less alone. I think, like you were just describing, even if you’re not in the presence of other people. Like you can listen to a song or see a work of art, or read a paragraph in a book that was written by somebody else. And you’re you are alone in your room consuming it. But there’s something about the act that makes you feel less alone, which is amazing.

Julia Hotz: [00:52:23] Isn’t it amazing to think that these five ingredients that have sustained our civilizations for thousands of years are the same ingredients we can turn to today and feel a sense of connection to these people and to one another. I don’t know if you had this experience with with the Good Life project or the writing you’ve done, but sometimes you discover your reason for writing it or doing it while you’re doing it. And that was true for me. I didn’t realize how lonely I was and how frustrated I was, and unwell I was, until I realized that it’s true that I might not be able to relate to the depths of depression and anxiety and chronic pain that other people I talk about have experienced. But all of us, by virtue of being human, can relate to the experience of being a little bit unwell. And I think that is extremely connective. I think that is extremely hopeful that all of us can find some amount of healing in some combination of these ingredients because they remind us, especially now in our times of intense division, that we are all going through these ups and downs together. And I really needed to hear that. But, you know, I needed to write a book to, to prove it, that.

Jonathan Fields: [00:53:48] That has been like every book that I’ve written. It’s always been scratching my own heads. It’s like, and I don’t really know what the itch. I think I know what it is going into it. And then halfway through you’re like, oh, right, this is about something entirely different. And it’s about me, right? And hopefully this will be interesting and valuable to other people too. But you also bring up a really interesting point. This is this is something that I’ve noticed, which is that nobody talks about this. I’m really curious about it. Um, I have found that one of the most powerful connecting energies is commiseration, and we don’t like to think about this because we don’t all want to, like, have some sort of shared suffering or angst, you know, so we don’t talk about that in general. And yet, if we go back to art, as an interesting example, you can have two people standing in front of a work on a wall, you know, and maybe their work represents something where it’s keying them both into a similar loss that they’ve experienced to profoundly different people who have different beliefs, different faiths, different upbringings, different histories, different politics. But in that moment, they’re having this shared experience and that whatever that loss is, that is being a vote is triggering all the emotions that goes around it and simply seeing them like next to each other, knowing that they’re experiencing that same thing is which is a form of commiseration. It’s to me, this it’s such a powerful source of connection that we rarely ever acknowledge, I think, because it’s just an uncomfortable thing to acknowledge.

Julia Hotz: [00:55:16] Absolutely. That’s so beautifully said. And I’m sure we can all relate to when we are commiserating. Whether the source of that is, you know, the loss of a loved one or a breakup or something really frustrating happening at work. Whatever it is, we feel our environments make us feel like we are the only one that is going through this. We are so in our own heads, and that’s what rumination is, right? Where we’re dwelling on these negative thought patterns, and we’re convinced that it’s not going to get better because, again, our environments are encouraging this. But what I think is so powerful about social prescribing is that it reconnects us to some other thing that takes us out of our head, brings us to other people, like we said, with parallel play, sometimes more passively, sometimes more actively, but other people that can relate to those ups and downs, that is the only thing that will get us through them. And you know, I want to be careful because I think there’s definitely a place for medication. I think there’s definitely a place for therapy. This is not about replacing those forms of medicine, but I do think that sometimes those medicines are designed to just treat the symptom and make it go away, when actually that symptom is telling us something about our environment. It’s telling us that this pain that you’re feeling right now is real, and you are going to be okay. You are resilient. You have evolved to get through this and to help you get to that understanding faster. A social prescription can help you feel like you are not alone in your commiseration.

Jonathan Fields: [00:57:01] If somebody’s listening to this conversation right now and they’re kind of nodding along and they’re like, yeah, this makes total sense to me, where do I even begin? Obviously, reading your book is a great place to begin, but if somebody’s sort of thinking about the first step in, what might you offer them?

Julia Hotz: [00:57:16] Totally. Well, I think I know you have a big global audience. I imagine most are in the United States. So you might be frustrated that this doesn’t really exist quite yet in our healthcare system, mainstream. The good news is that this is coming. There’s a great group, Social Prescribing USA, that’s determined to make these available to every American by 2035. And if you’re a health worker listening, you know you can get involved with them. If you’re a researcher, a policy maker, it’s definitely go get involved with them. But in the meantime, for the everyday person, the other good news is that you probably live in a place where there are communities doing this work. There are communities delivering art, prescriptions, nature prescriptions, movement prescriptions, service prescriptions, belonging prescriptions. The only difference is that a doctor or a therapist might not be prescribing it to you. You have to prescribe it to yourself. Of course, I hope people read this book, but I hope that they participate in both joining some of these local community groups and contributing them themselves. You know, you might have a listener who leads their own Saturday nature walks or cycling groups or art classes, and we’ve created a website, Socialprescribing.co, that organizes these kinds of social prescriptions by ingredients free or donation-based. Because again, this is all about not creating barriers to, you know, things that should be free, where people can go and prescribe themselves these things in the meantime. And, you know, in the back of the book, there is something we call the crowdsourced DSM, which will help you direct yourself to what kind of social prescription might be especially valuable based on what you’re feeling. So if you’re feeling stuck and sad, movement is a great antidote to that. If you’re feeling burnt out, stressed, can’t focus nature. Great antidote to that. If you’re feeling worried and anxious. Great antidote if you’re feeling really frustrated, angry, self-pitying right now. Service to your community. Volunteering. Great antidote if you, like many of us are feeling lonely, are feeling alone in that commiseration. Belonging groups with an intentional purpose of creating a sense of belonging can be really medicinal.

Jonathan Fields: [00:59:43] Love that I love. All the resources that you sort of put together as well. It feels like a good place for us to come full circle. So in this container of Good Life Project., if I offer up the phrase to live a good life, what comes up?

Julia Hotz: [00:59:55] To live a good life, I think, is to be extremely present in your life, to reconnect with the sources of joy, meaning and relationships that have been sustaining us for thousands of years. That’s a good life to me.

Jonathan Fields: [01:00:09] Mm. Thank you.

Julia Hotz: [01:00:11] Thank you so much, Jonathan. Such an honor.

Jonathan Fields: [01:00:14] Hey, before you leave, if you’d love this episode, safe bet you’ll also love the conversation we had with Robert Waldinger about the role of relationships in our ability to live good lives. You’ll find a link to his episode in the show notes. This episode of Good Life Project was produced by executive producers Lindsey Fox and me, Jonathan Fields. Editing help by Alejandro Ramirez. Kristoffer Carter crafted our theme music and special thanks to Shelley Adelle for her research on this episode. And of course, if you haven’t already done so, please go ahead and follow Good Life Project. in your favorite listening app. And if you found this conversation interesting or inspiring or valuable, and chances are you did. Since you’re still listening here, would you do me a personal favor? A seven-second favor and share it? Maybe on social or by text or by email? Even just with one person? Just copy the link from the app you’re using and tell those you know, those you love, those you want to help navigate this thing called life a little better so we can all do it better together with more ease and more joy. Tell them to listen, then even invite them to talk about what you’ve both discovered. Because when podcasts become conversations and conversations become action, that’s how we all come alive together. Until next time, I’m Jonathan Fields signing off for Good Life Project.