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You’re Not Sick. Your Environment Is.
May 31, 2024

You’re Not Sick. Your Environment Is.

Reading Time: 7 minutes

There’s a Key Flaw in How We Think About Sickness—and the Solution Is Right in Front of Us., Pill prescriptions and self-care treatments often ignore the underlying problem: Why are so many people struggling with mental health in the first place?, The Conn

Let’s imagine there are 10 people in a room and five of them are profusely, uncomfortably sweating. If your goal were to help them feel better, what would you do?

If you’re a doctor with a six-month waitlist and just 15 minutes to see each sweaty patient, you might measure their sweat levels, diagnose them with an overactive gland disorder, and prescribe a pill that blocks their brain’s sweat signals.

If you’re a wellness influencer, you might create a catchy reel that both validates their suffering (‘It’s OK to sweat … I sweat, too!’) and offers self-cooling hacks and a sponsored link to buy a handheld fan.

But say you’re an alien descending to Earth for the first time, untainted by the usual rigmarole of health care and self-care. You might come to a simpler conclusion: Maybe the room is too hot. Instead of diagnosing and treating or validating and commodifying each individual’s sweat excess, you might see, first, if you can cool the room down.

Replace ‘sweating’ with ‘struggling mentally,’ and the same points hold: Recent estimates suggest 50 percent of the world’s population will develop a mental health disorder in their lifetime, with a particular increase since COVID. Because it can be difficult to get an appointment with a therapist, primary care doctors often prescribe medication, typically antidepressants, which may or may not help. And to cope with these health care shortcomings, more people are turning to influencers, who tend to promote nonpharmaceutical products and practices of their own: fidget toys, gratitude journals, ice baths, and the like.

Let me be clear: Like sweat, the symptoms of our mental health struggles are real and painful. And just as the sweat-blocking pill and the handheld fan would genuinely help someone who is sweating feel better, our typical tools—medication, therapy, and self-care products—can help relieve our mental struggles, too.

The problem is not these tools, or the people who push them; they, too, are victims of a system that leaves little choice but to focus on symptoms, and understandably just wants people to feel better in the meantime. The problem, instead, is our naïve assumption that our epidemics of depression, anxiety, ADHD, trauma, chronic pain, and addiction can be solved through individual tools alone. The problem, according to the famed British epidemiologist Michael Marmot, is the way our health systems are forced to ‘treat people and send them back to the conditions that made them sick.’

In other words, the problem is that the room is too hot. If our modern living conditions continue to disconnect us from our long-proven need for sources of joy, meaning, and relationships, then the majority of us will continue to not feel well.

Thought leaders within Indigenous, Eastern, holistic, and integrative medicine and the field of positive psychology have long preached this idea. They’ve recognized the importance of basic resources: clean air, abundant trees, nutritious food, good housing, extra cash, protection from violence and from discrimination. And they recognize the importance of psychological resources, too: Is there someone we can call at 3 a.m. in a crisis? Do we feel we have a reason to wake up in the morning? Do we have outlets to cope with the sadness, anger, and fear that comes with being human?

Large-scale epidemiological studies suggest these factors—collectively called ‘social determinants’—contribute to 80 percent of our health outcomes. Multiple reviews suggest having sources of well-being, a sense of purpose, and meaningful relationships can influence our longevity. And, in its earlier forms, our own Diagnostic and Statistical Manual of Mental Disorders acknowledged this, too, from the other end—more than depression, anxiety or attention deficit disorders, you had depressive, anxious, and hyperkinetic ‘reactions.’ Sickness was seen less as a fixed set of symptoms ruled by purely biological factors in a body, and more as a response to a stressful environment.

Today, it seems those stressors are everywhere. A whopping 90 percent of Americans believe there is a mental health crisis. More and more of us report feeling that we are stressed, lonely,  ‘languishing,’ and pessimistic about the future.

But just as some social environments can exacerbate our symptoms, others can relieve them. Maybe, if we were systemically reconnected to both our basic needs for economic security and our psychological needs for joy, meaning, and relationships, more of us might start feeling better. We could, so to speak, cool the room down.

For a long time, this felt like pie-in-the-sky, Pollyanna-ish thinking: nice in theory, but unfeasible in health care, untenable against Big Pharma and Big Tech, and unhelpful to the majorities of us who struggle in the meantime Yeah buddy, while you’re waiting on the world to change, I’ll take my Prozac and my ice bath, thanks.

And yet, perhaps because our health care system of diagnosing and treating individuals is at its breaking point, and because self-help hacks can only take us so far, there is a movement to treat social determinants with social prescriptions.

Far from the forced-friendship introvert hellscapes they sound like, social prescriptions refer to nonmedical resources—like nutritious food, job support, and housing assistance—and activities—like cycling groups, art classes, and potluck dinners. To prescribe them, instead of just asking, ‘What’s the matter with you?,’ doctors, therapists, and health workers ask, ‘What matters to you?’ Then, they prescribe a real community-based activity connected to that answer, the same way they might prescribe pills.

While investigating the spread of this practice to 30 countries (including pockets of the U.S.) for my new book, The Connection Cure, I saw firsthand how social prescriptions actually do help people feel better. I saw how doctors prescribing cash and other nonmedical resources can, according to one study in Vancouver, increase patients’ confidence in their ability to manage or prevent future health problems, which can then improve their depression symptoms, PTSD symptoms, and quality of life. I saw how doctors prescribing legal aid can help clear chronic health conditions and, according to one study in Cincinnati, reduce hospitalizations by 38 percent. It makes complete sense: When doctors treat the underlying conditions that make people sick with practical, nonmedical resources, those people get better.

These resources are an important first step, since, of course, an art class doesn’t do much for someone struggling to afford groceries and rent. But activity-based social prescriptions that reconnect people to sources of joy, meaning, and relationships can be incredibly helpful, too (and are often easier to prescribe than money).

Take Jonas, a history buff who’d been diagnosed with agoraphobia and panic disorder, and had tried all kinds of health care and self-care treatments: therapy, medication, marijuana. He says his anxiety once felt like a self-fulfilling prophecy; when someone asked him about it, his symptoms got worse. But then Jonas was prescribed ‘culture vitamins,’ a 10-week course offering local art excursions like concerts, museum visits, and shared library reading sessions. Instead of focusing on what made Jonas feel sick, the culture vitamins occupied his body and mind with activities that made him feel well. And sure enough, by the end of the course, Jonas both reduced the severity of his anxiety and started feeling healthier all around. He says he rediscovered his childhood love of reading, began to leave the house more, and found ‘relief from his feelings.’ He’d gone from feeling like his ‘days were an undifferentiated gray mass’ to feeling like he ‘became himself again.’

It was a similar story with Akeela, a loving mother and devoted health worker who struggled with debilitating back pain. All she wanted was a way to get back to work. And when painkillers didn’t help her and relegated her to even more bed rest, she began to feel worse: angry, withdrawn from loved ones, and, eventually, suicidal. She says her antidepressants and counseling didn’t help much, either, since they made her feel there was something wrong with her. But then, when Akeela met a new health worker and confessed to feeling like she ‘couldn’t do anything anymore,’ that health worker reassured her otherwise, and sensed what Akeela really needed: a job where she could feel purposeful again. Searching for a way for Akeela to exercise her caretaker skills without taxing her back, that health worker prescribed a volunteering gig at a children’s charity.

Akeela says that prescription literally saved her life; today, she works full time at that charity. And though she still struggles with occasional back pain, she says she sees her symptoms as a part of her life, not the ruler of it.

My favorite before-and-after comes from Amanda, a passionate researcher who’d been diagnosed with major depression disorder after her mom died, her husband cheated on her, she lost her job, and she moved to a new place where she didn’t know anyone. Amanda had been prescribed the highest possible dosage of antidepressants, which did help her feel better. She was also prescribed a course in sea-swimming—an activity that got her meeting new people, pushed her out of her comfort zone, and was, well, pretty fun. Today, though Amanda says she’s still on a low dose of antidepressants, she says her true medicine is her community of fellow swimmers, who she still meets up with every weekend to swim. She says it was the sea-swimming group that helped ‘stave off the deep, dark thoughts’ and ‘helped life become bright again.’

Alongside a growing body of quantitative evidence, these patient anecdotes are proving our Pollyanna wishes can come true; they show us social prescriptions can both improve our health and reduce pressure on health care. I would know; to help cope with the anxiety I experienced about writing this provocative Op-Ed, I prescribed myself a spot in a local outdoor dance meetup to get the nervous energy out of my body, and a local birdwatching club to get myself out of my own head.

But these social prescriptions are not silver bullets, either; just as pills, therapies, and self-care products can’t, alone, solve our mental health crises, art classes, volunteering gigs, and swimming courses can’t do that, either. And besides, there are probably some people who would still find themselves sweating, even if the room cools down. We need all of the tools on the menu to help all of us feel better.

And yet, as we try to imagine what ‘feeling better’ looks like for the majority of us, we might consider reframing what ‘sickness’ is in the first place. Maybe it’s not always a fixed set of symptoms that we, as individuals, must shoulder on our own, and rely on health care and self-care to fix. Maybe, instead, it’s a reaction to an environment we didn’t evolve to live in. And just like a hot room can cool down, maybe our environment can actually reconnect us to what matters.


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