based on work by Paula Diane Relf in
“Agriculture and Health Care” and on
“Green Care: A Conceptual Framework”
In Europe and much of the rest of the English-speaking world terms like Green Care, Farm Care and Farming for Health are well known and repre-sent a growing movement. That movement involves farmers and the health-care community working together to create an environment in which the care and nurturing of plants and animals is an important aspect of therapy for disadvantaged individuals. A key element of this movement is that this therapy takes place in the context of a profitable agricultural business (the farm). This transcends therapy using outdoor experiences that provide na-ture opportunities without the personal responsibility of caring for nature.
Here in the United States these terms do not have this meaning, nor is this approach to the sustainability of small family farms apparent. Although the USDA acknowledges that “a key component of the future of agriculture” is improving human health, it sees this happening through the production of food, not by providing health-care services or preventative or therapeutic outdoor agricultural opportunities. In fact, the modern medical and health-care community has, until quite recently, failed to see the negative health impact of relocating the nation’s population from rural to urban en-vironments over the last century.
Agriculture and health care
During the Middle Ages many hospitals and monasteries looking after the sick traditionally incorporated arcaded courtyards to provide outside shelter for patients and created beautiful gardens in their surroundings. The earliest recognizable ‘care programs’ that used what may be called ‘green care principles’ were at Geel in Flanders in the 13th century. Here, ‘mentally distressed pilgrims’ came to worship at the holy shrine of St Dympna and stayed in a ‘therapeutic village’ where they were sympathetically cared for by the residents. This was a rural agricultural setting, and the main work activity for everybody was to work on the land. A range of structures and procedures were in place for taking care of these individuals in the context of local families and wider village life.
With the influence of Enlightenment thinking in the 19th century, the belief grew that by improving the quality of care, patients could be cured. This approach also reflected prevalent middle class notions around work and social conformity. The idea was that to be a part of so-ciety one must have regular work habits and “fit in” as a perceived productive member of society. As a result, 19th century asylums main-tained these societal norms and incorporated them into treatment plans with the expectation that they could eventually reintegrate patients back into society.
Dr. Benjamin Rush, a professor of the Institute of Medicine and Clinical Practice at the University of Pennsylvania, was one of the early people to call attention to the benefit of labor for psychiatric patients. In his 1812 book “Medical Inquiries and Observations Upon Diseases of the Mind”, he says that “It has been remarked, that the maniacs of the male sex in all hospitals, who assist in cutting wood, making fires, and digging in a garden, and the females who are employed in washing, ironing, and scrubbing floors, often recover, while persons, whose rank exempts them from performing such services, languish away their lives within the walls of the hospital.”
Thus agriculture has, in some form, played a role in treatment, rehabilitation and/or residential care of disabled individuals over the last two centuries. During the nineteenth century most psychiatric hospitals included agricultural components. In 1817 patients at the newly-opened Friends Asylum for the Insane, in Philadelphia, worked in vegetable gardens and fruit-tree planting.
More detailed and thorough observations are to be found in the records of the old Victorian asylums, most of which had their own farms and market gardens. Farm work was considered a useful way of keeping the patients out of mischief and of providing them with an interesting pastime. It also allowed them the opportunity for a variety of different sensory experiences that were considered to be therapeutic. The following is an extract from the Report of the Commissioners of the Scotch Board of Lunacy:
“It is impossible to dismiss the subject of asylum farms without some reference to the way in which they contribute to the mental health of the inmates by affording subjects of interest to many of them. Even among patients drawn from urban dis-tricts, there are few to whom the operations of rural life present no features of interest; while to those drawn from rural districts, the horses, the oxen, the sheep, and the crops are unfailing sources of attraction.”
Originally the farm was not intended as a treatment mechanism, however, but rather as a way for those individuals who could not pay to be at the facility to earn their room and board. The Pontiac State Hospital in Michigan, for instance, made extensive use of farming and dairy projects on 300 acres. Production was the chief goal, however, and any therapy involved was a fortunate by-product. Thoughtful observation of individuals required to work led to an ultimate recognition that having responsibilities actually expedited rehabilitation and return to the community.
By mid-century progressive ideas on the care of psychiatric patients were more easily accepted. In 1854 the superintendent of the Pennsylvania Hospital for the Insane, and founder of the American Psychiatric Association, Dr. Thomas Kirkbride encouraged the insane to work in the gardens or shops to aid them in recovery. As the nineteenth century proceeded, institutionalization became more common for individuals with behavior problems and the farm was seen as an integral part of the facility.
When the London Asylum for the Insane opened in 1870, its first superintendents were great supporters of this practice for improving the well-being of patients. They believed patients could be cured by participating in forms of treatment that emulated societal norms; the three main components being labor, amusement, and proper diet. Thus a farm and work on it were significant parts of the institution and its program of therapy.
The establishment of farms as a functioning location for therapeutic and rehabilitative efforts in the U. S. has a long history. The Berkshire Farm Center and Services for Youth, which serves families with troubled children on 580 acres in Caanan, NY, is one of the earliest such farm-based programs still in existence. Started in 1886, it was based on the philosophy that contact with nature, a stable, loving environment, and emphasis on a strong work ethic could help start ‘wayward’ boys on the road to better lives.
A broad understanding of the specific personal benefits to be gained from working with plants was evident in writings during this period. Such activity was seen not only to help mental patients, but also the urban poor and retarded individuals. In Darkness and Daylight or Lights and Shadows of New York Life, published in 1895, missionary and philanthropist Helen Campbell, author and journalist Col. Thomas W. Knox, and chief of the New York City police and detectives Thomas Byrnes, describe the impact of flowers on the poor, the infirm and prisoners: “Prisoners in the jail, men and women alike, stretch their hands through the bars for them, and there is one woman whose life, to the deep amazement of everybody concerned, has altered utterly under their influence.”
In 1899 E.R. Johnston cites the healing by mentally handicapped children after their experience with plants and gardens: “In the garden every sense is alert. How the eye brightens at the masses of gorgeous color and the beautiful outlines – how many things, hot and cool, rough and smooth, hard and soft, and of different forms are to be grasped and held by trembling uncertain hands whose sense of touch is hardly yet awakened”.
C. Lawrence, in a paper the following year, examined the helpful qualities of plants. “Don’t talk to the child about numbers; but while he is learning to distinguish one flower from another, he will unconsciously learn the number of leaves, petals, etc. And, of course, a very dull child will take pride in having more flowers in his own garden than a playmate has in his”.
Dr. C. F. Menninger and his son, Karl, in 1919 established the Menninger Foundation in Topeka, Kansas. They had been brought up in an environment that valued the qualities of plants. Gardening and nature study were fundamental parts of the patient’s activity at the Foundation from the start. In later years Dr. Karl Menninger described horticultural therapy as an activity that “brings the individual close to the soil and close to Mother Nature, close to beauty, close to the inscrutable mystery of growth and development”.
The first use of animals for therapy in the U. S. was in 1919. Franklin K. Lane had been inspired watching the use of dogs in World War I where “the lonesome boys in France found their dogs a great comfort and men with shell shock recover their balance by getting close to a dog”. He wrote the superintendent of St. Elizabeth’s Hospital in Washington, D.C., suggesting that dogs be introduced in the care of the men.
Dessa Hartwell, one of the pioneers of the horticultural therapy movement, in 1933 wrote: “The curative influence of gardening on suffering humanity is scarcely dreamed of by the world in general. Even workers in the field of occupational therapy have hardly begun to realize the therapeutic effects of working in or with the soil and its products”.
In the 1920s and 1930s many Occupational Therapy books mention gardening as an appropriate program. The first horticulture course was taught in 1942 at Milwaukee Downer College, the first college to award a degree in Occupational Therapy.
Army Air Corps personnel from all areas of operation needed a regime of restful activity during World War II. The Corps’ convalescent hospital in Pawling, New York, in cooperation with the Red Cross, used animal-assisted therapy and the men were encouraged to work on the center’s farm with hogs, cattle, horses and poultry.
After the war, however, it became more cost-effective to buy the food for such facilities than to raise it on-site and there was a significant shift away from the traditional farm-based institution. At the same time there was a moving of the population away from rural settings and facilities were more and more based on a medical model of therapy based on curing symptoms rather than treating the whole patient. In keeping with this shift, volunteers rather than medical professionals became responsible for the use of plants and animals in treatment facilities during the 1940s and 1950s. Volunteer garden clubs and horticulture industry members brought flowers and plant-based activities to veterans’ hospitals after World War II.
A horticultural-therapy greenhouse was opened in 1959 at the famed Institute for Rehabilitation Medicine at New York University Medical Center. Recruiting garden staff for support, however, often proved more successful than involving the medical staff. This ultimately led to the recognition of horticultural therapy as a profession.
In 1947 the Ross Family founded Green Chimneys, located in Pelham County, New York. Green Chimneys was a private school to allow children healing benefits from interaction with farm animals. In 1959 the first Camphill program was established in North America, based on the philosophy that “the path to wholeness involves relationships of mutual respect, education and (or) meaningful work, real participation in community life, including community decision-making, a healing rhythm of daily activities, seasonal celebrations, a rich artistic and cultural life, natural therapies, and acceptance, individual recognition, and dignity for everyone”.
This path is founded in the teachings of Camphill’s founder, Dr Karl Koenig and the philosopher who inspired him, Rudolf Steiner. It is designed for all Camphill community residents, not just for those with special needs. Also in 1959 the Colorado Boys Ranch — a home for wayward boys — was founded in response to a need for an alternative to correctional facilities for disadvantaged youngsters.
In 1960 “Therapy through Horticulture” was published by Dr. Donald Watson and Alice Burlingame. The Melwood Agricultural Training Center was founded in 1963 by parents who had raised their mentally handicapped sons and daughters at home and had no wish to place them in an institution. Melwood focused on a community-based on-the-job-training model for training and employment.
Boris Levinson published “The dog as a ‘Co-therapist’” in 1962, reporting significant progress with a disturbed child when Levinson’s dog, Jingles, attended therapy sessions. During the 1960s therapeutic riding centers developed throughout Europe, Canada and the United States. The North American Riding for the Handicapped Association (NARHA) was founded in 1969, based on earlier work done in Europe, to serve as an advisory body to the various ‘riding for the disabled’ groups.
In 1972 the first horticultural-therapy curriculum in the United States was established between the activity therapy department of the Menninger Foundation and the Horticulture Department of Kansas State University. Clemson University offered a graduate degree in horticultural therapy in 1973. Also in 1973, Michigan State University started its undergraduate horticultural therapy option, which included 12 weeks of practical training at the Clinton Valley Center, formerly Pontiac State Hospital.
Given this background, it is clear that programs related to use of plants and animals in therapy are seen as beneficial for individuals in treatment or rehabilitation. The greatest focus for these two programs currently is among the aging population. Animal-assisted therapy, however, continues to grow rapidly in rehabilitation for physically and visually impaired individuals, and horticultural therapy is expanding among programs for youth-at risk.
Psychiatric patients are now treated with drug intervention and outpatient talk therapy, limiting their use of plant and animal-based therapies. Likewise, such programs have been reduced for developmentally disabled youth by that population’s inclusion in the general classroom. Changes in the way that rehabilitation and therapeutic services are offered, however, have occurred concurrently with new types of programs being developed. There are now treatment programs involving plants and animals to address physical, mental, psychological, social and spiritual needs. Treatment audiences include: individuals with AIDS, cancer or other health issues, acquired or genetic physical and developmental disabilities, dementia and Alzheimer’s disease, brain injuries, chronic pain, substance-abuse problems and learning disabilities, adults and children with psychiatric disorders, mental retardation and developmental disabilities, speech and hearing impairments, physical disabilities and neurological impairments.
The activities that are used in effective programs are as varied as the participants, facilities and professionals conducting the program.
Both food and non-food crops are used extensively within horticulture-based programs. Activities can range from making cuttings of indoor plants to running large greenhouse operations; from working in tomato container gardens to market gardens; from pulling a few weeds to contractual landscape maintenance of large facility grounds.
Animal-assisted therapy is generally conducted on a small scale with pets, or the clients visiting a facility where they can have interaction with small animals including rabbits, ducks and chickens. Animals in pet types of programs, compared to the farm programs, are treated as non-production animals. Hippotherapy focuses on riding horses and requires space for the animals as well as the clients.
Farm programs often have vegetable gardens and large animals (cows, goats, llamas) as well as small ones. While some may be treated as pets, production and marketing for both crops and livestock is an integral part of what occurs.
The therapeutic activities involve different levels of responsibility that the client has for the life of the plant or animal. In some the plants and/or animals present simply a setting that is intrinsically therapeutic but which is completely cared for by others; i.e. Wandering Garden for Alzheimer patients. In others, the plants and/or animals are responsive to the individuals in the treatment program but still completely dependent on others for care; i.e. a visiting pet. In yet others, the plants and/or animals are in danger of being harmed or dying if the client does not fulfill his/her duties in nurturing the life in his/her care; properly making cuttings, watering plants, feeding the animal on a schedule. Lastly, the products and/or by-products of the plant and/or animal are used in treatment programs such as cooking, crafts, shows and demonstrations, etc.
Some individuals may only experience one level of responsibility within a program while others may experience several levels. This may influence results, in terms of meeting the goals of a specific activity; for example someone working in the greenhouse making a dried-flower picture from flowers they helped grow, harvest and dry may respond differently to the activity as compared with someone working in a windowless hospital room with flowers purchased and donated by a stranger.
Despite limited official recognition at this time, the potential for growth in the field of Farming as Therapy (care of plants and animals for therapy and rehabilitation) in the United States is quite significant. Here are some examples of successful programs that can serve as models and inspiration:
Berkshire Farm Center and Services for Youth is a New York statewide non-profit social-service organization with a 116-year history of success working with at-risk children and their families.
Colorado Boys Ranch is a national residential-treatment facility that provides mental-health services and accredited education to at-risk boys, ages 10 to 21, from Colorado and across the United States.
Green Chimneys in Brewster, NY, is a nationally renowned, non-profit agency recognized as the leader in restoring possibilities for emotionally injured and at-risk children.
Crossroads Group Home treatment program is a South Carolina organization based on the Green Chimneys model, using an animal-assisted therapy program for girls from 10 to 18 years old who have been physically, sexually or emotionally abused.
Camphill in North America consists of ten independent communities, home to over 800 people on over 2,500 acres of land, and is dedicated to social renewal through community building.
Red Wiggler Community Farm was founded to create meaningful jobs for adults with developmental disabilities through the business of growing and selling high-quality, home-grown vegetables in Montgomery County, Maryland.
Moody Gardens in Galveston, Texas began with a hippotherapy riding-program for people with head injuries, but it has expanded beyond the original goal to become an integral part of the general community for persons with a wide range of physical and emotional disabilities.
Log Cabin Boys Ranch, nestled in the Santa Cruz Mountains, is the San Francisco Juvenile Probation Department’s detention centre for boys 15 to 18 years old who are learning native-plant propagation, habitat restoration and organic farming.
Melwood, in the Washington, DC metropolitan area, is a leader in the advancement of services for people with developmental disabilities.
Urban Meadows, in Chicago, is the nation’s leading psychiatric recovery centre as an outgrowth of its horticultural-therapy program.
Tranquility Farm Equestrian Education and Renewal Center, Inc. is a non-profit organization whose main goal is to develop a symbiotic relationship between man and equine to help deal with high stress, trauma, a physical, emotional or situational problem or injury.
Gambrel Farm is a breeding and training facility located on western Washington State’s little-known Key Peninsula working with children and Haflinger horses.