Medics Need the Wilderness as Much as It Needs Medics: A Letter in Reply to “Can’t See the Wood for the Trees”

To the Editor:

I write in reply to the fascinating letter by Robert Cussen published in this journal ¹ extolling the unique place of woods and trees within medicine and the ways in which we interpret this phenomenon. Although I enjoyed the whole piece, I found myself drawn particularly to his final statement. As a medical student revising for examinations myself, the assertion that we would be better off returning to the trees (or else losing ourselves in the wilderness in general) is one that resonates deeply.

The benefits of this reimmersion are multiple. Although the superiority of outdoor exercise over equivalent indoor exertion is disputed, ² exercise is certainly beneficial to mood, health, and focus ³ and is something that is implicitly linked to the very act of finding oneself in a wilderness environment, far from easy comforts and motorized transportation. Furthermore, research into the effects of nature itself on our ability to focus profound directed attention, and on our mood, highlights a link between the range of soft-hard fascination ⁴ evoked within these wild environments and the maintenance/restoration ⁵ of the faculties we must possess to fulfill our roles as good students and good doctors. This research echoes Dr Cussen’s choice to mention “forest bathing,” a term that pleasantly evokes the mentally healing potential of such experiences.

Going even further, it is certainly possible to draw parallels between journeys into wilderness environments (where the conventions and rubric of normal life are defied by challenging surroundings) and entering liminal spaces that anthropologists suggest is a defining feature in the structure of rituals. ⁶ It is not an unthinkable stretch to characterize such an expedition as an example of a 3-part rite of passage. ⁷ These acts pluck someone away from their ordinary life and take them through a period of transformative liminality until they are returned, with altered status, to the life they were leading before. Consider overworked medical students assembling their hiking and wild-camping gear, throwing themselves into a period of solitude in nature, stripping back the mental and physical burdens that come from long hours at a laptop screen, and emerging lightened and more resilient to re-enter their studies.

The prescribed schematic rites necessary to pursue hiking, mountaineering, camping, sailing, and climbing as pastimes are used by many as a way of allowing the space and time required to change their mental state. This could be hypothesized to act as a direct tonic to the stresses and strains of professional life, with ∼60% of those who participate in outdoor exercise in the United States being college-educated. ⁸ Although clearly not a tool that is uniquely limited to those working within medicine, the relevance of this kind of contextualizing and grounding practice to the self-reflections we are required to perform in medical education in the United Kingdom ⁹ is immediately obvious. This seems especially evident in the process of engaging with past experiences from different perspectives and reframing them, ⁹ something that the addition of physical and contextual distance can only aid. Indeed, we see iterations of these same ideas accessed by many through the lens of mindfulness, ¹⁰ which is increasingly taught in medical schools ¹¹ and has scope for helping practitioners in areas including coming to terms with failure, adapting to changing roles, or preparing to embark on a new professional venture entirely.

Speaking from personal experience, I have found nothing to be quite as useful in helping to adapt to the demands of my medical degree as spending time in mountains, forests, and tents. These experiences are challenging, cathartic, and ultimately an expression of kindness that is sorely needed in the avoidance of burnout.