The doctors are saying they want me to go back to work…gradually. But I’m not sure. I’ve lost my confidence. My rehab specialist says we won’t know until we try. He means I won’t actually recover properly until I go back to work. The neurons that fire together, wire together – he keeps saying.
Theme music by Jonathan Zenti. Other music by Epidemic Sound and Blue Dot Sessions.
Associate Professor Ming Kuo’s academic article in Frontiers of Psychology, Feb 2019: Do Experiences With Nature Promote Learning? Converging Evidence of a Cause-and-Effect Relationship
Ming Kuo’s 2015 research paper in Frontiers of Psychology, How might contact with nature promote human health? Promising mechanisms and a possible central pathway
Read more about Amy Cuddy and her power poses, and how she successfully refuted criticism in this Forbes Magazine piece.
Neurologist Dr Ron Granot gives an update on the mechanism of botox in relation to the brain.
Sarah:
The doctors are saying they want me to go back to work…gradually. But I’m not sure. I’ve lost my confidence. I can’t imagine working again as a journalist at a TV network.
How am I gonna cope researching complex stories when I haven’t even made it through a novel yet?!
Dr Stuart Browne, my rehab specialist, says we won’t know until we try. He means I won’t actually recover properly until I go back to work. The neurons that fire together, wire together – he keeps saying.
Dr Stuart Browne: You know from a brain injury rehabilitation perspective work is is an excellent rehab program really. You have to adapt. You have to remember, concentrate. You know you’re you’re testing your brain and presumably improving your brain function just by turning up and functioning at work. So I always that that’s really the focus of our rehabilitation is to get people back to work because that’s going to hopefully boost their recovery that little bit further.
Sarah:
Just before I go back to work I hear an interview with a social psychologist – Amy Cuddy. She had a traumatic brain injury after being hit by a car when she was 19. Later she nearly quit Princeton but was encouraged to just fake it until she made it. She went on to Harvard and discovered that women gain confidence psychologically and hormonally if they take up more space with their bodies. Cuddy motivated women around the world to practice standing like wonder woman before they went into meetings and interviews.
The first time I return to work at SBS I head straight for the bathrooms and practice these power poses. I hope no one can see my arms stretched in a V above the cubicle door. Next it’s legs astride and hands on hips. You can laugh but I actually feel taller and stronger. I walk into an awkward boardroom to meet with HR, an occupational therapist and my new boss. Our boss changed while I was away so this feels like a job interview. I’m so nervous. I feel like I need to impress the boss I’ve never met but also make it clear that I’m gonna have to ease back into work. Amy Cuddy’s words are in my head. Just fake it until you become it. I pull it off. I feel myself acting confident, even though I don’t actually feel that way.
The first morning I sit at my work computer and find my way back into email. My boss asks me to look into a potential show about anxiety being on the rise amongst kids. I need to check these claims. Suss out the stats. How do I even do that again? I can literally feel the cogs of my brain turning as I figure it out. Oh yes that’s right I look up the Australian Bureau of Statistics. Actually, I can ring direct. I have a contact for them. I can feel my brain re-learning how to do my job.
Dr Browne was right. I need to be here to get better. But it’s slow. My headaches increase again. I’m forced to cut my hours back. Two steps forward and one step back.
I build up my hours over a few months and eventually return to full duties. I find ways to manage ongoing headaches. Part of this is flying under the radar. Many of my colleagues don’t even know what happened because they’re new here. The ones that do are discreet. They act normal like nothing happened. I didn’t just return from 8 months’ sick leave.
When a bad headache hits at work I slip out of the office and head to the local park to dose up on nature. I’ve worked here for seven years but before the accident I’d only ever come here twice. I didn’t even know the shortcut through the industrial estate. Now I’m here almost every day. I walk the park circuit and feel the fog clearing and my headache evaporating. It’s almost like magic. When we all hit the afternoon slump my colleagues head for coffee but I return to my patch of green.
Nature really seems to be my cure, so I continue to self-medicate with regular hikes. I take my kids camping on the weekends. I garden more. I swim in the ocean and rivers around Sydney. I basically change my whole lifestyle.
I’m busy dosing myself up on nature while my neurologist tries out various medications for my headaches. First super strong antihistamines that just make me drowsy. Then antidepressants that don’t do much.
Next we try botox. I’m reluctant. The idea of injecting botox into my head doesn’t really appeal. I’m still warily asking Dr Granot questions when I turn up for my first go.
Tape of Sarah getting botox injected into head, bedside chat with neurologist Dr Granot.
Sarah: Does the Botox possibly work in the way that it’s allowing my brain to sort of almost like a reset button.
Dr Granot: We don’t know. I can tell you what it does do, it blocks acetylcholine binding to muscle. It’s probably acting at trigger points which have high densities of those nerves. What that does to the brain we don’t know.
Ok slip off your shoes
Sarah
We go through to a small room with a bed. I climb up and lie down and close my eyes.
Dr Granot: So we’ll do the temples first which is middle soreness. Count of three and needle goes in. One two three. Needle goes in.
Sarah:
Luckily I can’t see the needles going in.
It’s more the idea of it I think the needles going in my head.
Dr Granot: It’s in your scalp it’s not in your head.
Sarah: (laughs)
Dr Granot: So here we go again, one two three in.
Sarah: So will I have any side effects today?
Dr Granot: It will be sore because you had lots of needles in your head. You’ll start to see that the muscles don’t move as much.
Sarah: In my forehead?
Dr Granot: Yep. These ones have a risk of a droopy eyelid.
Sarah: What’s that one? Is there more?
Dr Granot: Yes this Is the front one now so we did the temples now we’re doing the front one.
Sarah: (Laughs) Ok I thought we were all done!
Dr Granot: No right, You ready? So these ones go just below there.
Sarah: Just ones stop me getting wrinkles in my forehead as well, right?
Dr Granot: They do. They paralyze the muscle to smooth it out. But they’re the ones up here that can cause the droopiness. Count of three sting sting sting…
Sarah:The needles don’t go that far into my head but they feel horrible.
Sarah: Is there no kind of anesthetic or anything? laughs.
Dr Granot: They don’t do much as under the skin. They’re not popular ones.
Sarah: Can’t believe people do this by choice. So every three months I have to do this.
Dr Granot: If it works well on the headache. OK see how we go. Drop me an email, any issue give me a yell
Sarah:
But after going through that whole ordeal the Botox doesn’t even work. It actually seems to make my headaches worse.
Since my bike crash I’ve been building up to getting back on the bike. First I ride on footpaths and bike paths. Then a short stretch on a quiet road. It’s tempting to just give up cycling all together. I worry that I’ll get hit and bump my head again before I’ve even fully recovered from the last brain injury.
But my psychologist stresses the importance of not letting cycling become a phobia that seeps into other areas of my life. She wants me to actually ride back along that route through the quiet intersection where the driver cut the corner. Not just once. It’s important to repeat the activity over and over.
One Sunday afternoon I hop on my bike and start pedalling down the hill. It feels like I should be wearing a seatbelt. I feel so vulnerable.
Sarah Voice Diary After Riding on the Road:
I did it! I actually rode from my house, down Terrace Rd, under the rail bridge, through the roundabout, and into the dead end street and across the intersection where I was hit nearly two years ago. I did it. And I feel good. It just feels a big accomplishment but also I can feel my heart beating quite fast. I’m just going to stop and take a few deep breaths. But I feel good.
Sarah: A bit later something happens that catches me by surprise…
Sarah Voice Diary watching TV:
It’s like 10.30 at night poured myself a glass of wine put on some netflix. Started watching this show called Wanderlust with Toni Collette. But suddenly it was um spliced with shots of her flashbacks of her being knocked of her bike and looking like she sustained a head injury. Just the Reaction I experienced from watching that was so full-on…[laughs] trying to unwind with a glass of wine and watching some netflix after a late night at work that happening in the story has just completely thrown me.
Sarah:
I keep wondering if I’m better. If I’ve recovered. I’ve changed my lifestyle to prioritise nature. I keep researching why nature is continuing to help me. I learn to make audio stories, to make this podcast. But I still have to pace myself…to balance screen time with looking at trees. I wonder if this is just the new me. I wanna know whether this is my new norm. Should I stop seeing doctors and just get on with it? Continue using nature to find a balance but accept my recovery may have plateaued?
I asked my brain injury rehab specialist Dr Stuart Browne during what ended up being our final consult at St Vincent’s Hospital.
Dr Stuart Browne: It is certainly possible that people reach a plateau at some particular point. And as you say is this your new norm. So I guess that’s possible
Sarah:
I tell him I find that idea confronting. I’m worried my career will stagnate. I feel like I can’t move on to new positions or different organisations where I’m not comfortable slipping off to the park to get rid of my headache. But it seems like I just need to accept and focus on how far I’ve come since the accident.
I put all this to him the last time I saw him as a patient:
Dr Stuart Browne: So I kind of think if someone succeeded at work that’s a great success if you know that that’s their rehabilitation demonstrated beautifully. When you’ve got these residual symptoms of the headaches which which have been really really terrible for all those years um I think I think the solutions are non medication such as such as relaxation and the like but also looking at some of the more sophisticated treatments and hopefully just inching that little bit further forward with time yeah.
Sarah: Yep alright. Thank you.
Dr Stuart Browne: I don’t think I’ve got anything anything else up my sleeve.
Sarah:
He can’t really answer. I realise my questions aren’t quite right for a western medical doctor, yet.
Sarah Voice Diary at train station:
Instead of going to neurologist appointment I’m at Redfern changing trains to go to work. So yeah and instead I organised to come and interview him next Friday about my recovery. I feel really good
Sarah:
But when that Friday rolls around I start to feel nervous. I’ve been taking advice from my neurologist for three years now. This guy’s seen me at my most vulnerable. Now the power dynamic is shifting. I’m going back as a journalist instead of a patient. I wanna ask him the questions I didn’t feel I could before.
I lug a suitcase full of recording gear to the station. Catch a couple of trains across town. I feel edgy as I navigate the crowds waiting for buses at Bondi Junction. I’m nervous heading to his office with microphones I’m still learning to use. This is a big moment. I’ve answered his questions about my concentration and headaches. I’ve left with scripts for pills. Then a head full of botox. Finally instructions to meditate. I always asked lots of questions. Why is my recovery taking so long? Is this normal? What will the side effects of this medication be? But I’ve never asked what he thought of my use of nature. So far we’ve skirted that issue. I feel like he will be sceptical.
Dr Ron Granot: So we’ve certainly got studies showing that being in nature and exercise both of those do help brain function in general. There aren’t any studies I’m aware of particularly in brain injury but that’s certainly a general point.
Sarah:
Well I was wrong about Dr Ron Granot. This is pleasantly surprising.
Dr Ron Granot: So certainly exposure to nature we know improves brain functions. So it’s probably how we’re wired. We’re not used to living in a concrete jungle. So the best way to describe it, we’re trying to run new software on million year old hardware. So we meant to be exposed to trees and nature and that’s what our brain’s expecting and all the concrete jungle that we’re exposed to with the stresses and the noises and the hubbub of activity just not what we’re built to withstand and be used to. So I think getting back to nature is probably how we’re meant to be and there’s not a lot of data because it’s all these things are hard to study specifically but there is some data saying that it is better for us
Sarah: Do you have an idea of whether it’s the sounds or the visual or the tactile or the….
Dr Ron Granot: I don’t think we know. I would say so. As humans we love to dissect and find the key single component and the best analogy and I come back to your exact question in a sec. The best analogy is people want to take a vitamin of a Pill which is the component of a fish or the component of a salad or the component of whatever nature is giving you and take that only and forget about the rest. And the answer is they don’t work. We’ve got lots of studies to show they don’t work. If you want to get fish oil, eat a fish if you want to get the benefits of salad and vegetables salad, eat vegetables. So if you want to get nature I’d say get nature. Don’t sort of get nature’s sounds on your on your alarm clock. Get into nature. Then the answer is probably going to be very hard to dissect out which if any of those components specifically is the thing I would say Be in nature because that’s what’s intended.
Sarah: I think I like that take. so I’m now, I don’t want this to come across in the wrong way but because I wasn’t sure if you were going to be onboard with this idea or not, I thought you might be a bit skeptical because I um like yourself and the other doctors and specialists I saw were encouraging when I said that I was finding nature was useful but no one sort of suggested it or prescribed it and I’m just interested in whether you would consider suggesting it to patients.
Dr Ron Granot: I would certainly consider it. The problem is as a doctor it’s important for me to prescribe anything, that have an evidence base. In other words rather than the personal theory or a pet idea I need to tell you something that is based in some degree of fact and scientific evidence where others have tried it have documented and tried to remove a placebo effect out of it and shown it to be beneficial. So pet theories are great but pet theories are often wrong and even small studies that aren’t placebo controlled are also often wrong and we know that from lots of medications as well. So what I have to tell you as a patient has got to be limited by our limit of knowledge. And Then it’s a question of sort of risk benefit. So if you’re saying can I go out into nature can I do this can I do that. The answer is Sure absolutely and if it helps you, fantastic. Is that something that we can say with any degree of confidence will get you better in general? The answer is we can’t. So it’s difficult to sort of propose things that are out there that have no scientific backing. So we’re kind of stuck in medicine doing that. But there’s enough studies there to talk about diet. There’s enough studies that talk about exercise and we do but and that’s often also ignored in favor of more Instagram worthy sources.
Sarah:
The medical profession demands high levels of scientific evidence. Research experiments need to be randomised, placebo-controlled, double-blind and then reviewed by peers. And of course that costs lots of money.
Dr Ron Granot: It’s important for us not to sort of go down our own separate paths and have pet theories on things because I think that that will only bring the profession into disrepute in general. So that doctor told me to go visit the trees and this one said no the beaches are the only place and the answer is neither of us are right necessarily.
Sarah: So would you do that now?
Dr Ron Granot: I’d certainly mention it and raise it sure. And probably point people to your podcast.
Sarah: Excellent.
Sarah:
When I thank Dr Granot the following week he’s already mentioned my experience to another patient.
But you don’t need to be seeing a neurologist to benefit from nature. Access to the natural world is important for everyone. The number of trees in your neighborhood is actually a social issue.
During my research I kept hearing about Ming Kuo’s work. She’s an associate professor at the University of Illinois in Urbana Champaign. Ming directs the landscape and human health laboratory there.
Ming Kuo: I use field experiments so we have this work in Chicago public housing where we compare people who are essentially randomly assigned to different apartment buildings some of which have some greenery and some of which have pretty much none. So that’s one way and other ways to do longitudinal work.
So I have Chicago public school data over a ten year period in which city greened various school yards. And thankfully they didn’t do it all at once. They did about 100 schools over the course of the 10 years. And so we’re able to watch OK do we see a bump when a given school you know if we track schools over this period of time do we see a bump in test scores after the greening and is that bump maintained or does it go down or or what.
Sarah:
Ming Kuo’s substantial research found that kids at schools with green grounds behaved better and performed better academically. Her research also found that just having trees outside apartment windows made residents less likely to be violent or commit crimes.
Ming takes the basic premise that proximity to nature could benefit us and sees how this manifests in society.
Ming Kuo: Two of the effects that are most clearly known are that it helps us nature contact with nature views of nature help us help rejuvenate our attention and they also help us relax and in a kind of well can be profound way. And surprisingly both of those very simple effects have really huge ramifications so some of my work has really looked at the ramifications of this effect on attention. Which means that we are able to do all kinds of things better. We’re better not just at sort of cognitively effortful work but we’re also we’re also better at various social things because negotiating a difficult disagreement with someone takes mental effort and the capacity to inhibit unfortunate or unhelpful impulses.
Sarah:
When you think of a leafy neighborhood what comes to mind? Probably privilege. Some urban planners are working to change this. But access to the natural world is still a big equity issue.
Ming Kuo: It doesn’t suffice that there’s a spectacular nature three hours away you’d really need it on kind of an everyday basis. And the more minutes of it the better. You can’t just you know just have a great glob of nature at the beginning of the month and then live off of it. You have to have steady um additional doses.
Marc Berman: Ten minutes in a national forest versus two hours in a local park you know we don’t know those those relationships yet. That’s something that we’re really interested in looking into.
Sarah:
This is Marc Berman, that neuroscientist we heard from in earlier episodes. He runs the University of Chicago’s Environmental Neuroscience Lab.
Marc Berman: People think of nature as an amenity and not a necessity. So it’s nice if we had enough money or that’s for rich people or something like that. Whereas I think a lot of what our researchers are saying is that it’s not an amenity it’s a necessity. And it’s serious it’s important and we need to be incorporating this more in our daily lives.
Sarah:
So we all need it. Not all of us have access to it. And most of the world’s population now live in urban areas. But even if we don’t particularly like getting out into nature we can still benefit.
Marc Berman: The tricky part is you know people tend to do things that they like and you know it might be hard to get people to engage with these environments if they don’t enjoy the experience. But what we’re finding is that even if you don’t enjoy it you can still get the benefits. So you know I think one thing I don’t want to say that that mood isn’t important but it’s not the whole story and I think you know there are lots of people that really um enjoy cities a lot more and maybe don’t really like nature very much. But what we’re saying is that actually you you could still get the benefits the cognitive benefits.
Sarah: Can you spell out what were the benefits that those people who didn’t enjoy the experience what would they see.
Marc Berman: They were getting they were still improving in their sort of attention and their concentration. So we kind of feel like this is interaction with nature was improving this kind of ubiquitous cognitive process. It’s involved in lots of different aspects in our lives that would make people more productive and things like that.
What we were finding was that the effects of interacting with nature the positive effects on attention and memory were not simply driven by putting people into good moods but rather something else was going on and a strong demonstration and that is when we had people walk in winter it was quite cold. Subjects did not really enjoy the walk very much in the winter but they still showed the cognitive benefits. So you don’t even necessarily need to enjoy the nature experience to get the cognitive benefits you would need to enjoy the walk presumably to get the kind of the mood benefits.
Sarah:
The lab that Associate Professor Marc Berman runs has been getting people to lie in MRI machines and have their brains scanned while they’re doing working memory tests. Then Marc gets the subjects to watch nature videos as well as urban videos and then tests them again, while measuring their brain activity with the MRI.
Marc Berman: So the MRI is a very artificial environment you have to lie down on your back and be very still it’s you can make it can make people feel very claustrophobic. So we now have some new devices which are like these kind of like hair bands or headbands that people can wear. so we can actually have people walk in nature environments and walk in urban environments and also monitor their brain activity while they’re in real environment
Sarah: What is it about nature that is restorative? has your lab sort of figured out what it what those particular features are so we can hone in on those?
Marc Berman: Yeah. We’re trying to the one thing that we’re kind of looking at is sort of the amount of fractalness or curved edges in the scene. They kind of have this sweet spot of being engaging but not taxing. Whereas urban environments might not have that. The other thing that’s kind of interesting to think about too is that urban environments tend to bring about a lot of conceptions of work and stress and people and things like that. That might also be fatiguing. So we haven’t really separated those out completely yet. But the fact that we get the effects just with pictures or just with sounds suggests that there’s something about the perceptual features of nature that that lead to the benefits.
Sarah:
Hmmm…I admit I’m a bit wary of studies using videos or sounds of nature rather than getting people out into the real thing. It feels a bit limiting.
Anyway, there are a bunch of theories as to why interacting with nature benefits us. Marc Berman supports attention restoration theory…he explained that in episode five. Others say it’s about stress reduction. But then there’s biophilia. The idea that our innate connection with the natural world makes it just work for our brains. I asked Marc about that:
Marc Berman: Biophilia is it’s complicated for me for a number of reasons. So there does seem to be something innate about people’s preferences for nature [00:26:52][14.9] So people like for example we do a lot of studies where we show people hundreds of images and they vary in their urbanness to naturalness and people really have strong preferences for a lot of these nature scenes. But one thing that’s kind of tricky about Biophilia is that if humans had such an innate strong love of nature and you know it was really so strong in us then it seems like humans make decisions that you know destroy the environment pretty readily. And I know that things are complicated and you know there’s all these economic and job issues to weigh against but it seems like if biophilia was really the main mechanism people would be making a lot of different decisions.
Sarah:
Maybe this will come later. Perhaps our innate connection to nature and its potential to change our brains could actually drive us to look after the natural world.
It’s now nearly four years since I was hit by a car while riding my bicycle down Ness Avenue. People often ask if I’m fully better. How’s your head? It’s pretty good thanks. I’m making this podcast. I just have to keep my nature dose up. While I’m making this last episode I take a break and step into my garden. For one of the last times. We have to move and leave behind our massive yard. But we found another house to rent down the road. On Ness Avenue. A few metres from the scene of the accident.
We were actually offered two houses and had to make a really difficult decision: A renovated home with a modern kitchen, two bathrooms, a garage….but a tiny backyard and not many trees. Or, a house with no dishwasher or fresh paint but a decent yard on a leafy street near the Cooks River.
We chose nature over a tidy house. I think my brain will thank me.
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