Wilderness Deprivation Disorder - A Case Study

Wilderness Deprivation Disorder 1

running head: Wilderness Deprivation Disorder

Wilderness Deprivation Disorder: A Case Study

presented to Dr. Youngkhill Lee

In partial fulfillment of the requirements of HPER R561

Advanced Therapeutic Recreation Processes

by Ray Woodcock

March 29, 2006


Summary of Case

Laura is an 85-year-old Caucasian who shares a room with her husband in a nursing

home. The social services representative at her nursing home has agreed to allow me to work

with her, with her informed consent, to explore the possibility that her presenting symptoms,

detailed below, are consistent with the proposed diagnosis of Wilderness Deprivation Disorder

(WDD). The wellness-oriented diagnosis of WDD concentrates primarily upon the addition of

stimuli from nature, or the outdoors, to enhance the well-being of persons who may or may not

display signs of pathology as defined by the DSM-IV-TR. In the interests of developing the

WDD diagnosis, I have approached this client’s situation as a case study for research, and have

therefore invested a greater-than-normal amount of time in becoming familiar with its facts.

In this review, I have explored at length the problematic nature of Laura’s circumstances.

I have grappled, in particular, with the possibility that Laura might encounter the outdoors in

either of two forms: as a place in which she would derive pleasure from mere contact with

nature, or as something from which she might internalize certain perspectives or benefits by

means of activities conducted in the outdoors.

Because of the extremely constricting limits imposed by Laura’s circumstances, I have

concluded that one might best proceed along two tracks: (1) advocating and educating for

change, so that nursing homes like this one facilitate more possibilities for outdoors-oriented

contact and activities, and (2) in the meantime, treating Laura’s situation as essentially that of a

prisoner, and seeking to incorporate elements of nature in her nursing home room just as one

might seek to incorporate them in a prisoner’s cell. My conclusion, given the full array of

constraints, seems both realistic and bleak.


Background

Laura grew up in farming territory. She and her husband bought a house in the country,

and lived in that house for virtually all of their adult lives. Thus, from birth to about age 80, with

exceptions of perhaps two years in her youth, she always lived in the countryside. As such, she

was perpetually active in gardening; worked in and with shrubbery, woods, fields, and animals;

and was otherwise immersed in rural life. About five years ago, she and her husband decided

they could no longer manage the country life, and decided to move into an apartment in a nearby

town. In that apartment, their only regular contact with the outdoors was to take a walk, every

day or two, to drop their trash bag into a dumpster located about a city block away. They tended

to keep their shades drawn, primarily in fear of the potential for criminal acts by persons who

occasionally walked or bicycled past their apartment. This past year, after repeatedly failing to

mind their diets, medications, and other aspects of aging life, they were relocated to their present

residence. Their room in a nursing home has a view of a back yard and a field. Due to senility,

however, her husband is not allowed to leave the building unescorted, and Laura does not

attempt to go outdoors without him. There is, in any case, not really any place where they could

go: there are no sidewalks on the street; and while the exterior of the nursing home does have a

smallish lawn, it has no walkway, picnic table, or other location where she and her barely mobile

husband could sit down. Moreover, any activities on that lawn would be undertaken in full view

from the windows of their fellow nursing home residents’ rooms. Laura, a shy person, shows no

great inclination to be out on the lawn. Nursing home staff rarely escort residents outside the

building; and when they do, the destination is invariably a restaurant in town or some other

location in the built environment. There have been no guided individual or group forays to the

lawn, to the nearby lakefront, or to any other outdoor locations.


Comorbidity

Laura has met with the nursing home’s social services representative, but it does not

appear that she has ever undergone a thorough mental health assessment. There are also no

indications that any standardized instruments (e.g., Beck Depression Inventory, MCMI-III) have

been employed to assess her condition. This may be appropriate; she displays no signs of severe

pathology. Even if she did, for the record, her finances are essentially nonexistent, and the social

services representative doubts that her health insurance would pay for any such assessment.

In the event such assessment does become a possibility, I would suggest exploration of a

few potential diagnoses. First, I noticed some instances of memory lapse consistent with a

cognitive disorder typical of old age. From Laura’s remarks about the nature of her married life,

and from my observation of her interactions with her husband and others, one would ideally seek

to rule out dysthymia or a another mood disorder, as well as PTSD or possibly complex PTSD

(cf. Herman, 1997). Although it appears unlikely, one might also want to rule out social phobia

and avoidant personality disorder – after taking account, in all cases, of her current medications.

Given funding realities, as well as Laura’s strong sense of stigma associated with mental health

treatment, the social services representative suggested that Laura meet with me, to see whether

there may be some affordable intervention untainted by that stigma. In the interests of advancing

the understanding of WDD as a potentially viable diagnosis, I agreed to meet with Laura for this

purpose, and to explore her case extensively, without charging a fee.

Symptoms

It goes without saying that one might detect and interpret phenomena from Laura’s past

and present life experiences in an indefinite number of variant ways. My observations and

reflections have focused particularly upon identifiable regards in which her relationships to


nature, and to other activities linked to nature (e.g., nature-related socializing), differ markedly

from what appears to have been her experience during her years in the countryside, as follows:

• Deprivation of physical challenge. Both Laura and the social services representative

confirm that Laura is seeking opportunities to be of use, around the nursing home, and

particularly in a physical capacity. She was briefly helping to roll wheelchair-bound

fellow residents from the dining hall to their rooms, until it was decided that this well-

meaning effort deprived residents of their own needed exercise. The nursing home does

not offer an exercise room or exercise classes. It is not clear, in any event, that such

facility would appeal to her: during her four years in the apartment prior to entering the

nursing home, she had an exercise bike that she never got around to using. She does not

appear to suffer from any conditions that would prevent her from being more physically

active. One reason for her uninvolvement in some physical challenges appears to be that

she feels her husband relies increasingly upon her for guidance and cues in everyday

living, and she appears reluctant to relinquish that role or uncertain that she can do so

safely.

• Lack of contentment with available diversions. Unlike her husband, Laura does not

appear content to spend the afternoon watching TV. It is, for her, a nighttime diversion;

the daytime is a time to be active. Her inordinate shyness prevents her from becoming

deeply involved with the nursing home’s slate of activities, which in any event is quite

sparse. She is not able to name anyone toward whom she feels exceptionally close or

with whom she feels she can comfortably share secrets about herself. While she and her

husband report being on cordial terms with a number of their fellow residents, there is no

one with whom she engages in private conversation, other than her husband. She reads,


but does not find it a pastime sufficient to absorb large numbers of hours. The point is

not that she needs to find a way to become more socially involved than she seems to have

been at any other time in her adult life; it is, rather, that – working from where the client

actually is – she seems to perpetuate the activity-oriented sense of priorities that guided

her decades in the country, where there was work to be done and where she learned to

view social life as secondary.

• Loss of purpose. Despite stories of persons who have thrived in the protective

environment of a nursing home, Laura’s ingrained sense of life there is that one has

become forgotten, irrelevant, and unwanted, and is essentially just waiting to die. This

message appears to be underscored by the very low morale evident in the affect of

numerous residents. Laura did not merely have a purpose for others during her

childrearing years; she evidently retained a sense of purpose during the two ensuing

decades during which the children were gone and she was tending an empty nest. In her

worldview, it seems, purpose derives in part from the simple activities of struggling

against the elements to make a life – to keep the house and property in good shape, to

tend the flowers, and otherwise to defend one’s existential outpost. Ironically, the

nursing home environment, with its regular feeding, tracking of one’s medications, and

otherwise helpful ambiance, appears thereby to rob Laura of the necessity to fend for

herself and, with it, of a part of her sense of purpose.

• Loss of place. There could scarcely be a more profound contrast, within Laura’s lifetime

experience, than the contrast between her bed in a highly institutional nursing home

room, which appears to remind her of an extended stay in a cheap motel, and the home

she had in a rich rural setting for a period of more than half a century. During those


decades, her hands and eyes had probably covered every inch of that house – and most of

the three acres on which she lived, for that matter, as she worked on hands and knees to

plant flowers and grass, pull weeds, grow grapes, apply sawdust to the roots of seedlings,

pick her husband’s freshly clipped boughs off the ground, and so forth. In the old setting,

everything was special, had been in some sense personally incorporated into her

existence. Here, nothing is special; nothing holds the memory of a child or the echo of a

holiday; everything in this cinderblock and linoleum structure will endure just fine

without her when she is gone.

• Indicia of outdoor orientation. I took Laura and her husband for a ride in the car. When

we stepped out of the nursing home, I noticed immediately that her eyes were sparkling

and she was smiling – in sharp contrast to her husband, who despite his years of life in

the country, now seemed reluctant to stray from the safety of his home in the facility. I

also noticed, during the drive, that while she spoke of social relationships among farmers

in the countryside where she had spent her life, she also made numerous comments about

the cows and sheep, woods and fields, rainfall, storms, and other aspects of the outdoors.

• Loss of outdoor-oriented social opportunities. Activities in the outdoors – cutting wood

for heat, growing food in the garden, taking care of trees grown to sell, and other similar

undertakings – comprised a significant part of the time that Laura and her husband spent

together during their decades in the country. Without those activities, the couple appears

to have fewer things to talk about. Also, they do not seem to be spending time “together”

in the same sense: instead of being jointly occupied with a given task (e.g., helping one

another to tie up a tree’s branches), they appear to be largely silently as they sit in

separate chairs and watch TV. As just noted, Laura was also aware of neighbors’ social


interactions, with herself and with others, and she seems to have conceptualized many of

those interactions in terms arising from the rural life. For instance, she might cite a

farmer’s ownership of sheep, rather than cattle, to demonstrate that he and his neighbors

did not always see eye-to-eye. Previously, visiting a neighbor (or even being in the

company of others, as in church or when going shopping) always included an element an

outdoor activity – even if the actual socializing occurred indoors, which was not always

the case – insofar as it was necessary to travel across the countryside in order to get to

that neighbor’s residence. Finally, many of Laura’s social opportunities (e.g., working

with other women to decorate the church, or to prepare food for a monthly lunch for the

children in the nearby parochial schoolhouse) entailed an outdoor component (e.g.,

getting flowers from a nearby patch, or vegetables from the garden). It appears that, in an

apartment or nursing home residence in town, where she has lacked such obligations and

resources, she has concomitantly lacked the basis or justification for such social

interactions.

Review of Symptoms

The outdoors varies enormously in its physical features: it includes prairie and

mountains, wilderness and farmland. It would be impossible to approach Laura’s case from a

global perspective that sought to catalog the differential effects, upon her, of exposure to myriad

varieties of nature. Nor would such an approach necessarily be on the mark. In listing her

symptoms, above, the focus was upon the difference between her life now and the life she

experienced in the domesticated rurality of her former years. Perhaps she, and many before her,

would have benefited from exposure to various aspects of raw wilderness – including aspects

with which they may have had no appreciable contact for millenia, since mankind first began to


move away from an outdoor existence. But for purposes of a relatively immediate, clinical

intervention, the focus here is upon the effects of incremental denial of wilderness exposure

within the scope of Laura’s life experience.

How, in other words, can one hope to restore some missing elements of Laura’s

previously intensive outdoor exposure, short of the infeasible option of relocating her and her

husband back to the country house they vacated? One can imagine extension of that question to

children who experience profound homesickness when they leave home to go away to college; to

persons who are separated by divorce from the familial roots they have planted; to workers who

must relocate for their jobs; and so forth. Here, however, the focus is solely upon Laura.

One could seek to provide symptomatic relief, responding discretely to each of the ills

sketched above. There is a chance, however, that that list of symptoms neglects or misrepresents

something important, or that a single underlying mechanism is responsible for generating several

such effects – and, perhaps, that treating the effects will leave the underlying cause untouched.

Hence, rather than address those symptoms in isolation, the approach taken here will be to

outline theories that may provide more global insight into the case. This is not to say that the

specified symptoms cannot provide guidance or serve in any sense as limiting criteria; it is

merely that a point-by-point analysis of symptoms might miss the forest for the trees.

For reasons just described, it would appear relatively unhelpful to base this inquiry upon

an innate evolutionary preference, postulated by some writers, for savannah-like terrain (see

Riley, 1992). Most portions of the land surrounding Laura’s country home were either naked

farmland or dense woodland. It was not a particularly savannah-like place. Nor is it clear that

the arrangement of the surrounding landscape would be crucial to this inquiry in any event. The

symptoms described above would seem to lie within the experience of numerous persons from a


variety of backgrounds. Surely they are not all longing, in any immediate sense, to return to a

savannah-like existence that they, personally, have probably never experienced – that may,

indeed, seem less appealing to them than does their old home, wherever it may have been.

In part, this inquiry will disregard the last of the symptoms listed above, pertaining to the

loss of outdoor-oriented social opportunities. That decision is perhaps less significant than might

appear at first glance. Some of the richness of Laura’s life in the country arose from its web of

irreplaceable social links. The formative, old-fashioned, barn-raising rural social network of her

childhood may have lived on, inside her, for as long as she could experience actual and

remembered contacts with her brother, who inherited the farmhouse in which she was born, a

scant two miles from her marital home. That farmhouse, that memory of an older culture, may

live on inside her still; it may be a fount of inchoate recollection from which, even now, a

suitable intervention could draw. But for purposes of this inquiry, it will be assumed that the

culture of outdoor-oriented social opportunities has been dying since she was born – has been

drying up, in any case, for some 40 years now, since the advent of highly mechanized agriculture

and the closing of the adjacent one-room schoolhouse that served as her social focal point during

her children’s early years. There is some evidence that, over the decades, Laura slowly adapted

herself to what was becoming, for her, a social desert – that, in other words, it may not be a

question of seeking to return her to a rich life she left behind, but rather of recognizing that, by

the time she left, there was not much left to leave.

The list of symptoms, thus annotated, suggests two general spheres of inquiry, pertaining

to place and to activity within it. Regarding place, it appears that Laura now occupies a setting

that is alien to her, one that will not easily come to feel like a home. Regarding activity, Laura

seems to need to use her time and abilities in ways that provide exercise and challenge, absorb


her attention, and yield some social contact. Phrased thus, these are, again, not unique to old

folks; one can readily imagine similar experiences for the high school graduate who goes away

to college in a strange place, or for the worker whose relocation denies the possibility of

continuing in his/her accustomed ways of relating to place and activity.

And again, while the list of symptoms itself may neglect something important, the

possibility of such neglect seems less worrisome when one focuses on these two general spheres

(i.e., place and activity) rather than upon multiple specific symptoms. In respect to both such

spheres, there may be elements that she could – indeed, must – satisfy without recourse to the

outdoors. But the question here is whether access to nature can provide an efficient response to

multiple relevant concerns, so as to fuel one’s belief in the plausibility of WDD as a useful

diagnostic interpretation.

Theory

The theory at hand, baldly stated, using Laura’s case as an example, is that gradual or

rapid changes in life circumstances may deprive people of exposure to aspects of wilderness

experience that, if experienced, would enhance wellness or quality of life. This is not the same

as saying that Laura would immediately be better off if she were plunked down in the middle of

nowhere. Given her genes and rearing, her strengths and weaknesses, she may be at her best in

an environment that offers a decidedly diluted version of the primeval home – just so the

attenuation of environmental experience is less extreme than that which obtains in the residence

she now occupies.

Several different perspectives suggest that there is a pervasive human need or tendency to

be oriented toward nature. For example, Clayton and Opotow (2003) describe a controversy

surrounding the definition of nature itself – which, in some views, includes (or should be


considered as properly including) humans. Thus, they cite the ecopsychology movement as

holding that “humans need to rediscover their ties to the natural world in order to experience full

mental health” (p. 7). Taking a different approach, White and Heerwagen (1998) cite the

biophilia hypothesis, by which there is said to be “an innate tendency to focus on life and lifelike

processes” (Wilson, 1984, p. 1). Reaching a somewhat similar outcome, White and Heerwagen

suggest that positive responses to natural stimuli may be introduced into mental health

interventions in relaxation therapy, in wilderness challenge programs, and in the design of

clinical environments.

Because of irremediable changes in Laura’s life and society, the proposed solution path is

not to seek resurrection of a former lifestyle that, by now, may be lying stiff in its tomb. Instead,

it is suggested that, to some extent, the best aspects of the life formerly experienced by someone

like Laura may, themselves, have been mere shorthand for even better encounters with nature by

her ancestors, and that those ancestors’ adaptations may likewise have entailed, in turn, some

loss of wilderness exposure experienced by their ancestors, and so on, back up the tree of

heredity. In that conceptualization, an attempt to recreate Laura’s personal past would appear

misdirected, when compared to the project of introducing superior elements of wilderness, as

experienced by humans in somewhat more remote antiquity. There would be, one presumes,

some point at which the research would have gone too far back, where the relatively pure

wilderness experience would lie beyond Laura’s capacity to adapt and enjoy. Rather than install

her in yet another alien world, the trick would be to arrive at a purer, but not extreme, array of

circumstances that would not be vastly less diluted than those which she treasured in her old life.


Place

There are, logically, those places to which one is emotionally attached, and then there are

those places to which one is effectively not. It is not just that people tend to prefer certain kinds

of landscapes or views over others (Kaplan & Kaplan, 1989). Arefi (1999) suggests that place

and non-place do not integrate – that a person who finds him/herself living in a “non-place” (e.g.,

a nondescript, anonymous, industrial area) may experience something like a crisis of identity

and, from it, may experience physical as well as mental health impacts. For example, research in

environmental psychology has demonstrated beneficial effects of exposure to views of the

outdoors through a window and even in mere photographs and murals depicting nature, when

compared to more nondescript locations (Morris, 2003).

To illustrate the possibilities, in their volume on place attachment, editors Altman and

Low (1992) offer a half-dozen chapters that speak directly to aspects of Laura’s situation. These

include chapters on attachment to the ordinary landscape; to possessions (which, in Laura’s case,

are especially poignant due to the decision by her sister to empty the contents of Laura’s former

apartment during the hospital stay that preceded her transition to a nursing home, thereby

robbing Laura and her husband of even some basic elements of a dignified existence); to special

places from childhood and in the life courses of the elderly; to the home as a workplace in

women’s lives; and to one’s local community; as well as a chapter on involuntary relocation and

other disruptions.

Space will not permit an exploration of so many aspects of place attachment. To

introduce elements of the concept that do seem to address at least a part of Laura’s situation,

however, the last chapter just mentioned offers this definition:


Place attachment involves positively experienced bonds, sometimes occurring

without awareness, that are developed over time from the behavioral, affective,

and cognitive ties between individuals and/or groups and their sociophysical

environment. These bonds provide a framework for both individual and

communal aspects of identity and have both stabilizing and dynamic features.

The environments may include homes or communities, places that are important

and directly experienced but which may not have easily specified boundaries. …

Transformations in place attachment occur whenever the people, places, or

psychological processes change over time. Disruptions of place attachment are

noticeable transformations in place attachment due to noticeable changes in the

people, processes, or places. (Brown & Perkins, 1992, p. 284).

The theme of lost identity has other potential place-related dimensions as well. There is,

for example, the very real possibility that the surrender of a house for an apartment, and then of

an apartment for a room in a nursing home, implies a palpable loss of pride, of standing in the

community – as if to show the world that she is a person in decline, lacking significance. This is

very far from Laura at her apogee, when she occupied a large house on three beautiful acres,

with five children, and was heavily involved as well in the neighboring church and schoolhouse.

Yet place attachment, broadly defined, may digress profoundly from the topic of

wilderness exposure. Attachments to houses, children, and possessions – however important

such attachments may be, or may have been, to Laura’s sense of identity – is quite distinct from a

need for contact with the outdoors. The key point would seem to be, not wilderness, but rather

attachment – to something, anything, that will provide stability, self-respect, or other mooring in

the storm. The reply is that Laura no longer has many options in that regard. Her children are


physically distant. She will most likely not again reside in a house, and certainly will not return

to her high point. Exposure to nature is offered, not as a panacea, but as a single focus for the

attachment need. If she could also find attachment and identity elsewhere, so much the better;

but if nothing else comes through for her, there is at least the possibility that she will always

have access to nature in some direct or vicarious way, and through that access may be able to

derive some therapeutic benefit.

How great is that possibility? Under other circumstances, it might have been feasible to

mitigate the loss. Upon entering the nursing home, Laura was still able to drive. It might have

been possible for her to drive herself and her husband out to their countryside neighborhood – to,

particularly, Sunday services at the church they attended for about 40 years. Unfortunately, the

nursing home would not allow her to keep her car, and her sister has sold it. Moreover, her

husband’s animosity toward some members of that congregation would probably eliminate that

possibility from consideration.

Although the nursing home has a van for transporting its residents to the occasional

restaurant, it is unlikely to use that van to transport Laura or anyone else on a random drive

through the countryside. Experiences of that sort are likely to be reserved for those rare

instances when one of her children visits and takes her and her husband on a local tour. There is,

however, no specific place in the countryside where she appears comfortable with getting out

and walking around – not that her husband’s mobility would permit much of that in any case – so

for practical purposes she is marooned at the nursing home.

Indeed, it is possible that a return to the old haunts – particularly, with the new owner’s

permission, to the sold country home, and also to the neighboring church and now-vacant

schoolhouse – would merely remind Laura of how much she has lost. Brown and Perkins (1992)


offer a case study demonstrating that persons subjected to a natural disaster, wiping out their

homes and communities, “struggled to come to terms with their losses and to re-create a sense of

stability and a positive identity,” and eventually resolved the conflict between allegiance to past

and present by incorporating valuable elements from the past into new present-tense commit-

ments (p. 294). They also note, however, that it may be difficult to recreate place attachments

when the new setting is unfamiliar.

Not only the inside, but also the outside, has changed for Laura. At the nursing home,

there is no garden; there is no sidewalk across the lawn. There are few trees. There is no place

for solitude in the outdoors; there is not even a place to sit in it. And instead of a country road,

there is a city street. The possibilities for discovering or rediscovering any link with the outdoors

are severely circumscribed. Under such circumstances, it is not immediately obvious that Laura

has any realistic options for deriving any significant therapeutic benefit from explorations of the

link between personal identity and place attachment. Whether her circumstances are actually

harmful to her mental health is not resolved here; the present observation is merely that such

circumstances do not seem calculated to enhance her mental wellness.

In summary, it did not appear, from my observation, that Laura drew great solace from

the view out of her window, across a field and past a few trees to a railroad track perhaps a

quarter-mile away. The view may have had some incidental therapeutic benefit, but did not

seem equal to the task of counterbalancing symptoms like those described above. There also

appeared to be few other aspects of place, experienced in itself, in which her new home would

come to rival the old one in therapeutic power. This, and her apparent acquiescence in it, raises

the question of whether, indeed, it had never been, for her, a matter of merely enjoying the place

– whether, that is, her home had become a home because of what she had done with her time in


it. She had never been one to sit and gaze out of a window, or to spend time merely

contemplating in the outdoors.

My conclusion was that I should hope the poverty of her new home, in terms of natural

beauty and even sheer visibility, would somehow prove to be of slight significance in her overall

health picture – that, ultimately, although she came from a long line of farmers, her social and

aesthetic insticts were not terribly different from those of a city girl, and that it would be activity,

not mere place, that would matter most to her. It is also possible, though unexplored here, that

there are further permutations within the possibilities of experience of place, and that she may be

enjoying some such permutations on a non-obvious level. For example, one might use the

analysis of Borrie and Birzell (2001), which seeks to measure the quality of wilderness

experience, to examine Laura’s own present outdoor exposure in terms of satisfaction, benefits,

cognitive states, and socially constructed meanings applied to the experience.

Activity

In the Review of Symptoms, above, it appeared that Laura needs to use her time and

abilities in ways that, among other things, will provide exercise and challenge, absorb her

attention, and yield some social contact. In the examination of Place, just completed, it seemed

that Laura might find it difficult to achieve a point of enjoying nature through purely passive

experience in, or exposure to, natural settings in her new residence. Yet, going back to the

summary of Theory, above, it was implied that she may nevertheless achieve experiences of

nature that distill, in a microcosm, some of the best aspects of wilderness exposure – that, in

those regards, could actually supersede in quality (or, let us say, in intensity or therapeutic effect)

the experiences that she (or her parents, for that matter) may have had. The remaining option is

to look for such possibilities within the sphere of Activity – to suggest, in essence, that the list of


symptoms did indeed misrepresent what was most important for Laura, in terms of therapeutic

effects of exposure to the outdoors, insofar as that list substituted this researcher’s eye for her

own: the list of symptoms asked how she could possibly thrive after losing the lovely views

available during the rural segment of her life, when there are signs that her mere view of nature,

or presence within it, has not been an overwhelming concern for her.

Jones, Patterson, and Hammitt (2000) pose the possibility that people form affective

bonds with landscapes through the experience of significant activities within them. They

describe the difference between the view of the detached outsider, whom Laura is in the nursing

home, and that of the long-term resident, who experiences a sense of belonging. The difference

between this and place attachment is subtle, they say; it is that attachment refers to a specific

location – to Laura’s country home, in this case, or to aspects thereof – whereas affective

bonding, or a sense of belonging, is possible within any location that bears some identifiable

similarity. For present purposes, however, a better presentation of the concept may be that one

can simply distinguish between the unique attachment or bond to a specific place and the general

sense of belonging or familiarity that arises in any location in which one is reminded,

consciously or otherwise, of some aspect of the original location. The factor deserving greater

scrutiny, here, is the role that activity may play in forming those senses of bonding or familiarity.

Thus, Ohta (2001) appears to suggest that interpretations of nature scenes vary according

to people’s experiences – that the scene, even when viewed in a mere photograph, may be a real

environment for the viewer to the extent that s/he has experiences that come to mind or, perhaps,

that subconsciously cause his/her reactions to vary from those of people who have no such

experiences with that particular form of landscape. This possibility, in itself, could be taken to

suggest merely that Laura should attempt to have good experiences within the nursing home, so


that it, too, could eventually come to feel like home to her. The premise of this inquiry,

however, is that nature offers unique benefits – that the experiences sought are specifically

experiences having to do with nature, rather than with e.g., the interior of the nursing home.

As one ponders the experiences that Laura has had and may yet have with nature, it

begins to seem possible that the preceding discussion was superficial, in its impression that she

engaged in an extensively outdoor-oriented life during her years in the countryside. She did,

plainly, do exactly that. Yet in another sense, she did not. It may be that city people seek

refreshment in the countryside; and perhaps this researcher, overly exposed to habitation, is

imposing his impressions upon the subject – because while some city people are outbound, some

country people are inbound. During her country years, Laura did not avail herself of every

opportunity to be outdoors. She did not often go on picnics; she did not prefer to sit and read

outdoors. The world of nature was frequently not as appealing, to her and her family, as the

world shown on TV. Nature was not broadly seen as an adversary, but neither was it the ultimate

home. She would go out of the house to work in the garden, and no doubt this was good for her

in many ways; but then she would go back into the house, the schoolhouse, or other buildings, to

handle many other chores, and also to engage in most of the activities that constituted her leisure.

Indeed, in some important ways, Laura’s domestic life in the countryside may have been

isolating and entrapping for her (see Ahrentzen, 1992; Herman, 1997). It should not be

surprising if this inquiry has thus misconstrued the meaning of the country life to Laura. Others

(e.g., Ryan, 2005) have likewise treated the outdoors as an instrumentality, misconstruing its

actual significance to client or customer.

Stokowski (2002) suggests that the sense of place is a social, not individual, construction.

Stedman (2003) cautions that social interactions are not the only influences upon this


construction – that features of the landscape itself do contribute to it. Nonetheless, within a

given set of circumstances, such as those confronting Laura in the nursing home, one might

theorize that the task is to adapt to, join in, and co-opt to her own ends any possibilities for place-

creating activity. Injecting elements of exposure to the outdoors may thus be construed as a

partial response – a powerful one, perhaps, but nevertheless only part of the larger picture of

seeking out activities that will help to build a sense of belonging, of home, and of physical and

emotional safety.

In their classic work in environmental psychology, Rachel and Stephen Kaplan (1989)

identified four key components in restorative experience – which, as Scopelliti and Giuliani

(2004) emphasize, is distinct from the conception of natural environments as having some innate

restorative potential. Those key components are “being away” (i.e., getting away from the usual

situation, task, or mental preoccupation); “extent” (i.e., connectedness of the immediate

experience with the larger world, and particularly with a whole other world, as where one senses

that the wilderness extends far beyond the part of it that one sees immediately); “fascination”

(i.e., the restorative experience draws people’s attention without requiring them to make any

exertion to focus their attention on it); and “compatibility” (i.e., there must be mutual support

among patterns within the immediate environment, actions required by the environment, and the

individual’s own inclinations – so that, again, the individual’s attention tends to move, without

effort, in the direction suggested by the environment) (Kaplan & Kaplan, pp. 182-186). In a

more exhaustive review, which this paper cannot provide, it would be worth exploring the

varying extents to which Scopelliti and Giuliani, and others, find that older people require these

four key components. The state of knowledge presented in this paper, with respect to these key

components, is simply that Laura may find different activities beneficial in different ways, due to


their differential employment of such components – and that, in any case, there may be good

reason to focus upon activity rather than place in this analysis.

To underscore that restorative experience may consist of fragmentary exposure to

distractive phenomena, Kaplan (2001) explores the “micro-restorative experience” (p. 508) of

glancing out of a window in one’s home – which, she says, can briefly take one’s thoughts to

other places, many times each day, with potentially powerful recreational and therapeutic effects.

This argument suggests that the view out of Laura’s window may be significant, not because of

its function as a conscious reminder of her decades of country living, but rather because of its

potential for momentary, unconscious, but nevertheless therapeutic distraction – where the

distraction is congruent with Laura’s mindset because it does, after all, expose her to the outside

with which she is so familiar.

If it is possible for Laura to obtain therapeutic benefit from tiny snatches of positive

experience in that regard, it may also be possible to seek out other activities through which she

may obtain micro-restorative exposure to traces of wilderness. Glancing out of the window is a

rather extreme example of “activity”; the effort involved is so infinitesimal as to render it nearly

coextensive with one’s mere existence in the room. But as just explained, it is indeed the action,

the glance, that opens up the possibility of beneficial distraction from the here-and-now and

provides a reassurance that the great big outdoors is still there.

On a less extreme level, there may be actions, however slight, that in the aggregate may

keep Laura in touch with good aspects of the outdoors. The next section of this analysis explores

interventions that may facilitate the possibility of therapeutic activity.


Avenues of Recourse

According to Shank and Coyle (2002), “Quite often, environments that are intended to

give quality care are overly medicalized and impersonal, or they are stark, institutional, and

uninviting” (p. 176). Laura’s nursing home embodies some elements of both of those nadirs. To

be sure, the staff seems generally congenial, and Laura and her husband have admittedly had the

opportunity to bring personal effects into their room (although, again, her sister has comman-

deered most such effects and presently refuses to surrender them). Despite these touches,

however, the place fails to provide the sorts of interventions Shank and Coyle describe. There is

no program of pet-assisted therapy, nor much contact at all with animals. As mentioned earlier,

there is little to do outdoors, and no program through which to do it. There is no greenhouse, no

horticultural therapy program, not much greenery, no portable gardening cart, no potted plants in

the room. There are no birdfeeders, birdbaths, or caged birds, no gardens, no aquariums.

To compound the situation, Laura herself does not appear overly motivated to seize

opportunities for outdoor-related undertakings. She is not agitating for activities like those just

listed. That, however, may be a function of disempowerment. In the apartment they occupied

before moving to the nursing home, Laura’s husband did have a bird feeder, and filling it was an

activity he looked forward to each day. Laura seems to have considered it her duty in life to

make her husband happy, including whatever activities have been important to him. Thus, in

their previous apartment, she would comment upon the trains passing by on the nearby railroad

track (he spent his career working on the railroad), on the birds feeding at his feeder, and on

other outdoor topics of interest to him. It seems likely that a birdfeeder outside their window

would once again serve as a beneficial activity for both of them. Moreover, one might note that

the example of the birdfeeder suggests that it might be more appropriate to adopt a systems


perspective to this case – to consider the couple to be the true client, of which Laura is merely a

part, and for which she is a spokesperson (see e.g., Vetere, 2001). Several ambiguities regarding

Laura’s views toward the outdoors might fade in that case, given her husband’s unambiguously

enthusiastic orientation toward nature. Even without flinging her husband fully into the mix, the

mere awareness of his presence and priorities might work to Laura’s benefit, insofar as the

provision of distractions for him might help to reduce a sense that she is not succeeding in

keeping him happily occupied.

In several relevant ways, Laura and her husband are probably not unique. The

institutional rooms and dining hall of the nursing home are filled with people who seem to be, as

one resident put it, “waiting to die.” There is a palpable sense that the residents do not call the

shots, but are rather the sheep whom the staff members herd and direct. In other words, if this

nursing home can so dramatically fail to provide the therapeutic environment urged by Shank

and Coyle (2002), then so can others. The single most efficacious intervention might therefore

be, not to fix Laura’s situation by itself, but rather to proceed on the macro level to advocate for

legislation, regulation, litigation, and/or education, on a local, statewide, or national level (see

e.g., Galambos, 1998), so that nursing home operators and/or therapeutic staffers might become

obligated or encouraged to facilitate extensive contacts with nature. Less ambitiously, one might

at least seek to engage the relevant personnel at this nursing home in dialogue regarding the

possibilities for therapeutic, Green engagement.

Yet these suggestions, however good they may be, seem to dodge the question of whether

one can prevail despite such adversity – whether, that is, there is some way to sneak in some

micro-restorative activities with an outdoor flavor, under present circumstances, regardless of

whether the nursing home continues to resist measures like those mentioned in the previous


paragraph. In this regard, Laura made a comment that may provide a foothold. She said, at one

point, “I don’t intend to die here.” Her husband, in his state of advancing senility, will probably

never be allowed to leave. Given the unlikelihood that she would leave him there, it therefore

appears she meant that she would stay until he died, and would then move out.

That comment suggested that Laura essentially considers herself to be in prison, although

for less than a life term. The foothold, then, is to look at the literature of captivity – to see how

people have coped with being prisoners of war (e.g., McCain, 1999), refugees (e.g., Russell,

1996), political prisoners (e.g., Mandela, 2006), or with other environments that have deprived

them of basic elements of a decent existence. This is, in essence, a search for means to smuggle

traces of wilderness into an interior space whose only connection with the outdoors is its

unopenable window. Phrased thus, the search may embrace computer programmers, urban

dwellers, and others whose circumstances put much of nature beyond their reach.

It is not practicable to conduct that search at any great length in this paper. This is, in

that sense, a negative report, along the lines of research in which a certain hypothesis is found to

provide no explanation. It would have been easy enough to recommend, say, pet-assisted

therapy, and to cite quantitative or qualitative research (e.g., Ebenstein & Wortham, 2001)

testifying to its effectiveness – all the while leaving unstated the reality that Laura’s nursing

home does not have a functioning pet therapy relationship arrangement.

Such pretenses aside, the realities are that Laura – and, it seems, others in her nursing

home – face a bleak existence in which, among other things, they are highly shielded from

contact with nature, on multiple levels. Even if it should prove possible to make some initial

breakthroughs like those which some prisoners may make – to bring in a few small plants, for

example, and to install photos of outdoor scenes on the wall of her room – there is the problem


that Laura and her husband are tired. They no longer want complications; they do not seem to

want to do anything other than what the nursing home administrators recommend and encourage.

They appear, in other words, to have retreated into a helplessness, facilitated by the nursing

home itself, featuring extreme docility and amotivation. When the pictures fall down or the

plants die – assuming Laura is even willing to have plants in her room, which may or may not be

her final decision – inertia will likely leave things as they lie.

Sadly, in my role as one-time visitor and researcher from another location, several hours

away, I will not have the time and resources to perpetually revisit the premises, so as to insure

that any hard-won gains in outdoor experience have not been meanwhile rolled back in the name

of cost-cutting and administrative convenience. It would therefore not be feasible for me,

personally, to implement, maintain, and evaluate an outdoor-oriented program of therapy, even if

circumstances appeared conducive to such a program. This summary does not necessarily end

my involvement in the case, but it does capture the state of affairs as of a certain moment in time.


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Wilderness Deprivation Disorder - A Case Study