Hopefully you’ve been following (and enjoying!) our bi-weekly series on the many different kinds of nature therapy. This week, our spotlight lands on blue care, a field adjacent to water therapy and aquatic therapy.
Blue care is a subset of nature therapy that champions the power of water to heal issues of all kind: mental, physical, behavioral and social. It contends that time spent near, in and on healthy waters can have fantastic health benefits and argues that this “blue prescription” should be in every doctor’s toolkit alongside mainstays like exercise, a good diet, and sleep.
Time spent in water has been found to reduce chronic stress and anxiety, conditions which can exacerbate a variety of physical conditions including ulcers, colitis and heart disease. It helps patients manage things like depression, trauma, addiction, grief and PTSD. And it does wonders for fostering essential human qualities like happiness, play, creativity, awe and empathy.
Over 71% of our planet is covered in “blue space”—including lakes, rives, wetlands, oceans, and all waterways. Our blue space provides us over half of our oxygen, holds most of the planet’s biodiversity, affects our climate, provides jobs and food to people all over the globe, and is humanity’s sole source of hydration and hygiene.
Foundational to blue care is the idea that keeping our planet’s waters healthy, clean and accessible is critical to both our health as humans and the health of the entire planet. Blue care stresses the importance of biodiversity and the intimate interconnections that bind humans, animals and our environment together. Simply put, our lives and wellbeing depends on the robust health of our blue space, and it’s both our responsibility and our privilege as humans to make sure we’re taking care of it.
As this booklet on the Blue Mind Rx (worth reading in full!) reminds us, “Aquatic biodiversity has been directly correlated with the therapeutic potency of blue space, [and] immersive human interactions with healthy aquatic ecosystems can benefit both.” Basically, working to maintain the health and biodiversity of our blue spaces makes those spaces healthier for humans, and humans interacting with those ecosystems (in the right ways) can actually make them healthier in turn, creating a positive feedback loop that makes everyone and everything involved better for it.
The history of blue care
As seems to be the case with almost every kind of nature therapy, humans have been using blue care to heal ourselves long before the science caught up with us.
The ancient Greeks and Romans swore by their hot springs, which they bathed in to promote relaxation and improved circulation. Swiss monks were known to dip sick or disabled patients into thermal waters as early as 1238 CE, and even then immersion in warm water was known to decrease pain and increase flexibility. Therapeutic spas soon cropped up around these Swiss waters in the 19th and 20th centuries, eventually evolving into what we know today as the Bad Ragaz Ring Method of aquatic therapy. Japanese hot springs, which have been around for thousands of years at least, were thought to have positive effects on chronic pain, skin problems, menstrual disorders and constipation.
And poets and philosophers have espoused the healing benefits water for the mind and soul for almost as long as they’ve been writing. An ancient Slovakian proverb sagely contends that “pure water is the world’s first and foremost medicine.” The Koran tells us that “by means of water, we give life to everything.” And e.e. cummings wrote, “For whatever we lose (like a you or a me)/It’s always our self we find in the sea.”
Humanity has always been moved, soothed, awed and healed by water—but it’s only recently that we’ve been able to prove its efficacy in a more scientific setting and use that information to provide the healing power of blue care to more and more people.
What does the research say?
Like many types of nature therapy, blue care has been in use for far longer than it’s been studied. Some of the barriers to studying these interventions are the lack of funding and the difficulty in assessing their effectiveness. As one psychiatrist studying the effects of blue care on PTSD put it, “If I’m studying the benefits of fly fishing, do I control for the number of fish people caught? Or for the weather?”
Unlike pharmaceuticals, which easily translate to data and hard numbers, the benefits of blue care interventions, and all the variables involved, are far more subjective and thus harder for some scientists to wrap their minds around. An early 2011 study on the the impact of blue space on human health and wellbeing had a clear-eyed view of the obstacles the field currently faces. It said that the “inattentiveness to blue space” in our culture at large and in the health sphere specifically impacts our ability to study long-term its effect on our wellbeing: “There is still little respect for water and health in planning issues.”
Despite this, there is still thankfully a growing field of research fighting for attention and funding that confirms what many humans have known intuitively for centuries about the healing properties of water. A recent 2018 study, aimed at addressing the gap between our growing interest in the therapeutic uses of water and the lack of evidence-based studies on it, found that blue care can have “direct benefit for health, especially mental health and psycho-social wellbeing.” There was also evidence that blue care interventions fostered greater social connectedness, another key component of mental wellbeing.
A 2017 study did a systematic review of quantitative evidence collected on the relationship between outdoor blue space exposure, health and wellbeing. It found “consistent evidence of positive associations between blue space exposure and mental health and physical activity” and urged scientists to continue studying this area in order to better understand the causality.
A 2015 study used aquariums to look specifically at the influence of biodiversity within natural environments on human health. It found that the higher the species richness in these spaces, the greater the calming and stress-reducing benefits were for the viewers. Viewing aquariums with high biodiversity was associated with greater reductions in heart rate and greater increases in self-reported mood.
And a 2009 study that looked at health and wellbeing on the coasts made some highly relevant observations about the symbiotic relationship between the health of our blue spaces and our own health. It observed that spending time in blue spaces didn’t just improve human health and wellbeing; it increased people’s understanding of the threats to our coasts and their desire to be a part of the preservation process. Simply put: “We neglect these human health aspects of our coasts at our peril.”
Blue care in action
There are so many different ways that the healing power of our blue spaces can be harnessed to promote and maintain human wellbeing. As you can imagine, the types of activities that fall under the umbrella of blue care are as varied and vast as our planet’s blue spaces. They include swimming, board sports, floating, soaking, diving, scubaing, boating, fishing, beach/coastal walks, wildlife watching, and water-based or aquatic therapy, just to name a few. And these various water-based activities can be used to help solve a variety of health issues.
This fascinating article describes how scuba diving with whale sharks is used as a method to help veterans dealing with PTSD. Mike Hilliard, a dive master who is also a former army sergeant, described how traditional interventions like medication and exposure therapy had only made his PTSD worse, and he was considering ending his life until he found scuba diving. He described its profound impact on him eloquently: “Seeing the fish, hearing the ocean — there is a complete innocence about it. There are no bad memories in the water. Everything just wants to live. It made me want to live again.”
Surf therapy is another popular intervention for veterans and civilians alike. This article talks about the surfing program at the Naval Medical Center San Diego, which instigated a study back in 2018 whose results indicated that surfing can lead to a decrease in feelings of anxiety, insomnia, and other symptoms of depression. Surf therapy has also been found to be hugely beneficial for people with autism; this article details how the author’s son transformed when introduced to surfing, even inspiring a local non-profit called Surf for All. Surf for All expanded to eventually include “cancer survivors, paraplegics, quadriplegics, amputees, and platoons of Wounded Warriors on temporary furlough from Walter Reed Hospital,” all harnessing the power of the surf to heal “one wave at a time.”
Boating therapy, or therapeutic sailing, is another popular form of experiential blue care therapy. Organizations like Sail to Prevail allow disabled individuals, both adults and children, to overcome adversity and boost confidence and self-esteem through responsibility and leadership. It’s also used as an intervention for addicts in recovery, allowing them to build skills necessary for sobriety in an environment that helps them overcome challenges, develop mindfulness, and make decisions with consequences.
And for those who aren’t feeling up to activities so adventurous, just being in the water—swimming, exercising, or simply floating—can be hugely beneficial. The buoyancy of the water allows for a greater range of motion in the water than on the land, which is why so many seniors and people with disabilities see such a benefit from aquatic therapy. The hydrostatic pressure of the water can decrease pain, increase circulation, and even serve as a kind of passive massage for sore muscles—and it dampens tactile sensory information to the brain, making a float or swim a huge source of calming energy for many people.
The burgeoning field of blue care will only become more and more relevant as we move deeper into the 21st century and contend with threats to our natural environment which, in turn, threaten our own health. Patients are eager for less invasive, non-pharmaceutical solutions to their problems, and blue care (alongside other kinds of nature therapy) can be an excellent way to foster and maintain our own health alongside the health of our communities and environments.
Crucially, much of the research espousing the medical efficacy of blue space requires the blue spaces in question to be healthy; we can’t use water to heal ourselves if the water in question needs healing as well. Humans are made up of mostly water; we have a lot more in common with our planet than we might think, and our health and futures are intimately intertwined. Perhaps we—the humans and our watery planet—are each the solution we’ve been searching for. Blue care allows us to tend to the health of our only home and at the same time heal ourselves in the process.