Salugenology (WHY HUMANS REQUIRE HOBBIES) Part 1 with Julia Hotz
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Oh, hey, it's the guy at the falafel truck who gives you extra hummus, Ali Ward. So if you come to Allogies for the Toads, but you stay for the science-based self-help advice, this one delivers with info on how to lift your blues with some suggestions that make us healthier and calmer, less anxious and more present than ever.

This episode may alter the course of your life. So this guest is an award-winning author and a journalist who has written for Time, Wired, Scientific American, The New York Times, and she spent several years interviewing doctors and patients and digging into published research for a book that has been praised by Harvard University as the best public health book of the year. And it's backed by a bunch of doctors who are like,

Yes, this. And when I got a heads up on her book, The Connection Cure, The Prescriptive Power of Movement, Nature, Art, Service, and Belonging, I was like, is this bullshit? And then I looked into the bibliography and I wanted to chat with her for selfish reasons because it ripped. I was like, this is great. So I figured you might want to hear it too. And hence...

An episode was very much in order. Actually, two episodes. So part one and two, because this interview itself is almost two hours long. It's worth two installments, trust me. So social prescribing, it has its own ology. And sure, I have found it used only one time in the scientific literature, but the field is well established. But we're going to discuss the etymology in a bit.

But first, thank you to patrons for supporting the show for as little as $1 a month and submitting your questions. Thanks to everyone walking around in Ologies merch. We have summer stuff like hats and even bathing suits to wear on your rear end. We also have Smologies episodes for free. They're in their own feed, wherever you get podcasts. If you're looking for shorter episodes,

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Okay, so, Cyanogenology, let's get into it. It is most commonly known as social prescribing, and it centers on a shift from, like, what do you do when you're sick to when you're not sick?

What's the matter with you to what matters to you in treating and preventing illnesses? And I asked this guest an absolute fire hose of not smart questions about why five main factors improve our quality of life and longevity and

Why do we need to go outside more? How to figure out what lights you up? How to schedule time for hobbies if you have no time for hobbies? Free stuff you can get to make you happier? How has quarantine and a pandemic affected how we interact? What if social interaction gives you the willies? What if depression keeps you from doing things that lift depression?

How do you hang out with people without being drunk? Is there any data to support chilling out? The scientific deal with cold plunging, if your health insurance covers having fun, how capitalism can literally kill us, where to volunteer to check off a lot of life-improving boxes, how much money you can save if you join a knitting circle or a fishing club, if protesting is a good hobby, if you build it, will they come, and why she hates the title of her own book.

with author, journalist, deep diver, and absolutely lovely and altruistic person and salugenologist, Julia Jules Hotz. My name's Julia Hotz, and my pronouns are she, her.

I have known of your book for a while. And when I first got it, I was like, whoa, this is a thing. It's a thing. I was trying to describe it to patrons so they could submit their questions. And social prescribing was sort of the closest thing that we could like nail it down to. But what do you call this science?

Yeah, great questions. I mean, the study of health. But the word that people actually use is something called salutogenesis. And this is the study of health. Like if you're ever in Italy and they say salud or Spain or in France, they say something. That actually comes from this Greek word, you know, salud, which refers to health.

And so every time, you know, you're clinking the wine glass, they're saying to our health, to our health, to our health. And it's used in contrast to this thing called pathogenesis, right? The study of disease.

which science has done such a great job at. I mean, the fact that, you know, I could go to a doctor, they could swab my throat, they could be like, yep, you have a strep throat pathogen. I'm going to treat you with antibiotics. Boom. That's amazing. But there's been far less attention to the opposite, to the study of what makes us healthy. Oh, wow.

Oh, shit.

And so he was the one, Dr. Anton Antonovsky, who coined this idea, we should study the factors that make us healthy. Health is not just the absence of disease. It's the process through which individuals understand that their life is comprehensible, manageable, and meaningful, and can function even in the face of these extreme environmental changes.

So it's like the not just surviving but thriving kind of study? It's not just surviving but thriving, exactly. It totally makes sense that we don't think about health this way. Like from our earliest ages, we were going to the doctor, strep throat, ear infection, boom, we got the medicine. But an infection or breaking your arm, trying to do a backflip on your aunt's trampoline are pretty clear-cut in terms of diagnosis and treatment. But not so much...

Chronic pain, lingering illness, and mental health. Just waking up feeling like trash, going to bed feeling like trash, and then filling the waking hours with breaking horrific news. Like, what could go wrong here? For a long time, our healthcare systems haven't really been set up to ask this question. But now...

Drum roll. Based on the fact that people are getting sicker and sicker, you know, modern medicine therapy, it has its place. It's done wonders for us. But clearly there is something about our environment that's making us sick.

So what if healthcare actually got involved in helping us feel better, in prescribing us resources and activities that help us feel healthy? And this is where the practice of social prescribing comes in.

And does it help mental health? Does it help physical health? Or is it kind of like when your mental health is better, your physical health is better and vice versa? When it comes to tackling this, where does this tend to concentrate? What does it affect? Great question. And shout out to your great dolorology episode with Dr. Rachel Zoffness, who talks about the way that all of our pain is interconnected. So all of our health is too. And we kind of like know this intuitively, but

For example, today, it's like a beautiful spring day in New York. I was so excited about this interview, so I went for a little run before it. I got my heart rate up. I got those endorphins going. We know that movement is associated with the release of endorphins and serotonin, but also that exposure to sunlight is going to calm me down. So that's the beautiful thing about social prescriptions. They've been used to help treat everything from anxiety and depression to

things, you know, associated with a deficit in serotonin, as well as chronic

chronic pain, type 2 diabetes, even dementia in some cases. And I want to be really clear and say this is not NOT, not a replacement for other kinds of medicine. This is just about putting another option on the menu. So an illness or depression isn't in your head, but social prescribing or behavior modifications can help, sort of like therapy can? Absolutely, absolutely. And you know,

It comes down to this really fundamental statistic that 80% of our health outcomes as a population are driven by differences in our environment. Oh, that's nuts.

Yeah. If you're working, you know, three jobs, if you have to drive an hour to work, if you don't live in a community with green space, if you're struggling to, you know, keep ends meet, if you're the sole caretaker, all of these environmental factors are going to impact your health. Only 20% of our health differences come down to what happens in clinical care. True.

20% is clinical, 80% environmental. Oof, y'all. So you would think then that 80% of our health care would be about treating us through those environments. It would be about finding sources of childcare. It would be about getting transportation to take us to green spaces. So that's kind of like the practical, but philosophically what social prescribing is, it comes down to

shifting the question that doctors often ask, you know, what's the matter with you? Tell me about your symptoms to what matters to you. Tell me about what brings you a unique sense of joy and purpose. And then let me, as your doctor, work with my team to actually prescribe you something that helps you get closer to what matters to you. So for you, Allie Ward, I have made you... You're ready for this. Yes.

Julia held up a little medicine bottle, like a tiny capped diorama. That's amazing. This is a, you're showing me right now an amber prescription bottle, white cap, as you see, and there are objects in it. And I want to know what are those objects? Yeah.

Yeah, well, let me caveat this by saying, you know, this is a limited social prescription bottle for you, Al. You have so many things in listening to your show, learning about you that matter to you. But here are a couple I've picked out. So number one, of course, we have a doggie, your beautiful doggie, right? Yes. Gremmy, gremlin, who was dozing next to me and whose collar you might hear jangling, but also was in miniature in this little bottle. Call me. I know your dog matters to you so much.

We, of course, of course, have a little bug. It's actually a little snail. They didn't have too much in the bug collection over here. We have your partner. We have a ukulele. Yes. It's all underneath a tree. Oh, my God. I'm going to cry. Oh, my God. That's amazing. How did you remember that I played ukulele? Oh, girl, I've been listening to you a long time. Yeah.

Oh my God. I haven't played in years either. That is just it. That is exactly what you said right there. That is what social prescribing aims to do. It aims to help us tap into like, what are the things we love to do when we were younger? What are the things, if we had two more hours in the week, what would we spend it doing? We think of those things as like, nice to have one day if I have time. Healthcare is saying no.

This matters to you. This should be part of your health care plan, because guess what? If I prescribe you a spot in a ukulele class that meets every Tuesdays at six o'clock with nine other people, you're going to make the time for it. And I guarantee you, and I have lots of stories around this as proof and scientific studies as proof that your health will improve. Shit.

Now I got to join a ukulele group. That would be so cool. You know what? My sister works with dementia patients and they have a ukulele group that comes in place for them like once a month and like the days when the ukulele people come and play. And now, fuck, I'm going to have to do that. I love it. It's a sign. It's a sign. That's so cool. So for me, those are things that I love. I love looking at bugs.

I love running around with Gami, aka Gremlin. I was just running around with her in the yard and it was so cute and fun. I love hanging out with Jarrett. All those things. Love trees. What are other things that people might prescribe? Are there any doctors write that down on a pad so that you take it seriously? Because it's so easy to be like, oh, sounds pretty nice. Wish I had time or whatever, even though we spend so many hours scrolling. Nonsense.

Exactly. So it's a big yes to that question. First, let me talk about the different kinds of social prescriptions that there are and why they are what they are. So I've written this book, The Connection Cure, which is all about how doctors in 30 countries around the world, including the US, more on that, are actually prescribing this. And it's not just doctors, it's therapists, it's

And we can also talk about why, like why now are they doing this? But you'd asked about like the kinds of prescriptions. And from my research, it pretty much comes down to five core ingredients, let's say. It comes down to movement, nature, art, service, and belonging. Oh, wow. I got it. Thanks. Once again, movement, nature, art, service,

service and belonging. By the end of the episode, you're going to be applying for a personalized license plate that reads MNASB4EV. And so there's a couple of reasons for that. And the first one is like in these 30 countries, you know, these were the types of social prescriptions that people kind of kept organically independently landing on.

And we know this from the data that part of this has to do with the way we as humans are wired to be in these kinds of environments, right? Like think about us tens of thousands of years ago. We were out there trying to survive on the big bad wild. We had to move our bodies.

And so it was adaptive for us to be able to move our bodies well. And our bodies respond to that kind of movement, right? We increase our levels of serotonin. We increase our endorphins, right? It's not just, you know, Elle Woods. Endorphins make you happy. Happy people just don't shoot their husbands. They just don't. Endorphins make you happy. Happy people don't shoot their husbands. That whole line. Like, that's true. Yeah.

So right, movement. And that's not that controversial, right? Doctors have been saying for 50 years, exercise more, exercise more. Nature, same is true there. I mean, there's some really fascinating research from the 1980s

showing that nature has these unique powers of restoring our attention. It's really interesting, the 80s too. I know you're an 80s baby, like kind of like the prime decade of, you know, everything's distracting, video games, commercials, neon this and that.

Well, what these researchers found is that because of the way that we evolved to be in nature, we evolved to be able to say, hey, you know, there's a bird up there. That looks like a tasty dinner. There's a fish. There's something about the way we respond to it that doesn't suck up our attention. It actually restores our attention such that we're

When we leave a natural setting, we feel more calm. We feel more restored. We feel like we're actually better at focusing. That's so funny because I love running and walking. And if I do it on a treadmill inside of a gym, it feels really different than me going to the local lake and seeing people and seeing dogs. And I always see that guy running at the same time. And there's spiders in the trees. And I...

never put a lot of weight into that. I just think it's a preference, but it's actually probably chemically like helping my brain. So much so. I'll tell you two really interesting studies that show, yes, it's not just you. This is pretty universal. So these researchers at Stanford University put students in two conditions. They had them walk for 90 minutes. And in one condition, the walkers were, you know, just walking along like the busy street

Next to a highway, not a lot of green, not a lot of nature, not a lot of room for the imagination. In the other condition, those students walked in a park setting, you know, with all these lush trees and animals, just 90 minutes.

Well, what did they find at the end of these 90 minutes when they compared these two groups? You know, not only did the students in the nature group self-report feeling more calm, more relaxed, you know, better at focusing, but they also did fMRIs and they found that students who walked in the nature group had less anxiety.

activity in their subgenual prefrontal cortex, which is associated with rumination, which is associated with anxiety and depression. So you put that all together. Yeah. And you find that, wow, it's not just in our heads. Like there's some serious antidepressant anxiety relieving effects of being in nature. And I think it comes down to the way we evolve to love and pay attention to nature. Yeah.

So this was a 2015 study titled Nature Experience Reduces Rumination and Subgenual Prefrontal Cortex Activation in the Journal of the Proceedings of the National Academy of Sciences of the United States of America. And it notes that more than half of the world's population lives in urban settings. And while urbanization has many benefits, it's also associated with increased levels of mental illness, including depression.

depression. And in fact, it says city dwellers have a 20% higher risk of anxiety disorders and a 40% higher risk of mood disorders as compared to people in rural areas.

And I thought maybe that was all just having cheaper rent. But the paper details that those 90-minute walks and the effects on rumination centers of the brain, and it concludes that nature experience may improve mental well-being and accessible natural areas within cities may be a critical resource for mental health in our rapidly urbanizing world. So city dwellers.

Give us parks or give us death, like for real. But what else do all human animals need for enrichment? So there's movement, there's nature, there's belonging, there's art. There's belonging, there's art. Art's another one I love. People think, oh, art, you know, that's nice. But like, really? Doctors are going to prescribe that?

Researchers from Drexel University looked at what happened after just 45 minutes of engaging subjects in an artistic activity and found that they had significantly reduced their levels of cortisol, of stress. No way. So I perused this 2016 study, Reduction of Cortisol Levels in Participants' Responses Following Art Making, in the Journal of the American Art Therapy Association, and I found that

delightfully, that scientists did spit tests for cortisol levels on 39 volunteers between the ages of 18 to 59 before and after a crafting session. And then they asked them to describe their experience. And the researchers gave them collage materials, modeling clay and markers, and just told them...

scientifically go to town, do whatever you want. And the data show that making art stuff resulted in lower cortisol levels. And the participants said it was relaxing, enjoyable, helpful for learning about new aspects of self,

freeing from constraints and that the process of initial struggle to later resolution and losing themselves in that flow was all pretty nice and chill. And no, to be an artist, you do not need teen angst or decades of experience or even a septum piercing, as there were no significant differences in outcomes based on prior experience or art supply choice or gender.

And this is not that novel. I mean, art therapy has been around as a discipline. There's something about the way engaging with art sort of helps us shift our perspective and realize like, hey, we're not alone. But yeah, that also comes down to the way I think we as humans trying to make it in the big bad wild. We told stories with each other. We painted on caves. We made jewelry. We tried to seek out and talk about the beauty of the world. So there's something very primal about that, too.

Well, let's get depressed. How are we living that is not hitting these bases? Because I don't know a lot of people who are thriving at the moment, TBH. I know people who are succeeding, but on a day-to-day, how is your mental health doing? It's a struggle. Right. And we live in the United States, which is going through some stuff. But how is 2025 living...

maybe not engineered to hit these bases. Absolutely. Well, you're asking the great question because that's exactly how I felt when I wrote this book, sort of in the throes of the pandemic, especially.

And I think it was no coincidence that rates of stress, rates of loneliness, rates of anxiety, depression, all these things going up, up, up, up, up, up. You could see the recent long COVID episode too. And, you know, there has to be a reason for that. And what is that reason? And I think a lot of it comes down to the way our environment is making us sick.

Now we go back to like our evolutionary needs for survival, movement, nature, art, service and belonging. They weren't just a nice to have if I have time. You needed to do this to survive. And importantly, you couldn't do it alone. Like, yeah, you try to survive out there in the big bad wild on your own. Good luck. But now, of course, as I talk to you from my Brooklyn apartment, I can have all of my basic needs met online.

without leaving. I need food, I can order it. I want entertainment, I can stream it. I want to feel a sense of belonging, maybe I'll turn on a TV show where, you know, I'm feeling a connection to the characters. So I think it's become easier and easier for us to choose an environment that disconnects us from these things. And yet,

When I just replay back 20 minutes ago when I showed you this and I saw the way that your face lit up when you remembered how much you love ukulele or when you described to me the difference between running outside and running, you know, on a treadmill, intuitively, you know that.

that these things are good for us. And it's not just intuitive, right? There's a ton, a ton, a ton of data showing that these five things in particular have profound effects for our mood, our energy, our attention levels, our longevity. But the question is,

okay great so now what I mean what do we do about it and for a while right it was sort of this thing of the doctor with the wagging finger saying Allie you should relax you should take some time for yourself you should go outside more you shouldn't blah blah blah whatever it is yeah I heard that it would infuriate me like literally had doctors I was going through ovarian failure had doctors telling me can you just like quit your job and I was like who are you gonna pay my

my rent? Like, what are you taught? No. And, you know, my friends being like, you need to relax, you need to take time off. And it's really hard when you're like, if I take time off or whatever, what if I drop the ball on all my stuff? The anxiety of...

losing the momentum you have with work or whatever, it keeps you from relaxing. Right. How do people accept that as a prescription? Right. We're all on this treadmill. I totally get it. So let me tell you, let me tell you a story that shows, you know, what we kind of expect to happen in healthcare and what it could become and what is starting to happen.

So one of the first stories in the book is about this guy named Frank. And, you know, Frank is this lovely older man. He was a truck driver. And you can imagine the life of a truck driver. You know, you're sitting in your car. So you're sitting most of the day. You're probably not pulling over to the side of the road and picking fresh tomatoes like you're probably eating fast food and you're alone. Right. So Frank.

Frank was in this profession and, you know, he would go to the doctor and he would have a terrible time there because what did the doctors do? They would always focus on what was the matter with him. They would sort of shame him and say, you know, Frank, you're overweight. You have type two diabetes. I'm going to prescribe you insulin. You're going to be on this insulin for the rest of your life.

And so because of that negative experience, because going to the doctor, Frank really felt terrible about himself and felt exactly how you feel like, OK, yeah, well, I know that my job is the problem, but yeah, I'm not going to like go to an equinox class after my long day of truck driving. What can you do for me? They didn't have a lot of answers until he met somebody who was

adopts social prescribing and practices health a little bit differently and really is big into salutogenesis, right? The study of health. And that doctor, Dr. Ali Hart said, you know, Frank, tell me about something you loved to do when you were a kid. And it just so happened that Frank had moved to this new community. He didn't really know anybody. He didn't really know how to get involved. And so Frank starts to talking and eventually they both realized that they both love riding their bike. Oh, wow.

That's so cute. Right. And it wasn't this conversation of Frank, you need to exercise more. Tell me what you love to do to exercise. It was all about what do you love to do as when you were a kid and Frank could have said art, Frank could have said anything, but he said riding his bike. So then the doctor didn't say, okay, great. Good luck. Go ride your bike. He said, here's what I'm going to do. I'm going to prescribe you a bike and I'm going to prescribe you a spot in this cycling course that meets Tuesday evenings after your shift and

And if you don't want to go alone, I'll go with you. Wow. Dude, that's a good doctor. That is a good doctor. And let me tell you what happens to Frank. So he's prescribed a spot in this course and he's nervous. He doesn't know anybody. He's an older adult. He hasn't been bike riding in years. That's who the course is designed for.

Eventually he starts going. It becomes a weekly routine. He starts befriending the fellow cyclists. They have their little, you know, WhatsApp group on the side. They call themselves the chain gang. Eventually, even after this Tuesday course ended, the 10 of them said, well, we really love doing this. Let's keep meeting even outside of this prescription. Frank eventually loses 40 pounds. He's able to come off his insulin, which is what doctors originally told him was impossible.

And more importantly, he doesn't see himself as this sick person who hates doctors. He sees himself as this healthy person who's able to create his own health. And sure, the social prescription helped him get there.

But ultimately, these are all things that now that the bridge has been made, he can do on his own because you really have to experience the health benefits first to be able to say, OK, this is worth my time. This is an investment in my time. When I go for that two hour bike ride, I'm going to come back feeling more energized. I feel like I'm saving time down the line. So that is one example of what this could look like.

And if you're like, I wish I knew the name of that free program that gives bikes to older adults and provides a six-week course to intro them into biking and road safety, it's called Pedal Ready in the UK. Now, in the US, you can check with local YMCA programs. You can find resources through AARP, or there's something called Silver Sneakers, which can be covered by Medicare Part B and some supplemental health plans. And Silver Sneakers has a

bunch of different fitness programs from pickleball to water workouts. And their site says that from national gyms to local community centers, there are more participating fitness locations available in the U.S. to Silver Sneakers members than there are Starbucks, which is frankly

frankly dizzying and very encouraging. But what if just getting there is brutal? You can also look to the National Aging and Disability Transportation Center to help out older adults, people with disabilities, and caregivers.

And I also just found out that in 41 countries, there's a program called Cycling Without Age where volunteers on a bike can pick up older adults and give them rides in a trishaw, which is like a pedicab, for those who need a ride and some nature and fresh air and some good convo. And the passengers also seem to get that.

And you can start a Cycling Without Age chapter in your area, or you can hit the site that we'll link on our website to see if there's a chapter nearby. I looked just out of curiosity. I live in L.A., and there's one in Hollywood via the L.A. Bicycle Coalition. And after a quick break, we're going to address whether you're the one having a ride or giving it. What if mobility is an issue? We'll also chat about education.

how to pick a hobby, how the epidemic of loneliness affects emergency medicine, whether cold plunges are bullshit, and more. Right after, a quick hello from sponsors who make it possible to donate to a cause of theologist choosing. This week, Julia pointed us toward Grow NYC, and she's going to tell us more about them later in the show. So thank you, sponsors.

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Okay. Where were we? Yes. Whether you're the one having a ride or you're given one, what if mobility is an issue? Let's say that you have a disability where you can't hop on a bike. Do those types of like art combined with a club where you're going to see people and do the art or you're doing something where it's art and it's service, does it typically help if it's more than one thing, more than one of those five things at once?

Totally. And I mean, even with the biking, it was, you know, movement, it was nature and it was belonging. Right. And it's also service because now Frank goes and he talks to people about his experience. He helps other people in his shoes. I think more often than not, it's some combination of it. And I think more important than the activity itself is about it mattering to the person. Oh, you know, like, okay.

Of course, physical movement is really good for things like, you know, being overweight, type 2 diabetes, that sort of thing. Art, the studies show, is really good for stress and anxiety. Service is really good for people older in their life. It's also good for people with chronic pain. But, you know, at the end of the day, it's...

going to be about what matters to the person and also what's available in the community. And to your point, if somebody can't physically leave their house, I talk about a couple of examples where there are virtual social prescriptions available as well.

And those also are helpful despite the fact that you're on a screen, like if you have limited options. Absolutely. Yeah. I mean, one story is about this 92 year old named Glenn who, I mean, he's 92. So he literally had no social connections left. I mean, I can't even imagine the experience of being that age and having nobody to talk to, not leaving your house in years because you can't drive anymore. Well, he gets prescribed a volunteer phone call buddy.

And this volunteer phone call buddy is not just instructed to, you know, say, hey, how are you, Glenn? But is instructed really in the mechanics of belonging, of really making Glenn feel known, which evolution tells us that part of the reason why we seek belonging and seek close relationships is because of the way that we want to be seen and known. And this helps us with our evolutionary advantages, that sort of thing.

So that's what Glenn is prescribed. And sure enough, after these phone calls, they develop a genuine friendship. Ryan helps this, the, you know, his phone call buddy helps Glenn go to the doctor's office. He grocery shops for him. He

He's able to help him get a handle on his other health issues that he really didn't have the motivation to do before. So that's just one example of what this could look like. But I absolutely think, yeah, it doesn't make sense to prescribe somebody a cycling class who has their mobility compromised or doesn't have green space near them. It needs to be really about meeting people where they're at. I think that's the other thing about feeling known is that

You can't feel truly known if you can't be authentic and connecting with things that you actually love brings out an authenticity that you can't really suppress. Like for me, I might not have this authenticity if I were to go volunteer doing something that I hated doing or if I did a hobby that I wasn't interested in. I don't think that my authentic self would show up. And so that being known as who I am

wouldn't arise. But for me, you know, I definitely have battled anxiety and depression. For you, when you were motivated to write this book, especially in the throes of quarantine and things like that, did you find yourself coming from a place of wanting to help others or wanting to help yourself or what personally drove you down this road?

Yeah, I mean, and first of all, you know, it's incredible that that you could share that and you can be the person that you are. I think our culture has, you know, such a negative and limited depiction of what that is. And that's kind of why I wrote this book, because it's like all of us, by virtue of living in this world, we were really not designed to thrive in. Yeah. May struggle with some of those symptoms at time to time. And it's not a fault of

of the person. It's a fault of a world that doesn't set us up for what we need. So, you know, for me, I, yes, I really identified with that. And I think it's one of those things where I didn't really realize why I was writing the book until I'd written it. It was kind of like, this is interesting. I know a lot of people who really aren't thriving right now, but, uh,

Certainly not me. Until, you know, I, oh my gosh, I'd been so blind to all of the ways I was dealing with anxiety, depression, attention issues. I had like these chronic migraines that I like swore something was wrong with me. I clearly had a tumor, you know, and it was getting, trying to get all these answers until I,

I really got inspiration from the characters I reported on and thought, no, actually, it's funny how my migraines tend to be worse when I have no sleep and I have no control over my time or my inbox and all the things that, you know, lots of people on your pod have shared before. So remember, Julia is a professional journalist and is prone to falling down very,

research holes for stories. So digging into the research, it's not something new to her. And after compiling all these interviews with patients and doctors and looking at data, she decided to structure the book that she wrote in three parts. There's Social Prescribing for Better Health,

social prescribing for better health care, and social prescribing for you and me, because journalists heal theyself. I think it was a combo of that. And that's what encouraged me to really write this part three, where I got real deep, like, hey, I'm not doing well in all these ways. And based on the science, and based on what matters to me, and based on what's available in my New York community, I'm going to prescribe myself these things when I'm feeling this way, and I'm going to report back.

And even though the book is called The Connection Cure, I hate that title. I really. You hate the title. Did you title it? No, between you and me and all your listeners. Really? No, but.

I get it. It's catchy. They both start with C. But, you know, I think I opposed to it because it sort of reinforces this idea that we can be cured or that we are sick as individuals when really it's our environment that's sick. Yeah. Right. Like the analogy I use is like think about you have a lot of science listeners. So here's a little thought experiment. You have 10 people in a room and seven of them are sweating. Uh-huh.

In our current healthcare system, or healthcare as it had been, we would take those seven people. We would diagnose, like, okay, precisely when does the sweating start? And, you know, can I prescribe you something that blocks the sweat? Blah, blah, blah, blah. We'd go through sort of the clinical workup. Before asking...

If most people are sweating, maybe the room is too hot. Can we put the air conditioning on? The fact that I didn't see that coming is like... But we all don't. We all don't because we're so steeped into this sort of culture that starts when we're very young. When we don't feel well, we assume that something is wrong in our bodies and that there is something there to treat that wrong specific thing in your body.

body. This goes back to what Dr. Zoff said, and there is truth to that.

So Dr. Rachel Zoffness, side note, or Dr. Zoff, was our guest on the dolorology episode about pain and its biopsychosocial origins and the behavioral therapies based in scientific research on chronic pain. And we'll link that one in the show notes. So it's not a pain to find. But yeah, the world is a little fucky and so are our bodies. You know, it's not made up. It's not fake. These afflictions are very real. But by continuing to just

treat things in a biomedical way and not treating with the environment as well, we're really missing out. Well, what happens if you're so deep in the shit that you can't make yourself do this? That's one thing with depression is depression is like, why brush your teeth? So then it's hard to just be like, I'm going to join a knitting circle. What are the steps out of the swamp

Absolutely. And that's you're absolutely right. There's something called the depression catch 22. Really, really frustrating that, you know, the symptoms of depression are very,

Fatigue, low energy, low mood. You know, you want to isolate and lay in bed all day when the thing that is best for treating those symptoms is getting outside, moving, socializing. But of course, somebody who's in the thick of it, that's going to sound like the worst thing possible. And this was true for somebody I report on in the book. Her name's Amanda.

So this happened during quarantine. And during quarantine, you know, this was in itself a very socially disconnecting time. Now, you could imagine how somebody who during quarantine, they're already very socially connected. What would their bodies do if during that time? This was true for Amanda. She finds out her husband is having an affair. Her mom passes away.

She loses her job. And then because of all this, she has to move to a place where she knows nobody. And this is during quarantine itself. So super, super disconnected. No wonder that Amanda is severely, severely depressed. Yeah. So she gets prescribed an SSRI and it really, really helps her. It really, really helps her with those extreme deep, dark thoughts.

And it was true that after Amanda began her antidepressants, she said, this is great. I'm better than I was, but I'm still not thriving. What can I do to thrive? But it came again with this catch 22 thing of she didn't really want to leave her house. She didn't know anybody. So where would she begin? That step felt really, really hard.

So fortunately, the place where Amanda moved was a place that had just adopted social prescribing. Whoa, where was this? So there's this beautiful seaside community in England. And she ultimately starts to get a little bit curious. What would it be like if I went swimming? And again, the thought of her taking herself out there to practice swimming felt really, really hard. But she happened to have this mental health nurse who said that

There are sea swimming lessons available on prescription. And it's actually because of all this data showing that cold water exposure, swimming, moving your body, belonging is really, really good for certain symptoms of depression. It's going to be covered for you. Can I prescribe you a spot? Nice. Again, kind of like with Frank with the cycling, it makes it so much easier when A, it's something you're already a little bit interested in.

when you have all the logistics covered, when you know that there are other people in your boat that are going to be there, and when there is a specific time and place to do it. So...

Amanda gets prescribed this sea swimming lesson, which I go in the water with her when I go out to meet her. And let me tell you, it is freezing. I was there in September. These women do this 365 days a year. Cold open sea, no wetsuit, total ballers. Oh, God. And...

You know, like some of this is true on a level of physiologically. We know for the same reason we love taking cold showers. There's something about that that makes us feel really awake and alert and energized and all of these wonderful sort of antidepressant effects. But also, of course, there's the fact that Amanda is trying a new skill. She's moving her body. She's doing it with her fellow swimmers. She's exposed to this beautiful seaside environment she's never been before.

And then kind of like Frank, of course, they form a little texting group. They decide we want to, you know, actually be friends. Let's have tea on the weekend. Let's make jam together, like do all this English shit. And, you know, come to not only make sea swimming a part of like their friendship routine, but also all these other things as well. So yeah.

I know that it's going to look different for everybody. I'm not saying that the solution is sea swimming, but maybe for some people at some point, there's that thing that they're a little bit curious about and there's a healthcare provider who can help bring you closer to that thing.

Listen, I know what you're thinking, because I'm thinking it too. So I looked into cold plunges, partly just to be petty, and I did find a 2022 paper titled, Health Effects of Voluntary Exposure to Cold Water, a Continuing Subject of Debate. And it was published in the International Journal of Circumpolar Health.

which noted that while some studies have been small, cold water immersion, quote, seems to reduce and or transform body adipose tissue, as well as reduce insulin resistance and improve insulin sensitivity, which may have a protective effect against cardiovascular and metabolic disease and could have preventative health effects. However, without further conclusive studies, it says the topic will continue to be a subject of debate. So a further study, 20%,

2023's wildly descriptive and very generously hyphenated short-term head-out whole-body cold water immersion facilitates positive effect and increases interaction between large-scale brain networks in the journal Biology dunked a bunch of people in 20-degree water.

Americans, that's Celsius. So it was really 68 Fahrenheit. And the researchers measured brain connectivity and self-reported emotional states before and after this cold water immersion. And their findings showed that participants felt more active, alert, attentive, proud, inspired, and less distressed and nervous after having a cold water bath.

And the changes in positive emotions were associated with the coupling between brain areas that involved attention control, emotion, and self-regulation. And the study continues that the results indicate that short-term, whole-body, cold-water immersion may have integrative effects on brain functioning, leading to that reported improvement in mood.

But heads up, heads out, whole body cold water experimenters. In 2022, the American Heart Association cautioned via an incredibly sassy article titled, "You're Not a Polar Bear." The plunge into cold water comes with risks.

that plunging the body into cold water can trigger a sudden increase in heart rate and blood pressure known as the cold shock response. So some cardiologists caution against it for anyone with heart issues. So talk to your doc if that's you. And in general, keep your head out of the water to avoid gasping from it and then flooding your lungs and or acclimate slowly to colder water. But yeah, 68 degrees is not that bad.

Because let me tell you, it can feel pretty invigorating. And the cold plunge is pretty quick, just a few minutes. I've been a science correspondent for CBS's Innovation Nation for like a decade, and we did a segment on this. Okay, so before I go in, I'm preparing myself mentally and also putting my hair back. How does she get herself into these situations? For science. You got this. It's true. It's cool. Into the nose, out through the mouth.

It feels like I have little butterflies flying everywhere inside my body. Cold, cold little butterflies. And I will say, for the rest of the day, it feels like, you know when you're caught in a rainstorm outside and then you go inside and you change into dry clothes and you're like, oh, that's like the best. It feels like that all day after you do one. Also, it did hurt less than wearing high heels at a wedding reception. But I also have never done it again. So there's that. And

And when it came to researching the book, both personally and like taking a trip out, jumping in the ocean, hopefully having tea. Oh yeah, a lot of tea. And like pouring through all this research, how did you figure out which research was well vetted? And you can't quite do a double blind research.

on sea swimming versus staying inside. So like how does the research for this go into it, especially if we're kind of geared toward seeing a placebo pill versus an active ingredient? Like how do you research it? Yeah, it's a great question. And it's why some of this research comes under very valid criticism sometimes. I think the way that I wanted to structure the book is sort of in like two,

two levels. So on one level, there's all of the science showing that movement is really good for us. Nature is really good for us. Art is really good for us.

And in those service, belonging, right? And in those studies, we have the best kind of data. We have longitudinal studies showing that people who have close social connections literally live longer than those who don't. This is based on 80 years of data. Same with people who garden. Same with people who have a strong sense of purpose, right? We also can, like we did with the nature walking study, you can sort of randomize people, put them in two conditions. Do

do all these physiological tests that demonstrate, yeah, movement, nature, art, service, belonging, really, really good for us. And certainly not bad for us. Yeah. But you're absolutely right that the social prescribing bit, it can be tough to measure because it's kind of like the problem is the solution. People have to opt in. And we don't want to. We don't want to force a social prescription on somebody who's absolutely has zero interest in this.

But it is true that when we look at the data suggesting that social prescriptions do work for things like mild anxiety and depression, they do improve people's mood. They do help people feel less lonely and manage their stress. And then...

They reduce pressure on health care over time. There were some studies in England showing that one in five people going to the doctor are doing that for social reasons. Oh, my God. Oh, that makes me so sad and sick to my stomach. Oh, my God. So sad. There was even this one story I heard about a guy who would check himself into the emergency room every Friday night because he was so lonely and afraid of being alone on the weekends.

Oh, God. This weekend, I actually had lunch with a few friends, and one is an ER nurse in California, and she says her favorite patients are her regulars, the ones who may be older or sometimes unhoused, and they need a place to go for a night where people will be kind to them and they can get a shower or a sandwich, or they're just...

lonely and they need company. And she says many other healthcare professionals side-eye them, but she knows that they're in a type of pain too, and it's real. And it makes me want to cry so hard. And so in those sorts of situations, a social prescription makes a lot of sense. And what the data, which is again, imperfect for all the reasons we talked about, it's often small scale. There often is no control group, no randomization. And

But it does seem to suggest that, yeah, people improve their health and it reduces pressure on health care. I'm wondering, is this different in different nations? For example, if you have nationalized health care, they might say, great, less of a burden on the system. If you live in a society where health care is for profit. Not, yeah. Not nationalized? Yep, yep, yep.

Do they want you to get better? It's a great question. It's exactly how I set up the book. And I think, you know, there's two answers to that. Like on one hand,

It's true that this is a much easier sell for places with nationalized health care. That's actually how this began. So this practice began in England in the 1980s after, you know, doctors were seeing more and more people coming to them because it's free. Like, why the hell not? Yeah. But those doctors then the problem is they only have 15 minutes to see the patient. Right.

And if people are coming to them for things that are complicated, like depression and anxiety and, you know, things that are not as simple as, oh, you have strep throat, let me prescribe you an antibiotic or.

That's tough, right? Because the patients aren't getting the care they deserve. And that means the doctor has less time for the person with the clinical problem. I tell the story about my friend Gabby in the book to show you the state of health care in places where it's nationalized, particularly England, like there's a little British component to this. She waited until her tonsils turned black before.

before she went to the doctor because she was like, well, you know, somebody probably has a worse issue than me. Healthcare is limited. We don't want to use it. And that's true. Like it's not just England, a lot of places. It's a wonderful thing. I very much support universal healthcare, but when you make it free and universal, you have more people coming there. So social prescribing makes sense from an investment perspective of saying, okay,

If there are people coming to the doctor or the hospital or even the emergency room for non-clinical, non-medical reasons that might better be treated by a prescription for a ukulele group or swimming lessons or a bicycle than they would with anything a doctor who's clinically trained can prescribe, let's do that. And this will save the taxpayers money, right? Yeah. You know, but...

I was like, that's great. But where I live in the United States, not only is health care not nationalized, but it's also freaking huge. There's also all these other inequities that you talk about a lot on your podcast with women and people of color. There's already so much shit to fix in health care. So really, is it magical thinking to think that doctors are all of a sudden going to start prescribing art classes? And I'll say a couple of things.

One is that, do you have or do you know anybody who has an insurer who covers their gym classes? I don't think so. I mean, and I can't imagine would they cover like a...

Planet Fitness or an Equinox or only a lot. You know what I mean? Like what even is covered? So I don't know. Yeah. I think a lot of people also are just like, I don't even have health insurance. Right. Absolutely. And that's true, right? The healthcare in the U.S. is so limited. And it's true that for some people, particularly older people like my parents,

they are actually starting to get their, you know, very cheap and like not fancy gym membership covered. Not because these insurers have wonderfully big hearts and want my parents to be more active, but because this is seen as a money saving investment over time. In other words, if covering a gym membership gets my dad, uh,

who loves the couch, loves a pint of ice cream, is retired, is otherwise not really going to be moving his body and is on for blood pressure medications. If a prescription to the gym might help him get off one of those medications, might prevent future health expenditures down the line.

then that's a good investment for them. Okay, so gym memberships may be covered either fully or partly by your health insurance if you have it. So ask them. That is a step aerobics in the right direction. And healthcare companies who want to pay out less in heart surgeries know that

access to a rowing machine or some Zumba classes keeps you out of the hospital. And it also keeps more money in their bottom line. But it saves you money in terms of deductibles and co-pays and lost work. But what about all the other stuff? So that is starting to happen in the United States. Believe it or not, I'm sure your jaw's about to drop.

But there are places that are doing the same for art classes. Really? For similar reasons. Yes. Where I'm from in New Jersey, Horizon Blue Cross Blue Shield right now, if you are on one of their plans and you're at risk of overspending on your insurance, they will prescribe you an art class.

What? In partnership with, you know, the different art providers in the Newark community. And it's not just the prescription, right? It's transportation. It's all the workup because, you know, they believe that this is something that is going to save them money and prevent health issues down the line.

For more, you can feel free to kick back with the 2023 Journal of Economy and Society paper, Social Prescribing and the Search for Value in Healthcare. So it gives some quick history. Social prescribing emerged in the U.S. in the 1960s when there was rampant malnutrition in children. And one physician, Jack Geiger, started prescribing

prescribing food, which was paid for by the local health center's pharmacy budget. So instead of treating the effects of malnutrition with medicines that cost money, they just prevented it for less money with food for the people who didn't have enough food. So there's plenty of legitimacy and financial reason behind this, especially where equity is considered.

And this paper explains that the World Health Organization considers social determinants of health to be the conditions in which people are born, grow, live, work, and age. And it says these circumstances are in turn shaped by this wider set of forces, things like economics and social policies. And yes, politics. Things like patients' needs for housing and food and income benefits and transportation and legal support can

can be less expensive than the effects of them. And this is called value-based care. And it involves good economics, people. And the paper cites previous research that has found that nearly 10% of Americans can't afford health insurance. And some have to use government-funded free or low-cost programs. And also, as a country, even for those who are insured, the United States spends more per capita on health care than any other industrialized nation. Yet it ranks lower.

far below its peers in health outcomes and has some of the worst health inequalities. Even the US Secretary of Health and Human Services during Trump's first term was like, "Yo, we're saving nearly 4K per patient if we focus on fixing the cause of some of these illnesses, like type 2 diabetes, because we all know insulin is not cheap. We have a diabetology episode that goes into it."

So conservatism in a capitalist society has a real like pull yourself up by your bootstraps, get a job vibe, while also scrubbing the word equity from the National Institutes of Health archives, but then spending more money to fix the problems inherent to inequity. It's a real fuck around and find out situation we've got going on here. So it doesn't align with money saving and also on the social conservatism and the bent toward religion based politics.

and this newly established White House faith office, I do want to cite the Bible, which I googled to find a few passages, such as Matthew 10.8. Heal the sick, raise the dead, cleanse those who have leprosy, drive out demons. Freely you have received, freely you have received.

freely give. Now, I'm not a religious person, but perhaps the new Department of Government Efficiency can find some good economic strategies in those God bless the USA Trump approved Bibles that sell to schools for 60 to $100. So yeah, crack that open and find some good economic policies because a thousand in prevention might be worth a million in cures. Now, health insurance companies, also a good strategy.

So if it's good for their bottom line, then they'll help you out. And it's interesting to come at it from a, instead of everyone telling me I should go and I should volunteer, I should join a thing and I should exercise, the da-da-da. It's nice to think of it as like sticking it to the man a little bit. Yeah. Like it's kind of nice to be like, no, I'm going to do this for myself.

You can't keep me inside scrolling and buying things to try to feel better. Like, fuck you. I'm going to go for a walk in the park instead of engaging in capitalism to try to make me feel better because it doesn't even work. Hell yeah. I love a good fuck you walk. Exactly. It's so true though. I mean, and that's where like these badass doctors are coming into play. I think, frankly,

frankly, between you and me and your listeners, insurance companies are probably going to be the last to buy into this. There are some, there are some, and I think again, like insurance sentiment is bad, bad, bad, bad right now in the US. Yeah, I'd say. Some are trying to do this and say, look, you know, we care. But I think it's really going to happen first with doctors and therapists, like my best friend, Kate, for whom that's exactly true for. She was seeing a teenager who was,

Kind of like Amanda was put in a really stressful environment and was severely depressed and wanted to get this girl therapy. But the only therapist that was in her insurance plan didn't have availability for six months. So what are you going to do? Tell someone who's severely depressed to wait six months? No, you're going to prescribe them an SSRI. And again, like...

That can be a great solution for a lot of people. I think the problem is that it shouldn't be the only solution. We shouldn't be doing that because the other options feel too hard or too unavailable. We should be really trying to prescribe people what is the best thing for them. And so my friend, Kate, who is a doctor and loves this,

I would love to have prescribed her an art class. She's extremely creative. And I think being in an environment that's not her current home environment that could surround her with people who would inspire her, that would be amazing. But where do I begin? That's where the work ahead is. I have questions from listeners. Can I ask you one million? Okay. Also, we donate to a charity of your choice. Is there any off the top of your head that's related or you can think about it too? Yeah.

Yes, I have one I love. It's called Grow NYC, which is lovely because Grow NYC was born in the spirit of the first Earth Day, which is appropriate for April. And their mission is to empower all New Yorkers with equitable access to fresh, locally grown food, neighborhood green spaces and care for the environment. So

So, you know, we know that nature art service movement belonging is amazing for us. We also know that those opportunities are not as available to some people. So groups like Grow NYC work to put on free horticultural education, free field trips, investing in green spaces so that more people, regardless of your income or where you live, can have access to these medicines. So cool. We're going to donate.

in your honor. And then we'll put a link also in the show notes. I know I've already kept you so long because this is the best, but you have time for some listener questions. We'll fire off. Absolutely. Let's fire away.

Sweet. So she's down to clown a little longer. And we will return next week to answer questions about forest bathing, health insurance, social prescribing in different parts of the world, disabilities and social prescribing, animal therapy, how to handle the social part if you're an introvert or, frankly, hate socializing, and how these strategies are used even in dire medical circumstances.

And why also writing a pedicab for $0 could benefit everyone. So we'll be back next week with those. So ask salugenological people, sometimes basic questions, and people, fuck the system. Do the things your ancestors evolved you to do. Mindless scrolling steals your time and life and money, not to mention your data. Pharmaceutical companies,

and insulin makers love it when you're sick and sad. And there are people out there whose lives will be changed by hanging out and crafting or biking or fishing or chatting, including yours. So next week, we'll be back with more suggestions, research, and encouragement because honestly, this two-parter, it's an actual lifesaver as far as I'm concerned. I think it's one of our most important episodes in that realm. So tell everyone you know to listen. Things are

are hard and we need to not burn out. We got to survive this. So since this interview with Julia, I have started walking around my favorite lake four or five times a week. I love it so much that I got the shape of the lake painted on one fingernail to remind me every day how much that simple thing makes me so much happier and gives me something to look forward to and makes me less pissed and

and anxious, I'm also getting my work done in much less time because I'm not constantly looking for something online to raise my spirits, which it never does.

And since I've been walking more, Jarrett and I have been taking Gremi to this nearby park and walking, and she gets to sniff, pee, and terrorize lizards, even though she never comes close to catching one. I literally found my ukulele and I dusted it off. And my first session with this ukulele group is this coming weekend. And I wrote and researched this entire episode outside under an umbrella in my backyard, smelling trees, hearing hummingbirds whir by, and letting Gremi hang out.

keeping her eyes open for lizards she won't catch. And I thought that I had to earn this, but I don't. This is the stuff that makes life easier and makes us stronger to get through the hard parts. You don't wait until you earn it. You just take a fuck you walk.

Don't surrender your life to corporations. Cut banks. Tax your crush. Volunteer somewhere you selfishly just love being. You can join a club. You can start a club. Thank me later. Thank Julia. Once again, her book is The Connection Cure, and you can find her on Instagram at Hot Thoughts, which we'll link in the show notes, along with Grow NYC. We have links to all the research we talked about on our website at alieword.com slash saiyajnology.com.

That's linked in the show notes. We are at Ologies on Instagram at Blue Sky. I'm Allie Ward with one L on both. Smologies are shorter, kid-friendly episodes, and they're wherever you find podcasts. They're also linked in the show notes. You can find merch at ologiesmerch.com. You can tag any photos of you in it, Ologies merch, or just tag us, and we'll repost you on Mondays. Thank you to Aaron Talbert, who admins the Ologies podcast Facebook group, Aveline Malick,

makes our professional transcripts. Callie Ardoire does the website. Noelle Dilworth is our lovely scheduling producer who also posts your art on Fridays and your merch on Mondays. Susan Hale, managing directs the heck out of things. Jake Chafee edits beautifully and lead editor who connects it all together is Mercedes Maitland of Maitland Audio. Nick Thorburn made the theme music. And if you stick around to the end of the episode, I do tell you a secret. I already told you a long one, but I will end it with

As proof of how much easier it's been for me to just stay on task, I need you to know that Jarrett sent me a link to a video tour of the 120-acre, 100-year-old home that looks like heaven, owned by Walton Goggins, who is Sweet Baby Billy on the Righteous Gemstones. Also Rick from White Lotus. Whom's I love. And I clicked on this video tour of this beautiful house and I was like,

I'm going to save this for later after I finish the show. Who is she? She's someone who walks around the lake and takes her dog to the park and apparently has increased executive function. So thanks, Julia. Okay, go gather some friends or strangers. Make a diorama in an empty pill bottle. Tag me in any photos that you make so I can see what you love. Okay, bye-bye. I also play racquetball.

Do you have any hobbies?