How Does Your Garden Grow? The Value of Horticultural Therapy

Margaret Daniel

Disclosures

October 19, 2021

Humans have been cultivating gardens for millennia — growing fruits and vegetables for sustenance, herbs and spices for their flavor and medicinal properties, and flowers for their beauty. This act and expression of creation provides a tangible connection to the earth. Even the words "human" and "humus" (meaning "soil") spring from the same Indo-European root word, reminding us of this ancient connection.

But beyond its ability to provide vegetation, the garden acts as an equalizer, calling people of all ages, walks of life, and abilities to try their hand at tilling the earth, to slow down and observe, and to experience the wonder of caring for living organisms. In gardening, "there is hope, a sense of duty, of optimism, and stewardship," horticulturist Jenks Farmer muses. "There is an acceptance of our impermanence; that these things can go further and longer than we can." 

The rapidly growing field of horticultural therapy is harnessing this hope — formalizing and utilizing the work of tending the garden as an effective therapeutic modality, and teaching participants new skills and recovering lost ones. At the forefront are such organizations as the American Horticultural Therapy Association and Seed Your Future. The former provides certification and standardization for horticultural therapists and the latter promotes horticultural therapy through partner programs, workforce development, and youth education across the United States and Europe.

In a 2014 study, researchers found gardening to be effective for physical fitness — burning calories, developing fine motor skills, reducing pain after medical interventions, increasing fruit and vegetable consumption, decreasing symptoms associated with various mental health conditions, stimulating communal cohesion, and promoting alertness and cognitive abilities, among others.

"Playing in the dirt" builds up immune function and limits the number of invariant natural killer T cells, lowering one's chance of developing various forms of inflammatory bowel disease and asthma. Researchers also found inhaling Mycobacterium vaccae, a bacterium commonly found in soil, triggers the release of serotonin, a hormone key to the reduction of anxiety and depression. In addition, patients with lung cancer reported decreased pain and nausea when injected with the killed bacteria.

Emotional and behavioral management benefits for juvenile offenders were noted by the Journal of Therapeutic Horticulture, while the Fisher Center for Alzheimer's Research Foundation reports working in the garden offers similar regulation benefits and the reduction of aggressive behavior for persons with Alzheimer's disease and dementia, benefiting patients and caregivers.

Sowing Seeds of Hope

When Terry Garrett's brother, Louis, was diagnosed with end-stage COPD in 2003, he became wheelchair-bound and began to rapidly decline — unable to tend his beloved garden and enjoy a robust quality of life. Eager to aid his brother, Terry designed an elevated garden, 30 inches high, for Louis' wheelchair to slide under, so he could tend plants without the worries of a typical raised bed garden, such as a fall from his wheelchair and skin tears and splinters from the wooden walls. The table, made of a nontoxic, heat-dissipating polymer set atop a metal base, worked wonders; it gave Louis purpose anew, keeping him busy as he tended almost 40 of Terry's gardens.

Figure 1. The patented elevated table allows wheelchair-bound individuals to comfortably and easily tend to their gardens.

Inspired by the improvement he saw in his brother, Terry started T&L Group, so named for the two brothers, in Cleveland, Tennessee, and began selling his twice-patented design to schools (the University of Tennessee at Knoxville utilizes his elevated gardens for horticulture therapy), the VA, assisted care facilities, and nursing homes, where residents and caregivers alike have experienced the restorative work of gardening for patients with Alzheimer's, dementia, and PTSD. 

Figure 2. For people in assisted care facilities, gardening can help renew a sense of purpose.

"We found that physical and occupational therapists really like the gardens because when they are working on dexterity and mental regeneration, that they can work hands-on, directly with the patient," says Garrett. Program directors also reported patients exhibited better focus and reduced anxiety after horticultural therapy work.

Figure 3. After a rewarding day's work tending to their gardens, patients appeared to focus better and have less anxiety.

After his mother, Gloria, suffered a stroke this summer, South Carolina–based horticulturist Jenks Farmer worked tirelessly with her, guiding Gloria as she learned to walk again and aiding her in her quest to return to the garden. After all, the okra was growing and needed to be harvested. 

The precise work of gardening, demanding fine motor skills and balance as one cares for plants on uneven ground, improved Gloria's hand strength — compounding the benefits of her physical therapy — and it offered cardiovascular benefit and a healthy dose of vitamin D

But more than this, the garden gave her the transcendent pleasure of community and purpose throughout her recovery, allowing her to spend time with her son as they worked outside together.

Figure 4. Though there are plenty of health benefits associated with horticultural therapy, the opportunity to create something with a loved one is often most rewarding.

'A Sense of Our Own Purpose' 

These sublime benefits are not lost on Luis Garcia, MD, chief medical information officer at First Family Health in Pennsylvania. Garcia is the proud cultivator of a lush orchard of fruit trees, berry bushes, and raised bed vegetable gardens. 

During the pandemic, seed sellers reported record earnings for the spring 2020 season. Like many others, Garcia’s garden became a place of prosperity for him and his family. It offered perspective and peace while it grew and instilled a sense of comfort as it flourished, unaffected by the tumult COVID-19 was causing in the world beyond the garden fence.

Figure 5. A future generation of gardeners proudly pluck weeds from their vegetable plot.

His gardening work, requiring the conscious practice of patience, pruning, and presence, instills in him great gratitude and that aforementioned intangible — hope — giving him a fresh perspective on his clinical work. "When your hands are so close to something living out its ontological reality, what it was meant to do, it can awaken in us a sense of our own purpose in our vocation and life and society."

The perennial truths of the garden — its resilience and determination to thrive — remind us to put time and energy into our health and healing and to pursue community. In this way, the pandemic offered a much-needed interruption to our way of life — one defined by the fast, efficient, and disposable — rooting us back in the soil. "It enriches our family life: keeping us connected to the earth and connected with a sense of gratitude," says Garcia, who recognizes the impressive work creation does on its own. "We receive so much more than we put into it."

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