Instead of asking "what's the matter with you?" ask patients "what matters to you?" Dr. Sam Everington, Founding Social Prescribing Doctor
This morning John and I woke up at 3:30, ugh. By 4:30, we had decided to get up. We felt sluggish – in a funk. I had felt a bit off the day before as well.
Our clothes needed washing, the junk in the house seemed overwhelming. My friends and I seemed largely out of touch. My back had been out of whack for a week. I felt ancient. It seemed useless to write the blogs because they all seemed to be going to people's spam and I had no idea what to do about it. Blah. Blah. Blah.

Then I thought about this guy I like to listen to occasionally. Every time he ends his talks he says, “just go out there and put a little love or good into the world today.”
Such a simple and effective prescription for happiness, health, and a better world. Just put a little love into the world today. How might I do that on this day?
It came to me that I wanted to tell a friend who had been injured and was home-bound that I missed seeing her. Then I remembered another new friend who said she was worried about her ailing brother. I gave her a call.
Afterwards, the world looked much rosier. My back didn’t hurt as much. I was able to tackle a few chores. I felt young again.

This is mind/body medicine in action and it’s also what researchers and physicians are calling a “social prescription” …self-prescribed in this case. As it turns out, it’s highly effective and being used all around the world.
I recently read an article by Dr. Leif Hass, a hospital-based physician. He treats people with serious chronic health conditions. Because of these conditions, according to Hass, they lose not just energy but also connection to much of what makes them feel alive. He tells about the case of Mr. T., a 67-year-old man.
“Life with kidney failure is hard. Seems my life is just going to dialysis and that’s it. Sometimes I don’t know if I can keep doing it,” he told me. In fact, he was in the hospital due to not doing it. He had just been admitted with shortness of breath after missing one of his critical three-times-a-week dialysis sessions. Health conditions can leave folks isolated; this inevitably leads to worse health and quality of life.
For a few years now, Hass has been trying to address these issues with what he calls his “Prescriptions for Health and Happiness". These are paper doctor prescriptions; they're for things like helping others, writing a thank you note, singing in the shower or dancing, or walking in a beautiful place.
I am reading a new book (recommended by Hass) called The Connection Cure by Julia Hotz. Both Hass and Hotz believe “more and more in the idea that our social activities and community engagement are crucial for our health.”
As for Mr. T., Hass asked him a question that is key to the “social prescribing” movement: “Now that we have talked about ‘what is the matter with you, ’ I would like to learn ‘what matters to you.’
Hass was trying to get at what brought Mr. T. joy. Doing what we love is an important part of staying healthy, and Hass wanted to encourage Mr. T. to reconnect with the world in healthy ways.
“Well, doc, I’ve always loved music," Mr. T. says. Hass asked, “Have you ever thought about joining a choir?”
“I love to sing but haven’t in years, but you know the idea of doing it again?” It’s kind of exciting to think about!”

Both Hass and Hotz say the social prescribing movement is continuing to gain steam and evolving globally. For Hotz social prescribing utilizes the arts, nature, volunteerism, and local community organizations as “medicine” for patients of all ages.
Social prescribing considers social health just as integral to people’s well-being as their physical and mental health and an important tool to address a myriad of problems such as chronic pain, diabetes, hypertension, mental health conditions, and the loneliness epidemic. Social prescribing is an effort to move medicine away from this “pill for each problem” paradigm toward a broader view of health and health care.
The social prescribing movement started in England, most notably by Dr. Sam Everington (who has been knighted for his work, so I guess there’s a “Sir” there somewhere in his title). Worthington and others’ early work showed that prescribing and paying the cost of access to exercise programs saved money and improved health, at which point social prescribing, as it came to be called, received more attention and funding.
Researchers and doctors are beginning to believe that indeed social activity can be a form of medicine. When providers suggest that health comes from more than the absence of disease, but from doing things that bring joy and meaning, it just makes sense to me.
Now here’s something I thought was especially interesting in Hass's article and Hotz's book. On the English coast, folks were being prescribed cold water swimming for depression. Recovering drinkers were joining jogging groups. People dealing with ADHD were in hiking clubs in Vermont; art classes were being prescribed for anxiety in Denmark and Australia; volunteerism for the isolated in Canada, and farm work for people with dementia in Norway.
Of course with any intervention, one wonders about any downsides or detractors. Here's the only one reported. It's not any criticism of social prescribing, but rather anger at failures in our health system and our communities.
Cormac Russell is an outspoken critic of social prescribing for those reasons. He says, “Whoa, what fails before the health system? It is the community. Yes, in the short term it makes sense to invest in social prescribing, but ultimately, we need to think about what true connected communities would look like and devote resources to develop them. What we are seeing with the levels of anxiety of our youth, isolation of our elderly, and our high rates of substance use disorder is a society in distress.”
Russell uses the analogy of tears in the fabric of our society. With social prescribing, we are pulling people out as they fall through the tears, but fixing the fabric should be our goal.
Everyone feels anxious, depressed sometimes; everyone feels distracted, burned out at times. Why not proactively start introducing doses of these proven “medicines” when these feeling start to arise many people are asking. Prescribe proactively, like we do with vitamins. The tagline of the movement is about shifting from “what’s the matter with you” to “what matters to you.”
Hotz says this question feels a little big, so she likes breaking it down into smaller questions…When was the last time you experienced beauty, awe, or deep human connection? As we reflect on that, we can use our answers to write our own “prescription.” Self-medicate.
Social prescribing is about living in the direction of more connection, more awe, more wow states, and more joy. One of the researchers that Hass spoke to believes these prescriptions work simply by getting us out of our homes and in front of new stimuli that change the engrained pattern of our thoughts, which can drive some mental health issues. Then the activities activate us and help us feel a part of something bigger or see the world in a new way.
I especially liked some specifics that both Hass and Hotz mentioned. For certain symptoms, certain activities appear to be more effective than others.
Movement is good for stuckness, sadness, and many of the symptoms of depression. Art is good for symptoms of anxiety and being consumed by our worry. Nature is good when we are burned out, stressed, have a formal ADHD diagnosis, or are even just suffering from overstimulation. Service is great to help with loneliness.
This afternoon John and I had coffee with a friend. Our friend started talking about one of the times in his life when he was really depressed. He shared that he had moved to an area in the epicenter of action in the U.S., but he knew no one. Eventually, he was so down, he started making a plan to kill himself. His plan was to run three miles from his house to the ocean and drown himself.

However, the run felt so good that he decided to kill himself the next day. And, instead of killing himself, he became an outstanding athlete and met some friends who were also into running.
Let's consider taking social prescriptions seriously, seeing them as medicine or taking them proactively as vitamins. Movement, art, nature, service, and belonging…instead of a pill perhaps.
We’re probably doing some of this already, but we can be more intentional. The next time we wake up in a funk, we might ask ourselves not what’s the matter with us, but what matters to us… and go do a bit of that. Or we could just prescribe for ourselves, "put a little love into the world." Notice how we all get better.
How might we journey together toward The Good Life by prescribing ourselves some social activities?
Here are 10 questions/statements Hotz recommends to ask yourself or reflect on with a partner when trying to self-medicate with a social prescription.
Tell me about the last time you experienced a small moment that made you feel more calm, joyful, and grateful.
Tell me about the last time you felt "in the presence of something vast that transcended your current understanding of the world.
Tell me about the last time you felt "extremely present" in a moment.
If you had two more hours in your week, what would you spend it doing?
When you were a child, what activity could you spend endless amounts of time doing without getting bored?
What "activates" you?
What do you do to look after yourself?
What makes you light up when you talk about it?
What makes you feel like the healthiest version of yourself?
Tell me the last time you were "completely absorbed in an experience."
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