Wilderness as therapy

March 4, 2024
A small, but highly visible part of the outdoor education industry is the “wilderness therapy” world:  a movement based upon the premise that since being in the outdoors is healthy for most of us, it should be healing for persons (mostly youth) with emotional challenges.  Although superficially appealing, this premise has never been validated.
An unfortunate part of the wilderness therapy movement has been fatalities occurring with participants during programs.  These are nothing new; a book by Maria Szalavitz drew attention to the problem nearly twenty years ago.  They have continued.  The most recent episode involved a 12 year old boy in North Carolina.  This incident prompted an investigation by reporters for USA Today (North Carolina wilderness therapy death and the trauma for survivors (usatoday.com)).   This report deserves close reading.
Regular users of the wilderness will be particularly struck by one portion of this report.  It was claimed that the participants were “…living in filth.”  A big part of this was because of their need to defecate in plastic bags, and use natural items (“…sticks and leaves…”) for toilet paper.  While the uninitiated reader of USA Today may find this appalling, I doubt that many readers of this blog will be impressed or surprised.  Avoiding toilet paper by using natural substitutes is pretty standard wilderness technique; most of us look upon this as an expectation for environmentally-responsible use of the outdoors and have no problem with it.  Carrying out human waste, while not universal, is clearly the appropriate approach in certain high-traffic areas, or with specific environments (e.g. glaciers).  I have undertaken numerous enjoyable expeditions with my waste in my backpack or pulled in my toboggan.
The report further decries the participants’ being taken with their 40-pound packs on a “grueling 3-mile hike.”  While I suppose that it depends on the terrain, this would quality as an easy day on most of my trips!  And I am far from adolescence.
So, what’s the problem here?  Those of us who happily carry packs up mountains and clean ourselves with sticks and leaves (actually, small stones work better…) do so voluntarily because we find the entirety of the wilderness experience uplifting and positive,  We understand the need to care for wild places.  No one compels us to do these things.  This is not the case for teens in most wilderness therapy programs.  They are plucked from their lives (albeit largely chaotic) and thrown into something they did not ask for with people they don’t know.  Enjoyment of the wilderness begins with the well-considered decision to immerse oneself in it.  It cannot be forced.
Careful analyses of some of the incidents in these programs clearly shows some problems with staff training, equipment, and policies.  These are inexcusable.  More basically, the fundamental notion that forcing one into vigorous wilderness travel can be therapeutic is likely flawed.  Let’s not, however, focus on hygiene and hiking effort!

Tom Welch, MD