River of healing

How a group of veterans found solace on the River of No Return.

The first American veteran on Idaho’s main stem of the Salmon River was Capt. William Clark. He and Meriwether Lewis had split up to search for a route to the Pacific, but this one was not panning out. The rapids were too rough for the expedition’s 1,000-pound dugout canoes, and the canyons proved too steep to portage around the whitewater. After exploring the upper reaches in moccasins, Clark complained, “I Sliped & bruised my leg very much on a rock.” With that, he etched his name in a pine tree and got the heck out of there. He called this the River of No Return. That was in 1805.

Eventually, other explorers, fortune-seekers and recluses followed, braving the rough terrain to stake mining claims downstream. True to its cognomen as the River of No Return, it accommodated one-way traffic only. The miners built huge wooden boats laden with supplies and ventured down the rapids. If man and boat survived the passage, the boat would get cannibalized for a cabin and the miner would lay in for a long, long while.

The steep country that hemmed in the river was never ideal for human habitation. In 1980, Congress made the isolation official, designating the river and its surrounding mountains the largest chunk of the wilderness system in the Lower 48. The Frank Church-River of No Return Wilderness, sometimes just called “the Frank,” stretches across 2.3 million acres in the part of Idaho that starts to get skinny. The river running through it carves a long, forested gorge deeper than the Grand Canyon.

It was through that gorge that another group of American veterans — all women, all scarred emotionally and physically by their service — descended in the summer of 2014. Like Clark, they were also on a voyage of discovery in the American wilds. I wanted to witness it. If one minute of gazing up at a eucalyptus tree makes people more generous, and three days makes them more socially connected, calm and inspired, what could a week unleash? Were the inverse-PTSD effects of awe real, and if so, would they show up in the brains that needed them most?

 

Graham Smith

You have to be brave to venture down the Salmon, and a little bit addled. This group of women, sponsored by an Idaho-based nonprofit called Higher Ground, was both. Participants had to be former or current members of the military who suffer from PTSD, post-traumatic stress disorder. When I learned the organization was willing to invite a journalist, I signed on.

This was Higher Ground’s first all-women’s river trip. The plan was to float 81 miles of the river, try our skills at kayaking, rowing and paddle-boarding (non-mandatory), participate in “processing” groups and team-building activities (mandatory), eat together, collapse into tents, and then do it all over again the next day. On the sixth day, we’d leave the river, flying home off a dirt strip in small planes. Unlike the miners, we’d be returning to civilization, hopefully a little bit changed.

The night before launching our boats at the end of a dirt road, I met up with the women, gathered on a restaurant patio for pizza in the no-traffic-light town of Stanley, rimmed by the vaulting, aptly named Sawtooth Mountains. This clearly was not your usual river-rat crowd. These women were on the whole younger, more ethnically diverse and less able-bodied. The nine former service members carried an assortment of cigarettes, butch hairstyles, tattoos, piercings and physical supports that included a cane, orthopedic tape and an arm splint. Collectively, they brought a small pharmacy’s worth of anti-anxiety drugs, antidepressants, anti-seizure meds, painkillers, digestive aids and sleeping pills. One service dog, Major, a yellow lab mix, wore a bib that read “Do Not Pet.” The warning could have applied to anyone. Heavy-lidded and surly after a long day of travel, they were not about to smile for a bunch of cowtown selfies.

The recreation therapists, Brenna Partridge and Kirstin Webster, handed out matching black fleece jackets emblazoned with the unique crest of this “unit” — HG-714-RA, which stood for Higher Ground, July 14, Rafting. (Other Higher Ground units, typically coed or all-male, might spend a week fly-fishing or skiing or doing lake sports.)

Partridge smiled and asked us to introduce ourselves and talk about why we wanted to be on the trip. Marsha Anderson (some names, including hers, have been changed) described being medevaced out of Afghanistan on a stretcher, convinced for a while that she was already dead. It took her 13 months to relearn to walk. Now she felt angry, misunderstood by her family, and cheated of the sports she loved like surfing and cycling. She was hoping to find some new ones, along with new friends who had been through what she’d been through.

Graham Smith

Carla Garcia, 35, described how she’d volunteered for the first Iraq invasion in 2003 and then returned as a vehicle commander running fuel convoys across the war zone from Al Taqaddum. In 2005, her truck hit a roadside bomb and she was blasted from it, landing on her head. Her driver died. During her third tour, in Mosul, another bomb exploded, crashing her head against the vehicle roof and pelting her with shrapnel. Garcia pulled her ailing driver from the smoking wreckage and fought off insurgents with her M-16 until she passed out. (She received both a combat action badge and a Purple Heart, I found out later.) Doctors induced a weeklong coma to relieve pressure in her brain. Afterward, she had to learn how to talk. In addition to chronic pain, she suffers seizures, headaches, mood swings and nightmares. She can’t walk far, won’t drive, and can barely stand being in any kind of vehicle. “I don’t like crowds and I don’t like people,” she said. “This will be hard.”

After dinner, we grouped for the processing talk, our first one, to articulate goals for the trip. That’s when Kate Day, a Navy vet in her 50s from Las Vegas, mentioned her three-year stint of homelessness, a stay in a mental institution and her near-inability to leave her house. Two other women chimed in that they, too, had been institutionalized. One said she was still so depressed she didn’t want to keep living. Another said her anger and misery had alienated her whole family. Another, sitting expressionless, said in a flat voice that said she wanted some time to “be in the moment and not zone out.” A skinny blonde wearing a sparkly blue sundress and pink sunglasses, whom I’ll call Pam Hana, showed the opposite affect: maniacally chatty, never still. She woke up scared and crying because she hated airplanes and had successfully avoided them for years until this trip.

Tania Herrera, wearing a Gilliganesque fishing hat over her dark, cropped hair, talked about being limited by her body. First struck by shrapnel near Fallujah, then catapulted by a car bomb along her convoy route and finally struck by pieces of a collapsing mosque hit by a grenade, the former Army gunner now had one working arm, a bad leg and a brain that didn’t work too fast. Thirty-four years old, she rarely left her house near Fort Bragg. “It sucks to think that’s the way life is going to be, stuck in a rut,” she said. “It seems like a life sentence.”

Petite with smooth skin and a friendly, wide mouth, Herrera also told us that she now had trouble making friends, and on top of that, she had some serious hair issues. “I used to have long hair but can’t figure out how to do it with one arm,” she said. “I used to sit on my hair like Medea. I’m not that girly, but to have it stripped away from you is hard. I don’t want to go to family weddings because I can’t look pretty.”

Partridge, the group leader, gave Herrera her marching orders: “Find someone to bond with. This is your unit now.”

In the days following, more details of their battered lives would come out during processing, in one-on-one talks or in small groups. As a general rule, the younger women had seen combat, even though technically they weren’t supposed to be in combat roles at the time. That was a central irony of serving in recent wars, and yet, because they were women, it was often harder for them than for men to get diagnosed as having combat-related PTSD. Many of the older women were here because they suffered military sexual trauma (MST). One was gang-raped by eight men, including her commanding officers, while stationed in Okinawa; another was attacked in the Navy by her master-at-arms. Another was assaulted by a civilian while on leave in Europe. In only one instance did the perpetrators meet justice, and that was the civilian.

In both types of PTSD, the consequences are similar: life-altering social, professional and psychological impairments.

 

Every big war has its signature wounds. If the Civil War didn’t kill you, you were likely to end up with amputations. Surgeons in World War I advanced the art of facial plastic surgery. (Noses were destroyed by mustard gas.) Gulf War veterans barely saw combat, but many suffer from mysterious symptoms believed to be linked to nerve agents. PTSD was common after most of these wars — even Homer wrote about it — but it went by different names: shell shock, soldier’s heart, combat fatigue. Frederick Law Olmsted, who, in addition to being a badass nature guru, was witness to just about every significant beat of the 19th century, from plantation slavery to the gold rush to the invention of suburbia, described the Union soldiers after the Battle of Manassas as a “disintegrated herd. … They start and turn pale at the breaking of a stick or the crack of a percussion cap. … It is a terrific disease.” PTSD wasn’t officially named and recognized by the Veterans Administration until 1980.

In the general population, about 8 percent of us will experience PTSD. Among veterans, that figure is about 18 percent, but a recent examination of the data for over a million veterans of the wars in Afghanistan and Iraq found a 27 percent rate (with over 70 percent of that coexisting with depression.) The fingerprints of the recent wars are so far clear: PTSD, traumatic brain injury (TBI) from heavy use of explosives, and sexual assault.

Some studies suggest that women experience PTSD at slightly higher rates than men, or they may just more readily admit to having it. According to the latest iteration of the Diagnostic and Statistical Manual of Mental Disorders, symptoms of PTSD cluster around four subgroups: re-experiencing (flashbacks, nightmares), avoidance and withdrawal, bad moods and depression, and hyperarousal, such as jumpiness, vigilance, aggression and sleep problems. Women, who now make up about 15 percent of the military, express some symptoms differently, experiencing higher rates of anxiety and eating disorders. They are two to four times more likely than other women to be homeless; men have more problems with violent aggression and substance abuse, but plenty of women experience these also.

By all indications, the women on our trip were like Tania Herrera, who’d been an eager, straight-A high school student from North Philly: highly competent, enthusiastic recruits when they started out. Their intelligence and toughness were still in evidence. But pieces of them had crumpled. They no longer felt whole, or secure, or capable. Now they were grieving their lost selves. As Herrera put it during one group session, “I never thought I’d be 34 and unable to take care of myself. When I went to war, I thought either you die or you make it out. I didn’t factor in what if you came out different than when you went in.”

The women described daily lives involving constant physical pain. They couldn’t concentrate well. They were sometimes jumpy, depressed. They didn’t like being with people, but they didn’t like being alone all the time. The wars had taken away their ability to sleep well.

It was time for the women to get out of their lives and into the river. The first named rapid, called Killum, came up fast. I was paddling one of the four inflatable kayaks, and I saw the kayak in front of me meet a short wall of water and flip. I hit the same cold sideways wave, my paddle dove, and I flipped, too. Happily, the Class II and III rapids in this stretch are more wave than rock, and they are short, interspersed with deep, calm stretches. I managed to claw back into my boat. The six women paddling the raft cheered me and the other kayakers on.

Many rapids followed before camp, and I was alternately exhilarated, nervous, cold and determined in that I’m-committed-now kind of way. Entering a rapid, your vision narrows and so does your focus. Your heart rate picks up, your breath quickens, and your skin temperature rises. Your gut begins to tighten. In small doses like this, the adrenaline rush is fun. You feel present; the B-roll of your mind falls away, and there’s a heady release of endorphins when you’re safely through. Kayakers sometimes call paddling big water “combat boating,” and when hard-shell boaters roll their overturned kayaks back upright while still strapped in, it’s called a combat roll.

Graham Smith

I saw the basic inanity of this metaphor while surrounded by these very real veterans. In war combat, the stress response isn’t small or ephemeral. It’s big. And it lasts for days, sometimes weeks or months. It lasts so long that the brain changes — more in some people than in others. Blame evolution. Our nervous systems are naturally hardwired for fear, telling us what to avoid and how to stay safe. Some psychologists argue that fear is our oldest emotion, existing in the earliest planetary life forms and predating even the drive to reproduce. It starts deep in our brainstem, in the Milk Dud-sized amygdala.

When fear alone rules us, we lack the smarts to do much of anything creative, or interpersonal, or spatially demanding. Part of what makes us human is that our brains evolved a neocortex, the place where we plan and puzzle and tell ourselves we’re being drama queens. A fright causes a neurological tug of war between the old and new brains. In the deep clutch of fear, our primitive brainstem overrides our problem-solving neocortex, and we become stupid. With PTSD, the brain stays locked into amygdala hyperdrive. Failing to bounce back to baseline, it loses the ability to distinguish between a real and a perceived threat. That’s why soldiers with PTSD often cannot tolerate driving or shopping or loud noises even in safe places when they return home.

But there’s a reason we feel fear. It may have given us the gift of memory. The very reason we remember anything may be that we must remember near-misses, narrowly avoided dangers, and attacks from predators and enemies. Thanks to fear, we enjoy the smell of madeleines and the writers who write about them.

At its root, PTSD is a memory disorder. Brain scans of people suffering PTSD show cellular and volume changes in the hippocampus, a region that helps process memories and sits very close to the amygdala. In frightened lab animals, the fear hormones — glucocorticoids like cortisol, norepinephrine or adrenaline — flood receptors on the hippocampus and impair memory. It appears that persistent trauma memories shrink the hippocampus, and it’s well-established that PTSD leads to emotional as well as cognitive problems, such as poor focus and short-term memory deficits.

Physiologically, chronic, heightened stress looks like this: higher blood pressure, cellular inflammation, and a higher risk for cardiac disease. Longitudinal studies show that veterans with PTSD are sicker, in more pain, and die younger than their non-PTSD peers. They are also 4.5 times more likely to have substance abuse issues. Veterans are twice as likely to be divorced, and female veterans commit suicide at nearly six times the rate of other women.

Groups like Higher Ground — and there are many, from those offering surfing and fly-fishing programs for vets to a hospital in Los Angeles that promotes bonding between humans and abused parrots with symptoms resembling PTSD — believe that engaging with nature or wildlife can reduce trauma symptoms. Adventure sports like kayaking provide a laser focus for an unfocused mind, as well as a welcome distraction from unwelcome thoughts. The physical exertion often leads to better sleep, and the sensory elements of nature can calm the nervous system.          

Even knowing all this, I couldn’t help but worry a bit about these women in such an uncontrolled environment. What if they got pinned on a rock or had a bad swim? One of the kayakers was Marsha Anderson, who’d been a ski racer in her youth in Wyoming. Now she had nerve damage in an arm and a leg from an explosion in Afghanistan in 2009, and she hurt all the time. After her injury, she couldn’t walk for a year. She seemed fragile. When a rapid spat Anderson out of her inflatable boat in midafternoon, I held her boat next to mine and helped haul her back in. Then Herrera, riding in a double kayak, her right arm bearing her high-tech brace with a GoPro camera attached to it, went over. I wondered how she would get back in the high, slippery boat with one working arm; but her partner, a Higher Ground staffer, stayed in the river and heaved her over the gunnels.    

If these women came expecting a relaxing repose on the beach-lined river, this wasn’t it. We weren’t even allowed cocktails. Could they handle this sort of extreme adventure? These women lived in a constant playback of memories and anxieties. Maybe they should be home snuggling with their service dogs and using a rowing machine?

Or maybe not. Anderson, a Korean American in her early 30s with short hair, sat smiling while she ate an eggroll that evening. “I never thought I’d go by myself down a river,” she said. “I’m exhausted from the adrenaline.” She recalled the words of a yoga instructor: “Anxiety is just excitement without breath.” The river was teaching her to breathe. “I wasn’t sure I was going to go back in and keep kayaking,” she continued, “but I did, and I was trying to breathe in every rapid.” She clearly liked being a badass. As for Herrera, who was still relearning how to take basic care of herself, paddling a kayak was a revelation. She didn’t seem to mind the unplanned swim at all. She found that she could tape her bad hand around the paddle shaft and use the other arm for most of the power. Seeing her in the boat, I was reminded of another one-armed veteran who made a similar river voyage 145 years ago, Maj. John Wesley Powell. Wounded during the Civil War and commissioned to survey the frothy Colorado, he seemed to relish every minute of it: “We have an unknown distance yet to run; an unknown river yet to explore. What falls there are, we know not; what rocks beset the channel, we known not; what walls rise over the river, we know not.”

When Herrera flipped, she even had the presence of mind to salvage her combat-medal-bedecked Gilligan hat. “I was really happy that I was able to contribute and not have everyone do work for me,” she said. “It was neat to do something physical. At home, I can barely get my own mail.”

The rafters, too, had a good day. Anjah Mason, the expressionless Army vet who had told us she wanted to stop zoning out, described almost having a panic attack on the boat, but then talking herself through it. She’d learned how to adapt to a wholly new situation, and she was pleased.

Everyone was hungry. No one stayed up late. Manic Pam Hana finished a cigarette and then fell asleep in front of her tent under the still-bright Northern Rockies sky at 8 p.m.

I began the next day with my signature outdoor ailment, a bee sting. Catalina Lopez administered rubbing alcohol and Benadryl and told me to keep tabs on the swelling. A former Army nurse, she had served for 15 years in the Balkans, Somalia and Iraq, and was haunted by recurring dreams of blood and severed body parts. Once, while I was eating lunch, she had described watching an unconscious guard’s brain swell
and swell in the hospital. She told me normal intracranial pressure was 10, but this guy’s meter was reading 20, then 30 and then 85 — “and then I could see his cranium start to move.”

I looked at my sandwich.

“You see where I’m going with this.”

I nodded.

“Do you want me to stop?”

“Yes, please.”

Graham Smith

That second day, I joined the increasingly sociable paddle raft. At some point, Tania Herrera, sitting on the raft tube across from me in the bow, started singing, “I kissed a bug and I liked it.” She told stories about being in Iraq. She was part of an all-woman transport truck they nicknamed the Maxi Pad. Then someone asked me why I wanted to write about breasts, the topic of my first book. That inspired Herrera to come up with a name for our rubber boat: the Boob Tube.

It was a long day on the river, a hot, 20-mile paddle punctuated by swimming and a beachside lunch. The canyon in this section is steep and dotted with large ponderosa pines that emerge from shiny black gneiss outcrops. We were passing through the middle of the ancient Idaho batholith. Angela Day, a blond, plump Navy veteran, bobbed along in her kayak like a mellow duck, not working too hard and giggling through the waves. Anderson, the nerve-damaged former ski racer, rode the stand-up paddleboard; in the rapids it became more of a kneeling board, and sometimes an upside-down board. In the afternoon, nurse Lopez spilled out of her kayak in a tricky rapid. From the Boob Tube, I could see the panic in her face, the desperate gulps of air and water. She got back in the kayak, but she wasn’t happy about it.

At processing that evening, she looked defeated. Facilitator Partridge had asked the group what their passions were. “I used to be passionate about everything,” said Lopez, whose PTSD and a chronic back injury got her medical retirement from the Army. “Life, work, nature. Even today I was passionate about kayaking until, what the fuck, and now I expect to be disappointed by everything.” She shrugged. “Maybe I’ll get back in, I don’t know.”

Anjah Mason said she didn’t know what she was passionate about. “I used to be passionate about my family.”

Connie Smith, a former Navy captain from Texas, said she was passionate about her work training service dogs.

Angela Day said she was passionate about her relationship with the Lord. “Today, in the kayak, I was like, ‘Come on, Lord, bring it on! You can do better than that!’ ”

Linda Brown, soft-spoken, in her 50s, said she was passionate about outdoor sports. “I can’t say I’m passionate for any length of time, but I do believe I’m passionate about the outdoors, trees especially.”

Pam Hana, still manic, bouncing on her chair, said, “I’m passionate about staying single and frickin’ free! I’m loving it! Seriously!”

Herrera said she used to be passionate about her job in the Army. “I was a lead gunner in Iraq, in a turret, with a headset. My kid dream came true, of a car that talked to me. I wanted to be Knight Rider with the biggest gun and the coolest clothes. I remember thanking God for allowing my dream to come true.” She looked at the sand. “It’s so hard to create a dream again and go forward. That’s where I get stuck. How do I do that now with all these barriers, these health issues, the medicines, the bad relationships, no money, the disability?”

Angela Day said, “I don’t want to leave my safety zone.”

“You left it today on the river,” Partridge said.

“Yes. But it’s become normal for me to leave the house only once a month, to buy groceries. I do have a deep personal dream not to be that way.”

“Like when you’re on the river, sometimes you have to ask for help,” said Partridge. “People have your back.”

“It was the funnest day ever today!” said Hana.

“For you.” Lopez glowered.

 

We fell into a pattern of running the rapids, processing the day, making and breaking camp, telling stories, coming together sometimes and other times dropping off into pockets of introspection or quiet or just plain tiredness, not unlike riffles and eddies, the rhythm of the river. Before breakfast, we practiced group yoga. Several people grabbed a quick cigarette before they arranged themselves into lotus position, which never failed to crack me up. Day’s dog, Major, lay at her feet at all times and seemed perplexed by the strange body positions. Even impassive Mason, who moved as little as possible, swiveled her torso for gentle twists. Skinny Hana was usually cold but always smiled. I noticed she was babbling less.

Each day, there was more laughter. Lopez made nicknames for our guides, who rowed the gear boats, cooked the food, set up our tents and then left us alone. They were all young, strong, and mostly male. She dubbed the clean-cut trip leader, Reid, Captain America. Another, burlier guy with long hair became Fabio. Like an Army unit but with better hair, they had their jobs, routines and ways of contributing to the group. Some were funny, some wise, some watchful.

“This is not unlike war,” Herrera told me. “There’s something that can kill you. There’s a tight group that depends on you for survival, and everyone is a part of it. Bonds develop that have meaning. Life is better when it’s simple. Here, like in the Army, you don’t have 40 different options for toothpaste. You have your place. We all have it.”

It’s no wonder there is a storied American legacy of damaged soldiers heading for the wilderness. The backwoods of Idaho, Montana and Alaska are notoriously peopled by veterans. After Vietnam, men went there who felt misunderstood by civilization and found the greatest peace away from it. But despite its strong anecdotal legacy, the wilderness is not recognized by the Veterans Administration, or even by most psychologists, as a legitimate healing tool. It’s largely been the veterans themselves, privately funded and socially inclined, who are driving the current renaissance of programs aimed at helping service members.

Graham Smith

David Scheinfeld, who has led Outward Bound backpacking courses for veterans for 11 years, uses the term “therapeutic adventure,” but doesn’t necessarily share that with the participants. He has seen so many lives transformed by six-day trips in the wild that he decided to study them for his Ph.D. in psychology from the University of Texas, Austin. He wanted to know what was making the approach successful while the other standard interventions — cognitive behavior therapy and medication — were falling short.

When Scheinfeld assessed 159 veterans, he found that Outward Bound participants experienced 9 to 19 percent improvement in mental health; vets in the control group showed no such gains. The Outward Bound groups still showed the boost a month after the trips ended.

Why did the trips work? Scheinfeld noted that the participants, mostly male, tended to encourage each other to give counseling another try and stick with it. “There were always a couple in each group who were helped by counseling, and they became de facto mentors,” he said. Because of this, the participants showed a greater openness seeking treatment after the trips, and they were less likely to drop out of treatment. Another reason for success: The trip itself, being in the wilderness and part of a supportive group, counted as extended therapy, and for many hours a day, not the usual one hour per week offered by the VA. “It’s hard for these guys to sit in a room with four walls and talk about their feelings,” said Scheinfeld. “It just happens best when they’re in a natural setting. It draws them out.”

Other studies have shown similar results. Neil Lundberg of Brigham Young University looked at 22 participants from two Higher Ground trips in 2010. Compared to a similar group of veterans on a waiting list, they showed significant decreases — of up to 40 percent — in flashbacks, emotional numbing and hyperarousal after the trips. But not everyone is convinced. Craig Bryan, a psychologist and Air Force veteran who directs the University of Utah’s National Center for Veterans Studies, remains skeptical of nature-based treatment. Most of the studies out there, he said, are small, lack a meaningful control group, and don’t follow participants for very long. “It’s possible these treatments are better than existing treatments, but we just don’t know,” he said. “We don’t have the data to back it up. I want to see randomized control studies, bigger studies.”

To collect more data on its programs, Outward Bound is partnering with the Sierra Club and the U.S. Department of Veterans Affairs to run a large pilot study out of the Seattle Veterans Administration. Between them, Outward Bound and the Sierra Club reach hundreds of veterans per year. Stacy Bare is helping to coordinate the study for Outward Bound. A veteran who credits his time in the wilderness with saving his life, Bare understands the need for better metrics.

“It’s amazing to me that we don’t know more,” said Bare. “I think we all believe in the power and mystery of the great outdoors, but these are difficult things to quantify by science. Is it difficult to do a double-blind control study in nature? Very. I don’t think we have to hit that standard, but we have to have a more systematic approach to how we evaluate the effects of the outdoors.”

 

During the last days on the river, we floated through a landscape that had been ravaged by wildfire in 2000 and again in 2012. At the site of the older blaze, new teenaged evergreens were rising. Around the charred stalks of the more recent fire lay a carpet of brilliant green grass. It was a powerful reminder that life cycles onward. One morning, I sat on a big gear raft next to Linda Brown, the older vet who had been institutionalized for depression. She sat with her arms wrapped around her life jacket, her sandaled feet propped on the front tube of the boat. “The trees can’t control their lives,” she’d said, speaking so softly she practically whispered. “We can’t always control what happens to us. The trees can teach us acceptance. And metamorphosis.”

 

Months later, most of the women of Unit HG-714-RA would look back and say rafting in Idaho helped them on their long journeys to recovery. At least one of them, Catalina Lopez, nurse of exploding heads, would say it didn’t. Statistically, this seems about right. In other mental health studies, for example in Finland, about 15 percent of subjects remain wholly unmoved by their time in nature. Sometimes it’s because they just hate it there. They hate the bugs, the breeze, the big sky. Their nervous systems will never calm down outdoors.

That wasn’t Lopez’s problem. She said the trip just wasn’t nearly long enough. Not long enough for her to turn off her nightmares. Not long enough to stop her from sleep-driving through corn stubble at midnight on Ambien. Not long enough for her to start believing again in other people. Certainly not long enough to gain confidence swimming through swift currents. Many wilderness therapy programs for troubled adolescents run weeks and weeks, even months.

Although Higher Ground gives each participant a “recreation fund” to keep pursuing an outdoor sport at home, Lopez told me she still hadn’t decided whether she would use it. But Marsha Anderson and Carla Garcia would go surfing, sometimes together, in Southern California. Formerly passive Anjah Mason had joined a gym, determined to lose 20 pounds. I was amazed at her transformation. She now routinely hikes near her home, and she wanted camping gear. Pam Hana had been cycling and wanted to use her rec funds to buy a mountain bike.

As for Herrera, she told me she was signing up for another river trip, this time with Outward Bound. “I liked the river. I liked to be successful,” she said. And she was scoping out other programs as well, a shooting trip in the countryside in Alabama, maybe skydiving or rock-climbing if she could find a place that adapts to disabilities. “I want to find something to do every summer,” she said.

And, she told me with pride, she was growing her hair out.

Florence Williams is a Washington, D.C.-based journalist and the author of the forthcoming The Nature Fix: Why Nature Makes us Happier, Healthier and More Creative, from which this essay is excerpted. Her first book, Breasts: A Natural and Unnatural History, won the 2013 Los Angeles Times Book Prize. She is also a former intern and staffer of High Country News who now serves on its board of directors. 

This story was funded with reader donations to the High Country News Research Fund.