Dan Shoemaker served 10 months in Iraq as an infantry platoon leader, but he says his most vivid and lasting memories come from his last day there, June 11, 2010. The morning patrol through the marketplace. The gunfire as one of his men fired at the explosives-packed truck barreling toward them. The flash, his body flying through the air, and a huge chunk of engine whizzing past his head. The blast killed two of his men and wounded another six. Shrapnel shredded Shoemaker’s right side, from his ankle to his skull.
That evening, as hospital staff wheeled Shoemaker to a plane bound for Germany, a doctor approached him. While looking over his CAT scan for shrapnel or signs of internal damage, he found a racquetball-size tumor in his brain.
“Am I going to die?” Shoemaker asked.
“I don’t know,” the doctor said, and they carried him onto the plane.
On the flight to Germany, Shoemaker replayed the day’s events, the carnage he had seen, the men he had lost, and he wept. Even then, in those earliest hours after the blast, his mind still foggy from morphine, he had a moment of clarity: “If I don’t do everything I can to get through this mentally, as soon as I can, it will kill me,” he told himself. “No matter what it takes, I have to find a way to find peace with this.”
Surgeons removed most of the tumor from his brain, and he underwent months of radiation and chemotherapy. But doctors told him the cancer would likely return. Still dealing with the deaths of his friends and the bleak health prognosis, Shoemaker was despondent.
Joshua Brandon, who had been Shoemaker’s commander in Iraq, saw this after they had returned to Fort Lewis, near Seattle, and had an idea: He took Shoemaker to climb a mountain in Washington. It ended up being the best form of therapy for him. “You’re not thinking about being in a blast when you’re looking for the next handhold on a rock climb,” Shoemaker says. “My head’s not in combat. My head’s not in a bad place. I may be nervous, but I’m there in the moment, and I’m going to make the most of it.”
Shoemaker now shares with others the healing he found outside, as an assistant trip guide with Sierra Club Military Outdoors, which takes service members, veterans, and their families into the backcountry. “It could change their life, like it’s changed mine,” he says. “Instead of grabbing a bottle of whiskey to forget about what happened in combat, maybe grab a backpack and go for a long hike or climb a mountain.”
This combination of nature, adventure, and the support from military friends that pulled Shoemaker from a deepening depression has ballooned in popularity in recent years as veterans of the wars in Iraq and Afghanistan struggle to find their footing in the civilian world and cope with the lingering effects of combat. After Vietnam, Outward Bound started the country’s first small-scale outdoors programs for veterans; today the field is crowded with scores of groups that take vets horseback riding, cycling, and mountaineering, or surfing, fly fishing, and snowboarding.
Many could use the help. Military suicides far outpace combat deaths: In 2013, two hundred fifty-nine active-duty troops killed themselves, as did scores more Iraq and Afghanistan veterans; the Department of Veteran Affairs is saddled with a backlog of veterans seeking mental health treatment, and many avoid treatment altogether.
Correlations between physical activity and mental health are well established, and spending time in nature has positive neurological effects—boosting cognitive and creative ability—even for healthy brains. For veterans, outdoor-based programs can reduce the stigma of seeking therapy, and the wilderness setting can have particular benefits for those with post-traumatic stress. “They often limit situations they’re willing to put themselves in, so they’re not getting new data on the world around them,” says Jennifer Romesser, a psychologist with the VA in Salt Lake City who has taken patients on wilderness trips. With new feedback and positive experiences from a nature experience, they can change their understanding of themselves and the world around them and reconnect with who they were before the war.
“The outdoors gave me my life back,” says Stacy Bare, who runs the Sierra Club’s outdoors programs. He had served as an Army officer in Baghdad during the most violent months of the insurgency and afterward struggled with a traumatic brain injury and post-traumatic stress, using a treatment plan of liquor and drugs. After a couple years of self-destruction that spiraled into depression and thoughts of suicide, he started rock climbing at the invitation of a fellow Army vet. “It gave me the time and space to sort through the struggles in my head,” he says. “Getting outside was what led me to the notion that I needed therapy.”
Bare knew being outside had helped heal him, and he’d heard similar stories from dozens of others, but he couldn’t find any hard evidence to support that, which limited his ability both to get program funding and to entice veterans to participate. Treatments once seen as fringe—meditation, yoga, animal and music therapy, acupuncture, virtual reality—have been validated through extensive study and embraced by the Pentagon over the past decade. Research shows that time spent in the wilderness has positive effects on groups as varied as breast cancer survivors and children with behavioral issues, but it has not been expanded much to look at the effects on combat veterans.
Starting in 2011, the Sierra Club sent 100 veterans on outdoor trips—canoeing, rock climbing, backpacking, skiing—lasting from four to six days, and a University of Michigan team designed surveys that the participants completed a week before their trip, a week after, and a month after. The questions gauged a range of psychological and social markers: psychological well-being, perceived stress, attentional functioning, and feelings of tranquility. Did they have a hard time connecting with their experiences as veterans? How often did they experience feelings of being lonely or left out? Did they feel their lives were moving in positive directions?
You’re not thinking about being in a blast when you’re looking for the next handhold on a rock climb.
Dan Shoemaker, former infantry platoon leader in Iraq
“As we got into it, we became less and less optimistic,” says Jason Duvall, a researcher in environmental psychology at the University of Michigan. “This groups faces some really significant challenges. How realistic is it to expect a five-day canoeing trip to have significant effects? That seemed like a tall task. And yet, we see that on many of these measures, there is a significant impact. It does make a difference.”
Most of the participants reported improvement a week after the trips; one month after, the benefits had largely dropped off. “It’s not like the problems you left are gone. They’re still there. You still have to confront them,” Duvall says. “That suggests that spending time in natural environs has to be regular.”
Effectiveness also depends on the programs. Some are intended solely as recreational outings, a “Thank you for your service,” much like free tickets to a rock concert. Others are meant to give confidence and new skills to wounded veterans and serve as an example—for the public and those with disabilities—of overcoming obstacles. Still others mean to ease the mental and emotional strains of wartime service and reintegrating into civilian society.
Vets are often on their own in weighing the merits of these programs and whether they could benefit from them. Would it be just a fun trip or a step toward calming their minds, easing stress and leading to better coping skills? Do the programs have staff who know about veteran issues?
“There are a lot of programs that intend to help veterans, but they’re just an assisted vacation without a longer scope of benefit,” says Bert Gillette, the director of programs and outreach for the R4 Alliance, an umbrella group started by several recreational vet programs to get past what Gillette calls “big hearts and bad practices.” R4 (which stands for “recreation, research, rehabilitation, reintegration”) developed common standards, whether a program’s focus is therapy, deepening social contact, or developing outdoor skills. The group now represents 47 programs working in all 50 states. To get the R4 stamp of approval, programs must be designed around a RAND Corporation list of best practices for promoting psychological resiliency, be fiscally responsible, and be in good standing with veterans, based on participant surveys. With common standards of practice among the groups, Gillette says, researchers will be able to study and compare far larger sample sizes and potentially better match activities with need. Would a veteran with cognitive deficits from a traumatic brain injury get more benefit from fly-fishing or from backpacking?
Larger studies will also help researchers understand why veteran wilderness programs work and which components are the most useful, says Duvall. Is it the challenge and the mission-oriented nature of the trips? The camaraderie of being with other vets? The peacefulness and reflection from time spent in nature?
For Sean Gobin, a former tank commander who founded Warrior Hike, one of the most intensive outdoor veteran programs, those three factors are inextricably linked.
On the day he left the Marine Corps in 2012, he and a Marine buddy started hiking the 2,180-mile Appalachian Trail, a five-month trek that Gobin figured would give him a chance to decompress before starting grad school. Two violent deployments to Iraq and one to Afghanistan had left him angry and isolated. “I couldn’t connect with people anymore,” he says. “You disassociate yourself from people and start to develop a cynical view of humanity.”
The immersion in nature brought benefits he hadn’t expected. “Hiking eight hours a day, your brain has no choice but to process things,” he says. “You’re not running away from your problems but coming to terms.”
After his trek, Gobin started Warrior Hike, which outfits and supports veterans for months-long hikes of the Appalachian, Pacific Crest, and Continental Divide trails. This year he’ll send 30 veterans on those trails and several smaller cross-state routes. They hike in pairs or small groups and stop regularly at Veterans of Foreign Wars posts along the way for meals. “Being on the trail you have all the time to think about what you want to do next,” Gobin says. “And doing it with other veterans, everyone has been through similar things. You’ve got someone you can talk to.”
Warrior Hike has been working with psychology researchers at Georgia Southern University to gauge the effectiveness of long-term hiking, and the program has a built-in component of informal therapy. Shauna Joye, a psychologist from the university and a veteran, emails the hikers weekly messages that explain the psychological underpinnings of issues such as combat stress, present hypothetical scenarios, and offer tools for better regulating and processing emotions, handling stressful situations, or improving relationships.
“A six-month hike is not a cure, but it is a good reset button,” Gobin says. Which is why Warrior Hike lets participants keep their hiking gear, an encouragement to get outside regularly. “The outdoors is there,” Gobin says. “It’s accessible, and it’s free. Use that as your long-term coping strategy.”
This article was created in partnership with TakePart's parent company, Participant Media, in support of the film That Which I Love Destroys Me.