Under the Glass: News from the Greenhouse

It is not unusual for someone to ask, after hearing what I do, how long horticultural therapy has been around. They are usually quite surprised to hear that is quite old as a treatment. But when you give it some thought, it’s not hard to imagine that people have found solace in nature from the very beginning of time. According to Charles Lewis the first recorded use of horticulture in a treatment context took place in ancient Egypt where court physicians prescribed walking in palace gardens for royalty who were experiencing mental illness.

As far as we know, the use of horticulture in treatment did not progress much until the late 1700s and early 1800s, at which time it began to evolve into an accepted mode of treatment in the United States, England, and Spain. Dr. Benjamin Rush, widely considered the first American psychiatrist, used horticulture in the treatment of mental illness. He described the curative effects of field labor in a farm setting for people with mental illness. These findings were well-received by his colleagues in the US and Europe and led to further testing of this concept. In 1806 in Spain, hospital programming for patients with developmental disabilities began to include agricultural and horticultural activities. The positive results from these types of programs led to the idea that mental health institutions should be built in rural settings and that patients should be actively involved in the growing and harvesting of field crops.

Another important milestone in the development of horticultural therapy was the opening of Friends Hospital in Philadelphia. In addition to its farm landscape, Friends Hospital was surrounded by a parklike setting that included shady walks, forest paths, and open meadows. Patients were still involved in vegetable and fruit growing but the calming effects of nature as a passive form of therapy was now included as a treatment tool. The hospital’s grounds were a favorable environment favorable for therapy and one that awakened the patients’ senses. In 1879 Friends Hospital built the first greenhouse dedicated to therapeutic purposes.

In the twentieth horticulture is employed to help people with physical disabilities. In the United States, horticulture was being used with soldiers with physical disabilities from both World Wars I and II. During WW I, horticulture was used mostly as a diversion for long-term patients and for occupational and recreational purposes. During WW II that changed; horticulture was used less as a diversion and more as an important component of therapy and rehabilitation.

In 1917, near the end of WW I, the Women’s Occupational Therapy Department at Bloomingdale Hospital in White Plains, NY began offering education in horticulture. This is the first time training in horticulture focused on health care use was available and the program was actively pursued.

In 1919 the Menninger Foundation was established in Topeka, Kansas for patients with mental illness. From its very first day, plants, gardening, and the study of nature were fundamental components of a patient’s daily activities.

In 1936, the brand-new Association of Occupational Therapists in England formally acknowledged using horticulture as a specific treatment of physical and psychiatric disorders (McDonald, 1995). In 1942, Milwaukee Downer College, which was the first college to award a degree in occupational therapy, became the institution of higher learning to offer a course in horticulture within their occupational therapy program.

With horticulture now being accepted as a treatment method and used extensively in hospital settings, great numbers of garden club volunteers assisted occupational therapists in using plants and gardening activities in their therapy and rehabilitation programs. This created opportunities to test the validity of horticulture as a treatment option for people with physical disabilities as well as those with mental challenges. As a matter of fact, in 1951 the National Council of State Garden Clubs named horticultural therapy as one of the major objectives of its member clubs and in 1968 a total of 4609 of the council’s clubs had involvement in horticultural therapy programming.

In 1951 horticultural therapy was used with a geriatric population for the first time at the Michigan State Hospital in Pontiac. Alice Burlingame, a trained psychiatric social worker started the program, and the success of the program convinced her that this practice was significant enough to be its own, distinct profession. Four years later in 1955, Michigan State University awarded the very first Master of Science in Horticultural Therapy degree.

1953 was the first year a horticultural therapy program was developed through a public garden when the Arnold Arboretum of Harvard University started a program at a nearby veterans’ hospital. In 1956 the Holden Arboretum in Ohio developed a similar program for a senior center.

In 1959 Rusk Institute for Rehabilitative Medicine at NY University Medical Center developed a horticultural therapy program within an attached greenhouse. This was a major step forward for the horticultural therapy profession for two reasons: Rusk made the horticultural therapist a part of the patient’s treatment team and used horticulture for diagnostics as well as rehabilitation.

Therapy through Horticulture, the first textbook in horticultural therapy, was published in 1960. There have been several other textbooks written since then, with the latest, The Profession and Practice of Horticultural Therapy, being published in 2019.

Another big step forward happened in 1972 when the Menninger Foundation, a psychiatric institution in Topeka, Kansas developed a cooperative educational agreement with Kansas State University. As a result of this agreement the first horticultural therapy curriculum with a focus on mental health was established. Students in the program were given formal training in psychology and horticulture at KSU and then did a 7-month clinical internship at the Menninger Foundation. The program expanded over the years and its success led to other schools and institutions offering academic instruction in horticultural therapy.

Around this time, many people involved in the practice began to realize the need for a national forum for horticultural therapy. That led to the creation of the National Council for Therapy and Rehabilitation Through Horticulture (NCTRH) in 1973. The Council developed publications and educational programs, networked with healthcare and horticulture professional and trade organizations, and developed strategic plans and structured goals toward the advancement of the profession. In 1988 the NCTRH decided to simplify its name to increase name recognition and became the American Horticultural Therapy Association (AHTA). AHTA a membership-driven organization whose mission is to promote and advance the profession of horticultural therapy as a therapeutic intervention and rehabilitative modality. AHTA established professional standards and a code of ethics and is currently developing a credentialing exam. They accredit horticultural therapy education programs in the U.S. and the University of Florida Certificate in Horticultural Therapy received accreditation from AHTA in 2019.

This may have been more than you ever wanted to know about the history of horticultural therapy, but hopefully you found some of it interesting!

Elizabeth “Leah” Diehl, RLA, HTM
Lecturer, Dept. of Environmental Horticulture, College of Agricultural and Life Sciences
Director of Therapeutic Horticulture, Wilmot Botanical Gardens, College of Medicine