You’re Lonely: What’s the prescription? An Interview with author Julia Hotz, author of The Connection Cure

What if your doctor prescribed you a hiking group? A ceramics class? Not in place of whatever medication or treatment you may need, but as a complement to it? It’s called Social Prescribing, and journalist Julia Hotz traveled to some 30 countries to talk to patients and professionals who are at the forefront of this approach to wellness. I loved her book, and loved this conversation (and regret we didn’t have time to talk about AI chatbots!).

You can buy Julia’s book here to support her, independent bookstores, and this podcast. 

Transcripts may not appear in their final version and are subject to change.

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Um, how are you?

Most of us say fine or good, but obviously it’s not always fine, and sometimes it’s not even that good. This is a podcast that gives people the space to be honest about how they really feel.

It’s a place to talk about life, the good, the bad, the awkward, the complicated. I’m Nora McInerny, and this is Thanks For Asking. Imagine going to the doctor and being prescribed a mahjong league, a hiking group, a pottery class.

This is not just an exercise in imagination, this is called social prescribing.

And there are healthcare professionals around the world who are doing this, who are prescribing social connection, art, nature, friendship, because it improves our health. Now, we are living in very lonely times.

People are talking to AI chat bots and calling them their friends. And I’m not saying there are no applications where that might be useful, but I am saying that we seem really excited to find a technological solution to a very human problem.

We need connection. We’re built for it, we crave it, and it affects us. A lack of connection affects us physically and mentally.

There is a book that came out this year called The Connection Cure by journalist Julia Hotz. And I read it, I loved it, and I had to interview her.

Julia spent a long time traveling to over 30 countries, meeting with patients, meeting with health care professionals who have been a part of social prescribing and talking to them about the ways that belonging, connection, nature, art can help us

heal. And I know because we’re also living in a complicated time and there has been a public erosion in trust within the health care system and there’s been talk of people on antidepressants going to work camps.

You need to know that I am on antidepressants. I’ve been on antidepressants and I do tend to bristle at the idea that, oh, it’s just like on your head, go for a walk, like eat well, exercise.

Yeah, those are all things that are easier to do when you’re not depressed. And also, those are things that have helped my depression. It’s complicated.

The author is not suggesting, nor is anybody else, that social prescribing is a replacement for other forms of treatment, but rather it is a complement to other forms of treatment.

And looking at my life as a young widowed mother, I can say that social connection is a part of what saved my life.

When I was a young widow, I met other young widows and we formed a group and there was something about that physical proximity to other people who got it and that deep, deep emotional connection that I felt with them that really did help.

And so did therapy and so did antidepressants because it was grief, it was anxiety, it was PTSD. It was a lot, but connection has helped.

And I also work alone, I spend a lot of time alone in this room in the days where I get to pick up the phone and call you guys and have a call in show or open my laptop and talk to somebody like Julia Hotz.

I feel so much better because we do need each other, we need connection and loneliness is tough, loneliness is everywhere and we’ve talked about it a lot.

We’ve talked about it a lot on the podcast, we’ve talked about it on the YouTube channel because so many of us feel so lonely.

So, like I said, I was very lucky to be able to interview Julia Hotz, it was a long time coming, it took really months for me to just reply to an email, set a date and then show up and then it was as simple as that.

So this is my conversation with Julia Hotz, not just about the power of social prescribing, but also I’m currently in America like many listeners and viewers are, and it’s a mess here.

So in the absence of social prescribing here, what can we do to build more connection? I get into all of that with Julia. What I did not get to talk to her about was AI chatbots.

And my God, do I wish we would have had the time to go in to that. So as always, once you’ve listened, once you’ve watched, go ahead and leave a comment. I want to hear from all of you.

If you are listening on Substack, subscribers are able to comment. It is really wonderful. We’ve got a nice little chat.

We have some connection over there. If you are watching this on YouTube, hit the comment section, subscribe so that you get future videos as well. Thank you for being here.

Let’s go. Jules, I have had some form of a podcast for nine years. That mental math was very difficult for me.

Yeah.

You were an OG.

I mean, honestly, I think a common thread for almost all the conversations I’ve had on every iteration of this podcast has been loneliness, has been a lack of connection, or a need for connection.

You literally wrote, if not the book, definitely a book about the value of connection. Does this feel like a modern trend to you?

It does feel like a modern trend to me. It feels as though it’s in the news every day, I would say.

You know, whether it’s loneliness explicitly, there was a great article that came out recently about how people are choosing to spend time alone, which is different from loneliness a little bit. We could talk about that.

We have talked about the decline of third spaces. That’s in the news a lot for people to actually like meet and form the friends. We could talk about how the rates of people who report having zero friends has gone up and up and up and up and up.

It’s pretty bleak out there in that trend, but I will say that I have written a book and there are lots of great books out there all about the people who are trying to solve this problem because it is a problem.

It’s not just like, aha, everybody’s lonely. It’s, huh, everybody’s lonely and this is leading to profound consequences for our health, for our social fabric, for our children’s future.

So it’s been a wake up call and I’m excited to talk about what I see as some of the solutions to this problem.

You mentioned that there’s a difference between being alone and loneliness. And I do want to hear that official definition difference from you.

And also it does feel like because of all the factors that you included before that we are more alone now than we have been in the past.

Single-family homes, car culture versus mass transportation, having your groceries delivered, which of course there are accessibility uses for all of these things. I get it. And a lack of third spaces, clubs.

We’re working from home like I am. I spend a lot of time alone. And for me, I do get lonely.

And a part of that is I’m not going to an office every day and being annoyed by what my colleagues are microwaving.

Yeah, gosh, there’s nothing like community than having somebody microwave a tuna mill in the office microwave. Absolutely. And, you know, we joke, but that’s absolutely true.

And to your original question, I think there’s two things happening. You’re right, that like modern life has made it so convenient for us to get all of our basic needs met without leaving our house. We want groceries, we get them delivered.

We want entertainment, we turn on a TV show or scroll through our phones. We want company.

You don’t have to go to a movie theater. I used to love to go to the movie theater and stand in line. You know what I mean?

Like I stood in line to see Titanic. I almost died in a crowd crush seeing Titanic. Me and my two cousins versus a bunch of adults.

I was like, this movie is not for you. We are the target demographic. Sorry, I had to, but there’s all these things.

Anything that you used to have to go and do and participate in society, now you can do alone and on your phone.

Yeah, absolutely, absolutely. And you know what? To that point, it’s not even just seeing Titanic.

It’s waiting in line. It’s hanging out in the lobby after to talk about it. All of those little things that were adjacent to The Connection.

And so, like on one hand is awesome. And here’s how our mind tricks us. We think, wow, it’s so great that I can get any movie I want streamed from my home.

That’s so convenient. And I’m gonna have more time to do the things I wanna do. I need groceries, great.

I’ll get them shipped here. I’ll have more time, I’ll have more time, I’ll have more time. Now, this is a little mind trick because what actually happens is we do all those things and we feel like we have less and less and less time.

People are facing chronic rates of stress, burnout, anxiety, depression, all of those things. I think it actually is driven by the fact that alone is the default.

There’s a quote I love that’s something like, the modern condition is doing things by yourself that used to historically be done in a large village and wondering why you’re tired all the time.

Because yeah, it’s great you get your groceries to your door, but that neighbor that you met along the way that you want to water your plants in two weeks, you’re not meeting them, so you have to hire something.

I think coming back to your original question, are we alone or are we lonely? Lonely, I think it’s both. The definition of loneliness is sort of akin to hunger, right?

Being hungry is you want food, you have a craving for food. In the same way that we crave food, we crave nourishment, we have the same sort of system for social connection. We absolutely need that.

And loneliness is the gap between the amount of connection you want and the connection you have. So it’s like, I’m hungry, but there’s just like Doritos in my pantry, and that’s not going to fill me.

So I’m going to eat these Doritos, but I’m really going to want more. Being alone, choosing loneliness, is saying, I don’t want to go through the effort of connection.

We think we don’t want to go through the effort of connection because these other, again, like substitute forms of connection are so, so tempting. And we think they fill us. But actually, what the data suggests is they don’t.

And even if we don’t explicitly recognize that we’re lonely because pop culture has like depicted it in this way of like, you have to be older and isolated to be lonely.

I think it is universally true that many more of us than we think are not getting the kind of nourishing connection that we physiologically need.

I’ve been thinking so much about convenience culture, and convenience has made huge strides thanks to technology, and yet there’s something about convenience that is increasingly anti-human and anti-community. I live in Phoenix, Arizona.

We are in an area where they test out driverless cars. So for years, Waymo’s, I don’t know if you have Waymo’s where you live yet, but Waymo’s driverless cars, just ghost cars tooling around, training themselves on our streets.

They idle right outside my studio. They are spooky, and just even removing humanity from something like mass transportation, taxi where you have a driver, and maybe there’s variables there, right?

Like maybe the driver is a good driver, maybe the driver is a bad driver, maybe the driver, like happened to me numerous times, once with my entire family, is on a FaceTime call while smoking a cigarette in the car to a driverless car.

And all of these things chip away at community, chip away at our connection, and isolate us even further. When I was in college, and I almost said in a different century, it was the same century. But several decades ago, we lived in dorms.

Our dorms had a communal bathroom down the hall. When you graduated from the freshman dorm, you went to a slightly better dorm where two rooms shared an ensuite bathroom that connected the rooms.

When you were a little bit older, you would find friends and all rent a house that should be condemned, blocks from campus, and you would live five or six to a house and split the rent, and argue over who ate who’s pasta, and split the bills.

I have a son who is 24 currently, and I moved him into his first college living space. He unfortunately started college during COVID.

This living space was an apartment right by campus, where you did not sign a lease with a group of people, you signed a lease for one room within an apartment. You could be randomly assigned with somebody. Every bedroom had an en suite bathroom.

Every bedroom came with a mini fridge. Every apartment had in-unit laundry. It’s such a lonely way of living.

All I could think of was freshman year, I spent countless hours. I wouldn’t call it stalking, but it’s like stalking where you see somebody that you either want to be friends with or want to like you. And you’re like, when are they doing laundry?

When are they doing laundry? How can I go down with just with a basket of possibly clean clothes and just run into them, right? Maybe you had a Discman that you carried around, but it was kind of weird.

Like it was weird. If you walked around with headphones on, it was kind of odd, you know? And now that is like the default to be somewhere else, even while you’re in public.

You know, if you do go to the grocery store, you know, you have headphones on and you’re listening to a podcast or you’re on a bull-ass phone call that I don’t want to listen in to.

And I am nosy, but if I can only hear one half of the phone call, it doesn’t do anything for me.

So I really do think that when you look at it, at these things that sort of become normal over time, it’s hard to see the water you’re swimming in until you see a picture of what the water used to look like. This is falling apart quickly.

It’s so, gosh, you painted such a, like, haunting image of, again, in college, the time of, like, peak development, peak friendships, also peak inconvenience, peak, you know, going out of your comfort zone, and we’re absolutely removing all of those

barriers. And it’s really interesting because, you know, you see on the other end, and actually, I think in Arizona, especially, this is popular, we’re seeing the rise of these, like, co-housing communities.

Have you ever heard of these, like, these sort of planned villages?

I have, yeah.

There’s another author with a great book out right now, Raina Koh and the Other Significant Others, who, like, talks about the rise of friendship taking the status of marriage, you know, friends living together, or two families choosing to live

together and raise children together. There’s something called mamuens for, you know, single or widowed mothers who, like, come together in a house to raise kids.

And I love this, and I think the rise of that speaks to this need we all have, and also this idea that, yes, it’s a little bit inconvenient, but it also has all of these wonderful knock on benefits.

And so it scares me that your son is not getting that.

It bums me out. I’m like, college should be that way. It should be the time of the most meet cutes of your life.

It was eerie to go down to his campus and just see kids with headphones on, heads down, or a device in their hand. Meal plans even now, like we all went to the cafeteria.

You’d go to the cafeteria on a Saturday morning, hungover, looking like crap, but you just roll in with all your friends from the dorm and you’d sit at a long table and you’d have to like see the person that you maybe kissed the night before and get

in line with a tray. And now you can have a meal plan where you just order like chick-fil-a.

What? Really?

Yeah. It’s like a dining hall that’s more like the food court at the mall than a true cafeteria. And did we complain about the cafeteria?

Yeah, we did. But it had a purpose. We did not know the purpose was not simply to provide very, very low cost, low nutrient foods to us.

Absolutely.

It was having to confront that person that you said that really awkward thing to last night. It was, you know, getting to know in our college, we had like Matt, the egg guy, who, you know, was a homie and we got to know his life story.

Like Ron the Omelette Man. We had Ron the Omelette Man.

You had an omelette guy. Gosh, I wonder if there’s a network out there of just like all the university omelette makers.

If Ron in Cincinnati, Ron the Omelette Man, I want you to know, I think about you anytime I eat eggs because nobody made an omelette like Ron the Omelette Guy. No one. No one.

Wow, wow.

Yeah. And so, gosh, you know, like we think we want this. There’s a great study that came out of this researcher in Chicago who sort of did a similar study about commutes.

When we commute, we think that we want like total silence, total peace, everybody leave me alone. Like my day already sucks. I just want to listen to this podcast or be in my element and not talk to anyone or think about anything.

We think that, right? I think that, I’ll be honest. But this researcher did an experiment where he basically had, he put people in two conditions, one in which they did that and one in which they had to talk to a stranger on the commute.

And lo and behold, the people who had to talk to the stranger rated the ride as being much more pleasurable, memorable, something that they’re going to think about or something that shifted their perspective.

And we know this to be true, like of all the, I don’t know, hundreds, thousands of car rides we’ve taken with strangers in our lives, we remember the ones where we talked to someone and had an interaction like that.

And it’s just so interesting to me that this tension between, we think we don’t want that because we think we have to preserve our energy. But actually, when we have these sort of novel experiences and novel interactions, it gives us more energy.

It gives us new found optimism and pep in our step. It improves our mood. So I think what part of this book is, it’s about recognizing culturally that we do want this.

And then it becomes a question of like, you know, you have kids. It’s like, how do you get your kids to eat vegetables? How do we package connection in the most like appealing way?

Maybe you’re putting the vegetables in brownies. Maybe you’re like cutting them up in cute little shapes. I don’t know.

That’s what you’re overestimating.

My nope, I’m not doing any of that. No.

Well, that’s totally fair. That’s totally fair. But, you know, the analogy is there that like, yeah, we need to make connection sexy again.

Like every part of American culture, if you are not thriving, it is a personal feeling, right?

Like if you don’t have enough money, well, like you didn’t hustle hard enough or you didn’t, you know, save enough. And it doesn’t really matter that the federal minimum wage is what, like 725?

And that will not get you even, I don’t know what that’ll get you, but it won’t get you anything. You will not get ahead that way. Whatever you are struggling with, it comes down to you.

And it’s easy to feel like if you are living in America where everything is your responsibility and we have next to no social safety nets and we are during the year 2025 steadily chipping away at anything that resembles community focus or the greater

good, then if you feel lonely, it almost feels like, I mean, it’s your fault, right? Like, why would you be lonely?

Right? Right.

Why would you be lonely? Do something about it.

Exactly. Yeah. Why would you be lonely when you can, I don’t know, join a gym for $200 a month or, you know, whatever it might be.

I mean, I think people have realized that exactly this, the structures that supported community that used to be free, that used to just be part of how we lived our lives, that used to be, I mean, we’re talking tens of thousands of years ago now, like

what we needed to survive. We needed the group to be able to survive. Slowly, that’s been chippy, chippy, chippy, chipping away, and replaced with almost like a market for community.

And so what the book is about and what social prescribing is really about is saying that’s messed up. We need connection. We need access to sources of joy, sources of other people, ways to cope with our stress.

We need it for our health. So let’s get health care on board with this. And that’s what this movement of social prescribing is about.

It’s about getting your doctor, your therapist, and then believe it or not, your insurance company in some cases to cover prescriptions for things like art classes, cooking workshops, hiking excursions.

And we’re finding that this not only improves health outcomes, but get this, it also reduces health care costs over time.

So for, you know, the same people that are sort of creating a market for Connection, it’s important to recognize that this is happening in health care, and there’s a way to do it without spending extra for the consumer, right?

Is there something about that that kind of aches you out, though, to say like, oh, well, someone should pay for this sense of community? Like, why not make it your health insurance company?

And I will fully reveal my politics here, which I don’t think are a mystery to anybody, but like, I don’t think health insurance should exist. Like, I don’t think so. Okay, why are some people making billions of dollars?

Why is that publicly traded?

I was falling asleep last night thinking about the fact that my family, for the past four years, on and off, I’m part of the Writers Guild of America, that’s a union, very few unions left in America, which is another social connection, another social

safety net, or another economic safety net of all kinds. When our union insurance would lapse, we’d be on COBRA, it would be around $3,000 for a family of six.

It was great insurance, but also on top of that $3,000 a month for a family of six, which is $36,000 a year, we still had to pay out of pocket up to I think $10,000 a year. And that $46,000 times four, that’s a lot of money. Where’s that money?

Why am I not getting that back if I’m not costing you that? You know what I mean? So it’s like, I don’t know, I asked you a question.

Doesn’t it kind of give you the Ick?

It gives me the Ick 100%. And it is, I mean, I agree with you so much. Like, where is this money going?

Who even understands how to navigate the health care system? Like, I opened the book with that. EPOs, PPOs, despite writing a book about health care, I still don’t really understand it.

But the fact is…

No one does. I don’t think…

Nobody does. Even people who work in this, I’m like, can you explain this to me? And that just goes to show we are so baked into a system we don’t understand.

And that’s messed up and we could talk all about that. But it’s kind of like, well, you know, if we are baked in this system, we might as well get our bang for our buck. We might as well get the health-promoting connection we need out of it.

And if instead of my insurance dollar is going to pay some exec or some third party of a third party of a third party, I’d rather have it go to the Community Arts Center.

I’d rather have it go to the Parks Department that’s leading these birdwatching classes. So that’s kind of what social prescribing is about.

And it comes from this idea that our level of social connection is a huge predictor of our health and longevity.

It’s a bridge to ways to cope with our stress, to cope with the many different challenges that could come up in somebody’s life, not just because of the activity itself.

And we could talk about that like nature is really good for us, art is really good for us. Probably not surprising. But also the people it leads us to and the little villages we’re rebuilding over time as we start to do this as a culture.

And hopefully, here’s my hope, we’ll get to the point where we don’t need doctors to prescribe it.

Where we have this recognition that, yeah, spaces for connection are so integral to our health, we shouldn’t have to go through the middleman of health care.

We should be directly investing in this as a way to create health and prevent health problems before they start.

Yeah, my mom is 76 years old. She’s an active senior. Okay, she really is.

My mom is one of the, I mean, I don’t want to jinx it, and I believe in the power of the jinx, but my mom can do pull-ups. My mom goes to a very small gym. That’s her third space, right, is the gym.

Her third space is her church.

She’s got so many third spaces, her fourth space, her fifth space, but she took a class at the University of Minnesota, I believe, about aging recently, and they were talking about these four indicators of wellness, and one of them that was really

stressed to them was relational, was the need to keep these connections and really nurture those connections. And there are ties between Alzheimer’s, right, or like dementia, like cognitive.

I’m experiencing cognitive every time I speak, I’m like cognitive, cognitive downline, cognitive bad, cognitive go away. Yeah, down, not good, bad cognitive, and loneliness.

So it’s like we know this, and it’s also so difficult in the world we live in, where it just feels like there’s no time.

And I think you said to me at the very beginning of our conversation, more people are spending time alone, or more people are choosing to spend time alone, or reporting to spend time alone. Am I making that up?

No, you’re, you’re correct.

Yep.

So first of all, props to your mom. I actually feel that older people like know this so intuitively. We went to visit my partner’s grandma recently.

It’s like we joke that she’s like in a university. She’s got book club. She’s got exercise.

She’s seeing people. She’s out on the town. She broke her wrist recently.

She was up and at them the next week, because that’s just it for some reason. And not for some reason, because, you know, hopefully you’re at a point in your life where the caretaking tasks, your job, like that becomes less of a role in your life.

And you do have more time. And how do people often choose to spend that time by connecting with others, by being active, by reading books, engaging in creative pursuits? I love that.

And bless your mom, because that is going to help her so much down the line.

And it’s really inspiring to see the way that other countries, we’re not here in the United States, but other countries are recognizing that cognitive disease, dementia, Parkinson’s, all of this is on the rise.

It’s not sustainable for health care institutions or caregivers on their own to have to take care of this. We could talk all about the whole industrial complex of caregiving.

There are countries like Norway that have said, we are going to require every municipality to have a dementia daycare center. And the one that I visited, this was super, super cool, was actually a farm.

So there’s this little bus that comes and picks up people from the town who all have dementia because they can’t drive anymore. They get dropped off at this farm. They cook breakfast together.

They sit. They have a little meal. They go for a big, long walk around the farm.

And then they, like, do farm work. And some people hear that and they think, really? Like, they want to work?

And absolutely, they want to work. I mean, when you feel that so many of your abilities have been taken away from you, it feels incredible to be able to feel like there are still things you can do.

And not to mention all the benefits of being in nature and with other people. Again, we could talk about that, but I really think that the US needs to take a page out of the books of other countries.

It’s not just Norway, it’s Amsterdam, it’s England that are doing this because it’s really gone up in the US.

How did you discover social prescribing? Like when did this cross your desk?

Yeah, this crossed my desk originally like almost 10 years ago when I was going into grad school. I need a research topic. And it was the year actually 2017 that the UK established a Minister of Loneliness.

It was just like a headline. I read UK first country to establish a Minister of Loneliness. And I read that and I thought…

I remember this.

That was 2017.

Yeah, that was 2017. And notice how we haven’t heard too much about it since. So I was really curious about this.

Like what is this government appointed minister going to do about loneliness? What are people who are lonely want this government minister to do? And so that was my whole research project.

I went around, I interviewed lonely people. I like kind of created this fake cooking workshop, which is hilarious because I’m such a terrible cook, we ended up microwaving a lot of stuff. So, you know, come and talk, sort of focus group style.

The definition of cooking includes microwaving.

Okay.

It was nuked, but it was cooked. And by the way, I was expecting like people in their 70s, people in their 80s. That’s culturally who we think of when we think of loneliness.

We think about growing up with like the Christmas Carol or Boo Radley. Like there’s kind of these iconic lonely figures in our culture. But it was, you know, a woman in her 40s who had just moved to the UK.

It was an empty nester mother in her 50s. It was somebody in their 20s who was in this university town, but didn’t go to the university. And it was not just women, it was men as well.

And what they all ultimately said was like, we need things like this.

We need community activities that, you know, are based around some skill or some common interest that do not have to revolve around drinking, that do not cost an arm and a leg to get into. We need this. I wish the government would invest in this.

And at that same time, because of this sort of new discourse on loneliness, which, I mean, I said this in the beginning, is as bad for our health as smoking 15 cigarettes a day, is associated with anxiety, depression, stroke, premature death,

dementia, you name it. So this is a real public health concern.

And so at the time when the UK was investing in this, doctors around the country sort of independently said, we’re seeing a lot of people come to our office who are fundamentally lonely or fundamentally need help with their taxes or fundamentally

working three jobs and are stressed and don’t have any outlets for joy. In my medical training and in my, you know, doctor’s toolkit, I don’t have a lot of things I can prescribe to treat this.

So what if we prescribed people spots in community activities? And that is what doctors around the country started to sort of independently realize. And that’s really how social prescribing came about.

It’s funny, nobody knows how it became called social prescribing. But soon after, it was found that social prescribing was not only effective for patients, you know, it did help them with their symptoms of mild anxiety and depression.

It helped them make friends, it helped them feel less stress, it helped them in practical ways by getting them grocery support, housing support. But in doing this, it also reduced pressure on the health care system.

People who were going to the doctor were going to the emergency room because they had literally no where else to go. They weren’t doing that anymore because the community group was taking care of them instead.

And so that’s what turned the head of all these other countries like Canada, Australia, Portugal, 30 other countries that said, this is a really good idea because it benefits people and it benefits the system.

And it benefits the community groups as well by sort of redirecting revenue to them. So that’s how I heard about it.

And then during the pandemic, when I was like really feeling the effects of loneliness and disconnection, it just seemed like generally nobody was doing well, right? The pandemic was like the month of March just extended for a very long time.

That’s when I decided to write this book and see like, okay, what does this really look like? Are doctors really prescribing, you know, spots and community activities? I want to talk to some people who have been through this.

Yeah, you have a woman in your book who her name is Amanda, right?

She’s grieving she’s lost her mother, her husband, her job, her hometown. This all happens in like a matter of months, obviously. Diagnosed with major depressive disorder, which, you know, same.

I mean, not those same things, but like several tsunamis hitting you all at once. It’s like, yeah, it’s going to take a toll. Like you’re losing more than just people.

You’re losing like those are connections and every person you lose, you lose other connections that that person connected you to. It really is just like this Rube Goldberg machine of loss. She’s diagnosed with major depressive disorder.

What is her social prescription and what’s the effect for her?

Yeah, I’m glad you brought up Amanda because in some ways, her story reminded me of yours and of other folks you’ve had on. Like just life really hit her like a ton of bricks.

She had all of these major disconnections happen in such a short period of time. Her body was so dysregulated. She talked about just like her mind being in this constantly negative space.

She was replaying all the terrible things that happen. At the same time, she was unable to get out of bed. And so her first line is she was prescribed antidepressants and they really helped her.

They really helped her with some of her most severe symptoms. And also, you know, Amanda was in a place where it’s true that antidepressants really helped her, but she still didn’t feel like she was thriving, right?

And so what social prescribing does is it tries to shift the question from focusing on just what’s the matter with you to what matters to you. Like, what are some things in your community that you’re curious about?

What was something you loved to do as a kid but haven’t had a chance to do since? If you had two more hours in the week, what would you choose to spend it doing?

So you start getting into these questions and Amanda, who because of all these disconnecting events had to move to a new place where she didn’t know anybody, happened to be a seaside town.

And she realized she’s really curious about learning how to swim. She would see these people all months of the year going in the water and swimming. And she said, you know, I think I could do that.

And lo and behold, she goes to her primary care provider. Where she’s put on with a mental health nurse who says, actually, there’s a new sort of pilot here where we could prescribe you a spot in a sea swimming course.

It’s for people with mild anxiety and depression. But more importantly, it’s for people who want to learn how to swim and want to learn how to meet people. So Amanda gets prescribed a spot in this 10 week sea swimming course.

And Nora, I can’t emphasize enough. This is like not chill sea swimming. This is cold water, you know, badass women, no wetsuit, just going in to the cold ocean in the winter.

That’s what she was learning how to do. The breathing techniques, you know, the arm motions, the warm up stretches on the beach. And over time, as I’m sure is not a surprise, Amanda starts to feel like herself again.

She has a routine. She’s being exposed to this beautiful new landscape. She’s trying something new.

She’s trying something hard that’s out of her comfort zone.

But most importantly, she’s making friends, friends that she’s seeing not just at that sea swimming course, but that she creates a group text with and is now going to see on the weekends for tea and like doing all this English shit with, you know?

So ultimately, Amanda’s story is that she’s able to go from the maximum dose of antidepressants to the minimum. But again, that’s not why she did it. It was never about getting off medication.

And I should say right here, social prescribing is not anti-medication. This is supposed to be a complement to the options that doctors can prescribe. But she did that because she felt like she was in a place where she could.

She felt like in her own words, her life became bright again. And she still has really dark days. But when she has them, she now has a community she can rely on and an activity that she can use to help her cope.

That’s really beautiful.

That’s England. And we’re in America and our health care system, as we’ve touched on, is not good. What are the chances that an American Amanda could have this kind of social prescription?

There are places where American Amanda could go and she could get some form of social prescription.

You know, in my book I talk about in Vermont, for example, there’s a community health center that’s offering nature prescriptions. I talk about this veteran named Glenn, who’s 92 years old, couldn’t leave his house.

He gets prescribed a volunteer phone call buddy. This movement is growing in the US. And we could talk about this, but there’s actually some pilots where insurance companies are even getting on board.

But I do think you’re right, that England, fundamentally different system, they have a national health care system. So they have a national incentive to improve their health care, to reduce pressure on health care.

In the US., we don’t have this universally. We do have Medicare and Medicaid, where there are incentives to spend less, to get better care to people.

But frankly, I think the way that this happens, unfortunately, is not going to be like a health care fairy godmother, waving their magic wand and saying, Yay, we’ve figured out the models. Social prescriptions are now available.

I think it’s going to come from doctors and therapists who just want to do right by their patients. With the current options they have, don’t feel like they can.

One of my best friends works in a pediatric ICU and was seeing a young teenager, a young woman who was struggling with really severe depression, was also really struggling with feeling like she had no friends, school wasn’t a safe space, home wasn’t

a safe space, wanted more than anything to be able to A, prescribe her a therapist, and B, prescribe her a social prescription, right? But because the therapy wait time was six months for someone who would take her insurance, because social

prescribing was not available in her practice, she prescribed her an antidepressant. And again, like that’s better than nothing, and maybe that would have had to happen anyway, but I think doctors have had enough.

They don’t feel like the options they have are enough to treat the systemic issues that people are facing. And so that’s why there’s an amazing group called Social Prescribing USA.

It’s like a totally grassroots network of doctors around the country who are trying to do this in their practice, partnering with local organizations, doing small pilots, trying to get local insurers on board, universities on board, medical students

around the country are forming chapters at their schools and saying, we want this to be taught in our curriculum. So I am hopeful for American Amanda, but I would tell her, you know, let’s talk again in a couple of years, because I do think it’s

Yeah.

And in the meantime, outside of like an official social prescription, what would your advice be to a listener? Yeah. How do we write our own social prescription?

How do we write our own social prescription?

Well, I think the first step is talking about it. You know, like 15 years ago, the word mindfulness, for example, was pretty niche. Now more and more people, I think, accept that mindfulness is good.

It needs to be part of how we live our lives in this stressful ass world. I think the same should be true about social prescribing.

So I think the first is like talking about it, talking about the way, for example, people prescribe themselves birdwatching, and it helps them feel more focused and calm.

People prescribe themselves volunteering, and it helps them, you know, improve their mood. These are not just anecdotes. There’s actually a lot of data suggesting that this is true.

But beyond talking about it, I think it takes people trying it to believe it.

And so my book website, socialprescribing.co, has a list of, you know, hundreds of different organizations you could prescribe yourself a spot into that are either free or donation-based.

And it also has a list of questions you can ask yourself to help you arrive at the best social prescription for you. So for starters, there are some like, you could base it in the science.

Some of it is like if you’re struggling, for example, with burnout, with stress, you have like a hundred tabs open, you feel like you can’t focus on anything. Nature is really, really effective for that.

Nature has this unique property to restore our attention instead of taxing it so that when we spend even just 20 minutes in nature, we walk away feeling significantly more focused, calm, like our attention is restored.

If people are feeling anxious, if people are feeling like they are caught up at three in the morning with all these crazy, negative, intrusive thoughts, art is really, really helpful for that.

Engaging in some kind of art, losing yourself in somebody else’s story. So those are the kinds of prescriptions.

And then the questions, because it also has to be based on what matters to you, are asking about, like, what is an activity that you could do that you can totally lose yourself in?

Like, there’s nothing that could interrupt your focus on that activity. Or another one is, like, when was the last time you experienced awe? Like, a total out-of-body experience of wonderment at the world.

Some we talked about earlier. If you had two more hours in the week, what would you spend doing? What was something that eight-year-old Nora absolutely loved to do as a kid, but haven’t had a chance to do since?

These are the kinds of questions that I think can tap into that deep what matters to you, and that can, believe me, be really, really helpful for your health and your longevity.

I’m Nora McInerny. This has been Thanks For Asking, and that was my conversation with Julia Hotz, the author of The Connection Cure.

Socially, she goes by Jules, and so I called her Jules because that is how she signed her emails, but professionally, she’s Julia Hotz, H-O-T-Z. We will include a link to the book in the description of the podcast episode and the video as well.

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