Wendell Berry: Health is Membership… and The Plants are Watching!

‘The piece returns me to thoughts I had before I started my training that my training has turned on its head. Before I started I believed that it was relevant to say that humanity needed to get back to a better, natural place and I felt the world has moved away from that. However, every experience of the course has been medicalising’.

It does not feel right to report the discussions between a tutor and several nursing students at our UK university about Berry’s 1994 essay, Health is membership, as if it were a normal paper discussed in a journal club. Berry is not a nurse nor a psychiatrist, but a farmer from Kentucky, and a novelist, poet, essayist and philosopher. His 30-year-old essay spoke to us in ways that provoked existential feeling—sometimes hope and sometimes desolation. To echo Michael White, it brought the world into therapy. It might be fair to say that it brought us into it, too. 

In our module we began to explore how reductionism is an ever-present temptation in mental health services. Those of us studying adult and mental health nursing as a dual qualification found this equally applicable to our roles as adult nurses. To capture the dangers of reductionism the class learned some new terms—a lot of ‘isations’! Medicalisation, individualisation, decontextualisation, pathologisation… but also a kind of opposite reduction: discounting personal agency through excessive externalisation. We discussed the biological reductionism that leads to a pervasive sense that distress is mental illness and the treatment is drugs. Berry’s essay challenged us to question whether we should even ask if the drugs work. How could they work when, as Berry suggests, the smallest unit of health is a community? Medication could never solve the problems of health when looked at in this multifactorial, situated way. We found ourselves asking whether a service that ignores so much could ever be of much help. Berry’s perspective even led us to question if the phrase “person-centred” is something we should value.

Through Berry’s eyes, we all felt that the models of care we are being socialised into are dehumanising. However, he does not portray nurses as unable to change this, but rather as the ones who might. One message that resonated with us especially came from Berry’s example of his family visiting the hospital where his brother-in-law had been admitted for cardiac surgery. The family, waiting for news, were out of their depth. Whatever their own areas of knowledge and skill, they had no real way of understanding the processes involved in the surgery and would not know how to judge its quality beyond what they are told. We felt this was like one of us taking our car to the garage; the mechanic may give us an explanation and ask us to agree to a procedure, but mostly we can only take what they are saying on faith – and pay! In the hospital, the world of close family connection and love met a world of medical expertise. A nurse tried to comfort the brother’s wife by explaining that everything that was happening was as expected and that the brother was only experiencing that which was common in his situation. This sense of things being common to everybody was supposed to be reassuring, but it was not. The wife replied,

‘I’m not everybody’s wife’.

In our discussion we repeated this phrase many times as an exemplar of what nurses are meant, through empathy, to understand. Each person we care for is not a type or an example or a case. For them, their crisis is something experienced for the first time – a disruption of their biography; something unique. To be with someone in distress, we must meet them in the I’m not everybody’s wife place. One student shared a recent example of taking her grandfather to A&E with what seemed to be a stroke, affecting one side of his face. He isn’t everyone’s grandad and this is his only face seemed to be the equivalent feeling that was being lost in a world of service-driven industry, impersonal triage and waiting for tests. Sometimes these thoughts led us to feel energised: ‘WE are the therapy!’, said one student, ‘we are the intervention!’. Another said that the I’m not everyone’s wife quote is a powerful reminder to ‘stay true to ourselves and recognise our individual worth, while being expert caregivers’. It pointed to the radically different kind of expertise we are to embody. We might become the kind of expert with statistics, policies, outcome measures and care pathways; perhaps we could call this the logic of standardisation equals quality. Berry would call it industrialisation. Alternatively, we could become the experts in accompanying people in the I’m not everyone’s wife journeys. Probably, we need to be both.

Berry characterises this tension as the world of efficiency meeting the world of love. Yes, he gratefully acknowledges that the world of efficiency saved his brother’s life, but that does not entitle it to understand what health is! We drew connections to Professor McKeown’s 2024 paper on the the Bullshitisation of mental health nursing, the logic of capitalism reducing all of our values to a bottom line in which none of us are individuals with our own meanings and purposes, and we are increasingly involved in time-demanding activities of measurement and data that seem to reduce being with our service-users to being a luxury. The logical endpoint of such efficiency is not health, but a place no wise person would value.

In our module we asked whether perhaps strong emotions – such as feelings of depression – could ever be understood as an indicator not of pathology but that someone believes they deserve better, a kind of buried self-esteem, perhaps; a resistance offered to the world. In this way, it is not a pathology, but a strength; not a cognitive error, but the congruent truth; not a symptom to be removed but a belief to nurture. Berry challenges us to wonder if we all deserve better. One student remarked,

‘Clever marketing has drawn us into over-consumption and greed whilst destroying the planet without any regard for future generations and we no longer care about the people beside us…. whilst we all feel lonelier than ever, and life satisfaction has decreased.’

Our discussion group began with health and progressed to anger about greed. One of us was clear that if wholeness was our aim, if health is membership, to start from where we are now, to collectively tell ourselves the truth, the reality is that someone or something must be sacrificed. In these parts of our conversation, we seemed to be reaching for explanations in which we saw mental health services as something that are required to protect unsustainable fractures in society and in thought. These things are hard to talk about. 

For Berry, a person without a healthy community is not healthy. Discharging them into a polluted environment with no meaningful roles, relationships, money, or home… such a person is not healthy in any real sense. This returned us to a key question from our module: are we hoping to be nurses in the community, or nurses for the community? What do we do when we realise the former is not just a practical compromise but perpetuates the individualisation of distress, the pathologisation of emotions, and the atomisation of communities? Although our group did not share Berry’s belief in God, the essay was nevertheless something that was beyond intellectual. ‘I’m not religious’, said one student, ‘but I agree with him’.

Our conversation turned to pollution. In our UK city context, what struck us is not only pollution, but of degradation and disconnection from nature. Berry challenges us to consider whether there can be mental health in a society that normalises exploitation of other species and our shared land. Can we have mental health with this lack of understanding and connection, the casual destruction of the world upon which we depend? It seems that the best we could hope for would still be a kind of sickness. Another student commented that it is not just environments, but minds seem to be pollutable, too. What does it mean to feel better in the face of climate chaos, where the two default positions seem to be a stultifying panic or dissociation? Real power, and real value, lies with what we often rate as the lowliest in our ecosystems. As one of us put it, real power lies with THE PLANTS! And, they said, ‘the plants are watching’.

Within our conversation we spoke about Michael Marmot’s 2010 report on the social determinants of health—an extraordinary document. However, ten years later, the follow up had to conclude it had all got worse. This led our conversation, perhaps not quite in Berry’s vein, to explore Left- and Right-wing perspectives. To some, Marmot’s data may be very real but it does not prove that social determinants lead to health outcomes. Instead, they may argue that health outcomes (and other forms of achievement or lack of it through the choices people make) lead to social stratification. If such speculation about how Marmot has been discounted by the Right holds true, it underscores the value judgements involved in all of our models of health.

It seems important to notice that Berry’s statement that the smallest unit of health is a community is a political statement that risks reducing or even discounting individual agency. However, his views, like Marmot’s, also profoundly demonstrate the limits of individual agency. People deserve communities and environments that support their health and mental health—not toxic ones, where the most effective health promotion strategy involves finding a way to escape. While mental health nurses are busying themselves being, as one of us put it, ‘every other profession’s task rabbit’, who is thinking about community health? In our module we introduced this idea as being asked to mop the bathroom floor while the taps were still running. These themes illustrate the sadness that is the backdrop to all nursing that refuses to accept that health problems begin and end inside the person.

In the days following our conversation, there was a renewed desire to talk about communities—schools, cafés, primary care, drop-ins, foodbanks, and community teams. Somehow, despite the deinstitutionalisation of mental health services that formed the services we inherit, we feel we have yet to get out there properly. Perhaps things would be different if it felt like more caring hands were contributing to shaping our communities. Maybe we would then view our nursing role for those in the acute distress as just one part of the jigsaw, without needing to bring the entire world into therapy. We could remain ‘person-centred’ while others focussed on the broader concerns of biodiversity, climate, employment, regulations and protections, housing, schools, social media, AI, Incels, religious extremism, inequalities, immigration and understanding the past! Until then, Berry speaks to us about a fractured world in which our role is expansive. And yet…. and yet… the goal is also to become small enough, and focussed enough, to successfully join a suffering person inside the I’m not everyone’s wife place.

Special acknowledgment must go to nurse Benny Goodman, whose 2015 opinion piece—also inspired by Berry’s essay—helped guide us back to the original.