Take two waves and call me in the morning: International Surf Therapy Organization brings ocean healing into the mainstream

Marine Corps members share in post-surf exaltation with volunteers from the Jimmy Miller Memorial Foundation in 2015. Photo by Gus McConnell

Carly Rogers was told there was “no way” she would be able to pull it off. Jamie Marshall was told, “I don’t know what you’re going to do here.” And Joel Pilgrim was told that he was “just a surfer who wants to get paid to go surfing.”

The last one wasn’t entirely untrue. Pilgrim, the founder, and CEO of the Australia-based surf therapy charity Waves of Wellness, has spent more than two decades surfing. And it was his personal experience in the water that in 2016 led the mental health occupational therapist to launch an organization built around a belief in the healing power of the ocean.

But as he and other panelists shared last weekend at Cross Campus in El Segundo, his optimistic vision was not automatically accepted when he pitched it to philanthropic partners.

“They said I had rocks in my head,” Pilgrim said.

Pilgrim was in the South Bay for the International Surf Therapy Organization’s 2019 Symposium, a gathering of researchers, clinicians, nonprofit executives and, yes, surfers. The symposium, the first of its kind, was an opportunity for those in the still-nascent world of surf therapy to commiserate about challenges and share strategies for overcoming them. And it was also evidence of surf therapy’s gradual ascendence, with increasing recognition from government organizations, foundations and academic researchers.

Marshall, a director of ISTO, is a Ph.D candidate in surf therapy, perhaps the first of his kind, at Edinburgh’s Napier University. Marshall did his master’s thesis at the University of Edinburgh on The Wave Project, a United Kingdom-based surf therapy organization, and said that his advisors initially greeted his proposal with deep skepticism. The hope, he said, is that “future generations won’t raise an eyebrow” at surf therapy.

If that happens, much of the credit will belong in the South Bay. In the early 2000s, Rogers was pursuing a master’s degree in occupational therapy at USC. Rogers, then a Los Angeles County Lifeguard focusing on teaching kids about ocean safety, decided to see if there was a way to formally describe and account for the benefits of surfing that she had long observed anecdotally. The Ocean Therapy program was born. A short time later, Rogers became the Director of Programs for the newly formed Jimmy Miller Memorial Foundation, named after the South Bay native and Rogers’ fellow lifeguard, who took his own life in 2004. The foundation became a way for Rogers to put her ideas to the test, and over the years the foundation has conducted thousands of hours of surf therapy sessions, many of them taking place right in front of the El Porto parking lot. Pilgrim referred to Rogers as the “godmother” of surf therapy.

Kris Primacio succeeded Rogers at JMMF. In 2017, she represented the foundation when it was one of eight groups summoned to South Africa by Waves for Change, a nonprofit that had received a grant with the specific instruction to grow not just its own operations, but the whole surf therapy sector. The first ISTO conference was small — total attendance was 16 people, and they did not decide on the acronym until the last day — but it gave participants a sense that their efforts, which had felt like struggling in isolation, were part of a bigger revolution in how people think about the power of the ocean. The conference grew in 2018, and while there Primacio became convinced that surf therapy had built enough momentum for a “public-facing” event, and the 2019 symposium began to take shape. Her boldness led ISTO members to select her as the organization’s head.

Primacio said that the South Bay, with its history and cultural connection to surfing, is a natural “hub” for international surf therapy groups, a designation the organization plans to further develop. More than 60 organizations from a dozen countries ultimately contributed to last weekend’s gathering, and the ISTO board has set a goal of increasing that number by at least 20 percent for next year’s gathering.

“I think what you saw in that room was, there are just more people out there, ready in a collective effort that can put surf therapy into practice,” Primacio said.

Tim Conibear, a director of ISTO and the founder of Waves for Change, acknowledged that the surf therapy world remains “small, fragmented and poorly funded.” Stories like the one’s Pilgrim, Marshall and other surf therapy pioneers shared may repeat themselves for a while. But by allowing for greater collaboration, ISTO will enhance both the quality of research being done, and the number of people who are exposed to it.

“We’re getting people talking about this amazing therapeutic vehicle, so that we’re not going to them, they’re coming to us,” Conibear said.

Getting in the room

Pro surfers Aritz Aranburu and Alex Gray laugh about memories from the pro surfing tour at the ISTO conference on Saturday. Photo (CivicCouch.com)

Tijs van Bezeij, a doctor in the Netherlands, started out in emergency medicine, then shifted into rehabilitation out of a desire for greater follow-through with his patients. He ended up at a public clinic about 100 yards from the ocean, where he worked with patients with neurological disorders, including strokes and brain lesions from sustained drug use. One day, a patient suggested going surfing as a course of therapy, and van Bezeij was intrigued. He got approval to proceed, and was so moved by the results that he went on to found a Dutch nonprofit called Surf Therapie.

For surf therapy clinicians in the United States, though, the most shocking thing about van Bezeij’s story is probably not the effectiveness of the treatment; it’s the level of financial support offered by the government to pursue it: He and a team of nurses were all paid for the duration of the course of therapy. According to the most recent estimate from the Commonwealth Fund, a nonprofit organization that collects and analyzes data about healthcare systems around the world, 77 percent of curative healthcare services in the Netherlands were publicly financed. That’s more than twice the share provided by Medicare, Medicaid, and other government-run healthcare programs in the United States. (The United States nonetheless spends about 7 percent more of its gross domestic product on healthcare each year.)

Not surprisingly, veterans, who not only encounter a range of therapy-receptive issues after returning from service but have access to government-provided healthcare, have been among the most studied populations for the effectiveness of surf therapy.

Andy Manzi is a Marine Corps veteran who served in Operation Iraqi Freedom. He found that surfing helped him readjust to a very different life away from combat.

“Surfing was the first thing that slowed me down,” Manzi said.

Today, Manzi is the executive director of the Warrior Surf Foundation, a South Carolina-based nonprofit that runs a 12-week surf therapy course for veterans. He’s working with Maia Gill, a clinical psychologist with the Department of Veterans Affairs, who is studying Warrior Surf’s effectiveness. Gill said that surf therapy was expanding the idea of what constitutes accepted forms of therapy beyond the “doc-in-a-box” setting.

The military has become arguably the most powerful institution to embrace surf therapy. In 2008, Betty Michalewicz-Kragh, an exercise physiologist at the San Diego Naval Medical Center, was working with a soldier who had lost an arm and a leg to an explosive device in combat. The man asked to go surfing. Michaelwicz-Kragh saw the results it produced, and today, she is the naval center’s Surf Therapy Program Manager.

Michaelwicz-Kragh said that, during her time at the center, surf therapy has evolved as a physical activity adaptable for amputees, to something that can be used to treat post-traumatic stress syndrome, traumatic brain injuries and other conditions that may not have outwardly visible symptoms. In 2014, Rogers was the lead author of a breakthrough article in the American Journal of Occupational Therapy that examined veterans in the Los Angeles area participating in a surf therapy program. The study found that voluntary attendance at surf therapy sessions was notably higher than for other programs aimed at veterans. And though the study was not designed to measure the effectiveness of surfing to address PTSD, it found that that “participant reports of PTSD symptom severity were significantly lower after the five-week study period,” and that the veterans “also reported significant reductions in depressive symptom severity.”

There are signs that surf therapy’s successes may be encouraging broader change. Assemblymember Al Muratsuchi, who represents the South Bay in the California Legislature and was the author of a bill last year that made surfing the state’s official sport, attended the weekend’s symposium, and brought up the idea of introducing a bill that would make surf therapy eligible for widespread coverage by medical insurance.

But even in countries with very different healthcare systems than the United States, surf therapy around the world remains mostly the province of scrappy nonprofits. Securing backing generally comes down to the same thing everywhere: what Joe Taylor, founder of the Wave Project in the United Kingdom, described as being able “to walk into a room with someone who can make a decision.”

Taylor began his program with some funding from the government, but the money dried up after an election brought a change in Parliament. He found himself desperately trying to find someone with enough influence to keep funding for his program flowing.

Today in the United Kingdom, surfing is now available by prescription, with the wave project authorized by the country’s National Health Service to provide therapy for anxiety and depression. After months of failed attempts, Taylor secured a meeting with an NHS official. Taylor handed the administrator The Wave Project proposal. The man flipped casually flipped through it for perhaps 10 or 15 seconds, then put it down on his desk; Taylor’s heart sank and he prepared for another rejection. Then came a surprise.

“Well, I guess I need to get you some money,” the man said, and got on the phone.

Knowing the feeling

Joel Pilgrim, CEO of Waves of Wellness, helps a kid get stoked at an ISTO surf session at El Porto last Sunday. Photo by Ken Pagliaro

Ask people involved in surf therapy whether it works, and the response tends to come in the same sort of breathless tone with which surfers respond, on a day when the waves are firing, to the question, “How was it?” 

“It blows my mind how effective it is,” said Annericke Leonard, a researcher for the New Zealand-based surf therapy program Live For More.  

“It’s like three months of therapy in an hour,” said Kevin Sousa, the clinical director of the Jimmy Miller Memorial Foundation.

“The only thing that’s effective in 100 percent of my clients is surfing,” said Giovanni Martinez, a clinical psychologist and the founder of Surf4DEM, a Puerto Rico-based nonprofit that uses surfing as an alternative therapy for children with autism.

The effectiveness of surf therapy can be so profound that it challenges prevailing medical wisdom. Van Bezeij recalled working with a patient who had suffered a massive stroke. The patient participated in rounds of surf rehabilitation and, three years after suffering the stroke, was still improving (and still surfing). Van Bezeij said that the finding was “controversial,” because most literature shows that rehabilitative prospects for stroke patients fall sharply after the first year.

Stoked as they may be, part of the difficulty that surf therapy advocates face is the need to explain surfing to the wider, non-surfing, world. From Jack London to William Finnegan, the thrill of surfing has drawn talented writers who freely admit to coming up short on explaining its allure. Bruce Brown’s adage that “Only a surfer knows the feeling” may ring true, but it isn’t much use in a presentation to the board of directors of a foundation with dozens of other worthy causes competing for its dollars.

Part of the solution is more research. Between 2011 and 2017, there were eight papers published in academic journals on the surf therapy. From 2017 to the present, there have been nine. And, in March 2020, the Global Journal of Community Psychology Practice will dedicate a special issue to “Surf Therapy Around the Globe.” The edition will contain 11 peer-reviewed articles, with submissions coming in from all over the world, said Gregor Sarkisian, the director of research for JMMF. Some of the articles rely on the “gold-standard” of research: randomized clinical trials.

“The amount of research being done on surf therapy is exploding,” said Marshall, of Edinburgh Napier University.

There are also more tools. Van Bezeij said that his clinic had recently been able to access a portable machine that acts like a functional MRI scanner. It can be brought down to the beach, and can map brain activity before and after sessions.

Plenty of research remains to be done, including more long-term studies that examine participants’ social outcomes and surfing habits months or years after they first hit the water, and a “meta-analysis” comparing the results of multiple quantitative studies. But it’s not clear that more numbers will answer the deeper question of why surfing makes people feel better.

For one thing, it is difficult to separate wave-riding from some of its various component parts  — exercise, goal setting, structured social activity — that are widely accepted as therapeutic for human beings. There is also research, memorably synthesized in Wallace J. Nichols’ bestselling book “Blue Mind,” that suggests simply being in or near water can have significant benefits. (Nichols, a keynote speaker at the symposium, described surf therapy as “‘Blue Mind’ in action.’”)

There also may be limits to how much information researchers can get out of even the most willing of participants. Phil Ward, a professor of psychiatry at the University of New South Wales in Sydney, said that collecting the kind of data needed for quantitative studies risked overloading the people partaking in them, a phenomenon called “participant burden.”

“People don’t want to fill out forms; they want to be in the water,” Ward said.

While data-laden quantitative analyses are bound to be an important part of surf therapy’s move into the medical mainstream, researchers say qualitative studies, built around the feelings that participants report, also have a role to play.

Sousa said that his conversations with people undergoing surf therapy have led him to believe that the vulnerability associated with being exposed to the chaotic atmosphere of the ocean produces trust in people who may have a hard time trusting anything. He said that putting people in a new and challenging environment, while giving them the support that reassures them they can handle it, teaches people to rely on something other than “fight-or-flight responses.”

The benefits of surfing, though, seem to endure even for those with years of experience, people who learn in a group setting, but become comfortable going out on their own. For them, surfing’s benefits may come from its ability to quiet the mind. Marshall recalled one participant who had served in Iraq and Afghanistan and dealt with constant flashbacks — except when he was in the water.

“What seems to be really cool about surfing is the way it demands our focus,” said Marshall. “He said, ‘These are the only two hours when I don’t hear the voices in my head.’”


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