Julia Hotz is a solutions-focused journalist based in New York City. She is the author of the forthcoming book, The Connection Cure: The Prescriptive Power of Movement, Nature, Art, Service, and Belonging. Her stories have appeared in The New York Times, Wired, Scientific American, The Boston Globe, Time, and more. After studying Sociology at the University of Cambridge, she joined the Solutions Journalism Network, where she helps other journalists rigorously report on what’s working to solve today’s biggest problems.

Before becoming a journalist, Julia worked as a teacher, bartender, pizza server, and summer camp forest ranger. She enjoys hiking, biking, dancing, running, budget traveling, and building the longest road around Catan.

The transcript below has been edited for length and clarity. Listen to the audio of the interview here.

Brooke Siem: I’m going to start with an unconventional question. How old are you?

Julia Hotz: Not unconventional, we should normalize asking this. I am 31 years old.

Siem:  The reason I asked your age is because I’m 38. Before I researched you, I read your book and thought you were twenty years older. Part of this was because of your excellent writing and journalism, but there was a part of me that thought, “I can’t believe we need a book about this because it seems so obvious.” Then I realized you’re quite young and came of age with social media and a more technologically connected world. There’s a whole generation that doesn’t remember life before the internet. What seems obvious to me might not be obvious to them. So, let’s start there. How did you grow up? What was that like for you as a child, and how has it influenced your book?

Hotz: It’s rare to take being called older as a compliment, but I totally get where you’re coming from. I think people like you and me, people in our 30s, are on the cusp of having witnessed the beginning of a phone-based childhood versus a play-based childhood. I was very fortunate to be in the camp of a play-based childhood. I grew up in New Jersey, playing in the backyard for hours with my brother. Yes, we had AOL Instant Messenger in middle school, but it really wasn’t a dominating and central force in my life. I think that I was able to benefit from in-person connection. That was a privilege, right? Having a childhood where I felt safe, secure in my home, and could just play outside, doodle, move around, and go look at frogs. I got to see that.

I got a smartphone when I went to college at 18. I witnessed that play-based connection, even in your 20s, becoming a bit rarer. I think you’re right that some of this stuff—the health-creating value of time in nature, moving your body, creating art, serving some greater cause, and spending time in person with a group that you really feel you can belong to—it’s so obvious and intuitive that it’s hard to believe we need a book about it. But I think you’re alluding to the fact that kids and adults today spend more time on their phones and are more disconnected from these sources. We need to figure out a way to prescribe them, just as we prescribe any other medication.

Siem: I can’t say I’ve been socially thriving over the past year or so. I’ve felt a lot of loneliness and disconnection. Connection as the answer seems obvious to me, and yet, I am disconnected. The book definitely prompted me to think about how I can bring more meaningful connections into my own world. So, let’s talk about social prescription. And as you describe that to us, can you also give us an idea of what a social determinant is?

Hotz: Absolutely. And just to pull that thread together, I’ve certainly felt the same way. I think COVID was a strong force in helping us all get a taste of that disconnection. In some ways, because we were forced to spend time inside, screens and social media became our primary way of connection. A lot of us haven’t recovered from that. Loneliness, when we hear it, we think of a caricature—an older person alone in their house. But I think, in the past couple of years, we’ve seen an epidemic of loneliness.

That leads into your question about social determinants of health. This phrase suggests that most of our health is determined by factors in our environment. When we hear environment, we think of trees, which is part of it. But it’s also about access to food, safe and reliable transportation, and other basic resources. It’s also about psychological resources—having a community of friends, a job, or something that gives you a sense of purpose. These factors affect our health. Some studies suggest that 80% of our health differences are driven by these social determinants.

Social prescriptions aim to address those social determinants. These are not about forcing friendships; they are patient and doctor-driven prescriptions for activities and resources in your community that address your social determinants. They can involve just two people, 20 people, or even zero people—sometimes it’s as simple as a prescription for fresh fruits and veggies or housing assistance. For psychological social determinants, like a sense of belonging or purpose, it can look like art classes, nature clubs, cycling groups, volunteer opportunities, or farms. The list is endless, depending on what’s available in the community.

Siem: When you say social prescription, do you mean a literal prescription? Does it get written down, and can you turn that into an organization and get a service or item in return?

Hotz: It depends on how the health provider and patient determine this. Some are more ad hoc, but in many cases, I’ve seen a physical prescription pad. I’ll never forget a doctor in the Netherlands showing me a checklist that looks just like an Rx pad, with items like service, motherhood support, art, and nature. There are also electronic portals facilitating this in patients’ electronic medical records. So yes, in many cases, it’s a literal prescription. But even when it’s not, it’s different from just saying, “Go outside” or “Get a hobby.” It’s about having specific material support, financial or social, and accountability to actually take that social prescription, just like you would take a pill prescription.

Siem: Why did you want to write this book? How did it come about?

Hotz: I think there are two answers. As a journalist—much like how Robert Whitaker’s journalism led to Mad in America—I was curious about why, in a healthcare system that’s continually expanding with more medications, people are still feeling so sick. Mental illnesses are rising, and beyond diagnosable mental illness, reports of loneliness, stress, and languishing are increasing. I do solutions journalism, which looks at how different communities respond to problems. I found that social prescribing was a solution. It started in the UK and is now in about 30 countries, addressing socially determined symptoms with social prescriptions.

Personally, I was really interested in the concept of loneliness—what loneliness actually is. We have a cultural picture of loneliness as an older person being isolated. But in myself and my loved ones, especially during the pandemic, we understood loneliness as a qualitative disconnection. Even with friends and connections, living in a city full of opportunities, you might not benefit from deep, rich connections. I found social prescribing when I was a grad student, exploring what loneliness is and what’s working to address it. In 2018, the U.K. established a Minister of Loneliness, which intrigued me. I surveyed my community at Cambridge about loneliness and found that social prescribing was a concept some had heard about. Back then, it was hush-hush, not a buzzword. During the pandemic, I did a big investigation for Wired UK, looking at practices treating type 2 diabetes, chronic pain, and loneliness with social prescriptions.

More and more countries are looking for blueprints. The UK has invested systematically in social prescribing to expand it. It’s hard to believe for Americans like you and me, but it’s coming here. I just felt like this story hadn’t been told. We know nature is good for us. We know art is good for us. But we haven’t really heard about what healthcare is going to do to make those benefits more accessible to patients.

Siem: How did you find the first instance of social prescribing? Where did this term even come up?

Hotz: I found the first mention of social prescribing during my qualitative exploration of loneliness in 2018. I surveyed people in my community, asking, “Are you lonely?”

There’s a clinical scale for loneliness. People who met that sort of clinical threshold of being lonely—which is lacking companionship, feeling isolated, feeling left out—for those people, I was curious about what their day-to-day life looked like and what worked to combat the loneliness. I asked, “What do you think this minister should do?” And it was through them that I heard about social prescribing, which back in 2018 was very, very hush-hush. Only a couple of innovative health care providers were doing this.

Siem: There are effectively five major pillars of social prescribing. Can you explain what the five pillars are and how they’re helping?

Hotz: I should note that the five pillars I focused on in the book are really about the psychosocial determinants of health. Social prescriptions, like I said, also apply to food, money, housing support, legal support—because those things affect our health too, right? Somebody who can’t afford their rent, who can’t get healthy food, isn’t going to be interested in hearing about a cycling prescription.

I focus on those five because they kept coming up, whether I was in the UK, Portugal, South Korea, or the United States. Those are movement, which works well for lifestyle diseases and depression; nature, which is effective for treating disorders of attention, like ADHD, addiction, and stress; art, which helps treat symptoms of anxiety and helps people reframe trauma; service, which is effective for chronic pain, dementia, and physical ailments by keeping people engaged; and belonging, which is an antidote for loneliness and promotes a sense of community.

Siem: One of the things I found interesting is the seemingly clear line between the problem you’re having and the appropriate social prescription. Often, we feel overwhelmed with all the things we have to do—exercise, get into nature, volunteer, and make sure everyone’s okay. Can we simplify it? If we go all in on nature for a while, is that helpful? Is it clear-cut?

Hotz: I think two things are true. The tagline of social prescribing is to replace the question “What’s the matter with you?” with “What matters to you?” This might seem lofty, but it looks like questions about how you spend your spare time, what makes you light up, or what you loved as a child. Social prescriptions are driven by what matters to a patient, which means that even if someone is struggling with depression, if they love art, engaging in art is also effective. It’s about mixing science with patient choice, making it another option on the healthcare menu, not a replacement.

For example, Amanda, a woman I met, had severe depression and was on the highest dose of antidepressants. She experienced five major life stressors: her mother’s death, a divorce, job loss, a move to a new place, and the pandemic. She joined a sea swimming course for people with severe depression in Southwest England. She loved swimming as a child but was afraid of swimming in the ocean. This course helped her reconnect with something she loved, gave her a reason to wake up, and helped her make new friends. She went from the maximum dose of antidepressants to the minimum. Her relationship with her disorder changed—she saw that medication wasn’t the only thing that could help her.

Siem: Let’s talk more about antidepressants and prescription psychiatric drugs. Many people in my work, and from my experience on antidepressants, find that the drugs numbed their ability to understand what matters to them. How can people bridge that gap if they’ve been medicated for so long that they feel disconnected from themselves?

Hotz: You’re right, I don’t go deeply into the side effects of antidepressants in the book. That’s because your book and Whitaker’s book are important in telling that story. My book aims to show that doctors and therapists are now prescribing social connections, just as they would antidepressants.

The question “What matters to you?” can be lofty. Ideally, a doctor, therapist, or link worker—a person who bridges the healthcare and community organizations—can ask the right questions to uncover what matters. Amanda’s case shows that while the science says to move your body, the physical symptoms of depression make it hard. Social prescribing is about making it easier over time, not in the first appointment. It’s about building a relationship and asking questions to unlock what matters to the patient.

Siem: It’s so fascinating because, in the current landscape of mental health, there’s a cultural shift similar to the K-shaped economic recovery post-COVID, where people are heading in two different directions. On the one hand, there’s an intense focus on diagnoses, prescription medications, and constant discussions about feelings, with an emphasis on getting everyone into therapy. However, this approach doesn’t seem to be working. The antidote, as seen in your work, Jonathan Haidt’s work, and Abigail Shrier’s work, is to take the spotlight off the suffering. The paradoxical way out of this mess is to stop focusing so much on our problems. The Connection Cure and its five pillars align perfectly with this approach.

Hotz: You’re spot on. Dr. Lucy Foulkes at the University of Oxford wrote about the Prevalence Inflation Hypothesis, which suggests that constantly talking about our mental illness and suffering, especially on social media, is not actually beneficial. It’s controversial to say because, on the one hand, we don’t want to contribute to the stigma and we want people to feel free to talk about their suffering, which is very real. Looking back 20 or 30 years, or even longer, when the approach was to just “suck it up and get over it,” we know that’s certainly not the answer either. There has to be a third way to honor the reality of suffering. Because it is so real, we need to get real about what is actually working to address it. People dealing with these symptoms need to understand that this is just a part of them and that they are not broken. In the book, I discuss how the earliest conceptions of mental illness in the DSM described them as reactions to an environment. It’s fascinating how this concept has been expanded and somewhat written out of the DSM over time.

Siem: Can you imagine how different our world would be if we kept the term “reaction” instead of “diagnosis”?

Hotz: Absolutely. I remember being eight and watching a commercial for Zoloft with a little sad blob floating between A and B. That was the first time I heard about depression, through marketing. By the way, direct marketing of prescription drugs is only legal in the United States and New Zealand. That’s how I learned about what depression was.

If we reframed these issues as reactions, which are very real—something you eloquently discuss regarding how your father’s death impacted you—I think it would help. Sometimes, when we validate symptoms, we validate the suffering too. However, we often confuse this validation with rooting our identity in that suffering, almost making it a life sentence. How would your understanding of your symptoms have changed if you had seen them as reactions when you were 15?

Siem: I think about that every day, especially because a diagnosis at 15 is so impressionable. I would love to have a crystal ball to see what would have happened if I hadn’t gone through what I did. I can’t believe the scale at which we’re seeing this now with kids.

Hotz: There is some beautiful adaptive value in some of these reactions, right? Many of these symptoms, and the magnitude at which we’re seeing them, are responses to living in ways we were not meant to. When you’re dealing with the throes of the deepest, darkest depression, anxiety, ADHD, or whatever it might be, it doesn’t feel like an adaptation. However, understanding how our environments play a role in the extent to which we feel symptoms is crucial. This isn’t a new idea; indigenous communities and experts have been saying this for years. What’s new is that we now have a healthcare system, though not fully supported yet, that can deliver this understanding. Just as your environment can exacerbate the pain of your symptoms, it can also provide relief.

Siem: Even 100-150 years ago, most people were farmers. We were outside, growing our own food to share with our community. We moved our bodies as part of our daily life. At the end of the day, we didn’t have cell phones or television, so people would sit, play music, tell stories, and read. These five pillars were built into everyday life.
You talk about the Industrial Revolution and how it impacted our lack of connection. Can you elaborate on that? I was comparing the Industrial Revolution’s effects to the increased amount of leisure time we have because of AI. We’re seeing these disconnections again. We’re creating so much time for ourselves to sit around and focus on how we don’t feel well, while also directly supporting and buying things that take away our sense of purpose, much like the Industrial Revolution did.

Hotz: I had a permanent jaw-drop situation, similar to when I was reading Mad in America, when I realized that the Industrial Revolution was when everything hit the fan. When the industrial revolution arrived, there was a lot of excitement. The tasks humans used to spend their precious waking hours laboring over could now be done by machines, giving us a lot of free time. Initially, this was genuinely awesome. We saw the proliferation of public spaces, community groups, public sports, and the YMCA. People were excited to use this newfound leisure time in ways that met their leisure needs and allowed them to be together in the community.

And then something unfortunate happened, as it often does. Someone realized they could make a profit from this. Public spaces where people played and enjoyed each other’s company began charging membership fees. Sports that were fun and joyful, bringing people together, suddenly required expensive equipment and uniforms. The same is true for jobs. At one point, your last name was often tied to the work you did in the community—bakers, tailors, smiths. But with the industrial revolution, and even more so now, we see the rise of what the late anthropologist David Graeber called “bullshit jobs,” where people don’t understand their sense of purpose in the workplace. Outside of work, they’re disconnected from the activities that used to give them a sense of purpose. So, it’s no wonder that huge swathes of people are not feeling well—we were not meant to live like this.

Siem: You mentioned that social prescription is taught in most medical schools in the UK. How can we get that into the US?

Hotz: In the UK, pioneering medical students and doctors pushed for it despite initial resistance. They created a network and eventually made it official. In the US, places like Harvard and Columbia have social prescribing student collectives. Insurance companies are beginning to see the preventative health benefits. For example, Horizon Blue Cross Blue Shield in New Jersey is partnering with NJPAC Performing Arts Center to offer social prescriptions to at-risk individuals. This pilot shows that social prescribing is a sound economic investment.

Siem: How are insurance companies going to get on board with this?

Hotz: There’s a clear incentive for insurance companies to prescribe pills: it’s easy. Diagnosis code, boom, we cover this therapy. It sounds like it’s going to take a long time, right? Not so much.

What would social prescriptions do for insurance companies? Well, you’ll notice how some insurance companies have started to sponsor gym memberships. For example, my parents are in their 70s, and at that age, things stop working as they used to, making healthcare coverage very expensive. So, out of economic incentives—not necessarily the goodness of their hearts—insurance companies figure, “Okay, if we invest in gym memberships, and being active is associated with reduced cardiovascular risk, then it’s a smart preventative investment.” More physical activity reduces many of the major disease burdens in the United States. Not all insurance companies are on board yet, but they are coming around to this logic based on economics.

I know that more insurance companies are using that same logic as an investment in preventative health to cover things like art prescriptions. In New Jersey, for example, people who are at risk of being costly for the insurance company are eligible through this investment to receive social prescriptions, including art prescriptions, through the offerings at NJPAC. This trial is still underway, but if we know anything about how this has worked in other countries, we know this is actually a very sound investment from an economic standpoint. If people are preventing these costly health problems and not ending up in the emergency room, this is a healthcare win.

It sounds wild to say that out loud, to think this could become mainstream in the United States. I think this is how new things happen. A state tries it, gets good results, and shares it with another state. We’re seeing this with Medicaid, for example. Medicaid is now being used to cover food and rent in some states. It takes time, and I’m not going to sugarcoat it and say this is going to happen overnight, but I do think there is a future where insurance companies will cover more of these social prescriptions based on this logic.

Siem: Between prescribers, patients, insurance companies, and government, who’s going to have the biggest pull to get this into the mainstream?

Hotz: I think the change is going to come from patients saying, “I want more options.” It will also come from health workers being trained in how to provide these options. Additionally, there needs to be more support from insurance companies and governments, investing in both the practicalities of covering these options through insurance plans and in positions like link workers. Link workers would serve as liaisons between the patient and the health worker, because, let’s be honest, doctors and therapists in America already have their hands full. Adding another responsibility seems impossible.

I think the third, and perhaps most important, factor is cultural change. We’ve alluded to the fact that these conversations are happening. There is a bigger discussion about what the world would look like if we moved from a deficit-based model of defining ourselves through our illnesses and symptoms to an asset-based model. People resonate with this idea. When you talk to people who have been through this, some find that the usual healthcare routine of diagnosis, treatment, and prescription works. But for many, it doesn’t. Change will come when we can combine that frustration with a practical solution that has been effective in other countries.

Siem: What can someone in the US do if they don’t have access to a doctor who does social prescriptions?

Hotz: Part three of my book is about prescribing myself these things without a doctor. Ideally, social prescribing wouldn’t need to be accessed through healthcare. The book includes an appendix with practical steps for self-prescribing. For example, if someone feels like Amanda—depressed and lethargic—they can look into movement groups in their community. We’re building a database with Social Prescribing USA to help people find groups based on their location and interests. Stay tuned for this resource.

Siem: Can you tell us where we can find you on the internet?

Hotz: You can find my book, The Connection Cure, at Simon & Schuster, Barnes & Noble, Amazon, and local bookstores. I’m on Instagram, Twitter, TikTok, and LinkedIn at @hotzthoughts. We’re building a website at www.socialprescribing.co to provide resources for social prescribing.

Siem: I’m glad you’re building something actionable that people can use right away. Congratulations.

Hotz: Thank you. This is a collective effort, especially with Social Prescribing USA. They aim to make social prescribing available to every American by 2035.

Siem: Wonderful. Thank you so much for being with us, Jules, and for sharing your book.

Hotz: Thank you so much, Brooke. It was great to finally meet you.

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7 COMMENTS

  1. Everything you recommend refers to the normal requirements for good spiritual and mental health, so prescribing it to a psychotic is non-informative. And you have merely intellectualized your real needs. Living and being those real needs would transform your consciousness and reality and you would not be prescribing it to others in articles. You would be being it and others would be seeing it. So be it! Then we will see it, believe it, and maybe even be it too. Otherwise everything you say is just words, and words we have aplenty. Alas, they just never run out.

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  2. My Daughter is close to both your ages. She is doing well. But i couldn’t help but think of all the different connections and associations to this writing …. I had a MA in Recreation Therapy but never used it professionally. Instead i water kayaked, sea kayaked, back country skied, nordic skied, wrote poetry for myself. I couldn’t fix a soul. Still can’t. I surfed sea kayaks under the Golden Gate Bridge where you stand. I made my office at Pine View Falls on the Poudre. And most of all i raised my Daughter. Took care of my aging Mother. Did copious amounts of Jungian analysis. And wrote clunky poetry ( A Eugene O’Neill reference).

    Have fun with your writing, young Ladies. I have a number of comments and reflections but won’t mention them here.

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  3. It wasn’t that long ago when family doctors routinely ‘prescribed’ things like exercise or social activities for people who weren’t feeling up to par. But things began to change once Prozac hit the market in 1987. Before this it was pretty rare for them to automatically assign a psychiatric diagnosis which in my opinion is even more harmful (in insidious ways) than indiscriminately prescribing psychiatric drugs.

    It might be would worth it for people in the author’s age group to go a step further and drop the concept of “mental illness” altogether, to entertain the idea that perhaps even the most severe reactions to social determinants, i.e. “Major Depressive Disorder”, “Bipolar”, “Generalized Anxiety Disorder” are in reality just more intense responses to overwhelming circumstances. That alone might go a long way towards promoting a more positive mindset for everyone involved.

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    • I think we can see now that the rise of drugs like Prozac matches a rise in corruption in the UK and USA. Government corruption, organised crime and any number of events that can lead to upsetting people. The pattern was originally uncovered by Franco Basaglia in Italy who observed that the people in the abusive asylums at the time were almost exclusively fall out from public scandals, crime, corruption and bigotry. It’s wonderful to see more awareness of this in The Connection Cure. Of course rebuilding social connections makes perfect sense when people have often come out of a social situation that is more like “Who needs enemies with friends like these”.

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