Surf Therapy:

For retired Chief Warrant Officer Shawn (who asked that his last name be kept confidential), the water is a sanctuary. His upbringing in the Caribbean and Florida shaped his deep admiration for the ocean--it's where he went to find peace. "That's my church, it was always my church," he said.

After serving in the U.S. Marine Corps for 26 years--suffering from both chronic pain and mental afflictions after 13 deployments--Shawn discovered a program that brought him back to his haven of the water.

Shawn riding a wave. (Photo courtesy of Shawn)

While working as a director for the Marine Corps' adaptive sports division at Camp Pendleton, Shawn discovered the Jimmy Miller Memorial Foundation, a surf therapy program started in 2005 by the Miller family and friends to honor Jimmy Miller, a well-known surfer and lifeguard from the South Bay, who died by suicide in 2004 after a battle with mental illness.

Shawn made the decision to bring his surfboard down to the beach, and it wasn't long until his relationship with the foundation blossomed into an integral part of his personal recovery.

"The friends I made there have been really good, they're really good people," he said. "I consider them a second family which is what I lost when I got pulled out of my unit."

"It was just like going surfing with my buddies in the past. I started being reminded about how healing it is to go out [into the ocean]," Shawn added. "No matter how bad of a day of surfing, you come back in and feel like it was good that you went."

Before he made surfing a part of his healing, Shawn was struggling both mentally and physically. To cope with his pain, he engaged in self-destructive behaviors, such as riding his motorcycle carelessly fast. "Not a lot of things I was doing felt good at that point," he said.

Shawn's final deployment proved to be the most taxing: his final medical reports at discharge included three severe lower back disc herniations, a severed L5 nerve (which resulted in three lower back surgeries), multiple traumatic brain injuries (TBIs), and the long term effects that go along with many combat deployments, including a diagnosis of post-traumatic stress disorder (PTSD).

PTSD, what Shawn was experiencing, is caused by any traumatic or life-altering event or events. Not only can it cause visible changes to one's demeanor, such as fear or distrust, it alters how the brain responds to its environment, with some brain areas becoming overactive, while others do the opposite.

PTSD ranks high on the list of mental afflictions that veterans experience. The National Health Study for a New Generation of U.S. Veterans, which surveyed 60,000 deployed and non-deployed veterans, found a 13.5% PTSD prevalence rate.

"In my experience physical injuries, no matter how severe... pale in comparison to the mental recovery for a lot of guys," said Shawn.

Many service members encounter the same difficulties after being removed from their established support systems, some of which they have relied on in life or death situations. "You're ripped away from your family, probably one of the most important families a lot of military guys will have in their entire career," Shawn said.

For Shawn, surf therapy led him to find a new support system in the Jimmy Miller Foundation. He attended sessions from 2010-2014, transitioning from participant to volunteer. Yet, many other veterans struggle to find something similarly beneficial.

"In many ways, veterans are like immigrants. The military culture is very different from the civilian culture," said Carl A. Castro, a professor of social work and psychology at the University of Southern California's Suzanne Dworak-Peck School of Social Work and retired U.S. Army Colonel. He said that his own experience helps him empathize with veterans going through the transition process.

Castro said that a veteran's military identity can help create beneficial social bonds with others who have gone through similar experiences but can also hinder their reintegration back into the civilian population. He said undoing that mindset is difficult because it goes counter to what soldiers were being told in the military. In some instances, the bootcamp process can instill a belief that soldiers are better than civilians.

"Adjusting your identity and your acceptance of other people becomes really important in this whole transition process," Castro said. "It [requires] striking that balance between keeping your experience and being proud of what you've accomplished in the military but at the same time not prejudging [civilians]."

Castro noted that veterans may put up walls to protect themselves from anger and self-confidence issues that accompany the transition. "From a veteran's perspective, you have to accept that you will probably start below where you should and you're going to have to prove yourself," he said. "It does create a natural resentment for people who have served in the military [when] they come out and find that they're behind where their peers are."

Surf therapy helps to break down walls between civilian volunteers and veteran participants because the ocean acts as an equalizing force. Shawn said that for veterans, especially those with physical impairments, being in the water can help instill self-confidence in their abilities. "The water was my friend," said Shawn. "It doesn't matter when you're in the water, you're not a burden anymore."

Castro stressed that social interaction is key for helping veterans through the challenging transition to civilian life. Social interaction promotes positive mental health and provides veterans with the necessary support to heal from mental and physical wounds.

Participants learn how to maneuver a surfboard. (Photo courtesy of: The Jimmy Miller Memorial Foundation)

"Relationships are really important to one's mental health and well-being," said Castro. "Any activity that connects veterans to either other veterans or other people in a meaningful, fun, constructive way I'm 100% for. I think surfing serves as one mechanism to do that."

Adaptive sports programs, such as the Jimmy Miller Memorial Foundation, are a growing facet of veteran care because they provide participants with healing that is centered around social interaction and physical engagement, rather than using prescriptions to manage pain.

Shawn said the path to recovery for mental injuries is more complicated than that of physical injuries. He said prescription drugs were proposed as a solution for his pain throughout various steps in his recovery, a standard he does not necessarily agree with. "I've been given drugs. That's their solution to things," said Shawn. "The government and even the [psychiatric] world throws a [lot] of meds at [mental illness], but I don't think that's the right answer for it."

According to the U.S. Department of Veterans Affairs, more than 20% of veterans diagnosed with PTSD also suffer from substance abuse disorder, with painkillers and antidepressants ranking high on the list. To combat that statistic, the military has been looking for other means of treatment, including those centered around physical activity and nature.

The U.S. Navy recently provided $1 million in funding for surf therapy research--a field of study with growing interest. It is especially appealing to mental health researchers whose work underscores what may seem obvious: time spent surfing and in the water has positive physical and mental benefits.

Exercise has already been linked to promoting better mental health, with studies showing that it can induce neuroplasticity, or the rewiring of the brain's circuits, and normalize the body's response to stress through the hypothalamic pituitary axis (HPA).

Recent studies show that exercising in a natural environment can be even more effective. Exercising in water, specifically, promotes a greater amount of self-esteem, compared to other environments, such as the forest or mountains. A 2019 study on surf therapy for veterans with PTSD found that depression and anxiety symptoms decreased, and negative emotional states were replaced with more positive ones.

"It triggers all the same thing that an addiction has but in a positive way, said Kevin Sousa, program director for the Jimmy Miller Memorial Foundation and licensed therapist. "It builds self-efficacy and confidence, and when that happens, in the long term it can help rewire the brain."

Nancy Miller, Co-Founder of The Jimmy Miller Memorial Foundation, has seen the positive effects of surf therapy firsthand. Miller started the foundation in the hopes that others can benefit from surfing the same way that Jimmy did. She believes an injury that prevented Jimmy from surfing contributed to a sharp decline in mental health leading to his suicide.

The Foundation specifically works with a range of ages, from at-risk youth during surf sessions at Manhattan beach to veterans during surf sessions at Camp Pendleton. Her varied experiences have shown Miller that surf therapy is beneficial regardless of age.

Miller said that she sees a noticeable shift in participants' attitude after just one session of surf therapy. "You can see their expressions change and soften, and they smile," said Miller. "[Their] fears are kind of broken down almost organically."

Shawn echoed Miller's sentiments and said the way participants identify changes over the course of the session. He said that their focus switches from what they can't do to what they can.

"It's almost like a paradigm shift," said Shawn. "They learn to kind of live again through sports. They [appreciate] themselves and who they are in this world and what they can offer."

(Click here to see an interactive map of where The Foundation holds surf therapy sessions)

The blueprint for the Foundation's surf therapy sessions was the brainchild of occupational therapist Carly Rogers, who created the session's guidelines while completing her master's degree in occupational therapy program at the University of Southern California's Chan Division of Occupational Science and Occupational Therapy. Rogers, one of Jimmy's lifeguard friends, proposed the plan to Nancy Miller and Jimmy's brother, Jeff, following Jimmy's death, just as the newly formed foundation was searching for a cause to contribute to. Her idea was unanimously accepted by the Foundation's board.

Rogers said the goal of occupational therapy, which works to help individuals return to meaningful participation in activities, pairs well with the mission-based component of the military identities in healing veterans.

"These individuals have been removed from their roles as warriors--these Marines were cut off from their mission," said Rogers. "Everything is about the mission and the ability to complete it." She said that pairing intense physical activity, such as avoiding oncoming waves and maneuvering through unpredictable conditions, with a goal, standing up and riding a wave, creates a new mission rooted in rebuilding confidence in their abilities.

For the Foundation, surf therapy doesn't just consist of surfing as a form of physical therapy. It also includes verbal therapy with trained mental health professions to help break down mental walls and allow productive conversation. The Foundation's combination treatment is able to overcome one of traditional therapy's most prominent barriers-- the process of trust establishment between patient and therapist. Sousa, who works with clients in traditional therapy environments as well as in surf therapy, said that surf therapy is "like six months of therapy in three hours."

"We establish trust, then we put them in a situation where there's not a lot of control," said Sousa. "You can't call timeout in the ocean. What happens is, you're dependent on people you just met."

"It was very humbling and very frustrating," said Shawn of his recovery process. "But I truly believe that I am lucky to be alive and be around and have the abilities I have now." Shawn said that his time spent with the Foundation allowed him to become a better father to his daughter, and wanted to share his success with other veterans. Shawn made it his new mission to use his experience to help others, and is involved with veteran programs and volunteering.

"It kind of gives me, since retiring, a mission, a focus and something to do," he said. "So that's kind of like my new purpose because I don't have my military mission as a purpose--a reason for being."

Shawn said that volunteering helped maintain the mental health benefits he gained as a participant of surf therapy. Surf therapy is not only a restorative practice, but also a preventative treatment. The Foundation's volunteers also benefit greatly from the program's mental health advantages.

Participants engage in talk therapy sessions led by mental health professionals. (courtesy of the Jimmy Miller Memorial Foundation)

Rogers said that many volunteers have their own reasons for participating in surf therapy. "Volunteers show up for their own mental health," she said. "Many of our volunteers opened up about their challenges in life...I definitely feel like giving back is a piece of a healthy lifestyle."

Glenn Fox, Head of Program Design, Strategy and Outreach, at the University of Southern California's Performance Science Institute, explained that the mental health benefits volunteers feel is a neurological phenomenon: giving to others activates the same reward circuitry in the brain as receiving.

"The brain is trying to coach us toward behavior that will help us thrive and help us lead good lives," he said.

Sousa said that his experience volunteering continues to help him improve as a therapist. "I see 30-40 clients a week in a chair, and this gets me out of the chair and down to the beach," he said. "This gets me moving, this is good for me and helps me keep my instrument clean so I can be a better therapist."

Like Shawn, Nancy Miller said that surf therapy helped her heal after Jimmy's death, but in a different way. For Miller, creating a surf therapy foundation helped her find a new purpose. "It saved my life. It was and it continues to be the most powerful thing in my life in addition to my family," she said. "On a personal level, having a reason to get up, having a reason to interact with children and then the military was huge. We all heal in different ways."

Shawn has seen a lot of improvements to his mental health, yet says that self-care is something he still needs to work on. Nevertheless, he believes that surf therapy works.

"You think, 'Is this a success or not?' And then you see these guys' faces," he said. "It's a success."