Placing therapeutic landscape as theoretical development in Health & Place

Geopsychiatry from below: Exploratory review and preliminary analysis

BACKGROUND

This contribution advances claims about 'geopsychiatry from below', attending to how 'voices' with lived experience of mental ill-health speak about 'the geo' or, more specifically, 'place and space'.

AIMS

To explore relevant interdisciplinary literature for academic research, scholarship and commentary containing voices of experience speaking about the geo.

METHODS

An 'indicative' and 'facilitative' review of relevant transdisciplinary literature in arts and humanities and social science, alongside an exploratory workshop where materials are analysed and relationships detected and, provisionally, mapped.

RESULTS

The literature review discloses no coherent body of studies into the geo from below, but rather a fragmented amalgam of materials-field observations, primary quotes and occasional elaborations-that are rarely the direct focus of inquiry (except in some contributions by academic geographers). Combining the literature review and the workshop analysis, an outline series of prompts are developed for relating 'Kinds of Places', their associated 'Affective Qualities' and actual spaces and places on the ground.

CONCLUSIONS

This study signals what a geopsychiatry from below might entail, providing important foundations for future transdisciplinary work on 'the geo' and mental (ill-)health.

Micropolitics of Mental Health Recovery: An Assemblage Analysis of People's Experiences of Becoming Well

Mental health recovery takes place in a social and material world. However, socio-material contexts have often been absent from recovery studies. The present study was conducted in Norway, a Scandinavian welfare country. We interviewed people at meeting places who had experiences as service users, focusing on their experiences of becoming well, and analyzed their recovery stories using an assemblage framework. Our analysis identified four constitutive dimensions that promote mental health recovery: an atmosphere of togetherness, doings as more than the act, personal development, and integration in society. We discuss how these dimensions might be seen as social, relational, and material forces that create important micropolitics that challenge the individualistic professionalization of the recovery concept.

Qualitative Evaluation of a Garden-Based Healing and Learning Program for Young Adults with Intellectual Disabilities

This study investigated the impact of garden-based learning on young adults with intellectual disabilities (YAwID). Since YAwID often experiences difficulties collecting information, experiencing situations, and making decisions independently, we developed and implemented a customized learning program for them and analyzed its impact. This program was devised specially to help YAwID utilize the garden's resources properly. The findings showed that garden-based learning generated specific changes in the knowledge, skills, and attitudes of YAwID, such as emotional healing to recover psychological stability, social healing through social relationships, physical healing through new activities, and independent healing through individualized plans. Participants experienced sympathizing with others and maintaining positive relationships and obtained the knowledge, skills, and attitudes necessary for behaving responsibly through gardening. Garden-based learning utilizing flowers and plants enhanced participants' physical and mental health, improved their functioning, and helped them adapt to the environment and integrate into society. Our program can be considered a form of vocational training by which people with disabilities can enhance their employability by learning gardening skills, promoting their participation in society, and improving their quality of life. Hence, garden-based learning may transform people's perception of disability and help people with disabilities respond to challenges.

Supporting student learning and development through trauma-informed campuses

Many students come to higher education with a history of trauma. College life may also expose students to traumatizing events. While the past decade has witnessed greater discussion of trauma-informed frameworks, it has not regularly been applied to the college environment. We advance the concept of a trauma-informed campus, where administrators, faculty, staff, and students from diverse disciplines create an environment that recognizes the widespread nature of trauma, integrates knowledge about trauma into practices and procedures, and minimizes further re-traumatization for all community members. A trauma-informed campus is prepared for students' past or future traumatic experiences, while also recognizing and responding to structural and historical harms. In addition, it recognizes the role of the surrounding community challenges, particularly how violence, substance use, hunger, poverty, and housing insecurity may contribute to further trauma or negatively impact healing. We use an ecological model to frame and shape the construct of trauma-informed campuses.

Release: The acupuncture clinic as a therapeutic, health-enabling place

This paper critically reappraises the work of Wilbert Gesler (1992) on 'therapeutic landscapes' to explore the dual role of the acupuncture clinic as experienced by couples undergoing fertility treatment. Drawing on qualitative research in Ireland, I argue that the acupuncture clinic acts as a therapeutic space in two senses. First, the patient-acupuncturist relationship contributes to patient emotional support and wellbeing, with the clinic providing emotional sanctuary. Second, the clinic provides a therapeutic complement to allopathic approaches to fertility treatment, with the acupuncturist providing informational support which informs patient decision-making and, in some cases, arguably contributing to the treatment itself. In exploring the therapeutic and health-enabling importance of the acupuncture clinic, this paper adds important qualitative depth to an aspect of assisted reproduction that has become an essential complement to the medical process to many couples, but has arguably remained neglected in academic research.

Ethnographic understandings of sexual and reproductive health and HIV care for adolescents in Blantyre, Malawi

Sexual and reproductive health (SRH) care and support are provided to adolescents living with HIV, with the aim to build safer sex negotiation skills, sexual readiness and reproductive preparedness while reducing unintended pregnancies and sexually transmitted infections. We consider how different settings might either constrain or facilitate access to resources and support. Ethnographic research was conducted in Malawi in teen club clinic sessions at an enhanced antiretroviral clinic from November 2018 to June 2019. Twenty-one individual and five group interviews were conducted with young people, caregivers, and healthcare workers, and were digitally recorded, transcribed, and translated into English for thematic analysis. Drawing on socio-ecological and resilience theories, we considered the different ways in which homes, schools, teen club clinics, and community settings all functioned as interactional, relational, and transformational spaces to allow young people to talk about and receive information on sexuality and health. Young people perceived that comprehensive SRH support enhanced their knowledge, sexual readiness, and reproductive preparedness. However, their desire to reproduce at an early age complicated their adoption of safer sex negotiation skills and SRH care. Engaging and talking about SRH and related issues varied according to physical and social space, suggesting the value of multiple locations for support and resources for young people with HIV.

Health perception and restorative experience in the therapeutic landscape of urban wetland parks during the COVID-19 pandemic

Introduction

The effects of restoration and inspiration in the therapeutic landscape of natural environments on visitors during the COVID-19 pandemic have been well-documented. However, less attention has been paid to the heterogeneity of visitor perceptions of health and the potential impacts of experiences in wetland parks with green and blue spaces on visitors' overall perceived health. In this study, we investigate the impact of the restorative landscapes of wetland parks on visitors' health perceptions in the context of the COVID-19 pandemic.

Methods

In our survey, 582 respondents participated in an online questionnaire. We analyzed the respondents' health perceptions in terms of latent class analysis, used multinomial logistic regression to determine the factors influencing the potential categorization of health perceptions, and used structural equation modeling to validate the relationships between health perceptions of different groups and landscape perceptions of wetland parks, restorative experiences, and personality optimistic tendencies.

Results

The results identified three latent classes of health perceptions. Gender, marital status, education, occupation, income, distance, frequency of activities, and intensity of activities were significant predictors of potential classes of perceived health impacts among wetland park visitors.

Discussion

This study revealed the nature and strength of the relationships between health perception and landscape perception, restorative experience, and dispositional optimism tendencies in wetland parks. These findings can be targeted not only to improve visitor health recovery but also to provide effective references and recommendations for wetland park design, planning, and management practices during and after an epidemic.

What makes a space safe? Consumers' perspectives on a mental health safe space

The provision of community-based space for people experiencing a mental health crisis is regarded as a favourable alternative to the emergency department. However, the only non-emergency department safe spaces in Western Australia are located within hospitals or hospital grounds. This qualitative study asked mental health consumers in Western Australia with experience of presentation at the emergency department during a mental health crisis to describe what a safe space would look and feel like. Data were collected through focus groups and thematically analysed. The findings present the voices of mental health consumers through the framework of health geography and the therapeutic landscape. These participants articulated important physical and social features of a therapeutic safe space and their symbolism as inclusive, accessible places where they would experience a sense of agency and belonging. Participants also expressed a need for trained peer support within the space to complement the skilled professional mental health team. Participants' experiences of the emergency department during mental health crises were described as contrary to their recovery needs. The research reinforces the need for an alternative to the emergency department for adults who experience mental health crises and provides consumer-led evidence to inform the design and development of a recovery-focused safe space.

"And if my goal is never to leave Casey House?": The significance of place attachment for patients at a specialty HIV hospital in Toronto, Canada

The current healthcare context prioritizes shorter hospital stays and fewer readmissions. However, these measures may not fully capture care experiences for people living with HIV, especially those experiencing medical, psychosocial, and economic complexity. As part of a larger study, we conducted seven focus groups with people living with HIV (n = 52), who were current/former patients at a Toronto-based specialty hospital, examining their desires/needs for hospital programs. Using a novel place attachment lens, we conducted a thematic analysis focusing on the emotional bond between person (patient) and place (hospital). Our findings show that participants wanted an ongoing connection to hospital to fulfill their need(s) for control, security, restoration and belonging. Indeed, continual attachment to hospital may be beneficial for patients with complex care needs. Our research has implications for care engagement and retention frameworks.

Migrant gardeners, health and wellbeing: exploring complexity and ambivalence from a UK perspective

There has been increasing interest in how green spaces and gardening contribute to people's physical, mental and social wellbeing, and this interest has increased due to COVID-19. This article explores the particular experiences of migrant gardeners and the implications for their health and wellbeing. It draws on a qualitative research project that involved conducting semi-structured interviews with participants with migration heritage in and around a city in the north of England. The participants were recruited through purposive and snowball sampling; of the 25 participants, some were allotment holders, whilst the rest cultivated crops in their gardens or even on their balcony. Thematic analysis of the interview transcripts generated themes that reflect current definitions of health, encompassing physical, mental and social wellbeing. However, whilst the findings confirm many positive effects of gardening, they also point to some ambivalence in relation to cultivation, outdoor practices and health, with evidence of neutral or even negative effects at times. The article explores the implications of these findings for initiatives to encourage gardening, such as social prescribing, and to address 'green poverty'. An additional finding is that for gardeners with migration heritage, gardening can be understood in terms of cultural wellbeing. Consequently, there is a need to broaden the concept of wellbeing to include this cultural dimension.

The ends of an assemblage of health

This paper identifies and responds to three key challenges that have emerged in discussions of the assemblage across health geography. These challenges concern the problem of identifying the borders or limits of an assemblage of health; the problem of clarifying how such assemblages change over time; and the more general problem of identifying the affective and material character of the assemblage such that one may distinguish 'therapeutic' from 'oppressive' arrangements. The paper argues that each challenge calls for a novel analytics of power grounded in assessments of the generative forces of stratification and selection expressed within an assemblage. Assemblages of health are composed in relations of power, affect and desire that stratify the assemblage in ongoing processes of selection, acting upon heterogeneous entities (material and immaterial, intensive and extensive, human and nonhuman), bringing them into contact, causing them to affect one another, transforming their activity. Analysis of these processes provides potent tools for rethinking how relations, events, spaces and encounters mediate experiences of health and illness, and novel grounds for intervening in the formation of an assemblage of health.

Understanding the Ephemeral Moment of COVID Avoidance Hotels: Lessons Learned from Acknowledging Housing as Central to Dignified Later Life

Place and health are intricately bound. COVID has amplified system burdens and health risks within the housing care continuum, in which older adults with chronic illnesses are disproportionately represented. The paper identifies the health experiences of older adults with severe conditions living in and moving through temporary avoidance hotels during the COVID-19 pandemic. An interpretive descriptive approach was taken with qualitative chart data and provider observation to represent the experiences of 14 older avoidance hotel residents living with serious illnesses. Through provider documentation, we illustrate trends pre-pandemic, in the first nine months of the pandemic, and the second nine months. Such trends include strengths and opportunities such as the health-affirming nature of avoidance hotels, their potential in generating continuity of care and permanent housing, and synergy between harm reduction approaches and palliative care. Challenges were also identified in catering to the diverse medical, behavioral, and psychosocial-spiritual needs of older and seriously ill residents and the consequences of geographic dispersion on health care, health behaviors, and informal care networks. Through these strengths and challenges, avoidance hotels present essential lessons in considering future housing and healthcare intervention and implementation that addresses the needs of older seriously ill people facing homelessness and housing precarity.

Articulating mobile gendered landscapes: Thinking with care cultures

This paper relates work on global neoliberal gendered labor to geographies of care and it provides a tangible example of culturally specific dimensions of the relationship between health and place. The context is a temporary work migration pattern of Bulgarian women in Italy, who provide 24/7, live-in care to elderly, often dying patients. Through a longitudinal ethnographic fieldwork, this paper illustrates how mobile gendered landscapes are articulated and made meaningful by the research participants, offering a different reading of global care regimes. I argue that this articulation is a way of thinking with care cultures and showing how these are (re-)imagined by women who care in less than caring institutional/economic/familial landscapes. The paper contributes the concept 'care cultures' as a productive lens, through which to account for how place, people, ethics and care practices grow, merge and (mis-)align in attempts to construct and maintain meaningful lives.

Virtuous eating: Landscaping the ethics of elder care with food

The paper invigorates the discussion on ethics of care in 'care-ful geographies' by highlighting the importance of thinking with 'culture' and its moral dimensions in filtering local ethics of elder care in China. More specifically, it illuminates how care, both as ethics and virtue, was manifested by a group of Buddhist older adults' appreciation of vegetarian eating in relation to the responsibilities for their own health and accompanying moral obligations. The conceptualization of 'virtuous eating' provides a hermeneutic cultural tool to interpret the shifting identifications with vegetarian eating, articulated as xiu lian (cultivation), fu bao (blessing) and ci bei (compassion), thus generating its analytical capacity in highlighting the reciprocity and relationality of care. The meanings associated with values and morality of vegetarian eating were enacting in forging new configurations of ethics of care within their self-therapeutic caring encounters.

Towards cultural landscapes of care

This paper sets out a theoretical agenda for Cultural Landscapes of Care. It highlights the importance of engaging the cultural vectors within different 'care-ful geographies', in order to highlight the role of culture as both a lens of knowing a meaningful way of life, and a critical hermeneutic. Through revisiting discussions around everyday practices of care, both in this journal and elsewhere, we outline a research agenda that re-engages culture with inquiries into the relations between place and care, including spatialities of care, ethics and justice. We call for a shift to thinking with culture and its moral dimensions in order to make sense of the tensions, ambiguities and boundaries of care marked by austerity, neoliberalism and globalisation. We therefore coin the term 'cultural landscapes of care' to advance an agenda that is contextually and culturally sensitive, and committed to understanding what good care means in diverse trans-local contexts. Gathering together the papers in this collection, we show how culture 'filters' through meaningful everyday care practices. We argue for an understanding of culture as a toolkit and a condition for ethical encounters of care. Thus, we translate situated examples of caring experiences into a global standpoint of care-ful geography.

'Care-ful' boundary negotiation: Curating translocal subjectivities among Japanese women in London

This paper explores the everyday experience of Japanese female migrants in London. Asking how culture can offer us a lens through which to understand the diversity and heterogeneity of care in this globalised world, the Japanese concept of omoiyari, as curation of landscapes of care, is used as an analytical lens to unpack the interplay between culture, care and identity, illuminating the boundary-drawing aspects of ethics of care with which people make ongoing distinctions between self and others, and constructing translocal subjectivities. Understanding care as a form of communication, this paper uncovers the contextual and relational formation of care and self, and how this is enabled as well as constrained by culture. It contributes to an understanding of the relational formation of care in which caring practice is neither static nor embedded in place and culture, but is rather shaped through relationships dynamically, while social relationships in turn also shape the meaning of care.

Contemplative practices: The body as therapeutic site linking health and place

During times of upheaval, supporting stability, health and wellbeing on all levels is essential. While literature regarding 'therapeutic landscapes' has burgeoned over the last 30 years, to date no studies have considered the therapeutic potential of embodied contemplative practices (CP), such as yoga and meditation, within the most accessible, ordinary environment - the body at home. Equally, the field of mobilities appears to have overlooked the spiritual and political nature of these deliberately immobilising acts of resistance. Our paper draws on narrative data collected over the course of three months of daily CP. We interpret the resulting autoethnography through thematic analysis. We conclude that within a fast-paced, hyper-connected world, CPs can be a therapeutic counterpoint, connecting health and place by nurturing an appreciation for the immaterial, interdependent aspects of life.

Waterscapes for Promoting Mental Health in the General Population

The WHO estimates that, with the development of urbanization, 25% of the population is suffering from psychological and mental distress. Preliminary evidence has suggested that aquatic environments and riparian areas, i.e., waterscapes, can benefit psychological and mental wellbeing. The aim of this study was to identify the processes of waterscape psychological and mental health promotion through aliterature review. We propose a design framework of waterscapes for achieving psychological and mental health in the general population that often visits waterscapes, which has the function of therapeutic landscapes through values of accessibility, versatility, habitats, and biodiversity. According to theories, waterscapes can improve psychological and mental health to divert negative emotions through mitigation (e.g., reduced urban heat island), instoration (e.g., physical activity and state of nature connectedness), and restoration (e.g., reduced anxiety/attentional fatigue). By accessing water (e.g., streams, rivers, lakes, wetlands, and the coast) and riparian areas, people can get in close contact with nature and spend more time in activities (e.g., walking, exploring, talking, and relaxing). Waterscapes with healing effects can enhance psychological resilience to promote people's psychological and mental health. Future research should focus on ensuring an adequate supply of waterscapes and promoting the efficiency of waterscape ecosystem services on mental health. Moreover, fora deep understanding of the complexity of nature-human health associations, it is necessary to explore more consistent evidence for therapeutic waterscapes considering the characteristics and functional mechanisms of waterscape quality, in terms of freshness, luminescence, rippling or fluidity, and cultural value, to benefit public health and biodiversity conservation.

"Old friend and powerful cadre": Doctor-patient relationships and multi-dimensional therapeutic landscapes in China's primary hospitals

A positive doctor-patient relationship is believed to play a key role in the healing process in clinics. While challenges to the doctor-patient relationship are a global concern, complex social contexts which introduce familial collectivism and totalitarian bureaucracy to maintain a doctor's authority have complicated doctor-patient relationships in China. This study delineates a multi-dimensional therapeutic landscape of hospitals in China, focusing on the doctor-patient relationship performances used to improve patients' healing experiences. Based on fieldwork in two primary hospitals in Eastern China, we find that primary hospitals in China are not only professional spaces, but hybrids of professional and non-professional spaces. In these spaces, both professional and other discourses in various forms of social-environmental engagement affect therapeutic experiences. Varying time and space in hospitals allow doctors to construct multi-dimensional therapeutic landscapes vis-a-vis patients to secure patients' compliance with their recommendations, and thus improve health outcomes. We argue that these dimensions may also cause negative therapeutic experience such as unnecessary health care. This study contributes to the literature on therapeutic landscapes of health care by providing a critical view on the construction of multi-dimensional therapeutic hospital landscapes. Furthermore, it links the critical health geographies literature with China's broader social context to explicate the cultural and social transformation of health care spaces in contemporary China. Findings from this study inform both theoretical and empirical debates regarding therapeutic landscapes of health care by embedding the professional spaces of health care into broader geographical discourses. This calls for health professionals to reflect on ethical concerns in multi-dimensional health care landscapes.

Contextual influences on chronic illness: A multi-level analysis in the twin cities of Ramallah and Al Bireh in the occupied Palestinian Territory

The features of the urban environment can support human health as well as harm it, but less is known about such influences in the context of middle eastern countries. The association between green space and the political classifications of the urban environment and the risk of chronic illness was investigated in a novel setting, the twin cities of Ramallah and Albireh in the occupied Palestinian territory. We used a generalised multi-level regression analysis to link the 2017 census data with Geographic Information System data. We modelled individuals at level one (n = 54693) and areas of residence at level two (n = 228), adjusting for individual demographic and socio-economic characteristics.

The proportions of ‘mixed’ trees in residential areas had a significant inverse association with the risk of chronic illness. On the political dimension, only living in a refugee camp had a significant positive association with chronic illness; however, this was largely explained and rendered non-significant when green space variables were entered into the models. Our ability to differentiate between several types of green space was important, as findings demonstrated that not all types were associated with reduced risk of chronic illness. Our results from a middle eastern setting add to the largely Western existing evidence, that trees in urban settings are important and beneficial to human health. Researchers and policymakers should pay more attention to the health consequences of refugee camps but also the role of trees in benefiting individuals' health in such a disadvantaged context.

•

The study explored the urban political and environmental impacts on health in the Palestinian context.

•

Living in a refugee camp is positively associated with the risk of chronic illness, over and above individual characteristics.

•

Residential areas mixed trees are inversely associated with chronic illness, and explained the association with refugee camps.

•

Not all types of green space are associated with a reduced risk of chronic illness.

Creating a transformative space for change: A qualitative evaluation of the RHS Wellbeing Programme for people with long term conditions

PURPOSE

Our research aimed to evaluate the impact of the RHS Wellbeing (WB) Programme on people with long-term conditions.

FINDINGS

A thematic analysis identified how the WB programme facilitated improved social connectivity, sense of wellbeing and purpose through the creation of a 'healthy, natural and safe space' predicated on 'person-centred approaches'. Participants felt they were 'part of something larger' which enabled 'transformation of their health and wellbeing'.

CONCLUSIONS

The WB Programme offered space to grow, heal and reconnect. Losing oneself in a nature-based space can have a lasting transformative impact on individuals.

Therapeutic landscape experiences of everyday geographies within the wider community: A scoping review

As community dwelling populations of older people and those living with chronic and life limiting conditions continue to grow, the role of everyday geographies, particularly of community based settings and activities, in supporting health and wellbeing has become a focus in both research and policy development. The therapeutic landscape scholarship provides a holistic view of how place promotes health and wellbeing, and has in recent years expanded its focus from reputable places of healing to everyday geographies. Based on a scoping review of 45 studies on everyday community based therapeutic landscapes, this paper identifies and critically examines the settings, populations and mechanisms of therapeutic experiences. It presents critical summaries of the scales and boundaries of landscapes; the diverse and dichotomous characteristics of places; the therapeutic benefits of proximal and distal socio-spatial interactions; the role of everyday settings and activities as sources of refuge, anchor and resonance and finally the broader social, cultural, political and economic contexts in which everyday therapeutic landscapes are embedded. In so doing the paper highlights the complex nature of everyday therapeutic landscape experiences and how this research can further inform the development of community based settings and activities that promote health and wellbeing. It also identifies areas for future research on everyday therapeutic landscapes.

Health tourism destinations as therapeutic landscapes: Understanding the health perceptions of senior seasonal migrants

Health-driven seasonal tourism has become a new way of providing for the aged, which demonstrates a profound relationship between place and health. Therapeutic landscapes strongly suggest a causal relationship between health tourism destination and individual health. However, the quantitative validation of such relationship remains neglected and possible mechanisms underlying the relationship lack a strong theoretical basis. Based on therapeutic landscape theory and the REPLACE framework, this study quantitatively examines health promotion mechanisms of health tourism destinations by using data collected in Sanya, China, in January 2019. The effect of personal traits of dispositional optimism on health perceptions is also considered. The results show that physical, social, and symbolic landscapes positively influence health perceptions through restorative experiences. Social landscapes, symbolic landscapes and dispositional optimism positively affect health perception, while physical landscapes do not directly have a significant impact on health perception. It is expected that this study will fill the knowledge gap and advance our knowledge of therapeutic landscapes by exploring how they can influence health.