Space, Place and Mental Health

Sarah Curtis

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9780754673316
• eBook ISBN: 9781317051848
• Edition: 1
• Topic: Physical Sciences
• Subtopic: Geography
• Index: Geography

There is a strong case today for a specific focus on mental public health and its relation to social and physical environments. From a public health perspective, we now appreciate the enormous significance of mental distress and illness as causes of disability and impairment. Stress and anxiety, and other mental illnesses are linked to risks in the environment. This book questions how and why the social and physical environment matters for mental health and psychological wellbeing in human populations. While putting forward a number of different points of view, there is a particular emphasis on ideas and research from health geography, which conceptualises space and place in ways that provide a distinctive focus on the interactions between people and their social and physical environment. The book begins with an overview of a rich body of theory and research from sociology, psychology, social epidemiology, social psychiatry and neuroscience, considering arguments concerning 'mind-body dualism', and presenting a conceptual framework for studying how attributes of 'space' and 'place' are associated with human mental wellbeing. It goes on to look in detail at how our mental health is associated with material, or physical, aspects of our environment (such as 'natural' and built landscapes), with social environments (involving social relationships in communities), and with symbolic and imagined spaces (representing the personal, cultural and spiritual meanings of places). These relationships are shown to be complex, with potential to be beneficial or hazardous for mental health. The final chapters of the book consider spaces of care and the implications of space and place for public mental health policy, offering a broader view of how mental health might be improved at the population level. With boxed case studies of specific research ideas and methods, chapter summaries and suggestions for introductory reading, this book offers a comprehensive introduction which will be valuable for students of health geography, public health, sociology and anthropology of health and illness. It also provides an interdisciplinary review of the literature, by the author and by other writers, to frame a discussion of issues that challenge more advanced researchers in these fields.

Chapter 1
Mens Sana in Corpore Sano? Introduction to Geographical Perspectives on Health of the Mind and the Body

Summary

This book takes a geographical perspective on the growing public interest in mental health, happiness, and psychological ‘wellbeing’. It focuses on the significance of physical and social environments for these aspects of health. The aim is to explore how and why space and place are important for mental health and psychological wellbeing. The book reviews research that investigates geographical factors associated with risk of psychological distress or mental illness, or, conversely, with the chances of enjoying a ‘healthy’ mental state and positive sense of wellbeing.

This chapter provides a preliminary overview of geographical perspectives, which draw on a range of theories and methods, to interpret the complex relationships between our mental health and the social and physical environment in which we live.

This chapter starts with a discussion of the scope of health geography. It introduces some themes that are important for what follows later in this book. These include geographical theories about space, and place as they relate to health geography. Also introduced in this chapter are related ideas about ways of conceptualising risk. Consideration is given to aspects of classic and more recent debates concerning dichotomies of mind and body and the connections between ‘mental’ and ‘physical’ health. This book focuses on selected aspects of the ‘mind/body/environment complex’, and the ways that ‘states of mind’ are described in terms of positive ‘mental health’ or ‘psychological wellbeing’, as well as aspects of ‘mental illness’ and disorder. This chapter summarises some of the different ways that researchers define, describe and measure ‘mental health’ as it is construed in this book. Ideas from geographies of health are given most attention, but the perspective is interdisciplinary, aiming to illustrate how geography connects with ideas from, for example, sociology, anthropology, psychology and psychiatry to help us understand spaces of risk for public mental health.

Mental health and wellbeing comprise very significant aspects of human health. The importance of the burden of mental illnesses in human populations is considered, as well as the growing preoccupation in contemporary societies with the ways that our environment relates to wellbeing, ‘happiness’ and quality of life.

Introducing a perspective on space, place and mental health

How and why does the social and physical environment matter for mental health and psychological wellbeing in human populations? In this book this question is examined from a number of different points of view but with a particular emphasis on ideas and research from health geography. This book aims to show that health geography makes a distinctive contribution to knowledge about mental health through its focus on the interactions between people and their social and physical environment and in the ways that it conceptualises space and place.

Although the emphasis in this book is on a geographical perspective, the aim is also to demonstrate the connections between health geography and other disciplines particularly concerned with ‘states of mind’ and with mental health, including philosophy, psychiatry, psychology and public health. Therefore, this first chapter summarises selected parts of the relevant literature from these various disciplines concerning ‘mind-body dualism’ to contextualise mental health geography. A geographical perspective on mental health also fits well with the ‘social model’ used in public health to conceptualise the ‘wider determinants’ of health, which is considered below. Socio-geographical perspectives link to the sociology of health and illness in the way that they give attention to the idea of health as socially as well as medically constructed.

The book aims to review a rich body of theory and research to show how attributes of ‘space’ and ‘place’ are associated with human mental wellbeing or with mental illness. It will review concepts of space and place that help us to understand these associations. Some aspects of physical and social environments are associated with better chances of enjoying a ‘healthy’ mental state and positive sense of wellbeing. Conversely, some geographical factors may be associated with a higher probability of psychological distress or mental illness for individuals or populations. In the language of epidemiology and public health, these varying chances of mental health for different groups of people are often discussed in terms of ‘risks’ for mental public health. Much of the discussion in this book therefore aims to review what we learn from a geographical perspective about the connections between space, place and risk for mental health. This book also considers the ways that understandings of risk are constructed socially as well as scientifically. Thus some of the literature from social epidemiology and sociology of risk is relevant to the following discussion.

Arguments explaining the detailed reasons for these links between geographical factors and mental health are developed in later chapters in this book, but in this chapter some of the main themes are introduced. The sections of this chapter deal with the following topics: the scope of health geography; geographical interpretations of ‘relational’ concepts of space and place; concepts of risk; theories about ‘states of mind’; how far the mind and the body can be differentiated in research on health and geographical experience. Consideration is given to methods to assess mental health and wellbeing and what these tell us about the burden of mental illness and the importance of psychological wellbeing for human health. Also discussed is some of the international evidence for the significance of mental illness and wellbeing for human health more generally.

The scope of ‘health geography’: perspectives on the importance of place and space for health

This book is written primarily from a health geography perspective, and it makes sense at the outset to clarify what this approach involves. Geography considers the significance for physical and mental health of interactions between people and their environment. It investigates why space and place are important for health variation in human populations. Contrary to a view of geography which is apparently held by some of those who are not specialist in the field, health geography it is not solely about cartography (i.e. mapping health variation among geographical areas). As will be shown in this book, cartography is one of many tools that are useful for geographic research on health, but a large proportion of publications in health geography do not contain any maps at all. Also health geography is an investigative, rather than a purely descriptive endeavour. Although describing the geographical patterns of variation in mental health, health care facilities and resources may form part of geographical research, a more important element comprises explanatory studies which aim to investigate the reasons for these geographically variable distributions.

This book is one of several that have reviewed aspects of health geography, so that writing from a health geography standpoint, I am able to draw a number of earlier overviews. A summary in Box 1.1 discusses key reviews of health geography which may be of interest for further reading. From this we can see that health geography has a long pedigree; authors such as Barrett (2000) have compiled scholarly collections of material relating to the subject which date back at least as far as ancient Greek writings. Contemporary health geography has grown out of the field known as medical geography (which is particularly concerned with geographical aspects of medically defined diseases and medical care). The term health geography has been introduced in recognition of the widening of geographical concern to include aspects of health and wellbeing that are not medically defined and might be considered more broadly the domain of public health (e.g. for a recent discussion of the idea of wellbeing from a health geography perspective see Fleuret and Atkinson, 2007).

Some of the authors listed in Box 1.1 give specific attention to mental health; for example, Jones and Moon (1987), and Curtis (2004), do so within overviews of geographies of health in general. A significant geographical literature has also been more specifically concerned with mental health and psychiatric care (see Box 1.2 and especially Parr, 2008). These texts are all discussed in more detail in later chapters of this book and the notes in Box 1.2 are intended only as a brief guide to further reading in the form of key texts which have contributed to the development of geographies of mental health. These examples show that health geography has been concerned with various aspects of mental health and illness including: geographical patterns of mental illness at the population level; the distribution of psychiatric services and varying access to mental health care; the types of places where psychiatric care is provided; and the geographical experience of mental illness, psychological wellbeing and learning disability.

Box 1.1 Suggestions for further reading about health geography

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Readers who would like to have a more general sense of the field of health geography as a whole may be interested to read more widely in the subject. A good place to start is with a number of important overviews of the subject, several of which consider examples concerning mental as well as physical health. They include, for example, Barrett’s impressive compilations of material tracing the roots of health geography back to ancient Greek writings (Barrett, 2000). The medical geography perspective has also been very thoroughly presented by Learmonth (1988) and more recently by Meade and Earickson (2000) with the arguments illustrated using many international examples of research on specific diseases. Reviews by Shannon and Dever (1974), Haynes and Bentham (1979), Joseph and Phillips (1984) have been influential in the development of geographical work on the organisation of health care, access to services and territorial justice in health care. Other major landmarks in the general literature on health geography include a book by Jones and Moon (1987) which was especially influential because of the way that it interpreted social as well as biomedical theories from a geographical perspective. Curtis and Taket (1996) also focused more particularly on the significance of social processes for geographies of health and elaborated on the connection between geographical perspectives and public health policy, and Chapter 2 of their book provides an overview of developments in health geography in recent decades. Gatrell (2002) and Curtis (2004) have also provided more up to date reviews of a range of perspectives in health geography and Gatrell’s text is especially recommended for those interested to learn more about the physical environmental processes as well as the social processes that impact on human health. The field has now developed to such a level internationally that a compendium of health geography is currently in preparation (Brown and Moon, 2009) and the international strength of interest in the subject is reflected in reviews produced in languages other than English (e.g. Fleuret and Thouez, 2007).

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Box 1.2 Suggestions for complementary reading on the development of geographies of mental health

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A very helpful, succinct review of the evolution of literature in geographies of mental health is provided by Wolch and Philo (2000) (see also Philo and Woch, 2001; Philo, 2005; Philo 1997) summarising progress in geographies of mental health spanning the period 1970 to the present day and arguing that the agenda has shifted from studies of the locations in which psychiatric care is provided and the geographical location of people with mental illness towards research which is more focused on the role of space and place in differentiation and marginalisation of people with mental illness on the part of wider society (e.g. Parr, 2008). Research taking a longer historical perspective, has produced a series of studies of asylum and post-asylum geographies (some of which are referred to in Chapter 7 of this book. Philo (2004) provides a particularly authoritative account of the history of institutional provision for people with mental illness. Important contributions to early work in geography of mental health were also made by Smith and Giggs and Dear (e.g. See Giggs, 1973, 1975; Smith 1978; Smith and Giggs, 1988; Smith and Hanham, 1981a, 1981b; Dear and Taylor 1982) who explored the geographical distribution in the city of people with mental illness and of services provided for them, as well as the social processes associated with these distributions. Also often cited in the literature from this period is an important critique of deinstitutionalisation of psychiatric care in North America, based on a clearly formulated conceptual framework, by Dear and Wolch (1987). Moon and colleagues have provided analyses and reviews of geographies of psychiatric morbidity and care and the social construction of risk associated with mental illness (e.g. Jones and Moon, 1987; Moon, 2000; Duncan, Jones and Moon, 1995). Research using relatively advanced statistical techniques to extend our understanding of the geographical patterning of psychiatric illnesses also include studies by Congdon et al. (1996, 2006), Weich and Lewis (1998), Wiech et al. (2001), Kessler et al. (2004) and Middleton, Sterne, Gunnell et al. (2008). Also strongly recommended in the literature on mental health geographies is work by Parr (e.g. 1997, 1999, 2000, 2008) which has elucidated the experiences of people with mental illness from a geographical point of view. The collection of papers for which she was an editor (Butler and Parr, 1999) are valuable early examples of the geographical concern with embodiment and ‘states of mind’. Geographers also use similar approaches to consider aspects of learning disability and impairment that would not be defined as medical conditions; for example, a collection of papers on this topic is introduced by Philo and Metzel (2005).

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Theories of space and place in health geography

Health geography works with a range of theoretical and empirical approaches in which ideas about place and space are fundamental. Place and space are not seen merely as ‘containers’ for ‘epidemiological processes’ (causal pathways producing health variation). Rather, space and place contribute to processes helping to constitute health variation among individuals and populations (e.g. see Kearns, 1993; Kearns and Joseph, 1993). Consideration of these relationships has led to approaches in empirical research on population health which aim to investigate how ‘compositional’ attributes of the individuals making up the population interact with the ‘contextual’ aspects of a socio-geographical space or ‘setting’ that may impinge on many of the individuals embraced within it (e.g. reviewed by Cummins et al., 2007). Moreover, as I hope to demonstrate in this book, places and health have mutual effects on each other, in that states of mind and mental illness can also influence the ways that places are identified and interpreted. In earlier publications in health geography (Curtis and Rees-Jones, 1998; Curtis, 2004) key ideas in health geography were framed using the metaphor of different ‘types’ of ‘landscape’, each representing a body of theory about the connections between place and health, summarised in Figure 1.1. These relationships have been reviewed at length in my earlier book (Curtis, 2004) so I will not repeat here the detail of that discussion. In brief, we see from Figure 1.1 that health geography has viewed health inequality in human populations from a range of theoretical perspectives about space and place. These variously interpret humanistic and psychological theories about the following processes:

• our emotional and psychological response to places and their significance for sense of identity, wellbeing and identity;

• the role of space and place in processes of social and political control and resistance in the relations between dominant and subordinated social groups;

• the links between socially defined spaces in which we live (our ‘habitus’) and our choices and expression of taste through our private consumption of commodities and individual lifestyle practices;

• processes of collective consumption; action by which societies try to ensure socio-economic reproduction at the community and national level and promote social and territorial justice;

• epidemiological and ecological processes linking physical and bio-chemical conditions in the environment to human health.

Other conceptual frameworks have also been proposed in geography to express the various dimensions of the environment that are relevant for human health. Human disease ecology (e.g. discussed by Meade and Earickson, 2002) also conceptualises interactions between physical environmental processes, human biological attributes and human behaviours. Furthermore, from a humanist perspective in social geography, the idea of therapeutic landscapes was proposed by Gesler (e.g. Gesler 1992, 2003, 2005) and has been developed in subsequent research to explain the ways that certain landscapes offer potential for healing and promotion of good health (e.g. see edited collections by Williams, 1998, 2007). The ‘therapeutic landscapes’ perspective draws on several different areas of theory and is discussed in greater detail later in this book. It has proved very attractive to many researchers as a conceptual framework to organise ideas about how people experience landscape in ways that are important for their health. Although there are some variations in the way that the conceptual framework has been presented, it broadly proposes that geography should consider aspect...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• List of Figures
• List of Boxes
• Foreword
• Acknowledgements
• 1 Mens Sana in Corpore Sano? Introduction to Geographical Perspectives on Health of the Mind and the Body
• 2 ‘Virtuous Landscapes’: Therapeutic Material Settings
• 3 Material Hazards and Risks for Mental Health
• 4 Resilience, Social Capital and Social Integration
• 5 Anomie, Status Anxiety and Fear: Socio-spatial Relations and Mental Ill-health
• 6 Dreamscapes and Imagined Spaces: The Meaning of Place for Identity, Spirituality and Mental Health
• 7 Post-asylum Geographies of Mental Health Care: Spaces for Therapy and Treatment
• 8 Place, Space and Population Mental Health
• Bibliography
• Index