'Space, place and patient experiences of mental healthcare' 1948-1998

Taken from a chapter in 'Madness, Architecture and the Built Environment'(1)...

Spatial metaphors, physical descriptions of the buildings and wards, and a sense of movement from place to place are common descriptions when listening to people recalling their experiences as a psychiatric patient. Research by Kerry Davies (1) used 41 oral history interviews with patients and ex patients. Her argument is that while space and place are increasingly prominent in the history of psychiatry, patients are often absent or peripheral figures in these accounts. In her definition of 'place' (versus space) she uses William Gesler's definition of a place as 'space filled with people acting out their lives'.


But I'd probably think back to Martin Heideggers' definition:
Being-in-the-world
Space (abstract) versus Place (socially experienced)

The German word for space, Raum, originates from raumen which means 'freeing of places for human dwelling'.  Dwelling - implies being at one with the world, peaceful, contented, liberating. This is related to the kind of building which is cultivating or nurturing.  Considering a dining table as a 'dwelling', then moving the table around a room or setting it for a meal is a kind of building of a sort- done in response to the needs of the people who will eat there. So dwelling is dependent on building and also vice versa. One can occupy buildings daily but not feel at home in them or near to them. The German word for building, Bauen, originally means to dwell.
Dwelling requires building and then rebuilding to respond to changing needs of dwelling [- the concept of mutability?]
So, according to Martin Heidegger in "Building Dwelling Thinking" the relation between man and space takes on the form of dwelling. A building is what allows for a sense of place in which dwelling occurs (2).

Place & Time

A quote from a patient ('Christopher') emphasises the change from space to place requiring time:

"And I liked Littlemore to start with, but when they got the new building, I didn't like it. I was very depressed when I went there. And it had only just opened, you could smell the paint. You know, the ward - a ward has to have some time to get an atmosphere. It didn't have one, but it has now."

The change in the space was both physical (the newness, the smell of paint) and social (expressed as a lack of atmosphere).

Imagery

Another quote from a day patient:

"...it was the drab atmosphere when I was walking over the bridge - when I used to get off the bus and walk ... it was the hospital grounds, the grey buildings. The look of it as I was walking over it was quite dismal, you know, and I thought I want more from this in my life and that's ... the reason why I packed it in..."

The dramatic physical presence of large institutions, their place in local myths, the large number of people who work and live there, all serve to maintain the central and almost physical place in the histories of mental health. People's recollections of their time in mental healthcare facilities usually include vivid descriptions of the physical surroundings, the building, moving around within the buildings but also internal details such as taps, lampshades, the state of the paintwork.

[NB. I intend to investigate ceilings as a forgotten but significant internal detail since we often spend a lot of time starting at it when we're ill...]

Spatial ownership & surveillance

(See also previous blog entry on this)
There is often a sense of a public and private face of the hospital - the 'good' wards being more publicly visible compared with spaces in the further reaches of the hospital - back wards, tops of stairs, underground pathways and rooms, adding to the 'depth' of the building.
There was a common concern at having to enter 'staff space' (eg. the central nurses area, the glass box) in order to seek support. There is/was a definite line between patient and staff spaces. The central glass area was also described as a goldfish bowl - confusing the issue as to who is watching whom...
Themes of being under surveillance in specific (small) spaces, occupied by patients but 'owned' by staff, were common. However, when being watched, patients do interact and return both the gaze and the glance. This gaze is both mediated and reciprocal.

"...they've got these little windows, with these, its not blinds, you wouldn't call it a blind, like a shutter, you can lift up and look in? So they can check on you at night ... And they put me in a room on my own, right away from everyone ... And they put you on ... obs, which is fifteen minute observations just to make sure you're [okay] but, when you're trying to get to sleep at night and they're shining a torch - 'are you still there?", yeah, yeah, go away I'm trying to get some sleep..."

Observation is portrayed as comic and ridiculous, particularly night time surveillance, the lack of control over space, the images of torches, but was intrusive, shocking, and frustrating.

The grounds...

The most significant patient spaces have tended to be the hospital grounds - there is less 'observation', and the spaces are more flexible (informal or formal, work areas, exercise areas) and less regulated. Areas that could be used for illicit activity. Places of escape - from the wards, staff surveillance, other patients - and rest.

(1) Davies, Kerry. "'A Small Corner that's for Myself': Space, Place and Patients' experiences of Mental Healthcare, 1948-98." In Madness, Architecture and the Built Environment. Psychiatric Spaces in Historical Context, edited by Leslie Topp, James E Moran and Jonathan Andrews, 305-320. New York: Routledge, 2007.

(2) Sharr, Adam. Heidegger for architects. London, New York: Routledge, 2007.

(3) Gittens, Diana. Madness in its Place. Narratives of Severalls Hospital, 1913-1997. London: Routledge, 1998.
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