Hester Parr

Medical geography: care and caring

This, the second of my short reports into aspects of the current state of medical geography, concentrates on the themes of ‘care’ and ‘caring’ with respect to health and illness. This chosen slant neglects some important research work, especially that reflecting more traditional aspects of the subdiscipline, as well as new work which explores revealing dimensions to the dialectic between health and place (e.g., Bush et al., 2001; Cutchin, 2001; Dovey et al., 2001; Rapheal et al., 2001; Stead et al., 2001; Witten et al., 2001; Wakefield et al., 2001). However, at the same time it allows a selective commentary on the efforts of some geographers who are seeking to redefine this field in conceptually and empirically innovative ways, while still building on the foundations of past efforts. Medical geography has been conventionally mapped as a subdiscipline with two distinctive strands: research work on the spatial distribution of disease and death, and that on the geographical complexities surrounding the provision, access to and (in)equality of health care (Curtis and Taket, 1996; Kearns and Gesler, 2002). My last report partly engaged with the first strand by highlighting new ways in which medical, health and other geographers were critically investigating the diagnosed, diseased, disadvantaged and dying body in ways that expand and sometimes disrupt this ‘canon’. This piece picks up on the second strand and examines how geographers are taking forward agendas relating to health care in ways that go beyond matters of access and provision (although this is still a strong and important theme; see Hotchkiss, 2001; Higgs and Gould, 2001: Gould and Moon, 2000; Martin et al., 2002; Ricketts et al., 2001; Takahashi and Smutny, 2001; to list but a few examples). While there is nothing radically new in this general development (geographers have been seeking to go beyond a simple mapping of health care for some years now), a detailed examination of current work reveals some rich conceptual and empirical nuances to current research directions which merit our attention. Apart from the papers mentioned, this recent Progress in Human Geography 27,2 (2003) pp. 212–221

Medical geography: diagnosing the body in medical and health geography, 1999–2000

It has been a while since the last batch of progress reports on medical geography (Kearns, 1995; 1996; 1997), and these marked some of the evolving agendas in the ‘new’ medical and health geography. In this present report, I am not attempting to fill in all the gaps between then and now; rather, I am seeking to pick up some distinctive strands from the subdiscipline to characterize how current research is continuing to change the traditional field of medical geography in ways which are both challenging and disrupting. While, for some, this will mean a frustratingly narrow focus on particular types of work, it reveals what I believe to be important, cutting-edge research which is enabling a new sort of dialogue between different subfields of human geography and beyond that to wider social theory. In compiling the materials for this report, I was stunned at both the breadth and the amount of work being undertaken under the titles of ‘medical geography’ and ‘geographies of health and health care’; and, although these umbrella terms undoubtedly point to very different kinds of research, it is to the relationship between them that I want to return below. It is clear that there is still a very strong traditional medical geography, and by that I mean research which focuses on geographical variations in incidences of disease (Huff et al., 1999; McNally et al., 2000; Pampalon et al., 1999; Raynor and Phillips, 1999; Schoaerstrom, 1999; Thomas, 1999; to name but a few), on spatial inequalities in health and health care (Barnett et al., 2000; Hayes, 1999; Haynes and Gale, 2000; Dorling et al., 2000; Rosenburg and Wilson, 2000; Shaw et al., 1999; 2000a; 2000b) and health and disease in developing countries (for a review, see Phillips and Rosenberg, 2002; Tripathi, 1999). I have merely scratched the surface of this type of work here, and it would be unfair of me to argue that the above references are representative of these thriving and diverse research traditions or indeed of all medical Progress in Human Geography 26,2 (2002) pp. 240–251

Rural madness: a geographical reading and critique of the rural mental health literature

This paper provides a geographical reading and critique of existing literature on rural mental health. It investigates what this literature has to say about how different dimensions of rural space physical, demographic, economic, social and cultural impact upon both the mental health of rural dwellers and the provision of mental health services to rural populations. It is argued that there is much to be learned from the existing literature, although caution is expressed about slipping into stereotypical notions regarding the constitution of rural space. Questions are raised about a common tendency to lean upon more or less examined rural urban contrasts, although useful reflections can be found on the tangled representational politics of rural mental health embedded within differing characterisations of the countryside as opposed to the city

New Body-Geographies: The Embodied Spaces of Health and Medical Information on the Internet

This paper deals with the rise of health and medical information on the Internet and considers the implications of this for a sociocultural geography of the body. The key purpose is to document how this information is communicated, consumed, and embodied, and also to evaluate how ‘healthy’ and ‘ill’ bodies constitute important geographies which are negotiated and contested in virtual space. There are two clear foci in the paper. First, using Foucauldian understandings of medicalisation, the notion of a ‘fourth spatialisation’ of the medical gaze is evaluated in the context of the Internet as a new geography of health promotion which enables human subjects to ‘self-diagnose’ and to ‘discipline’ their bodies. Second, this argument is complicated by the use of empirical examples gathered from MS chat rooms, places in which communities of people gather to discuss and to contest medical knowledges which surround the ‘ill’ body. The paper concludes with speculation on research pathways for a ‘new medical geography’.

Rural mental health and social geographies of caring

This paper contributes to an emerging geographical literature on the social geographies of caring. Drawing on recently undertaken empirical work in the Scottish Highlands, personal accounts about the provision of both formal and informal care for people with mental health problems are evaluated. The notion of ‘community care’ is critiqued, as too are claims about how rural and remote rural locations engender particular configurations of caring roles, practices and relations. It is shown that geographical distance, social proximity, stoic cultures and rural gossip networks all have a part to play in how caring occurs in such places. The paper concludes by suggesting areas of future research.

Mental Health, Public Space, and the City: Questions of Individual and Collective Access

In recent revisionings of disablement and geography, conceptions of the body, of devinney, and of the social construction of difference have been interrogated. The author argues that it is important not to neglect a critical geography of mental health in this broader rewriting of disability and ableism. Empirical examples are drawn from research in Nottingham, UK. These examples show how people with mental health problems access the public realm through individual (and often disruptive) use of urban spaces, possibly as strategies of resistance to imposed medical identities. In the second half of the paper the author documents a more collective political process occurring through ‘user movements’ which have facilitated patient power and patient influence in the places of therapy spread across the city.

Mental Health, Nature Work, and Social Inclusion

In this paper the powerful relations between mental health and nature are explored with reference to past asylum horticultural practices and to contemporary community gardening schemes for people with mental-health problems in the United Kingdom. Through the use of archival evidence, alongside contemporary voices of experience, understandings of the therapeutic and social dimensions to nature work are outlined and deconstructed. It is argued that particular discourses concerning the powers of nature (work) in managing madness and mental-health problems are largely consistent across time and space (from the asylum to the community). However, in the contemporary era it is particular types of nature work that arguably contribute most directly to state agendas for social inclusion, and therefore to securing the place of people with mental-health problems in mainstream society. By briefly profiling the voices of staff and ‘volunteers’ from two urban garden schemes in England and Scotland, different experiences of garden work as ‘restorative’ and as ‘interventionist’ will be discussed. I conclude by evaluating how embodying and enacting gardening work act as a sustainable vehicle for new versions of social citizenship for people traditionally marginalised in mainstream society.

Collaborative film-making as process, method and text in mental health research

This paper explores how film-making can assist as part of the development of sensitive and participative methodologies appropriate to accessing the worlds of people with severe and enduring mental health problems. It discusses how the film-making process can also act as a text that holds valuable data about the impact of the arts on mental health, and facilitates a range of mutually beneficial outcomes for those collaborating across usual academic/community divides. This agenda contributes to a consideration of the role of the arts in participative social geographies of mental health, and critically expands recent discussions about uses of video and film in a visual discipline.

Delusional Geographies: The Experiential Worlds of People during Madness/Illness:

In this paper I contribute to recent writings concerning geographies of health, geographies of the therapeutic, and geographies of the self. By paying attention to the ‘delusional’ experiences of people named as having mental health problems, the spatial implications of a disruptive mesh between consciousness and unconsciousness are investigated. This empirical investigation explores individual accounts of delusional experience and the changed relationships with the body, home, and city. The ‘unboundedness’ of delusional experience is discussed, and the unpredictable therapeutic properties of nonmedical material spaces are addressed. It is argued that academic geography has neglected the voices of people who experience delusion and the many spaces which they inhabit.

'That awful place was home': reflections on the contested meanings of Craig Dunain Asylum

Abstract The paper explores a particular Scottish asylum geography (Craig Dunain Hospital near Inverness) as a meaningful social space. Drawing on archival evidence and combined with contemporary patient and staff voices, the contested meanings of this institution are discussed. In particular, patient narratives reveal both positive and negative assessments of internal and external asylum spaces. Changing feelings about the asylum are argued to be related to matters of geography, and are conceived in terms of distance from and proximity to the institution.