Seeking fluid possibility and solid ground: Space and movement in mental health service users' experiences of ‘crisis’

Since the closure of the UK asylums, ‘the community’ has become short hand for describing a variety of disparate and complex spaces, in which service users manage their experiences of distress. An examination of such spaces here forms the basis of an analysis of the way in which service users move through and within space, to establish agency and dis/order while distressed. Seventeen participants, with various experiences of mental distress took part in a qualitative study, and a further textual analysis was conducted on eight published autobiographies. In the context of the interviews, participants presented drawings of the spaces they occupy during times of crisis, wellbeing and recovery. All texts were analysed using a thematic approach, informed by theories of embodiment and relational space. In this paper, the focus is directed towards two key patterns of movement, in order to explore ways in which participants experiencing various forms of mental health crisis used space in order to maintain and manage feelings of agency. Firstly, incidents where participants described moving towards fluid, outside spaces are explored, with agency being established through seeking, and utilising, greater possibilities for action and engaging others. In addition, the opposite pattern of movement is also explored, using incidents where participants described moving indoors, using the private space of the home to establish order and restore feelings of agency and strength, in contrast to overwhelming experiences in public space. Connections between these patterns of movement and particular forms of distress are discussed. It is argued that community and private spaces are integral to the ways in which selfhood, agency and action is experienced in mental distress, which in turn has implications for policy, treatment and community action

Vital spaces and mental health.

The impact of social and material conditions on mental health is well established but lacking in a coherent approach. We offer the concept of 'vitality' as means of describing how environments facilitate 'feelings of being alive' that cut across existing diagnostic categories. Drawing on the work of Stern, Fuchs, Worms and Duff, we argue that vitality is not solely a quality of an individual body, but rather emerges from attunements and resonances between bodies and materials. We use vitality as a lens to explore how movements within and between assembled sets of relations can facilitate or disable feelings and expressions of being alive. Building on extended discussions of both inpatient and community-based mental healthcare, we sketch out a research agenda for analysing 'vital spaces'

Vitality and nature in psychiatric spaces: Challenges and prospects for ‘healing architecture’ in the design of inpatient mental health environments

Historically, nature has been considered central to healing and recovery in institutional mental health settings, with inpatient spaces designed to mirror the restorative forces nature may afford. Within contemporary healthcare architecture, the discourse surrounding nature’s role has once again become prominent, especially in the concept of ‘healing architecture’. While the literature on ‘healing architecture’ primarily considers how to connect recovery to nature through interventions in the built environment, less interest has been directed towards how nature is configured in design processes and what implications that has for the everyday experiences of patients and staff. In this paper we consider the design and implementation of one particular psychiatric hospital in Denmark to show that the ‘nature’ brought into this healthcare space can be experienced as anything but ‘natural’ and may reduce rather than enhance a felt sense of ‘vitality’ amongst patients. Based on our analysis, we end the paper by suggesting four principles for future healthcare design

Diagnosis special issue - Introduction: Moving beyond diagnosis: Practising what we preach

John Cromby, Dave Harper and Paula Reavey introduce the special issue

‘Never drop without your significant other, cause that way lies ruin’: the boundary work of couples who use MDMA together

MDMA has a variety of pro-social effects, such as increased friendliness and heightened empathy, yet there is a distinct lack of research examining how these effects might intertwine with a romantic relationship. This article seeks to compensate for this absence and explore heterosexual couples’ use of MDMA through the lens of the boundaries they construct around these experiences. Three couple interviews, two diary interviews and eight written diaries about couples’ MDMA practices were analysed. Douglas’ (2001) and Stenner’s (2013) work around order, disorder and what lies at the threshold between the two are employed here. This conceptual approach allows us to see what happens at the border of MDMA experiences as crucial to their constitution. Two main themes are identified in the data. First, MDMA use was boundaried from daily life both temporally and corporeally: the drug was tied to particular times in people’s lives as well as the performance of rituals which engaged the material world and reenchanted everyday spaces and selves. Secondly, other people are excluded from MDMA experiences to varying degrees in order to preserve the emotionally intense space for the couple alone. This paper claims that MDMA use forms part of a spectrum of relationship ‘work’ practices; a unique kind of ‘date night’ that revitalises couples’ connection. Hence, MDMA should be recognised as transforming couple as well as individual practices. Finally, it is suggested that harm reduction initiatives could distinguish more ‘messy’ forms of emotional harm and engage with users’ language of ‘specialness’ to limit negative impacts of MDMA use

Multimodality, visual methods and lived experience

View from the Top from Prof Paula Reavey Paula Reavey is Professor of Psychology and Mental Health at London South Bank University. This interview took place at the Qualitative Methods in Psychology (QMiP) and History & Philosophy of Psychology (HPP) joint 2019 conference at Cardiff Metropolitan University where Paula led a workshop on visual methods and delivered a keynote speech. Best known for her pathbreaking work on visual methods and multimodality (Reavey, 2011), she has also distinguished herself with her innovative interdisciplinary work in the field of mental health, space and embodiment. Susanne Langer (Senior Lecturer in Psychology, MMU) and Deborah Bailey-Rodriguez (Lecturer in Psychology, Middlesex University), who are both associate editors of the QMiP Bulletin, asked the questions

Biomarkers of chemical exposure: state of the art.

Establishing associations between environmental agents and disease presents challenges to both epidemiologists and toxicologists, particularly in cases of complex gene-environment interactions and when there is a long latency between exposure and disease. Biologic markers, physiological signals that reflect exposure, early cellular response, or inherent or acquired susceptibilities, provide a new strategy for resolving some of these problems. Biomarker research assumes that toxicant-induced diseases are progressive and that injury proceeds from entry of the toxicant into target cells, which induces subcellular biochemical events, to cell- and organ-level events that eventually induce irreversible or persistent organism dysfunction. The epidemiologic value of a biomarker lies in its ability to predict backward toward exposure and forward toward risk of clinical outcome, which is largely unknown. Research in mechanistic toxicology will advance the range of useful biomarkers in epidemiology and clinical medicine