Therapeutic relationships to landscapes: the role of place in panic and panic recovery

Panic disorder has commonly been understood through the lens of clinical literature, in which panic is a ‘disorder’ defined by the experience of recurrent and unexpected panic attacks. These are understood as divorced from the spatial, social and embodied contexts in which a person is. Recovery from panic disorder is understood as the palliation of panic attack symptoms or the disappearance of panic attacks altogether. Treatment for panic has focused on treating the ill body, either pharmacologically or through cognitive and behavioural training. Yet, even within clinical literature, the efficacy of these treatment options remains debated. In geography, the field of ‘therapeutic landscapes’ explores interactions between people and their environments, and the impacts of environments on people’s health. Although contributors to the field of therapeutic landscapes have argued for a ‘relational’ conceptualisation of place and space, authors have not engaged explicitly with what this actually means and the implications of this for processes of recovery. This has been accompanied by the tacit assumption that some places are inherently therapeutic. Bringing these areas of research together, this thesis offers a spatial and phenomenologically informed approach to panic disorder and recovery. By combining existential phenomenology and relational conceptualisations of space and place it investigates what therapeutic landscapes might ‘mean’ and how places might become ‘therapeutic’. The thesis uses semi-structured interviews, go-along interviews and drawing methods undertaken with four individuals. It draws on the Voice-Centred Relational method to analyse the material generated and a series of ‘relational poems’ inform the substantive thematic analysis. Drawing on interview material the thesis develops a relational and spatial conceptualisation of panic, identifying three key relational elements: between self and others, between self and space, and between self and the body. The experience of panic disrupts these relational elements and leads to the fragmentation of space into a patchwork of safe and phobic places. Phobic places emerge as bounded units of space in which the physicality of space takes on an ‘aggressive’ tone, and where the relationships to others becomes problematic. This creates a tension between individual and societal images of place and leads to a sense of deep existential outsideness. I investigate the role of safe places play in recovery through the concept of therapeutic landscapes, the concept of ontological security, and relational conceptualisations of space and place. Safe places play a key role in recovery. They allow individuals to rest, and to restore a sense of security, enough to begin transforming phobic places. This transformation is done through three strategies: using elements of space as affective resources, bringing objects to transform the embodied being-in phobic places, and creating exits. These strategies provide the possibility of new and safe experiences in phobic places. And this slowly dissolves the boundaries between safe and phobic places. Yet, safe places emerge hand in hand with phobic places. This has two important implications for the way in which we conceptualise therapeutic landscapes. First, therapeutic landscapes emerge through the experience of illness. Second, if the emergence of therapeutic landscapes is tied to the emergence of phobic places and thus, the experience of illness, what is therapeutic about therapeutic landscapes is not their particular ‘healing’ properties, but instead, the therapeutic relationships to those places. These relationships become therapeutic because they enable us to establish new relationships to the rest of the space in which we move through and live

REALITIES in Health Disparities: Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems

Introduction: Under the backdrop of pervasive health inequalities, public health professionals, researchers and non-academic partners in the United Kingdom are mobilising to understand how and in what ways community assets can address health disparities at scale in complex systems. While there is recognition that cultural, natural and community resources can improve health outcomes, these are unequally dispersed with lack of integration in communities and health and social care systems. Researching Evidence-based Alternatives in Living, Imaginative, Traumatised, Integrated, Embodied Systems (REALITIES) is a participatory action research Scottish consortium of 57 with established community asset hubs in five localities with strong relationships uniting conflicting ways of seeing the world. Our collective of lived and felt experience community members, community-embedded researchers, academics and non-academics draws upon a variety of practices, methods, datasets and philosophies to expand existing approaches to tackling health inequalities. Methods: We present conceptual and theoretical underpinnings for our co-produced systems-level model and empirical findings from testing REALITIES across three disadvantaged localities (November 2022, ongoing). After explaining the context that led to the development of the new scalable REALITIES model for integrated public systems to interface with ‘assets’, we detail philosophical pillars and guiding principles for our model and how we applied these mechanisms to explain how integrated partnership working can lead to improved health outcomes across multiple public systems. Results: We present a meta-analysis from co-producing and testing the model, showing how measuring change in complex public systems involves critical investigation of People, Process, Place, Price, Power and Purpose. Our critique reflects on power imbalances and inequities in Research-practice-Policy (RPP) partnerships and suggestions for how to nurture healthy ecosystems: overcoming barriers and enabling participation; reflecting on challenges of scaling up, testability and complexity of RPP partnerships; moving from siloed learning to transdisciplinary collaboration in practice; ensuring knowledge exchange has direct impact on communities and frontline practitioners; embedding relational ethics and safeguarding into daily practice. Discussion: We propose the REALITIES model to unite alternative, sometimes conflicting, ways of thinking about public systems and community assets by continuously reflecting on entanglements between different assumptions about knowledge, reality, evidence, and unnecessary binaries between creative methodologies and scientific method