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

Abstract

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.