‘Therapeutic Landscapes’: Examining the Idea and the Practice by anjani anjanipatel32

‘Therapeutic Landscapes’: Examining the idea and the practice

Anjani Patel Student Id: 210435263 4 January 2023

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Introduction to therapeutic landscape the “Idea” In 1858, it was suggested that the grounds of the hospital should be designed with gardens, pathways that had been levelled and packed, and seating areas with shade for that convalescing. This proposal was in line with a long history of gardens being utilised as therapeutic spaces. Since the Medieval period, the notion of the environment having the potential to both prevent and treat illnesses has been present. Gardens have been a part of the Western world for centuries, with their use stretching back to Ancient Greece. In Britain, gardens were mainly used to grow plants and food to support a healthy lifestyle. Gardens, both domestic and botanical, are a popular way to create spaces for people to enjoy. The Chelsea Physic Garden is an example of a botanical garden that has been created for the purpose of plant appreciation and enjoyment. Additionally, people often connected the powers of earthly gardens to the Garden of Eden, believing they provided healing properties. (Hickman, C. 2014) The idea of a 'therapeutic landscape' combines the concept of landscape with ideas from holistic health and has been applied to many di erent contexts to explore how environmental, social and individual factors work together to create a healing e ect in certain places. (Gesler, W.M., 1992) The concept of 'therapeutic landscapes' was introduced by health geographer Wilbert Gesler in 1992 to consider the reasons why some environments may be linked to feelings of health and well-being. Since then, research into this area has grown in scope and complexity, looking at the di erent material, emotional and socio-cultural factors that could be in luencing people's experiences in particular places. Studies have suggested that there may be a bene icial e ect on mental health from being in and around settings with more vegetation, such as gardens, parks, and woodlands (Plane and Klodawasky, 2013 Milligan and Bingley, 2007). Research has studied the impact of spaces and places on health and well-

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between experience, embodiment, and emotions and how they a ect individual and collective health outcomes. (Foley, 2015; Finlay et al., 2015). igure 1 is one of the key elements tables of therapeutic landscapes from Gesler

igure 1 is one of the key elements tables of therapeutic landscapes from Gesler

Clare Hickman's book, Therapeutic Landscapes: A History of English Hospital Gardens since 1800 with Manchester University Press, o ers insight on the use of gardens for therapeutic bene its throughout history. This book examines the landscapes associated with psychiatric, general, and specialist medical institutions, from 19th-century asylums to more modern hospital gardens. It provides an overview of how di erent features of the garden, such as grottos and Chinese galleries to Victorian pavilion hospital designs and Edwardian-era open-air institutions, have been used to provide therapeutic bene its. Contemporary designers, such as Dan Pearson, are also discussed in relation to modern hospital garden design. The expression I would like to deliver with this research paper is the signi icant role of therapeutic landscapes In the ield of medical institutions and their political approach to people's minds and Health. The landscape and surrounding changes from types of institutions, for example, hospitals, heritage sites, prisons, places of power, schools and many more. With the help of di erent research papers and case studies, I have compiled the e ects of therapeutic landscapes and explored the links between health and place and their political and cultural impacts.

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being, investigating the relationship

What is the connection between health and nature? Health and nature have been connected for many years, with nature providing a potential source of healing. Colorado Springs, for example, became popular in the late 1800s and early 1900s due to its advertising of sanatoriums as a potential remedy for tuberculosis, with many people believing the dry mountain air could reduce coughing and breathing di iculties. Additionally, village doctors and midwives have often used various herbs and plants to make healing tonics and poultices as a source of healing. Therapeutic landscapes, or “healing Gardens” are a way to heal the body and mind. The environment can have profound impacts on our health and well-being, which is why such gardens are becoming increasingly common in holistic medical practices. Lots of geographers and architects are exploring the ield of therapeutic designs as an alternative means of healing, away from the medication-heavy approach of Western medicine. The concept of therapeutic gardens originated in the late 1800s with Dr Edward Bach's use of gardening as a form of treatment for patients during his psychiatric practice at Clifton House in London, England. Early development of the ield of health geography drew from three distinct lines of thought. The

irst stemmed from traditional cultural

geography and environmental psychology, while the second and third were based on social theories that informed the 'new' cultural geography. These included ideas from cultural ecology and environmental psychology on the role of nature as a healer and the importance of building design; from structuralism on social interactions and power relations in health settings, legitimisation and marginalisation, and health consumerism; and from humanism on the importance of beliefs about disease and its treatment, the role of experiences and feelings in places, and the symbolic power of myths and stories (Cosgrove D, Jackson P, 1987)

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abstract concept which di ers from person to person, the e ects of such landscapes on health outcomes are one of the scenarios which will be covered in the coming paragraphs. There has been Research that has demonstrated that patients undergoing surgical procedures tend to have a quicker recovery when their hospital room has a view of nature.(Ulrich, R.S.,2001, 2002, Ulrich, 1999)This concept has been found in various cultures and events over the centuries. In recent years healthcare designers and administrators focused on creating landscapes that facilitated the new development in modern medical technology and its power. The traditional belief of the importance of medication was overcast by the newly developed approach of the ‘healing power of nature.’ This resulted in the development of a very Patient-centric design approach which would support stress and psychological development. It even added extra support to the healing process. One of the examples showcasing the connections between health and nature is seen when The town of Colorado Springs became popular in the late 1800s and early 1900s when it began advertising its sanatoriums as a remedy for tuberculosis patients. The dry mountain air was said to reduce coughing and breathing di iculties, and many people sought out such treatment. Village doctors and midwives also relied on a variety of herbs and plants to create healing tonics and poultices. Nature has been seen as a potential solution to a variety of di erent issues for many years (Brooks, L. 2021). The key concept of healing gardens can be described as Gardens intended for therapeutic purposes referred to as “healing gardens”. These gardens may feature real components of nature, such as green vegetation, lowers and water, and are often found in healthcare facilities such as hospitals or Alzheimer’s facilities. Healing gardens can range from small atriums to large outdoor spaces and can be indoor or outdoor areas.

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The role of therapeutic landscapes in medical institutions is a very

The importance of healing garden outcomes has been of major importance in medicine because they provide the soundest and widely accepted basis for evaluating whether particular treatments are medically e ective. The outcomes research potentially can indicate the degree to which gardens in healthcare facilities are medically bene icial and coste ective relative to such alternatives as not having gardens. The recent move to managed care as the dominant healthcare model in the United Kingdom and other countries has led to an increased emphasis on outcomes research for decisions made by healthcare providers. Outcome-based studies increasingly drive decisions on which treatments and measures are provided and reimbursed to patients. There is evidence that healthcare facility design decisions are also taking into account the potential of certain design strategies and environmental features to in luence outcomes. As a result, the future of gardens in healthcare facilities will depend on the extent to which research shows they can promote improved health outcomes. (Ulrich, Roger. 1999). It is believed that these gardens are able to help cope with the stress that comes with illness and hospitalisation. As such, the concept of stress can be used as a basis for constructing gardens that are designed to encourage restoration and recovery. This design can then be linked to e ects on health outcomes. These facilities can provide an additional form of care, aimed at reducing stress and improving patient medical outcomes. These gardens can create a restorative and bu ering environment, which can act as a complement to modern medical technology and help improve the quality of medical care. Research on healthcare gardens has indicated a range of potential bene its from a supportively designed setting. These include improved physical and mental health outcomes, enhanced social connections and improved quality of life for patients, increased sta morale and productivity and reduced stress levels, as well as improved economic outcomes such as cost savings and increased revenues.

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The research was conducted to explore the views of service users, nursing sta , and consultants regarding therapeutic landscapes in the medical sector, particularly in East London. This research was conducted through qualitative discussion groups and unstructured interviews. The views discussed included respect and empowerment towards people with mental illness, the balance between security and surveillance, freedom and openness, territoriality, privacy, refuge, social interactions, homeliness, contact with nature, places for expression, rea irmation of identity, autonomy and consumer choice, and integration into sustainable communities. Mental illness has often been associated with stigma and discrimination throughout history. In many cases, people with mental illnesses have been viewed as di erent, deviant, or dangerous and treated accordingly. Hospitals have traditionally been seen as places of medical power, where patient autonomy is sometimes compromised and control is exerted by medical sta and wider society. Thus open places and therapeutic gardens are important for understanding the individual's sense of identity and position in society, as they can be a source of both expression and formation. It is important to consider how far hospital settings respect the personalities, preferences, and cultural and religious mores of patients, particularly when these may be altered due to their mental illness, or when they may be detained in the hospital involuntarily. People with mental illness can sometimes struggle to have a say in their treatment process and may experience a lack of respect in hospitals as well as in the wider community. Such open spaces will allow the patients to reconnect with their surroundings and help them regulate their daily routines. Recent years have seen research conducted to evaluate the e ects of the closure of mental health care facilities. Some studies have suggested that asylums were often seen as places for controlling people, rather than providing a safe and secure environment for long-term patients to

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engage in activities such as farming, growing plants, physical activities and going for walks (Parr, 1997). The closure of these institutions has led to former residents being relocated to psychiatric wards or the community, some of whom may be looking for spaces in which to express themselves without judgment. According to Collins, there is a lack of available environments in modern hospital outpatient and community facilities that o er choice and meaning. (Collins et al.2016: 12). It has been suggested that creating a supportive atmosphere may help promote positive experiences of connection. These experiences are not limited to those between humans, as interactions with other animals could also be bene icial in a therapeutic context. The importance of connecting with personal everyday, place-related memories are explored in the concept of therapeutic landscapes of the mind. This concept goes beyond physical sites and helps to provide an understanding of how individuals respond to changes in their physical and mental health, as well as how they can adjust to maintain their well-being. The experience of patients is used to illustrate the signi icance of these mental landscapes. (Emma Rose,2012) The e ects of imagery, autogenic training, relaxation techniques, and meditation on the connection between mind, body and nature have been studied. It is believed that these practices can help people who su er from depression and asthma by altering their emotional state, thoughts, and psychological conditions. Psychological treatments conducted in nature have been noted to have potential bene its in the prevention, coping with, and healing of certain conditions. Hospital design is an important factor that can have an e ect on patient well-being as it deals with issues such as respect and empowerment for those with mental illness, security and surveillance versus freedom and openness for patients, privacy and refuge, social interaction among sta and

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patients, and psychological comforts of therapeutic landscapes. The physical environment, including elements such as light, colour, and quality of materials and gardens is the most commonly considered aspect of hospital design by architects, planners, and government ministers, and has been commented on both positively and negatively by respondents. Additionally, food quality, a homely environment, contact with nature, opportunities for self-expression, autonomy, consumer choice, and integration into sustainable communities are also important factors when considering hospital design. (Soc. Sci. Med.1998)

The concept of therapeutic landscaping has already been adopted in many hospitals and you can see the mark of it in history also. For example The Sioux Lookout Zone Hospital in northern Ontario serves the aboriginal population and allows family and friends to stay with the patient for extended periods of time. The facility includes several outdoor gardens and nature pockets, which may help promote positive interpersonal relationships between the patient and their family and friends and o er continual social support. A new hospital for the area's aboriginal population is being planned and is designed to be family-friendly, as well as provide traditional aboriginal food and translation services in aboriginal languages. The hospital board is comprised of a majority of aboriginal members, including one traditional healer, allowing for full aboriginal involvement in hospital governance and service delivery. (Hagan et al., 1989,Soc. Sci. Med.1998) Another example is the Chase Farm hospital rehabilitation gardens, in London. Chase Farm hospital has renovated two areas to create specialist therapeutic gardens. Drawing inspiration from Japanese design principles, the gardens provide a peaceful and calming sanctuary within the hospital and are open to patients, sta , and visitors. One of the gardens is speci ically

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designed to support dementia patients, while the other is tailored to care for stroke and rehabilitation patients. The design supports the rehabilitation and recovery process for patients dealing with neurological issues and stroke, providing a safe and engaging outdoor space for physical therapy sessions, horticultural activities, and family visits. A dedicated patient gardening area was included to help regain motor function through activities such as potting plants, pruning, and watering. This space also helps provide an enjoyable atmosphere to help reduce the feelings of depression associated with prolonged hospital stays. This garden provides a calm and peaceful atmosphere for patients receiving rehabilitative care. An existing day room has been extended outside for the continuation of horticultural and gardening activities, with accessible raised planters and a greenhouse. There is also a seating area for group discussions and meetings. A Japanese-style garden with looring materials such as paving, stone, stepping stones and white cobbles, and a Red Bridge has been included. Additionally, the space includes a ish pond with trickling water to provide a calming sound (Garden Design London: Tectonic: England, Ghadiri, N. 2017) Few other examples across the united kingdom are 1) Horatio’s Garden at Salisbury district hospital, Salisbury Horatio’s Garden is a charity which creates gardens of sanctuary in centres for spinal injury. The gardens, named after Horatio Chapple, were conceptualised by him and his father when they volunteered at a centre in Salisbury. These gardens provide a space for activities related to spinal injuries, such as painting classes with artist-in-residence Miranda Creswell. (Ghadiri, N. 2017) 2) Chapel Garden, Norfolk and Norwich university hospital, Norwich,This garden has been transformed with the addition of a central wish tree and a variety of water features, such as a vertical fountain and a rill. These

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features create a calming atmosphere and give the impression of an area with more space than before. (Ghadiri, N. 2017) 3) The Morgan Stanley garden, Great Ormond Street hospital, London,This garden, designed by Chris Beardshaw, was transplanted to a disused roof space surrounded by tall hospital buildings. It was originally showcased at the RHS Chelsea Flower Show, where it won a Gold medal. The garden includes a sculpture of a child and provides a tranquil atmosphere for children and their families. (Ghadiri, N. 2017) 4) Horatio’s Garden, Queen Elizabeth national spinal injuries unit, Glasgow, Horatio's Garden is divided into six distinct spaces, each designed to create di erent sensory experiences. It also features a greenhouse that is used for horticultural therapy activities. (Ghadiri, N. 2017)

5) Bournemouth hospital garden, Bournemouth A tarmac courtyard at the hospital has been transformed into a three-part garden. This includes a therapeutic garden located near the chemotherapy suite, a sensory garden connecting the courtyard to a lakeside garden, and a large area for exercise and leisure. (Ghadiri, N. 2017)

Conclusion To sum up, everything that has been stated so far in my opinion I believe Therapeutic landscapes are believed to have the potential to play a role in the healing process, although the e ects may vary from individual to individual. There is still much to be explored and studied in this ield, and it is generally thought that there is no risk in doing so. In addition, the natural approach can be less damaging than treating a patient with heavy medication. The other potential advantages of a therapeutic landscapes in a healthcare setting may include a reduction of anxiety and stress for patients, visitors and sta , a

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reduction in depression, improved quality of life for chronic and terminal patients, reduced pain, and improved way- inding. There is also the possibility of reduced provider costs, such as a need for fewer strong pain doses and a shorter length of stay for certain patient categories, increased patient mobility and independence, increased patient satisfaction with the facility and provider, and improved sta job satisfaction.

Reference

Gesler, W.M., 1992. Therapeutic landscapes: medical issues in light of the new cultural geography. Social science & medicine, 34(7), pp.735-746. V. Cattell, N. Dines, W. Gesler, S. Curtis Health & Place, 14 (2008), pp. 544-561 C. Milligan, A. Bingley Restorative places or scary spaces? The impact of woodland on the mental well-being of young adults Health & Place, 13 (2007), pp. 799-811 J. Plane, F. Klodawasky Neighbourhood amenities and health: examining the signi icance of a local park Soc. Sci. Med., 99 (2013), pp. 1-8 J. Finlay, T. Franke, H. McKay, J. Sims-Gould Therapeutic landscapes and wellbeing in later life: impacts of blue and green spaces for older adults Health & Place, 34 (2015), pp. 97-106 R. Foley Swimming in Ireland: immersions in therapeutic blue space Health & Place, 35 (2015), pp. 218-225 S.L. Bell, B.W. Wheeler, C. Phoenix Using geo-narratives to explore the diverse temporalities of therapeutic landscapes: perspectives from ‘green’ and ‘blue’ settings Ann. Assoc. Am. Geogr., 107 (1) (2017), pp. 93-108

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Ulrich, R.S., 2002, April. Health bene its of gardens in hospitals. In Paper for conference, Plants for People International Exhibition Floriade (Vol. 17, No. 5, p. 2010). Soc. Sci. Med. Vol. 46, No. 9, pp. 1193±1203, 1998

Ulrich, R.S., 2001. E ects of healthcare environmental design on medical outcomes. In Design and Health: Proceedings of the Second International Conference on Health and Design. Stockholm, Sweden: Svensk Byggtjanst (Vol. 49, p. 59). Ulrich, Roger. (1999). E ects of gardens on health outcomes: theory and research. Healing gardens: therapeutic bene its and design recommendations. 27. 27-86. Hickman, C. (2013). Therapeutic Landscapes: A History of English Hospital Gardens Since 1800. United Kingdom: Manchester University Press. Hickman, C. (2014) Therapeutic landscapes, Academia.edu. Available at: https://www.academia.edu/1848151/Therapeutic_Landscapes (Accessed: January 8, 2023). Curtis, S., Gesler, W., Fabian, K., Francis, S., & Priebe, S. (2007). Therapeutic Landscapes in Hospital Design: A Qualitative Assessment by Sta and Service Users of the Design of a New Mental Health Inpatient Unit. Environment and Planning C: Government and Policy, 25(4), 591–610. https:// doi.org/10.1068/c1312r Cosgrove D, Jackson P, 1987, ``New directions in cultural geography''Area 19 95 ^ 101 H. Parr Mental health, public space, and the city: questions of individual and collective access J. Collins, S. Avey, P. Lekkas Lost landscapes of healing: the decline of therapeutic mental health landscapes

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Emma Rose,Encountering place: A psychoanalytic approach for understanding how therapeutic landscapes bene it health and wellbeing, Health & Place,Volume 18, Issue 6,2012,Pages 1381-1387 Hagan, C., Casson, I., Wilson, R. (1989) Medical teaching in Sioux lookout: primary health care in a cross-cultural setting, Can. Family Phys. 35, 2939-2944. Garden Design London: Tectonic: England (no date) Tectonic. Available at: https://www.tectonicuk.co.uk/nhs-chase-farm-hospital-capetwon-wa (Accessed: January 9, 2023). Ghadiri, N. (2017) Seven of the UK's Healing Hospital Gardens – in pictures, The Guardian. Guardian News and Media. Available at: https:// www.theguardian.com/healthcare-network/gallery/2017/sep/12/seven-ukshealing-hospital-gardens-pictures (Accessed: January 9, 2023). Brooks, L. (2021) Why hospitals are Planting Gardens, Forbes. Forbes Magazine. Available at: https://www.forbes.com/sites/lakenbrooks/ 2021/05/29/why-hospitals-are-planting-gardens/?sh=36b522045812 (Accessed: December 10, 2022).

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