The spatial organization of psychiatric practice: A situated inquiry into 'healing architecture'

Thorben Simonsen

Publikation: Bog / Antologi / Rapport / Ph.D.-afhandlingPh.d.-afhandling


This dissertation is about the spatial organization of contemporary psychiatric practice, about ‘healing architecture’ in psychiatry. I take ‘healing architecture’ to represent a particular effort to spatially and materially organize contemporary psychiatric practice. The problem motivating my inquiry is not about how architecture and space mediate health outcomes and promote patient recovery, what ‘healing architecture’ is or should be, but rather, what it actually does. How architecture in health care settings contributes to the ordering of space and interaction, enabling certain practices, while constraining others is, I argue, largely eclipsed in the social science literature and thus a key point of convergence throughout the dissertation. The inquiry is brought to bear on a purpose-built psychiatric hospital in Slagelse, Denmark, opened in late 2015. With ‘healing architecture’ and the idea of recovery literally built into the bricks and mortar of the building, the new hospital in Slagelse is considered the vanguard of contemporary hospital design, representing the future of psychiatric inpatient facilities. As such, the Slagelse Hospital can be understood as a paradigmatic case for considering the spatial organization of contemporary psychiatric practice. When the subtitle of this dissertation is a situated inquiry into ‘healing architecture’ it is because I consider the novel spatial circumstances of the Slagelse site based on detailed ethnographic fieldwork and by empirically investigating how the relationships between space and interaction are ordered in and through psychiatric practice.

The dissertation consists of three individual papers. The first paper The Spatial Organization of Psychiatric (Dis)Order draws on the work of cultural anthropologist Mary Douglas (1966). Based on the claim that ‘healing architecture’ raises new questions about the demands on, and responses of, nursing staff working within such settings, the paper considers the relations between ward spaces, perceived dangers, and nursing work. The paper shows, firstly, how displacing patients, cleaning spaces, (re)moving objects and correcting patient behavior become salient tasks engendered by the spatial layout of a ward, and, secondly, how the invocation of the language of danger enables nursing staff to intervene when socio-spatial boundaries are transgressed by patients. In discussing the findings I suggest that the spatial layout of the inpatient setting amplifies tensions between professional interests and designed intentions, creating what I call ‘sites of contention’ where the social order of a ward is openly negotiated.

The second paper Unfulfilled promises? Staff reactions to the healing architecture of psychiatric inpatient wards is an empirically driven paper that draws on theoretical impulses found in science and technology studies combined with Erving Goffman’s (1959) approach to studying the presentation of self in everyday life. The paper investigates the mediating role a nursing station plays within an inpatient setting and shows how the transparent glass walls of said nursing station shape the manner in which staff engage and encounter patients, as well as change the way that they conduct themselves when inside the office space. The paper shows how particular staging contingencies arise due to the transparent nature of the nursing station, rendering activities visible which were previously out of sight. An environment of uncertainty is produced due to these contingencies, which is the opposite of the intended design.

The third and final paper, Healing architecture and psychiatric practice: (re)ordering work and space in an inpatient ward is co-authored with Cameron Duff from the Royal Melbourne Institute of Technology. The paper draws on the work of ethnomethodologist and science study scholar Michael Lynch (1991). Through the notion of spatial order(ing) the paper explores the key material and social effects of the hospitals ‘healing architecture’ and the spaces and practices it contributes to enacting. By analyzing an instance of the administration of medication the paper shows that the ordering of spaces is central to the enactment of control over patients so often required in everyday psychiatric work, highlighting the tensions that arise between the spatial layout of the ward and the orderings preferred by staff. The paper suggests that ‘healing architecture’ might indeed have great impact on the provision of psychiatric care, but that its instantiation as healing or therapeutic is better understood as a function of spatial orderings rather than as a strict material causation. As such, the spatial disposition of ‘healing architecture’ may have at least as great an impact on psychiatric work as on patient experiences of care and recovery. By redirecting the analytical orientation from lived experiences of mental health spaces towards the manner in which space and interaction are ordered in practice the dissertation contributes to ongoing conversations about caring and practicing architectures, adds insights to the body of work on the impact and importance of hospital design for mental health care and complements recent studies on the relational aspects of inpatient spaces. In relation to recent calls to draw on STS to investigate architecture, this dissertation furthermore offers input on how to come to terms with studying architecture from what might arguably be an STS-perspective. The aim of the dissertation is to further burgeoning cross-fertilizations within interdisciplinary scholarship found in health geography, the sociology of health and illness, and in STS, to extend lines of inquiry already taking place here, and thus to participate in debates related to questions of how mental health spaces make a difference, how we can study the relationships between space and interaction in practice, and offer empirical insights into what so-called ‘healing architectures’ do.
ForlagCopenhagen Business School Press
Vol/bindPhD Series 03.2020
Udgave1st edition
Antal sider250
ISBN (Trykt)978-87-93956-16-2, 978-87-93956-17-9
StatusUdgivet - 2020
Udgivet eksterntJa


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