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Selling the private asylum: therapeutic landscapes and the (re)valorization of confinement in the era of community care
Graham Moon*, Robin Kearns** and Alun Joseph†
This paper examines the role of place in the positioning and survival of the contemporary private asylum. While community care is now the dominant mental health care modality in most Western health economies, some asylum care has survived, often in the private sector, catering for a clientele able and willing to pay for a non-standard approach to care. We consider how landscapes, buildings and services provide a basis for marketing and selling asylum care. Drawing on fieldwork, documentary analysis and visual evidence, we analyse the representational strategies of the Homewood Health Centre Inc. (Ontario, Canada), the Ashburn Private Psychiatric Clinic (Dunedin, New Zealand) and the acute psychiatric hospitals within the Priory Group (UK). The paper draws conclusions about the role of therapeutic landscapes in the contemporary asylum, place marketing and the (re)valorization of historical ideas of asylum. key words therapeutic landscapes asylum private mental health care
*Institute for the Geography of Health, University of Portsmouth, Portsmouth PO1 3AS email: firstname.lastname@example.org **School of Geography and Environmental Science, University of Auckland, New Zealand † Department of Geography, University of Guelph, Ontario, Canada N1G 2W1
revised manuscript received 29 March 2006
The hegemonic position of community-based care in contemporary policy regarding mental health services provision is now well established. Accompanying the rise of community care has been a marked decline in large-scale residential provision for people with mental health problems. In this way, the asylum, once the key element in service provision, has become a rarity. 1 A small but significant land use in rural and urban fringe locations has dwindled and a very specific construction of ‘place as therapy’ largely has been abandoned. Governmental promotion of community care and rejection of the asylum model have been matched, in the main, by support from mental health professionals, service users and family carers. The reasons for this shift in policy and provision are many, varied and disputed. They are also well
documented (see, for example, Dear and Taylor 1982) and bear only brief enumeration. A shortlist of reasons would include the escalating costs of maintaining asylums, the availability of alternative drug therapies, a misplaced anticipation of cost savings, the social costs of institutionalization and maltreatment scandals. The last two factors serve as a reminder that the move away from asylum care was accompanied by a general perception that the asylum had ‘failed’ as a treatment modality for people with mental health problems. This verdict in turn reminds us that the original conception of the asylum had been, in part, positive and therapeutic, as well as profoundly geographic. It sought to promote the recovery of mental health by the removal of the ‘client’ from the stresses of everyday life through confinement in an ordered, harmonious and calming place of sanctuary – what might nowadays be termed a ‘therapeutic landscape’ (Gesler 1992).
Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006
for marketing purposes. we recognize that the constructions of notions such as therapeutic landscape and asylum are rich in history and deeply researched (Philo 2004). They tap a latent public demand for asylum and are thereby able to attract a client base sufficiently large to guarantee financial viability. Despite the general though not uncritical support for community care that presently exists. Moon et al. but is not historical in orientation. In the following section we provide background on asylum geographies. To this end. we seek connections with the wider geographical literatures on place marketing and commodification. notably through references to the ‘heritage’ of particular sites. They stand outside the state governance structures that brought about the dominance of non-residential treatment modalities. geographers have largely turned their attentions to the spatiality of discharged patients. examinations of the consequences of asylum closure. The substantive centrepiece of the paper is a detailed examination of case study asylums in the United Kingdom. For the most part. geographical studies of asylums have. therapeutic landscapes and the commodification of the asylum. the few present-day asylums attract far less research attention than the currently dominant treatment modality of community care. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . the specific focus is on the use of visual and textual imagery that presents the asylums as therapeutic landscapes. these facilities tend to be located in the private sector. thus overlooking the contemporary geographies present in surviving (private) institutions that provide opportunities for asylum. been historical. Philo 1997 2004. Canada and New Zealand. The key aim of this paper is to assess the extent to which traditional notions of asylum are evident in the presentation and positioning of present-day private-sector psychiatric hospitals. in earlier work (Joseph and Moon 2002) we engaged with this historical dimension of asylum in a study of one of the institutions considered in the present paper. contrasts with a dominant treatment modality based on the general hospital and community care networks. Our paper draws undoubted strength from the established body of work on historical geographies of the asylum (see. Our specific research contribution is located simultaneously in the relative absence of empirical studies of the present-day asylum and what we will claim is a neglected link between the concept of therapeutic landscape and contemporary notions of asylum. We conclude with a discussion that engages critically with the intersection of contemporary ideas of asylum as therapeutic landscapes with broader themes of commodification and place marketing. Background For the most part. for example. As intimated above. They highlight the continuing constrained and semiinstitutionalized lives of community-based patients2 Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. Attention then turns to an outline of the methodology for the empirical part of the paper. We contend that an implicit (re)mobilization of ideas of ‘therapeutic landscape’ is grounded in a desire to accentuate. we commence our examination of the background to our study by considering the relevance of the existing literature on asylum geographies to the positioning of the contemporary asylum. or indeed of (public) service provision. by virtue of their subject matter. a significant number of studies focusing on the delivery of community-based services are. present-day research focuses on the closure of asylums. Indeed. we argue that the contemporary character and commodification of the private psychiatric hospital is equally important. Parr and Philo 1996). While our focus is primarily contemporary. We argue that a key feature of these overlooked geographies is the marketing of asylum. In a sense. Asylum geographies As a form of health care. 2005). The idea of the asylum as a therapeutic landscape is introduced and a critical review of relevant past work on therapeutic landscapes is presented alongside an examination of the emerging role of commodification in health care. Although some of the images maintained and promoted by these facilities emphasize the past.132 Graham Moon et al. We examine critically the way in which the contemporary private asylum draws on these notions to attract the necessary flow of customers. More broadly. in effect. We necessarily reach back to the rich scholarship on the history of the asylum to project forward the implications of our analysis for understanding the future of the private asylum. it remains possible to find ‘institutional survivors’: relatively large residential facilities for people with mental health problems in which traditional notions of asylum appear still to loom large (Joseph and Moon 2002. Perhaps not surprisingly. With the ascendancy of community care policies.
located in rustic surroundings away from densely populated centres. Yet it is also the case that seclusion and concealment are. The therapeutic landscape of the asylum From past research on asylum geographies. Joseph and Kearns 1999). literally ‘far from the madding crowd’. This leads us to a consideration of the notion of ‘therapeutic landscape’ as a construct critical to this manufacturing of image. Embodied in the process were notions of seclusion and concealment that simultaneously revealed much of the contemporary thinking about care and much more about societal attitudes to mental health (Foucault 1967. and even dangers. In terms of work on the actual act of closure. precursors of present-day private residential psychiatric provision. Philo 1997. attractions for a client base that is. location and setting were undoubtedly potent elements in establishing competitive advantage. apply both to asylum and to community within the post-deinstitutionalization landscape of mental health care. it is necessary to note. Philo (2004) speaks to the positive claims that have been voiced about the historic asylum. and presents particular challenges in image management. forgetting. signalling the continuing imprint of stigma on its site. In shifting the focus of contemporary asylum geographies from a concern with closure or memory to a focus on surviving asylums. As Philo (1987a 2004. The particular case of the survival of the asylum in the private sector is discussed by Moon et al. that a selection of issues impact on the fact of asylum survival. The architecture of asylums. These consequences existed alongside the more established problems associated with the confined conditions that sometimes prevailed and the way that clients often succumbed to a debilitating state of ‘learned helplessness’. both in terms of identity and as a provider of work. Philo identifies the potentially negative impact of the spatial separation of people from family and friends: abandonment. Gleeson and Kearns (2001) examine the complex moral codings that. The present paper can be located tangentially within the broad theme of closure in that it examines asylums that have not closed and for which closure is not a threat other than on the economic grounds of business failure. The private madhouses that began to emerge in the seventeenth century were. Dear and Wolch 1987. Philo (2004) provides a reminder that this selling of removed location has particular historical antecedents. Moon 1988 2000). these removed locations had other. (2003) consider the contested memories aroused by closure. non-therapeutic possibilities. elements of social control logic remain in place in so far as seclusion and concealment remain as important manifestations. Parr et al. This is generally seen in a historic context as a particular moment in the history of mental health care: the shift of the spatial locus of care from the dispersed to the concentrated (Dear and Wolch 1987. we isolate the importance of image-making in selling seclusion and concealment. Demand simply could not be sustained if the image of asylum care was unacceptable. who note the importance of flexible ‘boundary crossing’ involving both the hospital/community and public/private dimensions of care provision. The culminating manifestation of this process was the building of the great public asylums on the rural fringes of many cities. The perceived ambivalence of removed location as therapeutic has also lived on with the remnant instances of the asylum. Setting and location provide refuge. within the impulse towards such locations there were ‘social control’ logics at work. Our concern in this present paper lies with the positive packaging of present-day removed locations. while Joseph and Kearns (1996) consider the symbolic position of a soon-to-be-closed asylum within its host community. as a consequence. Also important for the present study is a second theme in asylum geographies: the notion of the asylum as a ‘removed location’. (2005). Secluded places are popular with people who need a problem addressed discreetly and are able to pay for private care. it might be argued. to some extent.Selling the private asylum 133 (Joseph and Hall 1985. in a sense. and the successful marketing of a positive image for asylum care is central to this goal.4 They were businesses conducting a ‘trade in lunacy’. In this paper we move our gaze from the causes of asylum survival to a key aspect of the maintenance of survival: demand for (private) asylum through place-based image making. see also Parr and Philo 1996) points out. User demand remains critically important. Cornish (1997) provides a case study of the run-down of one facility. largely. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . Of course. In the (re)presentation of removed location as a selling point to today’s discerning market. the quality of their grounds and the variety of their facilities Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors.3 Within the context of ‘removed locations’. isolation. admitted on a voluntary basis. as well as treatment. in passing. Castel 1988).
It also presents a major challenge for the marketing of present-day asylum provision. However. in part. Moreover. are key manifestations of the image-making necessary to sustain a client base. This scholarship has immense value as a broader context to our research. The former writes from the perspective of landscape architecture. Following Kearns et al. been recast as ‘asylum:bad. not present-day provision. Kearns 1993. in attractive surroundings. we are interested in both their material reality in the built environment and the ideological presence in the perceptual landscape that this reality generates. this notion of place-as-therapy has retained its adherents.5 Among the few writers to engage overtly and substantively with the link between the asylum and the concept of therapeutic landscape are Paine (1998) and Franklin (2002). (2003). been recognized explicitly as therapeutic landscapes in the formal sense of the application of the term to the study of asylums. Indeed. since deinstitutionalization. Parr and Philo (1996) hint at the link between the historic asylum and concept of therapeutic landscapes and Philo (2004) has recounted how the historical justification for asylum care emphasized the virtues of offering a sanctuary that was intentionally removed from the (over)stimulation of everyday life in the rapidly changing emergent industrial city (Sennett 1992. albeit an attempt that has parallels with earlier attempts to market the historic asylum. as Gleeson and Kearns (2001) contend. The goal of this strategy was to create a more convivial and ‘therapeutic’ setting for the over-stressed mind in which the confusing chaos of the contemporary city was countered by the perceived stability and tranquillity of the rural and quasi-rural settings offered by asylums. Park-like grounds. It has captured the imagination of geographers as a tool with which to interpret places that have a reputation for healing or are health-promoting (see Williams 1999. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . community:bad’ has. Moon 1995).134 Graham Moon et al. seclusion and healing through removal from society and exposure to the positive properties of particular places were deeply embodied in traditional notions of ‘asylum’ as a care delivery modality. Despite this seeming resonance. Whatever their shortcomings in practice. and the associated construct of the therapeutic community has also retained significance. community:good’. It is our further contention that the construction and presentation of the contemporary asylum as a therapeutic landscape is a key response to this challenge. Kearns and Joseph 1993. Wilson 2003. though perhaps ultimately debateable. Gesler (1992) introduced the idea of the therapeutic landscape: places or settings that have a reputation for healing founded in a combination of factors including historical precedent. to be predicated on such ideas. Despite the pharmaceutical emphasis of community care and ‘de-hospitalisation’ (Geller 2000). may. emphasizing mutual support within the asylum community (Busfield 1986). be a consequence of the erasure of the positive therapeutic element in the history of the asylum in favour of a focus on its more recent negative image. Image-making and the commodification of the present-day asylum In terms of our focus on present-day asylums. the implicit historic binary construct of ‘asylum:good. This vilification of the asylum in the era of deinstitutionalization is ironic given that the small-scale residential components of contemporary community care initiatives often take on a custodial form reminiscent of the asylums they have replaced (Joseph and Kearns 1999). particularly in the private sector. to our knowledge. A warm. Work on the historical geography of asylums has. invoked implicitly cognate ideas. the latter is concerned with the changing built environment of the asylum. We contend that the lack of explicit work on the historic asylum as a therapeutic landscape. at least in part. Simmel 1995). pleasant atmosphere. The term ‘therapeutic landscape’ subsequently has come to be recognized as a significant theoretical construct within health geography (Kearns and Moon 2002). is seen as a valid complement to psychotherapy and chemotherapy. Thus ‘milieu therapy’ (Davis 1977) has gained increasing acceptance as a treatment for hospitalized clients. historic asylums have not. More generally a conceptual underpinning to the representation of the asylum as a therapeutic landscape is also implicit in research on the interrelationship of place and health (Jones and Moon 1993. however. natural attributes and symbolic association. we suggest that this response is not only a recovery of the therapeutic past of the historic asylum but also a present-day attempt to commodify health care. asylums appear. neither engages with the geographical literature on therapeutic landscapes and both are concerned with the historic asylum. we argue for a recursive link between the material and the Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. Smyth 2005).
2003) while simultaneously extending and developing ideas of representation and place marketing. Moon and Brown 2000 2001. The research material comprised archival and secondary data.Selling the private asylum 135 ideological. such trends are evident in the case of Auckland’s Starship Hospital. Our approach follows what Rose calls a critical visual methodology. Anderson and Gale 1992. but also as social productions. This limitation within the ‘health care market’ is potentially exacerbated by the stigma of the asylum. Gesler and Kearns 2002). become commodified and are rendered attractive to patients and investors through the conscious manipulation of images. Methodology Our objective is to assess the extent to which traditional notions of asylum and therapeutic landscape are repackaged in the representation of the contemporary private psychiatric hospital. like other parts of the urban realm. In New Zealand. the Ashburn Private Psychiatric Clinic (New Zealand) and the acute psychiatric hospitals within the Priory Group (UK). ideas of place marketing in the ‘selling cities’ literature (e. In this discourse. Our work also finds roots in the views of those cultural geographers who are increasingly expressing interest in the production and symbolism of urban landscapes. web pages comprising text and visual images.g. propelled by issues of branding and marketing (see Mansvelt 2005). it nevertheless needs to compete for the donated dollar. focusing on topics as diverse as cultural heritage (Waitt and McGuirk 1997) and new urban ‘megastructures’ (Crilley 1993). To this end. social practices and power relations in which it is embedded’ (2001. Our interest in this link builds on the work of cultural geographers for whom places and their imaginings are not given. (Ontario. the potential market for asylums is limited. Thus the strategic choice by a hospital administration of a captivating logo and name. shaping residual provision as a commodity to be desired. geographers have usefully added the perspective of place and sought to investigate the contemporaneous commodification of care and location. but rather are made through the contested processes of cultural production (e.e. This scholarship. elevated from the metaphoric into the everyday and taken-for-granted) (Holcomb 1993). In this paper. Notwithstanding the challenges from the past. and more traditional promotional material collected through postal and email approach to the organizations Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. Canada). to the selling of an asylum lifestyle. we suggest that an important geography is evident in the use of language and image to create. We focus on three case studies: the Homewood Health Centre Inc. At a time when the marketing of health care provision is increasing rapidly (Naidu and Narayana 1991). It is arguably important that an organization regards its potential benefactors as consumers of a branded image.g. class and cultural expectation. The selling of an urban lifestyle has become an integral part of an increasingly sophisticated commodification of everyday life.g. the commodification of health care services (Moynihan 1998. has a common interest in the commodification of places. 3). Kearns et al. in which the term ‘critical’ is invoked to signal an approach ‘that thinks about the visual in terms of the cultural significance. position and maintain the place-identity of present-day asylums as therapeutic landscapes. for instance. of successfully commodifying what was historically shunned. reflecting changing underlying relationships of power. Madsen 1992) find parallel in contemporary health care. While this remains New Zealand’s key teaching and tertiary care paediatric hospital and has no need to compete for patients. and the development of a building with high imageability (Lynch 1960). austerity and grim treatments heightens the challenge of promoting and marketing sites of asylum. They frame and clarify the nature of the asylum as a product in the contemporary landscape of health care. While there is long-standing interest in. Kearns and Philo 1993. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . Pellegrino 1999). The historical legacy of confinement. Advertising and promotional texts about present-day asylums can be seen as leading to their legitimation as an ongoing modality of care within the ‘health care talk’ of medical professionals and the public at large. hospitals in general. and commentary on. places such as hospitals exist not only as empirical entities. In this respect. in a sense. Our present investigation of private asylums serves to extend the handful of other studies within health geography that have embraced this convergence of cultural and economic concerns (e. we turn. in which images and myths are packaged and (re)presented until they become ‘hyperreal’ (i. was seen as a way of encouraging potential benefactors to become actual patrons and consumers of the Starship charity (Kearns and Barnett 1999).
seclusion and recovery as well as more straightforward themes about landscape. In addition to inpatient psychiatric care. Kearns and Barnett 1999. whether those users be doctors or patients (see Moon and Brown 2000). These represented textual motifs that challenged the central hypothesis that notions of therapeutic landscape and asylum are integral to the (re)presentation of the case study facilities. It can accommodate around 100 patients. 2003) in that we sought words. Kearns et al. This constraint is intended to ensure a clear focus on promotional intent rather than outcome. which had been using it for teaching psychiatry students. and the hospital and related extramural programming are currently operated through the Homewood Health Corporation (Joseph and Moon 2002). privacy. All are. sharing in decision making. buildings and facilities. Our goal was to note not only the particular images and metaphors used in promotional materials. This body purchased the hospital in late 1988 from the University of Otago. a self-care hostel and outpatient services. This interest in discourse can be linked to Gesler’s (1999) proposal for examining links between language. In other words. their similarities make them amenable to comparative analysis. All authors participated in data collection and analysis. which sees patients and staff working together and. corporate mental health promotion and addiction management programmes. To this extent. We sought to deconstruct this promotional and image-making material and understand how place is incorporated into the positioning of the case study institutions. Ashburn’s treatment philosophy is firmly anchored in ideas of therapeutic community. Counter-tropes were also sought. We supplemented this documentary evidence with fieldwork using observational approaches. at the same time the image which the facility wished to display to the public gaze. Other activities include community care. It currently has some 300 beds catering for a wide range of conditions. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . however. but currently comprises a 29-bed inpatient service and clinics catering for eating disorders. All can. Ashburn opened in 1882 in Dunedin. phrases and visual images that either illustrated or challenged our central themes. it is our contention that the messages about residential psychiatric care conveyed in promotional materials may assist in constructing new ways of understanding the very nature of mental health care itself. Our approach has parallels with studies of news media and printed institutional marketing documents (Joseph and Kearns 1999. In this paper we focus on the language of the promoters of the hospital. though their clientele certainly tends to exclude people with severe acute needs. but also to read the underlying discourses that reveal evidence of power and position in the maintenance of place. New Zealand. where appropriate. The Priory hospitals often. It has a 120-year history of private ownership. Our ‘data’ were taken to represent the self-images that the facilities were seeking to display to potential clients and to the wider community: the overt evidence that a potential consumer could access when contemplating use of a facility and. involved. The Priory Group was founded in 1980. our interest is in the ways in which therapeutic landscape and place are used to promote asylum rather than their effectiveness as promotional tools. Ontario. Presentation of preliminary findings in a number of conference and classroom settings assisted in developing the analysis to which we now turn. though not always.136 Graham Moon et al. Homewood was founded in 1883 in Guelph.6 Crucially all are ‘unusual’ in their emphasis on residential care. all cater for a full range of problems. Case studies The three case studies examined in this paper share elements of a common context. rather than that of the users. also admit publicly funded clients via contractual arrangements with mainstream health services. Priory has substantial Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. 77). By discourse we refer to language and writing (printed words as well as inscription in the landscape) intended to ‘persuade ourselves and others to a certain way of understanding’ (Harvey 1996. All operate in health care economies that are dominated by community care and by public-sector funding. Despite a popular perception that they deal only with addictions and less severe conditions. place and health. Analysis focused on identifying evidence of therapeutic landscape ideas. By 2003 it had 15 hospitals with 559 beds in diverse locations across the UK. and in reading and interpreting the range of research material. private-sector operations with comparable fee regimes. pre-date the foundation of the company and have individual histories of providing private and/or UK NHS care. We systematically searched for tropes engaging with notions of community. Canada. and do. It is run by the Ashburn Hall Charitable Trust. a day programme.
Selling the private asylum 137 detoxification services as well as commitments in the areas of executive stress. for example. as well as simple statements noting the size of the hospitals’ grounds. Philo (2004) gives explicit consideration to the employment of ‘opportunistic geographies’ arising from location and setting in the marketing of the historic private ‘mad house’. the objectives of the historic asylum incorporated ideas about therapeutic landscapes. the advertising of Haydock House made explicit reference to its rural qualities (p. the building looks across this vista to an artificial lake and mature woodland. These claims implicitly draw comparison with other (understaffed. Healing and Sanctuary’ to all and to assist each individual to take control of his or her own life within a safe and secure environment. 298). Innovation and Integrity and its purpose is to bring ‘Hope. security and safety enable an emphasis on protection for the service user. public) services. Two intertwined devices enable the marketing of sanctuary. there is. First. secure world lies within boundaries. 390). Alongside tranquillity and seclusion in these landscape tropes sit clear themes of ownership and privatized exclusion and exclusivity. the former issues offer clients a continuing connectivity with urban life and locate the facilities in areas signifying rural quality: isolation is tempered by accessibility and seclusion takes place in environments of repute. They sought the promotion of recovery through the calming properties of particular landscapes. focusing on the deployment of tropes associated with notions of asylum and therapeutic landscape. They are places from which threats and pressures are excluded. The archival record is replete with examples of proprietors lauding their locational resources: Hygeria Lodge had ‘the surface paradise of a country retreat’ (p. this safe. highly designed park-like settings are a characteristic of many of the Priory Hospitals and landscape is specifically noted in the marketing descriptions of many of the sites (Table I). landscape is a clear theme in the presentation of the Priory Hospitals. residential schooling and brain injury. As we argued earlier. There is full participation in national inspection schemes and accreditation by the UK Health Quality Service. Further themes that are evident in this use of landscape as a promotional device are reassurances about proximity to urban life and references to well-known nearby landscapes. The hospitals are promoted as sites where motifs of sanctuary. Moreover. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . The present-day Priory Hospitals explicitly echo this approach: landscape is portrayed as a key element in the promotion of better mental health and ordered. Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. The Group’s values are based on Service. 344). there is reference to high-quality service delivery. Looking inside the asylum world. security and safety. There is a clear separation between the inside of the asylum world and the outside. Potential disturbance is prevented from entering the user’s secluded world. what is being offered is the health care equivalent of the country house (hotel) experience. community. for example: ‘Exits through the building lead to safe gardens where patients are free to wander under the unobtrusive surveillance of nursing staff’ (Priory Group 2005b). While the latter theme contributes to the motif of seclusion. These qualities remain evident in the presentation of the Priory Hospitals to their presentday clients. What we see in more theoretical terms is the marketing of places as managed. The more urban Grovelands benefits from co-location alongside a public park from which it is separated by impressive ornamental fencing. In promoting this offer. accessible rurality and the mitigation of potential stigma by calming context. however. networks and accreditation of staff. is accessed via a winding drive through open parkland. Field visits substantiated this aspect to the claims made in these promotional materials. Publicity also emphasizes the regular inspection of facilities and the qualifications. Again there are historic parallels for this interplay of the rural with urban connectedness (Philo 2004. Priory Hospitals Priory’s aim is to provide the best quality care and services for all and to ensure that these are delivered to the highest standard by professional and committed staff. Materials stress the availability of carers providing oversight of the service user and protection from harm. the facilities are promoted as safe and secure in their own right. Second. We turn now to a more detailed examination of each case. Marchwood. It is invisible from the main road. everyday world: ‘It is easy to drive past the Priory in Roehampton with not the faintest idea of what goes on behind its high walls’ (Franks 1998). (Priory Group 2005a) Ideas of safety and separation from a threatening outside world were central to historic notions of asylum. In effect. recognition that care and treatment form part of an experience that is about more than landscape.
For the most part. which he felt was conducive to healing. (Priory Group 2005j) various Priory facilities. and thus do not evidence innovative new-build architectural Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . Kent. Thus the Roehampton Priory Hospital is ‘a most attractive building in a tranquil setting in Roehampton. (Priory Group 2005b) as does Ticehurst House: ‘Founded over 210 years ago. within its spacious grounds’ ‘Set in four acres of landscaped gardens.7 In this last quote. They deliver intensive but highly flexible care programmes in a safe and tranquil setting. ‘first became a hospital in 1866 and is now recognised as one of the foremost private psychiatric hospitals in the United Kingdom’ ((Roehampton) Priory Hospital 2005). The linkage of history and the therapeutic appeal to landscape noted above for Ticehurst House is also extended to Roehampton in a section of the main Priory Group website specifically devoted to the history of the group: The Priory Group owns two of the oldest private mental health hospitals in the UK: The Priory Hospital Roehampton and The Priory Ticehurst House. and is set in 31/2 acres of private grounds’ ‘Grovelands Priory Hospital is located in a secluded part of Southgate. the hospital stands in 48 acres of extensive grounds.138 Table I Hospital Altrincham Dukes Priory (Chelmsford) Grovelands (North London) ‘situated in its own extensive grounds in the heart of the Cheshire countryside’ ‘in a secluded part of Chelmsford. (Priory Group 2005k)8 The Priory Grange Hospital Heathfield exemplifies this claim: The space and tranquillity offered by the Unit and its surroundings provide a perfect setting for people who are experiencing severe and enduring mental health problems. They offer a home and treatment for adults with enduring mental and physical illness. The Priory Hospital Bristol offers a tranquil environment for those receiving treatment for psychiatric problems’ ‘set in several acres of private grounds’ ‘set in 10 acres of Hampshire countryside close to Southampton city centre and the New Forest’ ‘set in the Sussex countryside with close links to the local community’ Graham Moon et al. set in several acres of private grounds overlooking extensive parkland’ ‘in a lovely situation overlooking Hayes Common. Appeals to history are also evidenced as architectural signifiers of quality. providing a calming therapeutic environment for our patients’ (Priory Ticehurst House 2005). The Priory Hospital Roehampton is London’s oldest private psychiatric hospital and has been in continuous operation since its launch in 1872. The Roehampton Priory Hospital. These apply. for example. Landscape tropes in the marketing of Priory Hospitals Source Priory Group 2005c Priory Group 2005d Priory Group 2005e Hayes Grove (Bromley) Priory Group 2005f Bristol Priory Healthcare 2005g Lynbrook (Woking) Marchwood Priory Grange Heathfield Priory Group 2005h Priory Group 2005i Priory Group 2005b Hints of this are evident in quotes that place the actual hospital buildings in their landscape contexts. Essex. In other cases it is treatment that is linked to therapeutic landscape. on the one hand. when Dr William Wood moved his patients from Kensington to Roehampton’s then country atmosphere. to the provision of care. just south of Bromley. we discern a further theme: appeals to history that rework and memorialize positive aspects of both the specific pasts of the We see the manufacturing of appeals to historic ideals of sanctuary and implications that the Priory Hospitals are offering continuity with a historic mission dedicated to mental recovery in therapeutic landscapes. South London. Priory Hospitals occupy inherited sites. The Priory ‘Grange’ group of facilities make particular play of this second link. close to Richmond Park’ ((Roehampton) Priory Hospital 2005).
updated by a contemporary concern for physical fitness. However. The Roehampton hospital is described as ‘built in the first part of the 19th century in a style known as Strawberry Hill Gothic’ ((Roehampton) Priory Hospital 2005). (Woodbourne Priory Hospital 2004) By drawing attention to the architectural status of the hospital buildings. argued at a conference on the quality agenda in health care in 2000: ‘Our expectations now are very different from what they were in the past when communal bathrooms and shared rooms were taken for granted’ (Todd 2000). These include both leisure activities eg. computers etc or therapy such as aromatherapy. however. however. telephone and en-suite facilities. physiotherapy. A characteristic of the historic asylum was the idea that patients should have their time occupied with structured activities. Ashburn Clinic Current publicity signals that Ashburn Clinic caters to four types of patient. both within the hospitals and in the form of negotiated exclusive access beyond the hospital walls. horticulture as therapy continues at some hospitals. (Priory Group 2005f) At Chelmsford and Marchwood the buildings are reported as grade II listed and Farm Place is a seventeenth-century manor house. These pictures reinforce the points made above about architecture.Selling the private asylum 139 display. There is an emphasis on the status of the buildings in publicity material: The Priory Hospital Hayes Grove is situated close to Hayes Common. exercise and social facilities that would not disgrace a decent hotel complement these individualized facilities. There is an art room and activities area. Civic responsibility is also implicated in these references to architectural signifiers: Priory bought Heath House. Individual Aromatherapy. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . To this end. others can take part in carriage driving or ten pin bowling. It is in fact a ‘type-site’ for that particular architectural style. a Grade II listed building. Within its spacious grounds the hospital incorporates a listed Queen Anne mansion. clearly form an important part of the therapeutic landscape of the present-day asylum. in many cases. on agriculture and horticulture. At the Priory Hospital Glasgow the linkage of ideas about the therapeutic advantage of the internal environment and the quality of that environment are explicit: The environment we create for patients is as important as the treatment itself and each patient has the privacy of their own comfortable bedroom with television. cooking etc. The internal (land)scapes and facilities of the hospitals are also of importance in (re)presenting asylum to the contemporary public. Historic buildings. who Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. from the National Health Service in 1991. for those who cannot cope with the outside world we offer a safe environment with activities within our boundaries. We can see elements of this trope. in the present-day Priory Hospitals. but also touch on the issue of landscape by depicting historic buildings located. (Priory Group 2005l) While the asylum farm has vanished. At the Woodbourne Priory Hospital Communal areas provide a pleasant and comfortable environment and patients are encouraged to use facilities for physical exercise both within the hospital grounds and in the locality. Traditionally. After extensive restoration the building was totally renovated back to its original splendour and is now the centre of The Priory Hospital Bristol. As the chief executive of the Priory Group. Latterly. elements of sporting activity were introduced. (Priory Group 2005g) At most of the Priory Hospitals. the description of each hospital routinely includes a brief outline of the facilities that a user can expect. These are people. in park-like settings (Plate 1). The House dates back to the 18th century and for eleven years had been empty and almost derelict. ‘Occupational therapy’ also came to include significant ‘indoor’ activity. Dr Chai Patel. the focus was on the outdoors. (Priory Group 2005j) Visual cues in publicity material provide additional evidence of the use of therapeutic landscapes and the asylum tradition in the presentation of the Priory Hospitals. makes more of the provision of recreational facilities. Kent. art. Yet the stress on security and safety remains: Some patients swim at the local hydrotherapy pool. Reflexology. The marketing of the hospitals. It contributes to the positioning of the Priory Hospitals as a service provider of quality. dining. just south of Bromley. group Tai Chi and Yoga sessions are available. we contend that promotional material implicitly seeks to confer a similar aura of status on the users of the buildings. There is a picture of the hospital on each promotional factsheet and on the Priory Group website. music.
therefore. where the tropes are implicit. where the cycles of nature are a reminder of the regrowth that is fostered here. (Ashburn Clinic undated a. shrubs and exotic trees. A service need is identified and Ashburn is presented as the solution to that need. As with the Priory Hospitals. Greatest emphasis is however on the peace. with large lawns for outdoor sports. as close to urban life. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . The Ashburn Clinic has always had a role. or who are attracted to our setting rather than the public alternative. Landscape is a major trope in the representation of Ashburn Clinic. (Ashburn Clinic undated a. which attract a variety of native birds. who need a longer term residential environment. It is different in that it is an institution and different in that it is avowedly an institution in the era of community care. In a lengthy passage. The extensive grounds are filled with flowers. (Ashburn Clinic undated a. an information booklet specifically describes the hospital’s presentation as an asylum: The importance of the meaning of the word asylum for some patients has recently been affirmed in the literature. Images of greenery. (Ashburn Clinic 2005) This quote is important in that not only does it engage directly with the central concerns of this paper. It is also made clear that the built environment is well-maintained and high quality: ‘Our totally refurbished accommodation is Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. 2) In contrast to the Priory Hospitals. This viewpoint is echoed in recurrent visual images on the Ashburn website and in current newsletters and guides for intending users. A serene setting for just sitting or strolling.140 Graham Moon et al. The Ashburn Clinic. 2) Here we see a presentation that alludes to expert opinion (the literature) and to historical continuity (‘has always’. In past decades people who were chronically psychiatrically compromised were encouraged to stay in institutions in the belief that this afforded them a better quality of life. like certain of the Priory Hospitals. Indeed. 2) The reference to serenity is significant. exotic planting and blossom are used to present Ashburn as a garden retreat. tranquillity. in providing asylum. continues to have a role in the provision of asylum. ‘past decades’). on the role of Ashburn Clinic. the frontispiece banner on Ashburn’s website states: The Ashburn Clinic gardens are a place of quiet reflection. with some local patients. It also links Ashburn to ‘New Age’ notions of spiritual rebirthing. Ashburn sets store by the integration of its buildings with its physical landscape. but it also clearly positions Ashburn as different and as an institution. diversity and extent of the Clinic’s grounds: Plate 1 Ticehurst House: an example of a historic Priory hospital in a park-like setting Source: Priory Group (2005m) The Ashburn Clinic is situated 10 minutes from the city centre and is surrounded by farmland. notions of asylum and therapeutic landscape are explicit in the present-day objectives and presentation of Ashburn: Still today the design of the hospital and the grounds are integral to providing a therapeutic environment distinctly different to most psychiatric institutions. It links back to the therapeutic role of the landscape. Though in a classic urban fringe location. For some this is still true. who need psychotherapeutic treatment. it is presented. 2) fail the state system. (Ashburn Clinic undated b. and for many older patients leaving hospital is now not a real possibility.
2). however. 5). This is a bold initiative that echoes the bicultural spirit of developments at the former (public) Tokanui Hospital. designed by a leading New Zealand architectural partnership. grand vistas and historically significant architecture create an environment that is tranquil. structured recreational activity is an important theme at Ashburn. serene and reminiscent of a bygone era. netball and indoor bowls. (Homewood Health Centre 2003a) Notwithstanding this explicit comment about its grounds. The users of Ashburn play a part in running the Clinic. (Ashburn Clinic undated a. This distinction can be traced to an important difference between the two operations. There are. The lawns provide a setting for outdoor activity while. Second growth forests. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . Again. which closed in the late 1990s (Joseph and Kearns 1996 1999). Next to this is an outdoor tennis court. a sense of belonging. the Homewood Health Centre provides rather less evidence on its website and in its publicity material of notions of therapeutic environments or continuity with historic ideas of Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. Users are encouraged to personalize their rooms and there is some description of communal areas. Nonetheless. but it also means that there is a more workaday image with less emphasis on services provided by others and the opulence of the surroundings. While Priory emphasizes choice. the meandering Speed River. body and spirit. although provision appears rather more spartan than that at the Priory Hospitals.Selling the private asylum 141 staff and patients’. This is part of the recovery regime. trees and rhododendrons’ (Ashburn Clinic 2005). The interior facilities of Ashburn receive rather less attention in publicity materials compared to those of the Priory Hospitals. maintained lawns. seeks to capture both traditional (Western) notions of asylum and therapeutic healing and Maori concepts of spiritual well-being and recovery (Plate 2). safety and responsibility grows’ (Ashburn Clinic undated b. Ashburn presents itself as a therapeutic community where even the welcoming publicity is from ‘clinic A tour of the premises also reveals a large and well-loved billiard room. it is a form of occupational therapy. badminton. This building. Alongside our main building is our recreation hall which is equipped for a variety of indoor games including volley ball. The Homewood Health Centre From the beginning. We will return to this matter in our discussion of counter-tropes but. The activities at Ashburn tend to be team sports and they tend to require greater levels of physical exertion. it is relevant to note that. it is perhaps best seen as another manifestation of the distinction between a therapeutic community where people work together for healing and a hospital chain that prides itself on offering high-quality choices in a quasi-hotel environment. the quality of interior facilities and a hotel-like approach. we see the concern to promote sporting activity rather than the farming or horticultural activities that historically characterized the asylum. Homewood has emphasized the importance of a therapeutic environment for healing the mind. for the moment. While it is tempting to view this contrast as a reflection of difference in clientele or even gross stereotypes of national cultures. notable differences between Ashburn and the Priory Hospitals. 2) Plate 2 Te Whare Mahana o nga hau e wha (the warm house of the four winds) Source: Ashburn Clinic (2000) beautifully set in several acres of lawn. ‘In living together and performing the necessary domestic and administrative tasks. This therapeutic articulation of the physical and the built environment is most clearly articulated by the recent development of Te Whare Mahana o nga hau e wha (the warm house of the four winds): ‘In an old orchard beside a stream we have created a quiet spiritual place for people to sit and reflect’ (Ashburn Clinic undated a.
and raised garden beds. . Indeed. in shared rooms and on wards.142 Graham Moon et al. as well as on 47 acres of garden and wooded area. Ontario. Two sets are particularly Where the Priory Hospitals chose to present its indoor landscapes as akin to those of a hotel and Ashburn emphasized the therapeutic community dimension. Other images concern the provision of different therapies. in a beautiful setting on the banks of the Speed River. Horticultural therapy promotes a ‘natural’ sense of wellness. The hospital environment provides protection from the sources of stress. and is an adjunctive therapy in all treatment programs offered at Homewood. calm and authority. in the medicalized hospital tradition. the impression is that. rather more than the other case study facilities. the impression is one of order. providing specialized psychiatric services to all Canadians. . Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. In a short period of time you begin to calm down. the testimonial makes an implicit contrast between the negative image of the (historic) asylum and the more positive aspects of asylum: I had my fears about where I was going. Second. Homewood boasts a labyrinth (Figure 1) where spiritual health is grounded in place-specific activity. Accommodation is available in private rooms but also. First. There are visiting hours and no telephones in rooms. Figure 1 The Labyrinth at the Homewood Health Centre Source: Homewood Health Centre (2003d) asylum. I feared the worst. televisions are located in patient lounges. A user testimonial. Nevertheless. One view is shown of the main hospital building from the grounds. Homewood has been improving lives since 1883. historical referencing and place. No-one had really told me about what goes on in these places. Homewood exemplifies a third approach. Overall. But without question it was the best move I’ve made in my life. (Homewood Health Centre 2003c) Landscape and architecture interact in many of the images on the Homewood website. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . one of a series that together constitute a novel feature of the presentation of the Homewood. Located in Guelph. (Homewood Health Centre 2003b) relevant for the issues raised in this paper. Dining is recognized as a therapeutic opportunity. . the Homewood makes active use of its grounds: Homewood Health Centre hosts the largest and longest-running horticultural therapy program in Canada. Space is not necessarily open to personalization. (Homewood Health Centre 2003e) Here we again see claims to excellence. provides an indication that the hospital offers its residents secure safe sanctuary. Therapy takes place in the newly constructed ‘state-of-the-art’ conservatory and classroom. a range of relevant tropes are present that resonate with the themes identified above: Homewood Health Centre is a leader in mental health and addiction treatment. patio and container gardens. Homewood sees itself as a relatively traditional hospital. the presentation of pastoral therapy echoes the notions raised by Te Whare Mahana o nga hau e wha at the Ashburn Clinic. Meal times are assigned. but is also presented in terms of nutritional requirements.
the package of high-quality asylum in a therapeutic setting that we have discussed in previous sections is a central part of constructing a commodity that a discerning public will choose to purchase. we ensure that the choice. Destinations one and two would not be unusual at a Priory Hospital or at Ashburn. There is some evidence of this counter-trope of therapeutic community at Homewood. For example: To complement our care for the mind. The concepts of asylum and therapeutic landscape are least significant for Homewood. Homewood is represented as offering guidance on this journey. To assure this analysis. In contrast. however. in different ways. We also cater for special dietary requirements. continuity of care. On the weight of evidence. therapeutic communities operate on a more sociological level in which place-as-setting may matter less than place-as-group-dynamic.9 The Homewood website makes central use of the idea of a ‘healing journey’ from mental ill-health to mental wellness. Of course. preparation. the extent to which it is additionally crucial to represent that place as a therapeutic landscape or a benign shadow of the historic asylum is. however. At each meal there is a choice of hot and cold dishes to suit different tastes and nutritional needs. it is simply about presenting a quality service. Our emphasis is on working with the individual within the therapeutic community using a psychodynamic approach to promote individual and personal growth. associated with the healing properties of the physical or built environment. immaterial. they both distinguish and valorize this rather different form of care provision. Their relative significance for the three case studies examined in the present paper varies. is also active in community psychiatry. important to the presentation of Ashburn and the Priory Hospitals. Though we have drawn parallels with the themes addressed in this paper. their key focus is on residential care. While therapeutic landscapes are. In the former this importance arises from an articulation with therapeutic community. and Though these processes certainly unfold in a particular place isolated from the surrounding society. and quality of food is appealing to patients. we also need to consider counter-tropes: themes evident in our source material that suggest representations other than those on which we have concentrated thus far. In all three cases there are important counter tropes. acute or chronic mental health problems. presentation. one such counter-trope is provided by the theme of choice. or post-traumatic stress) in a residential setting. Destination three is distinctive: it reveals the positioning of Homewood within its regional community care economy and its role in promoting continuity of care. however. In the case of the Priory Hospitals. Our research material does. (Ashburn Clinic undated b) Counter-tropes So far we have carefully reviewed representations of our case study facilities. there is some case for seeing this idea as a countertrope with regard to our interest in the asylum as a therapeutic landscape. They concern. in the latter it reflects market positioning as a quality service. at least in the present paper. Our contention has been that these tropes are central to the representation of our case study facilities in the present-day era of community care. Though the Priory Hospitals provide a range of services. providing potential patients with (intermediate) destinations where the processes of resolving their mental and emotional health problems can begin. Our research material on Ashburn Hall reveals a strong commitment to the philosophy of the therapeutic community. Homewood. in a sense. Thus. meetings. Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. inpatient addiction treatment and ‘specialised psychiatric treatment’ (the care of people with eating disorders. respectively. in contrast. seeking evidence for the deployment of tropes associated with therapeutic landscapes and positive aspects of asylum.Selling the private asylum 143 interactions in community living. (Woodbourne Priory Hospital 2004) This is nothing to do with the selling ideas about asylum or therapeutic landscapes. where there is a countervailing stress on a medical model of care and integration with community care. both concepts are. a measured conclusion from our research material would be that asylum and therapeutic landscape are significant general tropes in the representation of contemporary institutionally-based mental care. The key counter-trope evident in the research material on Homewood is. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . support and understanding that is necessary for healing’ and treatment at the Ashburn Clinic revolves around participation in community activities. give some emphasis to choice as a distinct construct in its own right. patients live together with carers forming relationships which ‘provide the human warmth.
We focus first on what our empirical material has revealed regarding the deployment of language and image in the promotion of psychiatric care settings in terms of their material and symbolic construction as therapeutic landscapes. In a very particular sense. Kearns et al. Our facilities seek to sell themselves as places that heal. particularly at the Ashburn Clinic. Alongside statements of service quality and effectiveness as well as concerns for the ‘hotel’ aspects of their services. There is a clear importance that can be attached to the promotion of active minds and active bodies within healthy settings. but also through being ‘part of the team’ and integrated within a community. Gotham (2002). therapeutic landscapes can be read simply as an element in the place marketing of towns. material and institutional inscription on Auckland’s landscape. The spaces that most exemplify and to an extent commodify this contention are gymnasia (Andrews et al. The appropriation of notions of therapeutic landscape enhances their symbolic and material construction. Building on Gesler’s therapeutic landscape ideas. New Zealand. The bodies of clients are themselves living landscapes that need to be inscribed with therapeutic properties through disciplined engagement with wholesome physical activity in appropriate settings. Geores’ (1998) account of the history of Hot Springs. We have followed that paper in arguing that the way hospitals are described does much to construct them within the public consciousness. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . The deployment of place-based marketing arguments serves to supplement the positioning derived from health alone. In these classic studies.144 Graham Moon et al. replete with expertise and technology. in a paper on the place marketing of New Orleans. Images depicting aspects of ‘nature’ and promoting the hospital as a therapeutic landscape provide an extension of traditional theoretical conceptions of place marketing in that place is not simply a selling point or experience. A related theme that emerges from these concerns is the role of activity in our case study facilities. Through devices such as ‘quality’ or enhanced treatment regimes. Embodied recovery through active engagement with recreation is encouraged. language was carefully deployed to construct the hospital as part of the community. a hospital can enhance its market position on the ‘health’ side of this convergence. The urban studies literature on place marketing alluded to earlier offers interesting parallels in this regard. an appeal is made to contemporary body cultures in which activity is an act of exertion as well as an assertion of self. not only through participation itself. Boyle and Hughes 1994). our facilities each speak selectively to landscape and its implied therapeutic value in enhancing their health role. 2005. In the (post)modern health care market. South Dakota. The ‘selling’ of this surgical hospital was read as a symbolic. Fusco 2006). this selective presentation also revalorizes confinement and engages with historical notions of asylum in that the context of confinement is portrayed as acceptable. In the case of the surgical hospital. portrayed a spa town founded by entrepreneurs to sell a commodified notion of ‘health’. In this way the gyms and jogging paths are communal spaces in which sociality and recovery emerge from physicality. we reconnect with the background matters discussed earlier in the paper. (2003) explored similar themes to those in the previous paragraphs in a study of the creation and promotion of health care in a rather different setting: a private surgical hospital in Auckland. hospitals are under increasing pressure to ‘sell’ themselves in this way in order to establish or maintain a clientele as well as ensure more generalized legitimacy. To this end we support suggestions that it may be helpful to see hospitals as distinct sites in which health and place converge (Naidu and Narayana 1991). notes the importance of promoting selective images to manipulate markets and assure commercial success. The place marketing of our facilities as therapeutic landscapes is an exercise on a rather different scale. By marketing the availability in place of these aspects of provision. but also subtle differences. is seen as part of the healing process. Gesler himself undertook a similar study of Bath (Gesler 1998). high quality and therapeutic in its own right. Our case studies illustrate this theme in contemporary residential psychiatric care. In all our case study facilities such provision is evident. Indeed participation. Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. Our study suggests that the link between asylum and therapeutic landscapes is a potent element in the place marketing of our case study facilities. Discussion In this section. yet it too deals with regeneration – of an ‘unfashionable’ mode of care delivery that has to overcome stigma. In urban studies place marketing traditionally has been linked with city regeneration (Madsen 1992. it is also part of the treatment.
people generally wish (or are required) to leave as soon as illness. Place. It must also counter both the positive and the negative images of community care. to variable extents. it seems apposite to term the persistence of private residential mental health care a postmodernist phenomenon and to view our case studies as sites of resistance to the dominant modality of community care. Joseph and Kearns (1996) and Kearns and Joseph (1997 2000) on restructuring and deinstitutionalization.Selling the private asylum 145 and reflecting the latest in medical intervention. Community care. There was a preference for very large-scale facilities run on regimented lines serving well-delineated geographical populations. These connections between image. This contrasts with the inclusion sought by the surgical hospital and reflects again an element in the revalorization of confinement. but that importance is fleeting. the value of confinement was diminished. the traditional asylums. This much is well known. The private-sector funding of our case study institutions is an important part of this aspect of our story. language and images are. came to represent uniformity. That dislocation was to be addressed through a process of care(ful) management in which place. Both Ashburn and Homewood originally developed as alternatives to poorly-reputed public asylums. per se. They are anomalies: hospitals in a postasylum era. was not accorded a therapeutic role. Their predecessors. Indeed. the (albeit limited) rise of private psychiatric hospitals can be seen as part of a broader restructuring of health care that is opening space for both private capital and privatized need. in the form of a repackaging of traditional notions of asylum. It is in the residual asylum sector that there remains a place for longer stays in (confined) hospital settings in which convalescence can occur amid the tranquillity of quasi-natural surrounds. While there are many parallels between this earlier study and the present case studies. Any transfer of clients to community care within a broader political Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. The contemporary survival of the asylum is thus a market-led response to opportunity and demand. there are also differences. standardization and scale economy. asylum and welfare restructuring link clearly to the ideas of Smith (1987 1989). Our case studies provide an alternative perspective. In this interpretation the private-sector asylum is meeting a societal need for which the state has eschewed responsibility. The global policy shift in favour of the mixed economy of care ensured space for the private sector. Notwithstanding the idea of the servicedependent landscape of despair. What is at issue is exactly how private asylums are now ‘selling’ themselves – and their geographies – to potential clients. effective system of deinstitutionalized care delivered through a combination of state planning and medical progress. It seems that privatization in mental health care can be seen as an inevitable counterpart to the closure of state owned and funded psychiatric hospitals. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . place may be important. community care tended to be dislocated from specific places in comparison to asylum care. owes at least something to a market seeking to avoid the downside of the now equally hegemonic community care. In general terms this has manifested itself in the emergence of alternative private-sector providers of community care complementing and sometimes replacing elements of public provision. was similarly modernist in its vision of a well-ordered. Promoting (private) asylum facilities must involve countering the legacy of the poor reputation of the historic asylum. With these ideas in mind. More specifically. Priory. their continued existence. The core concept of asylum as a place of sanctuary was marginalized or even lost. plays a central role in this flexibility and in ensuring an effective fit with consumer demand. In the case of most hospitals. Given their positioning as in-patient mental health care facilities. fee-for-service facilities in national health systems. and that of the Priory Hospitals. The demise of dedicated psychiatric hospitals has meant that most acute phases of illness are dealt with in the psychiatric wards of general hospitals. injury or impairment are satisfactorily addressed. its flexibility and niche nature is the antithesis of a modernist project of hegemonic community care. Ashburn and Homewood have few peers in their national contexts. They have only to compete with what they are not: public psychiatric hospitals wards or community care provision. its successor. used to construct them as apart from (rather than part of) the community. The key issue for the present-day private asylum in this context is assuredly that of image. residual demand for residential care ensured that private residential provision can be filled at an acceptable financial rate of return. The historical weight of these ambivalent assessments provides an opportunity for a critical perspective on the present-day retention and reinvention of the asylum.
The obverse of the therapeutic landscape is evident in landscapes of despair characterized by high levels of homelessness. (1987. Our statement refers to the situation pertaining in much of Europe and North America. their presence within the countries we consider here points to the need for further work on a more general re-evaluation of confinement (or isolation) as a solution to social problems and the role of place in the marketing of this re-evaluation. . We note in passing a perception that these facilities cater to a celebrity clientele. For analyses and critiques of this position see. British policy. for instance. nurses and shop assistants. These possibilities are particularly evident in the emerging addictions industry. particularly those with the necessary economic means. is a more helpful term than deinstitutionalization. big businessmen and celebrities . There remain countries where the asylum is a significant modality in the care and treatment of people with mental health problems. writing of Ashburn Hall. . place marketing is also implicitly embodied in the promotion of community care as. variously. with its connotations of disadvantage. destitution and chronic mental ill-health. [it also treats] more everyday folk: labourers. Interestingly Ticehurst originated as one of the most famous of the eighteenth-century private madhouses (Philo 2004. is arguably moving towards re-establishing confinement as a way of containing people as a result of their potential ‘dangerousness’ (Moon 2000). We say ‘in a sense’ because. exercise their own choice. While consideration of these rather different institutions is beyond the scope of this paper. 3 4 5 6 7 Acknowledgements The authors gratefully acknowledge Chris Philo and the four independent referees. providing mental health promotion and stress management services to public. References Anderson K and Gale F 1992 Inventing places: studies in cultural geography Longman Cheshire. While Ashburn Hall has its share of politicians. It also serves as an opportunity to note that. The inconsistencies in the date of the founding of the hospital are noted. . housewives. Some. 328–46). Philo (1987b) offers a reminder that large asylums coexisted alongside smaller scale provision that was often more integrated and visible within its local community. A contemporaneous development of new spaces of care on a continuum from the high risk/high security (even imprisonment) option at one end to the private asylum/retreat centre at another (see Conradson 2005) means we can also see our case study facilities in the context of the current socio-political movement towards greater security of places in which one might situate everything from gated communities to retirement villages. provides the reality of the situation: a popular misconception of Ashburn Hall is that it is a mental home for the rich and a treatment centre for affluent alcoholics . Dear and Wolch (1987) and Pinfold (1999). 7) and ideological environment in which private ownership and the voluntary sector have a key role is almost bound to encounter the paradox of choice. We also note the implicit link between notions of therapeutic landscape and present-day community care. This ‘top end’ set of opportunities for private care can be seen to complement a ‘reinstitutionalization’ of those with psychiatric conditions. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . although the historic parallels are significant. We note in passing that Priory and Homewood both also have an involvement in corporate mental health care. will challenge the paternalist prescription of community care. as well as New Zealand and Australia. for example. Charteris.10 To this limited extent the notion of the public city (Dear 1980). poverty and exclusion. it is also the case that the private madhouses of the seventeenth century operated in a very different landscape of care and at a time of somewhat different societal attitudes to mental health problems. un-bounded and ‘home-based’.and private-sector employers. 8 9 Notes 1 We acknowledge here that these initial statements capture a scenario that is not universal. which has considerable parallels with the private mental health care sector (Wilton and deVerteuil forthcoming). particularly when that alternative is marketed attractively. These matters are beyond the scope of this paper. while the present paper is concerned with place marketing and surviving asylums. Melbourne Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors. . is replaced by a private city in which we see an elite choice of advantage and seclusion predicated on wealth and the ability to afford care.146 Graham Moon et al. and choose a residential alternative. dispossession. 2 This notion of community care as an ‘asylum without walls’ has led Geller (2000) to claim that dehospitalization 10 This statement would apply equally to Homewood and the Priory Hospitals. The landscape of community-based care has been seen as (ostensibly) therapeutic.
Syracuse 36– 52 Gesler W 1992 Therapeutic landscapes: medical issues in the light of the new cultural geography Social Science and Medicine 34 735–46 Gesler W 1998 Bath’s reputation as a healing place in Kearns R and Gesler W eds Place and health: making connections in geographic research Syracuse University Press.php?tID=1& sID=2&lID=9) Accessed 20 March 2006 Homewood Health Centre 2003e Horticulture therapy (http:/ /www. Oxford Foucault M 1967 Madness and civilisation: a history of madness in the age of reason Tavistock.php?tID=0) Accessed 20 March 2006 Homewood Health Centre 2003c IMAP [Integrated Mood and Anxiety Program] story: Ron Ellis’ story (http:/ / www. past and present Pergamon Press.php?tID=1&sID=0&lID=3) Accessed 20 March 2006 Homewood Health Centre 2003d Pastoral care (http:/ / www.homewood.co. Dunedin Ashburn Clinic 2005 The Ashburn Clinic (http:/ / www. London Dear M and Wolch J 1987 Landscapes of despair: from deinstitutionalisation to homelessness Polity Press. London Gleeson B and Kearns R 2001 Remoralising landscapes of care Environment and Planning D: Society and Space 19 61–80 Gotham K 2002 Marketing Mardi Gras: commodification.php?tID=1 &sID=3&lID=9) Accessed 20 March 2006 Jones K and Moon G 1993 Medical geography: taking space seriously Progress in Human Geography 17 515–24 Joseph A E and Hall G B 1985 The locational concentration of group homes in Toronto The Professional Geographer 37 143–55 Joseph A E and Kearns R 1996 Deinstitutionalisation meets restructuring: the closure of a psychiatric hospital in New Zealand Health and Place 2 179–89 Joseph A E and Kearns R 1999 Unhealthy acts: interpreting narratives of community mental health care in Waikato. Oxford 133–43 Homewood Health Centre 2003a Grounds (http:/ / www.org/healthcentre/main. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 .homewood.org/healthcentre/main. New Jersey 127–64 Davis D 1977 An implementation of therapeutic community in a private mental health center Diseases of the Nervous System 38 189–91 Dear M 1980 The public city in Clark W and Moore E eds Residential mobility and public policy Sage.Selling the private asylum Andrews G.and re-constructing the image of the industrial city in Kearns G and Philo C eds Selling places: the city as cultural capital. Dunedin Ashburn Clinic undated b About the Ashburn Clinic Ashburn Clinic. London Franklin R 2002 Hospital-heritage-home: reconstructing the nineteenth century lunatic asylum Housing Theory and Society 19 170–84 Franks A 1998 The last chance saloon The Times Magazine 31 October 22–32 Fusco C 2006 Inscribing healthification: governance.php?tID=0& sID=5&lID=2) Accessed 20 March 2006 Homewood Health Centre 2003b Home (http:/ / www. commercial opportunity and the repositioning of a Victorian private asylum Social Science and Medicine 55 2193–200 Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors.nz) Accessed 20 March 2006 Boyle M and Hughes G 1994 The politics of urban entrepreneurialism in Glasgow Geoforum 25 453–70 Busfield J 1986 Managing madness: changing ideas and practice Unwin Hyman. risk. Syracuse 17–35 Gesler W 1999 Words in wards: language.org/healthcentre/main.ashburn. health and place Health and Place 5 13–25 Gesler W and Kearns R 2002 Culture/place/health Routledge. Dunedin Ashburn Clinic 2000 The warm house of the four winds Ashburn Clinic Newsletter October Ashburn Clinic. London Castel R 1988 The regulation of madness: the origins of incarceration in France University of California Press.homewood. spectacle and the political economy of tourism in New Orleans Urban Studies 39 1735–56 Harvey D 1996 Justice.homewood. nature and the geography of difference Blackwell. New Zealand Health and Social Care in the Community 7 1–8 Joseph A E and Moon G 2002 From retreat to health centre: legislation. Sudwell M and Sparkes A 2005 Towards a geography of fitness: an ethnographic case study of the gym in British bodybuilding culture Social Science and Medicine 60 877–91 Ashburn Clinic undated a Welcome to the Ashburn Clinic Ashburn Clinic. ideology and design in Knox P ed The restless urban landscape Prentice Hall.org/healthcentre/main. care and the relational self: therapeutic encounters in rural England Health and Place 11 337–48 Cornish C 1997 Behind the crumbling walls: the reworking of a former asylum’s geography Health and Place 3 101–10 Crilley D 1993 Megastructures and urban change: aesthetics. Beverly Hills CA 219–41 Dear M and Taylor S 1982 Not on our street: community attitudes to mental health care Pion. surveillance and the subjects and spaces of fitness and health Health and Place 12 65–78 Geller J 2000 The last half century of psychiatric services as reflected in Psychiatric Services Psychiatric Services 51 41–67 Geores M 1998 Surviving on a metaphor: how health = hot springs created and sustained a town in Kearns R and Gesler W eds Place and health: making connections in 147 geographic research Syracuse University Press. Oxford Holcomb B 1993 Revisioning place: de. Berkeley CA Charteris R 1987 Ashburn’s fall? Otago Daily Times 5 December Conradson D 2005 Landscape.homewood.org/healthcentre/ main.
co. Barnett J R and Newman J 2003 Placing private health care: reading Ascot hospital in the landscape of contemporary Auckland Social Science and Medicine 56 2303–15 Lynch K 1960 The image of the city MIT Press.uk/Find-a-centre/Facilities/ Priory-Hospital-Bristol) Accessed 20 March 2006 Priory Group 2005h Priory Hospital Woking (http:/ / www. past and present Pergamon Press.uk/Find-a-centre/Facilities/ Priory-Hospital-Altrincham) Accessed 20 March 2006 Priory Group 2005d Priory Hospital Chelmsford (http:/ / www. London 203–23 Moon G 1995 (Re)placing research on health and health care Health and Place 1 1–4 Moon G 2000 Risk and protection: the discourse of confinement in contemporary mental health policy Health and Place 6 239–50 Moon G and Brown T 2000 Governmentality and the spatialized discourse of policy: the consolidation of the post-1989 NHS reforms Transactions of the Institute of British Geographers 25 65–76 Moon G and Brown T 2001 Closing Bart’s: community and resistance in contemporary UK hospital policy Environment and Planning D: Society and Space 19 43–59 Moon G.prioryhealthcare.uk/Find-a-centre/Facilities/ Priory-Grange-Heathfield) Accessed 20 March 2006 Priory Group 2005c Priory Hospital Altrincham (http:/ / www.prioryhealthcare. Oxford Kearns R 1993 Place and health: towards a reformed medical geography Professional Geographer 46 139–47 Kearns R and Barnett J R 1999 To boldly go? Auckland’s starship enterprise: metaphors and the marketing of a children’s hospital in New Zealand Environment and Planning D: Society and Space 17 201–26 Kearns R and Joseph A E 1993 Space in its place: developing the links in medical geography Social Science and Medicine 37 711–17 Kearns R and Joseph A E 1997 Restructuring health and rural communities in New Zealand Progress in Human Geography 21 18–32 Kearns R and Joseph A E 2000 Contracting opportunities: interpreting post asylum geographies of mental health care in Auckland.co.prioryhealthcare. London Moon G 1988 Is there one round here? Investigating reaction to small scale mental health hostel provision in Portsmouth.148 Kearns G and Philo C 1993 Selling places: the city as cultural capital.co. England in Smith C and Giggs J eds Location and stigma: contemporary perspectives on mental health and mental health care Unwin Hyman.co. health: influence and practice in Ontario Environments 26 37–47 Parr H and Philo C 1996 ‘A forbidding fortress of locks.prioryhealthcare. Joseph A E and Kearns R 2005 Towards a general explanation for the survival of the private asylum Environment and Planning C: Government and Policy 23 159–72 Moynihan D P 1998 On the commodification of medicine Academic Medicine 73 453–59 Naidu G M and Narayana C L 1991 How marketing oriented are hospitals in a declining market? Journal of Health Care Marketing 11 23–30 Paine C 1998 Design of landscapes in support of mental Graham Moon et al.prioryhealthcare. Philo C and Burns N 2003 ‘That awful place was home’: reflections on the contested meanings of Craig Dunain asylum Scottish Geographical Journal 119 341–60 Pellegrino E D 1999 The commodification of medical and health care: the moral consequences of a paradigm shift from a professional to a market ethic The Journal of Medicine and Philosophy 24 243–66 Philo C 1987a ‘Fit localities for an asylum’: the historical geography of the mad business in England as viewed through the pages of the Asylum Journal Journal of Historical Geography 13 398–415 Philo C 1987b Not at our seaside: community opposition to a nineteenth century branch asylum Area 19 297–302 Philo C 1997 Across the water: reviewing geographical studies of asylums and other mental health facilities Health and Place 3 73–90 Philo C 2004 The space reserved for insanity: the historical geography of the ‘mad-business’ in England and Wales to the 1860s Edward Mellen.prioryhealthcare. New Zealand Health and Place 6 159–69 Kearns R and Moon G 2002 From medical to health geography: novelty. Lampeter Pinfold V 1999 Community connections: geographies of rehabilitation amongst people with long term and enduring mental health problems Unpublished PhD thesis Department of Geography University of Nottingham Priory Group 2005a Overview (http:/ /www.co.uk/Find-a-centre/Facilities/ Priory-Hospital-North-London) Accessed 20 March 2006 Priory Group 2005f Priory Hospital Hayes Grove (http:/ / www.co. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 .prioryhealthcare.prioryhealthcare. Cambridge Madsen H 1992 Place-marketing in Liverpool: a review International Journal of Urban and Regional Research 16 633–40 Mansvelt J 2005 Geographies of consumption Routledge.uk/Find-a-centre/Facilities/ Priory-Hospital-Woking) Accessed 20 March 2006 Priory Group 2005i Priory Hospital Marchwood (http:/ / www.uk/Find-a-centre/Facilities/ Priory-Hospital-Hayes-Grove) Accessed 20 March 2006 Priory Group 2005g Priory Hospital Bristol (http:/ / www.uk/About-us/Overview) Accessed 20 March 2006 Priory Group 2005b Priory Grange Heathfield (http:/ / www. bars and padded cells’: the locational history of mental health care in Nottingham Historical Geography Research Series Paper 32 Historical Geography Research Group.uk/Find-a-centre/Facilities/ Priory-Hospital-Chelmsford) Accessed 20 March 2006 Priory Group 2005e Priory Hospital North London (http:/ / www.co. place and theory after a decade of change Progress in Human Geography 26 605–25 Kearns R.co.co. Edinburgh Parr H.prioryhealthcare.uk/Find-a-centre/Facilities/ Priory-Hospital-Marchwood) Accessed 20 March 2006 Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020 -2754 © 2006 The Authors.
uk/publications/magazine/tsarticles/ 2000/qualdrive.prioryhealthcare.uk/Find-a-centre/Facilities/ Priory-Hospital-Glasgow) Accessed 20 March 2006 Priory Group 2005m The Priory Ticehurst House (http:/ / www.priory-hospital.uk/Find-a-centre/Facilities/ The-Priory-Ticehurst-House) Accessed 20 March 2006 Priory Ticehurst House 2005 Statement of purpose The Priory Ticehurst House. Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006 . Lanham MD Wilson K 2003 Therapeutic landscapes and First Nations peoples: an exploration of culture.co.htm) Accessed 20 March 2006 Rose G 2001 Visual methodologies: an introduction to interpreting visual materials Sage.prioryhealthcare.prioryhealthcare.co.co. London 30–45 149 Smith C 1987 Mental health and the fiscal crisis: the prospects for a socially conscious urban geography Urban Geography 8 55–64 Smith C 1989 Privatisation and the delivery of mental health services Urban Geography 10 186–95 Smyth F 2005 Medical geography: therapeutic places. London Sennett R 1992 The uses of disorder: personal identity and city life W.uk/ htm/priory.W. Norton.co. Birmingham Trans Inst Br Geogr NS 31 131–149 2006 ISSN 0020-2754 © 2006 The Authors. health and place Health and Place 9 83–93 Wilton R D and deVerteuil G forthcoming Spaces of sobriety/sites of power: examining social model alcohol recovery programs as therapeutic landscapes Social Science and Medicine Woodbourne Priory Hospital 2004 Statement of purpose Woodbourne Priory Hospital.uk/About-us/The-Priory-GroupsHistory) Accessed 20 March 2006 Priory Group 2005l Priory Hospital Glasgow (http:/ / www.prioryhealthcare.co. New York Simmel G 1995 The metropolis and mental life in Kasnitz P ed Metropolis: centre and symbol of our times Macmillan.sense. Wadshurst (Roehampton) Priory Hospital 2005 Introducing the Priory Hospital (http:/ /www.org.Selling the private asylum Priory Group 2005j Priory Grange Hemel Hempstead (http:/ / www.uk/Find-a-centre/Facilities/ Priory-Grange-Hemel-Hempstead) Accessed 20 March 2006 Priory Group 2005k The Priory Group’s History (http:/ / www.htm) Accessed 20 March 2006 Waitt G and McGuirk P 1997 Selling the waterfront Tijdschrift voor Economische en Sociale Geografie 88 342–52 Williams A 1999 Therapeutic landscapes: the dynamic between place and wellness University Press of America. spaces and networks Progress in Human Geography 29 488–95 Todd H 2000 The drive for quality Talking Sense 46 (http:/ / www.
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