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Psychiatric spaces in transition: discourse, dwelling, doing

Periodic Reporting for period 1 - GART-PSYSPAC (Psychiatric spaces in transition: discourse, dwelling, doing)

Reporting period: 2017-01-01 to 2018-06-30

How societies treat their members once termed ‘mad’ and now termed ‘mentally ill’ is an index of civic willingness to promote human flourishing for all. Of particular significance are dedicated spaces – ‘psychiatric spaces’ – created for the care and maybe cure of such individuals, notably the most 'institutional' of such spaces comprised by large residential settings for in-patients, the asylums of old now recast as mental hospitals or psychiatric campuses. How such spaces are inhabited, used and understood, positively and negatively, by in-patients – but also by doctors, nurses, ancillary workers, volunteers, neighbours and others – become core issues for assessing broader patterns of social transformation.

The objective here is to foster an experience-based and overtly ‘spatialised’ perspective on European psychiatric transition between older institutional and more recent de-institutional mental health care. Specifically, it explores the experiences of different cohorts of patients, staff and others for whom Gartnavel Royal Hospital, Glasgow (Scotland, UK) has been a central point of reference, encounter and meaning. Gartnavel comprises a near-unique site, having housed a ‘lunatic asylum’ since the 1840s now closed and in partial ruins, alongside smaller wards/facilities added subsequently and a state-of-the-art acute in-patient facility opened in 2007-8. The overall site encompasses a diversity of spaces, each tied to different phases of psychiatric transition, and the project recovers experiences correlated with both Gartnavel as a whole and also with particular spaces (buildings, wards, corridors, gardens, walks). Probing and interpreting such experiences enables us to scale up to re-evaluate the intersections of psychiatric transition and social transformation.

A crucial conclusion is that ways forward for future psychiatric landscapes need to fuse the obvious gains from modernised, ‘enlightened’ and dignity-enhancing environments with what appears to have been the more organic production of sharing, community and busy-ness attendant on the less segregated geographies of older institutions. Additionally – mirroring reflections from participants, many of whom acknowledge the inevitable imperfections and risks associated with residential-institutional settings – we believe that there is still a crucial place for ‘the asylum’ (in all of the positive senses of refuge and respite) as one facet within a distributed portfolio of deinstitutionalised mental health provisions.
In tandem with documentary/map work on paper sources illuminating changes at Gartnavel, we have undertaken qualitative investigation pivoting around 33 in-depth interviews (generating 1000+ pages of transcripts) accessing the experiences of 10 patients/ex-patients, 14 staff (doctors and nurses), 6 volunteers, 1 architect, 1 services manager and 1 recreational site user. An arts workshop was held with 5 in-patients, working with photos of the site; several researcher walks circling the site were conducted; and informal Gartnavel events were witnessed. Numerous creative products, photographs, video clips and observational field notes resulted, producing – with the transcripts – a wealth of evidence to meet the project’s objectives.

The findings are detailed and nuanced, but we venture the following:
• Gartnavel as institution and site has been incredibly meaningful for all participants, central to their senses of self (personally and/or professionally) – proving that the material spaces of mental health care are fundamental to how psychiatric transition is lived, perceived and sensed (as success or failure);
• For many, Gartnavel has been “a happy place”, even across different incarnations, providing sanctuary, nurture and inclusive social relations, with powerful evocations of Gartnavel as ‘community’, ‘village’ and site of ‘belonging’;
• For some, it has also been a place of sadness, frustration and tragedy, acknowledging too that it can never entirely escape being a place of surveillance and control;
• There is pronounced recognition of specific ‘territories’ and ‘boundaries’ across the site – delimiting different subgroups of patients, types of activity, domains for patients and ones for staff – all supporting complex sets of meanings, negative and positive;
• There is clear valuing of the outdoors resources of the site, whether in past days (with horticultural work) or today, with participants speaking of therapeutic and social benefits deriving from gardening, walking or even just sitting, viewing and chatting;
• Different perceptions arise about the boundaries of Gartnavel – for some, it is the old boundary wall; for others, it is the entrance to the new building – and many accounts tell of a place that is much less sealed-off from the surrounding city than was true of earlier years;
• There is broad consensus about improvements in the built fabric of Gartnavel, now offering lighter, spacious and fit-for-purpose facilities, affording greater privacy, dignity and protection of patients than was previously the case – with appreciation for the range of specialist activities now on offer for patients;
• There is also some consensus about what has been lost from the social fabric of Gartnavel, in that older regimes – even if seeming more chaotic and crowded – arguably permitted a greater ‘busy-ness’ on the part of patients, less opportunities for boredom, and a more enhanced overall sense of shared community (across/between staff, patients and volunteers);
• Thus, despite undoubted gains in how the environment of the Gartnavel campus is now organised and maintained, there is concern about a spatial and temporal over-compartmentalisation of cohorts and activities, with a feeling that the overall ‘liveliness’ of the institution has been compromised – and with opportunities for mutual learning and local solidarities thereby diminished.
We are drafting academic papers and a book proposal, while the implications of our project beyond academia are many. To develop these implications, we always envisaged a ‘living archive’ of materials for wider dissemination, and during the last 18 months our ideas have matured – aided by additional ‘Knowledge Exchange’ funding from the University of Glasgow – for both a project website and a pop-up exhibition. The website (www.gart-psyspac.eu) will deploy a navigable Gartnavel site map with embedded links to different spatially-referenced interview quotes (anonymised), artworks, photos and video clips, as well as hosting working/published papers, position statements – about the future of ‘the asylum’; about the need to fuse the strengths of older and newer institutional regimes – and an interactive area (soliciting further input to our ‘living archive’). The pop-up exhibition will take the form of a ‘board game’ in an easy-to-move wooden box, complete with a base site map, packs of images, cards of quotes and also post-it notes (for others to record new thoughts), to use at Gartnavel’s Over the Wall open day event in late-August 2018, an History of Psychiatry conference in Glasgow days later and then, possibly, during next year’s Annual Glasgow Arts and Mental Health Festival. Options will also be explored for other uses of the exhibition: as induction materials for new patients and staff; as teaching resources for trainee staff or visiting student groups; and as an input to Scottish mental health policy symposia.
Shows a view of the overall Gartnavel campus, new in-patient building and old 'asylum'