Everyday Magic and Helpfulness
The first thing to say is that the idea that ordinary things can help people experiencing distress is not new and dates back 25 centuries to when Hippocrates helped his readers distinguish between ‘unhealthy places like swamps and healthy places like sunny breezy hillsides’.14 In the 1940s Cassel considered the healing of fractured families an essential venture for post-war psychiatry in order to ensure collective as well as individual healing.15 In Richmond, the Cassel Hospital for Functional Nervous Disorders undertook psychosocial experiments on ‘therapeutic community’ where they treated patients’ mental disorders as part of a wider network of social relationships and an instance of social, rather than individual, breakdown, encouraging patients to take active roles in the hospital management. However, it could be argued that it is only recently that public health has started to rediscover the importance of community and place in people’s recoveries.14
So, how do ordinary people, ordinary places and ordinary pursuits work for people experiencing sometimes acute distress? Why do people in hospitals with tree views have significantly shorter hospitalisations, less pain medication and fewer negative nurse notes than those without?16
Why do people so often report outdoor space to be therapeutic?17 Why is a sense of community integration and connectedness to other people so important?18 How is it that volunteering in a community arts programme is considered therapeutic for some people experiencing psychological distress?19
Well, central to understanding this requires a reimagining of what constitutes a ‘therapeutic space’. The term ‘therapeutic landscape’ has had prominence in recent years in health geography. Therapeutic landscapes allow for an understanding that environmental, social and individual factors interact in certain natural or built environments and that these facilitate the experiencing of subjective well-being. As part of this shift there has been an emphasis on the idea that ordinary places have potential for well-being—places like the home, local community amenities or the garden.20-22 Here, any specific space or setting could have potential for well-being albeit with the proviso that context is central and the challenge is to bring about an understanding of how health and well-being are emergent in and through these complex contexts of experience.1,20 This notion that many everyday activities and spaces can be therapeutic has been increasingly incorporated not only into professional but also public discourse.
If you ask most people in your street they’ll likely be able to tell you about things, people or places that they find therapeutic. They might tell you that walking by the river or painting or reading a book or handgliding or any manner of other things are therapeutic for them. And herein lies a strength and weakness of Furedi’s therapeutic culture. On the one hand lies an opening for those proponents of the social model on mental distress. Some of our work here is already done. We have a growing public acceptance for the wide benefits of non-medical interventions on psychological well-being. On the other hand, to some extent, we are still problematically restricted by that word—‘therapeutic’. As a term, therapeutic is one still mired in the discourse of biomedicine. Its meaning in the dictionary is ‘relating to the healing of disease’ and synonyms include ‘healing’, ‘curative’ and ‘medicinal’, among others. In recent years we have seen the words ‘therapeutic’ and ‘therapy’ move beyond the realms of medicine into the common vernacular where people regularly talk of retail therapy, bibliotherapy and all manner of other therapies.
One might conceptualise this as part of Furedi’s ‘therapeutic culture’, made possible through the enclosing tendencies of the psy institutions to appropriate themselves into an increasing number of areas of ordinary life (and, we stress again, sometimes helping people in doing so).
Some might argue that this concept of the therapeutic will, however, always be problematic since the ‘therapeutic social’, the walks in the countryside, the art groups and the other non-professional settings, spaces and places that people experience positively are always delegitimised in the hierarchy of medicinalities. Here, social and cultural ‘things’ can be therapeutic but always less so than biomedical and professional ‘things’. The social, the informal and the community will always find itself underprivileged in this hierarchy of value. The appropriation of medical terms to make sense of the social irrevocably refracts the informal and the social through the lens of biomedicine, framing such practices and activities within the realm of doctors and disorders and disease and other medicines. It reproduces biomedical distress and privileges biomedical interventions, even in their absence.
For some, the concept of therapeutic will ultimately continue to reinforce a biomedical approach to distress. The lay understandings, lay activities and knowledges, the impact that many non-trained, non-expert, non-psy ventures and activities that don’t fit within the medical model, but which many say have value, will remain inferior to the specialist preserve of medicine and its practitioners. So we may sit making bad tea on the tea bar at the local unemployed families centre project and watch people reap enormous psychosocial benefits from doing art in a place where nobody knows their history and where they have no built-in labels and stigma that walks through the door before they do, talking to people, sharing space, getting advice, doing yoga and volunteering. They might tell us about the massive impact this has on their mental well-being, more so than any statutory service has. The staff might tell us the same thing. Talk to staff and volunteers about whether this is a mental health centre or a mental health intervention, and the answer is that it is definitely neither of these. They have no professionals here to do that kind of work. There is no ownership. The centre is understood as therapeutic but not the therapeutic that can be provided by experts. They are really therapeutic. The centre is just a bit therapeutic.
So the problem is that the word therapeutic really has two meanings. ‘Therapeutic’ is predominantly a medical term (but only predominantly). It is also a lay term. One therapeutic is the medical therapeutic of experts and distress; it encompasses a range of interrelated medical activities including diagnoses, treatments, psychiatrists, psychologists, psychotherapy, pharmacology, experts, research, scientific evidence and the National Institute of Clinical Excellence (NICE). It is a term owned, enclosed and defined by the practitioners of medicine. And then there is ‘therapeutic- light’. This is our therapeutic, the public’s therapeutic. Things that are ‘therapeutic-light’ can be beneficial, healing and healthy, but some might argue that they can never truly be understood to be ‘properly medical therapeutic’ because to be this involves experts, diagnoses, therapies, evidence-based medicine and research. And as long as we describe any single activity of social life as therapeutic, we are immediately relegating it into the ‘therapeutic-light’ bracket. Because experts, scientists and practitioners are the only ones who have the keys to the properly medical therapeutic term. When we say things are therapeutic, we are automatically saying they are not as therapeutic as medical things. And this is no good if you think that what some people experience, for instance, at the centre above, is actually superior to the ‘properly’ professional biomedical therapeutics that they have experienced in the past.
Relationships of power are manifest in daily language through words, phrases and language forms, and the assumptions they carry.23 Some of these assumptions are very visible and some, like the implications of the word therapeutic, are less visible. Nonetheless, they are there and can be problematic when you try to shift the way an issue is understood when the only language you have is from the paradigm that you’re trying to shift in the first place. We live in a therapeutic culture24 where citizens are understood as emotionally fragile and confused, in need of guidance from wise experts with a privileged hotline to the truth. The widespread use of therapeutic jargon and techniques for ‘better relating’ has made it harder for many people to use their own intuitions to see how their feelings arise from what is going on in front of their noses. Moloney suggests that the therapeutic outlook and language have become all-pervasive, and that their mastery is essential to success in education, work, play, love and everything else.25
One way to start addressing this issue of linguistic connotations is to just drop the word ‘therapeutic’ and substitute it for ‘helpful’. Now some people won’t like this because they insist that they have successfully reclaimed the concept of therapeutic, and for them its connotations have shifted towards a greater sense of community and/or self-ownership. Others have argued that many psy professionals value these other kinds of spaces and support systems alongside formal therapeutic processes, so what does it matter that they use the term therapeutic to describe them? But we are suggesting that it does matter. If we accept that therapy and the therapeutic are irrevocably mired in medicine, passivity and lay impotence, then it’s clear that we need to rethink our concepts.
So let’s say that the word ‘therapeutic’ is no longer fit for purpose. Therapy and the therapeutic are not what happens in these spaces. People don’t engage actively in curative and healing practices and techniques; they don’t do therapeutic things. That’s it. Goodbye to ‘therapeutic’ and all the baggage it carries with it.
And it’s hello to helpful. We are going to talk about helpful practices, settings, spaces, organisations and landscapes. Helpfulness is characterised not by curing, healing and medicine but by humanity, neighbourliness, communitarianism and connectedness. By support and compassion and benevolence. Here we have a word that sums up the massively beneficial impacts of many routine human practices and everyday forms of expertise. Also inherent in this term is that it allows us to reposition distress as banal, albeit incredibly debilitating, artefacts of everyday life. We argue that it allows an emphasis on the fundamentally social nature of distress and trajectories away from distress as well as a broadening of our understanding of what constitutes that which is helpful.
Understanding what constitutes a helpful space requires a consideration of the multiple ways in which social experiences can reveal valuable impacts on people’s lives. Helpful spaces can provide environments where people encounter a range of resources, activities, experiences and relations without assuming the identity of a person receiving therapy or indeed a deviant that waits behind the glass partition. Formal health policies traditionally tend to overlook the importance of intersubjective processes that contribute to a positive sense of self.26 Indeed if people are given access to such metaphorical and physical space, they can experience superior outcomes than by trying to work on their problems while enveloped in regimes of alien and sometimes uncomfortable power and authority. Helpful spaces can support disadvantaged people to develop helping networks in ways that are often difficult in statutory services.27
As part of the tradition of ‘geographies of wellness’, sense of place can be understood to be created through a process of coming together of various environmental, social, cultural and historic factors. How this relates to subjective well-being relates not only to what a place has to offer in terms of amenities and opportunities, but to whether one feels safe and secure.28,29 Recent empirical work has suggested that the development of what we are now, still a little self-consciously, calling ‘helpful spaces’ can incorporate a wide array of contextual settings. They could include social firms where people can benefit from workshops in bicycle maintenance.30 Here people can experience a much-needed distraction, an accepting social group and a sense of being ‘held’ by the interpersonal environment. Helpful spaces may take the shape of ‘walk and talk’ groups31 which both those with histories of statutory service use for their distress and those without can meet for organised walks at the same time and day each week. In such groups, research suggests that walkers report benefits that include ‘being with people with similar experiences’ and ‘taking an active role in something’. Some have suggested that the psychosocial benefits of exercise depend on the environment it is performed in, with walking reducing what the authors call anxiety, depression and anger, and increasing revitalisation and tranquillity.32
The arrangement of space can confer information that make landscapes more or less interesting and make space more or less beneficent. Numerous studies incorporate the restorative impact of green and waterside environments on mood.17,33 It has been suggested that there is an inverse relationship between living less than one kilometre away from green space and what the authors of that text refer to as depression and anxiety. Indeed, each additional weekly use of natural environment lowers the risk of poor mental health.17,34-36
Other work has suggested benefits for people through volunteering in community arts organisations19 and in various forms of arts participation37,38 including music, painting, drama and dance.39-41 There is evidence to suggest that community arts projects can have a significant impact on mental well-being, especially with regard to reducing isolation, and improving self-esteem and confidence.42,43 Engaging people in creative activities, and using a mentor-based approach, has been found as a way of improving social networks, reconnecting people with their local communities and improving psychological and physical well-being.44 Creative art activity also often allows people to explore life in a safe environment, to find their own structure rather than having it imposed on them; it allows the collective and individual expression of emotions nonverbally which can, for many, be vital and liberating.45