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I Mental Health Across the Globe: Conceptual Perspectives from Social Science and the Humanities

Occupying Space: Mental Health Geography and Global Directions

Cheryl McGeachan and Chris Philo

Is there any worth in living? Live not for our own purpose. Instead of being arranged like rabbits, it is better to die. It seems that we are just occupying space (Rupa as quoted in Jadhav and Barua 2012, p. 1361, author’s emphasis). This extract comes from the clinical assessment of a ‘sad young lady’ from Assam in northeast India, diagnosed with dysthymia. After losing her husband in an elephant attack, Rupa has experienced a range of difficulties, including sleep problems, panic attacks and a deep sense of foreboding leading her to feel hopeless and humiliated about her mental health condition and fearful about her future (Jadhav and Barua 2012, p. 1361). These individual concerns of stigmatization and fear coincide with broader apprehension over treatment and confinement of individuals experiencing mental health problems, and are symbolic of a wider conceptualization of mental health and its spaces. Many academic disciplines, such as sociology, history of medicine, critical psychiatry, history, psychology, transcultural psychiatry and geography, have grappled with the different ways in which difference, in relation to ‘madness’, has been configured as mental illness and traced through a range of sites and spaces across the globe (see Porter 1987; Philo 2004; White and Sashidharan 2014). Many of these pieces have been informed by the work of French theorist Michel Foucault (1967, 2006, see also Philo 1992), who, as Parr (2008, pp. 3-4) has noted, ‘outlined a specifically spatial impulse in the historical disciplining of Unreason (as madness) by Reason’ in his attentiveness to the

C. McGeachan (*) • C. Philo

School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK © The Author(s) 2017

R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, DOI 10.1057/978-1-137-39510-8_2

spatial relations involved in separating and segregating individuals labelled with mental health problems in society. The impulse was arguably productive of a nuanced governmentality which was itself anchored in the development of a specialist science of the so-called mad mind. This emergence of psychiatry developed in a range of specific scientific sites, spaces and places, such as asylums, madhouses and hospitals, and this constricting web of governmentality arguably allowed the legitimization of psychiatric theory and practice through these spaces (see Parr 2008, pp. 1-30; Philo 2012).

There is therefore, undoubtedly, a complex geography to mental health (see Philo 2004, 2005). The geographies of mental health can comprise a number of elements, including the variations in incidences of mental ill-health, the range of locations occupied by the variety of institutions and facilities designed to diagnose and treat individuals experiencing mental health problems, and the different environmental components employed in the creation of therapeutic regimes for those experiencing mental ill-health (Philo 2005). For example, a range of spatial dimensions can be considered through a geographical lens. From the complex inner workings of the mind of individuals to a range of bodies experiencing and treating mental health problems that weave in and throughout medical and non-medical landscapes, geographers have attempted to chart the use and construction of these varied landscapes. The global corporate pharmaceutical machines that ensnare local general practitioner (GP) practices and hospitals in their webs are considered alongside the political action that sweeps across international borders. This fixing and asserting the position of mental health in global agendas and public discourse are simply a few of the spaces that comprise the complex geography of mental (ill-)health. This chapter seeks to highlight the significance of thinking geographically about mental health in a range of ways and aims to demonstrate what a geographically informed analysis of mental health can offer to future debates within global mental health. Beginning with an overview of mental health geography, this chapter will then focus upon four interconnecting strands of the subfield, that of ‘spatial epidemiologies’ and the ‘psychiatric city’, provision and the complex spaces of care, and therapeutic landscapes, to highlight the significance of a geographical approach. A range of examples from the work in mental health geography and beyond will be used to illustrate the different geographical components revealed by these studies, and possible connections of this work to future engagements with mental health geography beyond the Global North will be highlighted. Finally, future challenges and agendas for further critical exploration into global mental health from this perspective will be suggested, particularly in reference to the lack of attention currently given to those sites, spaces and voices in the Global South.

 
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