MENTAL HEALTH AND THE ENVIRONMENT
(This article was published in an edited form in the journal, "Care in Place" Vol 1 No.2. It is reproduced here with permission of Routledge publishers. The version here includes some material not included in the edited and published version - for example the discussion towards the end which is about the implications for community development, the role of experts and my disagreements with Professor Hugh Freeman on these points ).
"Home is where the heart is."
The word 'ecology' describes the scientific understanding of how living organisms interact with their environment. Literally ecology oceans the science or theory of home, derived from the Greek word, oikos, meaning house. Your home can be seen as many different concentric areas, from the whole planet down to the body in which you live. Graham Bell "The Permaculture Way", Thorsons Publishers 1992 p. 83.
A constant theme of writings by Green activists is the idea that our ecologically unfriendly civilisation is at the same time one that is highly stressful and that psychological disorder is the result of this. Green writers argue the need to replace an income and consumer orientated culture with a society which emphasises a different notion of the quality of life. There is a clear message that a different relationship with the environment will not only put less stress on planetary ecology but make us happier and mentally healthier. (This is true, for example, of Hazel Henderson' "The Politics of the Solar Age: Alternatives to Economics" Indianapolis, Indiana, USA 1983). In this essay I look at what evidence there is for a relationship between environment and mental health. It is important at the start of such a discussion to observe that the environmental characteristics focused upon by green activists as in need of change for reasons of minimising pollution, maintaining species diversity, preventing global warming and so on are not necessarily the same environmental characteristics we are thinking about when we consider the negative psychological effects of people's surroundings. Nevertheless, the technologies and different designs to resolve the environmental crisis of planetary ecology will often need to be implemented in the same places and spaces as those locations where we can find examples of 'environmental psychological toxicity'. The psychological need to have a room of one's own must be met in the same building we also need to make energy efficient and we must design and build for both these elements together.
Relating environment to mental health is not made easy by a lack of definiteness both in the concept of mental health and in the concept of environment. For the purposes of this essay I am going to define mental health as the extent to which a persons thoughts and feelings are congruent with coping with their day to day life. For my concept of environment I am going to borrow from the original meaning of the Greek Word oikos - which means home. We can imagine environment as a set of rings around any individual which radiates from where they are, to include their home and place(s) of work and leisure, up to and beyond the whole planet. (The idea that the moon influences madness is a very old environmental idea of the relationship of madness with the cosmos.). We can therefore make a useful distinctions between micro-environments - the influence of immediate surroundings like building and room design and macro-environments - our place as individuals and groups in larger patterns and spaces like districts, cities, regions and continents. I shall examine the influence of micro-environments ant macro-environments.
Everyone lives in both a social environment and a physical one and the two interrelate. Here I am interested in environment or ecology as the physical environment. Physical surroundings way have their effect on the human psyche through their direct sensory effects. Alternatively our surroundings may effect our thoughts and feelings by the way they inhibit or filter our experience of other things (buildings, for example, detach us from the external environment). In addition our physical surroundings mediate or effect, inhibit or encourage our social and personal relationships.
The asylum as 'an environment'
If at first glance all this seems very distant from the conventional concerns of Psychiatry a closer look reveals that many examples of the relationship between mental health and the environment can be found very close to home. The idea that physical surroundings influences mental health partly underpins moves towards de-institutionalisation and care in the community. Thinking on 'institutional neurosis' or 'institutional dependence' has stressed the way that large asylums, just through their scale and design, have tended to congregate and segregate their inmates from the rest of the community. By attempting to provide all needs internally, creating a sort of mini-world, they created a uniformity and routine that denied inmates any choice or privacy and thereby denied them any agency, any ability to influence their own individual world. This completed the process of dis-empowerment associated with slides into madness. The congregation and segregation perpetuated stigma and created fear of the outside world for inmates and fear of inmates by 'the community' outside. Within the institution there was little possibility to regain an ability to cope with the external world indeed the institution made people's mental health problems worse.
As enclosed communities many asylums had farms. In more recent times the extensive grounds around asylums became gardens in which inmates have often continued to work, If there it one remark that is made without exception against the closure of asylums and de-institutionalisation it is about the loss of their gardens which implies a universal assumption that gardens are therapeutic to the mind. Gardens are, of course, models for the environment as paradise and if we were to try to question the basic idea of their therapeutic quality we would have great difficulty explaining a large percentage of the world's poetry. (You can Pick up any compendium of verse to verify this - when I picked one of the shelf I not only found Wordsworth on daffodils, Donne on Twickenham Wardens but Charles Kingsley on 'The Poetry of a Root Crop'.)
I have no wish to romanticise the forced field labour of nineteenth century asylum inmates cut off from the outside world, nor the drudgery of mowing grass (dog toilets) around public sector buildings. However, there probably is something in the notion that gardening will often be an appropriate therapeutic activity whether for inmates or, where they have appropriately designed garden spaces, for the population at large. Anecdotally, a psychiatric nurse has told me his memory of how most patients would hang around after lunch, reluctant to return to the drudgery of various repetitive industrial ( so called) therapies. The garden group, however, would pop in, eat their food, and be gone again without this reluctance. Garden work can be varied in its physical tasks and its seasonal character. It can involve an unforced but positive learning process and therefore become interesting and engaging, It usually enables the worker to retain some control over his or her labour process without being machine paced. It is relaxed about dirt. Deadlines there are but they are not usually tight ones. It is possible to see the results of one's labour. It usually allows one too, the scope to adjust one's work relationships to one's individual needs - either working largely solitarily or alongside others as one wishes.
The Mental Hospital as an example of a disorientating environment
Alas the gardens are one of the few things that one can say in favour of asylums (and are usually missing around the District General Hospitals that now accommodate many psychiatric wards). The critique of the asylum, which comes from the relationship of physical structure and social relationships, ran be carried into many details. The long, usually enclosed, corridor so typical of asylums in and of itself has been found to be disorientating. 4 study by Mayer Spivak looked into the unconscious effects of 4 long mental hospital corridors and concluded ".....that such spaces interfere with normal verbal communication due to their characteristic acoustic properties. Optimal phenomena common to these passageways obscure the perception of the human figure and face, and distort distance vision. Paradoxical visual cues produced by one tunnel created
interrelated, cross-sensory illusions involving room size, distance, walking speed and time. Observations of patient behaviour suggest the effect of narrow tunnels upon anxiety is via the penetration of the personal space envelope" (M. Spivak "Sensory Distortion In Tunnels and Corridors". Hospital and Community
Psychiatry l8, No 1. January 1967)
(The corridor form of asylum arose as Victorian asylums developed as a modification of prison design - of cells off a central corridor. This is explained by the leading architect of Victorian asylums George T. Hire in a paper titled "Asylums and Asylum Planning" read before the Royal Institute of British Architects in February 1901 published in the Journal of the RoyaI Institute of British Architects Feb 1901).
Multiply disorientating or distressing environmental features are entirely typical of asylums or are commonly found in the District general Hospitals that now include psychiatric wards. Lighting provides many examples. "In a building with a uniform light levels there are few 'places' which function as effective settings for human events. This is because, to a large extent, the places which make effective settings are defined by light...People are by nature phototrophic they move towards light and when stationary, they orient themselves towards the light." Since people naturally walk towards entrances which usually tend to be lighter, or key points in circulation systems, these should be better lit than their surroundings, so as to become natural targets. "If there are places which have more light than the entrances and circulation nodes people will tend to walk towards them and will end up in the wrong place - with frustration and confusion as the result" (Alexander et al. "A Pattern Language" O.U.P. 1977 PP 645-646). In Nottingham I can think of several psychiatric wards where the best lit place is the corridor itself. Such corridors have a bright flickering neon light down the centre ceiling, winding up tension on the ward. "For virtually all working interiors and most relaxing interiors the occurrence of flicker is disliked...Large differences in flicker sensitivity were found with some people saying a certain flicker modulation was imperceptible whilst to others it was intolerable" (R. Boyce. "The Luminous Environment" in David Cate, Peter Stringer et. al. "Environmental Interaction: Psychological Approaches to our Physical Surroundings" Surrey University Press 1975 ).
Lighting is also important because it determines how well people can see facial expression, gesture and other expressions of the feelings of others. This reminds us that mental health problems are, crucially, manifested in difficulties in interpersonal relations which are reflected in spatial terms. "People diagnosed as schizophrenic tend to display an erratic spatial behaviour pattern either sitting too close (beside) or too far away for that particular situation. Schizophrenic spatial behaviour provides an excellent example of what we mean by the use of space for mediating information flow. Rather than their behaviour being irregular, it shows remarkable consistency, in that the positions chosen allowed for the least communication. This expresses one of the basic characteristics of schizophrenia which is the withdrawal from social relationships." (David Canter and Cheryl Kenny, "The Spatial environment in Environmental Interaction" op.cit. ppl43-144.) All the more reason then for a spatial organisation that enables people to regain a socially integrated behaviour pattern. For this to occur they need not only good lighting and acoustics, for communication to be noticed accurately, hut spaces and places where it is possible to make choices about about communication and social behaviour. The lack of privacy in most asylums and psychiatric wards does not help in this respect. On the psychiatric ward it is virtually impossible to make choices about personal space. Certainly doors to one's 'private space' which have windows for observation do nothing to reassure people suffering from paranoia.
Personal Space and Mental Health
Privacy has been defined as "freedom from unwanted intrusion and the freedom to determine the place and time of communication" (Ittelson quoted in "Environmental Interaction"). This useful definition enables us to speculate whether a prime cause of schizophrenia is the lack of privacy that parents afford to their children as they grow up, affording their offspring no space, in the psychological and locational sense, in which to take their own decisions and to be themselves. In this respect the ability to be oneself is very much a function of one's having a place to be it in, away from the intrusion and control of others. It was Virginia Woolf, a sufferer of recurrent mental health problems diagnosed as manic depression, who became famous for making the psychological case for a' A Room of One's Own'.
Psychiatrists Leff and Vaughan have investigated the likelihood of relapse of people after a schizophrenic breakdown and find that it is much higher for people who return to live in settings where the relationships (usually with parents) are 'High Expressed Emotion' of a critical and hostile character. Others, like clinical psychologist Lucy Johnstone, have speculated that the over critical and over involved relationships may account, not only for relapses, but for initial breakdowns.(A discussion on these issues will he found in her article in "The Journal of Mental Health Sept. 1993". My article "Madness and its Causative Contexts" in "Changes, the Journal of the Psychotherapy Section of the British Psychology Society", also provides a way of understanding madness in these terms.)
At any rate there is a markedly higher statistical difference in relapse rates for patients who spend more than 35 hours a week with critical and hostile relations compared with those who spend less than 35 hours a week with their relations. In short, to be in a different place is probably more helpful than any form of therapy.
It would very obviously be far too sweeping to claim that High EE is caused by spatial or building design characteristics in which people cannot find their own private space. Nevertheless it seems reasonable to suggest that this would make a big difference in some cases. Writings and research by psychologists- like Newman about 'defensible space' suggests that clearly defined boundraries between public space, semi-private areas and private territory are essential for well being. Likewise some architects and town planners like Christopher Alexander and his colleagues at the Centre of Environmental Structures in Berkeley, California, have written extensively on how spatial organisation and design should match social and psychological needs. 'Intimacy gradients' in housing are important to mediate and give choices about levels of social and personal interaction. A related idea is that people need places not only for being together but for being on their own. Thus a house for a couple need a shared coupled realm and space for each individual. Alexander and his colleagues also argue that houses with children need three distinct parts: a realm for the children, a realm for the adults, and common areas. Otherwise the whole house or flat tends to take on the character of a children's room with children's clothes, boots and shoes, toys and drawings everywhere in disarray. It seems obvious that for adults this, in turn, would considerably increase the tendency to be over critical and over controlling of their children and to lapse into 'High EE' as the family style. We can make another case for the accommodation needs of adolescence's. Once again how the house is laid out can considerably facilitate young peoples' changing needs - or exacerbate conflicts cover their growing independence.
As we try to move towards care in the community for people with mental health problems an underlying idea has been to create as nearly as possible support in 'ordinary living' and this has meant environments that are no different from those available to everyone else. One problem with this idea, however, is that what is ordinary outside the asylum is infinitely varied and, in this variety, there is more than enough scope for good and bad environments for psychological functioning. Flats in tower blocks are fairly ordinary - unfortunately "In high blocks particularly, people complain of feeling remote from any community life, with no real neighbourly contacts, yet at the same time lacking privacy, e.g. through the absence of sound insulation. Such disadvantaged groups as the elderly and physically handicapped often find these situations hazardous and stressful. This is because of their dependence on lifts and rubbish chutes which often fail to work, and because of their isolation (compared with conventional housing) and because they are harassed by groups of adolescents who hang around public areas and are remote from any observation or control. The common problem of public areas by litter, vandalism, urine or faeces and graffiti is also a source of distress to residents, not only because it is offensive, but also because it demonstrates the breakdown of the moral order of society - a situation out of control....in such circumstances it is surely impossible to feel any sense of comfort or familiarity around the surroundings of one's home." (Hugh Freeman, The Environment and Mental Health in Streetwise, Bulletin of the National Association for Urban Studies., Summer 1992 p27).
The Environment and Children - Traffic, Autonomy and High EE
Much of the writings about tower blocks is focused on the stress to mothers with young children who have difficulty with supervising play outside (Raymond Cochrane, "The Social Creation of Mental Illness", Longmanns, 1983 pp76-78). However this is not merely a problem for tower block dwellers. Traffic is a concern for all parents unless the lay out of neighbourhoods is right. In this respect Alexander and his colleagues make some highly interesting observations about neighbourhood lay out with children in mind. They quote evidence from research done on psychiatric morbidity on US Army intakes from the general population which showed that mental health problems were highly correlated with whether people had friends of the same age in early childhood. From this he deduces that the ability of young children to form friendships is highly important to healthy emotional development. However, the ability of children to meet other children and form unsupervised friendships is almost wholly a factor of safe connections within neighbourhoods which would allow children to meet each other. The authors of 'A Pattern Language' then go on to calculate that an average of 64 American households need to be connected in a way that is safe for children for these children to be able to find others of their own safe to play with.
This is a very striking idea of the influence of environmental lay-out on long term community mental health, Danger from traffic is another example of where environmental influences are damaging to child-adult relations. The need to he constantly under supervision limits the development of children, infringing on their independence and autonomy, perhaps creating a tendency of parents to 'over control' that we saw earlier could be so damaging - and which could lead to 'High EE' relationships. It is nice, therefore to see the issue taken seriously. In Nottingham, at the time of writing, there is a discussion about what is be done to improve long term community mental health in response to the government's 'Aiming for Health campaign'. The Nottingham Health authority proposals include a need for traffic calming and safe play areas for children....
Traffic and Community
Traffic does not only destroy relationship opportunities for children. Increasing traffic volumes decreases social contacts within streets.- In a study of three similar streets in San Francisco, traffic levels were inversely correlated with the number of friends and acquaintances each person had within the street. The figures are very striking and are worth quoting.
Light Traffic: 2000 vehicles per day, 200 per peak hour........3.0 friends, 6.3 acquaintances.
Moderate Traffic: 8000 vehicles per day, 550 per peak hour.....l.3 friends per person, 4.1 acquaintances
Heavy Traffic: 16000 vehicles per day, 1900 per peak hour......O.9 friends per person, 3.1 acquaintances.
(Appleyard, D and Lintell, in "American Institute of Planners Journal", March l972, pp 84-101 quoted in Elkin,T. McLaren, D. and Hillman M. "Reviving the City", Friends of the Earth/Policy Studies Institute 1991, p. 55)
This raises important questions. Mental health workers rarely even begin to consider issues of these type but, without taking them into account may form a totally distorted picture of the origins of their clients problems.
How much can natural settings effect mental health in their own right?
The influence of the settings in which we live may be very subtle - and there is scope for dispute as to how much physical settings effect our mental health in their own right. In discussing the value of wilderness to mental health environmental psychologist Peter Stringer cautions against a view that flora and fauna, rivers and rocks are in themselves therapeutic: " It is unlikely to be the environment as such which causes mental ill health, so much as the societal factors which lead the environment to be the way it is. If this is so, the flight to nature might have therapeutic or prophylactic value, not because of the influence of flora and fauna, rivers and rocks; but because the disturbing elements of an urban society and its institutions are left behind" (Peter Stringer, "The Natural Environment" in Chapter 9 of the book "Environmental Interaction")
Jungian analysts would see more connections than Stringer would allow for, however, so that natural elements can have more direct effects on deeper levels of the psyche. "Jung and Jungian analysists take great bodies of water as representing the dreamers unconscious. We even speculate, in the light of the psychoanalytical evidence, that going into water may bring a person closer to the unconscious processes of life. We guess people who swim and dive often, in lakes and pools and the ocean, may be closer to their dreams, more in contact with their unconscious, than people who swim rarely. Several studies have, in fact demonstrated that water has a positive therapeutic effect." (Alexander et al "A Pattern Language" p. 324)
Many single negative environmental influences on their own will have too weak an effect to cause mental health problems. Put considered in combination with each other, and as additions to non-environmental stressors, they may yet take their toll.
Consider two people who live in highly contrasting environments. One lives in a house whose main rooms face North and which are therefore dark and gloomy all day. The view out of the window is of brick walls. This person lives in a house identical to that of his neighbours which has a strip of grass between the door and a road which is always busy with heavy traffic and traffic noise. The neighbourhood is indistinguishable from neighbourhoods to the north, south, east and west so it is difficult for the person to develop a sense of belonging to an identifiable neighbourhood This person lives very distant from their work and spends three hours a day travelling there and back. His main relationships are with workmates but they are scattered over a large area and to meet them once a week he has to travel to the city centre where they go pubbing and clubbing, He has no car and the last bus leaves the city centre at 10.30 whereas the pubs close at 11.3Opm. The density of housing where he lives is not sufficient to sustain the a market for local shops and in the town planner designed community precinct, a half of the buildings, intended as shops, are boarded up and vandalised. The nearest pub is a mile away, a building in a car park. In consequence he has to travel to do his shopping, which he can ill afford, and it takes up a half of his Saturday. A small river runs through the neighbourhood, behind a barbed wire fence, in a concrete channel. There are two green playing fields and some rough ground adjacent to them where he can walk the dog nearby. The trees on the rough ground are spaced far apart randomly. Several trees are vandalised, This person became depressed following a bereavement and his loved one is buried in a very large municipal graveyard with identical rows of gravestones... Our comparison person survives a bereavement rather better. The graveyard in which her loved one is buried is small, connected to an old church. Nearby there is a small park with a stream running through it and a path along this stream where the trees have been frown to form and shape an avenue. There is a seat she can sit on watching moorhens and ducks and fish darting through the water. She does not feel less sad at this place, of which she has many memories, but there is a continuity in observing the changing seasons here and a sense that life goes on. This place is at the edge of the neighbourhood she lives in, a definite area defined by a bridge over the stream at one place and a medieval gateway at another. At these two boundraries only residential traffic it allowed across. The area is therefore safe for her young grandchildren to be let outside to play. The medieval gate leads towards a more compact and mixed cluster of residential and workshop buildings. Good shopping on a lively street is to be found through this gate nearby and she is within walking distance of work. She has taken to having a drink twice a week to a local pub/restaurant her daughter and son in law use. The pub has a garden bordering onto a canal and while there is always a mix of regulars and holidaymakers, with activity on the barges nearby. Her house is distinct, with a garden of its own that is partially walled and enclosed. It is part of a cluster of houses which share a common pathway where she often bumps into her neighbours. The main rooms of the house are on the south side, over look a view of gardens and are bright and sunny.
The quality of experience and the character of settings
In his book "The Timeless Way of Building" Alexander argues that life and culture for most of us consists of involvement in, and exposure to, repeated patterns of events and experiences. These are the things we do like rising and washing, the preparation of meals and eating them, dressing, our domestic and paid works, our periods of more passive observation when we might watch the clouds, or boats on the river from a window, sitting as a regular at a cafe watching the evening promenade of the local community, sleeping in a park, a visit to the opera or the Pub. Now the extent and quality of these events and experiences is determined in large part by the settings in which they happen or whether there are settings in which they can happen. Our patterns of experience are largely determined by what is available and the character of our humanly created habitats, as well as natural physical environments Settings can cheer us or depress us. They can calm us or stimulate us. They can delight us or repel us. It would be difficult (though perhaps it is not impossible) to create statistical measures of the degree of richness or impoverishment of habitats in the sense described here - then to relate these measures to geographical patterns of mental health and illness to satisfy the needs of scientific research. Nevertheless it seems difficult to deny that our lives can be greatly enriched or impoverished by the everyday settings in which we live.
It may be however that it is not so much, or even mainly, the setting on its own which effects our mental health, but the extent of our individual power to escape it, or alter it.
Emotions, motion and travel - and the well sped society
In the ordinary course of our lives it is our emotions which register the quality of our experience. The function of our emotions is to motivate us, to move us. Our emotions underlay and give the energy to our agency, our ability to act in the world and change things, or change locations, to our individual needs, Fear motivates us to run away. Anger energises us to resist. Love and friendship motivates bonding behaviours Our feelings may, however, be inconvenient to social and interpersonal structures of power and interest to whose will we may be forced to bow. The officers do not want their troops to let their fear motivate running away. The expression of our feelings may not get us the response we want - as when we are infants and cry out but are ignored.
Disempowerment entails the inability to follow one's own feelings, the inability to act on what they are saying to you. This can lead to helplessness and de-motivation instead. Over-critical and hostile relationships, High EE' relationships, are those in which one rarely gets one's own way. Sometimes these kind of destructive relationships may develop inside us an exaggerated concern to be noticed and approved of by others so that symptons like mania occur as the euphoric ego inflating fantasy that we are being noticed by others for wonderful achievements and this will give us the attention to our needs we have always lacked. depression may follow if this process is revealed painfully as a wish fulfilling fantasy.
Surrounded by a low quality impoverished environment healthy people will look for ways to improve it, move or find ways of escaping. Their emotions will set them into motion. But the structure of our urban spaces is not very maleable. Where people have the economic power, to get the purchasing power, to buy the horsepower, they can escape to commuter villages to live outside decaying urban areas, They can seek recreational environments at the weekends (the countryside/seaside) and in their holidays. Holiday travel can be considered a form of mass preventative therapy - a break from psychologically toxic environments. They have the power to act on their feelings - they can move and they are, in the words of Ivan Illich "well sped". In contrast those without the power to travel are much more vulnerable. Trapped in an impoverished environment, with 'learned helplessness' born from disempowered childhood relationships such people may become psychologically vulnerable. Their easiest forms of 'escape' may be drug or alcohol induced - or into psychotic fantasy and persistent day dreaming unattached to any action. (It has long been my view that to send many distressed people on holiday would be a therapy preferable to a psychiatric hospital admission - however that would be to reward illness.....)
Environmental opportunities for emotional displacements
Mental health problems arise when people are chronically unable to act on what their feelings are telling them. One solution to this problem is emotional displacement - one can act using the energy of the feeling but not directed to a long term solution. This may at least hold at bay a psychological collapse. The environment will contain varying degrees of possibility for emotional displacement. "A country child can cut a stick from hazel and smash down thistles...but what should a miserable child in a concrete and asphalt environment do? As it grows up it smashes telephone boxes and park benches instead, finding substitute adventures on the street and in drugs." (Bernd Lotsche, Was ist Stadt Oekologie? in Oeko Stadt. Band 1. <Ecocity. Volume 1> ed. Margrit Kennedy, Fischer Taschenbuch Verlags Frankfurt, 1984 P. 48. My translation).
Of course, some children in asphalt and concrete environments will find their parents taking exception to such forms of behaviour. We can see again how the environment can put pressure on parents to become High EE' - more conflict and more control over children are a partial result of setting Where I grew up for a few Years there was a wood quite big enough to absorb the destructiveness of a private and council house estate full of young children. Where I live now there is no such space for children. In the view of Lotsche, who describes growing up and playing in overgrown bomb sites near Vienna, children need half wild places to explore and play in. His ideas strike a personal chord.
The number and type of animals is also a part of the environment and relationships with animals also modify emotional life. Hunting is used to displace aggression against other species. There is evidence too that animals can play a role in children's emotional development. Pets are sometimes too humanised for this function. However "Ann Dreyfus, a family therapist in California has told us about the way that animals like goats and rabbits help children in their therapy. She finds that children who cannot make contact with people, are nevertheless able to establish contacts with these animals. Once this has happened and feelings have started to flow again, the children's capacity for making contacts starts to grow again and eventually spreads out to family and friends." (Alexander et al "A Pattern Language" p.372)
Emotional Meaning in Space, Form and Shape.
In her book 'Drawing on the Artist Within' (Fontana Collins, 1987, Betty Edwards Professor of Art at California State University, writes about an exercise in which people are asked to draw, without using any pictures or symbols, visual representations of human characteristics or emotional state-, i.e. anger, joy, peacefulness, depression, human energy, femininity etc... "One would expect an enormous variation in analog drawings - and in fact no two drawings are alike What is surprising however is the structural similarity of the drawings that express a single concept such as 'anger', 'joy', 'peacefulness' and so on." For example she shows how the concept of anger tends to expressed by people in overwhelming jagged, dark, pointed forms. Joy tends to be expressed in light, curving, circular forms that tend to rise within the forests Peacefulness or tranquility was mostly expressed through horizontal lines and depression consisted of lines and forms low in the visual format.
All this is suggestive of the way in which form, shape and line are connected to emotional states and may evoke such states. Art Psychotherapy is, of course, partly based on such connections and, in addition, it would not be surprising if the physical shapes which we inhabit, and which surround us, effect us on an emotional level.
There is a great deal of discussion in a book by Christopher Day about architecture and environmental design as a healing art. Day mentions particularly the tendency of many modern buildings and neighbourhoods to be based on straight lines and rectangular box-like forms. No living or naturally formed things take rectilinear shaper and Day argues that a rectangular environment tends to have a "life sapping quality". (Christopher Day, "Places of the Soul", Aquarian Press, 1990, p,77)
"Throughout the developed countries of the world, dominated by material possessions, the dominant house form is rectangular. Indeed throughout history, it is countries with rectangular built environments that have lead technological development - the applied science of the materially practical. Rectangular spaces may not be life enhancing but they are after all the best shape to store objects in. Organic filing cabinets are not so very practical." ( Ibid. pp 75-76) Day argues that it is difficult to escape from the idea that many buildings are stacks of people-storage boxes. It cannot feel good to live in hard rectangular mineral spaces without artificial support - vehicles, lifts, air conditioning, TV, Muzak, consumerist entertainment are all necessary to keep such places habitable.
We call extend this argument to make the obvious point that those without access to emotional diversions will be that much more vulnerable.
What makes these engineered environments even more insidious is that they frequently have an identical and repetitive character. variety may be the spice of life but variety is inconvenient to distant planners and the result is visual and spatial boredom. Repetition sets up a rhythm, like the beat of a drum, without the melody of variation, and like listening to Bolero several times over it subtly winds one up. "Beat without metamorphosis, merely reflecting bodily rhythms, floods the soul with bodily desire-emotions, overriding individual judgement. It is no empty coincidence that armies march to the drum" (Ibid p.9O)
When the same design is repeated without any change there is no place for individual identification. "We don't have to travel to Moscow to experience how rows of rectangular giants chillingly oppress the freedom of the individual.....Bureaucracies tend to approach people as numerical statistics, but a short step to treating them as material objects."(Ibid p89)
People who inhabit such spaces may not be able to put the resulting feelings for themselves into fine words but they will feel these feelings of devaluation nonetheless
Unseen Environmental Influences - Electomagnetic Fields and Radiation
Not all environmental influences may be visible. An area of dispute is the influence of electro-magnetic fields. "We are now exposed to electro-magnetic radiation some fifteen thousand million times as strong as that reaching us from the sun and of every frequency from 50Hz to 7,000,000,000GHz" ( Ibid p60).
German environmentalists take "Electro-smog" very seriously and have got courts to put brakes on the development of towers which are part of mobile telephone networks pending more information on their health effects. The suspicion is that, since the information stream in the human body is bio-electrical other electrical fields might interfere with these patterns, cauxing sleeplessness and nervousness, as well as a variety of physical symptons. These issues are being investigated at the University of Heidleberg and in Switzerland.
In Germany ecological town planning initiatives take such things seriously. An ecological concept commissioned for Potsdamer Platz in Berlin and prepared by Ekhart Hahn and Michael LaFond proposed that that areas above the electrified train tracks are to be avoided as sites for housing-as a preventative measure because of electromagnetic concerns.
Static electricity generated by synthetic materials in micro-environments is another concern. It "speeds up the ageing of air, so contributing to a variety of under-oxygenated blood ailments such as depression and lethargy (Day op.cit. P. 40)
There are issues here,about which,much remains to be discovered. Indeed we have perhaps lost wisdoms possessed by our ancestors which were inconvenient to the economics of civil engineering and large scale plans of developers. " An infra-red study of Regensburg showed that the streets followed the lines of subterranean water courses thereby ensuring the houses avoided them.Terrestial radiation, ionized by passing through water running in friction, is thought to have harmful effects ranging from insomnia to rheumatism and cancer. Underground currents and waterways ean be located by dowsing, which it would appear our ancestors undertook before building." (Day p39). Modern day construction does not bother. "In multi-storey buildings, the biological effects due to terrestial radiation filtered through underground (or piped) water currents, and those of the earth's geo-magnetic grid, are progressively amplified by each reinforced storey until some consider it unsafe to live above the eighth floor" (Ibid p38).
The seasons, weather and climate
Perhaps influences like electromagnetic fields are weak. However, their effect must be added onto other stressors. The same might be said for the influence of the weather and climate which, of course, vary in their effects with the seasons. In ancient Chinese medicine the primary causes of psychiatric disorder were suggested to be vicious air, abnormal weather and emotional stress. (Xiehe Liu "Psychiatry in Tradtional Chinese Medicine" Brit. J. Psychiatry (1981) Vol.138 pp.429-433). In our own times there is some recognition for the existence of a Seasonal Affective Syndrome. Weather, climate and seasons effect us all however micro-climates can vary widely within quite small areas depending on things like the existence of north and south facing slopes and other aspects of landform, wind breaks, surface vegetation and shade. Such local features can considerably moderate or exacerbate temperature and stress from climactic extremes.
Where moods swings are seasonal directly physical processes and socially mediated processes may be at play. We use the word 'gloomy' to describe a shortage of light and a mood. We say someone is 'bright and breezy' or refer to someone being 'heated' or 'keeping their cool'. This is suggestive of connections. Perhaps light acts directly on the body's biochemical system though the eyes. But the connections can be complex: in the Spring time a depressed young man can see more young women, and more of young women. This could exacerbate feelings arising out of sexual repression - or being unable to find a setting in which it is easy to get to make the acquaintance of such women. In general, of course, SAD sufferers are down in darker months and thus countries with many very long dark days can suffer very badly. Also, of course, the influence of English weather on mood is legendary. Although this is the cause for a certain amount of stoical humour it probably does have its influence - perhaps even more on migrants who are used to other climates. A German friend of mine was very gloomy at a wet and grey English Spring.
Bright sunlight, good weather and clean air enables us to access the colours and scents of the gardens parks and streets. These in turn may have subtle postive effects on mood. Aromatherapists suggest the different scents of herbs, flowers and fruit can be arousing sedative or relaxing, and colour therapists suggest green is calming and other colours have other effects. In contrast, if city smog obscures the view, coats everything in grime, permeates everywhere with acrid smells and brings a fear of heart attacks and asthma, we would expect this "vicious air" to have negative emotional effects.
Colour, smell and scent.
Colours and scents deserve more than passing mention. Both can effect mood and may be therapeutic or counter-therapeutic. In his book Christopher Day quotes from work by Kenneth Bayes, This is on the therapeutic effect of the environment on emotionally disturbed children and children with learning difficulties. Bayes' work shows that in addition to individual feelings about colour: "There are also universal aspects of colour: red speeds the metabolism, blue slows it down. This is a physiological fact - everyone responds this way. Different colours stimulate different glands: For instance, yellow - thyroid, blue - pituitary, red - male sexual, violet - female sexual glands. Knowledge of this kind can be used to manipulate people and can also be used therapeutically." (Day, op.cit., pp47-48.) The magazine "Design" in its April 1993 issue, has an article by Jeremy Myserson on "Design for Mental Health" which discusses the therapeutic use of colour in health and mental health settings.
Day also discusses the influence of smell. "It doesn't matter how nice a place looks if it smells of bad drains. The smell of fresh bread or ground coffee can be a shop's best advertisment - Better than any visual display...Its no good designing a place that looks nice but smells horrible especially as that smell means something about the air we breathe." (ibid, p49). Many mental health workers and patients will probably feel that one of the most distinctive and depressing features of institutions is their aroma of disinfectant. In this case it is not the scent as such that matters but what it represents. Textures are important too. Sitting in plastic chairs, so common in institutions, for long periods of time will often leave one with a soggy sweaty bottom, one of those subtly degrading features of a cheap institutional environment that can so devalue their inmates.
The Blackthorn Medical Centre in Maidstone in Kent was designed with issues like this given prominence. "At Blackthorn, there are no synthetic materials. Natural plasters woollen carpets and organic paints were specified by the designers. 'we made the building as green as possible', says Radysh, 'all as part of a natural, calming, holistic approach to the human being. So many influences in our environent today bombard the senses. Synthetics giveoff static electricity. Strong varnishes and solvents upset people. Electro-magnetic pollution is part of our modern culture". (Jeremy Myerson ' Sensual Healing. Design for Mental Health' in Design April 1993 p 28)
Hugh Freeman on the Environment
In total these influences are rarely considered in either psychiatry or clinical psychology and psychotherapy. Yet either singly, or added together, they are likely to be important questions for some users of mental health services. Without taking them into account mental health workers may form a totally distorted picture of the origins of their clients' problems.
One psychiatrist who has considered some of these influences is Professor Hugh Freeman, an otherwise totally orthodox psychiatric thinker and editor of the British Journal of Psychiatry. The subject has interested him for many years and he has edited and contributed to several books on this subject. A round up of his views is to be found in an paper already quoted from in this text, an article on the environment and mental health published in "Streetwise" in Summer 1992.
Freeman condemns "Those responsible for the building of structures, transport developments, and changes in the pattern of industry and commerce" for " a general lack of interest in the human consequences of their actions. Historically, economic considerations have been overwhelming, irrespective of the political ideology with which any society operates."
In his article he summarises the evidence on several themes. Slum clearance programmes have often broken up the kinship and mutual help networks of long established communities, ignoring the fact that most social problems in slums are not related to physical structure and improvement would often have been better. He notes the adverse emotional and psychological effects of the process, citing statistics of depression and bereavement patterns following removal from established communities. He questions whether the low density, ill-designed new estates are a real improvement - replacing sociability with suspicion. He finds no evidence that high density is socially pathological - density being different from crowding. He criticises high rise blocks and 'architecturally over-determined' deck acess buildings on multiple grounds - including their poor shelter from the English weather, Research by Coleman in London is mentioned that found that indicators of social malaise all became more common as four design variables increased - dwellings per entrance, dwellings per block, number of storeys and number of overhead walkways. In the new environments Freeman regrets the loss of " a formerly rich pattern of interaction that occurred around homes, local shops and cafes or bars - which were an important part of social support. He cites noise as an environmental source of stress. He criticisew the dispersal and differentiation of cities with zoning policies that separates functions - thus forcing dispersal, travel and traffic with their undesirable social and psychological effects. He argues that children and adolescents have suffered particularly from the consequences of contemporary environmental changes in cities - destruction of established neighbourhoods, high rise housing, urban motorways- leading to an inability to play spontaneously in the street.
Solutions - strategies for change
Freeman's article is altogether an impressive catalogue of criticism of recent urban- developments on mental health grounds Less impressive to me are Freeman's prescriptions for change. "Progress in the humanising of environments can only come through scrupulous, painstaking research, based on clear concepts and through action which is directly related to what has been scientifically demonstrated. In this process, the mental health professions could form a useful alliance with those architects and planners who have a genuine concern with the human consequences of their activities." (P.28).
One cannot quarrel with a call for more research. But one can question the elitist assumption that progress "can only" come from well intentioned, well informed professionals who will be guided by scientifically objective evidence. As Professor Freeman in fact agrees, there is no evidence that health and social welfare professionals have any clout when contesting big economic interests, whether they are guided by scientific evidence or not. Psychiatry has little claim for expertise in humanising environments, though isolated individuals like Freeman may have made an effort to change this. While having a model which acknowledges many factors, including environmental ones the dominant interests of psychiatrists have always been to locate people's problems inside themselves - with a heavy emphasis on the so-far fruitless search for bio-chemical and genetic causes of mental health problems. Its treatments approaches have also put little stress on environmental change. The major stress has been on tranquilising people - or making them forget their problems through electric shocks. As we have seen in this article the environments created by the mental health industry have few redeeming characters.
Above all we must question the idea that the environments should be left to architects planners and mental health workers claiming that science is on their side, The ideology that progress "can only" come through actions based on what "science" has demonstrated effectively expropriates any active role from people who inhabit environments - in favour of another group of alleged experts. This is a variants of the 'we are better informed and better intentioned' message the usual slogan of group making a bid for more powers money and prestige. People who claim to 'know what is good for other people' rarely have to live with the negative consequences - they are usually separated socially economically and spatially from the consequences of their own actions and usually have too limited a specialised conceptual framework from their professional training to recognise or care about other kinds of outcomes of what they have decided for other people which are not in their professional frame of reference. The claims of professional specialisms to "science" indeed rest on the quantitative measure of interrelationships that they identify as relevant to their work - but what such experts choose to measure, how they contextualise what they measure and what funders are prepared to pay for in the way of "research" are crucial issues in the claim to the "objectivity" of the science. In the clarification of human problems it can be said that, in large part, "science" discovers what institutions with money are prepared to fund researching. Moreover it is quite impossible to make scientific observations on anything without recognising that any observation comes out of a viewpoint. Professional viewpoints are not the same as "client" viewpoints. What you see looking into human problems from the outside is not the same as how they look when you are experiencing them from the inside. (The way in which vested interest sets the conceptual framework of the mental health professions is discussed in my article "Upbringing and Psychosis: An Afterword" in "Changes: An International Journal of Psychology and Psychotherapy", Vol 14 No1 )
Groups like planners and mental health workers invariably see the issues in which they claim expertise from too far away and do not have to live the negative consequences of their own actions. "The planner tends to judge the neighbourhood on the basis of its physical characteristics. His ability to evaluate its other characteritics is limited by what he can observe on a visit to an area, while residents tend to consider social factors such as neighbourliness in addition to physical characteristics." (Canter and Kenny "The Spatial Environment" in Environmental Interaction op.cit. A very similar criticism can be made of psychiatry - almost all psychiatrists spend little time, if any, getting a picture of the physical or relational context in which emotionally disabling conditions have arisen and then routinely locate "psychiatric problems" as arising in the physical characteristics of a non-coping person. (i.e. In their brain chemistry/geneties etc.). The British Journal of Psychiatry, which Hugh Freeman edits, contains few articles on environmental issues - but plenty on the central nervous system.)
(Professor Freeman wrote me a four page reply to an earlier edition of this paper claiming I misrepresented his views on change. In this he writes 'I obviously did not suggest that only professionals of particular kinds should do anything about the environment - that would he absurd". In response I would reiterate that I criticised what he wrote. This was that 'Progress in humanising environments can only come through painstaking, scrupulous research....'and it is unfortunate he was not more painstaking and scrupulous in his choice of words if he meant something else. In his "Streetwise" article he makes no reference to community empowerment which, in my view, is the central issue. Indeed, in his letter to me he draws attention to what he sees as the failure of community architecture and argues "It seems to me that more is achieved by people communicating their views strongly to professionals than by trying to do professional tasks themselves." This false counterposition (either professionals do things for people, with or without consultation, or they do things for themselves) misses out on the challenge of developing new techniques of empowerment and community development such as those pioneered by the Neighbourhood Initiative Foundation in order to even up power imbalances between professionals and people in neighbourhoods. On this, more below).
Community Empowerment for Environmental Improvement
Against this kind of approach I would counterpose that the main force for improvements in environments must be the initiative of the people who live in them. No other people are in a better position to know what local resources, needs and possibilities are, no other people are so intimately effected. Logistically it is quite impossible to organise appropriate changes at so many different locations unless through fostering processes of Community and neighbourhood development. No one else should have the right to do it except the inhabitants of each location. We saw earlier how mental health crises can arise out off disempowerment - and there is nothing more disempowering than experts with Compulsory purchase powers. Good community mental health correspondingly means processes of individual and community empowerment. In Nottingham where I live the redevelopment processes that Freeman criticises were partially contested and negotiated with a network of neighbourhood groups - clearance Area Tenants and Residents Associations. Thus members of some communities at least retained some agency in processes of redevelopment. I myself chaired a tenants and residents group that defeated the Nottingham fity Council in its desire to demolish the whole of the Raleigh Street area in Nottingham and we saved many houses for improvement rather than demolition, leaving a local community partially intact. In the Meadows area of Nottingham the Meadows Association of Tenants and Residents (MATAR) persuaded the Couneil to adopted a redevelopment process that enabled existing residents of the Meadows to have the new houees, thus doing something to keep a local community together. These are examples of community empowerment which provide a far better model for the creation of environments which meet human needs.
There is a role for research and science - to help and to support people discover for themselves the best ways of improving their homes, gardens, neighbourhoods, and places of work and leisure when Christopher Alexander and his colleagues wrote their book "A Pattern Language" it was not to guide the actions of planners and architects on behalf of communities but rather to be a handbook for a different kind of planning and architecture - one done by people for themselves. Since environments always evolve piecemeal, a patterning that is sufficiently held in common throughout society is needed to give each individual act coherence, through helping to generate or create larger global patterns that are harmonious as a whole. They hoped that communities and individuals would be able to refer to their book for the patterns that they Would need as answers to design problems (e.g. how much space in a neighbourhood should be devoted to grass and trees? what is the best way Of relating large industry and residential areas). Without treating their book as holy writ the authors hoped people would look at it and then proceed to develop things for themselves. At the University of Oregon Alexander and his team uaed the pattern languages to redesign a hostile university campus using the input of all its potential users (some thousands of people) to create a person friendly environment. This went way beyond "lay people communicating their views strongly to professionals"(Freeman).
Other approaches have also been developed that make local communities the leading force in planning processes. The Neighbourhood Initiative Foundation uses techniques developed at Nottingham University called 'Planning for Real'.Their techniques explicitly tackle the problem of articulate people with planning degrees (medical and social work qualifications) hijacking the decision making process by intimidating people with their long words ( or imposing elaims to science). They use models of neighbourhoods and buildings with cards which have planning and design options written on them. The models and cards enable people to show how they feel things should be developed. Disagreements can be registered and opinions on prioritisation revealed, all without having to say anything - rather as one were playing a board game. The result, described as 'better than bingo' has considerably contributed to neighbourhood uplift and been a force for environmental improvement in some very deprived estates.
Green activists and professionals are concerned that we must change our environments also to improve energy efficiency to become more self sufficient, to reduce transport, emmissions and pollution. Most have concluded that the change must embrace everyone and that top-down strategies have very limited usefulness. Dr Ekhart Hahn of the Berlin Science Centre argues that the technical solutions that could resolve most ecological problems have been known for some time - but they have not been extensively enough adopted. An comprehensive and integrated approach of 'socio-ecological design' is needed that goes beyond technical fixes. "A real solution to the environmental crisis is possible only when the social and cultural dimensions, i.e. its causes, are incorporated Designing socio-ecological technology means making the environmental and social dimensions of technology experiential again, overcoming the reduced comprehension of environmental goods as economic resources, as a pure "fuel of industrial society". The point is to make man back as a pro-active, fully aware, sensitive and responsible creature who can comfortably and creatively live with both technology and environment." A key 'Field of Action' in doing this is 'Grass Roots Democracy and Environmental Communication'. At the neighbourhood level "The severity of environmental problems but also the potential for solutions are recognisable best from intimate aquaintanee with one's own habitat"...where the real force for change can and must occur. (Ekhart Hahn, 'Ecological Urban restructuring: Theoretical Foundation and Concept for Action", Science Centre Berlin, 1991)
Many environmentalists recognise that individuals and communities will have to be supported in changing their own habitats and this entails issues of individual and community mental health. Graham Bell's bgook "The Permaculture Way", for example, seeks to persuade people to adopt the principles of Permsculture (permanent angriculture) in the design of their own homes, gardens and neighbourhoods. Chapter 4 of his book is "Making a Personal Stocktake - You are Your Best Asset". In it Bell recommends co-counselling and transactional analysis to develop the confidence and sense of self worth needed to make initiatives for environmental change. He recognises that change can be psychological stressful. There will be a need to release feelings of tension and hurt as people change their lives.
In this Bell is probably right. Extensive social changes are times of emotional tension and friction as people and their relationships change fundamentally. It helps to understand the underlying dynamics in this process. (Professor Freeman disagrees and loftily pronounces in his letter to me on the earlier draft of this paper to with the words "Co-counselling and transactional analysis" - I would he very surprised if this was of any practical help."'. He is also sarcastic about the reference to water and Jungian therapy made earlier).
In conclusion - replacing economic development with holistic development
For reasons of survival humanity is increasingly aware it must redesign its habitats and its relation with the environment. This realisation arises out of a particular form of economic development which is undermining the self sustaining mechanisms of the interrelated life forms on the planet. But a crisis means danger and opportunity. In the changes that are imposed on us we have the chance to design not only for a harmonious interplay between economic and ecological but also for the meeting of community social and psychological needs. Far from the environment being a constraint on development we can begin to think of it as the best location for a kind of development which means needs holistically. The changes are that are needed arise from global procesees to which we must all respond locally and individually. Structures of support, encouragement and communication are needed to facilitate this process if we are to have a genuinely ecological society. Extensive life style changes are involved - not the least in the psychological growth of a citizenry that needs to be assertive and self confident enough to manage the challenges and stresses of change. But we can create a happier world out of this, a mentally healthier society because we can break free of egocentric assumptions that happiness is to be found in personal enrichment and empowerment at the expense of others. Environmentalism impels us to look at the relations between people and the relations between people and their environment as the locations for changes for improved living. In this there is some cause for hope,
(2nd Revised Edition. June 1993.)
© BRIAN DAVEY