Tuesday, 18 June 2013

Therapeutic landscapes

Continuing my reflections on taking a patient's case history, I find that there are three other factors that need to be taken into account. These are the therapeutic landscape, the therapeutic milieu and cosmology.
Therapeutic landscape.
This refers to landscapes that promote healing and well being. These can range from gardens designed for the elders and active living, to gardens specially designed for the visually impaired, and those with senile dementia. This term also includes the benefits of well-designed civic landscapes. The web site www.healinglandscapes.org/resources/read-five.html elaborates on this concept, and gives detailed reference to resources. In clinical practice it is important, as unhappiness with, or disconnectedness from one’s surroundings may point to an early indication of illness and fatigue, as well as depression. Likewise, the ability to engage with landscape is a sign of healing, and growth of well being.
The migrant to the city, or the immigrant, are patients that may be affected by this aspect of healing. However, it can impinge on everyone in subtle ways. Feng shui is based on the principle of the therapeutic landscape. In rural Ireland, many of the old houses are usually situated facing in a south east/north west axis. This is the perfect aspect for capturing all of the summer and winter sun. Traditionally, houses were never sited on top of a hill, but  on its southern side where possible. Shelter from the northern winds was provided by the hill. 
Seasonal Affective Depression (SAD) may be seen as an illness that results from landscape, be it either summer or winter. Moving house is accepted as being  a cause of major stress and again this reflects the landscape within which a person is living. In more subtle ways, it can be seen in aversion to particular colours, furniture, or any hard landscape. Some simple questions, when taking case notes will elucidate quite quickly if your patient is happy within their environment.