Elsevier

Social Science & Medicine

Volume 108, May 2014, Pages 210-222
Social Science & Medicine

The ‘taking place’ of health and wellbeing: Towards non-representational theory

https://doi.org/10.1016/j.socscimed.2014.02.037Get rights and content

Highlights

  • Introduces non-representational theory to health geography and other health disciplines.

  • Re-examines the idea of wellbeing through the concept of affect.

  • Suggests new ways forward for geographical studies in health.

Abstract

For the last two decades health geography has focused on the dynamics between health and place. Although the social constructivist perspective of much research has provided many insights into the meanings of health and health care arguably, mirroring progress in the parent discipline of human geography, there could be a far more serious engagement with non-representational theory and the ‘taking place’ of health and health care. To showcase the importance and potential of this broadly, the idea of wellbeing is re-approached. The paper reflects on the ways wellbeing has been treated in research primarily as a meaningful and relatively prescribed state of life, to the neglect of process. Based on this critique, a qualitative study then illustrates the most immediate and everyday ways wellbeing might arise through ‘affect’; the pre-personal mobile energies and intensities that result from physical encounters within assemblages of bodies and objects. Indeed, theoretically the findings support the proposition that, at one level, wellbeing might not be taken from environment but instead might emerge as the affective environment. They certainly raise awareness of how much in health might originate at the surface, prior to meaning, within life's infinite spatial doings, and thus they launch some final thoughts on the wider challenges and opportunities for non-representational health geographies.

Introduction

Two decades ago a new era of research was set in motion that ultimately transformed and rebranded the sub-discipline of medical geography into health geography. Noting theoretical developments in the new cultural geography of the period, and specifically drawing on structure-agency debates and humanistic philosophy, Robin Kearns called for geographers to incorporate a dual ‘place-sensitive’, ‘post-medical’ perspective into their scholarship (Kearns, 1993). By this, Kearns meant moving beyond previous preoccupations with distributional aspects of disease and medicine by examining the meaning and significance of places (re-imagined as social and cultural phenomenon) in health and health care. In doing so, they might problematize medical categorization, challenge institutional assumptions and power and, beyond pathology, realise health as both a positive mental and physical state of wellbeing. Following Kearns' arguments – and some initial resistance (Mayer and Meade, 1994, Paul, 1994), supplementary advice (Dorn and Laws, 1994) and further explanation (Kearns, 1994a, Kearns, 1994b) – the understanding has since developed in geography that health and health care unroll in places that are acted, felt, felt about and represented. It is recognised that, as a result of the human agency, places possess basic functions (they do things). Moreover beyond this, in line with a phenomenological thinking, experiences of places, and the knowledge gained from being part of them or learning about them, gives rise to their intentionality (what places are about) and essences (how places feel) much being a result of purposeful designs and decisions (Andrews and Shaw, 2010, Kearns and Barnett, 2000). As a number of literature reviews have shown, a new generation of research has subsequently attempted to discover the place agencies, experiences, identities, attachments, meanings and representations associated with health and health care (Andrews et al., 2012a, Kearns and Collins, 2010, Kearns and Moon, 2002, Parr, 2002, Parr, 2004). This has involved a number of allied conversations including around the development of appropriate theory in health geography (see Dyck, 2003, King, 2010, Litva and Eyles, 1995, Philo, 1996), methodological and analytical innovation (Carpiano, 2009, Cutchin, 1999, Dyck, 1999, Elliott, 1999, Garvin and Wilson, 1999, Milligan et al., 2005, Milligan et al., 2011, Parr, 1998, Parr, 2007, Wilton, 1999), the relationships between space and place in health (Jones and Moon, 1993, Kearns and Joseph, 1993), and processes in place – including the emergence of medico-corporate cultures and power (Kearns and Barnett, 1997, Kearns and Barnett, 1999, Philo, 2000, Poland et al., 2005), healing and therapeutics (Gesler, 1992, Smyth, 2005). These diverse conversations frame the sub-discipline's current progressive, yet largely social constructivist, ‘representational’ paradigm, which in the last decade has reverberated beyond health geography and has informed the character of spatial turns amongst many other health-focused disciplines including nursing studies (Andrews, 2006, Carolan et al., 2006), social gerontology (Andrews et al., 2013a, Wiles, 2005), population and public health (Brown and Duncan, 2000, Brown and Duncan, 2002) and the sociology of health and fitness (Fusco, 2007, Kelly, 2003, Van Ingen, 2003). Indeed, they are conversations that have backed up the growing realisation across the health and social sciences that ‘place matters’ to health and health care; that where individuals are cared for, live, work, socialize, and how they use and experience their environments, have far-reaching implications (Andrews et al., 2012b).

Although a great deal of knowledge has been produced by health geography and over the last twenty years, it might be argued that in 2014 the sub-discipline once again needs to look to contemporary developments in its parent discipline for inspiration, but on this occasion specifically with respect to non-representational theory. In this regard, the current paper does three things. First it briefly introduces non-representational theory in human geography including the contributions of the few health geography studies that have thus far forged the approach. Second, by re-approaching wellbeing – an idea and concept clearly now central to health geography – the paper provides a broad and practical illustration of the fundamental importance and potential of non-representational theory. Specifically, it articulates current applications and understandings of wellbeing and proposes that research has missed the opportunity to explore the concept at a far more immediate level, and explain the processes through which wellbeing emerges in everyday situations and environments. Third, following this review, a participant observation study explores these processes in some detail. The key non-representational idea of ‘affect’ is employed as a study framework, indicating how wellbeing arises initially as an energy and intensity through the physical interaction of human bodies and non-human objects, and is experienced as a feeling state. Some focused observations are made on how the findings might help geographers and others rethink the fundamental nature of wellbeing, particularly in terms of it being something that emerges as environment (rather than something that results, or is consciously taken, from environment). Importantly they also anchor some final reflections on the much broader challenges and opportunities for researching and presenting non-representational health geographies.

Section snippets

Non-representational theory

With origins in the work of Nigel Thrift in the mid-1990s (see Thrift, 1996, Thrift, 1997), but far wider application in the new century (see Lorimer, 2005, Lorimer, 2008), this theoretical orientation in human geography is based on the observation that a sizeable portion of the world – what happens ‘out there’ in everyday life – has been suffocated and remains unrepresented by, social constructivist research. This is attributed to social constructivism's deep philosophical commitments

Geographies of wellbeing

Wellbeing is a familiar idea that reoccurs across western societies, substantiated through their officialdom, economic activities, consumption patterns and popular cultures. A loose consensus is that ‘well-being’ is fundamentally about ‘being-well’: content, healthy and in a good place in life. Other than this however, wellbeing is defined, understood and utilized in many different ways. At one level, wellbeing arises as a subject in the rhetoric of policy makers as something to be structurally

Methods

Empirical research framed by non-representational theory involves a form of ‘witnessing’ of happenings across space and time, even those that might first appear mundane (Cadman, 2009, Dewsbury, 2003). This witnessing aims to generate data infused with a fidelity or authenticity to happenings, relaying as much as possible of their character and action (see Latham, 2003, Laurier and Philo, 2006). With this in mind, we selected a form of participant observation as our primary data collection

From atomic to full bodies

Non-representational theory directs attention to the practices that comprise the often taken-for-granted ‘background’ of conscious thoughts, reflections and actions in life (Andrews et al., 2013b). In attempting to understand these practices, in recent years human geographers have become interested in the idea of ‘affect’ in particular as a way to explain their performative dimensions. Indeed, originating in early European philosophy of man-nature – specifically in Spinozas Ethics – and later

Wellbeing as an affective environment

The study challenges the ways in which wellbeing is conceptualized across disciplines including geography. On the one hand, academic literature typically positions wellbeing as a state of life, distinguishing ‘objective wellbeing’ from ‘subjective wellbeing’. While the former is statistically measured narrowly via substitutes or components (such as health status) (Gaspart, 1997), the latter is often assessed by individuals within specific areas (such their life satisfaction and general

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