The Spatial Organization of Psychiatric Practice A Situated Inquiry into ‘Healing Architecture’ Simonsen, Thorben Peter Document Version Final published version Publication date: 2020 License Unspecified Citation for published version (APA): Simonsen, T. P. (2020). The Spatial Organization of Psychiatric Practice: A Situated Inquiry into ‘Healing Architecture’. Copenhagen Business School [Phd]. PhD Series No. 03.2020 Link to publication in CBS Research Portal General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. Take down policy If you believe that this document breaches copyright please contact us ([email protected]) providing details, and we will remove access to the work immediately and investigate your claim. Download date: 03. Oct. 2021 COPENHAGEN BUSINESS SCHOOL INQUIRY INTO ‘HEALING ARCHITECTURE’ PRACTICE: A SITUATED OF PSYCHIATRIC ORGANIZATION THE SPATIAL SOLBJERG PLADS 3 DK-2000 FREDERIKSBERG DANMARK WWW.CBS.DK ISSN 0906-6934 Print ISBN: 978-87-93956-16-2 Online ISBN: 978-87-93956-17-9 Thorben Peter Simonsen THE SPATIAL ORGANIZATION OF PSYCHIATRIC PRACTICE A SITUATED INQUIRY INTO ‘HEALING ARCHITECTURE’ Doctoral School of Organisation and Management Studies PhD Series 03.2020 PhD Series 03.2020 THE SPATIAL ORGANIZATION OF PSYCHIATRIC PRACTICE A situated inquiry into ‘healing architecture’ Thorben Peter Simonsen Supervisors: Associate Professor, Morten Knudsen, Department of Organization, Copenhagen Business School Professor MSO, Signe Vikkelsø Department of Organization, Copenhagen Business School Doctoral School of Organisation and Management Studies Copenhagen Business School 1 The spatial organization of psychiatric practice: A situated inquiry into ‘healing architecture’ 1st edition 2020 PhD Series 03.2020 © Thorben Peter Simonsen ISSN 0906-6934 Print ISBN: 978-87-93956-16-2 Online ISBN: 978-87-93956-17-9 5IF%PDUPSBM4DIPPMPG0SHBOJTBUJPOBOE.BOBHFNFOU4UVEJFTis an active national and international research environment at CBS for research degree studentswho deal with economics and management at business, industry and countrylevel in a theoretical and empirical manner All rights reserved. No parts of this book may be reproduced or transmitted in any form or by any means,electronic or mechanical, including photocopying, recording, or by any informationstorage or retrieval system, without permission in writing from the publisher. Acknowledgments First, to Søren Bredkjær, Vice Director of Psychiatry in Region Zealand. I reached out to you before I held a position as a Ph.D. Fellow at Copenhagen Business School, inquiring about the Psychiatric Hospital in Slagelse, asking if I could use it as a case for a pending job application. Thank you for taking that first meeting with me. It essentially enabled this project to come to life. Thank you also to Sidse Arnfred. You supported the project early on, ensuring access to the hospital and subsequently to the inpatient settings where I conducted fieldwork. You showed me around, offered me a spot from where to work, and gave insightful comments along the way. A special thank you to the staff at the Slagelse site. For putting up with my questions, for letting me tag along, and for taking a serious interest in my ongoing investigations. At times, being a Ph.D. Fellow can be a lonely endeavor. However, to all my colleagues at the Department of Organization that made my endeavor a lot less lonely and a lot more interesting, thank you! I would like to thank Roddy Walker, Frank Meier, Vibeke Scheller, Cecilie Kampmann, Signe Bruskin, Andreas Kamstrup, Emil Husted, Christian Dyrlund, Maria Krysfeldt, Fabian Müller, Maibrith Kempka, Mette Brehm, and all the other Ph.D.’s at IOA. A special mention of the ‘Winner Games’ is warranted. Had it not been for the likes of Roddy Walker and Frank Meier the travails of considering different research problems, investigating data, and developing appropriate analytical tools would have been a lot tougher. Thank you for all your suggestions, readings, discussions, and laughs. And Roddy, you were also the best officemate a man could wish for! To Vibeke, Mette, and Cecilie thank you for being especially supportive during the last months of my dissertation work, it made all the difference. Furthermore, I would like to thank Kirstine Zinck and Anne Roelsgaard for inviting me to present my work at a joint seminar early on. My first paper grew out of this seminar and a thank you, therefore, also goes to Holger Højlund for seeing the potential in my work and for 3 subsequently accepting to co-author a paper with me. Also thank you to Jane Vedel, José Ossandon, Thomas Lopdrup, Anne Reff, Peter Holm, Lise Justesen, Mette Mogensen, Trine Pallesen, and Christian Frankel, who all spent time considering my work, either through conversation or by reading my material. Navigating a research process can be quite challenging. Thank you to both my supervisors, Morten Knudsen and Signe Vikkelsø, for helping me along the way, for both supporting and challenging my ideas, for forcing me to make hard decisions, and for making room for my project to develop. Morten, Auflösungs- und Rekombinationsvermögen is an important skill that I will aim to develop and cherish going forward, thank you for making me aware of it. Signe, thank you for your sharp insights and highly constructive input. Thank you also to Lise Justesen and Mikkel Bille for offering both constructive, critical, and challenging input at my first work-in- progress seminar, for pointing to the unavoidable significance of the work of Michel Foucault, while retaining that my research might also develop by going down other avenues. Thank you to Ebba Högström and Nanna Mik-Meyer for giving critical but considerate readings of the three papers of this dissertation at my second work-in-progress seminar. You made me revisit my data and pushed me to clarify the stories I was trying to tell, which, undoubtedly made for better papers. A special thank you to Cameron Duff. First, for hosting my research stay at the Royal Institute of Technology in Melbourne, and subsequently, for being immensely generous with your time, your feedback, and for continuously engaging with my work. Collaborating with you has simply been quite fantastic, and I hope we will continue to do so in the future. Finally, Anne, I could not have done this without you. Your unconditional support through the ups and downs made it possible for me to both manage and survive the process of conducting and finalizing this dissertation. Thank you for coming with me to the other side of the world, 4 for adapting, for believing in me, and for reminding me of the really important things in life. I love you! Thorben Peter Simonsen, October 2019 5 6 Table of contents ACKNOWLEDGMENTS 3 TABLES AND IMAGES 11 PREFACE 12 PART I 1. INTRODUCTIONS 14 ARCHITECTURAL ORDER AND SOCIAL ACTION 18 RESEARCH QUESTIONS 21 CONCEPTUAL CLARIFICATIONS 22 SUM AND SUBSTANCE 25 2. CONTEXT(ING) 29 THE GREAT CONFINEMENT 31 THE ASYLUM ERA 32 DEINSTITUTIONALIZATION 37 IN SUM 43 DESIGNING A RECOVERY-ORIENTED BUILDING 44 IN SUM 52 3. LITERATURE REVIEW 54 THE EPOCH OF SPACE? 55 GEOGRAPHIES OF SPACE AND MENTAL HEALTH CARE 58 7 IN SUM 65 THE ENDURING IMPORTANCE OF PLACE 67 IN SUM 75 4. ANALYTICAL APPROACH 78 MATERIALITY MEDIATES 80 INTERACTIONAL REPERTOIRES AND STAGING PROBLEMS 83 PRACTICAL ACTION AND THE PRODUCTION OF ORDER 86 SYSTEMS OF CLASSIFICATION SHAPE PRACTICES OF ORDERING 89 IN SUM 91 5. METHODOLOGY 95 DOING FIELDWORK 97 DOING INTERVIEWS 105 DOCUMENTS AND OTHER MATERIALS 109 ACCESS, POSITIONING, AND ETHICS 110 DOING ANALYSIS, PRODUCING DATA 118 IN SUM 121 PART II 6. PAPER I 123 INTRODUCTION 124 DIRT AND (DIS)ORDER 125 CONTEXT AND SITE 128 MAPPING THE FULL RANGE OF ‘DANGERS’ 131 8 DISCUSSION 141 7. PAPER II 144 INTRODUCTION 145 CONTEXT AND METHOD 147 FINDINGS 151 DISCUSSION 163 CONCLUSION 166 8. PAPER III 167 INTRODUCTION 168 SPATIAL ORDERING 170 METHODOLOGY 172 FINDINGS 175 DISCUSSION 182 CONCLUSION 186 PART III 9. CONCLUSIONS 188 SUMMARIZING THE PAPERS 190 ANSWERING THE RESEARCH QUESTIONS 197 CONTRIBUTIONS, CONSIDERATIONS, AND FUTURE DIRECTIONS 198 IMPLICATIONS FOR PRACTICE 206 FINAL REMARKS 210 10. REFERENCES 211 9 11. APPENDIX 241 ENGLISH SUMMARY 241 DANSK RESUMÉ 244 CO-AUTHOR DECLARATION 247 WRITTEN APPROVAL, KARLSSON ARCHITECTS 249 DECLARATION OF CONFIDENTIALITY 250 10 Tables and images Tables TABLE 1. CHANGING SPATIALIZATIONS OF PSYCHIATRIC TREATMENT 44 TABLE 2. CONCEPTS AND SENSIBILITIES 92 TABLE 3. DISTRIBUTION OF TIME AND METHODS APPLIED DURING FIELDWORK 98 TABLE 4. OVERVIEW OF INTERVIEWS 107 Images IMAGE 1. REPRESENTATION OF THE SLAGELSE HOSPITAL 45 IMAGE 2. MARKING LOCALIZATION, MOVEMENT, AND ACTIVITY OF ACTORS 103 IMAGE 3. DIAGRAM OF WARD LAYOUT – © KARLSSON ARCHITECTS/VLA 130 IMAGE 4. NURSING STATION – © KARLSSON ARCHITECTS/VLA, PHOTOGRAPH BY JENS LINDE 149 IMAGE 5. CONFERENCE ROOM – PHOTOGRAPH BY THORBEN SIMONSEN 159 IMAGE 6. INPATIENT WARD – © KARLSSON ARCHITECTS/VLA, PHOTOGRAPH BY JENS LINDE 174 11 Preface This dissertation is written as a paper-based dissertation. While four papers were written as part of the research conducted for this dissertation only three are included here. 1. ‘Rummets Grammatik: Helende arkitektur i psykiatrien’ is co-authored with Holger Højlund from the Department of Management, Politics, and Philosophy, Copenhagen Business School and has been published in Politik (2018 (2):22–42). The paper is written in Danish and is for this reason not included in this dissertation. An early version of the paper was presented at the 33rd EGOS Colloquium, Copenhagen, Denmark, July 6-8, 2017. 2. ‘The spatial organization of psychiatric (dis)order’ is aimed for publication in the journal Space and Culture 3. ‘Unfulfilled promises? Staff reactions to the ‘healing architecture’ of psychiatric inpatient wards’ is aimed for publication in the journal Social Science and Medicine.