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Spaces for smoking in a psychiatric hospital: social capital, resistance to control, and significance for 'therapeutic landscapes'

Wood, V.J.; Curtis, S.E.; Gesler, W.; Spencer, I.H.; Close, H.J.; Mason, J.M.; Reilly, J.G.

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V.J. Wood

W. Gesler

I.H. Spencer

H.J. Close

J.M. Mason

J.G. Reilly


This paper reports on research framed by theories of therapeutic landscapes and the ways that the social, physical and symbolic dimensions of landscapes relate to wellbeing and healing. We focus especially on the question of how attributes of therapeutic landscapes are constructed in different ways according to the variable perspectives of individuals and groups. Through an ethnographic case study in a psychiatric hospital in the North of England we explore the perceived significance for wellbeing of ‘smoking spaces’ (where tobacco smoking is practiced in ways that may, or may not be officially sanctioned). We interpret our findings in light of literature on how smoking spaces are linked to the socio-geographical power relations that determine how smoking is organised within the hospital and how this is understood by different groups using the hospital building. We draw on qualitative research findings from discussion groups, observations, and interviews with patients, carers and staff. These focused on their views about the building design and setting of the new psychiatric hospital in relation to their wellbeing, and issues relating to smoking spaces emerged as important for many participants. Creating and managing smoking spaces as a public health measure in psychiatric hospitals is shown to be a controversial issue involving conflicting aims for health and wellbeing of patients and staff. Our findings indicate that although from a physical health perspective, smoking is detrimental, the spaces in which patients and staff smoke have social and psychological significance, providing a forum for the creation of social capital and resistance to institutional control. While the findings relate to one case study setting, the paper illustrates issues of wider relevance and contributes to an international literature concerning the tensions between perceived psychological and psychosocial benefits of smoking vs. physical harm that smoking is likely to cause. We consider the implications for hospital design and the model of care.

Journal Article Type Article
Publication Date Nov 1, 2013
Deposit Date Aug 7, 2013
Publicly Available Date May 12, 2014
Journal Social science and medicine
Print ISSN 0277-9536
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 97
Pages 104-111
Keywords North East England, UK, Smoking spaces, Psychiatric hospital design, Power and place, Social capital, Resistance to control, Therapeutic landscapes.
Public URL


Accepted Journal Article (555 Kb)

Copyright Statement
NOTICE: this is the author’s version of a work that was accepted for publication in Social Science & Medicine. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Social Science & Medicine, 97, 2013, 10.1016/j.socscimed.2013.08.009.

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