Asylum

Selling the private asylum: therapeutic
Blackwell Publishing Ltd
landscapes and the (re)valorization of

confinement in the era of community care
Graham Moon*, Robin Kearns** and Alun Joseph†
This paper examines the role of place in the positioning and survival of the
contemporary private asylum. While community care is now the dominant mental
health care modality in most Western health economies, some asylum care has
survived, often in the private sector, catering for a clientele able and willing to pay
for a non-standard approach to care. We consider how landscapes, buildings and
services provide a basis for marketing and selling asylum care. Drawing on fieldwork,
documentary analysis and visual evidence, we analyse the representational strategies
of the Homewood Health Centre Inc. (Ontario, Canada), the Ashburn Private
Psychiatric Clinic (Dunedin, New Zealand) and the acute psychiatric hospitals within
the Priory Group (UK). The paper draws conclusions about the role of therapeutic
landscapes in the contemporary asylum, place marketing and the (re)valorization of
historical ideas of asylum.
key words therapeutic landscapes asylum private mental health care
*Institute for the Geography of Health, University of Portsmouth, Portsmouth PO1 3AS
email: graham.moon@port.ac.uk
**School of Geography and Environmental Science, University of Auckland, New Zealand
†
Department of Geography, University of Guelph, Ontario, Canada N1G 2W1
revised manuscript received 29 March 2006
documented (see, for example, Dear and Taylor

Introduction
1982) and bear only brief enumeration. A shortlist
The hegemonic position of community-based care of reasons would include the escalating costs of
in contemporary policy regarding mental health maintaining asylums, the availability of alternative
services provision is now well established. Ac- drug therapies, a misplaced anticipation of cost
companying the rise of community care has been a savings, the social costs of institutionalization and
marked decline in large-scale residential provision maltreatment scandals. The last two factors serve
for people with mental health problems. In this as a reminder that the move away from asylum
way, the asylum, once the key element in service care was accompanied by a general perception that
provision, has become a rarity. 1 A small but the asylum had ‘failed’ as a treatment modality for
significant land use in rural and urban fringe people with mental health problems. This verdict
locations has dwindled and a very specific in turn reminds us that the original conception
construction of ‘place as therapy’ largely has been of the asylum had been, in part, positive and thera-
abandoned. Governmental promotion of community peutic, as well as profoundly geographic. It sought
care and rejection of the asylum model have been to promote the recovery of mental health by the
matched, in the main, by support from mental removal of the ‘client’ from the stresses of everyday
health professionals, service users and family life through confinement in an ordered, harmonious
carers. and calming place of sanctuary – what might
The reasons for this shift in policy and provision nowadays be termed a ‘therapeutic landscape’
are many, varied and disputed. They are also well (Gesler 1992).
Trans Inst Br Geogr NS 31 131–149 2006

ISSN 0020-2754 © 2006 The Authors.
Journal compilation © Royal Geographical Society (with The Institute of British Geographers) 2006
132 Graham Moon et al.
Despite the general though not uncritical support More broadly, we seek connections with the wider
for community care that presently exists, it remains geographical literatures on place marketing and
possible to find ‘institutional survivors’: relatively commodification. We examine critically the way
large residential facilities for people with mental in which the contemporary private asylum draws
health problems in which traditional notions of on these notions to attract the necessary flow of
asylum appear still to loom large (Joseph and customers.
Moon 2002; Moon et al. 2005). Perhaps not surpri- In the following section we provide background
singly, these facilities tend to be located in the on asylum geographies, therapeutic landscapes and
private sector. They stand outside the state govern- the commodification of the asylum. The idea of the
ance structures that brought about the dominance asylum as a therapeutic landscape is introduced and
of non-residential treatment modalities. They tap a a critical review of relevant past work on therapeutic
latent public demand for asylum and are thereby landscapes is presented alongside an examination of
able to attract a client base sufficiently large to the emerging role of commodification in health care.
guarantee financial viability. Attention then turns to an outline of the methodology
With the ascendancy of community care policies, for the empirical part of the paper. The substantive
geographers have largely turned their attentions centrepiece of the paper is a detailed examination
to the spatiality of discharged patients, thus of case study asylums in the United Kingdom,
overlooking the contemporary geographies present Canada and New Zealand. As intimated above, the
in surviving (private) institutions that provide specific focus is on the use of visual and textual
opportunities for asylum. We argue that a key imagery that presents the asylums as therapeutic
feature of these overlooked geographies is the landscapes. We conclude with a discussion that
marketing of asylum. We contend that an implicit engages critically with the intersection of contem-
(re)mobilization of ideas of ‘therapeutic landscape’ is porary ideas of asylum as therapeutic landscapes
grounded in a desire to accentuate, for marketing with broader themes of commodification and place
purposes, contrasts with a dominant treatment marketing.
modality based on the general hospital and community
care networks. Although some of the images main-
Background
tained and promoted by these facilities emphasize
the past, notably through references to the ‘heritage’ For the most part, geographical studies of asylums
of particular sites, we argue that the contemporary have, by virtue of their subject matter, been
character and commodification of the private historical. Our paper draws undoubted strength
psychiatric hospital is equally important. from the established body of work on historical
The key aim of this paper is to assess the extent geographies of the asylum (see, for example, Philo
to which traditional notions of asylum are evident 1997 2004; Parr and Philo 1996), but is not historical
in the presentation and positioning of present-day in orientation. To this end, we commence our
private-sector psychiatric hospitals. Our specific examination of the background to our study by
research contribution is located simultaneously in considering the relevance of the existing literature
the relative absence of empirical studies of the on asylum geographies to the positioning of the
present-day asylum and what we will claim is a contemporary asylum.
neglected link between the concept of therapeutic
landscape and contemporary notions of asylum. Asylum geographies
While our focus is primarily contemporary, we As a form of health care, or indeed of (public)
recognize that the constructions of notions such service provision, the few present-day asylums
as therapeutic landscape and asylum are rich in attract far less research attention than the currently
history and deeply researched (Philo 2004). Indeed, dominant treatment modality of community care.
in earlier work (Joseph and Moon 2002) we For the most part, present-day research focuses on
engaged with this historical dimension of asylum the closure of asylums. In a sense, a significant
in a study of one of the institutions considered in number of studies focusing on the delivery of
the present paper. We necessarily reach back to community-based services are, in effect, examinations
the rich scholarship on the history of the asylum to of the consequences of asylum closure. They
project forward the implications of our analysis highlight the continuing constrained and semi-
for understanding the future of the private asylum. institutionalized lives of community-based patients2

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Selling the private asylum 133
(Joseph and Hall 1985; Dear and Wolch 1987; Philo the contemporary thinking about care and much
1997; Joseph and Kearns 1999). Gleeson and Kearns more about societal attitudes to mental health
(2001) examine the complex moral codings that, (Foucault 1967; Castel 1988).3
as a consequence, apply both to asylum and to Within the context of ‘removed locations’, Philo
community within the post-deinstitutionalization (2004) speaks to the positive claims that have been
landscape of mental health care. In terms of voiced about the historic asylum, located in rustic
work on the actual act of closure, Cornish (1997) surroundings away from densely populated centres,
provides a case study of the run-down of one literally ‘far from the madding crowd’. Of course,
facility, signalling the continuing imprint of stigma these removed locations had other, non-therapeutic
on its site, while Joseph and Kearns (1996) consider possibilities, and even dangers. Philo identifies
the symbolic position of a soon-to-be-closed asylum the potentially negative impact of the spatial
within its host community, both in terms of identity separation of people from family and friends:
and as a provider of work. Parr et al. (2003) consider abandonment, isolation, forgetting. These conse-
the contested memories aroused by closure. The quences existed alongside the more established
present paper can be located tangentially within problems associated with the confined conditions
the broad theme of closure in that it examines that sometimes prevailed and the way that clients
asylums that have not closed and for which closure often succumbed to a debilitating state of ‘learned
is not a threat other than on the economic grounds helplessness’. The perceived ambivalence of removed
of business failure. location as therapeutic has also lived on with the
In shifting the focus of contemporary asylum remnant instances of the asylum, and presents
geographies from a concern with closure or mem- particular challenges in image management.
ory to a focus on surviving asylums, it is necessary Our concern in this present paper lies with the
to note, in passing, that a selection of issues impact positive packaging of present-day removed loca-
on the fact of asylum survival. The particular case tions. Philo (2004) provides a reminder that this
of the survival of the asylum in the private sector selling of removed location has particular historical
is discussed by Moon et al. (2005), who note the antecedents. The private madhouses that began to
importance of flexible ‘boundary crossing’ involving emerge in the seventeenth century were, in a sense,
both the hospital/community and public/private precursors of present-day private residential
dimensions of care provision. In this paper we psychiatric provision.4 They were businesses con-
move our gaze from the causes of asylum survival ducting a ‘trade in lunacy’; location and setting
to a key aspect of the maintenance of survival: were undoubtedly potent elements in establishing
demand for (private) asylum through place-based competitive advantage. In the (re)presentation of
image making. Demand simply could not be sus- removed location as a selling point to today’s
tained if the image of asylum care was unacceptable. discerning market, it might be argued, elements of
User demand remains critically important, and social control logic remain in place in so far as
the successful marketing of a positive image for seclusion and concealment remain as important
asylum care is central to this goal. manifestations. Yet it is also the case that seclusion
Also important for the present study is a second and concealment are, to some extent, attractions for a
theme in asylum geographies: the notion of the client base that is, largely, admitted on a voluntary
asylum as a ‘removed location’. This is generally basis. Setting and location provide refuge, as well
seen in a historic context as a particular moment in as treatment. Secluded places are popular with
the history of mental health care: the shift of the people who need a problem addressed discreetly
spatial locus of care from the dispersed to the and are able to pay for private care.
concentrated (Dear and Wolch 1987; Moon 1988
2000). The culminating manifestation of this The therapeutic landscape of the asylum
process was the building of the great public asy- From past research on asylum geographies, we
lums on the rural fringes of many cities. As Philo isolate the importance of image-making in selling
(1987a 2004; see also Parr and Philo 1996) points seclusion and concealment. This leads us to a
out, within the impulse towards such locations consideration of the notion of ‘therapeutic land-
there were ‘social control’ logics at work. Embodied scape’ as a construct critical to this manufacturing
in the process were notions of seclusion and con- of image. The architecture of asylums, the quality
cealment that simultaneously revealed much of of their grounds and the variety of their facilities

are key manifestations of the image-making neces- changing emergent industrial city (Sennett 1992;
sary to sustain a client base. Simmel 1995). The goal of this strategy was to
Gesler (1992) introduced the idea of the thera- create a more convivial and ‘therapeutic’ setting
peutic landscape: places or settings that have a for the over-stressed mind in which the confusing
reputation for healing founded in a combination chaos of the contemporary city was countered by
of factors including historical precedent, natural the perceived stability and tranquillity of the rural
attributes and symbolic association. The term and quasi-rural settings offered by asylums.5
‘therapeutic landscape’ subsequently has come to Among the few writers to engage overtly and
be recognized as a significant theoretical construct substantively with the link between the asylum
within health geography (Kearns and Moon 2002). and the concept of therapeutic landscape are Paine
It has captured the imagination of geographers (1998) and Franklin (2002). The former writes from
as a tool with which to interpret places that have the perspective of landscape architecture; the latter
a reputation for healing or are health-promoting is concerned with the changing built environment
(see Williams 1999; Wilson 2003; Smyth 2005). of the asylum. However, neither engages with the
Whatever their shortcomings in practice, asylums geographical literature on therapeutic landscapes
appear, at least in part, to be predicated on such and both are concerned with the historic asylum,
ideas. Park-like grounds, seclusion and healing not present-day provision. We contend that the
through removal from society and exposure to the lack of explicit work on the historic asylum as a
positive properties of particular places were deeply therapeutic landscape, though perhaps ultimately
embodied in traditional notions of ‘asylum’ as a debateable, may, in part, be a consequence of the
care delivery modality. Despite the pharmaceutical erasure of the positive therapeutic element in the
emphasis of community care and ‘de-hospitalisation’ history of the asylum in favour of a focus on its
(Geller 2000), this notion of place-as-therapy has more recent negative image. Indeed, as Gleeson
retained its adherents. Thus ‘milieu therapy’ (Davis and Kearns (2001) contend, the implicit historic
1977) has gained increasing acceptance as a treatment binary construct of ‘asylum:good, community:bad’
for hospitalized clients, particularly in the private has, since deinstitutionalization, been recast as
sector, and the associated construct of the thera- ‘asylum:bad, community:good’. This vilification of
peutic community has also retained significance, the asylum in the era of deinstitutionalization is
emphasizing mutual support within the asylum ironic given that the small-scale residential compo-
community (Busfield 1986). A warm, pleasant nents of contemporary community care initiatives
atmosphere, in attractive surroundings, is seen as often take on a custodial form reminiscent of the
a valid complement to psychotherapy and chemo- asylums they have replaced (Joseph and Kearns
therapy. More generally a conceptual underpinning 1999). It also presents a major challenge for the
to the representation of the asylum as a therapeutic marketing of present-day asylum provision. It is
landscape is also implicit in research on the inter- our further contention that the construction and
relationship of place and health (Jones and Moon presentation of the contemporary asylum as a
1993; Kearns 1993; Kearns and Joseph 1993; Moon therapeutic landscape is a key response to this
1995). challenge. Moreover, we suggest that this response
Despite this seeming resonance, historic asylums is not only a recovery of the therapeutic past of
have not, to our knowledge, been recognized the historic asylum but also a present-day attempt
explicitly as therapeutic landscapes in the formal to commodify health care, albeit an attempt that
sense of the application of the term to the study has parallels with earlier attempts to market the
of asylums. Work on the historical geography of historic asylum.
asylums has, however, invoked implicitly cognate
ideas. This scholarship has immense value as a Image-making and the commodification of the
broader context to our research. Parr and Philo present-day asylum
(1996) hint at the link between the historic asylum In terms of our focus on present-day asylums, we
and concept of therapeutic landscapes and Philo are interested in both their material reality in the
(2004) has recounted how the historical justification built environment and the ideological presence in
for asylum care emphasized the virtues of offering the perceptual landscape that this reality gener-
a sanctuary that was intentionally removed from ates. Following Kearns et al. (2003), we argue for a
the (over)stimulation of everyday life in the rapidly recursive link between the material and the

ideological. Advertising and promotional texts health care. In this discourse, hospitals in general,
about present-day asylums can be seen as leading like other parts of the urban realm, become com-
to their legitimation as an ongoing modality of modified and are rendered attractive to patients
care within the ‘health care talk’ of medical and investors through the conscious manipulation
professionals and the public at large. They frame of images. While there is long-standing interest in,
and clarify the nature of the asylum as a product and commentary on, the commodification of health
in the contemporary landscape of health care, care services (Moynihan 1998; Pellegrino 1999),
shaping residual provision as a commodity to be geographers have usefully added the perspective of
desired. At a time when the marketing of health place and sought to investigate the contemporaneous
care provision is increasing rapidly (Naidu and commodification of care and location. In New
Narayana 1991), the potential market for asylums Zealand, for instance, such trends are evident in
is limited. This limitation within the ‘health care the case of Auckland’s Starship Hospital. While
market’ is potentially exacerbated by the stigma of this remains New Zealand’s key teaching and
the asylum. The historical legacy of confinement, tertiary care paediatric hospital and has no need
austerity and grim treatments heightens the chal- to compete for patients, it nevertheless needs to
lenge of promoting and marketing sites of asylum, compete for the donated dollar. It is arguably
of successfully commodifying what was historically important that an organization regards its potential
shunned. benefactors as consumers of a branded image. Thus
Notwithstanding the challenges from the past, the strategic choice by a hospital administration of
we suggest that an important geography is evident a captivating logo and name, and the development
in the use of language and image to create, position of a building with high imageability (Lynch 1960),
and maintain the place-identity of present-day was seen as a way of encouraging potential bene-
asylums as therapeutic landscapes. Our interest in factors to become actual patrons and consumers of
this link builds on the work of cultural geographers the Starship charity (Kearns and Barnett 1999). Our
for whom places and their imaginings are not present investigation of private asylums serves to
given, but rather are made through the contested extend the handful of other studies within health
processes of cultural production (e.g. Anderson geography that have embraced this convergence
and Gale 1992; Gesler and Kearns 2002). In this of cultural and economic concerns (e.g. Moon and
respect, places such as hospitals exist not only as Brown 2000 2001; Kearns et al. 2003) while sim-
empirical entities, but also as social productions, ultaneously extending and developing ideas of
reflecting changing underlying relationships of representation and place marketing.
power, class and cultural expectation. Our work
also finds roots in the views of those cultural
Methodology
geographers who are increasingly expressing
interest in the production and symbolism of urban Our objective is to assess the extent to which
landscapes. This scholarship, focusing on topics as traditional notions of asylum and therapeutic
diverse as cultural heritage (Waitt and McGuirk landscape are repackaged in the representation of
1997) and new urban ‘megastructures’ (Crilley the contemporary private psychiatric hospital. We
1993), has a common interest in the commodifica- focus on three case studies: the Homewood Health
tion of places, propelled by issues of branding and Centre Inc. (Ontario, Canada), the Ashburn Private
marketing (see Mansvelt 2005). The selling of an Psychiatric Clinic (New Zealand) and the acute
urban lifestyle has become an integral part of an psychiatric hospitals within the Priory Group (UK).
increasingly sophisticated commodification of Our approach follows what Rose calls a critical
everyday life, in which images and myths are visual methodology, in which the term ‘critical’ is
packaged and (re)presented until they become invoked to signal an approach ‘that thinks about
‘hyperreal’ (i.e. elevated from the metaphoric into the visual in terms of the cultural significance,
the everyday and taken-for-granted) (Holcomb social practices and power relations in which it
1993). In this paper, we turn, in a sense, to the selling is embedded’ (2001, 3). The research material
of an asylum lifestyle. comprised archival and secondary data, web pages
To this end, ideas of place marketing in the comprising text and visual images, and more
‘selling cities’ literature (e.g. Kearns and Philo traditional promotional material collected through
1993; Madsen 1992) find parallel in contemporary postal and email approach to the organizations

involved. We supplemented this documentary challenged our central themes. All authors par-
evidence with fieldwork using observational ticipated in data collection and analysis, and in
approaches. Our ‘data’ were taken to represent the reading and interpreting the range of research
self-images that the facilities were seeking to display material. Presentation of preliminary findings in a
to potential clients and to the wider community: number of conference and classroom settings assisted
the overt evidence that a potential consumer could in developing the analysis to which we now turn.
access when contemplating use of a facility and, at
the same time the image which the facility wished
Case studies
to display to the public gaze.
We sought to deconstruct this promotional and The three case studies examined in this paper share
image-making material and understand how place elements of a common context. All operate in health
is incorporated into the positioning of the case care economies that are dominated by community
study institutions. Our goal was to note not only care and by public-sector funding. All are, however,
the particular images and metaphors used in pro- private-sector operations with comparable fee
motional materials, but also to read the underlying regimes. All can, and do, also admit publicly
discourses that reveal evidence of power and funded clients via contractual arrangements with
position in the maintenance of place. By discourse mainstream health services. Despite a popular
we refer to language and writing (printed words perception that they deal only with addictions and
as well as inscription in the landscape) intended less severe conditions, all cater for a full range of
to ‘persuade ourselves and others to a certain problems, though their clientele certainly tends to
way of understanding’ (Harvey 1996, 77). In other exclude people with severe acute needs.6 Crucially
words, it is our contention that the messages all are ‘unusual’ in their emphasis on residential
about residential psychiatric care conveyed in pro- care. To this extent, their similarities make them
motional materials may assist in constructing new amenable to comparative analysis.
ways of understanding the very nature of mental Homewood was founded in 1883 in Guelph,
health care itself. This interest in discourse can be Ontario, Canada. It currently has some 300 beds
linked to Gesler’s (1999) proposal for examining catering for a wide range of conditions. Other
links between language, place and health. In this activities include community care, corporate men-
paper we focus on the language of the promoters of tal health promotion and addiction management
the hospital, rather than that of the users, whether programmes. It has a 120-year history of private
those users be doctors or patients (see Moon and ownership, and the hospital and related extramural
Brown 2000). This constraint is intended to ensure programming are currently operated through the
a clear focus on promotional intent rather than Homewood Health Corporation (Joseph and Moon
outcome; our interest is in the ways in which 2002). Ashburn opened in 1882 in Dunedin, New
therapeutic landscape and place are used to promote Zealand. It can accommodate around 100 patients,
asylum rather than their effectiveness as promo- but currently comprises a 29-bed inpatient service
tional tools. and clinics catering for eating disorders, a day pro-
Analysis focused on identifying evidence of gramme, a self-care hostel and outpatient services.
therapeutic landscape ideas. We systematically It is run by the Ashburn Hall Charitable Trust. This
searched for tropes engaging with notions of body purchased the hospital in late 1988 from the
community, privacy, seclusion and recovery as well University of Otago, which had been using it for
as more straightforward themes about landscape, teaching psychiatry students. Ashburn’s treatment
buildings and facilities. Counter-tropes were also philosophy is firmly anchored in ideas of therapeutic
sought. These represented textual motifs that community, which sees patients and staff working
challenged the central hypothesis that notions of together and, where appropriate, sharing in decision
therapeutic landscape and asylum are integral to making. The Priory Group was founded in 1980. By
the (re)presentation of the case study facilities. Our 2003 it had 15 hospitals with 559 beds in diverse
approach has parallels with studies of news media locations across the UK. The Priory hospitals often,
and printed institutional marketing documents though not always, pre-date the foundation of the
(Joseph and Kearns 1999; Kearns and Barnett 1999; company and have individual histories of providing
Kearns et al. 2003) in that we sought words, private and/or UK NHS care. In addition to in-
phrases and visual images that either illustrated or patient psychiatric care, Priory has substantial

detoxification services as well as commitments in Hospitals. As we argued earlier, the objectives
the areas of executive stress, residential schooling of the historic asylum incorporated ideas about
and brain injury. We turn now to a more detailed therapeutic landscapes. They sought the promotion
examination of each case, focusing on the deploy- of recovery through the calming properties of
ment of tropes associated with notions of asylum particular landscapes. Philo (2004) gives explicit
and therapeutic landscape. consideration to the employment of ‘opportunistic
geographies’ arising from location and setting in
Priory Hospitals the marketing of the historic private ‘mad house’.
The archival record is replete with examples of
Priory’s aim is to provide the best quality care and proprietors lauding their locational resources:
services for all and to ensure that these are delivered to Hygeria Lodge had ‘the surface paradise of a country
the highest standard by professional and committed
retreat’ (p. 298); the advertising of Haydock House
staff. The Group’s values are based on Service,
made explicit reference to its rural qualities (p. 390).
Innovation and Integrity and its purpose is to bring
‘Hope, Healing and Sanctuary’ to all and to assist each
The present-day Priory Hospitals explicitly echo
individual to take control of his or her own life within this approach: landscape is portrayed as a key
a safe and secure environment. (Priory Group 2005a) element in the promotion of better mental health
and ordered, highly designed park-like settings are
Ideas of safety and separation from a threatening a characteristic of many of the Priory Hospitals and
outside world were central to historic notions of landscape is specifically noted in the marketing
asylum. These qualities remain evident in the descriptions of many of the sites (Table I).
presentation of the Priory Hospitals to their present- Alongside tranquillity and seclusion in these
day clients. The hospitals are promoted as sites landscape tropes sit clear themes of ownership and
where motifs of sanctuary, security and safety privatized exclusion and exclusivity. Field visits
enable an emphasis on protection for the service substantiated this aspect to the claims made in these
user. promotional materials. Marchwood, for example,
Two intertwined devices enable the marketing is accessed via a winding drive through open
of sanctuary, security and safety. First, there is parkland; the building looks across this vista to an
reference to high-quality service delivery. Materials artificial lake and mature woodland. It is invisible
stress the availability of carers providing oversight from the main road. The more urban Grovelands
of the service user and protection from harm, for benefits from co-location alongside a public park
example: ‘Exits through the building lead to safe from which it is separated by impressive ornamental
gardens where patients are free to wander under fencing. Further themes that are evident in this
the unobtrusive surveillance of nursing staff’ use of landscape as a promotional device are reas-
(Priory Group 2005b). Publicity also emphasizes surances about proximity to urban life and references
the regular inspection of facilities and the quali- to well-known nearby landscapes, as well as simple
fications, networks and accreditation of staff. There statements noting the size of the hospitals’ grounds.
is full participation in national inspection schemes While the latter theme contributes to the motif of
and accreditation by the UK Health Quality Service. seclusion, the former issues offer clients a continuing
These claims implicitly draw comparison with other connectivity with urban life and locate the facilities
(understaffed, community, public) services. Second, in areas signifying rural quality: isolation is tem-
the facilities are promoted as safe and secure in pered by accessibility and seclusion takes place in
their own right. They are places from which threats environments of repute. Again there are historic
and pressures are excluded. Potential disturbance parallels for this interplay of the rural with urban
is prevented from entering the user’s secluded connectedness (Philo 2004, 344). What we see in
world. Moreover, this safe, secure world lies within more theoretical terms is the marketing of places as
boundaries. There is a clear separation between managed, accessible rurality and the mitigation of
the inside of the asylum world and the outside, potential stigma by calming context.
everyday world: ‘It is easy to drive past the Priory In effect, what is being offered is the health care
in Roehampton with not the faintest idea of what equivalent of the country house (hotel) experience.
goes on behind its high walls’ (Franks 1998). In promoting this offer, there is, however, recog-
Looking inside the asylum world, landscape is nition that care and treatment form part of an
a clear theme in the presentation of the Priory experience that is about more than landscape.

Table I Landscape tropes in the marketing of Priory Hospitals
Hospital Source
Altrincham ‘situated in its own extensive grounds in the heart of Priory Group 2005c
the Cheshire countryside’
Dukes Priory (Chelmsford) ‘in a secluded part of Chelmsford, Essex, and is set Priory Group 2005d
in 31/2 acres of private grounds’
Grovelands (North London) ‘Grovelands Priory Hospital is located in a Priory Group 2005e
secluded part of Southgate, set in several acres of
private grounds overlooking extensive parkland’
Hayes Grove (Bromley) ‘in a lovely situation overlooking Hayes Common, Priory Group 2005f
just south of Bromley, Kent, within its spacious
grounds’
Bristol ‘Set in four acres of landscaped gardens, The Priory Healthcare 2005g
Priory Hospital Bristol offers a tranquil environment
for those receiving treatment for psychiatric
problems’
Lynbrook (Woking) ‘set in several acres of private grounds’ Priory Group 2005h
Marchwood ‘set in 10 acres of Hampshire countryside close to Priory Group 2005i
Southampton city centre and the New Forest’
Priory Grange ‘set in the Sussex countryside with close links to the Priory Group 2005b
Heathfield local community’
Hints of this are evident in quotes that place the various Priory facilities. These apply, on the one
actual hospital buildings in their landscape con- hand, to the provision of care. The Roehampton
texts. Thus the Roehampton Priory Hospital is ‘a Priory Hospital, for example, ‘first became a hospital
most attractive building in a tranquil setting in in 1866 and is now recognised as one of the foremost
Roehampton, South London, close to Richmond private psychiatric hospitals in the United Kingdom’
Park’ ((Roehampton) Priory Hospital 2005). In other ((Roehampton) Priory Hospital 2005). The linkage
cases it is treatment that is linked to therapeutic of history and the therapeutic appeal to landscape
landscape. The Priory ‘Grange’ group of facilities noted above for Ticehurst House is also extended
make particular play of this second link. They to Roehampton in a section of the main Priory
Group website specifically devoted to the history
offer a home and treatment for adults with enduring of the group:
mental and physical illness. They deliver intensive but
highly flexible care programmes in a safe and tranquil The Priory Group owns two of the oldest private
setting. (Priory Group 2005j) mental health hospitals in the UK: The Priory Hospital
Roehampton and The Priory Ticehurst House. The
The Priory Grange Hospital Heathfield exemplifies Priory Hospital Roehampton is London’s oldest private
this claim: psychiatric hospital and has been in continuous
operation since its launch in 1872, when Dr William
The space and tranquillity offered by the Unit and its Wood moved his patients from Kensington to
surroundings provide a perfect setting for people who Roehampton’s then country atmosphere, which he felt
are experiencing severe and enduring mental health was conducive to healing. (Priory Group 2005k)8
problems. (Priory Group 2005b)
We see the manufacturing of appeals to historic
as does Ticehurst House: ‘Founded over 210 years ideals of sanctuary and implications that the Priory
ago, the hospital stands in 48 acres of extensive Hospitals are offering continuity with a historic
grounds, providing a calming therapeutic envi- mission dedicated to mental recovery in therapeutic
ronment for our patients’ (Priory Ticehurst House landscapes.
2005).7 Appeals to history are also evidenced as archi-
In this last quote, we discern a further theme: tectural signifiers of quality. For the most part,
appeals to history that rework and memorialize Priory Hospitals occupy inherited sites, and thus
positive aspects of both the specific pasts of the do not evidence innovative new-build architectural

display. Historic buildings, however, clearly form At most of the Priory Hospitals, dining, exercise
an important part of the therapeutic landscape of and social facilities that would not disgrace a
the present-day asylum. There is an emphasis on decent hotel complement these individualized
the status of the buildings in publicity material: facilities.
A characteristic of the historic asylum was the
The Priory Hospital Hayes Grove is situated close to
idea that patients should have their time occupied
Hayes Common, just south of Bromley, Kent. Within its
with structured activities. Traditionally, the focus
spacious grounds the hospital incorporates a listed
Queen Anne mansion. (Priory Group 2005f)
was on the outdoors, on agriculture and horticulture.
Latterly, elements of sporting activity were intro-
At Chelmsford and Marchwood the buildings duced. ‘Occupational therapy’ also came to include
are reported as grade II listed and Farm Place is significant ‘indoor’ activity. We can see elements
a seventeenth-century manor house. The Roeh- of this trope, updated by a contemporary concern
ampton hospital is described as ‘built in the first for physical fitness, in the present-day Priory
part of the 19th century in a style known as Hospitals. At the Woodbourne Priory Hospital
Strawberry Hill Gothic’ ((Roehampton) Priory
Communal areas provide a pleasant and comfortable
Hospital 2005). It is in fact a ‘type-site’ for that
environment and patients are encouraged to use
particular architectural style. Civic responsibility is facilities for physical exercise both within the hospital
also implicated in these references to architectural grounds and in the locality. There is an art room and
signifiers: activities area. Individual Aromatherapy, Reflexology,
group Tai Chi and Yoga sessions are available.
Priory bought Heath House, a Grade II listed building, (Woodbourne Priory Hospital 2004)
from the National Health Service in 1991. The House
dates back to the 18th century and for eleven years had While the asylum farm has vanished, horticulture
been empty and almost derelict. After extensive as therapy continues at some hospitals. The
restoration the building was totally renovated back to marketing of the hospitals, however, makes more
its original splendour and is now the centre of The of the provision of recreational facilities, both
Priory Hospital Bristol. (Priory Group 2005g)
within the hospitals and in the form of negotiated
By drawing attention to the architectural status exclusive access beyond the hospital walls. Yet the
of the hospital buildings, we contend that promo- stress on security and safety remains:
tional material implicitly seeks to confer a similar Some patients swim at the local hydrotherapy pool,
aura of status on the users of the buildings. It others can take part in carriage driving or ten pin
contributes to the positioning of the Priory Hospitals bowling. However, for those who cannot cope with the
as a service provider of quality. outside world we offer a safe environment with
The internal (land)scapes and facilities of the activities within our boundaries. These include both
hospitals are also of importance in (re)presenting leisure activities eg, music, art, computers etc or
asylum to the contemporary public. As the chief therapy such as aromatherapy, physiotherapy, cooking
etc. (Priory Group 2005j)
executive of the Priory Group, Dr Chai Patel,
argued at a conference on the quality agenda in Visual cues in publicity material provide addi-
health care in 2000: ‘Our expectations now are very tional evidence of the use of therapeutic landscapes
different from what they were in the past when and the asylum tradition in the presentation of the
communal bathrooms and shared rooms were Priory Hospitals. There is a picture of the hospital
taken for granted’ (Todd 2000). To this end, the on each promotional factsheet and on the Priory
description of each hospital routinely includes a Group website. These pictures reinforce the points
brief outline of the facilities that a user can expect. made above about architecture, but also touch on
At the Priory Hospital Glasgow the linkage of ideas the issue of landscape by depicting historic build-
about the therapeutic advantage of the internal ings located, in many cases, in park-like settings
environment and the quality of that environment (Plate 1).
are explicit:
The environment we create for patients is as important Ashburn Clinic
as the treatment itself and each patient has the privacy Current publicity signals that Ashburn Clinic
of their own comfortable bedroom with television, caters to four types of patient. These are people,
telephone and en-suite facilities. (Priory Group 2005l) who

In a lengthy passage, on the role of Ashburn
Clinic, an information booklet specifically des-
cribes the hospital’s presentation as an asylum:
The importance of the meaning of the word asylum for

some patients has recently been affirmed in the
literature. The Ashburn Clinic has always had a role,
with some local patients, in providing asylum. In past
decades people who were chronically psychiatrically
compromised were encouraged to stay in institutions in
the belief that this afforded them a better quality of life.
For some this is still true, and for many older patients
leaving hospital is now not a real possibility. The
Ashburn Clinic, therefore, continues to have a role in
the provision of asylum. (Ashburn Clinic undated a, 2)
Here we see a presentation that alludes to expert

opinion (the literature) and to historical continuity
(‘has always’, ‘past decades’). A service need is
identified and Ashburn is presented as the solution
to that need.
Landscape is a major trope in the representation
of Ashburn Clinic. Though in a classic urban fringe
location, it is presented, like certain of the Priory
Hospitals, as close to urban life. Greatest emphasis
is however on the peace, tranquillity, diversity and
extent of the Clinic’s grounds:
Plate 1 Ticehurst House: an example of a historic
The Ashburn Clinic is situated 10 minutes from the city
Priory hospital in a park-like setting
centre and is surrounded by farmland. The extensive
Source: Priory Group (2005m) grounds are filled with flowers, shrubs and exotic trees,
which attract a variety of native birds. A serene setting
for just sitting or strolling, with large lawns for outdoor
sports. (Ashburn Clinic undated b, 2)
fail the state system; who need psychotherapeutic The reference to serenity is significant. It links back
treatment; who need a longer term residential envi- to the therapeutic role of the landscape. It also
ronment; or who are attracted to our setting rather than links Ashburn to ‘New Age’ notions of spiritual
the public alternative. (Ashburn Clinic undated a, 2) rebirthing. This viewpoint is echoed in recurrent
In contrast to the Priory Hospitals, where the visual images on the Ashburn website and in
tropes are implicit, notions of asylum and thera- current newsletters and guides for intending users.
peutic landscape are explicit in the present-day Images of greenery, exotic planting and blossom
objectives and presentation of Ashburn: are used to present Ashburn as a garden retreat.
Indeed, the frontispiece banner on Ashburn’s
Still today the design of the hospital and the grounds website states:
are integral to providing a therapeutic environment
distinctly different to most psychiatric institutions. The Ashburn Clinic gardens are a place of quiet
(Ashburn Clinic undated a, 2) reflection, where the cycles of nature are a reminder of
the regrowth that is fostered here. (Ashburn Clinic
This quote is important in that not only does it
2005)
engage directly with the central concerns of this
paper, but it also clearly positions Ashburn as As with the Priory Hospitals, Ashburn sets store by
different and as an institution. It is different in that the integration of its buildings with its physical
it is an institution and different in that it is landscape. It is also made clear that the built
avowedly an institution in the era of community environment is well-maintained and high quality:
care. ‘Our totally refurbished accommodation is

staff and patients’. We will return to this matter in
our discussion of counter-tropes but, for the moment,
it is relevant to note that, ‘In living together and
performing the necessary domestic and adminis-
trative tasks, a sense of belonging, safety and
responsibility grows’ (Ashburn Clinic undated b,
5). The users of Ashburn play a part in running the
Clinic. This is part of the recovery regime; it is a
form of occupational therapy, but it also means
that there is a more workaday image with less
emphasis on services provided by others and the
opulence of the surroundings.
Nonetheless, structured recreational activity is
an important theme at Ashburn. The lawns provide
a setting for outdoor activity while,
Alongside our main building is our recreation hall
which is equipped for a variety of indoor games
Plate 2 Te Whare Mahana o nga hau e wha including volley ball, badminton, netball and indoor
bowls. Next to this is an outdoor tennis court. (Ashburn
(the warm house of the four winds)
Clinic undated a, 2)
Source: Ashburn Clinic (2000)
A tour of the premises also reveals a large and
well-loved billiard room. Again, we see the concern
beautifully set in several acres of lawn, trees and to promote sporting activity rather than the
rhododendrons’ (Ashburn Clinic 2005). This farming or horticultural activities that historically
therapeutic articulation of the physical and the characterized the asylum. There are, however,
built environment is most clearly articulated by the notable differences between Ashburn and the
recent development of Te Whare Mahana o nga Priory Hospitals. The activities at Ashburn tend to
hau e wha (the warm house of the four winds): ‘In be team sports and they tend to require greater
an old orchard beside a stream we have created a levels of physical exertion. While it is tempting to
quiet spiritual place for people to sit and reflect’ view this contrast as a reflection of difference in
(Ashburn Clinic undated a, 2). This building, clientele or even gross stereotypes of national
designed by a leading New Zealand architectural cultures, it is perhaps best seen as another mani-
partnership, seeks to capture both traditional festation of the distinction between a therapeutic
(Western) notions of asylum and therapeutic healing community where people work together for
and Maori concepts of spiritual well-being and healing and a hospital chain that prides itself on
recovery (Plate 2). This is a bold initiative that offering high-quality choices in a quasi-hotel
echoes the bicultural spirit of developments at the environment.
former (public) Tokanui Hospital, which closed in
The Homewood Health Centre
the late 1990s (Joseph and Kearns 1996 1999).
The interior facilities of Ashburn receive rather From the beginning, Homewood has emphasized the
less attention in publicity materials compared to importance of a therapeutic environment for healing
those of the Priory Hospitals. Users are encouraged the mind, body and spirit. Second growth forests, the
to personalize their rooms and there is some meandering Speed River, maintained lawns, grand
description of communal areas, although provision vistas and historically significant architecture create an
environment that is tranquil, serene and reminiscent of
appears rather more spartan than that at the Priory
a bygone era. (Homewood Health Centre 2003a)
Hospitals. This distinction can be traced to an
important difference between the two operations. Notwithstanding this explicit comment about its
While Priory emphasizes choice, the quality of grounds, the Homewood Health Centre provides
interior facilities and a hotel-like approach, Ash- rather less evidence on its website and in its
burn presents itself as a therapeutic community publicity material of notions of therapeutic
where even the welcoming publicity is from ‘clinic environments or continuity with historic ideas of

Figure 1 The Labyrinth at the Homewood Health Centre

Source: Homewood Health Centre (2003d)
asylum. Nevertheless, a range of relevant tropes relevant for the issues raised in this paper. First,
are present that resonate with the themes identified the presentation of pastoral therapy echoes the
above: notions raised by Te Whare Mahana o nga hau e
wha at the Ashburn Clinic. Homewood boasts a
Homewood Health Centre is a leader in mental health
labyrinth (Figure 1) where spiritual health is
and addiction treatment, providing specialized psychi-
atric services to all Canadians. Located in Guelph,
grounded in place-specific activity. Second, the
Ontario, in a beautiful setting on the banks of the Speed Homewood makes active use of its grounds:
River, Homewood has been improving lives since 1883. Homewood Health Centre hosts the largest and
(Homewood Health Centre 2003b) longest-running horticultural therapy program in
Here we again see claims to excellence, historical Canada. Horticultural therapy promotes a ‘natural’
sense of wellness, and is an adjunctive therapy in all
referencing and place.
treatment programs offered at Homewood. . . . Therapy
A user testimonial, one of a series that together
takes place in the newly constructed ‘state-of-the-art’
constitute a novel feature of the presentation of the conservatory and classroom, as well as on 47 acres of
Homewood, provides an indication that the hospital garden and wooded area, patio and container gardens,
offers its residents secure safe sanctuary. Indeed, and raised garden beds. (Homewood Health Centre
the testimonial makes an implicit contrast between 2003e)
the negative image of the (historic) asylum and the
Where the Priory Hospitals chose to present its
more positive aspects of asylum:
indoor landscapes as akin to those of a hotel and
I had my fears about where I was going. No-one had Ashburn emphasized the therapeutic community
really told me about what goes on in these places. I dimension, Homewood exemplifies a third approach.
feared the worst. But without question it was the best Space is not necessarily open to personalization.
move I’ve made in my life. The hospital environment Accommodation is available in private rooms but
provides protection from the sources of stress. In a
also, in the medicalized hospital tradition, in shared
short period of time you begin to calm down.
rooms and on wards. There are visiting hours and
(Homewood Health Centre 2003c)
no telephones in rooms; televisions are located in
Landscape and architecture interact in many of the patient lounges. Dining is recognized as a thera-
images on the Homewood website. One view is peutic opportunity, but is also presented in terms
shown of the main hospital building from the of nutritional requirements. Meal times are assigned.
grounds; the impression is one of order, calm and Overall, the impression is that, rather more than
authority. Other images concern the provision of the other case study facilities, Homewood sees
different therapies. Two sets are particularly itself as a relatively traditional hospital.

interactions in community living. Our emphasis is on
Counter-tropes working with the individual within the therapeutic
So far we have carefully reviewed representations community using a psychodynamic approach to
of our case study facilities, seeking evidence for the promote individual and personal growth. (Ashburn
deployment of tropes associated with therapeutic Clinic undated b)
landscapes and positive aspects of asylum. Our
Though these processes certainly unfold in a
contention has been that these tropes are central to
particular place isolated from the surrounding
the representation of our case study facilities in the
society, the extent to which it is additionally crucial
present-day era of community care; they both
to represent that place as a therapeutic landscape
distinguish and valorize this rather different form
or a benign shadow of the historic asylum is, in a
of care provision. To assure this analysis, we also
sense, immaterial.
need to consider counter-tropes: themes evident in
There is some evidence of this counter-trope of
our source material that suggest representations
therapeutic community at Homewood. The key
other than those on which we have concentrated
counter-trope evident in the research material on
thus far.
Homewood is, however, continuity of care. Though
In the case of the Priory Hospitals, one such
the Priory Hospitals provide a range of services,
counter-trope is provided by the theme of choice.
their key focus is on residential care. Homewood,
Of course, the package of high-quality asylum in
in contrast, is also active in community psychiatry.9
a therapeutic setting that we have discussed in
The Homewood website makes central use of the
previous sections is a central part of constructing
idea of a ‘healing journey’ from mental ill-health
a commodity that a discerning public will choose
to mental wellness. Homewood is represented as
to purchase. Our research material does, however,
offering guidance on this journey, providing
give some emphasis to choice as a distinct con-
potential patients with (intermediate) destinations
struct in its own right. For example:
where the processes of resolving their mental and
To complement our care for the mind, we ensure that emotional health problems can begin. Destinations
the choice, preparation, presentation, and quality of one and two would not be unusual at a Priory
food is appealing to patients. At each meal there is a Hospital or at Ashburn. They concern, respectively,
choice of hot and cold dishes to suit different tastes and inpatient addiction treatment and ‘specialised
nutritional needs. We also cater for special dietary psychiatric treatment’ (the care of people with
requirements. (Woodbourne Priory Hospital 2004) eating disorders, acute or chronic mental health
problems, or post-traumatic stress) in a residential
This is nothing to do with the selling ideas about
setting. Destination three is distinctive: it reveals
asylum or therapeutic landscapes; it is simply
the positioning of Homewood within its regional
about presenting a quality service.
community care economy and its role in promoting
Our research material on Ashburn Hall reveals
continuity of care.
a strong commitment to the philosophy of the
On the weight of evidence, a measured conclusion
therapeutic community. Though we have drawn
from our research material would be that asylum
parallels with the themes addressed in this paper,
and therapeutic landscape are significant general
there is some case for seeing this idea as a counter-
tropes in the representation of contemporary
trope with regard to our interest in the asylum as a
institutionally-based mental care. Their relative
therapeutic landscape. While therapeutic landscapes
significance for the three case studies examined in
are, at least in the present paper, associated with
the present paper varies, however. In all three cases
the healing properties of the physical or built
there are important counter tropes. The concepts
environment, therapeutic communities operate on
of asylum and therapeutic landscape are least
a more sociological level in which place-as-setting
significant for Homewood, where there is a coun-
may matter less than place-as-group-dynamic.
tervailing stress on a medical model of care and
Thus, patients live together with carers forming
integration with community care. In contrast, both
relationships which ‘provide the human warmth,
concepts are, in different ways, important to the
support and understanding that is necessary for
presentation of Ashburn and the Priory Hospitals.
healing’ and
In the former this importance arises from an articu-
treatment at the Ashburn Clinic revolves around lation with therapeutic community; in the latter it
participation in community activities, meetings, and reflects market positioning as a quality service.

the hospital as a therapeutic landscape provide an
Discussion
extension of traditional theoretical conceptions of
In this section, we reconnect with the background place marketing in that place is not simply a selling
matters discussed earlier in the paper. We focus point or experience; it is also part of the treatment.
first on what our empirical material has revealed Alongside statements of service quality and
regarding the deployment of language and image effectiveness as well as concerns for the ‘hotel’
in the promotion of psychiatric care settings in aspects of their services, our facilities each speak
terms of their material and symbolic construction selectively to landscape and its implied therapeutic
as therapeutic landscapes. value in enhancing their health role. In a very
Building on Gesler’s therapeutic landscape ideas, particular sense, this selective presentation also
Geores’ (1998) account of the history of Hot Springs, revalorizes confinement and engages with historical
South Dakota, portrayed a spa town founded by notions of asylum in that the context of confinement
entrepreneurs to sell a commodified notion of is portrayed as acceptable, high quality and thera-
‘health’. Gesler himself undertook a similar peutic in its own right.
study of Bath (Gesler 1998). In these classic studies, A related theme that emerges from these concerns
therapeutic landscapes can be read simply as an is the role of activity in our case study facilities.
element in the place marketing of towns. Our There is a clear importance that can be attached to
study suggests that the link between asylum and the promotion of active minds and active bodies
therapeutic landscapes is a potent element in the within healthy settings. The bodies of clients are
place marketing of our case study facilities. Our themselves living landscapes that need to be
facilities seek to sell themselves as places that inscribed with therapeutic properties through
heal. The appropriation of notions of therapeutic disciplined engagement with wholesome physical
landscape enhances their symbolic and material activity in appropriate settings. The spaces that
construction. The urban studies literature on place most exemplify and to an extent commodify this
marketing alluded to earlier offers interesting contention are gymnasia (Andrews et al. 2005;
parallels in this regard, but also subtle differences. Fusco 2006). In all our case study facilities such
In urban studies place marketing traditionally provision is evident. Embodied recovery through
has been linked with city regeneration (Madsen active engagement with recreation is encouraged.
1992; Boyle and Hughes 1994). The place marketing Indeed participation, particularly at the Ashburn
of our facilities as therapeutic landscapes is an Clinic, is seen as part of the healing process, not
exercise on a rather different scale, yet it too deals only through participation itself, but also through
with regeneration – of an ‘unfashionable’ mode of being ‘part of the team’ and integrated within a
care delivery that has to overcome stigma. community. In this way the gyms and jogging
Gotham (2002), in a paper on the place market- paths are communal spaces in which sociality and
ing of New Orleans, notes the importance of pro- recovery emerge from physicality. By marketing the
moting selective images to manipulate markets and availability in place of these aspects of provision,
assure commercial success. In the (post)modern an appeal is made to contemporary body cultures
health care market, hospitals are under increasing in which activity is an act of exertion as well as an
pressure to ‘sell’ themselves in this way in order to assertion of self.
establish or maintain a clientele as well as ensure Kearns et al. (2003) explored similar themes to
more generalized legitimacy. To this end we those in the previous paragraphs in a study of the
support suggestions that it may be helpful to see creation and promotion of health care in a rather
hospitals as distinct sites in which health and place different setting: a private surgical hospital in
converge (Naidu and Narayana 1991). Through Auckland, New Zealand. The ‘selling’ of this surgical
devices such as ‘quality’ or enhanced treatment hospital was read as a symbolic, material and
regimes, a hospital can enhance its market position institutional inscription on Auckland’s landscape.
on the ‘health’ side of this convergence. The We have followed that paper in arguing that the
deployment of place-based marketing arguments way hospitals are described does much to construct
serves to supplement the positioning derived from them within the public consciousness. In the case
health alone. Our case studies illustrate this theme of the surgical hospital, language was carefully
in contemporary residential psychiatric care. deployed to construct the hospital as part of the
Images depicting aspects of ‘nature’ and promoting community, replete with expertise and technology,

and reflecting the latest in medical intervention. view our case studies as sites of resistance to the
While there are many parallels between this earlier dominant modality of community care. In this
study and the present case studies, there are also interpretation the private-sector asylum is meeting
differences. In the case of most hospitals, people a societal need for which the state has eschewed
generally wish (or are required) to leave as soon as responsibility. The global policy shift in favour of
illness, injury or impairment are satisfactorily the mixed economy of care ensured space for the
addressed; place may be important, but that private sector. In general terms this has manifested
importance is fleeting. Our case studies provide an itself in the emergence of alternative private-sector
alternative perspective. Given their positioning as providers of community care complementing and
in-patient mental health care facilities, language sometimes replacing elements of public provision.
and images are, to variable extents, used to construct More specifically, residual demand for residential
them as apart from (rather than part of) the com- care ensured that private residential provision can
munity. This contrasts with the inclusion sought by be filled at an acceptable financial rate of return.
the surgical hospital and reflects again an element The contemporary survival of the asylum is thus a
in the revalorization of confinement. The demise of market-led response to opportunity and demand;
dedicated psychiatric hospitals has meant that its flexibility and niche nature is the antithesis of a
most acute phases of illness are dealt with in the modernist project of hegemonic community care.
psychiatric wards of general hospitals. It is in the Place, in the form of a repackaging of traditional
residual asylum sector that there remains a place notions of asylum, plays a central role in this flexi-
for longer stays in (confined) hospital settings in bility and in ensuring an effective fit with con-
which convalescence can occur amid the tranquillity sumer demand.
of quasi-natural surrounds. The key issue for the present-day private asylum
The private-sector funding of our case study in this context is assuredly that of image. Promot-
institutions is an important part of this aspect of ing (private) asylum facilities must involve coun-
our story. Priory, Ashburn and Homewood have tering the legacy of the poor reputation of the
few peers in their national contexts. They have historic asylum. It must also counter both the posi-
only to compete with what they are not: public tive and the negative images of community care.
psychiatric hospitals wards or community care Both Ashburn and Homewood originally devel-
provision. They are anomalies: hospitals in a post- oped as alternatives to poorly-reputed public asy-
asylum era, fee-for-service facilities in national lums; their continued existence, and that of the
health systems. Their predecessors, the traditional Priory Hospitals, owes at least something to a mar-
asylums, came to represent uniformity, standardi- ket seeking to avoid the downside of the now
zation and scale economy. There was a preference equally hegemonic community care. The historical
for very large-scale facilities run on regimented lines weight of these ambivalent assessments provides
serving well-delineated geographical populations. an opportunity for a critical perspective on the
The core concept of asylum as a place of sanctuary present-day retention and reinvention of the asy-
was marginalized or even lost; the value of con- lum. Indeed, the (albeit limited) rise of private psy-
finement was diminished. This much is well known. chiatric hospitals can be seen as part of a broader
Community care, its successor, was similarly restructuring of health care that is opening space
modernist in its vision of a well-ordered, effective for both private capital and privatized need. What
system of deinstitutionalized care delivered through is at issue is exactly how private asylums are now
a combination of state planning and medical ‘selling’ themselves – and their geographies – to
progress. Notwithstanding the idea of the service- potential clients.
dependent landscape of despair, community care These connections between image, asylum and
tended to be dislocated from specific places in welfare restructuring link clearly to the ideas of
comparison to asylum care. That dislocation was to Smith (1987 1989), Joseph and Kearns (1996) and
be addressed through a process of care(ful) man- Kearns and Joseph (1997 2000) on restructuring
agement in which place, per se, was not accorded a and deinstitutionalization. It seems that privatiza-
therapeutic role. tion in mental health care can be seen as an inevita-
With these ideas in mind, it seems apposite to ble counterpart to the closure of state owned and
term the persistence of private residential mental funded psychiatric hospitals. Any transfer of
health care a postmodernist phenomenon and to clients to community care within a broader political

and ideological environment in which private owner- is a more helpful term than deinstitutionalization. It
ship and the voluntary sector have a key role is also serves as an opportunity to note that, while the
almost bound to encounter the paradox of choice. present paper is concerned with place marketing and
Some, particularly those with the necessary eco- surviving asylums, place marketing is also implicitly
embodied in the promotion of community care as, vari-
nomic means, will challenge the paternalist pre-
ously, un-bounded and ‘home-based’. These matters
scription of community care, exercise their own
are beyond the scope of this paper.
choice, and choose a residential alternative, partic- 3 Philo (1987b) offers a reminder that large asylums
ularly when that alternative is marketed attrac- coexisted alongside smaller scale provision that was
tively.10 To this limited extent the notion of the often more integrated and visible within its local
public city (Dear 1980), with its connotations of community.
disadvantage, dispossession, poverty and exclu- 4 We say ‘in a sense’ because, although the historic
sion, is replaced by a private city in which we see parallels are significant, it is also the case that the
an elite choice of advantage and seclusion predi- private madhouses of the seventeenth century operated
cated on wealth and the ability to afford care. in a very different landscape of care and at a time of
somewhat different societal attitudes to mental health
This ‘top end’ set of opportunities for private
problems.
care can be seen to complement a ‘reinstitutionali-
5 We also note the implicit link between notions of
zation’ of those with psychiatric conditions. British therapeutic landscape and present-day community
policy, for instance, is arguably moving towards care. The landscape of community-based care has
re-establishing confinement as a way of containing been seen as (ostensibly) therapeutic. For analyses
people as a result of their potential ‘dangerousness’ and critiques of this position see, for example, Dear
(Moon 2000). A contemporaneous development of and Wolch (1987) and Pinfold (1999). The obverse of
new spaces of care on a continuum from the high the therapeutic landscape is evident in landscapes of
risk/high security (even imprisonment) option at despair characterized by high levels of homelessness,
one end to the private asylum/retreat centre at destitution and chronic mental ill-health.
6 We note in passing a perception that these facilities
another (see Conradson 2005) means we can also
cater to a celebrity clientele. Charteris, writing of
see our case study facilities in the context of the
Ashburn Hall, provides the reality of the situation:
current socio-political movement towards greater
security of places in which one might situate a popular misconception of Ashburn Hall is that it is a
everything from gated communities to retirement mental home for the rich and a treatment centre for
affluent alcoholics . . . While Ashburn Hall has its share of
villages. While consideration of these rather different
politicians, big businessmen and celebrities . . . [it also treats]
institutions is beyond the scope of this paper, their more everyday folk: labourers, housewives, nurses and
presence within the countries we consider here shop assistants. (1987, 7)
points to the need for further work on a more
This statement would apply equally to Homewood
general re-evaluation of confinement (or isolation) and the Priory Hospitals.
as a solution to social problems and the role of 7 Interestingly Ticehurst originated as one of the most
place in the marketing of this re-evaluation. famous of the eighteenth-century private madhouses
(Philo 2004, 328–46).
8 The inconsistencies in the date of the founding of the
Acknowledgements hospital are noted.
The authors gratefully acknowledge Chris Philo 9 We note in passing that Priory and Homewood both
also have an involvement in corporate mental health
and the four independent referees.
care, providing mental health promotion and stress
management services to public- and private-sector
Notes employers.
10 These possibilities are particularly evident in the
1 We acknowledge here that these initial statements
emerging addictions industry, which has considerable
capture a scenario that is not universal. There remain
parallels with the private mental health care sector
countries where the asylum is a significant modality
(Wilton and deVerteuil forthcoming).
in the care and treatment of people with mental
health problems. Our statement refers to the situation
pertaining in much of Europe and North America, as
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Selling the private asylum: therapeutic

Blackwell Publishing Ltd

landscapes and the (re)valorization of

key words therapeutic landscapes asylum private mental health care

revised manuscript received 29 March 2006

documented (see, for example, Dear and Taylor

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

The importance of the meaning of the word asylum for

Here we see a presentation that alludes to expert

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Figure 1 The Labyrinth at the Homewood Health Centre

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

Trans Inst Br Geogr NS 31 131–149 2006

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