Winner of 2020 PIF Essay Competition - for Medical Students - RANZCP

Winner of 2020 PIF Essay Competition
for Medical Students

Annora Ai-Wei Kumar
3rd year medical student, University of Western Australia

  Extending the vocabulary of place pathologies: an exploration of place and mental illness
  By Annora Ai-Wei Kumar

  Introduction
  The Welsh word, hiraeth, describes a feeling that many of us may have felt at some point in our lives. It is
  the desire to be at home, yet it is more than homesickness (King, 2000). Hiraeth is a feeling of
  incompleteness and a longing to go to a place where you belong (Petro, 2012). It is a homesickness that
  creeps up on you even when you are at home; it is an inexplicable yearning to return home, even to a
  home that no longer exists or a place that never was (Jones, 2016).
  More than a word that describes an indescribable feeling (Harrison, 2013), hiraeth can be used to
  understand the pathology of place (Casey, 1993) – that is, the role that place has in mental illness. It has
  been established that place has an important role both psychologically and anthropologically. For instance,
  the geographer Yi-Fu Tuan popularised the word ‘topophilia’, defined as ‘the affective bond between
  people and place or setting’ (Tuan, 1990, p. 4). Taking an environmental perspective, the word ‘biophilia’
  has been used by psychoanalyst Eric Fromm to describe an innate propensity towards living environments
  (Fromm, 1974). These words describe the affection between human and place – specifically, how we
  interact with and make sense of external environments. However, hiraeth describes the internal affection
  between humans and sense of place, rather than the affection for a place itself. In this essay, I will describe
  three components of hiraeth: a longing for home, a feeling of uncertainty, and a sense of displacement.
  Using these as a guide, I will characterize and explore the role of place in mental illness.

  A longing for home, even a home that no longer exists or never was
  The longing for home that hiraeth describes is not to be taken lightly. Homesickness has been described
  as ‘mini-grief’, placing it in the same category as mental illnesses arising from grief and bereavement
  (Stroebe et al., 2002). This has implications for the way that homesickness is treated. In the same way
  that avoidance mechanisms can exacerbate grief as they increase numbness and detachment (Baker et
  al., 2016), we should not focus on distracting ourselves from wanting to go home. Instead, it is important
  to acknowledge the longing for home that many people feel.
  However, a longing for home can occur even when one is at a physical location that they call home. The
  home that one longs for may not have ever existed. This is a defining feature of hiraeth. From this, the
  question arises – how can one long for something that doesn’t exist? This can partially be answered by
  the restorative capacity of place. That is, even if such a place does not exist, we long for the feelings of
  cognitive restoration, relaxation, and stress relief that certain places can give us. For example, it has been
  found that when compared to images of urban settings, pictures of nature had restorative effects, positively
  influencing mental states and psychological stress (Ulrich, 1981).
  Furthermore, the restorative capacity of place is not limited to natural landscapes. Cultural landscapes and
  places of worship both have restorative capacities (Xu et al., 2018, Herzog et al., 2010). Importantly, it has
  been found that changes in the perception of an area’s restorative capacities are dependent on anticipated
  emotions, as opposed to previously experienced emotions (Ruiz and Hernández, 2014). Thus, the
  restorative capacity of place depends largely upon on how we perceive the place itself.
  We are told that ‘there’s no place like home’ (Baum, 1958). Yet, for those who come home to children that
  need to be taken care of, chores that need to be done, and bills that need to be paid, home environments
  can be quite the opposite of restorative places (Hartig, 2012). In this way, there should be more focus on

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the way that place has a preventative role in mental illness, rather than looking at place from the singular
lens of homesickness.

A feeling of uncertainty / change
Another tenet of hiraeth is a feeling of restlessness, uncertainty, and lack of security. This can arise from
environmental or cultural change, as experienced in the original conceptualization of the term following
English occupation of Wales and the consequent social change (Petro, 2012, Thornton, 2017).
From a psychological point of view, it has been established that environmental change can tangibly
influence mental wellbeing. For instance, seasonal affective disorder is a type of depression (American
Psychiatric Association, 2013, pp. 187-188), hypothesized to be caused by circadian rhythm changes due
to seasonal environmental change (Lewy et al., 2007). The longer and more drawn-out process of climate
change can also cause significant mental distress. A case study from farmers in the Western Australian
wheatbelt found that climate change undermined self-identity, leading to greater perceived risks of mental
illnesses including depression and suicide (Ellis and Albrecht, 2017). Interestingly, these farmers reported
feeling that their farms ‘reflected aspects of their own values or personalities’ (Ellis and Albrecht, 2017, p.
164). This identity reflection has been observed in other studies (Ngo et al., 2014), and this emphasizes
the importance of place with regard to identity and therefore mental illness.
Additionally, it has been proposed that attachment theory can be applied to place attachment (Scrima et
al., 2017). Attachment theory emphasizes the importance of emotional bonds, and place represents an
important attachment ‘figure’ for many people (Scannel and Gifford, 2014). In the same way that
attachment theory describes the distress experienced when one is away from their attachment figure,
place attachment can therefore impact mental health.
As Scannel and Gifford point out, separation from a place that one is attached to does not have to be literal
– place disruption and its associated separation distress can be secondary to potential separation as well
as actual separation (Scannel and Gifford, 2014, p. 27). This reinforces the complexity of the person-place
relationship. Lack of place attachment can cause feelings of uncertainty and discomfort – which are the
same feelings that the word hiraeth describes.

An inexplicable feeling of displacement, even when you have never left home
Central to the concept of hiraeth is a feeling of displacement and lack of belonging. It is known that
residential displacement can damage mental health. Residential displacement in the context of urban
gentrification has been associated with higher rates of hospital mental health presentations and mental
illness diagnoses (Lim et al., 2017). Displacement following environmental disasters is also detrimental to
mental health, as evidenced by the increased demand for mental health services following Australian
bushfire and flood/cyclone events (Reifels et al., 2014). Higher rates of stress and anxiety have been found
in people who were displaced from public housing (Keene and Geronimus, 2011). Therefore, it is vital that
there are services to help people overcome the mental health challenges associated with residential
displacement.
However, a defining feature of hiraeth is that it is not exclusive to people who are away from home.
Considering the substantial mental detriment associated with residential displacement, it may seem far-
fetched to assume that such detriment can occur without the actual process of displacement.
Nevertheless, the term ‘solastalgia’, coined by Glenn Albrecht, demonstrates how this can occur (Albrecht,
2005). Solastalgia is defined as ‘the pain or sickness caused by the loss or lack of solace and the sense
of isolation connected to the present state of one’s home and territory’ (Albrecht, 2005, p. 45). That is, in
the wake of events challenging place identity such as environmental or even potential change (Moratis,
2020), solastalgia describes the concomitant feelings of physical desolation, loss of belonging and mental
distress.
Both hiraeth and solastalgia describe melancholia; a ‘homesickness one gets when one is still at ‘home’’
(Albrecht, 2005, p. 45). Whilst solastalgia describes a desire for something that has or will have been lost,
hiraeth acknowledges the inexplicable feelings of displacement in the absence of change (Jones, 2016).
This can be considered in conjunction with the damaging effects of residential displacement. Both terms

Extending the vocabulary of place pathologies: an exploration of place and mental illness. A Kumar     Page 2 of 5

emphasise the importance of place security and the need for mental health service provision for those
experiencing displacement – regardless of whether that displacement is literal or non-literal.

Conclusion
As COVID-19 and climate change pose pervasive challenges to existing place identities, it is more
important than ever to characterize and effectively define the role that place has in mental illness. As the
word hiraeth describes, place plays an important role in our mental health. Places have restorative
capacities, and in some ways, place attachment is similar to attachments that we have with other people.
As issues with place attachment are not limited to people who have been displaced or places that have
been destroyed, there is a need for interdisciplinary services addressing the mental health challenges
arising from the pathology of place.

Extending the vocabulary of place pathologies: an exploration of place and mental illness. A Kumar   Page 3 of 5

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