Jennifer & April Edwell// Where do medical and spiritual geographies overlap?
In the quest for healing, voyages across unfamiliar terrains have long been commonplace. Sites of mystical as well as medical healing have often been removed from the landscapes of daily life. Historically, places imbued with sacred significance have inspired hope for the alleviation of pain and a return to wholeness, and many scholars have investigated the role of spirituality in “therapeutic landscapes” (Gesler, 2003; Perriam, 2015). Additionally, scholars have turned their attention to geographies of health in order to show that our experience of the body, including sickness and death, is fundamentally situated (Cliff, 1981; Kearns & Gesler, 1998; Guthman & Mansfield, 2013; Parr, 2015). However, contemporary locations of medical intervention have not been widely explored in this way. Architects of hospitals and medical clinics have written about the aims, principles, and challenges of designing these sites (Dellinger, 2010; Guenther, 2013; Fottler & Ford, 2000), but beyond these discourses, relatively little has been said about these destinations in the modern search for healing.
Hospitals are a response to human finitude. These spaces are populated by those seeking care, including the sick, the wounded, and the dying, as well as those who have been trained to provide care. The material space of the hospital is, in part, a response to the needs of its occupants. However, the space does more than cradle the suffering. The hospital organizes and structures the work within it. The hospital responds to healing by literally transitioning patients to different floors, prompting hope. When rooms are filled and patients sit in hallways, it whispers its own limits. It converses in waiting rooms with families and loved ones. Hospitals speak of sterile fields, medical equipment, and human bodies.
Perhaps sacred space is not what we expect to encounter in the biomedical landscape, yet it is a common fixture, taking the form of traditional chapels, interfaith spaces, or mediation rooms. These are sites designated for religious and/or spiritual care. Aside from write-ups about the construction of new chapel spaces, very little has been published on hospital chapels. Sociologist Wendy Cadge is one of the only scholars across disciplines to study hospital chapels in recent decades. She investigates the role of religion and spirituality in hospitals in order to highlight and critique the commonly assumed dichotomy between religious and secular organizations. In “Negotiating Religious Difference in Secular Organizations: The Case of Hospital Chapels,” Cadge explores the influence of religious pluralism in secular, state-funded hospitals, and she worries that generic religious spaces may inadvertently inhibit authentic religious experience. Cadge writes, “whether, especially in interfaith chapels, spaces have been created that feel inviting to a range of people versus unfamiliar to most is an open question, as is the extent to which chapel spaces are theoretical versus actual sites of religious encounter” (p. 210).
Chapels are, nonetheless, radically different than other spaces in the hospital landscape. In this sense, chapels are heterotopic. We are borrowing this term from Michel Foucault, but it is also a medical term that refers to tissue growth in an abnormal place .[1] From a medical standpoint, the novelty of heterotopy can contribute to physiological evolution. Some mutations benefit the organism. Similarly, encounters with a spatial heterotopy can be transformative. The chapel is an abnormality in the hospital landscape, but it can serve an otherwise unfulfilled role. The chapel is a space where guests can draw on religious and spiritual resources to grapple with their finitude.
In “Of Other Spaces: Utopias and Heterotopias,” Foucault writes that heterotopias can juxtapose “in a single real place different spaces and locations that are incompatible with each other” (354). Unlike other religious sites (e.g., Catholic cathedrals) that act dogmatically, hospital chapels hold open a space of religious and spiritual pluralism. A guest may pull out a prayer mat, engaging in an Islamic prayer ritual. Simultaneously, a Christian guest may read from the Bible. Later, another guest may use the space for meditation. Further, the chapel is a non-medical space that guests enter into of their own volition. In a biomedical system that emphasizes control and expertise, freedom and self-direction are not central values; yet, in the chapel, patients can transform into empowered practitioners of religion, and health professionals can relax into their spiritual practices.
Additionally, heterotopias possess their own sense of time (“heterochronisms”). Time in the chapel passes differently than the clock-driven time of the hospital. According to Carla Danani, “sacred space is something that we or our ancestors have built, but that we inhabit only occasionally: that is when we let our time be the kairos in which we face God rather than the chronos that measures our existence in the world” (2014, p. 52). In the chapel, pain, suffering, and mortality are not measured in minutes or in pulse beats. Instead, the calendar of religious services marks time. The accumulation of prayers scribbled in specially marked binders bears witness to the past and looks toward the future. The rhythm of religious chants measures a sacred tempo.
In the hospital, where we grapple with the limitations of the human form, patients and providers naturally bring their religious beliefs and practices with them, especially in the United States. According to a Pew Research Center Study (2018), “Americans pray more often, are more likely to attend weekly religious services and ascribe higher importance to faith in their lives than adults in other wealthy, Western democracies.” Therefore, whether at the bedside or in a specially designated room, it is important to consider if and where and how the hospital holds space for faith.
[1] According to the Oxford English Dictionary, a heterotopy is a “displacement,” such as “the occurrence of a tumour in a part where the elements of which it is composed do not normally exist.”
References
Cadge, Wendy. “Negotiating Religious Differences in Secular Organizations: The Case of Hospital Chapels.” Religion on the Edge: De-centering and Re-centering the Sociology of Religion, ed. Courtney Bender, Wendy Cadge, Peggy Levitt, and David Smilde. Oxford: Oxford University Press, 2012.
Cliff, Andrew David. Spatial Diffusion: An Historical Geography of Epidemics in an Island Community. Cambridge: Cambridge University Press, 1981.
Danani, Carla. “Human Dwelling: A Philosophical Question Concerning Place and Space.” Religious Representation in Place: Exploring Meaningful Spaces at the Intersection of the Humanities and Sciences, ed. Mark K. George. New York: Palgrave Macmillan, 2014.
Dellinger, Barbara. “Healing Environments.” Evidence-based Design for Healthcare Facilities, ed. Cynthia McCullough. Indianapolis, IN: Sigma Theta Tau International, 2010.
Fottler, M. D. and R. C. Ford. “Creating A Healing Environment: The Importance Of The Service Setting In The New.” Journal Of Healthcare Management vol. 45, no. 2 (2000): 91-107.
Foucault, Michel. “Of Other Spaces: Utopias and Heterotopias.” Rethinking Architecture: A Reader in Cultural Theory, ed. Neil Leach. London: Routledge, 1997.
Gesler, Wilbert. Healing Places. Lanham, Maryland: Rowman & Littlefield, 2003.
Guenther, Robin. Sustainable Healthcare Architecture, 2nd ed. Hoboken, New Jersey: John Wiley & Sons, Inc., 2013.
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Kearns, R. A. and W.M. Gesler. Putting Health into Place: Landscape, Identity and Well Being. Syracuse, NY: Syracuse University Press, 1998.
Parr, H. “Medical Geography: Diagnosing the Body in Medical and Health Geography, 1999–2000.” Progress in Human Geography vol. 26 (2015): 240–251.
Perriam, Geraldine. “Sacred Spaces, Healing Places: Therapeutic Landscapes of Spiritual Significance.” The Journal of Medical Humanities Vol. 36, no. 1 (2015): 19-33.
