The shifting role of nature and the landscape in psychiatric Institutions: A case study from Germany in a historical perspective

Abstract

Nature has been pivotal in psychiatric care since the establishment of asylums, but its role within psychiatric institutions over time, including landscape design, utilisation, and therapeutic impact, has received limited attention. This study addresses this gap through a case study of a psychiatric clinic in Gütersloh, Germany. Drawing on scientific literature, historical analyses, and archival material, we trace the transformation of the clinic's landscape from its planning in 1904 to the present day. We examine its relationship with treatment paradigms, socio-political influences, and evolving theories of environmental mental health.

The analysis identifies five overlapping phases in the development: (1) Nature as Therapy, when rural locations and gardens were viewed as inherently therapeutic; (2) Work in Nature, a shift to agricultural work therapy which, under National Socialism, became distorted into forced labour; (3) Therapy Indoors, a post-war transition toward occupational and group therapies; (4) Therapy in the Individual Body, reflecting the rise of pharmacology and psychotherapy that shifted the locus of therapy and control to the patient's body; and (5) Therapy in the Community, outpatient care expanded in the decades following the “Psychiatry Enquête”.

Despite these shifts, research on current patient feedback highlights the continued value of greenspaces, aligning with the growing evidence of health-promoting effects of nature. By synthesising historical insights with current evidence, this research contributes to interdisciplinary understanding and provides insights for nature's integration into future psychiatric care. Participatory approaches and multifunctionality are essential to address the varied needs of psychiatric patients and maximise nature's therapeutic potential.