The 'taking place' of health and wellbeing: towards non-representational theory.

Social Science & Medicine 108 (2014) 210e222

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Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed

The ‘taking place’ of health and wellbeing: Towards non-representational theory Gavin J. Andrews a, *, Sandra Chen b, Samantha Myers c a

McMaster University, Department of Health, Aging and Society, KTH, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada Central East Community Care Access Centre, Ontario, Canada c Trent University, Canada b

a r t i c l e i n f o

a b s t r a c t

Article history: Received 21 November 2013 Received in revised form 3 February 2014 Accepted 22 February 2014 Available online 24 February 2014

For the last two decades health geography has focused on the dynamics between health and place. Although the social constructivist perspective of much research has provided many insights into the meanings of health and health care arguably, mirroring progress in the parent discipline of human geography, there could be a far more serious engagement with non-representational theory and the ‘taking place’ of health and health care. To showcase the importance and potential of this broadly, the idea of wellbeing is re-approached. The paper reflects on the ways wellbeing has been treated in research primarily as a meaningful and relatively prescribed state of life, to the neglect of process. Based on this critique, a qualitative study then illustrates the most immediate and everyday ways wellbeing might arise through ‘affect’; the pre-personal mobile energies and intensities that result from physical encounters within assemblages of bodies and objects. Indeed, theoretically the findings support the proposition that, at one level, wellbeing might not be taken from environment but instead might emerge as the affective environment. They certainly raise awareness of how much in health might originate at the surface, prior to meaning, within life’s infinite spatial doings, and thus they launch some final thoughts on the wider challenges and opportunities for non-representational health geographies. Ó 2014 Elsevier Ltd. All rights reserved.

Keywords: Health geography Non-representational theory Affect Health and place

1. Introduction Two decades ago a new era of research was set in motion that ultimately transformed and rebranded the sub-discipline of medical geography into health geography. Noting theoretical developments in the new cultural geography of the period, and specifically drawing on structure-agency debates and humanistic philosophy, Robin Kearns called for geographers to incorporate a dual ‘place-sensitive’, ‘post-medical’ perspective into their scholarship (Kearns, 1993). By this, Kearns meant moving beyond previous preoccupations with distributional aspects of disease and medicine by examining the meaning and significance of places (reimagined as social and cultural phenomenon) in health and health care. In doing so, they might problematize medical categorization, challenge institutional assumptions and power and, beyond pathology, realise health as both a positive mental and physical state of wellbeing. Following Kearns’ arguments e and some initial

* Corresponding author. E-mail address: [email protected] (G.J. Andrews). http://dx.doi.org/10.1016/j.socscimed.2014.02.037 0277-9536/Ó 2014 Elsevier Ltd. All rights reserved.

resistance (Mayer and Meade, 1994; Paul, 1994), supplementary advice (Dorn and Laws, 1994) and further explanation (Kearns, 1994a, 1994b) e the understanding has since developed in geography that health and health care unroll in places that are acted, felt, felt about and represented. It is recognised that, as a result of the human agency, places possess basic functions (they do things). Moreover beyond this, in line with a phenomenological thinking, experiences of places, and the knowledge gained from being part of them or learning about them, gives rise to their intentionality (what places are about) and essences (how places feel) much being a result of purposeful designs and decisions (Andrews and Shaw, 2010; Kearns and Barnett, 2000). As a number of literature reviews have shown, a new generation of research has subsequently attempted to discover the place agencies, experiences, identities, attachments, meanings and representations associated with health and health care (Andrews et al., 2012a; Kearns and Collins, 2010; Kearns and Moon, 2002; Parr, 2002, 2004). This has involved a number of allied conversations including around the development of appropriate theory in health geography (see Dyck, 2003; King, 2010; Litva and Eyles, 1995; Philo, 1996), methodological and analytical innovation (Carpiano, 2009; Cutchin, 1999; Dyck, 1999; Elliott, 1999; Garvin and Wilson, 1999; Milligan et al., 2005, 2011;

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Parr, 1998, 2007; Wilton, 1999), the relationships between space and place in health (Jones and Moon, 1993; Kearns and Joseph, 1993), and processes in place e including the emergence of medico-corporate cultures and power (Kearns and Barnett, 1997, 1999; Philo, 2000; Poland et al., 2005), healing and therapeutics (Gesler, 1992; Smyth, 2005). These diverse conversations frame the sub-discipline’s current progressive, yet largely social constructivist, ‘representational’ paradigm, which in the last decade has reverberated beyond health geography and has informed the character of spatial turns amongst many other health-focused disciplines including nursing studies (Andrews, 2006; Carolan et al., 2006), social gerontology (Andrews et al., 2013a; Wiles, 2005), population and public health (Brown and Duncan, 2000, 2002) and the sociology of health and fitness (Fusco, 2007; Kelly, 2003; Van Ingen, 2003). Indeed, they are conversations that have backed up the growing realisation across the health and social sciences that ‘place matters’ to health and health care; that where individuals are cared for, live, work, socialize, and how they use and experience their environments, have far-reaching implications (Andrews et al., 2012b). Although a great deal of knowledge has been produced by health geography and over the last twenty years, it might be argued that in 2014 the sub-discipline once again needs to look to contemporary developments in its parent discipline for inspiration, but on this occasion specifically with respect to nonrepresentational theory. In this regard, the current paper does three things. First it briefly introduces non-representational theory in human geography including the contributions of the few health geography studies that have thus far forged the approach. Second, by re-approaching wellbeing e an idea and concept clearly now central to health geography e the paper provides a broad and practical illustration of the fundamental importance and potential of non-representational theory. Specifically, it articulates current applications and understandings of wellbeing and proposes that research has missed the opportunity to explore the concept at a far more immediate level, and explain the processes through which wellbeing emerges in everyday situations and environments. Third, following this review, a participant observation study explores these processes in some detail. The key non-representational idea of ‘affect’ is employed as a study framework, indicating how wellbeing arises initially as an energy and intensity through the physical interaction of human bodies and non-human objects, and is experienced as a feeling state. Some focused observations are made on how the findings might help geographers and others rethink the fundamental nature of wellbeing, particularly in terms of it being something that emerges as environment (rather than something that results, or is consciously taken, from environment). Importantly they also anchor some final reflections on the much broader challenges and opportunities for researching and presenting nonrepresentational health geographies. 2. Non-representational theory With origins in the work of Nigel Thrift in the mid-1990s (see Thrift, 1996, 1997), but far wider application in the new century (see Lorimer, 2005, 2008), this theoretical orientation in human geography is based on the observation that a sizeable portion of the world e what happens ‘out there’ in everyday life e has been suffocated and remains unrepresented by, social constructivist research. This is attributed to social constructivism’s deep philosophical commitments involving theoretically-driven interpretative searches for significance and for the sake of orders, structures and processes imposed by researchers who employ it (Dewsbury et al., 2002). In contrast, non-representational understandings do not posit an external world waiting to be represented and theorised

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away by a detached observer. The idea is instead that they understand the lived world by engaging with it as an ongoing and performative achievement (Thrift, 2004). Thus, nonrepresentational theory moves the focus of inquiry away from ‘drilling down’ to find meaning in things, and onto the many subtle, unspoken and often unintentional performances and practices involved in the reproduction of life. As Thrift (2007) explains, it conveys the geography of ‘what happens’ in the active world; the ‘bare bones’ and ‘taking place’ of occasions and the onflow of life. Moreover, non-representational theory does not privilege or elevate the human subject, but is instead interested in the human body’s co-evolution with co-equal non-humans, and thus its relatedness to the world (Thrift, 2007). This involves an attention to the materiality, expressiveness, responsiveness and rhythms of practice, and its connection to human performativity and embodiment, including senses and expressions (Cadman, 2009). No single philosophy or philosopher has been drawn on to theoretically underpin non-representational theory, rather this has largely involved re-reading many of those that have already informed ‘representational’ geographies over the years. As Cadman (2009) explains first (and perhaps ironically), non-representational theory has involved re-reading Heidegger’s phenomenology, but instead of focussing on meanings derived from ‘being-in-theworld’, focussing on the consequences of humans being ‘throwninto-the-world’; being inseparable from it. This has helped foster a realization that how humans live and make the world is even more important than how they might subjectively reason it (Cadman, 2009). Second, there has been a re-engagement with vitalist philosophy to help escape phenomenology’s human-centred view of the world. This has led to an understanding that scholars might avoid the enduring dualism in research of ‘subjects versus objects’, and instead of focussing on what objects are to humans, focus on the energies and liveliness of humans doing things with objects (Cadman, 2009; Greenhough, 2010). Third, and building on this, there has been a re-reading some post-structuralist ideas and thought e particularly the works of Derrida and others e looking beyond their ideas on the significance and meaning of things, to their ideas on their materiality, force encounters and relations. This has helped develop an appreciation of the productive and disrupting capacities of material objects (Cadman, 2009). Coming out of these re-readings have been some fundamental realignments with popular subjects and topics in human geography. At one level, for example, there have been new forms of engagement with politics focussing, beyond political thinking, on the practical spread of political ideas e and how being political can be about creating and acting new realities (Cadman, 2009; Thrift, 2004). At another level there have been new forms of engagement with ethics and society, focussing on concepts such as hope, and how they might have potential, move forward and be acted, rather than remaining hypothetical or utopian (Cadman, 2009; McCormack, 2003; Popke, 2009). In sum then, as this initial explanation indicates, nonrepresentational theory is not strictly a theory in itself, rather it is a number of ways of understanding the active world and doing research on it, which has many obvious connections to allied developments and trends currently unfolding outside human geography in the wider social sciences (such as to sensory/performance ethnography, new materialisms and post-humanism more generally). Being an approach, it is quite resilient to attempts to reduce it to a specific subject of inquiry and thus can be e as has been e employed broadly across numerous empirical domains (Cadman, 2009). Although health geography has not drawn on nonrepresentational theory anyway near to the degree that some other sub-disciplines of human geography have, it certainly has not been completely disconnected from it. Many studies engage with

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some of the aforementioned concerns and facets on nonrepresentational theory, although they do not claim a heritage or spot within the tradition. Specifically for example this is evident in discussions of allied theoretical orientations including complexity theory (Curtis and Riva, 2010a, 2010b; Gatrell, 2005), thinking space relationally (Cummins et al., 2007; Curtis et al., 2009) and a range of empirical research and wider commentary published over the last fifteen years that deals with body senses, performance, mobility and materiality in health (see Butler and Parr, 1999; Davidson, 2000; Gatrell, 2013; Hall, 2000; Parr, 2002). Beyond this, a number of studies have made a useful start by directly introducing the perspectives, ideas and concepts of nonrepresentational theory in quite focused ways. This pioneering research falls loosely into three interrelated categories. First, there has been an empirical focus on community contexts and environments. Research here considering, for example, rhythms, relationality and networking of social and material resources in enabling or therapeutic situations (Conradson, 2005; Duff, 2011, 2012), and very specifically how musical performance facilitates conviviality, escape and hope in private and public spaces (Andrews, 2014; Evans, 2014; McCormack, 2003; Simpson, 2014). Second, there has been an empirical focus on health care considering, for example, the networking and engagements of bodies and nonhumans in medicalescientific events (Greenhough, 2006), holistic, therapeutic practice (Andrews et al., 2013b; Paterson, 2005) and in clinical settings (Bissell, 2010). A third group of studies is more conceptually and theoretically orientated. Whilst there have been broad reviews of key thinkers and theorists e such as Georges Canguilhem (Philo, 2007) and Gilles Deleuze (Duff, 2010a) e whose work might hold potential in developing non-representational theory in health scholarship, mirroring their wider deployment in human geography, Actor-Network Theory and the idea of ‘affect’ have specifically been drawn on. Whilst the former as helped elucidate the co-equal roles of humans and technologies in health and health care (Andrews et al., 2013b; Duff, 2011; Hall, 2004; Timmons et al., 2010), the latter has helped understand the senses and feels of health and health care (Andrews et al., 2013b; Bissell, 2010; Boyer, 2012; Conradson, 2005; Duff, 2010a, 2011; 2012; McCormack, 2003). The studies noted above are certainly insightful, yet beyond them there has been a lack of fundamental discussion of the implications of non-representational theory for health geography as a whole. Indeed, at times theoretical shifts at a sub-disciplinary level need to be proposed quite directly and straightforwardly so that scholars might relate them to their own empirical interests and areas of expertise (a clear quality of influential anchor papers in health geography e e.g. Gesler, 1992; Kearns, 1993). To this end, the following discussion and study of wellbeing provides a broad, practical illustration of the fundamental importance and potential of non-representational theory. 3. Geographies of wellbeing Wellbeing is a familiar idea that reoccurs across western societies, substantiated through their officialdom, economic activities, consumption patterns and popular cultures. A loose consensus is that ‘well-being’ is fundamentally about ‘being-well’: content, healthy and in a good place in life. Other than this however, wellbeing is defined, understood and utilized in many different ways. At one level, wellbeing arises as a subject in the rhetoric of policy makers as something to be structurally provided, achieved and protected in multiple contexts (see Atkinson et al., 2012). A political convergence has occurred here around a materialist assumption, that improving individual and population wealth, and the quality of the services available to people, increases their wellbeing

(MacKian, 2009; Stevenson and Wolfers, 2008). There are however differing views on how this might be achieved. Whilst, for example, the political left has mobilized the idea of ‘social wellbeing’ to support arguments for the creation and maintenance of welfare states, the right has mobilized the idea of ‘economic wellbeing’ to support neo-liberal arguments for market systems for the allocation of resources and to promote financial prosperity (Atkinson et al., 2012; MacKian, 2009). At another level, connecting further to capitalist systems is a prevailing perception in individuals and populations that the accumulation of wealth and consumption are a way to personal happiness and wellbeing. Listening to this, and then servicing an insatiable public appetite for an almost infinite range of goods and services, is the private sector that not only uses wellbeing in marketing and advertising products, but also designs and sells products specifically connected to wellbeing-promoting experiences, lifestyles and cultures (MacKian, 2009). Finally, related to this in a more personal and holistic sense, wellbeing arises in the minds and actions of individuals and significant proportions of populations as personal goal and part of achieving an optimal ‘good life’ (Kearns and Andrews, 2010; MacKian, 2009). Although a genesis for this has been the new age movement and its attention to the mind, body and spirit, more recently the rise in overlapping individualization, self-help and fitness movements have become prominent motivators. Across these cultures it is believed that wellbeing, as both a status and feeling, can be achieved through individuals being responsible for and assisting themselves mentally and physically (MacKian, 2009). It is not surprising then that, mirroring this widespread institutional and societal emphasis on wellbeing, academics have gradually developed an interest in the concept, often wrapped up in their wider considerations of human happiness (Duncan, 2005, 2013; Stevenson and Wolfers, 2008) and quality of life (Pacione, 2003a). Indeed, in this respect wellbeing is now just as much a well-used academic idea as a political or popular idea, appearing broadly across social and health sciences literatures (de Chavez et al., 2005; Diener et al., 1999; Sointu, 2005). Geography is no exception when it comes to the academic interest in wellbeing which appears in a wide-range of research (see Atkinson et al., 2012; Fleuret and Atkinson, 2007; Kearns and Andrews, 2010; Pain and Smith 2010). 3.1. Progressive empiricism Human geography’s earliest substantive engagements with wellbeing, although not explicitly reflecting on the concept itself, can be traced to the early 1970s. A concern for wellbeing arose then quite generally in Marxist geography’s objective to uncover the structures and causes of social and economic inequality in cities (Castells, 1983; Harvey, 1973), and in humanistic geography’s objective to uncover details in, and the essence of, human conditions and experiences (Tuan, 1977). More specifically, as Conradson (2012) explains, a concern for wellbeing also arose within the fledgling welfare geography of the time. Here set within a general concern for social and spatial inequalities in affluence, opportunities and resources across populations, early discussions of ‘quality of life’ and ‘life satisfaction’ emerged and their measurement within particular locales (see Helburn, 1982; Pacione, 1980; Smith, 1973). In more recent decades, although Marxist, Humanistic and even welfare geography have either been superseded or assumed into the broader disciplinary lexicon, there has been an ever-expanding concern for wellbeing and empirical engagement with its spatial aspects and expressions. While this can be seen across many contemporary fields of study, it is particularly evident across the sub-disciplines of health geography and social geography (Kearns and Andrews, 2010). Indeed whilst in the former sub-discipline


this has been part of the aforementioned more general interest in human health beyond bio-medical categorization (see Kearns, 1993; Kearns and Moon, 2002), in the latter this has been part of an ongoing concern for what is unjust and causes discontentment in life, such as inequality, poverty, isolation, exclusion and stigma (Pain and Smith, 2010). The expanding geographical interest in wellbeing is reflected in the publication of research dealing with a wide-range of empirical topics including, for example, environmental qualities (Pacione, 2003a, 2003b; Van Kamp, 2003), holistic medicine and lifestyles (Andrews, 2003; Williams, 1998), residence and social care (Milligan and Wiles, 2010; Wiles et al., 2012), illness, impairment and disability (Dyck, 1995; Gleeson, 1999; Hall and Kearns, 2001; Wilton, 1996), mental illness and disorders (Segrott and Doel, 2004; Parr, 2011), life events and happiness (Ballas and Dorling, 2007; Brereton et al., 2008), friendship (Coakley, 2002; Bunnell et al., 2012), music and art (Andrews et al., 2011, 2014; Parr, 2006), ethnic constructions and understandings (Panelli and Tipa, 2007, 2009) and more generally on healing, therapeutic and spiritual experiences (MacKian, 2012; Smyth, 2005; Williams, 2007). Much of this broad engagement with wellbeing, although insightful into particular situations, rarely defines the concept itself and opens it up to fundamental (re)interpretation and discussion. Indeed, most often wellbeing is a partial or oblique consideration, or else the understanding of wellbeing is implied; it being used in its most popular, everyday and metaphorical senses (Pain and Smith, 2010). The problem with this approach is that one never arrives at a deeper understanding of wellbeing. One only adds to the list of places where and when, as quite basically understood, it arises. Subsequently, inaccurate assumptions can be made. Pain and Smith (2010) note, for example, that the mere presence of noted facilitators of wellbeing or detractors of wellbeing does not necessarily mean that wellbeing will be enhanced or reduced in a given situation. The danger of untethered, unfocused and unreflective empiricism on wellbeing is that wellbeing explains almost everything, yet nothing explains wellbeing (Pain and Smith, 2010). 3.2. Critical engagements This surface engagement with wellbeing has however deepened in recent years. A small number of geographers have begun to consider wellbeing far more directly, critically and theoretically. They have thus posed the fundamental questions, what is wellbeing, and when does it occur? In terms of answers, a consensus seems to be emerging in research that wellbeing is a state of positive mental and physical health and welfare, attained or obtained in some way by fulfilling personal needs (see Aslam and Corrado, 2012). Indeed, along these lines Fleuret and Atkinson (2007), for example, draw loosely on classical psychological work (see Maslow, 1954), describing a three-tiered hierarchy of needs topped by vital needs (such as clean air, water, food, warmth), followed by spiritual and emotional needs (such as found in groups and identities with groups), followed by consumer products and luxuries (see also MacKian, 2009). There is recognition amongst geographers, however, that needs-based theories of wellbeing are not entirely adequate on their own, as they do not recognise human variability on many levels. Hence, as Fleuret and Atkinson (2007) argue, understandings of wellbeing need to account for the relative values, standards and capabilities of individuals and groups that lay emphasis on local opportunities available to them, and the choices they make. Indication of how a more critical and direct engagement with wellbeing has developed, and might be developed further, is provided in the recent work of Atkinson and colleagues. In particular,

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their research starts to address three further fundamental questions. Where are different forms of wellbeing found? How does space and place play a role in these situations? How are wellbeing, space and place contested? Fleuret and Atkinson (2007) engage with the first and second of these questions by setting a potential empirical research agenda around four potential spaces where wellbeing is created: spaces of human capacity, that assist and amplify it; integrative spaces, of networks that spread it; spaces of security, that provide refuge and support; therapeutic spaces, that facilitate healing. Meanwhile Atkinson et al. (2012) examine these spaces and more firmly engage with the second and third aforementioned questions. Indeed whilst certain contributions to this collection consider the facets of place that are thought to effect or determine wellbeing (Beck, 2012; Gilroy, 2012; Jack, 2012; Riva and Curtis, 2012), others interrogate different assumptions on wellbeing in different contexts, illuminating power imbalances and other inequalities (Carlisle et al., 2012; Gibson, 2012; Muirhead, 2012; Wheeler, 2012; Wight, 2012). Whilst it is certainly commendable that geographers are now deconstructing wellbeing and reflecting on it directly, arguably they could go further. The emphasis in research has clearly been on how wellbeing is attained as a state of life, and how it has meaning or is reached through things that have meaning. Research has however yet to consider the intimate processes through which wellbeing arises, potentially in everyday situations and daily lives. In other words, research currently pays attention to spatial contexts, constitutions and configurations that are thought to be actively engaged by individuals where and when wellbeing arises (Conradson, 2012), but is it time for geography to take a step further and think about the specificity of such spatial contexts, constitutions and configurations and how they are actively performed (see Anderson and Harrison, 2010). This proposition very much evokes the potential of non-representational theory and, as we shall see, its central working concept of affect. 4. Methods Empirical research framed by non-representational theory involves a form of ‘witnessing’ of happenings across space and time, even those that might first appear mundane (Cadman, 2009; Dewsbury, 2003). This witnessing aims to generate data infused with a fidelity or authenticity to happenings, relaying as much as possible of their character and action (see Latham, 2003; Laurier and Philo, 2006). With this in mind, we selected a form of participant observation as our primary data collection method. We each conducted an open ended naturalistic observation and reflection of the times and places we personally experienced wellbeing during a six month period in the summer and early autumn of 2012. In short, we each participated in our regular lives throughout this time, with our study in the back of our minds and our notebooks close at hand. Because we speculated that our wellbeing experiences could arise spontaneously and almost anywhere, we agreed to record them as soon after they occurred as possible with comprehensive field notes. These field notes not only conveyed the event, they also recorded relevant contextual information and some initial analytical/explanatory thoughts. Although no limit was placed on the number of observations that could be recorded by each researcher, in total twenty were: ten by Gavin, seven by Samantha and three by Sandra. With non-representational theory certain generic challenges persist in data collection related to the capture and presentation of events. At one level, as Ducey (2007) suggests, sensory happenings in life can never be translated directly through language and words, which tend to deaden them. At another level, when using words, one can easily go too far down contemplative and interpretative

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paths, and attempt to re-represent, not represent, what occurred (Latham, 2003). Recognising these challenges, we employed two strategies. The first was to describe in detail and quite expressively what happened, and our body sensations (see Laurier and Philo, 2006). The second was to introduce our own secondary approach, which involved photography. Taking photographs always occurred after the event/moment (as did our field notes), yet they help convey the situation and provide a second sensory insight (see Larsen, 2008). Even though, as researchers, we were attempting to focus on events before meaning and identity come into play, still as instruments of data collection we bring our own personal preferences and biases for wellbeing e for example related to socio-economic status or cultural background and individual tastes. These put us into particular situations and not others, and give us preference for certain feelings and experiences above others. Thus in terms of basic disclosure, Gavin is a male academic in his early 40s. He is married to Sandra who is a female community nurse and occasional researcher in her mid 30s. Samantha, their niece, is a female university student in her early 20s. All of us are middle class and live on the urban/rural fringe of a major Canadian city. In terms of analysis, we recorded all our field notes on laptops and, after the study period, combined them in a single file for management in a word processing package. This facilitated the splitting, manipulation and re-integration of the data, and the identification of the four sub-themes that structure the following findings section. During the analysis phase we met as a group to discuss our experiences, how the data might categorized, our initial interpretations and theoretical observations.

in front of him. He is looking through a heat haze, watching children play in a splash pad: The kids’ laughs and shouts are accompanied by the constant the pitter patter of the water falling from high parts of the structure and onto the floor e rat tat tat, rat tat tat, rat tat tat. I gradually look to the left. Hundreds more people are in the park, together appearing like a single entity. People sit under sunshades, others walk in all directions. This is their movement. Hundreds of conversations, making happy waves of fragmented voices; a few random words, parts of words, letters become clear in the waves. A band plays over them. This is their sound. A sea of red and white hats, t-shirts, painted faces. This is their look. Feeling the heat and energy, I look back towards the splash pad. The sound of the music and chattering public now joins the pitter patter of water. My son comes directly into view in front of me splashing in the water, slap slap. A balloon floats to my feet and comes to a rest. Feeling energised by it all e in my legs, arms and mind e I get up. I have an even bigger smile☺ At the most fundamental physical level, one can plot a vast prepersonal trajectory and process that leads up to, and is involved in, affective moments such as the one described above. With regard to heat and light, basic science tells us that solar energy is transported from the sun as electromagnetic radiation (consisting of photon waves and particles). What energy is not absorbed or reflected by the earth’s atmosphere travels through it, refracting on the way. Energy is then either absorbed or witnessed (felt and seen) by human bodies directly (as heat and light) or else is absorbed or

5. Wellbeing affects 5.1. From atomic to full bodies Non-representational theory directs attention to the practices that comprise the often taken-for-granted ‘background’ of conscious thoughts, reflections and actions in life (Andrews et al., 2013b). In attempting to understand these practices, in recent years human geographers have become interested in the idea of ‘affect’ in particular as a way to explain their performative dimensions. Indeed, originating in early European philosophy of man-nature e specifically in Spinozas Ethics e and later developed more thoroughly in Deleuzian social theory (see Deleuze, 1988, 1995; Deleuze and Guattari, 2004a, 2004b), affect has most recently become the prominent testing ground and explanatory concept for non-representational theory (see Duff, 2010b; Pile, 2010; Thrift, 2004; Woodward and Lea, 2010). In simple terms, affect is a mobile energy; an intensity which is the result of the relative movements and interactions between things e from atoms and molecules to fully formed human bodies and non-human objects e in space. Whilst initially affect is a purely physical non-cognitive event, it gives rise to less-than-fully conscious experiences. These are felt sensations or ‘feeling states’ that, preceding full cognition (thoughts and emotions for example), manifest on a somatic register as vague but intense ‘atmospheres’ or ‘vibes’ which impact on an individual’s capacity for engagement and involvement (and thus for themselves to affect others) (Massumi, 2002; McCormack, 2008; Thrift, 2004). With regard to the atomic and molecular levels, although these cannot be observed with the human eye, field notes from a lakeshore park on a public holiday highlight the basic importance and combination of heat, light, colour, movement and sound, and in turn the interaction of these related to, or as, full bodies and objects (see Slide One). Gavin is soaking in the warm afternoon sun, his legs stretched out

Slide One. The lakeshore public park.


reflected by objects and then absorbed or witnessed by human bodies secondarily. In terms of initial human experience, particles in the body itself (such as molecules in the brain, neurotransmission and nervous system) begin to respond and sense things visually and tactilely. Sound on the other hand is structured and delivered by soundwaves; longitudinal pressure waves produced by a vibrating source which causes air molecules to be disturbed, move and bounce off each other. The resulting pulsating motion of air then travels; the sound heard being the variation in pressure picked up by biological molecules in the human ear. Soundwaves vary in frequency (number of back and forth vibrations in a given unit of time), whilst the sensation of this frequency is heard as pitch (whereby the higher the frequency of the wave, the higher the pitch). Musical soundwaves e themselves often created, mixed and amplified by technologies e in particular possess certain characteristics. Whereas basic non-musical noise is a mixture of frequencies with no mathematical relationships between them (often unpleasant to the ear), music is a mixture of frequencies with a mathematical relationship between them (which is pleasant to the ear). Finally, movement possesses translational kinetic energy from the motion of molecules and objects from one point to another. This energy is made meaningful and explained further by other qualities, some basically observable by the human eye (such as directions, and velocity/speed) others that are measurable using simple technologies (acceleration, momentum). The constant presence of these fundamental and basic processes means that clearly the person is not always the beginning, centre and end of the human experience, and that much larger physical forces are forever and affectively at play (McCormack, 2007). They impact on individuals before they are consciously aware, can react and make sense, and constantly form and move along the materiality of daily life (McCormack, 2007). Indeed, as McCormack (2007: 372) explains, ‘events and encounters are not just interpersonal, they are molecular and in ways that are also implicated in barely tangible transformations of sense and sensibility’. They are essential ingredients in life, coming prior to anything else in life, and thus they are essential ingredients of a situated sense of wellbeing. Sound, light and other particle events, of course, often only appear to individuals as fully formed bodies and objects (entities) that interact as happenings. The following field note illustrates this. It is Samantha’s baby cousin’s birthday party at a local ‘jungle gym’ (a commercial venue, brightly coloured with climbing frames, slides, bouncy toys and more). Samantha walks into the indoor playing area where his party has already started and stops abruptly at witnessing the chaos that surrounds her: “Crash, bump, whizzz, bang”. Everywhere I look a child running or climbing or crawling. The area is filled with shrieks of laughter some reaching higher than the rest piercing the ears with their high notes. Its action, movement and young energy everywhere. I soon find myself the target of the kids in the “ball pit” throwing the multicoloured balls at me. As they flash by I try to dodge them one at a time, this way that way, left, right, right left. I laugh as a plastic ball ricochets off my head “booooong”. Without thinking I join in the throw fest and start to return the balls which are light and easy to the touch. Left hand pick up, right hand launch, left hand pick up, right hand launch e over and over. I’m smiling, throwing, missing and hitting and feeling young again. The relationship between molecular processes and full entities is certainly complex, yet the transitions are a seamless and constantly vacillating part of the physical world. In the above case, molecules make full bodies and objects (children and plastic balls). Full bodies and objects might move into an altered state (a plastic

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ball being thrown by a child) which itself involves actuation by molecular processes (in the child’s brain and muscle), and the physical mechanics of the full bodies and objects (the child’s throwing action, the size and weight of the ball). The result (a child’s moving arm, a plastic ball moving at a certain speed, then hitting its human target) possesses molecular energies (kinetic and sound) that, through further molecular sensing process (in the researcher’s eyes, ears and skin), are registered (by the researcher’s brain) and affect them. Related to this, the spreading and capacity building potential of affective energy is also something that shines through in the above field notes, exemplified by Samantha herself joining in the action with the children almost automatically prior to any conscious consideration of ‘fun’. This particular facet e the ‘infections’ of affect e is considered later. 5.2. From affects to emotions Pile (2010) provides a much more comprehensive explanation of our earlier brief observations on the relationships between affect and human cognition, describing a three layer model that maps the order and relationship between affect, feeling and emotion (see also Thien, 2005; Anderson, 2006). The first layer is non-cognitive affect; the purely physical interactions and resulting energies that occur within assemblages of bodies and objects (here humans, like all objects, are neutral, ahistorical, universal and integrated, e Pile, 2010). The second layer is a less-than-fully conscious affective feeling state; how these physical interactions are tacitly, intuitively picked up, yet not consciously registered or expressed. The third layer is fully-consciously felt and known emotion; the way affective feeling states are later fixed on or compared to established social categories and personal experiences, and expressed. Pile argues that a straightforward one-way movement typically occurs between the first, second and third layers (whether involving fractions of seconds or longer), that the first and second layers can occur without the third, but that no leaps can occur over the second. Thus, where environment is concerned, affect is necessarily a forerunner to and influence on emotion; emotion partly reflecting recognition of an affective state (see also Conradson and Latham, 2007; McCormack, 2008). The following field notes nicely exemplify this process. Sandra, who is travelling, experiences the physical mobility and her part in it, then later her mind becomes more actively involved as her affective state slips into particular personal memories and life histories (also, see Slide Two): I’m sitting in my car driving home. The road is clear, the car is at a comfortable temperature, the weather outside is fine. I look ahead at the road through a clean and spotless windshield under a clear blue sky. I absorb the bright and colourful surroundings as I pass by; the street lights, brick homes, cars, trees, and stores of the suburban neighbourhoods. There is no wind, the trees are still. The traffic is smooth and moving freely, putting me completely at ease. Every car is travelling at the same speed, in sinc with me and each other. All are moving together, like a pod. All is quiet, apart from the rumble of my tires, I hear the giggles of my son engrossed in his video game behind me. The sound of the video game is a low hum from a racing car, brrrrrrrrm, brrrm, brrrrrrrrrrrrrrrrrrrm. My footing is light on the accelerator, my mind is open and my heart is content as I enjoy the relaxation, the feeling of the moment, of being mobile. Then, I look to the left and notice a Gas Station that I have driven past a thousand times before but have never paid attention to. I am filled with fond memories of another city I used to lived in. I remember a similar Gas Station there that I went to every morning to buy coffee. It was never too crowded but always

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Slide Two. Driving past the gas station.

filled with friendly customers enjoying small talk. It was brightly lit with a self-serve coffee counter carrying my favourite coffee. Two sugars, two cream, two dispensing buttons and voila, my coffee was made. The employees were happy to be there, always smiling, interested, and talkative. It was a great morning every morning in that place.

considering emotion in isolation is often limiting as it is not sensitive to the sensations, movements and forces that often precede and evoke it (McCormack, 2003; Thien, 2005). Notably, the idea of an affective state of wellbeing being a less-than-fully conscious and pre-emotional form of cognition is also critical how wellbeing might arise in ‘everyday’ environments. This is because affect anchors wellbeing regardless of an individual’s particular personal knowledge of, or history with, the place which they are occupying in any given moment, and regardless of whether the place fits social categories traditionally associated with wellbeing (such as retreats, spas, natural landscapes, holiday destinations, particular caring environments etc). Being pre-emotional, affect facilitates wellbeing in potentially limitless situations and circumstances. On a methodological note, the involvement of emotions is a significant challenge and limitation when considering nonrepresentational issues and particularly engaging with the concept of affect. As Pile (2010) explains, an underlying problem is one of sequencing, and the inevitable involvement of the researcher’s own cognitive judgement ‘filters’ during their attempted observations and later articulations. Indeed the researcher, like any individual, might witness, experience or add to an affective state but, as soon as they reflect on this state, their reflection involves their personally, socially and historically anchored thoughts and emotions, which at best provide a false consciousness of it (Conradson and Latham, 2007; Ducey, 2007). Thus, in short, affect cannot ever be described on its own, even if the researcher attempts to keep their interpretation of the event to a minimum. As suggested earlier, the best he or she can do is acknowledge this limitation, that their articulations are never affective feelings themselves, and be as true and honest as possible to the energy and momentum of event that unfolded (Cadman, 2009; Ducey, 2007; Laurier and Philo, 2006).

I slowed the car down to stare at the gas station a bit longer. It had triggered memories and feelings as I had driven past.optimism, warmth, and acceptance The following field note was taken by Gavin whilst he was alone listening to music at a late night campfire. It exemplifies how quickly the transition from affect to emotion can occur and how quickly affect becomes submerged in emotion (also, see Slide Three): The air is warm on my face from the heat of the fire. Crackles and sparks are propelled from the blaze which lights up the water in the background. The music which is low on the stereo produces the perfect backdrop; ambient sounds and subtle drumbeats. I drift along with the sound, watching, smiling and thinking not much at all. Boom boom cha, boom boom cha, boom boom cha, I’m strumming my fingers on the arm on my chair and I’m tapping my foot on a log. I have no sense of time and how long I have existed in this moment. Then, I start to notice the lyrics phase in “i-don’t-pull-me-down. i-don’t-pull-me-down-onme“ and suddenly I’m thinking about the words, the band e Gorillaz and their Manga cartoon imagery. The experience has changed. My head is turned away from the fire and faces slightly towards the stereo In the above two scenarios, the pre-cognitive affective state creates the potential for later cognitive thoughts, feelings and emotions. Realizing this process has led scholars to observe that

Slide Three. The late night campfire.


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5.3. Making and spreading wellbeing capacities The idea of affect overturns the traditional understanding in research of the singular human body as self-contained and at the centre of human experience. Affect instead calls for a ‘relational ontology’ which involves two core understandings. First, that the singular body is no more important than any other humans or nonhumans present at, and making, an event in the same space and time. Second, that the singular body is open to, and influenced by, its relations to these humans and non-humans. Thus, affect brings attention to the body’s relational capabilities: its capacities to act and interact with other entities (see Deleuze, 1988, 1992). In terms of process, a shift in an individual’s energy, capacity and powers emerges as their body becomes affected within a network (Duff, 2010b, 2011). All of this is an almost instantaneous, open, rapid and constantly repeating process as bodies are affected, and then themselves affect (other bodies). In this sense affective environments can therefore be thought of as the taking place of these force-encounters, as the happening of the ebbs and swells of intensities passing between bodies (Seigworth and Gregg, 2010). Two of Gavin’s field notes speak nicely to these theoretical propositions. The first occurred over an hour, the second over a brief moment. Regarding the first, this contextual notes reads: I arrive at my four year old’s private swimming lesson with Nigel, a medical student who uses his fathers outside pool. I have always been impressed with the way Nigel teaches Jack, who is quite nervous of the water and can easily become scared. Nigel leaves no time for Jack to reflect, to argue or become upset- bouncing between activities, from one to another, to another to another. His observation reads: Before Jack can complain about the water temperature or come up with any excuses, Nigel has him in conversation rapidly firing questions one after another, ‘how are you? ‘Lets get right in’, ‘come on one step, two’, as he guides Jack with a firm hand on his back into the pool. Before i know it Jack is in the water, and before he can assess his situation he is straight into his first activity ‘ hold the float kick those legs’ Nigel narrates. The lesson continues in a similar manner, this exercise, then that e rolling, bouncing rapidly from one to another, no time to contemplate. I add to the momentum providing a background accompaniment; clapping at exercises competed, shouting words of encouragement or providing a sterner ‘come on mate;’ whenever Jack isn’t trying hard enough. Like a crowd at a sporting event it seems to work a little, providing some additional energy. One word, a harder kick, another word, a harder stroke, but I’m not consciously trying. My words flow almost instantaneously in response to my son’s movements. The pace of the lesson does not slow as we all play our parts; Nigel as the conductor, Jack as the player, myself as the crowd. An altogether different situation; a passing encounter: I’m in a shop, in a queue and in a strop. At last I walk up to the checkout. The happy bubbly cashier is in her late 50s with a welcoming face and shocks of curly red hair that thrust outwards towards me from underneath her hat. She looks at me directly and smiles. I almost return a smile but don’t. The cashier remarks merrily ‘great day hey!’ and smiles again. I now cannot help but smile back, the corners of my mouth rise beyond my control, higher. higher. to full height. The cashier says ‘now you have a nice day’, sits back and relaxes in her chair. I’m lifted mentally, feeling more positive. I walk towards the shop exit with a bounce in my step

As illustrated in the data presented so far affect, and the energy it involves, has associations with human wellbeing. This is because it might be felt by, and between, individuals either positively or negatively, and have a bearing upon their capacity for engagements. Indeed, on this subject Deleuze (1988) argues that whilst negative affection (described as ‘sadness affect’) acts like a form of poisoning that weighs an individual down and reduces their capacity to operate physically and mentally, positive affection (described as ‘joy affect’) acts as a nutrition that energizes an individual, carries them forwards and increases their capacity to operate (see also Simpson, 2014). Or as Deleuze and Parnet (2006: 45) notes more flamboyantly, ‘sometimes they [affects] weaken us insofar as they diminish our power to act and decompose our relationships, sometimes they make us stronger insofar as they increase our power and make us enter into a vast or superior individual’. In the following situation negative affection impacts on Gavin who is sitting in a crowded waiting room in a family medical practice wanting to see a doctor: I have a high temperature and a sore throat. I feel hot, vague and feint. I’m in a small room 20 by 20 ft, with no windows, no natural light, thick air, lined wall to wall with cheap plastic chairs (each with a sick person sitting on it). Some people are coughing, children sit on the floor, one is crying another being hugged. The sounds of the reception can be heard, computers bleeping and administrators talking; one of them arguing on the phone. Tense, fleeting glances are exchanged from patient to patient, none smiling or happy. I return looks and then return my gaze to the floor or my watch which seems not to move. Sweat drips off my nose and onto the floor. This situation is worsening my symptoms e i feel hotter, vaguer feint, my legs and arms heavy e its sapping me. Forty five minutes pass with this situation repeating, feeling worse, time standing still every minute holding out, seeming like five. Then suddenly ‘glory’ my name is called. “Gavin Andrews”. signals my release from this waiting room hell and even musters a smile. Only a name called, and I already feel a little bit brighter as I get up and walk past the other patients still waiting their turn. I enter the doctor’s room which is, quiet, private, cooler, and i feel a tiny bit better On the subject of physical ailments Bissell (2010) discusses how bodily preconditions change how the body is felt, and the materiality of environment felt, e which impacts upon affective relations. In particular, how preconditions potentially close off the body to transmissions that might have a positive affection on it and, at the same time, how they make transmissions that have a negative affection on other bodies. On another note Gavin’s waiting room situation, and the movement of him from it, also illustrates how a wellbeing feeling (in this case anti-wellbeing) builds with particular assemblage of humans and objects but then breaks down as the individual moves and the immediate assemblage around them changes. Conversely however, the individual might be stationary, or revisit a place, whilst the components of an assemblage change. Two of Samantha’s field notes further illustrate these scenarios: It’s peak time at the restaurant with people moving everywhere, food coming out, conversations in full swing, action and excitement all around. Suddenly the sound system breaks down destroying the vibe in a nanosecond. The remaining voices lower quickly, lest they actually be heard, until silence falls throughout the place. Whatever mood remains finally exits. ‘Is there something I can help you with?’ I politely ask a man who is wandering around my workplace late at night after it had

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closed. ‘No, I’m just looking around’, he replies. ‘I’ve never seen this place with the lights actually on before. It looks so different!’. I join him in looking around, slowly surveying the place in an slow moving arch of my head. I am struck my his observation and how right he is. The harsh light and absence of people draws my attention to the empty perfectly set tables and chairs, so stationary, so ordered. Without the smell of food, people conversing, low light, ambient music, and being constantly on the move between tables, it feels awkward and empty; a shell of a place. Indeed evident in these field notes, and in other data thus far presented, is the more general idea that assemblages that create affects are never closed or their relations complete. Instead assemblages are subject to a never-ending influx of bodies and objects (mediated by practices and ideas) from the very local to the global. These constantly interrupt, reopen, rework and readjust them (Jones, 2009). Thus affective environments are only ever temporary accomplishments in a constant state of becoming and unbecoming, of coming into being (Seigworth and Gregg, 2010). Extending the above restaurant scenario, for example, influxes might be the rhythm of a song from another country and time, light from a lighting idea borrowed from a competitor or the taste of a new food dish inspired by another national cuisine. These make the restaurant’s affect a locally experienced, yet far more broadly networked, creation. In the last field notes the ‘togetherness’ of wellbeing also comes to the fore; the idea of wellbeing as things, beyond the individual and personal, acting collectively as the environment. Whilst this might be a reasonable basic observation, it does however require a rethink of the fundamental nature of togetherness. Whilst traditional identity-based understandings of togetherness e for example in terms of class, gender, common tastes e might be important in life, it might be that togetherness arises prior to this through affect in different forms. As Thrift (2010) posits, affect raises the possibility that togetherness does not always have to be about commonly understood and acted identities. Other subtler and less conscious forms of human binding and solidarity arise immediately between individuals through their gathering and their parts and exchanges in immediate and constantly shifting spatial positioning (Thrift, 2005, 2010). Here, language, and even the reading of body performativity, are not so relevant, because who individuals are is not yet apparent, and has not been communicated. Ultimately the result is a ‘trans-human’ experience, whereby individuals experience themselves expansively as more than themselves, as part of a greater physical happening (Papoulias and Callard, 2010). 5.4. Affective possibilities for wellbeing Three ideas related to the production of affects are particularly relevant to wellbeing (see Andrews et al., 2013). First, related to human desires, needs, and preferences is the idea of ‘affective possibility’. As Conradson and Latham (2007) suggest, certain places attain reputations for providing opportunities for particular types of affective feeling states. Because of this identity, they might become focal points for individuals who value them and seek them out. Second is ‘affective economies’. Because, as suggested, value is attached by individuals to particular affective feeling states and the places where they are found, markets for affects might arise whereby financial resources are distributed and exchanged for their production and consumption (Conradson and Latham, 2007). Third, the practical mechanism for the creation of affective economies is ‘engineered affects’. Although certain places that provide

affective possibilities might do this as part of their ‘natural’ social or physical condition (such as an untouched natural landscape), most provide them following some level of purposeful design or manipulation. As Thrift (2004) argues, affects are often created by commercial and governmental interests that provide certain ‘textures’ and ‘feels’ to the things individuals do and places they frequent. Together these three ideas indicate that although many affective experiences in life might be involuntary, inadvertent and accidental, many might not be (Andrews et al, 2013). Moreover theoretically they also indicate that, although affects themselves are less-than-fully conscious, fully conscious and purposeful thoughts and actions can motivate and structure their existence. Certain field notes taken during the study, and the circumstances they describe, support this idea. A nightclub on a cruise ship provides Samantha with highly engineered affective possibilities and experiences that have been paid for (many connected to infections and togetherness of affects discussed previously): While aboard a cruise ship I walk into a “white party”. The pool deck is filled with people laughing and dancing. Lights flash around and paint the deck in a rainbow of colours. The music is so loud that the bass booms in my chest, creating a new tempo for my heartbeat. Boom boom boom boom. I’m a quiet, shy person but the atmosphere puts pay to that. Everybody in white means everybody is in. I feel invigorated. My shyness melts in the hot summer air. I rush the dance floor to be with the happy faces. I dance, sing and move with them, my body moving in time, without effort and without thought. Minutes and hours pass unnoticed as i dance without fatigue. I carry on and on, and on Importantly, even if an environment is a product of manipulation and engineering, individuals still do not, and cannot, seek out an exact affective experience. Two reasons might be suggested for this. On the one hand, as the data illustrates, each affective experience is a unique and unpredictable articulation of bodies and objects assembled in certain times and places that are specific and complex beyond any design. On the other hand, by the time individuals seek an affective experience, their previous experiences that might have been motivational have themselves been filtered through emotions and other full cognitions. Thus, individuals can only hope to seek out places with certain properties that might give rise to experiences that draw near to the affective experiences they expect or desire. This, in turn, leads to the more general observation that places do not ‘provide’ enduring and consistent wellbeing experiences that are in some way constantly captured in them or that constantly flow from them. Instead places provide opportunities for, and actual, unique affective moments of wellbeing set within general structural parameters and limits. 6. Discussion 6.1. Wellbeing as an affective environment The study challenges the ways in which wellbeing is conceptualized across disciplines including geography. On the one hand, academic literature typically positions wellbeing as a state of life, distinguishing ‘objective wellbeing’ from ‘subjective wellbeing’. While the former is statistically measured narrowly via substitutes or components (such as health status) (Gaspart, 1997), the latter is often assessed by individuals within specific areas (such their life satisfaction and general happiness) (Diener et al., 1999). Either way, strict parameters are set and enforced by professionals, and wellbeing is understood as something variable, attainable and


increasable; something that is known, has meaning and can be rated or judged. On the other hand, specifically with regard to the role of environment, most academic literature portrays wellbeing as obtained from particular places following an individual’s physical movement into them, and subsequently as a result of them experiencing and understanding the qualities places offer (Kearns and Andrews, 2010). In contrast, the current study forwards quite different yet complementary understandings of wellbeing connected to it being e rather than a state of life and/or something found in prescribed situations e anchored in a common and familiar feeling state. Indeed, because the idea of affect does not privilege human subjects and is not itself fully conscious or personal (concerned with the trans-human, all particles, objects, bodies and their interactions), it might be argued that wellbeing can be, in the way that it surfaces, free from objective or subjective judgements, itself part of the environment. In other words, wellbeing might initially emerge as an affective environment; the environmental action, then feeling of that action, prior to meaning. This propositions obviously speaks quite fundamentally to the when and how, as a state of existence, well comes into being. It indicates that wellbeing and environment might be entangled more frequently, earlier and more thoroughly than previous scholarship has thus far proposed. In short, recognising affective processes, if not leading to a ‘universal theory’ of wellbeing as such, certainly contributes to a more comprehensive understanding of it. These propositions arguably pave the way for new avenues of research focused on the initial, very immediate and momentary aspects of wellbeing. Indeed, what is particularly exciting and important is that these aspects will be familiar to individuals, and speak to the everyday experiences in their daily lives. However, at the same time, many fundamental theoretical questions remain unanswered and a number of lines of inquiry could be followed in future. Some of Pile’s general questions on affect are particularly relevant here. Pile (2010) argues, for example, that we need to know far more about the constitution of affect and the typical ingredients and circumstances that facilitate or hinder its emergence. Specifically, we need to think about how, through affect, wellbeing might ebb and flow through space and time. We need to know more about which affects drain and disturb individuals, and which have a positive energizing impact on them (how and why). We need to know more about affect and emotion and the permeable layer between the less-than-fully conscious and fully conscious (and into and out of what conscious personal and societal realities might affects flow). We need to consider whether individuals have equal capacity to transmit or pick up affects and, if not, what produces their different capacities? In short, Pile uses the metaphor of infectious disease suggesting that, just like diseases, affects infect individuals and spread amongst populations, but scholars need to understand what they infect, spread and how. What the transmission vectors might be and how they work. Meanwhile more specific questions on wellbeing health and health care need to be addressed. These include how the creation and manipulation of affects might facilitate wellbeing for political and commercial ends. What relationships might exist between spontaneity in affect and purposeful design and manipulation? What relationships might exist between wellbeing, affect and natural environments? How might embodied experiences of movement in affective encounters be related to health and wellbeing, and how might illness and impairment impact affective experiences and transmissions? Beyond wellbeing, questions include how affects might be engineered by health institutions for various ends and the role of technologies in this? What the implications of affect might be for ethical and other practice in health care? How affects in health and health care change through time and space, and how they are networked to other places, things,

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ideas and orders at different scales? Finally, in what ways can these affects be harnessed to make a meaningful impact on the way we understand health and improve peoples’ lives? None of these questions are easily answered, but research clearly needs to go beyond the current study’s initial foray e and the more focused pioneering work of other scholars (Andrews et al., 2013b; Bissell, 2010; Boyer, 2012; Conradson, 2005; Duff, 2010a, 2011; 2012; McCormack, 2003) e and develop more thorough and comprehensive lines of inquiry. 6.2. The promise of non-representational health geographies By indicating how so much wellbeing might be anchored in the affective backgrounds and doings, and the onflow of life, the study directs attention to the broader potential of non-representational theory in health geography. Kearns and other scholars have for a long time led the way in theorizing the dynamics between health and place, yet arguably the sub-discipline has not moved forward sufficiently from their influential arguments set within a social constructivist position. Whilst non-representational theory is the now at the forefront and ‘cutting edge’ of the parent discipline of human geography, and has been for some time, it is certainly not in health geography. Therefore, just as how Kearns drew on humanistic geography and the work of Tuan, Relph and others to talk about place meaning attachments and identities in health, arguably scholars need to now draw on the work of Deluze, Thrift and others to talk about what happens prior to the representation and meaning; the bodies, objects and performances in the doing and making e the ‘taking place’ e of health and place. As Anderson and Harrison (2010) note, Deluze writes in particular about life’s impersonality and much of it not being attributable to identifications. Life being everywhere, in all the moments that humans go through and create, and life being an immanent thing as it rolls along picking up further events (see Deleuze, 2001). It is this life that health geography is currently missing in large order, but could engage with through a fundamental re-reconnection with basic spatial movements. A new sub-disciplinary project like this would demand new ways of not only understanding the world of health but of working as academics. On a fundamental level as Thrift (2000) and Doel (2010) argue, non-representational thought and thinking must present the eventfulness and momentary nature of the world. It must also act ‘into it’, not treat it deferentially, overthink or over-theorize it, or hold it too far at arm’s length. Instead, as Doel (2010:120) eloquently states, “non-representational styles of thought collapse the longstanding separation of the world, which is reputedly ‘over there’, somewhere in the real, from its representation, supposedly ‘over here’, somewhere in the imaginary and symbolic”. Indeed, to engage properly with nonrepresentational theory the researcher must re-evaluate many of the things they might have previously thought of as representable or part of how things are represented e such as ideas, concepts, perceptions and words e and treat them as actual happenings and events themselves (Doel, 2010). These propositions do not require that existing understandings, approaches and areas of research in the sub-discipline be jettisoned. Indeed, we note Kearns’ point “to reform is not to discard” made in response to criticism of his own arguments for subdisciplinary reform twenty years ago (see Kearns, 1994a; Paul, 1994). Like Kearns, we consider there to be plenty of room for both ‘new’ and ‘old’ in health geography; non-representational theory not having to be a mutually exclusive endeavour. This point is backed up by recent commentaries in human geography (see Anderson, 2009; Anderson and Harrison, 2010) and specifically by varied arguments loosely centred on the ‘simultaneity’ of the new and the old in research.

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One issue that falls under simultaneity is retaining previous research interests whilst also incorporating emerging understandings and perspectives. On the subject of difference, for example, Colls (2012) notes how scholars might retain a legitimate research interest in differences in health even in the face of nonrepresentational theory’s tendency towards a universalist reduction of things (and not recognising variables such as gender, age, ethnicity and others). Colls argues that if researchers develop a “nomadic consciousness”, that remains critical of the problems that blindness to difference creates, but that it simultaneously open to the potential it offers, these problems might be navigable. Moreover, as Doel (2010) observes, with non-representational theory, difference can be understood, not in terms of difference observed and known in identity, but to difference in the repetition and remaking in events; difference not ‘after the fact’ but difference in itself, ‘during the fact’ and how it emerges (see Deleuze (1968) and Thrift (2010) aforementioned points on sameness and togetherness). Another issue that falls under simultaneity is finding ways forward without dumping the very theory and theorists that have provided so many insights into the dynamics between health, health care and place over the years. Emerging scholarship that starts to address the retaining and re-reading of theory, sets a precedent here. This work includes, for example, consideration of Derrida and Heidegger’s ideas on materiality, force-encounters (as suggested earlier e see Cadman, 2009), Foucault’s ideas on lively and unpredictable bodies and populations (Philo, 2012), Lacan’s ideas on engagements on life’s surface prior to language and knowledge (notably indicating the wider potential of exploring the psychoanalytic geographies and non-representational theory) (Evans et al., 2009), and the ideas of Wittgenstein, Merleau-Ponty and John Dewey among others with regard to the working of body aesthetics, sensations and consciousness (Shusterman, 2008). Finally with regard to simultaneity, and also involving a degree of sequentiality, is what actually happens practically in the unfolding of life. Quite fundamentally, as geographers have argued (see Pile, 2010), and the findings of the current paper also indicate, much that is active and less-than-fully conscious in life (and thus is non-representational) eventually flows into and out of the fully conscious realm and has meaning (and thus is representable). A vague feeling flows to-and-fro from memory, a passion to-and-fro from emotion, a vibe to-and-fro from conscious thought and so on. All this happens so quickly and seamlessly it is barely discernable to the observer or participant. Thus, it stands that in many circumstances non-representational health geographies are inextricably linked to representational health geographies. Both are essential sides of the whole human and health experience, and both need to be accounted for. Certainly non-representational theory has obvious consequences for health geography that, as a sub-discipline, is concerned with providing evidence in quite practical ways (see Andrews et al., 2012a). For those who might have concerns, we note Pile (2010) who argues that, whilst non-representational geography might be criticised for being abstract and disconnected with public and policy agendas and even peoples’ lives, it actually attempts to make human experience, and the ways people do things, easier to understand. Moreover, a foundation for future inquiry that feeds into applied conversations might be connecting non-representational theory to established ideas, concepts and debates across health specialties and disciplines. For example on the nature of being, knowing, reflectivity, embodied knowledge and performance in practice (see Benner, 2000; Effken, 2007), and on health care environments and human-health environment relations more generally (see Beyes and Steyaert, 2012; Butcher and Malinski,

2010; Ducey, 2007, 2010). Each of these would require carefully consideration. We conclude this paper on a note of caution. With any potential disciplinary movement or reform, scholars need to ensure that emerging research is rigorous. In the case of non-representational theory, as Thrift (2010) and Papoulias and Callard (2010) mention, it is all too easy to get carried away and a little giddy, particularly with ideas like affect, and say not very much about almost everything and anything one can imagine. Non-representational theory is however a particular way of researching particular parts of the world and being a researcher, and is not a ‘bumper sticker’. It demands respect and thorough engagement on each application. These traps can however be negotiated. Non-representational theory presents vast opportunities for understanding health and health care, and their emergence in place. It is therefore neglected at our intellectual peril.

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RSPH Health and Wellbeing Awards 2013: recognizing the contribution of health promotion to public health.

Health and Wellbeing Boards for a new public health.

Exploring the feasibility of theory synthesis: a worked example in the field of health related risk-taking.

The transfer and implementation of an Aboriginal Australian wellbeing program: a grounded theory study.

Health and wellbeing: giving weight to the argument.