Geographical narcissism in psychotherapy: Countermapping urban assumptions about power, space, and time.

Abstract

In the field of psychotherapy there is a subtle, often unconscious, devaluation of rural knowledge, conventions, and subjectivity, and a belief that urban reality is definitive. Through metaphors from geography and cartography and via psychoanalytic theory on privilege, I formulate urbanity as a seldom-addressed privilege and consider implications of the misrepresentation or absence of the rural world on the "map" of psychotherapy. I countermap urban biases on power, space, and time and explore consequences of frame, self-disclosure, ethics, and interpretations as I investigate urban valuing of specialized expertise over wisdom, urban disconnection from weather and distance, urban colonizing behavior, the dumping of incompetent professionals into rural areas, and the urban sense of entitlement to anonymity.

Exploration of rural physicians’ lived experience of practising outside their usual scope of practice to provide access to essential medical care (clinical courage): an international phenomenological study

“…You become more courageous, you become more willing to put yourself there because you've seen it work out well in the past and so it gives you courage to even do more. [1] Rural doctors do what they do through a deep connection to community and that connection goes both ways.…”

“…So I think about the times where adverse outcomes have happened in a remote setting and I haven't been ostracised. [1] I think once people understand their patients and their community, I think people build courage. [3] Rural doctors are attracted to the broad scope of rural practice even though it can be daunting.…”

“…And it was a great life, good and bad. [1] Participants identified that they are comfortable with uncertainty. Delivering safe, quality healthcare to patients when stretched beyond ones comfort is top of mind for rural doctors.…”

“…Normative values in clinical medicine tend to frame quality and safety assuming proximal and timely access for patients to specialist and subspecialist care. 1 Rural doctors describe consistent pressure to provide extended care beyond the limits of their formal training in order to meet the needs of the patients and communities they serve. Factors creating this tension include poorer patient access to care, healthcare professional undersupply, hospital resource limitations, overlapping clinical roles and training constraints.…”

Intertwined Strands for Ecology in Planetary Health

“…The point here is not to dispute the merits of the urban health agenda or its ongoing effort to engage with the ecological context of a growing proportion of humans on the planet [52,53,60]. Rather, a key concern is that a primary emphasis on the urban can have a domineering and 'othering' effect that tends to diminish the meaningful mutual relationships with the non-urban, creating an entrenched and misleading dichotomy that has long-term political, governance, ecological and societal consequences for our shared future [61,62]. In addition, a dichotomizing of the urban and non-urban simply fails to reflect the ecological principles of how living systems interact.…”