INTERPRETACIÓN CONSTITUCIONAL

Central to the practice of ‘new cultural geography’, the concept of landscape refers to the interrelationship between spatial form, meaning and representation (Mitchell 2005: 49). Landscape can be understood as ‘an ideologically infused mode of representation’ (Lilley 2004: 87), with space playing an active role in the structuring of social conduct. Both a subject in its ‘material’ form (a

landscape) and a verb (to landscape) in its discursive shaping of particular ‘ways of seeing’, landscapes – as ‘sites’ and ‘sights’ – are actively produced (Bunnell 2006: 28-29), establishing ‘what

is and what can be’ (Mitchell 2005: 50, original emphasis). As there are multiple ways of seeing and representing space, landscapes are constantly evolving, with ‘sites’/‘sights’ constituting, reproducing, contesting and reconstituting ‘geographical selves’, ‘shaping individual and collective socio-cultural practices… [and] (re)defin[ing] norms, ideals and objectives’ (Bunnell 2006: 28-29; Gesler 1992; Till 2005). Yet landscape’s naturalising tendencies also ‘mask the relations that go into

its making’ (Mitchell 2005: 51; Fannin 2003). To interpret their assemblages of invested meaning, landscapes can be ‘read’ as ‘texts’ unfolding within specific geohistorical contexts and fields of relations of ‘ongoing transformation’ (Bunnell 2006: 27-28), as relational nodes – ‘articulated moment[s] in knowledge networks stretching across spaces’ (Ibid. 2006: 29).

Given my concern with the promotion of a ‘Malaysia’ as an IMT destination, I wish to ‘read’ its unfolding ‘therapeutic landscape’ (Gesler 1991) in order to identify and trace the social, economic, cultural and political forces and processes involved in the country’s move towards acquiring ‘an enduring reputation for achieving physical, mental and spiritual healing’ (Gesler 1993: 171). The concept of ‘therapeutic’ is multi-faceted, a quality that invokes the provision of security, edifying recognition, relief, reassurance, comfort, continuity, well-being and healing. Acknowledging that ‘therapeutic’ status is historically contingent, caught up in the evolution of dominant discourses regarding what is ‘healthy’, Gesler and Kearns (2002: 125) advance that a ‘therapeutic’ reputation is constructed through historical events, promotional efforts and the experiences of visitors that over time accrete and become ‘fixed as “understood truths”’ in the public imagination.

With cultural theory informing an ‘opening-up’ of medical into health geography, a growing engagement with distinguishing the specificity of ‘place’ from abstract ‘space’ calls for greater sensitivity to how ‘language, symbolism, ideologies, and meaning all play a role in creating specific therapeutic landscapes’ (Gesler 1991: 182). Geographers have since critically engaged with the concept of ‘therapeutic landscape’, taking diverse approaches. They study the harnessing and exploitation of the ‘therapeutic’ properties of ‘natural’, physical landscapes (e.g., spas, colonial hill stations, rural settings, parks, etc.) (Gesler 1991, 1999; Williams 1999). Landscapes of institutionalised care (e.g., mental health facilities, elder care facilities, hospitals and hospices) (e.g., Fannin 2003) are deconstructed. Insight is sought from the reclamation of spaces for emotional healing after periods of political violence (Frazier and Scarpaci 1998). In the face of neoliberal reform, with de-institutionalisation and the retreat of the welfare state, geographers also have expanded the scope of study to include spaces of informal care-giving (e.g., the home, voluntarism, support and advocacy groups, etc.) (Bondi 2005; Milligan 2003; Milligan and Wiles 2010), the individualised search for spaces of self-expression and security in the public realm by people with mental ill-health and intellectual disabilities for whom institutionalisation and state support have become less of an option (Hall 2010; Parr 1999) and increasingly commodified places of healing (e.g., walk-in clinics, private hospitals, alternative medicine practices, etc.) (Kearns and Barnett 1997, 2000; Kearns et al. 2003). My study of IMT, attuned to the reconfigured relationships between the state, citizenship and commodified healthcare, seeks to build on this work.

If the ‘complex geographies of caring work at a range of scales’ (Popke 2006: 505), then what scales are privileged in the configuration of places of health and healing? While, as we have seen above, much scholarly work has attended to therapeutic landscapes at the micro-scale, little has explicitly conceptualised such landscapes at the national scale. Yet, in pondering ‘the bounds of a place that has significance to those within it’, Gesler (1991: 166) suggests that ‘“place” comes into being… when it embodies meaning’ and engenders attachment. Therapeutic landscapes are those places that fundamentally help people ‘maintain an identity’, which, as Bunnell (2006) argues below, certainly occurs at the national scale.

The ‘lure of the local’ in cultural geography has not precluded analyses of the work of landscape at the level of whole (national) populations. Landscapes in various media have been shown to articulate national identity which is, in turn, reworked and reconstructed through practices of individual and collective consumption… [L]andscapes are powerful ‘technologies of nationhood’ making known authoritative aims of and means to national development. Idealised national landscapes demonstrate appropriate or exemplary, individual and collective conduct which is folded into the (self-)regulating judgements and calculations of citizens. (Bunnell 2006: 29)

Enabled and legitimised by ‘national’ authority, a specifically national therapeutic landscape can be understood as offering a unique ‘package’ of regulation, human resources, political and economic stability and cultural credentials. In their study of Korean immigrants’ preferred use of ‘homeland medical services’, for example, Lee et al. (2010: 110) suggest that they experience the return to

Korea as ‘especially therapeutic’. Familiarity with the structures and hierarchies of their ‘native’ national health systems, expectations of medical authority and patient-handling, proximity of family and friends, and the lack of linguistic obstacles serve to both comfort and empower these transnational patient-consumers, returning a sense of control over their health and bodies. Whittaker (2009), in her work on reproductive tourism, examines the decision by some Thai migrant women married to Western men (farangi) to return to Thailand for IVF. Her respondents underscore the importance of receiving care ‘at home’, though the urban clinics they patronise are located far from their families’ villages. ‘Home’ here instead translates into ease in communication and familiarity with specifically national healthcare practices. The decision to return ‘home’ is a ‘re- assertion of place’ (Whittaker 2009: 320) that redresses a sense of ‘placelessness’ experienced through migration by selecting a health system ‘sensitive to culture and the social construction of health and illness’ (Elliot and Gille 1998: 337). These findings correspond to recent work that suggests that the perceived place of healing extends ‘beyond the formal spaces of care’ (Smyth 2005: 493).

The promotion of national therapeutic landscapes as IMT destinations can be understood as a ‘technology of nationhood’ (Bunnell 2006), a place-marketing technique used to reassert the

relevance of the nation-state within a globalising context, where the elements that set one country apart from others are thought to be increasingly indistinguishable (Van Ham 2008: 129) and the ‘legitimacy of government and other public institutions as purveyors and protectors of a place’s cultural and economic vitality’ are perceived to be waning (Aronczyk 2007: 109). Through its claims to ‘therapeutic’ status, the nation-state can be re-imagined as both a legitimate actor and territorialised entity able to compete in a globalised world by attracting tourism, trade, investment and generating jobs. Its claim to uniqueness and authority is premised upon the conjuring of

landscape as object, as container,… the poetic veneer that the nation-state adopts to colour its calculated translation of places into (national) space,… furnish[ing] the nation-state with a useful model for an orderly and meaningful composition of the various ‘parts’ of this same world… [a] ‘harmonious composition’… able to ‘put in order’ the national ‘heritage’, to embody national ‘essence’... (Minca 2007:438)

We see this objective at work among national councils that have been created throughout Asia in recent years to promote their countries as IMT destinations to both foreign and diasporic patient- consumers. Taglines, such as ‘Korea: Hospitality in healthcare’, ‘Malaysia Healthcare: Quality of care for your peace of mind’, ‘Philippines: The heart of Asia’, ‘Singapore Medicine: Peace of mind when health really matters’ and ‘Taiwan cares for your health’, welcome private patient-consumers across the globe (see Figure 1.3). Each campaign boasts specifically national expertise in providing ‘world class’ care, hospitality and peace of mind, as assured through an auspicious combination of territorialised factors. These include a high level of economic development at the national level or sub-national zones that are on par with ‘developed’ countries; affordability; internationally accredited facilities; highly skilled and innovative professionals with recognised credentials; short waiting times; social, cultural, economic and political stability; ease of entry into, and mobility within, the country via comfortable and safe, modern transport; and high-quality tourism infrastructure and offerings (Honors Integrated Marketing Communications 2008; KIMA 2010; MOH 2009; SingaporeMedicine 2007; Taiwan Taskforce for Medical Travel 2010).