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Social Science & Medicine xxx (xxxx) xxx–xxx

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Social Science & Medicine

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Place identity, autobiographical memory and life path trajectories: The

development of a place-time-identity model
Charis Lengena,b,∗, Christian Timma, Thomas Kistemanna
University of Bonn, Institute for Hygiene & Public Health, GeoHealth Centre, Sigmund-Freud-Straße 25, D-53105, Bonn, Germany
Praxis Kairou, Dr. med. Dr. sc. nat. Charis Lengen, Psychiatrist and Psychotherapist FMH, Florastrasse 12, CH-8008, Zurich, Switzerland


Keywords: The ability to remember, recognize and reconstruct places is a key component of episodic autobiographical
Place identity memory. In this respect, place forms an essential basis for the unfolding of experiences in memory and imagi-
Self nation. The autobiographical memory is seen to contribute to a sense of self and place identity.
Mental health The aim of this study was to concertedly analyze paintings, autobiographical narrations and places of birth
Episodic autobiographical memory
and life of clients under treatment at a psychiatric clinic in Switzerland who were manifesting psychiatric dis-
Time geography
orders, e.g. depression, anxiety disorders, bipolar disorder, personality disorder, substance dependence, and
Each client exhibited distinctive attitudes and approaches towards life characterized by unique personal
mental constructs for living in given places of time episodes that worked towards shaping the development of
their identities as well as the development of their health. For these clients, place and time function together to
leave a mark, a trajectory, that can hinder or help the resolution of a psychiatric condition. Based on six re-
presentative cases, we illustrate how each painting, each biographical narration and each interview reveals
deeper structures of individual perception, emotions, feelings, coping strategies, and capacities to reflect and
identify with place-time trajectories.
Based on this analysis, a place-time-identity model has been developed, which emphasizes the importance of
narration, the structure of personality, and emotional experiences in the development of the ‘relay station’ of
episodic autobiographical memory, self and autonoetic consciousness: these three elements are not only con-
nected through their embeddedness in time, but also through their embeddedness in place. In this context, place
provides an external fundus of memory, capable of supporting humans in healthy recollection and remembering.
The process of placing appears to contribute to the creation of self-esteem and identity. This psycho-geographical
place-life-time approach is contrasted to phenomenological place-space-time theories of Husserl, Heidegger,
Bachelard, and Sloterdijk.

1. Introduction the context and experiences of one's own biography (Markowitsch and
Staniloiu, 2011). This context memory contributes to a sense of self as
Characteristics of identity associated with the perception and com- well as to the content and continuity of identity (Addis and Tippett,
prehension of the spatial environment are often summarized in the term 2008). The ability to encode, recall and reconstruct landmarks, scenes,
‘place identity’ (Proshansky et al., 1983; Lengen, 2016). Proshansky landscapes and places is a key element within episodic forms of auto-
et al. (1983) assumed place as an external memory of the place-based biographical memory (Moscovitch et al., 2005).
aspects of our identity. Place identity is a construction of the self in its This study is focused on the neuroscientific approaches of auto-
spatial environment and reflects its socio-cultural relationship to place biographical memory, self and autonoetic consciousness concerning
and environment. Accordingly, place identity connotes both a self-re- place identity and their significance for mental health. Based on auto-
flective and an autobiographical perspective based on the auto- biographical memory approaches by Markowitsch and Staniloiu
biographical memory. (2011), Addis and Tippett (2008), Moscovitch et al. (2005), Damasio
The autobiographical ‘context’ memory (Steinvorth et al., 2005) is a (1999) and on the neuroscientific place identity approach of Lengen
multimodal and complex form of encoding, remembering and reliving and Kistemann (2012), as well as based on our ongoing qualitative

Corresponding author. Florastrasse 12, CH-8008, Zurich, Switzerland.
E-mail address: (C. Lengen).
Received 31 January 2018; Received in revised form 23 August 2018; Accepted 20 September 2018
0277-9536/ © 2018 Elsevier Ltd. All rights reserved.

Please cite this article as: Lengen, C., Social Science & Medicine,
C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

Fig. 1. EAM, autonoetic consciousness and the self (proto-, core- and extended self, Panksepp, 1998, Damasio, 1999).

mental health and place identity study, we aim at constructing a place- clinical symptoms such as amnesia, aphasia and/or paresis are pre-
time-identity model which enlarges the model of episodic auto- sented, we can combine and correlate the symptoms with the patho-
biographical memory (EAM), self and autonoetic consciousness logical brain process and learn which neurobiological processes are
(Markowitsch and Staniloiu, 2011): EAM, self and autonoetic con- involved in language and motion. The corresponding logic is the same
sciousness are not only connected by ‘embeddedness in time’ (Fig. 1), in research of mental disorders: where experiences on a cognitive,
but also by ‘embeddedness in place’. emotional and behavioral level change, we can obtain new information
The aim of developing a place-time-identity model is to develop a and knowledge out of the order revealed in a pathological process.
more general model as a theoretical basis for neurosciences and medical The introduction provides an overview of the state–of–the–art re-
geography to better understand which factors could play an important ferences to neuroscientific approaches regarding episodic auto-
role in place-time-identity experiences. Consequently, the place-time- biographical memory, self and consciousness, and relates them to
identity model could be a basis for a discourse in the psychotherapeutic phenomenological approaches to space, place and self. Based on an
landscape. Since the beginning of the 20th century, ego-centred and inductive qualitative coding process (Strauss and Corbin, 1990) of
ego-others-centred dyadic psychotherapeutic approaches have been narratives of clients with mental-health problems, and a time–-
prominent (see Erikson, 1966; Freud, 1915; Winnicott, 1953). How- geography approach (Hägerstrand, 1970), we visualize the life paths of
ever, there are also authors such as Bronfenbrenner (1979), Cobb each client in a time-geography model. Based on their autobiographical
(1977), Gebhard and Kistemann (2016) and Proshansky et al. (1983) narratives, we analyze and interpret their individual life movement
who are aware of the relationship between the individual and the en- patterns.
vironment. The development of our place-time-identity model echoes
the theoretical framework of the individual-environment-interaction in
1.1. Autobiographical memory, autonoetic consciousness, and the self
‘the Ecology of Human Development’ (Bronfenbrenner, 1979) and ‘the
Ecology of Imagination in Childhood’ (Cobb, 1977). However, in
Both episodic and semantic components of the autobiographical
medical geography, time as a factor in place identity has not been
memory generate the material for the content and continuity of identity
deeply discussed so far, and in neuroscience the place factor is not
(Kopelman et al., 1990). Personal episodic memory, the event-related
adequately considered concerning memory, self and consciousness.
characteristic of autobiographical memory, supports the process of
Ultimately the individual-environment-interaction approach of the
encoding and remembering of ‘personally experienced events including
place-time-identity model can be applied in psychotherapeutic work to
the contextual information about time and place. The retrieval of rich
better understand human experience and context in life crisis.
details provides a sense of re-experiencing that involves mental
For our research, we decided to recruit individuals experiencing a
time–travel of the self,’ (Addis and Tippett, 2008, p. 73). Personal
mental health crisis rather than healthy individuals. In their neurolo-
episodic memory must be distinguished from personal semantic
gical work, Damasio (1999) and Sacks (2010) show how neurologic
memory which is not event-related, and which is connected with a
disorders may reveal new approaches to healing: where pathological
‘feeling of knowing’ instead of remembering (Addis and Tippett, 2008;
processes happen—for example, a stroke in a specific brain area—and
Schwartz et al., 2014). Autobiographical memory is a condition,

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

functioning as a type of relay station for the construction and emer- emphasized in Sloterdjik's (1998) and Müller's (2017) criticism on
gence of the self and the autonoetic consciousness. Heidegger's (1927) failure to address being outside as being-out-of-the-
‘The sense of a unified and continuous self is, therefore, based on an world (‘Draussen-sein’ as ‘Aus-der-Welt-sein’). Sloterdijk's (1998) term
illusion, where the self is a fictional entity, a mental model that we ‘human as a dividuum’ aims at distinguishing between a phenomen-
unconsciously and unintentionally construct through the stories we tell ological inside space (‘Innenraum’) and outside space (‘Aussenraum’)
to others and to ourselves’ (Sani, 2008, p. 2). This sense of sameness (‘insideness’ and ‘outsideness’ using terms highlighted by Relph, 1976).
and continuity of self enables a connection between the past and the The experience of being excluded from the world of inside space as
future. Without a ‘sense of permanence’ it would be hard to integrally well as the crossing of borders are fundamental experiences which
preserve personal identity. As the sense of permanence itself is based on create and endow self and identity. Bachelard (1957) quoted Sartre
autobiographical episodic memory, this sense of permanence appears to (1975) writing on Baudelaire, using the quotation to allegorize the re-
be a construct of future thinking as well as a recollection of the past. lationship between space/place and being, using the quotation to al-
Nelson and Fivush (2004) and Markowitsch and Staniloiu (2011) sup- legorize the relationship between space/place and being: ‘(Emily) had
port the thesis of the effect of the relationship between the EAM and the been playing house in a corner right at the bow of the ship … tired of
creation and articulation of self-narratives, individual self-constructs this game, she walked aimlessly towards the stern, when suddenly she
and self-concepts. Additionally, the development of the sense of self is was struck by the dazzling thought that she was she … ’ This flash of
related to the development of the EAM during childhood and adoles- insight—of having a self—that the child experiences only arises after
cence. This development of the EAM is correspondingly based on in- the child has left her ‘home’. Bachelard points out that the child dis-
herent abilities of autonoetic ‘experiencing self’, ‘remembrance’ fea- covers that she is ‘herself’ as she moves from being at home to being
tures, the capacity to flexibly travel in mental time and space, and a outside: this is un-heim-lich [unheimlich = eerie; Heim = home]. The
superior awareness of oneself as a person in a social (and biological) experience of being outside is traumatic and indelible; Sloterdijk (1993)
environment. compared being outside with feelings of fear, panic, extemporaneity,
The general ability to recall and imagine the future is called au- being devoid of refuge, eeriness—in contrast to positive self-experi-
tonoetic consciousness (Tulving, 2005), an important component of ences of being familiar, intimate, grounded, and having refuge. The step
self-identity (Arnold et al., 2011). ‘Individuals with (autonoetic) epi- outside is both a waking-up and a self-experience. The physical and
sodic memory can, if the situation calls for it, think here and now about conceptual act of being outside or inside, of crossing borders, presents a
personal happenings in other places and other times’ (Tulving, 2005, p. challenge and an opportunity to create self and identity (Lengen, 2016).
7). Space and place characteristics have the same impact on the epi- The feeling of being inside—to identify with, to experience the feeling
sodic memory as time aspects. The concept of the relationship between of sameness—as well as the feeling of being outside—excluded, root-
EAM and the development of the self (Nelson and Fivush, 2004) along less, and different—cannot be detached from time and place: they are
with the notion of EAM as embedded in both time and place (Tulving's both intensively, spatially encoded, learned, recalled and experienced
revision of EAM (Tulving, 2005)) emphasize the ‘important contribu- (Relph, 1976; Sloterdijk, 1993). Such feelings can give us a sense of
tion of the socio-cultural milieu to the emergence of EAM’ (Fig. 1, identity and trust; paradoxically, they can give rise as well to feelings of
Markowitsch and Staniloiu, 2011, p. 25). alienation, all of which impact mental health. On the one hand, an
unknown, unfamiliar place or a place associated with trauma can
1.2. Self and consciousness in relation to philosophical approaches of place trigger anxiety, insecurity, unpleasantness, sickness and distress in in-
dividuals. On the other hand, as a function of the experiences in an
Our epistemological focus on EAM, the self and autonoetic con- original place, a new place can be a positive challenge: a change in life
sciousness in the context of sense of place and place identity intends to providing an opportunity to find the self, to develop a deeper self-
merge neuroscientific concepts of self with hermeneutical concepts of consciousness, to experience well-being amidst mental and physical
space/place and phenomenological concepts of the self in time and tension, and to find relaxation and health (Lengen, 2016).
German and French scholars have made substantial contributions to 1.3. Time geography
a philosophy of space and self. Phenomenologically-colored philoso-
phies (Husserl, 1973; Heidegger, 1927), and subsequent psychiatric- Hägerstrand (1970) and later on Schærström (1996), Lenntorp
therapeutical concepts (Jaspers, 1959), as well as Sloterdijk's (1998, (2004), and Sunnqvist et al. (2007) analyzed the changeability and
2004) ‘Sphärologie’ provide thoroughly elaborated representations of dynamics of daily life, visualizing life paths in time-space graphics
space/place-, body- and self-experience (‘Raum-‘, ‘Leib-‘ and ‘Selb- based on the concept of time-geography. Facing methodical problems in
sterleben’) and complement neuroscientific approaches; the new geography with large scale aggregated data, Hägerstrand (1970) pre-
German term ‘Raumselbst’ (Space-Self) emblematically points to this sented a method of analyzing the micro-situation of the individual and
discourse (Sloterdijk, 2004). Following Husserl's (1973) phenomen- the micro-environmental factors that are important for decision
ological approach (consciousness not separated from the outside making, e.g. with regard to moving, daily work, or visualization of life
world), consciousness is not understood as a sphere isolated from ob- paths.
jects where ideas are contained in an inner world; instead, these are To introduce our methodical approach, we elucidate three specific
rather a consciousness of something. The individual does not stand vis- terms of time-geography nomenclature (trajectory, path and prism)
à-vis the world (subject-object-dichotomy), but is embedded in the used to analyze the life paths and the underlying decisions. Within
world—in bodily, social, epochal and cultural relationships. time-space, the path of an individual starts at the point of birth and
From birth, the experience and development of identity and self are ends at the point of death. The life path—or parts of it—can be gra-
both collectively and individually anchored in the relationship to places phically depicted as a two-dimensional trajectory derived from a four-
and landscapes, especially in the topophilic experience of living in a dimensional time-space pattern. A path can be a symbol of a physical
home or house: ‘I am the space where I am’ (Bachelard, 1957), with body which can be represented within a trajectory (Hägerstrand, 1970;
each place and object having a symbolic meaning. Yet, experiences of Schærström, 1996; Lenntorp, 2004). Other representations of life paths,
rootlessness (Relph, 1976), homelessness and ‘placelessness’ (‘Ortslo- e.g. episodic autobiographical memories of time-spatial (or time-place)
sigkeit’, Lengen, 2016) contribute to identity and self. Individuals, characteristics, can also be illustrated as trajectories and prisms that are
groups and societies build and create their self and self-consciousness continuous, indivisible, and have a positive direction along the time
through experiences of being ‘inside’, being within as being-in-the- axis.
world (‘Dasein’ as ‘In-der-Welt-sein’) (Heidegger, 1927) or ‘outside’, as The prism describes a time-space within which trajectories progress

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Fig. 2. a–f: Autobiographical outlines.

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Fig. 3. a–f: Essences of interviews.

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confidence over the course of the psychotherapeutic process, we could

generate more personal information. The data collection of the twenty
participants comprised paintings, interviews and socio-biographical
anamnesis. However, for the work presented here it was impossible to
include all twenty clients because of the volume of the data.
Accordingly, we selected six representative clients based on the fol-
lowing criteria: (i) a broad range of mental disorders between stress-
related depressive disease (I12) and heavy manic episode of a bipolar
affective disorder (I14) or borderline psychosis with heavy suicidal
tendency (I4); (ii) diversity of places and times; and (iii) the cognitive
condition of the clients: how clearly and meaningfully they were able to
Painting and interviewing were carried out in a simply arranged
room (see Lengen, 2015). The participants were familiar with doing
artwork since they had used it in therapy. The clients were prepared for
their place imagination by a simple breathing and body-centred medi-
Fig. 4. Life path of Client 1. tation based on the Mindfulness-Based Stress Reduction method of Jon
Kabat-Zinn (see Lengen, 2015), which they were familiar with. In this
based on specific constraints: personal, social, cultural, biological and moment of relaxation, the participants were asked without further ex-
environmental. The prism focuses on these constraints rather than the planation, ‘What is your place?’ (‘Was ist Ihr Ort?’). After 5–10 min of
behavior per se, enabling a broader analytical focus of time-geography. meditation, the clients were invited to quietly paint their first associa-
Analogous to a molecular paradigm in the natural sciences, this time- tion in response to the place in question. After 20 min, their paintings
geographical method embraces changes and dynamics in life; funda- were qualitatively evaluated in a semi-structured, one-to-one interview
mental rules that shape an individual's life, a society and its possible applying a psychoanalytical approach (for details, see Lengen, 2015).
transformation; and fundamental ecological and social conditions and The audio files were fully transcribed. The interview data as well as
processes (Lenntrop, 2004, p. 223). the biographical data based on their CV, the socio-biographical ana-
This closer time-geographical look at the individual human being in mnesis and medical reports were analyzed using an open coding process
a situational setting enables a deeper understanding of human social, (Strauss and Corbin, 1990). In this comparative line-by-line analysis,
cultural, and environmental interactions; this perspective also allows a the data were coded in as many ways as possible and memos were
mapping of the individual's time-space pattern distinct to their per- written about the conceptual and theoretical ideas that emerged during
sonality. For example, Sunnqvist et al. (2007) analyzed life charts of the course of analysis. Essential terms and sentences were weighted by
psychiatric patients who systematically described their life courses and their frequency, emphasis, surprise effect and reflective power, as well
life events over time; this combination of theoretical, empirical and as the authors’ knowledge and experience in the therapeutic process
daily-life information and communication in research gave rise to a concerning the client. The open coding process was completed by vi-
‘user-centred spatio-temporal theory’. Analyzing and visualizing the sualizing the essential uncovered terms in timeline-based interview
deeper relationships of an individual with others within a culturally figures of each participant, as well as lifetime-based biographical fig-
engraved milieu in a continuous time-space gives depth and perspective ures of each participant (see Fig. 2a–f and 3a-f).
(Gibson, 1986). Referring to the time geography approach of Hägerstrand (1970),
Lenntorp (2004) and Sunnqvist et al. (2007), residential types and
2. Methods biographic place models were created (see Figs. 4–9). To visualize the
biographical life paths, all concretely mentioned locations regarding
Our study was carried out in a residential private psychiatric clinic place information were extracted from the interviews, the CVs and the
for adults that operates under public contract in the rural surroundings socio-biographical anamnesis using the QRA software Atlas.ti®.
of Zurich (see Lengen, 2015). Ethical authorization was received from Assuming that all mentioned places are of special importance, all
the Ethics Committee of Psychiatry, Neurology and Neurosurgery of the places were included. To distinguish between residential places and
Canton of Zurich, Switzerland. Clients with acute psychotic disturbance places where the clients lived out their lives (‘other places’), an in-
or with severe dementia, as well as patients in danger of harming ductive, qualitative codification and classification (Strauss and Corbin,
themselves or becoming violent vis-a-vis others, were not considered as 1990) for both types of places was done. Categories of residential places
participants in the study, nor were clients with terrifying past experi- (residence, former residence, birthplace) and categories of other places
ences or those for whom an interview might trigger panic attacks, re- (journey/voyage, trip/near residence, holiday spot, place of work,
peated traumatization or dissociative episodes. professional journey, negative place, place with particular meaning)
According to their diagnoses and personal life histories twenty adult were defined.
clients aged 23–59 years were invited to participate in the research The place information was set into the individual biographical
project. The participants were informed about the research project, they context (duration of stay and period of residence) of each client: based
gave their consent and were consistently informed that they had the upon this, trajectories were constructed (Hägerstrand, 1970; Lenntrop,
option of withdrawing from the study at any time. They originally came 2004). Residential places were rated and visualized as trajectories,
from three separate continents: Africa (Morocco), Europe (Belgium, while the other places were rated as prisms and visualized similar to the
Denmark, Germany, Switzerland) and North America (USA). Most of techniques set out in Hägerstrand (1970). The places were mapped in
the clients had been mentally ill for between two to three months. Their Google Earth using the Atlas.ti® geocoding tool. Subsequently, the
main diagnoses were as follows: dementia, substance dependence, geocoded places were exported to ArcMap® and ArcScene® (3D appli-
major depression, bipolar affective disorders, anxiety disorders, soma- cation of ArcGIS®). The time information applicable to each place was
tization and pain disorder, personality disorders, self-harming. overwritten in the feature table. The life paths were visualized using the
Interviews were carried out at the end of clinical stay, at which time the extrusion and base height tool of ArcScene®. The z-axis indicates the age
symptoms of the clients’ main diagnoses were in abeyance. The parti- of the individual person.
cipants knew the researcher as a therapist; this made it possible to get In the following section, we present the findings of the six selected
an informational in-depth interview. With patients developing greater clients concerning their socio-biographical anamnesis, the interview,

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Fig. 5. Life path of Client 2.

their paintings and their life path trajectories. In the discussion, we 3. Findings
present our place-time-identity model as an essence of the clients’
findings, neuroscientific memory and self-approaches and place iden- The in-depth portraitures of six clients reveal individual mental
tity literature. Additionally, we discuss five sub-themes based on the structures of living in place and time, of developing identity, and of
place-time-identity model: (i) fault lines of personality, especially in- developing individual health-illness continuities—embedded in their
and outsideness of the autobiographical memory; (ii) emotions and self; individual life paths. Because the data collection is an intensive, in-
(iii) latent biological, social, cultural and environmental structures of teractive process of the client and the therapist as researcher, it is dif-
place identity; (iv) the embeddedness of self in place and time; and (v) ficult to differentiate which observations and interpretations are from
the autobiographical place-time trajectories. the client and which from the researcher. Whenever possible we mark
the interpretations and metaphors of the clients.

Fig. 6. Life path of Client 4.

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Fig. 7. Life path of Client 7.

3.1. Client 1 protector instinct with the ability to be a good trouble-shooter and
caregiver for his family. But his intelligence and willingness to develop
In her narrations and trajectory, Client 1 emphasized the impact of himself in his professional life is at odds with this talent. The early
her migration from Morocco to Switzerland (Fig. 4), the existing gap abuse as well as the resulting coping strategies resulted in a suscept-
and conflict between a traditional family idea in a modern world, and ibility to mental disorders, first as somatization, later on as a depressive
the reality of a Swiss husband who didn't support her in her dream of development. His trajectory (Fig. 5) shows a widespread place-time-
having her own family. From this conflict, she finds herself in an in- pattern which is much more complex than the trajectories of Client 1
secure mode—a ‘turtle in a ship’ (Fig. 10) (as she herself remarked)—an and 7. This trajectory shows his restless life, his not-being-at-home, but
expression of depression, pain disorder and anxiety (Fig. 2a). Further, also his mental, physical, socio-economic capacity to travel and shape
in reflecting her self, she desires and needs to be protected, to have his life in different ways. Interestingly, he described more than one
control, security and stability in view of strong depressive, fearful and imaginary scenic place: a good-time landscape with green meadows and
sad moods and behavior (Fig. 3a). Shame and infamy, derived from blue lakes; a bad-time landscape with a night-moon landscape; and a
feelings of violation by the husband and colleagues at work, and from peace-calmness-relaxation landscape incorporating a savannah land-
abandonment by the family of origin and the husband, are discernible scape with pastel shades (Fig. 11), indicating a desire for peace,
as emotions, perceptions, cognitions, projections, body sensations, and calmness, a chance to breathe, and a view into the distance (Fig. 3b)—a
personality traits of anxiety and dependence (see Figs. 3a and 16). compensation for his painful experiences.

3.2. Client 2 3.3. Client 4

As a consequence of paternal corporal punishment and, later on, of Client 4 shows a similar widespread and diverse trajectory (Fig. 6):
fights with his classmates, Client 2 said that he had developed a she told us that she had experienced abuse in her early childhood with

Fig. 8. Life path of Client 12.

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Fig. 9. Life path of Client 14.

little protection and security from her parents; her mother suffered from
a recurrent major depressive disorder (Fig. 2c). In this familial context,
Client 4 developed a mental disorder with personality disorder and
major depression as well as obsessive thinking and thoughts of suicide
earlier in her life than Clients 1, 2, 7 and 12. But similar to Clients 2 and
7, she is someone with the capacity and creativity to construct and
control places—in her case as an architect as she reflected herself. The
difficulty of bringing her wide interests, needs and wishes together was
a big challenge, especially concerning her motherhood and work as an

3.4. Client 7

Client 7 also grew up together with a mentally ill mother who suf-
fered from paranoid schizophrenia (Fig. 2d). As a child, Client 7 de-
veloped both a maternal outlook for and dependence on her mother.
Based on her musicality, Client 7 grasped the opportunity to develop
her autonomy. However, her needs of dependence and autonomy were
Fig. 10. Painting of Client 1. at odds with one another: it was problematic to find a job or to stay in a
job because she was so homesick. She developed a morbid compulsive
yearning for her mother. Her trajectory is not diversified; it is a map of
the dependence on her mother and the effort to find a job. Unable to
sustain this conflict within herself, she became exhausted, tired and

3.5. Client 12

Hiking in the mountains for Client 12 was an important part of his

life from early on. However, pressured by his father, he became an
overachiever both in the mountains, at school and later on in his work,
with a remote sense of anxiety always present (Fig. 2e) as he reflected
himself. His overachievement is presumably a compensation for a lack
of sensitivity in his family of origin. Amidst this overachievement and
perfectionism, he failed to seize important relationship moments with
either of his parents: this made him depressive. He told us that he
realized that travel is his opportunity to gain new perspectives, which is
one reason why he was keen on traveling far away as well as on hiking
in the Swiss mountains. However, he has resided solely in one region
Fig. 11. Painting of Client 2. since his childhood. This gives both his life and self a path as well as
continuity. In this sense, his trajectory may be represented as a symbol
of himself: he spreads his wings like a free butterfly with a stable body
in the middle (Fig. 8). In comparison to the other clients, Client 12 was
the healthiest and most stable patient in the sample.

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

birds in the sky. He said that this harmony allows him to relax and feel
free, calm and peaceful. He told us that the associated landscape is a
symbol of being himself when he is in a healthy mode. Client 14 is
strongly connected with environmental elements; during times of
mania, he seeks solitude at Mediterranean places and connects in a
psychotic way with these places: developing a sense of belonging,
connection to and deep dependence on sunny places, such as Nice in
France (Fig. 3f). During times of depression, he related that he ulti-
mately finds himself unable to get out of bed and feels like he is im-
prisoned, lost and rootless. He does not like solitude, but he cannot
stand anything, anybody, or anyplace. He was sad to have left his home
where he knew every place, all his neighbors, his street, his shop, his
bench near the church; he also missed his wife and his daughter. His
trajectory is characterized by a stay in San Francisco where he felt so
well in the multicultural society of the U.S. west coast.

4. Discussion

Fig. 12. Painting of Client 4. 4.1. Outline: a place-time-identity model

Based on the EAM, autonoetic consciousness and self model of

Markowitsch and Staniloiu (2011), and the self concept of Damasio
(1999) and Panksepp (1998), as well as our sense of place and place
identity model (Lengen and Kistemann, 2012), we propose a place-
time-identity model which is complemented by the presented com-
ments of the clients in the interviews and their socio-biography
(Fig. 16). This model is constructed on the relay station EAM: self and
autonoetic consciousness as a place-time-identity moment which is in-
fluenced by individual aspects, e.g. perception; attention; emotions;
encoding and recollection; feelings of knowing; sense of place; per-
sonality structures; spirituality; narratives from the individual; and
other factors (the inner circle of the model, see Fig. 16). Non-individual
aspects play a role as well: relationships in the dyadic and triadic family
structures; broader social relationships (teacher, classmates, friends,
institutions); socio-economic factors; cultural scripts of art, technology,
science, philosophy and religion; natural environmental aspects of
place; and biological factors of the individual such as age, gender, ge-
netic and epigenetic factors (the outer circle of the model, Fig. 16). All
Fig. 13. Painting of Client 7. these characteristics are connected and play an important role in the
moment of remembering and being in place and time. The life path
trajectories are latent, unconscious structures of an autobiographical
remembering process incorporating spatiotemporal characteristics of
Environmentally relayed components (cognitions, ideas, values,
preferences, needs, desires, feelings, emotions), as well as behavioral
concepts and experiences of an individual play a role (i) in the re-
membrance of the ‘environmental’ past (Rubin, 1995); (ii) the imaging
of future ‘context’ (Addis and Tippett, 2008); and (iii) in moments of
mindfulness in the presence of the individual: this was observed in the
interviews with the clients. The past is based on place and space and
their characteristics in a biological, psychological, social and cultural
sense (see Fig. 16 and Proshansky et al., 1983); this multi-faceted sense
is encoded in the episodic autobiographical memory.
The episodic memories of place are a key element in influencing the
formation of early and subsequent identity, and relationship of self to
place and space. The place-time-identity model must be understood as a
continuity of identity from the moment of childhood, which Cobb
(1977) called the child's ecological sense of continuity with nature. This
Fig. 14. Painting of Client 12. sense of permanence (Sani, 2008) based on the EAM enables a con-
nection between the past and the future within the here and now. A part
3.6. Client 14 of this sense of permanence is manifested in the life path trajectories
which are figures of the unconscious part of the place identity con-
The ups and downs of Client 14, his manic and depressive moods, tinuity. Cobb (1977) postulated that ‘human identity depends, there-
give rise to his need and desire for a meadow with a mountain, a tree fore, on a sense of both discontinuity and continuity with nature as
and warm sunshine (Fig. 15). The only movement is indicated by the history. Testing of the self against bounded and the unbounded begins
with the spatiotemporal relations of mother and child and continues

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

variation depending on their personality (Singer and Salovey, 1993).

Additionally, physical settings vary in time and do not always fit to
individual needs and desires, e.g. Client 14 with his experience of re-
turning from San Francisco back to Zurich and feeling as an alien in his
own country. New individual and collective values, habits, feelings and
motives concerning the physical environment develop in a process of
adaptation: this constitutes and integrates the place identity of an in-
dividual (Lengen, 2016). Additionally, ‘the others’ play an important
role in place experience throughout life (see all clients). Thus, place
identity is also a function of what ‘the others’ think, do and say about a
physical setting. Accordingly, external (‘fremd’) and internal (‘eigen’)
narrations about place, location, and the sense of place experiences give
meaning (Lengen, 2016).
We present a contrast to the idea that place identity represents a
coherent, integrated cognitive substructure of ‘self identity’: our ap-
proach is that of a ‘potpourri’ consisting of episodic autobiographical
memories, interpretations, conceptual ideas and feelings identified with
specific physical settings and types of settings (Fig. 16). This potpourri
Fig. 15. Painting of Client 14. can be linked to a patchwork identity (Keupp et al., 2008) reflecting the
places lived in and experienced (Lengen, 2016). The characteristics of
place identity vary with gender, age, socioeconomic status and the
personality of the individual. This assembled notion of place identity is
a complex, cognitive-emotional structure characterized by ‘the emo-
tional bonds that people form with places … the cultural, historical and
spatial context within which meanings, values, and social interactions
are formed’ (Williams and Stewart, 1998, p.19).
Significant shifts in client identity may be prompted through in-
terior changes (the self) or in exterior changes (familial, social-cultural
or those of the physical environment) (Burris and Rempel, 2008).
Consequently, as revealed by the clients' narrations, patchwork iden-
tities are best understood as an ongoing process of identity construc-
tion; during any lived-out episode, old and new patches are woven
together by a pattern of articulations, both conscious and unconscious,
through narratives about the self, all based on episodic and semantic
autobiographical memories (Lengen, 2016). This memory-based iden-
tity construction provides ‘ontological security’—confidence borne
within the self as reflexively understood by the clients in terms of their
biography (Giddens, 1991, p. 53).
Concerning all these characteristics of the place-time-identity
model, we remember Bronfenbrenner's model of ‘The Ecology of
Human Development’ (Bronfenbrenner, 1979) which ‘can tell us how
those strange places and strange behaviors relate to the mundane
contexts we refer to as our everyday lives’ (p. ix). Both Bronfenbrenner's
(1979) and our model concern the relationship between the individual
and the environment. ‘Seen in different contexts, human nature, which I
had previously thought of as a singular noun, became plural and
Fig. 16. Adjusted place-time-identity model. pluralistic; for the different environments were producing discernible
differences, not only across but also within societies, in talent, tem-
into play and the iconography of play art’ (Cobb, 1977, p. 37). A young perament, human relations, and particularly in the ways in which the
child's mind is based on an inner awareness: this inner awareness en- culture, or subculture, brought up its next generation. The process and
compasses a preverbal method of knowing with the body within a product of making human beings human clearly varied by place and
spatiotemporal socio-cultural context; this may be viewed as primary time’ (Bronfenbrenner, 1979). Bronfenbrenner (1979) criticized the
layers or levels of mind. In this regard, the experience of the body in- absence of a broad individual-environmental-interaction perspective of
cluding motion, rhythmical patterns and continuity, vibrations and most psychological research; for him, this was investigation of ‘devel-
action via sing-song, standing up, or falling down give a structure for opment-out-of-context’. He postulated building context into the research
boundaries and sequences in time and place from a sensory point of model in both theory and empirical work. He referred to ‘this evolving
view. In this context, Cobb (1977) cited Charles Herrick with ‘Motility scientific perspective as the ecology of human development’. In his
is the cradle of the mind’ (Cobb, 1977, p. 40), whereas Gesell (1945) ecology of development, Bronfenbrenner (1979) focused in particular
found the development of genius as a continuity from the beginning and on relationship by opening and widening the dyadic and triadic model
interpreted this as a growth phenomenon; Cobb (1977, p. 44) defined of the child-mother and child-mother-father relationship. Concerning
‘genius as an evolutionary phenomenon’, that took place ‘at biocultural activities, roles and interrelationships of the developing person, he
levels, beginning with the natural genius of childhood and the spirit of construed different levels of interaction with the setting: from a nearer,
place’. inner familiar level (the ‘microsystem’) to wider levels (the ‘meso-
Identity processes are not harmonious and well-balanced. The needs system’) with interrelations among two broader systems, (i) the ‘exo-
and desires of our clients were only satisfied gradually and through system’ which affects the developing person without the person's help,
and (ii) the ‘macrosystem’, containing one or more systems ‘that exist,

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

or could exist, at the level of the subculture or the culture as a whole, with others and with places. Her self-created and controlled boundaries
along with any belief systems or ideology underlying such con- between inside space (‘Innenraum’) and outside space (‘Aussenraum’)
sistencies’ (Bronfenbrenner, 1979, p. 25). (Müller, 2017) are symbolic of her contact with herself. Her creativity
By contrast, the process of the individual experience in the in- in constructing spaces and places is a source of power for her, but one
dividual-environmental-interaction is the focus of our model of place- that paradoxically stands in conflict with her desire to be a good mother
time-identity. With the focus on the autobiographical memory concept and partner (professional work drawing her away from the responsi-
of Markowitsch and Staniloiu (2011), and the self-concept of Damasio bilities of these roles); this ultimately is what leads her—like her mo-
(1999) and Panksepp (1998) of the individual, we analyzed the place ther before her—to fall into a deep depression after her child's birth
identity aspects of the clients in relationship: (i) to others (mother, fa- (Fig. 2c).
ther, and other persons in the setting); and (ii) to the environment with For Client 14, boundaries are likewise very important in the changes
its biological, social and cultural characteristics in place and time. We occurring inside and outside. In crossing a border, he experiences both
broaden the EAM, self and autonoetic consciousness approach with fleeing himself as well as fleeing from himself. In remembering this, the
characteristics in personality, perception, emotion, and behavior in the feeling of being uprooted, the feeling of losing himself comes up, with
psychological framework as well as narration, meanings and symbols in the result that he was really sad in the interview, crying out ‘Yes! Your
a phenomenological way. question is my question! Where is my place?’
In the following sections, we discuss aspects of this model which are Once again, we observe the relationship between place and self both
developed based on neuroscientific and phenomenological approaches in a phenomenological way such as Heidegger (1927) described as
as well as upon the answers of our clients to the question about their being as in-the-world-being (‘Dasein’ as ‘In-der-Welt-sein’), as well as the
place identity. Since the phenomenological approach more closely ap- being outside as being outside of the world (‘Draussen-sein’ as ‘Aus-
proximates the responses of the clients, we first present the discussion der–Welt-sein’); these are the immanent phenomenological inside space
of aspects of place encoding in childhood and the recollection effect, (‘Innenraum’) and outside space (‘Aussenraum’) (Sloterdijk, 1998;
along with fault lines in personality, especially the inside-outside-axis. Müller, 2017). As Client 14 crosses the border from ‘insideness’ to
Afterwards, we consider the EAM, self and autonoetic consciousness ‘outsideness’, driven by the inner conflicts of his self, he arrives at an
approach, i.e. the latent biological, cultural, social and environmental existential form of outsideness, one which ‘involves a self-conscious and
structures of place identity, the embeddedness of self in time and place, reflective uninvolvement, an alienation from people and places,
and autobiographical place time trajectories: the self as an EAM pot- homelessness, a sense of the unreality of the world and of not be-
pourri. longing’ (Relph, 1976, p. 51). Finally, existential outsideness leads both
Client 4 and 14 to a disastrous state of extreme outsideness: they remain
4.2. Inside or outside: a fault line of personality in their beds and become increasingly suicidal. An open door, open to
escape this unendurable condition, turns out to be an illusion. Ac-
From assessing all the clients’ life stories, we observe that early cordingly, the bedroom, traditionally a part of inside space (‘In-
experiences in childhood are extremely important in the development nenraum’) turns into an outside space (‘Aussenraum’), something ex-
of the self, any flows of inner happiness as well as inner conflicts. ternal, alien (‘fremd’) that increasingly symbolizes both the unreality of
Autobiographical faults—intelligence and creativity versus parental being and being lost to themselves. In this condition, the self is no
care (Clients 2, 4, 7), abuse versus protection and avoidance (Client 1), longer connected with the context of being, e.g. with the place. Rather,
perfection and performance versus recreation and fun (Clients 2, 4, 7, the nature of internal and external lose meaning; the differences be-
and 12)—are also found in the autobiographical narrative of every tween these opposites are dissolved. The boundaries between these two
other client, each with his/her own distinctive coloring and personality. components are essential to the healthy creation of identity. When we
A further fault line in the personalities of the clients is the inside-out- are healthy–or intend to become healthy–time and place are essential
side-axis. components, with an autonoetic consciousness giving rise to the de-
The personality development of Client 2 and his movement pattern velopment of the self in both place and time as well as in relationship to
from Belgium to numerous places in Europe (trajectories in Fig. 5) as others, in the creation of an ongoing identity (Proshansky et al., 1983).
well as his socio-biographical comments (Fig. 2b), show that the ca-
pacity to travel brings Client 2 away from rootedness in existence 4.3. Autobiographical memory, emotions and self
(‘Dasein’) as ‘being-in–the-world’ (Heidegger, 1927) to a ‘being outside
as being-out-of-the-world’ (Sloterdijk, 1998; Müller, 2017): this takes Each of the clients has developed an individual place-time-identity
the form of living in the role of a demanding and busy businessman based on the EAM, their development and creation of self, their au-
characterized by the power of abuse and not on the power of love. Si- tonoetic consciousness as well as unconsciousness in place and time.
milarly, Client 1, who also moved but for reasons of emigration from During the entirety of their lives, they create and form their relationship
Morocco to Switzerland, endured a change from a traditional family to the environment by living out and narrating to themselves and to
structure to an environment without extended relationships following a others their daily interactions and experiences (Bruner, 1991). Thus,
marriage to a Swiss man. Subsequent to this move, Client 1 experienced their narrative identity is not only the narration of a biography, but also
social exclusion and, post-divorce, also socio-economic margin- a fundamental mode of social construction and reality (Keupp et al.,
alization. 2008). Through narration, place identity is consistently recalled, re-
In the sense of Bachelard (1957), Sloterdijk (1998, 2004) and Müller membered and reconstructed: for example, Client 7 may reinvent her
(2017), Client 4 creates her inside space (‘Innenraum’) which symbolizes self by narration when she stands by a lake and remembers her child-
her self in a phenomenological sense (her self-denoted space (‘Raum- hood. Her place and her autobiographical memories are deeply con-
selbst’). Her impulse to paint herself as being within her secure apart- nected and coherent through language. In this sense, Sarbin (1983)
ment (Fig. 12)—given that her first place association of standing at the postulated a sense of belonging and place through a symbolic process of
bottom of the mountain triggered a feeling of insecurity—shows how ‘emplotment’: a form of self-creation in which the person-place-re-
she copes with insecurity through constructing her own place. Her fear lationship is transformed into a plausible self-narration; this is ob-
of expanses and her need for security and boundaries, paralleled with servable in each of the clients' interviews. This process happens on a
her desire for unboundedness and wide-open views, became apparent in daily basis, whenever we tell one another what we do, where and at
her creative handling and control of place, as narrated in the interview. which time. However, the narratives which are based on episodic au-
Her self-destructive behavior can be understood symbolically as a tobiographical memory from childhood to the present incorporate
dysfunctional handling of boundaries within herself, in her interactions much unconscious content. Most of the clients reported that they didn't

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

think that place would be so important for them. All clients have strong absent support of her parents: all are involuntarily recalled and appear
EAMs from childhood. to be ‘directly encoded and authentically re-experienced’ (Robinson,
1995, p. 204).
4.3.1. Early experiences of childhood In the recollection process, significant emotion-arousing events are
The strong contrast between being intensively connected with more likely to be recalled than neutral everyday events (Lengen and
places or not being connected at all is a fault line in the autobiography Kistemann, 2012). In particular, pleasant events are more readily re-
of Client 14 based on childhood experiences. From early childhood called than emotionally neutral events. Salience, pleasantness and
onwards, he felt undesired and unwelcomed by his parents (Fig. 2f); emotional involvement seem to be important in the encoding and re-
this gave rise to the question of being or not being, and of having or not collection process (Linton, 1982; Arnold et al., 2011). Client 12 showed
having a home. Such observations have been described and discussed such positive and pleasant memories regarding the interaction with his
over a century of psychoanalytic literature, as well as in more recent grandfather and his own family, with the place of remembrance posi-
psychotherapeutic and psychological literature. For instance, Winnicott tively affect-loaded as part of this positive recollection. Similarly, Client
(1971) concluded 'Home is where we start from'. For Client 14, when in 7 remembered distinctive and recurrent memories about the pond
a healthy mode later on, an intensive feeling of being connected to his above her native city. Emotion-arousing events not only play an im-
former residence was triggered and strengthened through his episodic portant role in positive emotional judgment, but also in negative
autobiographical memories of being together with his daughter and ex- judgment, in which, for example, emotionally negative and unpleasant
wife at special places. This feeling of knowing, deeply related with re- events, especially traumatic events in childhood, may have profound
calling and remembering the past (Schwartz et al., 2014; Addis and effects on avoid-focused coping strategies as well as the development of
Tippett, 2008; Rubin, 1995), creates a sense of home, what we would mental-health problems such as anxiety, depression or dissociative
denote as a sense of place and place identity (Lengen and Kistemann, disorders (Christianson and Safer, 1995). Most of the clients had emo-
2012). The unconscious latent time and place structure of this EAM- tionally negative and unpleasant events in their childhood such as harsh
based place identity embodies the place time trajectory of each in- traditional education, corporal punishment, domestic abuse and sexual
dividual. Correspondingly, early experiences of childhood are im- assault, or emotional neglect, e.g. if one of the parents were ill or overly
portant in the development of self and a sense of place. absorbed by work.
Emotions, affect and feelings are continuously involved within the However, complexity characterizes the interaction between emotion
encoding and remembering process of place and environment, episodic and autobiographical memory. In real-life studies, negative emotions
autobiographical memory, autonoetic consciousness and self. Both and feelings are investigated more often than in clinical studies. Many
‘basic emotions’ and ‘background feelings’ are differentiated and are traumatized individuals show different emotion-based feelings, either
subject to their own biological and cultural development (Damasio, congruent to the to-be-remembered event, or incongruent—separated
1999). ‘Basic emotions may include fear, anger, sadness, disgust, sur- and disrupted from the to-be-remembered event. Post-traumatic
prise, or happiness, while ‘background feelings’ may include fatigue, symptoms such as neurotic anxieties (Client 4), anancasm, physiolo-
energy, excitement, well-being, sickness, tension, relaxation, sudden gical symptoms such as pain and sensorimotor symptoms without or-
change, reluctance, stability, instability, balance, imbalance, harmony, ganic cause (Client 1 and Client 2) and dissociative symptoms (Client
and discord. If we analyze the interviews and socio-biographic ana- 4), make patients unable to recall events or central details, or even the
mnesis of the clients, many of these terms can be detected: Client 1 original emotion associated with the trauma (Freud, 1915; Singer,
described her anxiety and painful sadness concerning her workplace, 1990).
with her instability and imbalance being symbolized as a ship at sea; In the context of these investigations of traumatic experiences, a
Client 2 and Client 4 were impressive in their dual presentation of ‘tunnel vision’ has been described, a narrowing of attention, emotion
tension and relaxation in different landscapes; Client 14 had a great and perception. Clients 1, 2, 4 and 14 described this tunnel vision
need for harmony, balance and stability at Mediterranean places, and is memory in that they remembered a ‘traumatic scene, at least tem-
frequently in a manic or depressive imbalance–either sadness or hap- porarily, as more focused spatially than the actual stimulus input and
piness. more focused spatially than a comparable neutral scene’ (Safer et al.,
Concerning the morbid relationship to her mother and the con- 1998). Subjects remember neutral scenes as more wide-angled than the
sequences of this relationship concerning her work places, Client 7's actual stimulus input (Intraub et al., 1992). Attentional widening in
narrative underpins the importance of the emotional component and remembering neutral visual information might contribute to the rea-
how deeply emotions and meanings are connected to places. For Client sons why people generally like to look upon a wide landscape (Clients
7, water is an important aspect in her emotions and life: for purposes of 2, 7, 12, 14). The mood of state-dependent effects and context-depen-
health recovery, she likes to swim, to look out upon the expanse of dent effects are important in the remembering process. If they return to
water. Water is for her a symbol of life (Fig. 3d): vivid in turbulence, the ‘scene of the crime’, they could remember details that they do not
serene, supportive, capable of constant floating, diverse, varied in at- remember otherwise (Christianson and Safer, 1995). Information
mosphere as well as in colors and shapes (Lengen, 2015). Client 7 views learned and events encoded in one context are obviously more difficult
water as a metaphor of being profound and unlimited (Fig. 13), where to recall in another context. Additionally, the mood of state-dependent
neither structure boundaries, nor limitations exist. The whole painting effects and mood congruence are important for the remembering pro-
is one of floating—an image of her personality and self. cess.
Especially for traumatic experiences, the associated affect is often
4.3.2. Recollection and re-experiencing of emotions unconscious and separated for individuals in a dissociative state:
Recollection of events, even upon involuntary recall, gave rise to the sometimes they do not remember the content of the trauma and the
reoccurrence of traumatic emotions. Client 1 narrated her experience of related affect to the trauma; sometimes if they return to the specific
recalling a traumatic event of bullying at her workplace in an affect- place where the traumatic event happened, they feel very un-
loaded manner, and how she had strong emotions–bad, angry, sad, and comfortable (see Client 1) with somatic presentation as a preliminary
of disgust–when she took part in the exposition training as part of a state of remembering a feeling or an idea with the same somatic irri-
therapeutic intervention. When she recalled and imagined the situation tation as in the original traumatic process. Sometimes individuals re-
during the interview, similar emotions arose. Similarly, Client 4 had member fragments of traumatic details associated with unpleasant
dissociated reactions to traumatic events such as being defenseless feelings, but are unable to remember why they do not like these aspects
against chronic domestic abuse at the hands of a brother, as well as (Christianson and Safer, 1995): this highlights the existence of mood
against sexual assault by a stranger when she was 13 years old, and the state-dependent and context state-dependent effects in the episodic

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

autobiographical memory. the repression of the ‘ecological unconsciousness’. Such images along
with a need for challenge in nature setting can be found in the narra-
4.4. Latent biological, cultural, social and environmental structures of place tives of Client 12 as he relates searching out and traveling into land-
identity scape settings in the mountains of Switzerland and the French Alps, as
well as in Africa, North America, Russia and China (Fig. 8).
The clients’ autobiographical data (socio-biographical anamnesis, Early on in his childhood, Client 12 developed a strong sense of
interviews) shows similar latent structures throughout their biological, relationship to settings of nature and landscapes, as well as to natural
cultural, social and environmental framework. The clients presented a objects—mountains, lakes, trees and birds. To be outdoors in nature
development of social scripts from the family of origin, through edu- was to be together with his family—especially, in early childhood, with
cation in school and study, to job and career, as well as from the family his grandfather (Fig. 3e) who taught him much about fauna and flor-
members to classmates, partnership, marriage, own family, and some- a—giving rise to biophilia (Wilson, 1984). The smell of the forest, the
times divorce and new family (Fig. 2a–f). Based on the autobiographical blue sky visible in the mountains, the shapes of rocks, and a tree
memory, the self is multi-dimensionally constructed. The self develops standing alone on farmland (Fig. 14) all symbolize power for him, as
based on self-experiences and autobiographical memories from child- well as calmness and relaxation.
hood which are embedded in the family of origin along the life line up
to and including the here and now (see Fig. 2a–f). 4.5. The embeddedness of self in time and place
Family, society and culture were shown to influence the encoding
and recalling process. In particular, the maternal reminiscing style in In the neuroscientific discourse (Lengen and Kistemann, 2012), the
the familial context and embedded in the cultural context especially temporal aspect of self has been insistently emphasized. In comparison
influences the ‘child-rearing practices, the view of selfhood and past, to Heidegger's (1927) philosophy as articulated in ‘Being and Time’,
preferences for high arousal versus low arousal emotional states or neuroscience interprets the experienced present as a dynamic interplay
degree of attention to social context’ (Nelson and Fivush, 2004). This of past and future based on the EAM. Every moment of self-con-
aspect is analogous to Bronfenbrenner's (1979) ‘microsystem’. Peterson sciousness is suffused with the sense of ‘being-in-time’ (Tafarodi, 2008).
et al. (2009) observed that Canadian children who spoke about re- In this temporal context, the act of remembrance takes place within
collections of their EAMs showed a more autonomous self-construal our culture: as children we learn to know the abstraction of time, spatial
style, while Chinese children showed a more relational one. Wang and visualizations on a time line or a clock are used which are encoded in
Conway (2004) observed differences between the Asian and American the semantic and, depending on the experience, in the episodic
societies and cultures in both the development of the continuity of self memory. In this sense, time and place/space are also connected in our
through EAM and the social position of the self in relation to others: mind.
interpersonal (Asian) rather than individualistic (Western) values in- In the EAM-based narrations of our clients, we found affect-loaded
fluenced the self-definition of individuals with marked contrasts in the narrations about place contents, as well as place-time correlations, with
historic developments in each of these societies (Nelson, 2008). especially larger episodes such as childhood, school time, or prominent
Social and cultural dimensions as well as biotic and abiotic en- positive experiences such as marriage (Client 1, 2, 4, 12, 14), job suc-
vironmental dimensions of self are comparable to Bronfenbrenner's cess (Client 2, 4, 12), concerts (Client 7), or negative experiences such
(1979) ‘macrosystem’. Each of these self-characteristics is embedded in as divorce (Client 1, 2, 14), and job loss (Client 2, 7). Narrations about
a larger ‘social community of minds’ (Nelson, 2008). In relationship these episodes are almost always correlated with episodic autobio-
with the members of the community, the child develops an awareness graphic context memory, a new term in the research of trauma therapy
of the experiences and memories of others as distinct from the experi- (Steinvorth et al., 2005). Client 2's narrations showed how time and
ences and memories of the self; this is observable in all clients. Ad- place are merged in the perception and symbolizing of self-meaning-
ditionally, the child unconsciously inculcates the latent structures of the process through his experiences of the circadian rhythm: the experience
social systems: those ethical and moral aspects of the society and cul- of sunrise and sunset is for him a symbol of his own metamorphosis as
ture into which it was born. Correspondingly, Client 1 unconsciously he reflected himself. Yet, this metamorphosis is only possible in the
felt the unspoken but lived out needs and desires of her family of origin, context of place and landscape. In discerning these findings of different
as well as the traditional culture, beliefs and meanings of the Moroccan time comprehension in different cultures and individuals, we assume
culture of her birth. Similarly, Client 12, embedded in his Swiss family that these cultural and individual variations also have an influence on
in the social context of the Zurich region, absorbed the Swiss-Germanic the symbolic meaning of time, on the EAM, as well as on self-con-
message that family members must be strong and stoic, not speaking sciousness.
about difficulties. Tafarodi (2008) discussed this cultural and individual conditioning
Through the cultural and social scripts, the self emerges across time of its phenomenal texture of the synchronic unity of the I: ‘First, the
and place. In this context, Tafarodi (2008, p. 31) asked ‘how the con- normal experience of the I as familiar and known appears to depend on
cept of the person itself differs in its particulars across living societies the ‘position’ of self-consciousness in relation to past experience and
and how these differences color the self-consciousness of the individual sustained intentions and objectives'. Any awareness of oneself thinking
… The cultural construction of the person gives us the only I that we and experiencing emerges against a dense background of paths and
can know through symbolic constitution.’ In his discussion of language trajectories that have led to the present moment. Equally woven into
and the self, Cassirer (1953) noted that culture gives us the symbols to this awareness are the vectors of desire, intention, anticipation, and
develop the awareness of our self and our subjectivity. Narrations of life progressive action that point forward in time and are constantly en-
history are deeply driven both culturally and personally, based on two gaged. In other words, the ‘past and future are represented, however
psychological processes: the recounting and interpretation of the nar- vaguely, in any momentary synchronic unity of the self’ (Tafarodi,
rative itself and the retrieval of memories. Such autobiographical nar- 2008, p. 35). Strawson (1997) posited ‘a bare locus of consciousness as
ratives are highly constructed, based on frames and scripts, and provide a ‘void of personality’. A pathological depersonalization, as Client 4
a patchwork of telling and understanding (Bruner and Fleisher showed in her personality disorder, illustrates the disorientation of the
Feldman, 1995). fragmented I in time and place from a familiar stable self. In this mo-
Landscape plays a role in these narrations: Client 2's painting brings ment, the I is unconscious, segregated and without identity or a sense of
to mind the concept of biophilia (Wilson, 1984)—the love and un- coherence. In any discussion about time, characteristics of space and
conscious rootedness to savannah-like landscapes. Roszak (1992) as- place can arise. Place and space approaches may provide a supple-
sumed that the deepest root of collusive madness in industrial society is mentary explanation of a feeling of continuity of I through the own

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

autobiography from the past to present into the future—a sense of co- learning about spatial-temporal life aspects in relationship to context,
herence in place and time. places, settings and the cultural, social and biological environment.
In this context of synchronic coherence, Bachelard's (1957) per- In our heavily scheduled post-modern era, characterized by ac-
spective is fundamental: space and place is experienced, not only celerated movements in space and time within what has come to be
measured by the geometer. In the experience of space and time, in- known as the global village, the notion of ‘place’ is becoming fuzzy and
dividuals code the space/place, encode spatial modalities of perception, diffuse; we live in a complex individual-environmental interactive
and then represent it in memory, based on imagination in different system. Client 12 mentioned his own experiences: he has an affect of
times, time spaces and different places. In analogy to psychoanalysis, fear, anger and disgust when recalling the main street of Zurich, where
Bachelard (1957) postulated the topo-analysis in which the systemic people in suits (literally, the ‘Cravatteten’ or ‘tie-wearers’) hurry and
psychological study of places of our inner life should be analyzed. rush around. With these forms of ‘time-space-compressions’ (Massey,
1991), people are often unable to cope and consequently fall ill. In our
4.6. Autobiographical place time trajectories: the self as an EAM potpourri current era, we often move and frequently change places, we commu-
nicate via the internet and use digital social media in which physical
The autobiographical-, object-, and context-based ‘place-time lines’ locations do not play a role. A new, virtual sense of place is developing.
in the trajectories and narrations of the clients are strong personality It is unclear whether or not this new digital, ‘multilocal’ sense of place
and self-identity constructors similar to the fault lines. Landscapes such has the same potential to create identity and self as the traditional sense
as the mood-related bad-time-landscapes and good-time-landscapes as of place which people call home has. At this point in time, our pre-
well as peace-calmness-relaxation-landscapes (Client 2, Fig. 11); a tree dominantly western ideal of place, our idea of home, is contrasted with
(Client 2, 12, 14); the hill, meadow sun and birds (Client 14); the self- and changed by the fragmentation and disruption of our globalized
constructed house and garden (Client 4); the mountains (Client 12) or world, exacerbated by new virtual informational communities that
water (Client 1, 7)—are self-relevant objects and places which symbo- continue to emerge (Massey, 1991). In view of the research underlying
lize different aspects of being in a ‘potpourri’ of EAMs, symbols, this study, it would be interesting to analyze these arguably different
meaning and feelings. It is a form of patchwork identity concerning the ‘time-space-compressions’ or time-space-extensions which arise in the
lived places (Lengen, 2016), varying with gender, age, socioeconomic mind based on the EAM in a time-geographical approach, in recognition
status and the personality of the individual. of the perception of place/space-time-distortion.
In the place time trajectories, the development of ‘essential aspects
of life’ (‘Lebensschwerpunkte’, Lengen, 2016) as well as the self are 4.7. Limitations
visible. Each client has his/her own pattern of time-geographical tra-
jectory, like a skeleton of the self. The fault lines are often based on One of the limitations of our study is the therapeutic experience of
abuse experienced during childhood and may influence the trajectories the clients. They have learned to reflect themselves, especially through
and thus the movements in the place-time line. If we compare the talk therapy, schema therapy, stress reduction therapy and/or cognitive
trajectories of the clients, the immigrants have more fragmentations in behavioral therapy, social competition therapy, as well as occupational
their trajectory of residential places than the native Swiss clients. Ex- therapy and active exercise therapy. Accordingly, the meditation,
emplary of this fragmentation is Client 7's intense need to return home paintings and narratives may have been biased through the conversa-
to her mother and the feelings she has while in the cathedral of her city; tion style present in all the different therapies, as well as the new
these places and landscapes may, referencing Winnicott (1953), be seen narratives about themselves. Additionally, the familiarity with doing
as forms of affect-loaded emblems which have a function as transitional artwork may have influenced the research process in the way clients
objects ‘preserving a person's sense of self, storing and cueing memories were more confident and efficient in expressing their self in a painting
and feelings that link people with their historical identity—their me of process. While this familiarity could support the data collection, it
days past’ (Burris and Rempel, 2008, p. 105). could also bias the idea of a primary association and expression act
In contrast to other studies that have applied time-geography to concerning the participants cognitions, emotions and behavior in the
visually explore and consider the individual space-time paths, e.g. investigation process.
among persons with MHI (Vrotsou et al., 2017), this study used direct Another limitation of the study is the researchers’ therapeutic re-
observations and diaries for visualizing the trajectories of the auto- lationship with the clients. The trustworthy relationship between re-
biographical memories and narrations about places which were of searcher and clients provided an advantage of a consistent therapeutic
special importance and were recalled during the interview. Since imprint over six to eight weeks that was based on a consistent interview
common time-geography studies often focus on the visualization of the situation (see Bruner and Fleisher Feldman, 1995; Kearns and Collins,
paths of intervention for persons with an illness, it is difficult to com- 2012; Lengen, 2015). As previously noted, the advantage of relation-
pare the results of the two approaches. However, a comparison of the ship between the researcher as a therapist and the participants was the
individual life space-time paths was a helpful step in finding different multiplicity and depth of the answers and information from the inter-
patterns of life paths. The time-geographical visualization based on views. A signal disadvantage is the bias in the interviewing and inter-
individual data (Sunnqvist et al., 2007; our study) both gives an over- pretation process, which is shaped through the relationship and So-
view of the large amount of personal data of this study and facilitates an cratic dialogue between participant and researcher-as-therapist. The
in-depth understanding of the overview through interactive visual ex- demand of objectivity in contrast to confidential personal data collec-
ploration of observations and narration of life paths. The time-geo- tion has to be deliberated both in this study as well as regarding the
graphical exploration is also an orientation and foundation for the qualitative approach as a whole. Our choice was to opt for richness in
generating hypothesis concerning complex individual-environmental data collection.
interacting systems considering place and time. Additionally, the The study process was intuitive, based on a body-oriented, un-
‘method of combining an interview with a time geographic life’ path conscious, pre-symbolic status concerning the introductory question for
(Sunnqvist et al., 2007, p.250) gives an in-depth understanding of in- their place via a painting-associated preverbal status which then moved
dividual life paths, which we can use empirically, in theory as well as in to an autonoetic conscious verbal narrative status. The body-oriented
therapy. Similar to the patients in the studies of Sunnqvist et al. (2007) meditation could also bias the outcome, especially regarding the im-
that showed patients' satisfaction with this method of (i) visualizing life mediate association of their places which was often a landscape of re-
course and life events in place and time; and (ii) learning from this laxation.
‘comprehensive and structured picture’ (Sunnqvist et al., 2007, p.250), Analyzing the transcripts of the clients in a representational way, we
our clients were surprised about the relevance of understanding and advance to the patterning of autobiographical memory and how ‘such

C. Lengen et al. Social Science & Medicine xxx (xxxx) xxx–xxx

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in human attention, perception, orientation, motivation, values and social identity
Somatization and pain disorder: mental disorder characterized by recurring, multiple, and
Glossary current, clinically significant complaints about somatic symptoms
Substance dependence: drug dependence, an adaptive state that develops from repeated
drug use
Amnesia: loss of the ability to remember
Time geography: a transdisciplinary perspective on spatial and temporal processes and
Anancasm: any form of repetitious stereotyped behavior that, if prevented, results in
events such as social and environmental interaction, and biographies of individuals
anxiety, obsessive compulsive behavior
Topophilic: topophilia topos = place, philia = love, strong sense of place based on a love
Anxiety disorders: group of mental disorders characterized by significant feelings of an-
of different aspects of such a place
xiety and fear
Trajectory: Time-geographical term which indicates a spatiotemporal footprint that an
Aphasia: an inability to comprehend and formulate language because of damage to spe-
individual leaves behind when he moves in space and time during a situation or
cific brain regions
during his life.
Aussenraum: outside space
Un-heim-lich: unheimlich eerie; Heim = home
Autonoetic consciousness: human ability to mental travel in the past, in the future or in