What to do with being/feeling ‘out of it’? Three options for health geographers

Abstract

In this commentary, I describe three ways health geographers might move forward with being/feeling ‘out of it’ or similar descriptors, and some of the possibilities and pitfalls associated with each. These I review in the light of health geographers’ longstanding objectives to represent and animate lived experiences of health and ill-health, but also given the interfaces that exist between their work, human geography and health science; the latter of which, in this particular context, already describes and addresses equivalents.

Introduction

Bissell describes being/feeling ‘out of it’ as an impactful state of existence and experience – involving vagueness, haziness, confusion, and separation – that has multiple causes and arises in numerous contexts. Yet he suggests, it is one that is relatively underappreciated, undertheorized and underresearched. In this commentary, I narrow the focus and explore the viability of being/feeling out of it as an interest, framing category and entry point for inquiry in health geography; in other words, what might be done with it in that subdiscipline specifically. I look forward and consider how health geographers might encounter and pursue it or equivalents. This is given that the topic seems to sit at the interface between their subdiscipline and human geography (theoretically eclectic, concerned with meanings and materialities of bodies), but also at the interface between their subdiscipline and health science (dominated by positivistic inquiry, possessing a more functional biomedical understanding of bodies).

Significant debates have already taken place in health geography on the relative merits of the subdiscipline ‘servicing’ versus ‘critiquing’ health science, on the relative merits of ‘medical geography’ (that aligns with medicine) versus ‘post-medical’ health geography (that aligns with human geography) and on the empirical, theoretical, and methodological character and implications of these positions (Kearns and Moon, 2002). I doubt that many health geographers would have an appetite for revisiting these old conversations, particularly if they are framed as zero-sum games. Yet still, the interfaces between health geography, human geography, and health science remain, and what health geographers want their work to do at these interfaces is still a highly relevant question that reemerges in new empirical and theoretical contexts, including the current one. With this in mind, the way I see it, there seem to be three ways forward for health geographers with being/feeling out of it and comparable ideas. At this stage, I do not recommend any one way in particular, but simply lay out some of the possibilities and pitfalls that arise with each.

(i) Make no adjustments

One way forward is to continue with the current ‘non-pursuit’ of ‘being/feeling out of it’ in health geography. By non-pursuit, I mean that this state and experience is not attributed any particular label, and there is no specific agenda to pay empirical or conceptual attention to it. Hence, the occurrence of this state and experience in empirical research is ‘organic’, in that it emerges in studies without prior encouragement; it conveyed independently by subjects and reported by scholars as a finding. To date, the current non-pursuit has not stifled such conveyance and reporting, though. This state and experience has been reported often across six empirical fields in health and illness contexts where subjects are re-navigating their socio-spatial worlds: (i) Geographies of brain disorders and injuries. Here, due to their cognitive incapacities and symptoms, subjects feel locked out of, or lost amidst, the social interactions ongoing around them. At best, they might find new ways to adapt and reengage (e.g. Andrews, 2019; Meijering and Lettinga, 2022). (ii) Geographies of anxiety disorders. Here, the experience of anxiety is at the fore. But reported is how, as a result of all-consuming fears, apprehensions, and stress responses, subjects feel unable to act and interact socially as coherently as they otherwise would do (e.g. Boyle, 2024; Segrott and Doel, 2004). (iii) Geographies of fatigue. Here, due to their reduced energies and capacities, subjects feel unable and/or are unable to keep up with the people and activities around them. This could be due to a chronic fatigue syndrome (Mackian, 2011), be a symptom or consequence of another health condition (Crooks, 2007), or be a product of circumstances or lifestyle (Kraftl and Horton, 2008). (iv) Geographies of alcohol and drug addiction. Here, both the physiological and psychological impact of substances taken, and a lack of self-care over time, impact on subjects’ connectivities with the social world. Whilst subjects’ enjoyment and/or compulsion work to keep them addicted and disconnected (Proudfoot, 2019), their willpower and involvement in support programs work in the opposite direction to reconnect them (DeVerteuil and Wilton, 2009; Evans et al., 2015). (v) Geographies of recreational alcohol and drug use. Here, the sensory lures of drugs and the contextual atmospheres of music, nightlife, and consumption combine to create affective, pleasurable, entertaining ‘other worlds’ that subjects dip into and out of (e.g. Duff, 2008; Jayne et al., 2010). (vi) Geographies of aging. Here, cognitive and physical decline can lead to older subjects feeling detached from social interactions and life. Whilst certain ‘caring’ practices and places might exacerbate this feeling, thoughtful interventions can facilitate reconnection (e.g. Goulding, 2024; Herron et al., 2023).

There are points for and against staying the course. On the upside, if this current organic track is sustained, it is likely that a good range of situations and experiences will continue to be articulated. Arguably because it is not a preconceived or purposefully pursued area of inquiry, the information that emerges will do so as it ‘deserves’ to, generally reflecting its occurrence in individuals and society. On the downside, this information will continue to be buried in studies that possess other primary interests. With it being buried, much of it will be overlooked. Moreover, without focused attention and a coherent, dedicated literature, what will not be gained is in-depth theoretical knowledge on the spatial processes and outcomes of this state and experience. It will not be possible to address such complexities and to build such knowledge.

(ii) Engage with health science

Another way forward is to make this state and experience a dedicated focus of attention and conceptualization in health geography. In doing so, though, engage with health science, its established research disciplines, clinical specialities, fields of inquiry, and importantly the equivalent terms it already uses across illness and care contexts. Here, the state and experience that Bissell describes is often discussed under the general term ‘brain fog’ (as Bissell uses himself as his personal example) or else falls under specific health-states such as ‘chemo brain’ and ‘confusion and delirium’, or specific performance categories such as ‘concentration and memory deficit’, ‘cognitive (dis)function’ and ‘cognitive impairment’. Particular fields of health science where these states and experiences are common include: (i) mental health and psychiatry (particularly in the cases of post-traumatic stress disorder and sedation) (e.g. Biringer et al., 2009; Sanger et al., 2025); (ii) complex diseases and advanced treatments (particularly in the case of cancer) (e.g. Haywood et al., 2023); (iii) viruses and infectious diseases (particularly in the case of COVID-19) (e.g. Heiberg et al., 2022); (iv) menopause and women's health (occurring through it and symptom management) (e.g. Johnson and Ogden, 2024); (v) chronic pain (occurring through it and its management) (e.g. Dass et al., 2023); and (vi) aging and mental processing (e.g. Weir and O’Brien, 2019). In most of these six areas, the objectives of studies are to recognize these states and experiences, their prevalence and impact, and ultimately to address them through clinical practice.

Engaging with these health science ideas opens up possibilities but possesses pitfalls. On the upside, established literatures and debates might be intervened in, with common languages and common knowledge emerging as a result. This knowledge should be comprehensive. It not only potentially multi-scaled – ranging from case reports to patient populations – it also potentially detailed, unpacking multi-layered disconnections, causes, and responses (e.g. chemo brain and constant worry might be experienced together but addressed differently in terms of care). On the downside, scholarship would be generated somewhat under the ‘shadow of medicine’ and hence could fail to deliver the kinds of insights that Bissell is looking for. Medical terms would continue to be used that categorize, narrow and pathologize subjects, bodies, and situations. These medical terms are not geared towards understanding the overflows of such states and experiences into everyday social and cultural contexts and lives. And they do not adequately capture numerous states and experiences that are not necessarily illness-related – such as general feelings of tiredness, stress, overindulgence, and minor ailments – and their more subtle impacts on, and parts in, social lives and well-being.

(iii) Go with Bissell

A third way forward is to allow the term ‘being/feeling out of it’ to speak for this state and experience (as Bissell indicates), and develop a dedicated focus on it aligned with the theoretical and empirical concerns of human geography (as Bissell argues for). With regard to the latter, Bissell posits that the disciplinary potential of being/feeling out of it, is developing a critical (post)humanism that appreciates how altered cognition might lead to different, embodied forms of displacement (i.e. being/feeling cut off from place whilst in place), disengagement (i.e. being/feeling tuned out and locked out from practice) and dispossession (i.e. being/feeling taken over with diminished powers of acting).

This way forward, unlike the other two, lacks a clear precedent. Whilst I do not disagree with its theoretical basis – in fact, it rather resonates with my own interests – for health geographers, there are other things to consider. On the upside, its possibilities include: First, the development of a field of interest that might bring health geography and human geography closer together around an important state and experience (one currently obscured in much health geography by the emphasis placed on illness-specific symptoms). Second, in researching feeling/being out of it in wider social domains, health geographers would encounter established literatures and ideas in human geography. Though engagements with these – perhaps related to cultural, work or family life – fuller pictures of subjects’ overall life-worlds might emerge. Moreover, connections might be made to wider social ways of being ‘out of it’ that subjects also experience. These could relate, for example, to their ethnicities, disabilities, genders, sexualities, ages or classes through which they are forced ‘outside’ mainstream social positions. Third, possibilities would be opened up for wider theoretical conversations on the nature of ‘it’ in feeling/being out of it, and on the nature of being in relation to ‘it’ (i.e. being in or out of whatever ‘it’ is). For example, interesting questions include the extent to which ‘it’ is a stable performance, relation, affect or expression of space–time that the subject is in or out of? And the extent to which ‘it’ is a stable mind (i.e. fully lucid and functional) that the subject is in or out of? Both raise further questions as to the ethics of such stabilities, and the way in which they serve to stabilize/destabilize and centre/decentre certain kinds of subject (e.g. do these states and experiences destabilize and decentre the general idea of a universal human subject or, because they are based on it, do they ultimately reinforce it?). Questions also emerge as to possible opposite or alternative states and experiences. What being ‘in it’ or perhaps ‘beyond it’ might be as forms of hyperinvolvement, hyperawareness, hyperconnection, and hyperfunction (e.g. Andrews, 2017; Philo et al., 2015)?

On the downside, the pitfalls of pursuing feeling/being out of it include: First, certain scholars would not be happy about the concepts and research agenda of health geography being driven by those of human geography. Exacerbating this, in the initial period of knowledge accumulation, potential confusion might occur as to what being/feeling out of it is exactly, whilst all the while recognizable health science equivalents exist. Second, the term feeling/being out might serve to shoehorn a diverse range of states and experiences into a single homogenizing category. This category might disguise differences, nuances and relational positions, and might even amplify them. For example, not distinguished might be how being/feeling out of it can be used as a derogatory term to describe the incapacity or unwillingness of people to establish and sustain social involvements (e.g. ‘look at her, tut, she's completely out of it’). In this particular case, being/feeling out of it might itself be an ableist and exclusionary term when not self-descriptive. Third, health geographers and others might not do the necessary theoretical work to ensure that being/feeling out of it is understood processually. If they do not, they run the risk of it becoming a general categorical ‘bumper sticker’ for empirical studies and realities. Moreover, if being/feeling out of it is to be embraced and approached comprehensively across health geography, significant challenges will need to be addressed in recognizing, distinguishing, assessing, and perhaps even measuring it. And challenges will also exist in ascertaining its specific power and consequences in everyday subjectivities, behaviours and social involvements.

Conclusion

As noted earlier, I do not recommend one particular way forward for health geographers. However, I personally feel that if scholars proceed with caution, the pitfalls and challenges associated with Bissell's way might be navigated and overcome; the potential dividends for health geography making it a worthwhile endeavour. For scholars deciding on which way to move forward, their inclinations will depend on the type of health geographer they see themselves as and the directions in which they would like to see their subdiscipline headed. Specific factors include their ontological, epistemological, and career perspectives on what health is and how it should be approached, whether they see their work as being ‘relevant’ to human geography and/or to health science, and whether they want their work to support, inform or critique knowledge in these disciplines.

The three ways forward I described are not exclusive to health geographers; they also exist for human geographers and health scientists thinking about approaching the topic of being/feeling out it (although different upsides and downsides will apply). Comparable ways forward also exist for other health-focused social scientists – such as medical sociologists, medical anthropologists, and social psychologists – thinking about the topic and who encounter and negotiate similar interfaces between their subdisciplines, their parent disciplines and health science.