Therapeutic cultural environments: An indigenous epistemological expansion of the therapeutic landscapes concept

Background Since Gesler's foundational 1992 paper, the therapeutic landscapes concept has generated a rich and productive research programme examining how place supports healing and well-being. However, the field has developed primarily within Western, post-Enlightenment epistemological traditions, raising serious questions about its capacity to explain, or meaningfully support, the health of the world's 476 million Indigenous people. Aim This paper critically examines the epistemological foundations of the therapeutic landscapes concept, identifies its culturally specific assumptions, and proposes an integrative framework, Therapeutic Cultural Environments (TCE), drawing on Indigenous health philosophies to expand and reorient the field. Approach Drawing on a critical conceptual synthesis of the therapeutic landscapes literature alongside Indigenous health epistemologies from Māori (Aotearoa New Zealand), Aboriginal and Torres Strait Islanders (Australia), and First Nations (Canada) traditions, we map the foundational divergences between Western and Indigenous frameworks along three axes: the ontology of place, the definition of health, and the understanding of therapeutic process, and examine how colonisation operationalised the dispossession of therapeutic landscapes, connecting the concept directly to resulting health disparities. Findings Indigenous frameworks challenge three foundational assumptions of the therapeutic landscapes concept: that ‘place’ is a spatial container for health processes; that healing is fundamentally an individual and physiological recovery; and that the relationship between person and landscape is contingent rather than constitutive. We propose the TCE framework as an integrative response, expanding the ontology of place from spatial setting to relational co-constitution, the definition of health to include identity, belonging, and intergenerational continuity, and the understanding of therapeutic process from individual to communal and ancestral. Conclusion The therapeutic landscapes concept requires not merely diversification but epistemological expansion; the TCE framework offers a theoretically grounded path toward a more inclusive, epistemologically extended landscape-health paradigm.