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Space to Heal _ Humanity in Healthcare Design _ Thoughts on Waiting
Attitudes to the provision of ‘healthcare’ are changing. In particular the second part of the word - ‘care’ - is starting to receive attention comparable to the ‘health’ element. Doctors are being trained not only to cure, but to heal.
In the Western world, at least, widespread acceptance of the concept of holistic care seems relatively new. From the earliest days the medical profession has concentrated its efforts on curing specific ailments or controlling symptoms. The very word ‘physician’ implies investigation of the physical attributes of illness. Until recently, little attention has been paid to the potential difference between a lack of symptoms and holistic “wellness”. The possibility that a state of mind can influence the health of the body has been little explored.
Interestingly, one of the first examples of this relationship to come to public notice was psychosomatic illness, or illness “caused by anxiety and worry and not by an infection or injury”. The negative side of life is often easier to understand than the positive. ‘Psychosomatic wellness’ is not a commonly used phrase, but is surely an inevitable counterpart. If a disturbed emotional state can cause symptoms, then a settled emotional state may help to dispel them.
The ability of the physical environment, and in particular buildings, to influence health (for example by admitting sunlight) is known and has contributed to the development of Modern architecture. The power of architecture to influence human emotion is equally self evident (churches to uplift, palaces to impress, fortresses to intimidate, etc), and architecture which encourages a state of emotional wellbeing can surely play a role in assisting the clinician to achieve a ‘well’ patient in a holistic as well as a physical sense.
Patients generally attend hospital because they have something wrong with them. Maternity is an obvious exception, although many of the issues are similar even here, as the period surrounding a birth is one where the mother is in a vulnerable state, physically and emotionally.
The purpose of hospitals is that people should be made well. To be well a person must feel well, in mind, body and spirit.
Hospitals, due to their function, are inevitably associated in people’s minds with negative feelings of illness, fear and even death. For a patient or carer, the experience of a hospital visit is seldom a positive one. The sense of release that patients experience on leaving can be considerable. Hospitals are almost the only type of building to generate a recognised (and reasonably common) phobia. For hospitals to be successful, these negative associations need to be countered. Caring, helpful and competent staff must be supported by a caring, helpful and competently designed environment.
A time of particular stress is any period of waiting. The mind can wander. Worry and doubt can grow. However, waiting can (and should) be seen in a more positive light than this. It is a time for thought, for reflection, for preparation. Given the nature of hospital visits though, people will often require assistance for this to become the case.
When the mind is troubled people may either look for opportunities to address the issues in thought or they may seek to escape their troubles, at least for a time, by searching out distractions. It is sometimes argued therefore that distraction is required in hospital waiting areas. This does not seem reasonable. The purpose of a visit to hospital is not to escape issues but to address them, mentally and physically, and distractions are unlikely to make a positive contribution.
It may be interesting here to draw a parallel with another commonly stressful situation. At some point in their life most people go through a job interview. When waiting to be called in, is it usual to want a distracting environment, or one that allows the mind to prepare itself for the coming ordeal? We believe the answer to be clear – not only is the latter the case, but distractions may be irritating and counter productive.
A hospital consultation has many similarities to an interview – it may be important, it can affect your future, the outcome is uncertain and it may be affected by what you say or do during the consultation. The need for mental preparation is therefore similar and the hospital should aim to provide an appropriate environment for this to happen.
In order to address difficult issues most people will naturally seek out a ‘quiet’ place to think. Sitting by a favourite window, walking along a beach, looking out to sea, sitting on a park bench, staring into a river, gazing into a fire. These are all places for restful contemplation which releases the mind to engage in the sort of introspective thought required to address personal issues. It is interesting to look at the areas of commonality between them.
First, they are ‘quiet’ rather than ‘silent’. The natural condition of the inhabited world is not, and never has been, silent. One of the things which explorers to Antarctica report as being most striking is the silence. Silence draws attention to itself. It asks questions. It unnerves. Humans have evolved over millennia to live in a world of noise. We are comfortable with it. However, the type and level of noise is of importance. It should not introduce uncertainty, and it should not threaten. The majority of the situations described involve the natural world. The sounds present are sounds that we have evolved to find comforting. Birdsong, the wind in trees, waves on a beach, the crackle of a fire, gentle human activity.
The second point is that these places are not merely acoustically quiet, they are visually quiet. As with sound, there is gentle visual stimulation – a familiar view, ripples on a stream, a fire in the grate, trees. There are no surprises, no real mysteries and no danger. Things tend to be either familiar or simple. Furthermore, the position which a person will naturally assume will give an outlook, both for orientation (to be comfortable you need to know where you are) and for security. The first people to arrive in a café will gravitate towards windows, and then walls. Central seats will be occupied last. If taking a rest during a woodland walk, one sits with one’s back to a tree, not facing it with one’s back to the path.
Taken together, the characteristics of such places lend them an atmosphere which settles the spirit. The challenge in architecture is to create such an atmosphere by design. The task is not simple, but the rewards are high:
We perceive atmosphere through our emotional sensibility – a form of perception that works incredibly quickly, and which we humans evidently need to help us survive. Not every situation grants us time to make up our minds on whether or not we like something or whether indeed we might be better heading off in the opposite direction. Something inside tells us an enormous amount straight away. We are capable of immediate appreciation, of a spontaneous emotional response, of rejecting things in a flash. That is very different from linear thought, which we are equally capable of, and which I love too: thinking our way through things from A to B in a mentally organised fashion. We know all about emotional response from music. The first movement of Brahms’ viola sonata, when the viola comes in – just two seconds and we’re there! (Sonata No. 2 in E Flat Major for Viola and Piano) I have no idea why that is so, but it’s like that with architecture too. Not so powerfully as with that greatest of arts, music – but it is there nonetheless.
Atmospheres – Peter Zumthor Birkhauser Verlag AG 2006
To us it is clear that we should strive to imbue hospital waiting areas with these characteristics, to ensure that they have the right atmosphere to be places for restful contemplation.
Architecture initiates, directs and organises behaviour and movement. ….. Architectural space is lived space rather than physical space, and lived space always transcends geometry and measurability.
The Eyes of the Skin: Architecture and the Senses - Juhani Pallasmaa
It is not possible to define rules or evidence on which such design may reliably be based. Efforts to do this at best produce mediocrity, and at worst provide a tick box framework which allows bad architecture to be labelled as ‘successful’. If the relevant issues are identified, the aspiration is there, and the right people are at work, then much may be achieved. There are buildings around that are a simple joy to be in, and consequently provide a therapeutic atmosphere. Hospitals should be, must be, amongst them.
Andy Law
ISBN 978 0 9556148 1 1 _ sleeper publications 2010
www.sleeper1.com
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